For heavy bleeding, first press hard on the wound with your hand; if you can't stop it on a limb, put on a tourniquet; and call 120 (China's ambulance number) at the same time

In a real emergency, call 911 first, then read this.

Cost

A windlass tourniquet costs a few dozen to over a hundred CNY; keep one in the car and in the first-aid kit. Learning "put it above the wound, twist until the bleeding stops, note the time" takes a few minutes.

What you get

Over 6 years, 11 Level I trauma centers in Texas received 1,026 cases of limb vascular injury, of which 181 (17.6%) had a tourniquet applied before reaching the hospital. Without any adjustment, 3.9% of those with a tourniquet died and 5.2% of those without. After evening out other conditions (multivariable adjustment), the tourniquet was still independently linked to survival. The adjusted OR was 5.86, with a 95% CI (confidence interval, the range the true value likely falls in) of 1.41 to 24.47. Among 232 wounded at a field hospital in Baghdad: 90% of those who got a tourniquet before shock set in survived, and only 10% of those who got it after shock. All 5 who needed a tourniquet and did not get one died, and 87% of those who got one survived. The order is: press directly, with clothing or a towel; if a limb bleed can't be stopped by pressing, put on a tourniquet; call 120; don't loosen it

Notes

Don't use thin things like rope or shoelaces as a tourniquet, since they can't squeeze an artery shut and cut the skin. Once a tourniquet is on, don't loosen it every so often to "let some blood through." For bleeding on the neck or trunk, you can only press, not tie. In that battlefield data, the tourniquet itself led to no amputations, and 4 cases had brief nerve paralysis. China's emergency physicians' expert consensus says the same: once it is on before reaching the hospital, loosening it is not advised, unless there is another way to stop the bleeding completely. For bleeding in the upper arm, tie on the upper-middle third of the upper arm, and for the thigh, tie at the top of the thigh. Don't tie on the forearm, lower leg, elbow or knee. The consensus advises keeping the total time, before and after reaching the hospital, under 2 hours where possible, but if you can't reach a hospital and have no other way to stop the bleeding, don't loosen it until proper rescue arrives. A tourniquet improvised from a belt, necktie or sleeve is hard to make stop the blood on its own, and needs a stick to twist it tight.

Evidence grade

A : Specific numbers from meta-analyses, large cohorts or randomized trials; for law and policy, the statute or official text.

Sources

1. 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
2. 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
3. Emergency Physicians Branch of the Chinese Medical Doctor Association and others (2020). Expert Consensus on the Emergency Use of Tourniquets [in Chinese]. Chinese Journal of Emergency Medicine 29(6):773-779: "In prehospital emergency care, once a tourniquet is applied it is not recommended to loosen it, unless definitive hemostatic treatment that can replace it is available" "It should not be used for longer than 2 h. But if, for objective reasons, treatment at a hospital is not possible or there is no alternative way to stop the bleeding, do not remove the tourniquet until formal rescue arrives". https://doi.org/10.3760/cma.j.issn.1671-0282.2020.06.006; full text http://www.cem.org.cn/rhtml/20200606/index.htm

Translated from the Chinese original. Original book, section 13, tip 12. Content may be out of date and rules differ by place. When you actually deal with an agency, a doctor or a court, follow what local officials, doctors and lawyers tell you. Disclaimer