Severe Bleeding Control: 4 Life-Saving Steps (Direct Pressure → Tourniquet)

Uncontrolled hemorrhage is the #1 preventable cause of trauma death. Follow this escalating sequence:

1. Direct Pressure (First & Most Effective)

• Apply firm, continuous pressure with sterile gauze/clean cloth directly on wound.
• Use both hands; lean into it. Do not peek—clot disruption restarts bleeding.
• Maintain until EMS arrives or bleeding stops completely.

2. Elevation (Adjunct)

• Raise injured extremity > heart level while maintaining direct pressure.
• Reduces hydrostatic pressure; aids venous return.
• Do not elevate if fracture suspected (splint first).

3. Pressure Points (For Extremity Bleeding Uncontrolled by Above)

• Brachial artery (medial upper arm) → for forearm/hand bleeding.
• Femoral artery (mid-inguinal point) → for lower leg bleeding.
• Compress artery against underlying bone with fingers/heel of hand.
• Continue direct pressure on wound simultaneously if possible.

4. Tourniquet (Last Resort – Life Over Limb)

• Indication: Life-threatening limb hemorrhage unresponsive to 1–3; amputation; mangled extremity; tactical/combat setting.
• Device: Commercial windlass tourniquet (CAT, SOFTT-W, SAM-XT) – not improvised (belts, cords fail).
• Placement: 2–3 inches proximal to wound (never over joint).
• Tighten: Until arterial pulse distal to tourniquet disappears and bleeding stops.
• Time: Write application time on tourniquet/patient. Do not loosen/remove—only surgeon in OR.
• Max safe ischemia: 2 hours (muscle/nerve damage); 4–6 hours (limb loss risk).

Critical

Call 911 immediately. These are temporizing measures until definitive surgical control.