Page 125 - JSOM Winter 2018

An Ongoing Series

Clinical Update

Concepts of Prehospital Traumatic Hemorrhage Control in the Operational K9

Lee Palmer, DVM, MS, DACVECC, CCRP, EMT-T, WEMT, NRP, TP-C

ABSTRACT
Major trauma often involves varying degrees of hemorrhage. for the Special Operations Forces or tactical medical provider
Left unattended, any amount of trauma-induced hemorrhage operating in an austere environment.
may rapidly become life threatening. Similar to humans, Op-
erational canines (OpK9s) can suffer penetrating trauma and Sources of Trauma-Induced Hemorrhage
blunt trauma that lead to compressible and noncompressible
hemorrhage. Preserving organ function and saving the life of Trauma-related hemorrhage is often classified by its vascular
a massively bleeding OpK9 require the implementation of im- source (i.e., arterial, venous, or capillary) and general anatomic
mediate and effective hemostatic measures. Effective hemor- location (internal versus external). Major trauma involves
rhage control interventions for the exsanguinating OpK9 are some degree of arterial, venous, and capillary bleeding. Ar-
similar to those for humans: direct pressure, wound packing, terial hemorrhage is described as bright red streams of blood
hemostatic agents and devices, pressure bandage, and, possi- that spurt or gush from the wound. Generally, it presents a
bly, tourniquet application. Although tourniquet application higher life-threatening risk as compared to venous or capillary
is a life-saving intervention in humans experiencing extremity bleeding. As the casualty enters a stage of hypotensive circula-
hemorrhage, it is not considered a necessary, immediate-action tory shock, even a large arterial hemorrhage, such as from the
life-saving intervention for canines with extremity injuries. femoral or carotid arteries, may not appear to gush but rather
This article provides a brief description of the basic methods only trickle from the wound. Although venous hemorrhages
for identifying life-threatening hemorrhage and achieving im- are often considered a lower risk for rapid exsanguination,
mediate hemostasis in the bleeding OpK9 during the prehos- hemorrhage from a large vein (e.g., external jugular vein) or
pital period. continued uncontrolled venous bleeding from multiple smaller
veins may quickly lead to a state of hemorrhagic shock.
Keywords: operational canine; hemorrhage control; trauma
Major trauma carries the risk of causing internal or external
hemorrhage, or both. Anatomic sites for exsanguinating in-
ternal hemorrhage in canines mainly include the abdominal
Introduction
cavity, retroperitoneal space, pleural space, and gastrointesti-
Prompt recognition and attenuation of life-threatening, nal tract. Injury to the liver and/or spleen constitutes the most
trauma-induced hemorrhage are paramount to improve the likely source of blunt trauma–induced intraabdominal hemor-
3–5
chances of survival for the exsanguinating Operational canine rhage. Unlike in humans, massive bleeding into the fascial
(OpK9). The main tenets for abating compressible hemor- planes around fractured long bones (e.g., femur) or into the
rhage in OpK9s are similar to those for humans and include pelvic space subsequent to pelvic fractures is not a commonly
direct digital pressure, pressure dressings, hemostatic agents identified source of life-threatening internal hemorrhage in
and devices, and/or wound packing. In human and canine canines. External hemorrhage is generally easier to identify
6–9
casualties, noncompressible intracavitary (i.e., intrathoracic, than internal hemorrhage and is more amenable to applica-
intraabdominal) hemorrhage remains relatively inaccessible tion of direct hemostatic interventions (e.g., direct digital pres-
to immediate, direct hemostatic interventions when operating sure, pressure dressing, wound packing). Keep in mind that
2
in the prehospital, austere environment. Although there are although an external hemorrhage may not appear significant
many similarities relative to trauma-induced hemorrhage and initially, it may become significant after restoration of systemic
hemorrhage control between humans and canines, there are arterial blood pressure as a result of fluid resuscitation and/
also species differences that this article attempts to highlight or patient handling and movement causing disruption of a
Correspondence to Lee Palmer, 1003 Felton Lane, Auburn, AL 36830; or Lpalmer2508@gmail.com
LTC Palmer is with the Veterinary Corps, US Army Reserves, and is lead of the K9 Tactical Emergency Casualty Care Working Group.

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