Knife crime is at a record high in the UK.

Every day the news report yet another story of injury or fatality related to knife crime. Would you know how to help with major bleeding while also keeping yourself safe? In London alone, there were more than 15,000 offences in 2019. MP Florence Eshalomi has warned that Londoners risk becoming ‘desensitised’ to knife crime. She once told the Commons about how she felt scared after coming across a teenager bleeding from knife wounds in his legs. Eshalomi said she felt disappointed that many passers-by walked on while she ‘frantically’ alerted the emergency services.

The Importance of First Aid

It is important to know how you can help if you end up in a situation where someone has been stabbed. In this way, you can react in an effective and calm manner. Catastrophic bleeding is a common result of stab wounds but is not just confined to crime. It can happen any time and anywhere. It can occur as a result of DIY injuries, accidents in the kitchen or even after a slip of a saw whilst cutting branches in the garden. There are some very simple steps to follow that could help enormously and save lives. Read on to find out what to do for treating major bleeding and shock, should you be first on the scene at such an accident. This article will help you learn how to help someone who has been stabbed or seriously bleeding. Find here our article on Bleed Kits. Click here for a Street Crime First Aid course

Bleeding

If someone is bleeding the priority is to stop the blood coming out! ALWAYS WEAR GLOVES WHEN DEALING WITH BLEEDING It is never a priority to wash a major injury – it will be cleaned in hospital. Sit or lie the person down – to manage shock and prevent them from feeling dizzy and faint. Examine the area to see if there is anything stuck in the wound – if there is do not remove it. Elevate the bleeding area above the level of the heart to slow down the bleeding. Please note that latest guidelines no longer recommend elevation. This alone will not stop bleeding and pressure is more important. Pressure – apply direct pressure on the wound to stop the blood coming out.

Shock

Shock is ‘a lack of oxygen to the tissues of the body. The most likely cause is a fall in blood volume or blood pressure. It occurs as a result of the body’s circulatory system failing to work properly. That means the tissues of the body, including the heart and the brain, struggle to get sufficient oxygen. The body’s response to this is to shut down the circulation to the skin. Therefore, it becomes pale, cold and clammy. The heart speeds up as it struggles to get sufficient blood supply and oxygen and to draw the blood away from the gut. Thus, the casualty may feel sick and thirsty. They may also feel anxious, dizzy and a bit confused. This is because their brain suffers from the lack of oxygenated blood too. If the person is pale, cold, clammy and showing signs of shock, or if there is a lot of blood – help their circulation by lying them down and raising their legs. Elevate the bleeding wound and apply direct pressure to control the bleeding. Keep them warm and get emergency help.

Symptoms of shock:

• A rapid pulse.
• Pale, cold and clammy.
• Grey-blue skin colour and blue tinge to the lips.
• Weak and dizzy.
• Nausea and vomiting.
• Thirst.
• Shallow, rapid breathing.
• May become restless and possibly aggressive – a sense of ’impending doom’.
• Yawning and gasping for air.
• Eventually they will lose consciousness and become unresponsive and they may stop breathing.

How much blood can you afford to lose?

Children have far less blood than adults. A person has approximately 0.5 litres of blood per 7kgs of body weight or one pint of blood per stone (although this does not increase if someone is over weight). An ‘average’ adult has roughly 10 pints / 6 litres of blood. If they lose about a 5^th of their blood volume it can cause the body to shut down and go into shock. The loss of a tea cup full of blood could be fatal for a baby. However, please note that head and facial injuries bleed copiously and can look far more scary than they are. A tea cup full of blood would make a major mess! If a casualty loses a substantial amount of blood – more than 40% of their blood volume, the body is no longer able to compensate for that amount of blood loss. Thus, casualties will develop hypovolaemic shock. Hypovolaemic shock is a low volume of blood causing failure of the circulatory system. if untreated, casualties will die. If someone is bleeding extremely heavily from either a major artery or vein, they can lose a lot of blood very quickly. The bleeding is likely to pulsate in time with the heart. This is more pronounced with an arterial bleed, but can also happen with a venous bleed. With extremely heavy, potentially catastrophic bleeding an adult could easily lose 40% of their blood volume in 3-4 minutes. This could be even quicker when dealing with children. Interested in a Street Crime First Aid course? Click here

The treatment of all bleeding remains the same:

• Encourage the casualty to sit or lay down in the most appropriate position for the location of the wound and the amount of blood lost – if they are feeling dizzy and showing early signs of shock, raise their legs.
• Examine the wound to rapidly assess:
  • The type and extent of bleeding
  • The source of the bleeding
  • Whether there are any foreign objects embedded in the wound. If so, do not remove them as they will be stemming bleeding. Apply direct pressure either side of the object.
• Apply direct pressure to try and control bleeding. If the bleeding is controlled with this direct pressure, keep holding for 10 minutes as it takes this amount of time for clots to form.
• Once bleeding is controlled, dress the wound. If the wound bleeds through the first dressing, apply another on top. If the wound bleeds through the second dressing you should consider alternative options to stop the bleeding.

Catastrophic bleeding

A Catastrophic bleed is when the bleeding is so severe that it is not possible to stop it with direct pressure. It usually occurs due to a damaged artery and someone can bleed to death in a matter of minutes. When dealing with a catastrophic bleed, stopping the bleeding takes priority over everything else – including CPR.

The first step when treating a catastrophic bleed is always to apply direct pressure. It is still likely to be the first and only solution needed for the casualty.

In environments where a catastrophic bleed is likely; tourniquets and haemostatic dressings should be an integral part of the first aid kit. All First Aiders should be trained in their use. For the general public; you are highly unlikely to need to use a tourniquet. However understanding how to improvise and how and when to use one, could save lives if you were involved in a major medical accident or emergency. One of the easiest way to make an improvised tourniquet using the contents of a standard First Aid kit is to use a triangular bandage folded into a broad fold bandage and tighten the tourniquet using your scissors as a windlass. If you have access to cutlery, such as a table knife, this would be even better. Otherwise you no longer have your scissors available to use! Please note: A tourniquet should be at least 4cm wide to prevent localised damage to nerves tissues.

• Tie the bandage around the bare limb –on a single bone. If the lower part of the arm or leg are bleeding, you should tie the tourniquet on the upper part, where there is only one bone rather than two.
• The tourniquet should be at least 5cm above the wound (or 5cm above the joint if the wound is on the lower limb. Never place a tourniquet over a joint).

If there’s a clean cut through an artery, for example deep incised wound, the artery can contract back up the arm or leg. This is why, it is recommended to place the tourniquet at least 5cm (or 2 inches) above the wound.

You may find other guidance on the positioning of a tourniquet, such as applying the first tourniquet mid-point over a single bone. This advice is also acceptable, so long as you position the tourniquet proximal to the wound (closer to the trunk of the body). Place the knife or your scissors on top of the knot and tie another knot on top of them. Use the knife or your scissors as a windlass to wind round and tighten the tourniquet. You can secure the windlass either by tying another triangular bandage to stop it unwinding or by wrapping and tying both ends of the triangular bandage around the ends of the windlass to ensure it remains in place. It is important to note the exact time in which you applied the tourniquet. Furthermore, you must arrange for urgent transfer for medical help. Ensure you tell them where and when you applied the tourniquet. Please note: it will be extremely painful for the casualty to have a tourniquet, but it is absolutely vital that you apply tourniquet tight enough to entirely stop the bleeding. If a tourniquet is not on tight enough it can make things worse. It can occlude the veins, but arteries may be harder to stop as they are less easy to get to. If the venous return is stopped by the tourniquet, the only place for blood to come out is from the wound.

NEVER be tempted to loosen or remove a tourniquet. Once you have applied it, ONLY a doctor in a hospital setting should remove the tourniquet

Follow the Government’s instructions advising what to do: https://act.campaign.gov.uk/ and download a handy app: https://www.citizenaid.org/ There are many initiatives operating around the country to try and curb the increase in knife crime and the numbers of our young people being injured and killed in this way. One proven initiative aimed at both preventing weapon carrying and increasing the chance of survival following an attack, is to teach these young people first aid.

First Aid for Life can help

We are a multi-award-winning, fully regulated first aid training business with experience working with schools, Young Offender Institutes, PRUs, voluntary organisations, charities and Youth clubs nationwide, to teach young people the vital skills they need to save a life, should the worst case scenario arrive. Our ebook on first aid for stabbings is a useful resource to educate and inform young people and youth organisations on the dangers of street crime. Moreover, it is a helpful guide to ensure people know what to do if they encounter a stabbing victim. First Aid for Life specialises in empowering young people with the skills and confidence to keep themselves and others that bit safer. We teach them that carrying a weapon makes you more at risk. The risks of carrying weapons such as knives, guns and acid and the damage this can do, are clearly explained. We equip young people with the skills and confidence to help each other in a first aid emergency, giving them both general first aid training as well as specialised first aid training encountered in a street crime context. We run courses for young people and youth workers across the country, who welcome the opportunity to learn how to treat serious and catastrophic bleeds with improvised and manufactured tourniquets and packing. Training can be entirely adapted to your needs and budget. We can blend practical and online modules. Our trainers are highly experienced medical, health, military medics and emergency services professionals, who will tailor any training to your needs and the needs of the children and young people you are working with. Our trainers are all DBS cleared and superb at teaching engaging practical courses to children, young people and adults.

About us

First Aid for Life provide award-winning first aid training tailored to your needs. Please visit our site and learn more about our practical and online courses. It is vital to keep your skills current and refreshed. We are currently providing essential training for individuals and groups across the UK. In addition, we have a great range of online courses. These are ideal as refreshers for regulated qualifications or as Appointed Person qualifications. You can attend a fully regulated Practical or Online First Aid course to understand what to do in a medical emergency. Please visit https://firstaidforlife.org.uk or call 0208 675 4036 for more information about our courses. First Aid for Life is a multi-award-winning, fully regulated first aid training provider. Our trainers are highly experienced medical, health and emergency services professionals who will tailor the training to your needs. Courses for groups or individuals at our venue or yours. First Aid for life provides this information for guidance and it is not in any way a substitute for medical advice. We are not responsible or liable for any diagnosis made, or actions taken on this information.

Knife crime is on the rise, with more fatalities and injuries among young people than at any other time. What can we do to protect children? One practical solution is to teach first aid skills in schools, which have seen a rise in the number of violent crime in and around them.

First Aid following a stabbing

Always ensure the area is safe and you are not in any danger, before commencing any first aid. Protect yourself and wear gloves if possible. Talk to the casualty and quickly establish if there is any response, or if they are unconscious. If they are unconscious and breathing, put them into the recovery position and treat any obvious bleeding. When they are unconscious and not breathing – if there is a life-threatening bleed that you are unable to stop with direct pressure – then this is a catastrophic bleed. Therefore, this is a priority over resuscitation. If there is no obvious pulsating bleed, and they are unconscious and not breathing – then call for an ambulance (and a defibrillator) and commence CPR immediately.

How to stop bleeding

Bleeding can be external (bleeding from an artery or vein) or internal (bleeding into a body cavity). For an external bleed: Bleeding from a major artery will result in bright red frothy blood that pulsates from the body – this is extremely serious and is a potentially catastrophic bleed. This sort of bleed can kill someone in just a few minutes. Bleeding from a major vein can also prove fatal, the blood tends to be deep red and flows rather than pulsates. A venous bleed may be easier to stop. The European Resuscitation Council guidelines on catastrophic bleeding 2015, state that tourniquets and haemostatic dressings are indicated only once direct pressure has been tried and been insufficient. Direct pressure to the site of the wound is always the initial first aid intervention of choice for a community first aider. Click here for Street Crime First Aid including catastrophic bleeding and tourniquets

This is a crime scene

Remember too that this is a crime scene. Preserve any evidence and don’t interfere with anything or move anything other than what you need to do in order to administer life-saving first aid.

• Wear gloves or take measures to protect yourself from blood contamination.
• Sit or lie the person down – to manage shock and prevent them from feeling dizzy and faint – for a serious bleed, help them lie down and elevate their legs.
• Examine the area to see if there is anything stuck in the wound. If so, do not remove it as it is likely to be stemming bleeding. Apply direct pressure either side of the object. Note that most perpetrators do not leave the weapon in the victim.
• Elevate the bleeding area above the level of the heart to slow down the bleeding (although latest guidelines no longer recommend elevation, as this alone will not stop bleeding). Moreover, they stress that direct pressure is more important. However, new studies have now reinforced medical experience demonstrating that elevation is helpful when attempting to control bleeding.
• Apply direct pressure on the wound to stop the blood coming out.
• Dress the wound with an appropriate non-adherent dressing.
• Keep the casualty warm and reassure them.

Further points to remember when treating a victim of serious bleeding

• Apply direct pressure to try and control bleeding. If the bleeding can be controlled with pressure, keep holding for 10 minutes as it takes this amount of time for clots to form.
• Keep checking their vital signs, level of consciousness and breathing – expect that they may deteriorate.
• Ensure the emergency services – ambulance and police have been informed.

Catastrophic bleeding – when blood loss is more important than CPR

Most bleeds can be controlled with direct pressure. However, with a catastrophic bleed, the casualty can lose a critical amount of blood in just 3 minutes. With an external catastrophic bleed there will be a lot of blood. If the bleed is in a limb and you are unable to stop the bleeding with substantial direct pressure, you may need a tourniquet. If the bleed is in the trunk of the body, you may need to locate the source of the bleeding by placing your finger or hand into the bleeding cavity. Once you have identified the source of bleeding, the cavity needs to be packed with an improvised or ideally a commercial sterile haemostatic dressing. To treat an open chest wound it is best not to use airtight dressings. Instead just leave the wound open and control any bleeding with direct pressure or a non-occlusive dressing.

turnstiles

If someone is bleeding from their limb and the bleed is pulsating and unable to be stopped with direct pressure, you need to use a tourniquet. A commercial tourniquet will undoubtably be more effective and easier to use; however an improvised tourniquet will work and save lives. A 2012 study found that almost a quarter of deaths in the wars in Iraq and Afghanistan were “potentially survivable.” Furthermore, 90 percent of deaths overall occurred before the casualty could be treated at a medical centre. 90 percent of victims with potentially survivable wounds die specifically from “uncontrolled” blood loss.

How to use an improvised tourniquet

One of the easiest ways to make an improvised tourniquet from the contents of a standard first aid kit is to use a triangular bandage folded into a broad fold bandage. Then tighten the tourniquet using scissors as a windlass. If you have access to cutlery, such as a table knife, this would be even better; a otherwise you no longer have your scissors available to use. Please note: A tourniquet should be at least 4cm wide to prevent localised damage to nerve tissues.

• Tie the bandage around the bare limb on a single bone (i.e. if the lower part of the arm or leg are bleeding, you should tie the tourniquet on the upper part, where there is only one bone rather than two).
• The tourniquet should be at least 5cm above the wound, or 5cm above the joint if the wound is on the lower limb. Never place a tourniquet over a joint.

If there’s a clean cut through an artery, for example in a deep incised wound, the artery can contract back up the arm or leg. This is why you should place the tourniquet at least 5cm (or 2 inches) above the wound. You may find other guidance on the positioning of a tourniquet, such as applying the first tourniquet mid-point over a single bone. This advice is also acceptable, so long as the tourniquet is positioned proximal to the wound (closer to the trunk of the body).

Step by step guide

1. Place the knife or your scissors on top of the knot and tie another knot on top of them.

2. Use the knife or your scissors as a windlass to wind round and tighten the tourniquet.

3. The windlass can be secured either by tying another triangular bandage to stop it unwinding or by wrapping and tying both ends of the triangular bandage around the ends of the windlass to ensure it remains in place. It is important to note the exact time that the tourniquet was applied and to arrange for urgent transfer for medical help.Ensure you tell them where and when the tourniquet was applied. Please note it will be extremely painful for the casualty to have a tourniquet applied. But it is absolutely vital that the tourniquet is applied tight enough to entirely stop the bleeding. If a tourniquet is not tight enough it can make things worse as it can restrict the veins. However, arteries may be harder to stop as they are less easy to get to. If the venous return is stopped by the tourniquet, the only place for blood to come out is from the wound. NEVER be tempted to loosen or remove a tourniquet. Once applied, tourniquets should only ever be removed by a doctor in a hospital setting. Removing a tourniquet outside of a hospital setting is likely to be fatal as accumulated toxins flood the bloodstream.

Unsuitable alternatives for an improvised tourniquet

A tie is likely to be too thin. A leather belt is also unsuitable as it is too tough to use with a windlass; you will be unable to provide sufficient force by hand to tighten it sufficiently to provide enough pressure to stop the blood flow. A tourniquet should be at least 4cm wide to prevent localised damage to nerves tissues.

Application of a tourniquet

A tourniquet must be put on sufficiently tight to stop the bleeding. If it is not tight enough it can actually result in increasing blood loss. It may be necessary to apply more than one tourniquet to completely stop bleeding. It is important for the doctor treating the casualty to have a good understanding of how long the tourniquet has been applied. Write the time you applied the tourniquet onto the tourniquet itself, or onto the casualty. Please remember that although tourniquets can save lives, their use should not be taken lightly. They remain a second-line treatment when direct pressure is not possible or insufficient to control bleeding. Click here for Street Crime First Aid including catastrophic bleeding and tourniquets

First Aid training for children

Equipping all children from key stage 2 upwards with basic life support skills and the knowledge to help themselves or others in a medical emergency will save lives. They love the practical nature of the learning and if it also makes them think twice before equipping themselves with knives, then it really is an obvious step forward in the fight to reduce fatalities from stabbing.

To read our article on knife crime and the how schools can protect their pupils click here

Written by Emma Hammett for First Aid for Life Award-winning first aid training tailored to your needs We strongly advise that you attend a fully regulated Practical or Online First Aid course to understand what to do in a medical emergency. Please visit https://firstaidforlife.org.uk or call 0208 675 4036 for more information about our courses. First Aid for Life is a multi-award-winning, fully regulated first aid training provider. Our trainers are highly experienced medical, health and emergency services professionals who will tailor the training to your needs. Courses for groups or individuals at our venue or yours. First Aid for life provides this information for guidance and it is not in any way a substitute for medical advice. First Aid for Life is not responsible or liable for any diagnosis made, or actions taken based on this information. Although a stab wound usually causes a small opening at the skin it may go very deep, causing serious damage to the body. You need to give first aid quickly if someone’s been stabbed as their life could be at risk. If you find yourself in a situation where someone has been stabbed you need to try and stay calm. Taking a couple of slow, deep breaths and then follow these simple steps. You could save someone’s life: 1. Call 999 for an ambulance
2. Apply pressure directly over the wound to stem the bleeding (wear protective gloves if available)
3. If the knife (or any other object) is still in the wound, apply pressure on either side of the object. NEVER REMOVE IT FROM THE WOUND
4. Help the casualty to lie down and elevate the bleeding area above the level of the heart to slow the bleeding.
5. Keep pressure on the wound until an ambulance arrives

Why is it bad to take a knife out after someone gets stabbed?

When you put a knife in someone it damages them but the knife is also like a plug, helping to seal any blood vessels etc that have been severed. By pulling it out you unplug these vessels and worsen the bleeding. Did you know that when Martin Luther King Jr. was stabbed with a letter opener, everyone wanted to pull it out. He refused and was taken to hospital, where the blade was safely removed. It turned out that letter opener was resting on his aorta and extracting it would probably have killed him.

What should I do if they go into shock?

When someone is stabbed they can go into shock if they lose a lot of blood either internally or externally. This is a potentially life-threatening condition as it means vital organs like the brain and heart are not getting enough oxygenated blood.

What are the signs of shock?

Signs of shock include:
• pale, clammy skin
• a fast, weak pulse
• fast, shallow breathing
• dizziness

First Aid for Shock

• lay the casualty on the floor and elevate their legs above the level of the heart.
• make sure the ambulance is on it’s way
• loosen tight clothing
• keep them warm (but don’t overheat them)
• reassure the casualty

How much blood do you have to lose before you die?

The average adult has 4-6 litres of blood (we have about half a litre of blood per 7kg). Once you have lost one third of your blood, blood pressure falls quickly and the brain is starved of oxygen and death will follow if immediate action is not taken.
Children have less blood than an adult and losing less than a litre of blood can be life-threatening for a baby.

Can you survive a stab wound?

Yes, many people will survive a stab wound if they are given medical treatment quickly. But, as Dr Martin Griffiths, a consultant trauma surgeon at the Royal London Hospital says “No injury is minor. Every one takes a mental and physical toll. This year we will admit 800 stabbing and 60 gunshot victims with life – or limb – threatening injuries. (Guardian Newpaper Article November 2019) This video from 20 year old Dom explains exactly what happens when you get stabbed:

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