Writing Blood Loss: FightWrite™

Trained fighter and author Carla Hoch shares the science and storytelling behind writing about blood loss and injuries.

A Pirate Fantasy writer recently asked me, “Where can I injure a character with a blade that will take a while to bleed out?”

(A Blessing for Writers and Storytellers in 2023)

That is a great question, and is probably in my top five most asked. The query is generally driven by the writer needing to know how much dialogue they can write for the injured character before they die. And that is a very important consideration if you want to keep the writing realistic. However, there’s actually another reason why we authors should be familiar with bleeding out that has nothing to do with duration of dialogue before death. And that reason is squarely focused on the most important part of our work: our readers.

The Setting Sets the Science

Because I hear this question so much, the first question I ask in return is, “What is the setting of your work?” The time period in which your work takes place generally dictates the medical care available to your injured character. If your genre falls under the speculative fiction umbrella, you determine the science of the time. When that is the case, be sure to establish normalcy as soon as you can and stick to it. If in your work there’s not really such a thing as a mortal injury, present that as a reality. You don’t have to explain it, you just have to make it real. Do any of us understand the science of how vampires live eternally on nothing but raw blood – which isn’t even digestible by humans? No. But we can tell you the rules of that science as if they are fact.

Any wounded character living in a normal timeline is at the mercy of the era. The correct care for a wound isn’t as important as whether the people of that time period are aware of it. Remember, once upon a time, people were bled on purpose to heal them. Sometimes they were bled to the point of death. But, hey, at least they weren’t sick anymore!

What Injuries Bleed Out

In my book, Fight Write: How to Write Believable Fight Scenes, there is a blood vessel map. It shows where the arteries and major veins track and connect throughout the body. Arteries carry oxygenated blood away from the heart. They tend to be deeper in the body, there are fewer of them than veins, and they are deep red in color. Arterial injuries spurt blood.

Veins carry de-oxygenated blood back to the heart. They are at different levels of depth in the body from deep within muscles to the surface of the skin. Because the blood they carry is low in oxygen, they are blue in color. Venous injuries flow blood steadily.

Whenever an artery or large vein is cut at all, even nicked, there is the potential to bleed out without the proper clotting factor. However, even with normal clotting, a large enough cut to a major vessel may cause death. If a large blood is severed completely, there’s likely no chance of survival. It is simply too difficult to compensate for that amount of blood loss that quickly, even with modern medicine.

IndieBound | Bookshop | Amazon
[WD uses affiliate links.]

How Much Blood to We Have

Blood accounts for about seven to eight percent of an adult’s body weight, eight to nine percent of a child’s body weight, and nine to 10 percent of an infant’s body weight. Why does that matter? Because the bigger you are the more blood you have. A character who weighs 200 pounds will carry more blood volume than one who weighs 100. That means if the two sustain the exact same bleeding, mortal wound, the larger character will take longer to die than the smaller. This is very, very important in a fight scene and why smaller characters should gird their loins well! It’s also why larger characters may need more injuries to bleed out.

How Blood Smells

If you’ve heard blood has a metallic smell, that’s dead on. It also tastes very tinny. A few weeks ago, I got a very bloody nose at the gym while sparring. The blood flowed down my throat and into my mouth, which is common for nose bleeds. The blood tasted like I had a mouth full of pennies. As blood congeals and rots, the smell grows stronger and sharpens and makes most humans recoil.

Blood Loss By Volume

Because the amount of blood we carry is a percentage of our body weight and not a strict volume, we have to look at blood loss by percentage. Each classification of blood loss has specific symptoms.

Class I Hemorrhage: Up to 15 percent blood volume. This is about how much blood we lose when we donate blood. This classification has few symptoms although some people, especially those lower in weight, can feel tired or feel faint. If they actually faint, it is not likely because of the blood loss. Some people simply faint at the sight of blood. It isn’t necessarily because they are squeamish. Their brain simply may think it is in trouble and needs more blood flow. For more blood flow, the brain needs to be level with the heart. The brain creates this lateral scenario by making the body pass out and go down.

Class II Hemorrhage: 15-30 percent blood volume. The heart will beat faster to try and oxygenate the blood left in the body. The victim will feel physically weak and breathe rapidly. The skin will pale, feel cool and mottle. They also may develop a headache, nausea or sweat profusely. The character may also feel anxiety or confusion.

Class III Hemorrhage: 30-40 percent blood volume. The heart will race, blood pressure will drop. There will be extreme fatigue and possibly confusion/panic. The character may feel very afraid and, even without seeing the amount of blood they have lost, feel like they are going to die. There will possibly be a headache, nausea, and a grayness to the skin. Lips and fingernails may turn blue. The character will likely pass out in a class III hemorrhage. On the plus side, the pain response will greatly diminish.

Class III Hemorrhage: More than 40 percent blood volume. The body will turn bluish gray and may go into a coma before the heart stops.

Does Bleeding Out Hurt?

I have been asked before if bleeding to death hurts. The answer is a solid yes and no. If it happens quickly, the body will not have time to register pain. If it happens slower, the person may have mild to extreme pain in their muscles until they get to a class III hemorrhage and the pain response lessens. Or, they may not feel a thing. A friend of mine lost so much blood she turned gray but she was still cracking jokes. She said it didn’t hurt, she just felt tired and couldn’t understand why the doctors were so concerned about her. She’s alive and well, by the way.

Basics Care for Bleeding

Here are a few basics for controlling bleeding acutely. Even characters without medical training from the past or present may know these basics.

Calm the bleeding character to slow the heart rate. Elevate the wound above the heart if possible. Apply direct or indirect pressure. Direct pressure is directly over the wound. If after 30 minutes or so the bleeding hasn’t slowed, apply a wrap with pressure and leave it until you can reach medical assistance. Indirect pressure is applying pressure to the vessels that feed the wound site. A character may also do what’s called digital ligation, meaning they place one or two fingers directly on the bleeding vessel. This may mean placing fingers inside the wound. Finally, a tourniquet may be applied. This should be a last measure. A tourniquet cuts off the blood supply and if left in place too long can cause a loss of the limb.

If the object causing the bleeding is still in the wound, do not remove it. Only a surgeon should do that. It’s possible that the wounding item is actually staunching the flow of blood or sealing it off completely. If removed, the clotted blood will be pulled away from the vessels and bleeding will resume.

What This Has to Do with Our Reader

Whenever we write, it is almost always better to show than tell. Showing allows a reader to relate. A reader may not understand what it is to lose a large amount of blood and certainly they won’t know what it feels like to bleed out completely. But they can understand the heart racing, panic, the skin paling and lips bluing. They also can picture pushing down on a wound with a hand and seeing blood still seep out from between the fingers. A reader will also likely understand that a character who has passed out and still has good color to their skin is in a less dire situation than if their skin is pale and lips are blue.

Just like you don’t have to be a fighter to write a great fight scene, you don’t need to be a doctor to write a great injury. And, your reader shouldn’t need to be a doctor to understand it. Keep the details correct but technical lingo to a minimum unless it is organic to the scene. Even if that is the case, if your scene takes place in an E.R., you should show what is happening to make the technical lingo make sense.

I hope this helps you in your sanguineous scenes. Injuries are such a great way to reach a reader. Regardless of who wins the fight in your scene, if you make your reader say, “ouch,” you have won. And, by the way, in case you are wondering, yes, I did write about bleeding out in honor of Valentine’s Day. This is why I simply couldn’t write a romance novel.

Struggling to choose a fighting style for your character? The struggle is over. The way your character does battle isn’t up to you. It’s up to the story. The time and place of the work, the society in which your character lives, their inherent and fostered traits and the needs of the story will determine how your character responds to aggression.

Click to continue.