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The body must have enough circulating blood volume to keep the body functioning, and keep the organs supplied with oxygen. Blood consists of red cells, which convey oxygen throughout the body; white cells, which fight introduced infection; platelets, which assist in the clotting process; and plasma, the fluid portion of blood. There are between five and seven litres of blood in the average adult body which makes up 7-8% of the body weight.

Blood is moved around the body under pressure by the heart and blood vessels. Without an adequate blood volume and pressure, the human body soon collapses. Bleeding, or haemorrhage, poses a threat by causing both the volume and the pressure of the blood within the body to decrease through blood loss when blood vessels rupture due to a severe injury.

Bleeding is one of the common causes of death in accidents. The aim of the first aider is to reduce the loss of blood from the casualty.

External bleeding External bleeding is usually associated with wounds. Serious wounds involve damage to blood vessels. Damage to an artery is characterised by bright red blood which can spurt with each heartbeat. Damage to veins appears as a darker red and tends to flow. Capillary damage is associated with wounds close to the skin and is a bright red and oozes.

A wound is caused when our body tissue is torn or cut. Types of wounds include abrasions, amputations, incisions, lacerations and punctures.

Abrasion: is a wound where the skin layers have been scraped off from a fall on a rough surface, pieces of shells, claws of animals, machinery etc. These wounds have torn or irregular edges and they tend to bleed less. Amputation: is the severing or partial severing of part of the body, such as a limb or part of a limb. Incision:is a wound characterised by ‘slicing’ as with a sharp knife or sharp piece of metal. It is often characterised by a narrow wound which has cut cleanly and bleeds extensively. Laceration: is a jagged-edge wound with associated tissue loss, such as from a barbed wire fence injury, or where a rider’s ankles, knees, elbows or wrists have abraded at speed, colliding with a road surface.

Puncture wounds are perforations, from anything from a corkscrew to a bullet, and generally with a limited external area but potentially quite deep, affecting internal organs.

Some bleeding, such as Varicose veins, can often rupture with little or no injury.

Life Threatening Bleeding

• call ‘000’ for an ambulance
• put on disposable gloves if available
• remove or cut clothing to expose the wound
• check the wound for visible foreign bodies
• apply direct pressure over the wound with a sterile or clean pad
  • the casualty may be able to apply direct pressure themselves
• lie the casualty down if not already in this position
• raise and support the injured part above the level of the heart if possible
• apply a dressing and a firm bandage to hold the pad in place
  • check circulation
  • reassess circulation every 30 minutes
• treat for shock if required
• check circulation regularly to ensure bandage is not too tight
• regularly monitor and record level of consciousness, pulse and breathing
  If unable to stop the bleeding consider a constrictive bandage
• cut or remove all clothing from the upper part of the affected limb
• select a firm wide bandage (minimum 5cm) that is not too elastic
• apply bandage firmly to limb and tighten until bleeding stops
• DO NOT cover the bandage – ensure that the constrictive bandage remains easily seen
  

Constrictive bandages are a measure of last resort, and should only be used in a life threatening situation where all other methods have failed.

Bleeding from Wounds

• put on disposable gloves if available
• check the wound for foreign matter
• immediately apply pressure to stop any bleeding
• bring the sides of the wound together and press firmly
• if a penetrating object is present
  • build up padding around the object for bleeding control and support
  • apply a firm roller or triangular bandage to support padding
• apply a non-stick dressing and a firm roller bandage
• immobilise and elevate the injured limb if injuries permit
• DO NOT remove any penetrating object
• DO NOT put pressure over penetrating object

Nosebleed

• put on disposable gloves if available
• have the casualty pinch the fleshy part of the nose just below the bone
• have the casualty lean slightly forward
• ask the casualty to breathe through their mouth
• maintain the pressure and posture for at least 10 minutes
  • a longer time may be needed in hot weather or after exercise or if the casualty has high blood pressure
• apply cool compress to the nose, neck and forehead
• if bleeding persists, obtain medical aid
•  advise the casualty not to blow or pick their nose for several hours or to swallow blood

Amputation

• treat as for bleeding from wounds
• after bleeding is controlled
  • collect amputated part – keep dry, DO NOT wash or clean
  • seal the amputated part in a plastic bag or wrap in waterproof material
  • place in iced water – DO NOT allow the amputated part to come in direct contact with ice. Freezing will kill tissue
• ensure the amputated part goes to the hospital with the casualty. Often the part can be re-attached using microsurgery

If bleeding occurs through the existing dressing, place a second dressing over the first leaving the existing dressing in place. Remove and replace only the bandage and padding. Maintain direct pressure over the bleeding area as much as possible. Avoid disturbing the bandage or pad once the bleeding has been controlled.

Wounds can be cleaned with clean water or sodium chloride.

With all wounds, the casualty should obtain medical advice for tetanus prevention.