CHAPTER FIVE



CHAPTER TWELVE

FIRST AID

12-1. GENERAL. The nature of patrolling operations causes casualties to become a greater consideration than on other missions. It is essential that all personnel know how to diagnose and treat injuries, wounds, and illnesses. The unit should also have a plan for handling KIA’s.

12-2. LIFESAVING STEPS (Applies to all injuries).

a. Open the airway and restore breathing.

b. Stop the bleeding and protect the wound.

c. Check, treat and monitor for shock.

3. STINGS AND BITES.

|BITES AND STINGS |

| TYPE | FIRST AID |

|Snake bite |1. Get the casualty away from the snake. |

| |2. Remove all rings and bracelets from the affected extremity. |

| |3. Reassure the casualty and keep him quiet. |

| |4. Apply constricting band(s) 1-2 finger widths proximal to the bite. |

| |One finger should be able to be slipped between the band and skin. |

| |ARM or LEG Bite - Place one band above and one band below the bite |

| |site. HAND or FOOT Bite - Place one band above the wrist or ankle. |

| |5. Immobilize the affected limb in a position below the level of the |

| |heart. |

| |6. Kill the snake, if possible, (without damaging its head or |

| |endangering yourself) and send it with the casualty. |

| |7. Seek medical treatment immediately. |

|Brown recluse |1. Keep the casualty calm. |

|Black Widow |2. Wash the area. |

|Spider bites |3. Apply ice or a freeze pack, if available. |

| |4. Seek medical treatment. |

|Tarantula |1. Wash the area. |

|bite, |2. Apply ice or a freeze pack, if available. |

|Scorpion |3. Apply baking soda, calamine lotion, or meat tenderizer to the bite |

|sting, |site to relieve pain and itching. |

|Ant bites |4. If site of bite(s) or sting(s) is on the face, neck (possible |

| |airway blockage), or genital area, or if reaction is severe, or if the|

| |sting is by the dangerous Southwestern scorpion, keep the casualty as |

| |quiet as possible and seek immediate medical aid. |

|Bee stings |1. If the stinger is present, remove by scraping with a knife or |

| |fingernail. DO NOT squeeze venom sack on stinger, more venom may be |

| |injected. |

| |2. Wash the area. |

| |3. Apply ice or freeze pack, if available. |

| |4. If allergic signs or symptoms appear, be prepared to perform CPR |

| |and seek medical assistance. |

|Human and |1. Cleanse the wound thoroughly with soap or detergent solution. |

|Other animal |2. Flush bite well with water. |

|Bites |3. Cover bite with a sterile dressing. |

| |4. Immobilize injured extremity. |

| |5. Transport casualty to a medical treatment facility. |

| |6. Kill the animal, if possible, without damaging its head or |

| |endangering yourself, and send it with the casualty. |

|Sharks, |1. Control the bleeding. |

|Barracuda and |2. Prevent shock. |

|Alligator |3. Provide basic life support. |

| |4. Splint any orthopedic injuries. |

| |5. Provide immediate medical attention. |

|Turtles, Moray|1. Clean the wound(s) thoroughly. |

|Eels, |2. Splint if necessary. |

|Corals | |

|Jellyfish, |1. Gently remove clinging tentacles with a towel. |

|Portuguese |2. Apply diluted ammonia, alcohol, meat tenderizer, or talcum powder.|

|Man-o-War, |3. Seek medical attention. |

|Anemones, etc.| |

|Spineyfish, |Soak the wound in warm water for 30-60 minutes. |

|Urchins, |Seek further first aid as necessary. |

|Stingrays, and| |

|Conch shells | |

4. AEROMEDEVAC - Nine line call format:

|LINE |ITEM |EXPLANATION |

|1 |Location of |Encrypt the grid coordinates of the pick-up site. When using|

| |pick-up site. |the DRYAD Numeral Cipher, the same “SET” line is used to |

| | |encrypt both the grid zone letters and the coordinates. To |

| | |preclude misunderstanding, a statement should be made that |

| | |grid zone letters are included in the message. (Unless unit |

| | |SOP specifies its use at all times.) |

|2 |Radio |Encrypt the frequency of the radio at the pick-up site and |

| |frequency, call|not a relay frequency. The call sign (and suffix if used) of |

| |sign w/suffix. |person to be contacted at the pick-up site may be transmitted|

| | |in the clear. |

|3 |Number of |Report only applicable information and encrypt the |

| |patients by |appropriate amount(s) and brevity number(s). |

| |precedence |(#)-1-Urgent - Save life/limb/eyesight EVAC w/in 2 hours |

| | |(#)-2-Priority - Evac w/in 4 hours. |

| | |(#)-3-Routine - Evac w/in 24 hours. |

| | |(#)-4-Tactical Immediate - ASAP. |

| | |If 2 or more categories must be reported in the same request,|

| | |insert the word “BREAK” between ea category. |

|4 |Special |Encrypt the appropriate brevity number(s). |

| |equipment |5 – None |

| |required. |6 – Hoist |

| | |7 - Stokes Litter |

| | |8 - Forest/Jungle Penetrator |

|5 |Number of |Report only applicable information and encrypt the |

| |patients by |appropriate amount(s) and brevity number(s). If requesting |

| |type. |MEDEVAC for both types, insert the proword “BREAK” between |

| | |the litter entry and ambulatory entry. (#) – Litter (#) – |

| | |Ambulatory (sitting) |

| 6 |Security of |1 – No enemy troops in area. |

| |pick-up |2 – Possibly enemy troops in area (approach with caution). |

| | |3 - Enemy troops in area (approach with caution). |

| | |4 – Enemy troops in area (armed escort required). |

| | |5 – Peacetime |

|7 |Method of |Encrypt the appropriate brevity number(s): |

| |marking pick-up|5 - Panels. |

| |site. |6 - Pyrotechnic signal. |

| | |7 - Smoke signal. |

| | |8 - Signal person. |

| | |9 - Strips of fabric or parachute. |

| | |0 - Tree branches, pieces of wood, or stones placed together.|

| | |1 - Signal lamp or flashlight. |

| | |2 - Vehicle lights. |

| | |3 - Open flame. |

|8 |Patient’s |The number of patients in each category need not be |

| |nationality and|transmitted. Encrypt only the appropriate brevity number(s):|

| |status. |4 - US military. |

| | |5 - US civilian. |

| | |6 - Non-US military. |

| | |7 - Non-US civilian. |

| | |8 - EPW. |

| 9 |NBC |Include this line only when applicable. Encrypt the |

| |Contamination |appropriate brevity number(s). |

| | |9 - Nuclear |

| | |0 - Biological |

| | |1 – Chemical |

| | |- Peacetime |

12-5. HEAD INJURY.

a. Symptoms:

(1) Bleeding

(2) Deformity

(3) Unconsciousness

(4) Memory loss

(5) Clear fluid or blood leaking from nose and ears

(6) Staggering/dizziness

(7) Change in pulse

(8) Breathing problems

(9) Nausea or vomiting

(10) Convulsions

(11) Slurred speech

(12) Confusion

(13) Sleepiness

(14) Black eyes

(15) Eye problems

(16) Paralysis

(17) Headache

b. Treatment:

(1) Maintain open airway.

(2) Place a dressing over wounded area.

(3) Do not attempt to clean the wound.

(4) Keep casualty warm.

(5) Do not attempt to remove an impaled object from the head.

(6) Do not give the casualty anything to eat or drink.

(7) Do not administer morphine or similar drugs.

(8) Do not attempt to push any brain matter back into the head.

(9) Keep the airway clean.

(10) Position the casualty on his side opposite the site of injury.

6. ENVIRONMENTAL INJURIES.

|INJURY |SIGNS/ SYMPTOMS |FIRST AID |

|COLD INJURIES |

|CHILLBLAIN |Red, swollen, hot, |1. Area usually responds to locally |

| |tender, itching skin. |applied warming (body heat). |

| |Continued exposure may|2. Do Not rub or massage area. |

| |lead to infected |3. Seek medical treatment. |

| |(ulcerated bleeding) | |

| |skin lesions. | |

|IMMERSION |Affected parts are |1. Gradual warming by exposure to warm|

|FOOT/ |cold, numb, and |air. |

|TRENCH FOOT |painless. As parts |2. DO NOT massage or moisten skin. |

| |warm they may be hot, |3. Protect affected parts from trauma.|

| |with burning and |4. Dry feet thoroughly: avoid walking.|

| |shooting pains. |5. Seek medical treatment. |

| |Advanced stage: skin | |

| |pale with bluish cast:| |

| |pulse decreases, | |

| |blistering, swelling, | |

| |heat hemorrhages, and | |

| |gangrene may follow. | |

| | | |

|FROST BITE |SUPERFICIAL: Redness,|SUPERFICIAL: |

| |blisters in 24-36 |1. Keep casualty warm; gently warm |

|NOTE 1 |hours and sloughing of|affected parts. |

| |the skin. |2. Decrease constricting clothing, |

| | |increase exercise and insulation. |

| |DEEP: Preceded by | |

| |superficial frostbite;|DEEP: |

| |skin is painless, |1. Protect the part from additional |

| |pale- yellowish, waxy,|injury. |

| |“wooden” or solid to |2. Seek medical treatment as fast as |

| |touch, blisters form |possible. |

| |in 12-36 hours | |

|SNOW |Eyes may feel |1. Cover the eyes with a dark cloth. |

|BLINDNESS |scratchy, watering, |2. Seek medical treatment. |

| |redness, headache, | |

| |increased pain with | |

| |exposure to light can | |

| |occur. | |

|DEHYDRATION |Similar to heat |1. Keep warm, loosen clothes. |

| |exhaustion. |2. Replace lost fluids, rest, and |

| | |additional medical treatment. |

|HYPOTHERMIA |Casualty is cold, |MILD HYPOTHERMIA: |

| |uncontrolled |1. Warm body evenly and without delay.|

| |shivering, until |(Heat source must be provided.) |

| |shivering stops, |2. Keep dry, protect from elements. |

| |rectal (core)temp less|3. Warm liquids may be given to |

| |95 degrees F |conscious casualty only. |

| |consciousness may be |4. Be prepared to start CPR. |

| |altered, uncoordinated|5. Seek medical treatment immediately.|

| |movements may occur, |SEVERE HYPOTHERMIA: |

| |shock and coma occur |1. Quickly stabilize body temperature.|

| |as body temperature |2. Attempt to prevent further heat |

| |drops. |loss. |

| | |3. Handle casualty gently. |

| | |4. Evacuate to nearest medical |

| | |treatment facility as soon as |

| | |possible. |

|HEAT INJURIES NOTE 2, 3 |

|HEAT CRAMPS |Casualty experiences |1. Move the casualty to a shaded area|

| |muscle cramps in arms,|and loosen clothing. |

| |legs and/or stomach, |2. Allow casualty to drink 1 quart of|

| |may also have wet skin|cool water slowly per hour. |

| |and extreme thirst. |3. Monitor casualty and provide water|

| | |as needed. |

| | |4. Seek medical attention if cramps |

| | |persist. |

|HEAT |Casualty experiences |1. Move the casualty to a cool, |

|EXHAUSTION |loss of appetite, |shaded area and loosen clothing. |

| |headache, excessive |2. Pour water on casualty and fan to |

| |sweating, weakness or |increase cooling effect of |

| |faintness, dizziness, |evaporation. |

| |nausea, muscle cramps.|3. Provide at least one quart of |

| |The skin is moist, |water to replace lost fluids. |

| |pale and clammy. |4. Elevate legs. |

| | |5. Seek medical aid if symptoms |

| | |continue. |

|HEATSTROKE |Casualty stops |1. Move casualty to a cool, shaded |

|(SUNSTROKE) |sweating (hot, dry |area, loosen clothing, remove outer |

| |skin), may experience |clothing if the situation permits. |

|NOTE 4 |headache, dizziness, |2. Immerse in cool water. If cool |

| |nausea, vomiting, |bath is not available, massage arms |

| |rapid pulse and |and legs with cool water. Fan |

| |respiration, seizures,|casualty to increase the cooling |

| |mental confusion. |effect of evaporation. |

| |Casualty may suddenly |3. If conscious, slowly consume one |

| |collapse and lose |quart of water. |

| |consciousness. THIS |4. SEEK MEDICAL AID AND EVACUATE AS |

| |IS A MEDICAL |SOON AS POSSIBLE. Perform any |

| |EMERGENCY! |lifesaving measures. |

NOTE 1: DO NOT attempt to thaw deep frostbite. There is less danger of walking on feet while frozen than after they have thawed.

NOTE 2: The first aid procedure for heat related injuries caused by wearing individual protective equipment is to move the casualty to a clear area and give him water to drink.

NOTE 3: When in a chemical environment, DO NOT loosen or remove casualty’s protective garments.

NOTE 4: Can be fatal if not treated promptly and quickly.

12-7 RESTORE BREATHING.

PERFORMANCE CHECKLIST

1. Responds to universal distress signal for choking.

2. Stands behind casualty.

3. Inserts arms under casualty's arms and around casualty's waist.

4. Places fist on midline slightly above navel and covers fist with other hand.

5. Presses fists into abdomen with a quick inward, upward motion [full force not applied], then relaxes the hold.

6. Administers thrusts at a rate of one thrust every 4 or 5 seconds.

7. The casualty has lost consciousness and you have lowered the casualty to the floor.

8. Opens the casualty's mouth and performs a finger sweep (grasps tongue and lower jaw between thumb and index finger, lifts jaw open, inserts index finger of other hand along the inside of cheek

to base of tongue, and uses a hooking motion to remove any visible obstruction).

9. Opens the airway by placing one hand on the casualty's forehead and tilting the head back while placing the fingertips of other hand under the tip of casualty's chin and lifts jaw forward.

10. Pinches nostrils closed, seals mouth over casualty's mouth, and delivers two full breaths.

11. Releases casualty's nostrils and breaks seal over mouth.

12. If the casualties airway is still blocked attempt to clear his airway by administering modified abdominal thrusts and additional finger sweeps.

a. Kneels astride the casualty's thighs.

b. Places heel of one hand on the midline just above casualty's navel and places other hand on top of first.

c. Delivers forward, upward thrust; then relaxes.

d. Once the blockage cleared, perform another finger sweep to remove the obstruction.

13. Ventilate the casualty at the rate of one cycle (deep breath, seal nose and mouth, blow, break seal) every 5 seconds (approximately).

14. Check casualty's pulse every minute or approximately every 12 breaths.

12-8 CARDIO-PULMINARY RESSUCITATION.

PERFORMANCE CHECKLIST

1. Slide fingers up ribcage nearest you to the notch at the end of sternum.

2. Place your middle finger on the notch and index finger next to it.

3. Put the heel of other hand next to index finger.

4. Remove hand from notch and put it on top of hand on chest.

5. Interlace, hold or extend fingers up.

6. Place your shoulders directly over your hands on the chest.

7. Keep arms straight and elbows locked.

8. Push sternum straight down 11/2 to 2 inches.

9. Do 15 compressions at 80 per minute. Count as you push down: "one and two and three and four and five and six and seven and .... fifteen and."

10. Push smoothly; do not jerk or jab; do not stop at the top or at the bottom.

11. When pushing, bend from your hips, not knees.

12. Keep fingers pointing across victim's chest, away from you.

13. Complete four cycles of 15 compressions and 2 breaths (takes about 1 minute) and check the pulse.

12-8 INITIATE AN INTRAVENOUS INFUSION.

PERFORMANCE CHECKLIST

1. Puts on gloves (should be performed before starting).

2. Removes protective covering from I.V. bag and identifies any leaks, passed expiration date, or unclear solution.

3. Checks IV set and catheter/needle unit and identifies any tears, cracks, watermarks, or damage.

4. Discards any bag, set, or catheter/needle unit that is not sterile.

5. Moves clamp on tubing away from the drip chamber and tightens the clamp.

6. Removes protective covering from outlet port, removes spike protective cap on infusion set and inserts spike into I.V. outlet port with a twisting motion without contaminating spike or port tip.

7. Holds (hangs) bag up and squeezes drip chamber until it is half-filled with solution.

8. Holds end of I.V. set tubing above bottom of bag.

9. Releases or loosens clamp on tubing and loosens protective cap over the adapter.

10 Gradually lowers tubing until solution reaches adapter (air expelled from tubing).

11. Reclamps tubing and retightens cap on adapter.

12. Looks and feels for vein.

13. Selects appropriate vein for infusion (not over a joint; free of scars, moles, and hair; etc.).

14. Applies constricting band above infusion site. Instructs casualty to clench and relax fist, then to leave fist clenched.

15. Cleanses the selected infusion site with a povidone-iodine impregnated cotton pad and wipes site once from proximal to distal with an isopropyl alcohol pad.

16. Removes protective cap from catheter/needle unit without touching the needle or catheter.

17. Pulls skin taut over injection site.

18. Positions needle with bevel up slightly to side of the selected vein at an angle (20o to 30o).

19. Inserts bevel of needle into skin, lowers angle, and inserts into vein.

20. Checks flash chamber for blood.

21. If no blood in chamber, withdraws catheter/needle slightly and inserts the needle into the vein.

22. Threads catheter (up to hub) into the vein.

23. Removes flash chamber with needle without pulling catheter out of vein.

24. Asks casualty to unclench fist and releases constricting band.

25. Constructing band has not been in place for more than 2 minutes (approximately).

26. Removes adapter cap and connects adapter and catheter hub.

27. Opens clamp and checks flow of solution in drip chamber.

28. Secures hub and adapter with strips of tape. Loops tubing on extremity and secures tubing with tape.

29. Checks for infiltration (asks casualty about pain; looks for swelling, redness, and leaking around site; feels for coolness, or some other method of checking for infiltration). If the infusion site is red, swollen, and cool to the touch, discontinues the I.V. and attempt to initiate another I.V. (above failed site or on another extremity) using a new needle/catheter unit.

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