Apply a dressing to a casualty with an open head wound.

Given a simulated casualty with an open head wound and needed supplies.

Score a GO on the performance checklist.

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

FM 21-11, First Aid for Soldiers.

A head injury may be the only injury (such as a single blow to the head) or it may be combined with other injuries (such as head and body injuries caused by an explosion). A head injury may consist of a cut or bruise of the scalp, a concussion, a fracture of the skull with injury to the brain, extruding brain matter, or a combination of these injuries. If the skin has been broken, it is called an open head injury. If the skin has not been broken, it is a closed head injury. Both can be life threatening.

Bleeding from the scalp is sign of an open head injury. The following signs and symptoms are also indications of a head injury, even if no open wound is present.

Visible skull fracture.

Visible brain tissue.

Deformity of the head.

Clear or bloody fluid leaking from the nose or ear.

"Black eyes."

Bruising behind one or both ears.

Headache, nausea, or vomiting.

Loss of consciousness (either current or recent unconsciousness).

Vision problems.

Staggering or dizziness.

Drowsiness.

Mental confusion.

Slurred speech.

Convulsions, twitching.

Difficulty in breathing.

Paralysis.

When a head injury is present, always check the casualty's level of consciousness by using the AVPU system to evaluate the casualty.

A-alert

V-responds to verbal commands only

P-responds to pain only

U-unresponsive

Remember to reassess the casualty at frequent intervals.

If the casualty is conscious, does not have a severe head or spinal injury, and other injuries do not prohibit his sitting up, have the casualty sit up. The casualty should lean against a tree, wall, or other stable object, if possible.

If the casualty is conscious, does not have a severe head or spinal injury, is not accumulating drainage in his throat, and is not able to sit up, elevate his head slightly.

If the casualty is choking, nauseous, vomiting, or bleeding from his mouth, position the casualty on his side in order to promote drainage and to maintain an open airway. Place the casualty on the side opposite that of the wound (wound away from the ground).

If the casualty is having convulsions (involuntary muscle movements such as uncontrolled jerking or shaking), ease him to the ground and gently support his head and neck. Do not try to forcefully hold his arms and legs. Trying to "pin down" jerking limbs will probably cause additional injury. A casualty with convulsions presents a two-fold problem in that you must treat his injuries and you must also keep him from causing additional injury to himself.

Remove the casualty's headgear.

Remove a field dressing from its wrappers. (If a field dressing is not available, improvise a dressing and bandages from the cleanest materials available.)

Grasp a tail in each hand, hold the dressing directly over the wound with the white side of the dressing toward the wound, pull the dressing open, and place the white side of the dressing directly over the wound.

Place one hand on the dressing to keep it from slipping. (You may have the casualty hold the dressing in place if he is able.)

CAUTION: Apply the dressing and bandage so as to not interfere with the casualty's vision or hearing unless the eye or ear is injured.

Wrap one tail horizontally around the casualty's head and bring it back across the dressing. Angle the bandage so that it will cover the top or bottom edge of the dressing.

Wrap the second tail around the casualty's head in the opposite direction.

Bring the tail back across the dressing angled so it will cover the other edge (top or bottom) of the dressing.

Continue to wrap the bandage around the head again until it meets the first tail.

Tie the tails in a nonslip knot on the side of the head.

CAUTION: The bandages should be tight enough so the dressing will not slip but not tight enough to place undue pressure on the wound.

FIGURE 7-3. TYING TAILS ON THE SIDE OF THE HEAD

Tuck in any excess tails. Tucking in excess material will keep the tails from catching on an object or accidentally hitting the casualty in the eye.

Remove a field dressing from its wrappers.

Grasp a tail in each hand, hold the dressing directly over the wound with the white side of the dressing toward the wound, pull the dressing open, and place the white side of the dressing directly over the wound. (If a field dressing is not available, improvise a dressing and bandages from the cleanest materials available.)

Place one hand on top of the dressing to hold it in place.

Grasp the near tail with the other hand.

Bring the tail down in front of the ear, under the chin, up in front of the opposite ear, over the dressing, and to a point just above and in front of the first ear (about a one and one-fourth circle).

CAUTION: When passing a tail under the chin, make sure that the tail remains wide and close to the front of the chin. This will keep the bandage from choking the casualty.

Remove your hand from the dressing and grasp the other (free) tail.

Bring that tail down the opposite side of the face in front of the ear, under the chin, and up until it meets the first tail (about a three-fourths circle).

Cross the tails so that each makes a 90º turn. The cross should be made slightly above and in front of the ear.

Bring one tail across the casualty's forehead and above the eyebrows until it is in front of the opposite ear (about a half circle).

FIGURE 7-5. CROSSING THE TAILS (WOUND ON TOP OF HEAD)

Bring the other tail back above the ear, low behind the head at the base of the skull, and up to a point above and in front of the opposite ear (about a half circle) where it meets the first tail. (Bringing the tail across the base of the skull will keep the bandage from slipping.)

Tie the tails in a nonslip knot in front of and above the ear.

Tuck in the excess material from the tails.

CAUTION: Apply the dressing and bandage so as to not interfere with the casualty's vision or hearing unless the eye or ear is injured.

FIGURE 7-6. TYING THE TAILS (WOUND ON TOP OF HEAD)

Remove a field dressing from its wrappers.

Grasp a tail in each hand, hold the dressing directly over the wound with the white side of the dressing toward the wound, pull the dressing open, and place the white side of the dressing directly over the wound so that the tails are vertical. (If a field dressing is not available, improvise a dressing and bandages from the cleanest materials available.)

Place one hand on top of the dressing to hold it in place. If the casualty is able, you can have the casualty hold the dressing in place while you secure it.

Bring the top (uppermost) tail over the top of the head, down in front of the ear, under the chin, up the side of the face, and over the dressing to a point just above the ear (a full circle). Avoid covering the ear, if possible.

CAUTION: When passing a tail under the chin, make sure that the tail remains wide and close to the front of the chin. This will keep the bandage from choking the casualty.

CAUTION: Apply the dressing and bandage so as to not interfere with the casualty's vision or hearing unless the eye or ear is injured.

Bring the other (bottom) tail down, under the chin, up the side of the face, in front of the ear, and over the top of the head until it meets the first tail (almost a full circle).

FIGURE 7-7. BRINGING SECOND TAILAROUND TO MEET FIRST TAIL

Cross the two tails just above the ear on the injured side of the face.

Bring one tail across the forehead (above the eyebrows) to a point just in front of the opposite ear (the ear on the uninjured side of the face).

Bring the other tail above the ear, low behind the back of the head at the base of the skull, and above the other ear until it meets the first tail.

Tie the tails in a nonslip knot just above and in front of the ear on the uninjured side of the head. Tuck in the ends of the tails.

CAUTION: If fluid is coming from the casualty's ear, put a field dressing or clean cloth over the ear to protect the ear and absorb the drainage. Secure the dressing loosely, but tight enough to keep the dressing from slipping. Evacuate the casualty as soon as possible.

Position the casualty as described in paragraph 7-4.

A casualty with a serious head wound (brain tissue visible, fractured skull, deformity of the head, or fluid leaking from an ear) or who does not regain consciousness should be examined by medical personnel, evacuated to a medical treatment facility as soon as possible.

Any person with a head injury should be evaluated by medical personnel (medic, physician assistant, etc.) even if evacuation is not needed.

If you remain with the casualty, check his level of consciousness every 15 minutes. Use the AVPU system to evaluate. If the casualty falls asleep, wake the casualty to check his level of consciousness. Note any changes from earlier observations.

Do not give the casualty anything to eat or drink. Eating or drinking may cause him to vomit.

Do not apply a pressure dressing to a head wound. The dressing should be adequate to control the bleeding.

Treat for shock, if necessary.

Practice dressing a wound on a casualty's forehead, on his cheek, and on top of his head. Have someone check your performance against a performance checklist.