24 Oct 2019
Guideline for Controlling Bleeding in Combat Sports (Australia)
Peter Allan
4 months ago

Guideline for Controlling Bleeding in Combat Sports (Australia)

In Mixed Martial Arts (MMA), athletes are at a high risk of requiring treatments for the management of bleeding. This guideline is to be used in combination with latest ANZCOR Guideline 9.1.1 First Aid Management of Bleeding (Australian Resuscitation Council). This guideline will cover the additional considerations for the management of both internal and external blood loss from an athlete during the participation within MMA. The management of a bleeding athlete must be taken seriously to safeguard the short- and long-term health and welfare of both the athlete and the person conducting the treatment.

Standard Precautions

Standard precautions are meant to reduce the risk of transmission of pathogens (viruses, bacteria, etc) from both recognized and unrecognized sources. They are the basic level of infection control precautions which are to be used, as a minimum, in the care of all athletes.

The standard precautions to be used within the management of bleeding include:

  • Hand washing (Before and after each treatment of an athlete)
  • Use of PPE such as gloves, glasses and face masks

External Bleeding

The use of pressure on or around the wound is usually the fastest, easiest and most effective way to stop external bleeding.


  • Use standard precautions (e.g. gloves, protective glasses) if readily available.
  • Management of all bleeding begins with application of pressure on or around the wound.
  • Advise the athlete to minimize their movement.
  • During competition the use of natural haemostatic products can be used.
  • If the athlete continues to fight, it is recommended direct pressure is applied for as long as possible and then coat the wound lightly with petroleum jelly.

Haemostatic products

Haemostatic products include gauze and dressings impregnated with natural agents that help stop bleeding. The haemostatic products recommended for use in Australia contain an agent called ‘kaolin.’  They are commonly used to control bleeding in the surgical and military settings but their use in the combat sports assist in the control of bleeding is becoming more common.

Adrenaline (Epinephrine)

The use of Adrenaline during competition in Australia is not recommended due to the safety risks to the athlete

The World Anti-Doping Agency lists Adrenaline on its prohibited substance list unless used as a local anaesthetic by a registered medical health professional. Within Australia adrenaline is a scheduled medication and an appropriate authority is required for use and possession. Adrenaline being a medication has many side effects, which include placing an increased amount of stress on the heart, using such a medication, including topically, is dangerous and can have severe outcomes for an athlete.

Internal Bleeding

Internal bleeding includes bruising, locally contained bleeding (e.g. an “egg on the head”) and can be associated with injury in the abdomen, chest or fracture.

Symptoms and signs may include:

  • pain, tenderness or swelling over or around the affected area
  • the appearance of blood from a body opening
  • shock in the case of severe bleeding


  • Use standard precautions (e.g. gloves, protective glasses) if readily available.
  • Cool the area and apply pressure (end-swell).
  • Advise the athlete to minimise their movement.


End-swell, sometimes called an Eye Iron, Enswell, Endswell, Stop-swell or No-swell, is a small smooth piece of thick metal with a handle. It is kept in the ice bucket and is used to cool the area of a bruise or a cut by applying direct pressure to decrease the blood flow to the area. The idea being that the cold will cause capillaries to constrict and reduce the flow of blood to the swelling.

When using End-Swell’s between athlete’s they are required to be cleaned appropriately to prevent the transmission of pathogen’s.

Nose Bleeding (Epistaxis)

Athlete’s participating in MMA have a high risk of trauma related nose bleeds. The following are additional guidelines for athletes with
bleeding from the nose.

Additional Treatment

  • Pressure must be applied equally to both sides of the nose, over the soft part below the bony bridge (usually between the thumb and index finger). The hand controlling the bleed should be positioned so it is not obstructing the mouth so you allow the athlete to continue breathing fresh air.
  • The athlete should lean with the head forward to avoid blood flowing down the throat.
  • Encourage the athlete to spit out blood rather than swallow it as swallowed blood irritates the stomach and causes vomiting, which can worsen the bleeding.
  • Following competition, the athlete should remain seated and maintain pressure for at least 20 minutes.
  • The athlete needs to be advised not to blow their nose. This is for several reasons:
    • will dislodge any blood clot and cause further bleeding.
    • Increases vascular pressure and may cause swelling around their eyes if they have an active internal bleed.
  • If bleeding continues for more than 20 minutes seek medical assistance.


Australian Resuscitation Council. Jul 2017. ANZCOR Guideline 9.1.1 Management of Bleeding, retrieved from https://resus.org.au/guidelines/

World Anti-Doping Agency. Jan 2019. Prohibited List, retrieved from https://www.wada-ama.org/en/resources/science-medicine/prohibited-list-documents