1. Return fire to gain fire superiority
2. Direct the casualty to return fire, move to cover, and apply self aid, if possible
3. Direct security team to provide security for casualty, moves to casualty once security team is in place and signaled for medic to move forward.
4. MAJOR LIFE THREATENING EXTREMITY HEMORRHAGE
• Apply HASTY tourniquet high on limb over uniform to control obvious extremity hemorrhage and move casualty to cover

1. If tactical situation permits, take BSI precautions
2. If not completed previously, assess responsiveness and chief complaint
• Either Responsive or Unresponsive
• If unresponsive, check for carotid pulse and Resp.  If absent, respond IAW tactical environment
3. Perform blood sweep of neck, auxiliary, inguinal, and extremity areas.  Assess effectiveness of previously placed TQs.
• Rapidly apply DELIBERATE TQ to any new wounds discovered on extremities.
• Rapidly apply hemostatic agent (hold pressure for 3 min) to neck, axillary, and/or inguinal wounds discovered.

4 Airway

1. Open (head tilt) and assess airway (look, listen, feel)
2. Insert appropriate adjunct, as indicated
• NPA or Surgical Cric
3. Position casualty to maintain an open airway

5. Breathing

1. Expose and assess torso.  Remove casualty's IBA if injuries are present.
2. Assess breathing for equal rise and fall of chest, spontaneous Resp effort, and attach pulse ox
• Adequate Resp or Artificial Ventilations
3. Inspect and Palpate chest DCAPBTLS TIC
4. Monitor penetrating chest wounds.  Use occlusive if present.
5. Monitor casualty's Resp effort.
• Progressive Resp distress+ torso trauma = needle chest decompression 
• Identify 2nd ICS MCL.  14g 3.25" needle over 3rd rib.  
6. If injuries permit, position casualty to facilitate Resp effort

6. Circulation

6b. Circulation Assessment

6B Circulation

1. Need for vascular access
2. Check radial pulse, if absent check carotid
3. Sig injury, rad pulse, no AMS= saline lock
4. Sig injury, no rad pulse, AMS= Direct IV and fluid resuscitation
5. IO placed after second  failed IV attempt
6. Initiate 500 ml of Hextend wide open.  
7. Reasses mental status and pulse in 30 min.  Abnormal = 500 ml of Hextend.

1. Check for specific drug allergy
2. Administer pain med