Types of damage in combat
In order to learn how to properly provide pre-medical aid in combat, it is need to know the main causes of death as a result of hostilities:
31% -are penetrating head trauma
25% – is a non-treatable torso with surgery
10% – is a trauma that is potentially treatable with surgery
9% – blood loss due to wounds after separation of limbs
7% -are crippling injuries
5% – intense pneumothorax
1% – problems with the respiratory tract
Less than 5% are deaths from wounds after an evacuation to a medical facility, mainly associated with infections and complications from shock.
It has been estimated that for all the potential causes of death, up to 90% of these can be avoided by the simple use of a tourniquet for bleeding from the extremities, rapid treatment of strained pneumothorax and the creation of airway patency.
Individual First Aid Kit (IFAK).
An Individual First Aid Kit is intended to be used by an individual for self-aid or to render aid to a buddy (such as for TCCC – Tactical Combat Casualty Care), as opposed to a more full featured medical kit that might be carried by a combat medic. A typical IFAK might contain:
CAT combat tourniquet, Celox or quikclot, Trauma Shears
Israeli compression trauma bandage, compressed gauze
Chest Seal, gauze sponge
Nasopharyngeal tube, lubricant, alcohol pads
Combat Wound Medication Pack (contains the following components: Moxifloxacin 400 mg tablet (one), Meloxicam 15 mg tablet (one), and Acetaminophen 1300 mg extended release (650mg caplet x 2); each of the three medications (in unit dosages) is contained in a blister pack.
Nitrile exam gloves, cloth tape roll.
A writing instrument like a sharpie or mini-sharpie marker is also commonly carried – in case any notes have to be made (anywhere or on anything.)
IFAK perferct to carry in a cargo pocket, in a backpack, or on kit, or to fill existing kit pouch. Comes packaged in a ziplock style resealable water tight bag, that can easily be stuffed into a backpack or cargo pocket. Some items may be swapped out or interchanged with like items, based on availability, items are new and military surplus items, never used. These are the same items supplied to our military service members.
Method of moving the victim to the recovery position
If a person is unconscious but is breathing and has no other life-threatening conditions, they should be placed in the recovery position. Putting someone in the recovery position will keep their airway clear and open. It also ensures that any vomit or fluid won’t cause them to choke.
These steps should be followed once the shaking has stopped.
Kneel on the floor to one side of the person.
Place the person’s arm that is nearest to you at a right angle to their body, so that it is bent at the elbow with the hand pointing upwards. This will keep it out of the way when you roll them over.
Gently pick up their other hand with your palm against theirs (palm to palm). Turn any rings inward to avoid scratching their face. Now place the back of their hand onto their opposite cheek (for example, against their left cheek if it is their right hand). Keep your hand there to guide and support their head as you roll them.
Use your other arm to reach across to the person’s knee that is furthest from you, and pull it up so that their leg is bent and their foot is flat on the floor.
Gently pull their knee towards you so that they roll over onto their side, facing you. Their body weight should help them to roll over quite easily.
Move the bent leg that is nearest to you, in front of their body so that it is resting on the floor. This position will help to balance them.
Gently raise their chin to tilt their head back slightly, as this will open up their airway and help them to breathe. Check that nothing is blocking their airway. If there is an obstruction, such as food in their mouth, remove this if you can do so safely. Stay with them, giving reassurance, until they have fully recovered.
Methods of moving to the abdomen of the casualty
The casualty is moved to the abdominal position within the first 5-6 seconds in order to reduce the risk of airway obstruction due to tongue congestion or vomiting.
Take the wounded man’s hand over his head and grasp his shoulder. Explanation: No signs of damage to the cervical spine can be detected in a coma or clinical death. Therefore, turning on the abdomen should be done with the obligatory safety of the cervical spine. The wounded head secures the neck and plays the role of the axis, which significantly speeds up and facilitates the rotation of the injured person on the abdomen (Fig. 1).
Fig. 1. Moving of the casualty to the abdomen
To grasp the wounded person behind his shoulder, tightly press against his torso and grab his leg with his leg. Explanation: Holding the shoulder far from the shoulder and grabbing the shin with your foot will allow you to roll over the wounded person as quickly as possible and with minimal effort (Fig. 2).
Fig. 2. Moving of the casualty to the abdomen
Closely pressed to the ground, sharply turn the wounded man from behind his shoulder on his stomach without lifting his head and shoulders above the wounded man’s head or grabbing the wounded shin with his foot sharply back with him. Norm: The time of turning of the injured person on the abdomen in the lying position for further transportation to the shelter should not exceed 5 seconds (Fig. 3).
Fig. 3. Moving of the casualty to the abdomen
Keeping the wounded man in a position on his stomach, continue to perform a combat task, if it is not possible to transport him to the shelter sector (Figure 4).
Fig. 4. Moving of the casualty to the abdomen
Distribution of tasks among fighters in providing pre-medical aid to a wounded person in the tactical field
Fig. 1. The distribution of tasks between fighters by numbers
The first number helps the third number to drag the wounded into the shelter. He then proceeds to take off his helmet and identify the signs of biological death. Examines the head for wounds and injuries of the skull bones. During transportation to the sanitary transport, the main end of the stretcher is to the left.
The second number spreads a raincoat or tent. Then removes from the wounded unloading vest and bulletproof vest, determines the pulse in the carotid artery. In case of clinical death, it causes a precardial stroke, conducts an indirect heart massage. During transportation to the sanitary transport, the main end of the stretcher is on the right.
The third number, after transporting the wounded to the shelter, helps to remove the unloading vest and then the bulletproof vest. Undoing the belt. During resuscitation he lifts the legs of the injured. When transported to sanitary transport, the delicate end of the stretcher bears.
The fourth number provides fire cover. If possible, it helps to move the wounded person from the ground to a stretcher and transport him to the sanitary transport, leaving the task of fire cover.
Algorithm for providing aid under the fire
Coordination of the actions of the soldiers in preparing the wounded for examination
The first number removes from the wounded weapon if it was left behind on the belt.
The second number spreads out a stretcher or tent and is to the left of it.
The third number puts the wounded person on a stretcher in the “lying on his back” position (fig.1).
Fig. 1. Actions of fighters by numbers in preparation of the wounded for examination
The first number is removed from the wounded weapon if it was left behind on the belt.
The second room spreads out a stretcher or tent and is to the left of it.
The third number puts the wounded man on a stretcher in the “lying on his back” position (fig.2).
Fig. 2. Actions of fighters by numbers in preparation of the wounded for examination
The first number shows signs of biological death. Examines the head for wounds and injuries of the skull bones. In the case of clinical death, performs artificial respiration by mouth-to-mouth.
The second number determines the pulse in the carotid artery. In case of clinical death (when there is no consciousness and there is no pulse on the carotid artery (but there are no signs of biological death) causes a precardial blow to the chest and, if necessary, starts an indirect cardiac massage.
The third number unfastens the wound belt. Examines his neck, chest, abdomen and legs for wounds and bleeding. In case of clinical death, it lifts the legs of the injured, restores strength after transportation (fig.3).
Fig. 3. Actions of fighters by numbers in preparation of the wounded for examination
Methods of examination of the head, neck, torso, extremities
Head examination. Before carrying out inspection from the wounded in a position on a back it is necessary to remove a helmet, to align a head. To determine the presence on the head of wounds, local hemorrhages and hidden lesions, it is necessary to simultaneously carry out with open fingers of the fingers the sensation of the integrity of the bones of the skull and the examination of the face, keeping the fingers under the nape of the neck, constantly gaze controlling the purity of gloves (blood, fluid). Then examine the bones of the forehead, eye pits, base of the nose, upper jaw, lower jaw for damage, bruising behind the ears and around the eyes (raccoon eyes). To look into the ears for the purpose of detecting blood, yellowish or pink fluid (liquor) – signs of a fracture of the base of the skull and a very serious wound to the head. Opening the eyelids with your fingers, examine the integrity of the eyes and the presence of bleeding. Determine the symmetry of the pupils: if one pupil is wide (anisocoria) and the other is narrow, it is a sign of severe head trauma.
Neck examination. It is necessary to examine the integrity of the neck and superficial veins of the neck, to determine the presence of wounds and local hemorrhages, hidden lesions. This requires:
– to feel the neck, having opened open fingers for a neck, in a collar zone, starting from the seventh vertebra (protruding), gradually rising to the base of the skull. However, there should be no asymmetrical projection, tension or sagging of the muscles on one side of the neck. The cleanliness of gloves (blood, liquid) should be constantly monitored;
– in the case of tension (swelling) of the superficial veins of the neck, it is possible to suspect chest injuries and intense pneumothorax.
– if the skin is exposed to blueness or pallor of the neck, and there may be swelling (emphysema) under the skin on one side: when you click on this area, you can hear a sound like snow creaking. These are signs of chest injury and intense pneumothorax;
– If the thyroid cartilage (cadaver) and the trachea below the neck are displaced away from the axis of the neck, chest injuries and intense pneumothorax should be suspected.
Chest examination. If the victim is conscious, then when the chest is detected during examination, the victim will strain the patient’s side, there will be pain in the victim, crunching. If the victim is unconscious, then in the presence of fractures at the hands will be felt unnatural piercing. Under the skin from the fracture (wound) may also be swelling (emphysema). After that, hidden damage is revealed:
– Before examination, the victim should remove the bulletproof vest and open (cut) the outer clothing. Clothes should be carefully inspected for blood stains and bullet holes. Press on shoulder shoulders (on shoulder straps): If there is no shoulder girdle damage, continue: Press on top of shoulders on top and stretch.
– Consecutively, symmetrically on both sides of the axillary regions downwards, palms tightly feel the chest and inspect the front, the edge of one palm, pressing the breastbone.
Examination of the abdomen. It is necessary to undo the belt on the trousers, open the belly. Conditionally divide the belly into four symmetrical sections. Consistently, with one hand on the fingers of the other hand, touch each square. The abdomen should be symmetrically soft. If there is tension in the abdominal muscles, it is a sign of injury to the abdomen.
Examination of pelvic bones. Clothes should be pressed to the sides of the iliac bones. If there is no unnatural puncture of the bones, crunch, pain in the injured, who is conscious, continue the action: Press the pelvic bones on top of the clothes, trying to spread them through the clothes. At a fracture of pelvic bones complication is bleeding from 2 to 4 liters of blood.
Examination of the perineum and inguinal folds. Keeping your hands under your underwear, fingers open, consistently, symmetrically on both sides to the inguinal areas downwards, it is necessary to feel the body tightly, revealing wound openings, blood, fluid. Inspect the crotch.
Then it is necessary to turn the wounded person to the position to the side and with his hands under his underwear, his fingers spread open, it is necessary to inspect the back, across, buttocks, crotch on the wound openings, fractures, integrity of the spine, blood, fluid.
Examination of extremities. Check the performance of the previously applied harnesses. First you need to look at the far extremity, then the neighbor. First examine the feet of the victim, then the hands. Without removing the garment (or cutting it), wrapping your hands under the limb with open fingers, sequentially, symmetrically on both sides, grasping the limb, it is necessary to feel the limb in order to detect unnatural mobility of the joints or mobility of the limbs outside the joints and joints. Take off your shoes and inspect your feet. In winter, it is not advisable to remove shoes due to hypothermia. If there is no suspicion of injury to the foot, it is necessary to inspect the shoes carefully.
At the end of the examination, it is necessary to fix the fractures and cervical spine, preparation for transporting the victim to a safe zone.