1. CONFIRM SCENE SAFETY AND DON PPE: Verify the scene is safe to enter before approaching the casualty. Pull a pair of nitrile exam gloves from the external pocket and don them before making any patient contact.
2. IDENTIFY AND PRIORITIZE LIFE-THREATENING HEMORRHAGE: Perform a rapid visual scan of the casualty and immediately identify any catastrophic external bleeding. Massive hemorrhage control takes absolute precedence over all other interventions.
3. APPLY WINDLASS TOURNIQUET TO BLEEDING EXTREMITY: Position the windlass tourniquet high and tight on the affected limb, above the wound and above the bicep or upper thigh as applicable. Turn the windlass rod until all bright red, pulsatile bleeding ceases completely, then lock the rod and record the exact time of application on the strap or the patient's forehead.
4. PACK JUNCTIONAL OR NON-EXTREMITY WOUNDS WITH HEMOSTATIC GAUZE: For severe bleeding at the neck, armpit, or groin where a tourniquet cannot be applied, pack the hemostatic gauze pad directly into the wound cavity to the source of bleeding. Apply firm, continuous direct pressure for a minimum of 3 to 5 minutes without releasing.
5. APPLY ISRAELI BANDAGE AS A PRESSURE DRESSING: Place the Israeli bandage over the wound, including over any packed hemostatic gauze. Use the integrated pressure bar to focus compression on the wound site and secure with the closure bar.
6. CONDUCT SECONDARY HEAD-TO-TOE SURVEY: Once catastrophic bleeding is controlled, use bandage shears to cut away clothing and fully expose the casualty for a rapid assessment. Identify all secondary injuries including lacerations, burns, suspected fractures, and signs of shock: pale or clammy skin, rapid pulse, and altered mental status.
7. MANAGE SECONDARY WOUNDS AND BURNS: Cover moderate lacerations using trauma pads in the appropriate size, secured with conforming gauze rolls and cloth athletic tape. Apply sterile water-gel burn dressings to minor or moderate thermal burns, secured loosely with conforming gauze. Do not cover more than 10 percent of body surface with burn dressings due to hypothermia risk.
8. TREAT FOR SHOCK PROACTIVELY: Unfold the emergency rescue blanket and wrap it around the casualty to reflect body heat and prevent further heat loss. Position the patient lying flat if no spinal injury is suspected. Initiate shock management before signs are fully present, as blood loss and hemodynamic compromise accelerate rapidly.
9. MONITOR AND REASSURE THE CASUALTY: Continuously monitor the patient's level of consciousness, breathing rate, and bleeding control at all intervention sites. Maintain verbal contact with a conscious patient to track mental status and provide reassurance until EMS arrives.
10. EXECUTE EMS HANDOVER WITH A CONCISE REPORT: Provide arriving EMS personnel with a structured report covering three points: the mechanism of injury and chief complaint, all injuries identified during assessment, and every intervention performed with times noted. Example: "Windlass tourniquet applied to left arm at 1430 hours, bleeding controlled."
11. DISPOSE OF CONTAMINATED MATERIALS AND INITIATE RESUPPLY: Place all used dressings, gloves, and disposables into the biohazard bag for safe disposal. Initiate a formal resupply request immediately after the incident. The kit is not mission-capable until fully restocked with medical-grade components.
