First aid for self-harm resource: cuts

This resource contains information which may be useful for performing care or advocacy work, or describes overall policy and principles.

This protocol is a draft. It has not yet been accepted as protocol and may be incorrect or poorly cited. Please do not use this in your work until it has been accepted.

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This is a resource for people who are self-harming, or people who are supporting someone who self-harms. It covers some basic first aid tips for treating cuts caused by self-harm. See the other first aid for self-harm resource pages for information about other kinds of injury.

You may also want to see our 'Safer self-harm resource' for discussion of how to reduce the risk of serious injury.

This is not a substitute for first aid training and does not qualify anyone to describe themself as a ‘first aider’.

This guide sets out signs that an injury may present an urgent/potentially life-threatening risk, requiring an ambulance. It also covers situations where the injury is likely to deteriorate and risk further damage unless you go to A & E or seek other urgent medical treatment. You can still call an ambulance in these scenarios if you don’t feel well enough to travel to hospital.

We recognise that many people may be concerned about the potential consequences of going to hospital after self-harming. This resource is intended to help you assess when the risks of not getting medical help may outweigh the risks of doing so.

If you are supporting another person to treat their injuries, it’s also important to remember the risks of disease transmission, and wear gloves while handling any bodily fluids.

Cuts

How to treat

If blood is spurting or pouring from the wound, you have punctured an artery - call 999 urgently. See the sections on going to A&E or calling an ambulance for other indications of more serious injuries.

Stop the bleeding by applying pressure. As you do this, keep the cut elevated above your heart if possible. Then clean the wound before dressing it.

1. Pressure
   • Press down onto the wound to stop the bleeding.
     • If possible, press on the injury through a sterile dressing pad, otherwise you can use a clean non-fluffy cloth.
   • If an object is stuck in the wound:
     • Press around the sides of the object to stem the bleeding
     • Do not attempt to remove the object.
     • Do not press the object itself.
   • If a cut is bleeding heavily:
     • It may take 10 minutes of continuous pressure to stem the bleeding
     • Don’t stop to check the injury while you’re applying pressure - this will interrupt the clotting process
     • If blood soaks through the pad, add another one on top rather than removing the first
2. Elevation
   • If possible, raise the cut above the level of your heart while you are pressing on it.
     • For example, you could lift your cut arm in the air while gripping the cut with your other hand.
     • With cuts in other locations, it may be difficult to do this without help. If you can’t apply pressure while elevating the wound, it’s more important to focus on pressure.
3. Cleaning
   • Clean the wound by rinsing it thoroughly under running water - tap water is fine.
     • If you can’t easily do this, you can use an alcohol-free saline wound wipe .
     • Don’t scrub the injury, as this may restart the bleeding
     • Pat the skin around the wound dry before you dress it
4. Dressing
   • Dress the wound as soon as possible after cleaning.
     • Dressings must include a sterile pad placed directly over the wound, plus a covering to fasten and protect this.
     • These can be all-in-one (e.g. plasters), or 2 separate parts (a dressing pad plus bandage or adhesive tape)
   • If you are planning to use steri-strips/butterfly stitches
     • Use these only if the wound is very clean, otherwise you may trap infection inside.
     • Follow the directions carefully to make sure that the edges of the cut line up
     • They only hold the top layers of skin together, so are not recommended for deeper cuts.

Call an ambulance if...

• You see large quantities of bright red blood spurting from the wound in time with your pulse.
  • This means that you’ve punctured an artery and will lose a dangerous amount of blood very quickly. Call 999 urgently and press directly on the wound as hard as you can.

• You have lost a lot of blood and notice any of the following symptoms
  • You feel weak, dizzy, sick or confused.
  • Your skin feels cold, but clammy and sweaty.
  • Your skin looks paler than usual (lighter skin) or has a greyish tone (darker skin).
  • This is called ‘shock’, and indicates that there is not enough blood circulating to your tissues and organs. Call 999 urgently and lie down with your feet propped up on a chair.

Go to A & E/get urgent medical help, if...

• There is an object stuck in the wound.
  • If you pull it out yourself, this might trigger dangerous levels of bleeding, if the object was plugging a punctured blood vessel.
  • It might also cause more damage to the edges of the wound.

• The wound is still bleeding after 10 minutes of continuous pressure.
  • If you lose too much blood, this will reduce your body’s ability to circulate oxygen to your tissues and vital organs.

• You have lost sensation in the area near the wound (e.g. your skin feels numb when you touch it).
  • This suggests you might have damaged a nerve, which may need surgery to repair it.

• You have developed difficulties with movement in the limb you cut (e.g. you can’t bend/straighten your fingers)
  • This indicates possible tendon damage, which means that you may need surgery to restore your ability to move.

• The wound is deep enough to see yellow fat, dark red muscle, or bone (which will look yellow, not white).
  • This presents a high infection risk and is likely to heal poorly unless you get it sutured. If you use steristrips, the lower levels of flesh will still be gaping apart.

Infected wounds

Cuts and burns may both become infected, in which case they will require treatment with antibiotics.

Call an ambulance if...

• The wound looks infected and you start to feel seriously ill in any way, including but not limited to:
  • Feeling feverishly hot or extremely cold
  • Feeling confused or sleepy
  • Shivering or muscle pain
  • Fast breathing or breathlessness

• These are possible signs of sepsis, a life threatening condition when your body responds to infection by attacking its own tissues and organs.

Go to A & E/get urgent medical help, if...

• You see any of the following signs of infection, but aren’t otherwise feeling ill
  • yellow or green pus (some clear fluid from burns is normal)
  • bad smell from the wound
  • skin around the wound feels hot
  • increased pain around the wound
  • increased swelling around the wound
  • on lighter skin, visible redness spreading from the injured area