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Combat First Aid for Marines

• LT Sameer Bakhda, M.D.
• Flight Surgeon, HMLA-267 ? Stingers ?
• SPMAGTF/February 2003

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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.)

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Overview

• Patient Evaluation
• Airway Management
• Choking/Rescue Breathing/CPR
• Sucking Chest Wound/Tension Pneumothorax
• Battle Dressings/Cravats
• Abdominal Wounds
• Pressure Dressings
• Tourniquets and Amputations

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Overview

• Treat for Shock
• Head and Face Wounds
• Fractures and Splinting
• Burns/Electrical Shock/Smoke Inhalation
• Preventive Medicine (hygiene/water safety)

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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

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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 dont apply on the battlefield!

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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)

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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!

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Airway
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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

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Breathing
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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

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Rescue Breathing/CPR

• This is the subject of a full course!
• Need refresher training if you are not
  up-to-date!!
• Dont do on the battlefield (not shown to help
  with battle injuries!!)

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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

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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

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Sucking Chest Wound

• Roll casualty onto injured side and check for
  exit wound
• If present, treat the same way
• Monitor airway and breathing

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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

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CirculationStop the Bleeding
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Battle Dressings

• Use to stop bleeding and cover wounds
• Large enough to cover most wounds
• Small/lightweight

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Battle Dressings
Standard Battle Dressing Tear open plastic wrap.
Twist to open paper wrapper and remove dressing
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Battle Dressings
Unfold bandage and apply to wound.
Wrap tails around and tie together.
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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

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Triangular Bandage (Cravat)

• Highly useful and multipurpose
• Can be used as a sling, tourniquet, head
  dressing, etc. etc. etc.

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Triangular Bandage (Cravat)
Fold bandage into a cravat (3-fold) and use for
tourniquet
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Triangular Bandage (Cravat)
? Elbow brace/splint
? Extremity (hand/stump) dressing
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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

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Pressure Dressings

• Tie gauze pack into place using cravat or battle
  dressing
• Do not cut off circulation!

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Pressure Points

• Use finger pressure on these points to stop
  bleeding
• Also, place tourniquet band over these points
  (arteries)

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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

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Tourniquets

• Still a treatment of last resort
• Use a pressure dressing first!
• Try finger pressure on pressure points
• Only apply tourniquet if bleeding doesnt stop!
• Will almost always need a tourniquet to stop
  bleeding from amputations

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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

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Applying a Tourniquet
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Abdominal Wounds

• Place victim on back with knees flexed

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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

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Abdominal Wounds

• Cover wound with dressing moistened with water
• Use sterile or potable water if available
• Tie tails at casualtys side, not directly on
  wound
• Minimize pressure on wound and internal organs!

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Head and Face Wounds

• Make sure airway is not obstructed!
• Control bleeding using direct pressure
• Monitor airway and breathing after bleeding is
  controlled

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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

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Head and Face Wounds
Use cravat and gauze to provide direct pressure
on wounds
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CirculationTreat for Shock
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SHOCK

• Shock is the failure to get blood and oxygen to
  the bodys tissues
• Can be caused by brain injuries, heart problems,
  allergic reactions, infections but is usually
  from loss of blood!

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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

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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

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Treat Other Injuries
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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!

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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

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Fractures and Splinting
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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 (dont 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

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Burns

• Place a battle dressing gently over the burned
  area
• Dont 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

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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.
• Dont touch victim or use conductive material!
• Water or metal will make YOU a victim!
• Treat ABCs and burns as needed

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Preventive Medicine
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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!

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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

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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)

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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
• Dont keep food or trash in your living quarters
• Attracts bugs and rodents that transmit disease

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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!

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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

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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.

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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.

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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 peoples 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

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Questions?