How do I stop severe bleeding?
Direct pressure, and the two situations that change what you do: something embedded in the wound, and a dressing that soaks through. Plus the position that treats shock.
- Difficulty
- beginner
- Time
- 7 min
- Read
- 4 min
- Safety
- warning
Short answer
Apply firm direct pressure to the wound with a sterile dressing, a clean non-fluffy cloth, or your hand. Ring 999. Help them lie down and raise their legs above the level of their heart. Bandage firmly enough to keep the pressure on but not tight enough to cut off circulation. If something is embedded, press either side of it, never on it. If blood soaks through, replace the pad and press again.
Direct pressure stops the great majority of bleeding, including bleeding that looks unstoppable. The two things that trip people up are the embedded object and the soaked dressing, and both have a specific answer that is not the obvious one.
Safety
Step by step
- Press on the wound, hard.A sterile dressing if you have one, a clean non-fluffy cloth if not, and a bare hand if there is nothing at all. Firm, direct, continuous pressure. This is the thing that works and everything else is secondary.
- Get 999 called.Ask someone else to do it so you can keep the pressure on. If you are alone, put the phone on speaker beside you.
- Do not pull out anything embedded.An object in a wound may be plugging it, and removing it can start much heavier bleeding. Apply pressure on either side of it to push the wound edges together, and build padding up around it so the bandage does not press on the object itself.
- Replace a dressing that soaks through.If blood comes through the dressing, remove it and reapply pressure with a fresh pad. The point is to get the pressure to the bleeding rather than onto a soaked bandage.
- Bandage to hold the pressure.Firm enough to maintain the pressure, not so tight that it restricts circulation below the bandage. Tie the knot over the wound so the pressure stays where it is needed. Check the fingers or toes beyond it stay warm and pink.
- Lie them down and raise their legs.Blood loss causes shock. Help them lie down on something insulating and raise and support their legs above the level of their heart. Keep them warm, and reassure them.
- Keep monitoring.Watch their level of response. If they become unresponsive and are not breathing normally, start CPR. Tell the 999 handler how much blood has been lost if you can judge it.
- Deal with a smaller wound differently.Bleeding that stops with a few minutes of pressure is not this. GuideHQ has guides on treating a cut and on a bad cut in the workshop, including the tetanus question and the signs of infection.
Tips
- Anything absorbent works — a tea towel, a folded T-shirt, a pillowcase. Do not spend time looking for a first aid kit while someone bleeds.
- If it is a limb, raising it above the level of the heart while you keep the pressure on helps and costs nothing.
- Note the time the bleeding started and roughly how much has been lost. Both matter at hospital and neither is recoverable afterwards.
Common mistakes
- Lifting the dressing to check whether it has stopped — It disturbs the clot that is forming and restarts the bleeding, exactly as with a nosebleed. Keep the pressure on and let the professionals look.
- Pulling out an embedded object — It can release bleeding that the object was containing, and it can do further damage on the way out. Press either side and leave it in place.
- Improvising a tourniquet — A tourniquet is a trained intervention. Applied too loosely it increases bleeding, applied wrongly or left on too long it costs the limb. For an untrained bystander, the answer is pressure and 999.
- Using cotton wool or a fluffy cloth — Fibres stick in the wound and have to be cleaned out later. Any smooth absorbent fabric is better.
If it doesn't work
Blood is spurting rather than flowing
Cause: Arterial bleeding — Fix: Very firm direct pressure and 999 immediately. Say on the phone that the blood is spurting — it changes the priority of the call.
They are becoming pale, cold, clammy and drowsy
Cause: Shock from blood loss — Fix: Keep the pressure on, keep them lying down with their legs raised, keep them warm, and tell the 999 handler. Do not give them anything to eat or drink.
The bleeding is from an amputated part
Cause: Traumatic amputation — Fix: Pressure on the stump and 999. Wrap the severed part in clean cling film or a plastic bag, put that bag into iced water — never directly onto ice — and send it with the patient.
Questions people ask
Should I use a tourniquet?
Not unless you have been trained and have a proper one. Improvised tourniquets are frequently applied too loosely, which increases blood loss, and the consequences of getting it wrong include losing the limb. Direct pressure controls the great majority of bleeding.
What about a bleed I cannot press on, like the abdomen?
Ring 999 and follow the handler. Some bleeding cannot be controlled by a bystander, and recognising that and getting the ambulance moving is the useful thing you can do.
Do I need gloves?
Use them if they are within reach. Do not spend time finding them while someone is bleeding heavily — a plastic bag over the hand is a reasonable improvisation, and washing thoroughly afterwards is the fallback.
How much blood is dangerous?
It is very hard to judge, and spilled blood always looks like more than it is. Judge by the person rather than the puddle: pale, cold, clammy, breathless, confused or drowsy all mean serious loss.