Knowing severe bleeding first aid can make the difference between life and death. A person with life-threatening bleeding can deteriorate very quickly, so controlling the bleeding and calling 999 are immediate priorities.

The most important first action is usually simple: apply firm, direct pressure to the bleeding wound.

For more serious injuries, trained first aiders may also need to use wound packing, haemostatic dressings or a tourniquet.

This guide explains how to recognise serious bleeding, what to do while waiting for an ambulance and how the treatment of life-threatening bleeding has developed in modern first aid training.

What Is Life-Threatening Bleeding?

Not every bleeding wound is life-threatening.

Small cuts and grazes can normally be managed using straightforward wound care. Life-threatening bleeding is different because the amount or rate of blood loss could rapidly threaten the casualty’s life.

Warning signs can include:

blood flowing continuously or very rapidly
a large amount of blood being lost
blood soaking rapidly through clothing or dressings
a partial or complete amputation
a deep or extensive wound
bleeding that does not stop with firm direct pressure
a casualty becoming pale, cold, weak, confused or less responsive

Do not wait for every sign to appear before acting.

Serious blood loss can cause shock and deterioration can be rapid.

Severe Bleeding First Aid: What Should You Do First?

If you discover someone with severe bleeding:

Make sure it is safe to approach.
Call 999 for an ambulance.
Expose the wound sufficiently to identify where the blood is coming from.
Apply firm, direct pressure to the bleeding site.
Use a suitable dressing where available.
Escalate bleeding control if direct pressure does not control life-threatening bleeding.
Monitor the casualty continuously until professional help arrives.

If you are alone, use your phone on speaker where possible so that you can continue helping the casualty while speaking to the ambulance service.

Follow the instructions given by the emergency call handler.

Step 1: Make Sure the Scene Is Safe

Before treating the casualty, quickly consider what caused the injury.

Potential hazards might include:

broken glass
machinery
traffic
sharp objects
electricity
falling objects
violence
chemicals

Do not put yourself in unnecessary danger.

If disposable gloves are immediately available, wear them. However, in genuinely life-threatening bleeding, do not waste valuable time searching for equipment while the casualty continues losing blood.

Step 2: Call 999

Life-threatening bleeding is a medical emergency.

Call 999 as early as possible.

Tell the ambulance service:

your location
what has happened
where the casualty is bleeding from
whether the bleeding is severe
what first aid is being provided
whether a tourniquet or other specialist bleeding-control equipment has been used

Stay on the line and follow the call handler’s instructions.

Step 3: Apply Firm Direct Pressure

Direct pressure is the foundation of severe bleeding first aid.

Place a dressing directly over the bleeding site and press down firmly.

If a first aid dressing is not available, use clean material such as a cloth or item of clothing.

The priority is to stop the blood escaping from the wound.

Maintain strong, continuous pressure.

Do not repeatedly lift the dressing to see whether the wound is still bleeding. Doing so can disturb clot formation and interrupt effective pressure.

Once the bleeding is controlled, a pressure dressing can be applied to help maintain pressure.

What If Blood Comes Through the Dressing?

Do not stop controlling the wound simply because blood appears through the dressing.

Maintain firm pressure and reassess whether your pressure is being applied directly over the actual source of bleeding.

Additional dressing material can be used as necessary while maintaining effective pressure.

The priority is not making the dressing look tidy.

The priority is stopping the bleeding.

What If Something Is Embedded in the Wound?

Do not pull an embedded object out of a wound.

Objects such as glass, metal or other debris may be helping to limit blood loss. Removing them can make bleeding considerably worse.

Instead:

leave the object where it is
apply pressure around the wound rather than directly on top of the object
use padding around the object if available
avoid pushing the object further into the wound
call 999 for serious bleeding

The casualty will need appropriate medical assessment and treatment.

When Is Wound Packing Used?

Some severe wounds are deep or located where simply placing a dressing over the surface does not provide enough pressure to the source of the bleeding.

In these circumstances, wound packing may be appropriate.

Wound packing involves placing suitable dressing material firmly into a wound cavity so that pressure can be applied directly to the bleeding site.

Current UK first aid guidance recognises wound packing as part of the escalating approach to life-threatening bleeding.

It is particularly relevant to areas where a tourniquet cannot be applied effectively, such as some wounds around the:

groin
armpit
shoulder

Packing must be firm enough to place effective pressure on the source of bleeding.

Once packed, maintain firm direct pressure over the wound.

Should an Untrained Person Pack a Wound?

In an emergency, the most important action for an untrained bystander remains firm, continuous direct pressure while calling 999 and following the ambulance service’s instructions.

First aiders who have been trained in wound packing can use the technique when appropriate.

This is one reason practical training matters. Wound packing is much easier to understand when you have physically practised the technique rather than simply read about it.

What Is a Haemostatic Dressing?

A haemostatic dressing is a specialist bleeding-control dressing designed to help promote clotting.

Current Resuscitation Council UK first aid guidance includes haemostatic dressings within the escalating treatment of life-threatening bleeding.

They may be used directly on a bleeding wound or as part of wound packing, depending on the product and the injury.

Always follow the manufacturer’s instructions and use equipment you have been trained to use.

For many ordinary workplace and everyday bleeding injuries, standard dressings and effective direct pressure remain sufficient.

When Should a Tourniquet Be Used?

A tourniquet is designed to control life-threatening bleeding from an arm or leg.

It is not required for every bleeding injury.

A tourniquet should be considered when life-threatening limb bleeding is not controlled by firm direct pressure, or where the circumstances and the first aider’s training indicate that rapid tourniquet application is required.

Current Resuscitation Council UK guidance advises applying a tourniquet as soon as possible when life-threatening bleeding from a limb is not controlled by direct manual pressure.

How Is a Tourniquet Applied?

If you have been trained to use a tourniquet:

place it approximately 5 to 7 cm above the injury
do not position it over a joint
tighten it until the bleeding slows and stops
record the time it was applied
do not loosen or remove it

Applying an effective tourniquet can be painful. This does not mean it should be loosened if it is required to control life-threatening bleeding.

Once applied, a tourniquet should remain in place until it is removed by an appropriate healthcare professional.

In some circumstances, a second tourniquet may be required above the first if bleeding remains uncontrolled.

Should You Improvise a Tourniquet?

For members of the public, continuous direct pressure is the priority.

Do not abandon effective pressure while searching for something to improvise into a tourniquet.

Purpose-made tourniquets are designed to generate the pressure required to control serious limb bleeding, and people expected to use them should receive appropriate training.

If you are dealing with a genuine emergency without suitable equipment, call 999 and follow the ambulance call handler’s instructions.

What If a Body Part Has Been Amputated?

A traumatic amputation can cause severe bleeding.

Control the casualty’s bleeding first.

Once the casualty is being treated and it is safe to do so, retrieve the amputated part.

The current UK approach is to:

Wrap the amputated part in a sterile dressing or clean cloth moistened with water or saline.
Place it inside a clean, watertight plastic bag or container.
Place that container inside another bag or container containing ice or ice water.
Keep the amputated part cold, but do not allow it to freeze or make direct contact with ice.
Send it to hospital with the casualty.

Do not delay lifesaving treatment of the casualty while looking for an amputated body part.

What About Severe Bleeding From the Chest?

Open chest wounds need particular care.

Call 999 immediately.

Current Resuscitation Council UK guidance advises leaving an open chest wound exposed rather than sealing it with an ordinary airtight dressing.

Localised external bleeding can be controlled with careful direct pressure where appropriate.

Specialist vented or non-occlusive chest dressings should only be used by people trained to use them and when suitable equipment is available.

Do not improvise an airtight seal over an open chest wound.

Internal Bleeding Can Be Life-Threatening Too

Not all severe bleeding is visible.

Internal bleeding can follow:

significant falls
road traffic collisions
crushing injuries
blows to the chest or abdomen
fractures
penetrating injuries

Possible warning signs can include:

pale or clammy skin
weakness
dizziness
increasing confusion
rapid deterioration
abdominal pain or swelling
difficulty breathing
signs of shock

You cannot control serious internal bleeding with a dressing.

Call 999, keep the casualty as still and comfortable as possible and monitor their condition until help arrives.

Recognising Shock After Severe Blood Loss

Severe blood loss can result in hypovolaemic shock, where there is no longer enough circulating blood to adequately supply the body’s tissues.

Possible signs include:

pale skin
cold or clammy skin
weakness
dizziness
rapid breathing
increasing anxiety or restlessness
confusion
reduced responsiveness

Controlling the source of bleeding remains the priority.

Keep the casualty warm, reassure them and continue monitoring their airway, breathing and responsiveness.

Do not give them food or drink.

What If the Casualty Becomes Unresponsive?

Severe blood loss can eventually result in cardiac arrest.

If the casualty becomes unresponsive and is not breathing normally, call 999 if this has not already been done and start CPR.

Use an AED as soon as one is available.

Our Seven Steps of CPR guide explains the adult CPR sequence.

You can also read our guide explaining how to use an AED.

Do not allow bleeding-control equipment to unnecessarily delay CPR when the casualty is in cardiac arrest.

Severe Bleeding First Aid Guide. How to Control Life-Threatening Bleeding

Severe Bleeding in Babies and Children

The basic priority remains the same with children:

call for help and control the bleeding.

Apply firm direct pressure over the wound.

A child has a smaller circulating blood volume than an adult, which means significant blood loss can become extremely serious.

Call 999 for severe or uncontrolled bleeding and monitor the child’s condition closely.

Parents, carers and people working with children can learn how to respond to serious injuries as part of practical Paediatric First Aid training.

Minor Bleeding Is Different

This article concentrates on severe bleeding first aid.

Most everyday cuts and grazes are not life-threatening.

For a minor wound:

wash your hands and use gloves where appropriate
control bleeding
clean the wound when appropriate
cover it with a suitable sterile dressing or plaster
monitor it for signs of infection

Medical attention may be needed if a wound is deep, contaminated, caused by a bite, has an embedded object, continues bleeding or shows signs of infection.

The NHS guidance on cuts and grazes provides further information about minor wound care.

Do You Need a Bleed Control Kit?

Not every workplace needs a dedicated bleed control kit.

For most everyday bleeding injuries, a properly stocked first aid kit and people who know how to apply direct pressure are extremely valuable.

However, some workplaces have a greater foreseeable risk of life-threatening bleeding.

Examples might include environments involving:

forestry and chainsaws
cutting machinery
construction
agricultural equipment
glass
engineering
remote working
other significant cutting or traumatic injury risks

Employers should consider these risks as part of their first aid needs assessment.

HSE guidance now specifically asks employers to consider life-threatening bleeding when deciding what first aid provision is appropriate.

If your risk assessment identifies a significant bleeding risk, additional equipment and training may be appropriate.

Our guide to workplace first aid kit requirements explains how workplace first aid provision should be considered.

Severe Bleeding and Workplace First Aid Training

Controlling serious bleeding is an important practical first aid skill.

Learners should understand more than simply how to put a bandage on a wound.

Training can help people develop the confidence to:

recognise potentially life-threatening blood loss
apply effective direct pressure
use dressings correctly
respond to embedded objects
recognise shock
understand when wound packing may be appropriate
understand the role of haemostatic dressings
use a tourniquet where this forms part of their training
call 999 and communicate effectively with the ambulance service

The exact level of bleeding-control training needed should reflect the risks people may realistically encounter.

First Aid at Work and Life-Threatening Bleeding

Employers have duties under the Health and Safety (First-Aid) Regulations 1981 to provide adequate and appropriate first aid arrangements.

There is no single first aid setup that suits every workplace.

An office and a forestry operation clearly present different injury risks.

A suitable first aid needs assessment should therefore consider factors including:

workplace hazards
previous incidents
workforce size
work patterns
remote or lone working
access to emergency medical services
the potential for serious injury

You can read more in our guide to the legal requirement for first aid at work.

The Health and Safety Executive’s first aid at work guidance also explains employers’ responsibilities for first aid provision.

Severe Bleeding First Aid: What to Remember

If you remember nothing else from this article, remember these priorities:

CALL 999

for life-threatening bleeding.

APPLY FIRM DIRECT PRESSURE

directly over the bleeding site.

KEEP THE PRESSURE ON

and do not repeatedly remove the dressing to check the wound.

ESCALATE BLEEDING CONTROL

using appropriate dressings, wound packing or a tourniquet where required and where you have the appropriate training.

DO NOT REMOVE EMBEDDED OBJECTS.

DO NOT REMOVE A TOURNIQUET ONCE APPLIED.

MONITOR THE CASUALTY

for deterioration, shock, loss of responsiveness and abnormal breathing.

Simple actions performed quickly and effectively can save a life.

Learn Severe Bleeding First Aid Practically

Reading about severe bleeding first aid helps you understand the principles, but practical training allows you to physically practise the techniques.

First Aid and Safety Training provides practical workplace first aid training across the North East, including:

Training can also be delivered onsite for organisations that need first aid provision tailored to their workplace risks.

Explore our first aid training across the North East or contact First Aid and Safety Training to discuss your requirements.

Our main training centre is at One Trinity Green in South Shields. You can view our South Shields location and customer reviews on Google Maps.

Real Skills, Real Confidence.