the closed fist of one hand and use the other hand to
give additional pressure. The artery at this point is
deeply buried in some of the heaviest muscle tissue in
the body, so a great deal of pressure must be exerted to
compress the artery against the bone.
Bleeding between the knee and the foot may be
controlled by firm pressure at the knee. If pressure at
the side of the knee does not stop the bleeding, hold the
front of the knee with one hand and thrust your fist hard
against the artery behind the knee, as shown in figure
4-27K. If necessary, you can place a folded compress
or bandage behind the knee, bend the leg back, and
hold it in place by a firm bandage. This is a most
effective way of controlling bleeding, but it is so
uncomfortable for the victim that it should be used
only as a last resort.
You should memorize these pressure points so that
you will know immediately which point to use for
controlling hemorrhage from a particular part of the
body. Remember, the correct pressure point is that
which is (1) nearest the wound, and (2) between the
wound and the main part of the body.
It is very tiring to apply digital pressure, and it can
seldom be maintained for more than 15 minutes.
Pressure points are recommended for use while direct
pressure is being applied to a serious wound by a
second rescuer. Using the pressure-point technique is
also advised after a compress, bandage, or dressing has
been applied to the wound, since this method will slow
the flow of blood to the area, thus giving the direct
pressure technique a better chance to stop the
hemorrhage. The pressure-point system is also
recommended as a stopgap measure until a pressure
dressing or a tourniquet can be applied.
The elevation of an extremity, where appropriate,
can be an effective aid in hemorrhage control when
used in conjunction with other methods of control,
especially direct pressure. This is because the amount
of blood entering the extremity is decreased by the
uphill gravitational effect. Do not elevate an extremity
until it is certain that no bones have been broken or
until broken bones are properly splinted.
Another effective method of hemorrhage control
in cases of bone fractures is splinting.
immobilization of sharp bone ends reduces further
tissue trauma and allows lacerated blood vessels to
clot. In addition, the gentle pressure exerted by the
splint helps the clotting process by giving additional
support to compresses or dressings already in place
over open fracture sites.
Later in this chapter we will go into the subject of
splinting in greater detail.
A tourniquet is a constricting band that is used
to cut off the supply of blood to an injured limb.
Use a tourniquet only as a last resort and if the
control of hemorrhage by other means proves to be
difficult or impossible. A tourniquet must always
be applied above the wound (i.e., toward the trunk),
and it must be applied as close to the wound as
Basically, a tourniquet consists of a pad, a band,
and a device for tightening the band so that the blood
vessels will be compressed. It is best to use a pad,
compress, or similar pressure object, if one is
available. The pressure object goes under the band and
must be placed directly over the artery or it will
actually decrease the pressure on the artery, allowing a
greater flow of blood. If a tourniquet placed over a
pressure object does not stop the bleeding, there is a
good chance that the pressure object is in the wrong
place. If placement is not effective, shift the object
around until the tourniquet, when tightened, will
control the bleeding.
Any long flat material may be used as the band. It
is important that the band be flat: belts, stockings, flat
strips of rubber, or neckerchiefs may be used; however,
rope, wire, string, or very narrow pieces of cloth should
not be used because they can cut into the flesh. A short
stick may be used to twist the band, tightening the
tourniquet. Figure 4-28 shows the proper steps in
applying a tourniquet.
To be effective, a tourniquet must be tight
enough to stop the arterial blood flow to the limb. Be
sure, therefore, to draw the tourniquet tight enough
to stop the bleeding. Do not make it any tighter than
necessary, though, since a tourniquet that is too tight
can lead to loss of the limb the tourniquet is applied
After you have brought the bleeding under control
with the tourniquet, apply a sterile compress or
dressing to the wound and fasten it in position with a