EDIT: ILSTATEMILITIA ask me to move this post, as a courtesy to him, from the Militia Gear/Logistics forum where he had originally posted it. This EDIT has been added, and the post was moved in whole, without change. CDJ--05/16/2007@7:45 pm-PDT
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Situation: Your on patrol with your squad and your team is ambushed, under heavy fire, and there are explosions going off. One of your teammates yells that his battle buddy was hit by something during an explosion near them, and was thrown and he isn't responding to calls for him. Your squad has returned fire and the enemy has broken contact. With security in place, the patrol leader sends a battle to search for him and they find him unresponsive. They call for help. Your assignment is the "medic" for this patrol.
Upon arrival you find the patient breathing, but unresponsive, what do you do next?
The steps you should take next:
1. Is the scene safe?
2. You call the patients name and he remains unresponsive
so you will:
Perform a Sternum Rub. (Make a Fist with middle finger knuckle extended further than the others. Push the knuckles into the patients sternum and rub vertically while calling his name.
3. If he responds to it with a "moan" or flinch, he is classified as semi-responsive.
4. Since he was thrown, you should suspect a possible spinal injury and therefore have a teammate hold C-Spine stabilization. while you perform you rapid trauma assessment.
Your RTA will consist of placing both hands gently below that particular extremity.
When touching the extremity, you will be looking for the following: (DECAP-BTLS)
B-Burns
T-Tenderness (softness of tissue)
L-Lacerations (Cuts)
S-Swelling
After feeling for these, you will remove your hands and look at them for any signs of blood.
The order of the extremities to examine is as follows:
Head
neck
Arms
Upper Back
Mid Back
Lower Back and Buttocks
and then legs and feet.
Then in reverse you will examine the front of the body.
If nothing is found, you will still have the C-Spine stabilized. Now you can perform your Full Exam.
Presuming a spinal injury and / or possible broken neck, how do you move a patient so as not to further exascerbate a potentially fatal condition?
Presuming the scene is "Safe", I would place a C-Collar on the patient, if none available, his/her boots filled with sand placed on both sides of the head will work (According to my Medic Training from 2000). Standard spinal precautions would be used to include the "log-role" and place the pt on a sked-co litter. If you have not seen one, (to me) they look like a rolled up usgi sleeping pad but slightly bigger. These are made of a very hard plastic that when unrolled, the pt can be placed on and either carried, or even drug from. ,When used correctly, they can secure the pt enough to lessen a spinal cord injury.
As for an unsafe scene, the patient will have to wait until the scene can be made safe. Or the Doc or a brave platoon mate can play Hero and go get him and drag him to a safer area.
While going through training, I raised the question "wont dragging the patient liken the chances of a severe spinal cord injury?" My Army instructor answered with "if it means saving the patients life, which is better, death or paralysis? It will be up to you...the Doc."
On a personal note, I was faced with a "joe" that had fallen from a guard tower while we were being shelled with indirect fire at an airfield in Afghanistan. I chose to stay where we were, out in the open, to treat him.
No, I'm not "tooting my own horn", however, I want you all to see that you should use your best judgment in this type of situation.
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