After completing this lesson, you should be able to:
2-1. Identify procedures for evaluating a casualty under combat conditions.
2-2. Identify the proper sequence of actions used in evaluating a casualty.
2-3. Identify the procedures for turning a casualty onto his back.
2-4. Identify the procedures for checking a casualty for breathing.
2-5, Identify the procedures for checking a casualty for bleeding.
REFERENCES
STP 21-1-SMCT, Soldier's Manual of Common Tasks: Skill
Level 1.
FM 4-25.11, First Aid.
FM 100-14, Risk Management.
Training Support Package 071-D-2316 / First Aid 1 (Evaluate a Casualty for
Life-Threatening Conditions).
LESSON 2
EVALUATING A CASUALTY
2-1. INTRODUCTION
This lesson assumes that you are in a combat situation,
there is a wounded soldier in need of help, and you can provide care without
endangering your combat mission.
WARNING:
If there are any signs of nerve agent poisoning, stop the evaluation, take the necessary NBC
protective measures, and then resume appropriate first aid measures (Lesson 8).
2-2. ACTIONS BEFORE APPROACHING THE CASUALTY
Take the following actions before approaching the casualty
on the battlefield. Remember to protect yourself.
a. Scan the area for potential danger.
(1) Survey the area for small arms fire.
(2) Detect area for fire or explosive devices.
(3) Determine threat for chemical or biological agents.
(4) Survey buildings, if any, for structural stability.
b.
Determine the best route of access to the casualty and the best route of
egress. If you need to move the casualty to a safer area, be sure to select
an area that provides optimum cover and concealment. Plan your evacuation
route prior to exposing yourself to possible hostile fire.
c. Request
covering fire to reduce the risk to yourself and the casualty during
movement to and from the casualty's location.
d. Anticipate
the type of injuries the casualty may have received and what care will
probably be needed. Did the casualty fall from a wall (broken bones)? Was
there an explosion (blast effects)? Was there only small arms fire (bleeding
wounds)?
e. Anticipate
how your actions (movement, noise, light, etc.) may affect the enemy's fire.
f. Decide what
care you can administer to the casualty when you reach him and what care
will have to wait until you have returned the casualty to a place of safety.
2-3. INITIAL ACTIONS
Remember, if you and the casualty are still under
effective hostile fire, return fire as directed or required. Do not expose
yourself to enemy fire in order to provide care.
a. If possible,
determine if casualty is alive or dead.
b. Provide
tactical care to the live casualty.
(1) Suppress enemy fire. Reducing enemy fire may be more important to the casualty's survival than the treatment you can provide.
(2) If the casualty can function, direct him to return fire, move to cover, and administer self-aid.
(3) If the casualty is unable to return fire or move to safety and you cannot assist him, tell the casualty to "play dead."
c. When the combat situation allows you to safely assist the casualty, do so.
(1) Approach the casualty by the safest route.
(2) Form a general impression as you approach the casualty (extent of injuries, chance of survival, and so forth).
(3) If you are still exposed to enemy fire, apply a tourniquet if there is a limb with severe, life-threatening bleeding and move the casualty and yourself to a safe location. DO NOT take time to evaluate the casualty's breathing until you and the casualty are in a safe location.
(4) If you move the casualty and yourself to a safer location, take the casualty's weapon and other mission-essential equipment with you.
2-4. CHECKING THE CASUALTY FOR RESPONSIVENESS
a. To check the
casualty for responsiveness:
(1) Ask in a loud, but calm, voice: "Are you okay?" Gently shake or tap the casualty on the shoulder.
(2) Determine level of consciousness by using AVPU (A = Alert; V = responds to Voice; P = responds to Pain; U = Unresponsive). See paragraph 1-4c of Lesson 1 for additional information.
NOTE: If the
casualty is alert or responds to voice, do not check the casualty's response
to pain.
NOTE: To check a
casualty’s response to pain, rub his breastbone briskly with a knuckle or
squeeze his fist.
b. If the
casualty is conscious, ask where it hurts or where his body feels different
than usual. This helps to determine the level of responsiveness and provides
you with information that can be used when treating the casualty.
c. If the
casualty is unconscious, position the casualty on his back, open his airway
(Lesson 3) and check for breathing. Opening his airway may result in the
casualty's level of consciousness being upgraded.
d. If the
casualty is conscious, evaluate his breathing and see if a nasopharyngeal
airway is needed.
2-5. POSITIONING THE CASUALTY ON HIS BACK
Position the casualty on his back if he is not already
lying on his back. To turn a casualty lying on his front onto his back,
perform the following steps.
NOTE: It is
assumed that you and the casualty are in a protected area. If you are still
exposed to enemy fire, apply a tourniquet to control any severe bleeding and
move the casualty and yourself to a safe location.
a. Kneel beside
the casualty with your knees near his shoulders, leaving space to roll the
body.
b. Take the
casualty’s arm that is nearest to you and move it so that it is straight and
above his head. Repeat the procedure with the other arm.
c. Adjust the
casualty’s legs so that they are together and straight or nearly straight.
d. Place one
hand behind the head or neck for support.
e. Reach across
the casualty with your free hand and grasp the casualty under the far arm
(armpit area).
f. Pull
steadily and evenly toward yourself, keeping the head and neck in line with
the torso.
g. Roll the
casualty as a single unit. The head and neck should stay in line.
h. Once the
casualty is rolled onto his back, place his arms at his sides.
NOTE: This method
of rolling the casualty is used to minimize further injury to the casualty's
spine in case he has suffered an injury to the head, neck, or back.
2-6. CHECKING THE CASUALTY FOR BREATHING
Check the casualty for breathing and for injuries that
could affect his respirations.
NOTE: If the
casualty is conscious and talking, his breathing is satisfactory for now.
However, continue to monitor the casualty's breathing since swelling throat
tissue, bleeding into the throat, or other injuries could require you to
establish an airway and perform rescue breathing.
a. Look, listen
and feel for respirations. If the casualty is breathing, determine if the
breathing rate is normal, rapid, or slow.
(1) Place your ear about one inch above the casualty's mouth and nose. Listen for breathing. Look at the casualty's chest to see if it is rising and falling.
(2) Feel for breathing by placing your cheek about one inch above the casualty's mouth and nose. Feel for air being exhaled.
NOTE: If the
casualty is not breathing, stop the evaluation and try to restore the airway
using the head-tilt/chin-lift or jaw thrust, then check for breathing again.
If you cannot detect breathing, proceed to perform rescue breathing (see
Lesson 3).
NOTE: In a combat
situation, if you find a casualty with no signs of life (no breathing and no
pulse), do not attempt to restore the airway. Do not attempt
to perform cardiopulmonary resuscitation. Do not continue first aid
measures.
(3) Count the casualty's respirations (one inhalation and one expiration together is one respiration) for 15 seconds. If the casualty has less than two respirations during the 15 seconds, insert a nasopharyngeal airway (Lesson 3) after checking for open chest wounds.
b. Expose the casualty’s chest to look for equal rise and fall of the chest and for wounds.
(1) If the casualty’s chest is not rising and falling evenly, make a mental note and proceed with the evaluation.
(2) If the casualty has a penetrating chest wound and is breathing or making an effort to breathe, stop the evaluation and apply an occlusive dressing (Lesson 4) to seal the penetrating wound.
NOTE: Check for entrance and exit wounds to the chest. If an entrance wound and an exit wound are present, both must be sealed.
(3) If the casualty has a penetrating chest wound, is not breathing, and is making no effort to breathe, do not attempt to treat the injury.
2-7. CHECKING THE CASUALTY FOR BLEEDING
a. Look for
blood-soaked clothes.
b. Look for
entry and exit wounds.
c. Place your
hands behind the casualty’s neck and pass them upward toward the top of the
head. Note whether there is blood or brain tissue on your hands from the
casualty’s wounds.
d. Place your
hands behind the casualty’s shoulders and pass them downward behind the
back, the thighs, and the legs. Note whether there is blood on your hands
from the casualty’s wounds.
e. If
life-threatening bleeding from an extremity (arm or leg) is present, stop
the bleeding using a tourniquet or emergency bandage (Lesson 5).
2-8. ADDITIONAL CARE
a. After any
needed immediate live-saving aid has been administered, perform additional
care. For example, bandage other wounds (Lesson 5) and splint major
fractures (Lesson 6).
b. If possible,
send a soldier to find a combat medic.
c. Administer
additional care until the combat medic arrives or until you are told to
resume your combat duties. Now that you are in a safe area, you can render
care that you could not administer while under fire.
d. Reassure the
casualty. Show confidence in your actions.
e. Continue to
monitor the casualty's breathing.
(1) If the casualty's breathing rate falls below two breaths every 15 seconds, insert a nasopharyngeal airway (Lesson 3).
(2) If tension pneumothorax develops, perform a needle chest decompression (Lesson 4)
f. If needed,
prepare the casualty for evacuation (Lesson 7).
2-9. CLOSING
a. As discussed
in Lesson 1, there are three primary preventable causes of death from
injury on the battlefield. You are able to help prevent death from all three
causes. The preventable causes of battlefield deaths are:
(1) Severe bleeding from an arm or leg wound (apply a tourniquet or emergency dressing).
(2) Collapsed lung (perform needle chest decompression).
(3) Blockage of the nose and throat from an injury to the face (insert a nasopharyngeal airway).
b. Remember, there are times when you should not provide care. Do not take time to treat an injured soldier if:
(1) You are under fire and providing care places your own life in immediate danger.
(2) Taking time to prove care will endanger the combat mission.
(3) The casualty does not have vital (life) signs; that is, the casualty is not breathing, does not have a pulse, and is not moving.
(4) The casualty's injury is probably not survivable given the battlefield situation. Examples of such injuries are:(a) Penetrating head injuries with brain tissue exposed.
(b) Severe burns covering a large part of the body.
(c) Mutilating blast injuries.
LESSON EXERCISES: LESSON 2
INSTRUCTIONS: Answer the following exercises by
marking the letter of the response that best answers the question or
best completes the sentence or by writing the answer in the space
provided.
After you have answered all of the exercises, check your
answers against the "Solutions to Lesson Exercises" at the end of the
exercises. For each exercise answered incorrectly, reread the lesson
material referenced.
1. You are going to the aid of an injured soldier on
the battlefield. Which of the following should you do first?
a. Scan the area for possible dangers.
b. Check the soldier's pulse.
c. Check the soldier for breathing.
d. Check the soldier for bleeding.
2. The casualty is lying on his back. You see a penetrating wound to the front of a casualty’s chest. Which of the following is true?
a. You only need to seal the visible chest wound.
b. You need to check for both entrance and exit wounds to the chest and seal both.
3. Your unit has received fire from the enemy. A fellow soldier has been wounded and cannot seek shelter on his own. You determine that you can reach the soldier without serious risk to yourself. When should you plan how you will move the soldier to safety?
a. Before you leave your place of safety to go to the wounded soldier.
b. As soon as you reach the wounded soldier.
c. As soon as you have treated the life-threatening conditions.
d. As soon as you have treated all of the casualty's injuries.
4. You unit is receiving enemy fire. You have safely reached a wounded casualty The casualty has a penetrating chest wound, is not breathing, and is making no effort to breathe. What should you do?
a. Begin performing cardiopulmonary resuscitation.
b. Seal the chest wound(s).
c. Apply a tourniquet and move the casualty to a place of safety.
d. Do not try to treat the casualty; seek safety for yourself.
5. You are determining the casualty's level of responsiveness. The casualty tells you that he has been shot. Should you test the casualty's responsiveness to pain?
a. Yes, a full testing is needed.
b. No, you already have sufficient information to make a determination that the casualty is alert.
6. When evaluating a casualty's breathing, the casualty should be in what position?
a. On his back (supine).
b. On his chest (prone).
c. Lying on his injured side.
d. Lying on his uninjured side.
7. Which of the following should you treat first if exposed to enemy fire?
a. Bleeding.
b. Breathing difficulties with a penetrating chest wound.
8. Which of the following should you treat first if you and the casualty are in a protected area?
a. Bleeding.
b. Breathing difficulties with a penetrating chest wound.
9. How does evaluation and treatment of a casualty in a
secure situation differ from that in a combat (under fire) situation?
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
10. What are the three principal preventable causes of
death on the battlefield?
________________________________________________________________
________________________________________________________________
________________________________________________________________
11. What are three situations in which you would not
treat a casualty?
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________________________________________________________________
________________________________________________________________
12. You are going to turn a casualty lying on his front
onto his back. Which of the following is correct?
a. Place his near arm above his head and his far arm by his side.
b. Place his far arm above his head and his near arm by his side.
c. Place both of his arms above his head.
d. Place both of his arms by his sides.
13. You are evaluating the responsiveness of a
casualty. He does not respond when you shake his shoulder or tell him to
move his arm. Your next step would be to check the casualty's response to
______________ . List two ways of performing this test
________________________________________________________________
________________________________________________________________
14. Practice performing an evaluation on a simulated casualty.
SOLUTIONS TO LESSON EXERCISES: LESSON 2 (SCROLL DOWN)
1. a (para 2-2a)
2. b (paras 2-6b(2), b(2) Note)
3. a (para 2-2b)
4. d (paras 2-6b(3), 2-9b); this casualty will not survive and you may
expose
yourself to enemy fire.
5. b (para 2-4a(2) first Note)
6. a (paras 2-4c, 2-5)
7 a (para 2-3c(3))
8. b (paras 2-6, 2-7)
9. In a secure environment, immediate danger from enemy fire will not be
a factor. This will allow you to focus more on the evaluation, treatment
,and evacuation of the casualty without worrying about danger to yourself.
(para 2-8c)
10. Severe bleeding from an arm or leg wound.
Collapsed lung (tension pneumothorax).
Blockage of the nose and throat from an injury to the face. (para 2-9a)
11. [Any three of the following]
Your own life is in imminent danger.
Your combat duties do not allow time to care for casualties.
The casualty does not have vital signs.
The casualty’s injury is not survivable.
Your combat duties do not allow you to treat the casualty. (para 2-9b)
12. c (para 2-5b)
13. pain
Rub his breastbone briskly with a knuckle
Squeeze his fist. (paras 2-4a(2) second note,
14. You should perform the steps in the following checklist and in the
sequence given on the checklist.
CHECKLIST FOR EVALUATING A CASUALTY
Situation: You have spotted a casualty (simulated). Your
area is not under fire. The casualty is lying in a prone position.
Establishes security of the site.
GO _____ NO-GO_____
Forms an impression of the casualty's condition.
GO _____ NO-GO_____
Checks for responsiveness.
GO _____ NO-GO_____
Positions the casualty on his back.
GO _____ NO-GO_____
Checks the casualty for breathing.
GO _____ NO-GO_____
Checks the casualty for bleeding.
GO _____ NO-GO_____
Sends a soldier to get medical help.
GO _____ NO-GO_____
(Note: This step can be performed at any time.)
OVERALL EVALUATION
GO
NO GO
(A no-go on any step gives an overall evaluation of no-go.)
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