To keep the body functioning, and to keep the organs supplied with oxygen, the body must have enough circulating blood volume. Blood consists of red cells (erythrocytes), which convey oxygen throughout the body; white cells (leucocytes), which fight introduced infection; platelets (thrombocytes), which assist in the clotting process; and plasma, the fluid portion of blood. There are between five and seven litres of blood in the average adult body which makes up 7-8% of the body weight.

Blood is moved around the body under pressure by the heart and blood vessels. Without an adequate blood volume and pressure, the human body soon collapses. Bleeding, or haemorrhage, poses a threat by causing both the volume and the pressure of the blood within the body to decrease through blood loss and is caused by the rupture of blood vessels due to the severity of the injury.

Bleeding is one of the commonest causes of death in accidents. There are two types of bleeding: external bleeding which is obvious and apparent; and internal bleeding where the bleeding is not apparent at the outset but may show itself later in the form of bleeding from the nose, ear, lungs or stomach.

External bleeding is usually associated with wounds caused by cutting, perforating or tearing the skin. Serious wounds involve damage to blood vessels. As arteries carry oxygenated blood from the heart, damage to an artery is characterised by bright red blood which can ‘spurt’ with each heartbeat. Damage to veins appears as a darker red and tends to flow. Capillary damage is associated with wounds close to the skin and is a bright red and ‘oozes’.

When tissue in our body is torn or cut by injury a wound is caused. Types of wounds include:

• Abrasion is a wound where the skin layers have been scraped off from a fall on a rough surface, pieces of shells, claws of animals, machinery etc. These wounds have torn or irregular edges and they tend to bleed less.
  Amputation is the cutting off of part of the body such as a limb or part of a limb.

• Incision is the type of wound made by ‘slicing’ with a sharp knife or sharp piece of metal. It is very thin, clean cut and bleeds extensively.
• Laceration is a deep wound with associated loss of tissue, the type of wound barbed wire would cause.
• Puncture wounds are perforations, and may be due to anything from a corkscrew to a bullet.

Some bleeding such as Varicose veins can often rupture with little or no injury, and should be treated with direct pressure.

CARE AND TREATMENT

Life Threatening Bleeding

• SRABC
  • call for an ambulance as soon as possible
• expose the wound
• check the wound for visible foreign bodies
• apply a dressing
• apply direct pressure over the wound with a sterile or clean padlay the casualty down if not already in this position
• raise and support the injured part above the level of the heart if possible
• apply a firm bandage to hold the pad in place
• treat for shock if required
• check circulation regularly to ensure bandage is not too tight
  • if unable to stop the bleeding consider a constrictive bandage
  • cut or remove all clothing from around upper limb
  • ensure that the constrictive bandage can be easily seen
  • select a firm wide bandage (minimum 7.5cm) that is not too elastic
  • apply bandage firmly to limb and tighten until bleeding stops
  • secure bandage
  • write time of application in pen on patient’s skin
  • reassess every 30 minutes

Constrictive bandages are a measure of last resort, and should only be used in a life threatening situation where all other methods have failed.

Incisions And Lacerations

• SRABC
• quickly check the wound for foreign matter
• immediately apply pressure to stop any bleeding
• bring the sides of the wound together and press firmly
• apply a non-adherent dressing and a firm roller bandage
• immobilise and elevate the injured limb if injuries permit

Abrasions

• SRABC
• check the wound for foreign matter
• swab with a diluted antiseptic solution

apply a non-stick dressing or a light, dry dressing if necessary

Puncture Wound

• SRABC
• check the wound - DO NOT remove any penetrating object
• apply direct pressure around the wound to stop any bleeding
• stabilise with a ring pad and non-stick dressing
• apply a firm roller bandage

rest and elevate injured limb if injuries permit

Amputation

• SRABC
• apply direct pressure to stop any bleeding
• apply a large pad or dressing to the wound
• treat for shock
• rest and elevate injured limb if possible
• collect amputated part - keep dry, do not wash or clean
• seal the amputated part in a plastic bag or wrap in waterproof material

place in iced water - do not allow the amputated

• part to come in
• irect contact with ice. Freezing will kill tissue

ensure the amputated part goes to the hospital with the casualty