Evaluate A

Casualty

Lesson Two

MSTC, FT LEWIS WA
 Primary Objective
► Rapid Casualty Assessment

► Control Hemorrhage

► Treat Penetrating Chest Trauma

► Maintain Airway

► Package Casualty for Transport

 Rapid Casualty
Assessment
► Approach the casualty

► Level of consciousness

► Casualty positioning

► Check airway

► Check breathing

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

 Form a general impression

 Determine mechanism of injury

Mechanism of Injury
Mechanism of Injury
 Rapid Casualty
Assessment
► Perform
a rapid casualty initial
assessment:
 M – Massive Bleeding
 A – Airway
 R – Respirations
 C – Circulation
 H – Head Injury
Care Under Fire
 Rapid Casualty
Assessment
► Perform
a rapid casualty initial
assessment:

 A – Airway

 B – Breathing

 C - Circulation
Tactical Field Care
 Rapid Casualty
Assessment
► Level of Consciousness:
 AVPU
►A – Alert
►V – Verbal Stimuli
►P – Pain Stimuli
►U – Unresponsive
 Gently shake or tap the casualty on the
shoulder and ask in a loud, but calm
voice: “Are you okay?”
 Rapid Casualty
Assessment
► Casualty Positioning:
 Position the casualty on his back, by log rolling
casualty
Airway
 Rapid Casualty
Assessment
Check Airway:

 If you suspect head or neck injuries, use

the jaw thrust method to open the airway.
Otherwise, use the head-tilt/chin-lift
method
Breathing
 Rapid Casualty
Assessment
Check Breathing:

 Look – Rise and fall of chest and abdomen

 Listen – Sounds of breathing

 Feel – Breath on the side of your face

 Rapid Casualty
Assessment
Check Breathing:

Count Respirations:

Inhalation + Exhalation = Respiration

Count each respiration for 15 seconds

 Rapid Casualty
Assessment
► Check Breathing:
 Normal= 12 to 20 resp./min.

 > 20 = RAPID Hyperventilation = Rapid,

Deep

 < 12 = SLOW
Hypoventilation = Slow, Shallow

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

 Rapid Casualty
Assessment
► Check Breathing:
 If the casualty has a penetrating chest
wounds and is breathing or making an effort
to breath, stop the evaluation and apply an
occlusive dressing to the open chest wound
 In a combat situation, if you find a casualty
with no signs of life (no respiration and no
pulse), do not continue first aid on the
casualty
Rapid Casualty
Assessment
Open Chest Wound
 Rapid Casualty
Assessment
► Check Breathing:
 Relieve a tension pneumothorax (as
necessary) by needle chest
decompression in an already existing
penetrating chest wound.
 Needle Chest
Decompression
 Needle Chest
Decompression
Asherman Chest Seal
 Tension Pneumothorax

Air pushes over

heart and collapses
lung

Air outside lung

from wound

Heart compressed not

able to pump well
Circulation
 Rapid Casualty
Assessment
► Check Circulation:

 Circulation is evaluated by assessing the

rate and quality of the pulse, identifying
external bleeding and evaluating the skin
 Rapid Casualty
Assessment
► Check Circulation:
 What is a pulse?
►The contraction and expansion of an artery
due to the surge of blood from the beat of the
heart
 Locate the Pulse Sites
► Carotid Pulse:

 Place the fingertips of your index and long

fingers along the carotid artery in the
groove between the trachea and the neck
muscle
Carotid Pulse
 Locate the Pulse Sites
► Radial Pulse:

 Place the tips of your first two fingers over

the radial artery on the wrist
Radial Pulse
 Locate the Pulse Sites
► Other Sites:
 Brachial Pulse – located at the underside
of the upper arm
 Femoral Pulse – located in the groin area
 Popliteal Pulse – located behind the knee
 Posterior Tibial Pulse – located on the
inside of the ankle
 Dorsalis Pedis – located on top of the foot
Locate the Pulse Sites
 Rapid Casualty
Assessment
► Check Circulation:
 Measure and Monitor Pulse
►Palpate (feel)
 Count the beat for 15 seconds

► Pulse Rates:
 Normal Pulse rate is 60-80 Beats Per Minute
►>100 Beats Per Minute = Tachycardic
►< 50 Beats Per Minute = Bradycardic
 Rapid Casualty
Assessment
► Check Circulation:
 Classify the strength
►Note significant changes in rate, rhythm, and
strength. Irregular or fluctuating pulse may
indicate early stages of shock. Weak and rapid
pulse may indicate more advanced stages of
shock.

 Assess the skin

►Evaluating the skin color, temperature and
moisture helps you determine if the body is
receiving adequate oxygenated blood.
 Rapid Casualty
Assessment
► Check Circulation:
 Perform blood sweep
►Look for blood soaked clothing

►Look for entry and exit wounds

►Controlany addition external bleeding by

necessary means
 Rapid Casualty
Assessment
► Check Circulation:
 Initiate intravenous access

 Apply saline lock to catheter

 Await additional instruction from medical

personnel for fluid therapy
 Rapid Casualty
Assessment
► Splint
Fractures and Recheck
Pulses:

 Check distal (below injury site) pulses

both before and after splinting

 To remedy any decrease in the pulse

caused by splinting, adjust the position of
the splint
 Additional Care
► Monitor the Casualty:

 Reassess the casualty

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

 Reassure the casualty

 Death of General Albert
Sidney Johnston
► Leading Confederate General
► KIA at Shiloh 7 April 1862
► Gen Johnston’s Surgeon - Dr. David Yandell -
directed that tourniquets be issued
► During the battle, Gen Johnston sustained injury
to popliteal artery - bled to death
► Tourniquet was in his pocket
 CASEVAC
► Package and Prepare Casualty for Evacuation
 Non-ambulatory via SKEDCO litter, Talon folding
litter or other field expedient methods

 Ambulatory

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

► Act as a leader of litter team

 CASEVAC

Talon Litter
Talon II Litter
 WALK
Warrior Aid Litter Kit
SKEDCO LITTER

SKED Litter
Mount LifeLine Video
 IFAK
Improved First Aid Kit
 Point of Wounding Care

► The only place in the continuum of

battlefield care where we can directly
influence survivability is at the point of
wounding. By training every soldier to
provide point of wounding care we can
save more lives on today's battlefield.
 Summary
► Asdiscussed in lesson 1, the three
primary preventable cause of death
from injury on the battefield are:
 Severe bleeding (apply a tourniquet or
emergency trauma dressing)
 Tension Pneumothorax (perform needle
chest decompression)
 Airway blockage (insert a nasopharyngeal
airway)
 Summary
► Circumstances in which you should not
treat a casualty while you are under enemy
fire:
 Your own life is in imminent danger

 Other soldiers in area require more urgent

treatment

 The casualty does not have vital (life) signs, ie.

breathing, pulse
Questions????