Bleeding is a common problem encountered during trauma. External bleeding is identified by the type of blood vessel injured. Arterial bleeding is bright red in color and spurts out of the wound every time the heart beats. Because of the pressure of the heart beat, arterial bleeding is almost always serious and must be treated immediately. Venous bleeding is usually darker in color and appears as a slow steady flow. This is usually less serious than arterial bleeding, but must be treated nonetheless.

Capillary bleeding is the least serious type of bleeding as it slowly oozes. This type is usually more of a nuisance than a life threat. Capillary bleeding is usually present with minor skin wounds and often requires no treatment because the bleeding stops within a few minutes. The body's normal response to any type of bleeding is to make the injured blood vessel constrict. This blood vessel constriction causes clotting, which helps minimize bleeding. However, large or more serious injuries may not clot. The body has a difficult time clotting an arterial bleed. There are four ways to control bleeding. Choose the best method based on the severity of the bleeding and the circumstances you are in.

The simplest and most effective method for controlling external bleeding is to place a dressing over the bleeding site and apply direct pressure with your gloved hand. If your patient has multiple wounds, place the dressing on the wound and ask the patient to use their hand to apply direct pressure. A venous bleed usually stops in a couple of minutes, while an arterial bleed may take five to ten minutes or possibly even longer. Serious arterial bleeds will not clot no matter how long you hold them, which means you must maintain continuous direct pressure.

If the dressings become soaked with blood, do not remove them. Layer on several more dressings and reapply pressure. This, in effect, creates a clot. Once the bleeding has stopped, you can remove your hand and place a bandage or tape over the dressing to hold it in place.

Simply elevating an injured extremity above the level of the heart can decrease bleeding. This is used effectively with direct pressure. You may wish to support the extremity to case stress on the patient.

When direct pressure and elevation do not work, pressure points can be used to control bleeding. This is effective when bleeding is occurring from a site below an artery. Pressure is applied to an artery somewhere between the injury site and the heart. Once pressure is applied appropriately, you should see a diminished blood flow. It is necessary to maintain the pressure until EMS arrives with more definitive treatment. To practice pressure points, place two fingers under your biceps muscle on the inside of your arm and press until you feel your pulse. By applying more pressure to this area, you will temporarily close off the artery and stem the flow of blood to your forearm and hand.

This is a last resort treatment and it is to be used only when all else fails. By placing a wide, very constrictive band on an extremity, between the injury sight and the heart, you can effectively close the flow of blood past the tourniquet site. Once applied, you must leave the tourniquet in place until a more highly trained person removes it. Tourniquets are almost always removed at the hospital by a doctor or surgeon. Good tourniquets can be made from belts, neck ties or towels. It is imperative you note the time the tourniquet was placed.

It was once believed a tourniquet implied absolute loss of a limb. Not so anymore. With the improvements in microsurgery, many limbs can be saved and remain useful to the patient. Tourniquets are used any time blood is drawn, I.V.'s are started or surgery is performed on a limb. Always remember these few simple rules when applying a tourniquet: Apply it between the heart and the injury site, note the time it was applied, only tighten enough to stem the blood flow and only use it when no other method will work.