Occasionally, these patients arrive with CPR in progress. If the mechanism of injury (MOI) is DCBI, the presumption must be made that they have gone into cardiac arrest secondary to hemorrhage, and the casualty needs rapid blood product resuscitation. CPR should be continued while a subclavian or IJ central line for rapid transfusion is placed. U.S. service members with DCBI as the MOI wear body armor, therefore, thoracic injuries were not prominent with this MOI, but another provider should ultrasound the chest to rule out thoracic injury. Outcome data from in military casualties from recent conflicts do suggest a reasonable survival rate in properly selected patients who undergo emergency resuscitative thoracotomy; however, the priority must be resuscitation with blood.7,8 Since these casualties have often exsanguinated, prior to a resuscitative thoracotomy, blood must be started while high quality CPR continues. As the casualty gets resuscitated and the blood pressure returns – all extremity TQs should be assessed and usually need to be tightened or additional TQs added. It is also necessary to ensure the casualty stays warm. Once cardiac activity returns, the casualty should be intubated. As mentioned above, prioritizing intubation over establishing circulation (and filling the heart) will result in cardiac arrest in the exsanguinated DCBI casualty.