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Bleeding Control

EMERGENCY
SEVERE BLEEDING = LIFE THREAT
Arterial: Bright red, spurting with pulse - can kill in minutes
Venous: Dark red, steady flow - serious but slower
Capillary: Slow oozing - usually self-limiting

Immediate Steps

  1. Scene safety - your safety first
  2. Call 911 for severe bleeding
  3. Expose wound - cut clothing if needed
  4. Identify source - may be multiple wounds
  5. Apply direct pressure - this is primary treatment

Direct Pressure

Technique

  1. Place clean cloth, gauze, or clothing directly on wound
  2. Press FIRMLY with palm or fingers
  3. Hold continuous pressure - 10-15 minutes minimum
  4. If blood soaks through, add MORE cloth on top - do NOT remove first layer
  5. Do NOT peek - every release restarts clotting

Use your body weight if needed. Lean into it. Direct pressure stops 90%+ of bleeding if applied correctly and long enough.

Wound Packing (Deep Wounds)

  1. For deep wounds (gunshot, stab, large laceration), packing may be needed
  2. Use hemostatic gauze (QuikClot) if available, otherwise regular gauze or clean cloth
  3. Push gauze DEEP into wound cavity with finger
  4. Pack tightly until wound is full
  5. Hold firm pressure on top of packed wound for minimum 3 minutes (hemostatic) or 10+ minutes (regular)
  6. Bandage over packing

Source: Hemostatic gauze from North American Rescue, Chinook Medical ($25-40/pack). Training recommended.

DIY: Any clean cloth packed tightly into wound. Sanitary pads are actually excellent wound packing material - designed for absorption. Tamp down with stick or finger.

Elevation

For limb wounds, elevate above heart level WHILE maintaining direct pressure. Gravity reduces blood pressure at wound site. Less effective for arterial bleeding but still helpful.

Don't elevate if fracture suspected, if it causes more pain, or if bone visible.

Tourniquets

WHEN TO USE: Life-threatening limb bleeding not controlled by direct pressure. Amputation. Obvious arterial spurting. Multiple casualties (triage situation - tourniquet frees you to help others).

Commercial Tourniquet Application

  1. Apply 2-3 inches ABOVE wound (between wound and heart) - NOT over joint
  2. Place as high on limb as possible if wound location unclear
  3. Thread strap through buckle, pull TIGHT
  4. Twist windlass rod until bleeding STOPS
  5. Secure windlass in clip/holder
  6. Note TIME applied - write on patient's forehead or tourniquet itself
  7. Do NOT loosen - leave for medical personnel

Source: CAT (Combat Application Tourniquet) Gen 7 ~$30 from North American Rescue. SOF-T Wide ~$35. RATS (Rapid Application Tourniquet) ~$20. BUY FROM AUTHORIZED DEALERS - fakes fail.

DIY: Cravat/bandana + stick. Wrap wide cloth (2+ inches) around limb, tie knot, insert stick, twist until bleeding stops, secure stick. Belt works but difficult to tighten enough. Blood pressure cuff inflated above systolic pressure works.

FAKE TOURNIQUETS ARE COMMON. If price seems too good ($8-15), it's counterfeit. Real CAT has markings, quality stitching, official packaging. Fakes break under stress when you need them most.

Tourniquet Myths

Pressure Points

If tourniquet not possible and direct pressure insufficient:

Brachial Artery (Arm)

Location: Inside upper arm, between biceps and triceps, about halfway between shoulder and elbow.

Technique: Place thumb or fist in groove, press against humerus bone. Maintain while other hand applies direct pressure to wound.

Femoral Artery (Leg)

Location: Groin crease, midpoint between pubic bone and hip bone.

Technique: Place fist or heel of hand in crease, press FIRMLY down and backward against pelvic bone. Use body weight. Very strong pressure needed.

Popliteal Artery (Knee)

Location: Behind knee, in center of crease.

Technique: Press thumb deep into center of knee crease against back of femur.

Special Wounds

Head/Scalp

Scalp bleeds heavily - lots of blood vessels. Direct pressure works but may need to clear hair from wound. Use comb or fingers to push hair aside. Don't press on skull fracture (depressed area, bone fragments) - pack around it. Watch for brain injury signs.

Neck

Dangerous due to airway and major vessels. Apply direct pressure but don't compress both sides of neck simultaneously. If penetrating object in neck, stabilize - don't remove. May need to apply pressure from both sides.

Torso

Cannot use tourniquet. Direct pressure or wound packing. For deep wounds, pack cavity. For penetrating object, stabilize - do NOT remove (may be tamponading bleeding). Cover open chest wounds with vented chest seal or 3-sided occlusive dressing.

Junctional (Groin, Axilla/Armpit)

Cannot use standard tourniquet. Junctional tourniquets exist (Sami JT, Abdominal Aortic Tourniquet) but are specialized. Direct pressure + packing is primary. For groin: femoral pressure point + pack wound. For armpit: pack + pressure point.

Source: Junctional tourniquets from medical suppliers, $150-300+. Not commonly available.

Internal Bleeding Signs

Internal bleeding cannot be treated in the field. Evacuate immediately. Keep patient lying down, legs elevated if no abdominal injury. Keep warm. Nothing by mouth. Monitor vital signs.

Shock

Severe bleeding leads to hypovolemic shock. See SHOCK guide for detailed treatment. Briefly:

Materials

Direct Pressure

Gauze pads (4x4), trauma dressings (Israeli bandage, OLAES), abdominal pads, clean cloth, t-shirts, towels.

Source: Israeli bandages $5-8 each, OLAES $10-15, gauze $3-5/pack. Amazon, medical supply, first aid stores.

DIY: Any clean cloth. Sanitary pads excellent for absorption. Diapers work. Towels for major bleeding. T-shirts for smaller wounds.

Hemostatic Agents

QuikClot Combat Gauze (kaolin), Celox Gauze (chitosan), ChitoGauze. Accelerate clotting when packed into wounds.

Source: North American Rescue, Chinook Medical, Amazon (verify authenticity). $25-45 per package.

DIY: No true substitute. Sugar or honey in wound can help (historical methods) but not equivalent. Direct pressure with regular gauze still works.

Pressure Dressings

Israeli (Emergency) Bandage: combines dressing + pressure bar + wrap. OLAES: has packing gauze inside, pressure bar. Elastic wrap with gauze.

Source: Israeli bandages $5-8, widely available. OLAES $10-15. Medical supply, Amazon, first aid kits.

DIY: Gauze on wound, wrap with elastic bandage (ACE wrap) firmly. Or gauze + tape with firm pressure. Achieve same goal with basic materials.

REMEMBER:
1. Direct pressure first - 10+ minutes
2. Tourniquet for life-threatening limb bleeding
3. Pressure points if needed
4. Treat shock - keep warm, legs up
5. Get to surgery
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