This lesson covers the middle ground: wounds bigger than a bandage and smaller than an emergency room, plus the one wound type that is an immediate emergency and needs a specific tool. Let us be clear about what belongs in each category, because getting the category wrong is the actual risk here. Most cuts need cleaning and covering and nothing else. Some need their edges held together, and there are inexpensive ways to do that at home which work well when the wound is right for them. A few are bleeding in a way that will kill somebody in minutes, and those need pressure and possibly a tourniquet, immediately, while somebody else calls nine one one. This lesson teaches you to sort a wound into the right category first, then act. Sorting is the skill. The products are secondary and always have been.

Three skills from this lesson. First, recognising the four signs a wound needs more than a bandage, so you are working from criteria and not from how squeamish you feel. Second, knowing what each closure option is actually for: adhesive closure strips, tissue adhesive, a pressure dressing, and packing material, each of which suits a different wound and none of which is general purpose. Third, applying a tourniquet correctly under time pressure, which is the one genuinely life-or-death psychomotor skill in this entire class. If you only practise one thing from these eight lessons, practise the tourniquet, because it is the only item here where a two-minute delay or a half-tightened application is the difference between somebody surviving and not.

Tissue adhesive is the household version of what an emergency department uses to close a small wound without stitches. Veterinary tissue adhesive sold under names like Vetbond needs no prescription and is a close cousin of the medical products, both being cyanoacrylate adhesives, though not the identical compound. One drop holds clean wound edges together for several days and comes off with the skin. The part that matters is the selection criteria, so here they are. The wound must be clean, freshly bleeding rather than hours old, straight-edged, shallow, and somewhere the skin is not under constant tension. Irrigate thoroughly first, dry the surrounding skin, hold the edges closed, and apply a thin line on top of the join, never into the wound itself. And know the exclusions, because they are not negotiable: nothing deep, gaping, contaminated, or from a bite or a puncture, and nothing over a joint that will pull the closure open every time it moves. Those wounds need a clinician.

An Israeli bandage is a pressure dressing built to be applied with one hand, including to yourself, which is why it belongs in a vehicle kit where you may be the patient. It is a sterile pad joined to an elastic wrap with a plastic pressure bar partway along it. The sequence is four moves. Open the package and put the pad directly over the wound. Wrap the elastic strap around the limb and back through the pressure bar. Reverse direction at the bar, which is the step that generates and holds the compression, and this is the step people get wrong or skip. Then continue wrapping over the pad and tuck the end into the closure clip. Two points to remember. It should be uncomfortably tight, because a pressure dressing that is merely neat is a bandage. And if blood soaks through, do not remove it. Add pressure on top, by hand or with a second dressing, and get moving.

Now the tourniquet, and this is the most important procedure in the class. Use it for life-threatening limb bleeding: blood spurting or pooling fast, an amputation, or bleeding that direct pressure has not controlled. Do not wait to see whether pressure works if the bleeding is obviously catastrophic. Four steps. Place it two to three inches above the wound, on the limb, never over a joint, and go higher up the limb rather than lower if you are unsure. Pull the strap as tight as you can by hand before you touch the windlass, because most failures are a tourniquet that was never pulled snug to begin with. Then twist the windlass until the bleeding stops and secure it. Then write down the time it went on, on the tourniquet, on tape, or on the patient's skin, because the treating clinician needs that number. It will hurt a great deal, and it should. Once it is on, leave it on and let a clinician remove it.

Four mistakes, and each one has a specific consequence. Buying a cheap unbranded tourniquet online: counterfeits of the recognised designs are widespread, and they fail under load, usually at the windlass or the buckle, at the one moment there is no second chance. Buy a genuine CAT or SOFTT-W from a reputable supplier. Placing it over a joint: the pressure cannot occlude the vessels there, so it hurts enormously and does not work. Using tissue adhesive on a deep, gaping or contaminated wound: you have sealed bacteria inside a wound that needed cleaning and closing properly, and turned a stitchable laceration into an abscess. And loosening a tourniquet to check whether the bleeding has stopped: that restarts the bleeding, undoes the clot, and costs blood the patient may not have. Notice that three of these four come from wanting to check or to economise, which are the two impulses to distrust here.

Recap. First, recognise the four signals that a wound needs more than a bandage: the edges will not stay together, you can see fat or muscle or bone, it is bleeding through dressings, or it came from a bite or a puncture. Those four send you to a clinician regardless of what is in your kit. Second, stock the small set that covers the rest: adhesive closure strips, tissue adhesive, a pressure dressing, gauze for packing, and gloves. Third, and this is the assignment, practise the tourniquet slowly, with a timer, on your own leg, until you can do it one-handed in under thirty seconds without thinking about the sequence. Then do it again in three months, because this is a skill that decays. Everything else in this lesson you can look up. That one you cannot.