US Navy Course NAVEDTRA 13119 - Standard First Aid Course

8/14/2019 US Navy Course NAVEDTRA 13119 - Standard First Aid Course

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Virtual Naval Hospital - Standard First Aid Course: NAVEDTRA 13119

STANDARD FIRST AID COURSENAVEDTRA 13119

Department of the Navy

Bureau of Medicine and Surgery

2300 E Street, NW

Washington, DC 20372-5300

Peer Review Status: Internally Peer Reviewed

Creation Date: Unknown

Last Revision Date: Unknown

able of Contents

q Chapter One-Introduction

q Chapter Two-Basic Life Support

q Chapter Three-Bleeding

q

Chapter Four-Shockq Chapter Five-Soft Tissue Injuries

q Chapter Six-Bones, Joints, and Muscles

q Chapter Seven-Environmental Injuries

q Chapter Eight-Chemical, Biological, and Radiological Casualties

q Chapter Nine-Poisoning

q Chapter Ten-Medical Injuries

q Chapter Eleven-Rescue and Transportation

q Chapter Twelve-Health Education

q Appendix

eceive Correspondence Course Credit for this Course from NSHS Portsmouth

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Virtual Naval Hospital - Standard First Aid Course: NAVEDTRA 13119

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Virtual Naval Hospital: Standard First Aid Course - Chapter One - Introduction

AVEDTRA 13119 Standard First Aid Course - Chapter One - Introduction

An Introduction to First Aid

epartment of the Navy

ureau of Medicine and Surgery

er Review Status: Internally Peer Reviewed

rst aid is the emergency care and treatment of a sick or injured person before professional medicalrvices are obtained. FIRST AID MEASURES ARE NOT MEANT TO REPLACE PROPER

EDICAL DIAGNOSIS AND TREATMENT, but will only consist of providing temporary suppo

ntil professional medical assistance is available. The purposes of first aid are (1) to save life, (2) pre

rther injury, and (3) to minimize or prevent infection.

veryone in the Navy must know how and when to render first aid and be prepared to provide compe

sistance to the sick and injured in all circumstances. The knowledge of first aid, when properly app

n mean the difference between temporary or permanent injury, rapid recovery or long-term disabil

d the difference between life and death.

hile administering first aid, the three primary objectives are (1) to maintain an open airway, (2)

aintain breathing, and (3) to maintain circulation. During this process you will also control bleeding

d reduce or prevent shock.

ou must respond rapidly, stay calm, and think before you act. Do not waste time looking for ready-

ade materials, do the best you can with what is at hand. Request professional medical assistance as

on as possible.

itial Assessment

hen responding to a casualty, take a few seconds to quickly inspect the area. Remain calm as you t

arge of the situation, and act quickly but efficiently. Decide as soon as possible what has to be don

d which one of the injuries needs attention first. During your initial assessment, consider the follow

Safety - Determine if the area is safe. If the situation is such that you or the casualty is in danger, y

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ust consider this threat against the possible damage caused by early movement. If you decide to mo

e casualty, do it quickly and gently to a safe area where proper first aid can be given. You cannot h

e casualty if you become one yourself.

Mechanism of injury - Determine the extent of the illness or injury and how it happened. If the

sualty is unconscious, look for clues. If the casualty is lying at the bottom of a ladder, suspect that

she fell and may have internal injuries.

Medical information devices - Examine the casualty for a MEDIC ALERT (Fig. 1-1) necklace,

acelet, or identification card. This medical tag, provides medical conditions, medications being tak

d allergies about the casualty. The VIAL OF LIFE, a small, prescription-type bottle, also contains

edical information concerning the casualty. This bottle is normally located in the refrigerator.

Number of casualties - Look beyond the first casualty, you may find others. One casualty may be

ert, while another, more serious or unconscious, is unnoticed. In a situation with more than one cas

mit your assessment to looking for an open airway, breathing, bleeding, and circulation, the life-

reatening conditions.

Bystanders - Ask bystanders to help you find out what happened. Though not trained in first aid,

ystanders can help by calling for professional medical assistance, providing emotional support to th

sualty, and keeping onlookers from getting in the way.

gure 1-1-Medic Alert Symbol

Introduce yourself- Inform the casualty and bystanders who you are and that you know first aid.

ior to rendering first aid, obtain the casualties consent by asking is it "OK' to help them. Consent is

mplied if the casualty is unconscious or cannot reply.

eneral Rules



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very illness or injury presents with its own individual problems. Prior to learning first aid for a spec

ness or injury, you must have a complete understanding of the following:

Keep the casualty lying down, head level with the body, until you determine the extent and serious

the illness or injury. You must immediately recognize if the casualty has one of the following

nditions that represent an exception to the above.

a. Vomiting or bleeding around the mouth - If the casualty is vomiting or bleeding around the

mouth, place them on their side, or back with head turned to the side. Special care must be ta

for a casualty with a suspected neck or back injury.

b. Difficulty breathing - If the casualty has a chest injury or difficulty breathing place them in

sitting or semi-sitting position.

c. Shock - To reduce or prevent shock, place the casualty on his or her back, with their legs

elevated 6 to 12 inches. If you suspect head or neck injuries or are unsure of the casualty'

condition, keep them lying flat and wait for professional medical assistance.

During your examination, move the casualty no more than is necessary. Loosen restrictive clothing

e neck, waist, and where it binds. Carefully remove only enough clothing to get a clear idea of the

tent of the injuries. When necessary, cut clothing along its seams. Ensure the casualty does not bec

illed, and keep them as comfortable as possible. Inform the casualty of what you are doing and wh

espect the casualty's modesty, but do not jeopardize quality care. Shoes may have to be cut off to av

using pain or further injury.

Reassure the casualty that his or her injuries are understood and that professional medical assistanc

ill arrive as soon as possible. The casualty can tolerate pain and discomfort better if they are confidyour abilities.

Do not touch open wounds or burns with your fingers or un-sterile objects unless it is absolutely

cessary. Place a barrier between you and the casualty's blood or body fluids, using plastic wr

oves, or a clean, folded cloth. Wash your hands with soap and warm water immediately after

oviding care, even if you wore gloves or used another barrier.

Do not give the casualty anything to eat or drink because it may cause vomiting, and because o

ossible need for surgery. If the casualty complains of thirst, wet his or her lips with a wet towel.

Splint all suspected, broken or dislocated bones in the position in which they are found. Do not

tempt to straighten broken or dislocated bones because of the high risk of causing further injury

ot move the casualty if you do not have to.

When transporting, carry the casualty feet first. This enables the rear bearer to observe the casualt

y complications.



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Keep the casualty comfortable and warm enough to maintain normal body temperature.

fectious Diseases

ou will probably render first aid to someone you know - a shipmate or family member. For this rea

ou will probably know your risk of contracting an infectious disease. Adopt practices that discourag

e spread of blood-borne diseases (Hepatitis and HIV) and air-borne diseases such as influenza wherforming first aid.

Wear gloves or use another barrier.

Wash your hands with soap and warm water immediately.

When possible, use a pocket mask or mouthpiece during rescue breathing.

he risk of contracting infections from a casualty is very remote. Do not withhold rendering first aid

cause of this rare possibility.

eferences

Karren, K. J. and Hafen, B. Q.: First Responder A Skills Approach, edition 3, Morton Publishing

ompany

American Red Cross Standard First Aid Workbook, edition 1991, American Red Cross

NAVEDTRA 10670-C, Hospital Corpsman 1 & C

NAVEDTRA 10669-C, Hospital Corpsman 3 & 2

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Virtual Naval Hospital: Standard First Aid Course - Chapter One - Basic Life Support

AVEDTRA 13119 Standard First Aid Course - Chapter Two - Basic Life Support

Basic Life Support




tmospheric air that is essential for life contains approximately 21% oxygen. When you breathe innhale) only a quarter of the air is taken by the blood in the lungs. The air you breath out (exhale)

ntains approximately 16% oxygen. Enough to support life! Seconds after being deprived of oxygen

e heart is at risk of developing irregular beats or stopping. Within four to six minutes, the brain is

bject to irreversible damage.

asic life support is maintenance of the ABCs (airway, breathing, and circulation) without auxiliary

uipment. The primary importance is placed on establishing and maintaining an adequate open airw

irway obstruction alone may be the emergency: a shipmate begins choking on a piece of food. Rest

reathing to reverse respiratory arrest (stopped breathing) commonly caused by electric shock,owning, head injuries, and allergic reactions. Restore circulation to keep blood circulating and

rrying oxygen to the heart, lungs, brain, and body. This course is not a substitute for formal trai

basic life support.

irway Obstruction

irway obstruction, also known as choking, occurs when the airway (route for passage of air into and

the lungs) becomes blocked. The restoration of breathing takes precedence over all other

easures.. The reason for this is simple: If a casualty cannot breathe, he or she cannot live. Individuho are choking may stop breathing and become unconscious. The universally recognized distress si

ig. 2-1) for choking is the casualty clutching at his or her throat with one or both hands. The most

mmon causes of airway obstruction are swallowing large pieces of improperly chewed food, drink

cohol before or during meals, and laughing while eating. The tongue is the most common cause of

bstruction in the casualty who is unconscious. A foreign body can cause a partial or complete airwa

bstruction.

artial Airway Obstruction



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the casualty can cough forcefully, and is able to speak, there is good air exchange. Encourage him

r to continue coughing in an attempt to dislodge the object. Do not interfere with the casualty's effo

remove the obstruction. First aid for a partial airway obstruction is limited to encouragement and

bservation. When good air exchange progresses to poor air exchange, demonstrated by a weak or

effective cough, a high-pitched noise when inhaling, and a bluish discoloration (cyanosis) of the sk

round the finger nails and lips), treat as a complete airway obstruction.

omplete Airway Obstruction

complete airway obstruction presents with a completely blocked airway, and an inability to speak,

ugh, or breathe. If the casualty is conscious, he or she may display the universal distress signal. As

Are YOU choking?" If the casualty is choking, do the following:

Shout "Help"-Ask the casualty if you can help.

Request medical assistance - Say "Airway is obstructed" (blocked), call (Local emergency numb

edical personnel).

gure 2-1 Universal Distress Signal



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gure 2-2 Abdominal Thrust

Abdominal thrusts (Heimlich Maneuver)

a. Stand behind the casualty.

b. Place your arms around the (Fig. 2-2) casualties waist.

c. With your fist, place the thumb side against the middle of the abdomen, above the navel anbelow the tip (xiphoid process) of the (sternum) breastbone.

d. Grasp your fist with your other hand.

e. Keeping your elbows out, press your fist (Fig. 2-3) into the abdomen with a quick upward

thrust.

f. Repeat until the obstruction is clear or the casualty becomes unconscious.

the casualty becomes unconscious, do the following:



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gure 2-3 Abdominal Thrust

gure 2-4 Head Tilt-Chin Lift

Finger sweep - Place the casualty on his or her back, open casualty's mouth and grasp the tongue

wer jaw between your thumb and fingers, lift jaw with your index finger into the mouth along insid

eek to base of tongue. Use "hooking" motion to dislodge object for removal.

Open airway (Head-tilt/Chin-lift) -Place your hand on the casualty's forehead. Place the fingers o

our other hand under the (Fig. 2-4) bony part of the chin. Avoid putting pressure under the chin, it muse an obstruction of the airway. Tilt the head and lift the jaw, avoid closing the casualty's mouth.

ace your ear over the casualty's mouth and nose. Look at the chest, listen and feel for breathing, 3 t

conds. If not breathing, say, "Not Breathing."

aw-thrust maneuver) - If you suspect the casualty may have an injury to the head, neck, or back, yo

ust minimize movement of the casualty when opening the airway. Kneeling at the top of the casual

ad, place your elbows on the surface. Place your fingers behind the angle of the jaw or hook your

ngers under the jaw, bring (Fig. 2-5) jaw forward. Separate the lips with your thumbs to allow breat



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rough the mouth. Note that the head is not tilted and the neck is not extended.

gure 2-5 Jaw Thrust

Give breaths - Pinch nose, open your mouth, take a deep breath, and make an air-tight seal around

sualty's mouth. Give 2 full breaths, each lasting 1 to 1 1/2 seconds. Pause between each breath. If

nsuccessful, perform abdominal thrusts.

Perform abdominal thrusts

a. Straddle the casualty's thighs.

b. Place the heel of your hand against the middle of the abdomen, above the navel and below

tip of the breastbone.

c. Place your other hand directly on top of the first (Fingers should point towards the casualty

head).

d. Press abdomen 6 to 10 times (Fig. 2-6) with quick upward thrusts.

Continue steps 4 to 7 -Until successful, you are exhausted, you are relieved by another trained

dividual, or by medical personnel.

the casualty is found unconscious, do the following:

Check unresponsiveness - Tap or gently shake the casualty, shout, "Are you OK?"

Shout, "Help" - If there is no response from casualty.

Position casualty - Kneel midway between his or her hips and shoulders facing casualty. Straighte

gs, and move arm closest to you above casualty's head. Place your hand on the casualty's shoulder a

ne on the hip. Roll casualty toward you as a unit, move your hand from the shoulder to support the b

the head and neck. Place the casualty's arm nearest you alongside his or her body.



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gure 2-6 Abdominal Thrust Reclining

Open airway (Head-tilt/Chin-lift or Jaw-thrust) - Place your hand on the casualty's forehead. Plac

ngers of your other hand under the bony part of the chin. Avoid putting pressure under the chin, it m

use an obstruction of the airway. Tilt the head and lift the jaw, avoid closing casualty's mouth. Plac

our ear over the casualty's mouth and nose. Look at the chest, listen, and feel for breathing, 3 to 5

conds. If not breathing, say, "Not Breathing."


sualty's mouth. Give 2 full breaths, each lasting 1 to 1 1/2 seconds. Pause between each breath. If

nsuccessful, reposition head, and give 2 full breaths.

Request medical assistance - Say "Airway is obstructed" (blocked), call local emergency number

edical personnel.

Perform abdominal thrusts

a. Straddle the casualty's thighs.

b. Place the heel of your hand against the middle of the abdomen, above the navel and below

tip of the breastbone.

c. Place your other hand directly on top of the first (fingers should point towards the casualty'head).

d. Press abdomen 6 to 10 times with quick upward thrusts.

Finger sweep - Place the casualty on his or her back, open the casualty's mouth and grasp the tong

d lower jaw between your thumb and fingers, lift jaw, insert your index finger into the mouth alon

side of cheek to base of tongue. Use "hooking" motion to dislodge object for removal.




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sualty's mouth. Give 2 full breaths, each lasting 1 to 1 1/2 seconds. Pause between each breath.

0. Continue steps 7 to 9 - Until successful, you are exhausted, you are relieved by another trained

dividual, or by medical personnel.

hest Thrusts

he chest thrust is the preferred method, in place of the abdominal thrust, for individuals who are

verweight or pregnant. Manual pressure to the abdominal area in these individuals can be ineffectiv

use serious damage. If the casualty is overweight or pregnant, do the following:

Conscious - Standing or Sitting.

a. Stand behind the casualty.

b. Place your arms under the casualty's armpits and around the chest.

c. With your fist, place the thumb side against the middle of the breastbone.

d. Grasp your fist with your other hand.

e. Press your fist against the chest with a sharp, backward thrust until the obstruction is clear o

casualty becomes unconscious.

Unconscious - Lying.

a. Kneel, facing the casualty's chest.

b. With the middle and index fingers of the hand nearest the casualty's legs, locate the lower e

of the rib cage on the side closest to you.c. Slide your fingers up the rib cage to the notch at t

d. Place your middle finger on the notch, and your index finger next to it.

e. Place the heel of your hand on the breastbone next to the index finger.

f. Place the heel of your hand, used to locate the notch, on top of the heel of your other hand.

g. Keep your fingers off the casualty's chest.

h. Position your shoulders over your hands, with elbows locked and arms straight.

i. Give 6 to 10 quick and distinct downward thrusts, each should compress the chest 1 1/2 to 2

inches.

j. Finger sweep.

k. Open the airway and give 2 full breaths.

epeat the last three steps until the obstruction is clear, you are exhausted, you are relieved by anoth

ained individual, or by medical personnel.

elf Abdominal Thrusts

you are alone and choking, try not to panic, you can perform an abdominal thrust (Fig. 2-7) on you



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y doing the following:

With the fist of your hand, place the thumb side against the middle of your abdomen, above the na

d below the tip of the breastbone. Grasp your fist with your other hand and give a quick upward th

You also can lean forward and press your abdomen over the back of a chair (with rounded edge), a

iling, or a sink.

gure 2-7 Self-Help for Airway Obstruction

the casualty is not breathing, do the following:

escue Breathing

escue breathing is the process of breathing air into the lungs of a casualty who has stopped breathin

espiratory arrest), also known as artificial respiration. The common causes are air-way obstruction,

owning, electric shock, drug overdose, and chest or lung (trauma) injury. Never give rescue breat

a person who is breathing normally.

Check unresponsiveness - Tap or gently shake the casualty, shout, "Are you OK?"

Shout, "Help" - If there is no response from casualty.

Position casualty - Kneel midway between his or her hips and shoulders facing the casualty.

raighten legs and move arm closest to you above casualty's head. Place your hand on the casualty's



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oulder and one on the hip. Roll casualty toward you as a unit, move your hand from the shoulder to

pport the back of the head and neck. Place the casualty's arm nearest you alongside his/her body.

Open airway (Head-tilt/Chin lift or Jaw thrust) - Place your hand on the casualty's forehead. Place


use an obstruction of the airway. Tilt the head and lift the jaw, avoid closing the casualty's mouth.

ace your ear over the casualty's mouth and nose. Look at the chest, listen, and feel for breathing, 3

conds. If not breathing, say, "Not breathing."


sualty's mouth (Fig. 2-8). Give 2 full breaths, each lasting 1 to 1 1/2 seconds. Pause between each

eath. Look for the chest to rise, listen, and feel for breathing.

Check pulse - While maintaining an open airway, locate the Adam's apple with your middle and i

ngers. Slide your fingers down into the groove (Fig. 2-9), on the side closest to you. Feel for a carot

ulse for 5 to 10 seconds. If you feel a pulse, say, "No breathing, but there is a pulse." Quickly exam

e casualty for signs of bleeding.

gure 2-8 Mouth-to-Mouth Ventilation



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gure 2-9 Check Carotid Pulse

Request medical assistance - Say "No breathing, has a pulse," call (Local emergency number or

edical personnel).

Rescue breathing (mouth-to-mouth) Maintain an open airway with head-tilt/chin-lift or jaw-thrus

aneuver, pinch nose. Open your mouth, take a deep breath, and make an air-tight seal around the

sualty's mouth. Give 1 breath every 5 seconds, each lasting 1 to 1 1/2 seconds. Count aloud "one o

ousand, two one-thousand, three one-thousand, four one-thousand," take a breath, and then give a

eath. Look at the chest, listen, and feel for breathing. Continue for 1 minute/12 breaths.

Recheck pulse - While maintaining an open airway, locate and feel the carotid pulse for 5 seconds

ou feel a pulse, say, "Has pulse." Look at the chest, listen, and feel for breathing 3 to 5 seconds. If th

sualty is not breathing, say, "No breathing."

0. Continue sequence - Maintain an open airway, give 1 breath every 5 seconds, recheck pulse eveinute. If pulse is absent, begin CPR. If pulse is present but breathing is absent, continue rescue

eathing. If the casualty begins to breathe, maintain an open airway, until medical assistance arrives

pecial Situations

Air in the stomach (Gastric Distention) - During rescue breathing and CPR, air may enter the

omach in addition to the lungs. To avoid this, keep the casualty's head tilted back, breathe only eno

make the chest rise, and do not give breaths too fast. Do not attempt to expel stomach contents b

ressing on the abdomen.

Mouth-to-nose breathing - Used when the casualty has mouth or jaw injuries, is bleeding from th

outh, or your mouth is too small to make an air-tight seal. Maintain head tilt with your hand on the

rehead, use your other hand to seal the casualty's mouth and lift the chin. Take a deep breath and se

our mouth around the casualty's nose and slowly breathe into the casualty's nose using the procedur

r mouth-to-mouth breathing.

Mouth-to-stoma breathing - Used when the casualty has had surgery to remove part of the windp

hey breathe through an opening in the front of the neck, called a stoma. Cover the casualty's mouth our hand, take a deep breath, and seal your mouth over the stoma and slowly breathe using the

ocedures for mouth-to-mouth breathing. Do not tilt the head back. (In some situations a person m

eathe through the stoma as well as his or her nose and mouth. If the casualty's chest does not rise, y

ould cover his or her mouth and nose and continue breathing through the stoma).

Mouth-to-mask breathing - Used when rescue breathing is required in a contaminated environm

ch as after a chemical or biological attack. A resuscitation tube is used to deliver uncontaminated a

e casualty. This resuscitation tube has an adapter at one end that attaches to your mask and a molde



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bber mouthpiece at the other end for the mouth of the casualty.

Dentures - Leave dentures in place, they provide support to the mouth and cheeks during rescue

eathing. If they become loose and block the airway or make it difficult to give breaths, remove them

irculation

rculation is the movement of blood through the heart and blood vessels. The circulatory system

nsists of the heart, which pumps the blood, and the blood vessels, which carry the blood throughou

ody.

ardiac arrest is the failure of the heart to produce a useful blood flow or the heart has completely

opped beating. The signs of cardiac arrest include unconsciousness, the absence of a pulse, and the

sence of breathing. If the casualty is to survive, immediate action must be taken to restore breathin

d circulation.

ardiopulmonary Resuscitation (CPR) is an emergency procedure for the casualty who is not breathi

d whose heart has stopped beating (cardiac arrest). The procedure involves a combination of chest

mpressions and rescue breathing. The casualty must be lying face up on a firm surface. Do not assu

at a cardiac arrest has occurred simply because the casualty appears to be unconscious. This cours

ot a substitute for formal training in cardiopulmonary resuscitation (CPR).



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gure 2-11 Xiphoid Process

hest Compressions

a. Kneel, facing the casualty's chest.

b. With your middle and index fingers (Fig. 2-11) of the hand nearest the casualty's legs, locat

the lower edge of the rib cage on the side closest to you.

c. Slide your fingers up the rib cage to the notch at the end of the breastbone.d. Place your middle finger on the notch, and your index finger next to it.

e. Place the heel of your other hand on the breastbone next to your index finger.

f. Place the heel of the hand used to locate the notch on top of the heel of your other hand.

g. Keep your fingers (Fig 2-12) off the casualty's chest.



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Figure 2-12 Interlocking fingers to help keep fingers off the chest wall

h. Position shoulders over your hands, with elbows locked and arms straight.

i. Give 15 compressions, each should compress the chest 1 1/2 to 2 inches at a rate of 80 to 10

compressions per minute. Count aloud, "One and two and three," until you reach 15. After eac

15 compressions, deliver 2 full breaths. Compressions should be smooth, rhythmic, anduninterrupted.

j. Continue 4 complete cycles of 15 compressions and 2 breaths. Check for a carotid pulse and

breathing for 5 seconds.

ontinue CPR - If the casualty has no pulse, give 2 full breaths and continue CPR. Check for a puls

ery few minutes. If the pulse is present but breathing is absent, continue rescue breathing. If the

sualty begins to breathe, maintain an open airway until medical assistance arrives. Continue CPR u

ccessful, you are exhausted, you are relieved by another trained in CPR, by medical personnel, or t

sualty is pronounced dead. Do not interrupt CPR for more than 7 seconds except for specialrcumstances.

PR with Entry of Second Person

hen a second person who is trained in administering CPR arrives at the scene, do the following:

The second person shall identify himself or herself as being trained in CPR and that they are willin

lp. ("I know CPR. Can I help?")

The second person should call the local emergency number or medical personnel for assistance if i

ot already been done.

The person doing CPR will indicate when he or she is tired; and should stop CPR after the next 2 f

eaths.

The second person should kneel next to the casualty opposite the first person, tilt the casualty's hea



21/175


ck, and check for a carotid pulse for 5 seconds.

If there is no pulse, the second rescuer should give 2 full breaths and continue CPR.

The first person will monitor the effectiveness of CPR by looking for the chest to rise during rescu

eathing and feeling for a carotid pulse (artificial pulse) during chest compressions.

PR for Children and Infants

the casualty is an infant (0-1 year old) or child (1-8 years old), do the following:

Check unresponsiveness - Infant: Tap or shake shoulder only. Child: Tap or gently shake the

oulder, shout, "Are you OK?"

Shout, "Help" - If there is no response from infant or child.

Position casualty - Turn casualty on back as a unit, supporting, the head and neck. Place casualty

rm surface.

Open airway (Head-tilt/Chin-lift or jaw thrust) - Place your hand on the casualty's forehead. Place


use an obstruction of the airway. Tilt the head and lift the jaw, avoid closing the casualty's mouth.

fant: Do not overextend the head and neck. Place your ear over the casualty's mouth and nose. Loo

e chest, listen, and feel for breathing, 3 to 5 seconds.

Give breaths - Open your mouth, take a breath, and make an air-tight seal around the casualty's m

d nose. Give 2 breaths (puffs for infants), each lasting 1 to 1 1/2 seconds. Pause between each brea

ook for the chest to rise, listen, and feel for breathing.

Check pulse - While maintaining an open airway, locate the carotid pulse (Infants: Locate the bra

ulse (Fig. 2-13) on the inside of the upper arm, between the elbow and shoulder). Feel for a pulse fo

10 seconds. Quickly examine the casualty for signs of bleeding.

Request medical assistance - If someone responded to your call for help, send them to call the locmergency number or medical personnel.

Chest compressions (infant) -

a. Face infant's chest.

b. Place your middle and index fingers on the breastbone at the nipple line.

c. Give 5 compressions, each should compress the chest 1/2 to 1 inch at a rate of at least 100



22/175


compressions per minute. After each 5th compression, deliver 1 breath. Compressions should

smooth, rhythmic, and uninterrupted.

d. Continue for 10 complete cycles of 5 compressions and 1 breath. Check for a brachial pulse

5 seconds.

Chest compressions (children) -

a. Face child's chest.b. With your middle and index fingers of the hand nearest the child's legs, locate the lower ed

the rib cage on the side closest to you.

c. Slide your fingers up the rib cage to the notch at end of the breastbone.

Figure 2-13 Check Infant's Pulse

d. Place your middle finger on the notch, and your index finger next to it.

e. While looking at the position of your index finger, lift that hand and place your heel (on

breastbone at nipple line) next to where your index finger was.

f. Keep your fingers off the child's chest.

g. Position your shoulder over your hand, with elbow locked and your arm straight.

h. Give 5 compressions, each should compress the chest 1 to 1 1/2 inches at a rate of 80 to 10

compressions per minute. After each 5th compression, deliver 1 breath. Compressions should

smooth, rhythmic, and uninterrupted.

i. Continue for 10 complete cycles of 3 compressions and 1 breath. Check for a carotid pulse f

seconds.

0. Continue CPR - If the infant or child has no pulse, give 1 breath and continue CPR. Check for a

ulse every few minutes. If the pulse is present but breathing is absent, continue rescue breathing (In

0 breaths/min; Child: 15 breaths/min.) If the infant or child begins to breathe, maintain an open airw

ntil medical assistance arrives. Continue CPR until successful, you are exhausted, you are relieved b

other trained in CPR or medical personnel, or the infant or child is pronounced dead. This course

ot a substitute for formal training in cardiopulmonary resuscitation (CPR).



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eferences

Instructors Manual for Basic Life Support, American Heart Association, ISBN 0-87493-601-2




[email protected]




odified: Tue Nov 11 08:58:14 2003splayed: Wed Dec 17 16:31:26 2003



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Virtual Naval Hospital: Standard First Aid Course - Chapter Three - Bleeding

AVEDTRA 13119 Standard First Aid Course - Chapter Three - Bleeding

Bleeding




eeding (hemorrhage) is the escape of blood from capillaries, veins, and arteries. Capillaries are ve

mall blood vessels that carry blood to all parts of the body. Veins are blood vessels that carry blood

e heart. Arteries are large blood vessels that carry blood away from the heart. Bleeding can occur

side the body (internal), outside the body (external) or both. Blood is a fluid that consists of a pale

llow liquid (plasma), red blood cells (erythrocytes), white blood cells (leukocytes), and platelets

hrombocytes). Plasma is the fluid portion of the blood that carries nutrients. Red blood cells give co

the blood and carry oxygen. White blood cells defend the body against infection and attack foreign

rticles. Platelets are disk shaped and assist in clotting the blood, the mechanism that stops bleeding

here are three types of bleeding. Capillary bleeding is slow, the blood "oozes" from the (wound) cuenous bleeding is dark red or maroon, the blood flows in a steady stream. Arterial bleeding is brigh

d, the blood "spurts" from the wound. Arterial bleeding is life threatening and difficult to contr

small wounds, only the capillaries are damaged. Deeper wounds result in damage to the veins and

teries. Damage to the capillaries is usually not serious and can easily be controlled with a Band-Aid

amage to the veins and arteries are more serious and can be life threatening. The adult body contain

proximately 5 to 6 quarts of blood (10 to 12 pints). The body can normally lose 1 pint of blood (us

mount given by donors) without harmful effects. A loss of 2 pints may cause shock, a loss of 5 to 6

nts usually results in death. During certain situations it will be difficult to decide whether the bleedarterial or venous. The distinction is not important. The most important thing to remember is that a

eeding must be controlled as soon as possible.

xternal Bleeding

hile administering first aid to a casualty who is bleeding, you must remain calm. The sight of blood

emotional event for many, and it often appears severe. However, most bleeding is less severe than

pears. Most of the major arteries are deep and well protected by tissue and bone. Although bleedin



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n be fatal, you will usually have enough time to think and act calmly. There are four methods to

ntrol bleeding: direct pressure, elevation, indirect pressure, and the use of a tourniquet.

irect Pressure

irect pressure is the first and most effective method to control bleeding. In many cases, bleeding ca

ntrolled by applying pressure directly (Fig. 3-1) to the wound. Place a sterile dressing or clean clot

e wound, tie a knot or adhere tape directly over the wound, only tight enough to control bleeding. Ieeding is not controlled, apply another dressing over the first or apply direct pressure with your han

ngers over the wound. Direct pressure can be applied by the casualty or a bystander. Under no

rcumstances is a dressing removed once it has been applied.

evation

aising (elevation) of an injured arm or leg (extremity) above the level of the heart will help control

eeding.

gure 3-1 Direct Pressure



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gure 3-2 Pressure Points for Control of Bleeding

evation should be used together with direct pressure. Do not elevate an extremity if you suspect a

oken bone (fracture) until it has been properly splinted and you are certain that elevation will not c

rther injury. Use a stable object to maintain elevation. Placing an extremity on an unstable object m

use further injury.

direct Pressure

cases of severe bleeding when direct pressure and elevation are not controlling the bleeding, indire



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essure must be used. Bleeding from an artery can be controlled by applying pressure to the appropr

essure point. Pressure points (Fig. 3-2) are areas of the body where the blood flow can be controlle

essing the artery against an underlying bone. Pressure is applied with the fingers, thumb, or heel of

nd.

ressure points should be used with caution. Indirect pressure can cause damage to the extrem

ue to inadequate blood flow. Do not apply pressure to the neck (carotid) pressure points, it can

use cardiac arrest.

direct pressure is used in addition to direct pressure and elevation. Pressure points in the arm (brach

d in the groin (femoral) are most often used, and should be thoroughly understood. The brachial ar

used to control severe bleeding of the lower part of the upper arm and elbow. It is located above th

bow on the inside of the arm in the groove between the muscles. Using your fingers or thumb, appl

essure (Fig. 3-2E) to the inside of the arm over the bone. The femoral artery is used to control seve

eeding of the thigh and lower leg. It is located on the front, center part of the crease in the groin.

osition the casualty on his or her back, kneel on the opposite side (Fig. 3-2H ) from the wounded le

ace the heel of your hand directly on the pressure point, and lean forward to apply pressure. If theeeding is not controlled, it may be necessary to press directly over the artery with the flat surface o

ngertips and to apply additional pressure on the fingertips with the heel of your other hand.

ourniquet

tourniquet should be used only as a last resort to control severe bleeding after all other methods h

iled and is used only on the extremities. Before use, you must thoroughly understand its dangers a

mitations. Tourniquets cause tissue damage and loss of extremities when used by untrained individu

ourniquets are rarely required and should only be used when an arm or leg has been partially ormpletely severed and when bleeding is uncontrollable.

he standard tourniquet is normally a piece of cloth folded until it is 3 or more inches wide and 6 or

yers thick. A tourniquet can be a strap, belt, neckerchief, towel, or other similar item. A folded

angular bandage makes a great tourniquet. Never use wire, cord, or any material that will cut th

in.

o apply a tourniquet (Fig. 3-3), do the following:

While maintaining the proper pressure point, place the tourniquet between the heart and the wound

aving at least 2 inches of uninjured skin between the tourniquet and wound.

Place a pad (roll) over the artery.

Wrap the tourniquet around the extremity twice, and tie a half-knot on the upper surface.



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Place a short stick or similar object on the half-knot, and tie a square knot.

Twist the stick to tighten, until bleeding is controlled.

Secure the stick in place.

Never cover a tourniquet.

gure 3-3 Applying a Tourniquet

Using lipstick or marker, make a 'T" on the casualty's forehead and the time tourniquet was applie

Never loosen or remove a tourniquet once it has been applied. The loosening of a tourniquet ma

slodge clots and result in enough blood loss to cause shock and death.

o not touch open wounds with your fingers unless absolutely necessary. Place a barrier betwe

ou and the casualty's blood or body fluids, using plastic wrap, gloves, or a clean, folded cloth.

Wash your hands with soap and warm water immediately after providing care, even if you wor

oves or used another barrier.

ternal Bleeding

ternal bleeding, although not usually visible, can result in serious blood loss. A casualty with intern

eeding can develop shock before you realize the extent of their injuries. Bleeding from the mouth,

ose, rectum, or other body opening (orifice) is considered serious and normally indicates internal

eeding.



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he most common sign of internal bleeding is a simple bruise (contusion), it indicates bleeding into t

in (soft tissues). Severe internal bleeding occurs in injuries caused by a violent force (automobile

cident), puncture wounds (knife), and broken bones.

gns of internal bleeding include:

Anxiety and restlessness.

Excessive thirst (polydipsia).

Nausea and vomiting.

Cool, moist, and pale skin (cold and clammy).

Rapid breathing (tachypnea).

Rapid, weak pulse (tachycardia).

Bruising or discoloration at site of injury (contusion).

you suspect internal bleeding, do the following:

Bruise (contusion) - Apply ice or cold pack, with cloth to prevent damage to the skin, to reduce pa

d (edema) swelling.

Severe internal bleeding:

a. Call local emergency number or medical personnel.

b. Monitor airway, breathing, and circulation (ABCs).

c. Treat for shock.

d. Place casualty in most comfortable position.

e. Maintain normal body temperature.

f. Reassure casualty

osebleed

osebleeds (epistaxis) can be caused by an injury, disease, the environment, high blood pressure, and

anges in altitude. They frighten the casualty and may bleed enough to cause shock. If a fractured

ull is suspected as the cause, do not stop the bleeding. Cover the nose with a loose, dry, sterile

ressing and call the local emergency number or medical personnel. If the casualty has a noseble

ue to other causes, do the following:



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Keep the casualty quiet, sitting with head tilted forward.

Pinch the nose shut (if there is no fracture), place ice or cold packs to the bridge of the nose, or pu

essure on the upper lip just below the nose. Inform the casualty not to rub, blow, or pick his or her

ose. Seek medical assistance if the nosebleed continues, bleeding starts again, or bleeding is becaus

gh blood pressure. If the casualty loses consciousness, place them on their side to allow blood t

rain from the nose and call the local emergency number or medical personnel.

oreign bodies in the nose usually occur among children. First aid consists of seeking professional

edical attention. Nasal damage and the possibility of pushing the object farther up the nose can resu

om searching and attempts at removal by unqualified personnel.

asualties with severe external bleeding and suspected internal bleeding must be seen by medic

ersonnel as soon as possible. All casualties with external and internal bleeding should be treat

r shock.

eferences

Karren, K. J. and Hafen, B.Q.: First Responder A Skills Approach, edition 3, Morton Publishing

ompany

American Red Cross Standard First Aid Workbook, edition 1991, American Red Cross




[email protected]




odified: Tue Nov 11 08:58:14 2003

splayed: Wed Dec 17 16:31:29 2003



31/175

Virtual Naval Hospital: Standard First Aid Course - Chapter Four - Shock

AVEDTRA 13119 Standard First Aid Course - Chapter Four - Shock

Shock




hock, is the failure of the heart and blood vessels (circulatory system) to maintain enough oxygen-r

ood flowing (perfusion) to the vital organs of the body. There is shock to some degree with every

ness or injury; shock can be life threatening. The principles of prevention and control are to recogn

e signs and symptoms and to begin treating the casualty before shock completely develops. It is

nlikely that you will see all the signs and symptoms of shock in a single casualty. Sometimes the sig

d symptoms may be disguised by the illness or injury or they may not appear immediately. In fact

any times, they appear hours later.

he usual signs and symptoms (Fig. 4-1) of the development of shock are:

Anxiety, restlessness and fainting.

Nausea and vomiting.

Excessive thirst (polydipsia).

Eyes are vacant, dull (lackluster), large (dilated) pupils.

Shallow, rapid (tachypnea), and irregular breathing.

Pale, cold, moist (clammy) skin.

Weak, rapid (tachycardia), or absent pulse.



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gure 4-1 Symptoms of Shock

ypovolemic Shock

ypovolemic shock is caused by a decreased amount of blood or fluids in the body. This decrease re

om injuries that produce internal and external bleeding, fluid loss due to burns, and dehydration du

vere vomiting and diarrhea.

eurogenic Shock

eurogenic shock is caused by an abnormal enlargement of the (vasodilation) blood vessels and poo

the blood to a degree that adequate blood flow cannot be maintained. Simple fainting (syncope) is

riation, it is the result of a temporary pooling of the blood as a person stands. As the person falls, b

shes back to the head and the problem is solved.

sychogenic Shock

ychogenic shock is a "shock like condition" produced by excessive fear, joy, anger, or grief. Shell



33/175


ock is a psychological adjustment reaction to stressful wartime experiences. Care for shell shock is

mited to emotional support and transportation of the casualty to a medical facility.

naphylactic Shock

naphylactic (allergic) shock occurs when an individual is exposed to a substance to which his or he

ody is sensitive. The individual may experience a burning sensation, loss of voice, itching (pruritus)

ves, severe swelling, and difficulty breathing. The causative agents are injection of medicines, venoy stinging insects and animals, inhalation of dust and pollens, and ingestion of certain foods and

edications. Individuals with known sensitivities carry medication in commercially prepared kits.

revention and Treatment of Shock

hile administering first aid to prevent or treat shock, you must remain calm. If shock has not

mpletely developed, the first aid you provide may actually prevent its occurrence. If it has develop

ou may be able to keep it from becoming fatal. It is extremely important that you render first aid

mmediately.

o provide first aid for shock, do the following:

Maintain open airway - Head-tilt/chin-lift or jaw-thrust.

Control bleeding - Direct pressure, elevation, indirect pressure, or tourniquet if indicated.

Position casualty - Place the casualty on his or her back, with legs elevated 6 to 12 inches (Fig. 4-it is possible, take advantage of a natural slope of ground and place the casualty so that the head is

wer than the feet. If they are vomiting or bleeding around the mouth, place them on their side, or ba

ith head turned to the side. If you suspect head or neck injuries, or are unsure of the casualty's

ndition, keep them lying flat.

Splint - Suspected broken and dislocated bones in the position in which they are found. Do not

tempt to straighten broken or dislocated bones, because of the high risk of causing further injur

plinting not only relieves the pain without the use of drugs but prevents further tissue damage and

ock. Pain and discomfort are often eliminated by unlacing or cutting a shoe or loosening tight cloththe site of the injury. A simple adjustment of a bandage or splint will be of benefit, especially whe

companied by encouraging words.



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gure 4-2 Position for Treatment of Shock

Keep the casualty comfortable, and warm enough to maintain normal body temperature. If possibl

move wet clothing and place blankets underneath the casualty. Never use an artificial means of

arming.

Keep the casualty as calm as possible. Excitement and excessive handling will aggravate their

ndition. Prevent the casualty from seeing his or her injuries, reassure them that their injuries are

nderstood and that professional medical assistance will arrive as soon as possible.

Give nothing by mouth - Do not give the casualty anything to eat or drink because it may cause

omiting. If the casualty complains of thirst, wet his or her lips with a wet towel.

Request medical assistance - Ask bystanders to call the local emergency number or medical

rsonnel.

eferences




[email protected]




odified: Tue Nov 11 08:58:14 2003

splayed: Wed Dec 17 16:31:30 2003



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Virtual Naval Hospital: Standard First Aid Course - Chapter Five - Soft Tissue Injuries

AVEDTRA 13119 Standard First Aid Course - Chapter Five - Soft Tissue Injuries

Soft Tissue Injuries




he most common injuries (trauma) seen in a first aid setting are soft tissue injuries with bleeding an

ock. Injuries that cause a break in the skin, underlying soft tissue, or other body membrane are kno

a wound. Injuries to the soft tissues vary from bruises (contusion) to serious cuts (lacerations) and

uncture wounds in which the object may remain in the wound (impaled objects). The two main thre

ith these injuries are bleeding and infection.

lassification of Wounds

ounds are classified according to their general condition, size, location, the manner in which the sktissue is broken, and the agent that caused the wound. It is usually necessary for you to consider so

all of these factors in order to determine what first aid treatment is appropriate.

eneral Condition

the wound is new, first aid consists mainly of controlling the bleeding, treating for shock, and redu

e risk of infection. If the wound is old and infected, first aid consists of keeping the casualty quiet,

evating the injured part, and applying a warm wet dressing. If the wound contains foreign objects, f

d may consist of removing the objects if they are not deep. Do not remove impaled objects or objmbedded in the eyes or skull.

ze

enerally, large wounds are more serious than small ones and they usually involve severe bleeding, m

mage to the underlying tissues and organs, and a greater degree of shock. However, small wounds

metimes more dangerous than large ones: they may become infected more readily due to neglect. T



36/175


pth of a wound also is important because it may lead to a complete (through & through) perforatio

organ or the body, with the additional complication of an entrance and exit wound.

ocation

nce a wound can cause serious damage to deep structures, as well as to the skin and tissues below i

e location is an important consideration. A knife wound to the chest is likely to puncture a lung and

use difficulty breathing. The same type of wound in the abdomen can cause a life-threateningfection, internal bleeding, or puncture the intestines, liver, or other vital organs. A bullet wound to

ad may cause brain damage, but a bullet wound to the arm or leg, may cause no serious damage.

ypes of Wounds

s the first line of defense against most injuries, soft tissues are most often damaged. There are two t

soft tissue injuries: open and closed. An open wound is one in which the skin surface has been bro

closed wound is where the skin surface is unbroken but underlying tissues have been damaged.

losed Wounds

blunt object that strikes the body will damage tissues beneath the skin. When the damage is minor

ound is called a bruise (contusion). When the tissue has extensive damage, blood and fluid collect

nder the skin causing discoloration (ecchymosis), swelling (edema), and pain. First aid consists of

plying ice or cold packs to reduce swelling and relieve discomfort. To guard against frostbite, ne

pply ice or cold packs directly to the skin.

ematomas are the result of a severe blunt injury with extensive soft tissue damage, tearing of large

ood vessels, and pooling of large amounts of blood below the skin. With large hematomas, look for

oken bones, especially if deformity is present. First aid consists of applying ice or cold packs to red

welling and relieve pain, direct pressure (manual compression) to help control internal bleeding,

linting, and elevation. When large areas of bruising are present, shock may develop.

pen Wounds

open soft tissue injuries, the protective layer of the skin has been damaged. This damage can causerious internal and external bleeding. Once the protective layer of skin has been broken, the wound

comes contaminated and may become infected. When you consider the way in which the skin or ti

s been broken, there are six basic types of open wounds: abrasions, amputations, avulsions, incisio

cerations, and punctures. Many wounds are a combination of two or more of these types.

brasions

brasions are caused when the skin is rubbed or scraped off. Rope burns, floor burns, and skinned kn



37/175


elbows are common examples of abrasions. Abrasions easily can become infected, because dirt an

rms are usually ground into the tissues. There is normally minimal bleeding or oozing of clear fluid

mputations

mputations (traumatic) are the non-surgical removal of the fingers, toes, hands, feet, arms, legs, and

rs from the body. Bleeding is heavy and normally requires a tourniquet, to control the blood flow.

here are three types of amputation:

Complete - Body part is completely torn off (severed).

Partial - More than 50% of the body part is torn off.

De-gloving - Skin and tissue are torn away from body part.

the casualty has an amputation, do the following:

Establish and maintain the airway, breathing, and circulation (ABCs).

Control bleeding with direct pressure, elevation, indirect pressure, or tourniquet only as a last re

ever remove or loosen a tourniquet once it has been applied.

Apply dressing to the stump with an ace wrap to replace direct pressure.

Treat for shock.

Request medical assistance immediately.

vulsions

n avulsion is an injury in which the skin is torn completely away from a body part or is left hanging

flap. Usually, there is severe bleeding. If possible, obtain the part that has been torn away, rinse it i

ater, wrap it in a dry sterile gauze, seal it in a plastic bag, and send it on ice with the casualty. Do n

low part to freeze and do not submerge in water. If the skin is still attached, fold the flap back in

normal position.

cisions

cisions, commonly called cuts, are wounds made by sharp cutting instruments such as knives, razo

broken glass. Incisions tend to bleed freely because the blood vessels are cut cleanly, without ragg

ges. The wound edges are smooth and there is little damage to the surrounding tissues. Of all the

asses of open wounds, incisions are the least likely to become infected.



38/175


acerations

acerations are wounds that are torn, rather than cut. They have ragged, irregular edges and torn tissu

nderneath. These wounds are usually made by a blunt, rather than a sharp, object. A wound made by

ull knife is more likely to be a laceration than an incision. Many of the wounds caused by machiner

cidents are lacerations, often complicated by crushed tissues. Lacerations are frequently contamina

ith dirt, grease, or other materials that are ground into the wound; they are very likely to become

fected.

unctures

unctures are caused by objects that enter the skin while leaving a surface opening. Wounds made by

ils, needles, wire, knives, and bullets are normally punctures. Small puncture wounds usually do n

eed freely; however, large puncture wounds may cause severe internal bleeding. The possibility of

fection is great in all puncture wounds, especially if the penetrating object is contaminated. Perfora

hrough & through) is a variation, it is the result of a penetrating object entering, passing through, an

iting the body.

auses

lthough it is not necessary to know what object or method has caused a wound, it is helpful. Knowi

hat caused the wound and how it occurred can help you determine its general condition, possible si

pe, and seriousness of the wound. This information will help you provide the appropriate first aid t

sualty.

reatment of Wounds

rst aid treatment for all wounds consists of controlling the flow of blood, treating for shock, and

eventing infection. When providing first aid to casualty with multiple injuries, treat the wounds tha

pear to be life-threatening first. Since most of the body is covered by clothing, carefully examine t

tire body for bleeding. When necessary, tear or cut clothing away from the wound because excessi

ovement of the injured part will cause pain and additional damage.

eeding

fter establishing an adequate open airway, the main concern will be to control bleeding, by direct

essure and elevation. Indirect pressure and the use of a tourniquet should be used only if direct pres

d elevation do not control the bleeding. Bleeding control is discussed further in Chapter 3. A

otective covering (dressing) that is properly applied should adequately control the bleeding. In case

vere bleeding, you may need to double the dressing. Never remove a dressing that is soaked with b

replace it with another; just place the new dressing over the old one.



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hock

hock may be severe in a casualty who has lost a large amount of blood or suffered a serious injury.

uses and treatment of shock are discussed further in Chapter 4.

fection

fections can occur in any wound. Infection is a hazard in wounds that do not bleed freely; in wound

here tissue is torn or the skin falls back into place and prevents the entrance of air; and in wounds th

volve the crushing of tissue. Incisions, in which there is a free flow of blood and relatively little

ushing of tissues, are the least likely to become infected. The signs of infection are tenderness, redn

at, swelling, and a discharge. Serious infections develop red streaks that lead from the wound to th

art. Infections are dangerous, especially in the area of the nose and mouth. From this area, (Fig. 5-

fections spread easily into the bloodstream, causing blood poisoning (septicemia), and into the brai

using a collection of pus (abscess) and infection. Small wounds should be washed immediately wit

ap and water, dried, and treated with an application of a mild, non-irritating antiseptic. Apply a

essing if necessary. Make no attempt to wash a large wound and do not apply an antiseptic. Cover

ound with a dry, sterile dressing. Further treatment of large wounds should be conducted by medica

rsonnel. All puncture wounds must be evaluated by medical personnel.

gure 5-1 Danger Zone for Infection

oreign Bodies

any wounds contain foreign bodies. Wood or glass splinters, bullets, metal fragments, wire, fishho

ils, and small particles from grinding wheels are examples of materials that are found in wounds. I

ost cases, first aid will include the removal of this material if the wound is minor and the object is n



40/175


e surface and exposed. However, first aid does not include the removal of deeply embedded object

owdered glass, or any scattered material. Never attempt to remove bullets, examine the casualty to

nd out whether the bullet remains in the body by looking for both an entrance and exit wound.

he general rule is: Remove foreign objects from a wound ONLY when you can do so easily and wit

using further damage.

o not attempt to remove an object that is embedded in the eye or that has penetrated the eye .

reatment of Specific Conditions

is impossible to list all wounds in simple categories. Some require special treatment and precaution

ou may see wounds that are not described in this course, but most wounds can be treated by calmly

membering the general treatment of wounds.

ye Wounds

oreign bodies such as particles of dirt, sand, paint chips, or fine pieces of metal frequently find their

ay into the eyes. They not only cause discomfort, but if not removed, they can cause inflammation

fection. Fortunately, through an increased flow of tears, nature dislodges many of these particles be

y damage is done. Never let the casualty rub the eye, since rubbing, can cause scratches (abrasio

the eye and can push a foreign body deeper into the eye, causing further damage. Gently flush the

sualty's eye with water at least 15 to 20 minutes. If flushing the eye is not successful in removin

e foreign body, patch both eyes and get the casualty to medical personnel. It is always safer to send

sualty to medical personnel than for you to attempt to remove foreign bodies. If the casualty has anbject embedded in, or penetrating from, the eye, or the eyeball is protruding from the socket, do the

llowing:

Take a thick dressing or several dressings and cut a hole in the middle, large enough to go over the

ithout touching the object. If you cannot cut a hole in the dressing, you can build several dressings

ound the object.

Take a paper cup or other object that is wide enough and strong enough to adequately protect the

bject without putting pressure on the eye. Place this over the top of the object. Close and cover thenaffected eye to minimize movement of the injured eye.

Take a roller bandage and wrap it over the cup and around the head several times ensuring that the

d dressing are snug enough not to come off, but not tight enough to cause discomfort.

hen finished, this type of dressing will adequately protect the eye.

aceration of the Eyelids



41/175


42/175


Blood or clear (cerebrospinal) fluid dripping from the nose or ears. (Cover loosely with a sterile

essing to absorb but not stop the flow).

you suspect a head injury, do the following:

Position the casualty flat, stabilize the head and neck as you found them by placing your hands on

oth sides of the head.

Establish and maintain open airway using the jaw-thrust maneuver. Note that the head is not tilt

d the neck is not extended. Check the airway, breathing, and circulation (ABC's).

Finger sweep to remove any foreign bodies from the mouth.

Maintain a neutral position of the head and neck and, if possible, apply a cervical collar or improv

owel) collar.

Control bleeding using gentle, continuous pressure. Never apply direct pressure if the skull is

epressed or bone fragments are seen.

Apply dressing - Do not use direct pressure or tie knots over the wound. Apply ice or cold packs w

oth to prevent damage to the skin.

Treat for shock - Casualtyies with suspected head and neck injuries are to remain flat. Do not rai

e casualty's feet. If casualty is vomiting or bleeding around the mouth, place them on their sideeping the neck straight. Do not give anything to eat or drink.

Request medical assistance immediately - Time is critical.

acial Wounds

acial wounds are treated, generally, like other flesh wounds. However, ensure that the tongue or sof

sue does not cause an airway obstruction. Keep the nose and throat clear of all foreign material and

osition the casualty so that blood will drain out of the mouth and nose. Facial wounds and scalp woueed freely. Any casualty that has suffered a facial wound that involves the eye, eyelids, or the tissue

ound the eye must receive professional medical attention as soon as possible. First aid for other fac

ounds is the same as head wounds.

andard First Aid Boxes

on-medical personnel are an important element in providing first aid to casualties prior to the arriva



43/175


ofessional medical personnel. Many lives have been saved by the first aid rendered by a shipmate.

andard first aid boxes are distributed throughout a ship to provide easy access to first aid supplies.

umber of first aid boxes and their location depends on the ship's mission and the size of her crew.

arious dressings, wire splints, tape, Band-Aids, tourniquets, skin pencils, and other first aid supplie

cluded in these boxes. Each box is secured with a wire or plastic seal that can be easily broken. The

als are used to identify whether the kit has been opened. A broken seal indicates that the first aid bo

ust be inventoried and restocked. The standard first aid box has three compartments. Each compart

ould have a plastic bag that is complete with the basic first aid supplies. Take one of these bags witou on your way to the casualty. Failure to take a bag to the scene may result in you having to go bac

r supplies. The box does not contain needles, syringes, or medications; but does contain the proper

pplies needed to render first aid until medical assistance arrives. First aid boxes are for emergenc

e only! Report all broken seals to medical personnel as soon as possible. It is important that yo

now the contents and locations of these boxes.

ressings

dressing is a protective covering for a wound and is used to control bleeding and preventntamination of the wound. A compress is a sterile pad that is placed directly on the wound. A

andage is material used to hold a compress in place. When applying a dressing, ensure that it remai

sterile as possible. The part of the dressing that is placed against the wound must never touch you

ngers, clothing, or any un-sterile object. If you drop, a dressing across the casualty's skin or it slips

is in place, the dressing should not be used.

attle Dressings

attle dressings are used most often aboard ship and in the field. Each dressing is complete (no otheraterials are needed) with four tabs which help in applying and securing the dressing. They have "ot

de next to wound" marked on the outer side. This will help you in (Fig. 5-2) placing the sterile sid

ainst the wound. Unless contraindicated, to assist in controlling the bleeding, tie the knot of the

essing over the wound.



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gure 5-2 Battle Dressing

ompresses

mergencies may occur when it is not possible to obtain a sterile compress. During these situations, u

e cleanest cloth available, a freshly laundered handkerchief, towel, or shirt. Unfold the material

refully so that you do not touch the part that will be placed against the wound. The compress shoul

rge enough to cover the entire wound and extend at least 1 inch beyond its edges. If a compress is n

rge enough, the edges of the wound will become contaminated. Materials that will stick to a wound

ay be difficult to remove should never be used directly on a wound. Absorbent cotton, adhesive tapd paper napkins are examples of materials that should never come in contact with a wound.

andages

andages are strips or rolls of gauze or other materials that are used for wrapping or binding any part

e body and to hold compresses in place. It is not necessary to take time to ensure that the bandage

sembles the textbook pictures. However, it is important that the dressing controls the bleeding, prev

rther contamination, and protects the wound from further injury. Some of the most commonly used

ndages are the roller bandage and the triangular bandage.

oller Bandages

he roller bandage (Fig. 5-3) consists of a long strip of material (usually gauze, or elastic) that is roll

d is available in several widths and lengths. Most are sterile, so pieces may be used as a compress

ounds. A strip of roller bandage can be used to make a four-tailed bandage (Fig. 5-4A), by splitting

oth from each end, leaving as large a center as needed. This type of bandage is used to hold a comp



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ig. 5-4B) on the chin, or (Fig. 5-4C) the nose.

gure 5-3 Roller Bandages

gure 5-4 Four Tailed Bandage

riangular Bandages



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iangular bandages (Fig. 5-5) are usually made of muslin. They are useful because they can be folde

variety of ways to fit almost any part of the body. Padding can be added to areas that may become

ncomfortable.

gure 5-5 - Triangular Bandage

gure 5-6 Cravat Bandage

he triangular bandage can be folded to make a cravat bandage, which is useful in controlling bleed

om wounds of the scalp or forehead. To make a cravat bandage, bring the point of the triangular

ndage (Fig. 5-6) to the middle of the base and continue to fold until a 2-inch width is obtained. If

ecially prepared bandages are not available, use whatever material you can find. Remember that th

sic purpose of a bandage is to hold the sterile compress in place. Any material or method of applic

at does not cause further injury to the casualty will be acceptable. Material used as a bandage does

ve to be sterile, since it will not come in direct contact with the wound. However, it should be as cl



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possible. Cloth bandages should be fastened by tying the ends with a square knot or by tacking the

ds with safety pins. If you use a knot to fasten the bandage, be sure to use a square knot. This knot

sy to tie, will not slip, and can be untied quickly. Place the knot so it will cause the least amount of

scomfort to the casualty and where it can be removed easily and quickly. Bandages should be appli

rmly but not too tight. A loose bandage will slip off the wound. A bandage that is too tight can cut o

e blood supply to the injured part and cause damage to the blood vessels and tissues. When you fas

ndage around an arm or leg, leave the fingers or toes uncovered. If they become blue or swollen, y

ill know that the bandage is too tight and should be loosened.

gures 5-7 through 5-12 show some of the uses of the roller, triangular, and cravat bandage.

gure 5-7 - Roller Bandage for the Hand and Wrist

gure 5-8 - Roller Bandage for the Ankle and Foot



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gure 5-9 - Triangular Bandage for the Head



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gure 5-10 - Triangular Bandage for the Chest

gure 5-11 - Cravat Bandage for the Elbow or Knee

gure 5-12 - Cravat Bandage for the Arm, Forearm, Leg, or Thigh

eferences

NAVEDTRA 10669-C,Hospital Corpsman 3 & 2



[email protected]






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odified: Tue Nov 11 08:58:14 2003

splayed: Wed Dec 17 16:31:31 2003



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Virtual Naval Hospital: Standard First Aid Course - Chapter Six - Bones, Joints and Muscles

AVEDTRA 13119 Standard First Aid Course - Chapter Six - Bones, Joints and Muscles

Bones, Joints and Muscles




ccidents cause many different types of injuries to bones, joints and muscles. When rendering first aou must be alert for signs of broken bones (fractures), dislocations, sprains, strains, and bruises

ontusions). Injuries to the joints and muscles often occur together, and it is difficult to tell whether

jury is to a joint, muscle, or tendon. It is difficult to tell joint or muscle injuries from fractures. Wh

doubt, always treat the injury as a fracture.

he primary process of first aid for fractures consists of immobilizing the injured part to prevent the

broken bones from moving and causing further damage to the nerves, blood vessels, or internal

gans. Splints are also used to immunize injured joints or muscles and to prevent the enlargement of

vere wounds. Before learning first aid for injuries to the bones, joints, and muscles, you need to haneral understanding of the use of splints.

plints

an emergency, almost any firm object or material will serve as a splint. Thus, umbrellas, canes, rif

cks, oars, wire mesh, boards, cardboard, pillows, and folded newspapers can be used. A fractured l

n be immobilized by securing it to the uninjured leg. Whenever possible, use ready-made splints su

the pneumatic or traction splints.

plints should be lightweight, padded, strong, rigid, and long enough to reach the joint above and bel

e fracture. If they are not properly p

US Navy Course NAVEDTRA 13119 - Standard First Aid Course

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