First Aid for Severe Bleeding Certification Manual: Steps to Control Bleeding

Controlling Severe Bleeding

Severe external bleeding can quickly reduce the amount of oxygen-rich blood reaching the body’s tissues and organs, leading to shock, organ damage, cardiac arrest, or death. Call 911 and begin bleeding control immediately. Use firm direct pressure first, followed by a commercial tourniquet or wound packing when appropriate and according to your training.

Steps to Control Bleeding With Direct Pressure:

1. Ensure scene safety and use disposable gloves or another protective barrier if available
2. Call 911. If another person is present, have that person make the call and retrieve the bleeding-control kit while you begin care
3. Locate and expose the source of the bleeding
4. Place gauze, a hemostatic dressing, or a clean cloth directly over the wound. (A hemostatic dressing contains an agent that helps promote rapid blood clotting and may be used according to the responder's training and product instructions)
5. Apply firm, continuous pressure. Use both hands when appropriate and position the injured area on a firm surface when possible
6. If an object is embedded in the wound, do not remove it. Apply pressure around the object and stabilize it with bulky dressings.
7. Do not repeatedly lift the dressing to check whether the bleeding has stopped
8. If blood soaks through the original dressing, maintain pressure. One additional gauze pad may be placed over the original dressing if needed, but do not build a large stack of dressings
9. Once bleeding is controlled, secure the dressing with a bandage and monitor for renewed bleeding
10. Continue monitoring the person’s responsiveness and breathing until EMS takes over

Using a Tourniquet

Use a commercial tourniquet for life-threatening bleeding from an arm or leg when direct pressure is ineffective or impractical.

Steps to use a tourniquet:

1. Place the tourniquet approximately 2 to 3 inches above the wound, between the wound and the heart
2. Do not place the tourniquet directly over a joint
3. Pull the strap tightly and secure it
4. Twist the windlass until the bleeding completely stops
5. Secure the windlass so it cannot unwind
6. Record the application time and leave the tourniquet visible
7. If bleeding continues, apply a second commercial tourniquet above the first if one is available and its use is consistent with your training
8. Do not loosen or remove the tourniquet
9. Continue monitoring the person until EMS takes over

Using Wound Packing

Use wound packing for life-threatening bleeding from an appropriate deep wound when a tourniquet cannot be applied and you are trained to perform the procedure.

First aid steps for wound packing:

1. Locate the source of the bleeding.
2. Pack plain gauze or hemostatic gauze firmly into the wound cavity.
3. Continue packing until the wound cavity is filled.
4. Apply firm, continuous pressure over the packed wound.
5. Secure the packed wound with a pressure bandage when bleeding is controlled.
6. Do not pack wounds of the chest or abdomen.
7. Continue monitoring for renewed bleeding until EMS takes over.

Once wound packing has been placed, do not remove it. Maintain firm pressure and leave the packing in place until EMS takes over. Begin CPR and use an AED if the person becomes unresponsive and is not breathing normally.