The immediate management of severe blood loss following a traumatic injury is time-sensitive, where quick, organized action can mean the difference between life and death. The “ABCs of Bleeding Control” provide a simple, systematic framework for bystanders to follow when faced with life-threatening hemorrhage. This protocol was developed through initiatives like the Stop the Bleed campaign, translating complex trauma care principles into accessible steps for the public. Recognizing that uncontrolled bleeding is the most common cause of preventable death in trauma situations, this approach prioritizes rapid intervention.
Recognizing a Severe Bleeding Emergency
Before initiating the protocol, it is necessary to recognize when a bleeding emergency is life-threatening. Injuries that cause rapid blood loss demand immediate attention, often presenting with clear visual indicators. Look for blood that is spurting rhythmically (suggesting an arterial injury) or pooling rapidly on the ground. Another sign is clothing or dressings that become quickly soaked through, indicating a high volume of blood flow.
Scene safety must always be the first consideration, ensuring the environment is secure for both the rescuer and the injured person. Rescuers should use personal protective equipment, such as nitrile or latex gloves, to minimize the risk of exposure to bloodborne pathogens. Only after confirming the scene is safe should the rescuer approach the individual to assess the wound.
Step A: Alerting Responders
The first action is to Alert professional medical personnel to the situation. Immediately call the local emergency number (such as 911) or instruct a specific bystander to make the call. Provide clear and accurate location details to the dispatcher, including the street address and any distinguishing landmarks.
The caller should remain on the line and follow any instructions provided by the dispatcher. If bystanders are present, delegating the call allows the primary rescuer to immediately move forward with stabilizing the victim without delay.
Step B: Finding the Bleeding Source
Once emergency services have been alerted, the next action is to Find the precise source of the severe bleeding. The wound must be fully exposed to ensure effective control measures, which may require cutting or tearing away the victim’s garments.
Pressure applied over clothing is significantly less effective than direct application on the skin. Quickly check the entire body for additional injury sites, as severe trauma frequently involves multiple sources of hemorrhage. A rapid, systematic check helps ensure that the rescuer does not miss a secondary, life-threatening bleeding site.
Step C: Applying Pressure and Control
The final and most active step involves Controlling the bleeding through direct intervention methods.
Direct Pressure
The most straightforward technique is applying direct manual pressure, using two hands if possible, directly onto the wound site. Use a clean cloth, sterile gauze, or any readily available material to cover the injury, then press down firmly and continuously. This sustained pressure physically blocks the flow of blood from the damaged vessel, helping the body’s natural clotting mechanisms begin to work.
Wound Packing
For deep, life-threatening wounds located in junctional areas (like the armpit, groin, or neck), direct pressure alone may be insufficient. In these cases, use the technique of wound packing, which involves stuffing the wound cavity tightly with gauze or clean fabric. The material should be pushed directly into the deepest part of the wound until the cavity is completely filled. After packing, firm pressure must still be applied directly over the material until medical professionals can take over.
Tourniquet Application
If the severe bleed is on an arm or a leg and cannot be stopped by direct pressure or wound packing, a tourniquet is the most effective intervention for extremity hemorrhage. A manufactured tourniquet should be applied high on the injured limb, regardless of the wound location, and placed directly onto the skin above the clothing. The device must be tightened by twisting the windlass until the flow of blood has completely stopped, as it is a common mistake not to tighten the device enough. Once applied, note the time the tourniquet was placed and do not remove it, as this intervention should only be reversed by professional medical personnel.