Casualty Evaluation

The time may come when you must instantly apply your knowledge of lifesaving and first aid measures, possibly under combat or other adverse conditions. Any soldier observing an unconscious and/or ill, injured, or wounded person must carefully and skillfully evaluate him to determine the first aid measures required to prevent further injury or death. He should seek help from medical personnel as soon as possible, but must NOT interrupt his evaluation or treatment of the casualty. A second person may be sent to find medical help. One of the cardinal principles of treating a casualty is that the initial rescuer must continue the evaluation and treatment, as the tactical situation permits, until he is relieved by another individual. If, during any part of the evaluation, the casualty exhibits the conditions for which the soldier is checking, the soldier must stop the evaluation and immediately administer first aid. In a chemical environment, the soldier should not evaluate the casualty until the casualty has been masked and given the antidote. After providing first aid, the soldier must proceed with the evaluation and continue to monitor the casualty for further medical complications until relieved by medical personnel. Learn the following procedures well. You may become that soldier who will have to give first aid some day.

NOTE Remember, when evaluating and/or treating a casualty, you should seek medical aid as soon as possible. DO NOT stop treatment, but if the situation allows, send another person to find medical aid.

WARNING Again, remember, if there are any signs of chemical or biological agent poisoning, you should immediately mask the casualty. If it is nerve agent poisoning, administer the antidote, using the casualty's injector/ampules. See task 081-831-1031, Administer First Aid to a Nerve Agent Casualty (Buddy Aid).

a. Step ONE. Check the casualty for responsiveness by gently shaking or tapping him while calmly asking, "Are you okay?" Watch for response. If the casualty does not respond, go to step TWO. See Chapter 2, paragraph 2-5 for more information. If the casualty responds, continue with the evaluation. (1) If the casualty is conscious, ask him where he feels different than usual or where it hurts. Ask him to identify the location(s) of pain if he can, or to identify the area in which there is no feeling. (2) If the casualty is conscious but is choking and cannot talk, stop the evaluation and begin treatment. See task 081-831-1003, Clear an Object from the Throat of a Conscious Casualty. Also see Chapter 2, paragraph 2-13 for specific details on opening the airway. WARNING IF A BROKEN NECK OR BACK IS SUSPECTED, DO NOT MOVE THE CASUALTY UNLESS TO SAVE HIS LIFE. MOVEMENT MAY CAUSE PERMANENT PARALYSIS OR DEATH. b. Step TWO. Check for breathing. See Chapter 2, paragraph 2-5c for procedure. (1) If the casualty is breathing, proceed to step FOUR. (2) If the casualty is not breathing, stop the evaluation and begin treatment (attempt to ventilate). See task 081-831-1042, Perform Mouth-to-Mouth Resuscitation. If an airway obstruction is apparent, clear the airway obstruction, then ventilate. (3) After successfully clearing the casualty's airway proceed to step THREE. c. Step THREE. Check for pulse. If pulse is present, and the casualty is breathing, proceed to step FOUR. (1) If pulse is present, but the casualty is still not breathing, start rescue breathing. See Chapter 2, paragraphs 2-6 and 2-7 for specific methods.

*(2) If pulse is not found, seek medically trained personnel for help.

d. Step FOUR. Check for bleeding. Look for spurts of blood or blood-soaked clothes. Also check for both entry and exit wounds. If the casualty is bleeding from an open wound, stop the evaluation and begin first aid treatment in accordance with the following tasks, as appropriate: (1) Arm or leg wound--Task 081-831-1016, Put on a Field or Pressure Dressing. See Chapter 2, paragraphs 2-15, 2-17, 2-18, and 2-19. (2) Partial or complete amputation--Task 081-831-1017, Put on a Tourniquet. See Chapter 2, paragraph 2-20. (3) Open head wound--Task 081-831-1033, Apply a Dressing to an Open Head Wound. See Chapter 3, Section I. (4) Open abdominal wound--Task 081-831-1025, Apply a Dressing to an Open Abdominal Wound. See Chapter 3, paragraph 3-12. (5) Open chest wound--Task 081-831-1026, Apply a Dressing to an Open Chest Wound. See Chapter 3, paragraphs 3-9 and 3-10.

WARNING IN A CHEMICALLY CONTAMINATED AREA, DO NOT EXPOSE THE WOUND(S).

e. Step FIVE. Check for shock. If signs/symptoms of shock are present, stop the evaluation and begin treatment immediately. The following are nine signs and/or symptoms of shock. (1) Sweaty but cool skin (clammy skin). (2) Paleness of skin. (3) Restlessness or nervousness. (4) Thirst. (5) Loss of blood (bleeding). (6) Confusion (does not seem aware of surroundings). (7) Faster than normal breathing rate. (8) Blotchy or bluish skin, especially around the mouth. (9) Nausea and/or vomiting.

WARNING LEG FRACTURES MUST BE SPLINTED BEFORE ELEVATING THE LEGS AS A TREATMENT FOR SHOCK.

See Chapter 2, Section III for specific information regarding the causes and effects, signs/symptoms, and the treatment/prevention of shock.

f. Step SIX. Check for fractures (Chapter 4). (1) Check for the following signs/symptoms of a back or neck injury and treat as necessary. Pain or tenderness of the neck or back area. Cuts or bruises in the neck or back area. Inability of a casualty to move (paralysis or numbness). o Ask about ability to move (paralysis). o Touch the casualty's arms and legs and ask whether he can feel your hand (numbness). Unusual body or limb position.

WARNING UNLESS THERE IS IMMEDIATE LIFE-THREATENING DANGER, DO NOT MOVE A CASUALTY WHO HAS A SUSPECTED BACK OR NECK INJURY. MOVEMENT MAY CAUSE PERMANENT PARALYSIS OR DEATH.

(2) Immobilize any casualty suspected of having a neck or back injury by doing the following: Tell the casualty not to move. If a back injury is suspected, place padding (rolled or folded to conform to the shape of the arch) under the natural arch of the casualty's back. For example, a blanket may be used as padding. If a neck injury is suspected, place a roll of cloth under the casualty's neck and put weighted boots (filled with dirt, sand, and so forth) or rocks on both sides of his head. (3) Check the casualty's arms and legs for open or closed fractures. Check for open fractures. o Look for bleeding. o Look for bone sticking through the skin. Check for closed fractures. o Look for swelling. o Look for discoloration. o Look for deformity. o Look for unusual body position. *(4) Stop the evaluation and begin treatment if a fracture to an arm or leg is suspected. See task 081-831-1034, Splint a Suspected Fracture, Chapter 4, paragraphs 4-4 through 4-7

(5) Check for signs/symptoms of fractures of other body areas (for example, shoulder or hip) and treat as necessary.

g. Step SEVEN. Check for burns. Look carefully for reddened, blistered, or charred skin, also check for singed clothing. If burns are found, stop the evaluation and begin treatment (Chapter 3, paragraph 3-14). See task 081-831-1007, Give First Aid for Burns.

h. Step EIGHT. Check for possible head injury. (1) Look for the following signs and symptoms: Unequal pupils. Fluid from the ear(s), nose, mouth, or injury site. Slurred speech. Confusion. Sleepiness. Loss of memory or consciousness. Staggering in walking. Headache. Dizziness. Vomiting and/or nausea. Paralysis. Convulsions or twitches.

(2) If a head injury is suspected, continue to watch for signs which would require performance of mouth-to-mouth resuscitation, treatment for shock, or control of bleeding and seek medical aid. See Chapter 3, Section I for specific indications of head injury and treatment. See task 081-831-1033, Apply a Dressing to an Open Head Wound.