External Bleeding

Many times bleeding can look worse than it is.  When large blood vessels are cut or torn, a victim may lose a lot of blood within minutes.  Most bleeding can be slowed or stopped with pressure.  If possible, have victim apply direct pressure to the wound while you put on any available personal protective equipment (PPE) – gloves, mask, etc…

Types of bleeding
  • Minor
    • Capillary (oozing)
  • Severe
    • Venous (flowing)
    • Arterial (spurting)
Types of open wounds
  • Abrasion
  • Laceration
  • Incision
  • Puncture
  • Avulsion
  • Amputation
Treating External Bleeding Wounds 
  • Check the scene for safety
  • Call or direct a bystander to call EMS
  • Treat wound according to severity
Minor wounds
  • Apply gloves
  • Inspect wound and look for point where bleeding is coming from
  • Apply direct pressure
  • Clean wound, apply antibiotic ointment and cover with clean bandage.  
  • Seek medical care, if necessary
Severe wounds
  • Apply gloves
  • Inspect wound and look for point where bleeding is coming from
  • Cover with a clean cloth or gauze
  • Apply direct pressure
  • Use a pressure bandage by wrapping a roller gauze or elastic bandage around the wound to control bleeding
  • Do NOT remove blood-soaked dressings
  • Leave all dressings on and add more, if/when needed
Amputation
  • Apply gloves
  • Apply direct pressure
  • Immobilize partial amputation with bulky dressing
  • Find amputated part, if possible and wrap in clean and/or sterile dressing, place in plastic bag and set in container of ice and water (do not soak/or freeze)
Tourniquet
If an arm or leg has severe bleeding that cannot be stopped with direct pressure, use a tourniquet.  If you do not have a pre-made tourniquet make one using a piece of cloth and a windless - straight, hard object like a stick to tighten the tourniquet. 
  • Fold a cloth or bandage so that it is long and at least 1” wide
  • Place the tourniquet 2 inches above the injury, if possible
  • Tie the ends of the bandage around a stick
  • Turn the stick to tighten the tourniquet
  • Tighten it until bleeding stops
  • Note the time you placed the tourniquet
  • Leave the tourniquet on until EMS arrives and takes over
  • Tourniquet’s that are applied correctly will cause pain as the bleeding stops. 
Ongoing Care until EMS arrives
  • Check the victim using ABC method:
    • Airway – use head tilt-chin lift method
    • Breathing – look, listen and feel for breathing
    • Circulation – check for severe bleeding
  • Care for shock, if necessary
    • Victim lies on back
    • Cover and keep warm
    • Do not give anything to eat or drink
  • Record any changes in victim
  • Report findings to EMS when they arrive
  • If victim becomes unresponsive or has agonal breathing (irregular, shallow or gasping) or is not breathing at all – begin CPR
    • Continue CPR cycles until EMS arrives, a second rescuer takes over or you are too tired to continue
    • If you do not know CPR begin “Hands Only” compressions at a rate of 100-120 per minute

Internal Bleeding

Signs of internal bleeding

  • Skin is not broken and blood is not seen
  • Bruising
  • Painful, tender, rigid and/or bruised chest and abdomen
  • Vomiting or coughing blood
  • Black or bright red stool
  • Shortness of breath
  • Injury to the abdomen or chest
  • Signs of shock – see shock section
  • Knife or gunshot wound

Care for internal bleeding

  • Assess the scene for safety
  • Call or direct a bystander to call EMS
  • Have the person lie down and remain still
  • Provide care for shock, if necessary
  • If vomiting occurs, roll victim on his or her side
  • Check the victim using ABC method:
    • Airway – use head tilt-chin lift method
    • Breathing – look, listen and feel for breathing
    • Circulation – check for severe bleeding
  • Care for shock, if necessary
    • Victim lies on back
    • Cover and keep warm
    • Do not give anything to eat or drink
  • Record any changes in victim
  • Report findings to EMS when they arrive
  • If victim becomes unresponsive or has agonal breathing (irregular, shallow or gasping) or is not breathing at all – begin CPR
    • Continue CPR cycles until EMS arrives, a second rescuer takes over or you are too tired to continue
    • If you do not know CPR begin “Hands Only” compressions at a rate of 100-120 per minute

Wound Care

When caring for wounds it is important to assess the scene for safety and wear (PPE) personal protective equipment, if available.  Activate EMS if you are unsure or unable to treat a victim.  Administer shock care, if needed.  If victim becomes unresponsive – begin CPR.  Perform CPR cycles until another bystander or EMS arrives and takes over, or you are too tired to continue. 

Caring for Nose Bleeds

  • Assess the scene for safety
  • Apply PPE
  • Pinch victim’s nose
  • Tilt the victim’s head forward
  • Keep constant pressure on both sides of the nostrils until the bleeding stops
  • If bleeding continues, press harder
  • Apply a cold pack to the bridge of the nose
  • Call or direct a bystander to call EMS if
    • The bleeding doesn’t stop in approximately 15 minutes
    • Bleeding is heavy (gushing)
    • The victim has trouble breathing
    • Do NOT have victim tilt head back

Caring for Bleeding from the Mouth
Bleeding from the mouth can lead to breathing problems if blood or broken teeth block the airway or you cannot reach the bleeding area.

  • Assess the scene for safety
  • Apply PPE
  • If you can reach the bleeding area
    • Apply pressure with clean, sterile dressings
  • Check the mouth for any missing teeth, or parts of teeth
    • Clean the wound with saline or clean water
    • If the victim has a loose tooth
      • Have the victim bite down on a piece of gauze to keep the tooth in place
      • Call a dentist
      • If the tooth is chipped, clean the area and call a dentist
    • If tooth is missing
      • Apply pressure with gauze to stop bleeding at the empty tooth socket
      • Place tooth in a cup of Hank’s balanced salt solution, propolis, egg white, coconut water, Ricetral or milk
      • Take victim to dentist or emergency room
    • If tooth becomes discolored – victim should see a dentist
  • Call or direct bystander to call EMS if
    • You cannot stop the bleeding
    • The victim has trouble breathing
  • If victim becomes unresponsive or has agonal breathing (irregular, shallow or gasping) or is not breathing at all – begin CPR
    • Continue CPR cycles until EMS arrives, a second rescuer takes over or you are too tired to continue
    • If you do not know CPR begin “Hands Only” compressions at a rate of 100-120 per minute 

Caring for an Eye Injury

  • Assess the scene for safety
  • Apply PPE
  • Call or direct a bystander to call EMS
  • Instruct victim to keep eyes closed
  • Use clean water to rinse the eye(s)
  • If the eye(s) have been punctured or penetrated by an object leave the object in place until EMS arrives and takes over

 Caring for Embedded (Impaled) Objects

  • Assess the scene for safety
  • Apply PPE
  • Call or direct bystander to call EMS, if necessary
  • Expose the injured area
  • Stabilize the object
  • Do NOT remove the object
  • Control bleeding around the object
  • Seek medical attention or wait for EMS to arrive
  • If victim becomes unresponsive or has agonal breathing (irregular, shallow or gasping) or is not breathing at all – begin CPR
    • Continue CPR cycles until EMS arrives, a second rescuer takes over or you are too tired to continue
    • If you do not know CPR begin “Hands Only” compressions at a rate of 100-120 per minute

 Caring for an Open Chest Wound

  • Assess the scene for safety
  • Apply PPE
  • Call or direct bystander to call EMS, if necessary
  • Leave the wound open or apply a dressing and pressure, if required to stop bleeding
    • Take care that dressing does not become occlusive (sealing the wound)

Determining if a wound needs medical attention

  • Arterial bleeding
  • Uncontrolled bleeding
  • Deep wounds
  • Large or deeply embedded objects
  • Foreign matter in wound
  • Human or animal bite that breaks the skin
  • Slit eyelid or lip
  • May cause large scar
  • Need tetanus shot
  • Uncertain of how to provide care