1. CONFIRM SCENE SAFETY: Verify the hazard is mitigated before approaching the casualty. Ensure machinery is off and the area is structurally stable. Your survivability as the responder is the priority.
2. DON PPE: Open the kit immediately and put on one pair of protective nitrile exam gloves before making contact with the casualty. Reserve the second pair for a secondary responder or as a replacement if the first pair is compromised.
3. CALL FOR ADVANCED HELP: Direct a specific individual by name or role to call 911. Provide the nature of the injury, the severity of bleeding, and the confirmed location. Do not assume someone else has already made the call.
4. EXPOSE THE INJURY: Use the bandage shears to cut away clothing, belts, or leather covering the wound. Fully visualize the bleeding source before selecting a treatment tool.
5. IDENTIFY BLEEDING TYPE AND SELECT TOOL: Pulsatile bright red bleeding from a limb indicates arterial hemorrhage and requires immediate tourniquet application. Deep bleeding from the groin, armpit, or neck requires hemostatic gauze packing. A wound that draws air or produces a sucking sound requires chest seal deployment.
6. APPLY THE WINDLASS TOURNIQUET FOR LIMB HEMORRHAGE: Position the tourniquet high and tight above the wound on the limb. Pull the strap through the buckle as tightly as possible by hand. Turn the windlass rod until bleeding stops completely, secure the rod in its clips, and lock the strap with the hook-and-loop closure. Write the exact time of application on the time strap using the marker. If the strap is saturated, write the time on the casualty's forehead in the format "T-14:30."
7. APPLY HEMOSTATIC GAUZE FOR JUNCTIONAL WOUNDS: Pack the hemostatic blood-clotting gauze directly into the wound cavity with firm, continuous pressure. Do not use it on superficial cuts. Do not remove the gauze once it has been packed.
8. APPLY CHEST SEAL FOR PENETRATING CHEST WOUNDS: Wipe blood and sweat from the skin surrounding the wound. Peel the backing from the chest seal and apply it adhesive-side down directly over the wound as the casualty exhales. Press firmly across the entire seal to ensure a complete occlusive bond. If an exit wound is present, apply the second chest seal over that wound using the same protocol.
9. REASSESS HEMORRHAGE CONTROL: Verify the tourniquet remains tight and that bleeding has not resumed. If bleeding continues through the first tourniquet, apply the backup tourniquet just below the first. Monitor for increasing respiratory distress following chest seal application, which may indicate tension pneumothorax.
10. MANAGE SHOCK AND PREPARE FOR EVACUATION: Once bleeding is controlled, lay the casualty flat. Wrap the casualty completely in the aluminized rescue blanket, including the head, to prevent hypothermia. Do not provide food or water.
11. APPLY SECONDARY WOUND PROTECTION: If life-threatening bleeding is fully controlled and time permits, apply the Israeli bandage or the 5x9 trauma pad over the wound for additional protection. Do not remove or loosen the tourniquet under any circumstances.
12. MONITOR AND REPORT TO EMS: Stay with the casualty and continuously monitor breathing and level of consciousness. Report all interventions to arriving EMS personnel, with specific emphasis on the tourniquet application time.
