Traumatic Bleeding and Wound Management: Trauma and Emergency Education
Scene Safety & Calling for Help
If you have found someone who is bleeding or has sustained a traumatic injury, the first step is to assess the scene for safety. If you and the injured person are in a safe location to deliver assistance, you may call for help.
If you are alone and you are able, call 112 for assistance. If you are not alone, send the person you are with to call for or obtain help.
Traumatic Bleeding
Once you have ensured that the scene is safe, assess the injured individual for a source of bleeding. This may require you to remove clothing to better visualize the extent of the injuries. Be sure to turn the individual, if possible, to look for any injuries that may be on their back and not immediately apparent.
If you identify bleeding, signs that the bleed may be life threatening include: bleeding that is splashing out of the wound, bleeding that has not stopped on its own, large amounts of blood around the injured individual, the loss of a large part or the entirety of a limb and loss of consciousness in the injured person.
After identifying the source of bleeding, it is critical to pack the wound with available materials (cloth or gauze if available), especially if the wound appears to be deep. Once the wound is packed, apply manual pressure over the wound.
You should apply constant direct pressure to the wound without interruption. The pressure should be directly over the area of bleeding using only a finger or two directly over the area of bleeding. Vessels are small, and so if you try to cover with your whole hand, you will not be providing adequate compression of the vessel or vessels. Do not lift pressure to check on the status of the wound until trained medical personnel arrive and instruct you to do so.
Please reference the following videos for visual instruction on how to stop the bleed:
- How to Stop the Bleed (Summary “Just-in-Time” Video)
- How to Stop the Bleed (Full Length Video)
Bleeding of wounds on arms or legs may also be stopped by application of a tourniquet above the level of the injury (upstream, or closer to the torso) (Picture 1).
https://www.istockphoto.com/illustrations/tourniquet
Keep in mind that the proper application of a tourniquet may cause a lot of pain for the injured person, of which you should inform them prior to application. To apply a tourniquet, tie material (a true tourniquet, cloth, or other material) tightly around the line upstream to the injury. For example, if the bleeding is coming from the knee, tie the tourniquet around the thigh, that is, upstream to the knee. The tourniquet serves to reduce blood flow to the injured area to minimize the amount of blood loss. Continue to tighten the tourniquet until the bleeding stops.
If the patient has lost consciousness, try to keep their head down and their feet up. Lift their feet to increase blood flow to their brain.
A significant amount of bleed can be lost from the scalp, so if the person has a scalp injury, wrap a sheet or a shirt around the scalp wound tight to stop the bleeding. Or, can also hold manual pressure if able.
Penetrating Wound Management
If you find someone who has a penetrating injury, which means a wound with a retained foreign body, do not move or remove the object. The foreign body may be serving to block further blood loss from the injury. Manipulating the foreign body may make the injury worse or cause more bleeding.
If there is severe bleeding associated with the penetrating injury, follow similar steps as discussed above with traumatic bleeding, this time being careful to not manipulate the foreign object. Take care to manage bleeding and stabilize the object with gauze or available cloth until help arrives.
If there is a penetrating wound to the chest, and with each breath, you notice air coming out from the chest, try to cover most of the wound (3 edges) with 1 edge open to air (picture 2). This will improve the patient’s ability to breath. If the wound is completely covered, this can actually make the patient’s breathing worse as outside air is trapped around the lung.
Pelvis Injury
If it is clear that the injured person’s pelvis is seriously injured, wrap a sheet around the patient’s pelvis and tie it tight. This is to stop the bleeding from within the pelvis until medical help arrives.
The sheet should be wrapped at the location of the femur head (picture 3).
https://www.uptodate.com/contents/image/print?imageKey=EM%2F76777&topicKey=EM%2F6571&source=see_link
References
- Shuker ST. The immediate lifesaving management of maxillofacial, life-threatening haemorrhages due to IED and/or shrapnel injuries: “when hazard is in hesitation, not in the action”. J Craniomaxillofac Surg. 2012 Sep;40(6):534-40. doi: 10.1016/j.jcms.2011.09.005. Epub 2011 Nov 8. PMID: 22070881.
- Voss JO, Thieme N, Doll C, et al. Penetrating Foreign Bodies in Head and Neck Trauma: A Surgical Challenge. Craniomaxillofac Trauma Reconstr. 2018;11(3):172-182. doi:10.1055/s-0038-1642035
- Brigham And Women’s Hospital YouTube Channel, “Training Video: How to Stop the Bleed” Mar 4, 2022; 0:39 https://youtu.be/Gv5cny19JAA
- Brigham And Women’s Hospital YouTube Channel, “Training Video: How to Stop the Bleed” Mar 4, 2022; 4:30 https://youtu.be/epCU2EiDXsc