Press firmly on severe bleeding; use a tourniquet for uncontrolled limb bleeding and call 120
Apply firm direct pressure with your hand or clothing. If limb bleeding cannot be controlled, apply a tourniquet, call China's 120 and do not loosen it. In battlefield casualties, survival was 90% when applied before shock versus 10% afterward; all 5 who needed but did not receive one died. Place above the wound, tighten until bleeding stops and note the time. Do not substitute shoelaces or thin cord. Neck and trunk wounds need pressure, not a tourniquet.
What it takes
A windlass tourniquet costs a few tens to over RMB 100 in China; keep one in a vehicle and first-aid kit. Learning to place it above the wound, tighten until bleeding stops and record the time takes minutes.
What you may gain
Eleven Texas level-I trauma centers recorded 1,026 peripheral vascular injuries over 6 years; 181 (17.6%) had prehospital tourniquets. Unadjusted mortality was 3.9% with a tourniquet and 5.2% without. After multivariable adjustment, tourniquet use remained independently associated with survival: adjusted OR 5.86, 95% CI 1.41–24.47. Among 232 Baghdad military-hospital casualties, survival was 90% with application before shock and 10% after shock. All 5 needing but not receiving a tourniquet died, while survival among those receiving one was 87%. The source's sequence is direct pressure with clothing/towel if needed, tourniquet for uncontrolled limb bleeding, emergency call, then no loosening.
Context & considerations
Thin ropes or shoelaces may fail to occlude arteries and damage skin. Do not periodically loosen a tourniquet to “let blood through.” Neck and trunk bleeding require direct pressure. In the military series, no amputation was attributed to the tourniquet itself; 4 temporary nerve palsies occurred. Chinese National Health Commission and Red Cross training pages could not be opened. TODO: verify the original Chinese official tourniquet-training text.
Research & references
Teixeira PGR et al. (2018). Civilian Prehospital Tourniquet Use Is Associated with Improved Survival in Patients with Peripheral Vascular Injury. Journal of the American College of Surgeons. https://doi.org/10.1016/j.jamcollsurg.2018.01.047; Kragh JF et al. (2009). Survival with emergency tourniquet use to stop bleeding in major limb trauma. Annals of Surgery. https://doi.org/10.1097/SLA.0b013e31818842ba