Bleeding, Life-Threating External

External bleeding is bleeding that is visible on the outside of the body. Volume and flow are two ways to tell if bleeding is life-threatening. Volume is the amount of blood present. Think about a soda can. Bleeding may be life-threatening when the amount of blood present is equal to about half of what a soda can contains. In a small child or infant, bleeding may be life-threatening when the amount of blood loss is even less. Flow is the movement of blood. Blood that is flowing continuously, or spurting, is a sign of life-threatening bleeding. To recognize life-threatening bleeding, look at the amount of blood, volume, and how the blood moves (flow).

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Emergency Steps

Check the scene safety, form an initial impression, obtain consent and put on PPE, as appropriate.

*Note: Signs and symptoms with a * require immediate emergency medical treatment.

Call 9-1-1 and get equipment if the person requires immediate emergency medical treatment.

General Care

  1. Apply direct pressure.
  2. Apply direct pressure and a tourniquet (if trained) for life-threatening bleeding on a limb.
  3. Use wound packing (if trained) for life-threatening bleeding from the scalp, neck, shoulder, groin, and back or from a limb if no tourniquet is available.
  4. Continue checking them as appropriate to determine if additional care is needed.
  5. Keep them from getting cold or overheated.
  6. Give care for shock, if necessary.
  7. Stay with them until EMS arrives.
  8. Position the person as appropriate.
  9. Reassure them you will help and that EMS has been called.
  10. Watch for changes in condition, including breathing and responsiveness, and give care as appropriate and trained.

Untrained Care (Direct Pressure)

  1. Find the source of the bleeding.
  2. Place dressing on wound. Use a hemostatic dressing, if available.
  3. Apply steady, firm pressure directly over wound. Make sure the injured body part is on a firm, flat surface.
  4. Hold direct pressure until bleeding stops or a tourniquet is available.
  5. If bleeding stops before EMS arrive
    1. Check circulation beyond injury.
    2. Apply a roller bandage over the dressing and secure it firmly.
    3. Re-check. circulation beyond the injury.
    1. Do not apply an additional dressing or bandage.
    2. Remove bandage and leave only the single dressing on wound in place.
    3. Apply direct manual pressure.

    Life-Threatening Bleeding FAQs

    How long should I apply direct pressure for life-threatening bleeding?

    Hold direct pressure until:

    What if blood soaks through the original dressing while I’m applying direct pressure to the wound?

    If blood soaks through the original gauze pad, you do not need to do anything, but you can put another gauze pad on top. Replace the new gauze pad as necessary if blood soaks through the pads. Do not remove the original gauze pad and do not stack multiple gauze pads.

    How do I check for circulation?

    When checking for circulation, check the skin on the side of the injury farthest from the heart (e.g., the hand or foot) for temperature, color and feeling. Also ask the person is there is any numbness or tingling.

    What do I do if the wound is from an embedded object?

    The person looks pale and feels cold and dizzy. What does this mean?

    This means the injured person could be in shock because there isn't enough blood flowing through the body. It can be life-threatening because it can lead to a heart attack or other organ damage very quickly.

    What is shock?

    Shock is a progressive, life-threatening condition in which the body does not get enough oxygen-rich blood often due to disturbed blood flow. As a result, organs and body systems begin to fail.

    Signs and symptoms include:

    Should I worry about infection or catching something from the person’s blood?

    While the risk of an infection is low, it is best to not contact someone else's blood when possible. You can use latex-free disposable gloves, a plastic bag, or get them to use their own hand to put pressure on the wound.

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