INTRODUCTION
GAIN ATTENTION
Throughout the history of urban warfare, one disturbing fact has remained a constant - the urban combat environment produces a high casualty rate. It is incumbent, on all of us, to be prepared for this eventuality and be prepared to take appropriate actions. Medical considerations must be a part of every combat operations plan.
PURPOSE
INDIVIDUAL TRAINING STANDARDS
0300.1.13, 0369.1.4, PVTX 17.1, PVTX 17.2, PVTX 17.3, PVTX 17.4,
CPLX 17.1, SGX 14.14, SGTX 17.1, GSGT 14.5
MISSION PERFORMANCE STANDARDS
TERMINAL LEARNING OBJECTIVE
Without the aid of references and in accordance with FMFM 21-11, be able to demonstrate the various types of first aid required during MOUT.
ENABLING LEARNING OBJECTIVES
1. Know how to control a hemorrhage.
2. Know how to dress wounds.
3. Know how to treat for shock.
4. Know how to splint fractures.
5. Know the proper way to carry a litter in an urban environment.
6. Know how to properly protect yourself in an NBC environment during MOUT.
7. Know the considerations of casualty evacuation during MOUT.
METHOD AND MEDIA
This period of instruction will be taught through lecture and demonstration.
TESTING
This period of instruction will be tested during practical application exercises.
TRANSITION
BODY
1. Control of a Hemorrhage:
a. Life Saving Measures:
1) Clear the airway and restore breathing and heart beat as necessary. This
allows oxygen into the lungs. If oxygen does not reach the lungs, brain
damage or death will occur within minutes.
2) Stop the bleeding, blood carries oxygen to all parts of the body and
significant loss can cause death.
3) Administer shock control measures. Shock may result from any type of
injury or wound. If not treated, shock may result in death.
4) Apply a dressing and a bandage. All wounds must be properly covered to
keep them clean. If this is not done, germs may get into the wound and cause
infection. An infected wound will not heal and may cause the wound to become
worse.
5) Apply lifesaving measures beginning with the area in the greatest immediate
threat. Generally speaking, the lifesaving measures should be applied in the
following order (ABCD):
a) A=Airway
b) B=Bleeding
c) C=Control
d) D=Dressing
b. Application of Pressure Dressing:
1) A pressure dressing is the recommended way to control bleeding from a
wound.
2) The following steps shall be followed:
a) Look for more than one wound. A round may have entered the body at one
point and exited at another.
b) Cut the clothing around the wound and lift it away from the wound.
Removing clothing in this manner will prevent further contamination of the
wound. If tearing the clothes might result in rough handling of the injured
part, do not tear the clothing away. Do not touch the wound. Keep it as
clean as possible to prevent further contamination. If the wound is already
dirty, leave it alone.
3) Open a first aid dressing and place it on the wound.
a) Remove the sterile dressing from the casualty's first aid case.
b) Remove the sterile dressing from the plastic bag. Twist the sterile
dressing to break the paper seal.
c) Holding the folded bandage, pull the dressing open.
d) Place the sterile side of the dressing on the wound without letting it
touch anything else.
e) Wrap the bandage tails tightly around the limb and over the dressing,
applying enough pressure to stop the bleeding, Tie the ends of the bandage
securely. The knots should be on top of the dressing if possible.
4) If bleeding continues, follow these steps:
a. Apply hand pressure to the dressing.
b. If bleeding still continues, utilize pressure points.
c. Elevate the injury above heart level. The injury may be elevated at any
time while applying a pressure dressing provided the limb is not broken.
5) If the dressing becomes soaked with blood, another dressing is placed directly on top of the soaked dressing.
6) If bleeding is now controlled, treat the casualty for shock.
c. Application of a Tourniquet:
1) If direct pressure, elevation and pressure points do not control the
bleeding, a tourniquet is applied as a last resort measure.
2) A tourniquet may be made with a strip of flexible material such as cloth,
a rifle sling or a belt. Anything thin, such as string or wire, should not be
used as it may cut into the injured limb.
3) A tourniquet is always place above the wound - between the heart and the
wound.
4) A tourniquet is only loosened by medical personnel, it may be tightened by
anyone if necessary to slow the bleeding.
5) Always leave the tourniquet exposed and mark the casualty by placing a "T"
and the time the tourniquet was applied on the forehead.
6) Treat the casualty for shock.
2. Treatment/Prevention of Shock:
a. When treating a casualty, assume shock is present or will be shortly. Do not wait until actual signs or symptoms of shock are present. This would put the casualty’s life in jeopardy.
b. The following steps are used:
1) Position the casualty:
a) Do not move the casualty or his limb if suspected fractures have not been splinted.
b) Lay the casualty on his back. Note: Some casualties in chock after suffering a heart attack, chest wound or breathing difficulty, may breathe easier in an upright position. Monitor carefully in case his condition deteriorates.
c) Elevate the casualty’s feet higher than hear level. Use a stable object, such as a wooden box, field pack or rolled up clothing in such a way as so his feet will not slip off.
d) Loosen the clothing at the neck, waist, or anywhere it may be binding. Loosen, but do not remove his boots. Remove any field equipment. Take care not to aggravate the injury when removing or loosening any items. Do not loosen clothing in a chemical/toxic area.
e) Prevent chilling or overheating. The key is to maintain normal body temperature. Place a blanket or other like items over and under the casualty to keep him warm and dry in cold weather. Place the casualty in the shade and avoid bundling him in hot weather.
f) Calm the casualty. While treating the casualty, reassure him if he is conscious. Be self confident, show him that you know what you are doing.
g) Do not give the casualty any food or drink while treating for shock.
h) If the casualty is unconscious, place him on his stomach and turn his head to one side.
3. Splinting of Fractures:
Fractures are defined as any break in the continuity of a bone. Many types of accidents cause injuries to bones, joints or muscles. In rendering first aid to an injured person, you must always look for signs of fractures, dislocations, sprains, strains and contusions (bruises).
a. In an emergency, almost any firm object or material will serve as a splint. Items such as umbrellas, canes, rifles, tent pegs, sticks, oars, wire mesh, boards, corrugated cardboard and folded newspaper can be used as splints. A fractured leg may sometimes be splinted by fastening it to the uninjured leg.
b. Characteristics of splints:
1) Splints should be lightweight, strong, fairly rigid, and long enough to reach past the joints above and below the fracture.
2) Splints should be wide enough so that the bandages used to hold them in place will not pinch the injured part.
3) Splints must be well padded on the side that comes in contact with the body.
4) If the victim is wearing heavy clothing, you may be able to apply the splints to the outside, thus allowing the clothing to serve as part of the required padding.
5) Fasten splints with bandages, strips of adhesive tape, clothing or other suitable material. If possible, one person should hold the splints in place and another fasten them to the casualty.
6) Although splints should be applied snuggly, they should never be tight enough to interfere with blood circulation. When you are applying a splint to an arm or leg, try to leave the fingers and toes exposed.
7) Examine the splinted part often as swelling may occur and splints and bandages that were applied correctly may later become too tight. Be sure to check the circulation.
c. Two Types of Fractures:
1) Closed – A closed fracture is one in which the injury is entirely internal; the bone is broken but there is no break in the skin.
2) Open – An open fracture is one in which there is an open wound in the tissue or skin. Sometimes the open wound is made when the sharp end of a broken bone pushes out through the skin. Another example of an open fracture is when the fracture is caused by shell fragments or a bullet.
d. Fracture Signs and Symptoms:
1) Tenderness or pain at injured part.
2) Swelling as well as discoloration of the skin at the injury.
3) Sharp pain when the casualty attempts to move a part.
e. Treatment:
1) If the fracture is open, stop the bleeding by applying a first aid dressing and bandage as you would on any wound.
2) Remove all binding objects such as watches or rings from the extremity to be splinted. These objects may restrict the flow of blood if the injured part becomes swollen. This can cause additional trauma.
3) Splint them where they lie. This means that if the situation permits, splint the fractured part before any movement of the casualty is attempted and without any changes in the position of the fractured part. If the bone is in an unnatural position of the joint is bent, do not try to straighten it out. If the joint is not bent, do not bend it.
4) Apply a splint so that the joint above the fracture and the joint below are completely immobilized.
5) Use padding between the injured part and the splint to prevent undue pressure and further injury to tissue. This is especially important in the area between the legs, the armpit and on places where the splint comes into contact with bony parts such as the elbow, wrist, knee or ankle joint.
6) Bind the splint with bandages at several points above and below the fracture. Do not bind so tightly that it interferes with the flow of blood. No bandage should be applied directly over the fracture. Tie bandages in a non-slip knot positioned against the splint.
7) Use a sling to support a splinted arm which is bent at the elbow.
8) Check circulation before and after you apply a splint. If there is a circulation problem after you apply a splint, you may have to loosen the bandages before securing the splint.
4. Litter Handling and Combat Casualty Carries:
Proper transport of the injured, utilizing proper equipment and techniques can prevent further injuries and save lives.
a. The A, B, Cs:
1) Careful and correct handling of the casualty is extremely important. If the casualty is incorrectly moved or roughed up, his injury may become more severe and even fatal (neck, spinal or chest for example)
2) Remember, before any movement is attempted, a quick evaluation is required. The ABCs of first aid are applied: Airway, Breathing, Circulation.
3) If immobilization is required, splinting should be done before movement, broken bones because of their sharp edges may cut tissue, veins or arteries. You may have greater problems if you do not immobilize.
b. Army Litter Carry:
c. Improvised Blanket Stretchers:
1) Open blanket, place one pole lengthwise across center of blanket and fold over pole.
d. One Man Carry Techniques:
1) Arms Carry – Carry the injured man shoulder high with arms.
5. Dressing of Wounds:
As a Marine you may encounter many types of wounds, your knowledge on how to properly bandage and care for the wound will help in the prevention of infection and save a fellow Marine’s life.
a. Applying a Field Dressing: Note – Use the casualties field dressing, not your own. Improvised dressings may be made from clothing, blankets or other materials if the field dressing not large enough to cover the wound. If this is the case, use the cleanest improvised dressing material available.
1) Grasp the tails in both hands.
Warning: Casualties with stomach wounds should not be given food or water. Moistening of the lips is allowed.
b. Seek medical aid.
6. Treating a Sucking Chest Wound:
a. Locate the open chest wounds. Examine the casualty to determine both the entry and exit wounds.
b. Expose the wound. If appropriate, cut or remove the casualties clothing to expose the entire area of the wound.
Warning: Do not remove clothing that is stuck to the wound as further injury could occur. Do not remove protective clothing in a NBC environment. Apply dressing over the protective clothing.
c. Open the casualty’s field dressing. Tear open one end of the plastic wrapper covering the field dressing and remove the inner packet. Be careful not to destroy or touch the inside of the last wrapper as it will be used to create an airtight seal over the wound. If necessary, any airtight material such as cellophane or foil may be used.
d. Place the inside surface of the plastic wrapper directly over the wound and hold it in place when the casualty exhales.
e. Apply the field dressing to the wound or over the protective clothing.
7. Treat a Head Injury:
a. Evaluate the casualty for open head injury:
b. Evaluate the casualty for closed head injury:
c. Apply first aid:
8. Casualty Evacuation Considerations:
When moving casualties back to the Casualty Collection and Clearing Point, the casualty evacuation team must ensure they avoid exposing themselves or the casualty to enemy fire of danger. The following should be remembered:
a. Movement within buildings is extremely difficult. Movement will be hampered by narrow corridors, doorways, mouseholes, stairs, rubble, other troops, re-supply teams and reinforcements. Movement, where possible, should be controlled and organized so that normal triage can take place.
b. Movement between buildings is also hazardous and difficult. Use must be made of any cover, such as walls, and concealment such as the use of smoke. Movement should be done under existing safe routes.
c. If secured, underground systems can be used as safe routes for casualty evacuation. Movement may be restricted by the confined space of some tunnels but it may be the quickest, safest and least congested option.
d. When possible, vehicles can be used for quick casualty evacuation. This is done when the route is free of enemy automatic and anti-tank fire.
e. The section, platoon and company medics should ensure that they have sufficient supplies for an urban battle.
f. All dead bodies, friendly or enemy, should be processed. This includes the redistribution of all weapons and equipment. The bodies should then be placed away from living casualties and separated according to friendly or enemy.
g. All casualties should be separated by priority at the Casualty Collection Points at each building awaiting evacuation. These should be marked using the NATO marking system covered in an earlier POI.
QUESTIONS
SUMMARY
The MOUT Homepage Hot Links:
Battalion Aid Station Support of Military Operations in Urban Terrain (BASS MOUT)
Combat Casualty Care in Stability Operations (CALL)
2) Patient placement – Bring liter to patient, using three men, roll patient. Man at the head counts (“on the count of three” for example), align patient to board, secure patient.
3) Patient transportation – Using poles, four men pick up the litter. Man at front right counts, carry patient feet first except up hills.
2) Place a second pole parallel to the other on the blanket and fold edges over the second pole. The weight of the casualty will hold them together.
3) Transport the same as the army litter.
2) Support Carry – Injured man must be able to walk, the bearer acts as a crutch.
3) Saddle Back Carry (Piggyback) – Only a conscious patient.
4) Fireman’s Carry.
2) Hold the dressing with the white side down directly over the wound. If the casualty is able, he may hold the dressing in place.
3) Hold the dressing in place with one of your hands and use the other to wrap one of the tails around the body.
4) Wrap the other tail in the opposite direction until the dressing is completely covered.
5) Tie the dressing firmly, yet loosely enough to insert two fingers between the tie and the dressing.
6) Overlap the dressing with improvised reinforcement material such as cravat, strips of torn T-shirt, or other cloth if available to provide additional protection.
7) Tie the wound bandages on the opposite of the dressing tie.
8) Keep the casualty with knees bent and evacuate him as soon as possible.
1) Place the white side of the dressing directly over the plastic wrapper, covering the open wound.
2) Hold the field dressing securely in place to create an airtight dressing.
3) Have the casualty breath normally.
4) Maintain pressure on the dressing while wrapping both tails around and under the body.
5) Apply pressure while the casualty is exhaling. Tie the tails into a non-slip knot (square knot) over the center of the field dressing.
6) Position the casualty in the prone position with his injured side toward the ground or in a sitting position – whichever makes breathing easier.
7) Seek medical aid.
1) Deformity of the head – abnormal pit or depression in the skull.
2) Blood or other fluid escaping from the scalp, ears or nose.
3) Object protruding from the head – glass, wood, shrapnel or exposed brain matter.
1) Nausea or vomiting, convulsions or twitching, confusion or slurred speech.
2) Current or recent loss of consciousness.
1) Clear the airway.
2) Position the casualty.
Note: Evaluate the injury slightly, treat as possible neck or spinal injury until proven otherwise. Do not elevate the casualty’s head if he is accumulating fluids in his throat. When there is bleeding from the mouth and throat, position the casualty on his side so that the blood will drain out of his mouth and not down his windpipe.
3) Control bleeding and protect the wound.
a) Do not attempt to remove an imbedded object from the head.
b) Leave severe head injuries where brain tissue is protruding alone.
c) Carefully place a fist aid dressing over the tissue.
d) Do not remove or disturb foreign matter that may be in the wound.
4) Apply dressing and bandages.
a) When applying dressing, have the conscious casualty sit up unless other injuries are evident or he is unable to sit up under his own power.
b) Position the casualty on his side with his face turned.
c) If the casualty is unconscious, has a severe head injury, or you suspect a possible neck/spinal cord injury, immobilize the casualty and bandage in place.
5) Do not give the casualty anything to drink.
6) Treat the casualty for convulsions.
Warning: Convulsions (seizures/involuntary jerking) may occur after a mild head injury. When the casualty is convulsing, protect him from himself.
7) Treat for shock.
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