Control of massive bleeding is all about achieving occlusion of the artery. We do this by using an approved tourniquet placed appropriately and tightened until bleeding stops. But how do we replicate achieving occlusion in training?

I highly recommend the use of a vascular or ultrasound doppler. Dopplers have been used in emergency departments and OB wards for decades. They are available for as little as $50+ dollars depending on where you shop. Dopplers will allow you to listen for the “whoosh” of blood in an artery. More importantly, they will let you know when the blood stops. The same can be done visually using an ultrasound doppler with color-motion enabled, but it can be cumbersome to use during training and with an ultrasound costing a ton, the doppler definitely wins.

This will make your hemorrhage control classes more authentic and consistent, as well as confidence building. There is no “eyeballing” that your junctional tourniquet is tight enough or the student waiting for the instructor to tell them it’s alright. You hear it or you don’t. The tourniquet is working or it’s not. Your indirect or proximal pressure is in the wrong place or it’s dead on.

See for yourself how well junctional tourniquets work, such as the Croc, SAM or JETT, or even a knee in the abdomen or over femoral artery. Hold medics to a standard and let them gain the confidence of turning off a human artery, as close as you can get without actually cutting it with a scalpel. (Not recommended.)

If you don’t have this, pulse checks and pulse oximetry may help, but are not as accurate.

   While a doppler is generally too difficult to hold still for a full trauma lane, this is good for training and testing them on just the intervention itself (proximal pressure, then a junctional tourniquet, for instance.)  See how well subclavian or brachial proximal pressure works.

One issue that comes up is holding the doppler to keep it in the right place so it can still “hear” the artery. I recommend not holding it up high, but hold it like a pencil with your wrist resting near the pulse location to steady your hand. You can also use your opposite hand to hold the probe in place in between your fingers. Marking the location with a permanent marker may also help.