What is the evidence for AB 2260 – Trauma Kits?

The management of severe bleeding in injured persons before reaching hospital has changed over time.

Direct pressure has been the main treatment by first aiders for years. But direct pressure can be difficult.

Persons trapped inside close spaces or in vehicles may be difficult to access. Direct pressure requires that you’re able to push down on a body part which is conveniently placed on the ground or other firm service. Direct pressure cannot be done in a patient who is being moved in most cases. Injuries to certain blood vessels may require a large amount of force, which can be tiring. Severe bleeding may also require the pressure be applied in exactly the right location for maximum effect.

What a bleeding control kit does is provide some additional tools that can make bleeding control more effective. These kids were provided to soldiers in US and NATO countries during operation Iraqi freedom and operation enduring freedom. Soldiers were trained how to use these kids on themselves and on their buddies.

Two important components in the kids include wound packing and tourniquets.

Wound packing is basically a length of gauze, sometimes impregnated with an agent to aid clotting which can be pushed into a wound to help improve the effective direct pressure. Wound packing with various types of dressings can require less pressure and sometimes stop bleeding without need for continued direct pressure.

The other important device in a trauma kit is a tourniquet. A tourniquet is a device which generates pressure Sercombe Franchel he, that is all the way around the extremity to include the blood vessels in that extremity and stop bleeding. Turn a kits were controversial for many years as when improperly applied, they can actually increase bleeding, or risk limb loss. However when applied properly they are very effective and are not associated with limb loss in environments with emergency medical services available. During the conflicts in Iraq and Afghanistan, there was no a triple limb loss to improper use of a tourniquet.

in civilian environments, paramedics and law-enforcement and fire officers are already carrying tourniquets. A study performed in Los Angeles county demonstrated that tourniquets being used in the prehospital environment by paramedics was associated with more than a 3X decrease in mortality without an increase in amputation rates.

These results are similar to a prior study in Texas with over 1000 cases showing more than a 5X reduction in mortality when prehospital tourniquets were used.

A review of out-of-hospital bleeding control interventions literature suggests that commercial tourniquets are superior to the application of direct manual pressure or hemostatic dressings for the treatment of life-threatening limb bleeding. In addition, hemostatic dressings decrease the time to hemostasis over the application of direct manual pressure with standard dressings alone and the application of direct manual pressure is superior to the use of pressure dressings or devices when stopping life-threatening bleeding.

In summary, modern bleeding control measures require direct pressure, wound packing and use of tourniquets. Giving the public access to trauma kits allows rapid control of severe bleeding before arrival of first responders, saving more lives.