How bystanders can stop severe bleeding after traumatic injury

by Jack Sava, MD, Chief of Trauma
January 9, 2018

Imagine you’re walking to the bus or train when you spot a person lying on the ground, blood pooling under their leg. What do you do?

The first instinct for many people is to freeze. Unfortunately, that response leads to avoidable deaths. Massive blood loss (hemorrhage) is the cause of death for more than 40 percent of people who die within 24 hours of sustaining a traumatic injury. Even when a person has the presence of mind to call 911, the victim could bleed to death by the time emergency responders can get them to our Level I Trauma Center. The luckier victims who make it to the hospital often are unconscious and need emergency surgery within minutes of arrival.

While our trauma team is specially trained for these emergency situations, bystander intervention can help us save many more lives. In other words, it’s just as important for regular people in our community to learn how to stop a stranger’s blood loss as it is to learn CPR. And that’s why my team and I are actively involved in the Stop the Bleed campaign, a national movement to teach bystanders how to help people with bleeding wounds.

LISTEN: Dr. Sava discusses how bystanders can stop blood loss in this Medical Intel podcast.

What is the Stop the Bleed campaign?

The Stop the Bleed campaign was started in response to mass shootings in the U.S. The general premise is that first responders, specifically police officers, should be able to stop bleeding with direct pressure, appropriate dressings and tourniquets. But we realized quickly that this doesn’t just apply to police officers and mass shootings—it applies to all our lives.

An adult can die in less than five minutes from a bleeding wound in a critical area. Some areas, such as the neck or groin, can be very hard to control, even by expert medics. Other smaller wounds may stop on their own without much help. Stop the Bleed focuses on the broader middle ground—people who have severe bleeding and who need quick action by others within the hour after injury to save their lives.

I’ve seen footage of crowds of people standing around a person on the ground, watching them bleed to death. They’re frozen, not sure what to do or scared to act. As a trauma surgeon, it’s torture to watch people who are well-intentioned but don’t have the training and preparation to do a couple simple things to save a life. Bleeding control, in many cases, can be easier—and more successful—than CPR.

A person can bleed out in < 5 minutes from a bad wound. Don’t hesitate—apply pressure and call 9-1-1. bddy.me/2mO19wT via @MedStarWHC

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What to do if you see someone bleeding

If you find the victim by yourself, your primary objective is to put pressure on the wound, then call 9-1-1 when you can. If another person is with you, one of you should call 9-1-1 while the other person puts pressure on the victim’s wound.

To apply pressure and stop the bleed, you first must find the actual wound. This sounds obvious, but if a person’s entire pant leg or shirt sleeve is covered in blood, the source might not be easy to identify. You might have to roll up, tear away or cut off the person’s clothing to find the wound.

The next step is to press on the wound—hard. This may cause the person more pain, but applying hard, continuous pressure is the only thing that will stop the bleed. Protect yourself with gloves when you can. It’s OK to use a shirt or bandage when you apply pressure, but it’s not critical. In fact, using too much cloth or gauze actually can spread out the pressure, making your efforts less effective. Use your hands or kneel directly on the wound, as military medics are trained to do in the field. Don’t worry if your hands or shoes are dirty—the risk of getting germs in the wound is meaningless if the person bleeds to death.

Additional steps may require some simple equipment. If any emergency responder arrives, or if you have access to a Stop The Bleed kit, you will be able to use hemostatic dressings, or a tourniquet. Hemostatic dressing is a type of gauze that is coated with special substances that help stop bleeding. The hemostatic dressing is placed directly on the wound and have continuous pressure applied until the bleeding stops.

The tourniquet is an ancient tool that has recently become very popular, especially with the new, easy-t0-use designs. A tourniquet is a device that’s similar to a belt—you can place it around a wounded limb and tighten it to stop blood loss. These devices have been around for a long time, and one of the goals of Stop the Bleed is to make them readily available, just like defibrillators are available in public places for cardiac resuscitation.

The key thing about a tourniquet is that it must be placed above the wound—upstream of the blood flow, if you will—rather than directly on the wound or below it. So, if you find a person with a bleeding wound right above their knee, you should place the tourniquet around the thigh (above the knee) and pull it tight to block blood flow to the wound and stop the bleed. A tourniquet can be left on for a few hours if necessary while awaiting medical care before the risk of permanent tissue damage from lack of blood flow would become a concern. Tourniquets can be highly effective for traumatic injuries to the legs or arms. However, if the wound is in the groin, armpit or another area of the torso, direct pressure is a more effective method to stop blood loss.

Over the past decade, we’ve seen more emergency responders putting on tourniquets in the field, and citizens commonly use them as well. We’ve seen patients in our trauma center who suffered a workplace accident and someone applied a tourniquet. Often, these individuals arrive awake and alert when, without the tourniquet, they likely would have arrived soaked in blood and perhaps near death.

How to get Stop the Bleed training

The Stop the Bleed campaign team has developed course materials with simple messaging around the importance of bystander intervention, bleeding wound management and more. We use a simulation mannequin leg to teach pressure application skills during our one- to two-hour education sessions at local organizations.

We’ve started to present Stop the Bleed sessions in middle schools, which have raised an interesting discussion nationally: What’s the appropriate age for kids to learn about bystander intervention for bleeding wounds? Across the country, middle and elementary school students learn basic first aid skills and CPR. However, many people consider bleed management to be too scary to teach to children. I disagree—I’ve been educating my kids about it from the time they were 4 or 5. If I got a minor cut on my finger while working around the house, I’d call the kids to me and show them how to stop the bleed.

If you’re interested in a Stop the Bleed course for your family or your community organization, visit StopTheBleedTraining.org to find courses online or contact our Level I Trauma Center or a trauma center local to you. There are many certified trauma providers in our community who want to help equip you with the skills to potentially save a life one day. While bleeding wounds might be scary, safe blood loss management is vital for all of us to learn to keep each other safe.

infographic for first aid bleeding treatment

Category: Healthy Living, Medical Intel     Tags: blood lossDr. Jack Savastop bleedingStop the Bleed campaigntraumatraumatic injury