Chapter 2 - Evaluate A Casualty

Evaluate A Casualty Lesson Two MSTC, FT LEWIS WA

Primary Objective ► Rapid

Casualty Assessment

► Control ► Treat

Hemorrhage

Penetrating Chest Trauma

► Maintain

Airway

► Package

Casualty for Transport

Rapid Casualty Assessment ►

Approach the casualty

►

Level of consciousness

►

Casualty positioning

►

Check airway

►

Check breathing

►

Check bleeding

Rapid Casualty Assessment ► Approach

the casualty:

 Scan the area for danger  Determine best route of access to the casualty and the best route of egress  Plan an evacuation route prior to exposing yourself to hostile fire  Plan what you will do to help the casualty before you go to the casualty’s aid  Then approach the casualty by the safest route

Rapid Casualty Assessment ► Approach

the casualty:

 Form a general impression  Determine mechanism of injury

Mechanism of Injury

Mechanism of Injury

Rapid Casualty Assessment ► Perform

a rapid casualty initial assessment:

 M – Massive Bleeding  A – Airway  R – Respirations  C – Circulation  H – Head Injury

Care Under Fire

Rapid Casualty Assessment ► Perform

a rapid casualty initial assessment:  A – Airway  B – Breathing  C - Circulation Tactical Field Care

Rapid Casualty Assessment ► Level

of Consciousness:

 AVPU ►A – Alert ►V – Verbal Stimuli ►P – Pain Stimuli ►U – Unresponsive  Gently shake or tap the casualty on the shoulder and ask in a loud, but calm voice: “Are you okay?”

Rapid Casualty Assessment ► Casualty

Positioning:

 Position the casualty on his back, by log rolling casualty

Airway

Rapid Casualty Assessment Check Airway:  If you suspect head or neck injuries, use the jaw thrust method to open the airway. Otherwise, use the head-tilt/chin-lift method

Breathing

Rapid Casualty Assessment Check Breathing:  Look – Rise and fall of chest and abdomen  Listen – Sounds of breathing  Feel – Breath on the side of your face

Rapid Casualty Assessment Check Breathing: Count Respirations: Inhalation + Exhalation = Respiration Count each respiration for 15 seconds

Rapid Casualty Assessment ► Check

Breathing:

 Normal= 12 to 20 resp./min.  > 20 = RAPID Deep

Hyperventilation = Rapid,

 < 12 = SLOW Hypoventilation = Slow, Shallow

S.O.B. (Shortness of Breath) = Rapid, Shallow

Rapid Casualty Assessment ► Check

Breathing:

 If the casualty has a penetrating chest wounds and is breathing or making an effort to breath, stop the evaluation and apply an occlusive dressing to the open chest wound  In a combat situation, if you find a casualty with no signs of life (no respiration and no pulse), do not continue first aid on the casualty

Rapid Casualty Assessment Open Chest Wound

Rapid Casualty Assessment ► Check

Breathing:

 Relieve a tension pneumothorax (as necessary) by needle chest decompression in an already existing penetrating chest wound.

Needle Chest Decompression

Needle Chest Decompression

Asherman Chest Seal

Tension Pneumothorax

Air pushes over heart and collapses lung Air outside lung from wound

Heart compressed not able to pump well

Circulation

Rapid Casualty Assessment ► Check

Circulation:

 Circulation is evaluated by assessing the rate and quality of the pulse, identifying external bleeding and evaluating the skin

Rapid Casualty Assessment ► Check

Circulation:

 What is a pulse? ►The

contraction and expansion of an artery due to the surge of blood from the beat of the heart

Locate the Pulse Sites ► Carotid

Pulse:

 Place the fingertips of your index and long fingers along the carotid artery in the groove between the trachea and the neck muscle

Carotid Pulse

Locate the Pulse Sites ► Radial

Pulse:

 Place the tips of your first two fingers over the radial artery on the wrist

Radial Pulse

Locate the Pulse Sites ► Other

Sites:

 Brachial Pulse – located at the underside of the upper arm  Femoral Pulse – located in the groin area  Popliteal Pulse – located behind the knee  Posterior Tibial Pulse – located on the inside of the ankle  Dorsalis Pedis – located on top of the foot

Locate the Pulse Sites

Rapid Casualty Assessment ► Check

Circulation:

 Measure and Monitor Pulse ►Palpate

(feel)

 Count the beat for 15 seconds

► Pulse

Rates:

 Normal Pulse rate is 60-80 Beats Per Minute ►>100

Beats Per Minute = Tachycardic ►< 50 Beats Per Minute = Bradycardic

Rapid Casualty Assessment ► Check

Circulation:

 Classify the strength ►Note

significant changes in rate, rhythm, and strength. Irregular or fluctuating pulse may indicate early stages of shock. Weak and rapid pulse may indicate more advanced stages of shock.

 Assess the skin ►Evaluating

the skin color, temperature and moisture helps you determine if the body is receiving adequate oxygenated blood.

Rapid Casualty Assessment ► Check

Circulation:

 Perform blood sweep ►Look

for blood soaked clothing

►Look

for entry and exit wounds

►Control

any addition external bleeding by necessary means

Rapid Casualty Assessment ► Check

Circulation:

 Initiate intravenous access  Apply saline lock to catheter  Await additional instruction from medical personnel for fluid therapy

Rapid Casualty Assessment ► Splint

Fractures and Recheck Pulses:  Check distal (below injury site) pulses both before and after splinting  To remedy any decrease in the pulse caused by splinting, adjust the position of the splint

Additional Care ► Monitor

the Casualty:

 Reassess the casualty ►Stable

casualty – every 15 minutes ►Unstable casualty - every 5 minutes

 Reassure the casualty

Death of General Albert Sidney Johnston ► Leading

Confederate General ► KIA at Shiloh 7 April 1862 ► Gen Johnston’s Surgeon - Dr. David Yandell directed that tourniquets be issued ► During the battle, Gen Johnston sustained injury to popliteal artery - bled to death ► Tourniquet was in his pocket

CASEVAC ► Package

and Prepare Casualty for Evacuation

 Non-ambulatory via SKEDCO litter, Talon folding litter or other field expedient methods  Ambulatory ► Fill

out a field medical card (DD Form 1380) and request evacuation (MEDEVAC request)

► Act

as a leader of litter team

CASEVAC

Talon Litter

Talon II Litter

WALK Warrior Aid Litter Kit

SKEDCO LITTER

SKED Litter

Mount LifeLine Video

IFAK Improved First Aid Kit

Point of Wounding Care ► The

only place in the continuum of battlefield care where we can directly influence survivability is at the point of wounding. By training every soldier to provide point of wounding care we can save more lives on today's battlefield.

Summary ► As

discussed in lesson 1, the three primary preventable cause of death from injury on the battefield are:  Severe bleeding (apply a tourniquet or emergency trauma dressing)  Tension Pneumothorax (perform needle chest decompression)  Airway blockage (insert a nasopharyngeal airway)

Summary ► Circumstances

in which you should not treat a casualty while you are under enemy fire:  Your own life is in imminent danger  Other soldiers in area require more urgent treatment  The casualty does not have vital (life) signs, ie. breathing, pulse

Questions????