Rule of nines (adult): head 9, each arm 9, each leg 18, front 18, back 18, genitals 1.
Before you read
Test yourself first: 5 questions
Question 1 of 5
Bleeding from an external genital injury is best controlled by:
Answer: A. These wounds bleed a great deal and answer to the same treatment as any other external bleeding — pressure on the point that is bleeding — with the patient covered and exposed only as much as the care requires. Internal packing is not a field procedure, a tourniquet cannot be applied here at all, and cold does not control bleeding.
Question 2 of 5
After applying a tourniquet, bleeding continues from the wound. You should:
Answer: A. Continued bleeding means the tourniquet is not tight enough. It is tightened further, and if bleeding still continues a second tourniquet is placed just above the first. A tourniquet is never loosened in the field to 'give the limb a break'.
Question 3 of 5
Bleeding continues from a thigh wound after you apply a tourniquet and tighten it. You should:
Answer: A. A thigh carries enough muscle that one band may not compress the artery, and a second placed beside it spreads the pressure over a wider area. Loosening or removing a tourniquet on a bleeding limb restores the flow it was stopping, and elevation has never controlled arterial bleeding.
Question 4 of 5
A bystander is pressing hard on a bleeding wound when you arrive. You should:
Answer: A. Care already in progress is assessed rather than restarted, and releasing pressure to redo it properly costs the clot that has had time to form. Leaving an untrained bystander responsible for a bleeding control point hands a life-saving task to somebody with no obligation and no training, and ignoring it entirely means nobody has confirmed it is actually stopping the bleeding.
Question 5 of 5
Where should a tourniquet be placed on an arm with severe bleeding from the forearm?
Answer: A. A tourniquet goes 2 to 3 inches above the wound, between the wound and the heart, and not over a joint where it cannot compress the vessels. If the wound site is unclear, it is placed high on the limb. It is tightened until the bleeding stops and the time is recorded.
Keep the streak going with more questions like these, each with a full rationale.
Key points to remember
- Rule of nines (adult): head 9, each arm 9, each leg 18, front 18, back 18, genitals 1.
- Infant: head about 18 and each leg about 14. The patient's palm is about 1 percent.
- Stop the burning, cool briefly with water, then dry sterile dressings and keep the patient warm.
- Tourniquet 2–3 inches above the wound, not over a joint; note the time; never loosen it.
- Splint the joints above and below a long-bone fracture and check pulse, motor and sensation.
Field priorities
- Sucking chest wound: occlusive dressing; lift a corner if the patient worsens.
- Evisceration: moist sterile then occlusive dressing — never push organs back.
- Impaled object: stabilize in place unless it blocks the airway or CPR.
Coaching the patient
- Amputated part: gauze, sealed bag, kept cool — never directly on ice.
Red flags: act now
- Small electrical burns hiding deep injury
- Bleeding that continues after a tourniquet
- Signs of a pelvic fracture with shock
Burns, Wounds & Bleeding: FAQs
What are the priority actions for Burns, Wounds & Bleeding in the field?
Sucking chest wound: occlusive dressing; lift a corner if the patient worsens. Evisceration: moist sterile then occlusive dressing — never push organs back. Impaled object: stabilize in place unless it blocks the airway or CPR.
What findings in Burns, Wounds & Bleeding change your plan or your transport decision?
Small electrical burns hiding deep injury. Bleeding that continues after a tourniquet. Signs of a pelvic fracture with shock.
What do I need to know about Burns, Wounds & Bleeding for the NREMT?
Rule of nines (adult): head 9, each arm 9, each leg 18, front 18, back 18, genitals 1. Infant: head about 18 and each leg about 14. The patient's palm is about 1 percent. Stop the burning, cool briefly with water, then dry sterile dressings and keep the patient warm. Tourniquet 2–3 inches above the wound, not over a joint; note the time; never loosen it.
What should the crew communicate or document for Burns, Wounds & Bleeding?
Amputated part: gauze, sealed bag, kept cool — never directly on ice.
