Severe bleeding (Stop the Bleed)

A person can bleed to death before the ambulance arrives. The Stop the Bleed program teaches three tools: direct pressure, wound packing, and a tourniquet. Life-threatening bleeding is bleeding that spurts or pulses, that does not stop, that forms a pool or soaks clothing or bandages, or when a limb or part of one has been lost.

Step 0: protect yourself and call

Safe scene, gloves (or a plastic bag over your hand if you have none), and 911. Expose the wound: cut or tear the clothing to see where the blood is coming from.

Direct pressure

1. Place gauze or clean cloth directly on the bleeding point (not just over the general area).
2. Push with both hands, arms straight, with all your weight. It should hurt.
3. Do not lift the gauze to "see if it has stopped." If it soaks through, add more on top and keep pushing.
4. Maintain pressure until medical personnel take over. A pressure bandage (the "Israeli" type) can replace your hands on limb wounds if you have to attend to another person.

Wound packing (deep wounds in the neck, armpit, groin, or where a tourniquet will not fit)

1. Find the source of the bleeding inside the wound.
2. Push the gauze (preferably hemostatic gauze; otherwise plain gauze or clean cloth) directly into the wound, pushing it in with your fingers until it completely fills the space.
3. Keep stuffing in gauze until no more fits and a little sticks out.
4. Press hard on the packed wound with both hands for at least 3 minutes (or whatever the hemostatic gauze packaging says), and then maintain pressure until help arrives.

Tourniquet (arms and legs)

The tourniquet is the most effective tool for severe bleeding in a limb. Use a commercial windlass tourniquet (for example, one of the models recommended for military and emergency use). Improvised ones made with belts or cords often fail: if you improvise, use a wide band of cloth, 1.5–2 in (4–5 cm) wide, and a rigid rod as the windlass.

1. Place it 2–3 in (5–8 cm) above the wound, between the wound and the trunk. Never over a joint (elbow, knee); if the wound is on it or just below, place it above the joint. If you cannot see the wound well or there are several, place it "high and tight," as high as possible on the arm or thigh.
2. Pull the strap as tight as possible and secure it with the Velcro.
3. Twist the windlass until the bleeding stops. It hurts a lot: that is normal and necessary.
4. Lock the windlass in its hook or clip so it does not unwind.
5. Write down the time on the tourniquet's label or on the person's forehead with a marker ("T 14:35").
6. If it keeps bleeding, place a second tourniquet above the first (closer to the trunk).
7. Do not loosen or remove it. Only medical personnel remove it. Leave it visible; do not cover it with clothing or blankets.

How long can a tourniquet stay on?

The risk of limb damage increases with the hours, but a properly applied tourniquet saves lives and is almost always removed at the hospital long before there is permanent damage. So the rule for you is simple: do not loosen it "to let blood circulate"; that restarts the bleeding. If medical help will take hours (disaster, remote area), insist with 911 on a priority evacuation and report the time it was applied.