Core principle: A first aider must decide quickly whether bleeding is life-threatening, protect themselves from blood exposure, stop blood loss, prevent shock and arrange definitive care. A clean-looking wound can still hide damaged arteries, tendons, nerves or bone.
Add images showing direct pressure, wound packing, a tourniquet and common bandages here.
Learning outcomes
- Define a wound and classify wounds and external bleeding.
- Recognise catastrophic haemorrhage and start immediate control.
- Apply direct pressure, packing, pressure dressings and tourniquets safely within training and local protocol.
- Use roller, triangular, sling, figure-of-eight and immobilising bandages correctly.
- Identify wounds requiring urgent referral, tetanus assessment, surgical review or specialist care.
1. Definition and causes
A wound is a break in the continuity of skin or deeper tissue. It may be caused by blunt force, sharp objects, glass, machinery, falls, road traffic crashes, bites, burns, injections, firearms or pressure and shearing. The mechanism predicts hidden injury: a small puncture from a nail may penetrate a joint; a deep cut across the wrist may divide tendons, nerves and vessels.
2. Types of wounds
| Wound | Description | Important first-aid concerns |
|---|---|---|
| Abrasion | Superficial scraping of skin | Remove loose contamination gently, cover, check for gravel and tetanus risk. |
| Incision | Clean cut from a sharp edge | May have major vessel, nerve or tendon injury despite a narrow skin opening. |
| Laceration | Torn or irregular wound | Crushing, devitalised tissue and contamination increase infection risk. |
| Puncture/penetrating wound | Small surface opening with deep track | Do not probe; consider retained object, deep infection, pneumothorax or abdominal injury. |
| Avulsion | Skin or tissue partly/fully torn away | Control bleeding, preserve tissue in moist sterile dressing in a sealed bag on ice—not directly on ice. |
| Crush injury | Compression damages muscle, vessels and nerves | Consider compartment syndrome, internal bleeding, crush syndrome and prolonged entrapment. |
| Amputation | Part or all of a limb is separated | Catastrophic bleeding and shock are priorities; preserve the part and arrange urgent surgery. |
| Bite wound | Human or animal teeth break skin | High infection risk; assess rabies, tetanus, tendon and joint involvement. |
3. Types of bleeding
| Type | Appearance and behaviour | Action |
|---|---|---|
| Arterial | Bright red, spurting or pulsing with the heartbeat; rapid loss | Immediate firm direct pressure; pack deep wounds and use a tourniquet for uncontrollable limb haemorrhage if trained. |
| Venous | Dark red, steady flow; can also be life-threatening | Direct pressure and pressure dressing; do not dismiss steady heavy flow. |
| Capillary | Slow ooze from superficial tissue | Clean, cover and monitor; reassess bleeding and contamination. |
| Internal | No external flow; blood collects in chest, abdomen, pelvis or tissues | Suspect after major trauma, pain, swelling, pallor, weak pulse, confusion or shock. Call emergency help immediately. |
4. Immediate management of severe bleeding
- Protect yourself: gloves, eye protection and a barrier for rescue breaths. Ask others to help and keep the casualty still.
- Expose only enough: cut clothing if necessary; identify the exact bleeding point and look for more than one wound.
- Direct pressure: place gauze or the cleanest available cloth over the wound and press continuously with both hands. Do not keep lifting the dressing to look.
- Pack deep wounds: for a junctional wound such as groin, armpit or deep neck wound, pack gauze firmly into the cavity and maintain pressure. Use haemostatic gauze only if trained and available.
- Pressure dressing: once bleeding is controlled, secure a firm bandage without making the limb numb, pale, blue or cold. Recheck circulation beyond the dressing.
- Tourniquet: for life-threatening limb bleeding that cannot be controlled by pressure, place a commercial tourniquet high and tight above the wound, never over a joint. Tighten until bleeding stops, record the time and do not loosen it.
- Shock prevention: lay the person safely if no breathing or spinal concern dictates another position, keep warm, reassure and do not give food or drink. Monitor breathing and consciousness continuously.
- Transport: call emergency services for severe bleeding, deep wounds, amputations, uncontrolled bleeding, shock, penetrating trauma or anticoagulant use.
Never: remove a soaked first dressing; add another layer and continue pressure. Never use a makeshift tourniquet unless trained local guidance instructs it. Never push an exposed bone or organ back inside, and never remove an embedded object.
5. Embedded objects and special wounds
- Impaled object: stabilise it with bulky dressings on both sides, control bleeding around it and do not pull it out.
- Chest wound: call emergency help, cover an open wound with a vented or loose dressing according to local protocol, and watch for increasing breathlessness or shock.
- Abdominal evisceration: do not replace organs; cover loosely with sterile moist dressings and a non-occlusive cover.
- Eye wound: do not press on the eye or remove a penetrating object; shield both eyes if possible and refer urgently.
- Scalp wound: bleeding can be heavy. Apply pressure unless there is a suspected skull fracture or a bone fragment/brain tissue visible.
- Amputation: control the casualty’s bleeding first. Wrap the amputated part in sterile moist gauze, seal in a labelled bag and place that bag in a second bag containing ice and water. Do not place tissue directly on ice.
- Bites: wash around the wound with clean running water, cover and arrange medical assessment for antibiotics, tetanus and rabies risk. Do not close a bite wound at home.
6. Cleaning and covering minor wounds
- Wash hands and wear gloves.
- Control bleeding with gentle pressure.
- Rinse superficial contamination with clean running water; do not scrub a deep wound.
- Remove only loose, visible debris that can be lifted without digging.
- Cover with a sterile non-adherent dressing and secure it.
- Explain infection signs—spreading redness, warmth, swelling, pus, worsening pain, fever or red streaks—and advise follow-up.
7. Bandaging techniques
| Technique | Method | Checks |
|---|---|---|
| Roller bandage | Anchor with two turns, work from distal to proximal with half-overlapping turns, and finish securely. | Firm but not constricting; check pulse, colour, warmth, sensation and movement. |
| Pressure bandage | Place a bulky pad over gauze and wrap firmly to maintain pressure. | Bleeding controlled; no increasing pain, numbness or cyanosis. |
| Figure-of-eight | Cross turns around a joint, such as ankle, wrist or elbow, leaving movement and circulation safe. | Avoid the wound becoming more compressed by a sharp fold. |
| Triangular bandage sling | Support the forearm with the hand slightly higher than the elbow; tie at the side of the neck and pad knots. | Fingers visible for circulation checks; reassess after movement. |
| Broad-fold bandage | Fold the triangle into a broad strip for securing a dressing or supporting a limb. | Never tie over a wound if it compromises direct pressure. |
| Improvised dressing | Use the cleanest available cloth, plastic barrier or sanitary pad when sterile supplies are unavailable. | Tell receiving staff what material was used and watch for retained fibres. |
Add labelled images of roller, figure-of-eight, triangular and pressure bandages here.
8. Signs of shock and urgent referral
Shock may follow severe external or internal bleeding, burns, crush injury, heart attack, infection or anaphylaxis. Warning signs include pale or grey skin, cold sweat, rapid weak pulse, rapid breathing, thirst, nausea, anxiety, confusion, drowsiness, fainting and falling blood pressure. Keep the person warm, treat the cause you can safely treat, call emergency help and reassess repeatedly.
9. Practical scenario
Scenario: A motorcyclist has a deep thigh wound with bright-red pulsatile bleeding. Response: protect yourself, call for emergency help, apply firm direct pressure immediately, pack the wound if deep, apply a commercial tourniquet high and tight if pressure fails, note the time, keep the casualty warm and monitor airway, breathing and consciousness. Do not allow walking or repeatedly remove the dressing to inspect it.
Exam points and revision questions
- Differentiate arterial, venous, capillary and internal bleeding.
- Demonstrate a pressure dressing and state the circulation checks performed afterwards.
- Explain the indications and precautions for a tourniquet.
- Describe first aid for an impaled object, evisceration and amputation.
- List six signs of haemorrhagic shock.