First Aid TC 4-02.1 PDF

Chat with Document Download Quiz & Flashcards

Document Details

AccomplishedBirch2515

Uploaded by AccomplishedBirch2515

Columbia College

2016

Tags

first aid military training emergency medical tactical medicine

Related

Summary

This document is a Training Circular (TC) 4-02.1, focusing on first aid procedures. It covers fundamental first aid practices, vital body systems, and various injury types. It appears to be a guide for military personnel on how to respond to medical emergencies.

Full Transcript

*TC 4-02.1 FIRST AID JANUARY 2016 DISTRIBUTION RESTRICTION. Approved for public release; distribution is unlimited. *This publication supersedes FM 4-25.11/NTRP 4-02.1.1/AFMAN 44-163(I)/MCRP 3-02G, dated 23 Decem...

*TC 4-02.1 FIRST AID JANUARY 2016 DISTRIBUTION RESTRICTION. Approved for public release; distribution is unlimited. *This publication supersedes FM 4-25.11/NTRP 4-02.1.1/AFMAN 44-163(I)/MCRP 3-02G, dated 23 December 2002. Headquarters, Department of the Army This publication is available at Army Knowledge Online (https://armypubs.us.army.mil/doctrine/index.html). To receive publishing updates, please subscribe at http://www.apd.army.mil/AdminPubs/new_subscribe.asp TC 4-02.1, C2 Change 2 Headquarters Training Circular Department of the Army No. 4-02.1 Washington, DC, 7 December 2018 FIRST AID 1. Change Training Circular (TC) 4-02.1, dated 21 January 2016, as follows: Remove Old Pages Insert New Pages page ii page ii pages 5-1 and 5-2 pages 5-1 through 5-3 2. A bar ( ) marks new or changed material. 3. File this transmittal sheet in front of the publication. DISTRIBUTION RESTRICTION: Approved for public release; distribution is unlimited. TC 4-02.1, C2 7 December 2018 By Order of the Secretary of the Army: MARK A. MILLEY General, United States Army Chief of Staff Official: KATHLEEN S. MILLER Administrative Assistant to the Secretary of the Army 1833708 DISTRIBUTION: Distributed in electronic media only (EMO). PIN: 106005-002 TC 4-02.1, C1 Change 1 Headquarters Training Circular Department of the Army No. 4-02.1 Washington, DC, 5 August 2016 FIRST AID 1. Change Training Circular (TC) 4-02.1, dated 21 January 2016, as follows: Remove Old Pages Insert New Pages iii through vi iii through vi pages 1-7 through 1-8 pages 1-7 through 1-8 N/A pages 24-1 through 27-2 References-1 and References-2 References-1 and References-2 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. TC 4-02.1, C1 5 August 2016 By Order of the Secretary of the Army: MARK A. MILLEY General, United States Army Chief of Staff Official: GERALD B. O’KEEFE Administrative Assistant to the Secretary of the Army 1621802 DISTRIBUTION: Active Army, Army National Guard, and United States Army Reserve: Distributed in electronic media only (EMO). PIN: 106005-001 *TC 4-02.1 Training Circular (TC) Headquarters No. 4-02.1 Department of the Army Washington, DC, 21 January 2016 First Aid Contents Page PREFACE............................................................................................................... v INTRODUCTION................................................................................................... vi Chapter 1 FUNDAMENTALS OF FIRST AID......................................................................... 1-1 Section I — Terminology...................................................................................1-1 Key Terms...........................................................................................................1-1 Definitions of Key Terms......................................................................................1-1 Section II — Vital Body Systems......................................................................1-2 Understanding Vital Body Systems......................................................................1-2 Respiratory System..............................................................................................1-3 Circulatory System.............................................................................................. 1-3 Blood................................................................................................................... 1-5 Blood Vessels..................................................................................................... 1-5 Musculoskeletal System.......................................................................................... 1-6 Section III — General Principles of First Aid....................................................... 1-7 Initial Encounter.................................................................................................. 1-7 Transporting or Moving the Casualty.................................................................. 1-7 Section IV — Combat and Operational Stress Reaction............................... 1-7 Support............................................................................................................... 1-7 Guidance for Supporting At-Risk Soldiers........................................................... 1-8 Chapter 2 EVALUATE A CASUALTY (081-COM-1001)....................................................... 2-1 Care Under Fire...................................................................................................2-1 Tactical Field Care...............................................................................................2-2 Tactical Evacuation..............................................................................................2-3 Chapter 3 OPEN THE AIRWAY (081-COM-1023)...............................................................3-1 Safely Position the Casualty to Open the Airway.................................................3-1 Opening the Airway.............................................................................................3-1 Chapter 4 AIRWAY OBSTRUCTIONS (081-COM-1003)....................................................4-1 Distribution Restriction: Approved for public release; distribution is unlimited. *This publication supersedes FM 4-25.11/NTRP 4-02.1.1/AFMAN 44-163(I)/MCRP 3-02G, dated 23 December 2002. i Contents Airway Obstruction Identification......................................................................... 4-1 Abdominal Thrusts.............................................................................................. 4-1 Chest Thrusts...................................................................................................... 4-1 Chapter 5 APPLY AN OCCLUSIVE DRESSING (081-COM-0069)....................................... 5-1 First Aid for an Open Chest Wound..................................................................... 5-1 Use of Commercial Chest Seal...........................................................................5-1 Use of Improvised Chest Seal............................................................................ 5-2 Chapter 6 PERFORM FIRST AID FOR BLEEDING OF AN EXTREMITY (081-COM-1032)....................................................................................................... 6-1 Control Bleeding....................................................................................................... 6-1 Methods for Controlling External Bleeding.......................................................... 6-1 Apply Direct Pressure.......................................................................................... 6-1 Apply a Pressure Dressing.................................................................................. 6-2 Apply a Tourniquet.............................................................................................. 6-2 Chapter 7 PERFORM FIRST AID FOR BURNS (081-COM-1007)..................................... 7-1 Perform First Aid for Burns...................................................................................... 7-1 Kinds of Burns.......................................................................................................... 7-1 Chapter 8 PERFORM FIRST AID TO PREVENT OR CONTROL SHOCK (081-COM-1005)....................................................................................................... 8-1 Signs and Symptoms of Shock........................................................................... 8-1 Position the Casualty.......................................................................................... 8-1 Calm and Reassure the Casualty........................................................................ 8-1 Chapter 9 PERFORM FIRST AID FOR NERVE AGENT INJURY (081-COM-1044)............ 9-1 First Aid for Nerve Agent Injury........................................................................... 9-1 Signs and Symptoms of Mild Nerve Agent Poisoning......................................... 9-1 Self-Aid for Mild Nerve Agent Poisoning............................................................. 9-1 Signs and Symptoms of Severe Nerve Agent Poisoning..................................... 9-2 Buddy Aid for Severe Nerve Agent Poisoning..................................................... 9-3 Chapter 10 FIRST AID FOR BITES AND STINGS (081-833-0072).................................... 10-1 Black Widow Spider...............................................................................................10-1 Scorpion (Harmless Species)............................................................................ 10-2 Scorpion (Deadly Species)................................................................................ 10-2 Bee, Wasp, Hornet, and Yellow Jacket (Mild Reaction).................................... 10-2 Bee, Wasp, Hornet, and Yellow Jacket (Severe Reaction)................................ 10-2 Fire Ant Stings and Bites................................................................................... 10-3 Ticks........................................................................................................................ 10-3 Unknown, Nonspecific Insects.......................................................................... 10-4 Treat the Bite or Sting....................................................................................... 10-4 Chapter 11 FIRST AID FOR HEAT ILLNESS (081-831-0038)............................................ 11-1 Heat Illness....................................................................................................... 11-1 Heat Exhaustion................................................................................................ 11-1 Heat Stroke....................................................................................................... 11-2 Hyponatremia (Water Intoxication)........................................................................ 11-2 Chapter 12 FIRST AID FOR COLD INJURY (081-831-0039)................................................12-1 Cold Weather Injuries.............................................................................................12-1 ii TC 4-02.1, C2 7 December 2018 Contents Hypothermia............................................................................................................ 12-1 Frostbite.................................................................................................................. 12-2 Cause of Nonfreezing Cold Injuries....................................................................... 12-3 Most Common Nonfreezing Injuries...................................................................... 12-3 Chapter 13 APPLY A RIGID SPLINT (081-833-0263)............................................................ 13-1 Fractures.......................................................................................................................13-1 Apply a Rigid Splint........................................................................................... 13-1 Lower Extremity Injury....................................................................................... 13-3 Chapter 14 RESCUE BREATHING (081-831-0048)............................................................... 14-1 Perform Rescue Breathing.................................................................................... 14-1 Mouth-to-Mouth Method.................................................................................... 14-1 Mouth-to-Nose Method..........................................................................................14-2 Chapter 15 EXTERNAL CHEST COMPRESSIONS (081-831-0046).................................. 15-1 Chapter 16 HEAD INJURIES (081-833-0038).........................................................................16-1 Types of Head Injuries...................................................................................... 16-1 First Aid for Head Injuries......................................................................................16-2 Chapter 17 ABDOMINAL INJURIES (081-831-0028)......................................................... 17-1 Chapter 18 IMPALEMENT INJURIES (O81-833-0029)..........................................................18-1 Chapter 19 APPLY AN ELASTIC BANDAGE (081-933-0264)........................................... 19-1 Chapter 20 APPLY A SLING AND SWATH (081-833-0265).............................................. 20-1 Chapter 21 TREAT A CASUALTY FOR A SNAKEBITE (081-833-0073)........................... 21-1 Chapter 22 INITIATE TREATMENT FOR ANAPHYLACTIC SHOCK (081-833-0003)....... 22-1 Chapter 23 TRANSPORT A CASUALTY (081-COM-1046)................................................... 23-1 Removing a Casualty From a Vehicle............................................................... 23-1 Types of Manual Carries................................................................................... 23-2 Evacuate the Casualty Using the Appropriate Type of Carry............................. 23-2 Litters....................................................................................................................... 23-4  Chapter 24 INITIATE FIRST AID FOR LACERATIONS OF THE EYELID (081-833-0040) WITH IFAK EYE-SHIELD........................................................ 24-1 Survey..................................................................................................................... 24-1 Shield...................................................................................................................... 24-1 Seek Evacuation and Medical Aid..................................................................... 24-3  Chapter 25 INITIATE FIRST AID FOR FOREIGN BODIES ON THE EYE (081-833-0039) WITH IFAK EYE-SHIELD........................................................ 25-1 Survey..................................................................................................................... 25-1 Shield...................................................................................................................... 25-1 Foreign Body Stuck or Impaled in the Eye............................................................25-2 Seek Evacuation and Medical Aid..................................................................... 25-2 5 August 2016 TC 4-02.1, C1 iii Contents  Chapter 26 INITIATE FIRST AID FOR EXTRUSIONS OF THE EYE (081-833-0042) WITH IFAK EYE-SHIELD................................................................................. 26-1 Survey............................................................................................................... 26-1 Shield................................................................................................................ 26-1 Seek Evacuation and Medical Aid..................................................................... 26-2  Chapter 27 INITIATE FIRST AID FOR CHEMICAL BURNS OF THE EYE (O81-833-0044) WITH IFAK EYE-SHIELD................................................................................. 27-1 Survey............................................................................................................... 27-1 Shield................................................................................................................ 27-2 Seek Evacuation and Medical Aid..................................................................... 27-2 Appendix A IMPROVED FIRST AID KIT....................................................................................A-1 GLOSSARY.................................................................................................Glossary-1  REFERENCES….................................................................................References-1 INDEX.................................................................................................................Index-1 Figures  Figure 24-1. Rigid eye-shield or cup properly secured over the injury.................................24-2 Figure A-1. Improved first aid kit.............................................................................................. A-1 Figure A-2. Improved first aid kit II........................................................................................... A-2 iv TC 4-02.1, C1 5 August 2016 Preface Training Circular (TC) 4-02.1 provides first aid techniques and guidance for Soldiers. Implementation of the techniques presented in this publication enable Soldiers to render first aid and prevent greater harm to injured Soldiers. The principal audience for TC 4-02.1 is commanders, subordinate leaders, individual Soldiers, Department of Defense (DOD) civilians and contractors. Commanders, staffs, and subordinates ensure their decisions and actions comply with applicable United States, international, and, in some cases, host-nation laws and regulations. Commanders at all levels ensure their Soldiers operate in accordance with the law of war and the rules of engagement. (Refer to Field Manual [FM] 27-10.) This publication is in consonance with the following North Atlantic Treaty Organization (NATO) Standards and Standardization Agreements (STANAGs): Title STANAGs Standards Allied Medical Publication (AMedP), Military Acute Trauma Care Training 8.12 Requirement for Training in First-Aid, Emergency Care in Combat Situations and Basic Hygiene for all Military Personnel 2122 First-Aid Dressings, First Aid Kits and Emergency Medical Care Kits 2126 First Aid and Hygiene Training in a Chemical, Biological, Radiological, and Nuclear or Toxic Industrial Hazard Environment 2358 Requirements for Military Acute Trauma Care Training 2544 This publication uses joint terms where applicable. Selected joint and Army terms and definitions appear in both the glossary and the text. This publication is not the proponent for any Army terms. Unless otherwise stated in this publication, the use of masculine nouns and pronouns does not refer exclusively to men. Training Circular 4-02.1 applies to the Active Army, Army National Guard/Army National Guard of the United States, and United States Army Reserve unless otherwise stated. The proponent and the preparing agency of this publication is the United States Army Medical Department Center and School, United States Army Health Readiness Center of Excellence. Send comments and recommendations on a DA Form 2028 (Recommended Changes to Publications and Blank Forms) to Commander, United States Army Medical Department Center and School, United States Army Health Readiness Center of Excellence, ATTN: MCCS-FDL (TC 4-02.1), 2377 Greeley Road, Building 4011, Suite D, JBSA Fort Sam Houston, Texas 78234-7731; by e-mail to usarmy.jbsa.medcom- [email protected]; or submit an electronic DA Form 2028. Recommended changes should be keyed to the specific page, paragraph, and line number. A rationale for each proposed change is required to aid in the evaluation and adjudication of each comment. 21 January 2016 TC 4-02.1 v Introduction Because medical personnel will not always be readily available, nonmedical Soldiers must rely on themselves and other Soldiers’ skills and knowledge of first aid methods to render aid until medical assistance arrives. First aid is given until medical care provided by medically trained personnel such as a combat medic or other health care provider arrives. The individual being provided first aid (by self-aid, buddy aid, or combat lifesaver) is considered a casualty. Once medically trained personnel (combat medic, paramedic, or other health care provider) initiates care, the casualty is then considered to be a patient. Training Circular 4-02.1 provides first aid procedures for nonmedical personnel in environments from home station to combat situations. This publication is meant to be used by trainers and individuals being trained based on common first aid tasks. Tasks are found in the Soldier’s Manual of Common Tasks, Warrior Skills Level 1, and appropriate modified tasks from the Soldier’s Manual and Trainer’s Guide, Military Occupational Specialty (MOS) 68W. These tasks are meant to reinforce and maintain proficiency in correct procedures for giving first aid throughout a Soldier’s time in Service. Training Circular 4-02.1 is designed to facilitate training and first aid competencies by bridging first aid training across the spectrum of assignments from training to permanent duty station and deployment. Tactical combat casualty care (TC3) is introduced in TC 4-02.1 with first aid tasks and procedures associated with combat situations. Individual and multiple first aid tasks in combination with collective tasks, may be integrated into various training scenarios.  This is a complete revision of FM 4-25.11/NTRP 4-02.1/AFMAN 44-163(I)/MCRP 3-02G that transforms the publication to an Army training circular. It is designed to facilitate training individual tasks and combining those tasks into logical and progressive training opportunities from individual, small unit, subsequently integrated into larger and more complex training scenarios. The purpose is to integrate and maintain first aid proficiency throughout the depth and breadth of the Army formation.  There are 27 chapters each covering an individual first aid task and one appendix describing and listing the contents of the United States Army Improved First Aid Kit (IFAK) and the new IFAK II. This revision and transformation of the first aid publication supports the United States Army Doctrine 2015 initiative. vi TC 4-02.1, C1 5 August 2016 Chapter 1 Fundamentals of First Aid 1-1. When a nonmedical Soldier encounters an unconscious or injured Soldier, he must quickly and accurately evaluate the situation and the casualty to determine if it is safe for him to act as well as what, if any, first aid measures may be needed to prevent further injury or death. He should ask if trained medical personnel are available or direct someone else at the scene to call for or locate trained medical personnel. To prevent further injury to the casualty, once first aid has begun to be administered there should be no interruptions and those efforts should continue until such time as that Soldier is relieved by medical personnel. Soldiers may also have to depend upon their own first aid knowledge and skills to save themselves (self-aid). A thorough understanding of the fundamentals of first aid can save a life, prevent permanent disability, or reduce long periods of hospitalization by knowing WHAT to do, WHAT NOT to do, and WHEN to do it. SECTION I — TERMINOLOGY 1-2. The following key terms are identified and described in order to provide a further understanding of first aid. The key terms are presented in alphabetical order, not in order of importance. KEY TERMS 1-3. Knowledge of a few key terms will help Soldiers to better understand and appreciate the role that they play when providing first aid in tactical and nontactical environments. These terms include—  Casualty evacuation (CASEVAC).  Combat lifesaver.  Combat medic.  Emergency medical treatment.  Enhanced first aid.  First aid (self-aid and buddy aid).  Medical evacuation.  Medical treatment.  Medical treatment facility.  Tactical combat casualty care. DEFINITIONS OF KEY TERMS 1-4. Knowing the key terms as they are used in Army doctrine assists in the understanding of when and how Soldiers provide first aid procedures in garrison or when deployed. CASUALTY EVACUATION 1-5. Nonmedical units use this to refer to the movement of casualties aboard nonmedical vehicles or aircraft without en route medical care. COMBAT LIFESAVER 1-6. Combat lifesavers are nonmedical Soldiers selected by their unit commander for additional training beyond basic first aid procedures. Combat lifesavers provide enhanced first aid for injuries. 21 January 2016 TC 4-02.1 1-1 Chapter 1 COMBAT MEDIC 1-7. Combat medics are the first individuals in the medical chain that make medically substantiated decisions based on medical MOS-specific training. EMERGENCY MEDICAL TREATMENT 1-8. Emergency medical treatment is the immediate application of medical procedures to the wounded, injured, or sick by specially trained medical personnel. ENHANCED FIRST AID 1-9. 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. FIRST AID (SELF-AID AND BUDDY AID) 1-10. 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 EVACUATION 1-11. Medical evacuation is the process of moving any person who is wounded, injured, or ill to and/or between medical treatment facilities while providing en route medical care. Also referred to as MEDEVAC in relation to the 9-line medical evacuation request. MEDICAL TREATMENT 1-12. Medical treatment is the care and management of wounded, injured, or ill personnel by medically trained personnel. MEDICAL TREATMENT FACILITY 1-13. Medical treatment facility is any facility established for the purpose of providing medical treatment. This includes battalion aid stations, Role 2 facilities, dispensaries, clinics, and hospitals. TACTICAL COMBAT CASUALTY CARE 1-14. Tactical combat casualty care is often referred to as TC3. Tactical combat casualty care is prehospital care provided in a tactical-combat setting. Tactical combat casualty care is divided into the following three stages:  Care under fire.  Tactical field care.  Tactical evacuation. SECTION II — VITAL BODY SYSTEMS 1-15. Basic understanding of vital body systems is crucial in the understanding and performance of first aid. Understanding vital body systems not only assists in first aid, but prevents doing any more harm to the casualty. UNDERSTANDING VITAL BODY SYSTEMS 1-16. For Soldiers to perform first aid effectively they must have a basic understanding of the structure and function of these vital body systems. These systems are the respiratory system, the circulatory system, and 1-2 TC 4-02.1 21 January 2016 Fundamentals of First Aid the musculoskeletal system. Injury to or compromise of these systems can quickly result in permanent injury or death of the injured. RESPIRATORY SYSTEM 1-17. Human beings require oxygen to live. Through the breathing process (respiration), the lungs draw oxygen from the air and transfer it to the red blood cells within the circulatory system. 1-18. The normal range of respirations varies based on the age and physical condition of the individual at rest. For example—  Adults 12 to 20 breaths per minute.  Children (1 to 10 years): 15 to 30 breaths per minute.  Infants (6 to 12 months): 25 to 50 breaths per minute.  Infants (0 to 5 months): 25 to 40 breaths per minute. COMPONENTS OF THE RESPIRATORY SYSTEM 1-19. The respiratory system consists of the—  Airway.  Lungs.  Rib cage. AIRWAY 1-20. 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 1-21. The lungs are two elastic organs made up of thousands of tiny air sacs and covered by an airtight membrane. RIB CAGE 1-22. The rib cage is formed by the muscle-connected ribs, which join the spine in back and the breastbone in front. CIRCULATORY SYSTEM 1-23. The circulatory system provides the vehicle for oxygen acquired through the respiratory process to be transported throughout the body. COMPONENTS OF THE CIRCULATORY SYSTEM 1-24. The circulatory system consists of the—  Heart.  Blood.  Blood vessels (arteries, capillaries, and veins). THE HEART 1-25. Simply stated the heart is the engine that drives the human body. The only function of the heart is to pump blood. The right side of the heart pumps blood to the lungs, where oxygen is added to the blood and carbon dioxide is removed from it. The left side pumps blood to the rest of the body, where oxygen and nutrients are delivered to tissues and waste products (such as carbon dioxide) are transferred to the blood for removal by other organs such as the lungs and kidneys. 21 January 2016 TC 4-02.1 1-3 Chapter 1 HEARTBEAT 1-26. The normal heart rate (heartbeats per minute) varies based on the age and physical condition of the individual at rest. For example—  Adults 60 to 100 heartbeats per minute.  Children (1 to 6 years): 70 to 120 heartbeats per minute.  Infants (6 to 12 months): 80 to 140 heartbeats per minute.  Infants (0 to 5 months): 90 to 140 heartbeats per minute. Note. The typical pulse for Soldiers and athletes (40 to 60 beats per minute) is lower than the average adult population. 1-27. The heartbeat is a rhythmic cycle of contraction and relaxation of the heart muscle which causes 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. PULSE 1-28. The pulse is the first major indicator of the general physiological state of a casualty when Soldiers are performing a casualty assessment. The presence or absence will determine what needs to be done and the order in which those actions must be taken to preserve the life of the injured. 1-29. The points where a pulse can be readily felt are located at the following arterial points of the body:  Carotid.  Femoral.  Radial.  Posterior tibial. Carotid Pulse 1-30. To check the carotid pulse (carotid arteries, felt at the neck), 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. Femoral Pulse 1-31. To check the femoral pulse (large femoral artery located in the thigh [felt in the groin]), press the tips of your first two fingers into the middle of the groin. Radial Pulse 1-32. To check the radial pulse (at the wrist), place your first two fingers on the thumb side of the casualty’s wrist. Posterior Tibial Pulse 1-33. To check the posterior tibial pulse (inside the big toe side of the ankle), place your first two fingers on the inside of the ankle. Note. Do not use your thumb to check a casualty’s pulse. The individual’s pulse can be felt in the thumb and may confuse the beat of his pulse with that of the casualty’s. 1-4 TC 4-02.1 21 January 2016 Fundamentals of First Aid WARNING It is imperative that first aid providers quickly determine if the casualty has a pulse (heartbeat). Absence of a pulse (heartbeat) will lead to the death of the casualty if not quickly restored. BLOOD 1-34. If the heart is the engine that drives the body, blood is the fuel which powers and sustains the human body. Blood is a mixture of plasma (liquid component), white blood cells, red blood cells, and platelets. The body contains about 5 to 6 quarts (about 5 liters) of blood. Once blood is pumped out of the heart, it takes 20 to 30 seconds to circulate through the body and return to the heart. 1-35. Blood performs essential functions as it circulates through the body. It delivers oxygen and essential nutrients (such as fats, sugars, minerals, and vitamins) to the body's tissues. It carries carbon dioxide to the lungs and other waste products to the kidneys for elimination from the body. Also, it carries components that fight infection and stop bleeding. WARNING It is imperative that first aid providers quickly determine if the casualty is losing blood. Excessive loss of blood can quickly lead to the death of the casualty if not stopped. BLOOD VESSELS 1-36. Blood vessels are the conduit which transports blood pumped by the heart to the body. The blood vessels consist of—  Arteries.  Arterioles.  Capillaries.  Venules.  Veins. ARTERIES 1-37. Arteries are vessels that carry blood high in oxygen content away from the heart to the farthest reaches of the body. Arteries flow into arterioles. ARTERIOLES 1-38. Arterioles are small branches of arteries that lead to the capillaries. CAPILLARIES 1-39. Capillaries are tiny blood vessels that connect arterioles (the smallest division of an artery) with venules. VENULES 1-40. Venules are small veins that go from capillaries to veins. 21 January 2016 TC 4-02.1 1-5 Chapter 1 VEINS 1-41. A blood vessel that carries blood that is low in oxygen content from the body back to the heart. WARNING It is imperative that first aid providers quickly determine if a casualty is losing blood. Many injuries can result in blood vessels being torn which result in excessive blood loss. Excessive loss of blood can quickly lead to the death of the casualty if not stopped. MUSCULOSKELETAL SYSTEM 1-42. The skeleton provides a structural framework for the body and, because bones are rigid, provides support and protection for vital organs and softer tissues. Skeletal muscles and bones work together to make body movement possible. COMPONENTS OF THE MUSCULOSKELETAL SYSTEM 1-43. The musculoskeletal system is composed of—  Bones.  Joints.  Muscles.  Cartilage.  Ligaments.  Tendons. BONES 1-44. Bone is the substance that forms the skeleton of the body. It is composed chiefly of calcium phosphate and calcium carbonate. The human body has 206 bones. There are 80 axial (head and trunk) bones and 126 appendicular (upper and lower extremity) bones. Bones provide structural support for the body. Individual and groups of bones provide structure for the attachment of soft tissues and protect organs. JOINTS 1-45. Joints are the areas where two bones are attached for the purpose of permitting body parts to move. MUSCLES 1-46. Muscle is the tissue of the body which primarily functions as a source of power. There are three types of muscle in the body. Muscle which is responsible for moving extremities and external areas of the body is called skeletal muscle. Heart muscle is called cardiac muscle. Muscle that is in the walls of arteries and bowel is called smooth muscle. CARTILAGE 1-47. Cartilage is a firm, rubbery tissue that cushions bones at joints. A flexible kind of cartilage makes up other parts of the body, such as the larynx and the outside parts of the ears. 1-6 TC 4-02.1 21 January 2016 Fundamentals of First Aid LIGAMENTS 1-48. Ligaments are a tough band of connective tissue that connects various structures, such as two bones. TENDONS 1-49. Tendons are a soft tissue by which muscle attaches to bone. Tendons are somewhat flexible, but tough. SECTION III — GENERAL PRINCIPLES OF FIRST AID 1-50. Proper conduct at the initial encounter of the casualty coupled with appropriate movement and transport is important in the successful provision of first aid. Appropriate decisions and first aid task execution helps to determine the health and well-being of the casualty. INITIAL ENCOUNTER 1-51. When a casualty is first encountered it is imperative that the responder quickly and accurately assess what has occurred, determine the nature and extent of injuries and what (if any) first aid measures are appropriate and necessary. 1-52. Accurately assessing the situation is as important for the safety and well-being of the responder as it is for the casualty. For example, if the casualty is being electrocuted the responder must not directly grab the casualty or he too will become a casualty. TRANSPORTING OR MOVING THE CASUALTY 1-53. Transporting or moving a casualty by Soldiers providing first aid must be carefully considered for a number of reasons. An example of this type of consideration may be based on the casualty having been involved in a motor vehicle crash. When responding to an accident, first aid providers must consider the possibility of injury to the casualty’s spine before extracting the casualty from the vehicle. In this situation moving the casualty may be ill advised unless there is an immediate life-threatening situation such as fire, explosion where the casualty may be at risk of greater injury or death unless moved promptly. 1-54. If there is no danger of greater injury to the casualty by leaving them where they are found, first aid responders should render such aid as is necessary and wait for trained medical personnel to arrive. Once medical personnel are on site they can accurately treat the casualty and direct how and when they should be transported or moved. For detailed discussion on transporting and moving casualties refer to Army Techniques Publication (ATP) 4-25.13. SECTION IV — COMBAT AND OPERATIONAL STRESS REACTION 1-55. One of the most important functions a Soldier performs is taking care of other Soldiers. The whole of the Army is based on teamwork and the inherent worth of every Soldier. Watching, intervening when and where appropriate, and following through in the battle-buddy concept, is critical in dealing with combat and operational stress reactions. SUPPORT 1-56. The best first aid for Soldiers is caring and observant battle buddies and their leaders. The Army as an institution provides combat and operational stress control support from the Soldier and on up to the highest levels of Army leadership. Soldiers need to identify distressed Soldiers, seek assistance, and support their battle buddies. 21 January 2016 TC 4-02.1 1-7 Chapter 1 GUIDANCE FOR SUPPORTING AT-RISK SOLDIERS 1-57. The Army has developed a tool for Soldiers and leaders to use to provide some guidelines on how to approach a distressed Soldier. You should—  Ask.  Care.  Escort. ASK 1-58. Ask your buddy how he is doing and whether or not he feels suicidal. The best way to ask someone if he is suicidal is to do just that. Ask the question: Are you suicidal? It is that simple. CARE 1-59. Care for your buddy. Upon recognition that your buddy is feeling suicidal, calmly remove any weapons or other items that may increase risk. It is extremely important to remain calm, as your anxiety will have an impact on your ability to calm the Soldier. Remaining calm will also increase your effectiveness at intervening. Once any weapon or other potentially dangerous items are removed, be there for the Soldier. Never leave him alone. Remember, we never leave a fallen comrade and these situations are no different. ESCORT 1-60. Escort the Soldier to get help and assistance, staying at his side. Failure to stay involved can have a devastating impact on the Soldier and his ability to drive on. Failure to act increases the risk of the Soldier  impulsively acting on his suicidal intent. Refer to ATP 6-22.5 for more information. 1-8 TC 4-02.1, C1 5 August 2016 Chapter 2 Evaluate a Casualty (081-COM-1001) 2-1. Evaluation of a casualty is necessary to identify and treat all life-threatening conditions and other serious wounds. Rapid and accurate evaluation of the casualty is the key to providing effective first aid. WARNING If a broken neck or back is suspected, do not move the casualty unless to save his life. CARE UNDER FIRE 2-2. Performing care under fire—  Return fire as directed or required before providing first aid.  Determine if the casualty is alive or dead. Note. In combat, the most likely threat to the casualty’s life is from bleeding. Attempts to check for airway and breathing will expose the rescuer to enemy fire. DO NOT attempt to provide first aid when your own life is in imminent danger. In a combat situation, if you find a casualty with no signs of life, no pulse, no breathing, DO NOT attempt to restore the airway. DO NOT continue first aid measures.  Provide care to the living casualty. Direct the casualty to return fire, move to cover, and administer self-aid (stop bleeding), if possible. Note. Reducing or eliminating enemy fire may be more important to the casualty’s survival than the treatment you can provide. If the casualty is unable to move and you are unable to move the casualty to cover and the casualty is still under direct enemy fire, have the casualty play dead.  Once enemy fire has been suppressed, conduct the following: In a battle-buddy team, approach the casualty (use smoke or other concealment if available) using the most direct route possible. Administer lifesaving hemorrhage control. Determine the relative threat of enemy fire versus the risk of the casualty bleeding to death. If the casualty has severe, life-threatening bleeding from an extremity or has an amputation of an extremity, administer lifesaving hemorrhage control by applying a tourniquet from the casualty’s IFAK before moving the casualty. See Chapter 6, Task 081-COM-1032, on page 6-1. Note. The only treatment that should be given at the point of injury is a tourniquet to control life threatening extremity bleeding. Move the casualty, his weapon, and mission-essential equipment when the tactical situation permits. Recheck bleeding control measures (tourniquet) as soon as behind cover and not under enemy fire. 21 January 2016 TC 4-02.1 2-1 Chapter 2 TACTICAL FIELD CARE 2-3. Once under cover and not under hostile fire, perform tactical field care as follows: Note. When evaluating and/or treating a casualty, seek medical aid as soon as possible. DO NOT stop first aid. If the situation allows, send another person to find medical aid. Form a general impression of the casualty as you approach (extent of injuries, chance of survival). Note. If a casualty is being burned, take steps to remove the casualty from the source of the burns before continuing evaluation and first aid. See Chapter 7, Task 081-COM-1007, on page 7-1. Ask in a loud, but calm, voice: Are you okay? Gently shake or tap the casualty on the shoulder. Determine the level of consciousness by using the mnemonic AVPU: A = Alert; V = responds to Voice; P = responds to Pain; U = Unresponsive. Note. To check a casualty’s response to pain, rub the breastbone briskly with a knuckle or squeeze the first or second toe over the toenail. If casualty is wearing individual body armor, pinch his nose or his earlobe for responsiveness. If the casualty is conscious, ask where his body feels different than usual, or where it hurts. Note. If the casualty is conscious but is choking and cannot talk, stop the evaluation and begin appropriate first aid. See Chapter 4, Task 081-COM-1003, on page 4-1. 2-4. Identify and control bleeding—  Check for bleeding as follows: Reassess any tourniquets placed during the care under fire phase to ensure they are still effective. Perform a blood sweep of the extremities, neck, axillary, inguinal, and extremity areas. Exposure is only necessary if bleeding is detected. Place your hands behind the casualty’s neck and pass them upward toward the top of the head. Note whether there is blood or brain tissue on your hands from the casualty’s wounds. Place your hands behind the casualty’s shoulders and pass them downward behind the back, the thighs, and the legs. Note. Look to see if there is blood on your hands from the casualty's wounds. If life-threatening bleeding is present, stop the evaluation and control the bleeding. See Chapter 6, Task 081- COM-1032, on page 6-1.  Once bleeding has been controlled, position the casualty and open the airway. See Chapter 3, Task 081-COM-1023, on page 3-1. 2-5. Assess for breathing and chest injuries as follows:  Expose the chest and check for equal rise and fall and for any wounds.  Look, listen, and feel for respiration. See Chapter 3, Task 081-COM-1023, on page 3-1. 2-2 TC 4-02.1 21 January 2016 Evaluate a Casualty (081-COM-1001) Note. If the casualty is breathing, insert a nasopharyngeal airway (see Chapter 3, Task 081- COM-1023, on page 3-1) and place the casualty in the recovery position. Only in the case of nontraumatic injuries such as hypothermia, near drowning, or electrocution should cardiopulmonary resuscitation (CPR) be considered when in a tactical environment prior to the tactical evacuation phase.  If in a nontactical environment, begin rescue breathing as necessary to restore breathing and or pulse. See Chapter 3, Task 081-COM-1023, on page 3-1.  If the casualty has a penetrating chest wound and is breathing or attempting to breathe, stop the evaluation to apply an occlusive dressing and position or transport with the affected side down, if possible. See Chapter 5, Task 081-COM-1026, on page 5-1.  Check for an exit wound. If found, apply an occlusive dressing.  Dress all nonlife-threatening injuries and any bleeding that has not been addressed earlier with appropriate dressings. See Chapter 6, Task 081-COM-1032, on page 6-1.  Determine the need to evacuate the casualty and supply information for lines 3 to 5 of the 9-line medical evacuation request to your tactical leader. See Soldier Training Publication (STP) 21-1- SMCT, Chapter 3, Task 081-COM-0101, on page 6-1. 2-6. Check the casualty for burns as follows:  Look carefully for reddened, blistered, or charred skin. Also check for singed clothes.  If burns are found, stop the evaluation and begin treatment. See Chapter 7, Task 081-COM- 1007, on page 7-1.  Administer pain medications and antibiotics (casualty’s combat pill pack) if available. Note. Each Soldier will be issued a combat pill pack before deploying on tactical missions.  Document the injuries and the treatment given on the casualty’s own DD Form 1380, Tactical Combat Casualty Care (TCCC) Card (found in the IFAK), if applicable. TACTICAL EVACUATION 2-7. Once the casualty is provided appropriate first aid, initiate the tactical evacuation phase. 2-8. Transport the casualty to the evacuation site. See STP 21-1-SMCT, Chapter 3, Task 081-COM- 1046. 2-9. Monitor the patient for shock and treat as appropriate. See Chapter 8, Task 081-COM-1005, on page 8-1. Continually reassess casualty until a medical person arrives or the patient arrives at a military treatment facility. 21 January 2016 TC 4-02.1 2-3 This page intentionally left blank. Chapter 3 Open the Airway (081-COM-1023) SAFELY POSITION THE CASUALTY TO OPEN THE AIRWAY 3-1. Techniques to safely position an adult casualty who is unconscious and does not appear to be breathing include the following: WARNING The casualty should be carefully rolled as a whole, so the body does not twist.  Roll the casualty onto his back, if necessary, and place him on a hard, flat surface.  Kneel beside the casualty.  Raise the near arm and straighten it out above the head.  Adjust the legs so they are together and straight or nearly straight.  Place one hand on the back of the casualty's head and neck.  Grasp the casualty under the arm with the free hand.  Pull steadily and evenly toward yourself, keeping the head and neck in line with the torso.  Roll the casualty as a single unit.  Place the casualty’s arms at his sides. OPENING THE AIRWAY 3-2. If foreign material or vomit is in the mouth, remove it as quickly as possible. HEAD-TILT CHIN-LIFT METHOD 3-3. To open the airway using the head-tilt chin-lift method— CAUTION DO NOT use this method if a spinal or neck injury is suspected.  Kneel at the level of the casualty’s shoulders.  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.  Do not use the thumb to lift.  Do not completely close the casualty’s mouth.  Do not press deeply into the soft tissue under the chin with the fingers. 21 January 2016 TC 4-02.1 3-1 Chapter 3 JAW-THRUST METHOD 3-4. To open the airway using the jaw thrust method— Note. Use this method if a spinal or neck injury is suspected. If you are unable to maintain an airway after the second attempt, use the head-tilt chin-lift method. Do not tilt or rotate the casualty’s head.  Kneel above the casualty’s head (looking toward the casualty’s feet).  Rest your elbows on the ground or floor.  Place one hand on each side of the casualty’s lower jaw at the angle of the jaw, below the ears.  Stabilize the casualty’s head with your forearms.  Use the index fingers to push the angles of the casualty’s lower jaw forward. Note. If the casualty’s lips are still closed after the jaw has been moved forward, use your thumbs to retract the lower lip and allow air to enter the casualty’s mouth. CHECK FOR BREATHING 3-5. While maintaining the open airway position, place an ear over the casualty’s mouth and nose, looking toward the chest and stomach.  Look for the chest to rise and fall.  Listen for air escaping during exhalation.  Feel for the flow of air on the side of your face.  Count the number of respirations for 15 seconds.  Take appropriate action. CAUTION Do not use the nasopharyngeal airway (NPA) if there is clear fluid (cerebrospinal fluid) coming from the ears or nose. This may indicate a skull fracture. 3-6. If the casualty is unconscious, if respiratory rate is less than 2 in 15 seconds, and/or if the casualty is making snoring or gurgling sounds, insert an NPA.  Keep the casualty in a face-up position.  Lubricate the tube of the NPA with water.  Push the tip of the casualty's nose upward gently.  Position the tube of the NPA so that the bevel (pointed end) of the NPA faces toward the septum (the partition inside the nose that separates the nostrils). Most NPAs are designed to be placed in the right nostril. CAUTION Never force the NPA into the casualty’s nostril. If resistance is met, pull the tube out and attempt to insert it in the other nostril. If neither nostril will accommodate the NPA, place the casualty in the recovery position.  Insert the NPA into the nostril and advance it until the flange rests against the nostril. 3-2 TC 4-02.1 21 January 2016 Open the Airway (081-COM-1023)  Place the casualty in the recovery position by rolling him as a single unit onto his side, placing the hand of his upper arm under his chin, and flexing his upper leg.  Watch the casualty closely for life-threatening conditions and check for other injuries, if necessary. 3-7. If the casualty is not breathing, immediately seek medical aid. 3-8. If the casualty resumes breathing at any time during this procedure, the airway should be kept open and the casualty should be monitored. If the casualty continues to breathe, he should be transported to medical aid or medical treatment facility in accordance with the tactical situation. 21 January 2016 TC 4-02.1 3-3 This page intentionally left blank. Chapter 4 Airway Obstructions (081-COM-1003) AIRWAY OBSTRUCTION IDENTIFICATION 4-1. In order for air to flow freely into and out of the lungs, the airway must remain unobstructed. The ability to move air freely can be compromised when a foreign body becomes lodged in the throat (while eating for example). 4-2. The airway may be partially or completely blocked. In either case removing the obstruction is vital. In cases of complete blockage, removing the blockage quickly is critical if the casualty is to survive.  Determine if the casualty needs help as follows: If a casualty has a mild airway obstruction (able to speak or cough forcefully, may be wheezing between coughs) do not interfere except to encourage the casualty. If the casualty has a severe airway obstruction (poor air exchange and increased breathing difficulty, a silent cough, cyanosis [bluish tinge to the skin], or inability to speak or breathe) continue with abdominal or chest thrusts. Note. You can ask the casualty one question, Are you choking? If the casualty nods yes, help is needed.  The decision to perform abdominal or chest thrusts is determined by the casualty’s condition. Note. Abdominal thrusts should be used unless the casualty is in advanced stages of pregnancy, is very obese, or has a significant abdominal wound. ABDOMINAL THRUSTS Note. Clearing a conscious casualty’s airway obstruction can be performed with the casualty either sitting or standing. 4-3. To perform abdominal thrusts—  Stand behind the casualty.  Wrap your arms around the casualty’s waist.  Make a fist with one hand.  Place the thumb side of the fist against the abdomen slightly above the navel and well below the tip of the breastbone.  Grasp the fist with the other hand.  Give quick backward and upward thrusts. Note. Each thrust should be a separate, distinct movement. Thrusts should be continued until the obstruction is expelled or the casualty becomes unconscious. CHEST THRUSTS 4-4. To perform chest thrusts—  Stand behind the casualty.  Wrap your arms under the casualty’s armpits and around the chest. 21 January 2016 TC 4-02.1 4-1 Chapter 4  Make a fist with one hand.  Give backwards thrusts. Note. Each thrust should be performed slowly and distinctly with the intent of relieving the obstruction.  Continue to give abdominal or chest thrusts, as required. Give abdominal or chest thrusts until the obstruction is clear, you are relieved by a qualified person, or the casualty becomes unconscious. Note. If the casualty becomes unresponsive, lay him down and then start mouth-to-mouth resuscitation procedures. 4-5. If the obstruction is cleared, watch the casualty closely and check for other injuries, if necessary. 4-6. Seek medical aid. 4-2 TC 4-02.1 21 January 2016 Chapter 5 Apply an Occlusive Dressing (081-COM-0069) FIRST AID FOR AN OPEN CHEST WOUND 5-1. First aid procedures for treating an open chest wound with a commercial chest seal include—  Apply gloves from casualty’s IFAK.  Uncover the wound (unless clothing is stuck to the wound or you are in a chemical, biological, radiological, and nuclear environment). CAUTION Removing stuck clothing or uncovering the wound in a chemical, biological, radiological, and nuclear environment could cause additional harm. Note. If unsure that the wound has penetrated the chest wall completely, treat the wound as though it were an open chest wound. If multiple wounds are found, treat as soon as they are discovered. First wound found, first wound treated.  Place gloved hand or back of hand over open chest wound to create temporary seal. Note. Since air can pass through most dressings and bandages, the open chest wound must be sealed with a commercial chest seal, plastic, cellophane, or other nonporous, occlusive (airtight) material to prevent air from entering the chest. USE OF COMMERCIAL CHEST SEAL 5-2. Apply occlusive material over the wound with the vented commercial chest seal supplied in the casualty’s IFAK as follows: Note. A vented commercial chest seal is the preferred type of chest seal. However if one is unavailable, a nonvented commercial chest seal may be applied in the same manner as a vented commercial chest seal.  Fully open the outer wrapper of the casualty’s commercial chest seal located in the casualty’s IFAK.  Wipe any dirt, blood, or sweat from the skin with gauze supplied in the commercial chest seal.  Instruct the casualty to fully exhale and then immediately place the vent of the commercial chest seal directly over the first wound encountered. Note. Do not touch the inner adhesive surface of the commercial chest seal. Ensure that the edges of the chest seal extend 2 inches beyond the wound. Firmly press the chest seal on the skin to ensure a good airtight seal. 7 December 2018 TC 4-02.1, C2 5-1 Chapter 5  If the chest seal does not provide a good airtight seal, apply 2-inch tape (from the casualty’s IFAK) to all four sides of the chest seal, ensuring the tape does not cover any vents, and secure it firmly to the casualty’s chest. Note. Check for additional wounds on the front side of the casualty, to include the armpits. If any wounds are found between the neck and belly button, treat as a chest injury with a chest seal.  Roll the casualty on his or her side or have the conscious casualty sit up and examine the back for any wounds.  If any wounds are present on the back, treat as a chest injury with a commercial chest seal.  Encourage the casualty to breathe normally.  Place casualty in position of comfort (usually sitting) if conscious, or in the recovery position (on the casualty’s side) with the injured-side down if unconscious.  Continue to monitor the casualty for signs of respiratory distress (increased difficulty breathing).  If the casualty has increased difficulty breathing, lift the chest seal, release any trapped air by wiping blood or debris from the wound, and reseal or replace the chest seal upon exhalation.  Seek medical aid and continue to monitor the casualty until relieved by medical personnel. USE OF IMPROVISED CHEST SEAL 5-3. First aid procedures for treating an open chest wound with an improvised chest seal include—  Apply gloves from casualty’s IFAK.  Uncover the wound (unless clothing is stuck to the wound or you are in a chemical, biological, radiological, and nuclear environment). CAUTION Removing stuck clothing or uncovering wound in a chemical, biological, radiological, and nuclear environment could cause additional harm. Note. If unsure that the wound has penetrated the chest wall completely, treat the wound as though it were an open chest wound. If multiple wounds are found, treat as soon as they are discovered. First wound found, first wound treated.  Place gloved hand or back of hand over open wound to create temporary seal. Note. Since air can pass through most dressings and bandages, the open chest wound must be sealed with a commercial chest seal, plastic, cellophane, or other nonporous, occlusive (airtight) material to prevent air from entering the chest. 5-4. When a commercial chest seal is unavailable, apply an improvised occlusive chest seal over the wound as follows:  Fully open the outer wrapper of the casualty’s dressing, or other occlusive material. 5-2 TC 4-02.1, C2 7 December 2018 Perform First Aid for an Open Chest Wound (081-COM-0069)  Wipe any dirt, blood, or sweat from the skin with gauze or any available clothing.  Instruct the casualty to fully exhale, then place the inner surface of the outer wrapper or other occlusive material directly over the wound. Note. Do not touch the inner surface of the occlusive material. Ensure that the edges of the occlusive material extend 2 inches beyond the wound.  Apply 2-inch tape from the casualty’s IFAK to three sides of the occlusive material and secure it firmly to the casualty’s chest. Leave the side nearest to the ground untaped. Note. If unconscious, the casualty will be placed in the recovery position with the injured-side down, therefore the outside edge on the injured side would be left untaped. If the casualty is conscious and sitting, the bottom edge would be left untaped. Note. Check for additional wounds on the front side of the casualty, to include the armpits. If any wounds are found between the neck and belly button, treat as a chest injury with an improvised occlusive chest seal.  Roll the casualty on his or her side or have the conscious casualty sit up and examine the back for any wounds.  If any wounds are present on the back, treat as a chest injury with a large improvised occlusive chest seal (such as the plastic wrapper from the emergency dressing in the IFAK).  Encourage the casualty to breathe normally.  Place casualty in position of comfort (usually sitting) if conscious, or in the recovery position (on the casualty’s side) with the injured-side down if unconscious.  Continue to monitor the casualty for signs of respiratory distress (increased difficulty breathing).  If the casualty has increased difficulty breathing, lift the chest seal, release any trapped air by wiping blood or debris from the wound, and reseal or replace the chest seal upon exhalation.  Seek medical aid and continue to monitor the casualty until relieved by medical personnel. 7 December 2018 TC 4-02.1, C2 5-3 This page intentionally left blank. Chapter 6 Perform First Aid for Bleeding of an Extremity (081-COM-1032) CONTROL BLEEDING 6-1. When evaluating a casualty it is imperative that an accurate determination be made as to whether the bleeding is life threatening or not. This determination will dictate the methods to be used to control the bleeding. CAUTION All body fluids should be considered potentially infectious. Always observe body substance isolation precautions by wearing gloves and eye protection as a minimal standard of protection. In severe cases, you should wear gloves, eye protection, gown and shoe covers to protect yourself from splashes, projectile fluids, spurting fluids or splashes onto your clothing and footwear. METHODS FOR CONTROLLING EXTERNAL BLEEDING 6-2. There are three methods of controlling external bleeding, they are—  Direct pressure.  Pressure dressing.  Tourniquet. 6-3. If the evaluation determines that the bleeding is life threatening, a tourniquet should be immediately applied. APPLY DIRECT PRESSURE 6-4. If bleeding is not life threatening, apply direct pressure as follows:  Expose the wound.  Place sterile gauze or dressing over the injury site and apply fingertips, palm or entire surface of one hand and apply direct pressure.  Pack large, gaping wounds with sterile gauze and apply direct pressure. 6-5. Once the bleeding has been controlled, it is important to check a distal pulse to make sure that the dressing has not been applied too tightly. If a pulse is not felt, adjust the dressing to re-establish circulation. WARNING The emergency bandage must be loosened if the skin distal to the injury becomes cool, blue, numb, or pulseless. 21 January 2016 TC 4-02.1 6-1 Chapter 6 APPLY A PRESSURE DRESSING 6-6. When applying a bandage always use the casualty’s emergency bandage.  Open the plastic dressing package.  Apply the dressing, white-side down (sterile, nonadherent pad) directly over the wound.  Wrap the elastic tail (bandage) around the extremity and run the tail through the plastic pressure bar.  Reverse the tail while applying pressure and continue to wrap the remainder of the tail around the extremity, while continuing to apply pressure directly over the wound.  Secure the plastic closure bar to the last turn of the wrap.  Check the emergency bandage to make sure that it is applied firmly enough to prevent slipping without causing a tourniquet-like effect. CAUTION In combat, while under enemy fire, a tourniquet is the primary means to control bleeding. It allows the individual, his battle buddy, or the combat medic to quickly control life threatening hemorrhage until the casualty can be moved away from the firefight. Always treat life threatening hemorrhage while you and the casualty are behind cover. APPLY A TOURNIQUET 6-7. If the evaluation of the casualty determines that the bleeding is life threatening a commercial tourniquet contained in the IFAK should be immediately applied.  Pull the free end of the self-adhering band through the buckle and route through the friction adapter buckle.  Place the tourniquet, 2 to 3 inches above the wound on the injured extremity.  Pull the self-adhering band tight around the extremity and fasten it back on itself as tightly as possible.  Twist the windlass until the bleeding stops.  Lock the windlass in place within the windlass clip.  Secure the windlass with the windlass strap.  Assess for absence of a distal pulse.  Place a T and the time of the application on the casualty with a marker.  Secure the commercial tourniquet in place with tape. 6-8. Once the injuries have been bandaged and the bleeding stopped initiate treatment for shock as needed. See Chapter 8, Task 081-COM-1005, on page 8-1. 6-9. Seek medical aid. 6-2 TC 4-02.1 21 January 2016 Chapter 7 Perform First Aid for Burns (081-COM-1007) PERFORM FIRST AID FOR BURNS 7-1. The first course of action when attempting to provide first aid for burns is to remove the casualty from the source of the burn to prevent further harm. CAUTION Synthetic materials, such as nylon, may melt and cause further injury. KINDS OF BURNS 7-2. There are four kinds of burns which are likely to be encountered. They are—  Thermal burns. Remove the casualty from the source of the burn. If the casualty’s clothing is on fire, cover the casualty with a field jacket or any large piece of nonsynthetic material and roll him on the ground to put out the flames. WARNING DO NOT touch the casualty or the electrical source with your bare hands. You will be injured too!  Electrical burns. WARNING High voltage electrical burns from an electrical source or lightning may cause temporary unconsciousness, difficulties in breathing, or difficulties with the heart (irregular heartbeat). If the casualty is in contact with an electrical source, turn the electricity off, if the switch is nearby. If the electricity cannot be turned off, use nonconductive material (rope, clothing, or dry wood) to drag the casualty away from the source. WARNING Blisters caused by a blister agent are actually burns. DO NOT try to decontaminate the skin where blisters have already formed. If blisters have not formed, decontaminate the skin.  Chemical burns. 21 January 2016 TC 4-02.1 7-1 Chapter 7 Remove liquid chemicals from the burned casualty by flushing with as much water as possible. Remove dry chemicals by carefully brushing them off with a clean, dry cloth. If large amounts of water are available, flush the area. Otherwise, do not apply water. Smother burning white phosphorus with water, a wet cloth, or wet mud. Keep the area covered with wet material.  Laser burns. Move the casualty away from the source while avoiding eye contact with the beam source. If possible, wear appropriate laser eye protection. Note. After the casualty has been removed from the source of the burn, continually monitor the casualty for conditions that may require basic lifesaving measures. WARNING DO NOT uncover the wound in a chemical, biological, radiological, and nuclear environment. Exposure could cause additional harm. 7-3. Uncover the burn as follows: WARNING DO NOT attempt to remove clothing that is stuck to the wound. Additional harm could result.  Cut clothing from the burned area. CAUTION DO NOT pull clothing over the burns.  Gently lift away clothing covering the burned area.  If the casualty’s hands or wrists have been burned, remove jewelry (rings, watches) and place them in his pockets. 7-4. Apply the casualty’s dry, sterile dressing directly over the wound as follows: Note. If the burn is caused by white phosphorus, the dressing must be wet. CAUTION DO NOT place the dressing over the face or genital area. DO NOT break blisters. DO NOT apply grease or ointments to the burns. 7-2 TC 4-02.1 21 January 2016 Perform First Aid for Burns (081-COM-1007)  Apply the dressing or pad, white-side down, directly over the wound.  Wrap the tail (or the elastic bandage) so the dressing or pad is covered.  For a field dressing, tie the tails into a nonslip knot over the outer edge of the dressing, not over the wound. For an emergency bandage, secure the hooking ends of the closure bar into the elastic bandage.  Check to ensure that the dressing is applied lightly over the burn but firmly enough to prevent slipping. Note. If the casualty is conscious and not nauseated, give him small amounts of water to drink. 7-5. Watch the casualty closely for signs of life-threatening conditions, check for other injuries (if necessary), and treat for shock. 7-6. Seek medical aid. 21 January 2016 TC 4-02.1 7-3 This page intentionally left blank. Chapter 8 Perform First Aid to Prevent or Control Shock (081-COM-1005) SIGNS AND SYMPTOMS OF SHOCK 8-1. Check the casualty for signs and symptoms of shock.  Sweaty but cool skin.  Pale skin.  Restlessness or nervousness.  Thirst.  Severe bleeding.  Confusion.  Rapid breathing.  Blotchy blue skin.  Nausea and/or vomiting. POSITION THE CASUALTY 8-2. Procedures for positioning the casualty include—  Move the casualty under a permanent or improvised shelter to shade him from direct sunlight.  Lay the casualty on his back unless a sitting position will allow the casualty to breathe easier.  Elevate the casualty’s feet higher than the heart using a stable object so the feet will not fall. WARNING Do not loosen clothing if in a chemical area.  Loosen clothing at the neck, waist, or anywhere it is binding.  Prevent the casualty from getting chilled or overheated. Using a blanket or clothing, cover the casualty to avoid loss of body heat by wrapping completely around the casualty. Note. Ensure no part of the casualty is touching the ground, as this increases loss of body heat. CALM AND REASSURE THE CASUALTY 8-3. Calm and reassure the casualty by—  Taking charge and show self-confidence.  Assuring the casualty that he is being taken care of. 8-4. Watch the casualty closely for life-threatening conditions and check for other injuries, if necessary. 8-5. Seek medical aid. 21 January 2016 TC 4-02.1 8-1 This page intentionally left blank. Chapter 9 Perform First Aid for Nerve Agent Injury (081-COM-1044) FIRST AID FOR NERVE AGENT INJURY 9-1. After reacting appropriately to a chemical attack (stop breathing, don your protective mask [see STP 21-1-SMCT, Chapter 3, Task 031-COM-1035]) and giving the alarm, it is important to observe yourself and other Soldiers for signs and symptoms of nerve agent poisoning. 9-2. There are two categories of nerve agent poisoning that Soldiers should be familiar with. These are—  Mild nerve agent poisoning.  Severe nerve agent poisoning. 9-3. Accurately determining if the poisoning is mild or severe helps to determine what first aid measures are necessary and appropriate. 9-4. To determine what steps are necessary, it is important to identify if the poisoning is mild or severe in nature. There are signs and symptoms specific to each category of nerve agent poisoning. SIGNS AND SYMPTOMS OF MILD NERVE AGENT POISONING 9-5. Signs and symptoms of mild nerve agent poisoning include—  Unexplained runny nose.  Unexplained sudden headache.  Sudden drooling.  Tightness in the chest or difficulty breathing.  Difficulty seeing (dimness of vision or miosis).  Localized sweating and muscular twitching in the area of contaminated skin.  Stomach cramps.  Nausea. SELF-AID FOR MILD NERVE AGENT POISONING 9-6. First aid for mild nerve agent poisoning is considered to be self-aid. 9-7. First aid, self-aid for mild nerve agent poisoning involves the use of the antidote treatment nerve agent, autoinjector (ATNAA). Administer the ATNAA as follows:  Acquire one ATNAA autoinjector. Note. Administer ONLY one ATNAA as self-aid. DO NOT self-administer the convulsant antidote for nerve agent (CANA).  Locate injection site (outer thigh muscle, about a hands width below the hip joint and above the knee) and ensure that it is clear of objects that will interfere with the injection. Note. If the individual is thinly built, injection should be given into the upper outer quadrant of the buttock. 21 January 2016 TC 4-02.1 9-1 Chapter 9 CAUTION DO NOT cover or hold the needle end with your hand, thumb, or fingers. You may accidently inject yourself.  With your dominant hand, hold the ATNAA in your closed fist with the needle (green) end extending beyond the little finger in front of you at eye level.  Pull off the safety cap from the bottom of the injector with a smooth motion using the nondominant hand, and drop it to the ground. CAUTION When injecting antidote into the buttock, be very careful to inject only into upper, outer quarter of the buttock to avoid hitting the major nerve that crosses the buttocks. Hitting the nerve may cause paralysis.  Place the needle end of the injector against chosen injection site and apply firm, even pressure until the needle activates into the muscle. Note. A jabbing motion is not necessary to trigger the activating mechanism.  Hold the injector firmly in place for at least 10 seconds.  Remove the injector from your muscle.  Secure the used injector.  Bend the needles of all used injectors by pressing on a hard surface to form a hook.  Attach all used injectors to a blouse pocket flap or the Joint Service Lightweight Integrated Suit Technology (JSLIST). WARNING DO NOT give yourself additional injections. If you are able to walk without assistance and know who you are and where you are, you will NOT need the second set of injections. If you continue to have symptoms of nerve agent poisoning, seek someone else (a buddy) to check your symptoms and administer the additional set of injections, if required.  Massage the injection site, mission permitting. SIGNS AND SYMPTOMS OF SEVERE NERVE AGENT POISONING 9-8. Signs and symptoms of severe nerve agent poisoning include—  Strange or confused behavior.  Wheezing, difficulty breathing, and coughing.  Severely pinpointed pupils.  Red eyes with tearing.  Vomiting.  Severe muscular twitching.  Involuntary urination and defecation. 9-2 TC 4-02.1 21 January 2016 Perform First Aid for Nerve Agent Injury (081-COM-1044)  Convulsions.  Unconsciousness with, or without respiratory failure.  Localized sweating and muscular twitching in the area of contaminated skin. BUDDY AID FOR SEVERE NERVE AGENT POISONING 9-9. First aid for severe nerve agent poisoning is considered buddy aid, it involves the use of the ATNAA and includes administering the CANA with the third ATNAA to prevent convulsions. 9-10. Administer buddy aid for severe nerve agent poisoning.  Mask the casualty if necessary.  If the casualty can follow instructions, have him clear his mask.  Check for a complete mask seal by covering the inlet valves of the mask.  Pull the protective hood over the head of the casualty.  Position the casualty on the right side (recovery position) with the head slanted down so that the casualty will not roll back over. 9-11. Administer ATNAA as follows: CAUTION Squat, do not kneel, when masking the casualty or administering the nerve agent antidotes to the casualty.  Position yourself near the casualty’s thigh.  Obtain the casualty’s three or remaining ATNAA auto-injectors. Note. Be sure to use the casualty’s own autoinjectors, and not your own.  Using the same method as in self-aid, administer up to, but no more than three doses of the ATNAA. Note. If the casualty’s condition improves (regains consciousness, become coherent, able to stand or walk) after the first or second dose, do not administer the remaining dose(s), but monitor until medical help arrives or he is evacuated to a higher role of care.  Bend the needles of all used injectors by pressing on a hard surface to form a hook.  Attach all used injectors to blouse pocket flat or JSLIST. 9-12. Administer CANA as follows: Note. Buddy aid also includes administering the CANA with the third ATNAA to prevent convulsions. CAUTION Squat, DO NOT kneel when masking the casualty or administering the nerve agent antidotes to the casualty. 21 January 2016 TC 4-02.1 9-3 Chapter 9  Position yourself near the casualty’s thigh.  Obtain one CANA autoinjector.  Locate injection site (outer thigh muscle, about a hand’s width below the hip joint and above the knee) and ensure it is clear of objects that will interfere with the injection. Note. If the individual is thinly built, injection should be given into the upper outer quadrant of the buttock. CAUTION DO NOT cover or hold the needle end with your hand, thumb, or fingers. You may accidently inject yourself.  With your dominant hand, hold the CANA in your closed fist with the needle extending beyond the little finger at eye level.  Pull off the safety cap from the bottom of the injector with a smooth motion using the nondominant hand, and drop it to the ground. CAUTION When injecting antidote in the buttock, be very careful to inject only into the upper, outer quarter of the buttock to avoid hitting the major nerve that crosses the buttocks. Hitting the nerve may cause paralysis.  Place the needle end of the injector against the chosen injection site and apply firm, even pressure until the needle activates into the muscle.  Hold the injector firmly in place for at least 10 seconds.  Remove the injector from the casualty’s muscle.  Secure the used injector. 9-13. Decontaminate the skin if necessary. Note. Information on this step is covered in STP 21-1-SMCT, Chapter 3, Task 031-COM-1013. 9-14. Put on remaining protective clothing. Note. Information on this step is covered in STP 21-1-SMCT, Chapter 3, Task 031-COM-1040. 9-15. Seek medical aid. 9-4 TC 4-02.1 21 January 2016 Chapter 10 First Aid for Bites and Stings (081-833-0072) 10-1. First aid procedures for a casualty with insect bites or stings, without causing further injury involves—  Exposing the injury site. Note. Removing clothing, rings, watches, and other constricting items that are in the area of the bite or sting to prevent circulatory impairment in the event swelling of the extremity occurs.  Determining the type of insect bite or sting.  Gathering information from the casualty, ask them if they saw what bit or stung them. WARNING Be alert for indicators of the casualty developing anaphylaxis such as hoarseness, a feeling of swelling or a lump in the throat, wheezing, and signs and symptoms of shock.  Checking an unconscious casualty for a medical alert bracelet or tag (allergy band). Note. It is important to determine if the casualty has a history of past reactions to similar bites or stings. 10-2. Assess the casualty for signs and symptoms of insect bites or stings. BLACK WIDOW SPIDER 10-3. Signs and symptoms of black widow spider bites include—  A pinprick sensation at the bite site, becoming a dull ache within about 30 minutes.  Severe painful muscle spasms, especially in the shoulders, back, chest and abdomen. Begin in 10 to 40 minutes. Peak in 1 to 3 hours. Persist for 12 to 48 hours.  Rigid, board-like abdomen.  Dizziness, nausea, vomiting, and respiratory distress in severe cases. 10-4. Signs and symptoms of brown recluse spider bites include— Note. The brown recluse spider is medium-sized, generally brown but can range in color from yellow to dark chocolate brown. It has a distinct groove between its chest and abdominal body parts. The characteristic marking is a brown, violin-shaped marking on the upper back.  Casualty seldom recalls being bitten, since the bite is painless at first.  Several hours after the bite, it becomes bluish surrounded by a white periphery. 21 January 2016 TC 4-02.1 10-1 Chapter 10  A red halo or bulls-eye pattern appears sometime later.  Within 7 to 10 days, the bite becomes a large ulcer. SCORPION (HARMLESS SPECIES) 10-5. Signs and symptoms of scorpion (harmless species) stings include— Note. There are two general types of scorpions. The Arizona (black) scorpion is the only deadly type in the United States.  Severity of the sting depends on the amount of venom injected.  Ninety percent of all scorpion stings occur on the hands.  Scorpion stings cause a sharp pain at the injection site.  The symptoms last for 24 to 72 hours. SCORPION (DEADLY SPECIES) 10-6. Signs and symptoms of scorpion (deadly species) stings include—  Sharp pain at the injection site, “pins and needles” sensation.  Severe muscle contractions.  Drooling.  Poor circulation.  Hypertension.  Cardiac failure.  Incontinence.  Seizures. BEE, WASP, HORNET, AND YELLOW JACKET (MILD REACTION) 10-7. Signs and symptoms of a mild reaction to

Use Quizgecko on...
Browser
Open
Browser
Browser