For external bleeds, The Australian and New Zealand Committee on Resuscitation (ANZCOR) recommends:
” 1. Firm pressure on or around the wound is the most effective way to stop bleeding.
2. In life-threatening bleeding, control of bleeding takes priority over airway and breathing interventions.
3. Use an arterial tourniquet for life-threatening limb bleeding that is not controlled by direct wound pressure.”
If you are the first aider helping someone who has a severe external bleed, remember to wear gloves; and that “the use of pressure on or around the wound is usually the fastest, easiest and most effective way to stop external bleeding. Other methods should be used if direct pressure alone does not control severe bleeding.
The aim is to stop further bleeding whilst waiting for help to arrive.
There is no evidence that elevating a bleeding part will help control bleeding and there is the potential to cause more pain or injury.”
“Management of all bleeding begins with application of pressure on or around the wound.
• If bleeding is severe or life-threatening, controlling the bleeding takes priority over airway and breathing interventions. Lie the victim down, apply pressure and send for an ambulance.
• If there is severe, life threatening bleeding from a limb, not controlled by pressure, apply an arterial tourniquet above the bleeding point, if trained in its use and one is available.
• If there is severe, life-threatening bleeding from a wound site not suitable for tourniquet, or from a limb when a tourniquet is not available or has failed to stop the bleeding, apply a haemostatic dressing, if trained in its use and one is available.
• For the majority of non-life-threatening cases, first aiders should follow the order of DRSABCD, where control of bleeding follows establishing airway and commencing CPR if required.
• If the victim is unresponsive and not breathing normally, follow the Basic Life Support Flowchart (ANZCOR Guideline 8)
“Where the bleeding point is identified, the rescuer, a bystander or the victim themself should control bleeding by:
• Applying firm, direct pressure sufficient to stop the bleeding. Pressure can be applied using hands or a pad over the bleeding point.
• If bleeding continues, apply a second pad and a tighter bandage over the wound. If bleeding still continues, check that the pad and bandage are correctly applied, directly over the bleeding. If not, it may be necessary to remove the pad(s) to ensure that a specific bleeding point has not been missed. Applying firmer pressure, only using 1-2 pads over a small area, will achieve greater pressure over the bleeding point than continuing to layer up further pads.
“To assist in controlling bleeding, where possible:
• Advise the victim to lie down and remain still
• Restrict movement by immobilising a bleeding limb
Where the object is embedded:
” If there is an obvious embedded object causing bleeding, use pressure around the object.
• Do not remove the embedded object because it may be plugging the wound and restricting bleeding.
• Apply padding around or on each side of the protruding object, with pressure over the padding. Pressure application methods may be insufficient to control bleeding. It may still be necessary to use other measures including an arterial tourniquet or haemostatic dressings.
When should you use an arterial tourniquet?
“Arterial tourniquets should only be used for life-threatening bleeding from a limb, where the bleeding cannot be controlled by direct pressure. Ideally, a tourniquet should not be applied over a joint or wound, and must not be covered up by any bandage or clothing.
“All arterial tourniquets should be applied in accordance with the manufacturer’s instructions (or 5 cm above the bleeding point if no instructions) and tightened until the bleeding stops.
• If a tourniquet does not stop the bleeding its position and application must be checked. Ideally the tourniquet is not applied over clothing nor wetsuits and is applied tightly, even if this causes local discomfort.
• If bleeding continues, a second tourniquet (if available) should be applied to the limb, preferably above the first. •
“If a correctly applied tourniquet(s) has failed to control the bleeding consider using a haemostatic dressing in conjunction with the tourniquet.
“Improvised tourniquets are unlikely to stop all circulation to the injured limb without risk of tissue damage. Improvised tourniquets which do not stop all circulation can increase bleeding. Nonetheless, in the context of life-threatening bleeding, an improvised tourniquet is likely to be better than no tourniquet. Tourniquets, ideally of a similar broad width to commercial types, can be improvised using materials from a first aid kit (e.g. triangular bandage, elastic bandage) from clothing, a surfboard leg rope or other available similar items. Improvised tourniquets should be tightened by twisting a rod or stick under the improvised tourniquet band, similar to the windlass in commercial tourniquets.
Click HERE to see a video of a simple improvised tourniquet.
• The time of tourniquet application must be noted and communicated to emergency/paramedic personnel. Once applied, the victim requires urgent transfer to hospital and the tourniquet should not be removed until the victim receives specialist care.