An arterial bleed occurs when a damaged artery releases blood under high pressure, requiring immediate intervention. Arteries carry oxygenated blood directly from the heart, meaning a breach results in rapid, profound blood loss. This rapid hemorrhage can lead to hypovolemic shock and death in a matter of minutes if not controlled quickly. Recognizing the signs and knowing the correct first aid steps is a time-sensitive ability.
Identifying Severe Bleeding
The distinguishing characteristic of an arterial bleed is the appearance and flow of the blood. The blood will be bright red due to its high oxygen content, contrasting with the darker, maroon color of venous blood.
A clear indicator of an arterial injury is the flow pattern: a rhythmic spurting or gushing that pulses with the person’s heartbeat. This forceful, intermittent stream is caused by the heart’s pumping action pushing blood through the damaged vessel. The volume of blood loss is rapid and profuse.
Immediate Safety and Emergency Contact
Before treating the wound, ensure the safety of the environment for both the injured person and the rescuer. Scan the area for hazards like traffic or fire, moving the person only if absolutely necessary. If available, the rescuer should put on protective gloves or use a barrier to reduce the risk of contact with bloodborne pathogens.
Immediately call or instruct a bystander to call 911 or the local emergency number, clearly stating the nature of the injury and the location. Initiating the emergency medical system early is necessary because advanced care is required to repair the artery and stabilize the patient. Once the call is made, focus entirely on controlling the hemorrhage.
Applying Direct Pressure and Wound Packing
The initial step for controlling severe bleeding is applying firm, continuous direct pressure over the wound site. Use the cleanest material available, such as sterile gauze, a clean cloth, or clothing, to cover the injury. The rescuer must push down with significant force, using the palm of one or both hands, to compress the bleeding vessel against the underlying bone or tissue.
Maintain this pressure without interruption for several minutes, resisting the urge to check if the bleeding has stopped. If the initial material becomes soaked, do not remove it, as this can dislodge forming clots and restart the bleeding. Instead, place additional layers of material directly on top and continue to press firmly.
Wound Packing
For deep, narrow wounds, especially where a tourniquet cannot be applied (like the groin, shoulder, or neck), wound packing is the necessary technique. This involves firmly stuffing the entire wound cavity with gauze or clean material, starting from the deepest part, until the wound is completely filled. The packing material applies internal pressure directly to the source of the bleeding vessel.
After the wound is tightly packed, maintain firm external pressure with a hand or pressure bandage to hold the material in place. This combined pressure creates a mechanical barrier strong enough to resist the high pressure of the arterial flow until coagulation occurs. Continuous, unrelenting force is the factor most likely to stop the life-threatening blood loss.
When and How to Use a Tourniquet
A tourniquet should be used for life-threatening bleeding on a limb that cannot be controlled by direct pressure and wound packing, or in cases of traumatic amputation. This device constricts blood flow to the entire limb, acting as a last resort to prevent death from hemorrhage. If bleeding remains profuse despite appropriate direct pressure, the immediate application of a tourniquet is warranted.
The device must be placed high and tight on the injured limb, approximately two to three inches above the wound and never directly over a joint. Ideally, apply the tourniquet to bare skin, but if time is a factor, it can be placed over clothing that can be tightened effectively. Commercially manufactured tourniquets are preferred, but sturdy material can be improvised with a windlass rod to achieve necessary pressure.
Tighten the tourniquet by twisting the rod or pulling the strap until the hemorrhage completely stops, a process that can be very painful but is necessary to save the person’s life. Once bleeding is controlled, secure the rod to prevent unwinding. Note the exact time the tourniquet was applied and relay this information to emergency personnel upon arrival.
Care While Awaiting Medical Personnel
Once bleeding is controlled, the focus shifts to monitoring the injured person and providing supportive care until emergency services arrive. Check the wound dressing or tourniquet continuously to ensure bleeding does not resume, which may require additional tightening or reinforcing the pressure dressing. Keep the person still and calm to minimize movement and stress on the circulatory system.
Monitor the person closely for signs of hypovolemic shock, which is a common consequence of massive blood loss. These signs include pale, cool, and clammy skin, a rapid pulse, and fast, shallow breathing. To manage shock, lay the person flat on their back and cover them with a blanket or coat to prevent body heat loss. Maintaining warmth is important for organ function and recovery.