First Aid for Soldier, Schemes and Mind Maps of Health sciences

Download First Aid for Soldier and more Schemes and Mind Maps Health sciences in PDF only on Docsity! FM 21-11 FIELD MANUAL %& DISTRIBUTION RESTRICTION: APPROVED FOR PUBLIC RELEASE; DISTRIBUTION iS UNLIMITED. HEADQUARTERS, DEPARTMENT OF THE ARMY CHANGE No. 1 FM 21-11 C 1 HEADQUARTERS DEPARTMENT OF THE ARMY Washington, DC, 28 August 1989 FIRST AID FOR SOLDIERS FM 21-11, 27 October 1988, is changed as follows: 1. New or changed material is indicated by a star ( ★ ). 2. Remove old pages and insert new ones as indicated below: Remove pages Insert pages C-9 through C-12 C-9 and C-10 Index-1 and Index-2 Index-1 and Index-2 3. File this transmittal sheet in front of the publication. DISTRIBUTION RESTRICTION: Distribution authorized to US Government agencies only. This limited distribution is intended to protect technical or operational information from automatic dissemination under the International Exchange Program or by other means. This determination was made on 27 July 1988. Other requests for this document will be referred to Commandant, AHS, USA, ATTN: HSHA-TLD, Fort Sam Houston, TX 78234-6100. DESTRUCTION NOTICE: Destroy by any method that will prevent disclosure of contents or reconstruction of the document. By Order of the Secretary of the Army: GORDON R. SULLIVAN General, United States Army Chief of Staff Official: MILTON H. HAMILTON Administrative Assistant to the Secretary of the Army 00105 DISTRIBUTION: Active Army, USAR and ARNG: To be distributed in accordance with DA Form 12-11E, requirements for FM 21-11, First Aid for Soldiers (Qty rqr block no. 161). This publication contains copyrighted material. FIELD MANUAL *FM 21-11 HEADQUARTERS DEPARTMENT OF THE ARMY Washington, DC, 27 October 1988 FIRST AID FOR SOLDIERS ★ TABLE OF CONTENTS i C2, FM 21-11 2-18. Manual Pressure (081-831-1016)... 219, Pressure Dressing (081-831-1016). 2-20. Tourniquet (081-831-1017)... Section TIL, Check and Treat for Shock 2-21. Causes and Effects... 2-22, Signs/Symptoms (081-831-1600) 2-23. Treatment/Prevention (081-831-1005). CHAPTER 3 FIRST AID FOR SPECIAL WOUNDS 31 Section 1 Give Proper First Aid for Head Injuries 3-1 3-1. Head Injuries... 3-2, Signs/Symptoms (081-831-1000 3-3. General First Aid Measures (081-831-1000 }. 3-4, Dressings and Bandages... Section Il. Give Proper First Aid for Face and Neck Injuries 35. juris Section Il. Give Proper First Aid for Chest and Abdominal Wounds and Burn Injuries 3-9. Chest Wounds (081-831-1026)... 3-10, Chest Wound(s} Procedure (081-831-1026) 3-11. Abdominal Wounds. 3-12. Abdominal Wound(s) (081-831-1025) 3-29 3-13. Section IV. Apply Proper Bandages to Upper and Lower Extremities 3:37 3-15. 3-16. Elbow Bandage. 3-17. Hand Bandage. 3-18. Leg {Upper and Lower) 3-42 3-19. Knee Bandage 3-20. Foot Bandage CHAPTER 4 _ FIRST AID FOR FRACTURES 41 4-1, Kinds of Fractures wicscsssccsseessesseessencessnnennee Ad 42, Signs/Symptoms of Fractures (081-831-1000) 4-3. Purposes of Immobilizing Fracture: 4-4, Splints, Padding, Bandages, Slings, and Swathes (081-831-1034) 45. Procedures for Splinting Suspected Fractures (081-831-1034), C2, FM 21-11 Page 8-9. Manual Carries (081-831-1040 and 081-831-1041)... B-10. Improvised Litters (Figures B-15 through B-17) (081-831-104 )).... Appendix C COMMON PROBLEMS/CONDITIONS C1 Section L HEALTH MAINTENANCE C-1 Cl. General... C-2. Personal Hygiene. C-3. Diarrhea and Dysentery. C-4, Dental Hygiene. C-5. Drug (Substance) Abus C-6, Sexually Transmitted Disease: Section IL. First Aid For Common Problems C-7, Heat Rash (or Prickly Heat). C-8. Contact Poisoning (Skin Rashes C9. Care of the Feet. C-10. Blisters... Appendix E DIGITAL PRESSURE E-l Appendix F DECONTAMINATION PROCEDURES F1 F-1. Protective Measures and Handling of Casualties... F-2. Personal Decontaminatio: F-3. Casualty Decontamination.. Appendix G SKILL LEVEL 1 TASKS Gl Glossary... Glossary-1 References-1 Index-0 C2, FM 21-11 1-2, 13. 1-4, 15. 21, 2-2. 2:3, 2-4, 2-5. 26. 21. 2-8. 2-9, 2-18. 2-19. 2-20. 2-21, 2-22, 2-23, 2-24, 2-25. vi LIST OF ILLUSTRATIONS Airway, lungs, and chest cage........cscssscssseressrerreeereeerenee Groin (femoral) pulse....... Wrist {radial} pulse............secesssssessessssessstenessensesnnsensenee Ankle (posterial tibial) pulse... eseesecsessesssseseseseeee Responsiveness checked......cccccscsssnsscssseenereeneeeesseerenees Airway blocked by tongue.. Airway opened (cleared)....... Jaw-thrust technique of opening airway... Head-tilt/chin-lift_ technique of opening airway................ Check for breathing. Head-tilt/chin-lift ............ Rescue breathing....... Placement of fingers to detect pulse... teeseeeseeeeees Universal sign of choking.............cececcccesesseceseseeteeeeteacseeaee Anatomical view of abdominal thrust procedure............... Profile view of abdominal thrust. Profile view of chest thrust.......ssssssssssssseessee Abdominal thrust on unconscious casualty........ Hand placement for chest thrust (Illustrated A-D)........... Breastbone depressed 1 1/2 to 2 inches..........eseeseseeseeens Opening casualty’s mouth (tongue-jaw lift)... 2-3 2-4 25 26 2-8 29 2-10 241 2-23 2-24 2-24 2-25 2-27 2-28 2-29 2-30 Figure 2-26. 2-27. 2-28. 2-29. 2-30. 2-31. 2-36. 2-37. 2-38. 2-39. 2-40. 2-41, 2-42. 2-43, 2-44, 2-45. 2-46. C2, FM 21-11 Opening casualty’s mouth (crossed-finger method)............. Using finger to dislodge foreign body..... Grasping tails of dressing with both hands............sscsssee Pulling dressing open... Placing dressing directly on WOUMKGL........sesssssseeseessseecseene Wrapping tail of dressing around injured patt................00+ Tails tied into nonslip knot............cscsscsecesessnssecseresearenesenes Direct manual pressure applied..............:sscsese Injured limb eievated.... Wad of padding on top of field dressing..... Improvised dressing over wad of padding...... Ends of improvised dressing wrapped tightly around limb Ends of improvised dressing tied together in nonslip knot. Tourniquet 2 to 4 inches above wound... Rigid object on top of half-knot. Full knot over rigid object....... Stick twisted... Free ends looped (Illustrated A and B)........00 Clothing loosened and feet elevated... Body temperature maintained. Casualty’s head turned to side....... 2-31 2-33 2-33 2-34 2-34 2-35 2-37 2-38 2-38 2-40 2-41 2-41 2-42 2-42 2-46 2-46 2-47 vii C2, FM 21-11 Figure 3-41. 3-42. 43. 45. 4-6. 47, 48. 4-9, 4-10. 412. 4-13. 4-15. 4-16, Page Cravat bandage applied to knee (Illustrated A thru C)}........... 3-42 Triangular bandage applied to foot ([Hustrated A thru E)..... 3-43 Kinds of fractures (Illustrated A thru C)..... 4-1 Nonslip knots tied away from casualty... 46 Shirt tail used for support... 47 Belt used for support 47 Arm inserted in center of improvised sling....... 47 Ends of improvised sling tied to side of neck........ 48 Corner of sling twisted and tucked at elbow. Arm immobilized with strip of clothing... Application of triangular bandage to form sling (two methods)....... Completing sling sequence by twisting and tucking the corner of the sling at the elbow (Illustrated A and B)......... 4-11 Board splints applied to fractured elbow when elbow is not bent (two methods) (081-831- 1084) (Illustrated A and B). 411 Chest wall used as splint for upper arm fracture when no splint is available (Illustrated A and B serene 412 Chest wall, sling, and cravat used to immobilize fractured elbow when elbow is bent... sesssesressesriees ALE Board splint applied to fractured forearm {Illustrated A and B)..... Fractured forearm or wrist splinted with sticks and supported with tail of shirt and strips o of material (Illustrated A thru C). wees 4:13 Board splint applied to fractured wrist and hand (Illustrated A thru C). pees Figure 4-17, 4-18. 4-19. 4-20. 4-21. 4-22, 4-23. 4-24, 4-26, 4-27, 4-28. 4-29, 4-30. 6-1. 6-2. 6-3. 6-4. 6-5. C2, FM 21-11 Board splint applied to fractured hip or thigh (081-831-1034)... Board splint applied t to fractured or dislocated knee (081-831-1034)... anaes seeneaee » 415 Board splint applied to fractured lower leg or ankle....... Improvised splint applied to fractured lower leg or ankle. Poles rolled in a blanket and used as ss splints applied to to fractured lower extremity... 416 Uninjured leg used as splint for fractured leg (anatomical splint)... ee ALT Fractured jaw immobilized (Illustrated A thru C).........c000 AIT Application of belts, sling, and cravat to immobilize a collarbone... aoe seeseesseees ilize a fractured shoulder ( Ulustrated A thru D).. Spinal column must maintain a swayback Position (Illustrated A and B}... aeteaeteenenennaneee . 420 Placing face-up casualty with fractured back onto litte 4-21 Casualty with roll of cloth (bulk) under neck.......0ccesene 423 Immobilization of fractured neck..... . 4-23 Preparing casualty with fractured neck for transportation {Illustrated A thru &)..... seteusenssennecaers sesee Characteristics of nonpoisonous snake... Characteristics of poisonous pit viper. 6-2 Poisonous snake: 6-2 Cobra snake...... 6-3 Coral snake. 6-4 xi C2, FM 21-11 6-10. 6-11, 6-12, T1. 7-6. 7-7. 78. 7-9. xii Page Sea snake., 6-5 Characteristics of poisonous snake bite..... 6-5 Constricting band... 6-7 Brown recluse spider..... Black widow spider..... 6-12 Tarantula 6-12 Scorpion. 6-12 Nerve Agent Antidote Kit, Maris 1..........eceeeeee 76 Thigh injection sit 78 Buttocks injection site. 7-8 Holding the set of autoinjectors by the plastic clip..... 7-10 Grasping the atropine autoinjector between the thumb and first two fingers of the hand..............0+ saeaeanes 7-10 Removing the atropine autoinjector from the clip....... Tl Thigh injection site for self-aid. Tl Buttocks injection site for self-aid......ecceseeese 712 Used atropine autoinjector placed between the little finger and ring finger. . 713 Removing the 2 PAM Cl autoinjector............c0 7-13 One set of used autoinjectors attached to pocket flap......... 7-14 Field first aid case and dressing {Illustrated A thru C).... sence Acl C2, FM 21-11 ★ PREFACE This manual meets the emergency medical training needs of individual soldiers. Because medical personnel will not always be readily available, the nonmedical soldiers will have to rely heavily on their own skills and knowledge of life-sustaining methods to survive on the integrated battlefield. This manual also addresses first aid measures for other life- threatening situations. It outlines both self-treatment (self-aid) and aid to other soldiers (buddy aid). More importantly, this manual emphasizes prompt and effective action in sustaining life and preventing or minimizing further suffering. First aid is the emergency care given to the sick, injured, or wounded before being treated by medical personnel. The Army Dictionary defines first aid as “urgent and immediate lifesaving and other measures which can be performed for casualties by nonmedical personnel when medical personnel are not immediately available.” Nonmedical soldiers have received basic first aid training and should remain skilled in the correct procedures for giving first aid. Mastery of first aid procedures is also part of a group study training program entitled the Combat Lifesaver (DA Pam 351-20). A combat lifesaver is a nonmedical soldier who has been trained to provide emergency care. This includes administering intravenous infusions to casualties as his combat mission permits. Normally, each squad, team, or crew will have one member who is a combat lifesaver. This manual is directed to all soldiers. The procedures discussed apply to all types of casualties and the measures described are for use by both male and female soldiers. Cardiopulmonary resuscitative (CPR) procedures were deleted from this manual. These procedures are not recognized as essential battlefield skills that all soldiers should be able to perform. Management and treatment of casualties on the battlefield has demonstrated that incidence of cardiac arrest are usually secondary to other injuries requiring immediate first aid. Other first aid procedures, such as controlling hemorrhage are far more critical and must be performed well to save lives. Learning and maintaining CPR skills is time and resource intensive. CPR has very little practical application to battlefield first aid and is not listed as a common task for soldiers. The Academy of Health Sciences, US Army refers to the American Heart Association for the CPR standard. If a nonmedical soldier desires to learn CPR, he may contact his supporting medical treatment facility for the appropriate information. All medical personnel, however, must maintain proficiency in CPR and may be available to help soldiers master the skill. The US Army’s official reference for CPR is FM 8-230. This manual has been designed to provide a ready reference for the individual soldier on first aid. Only the information necessary to support and sustain proficiency in first aid has been boxed and the task number has been listed. In addition, these first aid tasks for Skill Level 1 have xv C2, FM 21-11 been listed in Appendix G. The task number, title, and specific paragraph of the appropriate information is provided in the event a cross-reference is desired. Acknowledgment Grateful acknowledgment is made to the American Heart Association for their permission to use the copyrighted material. Commercial Products Commercial products (trade names or trademarks) mentioned in this publication are to provide descriptive information and for illustrative purposes only. Their use does not imply endorsement by the Department of Defense. Standardization Agreements The provisions of this publication are the subject of international agreement(s): NATO STANAG TITLE 2122 Medical Training in First Aid, Basic Hygiene and Emergency Care 2126 First Aid Kits and Emergency Medical Care Kits 2358 Medical First Aid and Hygiene Training in NBC Operations 2871 First Aid Material for Chemical Injuries Neutral Language Unless this publication states otherwise, masculine nouns and pronouns do not refer exclusively to men. Appendixes Appendix A is a listing of the contents of the First Aid Case and Kits. xvi C2, FM 21-11 Appendix B discusses some casualty transportation procedures. Much is dependent upon the manner in which a casualty is rescued and transported. Appendix C outlines some basic principles that promote good health. The health of the individual soldier is an important factor in conserving the fighting strength. History has often demonstrated that the course of the battle is influenced more by the health of the soldier than by strategy or tactics. Appendix E discusses application of digital pressure and illustrates pressure points. Appendix F discusses specific information on decontamination procedures. Appendix G is a listing of Skill Level 1 common tasks. Proponent Statement The proponent of this publication is the Academy of Health Sciences, US Army. Submit changes for improving this publication on DA Form 2028 directly to Commandant, Academy of Health Sciences, US Army, ATTN: HSHA-CD, Fort Sam Houston, Texas 78234-6100. xvii C 2, FM 21-11 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. See Chapter 2, paragraph 2-5c for procedure. (1) If the casualty is breathing, proceed to step FOUR. (2) If the casualty is not breathing, stop the evaluation and begin treatment (attempt to ventilate). See task 081-831-1042, Perform Mouth-to-Mouth Resuscitation. If an airway obstruction is apparent, clear the airway obstruction, then ventilate. (3) 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. (1) If pulse is present, but the casualty is still not breathing, start rescue breathing. See Chapter 2, paragraphs 2-6, and 2-7 for specific methods. ★ (2) 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: (1) Arm or leg wound–Task 081-831-1016, Put on a Field or Pressure Dressing. See Chapter 2, paragraphs 2-15, 2-17, 2-18, and 2-19. (2) Partial or complete amputation–Task 081-831-1017, Put on a Tourniquet. See Chapter 2, paragraph 2-20. (3) Open head wound–Task 081-831-1033, Apply a Dressing to an Open Head Wound. See Chapter 3, Section I. 1-3 C 2, FM 21-11 (4) Open abdominal wound–Task 081-831-1025, Apply a Dressing to an Open Abdominal Wound. See Chapter 3, paragraph 3-12. (5) Open chest wound–Task 081-831-1026, Apply a Dressing to an Open Chest Wound. See Chapter 3, paragraphs 3-9 and 3-10. 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. (1) (2) (3) (4) (5) (6) (7) (8) (9) 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. See Chapter 2, Section III for specific information regarding the causes and effects, signs/symptoms, and the treatment/prevention of shock. 1-4 C 2, FM 21-11 f. Step SIX. Check for fractures (Chapter 4). (1) 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. (2) 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. (3) Check the casualty’s arms and legs for open or closed fractures. 1-5 FM 21-11 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 (Figure 1-1). 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. 1-8 FM 21-11 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. (1) 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. (2) 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 (Figure 1-2). 1-9 FM 21-11 (b) Groin (femoral) pulse. To check the groin (femoral) pulse, press the tips of two fingers into the middle of the groin (Figure 1-3). (c) Wrist (radial) pulse. To check the wrist (radial) pulse, place your first two fingers on the thumb side of the casualty’s wrist (Figure 1-4). 1-10 C 2, FM 21-11 CHAPTER 2 BASIC MEASURES FOR FIRST AID INTRODUCTION 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. Section I. OPEN THE AIRWAY AND RESTORE BREATHING ★ 2-1. Breathing 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. 2-2. Assessment (Evaluation) Phase (081-831-1000 and 081-831-1042) a. Check for responsiveness (Figure 2-1A)—establish whether the casualty is conscious by gently shaking him and asking, “Are you O.K.?” b. Call for help (Figure 2-1B). 2-1 C 2, FM 21-11 c. Position the unconscious casualty so that he is lying on his back and on a firm surface (Figure 2-1C) (081-831-1042). WARNING (081-831-1042) 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). 2-2 C 2, FM 21-11 (1) 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. (2) 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). (3) Roll the casualty toward you using a steady and even pull. His head and neck should stay in line with his back. (4) 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. 2-3. Opening the Airway—Unconscious and Not Breathing Casualty (081-831-1042) ★ The tongue is the single most common cause of an airway obstruction (Figure 2-2). 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 (Figure 2-3). 2-3 C2, FM 21-11 (2) Perform the head-tilt/chin-lift technique (081-831-1042). 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 (Figure 2-5). 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: 2-6 FM 21-11 (1) LOOK for the chest to rise and fall. (2) LISTEN for air escaping during exhalation by placing your ear near the casualty’s mouth. (3) FEEL for the flow of air on your cheek (see Figure 2-6), (4) 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. 2-4. Rescue 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. 2-5. Preliminary Steps—All Rescue Breathing Methods (081-831-1042) 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: 2-7 FM 21-11 (1) Look for rise and fall of the casualty’s chest (Figure 2-6). (2) Listen for sounds of breathing. (3) 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. 2-6. Mouth-to-Mouth Method (081-831-1042) 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. 2-8 C 2, FM 21-11 (4) Step FOUR (081-831-1042). 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) (Figure 2-9). (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. ★ b. Rescue Breathing (mouth-to-mouth resuscitation) (081-831-1042). Rescue breathing (mouth-to-mouth or mouth-to-nose 2-11 160-065 O - 94 2 C 2, FM 21-11 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. (1) 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). (2) Step TWO. Take a deep breath and place your mouth (in an airtight seal) around the casualty’s mouth (Figure 2-8). (3) 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. (4) 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). (5) 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. (6) 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. (7) 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. 2-12 ★ ★ C 2, FM 21-11 2-7. Mouth-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. ★ 2-8. Heartbeat 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. 2-13 C2, FM 21-11 c. Upper airway obstruction may cause either partial or complete airway blockage. ★ (1) Partial airway obstruction. The casualty may still have an air exchange. A good air exchange means that the casualty can cough forcefully, though he may be wheezing between coughs. You, the rescuer, should not interfere, and should encourage the casualty to cough up the object on his own. A poor air exchange may be indicated by weak coughing with a high pitched noise between coughs. Additionally, the casualty may show signs of shock (for example, paleness of the skin, bluish or grayish tint around the lips or fingernail beds) indicating a need for oxygen. You should assist the casualty and treat him as though he had a complete obstruction. (2) Complete airway obstruction. A complete obstruction (no air exchange) is indicated if the casualty cannot speak, breathe, or cough at all. He may be clutching his neck and moving erratically. In an unconscious casualty a complete obstruction is also indicated if after opening his airway you cannot ventilate him. 2-13. Opening the Obstructed Airway-Conscious Casualty (081-831-1003) Clearing a conscious casualty’s airway obstruction can be performed with the casualty either standing or sitting, and by following a relatively simple procedure. WARNING Once an obstructed airway occurs, the brain will develop an oxygen deficiency resulting in/ unconsciousness. Death will follow rapidly if prompt action is not taken. a. Step ONE. Ask the casualty if he can speak or if he is choking. Check for the universal choking sign (Figure 2-18). 2-22 FM 21-11 b. Step TWO. If the casualty can speak, encourage him to attempt to cough; the casualty still has a good air exchange. If he is able to speak or cough effectively, DO NOT interfere with his attempts to expel the obstruction. c. Step THREE. Listen for high pitched sounds when the casualty breathes or coughs (poor air exchange). If there is poor air exchange or no breathing, CALL for HELP and immediately deliver manual thrusts (either an abdominal or chest thrust). NOTE The manual thrust with the hands centered between the waist, and the rib cage is called an abdominal thrust (or Heimlich maneuver). The chest thrust (the hands are centered in the middle of the breastbone) is used only for an individual in the advanced stages of pregnancy, in the markedly obese casualty, or if there is a significant abdominal wound. Apply ABDOMINAL THRUSTS using the procedures below: Stand behind the casualty and wrap your arms around his waist. 2-23 FM 21-11 Make a fist with one hand and grasp it with the other. The thumb side of your fist should be against the casualty’s abdomen, in the midline and slightly above the casualty’s navel, but well below the tip of the breastbone (Figure 2-19). Press the fists into the abdomen with a quick backward and upward thrust (Figure 2-20). 2-24 FM 21-11 (2) 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). Place your other hand on top of the first one. Point your fingers toward the casualty’s head. (3) Press into the casualty’s abdomen with a quick, forward and upward thrust. You can use your body weight to perform the maneuver. Deliver each thrust slowly and distinctly. (4) Repeat the sequence of abdominal thrusts, finger sweep, and rescue breathing (attempt to ventilate) as long as necessary to remove the object from the obstructed airway. See paragraph d below. (5) If the casualty’s chest rises, proceed to feeling for pulse. c. Apply chest thrusts. (Note that the chest thrust technique is an alternate method that is used when the casualty has an abdominal wound, when the casualty is so large that you cannot wrap your arms around the abdomen, or when the casualty is pregnant.) To perform the chest thrusts: (1) Place the unconscious casualty on his back, face up, and open his mouth. Kneel close to the side of the casualty’s body. o Locate the lower edge of the casualty’s ribs with your fingers. Run the fingers up along the rib cage to the notch (Figure 2-23A). o Place the middle finger on the notch and the index finger next to the middle finger on the lower edge of the breastbone. Place 2-27 FM 21-11 the heel of the other hand on the lower half of the breastbone next to the two fingers (Figure 2-23B). • Remove the fingers from the notch and place that hand on top of the positioned hand on the breastbone, extending or interlocking the fingers (Figure 2-23C). • Straighten and lock your elbows with your shoulders directly above your hands without bending the elbows, rocking, or allowing the shoulders to sag. Apply enough pressure to depress the breastbone 1½ to 2 inches, then release the pressure completely (Figure 2-23D). Do this 6 to 10 times. Each thrust should be delivered slowly and distinctly. See Figure 2-24 for another view of the breastbone being depressed. 2-28 FM 21-11 (2) Repeat the sequence of chest thrust, finger sweep, and rescue breathing as long as necessary to clear the object from the obstructed airway. See paragraph d below. (3) If the casualty’s chest rises, proceed to feeling for his pulse. d. Finger Sweep. If you still cannot administer rescue breathing due to an airway obstruction, then remove the airway obstruction using the procedures in steps (1) and (2) below. (1) Place the casualty on his back, face up, turn the unconscious casualty as a unit, and call out for help. (2) Perform finger sweep, keep casualty face up, use tongue- jaw lift to open mouth. • Open the casualty’s mouth by grasping both his tongue and lower jaw between your thumb and fingers and lifting (tongue-jaw lift) (Figure 2-25). If you are unable to open his mouth, cross your fingers and thumb (crossed-finger method) and push his teeth apart (Figure 2-26) by pressing your thumb against his upper teeth and pressing your finger against his lower teeth. 2-29 FM 21-11 2-16. Entrance and Exit Wounds 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. The EXIT wound is usually LARGER than the entrance wound. WARNING Casualty should be continually monitored for development of conditions which may require the performance of necessary basic lifesaving measures, such as clearing the airway and mouth-to-mouth resuscitation. All open (or penetrating) wounds should be checked for a point of entry and exit and treated accordingly. WARNING If the missile lodges in the body (fails to exit), DO NOT attempt to remove it or probe the wound. Apply a dressing. If there is an object extending from (impaled in) the wound, DO NOT remove the object. Apply a dressing around the object and use additional improvised bulky materials dressings (use the cleanest material available) to build up the area around the object. Apply a supporting bandage over the bulky materials to hold them in place. 2-17. Field Dressing (081-831-1016) a. Use the casualty’s field dressing; remove it from the wrapper and grasp the tails of the dressing with both hands (Figure 2-28). 2-32 FM 21-11 WARNING DO NOT touch the white (sterile) side of the dressing, and DO NOT allow the white (sterile) side of the dressing to come in contact with any surface other than the wound. b. Hold the dressing directly over the wound with the white side down. Pull the dressing open (Figure 2-29) and place it directly over the wound (Figure 2-30). 2-33 FM 21-11 c. Hold the dressing in place with one hand. Use the other hand to wrap one of the tails around the injured part, covering about one-half of the dressing (Figure 2-31). Leave enough of the tail for a knot. If the casualty is able, he may assist by holding the dressing in place. d. Wrap the other tail in the opposite direction until the remainder of the dressing is covered. The tails should seal the sides of the dressing to keep foreign material from getting under it. 2-34 C2, FM 21-11 NOTE Improvised bandages may be made from strips of cloth. These strips may be made from T-shirts, socks, or other garments. b. Place an improvised dressing (or cravat, if available) over the wad of padding (Figure 2-36). Wrap the ends tightly around the injured limb, covering the previously placed field dressing (Figure 2-37). 2-37 C 2, FM 21-11 c. Tie the ends together in a nonslip knot, directly over the wound site (Figure 2-38). DO NOT tie so tightly that it has a tourniquet- like effect. If bleeding continues and all other measures have failed, or if the limb is severed, then apply a tourniquet. Use the tourniquet as a LAST RESORT. When the bleeding stops, check and treat for shock. NOTE Wounded extremities should be checked periodically for adequate circulation. The dressing must be loosened if the extremity becomes cool, blue or gray, or numb. 2-38 C 2, FM 21-11 ★ NOTE If bleeding continues and all other measures have failed (dressing and covering wound, applying direct manual pressure, elevating limb above heart level, and applying pressure dressing maintaining limb elevation), then apply digital pressure. See Appendix E for appropriate pressure points. 2-20. Tourniquet (081-831-1017) 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 may not be bleeding when first discovered, but a tourniquet should be applied anyway. This absence of bleeding is due to the body’s normal defenses (contraction of blood vessels) as a result of the amputation, but after a period of time bleeding will start as the blood vessels relax. Bleeding from a major artery of the thigh, lower leg, or arm and bleeding from multiple arteries (which occurs in a traumatic amputation) may prove to be beyond control by manual pressure. If the pressure dressing under firm hand pressure becomes soaked with blood and the wound continues to bleed, apply a tourniquet. WARNING Casualty should be continually monitored for development of conditions which may require the performance of necessary basic life-saving measures, such as: clearing the airway, performing mouth-to-mouth resuscitation, preventing shock, and/or bleeding control. All open (or penetrating) wounds should be checked for a point of entry or exit and treated accordingly. ★ The tourniquet should not be used unless a pressure dressing has failed to stop the bleeding or an arm or leg has been cut off. On occasion, tourniquets have injured blood vessels and nerves. If left in place too long, a tourniquet can cause loss of an arm or leg. Once applied, it must stay in place, and the casualty must be taken to the nearest medical treatment facility as soon as possible. DO NOT loosen or release a tourniquet after it has been applied and the bleeding has stopped. 2-39 FM 21-11 (4) Twist the stick (Figure 2-42) until the tourniquet is tight around the limb and/or the bright red bleeding has stopped. 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. (5) Fasten the tourniquet to the limb by looping the free ends of the tourniquet over the ends of the stick. Then bring the ends around the limb to prevent the stick from loosening. Tie them together under the limb (Figure 2-43A and B). 2-42 FM 21-11 NOTE (081-831-1017) Other methods of securing the stick may be used as long as the stick does not unwind and no further injury results. NOTE If possible, save and transport any severed (amputated) limbs or body parts with (but out of sight of) the casualty. (6) DO NOT cover the tourniquet–you should leave it in full view. If the limb is missing (total amputation), apply a dressing to the stump. (7) Mark the casualty’s forehead, if possible, with a “T” to indicate a tourniquet has been applied. If necessary, use the casualty’s blood to make this mark. (8) Check and treat for shock. (9) Seek medical aid. CAUTION (081-831-1017) DO NOT LOOSEN OR RELEASE THE TOURNIQUET ONCE IT HAS BEEN APPLIED BECAUSE IT COULD ENHANCE THE PROBABILITY OF SHOCK. 2-43 FM 21-11 Section III. CHECK AND TREAT FOR SHOCK 2-21. Causes and Effects a. Shock may be caused by severe or minor trauma to the body. It usually is the result of— Significant loss of blood. Heart failure. Dehydration. Severe and painful blows to the body. Severe burns of the body. Severe wound infections. Severe allergic reactions to drugs, foods, insect stings, and snakebites. b. Shock stuns and weakens the body. When the normal blood flow in the body is upset, death can result. Early identification and proper treatment may save the casualty’s life. c. See FM 8-230 for further information and details on specific types of shock and treatment. 2-22. Signs/Symptoms (081-831-1000) Examine the casualty to see if he has any of the following signs/symptoms: Sweaty but cool skin (clammy skin). Paleness of skin. Restlessness, nervousness. Thirst. Loss of blood (bleeding). Confusion (or loss of awareness). 2-44 FM 21-11 (6) Calm the casualty. Throughout the entire procedure of treating and caring for a casualty, the rescuer 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. (7) Seek medical aid. b. Food and/or Drink. During the treatment/prevention of shock, DO NOT give the casualty any 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 should he vomit (Figure 2-46). c. Evaluate Casualty. If necessary, continue with the casualty’s evaluation. 2-47 FM 21-11 NOTES 2-48 C 2, FM 21-11 CHAPTER 3 FIRST AID FOR SPECIAL WOUNDS INTRODUCTION ★ Basic lifesaving steps are discussed in Chapters 1 and 2: clear the airway/restore breathing, stop the bleeding, protect the wound, and treat/prevent shock. They apply to first aid measures for all injuries. Certain types of wounds and burns will require special precautions and procedures when applying these measures. This chapter discusses first aid procedures for special wounds of the head, face, and neck; chest and stomach wounds; and burns. It also discusses the techniques for applying dressings and bandages to specific parts of the body. Section I. GIVE PROPER FIRST AID FOR HEAD INJURIES 3-1. Head Injuries A head injury may consist of one or a combination of the following conditions: a concussion, a cut or bruise of the scalp, or a fracture of the skull with injury to the brain and the blood vessels of the scalp. The damage can range from a minor cut on the scalp to a severe brain injury which rapidly causes death. Most head injuries lie somewhere between the two extremes. Usually, serious skull fractures and brain injuries occur together; however, it is possible to receive a serious brain injury without a skull fracture. The brain is a very delicate organ; when it is injured, the casualty may vomit, become sleepy, suffer paralysis, or lose consciousness and slip into a coma. All severe head injuries are potentially life-threatening. For recovery and return to normal function, casualties require proper first aid as a vital first step. 3-2. Signs/Symptoms (081-831-1000) A head injury may be open or closed. In open injuries, there is a visible wound and, at times, the brain may actually be seen. In closed injuries, no visible injury is seen, but the casualty may experience the same signs and symptoms. Either closed or open head injuries can be life-threatening if the injury has been severe enough; thus, if you suspect a head injury, evaluate the casualty for the following: Current or recent unconsciousness (loss of consciousness). Nausea or vomiting. 3-1 FM 21-11 (a) Lack of responses to stimuli. Starting with the feet, use a sharp pointed object–a sharp stick or something similar, and prick the casualty lightly while observing his face. If the casualty blinks or frowns, this indicates that he has feeling and may not have an injury to the spinal cord. If you observe no response in the casualty’s reflexes after pricking upwards toward the chest region, you must use extreme caution and treat the casualty for an injured spinal cord. (b) Stomach distention (enlargement). Observe the casualty’s chest and stomach. If the stomach is distended (enlarged) when the casualty takes a breath and the chest moves slightly, the casualty may have a spinal injury and must be treated accordingly. (c) Penile erection. A male casualty may have a penile erection, an indication of a spinal injury. CAUTION Remember to suspect any casualty who has a severe head injury or who is/unconscious as possibly having a broken neck or a spinal cord injury! It is better to treat conservatively and assume that the neck/spinal cord is injured rather than to chance further injuring the casualty. Consider this when you position the casualty. See Chapter 4, paragraph 4-9 for treatment procedures of spinal column injuries. c. Concussion. If an individual receives a heavy blow to the head or face, he may suffer a brain concussion, which is an injury to the brain that involves a temporary loss of some or all of the brain’s ability to function. For example, the casualty may not breathe properly for a short period of time, or he may become confused and stagger when he attempts to walk. A concussion may only last for a short period of time. However, if a casualty is suspected of having suffered a concussion, he must be seen by a physician as soon as conditions permit. d. Convulsions. Convulsions (seizures/involuntary jerking) may occur after a mild head injury. When a casualty is convulsing, protect him from hurting himself. Take the following measures: (1) Ease him to the ground. (2) Support his head and neck. 3-4 C 2, FM 21-11 (3) Maintain his airway. (4) Call for assistance. (5) Treat the casualty’s wounds and evacuate him immediately. e. Brain Damage. In severe head injuries where brain tissue is protruding, leave the wound alone; carefully place a first aid dressing over the tissue. DO NOT remove or disturb any foreign matter that may be in the wound. Position the casualty so that his head is higher than his body. Keep him warm and seek medical aid immediately. NOTE DO NOT forcefully hold the arms and legs if they are jerking because this can lead to broken bones. DO NOT force anything between the casualty’s teeth-especially if they are tightly clenched because this may obstruct the casualty’s airway. Maintain the casualty’s airway if necessary. 3-4. Dressings and Bandages (081-831-1000 and 081-831-1033) ★ a. Evaluate the Casualty (081-831-1000). Be prepared to perform lifesaving measures. The basic lifesaving measures may include clearing the airway, rescue breathing, treatment for shock, and/or bleeding control. b. Check Level of Consciousness/Responsiveness (081-831-1033). With a head injury, an important area to evaluate is the casualty’s level of consciousness and responsiveness. Ask the casualty questions such as— “What is your name?” (Person) “Where are you?” (Place) “What day/month/year is it?” (Time) 3-5 C 2, FM 21-11 Any incorrect responses, inability to answer, or changes in responses should be reported to medical personnel. Check the casualty’s level of consciousness every 15 minutes and note any changes from earlier observations. c. Position the Casualty (081-831-1033). WARNING (081-831-1033) DO NOT move the casualty if you suspect he has sustained a neck, spine, or severe, head injury (which produces any signs or symptoms other than minor bleeding). See task 081-831-1000, Evaluate the Casualty. If the casualty is conscious or has a minor (superficial) scalp wound: o Have the casualty sit up (unless other injuries prohibit or he is unable); OR o If the casualty is lying down and is not accumulating fluids or drainage in his throat, elevate his head slightly; OR o If the casualty is bleeding from or into his mouth or throat, turn his head to the side or position him on his side so that the airway will be clear. Avoid pressure on the wound or place him on his side –opposite the site of the injury (Figure 3-1). If the casualty is unconscious or has a severe head injury, then suspect and treat him as having a potential neck or spinal injury, immobilize and DO NOT move the casualty. 3-6 FM 21-11 (7) Hold the first tail in place and wrap the second tail in the opposite direction, covering the dressing (Figure 3-3). (8) Tie a nonslip knot and secure the tails at the side of the head, making sure they DO NOT cover the eyes or ears (Figure 3-4). f. Apply a Dressing to a Wound on Top of the Head (081-831-1033). To apply a dressing to a wound on top of the head– 3-9 FM 21-11 (1) Remove the dressing from the wrapper. (2) Grasp the tails of the dressing in both hands. (3) Hold it (white side down) directly over the wound. (4) Place it over the wound (Figure 3-5). (5) Hold it in place with one hand. If the casualty is able, he may assist. (6) Wrap one tail down under the chin (Figure 3-6), up in front of the ear, over the dressing, and in front of the other ear. 3-10 FM 21-11 WARNING (Make sure the tails remain wide and close to the front of the chin to avoid choking the casualty.) (7) Wrap the remaining tail under the chin in the opposite direction and up the side of the face to meet the first tail (Figure 3-7). (8) Cross the tails (Figure 3-8), bringing one around the forehead (above the eyebrows) and the other around the back of the head (at the base of the skull) to a point just above and in front of the opposite ear, and tie them using a nonslip knot (Figure 3-9). 3-11 C 2, FM 21-11 separates the scalp from the skull beneath it. Because the face and scalp are richly supplied with blood vessels (arteries and veins), wounds of these areas usually bleed heavily. 3-6. Neck Injuries Neck injuries may result in heavy bleeding. Apply manual pressure above and below the injury and attempt to control the bleeding. Apply a dressing. Always evaluate the casualty for a possible neck fracture/spinal cord injury; if suspected, seek medical treatment immediately. ★ NOTE Establish and maintain the airway in cases of facial or neck injuries. If a neck fracture or/ spinal cord injury is suspected, immobilize or stabilize casualty. See Chapter 4 for further information on treatment of spinal injuries. 3-7. Procedure When a casualty has a face or neck injury, perform the measures below. a. Step ONE. Clear the airway. Be prepared to perform any of the basic lifesaving steps. Clear the casualty’s airway (mouth) with your fingers, remove any blood, mucus, pieces of broken teeth or bone, or bits of flesh, as well as any dentures. b. Step TWO. Control any bleeding, especially bleeding that obstructs the airway. Do this by applying direct pressure over a first aid dressing or by applying pressure at specific pressure points on the face, scalp, or temple. (See Appendix E for further information on pressure points.) If the casualty is bleeding from the mouth, position him as indicated (c below) and apply manual pressure. CAUTION Take care not to apply too much pressure to the scalp if a skull fracture is suspected. c. Step THREE. Position the casualty. If the casualty is bleeding from the mouth (or has other drainage, such as mucus, vomitus, 3-14 FM 21-11 or so forth) and is conscious, place him in a comfortable sitting position and have him lean forward with his head tilted slightly down to permit free drainage (Figure 3-12). DO NOT use the sitting position if– It would be harmful to the casualty because of other injuries. The casualty is unconscious, in which case, place him on his side (Figure 3-13). If there is a suspected injury to the neck or spine, immobilize the head before turning the casualty on his side. CAUTION If you suspect the casualty has a neck/spinal injury, then immobilize his head/neck and treat him as outlined in Chapter 4. 3-15 FM 21-11 d. Step FOUR. Perform other measures. (1) Apply dressings/bandages to specific areas of the face. (2) Check for missing teeth and pieces of tissue. Check for detached teeth in the airway. Place detached teeth, pieces of ear or nose on a field dressing and send them along with the casualty to the medical facility. Detached teeth should be kept damp. (3) Treat for shock and seek medical treatment IMMEDIATELY. 3-8. Dressings and Bandages (081-831-1033) a. Eye Injuries. The eye is a vital sensory organ, and blindness is a severe physical handicap. Timely first aid of the eye not only relieves pain but also helps prevent shock, permanent eye injury, and possible loss of vision. Because the eye is very sensitive, any injury can be easily aggravated if it is improperly handled. Injuries of the eye may be quite severe. Cuts of the eyelids can appear to be very serious, but if the eyeball is not involved, a person’s vision usually will not be damaged. However, lacerations (cuts) of the eyeball can cause permanent damage or loss of sight. (1) Lacerated/torn eyelids. Lacerated eyelids may bleed heavily, but bleeding usually stops quickly. Cover the injured eye with a sterile dressing. DO NOT put pressure on the wound because you may injure the eyeball. Handle torn eyelids very carefully to prevent further injury. Place any detached pieces of the eyelid on a clean bandage or dressing and immediately send them with the casualty to the medical facility. (2) Lacerated eyeball (injury to the globe). Lacerations or cuts to the eyeball may cause serious and permanent eye damage. Cover the injury with a loose sterile dressing. DO NOT put pressure on the eyeball because additional damage may occur. An important point to remember is that when one eyeball is injured, you should immobilize both eyes. This is done by applying a bandage to both eyes. Because the eyes move together, covering both will lessen the chances of further damage to the injured eye. CAUTION DO NOT apply pressure when there is a possible laceration of the eyeball. The eyeball contains fluid. Pressure applied over the eye will force the fluid out, resulting in/permanent injury. APPLY PROTECTIVE DRESSING WITHOUT ADDED PRESSURE. 3-16 FM 21-11 NOTE When possible, avoid covering the casualty’s ear with the dressing, as this will decrease his ability to hear. (5) Bring the second tail under the chin, up in front of the ear (on the side opposite the wound), and over the head to meet the other tail (on the wound side) (Figure 3-16). 3-19 FM 21-11 (6) Cross the two tails (on the wound side) (Figure 3-17) and bring one end across the forehead (above the eyebrows) to a point just in front of the opposite ear (on the uninjured side). (7) Wrap the other tail around the back of the head (at the base of the skull), and tie the two ends just in front of the ear on the uninjured side with a nonslip knot (Figure 3-18). c. Ear Injuries. Lacerated (cut) or avulsed (torn) ear tissue may not, in itself, be a serious injury. Bleeding, or the drainage of fluids from the ear canal, however, may be a sign of a head injury, such as a skull fracture. DO NOT attempt to stop the flow from the inner ear canal nor 3-20 FM 21-11 put anything into the ear canal to block it. Instead, you should cover the ear lightly with a dressing. For minor cuts or wounds to the external ear, apply a cravat bandage as follows: (1) Place the middle of the bandage over the ear (Figure 3-19 A). (2) Cross the ends, wrap them in opposite directions around the head, and tie them (Figures 3-19 B and 3-19 C). (3) If possible, place some dressing material between the back of the ear and the side of the head to avoid crushing the ear against the head with the bandage. d. Nose Injuries. Nose injuries generally produce bleeding. The bleeding may be controlled by placing an ice pack over the nose, or pinching the nostrils together. The bleeding may also be controlled by placing torn gauze (rolled) between the upper teeth and the lip. CAUTION DO NOT attempt to remove objects inhaled in the nose. An untrained person who/removes such an object could worsen the casualty’s condition and cause permanent/injury. 3-21