If direct pressure fails to control external bleeding, what is the next step in many EMS protocols?

• A. Elevate the limb only
• B. Apply a tourniquet proximal to the wound and reassess regularly
• C. Apply ice packs
• D. Administer more fluids only

Answer: (B)

When direct pressure fails to stop external bleeding, the next step is to apply a tourniquet proximal to the wound and reassess regularly. A tourniquet cuts off blood flow to the injured limb, which is often the most reliable way to stop life-threatening hemorrhage when pressure isn’t enough. Place it above the wound (closer to the body) and tighten until bleeding ceases, then keep it in place.

Reassessing regularly is crucial: check that bleeding has stopped, and monitor distal perfusion and neuro status (color, warmth, pulse, cap refill, movement, sensation). Note the time of application and follow protocol for ongoing monitoring and potential risks, since tourniquets are time-sensitive but lifesaving in significant bleeding.

Elevating the limb or applying ice packs don’t reliably control heavy external bleeding, and giving more fluids doesn’t address the bleeding itself.