In a patient with heavy vaginal bleeding after a miscarriage, which action is the first step in field management?

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The first priority is to control external bleeding and keep the field clean, so placing a clean trauma pad over the vaginal opening is the best initial action. This quickly absorbs blood, prevents pooling, and allows you to assess how much bleeding is occurring while you prepare for transport. It also avoids internal insertion, which could cause harm or infection.

Other actions don’t address the immediate need. Applying abdominal pressure isn’t appropriate for vaginal bleeding and can cause discomfort or delay care. Restraining the patient isn’t necessary and doesn’t help with bleeding control. Obtaining a rapid EKG doesn’t tackle the urgent issue of hemorrhage and isn’t a priority in this scenario. After placing the pad, focus on assessing and supporting the patient’s circulation, provide oxygen as needed, and arrange for rapid transport.