1. ENSURE SCENE SAFETY AND DON PPE: Confirm the environment is safe before approaching the patient and apply appropriate personal protective equipment before making patient contact.

2. MANUALLY STABILIZE THE LIMB: Support the injured limb above and below the injury site with your hands to prevent movement until the sling is applied.

3. ASSESS DISTAL CMS: Check the radial pulse, ask the patient to wiggle their fingers, and assess sensation in the hand. Note all findings as your baseline for post-application comparison.

4. POSITION THE BANDAGE: Slide the open triangular bandage between the patient's torso and the injured forearm with the apex pointed toward the elbow. Position the forearm across the chest with fingertips slightly elevated above elbow height to reduce swelling.

5. APPLY THE SLING: Bring the bottom end of the bandage over the shoulder on the injured side and the top end over the opposite shoulder. Tie both ends with a square knot at the hollow of the neck on the uninjured side. Never place the knot on the cervical spine. Pad beneath the knot if necessary.

6. SECURE THE APEX: Twist or fold the excess fabric at the elbow and pin it to the front of the sling with a safety pin, closing the sling and preventing the elbow from slipping out.

7. APPLY SWATHE IF INDICATED: For clavicle or shoulder injuries, or when preparing for rough evacuation, fold a second triangular bandage into a wide cravat. Wrap it horizontally around the chest and slung arm and tie it on the uninjured side. The swathe must be snug enough to prevent swinging but must not restrict breathing.

8. REASSESS DISTAL CMS: Immediately re-check radial pulse, motor function, and sensation in the hand. Compare findings to your initial baseline. If pulse is diminished or absent, or if the patient reports numbness or tingling, loosen and readjust the sling immediately.

9. MONITOR UNTIL TRANSFER OF CARE: Continue CMS checks at regular intervals throughout transport and document all findings for the receiving medical team.

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