The ABCs of Bleeding Control provide a sequential framework for bystanders to deliver immediate, life-saving intervention for severe bleeding. Uncontrolled blood loss is the leading cause of preventable death following traumatic injury, sometimes resulting in death within five minutes. This standardized approach allows anyone, regardless of medical training, to recognize and stabilize life-threatening blood loss until professional emergency services arrive.
A: Alerting Emergency Services
A for Alert requires immediately contacting the local emergency number, such as 9-1-1. Calling for help is the initial priority to ensure advanced medical care is en route, as bystander actions are temporary measures to buy time. Provide a clear location and a brief description of the situation and injury to the dispatcher. Scene safety is a concurrent component. A rescuer must quickly assess the environment for hazards like traffic or fire, securing the immediate area before proceeding.
B: Locating the Bleeding Source
B for Bleeding focuses on a rapid assessment to find the exact source of blood loss. This often requires removing or cutting away clothing from around the wound. Life-threatening bleeding is characterized by blood that is actively spurting, pooling on the ground, or soaking through clothing quickly and continuously. This phase also incorporates Body Substance Isolation (BSI), which protects the rescuer from potential bloodborne pathogens. Using gloves or placing a barrier between your hands and the blood is advised if possible, though control is prioritized over finding sterile equipment.
C: Applying Pressure and Control
C for Compression or Control is the most hands-on phase and focuses on physically stopping the hemorrhage. The primary goal is to compress the damaged blood vessel to stop the flow, and this can be achieved using three main methods depending on the wound’s location and severity. These techniques are applied sequentially until the bleeding is controlled or until professional help takes over.
Direct Pressure
The simplest and most immediate method is applying firm, continuous direct pressure directly onto the wound. This is accomplished by covering the injury with a clean cloth, such as a trauma dressing or piece of clothing, and pushing down with as much force as possible. The pressure must be maintained without checking the wound repeatedly, as this interrupts the body’s natural clotting process. If the initial cloth becomes saturated, a new layer should be added on top rather than removing the first dressing, which could pull away newly formed clots.
Wound Packing
For deep or large wounds, especially in junctional areas like the groin or armpit where a tourniquet cannot be placed, direct pressure alone may be insufficient. Wound packing involves tightly stuffing the wound cavity with gauze or a clean cloth to apply pressure directly to the bleeding vessel deep inside the tissue. The material is pushed deeply until the cavity is full, and then firm pressure is maintained on the packed material for a minimum of three minutes to encourage clotting. This technique creates a mechanical barrier and concentrated compression at the source of the hemorrhage.
Tourniquets
For severe, life-threatening bleeding on an arm or a leg that cannot be stopped by direct pressure or wound packing, a tourniquet is the appropriate next step. The device should be applied two to three inches above the wound, placed directly on the skin if possible, or over clothing. The tourniquet must be tightened using the windlass mechanism until the bleeding completely stops, which often requires significant force and can be painful for the injured person. The tourniquet should never be placed directly over a joint, and once applied, it must not be loosened or removed by the bystander, as this can cause the bleeding to resume catastrophically. It is important to note the time the tourniquet was applied so this information can be conveyed to emergency medical personnel.