Stopping Bleeding

If a person loses about half (2 ½ liters) of their blood supply, no matter what anyone does, death is unavoidable. You must get bleeding under control as soon as possible. Indications of life-threatening bleeding include:

• Spurting (arterial) or steady bleeding (venous)

• Blood is pooling;

• Blood is soaking through overlying clothes or bandages;

• Amputation.

Loss of blood lowers blood pressure, putting the injured into a state of shock. Increasing symptoms of shock are increased heart rate, agitation or anxiety, and confusion. If an injured person appears lethargic, death will occur within minutes because of irreversible organ damage.

Direct Pressure

The first way to control excessive bleeding is through applying direct pressure.

After finding the source of bleeding, put a barrier (gloves, cloth, plastic bag) between the blood and your hands. Apply hard, steady pressure directly on the blood source—even if it is painful to the injured! Keep pressure on until EMTs take over or bleeding has stopped.

Change gloves or barrier if you work on multiple injured people. If your barrier becomes blood soaked, replace it, but do not layer more things on top of it. Do not place bulky layers between your hands and the blood source (decreases effectiveness).

Tourniquets

If you cannot stop the bleeding by applying direct pressure and medical professionals are delayed in responding, a tourniquet is safe and effective when applied appropriately. You are more likely to save a life than cause the loss of a limb if you use a tourniquet.

If a commercial tourniquet is not readily available, you can create one yourself using something that is broad, flexible, strong, and able to be twisted, tightened, and secured, such as a webbed belt or luggage strap or material. Improvised tourniquets often fail, but you can attempt to use them as a last resort to at least slow the bleeding.

To use a tourniquet:

1: Place as high as possible on the injured limb, close to the torso. (You can place it over clothing.)

2: Pull the strap through the buckle.

3: Twist the rod tightly until bleeding stops/slows significantly. (May be very painful.)

4: Secure the rod.

5: If bleeding does not stop, place a second tourniquet.

6: Write the date and time tourniquet was placed on the tourniquet or on the injured person with a pen/sharpie (very important for doctor)

7. Leave in place until medical professionals take over care.

Opening the Airway

Positioning an injured patient to keep their airway open and clear is critical to saving their life. The best position for the body is one in which the chest can expand fully, the tongue cannot flop back into the individual’s throat, and blood or fluid does not end up in the lungs (aspirated), particularly in the case with someone with facial trauma.

Someone who is awake (conscious) will naturally assume the position that is best for them given their injuries. Often this is standing or sitting with legs apart and leaning forward. Assist if needed.

If an individual is unconscious and breathing*, you can help by turning the person on his or her side so their chest can expand, tilting the head to drain fluid away from the airway (“Recovery Position”). *If they are not breathing, start CPR.

Lay the person on their side, trying to support the head and neck when rolling them and moving them only as much as necessary to prevent spine injuries. Stretch the bottom arm outward, place hand of top arm on bicep of bottom arm. Bend the legs slightly, raise the chin and point the mouth downward.

Recognizing and Treating Shock (Keeping warm)

The body will mask the symptoms of shock, making it difficult to diagnose. It is common for an individual suffering from shock to be fully coherent and not complaining of pain. However, shock can be life threatening.

CERTs learn a simple nemonic to recognize shock when someone is injured:

30-2-Can Do.

Three signs of shock are breathing more than 30 times a minute, blood not returning to a fingernail (after being pinched) within 2 seconds, and being confused or unable to answer simple questions such as “Squeeze my hand” (including being unconscious). Any one of these 3 symptoms means the injured may be in shock and should be kept warm and receive immediate medical attention.

When a patient is in shock, avoid rough or excessive handling and maintain the person’s body temperature. People with very serious injuries are susceptible to low body temperature, which increases the risk of death.

To keep a person warm, remove wet clothing and place something between the injured person and the ground (e.g., cardboard, jacket, blanket, etc). Wrap the injured person with dry layers (e.g., coat, blanket, or Mylar emergency blanket) and shield the injured person from the wind with your body or surrounding objects.