How to Stop Severe Bleeding on a Job Site: Tourniquets and Wound Packing

To stop severe bleeding, call 911, find where the blood is coming from, and press hard on the wound right away. If the wound is on an arm or leg and pressure doesn't control it, or the dressing soaks through, put on a tourniquet 2 to 3 inches above the wound, between the wound and the heart and never over a joint. Tighten it until the bleeding stops, lock it, and write down the time. Don't loosen it. Let EMS take it from there (DHS Stop the Bleed; American College of Surgeons Stop the Bleed). For wounds in the neck, armpit or groin, where a tourniquet won't fit, pack the wound tight with gauze and keep pressing (Stop the Bleed course).

A person with heavy bleeding can die before an ambulance reaches a remote lease. That's why the first few minutes, and the people already on location, matter most. Physician groups that reviewed the evidence say putting a tourniquet on earlier is linked to better survival (joint position statement, Annals of Emergency Medicine).

The ABCs of bleeding control

• A, Alert: call 911, or have someone else call, and send someone to meet the ambulance at the lease road turnoff.
• B, Bleeding: find the source. Open or cut away clothing if you need to see the wound.
• C, Compress: stop the bleeding with firm pressure, wound packing or a tourniquet (Stop the Bleed course).

Put on gloves if they're within reach, but don't delay pressure to look for them. Bleeding that spurts, flows steadily, pools on the ground or soaks a dressing is life-threatening. Treat it as an emergency.

How to put on a tourniquet (windlass type)

These steps follow the manufacturer instructions for the CAT windlass tourniquet, as published by the American College of Surgeons Stop the Bleed program (American College of Surgeons Stop the Bleed). Other designs work in a similar way, so read the instructions printed on the ones in your kits.

1. Slide the band around the arm or leg, or route it through its buckle. Position it 2 to 3 inches above the wound, directly on skin if you can.
2. Pull the free end of the band tight and fasten it back on itself. It should be tight enough that you can't slide three fingertips under it.
3. Twist the rod (windlass) until the bleeding stops.
4. Lock the rod in its clip so it can't unwind.
5. Secure the rod and band with the time strap and write the time it went on.
6. If bleeding doesn't stop, put a second tourniquet above the first and tighten it the same way.

If you can't quickly see where the bleeding is coming from, the same instructions say to put the tourniquet "high and tight" on the limb, over clothing, but not over anything in a pocket. Move it to 2 to 3 inches above the wound on bare skin once you can see the wound and the scene allows (American College of Surgeons Stop the Bleed).

Expect it to hurt. The Stop the Bleed course warns that a properly tightened tourniquet is painful, and that's not a reason to loosen it. You can also put one on yourself if you're injured and alone (Stop the Bleed course).

Common tourniquet mistakes

Wound packing and pressure

For a deep wound where a tourniquet can't go, like the neck, armpit or groin, pack the wound. Push gauze (hemostatic gauze if your kit has it, plain gauze if not) into the wound until it's filled, then hold firm pressure with both hands (Stop the Bleed course). For limb wounds, packing and pressure can control bleeding while someone gets the tourniquet. Keep pressing until help takes over.

When a tourniquet is the wrong tool

Tourniquets are for life-threatening bleeding from an arm or leg. They aren't for snakebite. CDC and Texas health officials say not to use one on a rattlesnake bite. See our rattlesnake bite first aid guide for what to do instead. For heat illness, the other common summer emergency on location, see heat stroke vs. heat exhaustion.

What a remote crew should carry

Under OSHA 1910.151, when there's no clinic or hospital nearby, a person trained in first aid has to be available, and first aid supplies have to be on hand. OSHA's first aid appendix uses the ANSI Z308.1 kit standard as its example of adequate supplies, and the current 2021 edition lists a tourniquet as a required item in the larger Class B kit. Class B is meant for higher-risk or more complex workplaces (ANSI). Keep tourniquets where crews can reach them in seconds, not buried at the bottom of a box in a locked truck (joint position statement, Annals of Emergency Medicine). For the full kit and training picture, see OSHA first aid rules for remote job sites.

Gear only helps if somebody knows how to use it under stress. Practice putting a tourniquet on a partner with a training unit, and replace any tourniquet that has been used for real.