Heavy bleeding

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Scene 1 · Opening

21.30, your brother-in-law's garage. He is finishing a cut through a sheet of steel, you are putting tools away behind him.

A sharp noise, a swear word. He sits down on the floor against the workbench and grips his forearm. Between his fingers it is running, and it is not stopping.

Scene 2 · The first move

The blood is not seeping: it is running steadily. There is a box of clean rags on the workbench, a metre away.

He is conscious, he is talking to you, he is frightened.

What do you do?

• Right move : I protect my hands, I take a clean rag and I press straight onto the wound.
  Direct pressure, with your hand : It is the simplest and the most effective way there is to stop bleeding. Avoid contact with the blood: disposable gloves, a plastic bag or a cloth. You can also ask him to press on his own wound himself.
• Mistake : I tighten my belt above the wound to cut off the blood supply.
  A tourniquet is not the first thing you do : A tourniquet is for when direct pressure does not work or cannot be done, or in particular situations such as isolation or a number of casualties. And it can only be applied to the upper or lower limbs. Here you have not even tried pressing. A badly placed belt compresses nothing and costs the seconds that would really have counted.
• Mistake : I run into the house to fetch the first aid kit.
  Meanwhile, nobody is pressing : You need nothing beyond your hand and a cloth, and the cloth is a metre away from you. A kit in another room means a wound left open for thirty seconds.

Scene 3 · He is going white

Your hand is in place and it has dropped right off. But he is going grey, he says he feels hot, his voice is changing.

What do you do?

• Right move : I lay him down flat, without letting go of the pressure.
  Lying flat, and the hand stays where it is : Lay the person down flat. All of it is done without ever interrupting the pressure: the pressure is what is holding the bleeding, not the position.
• Mistake : I lift the rag to check whether it is still bleeding.
  You have just reopened the wound : If the wound goes on bleeding, you press EVEN HARDER, and you keep pressing until help arrives. Looking means letting go.
• Not the best choice : I ask him whether his tetanus jab is up to date.
  Excellent question. In two hours. : The hospital will ask it, and he will have the whole journey to think about it. You have one hand occupied and one sentence to say on the phone.

Scene 4 · Calling without letting go

The dispatcher : “Samu, go ahead.”

Timer: 35 seconds.

You are alone with him, one hand on the wound. What do you say?

• Right move : “12 chemin des Sablons in Varennes, the garage at the back of the yard. A man of 40, a wound to the forearm bleeding heavily, I am pressing on it, he is going pale.”
  The place, what happened, how he is, what you are doing : Speakerphone, or the handset wedged against your shoulder: anything except letting go. The precise location, what the problem is, the state the casualty is in, and what has already been done.
• Mistake : I let go of the wound for two seconds so I can dial more easily.
  Two seconds is enough to lose all of it again : If you have to free yourself up, to go and raise the alarm for instance, put a pad in place to take over from your hand. You never let go into thin air.
• Mistake : “He has cut himself in the garage, we will be at A and E in ten minutes, I am just letting you know.”
  You cannot drive and press at the same time : Bleeding that runs without stopping is an emergency that comes to you, not the other way round. And you do not hang up before the person on the line asks you to.

Scene 5 · Holding on

The dispatcher tells you not to move and to call back if anything changes. Six minutes, he says.

Your arm is starting to shake.

You have six minutes to hold. How?

• Right move : I keep the pressure on, and if I have to free a hand I put a pad over the wound first.
  Keep going until help arrives : The cloth that goes in place of your hand has to be clean and has to cover the wound completely. If that pad does not stop the bleeding altogether, you put a second one on top of the first. If that fails, you go back to pressing by hand.
• Mistake : I ease off a bit, long enough to rest my arm.
  Easing off means starting again from nothing : The pressure on the wound carries on until help arrives. If your arm is tiring, change hands without letting go, lean in with your body weight, or put a pad in place.
• Mistake : I go and open the gate so they can get in faster.
  The gate will wait, the wound will not : You gave them the address and the way in: they will find it. If you really do have to free yourself up, put a pad in place first to take over from your hand.

Scene 6 · The crew

Blue light comes under the garage door. Two firefighters come in, a third stays outside.

Somebody tells you not to move yet, pulls on gloves, then puts a hand next to yours before you take yours away.

You did nothing complicated. You pressed, you did not let go of him, and you talked on the phone at the same time. Afterwards you will go and wash your hands.