Bleeding Control

Part of First Aid

A person can bleed to death from a severed artery in as little as 3-5 minutes. Knowing how to stop blood loss quickly and effectively is the most time-critical medical skill you can learn.

How Blood Loss Kills

An average adult has roughly 5 liters (10.5 pints) of blood. Here’s what happens as that volume drops:

Blood Lost	% of Total	Effects
Up to 750 ml	~15%	Minimal symptoms; slight increase in heart rate
750-1,500 ml	15-30%	Anxiety, faster heart rate, pale skin, delayed capillary refill
1,500-2,000 ml	30-40%	Confusion, rapid weak pulse, cold clammy skin, very low blood pressure
Over 2,000 ml	>40%	Unconsciousness, organ failure, death without intervention

The body cannot replace blood quickly. Even with perfect nutrition and hydration, it takes weeks to rebuild significant blood volume. In a survival situation with no transfusions available, preventing blood loss is the only option.

Identifying Bleeding Types

Before you act, recognize what you’re dealing with.

Arterial bleeding: Bright red blood that spurts rhythmically with each heartbeat. This is the most dangerous. Arteries carry blood under high pressure directly from the heart. An unchecked arterial bleed can be fatal in minutes.

Venous bleeding: Dark red blood that flows steadily without pulsing. Serious but slower than arterial. Veins carry blood back to the heart under lower pressure. Most venous bleeds can be controlled with direct pressure.

Capillary bleeding: Slow oozing from scrapes and shallow cuts. Rarely dangerous on its own. Usually stops within minutes as the blood clots naturally.

The Three-Step Protocol

For any significant bleeding, follow this sequence. Do not skip steps — each builds on the last.

Step 1: Direct Pressure

This stops most bleeding, including many arterial bleeds.

1. Grab the cleanest cloth available — shirt, bandana, towel, gauze if you have it. If nothing is available, use your bare hand. Infection risk is secondary to bleeding to death.
2. Press firmly directly on the wound. Use your palm flat, centered on the wound. Apply your body weight — don’t be gentle. You’re compressing blood vessels against underlying bone or tissue.
3. Hold for a minimum of 10 minutes without lifting to check. Every time you peek, you break the forming clot and restart the clock. Time it if you can.
4. Do not remove the first cloth if it soaks through. Add more material on top and increase pressure. Removing the saturated cloth pulls away clot that has started to form.

Critical Rule

Do NOT keep lifting the dressing to check if bleeding has stopped. This is the most common mistake and it can be fatal. Apply pressure, hold it, and commit to 10 full minutes before you reassess.

For wounds you can’t reach or compress easily (back of the head, between the shoulder blades), pack the wound. Push clean cloth directly into the wound cavity and press hard. This hurts — do it anyway.

Step 2: Pressure Bandage

Once direct hand pressure has slowed or stopped the bleeding, convert to a pressure bandage so your hands are free.

1. Keep the original dressing in place. Add more clean cloth padding on top if needed.
2. Wrap firmly with a long strip of cloth, elastic bandage, belt, or any flexible material. Wrap directly over the wound, overlapping each pass by half. Apply enough tension that the bandage maintains constant compression.
3. Check circulation below the bandage. Fingers or toes beyond the wrap should remain warm with color. If they turn blue, pale, cold, or numb, the bandage is too tight — loosen slightly and rewrap.

A well-applied pressure bandage can maintain hemostasis for hours, freeing you to deal with other injuries or move the patient.

Step 3: Elevation

If the wound is on a limb, elevate it above the level of the heart. This reduces blood pressure at the wound site by working with gravity rather than against it.

• Prop an injured arm on folded clothing or a pack
• For leg wounds, have the person lie down and support the leg on a log, rock, or gear stack
• Elevation alone won’t stop serious bleeding — it supplements direct pressure

When Pressure Fails: Wound Packing

For deep wounds, especially in areas where you can’t compress against bone (groin, armpit, neck, deep limb wounds), wound packing is essential.

Technique

1. Use clean cloth strips — torn T-shirt, gauze, any clean fabric cut into strips roughly 2-3 inches (5-7 cm) wide.
2. Push the fabric into the wound with your fingers, packing it tightly against the deepest point of the wound. Work from the bottom up.
3. Continue packing until the wound cavity is filled and fabric is level with or slightly above the skin surface.
4. Apply direct pressure on top of the packed wound with your palm.
5. Hold for 10 minutes, then secure with a pressure bandage.

This works because it places compression material directly against the bleeding vessel deep inside the wound, rather than trying to compress through layers of tissue from outside.

Wound Packing Hurts

This is extremely painful for the patient. If the person is conscious, warn them. Have someone hold the limb steady. The pain is temporary — the alternative is death from blood loss. Do not let the patient’s reaction stop you from packing firmly.

Pressure Points

When direct pressure on the wound isn’t enough or isn’t possible, compress the major artery upstream of the injury to reduce blood flow to the area.

Location	Artery	How to Compress
Upper arm	Brachial	Press fingers into the inner arm, between bicep and tricep, against the humerus
Groin/upper thigh	Femoral	Press hard with heel of hand into the crease where leg meets pelvis
Neck (one side only)	Carotid	Press into the side of the neck, in front of the large muscle; NEVER compress both sides
Wrist	Radial/Ulnar	Press against the inner wrist bones
Behind the knee	Popliteal	Press deep behind the knee joint

Pressure points buy time but aren’t a long-term solution — you’re cutting blood supply to an entire limb or region. Use them while setting up better direct pressure, wound packing, or a tourniquet.

Hemostatic Agents (If Available)

If you find commercial hemostatic agents in abandoned medical supplies or military gear, use them:

• QuikClot / Celox / HemCon: Pack directly into wound, then apply pressure for 3-5 minutes. These concentrate clotting factors and dramatically speed hemostasis.
• Yarrow (Achillea millefolium): The traditional herbal styptic. Crush fresh leaves and pack into wound. Contains achilleine, which has mild hemostatic properties. Better than nothing, but don’t rely on it for arterial bleeding.

Internal Bleeding

You cannot stop internal bleeding in the field. Recognize it so you understand the gravity of the situation.

Signs:

• Rigid or distended abdomen after blunt trauma
• Deep bruising over the torso
• Coughing or vomiting blood
• Blood in urine or stool
• Shock symptoms (rapid weak pulse, pale cold skin, confusion) without visible blood loss
• Pain and swelling at fracture sites (a broken femur can lose 1-2 liters internally)

If you suspect internal bleeding, keep the person lying flat, legs elevated if no spinal injury is suspected, and transport to any available medical care. There is no improvised field treatment for internal hemorrhage.

Shock Management

Significant blood loss leads to shock — inadequate blood flow to vital organs. While you control the bleeding, also manage shock:

1. Lay the person flat on their back
2. Elevate the legs 6-12 inches (15-30 cm) if no spinal, head, or leg injuries
3. Keep them warm — hypothermia worsens bleeding because cold blood clots poorly. Cover with blankets, jackets, or body heat
4. Do not give fluids if the person is vomiting, unconscious, or you suspect abdominal injury. Small sips of water are acceptable if alert and no abdominal trauma
5. Reassure and keep calm — anxiety increases heart rate, which increases bleeding

Key Takeaways

• Direct pressure for 10 minutes without peeking stops most bleeding — commit to the full time before reassessing
• Don’t remove blood-soaked dressings; add more material on top and increase pressure
• For deep wounds that won’t respond to surface pressure, pack the wound cavity tightly with cloth strips from the bottom up
• Know your pressure points — brachial (upper arm), femoral (groin), and carotid (neck) buy critical time
• Hypothermia makes bleeding worse — keep the patient warm while controlling blood loss