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Combat First Aid

First Aid Mass Casuality

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#1 WallyGator

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Posted 16 December 2015 - 01:08 PM

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 R
esponsiveness, B
reathing, B
leeding, 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'.
 

 


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#2 EndrewBolt

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Posted 24 March 2016 - 08:58 AM

It is good that such information can easily be found on this site! in principle, after the above, I have no questions, thank you for the informative article. However I would also add that it is important to have in a backpack first aid kit


On my blog you can learn more about the backpacks


#3 WallyGator

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Posted 26 March 2016 - 07:15 PM

A first aid kit is great to have but knowledge in how and when to use it can be as necessary. In a mass casualty situation, like what has happened in Belgium recently, you're going to run out of supplies quickly regardless of how large your kit is. That's when triage comes in and being able to improvise will reign supreme. I encourage every body to take a first aid and CPR class at the very minimum. Better yet would be an E.M.T course. 



#4 Ephie

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Posted 28 March 2016 - 09:03 AM

It is great advice WallyGator, I have plans to take an EMT course.

Free first aid training was just offered to residents of Paris, about 3,200 attended

http://bigstory.ap.o...ase-new-attacks



#5 Michael

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Posted 06 August 2016 - 03:31 PM

Good and detailed approach. It can be somewhat simplified as well. Medics of the Army variety are taught HABC as part of TC3 or Tactical Combat Casualty Care. This is what I was taught and did my 5 years as a Combat Medic:

 

Hemmorhage: Upon first contact with casualty assess if there is any arterial bleeding (arterial bleeding requires a hasty and then later a deliberate tourniquet, arterial bleeding is the MOST deadly type of wound and will kill you the fastest, therefore it is addressed first and foremost). If there is no obvious arterial bleeding, the casualty is evacuated via carry or drag to a safer spot off of the 'X' or the point at which the casualty was wounded.

 

**Once the casualty is evacuated to a safer area, you have time to address more detailed care**

 

Airway: This is addressed next and it vaguely falls under responsiveness. If your casualty is talking, yelling or screaming then they more or less have an airway. You can use the AVPU (Alert, Verbal, Pain, Unconscious) to see where they fall under responsiveness specifically, but if time is critical I always tried to get them talking and keep talking to me throughout the entire process. If your casualty is unresponsive your focus is an airway adjuct or a method to secure and maintain an airway. Your two options are a nasopharyngeal airway (NPA) pretty much a tube you stick into their nose to prevent their tongue from collapsing back and causing them so suffocate, or an Oral Pharyngeal Airway (OPA) a J-shaped plastic device you place in their mouth/throat that does the same thing. This is the least-preferred because if your casualty wakes up, it can cause vomiting and then you have to deal with that mess.

 

Breathing: If your casualty is responsive your focus is their respiratory rate within normal limits (this can vary based on the type of activity the casualty is doing like running, sprinting, crawling, shooting, etc. You're also looking to see if the casualty complains of any difficulty breathing or shortness of breath. If they're unresponsive, you need to Look Listen and Feel for their respiratory rate. If they're unconscious they can't tell you they have a hard time breathing, or they have a collapsed lung or Tension Pneumocardia. You have to look, listen and feel for this. 

 

Circulation: This is where you address blow flow, pulse and any potential need to push IV fluids. You assess their pulse (radial is preferred because it is at an extremity and if they have one in both arms you can general infer that they are getting blood flow to the extremities of the body). If they don't have radial pulses, you can infer that they're not getting enough blood flow and it's a good indication of incoming hypo-volemic shock. They always taught us to automatically push at least 500 mL of Hextend in this case. This is also where you do a thorough blood-sweep to address bleeding that isn't immediately life-threatening. You also convert your hasty tourniquets into deliberate ones (ones that are closer to any amputations or arterial bleeding). If you can stop bleeding without using a tourniquet like a pressure bandage or an Israeli Bandage then do it. The time limit for a tourniquet used to be 6 hours, I think it's 2 hours now before compartment syndrome sets in and the casualty will lose that limb no matter what. 

 

Some in terms of 'simplifying' not sure if it does that, but the steps are less numerous and it addresses what will actually kill your casualty FAST. If someone gets hurt, really bad, your main goal is to stabilize and get them out of there to higher care ASAP. Hope this helps. 



#6 Dan Post

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Posted 07 August 2016 - 01:50 AM

This is interesting to see how the military handles this. I have noticed some differences from my civilian EMT training. In a trauma, NREMT teaches to use AVPU (alert, verbal, pain, unresponsive) while checking for AMS.

I noticed the acronym used here is different as well. I use the standard ABC immediately (airway, breathing, circulation).

The first thing I'm trained to do in a trauma (with significant mech. Of injury) is to establish C-spine stabilization. Also, when obtaining a simple patent airway, using the jaw thrust over head tilt, chin lift.

Anyways, I know combat EMS is a much different animal than civilian EMS. It's just interesting to see the differences!

#7 Stupendous Walrus

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Posted 15 August 2016 - 08:52 PM

Thanks for posting this! Very interesting read. I assumed combat first aid was putting a band aid on your AK. 


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#8 WallyGator

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Posted 16 August 2016 - 03:20 AM

Thanks for posting this! Very interesting read. I assumed combat first aid was putting a band aid on your AK. 

 

or your AR-15 depending of where you're from.


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