We have two questions in reference to control bleeding.

  1.  Does the bleeding have to be described as serious bleeding for the need of control bleeding instructions?

  2.  If the patient is bleeding due to trauma, is it still appropriate to give the control bleeding instruction (for example, traffic accident with head injury)?

Chancy Huntzinger

Training/QA Coordinator

Newton County Central Dispatch

Neosho, Mo., USA


Yes and Yes.

External bleeding should be uncontrolled (actively flowing or spurting) for the need to “control” bleeding. This is important as it only serves to distract the caller from observing potentially more serious issues when not needed.

Bleeding control can and should be accomplished without significant movement of the trauma patient; serious bleeding is a greater risk than the relatively minor risk of exacerbating a neck injury that likely does not even exist. Encouraging the patient not to move and asking the caller not to move the patient are sufficient.

Brett A. Patterson

IAED Academics & Standards Associate

Research Council Chair


I have listened to a few EMD calls in which bleeding control instructions have been necessary and, at the same time, caused a debate among our staff when we discuss the issue. I hope you can resolve the problem.

The first instruction on that panel is “Do not use a tourniquet.” There are neither parentheses around the instruction nor an associated PDI. Does that mean it’s not an optional instruction and one that must be read whenever bleeding control instructions are provided? When reading the instruction for a patient whose uncontrolled bleeding is somewhere on the head, however, it feels very awkward. During a recent phone call, the caller reacted in anger when hearing the instruction, saying something to the effect: “I told you his cut is on his eyebrow, I can’t use a tourniquet there!” When that happens, time is wasted calming down the caller and regaining control of the call.

The Q reviewing this call suggested starting the instruction with a situational or conditional statement, such as: “I know you said the cut is on his eyebrow, but if any other injuries are found, do not use a tourniquet.” Would it be more appropriate to skip the instruction or is the instruction required whenever bleeding control instructions are accessed?

Heidi Gillespie

ED-Q Coordinator

Weld County Regional Communications


Greeley, Colo., USA


You are correct in that the instruction is mandatory, but PDIs are to be given when appropriate, possible, and necessary.

As an EMD-Q, I would be OK with either of the options you have described, preferably the one with the situational comment. This is best because it shows concern for the caller/patient and ensures that the instruction was provided. Incidentally, I used to work as a phlebotomist in the hospital nursery and we routinely put a rubber band (tourniquet) around the infant’s scalp to draw blood from scalp veins. Callers do weird things, so it’s best to cover the bases. Again, I would not fault an EMD for not giving the instruction for a non-extremity wound.

Brett A. Patterson

IAED Academics & Standards Associate

Research Council Chair


Are complaints of “seeing things” or “hallucinations,” considered decreased level of consciousness? If we use Protocol 25: Psychiatric/Abnormal Behavior/Suicide Attempt, it becomes an ALPHA-level response, which is nonemergent, according to our medical director. If we use Protocol 26: Sick Person (Specific Diagnosis), it would be considered altered level of consciousness and becomes a CHARLIE-level response, which is an emergent response, according to our medical director. I want to make sure that my EMDs are handling these situations in the same way in order to provide a consistent response to our patients.

Anthony L. Allen

American Medical Response

Communications Supervisor

Independence, Mo., USA


Hallucinations are generally considered a psychiatric complaint, but drugs or even illness may also cause them. It is important to listen carefully to the complaint and cover the safety and clinical (priority symptom) basics. I would not fault an EMD for using either P25 or P26, but I would lean toward 25 just for patient monitoring purposes. I know it may not seem a great fit for a non-violent, non-suicidal patient, but that’s the point—the Protocol rules these things out.

I completely agree with you, hallucinations are not what we consider a decreased level of consciousness, which, in our world, really means poor perfusion of the brain.

Brett A. Patterson

IAED Academics & Standards Associate

Research Council Chair

Brett A. Patterson is an Academics & Standards Associate and Medical Council of Standards Chair for the IAED.

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