Perform tactical field care when you and the casualty are no longer under direct enemy fire.
NOTE: Tactical field care is care rendered by the combat lifesaver when no longer under effective hostile fire. Tactical field care also applies to situations in which an injury has occurred on a mission, but there is no hostile fire. Available medical equipment is limited to that carried into the field by the combat lifesaver and individual soldiers.
A. Communication. In the following situations, communicate medical situation to the unit leader.
(1) Upon determining that casualty will not be able to continue mission.
(2) Before initiating any medical procedures. (Ensure that the tactical situation allows for time to treat the casualty before initiating any medical procedures.)
(3) Upon any significant change in casualty’s status.
B. General Impression. Form a general impression of the casualty as you approach (extent of injuries, chance of survival, and so forth) (See Lesson 2.) Evaluate the tactical situation.
NOTE: If the casualty has suffered from a blast or penetrating trauma and has no signs of life (no pulse and no respirations), do not perform cardiopulmonary resuscitation (CPR). The casualty will probably not survive and you may expose yourself to enemy fire.
C. Level of Consciousness. When possible, determine the casualty’s level of consciousness using the AVPU system. Ask questions that require more than a “yes” or “no” answer, such as, “What is your name?” “What is the date?” “Where are we?” Recheck the casualty’s level of consciousness about every 15 minutes to determine if
the casualty’s condition has changed.
(1) A–The casualty is alert, knows who he is, the date, where he is, and so forth
(2) V–The casualty is not alert, but does responds to verbal commands.
(3) P–The casualty responds to pain, but not to verbal commands.
(4) U–The casualty is unresponsive (unconscious).
NOTE: Maintaining a check on the casualty’s level of consciousness is especially important when the casualty has suffered a head injury.
D. Airway. Assess and secure the casualty’s airway (see Lesson 3).
(1) If the casualty is conscious, able to speak, and is not in respiratory distress, no airway intervention is needed.
(2) If the casualty is unconscious, perform the following.
(A) Use a head-tilt/chin-lift or jaw-thrust to open the airway. The head tilt/chin-lift is the normal method of opening the casualty’s airway. The jaw-thrust is used if you suspect that the casualty has suffered a spinal injury.
NOTE: The muscles of an unconscious casualty’s tongue may have relaxed, causing his tongue to block the airway by sliding to the back of the mouth and covering the opening to the trachea (windpipe). Using the head tilt/chin-lift or jaw-thrust to move the tongue away from the trachea may cause the casualty to resume breathing on his own.
(B) Check the casualty for breathing. Place your ear over the
casualty’s mouth and nose with your face toward the casualty’s chest while maintaining the casualty’s airway (head-tilt/chin-lift or jaw-thrust). Look for the rise and fall of the casualty’s chest and abdomen. Listen for sounds of breathing. Feel for his breath on the side of your face. If breathing is not present, begin rescue breathing.
(C) If the casualty is breathing on his own, use a nasopharyngeal
airway (NPA) to maintain the airway.
(D) If the casualty has no additional injuries, roll the casualty into the recovery position (on his side). This allows for accumulated blood and mucus to drain from the casualty’s mouth instead of choking the casualty. See figure 1-1.
Figure 1-1. Unconscious casualty placed in the recovery position.
E. Chest. Assess and treat the casualty for chest injuries.
(1) Expose the chest and check for equal rise and fall. Remove the
minimum of clothing required to expose and treat injuries. Protect the casualty from the environment (heat and cold) as much as possible.
(2) Examine the chest for wounds. Check for both entrance and exit
wounds (sucking chest wounds).
(3) Immediately seal any penetrating injuries to the chest with airtight material. Seal one open chest wound with a three-sided seal (one side of airtight material left untaped). Sealing the wound keeps air from entering the wound. If air can freely enter through the wound, the casualty’s lung may collapse. The three-sided seal
prevents air from entering the chest, but allows trapped air to escape.
(4) Monitor the casualty for progressive severe respiratory distress
(breathing becomes more labored and faster). If respiration becomes progressively worse, assume tension pneumothorax exists and decompress the affected chest side with a 14-gauge needle inserted at second intercostal space (ICS) on mid-clavicular line
(MCL). Secure the catheter in place with tape.
CAUTION: Only perform needle chest decompression on a casualty with a penetrating (sucking) chest wound.
(5) If the casualty has been treated for an open chest wound, position or transport the casualty with the affected side down, if possible. The body pressure acts to “splint” the affected side.
F. Bleeding. Identify and control major bleeding.
(1) Apply a tourniquet to a major amputation of the extremity.
(2) Apply an emergency trauma bandage and direct pressure to a severely bleeding wound.
(A) If conventional methods of controlling severe bleeding (emergency trauma bandage, direct pressure, pressure dressing, hemostatic dressing, and so forth) do not control the bleeding on an extremity, apply a tourniquet.
(B) If a tourniquet was previously applied, consider changing the
tourniquet to a pressure dressing and/or using a hemostatic dressing to control bleeding. Loosen the tourniquet, but do not remove the tourniquet while applying conventional methods of controlling bleeding. If conventional methods are not able to
control hemorrhage, re-tighten the tourniquet until bleeding stops.
NOTE: By converting the tourniquet to a pressure dressing or controlling the bleeding by other methods, you may be able to save the limb of the casualty if the tourniquet has not been in place for 6 hours. If tourniquet has been in place for more than 6 hours, do not remove the tourniquet.
G. Intravenous Fluids. Determine if the casualty requires fluid resuscitation. Use your initial assessment, the casualty’s radial pulse, and the casualty’s mental status to determine if fluid resuscitation is required. These can be determined even in the typical noisy and chaotic battlefield environment.
(1) If the casualty has only superficial wounds, intravenous (IV) resuscitation is not necessary, but oral fluid hydration should be encouraged. Over 50 percent of the casualties will be in this category.
(2) If the casualty has a significant wound to an extremity or to the trunk (neck, chest, abdomen, or pelvis) and the casualty is coherent and has a palpable radial pulse, initiate a saline lock. Do not administer intravenous fluids at this time, but continue to monitor the casualty. Begin administering fluids intravenously if the
casualty’s mental status (AVPU) decreases or his radial pulse is no longer detectable. (If you can no longer feel the casualty’s radial pulse, his blood pressure has probably dropped below 80 mmHg. This is a sign that the casualty is suffering from hypovolemic
NOTE: An upper extremity is the preferred site for the saline lock. Do not use a site distal to (below) a significant wound. See paragraph 5-2 for a definition of the term “distal.”
(3) If the casualty does not have a radial pulse, ensure that the bleeding has been controlled (direct pressure, pressure dressings, hemostatic bandage, or tourniquet as needed). Initiate a saline lock and begin administering fluids (500 ml of Hextend) as
rapidly as possible. Recheck the casualty’s pulse in 30 minutes.
(A) If the radial pulse has returned, do not give any additional fluids. Monitor the casualty’s pulse as frequently as possible.
(B) If the radial pulse does not return, give an additional 500 ml of
Hextend and evacuate the casualty as soon as possible.
NOTE: If the second IV pack has been administered and there is no radial pulse, use your remaining supplies to treat other casualties.
H. Other Wounds. Identify and treat other wounds. Dress all wounds, including exit wounds. Remember to remove only the minimum of clothing required to expose and treat injuries. Protect the casualty against the environment (hot and cold
temperatures, and so forth).
I. Fractures. Splint any obvious long bone fractures.
J. Combat Pill Pack. Administer pain medications and antibiotics (combat pill pack) to any soldier wounded in combat. Do not administer your own pack since you may need them yourself and you have no extra combat pill packs in your aid bag.
NOTE: Each soldier will be issued a combat pill pack prior to deployment on tactical missions.