Severe, life-threatening external bleeding

Severe, life-threatening external bleeding (uncontrolled bleeding) cannot be controlled by smaller, regularly used combine dressings and roller bandages. Unlike minor bleeding from small cuts and abrasions or nosebleeds, severe bleeding can lead to a significant drop in blood pressure, shock and death. Common causes around the water include propeller cuts and shark bites.

Signs and symptoms

• Amputated or partially amputated limb above wrist or ankle
• Bleeding that cannot be controlled by local pressure
• Decreased level of consciousness or unconsciousness
• Major trauma to any part of the body

Management

Manage severe, life-threatening external bleeding (uncontrolled bleeding) before checking the airway and breathing when performing a primary assessment (DRSABCD).

Severe, life-threatening bleeding from a limb

1. Send for help, additional resources (trauma kit with an arterial tourniquet, first aid kit, AED) and request an ambulance.
2. Expose the skin above the bleeding point where possible—you may use shears to cut clothing or wetsuits.
3. Stop uncontrolled bleeding from a limb as soon as possible by applying an arterial tourniquet high and tight as per the manufacturer’s instructions, or by using a windlass tourniquet as follows:
   • position the tourniquet:
     • horizontally
     • at least 5 cm above the bleeding point
     • over an intact part of the injured limb
     • over exposed skin where possible
     • not over a joint or wound
     • with the strap on the lateral (‘outer’) side of the limb
   • pull the tourniquet strap tightly through the buckle so there is no space between the strap and the limb
   • turn the windlass as tightly as is physically possible or until the bleeding stops
   • secure the windlass through the locking loop.
4. Record the time the tourniquet was applied on the tab of its strap (or on the person’s head) as well as in an incident report for the paramedics to note.
5. Monitor and reassure the person while waiting for the paramedics.

Note

• A second tourniquet (if available) should be applied to the limb, preferably above the first, if bleeding continues.
• After applying a tourniquet to control the severe, life-threatening bleeding, commence CPR and apply an AED if the person becomes unconscious and is not breathing normally. Place the person in the recovery (lateral) position if they become unconscious and are breathing normally.
• First responders must not ease the tension or remove a tourniquet after it has been applied.
• First responders qualified in advanced resuscitation may safely administer oxygen to persons showing the signs and symptoms of severe, life-threatening bleeding. Refer to the SLS Pathways website or the appropriate person at your SLS club for more information on advanced resuscitation training.
• Keep the person warm to avoid hypothermia and treat for shock (see Shock).
• Tightening tourniquets on people causes them pain and discomfort.
• Improvised tourniquets of a similar broad width to commercial ones that do not stop all circulation can increase bleeding and risk tissue damage. However, an improvised one is better than none. If you have no tourniquet, you may improvise one from bandages, clothing, a surfboard leg rope or other available items of a similar nature. Any improvised tourniquet should be tightened by twisting a rod or stick under its band, similar to the windlass in commercial tourniquets.
• Refer to the latest ARC Guideline for the management of bleeding to learn more.
  

Severe, life-threatening bleeding from a wound site not suitable for a tourniquet

When severe, life-threatening bleeding is not from a limb, treat the injury as major external bleeding with direct pressure.

Note

• Do not wrap bandages tightly around the chest or abdomen.
• First responders qualified in advanced first aid may apply a haemostatic dressing if one is available.
• First responders qualified in advanced resuscitation may safely administer oxygen to persons showing the signs and symptoms of severe, life-threatening bleeding. Refer to the SLS Pathways website or the appropriate person at your SLS club for more information on advanced resuscitation training.