Severe external bleeding is characterized by blood spurting rapidly or flowing continuously and heavily from the wound, suggesting damage to a major blood vessel. The rapid loss of blood volume can quickly lead to hypovolemic shock, a life-threatening condition where the body cannot circulate enough oxygen to the organs. Understanding the proper order of steps is paramount, as immediate actions can stabilize the injured person until professional medical help arrives. The initial focus must always be on stopping the blood loss, setting the stage for the second priorities.
The Immediate First Priority
The absolute first priority in any severe bleeding scenario is to physically stop the blood flow. This is achieved by applying firm, steady, direct pressure onto the wound site. The pressure helps compress the damaged blood vessels, allowing the body’s natural clotting mechanisms to take hold and form a stable plug.
Use the cleanest available material, such as a sterile dressing or a clean cloth, and place it directly over the wound. Apply significant force, often using the heel of the hand or even body weight, to push down firmly. Maintain this pressure continuously for at least five minutes without peeking to check the wound, as doing so can dislodge any forming clot and restart the bleeding. If blood soaks through the initial material, do not remove it; simply layer more material on top and continue pressing with the same force.
If the injury is located on an arm or a leg, elevating the wounded limb above the level of the heart can assist in slowing the blood flow. This uses gravity to reduce the hydrostatic pressure at the injury site, complementing the direct pressure being applied. The injured person should ideally be lying down to prevent a fall if they become dizzy or faint from blood loss.
Maintaining Control and Addressing Systemic Shock
Once the initial, manual pressure has stopped the active flow, the second priority involves two simultaneous actions: securing the dressing and treating for systemic shock. Securing the pressure dressing frees the rescuer’s hands while maintaining the necessary compression to prevent re-bleeding. The initial material should be secured firmly in place using a roller bandage or long strips of clean cloth wrapped around the limb.
The bandage must be tight enough to maintain pressure over the wound but not so tight that it cuts off circulation to the limb beyond the injury. A simple check involves pressing on a nail bed or the skin past the bandage; if the color does not return within two seconds after releasing the pressure, the bandage is too constrictive and must be loosened and reapplied. If the bleeding cannot be controlled with direct pressure alone, the temporary use of pressure points can be considered as an intermediate measure.
Pressure points are locations where a major artery lies close to the bone, such as the brachial artery on the inside of the upper arm or the femoral artery in the groin. Applying pressure with fingers or the heel of the hand to compress the artery against the bone can slow the blood flow to the injury site. This technique acts as a temporary measure to slow the bleed while preparing a more effective pressure dressing or a tourniquet if trained.
Addressing hypovolemic shock, which results from significant blood loss, is the other immediate component of the second priority. Symptoms of this condition include a pale, cool, and clammy skin, a rapid and weak pulse, and an accelerated but shallow breathing pattern. The injured person may also display confusion, anxiety, or dizziness as their brain receives less oxygenated blood.
To manage shock, the person should be kept lying flat, and if no head, neck, or spine injuries are suspected, the legs can be elevated by about twelve inches to help circulate blood toward the core organs. Maintaining the person’s body temperature is important, so covering them with a blanket or coat helps prevent heat loss, which can worsen shock. Reassuring the injured person and keeping them calm helps manage anxiety, which can contribute to a faster heart rate.
Criteria for Advanced Medical Intervention
Once the bleeding is controlled and the initial shock care is underway, recognizing when professional help is needed becomes the next step. Severe injuries require immediate emergency services, regardless of how successful initial first aid has been. Conditions such as blood spurting from the wound, indicating arterial damage, or bleeding that does not stop after ten minutes of firm, continuous direct pressure necessitate a 911 call.
Other criteria for immediately contacting emergency services include a deep cut that appears to gape open and likely requires sutures, or wounds located on the chest, abdomen, or head. Injuries involving an embedded foreign object, such as a knife or piece of glass, also require professional intervention, as removing the object can cause catastrophic bleeding. Any signs of shock that worsen, such as increasing confusion or loss of consciousness, are a clear signal for immediate advanced care.
When contacting the dispatcher, remain calm and clearly state the exact location of the emergency and the nature of the injury. Provide details on the severity of the bleeding, the first aid steps already taken, and any signs of shock observed. Staying on the line and following the dispatcher’s instructions ensures that arriving personnel are prepared and that the injured person receives the best possible care during the wait time.