Trauma: bleeding
Governing: RCUK First Aid Guidelines 2025, 'Control of life-threatening bleeding' and 'Open chest wounds'; Table A-VI/4-1. Builds on: L1.1.
The escalation
RCUK 2025 describes an escalating approach:
- Call for help.
- Firm direct manual pressure on the bleeding point.
- A standard or, ideally, haemostatic dressing applied to the wound with firm pressure; at some sites the dressing must be packed into the wound. If there is nothing else, use any clean material.
- Once controlled, a pressure dressing.
- For life-threatening bleeding from a limb that direct pressure is not controlling, a tourniquet as soon as possible.
| Tourniquet rule | RCUK 2025 |
|---|---|
| Position | 5-7 cm above the injury, not over a joint |
| Tightness | Until bleeding slows and stops; it will hurt |
| Record | Write the time of application |
| Release | Do not release; only a healthcare professional |
| Still bleeding | A second tourniquet above the first |
The older teaching of pressure points and elevation as a first step has given way to getting pressure on quickly and escalating. If your course taught otherwise, follow the current guidance.
Types of bleeding
| Type | Appearance |
|---|---|
| Arterial | Bright red, spurting in time with the pulse |
| Venous | Darker, flowing steadily |
| Capillary | Oozing, usually minor |
Internal bleeding is harder: suspect it after crush injuries, falls, blunt blows to the abdomen or a fractured femur or pelvis, when shock appears without much visible blood.
Embedded objects and special wounds
- Impaled object: leave it in, pad around it, bandage over the padding.
- Amputation: control bleeding first. RCUK 2025: wrap the part in a moist sterile dressing, seal it in a plastic bag, put that bag in another containing ice or ice water (never ice directly on tissue), label it with name and time, and send it with the casualty.
- Open chest wound: RCUK 2025 says leave it exposed; if trained and equipped, use a vented, non-occlusive dressing. Watch for worsening breathing.
Shock
Here shock means inadequate circulation, most often from blood loss.
| Signs | Actions |
|---|---|
| Pale, cold, clammy skin | Treat the cause: stop the bleeding |
| Fast, weak pulse; fast shallow breathing | Lie the casualty down |
| Anxiety, restlessness, thirst | Keep warm with blankets under and over |
| Confusion, then falling response | Nothing by mouth; monitor and record every few minutes |
Positioning should suit the injury: a breathless casualty may need to sit up, a suspected spinal injury stays flat and still.
WARNING — Mooring lines and tender davits Snap-back and crush injuries on yachts produce exactly the arterial limb bleeding a tourniquet is for. Keep one in the Immediate Response Bag and one at the tender garage, and train with it.
TIP — Gloves on first Put on gloves before you touch blood if you can; in the moment, pressure matters more.