ENABLING LEARNING OBJECTIVE BAction: Conditions: Standards:
Evaluate a simulated casualty for life-threatening conditions. Given a written situation concerning a casualty with signs and/or symptoms of injury and possible responses. Identifies all injuries/conditions that require immediate first treatment and identifies the appropriate sequence in which the injuries/conditions should be treated based upon instruction given in Subcourse IS0871.
Learning Step / Activity 1. Evaluating a Casualty Method of instruction: Conference/Discussion/Demonstration Instructor to Student Ratio: 1:100 Time of Instruction: 2 hrs Media: A/V
1. INTRODUCTION NOTE: Show Slide # 1-2 WARNING: If there are any signs of nerve agent poisoning, stop the evaluation, take the necessary NBC protective measures, and then resume appropriate first aid measures. In this lesson, assume that NBC protective measures are not needed. This lesson briefly reviews some of the material covered previously and provides a framework for the lessons that follow. You must be familiar with the procedures for evaluating a casualty and know the correct sequence in which they are to be performed. 2. BEFORE APPROACHING THE CASUALTY NOTE: Show Slide # 3 Take the following actions before approaching the casualty on the battlefield. Remember to protect yourself. Scan the area for potential danger. (1) Survey the area for small arms fire. (2) Detect area for fire or explosive devices. (3) Determine threat for chemical or biological agents. (4) Survey buildings, if any, for structural stability. NOTE: Show Slide # 4 Determine the best route of access to the casualty and the best route of egress. Plan your evacuation route prior to exposing yourself to hostile fire. Request covering fire to reduce the risk to yourself and the casualty.
NOTE: Show Slide # 5 Anticipate the type of injuries the casualty may have received. Anticipate what care will probably be needed. Did the casualty fall from a wall (fractures)? Was there an explosion (blast effects)? Was there small arms fire (open chest wound)? Anticipate how your actions will affect the enemy's fire. Plan what you will do to help the casualty before you go to the casualty's aid. 3. APPROACH THE CASUALTY NOTE: Show Slide # 6 Remember, if you and the casualty are still under effective hostile fire, return fire as directed or required. Do not expose yourself to enemy fire in order to provide care. If possible, determine if casualty is alive or dead. Provide tactical care to the live casualty. NOTE: Show Slide # 7
(1) Suppress enemy fire. Reducing enemy fire may be more important to the casualty's survival than the treatment you can provide. (2) If the casualty can function, direct him to return fire, move to cover, and administer self-aid. (3) If the casualty is unable to return fire or move to safety and you cannot assist him, tell the casualty to play dead. NOTE: Show Slide # 8 When the combat situation allows you to safely assist the casualty: (1) Approach the casualty by the safest route. (2) Form a general impression as you approach the casualty (extent of injuries, chance of survival, and so forth). (3) If you decide to move the casualty (and yourself) to a safer location, take the casualty's weapon and other mission-essential equipment with you. 4. CHECK THE CASUALTY FOR RESPONSIVENESS NOTE: Show Slide # 9 Check the casualty for responsiveness. We have already covered most of this in Lesson 1. NOTE: CHECK ON LEARNING QUESTION: You are approaching a casualty who appears to be unconscious. What is the first thing you do? ANSWER: Ask in a loud, but calm, voice: Are you okay? Gently shake or tap the casualty on the
shoulder. QUESTION: You get no response. What should you do next? ANSWER: Determine level of consciousness by using AVPU system (A = Alert; V = responds to Voice; P = responds to Pain; U = Unresponsive). QUESTION: In the previous two questions, the casualty appeared to be unconscious. What would you have done differently if the casualty had been yelling at you to help him? ANSWER: The casualty has shown himself to be responsive and alert. You would not need to test for responsiveness and level of consciousness. NOTE: Show Slide # 10 If the casualty is conscious, ask where it hurts or where his body feels different than usual. This provides you information you can use in evaluating and treating the casualty. If the casualty is unconscious, position the casualty on his back and open his airway. If the casualty's tongue is blocking his airway, opening his airway may move his tongue forward, thus unblocking the airway and let the casualty resume breathing on his own. 5. POSITION THE CASUALTY ON HIS BACK NOTE: Show Slide # 11 You will need to position the casualty on his back so that you can properly evaluate him. To turn a casualty onto his back: DEMONSTRATION: Rolling a Casualty Onto his Back Have an assistant instructor (or student) lie chest down and act as a simulated unconscious casualty. Demonstrate the procedure for turning the casualty onto his back while protecting the casualty's head and neck. Explain the procedure as it is performed. Stress that you are taking precautions to protect the casualty's head, neck, and back in case he has a spinal injury. ALTERNATIVE: Have an assistant instructor perform the procedure on another assistant instructor while you explain what is being performed. Make sure all of the students can see. Ask the students if they have any questions about what they have just seen before continuing the lesson. NOTES TO INSTRUCTOR: The steps for turning a casualty onto his back are given below. (1) Kneel beside the casualty with your knees near his shoulders, leaving space to roll the body. (2) Raise the casualty's arm that is nearest to you above the casualty's head. (3) Adjust the casualtys legs so that they are together and straight or nearly straight. (4) Place one of your hands under the casualty's head and neck for support. (5) With your free hand, reach across the casualty's back and grasp the casualty under the arm (far armpit area).
(6) Pull steadily and evenly toward yourself, keeping the head and neck in line with the torso. (7) Once the casualty is rolled onto his back, place his arms at his sides. 6. CHECK THE CASUALTY FOR BREATHING NOTE: Show Slide # 12 Next, check the casualty for breathing. We will cover this in more detail in Lesson 3. If you suspect that the casualty has head or neck injuries, use the jaw thrust method to open his airway. Otherwise, use the head-tilt/chin-lift method. Then use the look, listen, and feel method to detect breathing. I will now demonstrate the head-tilt/chin-lift method now. Notice that I maintain the casualty's airway while I check his breathing using the look, listen, and feel method. DEMONSTRATION: Checking a Casualty for Breathing NOTE: Show Slide # 13 Use an appropriate manikin or assistant instructor as the simulated casualty. Position the casualty in the correct position (lying on back). Demonstrate the head-tilt/chin-lift procedure for opening the airway. Demonstrate the procedures for checking respiration. ALTERNATIVE: Have an assistant instructor perform the procedures on a manikin or another assistant instructor while you explain what is being performed. Explain what is being done as the procedure is performed. Make sure all of the students can see. Ask the students if they have any questions about what they have just seen before continuing the lesson. NOTES TO INSTRUCTOR: The steps for performing the head-tilt/chin-lift are given below. The steps for opening an airway are also given in Lesson 3. (1) Kneel at the level of the casualtys shoulders. (2) Place one of your hands on the casualtys forehead and apply firm, backward pressure with the palm of your hand to tilt the head back. (3) Place the fingertips of your other hand under the tip of the bony part of the casualtys lower jaw and bring the chin forward. (4) Lift the chin forward until the upper and lower teeth are almost brought together. The mouth should not be closed as this could interfere with breathing if the nasal passages are blocked or damaged. If needed, the thumb may be used to depress the casualty's lower lip slightly to keep his mouth open.
NOTE: Show Slide # 14 Check the casualty's mouth. Remove foreign material with your fingers. NOTES TO INSTRUCTOR: The steps for checking the casualty for breathing are given below. Be sure to maintain the head-tilt/chinlift while checking for breathing. (1) Place your ear about one inch above the casualtys mouth and look toward the chest. (2) Look to see if the casualty's chest rises and falls. (3) Listen for air escaping during exhalation. (4) Feel for the flow of air on the side of your face. The casualty is breathing. NOTE: CHECK ON LEARNING QUESTION: Is there something else I can do while I'm in this position? ANSWER: Determine the casualty's respiration rate. QUESTION: And how can I do that? ANSWER: Count his respirations for 15 seconds. Remember that a complete respiration includes both an inhalation and an exhalation. QUESTION: If the casualty goes INHALE-EXHALE-INHALE-EXHALE-INHALE during the 15 seconds, how many respirations occurred? ANSWER: Two. QUESTION: Why are we counting the casualty's respirations? ANSWER: If there are less than two respirations during the 15 seconds, a nasopharyngeal airway may be required. QUESTION: After checking for responsiveness, opening his airway, and checking for breathing, what is the next thing I should do? ANSWER: Expose the casualty's chest and check for open chest wounds. NOTE: Show Slide # 15 If the casualty has a penetrating chest wound and is breathing or making an effort to breathe, stop the evaluation and apply an occlusive dressing to the open chest wound. This procedure will be demonstrated in a later lesson (Lesson 3). If the casualty has a penetrating chest wound, is not breathing and is not making any effort to breathe, do not attempt to treat the injury. In a combat situation, if you find a casualty with no signs of life (no respiration and no pulse), do not continue first aid on the casualty. DEMONSTRATION: Checking the Casualty for Life Signs
NOTE: Show Slides # 16 thru 18 Use an appropriate manikin or assistant instructor as the simulated casualty. Position the casualty in the correct position (lying on back). Demonstrate the head-tilt/chin-lift procedure for opening the airway and checking respiration (find none). Demonstrate checking the casualty for open chest wound (find open chest wound) Demonstrate the procedures for checking carotid pulse (find none). ALTERNATIVE: Have an assistant instructor perform the procedures on a manikin or another assistant instructor while you explain what is being performed. Explain that the casualty cannot be saved without massive medical help, and even then the casualty may not survive. The casualty is beyond the ability of the combat lifesaver and other casualties may need his help. Make sure all of the students can see. Ask the students if they have any questions about what they have just seen before continuing the lesson. 7. CHECK THE CASUALTY FOR BLEEDING NOTE: Show Slide # 19 NOTE: CHECK ON LEARNING QUESTION: Suppose I have opened the casualty's airway, determined that the casualty is breathing adequately, and have treated any open chest wounds. What should I do now? ANSWER: Check for bleeding wounds. Look for blood-soaked clothes. Look for entry and exit wounds. DEMONSTRATION: Check the Casualty for Bleeding Use an assistant instructor (or student) as the simulated casualty. Position the casualty lying on his back. Demonstrate checking the casualty for bleeding wounds. ALTERNATIVE: Have an assistant instructor perform the procedures on another assistant instructor while you explain what is being performed. Explain what is being done as the procedure is performed. Make sure all of the students can see. Ask the students if they have any questions about what they have just seen before continuing the lesson. NOTES TO INSTRUCTOR: The steps for checking for bleeding are given below.
(1) Place your hands behind the casualtys neck and pass them upward toward the top of the head. Note whether there is blood or brain tissue on your hands from the casualtys wounds. (2) Place your hands behind the casualtys shoulders and pass them downward behind the back, the thighs, and the legs. Note whether there is blood on your hands from the casualtys wounds. If life-threatening bleeding from an extremity (arm or leg) is present, stop the evaluation and control the bleeding using a tourniquet or other means. This will be demonstrated in a later lesson (Lesson 5). 8. PROVIDE ADDITIONAL CARE NOTE: Show Slide # 20 Send a soldier to find a combat medic. Administer additional care as needed, such as administering an intravenous infusion (which will be demonstrated in Lesson 6). Monitor the casualty until the combat medic arrives or until you are told to resume your combat duties or until the casualty is evacuated. Reassure the casualty. Show confidence in your actions. If a combat medic arrives, provide assistance if your mission allows. NOTE: Show Slide # 21 If a medic does not arrive, you may need to fill out a Field Medical Card on the casualty and request a medical evacuation (called a MEDEVAC) or prepare a casualty to be transported to a collection point. You may need to act as leader of a litter team that carries the casualty to a collection point or ride with the casualty if he is moved using a non-medical vehicle, such as a HMMWV (High Mobility Multipurpose Wheeled Vehicle). The Field Medical Card, Medical Evacuation Request, and transportation will be covered in future lessons (Lessons, 7, 8, and 9). 9. REVIEW NOTE: Show Slide # 22 As discussed in Lesson 1, the three primary preventable causes of death from injury on the battlefield are: (1) Severe bleeding from an arm or leg wound (apply a tourniquet or emergency trauma dressing). (2) Collapsed lung (perform needle chest decompression). (3) Blockage of the nose and throat from an injury to the face (insert a nasopharyngeal airway). NOTE: Show Slide # 23 I want to remind you that there are circumstances in which you should not treat a casualty while you are under fire from the enemy. (1) Your own life is in imminent danger.
(2) There are other soldiers in your area who require treatment more urgently. (3) The casualty does not have vital (life) signs; that is, the casualty is not breathing, does not have a pulse, and is not moving. NOTE: Show Slide # 24 (4) The casualty's injury is not survivable without immediate evacuation to a medical treatment facility and such evacuation is not possible. Examples of such injuries are: (a) Penetrating head injuries with brain tissue exposed. (b) Severe burns covering a large part of the body. (c) Mutilating blast injuries. 10. CLOSING In this lesson, we have covered how to evaluate a casualty on the battlefield. Remember that you must take measures to protect yourself. Also remember that a severely wounded casualty may die regardless of what you do. In the following lessons, I will demonstrate procedures that can save the lives of casualties whose deaths can be prevented by restoring the airway, treating chest wounds, treating tension pneumothorax, controlling bleeding, and treating hypovolemic shock. You will be required to perform these life-saving procedures in order to pass the course. NOTE: Show Slide # 25 CHECK ON LEARNING: Conduct a check on learning and summarize the learning activity.