Estimated reading time: 13 minutes
Injuries that result in bleeding are common. In most instances the bleeding is more of a nuisance than a threat and is easily treated with a bandage and some antiseptic cream.
But there are occasions when an injury results in major bleeding that goes beyond a few drops. We’ll explore the basic types of “bleeds” that can occur and how to identify both the severity and the best course of treatment.
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The most common causes of severe bleeding happen around tools. From tools in the kitchen to hand and power tools in the garage and garden. Many tools have sharp edges that can cause severe lacerations and punctures resulting in severe bleeds.
Other causes include automobile accidents, crimes of violence like shootings and stabbings, and simple home calamities like broken windows or an unfortunate encounter with a sharp metal edge.
When Disaster Strikes
A statistical spike in injuries resulting in severe bleeding occurs during and after natural disasters. Falling and airborne debris from disasters ranging from hurricanes and tornadoes to earthquakes and landslides increase the possibility of bleeding injuries.
Even after a disaster the risk level for bleeding injuries is high as cleanup and repairs put people in contact with fallen and shattered debris and objects.
Beyond the Bandaids
Major bleeding from an injury defies traditional approaches to treatment. One of the most common occurrences is bleeding that simply won’t stop. That situation can be both alarming and fatal. The immediate treatment is pressure on the bleeding area but even that simple approach can be complicated by the nature of the injury and its location.
What’s critical is that any severe bleeding needs to be stopped and treated immediately. Here are the unfortunate facts:
- Untreated severe bleeding from injuries is one of the leading causes of preventable deaths in the United States.
- The typical cause of death is referred to as a bleed out.
- An adult has an average of about 5 liters of blood. The loss of 2 to 3 liters of blood is immediately life threatening as a bleed out.
- A bleed out can occur in 2 to 3 minutes from a severely bleeding wound or injury.
- On average, it takes emergency medical services 6 to 10 minutes to reach the scene of an injury.
- Immediate treatments are critical to keep a severely bleeding person alive until EMS arrives.
If that sounds frightening, it is. Many people panic at the sight of blood and the amount of blood from a severely bleeding wound is significant. Here are the ways blood appears when a person is experiencing major bleeding:
- Blood that won’t stop coming out of a wound
- Blood that continues to pool on the ground
- Clothing that is soaked in blood
- Bleeding from a victim who is unconscious or confused
- When someone has lost all or part of an arm or leg
- When blood is spurting from the wound
Immediate Steps to Take
If you encounter someone with severe bleeding or are experiencing it yourself, here are the immediate steps to take:
- Call 911 (Remember, average EMS arrival time is 6 to 10 minutes)
- Immediately apply pressure to stop the bleeding.
- Proceed to the steps we will outline below to control the bleeding and further stabilize the victim. What’s most critical is that you stop the bleeding as soon as possible.
Bystander Blood Exposure
Anyone treating a severely bleeding person has the potential to get covered with blood. Here are the facts:
- There is a very low likelihood of contracting a blood borne disease through physical contact.
- According to the CDC, there are no documented cases when blood meeting intact skin led to cross-contamination or infection.
- However, protect yourself and the victim. If available, wear protective equipment including sterile gloves and glasses.
- If blood gets on you, wash the area with soap and warm water as soon as help has arrived.
- Follow up with your physician if you are concerned about any level of exposure.
Recognize the Type of Bleeding
There are three types of bleeding you may encounter. They are determined by the color of the blood and how the blood flow is behaving. Each characteristic indicates exactly which blood vessel in the body was cut.
Three types of bleeding based on blood vessel
- Arterial – Spurting blood/blood is a bright red in color/typically highest and fastest volume of blood loss.
- Venous – Slower but steady flow of blood/blood is a dark red color.
- Capillary – Slowest bleed with an even flow but if it continues can be life threatening. Blood is a primary red color.
- Cover the wound with a clean cloth or gauze if possible.
- If a cloth or gauze is unavailable, use your hands until help arrives or use your free hand to rip off a shirt (or any other fabric) while keeping pressure applied with your other hand. Then use the sleeve of the shirt of a folded length to cover the wound while applying pressure.
- Apply firm, direct pressure.
- Use the heel of your hand to apply pressure directly over the wound.
- Wrap the wound and continue to reinforce the covering with additional cloth, gauze wraps or elastic bandages wound tightly.
- Don’t remove saturated gauze. Add more gauze on top if needed.
- Don’t life the gauze to check the wound. This could pull away any clots that are forming.
- As much as possible, maintain pressure until medical assistance arrives.
- You could also apply a pressure bandage.
These bandages are sometimes known as Israeli bandages and consist of a thick layer of gauze and attached elastic wraps to compress against the body or limb. Which bandage you use varies depending on the type of bleed and we’ll cover that in a moment.
Restricting blood flow
In addition to and compression bandages, restricting the blood flow temporarily will go a long way towards managing severe bleeding. There are three basic ways to restrict blood flow:
- Wound packing
- Chest Seal
Which method you use depends on which part of the body is bleeding. Here is an illustration of various parts of the body and the types of blood restrictors that can be used on various treatment zones.
The variations are necessary because of the limitations of each method across various parts of the body.
The first and most common way to restrict blood flow is with a tourniquet. If you don’t have one on hand there are various ways to improvise one as outlined in this linked article.
1. Tourniquet Application Guidelines
- Go 2” to 3” above the wound or “high to survive.” The reason tourniquets are sometimes simply placed high on a limb is because the actual location of the internal hemorrhage may not be apparent or the muscle tissue has compressed or moved a blood vessel.
- The tourniquet can be applied over clothes but make sure there is nothing in the pockets to interfere with the performance of the tourniquet.
- Tighten until bleeding stops
- If the person complains of any pain from the tourniquet, reassure them that it will subside and that it’s necessary to stop the bleeding.
- It takes on average, 20 seconds or less to apply
- Some injuries may require more than 1 tourniquet especially for bleeding injuries on the legs.
- Note the time the tourniquet was applied
- When applying tourniquets to children with smaller extremities, bulky material like compresses or folded cloth can be placed benteath the tourniquet and the skin to increase limb circumference
Tourniquets come in a range oF sizes and types. All provide the same level of blood flow restriction. Here are the basic Tactical Combat Casualty approved tourniquet types:
The tourniquet that seems to be the most highly recommended by paramedics and EMT’s is the CAT GEN 7.
What’s always critical to remember is the write down the time that the tourniquet was applied. A tourniquet that is left in place for too long can cause damage, although there are numerous reports of wounded soldiers in Iraq and Afghanistan having tourniquets in place for hours with no ill effects from the tourniquet.
Many tourniquets have white tape or spaces to mark the time with a permanent marker.
Unfortunately, a tourniquet will not work on other parts of the body. This is particularly true around hips, shoulders, groin, neck and the trunk of the body. That brings us to the second approach to restricting blood flow: wound packing.
2. Wound Packing Guidelines
Wound packing is used primarily around the hips, groin, upper chest, neck and shoulders. These are areas where a tourniquet cannot be used.
Wound packing involves literally packing a wound with a soluble, hemostatic gauze specifically designed for wound packing. Hemostatic gauze is saturated with coagulants that assist the body in coagulation to stop bleeding. Any gauze or clean fabric can be used but the hemostatic gauze will clot faster and stop the bleeding.
Wound packing is a 3 step process:
- The first step is to expose the wound and try to feel for the sides defining the wound. This will be painful for the victim so you need to reassure them that it will be temporary and quick.
- The next step is to quickly and gently pack the wound by unrolling the gauze over and into the wound using a finger to gently pack the wound. Keep packing until the wound is filled with gauze.
- The final step is to cover with gauze and apply pressure.
- If the victim needs to be transported or if EMS is still some distance away a additional gauze and elastic wraps can be used to hold the compress in place. If any bleeding is evident, reapply and hold pressure until help arrives.
3. Chest Seal Guidelines
A chest seal is a type of bandage used on the trunk of the body from the abdomen to the chest. It is designed to be air-tight and is primarily designed to prevent air from entering the chest cavity or the lung(s).
There is actually specialized bandage known as a Chest Seal designed for this purpose.
A chest seal is designed to contain the blood from an open wound that has resulted in bleeding from the chest or abdomen.
It needs to be a tight seal around the entire circumference of the wound to prevent any airflow from entering the wound.
Medical Supplies for Major Bleeding
There are specialized medical kits that are designed to treat the 3 main types of bleeding including supplies for pressure bandages, wound packing and chest seals. These specialized bandages are specifically designed to treat severe bleeding depending on the location and cause of bleeding whether arterial, venous or capillary.
Many of these kits are based on military medical kits designed to treat severe bleeding as a result of bullet wounds. They all have the 3 primary bandages plus all other equipment related to wound management and sever bleeding.
Here is a review of the basic contents:
- Tourniquet (consider having more than one)
- Pressure bandage (Israeli bandage)
- Hemostatic gauze (be aware, hemostatic gauze has an expiration date so check it from time to time)
- Chest Seal
- Trauma Shears
- Combat tape
- Elastic wrap
- Sterile gloves
- nasopharyngeal airway
These bleed kits run about $50 and are worth the money given the severity of any serious injury resulting in major bleeding.
Treating Shock as a Result of Severe Bleeding
Shock is a serious condition that often accompanies traumatic injuries. Loss of blood can rapidly send someone into shock and the following treatment should be engaged once the bleeding has been successfully compressed and stopped:
- Lay the person down and elevate their legs slightly. If this causes pain because of the site of their injury, do not raise their legs.
- Keep them still and encourage them not to move unless necessary.
- Loosen tight clothing and if possible, cover person with a blanket. A space blanket is contained in many first aid and bleed kits.
- Don’t allow them to drink or eat anything.
- If they vomit or begin to bleed from the mouth, carefully turn them onto their side to prevent choking.
Shock is actually caused by a reduction in blood flow and severe bleeding is a direct cause of that condition.
Resources Worth Considering:
- Stop The Bleed, Hemorrhage Control Training (VIDEO)
- Stop the Bleed Tourniquet Training (VIDEO)
- Stop The Bleed: Chest Seals (VIDEO)
- Essentials of First Aid: Bleeding Control (BOOK)
- Severe bleeding: First aid (WEBSITE/MAYO CLINIC)
It Won’t Be Easy
It’s traumatic for anyone when significant amounts of blood accompany any injury. If you have a basic awareness of the importance of applying pressure to stop the bleeding and some of the other treatments we outlined, it will hopefully be less traumatic for all involved.
What’s critical is to take the time to watch some of the videos, review the information either in books or websites and purchase a specialized bleed kit. Injuries resulting in massive bleeding can happen anywhere and anytime to anyone, and its worth knowing that all of you will at least have a fighting chance to survive a leading cause of preventable death.
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