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Virtual Naval Hospital - Standard First Aid Course: NAVEDTRA 13119

STANDARD FIRST AID COURSE


NAVEDTRA 13119
Department of the Navy
Bureau of Medicine and Surgery
2300 E Street, NW
Washington, DC 20372-5300

Peer Review Status: Internally Peer Reviewed


Creation Date: Unknown
Last Revision Date: Unknown

Table of Contents

● Chapter One-Introduction
● Chapter Two-Basic Life Support
● Chapter Three-Bleeding
● Chapter Four-Shock
● Chapter Five-Soft Tissue Injuries
● Chapter Six-Bones, Joints, and Muscles
● Chapter Seven-Environmental Injuries
● Chapter Eight-Chemical, Biological, and Radiological Casualties
● Chapter Nine-Poisoning
● Chapter Ten-Medical Injuries
● Chapter Eleven-Rescue and Transportation
● Chapter Twelve-Health Education
● Appendix

Receive Correspondence Course Credit for this Course from NSHS Portsmouth

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Virtual Naval Hospital - Standard First Aid Course: NAVEDTRA 13119

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Virtual Naval Hospital: Standard First Aid Course - Chapter One - Introduction

NAVEDTRA 13119 Standard First Aid Course - Chapter One - Introduction

An Introduction to First Aid


Department of the Navy
Bureau of Medicine and Surgery
Peer Review Status: Internally Peer Reviewed

First aid is the emergency care and treatment of a sick or injured person before professional medical
services are obtained. FIRST AID MEASURES ARE NOT MEANT TO REPLACE PROPER
MEDICAL DIAGNOSIS AND TREATMENT, but will only consist of providing temporary support
until professional medical assistance is available. The purposes of first aid are (1) to save life, (2) prevent
further injury, and (3) to minimize or prevent infection.

Everyone in the Navy must know how and when to render first aid and be prepared to provide competent
assistance to the sick and injured in all circumstances. The knowledge of first aid, when properly applied,
can mean the difference between temporary or permanent injury, rapid recovery or long-term disability,
and the difference between life and death.

While administering first aid, the three primary objectives are (1) to maintain an open airway, (2)
maintain breathing, and (3) to maintain circulation. During this process you will also control bleeding,
and reduce or prevent shock.

You must respond rapidly, stay calm, and think before you act. Do not waste time looking for ready-
made materials, do the best you can with what is at hand. Request professional medical assistance as
soon as possible.

Initial Assessment

When responding to a casualty, take a few seconds to quickly inspect the area. Remain calm as you take
charge of the situation, and act quickly but efficiently. Decide as soon as possible what has to be done
and which one of the injuries needs attention first. During your initial assessment, consider the following:

1. Safety - Determine if the area is safe. If the situation is such that you or the casualty is in danger, you

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must consider this threat against the possible damage caused by early movement. If you decide to move
the casualty, do it quickly and gently to a safe area where proper first aid can be given. You cannot help
the casualty if you become one yourself.

2. Mechanism of injury - Determine the extent of the illness or injury and how it happened. If the
casualty is unconscious, look for clues. If the casualty is lying at the bottom of a ladder, suspect that he
or she fell and may have internal injuries.

3. Medical information devices - Examine the casualty for a MEDIC ALERT (Fig. 1-1) necklace,
bracelet, or identification card. This medical tag, provides medical conditions, medications being taken,
and allergies about the casualty. The VIAL OF LIFE, a small, prescription-type bottle, also contains
medical information concerning the casualty. This bottle is normally located in the refrigerator.

4. Number of casualties - Look beyond the first casualty, you may find others. One casualty may be
alert, while another, more serious or unconscious, is unnoticed. In a situation with more than one casualty
limit your assessment to looking for an open airway, breathing, bleeding, and circulation, the life-
threatening conditions.

5. Bystanders - Ask bystanders to help you find out what happened. Though not trained in first aid,
bystanders can help by calling for professional medical assistance, providing emotional support to the
casualty, and keeping onlookers from getting in the way.

Figure 1-1-Medic Alert Symbol

6. Introduce yourself - Inform the casualty and bystanders who you are and that you know first aid.
Prior to rendering first aid, obtain the casualties consent by asking is it "OK' to help them. Consent is
implied if the casualty is unconscious or cannot reply.

General Rules

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Every illness or injury presents with its own individual problems. Prior to learning first aid for a specific
illness or injury, you must have a complete understanding of the following:

1. Keep the casualty lying down, head level with the body, until you determine the extent and seriousness
of the illness or injury. You must immediately recognize if the casualty has one of the following
conditions that represent an exception to the above.

a. Vomiting or bleeding around the mouth - If the casualty is vomiting or bleeding around the
mouth, place them on their side, or back with head turned to the side. Special care must be taken
for a casualty with a suspected neck or back injury.
b. Difficulty breathing - If the casualty has a chest injury or difficulty breathing place them in a
sitting or semi-sitting position.
c. Shock - To reduce or prevent shock, place the casualty on his or her back, with their legs
elevated 6 to 12 inches. If you suspect head or neck injuries or are unsure of the casualty's
condition, keep them lying flat and wait for professional medical assistance.

2. During your examination, move the casualty no more than is necessary. Loosen restrictive clothing, at
the neck, waist, and where it binds. Carefully remove only enough clothing to get a clear idea of the
extent of the injuries. When necessary, cut clothing along its seams. Ensure the casualty does not become
chilled, and keep them as comfortable as possible. Inform the casualty of what you are doing and why.
Respect the casualty's modesty, but do not jeopardize quality care. Shoes may have to be cut off to avoid
causing pain or further injury.

3. Reassure the casualty that his or her injuries are understood and that professional medical assistance
will arrive as soon as possible. The casualty can tolerate pain and discomfort better if they are confident
in your abilities.

4. Do not touch open wounds or burns with your fingers or un-sterile objects unless it is absolutely
necessary. Place a barrier between you and the casualty's blood or body fluids, using plastic wrap,
gloves, or a clean, folded cloth. Wash your hands with soap and warm water immediately after
providing care, even if you wore gloves or used another barrier.

5. Do not give the casualty anything to eat or drink because it may cause vomiting, and because of the
possible need for surgery. If the casualty complains of thirst, wet his or her lips with a wet towel.

6. Splint all suspected, broken or dislocated bones in the position in which they are found. Do not
attempt to straighten broken or dislocated bones because of the high risk of causing further injury. Do
not move the casualty if you do not have to.

7. When transporting, carry the casualty feet first. This enables the rear bearer to observe the casualty for
any complications.

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8. Keep the casualty comfortable and warm enough to maintain normal body temperature.

Infectious Diseases

You will probably render first aid to someone you know - a shipmate or family member. For this reason
you will probably know your risk of contracting an infectious disease. Adopt practices that discourage
the spread of blood-borne diseases (Hepatitis and HIV) and air-borne diseases such as influenza when
performing first aid.

1. Wear gloves or use another barrier.


2. Wash your hands with soap and warm water immediately.
3. When possible, use a pocket mask or mouthpiece during rescue breathing.

The risk of contracting infections from a casualty is very remote. Do not withhold rendering first aid
because of this rare possibility.

References

1. Karren, K. J. and Hafen, B. Q.: First Responder A Skills Approach, edition 3, Morton Publishing
Company
2. American Red Cross Standard First Aid Workbook, edition 1991, American Red Cross
3. NAVEDTRA 10670-C, Hospital Corpsman 1 & C
4. NAVEDTRA 10669-C, Hospital Corpsman 3 & 2

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Virtual Naval Hospital: Standard First Aid Course - Chapter One - Basic Life Support

NAVEDTRA 13119 Standard First Aid Course - Chapter Two - Basic Life Support

Basic Life Support


Department of the Navy
Bureau of Medicine and Surgery
Peer Review Status: Internally Peer Reviewed

Atmospheric air that is essential for life contains approximately 21% oxygen. When you breathe in
(inhale) only a quarter of the air is taken by the blood in the lungs. The air you breath out (exhale)
contains approximately 16% oxygen. Enough to support life! Seconds after being deprived of oxygen,
the heart is at risk of developing irregular beats or stopping. Within four to six minutes, the brain is
subject to irreversible damage.

Basic life support is maintenance of the ABCs (airway, breathing, and circulation) without auxiliary
equipment. The primary importance is placed on establishing and maintaining an adequate open airway.
Airway obstruction alone may be the emergency: a shipmate begins choking on a piece of food. Restore
breathing to reverse respiratory arrest (stopped breathing) commonly caused by electric shock,
drowning, head injuries, and allergic reactions. Restore circulation to keep blood circulating and
carrying oxygen to the heart, lungs, brain, and body. This course is not a substitute for formal training
in basic life support.

Airway Obstruction

Airway obstruction, also known as choking, occurs when the airway (route for passage of air into and out
of the lungs) becomes blocked. The restoration of breathing takes precedence over all other
measures.. The reason for this is simple: If a casualty cannot breathe, he or she cannot live. Individuals
who are choking may stop breathing and become unconscious. The universally recognized distress signal
(Fig. 2-1) for choking is the casualty clutching at his or her throat with one or both hands. The most
common causes of airway obstruction are swallowing large pieces of improperly chewed food, drinking
alcohol before or during meals, and laughing while eating. The tongue is the most common cause of
obstruction in the casualty who is unconscious. A foreign body can cause a partial or complete airway
obstruction.

Partial Airway Obstruction

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If the casualty can cough forcefully, and is able to speak, there is good air exchange. Encourage him or
her to continue coughing in an attempt to dislodge the object. Do not interfere with the casualty's efforts
to remove the obstruction. First aid for a partial airway obstruction is limited to encouragement and
observation. When good air exchange progresses to poor air exchange, demonstrated by a weak or
ineffective cough, a high-pitched noise when inhaling, and a bluish discoloration (cyanosis) of the skin
(around the finger nails and lips), treat as a complete airway obstruction.

Complete Airway Obstruction

A complete airway obstruction presents with a completely blocked airway, and an inability to speak,
cough, or breathe. If the casualty is conscious, he or she may display the universal distress signal. Ask
"Are YOU choking?" If the casualty is choking, do the following:

1. Shout "Help"-Ask the casualty if you can help.

2. Request medical assistance - Say "Airway is obstructed" (blocked), call (Local emergency number or
medical personnel).

Figure 2-1 Universal Distress Signal

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Figure 2-2 Abdominal Thrust

3. Abdominal thrusts (Heimlich Maneuver)

a. Stand behind the casualty.


b. Place your arms around the (Fig. 2-2) casualties waist.
c. With your fist, place the thumb side against the middle of the abdomen, above the navel and
below the tip (xiphoid process) of the (sternum) breastbone.
d. Grasp your fist with your other hand.
e. Keeping your elbows out, press your fist (Fig. 2-3) into the abdomen with a quick upward
thrust.
f. Repeat until the obstruction is clear or the casualty becomes unconscious.

If the casualty becomes unconscious, do the following:

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Figure 2-3 Abdominal Thrust

Figure 2-4 Head Tilt-Chin Lift

4. Finger sweep - Place the casualty on his or her back, open casualty's mouth and grasp the tongue and
lower jaw between your thumb and fingers, lift jaw with your index finger into the mouth along inside of
cheek to base of tongue. Use "hooking" motion to dislodge object for removal.

5. Open airway (Head-tilt/Chin-lift) -Place your hand on the casualty's forehead. Place the fingers of
your other hand under the (Fig. 2-4) bony part of the chin. Avoid putting pressure under the chin, it may
cause an obstruction of the airway. Tilt the head and lift the jaw, avoid closing the casualty's mouth.
Place your ear over the casualty's mouth and nose. Look at the chest, listen and feel for breathing, 3 to 5
seconds. If not breathing, say, "Not Breathing."

(jaw-thrust maneuver) - If you suspect the casualty may have an injury to the head, neck, or back, you
must minimize movement of the casualty when opening the airway. Kneeling at the top of the casualty's
head, place your elbows on the surface. Place your fingers behind the angle of the jaw or hook your
fingers under the jaw, bring (Fig. 2-5) jaw forward. Separate the lips with your thumbs to allow breathing

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through the mouth. Note that the head is not tilted and the neck is not extended.

Figure 2-5 Jaw Thrust

6. Give breaths - Pinch nose, open your mouth, take a deep breath, and make an air-tight seal around the
casualty's mouth. Give 2 full breaths, each lasting 1 to 1 1/2 seconds. Pause between each breath. If
unsuccessful, perform abdominal thrusts.

7. Perform abdominal thrusts

a. Straddle the casualty's thighs.


b. Place the heel of your hand against the middle of the abdomen, above the navel and below the
tip of the breastbone.
c. Place your other hand directly on top of the first (Fingers should point towards the casualty's
head).
d. Press abdomen 6 to 10 times (Fig. 2-6) with quick upward thrusts.

8. Continue steps 4 to 7 -Until successful, you are exhausted, you are relieved by another trained
individual, or by medical personnel.

If the casualty is found unconscious, do the following:

1. Check unresponsiveness - Tap or gently shake the casualty, shout, "Are you OK?"

2. Shout, "Help" - If there is no response from casualty.

3. Position casualty - Kneel midway between his or her hips and shoulders facing casualty. Straighten
legs, and move arm closest to you above casualty's head. Place your hand on the casualty's shoulder and
one on the hip. Roll casualty toward you as a unit, move your hand from the shoulder to support the back
of the head and neck. Place the casualty's arm nearest you alongside his or her body.

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Figure 2-6 Abdominal Thrust Reclining

4. Open airway (Head-tilt/Chin-lift or Jaw-thrust) - Place your hand on the casualty's forehead. Place the
fingers of your other hand under the bony part of the chin. Avoid putting pressure under the chin, it may
cause an obstruction of the airway. Tilt the head and lift the jaw, avoid closing casualty's mouth. Place
your ear over the casualty's mouth and nose. Look at the chest, listen, and feel for breathing, 3 to 5
seconds. If not breathing, say, "Not Breathing."

5. Give breaths - Pinch nose, open your mouth, take a deep breath, and make an air-tight seal around the
casualty's mouth. Give 2 full breaths, each lasting 1 to 1 1/2 seconds. Pause between each breath. If
unsuccessful, reposition head, and give 2 full breaths.

6. Request medical assistance - Say "Airway is obstructed" (blocked), call local emergency number or
medical personnel.

7. Perform abdominal thrusts

a. Straddle the casualty's thighs.


b. Place the heel of your hand against the middle of the abdomen, above the navel and below the
tip of the breastbone.
c. Place your other hand directly on top of the first (fingers should point towards the casualty's
head).
d. Press abdomen 6 to 10 times with quick upward thrusts.

8. Finger sweep - Place the casualty on his or her back, open the casualty's mouth and grasp the tongue
and lower jaw between your thumb and fingers, lift jaw, insert your index finger into the mouth along the
inside of cheek to base of tongue. Use "hooking" motion to dislodge object for removal.

9. Give breaths - Pinch nose, open your mouth, take a deep breath, and make an air-tight seal around the

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casualty's mouth. Give 2 full breaths, each lasting 1 to 1 1/2 seconds. Pause between each breath.

10. Continue steps 7 to 9 - Until successful, you are exhausted, you are relieved by another trained
individual, or by medical personnel.

Chest Thrusts

The chest thrust is the preferred method, in place of the abdominal thrust, for individuals who are
overweight or pregnant. Manual pressure to the abdominal area in these individuals can be ineffective or
cause serious damage. If the casualty is overweight or pregnant, do the following:

1. Conscious - Standing or Sitting.

a. Stand behind the casualty.


b. Place your arms under the casualty's armpits and around the chest.
c. With your fist, place the thumb side against the middle of the breastbone.
d. Grasp your fist with your other hand.
e. Press your fist against the chest with a sharp, backward thrust until the obstruction is clear or
casualty becomes unconscious.

2. Unconscious - Lying.

a. Kneel, facing the casualty's chest.


b. With the middle and index fingers of the hand nearest the casualty's legs, locate the lower edge
of the rib cage on the side closest to you.
c. Slide your fingers up the rib cage to the notch at t
d. Place your middle finger on the notch, and your index finger next to it.
e. Place the heel of your hand on the breastbone next to the index finger.
f. Place the heel of your hand, used to locate the notch, on top of the heel of your other hand.
g. Keep your fingers off the casualty's chest.
h. Position your shoulders over your hands, with elbows locked and arms straight.
i. Give 6 to 10 quick and distinct downward thrusts, each should compress the chest 1 1/2 to 2
inches.
j. Finger sweep.
k. Open the airway and give 2 full breaths.

Repeat the last three steps until the obstruction is clear, you are exhausted, you are relieved by another
trained individual, or by medical personnel.

Self Abdominal Thrusts

If you are alone and choking, try not to panic, you can perform an abdominal thrust (Fig. 2-7) on yourself

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by doing the following:

1. With the fist of your hand, place the thumb side against the middle of your abdomen, above the navel
and below the tip of the breastbone. Grasp your fist with your other hand and give a quick upward thrust.

2. You also can lean forward and press your abdomen over the back of a chair (with rounded edge), a
railing, or a sink.

Figure 2-7 Self-Help for Airway Obstruction

If the casualty is not breathing, do the following:

Rescue Breathing

Rescue breathing is the process of breathing air into the lungs of a casualty who has stopped breathing
(respiratory arrest), also known as artificial respiration. The common causes are air-way obstruction,
drowning, electric shock, drug overdose, and chest or lung (trauma) injury. Never give rescue breathing
to a person who is breathing normally.

1. Check unresponsiveness - Tap or gently shake the casualty, shout, "Are you OK?"

2. Shout, "Help" - If there is no response from casualty.

3. Position casualty - Kneel midway between his or her hips and shoulders facing the casualty.
Straighten legs and move arm closest to you above casualty's head. Place your hand on the casualty's

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shoulder and one on the hip. Roll casualty toward you as a unit, move your hand from the shoulder to
support the back of the head and neck. Place the casualty's arm nearest you alongside his/her body.

4. Open airway (Head-tilt/Chin lift or Jaw thrust) - Place your hand on the casualty's forehead. Place the
fingers of your other hand under the bony part of the chin. Avoid putting pressure under the chin, it may
cause an obstruction of the airway. Tilt the head and lift the jaw, avoid closing the casualty's mouth.
Place your ear over the casualty's mouth and nose. Look at the chest, listen, and feel for breathing, 3 to 5
seconds. If not breathing, say, "Not breathing."

5. Give breaths - Pinch nose, open your mouth, take a deep breath, and make an air-tight seal around the
casualty's mouth (Fig. 2-8). Give 2 full breaths, each lasting 1 to 1 1/2 seconds. Pause between each
breath. Look for the chest to rise, listen, and feel for breathing.

6. Check pulse - While maintaining an open airway, locate the Adam's apple with your middle and index
fingers. Slide your fingers down into the groove (Fig. 2-9), on the side closest to you. Feel for a carotid
pulse for 5 to 10 seconds. If you feel a pulse, say, "No breathing, but there is a pulse." Quickly examine
the casualty for signs of bleeding.

Figure 2-8 Mouth-to-Mouth Ventilation

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Figure 2-9 Check Carotid Pulse

7. Request medical assistance - Say "No breathing, has a pulse," call (Local emergency number or
medical personnel).

8. Rescue breathing (mouth-to-mouth) Maintain an open airway with head-tilt/chin-lift or jaw-thrust


maneuver, pinch nose. Open your mouth, take a deep breath, and make an air-tight seal around the
casualty's mouth. Give 1 breath every 5 seconds, each lasting 1 to 1 1/2 seconds. Count aloud "one one-
thousand, two one-thousand, three one-thousand, four one-thousand," take a breath, and then give a
breath. Look at the chest, listen, and feel for breathing. Continue for 1 minute/12 breaths.

9. Recheck pulse - While maintaining an open airway, locate and feel the carotid pulse for 5 seconds. If
you feel a pulse, say, "Has pulse." Look at the chest, listen, and feel for breathing 3 to 5 seconds. If the
casualty is not breathing, say, "No breathing."

10. Continue sequence - Maintain an open airway, give 1 breath every 5 seconds, recheck pulse every
minute. If pulse is absent, begin CPR. If pulse is present but breathing is absent, continue rescue
breathing. If the casualty begins to breathe, maintain an open airway, until medical assistance arrives.

Special Situations

1. Air in the stomach (Gastric Distention) - During rescue breathing and CPR, air may enter the
stomach in addition to the lungs. To avoid this, keep the casualty's head tilted back, breathe only enough
to make the chest rise, and do not give breaths too fast. Do not attempt to expel stomach contents by
pressing on the abdomen.

2. Mouth-to-nose breathing - Used when the casualty has mouth or jaw injuries, is bleeding from the
mouth, or your mouth is too small to make an air-tight seal. Maintain head tilt with your hand on the
forehead, use your other hand to seal the casualty's mouth and lift the chin. Take a deep breath and seal
your mouth around the casualty's nose and slowly breathe into the casualty's nose using the procedures
for mouth-to-mouth breathing.

3. Mouth-to-stoma breathing - Used when the casualty has had surgery to remove part of the windpipe.
They breathe through an opening in the front of the neck, called a stoma. Cover the casualty's mouth with
your hand, take a deep breath, and seal your mouth over the stoma and slowly breathe using the
procedures for mouth-to-mouth breathing. Do not tilt the head back. (In some situations a person may
breathe through the stoma as well as his or her nose and mouth. If the casualty's chest does not rise, you
should cover his or her mouth and nose and continue breathing through the stoma).

4. Mouth-to-mask breathing - Used when rescue breathing is required in a contaminated environment,


such as after a chemical or biological attack. A resuscitation tube is used to deliver uncontaminated air to
the casualty. This resuscitation tube has an adapter at one end that attaches to your mask and a molded

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rubber mouthpiece at the other end for the mouth of the casualty.

5. Dentures - Leave dentures in place, they provide support to the mouth and cheeks during rescue
breathing. If they become loose and block the airway or make it difficult to give breaths, remove them.

Circulation

Circulation is the movement of blood through the heart and blood vessels. The circulatory system
consists of the heart, which pumps the blood, and the blood vessels, which carry the blood throughout the
body.

Cardiac arrest is the failure of the heart to produce a useful blood flow or the heart has completely
stopped beating. The signs of cardiac arrest include unconsciousness, the absence of a pulse, and the
absence of breathing. If the casualty is to survive, immediate action must be taken to restore breathing
and circulation.

Cardiopulmonary Resuscitation (CPR) is an emergency procedure for the casualty who is not breathing
and whose heart has stopped beating (cardiac arrest). The procedure involves a combination of chest
compressions and rescue breathing. The casualty must be lying face up on a firm surface. Do not assume
that a cardiac arrest has occurred simply because the casualty appears to be unconscious. This course is
not a substitute for formal training in cardiopulmonary resuscitation (CPR).

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Figure 2-11 Xiphoid Process

Chest Compressions

a. Kneel, facing the casualty's chest.


b. With your middle and index fingers (Fig. 2-11) of the hand nearest the casualty's legs, locate
the lower edge of the rib cage on the side closest to you.
c. Slide your fingers up the rib cage to the notch at the end of the breastbone.
d. Place your middle finger on the notch, and your index finger next to it.
e. Place the heel of your other hand on the breastbone next to your index finger.
f. Place the heel of the hand used to locate the notch on top of the heel of your other hand.
g. Keep your fingers (Fig 2-12) off the casualty's chest.

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Figure 2-12 Interlocking fingers to help keep fingers off the chest wall

h. Position shoulders over your hands, with elbows locked and arms straight.
i. Give 15 compressions, each should compress the chest 1 1/2 to 2 inches at a rate of 80 to 100
compressions per minute. Count aloud, "One and two and three," until you reach 15. After each
15 compressions, deliver 2 full breaths. Compressions should be smooth, rhythmic, and
uninterrupted.
j. Continue 4 complete cycles of 15 compressions and 2 breaths. Check for a carotid pulse and
breathing for 5 seconds.

Continue CPR - If the casualty has no pulse, give 2 full breaths and continue CPR. Check for a pulse
every few minutes. If the pulse is present but breathing is absent, continue rescue breathing. If the
casualty begins to breathe, maintain an open airway until medical assistance arrives. Continue CPR until
successful, you are exhausted, you are relieved by another trained in CPR, by medical personnel, or the
casualty is pronounced dead. Do not interrupt CPR for more than 7 seconds except for special
circumstances.

CPR with Entry of Second Person

When a second person who is trained in administering CPR arrives at the scene, do the following:

1. The second person shall identify himself or herself as being trained in CPR and that they are willing to
help. ("I know CPR. Can I help?")

2. The second person should call the local emergency number or medical personnel for assistance if it has
not already been done.

3. The person doing CPR will indicate when he or she is tired; and should stop CPR after the next 2 full
breaths.

4. The second person should kneel next to the casualty opposite the first person, tilt the casualty's head

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Virtual Naval Hospital: Standard First Aid Course - Chapter One - Basic Life Support

back, and check for a carotid pulse for 5 seconds.

5. If there is no pulse, the second rescuer should give 2 full breaths and continue CPR.

6. The first person will monitor the effectiveness of CPR by looking for the chest to rise during rescue
breathing and feeling for a carotid pulse (artificial pulse) during chest compressions.

CPR for Children and Infants

If the casualty is an infant (0-1 year old) or child (1-8 years old), do the following:

1. Check unresponsiveness - Infant: Tap or shake shoulder only. Child: Tap or gently shake the
shoulder, shout, "Are you OK?"

2. Shout, "Help" - If there is no response from infant or child.

3. Position casualty - Turn casualty on back as a unit, supporting, the head and neck. Place casualty on a
firm surface.

4. Open airway (Head-tilt/Chin-lift or jaw thrust) - Place your hand on the casualty's forehead. Place the
fingers of your other hand under the bony part of the chin. Avoid putting pressure under the chin, it may
cause an obstruction of the airway. Tilt the head and lift the jaw, avoid closing the casualty's mouth.
Infant: Do not overextend the head and neck. Place your ear over the casualty's mouth and nose. Look at
the chest, listen, and feel for breathing, 3 to 5 seconds.

5. Give breaths - Open your mouth, take a breath, and make an air-tight seal around the casualty's mouth
and nose. Give 2 breaths (puffs for infants), each lasting 1 to 1 1/2 seconds. Pause between each breath.
Look for the chest to rise, listen, and feel for breathing.

6. Check pulse - While maintaining an open airway, locate the carotid pulse (Infants: Locate the brachial
pulse (Fig. 2-13) on the inside of the upper arm, between the elbow and shoulder). Feel for a pulse for 5
to 10 seconds. Quickly examine the casualty for signs of bleeding.

7. Request medical assistance - If someone responded to your call for help, send them to call the local
emergency number or medical personnel.

8. Chest compressions (infant) -

a. Face infant's chest.


b. Place your middle and index fingers on the breastbone at the nipple line.
c. Give 5 compressions, each should compress the chest 1/2 to 1 inch at a rate of at least 100

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compressions per minute. After each 5th compression, deliver 1 breath. Compressions should be
smooth, rhythmic, and uninterrupted.
d. Continue for 10 complete cycles of 5 compressions and 1 breath. Check for a brachial pulse for
5 seconds.

9. Chest compressions (children) -

a. Face child's chest.


b. With your middle and index fingers of the hand nearest the child's legs, locate the lower edge of
the rib cage on the side closest to you.
c. Slide your fingers up the rib cage to the notch at end of the breastbone.

Figure 2-13 Check Infant's Pulse


d. Place your middle finger on the notch, and your index finger next to it.
e. While looking at the position of your index finger, lift that hand and place your heel (on
breastbone at nipple line) next to where your index finger was.
f. Keep your fingers off the child's chest.
g. Position your shoulder over your hand, with elbow locked and your arm straight.
h. Give 5 compressions, each should compress the chest 1 to 1 1/2 inches at a rate of 80 to 100
compressions per minute. After each 5th compression, deliver 1 breath. Compressions should be
smooth, rhythmic, and uninterrupted.
i. Continue for 10 complete cycles of 3 compressions and 1 breath. Check for a carotid pulse for 5
seconds.

10. Continue CPR - If the infant or child has no pulse, give 1 breath and continue CPR. Check for a
pulse every few minutes. If the pulse is present but breathing is absent, continue rescue breathing (Infant:
20 breaths/min; Child: 15 breaths/min.) If the infant or child begins to breathe, maintain an open airway,
until medical assistance arrives. Continue CPR until successful, you are exhausted, you are relieved by
another trained in CPR or medical personnel, or the infant or child is pronounced dead. This course is
not a substitute for formal training in cardiopulmonary resuscitation (CPR).

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Virtual Naval Hospital: Standard First Aid Course - Chapter One - Basic Life Support

References

1. Instructors Manual for Basic Life Support, American Heart Association, ISBN 0-87493-601-2
2. NAVEDTRA 10669-C, Hospital Corpsman 3 & 2

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Virtual Naval Hospital: Standard First Aid Course - Chapter Three - Bleeding

NAVEDTRA 13119 Standard First Aid Course - Chapter Three - Bleeding

Bleeding
Department of the Navy
Bureau of Medicine and Surgery
Peer Review Status: Internally Peer Reviewed

Bleeding (hemorrhage) is the escape of blood from capillaries, veins, and arteries. Capillaries are very
small blood vessels that carry blood to all parts of the body. Veins are blood vessels that carry blood to
the heart. Arteries are large blood vessels that carry blood away from the heart. Bleeding can occur
inside the body (internal), outside the body (external) or both. Blood is a fluid that consists of a pale
yellow liquid (plasma), red blood cells (erythrocytes), white blood cells (leukocytes), and platelets
(thrombocytes). Plasma is the fluid portion of the blood that carries nutrients. Red blood cells give color
to the blood and carry oxygen. White blood cells defend the body against infection and attack foreign
particles. Platelets are disk shaped and assist in clotting the blood, the mechanism that stops bleeding.
There are three types of bleeding. Capillary bleeding is slow, the blood "oozes" from the (wound) cut.
Venous bleeding is dark red or maroon, the blood flows in a steady stream. Arterial bleeding is bright
red, the blood "spurts" from the wound. Arterial bleeding is life threatening and difficult to control.

In small wounds, only the capillaries are damaged. Deeper wounds result in damage to the veins and
arteries. Damage to the capillaries is usually not serious and can easily be controlled with a Band-Aid.
Damage to the veins and arteries are more serious and can be life threatening. The adult body contains
approximately 5 to 6 quarts of blood (10 to 12 pints). The body can normally lose 1 pint of blood (usual
amount given by donors) without harmful effects. A loss of 2 pints may cause shock, a loss of 5 to 6
pints usually results in death. During certain situations it will be difficult to decide whether the bleeding
is arterial or venous. The distinction is not important. The most important thing to remember is that all
bleeding must be controlled as soon as possible.

External Bleeding

While administering first aid to a casualty who is bleeding, you must remain calm. The sight of blood is
an emotional event for many, and it often appears severe. However, most bleeding is less severe than it
appears. Most of the major arteries are deep and well protected by tissue and bone. Although bleeding

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can be fatal, you will usually have enough time to think and act calmly. There are four methods to
control bleeding: direct pressure, elevation, indirect pressure, and the use of a tourniquet.

Direct Pressure

Direct pressure is the first and most effective method to control bleeding. In many cases, bleeding can be
controlled by applying pressure directly (Fig. 3-1) to the wound. Place a sterile dressing or clean cloth on
the wound, tie a knot or adhere tape directly over the wound, only tight enough to control bleeding. If
bleeding is not controlled, apply another dressing over the first or apply direct pressure with your hand or
fingers over the wound. Direct pressure can be applied by the casualty or a bystander. Under no
circumstances is a dressing removed once it has been applied.

Elevation

Raising (elevation) of an injured arm or leg (extremity) above the level of the heart will help control
bleeding.

Figure 3-1 Direct Pressure

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Virtual Naval Hospital: Standard First Aid Course - Chapter Three - Bleeding

Figure 3-2 Pressure Points for Control of Bleeding

Elevation should be used together with direct pressure. Do not elevate an extremity if you suspect a
broken bone (fracture) until it has been properly splinted and you are certain that elevation will not cause
further injury. Use a stable object to maintain elevation. Placing an extremity on an unstable object may
cause further injury.

Indirect Pressure

In cases of severe bleeding when direct pressure and elevation are not controlling the bleeding, indirect

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pressure must be used. Bleeding from an artery can be controlled by applying pressure to the appropriate
pressure point. Pressure points (Fig. 3-2) are areas of the body where the blood flow can be controlled by
pressing the artery against an underlying bone. Pressure is applied with the fingers, thumb, or heel of the
hand.

Pressure points should be used with caution. Indirect pressure can cause damage to the extremity
due to inadequate blood flow. Do not apply pressure to the neck (carotid) pressure points, it can
cause cardiac arrest.

Indirect pressure is used in addition to direct pressure and elevation. Pressure points in the arm (brachial)
and in the groin (femoral) are most often used, and should be thoroughly understood. The brachial artery
is used to control severe bleeding of the lower part of the upper arm and elbow. It is located above the
elbow on the inside of the arm in the groove between the muscles. Using your fingers or thumb, apply
pressure (Fig. 3-2E) to the inside of the arm over the bone. The femoral artery is used to control severe
bleeding of the thigh and lower leg. It is located on the front, center part of the crease in the groin.
Position the casualty on his or her back, kneel on the opposite side (Fig. 3-2H ) from the wounded leg,
place the heel of your hand directly on the pressure point, and lean forward to apply pressure. If the
bleeding is not controlled, it may be necessary to press directly over the artery with the flat surface of the
fingertips and to apply additional pressure on the fingertips with the heel of your other hand.

Tourniquet

A tourniquet should be used only as a last resort to control severe bleeding after all other methods have
failed and is used only on the extremities. Before use, you must thoroughly understand its dangers and
limitations. Tourniquets cause tissue damage and loss of extremities when used by untrained individuals.
Tourniquets are rarely required and should only be used when an arm or leg has been partially or
completely severed and when bleeding is uncontrollable.

The standard tourniquet is normally a piece of cloth folded until it is 3 or more inches wide and 6 or 7
layers thick. A tourniquet can be a strap, belt, neckerchief, towel, or other similar item. A folded
triangular bandage makes a great tourniquet. Never use wire, cord, or any material that will cut the
skin.

To apply a tourniquet (Fig. 3-3), do the following:

1. While maintaining the proper pressure point, place the tourniquet between the heart and the wound,
leaving at least 2 inches of uninjured skin between the tourniquet and wound.

2. Place a pad (roll) over the artery.

3. Wrap the tourniquet around the extremity twice, and tie a half-knot on the upper surface.

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Virtual Naval Hospital: Standard First Aid Course - Chapter Three - Bleeding

4. Place a short stick or similar object on the half-knot, and tie a square knot.

5. Twist the stick to tighten, until bleeding is controlled.

6. Secure the stick in place.

7. Never cover a tourniquet.

Figure 3-3 Applying a Tourniquet

8. Using lipstick or marker, make a 'T" on the casualty's forehead and the time tourniquet was applied.

9. Never loosen or remove a tourniquet once it has been applied. The loosening of a tourniquet may
dislodge clots and result in enough blood loss to cause shock and death.

Do not touch open wounds with your fingers unless absolutely necessary. Place a barrier between
you and the casualty's blood or body fluids, using plastic wrap, gloves, or a clean, folded cloth.
Wash your hands with soap and warm water immediately after providing care, even if you wore
gloves or used another barrier.

Internal Bleeding

Internal bleeding, although not usually visible, can result in serious blood loss. A casualty with internal
bleeding can develop shock before you realize the extent of their injuries. Bleeding from the mouth, ears,
nose, rectum, or other body opening (orifice) is considered serious and normally indicates internal
bleeding.

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The most common sign of internal bleeding is a simple bruise (contusion), it indicates bleeding into the
skin (soft tissues). Severe internal bleeding occurs in injuries caused by a violent force (automobile
accident), puncture wounds (knife), and broken bones.

Signs of internal bleeding include:

1. Anxiety and restlessness.

2. Excessive thirst (polydipsia).

3. Nausea and vomiting.

4. Cool, moist, and pale skin (cold and clammy).

5. Rapid breathing (tachypnea).

6. Rapid, weak pulse (tachycardia).

7. Bruising or discoloration at site of injury (contusion).

If you suspect internal bleeding, do the following:

1. Bruise (contusion) - Apply ice or cold pack, with cloth to prevent damage to the skin, to reduce pain
and (edema) swelling.

2. Severe internal bleeding:

a. Call local emergency number or medical personnel.


b. Monitor airway, breathing, and circulation (ABCs).
c. Treat for shock.
d. Place casualty in most comfortable position.
e. Maintain normal body temperature.
f. Reassure casualty

Nosebleed

Nosebleeds (epistaxis) can be caused by an injury, disease, the environment, high blood pressure, and
changes in altitude. They frighten the casualty and may bleed enough to cause shock. If a fractured
skull is suspected as the cause, do not stop the bleeding. Cover the nose with a loose, dry, sterile
dressing and call the local emergency number or medical personnel. If the casualty has a nosebleed
due to other causes, do the following:

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1. Keep the casualty quiet, sitting with head tilted forward.

2. Pinch the nose shut (if there is no fracture), place ice or cold packs to the bridge of the nose, or put
pressure on the upper lip just below the nose. Inform the casualty not to rub, blow, or pick his or her
nose. Seek medical assistance if the nosebleed continues, bleeding starts again, or bleeding is because of
high blood pressure. If the casualty loses consciousness, place them on their side to allow blood to
drain from the nose and call the local emergency number or medical personnel.

Foreign bodies in the nose usually occur among children. First aid consists of seeking professional
medical attention. Nasal damage and the possibility of pushing the object farther up the nose can result
from searching and attempts at removal by unqualified personnel.

Casualties with severe external bleeding and suspected internal bleeding must be seen by medical
personnel as soon as possible. All casualties with external and internal bleeding should be treated
for shock.

References

1. Karren, K. J. and Hafen, B.Q.: First Responder A Skills Approach, edition 3, Morton Publishing
Company
2. American Red Cross Standard First Aid Workbook, edition 1991, American Red Cross
3. NAVEDTRA 10669-C, Hospital Corpsman 3 & 2

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Virtual Naval Hospital: Standard First Aid Course - Chapter Four - Shock

NAVEDTRA 13119 Standard First Aid Course - Chapter Four - Shock

Shock
Department of the Navy
Bureau of Medicine and Surgery
Peer Review Status: Internally Peer Reviewed

Shock, is the failure of the heart and blood vessels (circulatory system) to maintain enough oxygen-rich
blood flowing (perfusion) to the vital organs of the body. There is shock to some degree with every
illness or injury; shock can be life threatening. The principles of prevention and control are to recognize
the signs and symptoms and to begin treating the casualty before shock completely develops. It is
unlikely that you will see all the signs and symptoms of shock in a single casualty. Sometimes the signs
and symptoms may be disguised by the illness or injury or they may not appear immediately. In fact
many times, they appear hours later.

The usual signs and symptoms (Fig. 4-1) of the development of shock are:

1. Anxiety, restlessness and fainting.

2. Nausea and vomiting.

3. Excessive thirst (polydipsia).

4. Eyes are vacant, dull (lackluster), large (dilated) pupils.

5. Shallow, rapid (tachypnea), and irregular breathing.

6. Pale, cold, moist (clammy) skin.

7. Weak, rapid (tachycardia), or absent pulse.

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Figure 4-1 Symptoms of Shock

Hypovolemic Shock

Hypovolemic shock is caused by a decreased amount of blood or fluids in the body. This decrease results
from injuries that produce internal and external bleeding, fluid loss due to burns, and dehydration due to
severe vomiting and diarrhea.

Neurogenic Shock

Neurogenic shock is caused by an abnormal enlargement of the (vasodilation) blood vessels and pooling
of the blood to a degree that adequate blood flow cannot be maintained. Simple fainting (syncope) is a
variation, it is the result of a temporary pooling of the blood as a person stands. As the person falls, blood
rushes back to the head and the problem is solved.

Psychogenic Shock

Psychogenic shock is a "shock like condition" produced by excessive fear, joy, anger, or grief. Shell

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Virtual Naval Hospital: Standard First Aid Course - Chapter Four - Shock

shock is a psychological adjustment reaction to stressful wartime experiences. Care for shell shock is
limited to emotional support and transportation of the casualty to a medical facility.

Anaphylactic Shock

Anaphylactic (allergic) shock occurs when an individual is exposed to a substance to which his or her
body is sensitive. The individual may experience a burning sensation, loss of voice, itching (pruritus),
hives, severe swelling, and difficulty breathing. The causative agents are injection of medicines, venoms
by stinging insects and animals, inhalation of dust and pollens, and ingestion of certain foods and
medications. Individuals with known sensitivities carry medication in commercially prepared kits.

Prevention and Treatment of Shock

While administering first aid to prevent or treat shock, you must remain calm. If shock has not
completely developed, the first aid you provide may actually prevent its occurrence. If it has developed,
you may be able to keep it from becoming fatal. It is extremely important that you render first aid
immediately.

To provide first aid for shock, do the following:

1. Maintain open airway - Head-tilt/chin-lift or jaw-thrust.

2. Control bleeding - Direct pressure, elevation, indirect pressure, or tourniquet if indicated.

3. Position casualty - Place the casualty on his or her back, with legs elevated 6 to 12 inches (Fig. 4-2).
If it is possible, take advantage of a natural slope of ground and place the casualty so that the head is
lower than the feet. If they are vomiting or bleeding around the mouth, place them on their side, or back
with head turned to the side. If you suspect head or neck injuries, or are unsure of the casualty's
condition, keep them lying flat.

4. Splint - Suspected broken and dislocated bones in the position in which they are found. Do not
attempt to straighten broken or dislocated bones, because of the high risk of causing further injury.
Splinting not only relieves the pain without the use of drugs but prevents further tissue damage and
shock. Pain and discomfort are often eliminated by unlacing or cutting a shoe or loosening tight clothing
at the site of the injury. A simple adjustment of a bandage or splint will be of benefit, especially when
accompanied by encouraging words.

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Virtual Naval Hospital: Standard First Aid Course - Chapter Four - Shock

Figure 4-2 Position for Treatment of Shock

5. Keep the casualty comfortable, and warm enough to maintain normal body temperature. If possible,
remove wet clothing and place blankets underneath the casualty. Never use an artificial means of
warming.

6. Keep the casualty as calm as possible. Excitement and excessive handling will aggravate their
condition. Prevent the casualty from seeing his or her injuries, reassure them that their injuries are
understood and that professional medical assistance will arrive as soon as possible.

7. Give nothing by mouth - Do not give the casualty anything to eat or drink because it may cause
vomiting. If the casualty complains of thirst, wet his or her lips with a wet towel.

8. Request medical assistance - Ask bystanders to call the local emergency number or medical
personnel.

References

1. NAVEDTRA 10669-C, Hospital Corpsman 3 & 2

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Virtual Naval Hospital: Standard First Aid Course - Chapter Five - Soft Tissue Injuries

NAVEDTRA 13119 Standard First Aid Course - Chapter Five - Soft Tissue Injuries

Soft Tissue Injuries


Department of the Navy
Bureau of Medicine and Surgery
Peer Review Status: Internally Peer Reviewed

The most common injuries (trauma) seen in a first aid setting are soft tissue injuries with bleeding and
shock. Injuries that cause a break in the skin, underlying soft tissue, or other body membrane are known
as a wound. Injuries to the soft tissues vary from bruises (contusion) to serious cuts (lacerations) and
puncture wounds in which the object may remain in the wound (impaled objects). The two main threats
with these injuries are bleeding and infection.

Classification of Wounds

Wounds are classified according to their general condition, size, location, the manner in which the skin
or tissue is broken, and the agent that caused the wound. It is usually necessary for you to consider some
or all of these factors in order to determine what first aid treatment is appropriate.

General Condition

If the wound is new, first aid consists mainly of controlling the bleeding, treating for shock, and reducing
the risk of infection. If the wound is old and infected, first aid consists of keeping the casualty quiet,
elevating the injured part, and applying a warm wet dressing. If the wound contains foreign objects, first
aid may consist of removing the objects if they are not deep. Do not remove impaled objects or objects
embedded in the eyes or skull.

Size

Generally, large wounds are more serious than small ones and they usually involve severe bleeding, more
damage to the underlying tissues and organs, and a greater degree of shock. However, small wounds are
sometimes more dangerous than large ones: they may become infected more readily due to neglect. The

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depth of a wound also is important because it may lead to a complete (through & through) perforation of
an organ or the body, with the additional complication of an entrance and exit wound.

Location

Since a wound can cause serious damage to deep structures, as well as to the skin and tissues below it,
the location is an important consideration. A knife wound to the chest is likely to puncture a lung and
cause difficulty breathing. The same type of wound in the abdomen can cause a life-threatening
infection, internal bleeding, or puncture the intestines, liver, or other vital organs. A bullet wound to the
head may cause brain damage, but a bullet wound to the arm or leg, may cause no serious damage.

Types of Wounds

As the first line of defense against most injuries, soft tissues are most often damaged. There are two types
of soft tissue injuries: open and closed. An open wound is one in which the skin surface has been broken,
a closed wound is where the skin surface is unbroken but underlying tissues have been damaged.

Closed Wounds

A blunt object that strikes the body will damage tissues beneath the skin. When the damage is minor, the
wound is called a bruise (contusion). When the tissue has extensive damage, blood and fluid collect
under the skin causing discoloration (ecchymosis), swelling (edema), and pain. First aid consists of
applying ice or cold packs to reduce swelling and relieve discomfort. To guard against frostbite, never
apply ice or cold packs directly to the skin.

Hematomas are the result of a severe blunt injury with extensive soft tissue damage, tearing of large
blood vessels, and pooling of large amounts of blood below the skin. With large hematomas, look for
broken bones, especially if deformity is present. First aid consists of applying ice or cold packs to reduce
swelling and relieve pain, direct pressure (manual compression) to help control internal bleeding,
splinting, and elevation. When large areas of bruising are present, shock may develop.

Open Wounds

In open soft tissue injuries, the protective layer of the skin has been damaged. This damage can cause
serious internal and external bleeding. Once the protective layer of skin has been broken, the wound
becomes contaminated and may become infected. When you consider the way in which the skin or tissue
has been broken, there are six basic types of open wounds: abrasions, amputations, avulsions, incisions,
lacerations, and punctures. Many wounds are a combination of two or more of these types.

Abrasions

Abrasions are caused when the skin is rubbed or scraped off. Rope burns, floor burns, and skinned knees

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or elbows are common examples of abrasions. Abrasions easily can become infected, because dirt and
germs are usually ground into the tissues. There is normally minimal bleeding or oozing of clear fluid.

Amputations

Amputations (traumatic) are the non-surgical removal of the fingers, toes, hands, feet, arms, legs, and
ears from the body. Bleeding is heavy and normally requires a tourniquet, to control the blood flow.
There are three types of amputation:

1. Complete - Body part is completely torn off (severed).


2. Partial - More than 50% of the body part is torn off.
3. De-gloving - Skin and tissue are torn away from body part.

If the casualty has an amputation, do the following:

1. Establish and maintain the airway, breathing, and circulation (ABCs).

2. Control bleeding with direct pressure, elevation, indirect pressure, or tourniquet only as a last resort,
never remove or loosen a tourniquet once it has been applied.

3. Apply dressing to the stump with an ace wrap to replace direct pressure.

4. Treat for shock.

5. Request medical assistance immediately.

Avulsions

An avulsion is an injury in which the skin is torn completely away from a body part or is left hanging as
a flap. Usually, there is severe bleeding. If possible, obtain the part that has been torn away, rinse it in
water, wrap it in a dry sterile gauze, seal it in a plastic bag, and send it on ice with the casualty. Do not
allow part to freeze and do not submerge in water. If the skin is still attached, fold the flap back into
its normal position.

Incisions

Incisions, commonly called cuts, are wounds made by sharp cutting instruments such as knives, razors,
or broken glass. Incisions tend to bleed freely because the blood vessels are cut cleanly, without ragged
edges. The wound edges are smooth and there is little damage to the surrounding tissues. Of all the
classes of open wounds, incisions are the least likely to become infected.

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Lacerations

Lacerations are wounds that are torn, rather than cut. They have ragged, irregular edges and torn tissue
underneath. These wounds are usually made by a blunt, rather than a sharp, object. A wound made by a
dull knife is more likely to be a laceration than an incision. Many of the wounds caused by machinery
accidents are lacerations, often complicated by crushed tissues. Lacerations are frequently contaminated
with dirt, grease, or other materials that are ground into the wound; they are very likely to become
infected.

Punctures

Punctures are caused by objects that enter the skin while leaving a surface opening. Wounds made by
nails, needles, wire, knives, and bullets are normally punctures. Small puncture wounds usually do not
bleed freely; however, large puncture wounds may cause severe internal bleeding. The possibility of
infection is great in all puncture wounds, especially if the penetrating object is contaminated. Perforation
(through & through) is a variation, it is the result of a penetrating object entering, passing through, and
exiting the body.

Causes

Although it is not necessary to know what object or method has caused a wound, it is helpful. Knowing
what caused the wound and how it occurred can help you determine its general condition, possible size,
type, and seriousness of the wound. This information will help you provide the appropriate first aid to the
casualty.

Treatment of Wounds

First aid treatment for all wounds consists of controlling the flow of blood, treating for shock, and
preventing infection. When providing first aid to casualty with multiple injuries, treat the wounds that
appear to be life-threatening first. Since most of the body is covered by clothing, carefully examine the
entire body for bleeding. When necessary, tear or cut clothing away from the wound because excessive
movement of the injured part will cause pain and additional damage.

Bleeding

After establishing an adequate open airway, the main concern will be to control bleeding, by direct
pressure and elevation. Indirect pressure and the use of a tourniquet should be used only if direct pressure
and elevation do not control the bleeding. Bleeding control is discussed further in Chapter 3 . A
protective covering (dressing) that is properly applied should adequately control the bleeding. In cases of
severe bleeding, you may need to double the dressing. Never remove a dressing that is soaked with blood
to replace it with another; just place the new dressing over the old one.

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Shock

Shock may be severe in a casualty who has lost a large amount of blood or suffered a serious injury. The
causes and treatment of shock are discussed further in Chapter 4.

Infection

Infections can occur in any wound. Infection is a hazard in wounds that do not bleed freely; in wounds
where tissue is torn or the skin falls back into place and prevents the entrance of air; and in wounds that
involve the crushing of tissue. Incisions, in which there is a free flow of blood and relatively little
crushing of tissues, are the least likely to become infected. The signs of infection are tenderness, redness,
heat, swelling, and a discharge. Serious infections develop red streaks that lead from the wound to the
heart. Infections are dangerous, especially in the area of the nose and mouth. From this area, (Fig. 5-1)
infections spread easily into the bloodstream, causing blood poisoning (septicemia), and into the brain,
causing a collection of pus (abscess) and infection. Small wounds should be washed immediately with
soap and water, dried, and treated with an application of a mild, non-irritating antiseptic. Apply a
dressing if necessary. Make no attempt to wash a large wound and do not apply an antiseptic. Cover the
wound with a dry, sterile dressing. Further treatment of large wounds should be conducted by medical
personnel. All puncture wounds must be evaluated by medical personnel.

Figure 5-1 Danger Zone for Infection

Foreign Bodies

Many wounds contain foreign bodies. Wood or glass splinters, bullets, metal fragments, wire, fishhooks,
nails, and small particles from grinding wheels are examples of materials that are found in wounds. In
most cases, first aid will include the removal of this material if the wound is minor and the object is near

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the surface and exposed. However, first aid does not include the removal of deeply embedded objects,
powdered glass, or any scattered material. Never attempt to remove bullets, examine the casualty to
find out whether the bullet remains in the body by looking for both an entrance and exit wound.

The general rule is: Remove foreign objects from a wound ONLY when you can do so easily and without
causing further damage.

Do not attempt to remove an object that is embedded in the eye or that has penetrated the eye.

Treatment of Specific Conditions

It is impossible to list all wounds in simple categories. Some require special treatment and precautions.
You may see wounds that are not described in this course, but most wounds can be treated by calmly
remembering the general treatment of wounds.

Eye Wounds

Foreign bodies such as particles of dirt, sand, paint chips, or fine pieces of metal frequently find their
way into the eyes. They not only cause discomfort, but if not removed, they can cause inflammation and
infection. Fortunately, through an increased flow of tears, nature dislodges many of these particles before
any damage is done. Never let the casualty rub the eye, since rubbing, can cause scratches (abrasions)
to the eye and can push a foreign body deeper into the eye, causing further damage. Gently flush the
casualty's eye with water at least 15 to 20 minutes. If flushing the eye is not successful in removing
the foreign body, patch both eyes and get the casualty to medical personnel. It is always safer to send the
casualty to medical personnel than for you to attempt to remove foreign bodies. If the casualty has an
object embedded in, or penetrating from, the eye, or the eyeball is protruding from the socket, do the
following:

1 .Take a thick dressing or several dressings and cut a hole in the middle, large enough to go over the eye
without touching the object. If you cannot cut a hole in the dressing, you can build several dressings
around the object.

2. Take a paper cup or other object that is wide enough and strong enough to adequately protect the
object without putting pressure on the eye. Place this over the top of the object. Close and cover the
unaffected eye to minimize movement of the injured eye.

3. Take a roller bandage and wrap it over the cup and around the head several times ensuring that the cup
and dressing are snug enough not to come off, but not tight enough to cause discomfort.

When finished, this type of dressing will adequately protect the eye.

Laceration of the Eyelids

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Soft tissues around the eye bleed extensively. This bleeding may make the wound look more serious than
it is. However, the bleeding can be controlled easily with a pressure dressing. Before any pressure is
applied to the eye, make sure that the eyeball is not cut. If the eye is cut, do not apply pressure to the
eye, even to stop bleeding from the eyelid. Pressing on the eye will cause the fluid to leak out, and will
result in irreparable damage. If the eyelid is cut and you find fragments of skin, rinse them in water, wrap
in a dry sterile gauze, seal in a plastic bag, and send it on ice with the casualty. Do not allow part to
freeze and do not submerge in water. If the skin is still attached, fold the flap back into its normal
position.

When you cover the injured eye you must also cover the good eye. The eyes move together, and even
when the injured eye is patched it will move when the good eye moves. Tell the casualty what you are
doing, this will reduce their fears of not being able to see.

Foreign Objects in the Ear

Foreign bodies such as particles of dirt, paint chips, or small insects find their way into the ears. They not
only cause discomfort but, if not removed, they can cause inflammation and infection. Never insert
anything into the ear to dislodge foreign bodies because you can damage the lining of the ear or cut
(perforate) the ear drum. Do not attempt to flush objects out with water; many absorb water and can
cause damage from swelling. In the case of insects, if it is alive, shining a light into the ear may attract
the insect and cause it to come out. It is always safer to send the casualty to medical personnel than for
you to attempt to remove foreign bodies.

Head Wounds

Injuries to the head (scalp) can occur as a result of diving, automobile accidents, falls, blunt trauma,
knives, bullets, and many other causes. Head wounds can be open or closed. In open head wounds there
is an obvious injury in which there is normally a lot of bleeding. Closed head wounds may not be
obvious, many times you will have to treat the casualty based on how the accident happened. You may
see only the delayed symptoms, such as a seizure, confusion, or personality changes. Head wounds must
be treated with particular care, since there is always the possibility of brain damage.

If you suspect the casualty has suffered a head injury, look for the following:

1. Depressions, lacerations, deformities, bruising around the eyes (Raccoon's Sign) or behind the ears
(Battle's Sign).

2. Never touch a wound, examine a wound to determine depth, separate the edges of a wound, or remove
impaled objects.

3. Check the eyes: Are the pupils (constricted) small, (dilated) large, equal, or unequal?

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4. Blood or clear (cerebrospinal) fluid dripping from the nose or ears. (Cover loosely with a sterile
dressing to absorb but not stop the flow).

If you suspect a head injury, do the following:

1. Position the casualty flat, stabilize the head and neck as you found them by placing your hands on
both sides of the head.

2. Establish and maintain open airway using the jaw-thrust maneuver. Note that the head is not tilted
and the neck is not extended. Check the airway, breathing, and circulation (ABC's).

3. Finger sweep to remove any foreign bodies from the mouth.

4. Maintain a neutral position of the head and neck and, if possible, apply a cervical collar or improvised
(towel) collar.

5. Control bleeding using gentle, continuous pressure. Never apply direct pressure if the skull is
depressed or bone fragments are seen.

6. Apply dressing - Do not use direct pressure or tie knots over the wound. Apply ice or cold packs with
cloth to prevent damage to the skin.

7. Treat for shock - Casualtyies with suspected head and neck injuries are to remain flat. Do not raise
the casualty's feet. If casualty is vomiting or bleeding around the mouth, place them on their side
keeping the neck straight. Do not give anything to eat or drink.

8. Request medical assistance immediately - Time is critical.

Facial Wounds

Facial wounds are treated, generally, like other flesh wounds. However, ensure that the tongue or soft
tissue does not cause an airway obstruction. Keep the nose and throat clear of all foreign material and
position the casualty so that blood will drain out of the mouth and nose. Facial wounds and scalp wounds
bleed freely. Any casualty that has suffered a facial wound that involves the eye, eyelids, or the tissues
around the eye must receive professional medical attention as soon as possible. First aid for other facial
wounds is the same as head wounds.

Standard First Aid Boxes

Non-medical personnel are an important element in providing first aid to casualties prior to the arrival of

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professional medical personnel. Many lives have been saved by the first aid rendered by a shipmate.
Standard first aid boxes are distributed throughout a ship to provide easy access to first aid supplies. The
number of first aid boxes and their location depends on the ship's mission and the size of her crew.
Various dressings, wire splints, tape, Band-Aids, tourniquets, skin pencils, and other first aid supplies are
included in these boxes. Each box is secured with a wire or plastic seal that can be easily broken. The
seals are used to identify whether the kit has been opened. A broken seal indicates that the first aid box
must be inventoried and restocked. The standard first aid box has three compartments. Each compartment
should have a plastic bag that is complete with the basic first aid supplies. Take one of these bags with
you on your way to the casualty. Failure to take a bag to the scene may result in you having to go back
for supplies. The box does not contain needles, syringes, or medications; but does contain the proper
supplies needed to render first aid until medical assistance arrives. First aid boxes are for emergency
use only! Report all broken seals to medical personnel as soon as possible. It is important that you
know the contents and locations of these boxes.

Dressings

A dressing is a protective covering for a wound and is used to control bleeding and prevent
contamination of the wound. A compress is a sterile pad that is placed directly on the wound. A
bandage is material used to hold a compress in place. When applying a dressing, ensure that it remains
as sterile as possible. The part of the dressing that is placed against the wound must never touch your
fingers, clothing, or any un-sterile object. If you drop, a dressing across the casualty's skin or it slips after
it is in place, the dressing should not be used.

Battle Dressings

Battle dressings are used most often aboard ship and in the field. Each dressing is complete (no other
materials are needed) with four tabs which help in applying and securing the dressing. They have "other
side next to wound" marked on the outer side. This will help you in (Fig. 5-2) placing the sterile side
against the wound. Unless contraindicated, to assist in controlling the bleeding, tie the knot of the
dressing over the wound.

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Figure 5-2 Battle Dressing

Compresses

Emergencies may occur when it is not possible to obtain a sterile compress. During these situations, use
the cleanest cloth available, a freshly laundered handkerchief, towel, or shirt. Unfold the material
carefully so that you do not touch the part that will be placed against the wound. The compress should be
large enough to cover the entire wound and extend at least 1 inch beyond its edges. If a compress is not
large enough, the edges of the wound will become contaminated. Materials that will stick to a wound or
may be difficult to remove should never be used directly on a wound. Absorbent cotton, adhesive tape,
and paper napkins are examples of materials that should never come in contact with a wound.

Bandages

Bandages are strips or rolls of gauze or other materials that are used for wrapping or binding any part of
the body and to hold compresses in place. It is not necessary to take time to ensure that the bandage
resembles the textbook pictures. However, it is important that the dressing controls the bleeding, prevents
further contamination, and protects the wound from further injury. Some of the most commonly used
bandages are the roller bandage and the triangular bandage.

Roller Bandages

The roller bandage (Fig. 5-3) consists of a long strip of material (usually gauze, or elastic) that is rolled
and is available in several widths and lengths. Most are sterile, so pieces may be used as a compress on
wounds. A strip of roller bandage can be used to make a four-tailed bandage (Fig. 5-4A), by splitting the
cloth from each end, leaving as large a center as needed. This type of bandage is used to hold a compress

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(Fig. 5-4B) on the chin, or (Fig. 5-4C) the nose.

Figure 5-3 Roller Bandages

Figure 5-4 Four Tailed Bandage

Triangular Bandages

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Triangular bandages (Fig. 5-5) are usually made of muslin. They are useful because they can be folded in
a variety of ways to fit almost any part of the body. Padding can be added to areas that may become
uncomfortable.

Figure 5-5 - Triangular Bandage

Figure 5-6 Cravat Bandage

The triangular bandage can be folded to make a cravat bandage, which is useful in controlling bleeding
from wounds of the scalp or forehead. To make a cravat bandage, bring the point of the triangular
bandage (Fig. 5-6) to the middle of the base and continue to fold until a 2-inch width is obtained. If
specially prepared bandages are not available, use whatever material you can find. Remember that the
basic purpose of a bandage is to hold the sterile compress in place. Any material or method of application
that does not cause further injury to the casualty will be acceptable. Material used as a bandage does not
have to be sterile, since it will not come in direct contact with the wound. However, it should be as clean

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as possible. Cloth bandages should be fastened by tying the ends with a square knot or by tacking the
ends with safety pins. If you use a knot to fasten the bandage, be sure to use a square knot. This knot is
easy to tie, will not slip, and can be untied quickly. Place the knot so it will cause the least amount of
discomfort to the casualty and where it can be removed easily and quickly. Bandages should be applied
firmly but not too tight. A loose bandage will slip off the wound. A bandage that is too tight can cut off
the blood supply to the injured part and cause damage to the blood vessels and tissues. When you fasten a
bandage around an arm or leg, leave the fingers or toes uncovered. If they become blue or swollen, you
will know that the bandage is too tight and should be loosened.

Figures 5-7 through 5-12 show some of the uses of the roller, triangular, and cravat bandage.

Figure 5-7 - Roller Bandage for the Hand and Wrist

Figure 5-8 - Roller Bandage for the Ankle and Foot

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Figure 5-9 - Triangular Bandage for the Head

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Figure 5-10 - Triangular Bandage for the Chest

Figure 5-11 - Cravat Bandage for the Elbow or Knee

Figure 5-12 - Cravat Bandage for the Arm, Forearm, Leg, or Thigh

References

1. NAVEDTRA 10669-C,Hospital Corpsman 3 & 2

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Virtual Naval Hospital: Standard First Aid Course - Chapter Six - Bones, Joints and Muscles

NAVEDTRA 13119 Standard First Aid Course - Chapter Six - Bones, Joints and Muscles

Bones, Joints and Muscles


Department of the Navy
Bureau of Medicine and Surgery
Peer Review Status: Internally Peer Reviewed

Accidents cause many different types of injuries to bones, joints and muscles. When rendering first aid,
you must be alert for signs of broken bones (fractures), dislocations, sprains, strains, and bruises
(contusions). Injuries to the joints and muscles often occur together, and it is difficult to tell whether the
injury is to a joint, muscle, or tendon. It is difficult to tell joint or muscle injuries from fractures. When
in doubt, always treat the injury as a fracture.

The primary process of first aid for fractures consists of immobilizing the injured part to prevent the ends
of broken bones from moving and causing further damage to the nerves, blood vessels, or internal
organs. Splints are also used to immunize injured joints or muscles and to prevent the enlargement of
severe wounds. Before learning first aid for injuries to the bones, joints, and muscles, you need to have a
general understanding of the use of splints.

Splints

In an emergency, almost any firm object or material will serve as a splint. Thus, umbrellas, canes, rifles,
sticks, oars, wire mesh, boards, cardboard, pillows, and folded newspapers can be used. A fractured leg
can be immobilized by securing it to the uninjured leg. Whenever possible, use ready-made splints such
as the pneumatic or traction splints.

Splints should be lightweight, padded, strong, rigid, and long enough to reach the joint above and below
the fracture. If they are not properly padded, they will not adequately immobilize the injured part.
Articles of clothing, bandages, blankets, or any soft material may be used as padding. If the casualty is
wearing heavy clothes, you may be able to apply the splint on the outside, allowing the clothing to serve
as a part of the required padding.

Fasten splints in place with bandages, adhesive tape, clothing, or any suitable material. One person
should hold the splints in position while another person fastens them.

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Splints should be applied tight, but never tight enough to stop the circulation of blood. When applying
splints to the arms or legs, leave the fingers or toes exposed. If the tips of the fingers or toes turn blue or
cold, loosen the splints or bandages. Injuries will probably swell, and splints or bandages that were
applied correctly may later be too tight.

Fractures

A break or rupture in a bone is called a fracture. There are two basic types; open and closed. A closed
fracture does not produce an open wound in the skin, also known as a simple fracture (Fig. 6-lA). An
open fracture produces an open wound in the skin, also known as a compound fracture (Fig. 6-1B).
Open wounds are caused by the sharp end of broken bones pushing through the skin; or by an object such
as a bullet that enters the skin from the outside.

Open fractures are usually more serious than closed fractures. They involve extensive tissue damage and
are likely to become infected. Closed fractures can be turned into open fractures by rough or careless
handling of the casualty. Always use extreme care when treating a suspected fracture.

Figure 6-1 - Types of Fractures

It is not easy to recognize a fracture. All fractures, whether open or closed, can cause severe pain or
shock. Fractures can cause the injured part to become deformed, or to take an unnatural position.
Compare the injured to the uninjured part if you are unsure of a deformity. Pain, discoloration, and
swelling may be at the fracture site, and there may be instability if the bone is broken clear through. It
may be difficult or impossible for the casualty to move the injured part. If movement is possible, the

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casualty may feel a grating sensation (crepitus) as the ends of the bones rub against each other. If a bone
is cracked rather than broken, the casualty may be able to move the injured part without much difficulty.
An open fracture is easy to see if the end of the bone sticks out through the skin. If the bone does not
stick out, you might see a wound but fail to see the broken bone. It can be difficult to tell if an injury is a
fracture, dislocation, sprain, or strain. When in doubt, splint.

If you suspect a fracture, do the following:

1. Control bleeding with direct pressure, indirect pressure, or tourniquet only as a last resort.

2. Treat for shock.

3. Monitor the airway, breathing, and circulation (ABCs).

4. Remove all jewelry from the injury site, unless the casualty objects. Gently cut clothing away so that
you don't move the injured part and cause further damage.

5. Check the distal pulse of the injured part, if pulse is absent, gently move injured part to restore
circulation.

6. Cover all wounds with sterile dressings, including open fractures. Do not push bone ends back into
the skin. Avoid excessive pressure on the wound.

7. Apply splint - Do not attempt to straighten borken bones.

a. Apply and maintain traction until the splint has been secured.
b. Wrap from the bottom of the splint to the top, firmly but not too tight.
c. Check the distal pulse to ensure that circulation is still present. If the pulse is absent, loosen the
splint until circulation returns. Do not move the casualty until the injury has been splinted.

8. Request medical assistance - All suspected fractures require professional medical treatment.

Fracture of the Forearm

There are two long bones in the forearm, the radius and the ulna. When both are broken, the arm usually
appears to be deformed. When only one is broken, the other acts as a splint and the arm retains a more
natural appearance. Fractures usually result in pain, tenderness, swelling, and loss of movement.

In addition to the general procedures above, apply a pneumatic (air) splint if available; if not, apply two
padded splints; one on the top (backhand side), and one on the bottom (palm side). Make sure the splints
are long enough to extend from the elbow to the wrist.

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Once the forearm is sprinted, place the forearm across the chest. The palm of the hand should be turned
in with the thumb pointing up. Support the forearm in this position (Fig. 6-2) with a wide sling and cravat
bandage. The band should be raised about 4 inches above the level of the elbow.

Figure 6-2 - Sling Used to Support a Fractured Forearm

Fracture of the Upper Arm

There is one bone in the upper arm, the humerus. If the fracture is near the elbow, the arm is likely to be
straight with no bend at the elbow. Fractures usually result in pain, tenderness, swelling, and loss of
movement. In addition to the general procedures above, do the following:

If the fracture is in the upper part of the arm, near the shoulder, place a pad or folded towel in the armpit,
bandage the arm securely to the body, and support the forearm in a narrow sling. If the fracture is in the
middle of the upper arm, you can use one well padded splint on the outside of the arm. The splint should
extend from the shoulder to the elbow. Secure the arm firmly to the body and support the forearm in a
sling (Fig. 6-3).

If the fracture is at or near the elbow, the arm may be either bent or straight. Regardless what position
you find the arm, do not attempt to straighten or move it. Gently splint the arm in the position in
which you find it.

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Figure 6-3 - Splint and Sling for a Fractured Upper Arm

Fracture of the Rib

Make the casualty as comfortable as possible so that the chances of further damage to the lungs, heart, or
chest wall is minimized.

A common finding in all casualties with fractured ribs is pain at the site of the fracture. Ask the casualty
to point to the exact area of pain to assist you in determining the location of the fracture. Deep breathing,
coughing, or movement is usually painful. The casualty should remain still and may lean toward the
injured side, with a hand over the fracture to immobilize the chest and ease the pain.

Simple rib fractures are not bound, strapped, or taped if the casualty is comfortable. If the casualty is
more comfortable with the chest immobilized, use a sling and swathe (Fig. 6-4). Place the arm on the
injured side against the chest, with the palm flat, thumb up, and the forearm raised to a 45-degree angle.
Immobilize the chest, using wide strips of bandage (ace wrap) to secure the arm to the chest.

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Figure 6-4 - Swathe Bandage for Fractured Rib Victim

Fracture of the Thigh

There is one long bone in the upper leg between the kneecap and the pelvis, the femur. When the femur
is fractured, any attempt to move the leg results in a spasm of the muscles that causes severe pain. The
leg is not stable, and there is complete loss of control below the fracture. The leg usually assumes an
unnatural position, with the toes pointing outward. The injured leg is shorter than the uninjured one due
to the pulling of the thigh muscles. Serious bleeding is a real danger since the broken bone may cut the
large (femoral) artery. Shock usually is severe.

Figure 6-5 - Boards Used as Emergency Splint for Fractured Thigh

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In addition to the general procedures above, gently straighten the leg, apply two padded splints, one on
the outside and inside of the injured leg. The outside splint should reach from the armpit to the foot, the
inside splint from the groin to the foot. The splint should be secured in five places: (1) around the ankle,
(2) over the knee, (3) just below the hip, (4) around the pelvis, and (5) just below the armpit (Fig. 6-5).
The legs can then be tied together to support the injured leg. Do not move the casualty until the leg has
been splinted.

Fracture of the Lower Leg

There are two long bones in the lower leg, the tibia and fibula. When both are broken, the leg usually
appears to be deformed. When only one is broken, the other acts as a splint and the leg retains a more
natural appearance. Fractures usually result in pain, tenderness, swelling, and loss of movement. A
fracture just above the ankle is often mistaken for a sprain.

In addition to the general procedures above, gently straighten the leg, apply a pneumatic (air) splint if
available; if not, apply three padded splints, one on each side and underneath the leg. Place extra padding
(Fig. 6-6) under the knee and just above the heel. The splint should be secured in four places: (1) just
below the hip, (2) just above the knee, (3) just below the knee, and (4) just above the ankle. Do not place
the straps over the area of the fracture.

A pillow and two side splints also work well. Place a pillow beside the injured leg, then gently lift the leg
and place it in the middle of the pillow. Bring the edges of the pillow around to the front of the leg and
pin them together. Then place one splint on each side of the leg, over the pillow, and secure them in
place with a bandage or tape.

Fracture of the Kneecap

The kneecap is also known as the patella. Although fractures of the kneecap do occur, the more common
injuries are dislocations and sprains.

In addition to the general procedures above, gently straighten the leg, apply a pneumatic (air) splint if
available; if not, apply a padded board under the injured leg. The board should be at least 4 inches wide
and should reach from the buttock to the heel. Place extra padding under the knee and just above the
heel. The splint should be secured in four places: (1) just below the hip, (2) just above the knee, (3) just
below the knee, and (4) just above the ankle. Do not place the straps directly over the kneecap.

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Figure 6-6 - Immobilization of Fractured Kneecap

Fracture of the Collarbone

The collarbone is also known as the clavicle. When standing, the injured shoulder is lower, and the
casualty is unable to raise the arm above the shoulder. The casualty attempts to support the shoulder by
holding the elbow. This is the typical stance taken by a casualty with a broken collarbone. Since the
collarbone lies near the surface of the skin, you may be able to see the point of fracture by the deformity
and tenderness.

In addition to the general procedures above, gently bend the casualty's arm and place the forearm across
the chest. The palm of the hand should be turned in, with the thumb pointing up. Support the arm in this
position (Fig. 6-7) with a wide sling. The hand should be raised about 4 inches above the level of the
elbow. A wide roller bandage (or any wide strip of cloth) may be used to secure the casualty's arm to the
body.

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Figure 6-7 - Sling for Imobilizing Fractured Clavicle

Fracture of the Jaw

The lower jaw is also known as the mandible. The casualty may have difficulty breathing, difficulty in
talking, chewing, and swallowing, and have pain of movement of the jaw. The teeth may be out of line,
and the gums may bleed, and swelling may develop. The most important consideration is to maintain
an adequate open airway.

In addition to the general procedures above, apply a four-tailed bandage (Fig. 6-8), be sure the bandage
pulls the lower jaw forward. Never apply a bandage that forces the jaw backward, since this may
interfere with breathing. The bandage must be firm enough to support and immobilize the lower jaw, but
it must not press against the casualty's throat. The casualty should have scissors or a knife to cut the
bandage in case of vomiting.

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Figure 6-8 - Four Tailed Bandage for a Fractured Jaw

Fracture of the Skull

The skull is also known as the cranium. The primary danger is that the brain may be damaged. Whether
or not the skull is fractured is of secondary importance. The first aid procedures are the same in either
case, and the primary intent is to prevent further damage. Some injuries that fracture the skull do not
cause brain damage. But brain damage can result from minor injuries that do not cause damage to the
skull.

It is difficult to determine whether an injury has affected the brain, because symptoms of brain damage
vary. A casualty who has suffered a head injury must be handled carefully and given immediate medical
attention.

Signs and symptoms that may indicate brain damage include:

1. Wounds of the scalp, deformity of the skull.


2. Dizziness, weakness, conscious or unconscious.
3. Pain, tenderness, or swelling.
4. Severe headache, nausea and vomiting.
5. Restlessness, confusion, and disorientation.
6. Paralysis of the arms, legs, or face.
7. Unequal pupils, abnormal reaction to light.
8. Blood or clear fluid from the ears, nose, or mouth.
9. Pale, flushed skin.
10. Bruising behind the ear (Batlle's Sign).
11. Bruising under or around the eyes in the absence of trauma to the eyes (Raccoon's Sign).

If you suspect a head injury, do the following:

1. Position the casualty flat, stabilize the head and neck as you found them by placing your hands on

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both sides of the head.

2. Establish and maintain an open airway - jaw-thrust maneuver. Note that the head is not tilted and
the neck is not extended. Check the airway, breathing, and circulation (ABCs).

3. Finger sweep to remove any foreign bodies from the mouth.

4. Maintain neutral position of head and neck and, if possible, apply a cervical collar or improvised
(towel) collar.

5. Apply dressing - Do not use direct pressure or tie knots over the wound. Apply ice or cold packs if
available. (For blood or clear fluid from the nose or ears, cover loosely with a sterile dressing to absorb
but not stop the flow).

6. Treat for shock - Casualties with suspected head and neck injuries are to remain flat. Do not raise
the casualty's feet. If they are vomiting or bleeding around the mouth, place them on their side keeping
the neck straight. Do not give anything to eat or drink.

7.Request medical assistance immediately - Time is critical. Head and neck injuries should be
treated by professional medical personnel, if possible. Do not attempt procedures that you are not
trained to do.

Fracture of the Spine

The spine is also known as the backbone or spinal column. If the spine is fractured, the spinal cord may
be crushed, cut, or damaged so severely that death or paralysis may occur. If the fracture occurs in a way
that the spinal cord is not damaged, there is a chance of complete recovery. Twisting or bending of the
neck or back, whether due to the original injury or careless handling, is likely to cause irreparable
damage. The primary symptoms of a fractured spine are pain, shock, and paralysis. Pain may be acute at
the point of fracture and radiate to other parts of the body. Shock is usually severe, but the symptoms
may be delayed. Paralysis occurs if the spinal cord is damaged. If the casualty cannot move the legs, the
injury is probably in the back; if the arms and legs cannot move, the injury is probably in the neck. A
casualty who has back or neck pain following an injury should be treated for a fractured spine.

If you suspect a fractured spine, do the following:

1. Position the casualty flat, stabilize the head and neck as you found them by placing your hands on
both sides of the head.

2. Establish and maintain an open airway - jaw-thrust maneuver. Note that the head is not tilted and
the neck is not extended. Check the airway, breathing, and circulation (ABCs).

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3. Finger sweep to remove any foreign bodies from the mouth.

4. Maintain neutral position of head and neck and, if possible, apply a cervical collar or improvised
(towel) collar.

5. Keep the casualty comfortable and warm enough to maintain normal body temperature.

6. Treat for shock - Casualties with suspected spinal injuries are to remain flat. Do not raise the
casualty's feet. If the casualty is vomiting or bleeding around the mouth, place them on their side
keeping the neck straight. Do not give anything to eat or drink.

7. Request medical assistance immediately - Time is critical. Do not move the casualty unless it is
absolutely necessary. Do not bend or twist the casualty's body. Do not move the head forward,
backward, or sideways. Do not allow the casualty to sit up.

Fracture of the Pelvis

Fractures often result from falls, heavy blows, and crushing accidents. The greatest danger is damage to
the organs that are enclosed by the pelvis. There is danger that the bladder will be ruptured or that severe
internal bleeding may occur, due to the large blood vessels being torn by broken bone. The primary
symptoms are severe pain, shock, and loss of the ability to use the lower part of the body. The casualty is
unable to sit or stand and may feel like the body is "coming apart."

Treat for shock, but do not raise the casualty's feet. Do not move the casualty unless absolutely
necessary. Request medical assistance immediately.

Dislocations

A dislocation occurs when a bone is forcibly displaced from its joint. Many times the bone slips back
into its normal position; other times, it becomes locked and remains dislocated until it is put back into
place (reduction). Dislocations are caused by falls or blows and occasionally by violent muscular
exertion. The joints that are most frequently dislocated are the shoulder, hip, finger, and jaw.

A dislocation may bruise or tear muscles, ligaments, blood vessels, and tendons. The primary symptoms
are rapid swelling, discoloration, loss of movement, pain, and shock. You should not attempt to reduce
a dislocation. Unskilled attempts at reduction may cause damage to the nerves and blood vessels or may
fracture a bone. You should leave this treatment to professional medical personnel and concentrate your
efforts on making the casualty comfortable.

If you suspect a dislocation, do the following:

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1. Loosen clothing from around the injury.

2. Place the casualty in the most comfortable position.

3. Support the injured part with a sling, pillow, or splint.

4. Treat for shock.

5. Request medical assistance as soon as possible.

Sprains

A sprain is an injury to the ligaments that support a joint. It usually involves a sudden dislocation, with
the bone slipping back into place on its own. Sprains are caused by the violent pulling or twisting of the
joint beyond its normal limits of movement. The joints that are most frequently sprained are the ankle,
wrist, knee, and finger. Tearing of the ligaments is the most serious aspect of a sprain, and there is a
considerable amount of damage to the blood vessels. When the blood vessels are damaged, blood may
escape into the joint, causing pain and swelling.

If you suspect a sprain, do the following:

1. Splint to support the joint and put the ligaments at rest. Gently loosen the splint if it becomes so tight
that it interferes with circulation.

2. Elevate & rest the joint to help reduce the pain and swelling.

3. Apply ice or cold packs, with cloth to prevent damage to the skin, the first 24 hours, then apply warm
compresses to increase circulation.

4. Request medical assistance as soon as possible.

Treat all sprains as fractures until ruled out by x-rays.

Strains

A strain is caused by the forcible over-stretching or tearing of a muscle or tendon. They are caused by
lifting heavy loads, sudden or violent movements, or by any action that pulls the muscles beyond their
normal limits. The primary symptoms are pain, lameness, stiffness, swelling, and discoloration.

If you suspect a strain, do the following:

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1. Elevate & rest the injured area to help reduce the pain and swelling.

2. Apply ice or cold packs, with cloth to prevent damage to the skin, the first 24 hours, then apply warm
compresses to increase circulation.

3. Request medical assistance as soon as possible.

Treat all strains as fractures until ruled out by x-rays.

Contusions

A contusion (bruise) is an injury that causes bleeding into or beneath the skin, but it does not break the
skin. The primary symptoms are pain, tenderness, swelling, and discoloration. At first, the injured area is
red due to local irritation; as time passes the characteristic "black and blue" (ecchymosis) mark appears.
Several days after the injury, the skin becomes yellow or green in color. Usually, minor contusions do
not require treatment.

If you suspect a contusion, do the following:

1. Elevate & rest the injured area to help reduce the pain and swelling.

2. Apply ice or cold packs, with cloth to prevent damage to the skin, the first 24 hours, then apply warm
compresses to increase circulation.

3. Request medical assistance as soon as possible.

References

1. NAVEDTRA 10669-C, Hospital Corpsman 3 & 2

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Virtual Naval Hospital: Standard First Aid Course - Chapter Seven - Environmental Injuries

NAVEDTRA 13119 Standard First Aid Course - Chapter Seven - Environmental Injuries

Environmental Injuries
Department of the Navy
Bureau of Medicine and Surgery
Peer Review Status: Internally Peer Reviewed

Exposure to temperature extremes, whether heat or cold, causes injury to the skin, tissues, blood vessels,
vital organs, and in some cases, the entire body. Burns, heat cramps, heat exhaustion, and heat stroke are
caused by exposure to heat. Hypothermia (general cooling), frostbite, and (trenchfoot)immersion foot are
caused by exposure to the cold.

Burns and Scalds

Burns are caused by dry heat, and scalds are caused by moist heat. Treatment is the same for both.
Contact with an electric current also causes burns, especially if the skin is dry. The seriousness of the
burn can be determined by its depth, extent, and location and by the age and the health of the casualty.
You must take all these factors into consideration when evaluating burns. Burns are classified (Fig. 7-1)
according to their depth as first-degree, second-degree, and third-degree.

First-degree Burns

First-degree burns involve only the first (epidermal) layer of the skin. The skin is red, dry, warm,
sensitive to touch, and turns (blanches) white with pressure. Pain is mild to severe, swelling (edema) may
occur. Healing occurs naturally within a week.

Second-degree Burns

Second-degree burns involve the first and part of the second (dermis) layer of the skin. The skin is red,
blistered, weeping, and looks (spotted) mottled. Pain is moderate to severe, swelling often occurs.
Healing takes 2 - 3 weeks, with some scarring and depigmentation.

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Third-degree Burns

Third-degree burns involve all layers (full thickness) of the skin, penetrating into muscle, connective
tissue, and bone. The skin may vary from white and lifeless to black and charred. Pain will be absent at
the burn site if all the nerve endings are destroyed and the surrounding tissue will be painful. There is
considerable scarring, and skin grafting may be necessary. Third-degree burns are life threatening.

Figure 7-1, First-, Second-, and Third-degree Burns

It is important to remember that the extent (size) of the burned area (Fig. 7-2) is more important than the
depth of the burn. A first-degree burn that covers a large area of the body is usually more serious than a
small third-degree burn. The "rule of nines" is used to give a rough estimate of the surface area burned
and aids in deciding the correct treatment. Shock can be expected in adults with burns over 15 percent or
in small children with burns over 10 percent of the body surface area (BSA). In adults, burns involving
more than 20 percent of the body surface area endanger life and 30 percent burns are usually fatal if
adequate medical treatment is not received. The third factor in burn evaluation is the location: burns of
the head, hands, feet, or genitals may require hospitalization. The causes of burns are classified as
thermal (heat), chemical, electrical, or radiation.

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Figure 7-2-Rule of Nines

Thermal Burns

Thermal (heat) burns are caused by exposure to hot solids, liquids, gases, or fire. If the casualty has
thermal burns, do the following:

1. Monitor the airway, breathing, and circulation (ABC's). Always expect breathing problems when
there are burns around the face or if the casualty has been exposed to hot gases or smoke.

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2. Control bleeding using direct pressure, elevation, indirect pressure, or tourniquet if indicated.

3. Remove all jewelry from the area, unless the casualty objects. Swelling may develop rapidly.

4. Apply cool water to the affected area or submerge in cool water. Do not use ice or ice water.

5. Remove clothing gently from the burned area. Do not remove clothing that is sticking to the skin.

6. Cover area with dry, sterile dressings, if possible. Cover large areas with clean, dry sheets. Do not
break blisters or apply ointments of any kind.

7. Treat for shock - Keep the casualty comfortable and warm enough to maintain normal body
temperature. Elevate the burned area above the heart.

8. Request medical assistance for all burns. If possible, before transport, inform medical personnel of
the degree, location of the burn, and percentage of the body area affected.

Chemical Burns

When acids, alkalies, or other chemicals come in contact with the skin, they can cause injuries that are
generally referred to as chemical burns. These injuries are not caused by heat but by direct chemical
destruction of the tissues. The areas most often affected are the arms, legs, hands, feet, face, and eyes.
Alkali burns are usually more serious than acid burns; alkalies generally penetrate deeper and burn
longer.

If the casualty has chemical burns, do the following:

1. Flush area immediately with large quantities of fresh water, using an installed deluge shower or hose,
if available. Avoid excessive water pressure. Continue to flush the area for at least 15 minutes while
removing the clothes, including shoes, socks, and jewelry. Dry lime powder (alkali burns) creates a
corrosive substance when mixed with water; keep the powder dry and remove it by brushing it
from the skin. Acid burns caused by phenol (carbolic acid), should be washed with alcohol. Then wash
the area with large quantities of water. If alcohol is not available, flush the area with large quantities of
water. Cover chemical burns with a sterile dressing.

2. If available, follow the first aid procedures provided in the Material Safety Data Sheet (MSDS) for
the chemical.

3. Flush the eyes with fresh water immediately using an installed emergency eye/face bath or hose on
low pressure for at least 20 minutes. Ask casualty to remove contact lenses. Use your hands to keep the
eyelids open. Never use a neutralizing agent, mineral oil, or other material in the eyes.

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4. Monitor the airway, breathing, and circulation (ABCs).

5. Warning - Do not attempt to neutralize any chemical unless you are sure what it is and what
substance will effectively neutralize it. Further damage may be done by a neutralizing agent that is too
strong or incorrect. Do not apply creams or other materials to chemical burns.

6. Treat for shock - Keep the casualty comfortable and warm enough to maintain normal body
temperature.

7. Request medical assistance for all chemical burns. If possible, before transport, notify medical
personnel of the name and other pertinent information about the chemical involved, location of the burn,
and percentage of the body area affected. Send the container to medical personnel with the casualty.

Electrical Burns

Electrical burns may be more serious than they first appear. The entrance and exit wounds may be small,
but as electricity penetrates the skin, it burns a large area (Fig. 7-3) below the surface.

Figure 7-3. Electrical Penetration of the Skin

If the casualty has electrical burns, do the following:

1. Shut off the power. If you cannot shut off the power, remove the victim immediately. Stand on a well-

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insulated object, and use a dry rope, wooden pole, or other non-conductive material to either push or pull
the wire away from the casualty, or the casualty away from the electrical source. Do not attempt to
administer first aid or come in physical contact with an electrical shock casualty before shutting off
the power. If you cannot shut off the power immediately, remove the victim from the live
conductor before touching them.

2. Maintain a neutral position of the head and neck, apply a cervical collar or improvised (towel) collar.
(Casualty is usually thrown).

3. Establish and maintain the airway, breathing, and circulation (ABCs).

4. Begin CPR/rescue breathing - Electrical burns are often accompanied by respiratory or cardiac
arrest. If necessary start CPR (Chapter 2) immediately and continue until successful.

5. Cover burn areas with a moist, preferably sterile, dressing.

6. Treat for shock - Keep the casualty comfortable and warm enough to maintain normal body
temperature.

7. Request medical assistance for all electrical injuries. If possible, before transport, inform medical
personnel of the electrical source involved and the location of the entrance and exit wounds.

Sunburn

Sunburn results from prolonged exposure to the ultraviolet rays of the sun. First- and second- degree
burns similar to thermal burns may develop. Treatment is essentially the same as for thermal burns.
Unless a major percentage of the body is affected, the casualty will not require more than first aid
attention. Commercially prepared sunburn lotions and ointments may be used. Prevention through
education and the proper use of sunscreens and sunblocks is the best way to avoid this condition.

White Phosophorous Burns

A special category of burn, which may affect military personnel in a wartime or training situation, is that
caused by exposure to white phosphorous (WP or Willy Peter). First aid for this type of burn is
complicated by the fact that white phosphorous particles ignite upon contact with air. Superficial burns
caused by simple skin contact or burning clothes should be flushed with water and treated like thermal
burns. Partially embedded white phosphorous particles must be continuously flushed with water while
the first aid provider removes them with whatever tools are available, such as tweezers or pliers. Do this
quickly but gently. Deeply embedded particles that cannot be removed must be covered with a saltwater
(saline) soaked dressing that must remain wet until the casualty receives professional medical attention.
When rescuing casualties from a closed space where white phosphorous is burning, protect your lungs
with a wet cloth over your nose and mouth.

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Heat Exposure

Excessive heat affects the body in a variety of ways. When a person exercises in a hot environment, heat
builds up inside the body. The body automatically reacts to get rid of this heat through the sweating
mechanism. If the body loses large amounts of water and salt from sweating, heat cramps and heat
exhaustion may develop. If the body becomes too overheated, the sweat control mechanism of the body
malfunctions and shuts down. The result is heat stroke (sunstroke). Heat exposure injuries are a threat in
any hot environment, especially in desert or tropical areas and in the boiler rooms of ships.

Heat Cramps

Heat cramps are muscular pains and spasms resulting from the loss of water and salt from the body.
Excessive sweating may result in painful cramps of the muscles of the abdomen, legs, and arms. Heat
cramps also may result from drinking ice water or other cold drinks either too quickly or in too large a
quantity after exercise. Heat cramps are often an early sign of approaching heat exhaustion.

Signs and symptoms of heat cramps include:

1 Muscle pain and cramps.


2. Faintness or dizziness.
3. Nausea and vomiting.
4. Exhaustion and fatigue.

If you suspect heat cramps, do the following:

1. Move the casualty to a cool or air conditioned area.

2. If the casualty can drink, give him or her one-half glassful of cool water every 15 minutes. If the
casualty vomits, stop giving water. Do not give salt tablets.

3. Gently stretch or massage the muscle to relieve the spasm.

4. Request medical assistance if the casualty has other injuries or does not respond to the above
procedures.

Heat Exhaustion

Heat exhaustion is caused by the excessive loss of water and salt (sweating). It is the most common
condition from exposure to hot environments (Fig. 7-4).

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Figure 7-4. Symptoms of heat stroke and heat exhaustion.

Signs and symptoms of heat exhaustion include:

1. Pale, cool, (clammy) moist skin.


2. Large (dilated) pupils.
3. Normal or below normal temperature.
4. Rapid and shallow breathing.
5. Headache, nausea, loss of appetite.
6. Dizziness, weakness or fainting.

If you suspect heat exhaustion, do the following:

1. Move the casualty to a cool area, apply cold, wet compresses, and fan the casualty.

2. Treat for shock.

3. Remove the casualty's clothing, do not allow the casualty to become chilled.

4. If the casualty is conscious and can drink, give him or her one-half glassful of cool water every 15
minutes. If the casualty vomits, stop giving water. Do not give salt tablets.

5. Request medical assistance for heat exhaustion casualties as soon as possible.

Heat stroke

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Heat stroke, also known as sunstroke, is a life-threatening emergency. It is not necessary to be exposed to
the sun for it to develop. It is less common but more serious than heat exhaustion. The casualty
experiences a breakdown of the sweating mechanism (Fig. 7-4) and is unable to eliminate excessive body
heat. If the body temperature rises too high, the brain, kidneys, and liver may be permanently damaged.

Signs and symptoms of heat stroke include:

1. 105 degrees F (41 degrees C) or higher temperature.


2. Hot, wet, or dry and reddish skin.
3. Small (constricted) pupils.
4. Headache, nausea, dizziness, or weakness.
5. Deep and rapid breathing at first, then shallow and almost absent.
6. Fast and weak pulse.

If you suspect heat stroke, do the following:

1. Move the casualty immediately to a cool area, place them in a cold water bath. If this is not possible,
give a sponge bath by applying wet, cold towels to the entire body. If available, place cold packs around
the neck.

2. Monitor the airway, breathing, and circulation (ABCs).

3. Treat for shock.

4. Remove the casualty's clothing, do not allow the casualty to become chilled.

5. If the casualty is conscious and can drink, give him or her one-half glassful of cool water every 15
minutes. If the casualty vomits, stop giving water. Do not give salt tablets.

6. Request medical assistance for heat stroke casualties as soon as possible.

Cold Exposure

When the body is exposed to extremely cold temperatures, the blood vessels constrict and body heat is
gradually lost. As the body temperature falls, tissues are easily damaged. The extent of damage depends
on such factors as wind speed, temperature, type and duration of exposure, and humidity. Fatigue,
smoking, drugs, alcohol, stress, dehydration, and the presence of other injuries increase the harmful
effects of the cold.

General Cooling (Hypothermia)

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Hypothermia, an abnormally low body temperature, is a medical emergency. It is caused by continued


exposure to low or rapidly falling temperatures, cold moisture, snow, or ice. Individuals exposed to low
temperatures for long periods may suffer harmful effects, even if they are protected by clothing, because
cold affects the body slowly, almost without notice.

Signs and symptoms of hypothermia include:

1. Several stages of progressive shivering (an attempt by the body to generate heat).
2. Dizziness, numbness, and confusion.
3. Unconsciousness may follow quickly.
4. Signs of shock.
5. Extremities (arms and legs) freeze.

If you suspect hypothermia, do the following:

1. Move the casualty immediately to a warm place.

2. Monitor the airway, breathing, and circulation (ABCs).

3. Rewarm by applying external heat to both sides of the casualty. Natural body heat (skin to skin) from
two rescuers (buddy warming) is the best method. Do not place heat source next to bare skin. Since the
casualty is unable to generate body heat, placing him/her under a blanket or in a sleeping bag is not
sufficient.

4. If the casualty is conscious and can drink, give warm liquids. Do not give hot liquids, coffee, or
alcohol or allow casualty to smoke.

5. Request medical assistance for hypothermia as soon as possible.

Immersion Hypothermia

Immersion hypothermia, is the lowering of the body temperature due to prolonged immersion in cold
water. It is often associated with limited motion of the extremities and water-soaked clothing.
Temperatures range from just above freezing to 50 degrees F (1O degrees C).

Signs and symptoms of immersion hypothermia include:

1. Tingling and numbness of affected areas.


2. Swellina of the legs, feet or hands.
3. Bluish discoloration of the skin and painful blisters.

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If you suspect immersion hypothermia, do the following:

1. Move the casualty immediately but gently to a warm, dry area.

2. Monitor the airway, breathing, and circulation (ABC's).

3. Remove wet clothing carefully, keep casualty warm and dry. Do not rub or massage affected area.

4. Do not rupture blisters or apply ointment to affected area.

5. If the casualty is conscious and can drink, give warm liquids. Do not give hot liquids, coffee, or
alcohol or allow casualty to smoke.

6. Request medical assistance for immersion hypothermia as soon as possible.

Frostbite

Frostbite is damage to the skin due to continued exposure to severe cold. It occurs when ice crystals form
in the skin or deeper tissue after exposure to a temperature of 32 degrees F (0 degrees C) or lower. The
areas most commonly affected are the hands, feet, ears, nose, and cheeks. Frostbite is classified as
incipient, superficial, or deep.

Incipient Frostbite (Frost Nip)

Incipient frostbite affects the tips of the ears, nose, cheeks, toes, and fingers. Casualties normally are
unaware of the injury. Initially, the affected skin reddens, then becomes (blanched) white and painless.
Move the casualty to a warm area. Warm the affected areas with a buddy's body heat, or by immersing in
warm water. Do not rub or massage affected areas. Frostbite requires professional medical attention as
soon as possible.

Superficial Frostbite

Superficial frostbite affects the surface of the skin and the tissue beneath. The skin will be firm and
white, but the underlying tissue will be soft. The affected area may become blue, tingle, swell, and burn
during thawing. Move the casualty to a warm area. Hands can be rewarmed by placing them under the
armpit, or against the abdomen. Feet can be rewarmed by using a buddy's armpit or abdomen, other areas
can be rewarmed by immersing in warm water. Do not rub or massage affected areas. Frostbite
requires professional medical attention as soon as possible.

Deep Frostbite

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Deep frostbite is a medical emergency that affects the entire tissue layer. The skin feels hard and is
white to blue in appearance. The purpose of first aid is to protect the affected area from further damage,
to thaw the affected area, and to monitor the airway, breathing, and circulation. Move the casualty to a
warm area. Rewarm affected areas by immersion in water at 100 degrees F to 105 degrees F (30 degrees
C to 41 degrees C). Gently dry the area with a soft towel, place cotton between the toes and fingers to
avoid their sticking together. Do not rub or massage affected areas. Frostbite requires professional
medical attention as soon as possible. Do not allow the affected area to be exposed to the cold.

References

1. NAVEDTRA 10669-C, Hospital Corpsman 3 & 2

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Virtual Naval Hospital: Standard First Aid Course - Chapter 8 - Chemical, Biological, and Radiological Casualties

NAVEDTRA 13119 Standard First Aid Course - Chapter 8 - Chemical, Biological, and
Radiological Casualties

Chemical, Biological, and Radiological Casualties


Department of the Navy
Bureau of Medicine and Surgery
Peer Review Status: Internally Peer Reviewed

Biological and chemical substances for military use are primarily antipersonnel agents; they are intended
to produce casualties without the destruction of buildings, ships, or equipment. There is still a possibility
that a chemical, biological, or radiological (CBR) attack may occur in the future. Although the physical
damage to a ship or station may be minimal, the possibility that dangerous levels of contamination will
remain after an attack is real. All personnel should understand the nature of such attacks, the methods of
reducing their effects, and the handling of casualties resulting from such attacks.

Defense against an attack is both an individual and a group responsibility. What an individual does
before, during, and after an attack will affect both their own and the command's chances of survival.
Individuals are responsible for first aid and self aid, proper use of the protective mask, clothing, and
personal decontamination. Group responsibilities include the setting of proper material conditions,
detection of agents, isolation of contaminated areas, and decontamination and restoration of the ship or
station and equipment.

Chemical Warfare

The use of chemical agents in warfare, frequently referred to as "gas warfare," may be defined as the
deliberate use of a variety of chemical agents in gaseous, solid, or liquid states for the purpose of
harassing personnel, producing casualties, or contaminating food and water. Chemical agents produce
harmful physiological reactions when applied to the body externally, inhaled, or swallowed. They can be
spread by aircraft, projectiles, bombs, grenades, pots, candles, land mines, and missiles. These principal
factors determine the method by which a chemical agent is spread: the quantity of the agent required to
accomplish specific objectives, the nature of the agent being used, the distance to the place of attack, and
the way in which the agent must be used.

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Nerve Agents

Nerve agents are not quickly and easily detected. Small quantities can quickly cause casualties and
deaths. They may be colorless gases with little or no odor or colorless to light brown liquids. These
agents radically disturb the chemical processes of the nervous system, impairing or stopping other bodily
functions.

Nerve agents can enter the body by inhalation, ingestion, and absorption through the skin and eyes. Entry
through the skin is extremely effective. This means that the protective mask alone is not adequate
protection because the agent can enter through any exposed skin.

There are now two series or groups of nerve agents: The G series and the V series. The G series is
composed of the following agents: tabun (GA) "faintly fruity odor," sarin (GB), and soman (GD) "fruity
camphor odor," the V series is composed of agent VX "odorless."

Signs and symptoms:

1 .Runny nose, tightness of the chest, and difficulty breathing.


2. Small (constricted) pupils, drooling, and excessive sweating.
3. Nausea, vomiting, cramps, twitching, and headache.
4. Confusion, drowsiness, convulsion, and death.

Blister Agents

Blister agents, also known as vesicants, are odorless and vary in duration of effectiveness. In the pure
state, mustard is a yellowish, oily liquid. Most blister agents are insidious in action; there is little or no
pain at the time of exposure except with lewisite (L) "geranium odor," and phosgene oxime (CX), which
causes immediate pain on contact. Wet skin absorbs more mustard than dry skin.

Protection from blister agents is extremely difficult, because they attack any part of the body that comes
in contact with the liquid or vapor agent. The primary blister agents, distilled mustard (HD) "garlic odor,"
and nitrogen mustard (HN), are most effective for general use. The newer blister agents include the
nitrogen mustards (HN-1) "fishy or musty odor," (HN-2) "soapy to fruity odor," (HN-3) and the mixed
blister agent (HL) "garlic-like odor."

Signs and symptoms:

1. Irritation of the eyes, throat, and lungs.


2. Redness, blistering, and ulcers of the skin.
3. Long term incapacitation and death.

Incapacitating Agents

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Incapacitating agents, also known as psycho-chemical agents, are the latest discovery. Most agents are
colorless, odorless, and tasteless. They enter the body by inhalation and interfere with mental processes
that control bodily functions. Many are still in the research, development, and testing stage; much
remains to be learned.

These agents are used to wage and win a war without resorting to the massive killing, enormous
destruction of property, and immense monetary cost. An agent of this type is benzilate (BZ), a slow-
acting aerosol. Although there are many unanswered questions concerning the physiological action of
these compounds and much research remains to be accomplished, they offer many advantages.

1. They are flexible. The effects can range from drowsiness to complete withdrawal.

2. They are economical. They are less expensive to produce.

3. They are not destructive. Buildings will remain standing.

4. They are less injurious. Will cause less loss of life, maiming, crippling, and less permanent after-
effects.

5. They are a simpler weapons system. They are easily stored, loaded into munitions, and delivered on
target.

6. They are difficult to detect. They are colorless, odorless, and tasteless.

Signs and symptoms:

1. Impatience, restlessness, and anxiety to a sense of happiness (intoxication).


2. Delusions of persecution or grandeur.
3. Hallucinations, panic, and violent outbursts.

Blood Agents

Blood agents are chemicals that are in a gaseous state at normal temperatures and pressures. They are
systemic poisons and casualty producing agents that interfere with vital enzyme systems of the body.
They can cause death in a very short time after exposure by interfering with oxygen transfer in the blood.
Although very deadly, they are non-persistent agents.

The most common blood agents are hydrogen cyanide (AC) "bitter almond odor" and cyanogen chloride
(CK). Although AC is one of the most deadly poisons, it is one of the least effective chemical agents
because it evaporates rapidly. CK deteriorates the chemical canisters in protective masks within a short

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period of time. Death or recovery takes place rapidly.

Signs and symptoms:

1. Increase in depth of respiration.


2. Violent convulsions after 20 to 30 seconds.
3. Respiratory arrest and cardiac arrest within a few minutes.

Choking Agents

Choking agents, also known as lung irritants, primarily affect the respiratory tract (nose, throat, and
lungs), causing pulmonary edema. Their concentrations in the air are reduced fairly rapidly by water
condensation (rain and fog) and by dense vegetation. Unlike nerve and blister agents, choking agents
have no poisonous effect upon foods; they are too readily destroyed. The two most common choking
agents are phosgene (CG) "new mown hay odor" and diphosgene (DP) "new mown hay odor."

Signs and symptoms:

1. Watering of the eyes, coughing, and tightness of the chest.


2. Rapid, shallow, and labored breathing.
3. Rapid pulse, frothy sputum, and clammy skin.
4. Shock followed by death.

Vomiting Agents

Vomiting agents are dispersed as aerosols and produce their effects by inhalation. The symptoms may be
delayed for several minutes after initial exposure. Therefore, effective exposure may occur before the
presence of the smoke is suspected. If the protective mask is then put on, symptoms will increase for
several minutes, despite adequate protection. At high concentrations, effects may last for several hours.
Because of their arsenical properties, these agents make foods poisonous. The most important agents of
this type are diphenylchlorarsine (DA), diphenylchanosarsine (DC), and adamsite (DM).

Signs and symptoms:

1. Eye irritation and (tearing) lacrimation.


2. Feeling of pain and sense of fullness in the nose and sinuses.
3. Severe headache, burning throat, tightness and pain in the chest.
4. Violent coughing and sneezing, nausea, and vomiting.

Tear Agents

Tear agents, also known as lacrimators, are riot-control agents. They may be solids or liquids and may be

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dispersed in the air as vapors or smokes. This agent is highly successful in quelling riots. An individual is
incapacitated for 20 to 60 seconds after exposure. Effects last 5 to 10 minutes after the individual is
removed to fresh air.

Tear agents include CN, CNC, CNB, BBC, and CS. Of these, CS is the newest and most effective. It
produces immediate effects even in extremely low concentrations.

Signs and symptoms:

1. Burning of the eyes and excessive tearing.


2. Difficulty breathing, tightness of the chest, and coughing.
3. Stinging sensation of moist skin.

Self Aid and First Aid

At the first sign of a chemical agent in the atmosphere, put on your protective mask immediately. If a
liquid nerve or blister agent gets on your skin or clothing, take immediate action. If your clothing is
contaminated, put on new clothing and resume your duties. Treat contaminated skin with the M258A1
skin decontaminating kit. Do not get any chemicals from the kit in your eyes or mouth. The treatment
requires the use of two packets: Decon 1 wipe and Decon 2 wipe, which are found in the kit. Use these
packets according to the instructions on the M258A1 carrier.

After use, you should occasionally examine the contaminated areas for local sweating and muscular
twitching. If none develops in the next half hour and you have no tightness in your chest, your self aid
was successful. If these symptoms do occur, immediately use your atropine and 2 Pam-Chloride
injectors. These injections should be self-administered, through your clothing and into the outside of your
thigh. If no other symptoms develop, one injection each of atropine and 2 Pam-Chloride is enough.
Dryness of the mouth is a good sign indicating that you have had enough atropine.

If nerve agent symptoms persist, you may give yourself up to two more injections of atropine and 2 Pam-
chloride at 10 to 15 minute intervals. More than three injections may be given only under the direct
supervision of medical personnel or under the direction of the petty officer or officer in charge of the
battle station.

If liquid nerve agent gets into your eyes, immediately flush your eyes for 30 seconds or more. This must
be done in spite of the presence of nerve agent vapor. Hold your breath as long as possible during this
procedure. After taking several breaths with the mask on, again remove the mask and complete
decontamination. Watch the pupil of the contaminated eye, if it gets smaller, inject into your thigh one of
your atropine automatic injectors at once. Do not use atropine until you are sure that the symptoms are
those of nerve agent poisoning.

Severe nerve agent exposure may rapidly cause unconsciousness, muscular paralysis, and loss of

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Virtual Naval Hospital: Standard First Aid Course - Chapter 8 - Chemical, Biological, and Radiological Casualties

breathing. When this occurs, atropine and 2 Pam-chloride alone will not save a life. Begin rescue
breathing immediately and continue until breathing is restored or the casualty can be taken over by
medical personnel. An atropine injection increases the effectiveness of rescue breathing. It should be
administered as soon as possible, preferably by someone who is not performing rescue breathing.

Whenever liquid or vaporized blister agents are known to be present, be sure to wear your protective
mask. Liquid blister agents in the eyes or on the skin must be dealt with immediately.

If liquid blister agent gets into your eyes, immediately flush the eyes for 30 seconds to not more than 2
minutes. The risk of leaving blister agents in the eye is much greater than the risk of exposure to blister
agent vapors. Therefore, the decontamination procedure must be performed in spite of the presence of
vapor. Phosgene oxime reacts rapidly, decontamination will not be entirely effective after pain has
started. The contaminated area should be flushed immediately with large amounts of water.

If you notice any stimulation of breathing, an odor of bitter almonds, or any irritation of the eyes, nose,
or throat, mask at once. Within a few seconds after exposure, you probably will not be able to put on the
mask by yourself. There is currently no self-aid or buddy-aid for blood agent symptoms. Affected
personnel should seek medical attention immediately.

Irritation of the eyes or a change in the taste of a cigarette might indicate the presence of phosgene.
Smoking may become tasteless or offensive in taste. If any one of the signs occur, hold your breath and
put on your protective mask immediately. Unless you have difficulty breathing, experience nausea or
vomiting, or have more than the usual shortness of breath on exertion, continue your normal combat
duties. If any of these symptoms occur, you should rest quietly until you are evacuated by medical
personnel.

Biological Warfare

Biological warfare is the use of living agents such as bacteria, viruses, and other pathogenic
microorganisms to produce disease or death of humans, animals, or plants. Biological agents are a threat
that must be recognized and prepared for by all personnel. A large part of the defense against biological
agents depends upon self-protection and the ability to carry out duties in the presence of such agents.

Biological agents may be spread in various ways. They may be used as fillings in bombs or shells or
dispersed through aerial or surface spray tanks. They may be released from munitions such as aerosols.
The aerosols are cloud like formations of solid or liquid particles in which the biological agents are held
suspended.

There are no simple and rapid methods to detect biological agents such as those used to detect chemical
agents and nuclear radiation. The positive detection and identification of a pathogen can be obtained only
by taking samples of the organisms, growing a culture of the organisms under laboratory conditions, and
then subjecting the culture to a variety of biochemical and biological tests. Obviously, the final

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identification of pathogens is a problem for medical personnel.

Effects

Biological agents may be selected to produce various strategic or tactical goals. These goals range from
brief but crippling diseases to widespread serious illnesses with many deaths. The effects of biological
agents vary widely, depending upon the agent or agents selected.

The mere presence of a disease-producing organism on or in the body of a host does not guarantee
infection or illness. In fact, pathogenic organisms are frequently present and cause no harm in the human
body for long periods of time.

Microorganisms

Microorganisms are minute living organisms, which can usually be seen only with the aid of a
microscope. Each organism is composed of a single cell or a group of associated cells capable of carrying
on all functions of life, including growth and reproduction. They do not have a digestive tract, organs of
sight, or a heat regulating system. Many of them resemble plant life and are regarded as being in the
vegetable kingdom. Some, such as the protozoa, have characteristics that place them in the animal
kingdom.

Microorganisms are universally distributed in the air, water, and soil. Those capable of producing disease
are known as pathogens. Most of these pathogens are parasites and live on or within another living
organism, called a host, which provides shelter and nourishment.

Bacteria are very small single-cell organisms. They may be spherical, rod-shaped, or spiral in form.
They are visible through an ordinary microscope. They are present everywhere in nature, in air, soil,
water, and animal and plant bodies, both living and dead. Many types of bacteria can cause infection.
The powerful toxins produced by some could be used alone for biological warfare. Diseases caused by
bacteria are typhoid fever, meningitis, and tuberculosis.

Rickettsiae are usually smaller than bacteria, but they are still visible through an ordinary microscope.
They grow only within living cells, and they are potent disease producers in man and animals. Many of
them are transmitted by insect bites. Diseases caused by rickettsiae are Rocky Mountain spotted fever
and typhus.

Viruses are even smaller than rickettsiae and are not visible with the ordinary microscope. Some have
been photographed through the electron microscope. Like the rickettsiae, they will grow only within the
living cell. Viruses and rickettsiae are probably less well distributed than bacteria because they are more
particular in their growth requirements. However, it is known that they can survive for short periods of
time in the air. Diseases caused by viruses are mumps, smallpox, and influenza.

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Fungi include such plants as yeasts, molds, and mildews. These organisms are known for their ability to
spoil foods and fabrics. Generally speaking, diseases caused by fungi in humans are less severe than
those produced by other microorganisms. They usually produce low-grade, mild, and often chronic
diseases. A few fungi are capable of producing serious diseases. Diseases of plants caused by fungi are
potato blight, cotton root rot, corn smut, and wheat rust.

Protozoa are single-celled, animal-like forms that occur in a variety of shapes and often have
complicated life cycles. Some protozoa cause diseases in both man and animals. Problems of production
and transmission limit their application in biological warfare, but it must not be assumed that these
problems could not be solved. Protozoa infections of humans are amoebic dysentery and malaria.

Self Aid and First Aid

Since symptoms caused by pathogenic biological agents may not appear for some time, you may not
know that a biological attack has occurred. If you suspect biological contamination, put on your
protective mask and observe the basic principles of preventive medicine. These include individual
hygiene, sanitation, and physical check-ups. Report any illness to medical personnel immediately.

If there is a possibility that you have been contaminated, take the following actions: Carefully remove
your clothes to avoid spreading any contamination, and take a thorough soap and water shower as soon
as possible. Change your clothes and dispose of contaminated clothing as directed. Pay careful attention
to your face and hands. Use a fingernail brush to remove dirt under your nails. Brush your teeth and
gums frequently, including the roof of your mouth and your tongue. Some biological agents take effect
with great speed. You should apply self aid or first aid immediately if you think you may have been
exposed.

Radiological Warfare

When a nuclear device is detonated in space, in the atmosphere, or at or below the surface of the earth or
ocean, many characteristic effects are produced. Some effects, such as nuclear radiation and expanding
debris, are common to all of these environments, though varying in degree. Other effects, such as
cratering, blast, and water shock, are peculiar to certain environments.

Effects such as light and heat are visible or tangible. Others, like nuclear radiation, are not directly
apparent and can only be discerned by instruments or secondary effects. Some effects occur in and last
only micro-seconds, whereas others occur in micro-seconds but linger for days, months, or even years.
Meteorological conditions such as atmospheric pressure, temperature, humidity, winds, and precipitation
can affect some of the observed phenomena. All nuclear detonations, however, produce effects that can
damage equipment and injure personnel.

Airburst

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An airburst is a burst where the point of detonation is below an altitude of 100,000 feet and the fireball
does not touch the surface of the earth. Air blast, thermal radiation (heat and light), an electromagnetic
pulse, and initial nuclear radiation (neutron and gamma rays) are produced around the point of
detonation. There will be no significant residual nuclear radiation (gamma and beta radiation from
airborne or deposited radioactive material) unless rain or snow falls through the radioactive cloud.

High-altitude Burst

A high-altitude burst is an airburst where the point of detonation is above 100,000 feet. The high-altitude
burst produces air blast, thermal radiation, an electromagnetic pulse, initial nuclear radiation, and
atmospheric ionization. At such high altitudes, the proportion of energy appearing as blast decreases
considerably, and at the same time the proportion of radiation energy increases.

Surface Burst

A surface burst is a burst where the point of detonation is on, or above, the surface of the earth and the
fireball touches the surface of the earth. The surface burst produces air blast, thermal radiation, and an
electro-magnetic pulse. Surface bursts over water will also produce underwater shock and surface water
waves, but these effects will be of less importance except to submarines. Overland, earth shock will be
produced but will not be an important effect at any significant distance from the point of detonation.

Underwater Burst

An underwater burst is a burst where the point of detonation is below the surface of the water. An
underwater burst produces underwater shock and a water plume that then causes a base surge. Bursts
with very shallow points of detonation can also produce air blast, initial nuclear radiation, fallout, and
possibly some thermal radiation. These effects will be reduced in magnitude from those of a water
surface burst and will become rapidly insignificant as the depth of the point of detonation is increased.

Underground Burst

An underground burst is a burst where the point of detonation is below the ground's surface. An
underground burst produces a severe earth shock, especially near the point of detonation. Thermal
radiation, air blast, initial nuclear radiation, and fallout will be negligible or absent if the burst is confined
below the earth's surface. Early fallout can be significant, and at distances near the explosion, base surge
(evidenced by a dust cloud) will be an important hazard.

Self Aid and First Aid

The blast and heat injuries from a nuclear explosion are treated the same as those from explosive bombs,
incendiary weapons, and mechanical accidents. Fractures, concussions, lacerations, contusions, bleeding,
burns, shock, and exposure are treated with standard first aid measures.

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There is nothing that needs to be done immediately for nuclear radiation sickness. Remember that you
can receive a dose of radiation even though you are not contaminated with radioactive particles. If there
is the possibility that you have been exposed to nuclear radiation, be sure you are examined and treated
by medical personnel.

If directed, proceed to a personnel decontamination station. Discard your clothing and equipment and
take a shower using plenty of soap and warm water. In washing, pay close attention to the hairy parts of
your body, body creases, and fingernails, where dirt tends to gather.

Decontamination

The basic purpose of decontamination is to remove or neutralize CBR contamination so that the mission
of the ship or station can be carried out without endangering the life or health of assigned personnel.

Decontamination operations may be both difficult and dangerous. Personnel engaged in these operations
must be thoroughly trained in the proper techniques. Certain operations, such as the decontamination of
food and water, should be done only by experts qualified in such work. However, all members of a
command should receive adequate training in the elementary principles of decontamination so that they
can assist in emergency decontamination operations.

After an attack, data from CBR surveys will be used to determine the extent and degree of
decontamination. Contaminated personnel must be decontaminated as soon as possible. Before
decontamination of installations, machinery, and gear is undertaken, appraisals of urgency must be made
in the light of the tactical situation.

References

1. NAVEDTRA 10572, Damage Controlman 3 & 2


2. NAVEDTRA 10670-C, Hospital Corpsman 1 & C
3. NAVEDTRA 10669-C, Hospital Corpsman 3 & 2

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Virtual Naval Hospital: Standard First Aid Course - Chapter 8 - Chemical, Biological, and Radiological Casualties

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Virtual Naval Hospital: Standard First Aid Course - Chapter Nine - Poisoning

NAVEDTRA 13119 Standard First Aid Course - Chapter Nine - Poisoning

Poisoning
Department of the Navy
Bureau of Medicine and Surgery
Peer Review Status: Internally Peer Reviewed

Each year in the United States, there are thousands of deaths from suicide or accidental poisonings. In
addition to the fatalities, approximately one million cases of nonfatal poisoning occur because of
exposure to substances in everyday use such as medications, industrial chemicals, cleaning agents, and
plant and insect sprays.

The Navy Occupational Safety and Health (NAVOSH) Program requires a Material Safety Data Sheet
(MSDS) be readily available to all personnel working with hazardous material. MSDS's are technical
bulletins produced by chemical manufacturers. They contain safety precaution information, first aid
procedures, spill response, symptoms of over-exposure, and other vital safety information. The user
should review MSDSs before using a hazardous material, and the MSDSs must be accessible in case of a
mishap. An alternative source for the same information is the Hazardous Material User's Guide (HMUG).
Emergency information is also available from the National Response Center (NRC), 1-800-424-8802 or
the Chemical Treatment and Response Emergency Center (CHEMTREC) at 1-800-424-9300.

Since most poisons act rapidly, professional medical attention or assistance from a poison control center
should be obtained immediately. If more than one person is present, one should obtain assistance while
the other begins administering first aid. Although the symptoms of poisoning may disappear completely
before professional help is obtained, the poison may have harmful or fatal after effects.

A poison can be in a solid, liquid, or gaseous state. Poisons can be ingested (swallowed), inhaled,
absorbed, or injected into the body. Poisoning should be suspected whenever a sudden unexplained
illness develops. The immediate area should be searched for evidence of the cause. Clues such as gases
or other chemical odors may be present. Leftover food, drinking glasses, containers, or bottles may also
provide clues.

Ingested Poisons

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Ingested poisons are difficult to identify because there are many different kinds. Some substances are
fatal in small amounts, while other substances that are safe in small amounts become fatal if large
amounts are taken. Poisoning, can result from improperly stored foods, household products, or
commercial substances used aboard ship. If you suspect poisoning, do not waste time trying to find the
cause or the antidote, poisoning is a medical emergency.

Signs and symptoms of ingested poisoning include:

1. Large (dilated) or small (constricted) pupils.


2. Slow or abnormal breathing, chemical odors and unusual breath.
3. Burns or stains around the mouth.
4. Nausea, vomiting and diarrhea.
5. Excessive salivation, sweating, and tear formation.
6. Convulsions or seizures.

If you suspect poisoning by ingestion, do the following:

1. Monitor the airway, breathing, and circulation (ABCs). Establish and maintain an adequate open
airway.

2. Position the casualty sitting and leaning slightly forward, to prevent aspiration of vomit into the lungs.

3. Obtain if possible, all containers the substance was ingested from. If the casualty vomits, obtain a
sample.

4. Contact local Poison Control Center or medical personnel immediately.

5. Request medical assistance for Ingestion of poisons immediately.

A Material Safety Data Sheet (MSDS) for the material will provide more detailed first aid procedures for
ingestion of the chemical.

Shellfish and Fish

Mussels, clams, oysters, and other shellfish often become contaminated with bacteria during the warm
months of March to November. Numerous varieties of shellfish (Fig. 9-1) should not be eaten at all, so
wherever you serve in the world, learn which local seafood is known to be safe.

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Figure 9-1 - Poisonous Fish

Most fish poisoning occurs with fish that are normally considered safe to eat, but which become
poisonous at different times of the year from eating poisonous algae and plankton (red tide) that appear
in certain locations.

Signs and symptoms of shellfish and fish poisoning include:

1. Tingling and numbness of the face and mouth.


2. Muscular weakness.
3. Nausea and vomiting.
4. Increased salivation,: difficulty swallowing.
5. Respiratory failure.

First aid is directed toward evacuating the stomach contents; if the victim has not vomited, cause him or
her to do so. If respiratory failure occurs, give artificial ventilation and treat for shock.

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Inhaled Poisons

In the Navy, many industrial processes produce air contaminants. Workers or passersby could inhale the
air contaminants and suffer adverse health affects. Routine cleaning, painting, and preservation produce
toxic vapors, gases, and dusts. You can see and smell some toxic air contaminants; however, others are
invisible and odorless, like cyanide gas.

Other hazardous air contaminants are by-products of certain processes that include exhaust gases from
internal combustion engines; fumes or vapors from materials used in casting, molding, welding, and
plating; gases associated with bacterial decomposition in closed spaces, and gases that accumulate in
voids, double bottoms, empty fuel tanks, and similar spaces. Do not enter any closed compartment or
poorly ventilated space until the ship's engineer, or his or her authorized representative, has tested
the space and declared it safe to enter.

Signs and symptoms of inhaled poisoning include:

1. Excessive coughing, shortness of breath, wheezing, and a burning sensation of the nose and
throat.
2. Pale or bluish color to skin.
3. Dizziness, headache, nausea, and vomiting.
4. Chest pain or tightness.

You may observe a variety of symptoms, from irritation to asphyxiation. Some air contaminants work
slowly to damage the liver, kidneys, and central nervous system. Some materials can cause serious
diseases to the same areas. If respiratory problems are not corrected, serious illness or death could occur.

If you suspect inhalation poisoning, do the following:

1. Remove the casualty to fresh air immediately. Do not enter a toxic environment without proper
respiratory protection or oxygen breathing apparatus.

2. Loosen clothing around the neck and chest.

3. Monitor the airway, breathing, and circulation (ABCs). Establish and maintain adequate open airway.

4. Treat for shock.

5. Position the casualty sitting and leaning slightly forward, to prevent aspiration of vomit into the lungs.

6. Contact local Poison Control Center or medical personnel immediately.

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7. Request medical assistance for inhalation poisoning, immediately.

The Material Safety Data Sheet (MSDS) for the toxic material gives the symptoms of exposure and first
aid measures.

Carbon Monoxide Poisoning

Carbon monoxide, formed by the incomplete combustion of carbon, is the most common cause of
poisoning by inhalation. Carbon monoxide is colorless, tasteless, and odorless. It is usually the result of
faulty equipment, improper use of equipment, or poor ventillation of equipment.

Signs and symptoms of carbon monoxide poisoning include:

1. Throbbing headache, dizziness and nausea.


2. Difficulty breathing.
3. Irritability, loss of judgment and confusion
4. Chest pain, elevated pulse rate.
5. Normal skin, becoming pale, then bluish in color. Cherry-red appearance in high levels.

If you suspect carbon monoxide poisoning, do the following:

1. Remove the casualty to fresh air immediately. Do not enter a toxic environment without proper
respiratory protection or oxygen breathing apparatus.

2. Loosen clothing around the neck and chest.

3. Monitor the airway, breathing, and circulation (ABCs). Establish and maintain an adequate open
airway.

4. Treat for shock

5. Position the casualty sitting, and leaning slightly forward, to prevent aspiration of vomit into the
lungs.

6. Contact local Poison Control Center or Medical immediately.

7. Request medical assistance for carbon monoxide poisoning immediately.

Absorbed Poisons

Many substances enter the body through the skin. The sap or juice of certain plants will cause skin

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irritation. The most common are poison ivy, oak, and sumac. The poison comes from the leaves, but it
also may come from their roots and stems. The smoke from burning brush containing these plants has
been known to carry the poison considerable distances. Other substances are insecticides and industrial,
lawn, and garden chemicals.

Signs and symptoms of poisoning by absorption include:

1. Rash, itching, burning, swelling skin and blisters.


2. Difficulty breathing and increased pulse rate.
3. Fever, headache, and general body weakness.

If you suspect absorbed poisoning, do the following:

1. Remove contaminated clothing carefully, protecting yourself with gloves. do not spread the
contamination.

2. Absorb liquid substances on skin, carefully brush off dry substances.

3. Flush area immediately with large quantities of fresh water, using an installed deluge shower or hose,
if available. Flush area two separate times.

4. Monitor the airway, breathing, and circulation (ABCs).

5. Treat for shock.

6. Contact local Poison Control Center or medical personnelimmediately.

7. Request medical assistance for poisoning by absorption as soon as possible.

Injected Poisons

Injection of venom by stings and bites from various insects, while not normally life-threatening, can
cause an acute allergic reaction that can be fatal. Any allergic reaction can develop into anaphylactic
shock. Poisons also may be injected by snakes and marine animals.

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Figure 9-2 - Pit Vipers Found in the U.S. and Their Bite Patterns.

Snakebite

Poisonous snakes are found throughout the world, primarily in the tropical and temperate regions. Within
the United States, there are 20 species of poisonous snakes. They can be grouped into two families, the
Crotalidae (rattlesnakes, copperheads, and moccasins), and the Elapidae (coral snakes).

Identification

The Crotalidae are called pit vipers because of the small, deep pits between the nostrils and the eyes (Fig.
9-2). They have two long hollow fangs, which normally are folded against the roof of the mouth, but
which can be extended by a swivel mechanism when they strike. Other identifying features include thick
bodies, slit-like pupils of the eyes, and flat triangular heads. Further identification is provided by
examining the wound for signs of fang entry in the bite pattern shown (Fig. 9-2). Individual identifying
characteristics include audible rattles on the tails of most rattlesnakes and the cotton white interior of the
mouths of moccasins. These snakes are found in every state except Maine, Alaska, and Hawaii.

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Figure 9-3 - Neurotoxic Snakes and Their Bite Patterns.

Coral snakes are related to the cobras, kraits, and mamba snakes in other areas of the world (Fig. 9-3).
Corals, which are found in the Southeastern United States, are comparatively thin snakes with small
bands of red, black, and yellow (or almost white). Other nonpoisonous snakes have the same coloring,
but in the coral snake, the red band always touches the yellow band. Its short, grooved fangs must chew
(bite pattern Fig. 9-3) into its victim before the poison can be introduced.

Every reasonable effort should be made to kill or positively identify the snake..

Venom

Venom is a complex mixture of enzymes, peptides, and other substances. A single injection can cause
many different toxic effects in many areas of the body. Some of these effects are felt immediately while
the action of other venom components may be delayed for hours or days. A poisonous bite should be
considered a true medical emergency until symptoms prove otherwise.

The venom is stored in sacs in the snake's head. It is introduced into a casualty through hollow or
grooved fangs. An important point to remember is that a bitten casualty has not necessarily received a
dose of venom. The snake can control whether or not it will release poison and how much to inject.

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Signs and Symptoms

It is essential that you be able to quickly diagnose a snakebite as being envenomated or not. Normally
enough symptoms present within an hour of a poisonous snakebite to eliminate any doubt. The casualty's
condition provides the best information as to the seriousness of the situation. The bite of the pit viper is
extremely painful and is characterized by immediate swelling around the fang marks, usually within 5 to
10 minutes, spreading and possibly involving the whole extremity within an hour. If only minimal
swelling occurs within 30 minutes, the bite will almost certainly have been from a nonpoisonous snake,
or from a poisonous snake that did not inject venom. When the venom is absorbed, there is a general
discoloration of the skin, followed by blisters and numbness in the affected area. Other signs that may
occur are weakness, rapid pulse, nausea, shortness of breath, vomiting, shock, headache, fever, chills,
and blurred vision. The eastern diamondback rattler bite is further characterized by numbness and
tingling in the mouth and possibly the face and scalp. A metallic taste may be noted.

If you suspect a snakebite, do the following:

1. Move the casualty away from (the snake) danger.

2. Calm and reassure the casualty, keep them lying down, quiet, and warm. Do not give the casualty
anthing to eat or drink.

3. Immobilize the casualty's affected extremity, keeping the area below the level of the heart.

4. Remove jewelry from affected area, unless the casualty objects.

5. Apply a constricting band (belt, necktie) 2 to 4 inches above the fang marks (Fig. 9-4) between the
bite and the heart. It should be tight enough to stop the flow of blood in the veins but not through the
arteries. Adjust the band as swelling occurs. Never place a band around a joint, the head, neck, or
chest.

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Figure 9-4. Constricting Band Properly Applied.

6. Suction the bite over the fang marks, using an extractor from a snakebite kit. Suction by mouth is
recommended only as a last resort. Suction after 30 minutes is ineffective, the venom has already
diffused.

7. Monitor the airway, breathing, and circulation (ABCs).

8. Treat for shock.

9. Never apply ice to afflicted area.

10. Contact nearest medical facility, if possible, so that the proper antivenom can be made available.

11. Transport the casualty (and the dead snake) as soon as possible.

Insect Stings

Insects that most commonly cause allergic reactions are honeybees, wasps, yellow jackets, hornets, and
fire ants. Individuals with known sensitivities carry medication in commercially prepared kits.

Signs and symptoms of insect stings include:

1. Local reaction of pain, redness, itching, and swelling.


2. Allergic reaction of difficulty breathing or swallowing, generalized itching, redness, swelling

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(eyelids, lips, and tongue), hives, flushing, and abdominal cramps.


3. Shock may follow quickly, and death may occur.

If you suspect an insect sting, do the following:

1. Calm and reassure the casualty, keep them lying down, quiet, and warm.

2. Immobilize the casualty's affected extremity, keeping the area below the level of the heart.

3. Remove jewelry from affected area, unless the casualty objects.

4. Scrape stinger from the skin with a plastic card. Do not use tweezers.

5. Wash the area with soap and water.

6. Place a coldpack to area to reduce swelling and pain.


7. Monitor the airway, breathing, and circulation (ABCs).

8. Treat for shock.

9. Transport the casualty for professional medical treatment as soon as possible.

Spiders and Scorpions

The black widow spider is a small, glossy, jet-black spider. It has a distinctive hourglass-shaped red mark
(Fig. 9-5) on the underside of its abdomen. Black widow bites are the leading cause of death from spiders
in the United States.

Signs and symptoms of black widow bites include:

1. Pain and spasms of the back, chest, shoulders, and abdominal muscles within 30 minutes.
2. Nausea, vomiting, rigid abdomen.
3. Anxiety, fever, sweating, and rash.

If you suspect a black widow bite, do the following:

1. Apply coldpacks to affected area, do not apply ice.

2. Monitor the airway, breathing, and circulation (ABCs).

3. Treat for shock.

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4. Transport the casualty (and the spider) for professional medical treatment as soon as possible.

The brown recluse spider is yellow to dark brown. It has a distinctive violin-shaped marking (Fig. 9-5)
on its upper back. Brown recluse bites are non-healing and require skin grafting to repair.

Signs and symptoms of brown recluse spider bites include:

1. Bluish area surrounded by white, turning red (bulls-eye pattern).


2. Nausea, vomiting, joint pain, chills and fever within 24 hours.
3. Ulcer within 10 days.

If you suspect a brown recluse spider bite, do the following:

1. Monitor the airway, breathing, and circulation (ABCs).

2. Treat for shock.

3. Transport the casualty (and the spider) for professional medical treatment as soon as possible.

The scorpion is 2 to 3 inches in length with a long, narrow, segmented tail (Fig. 9-5) that ends in a
venomous stinger. Stings can be fatal, most occur on the hands.

Signs and symptoms of scorpion stings include:

1. Pain, swelling, and discoloration at sting site.


2. Nausea, vomiting, seizures, restlessness, and drooling.

If you suspect a scorpion sting, do the following:

1. Apply a constricting band (belt, necktie) 2 inches above the sting. It should be tight enough to stop the
flow of blood in the veins but not through the arteries. Adjust the band as swelling occurs. Never place a
band around a joint, the head, neck, or chest.

2. Apply coldpacks to affected area, do not apply ice.

3. Transport the casualty for professional medical treatment as soon as possible.

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Figure 9-5 - Black Widow and Brown Recluse Spiders and a Scorpion.

Ticks

The tick is 1/4 inch in length with a barbed protruding mouth part (proboscis) for attachment to the skin.
They cause Lyme disease, Rocky Mountain spotted fever, and other bacterial diseases.

Signs and symptoms of Lyme disease usually occur in three stages that include:

1. Red rash near site, chills and fever.


2. Joint and muscle pain, difficulty moving, and visual problems.
3. Symptoms of arthritis.

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Signs and symptoms of Rocky Mountain spotted fever that develop within 10 days of tick infestation
include nausea, vomiting, abdominal pain, and weakness.

If the casualty has a tick, do the following:

1. Remove with tweezers, grasp as close to the skin as possible.

2. Wash the area with soap and warm water.

3. Casualty should mark the date of exposure as a reminder if medical care is needed.

Marine Life

Marine life are not normally aggressive, most injuries occur when people disturb them. Their venom
causes more damage to the tissues and is destroyed by heat rather than ice.

If the casualty has a large bite (shark), do the following:

1. Remove casualty from the (danger) water.

2. Establish and maintain the airway, breathing, and circulation (ABC's).

3. Control bleeding with direct pressure, elevation, indirect pressure, or tourniquet.

4. Treat for shock.

5. Transport immediately to nearest medical treatment facility.

If the casualty has a tentacle sting (Fig. 9-6), do the following:

1. Remove, casualty from the (danger) water.

2. Gently remove tentacles and wash the area with rubbing alcohol or meat tenderizer.

3. Treat for shock.

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Figure 9-6 - Stinging Sea Animals.

4. Transport to nearest medical treatment facility.

If the casualty has a puncture wound (Fig. 9-7), do the following:

1. Remove casualty from the (danger) water.

2. Control bleeding with direct pressure and elevation.

3. Soak affected area for at least 30 minutes in hot water.

4. Protect the site from movement, the stinger must be removed by a physician.

5. Transport to nearest medical treatment facility.

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Figure 9-7 - Stingray.

Human and Animal Bites

Human and animal bites cause abrasions, lacerations, avulsions, and punctures. Human bites that break
the skin can become infected, since the mouth is contaminated with bacteria. Human bites must be
treated by a physician.

Animal bites, whether domestic (dogs and cats) or wild (bats, raccoons, and rats) present the possibility
of rabies in addition to tissue damage and infection. The animal should be captured and confined so it
can be observed for signs of rabies. If you must take the animal's life, do not damage the head, it will be
necessary to examine the brain.

If the casualty has a human or animal bite, do the following:

1. Control bleeding with direct pressure and elevation.

2. Wash the area with soap and warm water, apply a sterile dressing.

3. Transport to nearest medical treatment facility.

References

1. Karren K. J. and Hafen, B. Q. :First Responder A Skills Approach, ed. 3, Morton Publishing Company

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2. NAVEDTRA 10669-C, Hospital Corpsman 3 & 2

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Virtual Naval Hospital: Standard First Aid Course - Chapter Ten - Medical Emergencies

NAVEDTRA 13119 Standard First Aid Course - Chapter Ten - Medical Emergencies

Medical Emergencies
Department of the Navy
Bureau of Medicine and Surgery
Peer Review Status: Internally Peer Reviewed

Medical emergencies are defined as an unexpected or sudden occasion; an accident; an urgent or pressing
need.

Fainting

Fainting, also known as syncope is a temporary loss of consciousness. It is the result of blood pooling in
large (dilated) veins, which reduces the amount of blood being pumped to the brain. Causes include
getting up too fast, standing for long periods with little movement, and stressful situations. Fainting also
may result from an underlying medical problem such as diabetes, stroke, or heart problems. Signs and
symptoms of fainting include:

1. Dizziness, nausea, and visual problems.


2. Sweating, paleness, weakness, and rapid pulse.

As the body collapses, blood returns to the head and consciousness is quickly regained. If the casualty
has fainted, do the following:

1. Perform an initial assessment.

2. Place the casualty on his or her back, with legs elevated 6 to 12 inches. Do not allow casualty to sit
up.

3. Monitor the airway, breathing, and circulation (ABCs).

4. Loosen restrictive clothing, at the neck, waist, and chest.

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5. Check the casualty for injuries suffered during the fall.

6. Request medical assistance for fainting as needed.

Chest Injuries

All chest injuries must be considered serious, because they can cause difficulty breathing (dyspnea) and
severe bleeding. Any casualty complaining of difficulty breathing without signs of an airway obstruction
must be examined for either an open or closed chest injury.

The most serious chest wound that requires immediate first aid is a sucking chest wound (Open
Pneumothorax). This is a penetrating injury that makes a hole in the chest cavity, causing the lung to
collapse, which prevents normal breathing. This condition is a medical emergency that will result in
death if not treated quickly. Signs and symptoms of a sucking chest wound include:

1. Difficulty breathing and sharp chest pain.


2. Bluish skin color and anxiety.

If the casualty has a sucking chest wound, do the following:

1. Immediately seal the wound with your hand or any airtight (I.D. Card) material available. The
material must be large enough so that it will not be sucked into the wound when the casualty breaths.

2. Firmly tape the material in place with adhesive tape leaving one corner untaped to prevent a pressure
buildup. The purpose of the dressing is to keep air from going in through the wound. If the casualty's
condition deteriorates, remove the seal immediately.

3. Lay the casualty on his or her affected side.

4. Treat for shock - Place the casualty in a semi-sitting position, to help them breath easier.

5. Do not give the casualty anything to eat or drink. If the casualty complains of thirst, wet his or her lips
with a wet towel.

6. Request medical assistance immediately.

Flail Chest

A medical emergency in which two or more ribs are broken, each in at least two places; or a fracture or
separation of the ribs from the breastbone producing a free-floating segment. This segment is called the
"flail area," its motion is opposite the rest of the chest. The area between the fractures moves in the

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opposite direction of the rest of the chest during ventilation. This condition can be life-threatening
because it may bruise the lung beneath the flail area. The bone ends may also puncture a lung and cause
severe bleeding, which can produce shock. It may be difficult to detect a flail chest in an obese or
muscular casualty. Signs and symptoms of flail chest include:

1. Difficulty breathing that causes severe pain.


2. Swelling at site of injury.
3. Casualty will splint his/her chest wall with hands and arms.

If the casualty has a flail chest, do the following:

1. Establish and maintain the airway, breathing, and circulation (ABC's).

2. Gently feel the chest to locate the edges of the flail area.

3. Stabilize the flail area with a pad of dressings or a pillow and secure with wide cravats.

4. Position the casualty with the flail area against an external object in a semi-sitting position or lying on
the injured side.

5. Treat for shock.

6. Request medical assistance immediately.

Abdominal Injuries

Abdominal injuries are caused by severe blows, gunshots, and stabbings. They can easily become a
medical emergency because of the vital organs that may be damaged. Most injuries to the abdomen
require surgery to repair the internal damage.

Closed

Closed abdominal injuries are caused by a severe blow or crushing injury, where the skin remains intact.
Death is usually caused by bleeding into the abdomen. A complication known as peritonitis, usually the
result of a rupture of the intestines, is not seen immediately but develops later and can be fatal. Signs and
symptoms of (closed) abdominal injury include:

1. Intense pain, nausea, vomiting, and spasm of the abdominal muscle.


2. Tenderness, distention, muscle rigidity, and shock.
3. Casualty lies with legs pulled up, protecting the abdomen.

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If the casualty has a (closed) abdominal injury, do the following:

1. Establish and maintain the airway, breathing, and circulation (ABC's).

2. Place casualty in the most comfortable position.

3. Carefully remove enough clothing to get a clear idea of the extent of the injuries.

4. Treat for shock.

5. Give nothing by mouth.

6. Request medical assistance immediately.

Open

Open abdominal injuries are caused by gunshots, stabbings, and penetrating wounds where the skin is
broken. Always suspect that damage has occurred to internal organs, even if signs and symptoms are not
immediately present. Extensive lacerations may allow some of the internal organs (Fig. 10-1) to stick out,
a condition known as evisceration. Signs and symptoms of (open) abdominal injury include:

1. Signs and symptoms of (closed) abdominal injury.


2. Lacerations, puncture wounds, and vomiting blood.
3. Back pain (kidney damage).

If the casualty has an (open) abdominal injury, do the following:

1. Establish and maintain the airway, breathing, and circulation (ABC's).

2. Carefully remove enough clothing to get a clear idea of the extent of the injuries.

3. Place casualty in the most comfortable position.

4. Treat for shock.

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Figure 10-1 - Abdominal Wound with Protruding Intestines.

5. Control bleeding and apply a dry sterile dressing.

a. If organs are sticking out (protruding), do not touch or replace them. Apply a sterile
compress, moistened with sterile water. If sterile water is not available, use clean drinking water.
Do not use material that clings, such as paper towels, cotton, or toilet paper. Apply aluminum
foil or plastic wrap over the compress keeping the area moist and warm. Hold the compress in
place with a bandage, do not apply more pressure than is necessary to hold the bandage.

6. Give nothing by mouth.

7. Request medical assistance immediately.

Diabetic Emergencies

Diabetes also known as diabetes mellitus, is a disease that impairs the ability of the body to use sugar and
causes sugar to appear abnormally in the urine. The two basic types of diabetes are:

Type I: Insulin-dependent (juvenile), usually begins in childhood, controlled by daily insulin


injections.

Type II: Non-insulin-dependent (adult-onset), begins in adulthood, controlled by diet or oral


medication. Sometimes insulin injections are required.

Diabetic Coma

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Diabetic coma, also known as hyperglycemia, is a condition in which the body does not have enough
insulin and has too much sugar. Causes include stress, not enough insulin injections, and eating too much
sugar.

Signs and symptoms of diabetic coma include:

1. Fruity odor on breath and very thirsty.


2. Dizziness, drowsiness, and confusion.
3. Rapid, weak pulse and rapid breathing.
4. Nausea, vomiting, and abdominal pain.

If you suspect diabetic coma, do the following:

1. Establish and maintain the airway, breathing, and circulation (ABCs).

2. Lay casualty flat, slightly elevating the head and shoulders.

3. Do not give the casualty candy or soft drinks.

4. Treat for shock.

5. Request medical assistance immediately.

Insulin Shock

Insulin shock, also known as hypoglycemia, is a condition in which the body does not have enough sugar
and has too much insulin. Causes include skipping meals, too much insulin, strenuous exercise, and
changes in diet.

Signs and symptoms of insulin shock include:

1. Headache, dizziness, and irritability.


2. Pale, moist skin, and excessive sweating.
3. Muscle weakness, hunger, and normal to rapid pulse.

If you suspect insulin shock, do the following:

1. Ask casualty or family member these two questions.

a. Has the casualty eaten today?


b. Has the casualty taken his or her insulin?

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If the answer is "yes" to the first question and "no" to the second, the casualty is probably in a
diabetic coma.

2. Establish and maintain the airway, breathing, and circulation (ABC's).

3. Lay casualty flat, slightly elevating the head and shoulders.

4. Give the conscious casualty candy or soft drinks to increase blood sugar level.

5. Treat for shock

6. Request medical assistance immediately.

Stroke

Stroke, also known as cerebrovascular accident, is a condition in which one or more of the blood vessels
to the brain become blocked or rupture, causing part of the brain to die from lack of oxygen. Causes
include arteries blocked by a clot (thrombus), ruptured blood vessels (hemorrhage) in the brain, or a clot
that travels (embolus) to the brain from another part of the body.

Signs and symptoms of stroke include:

1. Onset is sudden, with little or no warning.


2. Weakness or paralysis of one side of the body.
3. Loss of facial expression and drooping mouth on one side.
4. Double vision, stuttering, and severe headache.
5. Difficulty speaking, and understanding speech.
6. Unequal pupils, nausea, and vomiting.

If you suspect a stroke, do the following:

1. Lay casualty flat, slightly elevating the head and shoulders.

2. Establish and maintain the airway, breathing, and circulation (ABCs).

3. Keep the casualty quiet and warm.

4. Give nothing by mouth.

5. Request medical assistance immediately.

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Heart Attack

Heart attack, also known as myocardial infarction, is a condition in which blood flow to part of the heart
is blocked, causing that part of the heart muscle to die from lack of oxygen. Most heart attacks are caused
by cardiovascular disease. Risk factors are things that are related to getting cardiovascular disease.
Casualties may deny that they are having a heart attack. Suspect heart attack in adults with chest pain
until proven otherwise.

1. Risk factors that you cannot change:

a. Heredity (family history of cardiovascular disease)


b. Sex (males have a greater risk)
c. Age

2. Risk factors that you can change:

a. Smoking
b. High blood pressure
c. High blood cholesterol
d. Obesity
e. Lack of exercise
f. Stress
g. Uncontrolled diabetes

Signs and symptoms of a heart attack include:

1. Severe, under the breastbone (substernal) chest pain (crushing, squeezing, or like somebody is
standing on my chest).
2. May spread to the jaw, shoulders, arms, neck, or back.
3. Difficulty breathing.
4. Pale, moist skin, and excessive sweating.
5. Anxiety, nausea, and vomiting.
6. Weakness and lightheaded.

If you suspect a heart attack, do the following:

1. Establish and maintain the airway, breathing, and circulation (ABCs).

2. Place the casualty in the most comfortable (sitting or semi- sitting) position.

3. Keep the casualty quiet, and warm.

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4. Loosen restrictive clothing, at the neck, waist, and chest.

5. Be prepared to give CPR (Chapter 2).

6. Request medical assistance immediately.

Seizures

Seizures, also known as convulsions, are a twisting of the body caused by violent, involuntary muscle
contractions. Causes include epilepsy, head injury, infection, disease, and fever. The casualty will be
drowsy and disoriented after the seizure.

Signs and symptoms of a seizure include:

1. A sensation or feeling (aura) usually visual, sound, taste, or smell).


2. Crying out or moan from casualty.
3. Partial or total loss of consciousness and muscle rigidity.
4. Jerking (spasm) of the arms and legs.
5. Frothing from the mouth.
6. Possible loss of bowel and bladder function.

If the casualty has a seizure, do the following:

1. Lay the casualty flat, protecting him or her from injury.

2. Move all objects out of the way to prevent further injuries.

3. Don't force anything between the teeth or restrain the casualty in any way.

4. Loosen restrictive clothing, at the neck, waist, and chest.

5. Calm and reassure the casualty.

6. Establish and maintain the airway, breathing, and circulation (ABC's).

7. Give nothing by mouth.

8. Request medical assistance immediately.

Alcohol Intoxication

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Alcohol is the most widely used and abused drug today. Alcohol intoxication, also known as
drunkenness, is so common that it fails to receive the attention and respect it deserves. Ethyl alcohol
(ethanol), is the primary ingredient in wine, beer, and liquor. Ethanol is classified as a drug because it
depresses the central nervous system, affecting physical and mental activities. Alcohol is addictive. What
starts out as social drinking may, and frequently does, result in alcoholism.

Alcohol affects the body in stages. First, there is a feeling of relaxation and well-being, followed by a
gradual disruption of coordination, resulting in an inability to accurately and efficiently perform normal
duties and activities. Continued drinking depresses body functions enough to cause difficulty breathing,
loss of consciousness, coma, and death. Withdrawal from alcohol can result in delirium tremens (DTs),
identified by anxiety, confusion, restless sleep, nausea, vomiting, depression, hallucinations, and seizures.
If you choose to drink, do so in moderation. If you can't control your drinking, get help before it's too
late.

Signs and symptoms of alcohol intoxication include:

1. Smell of alcohol on breath.


2. Staggering, loss of balance, and slurred speech.
3. Nausea, vomiting, and flushed face.

These signs and symptoms may indicate an illness or injury (e.g. diabetes, head injury) other than alcohol
abuse. If you suspect alcohol intoxication, do the following:

1. Sit or lay the casualty down, protecting him or her from further injury.

2. Establish and maintain the airway, breathing, and circulation (ABCs).

3. Perform an initial assessment.

4. Observe closely, casualty may become unconscious.

5. Don't criticize, be firm with casualty.

6. Never leave an intoxicated casualty alone.

7. Request medical assistance as soon as possible.

Psychiatric Emergencies

A psychiatric emergency is a sudden onset of behavioral or emotional responses that, if not responded to,
may result in a life-threatening situation. Probably the most common is the suicide attempt. This may

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range from verbal threats and suicide gestures to successful suicide. Always assume that a suicide
threat is real, do not leave the individual alone. In all cases, the main consideration is to keep them
from inflicting harm to themselves and getting them under the care of a medical professional.

Drowning

Drowning is suffocation by immersion in water or other liquid. Causes include diving accidents, drinking
alcohol prior to or during swimming, getting trapped under the water, and becoming exhausted while
swimming. Fluid rarely enters the lungs because upon contact with fluid, spasms of the windpipe occur
which seal the airway from the mouth and nose.

If a drowning has occurred, do the following:

1. Reach the casualty without putting yourself in danger.

2. Establish and maintain the airway, begin mouth-to-mouth or mouth-to-nose breathing while in the
water.

3. Don't remove the casualty from the water until a backboard or other rigid devise is available.

4. Maintain a neutral position of the head and neck, apply a cervical collar or improvised (towel) collar.

5. Be prepared to give CPR (Chapter 2).

After removal from the water.

6. Keep the casualty warm enough to maintain normal body temperature.

7. Request medical assistance immediately.

An apparently lifeless casualty who has been in cold water for a long period of time may still be revived
with rescue breathing. The body reduces the need for oxygen and protects the vital organs in water below
68 degrees F.

Electric Shock

Electric shock is the effect produced by the passage of an electric current through any part of the body.
Causes include contact with a "live" wire or circuit, and occasionally occur when a person is struck by
lightning. Fundamentally, electrical current rather than voltage is the criterion of shock intensity. The
passage of even a very small current through a vital part of the body can cause death. The voltage
necessary to produce the fatal current is dependent upon the resistance of the body, contact conditions,

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and the path through the body.

Signs and symptoms of electric shock include:

1. Skin pale or even bluish (cyanotic).


2. Pulse weak or absent.
3. Burns and unconsciousness.
4. Breathing is shallow or absent.
5. Body may become rigid or stiff due to the muscular reaction to the shock, don't consider this to
be rigor mortis. The appearance of rigor mortis shall not be assepted as a positive sign of
death.

If you suspect electrical shock, do the following:

1. Shut off the power. If you cannot shut off the power, remove the victim immediately. Stand on a well-
insulated object and use a dry rope, wooden pole, or other non-conductive material to either push or pull
the wire away from the casualty, or the casualty away from the electrical source. Do not attempt to
administer first aid or come in physical contact with an electrical shock casualty before shutting off
the power. If you cannot shut off the power immediately, remove the victim from the live
conductor before touching them.

2. Maintain neutral position of the head and neck, apply a cervical collar or improvised (towel) collar.
(Casualty is usually thrown).

3. Establish and maintain the airway, breathing, and circulation (ABCs).

4. Perform an initial assessment.

5. Begin CPR/rescue breathing if necessary (Chapter 2) and continue until successful.

6. Cover burn areas (Chapter 7) with a moist, preferably sterile dressing.

7. Treat for shock. (Chapter 4)

8. Request medical assistance for all electrical injuries. If possible, before transport, inform medical
personnel of the electrical source involved and the location of the entrance and exit wounds.

References

1. Karren, K. J., and Hafen, B. Q. :First Responder A Skills Approach, ed. 3, Norton Publishing
Company

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2. NAVEDTRA 10669-C, Hospital Corpsman 3 & 2

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Virtual Naval Hospital: Standard First Aid Course - Chapter 11 - Rescue and Transportation

NAVEDTRA 13119 Standard First Aid Course - Chapter 11 - Rescue and Transportation

Rescue and Transportation


Department of the Navy
Bureau of Medicine and Surgery
Peer Review Status: Internally Peer Reviewed

If you are faced with the problem of rescuing a person threatened by fire, explosive or poisonous gases,
or some other emergency, do not take action until you have had time to determine the extent of the
danger and your ability to cope with it. In a large number of accidents the rescuer rushes in and becomes
the second casualty. Do not take unnecessary chances! Do not attempt any rescue that needlessly
endangers your own life!

Protective Equipment

The Navy uses a wide variety of special protective equipment. It includes the oxygen breathing
apparatus; air-line masks; emergency escape breathing devices; protective (gas) masks; proximity suit;
tending lines; and detection devices.

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Figure 11-1 - A-4 Oxygen Breathing Apparatus.

Oxygen Breathing Apparatus

The type A-4 Oxygen Breathing Apparatus (OBA) is a self-contained breathing apparatus (Fig. 11-1)
used throughout the Navy. It is particularly valuable for rescue purposes because it enables the wearer to
breathe independently of the outside atmosphere. It produces its own oxygen and allows the wearer to
enter compartments, voids, or tanks that have a low oxygen content or that contain smoke, dust, or fire.
The face-piece contains the eyepiece, the speaking diaphragm, and the head straps. The breathing bag
contains the oxygen that is generated by the canister. One breathing tube transports the oxygen from the
breathing bag to the face-piece; the other transports the exhaled air back to the canister. Both tubes are
made of corrugated rubber. They control the flow and help cool the air. The timer is located so that you
can check the amount of time remaining. To set the timer, turn the knob clockwise to 60 minutes, and
then turn it counterclockwise to 30 minutes. By setting the timer to 60 first, you fully wind the alarm bell
spring. When 30 minutes have expired, the warning bell will sound continuously for 10 or more seconds.
All OBA equipment and canisters must be stored in a cool, dry place. The life of an OBA will be
lengthened if it is stored under these conditions.

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Figure 11-2 - Air-line Hose Mask Components.

Air-line Masks

The air-line mask (Fig. 11-2) is part of all ship's repair party locker allowance. Never use the air-line
mask to fight fires. It may be used to enter smoke-filled spaces to rescue personnel. The air-line mask is
a demand-flow, air-line respirator with a speaking diaphragm, monocular lens with adjustable head
harness, breathing tube, and belt-mounted demand regulator with male and female (buddy) quick-
disconnect fittings. A 25-foot length of hose with male and female quick-disconnect fittings is provided
for use with the air-line mask. This hose can be used to connect to the demand regulator fitting and a low-
pressure air supply, or to a compressed air cylinder with an intervening air regulator and air filter. The
maximum length of hose that may be used with the air-line mask is 250 feet.

Tending Lines

Tending lines (Fig. 11-3) are used as a precautionary measure to help rescue an individual who is
wearing an oxygen breathing apparatus, air-line mask, or similar equipment. A 50-foot nylon covered,
steel wire tending line is used aboard ship. The tending line has a stout hook on each end that is closed
with a snap catch. The line is pliable and can slide freely around obstructions.

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Figure 11-3 - Tending Lines.

If necessary, the rescue should be accomplished by having another person equipped with a breathing
apparatus follow the tending line to the person to be rescued. Do not drag the casualty out by the
tending line. If the rescue is to take place promptly, someone must be equipped with an OBA that is
ready for immediate use and must be standing by ready for immediate entry. The tender should wear
rubber gloves and shoes when handling steel tending lines and cables. The OBA wearer and the line
tender should both know and use the following system of line signals.

The OATH code is as follows:

Code Pull Meaning

O 1 pull OK
A 2 pulls Advance
T 3 pulls Take Up Slack
H 4 pulls Help

Atmosphere Testing Devices

All closed or poorly ventilated compartments, particularly those in which a fire has just occurred, are
potentially dangerous. The atmosphere may lack oxygen, contain poisonous gases, or present fire and
explosion hazards.

Aboard naval ships, no person may enter any closed compartment or poorly ventilated space
unless the ship's gas-free engineer, or his or her authorized representative, has tested the space and
declared that it is safe to enter.

Rescue Procedures

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If you are faced with the problem of rescuing an individual threatened by fire, explosive or poisonous
gases, or some other emergency, do not take any action until you have had time to determine the extent of
the danger and your ability to cope with it. In a large number of cases, the rescuer rushes in and becomes
the second casualty.

Do not take any unnecessary chances! Do not attempt any rescue that needlessly endangers your
own life!

Phases of Rescue Operations

When there are multiple casualties (explosions or ship collisions), rescue operations should be performed
in phases. These phases apply only to extrication operations. The first phase is to remove lightly pinned
casualties, such as those who can be freed by lifting boxes or removing a small amount of debris. In the
second phase, remove those casualties who are trapped in more difficult circumstances but who can be
rescued by the use of the equipment at hand and in a minimum amount of time. In the third phase,
remove casualties where extrication is extremely difficult and time consuming. This type may possibly
involve cutting through decks, or removing large amounts of debris. An example would be rescuing a
worker from beneath a large, heavy piece of machinery. The last phase is the removal of the dead.

Stages of Extrication

The first stage of extrication within the rescue phases outlined above is gaining access to the casualty.
Much will depend on the location of the accident, damage at the accident site, and the position of the
casualty.

The second stage involves giving lifesaving (emergency care) first aid.

The third stage is disentanglement. The careful removal of debris from the casualty.

The fourth stage is preparing the casualty for removal.

The final stage is removing the casualty from the trapped area and transporting to an ambulance or
medical facility.

Rescue from Fire

If you must go to the aid of a casualty whose clothing is on fire, try to smother the flames by wrapping
the casualty in a coat, or blanket. Leave the head uncovered. Beat out the flames around the head and
shoulders, then work downward toward the feet. If you have no material with which to smother the fire,
roll the casualty over slowly and beat out the flames with your hands. If the casualty sits or stands, they
may be killed instantly by inhaling flames or hot air. Inhaling flames or hot air can kill you! Do not
place your face directly over the flames. Turn your face away from the flames when you inhale!

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Always use an oxygen breathing apparatus or other protective breathing equipment when you enter a
burning compartment.

Rescue from Steam-filled Spaces

It is sometimes possible to rescue a casualty from a space in which there is a steam line. Since steam
rises, escape upward may not be possible. If the normal exit is blocked by escaping steam, move the
casualty to the escape trunk, or to the lowest level in the compartment. Equipment that offers
protection against fire does not protect against steam!

Rescue from Electrical Contact

Rescuing a casualty who has received an electrical shock can be difficult and dangerous.You must not
touch the casualty's body, the wire, or any object that may be conducting electricity!

Look for the switch and turn the power off immediately. Do not waste time hunting for the switch, every
second is important. If you cannot find the switch, try to remove the wire from the casualty or the
casualty from the wire. Use a dry broom handle, branch, pole, oar, board, or similar non-conducting
object. An old favorite is to remove the casualty from an electrical contact using the uniform belt. Be
careful, the belt was made of cotton, but is now made of nylon and other conductive material. When you
are trying to break an electrical contact, always stand on some non-conducting material. The old drop
kick method is extremely dangerous and not recommended.

Rescue from Unventilated Compartments

Rescuing a casualty from a void, double bottom, gasoline or oil tank, or any closed compartment or
unventilated space is a hazardous procedure. Aboard naval vessels and at naval shore activities, no person
is permitted to enter any such space or compartment until a gas-free engineer, or his or her authorized
representative, has tested the space and declared it safe to enter.

Rescue from Water

Never attempt to swim to the casualty unless you have been trained in water rescue techniques, and then
only if there is no safer way of reaching the casualty. If you do not have the skills, or if the conditions do
not warrant rescue by swimming, you should note the exact location (time and any landmarks), and seek
help immediately. Many double drownings occur when individuals untrained in water rescue
techniques attempt swimming rescues!

The casualty may panic and fight you so violently that you will be unable either to rescue the casualty or
to save yourself. Even if you are not trained in water rescue techniques, you can rescue the casualty by
holding out a pole, oar, or branch for the casualty to grab hold of, throwing a lifeline, or a buoyant object

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such as a life preserver. Various methods are used aboard ship to pick up survivors in the water. The
method used will depend upon the weather conditions, the type of equipment available aboard the rescue
vessel, the number of personnel available for the rescue operation, and the physical condition of the
casualty. Most rescue operations aboard ship use motor whaleboats (life boats) or helicopters.

Transportation

In an emergency, there are many ways to move a casualty to safety, ranging from one-person carries to
stretchers. The casualty's condition and the immediacy of danger will dictate the appropriate method, but
remember to give all necessary first aid before moving the casualty. At times it will be necessary to move
the casualty immediately, without regard to the severity of the injuries. Remember, when you move a
casualty, you are taking a calculated risk. You may cause further injury or even death!

You are justified in taking such a risk only when it is evident that the casualty will die if not moved.

General Rules

1. Whenever possible, render first aid before transporting the casualty. Reduce the casualty's pain and
make them as comfortable as possible.

2. Use a regular stretcher, with enough people to carry it, so that you will not drop the casualty.

3. Whenever possible, take the stretcher to the casualty, instead of carrying the casualty to the stretcher.

4. Fasten the casualty to the stretcher so that they don't slip, slide, or fall off.

5. Use blankets, clothing, or other material to pad the stretcher and protect the casualty from exposure.

6. Casualties should be lying on their back while being moved. However, in some case, the type or
location of the injury will necessitate the use of another position. In all cases, it is important to place the
casualty in a position that will best protect them from further injury.

7. Always move the casualty feet first so the rear bearer can watch for signs of difficulty breathing.

8. Always give a complete account of the situation before giving the casualty to other personnel. Include
what caused the injury and what first aid procedures have been completed. Also, get the name of the
casualty and the person whom you are turning them over to. This is one way of protecting yourself and at
the same time ensuring that the patient will be in good hands.

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Figure 11-4 - Neil Robertson Stretcher.

Neil Robertson Stretcher

The Neil Robertson stretcher (Fig. 11-4) is specially designed to remove a casualty from engineering
spaces, holds, vertical trunks, and other compartments where hatches or ladders are too small to use other
stretchers. It is made of semi-rigid canvas with wooden slats sewn the length of the stretcher. When
firmly wrapped around the casualty in a mummy fashion, it provides sufficient support for the casualty to
be lifted vertically. A 12-foot length of handling line is spliced on the O-ring at each end to prevent the
casualty from swaying against bulkheads while being lifted. Figures 11-5 through 11-10 provide

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instructions on its proper application. Secure the outer chest straps over the victim's chest and under his
arms. Secure the arms to the side by placing the middle chest strap over the upper arms and chest.

Figure 11-5 - Neil Robertson Stretcher. Arrange the stretcher as depicted.

Figure 11-6 - Neil Robertson Stretcher. Remove the hood.

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Figure 11-7 - Neil-Robertson Stretcher. Place the hood on the victim. This is easier than trying to
place the victim in the hood while it is still attached to the stretcher.

Figure 11-8 - Neil-Robertson Stretcher. Three persons should pick up the victim as depicted. A
fourth person should be available to slide the stretcher under the victim. In placing the victim in
the stretcher, ensure that the shoulders line up with the arm holes and chest flaps.

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Figure 11-9 - Neil-Robertson Stretcher. Place the victim on the stretcher. If the victim is a short
person, make sure that his or her armpits are even with the cut-out section of the flap. This will
place the casualty in the correct position in the stretcher and prevent them from slipping out.
Secure the hood to the stretcher. Place the chest flaps over the patient's chest and under the arms.

Figure 11-10 - Neil Robertson Stretcher. Fold the leg flaps in place over the victim's legs. If the
victim is positioned correctly the hands will be under the leg flap and against the thigh. Secure the
leg straps.

Miller (Full Body) Board

The Miller Board is constructed of an outer plastic shell with an injected foam core of polyurethane
foam. It is impervious to chemicals and the elements and can be used in virtually every confined space
rescue and vertical extrication. The casualty can be turned vertically and laterally with no movement, and
the board's narrow design allows passage through hatches and crowded passageways. It fits within a
Stokes (basket) stretcher and will float a 250-pound person. The Miller Board will eventually replace the
Neil Robertson Stretcher.

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Figure 11-11 - Stokes Stretcher

Stokes Stretcher

The most commonly used stretcher for transporting the sick and injured is called the (Fig. 11-11) Stokes
(basket) stretcher. It is essentially a wire basket supported by iron rods. A new version is made of molded
plastic. It is adaptable to a variety of uses, since the casualty can be held securely in place even if the
stretcher is tipped or turned. It can be used with floatation devices to rescue casualties from the water.
The Stokes should be padded with three blankets: two should be placed lengthwise, so that one will be
under each of the casualty's legs, and the third should be folded in half and placed in the upper part to
protect the head and shoulders. The casualty should be lowered gently into the stretcher and made as
comfortable as possible. Cover the casualty with one or more blankets. Fasten the casualty and blanket
with the straps provided over the chest, hips, thigh, and lower legs.

Do not place the straps over the knees or areas of suspected broken bones!

Army (Pole) Litter

The Army litter (Fig. 11-12) is collapsible, made of canvas, and supported by wooden or aluminum
poles. They are used aboard ship only for mass casualty situations and are not to be used for transporting
casualties throughout the ship.

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Figure 11-12 - Army Litter

Improvised Stretchers

Standard stretchers should be used whenever possible to transport casualties. If none are available, it may
be necessary for you to improvise. Sometimes a blanket may be used as a stretcher. The casualty is
placed in the middle of the blanket on his or her back. Four people kneel (Fig. 11-13) on each side and
roll the edges of the blanket toward the casualty. Stretchers may also be improvised (Fig. 11-14) by using
two long poles (approx. 7 feet long) and a blanket. Most improvised stretchers do not give sufficient
support in cases where there are fractures or extensive wounds of the body!

Figure 11-13 - Blanket used as improvised transport stretcher.

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Figure 11-14 - Stretcher made from poles and a blanket.

Fireman's Carry

The Fireman's Carry (Fig. 11-15) is one of the easiest ways to carry an unconscious casualty.

1 .Place the casualty face down. Face the casualty, and kneel on one knee at the casualty's head. Pass
your hands under the armpits; then slide your hands down the sides and grasp them across the back.

2. Raise the casualty to his knees. Take a better hold across the casualty's back.

3. Raise the casualty to a standing position and place your right leg between the casualty's legs. Grasp the
right wrist in your left hand and swing the arm around the back of your neck and down your left shoulder.

4. Stoop quickly and pull the casualty across your shoulders and, at the same time, put your right arm
between the casualty's legs.

5. Grasp the casualty's right wrist with your right hand and straighten up. The procedure for lowering the
casualty to the deck is also illustrated. Do not attempt if the casualty has an injured arm, leg, ribs,
neck, or back!

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Figure 11-15 - Fireman's Carry

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Figure 11-16 - Tied Hands Crawl

Tied-Hands Crawl

The tied-hands crawl (Fig. 11-16), may be used to drag an unconscious casualty for a short distance. It is
particularly useful when you must crawl underneath a low structure, but it is the least desirable because
the casualty's head is not supported.

1. Place the casualty face up. Cross the casualty's wrists and tie them together.

2. Kneel astride the casualty and lift the arms over your head so that the casualty's wrists are at the back
of your neck.

3. When you crawl forward, raise your shoulders high enough so that the casualty's head will not bump
against the deck. Blanket Drag

The blanket drag (Fig. 11-17), can be used to move a casualty who, due to the seriousness of the injury,
should not be lifted or carried by one person alone.

1. Place the casualty face up on a blanket, and pull the blanket along the deck.

2. Always pull the casualty head first, with the head and shoulders slightly raised, so that the head will
not bump against the deck.

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Figure 11-17 - Blanket Drag

Pack-Strap Carry

The pack-strap carry (Fig. 11-18), can be used to move a heavy casualty for some distance.

1. Place the casualty face up.

2. Lie down on your side along the casualty's uninjured or less injured side. Your shoulder should be next
to the casualty's armpit.

3. Pull the casualty's far leg over your own, holding it there if necessary.

4. Grasp the casualty's far arm at the wrist and bring it over your upper shoulder as you roll and pull the
casualty onto your back.

5. Rise up on your knees, using your free arm for balance and support. Hold both of the casualty's wrists
close against your chest with your other hand.

6. Lean forward as you rise to your feet, and keep both of your shoulders under the casualty's armpits.

Do not attempt if the casualty has an injured arm, ribs, neck, or back!

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Figure 11-18 - Pack-Strap Carry

Chair Carry

The chair carry (Fig. 11-19), can be used to move a casualty away from a position of danger. The
casualty is seated on a chair and the chair is carried by two people. This is a good method to use when
you must carry a casualty up or down steps or through narrow, winding passageways.

Do not attempt if the casualty has an injured neck, back, or pelvis!

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Figure 11-19 - Chair Carry

Figure 11-20 - One-Person Arm Carry

Arm Carries

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There are several kinds of arm carries that can be used in emergency situations to move a casualty to
safety. The one-person arm carry (Fig. 11-20), should not be used to carry a casualty who is seriously
injured. Unless the casualty is considerably smaller than you, you will not be able to carry the casualty
very far. The two-person carry (Fig. 11-21), unless absolutely necessary, should not be used to carry a
casualty who is seriously injured. An alternate two-person carry (Fig. 11-22) also can be used.

1. Two rescuers kneel beside the casualty at the level of the hips, and carefully raise them to a sitting
position.

2. Each rescuer puts one arm under the casualty's thighs; hands are clasped and arms are braced.

3. Both rescuers rise slowly to a standing position.

Do not attempt if the casualty is seriously injured!

Figure 11-21 - Two-Person Carry by Arms and Legs

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Figure 11-22 - Two-Person Arm Carry

References

1. NAVEDTRA 10669-C, Hospital Corpsman 3 & 2

2. NAVEDTRA 10572, Damage Controlman 3 & 2

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Virtual Naval Hospital: Standard First Aid Course - Chapter 12 - Health Education

NAVEDTRA 13119 Standard First Aid Course - Chapter 12 - Health Education

Health Education
Department of the Navy
Bureau of Medicine and Surgery
Peer Review Status: Internally Peer Reviewed

In the Navy, health education is defined as "the process that informs, motivates, and helps people adapt
and maintain healthful practices and life styles."

Specifically, the goals of this process are:

1. To assist individuals to acquire knowledge and skills that will promote their ability to care for
themselves more adequately.

2. To influence individual attitudinal chances from a disease to a health orientation.

3. To support behavioral chances to the extent that individuals are willing and able to maintain their
health.

Through good habits of cleanliness, regular exercise, and good nutrition you have control over your well-
being. Good health is no accident, it comes with conscious effort and good health habits.

Personal Hygiene

Because of the close living quarters in the Navy, particularly aboard ship, personal hygiene is of major
importance. Disease can spread and rapidly affect an entire compartment or division. Personal hygiene
promotes health and prevents disease. Some military personnel tend to be lax in paying attention to their
personal hygiene. Uncleanliness or disagreeable odors will affect the morale of your shipmates. A daily
bath or shower will assist in the prevention of body odor and is absolutely necessary to maintain
cleanliness. Shampoo the hair at least once a week using a commercial shampoo. Always wash your
hands with soap and water after using the toilet and before eating. Proper foot care is a vital factor in the

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overall performance of personnel, both ashore and afloat. Clean and dry your feet regularly, especially
between the toes; use foot powder to prevent chafing and to promote absorption; change socks and shoes
regularly, especially in wet environments; and have foot problems medically evaluated and treated
promptly. Proper exercise increases the body's resistance to certain diseases, promotes digestive and
excretory function, and decreases your risk for atherosclerotic heart disease. Smoking and
overindulgence in food and drink are detrimental and defeat the purpose of exercise. Proper nutrition is
essential to supplying the body with all the elements it needs to function. Energy for activity and
proteins, minerals, and vitamins for growth are all supplied by a proper diet. Proper sleep recharges
nervous energy, repairs damaged cells, and regains the body's bounce. It is important to sleep undisturbed
at regular hours and long enough to awaken refreshed. Continued physical and mental fatigue is
detrimental to the maintenance of good health.

Dental Hygiene

Dental plaque is described as a soft deposit that consists of bacteria and bacterial products. Plaque
utilizes the nutrients from food for growth, the most common is sugar. For this reason, nutrition plays an
important part in preventive dentistry. Plaque must be removed from the oral structures. All plaque
removal can be controlled by the individual. There is no one right method of plaque control. A
toothbrush should conform to the need in size, shape and texture. It must be easily and efficiently
manipulated with safety, easy to clean, and be durable. When you are finished brushing your teeth, brush
the tongue and palate (roof of your mouth). The surface of the tongue is an ideal location for bacterial
plaque and food debris to collect. Flossing is an effective and efficient way to remove plaque from the
surface of the tooth.

1. Obtain a 12- to 24-inch piece of floss.

2. Stretch the floss tightly between the thumb and forefinger of both hands.

3. Pass the floss gently through each contact point with a gentle sawing motion.

4. Wrap the floss around the surface of one tooth, at the base.

5. Move the floss firmly along the tooth gently up and down. Repeat this stroke five or six times.

6. Continue procedures throughout the entire mouth.

Oral irrigators (water pics) clean by directing a stream of water between and around the teeth. Irrigators
are especially useful for removing loose debris from areas that cannot be cleaned with a toothbrush. Oral
irrigators remove only a small amount of plaque from the tooth surfaces. Mouthwashes are pleasant to
use and make the mouth feel clean. Although some contain fluoride, there is no evidence that mouthwash
alone can maintain good oral hygiene.

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Health and Fitness

It is estimated that 50 percent of all deaths and illnesses in the United States directly relate to unhealthy
lifestyle habits; primarily poor diet, lack of exercise, alcohol abuse, smoking, and unmanaged stress.
Additional risks to good health and optimal productivity result from undiagnosed or inadequately
controlled high blood pressure and significant incidence of low back injuries. Preventive maintenance
principles and positive lifestyle changes can substantially reduce these threats to the health of the force.

Nutrition

Nutrition is a scientific term applied to the process by which food is taken into the body to produce
energy for activity, rebuild body tissue, and assist in regulating body functions. To meet these needs, it is
required that an individual's diet contain a proper balance from the Food Guide Pyramid.

1. Grain Group (for fiber) - Furnishes significant amounts of protein, iron, and many of the B vitamins.
Also included are carbohydrates that provide a quick energy source and supply the body with roughage.
Foods of this group include all breads and cereals that are whole grained, restored, or enriched.
Additionally, the group includes foods such as rice, oats, cooked cereals, and the pasta group.

2. Meat Group (for iron) - Provides a major source of protein, iron, and the B-complex vitamins. Foods
in this group include beef, veal, lamb, pork, and the organ nutrients such as liver and kidney. Fish,
poultry, and eggs are also included. Foods such as beans, peas, and nuts are alternative sources of
protein.

3. Milk Group (for calcium) - Supplies the body with calcium, some high-quality protein, and vitamins
A and riboflavin. Foods in this group include whole, evaporated, skim, and dry milk, buttermilk, ice
cream, yogurt, and a variety of cheeses.

4. Vegetable Group (for vitamin A) - Provides a major source of vitamin A and minerals. Foods in this
group include vegetable juice, raw and cooked vegetables, raw leafy vegetables, and potatoes.

5. Fruit Group (for vitamin C) - Provides a major source of vitamin C and minerals. Foods in this group
include fruit juices, raw, canned, or cooked fruit, apples, bananas, oranges, pears, cantaloupe, grapefruit,
and dried fruits.

Some foods don't have enough nutrients to fit in any of the five food groups. These foods are called
"Others," and are okay to eat in moderation. They should not replace foods from the five food groups.
Foods in this group include fats, oils, sweets, salty snacks, alcohol, other beverages, and condiments.

Each day a healthy adult requires 6-11 servings from the grain group, 2-3 servings from the meat group,
2-3 servings from the milk group, 3-5 servings from the vegetable group, and 2-4 servings from the fruit
group.

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1 .Plan a well-balanced diet around familiar foods.

2. Learn to judge portions, start measuring your foods.

3. Don't skip meals, this helps to prevent hunger and overeating later in the day.

4. Eat slowly, start with a salad and/or broth.

5. Cook to save calories, avoid fried foods and trim visible fat from meat, preferably before you cook it.
Broil, bake, roast or boil meats and vegetables. Eat fresh fruits and canned fruits without syrup.

6. Keep a supply of crisp, raw vegetables on hand for between meal snacks. Some good "nibbling" foods
are celery sticks, tomato slices, radishes, green pepper rings, cucumber slices, lettuce wedges, and dill
pickles.

7. Learn to stop eating before you feel full.

8. Weigh yourself regularly at the same time once each week.

Figure 12-1 - Food Guide Pyramid

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Physical Fitness

Physical fitness may be divided into four major components: aerobic fitness, musculoskeletal fitness,
flexibility, and body composition. These fitness components are not necessarily interrelated. For
example, a marathon runner with a high level of aerobic fitness may not possess a high degree of upper
body muscular strength.

Aerobic fitness is the ability to participate in sustained, vigorous physical activity for extended periods
of time. It is related to the efficiency of the heart, lungs, and blood vessels to deliver oxygen to the
working muscles. The Navy field tests to measure this component of fitness are the 1.5-mile run/walk
and 500-yard swim.

Musculoskeletal fitness is a combination of muscular strength and muscular endurance. Muscular


strength is often represented as the maximal amount of weight lifted during a single repetition. Muscular
endurance is the ability to sustain repeated repetitions without undue fatigue. Curl-ups and push-ups are
the Navy field tests to determine muscular endurance.

Flexibility is the ability to move joints through their entire range of motion. Lack of flexibility of the
hamstring muscles and the muscles/ligaments of the back is related to an increased risk of lower back
injury. The Navy field test to assess this component of fitness is the sit-reach test.

Body composition is the relative amount of total body weight made up of fat and lean tissue. The Navy
uses a percent body fat standard to assess body composition. The percent body fat value is determined
from circumference measurements. There are several reasons for measuring percent body fat rather than
using height/weight tables. Obesity is an excess of body fat frequently resulting in a significant
impairment of health. Excess body fat is associated with high blood pressure, diabetes, and heart disease.
Fat is clearly the culprit, not total body weight. Although height/weight tables are sometimes used to
assess the extent of "over-weightness" based on age and body size, these tables do not accurately
measure an individual's body fat content.

Tobacco Products

The Surgeon General of the United States has determined that tobacco use is the single most preventable
cause of illness and death. There can be no question that the use of tobacco products decreases the health
and readiness of the Navy. Research has consistently shown that the use of tobacco products increases
the risk of cancer, heart disease, and other major illnesses. This is the most avoidable public health
hazard we face. Medical and dental health care providers will advise tobacco users of the risks associated
with tobacco use and refer them, if agreeable, to locally available smoking cessation programs. They also
will emphasize to all pregnant tobacco users the special risks to the unborn child caused by smoking.

Drug Abuse

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The Navy has established a "zero tolerance" standard for drug usage. The major emphasis is on detection
and deterrence of illicit drug use. Drug abuse is the constant or excessive use of drugs for purposes or in
quantities for which they were not intended. When abused, drugs become a source of "poison" to the
body. They can lead to serious illness, dependency, and death.

Narcotics

Narcotics include the most effective and widely used pain killers in existence. Continual use of narcotic
drugs, even under medical supervision, leads to physical and psychological dependence. The most
common narcotics are opium, morphine, heroin, codeine, and methadone. Next to codeine, heroin is the
most popular narcotic drug, because of its intense euphoria and long-lasting effects. It is far more potent
than morphine but has no legitimate use in the United States. Codeine, although milder than heroin and
morphine, is sometimes abused as an ingredient in cough preparations. Symptoms of abuse include slow
shallow breathing, unconsciousness, constriction (narrowing) of the pupils, drowsiness, confusion, and
slurred speech.

Barbiturates

The legitimate use of barbiturates is primarily to induce sleep and to relieve tension. They are
depressants (downers), and statistically they are the most lethal of the abused drugs. The most common
barbiturates are Phenobarbital, amobarbital (blues), pentobarbital (yellows), and secobarbital (reds).
Overdose potential is extremely high and can occur accidentally. Symptoms of abuse include slurred
speech, faulty judgment, poor memory, staggering, tremors, rapid movement of the eyes, rapid shallow
breathing, shock, and coma.

Stimulants

Stimulants (uppers) directly affect the central nervous system by increasing mental alertness and
combating drowsiness and fatigue. The amphetamines, known as "speed," are the most commonly
abused and include Benzedrine, Dexedrine, Dexamyl, Desoxyn, and Methedrine. Symptoms include
hyperactivity, increased respiration, dilated (large) pupils, increased alertness, sweating, elevated
temperature, decreased appetite, and convulsions. The "comedown" is so unpleasant that the temptation
to take repeated doses is overwhelming and sometimes results in the abuser going on 'speed runs," which
can last up to a week. Then the abuser may sleep several days before waking depressed and extremely
hungry.

Hallucinogens

Hallucinogens affect the central nervous system by altering the user's perception of self and environment.
The most common hallucinogens include lysergic acid diethylamide (LSD), mescaline, dimethoxy-
methylarnphetaniine (STP), and phencyclidine (PCP). Symptoms include dilated (large) pupils, flushed

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face, increased heartbeat, and a chilled feeling. In addition, the person may display a distorted sense of
time and self, show emotions ranging from ecstasy to horror, and experience changes in depth
perception. Even though no longer under the direct influence of a hallucinogenic drug, a person who has
formerly used one of the drugs may experience a spontaneous recurrence (flashback) of some aspect of
the drug experience.

Cannabis

Cannabis sativa, commonly known as marijuana, is widely abused and can best be classified as a mild
hallucinogen. Symptoms include dryness of the mouth, irritation of the throat, bloodshot eyes, increased
appetite, and dizziness or sleepiness. Adverse reactions to the drug include anxiety, fear, dry mouth,
depression, suspicion, delusions, and, in rare cases, hallucinations.

Sexually Transmitted Diseases

Sexually transmitted diseases (STDs) are among the most common communicable diseases. Because of
embarrassment or lack of education, many cases go unreported and untreated. Changes in sexual
behavior, and the fact that many people have no symptoms, have added to the problems of control.
Education is a primary tool in controlling the spread of STDs. The best approach is one that is
straightforward, factual, and non-moralistic, but which at the same time does not condone promiscuity.
Abstinence is the only sure method of prevention. Condoms should be used to prevent infections but it
should be pointed out that condoms are not foolproof. The best method of combating and containing a
disease is to prevent it.

Chlamydial Genital Infections

The infectious agent is chlamydia trachomatis, with an incubation period of 5 to 10 days or longer. It is
transmitted through sexual intercourse, and the period of communicability is unknown. Males experience
an opaque discharge and burning or itching when urinating. Females experience symptoms similar to
gonorrhea with inflammation and infection of the cervix. Females are at risk of infertility.

Genococcal Infections

The infectious agent is the bacterium Neisseria gonorrhoea, with an incubation period of 2 to 7 days. The
period of communicability ranges from days to months in untreated individuals. Males experience a
purulent (pus) discharge with burning when urinating. Females may or may not experience a discharge
and pain. Females are at risk of infertility. Arthritis from systemic spreading may cause permanent joint
damage if treatment is delayed.

Herpes Simplex

Herpes simplex virus (HSV) types I and 2 usually produce distinct symptoms, depending on the port of

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entry. HSV type 2 usually produces genital herpes, with an incubation period from 2 to 12 days. The
most common sites of the lesions are the genital area, legs, and buttocks. Primary genital lesions are
infective for 7 to 12 days. Vaginal delivery of women with an active genital herpes infection presents a
risk of serious infection to the newborn. Infection in women is a possible risk factor associated with
cervical cancer.

Syphilis

The infectious agent is Treponema pallidum, a spirochete, with an incubation period of 10 days to 10
weeks. The period of communicability is variable and indefinite.

Primary - A papule (small, solid elevation of the skin), appears within 3 weeks at the site that
often erodes to form an indurated painless ulcer (chancre).
Secondary - After 4 to 6 weeks the chancre heals and a flat, reddish, and patchy rash appears on
the chest, back, arms, and legs. The rash is characteristically seen on the palms and soles.
Tertiary - After 5 to 20 years of untreated disease, the lesions can invade and destroy tissue in the
skin, bone, central nervous system, and heart. Individuals should avoid sexual contact until lesions
clear with proper antibiotic treatment.

Acquired Immune Deficiency Syndrome (AIDS)

The onset of AIDS is gradual with symptoms that are nonspecific, such as fatigue, fever, chronic
diarrhea, loss of appetite, weight loss, and involvement of the lymph nodes. A serologic test for
antibodies to the AIDS virus is being used for screening for evidence of past or present infection among
civilian and military personnel. The infectious agent is a virus designated as either human immune virus
(HIV), human T-lymphotrophic virus, type III (HTLV-3), or lymphadenopathy associated virus (LAV).
The incubation period is unknown; evidence suggests from 6 months to 5 years with an average of about
2 years for transfusion associated cases. AIDS is primarily transmitted by promiscuous sexual contact
(especially homosexual intercourse), sharing unclean needles, and through contaminated blood
transfusions or blood products. It also may occur with heterosexual contact. This is not to say that only
these populations are at risk; all personnel who engage in sexual activity with an unknown partner are at
risk. The period of communicability for AIDS is unknown, and may extend from a symptom free period
until the appearance of disease. There is no specific treatment for the immune deficiency. Personnel with
AIDS require intensive medical support, and the prognosis for long-term survival is poor. Preventive
measures are very important. Personnel should be educated that having promiscuous sexual behavior and
multiple random sexual partners increases the probability of contacting AIDS.

Rape and Sexual Assault

Sexual offenses, including rape, may be associated with serious injury, pregnancy, and sexually
transmitted diseases and are criminal offenses. Rape is the fastest growing crime in the United States, a
woman is sexually assaulted every seven minutes. In addition, countless children and men are raped or

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sexually assaulted each year. Rape is often committed by a relative, friend, boyfriend, date, or shipmate.
Most rape victims go into acute emotional shock during or shortly after an attack. Rape precautions
include using the buddy system, letting others know where you are going, walking in well-lit areas, and
staying in well-populated areas. The victim of sexual assault should not change their clothes, clean
themselves, douche, or urinate, because important evidence will be destroyed. Immediately refer all
sexual assault victims to the nearest medical treatment facility. It is the responsibility of the command to
contact NIS and the responsibility of the Medical Department to provide medical care. BUMEDINST
6320.57 series, Family Advocacy Program, provides guidelines on managing sexual offenses.

References

1. NAVEDTRA 10670-C, Hospital Corpsman 1 & C

2. NAVEDTRA 10669-C, Hospital Corpsman 3 & 2

3. NAVEDTRA 12570, Dental Assistant, Basic.

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Virtual Naval Hospital: Standard First Aid Course - Appendix

NAVEDTRA 13119 Standard First Aid Course - Appendix

Appendix
Department of the Navy
Bureau of Medicine and Surgery
Peer Review Status: Internally Peer Reviewed

This glossary has been developed to assist the non-medic in interpreting the meaning of common medical
terms. To be of immediate assistance to the non-medic, the definitions have been made as brief and
simple as possible. If more detailed definitions are required, a standard medical dictionary should
beconsulted.

Abdomen--the belly. The area of the body that lies between the chest and pelvis.

Abscess--a swollen, inflamed area of body tissue in which pus collects.

Absorbent--having ability to soak up or take in another substance.

Acute--sharp and severe. A condition of rapid onset and short duration, as in pain or illness.

Air passage--any of several tubes which transmit air from the nose or mouth to the lungs.

Airtight--preventing the passage of air.

Airway--the route for passage of air and/or gases into and out of the lungs.

Anaphylactic shock--a severe allergic reaction of the body to a foreign substance.

Antidote--a remedy or agent that neutralizes a poison.

Antiseptic--an agent which prevents or slows down growth of disease-producing organisms. Free from
contamination.

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Antitoxin--a substance that works against a poison.

Antivenin--an antitoxin against animal or insect venom.

Appendage--a body part branching off from the trunk; for example, an arm or leg.

Arterial pressure--the pressure of the blood in the arteries.

Artery--a tube-like body structure which carries blood and oxygen from the heart.

Artificial ventilation--movement of air into and out of the lungs by artificial means.

Aseptic--free from germs.

Asphyxiate--suffocate, smother.

Aspiration--to draw in or out. To suck in.

Blister--a small rounded elevation of skin, usually filled with fluid.

Blood poisoning--the presence of bacterial and toxic materials in the blood. Also referred to as
septicemia.

Boil--a red and swollen sore on the skin.

Buttocks--two rounded, muscular areas at the back of the hips; the rump.

Capillary--tiny tube-like vessels that connect veins and arteries.

Carbon monoxide--a poisonous gas without color, taste, or odor.

Carbuncle--a red and swollen sore filled with pus, located on the skin surface, and extending into deep
body tissue.

Cartilage--a tough, elastic, connective tissue in the joint ends of bones, and the nose and ears.

Cauterize--to burn or sear injured tissue.

Central nervous system (CNS)--the brain and spinal cord.

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Chronic--long and drawn out.

Clammy--damp and cool.

Clavicle--the collarbone. Forms the front part of the shoulder; attaches to the top of the sternum
(breastbone) and scapula (shoulder blade).

Clot--a semisolid lump or mass formed by thickened blood.

Coma--a deep state of unconsciousness usually caused by disease, injury, or poison.

Compress--a cloth wet or dry, applied to an injury, to control bleeding or swelling.

Compression--to press together into a smaller space.

Concussion--a jarring brain injury resulting from a head blow or fall.

Conscious--awake, aware, and responsive to stimuli or surroundings.

Constrict--to make narrow, as when the pupil of the eye reacts to light.

Contagious--catching. Transmitted from one person to another, either directly or indirectly.

Contaminate--to introduce an impure substance into a clean or aseptic area; for example, dirt entering a
wound. To infect.

Contraction--shortening or tightening.

Contraindication--A special condition which causes a normal treatment procedure to be improper or


undesirable.

Convulsion--an abnormal, violent, and involuntary contraction of the muscles. A fit or seizure that can
be caused by poison, drugs, drug withdrawal, or epilepsy.

Cyanosis--bluish discoloration of the skin from lack of oxygen in the blood.

Decomposition--decay.

Decontaminate--to rid the body, clothes, room, linen, containers, etc. of anything that is dangerous or
poisonous.

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Deformity--a bodily deviation from normal shape or size, resulting in distorted appearance.

Delirium--a temporary mental disturbance characterized by confusion, excitement, disordered speech,


and hallucinations.

Diagnosis--recognition of a specific disease.

Diarrhea--frequent passage of stools that have more or less liquid consistency.

Dilate--to make wider or to expand, as when the pupil of the eye adjusts to darkness.

Dilute--to make thinner by mixing with water or other liquids.

Direct pressure--force applied directly on top of a wound to stop bleeding.

Disinfectant--a chemical that kills or stops the growth of bacteria and germs.

Dislocation--displacement of a bone in a joint so that joint surfaces do not make proper contact.

Distention--stretched out. Inflated.

Dressing--sterile gauze or bandage applied to a wound and fixed in position.

Dyspnea--difficult or labored breathing.

Edema--a collection of fluid in the body tissues which causes swelling.

Elimination--getting rid of the body's waste products.

Embedded--surrounded closely.

Esophagus--the tube that carries food from the mouth and throat to the stomach.

Evaporate--to change from liquid to a gas or vapor.

Exhalation--breathing out.

Extension--a movement which straightens a limb.

External--pertaining to the outside.

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Virtual Naval Hospital: Standard First Aid Course - Appendix

Extremity--an arm or leg. A body part branching off from the trunk.

Femur--the thighbone. The bone that extends from the pelvis to the knees--the longest and largest bone
in the body.

Fever--an elevation of body temperature above normal (98.6 F) or (37-C) .

Flexion--the bending motion of a joint.

Flush--sudden redness of the skin; or to wash by pouring large amounts of water over an area.

Forceps--a tong-like instrument for holding or grasping skin, dressings, or instruments. Also used as
tweezers for removing splinters and barbs.

Foreign object--not normally a part of the body.

Fracture--any break or crack in a bone.

Frothy--bubbly or foamy.

Gangrene--death of tissue generally associated with loss of blood supply, injury, or disease.

Gastric distention--enlargement of the stomach caused by trapped air.

Groin--the region where the abdomen and thighs join.

Hair follicle--the root of the hair.

Hallucinations--seeing, smelling, or hearing things that are not real or true.

Hemorrhage--internal or external bleeding.

Hemotoxic--poisonous to the blood.

Hyperextension--extension of an arm or leg beyond normal limits.

Immobilize--to make incapable of moving, as with a splint or cast.

Impairment--sickness or injury.

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Virtual Naval Hospital: Standard First Aid Course - Appendix

Impermeable--not allowing passage of fluids.

Impregnate--to soak, fill, or saturate.

Improvise--to make from available materials, usually on the spur of the moment.

Incision--a cut made by a sharp instrument.

Incoherent--not understandable.

Infection--invasion and multiplication of germs in the body, resulting in tissue damage.

Ingestion--swallowing substances taken into the mouth.

Inhalation--breathing in.

Internal--pertaining to the inside.

Irrigation--cleansing by washing and rinsing with water or other fluids.

Larynx--voice box.

Listless--having no desire to exert oneself.

Litter--a stretcher for carrying sick or injured.

Microorganisms--bacteria or germs that are so small that they can be seen only through a microscope.

Mucous--a thick, sticky fluid secreted by mucous membranes and glands.

Nausea--a sickness in the stomach which produces a feeling of a need to vomit.

Neurotoxic--poisonous to nerve cells.

Neutralize--to make harmless. To destroy effectiveness.

Ointment--a soft, oily substance having antiseptic and healing properties.

Organism--any individual living thing.

Paralysis--temporary or permanent loss of feeling or ability to move.

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Virtual Naval Hospital: Standard First Aid Course - Appendix

Perforation--a hole or series of holes made through a substance.

Peritonitis--inflammation of the internal membranes lining the abdominal cavity.

Pharynx--throat.

Pneumonia--an inflammation of the lungs caused by viruses, germs, or physical and chemical agents.

Porous--containing or being full of tiny holes.

Potable--water or liquid suitable for drinking.

Potency--power, strength.

Pressure point--areas of the body where arterial blood flow can be stopped by pressing an artery against
a bone.

Profuse--in large amounts.

Prone--lying face downward.

Prostration--complete exhaustion.

Pulse--the throbbing of arteries caused by the beating of the heart.

Pungent--sharp and harsh in taste or odor, irritating.

Pupil--the opening in the center of the eye through which light passes--necessary for vision.

Relapse--slipping back or getting worse.

Respiratory obstruction--a blockage in the breathing system that prevents it from functioning normally.

Scalp--the skin of the head, excluding the face and ears.

Seizure--an attack, (fit), such as convulsions, in which there is some loss of body control.

Semiconscious--not fully awake or oriented to surroundings.

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Shock--a generalized depression of all body functions which results in decreased blood flow.

Signs--indications of a victim's condition visible to the rescuer.

Skull--the bony framework of the head.

Spasm--sudden, involuntary movement of a muscle or muscles which is usually associated with pain.

Spinal cord--the cord of nerve tissues extending from the brain down the length of the spine.

Spine--the backbone.

Spineboard--a device used primarily for transporting patients with suspected or actual spinal injuries.

Splint--any material used to immobilize, support, or protect an injured area.

Sterilize--to destroy germs. To make free from bacteria.

Stool--waste matter discharged from the large intestine.

Stretcher--a litter on which a patient can be carried.

Stupor--state of being less responsive or sensible.

Subcutaneous--just beneath the skin.

Suction--the act of drawing up or out.

Superficial--at, on, or near the surface.

Supine--lying on the back with the face upward.

Swathe bandage--a bandage that passes around the chest, used to hold an injured arm to the chest or
immobilizing fractured ribs.

Symptoms--indications of a victim's condition as stated by the victim.

Tetanus--a bacteria which can enter the body through dirty wounds. It causes muscle spasms, and rigid
neck and jaw muscles (lockjaw), often resulting in death.

Thoracic--pertaining to the chest.

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Virtual Naval Hospital: Standard First Aid Course - Appendix

Tissue--living cells formed into a body structure such as the muscles.

Tolerance--power to resist.

Tourniquet--a device that is twisted around an extremity to stop severe bleeding. Usually consists of a
band of flat material. Used only when all other measures fail.

Toxic--poisonous.

Toxin--a poison.

Trachea--the windpipe.

Traction--the act of pulling or drawing something straight.

Trauma--a wound or injury that is violently produced.

Triangular bandage--a piece of cloth cut in the shape of a right triangle, used as a sling for the arm and
other bandaging purposes.

Ulcer--an open sore on the skin or mucous membrane which drains tissue fluid.

Unconscious--unable to respond to stimulation--"out cold."

Vaccine--a prepared mixture of living or dead germs which assist the body in developing resistance to
certain diseases.

Vascular--relating to blood vessels.

Vein--a tube-like body structure which returns blood to the heart.

Ventilation--the process of breathing in and out to supply the body with oxygen and remove carbon
dioxide.

Virus--an organism that can cause infectious or communicable diseases.

Vital signs--measurable signs by which the physical state of an individual can be determined--usually
includes the pulse, respiratory rate, blood pressure, and the level of consciousness.

Windpipe--the tube through which air passes from the throat to the lungs.

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Virtual Naval Hospital - A digital library of naval medicine and military medicine

New content was added to the library on November 19, 2002 - see What's New

Information on Biological, Chemical and Nuclear Warfare for Providers and Patients.

● Welcome to Virtual Naval Hospital


Look here for our mission statement and introduction, how to use Virtual Naval Hospital, find out
what's new, and discover who we are.

● For Patients
Look here for information intended primarily for patients on health promotion / disease
prevention and first aid, consumer health information textbooks, consumer health organizations
and aids to searching the Internet.

● For Providers
Look here for information intended primarily for healthcare providers on disease diagnosis /
treatment / management, health promotion / disease prevention, occupational and environmental

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Virtual Naval Hospital - A digital library of naval medicine and military medicine

health, medical procedure descriptions, first aid, medical textbooks, MEDLINE, continuing
education, professional health organizations, Navy and DOD Internet health resources and aids to
searching the Internet.

● Administration
Look here for Navy Medical Department administrative information, including manuals,
instructions, and directives.

● Telelibrary (requires password)


For authorized U.S. Navy medical personnel only. Look here for information intended primarily
for specialists, including on-line medical journals and medical reference textbooks.

Virtual Naval Hospital Brochure (Adobe Acrobat required)

CD-ROM copies of the Virtual Naval Hospital are freely distributed to U.S. Navy, Military Sealift
Command, and U.S. Coast Guard active duty and reserve medical personnel. To obtain your own
copy of the VNH 2002 CD-ROM, e-mail your name, rank and mailing address to
cartographer@vnh.org

Virtual Naval Hospital(TM) is a service of the U.S. Navy Bureau of Medicine and Surgery and is
presented by the Electric Differential Multimedia Laboratory, University of Iowa College of
Medicine.

Virtual Naval Hospital(TM) is a trademark of The Virtual Naval Hospital Project.

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Virtual Naval Hospital: Help

Virtual Naval Hospital Help


Steve Ostrem, M.A.
Peer Review Status: Internally Peer Reviewed

Navigating a Web Page


The Virtual Naval Hospital, like most World Wide Web servers, is organized around the concept of a
"web page," an informational display that may contain both text and images, as well as hypertext links
to other "pages." The term "page" is a little misleading, as the material it contains may take several
screens to display. If you are using a graphical web browser like Netscape Navigator or Microsoft
Internet Explorer, there are some navigational aids that help you maneuver through a web page. These
include the scroll bar, icons or image maps that appear on the page, the location bar, and the back,
forward and home buttons at the top of your screen.

Hypertext links
A hypertext link is a "hot" area within a web page that links it to another web page. Links can take
several forms: colorized and underlined text (notice the links on this page?), buttons, maps or images.
When you click on a hypertext link, the browser takes you to a new page by interpreting the address
contained within the link. (Some browsers show the address of the web page at the bottom of your
screen). This can be another page on the same server, or on another web server halfway around the
world. When the link consists of colorized text, the text turns color (blue to red on many browsers) to
indicate it has been activated. This is useful for keeping track of which links you've followed.

Scroll bar
Scroll through the web page by clicking on the up and down arrows along the right hand side of the
screen. (If your keyboard has page up and page down keys, they can be used to move a screen at a time
in the desired direction).

Icons
In the Virtual Naval Hospital, an icon is a small "thumbnail" image that may represent a larger image, a
video clip, a sound file, or a link to another file. Clicking on an icon either activates a link, expands the
image to its full size, or launches the helper application that is needed to run the video or sound clip. The
progress bar at the bottom of the screen indicates that a video or sound file is loading and shows how the
load is progressing. For large files (video files are the largest), be prepared to wait a short while. Click
once on the Stop button at the top of the screen to halt the loading of an image.

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Virtual Naval Hospital: Help

Not all small images in the Virtual Naval Hospital are icons. Icons are identified by their colored borders.
These borders change color after the image has been activated, letting you know that you've viewed the
full image.

Image map
An image map is a "hot" image or collection of buttons that loads a new web page depending upon where
you click. The map labels indicate where the link takes you.

Location bar
Centered over the viewing area, the location bar shows the full World Wide Web "address" of the Virtual
Naval Hospital server, as well as the file name of the web page you are viewing. You'll note as you move
through the web pages that these file names change while the first portion of the address remains
constant. If you bookmark a particular web page, the browser records the full address, including file
name, of that page.

Back button
Each time you move from one web page to another by following links, your browser records those steps.
By clicking on the back button, you retrace those steps one link at a time.

Forward button
If, having retraced your steps through the Virtual Naval Hospital, you wish to revisit the pages you
viewed earlier, the forward button takes you back along that same path, one step at a time. Note that the
links that the back and forward buttons maintain are only good in the current browsing session. Unlike a
bookmark, they are lost when you quit the session.

Home button
Clicking the home button takes you to the "home page" of the web server your browser is set to. If your
browser has the Virtual Naval Hospital designated as its home page, clicking this button reloads the first
Virtual Naval Hospital screen.

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Search the Virtual Naval Hospital

Search the Virtual Naval Hospital

Search the contents of all the documents in the Virtual Naval Hospital by typing the word or phrase you
are looking for into the search box. Results will be returned in order of presumed relevancy.

Search: Search

Match: All words Description: Long Format Sort by: Relevancy

Enter any single word or combination of words in the Search field. Then make your selections in the
Match, Description, and Sort by fields.

Match: If you select 'All Words,' the search will find only the pages which match all the words in your
search request. By selecting 'Any Words,' the search will return pages which match any single word, but
not necessarily all of the words in your request. Finally, if you select 'Boolean Expression,' a boolean
expression using terms such as 'and,' 'or,' or 'not,' may be used in the search criteria.

Description: You may select a format for your search results. The 'Long Format' will provide a brief
excerpt from the matched pages and the 'Short Format' will list only the pages.

Sort by: You may also specify the order in which the results are returned. For example, if you select
'Relevancy' your search results will list the pages in order by the number of times the requested item was
found in that page; if you select 'Modification Date' the search will return pages in order by the latest
revision date; and if you select 'Title,' the search results will list first the pages in which the requested
item was located in the title of the page.

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Virtual Naval Hospital: Site Map

Virtual Naval Hospital Site Map

Welcome to the Virtual Naval Hospital

● Mission Statement and Introduction


● On-line Help
● What's New
● Site Map
● Internet Awards
● Reviews
● Comments
● Virtual Naval Hospital Training Materials
● Tour
● Statistics
● Bibliography
● The Electric Differential Multimedia Laboratory

Administrative Manuals

● Administrative Manuals on Virtual Naval Hospital

Information for Patients

● Information on Common Medical Problems for Patients


● Navy Health Book: Navy & Marine Corps Medical News, US Navy

Information for Providers

● Information on Common Medical Problems for Providers


● Medical Intelligence and Medical Planning

Aerospace Medicine

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Virtual Naval Hospital: Site Map

● Aeromedical Reference and Waiver Guide, NOMI


● Flight Surgeon Handbook 2nd edition, Society of US Naval Flight Surgeons
● Flight Surgeon Manual 3rd edition, NAMI
● Naval Flight Surgeon's Pocket Reference to Aircraft Mishap Investigation 5th edition, US Naval
Safety Center
● Performance Maintenance During Continuous Flight Operations - A Guide for Flight Surgeons:
NAVMED P-6410, NSAWC

Biological Warfare
● Defense Against Toxin Weapons, US Army
● Field Management of Chemical Casualties Handbook 2nd Edition, USAMRICD
● Medical Management of Biological Casualties 4th Edition, USAMRIID
● Medical Products for Supporting Military Readiness: Go Book, USAMRMC
● NATO Handbook on the Medical Aspects of NBC Defensive Operations: NAVMED P-5059 |
AFJMAN 44-151 | FM 8-9, US DOD
● Textbook of Military Medicine: Medical Aspects of Chemical and Biological Warfare, US Army
● Treatment of Biological Warfare Agent Casualties: NAVMED P-5042 | MCRP 4-11.1C |
AFJMAN 44-156 | FM 8-284, US DOD

Chemical Warfare
● Field Management of Chemical Casualties Handbook 2nd Edition, USAMRICD
● Medical Management of Chemical Casualties Handbook 3rd Edition, USAMRICD
● NATO Handbook on the Medical Aspects of NBC Defensive Operations: NAVMED P-5059 |
AFJMAN 44-151 | FM 8-9, US DOD
● Textbook of Military Medicine: Medical Aspects of Chemical and Biological Warfare, US Army
● Treatment of Chemical Agent Casualties and Conventional Military Chemical Injuries:
NAVMED P-5041 | FMFM 11-11| AFJMAN 44-149 | FM 8-285

Cold Weather Medicine


● Adverse Effects of Cold: GTA 6-8-12, US Army
● Medical Aspects of Cold Weather Operations: A Handbook for Medical Officers, USARIEM
● Sustaining Health & Performance in The Cold: Environmental Medicine Guidance for Cold
Weather Operations, USARIEM

Dermatology
● Textbook of Military Medicine: Milityar Dermatology, US Army

First Aid
● First Aid Anatomy, U of Iowa

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Virtual Naval Hospital: Site Map

● First Aid for Soldiers: FM 21-11, US Army


● Standard First Aid Course: NAVEDTRA 13119, US Navy

General Medicine and Surgery


● Emergency War Surgery Handbook 2nd edition, US DOD
● Fleet Medicine Pocket Reference, SWMI
● General Medical Officer Manual 4th edition: NAVMED P-5134, US Navy
● Guidelines for the Treatment of Sexually Transmitted Disease 1998, CDC
● Hospital Corpsman: NAVEDTRA 14295, US Navy
● Hospital Corpsman Sickcall Screener's Handbook, US Navy
● Sexually Transmitted Disease Clinical Management Guidelines: BUMEDINST 6222.10A, US
Navy
● Shipwreck's Go-By Physical Examination Guide 2nd edition, US Navy

High Altitude Medicine


● Medical Problems in High Mountain Environments: A Handbook for Medical Officers,
USARIEM

Hot Weather Medicine

● Heat Illness: A Handbook for Medical Officers, USARIEM

Nuclear Warfare and Radiation Safety


● Initial Management of Irradiated or Radioactively Contaminated Personnel: BUMEDINST
6470.10A, US Navy
● Medical Management of Radiological Casualties 1st Edition, AFRRI
● NATO Handbook on the Medical Aspects of NBC Defensive Operations: NAVMED P-5059 |
AFJMAN 44-151 | FM 8-9, US DOD
● Radiation Health Protection Manual: NAVMED P-5055, US Navy

Obstetrics and Gynecology | Women's Health


● Operational Obstetrics & Gynecology 2nd Edition, US Navy
● Surgical Emergencies in Obstetrics and Gynecology, US Navy

Operations Other Than War


● Famine-Affected, Refugee, and Displaced Populations: Recommendations for Public Health
Issues, CDC
● HA Multiservice Procedures for Humanitarian Assistance Operations: FM 100-23-1, US Army
● Handbook for the Soldier in Operations Other Than War: NO. 94-4, US Army

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Virtual Naval Hospital: Site Map

Ophthalmology
● Prevention and Medical Management of Laser Injuries: FM 8-50, US Army

Pediatrics
● Pediatric Emergency Manual, USAF

Preventive Medicine
● Clinician's Handbook of Preventive Services 2nd Edition, USPHS
● Field Hygiene and Sanitation: FM 21-10, US Army
● Guide to Clinical Preventive Services 2nd Edition, USPHS
● Manual of Naval Preventive Medicine: NAVMED P-5010, US Navy
● Nutritional Guidance For Military Field Operations in Temperate and Extreme Environments,
USARIEM
● US Navy Shipboard Pest Control Manual, US Navy

Psychiatry
● Combat Stress: MCRP 6-11C | NTTP 1-15M | FM 90-44/6-22.5, USMC
● Combat Stress Control: FM 22-51, FM 8-51, FM 8-55, GTA 21-3-4, GTA 21-3-5, GTA 21-3-6,
and more, US DOD
● Emergency Psychiatry Service Handbook, USAF and US Navy
● Textbook of Military Medicine: War Psychiatry, US Army

Travel and Tropical Medicine


● Health Information for International Travel: Yellow Book 2001-2002, CDC
● Navy Medical Department Pocket Guide to Malaria Prevention and Control: NEHC-TM PM
6250.1, NEHC

Undersea Medicine
● Diving Manual Revision 4, US Navy

Next Page | Previous Page | Section Top | Title Page

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Collective copyright © 1997-2003 The Virtual Naval Hospital Project. All rights reserved.

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Virtual Naval Hospital: Disclaimer

Disclaimer

Medicine is an ever-changing science. As new research and clinical experience broadens our knowledge,
changes in treatment and drug therapy are required. The authors have checked with sources believed to
be reliable in their efforts to provide information that is complete and generally in accord with the
standards accepted at the time of publication. However, in view of the possibility of human error or
changes in medical sciences, neither the authors nor the University of Iowa nor the U.S. Navy nor any
other party who has been involved in the preparation or publication of this work warrants that the
information contained herein is in every respect accurate or complete, and they are not responsible for
any errors or omissions or for the results obtained from the use of such information. Readers are
encouraged to confirm the information contained herein with other sources.

The appearance of hyperlinks on this Web site does not constitute endorsement by the U.S. Navy of this
Web site or the information, products, or services contained therein. For other than authorized activities
such as military exchanges and Morale, Welfare, and Recreation sites, the U.S. Navy does not exercise
any editorial control over the information you may find at these locations. These links are provided
consistent with the stated purpose of this DoD Web site.

Furthermore, any reference to commercial products or services are not meant to be U.S. Navy or DoD
endorsement of that product or service. Such references are for illustrative purposes only.

Finally, the information provided on this site is designed to support, not replace, the relationship that
exists between a patient and their existing physician.

Next Page | Previous Page | Section Top | Title Page

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Virtual Naval Hospital: Comments

Virtual Naval Hospital Comment Form

In order to help us better serve you, please fill out this comment form and select the "Send Comments Now" button
when finished. Thank you for your comments.

Please note: We are unable to answer your personal medical questions. Click here to see a list of other resources which
may help to answer your questions.

A. Please tell us about yourself:

Note: Your personal information remains confidential and is not sold, leased, or given to any third party be they reliable
or not.

1. E-mail address:

2. Name:

3. How would you describe yourself? (Click on one choice)


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4. What country are you from? (Briefly describe)

B. Please tell us about Virtual Naval Hospital:

5. What do you like about Virtual Naval Hospital? (Briefly describe)

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6. What do you dislike about Virtual Naval Hospital? (Briefly describe)

7. How would you improve Virtual Naval Hospital? (Briefly describe)

8. To you, how valuable is Virtual Naval Hospital?(Click on one choice)


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9. Any other comments about Virtual Naval Hospital you would like to share? (Briefly describe)

Finally:

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