Sean Z. Barnette, NRP, AAS

May 2, 2022

The Components of Lethal Triad

Trauma care is no doubt the most intriguing subject to law enforcement officers when it comes to medically related topics.  In this Medical Monday we are going to discuss the topic of the lethal triad.  We will talk about what the lethal triad is, what components make up the lethal triad, and what you the officer can do to prevent a trauma patient from slipping into the lethal triad which can cause a much higher mortality rate.  

The lethal triad is a combination of three components that if not treated correctly and immediately will raise the chances of a severe trauma patient’s chances to dying significantly.  Those three components are:

Coagulopathy: Very simply put, it is a condition where the blood is not clotting optimally.  The clotting ability is impaired.  Clearly, this is a major issue for patients that are severely bleeding internally or externally.  Think of your blood as a pitcher of Kool-Aid.  When you were growing up, the more sugar that was in the Kool-Aid the better.  Most likely, if you were the one making the Kool-Aid, your mother made you dilute it down with more water which made the Kool-Aid taste not nearly as good.  The same theory applies in the trauma patient that is massively bleeding.  If that blood is replaced with Saline Solution by an untrained medic, the blood and the clotting factors in the blood are becoming diluted which presents a serious problem when it comes to stopping the massive bleeding.  The reason that there is such a significant push to train law enforcement officers on stopping the bleeding is due to this portion of the lethal triad.  The speed at which we can stop the bleeding can have a very large impact on the patient’s survival.  The skills of tourniquet application, wound packing, and application of pressure dressings are essential officer survival skills as well as essential first aid skills that we may be called upon to provide to the general public.  

Acidosis:  You most likely have experienced sore muscles after a strenuous workout.  A partial reason for the soreness is that the lactic acid buildup in the muscle group has not had a chance to fully dissipate.  When the body experiences a massive trauma, the vessels throughout the body constrict (narrow) to attempt to keep the blood pressure within the body up as well as attempting to keep the body from going into a hypothermic state.  Because the vessels are narrowed, oxygen molecules have a more difficult time reaching the tissues throughout the body which results in an incredible amount of lactic acid beginning to accumulate.  Through a complex set of systems in the body, the normal pH balance in a person is between 7.35 and 7.45.  Once the patient’s pH drops below 7.35 the patient is considered acidic.  To further complicate the issue, Saline Solution that is administered by an untrained medic will increase the severity of the acidosis because the pH of Saline Solution is 5.5, well below the body’s normal pH of 7.35.  If I have completely lost you by now, just think of it this way.  Think of the soreness that you felt in your muscles after the most vigorous workout that you have ever done and multiply that by 1,000.  Obviously, that would be bad.  The treatment that you can do as a law enforcement officer is to again control the bleeding effectively AND KEEP THE PATIENT WARM!!  

Hypothermia:  It is very easy to believe that hypothermia is a condition that only occurs in colder temperature conditions.  Interestingly, hypothermia occurs in just over half of ALL severe trauma patients regardless of climate conditions.  As mentioned previously in the article, the body is made up of several complex systems that work together to keep the body in a state of homeostasis (everything working together in harmony).  When the body sustains major trauma, and especially when the body enters into the phases of going into shock, the body loses the ability to sustain temperature regulation.  A multitude of medical studies have proven that as the body’s temperature drops, the body’s ability to form clots drastically reduces as well.  If a person is experiencing massive bleeding, this is clearly a major issue.  The body’s coagulation system in part relies on a series of complex actions performed by enzymes to form clots.  Those enzymes only work optimally in temperatures that do not involve a hypothermic state.  To make this simple, the body has to stay warm to form clots.  To make this very easy, make every effort to cover any massive trauma patient and keep them warm.  When doing your assessment on a trauma patient as an example, once you examine the chest and back, cover them before moving to another body part.  It is a very good idea to carry a blanket in your patrol vehicle.  In addition to keeping trauma patients warm, it can serve as a vast array of other uses as well.  

In conclusion, stop massive bleeding, and cover the trauma patient up keeping them warm.  Do not forget to ensure that there is also a layer between the patient and the ground, especially in colder environments.  I hope that you took something away from this Medical Monday.  If you have any questions or anything to add, make a comment below.  Happy Memorial Day!!

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