Not all external hemorrhage is amenable to hemorrhage control using limb tourniquets. Often this is due to the anatomical location of the injury, either being too proximal on an extremity to allow for a limb tourniquet to compress the site of bleeding or an injury that is not on the extremity, but on the torso or neck, particularly in the junctional areas where the extremities meet the torso or the base of the neck.

Additionally, not all bleeding on extremities requires a tourniquet for adequate bleeding control. In these cases, an alternative strategy is to pack the wounds (with hemostatic dressings or plain gauze) and apply a pressure bandage. The principles of wound packing and applying pressure bandages apply to situations when hemostatic dressings are being used and when non-hemostatic gauze or dressings are being used.

Whenever possible, identify the exact source of bleeding and apply direct pressure as a temporary measure while preparing hemostatic dressings (preferable) or gauze for placement. Pack the wound maximizing contact between hemostatic dressing or gauze and the active site of bleeding. Maintain constant direct pressure at the source of bleeding while packing the wound.

After the wound has been packed, hold direct pressure over the dressing on the wound for at least 3 minutes. This is necessary even with the active hemostatic agent in the dressing. When packing a large wound, more than one hemostatic dressing and/or additional gauze may be needed.

Carefully observe the wound to determine if bleeding has been effectively controlled. Once bleeding has been controlled, apply a pressure bandage.