10.4 Bleeding Control, Shock Management & Recovery Position
Key Takeaways
- Control external bleeding mainly with firm direct pressure, appropriate dressings, and elevation only when suitable and trained—do not remove blood-soaked dressings; add more on top.
- Shock (circulatory failure to tissues) presents with pale clammy skin, rapid weak pulse, weakness, thirst, and anxiety; lie the casualty down, keep warm, monitor, and get urgent help.
- Use the recovery position for an unresponsive casualty who is breathing normally, to keep the airway clear of the tongue and vomit.
- Cool thermal burns with cool running water; for chemical splash, remove contaminated clothing carefully and irrigate as trained—never apply butter, toothpaste, or ice packs as ‘home remedies.’
- Know the major do-nots: no blind tourniquets unless trained and indicated, no food or drink for shock/major trauma awaiting surgery, no unnecessary movement of major trauma casualties.
Last updated: July 2026
10.4 Bleeding Control, Shock Management & Recovery Position
After ABC priorities, many workplace injuries still need competent bleeding control, recognition of shock, correct use of the recovery position, and calm handling of burns and chemical splashes. These skills appear frequently in Basic HSE multiple-choice items because they are practical, life-saving, and easy to get wrong under stress.
Bleeding Control Basics
External bleeding is classified roughly by severity:
| Type (awareness) | Features | Urgency |
|---|---|---|
| Capillary | Oozing from scrapes | Usually minor; clean and cover |
| Venous | Steady darker flow | Can be serious; pressure and dressing |
| Arterial | Spurting or rapid bright red flow | Life-threatening; immediate firm pressure and emergency help |
Core method: direct pressure
- Put on gloves if available.
- Expose the wound enough to see the source (cut clothing carefully).
- Apply a sterile dressing or clean cloth and press firmly and continuously.
- If blood soaks through, do not remove the original dressing—add another on top and keep pressing.
- Secure with a bandage firm enough to maintain pressure but not so tight that you deliberately cut off all circulation to a whole limb unless you are using a trained tourniquet protocol.
- Elevate the injured part only if it is appropriate (for example a bleeding hand or arm with no major fracture suspicion) and your training supports it. Do not elevate a limb with a major break, impaled object, or if elevation increases pain/harm.
- Treat for shock and call emergency help for severe bleeding.
Special bleeding situations (awareness only)
| Situation | Level 1 approach |
|---|---|
| Embedded / impaled object | Do not pull it out; pad around it and secure; urgent medical care |
| Amputation | Direct pressure on stump; preserve amputated part as trained (clean bag, cool—not directly on ice in many protocols); emergency help |
| Nosebleed (simple) | Sit forward, pinch soft part of nose as commonly taught; do not tip head far back |
| Internal bleeding suspicion | After trauma: pain, swelling, rigid abdomen, shock signs—urgent evacuation; you cannot bandage internal bleeding in the field |
| Tourniquet | Only if you have been specifically trained and the situation meets criteria (for example catastrophic limb bleeding not controlled by pressure). Incorrect tourniquets cause harm |
Shock — Recognition and Management
In first aid, shock usually means inadequate blood flow to the body’s tissues (often from blood loss, severe burns, severe infection, or heart problems)—not merely “emotional upset,” though fear can coexist.
Recognition signs
| Sign / symptom | What you may see |
|---|---|
| Skin | Pale, cool, clammy |
| Pulse | Rapid and often weak |
| Breathing | Rapid, shallow |
| Consciousness | Weakness, dizziness, anxiety, confusion; may progress to unresponsiveness |
| Other | Thirst, nausea, yawning, feeling cold |
Management (Level 1)
| Action | Reason |
|---|---|
| Call for urgent medical help | Shock can kill; field first aid buys time |
| Treat the cause if possible (stop bleeding) | Removes the driver of blood loss shock |
| Lie the casualty down | Improves blood flow to vital organs (unless breathing difficulty or injury requires a different position taught in training) |
| Keep warm with a blanket/foil blanket | Prevents heat loss that worsens shock |
| Loosen tight clothing at neck/chest/waist | Comfort and breathing ease |
| Monitor ABCs | Watch for deterioration toward cardiac arrest |
| Reassure | Reduces anxiety and oxygen demand |
| Nothing by mouth if major trauma or likely surgery | Avoids complications if anaesthesia is needed |
| Do not leave alone if avoidable | Early detection of collapse |
Exam trap: Giving food, water, alcohol, or pain tablets to a shocked trauma casualty “to help them feel better” is wrong in standard first-aid teaching when professional care is imminent.
Recovery Position — Unconscious but Breathing
If a casualty is unresponsive but breathing normally, and you do not suspect a condition that forbids turning (follow trauma training for spinal concerns), place them in the recovery position so the tongue does not block the airway and vomit can drain.
Typical steps (awareness of common adult method)
Exact hand placements vary slightly by course; the goals are standard:
- Kneel beside the casualty; make sure the scene remains safe.
- Remove spectacles; tidy bulky items in pockets if they would injure when rolled.
- Place the arm nearest you at a right angle (bent at elbow, palm up—per your course).
- Bring the far arm across the chest; hold the back of that hand against the cheek.
- Bend the far knee; roll the casualty toward you onto their side.
- Adjust so the airway stays open (tilt head back slightly as trained); the bent knee stabilises the body.
- Re-check breathing frequently.
- Await help; be ready to roll flat and start CPR if breathing stops.
| Recovery position: use when | Do not use as first choice when |
|---|---|
| Unresponsive + normal breathing | Casualty needs CPR (not breathing normally) |
| Protecting airway from vomit/fluids | You must keep them flat only for a trained spinal protocol and airway is managed another way |
| Waiting for ambulance after collapse with return of breathing | Major bleeding still uncontrolled—control bleeding and shock in parallel |
Burns and Chemical Splash — Basic Awareness
Thermal burns (heat/flame/hot liquid)
| Do | Do not |
|---|---|
| Cool with cool running water for a prolonged period as taught (often up to about 20 minutes for many thermal burns—follow your course) | Apply butter, oil, toothpaste, raw egg, or traditional pastes |
| Remove constricting jewellery/watches near the burn if safe and early | Burst blisters casually |
| Cover with clean non-fluffy dressing or cling film loosely as taught | Pack with ice directly (can cause cold injury) |
| Treat for shock on large burns; call emergency help | Remove clothing that is stuck to the burn—cut around it |
| Electrical burn: ensure power off; look for entry/exit; urgent medical care | Assume a small skin mark means a minor injury—electricity can damage deep tissues |
Chemical splash (skin or eyes)
| Priority | Action |
|---|---|
| 1 | Protect yourself (gloves, avoid the chemical) |
| 2 | Remove contaminated clothing carefully (avoid spreading chemical to face/eyes) |
| 3 | Irrigate with plenty of water as trained—for eyes, continuous gentle irrigation and urgent medical care |
| 4 | Note the chemical name/SDS if known for handover |
| 5 | Do not neutralise acids with alkalis (or reverse) unless a specialised protocol says so—heat reactions can worsen injury |
Cement burns, battery acid, solvents, and process chemicals are common on Nigerian construction and industrial sites—irrigation and medical escalation beat folk remedies.
Do-Nots Table (High-Yield Exam Content)
| Do not | Why |
|---|---|
| Become a second casualty | Two emergencies instead of one |
| Give food or drink to a shocked or major-trauma casualty awaiting care | Vomiting/aspiration risk; surgery complications |
| Pull out impaled objects | May worsen bleeding and damage |
| Remove blood-soaked dressings | Disrupts clots—add dressings on top |
| Use untrained tourniquets as a first habit | Tissue damage; wrong placement |
| Place unconscious breathing casualty flat on their back unattended long-term | Airway risk from tongue/vomit—prefer recovery position when appropriate |
| Put butter/toothpaste on burns | Traps heat; contaminates wound |
| Enter confined spaces or toxic atmospheres for rescue without training/equipment | Rescuer death |
| Leave severe bleeding or shock “to rest alone overnight” | Rapid deterioration |
| Claim study-guide theory equals full first-aid licence | Practical training and site designation still required |
Integrated Nigerian Scenarios
| Scenario | Correct emphasis |
|---|---|
| Deep laceration from angle grinder on a Lagos site | Gloves, direct pressure, dressings stacked if soaking, elevation if appropriate, shock care, clinic/hospital |
| Worker faints in heat, then recovers breathing but stays drowsy | Primary survey; if unresponsive but breathing → recovery position; cool environment; medical review for heat illness |
| Acid splash in a battery room | Protect self, remove wet clothing, irrigate, urgent care, chemical identity for handover |
| Hot-water scald in a camp kitchen | Cool running water; clean cover; no toothpaste; assess extent for emergency transfer |
| Traffic-injured worker pale and clammy after external bleed controlled | Still treat for shock; keep warm; urgent medevac; nothing by mouth |
Linking Domain 6 Together
| Topic | Core memory |
|---|---|
| Principles & kits | 3 aims; scene safety; kit contents; call help; within training + consent |
| Primary survey | DRSABC → ABC |
| CPR | 30:2, 100–120/min, 5–6 cm; hands-only if needed; AED; awareness ≠ certificate |
| Bleeding / shock / recovery | Pressure; shock care; recovery position; cool burns; know the do-nots |
Exam Focus
Expect items on direct pressure, not removing soaked dressings, shock signs and lying down/keeping warm, recovery position criteria (unresponsive + breathing), cool water for burns, chemical irrigation, and classic do-nots (butter on burns, food in shock, pulling impaled objects). Prefer answers that combine life-saving simplicity with early professional help.
Test Your Knowledge
What is the primary method taught at Basic HSE level for controlling severe external bleeding?
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Test Your Knowledge
Which set best describes common signs of circulatory shock and the correct first-aid management priorities?
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B
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D
Test Your Knowledge
When is the recovery position most appropriate, and which burn action is correct at Basic HSE awareness level?
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B
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D
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