C1, FM 4-25.11 (FM 21-11)
??NTRP 4-02.1.1
AFMAN 44-163(I)
??MCRP 3-02G
FIRST AID
??HEADQUARTERS, DEPARTMENTS OF
THE ARMY, THE NAVY, AND THE AIR FORCE
AND COMMANDANT, MARINE CORPS
DECEMBER 2002
DISTRIBUTION RESTRICTION: Approved for public release;
distribution is unlimited.
C1, FM 4-25.11 (FM 21-11)
NTRP 4-02.1.1
AFMAN 44-163(I)
MCRP 3-02G
Change 1 HEADQUARTERS
DEPARTMENTS OF THE ARMY,
THE NAVY, AND THE AIR FORCE
AND COMMANDANT, MARINE CORPS
Washington, DC, 15 July 2004
FIRST AID
1. Change FM 4-25.11/NTRP 4-02.1/AFMAN 44-163(I), 23 December
2002, as follows:
Remove old pages Insert new pages
Cover Cover
Back cover Back cover
2. New or changed material is indicated by a star (??).
3. File this transmittal sheet in front of the publication.
DISTRIBUTION RESTRICTION: Approved for public release;
distribution is unlimited.
C1, FM 4-25.11/NTRP 4-02.1.1/AFMAN 44-163(I)/MCRP 3-02G
15 JULY 2004
By Order of the Secretary of the Army:
PETER J. SCHOOMAKER
General, United States Army
Official: Chief of Staff
JOEL B. HUDSON
Administrative Assistant to the
Secretary of the Army
0417001
By Direction of the Chief of Naval Operations:
Official: R.G. SPRIGG
Rear Admiral, USN
Navy Warfare Development Command
By Order of the Secretary of the Air Force:
Official: GEORGE PEACH TAYLOR, JR.
Lieutenant General, USAF, MC, CFS
Surgeon General
By Direction of the Commandant of the Marine Corps:
Official:
EDWARD HANLON, JR.
Lieutenant General, U.S. Marine Corps
Commanding General
Marine Corps Combat Development Command
DISTRIBUTION:
US Army: Active Army, USAR, and ARNG: To be distributed
in accordance with the initial distribution
number 110161, requirements for FM 4-25.11.
US Navy: All Ships and Stations having Medical Department
Personnel.
US Air Force: F
US Marine Corps: PCN: 144 000037 00
*FIELD MANUAL HEADQUARTERS
NO. 4-25.11 DEPARTMENT OF THE ARMY,
NAVY TACTICAL THE NAVY, AND THE AIR FORCE
REFERENCE Washington, DC, 23 December 2002
PUBLICATION
NO. 4-02.1
AIR FORCE MANUAL
NO. 44-163(I)
FIRST AID
TABLE OF CONTENTS
Page
PREFACE .............................................................. v
CHAPTER 1. FUNDAMENTAL CRITERIA FOR FIRST AID
1-1. General .................................................... 1-1
1-2. Terminology .............................................. 1-2
1-3. Understanding Vital Body Functions
for First Aid............................................. 1-3
1-4. Adverse Conditions...................................... 1-7
1-5. Basics of First Aid ....................................... 1-7
1-6. Evaluating a Casualty ................................... 1-8
CHAPTER 2. BASIC MEASURES FOR FIRST AID
2-1. General .................................................... 2-1
Section I. Open the Airway and Restore Breathing............. 2-1
2-2. Breathing Process ........................................ 2-1
2-3. Assessment of and Positioning the Casualty ........ 2-1
2-4. Opening the Airway of an Unconscious or not
Breathing Casualty ..................................... 2-3
2-5. Rescue Breathing (Artificial Respiration)............ 2-6
2-6. Preliminary Steps—All Rescue Breathing
Methods.................................................. 2-6
2-7. Mouth-to-Mouth Method ............................... 2-7
2-8. Mouth-to-Nose Method ................................. 2-9
2-9. Heartbeat .................................................. 2-9
2-10. Airway Obstructions..................................... 2-10
2-11. Opening the Obstructed Airway—Conscious
Casualty.................................................. 2-11
2-12. Opening the Obstructed Airway—Casualty Lying
Down or Unconscious................................. 2-14
_________
*This publication supersedes FM 21-11, 27 October 1988
i
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FM 4-25.11/NTRP 4-02.1/AFMAN 44-163(I)
Page
Section II. Stop the Bleeding and Protect the Wound ......... 2-18
2-13. General ................................................... 2-18
2-14. Clothing .................................................. 2-19
2-15. Entrance and Exit Wounds ........................... 2-19
2-16. Field Dressing ........................................... 2-20
2-17. Manual Pressure ........................................ 2-21
2-18. Pressure Dressing ...................................... 2-22
2-19. Digital Pressure ......................................... 2-24
2-20. Tourniquet ............................................... 2-25
Section III. Check for Shock and Administer First
Aid Measures ........................................ 2-29
2-21. General ................................................... 2-29
2-22. Causes and Effects ..................................... 2-29
2-23. Signs and Symptoms of Shock ....................... 2-30
2-24. First Aid Measures for Shock ........................ 2-31
CHAPTER 3. FIRST AID FOR SPECIFIC INJURIES
3-1. General ................................................... 3-1
3-2. Head, Neck, and Facial Injuries ..................... 3-1
3-3. General First Aid Measures .......................... 3-2
3-4. Chest Wounds ........................................... 3-4
3-5. First Aid for Chest Wounds .......................... 3-5
3-6. Abdominal Wounds .................................... 3-9
3-7. First Aid for Abdominal Wounds ................... 3-9
3-8. Burn Injuries ............................................ 3-12
3-9. First Aid for Burns ..................................... 3-13
3-10. Dressings and Bandages ............................... 3-16
3-11. Shoulder Bandage ...................................... 3-29
3-12. Elbow Bandage ......................................... 3-30
3-13. Hand Bandage ........................................... 3-30
3-14. Leg (Upper and Lower) Bandage.................... 3-33
3-15. Knee Bandage ........................................... 3-34
3-16. Foot Bandage ............................................ 3-34
CHAPTER 4. FIRST AID FOR FRACTURES
4-1. General ................................................... 4-1
4-2. Kinds of Fractures ...................................... 4-1
4-3. Signs and Symptoms of Fractures ................... 4-2
4-4. Purposes of Immobilizing Fractures ................ 4-2
4-5. Splints, Padding, Bandages, Slings, and Swathes 4-2
4-6. Procedures for Splinting Suspected Fractures ..... 4-3
4-7. Upper Extremity Fractures ........................... 4-9
4-8. Lower Extremity Fractures ........................... 4-12
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FM 4-25.11/NTRP 4-02.1/AFMAN 44-163(I)
Page
4-9. Jaw, Collarbone, and Shoulder Fractures .......... 4-15
4-10. Spinal Column Fractures .............................. 4-16
4-11. Neck Fractures .......................................... 4-18
CHAPTER 5. FIRST AID FOR CLIMATIC INJURIES
5-1. General ................................................... 5-1
5-2. Heat Injuries ............................................. 5-2
5-3. Cold Injuries ............................................ 5-7
CHAPTER 6. FIRST AID FOR BITES AND STINGS
6-1. General ................................................... 6-1
6-2. Types of Snakes ........................................ 6-1
6-3. Snakebites ................................................ 6-5
6-4. Human or Animal Bites ............................... 6-7
6-5. Marine (Sea) Animals ................................. 6-8
6-6. Insect (Arthropod) Bites and Stings ................. 6-9
6-7. First Aid for Bites and Stings ........................ 6-12
CHAPTER 7. FIRST AID IN A NUCLEAR, BIOLOGICAL, AND
CHEMICAL ENVIRONMENT
7-1. General ................................................... 7-1
7-2. First Aid Materials ..................................... 7-1
7-3. Classification of Chemical and Biological
Agents ................................................. 7-2
7-4. Conditions for Masking Without Order or
Alarm .................................................. 7-3
7-5. First Aid for a Chemical Attack ..................... 7-4
7-6. Background Information on Nerve Agents ........ 7-5
7-7. Signs and Symptoms of Nerve Agent Poisoning . 7-7
7-8. First Aid for Nerve Agent Poisoning ............... 7-8
7-9. Blister Agents ........................................... 7-19
7-10. Choking Agents (Lung-Damaging Agents) ........ 7-21
7-11. Cyanogen (Blood) Agents ............................. 7-22
7-12. Incapacitating Agents .................................. 7-23
7-13. Incendiaries .............................................. 7-24
7-14. Biological Agents and First Aid ..................... 7-25
7-15. Toxins .................................................... 7-25
7-16. Nuclear Detonation ..................................... 7-27
CHAPTER 8. FIRST AID FOR PSYCHOLOGICAL REACTIONS
8-1. General ................................................... 8-1
8-2. Importance of Psychological First Aid ............. 8-1
8-3. Situations Requiring Psychological First Aid ..... 8-1
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FM 4-25.11/NTRP 4-02.1/AFMAN 44-163(I)
Page
8-4. Interrelationship of Psychological and Physical
First Aid ............................................... 8-2
8-5. Goals of Psychological First Aid .................... 8-2
8-6. Respect for Others’ Feelings ......................... 8-3
8-7. Emotional and Physical Disability ................... 8-3
8-8. Combat and Other Operational Stress Reactions . 8-4
8-9. Reactions to Stress ..................................... 8-4
8-10. Severe Stress or Stress Reaction ..................... 8-6
8-11. Application of Psychological First Aid ............. 8-6
8-12. Reactions and Limitations ............................. 8-8
8-13. Stress Reactions ......................................... 8-9
APPENDIX A. FIRST AID CASE AND KITS, DRESSINGS, AND
BANDAGES
A-1. First Aid Case with Field Dressings and
Bandages .............................................. A-1
A-2. General Purpose First Aid Kits ...................... A-1
A-3. Dressings ................................................. A-2
A-4. Standard Bandages ..................................... A-2
A-5. Triangular and Cravat (Swathe) Bandages ......... A-2
APPENDIX B. RESCUE AND TRANSPORTATION PROCEDURES
B-1. General ................................................... B-1
B-2. Principles of Rescue Operations ..................... B-1
B-3. Considerations .......................................... B-1
B-4. Plan of Action ........................................... B-2
B-5. Proper Handling of Casualties ....................... B-3
B-6. Positioning the Casualty ............................... B-4
B-7. Medical Evacuation and Transportation of
Casualties ............................................. B-5
B-8. Manual Carries ......................................... B-6
B-9. Improvised Litters ...................................... B-26
GLOSSARY .................................................. Glossary-1
REFERENCES .................................................. References-1
INDEX .................................................. Index-1
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FM 4-25.11/NTRP 4-02.1/AFMAN 44-163(I)
PREFACE
This manual meets the first aid training needs of individual service
members. Because medical personnel will not always be readily available,
the nonmedical service members must rely heavily on their own skills and
knowledge of life-sustaining methods to survive on the integrated battlefield.
This publication outlines both self-aid and aid to other service members
(buddy aid). More importantly, it emphasizes prompt and effective action in
sustaining life and preventing or minimizing further suffering and disability.
First aid is the emergency care given to the sick, injured, or wounded before
being treated by medical personnel. The term first aid can be defined as
“urgent and immediate lifesaving and other measures, which can be
performed for casualties by nonmedical personnel when medical personnel
are not immediately available.” Nonmedical service members have received
basic first aid training and should remain skilled in the correct procedures for
giving first aid. This manual is directed to all service members. The
procedures discussed apply to all types of casualties and the measures
described are for use by both male and female service members.
This publication is in consonance with the following North Atlantic
Treaty Organization (NATO) International Standardization Agreements
(STANAGs) and American, British. Canadian, and Australian Quadripartite
Standardization Agreements (QSTAGs).
TITLE STANAG QSTAG
Medical Training in First Aid, Basic Hygiene and
Emergency Care 2122 535
First Aid Kits and Emergency Medical Care Kits 2126
Medical First Aid and Hygiene Training in NBC
Operations 2358
First Aid Material for Chemical Injuries 2871
These agreements are available on request, using Department of
Defense (DD) Form 1425 from the Standardization Documents Order Desk,
700 Robins Avenue, Building 4, Section D, Philadelphia, Pennsylvania
19111-5094.
Unless this publication states otherwise, masculine nouns and
pronouns do not refer exclusively to men.
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FM 4-25.11/NTRP 4-02.1/AFMAN 44-163(I)
Use of trade or brand names in this publication is for illustrative
purposes only and does not imply endorsement by the Department of Defense
(DOD).
The proponent for this publication is the US Army Medical
Department Center and School. Submit comments and recommendations for
the improvement of this publication directly to the Commander, US Army
Medical Department Center and School, ATTN: MCCS-FCD-L, 1400
East Grayson Street, Fort Sam Houston, Texas 78234-5052.
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FM 4-25.11/NTRP 4-02.1/AFMAN 44-163(I)
CHAPTER 1
FUNDAMENTAL CRITERIA FOR FIRST AID
“The fate of the wounded rests in the hands
of the ones who apply the first dressing.”
Nicholas Senn (1898) (49th President of the
American Medical Association)
1-1. General
When a nonmedical service member comes upon an unconscious or injured
service member, he must accurately evaluate the casualty to determine the
first aid measures needed to prevent further injury or death. He should seek
medical assistance as soon as possible, but he should not interrupt the
performance of first aid measures. To interrupt the first aid measures may
cause more harm than good to the casualty. Remember that in a chemical
environment, the service member should not evaluate the casualty until the
casualty has been masked. After performing first aid, the service member
must proceed with the evaluation and continue to monitor the casualty for
development of conditions which may require the performance of necessary
basic lifesaving measures, such as clearing the airway, rescue breathing,
preventing shock, and controlling bleeding. He should continue to monitor
the casualty until relieved by medical personnel.
Service members may have to depend upon their first aid knowledge and
skills to save themselves (self-aid) or other service members (buddy aid/
combat lifesaver). They may be able to save a life, prevent permanent
disability, or reduce long periods of hospitalization by knowing WHAT to
do, WHAT NOT to do, and WHEN to seek medical assistance.
NOTE
The prevalence of various body armor systems currently fielded to
US service members, and those in development for future fielding,
may present a temporary obstacle to effective evaluation of an
injured service member. You may have to carefully remove the
body armor from the injured service member to complete the
evaluation or administer first aid. Begin by removing the outer–
most hard or soft body armor components (open, unfasten or cut
the closures, fasteners, or straps), then remove any successive
layers in the same manner. Be sure to follow other notes, cautions
and warnings regarding procedures in contaminated situations and
when a broken back or neck is suspected. Continue to evaluate.
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FM 4-25.11/NTRP 4-02.1/AFMAN 44-163(I)
1-2. Terminology
To enhance the understanding of the material contained in this publication,
the following terms are used—
• Combat lifesaver. This is a US Army program governed by
Army Regulation (AR) 350-41. The combat lifesaver is a member of a
nonmedical unit selected by the unit commander for additional training beyond
basic first aid procedures (referred to as enhanced first aid). A minimum of
one individual per squad, crew, team, or equivalent-sized unit should be
trained. The primary duty of this individual does not change. The additional
duty of combat lifesaver is to provide enhanced first aid for injuries based on
his training before the trauma specialist (military occupational specialty
[MOS] 91W) arrives. The combat lifesaver’s training is normally provided
by medical personnel assigned, attached, or in direct support (DS) of the
unit. The senior medical person designated by the commander manages the
training program.
• Trauma Specialist (US Army) or Hospital Corpsman (HM). A
medical specialist trained in emergency medical treatment (EMT) procedures
and assigned or attached in support of a combat or combat support unit or
marine forces.
• Casualty evacuation. Casualty evacuation (CASEVAC) is a
term used by nonmedical units to refer to the movement of casualties aboard
nonmedical vehicles or aircraft. See also the term transported below. Refer
to FM 8-10-6 for additional information.
CAUTION
Casualties transported in this manner do not receive en
route medical care.
• Enhanced first aid (US Army). Enhanced first aid is
administered by the combat lifesaver. It includes measures, which require an
additional level of training above self-aid and buddy aid, such as the initiation
of intravenous (IV) fluids.
• Medical evacuation. Medical evacuation is the timely, efficient
movement of the wounded, injured, or ill service members from the battlefield
and other locations to medical treatment facilities (MTFs). Medical personnel
provide en route medical care during the evacuation. Once the casualty has
entered the medical stream (trauma specialist, hospital corpsman, evacuation
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FM 4-25.11/NTRP 4-02.1/AFMAN 44-163(I)
crew, or MTF), the role of first aid in the care of the casualty ceases and the
casualty becomes the responsibility of the health service support (HSS) chain.
Once he has entered the HSS chain he is referred to as a patient.
• First aid measures. Urgent and immediate lifesaving and
other measures, which can be performed for casualties (or performed by the
casualty himself) by nonmedical personnel when medical personnel are not
immediately available.
• Medical treatment. Medical treatment is the care and
management of wounded, injured, or ill service members by medically trained
(MOS-trained) HM, and area of concentration (AOC) personnel. It may
include EMT, advanced trauma management (ATM), and resuscitative and
surgical intervention.
• Medical treatment facility. Any facility established for the
purpose of providing medical treatment. This includes battalion aid stations,
Level II facilities, dispensaries, clinics, and hospitals.
• Self-aid/buddy aid. Each individual service member is trained
to be proficient in a variety of specific first aid procedures. This training
enables the service member or a buddy to apply immediate first aid measures
to alleviate a life-threatening situation.
• Transported. A casualty is moved to an MTF in a nonmedical
vehicle without en route care provided by a medically-trained service member
(such as a Trauma Specialist or HM). First aid measures should be
continually performed while the casualty is being transported. If the casualty
is acquired by a dedicated medical vehicle with a medically-trained crew, the
role of first aid ceases and the casualty becomes the responsibility of the HSS
chain, and is then referred to as a patient. This method of transporting a
casualty is also referred to as CASEVAC.
1-3. Understanding Vital Body Functions for First Aid
In order for the service member to learn to perform first aid procedures, he
must have a basic understanding of what the vital body functions are and
what the result will be if they are damaged or not functioning.
a. Breathing Process. All humans must have oxygen to live.
Through the breathing process, the lungs draw oxygen from the air and put it
into the blood. The heart pumps the blood through the body to be used by
the cells that require a constant supply of oxygen. Some cells are more
dependent on a constant supply of oxygen than others. For example, cells of
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FM 4-25.11/NTRP 4-02.1/AFMAN 44-163(I)
the brain may die within 4 to 6 minutes without oxygen. Once these cells
die, they are lost forever since they do not regenerate. This could result in
permanent brain damage, paralysis, or death.
b. Respiration. Respiration occurs when a person inhales (oxygen
is taken into the body) and then exhales (carbon dioxide [CO2] is expelled
from the body). Respiration involves the—
• Airway. The airway consists of the nose, mouth, throat,
voice box, and windpipe. It is the canal through which air passes to and from
the lungs.
• Lungs. The lungs are two elastic organs made up of
thousands of tiny air spaces and covered by an airtight membrane. The
bronchial tree is a part of the lungs.
• Rib cage. The rib cage is formed by the muscleconnected
ribs, which join the spine in back, and the breastbone in front.
The top part of the rib cage is closed by the structure of the neck, and the
bottom part is separated from the abdominal cavity by a large dome-shaped
muscle called the diaphragm (Figure 1-1). The diaphragm and rib muscles,
which are under the control of the respiratory center in the brain,
automatically contract and relax. Contraction increases and relaxation
decreases the size of the rib cage. When the rib cage increases and then
decreases, the air pressure in the lungs is first less and then more than the
atmospheric pressure, thus causing the air to rush into and out of the lungs to
equalize the pressure. This cycle of inhaling and exhaling is repeated about
12 to 18 times per minute.
Figure 1-1. Airway, lungs, and rib cage.
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FM 4-25.11/NTRP 4-02.1/AFMAN 44-163(I)
c. Blood Circulation. The heart and the blood vessels (arteries,
veins, and capillaries) circulate blood through the body tissues. The heart is
divided into two separate halves, each acting as a pump. The left side pumps
oxygenated blood (bright red) through the arteries into the capillaries;
nutrients and oxygen pass from the blood through the walls of the capillaries
into the cells. At the same time waste products and CO2 enter the capillaries.
From the capillaries the oxygen poor blood is carried through the veins to the
right side of the heart and then into the lungs where it expels the CO2 and
picks up oxygen. Blood in the veins is dark red because of its low oxygen
content. Blood does not flow through the veins in spurts as it does through
the arteries. The entire system of the heart, blood vessels, and lymphatics is
called the circulatory system.
(1) Heartbeat. The heart functions as a pump to circulate
the blood continuously through the blood vessels to all parts of the body. It
contracts, forcing the blood from its chambers; then it relaxes, permitting its
chambers to refill with blood. The rhythmical cycle of contraction and
relaxation is called the heartbeat. The normal heartbeat is from 60 to 80
beats per minute.
(2) Pulse. The heartbeat causes a rhythmical expansion and
contraction of the arteries as it forces blood through them. This cycle of
expansion and contraction can be felt (monitored) at various points in the body
and is called the pulse. The common points for checking the pulse are at the—
• Side of the neck (carotid).
• Groin (femoral).
• Wrist (radial).
• Ankle (posterior tibial).
(a) Carotid pulse. To check the carotid pulse, feel for
a pulse on the side of the casualty’s neck closest to you. This is done by
placing the tips of your first two fingers beside his Adam’s apple (Figure 1-2).
Figure 1-2. Carotid pulse.
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FM 4-25.11/NTRP 4-02.1/AFMAN 44-163(I)
(b) Femoral pulse. To check the femoral pulse, press
the tips of your first two fingers into the middle of the groin (Figure 1-3).
Figure 1-3. Femoral pulse.
(c) Radial pulse. To check the radial pulse, place your
first two fingers on the thumb side of the casualty’s wrist (Figure 1-4).
Figure 1-4. Radial pulse.
(d) Posterior tibial pulse. To check the posterior tibial
pulse, place your first two fingers on the inside of the ankle (Figure 1-5).
Figure 1-5. Posterior tibial pulse.
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FM 4-25.11/NTRP 4-02.1/AFMAN 44-163(I)
NOTE
DO NOT use your thumb to check a casualty’s pulse because
you may confuse the beat of your pulse with that of the casualty.
1-4. Adverse Conditions
a. Lack of Oxygen. Human life cannot exist without a continuous
intake of oxygen. Lack of oxygen rapidly leads to death. First aid involves
knowing how to open the airway and restore breathing.
b. Bleeding. Human life cannot continue without an adequate
volume of blood circulating through the body to carry oxygen to the tissues. An
important first aid measure is to stop the bleeding to prevent the loss of blood.
c. Shock. Shock means there is an inadequate blood flow to the
vital tissues and organs. Shock that remains uncorrected may result in death
even though the injury or condition causing the shock would not otherwise be
fatal. Shock can result from many causes, such as loss of blood, loss of fluid
from deep burns, pain, and reaction to the sight of a wound or blood. First
aid includes preventing shock, since the casualty’s chances of survival are
much greater if he does not develop shock. Refer to paragraphs 2-21 through
2-24 for a further discussion of shock.
d. Infection. Recovery from a severe injury or a wound depends
largely upon how well the injury or wound was initially protected. Infections
result from the multiplication and growth (spread) of harmful microscopic
organisms (sometimes referred to as germs). These harmful microscopic
organisms are in the air, water, and soil, and on the skin and clothing. Some of
these organisms will immediately invade (contaminate) a break in the skin or
an open wound. The objective is to keep wounds clean and free of these
organisms. A good working knowledge of basic first aid measures also includes
knowing how to dress a wound to avoid infection or additional contamination.
1-5. Basics of First Aid
Most injured or ill service members are able to return to their units to fight or
support primarily because they are given appropriate and timely first aid
followed by the best medical care possible. Therefore, all service members
must remember the basics.
• Check for BREATHING: Lack of oxygen intake (through a
compromised airway or inadequate breathing) can lead to brain damage or
death in very few minutes.
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FM 4-25.11/NTRP 4-02.1/AFMAN 44-163(I)
• Check for BLEEDING: Life cannot continue without an
adequate volume of blood to carry oxygen to tissues.
• Check for SHOCK: Unless shock is prevented, first aid
performed, and medical treatment provided, death may result even though
the injury would not otherwise be fatal.
1-6. Evaluating a Casualty
a. The time may come when you must instantly apply your
knowledge of first aid measures. This could occur during combat operations,
in training situations, or while in a nonduty status. Any service member
observing an unconscious and/or ill, injured, or wounded person must
carefully and skillfully evaluate him to determine the first aid measures
required to prevent further injury or death. He should seek help from
medical personnel as soon as possible, but must not interrupt his evaluation
of the casualty or fail to administer first aid measures. A second service
member may be sent to find medical help. One of the cardinal principles for
assisting a casualty is that you (the initial rescuer) must continue the evaluation
and first aid measures, as the tactical situation permits, until another individual
relieves you. If, during any part of the evaluation, the casualty exhibits the
conditions (such as shock) for which the service member is checking, the
service member must stop the evaluation and immediately administer first
aid. In a chemical environment, the service member should not evaluate the
casualty until both the individual and the casualty have been masked. If it is
suspected that a nerve agent was used, administer the casualty’s own nerve
agent antidote autoinjector. After providing first aid, the service member
must proceed with the evaluation and continue to monitor the casualty for
further complications until relieved by medical personnel.
WARNING
Do not use your own nerve agent antidote autoinjector
on the casualty.
NOTE
Remember, when evaluating and/or administering first aid to a
casualty, you should seek medical aid as soon as possible. DO
NOT stop first aid measures, but if the situation allows, send
another service member to find medical aid.
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FM 4-25.11/NTRP 4-02.1/AFMAN 44-163(I)
b. To evaluate a casualty, perform the following steps:
(1) Check the casualty for responsiveness. This is done by
gently shaking or tapping him while calmly asking, “Are you OK?” Watch
for a response. If the casualty does not respond, go to step (2). If the
casualty responds, continue with the evaluation.
(a) If the casualty is conscious, ask him where he feels
different than usual or where it hurts. Ask him to identify the location of
pain if he can, or to identify the area in which there is no feeling.
(b) If the casualty is conscious but is choking and
cannot talk, stop the evaluation and begin first aid measures. Refer to
paragraphs 2-10 and 2-11 for specific information on opening the airway.
WARNING
If a broken back or neck is suspected, do not move the
casualty unless his life is in immediate danger (such as
close to a burning vehicle). Movement may cause
permanent paralysis or death.
(2) Check for breathing. (Refer to paragraph 2-6 for this
procedure.)
(a) If the casualty is breathing, proceed to step (3).
(b) If the casualty is not breathing, stop the evaluation
and begin first aid measures to attempt to ventilate the casualty. Attempt to
open the airway, if an airway obstruction is apparent, clear the airway
obstruction, then ventilate (see paragraphs 2-10 and 2-11).
(c) After successfully ventilating the casualty, proceed
to step (3).
(3) Check for pulse. (Refer to paragraph 1-3c(2) for specific
methods.) If a pulse is present and the casualty is breathing, proceed to step (4).
(a) If a pulse is present, but the casualty is still not
breathing, start rescue breathing.
(b) If a pulse is not present, seek medical personnel
for help.
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(4) Check for bleeding. Look for spurts of blood or bloodsoaked
clothes. Also check for both entry and exit wounds. If the casualty is
bleeding from an open wound, stop the evaluation and begin first aid
procedures as follows for a—
(a) Wound of the arm or leg (refer to paragraphs 2-16
through 2-18 for information on putting on a field or pressure dressing).
(b) Partial or complete amputation, apply dressing
(refer to paragraph 2-16 to 2-18) and then apply tourniquet if bleeding is not
stopped (refer to paragraph 2-20 for information on putting on a tourniquet).
(c) Open head wound (refer to paragraph 3-10 for
information on applying a dressing to an open head wound).
(d) Open chest wound (refer to paragraph 3-5 for
information on applying a dressing to an open chest wound).
(e) Open abdominal wound (refer to paragraph 3-7 for
information on applying a dressing to an open abdominal wound).
WARNING
In a chemically contaminated area, do not expose the
wounds. Apply field dressing and then pressure
dressing over wound area as needed.
(5) Check for shock. (Refer to paragraph 2-24 for first aid
measures for shock.) If the signs and symptoms of shock are present, stop
the evaluation, and begin first aid measures immediately. The following are
the nine signs and symptoms of shock.
(a) Sweaty but cool skin (clammy skin).
(b) Paleness of skin. (In dark-skinned service members
look for a grayish cast to the skin.)
(c) Restlessness or nervousness.
(d) Thirst.
(e) Loss of blood (bleeding).
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(f) Confusion (does not seem aware of surroundings).
(g) Faster than normal breathing rate.
(h) Blotchy or bluish skin, especially around the mouth.
(i) Nausea or vomiting.
WARNING
Leg fractures must be splinted before elevating the legs
as a first aid measure for shock.
(6) Check for fractures.
(a) Check for the following signs and symptoms of a
back or neck injury and perform first aid procedures as necessary.
• Pain or tenderness of the back or neck area.
• Cuts or bruises on the back or neck area.
• Inability of a casualty to move or decreased
sensation to extremities (paralysis or numbness).
• Ask about ability to move (paralysis).
• Touch the casualty’s arms and legs and
ask whether he can feel your hand (numbness).
• Unusual body or limb position.
(b) Immobilize any casualty suspected of having a back
or neck injury by doing the following:
• Tell the casualty not to move.
• If a back injury is suspected, place padding
(rolled or folded to conform to the shape of the arch) under the natural arch
of the casualty’s back. (For example, a blanket/poncho may be used as
padding.)
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WARNING
Do not move casualty to place padding.
• If a neck injury is suspected, immediately
immobilize (manually) the head and neck. Place a roll of cloth under the
casualty’s neck, and put weighted boots (filled with dirt or sand) or rocks on
both sides of his head.
(c) Check the casualty’s arms and legs for open or
closed fractures.
• Check for open fractures by looking for—
• Bleeding.
• Bones sticking through the skin.
• Check for pulse.
• Check for closed fractures by looking for—
• Swelling.
• Discoloration.
• Deformity.
• Unusual body position.
• Check for pulse.
(d) Stop the evaluation and begin first aid measures if
a fracture to an arm or leg is suspected. Refer to Chapter 4 for information
on splinting a suspected fracture.
(e) Check for signs/symptoms of fractures of other
body areas (for example, shoulder or hip) and provide first aid as necessary.
(7) Check for burns. Look carefully for reddened, blistered,
or charred skin; also check for singed clothing. If burns are found, stop the
evaluation and begin first aid procedures. Refer to paragraph 3-9 for
information on giving first aid for burns.
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NOTE
Burns to the upper torso and face may cause respiratory
complications. When evaluating the casualty, look for singed
nose hair, soot around the nostrils, and listen for abnormal breath
sounds or difficulty breathing.
(8) Check for possible head injury.
(a) Look for the following signs and symptoms:
• Unequal pupils.
• Fluid from the ear(s), nose, mouth, or injury
site.
• Slurred speech.
• Confusion.
• Sleepiness.
• Loss of memory or consciousness.
• Staggering in walking.
• Headache.
• Dizziness.
• Nausea or vomiting.
• Paralysis.
• Convulsions or twitches.
• Bruising around the eyes and behind the ears.
(b) If a head injury is suspected, continue to watch for
signs which would require performance of rescue breathing, first aid measures
for shock, or control of bleeding; seek medical aid. Refer to paragraph 3-10
for information on first aid measures for head injuries.
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CHAPTER 2
BASIC MEASURES FOR FIRST AID
2-1. General
Several conditions that require immediate attention are an inadequate airway,
lack of breathing, and excessive loss of blood (circulation). A casualty
without a clear airway or who is not breathing may die from lack of oxygen.
Excessive loss of blood may lead to shock, and shock can lead to death;
therefore, you must act immediately to control the loss of blood. All wounds
are considered to be contaminated, since infection-producing organisms
(germs) are always present on the skin and clothing, and in the soil, water,
and air. Any missile or instrument (such as a bullet, shrapnel, knife, or
bayonet) causing a wound pushes or carries the germs into that wound.
Infection results as these organisms multiply. That a wound is contaminated
does not lessen the importance of protecting it from further contamination.
You must dress and bandage a wound as soon as possible to prevent further
contamination.
NOTE
It is also important that you attend to any airway, breathing, or
bleeding problems IMMEDIATELY because these problems,
if left unattended, may become life threatening.
Section I. OPEN THE AIRWAY
AND RESTORE BREATHING
2-2. Breathing Process
All humans must have oxygen to live. Through the breathing process, the
lungs draw oxygen from the air and put it into the blood. The heart pumps
the blood through the body to be used by the cells that require a constant
supply of oxygen. Some cells are more dependent on a constant supply of
oxygen than others. For example, cells of the brain may die within 4 to 6
minutes without oxygen. Once these cells die, they are lost forever since
they do not regenerate. This could result in permanent brain damage,
paralysis, or death.
2-3. Assessment of and Positioning the Casualty
a. CHECK for responsiveness (Figure 2-1A)—establish whether
the casualty is conscious by gently shaking him and asking, “Are you OK?”
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b. CALL for help (Figure 2-1B).
c. POSITION the unconscious casualty so that he is lying on his
back and on a firm surface (Figure 2-1C).
WARNING
If the casualty is lying on his chest (prone position),
cautiously roll the casualty as a unit so that his body
does not twist (which may further complicate a back,
neck, or spinal injury).
Figure 2-1. Assessment (Illustrated A—C).
(1) Straighten the casualty’s legs. 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 for the other arm.
A
B
C
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(2) Kneel beside the casualty with your knees near his
shoulders (leave space to roll his body) (Figure 2-1B). Place one hand
behind his head and neck for support. With your other hand, grasp the
casualty under his far arm (Figure 2-1C).
(3) Roll the casualty towards you using a steady, even pull.
His head and neck should stay in line with his back.
(4) Return the casualty’s arms to his side. Straighten his legs.
Reposition yourself so that you are now kneeling at the level of the casualty’s
shoulders. However, if a neck injury is suspected and the jaw-thrust technique
will be used, kneel at the casualty’s head, looking towards his feet.
2-4. Opening the Airway of an Unconscious or Not Breathing Casualty
The tongue is the single most common cause of an airway obstruction (Figure
2-2). In most cases, simply using the head-tilt/chin-lift technique can clear
the airway. This action pulls the tongue away from the air passage in the
throat (Figure 2-3).
Figure 2-2. Airway blocked by tongue.
Figure 2-3. Airway opened by extending neck.
a. Call for help and then position the casualty. Move (roll) the
casualty onto his back (Figure 2-1C). (Refer to paragraph 2-3c for
information on positioning the casualty.)
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NOTE
Perform finger sweep. If foreign material or vomitus is visible
in the mouth, it should be removed, but do not spend an
excessive amount of time doing so.
b. Open the airway using the jaw-thrust or head-tilt/chin-lift
technique.
CAUTION
The head-tilt/chin-lift technique is an important procedure in
opening the airway; however, use extreme care because
excess force in performing this maneuver may cause further
spinal injury. In a casualty with a suspected neck injury or
severe head trauma, the safest approach to opening the
airway is the jaw-thrust technique because in most cases it
can be accomplished without extending the neck.
(1) Perform the jaw-thrust technique. The jaw-thrust may
be accomplished by the rescuer grasping the angles of the casualty’s lower
jaw and lifting with both hands, one on each side, displacing the jaw forward
and up (Figure 2-4). The rescuer’s elbows should rest on the surface on
which the casualty is lying. If the lips close, the lower lip can be retracted
with the thumb. If mouth-to-mouth breathing is necessary, close the nostrils
by placing your cheek tightly against them. The head should be carefully
supported without tilting it backwards or turning it from side to side. If this
is unsuccessful, the head should be tilted back very slightly. The jaw-thrust
is the safest first approach to opening the airway of a casualty who has a
suspected neck injury because in most cases it can be accomplished without
extending the neck.
Figure 2-4. Jaw-thrust technique of opening airway.
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(2) Perform the head-tilt/chin-lift technique. Place one hand
on the casualty’s forehead and apply firm, backward pressure with the palm
to tilt the head back. Place the fingertips of the other hand under the bony
part of the lower jaw and lift, bringing the chin forward. The thumb should
not be used to lift the chin (Figure 2-5).
NOTE
The fingers should not press deeply into the soft tissue under the
chin because the airway may be obstructed.
Figure 2-5. Head-tilt/chin-lift technique of opening airway.
(3) Check for breathing (while maintaining an airway).
After establishing an open airway, it is important to maintain that airway in
an open position. Often the act of just opening and maintaining the airway
will allow the casualty to breathe properly. Once the rescuer uses one of the
techniques to open the airway (jaw-thrust or head-tilt/chin-lift), he should
maintain that head position to keep the airway open. Failure to maintain the
open airway will prevent the casualty from receiving an adequate supply of
oxygen. Therefore, while maintaining an open airway the rescuer should
check for breathing by observing the casualty’s chest and performing the
following actions within 3 to 5 seconds:
(a) LOOK for the chest to rise and fall.
(b) LISTEN for air escaping during exhalation by
placing your ear near the casualty’s mouth.
(c) FEEL for the flow of air on your cheek (see Figure
2-6).
(d) PERFORM rescue breathing if the casualty does
not resume breathing spontaneously.
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NOTE
If the casualty resumes breathing, monitor and maintain the
open airway. He should be transported to an MTF, as soon as
practical.
2-5. Rescue Breathing (Artificial Respiration)
a. If the casualty does not promptly resume adequate spontaneous
breathing after the airway is open, rescue breathing (artificial respiration)
must be started. Be calm! Think and act quickly! The sooner you begin
rescue breathing, the more likely you are to restore the casualty’s breathing.
If you are in doubt whether the casualty is breathing, give artificial
respiration, since it can do no harm to a person who is breathing. If the
casualty is breathing, you can feel and see his chest move. If the casualty is
breathing, you can feel and hear air being expelled by putting your hand or
ear close to his mouth and nose.
b. There are several methods of administering rescue breathing.
The mouth-to-mouth method is preferred; however, it cannot be used in all
situations. If the casualty has a severe jaw fracture or mouth wound or his
jaws are tightly closed by spasms, use the mouth-to-nose method.
2-6. Preliminary Steps—All Rescue Breathing Methods
a. Establish unresponsiveness. Call for help. Turn or position
the casualty.
b. Open the airway.
c. Check for breathing by placing your ear over the casualty’s
mouth and nose, and looking toward his chest.
(1) LOOK for rise and fall of the casualty’s chest (Figure 2-6).
(2) LISTEN for sounds of breathing.
(3) FEEL for breath on the side of your face. If the chest
does not rise and fall and no air is exhaled, then the casualty is not breathing.
(4) PERFORM rescue breathing if the casualty is not
breathing.
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NOTE
Although the rescuer may notice that the casualty is making
respiratory efforts, the airway may still be obstructed and
opening the airway may be all that is needed. If the casualty
resumes breathing, the rescuer should continue to maintain an
open airway.
Figure 2-6. Check for breathing.
2-7. Mouth-to-Mouth Method
In this method of rescue breathing, you inflate the casualty’s lungs with air
from your lungs. This can be accomplished by blowing air into the person’s
mouth. The mouth-to-mouth rescue breathing method is performed as
follows:
a. If the casualty is not breathing, place your hand on his
forehead, and pinch his nostrils together with the thumb and index finger of
this hand. Let this same hand exert pressure on his forehead to maintain the
backward head tilt and maintain an open airway. With your other hand, keep
your fingertips on the bony part of the lower jaw near the chin and lift
(Figure 2-7).
Figure 2-7. Head tilt/chin lift.
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NOTE
If you suspect the casualty has a neck injury and you are using
the jaw-thrust technique, close the nostrils by placing your cheek
tightly against them.
b. Take a deep breath and place your mouth (in an airtight seal)
around the casualty’s mouth (Figure 2-8). (If the injured person is small,
cover both his nose and mouth with your mouth, sealing your lips against the
skin of his face.)
Figure 2-8. Rescue breathing.
c. Blow two full breaths into the casualty’s mouth (1 to 1 1/2
seconds per breath), taking a breath of fresh air each time before you blow.
Watch out of the corner of your eye for the casualty’s chest to rise. If the
chest rises, sufficient air is getting into the casualty’s lungs. Therefore,
proceed as described in step (1). If the chest does not rise, do the following
(a, b, and c below) and then attempt to ventilate again.
(1) Take corrective action immediately by reestablishing the
airway. Make sure that air is not leaking from around your mouth or out of
the casualty’s pinched nose.
(2) Reattempt to ventilate.
(3) If the chest still does not rise, take the necessary action
to open an obstructed airway (paragraph 2-10).
NOTE
If the initial attempt to ventilate the casualty is unsuccessful,
reposition the casualty’s head and repeat rescue breathing.
Improper chin and head positioning is the most common cause
of difficulty with ventilation. If the casualty cannot be ventilated
after repositioning the head, proceed with foreign-body airway
obstruction maneuvers (see paragraph 2-10).
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(4) After giving two slow breaths, which cause the chest to
rise, attempt to locate a pulse on the casualty. Feel for a pulse on the side of
the casualty’s neck closest to you by placing the first two fingers (index and
middle fingers) of your hand on the groove beside the casualty’s Adam’s
apple (carotid pulse) (Figure 2-9). (Your thumb should not be used for pulse
taking because you may confuse your pulse beat with that of the casualty.)
Maintain the airway by keeping your other hand on the casualty’s forehead.
Allow 5 to 10 seconds to determine if there is a pulse.
Figure 2-9. Placement of fingers to detect pulse.
(a) If signs of circulation are present and a pulse is
found and the casualty is breathing—STOP; allow the casualty to breathe on
his own. If possible, keep him warm and comfortable.
(b) If a pulse is found and the casualty is not breathing,
continue rescue breathing.
(c) If a pulse is not found, seek medically trained
personnel for help as soon as possible.
2-8. Mouth-to-Nose Method
Use this method if you cannot perform mouth-to-mouth rescue breathing
because the casualty has a severe jaw fracture or mouth wound or his jaws
are tightly closed by spasms. The mouth-to-nose method is performed in the
same way as the mouth-to-mouth method except that you blow into the nose
while you hold the lips closed with one hand at the chin. You then remove
your mouth to allow the casualty to exhale passively. It may be necessary to
separate the casualty’s lips to allow the air to escape during exhalation.
2-9. Heartbeat
If a casualty’s heart stops beating, you must immediately seek medical help.
SECONDS COUNT! Stoppage of the heart is soon followed by cessation of
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respiration unless it has occurred first. Be calm! Think and act! When a
casualty’s heart has stopped, there is no pulse at all; the person is unconscious
and limp, and the pupils of his eyes are open wide. When evaluating a
casualty or when performing the preliminary steps of rescue breathing, feel
for a pulse. If you DO NOT detect a pulse, seek medical help.
2-10. Airway Obstructions
In order for oxygen from the air to flow to and from the lungs, the upper
airway must be unobstructed.
a. Upper airway obstructions often occur because—
(1) The casualty’s tongue falls back into his throat while he
is unconscious. The tongue falls back and obstructs the airway, it is not
swallowed by the casualty.
NOTE
Ensure the correct positioning and maintenance of the open
airway for an injured or unconscious casualty.
(2) Foreign bodies become lodged in the throat. These
obstructions usually occur while eating. Choking on food (usually meat) is
associated with—
• Attempting to swallow large pieces of poorly
chewed food.
• Drinking alcohol.
• Slipping dentures.
(3) The contents of the stomach are regurgitated and may
block the airway.
(4) Blood clots may form as a result of head and facial
injuries.
b. Upper airway obstruction may cause either partial or complete
airway blockage.
(1) Partial airway obstruction. The casualty may still have
an air exchange. A good air exchange means that the casualty can cough
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forcefully, though he may be wheezing between coughs. You, the rescuer,
should not interfere, and should encourage the casualty to cough up the
object obstructing his airway on his own. A poor air exchange may be
indicated by weak coughing with a high pitched noise between coughs.
Further, the casualty may show signs of shock (paragraph 1-6b[5]) indicating
a need for oxygen. You should assist the casualty and treat him as though he
had a complete obstruction.
(2) Complete airway obstruction. A complete obstruction
(no air exchange) is indicated if the casualty cannot speak, breathe, or cough
at all. He may be clutching his neck and moving erratically. In an
unconscious casualty, a complete obstruction is also indicated if after opening
his airway you cannot ventilate him.
2-11. Opening the Obstructed Airway—Conscious Casualty
Clearing a conscious casualty’s airway obstruction can be performed with the
casualty either standing or sitting and by following a relatively simple
procedure.
WARNING
Once an obstructed airway occurs, the brain will
develop an oxygen deficiency resulting in unconsciousness.
Death will follow rapidly if breathing is not
promptly restored.
a. Ask the casualty if he can speak or if he is choking. Check for
the universal choking sign (Figure 2-10).
Figure 2-10. Universal sign of choking.
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b. If the casualty can speak, encourage him to attempt to cough;
the casualty still has a good air exchange. If he is able to speak or cough
effectively, DO NOT interfere with his attempts to expel the obstruction.
c. Listen for high pitched sounds when the casualty breathes or
coughs (poor air exchange). If there is poor air exchange or no breathing,
CALL FOR HELP and immediately deliver manual thrusts (either an
abdominal or chest thrust).
NOTE
The manual thrust with the hands centered between the waist
and the rib cage is called an abdominal thrust (or Heimlich
maneuver). The chest thrust (the hands are centered in the
middle of the breastbone) is used only for an individual in the
advanced stages of pregnancy, in the markedly obese casualty,
or if there is a significant abdominal wound.
(1) Apply abdominal thrusts. This can be accomplished by
using the following procedures:
(a) Stand behind the casualty and wrap your arms
around his waist.
(b) Make a fist with one hand and grasp it with the
other. The thumb side of your fist should be against the casualty’s abdomen,
in the midline and slightly above the casualty’s navel, but well below the tip
of the breastbone (Figure 2-11).
Figure 2-11. Anatomical view of abdominal thrust procedure.
(c) Press the fists into the abdomen with a quick
backward and upward thrust (Figure 2-12).
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Figure 2-12. Profile view of abdominal thrust.
(d) Each thrust should be a separate and distinct
movement.
NOTE
Continue performing abdominal thrusts until the obstruction is
expelled or the casualty becomes unresponsive.
(e) If the casualty becomes unresponsive, call for help
as you proceed with steps to open the airway, and perform rescue breathing.
(Refer to paragraph 2-7 for information on how to perform mouth-to-mouth
resuscitation.)
(2) Apply chest thrusts. An alternate technique to the
abdominal thrust is the chest thrust. This technique is useful when the
casualty has an abdominal wound, when the casualty is pregnant, or when the
casualty is so large that you cannot wrap your arms around the abdomen. To
apply chest thrusts with casualty sitting or standing:
(a) Stand behind the casualty and wrap your arms
around his chest with your arms under his armpits.
(b) Make a fist with one hand and place the thumb
side of the fist in the middle of the breastbone (take care to avoid the tip of
the breastbone and the margins of the ribs).
(c) Grasp the fist with the other hand and exert thrusts
(Figure 2-13).
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Figure 2-13. Profile view of chest thrust.
(d) Each thrust should be delivered slowly, distinctly,
and with the intent of relieving the obstruction.
(e) Perform chest thrusts until the obstruction is
expelled or the casualty becomes unresponsive.
(f) If the casualty becomes unresponsive, call for help
as you proceed with steps to open the airway and perform rescue breathing.
2-12. Opening the Obstructed Airway—Casualty Lying Down or Unresponsive
The following procedures are used to expel an airway obstruction in a casualty
who is lying down, who becomes unconscious, or who is found unconscious
(the cause unknown):
• If a conscious casualty who is choking becomes unresponsive,
call for help, open the airway, perform a finger sweep, and attempt rescue
breathing (paragraphs 2-4 through 2-8). If you still cannot administer rescue
breathing due to an airway blockage, then remove the airway obstruction
using the procedures as in b below.
• If a casualty is unresponsive when you find him (the cause
unknown), assess or evaluate the situation, call for help, position the casualty
on his back, open the airway, establish breathlessness, and attempt to perform
rescue breathing (paragraphs 2-4 through 2-8).
a. Open the airway and attempt rescue breathing (refer to
paragraph 2-7 for information on how to perform mouth-to-mouth
resuscitation).
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b. If still unable to ventilate the casualty, perform 6 to 10 manual
(abdominal or chest) thrusts.
(1) To perform the abdominal thrusts:
(a) Kneel astride the casualty’s thighs (Figure 2-14).
Figure 2-14. Abdominal thrust on unresponsive casualty.
(b) Place the heel of one hand against the casualty’s
abdomen (in the midline slightly above the navel but well below the tip of the
breastbone). Place your other hand on top of the first one. Point your
fingers toward the casualty’s head.
(c) Press into the casualty’s abdomen with a quick,
forward and upward thrust. You can use your body weight to perform the
maneuver. Deliver each thrust quickly and distinctly.
(d) Repeat the sequence of abdominal thrusts, finger
sweep, and rescue breathing (attempt to ventilate) as long as necessary to
remove the object from the obstructed airway.
(e) If the casualty’s chest rises, proceed to feeling for
pulse.
(2) To perform chest thrusts:
(a) Place the unresponsive casualty on his back, face
up, and open his mouth. Kneel close to the side of the casualty’s body.
1. Locate the lower edge of the casualty’s ribs
with your fingers. Run the fingers up along the rib cage to the notch (Figure
2-15A).
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2. Place the middle finger on the notch and the
index finger next to the middle finger on the lower edge of the breastbone.
Place the heel of the other hand on the lower half of the breastbone next to
the two fingers (Figure 2-15B).
3. Remove the fingers from the notch and place
that hand on top of the positioned hand on the breastbone, extending or
interlocking the fingers (Figure 2-15C).
4. Straighten and lock your elbows with your
shoulders directly above your hands without bending the elbows, rocking, or
allowing the shoulders to sag. Apply enough pressure to depress the
breastbone 1 1/2 to 2 inches, then release the pressure completely (Figure 2-
15D). Do this 6 to 10 times. Each thrust should be delivered quickly and
distinctly. See Figure 2-16 for another view of the breastbone being
depressed.
Figure 2-15. Hand placement for chest thrust (Illustrated A-D).
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Figure 2-16. Breastbone depressed 1 1/2 to 2 inches.
(b) Repeat the sequence of chest thrust, finger sweep,
and rescue breathing as long as necessary to clear the object from the
obstructed airway. See paragraph (3) below.
(c) If the casualty’s chest rises, proceed to feeling for
his pulse.
(3) If you still cannot administer rescue breathing due to an
airway obstruction, then remove the airway obstruction using the procedures
in steps (a) and (b) below.
(a) Place the casualty on his back, face up, turn the
unresponsive casualty as a unit, and call out for help.
(b) Perform finger sweep, keep casualty face up, use
tongue-jaw lift to open mouth.
1. Open the casualty’s mouth by grasping both
his tongue and lower jaw between your thumb and fingers and lifting (tonguejaw
lift) (Figure 2-17). If you are unable to open his mouth, cross your
fingers and thumb (crossed-finger method) and push his teeth apart (Figure
2-18) by pressing your thumb against his upper teeth and pressing your
finger against his lower teeth.
Figure 2-17. Opening casualty’s mouth (tongue-jaw lift).
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Figure 2-18. Opening casualty’s mouth (crossed-finger method).
2. Insert the index finger of the other hand
down along the inside of his cheek to the base of the tongue. Use a hooking
motion from the side of the mouth toward the center to dislodge the foreign
body (Figure 2-19).
Figure 2-19. Using finger to dislodge a foreign body.
WARNING
Take care not to force the object deeper into the airway
by pushing it with the finger.
Section II. STOP THE BLEEDING AND
PROTECT THE WOUND
2-13. General
The longer a service member bleeds from a major wound, the less likely he
will be able to survive his injuries. It is, therefore, important that the first aid
provider promptly stop the external bleeding.
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2-14. Clothing
In evaluating the casualty for location, type, and size of the wound or injury,
cut or tear his clothing and carefully expose the entire area of the wound.
This procedure is necessary to properly visualize injury and avoid further
contamination. Clothing stuck to the wound should be left in place to avoid
further injury. DO NOT touch the wound; keep it as clean as possible.
WARNING
DO NOT REMOVE protective clothing in a chemical environment.
Apply dressings over the protective clothing.
2-15. Entrance and Exit Wounds
Before applying the dressing, carefully examine the casualty to determine if there
is more than one wound. A missile may have entered at one point and exited at
another point. The EXIT wound is usually LARGER than the entrance wound.
WARNING
The casualty should be continually monitored for
development of conditions which may require the
performance of necessary basic lifesaving measures,
such as clearing the airway and mouth-to-mouth
resuscitation. All open (or penetrating) wounds should
be checked for a point of entry and exit and first aid
measures applied accordingly.
WARNING
If the missile lodges in the body (fails to exit), DO NOT
attempt to remove it or probe the wound. Apply a
dressing. If there is an object extending from (impaled
in) the wound, DO NOT remove the object. Apply a
dressing around the object and use additional
improvised bulky materials/dressings (use the cleanest
material available) to build up the area around the object
to stabilize the object and prevent further injury. Apply
a supporting bandage over the bulky materials to hold
them in place.
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2-16. Field Dressing
a. Use the casualty’s field dressing; remove it from the wrapper
and grasp the tails of the dressing with both hands (Figure 2-20).
Figure 2-20. Grasping tails of dressing with both hands.
WARNING
DO NOT touch the white (sterile) side of the dressing,
and DO NOT allow it to come in contact with any surface
other than the wound.
b. Hold the dressing directly over the wound with the white side
down. Pull the dressing open (Figure 2-21) and place it directly over the
wound (Figure 2-22).
Figure 2-21. Pulling dressing open.
Figure 2-22. Placing dressing directly on wound.
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c. Hold the dressing in place with one hand. Use the other hand
to wrap one of the tails around the injured part, covering about one-half of
the dressing (Figure 2-23). Leave enough of the tail for a knot. If the
casualty is able, he may assist by holding the dressing in place.
Figure 2-23. Wrapping tail of dressing around injured part.
d. Wrap the other tail in the opposite direction until the remainder
of the dressing is covered. The tails should seal the sides of the dressing to
keep foreign material from getting under it.
e. Tie the tails into a nonslip knot over the outer edge of the
dressing (Figure 2-24). DO NOT TIE THE KNOT OVER THE WOUND.
In order to allow blood to flow to the rest of an injured limb, tie the dressing
firmly enough to prevent it from slipping but without causing a tourniquetlike
effect; that is, the skin beyond the injury should not becomes cool, blue,
or numb.
Figure 2-24. Tails tied into nonslip knot.
2-17. Manual Pressure
a. If bleeding continues after applying the sterile field dressing,
direct manual pressure may be used to help control bleeding. Apply such
pressure by placing a hand on the dressing and exerting firm pressure for 5
to 10 minutes (Figure 2-25). The casualty may be asked to do this himself if
he is conscious and can follow instructions.
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Figure 2-25. Direct manual pressure applied.
b. Elevate an injured limb slightly above the level of the heart to
reduce the bleeding (Figure 2-26).
Figure 2-26. Injured limb elevated.
WARNING
DO NOT elevate a suspected fractured limb unless it
has been properly splinted.
c. If the bleeding stops, check shock; administer first aid for
shock as necessary. If the bleeding continues, apply a pressure dressing.
2-18. Pressure Dressing
Pressure dressings aid in blood clotting and compress the open blood vessel.
If bleeding continues after the application of a field dressing, manual pressure,
and elevation, then a pressure dressing must be applied as follows:
a. Place a wad of padding on top of the field dressing, directly
over the wound (Figure 2-27). Keep the injured extremity elevated.
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Figure 2-27. Wad of padding on top of field dressing.
NOTE
Improvised bandages may be made from strips of cloth. These
strips may be made from T-shirts, socks, or other garments.
b. Place an improvised dressing (or cravat, if available) over the
wad of padding (Figure 2-28). Wrap the ends tightly around the injured
limb, covering the previously placed field dressing (Figure 2-29).
Figure 2-28. Improvised dressing over wad of padding
Figure 2-29. Ends of improvised dressing wrapped tightly around limb.
c. Tie the ends together in a nonslip knot, directly over the wound
site (Figure 2-30). DO NOT tie so tightly that it has a tourniquet-like effect. If
bleeding continues and all other measures have failed, or if the limb is severed,
then apply a tourniquet. Use the tourniquet as a LAST RESORT. When the
bleeding stops, check for shock; administer first aid for shock as necessary.
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Figure 2-30. Ends of improvised dressing tied together in nonslip knot.
NOTE
Distal end of wounded extremities (fingers and toes) should be
checked periodically for adequate circulation. The dressing
must be loosened if the extremity becomes cool, blue, or numb.
NOTE
If bleeding continues and all other measures have failed
(dressings and covering wound, applying direct manual
pressure, elevating the limb above the heart level, and applying
a pressure dressing while maintaining limb elevation) then apply
digital pressure (see paragraph 2-19).
2-19. Digital Pressure
Digital pressure (often called “pressure points”) is an alternative method to
control bleeding. This method uses pressure from the fingers, thumbs, or
hands to press at the site or point where a main artery supplying the
wounded area lies near the skin surface or over bone (Figure 2-31). This
pressure may help shut off or slow down the flow of blood from the heart
to the wound and is used in combination with direct pressure and elevation.
It may help in instances where bleeding is not easily controlled, where a
pressure dressing has not yet been applied, or where pressure dressings are
not readily available.
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Figure 2-31. Digital pressure (pressure with fingers, thumbs or hands).
2-20. Tourniquet
DANGER
A tourniquet is only used on an arm or leg where
there is a danger of the casualty losing his life
(bleeding to death).
A tourniquet is a constricting band placed around an arm or leg to control
bleeding. A service member whose arm or leg has been completely amputated
may not be bleeding when first discovered, but a tourniquet should be applied
anyway. This absence of bleeding is due to the body’s normal defenses
(contraction or clotting of blood vessels) as a result of the amputation, but
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after a period of time bleeding will start as the blood vessels relax or the clot
may be knocked loose by moving the casualty. Bleeding from a major artery
of the thigh, lower leg, or arm and bleeding from multiple arteries (which
occurs in a traumatic amputation) may prove to be beyond control by manual
pressure. If the pressure dressing (see paragraph 2-18, above) under firm
hand pressure becomes soaked with blood and the wound continues to bleed,
apply a tourniquet.
WARNING
Casualty should be continually monitored for
development of conditions which may require the
performance of necessary basic lifesaving measures,
such as: clearing the airway, performing mouth-tomouth
resuscitation, preventing shock, and/or bleeding
control. All open (or penetrating) wounds should be
checked for a point of entry or exit and treated
accordingly.
The tourniquet should not be used unless a pressure dressing has failed to
stop the bleeding or an arm or leg has been cut off. On occasion, tourniquets
have injured blood vessels and nerves. If left in place too long, a tourniquet
can cause loss of an arm or leg. Once applied, it must stay in place, and the
casualty must be taken to the nearest MTF as soon as possible. DO NOT
loosen or release a tourniquet after it has been applied as release could
precipitate bleeding and potentially lead to shock.
a. Improvising a Tourniquet. In the absence of a specially
designed tourniquet, a tourniquet may be made from a strong, pliable
material, such as gauze or muslin bandages, clothing, or cravats. An
improvised tourniquet is used with a rigid stick-like object. To minimize
skin damage, ensure that the improvised tourniquet is at least 2 inches wide.
WARNING
The tourniquet must be easily identified or easily seen.
WARNING
DO NOT use wire or shoestring for a tourniquet band.
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b. Placing the Improvised Tourniquet.
(1) Place the tourniquet around the limb, between the wound
and the body trunk (or between the wound and the heart). Never place it
directly over a wound, a fracture, or joint. Tourniquets, for maximum
effectiveness, should be placed on the upper arm or above the knee on the
thigh (Figure 2-32).
Figure 2-32. Tourniquet above knee.
(2) The tourniquet should be well-padded. If possible, place
the tourniquet over the smoothed sleeve or trouser leg to prevent the skin
from being pinched or twisted. If the tourniquet is long enough, wrap it
around the limb several times, keeping the material as flat as possible.
Damaging the skin may deprive the surgeon of skin required to cover an
amputation. Protection of the skin also reduces pain.
c. Applying the Tourniquet.
(1) Tie a half-knot. (A half-knot is the same as the first part
of tying a shoe lace.)
(2) Place a stick (or similar rigid object) on top of the halfknot
(Figure 2-33).
Figure 2-33. Rigid object on top of half-knot.
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(3) Tie a full knot over the stick (Figure 2-34).
Figure 2-34. Full knot over rigid object.
(4) Twist the stick (Figure 2-35) until the tourniquet is tight
around the limb and/or the bright red bleeding has stopped. In the case of
amputation, dark oozing blood may continue for a short time. This is the
blood trapped in the area between the wound and tourniquet.
Figure 2-35. Stick twisted.
(5) Fasten the tourniquet to the limb by looping the free
ends of the tourniquet over the ends of the stick. Then bring the ends around
the limb to prevent the stick from loosening. Tie them together on the side of
the limb (Figure 2-36).
Figure 2-36. Tie free ends on side of limb.
NOTE
Other methods of securing the stick may be used as long as the
stick does not unwind and no further injury results.
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NOTE
If possible, save and transport any severed (amputated) limbs or
body parts with (but out of sight of) the casualty.
(6) DO NOT cover the tourniquet—you should leave it in
full view. If the limb is missing (total amputation), apply a dressing to the
stump. All wounds should have a dressing to protect the wound from
contamination.
(7) Mark the casualty’s forehead with a “T” and the time to
indicate a tourniquet has been applied. If necessary, use the casualty’s blood
to make this mark.
(8) Check and treat for shock.
(9) Seek medical aid.
CAUTION
Only appropriately skilled medical personnel may adjust or
otherwise remove/release the tourniquet in the appropriate
setting.
Section III. CHECK FOR SHOCK AND ADMINISTER
FIRST AID MEASURES
2-21. General
The term shock has a variety of meanings. In medicine, it refers to a collapse
of the body’s cardiovascular system which includes an inadequate supply of
blood to the body’s tissues. Shock stuns and weakens the body. When the
normal blood flow in the body is upset, death can result. Early recognition
and proper first aid may save the casualty’s life.
2-22. Causes and Effects
a. There are three basic mechanisms associated with shock.
These are—
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• The heart is damaged and fails to work as a pump.
• Blood loss (heavy bleeding) causes the volume of fluid
within the vascular system to be insufficient.
• The blood vessels dilate (open wider) so that the blood
within the system (even though it is a normal volume [the casualty is not
bleeding or dehydrated]) is insufficient to provide adequate circulation within
the body.
b. Shock may be the result of a number of conditions. These
include—
• Dehydration.
• Allergic reaction to foods, drugs, insect stings, and
snakebites.
• Significant loss of blood.
• Reaction to the sight of a wound, blood, or other
traumatic scene.
• Traumatic injuries, such as—
• Burns.
• Gunshot or shrapnel wounds.
• Crush injuries.
• Blows to the body (which can cause broken bones
or damage to internal organs).
• Head injuries.
• Penetrating wounds (such as from a knife, bayonet,
or missile).
2-23. Signs and Symptoms of Shock
Examine the casualty to see if he has any of the following signs and
symptoms:
• Sweaty but cool skin (clammy skin).
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• Weak and rapid pulse.
• Paleness of skin (in dark-skinned individuals they may have a
grayish look to their skin).
• Restlessness, nervousness.
• Thirst.
• Loss of blood (bleeding).
• Confusion (or loss of awareness).
• Faster-than-normal breathing rate.
• Blotchy or bluish skin (especially around the mouth and lips).
• Nausea and/or vomiting.
2-24. First Aid Measures for Shock
In the field, the first aid procedures administered for shock are identical to
procedures that would be performed to prevent shock. When treating a
casualty, assume that shock is present or will occur shortly. By waiting until
actual signs and symptoms of shock are noticeable, the rescuer may jeopardize
the casualty’s life.
a. Position the Casualty. (DO NOT move the casualty or his
limbs if suspected fractures have not been splinted. See Chapter 4 for details.)
(1) Move the casualty to cover, if cover is available and the
situation permits.
(2) Lay the casualty on his back.
NOTE
A casualty in shock from a chest wound or one who is
experiencing breathing difficulty, may breathe easier in a sitting
position. If this is the case, allow him to sit upright, but monitor
carefully in case his condition worsens.
(3) Elevate the casualty’s feet higher than the level of his
heart. Use a stable object (field pack or rolled up clothing) so that his feet
will not slip off (Figure 2-37).
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WARNING
DO NOT elevate legs if the casualty has an unsplinted
broken leg, head injury, or abdominal injury.
Figure 2-37. Clothing loosened and feet elevated.
WARNING
Check casualty for leg fracture(s) and splint, if
necessary, before elevating his feet. For a casualty with
an abdominal wound, place his knees in an upright
(flexed) position.
(4) Loosen clothing at the neck, waist, or wherever it may
be binding.
CAUTION
DO NOT loosen or remove protective clothing in a chemical
environment.
(5) Prevent chilling or overheating. The key is to maintain
body temperature. In cold weather, place a blanket or other like item over
him to keep him warm and under him to prevent chilling (Figure 2-38).
However, if a tourniquet has been applied, leave it exposed (if possible). In
hot weather, place the casualty in the shade and protect him from becoming
chilled; however, avoid the excessive use of blankets or other coverings.
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Figure 2-38. Body temperature maintained.
(6) Calm the casualty. Throughout the entire procedure of
providing first aid for a casualty, the rescuer should reassure the casualty and
keep him calm. This can be done by being authoritative (taking charge) and
by showing self-confidence. Assure the casualty that you are there to help
him.
(7) Seek medical aid.
b. Food and/or Drink. When providing first aid for shock, DO
NOT give the casualty any food or drink. If you must leave the casualty or if
he is unconscious, turn his head to the side to prevent him from choking if
he vomits (Figure 2-39).
Figure 2-39. Casualty’s head turned to side.
c. Evaluate Casualty. Continue to evaluate the casualty until
medical personnel arrives or the casualty is transported to an MTF.
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CHAPTER 3
FIRST AID FOR SPECIFIC INJURIES
3-1. General
Basic lifesaving steps are discussed in Chapters 1 and 2; they apply to first
aid measures for all injuries. Some wounds and burns will require special
precautions and procedures when applying these measures. This chapter
discusses specific first aid procedures for wounds of the head, face, and
neck; chest and stomach wounds; and burns. It also discusses the techniques
for applying dressings and bandages to specific parts of the body.
3-2. Head, Neck, and Facial Injuries
a. Head Injuries.
(1) Head injuries range from minor abrasions or cuts on the
scalp to severe brain injuries that may result in unconsciousness and
sometimes death. Head injuries are classified as open or closed wounds. An
open wound is one that is visible, has a break in the skin, and usually has
evidence of bleeding. A closed wound may be visible (such as a depression
in the skull) or the first aid provider may not be able to see any apparent
injury (such as internal bleeding). Some head injuries result in
unconsciousness; however, a service member may have a serious head wound
and still be conscious. Casualties with head and neck injuries should be
treated as though they also have a spinal injury. The casualty should not be
moved until the head and neck is stabilized unless he is in immediate danger
(such as close to a burning vehicle).
(2) Prompt first aid measures should be initiated for
casualties with suspected head and neck injuries. The conscious casualty
may be able to provide information on the extent of his injuries. However, as a
result of the head injury, he may be confused and unable to provide accurate
information. The signs and symptoms a first aid provider might observe are—
• Nausea and vomiting.
• Convulsions or twitches.
• Slurred speech.
• Confusion and loss of memory. (Does he know
who he is? Does he know where he is? Does he know what day it is?)
• Recent unconsciousness.
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• Dizziness.
• Drowsiness.
• Blurred vision, unequal pupils, or bruising (black
eyes).
• Paralysis (partial or full).
• Complaint of headache.
• Bleeding or other fluid discharge from the scalp,
nose, or ears.
• Deformity of the head (depression or swelling).
• Staggering while walking.
b. Neck Injuries. Neck injuries may result in heavy bleeding.
Apply pressure above and below the injury, but do not interfere with the
breathing process, and attempt to control the bleeding. Apply a dressing.
Always evaluate the casualty for a possible neck fracture/spinal cord injury;
if suspected, seek medical treatment immediately.
NOTE
Establish and maintain the airway in cases of facial or neck
injuries. If a neck fracture or spinal cord injury is suspected,
immobilize the injury and, if necessary, perform basic life
support measures.
c. Facial Injuries. Soft tissue injuries of the face and scalp are
common. Abrasions (scrapes) of the skin cause no serious problems.
Contusions (injury without a break in the skin) usually cause swelling. A
contusion of the scalp looks and feels like a lump. Laceration (cut) and
avulsion (torn away tissue) injuries are also common. Avulsions are
frequently caused when a sharp blow separates the scalp from the skull
beneath it. Because the face and scalp are richly supplied with blood vessels
(arteries and veins), wounds of these areas usually bleed heavily.
3-3. General First Aid Measures
a. General Considerations. The casualty with a head injury (or
suspected head injury) should be continually monitored for the development
of conditions that may require basic lifesaving measures. After initiating first
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aid measures, request medical assistance and evacuation. If dedicated medical
evacuation assets are not available, transport the casualty to an MTF as soon
as the situation permits. The first aid provider should not attempt to remove
a protruding object from the head or give the casualty anything to eat or
drink. Further, the first aid provider should be prepared to—
• Clear the airway.
• Control bleeding (external).
• Administer first aid measures for shock.
• Keep the casualty warm.
• Protect the wound.
b. Unconscious Casualty. An unconscious casualty does not have
control of all of his body’s functions and may choke on his tongue, blood,
vomitus, or other substances. (Refer to Figure 2-39.)
(1) Breathing. The brain requires a constant supply of
oxygen. A bluish (or in an individual with dark skin—grayish) color of skin
around the lips and nail beds indicates that the casualty is not receiving
enough oxygen. Immediate action must be taken to clear the airway, to
position the casualty on his side, or to initiate rescue breathing.
(2) Bleeding. Bleeding from a head injury usually comes
from blood vessels within the scalp. Bleeding can also develop inside the
skull or within the brain. In most instances visible bleeding from the head
can be controlled by application of the field first aid dressing.
CAUTION
DO NOT attempt to put unnecessary pressure on the wound
or attempt to push any brain matter back into the head
(skull). DO NOT apply a pressure dressing.
c. Concussion. If an individual receives a heavy blow to the
head or face, he may suffer a brain concussion (an injury to the brain that
involves a temporary loss of some or all of the brain’s ability to function).
For example, the casualty may not breathe properly for a short period of
time, or he may become confused and stagger when he attempts to walk.
Symptoms of a concussion may only last for a short period of time. However,
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if a casualty is suspected of having suffered a concussion, he should be
transported to an MTF as soon as conditions permit.
d. Convulsions. Convulsions (seizures/involuntary jerking) may
occur even after a mild head injury. When a casualty is convulsing, protect
him from hurting himself. Take the following measures:
(1) Ease him to the ground if he is standing or sitting.
(2) Support his head and neck.
(3) Maintain his airway.
(4) Protect him from further injury (such as hitting close-by
objects).
NOTE
DO NOT forcefully hold the arms and legs if they are jerking
because this can lead to broken bones. DO NOT force anything
between the casualty’s teeth—especially if they are tightly
clenched because this may obstruct the casualty’s airway.
Maintain the casualty’s airway if necessary.
e. Brain Damage. In severe head injuries where brain tissue is
protruding, leave the wound alone; carefully place a loose moistened dressing
(moistened with sterile normal saline if available) and also a first aid dressing
over the tissue to protect it from further contamination. DO NOT remove or
disturb any foreign matter that may be in the wound. Position the casualty so
that his head is higher than his body. Keep him warm and seek medical
assistance immediately.
NOTE
If there is an object extending from the wound, DO NOT
remove the object. Improvise bulky dressings from the cleanest
material available and place this material around the protruding
object for support, then apply the field dressing.
3-4. Chest Wounds
Blunt trauma, bullet or missile wounds, stab wounds, or falls may cause chest
injuries. These injuries can be serious and may cause death quickly if first aid
is not administered in a timely manner. A casualty with a chest injury may
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complain of pain in the chest or shoulder area; he may have difficulty breathing.
His chest may not rise normally when he breathes. The injury may cause the
casualty to cough up blood and to have a rapid or a weak heartbeat. A casualty
with an open chest wound has a punctured chest wall. The sucking sound
heard when he breathes is caused by air leaking into his chest cavity. This
particular type of wound is dangerous and will collapse the injured lung
(Figure 3-1). Breathing becomes difficult for the casualty because the wound
is open. The service members life may depend upon how quickly you apply
an occlusive dressing over the wound (refer to paragraph 3-5).
Figure 3-1. Collapsed lung.
3-5. First Aid for Chest Wounds
a. Evaluate the Casualty. Be prepared to perform first aid
measures. These measures may include clearing the airway, rescue breathing,
treatment for shock, and/or bleeding control.
b. Expose the Wound. If appropriate, cut or remove the
casualty’s clothing to expose the wound. Remember, DO NOT remove
clothing that is stuck to the wound because additional injury may result. DO
NOT attempt to clean the wound.
NOTE
Examine the casualty to see if there is an entry and exit wound.
If there are two wounds (entry, exit), perform the same
procedure for both wounds. Treat the more serious (heavier
bleeding, larger) wound first. It may be necessary to improvise
a dressing for the second wound by using strips of cloth, such as
a torn T-shirt, or whatever material is available. Also, listen
for sucking sounds to determine if the chest wall is punctured.
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CAUTION
If there is an object impaled in the wound, DO NOT remove
it. Apply a dressing around the object and use additional
improvised bulky materials/dressings (use the cleanest
materials available) to build up the area around the object.
Apply a supporting bandage over the bulky materials to hold
them in place.
CAUTION
DO NOT REMOVE protective clothing in a chemical
environment. Apply dressings over the protective clothing.
c. Open the Casualty’s Field Dressing Plastic Wrapper. In cases
where there is a sucking chest wound, the plastic wrapper is used with the
field dressing to create an occlusive dressing. If a plastic wrapper is not
available, or if an additional wound needs to be treated; cellophane, foil, the
casualty’s poncho, or similar material may be used. The covering should be
wide enough to extend 2 inches or more beyond the edges of the wound in all
directions.
(1) Tear open one end of the casualty’s plastic wrapper
covering the field dressing. Be careful not to destroy the wrapper and DO
NOT touch the inside of the wrapper.
(2) Remove the inner packet (field dressing).
(3) Complete tearing open the empty plastic wrapper using
as much of the wrapper as possible to create a flat surface.
d. Place the Wrapper Over the Wound. Place the inside surface
of the plastic wrapper directly over the wound when the casualty exhales and
hold it in place (Figure 3-2). The casualty may hold the plastic wrapper in
place if he is able.
Figure 3-2. Open chest wound sealed with an occlusive dressing.
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e. Apply the Dressing to the Wound.
(1) Use your free hand and shake open the field dressing
(Figure 3-3).
Figure 3-3. Shaking open the field dressing.
(2) Place the white side of the dressing on the plastic wrapper
covering the wound (Figure 3-4).
Figure 3-4. Field dressing placed on plastic wrapper.
NOTE
Use the casualty’s field dressing, not your own.
(3) Have the casualty breathe normally.
(4) While maintaining pressure on the dressing, grasp one
tail of the field dressing with the other hand and wrap it around the casualty’s
back. If tape is available, tape three sides of the plastic wrapper to the chest
wall to provide occlusive type dressing. Leave one side untapped to provide
emergency escape for air that may build up in the chest. If tape is not
available, secure wrapper on three sides with field dressing leaving the fourth
side as a flap.
(5) Wrap the other tail in the opposite direction, bringing
both tails over the dressing (Figure 3-5).
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Figure 3-5. Tails of field dressing wrapped around casualty
in opposite direction.
(6) Tie the tails into a square knot in the center of the
dressing after the casualty exhales and before he inhales. This will aid in
maintaining pressure on the bandage after it has been tied (Figure 3-6). Tie
the dressing firmly enough to secure the dressing without interfering with the
casualty’s breathing.
Figure 3-6. Tails of dressing tied into square knot over center of dressing.
NOTE
When practical, apply direct manual pressure over the dressing
for 5 to 10 minutes to help control the bleeding.
f. Position the Casualty. Position the casualty on his injured side
or in a sitting position, whichever makes breathing easier (Figure 3-7).
Figure 3-7. Casualty positioned (lying) on injured side.
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g. Seek Medical Assistance. Contact medical personnel.
WARNING
If an occlusive dressing has been improperly placed,
air may enter the chest cavity with no means of escape.
This causes a life-threatening condition called tension
pneumothorax. If the casualty’s condition (for example,
difficulty breathing, shortness of breath, restlessness,
or blueness/grayness of the skin) worsens after placing
the dressing, quickly lift or remove, and then replace
the occlusive dressing.
3-6. Abdominal Wounds
The most serious abdominal wound is one in which an object penetrates the
abdominal wall and pierces internal organs or large blood vessels. In these
instances, bleeding may be severe and death can occur rapidly.
3-7. First Aid for Abdominal Wounds
a. Evaluate the Casualty. Be prepared to perform basic first aid
measures. Always check for both entry and exit wounds. If there are two
wounds (entry and exit), treat the wound that appears more serious first (for
example, the heavier bleeding, protruding organs, larger wound, and so
forth). It may be necessary to improvise dressings for the second wound by
using strips of cloth, a T-shirt, or the cleanest material available.
b. Position the Casualty. Place and maintain the casualty on his
back with his knees in an upright (flexed) position (Figure 3-8). The kneesup
position helps relieve pain, assists in the treatment of shock, prevents
further exposure of the bowel (intestines) or abdominal organs, and helps
relieve abdominal pressure by allowing the abdominal muscles to relax.
Figure 3-8. Casualty positioned (lying) on back with knees (flexed) up.
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c. Expose the Wound.
(1) Remove the casualty’s loose clothing to expose the
wound. However, DO NOT attempt to remove clothing that is stuck to the
wound; removing it may cause further injury.
CAUTION
DO NOT REMOVE protective clothing in a chemical
environment. Apply dressings over the protective clothing.
(2) Gently pick up any organs that may be on the ground.
Do this with a clean, dry dressing or with the cleanest available material.
Place the organs on top of the casualty’s abdomen (Figure 3-9).
Figure 3-9. Protruding organs placed near wound.
NOTE
DO NOT probe, clean, or try to remove any foreign object
from the abdomen. DO NOT touch with bare hands any
exposed organs. DO NOT push organs back inside the body.
d. Apply the Field Dressing. Use the casualty’s field dressing,
not your own. If the field dressing is not large enough to cover the entire
wound, the plastic wrapper from the dressing may be used to cover the wound
first (placing the field dressing on top). Open the plastic wrapper carefully
without touching the inner surface. If necessary, other improvised dressings
may be made from clothing, blankets, or the cleanest materials available.
WARNING
If there is an object extending from the wound, DO NOT
remove it. Place as much of the wrapper over the
wound as possible without dislodging or moving the
object. DO NOT place the wrapper over the object.
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(1) Grasp the tails in both hands.
(2) Hold the dressing with the white side down directly over
the wound. DO NOT touch the white (sterile) side of the dressing or allow
anything except the wound to come in contact with it.
(3) Pull the dressing open and place it directly over the wound
(Figure 3-10). If the casualty is able, he may hold the dressing in place.
Figure 3-10. Dressing placed directly over the wound.
(4) Hold the dressing in place with one hand and use the
other hand to wrap one of the tails around the body.
(5) Wrap the other tail in the opposite direction until the
dressing is completely covered. Leave enough of the tail for a knot.
(6) Loosely tie the tails with a square knot at the casualty’s
side (Figure 3-11).
Figure 3-11. Dressing applied and tails tied with a square knot.
WARNING
When the dressing is applied, DO NOT put pressure on
the wound or exposed internal parts, because pressure
could cause further injury (vomiting, ruptured
intestines, and so forth). Therefore, tie the dressing
ties (tails) loosely at casualty’s side, not directly over
the dressing.
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(7) Tie the dressing firmly enough to prevent slipping
without applying pressure to the wound site (Figure 3-12).
Figure 3-12. Field dressing covered with improvised material
and loosely tied.
Field dressings can be covered with improvised reinforcement material
(cravats, strips of torn T-shirt, or other cloth) for additional support and
protection. Tie improvised bandage on the opposite side of the dressing ties
firmly enough to prevent slipping but without applying additional pressure to
the wound.
CAUTION
DO NOT give casualties with abdominal wounds food or
water (moistening the lips is allowed).
e. Seek Medical Assistance. Notify medical personnel.
3-8. Burn Injuries
Burns often cause extreme pain, scarring, or even death. Before
administering first aid, you must be able to recognize the type of burn.
There are four types of burns:
• Thermal burns caused by fire, hot objects, hot liquids, and
gases; or by nuclear blast or fireball.
• Electrical burns caused by electrical wires, current, or
lightning.
• Chemical burns caused by contact with wet or dry chemicals
or white phosphorus (WP)—from marking rounds and grenades.
• Laser burns (eye [ocular] injury).
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3-9. First Aid for Burns
a. Eliminate the Source of the Burn. The source of the burn must
be eliminated before any evaluation of the casualty can occur and first aid
administered.
(1) Quickly remove the casualty from danger and cover the
thermal burn with any large nonsynthetic material, such as a field jacket. If
the casualty’s clothing is still on fire, roll the casualty on the ground to
smother (put out) the flames (Figure 3-13).
Figure 3-13. Casualty covered and rolled on ground.
CAUTION
Synthetic materials, such as nylon, may melt and cause
further injury.
(2) Remove the electrical burn casualty from the electrical
source by turning off the electrical current. DO NOT attempt to turn off the
electricity if the source is not close by. Speed is critical, so DO NOT waste
unnecessary time. If the electricity cannot be turned off, wrap any
nonconductive material (dry rope, clothing, wood, and so forth) around the
casualty’s back and shoulders and drag the casualty away from the electrical
source (Figure 3-14). DO NOT make body-to-body contact with the casualty
or touch any wires because you could also become an electrical burn casualty.
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FM 4-25.11/NTRP 4-02.1/AFMAN 44-163(I)
Figure 3-14. Casualty removed from electrical source
(using nonconductive material).
WARNING
High voltage electrical burns may cause temporary
unconsciousness, difficulties in breathing, or difficulties
with the heart (heartbeat).
(3) Remove the chemical from the burned casualty. Remove
liquid chemicals by flushing with as much water as possible. Remove dry
chemicals by brushing off loose particles (DO NOT use the bare surface of
your hand because you could become a chemical burn casualty) and then flush
with large amounts of water, if available. If large amounts of water are not
available, then NO water should be applied because small amounts of water
applied to a dry chemical burn may cause a chemical reaction. When WP
strikes the skin, smother with a wet cloth or mud. Keep WP covered with a
wet material to exclude air; this should help prevent the particles from burning.
(4) Remove the laser burn casualty from the source. When
removing the casualty from the laser beam source, be careful not to enter the
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FM 4-25.11/NTRP 4-02.1/AFMAN 44-163(I)
beam or you may become a casualty. Never look directly at the beam source
and if possible, wear appropriate eye protection.
NOTE
After the casualty is removed from the source of the burn, he
should be evaluated for conditions requiring basic first aid
measures.
b. Expose the Burn. Cut and gently lift away any clothing
covering the burned area, without pulling clothing over the burns. Leave in
place any clothing that is stuck to the burn. If the casualty’s hands or wrists
have been burned, remove jewelry if possible without causing further injury
(rings, watches, and so forth) and place in his pockets. This prevents the
necessity to cut off jewelry since swelling usually occurs as a result of a burn.
CAUTION
DO NOT lift or cut away clothing if in a chemical
environment. Apply the dressing directly over the casualty’s
protective clothing. DO NOT attempt to decontaminate skin
where blisters have formed.
c. Apply a Field Dressing to the Burn.
(1) Grasp the tails of the casualty’s dressing in both hands.
(2) Hold the dressing directly over the wound with the white
side down, pull the dressing open, and place it directly over the wound. DO
NOT touch the white (sterile) side of the dressing or allow anything except
the wound to come in contact with it. If the casualty is able, he may hold the
dressing in place.
(3) Hold the dressing in place with one hand and use the
other hand to wrap one of the tails around the limbs or the body.
(4) Wrap the other tail in the opposite direction until the
dressing is completely covered.
(5) Tie the tails into a square knot over the outer edge of the
dressing. The dressing should be applied lightly over the burn. Ensure that
dressing is applied firmly enough to prevent it from slipping.
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FM 4-25.11/NTRP 4-02.1/AFMAN 44-163(I)
NOTE
Use the cleanest improvised dressing material available if a field
dressing is not available or if it is not large enough for the entire
wound.
d. Take the Following Precautions:
• DO NOT place the dressing over the face or genital area.
• DO NOT break the blisters.
• DO NOT apply grease or ointments to the burns.
• For electrical burns, check for both an entry and exit
burn from the passage of electricity through the body. Exit burns may
appear on any area of the body despite location of entry burn.
• For burns caused by wet or dry chemicals, flush the
burns with large amounts of water and cover with a dry dressing.
• For burns caused by WP, flush the area with water, then
cover with a wet material, dressing, or mud to exclude the air and keep the
WP particles from burning.
• For laser burns, apply a field dressing.
• If the casualty is conscious and not nauseated, give him
small amounts of water.
e. Seek Medical Assistance. Notify medical personnel.
3-10. Dressings and Bandages
a. Head Wounds.
(1) Position the casualty.
WARNING
DO NOT move the casualty if you suspect he has
sustained a neck, spine, or head injury (which produces
any signs or symptoms other than minor bleeding).
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• If the casualty has a minor (superficial) scalp
wound and is conscious:
• Have the casualty sit up (unless other injuries
prohibit or he is unable to).
• If the casualty is lying down and is not
accumulating fluids or drainage in his throat, elevate his head slightly.
• If the casualty is bleeding from or into his
mouth or throat, turn his head to the side or position him on his side so that
the airway will be clear. Avoid putting pressure on the wound and place him
on his uninjured side (Figure 3-15).
Figure 3-15. Casualty lying on side opposite injury.
• If the casualty is unconscious or has a severe head
injury, then suspect and treat him as having a potential neck or spinal injury,
immobilize and DO NOT move the casualty.
NOTE
If the casualty is choking or vomiting or is bleeding from or into
his mouth (thus compromising his airway), position him on his
uninjured side to allow for drainage and to help keep his airway
clear.
WARNING
If it is necessary to turn a casualty with a suspected
neck/spine injury; roll the casualty gently onto his side,
keeping the head, neck, and body aligned while providing
support for the head and neck. DO NOT roll the
casualty by yourself but seek assistance. Move him only
if absolutely necessary, otherwise keep the casualty
immobilized to prevent further damage to the neck/spine.
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(2) Expose the wound. Remove the casualty’s helmet (if
necessary). In a nuclear, biological, and chemical (NBC) environment, the
first aid provider must leave the casualty as much protection (such as
protective mask, mission-oriented protective posture [MOPP] overgarments)
as possible. What items of protective equipment can be removed is dependent
upon the casualty’s injuries (where on the body and what type), the MOPP
level, integrity of protective equipment (such as tears in the garment or mask
seal), availability of chemical protective shelters, and the tactical situation.
WARNING
DO NOT attempt to clean the wound or remove a
protruding object.
NOTE
Always use the casualty’s field dressing, not your own.
(3) Apply a dressing to a wound of the forehead or back of
head. To apply a dressing to a wound of the forehead or back of the head—
(a) Remove the dressing from the wrapper.
(b) Grasp the tails of the dressing in both hands.
(c) Hold the dressing (white side down) directly over
the wound. DO NOT touch the white (sterile) side of the dressing or allow
anything except the wound to come in contact with it.
(d) Place it directly over the wound.
(e) Hold it in place with one hand. If the casualty is
able, he may assist.
(f) Wrap the first tail horizontally around the head;
ensure the tail covers the dressing (Figure 3-16).
Figure 3-16. First tail of dressing wrapped horizontally around head.
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FM 4-25.11/NTRP 4-02.1/AFMAN 44-163(I)
(g) Hold the first tail in place and wrap the second tail
in the opposite direction, covering the dressing (Figure 3-17).
Figure 3-17. Second tail wrapped in opposite direction.
(h) Tie a square knot and secure the tails at the side of
the head, making sure they DO NOT cover the eyes or ears (Figure 3-18).
Figure 3-18. Tails tied in square knot at side of head.
(4) Apply a dressing to a wound on top of the head. To
apply a dressing to a wound on top of the head—
(a) Remove the dressing from the wrapper.
(b) Grasp the tails of the dressing in both hands.
(c) Hold it (white side down) directly over the wound.
DO NOT touch the white (sterile) side of the dressing or allow anything
except the wound to come in contact with it.
(d) Place it over the wound (Figure 3-19).
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FM 4-25.11/NTRP 4-02.1/AFMAN 44-163(I)
Figure 3-19. Dressing placed over wound.
(e) Hold it in place with one hand. If the casualty is
able, he may assist.
(f) Wrap one tail down under the chin (Figure 3-20),
up in front of the ear, over the dressing, and in front of the other ear.
Figure 3-20. One tail of dressing wrapped under chin.
WARNING
Ensure the tails remain wide and close to the front of
the chin to avoid choking the casualty.
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FM 4-25.11/NTRP 4-02.1/AFMAN 44-163(I)
(g) Wrap the remaining tail under the chin in the
opposite direction and up the side of the face to meet the first tail (Figure 3-21).
Figure 3-21. Remaining tail wrapped under chin in opposite direction.
(h) Cross the tails (Figure 3-22), bringing one around
the forehead (above the eyebrows) and the other around the back of the head
(at the base of the skull) to a point just above and in front of the opposite ear,
and tie them using a square knot (Figure 3-23).
Figure 3-22. Tails of dressing crossed with one around forehead.
Figure 3-23. Tails tied in square knot (in front of and above ear).
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FM 4-25.11/NTRP 4-02.1/AFMAN 44-163(I)
(5) Apply a triangular bandage to the head. To apply a
triangular bandage to the head—
(a) Turn the base (longest side) of the bandage up and
center its base on the center of the forehead, letting the point (apex) fall on
the back of the neck (Figure 3-24A).
(b) Take the ends behind the head and cross the ends
over the apex.
(c) Take them over the forehead and tie them (Figure
3-24B).
(d) Tuck the apex behind the crossed part of the
bandage or secure it with a safety pin, if available (Figure 3-24C).
Figure 3-24. Triangular bandage applied to head (Illustrated A—C)
(6) Apply a cravat bandage to the head. To apply a cravat
bandage to the head—
(a) Place the middle of the bandage over the dressing
(Figure 3-25A).
(b) Cross the two ends of the bandage in opposite
directions completely around the head (Figure 3-25B).
(c) Tie the ends over the dressing (Figure 3-25C).
Figure 3-25. Cravat bandage applied to head (Illustrated A—C).
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FM 4-25.11/NTRP 4-02.1/AFMAN 44-163(I)
b. Eye Injuries. The eye is a vital sensory organ, and blindness
is a severe physical handicap. Timely first aid of the eye may relieve pain
and may also help to prevent shock, permanent eye injury, and possible loss
of vision. Because the eye is very sensitive, any injury can be easily
aggravated if it is improperly handled. Injuries of the eye may be quite
severe. Cuts of the eyelids can appear to be very serious, but if the eyeball is
not involved, a person’s vision usually will not be damaged. However,
lacerations (cuts) of the eyeball can cause permanent damage or loss of sight.
(1) Lacerated/torn eyelids. Lacerated eyelids may bleed
heavily, but bleeding usually stops quickly. Cover the injured eye with a
sterile dressing. DO NOT put pressure on the wound because you may
injure the eyeball. Handle torn eyelids very carefully to prevent further
injury. Place any detached pieces of the eyelid on a clean bandage or
dressing and immediately send them with the casualty to the medical facility.
(2) Lacerated eyeball (injury to the globe). Lacerations or
cuts to the eyeball may cause serious and permanent eye damage. Cover the
injury with a loose sterile dressing. DO NOT put pressure on the eyeball
because additional damage may occur. An important point to remember is
that when one eyeball is injured, you should immobilize both eyes. This is
done by applying a bandage to both eyes. Because the eyes move together,
covering both will lessen the chances of further damage to the injured eye.
(However, in hazardous surroundings, leave uninjured eye uncovered to
enable casualty to see.)
CAUTION
DO NOT apply pressure when there is a possible laceration
of the eyeball. The eyeball contains fluid. Pressure applied
over the eye will force the fluid out, resulting in permanent
injury. APPLY PROTECTIVE DRESSING WITHOUT
ADDED PRESSURE.
(3) Extruded eyeballs. Service members may encounter
casualties with severe eye injuries that include an extruded eyeball (eyeball
out-of-socket). In such instances you should gently cover the extruded eye
with a loose moistened dressing and also cover the unaffected eye. DO NOT
bind or exert pressure on the injured eye while applying the dressing. Keep
the casualty quiet, place him on his back, treat for shock, and evacuate him
immediately.
(4) Burns of the eyes. Chemical burns, thermal (heat) burns,
and light burns can affect the eyes.
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FM 4-25.11/NTRP 4-02.1/AFMAN 44-163(I)
(a) Chemical burns. Injuries from chemical burns
require immediate first aid. Mainly acids or alkalies cause chemical burns.
The first aid measures consist of flushing the eyes immediately with large
amounts of water for at least 5 to 20 minutes, or as long as necessary to flush
out the chemical and, once flushed, bandaging the eyes. If the burn is an
acid burn, you should flush the eye for at least 5 to 10 minutes. If the burn is
an alkali burn, you should flush the eye for at least 20 minutes. After the eye
has been flushed evacuate the casualty immediately.
(b) Thermal burns. When an individual suffers burns
of the face from a fire, the eyes will close quickly due to extreme heat. This
reaction is a natural reflex to protect the eyeballs; however, the eyelids
remain exposed and are frequently burned. If a casualty receives burns of
the eyelids or face—
• DO NOT apply a dressing.
• DO NOT touch.
• SEEK medical assistance immediately.
(c) Light burns. Exposure to intense light can burn an
individual. Infrared rays, eclipse light (if the casualty has looked directly at
the sun), or laser burns cause injuries of the exposed eyeball. Ultraviolet
rays from arc welding can cause a superficial burn to the surface of the eye.
These injuries are generally not painful but may cause permanent damage to
the eyes. Immediate first aid is usually not required. Loosely bandaging the
eyes may make the casualty more comfortable and protect his eyes from
further injury caused by exposure to other bright lights or sunlight.
CAUTION
With impaled objects or significant sized foreign bodies, both
eyes are usually bandaged to help secure the foreign body
in the injured eye. In a battlefield environment, leave the
uninjured eye uncovered so that the casualty can see.
c. Side-of-Head or Cheek Wound. Facial injuries to the side of
the head or the cheek may bleed profusely (Figure 3-26). Prompt action is
necessary to ensure that the airway remains open and also to control the
bleeding. It may be necessary to apply a dressing. To apply a dressing—
(1) Remove the dressing from its wrapper.
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FM 4-25.11/NTRP 4-02.1/AFMAN 44-163(I)
(2) Grasp the tails in both hands.
(3) Hold the dressing directly over the wound with the white
side down and place it directly on the wound (Figure 3-27A). DO NOT
touch the white (sterile) side of the dressing or allow anything except the
wound to come in contact with it.
(4) Hold the dressing in place with one hand (the casualty
may assist if able). Wrap the top tail over the top of the head and bring it
down in front of the ear (on the side opposite the wound), under the chin
(Figure 3-27B) and up over the dressing to a point just above the ear (on the
wound side).
Figure 3-26. Side of head or cheek wound.
Figure 3-27. Dressing placed directly on wound. Top tail wrapped over
top of head, down in front of ear, and under chin (Illustrated A—B).
NOTE
When possible, avoid covering the casualty’s ear with the
dressing, as this will decrease his ability to hear.
(5) Bring the second tail under the chin, up in front of the
ear (on the side opposite the wound), and over the head to meet the other tail
(on the wounded side) (Figure 3-28).
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FM 4-25.11/NTRP 4-02.1/AFMAN 44-163(I)
Figure 3-28. Bringing second tail under the chin.
(6) Cross the two tails (on the wound side) (Figure 3-29)
and bring one end across the forehead (above the eyebrows) to a point just in
front of the opposite ear (on the uninjured side).
Figure 3-29. Crossing the tails on the side of the wound.
(7) Wrap the other tail around the back of the head (at the
base of the skull), and tie the two ends just in front of the ear on the uninjured
side with a square knot (Figure 3-30).
Figure 3-30. Tying the tails of the dressing in a square knot.
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FM 4-25.11/NTRP 4-02.1/AFMAN 44-163(I)
d. Ear Injuries. Lacerated (cut) or avulsed (torn) ear tissue may
not, in itself, be a serious injury. Bleeding, or the drainage of fluids from the
ear canal, however, may be a sign of a head injury, such as a skull fracture.
DO NOT attempt to stop the flow from the inner ear canal nor put anything
into the ear canal to block it. Instead, you should cover the ear lightly with a
dressing. For minor cuts or wounds to the external ear, apply a cravat
bandage as follows:
(1) Place the middle of the bandage over the ear (Figure 3-
31A).
(2) Cross the ends, wrap them in opposite directions around
the head, and tie them (Figures 3-31B and 3-31C).
Figure 3-31. Applying cravat bandage to ear (Illustrated A—C).
(3) If possible, place some dressing material between the
back of the ear and the side of the head to avoid crushing the ear against the
head with the bandage.
e. Nose Injuries. Nose injuries generally produce bleeding. The
bleeding may be controlled by placing an ice pack (if available) over the
nose, or pinching the nostrils together. The bleeding may also be controlled
by placing torn gauze (rolled) between the upper teeth and the lip.
CAUTION
DO NOT attempt to remove objects inhaled into the nose.
An untrained person who removes such an object could
worsen the casualty’s condition and cause permanent injury.
f. Jaw Injuries. Before applying a bandage to a casualty’s jaw,
remove all loose or free-floating foreign material from the casualty’s mouth.
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If the casualty is unconscious, check for obstructions in the airway and
remove if possible. If there is profuse bleeding in the oral cavity, the cavity
may require loose packing with soft bandaging material (for example:
Kerlix™ gauze) prior to applying a bandage. Care should be taken to avoid
occluding the airway. When applying the bandage, allow the jaw enough
freedom to permit passage of air and drainage from the mouth.
(1) Apply bandages attached to field first aid dressing to the
jaw. After dressing the wound, apply the bandages using the same technique
illustrated in Figure 3-32A—C.
NOTE
The dressing and bandaging procedure outlined for the jaw
serves a twofold purpose. In addition to stopping the bleeding
and protecting the wound, it also immobilizes a fractured jaw.
(2) Apply a cravat bandage to the jaw.
(a) Place the bandage under the chin and pull its ends
upward. Adjust the bandage to make one end longer than the other (Figure
3-32A).
(b) Take the longer end over the top of the head to
meet the short end at the temple and cross the ends over (Figure 3-32B).
(c) Take the ends in opposite directions to the other
side of the head and tie them over the part of the bandage that was applied
first (Figure 3-32C).
Figure 3-32. Applying a cravat bandage to jaw (Illustrated A—C).
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FM 4-25.11/NTRP 4-02.1/AFMAN 44-163(I)
NOTE
The cravat bandage technique is used to immobilize a fractured
jaw or to maintain a sterile dressing that does not have tail
bandages attached.
3-11. Shoulder Bandage
a. To apply bandages attached to the field first aid dressing—
(1) Take one bandage across the chest and the other across
the back and under the arm opposite the injured shoulder.
(2) Tie the ends with a square knot (Figure 3-33).
Figure 3-33. Shoulder bandage.
b. To apply a cravat bandage to the shoulder or armpit—
(1) Make an extended cravat bandage by using two triangular
bandages (Figure 3-34A); place the end of the first triangular bandage along
the base of the second one (Figure 3-34B).
(2) Fold the two bandages into a single extended bandage
(Figure 3-34C).
(3) Fold the extended bandage into a single cravat bandage
(Figure 3-34D). After folding, secure the thicker part (overlap) with two or
more safety pins (Figure 3-34E).
(4) Place the middle of the cravat bandage under the armpit
so that the front end is longer than the back end and safety pins are on the
outside (Figure 3-34F).
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FM 4-25.11/NTRP 4-02.1/AFMAN 44-163(I)
(5) Cross the ends on top of the shoulder (Figure 3-34G).
(6) Take one of the bandage ends across the back and under
the arm on the opposite side and the other end across the chest. Tie the ends
(Figure 3-34H).
Figure 3-34. Extended cravat bandage applied to shoulder or armpit
(Illustrated A—H).
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Be sure to place sufficient wadding in the armpit. DO NOT tie the cravat
bandage too tightly. Avoid compressing the major blood vessels in the
armpit.
3-12. Elbow Bandage
To apply a cravat bandage to the elbow—
a. Bend the arm at the elbow and place the middle of the cravat at
the point of the elbow bringing the ends upward (Figure 3-35A).
b. Bring the ends across, extending both downward (Figure 3-
35B).
c. Take both ends around the arm and tie them with a square knot
at the front of the elbow (Figure 3-35C).
Figure 3-35. Elbow bandage (Illustrated A—C).
CAUTION
If an elbow fracture is suspected, DO NOT bend the elbow;
bandage it in the position found.
3-13. Hand Bandage
a. To apply a triangular bandage to the hand—
(1) Place the hand in the middle of the triangular bandage
with the wrist at the base of the bandage (Figure 3-36A). Ensure that the
fingers are separated with absorbent material to prevent chafing and irritation
of the skin.
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(2) Place the apex over the fingers and tuck any excess
material into the pleats on each side of the hand (Figure 3-36B).
(3) Cross the ends on top of the hand, take them around the
wrist, and tie them (Figures 3-36C—E) with a square knot.
Figure 3-36. Triangular bandage applied to hand (Illustrated A—E).
b. To apply a cravat bandage to the palm of the hand—
(1) Lay the middle of the cravat over the palm of the hand
with the ends hanging down on each side (Figure 3-37A).
(2) Take the end of the cravat at the little finger across the
back of the hand, extending it upward over the base of the thumb; then bring
it downward across the palm (Figure 3-37B).
(3) Take the thumb end across the back of the hand, over
the palm, and through the hollow between the thumb and palm (Figure 3-
37C).
(4) Take the ends to the back of the hand and cross them;
then bring them up over the wrist and cross them again (Figure 3-37D).
(5) Bring both ends down and tie them with a square knot on
top of the wrist (Figure 3-37E—F).
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Figure 3-37. Cravat bandage applied to palm of hand
(Illustrated A—F).
3-14. Leg (Upper and Lower) Bandage
To apply a cravat bandage to the leg—
a. Place the center of the cravat over the dressing (Figure 3-
38A).
b. Take one end around and up the leg in a spiral motion and the
other end around and down the leg in a spiral motion, overlapping part of
each preceding turn (Figure 3-38B).
c. Bring both ends together and tie them (Figure 3-38C) with a
square knot.
Figure 3-38. Cravat bandage applied to leg (Illustrated A—C).
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3-15. Knee Bandage
To apply a cravat bandage to the knee as illustrated in Figure 3-39, use the
same technique applied in bandaging the elbow.
CAUTION
If a fracture of the kneecap is suspected, DO NOT bend the
knee; bandage it in the position found.
Figure 3-39. Cravat bandage applied to knee (Illustrated A—C).
3-16. Foot Bandage
To apply a triangular bandage to the foot—
a. Place the foot in the middle of the triangular bandage with the
heel well forward of the base (Figure 3-40A). Ensure that the toes are
separated by absorbent material to prevent chafing and irritation of the skin.
b. Place the apex over the top of the foot and tuck any excess
material into the pleats on each side of the foot (Figure 3-40B).
c. Cross the ends on top of the foot, take them around the ankle,
and tie them at the front of the ankle (Figure 3-40C—E).
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Figure 3-40. Triangular bandage applied to foot (Illustrated A—E).
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CHAPTER 4
FIRST AID FOR FRACTURES
4-1. General
A fracture is any break in the continuity of a bone. Fractures can cause total
disability or in some cases death by severing vital organs and/or arteries. On
the other hand, they can most often be treated so there is a complete recovery.
The potential for recovery depends greatly upon the first aid the individual
receives before he is moved. First aid includes immobilizing the fractured
part in addition to applying lifesaving measures when necessary. The basic
splinting principle is to immobilize the joints above and below the fracture.
4-2. Kinds of Fractures
Figure 4-1 depicts types of fractures.
Figure 4-1. Types of fractures (Illustrated A—C).
a. Closed Fracture (Figure 4-1A). A closed fracture is a broken
bone that does not break the overlying skin. The tissue beneath the skin may
be damaged. A dislocation is when a joint, such as a knee, ankle, or
shoulder, is not in the proper position. A sprain is when the connecting
tissues of the joints have been torn. Dislocations and sprains (swelling,
possible deformity, and discoloration) should be treated as closed fractures.
b. Open Fracture (Figure 4-1B and 4-1C). An open fracture is a
broken bone that breaks (pierces) the overlying skin. The broken bone may
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come through the skin or a missile such as a bullet or shell fragment may go
through the flesh and break the bone.
NOTE
An open fracture is contaminated and subject to infection.
4-3. Signs and Symptoms of Fractures
Indications of a fracture are deformity, tenderness, swelling, pain, inability
to move the injured part, protruding bone, bleeding, or discolored skin at the
injury site. A sharp pain when the service member attempts to move the part
is also a sign of a fracture.
WARNING
DO NOT encourage the casualty to move the injured
part in order to identify a fracture since such movement
could cause further damage to surrounding tissues and
promote shock. If you are not sure whether a bone is
fractured, care for the injury as a fracture. At the site of
the fracture, the bone ends are sharp and could cause
vessel (artery and/or vein) damage.
4-4. Purposes of Immobilizing Fractures
A fracture is immobilized to prevent the sharp edges of the bone from
moving and cutting tissue, muscle, blood vessels, and nerves. This reduces
pain and helps prevent or control shock. In a closed fracture, immobilization
keeps bone fragments from causing an open wound, which can become
contaminated and subject to infection.
4-5. Splints, Padding, Bandages, Slings, and Swathes
a. Splints. Splints may be improvised from such items as boards,
poles, sticks, tree limbs, or cardboard. If nothing is available for a splint, the
chest wall can be used to immobilize a fractured arm and the uninjured leg
can be used to immobilize (to some extent) the fractured leg.
b. Padding. Padding may be improvised from such items as a
jacket, blanket, poncho, shelter half, or leafy vegetation.
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c. Bandages. Bandages may be improvised from belts, rifle
slings, kerchiefs, or strips torn from clothing or blankets. Narrow materials
such as wire or cord should not be used to secure a splint in place. The
application of wire and/or narrow material to an extremity could cause tissue
damage and a tourniquet effect.
d. Slings. A sling is a bandage suspended from the neck to
support an upper extremity. If a bandage is not available, a sling can be
improvised by using the tail of a coat or shirt or pieces of cloth torn from
such items as clothing and blankets. The triangular bandage is ideal for this
purpose. Remember that the casualty’s hand should be higher than his
elbow, and the fingers should be showing at all times. The sling should be
applied so that the supporting pressure is on the uninjured side.
e. Swathes. Swathes are any bands (pieces of cloth or load
bearing equipment [LBE]) that are used to further immobilize a splinted
fracture. Triangular and cravat bandages are often used and are called
swathe bandages. The purpose of the swathe is to immobilize; therefore, the
swathe bandage is placed above and/or below the fracture—not over it.
4-6. Procedures for Splinting Suspected Fractures
Before beginning first aid procedures for a fracture, gather whatever splinting
materials are available. Ensure that splints are long enough to immobilize the
joint above and below the suspected fracture. If possible, use at least four
ties (two above and two below the fracture) to secure the splints. The ties
should be square knots and should be tied away from the body on the splint.
Distal pulses of the affected extremity should be checked before and after the
application of the splint.
a. Evaluate the Casualty. Be prepared to perform any necessary
lifesaving measures. Monitor the casualty for development of conditions that
may require you to perform necessary lifesaving measures.
WARNING
Unless there is immediate life-threatening danger, such
as a fire or an explosion, DO NOT move the casualty
with a suspected back or neck injury. Improper
movement may cause permanent paralysis or death.
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WARNING
In a chemical environment, DO NOT remove any
protective clothing. Apply the dressings and splints
over the garments.
b. Locate the Site of the Suspected Fracture.
(1) Ask the casualty for the location of the injury.
• Does he have any pain?
• Where is it tender?
• Can he move the extremity?
NOTE
With the presence of an obvious deformity, do not make the
casualty move extremity.
(2) Look for an unnatural position of the extremity.
(3) Look for a bone sticking out (protruding).
c. Prepare the Casualty for Splinting the Suspected Fracture.
(1) Reassure the casualty. Tell him that you will be
providing first aid for him and that medical help is on the way.
(2) Loosen any tight or binding clothing.
(3) Remove all jewelry from the injured part and place it in
the casualty’s pocket. Tell the casualty you are doing this because if the
jewelry is not removed and swelling occurs later, he may not be able to get it
off and further bodily injury could result.
(4) Boots should not be removed from the casualty unless they
are needed to stabilize a neck injury or there is actual bleeding from the foot.
d. Gather Splinting Materials. If standard splinting materials
(splints, padding, and cravats) are not available, gather improvised materials.
If splinting material is not available and the suspected fracture CANNOT be
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splinted, then swathes, or a combination of swathes and slings can be used to
immobilize the extremity.
e. Pad the Splints. Pad the splints where they touch any bony
part of the body, such as the elbow, wrist, knee, ankle, crotch, or armpit
areas. Padding prevents excessive pressure on the area, which could lead to
circulation problems.
f. Check the Circulation Below the Site of the Injury.
(1) Note any pale, white, or bluish-gray color of the skin,
which may indicate impaired circulation. Circulation can also be checked by
depressing the toe or fingernail beds and observing how quickly the color
returns. A slower return of color to the injured side when compared with the
uninjured side indicates a problem with circulation. The fingernail bed is the
method to use to check the circulation in a dark-skinned casualty.
(2) Check the temperature of the injured extremity. Use
your hand to compare the temperature of the injured side with the uninjured
side. The body area below the injury may be colder to the touch indicating
poor circulation.
(3) Question the casualty about the presence of numbness,
tightness, cold, or tingling sensations.
WARNING
Casualties with fractures of the extremities may show
impaired circulation, such as numbness, tingling, cold
or pale to bluish skin tone. These casualties should be
evacuated by medical personnel and treated as soon as
possible. Prompt medical treatment may prevent
possible loss of the limb.
WARNING
If it is an open fracture and the bone is protruding from
the skin, DO NOT ATTEMPT TO PUSH THE BONE BACK
UNDER THE SKIN. Apply a field dressing over the
wound to protect the area.
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g. Apply the Splint in Place.
(1) Splint the fracture in the position found. DO NOT
attempt to reposition or straighten the injury. If it is an open fracture, stop
the bleeding and protect the wound. Cover all wounds with field dressings
before applying a splint. Remember to use the casualty’s field dressing, not
your own.
(2) Place one splint on each side of the fracture. Make sure
that the splints reach, if possible, beyond the joints above and below the
fracture.
(3) Tie the splints. Secure each splint in place above and
below the fracture site with improvised (or actual) cravats. Improvised
cravats, such as strips of cloth, belts, or whatever else you have, may be
used. With minimal motion to the injured areas, place and tie the splints with
the bandages. Push cravats through and under the natural body curvatures,
and then gently position improvised cravats and tie in place. Use square
knots. Tie all knots on the splint away from the casualty (Figure 4-2). DO
NOT tie cravats directly over the suspected fracture site.
Figure 4-2. Square knots tied away from casualty.
h. Check the Splint for Tightness.
(1) CHECK to be sure that bandages are tight enough to
securely hold splinting materials in place, but not so tight that circulation is
impaired.
(2) RECHECK the circulation after application of the splint.
Che