First aid for trip sitters and psychedelic therapists

@First aid 

Tourniquet

The tourniquet is a modern compression bandage (formerly also called a tourniquet) that is applied to the arm or leg to stop very severe bleeding (e.g., in amputations). The rapid application of the tourniquet increases the chance of survival and makes it possible to transport a victim to the hospital for further treatment.

When to use a tourniquet?

The tourniquet is an emergency measure and is applied in urgent situations to prevent or slow down severe blood loss. Severe blood loss quickly leads to hypovolemic shock. It is therefore essential to act quickly.

A tourniquet is applied:

• In case of life-threatening blood loss (with amputation) to an arm or leg.
• If attempts to stop the bleeding by direct pressure are not possible or have failed.

Once the tourniquet has been applied:

• Check if the bleeding has stopped.
• Do not loosen the tourniquet once applied.
• Never cover the applied tourniquet.
• Note the time of application on the label of the spindle clip closure using a marker or pen. This allows other first responders to see how long the tourniquet has been secured to the affected limb. Use the 24-hour notation to avoid any misunderstandings.
• If you do not have a marker to mark the time, verbally communicate the time of application to professional care providers.
• Visually assess whether there are any other bleedings that need to be treated. If necessary, call in multiple first responders.

Prolonged use of a tourniquet can cause damage because nerves are compressed and the tissue is deprived of blood supply. Generally, the tourniquet can remain in place for well over 2 hours without causing damage to nerves or muscles. Therefore, it is important to note the time after applying the tourniquet.

Complications:

• The wound starts bleeding again or the bleeding does not stop:
  If necessary, apply further pressure to the wound by applying direct pressure with both hands and, if available, a (clean) cloth. If necessary, apply a second tourniquet over the first.

Hemostatic gauze

If a tourniquet cannot be applied using a gas seal, a hemostatic gauze can be an alternative for stopping severe bleeding. Hemostatic gauze is a sterile-packaged gauze treated with a natural hemostatic agent. As soon as this agent comes into contact with blood, the natural clotting of the blood is stimulated. Within seconds to minutes, a natural 'plug' forms due to a blood clot in the wound, which can prevent severe blood loss.

Hemostatic agents are available in gauze or powder form. In most situations, you will encounter gauze. Hemostatic gauze is applied in combination with direct pressure on the wound for life-threatening bleeding in transitional areas from the trunk to the arms, legs, and head. These transitional areas are called 'junctions' and are: the neck, armpits/shoulder and groin. Large blood vessels that are difficult to stop are located here.

If you are alone:

• Have the victim apply pressure to the bleeding if possible.
• Call professional help, first responders call 112.
• Activate the speakerphone function on your mobile phone so that you have your hands free to provide assistance.
• Put on medical gloves if immediately available.
• Apply direct pressure to the bleeding with one hand and, if available, a (clean) piece of textile.
• Remove the hemostatic gauze from the packaging with your free hand.

Then insert gauze:

• Open the packaging and remove the mesh. 
• Remove clothing from the wound.
• Locate the source of the bleeding and remove excess blood. Try to avoid formed clots.
• Take one end of the mesh.
• Press a small ball of gauze into the wound at the source of the bleeding and continue to apply pressure.
• With your other hand, insert a little more gauze into the wound at a time. Keep applying pressure to the gauze in the wound..
• As soon as the gauze comes into contact with blood, the clotting process begins.
• Next, apply direct pressure to the gauze in the wound with both hands (for at least 3 minutes).
• If the wound has protruding parts, insert hemostatic gauze around the protruding part.

After application:

• Assess whether the bleeding has stopped without applying direct pressure. If the wound continues to bleed, or the inserted gauze is completely soaked, consider inserting a second gauze.
• Visually assess whether there are any other bleedings that need to be treated. If necessary, call in multiple first responders.
• Continue applying direct pressure. If this is not possible, apply a bandage or trauma bandage as soon as the hemostatic gauze has been inserted. Do this as soon as you have applied direct pressure to the wound for at least 3 minutes.