Raid on Entebbe Raid on Entebbe

Raid
Raid on
on Entebbe
Entebbe
by
by RADM
RADM Bill
Bill McRaven
McRaven
“As previously ordered, the three
assault elements disregarded
Netanyahu and stormed the
building.”
“At this point in the operation, there
wasn’t time to attend to the
wounded.”
61
Do seconds really matter?
62
Ma’a
Ma’a lot
lot Rescue
Rescue Attempt
Attempt
by
by RADM
RADM Bill
Bill McRaven
McRaven
15 May 1974
¾ 3 PLO terrorists take 105 hostages
¾ Schoolchildren and teachers
¾ When assault commenced, terrorists began
killing hostages
¾ 22 children killed, 56 wounded
¾ The difference between a dramatic success
and a disaster may be measured in
seconds.
63
Care
Care Under
Under Fire
Fire
NO IMMEDIATE MANAGEMENT
of the airway should be anticipated at this
point because of the need to move the
casualty to cover as quickly as possible.
64
Care
Care Under
Under Fire
Fire
¾ Control of hemorrhage is the top priority.
¾ Bleeding to death from extremity wounds
is the number one cause of preventable
death on the battlefield.
¾ Cause of death in more than 2500
casualties in Vietnam who had no other
injuries.
65
Bloodborne
Bloodborne Pathogens
Pathogens
¾ First Aiders may be exposed to infectious
diseases when treating ill or injured
persons.
¾ Blood or body fluid contact with: mouth,
eyes, nose, or breaks in skin
¾ Needle sticks (or other sharps)
¾ Sexual contact
66
Bloodborne
Bloodborne Pathogens
Pathogens
¾ Bodily fluids can transmit:
¾HIV
¾Hepatitis
¾Tuberculosis
¾…
67
Universal
Universal Precautions
Precautions
If you don’t already share bodily fluids
with this person,
Now is not the time to start!
68
Universal
Universal Precautions
Precautions
¾ Gloves
¾ Eye and face protection
¾ Airway barrier devices
¾ Hand washing
¾ Contaminated clothing
¾ Potential exposure incidents
69
Universal
Universal precautions
precautions
¾ Bodily fluids can transmit HIV, hepatitis,
tuberculosis,…
¾ Gloves
¾First choice: nitrile
¾Second choice: latex (allergy?)
¾Avoid vinyl
¾ Need for eye protection, mask?
70
Is
Is This
This Life
Life
Threatening
Threatening
Hemorrhage?
Hemorrhage?
71
Extremity
Extremity Trauma
Trauma
Any penetrating extremity wound associated
with a fracture is at serious risk for life
threatening hemorrhage.
72
5.56mm Rifle Exit Wound
73
Questions/Comments?
74
How
How Do
Do You
You Control
Control
Hemorrhage?
Hemorrhage?
¾ Direct Pressure / Elevation
¾ Pressure point
¾ Pressure dressing
¾ Tourniquet
¾ Packing
75
Direct
Direct Pressure
Pressure
¾ Can you exert enough pressure?
¾ Can you exert enough pressure at the site
of bleeding?
76
Direct
Direct Pressure
Pressure
¾ Use both hands
¾ Gloves
¾ Gauze helps clotting
¾ Best method in a stable environment
¾ Elevate injured limb
77
Direct
Direct Pressure
Pressure
¾ Works most of the time for external
bleeding
¾ Two hands
¾ Ground or hard surface underneath
¾ Lean into it
¾ DON’T LET UP TO CHECK WOUND!
¾ Hard to maintain on big bleeders during
casualty carry
78
Pressure
Pressure Point
Point
¾ Apply where artery can be trapped against
bone
¾ Use two hands
¾ Should be use in conjunction with direct
pressure or pressure dressing
79
Pressure
Pressure Dressing
Dressing
¾ Used to replace direct (manual)
pressure
¾ If direct pressure didn’t work a dressing
WILL NOT be successful!
¾ A neat bandage (dressing) is a happy
bandage
80
Pressure
Pressure Dressing
Dressing
¾ Probably less effective that direct pressure
¾ Direct pressure possible on top of dressing
¾ Assess your treatment: bleeding in the
dressing is not effective
81
82
Questions?
83
Tourniquets
Tourniquets
¾ Discouraged by ATLS
¾ Most reasonable initial choice to stop
extremity bleeding in the Care Under Fire
Phase
¾ Direct pressure is hard to maintain during
casualty transport under fire.
84
Tourniquets
Tourniquets
–– from
from the
the front
front line
line
¾ Tourniquets are not being placed correctly
¾ Too liberal use on small oozing distal
wounds.
¾ They are not being tightened enough
Venous -vs- Arterial
85
The
The Death
Death of
of
General
Johnston
General Albert
Albert Sidney
Sidney Johnston
¾ Leading Confederate General
¾ KIA at Shiloh 7 April 1862
¾ Gen Johnston’s Surgeon - Dr. David
Yandell - directed that tourniquets be
issued
¾ During the battle, Gen Johnston sustained
injury to popliteal artery - bled to death
¾ Tourniquet was in his pocket
86
Extremity Hemorrhage Control
Over 2500
deaths occurred
in Vietnam
secondary to
hemorrhage
from extremity
wounds. These
casualties had no
other injuries.
Vietnam. Medical Evacuation. Marines of Company E, 2nd Battalion, 9th
Marines, while under heavy firefight with NVAs within the DMZ on Operation
07/29/1967
Hickory III, are carrying one of their fellow Marines to the H-34.
87
OIF
OIF Fatality
Fatality
¾ Marine shot in leg in Iraq
¾ Pulsatile femoral artery bleeding
¾ Corpsman arrived 10 minutes later
¾ Attempted to use hemostatic material
¾ Failed
¾ IV attempted – failed
¾ Tourniquet finally applied
¾ Casualty died
88
Hemorrhage
Hemorrhage Control
Control
in
in COMBAT
COMBAT
The recommended means to control bleeding
in a tactical environment while under fire is a
rapidly applied tourniquet
COMBAT APPLICATION TOURNIQUET ®
89
Journal of Special Operations Medicine, Volume 5, Edition 4 / Fall 05
90
Cravat/Windlass
91
Tourniquets
Tourniquets
¾ Damage to the arm or leg is rare if the
tourniquet is left on less than an hour.
¾ Tourniquets often left in place for several
hours during surgical procedures.
¾ In the face of massive extremity hemorrhage,
in any event, it is better to accept the small
risk of damage to the limb than to have a
casualty bleed to death.
92
The
The Five
Five Big
Big
Tourniquet
Tourniquet Mistakes
Mistakes
1. Not using one when you should
2. Using one when you shouldn’t
3. Putting it on too high above the wound
4. Not taking it off when you could
5. Not making it tight enough
93
Tourniquets
Tourniquets
How long does it take to bleed to death from
a complete femoral artery and vein
disruption?
Answer:
2-4 minutes
94