PERFORM FIRST AID FOR A BLEEDING AND/OR SEVERED EXTREMITY

By: SGT DeSpears
and
SGT Dykes

RISK ASSESSMENT

• Fires
• Earthquakes
• Dehydration
• Impending Weigh-in
• Use care during practical exercise

Task: 081-831-1032
Perform First Aid for a Bleeding and/or Severed Extremity

Conditions: You have a casualty who has a bleeding wound of the arm or leg. The casualty is breathing. You will need the casualty's emergency bandage, chitosan dressing, or field dressing, materials to improvise a pressure dressing (wadding and cravat or strip of cloth), materials to elevate the extremity (blanket, shelter half, poncho, log, or any available material), and combat application tourniquet (C-A-T) or materials to improvise a tourniquet-rigid object (stick, tent peg, or similar object) and a strip of cloth.

Standards: Control bleeding from the wound following the correct sequence. Place a dressing over the wound with the sides of the dressing sealed so it does not slip. Ensure that the dressings do not have a tourniquet-like effect. Apply a tourniquet to stop profuse bleeding not stopped by the dressings, for severed arms and legs, or to control life-threatening bleeding when under fire.

STEP ONE: UNCOVER THE WOUND

Warning!

Clothing or anything else stuck to the wound should be left alone to avoid injury. DO NOT ATTEMPT TO CLEAN THE WOUND!

Do not remove protective clothing in a chemical environment. Apply dressings over the protective clothing.

UNCOVER THE WOUND

• Expose the wound by pushing or cutting away loose clothing
• View the extent of the injury

STEP TWO: APPLY THE CASUALTY'S DRESSING

Dressing Pad:

A dressing pad is a pad made of soft material that is applied directly over a wound.

Always use the casualty's dressing!

Emergency Bandage:

A new item that can be used on any bleeding wound. It can be used as both a field dressing and as a pressure dressing. The emergency bandage consists of a white pad with an elastic band (tail) and pressure device used to control the amount of pressure applied to the wound.

The emergency bandage is also known as the "emergency trauma dressing," "emergency trauma bandage," " Israeli dressing," and "Israeli bandage."

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*Emergency bandages, field dressings, and pressure dressings should NOT have a tourniquet-like effect. The dressing must be loosened if the skin beyond the injury becomes cool, blue, or numb.

Chitosan (ki' to san)
is a naturally-occurring substance found in shrimp shells. It has been incorporated into a dressing that will effectively stop arterial bleeding. When chitosan comes in contact with blood or other body fluids, it becomes extremely adhesive and works like super-glue to plug the holes in the injured blood vessels. It does not cause the blood to clot.

The Chitosan hemostatic dressing is used to control serious arterial bleeding. It is not used for wounds with minimal to moderate bleeding. The dressing can be used in conjunction with a tourniquet to control sever arterial bleeding.

Apply the Chitosan Dressing:

1.) Hold the foil over-pouch so that the instructions can be read and the unsealed edges are at the top.
2.) Grasp the unsealed edges.
3.) Peel open the over-pouch by pulling the unsealed edges apart.
4.) Use your hand and thumb to trap the dressing between the bottom foil and the green/black polyester backing.

Apply the Chitosan Dressing:

5.) Hold the dressing by the nonabsorbent green/black backing and discard the foil over-pouch.
6.) Apply the light-colored sponge portion directly over the wound and apply pressure to the green/black backing with your fingers.
7.) Apply manual pressure and maintain the pressure until the dressing adheres and the bleeding stops (usually 2 to 4 minutes).

Do not try to reposition the bandage once it is applied.

Apply the Chitosan Dressing:

8.) Apply a field dressing or a cravat to secure the chitosan dressing and to prevent contamination.

Apply a field dressing:

1. Obtain the casualty's dressing and remove it from the plastic wrapper.
2. Grasp olive drab tails of the dressing with both hands.
3. Hold the dressing directly over the wound with the white side down.
4. Pull the dressing open and place it directly on the wound.
5. With one hand, hold the dressing in place. Use the other hand to wrap one of the tails around the wound. If the casualty is able, you may ask him to hold the dressing in place while you wrap the tails.

Apply a field dressing:

6. Wrap the other tail in the opposite direction until the remainder of the dressing is covered and both sides are sealed.
7. Tie the tails into a nonslip knot over the outer edge of the dressing.

******NOT OVER THE WOUND******

8. Check the dressing to make sure that it is tied firmly enough to prevent slipping without causing a tourniquet-like effect.

CHECK ON LEARNING

Under what conditions should a casualty's wound be left uncovered (clothing still over the wound)?

(2 answers)

Whose dressing is normally used for first aid on a casualty?

You have finished applying a dressing. What must be done if the skin beyond the injury (dressing) becomes cool, blue, or numb?

STEP THREE: APPLY MANUEL PRESSURE AND ELEVATE THE ARM OR LEG TO REDUCE BLEEDING, IF NECESSARY.

When practical, apply direct manual pressure over the dressing for 5-10 minutes to help control the bleeding. The casualty can be asked to do this if s/he is conscious and can follow instructions.

ELEVATE THE INJURED PART

• If bleeding continues, elevate the injured part above the level of the casualty's heart to reduce bleeding
• Do not elevate the injured part if a fracture is suspected and it is not splinted
• Use any of the following to elevate injured part: Blanket, Shelter half, Poncho, or Log

CHECK ON LEARNING

To help control bleeding after the initial dressing is in place, what actions should be taken next?

STEP FOUR: APPLY A PRESSURE DRESSING IF THE BLEEDING CONTINUES

If a field dressing was applied and bleeding continues, apply a pressure dressing.

A pressure dressing consists of the following:

(1) any bulky material which can be folded several times (e.g. , a rag or piece of the soldier's garment) and placed on top of the original dressing.

(2) strips of cloth torn from a garment, socks, or other material which are then wrapped around the padded material to secure it.

(1) place a wad of padding directly over the wound and on top of the original field dressing.

(2) Place an improvised dressing over the wad of padding and wrap it tightly around the limb.

(3) Tie the ends in a nonslip knot directly over the wound to secure the extra padding.

(4) Check to make sure that the dressing is tight, but not tight enough to act as a tourniquet. It must be loosened if the skin beyond the injury becomes cool, blue, or numb.

* if the bleeding stops, watch the casualty closely for life-threatening conditions, check for other injuries, if necessary, and treat for shock. Seek medical aid.

If the bleeding continues, apply a tourniquet.*

CHECK ON LEARNING

If bleeding continues after applying a field dressing, applying manual pressure and elevating the extremity, what is the next step?

STEP FIVE: APPLY A TOURNIQUET

If the bleeding continues despite proper application of a field dressing and a pressure dressing, an emergency bandage, or Chitosan dressing; or if the wound is a partial or complete amputation of the arm or leg, you will need to apply a tourniquet on the injured extremity. If you are under fire and need to control the bleeding quickly, apply a tourniquet first. When the tactical situation allows, you can loosen the tourniquet after applying other measures to control the bleeding such as a pressure dressing.

* A casualty whose arm or leg has been completely amputated may not be bleeding when first discovered, but a tourniquet should be applied anyway. The absence of bleeding is due to the body's normal defenses (contraction of blood vessels) as a result of the amputation, but after a period of time bleeding will start as the blood vessels relax. *

Application of any Tourniquet

(A) Position the tourniquet 2 inches above a bleeding site that is above the knee or elbow.

(B) If the wound is below the knee or elbow, initially position the tourniquet band 2 inches above the wound. If tourniquet applied below the knee or elbow is not successful at stopping the bleeding, apply a second tourniquet 2 inches above the joint (knee or elbow). Do not remove the first tourniquet until the second tourniquet has been applied.

Apply a Combat Application Tourniquet (C-A-T)

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Apply an Improvised Tourniquet

Improvised tourniquet should be at least 2 inches wide.

Made from strong, pliable material such as gauze or muslin bandages, clothing, or handkerchiefs.

An improvised tourniquet is used with a rigid stick-like object.

*tourniquet must be easy to see*

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After applying a tourniquet

• Mark the casualty's forehead with a letter "T" and the time, using a pen, mud, or whatever is available
• If applicable and the situation allows, save severed limbs and transport them, but out of sight of the casualty
• Once bleeding is controled, monitor casualty for life-threatening conditions, treat for shock and seek medical aid

CHECK ON LEARNING

When should you use a tourniquet on a casualty?

What is the minimum width for an improvised tourniquet?

What is the correct position for a tourniquet if a casualty has sever bleeding wound just below knee?

LET'S DO THIS!

QUESTIONS???