Perform tactical combat casualty care

cls 68w

1. In the Vietnam conflict, over 2500
soldiers died due to hemorrhage
from wounds to the arms and legs
even though the soldiers had no
other serious injuries.

2. What Happened
This individual was wounded by an IED
(improvised explosive device). He sustained
a penetrating shrapnel injury to the neck with
laceration of his right common carotid artery
from which he bled to death.
What Might Have Saved Him
Sustained direct pressure
over the bleeding site
HemCon dressing
Faster evacuation

3. Combat Lifesaver
•Functioning as a Combat Lifesaver is your
secondary mission.
•Your primary mission is still your combat
duties.
•You should render care only when such
care does not endanger your primary
mission.

5. Why CLS?

About 15 percent of the casualties
that die before reaching a medical
treatment facility can be saved if
proper measures are taken.
Stop severe bleeding (hemorrhaging)
Relieve tension pneumothorax
Restore the airway

6. The three goals of CLS
1. Save preventable deaths
2. Prevent additional casualties
3. Complete the mission

7. EQUIPMENT

8. Care Under Fire
•Care rendered by the medic or first
responder at the scene of the injury
while still under effective hostile fire
•Very limited as to the care you can
provide

9. Tactical Field Care
•Care rendered once you are no longer
under effective hostile fire
•You and the casualty are safe and you are
free to provide casualty care (primary
mission is complete)

10. Combat Casualty Evacuation
Care
•Care rendered during casualty evacuation
•Call Medivac and set up LZ
•Additional medical personnel and
equipment may have been pre-staged and
available at this stage of casualty
management

11. Care Under Fire

12. Care Under Fire
•If the casualty can function, direct
him to return fire, move to cover, and
administer self-aid
•If unable to return fire or move to
safety and you cannot assist, tell the
casualty to “play dead”
• If a victim of a blast or penetrating
injury is found without a pulse,
respirations, or other signs of life,
DO NOT attempt CPR

13. •About 90 percent of combat deaths occur on
the battlefield before the casualties reach a
medical treatment facility (MTF). Most of
these deaths cannot be prevented by you
or the medic. Examples: Massive head
injury, massive trauma to the body.

14. Care Under Fire
•move casualty to
cover quickly
•If the casualty has
severe bleeding from
a limb or has an
amputation, apply a
tourniquet
Improved First Aid Kit

15. Care Under Fire
•Hemorrhage from extremities is the
1
st
leading cause of preventable
combat deaths
•Prompt use of tourniquets to stop
the bleeding may be life-saving in
this phase

16. Combat Application Tourniquet
(CAT)
WINDLASS
OMNI TAPE BAND
WINDLASS STRAP

17. Tourniquets

18. Tactical Field Care

19. Tactical Field Care
•Perform tactical field care when you
and the casualty are not under direct
enemy fire.
•Recheck bleeding control measures if
they were applied while under fire.

20. Tactical Field Care
Casualties with confused mental status
should be disarmed immediately of both
weapons and grenades.

21. Tactical Field Care
•Initial assessment is the ABCs
–Airway
–Breathing
–Circulation

22. Tactical Field Care: Airway
•Open the airway with a chin-lift or jaw-thrust
maneuver
•If unconscious and spontaneously breathing,
insert a nasopharyngeal airway
•Place the casualty in the recovery position

23. Nasopharyngeal Airway

24. A survivable airway problem

25. Tactical Field Care: Breathing
•tension pneumothorax
–cover the wound with occlusive dressing
–Perform a needle chest decompression

27. Needle Chest Decompression

28. Tactical Field Care: Circulation
•Any bleeding site not previously
controlled should now be addressed
• Only the absolute minimum of
clothing should be removed, although
a thorough search for additional
injuries must be performed

29. Tactical Field Care: Circulation
•Apply a tourniquet to a major amputation of the
extremity
•Apply an emergency trauma bandage and direct
pressure to a severely bleeding wound
•If a tourniquet was previously applied, consider
changing to a pressure dressing and/or using
hemostatic dressings (HemCon) or hemostatic
powder (QuikClot) to control any additional
hemorrhage

30. Hemostatic Dressing

31. Tactical Field Care: Additional
injuries
•Splint fractures as circumstances
allow while verifying pulse and
prepare for evacuation
•Administer the Soldier’s Combat Pill
Pack

32. Combat Pill Pack

33. Combat Casualty Evacuation Care

34. Casevac Care
•If the casualty requires evacuation,
prepare the casualty
•Use a blanket to keep the casualty warm
•If the casualty is to be evacuated by
medical transport, you may need to
prepare and transmit a MEDEVAC request

35. Preservation of Amputation Parts
•Rinse amputated part free of debris
•Wrap loosely in saline-moistened sterile
gauze
•Seal amputated part in a plastic bag or
cravat
•Place in a cool container, do not freeze

•Never place amputated part in water
•Never place amputated part directly on ice
•Never use dry ice to cool an amputated part

37. Conclusion
“If during the next war you could do only
two things, (1) place a tourniquet and
(2) treat a tension pneumothorax, then
you can probably save between 70 and
90 percent of all the preventable deaths
on the battlefield.”
-COL Ron Bellamy

38. QUESTIONS?

39. United States Army Medical Material Agency (USAMMA)
http://www.usamma.army.mil/