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In the Direct Threat (Care Under Fire) phase, provider and patient survivability under active threat governs all decisions. The TCCC/TECC framework prioritizes returning effective fire, using cover/concealment, and addressing immediately fatal problems that can be corrected quickly. Massive external extremity hemorrhage is the leading preventable cause of death in this setting; therefore, rapid tourniquet application—high and tight if the exact site is obscured—is the intervention with the greatest survival impact that can be performed in seconds while moving to cover. Airway maneuvers, full MARCH sequence, and vascular access are deferred until the Indirect Threat/Tactical Field Care phase when the tactical situation allows. Attempting airway devices or IVs while exposed increases risk to the team and delays definitive hemorrhage control. Once in relative safety, reassess the tourniquet, convert to a pressure dressing if appropriate, and proceed through MARCH (Massive hemorrhage, Airway, Respiration, Circulation, Hypothermia/Head injury), but in Direct Threat the life-saving priority is controlling catastrophic bleeding with a tourniquet as rapidly as possible.