US Army First Aid for Soldiers FM 21-11

7/28/2019 US Army First Aid for Soldiers FM 21-11

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F M 2

FIELD MANUAL

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DISTRIBUTION RESTRICTION:

APPROVED FOR PUBLIC RELEASE; DISTRIBUTION IS UNLIMITED.

HEADQUARTERS, DEPARTMENT O F TH E ARMY


3/243

Recommended Equipment For Use With This Manual:

Elite Large Fully Stocked GI Issue Medic

First Aid Kit Bag

Large Fully Stocked GI Issue Medic First Aid Kit Bag. This is the model FA110. The Large

M17 Medic Bag is a great bag with a very nice set of contents. The G.I. style issue bag itself can

be carried by the carrying handle or the back pack straps. The bag folds out three ways for easy

access to all the contents. The FA110 measures 16''x10''x13.5'' and weights 12.25 lbs. A well-stocked first-aid kit can help you respond effectively to common injuries and emergencies. Keep

at least one first-aid kit in your home and one in your car. Store your kits in easy-to-retrieve

locations that are out of the reach of young children.

Read 73 Reviews on Amazon.com
http://www.amazon.com/Elite-Large-Stocked-First-Aid/product-reviews/B003H2EODW/?_encoding=UTF8&camp=1789&creative=390957&linkCode=ur2&showViewpoints=1&tag=totalprepper-20http://www.amazon.com/Elite-Large-Stocked-First-Aid/product-reviews/B003H2EODW/?_encoding=UTF8&camp=1789&creative=390957&linkCode=ur2&showViewpoints=1&tag=totalprepper-20http://www.amazon.com/Elite-Large-Stocked-First-Aid/product-reviews/B003H2EODW/?_encoding=UTF8&camp=1789&creative=390957&linkCode=ur2&showViewpoints=1&tag=totalprepper-20http://www.amazon.com/Elite-Large-Stocked-First-Aid/product-reviews/B003H2EODW/?_encoding=UTF8&camp=1789&creative=390957&linkCode=ur2&showViewpoints=1&tag=totalprepper-20http://www.amazon.com/Elite-Large-Stocked-First-Aid/product-reviews/B003H2EODW/?_encoding=UTF8&camp=1789&creative=390957&linkCode=ur2&showViewpoints=1&tag=totalprepper-20


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FM 21-11

27 OCTOBER 1 9 8 8

B y O rde r of the S e cre ta ry o f th e A rm y:

C A R L E . V U O N O

G e n e r a l , U n i t e d S t a t e s A r m y

C h i e f o f S ta f f

O f f i c i a l :

W I L L I A M J . M E E H A N I I

B r i g a d ie r G e n e ra l, U n it e d S t a te s A r m y

T h e A d j u t a n t G e n e r a l

D I S T R I B U T I O N :

A c t i v e A r m y , U S A R , a n d A R N G : T o

b e distrib uted in accorda nce

w ith D A F orm 12 -11 A , R eq uirem en ts for F irst A id for S o ldie rs Q ty

rq r

b l o c k n o. 1 61 ).

1 :1U .S . G O V E RN E M EN T P R IN T IN G O F F IC E : 1 9 9 4 0 - 3 0 0 - 4 2 1 0 0 2 3 0


5/243

CHAPTER

1

Section

I.

Section II.

This publica tion conta ins copyrighted materia l.

F I E L D M A N U A L *FM21-11

H E A D Q U A R T E R S

D E P A R T M E N T O F T H E A R M Y

W ashington, DC, 27 October 1988

FIRST AID FOR SOLDIERS

*

T A BLE O F C ON TE NT S

Page

PREFACE xv

CHAPTER 2

Section I.

Section

FUNDAMENTAL CRITERIA FOR

FIRST AID 1-1

Evaluate Casualty 1-1

1-1. Casualty Evaluation {081-831-1O00) 1-1

10

~-~.

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1 A : + In.o,

Q9 1 11\1\1\\ 1_

l.YJ.t:'UJ,\;Q .J. r1~O.10W11J\;t:: ,vo~ -o.:J~.~VVV1 .J.-.

Understand Vital Body Functions 1-7

1-3. Respiration and Blood Circulation 1-7

1-4. Adverse C onditions 1-11

BASIC MEASURES FOR FIRST AID 2-1

Open the Airway and Restore Breathing 2-1

2-1. Breathing Process 2-1

2-2. Assessment {Evaluation) Phase

{081-831-1000 and 081-831-1042) 2-1

2-3. Opening the Airway-Unconscious and not

Breathing Casualty (081-831-1042)

''''''''

2-3

2-4. Rescue Breathing {Artificial

Respiration). 2-7

2-5. Prelim inary Steps - A ll Rescue

II .

D--_4.-1..' __ '._L1 :I_/nO '1 on., 1n...n\. n,.,

DC tlU \.lW lg jYl tl \.n uu :,s \UOJ-O':U- JU 't .tO/ .to-,

2-6. Mouth-to-Mouth Method {081-831-1042) 2-8

2-7. Mouth-to-Nose Method 2-13

2-8. Heartbeat 2-13

2-12. Airway Obstructions 2-21

2-13. Opening the Obstructed Airway-

Conscious Casualty {081-831-1003) 2-22

2-14. Open an Obstructed Airway

{081-831-1042)-Casualty Lying or

Unconscious 2-26

Stop the Bleeding and Protect the Wound 2-31

011: '1 ,,4-L:__11\01 0911n.1~\ n91

~-~u. vJ.UI l1.L1JI > \VO.L-O.:J.L-.LV.LU/ ~-O.L

2-16. Entrance and Exit Wounds 2-32

2-17. Field Dressing {081-831-1016) 2-32

'This pubiication supersedes FM 21-11, 7 O ctober 1985.

1


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C2, FM 21-11

Section

CHAPTER 3

Section I.

Section

Section

Section

CHAPTER

ii

III.

Page

2-18. Manual Pressure (081-831-1016) 2-35

2.19. Pressure Dressing (081-831-1016) 2-36

2-20. Tourniquet (081-831-1017) 2-39

Check and Treat for Shock 2-44

2-21. Causes and Effects 2-44

2-22. Signs/Symptoms (081-831-1000) 2-44

2-23. Treatment/Prevention (081-831-1005) 2-45

II .

FIRST AID FOR SPECIAL WOUNDS 3-1

Give Proper First A id for Head Injuries 3-1

3-1. Head Injuries 3-1

3-2. Signs/Symptoms (081-831-1000) 3-1

3-3. General First Aid Measures (081-831-1000 )... 3-2

3-4. Dressings and Bandages 3-5

Give Proper First A id for Face and Neck Injuries 3-13

3-5. Face Injuries 3-13

3-6. Neck Injuries 3-14

3-7. Procedure 3-14

3-8. Dressings and Bandages (081-831-1033) 3-16

Give Proper First Aid for Chest and Abdom inal

W ounds and Bum Injuries

3-23

3-9. Chest Wounds (081-831-1026) 3-23

3-10. Chest Wound(s) Procedure (081-831-1026) 3-23

3-11. Abdominal Wounds 3-28

3-12. Abdominal W ound(s) Procedure

(081-831-1025) 3-29

3-13. Burn .Injuries

3-33

3-14. First Aid for Burns (081-831-1007) 3-33

Apply Proper Bandages to Upper and Lower

Extremities 3-37

3-15. Shoulder Bandage 3-37

3-16. Elbow Bandage 3-39

3-17. Hand Bandage 3-40

3-18. Leg (Upper and Lower) Bandage 3-42

3-19. Knee Bandage 3-42

3-20. Foot Bandage 3-43

III.

IV .

4

FIRST AID FOR FRACTURES 4-1

4-1. Kinds of Fractures '- 4.1

4-2. Signs/Symptoms of Fractures

(081-831-1000) 4-2

4-3. Purposes of Immobilizing Fractures 4-2

4-4. Splints, Padding, Bandages, Slings,

and Swathes (081-831-1034) 4-2

4-5. Procedures for Splinting Suspected

F ra ctu re s (0 81 -8 31 -1 034)

4-3


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CHAPTER

CHAPTER

CHAPTER

Section

Section

Section

Section

C2, FM 21-11

4-6.

4-7.

4-8.

4-9.

4-10.

Page

Upper Extrem ity Fractures

081-831-1034)

4-10

Lower Extrem ity Fractures

081-831-1034)

4-14

Jaw, Collarbone, and Shoulder Fractures 4-17

S pinal C olum n F ractu res 081-831-1000) 4-19

Neck F ra ctu re s 081-831-1000) 4-22

5

FIRST AID FOR CLIMATIC INJURIES 5-1

5-1. Heat Injuries 5-1

5-2. Cold Injuries 5-8

6

FIRST AID FOR BITES AND STINGS 6-1

6-1. Types of Snakes ,. 6-1

6-2. Snakebites 6-5

6-3. Human and Other Animal Bites 6-9

6-4. Marine (Sea) Animals 6-10

6-5. Insect B ites/Stings 6-11

6-6. Table 6-15

7

I.

FIRST AID IN TOXIC ENVIRONMENTS

Individual Protection and First Aid

Equipment For Toxic Substances 7-1

7-1. Toxic Substances 7-1

7-2. Protective and First A id Equipment 7-1

Chemical-Biological Agents 7-3

7 -3. Classification 7-3

7-4. Conditions for Masking W ithout Order

or A larm 7-3

7-5. First Aid for a Chemical Attack

081-831-1030 and 081-831-1031) 7-5

Nerve Agents 7-6

7~. Background Information 7~

7-7. Signs/Symptoms of Nerve Agent Poisoning

081-831-1030 and 081-831-1031) 7-7

7 -8. First Aid for Nerve Agent Poisoning

081-831-1030)

7-8

Other Agent 7-21

7-9. Blister Agent 7-21

7-10. Choking Agents (Lung-Damaging Agents) 7-23

7-11. Blood Agents , 7-24

7-12. Incapacitating Agents 7-25

7 -13. Incendiaries 7-26

7-14. First Aid for B iological Agents 7-27

7 -15. Toxins 7-28

7 -16. Radiological 7-30

7-1

II .

III.

IV .

Hi


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C2, FM 21-11

CHAPTER

Appendix

Appendix

IV

8

FIRST AID FOR PSYCHOLOGICAL

REACTIONS

8-1. Explanation of Term Psychological First

Aid ..............................................................

8-2. Im portance of Psychological First Aid.........

8-3. Situations Requiring Psychological First

A id...............................................................

8-4. Interrelation of Psychological and

Physical First Aid. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .

Goa ls o f P sy chologic al F irs t A id ..................

Respect for Others ' Feel ings. ... .. .. .. ... .. .. .. ... ..

Emotiona l a nd Phy sic al D is ab ility ..............

Emotiona l Reac tion to Inju ry ......................

Emotional Reserve Strength of

Distressed Soldiers.. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. ..

8-10. Battle Fatigue (and Other Combat

Stress Reactions [CSR]). .. .. .. .. .. .. .. .. .. .. .. .. .. ..

8 -11 . Reactions to Stress.. .. .. ... .. .. .. ... .. .. .. ... .. .. .. ... .. ..

8-12. Severe Stress or Battle Fatigue

Reactions .

8-13. Application of Psychological First

A id...............................................................

8 -14. Reac tions and L imita tions ............................

8-15. Tables ..........

8-5.

8-6.

8-7.

8-8.

8-9.

A

FIRST AID CASE AND KITS,

DRESSINGS; AND BANDAGES

A-I. First A id Case with Field Dressings

and Ban dages.............................................

A -2. Gene ra l Purpose F irs t A id Kits ....................

A -3. C ontents of F irst A id C ase and K its............

A -4. Dressings .......................................................

A-5. Standard Bandages. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. ..

A -6. Triangular and Cravat (Sw athe)

Bandages........................................................

B

RESCUE AND TRANSPORTATION

PROCEDURES

-n

...

D-l.

B-2.

'

1

uenenu...........................................................

Princ ip les of Rescue Opera tions ... ... .. .. .. ... .. ..

Task (Rescue) Identification.. .. .. .. .. .. .. .. .. .. .. .. .

Circumstances of the Rescue ,..........

B

0.

B-4.

Dt::

ll-lJ.

Plan of Action........ . .. . .. . .. . .. . .. . .. . .. . .. . .. . .. . .. . .. . .. .

B-6.

B-7.

B:8.

Mass Casu alties.............................................

Proper Handling of Casualt ies .. .. .. .. .. .. .. .. .. .. .

Transportat ion of Casualt ies.. .. .. .. .. .. .. .. .. .. .. ..

Page

8-1

8-1

8-1

8-2

8-2

8-3

8-3

8-3

8-4

8-5

8-5

8-5

8-8

8-8

8-10

8-11

A-I

A-I

A-I

A-2

A-4

A-4

A-4

B-1

'J:L1

L,I-

~

B- 1

B- 1

B- 2

n.,>

L.J-~

B-3

B-4

B-4


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Appendix

Section

Section

Appendix

Appendix

Appendix

C2, FM 21-11

Page

B-9.

M anual Carries (081-831-1040 and

081-831-1041) B-5

Improvised Litters (Figures B-15

through B-17) (081-831-1041) B-32

B-lO.

C

I.

COMMON PROBLEMS/CONDITIONS C-1

HEALTH MAINTENANCE C-1

C-1. General C-1

C-2. Personal Hygiene C-l

C-3. Diarrhea and Dysentery C-l

C-4. Dental Hygiene C-3

C-5. Drug (Substance) Abuse C-3

C-6. Sexually Transmitted Diseases C-3

First Aid For Common Problems C-6

C-7. Heat Rash (or Prickly Heat) C-6

C-8. Contact Poisoning (Skin Rashes) C-7

C-9. Care of the Feet C-8

C-I0. Blisters , C-9

II .

E DIGITAL PRESSURE

DECONT AM IN A TION PROCEDURES

F-l. Protective Measures and Handling of

Casualties F-l

F-2. Personal Decontamination F-2

F-3. Casualty Decontamination F-lO

E-l

F F-l

G SKILL LEVEL 1 TASKS

G-l

Glossary ' ''''

' ''''''''''

Glossary-l

References ,.

''''''''''''''''''''''''''''''''''''''''

References-I

Index Index-O

v


10/243

C2, FM 21-11

2-18.

2-19.

2-20.

2-21.

2-22.

2-23.

2-24.

001:

~-~u.

VI

L IS T O F IL L U S T R A T IO N S

1-1.

A irw ay, lungs, and chest cage

,

1-2.

1.3.

Neck (carotid) pulse ,

Groin (femoral) pulse ,

1-4.

Wrist (radial) pulse..............................................................

Ankle (posterial t ibial) pulse. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. ..

.5 .

2.1.

Responsiveness checked , ... ... ......

2-2.

2.3.

Airway blocked by tongue ..............

A irway opened (cleared).. ,... ,., ..............

2-4.

2-5.

Jaw-thrust technique of opening airway. .. .. .. .. .. .. .. .. .. .. .. .. .. .

Head-t il t/chin-l if t technique of opening airway.. .. .. .. .. .. .. .. .

Ch eck for breathing.............................................................

-6 .

2-7.

Head -tilt/chin-lift................................................................

2-8.

Rescue brea thing .................................................................

P lacement of f ingers to detec t pulse...................................

-9 .

Universal sign of choking

.......

Anatomical v iew of abdominal th ru st p rocedu re ...............

Profile view of abdominal thrust .. .. .. .. .. .. .. .. ... .. .. .. ... .. .. .. ... .. ..

Profile view of chest thrust ;..................

Abdomina l th rust on unconsc ious casua lty ...... ...... ..... ......

Hand nlacement fo r

chest thrust /Illustrated A-DLumu.

---~- c --- - --- -- -

,

- - - ,-----------

Breastbone depre ss ed 11/2 to 2 inches...............................

A___:_- 14 '...

~L

1

: 1 :1:..\

p~UU l~ \;i1~Ui:U Y ~ UIUU U \ UU ~U ~.Ji1W U I I.......................

1-8

1-9

1-10

1-10

1-11

2-2

2-3

2-4

2-5

2-6

2-8

2-9

2-10

2-11

2-23

2-24

2-24

2-25

2-27

2-28

2-29

n

t U \.

.G-':>U


11/243

Figure

2-26.

2-27.

2-28.

2-29.

2-30.

2-31.

2-32.

2-33.

2-34.

2-35.

2-36.

2-37.

2-38.

2-39.

2-40.

2-41.

2-42.

2-43.

2-44.

2-45.

2-46.

C2, FM 21-11

Opening casua lty 's mouth (crossed-finger method).. ...... .....

U sing f inger to dis lodge foreign body...................................

Grasping ta ils o f dress ing with bo th hands... ...... ...... ..... ......

Pulling dressing open.... .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. ..

P lacing dress ing direc tly on wound......................................

W rap pin g tail of d ressin g aro und inju red p art.....................

Tails t ied into nonslip knot.. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .

Direct manual pressure applied... .. .. .. .. .. .. .. ... .. .. .. ... .. .. .. ... .. .. ..

Injured limb elevaied... .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .

Wad of padding on top of f ie ld d re ss ing...............................

Improvis ed d re ssing ove r wad of padding............................

Ends of im provised dressing w rapped tightly around lim b

E nds of im provised dressing tied together in nonslip knot.

Tourn ique t 2 to 4 inches above wound..................................

Rigid object on top of half-knot. .. ... .. .. .. ... .. .. .. ... .. .. .. ... .. .. .. ... ..

Full knot over rigid object.. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .

Stick twisted..........................................................................

1


12/243

C2, FM 21-11

Figure

3-10.

Q

l'

-.I.L

3-12.

3-13.

3-14.

3-15.

3-16.

3-17.

3-18.

3-19.

3-20.

3-21.

Vlll

3-1.

Casualty lying on s ide oppos ite injury. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. ..

3-2.

F irst tail o f d ressin g w rap ped ho rizontally arou nd head .....

3-3.

Second ta il w rapped in oppos ite d ire ction............................

3-4.

Tails tied in nons lip knot a t s ide of head ...... ..... ...... ...... ..... ..

3-5.

Dressing placed over wound 3-10

One tail of dressing wrapped under chin 3-10

-6 .

3-7.

Remaining tail wrapped under chin in opposite direction... 3-11

3-8.

Tails of dressing crossed with one around forehead 3-11

Tails tied in nonslip knot (in f ront of and above ear) 3-12

-9 .

Page

3-6

3-8

3-9

3-9

Triangular bandage applied to head (Illustrated A thru C). 3-12

Casualty lea ning fo rward to perm it d ra in age.......................

Cravat b andage applied to h ead (Illu strated A tr.u~JC) 3..13

3-15

Casualty lying on side.... .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .

Side of head or cheek wound... .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .

Dressing placed directly on wound. (Illustrated A and B).

Bringing second ta il under the chin......................................

C ro ssing the tails o n th e sid e o f the wound..........................

Tying th e ta ils o f th e d re ssin g in a non slip kno t..................

A pplying cravat bandage to ear (Illustrated A thru C )........

A pplying cravat bandage to jaw (Illustrated A thru C ).......

Collapsed lung.......................................................................

3-15

3-18

3-19

3-19

3-20

3-20

3-21

3-22

3-23


13/243

Figure

3-22.

3-23.

3-24.

3-25.

C2, FM 21-11

Open ch est wou nd sealed w ith plastic w rap per....................

Shaking open the f ie ld dressing.. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. ..

F ie ld d re ss ing p la ced on p la stic wrapper..............................

Tails of field dressing w rapped around casualty in

opposite direction ...............................................................

Tails of dressing tied into nonslip knot over center

of dressing ..........................................................................

3 -27. Casualty positioned (ly ing) on in ju red s ide..........................

3.26.

3-28.

3.29.

3.30.

3-31.

3-32.

3-33.

3-34.

3-35.

3-36.

3-37.

3.38.

3-39.

3-40.

Casu alty positio ned (ly in g) on back w ith knees (fle xed ) up..

Pro truding o rgans p la ced nea r wound..................................

D re ss ing p la ced d ire ctly ove r the wound..............................

Dre ssin g applied and ta ils tie d w ith a non slip kno t.............

Field dressing covered w ith im provised m aterial and

loosely tied..........................................................................

Casua lty cover ed and ro lle d on g round.................................

Casualty removed from electrical source (using

nonconductive material) ...............

Shoulder band age..................................................................

Extended cravat banda~e applied to shoulder (or arm pit)

(Illustrated A thru H )~ ~.~ :.....

E lbow banda ge (Illu strated A th ru C )..................................

Triangular bandage applied to hand (Illustrated A thru E).

C ravat bandage applied to palm of hand (Illustrated

A ..1.-- V\

.M . IUU J :' / ...............

Cravat bandage applied to leg (Illustrated A thru C)...........

Page

3-25

3-26

3-26

3-27

3.27

3.28

3-29

3-30

3-31

3-32

3-32

3-33

3-34

3-37

00 0

. : J - . : JO

3-40

3.40

.Ld1

-~..L

3-42

IX


14/243

C2,

FM 21-11

Figure

3-41.

3-42.

4-10.

4-11.

4-12.

4-13.

4-14.

4-15.

4-16.

x

Page

Cravat bandage applied to knee (Illustrated A thru C) 3-42

Triangular bandage applied to foot (Illustrated A thru E) 3-43

4-1.

K inds o f fra ctu re s (Illu stra te d A th ru C )................................

4-1

4-2.

Nonslip knots t ied away from casua lty ..................................

4-6

4-3. Shirt tail used for support .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .

4-7

4-4.

Belt used for support ..............

4-7

4-5.

4-6.

Arm inserted in cen te r o f improv ised s ling ..... ...... ...... ...... .....

4-7

Ends o f improvised sling tied to s ide o f neck.........................

Corner of s ling twisted and tucked a t e lbow..... ...... ...... ..... .....

4-8

4-8

-7.

4-8.

4-9.

Arm immobil ized with s tr ip of clothing.. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .

4-9

A pplication of triangular bandage to form sling

(two methods) 4-10

Completing sling sequence by twisting and tucking the

corner of the sling at the elbow (Illustrated A and B) 4-11

Board splints applied to fractured elbow when elbow is

not bent (tw o m ethods) (081-831-1034)

(Illustrated A and B) 4-11

Chest wall used as splint for upper arm fracture when

no splint is a vailable (Illustrated A and B) 4-12

C hest w all, sling, and cravat used to im mobilize fractured

elbow when elbow is bent 4-12

Board splint applied to fractured forearm


Fractured forearm or wrist splinted with sticks and

supported with tail of shirt and strips of material

(Illustrated A thru C ) 4-13

Board splint applied to fractured wrist and hand

(Illustrated A thru C ) 4-14


15/243

Figure

4-17.

4-18.

4-19.

4-20.

4-21.

4-22.

4-23.

4-24.

4-25.

4-26.

4-27.

4-28.

4-29.

4-30.

C2, FM 21-11

Page

Board splint applied to fractured hip or thigh

(081-831-1034) 4-14

Board splint applied to fractured or dislocated knee

(081-831-1034) 4-15

Board splint applied to fractured lower leg or ankle 4-15

Improvised splint applied to fractured lower leg or ankle 4-16

Poles rolled in a blanket and used as splints applied to

fractured lower extrem ity 4-16

Uninjured leg used as splint for fractured leg

(anatomical splint) : 4-17

Fractured jaw immobilized (Illustrated A thru C) 4-17

A pplication of belts, sling, and cravat to im mobilize

a collarbone.. 4-18

A pplication of sling and cravat to im mobilize a fractured

or d islocated shoulder (Illustrated A thru D) 4-19

Spinal colum n m ust m aintain a sw ayback position


Placing face-up casualty with fractured back onto litter 4-21

Casualty with roll of cloth (bulk) under neck 4-23

Immobilization of fractured neck 4-23

Preparing casualty with fractured neck for transportation

(Illustrated A thru E ) ~ 4-25

6-1.

Characteristics of nonpoisonous snake 6-1

6-2.

Characteristics of poisonous pit viper 6-2

6-3.

Poisonous snakes 6-2

6-4.

6-5.

Cobra snake 6-3

Coral snake.. 6-4

xi


16/243

C2, FM 21-11

Figure

6-9.

6-10.

6-11.

6-12.

7-10.

7-11.

7-12.

7-13.

1 A

,-~~.

xii

6-6.

6-7.

Sea snake ....

Chara cte ris tic s o f poisonous snake b ite ..............................

6-8.

Constricting band.................................................................

Brown recluse spider ..............

B lack widow spider .....

Tarantula . ...........

Scorpion .

7-1.

Nerv e Agen t Antid ote K it, Ma rk 1 ......................................

7-2.

Thigh injection site , .....

7-3.

Buttocks inj ection site ......

7-4.

Holding th e set o f autoinjecto rs by th e plastic clip............

G rasping the atropine autoinjector betw een the thum b

and first two fingers of the hand.. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .

7-5.

7-6.

R em oving the atropine autoinjector from the clip..............

7-7.

7-8.

Thigh injec tion site for se lf -a id . .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .

Bu ttocks injection s it e for self -a id .. .. .. .. .. .. .. .. .. .. .. .. ... .. .. .. .. .. ..

7-9. Used atropine autoinjector placed between the little

finger and ring finger.. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. ..

Remov ing the 2 PAM CI auto in je cto r.................................

One set of used autoinjectors attached to pocket flap........

Tn;o HnO' t.ho >'IQll>'11t.v'Q t.hil7h

' ' 4 'J ' ' ''' '' '' ''' ''' ''0 - -- J

'- 0 .. . '=.:==.......

Injecting the casualty 's buttocks... .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .

Trliee sets of used autoinjectors attached to pocket flap....

A-I.

Field first aid case and dressing

(Illustrated A thru ..C)... .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .

Page

6-5

6-5

6-7

6-11

6-12

6-12

6-12

r-rr-

'-0

7-8

,..,n

-01

7-10

7-10

7-11

7-11

7-12

7-13

7-13

7-14

7-18

7-19

7-21

A-I


17/243

Figure

A-2.

B-l.

B-2.

B-3.

B-4..

B-5.

B-6.

B-7.

B-8.

B-9.

B-lO.

B-ll.

B-12.

D 1

t)

D-~ :>.

B-14.

D_1 ~

.LI-~tJ.

B-16.

B-17.

C2, FM 21-11

Page

Triangular and cravat bandages (Illustrated A thru E) A-5

B-6

ireman 's c arry (Illu strated A th ru N).................................

Support carry B-14

Arms carry B-14

Saddleback carry B-15

Pack-strap carry (Illustrated A and B) B-16

Pistol-belt carry (Illustrated A thru F) B-17

Pistoi-beit drag B-19

Neck drag.. B-20

C radle drop drag (Illustrated A thru D , ,,,,,,,,,,, B-21

Two-man support carry (Illustrated A and B) B-23

Two-man arms carry (Illustrated A thru D) B-25

Two-man fore-and-aft carry (Illustrated A thru C) B-27

Two-hand seat carry (Illustrated A and

B) B -29

Four-hand seat carry (Illustrated A and B) B-30

T

u : nnrl 1 ': ++ 1' 10 - u r: 4- 1

_n., ,,,,).,,1'\

0 ,1 _n.10e

.LJ..UP.l.VVJ.otJu

U :;;J.

YY.l.\lU ,pvu. ,.uv Q..u.u. }lv

;;;;o

(Illustrated A thru C B - 3 2

Im provised litter m ade w ith poles and jackets

(Illustrated A and B) B-33

Improvised litters made by. inserting poles through

sacks and by rolling blanket B-33

C-l.

C-2.

C-7

C-7

Poison ivy..............................................................................

Western poison oak ............................

C-3.

C-4.

C-7

C-9

Poison sumac... .....................

Protect an unbroken blister ........

xiii


18/243

C2, FM 21-11

Figure

C-5. Drain the blister likely to break C-IO

Page

E-l.

F -l. M258Al Skin Decontamination Kit.. ........ ........ ........ ......... ..

D igital p ressure (pressure w ith fingers, th umbs or hands)..

Tables

xiv

5-1.

Sun or Heat Inju rie s (081-831-1008) .. .. ... .. .. .. .. .. .. .. .. ... .. .. .. .. .. .

Cold and Wet Injuries (081-831-1009) 5-19

-2 .

E-l

F-4

Page

5-6

'

.. , ,.,

~

11 :

tlltes ana ;:jtlngs ... 0- ~

O J

-1 .

M ild Battle Fatigue 8-12

-1 .

8-2.

8-3.

More Serious Battle Fatigue 8-13

Preventive Measures to Combat Battle Fatigue 8-14


19/243

C2,

FM 21-11

* P R E F A C E

This manual meets th e emergency medic al tra in ing needs o f indiv idual

sold ie rs . Becausemed ical personne l will not a lways be readily ava ilable ,

th e nonmed ical so ld iers w ill h av e to rely h eav ily on th eir own sk ills an d

know ledge of life-sustaining m ethods to survive on the integrated

battle fie lc [ This manual a lso aodres ses firs t aid measure s fo r o tlie r life-

threatenin. .e ;i tuations. I t outl ines both self-t reatment (self-aid)and aid to

o th er so ld iers (b uddy aid ). Mo re impo rtan tly , this manual emphasizes

prompt and effective action in sustaining life and preventing or

minimIzing fu rther suf fe ring. F ir st a id is the emergency care g iven to the

s ick, inwreo, o r wounded befo re being trea ted by medlcal.personne l. The

A rmy lJictio nary d efin es first aid as u rg en t and immed iate lifesav in g

and o ther measure s which can be performed for casua ltie sby nonmed ical

p~rsonnel w hen m edical personnel are not immediately available.

Nonmedical so ld iers h av e receiv ed b asic first aid trainin g, and shou ld

remain skille d in th e corre ct p rocedu res fo r g iv ing firs t a iC i.Maste ry o f

first aid procedures is also part of a grouJ) study training program

en titled the Combat L ifesaver (DA Pam 351~O). A combat lifesav er is a

nonmed ical sold ie r who has been trained to p rovide emergency care. Th is

inc ludes adminis te ring intravenous infusions to casualt ies as h iscombat

m ission perm its. N orm ally, each sR .uad, team , or crew w ill have one

member who is a combat lif esaver .T llis manual is d irec ted to

all

soldiers.

The procedures discussed ap,ply to all types of casualties and the

measure s desc rib ed a re fo r u se lJy bothmale and fema le sold iers.

Cardiop,ulmonaryresuscitative

C P R procedureswere deleted from this

manual. These p,ro cedures are not recogn ized as essen tial b attlefield

skills that all soldiers should be able to p,erform . M anagem ent and

treatment of casualties on the battlefield has demonstrated that

incidence of cardiac arrest are usually secondary to other injuries

requiring im mediate first aid. O ther first aid procedures, such as

contro lling hemorrhage a re fa r mo re critic al and must be perfo rmed well

to sav e lives. L earn ing and maintain in g CPR sk ills is time and resou rce

intensive . CPR has very l it tle practica l ap ,p licat ion to ba tt le field f irst a id

and is not listed as a common task for sordiers. T he Academy of H ealth

Sciences, U S A rmy refers to the American H eart A ssociatIon for the

C PR standard. If a nonm edical soldier desires to learn C PR , he m ay

con ta ct h is sup -porting medic al tre atment fa cility fo r th e app ropria te

information . Al l medical personne l, however , must main ta in p ,rof ic iency

in CPR and m ay be available to hel12soldiers m aster the skIll. T he US

Army's o fficial referen ce fo r CPR is PM 8 -230.

T his m anual has been desigl)-ed to provide a ready reference for the

individual soldier on first ald . O n l 1 f t h e i n fo r m a t i o n n e c e s s a r y t o s u p p o r t

a n d s u s t a i n p , r o f i c i e n c y i n f i r s t a i d ~ h a s b e e n b o x e d a n d t h e t a s k n u m b e r

h a s b e e n l i s te d . n add Ition, th ese first aid task s fo r SkillLevell h ave

x v


20/243

C2,

FM 21-11

been lis ted in Append ix G. The ta sk number, title , and specificparag raph

9f the.appropria fe in fo rma tion is p rovided ill the event a c ross -re fe rence

ISdesIred.

Acknowledgment

Grateful acknowledgm ent is m ade to the

A m e r i c a n H e a r t A s s o c i a ti o n

fo r

their perm ission to use the copyrighted m aterial.

Commercial Products

Commercial products (trade names or trademarks) mentioned in this

pub lication a re to p rovIde desc rip tiv e in fo rmation and fo r illu strativ e

pUDJosesonly . TheIr use does not Imply endorsement by the Department

of Defense.

Standardizat ion Agreements

T he provisions of this publication are the subject of international

agreement(s):

NATO STANAG

2 1 2 2

TITLE

2 8 7 1

Medical Tra in ing in F irs t A idABasic

Hygiene and Emergency Lare

F irst A id K its and Emergency Medical

Care K its

Medica l F irst A id and Hyg iene Train ing in

NBC Operations

F irs t A id Mate ria l fo r Chemical In ju rie s

2 1 2 6

2 3 5 8

Neutral Language

Unle ss th is pub lication s ta te s o therwise, masculine nouns and pronouns

do not re fer exclu siv ely to men .

Appendixes

A ppendix A is a listing of the contents of the First A id C ase and K its.

x v i


21/243

C2,

FM 21-11

Append ix B discusses some casua lty transporta tion procedure s. Much is

dependent upon the manner in whicl1 a casua1ty is rescued and

transported.

App,endixC outl ines some basic principles that

r

romote good health. T he

health of the individual soldier IS an lm portan factor in conserving the

fighting strength. H istory: has often demonstrated that the course 01 the

batt~e is influenced m ore by the health of the soldier than by strategy or

tactICS.

Appendix ~ discusses application of digital pressure and illustrates

pressure pomts.

A ppendix F discusses specific inform ation on decontam ination

procedures.

A ppendix G is a listing of S kill L evell common tasks.

Proponent Sta tement

The pro 'ponen t o f th is pub lication is the Academy of Health Sciences ,


22/243

FM 21-11

CHAPTER 1

FU NDA MEN TAL CRITERIA FOR FIRST AID

INTRODUCTION

Sold iers may h av e to d ep end upon th eir first aid knowledg e and sk ills to

save themse lves o r o th er sold ie rs .They may be able to save a life , preven t

perm anent disability, and reduce long periods of hospitalization by

knowing w h a t to do, w h a t not to do, and w h e n

to seek medical ass is tance .

Anyth ing sold ie rs .cap do to .keep o ther s in good f ighting condition is Qart

of fhe pnmary m ISSiOno fIght or to support the w eapons system . Most

injured or ill soldiers are able to return to their units to fIght and lor

support

p ,r i m a r i l y b e c a u s e t h e y a re g iv e n a p 1 2 r o p r i a te a n d t i m e l y f i r s t a id

fo llowed by the Bes tmed ica l c are poss ib le . The re fo re , all sold Ie rs must

remember the bas ic s:

. Check for BREATHING: Lack of oxy)?;enintake

(thro ugh a compr9m ised airw ay or in adequate b reathing) can read to brain

dam age or death m very few m mutes.

. Check for BLEEDING: Life cannot continue without

an adequate volume of blood to carry oxygen to tissues.

. Check for SHOCK: Unless shock is prevented or

treated,death may result even thoughthe injurywould not otherwisebe

fatal.

Section I. EV ALU ATE CA SU ALTY

11-1. C asualty Evaluation 0 8 1 - 8 3 1 - 1 0 0 0 )

1

The tim e m ay com e when you must instantly apply your know ledge of

lif esav ing and f irs t a id measures , possib ly under com15ato r o th er adverse

conditions . Any sold ie r observing an unconsc ious and o r ill, in ju red, o r

wounded person must c are fu lly and skillfu lly eva luate h im to determ ine

the first aId m easures required to prevent further injury or death. H e

should seek help from medical personnel as soon as possible, but must

NOT interrupfhis evaluation or treatm ent of the casualj:y. A second

p erso n may be sent to fin d med ical h elp . One o f th e cardin al prin ciples o f

treating a casualty is that the initIal rescuer must continue the

ev alu atio n and treatmen t, as th e tactical situ atio n

f

erm its, until he is

reliev ed by anoth er in div id ual. If, du ring any part 0 th e ev alu ation , th e

casu alty exhib its th e condition s fo r wnlch tlie soldier is checking , th e

sold ier must stop the evaluation and immedia te ly admin is te r first a ld . In

a chem ical envIronment, the soldier should not evaluate the casualty


23/243

FM 21-11

until the casualtY has been masked and ~iven the antidote. After

providing first aia, the soldier must proceea w ith the evaluation and

continue fo monito r the casua lty for fu rther medical complications until

re lieved by medical personnel. Learn the fo llowing procedures well.

You

may become t h a t s o [ d i e r who will h ave to give fir sf a id some day.

N OT E

Remembe r, when eva luating and/o r tre ating a

casualty,

y ou

should seek medical aid as soon

as posslbfe.

D O N O T

stop trea tment, but if the

situation allow s, send another person to find

medical aid.

WARNING

Again, remember, if there are any signs of

cnem ical or biological agent poisoning, you

should immedia te l} rmaSKthe casua lty .lf I t is

nerve ay;entpoisonmg, adminis ter the antidote ,

using tI le casualty 's mjector

/

amp,ules .See task

081-'831-1031,

A a m i n is t e r F i r s t ~ id t o a N e r v e

A g e n t C a s u a lt y B u d d y A id ) .

a . S t e p ONE. Check the casual~ for responsiveness 9Y gently

shaking or tapp ing h im while calmly aSKing, Are you oktW? Wafch fo r

respon se. If th e casu alty does not respond go

to

s tep TWU. See Chapte r

2 ,.Raragraph 2-5.for more information. I f the casualty responds , contmue

WIth ilie evaluation.

(1) If the casualty is conscious, ask him where he feels

different than usual or where it hurts. A sk him to ident ify the locat ions

of pain if he can, or

to

identify the area in which there is no feeling.

(2) If the casualty, is conscious but is choking and cannot

ta lk , stop the eva luation and beg in treatment. See task D 8 1 - 8 3 1 - 1 0 0 3

C l e a r a n O b j e c t f r o m t h e T h r o a f o f a C o n s c i o u s C a s u a l t y . A lso see

Chapte r 2 , paragraph 2 -13 fo r specific deta ils on open ing the airway.

2


24/243

C

2, FM 21-11

WARNING

IF A BROKEN NECK OR BACK IS

SUSPECTED DO NOT MOVE THE

C ASU ALTY UN LESS TO SA VE HIS LIFE.

M OV EM EN T M AY C AUSE PER MAN ENT

PARALYSISOR DEATH.

b. S t e p T W O .

Check for breath ing. See Chapte r 2 , paragraph

2 - 5 c

for procedure.

(1) If the casualty is breathing, proceed to step FOUR .

(2) If the casualty is n ot breathin g, stQ~ t he ev alu ation and

beg in tre atmen t (attemp t to ven tilate). See fask 081 -831 -1042,

P e r f o r m

M o u t h - t o - M o u t h Resuscitation. If an airw ay obstruction is apparent,

c lear the a irway obstruc tion , then venti la te .

(3) After successfully clearing the casualty's airway,

p roceed to step THREE .

c.

S t f i J T H R E E .

Check for pulse. If pulse is present, and the

casua lty is b re ath ing, p roce ed to s tep FOUR.

(1) If pulse is 'present, but the casualty is still not

breathirw; s ta rt rescue breatf iing . See Chapter 2 , paragraphs 2-6 ,and 2-7

for s eClf icmethods .

*

(2 ) I f p ulse is not found , seek medically train ed p ersonnel

for help.

d . S t e p F O U R .

Checkfor b leed ing. Look for spurts o f b lood or

b lood-soaked c lo thes . A lso check fo r

b o t f f

entry and exitw ounds.

I f t h e

c a s u a l t y i s b l e e d in g f r o m a n o p e n w o u n d ,

stop the evaluation and beg in

first al< treatment in accordance witl\ the following tasks, as

appropnate:

(1) A rm or leg wound-T ask 081-831-1016 P u t o n a F i e l d o r

P r e s s u re D r e s s in g . See Chap te r 2 , paragraphs 2 -15,2 -17,2 -18,and 2-19.

(2) Partial or complete amputation-T ask 081-831-1017,

P u t o n a T o u rn iq u e t.

See Chap fer 2 , parag raph 2-20.

(3) Open head wound-Task 081-831-1033, A p p l y a

D r e s s i n g t o a n O p e n H e a d W o u n d .

See Chapte r 3 , Sec tionI .

1-3


25/243

C 2, FM 21-11

(4 ) Open abdomina l wound-Task 0 8 1 - 8 3 1 - 1 0 2 5 , A p 1 2 h l a

D r e s s i n g t o a n O p e n A b d o m i n a l W o u n d . SeeChapter 3 , p a r a g r a p H . 3 -1 2 .

(5) O pen chest w ound-Task 081-831-1026, A p p l y a

D r e s s i n g t o a n O p e n C h e s t W o u n d . SeeChapter 3 , paragraphs 3-9and

3 - 1 0 .

WARNING

IN A CHEMICALLY CONTAMINATED

AREA, DO NOT EXPOSE THE W OUND(S).

e . S t e p F IV E . C h e c k fo r s h o c k . If signs/symptoms of

s h o c k

are

present, stop the evaluation and begin treatmenf immediately. The

follow ing are nine signs and/or symptom s of shock.

(1) Sweaty but cool skin (clammy skin).

(2) Paleness of skin.

(3) R estlessness or nervousness.

(4) Thirst.

(5) Loss of blood (bleeding).

(6) C onfusion (does not seem aw are of surroundings).

(7) Faster than normal breathing rate.

(8) Blotchy or bluish skin, especially around the m outh.

(9) Nausea and/or vomiting.

WARNING

LEG FRACTURES M UST BE SPLINTED

BEFORE ELEVATING THE LEGS/AS A

TREA TM EN T FO R SH OCK .

See C hapter 2, Section III for specific inform ation regarding the causes

and effects, signs/symptom s, and the treatm ent/prevention of shock.

1-4


26/243

C 2, FM 21-11

f

S t e p SIX. Check for fractures (C hapter 4).

..

(1) Check fo r th e follow ing sign s / symp toms of a b a c k o r

n e c k l n J u r y and treat a s necessa ry .

. Pain or tenderness of the neck or back area.

. Cuts or bruises in the neck or back area.

numbness ).

. Inability of a casualty to m ove (paralysis or

0

Ask about ab ility to move (p araly sis).

0

Touch the casualty's arm s and legs and ask

whether he can feel you r hand (numbness).

. U nusual body or lim b position.

WARNING

UNLESS THERE IS IMMEDIATE LIFE-

THREATENING DANGER,

D O N O T M O V E

A CASUALTY W HO HAS A SUSPECTED

BACK OR NECK INJURY. M OVEM ENT

M AY CAU SE PERM ANEN T PARA LYSIS

OR D EATH .

(2) Immobilize any casualty suspected of having a neck or

b ack in ju ry by doing th e fo llowing

. Tell the casualty not to move.

. Ifa

b a c k i n j u r y

is su spec ted, p 'la ce padding (ro lled

or folded to conform to the shape of the arch) unaer the natura1 arch of

the casualty's back. For example, a blanket may be used as padding.

. If a n e c k i n ju r y

is suspected, Rlace a roll of cloth

under the casualty 's neck and put weijzhtedboots (filled with d irt, sand

and so forth) or rocks on both sides of his head.

(3) C heck the casualty's arm s and legs for open or closed

fractures.

1-5


27/243

C 2, FM 21-11

C h e c k fo r o p e n f r a c t u r e s .

L o o k f o r b le e d in g .

L o o k fo r b o n e s t ic k in g th r o u g h th e s k in .

C h e c k f o r c l o s e d f r a c t u r e s .

L o o k f o r s w e l l in g .

L o o k fo r d is c o lo ra tio n .

L o o k f o r d e f o r m ity .

L o o k fo r u n u s u a l b o d y p o s i t io n .

*

(4) S to p t h e e v a lu a t io n a n d b e g in t r e a tm e n t i f a f r a c t u r e to

a n a rm o r le g is s u s p e c te d . S e e T a s k 0 8 1 - 8 3 1 - 1 0 3 4 , S p l i n t a S u s p e c t e d

F r a c t u r e , C h a p te r 4 , p a r a g r a p h s 4-4 t h r o u g h 4 - 7 .

5 C h e c k f o r s ig n s / s y m p to m s o f f r a c t u r e s o f o th e r b o d y

a r e a s f o r e x a m p le , s h o u ld e r o r h ip a n d t r e a t a s n e c e s s a r y .

g . S te p S E V E N . C h e c k fo r b u m s . L o o k c a r e fu l ly f o r r e d d e n e d

b l is t e r e d , o r c h a r r e d s k in , a ls o c h e c k fo r s in g e d c lo th in g . I f b u m s a r e

f o u n d , s t o p th e e v a lu a t io n a n d b e ~ in t r e a tm e n t C h a p te r 3 , p a r a g r a p h

3 -1 4 . S e e ta s k 0 8 1 - 8 3 1 - 1 0 0 7 , G iv n - i r s t A i d f o r S u m s .

h . S te p E IG H T . C h e c k f o r p o s s ib le h e a d in ju r y .

1 L o o k f o r t h e fo l lo w in g s ig n s a n d s y m p to m s

U n e q u a l p u p i l s .

F lu id f r o m th e e a r s , n o s e , m o u th , o r in ju r y s i te .

S lu r r e d s p e e c h .

C o n f u s i o n .

S l e e p i n e s s .

L o s s o f m e m o r y o r c o n s c io u s n e s s .

S ta g g e r in g in w a lk in g .

1-6


28/243

FM 21-11

.

H e a d a c h e .

. D izziness.

. Vom iting and/or nausea.

. Paralysis.

. Convulsions or twitches.

(2) If a head injury is suspected , continue to watch for signs

which would require perfo rmance of mouth-to-mouth resuscitation ,

treatm ent for shock or control of bleeding and seek m edical aid. See

Chapter 3 , Section I for specif ic indications of head injll~Yand trea tment.

See task 081-831-1033,

A p p l y a D r e s s i n g t o a n O p e n H e a d W o u n d .

I

1-2.

Medical Assis tance 0 8 1 - 8 3 1 - 1 0 0 0 )

I

When a nonmed ically tra ined so ld ie r comes upon an unconsc ious and /o r

in ju red sold ie r, he must accura te ly eva luate tne casua lty to dete rmine the

firs t a id measuresneeded to prevent fu rther in ju ry or dea th . He should seek

medical ass is tance as soon as poss ib le ,but lie

M U S T N O T

interrupt

treatmen t. To in terrupt treatmen t may cau se mo re h arm th an good to fh e

casualty .A second person may be sent to find medical he lp . If, auring any

part o fthe eva luation, the casualty exh ib its the conditions fo r wh ich the

sold ie r is check ing, the sold ie r must s top the eva luation and immedia te ly

adminis ter f ir st a ieLRemember that in a chemicalenvironment, the soldier

shou ld not e valu ate th e casu alty until th e casu alty h as b een masked and

given the antidote .Af ter performmg first a id , the so1diermust proceed wi th

fh e ev alu atio n and contmue to monito r th e casu alty fo r d ev elop,men t o f

conditions which m ay, require the p'erform ance of necessary basic hfe saving

measu re s, su ch as cle armg th e airway , mouth -to -mouth resu scitatio n,

p reventing shock, a rdor b le ed ing con tro l. He shou ld con tinue to monito r

unti l relievedby medical personnel.

Section II. UNDERSTAND VITAL BODY FUNCTIONS

1-3 .Respira tion and B lood C ircula tion

Resp ira tion (inha la tion and exhala tion) and b lood c ircula tion a re v ita l

body func tions . In te rrup tion of e ither

of

th ese two functio ns n eed not b e

fa ta l IF app ropria te first a id measu re s a re corre ctly app lied.

1-7


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FM 21-11

a . R e s p i ra t i o n . When a person inhale s, o~ygen is taken in to the

b o d y

and when he exhale s, carDondioxide is expellea from the body- th is

i s respi ra tion . Respiration involves the-

. A i r w a y (nose,mouth, throat, voice box,w indpipe, and

bronchia l tree). The canal th rough which a ir passe s

to

and from th e lu ngs.

.

L u n g s (two elasticorgansmade up of thousandsof tiny

air sp aces and cov ered by an airtig ht membran e).

.

C h e s t c a g e

(fo rmed by the muscle-connected rib s wh ich

join the spine in back and the breastbone in front). The to p part of the

chest cage is closed by the structure of the neck, and the botfom part is

separated from the abdom inal cavity by a large dom e-shaped muscle

caIled the d iaphragm (Fi? ;.Ure- I} . The d iaphragm and r ib musc le s, wh ich

are under th e con fro l o f fh e re sp ira to ry cente r m the b rain , automatica lly

c o n t r a c t and r e l a x . C o n t ra c ti o n increases and r e l a x a t i o n decreases the

size o f the chest cag e.

When the ch est cag e in creases and th en d ecreases, th e air p ressu re in th e

lungs is first less and then m ore than the atm ospheric pressure, thus

causmg the air

to

rush in and out of the lungs

to

equa lize the pressure.

T~is cycle o f in haling and exh alin g is rep eated abou t 1 2

to

18 fimes per

mmute.

R I B S

NOSE

THROAT

WINDPIPE

BRONCHIAL TREE

AB DOM INA L C AVI TY

V :

,.

1_ 1

A

;-..,

J YI\.

7. 0

rY'YIrJ

, .. .1 ,, ,. .. + r ar t, .. ., .

L ~I5UIt; .1.-.1..

.r1ld

wu..y,

[,UH15 , UHU l, .-If.,t::::.. ,, , L-U,5t::::.

1-8


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FM 21-11

b . B l o o d C i r c u la t i o n .

The hea rt and the b lood vessels (a rte rie s,

veins, and cap illa rie s) c i rcula te b lood th rough the body tis sues . The heart

is d iv id ed in fo two se_parateh alv es, ea ch actin g as a pump. The left sid e

pum ps oxygenated blood (bright red) through m e arteries into the

capilfar ies; nutr ients and oxygen

l

ass from the Dlood through the walls

of the capillaries into the cens. t the same time waste products and

carbon dioxide enter the capillaries. From the capillaries the oxygen R oor

blood is carried through the veins to the right sIde of the heart and then

into the lungs w here it expels carbon dioxicre and picks up oxygen, Blood

in the veins IS d ark red because of its low oxygen content. Blooo. does not

flow through the veins in spurts as it does tRrough the arteries.

1 H e a r t b e a t . The heart functions as a IJum p to circulate

the blood continuously through the blood vessels to all pads of the body.

It

c o n t r a c t s ,

forcing the blood from its chambers; then it

r e l a x e s ,

perm itting its ch amDers to refill w ith blood. T he rhythm ical c y c le o f

c o n t r a c t i o n and r e l a x a t i o n is called th e h eartb eat. T he normal h eartb eat

is from 60 to 80 beats per minute.

2 P u l s e .

The heartb ea t cau ses a rhythm ical

e x p a n s i o n

and

c o n t r a c t i o n o f the arteries as it forces bloo d through them . T his c y c l e of

exp,ansion and contraction can be felt (m onitored) at various body points

ana is called the p u l s e . The common po ints for checking the pulse are at

the side o f the neck (caro tid ), th e g ro in (femora l), th e wrist (radia l), and

the ankle (posteria l t ib ia l) .

a ) N e c k c a r o t i d ) p u l s e . To check th e neck (caro tid )

pulse, feel fo r a pu lse on the side

of

the casua lty 's neck c losest to y ,ouby

p lacing th e tip s o f you r first two fingers b esid e h is Adam 's apple (1


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FM 21-11

b ) G r o i n f e m o r a l ) p u l s e .

To check the )?;roin ( femoral)

pulse, press the tips of tw o fingers into the m iddle of tfie groin (Figure

1 - 3 .

Figure 1 - 3 . G r o i n f e m o r a l) p u l s e .

c ) W r i s t r a d i a l ) p u l s e . To check the w rist (radial)

pu~se,p,lace your first two fingers on the thumb side of the casualty's

wnst (F igure 1 -4 ).

/-'l//~

Figure 1-4. W rist radial) pulse.

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FM 21-11

d ) A n kle p os te ria l tib ia l) p -u ls e.To check the ankle

(posteri~l tibial)

f,

ulse, place your first tw o fingers on the inside of the

ank le (F Igure 1-5 .

A N K L E P U L S E S IT E

Figure

1-5.

A nkle posterial tibial) pulse.

NOTE

DO NOT use your thumb to check a casualty's

pulse because you m ay: c onfuse your pulse beat

with that of the casualty.

1-4.

Adverse Condit ions

a Lack of Oxygen Human life cannot exist without a

continuous intake of oxygen. L ack of o~en rapidly leads to death. F irst

aid involves know ing_how to OPEN THE A IRW AY AND RESTORE

BREATHING AND HEARTBEAT (Chapter 2, S ection

I) .

b leeding

Human life cannot continue w ithout an adequate

volume of blood to carry oXYKeno the tissues. An imp-ortant firs1 a id

measure is to STOP THE BLEED ING to prevent loss of blood (Chapter

2 , Sec tion II).

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FM 21-11

c .

S h o c k . Shock m eans there is inadequate blood flow to the

vital tissues and organs. S hock that remains uncorrected may result in

death even though the injury or condition causing the shock would not

otherw ise be fatal. Shock can result from many causes, such as loss of

blood, loss of fluid from deep burnsd)ai;l? and reaction to the sight of a

wound or blood. F irst aid includes

PREvENTING SHOCK,

SIncethe

casualty's chances of survival are much greater if he does not develop

shock (Chap te r 2 , Sec tion III).

d . I n f e c t i o n .

R e c o v e r y from a severe in iu ry o r a wound depends

lar.,gely upon how well the injury or w ound w as initially protected.

In fe ctions re su lt from the mu ltlphca tion and g rowth (sp 're ad ) o f germs

(pacter ia : harmful microscopic organisms) . S ince harmful bac te ria a re in

the air and on the skin and clothing, some of these organism s will

immedia tely invade (contaminate) a b re ak in th e sk in o r an oQenwound.

The obkctIve is to 'KEEP ADOITIONAL GERM S OUT OF THE

WOUND. A good working know ledge of basic first aid measures also

in cludes knowmg how to d re ss th e wound to avo id in fec tiono r add itiona l

contamination (Chap ters 2 and 3 ).

1-12


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C 2, FM 21-11

CHAPTER 2

BASIC MEASURES FOR FIRST AID

INTRODUCTION

Several conditions which require immediate attention are an inadequateairway, lack of breathing or lack of heartbeat, and excessive loss of blood.

A casualty without a clear airway or who is not breathing may die fromlack of oxygen. Excessive loss of blood may lead to shock, and shock canlead to death; therefore, you must act immediately to control the loss of

blood. All wounds are considered to be contaminated, since infection-producing organisms (germs) are always present on the skin, on clothing,and in the air. Any missile or instrument causing the wound pushes orcarries the germs into the wound. Infection results as these organismsmultiply. That a wound is contaminated does not lessen the importanceof protecting it from further contamination. You must dress and bandagea wound as soon as possible to prevent further contamination. It is alsoimportant that you attend to any airway, breathing, or bleeding problemIMMEDIATELYbecause these problems may become life-threatening.

Section I. OPEN THE AIRWAY AND RESTORE BREATHING

2-1. Breathing Process

All living things must have oxygen to live. Through the breathingprocess, the lungs draw oxygen from the air and put it into the blood. Theheart pumps the blood through the body to be used by the living cellswhich require a constant supply of oxygen. Some cells are moredependent on a constant supply of oxygen than others. Cells of the brainmay die within 4 to 6 minutes without oxygen. Once these cells die, theyare lost forever since they DO NOT regenerate. This could result inpermanent brain damage, paralysis, or death.

2-2. Assessment (Evaluation) Phase (081-831-1000 and 081-831-1042)

a. Check for responsiveness (Figure 2-1A)establish whether

the casualty is conscious by gently shaking him and asking, Are youO.K.?

b. Call for help (Figure 2-1B).

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C 2, FM 21-11

c. Position the unconscious casualty so that he is lying on hisback and on a firm surface (Figure 2-1C) (081-831-1042).

WARNING (081-831-1042)

If the casualty is lying on his chest (proneposition), cautiously roll the casualty as a unitso that his body does not twist(which may

further complicate a neck, back or spinalinjury).

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C 2, FM 21-11

(1) Straighten the casualtys legs. Take the casualtys armthat is nearest to you and move it so that it is straight and above hishead. Repeat procedure for the other arm.

(2) Kneel beside the casualty with your knees near hisshoulders (leave space to roll his body) (Figure 2-1B). Place one hand

behind his head and neck for support. With your other hand, grasp thecasualty under his far arm (Figure 2-1C).

(3) Roll the casualty toward you using a steady andeven pull. His head and neck should stay in line with his back.

(4) Return the casualtys arms to his sides. Straighten hislegs. Reposition yourself so that you are now kneeling at the level of thecasualtys shoulders. However, if a neck injury is suspected, and the jaw-thrust will be used, kneel at the casualtys head, looking toward his feet.

2-3. Opening the AirwayUnconscious and Not BreathingCasualty (081-831-1042)

The tongue is the single most common cause of an airway obstruction(Figure 2-2). In most cases, the airway can be cleared by simply using thehead-tilt/chin-lift technique. This action pulls the tongue away from theair passage in the throat (Figure 2-3).

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C 2, FM 21-11

a. Step ONE (081-331-1042). Call for help and then position thecasualty. Move (roll) the casualty onto his back (Figure 2-1C above).

CAUTION

Take care in moving a casualty with asuspected neck or back injury. Moving an

injured neck or back may permanently injurethe spine.

NOTE (081-831-1042)

If foreign material or vomitus is visible in themouth, it should be removed, but do not spendan excessive amount of time doing so.

b. Step TWO (081-831-1042). Open the airway using thejaw-thrust or head-tilt/chin-lift technique.

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C2, FM 21-11

NOTE

The head-tilt/chin-lift is an importantprocedure in opening the airway; however, useextreme care because excess force inperforming this maneuver may cause furtherspinal injury. In a casualty with a suspectedneck injury or severe head trauma, the safestapproach to opening the airway is the jaw-thrust technique because in most cases it can

be accomplished without extending the neck.

(1) Perform the jaw-thrust technique. The jaw-thrust maybe accomplished by the rescuer grasping the angles of the casualtyslower jaw and lifting with both hands, one on each side, displacing the

jaw forward and up (Figure 2-4). The rescuers elbows should rest on thesurface on which the casualty is lying. If the lips close, the lower lip can

be retracted with the thumb. If mouth-to-mouth breathing is necessary,close the nostrils by placing your cheek tightly against them. The headshould be carefully supported without tilting it backwards or turning itfrom side to side. If this is unsuccessful, the head should be tilted backvery slightly. The jaw-thrust is the safest first approach to opening theairway of a casualty who has a suspected neck injury because in mostcases it can be accomplished without extending the neck.

1. American Heart Association (AHA). Instructors Manual for Basic Life Support(Dallas:AHA, 1987), p. 37.

2. Ibid.

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C2, FM 21-11

(2) Perform the head-tilt/chin-lift technique (081-831-1042).Place one hand on the casualtys forehead and apply firm, backwardpressure with the palm to tilt the head back. Place the fingertips of theother hand under the bony part of the lower jaw and lift, bringing thechin forward. The thumb should notbe used to lift the chin (Figure 2-5).

NOTE

The fingers should not press deeply into the

soft tissue under the chin because the airwaymay be obstructed.

c. Step THREE. Check for breathing (while maintaining anairway). After establishing an open airway, it is important to maintainthat airway in an open position. Often the act of just opening andmaintaining the airway will allow the casualty to breathe properly. Oncethe rescuer uses one of the techniques to open the airway (jaw-thrust orhead-tilt/chin-lift), he should maintain that head position to keep the

airway open. Failure to maintain the open airway will prevent thecasualty from receiving an adequate supply of oxygen. Therefore, whilemaintaining an open airway, the rescuer should check for breathing byobserving the casualtys chest and performing the following actionswithin 3 to 5 seconds:

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FM 21-11

(1) LOOK for the chest to rise and fall.

(2) LISTEN for air escaping during exhalation by placingyour ear near the casualtys mouth.

(3) FEEL for the flow of air on your cheek (seeFigure 2-6),

(4) If the casualty does not resume breathing, give mouth.to-mouth resuscitation.

NOTE

If the casualty resumes breathing, monitor andmaintain the open airway. If he continues to

breathe, he should be transported to a medicaltreatment facility.

2-4. Rescue Breathing (Artificial Respiration)

a. If the casualty does not promptly resume adequatespontaneous breathing after the airway is open, rescue breathing(artificial respiration) must be started. Be calm! Think and act quickly!The sooner you begin rescue breathing, the more likely you are to restorethe casualtys breathing. If you are in doubt whether the casualty is

breathing, give artificial respiration, since it can do no harm to a personwho is breathing. If the casualty is breathing, you can feel and see hischest move. Also, if the casualty is breathing, you can feel and hear air

being expelled by putting your hand or ear close to his mouth and nose.

b. There are several methods of administering rescue breathing.The mouth-to-mouth method is preferred; however, it cannot be used in

all situations. If the casualty has a severe jaw fracture or mouth woundor his jaws are tightly closed by spasms, use the mouth-to-nose method.

2-5. Preliminary StepsAll Rescue Breathing Methods(081-831-1042)

a. Step ONE. Establish unresponsiveness. Call for help. Turnor position the casualty.

b. Step TWO. Open the airway.

c. Step THREE. Check for breathing by placing your ear overthe casualtys mouth and nose, and looking toward his chest:

2-7


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FM 21-11

(1) Look for rise and fall of the casualtys chest (Figure 2-6).

(2) Listen for sounds of breathing.(3) Feel for breath on the side of your face. If the chest does

not rise and fall and no air is exhaled, then the casualty is breathless (notbreathing). (This evaluation procedure should take only 3 to 5 seconds.Perform rescue breathing if the casualty is not breathing.

NOTE

Although the rescuer may notice that the

casualty is making respiratory efforts, theairway may still be obstructed and opening theairway may be all that is needed. If thecasualty resumes breathing, the rescuer shouldcontinue to help maintain an open airway.

2-6. Mouth-to-Mouth Method (081-831-1042)

In this method of rescue breathing, you inflate the casualtys lungs withair from your lungs. This can be accomplished by blowing air into thepersons mouth. The mouth-to-mouth rescue breathing method isperformed as follows:

a. Preliminary Steps.

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C 2, FM 21-11

(1) Step ONE (081-831-1042). If the casualty is notbreathing, place your hand on his forehead, and pinch his nostrils togetherwith the thumb and index finger of this same hand. Let this same handexert pressure on his forehead to maintain the backward head-tilt andmaintain an open airway. With your other hand, keep your fingertips onthe bony part of the lower jaw near the chin and lift (Figure 2-7).

NOTEIf you suspect the casualty has a neck injuryand you are using the jaw-thrust technique,close the nostrils by placing your cheek tightlyagainst them.

(2) Step TWO (081-831-1042).Take a deep breath andplace yourmouth (in an airtight seal) around the casualtys mouth

(Figure 2-8). (If the injured person is small, cover both his nose and mouthwith your mouth, sealing your lips against the skin of his face.)

3. Ibid.

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C 2, FM 21-11

(3) Step THREE (081-831-1042). Blow two full breathsinto the casualtys mouth (1 to 1 1/2 seconds per breath), taking a breathof fresh air each time before you blow. Watch out of the corner of your eyefor the casualtys chest to rise. If the chest rises, sufficient air is gettinginto the casualtys lungs. Therefore, proceed as described in step FOURbelow. If the chest does not rise, do the following (a, b, and cbelow) andthen attempt to ventilate again.

(a) Take corrective action immediately byreestablishing the airway. Make sure that air is not leaking from aroundyour mouth or out of the casualtys pinched nose.

(b) Reattempt to ventilate.

(c) If chest still does not rise, take the necessaryaction to open an obstructed airway (paragraph 2-14).

NOTE

If the initial attempt to ventilate the casualtyis unsuccessful, reposition the casualtys headand repeat rescue breathing. Improper chinand head positioning is the most, commoncause of difficulty with ventilation. If the

casualty cannot be ventilated afterrepositioning the head, proceed with foreign-body airway obstruction maneuvers (seeOpenan Obstructed Airway, paragraph 2-14).4

4. Ibid., p. 38

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C 2, FM 21-11

(4) Step FOUR (081-831-1042). After giving two breathswhich cause the chest to rise, attempt to locate a pulse on the casualty.Feel for a pulse on the side of the casualtys neck closest to you byplacing the first two fingers (index and middle fingers) of your hand onthe groove beside the casualtys Adams apple (carotid pulse) (Figure2-9). (Your thumb should not be used for pulse taking because you mayconfuse your pulse beat with that of the casualty.) Maintain the airway

by keeping your other hand on the casualtys forehead. Allow 5 to 10seconds to determine if there is a pulse.

(a) If a pulse is found and the casualty is breathingSTOP allow the casualty to breathe on his own. If possible, keep himwarm and comfortable.

(b) If a pulse is found and the casualty is notbreathing, continue rescue breathing.

(c) If a pulse is not found, seek medically trainedpersonnel for help.

b. Rescue Breathing (mouth-to-mouth resuscitation)(081-831-1042). Rescue breathing (mouth-to-mouth or mouth-to-nose

2-11160-065 O - 94 2


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C 2, FM 21-11

resuscitation) is performed at the rate of about one breath every 5seconds (12 breaths per minute) with rechecks for pulse and breathingafter every 12 breaths. Rechecks can be accomplished in 3 to 5 seconds.See steps ONE through SEVEN (below) for specifics.

NOTE

Seek help (medical aid), if not done previously.

(1) Step ONE. If the casualty is not breathing, pinch hisnostrils together with the thumb and index finger of the hand on hisforehead and let this same hand exert pressure on the forehead tomaintain the backward head-tilt (Figure 2-7).

(2) Step TWO. Take a deep breath and place your mouth(in an airtight seal) around the casualtys mouth (Figure 2-8).

(3) Step THREE. Blow a quick breath into the casualtysmouth forcefully to cause his chest to rise. If the casualtys chest rises,sufficient air is getting into his lungs.

(4) Step FOUR. When the casualtys chest rises, removeyour mouth from his mouth and listen for the return of air from his lungs(exhalation).

(5) Step FIVE. Repeat this procedure (mouth-to-mouthresuscitation) at a rate of one breath every 5 seconds to achieve 12breaths per minute. Use the following count: one, one-thousand; two,

one-thousand; three, one-thousand; four, one-thousand; BREATH; one,one-thousand; and so forth. To achieve a rate of one breath every 5seconds, the breath must be given on the fifth count.

(6) Step SIX. Feel for a pulse after every 12th breath. Thischeck should take about 3 to 5 seconds. If a pulse beat is not found, seekmedically trained personnel for help.

(7) Step SEVEN. Continue rescue breathing until thecasualty starts to breathe on his own, until you are relieved by anotherperson, or until you are too tired to continue. Monitor pulse and return of

spontaneous breathing after every few minutes of rescue breathing. Ifspontaneous breathing returns, monitor the casualty closely. Thecasualty should then be transported to a medical treatment facility.Maintain an open airway and be prepared to resume rescue breathing, ifnecessary.

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C 2, FM 21-11

2-7. Mouth-to-Nose Method

Use this method if you cannot perform mouth-to-mouth rescue breathingbecause the casualty has a severe jaw fracture or mouth wound or hisjaws are tightly closed by spasms. The mouth-to-nose method isperformed in the same way as the mouth-to-mouth method except thatyou blow into the nose while you hold the lips closed with one hand at thechin. You then remove your mouth to allow the casualty to exhalepassively. It may be necessary to separate the casualtys lips to allow theair to escape during exhalation.

2-8. Heartbeat

If a casualtys heart stops beating, you must immediately seek medicallytrained personnel for help. SECONDS COUNT! Stoppage of the heart issoon followed by cessation of respiration unless it has occurred first. Becalm! Think and act! When a casualtys heart has stopped, there is nopulse at all; the person is unconscious and limp, and the pupils of his eyesare open wide. When evaluating a casualty or when performing thepreliminary steps of rescue breathing, feel for a pulse. If you DO NOTdetect a pulse, immediately seek medically trained personnel.

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C 2, FM 21-11

Paragraphs 2-9, 2-10, and 2-11 have beendeleted. No text is provided for pages 2-15through 2-20.

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C2, FM 21-11

2-12. Airway Obstructions

In order for oxygen from the air to flow to and from the lungs, the upperairway must be unobstructed.

a. Upper airway obstructions often occur because

(1) The casualtys tongue falls back into his throat while he

is unconscious as a result of injury, cardiopulmonary arrest, and so forth.(The tongue falls back and obstructs, it is not swallowed.)

(2) Foreign bodies become lodged in the throat. Theseobstructions usually occur while eating (meat most commonly causesobstructions). Choking on food is associated with

Attempting to swallow large pieces of poorlychewed food.

Drinking alcohol.Slipping dentures.

(3) The contents of the stomach are regurgitated and mayblock the airway.

(4) Blood clots may form as a result of head and facial injuries.

b. Upper airway obstructions may be prevented by taking thefollowing precautions:

(1) Cut food into small pieces and take care to chew slowlyand thoroughly.

(2) Avoid laughing and talking when chewing and swallowing.

(3) Restrict alcohol while eating meals.

(4) Keep food and foreign objects from children while theywalk, run, or play.

(5) Consider the correct positioning/maintenance of theopen airway for the injured or unconscious casualty.

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C2, FM 21-11

c. Upper airway obstruction may cause either partial orcomplete airway blockage.

(1) Partial airway obstruction. The casualty may still havean air exchange. A good air exchange means that the casualty can coughforcefully, though he may be wheezing between coughs. You, the rescuer,should not interfere, and should encourage the casualty to cough up theobject on his own. Apoor air exchange may be indicated by weakcoughing with a high pitched noise between coughs. Additionally, thecasualty may show signs of shock (for example, paleness of the skin,

bluish or grayish tint around the lips or fingernail beds) indicating a needfor oxygen. You should assist the casualty and treat him as though hehad a complete obstruction.

(2) Complete airway obstruction.A complete obstruction(no air exchange) is indicated if the casualty cannot speak, breathe, orcough at all. He may be clutching his neck and moving erratically. In anunconscious casualty a complete obstruction is also indicated if afteropening his airway you cannot ventilate him.

2-13. Opening the Obstructed Airway-Conscious Casualty(081-831-1003)

Clearing a conscious casualtys airway obstruction can be performedwith the casualty either standing or sitting, and by following a relativelysimple procedure.

WARNING

Once an obstructed airway occurs, the brainwill develop an oxygen deficiency resulting in/unconsciousness. Death will follow rapidly ifprompt action is not taken.

a. Step ONE. Ask the casualty if he can speak or if he ischoking. Check for the universal choking sign (Figure 2-18).

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FM 21-11

b. Step TWO. If the casualty can speak, encourage him toattempt to cough; the casualty still has a good air exchange. If he is ableto speak or cough effectively, DO NOT interfere with his attempts toexpel the obstruction.

c. Step THREE. Listen for high pitched sounds when thecasualty breathes or coughs (poor air exchange). If there is poor airexchange or no breathing, CALL for HELP and immediately delivermanual thrusts (either an abdominal or chest thrust).

NOTE

The manual thrust with the hands centeredbetween the waist, and the rib cage is called anabdominal thrust (or Heimlich maneuver). The

chest thrust (the hands are centered in themiddle of the breastbone) is used only for anindividual in the advanced stages ofpregnancy, in the markedly obese casualty, orif there is a significant abdominal wound.

Apply ABDOMINAL THRUSTS using the proceduresbelow:

Stand behind the casualty and wrap your armsaround his waist.

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FM 21-11

Make a fist with one hand and grasp it with theother. The thumb side of your fist should be against the casualtysabdomen, in the midline and slightly above the casualtys navel, but well

below the tip of the breastbone (Figure 2-19).

Press the fists into the abdomen with a quickbackward and upward thrust (Figure 2-20).

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C 2, FM 21-11

o Each thrust should be a separate and distinctmovement.

NOTE

Continue performing abdominal thrusts untilthe obstruction is expelled or the casualty

becomes unconscious.

o If the casualty becomes unconscious, call for help asyou proceed with steps to open the airway and perform rescue breathing(Seetask 081-831-1042,Perform Mouth-to-Mouth Resuscitation.)

Applying CHEST THRUSTS.An alternate techniqueto the abdominal thrust is the chest thrust. This technique is useful whenthe casualty has an abdominal wound, when the casualty is pregnant, orwhen the casualty is so large that you cannot wrap your arms around theabdomen. TO apply chest thrusts with casualty sitting or standing:

o Stand behind the casualty and wrap your armsaround his chest with your arms under his armpits.

o Make a fist with one hand and place the thumb sideof the fist in the middle of the breastbone (take care to avoid the tip of thebreastbone and the margins of the ribs).

o Grasp the fist with the other hand and exert thrustsFigure 2-21).

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o Each thrust should be delivered slowly, distinctly,and with the intent of relieving the obstruction.

o Perform chest thrusts until the obstruction isexpelled or the casualty becomes unconscious.

o If the casualty becomes unconscious, call for help asyou proceed with steps to open the airway and perform rescue breathing.(See task 081-831-1042,Perform Mouth-to-Mouth Resuscitation.)

2-14. Open an Obstructed AirwayCasualty Lying orUnconscious (081-831-1042)

The following procedures are used to expel an airway obstruction in acasualty who is lying down, who becomes unconscious, or is foundunconscious (the cause unknown):

If a casualty who is choking becomes unconscious, callfor help, open the airway, perform a finger sweep, and attempt rescuebreathing (paragraphs 2-2 through 2-4). If you still cannot administerrescue breathing due to an airway blockage, then remove the airwayobstruction using the procedures in steps a through ebelow.

If a casualty is unconscious when you find him (thecause unknown), assess or evaluate the situation, call for help, positionthe casualty on his back, open the airway, establish breathlessness, andattempt to perform rescue breathing (paragraphs 2-2through2-8).

a. Open the airway and attempt rescue breathing. (See task081-831-1042,Perform Mouth-to-Mouth Resuscitation.)

b. If still unable to ventilate the casualty, perform 6 to 10manual (abdominal or chest) thrusts. (Note that the abdominal thrustsare used when casualty does not have abdominal wounds; is not pregnantor extremely overweight.) To perform the abdominal thrusts:

(1) Kneel astride the casualtys thighs (Figure 2-22).

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(2) Place the heel of one hand against the casualtysabdomen (in the midline slightly above the navel but well below the tip ofthe breastbone). Place your other hand on top of the first one. Point yourfingers toward the casualtys head.

(3) Press into the casualtys abdomen with a quick, forwardand upward thrust. You can use your body weight to perform themaneuver. Deliver each thrust slowly and distinctly.

(4) Repeat the sequence of abdominal thrusts, finger sweep,and rescue breathing (attempt to ventilate) as long as necessary toremove the object from the obstructed airway. Seeparagraph dbelow.

(5) If the casualtys chest rises, proceed to feeling for pulse.

c. Apply chest thrusts. (Note that the chest thrust technique is

an alternate method that is used when the casualty has an abdominalwound, when the casualty is so large that you cannot wrap your armsaround the abdomen, or when the casualty is pregnant.) To perform thechest thrusts:

(1) Place the unconscious casualty on his back, face up, andopen his mouth. Kneel close to the side of the casualtys body.

o Locate the lower edge of the casualtys ribs withyour fingers. Run the fingers up along the rib cage to the notch (Figure2-23A).

o Place the middle finger on the notch and the indexfinger next to the middle finger on the lower edge of the breastbone. Place

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the heel of the other hand on the lower half of the breastbone next to the

two fingers (Figure 2-23B). Remove the fingers from the notch and place that

hand on top of the positioned hand on the breastbone, extending orinterlocking the fingers (Figure 2-23C).

Straighten and lock your elbows with yourshoulders directly above your hands without bending the elbows,rocking, or allowing the shoulders to sag. Apply enough pressure todepress the breastbone 1 to 2 inches, then release the pressurecompletely (Figure 2-23D). Do this 6to 10 times. Each thrust should bedelivered slowly and distinctly. SeeFigure 2-24 for another view of thebreastbone being depressed.

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(2) Repeat the sequence of chest thrust, finger sweep, andrescue breathing as long as necessary to clear the object from theobstructed airway. See paragraph dbelow.

(3) If the casualtys chest rises, proceed to feeling for hispulse.

d. Finger Sweep. If you still cannot administer rescue breathingdue to an airway obstruction, then remove the airway obstruction usingthe procedures in steps (1) and (2) below.

(1) Place the casualty on his back, face up, turn theunconscious casualty as a unit, and call out for help.

(2) Perform finger sweep, keep casualty face up, use tongue-jaw lift to open mouth.

Open the casualtys mouth by grasping both his

tongue and lower jaw between your thumb and fingers and lifting(tongue-jaw lift) (Figure 2-25). If you are unable to open his mouth, crossyour fingers and thumb (crossed-finger method) and push his teeth apart(Figure 2-26) by pressing your thumb against his upper teeth andpressing your finger against his lower teeth.

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Insert the index finger of the other hand downalong the inside of his cheek to the base of the tongue. Use a hooking

motion fromthe side of the mouth toward the center to dislodge theforeign body (Figure 2-27).

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WARNING

Take care not to force the object deeper intothe airway by pushing it with the finger.

Section II. STOP THE BLEEDING AND PROTECT THE WOUND

2-15. Clothing (081-831-1016)

In evaluating the casualty for location, type, and size of the wound orinjury, cut or tear his clothing and carefully expose the entire area of thewound. This procedure is necessary to avoid further contamination,Clothing stuck to the wound should be left in place to avoid furtherinjury. DO NOT touch the wound; keep it as clean as possible.

WARNING (081-831-1016)

DO NOT REMOVE protective clothing in achemical environment. Apply dressings over

the protective clothing.

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2-16. Entrance and Exit Wounds

Before applying the dressing, carefully examine the casualty todetermine if there is more than one wound. A missile may have entered atone point and exited at another point. The EXIT wound is usuallyLARGER than the entrance wound.

WARNING

Casualty should be continually monitored fordevelopment of conditions which may requirethe performance of necessary basic lifesavingmeasures, such as clearing the airway andmouth-to-mouth resuscitation. All open (orpenetrating) wounds should be checked for apoint of entry and exit and treatedaccordingly.

WARNING

If the missile lodges in the body (fails to exit),DO NOT attempt to remove it or probe thewound. Apply a dressing. If there is an objectextending from (impaled in) the wound, DONOT remove the object. Apply a dressingaround the object and use additionalimprovised bulky materials dressings (use the

cleanest material available) to build up the a

Documents

US Army First Aid for Soldiers FM 21-11