Uncontrolled bleeding is a leading cause of preventable death after injury, from road crashes, machete and gunshot wounds, farm and industrial accidents, or falls. Death from massive bleeding can occur within minutes, often before professional help arrives. Nurses, whether on duty or off, can save lives by acting fast. Campaigns such as “Stop the Bleed” teach these skills to health workers and the public alike.
Recognising life-threatening bleeding
- Blood spurting or pulsing from a wound.
- Blood that keeps flowing and won’t stop.
- Blood pooling on the ground.
- Clothing soaked with blood.
- A traumatic amputation.
- Signs of shock: confusion, pale cold skin, rapid weak pulse.
Step 1: Ensure safety and call for help
Make sure the scene is safe for you. Call emergency services (or get someone else to). Wear gloves if available, but don’t delay life-saving action.
Step 2: Direct pressure
- Expose the wound to see where the bleeding comes from.
- Apply firm, continuous pressure directly on the wound with a clean cloth, gauze or your hand.
- Push hard, using both hands and your body weight if needed.
- Don’t lift to check; maintain pressure. Add more cloth on top if it soaks through.
Step 3: Wound packing
For deep wounds, especially in junctional areas (groin, armpit, neck) where tourniquets can’t be used, pack the wound: push gauze (ideally haemostatic gauze) or clean cloth deep into the wound, filling it completely, then hold firm pressure for at least 3 minutes (longer for plain gauze).
Step 4: Tourniquet for limb bleeding
- Use for life-threatening bleeding from an arm or leg that direct pressure can’t control, or traumatic amputation.
- Place high and tight on the limb, about 5–7 cm above the wound (not over a joint), or as high as possible if unsure.
- Tighten until the bleeding stops; it will be painful. Then secure it.
- If bleeding continues, apply a second tourniquet above the first.
- Note the time applied (write it on the tourniquet or the patient).
- Don’t loosen or remove it; that is done in hospital.
Commercial tourniquets work best. Improvised tourniquets (a wide strip of cloth with a stick as a windlass) can work if nothing else is available, but are less reliable. Thin cords or wires can cause injury and are often ineffective.
While waiting for help
- Keep the person lying down and warm. Hypothermia worsens bleeding.
- Reassure them.
- Don’t give food or drink.
- Monitor breathing and consciousness.
In hospital
Activate the major haemorrhage protocol, give tranexamic acid within 3 hours of injury as prescribed, transfuse blood products, and prepare for surgery or interventional radiology. See our trauma primary survey guide and blood transfusion care.
Consider teaching these skills in your community, church or workplace. Bystanders who act in the first minutes save lives.
Based on the American College of Surgeons Stop the Bleed programme, WHO Basic Emergency Care and international first aid guidelines. Educational content; seek practical training.