Severe, uncontrolled external bleeding is a life-threatening medical emergency. Recognizing severity is the first step, often indicated by blood visibly spurting, rapidly pooling on the ground, or if the victim becomes confused due to blood loss. When blood loss soaks through clothing or dressings, immediate action is required. First aid techniques are applied sequentially to control hemorrhage and stabilize the injured person until professional medical help arrives.
The Critical Initial Action
The first priority in treating a bleeding wound is to apply immediate, firm, and direct pressure to the injury site. This action compresses damaged blood vessels, encouraging the body’s natural clotting mechanisms to seal the rupture. Use a clean dressing, thick gauze, or cloth, pushing down directly onto the source of the bleeding. The pressure must be maintained continuously and forcefully, typically using the palm of the hand. Do not check the wound repeatedly; the goal is to stop the flow of blood and prevent further loss.
Sustaining Control: Pressure and Positioning
Once initial manual pressure is applied, the second priority is converting that force into a sustained, hands-free method. This involves securing a pressure dressing over the wound. If the injury is on a limb, the affected area should also be elevated above the level of the heart. Create the pressure dressing by wrapping a bandage firmly over the initial gauze or cloth while maintaining pressure. Ensure the bandage is snug enough to hold compression without completely cutting off circulation to the rest of the limb.
Elevation leverages gravity to reduce hydrostatic pressure in the injured limb, slowing the rate of blood loss. Raising the wound above the heart decreases the force of blood flow toward the injury site, aiding the pressure dressing in achieving hemostasis. This step must be skipped if there is suspicion of a broken bone or an impaled object, as movement risks further internal damage. If blood soaks through the original dressing, add additional layers on top. Pressure must be reapplied without removing the soaked material.
Escalating Care for Uncontrolled Bleeding
If direct pressure and a sustained pressure dressing with elevation fail to stop the hemorrhage, care must escalate to more advanced techniques. Failure is identified when blood quickly soaks through the dressing, indicating insufficient force to compress the damaged vessel. For life-threatening hemorrhage on an arm or leg, a tourniquet is the necessary intervention to completely restrict blood flow. Apply the tourniquet high and tight, typically two to three inches above the wound but never directly over a joint. Tighten it until the bleeding stops completely.
For severe bleeding where a tourniquet cannot be used, such as the neck, shoulder, or groin, wound packing is utilized. This involves stuffing the wound cavity with specialized hemostatic gauze, which contains agents that accelerate clotting, or with plain gauze if unavailable. After packing, continuous, firm pressure must be maintained directly over the packed material for several minutes. These aggressive methods are reserved for situations of massive, uncontrolled bleeding.
Addressing Systemic Impact: Recognizing and Treating Shock
Severe blood loss can lead to hypovolemic shock, where the circulatory system fails to deliver enough oxygenated blood to the body’s tissues. Recognizing the signs of this systemic reaction is the final stage of immediate care. Symptoms of impending shock include the injured person becoming pale, cool, and clammy as the body redirects blood flow toward vital organs. The pulse may become weak and rapid, and breathing may be shallow and quick.
While waiting for professional help, support the patient’s circulation and maintain body temperature. The injured person should be laid down on their back and covered with a blanket to conserve body heat, as a drop in temperature can worsen shock. If there are no suspected head, neck, back, or leg injuries, the patient’s legs can be gently elevated about 12 inches to encourage blood flow back to the core. Keeping the patient warm and calm is essential until definitive medical treatment can be provided.