Managing External Bleeding: Recognizing Severity and Delivering First Aid

Bleeding, whether external or internal, can range from minor to life-threatening, and recognizing the type and severity of bleeding is crucial for effective first aid. 

Severe bleeding, often resulting from large veins or arteries, can lead to significant blood loss and life-threatening conditions if not promptly managed. Quick action to stop the bleeding and call for emergency help can save lives. This guide provides essential first aid steps to manage different types of bleeding and ensure an effective emergency response.

The Different Types of Bleeding

Bleeding can manifest as either external or internal, with the severity often determined by the mechanism of injury.

Recognizing the severity of bleeding is crucial to providing appropriate first aid.

There are three main types of bleeding:

1. Capillary bleeding: Capillaries are small blood vessels that connect arteries and veins. Capillary bleeding is characterized by a slow, oozing flow, is often associated with superficial wounds, and is normally not life-threatening.
2. Venous bleeding: Veins carry blood back to the heart, and bleeding from a vein is usually darker and steadier. Venous bleeding is potentially life-threatening.
3. Arterial bleeding: Arteries carry oxygenated blood away from the heart, and bleeding from an artery is typically bright red and spurts in time with the heartbeat. Arterial bleeding is usually life-threatening.

NOTE: While venous bleeding is serious, it is often easier to control compared to arterial bleeding. Arterial bleeding is considered more severe and is usually life-threatening. Capillary bleeding can be readily stopped by applying direct pressure.

How to Recognize Severe Bleeding?

Severe bleeding occurs when a large blood vessel is cut or torn (veins and arteries). The wound is often larger or deeper than those causing minor bleeding. You may observe significant pooling of blood around the person.

The person can lose a large amount of blood within minutes, and the bleeding can quickly become life-threatening if not controlled.

It is crucial to promptly stop the bleed and call your local emergency number if:

• There is a lot of blood on the floor.
• You cannot stop the bleeding.
• You see an open fracture.
• You see signs of shock.
• You suspect a head, neck, or spine injury.
• You are not sure what to do.

Nevertheless, even if the sight of blood may be challenging, it is important to stay calm. Bleeding often looks worse than it is. Most bleeding can be stopped with pressure.

NOTE: Profuse bleeding can lead to severe complications and requires professional medical intervention. Losing about 30% of blood volume can lead to shock and death. Therefore, it is essential to stop the bleed and call emergency medical services quickly.

Dressing VS Bandaging

Many people confuse the terms dressing and bandage. Here is what they mean and how they work together:

• A dressing: clean material used directly on a wound to stop bleeding. It can be a piece of gauze or any other clean piece of cloth.
• A bandage: clean material used to protect or cover an injured body part. A bandage may also be used to help keep the pressure on a wound. If necessary, you can hold gauze dressings in place over a wound with a bandage.

NOTE: If available, always use gloves to protect yourself from contaminations and bloodborne pathogens.

First Aid actions to Stop Bleeding with Direct Pressure and Bandaging

Follow these first aid action steps to help someone who is severely bleeding with direct pressure and bandaging:

1. Make sure the scene is safe: Before approaching the victim, assess the scene for any potential hazards to ensure your safety and the safety of others.
2. Ask permission to help: Obtain the person's consent before to help.
3. Reassure the person: Make sure the person stays calm and rests.
4. Assess the situation: Evaluate the severity of the bleeding.
5. Seek for medical assistance: For severe bleeding, immediately call your local emergency number (1.6.6.9 in Thailand). Ask someone to get the first aid kit and AED, if available.
6. Put on gloves and personal protective equipment (PPE): Protect yourself by wearing gloves and any other necessary PPE to prevent exposure to bloodborne pathogens. If possible, have the person apply direct pressure to the wound while you put on your PPE.
7. Apply Direct Pressure: Use a clean cloth or dressing to apply firm pressure directly on the wound. Use the flat part of your fingers or the palm of your hand. Maintain pressure until the bleeding stops or significantly decreases.
8. If the bleeding does not stop: you will need to add a second dressing and press harder. Keep pressure on the wound until it stops bleeding. Do not remove a dressing once it is in place because this would cause the wound to bleed more.
9. Apply Bandage: Once the bleeding has stopped or significantly decreased, wrap a bandage firmly over the dressings to hold them in place.
10. Maintain body temperature: Check for signs of shock and cover the person with a blanket to keep them warm.
11. Check for other injuries: Check for other potential injuries on the person's body and give first aid if necessary.
12. Monitor and stay with the person: 
13. Remain with the person until emergency help arrives and takes over.
14. If the person becomes unresponsive but is breathing normally, place them in the recovery position.
15. If the person is not breathing normally, give CPR.

NOTE: For minor cuts, wash the area with soap and water. Then, apply a dressing to the wound.

What is a Tourniquet?

If an arm or leg has severe bleeding and you can't stop the bleeding with direct pressure and a compression bandage, you can use a tourniquet.

A tourniquet is a constricting device applied to a limb to restrict blood flow. If applied correctly, a tourniquet should stop the bleeding.

Your first aid kit should contain a premade or manufactured tourniquet, which is made of:

• A strap that you can wrap around the injured person's arm or leg and a straight.
• A windlass, a stick-like object used to tighten the tourniquet.
• A clip where the windlass must be locked.

NOTE: Remember, tourniquets should only be used as a last resort for severe, life-threatening bleeding that cannot be controlled by other means. They carry risks such as tissue damage, nerve injury, and compartment syndrome if left in place for too long (typically after 2 to 3 hours).

How do I Apply a Tourniquet?

Follow these first aid action steps to apply a premade tourniquet from your first aid kit:

1. Make sure the scene is safe: Before approaching the victim, assess the scene for any potential hazards to ensure your safety and the safety of others.
2. Ask permission to help: Obtain the person's consent before to help.
3. Reassure the person: Make sure the person stays calm and rests.
4. Assess the situation: Evaluate the severity of the bleeding. Use a tourniquet if you can't stop the bleeding with direct pressure and a compression bandage,
5. Seek for medical assistance: For severe bleeding, immediately call your local emergency number (1.6.6.9 in Thailand). Ask someone to get the first aid kit and AED, if available.
6. Put on gloves and personal protective equipment (PPE): Protect yourself by wearing gloves and any other necessary PPE to prevent exposure to bloodborne pathogens. If possible, have the person apply direct pressure to the wound while you put on your PPE.
7. Place the tourniquet: Position the tourniquet proximal (closer to the body) to the bleeding site, between the wound and the heart (about 2 inches above the injury, if possible).
8. Secure the tourniquet: Tighten the tourniquet until the bleeding stops and fasten it securely around the limb.
9. Note the time: Once you have the tourniquet in place and the bleeding has stopped, note what time the tourniquet was placed on the body.
10. Do not Remove: Once applied, do not remove the tourniquet or release the pressure; leave it alone until someone with more advanced training arrives and takes over.
11. Maintain body temperature: Ensure that the person is kept warm.
12. Check for Injuries: Check for other potential injuries on the person's body and give first aid if necessary.
13. Monitor and stay with the person: Remain with the person until emergency help arrives and takes over. If the person becomes unresponsive but is still breathing, place them in the recovery position. If the person is not breathing normally, give CPR.

NOTE: The use of tourniquets in civilian and military settings significantly improves survival rates for patients with severe limb trauma and life-threatening bleeding. A study of combat casualties in Iraq and Afghanistan found that tourniquet application was associated with a 92% survival rate among those with extremity injurie.

Conclusion

In managing external bleeding, swift action is paramount. By recognizing the severity of the situation and employing techniques such as applying direct pressure and proper bandaging, we can significantly impact outcomes, potentially saving lives and minimizing complications. Equipping ourselves with the knowledge and skills to handle severe bleeding empowers us to respond effectively in emergencies, ensuring the best possible care for those in need.