Hemorrhage is the leading cause of preventable death from trauma, yet little research has been done in the pre-hospital first aid environment to evaluate the best methods for first aid bleeding control. The most common technique and first line therapy for bleeding control in the first aid setting is the use of direct pressure, with which slows bleeding and promotes clotting. Instructions for direct manual compression (DMC), however, does not specify how or to what degree pressure must be applied. This study evaluated the effect of fatigue over time on quality of DMC in an attempt to provide guidance for the creation of guidelines on DMC for bleeding control. Participants were asked to perform two-handed, straight-arm DMC on a bleeding control simulator (Z-Medical Bleeding Control Simulator with Biofeedback) which continually recorded data on the pressure exerted (psi) over an elapsed period of 8 minutes. This timeframe mimics the average urban/suburban EMS response time. Participants were asked to inform researchers when they felt fatigue affected their performance, and participants’ demographics were also recorded to evaluate variables affecting performance. The results are pending, but fatigue is predicted to interfere with effectiveness of manual compression during the 8-minute time period. This data will aid in the development of bleeding control guidelines on best practices for DMC, including a switch-off rule when two rescuers are present—similar to that for cardiopulmonary resuscitation (CPR)—and adjunctive therapies such as hemostatic dressings.