>> What is the most unconventional way
you've ever seen someone take care of a wound?
>> Objection, leading the witness!
You clearly have an example ready to go.
>> I saw a friend our ours, whom you know,
crash through some drywall after riding
an ironing board down the stairs.
When he stood up he had a compound fracture,
the bone coming out of his hand,
he pops it back into place, wraps it
in duct tape, keeps going.
♪ [upbeat guitar] ♪
♪ ♪
♪ [music swells] ♪
[diagetic sound bleeds in]
>> robot voice: Part one, Bleeding Control.
>> All right we're here with Daniel and Jenna,
our EMT friends.
You're just going to live here now, right?
>> Sure! >> Absolutely I really like it!
>> Because we can't trusted.
>> Maybe we can fix all this up first and then make it safe?
>> Until it's safe, we definitely need them.
>> So you guys are both EMTs, right?
>> Yes sir.
>> But not paramedics, and I guess there's a difference
between the two. >> Clear it up please.
What is the difference?
>> Well there's the two types.
There's your EMT basic which is what we are,
and then there's a paramedic.
There's an intermediate level but no one uses that anymore.
Basics are more for wound care.
They can do basic drugs like albuterol
for asthma attacks and stuff.
Paramedics is when you get into the IVs,
and other medicines for cardiac issues.
>> So EMTs might be first on the scene but there'll
be certain drastic measures that can't be taken by EMTs
and you have to wait for the paramedics to arrive.
>> Correct or in a more advanced urban ambulance system
you'll have an EMT and a paramedic partnered together
so that the EMT can compliment the paramedic by doing
the easier tasks and the paramedic
can do the more complicated stuff.
>> Jenna: Yeah. >> I would love to believe like
a paramedic is like a Michael Scott kind of,
you know, they show up and you're like
"Eh, this seems more like an EMT job to me."
[laughter] >> Sometimes that happens.
>> Really? >> Yes [laughter]
>> Yeah it does, depends on who you're working with but yeah.
>> So asking for a friend, can you write prescriptions?
>> No, not at all. >> No.
>> What are we learning today?
>> Okay, so we're going to start with bleeding control.
There are two main types of bleeding.
There's your compressible bleeds
and your non-compressible bleeds.
So if you were to be stabbed or shot,
that's a compressible bleed.
That's, you're bleeding to the outside of your body.
That can be stopped.
>> Anything that gets stopped when
you squeeze it is a compressible bleed?
>> Basically. >> For example,
when I split my knuckle open
shattering the lock and then did this.
♪ ♪
[sharp impact, small metal fragments bouncing]
>> Oh! >> Yeah dude, it totally shattered.
>> Oh and I think they're in my pants.
>> Cut my knuckle.
>> What's that? >> I banged my hand [mumbles].
>> Oh hell, it burned through my shirt.
>> So what does it look like when
you discover a non-compressible bleed?
>> Well a non-compressible bleed is something internal
so if you were to be involved in a car accident
or another blunt force trauma and you were bleeding
to the inside of your body, a lot of times in
the abdomen you can feel, what we call pulsating mass.
And that's actually the blood inside your abdomen.
>> Let's say a rib fractures and pokes something
and then stuff is bleeding so I would imagine
the blood would fill a void and then what
you're actually feeling is the pulse just, sort of,
because it has nowhere to go so it just blub, blub, blubs.
>> It's starting to come out there.
>> Boy, that's awful.
>> Into the tissue. >> Yeah.
>> You can also check your blood pressure.
When your blood pressure starts to drop but there's
no obvious reason, that is a clue that it could
be an internal bleed especially if trauma's involved.
>> So what do you do in that case?
>> Well a lot of times we call it lights, sirens, and diesel.
>> Yeah. >> LSD.
>> Get them to a hospital as fast as possible.
>> Okay, okay, okay.
>> And get to a trauma surgeon
because that's sometime the only way you can get that fixed.
>> Is it a case where there's a general rule of thumb
about how much time you have if
you know you have an internal bleed?
>> Yes so, especially the system where I work, we have
a 15 minute time limit for certain trauma categories.
So certain things, including internal bleeding,
if you figure it out, we've got 15 minutes
to get off the scene and get going.
>> Wow.
>> What if something stupid happens like you get cut
by steel wool or something like that?
>> I'm bleeding.
>> How'd you do that?
>> I don't, I think.
[laughs]
>> That's not necessarily trauma category
so if we were to, and I actually did this,
where there was a dude who had crashed
his scooter and he broke his wrist.
That's not a trauma activation.
It's something we can splint and we have time to get
to the hospital but if someone's involved in
a massive car accident and they're unconscious,
we've got 15 minutes to get going.
>> Was it one of those dumb Lime scooters?
>> Yes. >> Whoa, whoa,
you take that back!
Those are the best things to happen to America.
>> You still administered aid.
>> Absolutely. >> Yep.
>> I do my job.
>> So what are we learning here?
>> Okay so this is just a simple wound trainer that we built.
It's just a pool noodle with some PVC in it
but it represents an arm or a leg with bone in there.
Basically if you were to get cut in your arm,
there are certain types of bleeding that you can see
like capillary bleeding, venous bleeding
and arterial bleeding.
>> So venous bleeding is what, veins?
>> A vein. >> Those are the ones
that comically go bloop, bloop, bloop.
>> No, that would be an arterial bleed.
>> Yep. >> There you go.
>> So a capillary bleed when you so often cut your finger--
>> Okay... >> Is usually what's going on there.
>> Capillary bleeds, those are minor.
>> Those are the very minor, a small cut.
It's just oozing out of the wound.
Bright red or slightly darker blood.
>> That's the one that usually you stick in your mouth first
and then you squeeze and--
>> Put a Band Aid on it.
A venous bleed is, a vein.
It's slower and dark, almost blue.
Dark purple kind of color.
>> And this is the oxygenated or non-oxygenated?
>> Yes. >> Non-oxygenated.
>> That would be non-oxygenated.
>> Oh that's right, that's right
because it's more red when its got the oxygen in it.
>> That's when it's leaving the body.
>> Got it. >> And that's
where they take blood when you're giving blood.
>> I never realized that.
>> That's a vein, not an artery.
>> Yep, that's a vein. >> And you can tell
because it goes out in a smooth,
if it was an artery it would go bleugh, bleugh, bleugh.
>> Yeah, it's a lot lower pressure.
>> Yep.
>> Arterial bleeds are the worst ones.
They're the ones that comically spray.
>> And they're bright red,
like bright red. >> Bright red.
If you recognize one of those which is very easy
to recognize, the first thing you do is get pressure on it.
Anything you have, whether it be your hand, if you have
any kind of gauze at all or if you need to take off
your tee shirt. >> Plastic bag, tee shirt,
>> Anything at all. >> Anything.
>> Get pressure on that wound.
A lot of times that's not going to help anything
because it's under such pressure
and you can't just get enough pressure there.
>> Wait, do you do the thing where
you raise it above your heart?
Is that a thing?
>> So it can help but honestly you're under
so much pressure that it's not going to
do anything except get blood on you.
>> You want to put the pressure like on the wound directly,
not in the surrounding area, not like, okay, here's where
I think the blood is coming from.
>> Directly on and if, say it's your arm, if you can get
on a table and then press down as hard as you can.
>> Press as hard as you need to to cause the blood to stop.
>>> Yes.
>> If blood is still coming, press even harder.
>> Right. >> Yes.
>> At what point do you get into tourniquet territory?
>> So a lot of times when that's not working, people
have said that it doesn't help to put the tourniquet on
because all you're going to do is kill your hand
but I'd rather have an amputation than be dead.
And when all your blood is gone, you're dead.
>> Okay so this ties into all the way back in Cub Scouts,
I remember hearing like, the moment you put
a tourniquet on something, that's gone.
>> Not necessarily. >> Okay.
>> It's surprising especially, depends on where you are.
Because if you're out in the boondocks doing something
and you get cut like that, you could probably say goodbye
to your arm but it's better that than dead.
If you're in a city and you cut yourself on a rusty pipe
or something, then as long as you get
to the hospital soon, they can generally save it.
>> Wow.
>> It's within four hours, right?
>> Yeah four hours is a good--
>> Generally speaking.
>> It's a good window.
>> What is the first thing you do
when you come across one of these?
>> We got it, pressure, got it, pressure.
>> So pressure on, if you can put something on there like
a cloth, a tee shirt, whatever pressure.
>> You can constantly talk about whether or not
it's going to get into college.
You can ask how it's doing on its SATs.
If its finished its homework.
>> All the pressure. >> You stay with me!
>> Don't you die on me.
If that's not going to work, we're going to
have to go to the tourniquet.
And this is a very simple, it's a triangle bandage we had
but honestly a piece of tee shirt,
anything you can tear into a strip is going to work.
And you're going to want to put it on high and tight.
>> So at least two inches above the wound.
>> But honestly if you can get it up as far up as possible--
>> Yeah the higher you can get it, the better.
>> Not near the wound necessarily.
>> Not even necessarily.
>> So let's say the wound is here,
would you put the tourniquet up here?
>> I would.
>> Whoa, really? >> Yeah.
>> High and tight is just the general rule
so I'd want to get it as high as possible
and as tight as possible and that's going to give you
the best chance of stopping that bleed.
>> Tourniquets of course, also only apply
to the limbs, right?
>> Right. >> Yes.
>> You're not going to try to like--
>> Right. >> Yes.
>> You're like, "Put it around the neck, high and tight!"
I just realized I'm still putting pressure on this.
[laughter]
>> Good man.
>> If this was a real scenario, you'd be good
but it only works on the limbs.
And sometimes the legs you're going to need two or three
because there's so much mass there.
>> Whatever the strip is, you wrap it around and then what?
You put a stick in there and twist or something?
>> Yeah, I'm going to use my wife's arm as an example because--
>> Oh, that's safe.
>> Yes it is.
So she's got a bleed down here, the pressure isn't working,
I'm going to get it high and tight.
I'm going to kind of tie it off here.
>> So the first part it's basically
like you're tying your shoes.
>> Yes. >> Kind of, yeah.
I'm getting it as tight as possible
and I'm going to put a pen in there.
>> What's the pen for?
>> A windlass. >> It's a windlass.
>> Wait, a windlass?
>> Yeah. >> It's called a windlass.
I'm going to try to tighten this up. >> I've never heard that.
>> So you would just tie it kind of like
you're tying a double knot type deal.
>> And then you got to--
>> Oh, you're trying to get it as tight as possible.
>> Oh yeah. >> Absolutely.
>> Basically you get it snug, you wrap it over on the bottom
and then you tie it over top and then
you just start twisting and then the whole thing
just gets tighter and tighter and tighter.
You're building a little motor.
>> It's the same principle, uh, when
you choke someone with a garrotte.
>> Yes.
>> Well yes.
>> And then you get it as tight as possible
and the goal is... I shouldn't feel a pulse.
[gasp]
And that's the point. >> Wait, do you not feel a pulse?
>> I do not feel a pulse.
>> So this is a trick that-- >> Better do it quick.
>> Get an ax!
[laughter]
>> So psychics would claim to go into a trance
and actually stop their heart and they would make
a big deal about having a nurse
there taking their pulse the whole time.
They would just have a tennis ball in their armpit
and they would just squeeze down until
and then you couldn't feel the pulse.
>> Fascinating.
>> But I'm going to bet that a tennis ball
is not as effective as a tourniquet.
>> Definitely not. [laughter]
So if compression is not working
on the outside, you go a tourniquet, right?
>> Absolutely.
>> Then what are we learning besides the tourniquet then?
>> Well there's other places that you can stop bleeding so
if for example I were to shoot you with a gun right here--
>> Then I would consider that rude.
>> That would be very rude but--
>> Dick move, Daniel.
[laughter]
>> And I thought we were friends!
>> Totally.
You can pack that wound and stop the bleeding there.
It's very painful for whomever's been shot
but it's better than dead, right?
>> Really the only places you pack on your body
are like this area here or this area here.
>> Definitely, I mean with anything like a gun shot
in your leg, you can tourniquet that.
But if you get up here, you can't really tourniquet
that, it's too high but it still bleeds a lot, right?
I mean if I where on the ambulance I'd have one of these
but anything, again, works,
a tee shirt, something like that.
>> Wait a minute, I've heard that tampons
are really good to plug gun shot wounds.
>> Tampons are very good.
>> Tampons will work, yeah. >> Yeah.
If this was a gun shot, I can pack this wound
and then you go in to where you find the bone
and you can actually find the bleed
and the whole point of this is to keep
as much pressure on it as possible.
>> Brian: And the whole time
they're just definitely screaming.
>> They're probably screaming. >> Yeah.
>> And you're just getting as much in there as possible.
>> Right. >> So it won't take anymore.
It's a lot like packing your teeth when
you have your wisdom teeth removed.
>> For sure, yeah, yeah.
>> Very much like that.
>> And we've even been taught to get your knee on it.
>> Oh geez. >> Yeah.
>> Daniel: And just sit on them
until you get help. >> I would be so pissed at you.
>> Oh yeah. >> Like, "Dude I got shot there stop!"
>> Yeah.
>> So is the thinking on this that basically
you're creating pressure from inside by filling the void
and it's pressing down on all the capillaries?
>> Absolutely and even find where the bleeding
is coming from, find the arterial source
and push directly on that.
>> Wow so
just a dude's thumb in your chest >> So find where the blood--
as you're walking
into the trauma ER.
>> Essentially. >> Yeah.
>> You see that in like dramatizations and ER movies
and what have you where they'll root around
in there to find the actual vein and tie it off.
>> Yeah that was Black Hawk Down there.
>> So we've got packing the wounds, we've got putting pressure
on it, we've got tourniquets,
is there anything else we need to know?
>> I mean, if you have quikclot gauze,
that's an option we've got--
>> Quik, quikclot gauze, is that what you?
>> Quikclot gauze, yes.
>> Quikclot gauze.
>> Say that five times fast, right?
>> That's right, I will not.
>> This is kind of a military thing
but you can buy it civilian use.
It's just got some hemostatic agent in there.
>> Like instant coagulant basically?
>> Right. >> Yeah.
>> So the blood comes out as a liquid, normally
it would coagulate and turn into a jelly
and then kind of a scab, this just speeds everything up.
>> Yep. >> Most definitely.
>> You're saying the gauze is actually made in such a way
that it too, on its own, will help with clotting.
>> Definitely. >> Yes.
>> That's why you don't want to take gauze off if you've put
it on, if it gets soaked through, you just put more on
so that it's actually clotting because it's woven properly.
>> And so I assume that's all just maximal surface area
because the surface area, more exposure
to the air and look at this, I'm sw--
We're getting very science-adjacent.
We're getting better by the minute.
>> We're practically doctors.
>> So you come up, the first thing you want to do
is find out what kind of bleeding are they have.
Is it capillary, is it arterial or venal.
Wait venal, isn't that a type of sinning?
[crosstalk] Venous!
Venous, okay.
[laughter]
>> Same Latin root. [laughter drowns out sound]
>> Kind of the same, venal versus mortal, I mean.
[laughter]
Figure out what the bleeding is, apply pressure until
it stops, if it doesn't stop go to tourniquet.
>> High and tight.
>> High and tight!
If it's in a place that you can't tourniquet,
then you pressure, you plug, if you need to you dig in,
you find the vein, you pinch it off
and then you go call trauma ER.
>> Call 911.
>> Oh yeah.
>> That's an important number anyhow. >> That makes sense.
>> Call them, call the, yes.
>> Internationally there's all different--
>> Definitely. >> Yes.
>> Is it 999? >> Yes.
>> Jason: There is.
>> I think that's Britain.
>> Know where you are
and then call that number.
[laughter]
>> Yes. >> Right, that's a good one.
>> Although actually that's pretty good because if
you're traveling then that's something
that you might not consider in an emergency situation.
Do you guys have anything to plug? Or...
>> No. >> Well, I mean, now this--
[laughter]
>> If you get hurt in Austin.
>> Is there a resource that people should in general
go to to get emergency preparedness training?
>> You know, there really isn't anything nationally noticed
but you can always go to your local fire EMS station,
whatever you have and they'll most likely
be glad to help you out.
>> Right on.
[quieter] >> Oh no, yeah, because people were doing it sitting.
And he flipped it over and got the leg, shink.
>> Brian: Oh my God.
>> Jet ski'd down, ended up going through the dry wall.
Compound fracture.
>> Yeah because the other sides a whole lot smoother
so it's a faster ride.
>> But about halfway down the nose caught--
>> Brian: Oh geez.
>> Yeah.