When a major artery is severed, the resulting blood loss is a life-threatening emergency that demands immediate action. Arterial bleeding is characterized by bright red blood that spurts or pulsates with each heartbeat, reflecting high pressure. This rapid, forceful blood loss can lead to death within minutes, often faster than the arrival of emergency medical services. Understanding the correct sequence of first aid steps to stop this catastrophic hemorrhage is the fastest way to bridge the gap between injury and professional medical care.
Immediate Safety and Emergency Activation
The first priority in any emergency situation involving severe bleeding is to ensure the safety of the rescuer and the injured person. Before approaching the victim, quickly assess the environment for ongoing threats, such as traffic, unstable structures, or hazardous materials. You must not become a secondary casualty.
Once the scene is safe, immediately activate the emergency response system by calling 911 or the local equivalent number. If you are not alone, delegate this task to a specific bystander, instructing them to clearly state the exact location and the nature of the injury. If possible, put on disposable gloves to protect against bloodborne pathogens.
If available, instruct another person to retrieve a dedicated bleeding control kit. These kits typically contain tourniquets, hemostatic gauze, and compression bandages. If no kit is present, gather the cleanest, most absorbent material available, such as a thick cloth, towel, or sterile gauze, to prepare for controlling the hemorrhage.
Applying Direct Pressure and Wound Packing
The most effective initial treatment for any severe bleed is the immediate and continuous application of direct pressure. Place a sterile dressing or a clean, thick cloth directly over the source of the bleeding and press down with firm, steady force using the palm of your hand or your full body weight if necessary. The goal is to compress the injured artery against the underlying bone to halt the blood flow.
Maintain this pressure without interruption for at least five minutes before checking the wound, as prematurely lifting the dressing can disrupt the body’s natural clotting process. If the initial material becomes completely soaked with blood, do not remove it. Instead, place additional layers of dressing material directly on top of the saturated pad and continue to press firmly.
If the bleeding remains uncontrolled by direct pressure alone, the wound may require packing, especially if it is a deep, penetrating injury in a location that a tourniquet cannot reach, such as the torso or groin. Wound packing involves forcefully stuffing gauze or clean cloth directly into the wound cavity until it is completely filled. Push the material down to the deepest point of the injury to directly contact the bleeding vessel. The packing must be done tightly and quickly until the gauze is flush with the skin surface. Once the wound is packed, maintain strong direct pressure over the top of the packed material until emergency responders arrive.
Using a Commercial or Improvised Tourniquet
The application of a tourniquet is the next intervention when direct pressure and wound packing fail to control life-threatening hemorrhage on a limb. Tourniquets are also the preferred first step if the injury involves a traumatic amputation or if the scene is unsafe, making prolonged direct pressure impractical. A commercial tourniquet, such as a windlass-style device, is preferred due to its proven ability to generate the necessary occlusive force.
The device should be placed directly on the skin, if possible, two to three inches above the wound and never directly over a joint. Tighten the strap as much as possible, then twist the windlass rod until the arterial bleeding stops and the pulse below the tourniquet is no longer detectable. Once tightened, secure the windlass to prevent it from unwinding. Clearly mark the time of application on the tourniquet itself or the person’s forehead, as this information is important for hospital staff.
If a commercial tourniquet is unavailable, an improvised device may be constructed using a wide, non-elastic material, such as a necktie or scarf, and a sturdy stick or rod as a windlass. The improvised material must be at least two inches wide to minimize tissue damage. Wrap it around the limb and tie a simple knot. Insert the stick over the knot and twist it to tighten the band until the bleeding stops, then secure the stick so it cannot loosen. Improvised tourniquets are less reliable than commercial designs, but they can still be a life-saving measure.
Managing the Victim Until Help Arrives
After the bleeding is controlled, the focus shifts to monitoring the injured person for signs of shock. Hemorrhagic shock is a severe condition resulting from inadequate blood flow to the body’s tissues due to significant blood loss. Symptoms of developing shock include pale, cool, and clammy skin, a rapid but weak pulse, and fast, shallow breathing.
Help the person lie down flat. If there are no signs of head, neck, or spinal injury, slightly elevate their legs to promote blood return to the core organs. Cover the victim with a blanket, coat, or whatever is available to maintain their body temperature and prevent hypothermia, which can worsen shock. Continuously reassess the wound to ensure the bleeding does not restart and provide calm reassurance until emergency medical personnel take over care.