First aid - managing bleeding

Managing bleeding

Bleeding, from trauma for example, is associated with significant levels of morbidity and mortality (Charlton et al., 2021). Nurses should be able to deal with first aid situations, including bleeding, from the point of registration (Nursing and Midwifery Council, 2018). Bleeding may be internal and/or external to the body; this guide deals with external bleeding. 

Regardless of the mechanism of injury, the management of blood loss from the body utilises the same key principles. Nurses dealing with bleeding as a first aid event will need to adapt their response according to where the event is occurring and the needs of the patient. 

Staying safe

The nurse should be aware of the potential for coming into contact with bloodborne infections, e.g. hepatitis and HIV. The best defence against these is to wear appropriate personal protective equipment, especially gloves, when dealing with blood loss. Other personal protective equipment such as aprons, masks and eye protection may be indicated where the patient is:

• known/suspected to have a bloodborne infection
• bleeding arterially

Handwashing after an event is also helpful in managing the risks of infection to the nurse.

Getting help

Some events which involve bleeding require rapid assessment in a healthcare environment like a hospital, others may need the patient to present to their general practitioner. It is always a sensible precaution to call for help if the blood loss appears to be:

• affecting the patient’s consciousness
• more than just a small amount
• associated with other injuries
• associated with the potential for infection

In the hospital

Managing complications

• some people who are bleeding may feel faint either because of blood loss or psychological shock. If possible, it may be a good idea to lay them down and elevate their legs ensuring they are kept warm and dry.
• if the person loses consciousness, they should be laid in the recover position (See: managing  loss of consciousness).
• if the patient stops breathing, start cardiopulmonary resuscitation immediately (St John Ambulance, 2021)

References

British Red Cross. Learn first aid for someone who is bleeding heavily.  2022. https://www.redcross.org.uk/first-aid/learn-first-aid/bleeding-heavily (accessed 12 April 2022).

Charlton NP, Swain JM, Brozek JL, et al. Control of Severe, Life-Threatening External Bleeding in the Out-of-Hospital Setting: A Systematic Review. Prehospital Emergency Care. 2021; 25(2): 235-267. https://doi.org/10.1080/10903127.2020.1743801.

Morgan S. Emergency Care, In: Delves-Yates (ed.) Essentials of Nursing Practice. (3^rd edn). Sage; 2015 pp. 509-530.

Nursing and Midwifery Council. Future nurse: Standards of proficiency for registered nurse. 2018. https://www.nmc.org.uk/globalassets/sitedocuments/education-standards/future-nurse-proficiencies.pdf (accessed 12 April 2022).

St John Ambulance. Severe Bleeding. 2021. https://www.sja.org.uk/get-advice/first-aid-advice/bleeding/severe-bleeding/ (accessed 12 April 2022).