Severe Bleeding – Symptoms and First Aid Advice

Severe bleeding can be described as an extensive amount of blood loss that usually results in the person losing consciousness and potentially developing shock.

Severe bleeding is a serious condition and immediate medical assistance should always be sought when it occurs. It is possible for someone who has experienced severe blood loss to die within minutes without prompt treatment, so it is important to recognise the symptoms associated with this potentially life-threatening situation.

Your priority is to stop the bleeding.

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Symptoms of severe bleeding

The most apparent symptom of severe bleeding is a sudden drop in blood pressure, which leads to fainting or dizziness. If the person affected by severe bleeding loses enough blood they may not appear pale but instead will look red and sweaty because their body isn’t able to carry sufficient oxygen around their body due to low levels of haemoglobin (the substance in blood that carries oxygen). Other symptoms of severe bleeding can include:

• Rapid and shallow breathing
• A weak, rapid pulse
• Nausea and vomiting
• Feeling cold or clammy.

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How to treat severe bleeding

If someone is suspected to be suffering from severe bleeding, it is important to take the following steps:

1. It’s possible that an open wound will become infected, so use protective first-aid gloves (if accessible) to help prevent the spread of infection between you both. Keeping these and sterile dressings stocked is one reason to choose the right first aid kit for your workplace.
2. If possible, use a sterile dressing or a clean non-fluffy cloth to apply direct pressure to the wound to prevent bleeding.
   • If you don’t have a dressing, ask the victim to do it themselves.
   • Remove or cut the clothing to expose the wound if it is covered by the victim’s clothing.
   • Never yank anything from a wound if there is an object in it. It might be blocking the flow of blood. rather, apply pressure on both sides of the item to bring the edges together.
3. Call 999 or 112 for emergency assistance and provide Ambulance Control with the location of the wound and how much blood is flowing.
   • If you are alone, use a hands-free phone to treat while talking to ambulance control.
4. To keep pressure on the wound, wrap a bandage around it. Make sure it’s firm enough to keep pressure but not too tight that it limits their flow of blood.
5. Examine their circulation beyond the bandage. For five seconds, press one of the nails or skin past the bandage until it goes pale, then release the tension. If no colour returns within two seconds, the bandage is too tight. If required, loosen and reapply the bandage as needed.
6. Loss of blood might induce shock in the victim. To help them rest, place them on a rug or blanket and assist them to recline. Raise and support their legs so that they are higher than their heart level. You should then remove any constricting garments around the casualty’s neck, chest, and waist before covering them with a blanket to keep them warm.
7. Support the injured area with a sling or bandage and check for circulation on the skin every 10 minutes.
8. Continue to monitor their condition until help arrives. Prepare to begin CPR if they go unresponsive at any time.

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Life-threatening (catastrophic) bleeding

Most bleeding is controlled by firm direct pressure and the steps above. However, some bleeding is life-threatening and direct pressure alone will not stop it. Treat bleeding as life-threatening if blood is pumping or spurting from the wound, the bleeding is not slowed by firm direct pressure, or the casualty is soaking through dressing after dressing. In these cases you need to escalate quickly:

1. Call 999 or 112 immediately (if you have not already) and follow the instructions given by Ambulance Control.
2. For catastrophic bleeding from an arm or leg (for example a partial amputation, stabbing, gunshot, or a blast or power-tool injury), apply a tourniquet as soon as possible. Place it around the limb close to and above the wound, never over a joint, and below the elbow or knee where possible (the Resuscitation Council UK gives a figure of around 5–7 cm above the injury). Tighten it until the bleeding stops. Once a tourniquet is applied, do NOT loosen it, and write down the time it was put on so the ambulance crew know how long it has been in place. Tourniquets are for limbs only.
3. Where a tourniquet cannot be used – for wounds to the head, neck, chest or abdomen, or at the junctions where a limb meets the body – pack or apply a haemostatic dressing firmly into the wound and hold firm direct pressure for at least 5 minutes.
4. If no commercial tourniquet or haemostatic dressing is available, only improvise one on the instruction of Ambulance Control.

Sources: Resuscitation Council UK First Aid Guidelines (2021/2025); St John Ambulance.

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