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Texas Emergency Management ONLINE 2017 Vol. 64 No. 7

Bleeding Control: Management of the injured when seconds count

Have you ever thought about what you would do if you or a family member suffered a severe injury and had major bleeding? Per the American College of Surgeons, uncontrolled bleeding is the number one cause of trauma-related death. To increase the chance of survival when there is major bleeding, quick action is required. The four methods you can implement immediately that require little effort on your part – yet offer a quick and effective response to stop major bleeding – are as follows

  • Apply immediate pressure points
  • Apply a tourniquet to the effected leg or arm
  • Apply a pressure dressing
  • Pack the open wound with gauze and apply pressure

Each of these techniques is easily done in the appropriate manner and location:

  • Major Pressure Points:
    • Applied to the brachial artery (upper arm area), femoral artery (groin area), carotid artery (neck area) and other affected areas NOT near a major pressure point.
    • To be applied with hands in all locations OR knee on arms and legs if needed.
      • It only takes 2.3 pounds of pressure to block off the major arteries and veins at the pressure point locations.
  • Tourniquet:
    • To be applied high on the arms and high on the legs.
    • Tourniquet replaces direct pressure on the pressure points for arms and legs.
  • Pressure Dressing:
    • Wrap the area of the wound as tight as you can to maintain blockage of the major vessels to stop bleeding.
    • Can be used like a tourniquet and wrapped around the arm or leg in the same location you would put a tourniquet. The key to success is wrapping very tightly (you should NOT be able to slide your finger under the dressing; if you can, it's too loose).
  • Wound packing:
    • Pack the open wound with gauze or clean cloth.
    • After you have packed the wound and filled it with gauze or a cloth, apply direct pressure over the wound.
    • Wound packing is done when you have exhausted all other efforts with direct pressure and tourniquets or when a tourniquet is not available.

The odds are high that each of us will eventually come across someone who is injured and in need of assistance before EMS arrives on scene. The human body can bleed out (5-6 liters of blood) in less than two minutes during a major bleeding event. Types of incidents that can cause severe bleeding include some of the following:

  • Motor vehicle accidents
  • Shootings/stabbings
  • Industrial accidents
  • Puncture wounds
  • Open and closed fractures of large bones (arms and legs)
  • Auto pedestrian accidents
  • Blast injuries

The keys to success in managing a severe injury with bleeding are to be prepared and willing to help. With the simple applications of bleeding control techniques, lives can easily be saved. Of the large number of survivors during mass shootings over the last few years, we see that a large portion of the injured received tourniquets and/or pressure dressings prior to the arrival of EMS. These were administered by law enforcement and civilians alike who had minimal training and were able to save lives.

To find more information on classes and training material, please visit:

Jason Dush, FF/EMT-P, FP-C, TEMS
EMS Manager
Texas Division of Emergency Management

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