Control Bleeding Injuries
While bleeding injuries can be scary or intimidating, they are surprisingly easy to treat with a calm approach and a little First Aid knowledge.
If you have never had First Aid training, your reactions will likely be spontaneous based on any TV medical drama you might have watched, like ER. If there is one thing TV is good for, it is obscuring the details and the truth to make a scene look more visually enthralling for the viewer.
Let’s discover how to control bleeding injuries correctly, calmly, and confidently!
Management Of Bleeding Injuries
The first rule in controlling a bleeding injury is to assess what type of injury it is and then what will be the best way to apply firm pressure to the area. Not all injuries can have direct pressure applied, and some injuries need to be stabilised before you apply the pressure by packing the wound or using a ring bandage around a protruding object.
So, where do we start on a normal injury received by a sharp object or grazing that lacerates the skin, causing a bleeding injury that is fairly surface level? Say a child falling off their bike and sliding along the road or cutting a finger using scissors or a knife.
Remove any restrictive clothing from the area. Assess the wound site for size. Cover the bleeding injury with a clean towel or sterile gauze. Apply firm pressure directly onto the injury site and maintain that firm pressure until the bleeding stops. If the person is conscious, they can do this step.
Once the bleeding has been controlled, assess the wound for follow-up medical treatment required by a medic, like sutures, salt sealing, or wound debriding any loose stones, dirt and infection-causing agents.
SteriliseSterilise and clean the area, apply a surface antibacterial agent and then, using sterile products, bandage the area, or apply suitable band-aids as the injury area and size dictate.
For life-threatening bleeding injuries, such as a multiple stabbing or severing of an artery, or traumatic limb amputation, control of the bleeding takes priority over CPR. There is no point giving chest compressions if every time you pump the heart, the blood shoots out of the severed artery. In extreme cases like these, a tourniquet is required to compress the artery to the point the bleeding is stopped using anything on hand to affect that artery closure.
To apply a tourniquet where it is possible, place the restrictive device the width of your palm above the severed artery and apply the tourniquet there until the bleeding stops. Do not keep applying pressure once the blood flow has stopped.
Then call emergency services on 000 for help if you are a solo First Aid responder and someone else has not already called emergency services to attend the scene, and begin CPR if required.
If CPR is not required, continue to treat any other wounds in order of severity. Watch and treat for shock in the person. Keep them calm and warm and reassure them. Even if you suspect they might die, encourage them to hold on to the emergency services and try to keep them distracted and talking.
The brain cannot hold a conversation and think of dying simultaneously. It is one or the other so where they will talk about their loved ones or anything they want as a dying wish, let them talk. Ask questions as you work if they need help to keep the conversation going until help arrives.
In traumatic accidents involving multiple life-threatening injuries and internal bleeding, the First Aid responder has no control or ability to offer anything but First Aid to the external injuries and reassurance.
If, for any reason, the bleeding of a wound not considered life-threatening cannot be controlled with direct pressure, and three pads have been applied and soaked, the use of an arterial tourniquet for life-threatening limb bleeding that is not controlled by direct wound pressure can be applied as in step 2.
DNR: A Rare But Legally Binding Order
Please note: While it is extremely rare, if you ever see the letters DNR tattooed anywhere on a body, particularly on the chest or arms around the inner elbow area, this is a legally binding instruction by the patient to be followed if they are unconscious.
DNR is the medical abbreviation for DO NOT RESUSCITATE! In some cases, the three words might be spelt out to ensure there is no mistaking their intent. That means the person has chosen not to have any form of life-saving procedure undertaken on them in the event of an accident.
While you may not personally agree with their choice, it is their legal right to refuse medical assistance even if it saves their lives. Some religions and people with known terminal conditions will actively choose to have the letters applied to their body to refuse life-saving treatment. All you can do is respect their rights the same way you would want them to respect yours if the situation was reversed.
External Bleeding Injuries Control
The use of pressure on or around the wound is usually the fastest, easiest, and most effective way to stop external bleeding. The aim is to prevent further bleeding whilst waiting for help to arrive. There is no evidence that elevating a bleeding part will help control bleeding, and there is the potential to cause more pain or injury.
Bleeding should be managed as severe, life-threatening bleeding in the following situations:
• amputated or partially amputated limb above wrist or ankle
• shark attack, propeller cuts or similar major trauma to any part of the body
• bleeding not controlled by local pressure
• bleeding with signs of shock, i.e., pale and sweaty plus pulse rate >100, or capillary refill > 2 sec and/or decreased level of consciousness.
Management Of Bleeding Injuries
• Use standard precautions (e.g., gloves, protective glasses) if readily available.
• Management of all bleeding begins with the application of pressure on or around the wound.
• If bleeding is severe or life-threatening, controlling the bleeding takes priority over airway and breathing interventions. Lie the person down, apply pressure and call for an ambulance.
• If there is severe, life-threatening bleeding from a limb, not controlled by pressure, we suggest applying an arterial tourniquet above the bleeding point, if trained in its use and one is available.
• If there is severe, life-threatening bleeding from a wound site unsuitable for tourniquet, or from a limb when a tourniquet is unavailable or has failed to stop the bleeding, we suggest applying a haemostatic dressing, if trained in its use and one is available.
• For most non-life-threatening cases, First Aiders should follow the sequence of DRSABCD, where control of bleeding follows establishing an airway and commencing CPR if required.
• If the person is unresponsive and not breathing normally, follow the Basic Life Support Flowchart.
Control Bleeding Injuries Direct Pressure Method
Where the bleeding point is identified, the rescuer, a bystander or the injured person should control bleeding by:
• Applying firm, direct pressure sufficient to stop the bleeding injuries. Pressure can be applied using hands or a pad over the bleeding point.
• If bleeding continues, apply a second pad and a tighter bandage over the wound. If bleeding still continues, check that the pad and bandage are correctly applied directly over the bleeding.
If not, it may be necessary to remove the pad(s) to ensure that a specific bleeding point has not been missed. Applying firmer pressure, only using 1 to 2 pads over a small area, will achieve greater pressure over the bleeding injuries point than continuing to layer up further pads.
To Assist In Controlling Bleeding
• Advise the person to lie down and remain still
• Restrict movement by immobilising a bleeding limb
Bleeding Injuries Embedded Objects
If there is an obvious embedded object causing bleeding, use pressure around the object.
• Do not remove the embedded object because it may be plugging the wound and restricting bleeding.
• Apply padding around or on each side of the protruding object, with pressure over the padding. Pressure application methods may be insufficient to control bleeding. Other measures may still be necessary, including an arterial tourniquet or haemostatic dressings.
Bleeding Injuries Arterial Tourniquet
• Arterial tourniquets should only be used for life-threatening bleeding from a limb, where the bleeding cannot be controlled by direct pressure. Ideally, a tourniquet should not be applied over a joint or wound and must not be covered up by any bandage or clothing.
• Commercially manufactured windlass tourniquets such as those based on military designs are more effective than improvised tourniquets. Effective use of commercial tourniquets is optimal when First Aid providers are trained in proper application techniques.
• All arterial tourniquets should be applied in accordance with the manufacturer’s instructions (or 5 cm above the bleeding point if no instructions) and tightened until the bleeding stops.
• If a tourniquet does not stop the bleeding, its position and application must be checked. Ideally, the tourniquet is not applied over clothing or wetsuits and is applied tightly, even if this causes local discomfort.
• If bleeding continues, a second tourniquet (if available) should be applied to the limb, preferably above the first.
• If a correctly applied tourniquet(s) has failed to control the bleeding, consider using a haemostatic dressing in conjunction with the tourniquet.
• An elastic venous tourniquet (designed to assist in drawing blood samples or inserting intravenous cannulas) is unsuitable for an arterial tourniquet.
• Improvised tourniquets are unlikely to stop all circulation to the injured limb without risk of tissue damage. Improvised tourniquets which do not stop all circulation can increase bleeding. Nonetheless, in the context of life-threatening bleeding, an improvised tourniquet is likely to be better than no tourniquet.
Tourniquets, ideally of a similar broad width to commercial types, can be improvised using materials from a First Aid kit (e.g., triangular bandage, elastic bandage) from clothing, a surfboard leg rope, or other available similar items. Improvised tourniquets should be tightened by twisting a rod or stick under the improvised tourniquet band, similar to the windlass in commercial tourniquets.
• The time of tourniquet application must be noted and communicated to emergency/paramedic personnel. Once applied, the person requires urgent transfer to a hospital, and the tourniquet should not be removed until the person receives specialist care.
Bleeding Injuries Haemostatic Dressings
• Haemostatic dressings are impregnated with agents that help stop bleeding. The haemostatic dressings included in the CoSTR 2015 recommendations contained kaolin and chitosan products. They are commonly used to control bleeding in surgical and military settings, but their use in the civilian, non-surgical environment is becoming more common.
• When available and the First Aid provider is trained in their use, we suggest that haemostatic dressings are of most value in the following situations.
- Severe, life-threatening bleeding not controlled by wound pressure from a site not suitable for tourniquet use.
- Severe, life-threatening bleeding from a limb, not controlled by wound pressure, when the use of a tourniquet(s) alone has not stopped the bleeding, or a tourniquet is not available.
• Haemostatic dressings must be applied as close as possible to the bleeding point, held against the wound using local pressure (manually initially), and then held in place with the application of a bandage (if available). Haemostatic dressings should be left on the bleeding point until definitive care is available.
The need to control the bleeding is paramount. The risks associated with the First Aid use of tourniquets and haemostatic dressings are less than the risk of uncontrolled severe, life-threatening bleeding. These adjuncts provide temporary bleeding control, and rapid transfer to the hospital remains critically important.
Take A Basic First Aid Course With First Aid Course Experts
Taking a FACE First Aid course sounds like something expensive and time-consuming, which was true in the past. However, times have changed, and the means of delivering the course content have also changed. A basic FACE First Aid course will set you back around $100 and take 6 hours to complete on average.
Test your current First Aid skills and knowledge by taking our FACE Quiz and then read up on a wide range of First Aid topics to further improve your First Aid knowledge in advance of your course on our FACE Blog page.