Kraujavimo stabdymas: spaudimas, tamponavimas ar turniketas – kada ką naudoti

Bleeding Control: Direct Pressure, Wound Packing, or Tourniquet – When to Use What

In the event of trauma, severe bleeding can become fatal in just a few minutes. At the same time, it is one of those causes of death that can often be prevented: the European Resuscitation Council (ERC) identifies uncontrolled bleeding as a potentially preventable cause of post-trauma death. While an ambulance is still on the way, the reaction and actions of a bystander become the decisive factor.

The good news is that the basic emergency steps are simple. They are taught in the Stop the Bleed program, and the same principles are reflected in the 2025 ERC first aid guidelines. This overview explains how to timely recognize life-threatening bleeding and when to choose direct pressure, wound packing, or a tourniquet.

First – Environmental Safety and Calling 112

  • Assess the environment. Provide aid only after making sure you are not in danger yourself. Put on disposable gloves if you have them at hand.
  • Call 112 or ask another bystander to do so. By putting the call on speaker, you can communicate with the dispatcher while simultaneously controlling the bleeding.
  • Bleeding control before airway. In ERC guidelines, life-threatening bleeding is evaluated immediately after checking scene safety and the casualty's responsiveness, prior to checking the airway.

How to Recognize Life-Threatening Bleeding

Expose the injured site: unbutton or cut open clothing so you can clearly see where the blood is coming from. According to Stop the Bleed training materials, life-threatening bleeding is indicated by the following signs:

  • blood spurting from the wound;
  • bleeding that does not stop;
  • a pool of blood on the ground;
  • clothing or bandages completely soaked with blood;
  • the victim has lost a limb or part of it;
  • the bleeding person appears confused or unconscious.

Three Ways to Control Bleeding

The main objective of all three methods is the same: to compress the damaged blood vessel. What differs is the wound location and available tools.

1. Direct Pressure

Cover the wound with a dressing or a clean cloth and apply firm pressure to the bleeding site with both hands. Press firmly using your body weight and never lift the dressing to "check." Keep pressing until medical personnel take over.

Once bleeding stops, the ERC recommends applying a pressure bandage. The same guidelines do not recommend pressing so-called pressure points away from the wound – direct pressure directly on the wound itself is recommended.

2. Wound Packing

If the wound is deep, superficial pressure is often insufficient. In such cases, the wound must be filled – packed – all the way to its base so that pressure reaches the bleeding site.

  • Wound packing is the primary method when bleeding occurs on the neck, armpit, shoulder, or groin – locations where applying a tourniquet is impossible.
  • This method is also suitable for a limb when you do not have a tourniquet at hand.
  • For packing, use a hemostatic bandage (if available), plain gauze, or clean cloth, and then press firmly with both hands.

The 2025 ERC guidelines recommend hemostatic dressings for first aid providers: research shows they reduce bleeding time compared to standard gauze.

3. Tourniquet

A tourniquet is designed to stop life-threatening bleeding from an arm or leg. The ERC recommends applying it as quickly as possible if limb bleeding cannot be controlled by direct pressure. Stop the Bleed teaches: if a tourniquet is nearby, use it for life-threatening limb bleeding.

  • Use a manufactured tourniquet – according to ERC data, it is easier to apply and compresses the artery more effectively than improvised tools.
  • Apply 5–7 cm (2–3 inches) above the wound, but not over a joint.
  • Tighten until the bleeding completely stops. This can cause severe pain, but it is necessary.
  • Write the time of application on the tourniquet.
  • Never loosen the tourniquet under any circumstances. Only a healthcare professional can remove it.
  • If bleeding does not stop, apply a second tourniquet above the first one.

In Tactical Combat Casualty Care (TCCC), when the environment is unsafe and maintaining direct pressure is impossible, a tourniquet is used first for life-threatening limb bleeding. If the exact location of bleeding is unclear, it is placed high and tight on the injured limb.

We show how a tourniquet is applied in practice in the video.

When and Which Method to Choose: Quick Reference

  • Continuous but non-massive bleeding – direct pressure, followed by a pressure bandage.
  • Life-threatening bleeding from an arm or leg – tourniquet as soon as you have it, especially if direct pressure does not help. Apply pressure to the wound while preparing the tourniquet.
  • Deep limb wound when you don't have a tourniquet – wound packing and firm pressure.
  • Neck, armpit, groin – wound packing and firm pressure.
  • Young child – ERC states that a manufactured windlass tourniquet can be used if the limb is large enough. If not – firm direct pressure, using a hemostatic dressing if needed.

Actions After Bleeding Is Stopped

  • Stay with the casualty. Monitor whether the dressing becomes soaked and whether bleeding resumes. If it does – apply firm pressure again.
  • Do not remove the tourniquet. Even if bleeding has stopped, only healthcare professionals can loosen the tourniquet.
  • Protect from hypothermia. Cover the person with a thermal blanket, isolate them from the cold ground, protect them from wind, and replace wet clothing with dry clothes if possible.
  • Hand over information to medical personnel. Explain accurately what happened, what aid was rendered, and when the tourniquet was applied.

Most Common Mistakes

  • Applying insufficient pressure or constantly lifting the dressing to check the wound.
  • Applying a tourniquet over a joint or not tightening it enough.
  • Loosening a tourniquet to "give it a rest" – this is strictly forbidden.
  • Failing to mark the time of tourniquet application.
  • Delaying the call to 112 hoping to handle it alone.

Essential Gear for Your Kit

A few essential items are sufficient to control massive bleeding: a tourniquet, a pressure bandage, packing or hemostatic gauze, gloves, and shears. Most importantly, they should be accessible within seconds – in a pocket, on a belt, or in the car cabin, rather than deep inside a closet.

We have gathered these items in the Stop the Bleed aid gear section. You can find more bandages, kits, and pouches in the medical equipment catalog, and tips on how to properly build your personal kit are available in our article "Individual First Aid Kit (IFAK)".

Important: this article does not replace practical skills. Wound packing and tourniquet application should be practiced at least once under an instructor's guidance, for example, during training sessions organized by Locked N' Loaded.

Sources

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