5.2 Wounds, Bleeding, and Choking Management

Wounds, Bleeding, and Choking Management

In the daily duties of a private security guard in Qatar, trauma injuries such as severe wounds and acute airway obstructions represent immediate, life-threatening emergencies. Whether stationed at a commercial shopping center in Doha, a residential compound in Al Waab, or an industrial site in Ras Laffan, a guard must act swiftly to control external bleeding and clear obstructed airways. Effective management of these conditions before the arrival of professional paramedics from the Hamad Medical Corporation (HMC) can prevent shock, brain damage, and death. To perform these duties, guards must understand the physiological processes of bleeding, the application of pressure, and the mechanics of airway clearance.

Managing Wounds and Bleeding

Bleeding, or hemorrhage, occurs when blood vessels are ruptured due to physical trauma. To manage bleeding effectively, a security guard must first recognize the type of bleeding, as this determines the severity and speed of blood loss.

Types of Bleeding

Bleeding Control Protocol

When responding to a casualty with external bleeding, the security guard must prioritize personal protection by wearing nitrile or latex gloves to prevent exposure to bloodborne pathogens. Once protected, the guard must follow these steps immediately:

1. Direct Pressure: This is the primary and most effective method. Place a sterile dressing, clean cloth, or gauze directly over the wound and apply firm, continuous pressure with your hands. The pressure compresses the ruptured vessels against underlying bone or muscle, allowing blood clotting to begin. If the dressing becomes soaked with blood, do not remove it, as this will disrupt the clotting process. Place additional dressings on top and continue pressing.
2. Elevation: If the wound is on a limb, elevate the injured limb above the level of the heart, provided there are no signs of a fracture. This reduces hydrostatic pressure in the blood vessels at the wound site, slowing down the rate of blood loss.
3. Dressing and Bandaging: Once bleeding is controlled, secure the dressings in place with a bandage. Wrap it firmly but not so tightly that it cuts off distal circulation. Check circulation below the bandage by assessing warmth, color, and pulse in the fingers or toes.
4. Tourniquet Application: For severe, life-threatening extremity bleeding that cannot be controlled by direct pressure, a tourniquet must be used. Apply the tourniquet 2 to 3 inches above the wound, but never directly on a joint. Tighten the windlass until the bleeding stops and the distal pulse is no longer detectable. Write the exact time of application on the casualty's forehead or on the tourniquet itself ("T: HH:MM"). Once applied, never loosen or remove the tourniquet; only a medical professional should do so.

Recognizing and Managing Hypovolemic Shock

Severe blood loss leads to hypovolemic shock, a state where the circulatory system fails to deliver enough oxygen-rich blood to vital organs. The guard must recognize symptoms of shock, which include:

• Cold, clammy, and pale skin.
• A rapid, weak pulse.
• Rapid, shallow breathing.
• Dizziness, confusion, or altered mental status.
• Excessive thirst or nausea.

To manage shock, the guard should have the casualty lie flat on their back and elevate their legs about 12 inches (if no spinal or leg fractures are suspected) to improve blood flow to the brain and heart. Keep the casualty warm with a blanket, as hypothermia impairs the blood's ability to clot, making bleeding worse. Do not give the casualty anything to drink, even if they complain of thirst, as this can lead to vomiting or airway aspiration.

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Managing Choking (Airway Obstruction)

Choking occurs when a foreign object blocks the airway, preventing normal breathing. The universal sign of choking is the casualty holding their throat with one or both hands. The guard must assess whether the obstruction is mild or severe.

Mild vs. Severe Airway Obstruction

• Mild Obstruction: The casualty can speak, cough, and breathe. They may make high-pitched noises. The guard should encourage them to keep coughing. Do not perform abdominal thrusts.
• Severe Obstruction: The casualty cannot speak, cough, or breathe. Their face may turn blue (cyanosis), and they may become unresponsive. Immediate action is required.

Abdominal Thrusts (Heimlich Maneuver)

To perform abdominal thrusts on a conscious adult:

1. Stand behind the casualty and wrap your arms around their waist.
2. Make a fist with one hand and place the thumb side against the casualty's abdomen, slightly above the navel (umbilicus) and well below the breastbone (sternum).
3. Grasp the fist with your other hand.
4. Press into the abdomen with a quick, upward and inward thrust.
5. Repeat this motion until the object is expelled or the casualty becomes unresponsive.

Special Populations

For pregnant or obese casualties, abdominal thrusts are not safe or effective. Use Chest Thrusts instead:

• Place your hands around the casualty's chest under the armpits.
• Place the thumb side of your fist in the center of the breastbone.
• Deliver quick, backward thrusts to expel the object.

Unconscious Choking Casualty

If the casualty becomes unresponsive and falls to the ground:

1. Carefully lower them to the ground, ensuring their head is protected.
2. Call 999 for emergency medical assistance.
3. Immediately begin CPR, starting with 30 chest compressions. Chest compressions increase the pressure in the chest cavity, which can act as mechanical thrusts to force the object out of the airway.
4. Before attempting rescue breaths, open the airway and look inside the mouth. If you see the foreign object, perform a finger sweep to remove it. Never perform a blind finger sweep, as this can push the object deeper.
5. Give 2 rescue breaths and continue the 30:2 CPR cycle.