Why Hemorrhage Control Matters
Uncontrolled hemorrhage is the leading cause of preventable death in trauma patients. The NREMT heavily tests your ability to identify life-threatening bleeding and intervene rapidly. The national Stop the Bleed initiative has elevated hemorrhage control to a critical skill for all EMS providers, and the NREMT reflects this emphasis.
Direct Pressure
Direct pressure is the first-line treatment for most external bleeding. Apply firm, continuous pressure directly to the wound using a gloved hand and gauze. Do not remove blood-soaked dressings; add more on top. Maintain pressure for at least 10 minutes before checking. If direct pressure alone does not control the bleeding, escalate to wound packing or tourniquet application.
Wound Packing
For deep wounds in junctional areas (where the limb meets the torso, such as the groin, axilla, or neck) that are not amenable to tourniquet placement, wound packing is the preferred technique. Pack hemostatic gauze or plain gauze tightly into the wound, then apply direct pressure over the packed wound. The goal is to create enough pressure within the wound to compress the bleeding vessels.
Tourniquet Application
Apply a tourniquet for life-threatening extremity hemorrhage that cannot be controlled with direct pressure. Place the tourniquet 2 to 3 inches proximal to the wound (closer to the torso). Tighten until bleeding stops. Note and communicate the time of application. Do not remove a tourniquet once applied in the prehospital setting. A second tourniquet may be needed if the first does not control bleeding. Commercial tourniquets (CAT, SOFT-T) are preferred over improvised tourniquets.
Exam Tips
The NREMT expects you to know the progression from direct pressure to tourniquet and when to skip directly to a tourniquet. For massive, life-threatening extremity bleeding, a tourniquet may be the first intervention applied. Know that tourniquets are not appropriate for head, neck, or torso bleeding. For those areas, direct pressure and wound packing are the primary interventions.