Bleeding & Trauma

Overview

Uncontrolled bleeding is a leading preventable cause of death in trauma. Find the source fast, apply direct pressure, escalate to hemostatic packing and tourniquets when needed, then protect and reassess. Stabilize fractures to reduce further damage.

Skill Level: Intermediate

Direct Pressure

Most bleeding stops with steady, firm pressure.

• Gloves if available; expose the wound; remove large loose debris only.
• Heel of hand or stacked gauze directly on source; press hard and do not peek for 2–3 minutes.
• Add more gauze on top if soaked; do not remove the base layer (maintains clot).

Hemostatic Gauze

For deep, narrow wounds or junctional areas where tourniquets don’t work.

• Indications: Deep lacerations to groin/axilla/neck; uncontrolled bleeding after direct pressure.
• Technique: Pack gauze into wound cavity with fingertip or tool, directly onto bleeding vessel; fill fully; maintain firm pressure 3+ minutes (follow product instructions).
• Dwell: Leave the packed gauze in place; cover with pressure dressing.

Tourniquets

For life‑threatening extremity bleeding not controlled by pressure.

• Placement: 5–7 cm (2–3 in) above the wound (closer to the torso), not over a joint. If location uncertain or multiple wounds, place “high and tight.”
• Tighten: Twist windlass until bleeding stops and distal pulse is absent; secure windlass.
• Pain is expected; do not loosen. Note time of application visibly on TQ or patient.
• Multiple TQs: If first fails, place a second above the first.

Splinting (Improvised)

Stabilize to reduce pain, bleeding, and further injury.

• Above and below: Immobilize joints above and below the suspected fracture.
• Padding: Use clothing/foam; avoid direct pressure on deformity.
• Materials: Sticks/trekking poles + cloth/tape; SAM splints if available.
• Re‑check circulation/sensation/motion before and after splinting.

Sling & Swathe

Support arm/shoulder injuries.

• Sling: Triangle bandage under wrist/forearm, tied behind neck; elevate slightly.
• Swathe: Wrap torso to secure arm to chest; pad bony points.

Wound Irrigation

Clean wounds reduce infection risk.

• Volume: 500–1000 mL for small wounds; more for contaminated wounds.
• Pressure: Use a syringe or squeeze bottle; aim for brisk stream; avoid high‑pressure damage to tissue.
• Remove visible dirt/grass only; do not aggressively scrub devitalized tissue in field.

Dressings

Protect and monitor.

• Layers: Non‑adherent layer (if available) over wound, then absorbent pads, then wrap to secure.
• Monitoring: Check for strike‑through (bleed‑through) and distal circulation; elevate injured limb if appropriate.

Impaled Objects

Do not remove impaled objects in the field unless they obstruct the airway or prevent effective CPR.

• Stabilize: Build bulky dressings on both sides and secure to prevent movement; avoid pressure on the object’s tip.
• Shorten only if necessary: If transport is impossible otherwise and it is safe to do so, carefully shorten the exposed end without moving the embedded portion.
• Exceptions: For small cheek or lip impalements interfering with airway, removal may be appropriate with immediate bleeding control—only if trained and safe.

☑️ Checklist — Bleed/TQ Pack

• Gloves, gauze rolls/pads, hemostatic gauze
• Tourniquet with windlass (CAT/SOF‑T style) ×2
• Pressure bandage, tape/elastic wrap
• Shears, marker (to note TQ time)

Examples

• Chainsaw leg laceration: Direct pressure fails → hemostatic packing + 3 minutes firm pressure → pressure bandage; prepare TQ if strike‑through persists.
• Arterial arm bleed: Immediate tourniquet high and tight; bleeding stops; time noted; treat for shock, prevent hypothermia; rapid evac.

Narrative — Three Minutes That Matter

The shirt was already soaked. You dropped to a knee, gloved, and pushed a wad of gauze straight into the deepest part of the wound. “Hold this,” someone said—“No,” you answered, “I am holding. Don’t peek.” Ninety seconds in, the edges oozed; you packed more gauze, fingertip seeking the pulsing point, then pressed again. At three minutes, you wrapped a pressure bandage, checked the distal pulse, and only then looked for a tourniquet—ready, but not needed. A jacket under and over the patient kept the shivers at bay while you called in the location and time.

Scenario

🧭 Scenario (Chainsaw gash): Deep thigh laceration; bleeding heavily.
🔍 Decisions: Pressure vs tourniquet first; hemostatic packing; documentation.
✅ Outcome: You apply a high, tight tourniquet until bleeding stops, pack residual cavity with hemostatic gauze, and note TQ time on the patient.
🧠 Lessons: Don’t hesitate on life‑threatening limb bleeds; pack and press
🏋️ Drill: Pack a wound trainer (or towel in bottle) for 3 minutes without peeking.

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Common Mistakes

• Peeking during pressure; lifting gauze breaks clots. Add more on top instead.
• Tourniquet too loose or over a joint; failure to note time; loosening in the field.
• Packing shallowly; not pressing directly on the bleeding source.
• Using stretchy/rope improvised TQs without a windlass; they fail under motion/pain.
• Delaying TQ on clear life‑threatening limb bleeding.
• Forgetting hypothermia prevention; cold blood doesn’t clot.
• Giving food/drink to unstable patients; risking aspiration and complicating care.

Key Takeaways

• Pressure works; commit to firm, sustained pressure before escalating.
• Tourniquets save lives when used early and correctly; don’t loosen in the field.
• Pack deep wounds with hemostatic gauze and hold pressure long enough to clot.
• Splint and dress to protect; reassess circulation and bleeding frequently.