CAT Tourniquet manufacturer’s instructions can be downloaded from here.
Last updated 4.2.25
CATASTROPHIC HAEMORRHAGE
Catastrophic haemorrhage is major bleeding that is an immediate threat to life. If untreated, it will result in death within minutes. It is rare in Mountain Rescue. There are two types:
i) Internal bleeding following a blunt injury e.g. from a major blood vessel in the chest or abdomen. CPR in this case will be ineffective as we cannot control this type of bleeding and blood loss will continue until the patient dies.
ii) External bleeding will be excessive and visible from a limb or penetrating injury causing the punture of a large blood vessel.
External bleeding will be clearly visible as you approach e.g. large amounts of blood on the ground, blood welling up/spurting e.g. out of a puncture wound, open fracture or amputation. Don’t forget blood loss could also be hidden in overtrousers/jacket.
Casualty or bystander may alert you that there is massive bleeding.
History of trauma.
If the casualty has a reduced conscious level from bleeding alone, ≥2L has already been lost.
Pulse rate almost always very high. Rarely, the pulse rate can be <100/min – due to a quirk in physiology in response to major bleeding.
BP will be very low i.e well below 90 per minute.
IMMEDIATE ACTION
Don’t waste time with any other task. Priority is to slow the bleeding.
As quickly as possible aim to put pressure (using your hand/knee) on the blood vessel ( e.g. femoral artery in the groin, brachial artery in the arm) supplying the limb to slow/stop the bleeding. If bleeding cannot be controlled a decision will need to be taken when to use a tourniquet. A tourniquet, if available, can be used for a limb (Note: a tourniquet can threaten the viability of a limb if used incorrectly. See demonstration below and familiarise yourself with the CAT Tourniquet. The tourniquet is in the ‘Trauma’ pouch in the medical sac.
Other actions to consider:
Elevation of limb if possible.
Pack open cavities firmly with a haemostatic dressing or granules e.g. CELOX, so it makes good contact with the tissues. Apply pressure for 3-10 min over the packed wound (time depends on which product is being used and will be written on the package). Then apply a sterile non adhesive dressing over the CELOX. Continue to apply direct pressure for as long as required (10 min minimum).
If oozing continues apply new dressings on top of old, if required, for additional pressure.
The use of a trauma bandage will also be needed to continue pressure application. Immobilise, possibly with a splint. Urgent evacuation by air if possible.
Tranexamic Acid (TXA) is administered intravenously by Health Care Professionals and intramuscularly (2 x 5ml injections - one 5ml injection using a 21g safety needle into each thigh muscle) by Cas Carers
CAT TOURNIQUET (CAT = Combat Application Tourniquet).
Video of CAT being used from manufacturer website
CAT Tourniquet instructions can be downloaded from here.