If bleeding persists after direct pressure and a hemostatic dressing, which device should be applied?

• A. Tourniquet
• B. Elastic wrap
• C. Cold pack
• D. Pressure bandage

Answer: (A)

When bleeding from an extremity cannot be controlled with direct pressure and a hemostatic dressing, the next step is to stop the blood flow to the area. A tourniquet does this by applying pressure around the limb to occlude arterial inflow, which is essential for life-threatening limb hemorrhage.

Apply the tourniquet on the limb proximal to the wound, usually about 2-3 inches above it and away from joints or not over a bony prominence. Tighten it until the bleeding stops or no longer bleeds, then leave it in place and note the time of application. If you’re using an improvised tourniquet, use a wide, firm strap and a means to secure and tighten it effectively, ensuring the device remains in place until further treatment can be provided.

The other options don’t reliably control severe extremity bleeding in this scenario: elastic wrap and a pressure bandage rely on sustained pressure and can fail with heavy arterial bleeding, and a cold pack helps with pain and swelling but doesn’t stop hemorrhage.