examinations for combat lifesaver certification and recertification. All of the CONDITIONS: Given a combat lifesaver medical equipment set and a casualty with. Interschool Subcourse , Combat Lifesaver Course: Student Self-Study, CONDITIONS: Given a combat lifesaver aid bag and a casualty with one or more . filename=/docs/doc/pdf. DIGITAL VERSION AVAILABLE. A digital version of this CALL publication is available to view, download, or reproduce from.
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Public Lands Institute. Combat Lifesaver Course. Telemedicine and Advanced Technology Research Center. Follow this and additional works at. Tactical Combat Casualty Care (TCCC) has saved hundreds of lives during our nation's conflicts in Iraq and Afghanistan. Nearly 90 percent of combat fatalities. US Army IS medical course – Combat Lifesaver Course CC The "D" edition of the Combat Lifesaver Course replaces the previous "C" Inte.
Your instructor, the staff surgeon combat lifesaver supervisor, or previous instructors of the CL course may be able to give you an idea of how much extra to have on hand. The combat lifesaver program is a continuous ongoing program and requires continuous equipment and material support for the already qualified CLs. Be sure to maintain contact with your supply source to ensure your CL supplies are programmed into the system.
Resupply, during field operations, is accomplished in the same manner as during garrison operations with two exceptions. Field medical units maintain stocks of medical material with which to effect resupply of combat lifesaver aid bags during field operations. Reserve facilities. The facilities should allow the students to clearly see the demonstrations and provide plenty of room for student practice. Make sure there are enough tables and chairs available for the number of students participating.
Inform instructor, assistant instructors, and students: a. Instructor and assistant instructors. If you are not the medical instructor, the arrangements and documentation should be provided to the primary instructor. The instructor is responsible to verify the shipment is complete and to distribute the subcourses to the students.
If classes on IS immediately follow testing on IS, then distribute both subcourses at the same time. CLS 5. It is important to realize that civilian trauma care in a non-tactical setting is dissimilar to trauma care in a combat environment. TCCC and CLS are an attempt to better prepare medical and non-medical personnel for the unique factors associated with combat trauma casualties.
This fact illustrates the importance of first responder care at the point of injury. TCCC was originally a US Special Operations research project which was composed of trauma management guidelines focusing on casualty care at the point of injury. This multiservice committee is comprised of military and civilian trauma specialists, operational physicians, and combat medical personnel. The CoTCCC is responsible for updating the guidelines based on current civilian and military trauma care, medical research, and combat doctrine.
Three preventable causes of death on the battlefield, see Figure 1: Prevent additional casualties — Continued fire superiority, performing the correct intervention at the correct time. Complete the mission — Mission accomplishment is paramount but the number and severity of casualties may require a contingency plan be considered. The 3 phases of CLS care during hostile engagements focus on eliminating threats first, then focusing on casualty management.
Equipment limitations are still an issue. Apply occlusive material to cover sucking chest wound and combat gauze is the hemostatic agent of choice. Expose and clearly mark tourniquet time. Document on casualty card. Additional personnel and equipment may be pre-staged for continued casualty care. Movement from forward edge of battle area, aircraft may be exposed to hostile fire. From one point of care to another in theater.
Combat Lifesaver Medical Gear a. Overview - Knowledge of how the human body is constructed and how it works is an important part of the training of everyone concerned with healing the sick or managing conditions following injuries.
The human body is a combination of organ systems, with a supporting framework of muscles and bones and an external covering of skin. It supports and gives shape to the body; protects vital organs; and provides sites of attachment for tendons, muscles, and ligaments.
The skeletal bones are joined members that make muscle movement possible. See Figure-1 2 Axial Skeleton - The axial skeleton consists of the skull, spinal column and rib cage. The action of the muscle is determined mainly by the kind of joint it is associated with and the way the muscle is attached to the joint. Muscle seldom act alone, they usually working in groups to provide movement. Conscious or unconscious casualty. This casualty will have spontaneously open eyes, will respond to voice although may be confused and will have bodily motor function.
The response could be as little as a grunt, moan, or slight move of a limb when prompted by the voice of the CLS. A fully conscious casualty would normally locate the pain and push it away; however, a casualty who is not alert and who has not responded to is likely to exhibit only withdrawal from pain, or even involuntary flexion or extension of the limbs from the pain stimulus.
Breathing Process. All humans must have oxygen to live. Through the breathing process, the lungs draw oxygen from the air and put it into the blood. The heart pumps the blood through the body to be used by the cells that require a constant supply of oxygen.
Some cells are more dependent on a constant supply of oxygen than others. For example, cells of the brain may die within 4 to 6 minutes without oxygen. Once these cells die, they are lost forever since they do not regenerate. This could result in permanent brain damage, paralysis, or death. Respiration occurs when a person inhales oxygen is taken into the body and then exhales carbon dioxide [CO2] is expelled from the body. Respiration involves the airway, the lungs, and diaphragm. See Figure-2 1 Airway.
The airway consists of the nose, mouth, throat, voice box, and windpipe. It is the canal through which air passes to and from the lungs. The lungs are two elastic organs made up of thousands of tiny air spaces and covered by an airtight membrane. The bronchial tree is a part of the lungs. The diaphragm is a large dome-shaped muscle that separates the lungs from the abdominal cavity.
This muscle, which is controlled by the brain, regulates the breathing cycle. The normal breathing rate is about 12 to 20 breaths per minute. Respiration rhythm is classified as regular or irregular. A regular rhythm is when the interval between breaths is constant, and an irregular rhythm is when the interval between breaths varies. Respiration depth is classified as normal, deep, or shallow. Figure — 2 Respiratory System d.
Blood Circulation. The heart and the blood vessels arteries, veins, and capillaries circulate blood through the body tissues. The heart is divided into two separate halves, each acting as a pump.
See Figure — 3 1 The left side pumps oxygenated blood bright red through the arteries into the capillaries. This is know as the heartbeat, which is normally 60 to 80 beats per minute. Figure — 3 Circulatory System 4 The heart expands and contracts forcing blood through the arteries and veins in a pulsating manner. This cycle of expansion and contraction can be felt monitored at various points in the body and is called the pulse. The common points for checking the pulse are at the side of the neck carotid , groin femoral , and wrist radial.
The CLS must work from the furthest point away from the heart to get the highest blood pressure. Skin becomes pale when blood is shunted away from an area. Bluish coloration indicates incomplete oxygenation. Examination of the nail beds and mucous membranes serves to overcome the difference in skin pigments. Changes in color first appear in lips, gums or fingertips. Cool skin indicates decreased perfusion, regardless of cause.
Moist skin is associated with shock and decreased perfusion. This is a tool in estimating blood flow through the most distal part of the circulation. Should be less than 3 seconds. Greater than 3 Seconds indicate a potential circulatory problem.
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Lack of Oxygen. Human life cannot exist without a continuous intake of oxygen. Lack of oxygen rapidly leads to death. First aid involves knowing how to open the airway and restore breathing.
CLS providers have 4 to 6 minutes to provide an adequate airway. Life-Threatening Hemorrhage Bleeding. Human life cannot continue without an adequate volume of blood circulating through the body to carry oxygen to the tissues.
An important first aid measure is to stop the bleeding to prevent the loss of blood. CLS providers have seconds to stop the massive life- threatening hemorrhage.
Shock means there is an inadequate blood flow to the vital tissues and organs. Shock that remains uncorrected may result in death even though the injury or condition causing the shock would not otherwise be fatal. Shock can result from many causes, such as loss of blood, loss of fluid from deep burns, pain, and reaction to the sight of a wound or blood. The objective is to keep wounds clean and free of organisms.
A good working knowledge of basic first aid measures also includes knowing how to dress a wound to avoid infection or additional contamination. Of the battlefield casualties who die, approximately 65 percent will die of massive, multi-system trauma and are probably not salvageable. These wounds may be fatal within minutes. In a combat environment, the treatment of a life-threatening hemorrhage is the first priority.
This is because the brain can go 4 to 6 minutes without oxygen before permanent brain damage occurs. The heart pushes oxygen rich blood through the arteries and into the capillaries where oxygen is dropped off and carbon dioxide is picked up. Once that exchange has taken place, the blood is then pushed into the veins back into the heart. The heart sends that blood to the lungs where it picks up more oxygen and then continues that cycle.
Types of Hemorrhage 1 Arterial. Venous bleeding is characterized by a steady, even flow. If capillaries bleed, the blood oozes out slowly. Any arterial bleed is life threatening. Some venous bleeds are considered life threatening based off of how much blood is being lost and how quickly.
Slow venous bleeds and capillary bleeds. Bleeding from the arms, hands, legs or feet. Bleeding from head, neck, chest, back, abdomen, or pelvis. Either a commercially manufactured absorbent material or improvised materials used to cover and protect wounds from further injury, infection, or physical contamination.
Bandages A piece of gauze either commercially manufactured or improvised. It can be applied to wrap or bind a body part or dressing. Called by some the workhorse of the aid bag. Apply direct pressure to the wound with your gloved hand. Extremity wounds: Non-extremity wounds: Used to control life-threatening extremity hemorrhage.
Material such as rope, wire and string should not be used because they can cut into flesh. This will allow the windless to turn creating circumferenial pressure to stop the bleed. Leave it exposed over the uniform for open viewing.
Figure — 2 Improvised Tourniquet e. Hemostatic agent: Other previous hemostatic agents Quickclot, HemCon, etc. If multiple Combat Gauze rolls are needed, apply as many as necessary to completely pack the wound. Reassess wound to ensure bleeding is controlled. Combat Gauze may be repacked or a second gauze used if initial application fails. Do not remove the pressure dressing or the Combat Gauze.
Reassess the casualty to ensure bleeding remains controlled. Figure — 3 Combat Gauze 4. Apply direct pressure to the wound with your gloved hand b. Pressure dressings: The dressing should cover the entire wound and the bandage should cover the entire dressing. Do not tie the knot of the first bandage directly on the wound. This knot is tied directly on top of the wound. Anatomical Structures 1 The airway consists of the nose, mouth, throat, voice box and wind pipe.
It is the canal through which air passes to and from the lungs Figure 1. The lungs are protected by the rib cage, which is formed by the muscle-connected ribs, which join the spine in the back, and the breastbone in the front Figure 1. Contraction increases and relaxation decreases the size of the rib cage.
When the rib cage increases and then decreases, the air pressure in the lungs is first less and then more than the atmospheric pressure, thus causing the air to rush into and out of the lungs to equalize the pressure.
This cycle of inhaling and exhaling is repeated 12 to 20 times per minute Figure 1. Breathing Process 1 All humans must have oxygen to live. Some cells are more dependant on a constant supply of oxygen than others.
Respiration 1 Respiration occurs when a person inhales oxygen is taken into the body and then exhales carbon dioxide [CO2] is expelled from the body. The tongue is the most common cause for obstruction in an unconscious patient.
Proper Positioning of an Unresponsive Casualty 1 Placing a casualty flat on their back is the best position to work on maintaining an airway.
Repeat the procedure for the other arm Figure 2B. With your other hand, grasp the casualty under his far arm Figure 2C. Figure 2. Leave the upper leg in a flexed position to stabilize the body. Figure 4. If the lips close, the lower lip can be retracted with the thumb.
Figure 5. Trauma Chin Lift. Figure 6. Check for Breathing While Maintaining Airway 1 After establishing an open airway, it is important to maintain the airway in an open position. Types of Airway Adjuncts.
The NPA works well with both conscious and unconscious casualties. Figure 7. NPA b.
Traumatic chest injuries can be caused by a variety of mechanisms, including motor vehicle collisions, falls, sport injuries, crush injuries, stab wounds, and gun shot wounds. Most often, the organs injured are those that lie along the path of the penetrating object.
Tension Pneumothorax is the second leading cause of preventable death on the battlefield 1. Thorax chest cavity: See Figure-1 1 The skeletal portion of the thorax is a bony cage formed by the sternum, costal cartilages, ribs, and the bodies of the thoracic vertebrae.
Figure - 1 Thorax b. See Figure-2 1 A thin membranous lining that covers an organ. Figure - 2 Pleura c.
Once the body receives its oxygen; oxygen-deficient, carbon dioxide-rich blood returns to the lungs where the carbon dioxide is exhaled and new oxygen begins its process all over. Mediastinum - Area in the middle of the thoracic cavity in which all the other organs and structures of the chest cavity lie. The following are located within the mediastinum: Definition - A collection of air or gas in the pleural space causing the lung to collapse most often as a result of penetrating trauma such as a stab or gunshot wound.
Many small wounds will seal themselves. These wounds are of particular concern because of their potential to cause a tension pneumothorax. Some large wounds will be completely open, allowing air to enter and escape the pleural cavity. Causes - Most often the result of gunshot wounds, but they can also occur from other penetrating injuries, such as; impaled objects, shrapnel, stab wounds.
Motor vehicle accidents, and falls are also known causes of sucking chest wounds. Cover the wound with an occlusive dressing. Tape the dressing on four 4 sides to temporarily seal the wound and prevent the occurrence of a Tension Pneumothorax.
See figure-3 b.
Assess for associated penetrating chest trauma i. Monitor for signs and symptoms of Tension Pneumothorax. Definition - A self-sealing type of injury in which air can enter the pleural space but cannot escape via the route of entry. This leads to an increase of pressure in the pleural space and eventual collapse of the lung. Increasing pressure within the pleural space further collapses the lung on the affected side and forces the mediastinum to the opposite side.
This can result in two 2 serious consequences: See figure Cause — Penetrating chest trauma. This is the second leading cause of preventable death on the battlefield. A presumptive diagnosis of tension pneumothorax should be made when significant respiratory distress develops with penetrating trauma. A needle thoracentesis should be performed immediately.
A profile of combat injury.
The additional trauma caused by the needle would not be expected to significantly worsen their condition should he not actually have a Tension Pneumothorax. Treat chest injuries as appropriate i. Perform needle thoracentesis. This should be performed on all casualties with penetrating chest trauma with an increase of respiratory difficulty.
Needle Thoracentesis a. This provides a conduit for the release of accumulated pressure. Required Equipment 1 Alcohol or betadine swabs. See Figure-6 Figure — 6 Decompression Needle d.
This is approximately three 3 finger widths below the clavicle.
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Complications 1 Hemothorax - Blood within the pleural space. Caused when the needle punctures any of the vessels within the chest wall. The initial diagnosis of shock is based upon the presence of inadequate organ perfusion and tissue oxygenation.
The initial step for managing shock in the injured patient is to recognize its presence. Below are the parameters for estimating blood pressure: The cardiovascular system consists of a pump the heart , a container the vascular system , and circulating fluid the blood.
Pump — four 4 chambered muscle heart.
Container - arteries, veins, and capillaries. There are literally hundreds of classifications of shock in medical literature. Because uncontrolled hemorrhage and the shock that ensues is the number one cause of preventable death on the battlefield, we will focus our efforts there. Hemorrhagic Shock 1 Definition - Loss of blood or blood components. The heart and lungs are functioning normally; however, there is not enough circulating volume within the circulatory system to carry the required amount of oxygen to the body and its vital organs.
This is the most common cause of shock on the battlefield. The effects from a traumatic injury can vary from individual to individual.
Treatment should not be delayed and controlling major hemorrhage should be the first priority over securing an airway in a combat environment.
This is the most important step in shock prevention and treatment. Keep protective gear on, if feasible.
The most important function is to form a protective barrier against the external environment. The skin also prevents fluid loss, helps regulate body temperature, and allows for sensation. Skin is composed of three layers: See figure-1 1 The epidermis, which is the outermost layer, is made up entirely of skin cells with no blood vessels 2 Underlying the epidermis is the thicker dermis, made up of a framework of connective tissues containing blood vessels, nerve endings, sebaceous glands, and sweat glands.
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Figure - 1 Anatomy of the Skin 2. Overview - Burns are classified by the depth of the burn and the extent of the total body surface area TBSA of the burn. The severity of all burns will vary depending on the source of the burn, duration of exposure, and location of the burn. The depth of the burn is related to how deep the skin is damaged.
Due to the nature of burn injuries, final judgment of burn depth should be withheld for 48 hours after the injury occurs. Second degree burns can be classified as superficial or deep. Fourth-Degree Burns — A burn that not only encompasses all 3 layers but also includes underlying fat, muscles, bone, or internal organs.
Burn injuries have many causes on and off the battlefield. Burns are caused by exposure to extreme heat, a biologic reaction from chemicals, or energy transfer through cells from electrocution or radiation.
Many weapons and munitions cause burn injuries. Some, such as incendiary and flame munitions, are designed to cause high heat and burning. Others, such as high explosives, bombs, and mines cause burns secondarily to their primary effect. The four primary causes of burns are thermal, electrical, chemical, and radiant.
Thermal Burns: Thermal burns are the most common type of burn on the modern battlefield. These weapons are designed to burn at very high temperatures and incorporate napalm, thermite, magnesium, and white phosphorous. The primary effect of incendiary and flame munitions against personnel is to cause severe burns.
Due to the high burning temperature of these weapons, airway compromise must be considered. Its design and employment against personnel will result in many more burns than other devices.
Hottest burn and can rapidly melt through steel armor. This deserves special mention because it combusts with air and continues to burn until the oxygen source is removed. The casualty may be showered with WP fragments from a near-by explosion, which may become embedded in their skin. Electrical - Electrical burns may be far more serious than a preliminary examination may indicate.Fractured Clavicle 1 Immobilize using figure eight bandage.
CLS 2. Download pdf. These weapons are designed to burn at very high temperatures and incorporate napalm, thermite, magnesium, and white phosphorous. Fractured Pelvis 1 Check distal pulse 2 Place patient in position of comfort legs straight or knees bent.