The first 60 seconds

Your first job is not to grab the fanciest item in the trauma kit. It is to make sense of the scene and get lifesaving help moving.

1. Look for immediate danger.Traffic, fire, electricity, running machinery, broken glass, weapons, or unstable structures can create a second patient. Make the scene reasonably safe.
2. Activate EMS.Call 911. If others are present, point to a specific person: “Mike, call 911 and put it on speaker.” Send another person for the trauma kit or AED.
3. Protect yourself when possible.Use gloves or another barrier if readily available, but do not allow a search for perfect equipment to create a dangerous delay.
4. Find the source.Expose the injured area enough to locate the bleeding. Clothing can hide a serious wound.
5. Start controlling it.Apply firm direct pressure while you decide whether the wound needs continued pressure, a tourniquet, or packing.

Recognize the threat

You do not need to decide whether an artery or vein was injured. You need to recognize when blood loss is immediately dangerous.

Signs of life-threatening bleeding

Direct pressure

Direct pressure is simple, fast, and effective. It is often the first action for severe external bleeding while other equipment is being obtained.

1. Expose and locate the wound.Remove or cut clothing only as needed to see where the blood is coming from.
2. Place gauze or a clean cloth over the source.If nothing suitable is immediately available, use your gloved hand.
3. Press firmly and continuously.Use the heel of your hand and enough body weight to compress the source.
4. Do not repeatedly lift the dressing to look.That releases pressure and disrupts clot formation. If blood soaks through, maintain pressure and add material without removing the original layer.
5. Escalate when appropriate.For life-threatening limb bleeding not controlled by pressure, use a commercial tourniquet. For a deep wound in a location where a tourniquet cannot be used, wound packing may be appropriate.

Tourniquets

A commercial tourniquet is for life-threatening bleeding from an arm or leg. Correct use is more important than brand loyalty.

1. Place it on the injured limb.Position it about 2–3 inches above the wound, between the wound and the torso. Never place it directly over a joint. If the wound cannot be located quickly, place it high on the limb.
2. Pull the strap tight.Remove as much slack as possible before operating the windlass.
3. Turn the windlass until bleeding stops.It will hurt. Secure the windlass so it cannot unwind.
4. Reassess.If life-threatening bleeding continues, tighten further or apply a second tourniquet above and next to the first.
5. Record the time.Write down the application time and tell EMS.

Common failures

Placing it too low, putting it over a knee or elbow, leaving slack in the strap, failing to tighten until bleeding stops, covering it with clothing, or loosening it because the patient reports pain.

Wound packing

Packing is used for certain deep, severely bleeding wounds where a tourniquet cannot be applied, such as the groin or armpit.

1. Expose the wound and identify the source.Use gauze to wipe away pooled blood only as needed to see into the wound.
2. Place gauze directly at the bleeding source.Maintain pressure with a finger while feeding gauze into the cavity.
3. Fill the entire wound cavity.Pack tightly with continuous gauze until there is no space left.
4. Apply firm pressure.Hold pressure according to the product instructions and until bleeding is controlled. Secure with a pressure dressing if available.
5. Reassess continuously.If bleeding continues, maintain pressure, add packing as needed, and follow dispatcher instructions.

Hemostatic gauze

Hemostatic gauze contains an agent that supports clotting. It is still gauze: it must be placed at the bleeding source, packed correctly, and held under firm pressure. It is not poured or sprinkled into a wound, and it does not replace good technique.

After it stops

Bleeding control is not the end of the emergency. The injured person can deteriorate, and your treatment can fail if it is not watched.

1. Recheck the wound.Confirm bleeding remains controlled. Check around and beneath the person for blood you may have missed.
2. Monitor breathing and responsiveness.Tell the dispatcher immediately if the person becomes unresponsive or is not breathing normally. Follow CPR/AED instructions.
3. Prevent heat loss.Place a blanket or coat under and over the person when possible. Do not overheat them.
4. Do not give food or drink.Keep them as calm and still as circumstances allow. Do not move them unless there is danger or the dispatcher directs you.
5. Prepare a clear handoff.Tell EMS what happened, where the wounds are, what you did, whether bleeding restarted, and the tourniquet application time.

Choose the tool

Real emergencies do not arrive labeled “tourniquet question.” Identify the location and severity, then choose the simplest effective action.

Show your judgment

Choose the best answer for each question. A score of 80% or higher completes the course. This completion is educational only and is not a medical certification.

Knowledge is equipment you always have with you.

You have completed Nexus Civilian Medical Series, Course 01: Bleeding Control.

Take the next step

Find supervised, hands-on bleeding-control training through ACS STOP THE BLEED®. Consider a recognized first aid, CPR, and AED course through the American Red Cross or American Heart Association.