1. Assess for unrecognized hemorrhage and control all sources of external bleeding with manual or direct pressure via application of hemostatic agents, pressure bandages and/or wound packing as first line intervention.
2. Apply CoTCCC-recommended hemostatic dressings with at least 3 minutes of direct pressure (optional for XStat). Each dressing works differently, so if one fails to control bleeding, it may be removed and a fresh dressing of the same type or a different type applied. (Note: XStat is not to be removed in the field, but additional XStat, other hemostatic adjuncts, or trauma dressings may be applied over it.)
3. Junctional wounds should be treated with aggressive application and packing with hemostatic, pressure dressings and direct pressure to control bleeding.

* CoTCCC recommended windlass, limb tourniquets designed for humans (e.g. C-A-T, SOFTT-W) tend to slip distally and generally fail on MWDs due to conformational differences and should not be used as first line therapy for hemorrhage control in MWDs.

* The only tourniquet that should be considered for use on a massive extremity hemorrhage in a MWD’s is a stretchable and elastic tourniquet such as the SWAT-T. This type of material allows it to mold to nearly any limb size and conformation in conjunction with its wide design, allows it to serve as an effective circumferential pressure bandage on an MWD’s limb.

*Junctional tourniquets have not been evaluated in dogs and are not recommended at this time.