First Aid for Severe Bleeding: Tourniquets and Hemostatic Dressings

Application of a Tourniquet

To apply a tourniquet correctly, follow these steps:

1. Placement: Place the device 5 to 10 cm (2 to 4 in.) above the injury.
2. Joint Consideration: If the injury is located near a joint (such as the elbow or knee), place the tourniquet above the joint, ensuring it is at least 2.5 cm (1 in.) away from the joint.
3. Tightening: Tighten the device firmly until the bleeding stops completely.
4. Securing and Recording: Secure the tourniquet so it does not slip, and immediately record the time of application on the patient. This information is vital for the medical professionals who will take over care.

CRITICAL NOTE: Once a tourniquet has been applied, it must not be removed for any reason by anyone other than trained medical professionals.

Hemostatic Dressings

There are certain areas of the body where a tourniquet cannot be used, specifically the neck or the torso. In these cases, or when a tourniquet is not appropriate, you may need to use hemostatic dressings.

A hemostatic dressing is a medical dressing treated with specific substances designed to accelerate the body's natural clot formation. These are used when standard first aid (like direct pressure) fails or when the wound is in a location where a tourniquet cannot be applied.

To use a hemostatic dressing:

• Apply the dressing directly to the bleeding site. In deep wounds, this may involve packing the dressing into the wound.
• Always use the dressing in conjunction with firm direct pressure to ensure the clotting agents can work effectively.

Life-Threatening Internal Bleeding

Internal bleeding is the escape of blood from vessels into body spaces, rather than through an open wound. This is often caused by penetrating objects or blunt force trauma. Unlike external bleeding, you cannot see the source of the blood, making it much harder to treat in the field.

Signs and Symptoms of Internal Bleeding

Because you cannot see the blood, you must look for physical indicators and patient reports. Common signs include:

• Bruising: Large areas of discoloration on the skin.
• Swelling and Tenderness: Visible swelling or pain when the area is touched.
• Blood in Bodily Fluids: The presence of blood in saliva or vomit.
• Severe Thirst: A common symptom as the body attempts to compensate for fluid loss.

Managing Internal Bleeding

First aiders do not have the tools or training to stop life-threatening internal bleeding. Your role is to stabilize the person and facilitate professional medical intervention.

1. Call EMS/9-1-1 immediately: This is a medical emergency that requires hospital-level care.
2. Keep the person comfortable and still: Minimize any movement that could worsen the injury.
3. Avoid giving anything by mouth: Do not give the person water or food. Providing fluids can cause complications, especially if the person requires emergency surgery.

Exam Tip: If a question asks how to treat internal bleeding, remember that the primary goal is to get the person to professional medical help as quickly as possible. You cannot "fix" internal bleeding with first aid supplies; you can only manage the patient until EMS arrives.