Where should a band be tied to stop bleeding from wound?

Question

Suppose a leg is wounded (either from a gunshot or a knife) and there is significant bleeding. We see in movies that a fabric is tied around the place of bleeding to decrease/stop bleeding.

My question is: where should you apply the tight bandage, exactly on the wounded spot, above the wounded spot, or below the wounded spot?

The context is that you are in The Great Outdoors where you cannot promptly get a trained medic to help and you need to use your first-aid equipment to treat the wound yourself.

Answer 1

"tight bandage/band" = Tourniquet. An emergency tourniquet is generally used as a last resort, especially in civilian applications, for all blood flow below the application of an emergency tourniquet is stopped, and can subsequently kill the tissue, leading to eventual loss of the limb below application. Never attempt to apply a tourniquet unless you are qualified to do so. A tourniquet is a last resort to stop bleeding and is used to save life at possible loss of limb.

Where: place a 2 inch or wider tourniquet 2-4 Inches from the wound towards the heart. Never wrap your tourniquet directly around a wound, fracture, or joint. Doing so may cause severe pain and permanent physical damage to the patient.

Place some sort of padding underneath the tourniquet and wrap the tourniquet material around the limb several times. Use a torsion device such as a strong stick-like instrument that is 1 foot or longer. Tie an overhand knot over your torsion device, and then tie another. This will ensure that you have reached the torsion necessary to stop the bleeding entirely. Tighten the torsion device by twisting it in one direction until the material is tight around the limb and/or the bright red bleeding has stopped. Tie the loose ends of the tourniquet around the ends of the torsion device. This will help to ensure that your tourniquet does not loosen.

Please do understand that Two hours is considered the length of time a tourniquet can be in place before neuromuscular injury and functional loss begin. For applications longer than 2 hours, cooling the limb may help delay injury and loss of function. The best method to save a limb is rapid transport and converting to a less-damaging means of hemorrhage control as soon as practicable. [Walters TJ, Mabry RL. Issues related to the use of tourniquets on the battlefield. Military Medicine 170(9):770-775, 2005.]

Answer 2

For wounds with heavy bleeding or that are deep, the standard practice is to:

1. Apply direct pressure to the wound.
2. Elevate the injury to decrease blood flow.

In short, if the flow of blood is high enough that it won't clot then you want to impede the bleeding by whatever means possible. As mentioned elsewhere, tourniquets are a last resort, where the loss of the limb is considered an acceptable outcome.

You can find on how to act in this case for example on the Mayo Clinic site or with your country's Red Cross or Red Crescent.

Answer 3

Small addendum to the excellent answers already present:

Never release a tourniquet unless you have received expert instruction on doing so.

If the patient who received a tourniquet does not receive medical attention within a few hours, it is likely that the patient will loose the affected limb. Therefore, before applying a tourniquet, make sure that a high likelihood of loosing a limb is a better outcome then not applying a tourniquet.

Answer 4

To the direct question, as indicated in other answers, tourniquets are placed towards the torso from the site of injury.

There's been a major initiative in the US known as "Stop the Bleed." You'll find a significant number of authoritative trainings and recommendations, including the use of tourniquets. https://www.dhs.gov/stopthebleed.

Other answers mention the risk of complications with the tourniquet both in tissue damage from prolonged usage as well as Compartment Syndrome upon release. Considering how long it will be to reach extended medical care is part of the equation that's beyond the immediate question. "The Great Outdoors" includes back country where it may be several days to care, or a quick trip down the hill, the car, and a freeway to a trauma unit - or even a helicopter rescue.

There are a number of other suggestions on the thread such as elevation that are situationally dependent on the method of injury and possibility of other injuries. They may not be appropriate in all cases. For instance, a torso injury related to a fall in The Great Outdoors might be combined with an extremity bleed where elevation may exacerbate the combined injuries.

In the US, there are in-person trainings that include pressure point usage including (but not limited to): Stop the Bleed, general First Aid (often including CPR), Wilderness First Responder, and Community Emergency Response Team (CERT) sections on medical response.

The Wikipedia article on tourniquets is well written: https://en.wikipedia.org/wiki/Tourniquet

Please note: I'm not a doctor, and this shouldn't be construed as authoritative medical advice. I recommend the "Stop the Bleed" links and resources mentioned over any unattributed advice in my or other answers.