First Aid following a serious bleed

A severe bleed can be caused by any accident in the home or garden, a mishap at work or sadly, through violence on the street.

In the last year, unbelievably, two good friends of mine have individually opened their front doors to find victims of knife crime on their doorsteps in need of first aid. Fortunately, both casualties survived, thanks to the nature of their injuries and the immediate first aid given by my friends. However, it was a harrowing experience for all involved.

It is vital to know what to do if someone is bleeding and to act quickly, since in the case of a catastrophic bleed, the casualty can lose a critical amount of blood in just three minutes.

In these situations, immediate first aid is the only option to possibly saving a life.

A severe bleed

In the case of a severe bleed your aim is to prevent further blood loss and to prevent shock.

Elevate, examine and apply pressure

Sit or lie the person down to manage shock and prevent them from feeling dizzy and faint – for a serious bleed, help them lie down and elevate their legs.

Examine the area with gloved hands if possible, to see if anything is stuck in the wound – if so, DO NOT remove it as it is likely to be stemming bleeding, instead apply direct pressure either side of the object.

Apply direct pressure to the site of the wound to try and control bleeding. If the bleeding can be controlled with pressure, keep holding for at least 10 minutes as it takes this time for clots to form.

Dress the wound with an appropriate non-adherent dressing. Apply a pressure dressing if possible, to avoid having to continue to apply pressure manually. If the bleeding comes through the pad, keep applying pressure and add a fresh dressing on top, securing it in place with a bandage. Don’t remove the original dressing or pad.

Keep the casualty warm and reassure them.

Control the bleeding and call the emergency services

Call 999 or 112 for emergency help.

Catastrophic bleeding

These bleeds can be fatal in a few minutes – there will be a lot of blood.

Limb if the bleed is from a limb and you are unable to stop the bleeding with substantial direct pressure, you may need a tourniquet.

Torso if the bleed is in the torso or trunk of their body, use your finger or hand to locate the source of the bleeding. Once located, pack the bleeding cavity ideally with a commercial sterile haemostatic dressing – a wound dressing that contains an agent that promotes blood clotting – or an improvisedone.

Open chest wound that appears to be sucking as the casualty breathes – leave the wound open and control any bleeding with direct pressure or a specialist non-occlusive dressing for a sucking chest wound – if you have one.

Encourage them to sit up and lean towards their injured side.

Tourniquets

If someone is bleeding from a limb and the bleed is pulsating and can’t be stopped with direct pressure –use a tourniquet.

A commercial tourniquet will be more effective and easier to use if you have one.

An improvised tourniquet will work and can save lives. A tourniquet should be at least 4cm wide to prevent localised damage to nerves tissues. An item such as a strong cotton scarf that isn’t fluffy or stretchy would work well or a calico triangular bandage from a regular first aid kit.

Apply the tourniquet sufficiently tightly to stop the bleeding. If it is not tight enough it can result in increasing the blood loss.

More than one tourniquet may need to be applied to completely stop bleeding.

Neverbe tempted to loosen or remove a tourniquet. Once applied, tourniquets should only be removed by a doctor in a hospital setting. Removing a tourniquet outside of a hospital setting is likely to be fatal, as it would allow accumulated toxins to flood the bloodstream.

There is more information on this topic, including step by step guidance to using an improvised tourniquet in our article on First Aid for Life

https://firstaidforlife.org.uk/tourniquets/