1. CONFIRM SCENE SAFETY: Ensure the immediate hazard, such as active machinery, is neutralized before approaching the casualty. Your safety and the safety of bystanders is the first operational priority.
2. DON NITRILE EXAM GLOVES: Open the kit and put on one pair of nitrile exam gloves before making any patient contact. This establishes your Body Substance Isolation barrier against fluid-borne pathogens.
3. CALL FOR ADVANCED CARE: Direct a specific, named person to call 9-1-1 or your internal emergency response number immediately. Provide a clear location and a concise description of the injury.
4. EXPOSE THE INJURY SITE: Use the bandage shears to cut clothing away from the affected limb, exposing the wound from hip to knee for a thigh injury. Identify the exact source and severity of the most critical bleeding before selecting your intervention.
5. APPLY TOURNIQUET HIGH AND TIGHT: For massive, pulsatile arterial bleeding from a limb, place the windlass tourniquet strap high on the thigh, above the wound and as close to the torso as possible. Do not position it over a joint or over items in a pocket.
6. TIGHTEN THE STRAP AND ENGAGE THE WINDLASS: Route the strap through the buckle and pull forcefully to eliminate all slack, then secure the strap back on itself. Twist the windlass rod until bleeding stops completely, with the clinical endpoint being the absence of a distal pulse.
7. SECURE AND TIME-STAMP THE TOURNIQUET: Lock the windlass rod into the security clip and secure it with the white security strap. Write the exact time of application on the time strap using the permanent marker, for example: T: 1430. This data is critical for receiving medical professionals.
8. PACK JUNCTIONAL WOUNDS WITH HEMOSTATIC GAUZE: For deep wounds in areas inaccessible to a tourniquet such as the groin, neck, or axilla, open the hemostatic gauze pad and pack it firmly and directly into the wound cavity, making contact with the bleeding source. Apply firm, direct pressure with both hands for a minimum of 3 to 5 minutes without releasing to inspect the wound.
9. SECURE THE PACKED WOUND WITH ISRAELI BANDAGE: After completing the full pressure hold on the hemostatic gauze, apply the Israeli bandage directly over the packed wound to maintain sustained pressure. Secure it tightly so the dressing cannot shift.
10. APPLY CHEST SEAL TO PENETRATING CHEST WOUNDS: Expose the patient's torso and check both the front and back for wounds. Wipe blood and fluid away from the skin, peel the backing from a chest seal, and apply the adhesive side firmly over the wound, ensuring a complete seal on all edges to prevent air from entering the chest cavity.
11. APPLY SECOND CHEST SEAL IF EXIT WOUND IS PRESENT: If an exit wound exists, apply the second chest seal using the same technique. Position a conscious patient sitting upright and leaning slightly forward to ease respiratory effort.
12. APPLY EMERGENCY BLANKET, REASSESS, AND PREPARE FOR EMS HANDOFF: Once bleeding is controlled, unfold the Mylar emergency blanket and cover the casualty entirely to prevent heat loss and combat hypothermia. Monitor the tourniquet continuously and apply a second tourniquet directly beside the first if bleeding resumes. Prepare a concise verbal report for arriving EMS, including the exact tourniquet application time and all interventions performed.
