External bleeding will follow from a wound to the flesh. The four types of wounds are -
- Abrasians and grazes: The rubbing- or scraping-away of the skin surface. Only small capillaries are damages and so bleeding should be fairly slight.
- Lacerations: The tearing of the skin by a sharp object (for example, barbed wire). The edges of the wound will be jagged and uneven. Lacerations can be very deep and cause severe bleeding.
- Incisions: Clean cuts through the flesh caused by a sharp object (for example, glass or a blade). These wounds are often deep and will bleed profusely.
- Puncture wounds: Piercing of the flesh by a pointed object (for example, a spike or a bullet). The wound may close around the penetration and bleeding may not be severe, although infe ction may be carried deep into the wound.
Types of bleedsIn general, the brighter and more free-flowing the blood is, the more urgent will be the need to control the bleeding. The following points are worth noting
- Blood which is a bright red colour and moves in spurts indicates bleeding from an artery. These injuries cause high blood loss.
- Blood which is dark red and flows freely indicates bleeding from a vein. The loss of blood can be significant.
- Blood which is bright red but oozes comes from injured capillaries. The blood loss will tend to be slight.
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ManagementIn all cases, check the wound and confirm that there is no foreign object.
Minor bleedingClean the wound with warm soapy water or a solution of antiseptic, then apply a clean (ideally non-adherent) dressing.
Significant bleedingDirect pressure should be applied to the wound, ideally with a clean pad. Secure the pad in place with a bandage which is tight enough to hold it in place but not so tight it restricts circulation. If casualty bleeds through the pad, remove the bandage and place a second pad on top of the first (replace the second pad as necessary). Do not remove the first pad unless significant bleeding continues: if this occurs you may need to remove the pad to identify the injury site more precisely so to apply pressure to it.
If the bleeding is from a limb, elevate it above the level of the heart so as to reduce the blood flow. Remember to reassure the casualty and keep them calm so as to keep their heart rate down.
Extreme CircumstancesLife-threatening bleeding can be controlled by an arterial torniquet. However, this may well cause catastrophic damage to a limb. A torniquet can be applied by wrapping a bandage of at least 2 inches / 5 centimetres directly above the knee or elbow. Apply it tightly enough to stop circulation of blood to the limb.
This should only be used as a last resort when all other methods of controlling the bleeding have failed. Eden suggests traumatic amputation or shark attack as examples of injuries which may require a tourniquet.