First Aid for Severe Bleeding Certification Manual: Tourniquets & Hemostatic Agents

Tourniquets and Hemostatic Dressings

Tourniquets and hemostatic dressings are used to control life-threatening bleeding when direct pressure alone is ineffective or impractical. A tourniquet is used only on an arm or leg. Hemostatic gauze may be applied directly to a wound or used for wound packing when the wound’s location is appropriate and the responder is trained.

Tourniquets

A commercial tourniquet is designed to stop life-threatening bleeding from an arm or leg by compressing the blood vessels supplying the injured area. Place the tourniquet approximately 2 to 3 inches above the wound, between the wound and the heart. Never place a tourniquet directly over a joint or apply one to the head, neck, chest, or abdomen.

A tourniquet must be tightened until the bleeding completely stops. Applying it loosely may increase bleeding without stopping arterial blood flow. Once the tourniquet is applied, secure it, record the application time, and leave it visible. Do not loosen or remove it. EMS or another qualified healthcare professional should manage its removal.

Steps to Applying a Windlass Tourniquet:

1. Place the tourniquet approximately 2 to 3 inches above the wound, avoiding a joint
2. Pull the strap tightly and secure it
3. Twist the windlass until the bleeding completely stops
4. Secure the windlass so it cannot unwind
5. Record the application time
6. If bleeding continues, apply a second commercial tourniquet above the first if one is available and its use is consistent with your training
7. Do not loosen, remove, or cover the tourniquet
8. Continue monitoring the person until EMS takes over

Wound Packing

Wound packing may be used by trained responders for life-threatening bleeding from a deep wound when a tourniquet cannot be applied. Wounds of the groin, shoulder, or other junctional areas may require packing because a tourniquet cannot be positioned effectively.

Pack plain gauze or hemostatic gauze firmly into the wound cavity, placing the material as close as possible to the source of bleeding. Continue packing until the wound cavity is filled, and then apply firm, continuous pressure. Do not pack wounds of the chest or abdomen. Follow your training, the product instructions, and directions from 911.

Hemostatic Dressings

Hemostatic dressings are gauze products containing substances that help promote clotting. They may be placed directly over a wound or used for wound packing when appropriate. Firm, continuous pressure must still be applied after the dressing is placed.

Follow the product instructions and use hemostatic products only according to your training. Avoid pouring loose hemostatic powder into a wound unless specifically trained and directed to use that product.