First Aid Guide: Managing Catastrophic Bleeding

In this post we’re going to look in more depth at Managing Catastrophic Bleeding, how it differs from ‘Significant’ bleeding, and what should be done to manage it.

Catastrophic bleeding is becoming more a part of the public consciousness thanks to increasing numbers of terrorism incidents and incidents involving mass casualties such as shootings and natural disasters worldwide. However it has been in the parlance of the military, and of some sectors such as the Forestry industry for some time. Managing Catastrophic Bleeding forms part of the ‘+F’ requirements for first aid for forestry workers.

What is Catastrophic Bleeding?

Catastrophic Bleeding is defined by the UK Ambulance Services Clinical Practice Guidelines 2013 as: “Extreme bleeding likely to cause death in minutes.”

This differs from what we term a ‘Significant’ Bleed on our usual first aid courses. Significant bleeding forms a puddle of blood, or will soak clothing. It is typically estimated as where the adult casualty has lost c. 250mls or 1/2 pint of blood. Although dangerous, significant bleeding does not mean the casualty’s life is in immediate danger.

Catastrophic Bleeding however, means that the casualty could be losing litres of blood. The wound will be ‘gushing’ with blood, or blood may be ‘pumping’ out. We must act immediately to save their life.

Catastrophic bleeding is usually associated with amputations, or significant damage to major blood vessels. These are usually caused by lacerations, but can also be caused by complicated fractures where the broken bone damages blood vessels. If you want to see what this looks like in real life, this video of mountain biker Cedric Gracia is very instructive, and not too gory (but does show a LOT of blood).

How can I manage Catastrophic Bleeding?

Remembering to ensure first that we are safe, and the casualty has an open airway and is breathing effectively, the first rule of bleed management is applying direct pressure to the wound. Where there is a lot of blood, we will need to use something to pack the wound, and we will need a lot of pressure. There are specific bandages, heamostatic dressings, and tourniquets available that help us do that more effectively. Their use is explained in this blog and in much more detail with specific training on our Managing Catastrophic Bleeding courses.

If we don’t have the correct equipment to hand, we need to improvise with anything absorbent to pack the wound and apply pressure. Bandages and clothing are likely to be the best option. We can also improvise a tourniquet if required by using a bandage or any suitable strap, with a stick used as a windlass.

The specialist bleeding management items found in a Bleed Control Kit are easy to use, extremely effective, and can save a life. Learning how to use them properly makes them even more so.

Why should I learn more about Catastrophic Bleeding?

Our Managing Catastrophic Bleeding course is run by Toni Murch of the CELOX Academy. It is suitable for anyone who wants to take their understanding of bleed management to the next level. It is ideal CPD for first aiders with any level of experience, particularly those who work in dangerous environments such as forestry, or where a terrorist attack is an identified risk.

A Public Access Bleed Control Kit


You may have seen publicly accessible trauma or bleed control kits such as those above more frequently in cities around the UK. These are likely to become more commonplace. Although designed for lay people to use, doing our Managing Catastrophic Bleeding course will mean you are much better prepared should the worst happen.