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Hospital Corpsman, Nurse, Or Physician

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Hospital Corpsman, Nurse, Or Physician CHAPTER 4 EMERGENCY MEDICAL CARE PROCEDURES For a Navy Corpsman, the terms “first aid” and against the potential damage caused by premature “emergency medical procedures” relate to the transportation. If you decide to move the victim, do it professional care of the sick and injured before in-depth quickly and gently to a safe location where proper first medical attention can be obtained. Appropriate care aid can be administered. procedures may range from providing an encouraging 3. In a multivictim situation, limit your word to performing a dramatic struggle to draw a person preliminary survey to observing for airway patency, back from the brink of death. Always remember, however, that first aid measures are temporary breathing, and circulation, the ABCs of basic life expedients to save life, to prevent further injury, and to support. Remember, irreversible brain damage can preserve resistance and vitality. These measures are occur within 4 to 6 minutes if breathing has stopped. not meant to replace proper medical diagnosis and Bleeding from a severed artery can lethally drain the treatment procedures. Hospital Corpsmen will be able body in even less time. If both are present and you are to provide the competent care that makes the alone, quickly handle the major hemorrhage first, and difference between life or death, temporary or then work to get oxygen back into the system. Shock permanent injury, and rapid recovery or long-term may allow the rescuer a few minutes of grace but is no disability if they less deadly in the long run. • understand the relationship between first aid and 4. Examine the victim for fractures, especially in proper medical diagnosis and treatment, the skull, neck, spine, and rib areas. If any are present, prematurely moving the patient can easily lead to • know the limits of the professional care increased lung damage, permanent injury, or death. Corpsmen can offer, and Fractures of the hip bone or extremities, though not as • keep abreast of new emergency medical immediately life-threatening, may pierce vital tissue or equipment. blood vessels if mishandled. 5. Remove enough clothing to get a clear idea of GENERAL FIRST AID RULES the extent of the injury. Rip along the seams, if possible, or cut. Removal of clothing in the normal way may aggravate hidden injuries. Respect the victim’s LEARNING OBJECTIVE: Recall modesty as you proceed, and do not allow the victim to general first aid rules. become chilled. 6. Keep the victim reassured and comfortable. If There are a few general first aid rules that you possible, do not allow the victim to see the wounds. The should follow in any emergency: victim can endure pain and discomfort better if confident in your abilities. This is important because 1. Take a moment to get organized. On your way under normal conditions the Corpsman will not have to an accident scene, use a few seconds to remember the strong pain relief medications right at hand. basic rules of first aid. Remain calm as you take charge of the situation, and act quickly but efficiently. Decide 7. Avoid touching open wounds or burns with your as soon as possible what has to be done and which one of fingers or unsterile objects, unless clean compresses the patient’s injuries needs attention first. and bandages are not available and it is imperative to stop severe bleeding. 2. Unless contraindicated, make your preliminary examination in the position and place you find the 8. Unless contraindicated, position the victim. Moving the victim before this check could unconscious or semiconscious victim on his side or gravely endanger life, especially if the neck, back, or back, with the head turned to the side to minimize ribs are broken. Of course, if the situation is such that choking or the aspirating of vomitus. Never give an you or the victim is in danger, you must weigh this threat unconscious person any substance by mouth. 4-1 9. Always carry a litter patient feet first so that the SORTING FOR TREATMENT rear bearer can constantly observe the victim for (NONTACTICAL) respiratory or circulatory distress. In civilian or nontactical situations, sorting of casualties is not significantly different from combat TRIAGE situations. There are four basic classes (priorities) of injuries, and the order of treatment of each is different. LEARNING OBJECTIVE: Recognize Priority I Patients with correctable life-threatening the protocols for tactical and nontactical illnesses or injuries such as respiratory triage. arrest or obstruction, open chest or abdomen wounds, femur fractures, or critical or complicated burns. Triage, a French word meaning “to sort,” is the process of quickly assessing patients in a Priority II Patients with serious but non-life- multiple-casualty incident and assigning patient a threatening illnesses or injuries such as priority (or classification) for receiving treatment moderate blood loss, open or multiple according to the severity of his illness or injuries. In the fractures (open increases priority), or eye military, there are two types of triage, tactical and injuries. nontactical, and each type uses a different set of Priority III Patients with minor injuries such as soft prioritizing criteria. The person in charge is responsible tissue injuries, simple fractures, or minor for balancing the human lives at stake against the realities to moderate burns. of the tactical situation, the level of medical stock on Priority IV Patients who are dead or fatally injured. hand, and the realistic capabilities of medical personnel Fatal injuries include exposed brain on the scene. Triage is a dynamic process, and a patient’s matter, decapitation, and incineration. priority is subject to change as the situation progresses. As mentioned before, triage is an ongoing process. SORTING FOR TREATMENT (TACTICAL) Depending on the treatment rendered, the amount of The following discussion refers primarily to time elapsed, and the constitution of the casualty, you battalion aid stations (BAS) (where neither helicopter may have to reassign priorities. What may appear to be nor rapid land evacuation is readily available) and to a minor wound on initial evaluation could develop into shipboard battle-dressing stations. a case of profound shock. Or a casualty who required initial immediate treatment may be stabilized and Immediately upon arrival, sort the casualties into downgraded to a delayed status. groups in the order listed below. Class I Patients whose injuries require minor SORTING FOR EVACUATION professional treatment that can be done on an outpatient or ambulatory basis. These During the Vietnam war, the techniques for personnel can be returned to duty in a short helicopter medical evacuation (MEDEVAC) were so period of time. effective that most casualties could be evacuated to a major medical facility within minutes of their injury. Class II Patients whose injuries require immediate This considerably lightened the load of the Hospital life-sustaining measures or are of a moderate Corpsman in the field, since provision for long-term nature. Initially, they require a minimum care before the evacuation was not normally required. amount of time, personnel, and supplies. However, rapid aeromedical response did not relieve Class III Patients for whom definitive treatment can the Corpsman of the responsibility for giving the best be delayed without jeopardy to life or loss emergency care within the field limitations to stabilize of limb. the victim before the helicopter arrived. Triage was seldom needed since most of the injured could be Class IV Patients whose wounds or injuries would evacuated quickly. require extensive treatment beyond the immediate medical capabilities. Treatment New developments in warfare, along with changes of these casualties would be to the in the theaters of deployment, indicate that the detriment of others. helicopter evacuation system may no longer be viable 4-2 in future front-line environments. If this becomes the Although this information could later prove to be case, longer ground chains of evacuation to the erroneous, you should use this time to consider what battalion aid station or division clearing station may be equipment you may need and what special procedures required. This will increase the need for life-stabilizing you should use immediately upon arrival. activities before each step in the chain and in transit. Evacuation triage will normally be used for personnel ARRIVAL AT THE SCENE in the Class II and Class III treatment categories, based on the tactical situation and the nature of the injuries. When you arrive at an emergency scene, you need Class IV casualties may have to receive treatment at to start gathering information immediately. First, the BAS level, and Class I personnel will be treated on make sure the scene is safe for yourself, then for the the line. patient or patients. Do not let information you received before your arrival form your complete conclusion Remember, triage is based on the concept of saving concerning the patient's condition. Consider all related the maximum number of personnel possible. In some factors before you decide what is wrong with the cases, a casualty may have the potential to survive, but patient and what course of emergency care you will to ensure that casualty's survival, the treatment take. necessary may require a great deal of time and supplies. As difficult as it may be, you may have to You can quickly gain valuable information as to forsake this patient to preserve the time and supplies what may be wrong with the patient. Observe and necessary to save others who have a greater potential listen as you proceed to your patient. Do not delay the for survival. detection of life-threatening problems. Be alert to clues that are obvious or provided to you by others. Some immediate sources of information may come PATIENT ASSESSMENT IN THE FIELD from the following: • The scene¾Is it safe or hazardous? Does the LEARNING OBJECTIVE: Recognize the patient have to be moved? Is the weather severe? assessment sequence for emergency medical care in the field, and identify initial equipment • The patient¾Is the patient conscious, trying to and supply needs.
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