What is the recommended tourniquet practice for uncontrolled limb bleeding when direct pressure fails and bleeding persists?

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When direct pressure fails to control life-threatening limb bleeding, the priority is to rapidly control hemorrhage and get the patient to definitive care. Once a tourniquet is in place and bleeding is controlled, it should be left there and the patient transported promptly. Loosening the tourniquet briefly can allow blood flow to resume and risk massive blood loss, so it undermines the control you’ve achieved. While adding a second tourniquet above the first might be considered in some protocols if bleeding persists, the safest and most effective immediate action in this scenario is to maintain the current tourniquet and move toward definitive care. Removing the tourniquet as soon as bleeding slows can lead to rebleeding, which is unsafe in the field.