By the Stop The Bleed Coalition
The call comes in as a stabbing. By the time the crew arrives, a man is on the ground with a tourniquet already applied. It’s tight and positioned about two inches above the wound. A bystander crouches next to him, phone in hand, visibly shaken but focused. She tells the paramedic exactly when she applied it.
The quick actions she learned in a STOP THE BLEED® class just saved his life. EMS arrived 9 minutes after the stabbing, and a person can bleed out from a life-threatening wound in as little as 3-5 minutes. In the United States, approximately 40,000 people die each year from traumatic bleeding, and many of these deaths could have been prevented if someone on the scene knew what to do and took the appropriate action.
Scenes like this are exactly what the STOP THE BLEED program was designed to make possible. May 21, 2026 is STOP THE BLEED Day, held annually on the Thursday of National EMS Week, when communities rally around a single, urgent idea: that ordinary people, given the right skills, can save lives in the minutes before EMS arrives.
| MORE: ‘Stop the Bleed’ turns 10: A decade of turning bystanders into lifesavers
More than six million people have now been trained through the program, which teaches civilians the same hemorrhage control techniques developed on the battlefields of Iraq and Afghanistan.
“As that trained population grows, the likelihood of EMS responders arriving to find bleeding already controlled, by bystanders, increases with it,” says Dr. Matthew Levy, chair of the Stop the Bleed Coalition. For many medics, that’s a welcome development, but it also comes with new variables to assess, new communication requirements, and new expectations for what a clean handoff looks like, all the way from the sidewalk to the surgical suite.
What good bystander intervention looks like
Effective bystander hemorrhage control, from the EMS perspective, has three components:
- The right technique
- Applied in the right manner
- At the right time
STOP THE BLEED® trains civilians to recognize which type of bleeding requires which immediate action, focusing on three core interventions:
- Direct pressure
- Wound packing with gauze
- Tourniquet application
When a bystander has correctly used pressure and packed a wound, or identified an extremity wound and applied a commercial tourniquet proximal to the injury, arriving EMS crews have a meaningful head start. The patient’s hemorrhage has been addressed, and the first link in the chain of survival has been upheld.
What EMS providers often note as the hallmark of a well-trained bystander is not just the technique; it’s the communication. A bystander who can say, “I applied the tourniquet at 2:23 p.m., the bleeding slowed within about a minute, and he hasn’t lost consciousness since,” is handing the crew actionable clinical information. That’s the goal of STOP THE BLEED training, and when it works, it works exactly that way.
Common issues crews encounter in the field
That said, bystander intervention is not always textbook, and EMS crews need to be prepared to assess and correct what they find on arrival.
- Proper tourniquet application and for appropriate indications are the most common issues. A tourniquet applied too distally, close to the wound rather than two to three inches above it, may not fully occlude arterial flow. When applied without sufficient tension it may slow but not stop bleeding. Crews should reassess all bystander-applied tourniquets on arrival: check placement, check tension and check whether the limb distal to the device is still perfused when it shouldn’t be, and also importantly, if there is still a need for a tourniquet. “Local EMS protocols should allow for tourniquets that are not clinically indicated to be converted to pressure dressings by trained personnel,” Levy added.
- Wound packing technique can also vary. STOP THE BLEED teaches civilians to pack wounds firmly and hold direct pressure, but the depth and consistency of that pressure matters. Upon arrival, crews should assess whether packing is intact, whether it has been held continuously, and whether the wound is still actively bleeding through or beneath it. If indicated, removing and repacking in the field should be done so in a thoughtful manner, a well-packed wound that has begun to clot is better left undisturbed when possible.
- Improvised devices present their own set of challenges. While commercial tourniquets are the standard taught in STOP THE BLEED courses, crews will sometimes find improvised devices like belts, zip ties or torn clothing applied by untrained bystanders acting on instinct. These require immediate reassessment. Improvised tourniquets fail to occlude arterial flow far more often than commercial devices, and their application time is frequently unknown.
- Scene communication gaps remain a persistent challenge. Bystanders who intervened may have left the scene, may be in shock themselves, or may not have noted a time. When intervention time is unknown, EMS crews should document arrival time and estimated intervention window based on available information, including the time that 911 was activated and communicate that uncertainty explicitly during hospital handoff.
The handoff: What travels with the patient
The quality of information that moves with the patient from bystander, to EMS, to trauma team, is nearly as clinically significant as the intervention itself. For hemorrhage control specifically, the handoff chain carries several essential data points:
- Time of tourniquet application is the most critical. Limb ischemia is a meaningful concern and increases substantially after approximately 2 hours; surgical teams need to know where they are on that clock the moment the patient rolls through the trauma bay doors. If the bystander provided a time, document it and communicate it to hospital staff.
- Intervention sequence matters too. It’s worth asking if the bystander attempted direct pressure before applying a tourniquet. Was wound packing attempted before or after? Was the patient ambulatory at any point after the injury?
- Patient status changes between bystander intervention and EMS arrival should be documented. Was the patient conscious and oriented when crews arrived? Has mental status changed? Was there any reported loss of consciousness? These details, communicated during trauma team notification, shape the hospital’s preparation before the patient arrives.
The standard EMS trauma handoff — mechanism, injuries, signs, treatment — applies here, with hemorrhage control specifics included. Crews should know what their receiving facilities require and communicate it consistently.
STOP THE BLEED Makes EMS Better
STOP THE BLEED was built on the same evidence base that informs prehospital trauma care, battlefield data and a decade of civilian outcome research.
“When bystanders are trained and empowered to act, they become an important extension of the hemorrhagic shock chain of survival,” Dr. Levy notes. The EMS crew’s job on arrival shifts from starting hemorrhage control from scratch to assessing, confirming and building on what has already been done.
That shift, from zero to a meaningful head start, is what six million STOP-THE-BLEED-trained civilians represent. And for the EMS professionals who arrive after them, it shows up one scene at a time, in the form of life-threatening bleeding controlled and a patient who is still alive to be handed off.
