How to Stop Bleeding: Severe Bleeding First Aid

Most of what people remember about bleeding first aid is either out of date or was never right. Pressure points, elevating the limb, tourniquets as a last-ditch horror — the guidance has moved on, and Australian guidance in particular is now very simple.

The Australian and New Zealand Committee on Resuscitation puts it in one sentence: “Firm pressure on or around the wound is the most effective way to stop most bleeding.” Almost everything else is detail.

How to stop severe bleeding, step by step

1. Check for danger and follow DRSABCD. Put gloves on if you have them.
2. Call Triple Zero (000), or send someone else to call while you start.
3. Lie the person down. It slows the bleeding and protects them if they faint.
4. Expose the wound. Move or cut clothing so you can see what you are pressing on.
5. Press firmly, directly on the bleeding point, with your hands. Do not ease off to check. Keep going.
6. Put a pad or dressing over the wound when one is available, and keep the pressure on through it.
7. Bandage firmly over the pad once the bleeding is controlled — firm enough to maintain the pressure, not so tight it cuts off circulation below.
8. If blood soaks through, add one more pad and bandage it tighter. Do not keep piling loose pads on top; the pressure is what works, not the padding.
9. Keep watching them — consciousness, breathing, and whether the bleeding restarts. Give them nothing to eat or drink.

If something is stuck in the wound, leave it there

An embedded object — glass, a knife, a piece of metal, a stick — may be the only thing plugging the wound. Pulling it out can turn controlled bleeding into catastrophic bleeding, and can do more damage on the way out than it did going in.

• Do not remove it.
• Apply pressure on either side of the object, not on top of it.
• Build up padding around it — rolled dressings on each side of the protruding part — then bandage over the padding without pressing the object down.
• Tell the 000 call taker what is embedded and roughly how deep, if you can see.

Tourniquets: when they are right, and the rule people break

Tourniquets have a bad reputation left over from decades-old teaching. Current Australian guidance is clear that for the right injury they are the correct tool, and that the risk of using one is smaller than the risk of uncontrolled life-threatening bleeding.

When to use one

Life-threatening bleeding from an arm or a leg that direct pressure has not stopped. That is the whole indication. Not for a bad cut that is bleeding steadily. Not anywhere on the torso, neck or head, where a tourniquet cannot work.

How to apply it

• Place it about 5 cm above the bleeding point, on the limb.
• Tighten until the bleeding stops. Australian guidance says to apply it tightly even if that causes local discomfort — a tourniquet that is not tight enough is worse than none, because it can block the veins without blocking the artery.
• Ideally not over clothing or a wetsuit.
• A commercial windlass tourniquet works better than an improvised one. Improvised belts and bandages frequently fail to reach arterial pressure.

The two rules people break

• Write down the time you applied it and tell the paramedics. Guidance is explicit that the time of application must be noted and communicated. Write it on the person's skin if you have nothing else.
• Do not loosen it, and do not cover it. It stays on until hospital staff remove it, and it must stay visible — never hide it under a bandage, a blanket or a sleeve.

What about haemostatic dressings?

These are gauze impregnated with a clotting agent, and they are increasingly common in workplace and remote-area kits. Australian guidance positions them for severe bleeding where a tourniquet cannot be used — a shoulder, a groin, an armpit — or where a tourniquet has failed. Pack it as close to the bleeding point as you can, hold firm pressure, then bandage over it and leave it in place.

Watch for shock

Serious blood loss causes shock, and shock is what actually kills. The signs build quietly:

• Pale, cool, moist skin
• A weak, rapid pulse
• Rapid or gasping breathing
• Restlessness, nausea or thirst
• Faintness, dizziness, confusion, and eventually loss of consciousness

Lie them down, keep them warm, keep the pressure on the wound, and keep talking to them. Do not give them anything to drink, however thirsty they say they are — they may need surgery. If they become unresponsive and are not breathing normally, start CPR. If they are unresponsive but breathing normally, use the recovery position.

Blood thinners change everything

Anticoagulants and antiplatelet medicines — warfarin, apixaban, rivaroxaban, clopidogrel, even regular low-dose aspirin — mean a wound that would normally clot may simply keep bleeding. It also changes what the hospital does on arrival.

So if the person takes one, say so when you call 000. If they cannot tell you, it is exactly the kind of thing worth being able to find on them. The same applies to haemophilia and other bleeding disorders.

Nosebleeds

Common, alarming, and almost always handled wrongly — the instinct to tip the head back sends blood down the throat, which causes vomiting and hides how much is being lost.

1. Sit them upright and tip the head slightly forward.
2. Have them breathe through their mouth.
3. Pinch the soft part of the nose, just below the bony bridge, with thumb and forefinger.
4. Hold it for at least 10 minutes without letting go to check.
5. If it is still bleeding after 20 minutes, seek medical help.

Also get it looked at if nosebleeds keep recurring, if it followed a head injury, or if the person is on a blood thinner.

When to call an ambulance

• Bleeding that spurts, or that will not stop with firm pressure
• Blood soaking through dressings
• A wound to the neck, chest, abdomen or groin
• An embedded object, or an amputation
• Signs of shock
• The person takes a blood thinner or has a bleeding disorder
• You have applied a tourniquet

Related reading: what to say when you call an ambulance, the 10 most common medical emergencies, and signs of stroke and the FAST test. If you take a blood thinner, that is exactly what a medical ID is for — you can create your emergency profile in a few minutes.

Severe bleeding FAQs

Sources

• ANZCOR Guideline 9.1.1 — First aid for management of bleeding — direct pressure as the most effective measure, the position against elevation, embedded objects, arterial tourniquet indication, placement, tightness, timing and non-removal, and haemostatic dressings.
• St John Ambulance Australia — Severe bleeding — step-by-step management, padding and bandaging, and the signs of shock.
• Better Health Channel — Bleeding — background, nosebleeds and when to seek help.
• healthdirect — Shock — recognising and managing shock.
• Triple Zero (000) — when and how to call.

Disclaimer: This article is general first aid information, not medical advice or a substitute for accredited first aid training. In an emergency, always call Triple Zero (000). For non-urgent health advice, call healthdirect on 1800 022 222 (NURSE-ON-CALL 1300 60 60 24 in Victoria, 13 HEALTH 13 43 25 84 in Queensland) or speak with your GP. Never start, stop or change a prescribed medication, including a blood thinner, on the basis of a web page. MedibandPlus stores and provides access to a member’s own medical information; it does not assess, diagnose or treat any condition.

More first aid guides

• DRSABCD: the first aid action plan explained
• How to do CPR: a beginner’s guide
• The recovery position, step by step
• Snake and spider bite first aid
• Burns and scalds first aid
• Calling an ambulance in Australia