PROMPT FIRST AID for a bleeding wound aims to stop bleeding and to prevent or treat shock. Controlling blood flow can mean the difference between life and death for someone with a severe wound involving an artery or a large vein. Here's what to do.
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Treat the victim
* Have the victim stop activity. If he's conscious and alert, direct him to immediately cover the bleeding wound with any available clean, dry material and to apply firm, direct pressure while you put on gloves and other protective gear.
* Assist him to a comfortable position, unless bleeding is severe or he's feeling light-headed or dizzy. In that case, have him lie down and elevate his feet to achieve a modified Trendelenburg position and increase blood pressure (BP).
* Assess the victim's airway, breathing, and circulation. If his airway is compromised or his breathing is ineffective, intervene to maintain the airway and support respiration before focusing on hemorrhage control.
* Make sure he doesn't have other injuries that might be a greater threat to survival than the bleeding wound, such as a cervical spine injury.
* Don't remove an impaled object from the wound, which could cause severe, uncontrolled bleeding. Instead, stabilize the object in place using rolls of gauze or similar items to prevent movement and inadvertent dislodgment.
* Examine the injury. If bleeding is active and involves an arm or leg, make sure the limb is elevated above the victim's heart. Layer dressings over the wound while applying pressure to the bleeding site. Gauze or a large, clean cloth works well.
* Don't wet the dressing; this would inhibit blood clotting.
* Don't remove a saturated dressing and replace it with dry material. This would disrupt clot formation and impair your ability to control bleeding.
* As the dressing becomes saturated with blood, continue to pile more dressings on top. Apply firm, direct pressure to achieve hemostasis. Consider using an elastic bandage to provide compression if necessary.
* If you can't stop the bleeding, have someone call 911 while you apply pressure over arterial pulse points proximal to the site of hemorrhage. For example, to control hemorrhage from a lacerated radial artery, apply pressure over the brachial artery at the antecubital fossa.If no other hemorrhage control technique is effective, you may need to apply a tourniquet to stop life-threatening blood loss. Consider using a tourniquet only as a last resort, however, because pressure from a tourniquet can cause ischemia and may threaten the limb's viability. Apply a tourniquet only if you must risk a limb to save a life.
* Take the victim's baseline vital signs. If you must continue applying pressure to the wound or proximal artery, you can probably take his pulse and respiratory rate and estimate his systolic BP by assessing for the presence of pulses in specific areas: radial indicates 80 mm Hg or greater; femoral, at least 70 mm Hg; and carotid, 60 mm Hg.
* Find out how the injury occurred and assess for any factors that may contribute to blood loss, including anticoagulant use (warfarin, aspirin, other antiplatelet drugs) or medical conditions that predispose the victim to hemorrhage (hemophilia, liver disease).
* Don't clean a severely bleeding wound; leave that intervention to emergency department personnel. Cleaning the wound could trigger more bleeding. You can clean a minor wound with soap and water.
Pass on information
Report to the emergency medical providers how the injury occurred, as described by the victim or bystanders. Note any first-aid measures used before you intervened. Communicate your assessment findings, emergency care interventions, and the victim's response.
Items that can help
* gloves to protect you from contact with blood and body fluids
* eye and face protection and a fluid-impervious cover-up if spattering is likely
* gauze or any clean, dry material to layer over the wound, including washcloths, towels, clothing, and even feminine hygiene products such as sanitary napkins
* an elastic bandage to fashion a pressure dressing
Linda Laskowski-Jones is vice-president of emergency, trauma, and aeromedical services at Christiana Care Health System in Wilmington, Del.