Top 5 First Aid Tricks Everyone Should Know, Part 1: Direct Pressure

bleedingIn my profession as a paramedic / firefighter one question repeatedly gets asked of me- “What are some simple first aid tricks to know in case of an emergency?” As such, I thought it would be a good idea to do a little article series on the subject.  This will be a 5 part series published throughout this week on the Top 5 First Aid Tricks Everyone Should Know.

The obvious question arises, according to whom? The top 5 of almost anything will always be subjective. In this case, for example, someone with diabetes might think giving insulin should be the #1 “trick”, while someone who just broke their ankle might think pain relief should be #1. These top 5 are not the top five medical conditions that can kill you and how to treat them, but 5 easy to do first aid things that anyone can perform- being able to perform them will allow you to save someone’s life, and knowing them will help in a wide range of situations. With this in mind, I used my own expertise and polled numerous paramedics and doctors in the emergency system I work, and came up with the top 5 first aid tricks everyone should know.

Some of these things might seem mundane and by no means technical, but what they are and the science behind why they save lives will be discussed in the following 5 article series as well as proper methods.  So without further ado, let’s start with #5 on the list.

#5- Direct Pressure:

Direct pressure, as most people know, is one way to stop bleeding, arguably the best way. It involves taking your hand (hopefully gloved, or with some sort of barrier device to prevent the spread of disease) and placing it directly over the wound. Apply enough force to stop the bleeding. (It’s not rocket surgery.) Even in the worst types of bleeding, you won’t need more than 3-4 pounds per square inch. Why 3-4 psi?

Blood pressure is measured in millimeters of mercury. 1 millimeter of mercury equals .0193 psi. (See What Do the Numbers on a Blood Pressure Test Mean and What Does It Tell the Doctor) Even if you’re extremely scared because of your blood loss and your blood pressure is elevated to 200/100, that still only requires 3.86 psi to stop the bleeding. Obviously veins and arteries aren’t 1 square inch (unless you’re the Jolly Green Giant) so you can even apply a little less pressure to that wound. The best rule of thumb, squeeze till the bleeding stops. You won’t have to squeeze hard.

There are 3 types of bleeding. The first is “capillary”, where the blood just oozes out, like in the case of a scraped knee. The biggest problem with capillary bleeding is infection. The second is “venous”, usually dark red or maroon (because it doesn’t contain as much oxygen as arterial blood). This type is easily controlled with direct pressure because it isn’t itself under a lot of pressure. It can take a bit longer to clot than capillary bleeding, but with minimal pressure applied, it will stop. Then there is arterial bleeding. Even if you’re right across the street from the hospital and you begin to bleed from an artery, without direct pressure, you could die before you get a doctor there to help you.

As you might expect, arterial bleeding is blood loss from an artery. Your arteries carry oxygenated blood to your body and organs under pressure. Arterial blood loss looks just like you often see on TV and in the movies- like a sprinkler that squirts out blood with every heartbeat. The higher your blood pressure, the farther it will reach. Approximately 2.4 ounces (70 milliliters) of blood is ejected from your heart with every beat (assuming you’re a healthy adult of average size). Let’s say you just cut your femoral artery and you’re a little excited because you’re pasting the walls with your precious blood volume, so your heart rate is 100 beats per minute. That’s 7 liters per minute! Considering the average adult female has around 5 liters, and males around 6, of blood volume in their body- you’re drained like a vampire victim very quickly, should you not stop that bleeding immediately. (It should be noted that the actual time it will take depends on the size of the artery. All sizes of arteries drain you very quickly, though.)

Direct pressure as soon as possible becomes extremely important in this type of bleeding. It will very probably save the person’s life. If there is any doubt as to the type of blood loss the victim is suffering from, direct pressure will stop all types. It’s simple, easy, and unless you’re a quadriplegic or have some debilitating muscle issue, almost anyone can apply enough force.

According to the Centers for Disease Control and Prevention, trauma is the leading cause of death for people under 44 and blood loss plays a huge role in their outcomes. Due to this, and because uncontrolled bleeding will definitely kill you, direct pressure comes in at #5.  Stay tuned tomorrow for #4 on this “first aid tricks” series.

A note on tourniquet usage:

It’s true there are some types of injuries that involve bleeding where direct pressure will not work- severe trauma to a limb in battle or the case of someone who got their arm caught in a meat grinder, to name a couple. Where do you apply the pressure when so many different veins and arteries are bleeding? In these extreme cases, many medical professional, and the American Heart Association (AHA) are advocating the use of tourniquets.

The use of tourniquets to stop emergency bleeding has been frowned upon for decades. It involves placing a restrictive band around an injured extremity and then tightening it until the bleeding stops. The use of tourniquets is so controversial it seems every doctor has a differing opinion. The controversy revolves around the risk versus benefits of their use.

When you place a tourniquet appropriately, you severely reduce, or cut off completely, blood- flow to that extremity. When you do this, the muscle and other tissues in that limb begin to die. Once this happens, there are several different electrolytes and toxic metabolites that begin to build up, while the pH of the blood slowly becomes more acidic. The longer the tourniquet is in place, the lower the pH of the blood in that extremity will become and the greater the number of toxic metabolites will be. When you release the tourniquet, the chances of your acid-like blood and those deadly metabolites reaching your heart and killing you becomes very good. In many cases, the only treatment option left to the doctor is amputation. It’s because of these deadly risks, and the potential for amputation after the fact, that tourniquet use is often viewed as “not worth the risk”.

Due to the availability of trauma patients in the war in Afghanistan and Iraq (take this time to thank a veteran please!), several studies, both retrospective and prospective, have found that tourniquet use will indeed save someone’s life when direct pressure simply cannot be performed. In these extreme cases, the risk of death from blood loss far outweighs the risk of having the limb amputated. Some of these studies pointed out that many times amputation wasn’t necessary, and sometimes there were no adverse effects due to the tourniquet.

These studies are changing how doctors and medical professionals view tourniquets. The AHA is now advocating their use, and teaching the technique to those who attend their first aid classes. The point must be made, however, that they should only be used when direct pressure and all other methods of bleeding control have been attempted first.

Be Sure and Check Out the Other Parts of this series:

Bonus Facts:

  • Someone needs a blood transfusion every 2 seconds in the United States. The average red blood cell transfusion requires 3 pints and approximately 30 million blood components are transfused each year. 16 million donations are collected each year to meet this demand. They come from about 9.5 million donors. That being said, less than 38% of the U.S. Population is eligible to give blood. Since blood cannot be manufactured, but only donated from others, donate people!
  • Type O blood is the most commonly requested by hospitals, and type O-negative red blood cells can be transfused to patients of all blood types. Type AB-positive plasma can also be transfused to people of all blood types.

*Legal Disclaimer: This article contains general information about medical conditions and treatments. The information is not direct advice for your specific situation, and should not be treated as such, nor should it be viewed as a replacement for proper, professional first aid training. You should never delay seeking medical advice, disregard medical advice, or discontinue medical treatment because of information in this article…. There, I’ve covered myself.  😉

[Image via Shutterstock]

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  • Forty-five years ago, in Boy Scouts, our first aid training said pressure first, and if a pad fills up with blood, don’t replace it, just put another one on top of it and keep pressing. For some bleeding a pressure point on artery in the arm or leg (groin) could be used, but a tourniquet was to be used when it was a choice between “Life or Limb.”

  • Good series of articles.

    I would submit that one of the best first aid skills to have is to know when AND how to call for help in the places you frequent (have to dial 9 to get outside, so 9911, etc.), as well as how to instruct “helpers” to flag down EMS/FD when they arrive, among other tasks. Preplan preplan preplan, ain’t just for the pros 🙂

    It’s OK, as a fellow paramedic (who now does something else full-time), I’ve had the humbling experience of “oh, #$#%, I don’t have that handy, time to improvise and/or get help …”

    Put another way: “I’m a trained medical professional. I can dial 911 faster than anybody else in this room.”