Guidelines for Treatment of Life-Threatening (Catastrophic) Bleeding

Treating a life-threatening catastrophic bleed requires swift and decisive action. Here are the key guidelines to follow:

Ensure Safety
  • Personal Safety: Ensure your own safety before helping. Wear gloves or use any barrier if available to minimise the risk of infection.
  • Scene Safety: Make sure the area is safe from ongoing danger (e.g., traffic, weapons).
Call for Help
  • Dial 999 (or 112) immediately and state it is a life-threatening bleed.
  • Be clear and concise, providing the location and nature of the injury.

Control of Life-Threatening Bleeding

1. Direct Manual Pressure
  • Apply direct manual pressure immediately to control severe, life-threatening bleeding.
  • Use:
    • A gloved hand.
    • Gauze dressing.
    • Any clean material if sterile supplies are unavailable.
2. Haemostatic Dressings
  • When to use:
    • For severe, life-threatening bleeding where direct pressure alone may not suffice.
  • How to apply:
    1. Place the haemostatic dressing directly onto the wound.
    2. Apply firm manual pressure over the dressing.
3. Pressure Dressings
  • Use only after bleeding has been controlled with direct manual pressure.
  • A pressure dressing can help maintain haemostasis but should not replace direct pressure for uncontrolled bleeding.

Tourniquets for Life-Threatening Bleeding

1. When to Use a Tourniquet
  • For life-threatening bleeding from a limb wound (e.g., arm, leg, or traumatic amputation) if a tourniquet is possible.
2. Applying a Manufactured Tourniquet
  1. Position:
    • Place the tourniquet 5 – 7 cm above the wound.
    • Ensure it is not over a joint.
  2. Tighten:
    • Tighten until the bleeding slows and stops.
    • Expect it to be painful for the casualty.
  3. Maintain:
    • Keep the tourniquet tightened and in place.
    • Do not release the tourniquet — only a healthcare professional should do so.
  4. Record the Time:
    • Note the exact time the tourniquet was applied.
  5. Multiple Tourniquets:
    • If required, use two tourniquets in parallel to control severe bleeding.
3. When a Manufactured Tourniquet is Unavailable
  • Use direct manual pressure with:
    • A gloved hand.
    • A gauze dressing.
    • A haemostatic dressing, if available.
4. Improvised Tourniquets
  • When to use:
    • Only if a manufactured tourniquet is not available.
    • Direct manual pressure has failed to stop the bleeding.
    • You are trained in its use.
  • Improvised tourniquets should be used cautiously and only as a last resort.

Key Actions After Bleeding Control

  • Take the casualty to hospital immediately.
  • Ensure all treatments (e.g. haemostatic dressings or tourniquets) are properly communicated to emergency services.

By acting quickly and following these steps, you can significantly improve the casualty’s chances of survival.