The United States is a world leader in gun violence, far surpassing other high-income nations like Chile, Canada, and Portugal. Guns are also now the leading cause of death in children in the U.S., surpassing car crashes and cancer. Given the sheer number of guns in the United States — 121 firearms for every 100 people — there is a small but real chance of being a bystander to gun violence.Bleeding out is the biggest concern after someone is shot. If a bullet hits an artery, a gunshot victim could bleed to death in just three to five minutes. Knowing how to staunch bleeding from a gunshot wound until emergency help arrives could save someone’s life.

Here are the steps to take.

First, assess your surroundings to see if you are safe to respond, says Jeffrey Luk, MD, director of prehospital and disaster medicine at University Hospitals Cleveland Medical Center in Cleveland, Ohio. Is there still active fire? Is the gunman gone? It’s critical to check in and think about whether you feel capable of responding under the circumstances.

“You can't help anyone if you yourself are injured, right?” Dr. Luk says.

It’s perfectly normal to feel overwhelmed in a scenario where other people have been shot. But your actions as a bystander can give emergency medicine the best chance of helping a gunshot victim, says Erin Hall, MD, MPH, the medical director of the MedStar Washington Hospital Center–Community Violence Intervention Program in Washington, DC. She’s also an instructor for Stop the Bleed, a national public service campaign and training program run by the American College of Surgeons’ Committee on Trauma to teach people how to effectively respond in emergency scenarios where someone is severely bleeding.

Dr. Hall says you can remember the next steps as the ABCs of responding:

• Alert the authorities

• Bleeding — find the source

• Compression on the wound

If someone else is nearby, tell them to call 911 and get emergency medical assistance on the way. Some places like schools, offices, and transit stations have kits containing gauze, gloves, and a tourniquet near cardiopulmonary resuscitation (CPR) or defibrillator kits. If you know of a nearby kit, you could also direct someone to run and grab it for you. These supplies could be helpful in responding, but you can still be an effective emergency responder without any medical supplies.

You can advocate for Stop the Bleed kits to be installed alongside other first aid kits — in schools, places of worship, and other public venues. North American Rescue

It’s important to find where the bullet actually entered the body. When someone has been shot, blood might drip or splatter over multiple areas. There may be entrance and exit wounds if a bullet went the whole way through the body. Before attending to the wound, you need to correctly identify where exactly the person has been shot and if there are multiple wounds.In the event where more than one person has been shot, it’s helpful to triage the situation. Go first to the people who are still breathing and are likely to survive if given help.Once you’ve found the wound, remove any debris or clothing in the wound, then put a clean cloth or gauze over it and apply steady, direct pressure. You need to press down harder than you think — hard enough that the skin bows beneath your hands. Remember, the goal is to control the bleeding and get the blood to clot. Luk says blood clotting can save a victim’s life.

“If you apply pressure to stop the bleeding, they have less blood loss and they have a higher chance of survival,” he says.

No matter where the wound is, applying steady and firm compression directly over it is an effective way to slow the blood flow. For torso wounds, direct pressure is the only option until medical help arrives.

If you have access to a medical-grade tourniquet, you can use it to staunch bleeding on gunshot wounds in the arms or legs. Help the person lie down on a blanket if possible to decrease loss of body heat and maintain blood flow to their brain. A gunshot wound can shatter bones, which would require surgery, so try not to move the person too much.

Only use a medical-grade tourniquet, because makeshift ones could cause more problems than they solve.North American Rescue

A tourniquet is a medical device that’s wrapped tightly around an extremity to stop severe, life-threatening bleeding. The goal of using one is to cut off blood flow to the arm or leg for a period of time.

Mark Conroy, MD, an emergency medicine physician at The Ohio State University Wexner Medical Center in Columbus, says to apply a tourniquet to an arm or leg, you should go high and tight. You should not be able to slip your fingers underneath.

If a tourniquet is applied correctly, it should feel uncomfortable to the victim. It should be placed two to three inches above the wound, not on top of it. Also avoid placing the tourniquet directly on a joint.You’ll know the tourniquet is working if the blood coming from the wound slows or stops. That means the blood is not reaching the wound and is clotting.Dr. Conroy says to make a note of what time you applied the tourniquet so you can pass that information on to the emergency medicine team. Once the tourniquet is in place, you should still apply pressure directly to the wound. Don’t loosen the tourniquet, and let emergency medicine professionals take it from there.

Tourniquets can be helpful for gunshot wounds on the arms and legs. But fashioning a makeshift tourniquet out of common items like belts, neck ties, or ripped clothes can do more harm than good, according to Sharon M. Henry, MD, who works as a trauma surgeon at the University of Maryland Medical Center and serves as the Anne Scalea Professor of Trauma at the University of Maryland School of Medicine in Baltimore.

“The standard party line from the American College of Surgeons is that you should not fabricate a tourniquet,” Dr. Henry says. “You can do harm by putting on an ineffective tourniquet. You can in fact increase the bleeding.” It can also be really hard to get the necessary amount of pressure and tightness for a makeshift tourniquet to function correctly.

If you don’t have a medical-grade tourniquet, just apply direct pressure to the wound instead.

Hall says studies have shown that makeshift tourniquets are not as effective as medical-grade tourniquets, or even correctly applied direct pressure to the wound. When in doubt, apply direct pressure directly over where the person is bleeding.While you shouldn’t try to make your own tourniquet, common items you may have in your purse or backpack could still be helpful. If you have a plastic bag or a clean cloth, you could use it as a barrier between your hands and the wound.

You could also shout out to ask any other bystanders if they have a medical-grade tourniquet, gauze, or gloves. Some people carry these items in their bags or keep them in their cars, or they might know of a nearby Stop the Bleed kit.

Whether you have access to those items or not, wash your hands thoroughly with soap and water after emergency personnel take over — especially if you got any blood on them. If you had cuts on your hands while providing care to a bleeding wound, let your doctor know. They can help you with any preventive care or treatment for bloodborne diseases, if necessary.

Henry says that when everyday people are asked what worries them most about intervening in a scenario when someone has been shot, their main concern is not their own safety. Most people worry about doing more harm than good and hurting the person further.

Training programs like Stop the Bleed can give you the confidence and knowledge to help save a life. There, you can practice using a tourniquet and applying compression while being monitored and corrected by doctors that will improve your form and make you prepared to help in a medical emergency.Most states also have Good Samaritan laws that protect bystanders from the unlikely event of being sued in these situations. Doing Stop the Bleed training and advocating for Stop the Bleed kits to be in your schools, churches, libraries, and other public buildings could help members of your community survive gun violence.

When in doubt, stick to the ABC’s: By alerting authorities, finding the bleeding, and applying compression, you can do your part to staunch bleeding before emergency medicine takes over.

• Knowing how to control bleeding from a gunshot wound while waiting for emergency responders could save someone’s life.

• First, check the scene for safety before intervening to help and call 911 or instruct someone else to do so.

• Look for a Stop the Bleed kit or equivalent aids, as prompt professional help and utilization of available emergency medical tools can be life-saving.

• Locate the gunshot wound, clear debris, and apply steady, direct pressure to it. This approach helps slow blood flow and supports blood clotting until emergency personnel arrive.