First Aid for Severe Trauma

Handbook

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American Red Cross

First Aid
for Severe
Trauma
Handbook
 This Handbook is part of the American National Red Cross’ First Aid for Severe Trauma™
program. The emergency care procedures outlined in the program materials reflect the standard
of knowledge and accepted emergency practices in the United States at the time this handbook
was published. It is the reader’s responsibility to stay informed of changes in emergency
care procedures.
PLEASE READ THE FOLLOWING TERMS AND CONDITIONS (the “Terms and Conditions”)
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Copyright © 2021 by The American National Red Cross. ALL RIGHTS RESERVED.
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are trademarks of The American National Red Cross and protected by various national statutes.
Printed in the United States of America
ISBN: 978-1-7341681-6-7

ii
Funding
The American National Red Cross’ (Red Cross) First Aid for Severe Trauma™ (FAST) program
is based on funding provided by the U.S. Department of Homeland Security under Grant
Number 18STFRG00010-01-00 to the Henry M. Jackson Foundation for the Advancement of
Military Medicine on behalf of the Uniformed Services University’s National Center for Disaster
Medicine and Public Health.
Disclaimer: The views and conclusions contained in this handbook are those of the authors
and should not be interpreted as representing the official policies, either expressed or implied,
of the U.S. Department of Homeland Security or the U.S. Department of Defense.

Science and Technical Content

The American Red Cross Scientific Advisory Council (www.redcross.org/science), a volunteer
committee of nationally recognized health care, aquatics, preparedness and educational
professionals, helps establish and assure the scientific basis for Red Cross programs, products
and public guidance. Council members’ contributions help ensure that the Red Cross is using
the latest science, addressing current needs and is preparing for future changes.
The scientific content within the FAST program is consistent with the most current science
and treatment recommendations from the International Liaison Committee on Resuscitation
(ILCOR) 2020 International Consensus on Cardiopulmonary Resuscitation and Emergency
Cardiovascular Care Science with Treatment Recommendations; the International Federation
of Red Cross and Red Crescent Societies; and the policy statements, evidence reviews and
guidelines of the American Academy of Pediatrics (AAP), the American College of Emergency
Physicians (ACEP), the American College of Surgeons (ACS), the Committee on Tactical
Combat Casualty Care (CoTCCC), the Society of Critical Care Medicine (SCCM) and the
American College of Critical Care Medicine (ACCM).

Dedication
This program is dedicated to the thousands of employees and volunteers of the American
Red Cross who contribute their time and talent to supporting and teaching lifesaving skills
worldwide and to the thousands of course participants who have decided to be prepared to
take action when an emergency strikes.

iii
 Acknowledgments
Many individuals shared in the development of the American Red Cross First Aid for Severe
Trauma program in various technical, editorial, creative and supportive ways. Their commitment
to excellence made this program possible.

American Red Cross Content Direction

Scientific Advisory Council The development of this program would not
have been possible without the leadership,
We would like to extend our gratitude to the
valuable insights and dedication of the
following members of the American Red
subject matter experts, who generously
Cross Scientific Advisory Council for their
shared their time to ensure the highest
guidance and review of this program:
quality program:
David Markenson, MD, MBA, FCCM,
Roy Edward Cox, Jr., D.Ed., EMT-P
FAAP, FACEP, EMT-P
Adjunct Faculty, Point Park University
Chief Medical Officer, American Red Cross
District Chief, City of Pittsburgh EMS,
Scientific Advisory Council Co-Chair
Retired
Eunice (Nici) Singletary, MD, FACEP
Marianne Gausche-Hill, MD, FACEP,
Professor of Emergency Medicine,
FAAP, FAEMS
University of Virginia
Professor of Clinical Medicine and Pediatrics,
Scientific Advisory Council Co-Chair
David Geffen School of Medicine at the
Nathan P. Charlton, MD University of California, Los Angeles
Associate Professor of Emergency Medicine, Medical Director, Los Angeles County
University of Virginia Emergency Medical Services (EMS) Agency
First Aid Sub-Council Chair
Craig Goolsby, MD, MEd, FACEP
Craig Goolsby, MD, MEd, FACEP Professor and Vice Chair, Department of
Professor and Vice Chair, Department of Military and Emergency Medicine
Military and Emergency Medicine Science Director, National Center for
Science Director, National Center for Disaster Medicine and Public Health
Disaster Medicine and Public Health Uniformed Services University of the
Uniformed Services University of the Health Sciences
Health Sciences
Matthew Jason Levy, DO, MSc, FACEP,
First Aid Sub-Council Member
FAEMS, NRP
Matthew Jason Levy, DO, MSc, FACEP, Associate Professor of Emergency Medicine,
FAEMS, NRP Johns Hopkins University School of Medicine
Associate Professor of Emergency Medicine, Medical Director, Howard County
Johns Hopkins University School of Medicine Department of Fire and Rescue Services
Medical Director, Howard County
Matthew D. Neal, MD, FACS
Department of Fire and Rescue Services
Assistant Professor of Surgery, Clinical
First Aid Sub-Council Member
and Translational Sciences and Critical
Jeffrey L. Pellegrino, Ph.D., MPH, MS Care Medicine, University of Pittsburgh
Assistant Professor, Emergency Medical Center
Management and Homeland Security, Clinical and Translational Science Institute
The University of Akron (CTSI), University of Pittsburgh
Education Sub-Council Chair

iv
Raphaelle H. Rodzik, MPH Supporting Organizations
Project Manager, National Center for Thank you to the following organizations
Disaster Medicine and Public Health and their staffs for accommodating the
Henry M. Jackson Foundation for the Red Cross and coordinating resources for
Advancement of Military Medicine this program’s development.
Kimberly J. Stoudt, Ed.D, LAT, ATC, ■ American Red Cross Southeastern
EMT, EMT-T Pennsylvania Chapter
Instructional Design and Assessment ■ Central Montco Technical High School.
Specialist, National Center for Disaster Special thanks to Allison Latzo, MSN, RN,
Medicine and Public Health and her students.
Henry M. Jackson Foundation for the ■ HOSA-Future Health Professionals.
Advancement of Military Medicine Special thanks to Karen Bachelor, Jan
Assistant Professor, Clinical Education Mould, Maria Ramirez and Walt Slauch.
Coordinator, Alvernia University

Program Development
Special thanks to the program development
team for their expertise and mix of patience
and persistence to bring this program
through to completion: Danielle DiPalma,
Marie Manning, Maureen Pancza, Anna
Pruett, Josh Rowland, Maureen Schultz,
Laura Scott, Melanie Sosnin, Nichole
Steffens and Whitney Wilson.

v
Table of Contents
CHAPTER 1
You Can Save a Life . . . . . . . . . . . 1
Preparing for Bleeding Emergencies . . . . . . . . . . . . . . . . . . . 2
Recognizing That a Bleeding Emergency Exists . . . . . . . . . 4
Emergency Action Steps . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
Deciding to Act in an Emergency . . . . . . . . . . . . . . . . . . . . . . . 12

CHAPTER 2
Safety in Emergency Situations . . . . 15
Keeping Yourself Safe in an Emergency . . . . . . . . . . . . . . . . 16
Helping Others to Safety . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
Violent Situations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18

CHAPTER 3
Communicating in Emergency
Situations . . . . . . . . . . . . . . . . . 19
Communication Basics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
Communicating with Others at the Scene . . . . . . . . . . . . . . . 22
Communicating with the Emergency Dispatcher . . . . . . . . 24

CHAPTER 4
Caring for a Person with
Life-Threatening Bleeding . . . . . . . 27
Using Pressure to Stop Bleeding . . . . . . . . . . . . . . . . . . . . . . . 28
Applying Direct Pressure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30
Using a Tourniquet . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32
After the Bleeding Stops . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37
Skill Sheet 4-1: Applying Direct Pressure . . . . . . . . . . . . . . . 40
Skill Sheet 4-2: Using a Windlass Rod Tourniquet . . . . . . . 41
Skill Sheet 4-3: Using a Ratcheting Tourniquet . . . . . . . . . . 42

Glossary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43

Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45

vii
 Reprinted with permission from the Omaha World-Herald

CHAPTER 1

You Can
Save a Life
Traumatic injuries are the leading cause of death for people between the ages
of 1 and 44 years. Many people who die from a traumatic injury die from blood
loss. Knowing how to provide first aid care for
a person with life-threatening bleeding
can save a life. But acting quickly is important. Uncontrolled bleeding
Severe bleeding can lead to death in a matter is the number one
of minutes, even before an ambulance arrives. cause of preventable
death from trauma.

Chapter 1 | You Can Save a Life 1

 Preparing for Bleeding
Emergencies
Injuries that cause life-threatening bleeding can happen anywhere at any
time. They may be the result of an accident, a natural disaster or violence. By
participating in this First Aid for Severe Trauma (FAST) training, you have taken
an important first step in preparing yourself to respond to an emergency involving
life-threatening bleeding. You will learn the concepts and skills you need to
recognize life-threatening bleeding and respond appropriately until professional
responders arrive and take over. Once you have learned these concepts and
skills, review them regularly so that if you ever have to use them, you will be
prepared and have the confidence to take action (Figure 1-1).

Make sure you have access to information and items that will make it easier to
respond in an emergency.
■ Know who to call in an emergency. Most communities in the United States
call 9-1-1 for help in emergencies. But in some areas of the United States
and in many workplaces, you may need to dial a designated emergency
number instead. If you live or work in an area where 9-1-1 is not the number
you should call in an emergency, make sure you know what the designated
emergency number is.

Figure 1-1. When a person has life-threatening bleeding, first aid care provided
before professional responders arrive can save the person’s life.

2 Copyright © 2021 American National Red Cross | First Aid for Severe Trauma
■ Know the location of the bleeding control kit (Figure 1-2, Box 1-1), first
aid kit and AED in your school, workplace, home and other places where you
spend a lot of time.
■ Download the American Red Cross First Aid app to your mobile phone so that
you always have a first aid reference at your fingertips.

In an emergency that involves life-threatening bleeding,

people in the area need to help until professional responders
arrive. A person with life-threatening bleeding can die from
their injuries before professional responders arrive if the
bleeding is not controlled.

Figure 1-2. Bleeding control kits, first aid kits or both can often be found near
AEDs in public places. Courtesy of Uniformed Services University.

Box 1-1. What’s in an American Red Cross Bleeding Control Kit?

■ Instruction card
■ Windlass rod tourniquet
■ Elasticized wrap
■ Gauze roll
■ Gauze pads (4 x 4)
■ Scissors (trauma shears)
■ Hemostatic dressing
■ Latex-free disposable gloves

Chapter 1 | You Can Save a Life 3

 Recognizing That a Bleeding
Emergency Exists
Life-threatening bleeding will not stop on its own and the person is at risk for
losing a large amount of blood in a short time. Being able to recognize when
bleeding is life-threatening is important because some methods of controlling
bleeding, such as tourniquets, should only be used when the bleeding is life-
threatening. Not all bleeding is life-threatening. Non-life-threatening bleeding
will usually stop if you apply direct pressure.

To tell if bleeding is life-threatening, look at the amount of blood and how

the blood moves (Figure 1-3). Volume is the amount of blood. Bleeding is
life-threatening when there is a large amount of blood lost (equal to about
half of what a soda can contains). In a small
child or an infant, bleeding may be life-
threatening when the amount of blood lost When there is life-
is even less. Flow is the movement of blood. threatening bleeding,
Blood that is flowing continuously or spurting immediate action is
is a sign of life-threatening bleeding. needed to save the
person’s life.

Spurting

Flowing
continuously

Figure 1-3. To recognize life-threatening bleeding, look at the amount of blood

(volume) and how the blood moves (flow). When the amount of blood lost could
fill a soda can about halfway, the bleeding is life-threatening. Blood that flows
continuously or spurts from the wound is a sign of life-threatening bleeding.

4 Copyright © 2021 American National Red Cross | First Aid for Severe Trauma
Emergency Action Steps
In any emergency, there are three simple steps you can take to guide your
actions. If you ever feel nervous or confused, remember these three emergency
action steps to get you back on track:

1. CHECK the scene and the person.

2. CALL 9-1-1 and get equipment.
3. CARE for the person.

CHECK
First, check the scene for safety and assess the situation. Before rushing to help,
stop and look around (Figure 1-4). Ask yourself:
■ Is the scene safe to enter? Check for hazards that could put you or others
in the area in danger, such as traffic, an unstable building, downed electrical
wires, spilled chemicals, flooding or the presence of a person who is actively
trying to harm others. When you are checking the scene, do a 360-degree
check of the entire area. Look up, down and all around. Use your senses
to recognize safety hazards. What do you see, hear and smell? If there are
hazards, stay at a safe distance and call 9-1-1 immediately. Once professional
responders have made the scene safe, you can offer to help as appropriate.

Figure 1-4. Before rushing to help, check the scene.

Chapter 1 | You Can Save a Life 5

 ■ How many people are involved? Look for people who have been injured.
You will probably notice a person who is moving or making noise or who has
obvious injuries right away, but there may be a person who is silent and not
moving or a person hidden by debris or wreckage that you do not notice at
first. It is also easy to overlook a small child or an infant. In an emergency with
more than one injured person, you may need to decide who needs help first.
■ Are there signs of life-threatening conditions? Before you even enter
the scene, look for signs that will give you an idea of how serious the person’s
condition is (Figure 1-5). Do you see life-threatening bleeding? Does the
person seem to be unconscious?
■ Is anyone else available to help? Others at the scene can assist by
calling 9-1-1, getting needed items (such as a bleeding control kit), providing
care when there is more than one injured person, or meeting professional
responders and leading them to the site of the emergency (Figure 1-6).

Figure 1-5. When you are checking the scene, look for people with obvious life-
threatening conditions, such as severe bleeding. These people will need help as soon
as you determine the scene is safe to enter.

6 Copyright © 2021 American National Red Cross | First Aid for Severe Trauma
 Figure 1-6. When you are checking the scene, note other people who may be able
to help.

As part of checking the scene, obtain the person’s consent (permission) to help
(Box 1-2).

Box 1-2. Obtaining Consent

In an emergency, always get the person’s consent (permission) to help before

you touch the person. Obtain consent during the CHECK step, after you check
the scene for safety and before you check the person.

Obtaining consent is simple. Tell the person who you are, the type and level of
training that you have (such as training in first aid for severe trauma) and what
you plan to do. Then help the person, unless the person says they do not want
your help. If the person says they do not want your help, do not touch the person,
but do call 9-1-1 and stay with the person until help arrives.

In some situations, consent is implied. This means that the law assumes the person
would give consent if they were able to. You have implied consent when:

■ The person is unresponsive or mentally altered (for example, the person is

confused or disoriented).
■ The person is a minor (a person younger than 18 years in most states) and
the person’s parent or guardian is not present.

Chapter 1 | You Can Save a Life 7

 CALL
Next, direct someone to call 9-1-1 and
grab equipment that will help you provide
care (such as a bleeding control kit, first You should always
aid kit and AED). Calling 9-1-1 will send call 9-1-1 for life-
professional responders on their way as threatening bleeding.
fast as possible (Figure 1-7). Box 1-3 lists
reasons to call 9-1-1.

If you are alone with an injured person with life-threatening bleeding and there
is no one you can ask to call 9-1-1 or get equipment, you must take steps to
control the bleeding first. You can call 9-1-1 using the speaker mode on a mobile
phone so that your hands are free to provide care (Figure 1-8). Or, if you are
alone and you don’t have a mobile phone, control the bleeding with whatever
you have available and then call 9-1-1.

You will learn more about calling 9-1-1 in Chapter 3.

Figure 1-7. Calling 9-1-1 Figure 1-8. If you are alone with a person with
gets professional help on the life-threatening bleeding and you have a mobile
way quickly. phone, call 9-1-1 using the speaker mode so
your hands are free to give care.

8 Copyright © 2021 American National Red Cross | First Aid for Severe Trauma
Box 1-3. When to Call 9-1-1

Call (or instruct someone to call) 9-1-1 for any of the following emergency
situations and conditions.

Emergency Situations
■ An injured or ill person who needs
medical attention and cannot
be moved
■ Fire or explosion
■ Downed electrical wires
■ Swiftly moving or rapidly rising
flood waters
■ Drowning
■ Poisonous gas
■ Spilled chemicals
■ Serious motor vehicle collision
■ Violent situations

Emergency Conditions
■ Life-threatening bleeding
■ Unresponsiveness or a change in level of consciousness (such as drowsiness
or confusion)
■ Breathing problems (trouble breathing or no breathing)
■ Chest pain, discomfort or pressure lasting more than a few minutes or that
spreads to the shoulder, arm, neck, jaw, stomach or back
■ Persistent stomach pain or pressure
■ Vomiting blood or passing blood
■ Severe (critical) burns
■ Suspected poison exposure or drug overdose
■ Seizures
■ Signs or symptoms of stroke (drooping of the face on one side; sudden
weakness on one side of the body; sudden slurred speech or difficulty
speaking; or a sudden, severe headache)
■ Suspected or obvious injuries to the head, neck, spine or pelvis
■ Suspected or obvious broken bone

Chapter 1 | You Can Save a Life 9

 CARE
Finally, care for the person. When there is life-threatening bleeding, you must
take immediate action to stop the flow of blood (Figure 1-9). You will learn how
to care for a person with life-threatening bleeding in Chapter 4.

Before giving care, take steps to lower the risk for infection, for both yourself
(Box 1-4) and the injured person. If time permits, wash your hands before you
give care and use latex-free disposable gloves. When more than one person
needs care, remove your gloves and replace them with a clean pair before
helping the next person. When a person has life-threatening bleeding, it is
important to act quickly to stop the flow of blood. If you have gloves, use them,
but do not wait until you have gloves to take action!

Figure 1-9. When there is life-threatening bleeding, you must take immediate action to
stop the flow of blood.

10 Copyright © 2021 American National Red Cross | First Aid for Severe Trauma
Box 1-4. Lowering Your Risk for Infection

Although you may be concerned

about touching another person’s
blood, it is extremely unlikely that
you will catch a disease this way,
especially if your skin is healthy and
intact (without cuts or scrapes)
and you avoid touching your eyes,
nose and mouth. You can reduce
your risk even more by using gloves
and washing your hands as soon as
possible after you give care.

■ If you have them, use latex-free disposable gloves.

– Gloves are usually included in bleeding control kits and first aid kits. You
can also carry a keychain kit that contains gloves with you so that you
always have a pair of gloves readily available.
– When a person has life-threatening bleeding, do not wait until gloves are
available to begin providing care.
■ When you are finished giving care, wash your hands with soap and warm
running water, even if you wore gloves. Wash for a minimum of 20 seconds
and make sure to cover all surfaces of both your hands: your wrists, the
palms and backs of your hands, in between your fingers and underneath your
fingernails. If soap and water are not available, use an alcohol-based hand
sanitizer instead, and then wash your hands with soap and water as soon
as possible.

When caring for a person with life-threatening bleeding, using gloves is best.
However, often no gloves are available, and when bleeding is life-threatening,
you must act quickly to control the bleeding. If you do not have gloves, wash
your hands as soon as possible after giving care, and avoid touching your eyes,
nose and mouth. Your risk of getting a serious disease from being exposed
to another person’s blood while giving first aid care is very low (Source:
CDC, https://www.cdc.gov/hai/pdfs/bbp/exp_to_blood.pdf). Still, if you are
exposed to another person’s blood while giving care, you should contact your
healthcare provider.

Chapter 1 | You Can Save a Life 11

 Deciding to Act in
an Emergency
In an emergency that involves life-threatening bleeding, your decision to act could
make the difference between life and death for the person who needs help. There
may be a crowd of people at the scene of the emergency, but it is possible that no
one is helping. If no one is giving care or directing the actions of others, you can
take the lead. If someone else is already giving care, confirm that 9-1-1 has been
called and that the person giving care knows how to apply direct pressure and a
tourniquet, if applicable. If the person giving care has not been trained in these
skills, you should take over care. Otherwise, ask how you can help.

You might worry that you will make a mistake or cause the person more harm,
or that you won’t be able to handle the sight of blood or a traumatic injury.
These are normal concerns, but know that by completing the First Aid for
Severe Trauma training, you have the knowledge and skills you need to respond
appropriately in an emergency that involves life-threatening bleeding. If you are
ever unsure about what to do, call 9-1-1 and follow the emergency dispatcher’s
instructions. It is also important to know that laws are in place to help protect
people who take action in an emergency (Box 1-5).

■ When there is life-threatening bleeding, first aid care provided by members

of the community may make the difference between life and death for the
injured person.
■ To decide if bleeding is life-threatening, look at the amount of blood (volume)
and the way the blood is moving (flow). If the amount of blood lost could fill a
soda can halfway, or if the blood is flowing continuously or spurting, then the
bleeding is life-threatening.
■ In any emergency, remember the three action steps: CHECK–CALL–CARE.
Check the scene for safety, then check the person for life-threatening conditions.
Call 9-1-1 and get equipment. Then give care.
■ When there is life-threatening bleeding, you must take action to control the
bleeding as quickly as possible.

12 Copyright © 2021 American National Red Cross | First Aid for Severe Trauma
Box 1-5. Good Samaritan Laws

Good Samaritan laws were developed to encourage people to help others in

emergency situations. They assume that a person who steps in to help in an
emergency will:

■ Do their best to save a life or prevent further injury.

■ Use common sense.
■ Provide care with a reasonable amount of skill.
■ Provide only care that they have been trained to give.

Good Samaritan laws usually protect a person who acts the way a “reasonable
and prudent” person would act if that person were in the same situation. For
example, a reasonable and prudent person would:

■ Move a person only if the person’s life is in danger.

■ Obtain consent from the person (or from the person’s parent or guardian if
the person is a minor) before giving care.
■ Check the person for life-threatening conditions before giving care.
■ Call (or tell someone to call) 9-1-1.
■ Continue to give care until more highly trained responders take over.

For more information about your state’s Good Samaritan laws, contact a lawyer.

Chapter 1 | You Can Save a Life 13

CHAPTER 2

Safety in
Emergency
Situations
In any emergency situation, your own safety is a primary concern. In this
chapter, we’ll review how to ensure your own safety, as well as the safety
of others who are present, when responding to an emergency situation.

Chapter 2 | Safety in Emergency Situations 15

 Keeping Yourself Safe
in an Emergency
Before helping in an emergency, take a moment to check for potential safety
hazards (Figure 2-1). If you become injured or ill while trying to help, you will be
unable to help others, and you will have increased the number of people in need of
help. In Chapter 1, you learned about checking the scene for safety. Before going
to help an injured person, scan the entire area for safety hazards. Look up, down
and all around. Think of
this as doing a 360-degree
check. Remember that your
senses of smell and hearing
may also alert you to
potential dangers (Box 2-1).
If you decide that the scene
is safe, stay and help, but
remain alert and aware of
your surroundings at all
times. A scene may become
unsafe at any time. If you
decide that the scene is not Figure 2-1. Don’t put yourself in danger while trying to
safe, stay a safe distance help others. Take a moment to check for safety hazards
away and call 9-1-1. before deciding on your next steps. iStock.com/photovs

Box 2-1. Signs of Safety Hazards

Unusual Sights
■ Broken glass
■ Flames, sparks or smoke
■ Downed wires
■ Collapsed structures
■ Leaking or spilled fluids

Unusual Sounds Unusual Smells

■ Ringing alarms ■ A foul odor
■ Glass breaking ■ An unrecognizable odor
■ Loud or muffled popping ■ A chemical odor
or banging ■ An acrid or “burning” smell
■ Hissing or crackling ■ The smell of gas or propane

16 Copyright © 2021 American National Red Cross | First Aid for Severe Trauma
Helping Others to Safety
In general, you should not move an injured person. Unnecessary movement
can cause additional injury and pain and might complicate the person’s
recovery. However, under the following three conditions it may be appropriate
to move an injured person:

■ You must move the person to protect them from immediate danger (such
as fire, flooding or poisonous gas). Only attempt this if you can reach the
person and remove them from the area without putting yourself in danger.
■ You must move the person to provide care for another person who is more
seriously injured.
■ You must move the person to give proper care.

If you must move a person in an emergency situation, do so as quickly

and carefully as possible. (Figure 2-2).

Figure 2-2. The “clothes drag” technique can be used if you have to move a person to
safety. Grab the person’s shirt behind the neck, gathering enough material so that you
have a firm grip. Cradle the person’s head with the shirt and your hands, and pull the
person to safety.

Chapter 2 | Safety in Emergency Situations 17

 Violent Situations
In a violent situation, such as an active shooter situation, always follow the
instructions given by police or medical personnel who have arrived on the scene.
If you are not sure what to do, think RUN–HIDE–FIGHT.

RUN
Your first option, if you have a clear escape route, is to run. Run away from the
sounds of gunfire or other danger. Leave your belongings behind. Help move
others to safety if possible, but do not try to move injured people. After you are
safe, call 9-1-1.

HIDE
If you cannot run, hide. Choose a hiding place with few windows, if possible.
Cover any windows to make it more difficult for the attacker to see you. Block
the entry to your hiding place and lock the door. Silence all electronic devices
and stay quiet.

FIGHT
If your life is in immediate danger and you have no other options, fight. Have a
plan for disabling the attacker. If possible, work as a team with others. Use heavy
items that are available to you (such as a fire extinguisher or chair) to strike the
attacker in sensitive areas, such as the head, neck, groin or knees.

■ In an emergency situation, your first priority is your own safety. Before rushing
to help, do a 360-degree check for safety hazards. Look up, down and all
around. Pay attention to any sounds or smells that could be signs of danger.
If you decide the situation is unsafe, stay a safe distance away and call 9-1-1.
■ Try to avoid moving an injured person. If you must move a person, do so as
safely as possible. You don’t want to injure yourself or cause further injury to
the person.
■ In a violent situation, think RUN–HIDE–FIGHT. Remember to always
follow the instructions of any professional responders who have arrived on
the scene.

18 Copyright © 2021 American National Red Cross | First Aid for Severe Trauma
CHAPTER 3

Communicating
in Emergency
Situations
In an emergency situation, every second
counts. Communicating effectively with
other people at the scene and with In an emergency situation,
the emergency dispatcher prevents communicating effectively
misunderstandings that can cause can be lifesaving.
delays in care. In this chapter, we’ll
review the basics of communicating
in an emergency situation.

Chapter 3 | Communicating in Emergency Situations 19

 Communication Basics
Communication, or the process of giving and receiving information, involves a
sender and a receiver. The people communicating with each other switch roles,
sending and receiving messages back and forth.

In an emergency situation, it is often necessary to communicate with others.

The person leading the response may ask another person at the scene to
perform a task, such as getting the bleeding control kit or calling 9-1-1.
The emergency dispatcher may provide instructions about what to do next
or how to provide care. In situations like these, when the purpose of the
communication is to make a request or give instructions, using a technique
called closed-loop communication helps to ensure clear communication
and prevent misunderstandings.

In closed-loop communication, the sender starts by sending a clear message.

After receiving the sender’s message, the receiver delivers their own message,
called feedback. The sender then confirms the receiver’s understanding or
provides clarification as needed to “close the loop” (Figure 3-1). Providing
feedback is very important because it lets the sender know that their message
was received and understood.

To be a good communicator, you must be able to express yourself clearly in a

way the other person can easily understand. You must also be able to receive
information from the other person, which requires good listening skills. Strategies
for effective communication include the following.

■ Make sure your message is clear. Speak clearly in a calm tone of voice.
Speak loudly enough to be heard. Use short sentences.
■ Use body language. Use actions to make your communication stronger
(such as making eye contact with the person you are speaking to or pointing
to a person to make it clear that you are addressing them).
■ Be a good listener. Focus on what the person is saying to you. If anything
is unclear or you don’t understand, tell the person.
■ Get and provide feedback. When you are the sender, wait for feedback
from the receiver. If the receiver does not provide feedback, get it before
continuing. When you are the receiver, confirm that you have received the
sender’s message by repeating, in your own words, what the sender said.

20 Copyright © 2021 American National Red Cross | First Aid for Severe Trauma
 Message

Feedback

Sender
2 1 3

Feedback

Receiver
Figure 3-1. The sender starts by sending a clear message. The receiver
provides feedback. The sender then provides their own feedback by
confirming the receiver’s understanding or providing clarification as needed
to “close the loop.”

Chapter 3 | Communicating in Emergency Situations 21

 Communicating with
Others at the Scene
At the scene of an emergency, there may be multiple injured people,
multiple responders and many things happening at once. Clear, closed-loop
communication can help to limit confusion and save time by preventing
misunderstandings (Figure 3-2).

When you are asking someone to do something for you at the scene of an
emergency, clearly identify the person you want to complete the task. If you
know the person’s name, use it. If you do not know the person’s name, identify
the person in some other way. For example, you could say, “You, in the blue shirt,
go get the bleeding control kit. It’s on the wall by the main office.” In addition to
using words, use gestures. Make eye contact and point to the person to make
it very clear who you are speaking to (Figure 3-3). Then look and listen for
feedback from the person to ensure that your request was heard, understood
and will be acted on. After the person provides feedback, confirm their
understanding or provide clarification as needed.

Figure 3-2. During an emergency, many things may be happening at once. Good
communication helps to minimize confusion and promotes efficiency.

22 Copyright © 2021 American National Red Cross | First Aid for Severe Trauma
Figure 3-3. At the scene of an emergency, avoid making general requests. Make it
clear who you are speaking to and what you want the person to do.

When someone asks you to do something for them at the scene of an

emergency, provide feedback by repeating what the person asked you to do
in your own words (Figure 3-4). For example, if someone asks you to get the
bleeding control kit, you could say, “I’m
leaving to get the bleeding control
kit from the wall by the main office.”
This lets the person know that you
heard their request correctly, that you
understood their request, and that you
are going to act on their request. If
you are unsure of what the person is
telling you or asking you to do, ask the
person to repeat themselves or explain
further. For example, you could say,
“What did you want me to get?” This
way, the person can clarify as needed.
When you finish a task, let the person
know. For example, when you return
with the bleeding control kit, tell the
person, “Here is the bleeding control
kit you asked for.” Then look and Figure 3-4. Providing feedback is
listen for feedback from the person to important because it lets the sender know
ensure that they got your message. their message was received.

Chapter 3 | Communicating in Emergency Situations 23

 Communicating with the
Emergency Dispatcher
When calling 9-1-1, try to stay calm. Dispatchers are highly trained and will
direct the conversation (Figure 3-5). Listen carefully to the dispatcher, answer
the dispatcher’s questions to the best of your ability and stay on the phone
until the dispatcher ends the call. Many dispatchers are trained to give first aid
instructions over the phone, which can be helpful if the person giving care needs
to be reminded of the proper care steps or is unsure of what to do. If you are not
the person giving care and you are calling from a mobile phone, the dispatcher
may ask you to put the phone on speaker mode and bring it to the injured
person’s side. Follow any instructions that the dispatcher may give you.

Figure 3-5. The emergency dispatcher will direct the call. Answer the dispatcher’s
questions to the best of your ability and follow any instructions the dispatcher may give
you. Do not end the phone call until the dispatcher tells you it is OK to hang up.

24 Copyright © 2021 American National Red Cross | First Aid for Severe Trauma
Be ready to give the dispatcher essential information that will allow the
dispatcher to get the right people to the scene to help quickly. Be prepared to tell
the dispatcher:
■ The location of the emergency (the address, or nearby intersections or
landmarks if you do not know the address). Give details such as where the
nearest entrance is located, what floor you are on, or what room or part of
the building you are in (Figure 3-6). Let the dispatcher know if there are any
special considerations related to gaining access to the building or property.
For example, are there gates or doors that need to be unlocked? Are there
animals that could present a hazard to responders?
■ The type of emergency (for example, whether police, fire or medical
assistance is needed).
■ The telephone number of the phone you are calling from.
■ A description of what happened.
■ The number of injured or ill people.
■ What help, if any, has been given so far, and by whom.
■ Whether the person giving care needs instructions for providing first aid.

Figure 3-6. When calling 9-1-1, be prepared to answer the

dispatcher’s questions, including the location of the emergency.

Chapter 3 | Communicating in Emergency Situations 25

 ■ In an emergency, use closed-loop communication skills to limit confusion
and ensure that the injured person receives help quickly.
■ When calling 9-1-1, be prepared to provide information that will help the
dispatcher get the right people to the scene quickly. Answer the dispatcher’s
questions to the best of your ability and follow any instructions the dispatcher
may give you. Stay on the phone until the dispatcher tells you it is OK to
hang up.
■ Dispatchers are often trained to give first aid instructions over the phone.

26 Copyright © 2021 American National Red Cross | First Aid for Severe Trauma
CHAPTER 4

Caring for a
Person with
Life-Threatening
Bleeding
When a person has life-threatening bleeding,
you must control the bleeding as quickly as
possible to save the person’s life. In this chapter, Pressure stops
you’ll learn how to provide first aid care for a bleeding.
person with life-threatening bleeding.

Chapter 4 | Caring for a Person with Life-Threatening Bleeding 27

 Using Pressure to
Stop Bleeding
Firm, continuous pressure is the key to controlling bleeding (Box 4-1).
Depending on the situation and the location of the wound, you may use direct
pressure, a tourniquet (a device placed around an arm or leg to apply pressure
to the blood vessels and stop blood flow to a wound), or both to control life-
threatening bleeding (Figure 4-1).

Box 4-1. How Does Pressure Control Bleeding?

When you apply pressure

to control life-threatening
bleeding, you are squeezing
the blood vessels so that
they collapse, which will slow
or stop the bleeding. With
direct pressure, you collapse
the vessels at the site of the
wound, and with a tourniquet,
you collapse the vessels that
lead to the wound.

Because the vessels can be

located deep in the body,
it takes a lot of pressure
to stop life-threatening
bleeding. To get an idea of how much pressure is needed, think about having
your blood pressure taken. To measure your blood pressure, the healthcare
provider puts a cuff around your arm and pumps it up. As the cuff fills with air, it
puts pressure on your arm, stopping the normal flow of blood. If you have ever
had your blood pressure taken, you know that the amount of pressure the inflated
cuff applies to your arm can be uncomfortable. It’s a lot of pressure! When you
are using pressure to control life-threatening bleeding in an emergency situation,
you need to apply at least as much pressure as a blood pressure cuff, if not
more. That’s why you need to push as hard as you can when you are applying
direct pressure, and why you need to tighten the tourniquet as much as you can
when you are using a tourniquet.

28 Copyright © 2021 American National Red Cross | First Aid for Severe Trauma
 Stop Life-Threatening Bleeding
No • Stay a safe distance away.
Is the scene safe?
• Call 9-1-1.
Yes
CHECK
Is there life-threatening No • Give care according to the
bleeding? conditions that you find
and your level of training.
Yes

• Call 9-1-1 using speaker mode

Is there another person
No on a mobile phone while taking
CALL available to call 9-1-1
steps to control the bleeding.
and get equipment?
• Control the bleeding with
whatever you have available.
Yes

• Direct someone to call 9-1-1

and get equipment.

CARE Where is the wound?

Head
Neck

Trunk
Arm

Leg

• Apply direct pressure (use a • Apply direct pressure (use a

hemostatic dressing if available). hemostatic dressing if available).
• Use a tourniquet as soon as
one is available.

Figure 4-1. The approach you use to stop life-threatening bleeding depends on the
situation and the location of the wound.

Chapter 4 | Caring for a Person with Life-Threatening Bleeding 29

 Applying Direct Pressure
Applying steady pressure directly over a wound is one way to stop bleeding. If
you have ever held a piece of gauze, tissue or cloth over a small cut or minor
wound and applied pressure until the bleeding stopped, then you have used
direct pressure to stop bleeding. The idea is the same when you are using
direct pressure to stop life-threatening bleeding—you just may have to apply
more pressure and hold it for a longer period of time.

When bleeding is life-threatening and the wound is on the head, neck or trunk,
you should use direct pressure to stop the bleeding (Figure 4-2A). You should
also use direct pressure to stop life-threatening bleeding from an arm or a
leg until a tourniquet can be applied, or if no tourniquet is available (Figure
4-2B). When you are using direct pressure to control life-threatening bleeding,
remember two key things:
■ Press as hard as you can, directly on the wound.
■ Hold the pressure until the bleeding stops. This may take at least 5 minutes
and could take much longer.

A B A B

A B

Figure 4-2. (A) Use direct pressure when there is life-threatening bleeding from a
wound on the head, neck or trunk. (B) You should also use direct pressure until you
can apply a tourniquet (or if no tourniquet is available) when there is life-threatening
bleeding from a wound on an arm or a leg.

30 Copyright © 2021 American National Red Cross | First Aid for Severe Trauma
To apply direct pressure, put on gloves if you have them. Then place a dressing
on the wound. A dressing is a pad that absorbs blood and promotes clotting.
Bleeding control kits and first aid kits often contain a special type of dressing
called a hemostatic dressing (Figure 4-3). A hemostatic dressing contains
a substance that helps stop bleeding faster (“hemo” = blood; “static” = stop).
When the bleeding is life-threatening, use a hemostatic dressing if you have
one. Otherwise, use gauze. If you don’t have gauze, you can use another piece of
material (such as a clean T-shirt) as a dressing. If there is no material available to
use as a dressing, just apply direct pressure without a dressing.

The dressing is most effective when there is good contact between the dressing
and the bleeding surfaces of the wound, so press the dressing against the
bleeding surfaces of the wound as
you place it on the wound. Then
put one hand on top of the other
on top of the wound. Position your
shoulders over your hands and lock
your elbows. Then push down as
hard as you can to apply pressure
directly over the wound until the
bleeding stops (Figure 4-4). If you
need your hands, use your knee to
keep applying direct pressure. Keep
in mind that a hard, flat surface
underneath the part of the body
where you are applying pressure
makes applying direct pressure
more effective.

Figure 4-4. When applying direct pressure,

position your shoulders directly over your
hands and lock your elbows. Use both
hands and push down as hard as you
can. If possible, position the injured body
Figure 4-3. Hemostatic dressings are part on a flat, hard surface so that when
treated with a substance that helps you apply pressure, you are pressing
stop bleeding faster. against something.

Chapter 4 | Caring for a Person with Life-Threatening Bleeding 31

 You need to use a lot of pressure for the bleeding to stop. The amount of
pressure that you must apply is likely to be uncomfortable for the person. Tell
the person to expect pain, and explain that you have to press hard to control the
bleeding. Do not release the pressure. Keep applying pressure until the bleeding
stops, a tourniquet is applied (for life-threatening bleeding from an arm or a
leg), someone else takes over for you, you are too exhausted to continue or the
situation becomes unsafe.

See Skill Sheet 4-1 at the end of this chapter for step-by-step instructions for
applying direct pressure.

Using a Tourniquet
Only use a tourniquet for life-threatening bleeding from an arm or a leg
(Figure 4-5). Never use a tourniquet for non-life-threatening bleeding or for
bleeding from a wound on the head, neck or trunk.

Use a tourniquet as soon as you recognize life-threatening bleeding from an

arm or a leg and a tourniquet is available. Continue to apply direct pressure until
the tourniquet is in place and the bleeding has stopped (Figure 4-6). Applying a
tourniquet can be painful for the person, so warn the person ahead of time and
explain that you need to tighten the tourniquet as much as possible in order to
stop the bleeding.

Figure 4-5. Only use a tourniquet for life-threatening bleeding

from an arm or a leg.

32 Copyright © 2021 American National Red Cross | First Aid for Severe Trauma
 Figure 4-6. Continue to apply direct pressure until the tourniquet is on and
the bleeding has stopped.

Once you have applied a tourniquet, do not loosen or remove it. Only a trained
medical professional should loosen or remove a tourniquet. If you have tightened
the tourniquet as much as you can but the bleeding still has not stopped, you can
apply a second tourniquet above the first, closer to the heart (Figure 4-7).

1
2

Figure 4-7. If necessary, apply a second tourniquet above the first.

Chapter 4 | Caring for a Person with Life-Threatening Bleeding 33

 Windlass rod tourniquets
One common type of tourniquet is called a windlass rod tourniquet (Figure 4-8).
To use a windlass rod tourniquet, place the tourniquet around the arm or leg at
least 2 to 3 inches above the wound, between the wound and the heart. Do not
place the tourniquet directly on top of the wound or a joint. Attach the buckle or
pass the end of the strap through the buckle. Then, think PULL–TWIST–CLIP
(Figure 4-9).

Buckle
Rod

Clip

Strap

Rod Buckle

Clip

Strap

Figure 4-8. Windlass rod tourniquets have four main parts: a strap,
a buckle, a rod and a clip. Examples of windlass rod tourniquets
include (A) a SOF Tactical Wide windlass rod tourniquet and
(B) a CAT windlass rod tourniquet.

34 Copyright © 2021 American National Red Cross | First Aid for Severe Trauma
 Figure 4-9. To secure a
windlass rod tourniquet,
think PULL–TWIST–CLIP.

■ PULL the free end of the strap until the tourniquet is as tight as possible
around the arm or leg. If the strap has a hook-and-loop fastener, securely
fasten the strap back onto itself after you have pulled the tourniquet as tight
as possible around the arm or leg.
■ TWIST the rod. This is likely to be uncomfortable for the person, but keep
twisting until the bleeding stops or until you cannot twist the rod anymore,
even if the person complains of pain.
■ CLIP the rod in place to prevent the rod from untwisting and to keep the
tourniquet tight.

See Skill Sheet 4-2 at the end of this chapter for step-by-step instructions for using
a windlass rod tourniquet.

Chapter 4 | Caring for a Person with Life-Threatening Bleeding 35

 Ratcheting tourniquets
Position a ratcheting tourniquet the same way you would position a windlass rod
tourniquet, and pull the strap to tighten the tourniquet around the arm or leg.
To finish tightening a ratcheting tourniquet, lift up on the buckle to operate the
ratchet and tighten the tourniquet (Figure 4-10). You will hear a clicking sound as
you lift up on the buckle. Keep lifting up on the buckle until the bleeding stops or
until you cannot lift the buckle anymore. Ratcheting tourniquets are self-securing.

See Skill Sheet 4-3 at the end of this chapter for step-by-step instructions for
using a ratcheting tourniquet.

Other types of tourniquets

Follow the manufacturer’s instructions for applying the tourniquet that you have.
Although tourniquets may have slightly different designs, all are used in generally
the same way:
1. Position the tourniquet snugly around the arm or leg at least 2 to 3 inches
above the wound, between the wound and the heart.
2. Tighten the tourniquet until the bleeding stops.
3. Secure the tourniquet so that it stays tight.

Loop

Ratchet

Strap

Figure 4-10. A ratcheting tourniquet has a ratchet instead of a rod.

36 Copyright © 2021 American National Red Cross | First Aid for Severe Trauma
After the Bleeding Stops
After you have stopped the bleeding, make sure the person is in a position of
comfort. This is a position that allows the person to breathe most easily and
remain comfortable and minimizes the person’s risk for a blocked airway.

A person who is awake and alert will often get into a position of comfort on their
own. For example, many people who feel short of breath find that leaning forward
with their hands on their knees makes it easier to breathe. After stopping the
bleeding, let an injured person who is awake and alert position themselves
(Figure 4-11). Do not force the person to lie down.

If the person is unresponsive but breathing or responsive but not fully awake, put
the person into a recovery position onto their side after you have stopped the
bleeding (Box 4-2). The recovery position helps to keep the person’s airway open.
You should also use the recovery position if the person begins to vomit. If you think
the person might have a head, neck, spinal or pelvic injury, leave the person in the
position that you found them in.

Figure 4-11. After you have stopped the bleeding, let a person who is awake and alert
position themselves the way they are most comfortable. Do not force the person to
lie down.

Chapter 4 | Caring for a Person with Life-Threatening Bleeding 37

 Box 4-2. Recovery Position

To place a person in the recovery position:

■ Extend the person’s arm that is closest to you above the person’s head.

■ Roll the person toward you onto their side, so that the person’s head rests
on their extended arm.

■ Bend both of the person’s knees to stabilize the person’s body.

After placing the person in the recovery position, check to make sure any
tourniquets that have been applied are still in place and tight and that the
bleeding has not restarted. Remember the person may have bleeding from more
than one wound.

38 Copyright © 2021 American National Red Cross | First Aid for Severe Trauma
After you have provided care for a person with life-threatening bleeding, maintain
the person’s body temperature. You may need to cover the person with extra
clothing or a blanket to prevent the loss of body heat (Figure 4-12).

Figure 4-12. After you have stopped life-threatening bleeding, cover the person if
needed to help keep them warm.

■ Firm, continuous pressure stops bleeding. You can apply pressure using your
hands, a tourniquet, or both.
■ When using direct pressure to control life-threatening bleeding, press as
hard as you can, directly on the wound, until the bleeding stops. This may
take at least 5 minutes but could take much longer.
■ When using a windlass rod tourniquet to control life-threatening bleeding,
position the tourniquet at least 2 to 3 inches above the wound on the side
closest to the heart and think PULL–TWIST–CLIP. Keep twisting the rod
until the bleeding stops or until you cannot twist the rod anymore.
■ Only use a tourniquet for life-threatening bleeding from an arm or a leg.
■ After controlling the bleeding, ensure that the person is in a position of
comfort, and cover the person as needed to help keep them warm.

Chapter 4 | Caring for a Person with Life-Threatening Bleeding 39

 Skill Sheet 4-1. Applying Direct Pressure

1. Put on gloves, if you have them. 6. Apply steady, firm pressure

■ If the bleeding is life-threatening, directly over the wound until the
do not wait until you have gloves to bleeding stops.
provide care. ■ Put one hand on top of the dressing
and put your other hand on top.
2. Find the source of the bleeding. ■ Position your shoulders over your
■ There may be one wound or more hands and lock your elbows.
than one wound. ■ Push down as hard as you can.
■ Care for life-threatening bleeding ■ If you need your hands, use your
first. knee to apply pressure.
■ Remember that direct pressure is
3. Tell the person to expect pain. most effective when the injured
■ The amount of pressure you need body part is on a firm, flat surface.
to apply may be painful for the
person, but it is necessary to
control the bleeding.

4. Choose a dressing.
■ If the bleeding is life-threatening,
use a hemostatic dressing if you
have one.
■ Otherwise, use a gauze pad or
other available material (such as
a clean T-shirt) as a dressing.

5. Place the dressing on the wound.

■ Ensure good contact with the
bleeding surfaces of the wound.

7. Hold direct pressure until:

■ A tourniquet is applied (for life-
threatening bleeding from an arm or
leg) and the bleeding has stopped.
■ Another person relieves you.
■ The bleeding stops.
■ You are too exhausted to continue.
■ The situation becomes unsafe.

40 Copyright © 2021 American National Red Cross | First Aid for Severe Trauma
Skill Sheet 4-2. Using a Windlass Rod Tourniquet

1. Put on gloves, if you have them. 6. PULL.

■ If the bleeding is life-threatening, ■ Pull the free end of the strap
do not wait until you have gloves to until the tourniquet is as tight as
provide care. possible around the arm or leg.
■ If the strap has a hook-and-loop
2. Find the source of the bleeding. fastener, securely fasten the strap
■ There may be one wound or more back onto itself after you have
than one wound. pulled the tourniquet as tight as
■ Use a tourniquet for life-threatening possible around the arm or leg.
bleeding on an arm or a leg.

3. Tell the person to expect pain.

■ Tightening the tourniquet may be
painful for the person, but it is
necessary to control the bleeding.
7. TWIST.
4. Position the tourniquet. ■ Twist the rod until the bleeding stops
■ Place the tourniquet at least 2 or until you cannot twist it anymore.
to 3 inches above the wound,
between the wound and the heart.
■ Do not place the tourniquet on top
of the wound or a joint.

8. CLIP.
■ Clip the rod in place to prevent the
rod from untwisting and to keep the
tourniquet tight.

5. Buckle the tourniquet.

■ Attach the buckle or pass the end
of the strap through the buckle.

Chapter 4 | Caring for a Person with Life-Threatening Bleeding 41

 Skill Sheet 4-3. Using a Ratcheting Tourniquet

1. Put on gloves, if you have them. 5. PULL.

■ If the bleeding is life-threatening, ■ While holding the loop, pull tightly
do not wait until you have gloves to on the strap until the tourniquet is
provide care. as tight as possible around the arm
or leg.
2. Find the source of the bleeding.
■ There may be one wound or more
than one wound.
■ Use a tourniquet for life-threatening
bleeding on an arm or a leg.

3. Tell the person to expect pain.

■ Tightening the tourniquet may be
painful for the person, but it is 6. LIFT.
necessary to control the bleeding. ■ Lift up on the buckle to operate the
ratchet and tighten the tourniquet.
4. Position the tourniquet. ■ You will hear a clicking sound as
■ Place the tourniquet at least 2 you lift up on the buckle.
to 3 inches above the wound, ■ Keep lifting up on the buckle until
between the wound and the heart. the bleeding stops or until you
■ Do not place the tourniquet on top cannot lift it up anymore.
of the wound or a joint.

42 Copyright © 2021 American National Red Cross | First Aid for Severe Trauma
Glossary
360-degree check: a technique for checking an emergency scene for safety;
look up, down and all around for safety hazards
Bleeding control kit: a response kit that contains equipment used to control
life-threatening bleeding, such as hemostatic dressings and tourniquets
Closed-loop communication: a communication technique used to ensure
clear communication and prevent misunderstandings; the receiver confirms that
the message is received and understood
Consent: permission to give care
Direct pressure: a technique used to control bleeding that involves pushing
firmly on the wound until the bleeding stops
Dressing: a pad that is placed on or in a wound to absorb blood and other fluids
and promote clotting
External bleeding: bleeding that is visible on the outside of the body
Feedback: in closed-loop communication, confirmation by the receiver that the
message is received and understood
Flow: a way to recognize life-threatening bleeding; the movement of blood
Good Samaritan laws: laws that protect people against claims of negligence
when they give emergency care in good faith without accepting anything in
return
Hemostatic dressing: a dressing that contains a substance that speeds clot
formation, helping to stop bleeding faster
Implied consent: permission to give care that is not expressly granted by
the person but is assumed because circumstances exist that would lead a
reasonable person to believe that the person (or the person’s parent or guardian)
would give consent if they were able to
Internal bleeding: bleeding that occurs inside the body
Life-threatening bleeding: severe bleeding in terms of the amount of blood
lost (enough to fill a soda can halfway), the way the blood moves (flowing
continuously or spurting), or both; can lead to death in a matter of minutes

Glossary 43
 Message: in closed-loop communication, the content of the communication
Position of comfort: a position that allows the person to breathe most easily
and remain comfortable and minimizes the person’s risk for a blocked airway
Receiver: in closed-loop communication, the person for whom the message is
intended
Recovery position: a side-lying position that is used to keep a person’s airway
open and decrease the risk for choking
Sender: in closed-loop communication, the person initiating the communication
Tourniquet: a device placed around an arm or leg to apply pressure to the
blood vessels and stop blood flow to a wound
Volume: a way to recognize life-threatening bleeding; the amount of
blood present

44 Glossary
Index
Note: Locators followed by b indicate boxes, f indicate figures.

9-1-1 CAT windlass rod tourniquet, 34f

calling, 2, 5, 8, 9b check the scene, 5–7, 5f, 6f, 7f, 16, 16f,
communicating with dispatcher, 20, 18
24–26 closed-loop communication, 20, 21f, 26,
when to call, 9b 43
360-degree check, 5, 43 “clothes drag” technique, 17f
communication
active shooter situations, 18 basics, 20, 21f
American Red Cross bleeding control kit, closed-loop, 20, 21f, 26, 43
3, 3b with emergency dispatchers, 20,
American Red Cross First Aid app, 3 24–26, 24f, 25f
in emergency situations, 19–26
bleeding at scene, 22–23, 22f, 23f
See also life-threatening bleeding strategies for effective, 20
after stopping of, 37–39, 38b consent
applying direct pressure to stop, defined, 43
30–32, 30f, 31f, 40 implied, 7b, 43
external, 43 obtaining, 7, 7b
internal, 43
using pressure to stop, 28, 28b, 29f, 39 direct pressure, 4, 12, 29f, 39
using tourniquets to stop, 32–36, 32f, applying, 30–32, 30f, 31f, 40
33f, 39 control of bleeding by, 28
bleeding control kit, 3, 3b, 3f, 43 defined, 43
bleeding emergencies dressing, 31, 31f, 43
deciding to act in, 12, 13b
preparing for, 2–3 emergencies
providing care in, 27–42 See also bleeding emergencies
recognizing, 4, 4f calling 9-1-1 in, 2, 5, 8, 9b
steps to take in, 5–11 communicating in, 19–26
when bleeding stops, 37–39, 38b deciding to act in, 12, 13b
blood, risks of exposure to, 11b safety in, 15–18
blood flow, 4, 4f, 12, 43 who to call in, 2
blood loss, 1 emergency action steps, 5–11, 12, 29f
blood volume, 4, 4f, 12, 44 emergency dispatchers, communicating
body language, 20 with, 20, 24–26, 24f, 25f
body temperature, 39 external bleeding, 43

call 9-1-1. See 9-1-1 feedback, in communication, 20, 21f, 23,

care, during emergencies, 10 23f, 43

Index 45
 fight, in violent situations, 18 position of comfort, 37, 44
First Aid for Severe Trauma (FAST), 2, 12 preparation, for bleeding emergencies,
flow, of blood, 4, 4f, 12, 43 2–3
pressure
gauze dressing, 31 direct, applying, 30–32, 30f, 31f, 39, 40
gloves, 10, 11b using to stop bleeding, 28, 28b, 29f, 39
Good Samaritan laws, 13b, 43
ratcheting tourniquets, 36, 36f, 42
hand sanitizer, 11b receiver, in communication, 20, 21f, 44
hand washing, 11b recovery position, 37, 38b, 44
help run, to escape violent situations, 18
from others at scene, 6, 7f
providing during emergency, 12, 13b safety
hemostatic dressing, 31, 31f, 43 in emergency situations, 15–18
hide, in violent situations, 18 helping others to, 17
of responder, 16, 18
implied consent, 7b, 43 in violent situations, 18
infection, protection from, 10, 11b safety hazards
injured persons checking for, 5, 16, 16f, 18
checking for, 6 signs of, 16b
keeping warm, 39, 39f scene of emergency
moving/not moving, 17, 17f, 18 checking the, 5–7, 5f, 6f, 7f, 16, 16f, 18
obtaining consent from, 7, 7b communicating with others at, 22–23,
positioning after bleeding stops, 22f, 23f
37–39, 37f, 38b sender, in communication, 20, 21f, 44
providing care to, 10, 10f, 27–42 SOF Tactical Wide windlass rod tourniquet,
internal bleeding, 43 34f

life-threatening bleeding, 1, 2, 43 tourniquets, 4, 12, 28, 29f, 44

See also bleeding emergencies other types of, 36
applying direct pressure to stop, ratcheting, 36, 36f, 42
30–32, 30f, 31f using, 32–36, 32f, 33f, 39
caring for person with, 27–42 windlass rod, 34–35, 34f, 35f, 39, 41
checking for, 6, 12 traumatic injuries, as leading cause of
providing care for, 10, 10f death, 1
using pressure to stop, 28, 28b, 29f, 39
using tourniquets to stop, 32–36, 32f, violent situations, 18
33f volume, of blood, 4, 4f, 12, 44
listening skills, 20
windlass rod tourniquets, 34–35, 34f, 35f,
message, in communication, 20, 21f, 44 39, 41

46 Index
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