How should we control bleeding?

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BleedingExperts in first aid have always advised to cover any bleeding wound with a sterile dressing, apply direct pressure and elevate where possible.

 

This practice has always been widely accepted and aims primarily to stem blood loss through encouraging coagulation at the wound site and also protecting the wound from contamination which may cause infection.

 

Do:

  • Sit or lay the patient down.
  • Get patients help, let them apply direct pressure with their hand.
  • Elevate the wound.
  • Put on protective gloves.
  • Examine the wound carefully for, correct location of wound and foreign objects.
  • Apply correct size dressing directly over the wound and apply firmly.
  • Check to see if the dressing has been applied to tightly, patients hand tingling.
  • If bleeding persists apply a further dressing.

Do not:

  • Remove any foreign objects.
  • Restrict the flow of blood to the rest of the limb.

The dressing

Where bleeding seeps through the initial dressing, the application of a second dressing is advised overlying the first. If the bleeding seeps through this one then standard HSE recommendations are that both dressings are removed and new ones are applied.

 

This is where I question the advice and ask; what advantage is there to removing both dressings and starting again? If the purpose of applying pressure and elevation is to assist the natural healing process, encouraging coagulation to stem the blood loss, surely by removing both dressings any coagulation process that has taken place will be disturbed and bleeding is more likely to increase, not to mention the wound being exposed to further possible infection. The possible exception to this is where a suitable pad has been placed over the wound before the dressings applied which will assist in protecting the wound site.

 

I therefore ask; should first aiders be advised to remove and reapply new dressings, leaving the first application in place, to avoid disturbing any healing process? Surely, removing and replacing only the second dressing, with the focus on maintaining firm pressure, is likely to achieve better results, as well as reducing the cross contamination risk for the patient and the and first aider.

 

A patient who is presenting with a wound that is bleeding enough to penetrate through a dressing will no doubt be experiencing a degree of shock and self-concern. By removing both dressings, repositioning and replacing, will this reduce the confidence that the patent has in the first aider? A correctly positioned firmly applied initial dressing will reduce the need to apply a second.

Control of bleeding

The answer to the control of bleeding should surely revolve around quality of teaching and training, focusing both on the application of these skills in practice in addition to the first aid knowledge underpinning this practice. This should result in standardised first aid practice and promote competence and confidence in those who administer this.

 

I have been employed as an NHS emergency ambulance practitioner for 32 years, within this time I can only recall one incident where I had to totally remove a dressing and reapply, this was due to the dressing being displaced by the patient who had received a head injury. These dressings are notoriously difficult to secure therefore not obtaining adequate pressure over the wound site.

 

Further to this I ask; do we need to secure dressings by using a reef knot or is the method of securing irrelevant as long as the dressing remains firmly in place? Any removal can be aided with a pair of scissors.

 

Please feel free to add your thoughts on this subject.

 

You might also like our A-Z of first aid - see B for bleeding.

 

First Response. Training for life. Training to save a life.

 

Last modified on Thursday, 24 September 2015
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Tim Hart

Tim Hart IQA AET - Director

Emergency Ambulance Practitioner RRV/CIEH Professional Trainer/Assessors A1/FAETC Stage 1/CTLLS/Safe People Handling Instructor (RoSPA)
Great Western Ambulance NHS Trust. Affiliate Member of the Society for Education and Training.

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