introduction to the combat lifesaver course - UNC Charlotte Army ...

Section1INTRODUCTION TOTHE COMBAT LIFESAVERCOURSEKey Points1 Tactical Combat Casualty Care2 Performing Care Under Fire3 Performing Tactical Field Care4 Performing Combat Casualty Evacuation CareTactics andTechniques TrackeLeadership in the field depends to an important extenton one’s legs, and stomach, and nervous system, andone’s ability to withstand hardships, and lack of sleep,and still be disposed energetically and aggressivelyto command men, to dominate men in the battlefield.GEN George Marshall

Introduction to the Combat Lifesaver Course n 231IntroductionThe Army battle doctrine was developed for a mobile and widely dispersed battlefield.The doctrine recognizes that battlefield conditions will limit the ability of trainedmedical personnel, including combat medics, to provide immediate, far-forwardcare. Therefore, the Army developed a plan to provide additional care to injuredcombat Soldiers. The Combat Lifesaver Course is part of that plan. You will be requiredto attend and graduate from the course and certify as a Combat Lifesaver, addingto your leadership skills. A Combat Lifesaver (CLS) must recertify every year or attendthe entire course again. This section will introduce you to some of the proceduresyou will need to know to certify as a CLS.It’s important to recognize that up to 90 percent of combat deaths occuron the battlefield before the casualties reach a medical treatment facility (MTF).Most of these deaths are inevitable (massive trauma, massive head injuries, andso forth). Some conditions, however—such as bleeding from a wound in an armor leg, tension pneumothorax, and airway problems—can be treated on thebattlefield. This treatment can be the difference between a Soldier dying on thebattlefield or recovering in an MTF. Estimates hold that proper use of self-aid,buddy-aid, and Combat Lifesaver skills can reduce battlefield deaths by 15 percent.But remember that in combat, functioning as a CLS is your secondary mission.Your combat duties remain your primary mission. Your first priority while under fireis to return fire and kill the enemy. You should render care to injured Soldiers onlywhen such care does not endanger your primary mission.tensionpneumothoraxlung collapseTABLE 1.1Estimated Breakdown of Battlefield DeathsDEATHS DUE TO GROUND COMBAT31 percent—Penetrating head trauma25 percent—Surgically uncorrectable torso trauma10 percent—Potentially correctable surgical trauma9 percent—Exsanguination (bleeding out) from extremity wounds7 percent—Mutilating blast trauma5 percent—Tension pneumothorax1 percent—Airway problems12 percent—Died of wounds after evacuation to a MTF,mostly from infections and complications of shock

232 n SECTION 1CLS Course Trains Soldiers to Save LivesCAMP ATTERBURY, Ind.—When Soldiers are wounded in combat, the mostimmediate medical care available might be given by other Soldiers on thebattlefield, most of whom are not combat medics.Many Soldiers training at Camp Atterbury, Indiana, are taking the CombatLifesaver (CLS) Course offered by the 205th Infantry Brigade in order to preparethem for such situations.“I’m helping a Soldier save a life,” said SGT Stacey N. Edwards, CLS instructor,205th Infantry Brigade. “In Iraq and Afghanistan, 9 out of 10 times, a combatlifesaver will be able to treat a wounded Soldier before a medic will. Skills weare teaching them here save lives over there.”The Army requires 20 percent of personnel in each unit to be CombatLifesaver certified, said SGT Clint Higgins, CLS instructor, 205th Infantry Brigade.The four-day course involves 40 hours of training from Soldiers who arecombat medics. Eight hours of the course are taught in the warrior trainingcourse at Forward Operating Base Bayonet (on Camp Atterbury), said SGTChris W. Rhea, CLS instructor, 205th Infantry Brigade.The three main areas of preventable combat deaths addressed in the courseare bleeding out, lung collapse, and airway blockage. Nearly 90 percent ofthese deaths are due to these types of wounds, said SGT Anthony Bussing,a CLS instructor, 205th Infantry Brigade.If the CLS-certified Soldiers can initially treat these wounds, it will help medicssave more lives on the battlefield by enabling the wounded Soldiers to stay aliveuntil a medic can treat them. Not only does the CLS course here teach Soldiersthese skills, it also adds the stresses of a combat environment into the training,added Bussing.In the final exercise of the course, Soldiers break into teams and practiceCLS skills on each other in a simulated combat environment. Soldiers must weartheir Individual Body Armor, and those Soldiers who are mobilizing must alsocarry their weapons with them.

Introduction to the Combat Lifesaver Course n 233In addition to the IBA and weapons, the exercise also incorporates olduniforms for “casualties” to wear in order to make the training as realisticas possible.“We’ve been donated old uniforms,” said Rhea. “It adds to the realismbecause the students have to expose the (simulated) wound by cutting throughthe clothing.”After completing the course, Soldiers become more confident in their abilityto keep their fellow Soldiers alive if they are hurt on the battlefield.“If I have to perform the CLS tasks, I know what needs to be done,” saidSSG Gregory Dumas Jr., human resources specialist, 2nd Battalion 337th InfantryRegiment (Training Support Battalion), 205th Infantry Brigade. “I won’t beso nervous because the hands-on training was very realistic.”During the final exercise, the students also practiced inserting IVs in eachother to get hands-on experience.“I know that I have seen improvement in my ability to initialize an IV sinceyesterday when we practiced it in the classroom,” said Dumas.Edwards, who is a qualified combat medic, [says requiring] students to applythe skills they were taught in the classroom within a combat environment helpsto ensure that the Soldiers will be able to use them effectively anytime a realsituation does arise.Through the CLS course at Camp Atterbury and others like it throughoutthe Army, Soldiers become better prepared to overcome the stresses andcomplications, that occur on the battlefield, said Edwards.The Atterbury CrierMore than 2,500Soldiers died in Vietnambecause of hemorrhage(bleeding) fromextremity wounds(wounds to the armor leg) even thoughthe Soldiers had noother serious injuries.care under firecare rendered when youare under hostile fireand are very limited inthe care you can providetactical field carecare rendered whenyou and the casualty aresafe, and you are freeto provide casualty careto the best of your abilitycombat casualtyevacuation carecare rendered duringcasualty evacuation(CASEVAC) aboardnonmedical vehiclesor aircraftTactical Combat Casualty CareThere are three types of tactical combat casualty care:1. Care under fire: You are under hostile fire and are very limited in the careyou can provide.2. Tactical field care: You and the casualty are safe, and you are free to providecasualty care to the best of your ability.3. Combat casualty evacuation care: You render the care during casualty evacuation(CASEVAC). Casualty evacuation means moving casualties aboard nonmedicalvehicles or aircraft. You give combat casualty evacuation care while the casualtyis awaiting pickup or is being transported by a nonmedical vehicle.Casualty evacuation(CASEVAC) is differentfrom medical evacuation(MEDEVAC). WhileCASEVAC uses nonmedicaltransport, MEDEVACuses medical vehicles(ground ambulances),medical helicopters(air ambulances),or other medicaltransportation.

234 n SECTION 1Performing Care Under FireYou may have to render care at the scene of the injury while you (the CLS) and the casualtyare still under effective hostile fire. In such a situation, you should perform the following.If the casualty hasequipment that isessential to the mission,move the missionessentialequipmentalso. Do not try tomove equipment thatis not mission essential.You must determine therelative threat of thetactical situation versusthe risk to the casualty.Can you remove thecasualty to a place ofrelative safety withoutbecoming a casualtyyourself? Is the casualtysafer where he or she is?If possible, Soldiersshould seek assistancefrom their leader.1. Return fire as directed or required before providing medical treatment.2. Determine if the casualty is alive or dead.3. Provide tactical care to the live casualty. Remember, though, that reducingor eliminating enemy fire may be more important to the casualty’s survival thanthe treatment you can provide.• Suppress enemy fire• Use cover or concealment (smoke)• Direct the casualty to return fire, move to cover, and administer self-aid (such astaking measures to stop bleeding), if possible—if the casualty can’t move, and youcan’t move the casualty to cover, and the casualty is still under direct enemy fire,have the casualty “play dead”• Keep the casualty from sustaining additional wounds• Reassure the casualty.

Introduction to the Combat Lifesaver Course n 2354. If you decide you can safely move the casualty to a safe area, you may need toadminister lifesaving care (such as a tourniquet to stop bleeding) before movingthe casualty.• If the casualty is unresponsive, move the casualty and his or her weapon to coveras the tactical situation permits• If the casualty has severe bleeding from a limb (arm or leg) or has sufferedamputation of a limb, administer lifesaving hemorrhage control (i.e., apply atourniquet) before moving the casualty.5. Soldiers should communicate the medical situation to their team leader.6. Tactically transport the casualty, his or her weapon, and any mission-essentialequipment to cover.You render tactical fieldcare when no longerunder effective hostilefire. Tactical field carealso applies to situationsin which an injury hasoccurred on a mission,but there is no hostilefire, and the onlyavailable medicalequipment is whatthe CLS and individualSoldiers have carriedinto the field.7. Recheck the bleeding-control measures as the tactical situation permits.Performing Tactical Field CareYou perform tactical field care when you and the casualty are no longer under direct enemyfire. In general, you and your Soldiers should follow the following steps:1. Communication. Soldiers should communicate the medical situation to theirunit leader:• upon determining that the casualty can’t continue the mission• before initiating any medical procedures (ensure that the tactical situation allowsfor time to treat the casualty before initiating any medical procedures)• upon any significant change in the casualty’s status.2. General impression. Form a general impression of the casualty as you approach(extent of injuries, chance of survival, and so forth). Evaluate the tactical situation.3. Level of consciousness. When possible, determine the casualty’s level ofconsciousness using the AVPU system. Ask questions that require more thana “yes” or “no” answer; for example, “What is your name?” “What is the date?”“Where are we?” Recheck the casualty’s level of consciousness about every15 minutes to determine if the casualty’s condition has changed.4. Airway. Assess and secure the casualty’s airway.Maintaining a check onthe casualty’s level ofconsciousness isespecially importantwhen the casualty hassuffered a head injury.AVPU systema system tocommunicate acasualty’s statusA—The casualty is alert,knows who he or she is,the date, where youboth are, and so forthV—The casualty isnot alert, but respondsto verbal commandsP—The casualtyresponds to pain, butnot to verbal commandsU—The casualtyis unresponsive(unconscious)• If the casualty is conscious, can speak, and is not having trouble breathing, no airwayintervention is needed• If the casualty is unconscious, perform the following:• Use a head-tilt/chin-lift or jaw-thrust to open the airway. The head-tilt/chin-liftmethod is the normal method of opening the casualty’s airway. Use the jaw thrustmethod if you suspect that the casualty has suffered a spinal injury, in whichcase you don’t want to move the head

236 n SECTION 1Figure 1.1Unconscious casualty placed in the recovery position• Check the casualty for breathing. Place your ear over the casualty’s mouth andnose with your face toward the casualty’s chest while maintaining the casualty’sairway (head-tilt/chin-lift or jaw-thrust). Look for the rise and fall of the casualty’schest and abdomen. Listen for sounds of breathing. Feel for his or her breath onthe side of your face. If the casualty is not breathing, begin rescue breathing• If the casualty is breathing on his or her own, use a nasopharyngeal airway (NPA)device to maintain the airway• If the casualty has no additional injuries, roll the casualty into the recovery position(on his or her side). This allows accumulated blood and mucus to drain fromthe casualty’s mouth instead of choking the casualty.5. Chest. Assess and treat the casualty for chest injuries.• Expose the chest and check for equal rise and fall. Remove the minimum of clothingrequired to expose and treat injuries. Protect the casualty from the environment(heat and cold) as much as possible• Examine the chest for wounds. Check for both entrance and exit wounds (suckingchest wounds)• Immediately seal any penetrating injuries to the chest with airtight material. Sealone open chest wound with a three-sided seal (i.e., with one side of airtight materialleft untaped). Sealing the wound keeps air from entering the wound. If air can freelyenter through the wound, the casualty’s lung may collapse. The three-sided sealprevents air from entering the chest, but allows trapped air to escape• Monitor the casualty for increased difficulty breathing (severe respiratory distress—breathing becomes more labored and faster). If respiration becomes progressivelyworse, assume tension pneumothorax exists and decompress the affected chest sidewith a 14-gauge needle inserted at the second intercostal space (ICS) on midclavicularline (MCL). Secure the catheter in place with tape• If the casualty has been treated for an open chest wound, position or transport thecasualty with the affected (injured) side down, if possible. This way, the body pressureacts to “splint” the affected side.

Introduction to the Combat Lifesaver Course n 2376. Bleeding. Identify and control major bleeding.• Apply a tourniquet to a major amputation of the extremity (arm or leg)• Apply an emergency trauma bandage and direct pressure to a severely bleeding wound.• If conventional methods of controlling severe bleeding (emergency traumabandage, direct pressure, pressure dressing, hemostatic dressing, and so forth) donot control the bleeding on an extremity, apply a tourniquet• If a tourniquet was previously applied, consider changing the tourniquet to apressure dressing and/or using a hemostatic dressing to control bleeding. Loosenthe tourniquet, but do not remove it, while applying conventional methods ofcontrolling bleeding. If conventional methods can’t control the hemorrhage,retighten the tourniquet until the bleeding stops.7. Intravenous fluids. Determine if the casualty requires fluid resuscitation(replacement). Use your initial assessment, the casualty’s radial pulse (the pulseon the side of the wrist), and the casualty’s mental status to determine if fluidresuscitation is required. You can determine these items of information evenin the typical noisy and chaotic battlefield environment.• If the casualty has only superficial wounds, intravenous (IV) resuscitation is notnecessary, but you should encourage the casualty to drink. More than 50 percentof casualties are in this category• If the casualty has a significant wound to an extremity or to the trunk (neck,chest, abdomen, or pelvis), the casualty is coherent, and you can feel a radial pulse,insert a saline lock. Do not give intravenous fluids at this time, but continue tomonitor the casualty. Begin administering fluids intravenously if the casualty’smental status (which you rate using the AVPU system) decreases, or you can nolonger determine his or her radial pulse• If the casualty does not have a radial pulse, ensure that the bleeding has beencontrolled (using direct pressure, pressure dressings, hemostatic bandage, or atourniquet as needed). Insert a saline lock and begin administering intravenousfluids (one IV bag contains 500 milliliters [ml] of Hextend®) as rapidly as possible.Recheck the casualty’s pulse in 30 minutes.• If the radial pulse has returned, do not give any additional fluids. Monitor thecasualty’s pulse as frequently as possible• If the radial pulse does not return, give an additional 500 ml of Hextend® andevacuate the casualty as soon as possible.8. Other wounds. Identify and treat other wounds. Dress all wounds, including exitwounds. Remember to remove only the minimum of clothing required to exposeand treat the injuries. Protect the casualty against the environment (hot and coldtemperatures).9. Fractures. Splint any obvious long bone fractures.

238 n SECTION 110. Combat pill pack. Give pain medications and antibiotics to any Soldier woundedin combat, using the Soldier’s combat pill pack. Do not administer your own pack,since you may need it yourself, and you have no extra combat pill packs in youraid bag.11. Field Medical Card. Initiate a DD Form 1380, US Field Medical Card (FMC),to document the casualty’s injuries and the treatment given.Performing Combat Casualty Evacuation CareIn combat casualty evacuation care, you prepare the casualty for evacuation, if needed. Ifthe casualty will be evacuated by medical transport, you may need to prepare a MEDEVACrequest. If medical evacuation is not available, prepare the casualty for evacuation usingnonmedical means (CASEVAC).If the casualty can’t walk, transport him or her using a SKED® or improvised litter.If you evacuate an unconscious casualty on a nonmedical vehicle, the CLS may need toaccompany the casualty to monitor his or her airway, breathing, bleeding, and IV, and toreinforce the casualty’s dressings as needed.TABLE 1.2The Combat Lifesaver CourseThe Combat Lifesaver Course includes the following topics:Lesson 1: Performing Tactical Combat Casualty CareLesson 2: Evaluating a CasualtyLesson 3: Opening and Managing a Casualty’s AirwayLesson 4: Treating Penetrating Chest Trauma andDecompressing a Tension PneumothoraxLesson 5: Controlling BleedingLesson 6: Initiating a Saline Lock and Intravenous InfusionLesson 7: Initiating a Field Medical CardLesson 8: Requesting a Medical Evacuation (MEDEVAC)Lesson 9: Evacuating a Casualty Using a SKED ® or Improvised Litter

Introduction to the Combat Lifesaver Course n 239eCONCLUSIONThis introduction to the Combat Lifesaver Course aims to assist you in the futurewhen you will be required to attend and graduate from the course and certifyas a Combat Lifesaver, adding to your leadership skills. Remember, a CLS mustrecertify every year or attend the entire course again. The CLS program hasshown its value on the battlefield since its inception and will continue to assistSoldiers in saving lives.Key Wordstension pneumothoraxcare under firetactical field carecombat casualty evacuation careAVPU systemLearning Assessment1. List the top three causes of deaths due to ground combat.2. Compare and contrast the three phases of tactical combat casualty care.3. Discuss the three basic steps you should take if you encounter a casualtywhile under fire.4. Outline the 11 steps to performing tactical field care successfully.5. Explain when it is important to accompany a casualty you are evacuatingon a nonmedical vehicle.ReferencesAR 350-1, Army Training and Education. 13 January 2006.Campbell, A. (n.d.). CLS course trains Soldiers to save lives. The Atterbury Crier. Retrieved4 November 2008 from http://www.campatterbury.in.ng.mil/cls_trains.htmDA PAM 350-59, Army Correspondence Course Program Catalog. 1 October 2005.Field Manual 8-10-15, Employment of the Field and General Hospitals Tactics, Techniques,and Procedures. 26 March 1997.Sub-course ISO873, Combat Lifesaver Instructor Guide. September 2006.