Identify appropriate evaluation and treatment procedures, including sequence, performed on the battlefield.

Given multiple-choice examination items pertaining to evaluating and treating a casualty.

Score 70 or more points on the 100-point written examination.

FM 8-285, Treatment of Chemical Agent Casualties and Conventional Military Chemical Injuries.

STP 21-1-SMCT, Soldier's Manual of Common Tasks: Skill Level 1.

FM 21-11, First Aid for Soldiers.

STP 8-91-SM, Soldier's Manual : CMF 91 General Medical Tasks.

On the battlefield, you must be able to identify and treat injuries and life-threatening conditions. The sequence in which injuries and conditions are treated can mean the difference between life and death for the casualty.

When treating a casualty, you must identify and treat the most serious condition first. In general, you must make sure the casualty has an open airway and is breathing; then control any major bleeding; and then take measures to control shock. This is referred to as the primary survey of the casualty.

Once life-threatening conditions and/or injuries have been identified and treated, look for other injuries or problems and treat them. This is usually referred to as the secondary survey of the casualty.

If you have more than one casualty, perform a quick primary survey of each casualty. If you find a life-threatening condition during your primary survey, treat that condition immediately. After you have performed primary surveys on all casualties and have treated all immediate life-threatening conditions, perform a secondary survey on each casualty. Treat the more serious casualty first.

Some of the standard evaluation steps may be performed so fast that they appear to be skipped. A casualty who is yelling in pain, for example, is obviously conscious (responsive) and breathing.

This lesson brings together certain buddy-aid tasks presented in IS0824 and certain medical tasks presented in IS0825. The following learning events give the steps normally used in performing a primary and secondary survey in the sequence they are normally performed. The lesson assumes you are in a combat situation, your combat mission allows you to stop and render aid, and no combat medic is immediately available to assist the casualty.

Quickly evaluate your immediate surroundings to gather vital information.

Look for obvious, immediate, life-threatening hazards (fires, explosions, enemy fire, electrical hazards, etc.). You cannot safely evaluate and treat a casualty in a hazardous environment. You must first tactically move the casualty (and yourself) to safety, thus preventing yourself from being injured.

Note the terrain and climate (temperature and weather conditions). This information may alert you to other potential injuries (heat injury in hot climates, immersion foot in marshy terrain, frostbite in cold climate, etc.).

Note the type of battle or incident that occurred. This may help you determine the type of injuries you can expect to treat (bullet wounds after a fire fight, shrapnel injuries after a mortar attack, fractured limbs and spinal injuries after an airborne accident, etc.).

Note whether chemical agents may be present.

If a life-threatening hazard (such as a fire fight) is present, remove the casualty to a place of safety using the cradle drop drag or other appropriate carry (IS0824, Lesson 15).

If the casualty is being burned (flames, chemicals, electrical current, etc.), eliminate the source of the burn (IS0824, Lesson 11). Take care to prevent being injured yourself, especially if separating the casualty from an electrical wire.

If a spinal injury is suspected (IS0824, Lesson 10), take care to prevent additional damage to the spinal column. Immobilize the casualty's neck and back after completing your primary survey.

If you are in a chemical environment or suspect that chemical agents have been used, protect yourself and then make sure the casualty is properly masked. If severe nerve agent poisoning is present, administer three Mark I kits and one CANA. (IS0824, Lesson 14).

If liquid blister agent is present in the casualty's eyes, flush his eyes with water (IS0825, Lesson 22) even if you are still in a chemical environment.

Calmly ask in a loud voice, "Are you okay?" or some similar question that demands a response from the casualty. If he does not respond, gently shake him or tap him on the shoulder and repeat the question.

If the casualty responds, ask the casualty for information ("Where do you hurt?" "Were you hit?" "Were you exposed to chemical agents?" etc.) This information will be useful in your evaluation, but continue to evaluate the casualty in a systematic method since the injury that hurts the most may not be the injury that needs to be treated first.

If the casualty is not responsive, send a soldier to get a combat medic and continue your evaluation.

If the casualty is responsive, evaluate him for airway obstruction (universal choking sign, difficulty in breathing, etc.). If the casualty has poor or no air exchange, apply abdominal and or chest thrusts (IS0824, Lesson 2).

If the casualty is not responsive (unconscious), open his airway using the head-tilt/chin-lift or jaw thrust method (IS0824, Lesson 3).

If a responsive casualty is talking or yelling in pain, his breathing is adequate.

If the casualty is not responsive (unconscious), evaluate his breathing by feeling for breath on your face, looking for the rising and falling of his chest, and listening for sounds of breathing.

If the casualty is not breathing or is having difficulty in breathing, open his airway, clear any airway obstruction, and perform mouth-to-mouth resuscitation (IS0824, Lesson 3).

CAUTION: Do not perform mouth-to-mouth (or -nose) resuscitation in a chemical environment.

If the casualty is responsive and breathing adequately, he has a pulse.

If the casualty is unresponsive or not breathing, check his pulse (IS0825, Lesson 18). If the casualty has no pulse, seek medical help immediately.

Look for blood-soaked clothing, spurts of blood, pooling of blood under the body and other signs of external bleeding.

If a major amputation of a limb (amputation of the upper arm, forearm, thigh, lower leg, complete hand, or complete foot) is found, apply a tourniquet to the upper arm or thigh and dress the stump (IS0824, Lesson 4). (Amputation of a part of the hand or foot is controlled by pressure dressings.)

If serious bleeding from a wound of the arm or leg is found, apply a field dressing or improvised dressing and bandage to the wound (IS0824, Lesson 4). If the injury has been caused by a missile (bullet, shrapnel), look for both entry and exit wounds. Apply manual pressure and, if the limb is not fractured, elevate the wound.

If serious bleeding from a limb is not controlled by the field dressing, apply a pressure dressing (IS0824, Lesson 4).

If serious bleeding from a limb is not controlled by the pressure dressing, apply a tourniquet (IS0824, Lesson 4).

If an open chest wound is found, seal the wound with the plastic dressing wrapper or other airtight material, tape the sealing material on three sides to form a flutter valve, and apply a field dressing to the wound (IS0824, Lesson 5).

If an open abdominal wound is found, position the casualty in a flexed-knee position, position any protruding organs on the casualty's abdomen, apply a field or improvised dressing over the wound and organs, and secure the dressing (IS0824, Lesson 6).

If an open head wound is found, dress the wound (IS0824, Lesson 7). If the casualty has a severe head injury, immobilize the casualty's head and neck (IS0824, Lesson 10).

CAUTION: If the casualty has more than one severe wound, treat the wound loosing the most blood first.

CAUTION: Do not further expose the wound(s) if you are in a chemical environment.

If the casualty has signs and symptoms of chemical agent poisoning (IS0825, Lesson 22), he is breathing, and all life-threatening wounds have been treated, administer treatment for chemical agent poisoning. (NOTE: The casualty has already been masked. If severe nerve agent poisoning was present, three Mark I antidote kits and one CANA were administered.)

Have the casualty begin self-aid decontamination procedures if he is able (IS0824, Lesson 14). If he cannot, have another soldier decontaminate the casualty. Do not stop your evaluation and treatment at this time to decontaminate the casualty.

If the casualty is suffering from severe nerve agent poisoning and 5 minutes have passed since you administered the last Mark I kit and the CANA, take the casualty's pulse. If the pulse rate is below 90 beats per minute, administer an atropine injector.

If the casualty still twitches, showing signs of seizure, you may administer up to two additional CANA injections at about 5 to 10 minute intervals. Actually, time is less important here than the symptoms. Three CANAs are the limit--normally one from the soldier and two from your combat lifesaver aid bag.

Check the casualty for signs and symptoms of shock (clammy and pale skin, severe loss of blood, severe burns, increased breathing rate, mental confusion, etc.).

If hypovolemic shock is present, position the casualty, protect him from the environment, and administer fluids intravenously (IS0824, Lesson 8, and IS0825, Lesson 16).

If the casualty has a fractured leg, do not elevate the leg until it is splinted.

Initiate an I.V. if the casualty has suffered severe blood loss or has second or third degree burns on 20 percent or more of his body.

 

Check legs and arms for protruding bone, abnormal limb position, major wounds, bruises, and painful or tender spots.

If a fracture or a massive wound is present, dress any open wounds (including burns) and immobilize the limb with a padded splint (IS0824, Lesson 9, and IS0825, Lesson 19). Secure the splint above and below the fracture site.

CAUTION: Do not try to straighten (align) the broken bone before applying the splint.

 

CAUTION: Check the casualty's circulation below the fracture before and after applying the cravats. Loosen the cravats and reapply if needed.

 

Apply a sling and swathe to further immobilize a fractured upper arm, forearm, or wrist (IS0824, Lesson 9).

If a spinal injury is suspected, immobilize the casualty's neck and back (IS0824, Lesson 10).

Look for reddened, blistered, or charred skin, for burned or singed clothing, and for other evidence of burns. Pay special attention to burns about the head and neck for possible inhalation burns. Some burns, such as chemical burns, may not be readily seen unless the casualty's clothing is removed.

Do not further expose wounds if you are in a chemical environment.

Apply a dry dressing to burned areas on the trunk and limbs (IS0824, Lesson 11).

Remove jewelry from a burned limb.

Do not apply a bandage to burns of the face or genitalia.

If an electrical current passed through the casualty, locate and dress both the entry and exit wounds.

If the casualty has a chemical burn, remove as much of the chemical as possible before applying a dressing. NOTE: Keep white phosphorus burns wet to keep the particles away from oxygen and thus igniting, but do not try to remove the particles.

If second and third degree burns cover 20 percent or more of the skin surface, initiate an intravenous infusion (IS0825, Lesson 17).

c. Check the Casualty for Closed Head Injury (Concussion)

Look for unequal pupils, fluid leaking from the ear or nose, slurred speech, mental confusion, drowsiness, headache, dizziness, loss of memory, loss of consciousness, twitching or convulsions, difficulty in walking (staggering), and nausea or vomiting (IS0824, Lesson 7).

If a closed head injury is suspected, evacuate the casualty to a medical treatment facility.

If the casualty is having convulsions, support his head and neck and maintain an open airway.

Monitor the casualty's respirations and be prepared to administer mouth-to-mouth resuscitation should it be needed.

If the casualty has been working in a hot environment, check for signs and symptoms of heat stroke, heat exhaustion, and heat cramps (IS0824, Lesson 12).

If the casualty has heat stroke, expose his skin, pour or spray water on him, fan him, and evacuate him as quickly as possible. Continue cooling efforts, such as pouring or spraying water over the casualty and fanning him, during evacuation. Have him drink cool water if he can tolerate it without vomiting.

If the casualty is suffering from heat cramps or heat exhaustion, move him to a shaded place and cool him off. Have the casualty drink at least one quart of cool water.

All casualties with heat exhaustion or heat stroke should get an intravenous infusion (IS0825, Lesson 17).

If the casualty has been exposed to cold or freezing weather, check for signs and symptoms of general hypothermia, frostbite, immersion syndrome, and chilblain (IS0824, Lesson 13).

If general hypothermia is present, move the casualty to a protected location and use a heat source (such as another soldier's body) to rewarm the casualty. Evacuate the casualty as soon as practical.

If deep frostbite is found, move the casualty to a warm place, thaw the area, and evacuate the casualty as soon as practical. NOTE: Do not thaw frozen feet if the casualty will be required to walk.)

If superficial frostbite or chilblain is found, rewarm and protect the affected area.

If immersion syndrome is found, dry and rewarm the affected area.

Check the casualty for visual problems resulting from lasers weapons or snow blindness (IS0824, Lesson 11, and IS0824, Lesson 13).

Protect the casualty from additional injury. Cover the eyes with a dark cloth if the casualty is in pain or if vision loss is severe.

Evacuate the casualty if practical.

Look for minor wounds and fractures. Dress and bandage the wounds as time permits. Bleeding from severed fingers and toes can be controlled without the use of a tourniquet. Splint fractured fingers using the same basic splinting procedures given in IS0824, Lesson 9.

If the casualty appears to be injured but you cannot find any physical injury, look for symptoms of combat stress reaction (IS0825, Lesson 23). If combat stress reaction is suspected, take appropriate measures.

Monitor the casualty throughout the evaluation process for the presence of life-threatening conditions. For example, a casualty who is breathing when you begin your evaluation may suddenly stop breathing. Anytime a life-threatening condition is detected, stop your evaluation and treat the life-threatening condition.

Some conditions may require time to properly evaluate. If you put a field dressing on a bleeding wound on the casualty's leg, for example, continue to monitor the injury in case additional measures (pressure dressing or tourniquet) are needed to control bleeding. You can proceed with your evaluation of the casualty while continuing to monitor the wound for bleeding.

If you have administered nerve agent antidote to a severe nerve agent casualty, continue to check the casualty's pulse every five minutes. If the casualty's pulse rate is below 90 beats per minute, administer an atropine autoinjector. Give CANA (up to a total of three doses) for control of seizures (IS0825, Lesson 22).

If the casualty has not been treated for shock, take measures to prevent shock. The measures used to control shock given in Lesson 8 of IS0824 (such as loosening clothing, positioning the casualty, and protecting the casualty from the cold) are also used to prevent shock from occurring.

Monitor a heat cramp or heat exhaustion casualty to ensure that he continues to drink water without vomiting and that his condition does not become more serious. Be prepared to administer mouth-to-mouth resuscitation, increase cooling efforts, initiate an I.V., and evacuate the casualty if his condition worsens.

Be ready to open his airway and administer mouth-to-mouth resuscitation should the need arise. If medical personnel arrive, report your findings.

Insert an oropharyngeal airway in an unconscious casualty to keep his airway open, if needed (IS0825, Lesson 21).

Continue to perform any needed procedures, such as keeping white phosphorus burns wet.

If you are treating more than one casualty, continue to monitor the other casualties for life-threatening conditions while administering treatment to a casualty.

Whenever possible, have the casualty evaluated by a combat medic or other medical personnel.

Continue to monitor the casualty until you return the casualty to duty, until a medical person (usually a combat medic or member of a medical evacuation team) takes over, or until you must resume your combat duties.

If the casualty requires evacuation, transport him using the most effective means available (IS0825, Lesson 25, and IS0824, Lessons 15).

If you are the leader of a litter team evacuating the casualty, continue to monitor the casualty during the evacuation. Stop and render your aid if a life-threatening condition arises.

If a medic is not available and a soldier has a minor headache, cold, or hay fever, administer acetaminophen or pseudoephedrine hydrochloride tablets as needed if no contraindications are present (IS0825, Lesson 24).

If the medic requests assistance and your combat duties allow, assist the combat medic in providing care to casualties and in evacuating casualties. The medic will provide instructions as needed.