The Association of Ambulance Chief Executives (AACE) recognises that first aid saves lives and that even basic knowledge of simple first aid skills can make a profound difference to patient outcomes.
AACE believes that education, prevention and early intervention are the most important factors in improving outcomes from injury and medical emergencies. The international evidence base supports this position.
Skills including chest compressions, use of a defibrillator and how to manage bleeding should be taught widely and their use actively encouraged. This position is consistent with the wider NHS approach that prioritises public education, prevention and bystander intervention as key components of improving survival and reducing harm.
Bleeding can occur internally or externally, depending on the cause or type of injury sustained. If not treated immediately, excessive bleeding can be life-threatening. Death from bleeding can occur before a person reaches or receives definitive care.
Many first aid skills require little or no equipment and it is the knowledge and confidence to act in an emergency that can save a life. AACE actively encourages everyone to learn first aid, in line with the NHS-supported clinical consensus and expert review (Appendix 2).
AACE recognises that bystander bleeding control using direct pressure is a simple, effective intervention that can be delivered with little or no specialist equipment and can make a critical difference in the first few minutes following injury. There are concerns that the application of some clinical equipment which requires specialist training may lead to poorer outcomes if used by those without appropriate first aid training.
When a person has an external bleed, whatever the cause, first aid measures, including applying direct pressure to an actively bleeding wound, are vital and require little or no equipment. Applying direct pressure can be undertaken with a simple first aid dressing, but if no such dressing is available, any suitable clean, dry cloth or item of clothing may be used to apply pressure to the wound.
When a 999 or 111 call is made for someone who is bleeding, the telephone triage system supports the emergency call handler to provide these specific instructions for bleeding control. NHS online systems provide the same advice.
AACE recognises that, a bleed kit (Appendix 1) may provide additional equipment to support the management of catastrophic bleeding. However, locating then retrieving a bleed kit should not delay immediate lifesaving actions. Direct pressure remains the most important first aid intervention, and bystanders should use whatever appropriate materials are immediately available while following advice provided by 999 or 111 call handlers.
Where a specific risk assessment for a geographical location, workplace, public venue or event indicates that additional trauma equipment for the management of severe bleeding may be beneficial, an organisation may choose to procure equipment either within a first aid kit or as a standalone bleed kit. Appropriate training should be provided for those who may use such equipment.
AACE strongly recommends that all first aid and emergency equipment is easily and readily available and should be stored in unlocked, clearly identifiable locations wherever possible.
It is important to note that responsibility for the governance, training, maintenance and deployment of community bleed kits does not sit with NHS ambulance services.
AACE supports ongoing research and evaluation into bystander bleeding control, public education, equipment design and clinical outcomes. Research and clinical audit will help strengthen the evidence base and support the development of proportionate, evidence-informed approaches to education, prevention and emergency preparedness.
All NHS ambulance services actively encourage people of all ages to become trained in first aid because, in many circumstances, it is these simple first aid skills, delivered quickly by confident bystanders that save lives. The provision of emergency equipment should be viewed as complementary to, and not a replacement for, widespread public education, prevention initiatives and first aid training.
References
bystander-skills-position-statement-final-august-2024.pdf
The Circuit – the national defibrillator network
Standards for Public Access Trauma (PAcT) First aid kits – equipment | ProtectUK
Bystander Bleed Control – a London Joint Position Statement – London Ambulance Service NHS Trust
Appendix 1: trauma / bleed kit types:
- A Public Access Trauma Kit (PAcT) is a specialist first aid kit designed to provide immediate treatment for life-threatening traumatic injuries, particularly severe bleeding, until emergency services arrive. It is intended to be accessible to the public and usable by anyone, regardless of their level of first aid training. PAcT kits are typically placed in publicly accessible locations such as:
- Shopping centres
- Transport hubs
- Sports stadiums
- Entertainment venues
- Public buildings
They are often described as the trauma-care equivalent of a public access defibrillator (AED), providing equipment to help save lives in the critical minutes following a serious incident.
Typical contents include:
- Tourniquet
- Trauma wound dressings
- Triangular bandages
- Protective gloves and other PPE
- Trauma scissors
- CPR face shields
- Instruction cards or guidance materials
- ‘Stop the Bleed’ – style kits, are designed specifically to support rapid bystander first aid management of catastrophic haemorrhage using first aid bleeding-control equipment and associated instructions.
The contents and configuration of different kits may vary. AACE does not endorse any specific bleed kit, product or manufacturer. Organisations should ensure that any equipment procured is supported by appropriate governance, training, maintenance, replacement and local risk assessment systems.
Appendix 2: NHS England major trauma clinical reference group consensus statements on the public use of bleed kits
