Controlling Bleeding in an Emergency

I have a hard time remembering things like that under normal conditions, let alone a high stress situation! In this article I’m going to talk about how to stop bleeding and why it is the first thing you should do when treating trauma. I’m also going to explain why you do the things that you do. If you know why you do something, then you don’t have to memorize a checklist or an acronym that you most likely forget in the heat of the moment.

A long time ago I was told something by a Special Forces medic that has stuck with me to this day, “Put your hands on the red.” This simple phrase has gone through my head every time I’ve had to work on someone bleeding uncontrollably (mostly blast related traumatic amputations). It’s simple, easy to remember and easy to implement. It also does something else… it gets you doing something. Just starting to act can often get you past that initial shock and get you into the fight.

Why do you treat blood loss first?

The circulatory system functions like a hydraulic system. If there isn’t enough fluid in the system then the pressure drops. The pump has to work harder and harder to move fluid through the system as the pressure drops. Finally, the pump just can’t move the fluid through the system any longer. This is why you stop severe blood loss first, and as fast as you can. If your patient losses to much blood then it doesn’t matter if the person is breathing.

How do you stop bleeding?

You should take the time to put on a pair of surgical gloves if you have them available. This is for your own protection against any bloodborne diseases your patient may have. Yes, it will also stop some contamination of the wound and prevent infection, but this is secondary.

This article is mainly focused on stopping the loss of blood from severe wounds. If you are dealing with a smaller, manageable wound, the application of direct pressure is the best option. Apply a bandage to the area, put pressure on the wound with your hand or use a pressure dressing (like an Israeli bandage) and elevate the wound above the heart if possible. This reduces the blood flow to the area, and assists in stopping the bleeding. If the bleeding does not stop, then you will need to apply a tourniquet or a hemostatic impregnated dressing (discussed below).

When do you apply a tourniquet?

For amputations and wounds on appendages that are gushing blood, immediately apply a tourniquet.

Place the tourniquet 2-3 inches above the wound and tighten it until the flow of blood stops. Our goal here is to apply just as much pressure as is needed to stop the flow of blood. With amputations, I have found that the right amount of pressure is simply however much pressure it takes to stop the blood flow. When treating intact limbs, you should tighten the tourniquet until there is no pulse (taken at the wrist or the ankle).

For amputations, try to apply the tourniquet lower than the next joint up the appendage. For example, if someone has suffered an amputation mid-forearm, you would place the tourniquet below the elbow. This increases the likelihood that the elbow, and the stump below it, can be saved making the fitting of a prosthetic much easier. Do not try to save a joint in-lieu of efficient placement of the tourniquet!

Stay with the patient until they are handed off to a higher level medical authority. Make sure to tell medical personnel a tourniquet was used and the time that it was applied. You should mark the patient with a “T” and the time that you applied the tourniquet if you cannot stay with them (if you need to go to get help).

Never cover a tourniquet! The intent here is to ensure that it is obvious that a tourniquet was applied. You don’t want your patient to get to a hospital and wait for hours with a tourniquet on.

Take some time to practice this on yourself.

Apply a tourniquet to your own arm or leg and tighten it until you cannot feel a pulse. This will give you an idea of exactly how much pressure it will take to stop the bleeding on others. It will also teach you how to apply a tourniquet to yourself if you ever get injured while on your own.

Isn’t a tourniquet only used as a last resort?

Anyone who has served in the military since the Iraq War has probably already been taught this. I was surprised to see that there is still so much debate about the application of tourniquets in the civilian world. According to studies conducted in 2012, the early application of tourniquets to extremities during the wars in Iraq and Afghanistan saved between 1000 and 2000 lives. All with almost no record of long-term damage to these personnel.

Two hours is the generally accepted length of time that a tourniquet can be in place. Post-tourniquet syndrome is sometimes found in patients who have a tourniquet on for periods longer than 2 hours. This syndrome is marked by the loss of feeling in the limb. Patients normally regain full feeling in their limbs in 1-6 weeks.

Use of a tourniquet on patients is a proven way to save lives. When you are more than 2 hours from a higher level of care, you should try to stop bleeding by applying direct pressure first. If this doesn’t work, do not hesitate to apply a tourniquet.

Types of tourniquets.

There is a wide variety of commercially available tourniquets for sale. I prefer the Combat Application Tourniquet, but others like the SOF Tactical Tourniquet. Both will do the job and it really comes down to personal preference. Practice is key regardless of the type of tourniquet you decide to carry.

One company, RevMed, makes a ratcheting, daily wear belt called the Parabelt that can act as a proper tourniquet. It seems like a decent option for everyday carry, but may not be the best if you carry a pistol (and you should!).

You can always improvise a tourniquet if you have to. According to several EMS journals, a manual blood pressure cuff is one of the best improvised tourniquets. I have never tried it, but it came up several times in my research.