External hemorrhage, or severe bleeding visible outside the body, is a life-threatening emergency requiring immediate intervention. Rapid control of blood loss is the most time-sensitive action in trauma care, as a person can lose a fatal amount of blood in minutes. Before intervening, immediately call emergency services, such as 911 or your local equivalent. Controlling the bleeding takes priority over all other first aid steps once the scene is safe.
Immediate Response: Direct Pressure and Elevation
The first step for controlling external bleeding is applying direct pressure to the wound site. This technique compresses damaged blood vessels, allowing the body’s natural clotting process to form a clot. Use a clean material, such as a trauma dressing, sterile gauze, or clean cloth, and place it directly over the injury.
Apply continuous, firm pressure with both hands, pushing down hard enough to slow or stop the flow of blood. Sustain the pressure without interruption for three to five minutes to allow a clot to form.
If the initial dressing becomes soaked, do not remove it, as this can dislodge the clot and restart bleeding. Instead, layer a new pad directly on top of the saturated material and maintain firm pressure.
Elevation of an injured limb above the heart can supplement direct pressure by using gravity to reduce hydrostatic pressure. However, elevation alone has limited effectiveness and should not delay the primary intervention.
Last Resort for Limb Injuries: Tourniquet Use
When severe, life-threatening hemorrhage on an extremity cannot be controlled by direct pressure, a tourniquet is required. This device stops all blood flow to the injured limb to prevent death. Apply a tourniquet rapidly if the bleeding is massive or spurting.
A commercially manufactured tourniquet is preferred over an improvised one for achieving full arterial occlusion. Place the device high and tight on the limb, approximately 2 to 3 inches above the wound site, but never directly over a joint. While bare skin is ideal, apply it over clothing if removal would cause delay.
Twist the windlass rod until the bleeding stops completely, indicating proper application. The tourniquet will cause pain, but continue tightening until the hemorrhage is controlled, prioritizing the person’s life. Once applied, note the time of application on the device or the person’s forehead for medical personnel.
Managing Deep Wounds: Packing and Sustained Pressure
For deep, penetrating wounds in junctional areas where a tourniquet cannot be applied—such as the neck, armpit, or groin—wound packing controls hemorrhage. This method involves filling the wound cavity to apply direct internal pressure to the bleeding source.
Stuff the entire wound cavity with material, ideally hemostatic gauze, which promotes clotting, but regular gauze or clean cloth can be used. Push the material firmly into the wound, starting at the deepest point and directly on the bleeding vessel. Continue filling the space until the wound is packed tight.
After packing, apply sustained, firm manual pressure directly over the material for at least three to five continuous minutes. This pressure allows the gauze to compress the bleeding tissue effectively. If bleeding continues after this period, insert more packing material and reapply pressure.
Next Steps: Monitoring and Professional Care
Once bleeding is controlled by direct pressure, a tourniquet, or wound packing, maintain the person’s stability while waiting for emergency medical services. Continuously monitor the person’s consciousness, breathing, and the wound for any return of bleeding. If a tourniquet was applied, ensure it remains secure and the application time is visible for the medical team.
Preventing hypothermia is crucial, as cold temperatures complicate the body’s ability to clot blood. Cover the injured person with blankets or clothing to maintain body temperature. Do not give the person anything to eat or drink, and keep them calm and still until professional responders arrive for transport to a trauma center.