1. Resuscitate per advanced trauma life support.
2. Rule out major thoracic trauma (CXR/EFAST/Bilateral chest tubes)
3. Confirm abdominopelvic source of shock (FAST exam and Pelvic X-ray if blunt trauma)
4. Confirm bilateral femoral pulses are present
5. Establish arterial access with 7 Fr Sheath in an uninjured common femoral artery
6. Measure balloon distance
7. Evacuate the balloon
8. Flush the arterial line
9. Insert the catheter
10. Inflate the balloon (Zone 1: start with 8ml; Zone 3: start with 2ml)
11. Secure the catheter
12. Control major bleeding
13. Monitor the patient, hemodynamics, catheter, and sheath
14. Resuscitate and deflate the balloon
15. Complete damage control surgery
16. Remove sheath when coagulopathy corrected
17. Check distal pulses after sheath removal