What are the Types of Bleeding?

Bleeding is a very common condition requiring first aid. Bleeding also termed haemorrhage, occurs when there is a rupture of blood vessels causing a loss of blood. Bleeding can vary from minor to life-threatening, depending on which vessels have been damaged.

 In the most serious bleeds, arteries (which carry fast-flowing blood from the heart) are damaged. An arterial bleed will typically be very fast, bright red and can result in a great loss of blood if not controlled. If damage occurs to the major arteries such as the aorta or femoral arteries, immediate attention is required to prevent death from blood loss. This is referred to as arterial bleeding.

Types of Bleeding

• External bleeding means there is damage to the vessels and skin, and the blood is leaking outside the body. This is generally easy to see, however, this can be hidden beneath clothing and should be checked for during your DRS ABCD check. First Aid measures for external bleeding should include controlling blood loss, using sterile, hygienic measures to reduce the risk of infection where possible and watching for signs of shock.
• Internal bleeding is the same process as external bleeding, the only difference being the blood is leaking INSIDE the body, hence this can be very difficult to detect unless specifically looking for it. When checking for bleeding during your DRS ABCD check, you should always include a palpation touch of the casualty’s abdomen and thighs so that any internal bleeding can hopefully be detected early.
  

First Aid for Bleeding (minor)

For minor bleeding (cuts, scrapes, etc.) apply pressure with a dressing for about 30 seconds. Clean the wound if necessary, and cover with a sterile or clean dressing.

First Aid for Bleeding (external) (R.I.D.)

First aid of serious bleeds should follow 3 basic steps as listed below:

• Rest – Any movement of the injured body part can potentially increase the bleeding and make it harder to control. The body part should be kept still until bleeding is controlled.
• Immobilise – Immobilise the bleeding part and restrict movement
• Direct Pressure – This step is by far the most important and involves using an absorbent material, ideally a dressing such as sterile gauze. If you do not have this, then a clean towel, a piece of clothing or even just their hand can be used if there is nothing else available. Once the pressure is applied to the wound, a pressure bandage can be used to maintain the pressure by wrapping it firmly around the wound and dressing.

Bleeding Video

Please watch the video on how to apply the R.I.D. treatment (first half of the video) as you will be asked to demonstrate this for your assessment. 

Bleeding (embedded objects)

• This is an object that has punctured the skin and is physically stuck in the casualty. Examples include shrapnel, glass, or even being stabbed by a knife.
• NEVER attempt to remove an embedded object
• A donut bandage should be applied around the object, to reduce the bleeding and to keep the object as still as possible
• Carefully place the bandage over the object without moving the object
• Use a roller bandage to firmly wrap around the donut bandage to keep it in place. This will also apply firm pressure around the object to reduce any bleeding
• Seek medical aid

Incision

• Type: An incision is a cut to the skin caused by a sharp-edged item such as a knife, broken glass, razor blade, sheet metal, scissors, etc. The cut edges of the skin are usually neat, straight or smooth.
• Skin Level: Incisions can be shallow, only harming the surface skin, or quite deep, causing injury to the ligaments, muscles, tendons, blood vessels or nerves and bleeding extensively
• First Aid: All incisions should be thoroughly cleaned. Apply RID to stop the bleeding. Seek medical attention for deep incisions.

Bleeding (internal)

Signs of Internal Bleeding:

• bruised, swollen, tender or rigid abdomen
• blood in vomit
• wounds that have penetrated the chest or abdomen

First Aid for Internal Bleeding:

• If the internal bleed is minor, such as some bruising, cold packs can be applied to the area to reduce the swelling and relieve pain
• If you suspect more severe internal bleeding, carefully monitor the casualty and call 000 / 112 immediately
  

Bleeding (head/skull)

• If a casualty has sustained a significant head injury, then internal bleeding into the brain should be considered
• If the casualty complains of a severe headache, seems confused, disorientated or loses consciousness after a head injury you should call 000 / 112 immediately
• If the casualty is bleeding from the head after a trauma, a first aider should not apply firm direct pressure on the wound if there is a risk of a skull fracture
• If the skull feels ‘spongy’ or you are not sure, indirect pressure can be applied by wrapping a bandage around the head with minimal risk of causing brain injury by pushing a fractured skull into the brain

Treatment:

• If concussion, bleeding inside the skull, or a skull fracture is suspected, the casualty should be placed in a quiet and dark room, with the head and shoulders raised slightly on a pillow or blanket – (lying down the casualty will help reduce the risk of fainting)
• Try not to move the casualty unnecessarily, and avoid moving the casualty’s neck. Call 000 / 112
• If a skull fracture is not suspected use firm direct pressure on the wound with a sterile dressing or clean cloth
• If the area feels spongy, do not apply direct pressure, as the casualty may have a skull fracture
• Seek medical aid, watch for changes, and apply DRS ABCD as required

Bleeding (ear)

• Bleeding from the ear is a sign of internal bleeding within the skull
• Medical aid should be sought for all situations where this occurs

Treatment:

• If the casualty is conscious ask them to get comfortable (sitting up preferred) and lean towards the injured side, with the affected ear facing toward the floor
• Place an absorbent cloth underneath to collect the blood
• If the casualty is unconscious, then follow DRS ABCD, and if they are breathing,  place the casualty into the recovery position with the affected ear facing down
•  Call 000 / 112 and do not leave the casualty unattended

Bleeding (nose) 

Bleeding from the nose is fairly common and normally not serious unless bleeding continues for more than 20 minutes.

Signs and Symptoms:

• Bleeding from either or both nostrils
• A sensation of flowing liquid at the back of the throat
• The urge to swallow frequently

Treatment:

• Ask the casualty to sit down, with their head tilted forwards
• The casualty should pinch the soft part of their nose while keeping their head tilted forward to allow the blood to clot
• The casualty should breathe through their mouth and avoid speaking, swallowing, coughing, spitting or sniffing because this may disturb blood clots that may have formed in the nose
• Cold compressions applied to the back of the neck can also assist in reducing the bleeding
• If the bleeding does not stop within 20 minutes, seek immediate medical help
  

Amputation (complete)

Amputation is the removal of any part of the body, either by surgery, disease or traumatic event.

Amputation accidents around the home or workplace normally involve a finger or a toe. More serious amputations include legs or arms and can occur in workplaces using industrial equipment.

First Aid – Stop the bleeding: (R.I.D.)

In the event of amputation of a body part first aid involves controlling the bleeding and looking after the casualty, finding the amputated part and transporting the casualty to hospital or calling 000 / 112.

• Lay the casualty down (REST)
• Apply DIRECT PRESSURE using sterile gauze, or if unavailable, a clean cloth
• Continue direct pressure for at least 15 minutes
• IMMOBILISE the bleeding part and restrict movement
• If the bandaging soaks through with blood, apply another on top and continue direct pressure

Amputated Parts:

• Care should be taken for the amputated part, as it may still be possible to surgically reattach it. The most important thing would be to keep it cool and clean
• Do not wash the amputated part
• Cover and wrap the cleaned amputated part in the sterile dressing then place it in a plastic resealable bag
• Place the sealed bag on ice or in a container of cold water
• Never place the amputated part directly on ice as that could damage the tissue
• Transport the amputated part with the casualty to the nearest hospital

Amputation (Partial)

• Partial amputation is where a limb has been severely damaged but is still partially attached to the body
• Wrap or cover the injured area with a sterile dressing or clean cloth
• Apply direct pressure to reduce the bleeding if necessary
• Remember not to cut off blood flow to the area by compressing the area too tightly
• Gently splint the injured area to prevent movement or further damage
• Transport the casualty to medical assistance or call 000 / 112

Bleeding – If Severe or Life-Threatening:

(Following excerpt from ANZCOR Guideline 9.1.1)

Bleeding should be managed as severe, life-threatening bleeding in the following situations:

• Amputated or partially amputated limb above wrist or ankle
• Shark attack, propeller cuts or similar major trauma to any part of the body
• Bleeding is not controlled by local pressure
• Bleeding with signs of shock, i.e. pale and sweaty plus pulse rate >100 and/or decreased level of consciousness

Controlling the bleeding takes priority over airway and breathing interventions

• If available, use standard precautions, e.g. gloves, protective glasses
• If bleeding from a limb, & not controlled by pressure, apply an arterial tourniquet *above the bleeding point
• If the wound site is not suitable for a tourniquet, or from a limb when a tourniquet is not available or has failed to stop the bleeding, apply a haemostatic dressing *
• For the majority of non-life-threatening cases, follow DRSABCD, where control of bleeding follows establishing an airway and commencing CPR if required * If trained in its use and one is available
  

Arterial Tourniquet (Following excerpt from ANZCOR Guideline 9.1.1)

• Arterial tourniquets should only be used for life-threatening bleeding from a limb, where the bleeding cannot be controlled by direct pressure
• Commercially manufactured windlass tourniquets such as those based on military designs are more effective than improvised tourniquets. An example of a military tourniquet is shown
• Effective use of commercial tourniquets is optimal when first aid providers are trained in proper application techniques
• All arterial tourniquets should be applied in accordance with the manufacturer’s instructions (or 5 cm above the bleeding point if no instructions) and tightened until the bleeding stops

CAUTION: A tourniquet should not be applied over a joint or wound, and must not be covered up by any bandage or clothing.

• If a tourniquet does not stop the bleeding its position and application must be checked. Ideally, the tourniquet is not applied over clothing or wetsuits and is applied tightly, even if this causes local discomfort
• If bleeding continues, a second tourniquet (if available) should be applied to the limb, preferably above the first
• If a correctly applied tourniquet(s) has failed to control the bleeding consider using a haemostatic dressing in conjunction with the tourniquet
• The time of tourniquet application must be noted and communicated to emergency/paramedic personnel
• Once applied, the casualty requires urgent transfer to the hospital and the tourniquet should not be removed until the casualty receives specialist care

NOTE: An elastic venous tourniquet (generally used to assist with drawing blood samples) is not suitable for use as an arterial tourniquet

Improvised tourniquets are unlikely to stop all circulation to the injured limb without risk of tissue damage. Improvised tourniquets which do not stop all circulation can increase bleeding.

Nonetheless, in the context of life-threatening bleeding, an improvised tourniquet is likely to be better than no tourniquet. Tourniquets, ideally of a similar broad width to commercial types, can be improvised using materials from a first aid kit (e.g. triangular bandage, elastic bandage) from clothing, a surfboard leg rope or other available similar items.

Improvised tourniquets should be tightened by twisting a rod or stick under the improvised tourniquet band, similar to the windlass in commercial tourniquets.

• If a tourniquet does not stop the bleeding its position and application must be checked. Ideally, the tourniquet is not applied over clothing or wetsuits and is applied tightly, even if this causes local discomfort
• If bleeding continues, a second tourniquet (if available) should be applied to the limb, preferably above the first
• If a correctly applied tourniquet(s) has failed to control the bleeding consider using a haemostatic dressing in conjunction with the tourniquet
• The time of tourniquet application must be noted and communicated to emergency/paramedic personnel
• Once applied, the casualty requires urgent transfer to the hospital and the tourniquet should not be removed until the casualty receives specialist care

NOTE: An elastic venous tourniquet (generally used to assist with drawing blood samples) is not suitable for use as an arterial tourniquet

Improvised tourniquets are unlikely to stop all circulation to the injured limb without risk of tissue damage. Improvised tourniquets which do not stop all circulation can increase bleeding.

Nonetheless, in the context of life-threatening bleeding, an improvised tourniquet is likely to be better than no tourniquet. Tourniquets, ideally of a similar broad width to commercial types, can be improvised using materials from a first aid kit (e.g. triangular bandage, elastic bandage) from clothing, a surfboard leg rope or other available similar items.

Improvised tourniquets should be tightened by twisting a rod or stick under the improvised tourniquet band, similar to the windlass in commercial tourniquets.

Haemostatic dressings (Following excerpt from ANZCOR Guideline 9.1.1)

• Haemostatic dressings are impregnated with agents that help stop bleeding.
• When available and the first aid provider is trained in their use, haemostatic dressings are of most value in the following situations:
  o Severe, life-threatening bleeding not controlled by wound pressure, from a site not suitable for tourniquet use such as a large ‘crater’ wound
  o Severe, life-threatening bleeding from a limb, not controlled by a wound pressure, when the use of a tourniquet(s) alone has not stopped the bleeding, or a tourniquet is not available
• Haemostatic dressings must be applied as close as possible to the bleeding point, held against the wound using local pressure (manually initially) then held in place with the application of a bandage (if available). Haemostatic dressings should be left on the bleeding point until definitive care is available

Summary Statement (Following excerpt from ANZCOR Guideline 9.1.1)

The need to control the bleeding is paramount.

The risks associated with the first aid use of tourniquets and haemostatic dressings are less than the risk of uncontrolled severe, life-threatening bleeding.

These adjuncts provide temporary bleeding control and rapid transfer to the hospital remains critically important.

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