Direct pressure first, firmly and without peeking.
Before you read
Test yourself first: 5 questions
Question 1 of 5
In a traumatic arrest from hemorrhage, why do vasopressors take a lower priority than hemorrhage control and volume replacement?
Answer: A. Hypovolemic arrest follows maximal sympathetic vasoconstriction; the problem is an empty circulation, so squeezing vessels harder adds little until bleeding is stopped and volume restored. Vasopressors have no age cutoff and do not require stopping compressions; the priority order reflects physiology, not a blanket prohibition.
Question 2 of 5
A tourniquet has been placed on the thigh for arterial bleeding, but bright red blood continues to flow from the wound. The best next action is to:
Answer: A. Continued bleeding means the tourniquet is not occluding arterial flow; tighten until bleeding stops and distal pulse is lost, and if one device cannot do it (common on a large thigh), place a second immediately proximal. Removing it or periodically loosening it causes renewed blood loss; elevation and pressure points are not reliable hemorrhage control.
Question 3 of 5
A worker has a length of rebar impaled in the abdomen and the object is not in the airway. The correct management of the object is to:
Answer: A. An impaled object may be tamponading a vessel; removing it can unleash uncontrolled internal hemorrhage. Stabilize it in place so it cannot move, and shorten it only if necessary for transport, without transmitting motion into the wound. Removal is reserved for objects that obstruct the airway or prevent CPR.
Question 4 of 5
A 14-year-old girl slipped and landed straddling a fence rail. She has steady bleeding from the external genital area. The correct way to control it is:
Answer: A. External genital injuries bleed freely because the tissue is very vascular, but they respond to direct pressure from a pad held against the outside. Nothing is ever packed into the vagina. A tourniquet cannot reach this area, and withholding pressure because of swelling lets an avoidable hemorrhage continue.
Question 5 of 5
What is the main physiologic advantage of whole blood or balanced blood products over crystalloid in hemorrhagic shock?
Answer: A. Hemorrhage loses red cells, plasma and platelets, so replacing like with like restores oxygen delivery and coagulation at once. Blood products stay intravascular longer than crystalloid, they never replace source control, and they do contain citrate preservative and can cause reactions.
Keep the streak going with more questions like these, each with a full rationale.
Key points to remember
- Direct pressure first, firmly and without peeking.
- Tourniquet for an extremity when pressure fails or cannot be maintained.
- Wound packing plus pressure for junctional sites a tourniquet cannot reach.
- Keep the patient warm — cold blood does not clot.
Field priorities
- Massive hemorrhage is controlled within the primary assessment.
- Target perfusion rather than a normal pressure in uncontrolled bleeding.
Coaching the patient
- A correctly applied tourniquet is safe for prehospital durations — hesitation is what harms.
Red flags: act now
- Bleeding through successive dressings
- A cold, bleeding patient
Hemorrhage Control: FAQs
What are the priority actions for Hemorrhage Control in the field?
Massive hemorrhage is controlled within the primary assessment. Target perfusion rather than a normal pressure in uncontrolled bleeding.
What findings in Hemorrhage Control change your plan or your transport decision?
Bleeding through successive dressings. A cold, bleeding patient.
What do I need to know about Hemorrhage Control for the NREMT?
Direct pressure first, firmly and without peeking. Tourniquet for an extremity when pressure fails or cannot be maintained. Wound packing plus pressure for junctional sites a tourniquet cannot reach. Keep the patient warm — cold blood does not clot.
What should the crew communicate or document for Hemorrhage Control?
A correctly applied tourniquet is safe for prehospital durations — hesitation is what harms.
