All about bleeding

Ensure Your Safety

• Before you offer any help, you must ensure your own safety!
• If you become injured, you will not be able to help the victim.
• Provide care to the injured person if the scene is safe for you to do so.
• If, at any time, your safety is threatened, attempt to remove yourself (and the victim if possible) from danger and find a safe location.
• Protect yourself from blood-borne infections by wearing gloves, if available.

Look for Life-Threatening Bleeding

• Find the source of bleeding
• Open or remove the clothing over the wound so you can clearly see it. By removing clothing, you will be able to see injuries that may have been hidden or covered.
• Look for and identify “life-threatening” bleeding. Examples include:
  
  • Blood that is spurting out of the wound.
  • Blood that won’t stop coming out of the wound.
  • Blood that is pooling on the ground.
  • Clothing that is soaked with blood.
  • Bandages that are soaked with blood.
  • Loss of all or part of an arm or leg.
  • Bleeding in a victim who is now confused or unconscious. 

Compress and Control

Key Point

There are a number of methods that can be used to stop bleeding and they all have one thing in common—compressing a bleeding blood vessel in order to stop the bleeding. 

If you don’t have a trauma first aid kit:

Apply direct pressure on the wound (Cover the wound with a clean cloth and apply pressure by pushing directly on it with both hands)

1. Take any clean cloth (for example, a shirt) and cover the wound.
2. If the wound is large and deep, try to “stuff” the cloth down into the wound.
3. Apply continuous pressure with both hands directly on top of the bleeding wound.
4. Push down as hard as you can.
5. Hold pressure to stop bleeding. Continue pressure until relieved by medical responders.

If you do have a trauma first aid kit:

For life-threatening bleeding from an arm or leg and a tourniquet is NOT available OR for bleeding from the neck, shoulder or groin:

• Pack (stuff) the wound with a bleeding control (also called a hemostatic) gauze, plain gauze, or a clean cloth and then apply pressure with both hands

1. Open the clothing over the bleeding wound. (A)
2. Wipe away any pooled blood.
3. Pack (stuff) the wound with bleeding control gauze (preferred), plain gauze, or clean cloth. (B)
4. Apply steady pressure with both hands directly on top of the bleeding wound. (C)
5. Push down as hard as you can.
6. Hold pressure to stop bleeding. Continue pressure until relieved by medical responders.

For life-threatening bleeding from an arm or leg and a tourniquet is available:

• Apply the tourniquet

1. Wrap the tourniquet around the bleeding arm or leg about 2 to 3 inches above the bleeding site (be sure NOT to place the tourniquet onto a joint—go above the joint if necessary).
2. Pull the free end of the tourniquet to make it as tight as possible and secure the free end. (A)
3. Twist or wind the windlass until bleeding stops. (B)
4. Secure the windlass to keep the tourniquet tight. (C)
5. Note the time the tourniquet was applied. (D)

Note: A tourniquet will cause pain but it is necessary to stop life-threatening bleeding.

Instructions and photos have been taken from the Save a Life booklet. Download the booklet for additional information on how to stop the bleed.
Organization, traumatic injuries worldwide are responsible for over 5 million deaths annually. Post-traumatic bleeding caused by traumatic injury-associated coagulopathy is the leading cause of potentially preventable death among trauma patients. Despite these facts, awareness of this problem is insufficient and treatment options are often unclear. The STOP the Bleeding Campaign therefore aims to increase awareness of the phenomenon of post-traumatic coagulopathy and its appropriate management by publishing European guidelines for the management of the bleeding trauma patient, by promoting and monitoring the implementation of these guidelines and by preparing promotional and educational material, organising activities and developing health quality management tools. The campaign aims to reduce the number of patients who die within 24 hours after arrival in the hospital due to exsanguination by a minimum of 20% within the next 5 yearsThe acronym STOP comprises the following elements: Search for patients at risk of coagulopathic bleeding; Treat bleeding and coagulopathy as soon as they develop; Observe the response to interventions; Prevent secondary bleeding and coagulopathy.

Search for patients at risk of coagulopathic bleeding

The early recognition of bleeding and coagulopathy requires awareness of the phenomenon. Although the Advanced Trauma Life Support programme addresses the circulatory problem during the primary survey and suggests that bleeding sources should be sought if shock is present [13], the issue of coagulopathy associated with traumatic injury is not well addressed at present. The STOP concept specifically addresses three important aspects of coagulopathic bleeding: rapid detection of all relevant bleeding sources; estimation of blood loss, risk of ongoing haemorrhage and need for massive transfusion; and targeted screening for and monitoring of coagulopathy upon arrival in hospital and intermittently thereafter.

Treat bleeding and coagulopathy as soon as they develop

Bleeding should be stopped using surgical or other means as quickly as possible. Damage control surgery should be applied to patients in shock, including packing of the abdomen in haemorrhagic patients, application of external fixators to long bone fractures and an attempt to limit operation times to ≤90 minutes per intervention. Aggressive treatment of coagulopathy should be implemented simultaneously, including the early administration of tranexamic acid and the use of blood products according to evidence-based clinical practice guidelines.

Observe the response to interventions

After treatment, the response to intervention should be observed. Important variables to be considered include the surgeon's interoperative judgement, laboratory tests, thrombelastometric assessment and the necessity of continued blood product administration. The vital status - especially blood pressure, pulse rate, lactate and urinary output - should also be evaluated.

Prevent secondary bleeding and coagulopathy

Especially important is the avoidance of secondary coagulopathy. Measures may include the use of damage control surgery rather than primary definitive surgery in patients in shock and the prevention of all risk factors that trigger haemostatic disorders, including hypothermia and acidosis.