Fundamental Criteria for First Aid

Soldiers may have to depend upon their first aid knowledge and skills to save themselves or other soldiers.
They may be able to save a life, prevent permanent disability, and reduce long periods of hospitalization by knowing what to do, what not to do, and when to seek medical assistance. Anything soldiers can do to keep others in good fighting condition is part of the primary mission to fight or to support the weapons system. Most injured or ill soldiers are able to return to their units to fight and/or support primarily because they are given appropriate and timely first aid followed by the best medical care possible. Therefore, all soldiers must remember the basics

Check for BREATHING: Lack of oxygen intake (through a compromised airway or inadequate breathing) can lead to brain damage or death in very few minutes

Check for BLEEDING: Life cannot continue without an adequate volume of blood to carry oxygen to tissues

Check for SHOCK: Unless shock is prevented or treated, death may result even though the injury would not otherwise be fatal

1.1Casualty Evaluation

The time may come when you must instantly apply your knowledge of lifesaving and first aid measures, possibly under combat or other adverse conditions. Any soldier observing an unconscious and/or ill, injured, or wounded person must carefully and skillfully evaluate him to determine the first aid measures required to prevent further injury or death. He should seek help from medical personnel as soon as possible, but must
NOT interrupt his evaluation or treatment of the casualty. A second person may be sent to find medical help
One of the cardinal principles of treating a casualty is that the initial rescuer must continue the evaluation and treatment, as the tactical situation permits, until he is relieved by another individual. If, during any part of the evaluation, the casualty exhibits the conditions for which the soldier is checking, the soldier must stop the evaluation and immediately administer first aid.
In a chemical environment, the soldier should not evaluate the casualty until the casualty has been masked and given the antidote.
After providing first aid, the soldier must proceed with the evaluation and continue to monitor the casualty for further medical complications until relieved by medical personnel. Learn the following procedures well. You may become that soldier who will have to give first aid some day

NOTE
Remember, when evaluating and/or treating a casualty, you should seek medical aid as soon as possible. DO NOT stop treatment, but if the situation allows, send another person to find medical aid

WARNING

Again, remember, if there are any signs of chemical or biological agent poisoning, you should immediately mask the casualty. If it is nerve agent poisoning, administer the antidote, using the casualty’s injector/ampules

a. Step ONE. Check the casualty for responsiveness by gently shaking or tapping him while calmly asking, “Are you okay?” Watch for response. If the casualty does not respond, go to step TWO.

If the casualty is conscious, ask him where he feels different than usual or where it hurts. Ask him to identify the locations of pain if he can, or to identify the area in which there is no feeling

If the casualty is conscious but is choking and cannot talk, stop the evaluation and begin treatment of chock

WARNING
IF A BROKEN NECK OR BACK IS SUSPECTED, DO NOT MOVE THE CASUALTY UNLESS TO SAVE HIS LIFE. MOVEMENT MAY CAUSE PERMANENT PARALYSIS OR DEATH

b. Step TWO. Check for breathing

If the casualty is breathing, proceed to step FOUR

If the casualty is not breathing, stop the evaluation and begin treatment (attempt to ventilate) Mouth-to-Mouth Resuscitation. If an airway obstruction is apparent, clear the airway obstruction, then ventilate

After successfully clearing the casualty’s airway, proceed to step THREE

c. Step THREE. Check for pulse. If pulse is present, and the casualty is breathing, proceed to step FOUR

If pulse is present, but the casualty is still not breathing, start rescue breathing

If pulse is not found, seek medically trained personnel for help

d. Step FOUR. Check for bleeding. Look for spurts of blood or blood-soaked clothes. Also check for both entry and exit wounds. If the casualty is bleeding from an open wound, stop the evaluation and begin first aid treatment in accordance with the following tasks, as appropriate

Arm or leg wound– Put on a Field or Pressure Dressing
Partial or complete amputation– Put on a Tourniquet
Open head wound– Apply a Dressing to an Open Head Wound
Open abdominal wound– Apply a Dressing to an Open Abdominal Wound
Open chest wound– Apply a Dressing to an Open Chest Wound

WARNING
IN A CHEMICALLY CONTAMINATED AREA, DO NOT EXPOSE THE WOUND/S

e. Step FIVE. Check for shock. If signs/symptoms of shock are present, stop the evaluation and begin treatment immediately. The following are nine signs and/or symptoms of shock

Sweaty but cool skin -clammy skin
Paleness of skin
Restlessness or nervousness
Thirst
Loss of blood -bleeding
Confusion -does not seem aware of surroundings
Faster than normal breathing rate
Blotchy or bluish skin, especially around the mouth
Nausea and/or vomiting

WARNING
LEG FRACTURES MUST BE SPLINTED BEFORE ELEVATING THE LEGS/AS A TREATMENT FOR SHOCK

f. Step SIX. Check for fractures
Check for the following signs/symptoms of a back or neck injury and treat as necessary

Pain or tenderness of the neck or back area
Cuts or bruises in the neck or back area
Inability of a casualty to move paralysis or numbness
Ask about ability to move - paralysis
Touch the casualty’s arms and legs and ask whether he can feel your hand -numbness
Unusual body or limb position

WARNING
UNLESS THERE IS IMMEDIATE LIFE-THREATENING DANGER, DO NOT MOVE A CASUALTY WHO HAS A SUSPECTED BACK OR NECK INJURY. MOVEMENT MAY CAUSE PERMANENT PARALYSIS OR DEATH

Immobilize any casualty suspected of having a neck or back injury by doing the following

Tell the casualty not to move

If a back injury is suspected, place padding (rolled or folded to conform to the shape of the arch) under the natural arch of the casualty’s back. For example, a blanket may be used as padding

If a neck injury is suspected, place a roll of cloth under the casualty’s neck and put weighted boots (filled with dirt, sand and so forth) or rocks on both sides of his head

Check the casualty’s arms and legs for open or closed fracture

Check for open fractures
Look for bleeding
Look for bone sticking through the skin
Check for closed fractures
Look for swelling
Look for discoloration
Look for deformity
Look for unusual body position

Stop the evaluation and begin treatment if a fracture to an arm or leg is suspected

Check for signs/symptoms of fractures of other body areas (for example, shoulder or hip) and treat as necessary

g. Step SEVEN. Check for burns. Look carefully for reddened blistered, or charred skin, also check for singed clothing. If bums are found, stop the evaluation and begin treatment First Aid for Burns

h. Step EIGHT. Check for possible head injury

Look for the following signs and symptoms
Unequal pupils
Fluid from the ear(s), nose, mouth, or injury site
Slurred speech
Confusion
Sleepiness
Loss of memory or consciousness
Staggering in walking
Headache
Dizziness
Vomiting and/or nausea
Paralysis
Convulsions or twitches

If a head injury is suspected, continue to watch for signs which would require performance of mouth-to-mouth resuscitation, treatment for shock, or control of bleeding and seek medical aid. for specific indications of head injury and treatment, Apply a Dressing to an Open Head Wound

1.2Medical Assistance

When a nonmedically trained soldier comes upon an unconscious and/or injured soldier, he must accurately evaluate the casualty to determine the first aid measures needed to prevent further injury or death. He should seek medical assistance as soon as possible, but he MUST NOT interrupt treatment
To interrupt treatment may cause more harm than good to the casualty. A second person may be sent to find medical help. If, during any part of the evaluation, the casualty exhibits the conditions for which the soldier is checking, the soldier must stop the evaluation and immediately administer first aid
Remember that in a chemical environment, the soldier should not evaluate the casualty until the casualty has been masked and given the antidote. After performing first aid, the soldier must proceed with the evaluation and continue to monitor the casualty for development of conditions which may require the performance of necessary basic life saving measures, such as clearing the airway, mouth-to-mouth resuscitation, preventing shock, ardor bleeding control. He should continue to monitor until relieved by medical personnel

UNDERSTAND VITAL BODY FUNCTIONS

Respiration and Blood Circulation

Respiration (inhalation and exhalation) and blood circulation are vital body functions. Interruption of either of these two functions need not be fatal IF appropriate first aid measures are correctly applied

a. Respiration. When a person inhales, oxygen is taken into the body and when he exhales, carbon dioxide is expelled from the body–this is respiration. Respiration involves the—

Airway (nose, mouth, throat, voice box, windpipe, and bronchial tree). The canal through which air passes to and from the lungs

Lungs two elastic organs made up of thousands of tiny air spaces and covered by an airtight membrane

Chest cage (formed by the muscle-connected ribs which join the spine in back and the breastbone in front). The top part of the chest cage is closed by the structure of the neck, and the bottom part is separated from the abdominal cavity by a large dome-shaped muscle called the diaphragm
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The diaphragm and rib muscles, which are under the control of the respiratory center in the brain, automatically contract and relax. Contraction increases and relaxation decreases the size of the chest cage

When the chest cage increases and then decreases, the air pressure in the lungs is first less and then more than the atmospheric pressure, thus causing the air to rush in and out of the lungs to equalize the pressure. This cycle of inhaling and exhaling is repeated about 12 to 18 times per minute

b. Blood Circulation. The heart and the blood vessels (arteries, veins, and capillaries) circulate blood through the body tissues. The heart is divided into two separate halves, each acting as a pump. The left side pumps oxygenated blood (bright red) through the arteries into the capillaries; nutrients and oxygen pass from the blood through the walls of the capillaries into the cells. At the same time waste products and carbon dioxide enter the capillaries. From the capillaries the oxygen poor blood is carried through the veins to the right side of the heart and then into the lungs where it expels carbon dioxide and picks up oxygen, Blood in the veins is dark red because of its low oxygen content. Blood does not flow through the veins in spurts as it does through the arteries

Heartbeat. The heart functions as a pump to circulate the blood continuously through the blood vessels to all parts of the body. It contracts, forcing the blood from its chambers; then it relaxes, permitting its chambers to refill with blood. The rhythmical cycle of contraction and relaxation is called the heartbeat. The normal heartbeat is from 60 to 80 beats per minute

Pulse. The heartbeat causes a rhythmical expansion and contraction of the arteries as it forces blood through them. This cycle of expansion and contraction can be felt (monitored) at various body points and is called the pulse. The common points for checking the pulse are at the side of the neck (carotid), the groin (femoral), the wrist (radial), and the ankle -posterial tibial

a) Neck (carotid) pulse. To check the neck (carotid) pulse, feel for a pulse on the side of the casualty’s neck closest to you by placing the tips of your first two fingers beside his Adam’s apple

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b) Groin (femoral) pulse. To check the groin (femoral) pulse, press the tips of two fingers into the middle of the groin
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c) Wrist (radial) pulse. To check the wrist (radial) pulse, place your first two fingers on the thumb side of the casualty’s wrist

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d) Ankle (posterial tibial) pulse. To check the ankle (posterial tibial) pulse, place your first two fingers on the inside of the ankle
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NOTE
DO NOT use your thumb to check a casualty’s pulse because you may confuse your pulse beat with that of the casualty

[all1=003300]1.4Adverse Conditions[/all1]

a. Lack of Oxygen. Human life cannot exist without a continuous intake of oxygen. Lack of oxygen rapidly leads to death. First aid involves knowing how to OPEN THE AIRWAY AND RESTORE BREATHING AND HEARTBEAT

b. Bleeding. Human life cannot continue without an adequate volume of blood to carry oxygen to the tissues. An important first aid measure is to STOP THE BLEEDING to prevent loss of blood

c. Shock. Shock means there is inadequate blood flow to the vital tissues and organs. Shock that remains uncorrected may result in death even though the injury or condition causing the shock would not otherwise be fatal. Shock can result from many causes, such as loss of blood, loss of fluid from deep burns, pain, and reaction to the sight of a wound or blood. First aid includes PREVENTING SHOCK, since the casualty’s chances of survival are much greater if he does not develop shock

d. Infection. Recovery from a severe injury or a wound depends largely upon how well the injury or wound was initially protected. Infections result from the multiplication and growth (spread) of germs (bacteria: harmful microscopic organisms). Since harmful bacteria are in the air and on the skin and clothing, some of these organisms will immediately invade (contaminate) a break in the skin or an open wound. The objective is to KEEP ADDITIONAL GERMS OUT OF THE WOUND. A good working knowledge of basic first aid measures also includes knowing how to dress the wound to avoid infection or additional contamination

The next part is
Basic Measures for First Aid

Basic Measures for First Aid
Several conditions which require immediate attention are an inadequate airway, lack of breathing or lack of heartbeat, and excessive loss of blood. A casualty without a clear airway or who is not breathing may die from lack of oxygen
Excessive loss of blood may lead to shock, and shock can lead to death; therefore, you must act immediately to control the loss of blood
All wounds are considered to be contaminated, since infection-producing organisms (germs) are always present on the skin, on clothing, and in the air
Any missile or instrument causing the wound pushes or carries the germs into the wound. Infection results as these organisms multiply. That a wound is contaminated does not lessen the importance of protecting it from further contamination. You must dress and bandage a wound as soon as possible to prevent further contamination
It is also important that you attend to any airway, breathing, or bleeding problem IMMEDIATELY because these problems may become life-threatening
OPEN THE AIRWAY AND RESTORE BREATHING
2.1Breathing Process
All living things must have oxygen to live. Through the breathing process, the lungs draw oxygen from the air and put it into the blood. The heart pumps the blood through the body to be used by the living cells which require a constant supply of oxygen. Some cells are more dependent on a constant supply of oxygen than others. Cells of the brain may die within 4 to 6 minutes without oxygen. Once these cells die, they are lost forever since they DO NOT regenerate. This could result in permanent brain damage, paralysis, or death
2.2Assessment -Evaluation

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a. Check for responsiveness -establish whether the casualty is conscious by gently shaking him and asking, “Are you O.K
b. Call for help
c. Position the unconscious casualty so that he is lying on his back and on a firm surface
WARNING
If the casualty is lying on his chest (prone position), cautiously roll the casualty as a unit so that his body does not twist (which may further complicate a neck, back or spinal injury

Straighten the casualty’s legs. Take the casualty’s arm that is nearest to you and move it so that it is straight and above his head. Repeat procedure for the other arm

Kneel beside the casualty with your knees near his shoulders (leave space to roll his body) (Figure 2-1B). Place one hand behind his head and neck for support. With your other hand, grasp the casualty under his far arm -Figure 2-1C

Roll the casualty toward you using a steady and even pull. His head and neck should stay in line with his back

Return the casualty’s arms to his sides. Straighten his legs. Reposition yourself so that you are now kneeling at the level of the casualty’s shoulders. However, if a neck injury is suspected, and the jaw-thrust will be used, kneel at the casualty’s head, looking toward his feet

2.3Opening the Airway—Unconscious and Not Breathing Casualty

The tongue is the single most common cause of an airway obstruction
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In most cases, the airway can be cleared by simply using the head-tilt/chin-lift technique. This action pulls the tongue away from the air passage in the throat
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a. Step ONE Call for help and then position the casualty. Move (roll) the casualty onto his back /Figure 2-1C
CAUTION
Take care in moving a casualty with a suspected neck or back injury. Moving an injured neck or back may permanently injure the spine
NOTE
If foreign material or vomitus is visible in the mouth, it should be removed, but do not spend an excessive amount of time doing so

. Step TWO Open the airway using the jaw-thrust or head-tilt/chin-lift technique
NOTE
The head-tilt/chin-lift is an important procedure in opening the airway; however, use extreme care because excess force in performing this maneuver may cause further 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 it can be accomplished without extending the neck

Perform the jaw-thrust technique. The jaw-thrust may be accomplished by the rescuer grasping the angles of the casualty’s lower jaw and lifting with both hands, one on each side, displacing the jaw forward and up
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The rescuer’s elbows should rest on the surface on which the casualty is lying. If the lips close, the lower lip can be retracted with the thumb. If mouth-to-mouth breathing is necessary, close the nostrils by placing your cheek tightly against them. The head should be carefully supported without tilting it backwards or turning it from side to side. If this is unsuccessful, the head should be tilted back very slightly. The jaw-thrust is the safest first approach to opening the airway of a casualty who has a suspected neck injury because in most cases it can be accomplished without extending the neck

Perform the head-tilt/chin-lift technique Place one hand on the casualty’s forehead and apply firm, backward pressure with the palm to tilt the head back. Place the fingertips of the other hand under the bony part of the lower jaw and lift, bringing the chin forward. The thumb should not be used to lift the chin
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NOTE
The fingers should not press deeply into the soft tissue under the chin because the airway may be obstructed

c. Step THREE. Check for breathing (while maintaining an airway). After establishing an open airway, it is important to maintain that airway in an open position. Often the act of just opening and maintaining the airway will allow the casualty to breathe properly. Once the rescuer uses one of the techniques to open the airway (jaw-thrust or head-tilt/chin-lift), he should maintain that head position to keep the airway open. Failure to maintain the open airway will prevent the casualty from receiving an adequate supply of oxygen. Therefore, while maintaining an open airway, the rescuer should check for breathing by observing the casualty’s chest and performing the following actions within 3 to 5 seconds

LOOK for the chest to rise and fall
LISTEN for air escaping during exhalation by placing your ear near the casualty’s mouth
FEEL for the flow of air on your cheek

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If the casualty does not resume breathing, give mouth-to-mouth resuscitation

NOTE
If the casualty resumes breathing, monitor and maintain the open airway. If he continues to breathe, he should be transported to a medical treatment facility

2.4Rescue Breathing -Artificial Respiration

a. If the casualty does not promptly resume adequate spontaneous breathing after the airway is open, rescue breathing (artificial respiration) must be started. Be calm! Think and act quickly! The sooner you begin rescue breathing, the more likely you are to restore the casualty’s breathing. If you are in doubt whether the casualty is breathing, give artificial respiration, since it can do no harm to a person who is breathing. If the casualty is breathing, you can feel and see his chest move. Also, if the casualty is breathing, you can feel and hear air being expelled by putting your hand or ear close to his mouth and nose

b. There are several methods of administering rescue breathing. The mouth-to-mouth method is preferred; however, it cannot be used in all situations. If the casualty has a severe jaw fracture or mouth wound or his jaws are tightly closed by spasms, use the mouth-to-nose method

2.5Preliminary Steps—All Rescue Breathing Methods

a. Step ONE. Establish unresponsiveness. Call for help. Turn or position the casualty
b. Step TWO. Open the airway
c. Step THREE. Check for breathing by placing your ear over the casualty’s mouth and nose, and looking toward his chest

Look for rise and fall of the casualty’s chest
Listen for sounds of breathing
Feel for breath on the side of your face. If the chest does not rise and fall and no air is exhaled, then the casualty is breathless (not breathing). This evaluation procedure should take only 3 to 5 seconds. Perform rescue breathing if the casualty is not breathing
NOTE
Although the rescuer may notice that the casualty is making respiratory efforts, the airway may still be obstructed and opening the airway may be all that is needed. If the casualty resumes breathing, the rescuer should continue to help maintain an open airway

2.6Mouth-to-Mouth Method
In this method
of rescue breathing, you inflate the casualty’s lungs with air from
your lungs. This can be accomplished by blowing air into the person’s
mouth. The mouth-to-mouth rescue breathing method is performed as
follows
a. Preliminary Steps
Step ONE
If the casualty is not breathing, place your hand on his forehead, and
pinch his nostrils together with the thumb and index finger of this
same hand. Let this same hand exert pressure on his forehead to
maintain the backward head-tilt and maintain an open airway. With your
other hand, keep your fingertips on the bony part of the lower jaw near
the chin and lift

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

Step TWO Take a deep breath and place your mouth (in an airtight seal) around the casualty’s mouth

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If the injured person is small, cover both his nose and mouth with your mouth, sealing your lips against the skin of his face

Step THREE Blow two full breaths into the casualty’s mouth (1 to 1 1/2 seconds per breath),
taking a breath of fresh air each time before you blow. Watch out of
the corner of your eye for the casualty’s chest to rise. If the chest
rises, sufficient air is getting into the casualty’s lungs. Therefore,
proceed as described in step FOUR below. If the chest does not rise, do
the following (a, b, and c below) and then attempt to ventilate again
a)
Take corrective action immediately by reestablishing the airway. Make
sure that air is not leaking from around your mouth or out of the
casualty’s pinched nose
b) Reattempt to ventilate
c) If chest still does not rise, take the necessary action to open an obstructed airway
NOTE
If
the initial attempt to ventilate the casualty is unsuccessful,
reposition the casualty’s head and repeat rescue breathing. Improper
chin and head positioning is the most, common cause of difficulty with
ventilation. If the casualty cannot be ventilated after repositioning
the head, proceed with foreign-body airway obstruction maneuvers

Step FOUR After
giving two breaths which cause the chest to rise, attempt to locate a
pulse on the casualty. Feel for a pulse on the side of the casualty’s
neck closest to you by placing the first two fingers (index and middle
fingers) of your hand on the groove beside the casualty’s Adam’s apple
(carotid pulse)
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(Your
thumb should not be used for pulse taking because you may confuse your
pulse beat with that of the casualty.) 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

a) If a pulse is found and the
casualty is breathing—STOP allow the casualty to breathe on his own. If
possible, keep him warm and comfortable
b) If a pulse is found and the casualty is not breathing, continue rescue breathing
c) If a pulse is not found, seek medically trained personnel for help

Rescue
Breathing (mouth-to-mouth resuscitation) Rescue breathing
(mouth-to-mouth or mouth-to-nose resuscitation) is performed at the
rate of about one breath every 5 seconds (12 breaths per minute) with
rechecks for pulse and breathing after every 12 breaths. Rechecks can
be accomplished in 3 to 5 seconds. See steps ONE through SEVEN (below)
for specifics

NOTE
Seek help (medical aid), if not done previously

Step ONE.
If the casualty is not breathing, pinch his nostrils together with the
thumb and index finger of the hand on his forehead and let this same
hand exert pressure on the forehead to maintain the backward head-tilt
-Figure 2-7

Step TWO. Take a deep breath and place your mouth (in an airtight seal) around the casualty’s mouth -Figure 2-8

Step THREE.
Blow a quick breath into the casualty’s mouth forcefully to cause his
chest to rise. If the casualty’s chest rises, sufficient air is getting
into his lungs

Step FOUR. When the casualty’s chest rises, remove your mouth from his mouth and listen for the return of air from his lungs -exhalation

Step
FIVE. Repeat this procedure (mouth-to-mouth resuscitation) at a rate of
one breath every 5 seconds to achieve 12 breaths per minute. Use the
following count: “one, one-thousand; two, one-thousand; three,
one-thousand; four, one-thousand; BREATH; one, one-thousand;” and so
forth. To achieve a rate of one breath every 5 seconds, the breath must
be given on the fifth count

Step SIX.
Feel for a pulse after every 12th breath. This check should take about
3 to 5 seconds. If a pulse beat is not found, seek medically trained
personnel for help

Step SEVEN.
Continue rescue breathing until the casualty starts to breathe on his
own, until you are relieved by another person, or until you are too
tired to continue. Monitor pulse and return of spontaneous breathing
after every few minutes of rescue breathing. If spontaneous breathing
returns, monitor the casualty closely. The casualty should then be
transported to a medical treatment facility. Maintain an open airway
and be prepared to resume rescue breathing, if necessary
2.7Mouth-to-Nose Method
Use
this method if you cannot perform mouth-to-mouth rescue breathing
because the casualty has a severe jaw fracture or mouth wound or his
jaws are tightly closed by spasms. The mouth-to-nose method is
performed in the same way as the mouth-to-mouth method except that you
blow into the nose while you hold the lips closed with one hand at the
chin. You then remove your mouth to allow the casualty to exhale
passively. It may be necessary to separate the casualty’s lips to allow
the air to escape during exhalation
2.8Heartbeat
If
a casualty’s heart stops beating, you must immediately seek medically
trained personnel for help. SECONDS COUNT! Stoppage of the heart is
soon followed by cessation of respiration unless it has occurred first.
Be calm! Think and act! When a casualty’s heart has stopped, there is
no pulse at all; the person is unconscious and limp, and the pupils of
his eyes 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, immediately seek medically trained personnel