Internal Bleeding -
Recognition and First Aid



What to do with severe bleeding:




Quick Summary:-

  • Check the person's breathing and pulse. If needed apply CPR. 

    Then the immediate things to do are :- 1. Call for help and call emergency services 2. Apply gloves if available 3. Apply pressure to the bleeding wound 4. And elevate above the heart. Injuries permitting 5. When the severe bleeding slows down or stops tie the padding firmly in place. 6. Montior DR-ABCD's - (New version of ABC's). If needed apply CPR.

**Please review the below explanations of these steps.**

Here is a more IN-DEPTH EXPLANATION of the above steps to treat severe bleeding:-

  • If possible, before you touch the bleeding area wash your hands with soap and water. DO NOT wash the wound except in the case of a dog bite or chemical burn.
  • If you have synthetic gloves "fantastic". Use them to protect you from possible transmission of the unfortunate nasties that can be in peoples' blood (which is the primary reason why gloves are used in these situations). Otherwise avoid coming in contact with blood if possible which is easier said then done.
  • You may need to remove or cut clothing so you can see the wound and make an assessment.
  • If the severe bleeding is from the trunk of the body and organs are showing or have come out do not push them back in. Cover the wound with a dressing to help prevent foreign contaminates entering the area. It is very difficult and usually not advised to apply pressure around organs.
  • At this point the priority is to stop the severe bleeding so don't probe around the wound removing objects or cleaning at this stage. The only time to remove debris or objects is if they are on the surface of the wound and are quickly and easily removed.
  • If exposed organs are not involved then apply DIRECT PRESSURE on the wound (but do not apply direct pressure on penetrating objects see below).
    NOTE:- the purpose of applying direct pressure is to help the blood form a clot at the wound site. This is the body's natural way of forming a "cork" to block the blood from exiting. Much in the way a cork stops wine from leaving a bottle.
  • If possible use a dressing pad but if that is not available be creative by using things such as a clean towel/s, clothing like clean socks or even a clean nappy (diaper) anything that will absorb the blood and help with applying pressure. If you can't locate anything to use straight away then just use your hand.
  • DO NOT apply pressure directly to penetrating objects. AND DEFINITELY do not remove large or deeply embedded objects as this can make the bleeding worse or cause more damage (at times these objects may actually be assisting in reducing the severity of bleeding by blocking a damaged blood vessel). Leave their removal to medical professionals.
  • And certainly do not apply disinfectant or the like as wound care is secondary at this stage. Your time is best spent in stopping the flow of blood.
  • ELEVATE - (if injuries permit) Elevation assists in reducing blood flow to the area therefore reducing pressure at the site and helps give clotting a better chance to form.
  • Hold continuous pressure for at least 20 minutes before you check to see if bleeding has stopped.
  • If blood seeps through the dressing do not remove it as this may dislodge the clot resulting in you being back to square one where the blood flows freely again. You may need to make sure you are applying pressure at the correct point and "peek" under the pad rather than remove it altogether for a look.
  • Then put a second padding on top of the first and re apply direct pressure.
  • IF injuries allow, lie the person down. This is for the reasons below:-
    it can make it easier to elevate the effected area. it can help reduce blood flow at the wound site. the body's response will be to "faint/fall down" in an attempt to get the person to lie flat. This makes it easier for the heart to get blood and therefore oxygen to the brain as it is not working "against" gravity. So if injuries allow try and have the head lower then the heart to help this process. some people find seeing blood difficult and can end up getting "wobbly" and faint, so if they are laying down then they do not fall down. This is better for everyone.
  • If it is difficult to maintain pressure with your hand you can bind the wound with a bandage or the like (strips of cloth etc) and the bandage can be held together with tape of any sort if available. The important thing is that sufficient pressure is applied to help the clotting process.
  • If the bleeding has not been controlled by the above steps then go to first aid for uncontrolled bleeding for what to do next.
  • When the severe bleeding slows down or stops tie the padding firmly in place. If you have a bandage apply it but if not be creative again and use things like a scarf, a neck tie or strips of cloth. If it is difficult to tie or you prefer to tape the end of the "bandage" down then use any type of tape that will adhere to the material, or wind the tape completely around so it can adhere to itself. Electrical tape can work a treat. But whatever you use do not bind/tie/tape it so tightly that blood flow is so restricted that the area past the wound does not receive the vital blood that it needs. A slow pulse below the area and/or bluish fingers or toes are signals that the bandaging may be too tight and impeding circulation.
  • Otherwise Immobilise the injured part. There are a variety of ways to do this such as using another limb with an injured leg or the trunk if the arm is injured. So just use common sense as the principle is to stop the area from moving around and re-triggering the bleeding.
  • If possible cover the person with a blanket. Do this in a way that does not interfere with access to the wound so it can be observed in case it starts bleeding again.
  • Observe for Shock as it is highly probable as a result of severe bleeding. (see Shock)
  • Reassurance goes a long way in helping the injured person feel secure and safe.
  • Monitor DR-ABCD's (new version of ABC's). Stay with the person until medical help arrives. If you want a better understanding of CPR go to CPR Questions and Answers.
  • Keep checking the injury site to see that it is stable so the severe bleeding remains under control.
  • Do not give food or drink unless given permission by medical help.

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