Life-saving hemorrhage control techniques with step-by-step instructions. Includes when to use tourniquets, proper application, and wound packing.
Bleeding Kills: Why This Skill Saves Lives
Uncontrolled hemorrhage is the leading cause of preventable death in trauma situations. A person can bleed to death from a severed femoral artery in as little as 3-5 minutes. In mass casualty events, natural disasters, and remote emergencies, professional medical help may be minutes or hours away. The ability to stop bleeding quickly and effectively is the single most important emergency medical skill a civilian can possess. The Stop the Bleed campaign, endorsed by the American College of Surgeons, teaches that bystanders with basic hemorrhage control training save lives every day. This guide provides detailed, step-by-step instructions for the three primary methods of controlling severe emergency bleeding: direct pressure, tourniquet application, and wound packing.
Assessing the Severity of Bleeding
Not all bleeding requires the same response. Capillary bleeding from minor scrapes oozes slowly and stops on its own. Venous bleeding flows steadily and is dark red. Arterial bleeding spurts bright red blood in rhythm with the heartbeat and is immediately life-threatening. The volume of blood loss determines urgency. An adult has approximately 5 liters of blood. Losing 1 liter causes increased heart rate and anxiety. Losing 1.5-2 liters causes confusion, weakness, and pale skin. Losing more than 2 liters causes unconsciousness and death without intervention. When you see bright red blood spurting or pooling rapidly, act immediately. Do not waste time removing clothing to find the exact wound. Apply hemorrhage control through the clothing if necessary. Speed saves lives in trauma care situations.
Direct Pressure: Your First Response
For most bleeding wounds, firm direct pressure is the first and often only treatment needed. Place a clean cloth, gauze pad, or even your bare hand directly over the wound and press firmly. Maintain constant, firm pressure for a minimum of 10 minutes without lifting. Lifting the dressing disrupts clot formation and restarts bleeding. If blood soaks through the first dressing, add more material on top without removing the original dressing. For wounds on extremities, elevate the injured limb above the heart while maintaining pressure to reduce blood flow to the area. Direct pressure controls the majority of bleeding wounds effectively. However, when direct pressure fails to control bleeding from an extremity wound, or when the bleeding is too severe for pressure alone, escalate immediately to tourniquet application.
Tourniquet Application: Step by Step
Commercial tourniquets like the CAT Gen 7 and SOFTT-W are designed for rapid, one-handed application. Place the tourniquet 2-3 inches above the wound, never directly on a joint. Pull the strap tight and secure the velcro. Turn the windlass rod until bleeding stops completely. You will need to turn it tighter than feels comfortable. Secure the windlass in the clip and note the time of application on the tourniquet or the patient's forehead. A properly applied tourniquet is painful, this is normal and expected. Do not loosen it due to patient complaints. Once applied, only a physician should remove a tourniquet. Common mistakes include placing the tourniquet too loosely, which increases bleeding by blocking venous return while allowing arterial flow, and placing it too close to the wound where tissue damage prevents effective compression. Practice tourniquet application regularly until you can apply one in under 30 seconds.
Wound Packing for Junctional Hemorrhage
Some severe bleeding occurs in areas where tourniquets cannot be applied: the neck, armpit, groin, and torso. For these junctional wounds, wound packing is the primary hemorrhage control technique. Using hemostatic gauze like QuikClot Combat Gauze, pack the wound cavity tightly by feeding gauze directly into the wound and pressing firmly. The hemostatic agent in the gauze accelerates clotting while the physical packing creates pressure from within the wound. Continue packing until the wound is completely filled, then apply a pressure dressing over the packed wound and maintain firm pressure for 3-5 minutes. This technique requires overcoming the natural reluctance to push material into a wound, but it is the most effective method for controlling life-threatening emergency bleeding in areas inaccessible to tourniquets. Practice on wound packing trainers to build confidence and technique.
After Bleeding Is Controlled
Once bleeding is controlled, monitor the patient continuously for signs of shock: pale skin, rapid weak pulse, confusion, and cold extremities. Keep the patient warm with blankets or emergency blankets, as blood loss impairs the body's ability to regulate temperature. Elevate the legs if no spinal injury is suspected to improve blood flow to vital organs. Do not give food or water to a patient with significant blood loss, as they may need surgery. Document the time of tourniquet application, estimated blood loss, and the patient's vital signs. Seek professional medical care as soon as possible. Even with successful hemorrhage control, patients with significant blood loss need IV fluids, blood transfusions, and surgical repair. Your trauma care actions in the first minutes buy the time needed for definitive medical treatment to save the patient's life.
Dr. Amanda Foster
Dr. Foster is an emergency medicine physician and Stop the Bleed instructor who has trained thousands of civilians in hemorrhage control.