[This film has been acquired for distribution by the National Medical Audiovisual Center]

[This film contains scenes of injuries and bleeding. It should not be used for public exhibitions or television.

Use of this film is limited to students attending a school on emergency medical service. 

It should be shown only under the guidance of a medically trained person.]

[Music]

[Narrator:] Have you ever stopped to take a look at people's hands? 

They can do many things. 

Some knit.

Some help. 

Others point, and there are those that pound. 

Or they may repair watches.

But at this moment these are the hands of action I want you to meet.

[Sirens and music]

[Hands of Action]

[Produced for the American College of Surgeons, The North Carolina Chapter, Committee on Trauma, 

Jesse H. Meredith M.D., F.A.C.S. Chairman

By the R.J. Reynolds Tobacco Co., under a grant from Emergency Medical Services Branch, Division of Accident Prevention, 

Public Health Service, Department of Health, Education, & Welfare]

[Sirens and music]

[Narrator:] Exciting? Maybe so, but serious is the better word 

to describe the action that these two men train their hands for. 

There are people living who would say that these are the most important hands in the world,

and if you will permit me a little boasting, 

I help them every now and then to train to do their work.

[Music]

You can tell immediately when Ed and Clarence are in a first-class argument. 

Ed sits as far over as he can in the driver's seat and frowns. 

Clarence sits over next to the other door and frowns. 

Their argument this time: at the scene of an accident, 

what are the most serious kind of injuries and what can be done 

to keep people alive until they are in safe hands at the hospital?

[Music]

[Doctor:] Thank you, Suzanne.

[Music]

Okay, fellows, so you don't agree about the right treatment for seriously injured people. 

To tell you the truth I'm glad you don't. 

Your argument gives me a chance to give you some information 

that should clear up a lot of misunderstandings. 

To begin with, there is nothing new about injuries. 

Since the beginning of time, man has had to care for injuries to his body. 

The injury received by a caveman who loses the battle with a dinosaur 

and the injury received because of an accident, 

say with a forklift truck, are alike in all but one way. 

What is different is that today's people are able to get better treatment for their injuries.

You are concerned with getting the injured person from the place he was injured 

to the place where he can get this improved treatment in the best possible condition. 

The care and transportation of injured people 

must be done by you without causing further injury. 

I want you to think about four critically important points. 

Four things that you could see on your next emergency run. 

They are, one, blocked airway. 

[Blocked Airway]

Breathing passages which become blocked and make breathing difficult or impossible. 

[Blocked airway, Bleeding]

Two, bleeding. 

[Blocked airway, Bleeding, Open wounds]

Three, open wounds. 

[Blocked airway, Bleeding, Open wounds, Broken bones]

Four, last of all, broken bones. 

Now, laboratories have a way of giving us the whys and wherefores of almost any problem. 

So let's see what we can uncover about these four. 

Let's step right over into this next room. 

Right after you, gentlemen. 

Clarence, Ed, I think you'll be interested in this.

Well fellas, an airway is the passage leading from the nose and mouth to the lungs. 

Now when it becomes blocked, the flow of air to the lungs is slowed down or stopped. 

If this occurs, the injured person may die in just a few minutes. 

There are many things that can block airways. 

Sometimes the items are swallowed, such as a button, 

a piece of steak...you name it, 

it's been found in someone's lungs. 

More often than not the obstruction is water, vomit, or blood. 

Any of these objects or materials can cause a man to die from lack of air 

just the same as if he had been smothered with a blanket. 

This is how a person breathes. 

See how the air flows freely to the lungs and returns. 

Now, I'll use a golf tee, and believe me, golf tees have been found lodged in throats. 

This will be our object here, right in the throat. 

There now, close up, you see? The stage is set for suffocation. 

Now, when the object is removed, breathing can then become normal again. 

Now frequently the obstruction is bleeding and is located

so the blood flows into the airway. 

This can occur when a fractured face breaks a blood vessel,

or if the person vomits,

or when a rib breaks a blood vessel, or in many other ways. 

It's worse if he's placed on his back. 

See how the blood could run from a broken nose right into the lungs? 

Muscles of the throat are arranged so that any object in the throat 

causes them to tighten up and prevents the air from being inhaled into the lungs. 

Well, the solution to the problem of a blocked airway is simple--

remove the obstruction; don't let it happen again. 

Suzanne, would you bring in Blondie? 

All right now, to remove a small object the well-known method 

is pounding on the back, and turning upside down. Sorry.

These will usually work, but, well, it can be dangerous if there are other injuries,

and may even cause more damage to the person by these methods. 

Clarence, could you help me out? Sit up here, please. 

All right come on over and bring this arm down and over on your side. 

Get your shoulder up here...

Now, the best way to take the object out of the airway 

is to reach in with your fingers and pull it out. 

This is particularly true when the object is visible; not lodged deep in the throat. 

Have the injured man on his side and open his mouth like this. 

If you can see the obstruction then pull it out. 

If the material is blood, vomit, or something like that, 

then turn his head to the side and clear his mouth in this way. 

One of the most valuable services you can perform for an injured person 

is to prevent his airway from becoming blocked. 

If you see bleeding from the mouth, nose, eyes, ears,

or for some other reason you suspect that the injured person 

may have internal bleeding, then he should be transported like this on his side. 

Okay, Clarence, thank you. Now, fellows, let's think about bleeding.

[Music]

How much blood do you have in your body? 

Normally the body contains five quarts. 

If two to three quarts are lost, a person usually dies. 

To show you how much blood I'm talking about, watch this.

[Music]

A person can lose this much blood and live. 

If he loses more, he may die. 

By cutting a large artery, 

a person can lose that amount in just about ten minutes. 

Now, this is why it's important for you, 

Clarence and Ed and all of our attendants, to treat bleeding quickly. 

Now how does this blood move about in the body, circulate? 

All right, let's use this model and we'll demonstrate. 

Now the heart is the pump of our circulatory system. 

When the heart beats, it tightens up and blood squeezes from it 

and through the blood vessels of the body. 

As blood leaves the heart, it pulses through the artery. 

Now they are the pipelines that carry the blood from the heart 

to the rest of the body. 

In the arteries, the blood is bright red and moves in spurts and jumps. 

It then travels through the capillaries, 

which are very, very small blood vessels. 

The last step in the circulation process is the return 

of the blood to the heart through the veins. 

When the blood travels through the veins, 

it moves in a smooth-flowing stream and it has a dark red color. 

If we cut an artery, blood comes out in spurts. 

If a vein is cut, it flows out smoothly. 

Now fellas, remember that bleeding can occur 

inside the body as well as on the surface. 

It's important that you recognize bleeding and know how to stop it. 

First, in medical schools and in hospitals, bleeding is a common event. 

Let's use a film from our medical school to look at bleeding.

[Music]

This is actual bleeding from an artery and a vein. 

Notice the hole in the artery made by the scissors. 

It bleeds bright red blood in spurts. 

The bleeding can be stopped by direct pressure with a finger over the hole. 

The vein bleeds dark red blood in a steady stream. 

It, too, can be stopped by direct pressure.

Arteries spurt bright red; veins flow dark red. 

Both can be stopped by pressure on the bleeding area.

[Music]

Let me show you something else about bleeding and its control. 

Come on over here.

[Music]

All right, now this represents the wound, the puncture. 

The water flowing from this hose can be compared to bleeding.

You can put your hand over it to stop it. 

You can pinch the hose above the hole. 

That'll stop it. 

Or you can take some adhesive tape and try to get control. 

Here there we are. See, that'll stop it.

[Music]

These are the same methods you can use to control bleeding. 

Let me show you how these methods work. 

Suzanne, may I have the railroad picture? 

Now this accident occurred when the trainman missed his footing,

fell, and cut his arm on a broken jar. 

The ambulance was called by a radio telephone

and we will see how the attendants controlled severe bleeding. 

They first find out what the injury is and the man's general condition. 

When they are satisfied that there is no worse injury than the bleeding, 

they will try to stop it. 

There is the jar that did it. 

That's an artery bleeding. 

See how the blood gushes out? 

To stop the bleeding, he will apply direct pressure on the cut using a gauze pad and his hand. 

Notice here that these pads are too small. 

He needs a much larger one. 

The pale face shows that he has lost a lot of blood and he may be in shock. 

They are now wrapping an elastic bandage tightly over the gauze pad. 

This keeps the bleeding under control. 

Watch him give the bandage a twist occasionally. See? 

He does this to keep the edges tight. 

He also pulls on the elastic bandage to put pressure on the wound. 

The bandage should be very tight. 

They keep wrapping until the bleeding stops.

[Music]

With the bleeding stopped, the attendants carry the injured man to the ambulance and then to a hospital.

[Music]

I'll talk about the trouble with tourniquets in a minute, 

but first let's review some points. 

How did the men know it was an artery that was cut?

[Ed:] The blood was bright red and was coming out in spurts.

[Doctor:] That's right. Good. 

He remembered that when the blood left the heart 

and traveled through the arteries it was under pressure 

and moved along in jumps or spurts. 

Had it been a vein that was cut, 

then the blood would have been darker and would have flown smoothly. 

Another fact you remember is that the pressure was applied 

above the wound in the case of an artery,

since the blood was flowing from the heart to the wound,

and if it's in a vein,

then to stop the bleeding,

he would apply the pressure below the wound. 

Now, about tourniquets. 

Suzanne, would you help me? 

I want to demonstrate this. Roll up your sleeve.

A tourniquet should be applied only when other methods fail. 

Remember this, if nothing else works, then you apply the tourniquet 

to an arm or a leg. 

All right, that represents our tourniquet, and we have the wound here, you see...

And then we twist it until the blood flow ceases. 

There's an important rule to remember here. 

Very important. 

Do not release the tourniquet once it is applied. 

This is a job to be done at the hospital. 

Thank you, Suzanne.

Another possible injury is an internal hemorrhage; 

this is bleeding that is hidden or contained inside the body. 

With these injuries we may not see any blood, 

or even if we do it may be only a small amount.

A hemorrhage in the lungs often occurs 

when the body slams into something like a dashboard or a wall. 

May I have this picture?

If the injured person is placed on his back, 

blood will collect in his lungs,

and it is possible for him to drown in his own blood. 

The best position to place someone bleeding from the nose or mouth 

is lying on his side with his mouth lower than his lung. 

This may not appear to be a comfortable position but believe me it's the best one. 

Placing a person bleeding from the nose or mouth on his side 

may be the most important thing you will do to save his life. 

Now fellows, let's talk about a situation I'm sure you've faced more often than you like. 

It involves wounds that are severe and open. 

They require immediate attention. 

Ed, would you put up our next point, please, on the board? 

The danger with open wounds is that infection may follow. 

So clean dressings, clean hands, 

and avoiding touching open wounds are the things to remember. 

Does this look familiar? It ought to. 

Now, if you've ever put a patch on one of these like this, 

then of course you have some idea of how a bandage works. 

What we're doing when we use a bandage is applying a temporary patch on the body 

to prevent dirt from getting into the wound. 

Suzanne, would you give me that box? 

A sterile compress like this is the best thing to use for a bandage. 

There are other things you can use such as adhesive tape or elastic bandages. 

The bandages used may vary from one type of wound to another, 

but the principle remains the same, 

keep the wound clean and to follow this rule, the things you need to do are, 

first of all do not touch the wound with your hand. 

Secondly, cover the wound and the area around it with something that is clean. 

Third, keep the edges of the bandage tight against the skin so that dirt cannot get in. 

Now fellas, if you do not have a first-aid kit, 

a bandage can be anything that is clean that will do the job for you. 

For instance, well, a sheet, a cloth napkin, 

handkerchief, piece of clothing like this sweater. 

These things are not as ideal as the sterile compress. 

Now, let's examine situations in which applying bandages was necessary. 

Watch how the bandages are put on. 

Ed, would you put on the projector, please?

[Music]

The first thing the attendants do is examine all of the injured men

and decide the order of treating them. 

This man has a sucking wound. 

It happened when he fell on a drill and punctured his chest. 

That torch on the scaffold caused this burn. 

Don't touch burns. 

The danger of infection is too great and you can't do anything to help. 

In spite of all the blood, this cut is not too serious,

and can wait until the rest of the people have been examined 

and the worst of the injuries have been taken care of. 

A piece of sheet metal has cut through this man's belly. 

Those are his intestines sticking out. 

The attendant is raising his knees to relax the stomach muscle. 

This helps keep the pressure off the intestines and wound. 

Notice that someone remains with this man 

to help protect the wound until the attendants return. 

They must treat the sucking wound first. 

The air coming through the hole could cause two things. 

The lung will collapse, or dirt and trash could be sucked into the chest. 

This is why his injury is so urgent.

[Music]

First the hole is sealed with a piece of adhesive tape. 

Then a large sterile dressing is put over the patch and taped down tightly.

The tape over the dressing should also help seal out air. 

The edges of the tape overlap each other and are pressed down tightly. 

The gasping for air is not unusual because only one lung is working. 

You can also expect bleeding from the nose or mouth like you have here.

[Music]

The next most serious injury is the intestine that is sticking out. 

Infection of this wound could kill this man so don't touch it. 

Leave the intestine out. 

Keep your hands off of it and apply a sterile dressing. 

Don't do anything that will cause more of the intestine to come out. 

Like pushing on his chest or stomach. 

Paste the dressing tightly enough to hold the intestines still,

but not tightly enough to push it back into the wound. 

Carry this man on his back; not on his side or face down. 

With burns like this there is nothing you can do. 

Infection is the greatest problem here, 

so keeping your hands off the burn is best. 

Don't put any dressing on. Take him to the hospital as he is. 

This cut only needs a sterile dressing.

[Music]

If possible, use a large dressing on these cuts. 

It's better to have one too large than one too small. 

This is the size which you should keep in your ambulance. 

Elastic bandage holds the dressing in place. Put it on tightly. 

Since there was no spurting blood, it's not likely that any major artery was cut. 

This type of injury often looks more serious than it really is.

[Music]

Now let's review the steps these attendants followed in each case. 

They check carefully to see what kind of wound they had to work with. 

Then they selected the correct bandage. 

They were careful not to touch the bandage where it touched the wound. 

Then the bandage was applied so that it overlapped the injured area. 

They did not put any ointment or medicine on the wound. 

They left that for the doctors to do.

[Clarence:] Doc, what do we do when we find a person with something sticking in him?

[Doctor:] Good question, Clarence. 

The answer is, leave it alone. 

If, as in the cowboy movies, you find an arrow or any other object sticking in a person,

just take the person and the object to the doctor. 

Don't take it out or cram it in. 

A good rule to follow is this one. 

Don't touch a wound if you don't have to. 

The bandages you put on will only last to the hospital. 

The doctors will strip them off. 

Your job is to see that the injured person arrives in as good a condition as possible,

and not to tie up pretty bandages. 

Ed, would you put up our fourth and final point, broken bones? 

The broken bone or fracture is an injury that you will often see, 

but being common doesn't make it any less trouble to take care of. 

Broken bones can vary from an uncomfortable, inconvenient injury 

to a very serious injury requiring surgery. 

Bone injuries can and do cause death. 

You are sometimes in a position to save a life or a limb by doing the right thing. 

You can cause death if you're careless when handling broken bones. 

There are two main types of broken bones: 

closed fractures and open fractures. 

Now this represents the bone, and a closed fracture 

is one in which the sharp ends of the broken bone do not come through the skin. 

If the sharp ends of the broken bones do come through the skin,

then it's an open fracture. 

Now, closed fractures can vary, quite a difference. 

Closed fractures can vary from a small crack in the bone like this... 

all the way to a bone that is shattered. 

The usual symptoms of a broken bone are swelling, 

an unusual twist of the limb, 

tenderness and pain, 

and a good way to find out if the person has a fracture is to ask him where it hurts. 

Now, an open fracture is more obvious,

but it poses a different problem for you. 

The danger of infection is great because of the exposed sharp bone end. 

Even gangrene and loss of the limb could occur. 

There are two rules for the care of all fractures,

and some special rules for open fractures. 

Now rule number one, splint all suspected fractures,

and rule two, splint them where they lie; 

that is, where you find them. 

A splint can be any material that you want to use 

that will hold a broken bone in place,

and there are reasons you immediately splint suspected fractures. 

First of all, a small amount of body movement can cause the sharp ends 

of the broken bone 

to punch through the skin, 

thus changing a closed fracture to an open fracture. 

Secondly, splinted fractures are less painful,

and third, there is less damage to surrounding muscles and other tissues, 

so therefore, less shock to the patient when the fracture is splinted. 

A splinting is easy if you understand the idea. 

You put something rigid around the break to keep the bones from moving. 

Splinting materials are no trouble to find. 

For instance, well, we have packaged splints, 

limbs from trees, magazines, blankets, pillows 

are just some I can think of offhand. 

Let me show you this. 

Ed, bring over the blanket and the magazine.

This'll give you a good idea here.

Now, a blanket rolled from each end toward the center 

can be made into a splint like this. 

Of course it's wrapped. 

Magazines can be interfolded like this and then wrapped. 

Ed, would you get me that item leaning against the counter there? 

Over behind the skeleton there. That's a Thomas splint. 

This is a traction splint, fellows. 

Ed, I'm going to ask you to help me with the demonstration. 

Clarence, would you come around here? 

You should have two men for applying this splint. 

And it works by the pull that it puts on the limb. 

Ed, get up here on the table. 

Notice that it has this reversible metal ring. 

That means that you can use it on either leg. 

Also this buckle should be on the outside. 

Good. 

Now the metal ring is placed underneath snug against the pelvis,

and of course, then this is buckled down very tightly and securely. 

Clarence, pull, pull very hard on that. 

That keeps the leg in traction. 

Now what we're going to do is we're going to tie the leg

to the bottom of the splint by using an ankle hitch. 

[Tie the Thomas Splint with a soft piece of material instead of rope.]

Regular knot, put this around under and loop it and then this is tied, 

[After tieing the splint in place, wrap both let and splint with an elastic bandage.]

keep pulling on that now Clarence, that's tied to the end of the splint 

and that keeps the leg in traction. 

That's good. Very fine, thank you. 

Remember to leave the shoe on. 

Thank you, fellas. 

Applying the splint to the injury is not difficult at all. 

What you're doing is you're tying it down tightly enough so the bone will not move. 

I want you to look at some pictures that show the splinting of a fracture. 

Suzanne, would you turn on our projector again, please?

[Music]

This girl was injured on water skis. 

Her leg was fractured at the shin bone. 

The two most important rules about open fractures are, 

one, don't touch the wound or bone

and, two, don't pull or push the bone back in. 

Leave it out. 

You should apply a large sterile compress to the wound to keep out dirt. 

Notice how he raises the leg to allow the other person to put the bandage on. 

Be gentle. If you pull very hard, the ends of the bone will go back in. 

This will happen to you a lot of times. 

The wrapping around the compress should be tight enough to hold it in place and stop bleeding, 

but not tight enough to push the bone back in. 

You should not use a Thomas splint on an open fracture below the knee; 

however, it should be used on any fracture of the thigh,

but don't use too much traction if the bones stick through the skin. 

Here they used an oar for a splint. 

A stick or a tree limb would do as well. 

It's better to have a splint too long than one too short. 

You must keep the broken bone from moving. 

The splint is held firmly to the leg by elastic bandages,

or any other wrapping material that will do the job. 

The pain with broken bones can be very severe, 

but good splinting can help and may prevent shock. 

You should remember this. The bandage is to keep out infection and stop bleeding. 

The splint is to keep the bone from moving. 

If you even think the bone is broken, splint it.

[Music]

This girl is ready to be moved. 

Well, fellows. You've seen the way to splint a fracture. 

I don't want to leave the subject of fractures without emphasizing that your most important act 

is to keep the broken bone from sticking through the skin. 

If you let this happen, you can't do enough things right to make up for the damage you've caused. 

Suzanne, let me have this, please. 

The open fracture is splinted identically to the closed fracture,

but the special rule is to cover the exposed bone end with a clean dressing 

to prevent the further introduction of dirt and trash into the wound. 

Do not, and I repeat this, 

do not push bone ends back into the wound,

as this carries dirt deep into the wound. 

Now, if the neck or the back is the suspected area of a fracture or broken bone, 

then you will have to use great care. 

This represents the backbone, called the spinal column, and it has the spinal cord running through it. 

Any damage to this cord can cause permanent paralysis or death. 

Now, if the bone or two is broken,

and there's a possibility that any movement can cause the spinal cord to be damaged or injured,

you must not let this happen. 

Clarence, would you get up here, please, and lie back straight? 

I want to show you the manner in which to handle a suspected fracture of the neck. 

Keep the head straight. 

Do not allow it to twist. 

The way to do this is to always have one person pull on the head and the chin 

while the others move the body. 

Place the fingers behind the head with the thumbs on the chin. 

Pull hard and keep the chin up. 

Do not move the head to the side or tilt it forward. 

Thank you, Clarence.

Well, fellows, we talked about four very important points. 

Right now I want to talk about something else that's just as important. 

Oh, uh, I goofed again. Fellows, I have to go. 

Gee honey, I'm sorry, believe me. One second more. 

Fellows, I helped you. Would you mind helping me? 

With all these demonstrations we've had here in the lab,

it's not in very good condition for tomorrow. 

So, would you mind giving Suzanne a hand? 

I'll see you tomorrow. Thank you.

[Music]

[Blocked Airway, Bleeding, Open Wounds, Broken Bones]

[Doctor....John Batchelder, Ed......Ed Fox, Clarence......Clarence Stevens, Nurse.....Suzanne Linder]

[Film Coordinator...Neal Forney, Script.....Perry Powell, Make up.....James Parham, Film Editor.....Jere Snyder]

[Medical Consultants, John Brabson, M.D., F.A.C.S., Milton C. Cobey, M.D., F.A.C.S., Joseph H. Gerber, M.D., Walter S. Hunt, M.D., F.A.C.S.]

[Medical Consultants, George Johnson, Jr., M.D., F.A.C.S., Jesse H. Meredith, M.D., F.A.C.S., John W. Morris, M.D., F.A.C.S., Christian F. Siewers, M.D., F.A.C.S.]

[Cameras, Ben Harrison, Bill Hurt]

[Directed by Erwin W. Cook]

[Filmed at Alderman Studios, Color by Byron Laboratories]