Combat First Aid for Marines

1. Combat First Aid for Marines LT Sameer Bakhda, M.D. Flight Surgeon, HMLA-267  “Stingers”  SPMAGTF/February 2003

2. First Aid • Just like our motto says – you may need it any time, any where • First responder can make a big difference in patient outcome • Remember to call for help! (911, etc.) HMLA-267 Combat First Aid

3. Overview • Patient Evaluation • Airway Management • Choking/Rescue Breathing/CPR • Sucking Chest Wound/Tension Pneumothorax • Battle Dressings/Cravats • Abdominal Wounds • Pressure Dressings • Tourniquets and Amputations HMLA-267 Combat First Aid

4. Overview • Treat for Shock • Head and Face Wounds • Fractures and Splinting • Burns/Electrical Shock/Smoke Inhalation • Preventive Medicine (hygiene/water safety) HMLA-267 Combat First Aid

5. 6 Steps of Basic First Aid • Ensure area is safe and get help • Open the airway and restore breathing • Stop bleeding and protect wounds • Check and treat for shock • Check for other injuries and treat • Give a good report to Medical HMLA-267 Combat First Aid

6. Combat vs. Civilian First Aid • The best medicine on the battlefield is fire superiority. • Return fire, get the victim OUT of the line of fire before detailed care. • Some rules don’t apply on the battlefield! HMLA-267 Combat First Aid

7. Initial Evaluation • First step – evaluate the victim • “Are you OK?” • Establish ABCs – Airway, Breathing, Circulation • CPR if needed (separate course) • Identify injuries and mechanism (how it happened) HMLA-267 Combat First Aid

8. Initial Evaluation – CBR • If a suspected CBR injury, immediately mask the patient (and yourself!) • Don your MOPP suit to protect yourself • Do not expose wounds or injuries in an CBR environment • Put on dressings/tourniquets OVER protective overgarments! HMLA-267 Combat First Aid

9. Airway HMLA-267 Combat First Aid

10. Open the Airway • Check for airway obstruction/choking • Use Heimlich maneuver, back blows, or finger sweep to clear obstruction • Open airway • Head-tilt/chin-lift • Jaw-thrust HMLA-267 Combat First Aid

11. Breathing HMLA-267 Combat First Aid

12. No Breathing • Tilt head back and pinch nose • Give 2 full, slow breaths • If not going in, check for obstruction • Reposition head if needed • 1 breath every 5 seconds HMLA-267 Combat First Aid

13. Rescue Breathing/CPR • This is the subject of a full course! • Need refresher training if you are not up-to-date!! • Don’t do on the battlefield (not shown to help with battle injuries!!) HMLA-267 Combat First Aid

14. Sucking Chest Wound • Also known as “open pneumothorax” • Wound to chest will allow air to leak inside • This can collapse the lung and compress the heart • “Tension pneumothorax” – as in Three Kings • Must prevent air from entering chest cavity • Use a 3-sided dressing to create a “flutter valve” effect HMLA-267 Combat First Aid

15. Sucking Chest Wound • Use the plastic wrapper from a battle dressing to create a seal • Tape dressing in place on three sides • Leave one side open • Allows air to escape, but not reenter • Cover wound with battle dressing • Tie in place after he exhales and before he inhales HMLA-267 Combat First Aid

16. Sucking Chest Wound • Roll casualty onto injured side and check for exit wound • If present, treat the same way • Monitor airway and breathing HMLA-267 Combat First Aid

17. HMLA-267 Combat First Aid

18. Tension Pneumothorax • #2 cause of battlefield death (after bleeding) • Treat by inserting large needle (IV catheter) into space between 2nd and 3rd ribs in middle of affected side • Decompresses chest and reexpands lung HMLA-267 Combat First Aid

19. Circulation:Stop the Bleeding HMLA-267 Combat First Aid

20. Battle Dressings • Use to stop bleeding and cover wounds • Large enough to cover most wounds • Small/lightweight HMLA-267 Combat First Aid

21. Battle Dressings Standard Battle Dressing Tear open plastic wrap. Twist to open paper wrapper and remove dressing HMLA-267 Combat First Aid

22. Battle Dressings Unfold bandage and apply to wound. Wrap tails around and tie together. HMLA-267 Combat First Aid

23. Battle Dressings • If the dressing is not big enough to cover wound, you can put the inside (sterile) part of the wrapper over the wound • Cover with the battle dressing and tie into place HMLA-267 Combat First Aid

24. Triangular Bandage (Cravat) • Highly useful and multipurpose • Can be used as a sling, tourniquet, head dressing, etc. etc. etc. HMLA-267 Combat First Aid

25. Triangular Bandage (Cravat) Fold bandage into a cravat (3-fold) and use for tourniquet HMLA-267 Combat First Aid

26. Triangular Bandage (Cravat)  Elbow brace/splint Extremity (hand/stump) dressing HMLA-267 Combat First Aid

27. Pressure Dressings • Use if bleeding has soaked through battle dressing • Usually for extremity wounds • Elevate limb and put wad of gauze padding over injury site HMLA-267 Combat First Aid

28. Pressure Dressings • Tie gauze pack into place using cravat or battle dressing • Do not cut off circulation! HMLA-267 Combat First Aid

29. Pressure Points • Use finger pressure on these points to stop bleeding • Also, place tourniquet band over these points (arteries) HMLA-267 Combat First Aid

30. Tourniquets • Civilian use frowns on tourniquet use • Assumes trauma center nearby • Critically valuable in military setting • #1 cause of preventable battle death is bleeding • Tourniquets can stop this blood loss • Surgeons use tourniquets for hours without damage to limb HMLA-267 Combat First Aid

31. Tourniquets • Still a treatment of last resort • Use a pressure dressing first! • Try finger pressure on pressure points • Only apply tourniquet if bleeding doesn’t stop! • Will almost always need a tourniquet to stop bleeding from amputations HMLA-267 Combat First Aid

32. Tourniquet Use • Need a triangular dressing and a stick • Fold dressing into a cravat (3-fold) – at least 2” wide! • Wrap cravat around limb above wound and tie a half-knot • Place stick over knot, tie a full knot, and then twist until tight • Tie loose ends around limb to secure tourniquet and prevent untwisting HMLA-267 Combat First Aid

33. Applying a Tourniquet HMLA-267 Combat First Aid

34. Abdominal Wounds • Place victim on back with knees flexed: HMLA-267 Combat First Aid

35. Abdominal Wounds • Place any protruding organs on top of wound • Use clean dressing or cleanest material for this • Do NOT try to replace intestines or organs HMLA-267 Combat First Aid

36. Abdominal Wounds • Cover wound with dressing moistened with water • Use sterile or potable water if available • Tie tails at casualty’s side, not directly on wound • Minimize pressure on wound and internal organs! HMLA-267 Combat First Aid

37. Head and Face Wounds • Make sure airway is not obstructed! • Control bleeding using direct pressure • Monitor airway and breathing after bleeding is controlled HMLA-267 Combat First Aid

38. Head and Face Wounds • Can use battle dressings and/or cravats to control bleeding • Scalp and face wounds bleed profusely • However, these are often not serious or life-threatening! • Wrap tails under chin, cross over site of injury and loop around back of head; tie into place on uninjured side HMLA-267 Combat First Aid

39. Head and Face Wounds Use cravat and gauze to provide direct pressure on wounds: HMLA-267 Combat First Aid

40. Circulation:Treat for Shock HMLA-267 Combat First Aid

41. SHOCK • Shock is the failure to get blood and oxygen to the body’s tissues • Can be caused by brain injuries, heart problems, allergic reactions, infections… but is usually from loss of blood! HMLA-267 Combat First Aid

42. Signs of Shock • Anxiety, restlessness and fainting • Nausea and vomiting • Excessive thirst • Eyes are vacant or dull; large pupils • Shallow, rapid, and irregular breathing • Pale, cold, moist, clammy skin • Weak, rapid, or absent pulse HMLA-267 Combat First Aid

43. Treat for Shock • Maintain ABCs – open airway, control bleeding, splint fractures • Loosen clothing and elevate legs higher than heart • Keep victim warm – remove wet clothes • Restore fluids – IV fluids if possible, give lots of fluids by mouth if no belly injuries and not vomiting • On battlefield, may be long time to surgery! • Watch for vomiting and turn head to side if present HMLA-267 Combat First Aid

44. Treat Other Injuries HMLA-267 Combat First Aid

45. Fractures and Splinting • Two types of fractures: • Closed = no skin breaks • Open = fracture breaks through skin • Used to be called a “compound” fracture • Immobilize fracture for comfort and prevent further injury • Do not try to straighten or reposition bones! • Do not push ends of bones back into body! HMLA-267 Combat First Aid

46. Fractures and Splinting • Can use any rigid material for splint • Wood, cardboard, plastic – even 2 M-16s! • Pad the splint where it touches the body • Place splints on both sides of the arm/leg • Immobilize the joint ABOVE and BELOW if possible • Check for circulation in limb after splint placed • If no circulation below splint, loosen splint! • Tie into place using cravats away from injury HMLA-267 Combat First Aid

47. Fractures and Splinting HMLA-267 Combat First Aid

48. Burns • First step – remove victim from source of burn! • Stop/Drop/Roll for fire • Remove chemicals causing burns • LOTS of water for wet chemicals • Brush off dry chemicals (don’t use your hand!) • White phosphorus burns in air – cover with wet dressing • Cut away clothing around burn and remove jewelry • Do not cut clothing stuck to skin HMLA-267 Combat First Aid

49. Burns • Place a battle dressing gently over the burned area • Don’t put ointments or anything else on the burn • Encourage oral hydration, especially if a large area is burned • Burned-off skin loses moisture very rapidly! • Must replace fluid orally and/or with an IV HMLA-267 Combat First Aid

50. Electrical Shock • TURN OFF POWER, if able to quickly! • If not, remove victim from current • Use nonconductive material to drag victim away – dry rope, dry clothing, etc. • Don’t touch victim or use conductive material! • Water or metal will make YOU a victim! • Treat ABCs and burns as needed HMLA-267 Combat First Aid