Public Lands Institute. Combat Lifesaver Course. Telemedicine and Advanced Technology Research Center. Follow this and additional works at. Tactical Combat Casualty Care (TCCC) has saved hundreds of lives during our nation's conflicts in Iraq and Afghanistan. Nearly 90 percent of combat fatalities. US Army IS medical course – Combat Lifesaver Course CC The "D" edition of the Combat Lifesaver Course replaces the previous "C" Inte.
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examinations for combat lifesaver certification and recertification. All of the CONDITIONS: Given a combat lifesaver medical equipment set and a casualty with. Interschool Subcourse , Combat Lifesaver Course: Student Self-Study, CONDITIONS: Given a combat lifesaver aid bag and a casualty with one or more . filename=/docs/doc/pdf. DIGITAL VERSION AVAILABLE. A digital version of this CALL publication is available to view, download, or reproduce from.
Include equipment for the buddy-aid tasks, IS, even though it may not be taught in a group. The equipment will be used for the performance evaluation. Plan on enough materials to allow for practice and retests. Your instructor, the staff surgeon combat lifesaver supervisor, or previous instructors of the CL course may be able to give you an idea of how much extra to have on hand. The combat lifesaver program is a continuous ongoing program and requires continuous equipment and material support for the already qualified CLs. Be sure to maintain contact with your supply source to ensure your CL supplies are programmed into the system.
Your instructor, the staff surgeon combat lifesaver supervisor, or previous instructors of the CL course may be able to give you an idea of how much extra to have on hand. The combat lifesaver program is a continuous ongoing program and requires continuous equipment and material support for the already qualified CLs.
Be sure to maintain contact with your supply source to ensure your CL supplies are programmed into the system. Resupply, during field operations, is accomplished in the same manner as during garrison operations with two exceptions.
Field medical units maintain stocks of medical material with which to effect resupply of combat lifesaver aid bags during field operations.
Reserve facilities. The facilities should allow the students to clearly see the demonstrations and provide plenty of room for student practice.
Make sure there are enough tables and chairs available for the number of students participating. Inform instructor, assistant instructors, and students: a. Instructor and assistant instructors.
If you are not the medical instructor, the arrangements and documentation should be provided to the primary instructor. The instructor is responsible to verify the shipment is complete and to distribute the subcourses to the students.
If classes on IS immediately follow testing on IS, then distribute both subcourses at the same time. Life-Threatening Hemorrhage Bleeding. Human life cannot continue without an adequate volume of blood circulating through the body to carry oxygen to the tissues. An important first aid measure is to stop the bleeding to prevent the loss of blood.
CLS providers have seconds to stop the massive life- threatening hemorrhage. Shock means there is an inadequate blood flow to the vital tissues and organs.
Shock that remains uncorrected may result in death even though the injury or condition causing the shock would not otherwise be fatal. Shock can result from many causes, such as loss of blood, loss of fluid from deep burns, pain, and reaction to the sight of a wound or blood.
The objective is to keep wounds clean and free of organisms. A good working knowledge of basic first aid measures also includes knowing how to dress a wound to avoid infection or additional contamination. Of the battlefield casualties who die, approximately 65 percent will die of massive, multi-system trauma and are probably not salvageable.
These wounds may be fatal within minutes. In a combat environment, the treatment of a life-threatening hemorrhage is the first priority. This is because the brain can go 4 to 6 minutes without oxygen before permanent brain damage occurs. The heart pushes oxygen rich blood through the arteries and into the capillaries where oxygen is dropped off and carbon dioxide is picked up.
Once that exchange has taken place, the blood is then pushed into the veins back into the heart. The heart sends that blood to the lungs where it picks up more oxygen and then continues that cycle. Types of Hemorrhage 1 Arterial. Venous bleeding is characterized by a steady, even flow. If capillaries bleed, the blood oozes out slowly. Any arterial bleed is life threatening. Some venous bleeds are considered life threatening based off of how much blood is being lost and how quickly.
Slow venous bleeds and capillary bleeds. Bleeding from the arms, hands, legs or feet. Bleeding from head, neck, chest, back, abdomen, or pelvis. Either a commercially manufactured absorbent material or improvised materials used to cover and protect wounds from further injury, infection, or physical contamination. Bandages A piece of gauze either commercially manufactured or improvised. It can be applied to wrap or bind a body part or dressing.
Called by some the workhorse of the aid bag. Apply direct pressure to the wound with your gloved hand. Extremity wounds: Non-extremity wounds: Used to control life-threatening extremity hemorrhage. Material such as rope, wire and string should not be used because they can cut into flesh.
This will allow the windless to turn creating circumferenial pressure to stop the bleed. Leave it exposed over the uniform for open viewing. Figure — 2 Improvised Tourniquet e. Hemostatic agent: Other previous hemostatic agents Quickclot, HemCon, etc. If multiple Combat Gauze rolls are needed, apply as many as necessary to completely pack the wound. Reassess wound to ensure bleeding is controlled. Combat Gauze may be repacked or a second gauze used if initial application fails.
Do not remove the pressure dressing or the Combat Gauze. Reassess the casualty to ensure bleeding remains controlled. Figure — 3 Combat Gauze 4. Apply direct pressure to the wound with your gloved hand b. Pressure dressings: The dressing should cover the entire wound and the bandage should cover the entire dressing. Do not tie the knot of the first bandage directly on the wound. This knot is tied directly on top of the wound. Anatomical Structures 1 The airway consists of the nose, mouth, throat, voice box and wind pipe.
It is the canal through which air passes to and from the lungs Figure 1. The lungs are protected by the rib cage, which is formed by the muscle-connected ribs, which join the spine in the back, and the breastbone in the front Figure 1.
Contraction increases and relaxation decreases the size of the rib cage. When the rib cage increases and then decreases, the air pressure in the lungs is first less and then more than the atmospheric pressure, thus causing the air to rush into and out of the lungs to equalize the pressure. This cycle of inhaling and exhaling is repeated 12 to 20 times per minute Figure 1.
Breathing Process 1 All humans must have oxygen to live. Some cells are more dependant on a constant supply of oxygen than others. Respiration 1 Respiration occurs when a person inhales oxygen is taken into the body and then exhales carbon dioxide [CO2] is expelled from the body. The tongue is the most common cause for obstruction in an unconscious patient. Proper Positioning of an Unresponsive Casualty 1 Placing a casualty flat on their back is the best position to work on maintaining an airway.
Repeat the procedure for the other arm Figure 2B. With your other hand, grasp the casualty under his far arm Figure 2C. Figure 2. Leave the upper leg in a flexed position to stabilize the body. Figure 4. If the lips close, the lower lip can be retracted with the thumb. Figure 5. Trauma Chin Lift. Figure 6. Check for Breathing While Maintaining Airway 1 After establishing an open airway, it is important to maintain the airway in an open position. Types of Airway Adjuncts.
The NPA works well with both conscious and unconscious casualties. Figure 7. NPA b. Traumatic chest injuries can be caused by a variety of mechanisms, including motor vehicle collisions, falls, sport injuries, crush injuries, stab wounds, and gun shot wounds.
Most often, the organs injured are those that lie along the path of the penetrating object.
Tension Pneumothorax is the second leading cause of preventable death on the battlefield 1. Thorax chest cavity: See Figure-1 1 The skeletal portion of the thorax is a bony cage formed by the sternum, costal cartilages, ribs, and the bodies of the thoracic vertebrae. Figure - 1 Thorax b. See Figure-2 1 A thin membranous lining that covers an organ.
Figure - 2 Pleura c. Once the body receives its oxygen; oxygen-deficient, carbon dioxide-rich blood returns to the lungs where the carbon dioxide is exhaled and new oxygen begins its process all over.
Mediastinum - Area in the middle of the thoracic cavity in which all the other organs and structures of the chest cavity lie. The following are located within the mediastinum: Definition - A collection of air or gas in the pleural space causing the lung to collapse most often as a result of penetrating trauma such as a stab or gunshot wound.
Many small wounds will seal themselves. These wounds are of particular concern because of their potential to cause a tension pneumothorax. Some large wounds will be completely open, allowing air to enter and escape the pleural cavity.
Causes - Most often the result of gunshot wounds, but they can also occur from other penetrating injuries, such as; impaled objects, shrapnel, stab wounds.
Motor vehicle accidents, and falls are also known causes of sucking chest wounds. Cover the wound with an occlusive dressing.
Tape the dressing on four 4 sides to temporarily seal the wound and prevent the occurrence of a Tension Pneumothorax. See figure-3 b. Assess for associated penetrating chest trauma i. Monitor for signs and symptoms of Tension Pneumothorax.
Definition - A self-sealing type of injury in which air can enter the pleural space but cannot escape via the route of entry. This leads to an increase of pressure in the pleural space and eventual collapse of the lung. Increasing pressure within the pleural space further collapses the lung on the affected side and forces the mediastinum to the opposite side. This can result in two 2 serious consequences: See figure Cause — Penetrating chest trauma.
This is the second leading cause of preventable death on the battlefield.
A presumptive diagnosis of tension pneumothorax should be made when significant respiratory distress develops with penetrating trauma. A needle thoracentesis should be performed immediately. The additional trauma caused by the needle would not be expected to significantly worsen their condition should he not actually have a Tension Pneumothorax. Treat chest injuries as appropriate i. Perform needle thoracentesis. This should be performed on all casualties with penetrating chest trauma with an increase of respiratory difficulty.
Needle Thoracentesis a. This provides a conduit for the release of accumulated pressure. Required Equipment 1 Alcohol or betadine swabs. See Figure-6 Figure — 6 Decompression Needle d. This is approximately three 3 finger widths below the clavicle.
Complications 1 Hemothorax - Blood within the pleural space. Caused when the needle punctures any of the vessels within the chest wall.
The initial diagnosis of shock is based upon the presence of inadequate organ perfusion and tissue oxygenation. The initial step for managing shock in the injured patient is to recognize its presence. Below are the parameters for estimating blood pressure: The cardiovascular system consists of a pump the heart , a container the vascular system , and circulating fluid the blood.
Pump — four 4 chambered muscle heart. Container - arteries, veins, and capillaries. There are literally hundreds of classifications of shock in medical literature. Because uncontrolled hemorrhage and the shock that ensues is the number one cause of preventable death on the battlefield, we will focus our efforts there.
Hemorrhagic Shock 1 Definition - Loss of blood or blood components. The heart and lungs are functioning normally; however, there is not enough circulating volume within the circulatory system to carry the required amount of oxygen to the body and its vital organs.
This is the most common cause of shock on the battlefield. The effects from a traumatic injury can vary from individual to individual. Treatment should not be delayed and controlling major hemorrhage should be the first priority over securing an airway in a combat environment. This is the most important step in shock prevention and treatment.
Keep protective gear on, if feasible. The most important function is to form a protective barrier against the external environment. The skin also prevents fluid loss, helps regulate body temperature, and allows for sensation.
Skin is composed of three layers: See figure-1 1 The epidermis, which is the outermost layer, is made up entirely of skin cells with no blood vessels 2 Underlying the epidermis is the thicker dermis, made up of a framework of connective tissues containing blood vessels, nerve endings, sebaceous glands, and sweat glands.
Figure - 1 Anatomy of the Skin 2. Overview - Burns are classified by the depth of the burn and the extent of the total body surface area TBSA of the burn. The severity of all burns will vary depending on the source of the burn, duration of exposure, and location of the burn.
The depth of the burn is related to how deep the skin is damaged. Due to the nature of burn injuries, final judgment of burn depth should be withheld for 48 hours after the injury occurs. Second degree burns can be classified as superficial or deep.
Fourth-Degree Burns — A burn that not only encompasses all 3 layers but also includes underlying fat, muscles, bone, or internal organs. Burn injuries have many causes on and off the battlefield.
Burns are caused by exposure to extreme heat, a biologic reaction from chemicals, or energy transfer through cells from electrocution or radiation. Many weapons and munitions cause burn injuries. Some, such as incendiary and flame munitions, are designed to cause high heat and burning. Others, such as high explosives, bombs, and mines cause burns secondarily to their primary effect. The four primary causes of burns are thermal, electrical, chemical, and radiant.
Thermal Burns: Thermal burns are the most common type of burn on the modern battlefield. These weapons are designed to burn at very high temperatures and incorporate napalm, thermite, magnesium, and white phosphorous.
The primary effect of incendiary and flame munitions against personnel is to cause severe burns. Due to the high burning temperature of these weapons, airway compromise must be considered.
Its design and employment against personnel will result in many more burns than other devices. Hottest burn and can rapidly melt through steel armor. This deserves special mention because it combusts with air and continues to burn until the oxygen source is removed. The casualty may be showered with WP fragments from a near-by explosion, which may become embedded in their skin.
Electrical - Electrical burns may be far more serious than a preliminary examination may indicate. The entrance and exit wounds may be small, but as electricity penetrates the skin, it burns a large area below the surface along the path it travels through the body. The underlying injuries are not visible to the CLS and could be potential fatal. Chemical - Chemical burns occur when the skin comes in contact with various caustic agents. These injuries are not caused by heat but by direct chemical destruction of body tissues.
Radiation - Burns associated with nuclear blasts and radiation. Skin that is exposed to an explosion is burned by the infrared rays emitted at detonation. Then apply a sterile dressing over it. See figure-3 5 Remember to keep the casualty warm since burned skin is unable to properly maintain body temperature. Keep in mind that skin burns are not immediately fatal and can wait until all other life threats are addressed. Water Gel - is helpful as it isolates, soothes, and protects the burn from infection.
To apply burn gel, simply remove it from the package and apply to affected area, covering the burn gel with a loose dressing for protection dirt and dust will cling to it if left exposed b. Electrical Burns 1 Before touching the victim, stop the source of the current, if possible, turn off the source of the power and deactivate the main circuit breaker. Chemical Burns 1 Immediately flush the affected areas with large quantities of water.
A fracture is any break in the continuity of a bone. Complete recovery depends greatly upon the first aid the casualty receives before being moved. The most common bones in which the CLS will have to deal with are the jaw, clavicle, ribs, pelvis, knee and the bones of the arms and legs See figure 1.
Figure 1. Bones of the body 1. Open Fracture - A broken bone that breaks the overlying skin. The bone may protrude through the skin or a penetrating object such as a bullet or shell fragment may go through the flesh and break the bone. See figure 2 b. Closed Fracture - A broken bone with no skin penetration. The tissue beneath the skin may be damaged. Splints are used to immobilize a portion of the body that is injured, prevent further damage, and to alleviate pain.
Rigid Splints - Rigid splints cannot be changed in shape. The injured body part must be positioned to fit the splint. Formable Splints - Formable splints can be molded into various shapes and combinations to accommodate the shape of the injured extremity.
Examples include vacuum splints, pillows, blankets, cardboard splints, SAM splints and wire ladder splints.
See figure 3 c. Improvised Splints - Improvised splints are made from any available material that can be used to stabilize a fracture. Examples include sticks, branches, and tent poles.
Examples include securing the legs together, securing the arm to the body, and taping the fingers together. See figure 4 Figure 3. Formable splint Bandage Figure 4. Bandages in splinting - Bandages can be used to wrap or bind a body part. When using a sling, position the hand higher then the elbow and never cover the fingers. See figure 7 3.
Regardless of the type of splint you are using, certain guidelines must be followed. Control hemorrhage and treat for shock. Establish distal pulse prior to splinting. Expose fracture site. If bone is exposed, ensure to cover the ends with sterile dressing prior to splinting. Splint fracture in position found. Attempt to straighten a deformed limb only if it is a closed injury with no distal pulses.
Do not try to reposition or put back an exposed bone. Move the fractured part as little as possible while applying the splint. Pad the splint at any bony prominence points i.
Immobilize the splint above and below the fracture. Reassess distal pulses after splint is secured. When in doubt, treat all injuries as a possible fracture. The most common fractures encountered are: Fractured Jaw 1 Apply a bandage to immobilize jaw Modified Barton. See figure 5. Doing so may cause airway obstruction. Immobilized Jaw b. Fractured Clavicle 1 Immobilize using figure eight bandage.
See figure 7 Figure 6. Immobilized Clavicle Figure 7. Fractured Humerus 1 Check for distal pulse 2 If fracture is located on the upper arm near shoulder, place padding in the armpit, bandage arm securely to body See figure 8. Support with sling See figure 9. Support with sling. Figure 8. Upper arm splint 1 Figure 9. Upper arm splint 2 d. Fractured Forearm 1 Check for distal pulse 2 If only one bone in the forearm is broken, the other may be used as a splint. Figure Forearm Splint e.
See figure 11 3 Re-check radial pulse 4 Support with sling. See figure 12 5 Secure arm to chest using swath bandage. This will only make breathing more difficult!
Rib Splint g. Fractured Pelvis 1 Check distal pulse 2 Place patient in position of comfort legs straight or knees bent. See figure 13 6 Re-check distal pulse Figure Fractured Femur 1 Check distal pulse 2 Using four 4 cravats to secure injured leg to the uninjured leg anatomical splint. Consider traction splinting for midshaft fractures.