Time is of the essence when a deep wound is bleeding profusely.  Call or send for help immediately, or come up with a plan to reach medical personnel if you are somewhere remote.  Stabilize the injured person as much as possible before you consider leaving him if it is just the two of you.  Delegate duties if several people are present.  Let someone call or go for help if there is another who can help with the pressure dressing. If the person is conscious, ask for his consent to treat the wound before you touch it. Cut, tear, push, and/or lift any clothing away from the wound.  If clothing is stuck to the wound, leave that portion in place and work around it.  Do not try to wash the wound.  Resist the impulse to remove any impaled objects from the wound.  If you have access to a sterile saline solution, you can add some of this to keep the wound moist and to lift away clothing gently. Help the wound to coagulate.  Ripping off the portion of clothing stuck to the wound may disturb blood clots and cause more bleeding.  Do not remove objects because they may be having a tamponade or compression effect within the wound.  Injured blood vessels, arteries, or veins can clot faster when any type of pressure is applied.  Removing an object from the wound may lead to more rapid hemorrhage or blood loss.  If an impaled object is involved, take a triangular bandage and roll it into a cord. Wrap this cord around the object to keep it from moving. Try not to jostle the object as you do this. You can also use rolled up gauze on either side of the object as well. Tape the support dressing in place. In a pinch, use clothing or other materials that are as clean as you can find. It is important that the impaled object move as little as possible, so that it does not cause tissue/blood vessel damage or initiate new bleeding. Leave washing the wound to medical personnel.  The gentlest cleansing could dislodge blood clots. Treat serious and deep wounds differently from everyday superficial wounds.  Do not manipulate the wound more than necessary.  It is okay to protect the wound from further contamination if the area around the victim is dirty or filled with chemicals. Find the cleanest cloth available if you do not have a first-aid kit.  Stabilize any impaled objects sticking out the wound with some of the bandage/cloth before you cover the wound.  Secure the dressing in place.  If no impaled object is involved, make a dressing of sterile, nonstick gauze or the cleanest, most absorptive cloth available. Fold it into a dressing about 1 inch thick and apply it to wound. Then, take a triangular bandage (or other length of cloth about 3 feet long). Fold it into a ribbon the width of your palm, then wrap it around the limb. Secure it with a firm but easily adjustable knot. Do not place the knot on the wound, but to the outside of the limb. Make sure it has not turned blue or cool. This is a vital step if cloth has been tied around the limb.  Loosen the bandage slightly if you see signs of inadequate oxygen delivery to the limb or if you cannot find the pulse.  Check the pulse below the bandage.  Check on the inside of the wrist near the thumb or on top of the foot near the ankle. The limb should be elevated above the level of the injured person’s heart.  Do not elevate the limb before you splint any broken bones.   Elevate the leg by placing the foot or ankle on a pack, log, rock, or any other object; this works if the injured person is lying down or sitting.  Elevate the arm by placing the forearm on the chest if the injured person is lying on her back or by placing the wrist on top of the head if she is sitting.  Splint a limb by finding straight objects (branches, foam, or cardboard) and wrapping material (clothing or climbing web).  Use the wrapping material to first cover the objects that you will use as splints to avoid infection. Cut or rip sections so that you have at least three ties; use them to secure the objects on the limb to keep the fracture immobilized and to keep any injured joints straight.  Do not compromise the blood flow to the limb by wrapping it too tightly.  Do not apply these bandage ties on top of the wound or the break. Apply them above and below the injury site. Remember to check the hand/foot beneath the splint for adequate blood flow. Put direct pressure over the bandage with the hand.  Maintain this for five to 10 minutes.  Reassess for signs of uncontrolled hemorrhage like blood soaking the regular dressing or dripping from under the dressing. If direct pressure fails to stem bleeding and the wound still bleeds through a second layer of bandage, then it is time to apply a pressure bandage. Pressure bandages prevent prolonged and excessive blood loss, which can cause a drop in blood volume (a decrease in the amount of blood flowing in your vessels), decreased blood pressure, loss of consciousness, and death. Replace any blood volume losses and raise the victim’s blood pressure with liquids by mouth.  Only do this if he is fully awake and the wound has been stabilized. Use ripped or cut  garments like T-shirts, pants, or socks.  Place the pressure dressing on top of the regular dressing. Protect the wound and guard against making the bleeding worse.  If you need to remove the pressure dressing for any reason, the regular dressing will be in place to prevent disturbing any clot which has formed in the wound. Take a longer piece of cloth and wrap it firmly around the wadded bandages.  Tie the ends together.  Apply enough pressure to help gain hemostasis, but do not create a tight tourniquet-like effect.  One finger should be able to fit under the knot. After you apply the securing bandage, check the fingers or toes past the bandage to ensure that they are still pink and warm. If not, loosen the bandages and try again. Reassess the limb to make sure the bleeding has stopped.  Additional treatment may be indicated.  Look for signs of decreased circulation in the limb, as well.  There is a risk of tissue loss if a bandage impedes bloodflow for too long. Loosen the pressure bandage if the extremity becomes cool, blue, numb, or loses the pulse below the pressure dressing.  When there is inadequate oxygen delivery to the limb, tissue can begin to die off and the limb could be compromised to the point of requiring an amputation. Use the improvised bandages or bandages from a first-aid kit to apply manual pressure on the torso (chest and abdomen) and head in a very specific way.  Use extreme caution when applying compression to these areas.  Change your technique when applying a pressure dressing to the torso.  The first steps are the same.  Do not remove any objects from the wound.  Apply the regular dressing.  Tape this dressing, if you can.  But, do not secure the dressing by wrapping cloth around the injured person.  This could compromise the victim’s ability to breathe.  Wad the cloth or bandages over the regular dressing on the wound.  Apply enough manual pressure over the wad to stop the hemorrhage without interfering with the injured person’s breathing.  Maintain this compression for 15 minutes.  Continue the manual pressure if there are signs of continuing hemorrhage, such as a soaked dressing or blood dripping around the regular dressing.  You will have to continue this compression until medical personnel arrive or until the wound begins to clot. Do not apply any pressure to a head wound if the victim’s skull appears deformed.  Look for sunken areas, visible bone fragments, or exposed brain tissue.  Do not apply pressure to a wound which involves the eye or when an object in the wound clearly pierces the skull.  Cover the wound gently with bandages, have the person lie down, and get him medical attention as soon as possible.  Keep adding more bandages on top if the dressing gets soaked.  Assess the head wound and make sure pressure can be applied safely.  Establish which dressing will be considered the regular dressing, even if it is not secured, and do not remove it. Apply manual pressure on wadded cloth or bandages over the regular dressing for 15 minutes.  If the hemorrhage continues, reapply the manual pressure until medical personnel arrives. Wounds on the head bleed a lot because there are a lot of blood vessels close to the surface of the skin, so have plenty of extra dressings handy if you have them available.  Keep in mind that hair makes it hard to use tape and even long pieces of cloth wrapped around the head have a tendency to slip.  Do not waste time trying to secure a regular dressing. Never wrap anything around the neck. Use a tourniquet when no other technique (elevation, manual pressure, or a pressure dressing) has worked.  A tourniquet compresses arteries and veins very firmly.  There is very little blood flowing past the point of the tourniquet, thus preventing hemorrhage from the wound   A tourniquet can be anything like a special device, a belt, or a long piece of cloth.  It is used for limbs only.  The best location to wrap the tourniquet is within 1-3" of the wound site, to minimize tissue death/damage.  The tourniquet must be closer to the heart than the wound.  Put something, a piece of cloth or the person’s clothing, under the tourniquet to protect the skin.  Do not remove the tourniquet once it is placed. It does not take too much constant pressure to impede blood flow. However, a tourniquet is not a bandage like a pressure dressing.  It is a very, very tight band around a limb. There is a definite risk of tissue loss and ischemia.  Weigh the risk of loss of a limb versus the loss of life.
اجعل علاج الجروح النازفة أولويتك. اكشف الجرح بالكامل لرؤية الإصابة بالكامل. استخدم ضمادة عادية على الجرح. تفقّد الطرف للبحث عن دلالات عجز التروية الدموية بعد إحكام الضمادة  وتأكد من أن الطرف لم يتحول للون الأزرق وأنك لا تشعر ببرودته. ارفع الطرف المصاب. استخدم الضغط اليدوي على الجرح. اضغط على الضمادة إن لم ينجح الضغط اليدوي ورفع الطرف. اصنع ضمادات مرتجلة من قطع الملابس. ثبّت حشوة من الضمادة المرتجلة على الجرح. تفقّد الطرف الذي استخدمت عليه الضمادة الضاغطة بشكل متكرر. تعامل مع الجروح النازفة في الجذع والرأس بشكل مختلف. استخدم عاصبة على الطرف كملاذ أخير.