Controlling excessive bleeding is one of those things that can overwhelm people. There are all kinds of acronyms and other memory boosters that try to help you remember what you are supposed to do. I have a hard time remembering things like that under normal conditions, much less in a high-stress situation! In this article I am going to talk about how to stop bleeding and why it is the first thing to do when treating trauma. I’m also going to explain why you do the things you do. If you know why you’re doing something, then you don’t have to memorize a checklist or acronym that you probably forget in the heat of the moment.

A long time ago, a Special Forces medic told me something that has stuck with me to this day: “Put your hands on red.” This simple phrase has crossed my mind every time I’ve had to work with someone who is bleeding uncontrollably (mostly blast-related traumatic amputations). It is simple, easy to remember, and easy to implement. It also does something else … it makes you do something. Simply taking action can often overcome that initial shock and carry you into the fight.

Why is blood loss treated first?

The circulatory system works like a hydraulic system. If there is not enough liquid in the system, the pressure drops. The pump has to work harder and harder to move the fluid through the system as the pressure drops. Ultimately, the pump can no longer move fluid through the system. That is why it stops severe blood loss first and as quickly as possible. If your patient loses a lot of blood, it doesn’t matter if the person is breathing.

How do you stop bleeding?

You should take the time to put on a pair of surgical gloves if you have them available. This is for your own protection against any blood-borne diseases your patient may have. Yes, it will also stop some contamination of the wound and prevent infection, but this is secondary.

This article focuses primarily on stopping blood loss from serious injuries. For a smaller, more manageable wound, applying direct pressure is the best option. Apply a bandage to the area, press on the wound with your hand or use a compression bandage (such as an Israeli bandage), and elevate the wound above the heart if possible. This reduces blood flow to the area and helps stop bleeding. If the bleeding does not stop, you will need to apply a tourniquet or an impregnated hemostatic dressing (explained below).

When is a tourniquet applied?

For amputations and gushing appendage wounds, immediately apply a tourniquet.

Place the tourniquet 2-3 inches above the wound and tighten until blood flow stops. Our goal here is to apply as much pressure as necessary to stop the flow of blood. With amputations, I have found that the correct amount of pressure is simply the amount of pressure needed to stop blood flow. When treating intact limbs, you should tighten the tourniquet until there is no pulse (taken at the wrist or ankle).

For amputations, try applying the tourniquet lower than the next joint to the appendix. For example, if someone has had a mid-forearm amputation, they would place the tourniquet below the elbow. This increases the likelihood that the elbow and stump below it can be salvaged, making prosthetic placement much easier. Don’t try to save a joint instead of effectively placing the tourniquet!

Stay with the patient until they are released to a higher level medical authority. Be sure to inform medical staff that a tourniquet was used and the time it was applied. You should mark the patient with a “T” and the time the tourniquet was applied if you cannot keep it (if you need to go get help).

Never cover a tourniquet! The intent here is to ensure that it is obvious that a tourniquet was applied. You don’t want your patient to come to a hospital and wait hours with a tourniquet on.

Take some time to practice this on yourself.

Apply a tourniquet to your own arm or leg and tighten it until you do not feel a pulse. This will give you an idea of ​​exactly how much pressure it will take to stop bleeding in other people. It will also teach you how to put on a tourniquet if you are ever injured while alone.

Isn’t a tourniquet used only as a last resort?

Anyone who has served in the military since the Iraq war has probably already learned this. I was surprised to see that there is still so much debate about tourniquet application in the civilian world. According to studies in 2012, the early application of tourniquets to the extremities during the wars in Iraq and Afghanistan saved between 1,000 and 2,000 lives. All with almost no record of long-term damage to these personnel.

Two hours is the generally accepted period of time that a tourniquet can be in place. Post-tourniquet syndrome is sometimes found in patients who have a tourniquet for periods longer than 2 hours. This syndrome is characterized by loss of sensation in the limb. Patients normally regain a feeling of fullness in their extremities in 1-6 weeks.

Using a tourniquet on patients is a proven way to save lives. When you are more than 2 hours away from a higher level of care, you should try to stop the bleeding by applying direct pressure first. If this doesn’t work, feel free to apply a tourniquet.

Types of turnstiles.

There is a wide variety of commercially available turnstiles for sale. I prefer the combat application tourniquet, but others like the SOF tactical tourniquet. You will both get the job done and it really comes down to personal preference. Practice is key regardless of the type of tourniquet you decide to wear.

One company, RevMed, makes a daily ratcheting belt called the Parabelt that can act as a suitable tourniquet. It seems like a decent option for everyday wear, but it might not be the best if you’re carrying a gun (and it should!).

You can always improvise a tourniquet if necessary. According to various EMS magazines, a manual blood pressure cuff is one of the best makeshift tourniquets. I never tried it, but it came up several times in my research.

Makeshift turnstile

Other makeshift tourniquets can be made from a t-shirt, belt, rope, or other piece of material and a hard item that can be used as a windlass. Try to use a strip of material that is at least one inch wide. The narrower your tourniquet, the more likely you are to damage the tissue and nerves under the tourniquet. Start by tying your makeshift tourniquet around the limb, then place the windlass on top of the knot and tie another knot on top. Use the windlass to tighten the tourniquet and then secure the windlass in place.

What is a hemostatic dressing and how is it used to stop bleeding?

A hemostatic dressing is a bandage that is impregnated with a hemostatic agent. These agents accelerate the body’s natural clotting ability. They were originally designed for the battlefield, but are now being used throughout the civilian world by hunters, hikers, mountain bikers and the prepared. QuikClot Gauze and Celox Z-Fold Gauze are common examples of these types of dressings.

Haemostatic dressings really stand out when it comes to stopping bleeding from a wound in areas where it is difficult to put direct pressure on an artery (such as a wound in the upper groin). They are also useful for deep wounds (like a gunshot). Large, wide bandages are best for more open wounds. Long, thin bandages are best used on penetrating wounds.

Pack the dressing on the wound, trying to cover the entire bleeding surface. You can use another hemostatic dressing, or normal dressings, to fill the wound cavity for very wide wounds. Apply pressure to the wound with your hand or by applying a pressure bandage. By squeezing the wound, you are creating pressure that will help form a clot and stop the bleeding.

Pressure points

The two most commonly used pressure points are over the brachial artery (at the top of the armpit) and the femoral artery (at the top of the groin). To help stop bleeding from a wound, apply pressure to the brachial artery for an arm injury and the femoral artery for a leg injury.

If you are working with a partner, have one person apply pressure to the pressure point while the other treats the wound. If you are alone, you can use your knee to put pressure on the femoral artery so that you can use both hands while treating the wound. A good way to put pressure on the brachial artery is to place something in the armpit area and then use your leg to push the patient’s arm toward your body, putting pressure on the artery. You can even do this to yourself if you have to. Place a rolled towel or t-shirt in your armpit and put your body weight on that arm.

If you are using the carotid artery to try to reduce bleeding from a head injury, DO NOT apply pressure on both sides! It will cut off the blood flow to the brain and cause the patient to lose consciousness.

Final thoughts:

You are going to be nervous! This is absolutely normal, especially if you are treating a loved one. Take a deep breath and try to calm yourself.

With some amputations, it is difficult to know if the bleeding has stopped. This is especially true if you are on a surface that quickly absorbs blood. Before moving on to another patient, make sure blood flow has stopped.

Do something! Your actions can mean the difference between life and death.

I carry these three items: Adventure Medical Trauma Pak, Ever Ready Battle Dressing (aka Israeli Bandage), and the Combat Appliance Tourniquet. For around $ 60 it can stop almost any type of bleeding. Together they make a kit that can fit in a large pocket or slip into a pack or purse. This is not the end of all, be it all trauma kits, but it is very robust for the size and the cost.

As always, contact your local Red Cross for proper first-hand training. This article is as comprehensive and up-to-date as we can make it, but it is not a substitute for first-hand training.