Bleeding, whether internal or external, as a result of an accident (a wound or bruising) or pathological (haemophilia), is considered to be a haemorrhage. The first thing you need to know is the difference between an external haemorrhage and an internal haemorrhage.

� External haemorrhage: when we see that blood is coming out of a wound. It may be caused by a cut or other kinds of trauma.
� Internal haemorrhage: when the blood does not flow outside the body but stays inside, building up under the skin or in a body cavity. It may be caused by crushing, puncture wounds, damage to organs and blood vessels, and fractures.

But this is not the only way haemorrhages can be classified. Depending on where the blood is coming from, different types of haemorrhage may be identified. These are:

Capillary or Superficial Haemorrhage: when the blood is coming from blood vessels near the surface of the skin.
Characteristics: this is a light, slow bleeding which seems to come from the skin tissue itself and can be easily stemmed.

Venous Haemorrhage: when the blood is coming from a vein, whose job it is to carry blood from the vital organs back to the heart.
Characteristics: this is a steady, slow, slight or copious bleeding, and the blood is dark red since it contains less oxygen.

Arterial Haemorrhage: when the blood is coming from an artery, whose job it is to carry blood from the heart to the rest of the organs.
Characteristics: this is an intense, copious and pulsing haemorrhage because the blood is circulating under greater pressure and each heart beat raises that pressure. The blood is bright red because it is full of oxygen.

What to do?
The important thing is to know what to do. Not to panic, to act calmly and to do what we can but without trying play at being emergency doctors if we don�t know what we are doing. The body has natural mechanisms of its own to stop bleeding. The blood clots, and a process of natural repair and healing begins. However there are some things that you can do to help:�

If the haemorrhage is external:
� Lay the victim down.
� Put on some gloves and locate the wound.
� Apply a compress, dressing or clean cloth to the wound and press hard.
� If the haemorrhage is coming from a limb, raise it, unless you suspect the presence of an injury to the spinal column or fractures. Raising the affected limb lowers the blood pressure to that area and so slows down the haemorrhage.
� Bandage the wound leaving the compress, dressing or cloth you used originally in place.
� Call for medical help.

� If the arterial haemorrhage is in the arms, apply pressure to the brachial artery, which is on the inside of the proximal third of the arm (upper arm), to reduce the flow of blood into upper arm, forearm and hand.

� If the arterial haemorrhage is in the legs, the pressure should be applied to the femoral artery in the groin, to reduce the flow of blood into thigh, leg and foot.

� As a last resort make a torniquet with a folded triangular bandage or a strip of cloth at least 4 cm wide. Place the bandage at four fingers distance above the wound, wind it twice round the arm or leg, tie the ends in a knot, place a short, strong stick over the knot and tie the ends again in a double knot to secure the stick. Then turn the stick gently so as to increase the pressure until the bleeding stops. Release the pressure every seven minutes.

� The patient can be given water or serum to drink .

If the haemorrhage is internal:
� Call an ambulance immediately.
� Keep the person still.
� Loosen any tight clothing.
� Raise the patient�s head and feet by putting a pillow or folded jacket under them. The feet should be higher than the head.
� Cover the patient with a blanket or coat to keep them warm.
� Turn the patient very carefully onto their side to aid breathing.
� Do not give the patient any water even if they are complaining of being very thirsty.

State of shock
It is important to see if the person who is haemorrhaging is in a state of shock. Watch for the following symptoms:
� Extreme paleness.
� Cold, clammy skin.
� Weak and rapid pulse rate.
� Laboured breathing.
� Feeling faint.
� Unconsciousness.
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If you find these symptoms, you need to get the patient straight to hospital, check their breathing and pulse rate every five minutes, cover them up well and do not give them anything to eat or drink.

Normally, a state of shock is a symptom of an internal haemorrhage, along with a hard or highly sensitive abdomen, the loss of blood through the anus or vagina and vomiting blood.

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