FIRST AID AND RESCUE 1. PURPOSE OF FIRST AID. To save life, prevent further injury, and prevent infection. a. Definition: First aid is the emergency care given to sick and injured people until medical care can be given. b. The general rules of first aid (listed in priority of importance): (1) Keep victim lying down until the extent of injuries have been determined. (2) Examine the victim for open airway, breathing, and circulation. This is known as a primary survey. Conduct a head-to-toe secondary survey, checking for bleeding, shock, broken bones, etc. mouth. (3) DO NOT give an unconscious victim anything by (4) Remove enough clothing to get a clear idea of the extent of injury. Do not allow victim to get chilled. (5) Keep victim reassured and comfortable, do not allow them to see their injuries. (6) Do not touch wounds and burns with hands or other unsterile objects unless proper dressings are not available. (7) When treating a wound: stop the bleeding, prevent infection, and prevent shock. (8) DO NOT move victim until the extent of injuries are determined and appropriate first aid measures are taken, except when required due to flooding, fires, or toxic gases. (9) After treatment of victim, always continue to monitor the victim until relieved by medical personnel. (10) Keep the victim warm.
(11) Ensure a litter is carried feet forward, except when going up a ladder; then it is head first.
2. DRESSING WOUNDS a. Chest (1) Sucking chest wound. Use plastic cover material (e.g., ID card, package wrapper) and place over the wound only taping three sides to the victim's chest (leaving one side untaped). When victim inhales, the material will seal the wound and when he/she exhales, it will release excess pressure. (2) Examine for other entrance or exit wounds and treat as noted above. Lay victim on affected side. b. Head (1) For any head injury, assume that the victim also has a neck injury and immobilize. (2) Keep the victim lying flat, with the head at the same level as the body. DO NOT RAISE THE FEET. (3) If victim is conscious, attempt to maintain some level of consciousness (normally talking is enough). (4) If necessary, turn the victim on his/her side to prevent choking on vomit, blood, etc. ALWAYS maintain complete stability of the neck while turning victim. c. Abdominal (1) These wounds usually cause intense pain, nausea, vomiting, muscle spasms, and severe shock. (2) Keep victim lying on his/her back and expose the wound area. (3) Do not touch the intestines and do not attempt to push or manipulate them back into the abdominal cavity. (4) If bleeding is severe, try to stop with direct pressure at the site of the bleeding only. Do not apply pressure over intestine or other abdominal organs. (5) If available, obtain a large battle dressing and moisten with sterile water or potable water if
intestine is exposed. If not exposed, keep dressing dry. When securing the dressing, be sure not to place the tie across the abdomen and risk obstructing the intestines.
(6) Treat for shock and get the victim medical help as soon as possible. Victim may be more comfortable with knees drawn up. (7) DO NOT give victim anything to drink or eat; this will only cause increased peristalsis (movements) of the intestines. Moisten only the victim's mouth. d. Arm and Leg (1) Apply direct pressure or pressure the dressings to control bleeding. When using battle dressings, ensure ties are tied over the wound to maintain pressure. DO NOT APPLY A TOURNIQUET EXCEPT AS A LAST RESORT. (2) If fractures are involved, splint the affected limb as it lies. Do not attempt to reposition it. 3. CONTROLLING BLEEDING a. Arterial bleeding. Blood is bright red and is easily identified by the pulsating spurts. b. Venous bleeding. Blood is dark red and has a steady flow. c. Capillary bleeding. Blood is brick red and oozes slowly. NOTE: DIRECT PRESSURE IS USUALLY THE MOST EFFECTIVE METHOD OF CONTROLLING BLEEDING. (1) Use sterile dressing, if available, improvise as situation dictates. (2) If dressing has been applied and bleeding continues, place additional dressings over those dressings previously applied. DO NOT REMOVE OLD DRESSINGS. d. Pressure points (1) Applying pressure to the appropriate pressure point above the wound may often control arterial or venous bleeding.
(2) The following eleven major pressure points are on each side of the body and can be located by feeling for the pulse (refer to Figure 2-1): (a) Temporal - In front of ear. (b) Facial - On lower jawbone. (c) Carotid - Next to windpipe (do not apply pressure to both carotids at the same time). (d) Subclavian - Collarbone. (e) Brachial (upper) - Inside upper arm. (f) Brachial (lower) - Bend of arm. (g) Radical Ulnar - Inside wrist. (h) Iliac - Middle of groin. (i) Femoral - Upper inside thigh. (j) Popliteal - Behind knee. (k) Anterior/Posterior Tibial - Above ankle. e. Tourniquet. Constricting band used to cut off the supply of blood to an injured limb (refer to Figure 2-2). possible. (1) Place above and as close to the wound site as (2) A "T" should be marked on the victim's forehead along with the time the tourniquet was applied. NOTE: TOURNIQUETS ARE THE LEAST PREFERRED METHOD TO CONTROL HEMORRHAGE. A TOURNIQUET IS WARRANTED ONLY WHEN BLEEDING CANNOT BE CONTROLLED BY DIRECT PRESSURE OR OTHER MEANS AND ONLY ON EXTREMITIES. (3) Once a tourniquet is applied, only a medical officer or corpsman can remove it. 4. FRACTURES (refer to Figure 2-3)
a. Simple fractures are those in which the broken bone does not break the skin. b. A comminuted fracture is one in which the bone has been fractured into two or more fragments. c. A compound/open fracture is one in which the bone breaks the skin and is exposed. d. Immobilizing a fracture. Use any solid material at hand and wrap with an Ace bandage, belt, or tape to prevent movement.
PRESSURE POINTS Figure 2-1
APPLYING A TOURNIQUET Figure 2-2 FRACTURES Figure 2-3
e. Splint/immobilize the fracture as it lies. DO NOT TRY TO REDUCE OR MANIPULATE. f. Check for a pulse below the fracture site. If no pulse is felt, obtain medical help immediately. 5. SHOCK. Body state in which circulation of blood is seriously disturbed either by blood volume depletion, circulatory collapse, or sudden psychological overload (refer to Figure 2-4). a. Common causes. Crushing injuries, fractures, burns, poisoning, prolonged bleeding, asphyxiation and/or witnessing a traumatic event. b. Symptoms (1) Weak or absent pulse. (2) Shallow or irregular breathing. (3) Pale, cold, or moist skin. (4) Eyes vacant, lackluster, and dilated. (5) Dizziness and nausea. c. Treatment (1) Every victim should be treated for shock as soon as possible. (2) Victim should be kept warm and comfortable with feet higher than head (approximately 6-8 in.). 6. TREATMENT FOR ELECTRICAL SHOCK a. Secure power. b. Remove victim from electrical source. NOTE: DO NOT TOUCH VICTIM WHILE THEY ARE STILL IN CONTACT WITH ENERGIZED EQUIPMENT.
c. Begin breathing or mouth-to-mouth artificial resuscitation as needed (see procedure for resuscitation below). d. Treat wounds and burns as needed.
SYMPTOMS AND TREATMENT FOR SHOCK Figure 2-4
7. ASPHYXIATION (follow current American Heart Association Standards). a. Mouth to mouth artificial resuscitation (rescue breathing). (1) Place victim on back. Immediately remove anything from victim's mouth and bring victim's tongue forward by using the head tilt-chin lift method. (2) Lift lower jaw forward. (3) Pinch nose shut (or seal mouth) to prevent air leakage. (4) Take a deep breath and blow forcefully into mouth of victim watching for a rise and fall of the chest. (5) Remove your mouth from the victim and repeat step 4 giving 1 breath every 5 seconds. (6) Continue rescue breathing until victim begins to breath normally or when relieved by medical personnel. (7) If stomach becomes distended (swollen): (a) Place victim on their side (keeping head and neck supported). (b) Use the flat of your hand to exert moderate pressure on the victim s stomach between the navel and rib cage. (c) After the vomiting has ceased, quickly clear the mouth and reposition the victim, and continue rescue breathing. 8. HEAT CASUALTIES (refer to Figure 2-5) a. Heat stroke (MEDICAL EMERGENCY) occurs due to the inability of the body to regulate body temperature and the sweating mechanism. (1) Serious condition with a high death rate. (2) Characterized by extremely high body temperature (106-110 F).
(3) Skin usually will become hot, red, and dry, with little or no sweating.
(4) Victim is often unconscious or convulsions are present. (5) Full and rapid pulse (6) Rapid deep breathing (7) High blood pressure (8) Treatment (a) Immediately cool victim's body if possible by removing clothing, immersing victim in cool water, or sprinkling the body with water and fanning. (b) Raise the head and shoulders slightly and massage limbs to release body heat. SYMPTOMS OF HEAT CASUALTIES Figure 2-5
b. Heat exhaustion (1) Victim rarely loses consciousness. (2) Considerable sweating, pallor of the skin (paleness, no color). (3) Rapid pulse (140-200 per min) (4) Treatment (a) Move victim to cool place to rest. Give victim plenty of water. (b) Elevate feet, massage arms, and legs. treatment. (c) Obtain medical help for further c. Heat cramps (1) Painful cramps to the voluntary muscles (arms, legs, etc.). (2) Results from excessive loss of electrolytes (salt) from the body. (3) Body temperature is usually normal. (4) Treatment. First aid is same as for heat exhaustion. NOTE: PERSONNEL MAY BEGIN WITH SYMPTOMS OF HEAT CRAMPS AND PROGRESS THROUGH HEAT EXHAUSTION TO HEAT STROKE. 9. BURNS (refer to Figure 2-6) a. First degree (partial thickness) (1) Skin is red (2) Treatment (a) Immerse burn area in cold water
feasible. (b) Apply cold compress if immersion not b. Second degree (partial thickness) (1) Skin is red with blisters. (2) Characterized by severe pain. (3) Treatment (a) Soak in cold water, if possible. (b) Do not break blister. (c) Apply a sterile dressing. c. Third degree (full thickness) (1) Destroys skin and may destroy muscle tissue. May destroy bones in severe cases. (2) Severe pain may be absent because nerve endings have been destroyed. (3) Color may vary from white to black (charring). (4) Treatment (a) Treat for shock wrap victim. (b) Use sterile sheets (if available) to (c) Get immediate help. d. Use the Rule of Nines for determining percentage of total body area that is burned (refer to Figure 2-7).
BURNS Figure 2-6
RULE OF NINES Figure 2-7 10. STRETCHERS a. Reese Sleeves (1) There are five Reese Sleeves stretchers, made of vinyl-coated nylon, on BAINBRIDGE (located in the Repair Lockers). (2) Very effective for moving victim from engine rooms, trunks, and other compartments too confining to permit the use of a Stokes Stretcher. (3) Passageways inside the skin of the ship are too narrow to use Stokes Stretchers. Therefore, the Reese
Sleeves will be the only stretcher used when moving a victim up or down ladders or through hatches. b. Stokes (refer to Figure 2-8)
(1) Most common stretcher in the Navy. (a) Consists of a tubular metal frame, which is constructed with a shallow wire basket where the victim can be laid. (b) Securing straps can be used to hold the victim in place. (2) There are 15 stokes stretchers on USS BAINBRIDGE. STOKES STRETCHER Figure 2-8 11. RESCUE OF A PERSON OVERCOME BY TOXIC FUMES a. Done under the supervision of the Duty Fire Marshal/Gas Free Engineer due to the hazards of entering the space. b. Wear a SAR/SCBA. c. Once the space has been entered, use most appropriate means available to remove the victim and administer first aid. 12. FIRST AID BOXES a. There are 49 first aid boxes (identified with a large red cross) in various locations throughout the ship, which are used to provide first aid treatment to victim.
13. BATTLE DRESSING STATION (BDS) AND MEDICAL TREATMENT ROOM LOCATIONS a. There is one Medical Treatment Room and two BDS for treatment of casualties.
b. Location of the Medical Treatment Room is (1-220- 3-L). c. BDS locations: (1) FWD BDS (1-58-2-L) (2) AFT BDS (2-410-1-L) d. Victims are transported to the nearest BDS via a route designated by the DCA in DC Central/CCS. e. BDS treats casualties not requiring surgery or advanced life saving measures. f. More serious casualties are transported and treated in the Medical Treatment Room (sick bay). g. Triage and staging area for mass casualties is the enlisted mess decks. 14. POISON ANTIDOTE LOCKER LOCATION: Outside Medical Treatment Room (1-220-3-L) in passageway 1-220-5-L. 15. PORTABLE MEDICAL LOCKERS LOCATION a. Passageway 1-78-01-L (outside Repair 2) b. Passageway 2-442-2-L (aft of Repair 3) 16. WATER SURVIVAL a. The greatest immediate threat to your life is hypothermia. (1) If the water temperature is 66 degrees, you have a 50% chance of survival after 4 1/2 hours. (2) If the water temperature is 50 degrees, you have a 1% chance of survival after 3 1/2 hours. (3) Be alert for signs of hypothermia in water colder than 75 degrees. b. To protect yourself against hypothermia:
(1) Minimize heat loss; raise as much of your body as possible out of the water. (2) Cover your head and neck as much as possible.
(3) Shield yourself from the wind. (4) Huddle together to conserve warmth. c. You can survive for a month without food but you will likely die after a week without water. Water is lost from the body by the evaporation of perspiration. Water loss can be reduced by keeping your clothes wet during the day (weather permitting), and drying them before sundown. d. To minimize moisture loss, conserve water and food: (1) Protect yourself from sunburn (increases moisture loss). (2) Do not eat or drink for the first 24 hours. (3) Never drink seawater. (4) Drink small amounts of water three to four times a day. You can survive on six ounces of water per day. 17. TRIAGE. The sorting and classification of mass casualties to determine priority of treatment, evacuation, and proper place of treatment. a. General Principles (1) Return as many people to duty after minor treatment. Treat and evacuate those not able to return to duty. (2) Usually six casualties or more constitute a mass victim situation. However, the types of injuries alone determine to what extent the treatment system will be overtaxed. (3) Do the greatest good for the greatest number of people. (4) You have limited time, supplies, and personnel. (5) Victims with minor wounds may be used to treat themselves or others.
b. Triage Categories and Color Codes. (1) Minimal (Green) - those who can be treated and returned to duty immediately or used for assistance. Minor first aid is usually all that is required.
(2) Immediate (Red) - those with life threatening injuries requiring emergency treatment. This may include uncontrolled bleeding, airway compromise, tourniquet cases, compound fractures of major bones, open abdominal wounds, severe burns, closed head injuries, and severe shock. (3) Delayed (Yellow) - after emergency treatment is completed further treatment may be delayed. Often the immediate victim can be reclassified as delayed status. (4) Expectant (Blue) - those who will probably die whether treated or not. (5) Triage Systems - two priority systems; one for treatment and one for evacuation. TREATMENT a - Minimal b - Immediate c - Delayed d - Expectant EVACUATION a - Immediate b - Delayed c - Minimal d - Expectant d. Considerations (1) Type and duration of available transportation, tactical situation, and ability of victim to tolerate evacuation. (2) Victim must be stabilized before evacuation. 18. RE-TRIAGE. Go back and re-evaluate, important changes may have occurred after initial triage was conducted. Reevaluate immediate, delayed, and then expectant. It is not uncommon for categories to change back and forth. Continue re-evaluation until all victims are stabilized and evacuated.