Massive hemorrhage is one of the leading causes of death in motor vehicle-related trauma, and with only minutes to death from a significant arterial bleed, the reality is that a percentage of salvageable casualties will die from potentially compressible bleeds prior to emergency services arriving. The authorities in the United States have recognized this fact in regard to active shooter scenarios and terrorist mass-casualty incidents, and have instituted the bystander “Stop The Bleed” campaign aimed at empowering the civilian first-responder in such a scenario to save lives (Homeland Security, 2015).


While an active shooter event or mass-casualty terrorist incident remains an unfortunate possibility in our current world climate, a far more likely instance in which the life-saving skills of massive hemorrhage control might be required is a motor vehicle accident.

As per the Stop The Bleed infographic above, if external bleeding can be seen, and you have decided to act to stop it (considering the danger of the situation and risk of potential blood-borne virus exposure) the initial technique is firm, direct pressure to the wound. Research shows that the maximum pressure achievable with a firm pressure dressing will be around 90mmHg (Naimer 2000), which will be enough to control most bleeding from the low-pressure venous system.

However, if the bleeding is from a severed artery, a pressure dressing alone may not be enough to stop it. Normal peak pressures in the arteries of an adult range from 120-140 mmHg, and under duress or in pain, such as a casualty situation, may exceed 200 mmHg. Looking at those numbers, it can be seen that a firm pressure dressing may be inadequate to control bleeding, and an arterial tourniquet might be appropriate. This tourniquet should be placed around 5-10cm (2-4 inches) above the level of the injury on an arterially bleeding limb.

If a commercially made arterial tourniquet is available, then the problem is solved fairly easily by the skilled first-responder following the steps below:


The life-saving application of an arterial tourniquet by two appropriately trained police officers can be seen in the video below.