"All I saw was RED!"

Firm pressure applied directly over the site of the wound (“direct pressure”) is the most effective method for controlling bleeding. However, when dealing with any body fluid it is imperative that the provider takes precaution to isolate himself/herself from the body substance. Traditionally this is done by wearing latex or vinyl gloves, face shields or goggles, and /or fluid barrier gowns. In the field these items may not be available and the provider is encouraged to improvise.

The wound should be covered with a clean, thick absorbent pad and direct pressure applied through the pad. If the pad becomes soaked with blood, an additional pad should be added to the first. The original pad should NOT be removed, this will only destroy any clotting that may have already formed. If the bleeding is ARTERIAL, pads (no matter how many) may not actually control the flow of blood. This type of bleeding is "high pressure," and will be characterized by spurting blood. It may actually be necessary to "pinch off" the artery (using a gloved or protected hand) by reaching into the wound and grabbing the source of the spurting blood then pinching it. Your patient is NOT GOING TO LIKE YOU. This, no doubt, will hurt. But left un-pinched, the patient will bleed to death in a relatively short period of time, and I hate when that happens.

If the bleeding does not seem to be arterial, but is very persistent, elevate the wound above the level of the patient's heart while applying direct pressure. If additional blood-loss control is needed, pressure points located in the extremities (just below the biceps in the arms, and on the inner surface of the upper thigh in the legs [Illustration],) may help slow the flow of blood. It is necessary to exert extreme pressure when using pressure points and will probably require the assistance of another person. If you suspect that the patient has a broken bone in the extremity that is bleeding, then it is best NOT to move it excessively. This extremity probably should not be elevated and pressure points should NOT be used in extremities that have broken bones.

If the wound is so large that internal organs are protruding out though the opening, bleeding control is probably NOT your first concern. Cover the opening with large clean pads, do not attempt to replace any of the organs or any part of the organs, and keep the patient from moving.

If the wound is the result of some protruding object (a knife, pencil, telephone pole, etc.,) guard against any additional injury by immobilizing the object as soon as possible. DO NOT attempt to remove the object (especially if it's a telephone pole.) Hey, I warned you. Keep the patient calm and don't move them.

If the protruding object is in the eye, immobilize it as suggested above, then cover both eyes to help avoid any involuntary movement of the eyes. Remain with the patient and keep them calm.

NOSEBLEEDS

Direct pressure is still the best "fix." Have the patient sit down and lean forward. Apply pressure to both sides of the nose, high on the bridge of the nose. Cool or cold towels, or ice packs can be applied to the back of the neck, if comfortable for the patient, to help lower blood pressure and "slow the flow."

DO NOT pack anything into the nostrils.

DO NOT tilt the head back. Swallowed blood is a irritant to the lining of the stomach and just about the time you get this nosebleed to stop, the patient will vomit and the bleeding will resume.

Generally speaking, as is the case with most first aide, bleeding control is accomplished by practicing common sense. Remember to protect yourself from exposure to body substances and keep in mind that if you do nothing.....all bleeding eventually stops.