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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.

Internal bleeding Internal bleeding is classified as either visible, in that the bleeding can be seen, or concealed, where no direct evidence of bleeding is obvious.

Always consider internal bleeding after injury, understanding it cannot be controlled by the first aider.
In most instances, obtaining an adequate history of the incident or illness will give the first aid provider the necessary clue as to whether internal bleeding may be present.

Remember that current signs and symptoms, or the lack of them, do not necessarily indicate the casualty’s condition.

Certain critical signs and symptoms may not appear until well after the incident due to the stealth of the bleed, and may only be detected by the fact that the casualty’s observations worsen despite there being no visible cause.

Visible Internal Bleeding Visible internal bleeding is referred to this way because the results can be seen in bleeding from:

• Anus or vagina – usually red blood mixed with mucus
• Ears – bright, sticky blood or blood mixed with clear fluid
• Lungs – frothy, bright red blood coughed up by the casualty
• Stomach, bowel or intestines – bright, dark or tarry blood
• Under the skin (bruising) – the tissues look dark due to the blood under the skin
• Urinary tract – dark or red coloured urine

Concealed Internal Bleeding Detecting internal bleeding relies upon good observations and an appreciation of the physical forces that have affected the casualty. In these cases, the first aid provider relies heavily on history, signs and symptoms. If you are unsure, assume the worst and treat for internal bleeding.

Remember to look at the important observations that may indicate internal bleeding, which include:

• Skin appearance
• Conscious state
• Pulse
• Respiration

• pale, cool, clammy skin
• thirst
• rapid, weak pulse
• rapid, shallow breathing
• ‘guarding’ of the abdomen, with foetal position if lying down
• pain or discomfort
• nausea and/or vomiting
• visible swelling of the abdomen
• gradually lapsing into shock

• call ‘000’ for an ambulance
• put on disposable gloves if available
• if conscious – lie the casualty down with legs elevated and bent at the knees
• if unconscious – recovery position and elevate the legs if possible
• reassurance
• treat any injuries
• give nothing by mouth