Direct Pressure or Tourniquet — Which Is Best for Major Hemorrhage Control?

Choosing the Right Tourniquet

When it comes to major hemorrhage control, the type and quality of the tourniquet matter. Look for a tourniquet with a secure buckle, windlass, and a padded strap to prevent skin chafing. The CAT (Combat Application Tourniquet) and SOFTT-Wide (Special Operations Forces Tactical Tourniquet - Wide) are two popular options.

Applying the Tourniquet

Apply the tourniquet to the injured limb, about 2-3 inches above the wound and 2 inches below the last palpable pulse. Tighten the tourniquet by turning the windlass until the bleeding stops. Be careful not to over-tighten, as this can cause nerve damage. Aim for a pressure of 200-250 mmHg. If using a CAT, you can also use the “two-palm” technique to tighten the tourniquet.

Alternatives to Tourniquets

If a tourniquet is not available, direct pressure remains the next best option. Apply firm, direct pressure to the wound using a clean cloth or gauze, applying pressure for at least 10-15 minutes to ensure adequate control. In the absence of both a tourniquet and direct pressure, a hemostatic agent like QuikClot or Celox can be used to help control bleeding.