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Combat First Aid for Marines.ppt

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									 Combat First Aid for Marines

         LT Sameer Bakhda, M.D.
Flight Surgeon, HMLA-267  “Stingers” 
         SPMAGTF/February 2003
          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.)

February 2003            HMLA-267 Combat First Aid   Slide 2
          Overview
               Patient Evaluation

               Airway Management
                   Choking/Rescue Breathing/CPR

               Sucking Chest Wound/Tension Pneumothorax

               Battle Dressings/Cravats
                   Abdominal Wounds
                   Pressure Dressings
                   Tourniquets and Amputations


February 2003                 HMLA-267 Combat First Aid    Slide 3
          Overview
               Treat for Shock

               Head and Face Wounds

               Fractures and Splinting

               Burns/Electrical Shock/Smoke Inhalation

               Preventive Medicine (hygiene/water safety)

February 2003             HMLA-267 Combat First Aid       Slide 4
          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

February 2003            HMLA-267 Combat First Aid   Slide 5
          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!
February 2003            HMLA-267 Combat First Aid   Slide 6
          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)

February 2003               HMLA-267 Combat First Aid     Slide 7
          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!
February 2003               HMLA-267 Combat First Aid        Slide 8
                Airway

February 2003   HMLA-267 Combat First Aid   Slide 9
          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


February 2003                HMLA-267 Combat First Aid      Slide 10
                Breathing

February 2003    HMLA-267 Combat First Aid   Slide 11
          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
February 2003               HMLA-267 Combat First Aid        Slide 12
          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!!)

February 2003             HMLA-267 Combat First Aid     Slide 13
          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

February 2003                HMLA-267 Combat First Aid          Slide 14
          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


February 2003                HMLA-267 Combat First Aid            Slide 15
          Sucking Chest Wound

               Roll casualty onto injured side and
                check for exit wound
                   If present, treat the same way


               Monitor airway and breathing


February 2003               HMLA-267 Combat First Aid   Slide 16
February 2003   HMLA-267 Combat First Aid   Slide 17
          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


February 2003    HMLA-267 Combat First Aid                      Slide 18
          Circulation:
       Stop the Bleeding

February 2003   HMLA-267 Combat First Aid   Slide 19
          Battle Dressings
               Use to stop bleeding and cover wounds

               Large enough to cover most wounds

               Small/lightweight



February 2003            HMLA-267 Combat First Aid   Slide 20
          Battle Dressings

                          Standard Battle Dressing
                          Tear open plastic wrap.




                          Twist to open paper
                          wrapper and remove
                          dressing


February 2003     HMLA-267 Combat First Aid          Slide 21
          Battle Dressings

                   Unfold bandage and
                   apply to wound.




                             Wrap tails around and
                             tie together.



February 2003     HMLA-267 Combat First Aid          Slide 22
          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

February 2003            HMLA-267 Combat First Aid   Slide 23
          Triangular Bandage (Cravat)

                                Highly useful and
                                 multipurpose

                                Can be used as a
                                 sling, tourniquet, head
                                 dressing, etc. etc. etc.

February 2003     HMLA-267 Combat First Aid          Slide 24
          Triangular Bandage (Cravat)




                               Fold bandage into a cravat (3-
                                fold) and use for tourniquet


February 2003     HMLA-267 Combat First Aid              Slide 25
          Triangular Bandage (Cravat)



                                     Elbow brace/splint



                             Extremity (hand/stump)
                                    dressing


February 2003     HMLA-267 Combat First Aid                Slide 26
          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
February 2003              HMLA-267 Combat First Aid   Slide 27
          Pressure Dressings

                                   Tie gauze pack into
                                    place using cravat or
                                    battle dressing

                                   Do not cut off
                                    circulation!


February 2003     HMLA-267 Combat First Aid          Slide 28
          Pressure Points

                                             Use finger
                                              pressure on
                                              these points to
                                              stop bleeding

                                             Also, place
                                              tourniquet band
                                              over these points
                                              (arteries)

February 2003     HMLA-267 Combat First Aid                 Slide 29
          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


February 2003                HMLA-267 Combat First Aid          Slide 30
          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

February 2003               HMLA-267 Combat First Aid       Slide 31
          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

February 2003                   HMLA-267 Combat First Aid                      Slide 32
          Applying a Tourniquet




February 2003     HMLA-267 Combat First Aid   Slide 33
          Abdominal Wounds
               Place victim on back with knees flexed:




February 2003            HMLA-267 Combat First Aid   Slide 34
          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




February 2003                 HMLA-267 Combat First Aid            Slide 35
          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!




February 2003                   HMLA-267 Combat First Aid             Slide 36
          Head and Face Wounds
               Make sure airway is not obstructed!

               Control bleeding using direct pressure

               Monitor airway and breathing after
                bleeding is controlled


February 2003            HMLA-267 Combat First Aid    Slide 37
          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

February 2003                HMLA-267 Combat First Aid              Slide 38
          Head and Face Wounds
                     Use cravat and gauze to
                provide direct pressure on wounds:




February 2003          HMLA-267 Combat First Aid     Slide 39
                  Circulation:
                Treat for Shock

February 2003       HMLA-267 Combat First Aid   Slide 40
          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!


February 2003            HMLA-267 Combat First Aid   Slide 41
          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

February 2003                      HMLA-267 Combat First Aid   Slide 42
          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


February 2003                  HMLA-267 Combat First Aid                  Slide 43
Treat Other Injuries

February 2003   HMLA-267 Combat First Aid   Slide 44
          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!

February 2003                   HMLA-267 Combat First Aid           Slide 45
          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

February 2003                     HMLA-267 Combat First Aid               Slide 46
          Fractures and Splinting




February 2003     HMLA-267 Combat First Aid   Slide 47
          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

February 2003                   HMLA-267 Combat First Aid                  Slide 48
          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


February 2003                HMLA-267 Combat First Aid             Slide 49
          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
February 2003                  HMLA-267 Combat First Aid            Slide 50
Preventive Medicine

February 2003   HMLA-267 Combat First Aid   Slide 51
          Basic Preventive Medicine
               Diseases from Non-Battle Injury (DNBI)
                cause more loss of military personnel
                than battle injuries!

               You are no use to yourself, your
                friends, or your unit if you are sick

               We need you to stay in the fight!
February 2003             HMLA-267 Combat First Aid     Slide 52
          Basic Preventive Medicine
               Shower every day (or at least wash with
                soapy water) and wear clean uniforms

               Wash and dry your feet every day
                   Change your socks and use foot powder


               Wash your hands before eating and after
                using the head
                   Use the towelettes in your MRE before eating

February 2003                HMLA-267 Combat First Aid             Slide 53
          Basic Preventive Medicine
               Clean your mouth and teeth twice a day

               Get enough sleep, when possible!

               Use sunscreen and insect repellant
                   Doxycycline (anti-malaria pills) will make
                    you very sensitive to the sun!
                   Use sunscreen with SPF 15 (or higher)

February 2003               HMLA-267 Combat First Aid       Slide 54
          Basic Preventive Medicine
               Stay hydrated – drink plenty of water and keep your
                canteens/CamelBak full
                   Coffee, soda, and alcohol will DEHYDRATE you


               Use only the water bull or other sources of tested,
                potable water
                   Use MRE water flavoring if needed


               Don’t keep food or trash in your living quarters
                   Attracts bugs and rodents that transmit disease


February 2003                  HMLA-267 Combat First Aid              Slide 55
          Insect Protection
               Wear sleeves down/pants bloused in boots

               Make sure uniform is treated with permethrin

               Use insect repellant (DEET cream) every 4-6
                hours and use your insect head/bed netting

               Shake out your boots and check your bed for
                scorpions and other nasty visitors!
February 2003             HMLA-267 Combat First Aid     Slide 56
          Food Safety
               Diarrhea and food poisoning can quickly take you out
                of the fight

               Avoid local food and water (including ice!)
                   Eat MREs and drink water from the water bull

               If you must, eat only hot food, baked goods, or fruit
                you can peel

               Do not consume food or drink in galvanized
                containers; aluminum canned sodas are OK


February 2003                  HMLA-267 Combat First Aid           Slide 57
          Water Purification
               Fill your canteen with water (be careful not to
                get trash or other objects in your canteen).

               Add two iodine tablets per quart of water
                   If you are out, boil the water for 5 minutes


               Replace the cap loosely.


February 2003                 HMLA-267 Combat First Aid            Slide 58
          Water Purification
               Wait 5 minutes.

               Shake the canteen well and allow some of the
                water to leak out.

               Tighten the cap.

               Wait an additional 20 minutes before drinking
                the water.
February 2003             HMLA-267 Combat First Aid      Slide 59
          Conclusion
               You may be the first one on scene at a battlefield
                injury, an aircraft mishap, or a traffic accident…

               BE PREPARED and you can save people’s lives!
                   Stay current with your first aid and CPR training throughout
                    your life
                   Keep your personal first aid kits and supplies stocked and up
                    to date


               Always contact trained medical help EARLY for
                definitive care

February 2003                  HMLA-267 Combat First Aid                   Slide 60
          Questions?




February 2003    HMLA-267 Combat First Aid   Slide 61

								
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