Massive bleeding must be controlled immediately. If the victim also requires resuscitation, the two problems must be handled simultaneously. Bleeding may involve veins or arteries; the urgency and method of treatment will be determined in part by the type and extent of the bleeding.

External Arterial Hemorrhage.

Arterial bleeding can usually be identified by bright red blood, gushing forth in jets or spurts that are synchronous with the pulse. The first measure used to control external arterial hemorrhage is direct pressure on the wound.

Direct Pressure.

Pressure is best applied with sterile compresses, placed directly and firmly over the wound. In a crisis, however, almost any material can be used. If the material used to apply direct pressure soaks through with blood, apply additional material on top; do not remove the original pressure bandage. Elevating the extremity also helps to control bleeding. If direct pressure cannot control bleeding, it should be used in combination with pressure points.

Pressure Points.

Bleeding can often be temporarily controlled by applying hand pressure to the appropriate pressure point. A pressure point is a place where the main artery to the injured part lies near the skin surface and over a bone. Apply pressure at this point with the fingers (digital pressure) or with the heel of the hand; no first aid materials are required. The object of the pressure is to compress the artery against the bone, thus shutting off the flow of blood from the heart to the wound.

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