After direct pressure fails to control life-threatening bleeding from an extremity, what is the next recommended step?

• A. Apply a tourniquet and immediately evac.
• B. Immediately loosen the tourniquet after application.
• C. Record the time of tourniquet application and reassess distal status.
• D. Apply a second tourniquet proximal to the first.

Answer: (C)

When direct pressure isn’t enough to control life‑threatening bleeding from an extremity, the next essential step is to secure a tourniquet and then carefully document and monitor. Recording the exact time the tourniquet was applied is crucial because it informs how long the limb has been without adequate blood flow and guides evacuation timing and further care. Reassessing distal status means checking whether the distal limb remains perfused—look for color, warmth, cap refill, movement, and sensation—to confirm that the tourniquet is effectively limiting bleeding without causing unnoticed nerve or tissue compromise. Loosening the tourniquet would risk losing control of the bleed, and adding a second tourniquet is something to consider only after evaluating the first tourniquet’s effectiveness and the patient’s distal perfusion. Evacuation continues, but the immediate focus is on documenting time and confirming distal perfusion.