This still leaves a couple of questions:
- What's the best technique for stopping bleeding in most wounds?
- How to stop potentially life-threatening bleeding if the above technique doesn't work?
How to Stop Most Bleeding
The best way to stop the vast majority of external bleeding is simply well-aimed direct pressure. We recommend buying and carrying maxi-pads (preferably without the wings); they are cheap and effective. If you anticipate a need for a larger dressing, try bladder control pads. Use the pad to wipe away excess blood and find the wound, then push hard over the entire surface of the wound and hold it. If the pad is in the right place and you have enough pressure, the bleeding will stop immediately. Clotting will take a longer, 5-15 minutes. If you need to free your hands, hold the pad — and pressure — in place with an elastic wrap. Remove the wrap after the wound clots. This technique will stop bleeding, even rather severe bleeding, quickly and easily. Once the bleeding has stopped, evaluate, clean, dress, and bandage the wound. It's worth another sentence or two to talk about practical application: Both maxi-pads and bladder control pads have a peel-off section of plastic that exposes an adhesive. The adhesive is to make sure the pad stays in place when wearing and sticks to the person's underwear. Since you are improvising, stick the side with the adhesive to the elastic wrap, and then wrap; DON'T put the adhesive side against the patient's skin (yes, I've seen people do this and yes, while it's amusing, it doesn't work).
The hematologic (clotting) agents — and there are a few out there — have had some success but are unnecessary. If there is an obvious gaping hole, stuff gauze into the hole before applying the pad and pressure over it. An effective technique involves pulling gauze from the center of the roll and fully packing the wound from the inside out.
And what about pressure points and elevation. Pressure points can slow bleeding; however, most people are unable to locate and use them. Elevation helps. But...well-aimed direct pressure trumps both.
How to Stop ALL Bleeding
If you have done all of the above and blood is still leaking from the edges of the dressing — as it may in some ugly gunshot or IED wounds — you may need to improvise a tourniquet. Military personnel in combat zones (along with cousin para-military groups SWAT, FBI, etc.) carry commercial tourniquets that may be applied with one hand. There are many on the market and most work quite well; although, they do require practice. For most, if not all wilderness travelers, carrying a commercial tourniquet is just plain silly. If you are a hunter (or a hunting guide), you might be tempted to argue that you should be prepared to improvise a tourniquet. Since improvised tourniquets are relatively easy to make and can be quite inexpensive, go ahead. Here's what you'll need: a maxi-pad (or bladder control pad), a two or three-inch elastic wrap, and a metal pen. (Yes, you could use a tent stake or spoon...but who carries a spoon or tent stake in their first aid kit?) First, leave the pressure bandage in place and wrap the second elastic wrap around the patient's limb about two inches above the wound. Next, insert the pen and start winding. Keep winding until the blood stops leaking from the wound site and anchor the pen in place. Nice. You have successfully improvised a tourniquet; be advised: if you leave it in place, it could lead to an amputation. That said, begin an urgent evacuation to the nearest trauma center. DO NOT remove the tourniquet in the field if an amputation or near-amputation is present, the patient exhibits signs and symptoms of volume shock, or the patient's condition is unstable due to another critical system problem. Reassess the patient after 30 min. If no red flags for removal (listed above) are present, make sure a pressure bandage is directly over the wound site and loosen the tourniquet. If there is bleeding from the site, re-tighten the tourniquet. If there is no bleeding, slowly remove the tourniquet. Wait another 10-20 minutes and loosen the pressure bandage. DO NOT remove the pad or attempt to clean the wound: either may disturb the clot and cause the bleeding to resume. If appropriate, downgrade the evacuation level.
Watch the video below for a demonstration of a pressure bandage and improvised tourniquet.