Soldier Combat Skills

Chapter 3-1 – Combat Casualty Care

Section I – Combat Casualty Care

The Army warfighter doctrine, developed for a widely dispersed and rapidly moving battlefield, recognizes that battlefield constraints limit the number of trained medical personnel available to provide immediate, far-forward care. This section defines combat lifesaver, provides life-saving measures (first aid) techniques, and discusses casualty evacuation.

COMBAT LIFESAVER

3-1. The role of the combat lifesaver was developed to increase far-forward care to combat Soldiers. At least one member–though ideally every member of each squad, team, and crew–should be a trained combat lifesaver. The leader is seldom a combat lifesaver, since he will have less time to perform those duties than would another member of his unit.

3-2. So what exactly is a combat lifesaver? He is a nonmedical combat Soldier. His secondary mission is to help the combat medic provide basic emergency care to injured members of his squad, team, or crew, and to aid in evacuating them, mission permitting. He complements, rather than replaces, the combat medic. He receives training in enhanced first aid and selected medical procedures such as initiating intravenous infusions. Combat lifesaver training bridges the first aid training (self-aid or buddy aid, or SABA) given to all Soldiers in basic training, and the more advanced medical training given to Medical Specialists (MOS 91W), also known as combat medics.

3-3. The Academy of Health Sciences developed the Combat Lifesaver Course as part of its continuing effort to provide health service support to the Army. The current edition of the Combat Lifesaver Course lasts three days. The first day tests the buddy-aid tasks, and the other two days teach and test specific medical tasks.

LIFESAVING MEASURES (FIRST AID)

3-4. When a Soldier is wounded, he must receive first aid immediately. Most injured or ill Soldiers can return to their units to fight or support. This is mainly, because they receive appropriate and timely first aid, followed by the best possible medical care. To help ensure this happens, every Soldier should have combat lifesaver training on basic life-saving procedures (Table 3-1).

Table 3-1. First aid.

1 Check for BREATHING Lack of oxygen, due either to a compromised airway or inadequate breathing, can cause brain damage or death in just a few minutes.
2 Check for BLEEDING Life can continue only with sufficient blood to carry oxygen to tissues.
3 Check for SHOCK Unless shock is prevented, first aid performed, and medical treatment provided, death may result, even with an otherwise nonfatal injury.

CHECK FOR BREATHING

3-5. Check first to see if the casualty’s heart is beating, then to see if he is breathing. This paragraph discusses what to do in each possible situation.

React to Stoppage of Heartbeat

3-6. If a casualty’s heart stops beating, you must immediately seek medical help. Seconds count! Stoppage of the heart is soon followed by cessation of respiration, unless that has already happened. Remain calm, but think first, and act quickly. When a casualty’s heart stops, he has no pulse. He is unconscious and limp, and his pupils are open wide. When evaluating a casualty, or when performing the preliminary steps of rescue breathing, feel for a pulse. If you do not detect a pulse, seek medical help.

Open Airway and Restore Breathing

3-7. All humans need oxygen to live. Oxygen breathed into the lungs gets into the bloodstream. The heart pumps the blood, which carries the oxygen throughout the body to the cells, which require a constant supply of oxygen. Without a constant supply of oxygen to the cells in the brain, we can suffer permanent brain damage, paralysis, or death.

Assess and Position Casualty

3-8. To assess the casualty, do the following:

  1. Check for responsiveness (A, Figure 3-1). Establish whether the casualty is conscious by gently shaking him and asking, “Are you OK?”
  2. Call for help, if appropriate (B, Figure 3-1).
  3. Position the unconscious casualty so that he is lying on his back and on a firm surface (C, Figure 3-1).

WARNING

If the casualty is lying on his chest (prone), cautiously roll him as a unit, so that his body does not twist. Twisting him could complicate a back, neck, or spinal injury.

  1. Straighten his legs. Take the arm nearest to you, and move it so that it is straight and above his head. Repeat for the other arm.
  2. Kneel beside the casualty with your knees near his shoulders. Leave room to roll his body (B, Figure 3-1). Place one hand behind his head and neck for support. With your other hand, grasp him under his far arm (C, Figure 3-1).
  3. Roll him towards you with a steady, even pull. Keep his head and neck in line with his back.
  4. Return his arms to his side. Straighten his legs, and reposition yourself so that you are kneeling at the level of his shoulders.
  5. If you suspect a neck injury, and you are planning to use the jaw-thrust technique, then kneel at the casualty’s head while looking towards his feet.

Open Airway of Unconscious or Nonbreathing Casualty

3-9. The tongue is the single most common airway obstruction (Figure 3-2). In most cases, just using the head-tilt/chin-lift technique can clear the airway. This pulls the tongue away from the air passage (Figure 3-3).


3-10. Call for help, and then position the casualty. Move (roll) him onto his back (C, Figure 3-1). Perform a finger sweep. If you see foreign material or vomit in the casualty’s mouth, promptly remove it, but avoid spending much time doing so. Open the airway using the jaw-thrust or head-tilt/chin-lift technique.

CAUTION

Although the head-tilt/chin-lift technique is an important procedure in opening the airway, take extreme care with it, because using too much force while performing this maneuver can cause more spinal injury. In a casualty with a suspected neck injury or severe head trauma, the safest approach to opening the airway is the jaw-thrust technique because, in most cases, you can do it without extending the casualty’s neck.

Perform Jaw-Thrust Technique

3-11. Place your hands on both sides of the angles of the casualty’s lower jaw, and lift with both hands. Displace the jaw forward and up (Figure 3-4). Your elbows should rest on the surface where the casualty is lying. If his lips close, you can use your thumb to retract his lower lip. If you have to give mouth-to-mouth, then close his nostrils by placing your cheek tightly against them. Carefully support his head without tilting it backwards or turning it from side to side. This technique is the safest, and thus the first, to use to open the airway of a casualty who has a suspected neck injury. Why? Because, you can usually do it without extending his neck. However, if you are having a hard time keeping his head from moving, you might have to try tilting his head back very slightly.

Perform Head-Tilt/Chin-Lift Technique

3-12. Place one palm on the casualty’s forehead and apply firm, backward pressure to tilt his head back. Place the fingertips of your other hand under the bony part of his lower jaw, and then lift, bringing his chin forward. Avoid using your thumb to lift his chin (Figure 3-5).

WARNING

Avoid pressing too deeply into the soft tissue under the casualty’s chin, because you might obstruct his airway.

Check for Breathing while Maintaining Airway

3-13. After opening the casualty’s airway, you must keep it open. Often this is enough to let the casualty breathe properly. Failure to maintain the open airway will keep the casualty from receiving sufficient oxygen. While maintaining an open airway, check for breathing by observing the casualty’s chest, and then, within a period of three to five seconds (Figure 3-6)–

  1. Look for his chest to rise and fall.
  2. Listen for sound of breathing by placing your ear near his mouth.
  3. Feel for the flow of air on your cheek.
  4. Perform rescue breathing if he fails to resume breathing spontaneously.

Note: If the casualty resumes breathing, monitor and maintain the open airway. Ensure he is transported to a medical treatment facility as soon as possible. Although the casualty might be trying to breathe, his airway might still be obstructed. If so, open his airway (remove the obstruction) and keep the airway open (maintain his airway).

Perform Rescue Breathing or Artificial Respiration

3-14. If the casualty fails to promptly resume adequate spontaneous breathing after the airway is open, you must start rescue breathing (artificial respiration, or mouth-to-mouth). Remain calm, but think and act quickly. The sooner you start rescue breathing, the more likely you are to restore his breathing. If you are not sure if the casualty is breathing, give him artificial respiration anyway. It cannot hurt him. If he is breathing, you can see and feel his chest move and, if you put your hand or ear close to his mouth and nose, you can hear him expelling air. The preferred method of rescue breathing is mouth-to-mouth, but you cannot always use it. For example, if the casualty has a severe jaw fracture or mouth wound, or if his jaws are tightly closed by spasms, you should use the mouth-to-nose method instead.

Use Mouth-to-Mouth Method

3-15. In this best known method of rescue breathing, inflate the casualty’s lungs with air from yours. You can do this by blowing air into his mouth. If the casualty is not breathing, place your hand on his forehead, and pinch his nostrils together with the thumb and index finger of the hand in use. With the same hand, exert pressure on his forehead to keep his head tilted backwards, and to maintain an open airway. With your other hand, keep your fingertips on the bony part of his lower jaw near his chin, and lift (Figure 3-5).

Note: If you suspect the casualty has a neck injury and you are using the jaw-thrust technique, close his nostrils by placing your cheek tightly against them.

3-16. Take a deep breath, and seal your mouth (airtight) around the casualty’s mouth (Figure 3-7). If he is small, cover both his nose and mouth with your mouth, and then seal your lips against his face.

3-17. Blow two full breaths into the casualty’s mouth (1 to 1 1/2 seconds each), taking a fresh breath of air each time, before you blow. Watch from the corner of your eye for the casualty’s chest to rise. If it does, then you are getting enough air into his lungs. If it fails to rise, then do the following:

  1. Take corrective action immediately by reestablishing the airway. Ensure no air is leaking from around your mouth or from the casualty’s pinched nose.
  2. Try (again) to ventilate him.
  3. If his chest still fails to rise, take the necessary action to open an obstructed airway.
  4. If you are still unable to ventilate the casualty, reposition his head, and repeat rescue breathing. The main reason ventilation fails is improper chin and head positioning. If you cannot ventilate the casualty after you reposition his head, then move on to foreign-body airway obstruction maneuvers.
  5. If, after you give two slow breaths, the casualty’s chest rises, then see if you can find a pulse. Feel on the side of his neck closest to you by placing the index and middle fingers of your hand on the groove beside his Adam’s apple (carotid pulse; Figure 3-8). Avoid using your thumb to take a pulse, because that could cause you to confuse your own pulse for his.
  1. Maintain the airway by keeping your other hand on the casualty’s forehead. Allow 5 to 10 seconds to determine if there is a pulse.
    1. If you see signs of circulation and you find a pulse, and the casualty has started breathing-
      1. Stop and allow the casualty to breathe on his own. If possible, keep him warm and comfortable.
      2. If you find a pulse, and the casualty is unable to breathe, continue rescue breathing until told to cease by medical personnel.
      3. If you fail to find a pulse, seek medical personnel for help as soon as possible.

Use Mouth-to-Nose Method

3-18. Use this method if you cannot perform mouth-to-mouth rescue breathing. Normally, the reason you cannot is that the casualty has a severe jaw fracture or mouth wound, or, because his jaws are tightly closed by spasms. The mouth-to-nose method is the same as the mouth-to-mouth method, except that you blow into the nose while you hold the lips closed, keeping one hand at the chin. Then, you remove your mouth to let the casualty exhale passively. You might have to separate the casualty’s lips to allow the air to escape during exhalation.

React to Airway Obstructions

3-19. For oxygen to flow to and from the lungs, the upper airway must be unobstructed. Upper airway obstruction can cause either partial or complete airway blockage. Upper airway obstructions often occur because–

  1. The casualty’s tongue falls back into his throat while he is unconscious.
  2. His tongue falls back and obstructs the airway.
  3. He was unable to swallow an obstruction.
  4. He regurgitated the contents of his stomach, and they blocked his airway
  5. He has suffered blood clots due to head and facial injuries.

Note: For an injured or unconscious casualty, correctly position him, and then create and maintain an open airway.

Determine Degree of Obstruction

3-20. The airway may be partially or completely obstructed.

Partial

3-21. The person might still have an air exchange. If he has enough, then he can cough forcefully, even though he might wheeze between coughs. Instead of interfering, encourage him to cough up the object on his own. If he is not getting enough air, his coughing will be weak, and he might be making a high-pitched noise between coughs. He might also show signs of shock. Help him and treat him as though he had a complete obstruction.

Complete

3-22. A complete obstruction (no air exchange) is indicated if the casualty cannot speak, breathe, or cough at all. He might clutch his neck and move erratically. In an unconscious casualty, a complete obstruction is also indicated if, after opening his airway, you cannot ventilate him.

Open Obstructed Airway, Casualty Lying Down or Unresponsive

3-23. Sometimes you must expel an airway obstruction in a casualty who is lying down, who becomes unconscious, or who is found unconscious (cause unknown; Figure 3-9):

1. If a conscious casualty, who is choking, becomes unresponsive–

  • a. Call for help.
  • b.
    Open the airway.
  • c.
    Perform a finger sweep.
  • d.
    Try rescue breathing. If an airway blockage prevents this,
  • e.
    Remove the airway obstruction.

2. If a casualty is unresponsive when you find him (cause unknown)–

  • a.
    Assess or evaluate the situation.
  • b.
    Call for help.
  • c.
    Position the casualty on his back.
  • d.
    Open the airway.
  • e.
    Establish breathlessness.
  • f.
    Try to perform rescue breathing. If still unable to ventilate the casualty,
  • g.
    Perform six to ten manual (abdominal or chest) thrusts.

3. To perform the abdominal thrusts–

  • a.
    Kneel astride the casualty’s thighs.
  • b.
    Place the heel of one hand against the casualty’s abdomen, in the midline slightly above the navel, but well below the tip of the breastbone.
  • c.
    Place your other hand on top of the first one.
  • d.
    Point your fingers toward the casualty’s head.
  • e.
    Use your body weight to press into the casualty’s abdomen with a quick, forward and upward thrust.
  • f.
    Deliver each thrust quickly and distinctly.
  • g.
    Repeat the sequence of abdominal thrusts, finger sweep, and rescue breathing (try to ventilate) as long as necessary to remove the object from the obstructed airway.
  • h.
    If the casualty’s chest rises, check for a pulse.

4. To perform chest thrusts–

  • a.
    Place the unresponsive casualty on his back, face up, and open his mouth.
  • b.
    Kneel close to his side.
  • c.
    Locate the lower edge of his ribs with your fingers.
  • d.
    Run your fingers up along the rib cage to the notch (A, Figure 3-10).
  • e.
    Place your middle finger on the notch, and your index finger next to your middle finger, on the lower edge of his breastbone.
  • f.
    Place the heel of your other hand on the lower half of his breastbone, next to your two fingers (B, Figure 3-10).
  • g.
    Remove your fingers from the notch and place that hand on top of your hand on his breastbone, extending or interlocking your fingers.
  • h.
    Straighten and lock your elbows, with your shoulders directly above your hands. Be careful to avoid bending your elbows, rocking, or letting your shoulders sag. Apply enough pressure to depress the breastbone 1 1/2 to 2 inches, and then release the pressure completely. Repeat six to ten times. Deliver each thrust quickly and distinctly. Figure 3-11 shows another view of the breastbone being depressed.
  • i.
    Repeat the sequence of chest thrust, finger sweep, and rescue breathing as long as necessary to clear the object from the obstructed airway.
  • j.
    If the casualty’s chest rises, check his pulse.


5. If you still cannot administer rescue breathing due to an airway obstruction, remove the obstruction:

  • a.
    Place the casualty on his back, face up.
  • b.
    Turn him all at once (avoid twisting his body).
  • c.
    Call for help.
  • d.
    Perform finger sweep.
  • e.
    Keep him face up.
  • f.
    Use the tongue-jaw lift to open his mouth.
  • g.
    Open his mouth by grasping both his tongue and lower jaw between your thumb and fingers, and lift (tongue-jaw lift; Figure 3-12).
  • h.
    If you cannot open his mouth, cross your fingers and thumb (crossed-finger method), and push his teeth apart. To do this, press your thumb against his upper teeth, and your finger against his lower teeth (Figure 3-13).

Figure 3-13. Opening of casualty’s mouth, crossed-finger method.

i. Insert the index finger of your other hand down along the inside of his cheek to the base of his tongue. Use a hooking motion from the side of the mouth toward the center to dislodge the foreign body (Figure 3-14).

DANGER
Take care not to force the object deeper into the airway by
pushing it with your finger.

CHECK FOR BLEEDING

Stop Bleeding and Protect Wound

3-24. The longer a Soldier bleeds from a major wound, the less likely he will survive it. (FM 4-25.11 covers first aid for open, abdominal, chest, and head wounds.) You must promptly stop the external bleeding.

Clothing

3-25. In evaluating him for location, type, and size of wound or injury, cut or tear the casualty’s clothing and carefully expose the entire area of the wound. This is necessary to properly visualize the injury and avoid further contamination. To avoid further injury, leave in place any clothing that is stuck to the wound. Do not touch the wound, and keep it as clean as possible.

WARNING

In a chemical environment, leave a casualty’s protective clothing in place. Apply dressings over the protective clothing.

Entrance and Exit Wounds

3-26. Before applying the dressing, carefully examine the casualty to determine if there is more than one wound. A missile may have entered at one point and exited at another point. An exit wound is usually larger than its entrance wound.

DANGER
If the missile lodges in the body (fails to exit), DO NOT try
to remove it, and DO NOT probe the wound. Apply a dressing.
If an object is extending from (impaled in) the wound, leave it.
DO NOT try to remove it. Instead, take the following steps to
prevent further injury:
1. In order to prevent the object from embedding more deeply, or
from worsening the wound, use dressings or other clean,
bulky materials to build up the area around the object.
2. Apply a supporting bandage over the bulky materials to hold
them in place.
Monitor the casualty continually for development of conditions
that may require you to perform basic life-saving measures such
as clearing his airway and performing mouth-to-mouth
resuscitation.
Check all open (or penetrating) wounds for a point of entry and
exit, with first aid measures applied accordingly.

Emergency Trauma Dressing

3-27. Remove the emergency bandage from the wounded Soldier’s pouch (Figure 3-15). (Do not use the one in your pouch.)

3-28. Place the pad on the wound, white side down, and wrap the elastic bandage around the injured limb or body part (A, Figure 3-16). Insert the elastic bandage into the pressure bar (B, Figure 3-17). Tighten the elastic bandage (C, Figure 3-18). Pull back, forcing the pressure bar down onto the pad (D, Figure 3-19). Wrap the elastic bandage tightly over the pressure bar, and wrap over all the edges of the pad (E, Figure 3-20). Secure the hooking ends of the closure bar into the elastic bandage. Do not create a tourniquet-like effect (F, Figure 3-21).



Figure 3-20.
Wrapping of bandage over pressure bar.

Field Dressing

3-29. Remove the casualty’s field dressing from the wrapper, and grasp the tails of the dressing with both hands (Figure 3-22).

WARNING
Do not touch the white (sterile) side of the dressing.
Do not allow that side of the dressing to touch any surface other
than the wound.

3-30. Hold the dressing directly over the wound with the white side down. Open the dressing (Figure 3-23), and place it directly over the wound (Figure 3-24). Hold the dressing in place with one hand. Use the other hand to wrap one of the tails around the injured part, covering about half the dressing (Figure 3-25). Leave enough of the tail for a knot. If the casualty is able, he can help by holding the dressing in place.

3-31. Wrap the other tail in the opposite direction until the rest of the dressing is covered. The tails should seal the sides of the dressing to keep foreign material from getting under it. Tie the tails into a nonslip knot over the outer edge of the dressing (Figure 3-26). Do not tie the knot over the wound. In order to allow blood to flow to the rest of the injured limb, tie the dressing firmly enough to prevent it from slipping, but without causing a tourniquet effect. That is, the skin beyond the injury should not become cool, blue, or numb.

Manual Pressure

3-32. If bleeding continues after you apply the sterile field dressing, apply direct pressure to the dressing for five to ten minutes (Figure 3-27). If the casualty is conscious and can follow instructions, you can ask him to do this himself. Elevate an injured limb slightly above the level of the heart to reduce the bleeding (Figure 3-28).

WARNING
Elevate a suspected fractured limb only after properly splinting it.

3-33. If the bleeding stops, check for shock, and then give first aid for that as needed. If the bleeding continues, apply a pressure dressing.

Pressure Dressing

3-34. If bleeding continues after you apply a field dressing, direct pressure, and elevation, then you must apply a pressure dressing. This helps the blood clot, and it compresses the open blood vessel. Place a wad of padding on top of the field dressing directly over the wound (Figure 3-29). Keep the injured extremity elevated.

Note: Improvise bandages from strips of cloth such as tee shirts, socks, or other garments.

3-35. Place an improvised dressing (or cravat, if available) over the wad of padding (Figure 3-30). Wrap the ends tightly around the injured limb, covering the original field dressing (Figure 3-31).


3-36. Tie the ends together in a nonslip knot, directly over the wound site (Figure 3-32). Do not tie so tightly that it has a tourniquet-like effect. If bleeding continues and all other measures fail, or if the limb is severed, then apply a tourniquet, but do so only as a last resort. When the bleeding stops, check for shock, and give first aid for that, if needed.


3-37. Check fingers and toes periodically for adequate circulation. Loosen the dressing if the extremity becomes cool, blue, or numb. If bleeding continues, and all other measures fail–application of dressings, covering of wound, direct manual pressure, elevation of limb above heart level, application of pressure dressing while maintaining limb elevation–then apply digital pressure.

Digital Pressure

3-38. Use this method when you are having a hard time controlling bleeding, before you apply a pressure dressing, or where pressure dressings are unavailable. Keep the limb elevated and direct pressure on the wound. At the same time, press your fingers, thumbs, or whole hand where a main artery supplying the wounded area lies near the surface or over bone (Figure 3-33). This might help shut off, or at least slow, the flow of blood from the heart to the wound.

Tourniquet

3-39. A tourniquet is a constricting band placed around an arm or leg to control bleeding. A Soldier whose arm or leg has been completely amputated might not be bleeding when first discovered, but you should apply a tourniquet anyway. The body initially stops bleeding by contracting or clotting the blood vessels. However, when the vessels relax, or if a clot is knocked loose when the casualty is moved, the bleeding can restart. Bleeding from a major artery of the thigh, lower leg, or arm, and bleeding from multiple arteries, both of which occur in a traumatic amputation, might be more than you can control with manual pressure. If even under firm hand pressure the dressing gets soaked with blood, and if the wound continues to bleed, then you must apply a tourniquet.

DANGER
Use a tourniquet only on an arm or leg and if the casualty is in
danger of bleeding to death.

WARNING

Continually monitor the casualty for the development of any conditions that could require basic life-saving measures such as clearing his airway, performing mouth-to-mouth breathing, preventing shock, or controlling bleeding.

Locate points of entry and exit on all open and penetrating wounds, and treat the casualty accordingly.

3-40. Avoid using a tourniquet unless a pressure dressing fails to stop the bleeding, or unless an arm or leg has been cut off. Tourniquets can injure blood vessels and nerves. Also, if left in place too long, a tourniquet can actually cause the loss of an arm or leg. However, that said, once you apply a tourniquet, you have to leave it in place and get the casualty to the nearest MTF ASAP. Never loosen or release a tourniquet yourself after you have applied one, because that could cause severe bleeding and lead to shock.

Combat Application Tourniquet

  1. The C-A-T is packaged for one-handed use. Slide the wounded extremity through the loop of the C-A-T tape (1, Figure 3-34).
  2. Position the C-A-T 2 inches above a bleeding site that is above the knee or elbow. Pull the free running end of the tape tight, and fasten it securely back on itself (2, Figure 3-34).
  3. Do not affix the band past the windlass clip (3, Figure 3-34).
  4. Twist the windlass rod until the bleeding stops (4, Figure 3-34).
  5. Lock the rod in place with the windlass clip (5, Figure 3-34).
  6. For small extremities, continue to wind the tape around the extremity and over the windlass rod (6, Figure 3-34).
  7. Grasp the windlass strap, pull it tight, and adhere it to the hook-pile tape on the windlass clip (7, Figure 3-34). The C-A-T is now ready for transport.

WARNING

The one-handed method for upper extremities may not be completely effective on lower extremities.

Ensure everyone receives familiarization and training on both methods of application.

3-41. The improved first-aid kit (IFAK) allows self-aid and buddy aid (SABA) interventions for extremity hemorrhages and airway compromises (Figure 3-35). The pouch and insert are both Class II items. Expendables are Class VIII.

Improvised Tourniquet

3-42. In the absence of a specially designed tourniquet, you can make one from any strong, pliable material such as gauze or muslin bandages, clothing, or cravats. Use your improvised tourniquet with a rigid, stick-like object. To minimize skin damage, the improvised tourniquet must be at least 2 inches wide.

WARNING

The tourniquet must be easily identified or easily seen. Do not use wire, shoestring, or anything else that could cut into flesh, for a tourniquet band.

Placement

3-43. To position the makeshift tourniquet, place it around the limb, between the wound and the body trunk, or between the wound and the heart. Never place it directly over a wound, a fracture, or joint. For maximum effectiveness, place it on the upper arm or above the knee on the thigh (Figure 3-36).

3-44. Pad the tourniquet well. If possible, place it over a smoothed sleeve or trouser leg to keep the skin from being pinched or twisted. If the tourniquet is long enough, wrap it around the limb several times, keeping the material as flat as possible. Damaging the skin may deprive the surgeon of skin required to cover an amputation. Protecting the skin also reduces the casualty’s pain.

Application

3-45. To apply the tourniquet, tie a half knot, which is the same as the first part of tying a shoe lace. Place a stick, or other rigid object, on top of the half knot (Figure 3-37).

3-46. Tie a full-knot over the stick, and twist the stick until the tourniquet tightens around the limb or the bright red bleeding stops (Figure 3-38). In the case of amputation, dark oozing blood may continue for a short time. This is the blood trapped in the area between the wound and tourniquet.

3-47. To fasten the tourniquet to the limb, loop the free ends of the tourniquet over the ends of the stick. Bring the ends around the limb to keep the stick from loosening. Tie the ends together on the side of the limb (Figure 3-39).

3-48. You can use other means to secure the stick. Just make sure the material remains wound around the stick, and that no further injury is possible. If possible, save and transport any severed (amputated) limbs or body parts with (but out of sight of) the casualty. Never cover the tourniquet. Leave it in full view. If the limb is missing (total amputation), apply a dressing to the stump. All wounds should have a dressing to protect the wound from contamination. Mark the casualty’s forehead with a “T” and the time to show that he has a tourniquet. If necessary, use the casualty’s blood to make this mark. Check and treat for shock, and then seek medical aid.

CAUTION

Do not remove a tourniquet yourself. Only trained medical personnel may adjust or otherwise remove or release the tourniquet, and then only in the appropriate setting.

SHOCK

3-49. The term shock means various things. In medicine, it means a collapse of the body’s cardiovascular system, including an inadequate supply of blood to the body’s tissues. Shock stuns and weakens the body. When the normal blood flow in the body is upset, death can result. Early recognition and proper first aid may save the casualty’s life.

Causes and Effects of Shock

3-50. The three basic effects of shock are–

  • Heart is damaged and fails to pump.
  • Blood loss (heavy bleeding) depletes fluids in vascular system.
  • Blood vessels dilate (open wider), dropping blood pressure to dangerous level.

3-51. Shock might be caused by–

  • Dehydration.
  • Allergic reaction to foods, drugs, insect stings, and snakebites.
  • Significant loss of blood.
  • Reaction to sight of wound, blood, or other traumatic scene.
  • Traumatic injuries. — Burns. –Gunshot or shrapnel wounds. — Crush injuries. –Blows to the body, which can break bones or damage internal organs. — Head injuries. –Penetrating wounds such as from knife, bayonet, or missile.

Signs and Symptoms of Shock

3-52. Examine the casualty to see if he has any of the following signs and symptoms:

  • Sweaty but cool (clammy) skin.
  • Weak and rapid pulse.
  • (Too) rapid breathing.
  • Pale or chalky skin tone.
  • Cyanosis (blue) or blotchy skin, especially around the mouth and lips.
  • Restlessness or nervousness.
  • Thirst.
  • Significant loss of blood.
  • Confusion or disorientation.
  • Nausea, vomiting, or both.

First-Aid Measures for Shock

3-53. First-aid procedures for shock in the field are the same ones performed to prevent it. When treating a casualty, always assume the casualty is in shock, or will be shortly. Waiting until the signs of shock are visible could jeopardize the casualty’s life.

Casualty Position

3-54. Never move the casualty, or his limbs, if you suspect he has fractures, and they have not yet been splinted. If you have cover and the situation permits, move the casualty to cover. Lay him on his back. A casualty in shock from a chest wound, or who is having trouble breathing, might breathe easier sitting up. If so, let him sit up, but monitor him carefully, in case his condition worsens. Elevate his feet higher than the level of his heart. Support his feet with a stable object, such as a field pack or rolled up clothing, to keep them from slipping off.

WARNINGS

  1. Do not elevate legs if the casualty has an unsplinted broken leg, head injury, or abdominal injury.
  2. Check casualty for leg fracture(s), and splint them, if needed, before you elevate his feet. For a casualty with an abdominal wound, place his knees in an upright (flexed) position.

3-55. Loosen clothing at the neck, waist, or wherever it might be binding.

CAUTION

Do not loosen or remove protective clothing in a chemical environment.

3-56. Prevent the casualty from chilling or overheating. The key is to maintain normal body temperature. In cold weather, place a blanket or like item over and under him to keep him warm and prevent chilling. However, if a tourniquet has been applied, leave it exposed (if possible). In hot weather, place the casualty in the shade and protect him from becoming chilled; however, avoid the excessive use of blankets or other coverings. Calm the casualty. Throughout the entire procedure of providing first aid for a casualty, you should reassure the casualty and keep him calm. This can be done by being authoritative (taking charge) and by showing self-confidence. Assure the casualty that you are there to help him. Seek medical aid.

Food and Drink

3-57. When providing first aid for shock, never give the casualty food or drink. If you must leave the casualty, or if he is unconscious, turn his head to the side to prevent him from choking if he vomits.

Casualty Evaluation

3-58. Continue to evaluate the casualty until medical personnel arrives or the casualty is transported to an MTF.

CASUALTY EVACUATION

3-59. Medical evacuation of the sick and wounded (with en route medical care) is the responsibility of medical personnel who have been provided special training and equipment. Therefore, wait for some means of medical evacuation to be provided unless a good reason for you to transport a casualty arises. When the situation is urgent and you are unable to obtain medical assistance or know that no medical evacuation assets are available, you will have to transport the casualty. For this reason, you must know how to transport him without increasing the seriousness of his condition.

3-60. Transport by litter is safer and more comfortable for a casualty than manual carries. It is also easier for you as the bearer(s). However, manual transportation might be the only feasible method, due to the terrain or combat situation. You might have to do it to save a life. As soon as you can, transfer the casualty to a litter as soon as you find or can improvise one.

MANUAL CARRIES

3-61. When you carry a casualty manually, you must handle him carefully and correctly to prevent more serious or possibly fatal injuries. Situation permitting, organize the transport of the casualty, and avoid rushing. Perform each movement as deliberately and gently as possible. Avoid moving a casualty until the type and extent of his injuries are evaluated, and the required first aid administered. Sometimes, you will have to move the casualty immediately, for example, when he is trapped in a burning vehicle. Manual carries are tiring, and can increase the severity of the casualty’s injury, but might be required to save his life. Two-man carries are preferred, because they provide more comfort to the casualty, are less likely to aggravate his injuries, and are less tiring for the bearers. How far you can carry a casualty depends on many factors, such as–

  • Nature of the casualty’s injuries.
  • Your (the bearer’s or bearers’) strength and endurance.
  • Weight of the casualty.
  • Obstacles encountered during transport (natural or manmade).
  • Type of terrain.

ONE-MAN CARRIES

3-62. Use these carries when only one bearer is available to transport the casualty:

Fireman’s Carry

3-63. This is one of the easiest ways for one person to carry another. After an unconscious or disabled casualty has been properly positioned (rolled onto his abdomen), raise him from the ground, and then support him and place him in the carrying position (Figure 3-40). Here’s what you do:

A. Position the casualty by rolling him onto his abdomen and straddle him. Extend your hands under his chest and lock them together (A, Figure 3-40).

B. Lift him to his knees as you move backward (B, Figure 3-40).

C. Continue to move backward, straightening his legs and locking his knees (C, Figure 3-40).

D. Walk forward, bringing him to a standing position. Tilt him slightly backward to keep his knees from buckling (D, Figure 3-40).

E. Keep supporting him with one arm, and then free your other arm, quickly grasp his wrist, and raise his arm high. Immediately pass your head under his raised arm, releasing the arm as you pass under it (E, Figure 3-40).

F. Move swiftly to face the casualty and secure your arms around his waist. Immediately place your foot between his feet, and spread them apart about 6 to 8 inches (F, Figure 3-40).

G. Grasp the casualty’s wrist, and raise his arm high over your head (G, Figure 3-40).

H. Bend down and pull the casualty’s arm over and down on your shoulder, bringing his body across your shoulders. At the same time, pass your arm between his legs (H, Figure 3-40).

I. Grasp the casualty’s wrist with one hand, and place your other hand on your knee for support (I, Figure 3-40).

J. Rise with the casualty positioned correctly. Your other hand should be free (J, Figure 3-40).


Alternate Fireman’s Carry

3-64. Use this carry only when you think it is safer due to the location of the casualty’s wounds. When you use the alternate carry, take care to keep the casualty’s head from snapping back and injuring his neck. You can also use this method to raise a casualty from the ground for other one-man carries. First, kneel on both knees at the casualty’s head and face his feet. Extend your hands under his armpits, down his sides, and across his back (A, Figure 3-41). Second, as you rise, lift the casualty to his knees. Then secure a lower hold and raise him to a standing position with his knees locked (B, Figure 3-41).

Supporting Carry

3-65. With this method (Figure 3-42), the casualty must be able to walk or at least hop on one leg, with you as a crutch. You can use this carry to help him go as far as he can walk or hop. Raise him from the ground to a standing position using the fireman’s carry. Grasp his wrist, and draw his arm around your neck. Place your arm around his waist. This should enable the casualty to walk or hop, with you as a support.

Neck Drag

3-66. This method (Figure 3-43) is useful in combat, because you can carry the casualty as he creeps behind a low wall or shrubbery, under a vehicle, or through a culvert. If the casualty is conscious, let him clasp his hands together around your neck. To do this, first tie his hands together at the wrists, and then straddle him. You should be kneeling, facing the casualty. Second, loop his tied hands over and around your neck. Third, crawl forward and drag the casualty with you. If he is unconscious, protect his head from the ground.

WARNING
Avoid using this carry if the casualty has a broken arm.

Cradle-Drop Drag

3-67. Use this method to move a casualty up or down steps. Kneel at the casualty’s head (with him on his back). Slide your hands, with palms up, under the casualty’s shoulders. Get a firm hold under his armpits (A, Figure 3-44). Rise partially while supporting the casualty’s head on one of your forearms (B, Figure 3-44). You may bring your elbows together and let the casualty’s head rest on both of your forearms. Rise and drag the casualty backward so he is in a semi-seated position (C, Figure 3-44).

TWO-MAN CARRIES

3-68. Use these when you can. They are more comfortable to the casualty, less likely to aggravate his injuries, and less tiring for you.

Two-Man Support Carry

3-69. Use this method to transport either conscious or unconscious casualties. If the casualty is taller than you (the bearers), you might have to lift his legs and let them rest on your forearms. Help him to his feet, and then support him with your arms around his waist (A, Figure 3-45). Then, grasp the casualty’s wrists and draw his arms around your necks (B, Figure 3-45).

Two-Man Fore-and-Aft Carry

3-70. You can use this to transport a casualty for a long distance, say, over 300 meters. The taller of the you (the two bearers) should position yourself at the casualty’s head.

3-71. The shorter of you spreads the casualty’s legs and kneels between them, with your back to the casualty. Position your hands behind the casualty’s knees. The taller of you kneels at the casualty’s head, slides your hands under his arms and across his chest, and locks your hands together (A, Figure 3-46). Both of you should rise together, lifting the casualty (B, Figure 3-46). If you alter this carry so that both of you are facing the casualty, you can use it to place him on a litter.

Two-Hand Seat Carry

3-72. You can use this method to carry a casualty for a short distance or to place him on a litter. With the casualty lying on his back (A, Figure 3-47), one of you should kneel on one side of the casualty at his hips, and the other should kneel on the other side. Each of you should pass your arms under the casualty’s thighs and back, and grasp the other bearer’s wrists. Both of you then rise, lifting the casualty (B, Figure 3-47).

IMPROVISED LITTERS

3-73. Two men can support or carry a casualty without equipment for only short distances. By using available materials to improvise equipment, two or more rescuers can transport the casualty over greater distances.

  1. Sometimes, a casualty must be moved without a standard litter. The distance might be too great for a manual carry, or the casualty might have an injury, such as a fractured neck, back, hip, or thigh, that manual transportation would aggravate. If this happens, improvise a litter from materials at hand. Construct it well to avoid dropping or further injuring the casualty. An improvised litter is an emergency measure only. Replace it with a standard litter as soon as you can.
  2. You can improvise many types of litters, depending on the materials available. You can make a satisfactory litter by securing poles inside such items as ponchos, tarps, jackets, or shirts. You can improvise poles from strong branches, tent supports, skis, lengths of pipe, or other objects. If nothing is available to use as a pole, then roll a poncho or similar item from both sides toward the center, so you can grip the roll(s) and carry the casualty. You can use most any flat-surfaced object as long as it is the right size, for example, doors, boards, window shutters, benches, ladders, cots, or chairs. Try to find something to pad the litter for the casualty’s comfort. You can use either the two-man fore-and-aft carry (Figure 3-46) or the two-hand seat carry (Figure 3-47) to place the casualty on a litter.
  3. Use either two or four service members (head/foot) to lift a litter. Everybody should raise the litter at the same time to keep the casualty as level as possible.
DANGER
Unless there is an immediate life-threatening situation (such as
fire or explosion), NEVER move a casualty who has a suspected
back or neck injury. Instead, seek medical personnel for guidance
on how to transport him.

WARNING
Use caution when transporting on a sloping incline/hill.


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