Pre-Hospital Hemorrhage Control: The Critical Role Of Paramedics In Managing Severe Bleeding Emergencies

Abstract

Severe bleeding, or hemorrhage, is one of the leading preventable causes of death in trauma patients worldwide. Rapid and effective control of hemorrhage in the pre-hospital environment is crucial to reducing mortality and improving outcomes. Paramedics, as frontline providers in emergency medical services (EMS), play a pivotal role in the recognition, management, and stabilization of patients suffering from life-threatening bleeding. Their responsibilities range from initial assessment, airway and circulation stabilization, to the application of advanced hemorrhage control measures such as tourniquets, hemostatic dressings, pelvic binders, and intravenous fluid resuscitation guided by permissive hypotension principles. This review explores the evolving role of paramedics in pre-hospital hemorrhage control, drawing on evidence from recent literature, trauma guidelines, and case studies. It examines the effectiveness of paramedic interventions, the challenges faced in the field, and the critical need for specialized training and protocols. Furthermore, the review highlights future directions, including integration of point-of-care technologies and telemedicine support. Ultimately, strengthening paramedics’ capacity to manage severe bleeding has the potential to significantly reduce trauma-related deaths and contribute to global initiatives aimed at improving trauma care systems.