Bleeding, burns, sprains and other injuries

30 min

Hands, water and cold

Most first aid for injuries needs very little equipment. For bleeding, the most important tool is your hands pressing on the wound. For a burn, it is cool running water, and time. For a sprain, it is stopping, keeping still and a little cold. What matters is doing the right thing in the right order, and avoiding the old habits that do harm: pressing on "pressure points", rubbing butter on burns, or sending a limping player back on. This lesson gives the procedures for the injuries you met in lesson 2, based on the ERC Guidelines 2025, ILCOR and WHO, and on the ERC 2021 guidance for burns and joint injuries, which the 2025 guidelines did not review again.

Definition

Direct pressure: firm pressure with the hand, or a dressing under the hand, straight onto a bleeding wound.

Pressure dressing: a dressing bandaged firmly enough to keep pressure on a wound once the bleeding is under control.

Tourniquet: a strap tightened around a limb above a wound to stop life-threatening bleeding that direct pressure cannot control.

Cold therapy: cooling a closed injury, such as a bruise or sprain, with a wrapped cold pack or ice and water in a bag.

Splint: a support that keeps an injured limb still in the position it was found.

Three action cards

Bleeding (ERC 2025)

Apply firm direct pressure to the wound straight away. Put a standard or haemostatic dressing into or onto the wound and press firmly on top; once the bleeding is controlled, apply a pressure dressing.
For life-threatening bleeding from an arm or leg that direct pressure does not control, apply a tourniquet as soon as possible: 5 to 7 cm above the wound, not over a joint, tightened until the bleeding slows and stops (this hurts). Write the time on it and never loosen it: only a health professional removes it.
Do not use "pressure points" away from the wound instead of direct pressure: ILCOR recommends against it.
Small cuts and grazes: rinse with clean running water, then cover with a clean dressing or plaster.

Burns

Cool the burn at once with cool running water: ILCOR (2025) makes this a strong recommendation for adults and children.
Keep cooling for 20 minutes. The ERC 2021 guideline says at least 20 minutes; ILCOR found no study proving one exact time better than another, so 20 minutes remains the standard to teach. Watch young children for getting too cold.
Remove rings, watches and clothing from the area unless they are stuck to the skin. Cover loosely with cling film or a clean, non-fluffy dressing, and get medical care.
Never put ice on a burn (it deepens the injury), and never apply paste, oil, butter, toothpaste or raw cotton (WHO). Do not burst blisters.

Sprains, strains, fractures and head injuries

Sprains and strains: stop the activity and ask the person not to move the injured joint (ERC 2021). A cold pack or ice and water in a bag, wrapped in a cloth, may ease pain and swelling; apply it for no more than about 20 minutes at a time, never directly on the skin. A compression bandage on a sprained ankle is optional: ILCOR (2025) found no evidence that wrapping helps or harms, and it needs training to apply well.
Fractures and dislocations: do not try to straighten the limb or push a joint back. Support it in the position found, with a splint or sling if you are trained, and get medical help; call 912 for an open fracture, a deformed limb or a suspected thigh, neck or back injury.
Concussion: remove from play, refer to a health professional, and no return to play that day.
Heat stroke: call 912, move into shade, remove excess clothing and cool actively with whatever is at hand.

Worked example

Worked example 1: a deep cut at sports day. At 14:50 a pupil slips on the edge of the track and a broken bottle cuts deep into his calf. Blood is pumping out and soaking through a towel.

Make the area safe, put on gloves and shout for someone to call 912.
Press firmly and directly on the wound; push a dressing or clean cloth into it and keep pressing on top.
At 14:52 blood is still pouring through. A tourniquet from the kit is placed 5 to 7 cm above the wound, not over the knee, and tightened until the bleeding stops. Write 14:52 on it.
Do not loosen it. Keep him lying down and warm, and tell the ambulance crew the time it was applied.

Worked example

Worked example 2: a scald at a sports camp. At 18:05 a pupil spills boiling water from a kettle over the back of her hand.

Hold the hand under cool running water straight away. Take off her ring while you can, before the hand swells.
Keep cooling until 18:25: $18{:}05 + 20\,\mathrm{min} = 18{:}25$ .
Cover the burn loosely with cling film and take her to a health centre. No ice, no oil, no toothpaste.

Worked example

Worked example 3: an ankle sprain in netball. A shooter lands on the side of her foot. She can stand, with pain and swelling below the outer ankle bone.

Stop play and help her off without putting weight on the foot. Ask her to keep the ankle still and support it on a folded jacket.
Wrap a cold pack in a cloth and hold it on the ankle from 10:10, removing it by 10:30 at the latest.
Whether to add a compression bandage depends on training: ILCOR finds either choice acceptable for an ankle.
If later she cannot take four steps on it, or the ankle looks deformed, treat it as a possible fracture and get it checked.

Video: "First Aid Training: Life-threatening bleeding", St John Ambulance. A short demonstration of direct pressure and of applying a tourniquet. The video gives UK emergency numbers: in Rwanda, call 912.

Warning

Harmful habits to unlearn. Pressing on pressure points instead of the wound. Loosening a tourniquet "to let the blood through". Putting ice, butter, oil or toothpaste on burns. Holding ice directly on the skin, or for a long time. Pulling on a deformed limb to straighten it. Giving a player with a head injury painkillers and sending them back on. Always protect yourself with gloves when blood is present.

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Practice

What is the first thing to do for a heavily bleeding wound?
Where should a tourniquet be placed, and what must you write on it?
For how long should a burn be cooled, and with what?
Name three things that must never be put on a burn.
How long, at most, should a wrapped cold pack be held on a sprain at one time?
A player's forearm is bent at an odd angle after a fall. What should you do, and what should you not do?
A pupil's arm is burnt at 09:47. At what time can the cooling stop?
Evaluate this advice from a spectator: "Raise the bleeding leg and press on the groin instead of the wound."

Show answersHide answers

Apply firm, direct pressure on the wound (with gloves if available), then a dressing pressed on firmly.
5 to 7 cm above the wound, on the limb, not over a joint; write the time it was applied.
20 minutes, under cool running water, starting at once.
Any three: ice, oil, butter, paste or toothpaste, raw cotton.
About 20 minutes, wrapped in a cloth, never directly on the skin.
Support it in the position found (splint or sling if trained), keep the person still and get medical help, calling 912 if it is serious. Do not try to straighten it.
10:07 (09:47 + 20 minutes).
Poor advice. ILCOR recommends against using pressure points instead of direct pressure, and raising the limb is not a substitute for it. Press directly on the wound with a dressing; if a limb is still bleeding life-threateningly, apply a tourniquet and call 912.

Remember

Bleeding: direct pressure, dressing, pressure dressing; tourniquet for uncontrolled limb bleeding, time written, never loosened.
Burns: cool running water at once, for 20 minutes; cover loosely; no ice, oil or paste.
Sprains: stop, keep still, wrapped cold for up to 20 minutes; compression optional.
Fractures: do not straighten; support as found.
Concussion: off, referred, no return that day.

1Hands, water and cold

2Three action cards

3Bleeding (ERC 2025)

4Burns

5Sprains, strains, fractures and head injuries

Hands, water and cold

Three action cards

Bleeding (ERC 2025)

Burns

Sprains, strains, fractures and head injuries