Had a 2 a.m. hit-by-car (HBC) with a distal limb arterial bleed 12 minutes out; we kept the owner on the line for continuous direct pressure, applied a SWAT-T within 60 seconds of arrival, and converted to a pressure bandage after 9 minutes. How are you deciding when to have owners attempt a tourniquet versus pressure-only in transit, and what max time are you comfortable with on a small dog?
And i use a simple phone test: if the towel is “soaked through in under a minute” despite hard two-hand pressure, I talk the owner through a SWAT‑T (or tight leash) 2–3 inches proximal and have them say the time out loud so we can track it. In the truck I try to convert at 5–10 minutes if distal perfusion looks okay; if they’re shocky or it’s near a joint, I leave it and reassess at 15. Small caveat: ears/tails stay pressure-only since a tourniquet won’t help much there.
I default to pressure-only unless there’s obvious arterial flow despite body‑weight compression; if so, I coach a high‑and‑tight SWAT‑T, start a timer, and try to convert around 10–12 minutes if it’s safe. What’s helped is a quick video check so I can confirm position and tell them, “if you still see ‘pulsing past your grip,’ tighten another half inch,” though I’m more conservative on toy breeds.
Building on @kristen_b76, my trick is to have the owner “count out loud every 60 seconds” so we’ve got a clean tourniquet clock, and before we green‑light a strap I have them pack a firm roll of gauze or a golf ball–size sock knot right over the wound under the wrap as a quick focal‑pressure step; caveat: skip that if you suspect a comminuted distal fracture.