Section III. GIVE PROPER FIRST AID FOR CHEST AND ABDOMINAL WOUNDS AND BURN INJURIES
3-9. Chest Wounds (081-831-1026)
Chest injuries may be caused by accidents, bullet or missile wounds, stab wounds, or falls. These injuries can be serious and may cause death quickly if proper treatment is not given. A casualty with a chest injury may complain of pain in the chest or shoulder area; he may have difficulty with his breathing. His chest may not rise normally when he breathes. The injury may cause the casualty to cough up blood and to have a rapid or a weak heartbeat. A casualty with an open chest wound has a punctured chest wall. The sucking sound heard when he breathes is caused by air leaking into his chest cavity. This particular type of wound is dangerous and will collapse the injured lung (Figure 3-21). Breathing becomes difficult for the casualty because the wound is open. The soldier’s life may depend upon how quickly you make the wound airtight.

3-10. Chest Wound(s) Procedure (081-831-1026)
* a. Evaluate the Casualty (081-831-1000). Be prepared to perform lifesaving measures. The basic lifesaving measures may include clearing the airway, rescue breathing, treatment for shock, and/or bleeding control.
b. Expose the Wound. If appropriate, cut or remove the casualty’s clothing to expose the entire area of the wound. Remember, DO NOT remove clothing that is stuck to the wound because additional injury may result. DO NOT attempt to clean the wound.

NOTE
Examine the casualty to see if there is an entry and/or exit wound. If there are two wounds (entry, exit), perform the same procedure for both wounds. Treat the more serious (heavier bleeding, larger) wound first. It may be necessary to improvise a dressing for the second wound by using strips of cloth, such as a torn T-shirt, or whatever material is available. Also, listen for sucking sounds to determine if the chest wall is punctured.

CAUTION
If there is an object extending from (impaled in) the wound, DO NOT remove the object. Apply a dressing around the object and use additional improvised bulky materials/dressings (use the cleanest materials available) to buildup the area around the object. Apply a supporting bandage over the bulky materials to hold them in place.

CAUTION (081-831-1026)
DO NOT REMOVE protective clothing in a chemical environment. Apply dressings over the protective clothing.

c. Open the Casualty’s Field Dressing Plastic Wrapper. The plastic wrapper is used with the field dressing to create an airtight seal. If a plastic wrapper is not available, or if an additional wound needs to be treated; cellophane, foil, the casualty’s poncho, or similar material may be used. The covering should be wide enough to extend 2 inches or more beyond the edges of the wound in all directions.
(1) Tear open one end of the casualty’s plastic wrapper covering the field dressing. Be careful not to destroy the wrapper and DO NOT touch the inside of the wrapper.
(2) Remove the inner packet (field dressing).
(3) Complete tearing open the empty plastic wrapper using as much of the wrapper as possible to create a flat surface.
d. Place the Wrapper Over the Wound (081-831-1026). Place the inside surface of the plastic wrapper directly over the wound when the casualty exhales and hold it in place (Figure 3-22). The casualty may hold the plastic wrapper in place if he is able.

e. Apply the Dressing to the Wound (081-831-1026). (1) Use your free hand and shake open the field dressing (Figure 3-23)

(2) Place the white side of the dressing on the plastic wrapper covering the wound (Figure 3-24).

NOTE (081-831-1026)
Use the casualty’s field dressing, not your own.

(3) Have the casualty breathe normally.
(4) While maintaining pressure on the dressing, grasp one tail of the field dressing with the other hand and wrap it around the casualty’s back.
(5) Wrap the other tail in the opposite direction, bringing both tails over the dressing (Figure 3-25).

(6) Tie the tails into a nonslip knot in the center of the dressing after the casualty exhales and before he inhales. This will aid in maintaining pressure on the bandage after it has been tied (Figure 3-26). Tie the dressing firmly enough to secure the dressing without interfering with the casualty’s breathing.

NOTE (081-831-1026)
When practical, apply direct manual pressure over the dressing for 5 to 10 minutes to help control the bleeding.

f. Position the Casualty (081-831-1026). Position the casualty on his injured side or in a sitting position, whichever makes breathing easier (Figure 3-27).

g. Seek Medical Aid. Contact medical personnel.

*WARNING
Even if an airtight dressing has been placed properly, air may still enter the chest cavity without having means to escape. This causes a life-threatening condition called tension pneumothorax. If the casualty’s condition (for example, difficulty breathing, shortness of breath, restlessness, or grayness of skin in a dark-skinned individual [or blueness in an individual with light skin]) worsens after placing the dressing, quickly lift or remove, then replace the airtight dressing.

3-11. Abdominal Wounds
The most serious abdominal wound is one in which an object penetrates the abdominal wall and pierces internal organs or large blood vessels. In these instances, bleeding may be severe and death can occur rapidly.

3-12. Abdominal Wound(s) Procedure (081-831-1025)
a. Evaluate the Casualty. Be prepared to perform basic lifesaving measures. It is necessary to check for both entry and exit wounds. If there are two wounds (entry and exit), treat the wound that appears more serious first (for example, the heavier bleeding, protruding organs, larger wound, and so forth). It may be necessary to improvise dressings for the second wound by using strips of cloth, a T-shirt, or the cleanest material available.
b. Position the Casualty. Place and maintain the casualty on his back with his knees in an upright (flexed) position (Figure 3-28). The knees-up position helps relieve pain, assists in the treatment of shock, prevents further exposure of the bowel (intestines) or abdominal organs, and helps relieve abdominal pressure by allowing the abdominal muscles to relax.

c. Expose the Wound.
(1) Remove the casualty’s loose clothing to expose the wound. However, DO NOT attempt to remove clothing that is stuck to the wound; it may cause further injury. Thus, remove any loose clothing from the wound but leave in place the clothing that is stuck.

CAUTION (081-831-1000 and 081-831-1025)
DO NOT REMOVE protective clothing in a chemical environment. Apply dressings over the protective clothing.

(2) Gently pick up any organs which may be on the ground Do this with a clean, dry dressing or with the cleanest available material, Place the organs on top of the casualty’s abdomen (Figure 3-29).

NOTE (081-831-1025)
• DO NOT probe, clean, or try to remove any foreign object from the abdomen.
• DO NOT touch with bare hands any exposed organs.
• DO NOT push organs back inside the body.

d. Apply the Field Dressing. Use the casualty’s field dressing not your own. If the field dressing is not large enough to cover the entire wound, the plastic wrapper from the dressing may be used to cover the wound first (placing the field dressing on top). Open the plastic wrapper carefully without touching the inner surface, if possible. If necessary other improvised dressings may be made from clothing, blankets, or the cleanest materials available because the field dressing and/or wrapper may not be large enough to cover the entire wound.

WARNING
If there is an object extending from the wound, DO NOT remove it. Place as much of the wrapper over the wound as possible without dislodging or moving the object. DO NOT place the wrapper over the object.

(1) Grasp the tails in both hands.
(2) Hold the dressing with the white, or cleanest, side down directly over the wound.
(3) Pull the dressing open and place it directly over the wound (Figure 3-30). If the casualty is able, he may hold the dressing in place.

(4) Hold the dressing in place with one hand and use the other hand to wrap one of the tails around the body.
(5) Wrap the other tail in the opposite direction until the dressing is completely covered. Leave enough of the tail for a knot.
(6) Loosely tie the tails with a nonslip knot at the casualty’s side (Figure 3-31).

WARNING
When dressing is applied, DO NOT put pressure on the wound or exposed internal parts, because pressure could cause further injury (vomiting, ruptured intestines, and so forth). Therefore, tie the dressing ties (tails) loosely at casualty’s side, not directly over the dressing.

(7) Tie the dressing firmly enough to prevent slipping without applying pressure to the-wound-site (Figure 3-32).

Field dressings can be covered with improvised reinforcement material (cravats, strips of torn T-shirt, or other cloth), if available, for additional support and protection. Tie improvised bandage on the opposite side of the dressing ties firmly enough to prevent slipping but without applying additional pressure to the wound.

CAUTION (081-831-1025)
DO NOT give casualties with abdominal wounds food nor water (moistening the lips is allowed).

e. Seek Medical Aid. Notify medical personnel.

3-13. Burn Injuries
Burns often cause extreme pain, scarring, or even death. Proper treatment will minimize further injury of the burned area. Before administering the proper first aid, you must be able to recognize the type of burn to be treated. There are four types of burns: (1) thermal burns caused by fire, hot objects, hot liquids, and gases or by nuclear blast or fire ball; (2) electrical burns caused by electrical wires, current, or lightning; (3) chemical burns caused by contact with wet or dry chemicals or white phosphorus (WP)—from marking rounds and grenades; and (4) laser burns.

3-14. First Aid for Burns (081-831-1007)
a. Eliminate the Source of the Burn. The source of the burn must be eliminated before any evaluation or treatment of the casualty can occur.
(1) Remove the casualty quickly and cover the thermal burn with any large nonsynthetic material, such as a field jacket. Roll the casualty on the ground to smother (put out) the flames (Figure 3-33).

CAUTION
Synthetic materials, such as nylon, may melt and cause further injury.

(2) Remove the electrical burn casualty from the electrical source by turning off the electrical current. DO NOT attempt to turn off the electricity if the source is not close by. Speed is critical, so DO NOT waste unnecessary time. If the electricity cannot be turned off, wrap any nonconductive material (dry rope, dry clothing, dry wood, and so forth) around the casualty’s back and shoulders and drag the casualty away from the electrical source (Figure 3-34). DO NOT make body-to-body contact with the casualty or touch any wires because you could also become an electrical burn casualty.

WARNING
High voltage electrical burns may cause temporary unconsciousness, difficulties in breathing, or difficulties with the heart (heartbeat).

(3) Remove the chemical from the burned casualty. Remove liquid chemicals by flushing with as much water as possible. If water is not available, use any nonflammable fluid to flush chemicals off the casualty. Remove dry chemicals by brushing off loose particles (DO NOT use the bare surface of your hand because you could become a chemical burn casualty) and then flush with large amounts of water, if available. If large amounts of water are not available, then NO water should be applied because small amounts of water applied to a dry chemical burn may cause a chemical reaction. When white phosphorous strikes the skin, smother with water, a wet cloth, or wet mud. Keep white phosphorous covered with a wet material to exclude air which will prevent the particles from burning.

WARNING
Small amounts of water applied to a dry chemical burn may cause a chemical reaction, transforming the dry chemical into an active burning substance.

(4) Remove the laser burn casualty from the source. (NOTE: Lasers produce a narrow amplified beam of light. The word laser means Light Amplification by Stimulated Emission of Radiation and sources include range finders, weapons/guidance, communication systems, and weapons simulations such as MILES.) When removing the casualty from the laser beam source, be careful not to enter the beam or you may become a casualty. Never look directly at the beam source and if possible, wear appropriate eye protection.

NOTE
After the casualty is removed from the source of the burn, he should be evaluated for conditions requiring basic lifesaving measures (Evaluate the Casualty).

b. Expose the Burn. Cut and gently lift away any clothing covering the burned area, without pulling clothing over the burns. Leave in place any clothing that is stuck to the burns. If the casualty’s hands or wrists have been burned, remove jewelry if possible without causing further injury (rings, watches, and so forth) and place in his pockets. This prevents the necessity to cut off jewelry since swelling usually occurs as a result of a burn.

CAUTION (081-831-1007)
• DO NOT lift or cut away clothing if in a chemical environment. Apply the dressing directly over the casualty’s protective clothing.
• DO NOT attempt to decontaminate skin where blisters have formed.

c. Apply a Field Dressing to the Burn.
(1) Grasp the tails of the casualty’s dressing in both hands.
(2) Hold the dressing directly over the wound with the white (sterile) side down, pull the dressing open, and place it directly over the wound. If the casualty is able, he may hold the dressing in place.
(3) Hold the dressing in place with one hand and use the other hand to wrap one of the tails around the limbs or the body.
(4) Wrap the other tail in the opposite direction until the dressing is completely covered.
(5) Tie the tails into a knot over the outer edge of the dressing. The dressing should be applied lightly over the burn. Ensure that dressing is applied firmly enough to prevent it from slipping.

NOTE
Use the cleanest improvised dressing material available if a field dressing is not available or if it is not large enough for the entire wound.

d. Take the Following Precautions (081-831-1007):
• DO NOT place the dressing over the face or genital area.
• DO NOT break the blisters.
• DO NOT apply grease or ointments to the burns.
For electrical burns, check for both an entry and exit burn from the passage of electricity through the body. Exit burns may appear on any area of the body despite location of entry burn.
• For burns caused by wet or dry chemicals, flush the burns with large amounts of water and cover with a dry dressing.
• For burns caused by white phosphorus (WP), flush the area with water, then cover with a wet material, dressing, or mud to exclude the air and keep the WP particles from burning.
• For laser burns, apply a field dressing.
• If the casualty is conscious and not nauseated, give him small amounts of water.
e. Seek Medical Aid. Notify medical personnel.

Continue to Apply Proper Bandages to Upper and Lower Extremities

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