Page 136 - JSOM Fall 2021

o If there is no protective equipment, treat the bleeding • Seizures
injuries. o Protect the airway and immobilize the patient for
o In the Green Zone, provide spine immobilization if safe transport.
there is pain in the neck or back or paralysis. o Use diazepam, propofol, or midazolam, according to
o Transport to medical center. the discretion of the physician or medical specialist.
• Burns o Transport to medical center.
o Stop the burning process and cover the casualty.
o Cover the burn injuries with dry sterile dressings.
o Transport the patient to the Green Zone.
o Estimate the total burned surface area by the Rule
of Nines.
o Initiate burn fluid resuscitation using the Parkland
formula and Ringer’s lactate solution.
o Always consider the chance of airway burn.
o Transport to medical center.

• Fractures
o Apply the MARCH protocol (Figure 3) and treat
hemorrhages.
o Immobilize.
o Cover wounds.
o Use pain relief medications if there are no contra -
indications.
o Transport to medical center.

• Open chest trauma
o Apply pressure in the injury.
o Use the chest seal to close the open injury.
o Beware the possibility of tension pneumothorax
development.

Specific Treatment Maneuvers
Tourniquet Placement
Place the tourniquet in the most proximal part of the extremity
as possible (Figure 17). Tighten the tourniquet until bleeding
stops and the distal pulse disappears, secure the tourniquet
by locking the windlass rod, and write down the time of
placement.

Use of Combat Gauze Hemostatic Dressing
• Dehydration for Hemorrhage Control
o If the casualty is awake, can protect the airway, there Place the end of the gauze over the dominant hand (Figure 18).
is no airway obstruction, and is able to swallow, re- Using the index finger, place the gauze continuously inside the
hydration should be performed orally. wound directly at the pulsatile artery until the wound is full.
o If the patient is unconscious and is not able to swal- Then place the remainder of the gauze directly over the wound
low, use intraosseous or intravenous access for fluid. and apply pressure for at least 3 minutes.

134 | JSOM Volume 21, Edition 3 / Fall 2021