This has some advantages over the existing technique (packing w/ hemostatic z-fold gauze), but some big disadvantages.
It's a pretty bulky device, and space is at a premium on an ambulance. It also has a battery that needs to be maintained. I'm not sure a bulky device that needs routine maintenance (everything with a battery gets checked at least once a day in every ambulance service I've ever worked with) is worth carrying for very rare events. A couple packs of z-fold gauze take up as much room as a few decks of playing cards and would only need to get checked monthly (to see if they had expired).
Even in a place where stabbings are "common", this device is only useful in a specific subset of stabbings where wound packing can be used. If wound is in the torso/abdomen, this device isn't useful (there's nothing to press against), and if it's in a limb, a tourniquet is the right tool for the job.
It's a pretty bulky device, and space is at a premium on an ambulance.
The intended use case is for the police to carry this, not ambulances:
He said it was key for the first people to a stabbing, which is often the police, to stop excessive blood loss while they wait for paramedics to arrive.
So maybe the debate people are having about this detail is a moot point?
The typical police cruiser has a much more severe space premium, particularly for first aid supplies. An ambulance is a whole box full of first aid supplies.
It’s about the size of a hand drill and can probably be miniaturized further, heck you might not even need to inflate with an electric pump, you can probably have a small electronically controlled valve and a CO2 canister similar to those used for quickly inflating bike tires.
The only real issue I see with this is it’s actual applicability most stab victims get stabbed multiple times, often in the same area plugging one hole might not do you good when there are 5 more around it, heck the balloon might exacerbate the bleeding from adjacent injuries.
I've been around a lot of police officers in my life and I can count on one hand the number that have even attempted life savings measures when arriving first to a scene that required them
There's a great study that shows how the "homeboys" driving their buddies to the hospital after gunshot / stabbing trauma have better outcomes than the paramedics because (1) the police mostly delay paramedics' arrival, (2) homeboys are already on the scene, (3) homeboys are faster at getting to the hospital. This is why police are not allowed inside hospitals to interview patients - their loitering outside ERs is barely tolerated by staff in major metros. They harm health outcomes (surprise, surprise).
Is this lack of training? Where were the police earlier, before the gangsters shot each other? There is already evidence they delay care and harm outcomes, and they do not change what they do, so why would they carry life saving devices? They don't, because like with drug addiction, public health isn't commensurable with modern law enforcement.
On the flip side, nobody is really satisfied with the idea that it takes a trauma surgeon to save you. You're right that it takes skills, but not skills that a paramedic, a nurse or many other people have.
>On the flip side, nobody is really satisfied with the idea that it takes a trauma surgeon to save you. You're right that it takes skills, but not skills that a paramedic, a nurse or many other people have.
Although it takes a surgeon to save someone from a serious wound, I am very skeptical of the suggestion (perhaps unintentionally implied?) that an EMT or first responder can't do anything to improve outcomes except transport the patient fast. There is a whole list of things they train combat medics to do and none of them involve an operating theater.
It's possibly outside the scope of their training and just not what they are there for.
This device may be technically cool but simply not practical in application for a long list of reasons. Logistics, what works in practice given humans being human, etc may make this a nice idea in theory but not practice.
Stab wounds are particularly ugly. I used to pay accident claims and our payouts were not designed to adequately address stab wounds. Pay was based on length of the cut requiring sutures and stab wounds are often small in size, may go unsutured while they try to prevent gangrene from taking hold and have various other challenges to both treatment and trying to figure out how to classify them for purposes of trying to pay for the treatment.
I'm sympathetic to the inventors horror at stab wounds but a lot of medical stuff is just not as simple and straight forward as we would like it to be.
I'm not trying discourage the use of this. I have no power to make policy or decisions of that sort. HN is just an online discussion forum and I know something about medical topics and for the conversation to be at all meaningful, you at least need to be talking about what is actually being proposed. I was just trying to nudge the discussion in that direction.
Is there not existing pressure onboard an ambulance from oxygen supply? Or perhaps a compressor air line from the suspension system? I do like the falling back to a hand pump solution, similar to the bags used for providing artificial respiration [1].
At my last ambulance ride I noticed there were separate lines for oxygen and also for regular compressed air, which I suppose is pretty much infinite (the ambulance can gather more air as it is used)
I've never seen compressed air on an ambulance in the US (not to say it isn't a thing, I just haven't seen it). Ambulances are generally plumbed for oxygen and a vacuum system for suction.
His project is part of a cohort of cap stone design projects [0]. Browsing through them gives some real insight into current societal zeitgeist: A very large portion of them are related to health/medical issues, with a sizeable subset of those dealing with declining functionality due to aging.
Growing up, nearly all the women in my extended family on both sides were in education. Now, it’s predominantly health care.
My standard joke when I meet someone studying to be a doctor or nurse is that in another 20-30 years, everyone will either work at or be in a hospital. Or both.
This represents the current research interest in the UK nicely. There is currently a wide gap between lifespan and 'healthspan'- the duration in which someone is independent and healthy. This leads to high care costs, and combined with an ageing population is a recipe for economic disaster. If we can e.g. prevent decline in muscle strength (sarcopenia) we can potentially help people to live independently for longer (this is my own research focus)
This is a actually a pretty good idea. Later on the maybe can impregnate the balloon with helpful molecules… I’m struggling to think right now what would be most appropriate. Pro-thrombotic molecules might work but might also have negatives (eg clot adhesion).
One comment said charging is a big downside; I don’t really agree. It could just as easily be corded or hand-powered. We use hand powered balloons all the time (eg in angioplasty), admittedly not as large but also likely at far higher pressures than would be required for simple hemostasis.
The (potentially very big) problem is that wounds are not always circular or even ovoid like a balloon might be. With gauze you can pack down into whatever shape you are presented with and fill the space, causing hemostasis. With a ballon, you probably cannot. That difference could actually be very important. Think of it as the space-filling resolution of the technique. It also doesn’t take that long to pack a wound, so I don’t think that is a huge advantage with this device.
Thanks. Always good to have an insider's perspective on things. It's what's great about HN. Sure most of us can spend 10 minutes getting up to speed on the very basics of even complex topics, but the community also attracts lots of people with actual deep knowledge in areas outside of what you'd expect from a community ostensibly geared towards startup tech & culture.
It would be useful to know what the significance of this is - the inventor himself calls it a game changer, but the only expert quoted acknowledges there are plenty of interesting ideas out there that need to go through trials.
The lack of context for why this particular idea is a headline story (beyond "knife crime") is frustrating.
That's the point... knife crime is their new gun violence. Every problem solved will be replaced by some new problem - the politicians need their talking points.
How is this misleading at best? Do you have a source that suggests it's misleading? It would seem that your comment was the misleading one given that it didn't respond to the claim about violent crime in my comment and instead changed the subject to murder, right?
I can't find the original source I saw this in, but #2 in this link from a quick search gives a decent explanation about it. The original source I saw this in put it at about 2x and it was based on reconciling the definitions, not just a "guess" as this one does.
> Stabbing deaths and injuries are more common in Europe than they are in the Americas. Particularly in northern Europe, where levels of knife crimes among young people have increased and made headlines.
It also has virtually no numbers other than percentages of deaths compared to other means, which isn't terribly helpful since overall homicide rates aren't compared, and that knife stabbings often do not actually result in death.
Whether talking about gun crime or knife crime, socioeconomic factors are the main driver. Stuff like not having job opportunities, being raised in an environment where violence is ok, etc.
This is correct, and ultimately a preferable outcome to guns.
There are two causal factors for gun violence -- access to guns, and desire to cause destruction.
With knives, your arms quite literally will tire out. Still not a GOOD outcome, but is the best to be expected when only one causal factor is blocked.
Blocking the other is probably beyond the scope of policy generally, but decreasing it may be possibly impacted by social policies encouraging people's proclivity towards violence.
> [Knife use] ultimately a preferable outcome to guns.
Not if you are one of the hundred million people who have guns for defense it’s not. There is no better equalizer for the physically small or weak or elderly or disabled than a firearm.
>There are two causal factors for gun violence -- access to guns, and desire to cause destruction
Yes, where tool is available, people use it as intended and not. Firearms are used almost exclusively for legal defense, as frustrating as that may be to people who think the tool is the problem, and just banning the idol will abate the evil spirits.
> With knives, your arms quite literally will tire out.
This is not written by someone with edged weapons training. An actual fact of knife use from someone does is if you use a knife, you can EXPECT to be cut yourself.
> encouraging people's proclivity towards violence.
That’s interesting. If we look at the statistics of gun violence, would you be helpful and make more generalizations on who these people who have a “proclivity towards violence” are?
True, without practice, neither tool is likely to lead to the desired outcome.
A gun is useless to some, especially those who are afraid to pick it up. A knife is useless to me - unless the attacker is a truckload of Amazon boxes.
You are welcome to believe (and be statistically incorrect) about whatever you like and decide as appropriate for you. If you don’t feel you can operate a fire extinguisher or motor vehicle either, everyone will respect your choice in tools.
The rest of society asks that you not make personal defense decisions for us.
> We find that the claim of many millions of annual self-defense gun uses by American citizens is invalid.
> Criminal court judges who read the self-reported accounts of the purported self-defense gun use rated a majority as being illegal
> Most purported self-defense gun uses are gun uses in escalating arguments, and are both socially undesirable and illegal
> We found that firearms are used far more often to frighten and intimidate than they are used in self-defense.
> We found that guns in the home are used more often to frighten intimates than to thwart crime
> most of the reported self-defense gun uses were hostile interactions between armed adolescents
> We found that one in four of these detainees had been wounded, in events that appear unrelated to their incarceration. Most were shot when they were victims of robberies, assaults and crossfires. Virtually none report being wounded by a “law-abiding citizen.”
> little evidence that self-defense gun use is uniquely beneficial in reducing the likelihood of injury or property loss
Overall, it seems that:
* Many publicized statistics about self-defense usage are inaccurate (millions of self-defensive usages appears to be completely impossible, for example).
* Even legal guns are used more often illegally than for self-defense, generally for intimidation or during escalating arguments.
* When used for legal self-defense, guns do not appear to be any more effective than other defensive alternatives for protecting either you or your property.
These are high-profile peer-reviewed studies from a variety of research organizations, backed by varied selection of sources, and they come to consistent conclusions. I'd be interested to see any similar analysis that points towards any other conclusion.
Those studies are pretty old (97-04). Here's a more recent one done in 2013 by the CDC (link to report in article, but costs money). It seems to refute some of the claims in those articles. Also, it would seem that Harvard has some bias (as everyone does) given they choose to hold on to these older studies and they are all one sided. Some of them seem pretty poorly formed from a basic conceptual standpoint (ie that a defensive gun use requires that one shoots the assailant which is inconsistent with the definition that they are trying to verify, or that using a sample size of 300 claim that women never use a gun to defend against sexual assualt even though there are news reports showing it does occur).
The study of the two phone surveys that were reviewed by judges piqued my interest. I was intrigued to see what these judges were reviewing (I thought maybe cases or police reports). Then it got interesting from a design point of view.
Not only is that old information as another user posted, but it’s all literally funded by Joyce Foundation and later Michael Bloomberg directly.
The Harvard School Of Public Health is without any exaggeration a paid-for propaganda wing. No one actually takes them seriously.
You clearly don’t know gun control history, but see how many references are by Hemenway, David? He is probably the #1 junk science producer in the field.
You know how the CDC was banned from studying gun control? (They weren’t actually, they or banned from recommending policy, which meant that suddenly no one wanted them to study gun control anymore) Well, it was Bill Clinton in 90 to the direct to the CDC to fund a bunch of junk science in order to drum up support for his assault weapons ban and 93/94.
Millions of dollars went to Hemenway, Who produced garbage studies, small sample size, never released the data, everything he published has been fully discredited.
This guy’s “work” was the reason the Dickey amendment passed. Absolute garbage from the 90s.
Still alive and kicking today. they posted up on their site, it says Harvard, here you are happy to post it. Same plan they had in 1992.
EDIT: To add on to the other user’s correct comments about the junk science. Hemenway is “famous” for his bad methodology, like the phone surveys, and looking at incidents where a gun was used in the home but not who the gun owner was, meaning every drug shooting was counted, hardly representative of most people’s lives.
EDIT2: I asked for evidence of these fantastic claims, and you posted classic trade-A nonsense that everyone who knows anything on the topic has seen for 20 some years. Probably the first search result you found. Do you really consider yourself to know anything on this topic? Why is it you think you do?
As in my previous post: I'd be interested to see any similar research that points towards any other conclusion.
Seriously, I don't have a dog in this fight, I'm interested in the reality. In your previous comment, you asked for evidence - I've provided a selection of studies supporting the previous poster's position. If you disagree, please produce peer-reviewed studies refuting these points.
Currently you're listing unsupported ad-hominems against both the various researchers involved and Harvard (and honestly, I think saying that nobody takes Harvard seriously is a bit of a stretch). Regardless of the individuals: the linked studies were all reviewed in depth and accepted by a wide assortment of respected academic journals from across the field of public health.
If you think there are specific flaws in the methodology then please, be specific, but rejecting evidence you disagree with as 'junk science' out of hand is not helpful.
The 'small sample size' and 'unreleased data' you reference is specifically tenuous, since much of the referenced research is based entirely on public data & official statistics, such as the National Crime Victimization Survey (https://bjs.ojp.gov/data-collection/ncvs) produced and released annually by the US Justice Department.
On age: the sibling reply here was wrong and the most recent study listed in that Harvard analysis is actually 2015, but still, age has little bearing here unless you think there's been a very significant change in gun usage in recent years that would invalidate the past conclusions. If so, do please explain why that is.
In the meantime, take a look at https://jamanetwork.com/journals/jamainternalmedicine/articl... as one more example: a 2020 research paper published by a peer-reviewed medical journal, which doesn't involve David Hemenway or Harvard, but supports similar claims backed by public fatality statistics from 2011-2018, and specifically showing that gun self-defense statistics today continue to match patterns from past research in the 80s.
I understand that you don't agree with this research. If you want to convince anybody else, find some concrete reviewed research or hard statistics that directly support your claims (specifically, research that shows "Firearms are used almost exclusively for legal defense", as you claimed above).
I think there's a serious misunderstanding about definitions. This study is looking at fatalities. Justifiable homicide is not the only thing included in the estimates of defensive gun use. In fact, the claim is that most defensive gun use does not involve shots being fired.
I see that you are just posting more studies that support your own view. Do you have anything that refutes the CDC's findings posted earlier?
I also stated two different concerns with studies from your Harvard links. Would you care to address those, or continue ignoring valid conversation?
You ask why old data should be called into question. It is well known that violent crime rates have been falling for decades. This could drastically affect the number of people being threatened and the number of people using a gun defensively. Also, a number of prior restrictions on the carrying of firearms have been reduced in many states. If you have more people with the ability/access to use a firearm, that could also affect both sides of the equation. Yes, I do see one study in that list from 2015. I wonder why that one conflicts with the CDC's finding.
I believe there have been peer reviewed and published studies by Kleck and Lott that you can look up if you are truly interested. I'm sure these can be questioned along the same lines as the other comments concerning the author of those other studies and Bloomberg money. American Homicide is supposed to be a good read too.
The main issue with just regurgitating studies like this is that studies can be misinterpreted and misapplied. The way the study is designed can make it a valid study, but at the same time it can limit the scope. Then we end up comparing defensive gun use to justifiable homicide, which are not the same thing.
Anyone got more info on this? It seems there's a balloon that is inflated into the wound. It also talked about the benefit of not pulling out the clot when the balloon is removed. Is it because the material won't stick to blood clots?
Yeah, the current technique (which, IMO, is still the way to go) uses gauze, which the clot will form around. It's difficult/impossible to remove that gauze without removing at least some of the clot and causing some bleeding. At that point though, they're already in the OR, and that bleeding is generally fairly easily managed w/ the right equipment.
According to the writeup, that is less effective for some wound locations. I'm no expert to be able evaluate that claim though.
Otherwise the main advantage here seems time-to-deploy, as it may be faster than wound packing, and it may be more user-friendly for police first on the scene before paramedics show up.
That said, this is far from a finished product. It's only a partial prototype, and it looks like there will need to be a lot of testing on a different wound shapes & depths & locations to calibrate the appropriate pressure in each case.
I haven't seen any data on how effective this is, or if it would be more effective than wound packing. I'd be very surprised if it worked any better for abdominal wounds (it has the same problem... there is nothing to compress against, and the abdomen can just keep expanding and organs can shift out of the way).
I would also be suspicious of any "net" time-to-deploy improvements. Z-Fold gauze is small and light enough that it lives in the trauma bag, and I will definitely have it with me upon arrival to a stabbing patient. Given the relative rarity of stab wound where this would be useful (even simply as a percentage of all stab wounds), I think it's likely it wouldn't be grabbed by default, which means a trip back to the rig to get it.
Obviously, take my opinion with a grain of salt... All the info I have about this is from this single article, and EMS is notoriously suspicious of change and "new shiny".
Is gauze packing like this something that a typically trained police officer could do? If not, that might be the main benefit of the device. Otherwise, yeah, I guess an EMS that deals with these issues regularly may have the process down well enough that speed isn't the issue.
Also curious, because I know nothing about trauma wounds like this. I know I'm wrong, but I don't know why: Could you use tissue glue to seal the edges? It seems like that's what would happen in surgery for a permanent "fix" anyway, so doing it temporarily in the field, with the edges adhering to themselves, would reduce the need for compression.
Yeah, cops (at least around here) generally know how to pack a wound. It's not terribly hard (you're just repeatedly shoving your finger in the hole, stuffing a bit more gauze in there each time).
The external wound isn't the issue, and that's really the only thing that you could practically "glue" in the field. The issue is the artery inside that's spurting blood (and even if none of that blood actually escapes the body, there's more than enough room to lose enough blood inside the body to kill someone.
The surgical intervention will involve opening up the area of the wound a bit further so that you can actually find the hole in the artery and have room to work. Once the specific location of the bleed has been found, generally a clamp will be applied "upstream" of the bleed, which will then be stitched closed (ideally reattaching it to the other end if it was severed completely). Glue isn't going to hold up against arterial pressure.
In my first aid course in Australia the teacher told us we are not allowed to be taught wound packing and that if anyone asks we didn't learn it - before telling us about it. He'd been in the military where it might see some use and apparently wound packing is also recommended in the US, but over here I guess it's needed rarely enough that teaching everyone might cause more harm than good.
It might also be because it was a part of a "first aid" course and not a more professional course or certification. In my lifeguard certification here in the states, for example, they explicitly don't train on tourniquets because we had an on-site EMT that would do the more dramatic procedures like that before an ambulance arrived.
Tourniquets are definitely a last-resort measure and an untrained provider using one can certainly cause more harm than good, so it was omitted from training at our level. The same might apply to wound packing- knowing _when_ to use it is harder to teach than _how_ so many people don't understand when it is appropriate, which could be dangerous.
> Tourniquets are definitely a last-resort measure and an untrained provider using one can certainly cause more harm than good
This is a bit of a stigma that is starting to get cleared up. Tourniquets should be a "first resort" for significant bleeding in a limb that can't be easily controlled with direct pressure. Protocols used to involve all sorts of additional things to try (elevate the limb, use pressure points, apply more dressings/pressure, etc). Now it's "Squeeze the wound with gauze and a gloved hand. Did it stop? No? Apply a tourniquet."
Assuming someone gets to a hospital within a reasonable period of time (where "reasonable" is "within a couple hours"), there is very little risk in applying a tourniquet.
Interesting. This was a few years ago so my memory of the actual class is rather fuzzy, especially considering I have taken more first-aid/CPR classes than I can count. I've learned how to do a tourniquet probably as many times as I've been told that I shouldn't do tourniquets, it really seems to depend on the organization and instructor.
I think RedCross taught tourniquets as a last-resort but Ellis didn't even touch them because Ellis facilities are generally waterparks with on-site EMTs.
It was accredited, the type of course you get told to do if you have certain responsibilities like volunteer teaching a class where it might be necessary, or the sort of thing you need a few people per floor to have at work for OHS.
I assume people who make a career about it get more into the advanced topics. Being in Australia, we covered snakes, spiders, and jellyfish more than some countries would, while gunshot trauma wasn't really mentioned in a large amount of detail.
Wound packing is part of the "Stop the Bleed" training that is increasingly common in the US. It's not a hard skill, and just like tourniquet usage, it is one of the few skills that can actually save someone's life.
Such an UK invention / media article. Reminds me of 4Chans weekly review of bin fires reported by the UK media.
Random fact acid attacks are mostly against men. Although it's somewhat equal around the world the UK where it's one of the highest rates tips it to men. (Like all stats the different NGO's argue this differently)
It's a pretty bulky device, and space is at a premium on an ambulance. It also has a battery that needs to be maintained. I'm not sure a bulky device that needs routine maintenance (everything with a battery gets checked at least once a day in every ambulance service I've ever worked with) is worth carrying for very rare events. A couple packs of z-fold gauze take up as much room as a few decks of playing cards and would only need to get checked monthly (to see if they had expired).
Even in a place where stabbings are "common", this device is only useful in a specific subset of stabbings where wound packing can be used. If wound is in the torso/abdomen, this device isn't useful (there's nothing to press against), and if it's in a limb, a tourniquet is the right tool for the job.