Look
at all that Blood Shattering News for
Responders and Instructors, or is it?
By Valerie DeFrance
From the Prehospital Emergency Care, July/September 1999 came this
startlingly news.
"Blood loss estimation by out-of-hospital emergency care
providers are not accurate of how much blood volume was actually lost by
the patient. The range of their estimates is considerable. Following a
formal teaching session on estimating blood loss volumes, the
out-of-hospital personnel showed improvement. Similar training could be
incorporated into EMT training."
What is this about? Simple enough; it says that the EMT is way off in
estimating a patients blood loss volume. What does this indicate to the
EMT instructor? I'd say it indicates that we instructors should be
teaching the
students how to better gauge patient blood loss volumes.
Oh, "Bull-pucky" I say! This insane bit of information has
reared its ugly head before. I have actually witnessed other instructors
spending inordinate amounts of time trying to teach blood loss volumes.
The responder should place importance on blood loss they see? (Not to
mention the blood loss you cannot see.) First, this is not an easy thing
to do. Estimating blood on a linoleum floor is considerably different
than trying to estimate blood absorbed by Mother Earth. Secondly, the
focus should be on how the patient is reacting to the blood loss and how
you are going to treat that loss.
Let's say you arrive at the facility with a patient and the doctor asks
you about blood loss. You, because you had an instructor take 3 hours to
cover this, take a guesstimate and say, "Oh, about a unit."
However, this patient manifested shock. They are cold and clammy, have
an altered mental status, tachycardia and a BP less than 100 systolic.
Hardly what a measly unit of blood loss would induce, isn't it? Do you
suppose the doctor is going to waste time arguing the point with you. Is
he going to change how much blood he orders up, if he does at all? No,
the focus is going to be on immediately treating the patient for shock.
Yes, if the signs and symptoms are out of line for the amount you think
they lost, then something else is going on, an internal bleed perhaps,
that will be rooted out.
EMT's do not have to be pro's at gauging blood loss they see. They do
have to treat the patient. I'll bet my EMT B student against yours that
the guess is more accurate using the patient reaction as a guide. I'll
also bet they will
quickly perform appropriate, timely treatment since they are not gawking
at a pool of blood, interesting a puzzle as it may be. I will concede
however that the E.R. staff won't be as impressed with my students
guesstimate abilities as yours, who took your 3 hour blood loss estimate
class.
Of course I will wonder which part the 'good stuff' we teach you omitted
from your students' education since the three hours had to come from
somewhere.
Have you thanked an EMS volunteer today?