First Aid & Trauma Care Field Manual

FIELD FIRST AID -- WHEN AMBULANCE IS FAR OR SLOW The biggest preventable death in trauma is BLEEDING OUT. Stop the bleeding first. Everything else is secondary. 0) THE IMMEDIATE ACTIONS -- M.A.R.C.H. - M Massive bleed: stop it (below). Pack it, press hard, tourniquet if a limb. - A Airway: keep the airway open; tilt head back only if no spine injury suspected; clear mouth. - R Respiration: check breathing; if not, start chest compressions (100/min, 2 in deep) if trained. - C Circulation & Catastrophic bleed control. - H Hypothermia & Head: keep them warm; check responsiveness. 1) STOP THE BLEEDING FIRST a) DIRECT PRESSURE. Push hard on the wound with the cleanest cloth you have. Hold at least 10 minutes WITHOUT lifting to peek. Most bleeding stops here. b) PACK the wound if deep/large: stuff clean cloth/gauze INTO the hole and press hard. Used for junctional wounds (groin, neck, armpit) where you can't tourniquet. c) TOURNIQUET (limb only -- arm or thigh): - Place 2-3 INCHES ABOVE the wound, NOT on a joint. - Use a CAT or windlass type. Tighten until bleeding AND pulse below it stops. - Write the TIME on the forehead or the tourniquet. - Do NOT loosen once placed. Do NOT cover it. A tourniquet for hours is survivable; 'loosen to check' can kill. Leave it for medics. - No tourniquet? Use a belt/bandana + a stick as a windlass. Less ideal, beats bleeding out. 2) GUNSHOT WOUND CARE - Apply DIRECT PRESSURE / PACK immediately; many gunshot holes can be packed and pressed to stop bleeding. - Tourniquet on arms/legs if the bullet hit a limb and it's bleeding hard. - DO NOT remove the bullet or any embedded object -- it may be plugging a vessel. Stabilize it with bulky dressing around (not on) it. - CHEST WOUNDS: if the bullet went into the chest and the wound is 'sucking' air (bubbling, frothy blood), cover with a chest seal or plastic + tape on THREE sides only -- air can escape, not enter. This buys time for a tension pneumothorax -- get to a hospital fast. - Treat for shock: lay flat, elevate legs, keep warm, calm. Keep them talking. 3) CUTS & LACERATIONS a) STOP the bleeding first (above). b) CLEAN: flush the wound with CLEAN WATER under pressure for several minutes. Tap water if safe; otherwise boiled-then-cooled water. Do NOT put alcohol, peroxide, or iodine INSIDE the wound -- they damage tissue. Use them only on surrounding unbroken skin. c) DISINFECT: thorough clean-water flushing IS the disinfection step. Apply a thin layer of antibiotic ointment if you have it (on the wound surface, not deep inside). d) COVER: a non-stick pad + tape or bandage. Change it daily; watch for infection (redness, swelling, pus, red streaks, fever). e) SUTURE (only if you can't reach care in ~6-12h AND it's a clean, shallow cut): - Use a STERILE suture kit, clean gloves, clean the intact skin with povidone-iodine. - Simple interrupted stitches about 1/4 in apart and 1/4 in deep. - NOT trained? Use STERI-STRIPS or butterfly bandages (tape the edges together) -- far safer than your first attempt at suturing. - Superglue works in a pinch for small clean cuts. - NEVER suture a bite, puncture, crush, or heavily contaminated wound -- leave open to drain. - Update tetanus (>5 years for a dirty wound). 4) BROKEN ARM - DO NOT try to straighten. Splint in the position found. - Splint above AND below the joint nearest the break, using something rigid (sticks, a rolled magazine, a board) padded with cloth. - Use a sling (arm in a folded cloth across the chest) + a swath (cloth tied around the chest to stop the arm swinging). - Check the hand BELOW: can they feel you? Is it warm/pink? Re-check every few minutes -- if it goes cold/pale/numb, the splint is too tight; loosen and re-splint. - Ice (wrapped) 20 min helps swelling; never ice bare skin. - OPEN FRACTURE (bone through skin): cover with clean dressing, gentle pressure around (not on) the bone, splint, get help fast. 5) BROKEN LEG - Same splinting but the leg is heavier; use longer rigid splints on both sides, tied above/below knee and ankle. - THIGH (femur) fracture: a traction splint is ideal; without one, BUDDY-SPLINT both legs together with heavy padding. Femur breaks lose a LOT of blood. - No weight bearing. Keep the person lying flat and warm. - If you must move: immobilize first; an improvised stretcher (two poles + a jacket) moves them safely. - Suspect SPINE injury? Don't move them unless their spot is unsafe. If you must, LOG-ROLL them as one rigid unit with the head in line. 6) SHOCK -- the silent killer after trauma - Lay flat, raise legs ~12 in, keep them warm (blanket/jacket). Trauma patients get hypothermic even in summer, and cold patients bleed more. - Give NOTHING by mouth. Calm them; tell them help is coming. 7) WHEN/HOW TO MOVE SOMEONE - Move only if (a) their spot is unsafe (fire, collapse, traffic) or (b) you have no signal and need to send a runner for help. - Spine suspected and you must move: log-roll as one unit, someone holding the head in line with the body. - Improvised stretcher: two long poles through a blanket, coat, or two jackets; or drag on a flat board. 8) NEVER - Put a tourniquet around the neck or directly on a joint. - Remove an impaled object. - Apply a tourniquet loosely -- it must stop the pulse below it to work. - Give food/water to a person with a possible internal injury or surgery coming. - Push a bone back in -- splint as it lies. KITS TO KEEP READY: a CAT or SOFTT tourniquet, an Israeli bandage, hemostatic gauze (QuikClot), 2 chest seals, trauma shears, nitrile gloves, a SAM splint, duct tape, superglue (small cuts in a pinch), a flashlight, and an emergency blanket. See the Gear Shop to assemble one. ALWAYS call 911 / use the SOS page first. Field first aid buys time; it does NOT replace a hospital. Take a Stop-the-Bleed and a CPR class NOW while everything is calm.