Are you confident that you could stop a major bleed? We’ve all heard, "apply direct pressure!" But do you know how much pressure to apply? Do you know when to reach for a tourniquet?
The nuances are important. Though emergency medicine strives for simplicity, some things can be oversimplified.
"Everything should be made as simple as possible, but no simpler."
- Albert Einstein
With that said, let's explore some of the biggest mistakes people make when they attempt to stop a major bleed.
6 Common Mistakes People Make when Controlling a Bleed
In this section, we list the most common mistakes people make when controlling a major bleed.
Mistakes to avoid:
- Not holding direct pressure hard enough
- Not holding direct pressure long enough
- Hesitating to apply a tourniquet
- Misunderstanding wound packing
- Getting distracted
- Believing trauma pads are magical (and stacking on too many!)
Let's explore these mistakes in more depth.
1. Not Applying Enough Pressure
When you take a first-aid class, often the instructor will tell you, "What do we do for a major bleed? Hold direct pressure." And that's the extent of the information. Usually, they explain this while placing their hand lightly over their forearm.
What's the problem? This isn't direct pressure - this is more like general pressure. When someone is bleeding, you need to provide firm, direct pressure - not general soft pressure.
Think about the pressure you feel when a blood pressure cuff inflates over your arm - it gets uncomfortable, doesn't it? You should try to give at least this much pressure, if not more.
Key point: Apply firm, steady, direct pressure.
2. Not Holding Direct Pressure for Enough Time
Another big problem is releasing pressure too soon or constantly checking to see if the wound is still bleeding. You should be holding firm, direct pressure for at least 5 minutes.
The only way you should be checking to see if the wound is still bleeding is by inspecting around your fingers or the gauze. If the gauze still appears to be soaking up blood, you may want to adjust how you're holding pressure.
Note: Don't just continually stack gauze pads on top of each other! All you're doing is catching the blood. We're not trying to catch the blood - we're trying to stop it!
Here's a video explaining how we've been doing bleeding control wrong.
3. Hesitation to Apply a Tourniquet (When You Know it's Needed)
If you ever hear someone say, "this is how we did it back in the old days," be careful. Though we should respect those with many years of medical experience, "the old days" is not a good reason to do something - especially in emergency medicine.
Not long ago, applying a tourniquet was considered a "last resort." And if you applied a tourniquet, the patient was "guaranteed to lose the limb." This is false. Sadly, people still believe this outdated knowledge.
Today, the tourniquet should be a go-to medical device when you recognize an arterial bleed (bright red, pulsing, or spurting blood). If you are helping someone with an injury and think, "wow, that's a lot of blood," consider applying the tourniquet. And fast.
If you wait to employ a tourniquet, you could be jeopardizing the patient's life. A tourniquet can be left in place for up to two hours without causing serious damage (and some even longer).
Here are several good scenarios to consider a tourniquet:
- Amputations above the wrist
- Amputations on the legs
- Gunshots to the arms or legs
- Stab wounds to the arms or legs
- Injuries from power tools to the arms and legs
If you're curious about the tourniquet, you can read the article tourniquets vs. trauma dressing.
Also, here's a video explaining how to use a tourniquet.
Key point: Tourniquets are lifesaving - don't hesitate if you think the patient needs one.
4. Misunderstanding Wound Packing (Or forgetting)
Wound packing is an effective way to stop major bleeds at the junction of the arms and legs (groin area, neck, and armpits). The reason you use wound packing at the junctions is that traditional tourniquets are ineffective in these areas.
Common mistake: Some people will try to pack the abdomen and chest. There is too much space in the abdomen and chest for the gauze to apply pressure effectively. Here's a video explaining why you shouldn't pack the chest.
Once you start holding direct pressure, you don't stop until the bleeding is under control. As you can probably imagine, the scene of an emergency is hectic.
There are sirens, flashing lights, family members screaming, the patient screaming, and sometimes disagreements among emergency personnel. Chaos is natural in an emergency, but when someone's life is on the line, the person keeping pressure on a bleed can't be distracted.
Think about a boat. When a boat begins to leak, it can only take on so much water before it sinks. Eventually, the boat takes on one drop too many, and the whole thing stinks.
The human body is similar. The body can compensate for some blood loss. But, eventually, it loses too much blood, and there's no going back.
Think about this when you're holding pressure - eventually, the patient won't be able to lose any more blood. So, don't whimsically stop holding pressure to check if it's stopped bleeding, and don't allow distractions to pull you away from the task at hand.
6. Thinking Trauma Pads are Magical
The trauma pad doesn't stop the bleed - especially large trauma pads. Direct pressure stops the bleed (good direct pressure!).
However, gauze rolls - especially gauze impregnated with hemostatic agents - can help form blood clots, thus slowing the bleed.
Some people are tempted to reach for a huge trauma pad when they see a bad injury. The reality is, they should probably reach for the tourniquet or good direct pressure, combined with wound-packing.
Key takeaway: Psychologically, for some reason, we want to "hide the wound." Of course, this is understandable, as some people become queasy at the sight of other people's blood (or their own). However, hiding the bleeding doesn't stop the bleeding.
So, resist the urge to grab a large pad (or a towel); instead, use sound techniques like direct pressure and wound packing to control the bleed.
Step by Step Guide to Stop the Bleed
When you or someone else is bleeding, you need to act fast. If the major blood vessels are involved, someone could bleed out in less than two minutes. As we go through these steps, remember: Don't catch the blood. Stop the blood.
Steps to stop the bleed:
- Locate the bleed
- Apply pressure
- Consider a tourniquet
Let's cover these four steps below.
1. Safety when if Possible
If you can, apply gloves and eye protection. However, this won't always be practical. A major bleed needs to be handled right away. The risk of infection is relatively low. Applying direct pressure with your bare hands could save a life. With that said, this is a decision everyone will need to make for themselves.
2. Locate the Bleed
If there's a lot of blood, you may need to take some time to find exactly where the blood is coming from. Also, that patient could be bleeding in more than one place (especially for gunshot and stab victims). Don't forget to look at the front and back of the patient. Also, if the patient sustained multiple injuries, watch out for distracting injuries. For example, the patient might be complaining of a broken leg, but you need to address the arterial bleed from their arm.
3. Apply FIRM Direct Pressure
Using your hand, apply direct pressure to the site of the bleed. You want the pressure focused - push a little harder than you think. If the bleeding appears severe, consider applying a tourniquet.
Apply pressure for at least five minutes - uninterrupted. If the bleed seemed bad, you might need to hold for even longer.
Note: If you must apply a tourniquet, try to continue holding direct pressure while you do. If possible, direct someone standing nearby, or the patient themselves (if they can), to continue holding pressure.
4. Consider a Tourniquet
If the bleeding appears to be pulsing or spurting, then you may need a tourniquet. However, the decision doesn't need to be overly scientific. If the bleeding looks bad, apply a tourniquet.
Typically, you can only apply tourniquets to the arms and legs (there are some junctional tourniquets on the market). In general, apply the tourniquet at least two inches above the bleeding. Or, place the tourniquet "high and tight" - as high as you can on the arm or leg, especially if you're unsure of the exact location of the bleed.
Here's a video explaining how to apply a tourniquet.
Final Words On Stopping the Bleed
Hopefully, you learned something from the article. With that said, you need to try to get some hands-on training. If possible, research first aid classes in your area.
Also, if you know an EMT, nurse, or paramedic, ask them for some tips on stopping a major bleed.
Learning the stop a bleed is one of the most lifesaving skills you can learn. If you take the time to learn and practice, you could help someone in need.
Note: No advice in this article is meant to take the place of your local protocols and laws surrounding first aid.