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STOP THE BLEED: Understanding Bleeding

It’s STOP THE BLEED Month, so we’re going back to basics with a critical question: What is Massive Haemorrhage? The Rescue Trauma & Casualty Care describes massive haemorrhage as "a major bleed that will rapidly become life-threatening"—think losing over 2 litres of blood in an adult, fast. But what does TacMed Nation think? We asked this critical question on Instagram, and here's a few of their responses:

“Blood freely flowing from the wound,”

“Bleeding through pressure dressings,”

“Blood pooling on ground,”

“Clothing surrounding wound saturated with blood,”

“Pulsating bleeding,”

“>500mL acutely,”

“High flow, high volume.”

Bleeding occurs when blood escapes the circulatory system, ranging from minor scrapes to life-threatening emergencies—as first responders, understanding its types and severity can be the difference between a manageable incident and a devastating outcome.

Bleeding varies by source, each with distinct characteristics that guide response:

Arterial: Bright red blood spurts rhythmically with the heartbeat due to high pressure in arteries, making it the most dangerous type.
Venous: Darker red blood flows steadily from veins, less forceful but still serious, especially from larger veins.
Capillary: Slow oozing from tiny vessels near the skin’s surface, common in minor cuts and typically the easiest to manage.

Recognising these differences in a high-stress emergency situation can be difficult—even for the most experienced first responders—which means knowing how to treat effectively and taking quick action challenging.

Bleeding can present in two forms—external, which is visible and often immediate, and internal, which may go unnoticed but still pose a serious threat.

A TacMed Australia trainer in a black shirt demonstrates wound packing technique on a simulator.

External Bleeding

External bleeding is visible blood loss often caused by cuts, punctures, abrasions, or trauma from accidents, falls, violence, or a run in with a dangerous animal. Severe cases can include amputated limbs, penetrating chest wounds, abdominal punctures, or major trauma to any body part.

Warning signs for major external bleeding include rapid blood flow, blood pooling or spurting, blood soaked clothing, and bleeding that is not able to be controlled by direct pressure. Critical cases are often accompanied by systemic shock symptoms like dizziness, pale and sweaty skin, pulse rate >100, capillary refill >2 seconds, or decreased consciousness.

ANZCOR emphasises that applying pressure on or around the wound is the fastest, easiest, and most effective way to stop external bleeding.

Apply firm, direct pressure with a pad or hands to stop the bleeding. Maintain firm direct pressure until the bleeding stops. Avoid layering multiple pads, as this simply absorbs more blood and reduces pressure effectiveness.
If an embedded object is present, apply pressure around it without removing the object, as it may be plugging the wound. Use a dressing around or on each side of the object and apply pressure over the padding.
For severe, life-threatening bleeding from a limb not controlled by pressure, apply an arterial tourniquet above the bleeding point (5-10cm above and not over a joint or wound). Commercial tourniquets, like the SOF Tourniquet or C-A-T, are most effective. Apply the tourniquet per manufacturers advice and tighten until the bleeding stops. If bleeding is still not controlled, a second tourniquet may be applied above the first.
If a tourniquet isn’t suitable or available, wound packing with haemostatic dressings can be extremely effective. Pack the wound tightly and hold pressure for at least 5 minutes or until the bleeding stops. Secure with a pressure bandage—OLAES or Emergency Bandage are highly recommended.
Lie your patient down, restrict their movement, and call for an ambulance.
Contrary to popular belief, ANZCOR notes there’s no evidence that elevating a bleeding body part helps and it may cause more pain or injury.

"The use of pressure on or around the wound is usually the fastest, easiest and most effective way to stop external bleeding." ANZCOR

Internal Bleeding

Internal bleeding occurs inside the body, often affecting organs or cavities like the brain, chest, or abdomen. It can result from blunt trauma (e.g., car accidents, falls), fractures, organ injuries, or conditions like ulcers or pregnancy complications. ANZCOR highlights that internal bleeding can present as bruising, locally contained bleeding (e.g., a hematoma on the head), but may not be visible at all. Warning signs include pain, tenderness, or swelling in the affected area, blood from body openings (e.g., bright red frothy blood coughed up, dark brown vomited blood, blood-stained urine, vaginal or rectal bleeding), and signs of shock (pale, sweaty skin, rapid weak pulse, or confusion).

For first response of suspected internal bleeding, ANZCOR advises:

Lie the person down and assist them into a comfortable position, keeping them warm.
Monitor vital signs frequently and treat for shock (e.g., pale, clammy skin). Administer oxygen if available and trained to do so.
Avoid giving food, drink, or medications, as surgery is likely needed.
For bruising on a limb without external bleeding, apply pressure and a cold pack if available.
Call for an ambulance immediately, as severe internal bleeding requires urgent hospital treatment, including imaging or surgery.

If the person is unresponsive and not breathing normally, follow ANZCOR ’s Basic Life Support Flowchart for CPR.

"In life-threatening bleeding, control of bleeding takes priority over airway and breathing interventions." ANZCOR

A TacMed Australia trauma kit on a concrete floor with blood stains, containing a tourniquet, bandages, gloves, scissors, and a chest seal, next to a yellow line.

Be Prepared, Not Scared

Preparation is key to being able to effectively manage bleeding emergencies. The Rescue Trauma & Casualty Care (RTACC) recommends carrying a trauma kit with quality bleeding control supplies, ensuring accessibility in high-risk settings like sports, hiking, surfing, road trips, and workplaces. ANZCOR recommends using standard precautions (e.g., gloves) to minimise infection risk during first aid.

It's also important to know your gear before you have to use it—check out our YouTube channel for product demo's to get a basic understanding of how to apply a tourniquet or read the manufacturers manual.

Remember, controlling catastrophic bleeding takes priority, even over airway and breathing interventions, in life-threatening cases. To read more about our recommended primary assessment method for trauma emergencies, go check out our BLOG: The MARCH Approach.

Summary

Whether facing spurting arterial bleeding or the hidden dangers of internal haemorrhage, your ability to act confidently—applying firm pressure, using tourniquets or haemostatic dressings, and stabilising a patient—can save lives. Preparation and a good Bleeding Control Kit are your greatest tools.

Can you do us a favour? This STOP THE BLEED Month, send our Understanding Bleeding article to a mate and help us spread the knowledge that could make a life-saving difference.

Stay safe,

Team TacMed

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