Which sequence is correct for controlling life-threatening extremity hemorrhage in the field?

• A. Begin with applying a tourniquet proximal to the wound, without direct pressure.
• B. Apply direct pressure first; if bleeding persists, apply a tourniquet proximal to the wound, record the time, and reassess distal status.
• C. Apply direct pressure, then immediately leave the wound to evac without further intervention.
• D. Apply direct pressure first and ignore the possibility of a tourniquet.

Answer: (B)

In controlling life-threatening extremity hemorrhage, the immediate step is to apply direct pressure to the wound to clamp down bleeding. This simple, first-line technique works quickly for many injuries and helps stabilize the patient. If bleeding remains uncontrolled after firm direct pressure, the next step is to apply a tourniquet proximal to the wound to stop arterial inflow and halt the bleed. Recording the time the tourniquet is applied is essential, because it communicates how long the limb has been without perfusion and guides ongoing care. After the tourniquet is in place, reassess distal status—check for distal circulation, color, warmth, and overall limb perfusion—to ensure that the intervention is effective and to detect any signs of evolving complications.

The other sequences fall short because they skip or delay the necessary escalation to a tourniquet when direct pressure fails, or they omit the vital step of reassessing distal perfusion after stopping the bleed.