If possible, before you try to stop severe bleeding, wash your hands to avoid infection and put on gloves. If the wound is abdominal and organs have been displaced, don't try to push them back into place — cover the wound with a dressing.
For other cases of severe bleeding:
- Have the injured person lie down and cover the person to prevent loss of body heat. If possible, position the person's head slightly lower than the trunk or elevate the legs and elevate the site of bleeding.
- While wearing gloves, remove any obvious dirt or debris from the wound. Don't remove any large or more deeply embedded objects. Your principal concern is to stop the bleeding.
- Apply pressure directly on the wound until the bleeding stops. Use a sterile bandage or clean cloth and hold continuous pressure for at least 20 minutes without looking to see if the bleeding has stopped. Maintain pressure by binding the wound tightly with a bandage or clean cloth and adhesive tape. Use your hands if nothing else is available. If possible, wear rubber or latex gloves or use a clean plastic bag for protection.
- Don't remove the gauze or bandage. If the bleeding continues and seeps through the gauze or other material you are holding on the wound, don't remove it. Instead, add more absorbent material on top of it.
- Squeeze a main artery if necessary. If the bleeding doesn't stop with direct pressure, apply pressure to the artery delivering blood to the area. Pressure points of the arm are on the inside of the arm just above the elbow and just below the armpit. Pressure points of the leg are just behind the knee and in the groin. Squeeze the main artery in these areas against the bone. Keep your fingers flat. With your other hand, continue to exert pressure on the wound itself.
- Immobilize the injured body part once the bleeding has stopped. Leave the bandages in place and get the injured person to the emergency room as soon as possible.
If you suspect internal bleeding, call 911 or your local emergency number. Signs of internal bleeding may include:
- Bleeding from body cavities
- Vomiting or coughing up blood
- Bruising on neck, chest, abdomen or side
- Wounds that have penetrated the skull, chest or abdomen
- Abdominal tenderness, possibly accompanied by rigidity or spasm of abdominal muscles
- Shock, indicated by weakness, anxiety, thirst or skin that's cool to the touch
- Jevon P, et al. First aid part 5: Treatment for severe bleeding. Nursing Times. 2008;104:26. http://www.nursingtimes.net/nursing-practice-clinical-research/first-aid-part-5-treatment-for-severe-bleeding/524731.article. Accessed Aug. 15, 2011.
- What to do in a medical emergency. American College of Emergency Physicians Foundation. http://www.emergencycareforyou.org/EmergencyManual/WhatToDoInMedicalEmergency/Default.aspx?id=264. Accessed Aug. 14, 2011.
- Approach to the trauma patient. The Merck Manuals: The Merck Manual for Healthcare Professionals. http://www.merckmanuals.com/professional/sec22/ch327/ch327a.html#v1109755. Accessed Aug. 14, 2011.
- Haywood A, et al. Gastrointestinal bleeding. In: Stone KC, et al. Current Diagnosis and Treatment: Emergency Medicine. 6th ed. New York, N.Y.: The McGraw-Hill Companies; 2007.
- Subbarao I, et al, eds. American Medical Association Handbook of First Aid and Emergency Care. New York, N.Y.: Random House; 2009:52.
- Young WF. Shock. In: Stone KC, et al. Current Diagnosis and Treatment: Emergency Medicine. 6th ed. New York, N.Y.: The McGraw-Hill Companies; 2007.