Firm, direct pressure on the bleeding point, and call 000. Almost everything else people remember about bleeding — elevation, pressure points, piling on more and more padding — matters far less than getting pressure in exactly the right place and keeping it there.
What counts as life-threatening
- A limb amputated or partly amputated above the wrist or ankle
- Major trauma — a propeller cut, a shark attack, a serious machinery injury
- Bleeding not controlled by local pressure
- Signs of shock — pale and sweaty, pulse over 100, capillary refill longer than 2 seconds, reduced consciousness
Call an ambulance for all severe bleeding.
Direct pressure — the first and main step
- Press firmly on or around the wound, with your hands or a pad. Gloves if you have them.
- Lie the person down and keep them still. Immobilise a bleeding limb.
- If blood comes through, add a second pad and bandage more firmly.
- If it still continues, check your placement. The usual reason pressure fails is that it is not over the bleeding point. Take pads off if you need to in order to find it.
One or two pads over a small area with firm pressure beats a thick stack of padding — the more layers between your hand and the vessel, the more the force spreads out and the less reaches where it is needed.
On elevation: ANZCOR states there is no evidence that raising the limb controls bleeding, and that it may cause more pain or injury. It is no longer the instruction it once was.
Embedded objects — leave them in
Do not pull out anything stuck in a wound. It may be the only thing plugging the hole. Pad around the object and press on the padding, not on the object itself.
Tourniquets
For life-threatening limb bleeding that direct pressure has not controlled, and only if you are trained and have one.
- Apply it above the bleeding point, avoiding a joint or the wound itself where possible
- Follow the manufacturer’s instructions; without them, about 5 cm above the bleeding point
- Tighten until the bleeding stops. If it does not, check placement and apply a second tourniquet above the first
- Write down the time it went on and tell the paramedics
- Do not cover it with a bandage or clothing, and do not release it — it stays on until specialist care
A commercial windlass tourniquet works better than an improvised one. An improvised tourniquet may not fully stop circulation, but is better than nothing in a life-threatening bleed. Never use the elastic band type used for blood tests.
Haemostatic dressings
If trained and available: for life-threatening bleeding somewhere a tourniquet cannot go, or a limb where a tourniquet has failed or is unavailable. Pack it as close to the bleeding point as possible, press firmly, then bandage over it. Leave it in place.
Bleeding you cannot see
Suspect internal bleeding when there are signs of shock — pale, sweaty, fast pulse, deteriorating consciousness — or blood appearing from anywhere it should not. Call an ambulance, lie the person down, keep them warm, and give nothing by mouth, including medication.
While you wait
- Reassure them and keep them warm
- Keep checking breathing and consciousness
- Nothing to eat or drink
- If they become unresponsive and are not breathing normally, start CPR — see DRSABCD
For a bleeding nose specifically, see how to stop a nosebleed.
This is a summary of what is taught in class, not a substitute for training. Skills like this are assessed practically for a reason — reading about them is not the same as having done them. In a real emergency, call 000.
Learn it properly
Bleeding control is taught and practised in HLTAID011 first aid including CPR. Best First Aid Training runs it at Parramatta, Penrith, Blacktown and Liverpool, and supplies first aid kits and wound dressings. If your workplace carries a tourniquet, make sure the people who might need it have actually handled one — see what goes in a workplace first aid kit.
Source: Australian and New Zealand Committee on Resuscitation, ANZCOR Guideline 9.1.1 — First Aid for Bleeding.
