HealthONE - July 10, 2019

In a life-threatening situation, it's hard to know how to react. Unless you're a doctor or nurse, you probably don't think about what to do during an emergency. However, knowing how to help someone during an accident or emergency could save a person's life. Many people don't know that the leading cause of preventable trauma-related death is uncontrolled bleeding.

What to do during an emergency

It's not always easy to know if someone is critically injured.

Dr. Scott Bentz, medical director of the Emergency department at Presbyterian/St. Luke's Medical Center, says that if there is a lot of blood — or if the flow of blood is pulsating, this is usually an indication of an arterial injury.

"Arteries are under a lot more pressure than veins," Dr. Bentz says. "If you cut a vein or a capillary (a tiny blood vessel), the blood oozes out. But with an arterial injury, the artery will pump out the blood."

If the victim is seriously bleeding, they may also be acting confused or even be unconscious.

Here's what you should do if someone is bleeding during an emergency:

1. Call 911

Always call 911 first. If you are helping the victim, ask someone else to call — or quickly call 911 if you are the only person on-site. After you call 911, your job is to try and stop the bleeding while you wait for the ambulance or Emergency Medical Services (EMS) team to arrive.

2. Direct pressure onto the wound to stop the bleeding

After you identify the source of the bleeding, you may need to remove the victim's clothing to put direct pressure on the wound itself. If you have access to a first aid kit, use a sterile gauze pad to put pressure on the wound. If gauze isn't available, use a clean washcloth, paper towel, shirt — whatever you have on hand — to try and stop the bleeding.

"If you have gloves, you can even use your finger or hand to push on the wound," Bentz says.

If the victim's wound is deep, try to pack the gauze or cloth into the wound and then apply pressure. Use both hands to stop the bleeding if needed. If the victim bleeds through the fabric, add another cloth on top. You don't want to replace the original cloth or remove an object from the wound, because the first cloth might be preventing more bleeding. Focus on what you can do to slow the flow of blood — leave the rest to the medical professionals.

3. Elevate the wound

After apply pressure, try to elevate the injury above the heart. Doing so will allow gravity to help with decreasing the flow of blood. If the victim feels lightheaded from all the bleeding, have them lie on the ground and elevate his or her legs.

"There's a lot of blood stored in reserve in the legs and putting the victim's head on the ground brings blood to the head to help keep the person conscious," says Bentz.

4. Apply a tourniquet

A tourniquet should be applied only by someone trained to use them and only as a last resort. In instances where someone has lost a limb in an emergency, a tourniquet can be life-saving and help stem blood loss. A tourniquet puts pressure on the blood vessels above the wound, closer to the heart, closing the vessels to stop the loss of blood.

Improperly using a tourniquet can lead to a person losing their arm or leg unnecessarily, so this method should only be used by people who have been trained to use a tourniquet.

"A tourniquet should be used when direct pressure won't stop the bleeding," Bentz says. "With the vast majority of non-military, non-gunshot wounds, you can stop bleeding with direct pressure unless a major artery is involved."

5. Know that some are more at risk for heavy bleeding

Certain medical conditions, like von Willebrand disease or hemophilia, can put someone more at risk for serious bleeding. Some blood thinning medications, such as warfarin, can also affect blood clotting, which slows the body's ability to form a blood clot. Additionally, anticoagulant (anti-clotting) drugs, like Xarelto or Pradaxa, could put a person more at risk for serious bleeding, even from a minor wound.

"It's good to ask a person who's bleeding if they are on blood thinning medications or aspirin," Bentz says. "If you find out they are, be extra vigilant. The person will not form clots in a normal fashion. It will take a lot longer to stem the flow, and they are more at risk for bleeding out."