FIRST AID. Field Manual (2002)

NOTE

When providing first aid for immersion foot and trench foot—

DO NOT massage the injured part. DO NOT moisten the skin.

DO NOT apply heat or ice.

(3)

Frostbite. Frostbite is the injury of tissue caused from

exposure to cold, usually below 32°F depending on the windchill factor,

duration of exposure, and adequacy of protection. Individuals with a history

of cold injury are likely to suffer an additional cold injury. The body parts

most easily frostbitten are the cheeks, nose, ears, chin, forehead, wrists,

hands, and feet. Frostbite may involve only the skin (superficial), or it may

extend to a depth below the skin (deep). Deep frostbite is very serious and

requires prompt first aid to avoid or to minimize the loss of parts or all of the

fingers, toes, hands, or feet.

•

Signs and symptoms.

•

Loss of sensation (numb feeling) in any part

of the body.

•

Sudden blanching (whitening) of the skin of

the affected part, followed by a momentary tingling sensation.

•

Redness of skin in light-skinned service

members; grayish coloring in dark-skinned service members.

•

Blisters.

•

Swelling or tender areas.

•

Loss of previous sensation of pain in affected

area.

•

Pale, yellowish, waxy-looking skin.

•

Frozen tissue that feels solid (or wooden) to

the touch.

CAUTION

Deep frostbite is a very serious injury and requires

immediate first aid and subsequent medical treatment to

avoid or minimize loss of body parts.

5-11

•

First aid measures.

•

Face, ears, and nose. Cover the casualty’s

affected area with his and/or your bare hands until sensation and color return.

•

Hands. Open the casualty’s field jacket and

shirt.

(In a chemical environment, do not loosen or remove the clothing and

protective overgarments.) Place the affected hands under the casualty’s

armpits. Close the field jacket and shirt to prevent additional exposure.

•

Feet. Remove the casualty’s boots and socks

if he does not need to walk any further to receive additional treatment.

(Thawing the casualty’s feet and forcing him to walk on them will cause

additional pain and injury.) Place the affected feet under clothing and against

the body of another service member.

WARNING

DO NOT attempt to thaw the casualty’s feet or other

frozen areas if he will be required to walk or travel to an

MTF for additional medical treatment. The possibility

of additional injury from walking is less when the feet

are frozen than when they are thawed.

(However, if

possible avoid walking.) Thawing in the field increases

the possibilities of infection, gangrene, or other injury.

NOTE

Thawing may occur spontaneously during transportation to the

MTF; this cannot be avoided since the body in general must be

kept warm.

In all of the above areas, ensure that the casualty is kept warm and that he is

covered (to avoid further injury). Seek medical treatment as soon as possible.

Reassure the casualty, protect the affected area from further injury by covering

it lightly with a blanket or any dry clothing, and seek shelter out of the wind.

Remove or loosen constricting clothing (except in a contaminated environment)

and increase insulation. Ensure the casualty exercises as much as possible,

avoiding trauma to the injured part, and is prepared for pain when thawing

occurs. Protect the frostbitten part from additional injury. DO NOT—

•

Rub the injured part with snow or apply cold water

soaks.

5-12

•

Warm the part by massage or exposure to open

fire because the frozen part may be burned due to the lack of feeling.

•

Use ointments or other salves.

•

Manipulate the part in any way to increase

circulation.

•

Use alcohol or tobacco because this reduces the

body’s resistance to cold.

NOTE

Remember, when freezing extends to a depth below the skin, it

is a much more serious injury. Extra care is required to reduce

or avoid the chances of losing all or part of the toes or feet.

This also applies to the fingers and hands.

(4)

Snow blindness. Snow blindness is the effect that glare

from an ice field or snowfield has on the eyes. It is more likely to occur in

hazy, cloudy weather than when the sun is shining. Glare from the sun will

cause an individual to instinctively protect his eyes. However, in cloudy

weather, he may be overconfident and expose his eyes longer than when the

threat is more obvious. He may also neglect precautions such as the use of

protective eyewear. Waiting until discomfort (pain) is felt before using

protective eyewear is dangerous because a deep burn of the eyes may already

have occurred.

•

Signs and symptoms. Symptoms of snow blindness

are a sensation of grit in the eyes with pain in and over the eyes, made worse

by moving the eyeball. Other signs and symptoms are watering, redness,

headache, and increased pain on exposure to light.

•

First aid measures. First aid measures consist of

blindfolding or covering the eyes with a dark cloth which stops painful eye

movement. Complete rest is desirable. If further exposure to light is not

preventable, the eyes should be protected with dark bandages or the darkest

glasses available. Once unprotected exposure to sunlight stops, the condition

usually heals in a few days without permanent damage. The casualty should

be evacuated to the nearest MTF.

(5)

Dehydration. Dehydration occurs when the body loses

too much fluid. A certain amount of body fluid is lost through normal body

processes. A normal daily intake of liquids replaces these losses. When

individuals are engaged in any strenuous exercises or activities, fluid is lost

5-13

through sweating and this loss creates an imbalance of fluids in the body, and

if not matched by rehydration it can contribute to dehydration. The danger

of dehydration is as prevalent in cold regions as it is in hot regions. In hot

weather, the individual is aware of his body losing fluids through sweat. In

cold weather, however, it is extremely difficult to realize that this condition

exists since sweating is not as apparent as in a hot environment. The danger

of dehydration in cold weather operations is a serious problem. In cold

climates, sweat evaporates so rapidly or is absorbed so thoroughly by layers

of heavy clothing that it is rarely visible on the skin. Dehydration also occurs

during cold weather operations because drinking is inconvenient.

Dehydration will weaken or incapacitate a casualty for a few hours, or

sometimes, several days. Because rest is an important part of the recovery

process, casualties must take care that limited movement during their

recuperative period does not enhance the risk of becoming a cold injury

casualty.

•

Signs and symptoms. The symptoms of cold

weather dehydration are similar to those encountered in heat exhaustion. The

mouth, tongue, and throat become parched and dry, and swallowing becomes

difficult. The casualty may have nausea (with or without vomiting) along

with extreme dizziness and fainting. The casualty may also feel generally

tired and weak and may experience muscle cramps. Focusing the eyes may

also become difficult.

•

First aid measures. The casualty should be kept

warm and his clothes should be loosened (if not in a chemical environment)

to allow proper circulation. Shelter from wind and cold must be provided.

Fluid replacement should begin immediately and the service member

transported to an MTF as soon as possible.

(6)

Hypothermia

(general cooling). When exposed to

prolonged cold weather a service member may become both mentally and

physically numb, thus neglecting essential tasks or requiring more time and

effort to achieve them. Under some conditions (particularly cold water

immersion), even a service member in excellent physical condition may die

in a matter of minutes. The destructive influence of cold on the body is

called hypothermia. This means bodies lose heat faster than they can produce

it. Hypothermia can occur from exposure to temperatures either above or

below freezing, especially from immersion in cold water, wet-cold conditions,

or from the effect of wind. Physical exhaustion and insufficient food intake

may also increase the risk of hypothermia. General cooling of the entire

body to a temperature below 95°F is caused by continued exposure to low or

rapidly dropping temperatures, cold moisture, snow, or ice. Fatigue, poor

physical condition, dehydration, faulty blood circulation, alcohol or other

drug use, trauma, and immersion can cause hypothermia. Remember, cold

5-14

may affect the body systems slowly and almost without notice. Service

members exposed to low temperatures for extended periods may suffer ill

effects even if they are well protected by clothing.

•

Signs and symptoms. As the body cools, there are

several stages of progressive discomfort and impairment. A sign that is

noticed immediately is shivering. Shivering is an attempt by the body to

generate heat. The pulse is faint or very difficult to detect. People with

temperatures around 90°F may be drowsy and mentally slow. Their ability

to move may be hampered, stiff, and uncoordinated, but they may be able to

function minimally. Their speech may be slurred. As the body temperature

drops further, shock becomes evident as the person’s eyes assume a glassy

state, breathing becomes slow and shallow, and the pulse becomes weaker or

absent. The person becomes very stiff and uncoordinated. Unconsciousness

may follow quickly. As the body temperature drops even lower, the

extremities freeze, and a deep (or core) body temperature (below 85°F)

increases the risk of irregular heart action. This irregular heart action or

heart standstill can result in sudden death.

•

First aid measures. Except in cases of the most

severe hypothermia (marked by coma or unconsciousness and a weak pulse),

first aid measures for hypothermia are directed towards protecting the casualty

from further loss of body heat. For the casualty who is conscious, first aid

measures are directed at rewarming the body evenly and without delay.

Provide heat by using a hot water bottle or field expedient or another service

member’s body heat.

CAUTION

DO NOT expose the casualty to an open fire, as he may

become burned.

NOTE

When using a hot water bottle or field expedient (canteen filled

with warm water), the bottle or canteen must be wrapped in

cloth prior to placing it next to the casualty. This will reduce

the chance of burning the casualty’s skin.

Always call or send for help as soon as possible and protect the casualty

immediately with dry clothing or a sleeping bag. Then, move him to a warm

place. Evaluate other injuries and provide first aid as required. First aid

measures can be performed while the casualty is waiting transportation or

5-15

while he is en route. In the case of an accidental breakthrough into ice water,

or other hypothermic accident, strip the casualty of wet clothing immediately

and bundle him into a sleeping bag. Rescue breathing should be started at

once if the casualty’s breathing has stopped or is irregular or shallow. Warm

liquids (NOT HOT) may be given gradually if the casualty is conscious. DO

NOT force liquids on an unconscious or semiconscious casualty because he

may choke. The casualty should be transported on a litter because the

exertion of walking may aggravate circulation problems. Medical personnel

should immediately treat any hypothermia casualty. Hypothermia is life

threatening until normal body temperature has been restored. The first aid

measures for a casualty with severe hypothermia are based upon the following

principles: attempt to avoid further heat loss, handle the casualty gently, and

transport the casualty as soon as possible to the nearest MTF. If at all

possible, the casualty should be evacuated by medical personnel.

WARNING

Rewarming a severely hypothermic casualty is

extremely dangerous in the field due to the possibility

of such complications as rewarming, shock and

disturbances in the rhythm of the heartbeat. These

conditions require treatment by medical personnel.

NOTE

Resuscitation of casualties with hypothermic complications is

difficult if not impossible to do outside of an MTF setting.

CAUTION

The casualty is unable to generate his own body heat.

Therefore, merely placing him in a blanket or sleeping bag

is not sufficient.

Table. See Table 5-2 for further information.

5-16

Table 5-2. Injuries Caused by Cold and Wet Conditions

INJURIES

SIGNS/SYMPTOMS

FIRST AID

CHILBLAIN

RED SWOLLEN, HOT, TENDER,

1. AREA USUALLY

ITCHING SKIN. CONTINUED

RESPONDS TO LOCALLY

EXPOSURE MAY LEAD TO

APPLIED REWARMING

INFECTED (ULCERATED OR

(BODY HEAT).

BLEEDING) SKIN LESIONS.

2. DO NOT RUB OR

MASSAGE AREA.

3. SEEK MEDICAL AID.

IMMERSION

AFFECTED PARTS ARE COLD,

1. GRADUAL REWARMING

SYNDROME

NUMB, AND PAINLESS. PARTS

BY EXPOSURE TO WARM

(IMMERSION

MAY THEN BE HOT, WITH

AIR.

FOOT/TRENCH

BURNING AND SHOOTING PAINS.

FOOT)

ADVANCED STAGE: SKIN PALE

2. DO NOT MASSAGE

WITH BLUISH CAST; PULSE

OR MOISTEN SKIN.

DECREASES; BLISTERING,

SWELLING, HEAT,

3. PROTECT AFFECTED

HEMORRHAGING, AND GANGRENE

PARTS FROM TRAUMA.

MAY FOLLOW.

4. DRY FEET

THOROUGHLY, AVOID

WALKING.

5. SEEK MEDICAL AID.

FROSTBITE

LOSS OF SENSATION (NUMB

1. WARM THE AREA

FEELING) IN ANY PART OF THE

AT THE FIRST SIGN OF

BODY. SUDDEN BLANCHING

FROSTBITE, USING FIRM,

(WHITENING) OF THE SKIN OF THE

STEADY PRESSURE OF

AFFECTED PART, FOLLOWED BY A

THE HAND, UNDERARM,

MOMENTARY TINGLING SENSATION.

OR ABDOMEN.

REDNESS OF SKIN IN LIGHT-

SKINNED SERVICE MEMBERS;

2. FACE, EARS, NOSE:

GRAYISH COLORING IN DARK-

COVER AREA WITH HANDS

SKINNED SERVICE MEMBERS.

(CASUALTY’S OWN OR

BLISTERS. SWELLING OR TENDER

BUDDY’S).

AREAS. LOSS OF PREVIOUS

SENSATION OF PAIN IN THE

3. HANDS: OPEN FIELD

AFFECTED AREA. PALE

JACKET AND PLACE

YELLOWISH, WAXY-LOOKING

CASUALTY’S HANDS

SKIN. FROZEN TISSUE THAT

AGAINST HIS BODY,

FEELS SOLID (WOODEN) TO

THEN CLOSE THE JACKET

THE TOUCH.

TO PREVENT HEAT LOSS.

4. FEET: REMOVE THE

CASUALTY’S BOOTS AND

SOCKS AND PLACE HIS

FEET AGAINST THE BODY

OF ANOTHER SERVICE

MEMBER.

5-17

Table 5-2. Injuries Caused by Cold and Wet Conditions (Continued)

INJURIES

SIGNS/SYMPTOMS

FIRST AID

5. WARNING: DO NOT

ATTEMPT TO THAW THE

CASUALTY’S FEET OR

OTHER FROZEN AREAS IF

HE WILL BE REQUIRED TO

WALK OR TRAVEL TO AN

MTF FOR ADDITIONAL

TREATMENT. THE

POSSIBILITY OF INJURY

FROM WALKING IS LESS

WHEN THE FEET ARE

FROZEN THAN WHEN

THEY HAVE BEEN

THAWED. (HOWEVER, IF

POSSIBLE AVOID

WALKING.) THAWING IN

THE FIELD INCREASES

THE POSSIBILITY OF

INFECTION, GANGRENE,

OR INJURY.

6. LOOSEN OR REMOVE

CONSTRICTING CLOTHING

AND REMOVE ANY

JEWELRY.

7. INCREASE INSULATION

(COVER WITH BLANKET

OR OTHER DRY

MATERIAL). ENSURE

CASUALTY EXERCISES AS

MUCH AS POSSIBLE,

AVOIDING TRAUMA TO

INJURED PART.

SNOW

EYES MAY FEEL SCRATCHY.

1. COVER THE EYES

BLINDNESS

WATERING, REDNESS, HEADACHE,

WITH A DARK CLOTH.

AND INCREASED PAIN WITH

EXPOSURE TO LIGHT CAN OCCUR.

2. SEEK MEDICAL AID.

DEHYDRATION

SIMILAR TO HEAT EXHAUSTION

1. KEEP WARM.

(REFER TO TABLE 5-1).

2. CASUALTY NEEDS

FLUID REPLACEMENT,

REST, AND PROMPT

MEDICAL AID.

HYPOTHERMIA

CASUALTY IS COLD. SHIVERING.

MILD HYPOTHERMIA

CORE TEMPERATURE IS LOW.

CONSCIOUSNESS MAY BE

1. REWARM BODY

5-18

Table 5-2. Injuries Caused by Cold and Wet Conditions (Continued)

INJURIES

SIGNS/SYMPTOMS

FIRST AID

ALTERED. UNCOORDINATED

EVENLY AND WITHOUT

MOVEMENTS MAY OCCUR. SHOCK

DELAY. (NEED TO

AND COMA MAY RESULT AS BODY

PROVIDE HEAT SOURCE;

TEMPERATURE DROPS.

CASUALTY’S BODY

UNABLE TO GENERATE

HEAT.)

2. KEEP DRY, PROTECT

FROM THE ELEMENTS.

3. WARM (NOT HOT)

LIQUIDS MAY BE GIVEN

GRADUALLY (TO

CONSCIOUS CASUALTIES

ONLY).

4. BE PREPARED TO

START BASIC LIFE

SUPPORT MEASURES

FOR THE CASUALTY.

5. SEEK MEDICAL

TREATMENT

IMMEDIATELY.

SEVERE HYPOTHERMIA

1. STABILIZE THE

TEMPERATURE.

2. ATTEMPT TO AVOID

FURTHER HEAT LOSS.

3. HANDLE THE

CASUALTY GENTLY.

4. EVACUATE TO THE

NEAREST MTF AS SOON

AS POSSIBLE.

5. WARNING:

HYPOTHERMIA IS A

MEDICAL EMERGENCY.

PROMPT MEDICAL

ATTENTION IS

NECESSARY.

5-19

CHAPTER 6

FIRST AID FOR BITES AND STINGS

6-1.

General

Snakebites, insect bites, or stings can cause intense pain and/or swelling. If

not treated promptly and correctly, they can cause serious illness or death.

The severity of a snakebite depends upon: whether the snake is poisonous or

nonpoisonous, the type of snake, the location of the bite, and the amount of

venom injected. Bites from humans and other animals, such as dogs, cats,

bats, raccoons, and rats, can cause severe bruises and infection and tears or

lacerations of tissue. Awareness of the potential sources of injuries can

reduce or prevent them from occurring. Knowledge and prompt application

of first-aid measures can lessen the severity of injuries from bites and stings

and keep the service member from becoming a serious casualty.

6-2.

Types of Snakes

Nonpoisonous Snakes. There are approximately 130 different

varieties of nonpoisonous snakes in the United States. They have oval-

shaped heads and round eyes. Unlike poisonous snakes, discussed below,

nonpoisonous snakes do not have fangs with which to inject venom. Figure

6-1 depicts the characteristics of a nonpoisonous snake.

Figure 6-1. Characteristics of nonpoisonous snake.

Poisonous Snakes. Poisonous snakes are found throughout the

world, primarily in tropical to moderate climates. Within the United States,

there are four kinds:

rattlesnakes, copperheads, water moccasins

(cottonmouth), and coral snakes. Poisonous snakes in other parts of the

world include sea snakes, the fer-de-lance, the bushmaster, and the tropical

rattlesnake in tropical Central America; the Malayan pit viper in the tropical

Far East; the cobra in Africa and Asia; the mamba (or black mamba) in

central and southern Africa; and the krait in India and Southeast Asia. Refer

to Figure 6-2 for characteristics of a poisonous pit viper.

6-1

Figure 6-2. Characteristics of poisonous pit viper.

Pit Vipers

(Poisonous). Figure

6-3 depicts a variety of

poisonous snakes.

Figure 6-3. Poisonous snakes.

(1)

Rattlesnakes, bushmasters, copperheads, fer-de-lance,

Malayan pit vipers, and water moccasins (cottonmouth) are called pit vipers

because of the small, deep pits between the nostrils and eyes on each side of

the head (Figure 6-2). In addition to their long, hollow fangs, these snakes

have other identifying features: thick bodies, slit-like pupils of the eyes, and

flat, almost triangular-shaped heads. Color markings and other identifying

characteristics, such as rattles or a noticeable white interior of the mouth

(cottonmouth), also help distinguish these poisonous snakes. Further

6-2

identification is provided by examining the bite pattern of the wound for

signs of fang entry. Occasionally there will be only one fang mark, as in the

case of a bite on a finger or toe where there is no room for both fangs, or

when the snake has broken off a fang.

(2)

The casualty’s condition provides the best information

about the seriousness of the situation, or how much time has passed since the

bite occurred. Pit viper bites are characterized by severe burning pain.

Discoloration and swelling around the fang marks usually begins within 5 to

10 minutes after the bite. If only minimal swelling occurs within 30 minutes,

the bite will almost certainly have been from a nonpoisonous snake or possibly

from a poisonous snake which did not inject venom. The venom destroys

blood cells, causing a general discoloration of the skin. Blisters and numbness

in the affected area follow this reaction. Other signs, which can occur, are

weakness, rapid pulse, nausea, shortness of breath, vomiting, and shock.

Corals, Cobras, Kraits, and Mambas. Corals (Figure 6-4),

cobras (Figure 6-5), kraits, and mambas all belong to the same group even

though they are found in different parts of the world. All four inject their

venom through short, grooved fangs, leaving a characteristic bite pattern.

Figure 6-4. Coral snake.

(1)

The small coral snake, found in the Southeastern US, is

brightly colored with bands of red, yellow (or almost white), and black

completely encircling the body. Other nonpoisonous snakes have the same

coloring, but on the coral snake found in the US, the red ring always touches

the yellow ring. To know the difference between a harmless snake and the

coral snake found in the United States, remember the following:

“Red on yellow will kill a fellow,

Red on black, venom will lack.”

6-3

Figure 6-5. Cobra snake.

(2)

The venom of corals, cobras, kraits, and mambas

produces symptoms different from those of pit vipers. Because there is only

minimal pain and swelling, many people believe that the bite is not serious.

Delayed reactions in the nervous system normally occur between 1 to 7 hours

after the bite. Symptoms include blurred vision, drooping eyelids, slurred

speech, drowsiness, and increased salivation and sweating. Nausea, vomiting,

shock, respiratory difficulty, paralysis, convulsions, and coma will usually

develop if the bite is not treated promptly.

Sea Snakes. Sea snakes (Figure 6-6) are found in the warm

water areas of the Pacific and Indian oceans, along the coasts, and at the

mouths of some larger rivers. Their venom is VERY poisonous, but their

fangs are only 1/4 inch long. The first aid outlined for land snakes also

applies to sea snakes.

Figure 6-6. Sea snake.

6-4

6-3.

Snakebites

Poisonous snakes DO NOT always inject venom when they

bite or strike a person. However, all snakes may carry tetanus (lockjaw);

anyone bitten by a snake, whether poisonous or nonpoisonous, should

immediately seek medical attention.

•

Poison is injected from the venom sacs through grooved

or hollow fangs. Depending on the species, these fangs are either long or

short. Pit vipers have long hollow fangs. These fangs are folded against the

roof of the mouth and extend when the snake strikes. This allows them to

strike quickly and then withdraw. Cobras, coral snakes, kraits, mambas, and

sea snakes have short, grooved fangs. These snakes are less effective in their

attempts to bite, since they must chew after striking to inject enough venom

(poison) to be effective. Figure 6-7 depicts the characteristics of a poisonous

snakebite.

•

In the event you are bitten, attempt to identify and/or kill

the snake. Take it to medical personnel for inspection/identification. This

provides valuable information to medical personnel who deal with snakebites.

TREAT ALL SNAKEBITES AS POISONOUS.

Figure 6-7. Characteristics of poisonous snakebite.

The venoms of different snakes cause different effects. Pit

viper venom (hemotoxin [blood toxin]) destroys tissue and blood cells.

Cobras, adders, and coral snakes inject powerful venom (neurotoxin [nerve

toxin]) which affect the central nervous system, causing respiratory paralysis.

Water moccasins and sea snakes have venom that is both hemotoxic and

neurotoxic.

The identification of poisonous snakes is very important since

medical treatment will be different for each type of venom. Unless it can be

positively identified, the snake should be killed and saved. When this is not

possible or when doing so is a serious threat to others, identification may

6-5

sometimes be difficult since many venomous snakes resemble harmless

varieties. When dealing with snakebite problems in foreign countries, seek

advice, professional or otherwise, which may help identify species in the

particular area of operations.

Get the casualty to an MTF as soon as possible and with

minimum movement. Until evacuation or treatment is possible, have the

casualty lie quietly and not move any more than necessary. If the casualty

has been bitten on an extremity, DO NOT elevate the limb; keep the extremity

level with the body. Keep the casualty comfortable and reassure him. If the

casualty is alone when bitten, he should go to the medical facility himself

rather than wait for someone to find him. Unless the snake has been positively

identified, attempt to kill it and send it with the casualty. Be sure that

retrieving the snake does not endanger anyone or delay transporting the

casualty.

(1)

If the bite is on an arm or leg, place a constricting band

(narrow cravat [swathe], or narrow gauze bandage) one to two fingerbreadths

above and below the bite (Figure 6-8). If the bite is on the hand or foot,

place a single band above the wrist or ankle. The band should be tight

enough to stop the flow of blood near the skin, but not tight enough to

interfere with circulation. In other words, it should not have a tourniquet-

like affect. If no swelling is seen, place the bands about 1 inch from either

side of the bite. If swelling is present, put the bands on the unswollen part at

the edge of the swelling. If the swelling extends beyond the band, move the

band to the new edge of the swelling.

(If possible, leave the old band on,

place a new one at the new edge of the swelling, and then remove and save

the old one in case the process has to be repeated.)

Figure 6-8. Constricting band.

CAUTION

DO NOT attempt to cut open the bite nor suck out the

venom. If the venom should seep through any damaged or

lacerated tissues in your mouth, you could immediately lose

consciousness or even die.

6-6

(2)

If the bite is located on an arm or leg, immobilize it at a

level below the heart. DO NOT elevate an arm or leg even with or above the

level of the heart.

CAUTION

When a splint is used to immobilize the arm or leg, take

EXTREME care to ensure the splinting is done properly and

does not bind. Watch it closely and adjust it if any changes

in swelling occur.

(3)

When possible, clean the area of the bite with soap and

water. DO NOT use ointments of any kind.

(4)

NEVER give the casualty food, alcohol, stimulants

(coffee or tea), drugs, or tobacco.

(5)

Remove rings, watches, or other jewelry from the

affected limb.

6-4.

Human or Animal Bites

Human or other land animal bites may cause lacerations or bruises. In

addition to damaging tissue, bites always present the possibility of infection.

Human Bites. Human bites that break the skin may become

seriously infected since the mouth is heavily contaminated with bacteria.

Medical personnel MUST treat all human bites.

Animal Bites. Land animal bites can result in both infection

and disease. Tetanus, rabies, and various types of fevers can follow an

untreated animal bite. Because of these possible complications, the animal

causing the bite should, if possible, be captured or killed (without damaging

its head) so that it can be tested for disease.

First Aid.

(1)

Cleanse the wound thoroughly with soap.

(2)

Flush it well with water.

(3)

Cover it with a sterile dressing.

6-7

(4)

Immobilize the injured arm or leg, if appropriate.

(5)

Transport the casualty immediately to an MTF.

NOTE

If unable to capture or kill the animal, provide medical personnel

with any information that will help identify it.

6-5.

Marine (Sea) Animals

With the exception of sharks and barracuda, most marine animals will not

deliberately attack. The most frequent injuries from marine animals are

wounds by biting, stinging, or puncturing. Wounds inflicted by marine

animals can be very painful, but are rarely fatal.

Sharks, Barracuda, and Alligators. Wounds from these marine

animals can involve major trauma as a result of bites and lacerations. Bites

from large marine animals are potentially the most life threatening of all

injuries from marine animals. Major wounds from these animals can be

treated by controlling the bleeding, preventing shock, giving basic life

support, splinting the injury, and by securing prompt medical aid.

Turtles, Moray Eels, and Corals. These animals normally

inflict minor wounds. Treat by cleansing the wound(s) thoroughly and by

splinting if necessary.

Jellyfish, Portuguese Man-of-War, Anemones, and Others.

This group of marine animals inflict injury by means of stinging cells in their

tentacles. Contact with the tentacles produces burning pain with a rash and

small hemorrhages on the skin. Shock, muscular cramping, nausea,

vomiting, and respiratory distress may also occur. Gently remove the clinging

tentacles with a towel and wash or treat the area. Use diluted ammonia or

alcohol, meat tenderizer, and talcum powder. If symptoms become severe or

persist, seek medical assistance.

Spiny Fish, Urchins, Stingrays, and Cone Shells. These

animals inject their venom by puncturing the skin with their spines. General

signs and symptoms include swelling, nausea, vomiting, generalized cramps,

diarrhea, muscular paralysis, and shock. Deaths are rare. Treatment consists

of soaking the wounds in hot water (when available) for 30 to 60 minutes.

This inactivates the heat sensitive toxin. In addition, further first aid measures

(controlling bleeding, applying a dressing, and so forth) should be carried out

as necessary.

6-8

CAUTION

Be careful not to scald the casualty with water that is too hot

because the pain of the wound will mask the normal reaction

to heat.

6-6.

Insect (Arthropod) Bites and Stings

An insect bite or sting can cause great pain, allergic reaction, inflammation,

and infection. If not treated correctly, some bites/stings may cause serious

illness or even death. When an allergic reaction is not involved, first aid is a

simple process. In any case, medical personnel should examine the casualty

at the earliest possible time. It is important to properly identify the spider,

bee, or creature that caused the bite/sting, especially in cases of allergic

reaction.

Types of Insects. The insects found throughout the world that

can produce a bite or sting are too numerous to mention in detail. Commonly

encountered stinging or biting insects include brown recluse spiders (Figure

6-9), black widow spiders (Figure 6-10), tarantulas (Figure 6-11), scorpions

(Figure 6-12), urticating caterpillars, bees, wasps, centipedes, conenose

beetles

(kissing bugs), ants, and wheel bugs. Upon being reassigned,

especially to overseas areas, take the time to become acquainted with the

types of insects to avoid.

Figure 6-9. Brown recluse spider.

Figure 6-10. Black widow spider.

6-9

Figure 6-11. Tarantula.

Figure 6-12. Scorpion.

Signs and Symptoms. Discussed in paragraphs (1) and (2)

below are the most common effects of insect bites/stings. They can occur

alone or in combination with the others.

(1)

Less serious. Commonly seen signs/symptoms are pain,

irritation, swelling, heat, redness, and itching. Hives or wheals (raised areas

of the skin that itch) may occur. These are the least severe of the allergic

reactions that commonly occur from insect bites/stings. They are usually

dangerous only if they affect the air passages (mouth, throat, nose, and so

forth), which could interfere with breathing. The bites/stings of bees, wasps,

ants, mosquitoes, fleas, and ticks are usually not serious and normally produce

mild and localized symptoms. A tarantula’s bite is usually no worse than that

of a bee sting. Scorpions are rare and their stings (except for a specific

species found only in the Southwest desert) are painful but usually not

dangerous.

(2)

Serious. Emergency allergic or hypersensitive reactions

sometimes result from the stings of bees, wasps, and ants. Many people are

allergic to the venom of these particular insects. Bites or stings from these

insects may produce more serious reactions, to include generalized itching

and hives, weakness, anxiety, headache, breathing difficulties, nausea,

vomiting, and diarrhea. Very serious allergic reactions (called anaphylactic

shock) can lead to complete collapse, shock, and even death. Spider bites

(particularly from the black widow and brown recluse spiders) can also be

6-10

serious. Venom from the black widow spider affects the nervous system.

This venom can cause muscle cramps, a rigid, nontender abdomen, breathing

difficulties, sweating, nausea, and vomiting. The brown recluse spider

generally produces local rather than system-wide problems; however, local

tissue damage around the bite can be severe and can lead to an ulcer and even

gangrene.

First Aid. There are certain principles that apply regardless of

what caused the bite/sting. Some of these are—

•

If there is a stinger present (for example, from a bee),

remove the stinger by scraping the skin’s surface with a fingernail or knife.

DO NOT squeeze the sac attached to the stinger because it may inject more

venom.

•

Wash the area of the bite/sting with soap and water

(alcohol or an antiseptic may also be used) to help reduce the chances of an

infection and remove traces of venom.

•

Remove jewelry from bitten extremities because swelling

may occur.

•

In most cases of insect bites the reaction will be mild and

localized; use ice or cold compresses (if available) on the site of the bite/

sting. This will help reduce swelling, ease the pain, and slow the

absorption of venom. Meat tenderizer

(to neutralize the venom) or

calamine lotion (to reduce itching) may be applied locally. If necessary,

seek medical assistance.

•

In more serious reactions (severe and rapid swelling,

allergic symptoms, and so forth) treat the bite/sting like you would treat a

snakebite; that is, apply constricting bands above and below the site.

•

Be prepared to perform basic life-support measures, such

as rescue breathing.

•

Reassure the casualty and keep him calm.

•

In serious reactions, attempt to capture the insect for

positive identification; however, be careful not to become a casualty yourself.

•

If the reaction to the bite/sting appears serious, seek

medical assistance.

6-11

WARNING

Insect bites/stings may cause anaphylactic shock (a

shock caused by a severe allergic reaction). This is a

life-threatening event and a TRUE MEDICAL EMER-

GENCY. Be prepared to perform the basic life-support

measures and to immediately transport the casualty to

an MTF.

NOTE

Be aware that some allergic or hypersensitive individuals may

carry identification or emergency insect bite treatment kits. If

the casualty is having an allergic reaction and has such a kit,

administer the medication in the kit according to the instructions

which accompany the kit.

Supplemental Information.

For additional information

concerning biting insects, see FM 21-10.

6-7.

First Aid for Bites and Stings

See the table below for information on bites and stings.

Table 6-1. First Aid Measures for Bites and Stings

TYPES

FIRST AID MEASURES

SNAKEBITE

1. MOVE CASUALTY AWAY FROM THE SNAKE.

2. REMOVE JEWELRY FROM THE AFFECTED AREA, IF

APPLICABLE.

3. REASSURE CASUALTY AND KEEP HIM QUIET.

4. APPLY CONSTRICTING BAND, 1-2 FINGERBREADTHS

FROM THE BITE. YOU SHOULD BE ABLE TO INSERT A

FINGER BETWEEN THE BAND AND THE SKIN.

a. ARM OR LEG BITE. PLACE ONE BAND ABOVE AND

ONE BAND BELOW THE BITE SITE.

b. HAND OR FOOT BITE. PLACE ONE BAND ABOVE

THE WRIST OR ANKLE.

6-12

Table 6-1. First Aid Measures for Bites and Stings

TYPES

FIRST AID MEASURES

IMMOBILIZE THE AFFECTED PART IN A POSITION

BELOW THE LEVEL OF THE HEART.

KILL THE SNAKE (IF POSSIBLE, WITHOUT DAMAGING

ITS HEAD OR ENDANGERING YOURSELF) AND SEND IT

WITH THE CASUALTY.

SEEK MEDICAL ASSISTANCE IMMEDIATELY.

BROWN RECLUSE

KEEP CASUALTY QUIET.

SPIDER

REMOVE ALL JEWELRY FROM AFFECTED PART, IF

BLACK WIDOW

APPLICABLE.

SPIDER BITE

WASH THE AREA.

APPLY ICE OR FREEZE PACK, IF AVAILABLE.

SEEK MEDICAL ASSISTANCE.

TARANTULA BITE

WASH THE AREA.

SCORPION STING

REMOVE ALL JEWELRY FROM AFFECTED PART, IF

APPLICABLE.

ANT BITE

APPLY ICE OR FREEZE PACK, IF AVAILABLE.

APPLY BAKING SODA, CALAMINE LOTION, OR MEAT

TENDERIZER (IF AVAILABLE) TO BITE SITE TO RELIEVE

PAIN AND ITCHING.

IF THE SITE OF THE BITE IS ON THE FACE, NECK

(POSSIBLE AIRWAY PROBLEMS), OR GENITAL AREA,

OR IF LOCAL REACTION SEEMS SEVERE, OR IF THE

STING IS BY THE DANGEROUS TYPE OF SCORPION

FOUND IN THE SOUTHWEST UNITED STATES DESERT,

KEEP THE CASUALTY AS QUIET AS POSSIBLE. SEEK

MEDICAL ASSISTANCE.

BEE STING

IF THE STINGER IS PRESENT, REMOVE BY SCRAPING

WITH A KNIFE OR FINGERNAIL. DO NOT SQUEEZE

VENOM SAC ON STINGER; MORE VENOM MAY BE

INJECTED.

REMOVE ALL JEWELRY FROM AFFECTED PART, IF

APPLICABLE.

6-13

CHAPTER 7

FIRST AID IN A NUCLEAR, BIOLOGICAL,

AND CHEMICAL ENVIRONMENT

7-1.

General

American forces have not been exposed to NBC weapons/agents on the

battlefield since World War I. In future conflicts and wars we can expect the

use of such agents. Nuclear, biological, and chemical weapons will rapidly

degrade unit effectiveness by forcing troops to wear protective clothing and by

creating confusion and fear. Through training in protective procedures and

first aid, units can maintain their effectiveness on the integrated battlefield.

7-2.

First Aid Materials

You may be issued the following materials to protect, decontaminate, and use

as first aid for NBC exposure. You must know how to use the items; some

items are described in a through d below. It is equally important that you

know when to use them.

Nerve Agent Pyridostigmine Pretreatment (NAPP). You may

be issued a blister pack of pretreatment tablets when your commander directs.

The NAPP is a pretreatment; it is not an antidote. It improves the

effectiveness of the nerve agent antidote. When ordered to take the

pretreatment you must take one tablet every 8 hours, mission permitting.

This must be taken prior to exposure to nerve agents, since it may take

several hours to develop adequate blood levels.

NOTE

Commanders must follow investigational new drug protocols

for use of the NAPP.

M291 Skin Decontaminating Kit. The M291 Skin Decontam-

inating Kit (Figure 7-1) contains six packets of XE-555 decontaminant resin.

WARNING

For external use only. May be slightly irritating to the

eyes. Keep decontaminating powder out of eyes. Use

water to wash toxic agent out of eyes.

7-1

Nerve Agent Antidote Kit, MARK I. Each service member is

issued three MARK Is for use in first aid for nerve agent poisoning (Figure

7-2 and paragraph 7-6).

Figure 7-1. M291 Skin Decontamination Kit.

Antidote Treatment, Nerve Agent, Autoinjector. A new nerve

agent antidote injection device, Antidote Treatment, Nerve Agent, Autoinjector

(ATNAA) is currently under development that will replace the MARK I.

The ATNAA is a multichambered device with the atropine and pralidoxime

chloride in separate chambers. Both antidotes will be administered through a

single needle.

7-3.

Classification of Chemical and Biological Agents

Chemical agents are classified according to the primary

physiological effects they produce, such as blistering, choking, vomiting,

and incapacitating agents.

Biological warfare agents are classified according to the effect

they have on man. The effects include their ability to incapacitate and cause

death. Most biological warfare agents are delivered as aerosols that effect

the respiratory tract; some can be delivered by releasing infected insects, by

contaminating food and water, and by injection

(injecting material in

individuals by terrorist, not mass exposure). These agents are found in living

organisms such as fungi, bacteria, and viruses.

WARNING

Swallowing water or food contaminated with nerve,

blister, and other chemical agents and with some

biological agents can be fatal. NEVER consume water

or food that is suspected of being contaminated until it

has been tested and found safe for consumption by

medical personnel.

7-2

7-4.

Conditions for Masking Without Order or Alarm

Once an attack with a chemical or biological agent is detected

or suspected, or information is available that such an agent is about to be

used, you must STOP BREATHING and mask immediately. DO NOT

WAIT to receive an order or alarm under the following circumstances:

•

Your position is hit by artillery missiles, rockets that

produce vapors, smoke, and mists, and aerial sprays.

•

Smoke or vapor cloud from an unknown source is

present or approaching.

•

A suspicious odor, liquid, or solid is present.

•

A chemical or biological warfare agent attack is

occurring.

•

You are entering an area known or suspected of being

contaminated.

•

When casualties are being received from an area where

chemical or biological agents have reportedly been used.

•

You have one or more of the following symptoms:

•

An unexplained runny nose.

•

A sudden unexplained headache.

•

A feeling of choking or tightness in the chest or

throat.

•

Dimness of vision.

•

Irritation of the eyes.

•

Difficulty in or increased rate of breathing without

obvious reasons.

•

Sudden feeling of depression.

•

Dread, anxiety, or restlessness.

•

Dizziness or light-headedness.

7-3

•

Slurred speech.

•

Unexplained laughter or unusual behavior is noted in others.

•

Numerous unexplained ill personnel.

•

Service members suddenly collapsing without evident cause.

•

Animals or birds exhibiting unusual behavior or suddenly

dying.

For further information on protection and masking procedures,

refer to FM 3-4, FM 4-02.7, FM 8-284, and FM 8-285.

7-5.

First Aid for a Chemical Attack

Your field protective mask gives protection against biological and chemical

warfare agents as well as radiological fallout. With practice you can mask in

9 seconds or less, or put on your mask with hood within 15 seconds.

Stop breathing. Don your mask, seal it properly, and clear

and check it; then resume breathing. Give the alarm, and continue the

mission. Keep your mask on until the “all clear” signal has been given.

NOTE

Keep your mask on until the area is no longer hazardous and

you are told to unmask.

If symptoms of nerve agent poisoning (paragraph 7-7) appear,

immediately give yourself one MARK I or ATNAA.

CAUTION

Do not inject a nerve agent antidote until you are sure you

need it.

If your eyes and face become contaminated, you must

immediately try to get under cover. You need shelter to prevent further

contamination while performing decontamination procedures on your face.

If no overhead cover is available, put your poncho over your head before

beginning the decontamination process. Then you put on the remaining

7-4

protective clothing. If vomiting occurs, the mask should be lifted

momentarily and drained—with your eyes closed and while holding your

breath—then replaced, cleared, and sealed.

If nerve agents are used, mission permitting, watch for persons

needing nerve agent antidotes and immediately follow procedures outlined in

paragraph 7-8b or c.

Decontaminate your skin immediately and clothing and

equipment as soon as the mission permits.

7-6.

Background Information on Nerve Agents

Nerve agents are among the deadliest of chemical agents.

Nerve agents enter the body by inhalation, by ingestion, and through the

skin. Depending on the route of entry and the amount, nerve agents can

produce injury or death within minutes. Nerve agents can achieve their

effects with small amounts. Nerve agents are absorbed rapidly, and the

effects are felt immediately upon entry into the body. You will be issued

three MARK Is or three ATNAAs and one Convulsant Antidote for Nerve

Agent (CANA). Each MARK I consists of one atropine autoinjector and one

pralidoxime chloride (2 PAM Cl) autoinjector (Figure 7-2A). Each ATNAA

consist of a multichambered autoinjector with the atropine and pralidoxime

chloride in separate chambers

(Figure

7-2C). The CANA is a single

autoinjector with flanges (Figure 7-2B). Procedures for use of both the

MARK I and ATNAA are described below. You will use either the MARK I

or the ATNAA in self-aid and buddy aid as issued.

Figure 7-2. Nerve Agent Antidote Kit, MARK I, CANA, and ATNAA.

7-5

When you have the signs and symptoms of nerve agent

poisoning, you should immediately put on the protective mask and then inject

yourself with one set of the MARK I or ATNAA. Do not administer the CANA.

You should inject yourself in the outer (lateral) thigh muscle (Figure 7-3) or if

you are thin, in the upper outer (lateral) part of the buttocks (Figure 7-4).

Figure 7-3. Thigh injection site.

Figure 7-4. Buttocks injection site.

Also, you may come upon an unconscious chemical agent

casualty who will be unable to care for himself and who will require first aid.

You should be able to successfully—

(1)

Mask him if he is unmasked.

(2)

Inject him, if necessary, with all of HIS autoinjectors.

(3)

Decontaminate his skin.

(4)

Seek medical assistance.

7-6

7-7.

Signs and Symptoms of Nerve Agent Poisoning

The symptoms of nerve agent poisoning are grouped as MILD—those that

you recognize and for which you can perform self-aid, and SEVERE—those

which require buddy aid.

MILD Signs and Symptoms.

•

Unexplained runny nose.

•

Unexplained sudden headache.

•

Sudden drooling.

•

Difficulty seeing (dimness of vision and miosis).

•

Tightness in the chest or difficulty in breathing.

•

Localized sweating and muscular twitching in the area of

contaminated skin.

•

Stomach cramps.

•

Nausea.

•

Tachycardia followed by bradycardia.

(Tachycardia is

an abnormally rapid heartbeat with a heart rate of over 100 beats per minute.

Bradycardia is a slow heart rate of less than 60 beats per minute.)

SEVERE Signs and Symptoms.

•

Strange or confused behavior.

•

Wheezing, dyspnea

(difficulty in breathing), and

coughing.

•

Severely pinpointed pupils.

•

Red eyes with tearing.

•

Vomiting.

•

Severe muscular twitching and general weakness.

•

Involuntary urination and defecation.

7-7

FIRST AID. Field Manual (2002) - page 5