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Stop the Bleed Month...

 Did you know that May is ‘Stop the Bleed’ month?

To support ‘Stop the Bleed’, we’re going to take a closer look at blood and how to manage a bleed in this week's blog. Starting with a bit of biology…

The human body contains around 5 litres of blood, depending on the individual’s size and weight, and this makes up approximately 10% of their overall body weight (cue jokes about ‘heavy blood!). Blood is broken down into the 4 key constituents of Red Blood Cells, White Blood Cells, Platelets and Plasma, and it has multiple functions. 

The most common function is the blood’s ability to carry oxygen (and glucose) around the body. Without this transport mechanism, individual cells would be starved of oxygen and begin to die. From here, whole body systems would begin to fail, leading to a global state of hypoxia and ultimately death.

Blood is contained in the Circulatory System. This is the network of arteries, veins and capillaries that allow the blood to be transported all around the body, delivering oxygen to the cells. When we talk about bleeding, or haemorrhage to use its technical term, the first thing we need to consider is whether the bleeding is external or internal. 

External bleeding is probably the easiest of the two to manage. External bleeding is visible, and we have a host of tools and techniques available to us to stop external blood loss quickly and effectively. 


Step 1: Identify the source of the bleeding – this may not always be obvious if it is dark; if the casualty is wearing clothing or coveralls, or if the bleeding is in an anatomical location that you cannot immediately see.


Top Tip: Always check their back, groin and under the armpits!


Step 2: Try to apply direct pressure. Direct pressure needs to be firm and focused. Ideally this should be done with a gloved hand and may be used temporarily, while someone else finds kit/dressings in the First Aid Kit. For small wounds, such as a burst varicose vein, the direct pressure may be as simple as one finger tip.


Top Tip: Before applying pressure to a wound, always have a quick look to ensure there is no foreign object embedded in the wound, such as a piece of broken glass!


Step 3: Transition the pressure. It’s blooming hard work to maintain manual direct pressure on a bleed for any length of time! It is also not ideal from a logistical point of view, especially if you need to move the patient. Modern pressure dressings are exceptional at maintaining focused pressure on a wound when applied correctly, though this transition is likely to be a 2-person job. 

The Olaes bandage is highly effective and will control almost all external bleeds. 

(Watch this space for a how-to guide on the Olaes many uses - we love them almost as much as triangular bandages!)


Top Tip: Pressure dressings are simple to use – but only if you know how! Make sure you’re familiar with your kit before you have to use it in an emergency. 


Step 4: If the bleed is so severe that a pressure dressing is not controlling the bleeding, then an arterial tourniquet may be required. Tourniquets are used to entirely stop the blood flow to a limb. They are placed just above the wound (between the wound and the heart) and are tightened until all bleeding stops. Once applied, seek immediate topside support regarding next steps!


There may be certain situations where you approach a patient and blood is literally hosing out. Under these circumstances, it may be appropriate to use a tourniquet as the first line of defence. 


Top Tip: A genuine arterial tourniquet such as the Combat Application Tourniquet (CAT) costs approximately £30. They cost this much for a reason; because they are tried, tested and manufactured according to strict quality assurance processes. You can buy a fake CAT tourniquet online for £2.99, but you run the risk of it breaking when you most need it. Avoid cheap, fake tourniquets – lives depend on the quality of your kit.

What if the bleeding is in an awkward place such as the groin or the neck? 


Bleeding in areas such as the groin or neck are referred to as junctional bleeds. These areas don’t always lend themselves to the use of tourniquets or pressure dressings. Instead, a Haemostatic dressing such as Celox Rapid may be required, and applied using a technique known as wound packing. Wound packing involves actively pushing haemostatic gauze into the wound to apply direct pressure deep into the source of the bleeding. 


Modern haemostatics contain various compounds, often derived from crushed shellfish shells. The compounds promote blood clotting and are highly effective.


Top Tip: Haemostatics can safely be used on people even if they have a severe shellfish allergy. The proteins that cause the allergy are removed during synthetic processing, making them perfectly safe. They can also be used for people taking blood thinning medications or with conditions such as haemophilia.

Internal bleeding occurs when blood is escaping from the circulatory system but leaking into cavities or tissues within the body. It can be very difficult to identify and a casualty can bleed to death without a single drop of blood being seen?


Internal bleeding is often caused by blunt force injury in trauma and because it’s often harder to detect, and we might need to become something of a medical detective in order to find and treat the bleeding effectively.


So how will I know if the casualty has an internal bleed if there’s no blood visible?


When we bleed, our bodies will try their best to maintain a normal balance. This means the body will compensate for a reduced volume of blood by working harder. The respiratory rate increases to try and get more oxygen into the system quicker and the heart rate increases to compensate for the reduction in circulating blood volume by pumping faster. These are subtle, but important, signs that the patient could be bleeding internally and going into shock.

So, where does the blood go?


If you’re in front of a potentially bleeding casualty, remember the phrase:


Blood on the floor and four more!


Blood visible on the floor tells you there’s an external bleed, and if it’s enough to make you catch your breath, it’s significant! But, if there are signs making you suspicious of an internal bleed, or the mechanism of injury is suggesting it, then we need to check the four other places that a casualty could bleed into. You can find out more about mechanism of injury in this previous blog https://www.redsquaremedical.com/moi-mechanism-of-injury

  • Chest cavity. This could cause a life threatening condition called a haemothorax.
  • Abdomen. This could be from any number of organs or viscera, such as the spleen or liver.
  • Pelvis. The pelvis has a rich blood supply and some major blood vessels pass through it. High impact forces can cause disruption causing significant, life-threatening haemorrhage
  • Long bones. A broken Femur (thigh bone) can bleed approximately 1.5 litres of blood. If you break both of your legs, that’s 3 of your 5 litres potentially lost. This can be life-threatening.

Signs & Symptoms of Internal Bleeding:


  • Mechanism of Injury - how did they become injured?
  • Pale skin – this is due to the body diverting blood from the skin (less important) to the vital organs (very important).
  • Bruising. Note the area, location and any pattern associated with the bruising.
  • Deformity – perhaps an uneven pelvis, one leg longer/shorter than the other or feet splayed outwards.
  • Increased respiratory rate – to take in more oxygen.
  • Increased heart rate – to pump what’s left of the blood around quicker.
  • A reduced level of consciousness – if the brain is starved of blood and oxygen, the patient will gradually become unconsciousness.


There’s nothing we can do about internal bleeding – right?... WRONG!


This is a phrase that is sometimes (incorrectly) taught on First Aid courses. Although we cannot directly fix the bleeding, our actions can certainly help to minimise further blood loss, prevent disruption of that all important first clot and optimise physiology until we can get the casualty to definitive care.


  • Firstly – recognise internal bleeding. This may be subtle, with a slow progression. Sometimes internal bleeds may onlMinimise patient movement. Minimal handling techniques are becoming more recognised in modern medicine. If we do have to significantly move a casualty, try to do it once and as early as possible in their care.
  • Give Oxygen if it’s available.
  • Splinting suspected fractures can reduce pain, anxiety and blood loss.
  • Remember that a pelvic binder is a treatment device, not a packaging device. If you suspect a pelvic fracture, use it early.
  • Keep the casualty warm. Cold prevents the blood from clotting and can impact on the bleeding.

Plan early to medevac your patient to definitive care.


Top Tip: Know your vital signs. When haemorrhage occurs, the body will compensate. This compensation is often the first sign that something is wrong. It can be subtle, so conducting regular observations and noting these on an Obs Chart will allow trends to be highlighted at a glance.


If you’d like to get involved with Stop the Bleed, this link will take you to a short online course https://www.stopthebleed.org/training/online-course/. It’s a fun bit of CPD, but is from the USA, so remember to call for help using the appropriate phone number for the country you’re in - though 999, 911 and 112 will all work in Europe! Also, tourniquets can now be positioned as close to the wound as possible, to preserve the maximum tissue above the wound.

Such an important skill that we should all make sure we have in our toolkit....

Guest blog: Jordan Lin

by Rachel Smith • 08 May, 2024
At Red Square Medical, we’re keen to support those who have a passion for maritime medicine. While we can’t provide placements for everyone, occasionally a request pops up at just the right time and we can provide some experience and insight into our unique and specialised world. Last year we were contacted by Jordan Lin, a medical student with a love of the ocean. This is his story… When I was a boy, my dad and I used to go fishing with a local fisherman off the Norfolk coast. I absolutely loved being on the sea and so for quite a long time, I wanted to be a fisherman. When I got a bit older I kind of forgot about this and think I may have been slightly put off by watching the TV series ‘World’s Deadliest Catch’! But I have always loved being on the water and spent a lot of time sailing dinghies; I was also a swimming teacher for children back in high school and college. Later, I decided to study medicine and I’m now a final year medical student at the University of Bristol where I completed an intercalated degree; a Masters in Health Sciences Research. I’m now looking forward to starting work as a qualified Doctor in August. Though having spent 6 years training, my next 2 years will be spent working for the required two foundation training years that must be completed before being able to work independently as a Doctor in the UK. At university, I joined the VITA network which is a group dedicated to developing a health and public health approach at the heart of any response to human trafficking and exploitation. I became the blog coordinator for the organisation and you can read the blogs, including those that I have written, here: https://vita-network.com/blog/ In my spare time, I have been involved with the Bristol University Hot Air Ballooning Society and trained through the society to get my Balloon pilots licence. So, I often spend weekends during the summer flying in a leisurely fashion over Bristol and the surrounding area!

That Lightbulb Moment!

by Rachel Smith • 24 Apr, 2024
At Red Square Medical, we’re fascinated by the learning process - it’s key to our business after all. But we often wonder what happens when our students leave the classroom. Do they remember what they’ve learnt? What if they’re faced with a real emergency, will they know what to do? Is there a lightbulb moment when it all clicks into place? Skill fade is a very real issue, as we wrote about in this blog , and we know that setting up drills and practice scenarios when you’re back in your environment, with your kit and crew, can make a massive difference. It’s great to get some feedback from our students too. Last year, we received photos from the Southern Ocean from a solo round the world sailor who was able to successfully steri-strip a cut eyebrow closed. Or the Captain who recognised a heart attack in a crew member because they looked just like the guy he saw in the video on one of our courses.

Worse Things Happen at Sea… a salty tale of dysentery, haemorrhoids, accidents, depression and death!

by Rachel Smith • 03 Apr, 2024
You might wonder about the title of this month’s guest blog, as Worse Things Happen at Sea is also the name of our monthly newsletter. But this month, we’re delighted to introduce Andrew Edwards as our Guest Blogger, and we felt his amazing story about life at sea really deserved a dramatic headline… Dysentery... In the summer of 1966, I was a cadet on a cargo ship that loaded in the UK for 9 ports in West, South and East Africa. Our first port of call was Luanda, the capital of Angola – which was then a colony of Portugal. Next, 300 miles down the coast we called in to Lobito – also in Angola. In Lobito two of the ship's company contracted dysentery; myself and a big Irishman called Reg. The shoreside Doctor we saw simply diagnosed the condition (amoebic dysentery) and said, ‘sorry but I have no antibiotics for this!’. Thankfully the ship’s purser stood our corner and demanded that the Doctor find some. The following day the antibiotics were flown in from the Belgian Congo. The Doctor gave us no advice as to how to deal with the condition, not a word about how contagious it was, not a word as to the importance of thoroughly washing our hands and maintaining scrupulous personal hygiene. Thankfully both Reg and I were quartered just a short sprint from the heads, and we were left to get on with it by our shipmates. It took about a week to get over the dysentery, by which time I had lost several stone in weight and was as weak as a kitten. By the time we arrived in Walvis Bay, South West Africa (now known as Namibia), a further 1000 miles south, I was just about fit enough to play football for the ship against a local team. Their football ground had a main road going right through the middle of it which made for some challenging moments, but they still beat us comfortably and they were playing in bare feet!

How does the Easter Bunny avoid Diabetes?

by Rachel Smith • 20 Mar, 2024
As it’s Easter, we thought that it would be a very appropriate time, what with all that chocolate around, to take a closer look at the subject of Diabetes and why it’s such a huge problem in the UK and across the world. The Easter Bunny always looks so cute and cuddly, but is he a diabetes case waiting to happen? Or does his diet of grass and all that hopping around for the rest of the year make an important difference? According to the WHO, diabetes is a chronic, metabolic disease which is characterised by elevated levels of blood glucose (or blood sugar). Over time, this leads to serious damage to the heart, blood vessels, eyes, kidneys and nerves. The most common is type 2 diabetes, and it usually develops with a late onset in adults. It occurs when the body becomes resistant to insulin or doesn't make enough insulin. Worryingly, in the past 3 decades the prevalence of type 2 diabetes has risen dramatically in countries of all income levels and is closely linked to obesity, poor diet, and an unhealthy lifestyle. Symptoms for type 2 diabetes are generally similar to those of type 1 diabetes (need to urinate often, thirst, constant hunger, weight loss, vision changes and fatigue), but are often less marked. As a result, the disease may be diagnosed several years after onset, after complications have already arisen. For this reason, it is important to be aware of risk factors. Effective approaches are available to prevent type 2 diabetes and to prevent the complications and premature death that can result from all types of diabetes. These include policies and practices across whole populations and within specific settings (school, home, workplace) that contribute to good health for everyone, regardless of whether they have diabetes, such as exercising regularly, eating healthily, avoiding smoking, and controlling blood pressure and lipids. Type 1 diabetes, once known as juvenile diabetes or insulin-dependent diabetes, is a chronic condition in which the pancreas produces little or no insulin by itself. Normal onset is in younger people, but can also be in adults. Symptoms of type 1 diabetes include the need to urinate often, thirst, constant hunger, weight loss, vision changes and fatigue. These symptoms may occur suddenly. Type 1 diabetes cannot currently be prevented. It’s thought to be caused by an autoimmune reaction which destroys the cells in the pancreas that make insulin. It can also be caused by genetics, viruses, trauma, tumours, removal of the pancreas or other damage to the pancreas. About 422 million people worldwide have diabetes, the majority living in low-and middle-income countries, and 1.5 million deaths are directly attributed to diabetes each year. But the number of cases and the prevalence of diabetes have been steadily increasing over the past few decades. The starting point for living well with type one or type 2 diabetes is an early diagnosis – the longer a person lives with undiagnosed and untreated diabetes, the worse their health outcomes are likely to be. Easy access to basic diagnostics, such as blood glucose testing, should therefore be available in primary health care settings. Patients will need periodic specialist assessment or treatment for complications. A series of cost-effective interventions can improve patient outcomes, regardless of what type of diabetes they may have. These interventions include blood glucose control through a combination of diet, physical activity and, if necessary, medication; control of blood pressure and lipids to reduce cardiovascular risk and other complications; and regular screening for damage to the eyes, kidneys and feet to facilitate early treatment.

Reflective Practice and why it’s so important

by Rachel Smith • 21 Feb, 2024
Well, we’ve made it to February! How are your goals for the year going so far? As you’ll know, we do love a bit of goal setting at Red Square Medical HQ. But, we also understand the importance of Reflective Practice too. Especially in relation to setting goals. Want to know more? Please read on…

Guest Blog - Sam Kelly MSA

by Rachel Smith • 07 Feb, 2024
Today we start the first in a series of blogs in conjunction with our friends at the Maritime Skills Academy, and kicking it all off is a Guest Blog from MSAs Head of Training, Sam Kelly. Sam is 37 and lives in southeast Kent, in the quaint seaside town of Deal with with his wife, two children and a ‘Golden Doodle’ called Pringle. He has lived in the area ever since his father, a serving Royal Marine at the Deal Depot, and mother decided this was the place to raise their family. And it is, quite frankly, an excellent place to live. Here is his story… I’m the Head of Training for the Maritime Skills Academy, based in our head office in Dover. I oversee a team of Maritime Safety Instructors who deliver all STCW training for seafarers. Outside the Dover base, we have MSA Gibraltar. This location is operated in partnership with the University of Gibraltar and delivers Basic Safety Training and most recently Operational Firefighting, We are actually in the process of building a state-of-the-art Fire Training Module on ‘the Rock’.

Dry January!

by Rachel Smith • 17 Jan, 2024
So Christmas seems like years ago, and we’re all well into the New Year now. Did you make any resolutions? Some love to, some don’t. At Red Square Medical HQ, we love a goal or two and think the turn of the years can be a good prompt to make some positive changes. But, it’s well known that New Year resolutions don’t last. Forbes magazine tells us that 21% don’t make their resolution stick for even a month. While 34% state that it lasted for between one and three months. Is that a failure though? Or could it be all it takes to make some small changes that have a lasting impact? We thought it would be good to take a closer look at one of the most popular resolutions… Dry January! Now, let’s get one thing straight, the Red Square Medical team are not averse to a tipple or two! But as medics, we’re very aware of the short and long term benefits of giving our livers a little breather every so often. Of course, everyone responds differently to stopping drinking for a month, so the timeline below is just a guide. But it might help you to decide whether it’s a good idea to give the booze a break for a while, or work towards reducing your intake - we know it’s easy for it to creep up over time!

12 months since I left the NHS

by Rachel Smith • 03 Jan, 2024
What I miss most about the Ambulance Service… It’s been 12 months since I left the Ambulance service after 8 years of working frontline, and to be honest it’s flown by. A few weeks ago the team at Red Square Medical HQ were chatting about how life has changed in that time and what, if anything, I was missing from my former life! The list might just surprise you… Most of all, I miss my old colleagues and I definitely miss the patient contact. And driving on blue lights… that was one of the best parts of the job! Working in the ambulance service with regular partners who you get on well with really does create friendships for life. Or even doing a tricky job with someone you don’t know well provides a common bond forever. Every day you’re facing stressful situations and sometimes split second, life changing decisions. You rely on each other totally and make sure you keep each other safe in some difficult and challenging situations. I worked with 3 very different partners most of the time for my last few years and I miss them all. Happily though, I have some great new colleagues at Red Square Medical and Outreach Rescue, the other company that I work for.

Guest Blog - Rachel Smith

by Rachel Smith • 03 Jan, 2024
I was born in a tiny village in Northamptonshire but had a fairly nomadic childhood, eventually settling in the industrial town of St Helens in the north west. As a child I was horse mad, so boats never got a look in. Apparently ‘horse’ was the first word I said and despite the fact that we could never afford a horse, my dream was always to ride and work with horses. It’s perhaps an early indication of my goal-oriented side that I got a Saturday job as soon as I could. At the age of 13, I’d cycle a 12 mile round trip, twice a day, just to go and ‘muck out’ at a local farm where they bred Welsh ponies and Arab horses! There wasn’t even any riding. Later, I found myself working for the family of a young girl who would go on to represent Great Britain in dressage at the Olympics. The work was physically hard and the standards high. No corners were cut and I learnt the skills I needed the old fashioned way. I got to travel all over the UK in the branded horsebox which was pretty exciting for a teenager. But I think I will always be grateful for the solid work ethic and sense of responsibility that this job instilled in me. I always planned to leave school at 16 and go to ride racehorses. But I got quite reasonable exam results and a new degree course was announced in Equine Science and Business which changed the plan. So, after taking the required year out, when I worked in an eventing yard in Yorkshire, I started the 3 year course. For the two work placements, I opted to go abroad, to Italy and the USA, which supercharged my desire to travel. I continued working in the equestrian world for a couple more years, but the poor pay and prospects, plus a dose of pneumonia pushed me onto a different path. I got a job in telemarketing for a bank, and after putting forward the idea of finance for horses, I found myself transferred to Marketing for 6 months. 16 years later, I was still there!

Are they wearing a beer jacket??

by Rachel Smith • 20 Dec, 2023
Christmas is coming and the season of parties is upon us. Of course this means that most of us will overindulge in large amounts of luscious food and, of course, a tipple or two. At Red Square Medical HQ, we have a method of categorising drunk people. During our combined careers, we’ve dealt with more drunks than we can remember; it’s easily running into several hundred. What we’ve learnt, amongst other things, is that most people who are drunk fall into one of these categories. Now please don’t judge as it is purely observation and also makes for an interesting chat when delivering the STCW Medical training, because we all know at least one person from each category and sometimes… a person can be in multiple categories depending on many other factors, or, we might even have been there ourselves! Once we have established these categories there is a serious note to this blog so please do keep reading.
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