Life-threatening bleeding, or hemorrhage, involves rapid blood loss that can lead to death within minutes. This type of bleeding is characterized by profuse, continuous flow or spurting blood, often pooling quickly on the ground. When a major artery or vein in the leg is compromised, the high pressure and volume of blood circulating mean that the body’s natural clotting mechanisms cannot keep pace with the loss. Recognizing this severity instantly is the first step, as intervention must occur before the patient loses a volume of blood that makes resuscitation impossible.
Scene Safety and Activating Emergency Services
Before approaching the injured person, the rescuer must quickly confirm that the surrounding environment is safe. Hazards like traffic, unstable structures, or ongoing threats must be avoided, as an injured victim cannot be helped if the rescuer is also harmed. Once the scene is safe, the immediate priority is to contact professional medical assistance by calling 911 or the local emergency number, or directing a specific bystander to make the call.
The person calling should clearly state that the injury involves severe, life-threatening bleeding from a leg, which helps dispatchers prioritize the response. Protecting oneself from bloodborne pathogens involves the use of gloves, if available, or improvising a barrier like a plastic bag or multiple layers of cloth between the wound and the rescuer’s hands.
Applying Immediate Direct Pressure
The most fundamental technique for controlling external hemorrhage is the application of firm, continuous direct pressure to the wound site. The goal is to compress the damaged blood vessels against the underlying bone or muscle to halt the flow of blood. The rescuer should expose the wound completely by cutting or tearing away clothing to locate the exact source of the bleeding.
Using a clean cloth, trauma gauze, or even a piece of clothing, the material is placed directly onto the wound. The rescuer then applies significant, sustained pressure, leaning their body weight into the wound. If the wound is deep, such as a puncture or large laceration, the technique of wound packing becomes necessary. This involves stuffing the wound cavity tightly with gauze or clean material, layer by layer, until the wound is completely filled.
Once the wound is packed, firm pressure is applied directly over the material. If the material becomes saturated with blood, it should not be removed, as this could disrupt any forming clots. Instead, more material is layered on top, and continuous pressure is maintained until the bleeding stops or a tourniquet is applied.
When and How to Use a Tourniquet
The use of a tourniquet represents an escalation when direct pressure and wound packing fail to control severe bleeding from the leg, or if the injury, such as a partial or full amputation, makes direct pressure ineffective. A tourniquet should only be applied to a limb and is reserved for life-threatening hemorrhage. Commercial tourniquets are significantly more effective than improvised versions, which often lack the mechanical ability to generate sufficient pressure to fully stop arterial flow.
The device must be placed high on the injured leg, as close to the groin as possible, or at least two to three inches above the wound site, but never directly over a joint like the knee. The tourniquet is applied over the clothing if immediate access to bare skin is not possible, and it must be cinched down tightly to apply circumferential pressure. The windlass, a rod used to twist and tighten the strap, is rotated until the bleeding completely ceases, which is the definitive sign of proper application.
Once tightened, the windlass must be secured to prevent it from unwinding, and the time of application must be clearly noted on the device or written on the patient. The goal of the tourniquet is to serve as a temporary measure to completely arrest blood loss until the patient can receive professional surgical care.
Stabilizing the Victim While Awaiting Help
After the bleeding is controlled, attention shifts to maintaining the victim’s stability until emergency medical services arrive. The injured person should be kept lying flat, which helps to maintain blood flow to the brain and core organs. The patient should also be covered with a blanket, coat, or anything available to prevent the loss of body heat, as hypothermia is a complication in patients who have experienced significant blood loss and are at risk of shock.
Signs of shock, such as pale, cool, or clammy skin and a rapid or weak pulse, indicate that the circulatory system is struggling to perfuse the body’s tissues. The rescuer should continuously monitor the patient’s responsiveness and breathing quality while reassuring them that help is on the way. It is important to periodically check the bleeding control measure to ensure it remains effective, adjusting the pressure or the tourniquet if the bleeding restarts. Once applied, a pressure dressing or tourniquet should never be removed by the rescuer, as this action should be performed only by trained medical personnel.