"DIRECT CONNECTION" IS MADE BY MPT TO SERVE ALL OF OUR DIVERSE COMMUNITIES AND IS MADE POSSIBLE BY THE GENEROUS SUPPORT OF OUR MEMBERS.

THANK YOU.

LIVE FROM MARYLAND PUBLIC TELEVISION, THIS IS "DIRECT CONNECTION" WITH JEFF SALKIN.

>> GOOD EVENING EVERYONE.

WE'RE LIVE TONIGHT FROM THE MARYLAND SHOCK TRAUMA CENTER IN DOWNTOWN BALTIMORE.

THIS IS THE INSTITUTION THAT PIONEERED THE IDEA OF THE GOLDEN HOUR IN EMERGENCY MEDICINE.

AND IN THE 50 YEARS SINCE THEN, HELICOPTERS HAVE GOTTEN BIGGER AND FASTER, SURGICAL TECHNIQUES HAVE IMPROVED.

AND NOW THE FOCUS IS SHIFTING TO WHAT ELSE CAN BE DONE TO IMPROVE SURVIVAL IN ACCIDENT CASES AND OTHER TYPES OF SERIOUS INJURIES.

THE FOCUS IS ON WHAT INDIVIDUALS CAN DO BEFORE THE PARAMEDICS GET THERE.

IT IS A PROGRAM CALLED STOP THE BLEED.

WE WILL HAVE A DEMONSTRATION COMING UP WITH TECHNIQUES YOU NEED TO KNOW ABOUT.

THERE WILL BE NO BLOOD, MAYBE A LITTLE BIT OF PLASTIC BUT STAY TUNED FOR THAT IN A FEW MINUTES.

ALSO TONIGHT WE ARE TAKING YOUR QUESTIONS BY E-MAIL.

THE E-MAIL ADDRESS AT MPT.ORG.

JOINING US IS Dr. THOMAS SCALIA, THE PHYSICIAN AND CHIEF AT SHAH TRAUMA FOR 27 YEARS.

TELL ME ABOUT THE PATIENTS YOU SEE, WHAT SITUATIONS ARE COMING IN.

>> ?

SOME OFFER THE YEARS, IF YOU ASK ME ABOUT OUR CURRENT PROFILE, A THIRD ARE VEHICULAR CRASHES, DEFINED AS IN ALL WAYS.

ABOUT 35 OR 40% ARE ACTUALLY OLDER PEOPLE THAT HAVE FALLEN.

AND ABOUT 25% ARE PEOPLE THAT HAVE BEEN INJURED WITHIN A PERSONAL VIOLENCE.

LARGELY BALLISTICS, GUNSHOT WOUNDS AND A LITTLE BIT OF INDUSTRIAL AND RECREATIONAL INJURIES.

>> Jeff: IF YOU WATCH THE EVENING NEWS IN BALTIMORE YOU FREQUENTLY HEAR SHOCK TRAUMA IN THE CONTEXT OF A SHOOTING VICTIM BEING TRANSPORTED TO HAVE THEIR LIFE SAVED.

HOW MANY PEOPLE WHAT ARE THE TRENDS YOU SEE IN THAT?

>> WE'RE SEEING THIS YEAR PROBABLY 700 OR 800 GUNSHOT WOUNDS.

ANOTHER SEVERAL HUNDRED, 300 PEOPLE STABBED.

SO IT'S A LOT.

IT'S A SUBSTANTIAL NUMBER WELL OVER A THOUSAND PEOPLE A YEAR THAT ARE INJURED BY WHAT WE CALL PENETRATING TRAUMA.

>> Jeff: YOU WERE TELLING ME ABOUT A 12-YEAR-OLD PATIENT OF YOURS THAT YOU SAW RECENTLY WITH PENETRATING TRAUMA FROM AN ASSAULT WEAPON?

>> INDEED.

CERTAINLY ONE OF THE THINGS THAT HAS GOTTEN A LOT OF ATTENTION, APPROPRIATELY SO, IS THE REAL SPIKE IN INJURIES, PARTICULARLY GUNSHOT WOUNDS TO YOUNG PEOPLE, TO CHILDREN.

AND LAST NUMBERS I SAW THERE WERE 10 DEATHS SO FAR THIS YEAR AND ANOTHER 50 OR 60 NONFATAL SHOOTS IN KIDS WHICH IS A NOTICEABLE DIFFERENCE FOR US RELATIVE TO THE LAST FEW YEARS.

>> Jeff: AND EVEN WHEN YOU ARE ABLE TO SAVE SOMEBODY'S LIFE, FREQUENTLY THEY DON'T WALKOUT THE DOOR AS THE SAME PERSON THEY CAME IN.

>> WELL, IT IS A COMPLICATED SET OF CIRCUMSTANCES.

PARTICULARLY YOUNG PEOPLE AND OLDER PEOPLE AS WELL.

THERE IS A HUGE EMOTIONAL TOLL TO BEING INJURED AND BEING INJURED VIOLENTLY EVOKES A WHOLE SET OF ISSUES THAT REQUIRE LONGER TERM OFTEN THERAPY.

AND EVEN THOUGH WE SAVE ALMOST EVERYBODY THAT COMES HERE, THAT DOESN'T MEAN THAT THEY DON'T HAVE PHYSICAL HE IS EQUALLY.

SO WE CERTAINLY DO OUR BEST TO BE AS HOLISTIC AS POSSIBLE.

WE TRY TO TREAT THE BODY, WE TRY TO TREAT THE PSYCHE, WE TRY TO TREAT THE MIND BUT IT CAN BE A PROBLEM.

>> Jeff: YOU VENTURED OUTSIDE OF THE HOSPITAL IN TERMS OF VIOLENCE PREVENTION.

WHAT HAVE YOU TRIED AND WHAT HAVE THE RESULTS BEEN?

>> WE HAD THE FIRST HOSPITAL BASED VIOLENCE INTERVENTION PROGRAM IN 2006 IF I REMEMBER CORRECTLY.

AND IT IS ONE OF THE FEW TO DATE THAT HAS RANDOMIZED DATA THAT SAYS IT ACTUALLY CHANGES BEHAVIOR.

AND SO IT WAS VERY DISCOURAGING FOR MANY YEARS.

WE WERE UNABLE TO GET IT FUNDED.

I'M HAPPY TO SAY WE HAVE OBTAINED FUNDING AND WE ARE TRYING TO AMPLIFY THAT UP TO MAKE THAT ASES ASEST EVIDENT AS POSSIBLE.

THE NEW AREA WHERE WE ARE CONCENTRATING IS WE JUST OPENED AS OF MAY FIRST, NOT EVEN A MONTH AGO, THE UNIVERSITY OF MARYLAND BALTIMORE VIOLENCE PREVENTION CENTER.

AND WE HAVE OUR NEW EXECUTIVE DIRECTOR Mr. CARR IN WE ARE JUST GETTING GOING.

BUT THE IDEA IS TO MAKE THIS COMMUNITY-BASED PREVENTION WHAT WE'D LIKE TO DO IS NOT HAVE TO FIX THEM AFTER THEY GET HERE.

BUT PREVENT THEM FROM EVER COMING HERE.

THAT IS A TALL ORDER AND IS A SET OF ISSUES THAT IS GOING TO TAKE A GENERATION TO REALLY AFFECT.

WE HAVE TO SORT OF DIG IN AND MAKE THE LONG-TERM COMMITMENT TO GETTING THAT DONE.

THAT IS NOT A QUICK FIX.

>> Jeff: IF YOU HAVE A QUESTION FOR Dr. SCALIA OR BROCK TRAUMA SEND US LIVE QUESTIONS AT MPT.ORG.

I MENTIONED AT THE BEGINNING IT WAS Dr. CO-LY'S CONCEPT OF THE GOLDEN HOUR HOW RADICAL WAS THAT 50 YEARS AGO AND HAS IT SPREAD BEYOND BALTIMORE?

>> ABSOLUTELY.

THIS IS A WELL ESTABLISHED CONCEPT.

INJURY IS THE QUINTESSENTIAL TIME SENSITIVE DISEASE AND IT'S DISEASE.

THE CLOCK STARTS TICKING AT THE TIME OF INJURY NOT AT THE TIME OF HOSPITAL ARRIVAL.

WHAT YOU NEED A SYSTEM TO DELIVER THE RIGHT PATIENT TO THE RIGHT PLACE AND THE RIGHT AMOUNT OF TIME.

THAT SLOGAN THAT WE USE WAS ALSO THE SLOGAN ADOPTED BY THE U.S. MILITARY IN IRAQ AND AFGHANISTAN.

RIGHT PERSON, RIGHT PLACE, RIGHT AMOUNT OF TIME.

AND SO WHETHER YOU BELIEVE THAT THE GOLDEN HOUR IS 60 MINUTES OR SOMETIMES FOR TERRIBLY INJURED PATIENTS IT MAY BE SIX MINUTES, THE CLOCK IS TICKING.

AND OUR JOB IS TO GET THE PATIENT TO CARE, DEFINE THAT AS YOU LIKE IT'S DIFFERENT, DIFFERENT DAYS AND FOR DIFFERENT PEOPLE.

BUT GET THE PATIENT TO THE RIGHT CARE AS FAST AS WE CAN.

>> Jeff: AND THE RIGHT CARE MAY NOT BE AT SHAW TRAUMA.

IT'S NOT JUST YOU GUYS AND YOUR HELICOPTERS.

>> IT IS A SOPHISTICATED SYSTEM IT'S FIVE EMS ZONES A HELICOPTER IN EACH ZONE A REGIONAL TRAUMA CENTER IN EACH ZONE.

FOUR TRAUMA CENTERS IN THE CITY.

IT IS A BIG SYSTEM.

WE STAND AT THE TOP OF THAT SYSTEM.

BEING THE PRINCIPLE RESOURCE CENTER FOR THE STATE AND THE NEUROTRAUMA CENTER FOR THE STATE OF MARYLAND.

BUT CERTAINLY IF EVERY INJURED PATIENT CAME TO HERE, WE'D BE CROWDED BEYOND BELIEF.

IT'S THE RIGHT PERSON THAT NEEDS TO COME HERE NOT EVERY PERSON.

>> Jeff: YOU MENTIONED THE MILITARY'S APPROACH TO TRAUMA CARE.

YOU TRAIN MILITARY DOCTORS HERE.

>> WE STARTED THAT IN 2001 AND WE HAVE BEEN PROUD TO BE THE AIR FORCE TRAINING SITE FOR 22 YEARS.

WE WILL BE THE AIR FORCE TRAINING SITE AS LONG AS THE AIR FORCE WANTS TO STAY OR AT LEAST AS LONG AS I'M HERE AND LONG AFTER I'M GONE.

I THINK THERE IS GREAT SYNERGY BETWEEN US AND THE MILITARY.

WE TAUGHT THEM A NUMBER OF LESSONS FROM THE EXPERIENCES WE GARNERED IN THE 90s WHEN CRACK COCAINE CAME TO THE UNITED STATES AND THERE WAS LITERALLY WAR ON THE STREETS OF AMERICA.

THEY HAVE BROUGHT BACK MANY IMPORTANT LESSONS FROM THE WAR, INCLUDING NEW WAYS OF USING BLOOD AND PLASMA.

SO IT GOES BACK AND FORTH.

AND MY MIND THEN EVERYBODY WINS.

>> Jeff: IF YOU WERE NAMED BOB, HOW DO YOU PROCESS ALL THE TRAUMA THAT YOU WITNESS PSYCHOLOGICALLY AND EMOTIONALLY?

NOT JUST YOU, IF PEOPLE SAW THE VIDEO FROM THE RESUCITATION UNIT THERE CAN BE 20 PEOPLE IN THERE.

>> THAT IS A GREAT QUESTION.

IF I CAN'T DO THAT I'M NOT VERY GOOD AT MY JOB I WOULD BE INEFFECT YOU'LL.

WHEN I'M ON I DON'T HAVE THE LUXURY OF GRIEF.

I HAVE TO PUT THAT IN A DIFFERENT PLACE BECAUSE THE RADIO IS GOING TO GO OFF AND THE PHONE IS GOING TO RING AND THE NEXT PERSON COMES IN DESERVES MY A GAME NOT ME GOING I'M SAD.

EACH OF US HAS A WAY OF PUTTING THE FEELINGS IN A DIFFERENT PLACE AND THEN EACH OF US HAS OUR WAY OF DEALING WITH THEM WHEN WE GET TO NOT BE CLINICALLY TIFFANY MORE.

MY WAY, IS TO GO TO THE GYM.

>> Jeff: YOU TEACH.

Dr. HENRY COMING UP PROFESSOR OF MEDICINE WHEN YOU ARE TALKING TO STUDENTS OF SURGERY AND TRAUMA CARE AND PREPARING THEM FOR THE EMOTIONAL ASPECT OF WHAT THEY ARE GOING TO SEE, HOW DO YOU SET IT UP FOR THEM?

>> THIS ISN'T FOR EVERYBODY.

AND I THINK PEOPLE NEED TO MAKE AT LEAST A CERTAIN LEVEL OF DECISION IN MEDICAL SCHOOL OR IN RESIDENCY.

AND SOME PEOPLE WANT TO BE OUTPATIENT DOCTORS AND THAT IS GREAT BECAUSE WE NEED A BUNCH OF OUTPATIENT DOCTORS.

AND SOME PEOPLE WANT TO BE VERY DIRECTED IN THEIR PRACTICE.

HAVE A LITTLE NICHE AND BECOME AN EXPERT AT A SMALL AREA.

WE NEED THOSE PEOPLE.

WE ARE THE DOCTORS AND THE NURSES FOR THE SICK PEOPLE.

AND TO A LARGE EXTENT, IT DOESN'T MATTER HOW YOU ARE SICK, IF YOU ARE REALLY SICK, WE'RE YOUR GUYS AND WE'RE HAPPY TO SWING IN AND HELP.

>> Jeff: WE TALKED DURING THE PANDEMIC BY ZOOM, OF COURSE, AND AT THE TIME THINGS WERE REALLY DIFFERENT BECAUSE NOBODY WAS DRIVING ANYWHERE.

I IMAGINE THE NUMBER OF CRASH VICTIMS WAS DECLINING.

AND YOU MOVED INTO A DIFFERENT ROLE.

>> WE DID.

WE REALLY REINVENTED OURSELVES.

IS SAYS SHOCK ON THE BUILDING BEFORE IT SAYS TRAUMA.

IT'S ABOUT THE CARE OF CRITICALLY ILL AND OR INJURED PATIENTS.

WE BECAME THE CENTER FOR RESPIRATORY FAILURE FROM COVID.

WE SETUP A A 32 BED UNIT AND WE OFFERED THE HIGHEST LEVEL OF SUPPORT FOR RESPIRATORY FAILURE.

WE PUT ALMOST 90 PEOPLE ON HEART LUNG BYPASS FOR RESPIRATORY FAILURE WITH A SURVIVAL OVER 70%.

IT IS SORT OF A STAGGERING SET OF RESULTS.

AND THE MEN AND THE WOMEN OF THE SHOCK TRAUMA CENTER LED THAT FIGHT IN EVERY DISCIPLINE.

DOCTORS, NURSES, RESPIRATORY THERAPISTS, TECHS, EVERYBODY LEANED IN AND SAID HERE WE ARE.

WE ARE GOING TO SAVE LIVES IT DOESN'T MATTER WHY ARE YOU SICK.

>> Jeff: LAST QUESTION YOU WERE PRACTICING MEDICINE IN NEW YORK CITY 27 YEARS AGO WHEN THIS JOB OPENED UP.

WHAT BROUGHT YOU TO BALTIMORE?

>> THE JOB.

I NEVER INTENDED TO LEAVE NEW YORK CITY.

I WAS GOING TO LIVE AND DIE THERE.

AND WHEN THIS OPPORTUNITY BECAME POSSIBLE, I HESITATED ABOUT FOUR MILLION SECONDS AND SAID OWE FOUR MILLISECONDS AND SAID YES.

THE ANALOGY IS LIKE PLAYING CENTER FIELD FOR THE YANKEES OR THE ORIOLES DEPENDING ON YOUR GEOGRAPHY.

THIS IS THE BEST JOB IN TRAUMA CARE IN THE WORLD.

AND I WOULD SAY IT'S THE BEST JOB IN ACADEMIC MEDICINE IN THE UNITED STATES FOR SURE.

WHEN THIS BECAME A POSSIBILITY, I WAS ALL IN.

AND I STILL AM.

>> Jeff: CAN DOCTOR IT IS ALWAYS AN HONOR TO TALK TO YOU.

WE'LL BE BACK ABOUT HOW YOU CAN STOP THE BLEED IN JUST A MOMENT.

>> Jeff: MEDICINE AT THE UNIVERSITY MARYLAND SCHOOL OF METHOD SIP AND DIRECTOR OF WOUND HEALING AND METABOLISM AT THE SHOCK TRAUMA CENTER THANK YOU FOR YOUR TIME.

>> THANK YOU FOR HAVING ME.

>> Jeff: TELL ME ABOUT STOP THE BLEED.

WHERE DID THIS PROGRAM COME FROM?

>> SO, STOP THE BLEED WAS A REALLY A JOINT EFFORT OF MULTIPLE ORGANIZATIONS AND THE FEDERAL GOVERNMENT.

AND IT REALLY WAS ONE OF THE FIRST PROGRAMS THAT REALLY SOUGHT TO INVOLVE THE PUBLIC IN TRYING TO IMPROVE SURVIVAL FROM INJURY.

AND IT DEVELOPED SOME REALLY SIMPLE TECHNIQUES THAT WE CAN TRAIN THE PUBLIC TO USE WHEN THERE IS LIFE-THREATENING BLEEDING.

THAT CAN IMPROVE SURVIVAL OF PATIENTS TO GET TO THE HOSPITAL WHERE THEY CAN GET EXPERT CARE.

>> Jeff: WHAT IS THE RESPONSE FROM THE PUBLIC BEEN LIKE?

PEOPLE EVERYBODY'S LEARNED THE HEIMLICH MANEUVER AND CPR AND HOPEFULLY HAVE LEARNED HOW TO WORK A DEFIBRILLATOR.

WHY IS THIS AN IMPORTANT PART FOR REGULAR CIVILIANS TO KNOW.

>> AS YOU HEARD IN THE SEGMENT BEFORE, BLEEDING IS STILL THE LEADING CAUSE OF DEATH AFTER INJURY.

SO IF WE WANT TO IMPACT THAT NUMBER AND SAVE MORE LIVES, THE SOONER WE CONTROL BLEEDING THE BETTER CHANCE WE HAVE OF SAVING A PATIENT.

SO WHEN THERE IS THAT LIFE-SAVING HEMORRHAGE WE RELY ON OUR PROFESSIONAL EMERGENCY RESPONSE PEOPLE AND AS WE HEARD WE HAVE A WONDERFUL SORT OF ELEGANT SYSTEM IN THE STATE OF MARYLAND THAT GOES OUT AND GETS YOU WHEN THEY KNOW YOUR INJURED.

AND THEY HAVE TO GET TO YOU.

SO THERE IS OFTEN A LAG BETWEEN THE TIME OF INJURY AND THE TIME THAT HELP ARRIVES.

AND IF A BYSTANDER WHO IS THERE AT THE MOMENT OF INJURY OR CLOSE THERE AFTER, CAN DO SOME SIMPLE TECHNIQUES THAT WILL LESSEN THE AMOUNT OF BLOOD LOSS THEN THAT GIVES A PATIENT A MUCH BETTER SHOT AT SURVIVAL.

>> Jeff: IF SOMEBODY WAS IN THE SCOUTS OR TOOK A LIFE-SAVING COURSE THEY PROBABLY LEARNED ABOUT TOWABOUT TURN COURAGE TOURNIQUETS.

>> WE HAVE BETTER TOW TURN QUITS AVAILABLE SO YOU CAN HAVE YOUR STOP THE BLEED KIT FOR ABOUT $40.

WHERE YOU WILL HAVE GLOVES AND GAUZE AND A KIT TUSH KIT TURN KIT AND THINGS TO STOP THE BREED.

THE TOWN KETS ARE OUR BEST BET.

ON PEOPLE ON TV TAKING THE BELT OFF AND A SCARF AND WRAPPING IT AROUND THE ARMAS A METHOD TO CONTROL HEMORRHAGE AND THAT LOOKS GREAT ON TV BUT WE KNOW FROM TESTING THAT IT DOESN'T ACTUALLY STOP THE BLEED WELL.

AND IN CERTAIN CIRCUMSTANCES, CAN ACTUALLY INCREASE THE AMOUNT OF BLEEDING.

BECAUSE THINK ABOUT IT WHEN YOU GET YOUR BLOOD DRAWN WHAT DO WE DO?

WE PUT A TURN QUIT AND WE STICK THE NEEDLE IN AND THE BLOOD COMES BACK FREELY.

A VENUS TURN TURN KIT THERE IS NO BLOOD BELOW THE AREA.

A.

>> Jeff: DO YOU WANT TO TRY IT?

NOT ON ME MAYBE ON THIS THING.

>> I WANT TO START WITH FIRST STEP BECAUSE YOUR FIRST STEP IS NOT NECESSARILY TO PUT A TOURNIQUET ON IT IS TO DO MORE SIMPLE MEASURES AND THAT IS JUST APPLYING PRESSURE.

THAT IS REALLY THE FIRST STEP TO THE ACTUAL PROCESS OF STOPPING THE BLEED.

AND IT CAN'T BE JUST OH, I'M APPLYING PRESSURE.

NO I'M NOT.

YOU HAVE TO REALLY APPLY PRESSURE.

YOU ARE LEANING INTO IT PUTTING YOUR BODY WEIGHT YOU ARE EXHAUSTED AFTER YOU FINISH BECAUSE YOU'RE HOLDING PRESSURE.

REMEMBER YOU HAVE TO STOP THAT ARTERY YOU ARE TRYING TO BLOCK AN ARTERY.

YOU ARE TRYING TO PREVENT THE BLOOD FROM COMING OUT.

APPLYING PRESSURE IS THE FIRST STEP.

THE SECOND STEP IF YOU HAVE A WOUND THAT IS DEEP AS THESE ON THESE MODELS ARE, SOMETIMES PUTTING PRESSURE ISN'T ENOUGH AND YOU LITERALLY HAVE TO PACK THE WOUND WITH GAUZE.

OR IF YOU DON'T HAVE GAUZE, THIS A SHIRT, ANY PIECE OF CLOTH, A SCARF, WHATEVER YOU HAVE COULD BE USED TO PACK A WOUND.

>> BECAUSE WE ARE NOT WORRIED IF IT'S STERILE.

>> WE ARE NOT, BECAUSE IF YOU DON'T SURVIVE TO GET TO THE HOSPITAL YOU DON'T SURVIVE TO GET AN INFECTION.

THIS IS ABOUT SAVING A LIFE AND ALL YOU WANT TO DO IS PUT THAT GAUZE IN TO THE BOTTOM OF THE WOUND AND FILL IT UP COMPLETELY.

SO YOU CAN USE GAUZE, YOU CAN USE THE SCARF OR A SHIRT AS I MENTIONED.

OR YOU CAN USE A REGULAR BANDAGE.

WHATEVER YOU HAVE CAN BE UTILIZED.

>> Jeff: THIS IS NOT FOR THE FAINT OF HEART.

THIS IN REAL-LIFE, YOU KNOW, THIS PERSON'S BLEEDING BADLY SOMEBODY MAYBE CONCERNED ABOUT BLOOD-BORNE ILLNESS BUT THERE IS A LIFE TO BE SAVED?

>> YES.

AND MOST OF US DON'T WALK AROUND THE STREETS WITH GLOVES IN OUR POCKETS.

WHEN IT COMES TO THAT YOU MAY NOT HAVE A PAIR OF GLOVES TO PUT ON.

ONE OF THE THINGS I TELL CLASSES THAT I TEACH THAT YOU CAN USE YOU KNOW THE TERRIBLE PLASTIC BAGS THAT THE STATE OF MARYLAND WANTS US TO NOT USE ANYMORE.

IF YOU SAVE THEM AND HAVE THEM IN YOUR CAR YOU CAN STICK YOUR HAND IN THAT AND HAVE THAT ACT AS A BARRIER BETWEEN YOU AND THE BLOOD IF YOU SHOULD FIND YOURSELF IN THIS KIND OF CIRCUMSTANCE.

>> Jeff: WE'LL GET BACK TO THE DEMO.

GOOD E-MAIL QUESTION FROM ROBERT.

WHAT SHOULD BE IN TRAUMA KITS FIRST AID KITS AT PUBLIC PLACES, SCHOOLS, WORKPLACES?

>> RIGHT.

THAT IS A WONDERFUL QUESTION, ROBERT.

I THINK THE THINGS THAT ARE NECESSARY ARE GLOVES, HAVING GLOVES SO THAT WE CAN PROTECT OURSELVES AS WE TRY TO HELP PATIENTS.

WE NEED SOME GAUZE SO IT DOESN'T HAVE TO BE FANCY GAUZE.

THIS IS WHAT I CALL FANCY GAUZE.

THIS HAS HEMOSTATIC AGENTS IN IT SO IT HELPS THE BLOOD TO CLOT FASTER BUT THIS PLAIN GAUZE WILL WORK AS WELL.

GAUZE OR ONE OF THESE HEMOSTATIC GAUZE, YOU WILL NEED SCISSORS AND A MARKING PEN BECAUSE IT'S IMPORTANT TO WRITE ON THE TOURNIQUET THE TIME.

IF YOU ARE GOING TO PUT A TOURNIQUET ON WE WANT TO KNOW WHAT TIME THAT TOURNIQUET WAS PLACED BECAUSE THERE IS A LIMIT TO THE AMOUNT OF TIME WE WANT TO LEAVE A TOURNIQUET IN PLACE BEFORE WE TAKE IT DOWN SO THAT LIMB WON'T NECESSARILY REQUIRE AMPUTATION.

>> Jeff: YOU WANTED TO DEMO THE TOURNIQUET ON OUR FRIEND HERE.

>> SURE YOU DON'T WANT ME TO DO IT ON YOU.

>> Jeff: I DON'T LIKE THE BLOOD PRESSURE TEST.

>> USUALLY WE LEAVE THE LOOP IN.

THIS TOURNIQUET CAN BE USED ON AN ARM OR A LEG.

SO IT'S BIG ENOUGH THAT IT CAN GO ON EITHER.

USUALLY YOU JUST SIMPLY SLIP THE LOOP THROUGH THE EXTREMITY.

YOU WANT TO ASSURE YOU PLACE THE TOURNIQUET BETWEEN THE HEART AND THE WOUND.

SO IF MY INJURY IS HERE, MY HEART'S HERE I WANT THE TOURNIQUET UP HERE.

YOU WANT IT AWAY FROM THE WOUND BUT NOT BELOW IT.

IT HAS TO GO ON TIGHT AND IF YOUR PATIENT IS CONSCIOUS, THEY ARE NOT GOING TO LIKE IT.

THEY ARE GOING TO SAY IT HURTS.

THEY ARE GOING -- THEY MAY SCREAM AND HOLLER BUT YOU HAVE TO ASSURE THEM THAT WHAT YOU ARE DOING IS MEANT TO HELP.

SO YOU WANT TO MAKE IT TIGHT.

AND YOU KNOW IT'S TIGHT BECAUSE YOU DON'T WANT TO GET YOUR FINGER BETWEEN THE TOURNIQUET AND THE SKIN.

SO I'VE SECURED IT.

I'VE FASTENED THE VELCRO DOWN AND THIS THIS WINLESS A KEY PART OF THE TOURNIQUET THAT ALLOWS YOU TO TIGHTEN IT FURTHER.

IF YOU LOOK YOU CAN SEE IT DIMPLING IN AND USUALLY IT TAKES ABOUT TWO TURNS OF THE WINLESS AND THEN YOU ARE GOING TO LOCK IT THERE.

AND THEN YOU ARE GOING TO BRING YOUR VELCRO STRAP OVER AND THEN STRAP THIS.

AND THIS IS WHERE YOU NEED YOUR MARKING PEN WHERE YOU ARE GOING TO NOTE THE TIME SO THAT WHEN THE PATIENT ARRIVES AT THE HOSPITAL THE HOSPITAL PERSONNEL WILL KNOW HOW LONG THE TOURNIQUET HAS BEEN IN PLACE.

>> Jeff: PLEASE.

>> AND YOU ARE GOING TO KNOW HOW DO YOU KNOW YOU'VE DONE A GOOD JOB?

YOU WON'T SEE BLEEDING.

SO IF THE BLEEDING STOPS YOU'VE DONE A GOOD JOB.

>> Jeff: HOW DO YOU KNOW THIS IS THE RIGHT TREATMENT?

THAT IT IS A SITUATION INSTEAD OF THE PRESSURE YOU DEMOED THAT IS NOT WORKING WE NEED THE TOURNIQUET?

>> IF YOU ARE APPLYING PRESSURE AND YOU STILL SEE BLOOD DRIPPING UNDER YOUR HAND, THEN IT'S TIME TO TRY SOMETHING ELSE.

SOMETIMES YOU WILL NEED TO YOU WILL NEED YOUR HANDS.

MAYBE IF YOU ARE BY YOURSELF, YOU WILL NEED YOUR HANDS FREE SO THAT YOU CAN GO FOR HELP OR YOU CAN DO SOME OTHER MANEUVER THAT YOU MAY NEED.

SO PUTTING A TOURNIQUET ALLOWS YOUR HANDS TO BE FREE IN SOME WAYS.

SO IT HAS THAT ADVANTAGE.

BUT USUALLY YOU KNOW YOU NEED TO MOVE ON TO THE NEXT STEP BECAUSE THIS IS INEFFECTIVE OR MAYBE YOU ARE GETTING TIRED.

BECAUSE AS I SAID, YOU ARE USING ENERGY WHEN YOU ARE APPLYING PRESSURE AND YOU DO THIS FOR 10 MINUTES, YOU KNOW, IT MAY GET TIRE SOME.

>> Jeff: I HAVE HALF A MINUTE.

YOU AND YOUR COLLEAGUES HAVE WITHIN TAKING OUR FRIEND OUT IN THE COMMUNITY AND TRAINING GROUPS.

HOW LONG DOES THAT TAKE?

>> THE TRAINING IS ABOUT AN HOUR.

IT'S NOT A SUPER LONG -- THERE IS A SMALL SORT OF SLIDE SHOW THAT WE GIVE WHERE WE TEACH SOME BACKGROUND ABOUT WHAT DOES LIFE-THREATENING HEMORRHAGE LOOK LIKE BECAUSE PEOPLE OFTEN DON'T KNOW WHAT THAT LOOKS LIKE.

AND SO WE HAVE TO SORT OF IF YOU SEE BLOOD SOAKING THROUGH CLOTHING IF YOU SEE IT PUDDLING UP AROUND A WOUND THOSE ARE SIGNS THAT THERE MAY BE LIFE-THREATENING HEMORRHAGE.

>> Jeff: Dr. SHARON HENRY A PLEASURE TALKING TO YOU.

HOPE NOBODY HAS TO DO THIS BUT YOU WOULD LIKE TO DO A TRAINING GROUP FOR CHURCHES AND OTHER GROUPS.

STOP THE BLEED FOR MORE INFORMATION.

THANK YOU FOR JOINING US FOR "DIRECT CONNECTION" BACK FRIDAY WITH "STATE CIRCLE".

FROM ALL OF US AT MPT HAVE A GOOD NIGHT.

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