If life-threatening external bleeding cannot be controlled by direct pressure, which step should be taken next?

• A. Apply a tourniquet and immediately evac.
• B. Apply a tourniquet proximal to the wound, record the time, and reassess distal status.
• C. Ignore bleeding and monitor.
• D. Place a hemostatic dressing only.

Answer: (B)

When bleeding is life-threatening and direct pressure fails, the priority is to stop the hemorrhage quickly with a tourniquet placed proximal to the wound. After applying the tourniquet, record the exact time of application and reassess distal status to confirm that blood flow is effectively interrupted and to monitor for ongoing bleeding or signs of limb ischemia. The time code is crucial for evacuation planning and for guiding future care, since prolonged tourniquet time increases risk to the affected limb. Reassessing distal status (pulse, color, warmth, sensation, and motor function) ensures you’re not masking ongoing bleeding and helps detect complications early. Using a hemostatic dressing alone is not sufficient for life-threatening external bleeding, and ignoring the bleeding is not acceptable. Evacuation remains important, but the key immediate steps are applying the tourniquet, noting the time, and checking distal perfusion.