When people think of First Aid, they often think of CPR. Whilst undoubtedly important – CPR is just one small part of First Aid. First Aid to stop bleeding is just as important. Why? Because failure to start appropriate early management in patients with traumatic bleeding is a leading cause of preventable death from trauma. [British Medical Journal]. Regardless of whether you’re in a city, in rural areas or anywhere else – we should all know some First Aid to stop bleeding.
So, how do we stop the bleed?
Direct pressure is the primary technique used to control bleeding. However, simply using the palm of your (ideally gloved/covered) hand may not always create enough pressure to stop the bleed. We need to apply direct pressure to the exact source of the bleed. We can do this by placing a finger against the bleeding vessel. This technique is called using digital pressure. It works by increasing the amount of pressure applied due to the reduction in surface area through which the pressure is applied.
It can be difficult to apply digital pressure for more than a few minutes – especially if the casualty needs to be transported. If bleeding is severe, this is where haemostatic agents (see below) may be useful. These speed up the clotting process, stopping the bleed much faster than through using direct pressure alone.
There are many types of haemostatic agents available, each type working in a different way. Some of the more popular haemostatic agents are Celox and ChitoSAM. The granules are very high surface area flakes. When they come into contact with blood, they swell, gel and stick together to make a gel like clot. Unlike previous versions of clotting agents, the newer generations don’t create any heat. They work independently of the body’s normal clotting mechanism and can clot hypothermic and heparinised blood.
To work, haemostatic agents (whether in powder, granular or gauze form) need to be packed against the source of bleeding. This needs to be done with enough pressure for 3-5 minutes – depending on the manufacturer’s recommendations, or until the bleeding stops. Simply pouring haemostatic powder or granules into a wound is unlikely to create adequate pressure to stop the bleeding. Ideally, pooled blood should be removed (mopped out) before applying the haemostatic agent.
If using a haemostatic impregnated gauze, this should be packed tightly into the wound using digital pressure, to push the haemostatic agent right to the source of bleeding. Once packed, palm pressure can be used for the amount of time specified by the manufacturer of that particular product. Once bleeding has been stopped, a dressing can be applied to hold everything in place for transport to hospital. Tucking the packaging of the haemostatic agent into the top layer of the dressing ensures that the receiving hospital knows which type of haemostatic agent has been used and makes them aware of how to deal with the agent.
As the name suggests, pressure dressings allow more pressure to be applied to a wound than a conventional wound dressing. They do this by incorporating a pressure bar or a cup. The standard pressure dressing is the Emergency Bandage Trauma Wound Dressing. Some, like the Olaes Modular Bandage have gauze attached which can be used to pack a wound before applying the dressing, a removable occlusive plastic sheet and a pressure cup. Some are designed with features to make application to junctional areas (for example armpits or the groin) more simple and effective too.
Whether using a standard wound dressing or a pressure dressing, adding multiple dressings to the same wound is not always effective. The aim is to stop the bleed using direct pressure rather than simply soaking up the blood.
A tourniquet is a device for stopping the flow of blood through a vein or artery. If blood can’t reach the wound, it can’t leave the body. Standard tourniquets such as the Combat Application Tourniquet or CAT, the SAM XT and SOF Tactical Tourniquet Wide can only be used on the extremities (the arms or legs) and are used when catastrophic bleeding can’t be controlled by direct pressure. The European Resuscitation Guidelines explain that to ensure effective application, people should be trained in their use.
Sometimes a single tourniquet may not be enough to control the bleed, so a second tourniquet may need to be applied above the first. Once a tourniquet has been applied, the time of application needs to be recorded. Any potential blood flow should be monitored as it may need to be tightened further as time progresses. Once applied, tourniquets are not loosened or removed until the casualty is in definitive medical care.
The best tourniquets are commercially bought, purpose built tourniquets. However, in an emergency a cotton triangular bandage, a shirt sleeve, a scarf or something similar can be used. These can be tightened using a piece of cutlery, a spanner, a pair of scissors or something similar. It’s a popular misconception that leather belts make good tourniquets. It’s unlikely that the buckle of a belt would be strong enough to withstand the amount of pressure required and tightening the belt with a makeshift windlass is almost impossible due to the rigidity of the belt.
There were some updates regarding the use of tourniquets in 2018 which you can read about on our blog here.
Tampons are not appropriate or useful for haemorrhage control. Although the internet is full of unverified information recommending their use for gunshot wounds and other penetrating injuries – there are no evidence based recommendations for their use.
A tampon cannot provide the surface area or the pressure required to control massive bleeding. Tampons simply absorb blood – they offer no homeostatic assistance. The average tampon can absorb around 9ml of blood – which is about two teaspoons. Life threatening bleeding can be around 1500ml. Tampons should not be in a First Aid kit for haemorrhage control, period! Packing a wound with ripped clothing and then applying pressure would be a better alternative.
Reducing deaths due to uncontrolled bleeding can be achieved by understanding haemorrhage control methods, being prepared and applying them quickly.
Reading this blog isn’t a sufficient replacement for proper, hands-on training. Want to learn how to deal with a variety of bleeding incidents? Need to learn how to effectively apply a tourniquet? Need to learn about haemostatic agents and wound packing? Need First Aid in Newcastle, Gateshead, Sunderland or across the North East? Simply check out some of our courses from the homepage, get in touch and we’ll be happy to help.