Bleeding Control: Does Elevating the Wound Actually Help?
2026 Update: This article was originally published in January 2021. We've revised it to reflect current bleeding-control guidance. The American Heart Association and American Red Cross (2024 First Aid Guidelines) and the European and UK resuscitation councils do not recommend elevation as a bleeding-control step. For serious bleeding, apply firm direct pressure, then pack the wound or apply a tourniquet. The 2018 study discussed below is interesting, but it doesn't change that guidance. See the revised “What Does It Mean?” section for details.
Research is a vital component to medical care. Without medical researchers constantly developing new techniques and testing the effectiveness of old ones, we’d still be stuck with medieval era medicine.
Thankfully, the medical world is a constantly changing and shifting environment, which is why we no longer drill holes in our patient’s head to let out evil spirits and cure mental illness.
Progress is a good thing, and we need to continually question why we do what we do, and if there's a better way.
In 2010, about the time when I was cutting my teeth on trauma medicine, I was taught that elevating the wound was no longer recommended for bleeding control.
This technique was taught for many years in first aid classes around the world, but soon it was questioned if there was any evidence to support it.
It was discovered that there had been no research of any kind to study the effectiveness of wound elevation, and as a result, the procedure quickly fell out of favor.
“The use of limb elevation as an adjunct to direct wound pressure for the control of extremity hemorrhage was for many decades a standard part of first aid and prehospital EMS provider training until 2010, when the practice was widely discontinued due to lack of evidence to support the intervention.” (Du Pont 2018)
This happens all the time as homeopathic and pseudoscience procedures are tested and many of them are found to have little, or no effect.
Passed down from generation to generation of care givers without indication of its actual worth, many of these are thrown away for better researched and more useful methods.
But not all of them.
In 2018, researchers at the University of Pennsylvania studied the effectiveness elevating a wound has on bleeding control.
25 volunteers were enrolled, and 24 completed the study. Each had a small IV catheter placed in a vein on the back of the hand and was allowed to bleed for three seconds with the arm raised, and for three seconds with the arm hanging down. The results:
“Participants bled less when the arm was in the elevated position as compared to the blood loss with the arm in a dependent position (0.015 vs. 0.55 grams, respectively, mean difference=0.545, p=0.0002).” (Du Pont 2018)
What Does It Mean?
In relative terms, that's a big difference: participants lost roughly 36 times less blood with the arm raised. In absolute terms, though, the amounts were tiny, averaging about half a gram with the arm down, and they came from a small IV catheter in a hand vein over three seconds. That is a very different situation from a real traumatic wound.
Based on their results, the study authors concluded:
“The results demonstrate that elevation of an extremity is a simple intervention that reduces venous hemorrhage when compared to a limb that is not elevated. We recommend that wound elevation be reintegrated into standard hemorrhage control educational standards and protocols for first aid and EMS providers.” (Du Pont 2018)
That recommendation has not been adopted, and there are good reasons to be cautious about it:
- It only tested low-pressure venous bleeding. The authors themselves note it's unclear how much elevation would help with arterial bleeding, which is what kills people fastest.
- An IV catheter isn't a wound. A clean catheter in a hand vein doesn't behave like torn tissue, so the results may not carry over to real injuries.
- It's a single, small study. 24 participants in one journal isn't enough to overturn international guidelines.
- The authors excluded severe bleeding. They state that massive bleeding from an arm or leg should go straight to a tourniquet, skipping elevation entirely.
What Current Guidelines Say
The 2024 American Heart Association and American Red Cross First Aid Guidelines direct first aid providers facing life-threatening bleeding to apply direct pressure, followed by a tourniquet or wound packing where the wound location allows. Elevation is not part of that sequence. European and UK first aid guidelines have likewise not recommended elevation since 2015.
The Bottom Line
- For serious bleeding, don't spend time positioning the limb. Apply firm direct pressure, pack the wound, and use a tourniquet on an arm or leg when pressure isn't enough.
- For minor bleeding, such as a cut on the hand, raising it after pressure is on won't hurt and may slow oozing. Never use it in place of pressure, packing, or a tourniquet, and don't elevate a limb that may be broken.
Excellent investigation and explanation of established protocol.
Thank you Mr. Cory
Great training vids that you do. Thanks for that.
Can you put one out about what to do if you accidentally shoot yourself in the leg while reholstering a pistol? Thanks again.
0.55gm *is* a minuscule *amount* of blood, but the change between .015 and .55 grams is an enormous *difference* — it’s like 36 times more blood lost with a dependent limb compared to elevated (p=like, duh). Maybe the difference would not be as great with a more significant wound — that would be worth a study to verify. I’m an old medic who can only shake my head to hear that a standard would be *abandoned* because nobody had studied the physics of fluids in this specific context to see if they were the same as the physics of fluids in every other context.!?!? It seems like nowadays every traumatic injury is supposed to be a bomb blast — with TQ, fairy dust, chest needle, and medivac any Joe Mope is all set for any emergency. Without the toys, you’re not responsible to even be on the street. C’mon, people — brains on!
Well said Techs, Thanks for the comment.
Funny that a ‘common sense’ and time-tested procedure could be summarily dismissed as
archaic, outdated and unwise, simply because no current, ‘authority’ had performed a modern test to verify…..just throw it out if it hasn’t gotten the vetting of a nice, costly study by a couple of PHDs.
Give me a break.
So, just a lowly paramedic here, I know the bulk of our trauma procedures come from the field notes and research produced by the Army and Navy handling battlefield injuries. That being said, it was, to my knowledge, inconclusive if elevation was effective in live wound bleeding. I say this, because if anyone digs deeper into the procedure of the author’s cited study, you find that peripheral IV catheters were placed in subjects to measure blood flow. My question is, is there significant evidence to say that an IV catheter is an approximate example of a wound? I would argue that an IV catheter may skew results to promote a measurable rate of blood flow, but may not actually advise us on whether elevating the wound reduces blood loss during injury, because we have physiological affects of wound closure with turgor and collagen fibers that an IV catheter would negate. I just don’t find the study to be very scientific or applicable to answering the root question.
Great comment. A well communicated and defended argument. Thanks Phillip. I can see your point.
To be honest, however, I think the point is kind of moot. I have never once controlled bleeding by elevating the wound. I controlled it with direct pressure, TQs and wound packing.
There may be some slight affect, but I worry the every day civilian may think that is an adequate trauma procedure, wasting time on it when they could be focusing on techniques that are more proven to work.
The Resuscitation Council UK’s guidelines were last updated in May 2021. These updates included significant changes to the recommendations for controlling bleeding, such as no longer recommending elevation or indirect pressure and emphasising the use of haemostatic dressings and tourniquets for catastrophic bleeding
The UK Resuscitation Council clearly distinguishes between indirect pressure and the use of tourniquets. Indirect pressure, which involves pressing on specific pressure points to reduce blood flow, is not recommended due to a lack of evidence supporting its effectiveness in controlling serious bleeding.
In contrast, tourniquets are recommended for use in cases of catastrophic bleeding when direct pressure does not suffice. Tourniquets apply direct pressure to blood vessels in a limb to stop blood flow beyond the point of application. This method effectively controls severe bleeding and is supported by extensive research and practical use in military and civilian settings.