(FM 4-25.11) First Aid
(FM 21-75) Common Skills of the Soldier
The First Thing: Eliminate Danger
Occasionally cadre will give you a hypothetical situation with some source(s) of danger and a victim. Evaluating/treating the casualty, calling in for help, are not the first things you do. The first thing you do is eliminate the danger source, however this may be. If you're in a combat situation, you defeat the enemy first and you are sure to remember that you do not become a casualty as well. Dashing out into a killing field or other danger area without first eliminating the danger source only makes you another casualty. Cadre often like to trip people up with this because you get used to rattling off answers.
The Second Thing: Evaluate a Casualty
These are formal steps you go through when you first find someone who is hurt. Remember as you list them that in real life you will be looking for multiple things simultaneously and you will be going very quickly. Remember also that if you see or are told the specific cause of injury, there's no need to go through the whole list. So if you're buddy is fine one moment then he gets shot in the leg, check for head injuries is not necessary and therefore you do not need to run down the list for your cadre.
When you find a casualty you check for:
Responsiveness: Say their name, tap them, etc. If cause of injury is unknown, be careful with moving their spine.
Breathing: If they don't talk back or make obvious choking signs, get down on your knees and one of your ears very close to their lips. This way you can feel for breathing, listen for it, and look down towards their chest, all at the same time.
Bleeding: Lay the casualty out spread-eagle and then, using both hands, pat down their entire body. Every now and then, check your hands for blood. Keep in mind that exit wounds will be where most of the blood will be so do not forget their back. Once again, keep in mind spinal injuries.
Shock: The body and/or mind is basically overloaded. Common signs include but are not limited to: pale and clammy skin (darker skinned soldiers may exhibit an ashen hue), disorientation, memory failure, lack of balance, no sensation of pain, sweaty, passing out and blotched or bluish skin, especially around the mouth.
Fractures: IE broken bones. While you check for bleeding, you should also be feeling for any unusual bumps, limbs at unusual angles, sharp protrusions, and listening for any grinding noises. Should your victim be conscious, just ask them what hurts.
Burns: Another thing you can check while doing your full body sweep for bleeding. Use your nose to smell for something burning (hair and flesh are very distinctive), check for fabric sticking to the skin (do NOT peel it off), blisters, or blackened areas of skin.
Head Injuries: Lack of balance, different sized pupils (black part of eye), clear fluid running from the ears, fluid from the ears, nose, or mouth, nausea, convulsions/twitching, bruising around and behind the eyes, slurred speech, and memory loss are all signs of a head injury.
9 Line Medevac
First aid is only a temporary fix: eventually the casualties must get better treatment and the 9 Line Medevac is what you use to call in for it. Keep in mind that this is meant to be sped read. So, you might call up and simply say:
"This is Charlie 2-six, request medevac, over".
"Send request over".
"ONE, Uniform-Tango 45319840, break"
"TWO, 39.39,Charlie 2-six, break"
"THREE, 1-Bravo, 1-Charlie, break"
"FOUR, Alpha, break"
"FIVE, Lima-1, Alpha-1, over"
Line 1. Location of the pick-up site Giving your 8 digit grid coordinates is what you most typically be doing in LDAC.
Line 2. Radio frequency, call sign, and suffix.
Line 3. Number of patients by precedence: 99.9% of your time in LDAC and basic, you will be using Urgent.
A Urgent (needed within 2hrs)
B Urgent Surgical (needs surgery as well)
C Priority (within 4 hrs)
D Routine (within 24 hrs)
E Convenience (I just thought I'd like to talk to you)
Line 4. Special equipment required:
C Extraction equipment
Line 5. Number of patients:
Line 6. Security at pick-up site:
N No enemy troops in area
P Possible enemy troops in area (approach with caution)
E Enemy troops in area (approach with caution)
X Enemy troops in area (armed escort required)
* In peacetime number and types of wounds, injuries, and illnesses
Line 7. Method of marking pick-up site:
B Pyrotechnic signal
C Smoke signal
Line 8. Patient nationality and status:
A US Military
B US Civilian
C Non-US Military
D Non-US Civilian
Line 9. NBC Contamination:
* In peacetime terrain description of pick-up site
- Remove any obstructing clothing or gear. Don't try to dig any stuck clothing out of the wound.
- Apply a field dressing. To apply a field dressing, simply remove the dressing from its package, unwrap it, and place the gauzy part on the wound. Wrap it up until you can't see any more white and then tie it off with the knot to the side of the wound. You should be able to fit two fingers under your knot.
- Elevate the wound and apply pressure.
- If the bleeding does not stop, then you move to a pressure dressing. A pressure dressing simply builds off the field dressing. Take a rag or something similar, wad it up into a ball and place it directly atop the padded portion of the dressing. Next, take another piece of cloth and tie a knot directly on top of that. You should be able to fit one finger under this time.
- Elevate and compress for five to ten minutes.
- If all else has failed, you move onto a tourniquet. There are two ways to do this:
- The first and easiest way is to use the new CAT's (Combat Application Tourniquet). Simply place the CAT approximately two to three fingers above the wound, tighten until the bright red blood or the major of the gushing stops, then secure the tightening rod with the clips and straps.
- Now for the old fashion way:
- To properly apply a tourniquet, a strap, preferably a wide and non-elastic strap such as a necktie, belt, sling or scarf, is tightened around the limb, between the wound and the heart. The tourniquet ideally should be at least 2 inches (approx 3 fingerwidths) wide, to prevent tissue damage. Rubber tubing is more difficult to tighten properly and generally should only be used by paramedics or medical teams.
- If a suitable strap is not available, any improvised material long enough can be used, though avoid thinner material if at all possible to keep from cutting into the victim and thereby increasing the chances of amputation; stuff like wire and wrapping cord.
- Once again, apply the tourniquet approximately two to three fingers above the wound, unless the leaves on joint. If that happens, simply move the tourniquet up until it is slightly above the joint.
- The tourniquet is usually tied with a square knot. Tie the tourniquet square knots as you would a shoelace. You can also wrap the strap around the limb and tie tightly; a stick is wound underneath the tubing and twisted until the strap is tightened so that the bleeding is stopped, the stick is tied in its present position with additional tubing or bandages.
- A tourniquet must not be tightened more tightly than is required to stop the bleeding. This is to minimize the tissue damage inflicted by the tourniquet. If a tourniquet is used, immediately mark the letter "T" on the victim's forehead with the victim's blood, a marker, pen, or dirt; if possible write the date and 24-hour time the tourniquet was applied (example: "8/7 2215". When transferring the patient to another person's care, be certain that receiving medical personnel know that a tourniquet has been applied. This is imperative to identify the patient for priority medical care which may save limb or life.
- Treat the cause of shock IE stop the bleeding, get them out of the heat or cold, etc.
- Elevate the legs
- Loosen any constrictive clothing or gear
- Prevent overheating or chilling
- Do NOT provide any food or drink. At most, let them wet their lips.
- If casualty is unconscious, turn their heads so they don't choke on bodily fluids or their tongue
- Get the wrapper from the casualty's field dressing or something similar (plastic bag, cellophane, piece of a poncho)
- Place and hold the covering on the wound when the casualty exhales. If possible, have the casualty or a buddy hold the covering
- While the covering is secure, place the white part of the field dressing directly on top of the covering and the wound and apply pressure
- If possible seal up three sides of covering, leaving one side open. Tape is a good seal, as is grease or other heavy petrol product, MRE peanut butter or cheese or cellophane
- Now, tie the tails of the filed dressing up, once again covering the three sides of the covering. After the casualty exhales and before he inhales, tie a square knot directly over the wound.
- Lay the casualty on his side or in a sitting position, whichever makes breathing easier.
Treating Sucking Chest Wounds
Sucking chest wounds are the result of any time the lungs have been pierced. Bullets and shrapnel are the most common cause. If someone has been impaled and the object remains in their chest, do NOT attempt to take it out. Instead, do your best to clean and seal the wound around the object.
Signs of a sucking chest wound include foaming or bubbly blood around a chest wound, difficulty breathing, failure of the chest to properly rise and a sucking sound.
Note: Sucking chest wounds commonly have both entry and exit wounds. You must seal both wounds.
Fractures and Broken Bones
There are two types of fractures: closed and open. Closed is where the bone has broken through the skin and closed is where it has.
In all cases, your best bet is to immobilize the area of the wound. Slings and splints are the way that you typically do this. See FM 4-25, page 4-4 and onward for details on constructing slings and splints.
*Next update I'll try to get some mnemonic devices in (sayings to help remember acronyms) as well as clear up some issues with the 9 line and using a needle to relieve pressure in a sucking chest wound.