Final answer:
If SECOND full packaging fails to control external hemorrhage distal to the groin or shoulder, use a tourniquet between the wound and the heart and tighten until bleeding stops. Monitor the patient and transport to a medical facility urgently.
Step-by-step explanation:
If SECOND full packaging does not control the bleeding of an external hemorrhage and the bleed is distal to the groin or shoulder, the next step in the protocol would likely involve the application of a tourniquet. A tourniquet is applied proximal to the bleeding site, between the wound and the heart, and tightened until the bleeding stops. This method is generally considered when direct pressure and dressing have failed to stop heavy bleeding. After applying a tourniquet, it is critical to monitor the patient and prepare for immediate transport to the nearest medical facility for further care. Moreover, it is important to never apply a tourniquet directly over a joint and to note the time of application, as this information is vital for emergency medical personnel.