LESSON 3
EVALUATE A CASUALTY
(TASK 081-831-1000)
TASK:
Identify the first aid evaluation procedures performed on the battlefield and the sequence in which the are performed.
CONDITIONS:
Given multiple-choice examination items pertaining to evaluating and treating a casualty.
STANDARD:
Score 70 or more points on a 100-point comprehensive examination.
REFERENCES:
STP
21-1-SMCT, Soldier's Manual of Common Tasks: Skill Level 1.
FM
21-11, First Aid for Soldiers.
NOTE: Some of the task titles and information have changed and are not reflected in FM 21-11 and STP 21-1-SMCT. Refer to the Army Training Support Center, Common Core Task internet site at: http://www.atsc.army.mil/dld/comcor/comcore.htm for up-to-date task information.
Every soldier must know how to identify and treat certain life-threatening medical conditions. On the battlefield, the ability to quickly evaluate a person's condition and to take immediate corrective measures can mean the difference between life and death. When treating a casualty, you must identify and treat the most serious condition first. In general, you must make sure that the casualty is breathing, then control any major bleeding, and then take measures to control shock.
During the evaluating or treating process, you should seek medical aid as soon as possible. Do not stop the treatment, but if the situation allows, send another person to find medical aid.
Your evaluation must be adjusted to the situation. If the environmental conditions favor heatstroke, for example, you will check the casualty's breathing, then quickly check for other conditions while you begin treatment for heatstroke. If a soldier collapses during a battle, however, you will probably spend a good deal more time looking for entry and exit wounds.
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.
3-2. EVALUATE AND PERFORM NEEDED BUDDY-AID PROCEDURES
The following paragraphs give the steps normally used in evaluating a casualty and present the steps in an appropriate sequence.
Assume that you are in a combat situation and see a fellow soldier lying on the ground. Also assume that your mission will allow you to stop and give buddy-aid.
Quickly evaluate your immediate surroundings and the casualty for obvious, immediate, life-threatening hazards. Examples of such hazards include burning vehicles, explosion, enemy fire, flames from casualty's clothing, flames (burning chemicals) from casualty's skin, and electrical wires touching or very near the casualty.
If there are any signs of chemical or biological agent poisoning, immediately mask the casualty. If the casualty appears to have chemical agent poisoning other than nerve agent poisoning, get medical help immediately and decontaminate exposed skin and gross contamination (large wet or oily spots) of the clothing or overgarments.
If it is nerve agent poisoning, administer the antidote before decontamination (Lesson 4, Perform First Aid for a Nerve Agent Injury).
If you and the casualty are in a relatively safe location and the casualty is not being burned, continue your evaluation.
If the casualty is being burned, eliminate the source of the burn ( Lesson 13, Perform First Aid for Burns). Take care to prevent being injured yourself, especially if removing an electrical wire.
If an immediate, life-threatening hazard (such as a burning building) is present, remove the casualty to a place of safety using an appropriate carry (Lesson 16, Transport a Casualty). Then continue your evaluation.
3-4. CHECK CASUALTY FOR RESPONSIVENESS
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, 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 someone to get medical help (usually a combat medic) and continue your evaluation.
3-5. CHECK CASUALTY FOR BREATHING DIFFICULTIES
If the casualty is responsive, evaluate him for airway obstruction (universal choking sign, difficulty in breathing).
If the casualty has good exchange, continue your evaluation.
If the casualty has poor or no air exchange, expel the obstruction (Lesson 5, Perform First Aid to Clear an Object Stuck in the Throat of a Conscious Casualty) and continue your evaluation.
If the casualty is not responsive (unconscious), evaluate his respirations by:
(1) Looking for rise and fall of the casualty's chest.
(2) Listening for breathing by placing your ear about one inch above the casualty's mouth and nose.
(3) Feeling for breathing by placing your hand or cheek about one inch above the casualty's mouth and nose.
If the casualty has good air exchange, continue your evaluation.
If the casualty is not breathing, open his airway and perform mouth-to-mouth resuscitation ( Lesson 6, Perform Mouth-To-Mouth Resuscitation). [NOTE: Mouth-to-mouth (or mouth-to-nose) resuscitation is not performed in a chemical environment.]
If the casualty has no pulse after initiating mouth-to-mouth (or mouth-to-nose) resuscitation, seek medical aid immediately.
If the casualty resumes breathing, continue your evaluation.
Check the casualty for bloody clothing, pools of blood, spurts of blood, entry and exit wounds, etc.
If there is no serious bleeding, continue the evaluation.
If bleeding is present, stop the evaluation and begin treatment as appropriate.
| CAUTION: | Do not turn the casualty onto his back or move his head or trunk until you have checked for a back or neck injury. |
Some features of shock are the following:
Check the casualty for clammy skin, pale or blotchy skin, bluish skin (especially around the mouth), nausea and/or vomiting, severe loss of blood, increased breathing rate, unusual thirst, restlessness, and mental confusion.
If shock is not present, continue your evaluation.
If shock is present, stop the evaluation and begin treatment (Lesson 11, "Perform First Aid to Prevent or Control Shock"). Splint leg fractures before elevating the legs as a treatment for shock (Lesson 12, "perform First Aid for a Suspected Fracture").
| UNLESS THERE IS IMMEDIATE LIFE-THREATENING DANGER, DO NOT MOVE A CASUALTY WHO HAS A SUSPECTED BACK OR NECK INJURY. | |
Check for cuts and bruises in and around the neck and back area, paralysis or numbness, pain or tenderness around the spinal column, severe head injury (deformed skull or visible brain tissue or skull fragments), and unusual positioning of the head, neck, and/or back.
If no spinal injury is suspected, continue your evaluation.
If a neck or back injury is suspected, immobilize the casualty by doing the following:
(1) Tell the casualty not to move.
(2) For a back injury, place padding under the natural arch of the casualty's back. Roll or fold the padding to conform to the shape of the arch.
(3) For a neck injury, place a roll of cloth under the casualty's neck and immobilize the neck by putting boots (filled with dirt, sand, etc.) on both sides of the head. Rocks can be used, if necessary, on the sides of the casualty's head provided they are padded.
After immobilizing the casualty, check his arms and legs for open or closed fractures.
An open fracture is a broken bone that breaks (pierces) the overlying skin.
(1) Look for bleeding.
(2) Look for bone sticking through the skin.
(3) Ask a conscious casualty to tell you where there is pain or tenderness or which areas cannot be moved.
A closed fracture is a broken bone that does not break the overlying skin. Look for:
(a) Swelling.
(b) Discoloration.
(c) Deformity.
(d) Unusual body position.
(e) Presence, quality, and rate of distal pulses beyond the suspected fracture site.
If no fracture or massive wound is found, continue your evaluation.
If a fracture is found, perform first aid for the fracture (Lesson 12, Perform First Aid for a Suspected Fracture).
Burns often cause extreme pain, scarring, or even death. Proper treatment will minimize further injury.
The source of the burn (electricity, etc.) must be eliminated before any evaluation or treatment of the casualty can occur.
Checking for burns involves checking for singed clothing, and for reddened, blistered, or charred skin.
If no burns are found, continue your evaluation.
If burns are found, stop the evaluation and begin treatment (Lesson13, Perform First Aid for Burns).
If the casualty has been working in a hot environment or has been working hard, check for signs and symptoms of heat cramps (painful contractions of the limbs or abdomen and heavy perspiration), heat exhaustion (heavy perspiration, pale and clammy skin, weakness or faintness, and dizziness), and heatstroke (little or no perspiration, hot and flushed skin, nausea, mental confusion, convulsions, and possible unconsciousness).
If no heat injury is present, continue your evaluation.
If the casualty has a heat injury begin first aid for the injury (Lesson 14, Perform First Aid for a Heat Injury).
If the casualty has been exposed to freezing weather, check for blanched skin, yellowish or waxy-looking skin, numb areas, and frozen (solid feeling) tissue.
If no cold injury is present, continue your evaluation.
If a cold injury is found begin first aid for a cold injury (Lesson 15, Perform First Aid for Cold Injuries).
Usually, serious skull fractures and brain injuries occur together; however, it is possible to receive a serious brain injury without a skull fracture. The brain is a very delicate organ. When it is injured, the casualty may exhibit a number of signs and/or symptoms.
Check the casualty for unequal pupils, fluid leaking from the ears or nose, mental confusion (cannot tell you the date when asked, etc.), slurred speech, recent unconsciousness, loss of memory, dizziness or difficulty in walking, nausea, sleepiness, and twitching or convulsions.
If no head injury is found, continue your evaluation.
If the casualty has a suspected concussion, position the casualty in a sitting position, on his side, or on his stomach with his head turned to one side.
If the casualty is having convulsions, support his head and neck and maintain an open airway.
Have a casualty with a closed head injury evaluated by medical personnel even if the casualty seems to recover.
Continue to watch for signs that would require: performance of mouth-to-mouth resuscitation ( Lesson 6, Perform Mouth-to-Mouth Resuscitation), treatment for shock ( Lesson 11, Perform First Aid To Prevent or Control Shock), or control of bleeding ( Lesson 7, Perform First Aid for Bleeding of an Extremity).
If the casualty has an open head wound, begin first aid for a head wound (Lesson 10, Perform First Aid for an Open Head Wound).
If the military situation requires the soldier to stay on duty if able and his injuries permit him to do so, have him seek medical care (usually the combat medic) when practical.
When the situation permits, you should seek medical aid for the soldier as soon as possible. Do not interrupt treatment. If possible, send a second person to find medical aid. If no one else is available to seek medical aid, you may need to carry the casualty (litter or manual carry) to a location where he can receive medical care after first aid is given.
A casualty must be monitored throughout the evaluation process for life-threatening conditions. For example, a casualty who is breathing when you begin your check 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, you must 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.
At times, you may complete your evaluation and buddy-aid treatment and be waiting until the casualty can be safely evacuated. Continue to check his breathing and take proper measures should his airway need to be opened and/or he needs mouth-to-mouth resuscitation.
Whenever possible, have the casualty evaluated by a combat medic or other qualified medical personnel.