CONTROL OF HEMORRHAGE
When administering first aid to a bleeding victim, you must remain calm. Loss of blood is a dramatic event and always appears severe. In fact, most bleeding is less severe than it may appear to be at first glance. Most of the major arteries are deep and well protected by tissue and bony prominence. Although bleeding can be fatal, you usually have enough time to think and act calmly before the victim expires. Remember that most errors in first aid are made because of acting without thinking. The four methods for controlling hemorrhage are direct pressure, elevation, indirect pressure, and the use of a tourniquet.
Direct pressure is the first method to use when you are trying to control hemorrhage. In almost every case, bleeding can be stopped by the application of pressure directly on the wound, as shown in figure 10-38. Use a sterile first-aid dressing, when available, and tie the knot directly over the wound, only tight enough to stop the bleeding. Any clean material can be used in the absence of regular first-aid dressings. If the bleeding does not stop, firmly apply another dressing over the first dressing, or apply direct pressure with your hand or fingers over the dressing. This pressure may be applied by the victim himself or by a buddy. Under no
Figure 10-38.-Direct pressure.
circumstances should a dressing be removed once it is applied.
In cases of severe hemorrhage, do not worry too much about the dangers of infection. Although the prevention of infection is important, the basic problem is to stop the flow of blood. When no material is available, simply thrust your hand onto the wound.
Elevating or raising an injured limb above the level of the heart helps to control the bleeding. Elevation should be used together with direct pressure; however, do not elevate a limb when you suspect a fracture until the fracture has been splinted and you can be reasonably certain that elevation will not cause further injury. Use a stable object to maintain elevation, for propping the limb on an unstable object can do more harm than good.
In instances of severe bleeding where direct pressure and elevation are not controlling the bleeding, indirect pressure may be used. Bleeding from a cut artery or vein can often be controlled by applying pressure to the appropriate pressure point. This pressure point is a place where the main artery to the injured part lies near the skin surface and over a bone. Pressure at such a point is applied with the fingers, thumb, or with the heel of the hand; no first-aid materials are required. The object of the pressure is to compress the artery against the bone, thus shutting off the flow of blood from the heart to the wound.
Use of pressure points may cause damage to the limb as a result of an inadequate flow of
Figure 10-39.-Pressure points for control of bleeding.
blood. When the use of indirect pressure at a pressure point is necessary, do not substitute indirect pressure for direct pressure; use both. Figure 10-39 shows the locations of pressure points and the area of bleeding they control. Pressure points on the arms (brachial pressure points) and in the groin (femoral pressure points) are the ones that are most often used in first-aid treatment. These pressure points should be thoroughly understood.
Pressure on the brachial artery is used to control severe bleeding from an open wound on the upper extremity (arm). This pressure point is located in a groove on the inside of the arm and the elbow. Using either the fingers or the thumb, apply pressure to the inner aspect of the arm. Figure 10-39, view E, shows the proper location for the digital pressure.
The femoral artery is used to control severe bleeding from a wound on the lower extremity (leg). The pressure point is located in the front, center part of the crease in the groin area. This is where the artery crosses the pelvic basin on the way into the lower extremity. To apply pressure, position the victim flat on his back, if possible. Kneeling on the opposite side from the wounded limb, place the heel of one hand directly on the pressure point, and lean forward to apply the small amount of pressure needed to close the artery (fig. 10-39, view H). If bleeding is not controlled, it may be necessary to press directly over the artery with the flat surface of the fingertips and to apply additional pressure on the fingertips with the heel of the other hand.