The femoral artery is the major blood vessel supplying oxygenated blood to the lower limb, traveling near the surface in the upper thigh and groin region. Due to its size and high blood pressure, an injury can result in life-threatening blood loss within minutes. Immediate, decisive action is necessary to control the hemorrhage before professional medical help arrives. The objective is to stop the blood loss and stabilize the victim until emergency medical services (EMS) take over.
Recognizing a Femoral Artery Injury
Identifying an injury to the femoral artery requires recognizing the specific characteristics of arterial bleeding, which is distinct from slower, venous flow. The blood loss is pulsatile, meaning it spurts or pumps out in rhythm with the victim’s heartbeat due to the high pressure directly from the heart. The blood itself will be bright red because it is highly oxygenated.
The sheer volume and speed of the blood loss is an obvious sign, rapidly soaking clothing and creating a large pool on the ground. The location of the wound is also telling, specifically in the groin, upper thigh, or hip crease. Upon seeing these signs, immediately call emergency services or instruct a bystander to call the local equivalent of 911. Rapid identification allows for the quickest possible intervention.
Immediate Manual Pressure Application
Applying immediate, direct manual pressure is the first and most important step in controlling a femoral artery bleed. This technique aims to compress the artery against the underlying bone structure, specifically the femoral head and pelvis, to stop the flow of blood. The amount of force required is considerable, far exceeding what is needed for a minor wound.
To be effective, the rescuer must apply all available body weight directly over the injury site. Position yourself so you can lean into the wound, using the heel of your hand, a clenched fist, or even a knee if the wound is in the groin crease. This pressure must be sustained and unrelenting, as reducing the force for even a moment can allow the artery to pump out a significant amount of blood.
If a clean dressing, gauze, or clothing is available, the wound cavity should be packed tightly before applying direct pressure. This wound packing helps to fill the space and create internal pressure against the bleeding vessel, which is effective in deep, junctional wounds in the groin. Maintain the maximum possible manual compression until medical professionals arrive. The pressure must not be released to check the wound, as this risks re-bleeding and losing the clot that has begun to form.
Proper Application of a Tourniquet
A tourniquet is a secondary control measure used when direct pressure is unsuccessful, impractical, or when the rescuer needs to attend to multiple severe injuries. For massive bleeding in the upper thigh or groin area, a standard limb tourniquet may not be appropriate, but specialized junctional tourniquets are designed for this region. If using a standard commercial tourniquet, it must be placed as high on the limb as possible (“high and tight”) to maximize the chance of compressing the main vessel.
The tourniquet must be tightened until the bright red, pulsatile bleeding completely stops, and the pulse below the device is no longer detectable. Once fully tightened, the time of application must be clearly marked on the device or on the victim’s forehead using a permanent marker. This time stamp is important information for the medical team, as it helps them manage potential complications related to prolonged tissue ischemia.
Using improvised tourniquets, such as belts or thin ropes, is strongly discouraged because they rarely generate enough circumferential pressure to occlude the deep femoral artery and often cause more tissue damage without stopping the hemorrhage. Commercial tourniquets are engineered with a windlass system to ensure the necessary, uniform pressure is achieved. If no commercial device is available, the priority remains sustained manual pressure or wound packing, as improvised solutions are less reliable.
Monitoring the Victim and Aiding EMS Transition
While maintaining hemorrhage control, the victim must be continuously monitored for signs of shock, which results from insufficient blood flow to the body’s organs. Early signs include a rapid, weak pulse, confusion or restlessness, and pale, cool, or clammy skin. Keeping the victim warm by covering them with a blanket or jacket helps to combat shock, as a drop in body temperature can negatively affect the blood’s ability to clot.
The rescuer should maintain constant communication with the victim to monitor their level of consciousness. As EMS arrives, a smooth and organized transition of care is necessary for the victim’s survival. Immediately relay specific, concise information to the arriving team, including the mechanism of injury and an estimate of the total blood loss.
Providing the exact time the tourniquet was applied or the time manual pressure began is a mandatory piece of information for the medical team’s treatment protocol. The rescuer should also inform them of any materials used for wound packing and the victim’s current level of responsiveness. This preparation allows the EMS team to activate the appropriate massive hemorrhage protocol without delay.