First things First! The very first thing you should do if you think a person might be in danger of bleeding to death is to call 911 as soon as possible.
You must get EMS enroute a fast as you can in order to get the victim to the hospital for help. While on the phone (use the hands free speaker!) apply any available tourniquets (TQs.)
If you don’t have any TQs, put your hand directly over the wound and press down hard, applying direct pressure and hopefully halting the flow of blood.
In the middle of an emergency, it can be difficult to decide when it’s time to apply tourniquets. Knowing how dangerous a wound is can be hard with your adrenalin running high.
Some wounds, like those on the face and head where there are lots of blood vessels close to the surface of the skin, will bleed a lot and tend to look worse than they really are. But how much is too much?
The average adult human has around 5 liters of blood in their body give or take some depending on your size. Symptoms of blood loss will begin to show at a loss of around 750 ml, but that amount of fluid is difficult to determine in the middle of a stressful emergency, and a lot of factors can change the appearance of blood depending on the surface it’s poured on.
So how will you possibly know if the blood loss is life threatening?
- How Much Blood is Too Much?
Many people are afraid to apply a tourniquet, worried that the application of a TQ will guarantee the victim will have that limb amputated. This is a rumor that has been around for many years and it’s one I hear all the time but, it’s absolutely wrong.
Current studies on the topic of TQ application agree that the casualty has about 2 hours with a TQ applied before there becomes a risk of tissue and nerve damage. This is a long time in America where we have medics, doctors and nurses only a quick ambulance or helicopter ride to the hospital.
And losing a limb is preferable to losing a life. If a tourniquet is needed, don't hesitate.
So, when is the right time to apply? Here’s how I decide:
If at any point I look at the wound and think to myself, “That’s a worrying amount of blood and it doesn’t appear to be slowing or stopping,” this means it’s time to apply a TQ.
When in doubt apply the TQ. If you were wrong and there wasn’t really a need for a TQ, as long as the casualty is seen by a doctor within 2 hours, there’s little risk of complications. Better to be safe than sorry. Don’t waste time trying to decide.
- The Color of Blood
The color of blood and the characteristics of the bleeding can give clues to the severity of the wound. Wounds that are bleeding from a vein will ooze a dark red color of blood because it’s on its way back to the lungs to be oxygenated.
Wounds that have severed an artery, however, will look and act differently. Arterial bleeding is bright red in color because it still retains the oxygen being carried to the body tissues. The wound will not ooze, like with venous bleeding, but instead will pump from the wound with every beat of the victim’s heart.
If you come across this during your casualty assessment, it’s time to be worried and get a TQ applied or get the wound packed ASAP.
- Is the Casualty Acting Weird?
Since blood carries oxygen around the body, a person who has lost too much blood will begin to show signs of danger in their mental status. A brain trying to operate without an adequate supply of blood will begin to struggle noticeably. The casualty might slur their words, have difficulty remembering where they are and what happened, and might even act erratically.
If you were to come across a victim who has lost blood, and you notice that they are not acting appropriately to the situation, there is a reasonably good chance it’s because of blood loss and you should be concerned the casualty will expire if not taken care of quickly.
This is when you need to get out your trauma shears and expose the wound(s) and see what you’re dealing with, and then you can determine the severity.
- Skin Condition
If a casualty is in danger of expiring, the skin will have an appearance that will clue you in. Since blood is what helps to regulate body temperature, life-threatening blood loss means the victim’s skin will be cool, pale, and clammy to the touch.
If you touch their skin and notice these characteristics, combined with blood loss, it’s reasonable to start thinking this might be a blood loss problem that needs to be addressed as soon as possible.
After you have completely controlled bleeding, make sure to treat the victim for hypothermia. The reduced blood in the victim’s body means they aren’t able to maintain a steady body temperature and we need to help keep them warm. A survival blanket in your kit is a great way to help with this, but don’t forget to move the casualty into the cab of a truck, near a fire, or buried deep in blankets, coats, or whatever warming layers you can acquire.