Practical Answers for Everyday Independence

How to Control Serious Bleeding

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Category: Health & Safety

How to Control Serious Bleeding

Serious bleeding can become life-threatening within minutes. A person may lose a dangerous amount of blood before an ambulance arrives, so immediate action from someone nearby can make an important difference.

The priorities are to make sure the scene is safe, call 911, locate the source of the bleeding, and apply firm pressure. Life-threatening bleeding from an arm or leg may also require a commercially manufactured tourniquet. Certain deep wounds may need to be packed by someone who has been trained.

You do not need to clean a serious wound or determine exactly which blood vessel was injured. Your job is to control the bleeding and keep the person alive until emergency professionals take over.

Recognize Life-Threatening Bleeding

Bleeding may be life-threatening when:

  • Blood is spurting or pulsing from a wound.
  • Blood is flowing continuously.
  • Blood is pooling on the ground.
  • Clothing or bandages are rapidly becoming soaked.
  • A body part has been partially or completely severed.
  • The wound is deep, large, or caused by major trauma.
  • Bleeding does not stop with firm pressure.
  • The person becomes pale, weak, confused, or unconscious.
  • The person has a rapid pulse or rapid breathing.
  • The person takes blood-thinning medication or has a bleeding disorder.
  • You believe a large amount of blood has been lost.

The color of the blood does not determine whether the bleeding is dangerous. Bright red, dark red, or mixed bleeding can all be serious.

When you are uncertain, treat rapidly flowing or uncontrolled bleeding as an emergency.

Helpful Resources: Browse Cuts, Scrapes & Wound Care for products, equipment, services, or supplies related to this section.

Make Sure the Scene Is Safe

Before approaching, look for hazards such as:

  • Traffic
  • Fire
  • Electrical wires
  • Broken glass
  • Chemicals
  • Weapons
  • Aggressive people or animals
  • Unstable equipment or structures
  • Moving machinery

Do not enter an unsafe area and become another injured person. Call 911 and wait for trained responders when the danger cannot be controlled.

If the injury resulted from violence, remain alert to your surroundings and follow law-enforcement instructions.

Protect Yourself From Blood Exposure

Use disposable medical gloves when they are available. Eye protection may also be useful when blood is spraying.

If gloves are not available and the bleeding is life-threatening, do not delay lifesaving care. You may be able to:

  • Ask the injured person to apply pressure to their own wound.
  • Use several layers of cloth or gauze as a barrier.
  • Place your hand inside a clean plastic bag.
  • Avoid direct contact with blood as much as possible.

Afterward:

  • Wash your hands and exposed skin thoroughly with soap and water.
  • Do not touch your face before washing.
  • Report an occupational exposure according to workplace procedures.
  • Seek prompt medical advice if blood entered your eyes, mouth, broken skin, or a puncture wound.

Call 911

Call 911 or your local emergency number immediately for serious bleeding.

Put the phone on speaker and tell the dispatcher:

  • Your exact location
  • What caused the injury
  • Where the person is bleeding
  • Whether the bleeding is spurting or flowing continuously
  • Whether the person is awake
  • Whether the person is breathing normally
  • Whether a tourniquet has been applied
  • Whether there are additional injuries or dangers

If other people are present, give one person a direct instruction:

“Call 911 and bring the first aid kit, bleeding-control kit, and AED.”

Do not assume someone else has called.

Expose the Wound

Locate the exact source of the bleeding.

Remove or cut away clothing when it can be done safely. Trauma shears are useful because they are designed to cut clothing with less risk of injuring the person.

Do not:

  • Spend time completely undressing the person.
  • Remove clothing stuck inside a wound.
  • Probe deeply with your fingers.
  • Pull out an embedded object.
  • Delay pressure while searching for supplies.

A person may have more than one injury. Control the most serious bleeding first, then look for additional wounds.

Apply Firm Direct Pressure

Direct pressure is the most important first action for many bleeding wounds.

To apply pressure:

  1. Place sterile gauze, a trauma dressing, or a clean cloth directly over the wound.
  2. Put one hand over the other when additional force is needed.
  3. Press down firmly and continuously.
  4. Use your body weight to help maintain pressure.
  5. Keep the injured area supported on a firm surface when possible.
  6. Continue until the bleeding stops, a tourniquet takes over, or emergency responders relieve you.

Pressure may need to be uncomfortable to control life-threatening bleeding. Reassure the person while continuing to press.

The American Red Cross advises maintaining direct pressure until the bleeding stops, a tourniquet controls the bleeding, another rescuer takes over, you become unable to continue, or the scene becomes unsafe. American Red Cross: Life-Threatening External Bleeding

Do Not Keep Checking the Wound

Do not lift the dressing every few seconds to see whether the bleeding has stopped. Releasing pressure can break apart the clot that is beginning to form.

Keep your hands in place and maintain continuous pressure.

If blood soaks through the original dressing, keep the original material against the wound. You may place additional material on top when necessary, but do not create a large, unstable stack that reduces effective pressure.

The key is firm pressure directly over the bleeding source.

When to Use a Tourniquet

A tourniquet is used for life-threatening bleeding from an arm or leg.

Use a commercially manufactured tourniquet when:

  • Blood is spurting or flowing heavily from a limb.
  • Direct pressure is not controlling the bleeding.
  • The injury prevents you from maintaining pressure.
  • There are several injured people.
  • The scene requires the person to be moved quickly.
  • The limb is partially or completely severed.
  • You have been trained and recognize life-threatening extremity bleeding.

If a tourniquet is immediately available for obvious life-threatening bleeding from an arm or leg, use it promptly according to your training and the device instructions.

Do not use a limb tourniquet for bleeding from the:

  • Head
  • Neck
  • Chest
  • Abdomen
  • Groin
  • Shoulder

The American College of Surgeons’ Stop the Bleed program teaches three core bleeding-control actions: applying direct pressure, packing an appropriate wound, and applying a tourniquet. ACS Stop the Bleed: Get Trained

Applying a Commercial Tourniquet

Tourniquet designs vary. Follow the instructions provided with the device and your hands-on training.

A general application involves:

  1. Expose the injured limb when possible.
  2. Place the tourniquet approximately two to three inches above the wound, between the wound and the heart.
  3. Do not place it directly over the wound.
  4. Do not place it over an elbow, knee, or another joint.
  5. Pull the strap as tight as possible.
  6. Secure the strap.
  7. Twist the windlass or tightening device until the bleeding stops.
  8. Secure the windlass so it cannot unwind.
  9. Record the time.
  10. Leave the tourniquet visible for emergency responders.

If the wound location cannot be identified quickly, place the tourniquet high on the injured limb and tighten it according to your training.

A properly applied tourniquet is usually painful. Pain does not mean it should be loosened.

Tighten Until the Bleeding Stops

A tourniquet that is not tight enough may allow continued blood loss.

After applying it:

  • Check the wound.
  • Confirm that active bleeding has stopped.
  • Tighten it further if bleeding continues.
  • Do not cover the tourniquet with clothing or a blanket.
  • Do not remove or loosen it.

If bleeding continues despite a fully tightened commercial tourniquet, apply a second tourniquet immediately above the first when one is available and you have been trained to do so.

Tell emergency responders how many tourniquets were used and when each was applied.

Never Loosen a Tourniquet

Once a tourniquet has controlled life-threatening bleeding, leave it in place.

Do not loosen it:

  • To reduce pain
  • To allow circulation temporarily
  • To see whether the bleeding has stopped
  • Because the ambulance is delayed
  • Because the person asks you to remove it

Emergency medical professionals will determine when and how it should be removed.

Repeated loosening can restart severe bleeding and cause additional complications.

Avoid Improvised Tourniquets When Possible

A commercially manufactured tourniquet is preferable because it is designed to apply enough pressure to stop arterial blood flow.

Belts, cords, shoelaces, and narrow materials often fail to control bleeding and may cause tissue damage.

If no commercial tourniquet is available, continue direct pressure. A 911 dispatcher may provide instructions based on the injury, available materials, and expected response time.

Hands-on bleeding-control training can teach safer emergency alternatives for situations in which professional help is significantly delayed.

Packing a Deep Wound

Certain deep wounds cannot be treated with a limb tourniquet. A trained person may need to pack an appropriate wound in the:

  • Groin
  • Shoulder
  • Scalp
  • Neck
  • Back
  • Arm or leg when a tourniquet is unavailable or cannot be positioned

Do not pack a wound of the chest or abdomen unless a qualified emergency professional specifically instructs you to do so.

To pack an appropriate wound according to training:

  1. Locate the source of bleeding.
  2. Use plain gauze or a hemostatic dressing from a bleeding-control kit.
  3. Place the material directly into the wound at the source.
  4. Continue filling the wound cavity tightly.
  5. Apply firm direct pressure.
  6. Maintain pressure according to your training and the dressing instructions.
  7. Do not remove the packing.

Wound packing is best learned through hands-on practice. In an emergency, follow instructions from the 911 dispatcher.

Hemostatic Dressings

A hemostatic dressing contains a substance designed to help blood clot. These dressings are often included in bleeding-control kits.

Use one according to:

  • Your training
  • The manufacturer’s instructions
  • Instructions from the 911 dispatcher

The dressing still requires firm direct pressure. It is not enough to lay the material loosely over the wound.

Do not remove the dressing once it has been packed into the wound unless a qualified medical professional directs you to do so.

Embedded Objects

Do not remove a deeply embedded object.

The object may be:

  • Damaging tissue
  • Near a blood vessel
  • Partially controlling the bleeding
  • Difficult to remove without surgery

Instead:

  1. Call 911.
  2. Apply pressure around the object.
  3. Use bulky dressings to stabilize it.
  4. Avoid pressing directly on the object.
  5. Prevent it from moving.
  6. Keep the person still.

Do not shorten, twist, or push the object farther into the wound unless emergency responders direct you because of an immediate safety need.

Open Fractures

An open fracture occurs when the skin is broken near a broken bone or bone is visible through the wound.

Call 911.

Do not:

  • Push the bone back inside.
  • Straighten the limb.
  • Test movement.
  • Apply pressure directly to exposed bone.
  • Wash or probe the wound.

Apply pressure around the bleeding area, cover it loosely with a sterile dressing, and keep the limb still.

If life-threatening bleeding from the arm or leg cannot be controlled with pressure around the wound, use a tourniquet according to your training.

Partial or Complete Amputation

Call 911 immediately.

Control bleeding from the injured person using direct pressure or a tourniquet when appropriate.

If a body part has been completely severed:

  1. Locate it if doing so is safe.
  2. Handle it carefully.
  3. Do not scrub it.
  4. Wrap it in clean, slightly damp gauze or cloth.
  5. Place it in a sealed plastic bag.
  6. Place that bag on a second container or bag containing ice and water.
  7. Send it to the hospital with the person.

Do not place the body part directly on ice or allow it to freeze. Do not immerse it directly in water.

Do not delay bleeding control or emergency care while searching for the severed part.

Head and Scalp Bleeding

Scalp wounds can bleed heavily because the scalp has many blood vessels.

Apply direct pressure when there is no obvious skull deformity, deeply embedded object, or exposed bone.

Use extra caution when:

  • The injury followed a major fall or collision.
  • The skull appears dented or deformed.
  • Bone is visible.
  • Clear fluid is draining from the nose or ears.
  • The person is confused or unconscious.
  • A spinal injury may be present.

For a possible skull fracture, cover the wound loosely and avoid firm pressure directly over the damaged area. Call 911 and follow the dispatcher’s instructions.

Bleeding From the Neck

Neck wounds can damage major blood vessels and the airway.

Call 911 immediately.

Apply direct pressure over the bleeding site while avoiding pressure across the front of the neck or windpipe. Do not wrap a bandage completely around the neck.

If an object is embedded, stabilize it and apply pressure around it.

Monitor breathing closely.

Chest and Abdominal Wounds

Call 911 for a deep, penetrating, or seriously bleeding wound to the chest or abdomen.

Do not:

  • Pack material deeply into the chest or abdomen.
  • Push exposed tissue or organs back inside.
  • Remove an embedded object.
  • Give food or drink.
  • Apply a tourniquet.

Cover the wound as directed by the 911 dispatcher or according to your certified first aid training.

Chest wounds may affect breathing and require specialized dressings. Follow current professional instructions rather than improvising an airtight seal without training.

Internal Bleeding

Internal bleeding may occur after a fall, collision, crushing injury, penetrating wound, or spontaneous medical problem. It cannot be controlled with external pressure.

Possible warning signs include:

  • Abdominal, chest, back, or pelvic pain
  • A swollen, rigid, or tender abdomen
  • Large or rapidly spreading bruises
  • Blood in vomit
  • Vomit that looks like coffee grounds
  • Black, tarry stool
  • Red or maroon stool
  • Blood in urine
  • Coughing up blood
  • Vaginal bleeding that is unusually heavy
  • Dizziness or fainting
  • Pale, cool, or clammy skin
  • Rapid breathing
  • Weakness or confusion
  • Signs of shock

Call 911 for suspected serious internal bleeding.

Keep the person still, monitor breathing, and do not give food, drink, or medication.

Recognizing Shock

Severe blood loss can cause shock, which means the organs are not receiving enough blood and oxygen.

Possible signs include:

  • Pale, cool, or clammy skin
  • Rapid, shallow breathing
  • A rapid, weak pulse
  • Dizziness
  • Confusion
  • Restlessness
  • Extreme thirst
  • Nausea
  • Weakness
  • Fainting or unconsciousness

While waiting for help:

  • Have the person lie still when that position is safe.
  • Keep them comfortably warm.
  • Do not overheat them.
  • Do not give food or drink.
  • Continue controlling the bleeding.
  • Monitor breathing and responsiveness.
  • Be prepared to begin CPR.

Do not raise the legs if doing so causes pain or if there may be an injury to the head, spine, pelvis, hips, or legs.

If the Person Becomes Unresponsive

If the person becomes unresponsive:

  1. Check whether they are breathing normally.
  2. Call 911 if this has not been done.
  3. Begin CPR if they are not breathing normally.
  4. Use an AED as soon as one is available.
  5. Continue bleeding control when another rescuer is available.
  6. Follow the dispatcher’s instructions.

When several people are available, assign separate tasks:

  • One person performs CPR.
  • One person controls bleeding.
  • One person retrieves the AED and supplies.
  • One person meets emergency responders.

Serious Bleeding in a Child

The same basic priorities apply:

  • Call 911.
  • Apply firm direct pressure.
  • Use an appropriately sized commercial tourniquet for life-threatening arm or leg bleeding when trained.
  • Keep the child warm.
  • Monitor breathing and responsiveness.

A child has less total blood than an adult, so an amount that appears small may still be dangerous.

Reassure the child, but do not reduce pressure because the treatment hurts. Continue until the bleeding is controlled or trained responders take over.

Blood-Thinning Medication

Someone who takes a blood thinner may bleed more heavily or for longer.

Tell emergency responders:

  • The medication name
  • The dose, if known
  • When the last dose was taken
  • Why it was prescribed
  • Whether the person also takes aspirin or another medication affecting bleeding

Do not stop or change a prescribed blood thinner after the event unless a healthcare professional directs you to do so.

Do Not Clean a Serious Wound

Cleaning is appropriate for many minor cuts, but it is not the priority during life-threatening bleeding.

Do not:

  • Pour water into a major wound.
  • Scrub the area.
  • Apply hydrogen peroxide or alcohol.
  • Remove clots.
  • Pull away tissue.
  • Dig for debris.
  • Spend time applying ointment.
  • Delay pressure while preparing supplies.

Control the bleeding first. Emergency professionals can clean and treat the wound after circulation has been protected.

Preparing a Bleeding-Control Kit

A bleeding-control kit may include:

  • Nitrile gloves
  • Sterile gauze
  • Compressed gauze
  • Hemostatic dressing
  • Commercial windlass tourniquet
  • Trauma dressing
  • Trauma shears
  • Permanent marker
  • Emergency blanket
  • Instructions

Purchase recognized emergency equipment from a reliable source. Counterfeit or poorly manufactured tourniquets may break or fail when tightened.

Keep kits:

  • At home
  • In a vehicle
  • At work
  • Near an AED
  • In a workshop
  • With outdoor or sports equipment
  • Anywhere serious injuries may occur

Inspect supplies regularly and replace anything damaged, opened, expired, or missing.

Take Hands-On Training

Serious bleeding control is a physical skill. Reading the steps is helpful, but training allows you to practice:

  • Finding the bleeding source
  • Applying effective direct pressure
  • Packing a wound
  • Applying a tourniquet
  • Checking whether bleeding has stopped
  • Responding when the first technique does not work

The ACS Stop the Bleed program offers community courses designed for members of the public. More than five million people have received its bleeding-control training.

Common Mistakes to Avoid

Try not to:

  • Enter an unsafe scene.
  • Delay calling 911.
  • Spend time cleaning a serious wound.
  • Apply weak or intermittent pressure.
  • Lift the dressing repeatedly to check.
  • Pull out an embedded object.
  • Push exposed bone or tissue back inside.
  • Apply a tourniquet over a joint.
  • Use a tourniquet on the neck, chest, abdomen, or groin.
  • Leave a tourniquet too loose.
  • Loosen a tourniquet after it has stopped the bleeding.
  • Cover the tourniquet so responders cannot find it.
  • Forget to record the application time.
  • Pack a chest or abdominal wound.
  • Give food, drink, or medication to someone with serious blood loss.
  • Allow the person to stand or walk.
  • Assume bleeding has stopped without continuing to monitor it.

A Simple Serious-Bleeding Checklist

When someone is bleeding heavily:

  1. Make sure the scene is safe.
  2. Put on gloves if they are available.
  3. Call 911.
  4. Find the source of the bleeding.
  5. Apply firm, continuous direct pressure.
  6. Do not repeatedly lift the dressing.
  7. Use a commercial tourniquet for life-threatening arm or leg bleeding when appropriate.
  8. Tighten the tourniquet until the bleeding stops.
  9. Record the time and never loosen it.
  10. Pack an appropriate deep wound only according to training or emergency instructions.
  11. Leave embedded objects in place and apply pressure around them.
  12. Keep the person still and comfortably warm.
  13. Watch for shock.
  14. Monitor breathing and responsiveness.
  15. Continue care until emergency responders take over.

Severe bleeding is frightening, but the response is direct: call for help, find the wound, and stop the blood loss. Firm pressure, proper wound packing, and correctly applied tourniquets can save lives when used quickly and appropriately.

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Important Health & Safety Notice

The information in this guide is provided for general educational purposes only. Independence Answers is not a medical provider, and this content is not a substitute for professional medical advice, diagnosis, treatment, or supervision. Always follow the instructions of your doctor, pharmacist, or other qualified healthcare professional, especially if you have a medical condition, take medication, or are unsure whether an action is safe for you.

Do not ignore or delay seeking professional care because of something you read here. If you believe someone may be experiencing a serious or life-threatening emergency, call 911 or your local emergency number immediately.