I recieved this in my email from www.infidelbodyarmor.com and thought it was a very concise down-to-earth approach to a mass casualty situation. The article is reprinted by permission of Infidel Body Armor.
Combat First Aid
One of the instructional videos I was shown during Combat Lifesaver classes while training up to go overseas to Afghanistan was, strangely enough, a scene from the movie Black Hawk Down. In the scene, several soldiers are running across a street to get to cover. One of the soldiers gets shot in the radio backpack he has, and goes down. Another soldier goes out to retrieve him, gets shot through the leg, and they both get back to safety. The first soldier to get shot was unharmed, just knocked down. The second soldier dies because the bullet pierced an artery. It really drove home the point of what the first step of Combat Lifesaving is: return fire!
If someone in your group is injured in any way while out on a mission, or defending your home, the first step you must take is to deal with any active threats. It makes sense, but I would have never thought about it before it was taught to me. So, instead of running out and making yourself another possible casualty, you keep sending rounds down range until the threat is dealt with, or until you have enough cover to get the wounded in the case of a hasty retreat.
A handy acronym for evaluating a casualty when you're at a safe spot is RBBSFBH (I always rememebered it by thinking of a nonsense word, “Rubsfub,” or the sadly juvenile “Really Big Boobs Should Fill Both Hands.”) It stands for Responsiveness, Breathing, Bleeding, Shock, Fractures, Burns, Headtrauma. Also, at this point, it would be good to note that you absolutely need some first aid kits on each person in your group, along with a larger first aid bag assigned to a designated Combat Lifesaver, if possible.
Responsiveness: The first thing you want to do is check for responsiveness in the casualty by asking them questions, gently shaking them, or snapping fingers. Anything you can do to see if they are conscious or not. This is the first step, because if someone is conscious, they can often times tell you what's wrong with them, or you can gather more information quickly based on if they can't speak (choking, sucking chest wound, etc.) and so on.
Breathing: Breathing is next. If the casualty is not conscious, the best way to check for this is to put your ear over their mouth, and look at the chest. You should feel the air on your cheek, and see the chest rise and fall. At this point, if they are not breathing, it is the best time to do the head-tilt, chin-lift on the casualty, which is to tilt the head back, while lifting the chin up. This opens their airway. We were taught in the Army to not perform any sort of CPR in a combat situation if someone isn't breathing. It's a hard, sad truth, but CPR is a continuous process which heavily taxes the one performing it, and unless you have some extreme MEDEVAC (Medical Evacuation) in place with life support, you are not going to save their life. Immediately stop treatment, and secure any high priority items.
Bleeding: Pretty self explanatory. Look for bloodstains on the clothing. Check their circulation through the neck and/or wrists. Sandwich the limbs with each hand held flat, and work your way down them to check underneath for moisture. Also slide your hands under their back/front, or whichever you can't readily see. If the bleeding is extensive, then immediately slap a tourniquette on the affected limb. Otherwise, apply a pressure-dressing, or stuff gauze, or even a tampon, into the wound. If you've applied a tourniquette, try and apply a pressure dressing to the wound and loosen the tourniquette after an hour or so to see if the bleeding has stopped. This might potentially save a limb if within six hours.
Shock: To check for shock, press their fingernails and toenails and observe how quickly the color returns. Also check for sweaty but cool skin, paleness, restlessness, thirst, nasuea and/or vomiting. To treat, try and regulate their body temperature by wrapping in a blanket if cold, or moving the victim to shade if it's hot, and loosening clothing around the neck and waist, or wherever else that is binding.
Fractures: Simply check for any broken bones, either sticking out of the skin, or visibly disjointed. Apply a splint when possible, and avoid moving the patient unless it's necessary to their survival.
Burns: For burns, you will want to cut and lift any clothing away from the burn site. If it sticks to the skin, leave the clothing in place. Wrap the burn wounds in the cleanest field dressing you can find to avoid infection.
Headtrauma: Lastly, check for fluids around the ears or nose, uneven pupil dilation, irratic behavior, confusion, lack of eye control and responsiveness, vertigo, vomiting, slurred speech, and hearing loss. Always assume the risk of spinal injury, and avoid moving the casualty unless absolutely necessary, keeping the spine and neck aligned. Keep the airway open and check circulation. There is not a lot you can do, except get the person to safety and get them to further treatment.
In closing, remember that if you find someone who has no vital signs and you are not able to help them, that they are not “them,” they are a corpse. This is vital to keep your mental stability in the face of tragedy. Hopefully it won't come to that. Keep on survivin'.
