In Phase 1 or Care Under Fire (meaning combat scenario) or Care Under Threat, such as during a fire, industrial accident etc. the scene is often chaotic and there are many things that require your immediate attention, as you begin to approach a casualty.

There are four major areas for action:

1. Scene Safety
2. Casualty Movement
3. Control of any Massive Bleeding
4. Proper Communication

What you do first really depends on the scenario, but generally, scene safety is paramount. If the scene is safe, and there is massive life-threatening bleeding, your first step could be tourniquet placement. Each scenario is different, and the ordering of these actions could vary.

Scene Safety; First, you must ensure the scene is safe for you to enter. You can help others who may be working to secure the scene or you may have to do what you can to make the scene safe to enter (return gunfire, firefighting etc.). You can’t risk your personal safety or the safety of your casualty.

You may need to move the casualty to a safer area due to a real or potential threat that exists in the environment. In that case, you must quickly develop a casualty movement plan that takes into account these important considerations: the location of the nearest cover, how best to move yourself or the casualty, the weight of the casualty, and the distance to be covered.

You should also be aware of environment threats in forming a plan such as; Enemy engagement, active shooters, fire, flood, smoke and toxic gas, energized circuits or other force protection threats when planning a move.

One person or two person drags and carries, or other appropriate movement techniques can be used depending on the availability of personnel and physical movement constraints present (e.g. wooded area, tanks, vehicles, ships, aircraft).

Special circumstances exist when moving casualties into or around different aircraft, vehicles and ships. You may be required to pull someone out of an aircraft or tank or go up and down ladders and stairways on ships. You should make sure you are familiar with the types of casualty movement specific to your location and circumstance. The following video will show the most common types of drags and carries.

In Care under Fire, consider placing one or more hasty tourniquets in a “high and tight” manner to an arm or leg to control massive life-threatening bleeding. This should be accomplished in less than 1 minute. If the casualty is conscious, you make direct the casualty to render self-aid and apply a tourniquet to him/herself, if they have one. Regardless, a tourniquet applied in the CUF/Threat phase must be re-evaluated in Tactical Field Care or Phase II.

Once you are able to reach the casualty safely and taken any other precautions, you must communicate with the casualty.

Responsiveness: As soon as possible, maybe even before you have moved the casualty to a safe area, communicate with the casualty to determine if they are awake, confused or disoriented. If they are awake, let them know you are there to help.

Request assistance from other first responders or medics, if available. Rarely are you alone in these circumstances.