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* The diagnosis of anaphylaxis can be a challenge, even for professionals, and excessive epinephrine administration may produce complications (eg, worsening of myocardial ischemia or arrhythmias) if given to patients who do not have anaphylaxis (eg, if administered to a patient with ACS). Therefore, the first aid provider is encouraged to activate the EMS system before administering a second dose of epinephrine. * - Rescuers are encouraged to activate EMS for anyone with chest discomfort, however while waiting for EMS, * - Because of the potential adverse effects of tourniquets and difficulty in their proper application, use of a tourniquet to control bleeding of the extremities is indicated only if direct pressure is not effective or possible and if the first aid provider has proper training in tourniquet use. Why: There has been a great deal of experience with using tourniquets to control bleeding on the battlefield, and there is no question that they work under proper circumstances and with proper training. However, there are no data on tourniquet use by first aid providers. The adverse effects of tourniquets, which can include ischemia and gangrene of the extremity, as well as shock and even death, appear to be related to the amount of time tourniquets remain in place, and their effectiveness is partially dependent on tourniquet type. In general, specially designed tourniquets are better than improvised ones. * Why: Despite the fact that a number of hemostatic agents have been effective in controlling bleeding, their use is not recommended as a first aid method of bleeding control because of significant variability in effectiveness and the potential for adverse effects, including tissue destruction with induction of a proembolic state and potential thermal injury. * No effect on distal pulses was found in volunteers when pressure points were used.72 Most important, these unproven procedures may compromise the proven intervention of direct pressure, so they