Hemostasis (Controlling Bleeding)

There are several ways to control bleeding.  Before tackling this, however, one must differentiate between simple "bleeding" and true hemorrhage.  Bleeding in and of itself is not necessarily life-threatening.  In fact, it can actually be helpful, in that the outward flow of blood from most venous cuts will actually help to clean the wound with minimal loss of blood volume.  One needs to keep in mind that a little blood on the right surface can look like way more than it actually is.

The following methods are known to be effective in controlling bleeding.  One must always use the least risky method to control bleeding.

Direct Pressure


The most common and generally most successful method for controlling bleeding, whether venous or arterial.  Placing direct pressure onto the bleeding part of the wound works 99% of the time (in non-combat situations), and direct pressure can be applied for 30 - 60 minutes.  To perform direct pressure, you literally hold direct, forceful, downward pressure on the bleeding wound, in sufficient force to stop the outward flow of blood, yet not forceful enough to cut off all circulation (unless absolutely necessary).  Depending on the size of the cut and the amount of bleeding, one does not want to frequently check to see if the bleeding has stopped.  Every 20 or so minutes should suffice.

Indirect Pressure


Indirect pressure is applied by using direct force to occlude a vessel (an artery) at a point between the wound and the heart.  Best pressure points are at relatively superficial vessel location, where the vessel crosses over bone.  Locations are typically near the front of the wrist (radial), near the pit of the arm (brachial), in the antecubital space (radial), in the groin area (femoral) or behind the knees (popliteal).  Indirect pressure is generally applied after 20 or so minutes of direct pressure that does not appear to be stemming blood flow.  NOTE:  carotid pressure (applying pressure on the neck to stem blood flow to a scalp injury) is NEVER a wise move.  The appendage should be elevated while pressure is applied.

CAT/Tourniquet


Application of any type of tourniquet should be a last choice, as it is a risky, desperate move.  Because of this, only major trauma (partial loss of leg, IED's, traumatic crush injuries that do not respond to direct, indirect or chemical hemostatis) should have a tourniquet.  Tourniquets need a lot of force to work, and because of this, the risk of loss of limb is very high.  If you ever put a tourniquet on a victim, always write the time the tourniquet went on, especially if handing the victim off to another set of caregivers.  The best and most obvious way to do this is by writing tourniquet time on the victim's forehead with a sharpie.  Again, last resort of desperation.

Chemical Hemostasis


These agents are becoming more reasonable in price and availability, and are quite easy to use.  Of all of the current major brands, all appear to work fairly well