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First Aid

Bleeding and Wounds

Controlling bleeding and caring for wounds, from minor cuts to life-threatening hemorrhage.

Types of Bleeding

By Source

TypeCharacteristicsSeverity
ArterialBright red, spurting, pulsatesMost severe
VenousDark red, steady flowSerious
CapillarySlow ooze, clots quicklyMinor

By Severity

Life-threatening bleeding:

  • Blood spurting
  • Blood pooling on ground
  • Clothing/bandages soaked
  • Amputation
  • Victim confused or unconscious

This requires immediate action.

Controlling External Bleeding

Standard Approach

Remember: STOP THE BLEED

  1. Apply direct pressure

    • Use cloth, gauze, or bare hands if necessary
    • Press FIRMLY
    • Don't lift to check (this disrupts clotting)

  2. Maintain pressure

    • If blood soaks through, add more cloth ON TOP
    • Do NOT remove original dressing
    • Press harder if needed

  3. Elevate (if possible)

    • Raise injured area above heart level
    • Helps reduce blood flow

  4. Bandage firmly

    • Once bleeding slows, secure dressing
    • Tight enough to maintain pressure
    • Check circulation below bandage

  5. Call 911 for severe bleeding

Pressure Points

If direct pressure isn't enough, add pressure to arterial pressure point:

LocationPressure Point
ArmBrachial artery (inside of upper arm)
LegFemoral artery (groin crease)

Press artery against bone.

Tourniquets

When to Use

Only for life-threatening limb bleeding when direct pressure fails:

  • Arterial bleeding that won't stop
  • Mass casualty with limited responders
  • Amputation
  • Can't reach wound (trapped limb)

How to Apply

  1. Place tourniquet

    • 2-3 inches above wound
    • NOT over joint
    • Over single bone if possible (upper arm or thigh)

  2. Pull strap tight

    • Secure with buckle/clip

  3. Turn windlass

    • Twist until bleeding stops
    • Secure windlass in place

  4. Note time

    • Write time on forehead or tourniquet
    • "TK" + time (e.g., "TK 14:30")

  5. Do NOT remove

    • Only removed by medical professionals

Improvised Tourniquet

If no commercial tourniquet:

  • Use wide, flat material (belt, tie, bandana, at least 1.5 inches wide)
  • NOT rope, wire, or narrow cord
  • Add windlass (stick, pen) to tighten
  • Same placement rules apply

Commercial tourniquets (CAT, SOFTT) are much more effective.

Wound Packing

For deep wounds (especially junctional areas like groin, armpit, neck):

  1. Expose wound - Remove clothing
  2. Pack gauze deep into wound - Push firmly
  3. Continue packing - Fill entire cavity
  4. Apply direct pressure - Over packed wound
  5. Maintain pressure - 3+ minutes

Wound Types

Abrasions (Scrapes)

Care:

  1. Clean gently with soap and water
  2. Remove debris carefully
  3. Apply antibiotic ointment
  4. Cover with bandage
  5. Change dressing daily

Lacerations (Cuts)

Minor:

  1. Control bleeding with pressure
  2. Clean with water
  3. Close with butterfly strips or bandage
  4. Watch for infection

Deep/Gaping:

  • May need stitches (within 6-8 hours)
  • Control bleeding
  • Cover with clean dressing
  • Seek medical care

Punctures

Concern: May be deeper than they appear

Care:

  1. Let it bleed briefly (helps clean)
  2. Clean gently
  3. Apply antibiotic
  4. Cover
  5. Watch closely for infection
  6. Check tetanus status

Avulsions (Tissue torn away)

Care:

  1. Control bleeding
  2. If flap present, gently return to position
  3. Cover with moist dressing
  4. Seek medical care

Amputations

Immediate care:

  1. Control bleeding (tourniquet usually needed)
  2. Call 911

Caring for amputated part:

  1. Rinse gently with clean water
  2. Wrap in moist gauze
  3. Place in plastic bag
  4. Place bag on ice (NOT directly on ice)
  5. Label with patient name and time
  6. Send with patient

Time matters. Reattachment may be possible.

Impaled Objects

DO NOT REMOVE

Removing may cause:

  • Increased bleeding
  • Further internal damage

Care:

  1. Stabilize object in place
  2. Use bulky dressings around object
  3. Bandage dressings to prevent movement
  4. Shorten object only if necessary for transport
  5. Seek immediate medical care

Exception: Object in cheek obstructing airway, may need removal.

Internal Bleeding

Signs

External clues:

  • Bruising
  • Swelling
  • Tenderness

Systemic signs:

  • Pale, cool, clammy skin
  • Rapid, weak pulse
  • Rapid breathing
  • Thirst
  • Confusion
  • Anxiety
  • Nausea/vomiting

Causes

  • Blunt trauma
  • Fractures (especially pelvis, femur)
  • Penetrating injuries
  • Medical conditions

Care

  1. Call 911 immediately
  2. Keep victim lying down
  3. Elevate legs if no spinal injury suspected
  4. Keep warm
  5. Do NOT give food or drink
  6. Monitor for shock
  7. CPR if needed

Wound Infection

Prevention

  • Clean all wounds thoroughly
  • Apply antibiotic ointment to minor wounds
  • Keep wounds covered
  • Change dressings regularly
  • Keep tetanus immunization current

Signs of Infection

Watch for (especially after 24-48 hours):

  • Increasing redness
  • Swelling
  • Warmth
  • Pus or discharge
  • Red streaks radiating from wound
  • Fever
  • Increased pain

Seek medical care if infection signs appear.

Tetanus

Get tetanus shot if:

  • More than 5 years since last shot AND wound is deep/dirty
  • More than 10 years since last shot for any wound
  • Unknown vaccination status

Special Situations

Nosebleed

  1. Sit upright, lean slightly forward
  2. Pinch soft part of nose firmly
  3. Hold for 10-15 minutes continuously
  4. Don't check; keep pinching
  5. Apply cold pack to bridge of nose
  6. Seek care if bleeding doesn't stop in 20-30 minutes

Knocked-out Tooth

  1. Handle by crown only (not root)
  2. Rinse gently if dirty
  3. Try to reinsert in socket
  4. If can't reinsert: Place in milk or saliva
  5. Get to dentist within 30 minutes

Eye Injury with Bleeding

  1. Do NOT apply pressure
  2. Cover both eyes loosely
  3. Keep victim calm and still
  4. Seek immediate medical care

Wound Care Supplies

Basic wound care kit:

  • Sterile gauze pads (various sizes)
  • Adhesive bandages
  • Roller gauze
  • Medical tape
  • Antibiotic ointment
  • Antiseptic wipes
  • Gloves
  • Scissors
  • Tweezers

For serious bleeding:

  • Commercial tourniquet
  • Hemostatic gauze (QuikClot, Celox)
  • Israeli bandage or pressure dressing

Key Points

  1. Apply direct pressure - The foundation of bleeding control
  2. Don't remove dressings - Add more on top
  3. Use tourniquet for life-threatening bleeding - Don't hesitate
  4. Don't remove impaled objects - Stabilize in place
  5. All wounds need cleaning - Prevents infection
  6. Watch for infection - Signs appear in 24-48 hours
  7. Seek medical care for deep wounds, heavy bleeding, or infection signs