What’s the Best Way to Stop Severe Bleeding?
Severe bleeding can start when someone has suffered a deep cut, gunshot or knife wound, amputation, crush injury, or car accident, and it can be life-threatening if the bleeding isn't stopped or significantly slowed in the first few minutes following the event. After recognizing a bleeding emergency and calling 911, applying highly effective first aid techniques can help to stop the bleeding and potentially save the injured person's life.
Step 1: Assess the Scene and Prepare to Act
- First, check that it's safe to approach.
- Apply your personal protective equipment (PPE). This should at minimum include a pair of sterile gloves, as well as goggles if available.
- Have the injured person lie down if possible, unless cervical injury is suspected.
- Locate the source of the bleeding. If there is an object in the wound that's keeping it sealed (such as a knife), do not remove the object. Likewise, do not peel away clothing that's stuck in the wound, helping it to clot. Visible objects that aren’t helping to stop the bleeding can be carefully removed with tweezers.
- Using a pair of scissors, cut away the clothing around the wound.
A note about puncture wounds and crush injuries: Puncture wounds and crush injuries often bleed under the surface of the skin rather than bleeding externally. Signs of a puncture wound, in particular, are swelling and a reddish-purple discoloration around the wound. If you find a crush injury or a puncture wound that is bleeding profusely under the skin, you will need to apply a tourniquet (see step 4 below).
Step 2: Apply Pressure and Keep the Wound Elevated (for External Bleeding)
- Taking folded-up gauze or clean cloth, apply direct pressure to the bleeding wound, attempting to pack the wound with the gauze, and elevate it above the level of the person's heart, if possible. If there is an object stuck in the wound, apply pressure around the object—not directly on top of it.
- If the blood soaks through the gauze or cloth, apply another layer of gauze or cloth on top of the first one, without removing the blood-soaked material.
Best way to stop severe bleeding: If hemostatic gauze is available, use this instead of regular gauze, pressing it all the way into the wound to aid with clotting. Hemostatic gauze comes in most bleeding kits and can be applied everywhere except the brain (head injuries), eyes, chest, and abdomen. Chest wounds should be dressed with a vented chest seal if there’s any chance of a perforated lung.
Step 3: If the Bleeding Stops, Clean and Dress the Wound
- If the blood flow slows so that it's just a trickle or mild ooze, apply more gauze or a clean cloth and tie a sterile bandage firmly around the wound (not tightly enough to stop blood flow to the limb).
- If the bleeding stops completely and nothing is stuck to it, wash the wound carefully with soap and water. Disinfecting a wound with hydrogen peroxide or rubbing alcohol can cause tissue damage and slow healing.
- Dress the wound in sterile gauze and a sterile bandage tied firmly around the gauze. Continue to apply direct pressure to the wound and keep it elevated.
Step 4: If the Bleeding Continues, Apply a Tourniquet
Sometimes, wounds won't stop bleeding even after prolonged direct pressure. If the wound is on an arm or a leg and heavy bleeding doesn't stop with direct pressure, you'll need to apply a tourniquet.
- Tell the injured person that you are going to apply a tourniquet and that it will hurt but is needed in order to save the limb and possibly their life.
- Take the commercial tourniquet out of your bleeding control kit and apply the tourniquet a few inches above the wound, between the wound and the person's heart. If the injury is close to the elbow or knee, apply the tourniquet above the joint—not over it.
- Tighten the tourniquet until the blood flow stops and there is no longer a pulse on the other side of the tourniquet.
Write the time you applied the tourniquet with a black marker on thetourniquet if there is a dedicated space, or on the patient's limb or forehead. Tourniquets should not be left on for longer than two hours and should only be removed by medical personnel.
Important note: If no commercial tourniquet is available and the victim is experiencing rapid blood loss, an improvised tourniquet can be made using strips of cloth, a scarf, or a towel with a stick or pencil as a windlass to tighten the tourniquet. While sometimes needed as a last resort, improvised tourniquets are often ineffective and can damage the muscle and tissue in the limb. For this reason, we recommend purchasing and using only tried-and-tested commercial tourniquets.
Step 5: Hand Over to Emergency Medical Services
When emergency medical services arrive, explain what has been done to control the bleeding, that the person has a tourniquet (if relevant), and the time the tourniquet was applied (if one was used). EMS professionals are thoroughly trained in emergency medicine and will use the information you provide to administer the most appropriate follow-up treatment.
Step 6: After the Incident
Once the injured person is receiving professional medical help, there are a few more things that you’ll need to do:
- If the injury was clearly caused by an accident (and not a crime), clean up any blood on the floor and other surfaces and apply a disinfectant.
- If there is any chance the injury was the result of a crime, leave everything as-is so that forensic investigators can analyze the scene.
- Wash your hands with soap and warm water to kill germs and bacteria.
- Fill out any incident report forms if available—especially if the accident happened in a workplace or educational facility. You might also want to take notes for yourself in case you're asked about the event at a later date.
- Debrief with others who were present as well as a superior at the workplace or institution where the person was injured. Seek counsel from a therapist you trust to help you process the event, if and whenever you need it.
- Check on the injured person in the hospital or at home after they have stabilized if you can. This can help to reassure you that your actions helped and also give the injured person a chance to debrief, respond, and feel supported.
Severe Bleeding Is an Emergency and Your Timely Action Can Help to Prevent the Worst
Severe bleeding can happen for many reasons and is always an emergency. If you or someone near you is bleeding heavily, apply direct pressure, keep the wound elevated, and use a tourniquet if needed.
Having a bleeding control kit on hand and taking First Aid and STOP THE BLEED® courses will help you to feel even more prepared and confident to help someone who is injured. You never know when you'll be called upon to act.