Bleeding is one of the most common emergencies First Aiders can expect to encounter. Knowing how to recognise different types of bleeding and how to stop bleeding quickly and correctly can prevent complications and save lives. This guide explains the basics of bleeding control and wound care for First Aiders.
Bleeding occurs when blood escapes from the circulatory system due to damaged blood vessels. Bleeding can happen inside the body (internal bleeding) or outside the body (external bleeding), either through a break in the skin or via natural openings such as the nose, mouth, or ears.
The severity of bleeding depends on which blood vessels are damaged:
· Arterial bleeding: Blood appears bright red and may spurt from the wound. This type of bleeding is difficult to control and requires urgent treatment.
· Venous bleeding: Blood is darker in colour (and may appear blueish) and flows steadily. Smaller venous bleeds are easier to manage, while larger ones can be more challenging but are often controllable.
· Capillary bleeding: Blood slowly oozes from the wound. This type of bleeding is the easiest to stop.
Different injuries cause different types of wounds, including:
· Abrasions: Also known as grazes, abrasions are caused by scraping and are usually superficial.
· Lacerations: Jagged, irregular wounds caused by impact to soft tissues.
· Incisions: Clean cuts made by a sharp object, such as a scalpel or broken glass.
· Avulsions: Tissue or a body structure is pulled off or torn away and left hanging from the body.
· Puncture wounds: Deep, narrow wounds caused by sharp objects.
· Contusions: Bruising caused by blunt trauma.
· Hematomas: Pooled blood under the skin, often accompanied by a lump or swelling.
. Gunshot wounds: May involve entry and exit wounds. The level of tissue damage caused depends on the velocity of the weapon used.
Before assisting a casualty, always protect yourself. Assess the scene to ensure that it is safe for you to approach. Always use gloves and, if available, eye protection or a face shield to reduce the risk of contact with blood. Once you’ve ensured your own safety, asses the casualty’s wound and focus on stopping or slowing the bleeding as quickly as possible.
Direct pressure is an effective first step for controlling external bleeding:
1. Place gauze or a clean dressing directly over the wound.
2. Apply firm, steady pressure to the bleeding site without interruption.
3. If possible, elevate the limb while continuing to apply pressure.
4. Maintain pressure until bleeding slows or stops.
If applying direct pressure doesn’t stop the bleeding, apply a pressure bandage to the wound while you wait for emergency services to arrive:
1. Place a bandage or field dressing over the original gauze. Do not remove the first layer, as this can disturb clots and restart bleeding.
2. Secure the bandage firmly, ensuring it is tight enough to apply pressure but not so tight that circulation below the wound is completely cut off.
3. Elevate the limb if possible.
A tourniquet is a last-resort measure to stop severe, uncontrollable bleeding from a casualty’s arms or legs (for example, as a result of an amputation). Always first try to stop bleeding using direct pressure, elevation, or a pressure bandage before resorting to a tourniquet.
· Continue applying direct local pressure to the wound while positioning and tightening the tourniquet.
· Place the tourniquet just above the bleeding site or wound.
· Tighten the tourniquet strap or dial until bleeding slows or stops.
· Record the exact time the tourniquet was tightened or the bleeding stopped.
· Monitor the casualty, the limb, and the tourniquet closely.
· Leave the tourniquet in place until emergency services take over.
Objects lodged in the body must not be removed. Secure the object in place using bandages or a ring bandage if available. Leave the removal of impaled objects to medical professionals in a hospital setting.
If a body part (arm, leg, or finger) has been completely detached from the rest of the body:
1. Follow the directions for how to stop bleeding outlined above (direct pressure, pressure bandage, or tourniquet).
2. Wrap the amputated part in cling film or place it in a plastic bag.
3. Cover the plastic-wrapped limb with cloth or bandaging, then place it in a bag of ice (avoid direct contact with ice as this may cause tissue damage).
4. Label the package with the casualty’s name and time of injury.
5. Send the amputated limb with the casualty to the hospital.
If the bleeding is coming from local tissue (not from the ear canal), cover the entire ear loosely with gauze and secure it in place with medical tape.
Bleeding from the ear can indicate a serious head injury. If the blood appears to be coming from inside the ear canal and other head injury signs are present:
1. Call the emergency services immediately.
2. Keep the casualty still.
3. Support and stabilise the head.
4. Continue with standard primary and secondary survey treatment.
Do not insert dressings into the ear canal and do not remove any impaled objects from the ear.
Nosebleeds are commonly caused by trauma (such as a blow or impact to the face) or the insertion of foreign objects (such as a fingers or a pencil). To manage a nosebleed:
1. Have the casualty sit upright and tilt their head forwards. This allows blood to drain forwards and outwards, decreasing the chance of the casualty swallowing excess amounts of blood, which can cause nausea and vomiting.
2. Pinch the soft, fleshy part of the nose firmly to apply direct pressure.
3. Maintain the pressure for at least five minutes, and up to 20 minutes if needed.
Once a wound has stopped bleeding, it’s important to properly clean and dress the wound:
1. Always wear gloves to protect yourself.
2. Assess how severe the wound is to determine how much gauze and which size first aid dressing you need.
3. Using sterile gauze, gently clean the wound and surrounding skin to remove dirt or debris.
4. If needed, use clean water to rinse the wound.
5. Cover the entire wound with clean, sterile gauze.
6. Secure the dressing in place by firmly wrapping a clean bandage over and around the area.
Severe bleeding is a medical emergency that can be fatal without swift treatment. Knowing how to stop bleeding quickly and safely is a lifesaving skill that we teach in our first aid courses. Get hands-on, practical training in how to apply direct pressure, apply pressure bandages, monitor a casualty’s condition, and much more, by attending a first aid course. Get in touch for more information or download our course schedule to find a date that works for you.
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