Rotterdam EMS major trauma bag training

1. Trauma Equipment In-Service
Rotterdam Emergency Medical Services
Douglas Hexel, AEMT-P, NYS CLI

2. Reasoning
• REMS has recently developed a new trauma
bag for the purpose of controlling massive
hemorrhages in the field.
• The bags and items within the bag are based
on military technologies, aimed at rapidly
stopping life-threatening hemorrhages.
• They will be maintained separately in the bag
for the purpose of rapidly locating and
implementing.

3. Agenda
• New Bag
• Contents
• Quikclot
• Combat Application Tourniquet (C-A-T)
• Emergency Trauma Dressing (ETD)
• Hy-Fin Chest Seal

4. New Bag

5. New Bag

6. New Bag

7. New Bag

8. Contents
• (1) 10” x 30” Trauma Dressing
• (4) 8” x 10” Trauma Dressings
• (1) Quikclot Z-Rolled Gauze
• (2) Combat Application Tourniquets (CATs)
• (1) Emergency Trauma Dressing (ETD)
• (2) Hy-Fin Chest Seal Occlusive Dressings
• (1) EMS Shears

9. Contents
• Quikclot: For use on arterial bleeding or deep,
profusely bleeding venous bleed that cannot be
controlled with a tourniquet (i.e. to torso, pelvis,
or neck.) DO NOT USE ON HEAD WOUNDS.
• C-A-T: For use with severe extremity bleeds that
cannot be stopped with traditional dressings.
• ETD: Best used with venous bleeds to quickly
control.
• Hy-Fin: For use as occlusive dressing.

10. Quikclot
• 3” x 4yd Z-rolled, soft, white,
sterile, nonwoven gauze
impregnated with kaolin, an inert
mineral that does not contain
animal or human proteins or
botanicals.
• It is safe for use on those with
allergies unlike previous
generations of hemostatic agents
containing shellfish derivatives.
• It does NOT cause exothermic
reactions like previous
generations.

11. Quikclot Directions
1. If the location of the wound allows, apply a
tourniquet.
Tourniquet

12. Quikclot Directions
2. If needed, wipe or suction away any pooled
blood.

13. Quikclot Directions
3. Begin packing gauze into source of bleeding.
Simply placing the gauze over the wound will
NOT work. The gauze must make contact with
the bleeding vessel(s).

14. Quikclot Directions
4. Continue packing gauze into wound until all
gauze has been used. Firmly apply pressure for
2-3 minutes until all bleeding has stopped.

15. Quikclot Directions
5. Cover wound with standard gauze and write
ON the dressing that quikclot has been used.

16. Quikclot Directions
6. Ensure that all ED staff are aware of quikclot
placement. Quikclot requires surgical removal.

17. Combat Application Tourniquet
• Developed for the United
States Army, it has been
their standard issue
tourniquet since 2005.
• Proven 100% effective in
occluding blood flow in
both upper & lower
extremities by the U.S.
Army’s Institute of Surgical
Research.
• Expands up to 37.5” to fit
nearly any extremity.

18. C-A-T Directions

19. C-A-T Directions

20. C-A-T Directions

21. Emergency Trauma Dressing
• Sterile, non-
adherent gauze
attached to an
elastic bandage.
• Suitable for
application to
limbs or torso
when tourniquet
cannot be used.
• Applies immediate
pressure to
wounds, helping
to stop bleeding.

22. ETD Directions
1. Place sterile pad side down on wound

23. ETD Directions
2. Begin wrapping with tension on bandage to
create tight dressing.

24. ETD Directions
3. If necessary to apply more pressure, twist the
bandage over like with old pressure dressings.

25. ETD Directions
4. Continue wrapping tightly and secure with
built-in C-clips.

26. Hy-Fin Occlusive Dressing
• Advanced adhesive technology to
create a superior seal.
• Transparent backing allows
placement directly over the
wound and easily conforms to the
patient’s chest.
• Red elliptical tab for single step
peel-and-apply. application that
can also facilitate burping of the
wound.
• As there is no one-way valve, the
seal is to used in conjunction with
needle decompression, but can
be “burped to relieve air pressure
in wound.

27. Hy-Fin Directions
1. Wipe blood/dirt from around wound

28. Hy-Fin Directions
2. Grip red tab (not pictured) and peel backing
from dressing

29. Hy-Fin Directions
3. Place dressing with adhesive side down,
centered on the wound

30. Hy-Fin Directions
4. Firmly press dressing onto wound, assuring it
adheres on all sides

31. Hy-Fin Directions
5. Monitor for tension pneumothorax and
perform needle decompression as needed.

32. Conclusion
The presentation provides a quick in-service for
the new major trauma kits that will be placed in
each ambulance.
Remember that these are designed for massive
hemorrhages and not suitable for easy to
control bleeding.

33. Questions/Comments
Questions? Comments? Concerns?
Please direct them to me at dhexel@gmail.com