Severe bleeding and shock
Press hard and keep pressing to stop heavy bleeding, and look after someone who is going into shock.
SEVERE OR NOT
How to tell bleeding is severe
Most cuts ooze and slow down on their own. Severe bleeding looks different: blood spurting or pouring out, soaking through clothes or a pad quickly, or pooling on the ground. Someone can lose a dangerous amount of blood in minutes, so this comes straight after the airway and breathing checks. Call the emergency number, or point at one person and tell them to call, and start pressing.
A knife slips and Sara's palm bleeds, then slows within a minute under a cloth: an ordinary cut. Blood running steadily down Reza's leg and darkening his whole trouser leg: severe.
Check yourself
On a football pitch, Reza slides into a broken bottle. Blood is pouring from his thigh and has soaked his sock. He's awake and talking, and the glass has been cleared away. What do you do?
- Have someone call 115, and press hard on the wound with a cloth and keep pressing
- Raise his leg and wait a few minutes to see if it slows down
- Tie your belt tightly around his leg above the wound
- Help him walk to a car so you can drive him to hospital
Show the answer
Have someone call 115, and press hard on the wound with a cloth and keep pressing
Right. Pouring blood that soaks clothing is severe, and firm pressure on the wound is what works. Getting the call made at the same time means help is on its way while you press.
Direct pressure, step by step
- Protect your hands
Gloves if there are any. If not, a clean plastic bag over your hand works in a pinch. If the person is alert, they can press on the wound themselves while you get ready.
- Press a pad firmly on the wound
A clean dressing, or a cloth or T-shirt folded into a pad; if there's nothing, your gloved hand. Press hard, right where the blood is coming from. Raising the limb or pressing on "pressure points" elsewhere, which older courses taught, is no longer a main step in current European guidance: pressure on the wound is what works.
- Keep pressing, and don't peek
Hold firm, continuous pressure for at least about 10 minutes. Lifting the pad to check lets the bleeding start again.
- Soaked through? Add, don't remove
Put another pad on top of the first and press harder. Pulling off the first pad disturbs the clot that is starting to form.
- Bandage firmly, then check fingers or toes
Wrap a bandage over the pads firmly enough to keep the pressure on. If the fingers or toes beyond it go cold, pale or blue, it's too tight: loosen it a little.
Check yourself
Five minutes in, blood has soaked right through the cloth Parisa is pressing on her brother's arm. What should she do?
- Take the soaked cloth off and press with a fresh one
- Put another cloth on top and press harder
- Lift the cloth to see exactly where the blood is coming from
- Stop pressing and hold his arm above his head instead
Show the answer
Put another cloth on top and press harder
Yes. Layer on top and press harder. The first cloth stays where it is, so the clot forming under it isn't pulled away.
Something stuck in the wound
Pull it out
It feels like the obvious thing to do. But a piece of glass or a knife can be plugging the wound. Pulling it out can release bleeding it was holding back, and do more damage on the way out.
Leave it in, press around it
Press firmly on either side of the object, not on it. Build pads up around it so a bandage can go over them without pushing on the object, and call for help. It gets removed in hospital.
Check yourself
A shard of glass from a shattered shop window is stuck in Kian's forearm, and the cut around it is bleeding. What's the right move?
- Pull it out quickly so you can press on the wound properly
- Leave it in, press on either side of it, pad around it and call for help
- Press down hard on the glass itself to seal the cut
- Rinse it under the tap until it slides out
Show the answer
Leave it in, press on either side of it, pad around it and call for help
Right. The glass may be plugging the wound, so it stays. Pressure goes on either side of it, and pads built up around it keep a bandage off it.
TRAINED USE ONLY
Tourniquets: a tool for trained hands
A tourniquet is a tight band around an arm or leg that stops blood flowing to the wound below it. For life-threatening bleeding from a limb that firm pressure can't control, current guidance recommends a manufactured tourniquet, applied by someone trained to use one. Improvised ones, like a belt or a scarf, often fail to stop the bleeding. So for you, today, pressure is the tool. If you want to be able to use a tourniquet, learn it hands-on first, for example on a bleeding-control course.
If a trained person does put one on, the time matters to the hospital: note when it went on and tell the paramedics.
Shock
A dangerous state where not enough blood is flowing round the body, for example after heavy bleeding. It isn't the same as being frightened or upset. Signs: pale, cold, clammy skin; a fast, weak pulse; fast, shallow breathing; thirst, dizziness or confusion; later, growing drowsiness.
After a fall from a scooter, Leila's wound is under control, but she's gone grey, her skin is cold and sweaty, and she keeps asking for water. Those are signs of shock: look after her as if it is.
Looking after someone in shock
- Treat the cause and call
Keep pressure on any bleeding, and make sure the emergency number has been called. Tell them you think the person may be in shock.
- Help them lie down
On their back, on a coat or mat if you can. Don't let them walk around.
- Keep them warm
Cover them with a coat or blanket, and put something between them and the cold ground.
- Loosen and reassure
Loosen tight clothing at the neck, chest and waist. Stay with them and talk calmly.
- Nothing to eat or drink
They may need surgery. If they're very thirsty, you can moisten their lips.
- Keep watching their breathing
If they become unresponsive, go back to the start: check response and breathing, and start CPR if they aren't breathing normally.
Check yourself
Leila is showing signs of shock. Which of these help her, and which don't?
- Helping her lie down on a coat
- Giving her a glass of water because she's thirsty
- Putting a jacket over her and something under her
- Walking her around to get the blood flowing
- Loosening her tight belt
- Giving her a biscuit for energy
Show the answer
Helps: Helping her lie down on a coat, Putting a jacket over her and something under her, Loosening her tight belt
Don't do this: Giving her a glass of water because she's thirsty, Walking her around to get the blood flowing, Giving her a biscuit for energy
A nosebleed, done right
- Sit up and lean forward
Leaning forward lets blood run out of the nose instead of down the throat, where it can cause coughing or vomiting.
- Pinch the soft part of the nose
Just below the hard, bony bridge. Breathe through the mouth.
- Hold for 10 to 15 minutes
Without letting go to check. Watch a clock; it's longer than it feels.
- Get help if it won't stop
If it's still bleeding after about 20 to 30 minutes, or it started after a blow to the head, get medical help.
Check yourself
Maryam's son gets a nosebleed at a family lunch. She should tilt his head back so the blood stops running.
Show the answer
False
False. Tilting the head back sends blood down the throat, which can make him cough or vomit, and it doesn't stop the bleeding. Sit him up, lean him forward and pinch the soft part of his nose for 10 to 15 minutes.
Lesson recap
- Severe bleeding pours, spurts, soaks through or pools. After danger, response and breathing, it's next: get the call made and press.
- Press a pad firmly on the wound and keep pressing for at least about 10 minutes without peeking. Soaked through? Add a pad on top and press harder.
- Never pull out an embedded object: press on either side of it and pad around it.
- Tourniquets are for trained hands with a manufactured device. For you, pressure is the tool.
- Shock means not enough blood flow: pale, cold, clammy, breathing fast, confused. Lie them down, keep them warm, nothing to eat or drink, watch their breathing.
- Nosebleed: sit up, lean forward, pinch the soft part for 10 to 15 minutes. And the next step for all of this is a hands-on first aid course.