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FIRST AID. Field Manual (2002) - page 3

e.

Apply the Dressing to the Wound.

(1)

Use your free hand and shake open the field dressing

(Figure 3-3).

Figure 3-3. Shaking open the field dressing.

(2)

Place the white side of the dressing on the plastic wrapper

covering the wound (Figure 3-4).

Figure 3-4. Field dressing placed on plastic wrapper.

NOTE

Use the casualty’s field dressing, not your own.

(3)

Have the casualty breathe normally.

(4)

While maintaining pressure on the dressing, grasp one

tail of the field dressing with the other hand and wrap it around the casualty’s

back. If tape is available, tape three sides of the plastic wrapper to the chest

wall to provide occlusive type dressing. Leave one side untapped to provide

emergency escape for air that may build up in the chest. If tape is not

available, secure wrapper on three sides with field dressing leaving the fourth

side as a flap.

(5)

Wrap the other tail in the opposite direction, bringing

both tails over the dressing (Figure 3-5).

3-7

Figure 3-5. Tails of field dressing wrapped around casualty

in opposite direction.

(6)

Tie the tails into a square knot in the center of the

dressing after the casualty exhales and before he inhales. This will aid in

maintaining pressure on the bandage after it has been tied (Figure 3-6). Tie

the dressing firmly enough to secure the dressing without interfering with the

casualty’s breathing.

Figure 3-6. Tails of dressing tied into square knot over center of dressing.

NOTE

When practical, apply direct manual pressure over the dressing

for 5 to 10 minutes to help control the bleeding.

f.

Position the Casualty. Position the casualty on his injured side

or in a sitting position, whichever makes breathing easier (Figure 3-7).

Figure 3-7. Casualty positioned (lying) on injured side.

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g.

Seek Medical Assistance. Contact medical personnel.

WARNING

If an occlusive dressing has been improperly placed,

air may enter the chest cavity with no means of escape.

This causes a life-threatening condition called tension

pneumothorax. If the casualty’s condition (for example,

difficulty breathing, shortness of breath, restlessness,

or blueness/grayness of the skin) worsens after placing

the dressing, quickly lift or remove, and then replace

the occlusive dressing.

3-6.

Abdominal Wounds

The most serious abdominal wound is one in which an object penetrates the

abdominal wall and pierces internal organs or large blood vessels. In these

instances, bleeding may be severe and death can occur rapidly.

3-7.

First Aid for Abdominal Wounds

a.

Evaluate the Casualty. Be prepared to perform basic first aid

measures. Always check for both entry and exit wounds. If there are two

wounds (entry and exit), treat the wound that appears more serious first (for

example, the heavier bleeding, protruding organs, larger wound, and so

forth). It may be necessary to improvise dressings for the second wound by

using strips of cloth, a T-shirt, or the cleanest material available.

b.

Position the Casualty. Place and maintain the casualty on his

back with his knees in an upright (flexed) position (Figure 3-8). The knees-

up position helps relieve pain, assists in the treatment of shock, prevents

further exposure of the bowel (intestines) or abdominal organs, and helps

relieve abdominal pressure by allowing the abdominal muscles to relax.

Figure 3-8. Casualty positioned (lying) on back with knees (flexed) up.

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c.

Expose the Wound.

(1)

Remove the casualty’s loose clothing to expose the

wound. However, DO NOT attempt to remove clothing that is stuck to the

wound; removing it may cause further injury.

CAUTION

DO NOT REMOVE protective clothing in a chemical

environment. Apply dressings over the protective clothing.

(2)

Gently pick up any organs that may be on the ground.

Do this with a clean, dry dressing or with the cleanest available material.

Place the organs on top of the casualty’s abdomen (Figure 3-9).

Figure 3-9. Protruding organs placed near wound.

NOTE

DO NOT probe, clean, or try to remove any foreign object

from the abdomen. DO NOT touch with bare hands any

exposed organs. DO NOT push organs back inside the body.

d.

Apply the Field Dressing. Use the casualty’s field dressing,

not your own. If the field dressing is not large enough to cover the entire

wound, the plastic wrapper from the dressing may be used to cover the wound

first

(placing the field dressing on top). Open the plastic wrapper carefully

without touching the inner surface. If necessary, other improvised dressings

may be made from clothing, blankets, or the cleanest materials available.

WARNING

If there is an object extending from the wound, DO NOT

remove it. Place as much of the wrapper over the

wound as possible without dislodging or moving the

object. DO NOT place the wrapper over the object.

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(1)

Grasp the tails in both hands.

(2)

Hold the dressing with the white side down directly over

the wound. DO NOT touch the white (sterile) side of the dressing or allow

anything except the wound to come in contact with it.

(3)

Pull the dressing open and place it directly over the wound

(Figure 3-10). If the casualty is able, he may hold the dressing in place.

Figure 3-10. Dressing placed directly over the wound.

(4)

Hold the dressing in place with one hand and use the

other hand to wrap one of the tails around the body.

(5)

Wrap the other tail in the opposite direction until the

dressing is completely covered. Leave enough of the tail for a knot.

(6)

Loosely tie the tails with a square knot at the casualty’s

side (Figure 3-11).

Figure 3-11. Dressing applied and tails tied with a square knot.

WARNING

When the dressing is applied, DO NOT put pressure on

the wound or exposed internal parts, because pressure

could cause further injury

(vomiting, ruptured

intestines, and so forth). Therefore, tie the dressing

ties (tails) loosely at casualty’s side, not directly over

the dressing.

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(7)

Tie the dressing firmly enough to prevent slipping

without applying pressure to the wound site (Figure 3-12).

Figure 3-12. Field dressing covered with improvised material

and loosely tied.

Field dressings can be covered with improvised reinforcement material

(cravats, strips of torn T-shirt, or other cloth) for additional support and

protection. Tie improvised bandage on the opposite side of the dressing ties

firmly enough to prevent slipping but without applying additional pressure to

the wound.

CAUTION

DO NOT give casualties with abdominal wounds food or

water (moistening the lips is allowed).

e.

Seek Medical Assistance. Notify medical personnel.

3-8.

Burn Injuries

Burns often cause extreme pain, scarring, or even death. Before

administering first aid, you must be able to recognize the type of burn.

There are four types of burns:

•

Thermal burns caused by fire, hot objects, hot liquids, and

gases; or by nuclear blast or fireball.

•

Electrical burns caused by electrical wires, current, or

lightning.

•

Chemical burns caused by contact with wet or dry chemicals

or white phosphorus (WP)—from marking rounds and grenades.

•

Laser burns

(eye [ocular] injury).

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3-9.

First Aid for Burns

a.

Eliminate the Source of the Burn. The source of the burn must

be eliminated before any evaluation of the casualty can occur and first aid

administered.

(1)

Quickly remove the casualty from danger and cover the

thermal burn with any large nonsynthetic material, such as a field jacket. If

the casualty’s clothing is still on fire, roll the casualty on the ground to

smother (put out) the flames (Figure 3-13).

Figure 3-13. Casualty covered and rolled on ground.

CAUTION

Synthetic materials, such as nylon, may melt and cause

further injury.

(2)

Remove the electrical burn casualty from the electrical

source by turning off the electrical current. DO NOT attempt to turn off the

electricity if the source is not close by. Speed is critical, so DO NOT waste

unnecessary time. If the electricity cannot be turned off, wrap any

nonconductive material (dry rope, clothing, wood, and so forth) around the

casualty’s back and shoulders and drag the casualty away from the electrical

source (Figure 3-14). DO NOT make body-to-body contact with the casualty

or touch any wires because you could also become an electrical burn casualty.

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Figure 3-14. Casualty removed from electrical source

(using nonconductive material).

WARNING

High voltage electrical burns may cause temporary

unconsciousness, difficulties in breathing, or diffi-

culties with the heart (heartbeat).

(3)

Remove the chemical from the burned casualty. Remove

liquid chemicals by flushing with as much water as possible. Remove dry

chemicals by brushing off loose particles (DO NOT use the bare surface of

your hand because you could become a chemical burn casualty) and then flush

with large amounts of water, if available. If large amounts of water are not

available, then NO water should be applied because small amounts of water

applied to a dry chemical burn may cause a chemical reaction. When WP

strikes the skin, smother with a wet cloth or mud. Keep WP covered with a

wet material to exclude air; this should help prevent the particles from burning.

(4)

Remove the laser burn casualty from the source. When

removing the casualty from the laser beam source, be careful not to enter the

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•

If the casualty has a minor

(superficial) scalp

wound and is conscious:

•

Have the casualty sit up (unless other injuries

prohibit or he is unable to).

•

If the casualty is lying down and is not

accumulating fluids or drainage in his throat, elevate his head slightly.

•

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 putting pressure on the wound and place him

on his uninjured side (Figure 3-15).

Figure 3-15. Casualty lying on side opposite injury.

•

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.

NOTE

If the casualty is choking or vomiting or is bleeding from or into

his mouth (thus compromising his airway), position him on his

uninjured side to allow for drainage and to help keep his airway

clear.

WARNING

If it is necessary to turn a casualty with a suspected

neck/spine injury; roll the casualty gently onto his side,

keeping the head, neck, and body aligned while pro-

viding support for the head and neck. DO NOT roll the

casualty by yourself but seek assistance. Move him only

if absolutely necessary, otherwise keep the casualty

immobilized to prevent further damage to the neck/spine.

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(2)

Expose the wound. Remove the casualty’s helmet (if

necessary). In a nuclear, biological, and chemical (NBC) environment, the

first aid provider must leave the casualty as much protection

(such as

protective mask, mission-oriented protective posture [MOPP] overgarments)

as possible. What items of protective equipment can be removed is dependent

upon the casualty’s injuries (where on the body and what type), the MOPP

level, integrity of protective equipment (such as tears in the garment or mask

seal), availability of chemical protective shelters, and the tactical situation.

WARNING

DO NOT attempt to clean the wound or remove a

protruding object.

NOTE

Always use the casualty’s field dressing, not your own.

(3)

Apply a dressing to a wound of the forehead or back of

head. To apply a dressing to a wound of the forehead or back of the head—

(a) Remove the dressing from the wrapper.

(b) Grasp the tails of the dressing in both hands.

(c) Hold the dressing (white side down) directly over

the wound. DO NOT touch the white (sterile) side of the dressing or allow

anything except the wound to come in contact with it.

(d) Place it directly over the wound.

(e) Hold it in place with one hand. If the casualty is

able, he may assist.

(f)

Wrap the first tail horizontally around the head;

ensure the tail covers the dressing (Figure 3-16).

Figure 3-16. First tail of dressing wrapped horizontally around head.

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(g) Hold the first tail in place and wrap the second tail

in the opposite direction, covering the dressing (Figure 3-17).

Figure 3-17. Second tail wrapped in opposite direction.

(h) Tie a square knot and secure the tails at the side of

the head, making sure they DO NOT cover the eyes or ears (Figure 3-18).

Figure 3-18. Tails tied in square knot at side of head.

(4)

Apply a dressing to a wound on top of the head. To

apply a dressing to a wound on top of the head—

(a) Remove the dressing from the wrapper.

(b) Grasp the tails of the dressing in both hands.

(c) Hold it (white side down) directly over the wound.

DO NOT touch the white (sterile) side of the dressing or allow anything

except the wound to come in contact with it.

(d) Place it over the wound (Figure 3-19).

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Figure 3-19. Dressing placed over wound.

(e) Hold it in place with one hand. If the casualty is

able, he may assist.

(f)

Wrap one tail down under the chin (Figure 3-20),

up in front of the ear, over the dressing, and in front of the other ear.

Figure 3-20. One tail of dressing wrapped under chin.

WARNING

Ensure the tails remain wide and close to the front of

the chin to avoid choking the casualty.

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(g) Wrap the remaining tail under the chin in the

opposite direction and up the side of the face to meet the first tail (Figure 3-21).

Figure 3-21. Remaining tail wrapped under chin in opposite direction.

(h) Cross the tails (Figure 3-22), 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 square knot (Figure 3-23).

Figure 3-22. Tails of dressing crossed with one around forehead.

Figure 3-23. Tails tied in square knot (in front of and above ear).

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(5)

Apply a triangular bandage to the head. To apply a

triangular bandage to the head—

(a) Turn the base (longest side) of the bandage up and

center its base on the center of the forehead, letting the point (apex) fall on

the back of the neck (Figure 3-24A).

(b) Take the ends behind the head and cross the ends

over the apex.

(c) Take them over the forehead and tie them (Figure

3-24B).

(d) Tuck the apex behind the crossed part of the

bandage or secure it with a safety pin, if available (Figure 3-24C).

Figure 3-24. Triangular bandage applied to head (Illustrated A—C)

(6)

Apply a cravat bandage to the head. To apply a cravat

bandage to the head—

(a) Place the middle of the bandage over the dressing

(Figure 3-25A).

(b) Cross the two ends of the bandage in opposite

directions completely around the head (Figure 3-25B).

(c) Tie the ends over the dressing (Figure 3-25C).

Figure 3-25. Cravat bandage applied to head (Illustrated A—C).

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(2)

Grasp the tails in both hands.

(3)

Hold the dressing directly over the wound with the white

side down and place it directly on the wound (Figure 3-27A). DO NOT

touch the white (sterile) side of the dressing or allow anything except the

wound to come in contact with it.

(4)

Hold the dressing in place with one hand (the casualty

may assist if able). Wrap the top tail over the top of the head and bring it

down in front of the ear (on the side opposite the wound), under the chin

(Figure 3-27B) and up over the dressing to a point just above the ear (on the

wound side).

Figure 3-26. Side of head or cheek wound.

Figure 3-27. Dressing placed directly on wound. Top tail wrapped over

top of head, down in front of ear, and under chin (Illustrated A—B).

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 wounded side) (Figure 3-28).

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Figure 3-28. Bringing second tail under the chin.

(6)

Cross the two tails (on the wound side) (Figure 3-29)

and bring one end across the forehead (above the eyebrows) to a point just in

front of the opposite ear (on the uninjured side).

Figure 3-29. Crossing the tails on the side of the wound.

(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 square knot (Figure 3-30).

Figure 3-30. Tying the tails of the dressing in a square knot.

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d.

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 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-

31A).

(2)

Cross the ends, wrap them in opposite directions around

the head, and tie them (Figures 3-31B and 3-31C).

Figure 3-31. Applying cravat bandage to ear (Illustrated A—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.

e.

Nose Injuries. Nose injuries generally produce bleeding. The

bleeding may be controlled by placing an ice pack (if available) 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 into the nose.

An untrained person who removes such an object could

worsen the casualty’s condition and cause permanent injury.

f.

Jaw Injuries. Before applying a bandage to a casualty’s jaw,

remove all loose or free-floating foreign material from the casualty’s mouth.

3-27

If the casualty is unconscious, check for obstructions in the airway and

remove if possible. If there is profuse bleeding in the oral cavity, the cavity

may require loose packing with soft bandaging material (for example:

Kerlix™ gauze) prior to applying a bandage. Care should be taken to avoid

occluding the airway. When applying the bandage, allow the jaw enough

freedom to permit passage of air and drainage from the mouth.

(1)

Apply bandages attached to field first aid dressing to the

jaw. After dressing the wound, apply the bandages using the same technique

illustrated in Figure 3-32A—C.

NOTE

The dressing and bandaging procedure outlined for the jaw

serves a twofold purpose. In addition to stopping the bleeding

and protecting the wound, it also immobilizes a fractured jaw.

(2)

Apply a cravat bandage to the jaw.

(a) Place the bandage under the chin and pull its ends

upward. Adjust the bandage to make one end longer than the other (Figure

3-32A).

(b) Take the longer end over the top of the head to

meet the short end at the temple and cross the ends over (Figure 3-32B).

(c) Take the ends in opposite directions to the other

side of the head and tie them over the part of the bandage that was applied

first (Figure 3-32C).

Figure 3-32. Applying a cravat bandage to jaw (Illustrated A—C).

3-28

NOTE

The cravat bandage technique is used to immobilize a fractured

jaw or to maintain a sterile dressing that does not have tail

bandages attached.

3-11. Shoulder Bandage

a.

To apply bandages attached to the field first aid dressing—

(1)

Take one bandage across the chest and the other across

the back and under the arm opposite the injured shoulder.

(2)

Tie the ends with a square knot (Figure 3-33).

Figure 3-33. Shoulder bandage.

b.

To apply a cravat bandage to the shoulder or armpit—

(1)

Make an extended cravat bandage by using two triangular

bandages (Figure 3-34A); place the end of the first triangular bandage along

the base of the second one (Figure 3-34B).

(2)

Fold the two bandages into a single extended bandage

(Figure 3-34C).

(3)

Fold the extended bandage into a single cravat bandage

(Figure 3-34D). After folding, secure the thicker part (overlap) with two or

more safety pins (Figure 3-34E).

(4)

Place the middle of the cravat bandage under the armpit

so that the front end is longer than the back end and safety pins are on the

outside (Figure 3-34F).

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(5)

Cross the ends on top of the shoulder (Figure 3-34G).

(6)

Take one of the bandage ends across the back and under

the arm on the opposite side and the other end across the chest. Tie the ends

(Figure 3-34H).

Figure 3-34. Extended cravat bandage applied to shoulder or armpit

(Illustrated A—H).

3-30

Be sure to place sufficient wadding in the armpit. DO NOT tie the cravat

bandage too tightly. Avoid compressing the major blood vessels in the

armpit.

3-12. Elbow Bandage

To apply a cravat bandage to the elbow—

a.

Bend the arm at the elbow and place the middle of the cravat at

the point of the elbow bringing the ends upward (Figure 3-35A).

b.

Bring the ends across, extending both downward (Figure 3-

35B).

c.

Take both ends around the arm and tie them with a square knot

at the front of the elbow (Figure 3-35C).

Figure 3-35. Elbow bandage (Illustrated A—C).

CAUTION

If an elbow fracture is suspected, DO NOT bend the elbow;

bandage it in the position found.

3-13. Hand Bandage

a.

To apply a triangular bandage to the hand—

(1)

Place the hand in the middle of the triangular bandage

with the wrist at the base of the bandage (Figure 3-36A). Ensure that the

fingers are separated with absorbent material to prevent chafing and irritation

of the skin.

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(2)

Place the apex over the fingers and tuck any excess

material into the pleats on each side of the hand (Figure 3-36B).

(3)

Cross the ends on top of the hand, take them around the

wrist, and tie them (Figures 3-36C—E) with a square knot.

Figure 3-36. Triangular bandage applied to hand (Illustrated A—E).

b.

To apply a cravat bandage to the palm of the hand—

(1)

Lay the middle of the cravat over the palm of the hand

with the ends hanging down on each side (Figure 3-37A).

(2)

Take the end of the cravat at the little finger across the

back of the hand, extending it upward over the base of the thumb; then bring

it downward across the palm (Figure 3-37B).

(3)

Take the thumb end across the back of the hand, over

the palm, and through the hollow between the thumb and palm (Figure 3-

37C).

(4)

Take the ends to the back of the hand and cross them;

then bring them up over the wrist and cross them again (Figure 3-37D).

(5)

Bring both ends down and tie them with a square knot on

top of the wrist (Figure 3-37E—F).

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Figure 3-37. Cravat bandage applied to palm of hand

(Illustrated A—F).

3-14. Leg (Upper and Lower) Bandage

To apply a cravat bandage to the leg—

a.

Place the center of the cravat over the dressing (Figure 3-

38A).

b.

Take one end around and up the leg in a spiral motion and the

other end around and down the leg in a spiral motion, overlapping part of

each preceding turn (Figure 3-38B).

c.

Bring both ends together and tie them (Figure 3-38C) with a

square knot.

Figure 3-38. Cravat bandage applied to leg (Illustrated A—C).

3-33

3-15. Knee Bandage

To apply a cravat bandage to the knee as illustrated in Figure 3-39, use the

same technique applied in bandaging the elbow.

CAUTION

If a fracture of the kneecap is suspected, DO NOT bend the

knee; bandage it in the position found.

Figure 3-39. Cravat bandage applied to knee (Illustrated A—C).

3-16. Foot Bandage

To apply a triangular bandage to the foot—

a.

Place the foot in the middle of the triangular bandage with the

heel well forward of the base (Figure 3-40A). Ensure that the toes are

separated by absorbent material to prevent chafing and irritation of the skin.

b.

Place the apex over the top of the foot and tuck any excess

material into the pleats on each side of the foot (Figure 3-40B).

c.

Cross the ends on top of the foot, take them around the ankle,

and tie them at the front of the ankle (Figure 3-40C—E).

3-34

Figure 3-40. Triangular bandage applied to foot (Illustrated A—E).

3-35

CHAPTER 4

FIRST AID FOR FRACTURES

4-1.

General

A fracture is any break in the continuity of a bone. Fractures can cause total

disability or in some cases death by severing vital organs and/or arteries. On

the other hand, they can most often be treated so there is a complete recovery.

The potential for recovery depends greatly upon the first aid the individual

receives before he is moved. First aid includes immobilizing the fractured

part in addition to applying lifesaving measures when necessary. The basic

splinting principle is to immobilize the joints above and below the fracture.

4-2.

Kinds of Fractures

Figure 4-1 depicts types of fractures.

Figure 4-1. Types of fractures (Illustrated A—C).

a.

Closed Fracture (Figure 4-1A). A closed fracture is a broken

bone that does not break the overlying skin. The tissue beneath the skin may

be damaged. A dislocation is when a joint, such as a knee, ankle, or

shoulder, is not in the proper position. A sprain is when the connecting

tissues of the joints have been torn. Dislocations and sprains (swelling,

possible deformity, and discoloration) should be treated as closed fractures.

b.

Open Fracture (Figure 4-1B and 4-1C). An open fracture is a

broken bone that breaks (pierces) the overlying skin. The broken bone may

4-1

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