BASIC MILITARY REQUIREMENTS

b. Shortness of breath: If the victim hasa chest injury or breathing difficulties, place the victim in a sitting or semisitting position. c. Shock: If the victim is in shock, place the victim on his or her back with the head slightly lower than the feet. (Shock ise xplained later in this chapter.) 2. Move the victim no more than is absolutely necessary. To determine the extent of the victim’s injuries, carefully rip or cut the clothing along the seams. Removal of clothing in the normalw ay may make injuriesw orse, especially if fracture injuries are involved. Shoes may also be cut off toa void causing pain or increasing an injury. When the clothing is removed, make sure the victim does not become chilled. 3.K eep the victim reassured and as comfortable as possible. If possible, don’tlet the victim see his or her injuries. The victim can endure pain and discomfort better if he or she is confident of your abilities. 4. Don’ttouch openw ounds orb urns withf ingers or other objectse xcept when sterile compresses or bandages aren’t available and it’sabsolutely necessary to stop severe bleeding. 5. Don’t try to give an unconscious person any solid or liquid substance by mouth. The person may vomit and get some of the material into the lungs when he or she breathes, causing choking and possibly death. 6. Ifa bone is broken or you suspect that one is broken, don’t move the victim until you have immobilized the injured part. That may prove lifesaving in cases of severe bone fractures or spinal cord injuries, for the jagged bone may sever nerves and bloodv essels, damage tissues, and increase shock. Of course, threat of fire, necessity to abandon ship, or other similar situations may require that you move the victim. But alwaysk eep in mind the principle that moving the victim could do further damage; always weigh the risk of moving the victim against other factors. 7. When transporting an injured person, always see that the litter is carried feet forward no matter what the injuries are. Carrying the litter thisw ay lets the rear bearer observe the victim for any respiratory obstruction or stoppage of breathing. 8. Keep the injured person comfortably warm—warm enough to maintain normal body temperature. Very serious and mutilating injuries may require heroicf irst-aid measures on your part. However, the greater the number of injuries, the more judgment and self-control you muste xhibit to prevent yourself and well-intentioned bystanders from trying to do too much. REVIEW 1 QUESTIONS Q1. Describe the primary purpose of first aid. Q2. List the primary tasks when administeringf irst aid. a. b. c. Q3. Describe the general first-aid rule for the following conditions: a. Shock b. Broken bones c.T ransporting injured personnel ARTIFICIAL VENTILATION Learning Objective: When youf inish this chapter, you will be able to— • Recall the procedures used to administer artificial ventilation. 14-2 Student Notes:

A person who has stopped breathing may not be deadb ut is in immediate critical danger.Life depends on oxygen that is breathed into the lungs and then carried by the blood toe very body cell. Since body cells can’t store oxygen and the blood can hold onlya limited amount (and only fora short time), death will result from a continued lack of oxygen. The heart may continue to beat and the blood may still be circulated to the body cells for some time after breathing has stopped.F ora short time, blood will containa small supply of oxygen; therefore, the body cellsw on’tdie immediately. Forav ery few minutes, there’s achance that the person’slife may be saved. A person who’sstopped breathingb ut who is still alive is ina state of respiratory failure. Thef irst-aid treatment for respiratory failure is artificial ventilation. Artificialv entilation provides aire xchange until natural breathing is reestablished. Artificialv entilation should be given only when natural breathing has stopped. Never give artificial ventilation to any person who is still breathing. Don’tassume breathing has stopped ifa person is unconscious or ifa person has been rescued from the water, from poisonousg as, or from contact with an electrical wire. Remember, never give artificial ventilation toa person who is breathing naturally. If the victim doesn’tbegin spontaneous breathing (breaths by himself/herself) after using the head or jaw tilt techniques (discussed later) to open the airway, give artificialv entilation immediately. Ifa blocked airway prevents ventilation, one of the “thrust” methods (discussed later) to clear the airway must be performed, followed by another attempt at artificial ventilation. MOUTH TO MOUTH To perform mouth-to-mouthv entilation, take the following steps: 1. Clear the victim’smouth of obstructions (false teeth and foreign matter). 2. Place the heel of one hand on the victim’s forehead, and use the other hand placed under the chin to tilt back the head to open the airway. 3. Using the thumb and index f inger, pinch the nostrils shut. 4.T ake a deep breath, cover the victim’s mouth with your own, and blow. 5. Then remove your mouth from the victim to allow him or her to exhale. Observe the victim’s chest for movement. If the victim hasn’tstarted to breathe normally, start artificial ventilation with four quickv entilations in succession, letting the lungs inflate only partially. If the victim still doesn’trespond, then you must fully inflate the victim’s lungs at the rate of 12 to 15v entilations per minute, or one breath every 5 seconds. MOUTH TO NOSE Mouth-to-nosev entilation is effective when the victim hase xtensive facial or dental injuries or isv ery young. Mouth-to-nosev entilation creates an effective air seal. To administer this mouth-to-nose ventilation— 1. Place the heel of one hand on the victim’s forehead and use the other hand to lift the jaw. 2. After sealing the victim’s lips, take a deep breath, place your lipso ver the victim’snose, and blow. Observe the chest for movement and place your ear next to the victim’s nose to listen for or feel air exchange. Again, you must continue your efforts at the rate of 12 to 15v entilations per minute, or one breath every5 seconds, until the victim can breathe without assistance. Sometimes during artificialv entilation air enters the stomach instead of the lungs. This condition is called gastric distention. It can be relieved by moderate pressuree xerted witha flat hand between the navel and the rib cage. Before applying pressure, turn the victim’s head to the side to prevent choking on the stomach contents that are often brought up during the process. BACK PRESSURE/ARM LIFT The back pressure/arm lift method is an alternate technique used when other methods are not possible.To 14-3 Student Notes:

perform the back pressure/arm lift method, do the following steps: 1. Place the victim on the stomach,f ace to one side, neckh ypere xtend, with hands under the head. 2. Quickly clear the mouth of any foreign matter. 3. Kneel at the victim’shead and place your hands on the victim’s back so that the heels of the hands lie just below a line between the armpits, with thumbs touching andf ingerse xtending downward and outward. 4. Rock forward,k eeping your arms straight, and exert pressure almost directly downward on the victim’s back, forcing air out of the lungs. 5. Then rock backward, releasing the pressure and grasping the arms just above the elbows. 6. Continue to rock backward, pulling the arms upward and inward (toward the head) until resistance and tension in the victim’sshoulders are noted. Thate xpands the chest, causing active intake of air (inspiration). 7. Rock forward and release the victim’s arms. That causes passive exiting of air (expiration). Repeat thec ycle of press,r elease, lift, and release 10 to 12 timesa minute until the victim can breathe naturally. CARDIAC ARREST AND CARDIOPULMONARY RESUSCITATION Learning Objective: When youf inish this chapter, you will be able to— • Recall the procedures to administer cardiopulmonary resuscitation (CPR). Cardiac arrest is the complete stoppage of heart function. If the victim is to live, action must be taken immediately to restore heart function. The immediate administration of cardiopulmonary resuscitation (CPR) bya rescuer using correct procedures greatly increases the chances ofa victim’s survival. CPR consists of external heart compression and artificialv entilation. The compression is performed on the outside of the chest, and the lungs are ventilated either by mouth-to-mouth or mouth-to-nose techniques. To be effective, CPR must be started within4 minutes of the onset of cardiac arrest. The victim should be lying on a firm surface. CAUTION A rescuer who has not been properly trained should not attempt CPR. (To learn CPR, you should take an approved course from a qualified CPR instructor.) Improperly done, CPR can cause serious damage. Therefore, it is never practiced ona healthy individual for training purposes;a training aid is used instead. ONE-RESCUER TECHNIQUE In an unwitnessed cardiac arrest, don’tassume that an arrest has occurred solely because the victim is lying on the floor and appears to be unconscious. Before beginning CPR, you should— 1.T ry to arouse the victim (shake the victim’s shoulders and shout to try to obtaina response). 2. Lie the unconscious victim on his/her back. 3. Kneel at the shoulders and establish an open airway, using the procedures outlined previously in artificialv entilations. 4. Check for breathing by looking, listening, and feeling. a. Look to see if the chest is rising andf alling. b. Listen for air coming from the mouth. c. Check close to the victim’smouth and feel for air coming out. 5. If the victim isn’tbreathing, seal the nose, take a deep breath, and blow four quick breaths into the victim without allowing time for the lungs to deflate fully. 6. Quickly remove your mouth and allow the victim to exhale by himself/herself. 7. Check the carotid pulse as shown inf igure 14-1. If no pulse is present, start CPR immediately. 14-4 Student Notes:

To start external cardiac compression— 1. Place the victim on his/her back, establish an open airway, and kneel at right angles to the victim’s body. 2. Then locate the victim’ssternum (breastbone) by— a. Baring the chest and locating the sternum by drawing an imaginary line from one nipple to the other to identify the proper area of the sternum, which is darkened in figure 14-2. b. Locating the lower tip of the sternum with the index and middlef ingers, placing the heels of your hands above yourf ingers in the darkened area. NOTE There isa small piece of cartilage at the lower end of the sternum (fig. 14-2). A fracture of this area can damage the liver, causing hemorrhage (heavy bleeding) and death. When you place the heels of your hands on the victim’s chest, stay above the tip of the sternum. 3. Place the heel of one hand directly on the sternum, and the heel of the other on top of the first. Figure 14-3, view A, shows this technique. Interlock yourf ingers, and keep them off the victim’s chest! 4. Lean or rock forward with elbows locked, and applyv ertical pressure to depress the sternum (adult) 1 ½ to 2 inches (fig. 14-3, view B). 5. Then release the pressure,k eeping the hands in place. 6. Administer 60 to 80 compressions per minute. You won’t get as tired if you use the proper technique, and you will be more effective. Ineffective compression occurs when the elbows are not locked, the rescuer is not directlyo ver the sternum, or the hands are improperly placed on the sternum. 14-5 Student Notes: Figure 14-1.— Feeling for the carotid pulse. Figure 14-2.—Locating the ste rnum. Figure 14-3.— Position for cardiac compression.

When one rescuer performs CPR, as shown in figure 14-4, the ratio of compressions tov entilations is 15 compressions to2v entilations (or 15 to 2). This ratio must continue for four fullc ycles. Then check for pulse and breathing. If there are still no signs of recovery, continue CPR until the victim can breathe unassisted or you are relieved by medical personnel. Before reviewing the next technique, let’sgoo ver the steps to take in an unwitnessed cardiac arrest involving one rescuer. 1. Determine whether the victim is conscious. 2. Check the vital signs. 3.V entilate four times. (You may have to remove an airway obstruction at this time.) 4. Again check the vital signs; if none— a Begin compression-ventilation rate of 15 to 2 for four complete cycles; b. Check pulse, breathing, pupils; if no change, c. Continue compression— ventilation rate of 15 to2 until victim is responsive or you are relieved by medical personnel. TWO-RESCUER TECHNIQUE If two people trained in CPR are on the scene, one performs compressions while the other performs artificialv entilation. The compression-ventilation ratio for two-person CPR is5 compressions to1v entilation (5 to 1). One rescuer is positioned at the chest area and the other beside the victim’shead. The rescuers should be on opposite sides of the victim. To avoid confusion, one rescuer is designated the leader. The leader makes the preliminary checks of the victim’s vital signs and performs the initial four ventilations. The second rescuer will perform the compressions. When CPR is started, the compressions should be given ina constant, methodical rhythm. The rescuer giving the compressions counts them out loud. As the fifth compression is released, the other rescuer ventilates the victim. Do not stop the compressions while ventilation is being given. AIRWAY BLOCKAGE Learning Objective: When youf inish this chapter, you will be able to— • Recall the procedures used to clear an airway passage. Obstruction in the upper airway (throat) is often caused by attempting to chew food and talk at the same time. One of the most reliable indications of an airway obstruction is the inability of the victim to speak. Other indicators are the victim’sgrasping or pointing at his or her throat,e xaggerated breathing efforts, and the skin turning a bluish color. Your first action upon encounteringa victim with this problem is to clear the mouth of any food particles, foreign objects, or loose dentures. If that is not effective, you should use one of the following procedures: 14-6 Student Notes: Figure 14-4.—One- rescuer CPR technique.

14-7 PROCEDURE STEPS Standing abdominal thrust 1. 2. 3. Stand behind the victim and wrap your arms around the victim’s waist (fig. 14-5). Grasp your wrist and place the thumb side of your fist against the victim’s abdomen, above the navel and just below the rib cage (fig. 14-6). Give four quick upward thrusts to the victim. The obstruction should pop out like a champagne cork. If unsuccessful, repeat until the obstruction is dislodged. Reclining abdominal thrust 1. 2. Position yourself for the thrust by either straddling the victim at the hips, straddling one leg, or kneeling at the victim’s hips. Place your hands one on top of the other in the area between the lower end of the sternum and the navel, and give four quick upward thrusts into the abdomen, as shown in figure 14-7. Standing chest thrust 1. 2. 3. Bring your arms under the arms of the victim and encircle the lower chest, as shown in figure 14-8. Grasp your wrist, keeping the thumb side close to the victim’s chest. (Keep your fist on the middle, not the lower part, of the sternum.) Press the chest with a sharp, backward thrust. Reclining chest thrust 1. 2. Kneel at either side of the victim, place hands in same position as used for CPR. Deliver thrusts slowly and downward on the sternum (fig. 14-9). Figure 14-5.— Position for standing abdominal thrust. Figure 14-6.—Cor rect hand positioning. Figure 14-7.— Position for reclining abdominal thrust.

REVIEW 2 QUESTIONS Q1. What is thef irst-aid treatment for respiratory failure? Q2. When should artificial ventilation be administered? Q3. List the three types of artificial ventilation. a. b. c. Q4. What is cardiac arrest? Q5.T o be effective, CPR must be started within how many minutes of the onset of cardiac arrest? Q6. When you use the one-rescuer technique of CPR, what is the ratio of compressions tov entilations? Q7. When you use the two-rescuer technique of CPR, what is the ratio of compressions tov entilations? Q8. List the symptoms of airway blockage. a. b. c. Q9. List the four methods you can use to clear a person’s airway. a. b. c. d. 14-8 Student Notes: Figure 14-8.— Position for standing chest thrust. Figure 14-9.— Position for reclining chest thrust.

HEMORRHAGE AND METHODS OF CONTROLLING BLEEDING Learning Objective: When youf inish this chapter, you will be able to— • Recall the procedures used to controle xternal bleeding. Blood is circulated throughout the body by three different kinds of blood vessels. 1. Arteries, which are largev essels that carry the blood away from the heart 2.V eins, which are largev essels that carry the blood back to the heart 3. Capillaries, which forma connecting network of smallerv essels between the arteries and the veins Hemorrhage (escape of blood) occurs whenever there isa break in thew all of one or more bloodv essels. In most small cuts, only capillaries are injured. Deeper wounds result in injury tov eins or arteries. Bleeding severe enough to endanger life seldom occurs except when arteries or veins are cut. Thea v erage adult body contains about5 quarts (4.75 liters) of blood. One pint of blood can usually be lost without harmful effect—i nf act, that’sthe amount usually given by blood donors. However, the loss of 2 pints (0.95 liter) will usually cause shock, and shock becomes greater as the amount of blood loss increases. (Shock will be discussed later in this chapter.) If half the blood in the body is lost, death almost always results. Capillary blood is usually brick red in color. If capillaries are cut, the blood oozes out slowly. Blood from thev eins is dark red. Ifav ein is cut, the blood escapes ina steady, even flow. If an artery near the surface is cut, the blood will gush out in spurts that are synchronized with the heartbeats;b ut if the cut artery is deeplyb uried, the bleeding will appear to bea steady stream. Arterial blood is usually bright red in color. In actual practice, you mightf ind it difficult to decide whether bleedingw as fromav ein or an artery; but the distinction is not usually important.A person can bleed to death quickly froma cut artery; prolonged bleeding from any large cut can, of course, have the same effect. The important thing to know is that all bleeding must be controlled as quickly as possible. The onlyw ay to stop serious bleeding is by the application of pressure. In practically all cases, bleeding can be stopped if pressure is applied directly to the wound. If direct pressure doesn’t stop the bleeding, pressure should be applied at the appropriate pressure point. In thosev ery rare cases where bleeding is so severe that it cannot be controlled by either of these methods, pressure can be applied bya tight constricting band. The actual procedures you should use to stop bleeding are shown in chart on pages 14-10 and 14-11. CAUTION Never put ona constricting band unless the hemorrhage is so severe that it cannot be controlled in any otherw ay.Oncea constricting band has been applied, it should be released only by medical personnel. BATTLE DRESSINGS Learning Objective: When youf inish this chapter, you will be able to— • Recall the procedures used to apply battle dressings. A battle dressing isa combination compress and bandage, in whicha sterileg auze pad isf astened to a gauze, muslin, or adhesive bandage. Most Navy first-aid kits contain both large and small battle dressings. Battle dressings are also supplied at battle dressing stations located throughout the ship. Any part ofa dressing that is to come into direct contact with a wound should be absolutely sterile. The dressing you find in Navyf irst-aid kits have been sterilized. Never toucha battle dressing with yourf ingers, clothing, or any other unsterile object. When applyinga battle dressing, make sure the dressing is the proper size so that it covers thew ound completely. Some wounds, such as protruding abdominal wounds, require the dressing to be moistened in sterilew ater. Battle dressing should be applied so it doesn’tallowthe dressing to moveor slip 14-9 Student Notes:

14-10 PROCEDURE STEPS Direct pressure In most cases, bleeding can be stopped by the application of pressure directly on the wound. • Placea dressing (sterile or clean, if possible) over the wound and firmly fasten it in position with a bandage. • If bleeding doesn’t stop, firmly secure another dressing over the first, or apply direct pressure with your hand to the dressing (fig. 14-10). • In cases of severe hemorrhage, don’t worry too much about the danger of infection. The basic problem is to stop the flow of blood. If no material is available, simply place your hand firmly on the wound. Remember, direct pressure is the first method to use when you are trying to control hemorrhage. Pressure points Bleeding froma cut artery or vein may often be controlled by applying pressure to the appropriate pressure point.A pressure point isa place where the main artery to the injured part lies near the skin surface and overa bone. Pressure at sucha point is applied with the fingers (digital pressure) or with the hand; no first-aid materials are required. The object of the pressure is to compress the artery against the bone, shutting off the flow of blood from the heart to the wound. There are 10 principal points (fig. 14-11) on each side of the body where hand or finger pressure can be used to stop hemorrhage. You should memorize these pressure points so that you will know immediately which point to use for hemorrhage froma particular part of the body. The correct pressure point you should use is the one that is— 1. Nearest the wound. 2. Between the wound and the main part of the body, or between the wound and the heart. Applying finger pressure is very tiring, and it can seldom be maintained for more than 15 minutes. Pressure points are recommended for use while direct pressure is being applied to a serious wound. While pressure is being applied at the appropriate pressure point, an assistant can bandage the wound (or wounds). If available,a battle dressing should be used. After opening the dressing, be careful not to contaminate it. Place the compress portion over the wound, then bind it tightly in place with the attached straps (fig. 14-12). If bleeding continues to be severe even after direct pressure and pressure points have been used, you may have to apply a constricting band. Constricting band A constricting band isa band used to cut off the supply of blood to an injured limb. It can’t be used to control bleeding from the head, neck, or body because its use in these locations would result in greater injury or death. Only usea constricting band when hemorrhage can’t be controlled by other means. A constricting band consists ofa pad,a band, anda device for tightening the band so that the blood vessels will be compressed. There are several different kinds of ready-made constricting bands.A variety of materials can be used to improvise constricting bands. Any round, smooth pressure object may be used for the pad (such asa compress,a roller bandage, a stone, ora rifle shell), and any long, flat material may be used as the band. Remember, the band must be flat! Belts, stockings, flat strips of rubber, or neckerchiefs can be used; but rope, wire, string, or very narrow pieces of cloth shouldn’t be used because they will cut into the flesh. A short stick may be used to twist the band, tightening the constricting band.

14-11 PROCEDURE STEPS Constricting band (Continued) A constricting band must always be applied above the wound; that is, toward the body, and it must be applied as close to the wound as practicable. The best object to be used for the pad is eithera pad, compress, or similar pressure object. The pad goes under the band. Place it directly over the artery, or it will actually decrease the pressure on the artery and allow greater flow of blood. Ifa constricting band placed over a pressure object doesn’t stop the bleeding, the pressure object is probably in the wrong place. If that occurs, shift the object around until the constricting band, when tightened, controls the bleeding. If no suitable pressure object is available, use the constricting band without it. To apply an emergency constricting band (fig. 14-13) made from something like a neckerchief— 1. Wrap the material (which isa minimum of2 inches wide) at least twice around the limb and tie an overhand knot. 2. Placea short stick on the overhand knot and tiea square knot over it. Then twist the stick rapidly to tighten the constricting band. The stick may be tied in place with another strip of material. To be effective,a constricting band must be tight enough to stop the blood flowing to the limb. If the pressure from the constricting band is less than the arterial pressure, arterial bleeding will continue. Also, insufficient constricting band pressure may actually increase the amount of bleeding from the veins. So be sure to draw the constricting band tight enough to stop the bleeding. However, don’t make it any tighter than necessary. After you have brought the bleeding under control with the constricting band, apply a sterile compress or dressing to the wound, and fasten it in position with a bandage. Some points to remember about using a constricting band are as follows: • Don’t usea constricting band unless you can’t control the bleeding by any other means. • Don’t usea constricting band for bleeding from the head, face, neck, or body. Use one only on the limbs. • Always applya constricting band above the wound and as close to the wound as possible. • Be sure you draw the constricting band tight enough to stop the bleeding, but don’t make it any tighter than necessary. • Don’t loosen a constricting band after it has been applied. Don’t covera constricting band witha dressing. If it’s necessary to cover the injured person in some way, make sure all other people concerned with the case know about the constricting band. Usinga crayon, skin pencil, or blood, makea large T on the victim’s forehead or ona medical tag attached to the wrist, and note the time the constricting band was applied.

14-12 Figure 14-11.—P ressure points for control of bleeding.

off thew ounded area. Oncea battle dressing has been applied toaw ound, it shouldn’tbe removede xcept by medical personnel. Each ship in the Navy holds periodic training onf irst aid. There are always new and updated techniques on how to administer first-aid procedures, including how to apply battle dressings. Pay particular attention to these training sessions and learn as must as you possibly can. REVIEW 3 QUESTIONS Q1. List the three types of bloodv essels the body uses to circulate blood. a. b. c. Q2. Under what condition is hemorrhage (bleeding) severe enough to endanger life? Q3.A loss of how many pints of blood will usually cause shock? Q4. What color is blood carried by (a) capillaries, (b) veins, and (c) arteries? a. b. c. Q5. What is the only way to stop serious bleeding? 14-13 Figure 14-10.—Di rect pressure. Figure 14-12.—Battle d ressing. Figure 14-13.— Applying a constricting band. Student Notes:

Q6. What is a constricting band? Q7. Whena battle dressing is applied, what person should release or remove it? Q8. What is a battle dressing? Q9. How should you apply a battle dressing? SHOCK Learning Objective: When youf inish this chapter, you will be able to— • Recognize the symptoms, prevention, and treatment of shock. If you’ve ever hit yourf inger witha hammer and felt—in addition to the pain—weak, dizzy, and nauseous, then you have experienceda mild form of shock. In this case, the symptoms appeared immediately after the injury, but they may not show up for several hours. Shock isa condition in which blood circulation is seriously disturbed. Crushed or fractured bones,b urns, prolonged bleeding, and asphyxia all cause shock. Shock may be slight or it may be severe enough to cause death. Because all traumatic injuries result in some form of shock, you should learn its symptoms and know how to treat the victim. HOW TO RECOGNIZE SHOCK A person who is going into shock may show quite a few signs or symptoms, some of which are indicated in figure 14-14, and are discussed in the following paragraphs. Remember, that signs of shock don’t always appear at the time of the injury; and, in many very serious cases, symptoms may not appear until hours later. The symptoms ofa person suffering from shock are caused, directly or indirectly, by the disturbance of the circulation of the blood. Symptoms of shock include the following: • The pulse is weak and rapid. • Breathing is likely to be shallow, rapid, and irregular, because the poor circulation of the blood affects the breathing center in the brain. • The temperature near the surface of the body is lowered because of the poor blood flow; so thef ace, arms, and legs feel cold to the touch. • Sweating is likely to be very noticeable. • A person in shock is usuallyv ery pale,b ut, in some cases, the skin may have abluish or reddish color. In the case of victims with dark skin, you may have to rely primarily on the color of the mucous membranes on the inside of the mouth or under thee yelid or under the nail bed.A person in or going into shock hasa bluish color to these membranes instead of a healthy pink. 14-14 Student Notes: Figure 14-14.—Symptoms of shock.

• The pupils of the eyes are usually dilated (enlarged). • A conscious person in shock may complain of thirst and have a feeling of weakness,f aintness, or dizziness. The victim may feel nauseous, restless, frightened, and/or anxious. As shock deepens, these signs gradually disappear and the victim becomes less and less responsive to what is going on. Even pain may not arouse the shock victim. Finally, the victim may become unconscious. You will not likely see all the symptoms of shock in any one case. Some of them may appear only in late stages of shock when the disturbance of the blood flow has become so great that the person’slife is in serious danger. Sometimes the signs of shock may be disguised by other signs of the injury. You must know what symptoms indicate the presence of shock,b ut don’t ever wait for symptoms to develop before beginning the treatment for shock. Remember, every seriously injured person is likely to develop serious shock! PREVENTION AND TREATMENT OF SHOCK You should begin treatment for shock as soon as possible. Prompt treatment may prevent shock or, if it has already developed, prevent its reachinga critical point. Keep the victim lying down and warm. If conscious, the victim should be encouraged and assured that expert medical help will arrive soon. Keep an injured person warm enough for comfort, but do not let the victim become overheated. The best position to use to prevent or to treat shock is one that encourages the flow of blood to the brain. If possible, place the injured person on his or her back on a bed,a cot, ora stretcher. Raise the lower end of the support about 12 inches so that the feet are higher than the head (fig. 14-15). If you can’t do that and it’s possible, raise the feet and legs enough to help the blood flow to the brain. Sometimes it’s possible to take advantage ofa natural slope of ground and place the victim so that the head is lower than the feet. Of course ine very case, you’ll have to consider what type of injury is present before you can decide on the best position. Here are some examples: • Ifa person hasa chestw ound, he/she may have so much trouble breathing that you will have to raise the head slightly. • If thef ace is flushed, rather than pale, or if you have any reason to suspecta head injury, don’t raise the feet. Instead, you shouldk eep the head level with or slightly higher than the feet. • If the person has broken bones, you will have to judge what positionw ould be best both for the fractures and for shock.A fractured spine must be immobilized before the victim is moved at all, if further injuries are to be avoided. If you have any doubts about the correct position to use, have the victim lie flat on his/her back. The basic positionf or treating shock is one in which the head is lower than the feet. Do the best you can under the particular circumstances to get the injured person into this position. In any case, never leta seriously injured person sit, stand, or walk around. Administer liquids sparingly, and not at all if medical attention will bea vailable withina short time. If necessary, small amounts ofw armw ater, tea, or coffee may be given toa victim who is conscious. Persons having seriousb urns are ane xception. Burn victims require large amounts of fluids.W ater, tea, fruit juices, and sugarw ater may be given freely toa victim who is conscious, able to swallow,and has no internal injuries. Slightly saltedw ater is also beneficial. Never give alcohol to a person in shock. An injured person may or may not be in pain. The amount of pain felt depends in part on the person’s physical condition and the type of injury. Extreme pain, if not relieved, can increase the degree of shock. Make 14-15 Student Notes: Figure 14-15.— Position for the treatment of shock.

the victim as comfortable as possible. Fractures should be immobilized and supported. Immobilization greatly reduces, and sometimes eliminates, pain. An injured person’sbody heat must be conserved. Therefore, heat is important in the treatment of shock. Exposure to cold, with resulting loss of body heat, can cause shock to develop or to becomew orse.Y ou will have to judge the amount of covering to use by considering the weather and the general circumstances of the accident. Oftena light covering will be enough to keep the casualty comfortable.W et clothing should be removed and dry covering provided,e ven ona hot day. Use blankets or any dry material to conserve body heat. Artificial means ofw arming (hotw ater bottles, heated bricks, heated sand) should not ordinarily be used. Artificial heat may cause loss of body fluids (by sweating), and it brings the blood closer to the surface, defeating the body’s own efforts to supply blood to the vital organs and to the brain. Also, thew arming agent may burn the victim. REVIEW 4 QUESTIONS Q1. What is shock? Q2. List the symptoms of shock. a. b. c. d. e. f. g. Q3.T rue orf alse.K eep an injured personw arm enough for comfort,b ut do not let the victim become overheated. Q4. If you suspecta person to be in shock, what is the best position for that person? SUICIDE Learning Objective: When youf inish this chapter, you will be able to— • Recognize suicidal tendencies and possible treatment. Suicide among young adults is a serious and growing problem. Among Navy personnel, approximately 10% of the Navy’s nonhostile active-duty deaths are caused by suicide. Among the leading causes of nonhostile deaths in the Navy, suicide ranks third behind accidents and heat-related causes. The most frequent suicide victims in the Navy are enlisted males between the ages of 17 and 24 and in paygrades E-1 to E-6. Why suicide? There isn’t asimple answer as to why people choose to kill themselves. Usually, some emotional trauma is so great they “justw ant to stop the pain.”They feel helpless, hopeless, andw orthless. They feel that suicide is the only way out. CAUSES OF SUICIDE Most suicides are caused by a combination of events that leada person to believe that suicide is the onlyw ay out. The following are some common causes of suicide: • The breakup ofa close relationship witha loved one or difficulties in interpersonal relationships • The death ofa loved one, spouse, child, parent, sibling, friend, or even a pet • The loss of social orf inancial status of thef amily 14-16 Student Notes:

• The compounding and disorienting effects of drugs and/or alcohol DEPRESSION Depression is often associated with suicide. In 75% to 80% of all suicides, depression isa contributing factor.Sadness and an occasional “case of the blues”are normal emotions. However, depression isn’t a normal emotional state. Depression isa deep sadness that’s present almost daily for at least 2 weeks. WHAT TO DO If you believe someone you know is suicidal, remember the following: • Take all threats seriously • Answer cries for help • Confront the problem • Tell the person you care • Listen actively • Get professional help • Don’t leave the person alone REVIEW 5 QUESTIONS Q1. In the Navy, who is the most frequent suicide victim? Q2. List the common causes of suicide. a. b. c. d. Q3. What condition is often associated with suicide? Q4. List some actions you should take if someone you know might be suicidal. a. b. c. d. e. f. g. BURNS Learning Objective: When youf inish this chapter, you will be able to— • Recognize the symptoms of, classification of, and first-aid treatment for burns. The seriousness of a burn depends on two factors—th ee xtent of theb urned area and the depth of theb urn. Shock can bee xpected fromb urns involving 15% or more of the body. Burns involving 20% endanger life.W ithout adequate treatment,b urns of over 30% are usuallyf atal. The depth of the injury determines whether it isaf irst-, second-, or third-degree burn. First-degreeb urns. First-degreeb urns are mildest. Symptoms are slight pain, redness, tenderness, and increased temperature of the affected area. Second-degreeb urns. Second-degreeb urns are more serious. The inner skin may be damaged, resulting in blistering, severe pain, some dehydration, and possible shock. 14-17 Student Notes:

Third-degreeb urns. Third-degreeb urns arew orst of all. The skin is destroyed, and possibly also the tissue and muscle beneath it. The skin may be charred, or it may be white and lifeless (from scalds). After the initial injury, pain may be less severe because of destroyed nerve ends. There may be chilling of the body. Some form of shock will result. Probably the most important aspect is thee xtent of theb urned area.Af irst-degreeb urn coveringa large area could be more serious thana small third-degree burn.A sunburn, fore xample, ranging from mild to serious, is easily obtained, particularly if you aren’t accustomed to thee xposure. If youf all asleep while sunbathing, possible second- ore ven third-degreeb urns might occur and could be fatal. The most effective immediate treatment ofb urns and of pain is as follows: 1. If theb urn area covers less than 20% of the body, immerse theb urned area in coldw ater, or apply cold compresses if immersion is impracticable. Cold water not only minimizes painb ut also reduces the burning effect in the deeper layers of the skin. Gently pat dry the area with lint-free cloth or gauze. 2. If theb urn area covers more than 20% of the body, apply sterile, dry bandages. Aspirin is also effective for the relief of pain. Continue treatment until no pain is felt when theb urned area ise xposed to the air. Burn victims require large amounts ofw ater, which should be slightly salted. Because of the nature of the injury, most burns are sterile. Therefore, the best treatment for uninfectedb urns is merely to protect the area by covering it with the cleanest (preferably sterile) dressing available. Some actions that should not be taken when dealing with burns are as follows: • Never apply ointments to a burn or use petrolatum gauze. • Don’t attempt to break blisters or to remove shreds of tissue or adhered particles of charred clothing. • Never applya greasy substance (butter, lard, or Vaseline™), antiseptic preparations, or ointments. These may cause further complications and interfere with later treatment by medical personnel. REVIEW 6 QUESTIONS Q1. Define the following types of burns: a. First-degree burn b. Second-degree burn c. Third-degree burn Q2. Ifab urn covers less than 20% ofa victim’sbody, you should immerse theb urned area in cold water or apply cold compresses. Why should you take these actions? Q3. Ifab urn covers more than 20% ofa victim’s body, what actions should you take? Q4. When treatingb urns, you should NEVER take which of the following actions? a. Apply petrolatum gauze b. Break blisters c. Apply butter, lard, or Vaseline™ d. Each of the above HEAT-RELATED PROBLEMS Learning Objective: When youf inish this chapter, you will be able to— • Recognize the symptoms of and first-aid treatment for heat-related illnesses. 14-18 Student Notes:

Look atf igure 14-16. Here, you seea comparison of the symptoms of heatstroke and heate xhaustion. These are dangers youf ace whenw orking ore xposed to conditions that might cause heatstroke or heat exhaustion. HEATSTROKE Sunstroke is more accurately called heatstroke since it is not necessary fora person to bee xposed to the sun for this condition to develop. It isa less commonb ut far more serious condition than heate xhaustion, since heatstroke has a 20% mortality rate. The more important feature of heatstroke is thee xtremely high body temperature (105 F [41 C] or higher) that accompanies it. In heatstroke, the victim has a breakdown of the sweating mechanism and is unable to eliminatee xcessive body heatb uilt up whilee xercising. If the body temperature rises too high, the brain, kidneys, and liver may be permanently damaged. Signs and symptoms of heatstroke. Sometimes the victim may have preliminary symptoms such as headache, nausea, dizziness, or weakness. Breathing will be deep and rapid atf irst, later shallow and almost absent. Usually the victim will be flushed,v ery dry,and very hot. The pupils will be constricted (pinpoint) and the pulse fast and strong. Treatment of heatstroke. When you providef irst aid for heatstroke, remember that this is a true life-and-death emergency. The longer the victim remains overheated, the higher the chances of irreversible body damage or even death. First-aid treatment for heatstroke is designed to reduce body heat and includes the following: • Reduce body heat immediately by dousing the body with coldw ater, or applying wet, cold towels to the whole body. • Move the victim to the coolest possible place and remove as much clothing as possible. • Maintain an open airway. • Place the victim on his or her back, with the head and shoulders slightly raised. • If cold packs area vailable, place them under the arms, around the neck, at the ankles, and on the groin. 14-19 Student Notes: Figure 14-16.—Symptoms of heatst roke and heat exhaustion.

• Expose the victim toaf an or air-conditioner since drafts will promote cooling. • Immersing the victim ina coldw ater bath is also effective. • Give the victim (if conscious) coolw ater to drink. Do not give any hot drinks or stimulants. • Get the victim toa medicalf acility as soon as possible. Cooling measures must be continued while the victim is being transported. HEAT EXHAUSTION Heate xhaustion (heat prostration or heat collapse) is the most common condition caused byw orking or exercising in hot spaces. Heate xhaustion produces a serious disruption of blood flow to the brain, heart, and lungs. This disruption of blood flow causes the victim to experience weakness, dizziness, headache, loss of appetite, and nausea. Signs and symptoms of heat exhaustion. Signs and symptoms of heate xhaustion are similar to those of shock: for example— • The victim will appear ashen gray; the skin cold, moist, and clammy. • The pupils of thee yes may be dilated (enlarged). • The vital signs (blood pressure, temperature, pulse, and respiration) usually are normal; however, the victim may have a weak pulse together with rapid and shallow breathing. • Body temperature may be below normal. Treatment of heat exhaustion . To treat heat exhaustion victims, you should treat them as if they were in shock. • Loosen the clothing; apply cool, wet cloths. • Move the victim to either a cool or an air-conditioned area, and fan the victim. • Do not allow the person to become chilled. • If the victim is conscious, administera solution of1 teaspoon of salt dissolved ina quart of cool water. • If the victimv omits, don’tgiveany more fluids. • Transport the victim toa medicalf acility as soon as possible. REVIEW 7 QUESTIONS Q1. List the three most important signs of heatstroke. a. b. c. Q2. List the three most important signs of heat exhaustion. a. b. c. Q3. What is the most important action when treating someone who is showing signs of heatstroke or heat exhaustion? Q4. True or false. In case of heatstroke/heat exhaustion, you should transport the victim to a medical facility as soon as possible. FRACTURES, SPRAINS, AND STRAINS Learning Objectives: When youf inish this chapter, you will be able to— 14-20 Student Notes:

• Recognize the classification of, symptoms of, and first-aid treatment for fractures. • Recall the first-aid treatment for strains and sprains. Simply put,a fracture isa broken bone. The severity of the injury depends on the part of the body affected, the type of fracture, and the amount of tissue damaged. FRACTURES In this section, you will learn about fractures—h ow they’re classified and thef irst-aid youw ould give the victim. Additional information is given on how to transport victims. Classification Fractures may be classified in several ways. However, they are generally classified as are either closed or open.A closed fracture is one in which the skin remains intact. An open fracture is one in which the bone protrudes from the skin. These fractures are shown in figure 14-17. Symptoms You can’talways tell thata fracture has occurred. However, if the victim has been involved in some form of violence, you may suspect that one or more bones have been broken. The victim maye ven have heard the bone snap. Some symptoms ofa fracture are as follows: • Pain and tenderness • Inability to use the part • Creaking or cracking • Motion at points other than joints • Swelling • Deformity • Discoloration of skin Treatment If you are required to give first aid toa person who has suffereda fracture, you should follow these general rules: • If there is any possibility thata fracture has been sustained, treat the injury as a fracture. • Get medical aid at thef irst possible opportunity. All fractures require medical treatment. • Don’t move the victim until splints have been applied to the injured parts, unless the victim’s life is in danger. • Treat for shock. • Don’tattempt to locatea fracture by grating the ends of the bone together. • Don’t attempt to set a broken bone. • Whena long bone in the arm or leg is fractured, the limb should be carefully straightened so that splints can be applied. Pulling gently with your hands in the long axis of the limb is permissible, and it may be all that is necessary to get the limb back into position. • Apply splints. Emergency splinting may be placedo ver clothing if the victim will be seen very soon bya medical officer or if the victim will be transported for a short distance. Otherwise, it’s best to remove just enough clothing so you can apply well-padded splints 14-21 Student Notes: Figure 14-17.— Types of fractures.

directly to the injured part. If you decide to remove clothingo ver the injured part, cut the clothing or rip it along the seams. In any case, be careful! Rough handling of the victim may turn a closed fracture into an open fracture. That could increase the severity of shock and cause extensive damage to the bloodv essels, nerves, muscles, and other tissues around the broken bone. If the fracture is open, you must treat thew ound before you can deal with the fracture. Bleeding from the wound may be serious. Most bleeding can be stopped by direct pressure on thew ound or byf inger pressure at the appropriate point. If, after your best efforts, these methods are not successful, usea constricting band; then treat the fracture. Use of Splints An essential part of the first-aid treatment is immobilizing the injured part with splints so that the sharp ends of broken bonesw on’t move around and cause further damage to nerves, bloodv essels, or vital organs. Splints are also used to immobilize severely injured joints or muscles and to prevent the enlargement ofe xtensive wounds. Before you can usea splint, you need to have a general understanding of the use of splints. In an emergency,almost any firm object or material can be used asa splint. Such things as umbrellas, canes, swords, rifles, tent pegs, laths, sticks, oars, paddles, spars, wire, leather, boards, pillows, heavy clothing, corrugated cardboard, and folded newspapers can be used as splints.A fractured leg may sometimes be splinted by fastening it securely to the uninjured leg. Splints, whether ready-made or improvised, must meet the following requirements: • Be light in weight,b ut still be strong andf airly rigid. • Be long enough to reach the joints above and below the fracture. • Be wide enough so the bandages used to hold them in place won’t pinch the injured part. • Be well padded on the sides that touch the body. If they’re not properly padded, they won’t fit well andw on’t adequately immobilize the injured part. • Toimprovise the padding fora splint, use articles of clothing, bandages, cotton, blankets, or any other soft material. • If the victim is wearing heavy clothes, apply the splint on the outside, allowing the clothing to serve as at least part of the required padding. Although splints should be applied snugly, never apply them tight enough to interfere with the circulation of the blood. When applying splints to an arm ora leg, try to leave thef ingers or toese xposed. If the tips of the fingers or toes become blue or cold, you will know that the splints or bandages are too tight. You should examinea splinted part approximatelye very half-hour, and loosen thef astenings if circulation appears to be cut off. Remember that any injured part is likely to swell, and splints or bandages that are all right when applied may be too tight later. Figure 14-18 showsa method of immobilizing the leg ofa person witha broken kneecap.T o secure the limb to the splint, belts, neckerchiefs, rope, or any suitable material may be used. If possible, tie the limb at two places above and two places below the break. Leave the treatment of other types of fractures, such as jaw, ribs, and spine, to medical personnel. Never try to move a person who might have a fractured spine or neck. Moving sucha person could cause permanent paralysis. Don’t attempt to reset bones. SPRAINS AND STRAINS A person witha sprain ora strain might have some of the same symptoms asa person who hasa fracture. The information contained in this section will help you 14-22 Student Notes: Figure 14-18.—Splintin g.

know what to do ifa there isa possibilitya shipmate has sustained a strain or a sprain. Sprains A sprain is an injury to the ligaments and soft tissues that supporta joint.A sprain is caused by the violent wrenching or twisting of the joint beyond its normal limits of movement. Any joint may be sprained; however, sprains of the ankle, wrist, knee, andf inger are most common. SYMPTOMS .—Symptoms of sprains include pain or pressure at the joint, pain upon movement, swelling and tenderness, possible loss of movement, and discoloration. TREATMENT.—Treat all sprains as fractures until ruled out by X-rays.T o treata sprain, you should take the following actions: • Application of cold packs for thef irst 24 to 48 hours. • Elevation and rest of the affected area. • Application of a snug, smooth, figure-eight bandage to control swelling and to immobilize (keep from moving) the affected area. (NOTE: Check bandaged areas regularly for swelling that might cause circulation problems and loosen bandages if necessary.) • After the swelling stops (24 to 48 hours), apply moist heat for short periods (15 to 30 minutes). CAUTION Do not apply heat until 24 hours after the last cold pack. After applyingf irst aid, make sure the victim has a follow-upe xamination bya medical officer. Thise xam includes X-rays to rule out fractures. Strains A strain is an injury caused by the forcibleo ver stretching or tearing ofa muscle or tendon.A strain may be caused by liftinge xcessively heavy loads, sudden or violent movements, or any other action that pulls the muscles beyond their normal limits. SYMPTOMS .—Symptoms of strains include pain, lameness or stiffness, moderate swelling at the place of the injury, discoloration caused by blood escaping from injured bloodv essels into the tissues, possible loss of power, anda distinctg ap felt at the site of the injury. TREATMENT.— Totreata strain, you should take the following actions: • Elevate the affected area. • Apply cold packs for 24 to 48 hours. • After the swelling stops, apply mild heat to increase circulation and aid in healing. NOTE Do not apply heat until 24 hours after the last cold pack. The victim should bee vacuated toa medicalf acility where X-rays can be taken to rule out the possibility of a fracture. 14-23 Student Notes:

REVIEW 8 QUESTIONS Q1. Label the following fractures. Q2. List the symptoms of a fractured leg or arm. a. b. c. d. e. f. g. Q3. Briefly describe how to give first aid to someone with a fractured leg or arm. a. b. c. d. e. f. g. Q4. List the types of fractures that should be treated by medical personnel. a. b. c. Q5. What is the reason that you should never move a person who might have a fractured spine or neck? Q6. List the symptomsa victim might have with a sprained or strained leg. a. b. c. d. e. 14-24 Student Notes:

f. g. Q7. Describe thef irst aid that should be given to a victim suspected of havinga sprained or strained leg. RESCUE PROCEDURES Learning Objective: When youf inish this chapter, you will be able to— • Recall the procedures to rescue a person. There are many ways to move victims. The method used depends on severalf actors—wher e the victim is located and where the victim is to be taken, assistance available, equipment on hand, and so forth. Ifa vailable, litters or stretchers should be used. In you don’t have any help, there are several methods you can use to move a victim alone. One method is simply to pick up and carry the victim in your arms,b ut it can be quitea task if the victim weighs more than you. Ifa blanket is handy, the victim can be placed upon it and dragged.T w oother means are thef ireman’s carry (fig. 14-19) and the tied-hands crawl (fig. 14-20). FIREMAN’S CARRY One of the easiestw ays to carry an unconscious person is by thef ireman’slift, also called the fireman’s carry (fig. 14-19). 14-25 Student Notes: Figure 14-19.—Fi reman’s carry.

1. Place the victimf ace down, as shown inf igure 14-19, view A. Kneel on one knee at the head, facing the victim.P ass your hands under the armpits. 2. Raise the victim, as shown inf igure 14-19, view B. Take a better hold across the back. 3. Raise the victim toa standing position and stick your right leg between the victim’s legs, as shown in figure 14-19, view C. Grasp the victim’sright wrist in your left hand and swing the arm around the back of your neck and down your left shoulder. 4. Stoop quickly and pull the victim across your shoulders and, at the same time, put your right arm between the victim’s legs, as shown in figure 14-19, view D. 5. Grasp the victim’s right wrist with your right hand and straighten up, as shown in figure 14-19, view E. The procedure for lowering the victim to the deck is shown in figure 14-19, views F and G. TIED-HANDS CRAWL The tied-hands crawl shown inf igure 14-20 may be used to drag an unconscious person fora short distance; it is particularly useful when you must crawl underneath a low structure. RESCUE FROM ELECTRICAL CONTACT Rescuinga person who has received an electric shock is likely to be difficult and dangerous. Use extreme caution or the rescuer may also be electrocuted. Don’t touch the victim’sbody, the wire, or any other object that may be conducting electricity. Some procedures you might use to rescuea person who’s received an electric shock are as follows: • Look for the switchf irst of all, and if youf ind it, turn off the current immediately.Don’t waste too much time hunting for the switch; however, every second is important. • If you cannotf ind the switch, you should try to remove the wire from the victim witha dry broom handle, branch, pole, oar, board, or similar nonconducting object (fig. 14-21). • It may be possible to use dry rope or dry clothing to pull the wire away from the victim. • You can also break the contact by cutting the wire withaw ooden-handled axe,b ut that ise xtremely dangerous because the cut ends of the wire are likely to curl and lash back at you before you have time to get out of the way. When you are trying to break an electrical contact, always stand on some nonconducting material, such as a dry board, newspaper, or clothing. Administer artificialv entilation immediately after freeing the person from the wire if the electric shock caused breathing to stop. Check the victim’s pulse, since electric shock may also cause the heart to stop. If 14-26 Figure 14-20.— Tied-hands crawl. Figure 14-21.—Pushing a victim away f rom a power line. Student Notes:

you do not feela pulse, immediately administer CPR. Get the victim toa medicalf acility as soon as possible. TRANSPORTATION PROCEDURES Learning Objective: When youf inish this chapter, you will be able to— • Recall the procedures to transport a person. So fa r, you’ve learned about the emergency methods used to get an injured person out of danger and intoa position wheref irst aid can be administered. As you have learned, these emergency rescue procedures often involve substantial risk to the victim and should be used only when clearly necessary. Once you’verescued the victim from the immediate danger, slow down! Handle and transport the victim with care, being careful about the injuries that havebeen sustained. In thee xcitement and confusion that almost always accompany a mishap, you are likely to feel rushed, as though you must doe verything rapidly. This isa reasonablew ay to feel. Speed is essential in treating many injuries and in getting the casualty toa medical officer or hospital. However, it’s not reasonable to let yourself feel so hurried that you handle the victim roughly or carelessly or transport the victim inaw ay that will make the injuries worse. GENERAL PRECAUTIONS The basic precautions to observe when transporting an injured person are summarized as follows: • Give necessaryf irst aid before attempting to transport the victim if possible. Be sure all injuries have been located. Treat serious breathing problems, bleeding, and shock in that order. Immobilize all fractures, sprains, and dislocations. Do whatever you can to reduce the victim’spain and to make the victim as comfortable as possible under the circumstances. • Usea regular stretcher if one isa vailable. If you must use an improvised stretcher, be sure it is strong enough. Also, be sure that you haveenough personnel to carry the stretcher so that youw on’t run any risk of dropping the victim. • Whenever possible, bring the stretcher to the victim instead of carrying the victim to the stretcher. • Fasten the victim to the stretcher to prevent slipping, sliding, orf alling off.T ie the victim’s feet together, unless the injuries make it impracticable. • Use blankets,g arments, or other material to pad the stretcher and to protect the victim from exposure. • Asa general rule, an injured person should be lying down,f ace up, while being moved. However, in some instances the type or location of the injury will necessitate the use of another position. If the victim has a chestw ound, raising the head and shoulders may give greater comfort, and ease any breathing difficulties the victim may have.A person who hasa broken bone should be movedv ery carefully so that the injury will not be madew orse. If the victim has receiveda severe injury to the head, the victim should bek ept lying on the side or on the back with the head turned to one side to prevent choking on saliva, blood, orv omit while being transported. In all cases, it is important to place the victim in a position that prevents further injuries. • The stretcher should be carried in suchaw ay that the victim will be moved feetf irst, so that the rear stretcher bearer can continuallyw atch the victim for signs of breathing difficulty. • If you must usea motorv ehicle to transport a seriously injured person, the best means is an ambulance. If no ambulance isa v ailable,a truck or stationw agon makesaf airly good substitute. If it is necessary to usea passenger car to transporta seriously injured person, the victim should be put ina place that requires the least amount of bending, twisting, or turning. • Don’t turn the victimo v er to anyone without givinga complete account of the situation. Be sure the person takingo ver knows what caused the injury and whatf irst-aid treatment has been given. Ifa constricting band has been applied, make sure that is known to the person who is taking charge of the victim. 14-27 Student Notes:

STOKES STRETCHER The Navy service litter most commonly used for transporting sick or injured persons is called the Stokes stretcher (fig. 14-22). The Stokes stretcher isa wire basket supported by iron or aluminum rods. It’s adaptable toav ariety of uses, since the victim can be held securely in place,e ven if the stretcher is tipped or turned. The Stokes stretcher is particularlyv aluable for transferring injured persons to and from boats. It is also used for direct ship-to-ship transfer of injured persons. NEIL ROBERTSON STRETCHER The Neil Robertson stretcher is designed for removing an injured person from engine-room spaces, holds, and other compartments where access hatches are too small to permit the use of regular stretchers. The Neil Robertson stretcher is made of semirigid canvas. When firmly wrapped around the victim mummy-fashion, it gives sufficient support so the victim may be liftedv ertically (fig. 14-23).T okeep the injured person from swaying againstb ulkheads and hatchways while being lifted, tiea guideline to the victim’s ankles. Stretchers of this type can be made on board ship andk ept in appropriate places ready for use. Ifa Neil Robertson stretcher is nota v ailable when needed, a piece of heavy canvas, wrapped firmly around the victim, will serve somewhat the same purpose. EMERGENCY RESCUE LINES An emergency rescue line can be made from any strongf iber line. These lines should be used only in extreme emergencies when an injured person must be moved and no other means is available. Figure 14-24 shows an emergency rescue line that could be used to hoista person fromav oid or small compartment. Notice thata running bowline is passed around the body,just below the hips, anda half hitch just under the arms. Again,a guideline is tied to the victim’s ankles. 14-28 Student Notes: Figure 14-22.—Sto kes stretcher. Figure 14-23.—Neil Robertson st retcher.

REVIEW 9 QUESTIONS Q1. What is one of the easiestw ays to carry an unconscious person? Q2. Describe the precautions you should take when rescuinga person who has received an electric shock. Q3. How should you carry a stretcher? Q4. What type of stretcher is used to transport an injured person from engine-room spaces? Q5. When are emergency rescue lines used? PERSONAL HYGIENE Learning Objectives: When youf inish this chapter, you will be able to— • Identify the purpose for personal hygiene. • Recognize the consequences of not following a personal hygiene program. Because of the close living quarters in the Navy, particularly aboard ship, personal hygiene is very important. Developing good personalh ygiene habits is essential for the good health of the individual and for the protection of the entire crew. For the same reasons, sanitary conditions aboard ship must be maintained at all times. Clean spaces area necessity. Dirt breeds disease. When spaces arek ept clean and orderly, the general well-being of the crew improves and morale increases. No onew ants to live orw ork inaf ilthy environment. In the Navy and at home,e veryone should make ita habit tok eep living andw orking spaces as clean as possible. Maintaining a clean, healthy environment reduces the chances of illness. Negligence in reporting to the medical officer any matter that affects one’s health is inexcusable. It can lead toa more serious illness. Don’t ignore minor injuries. An untreated cut or scratch can lead to infection, loss ofa limb, ande ven death. If you can’t report for treatment righta way, wash the injury with soap and cleanw ater. A largew ound should not be washed; cover it witha clean dressing until it can be attended to by medical personnel. Some practices you can take to be healthy include the following: Showering. Shower and change underwear daily. After showering, dry thoroughly, particularly your feet to prevent fungus development.W ear shower shoes when takinga shower toa v oid contracting athlete’s foot. Shoes and socks.W ear properlyf itted shoes and socks. The inner dimensions of the shoe should be about 1/4 inch longer and wider than the foot. Improperly fitted socks and socks with holes can cause blisters. Change your socks daily. 14-29 Student Notes: Figure 14-24.—Eme rgency rescue line.

Toenails and feet. Cut your nails straight across to prevent ingrown toenails. If corns or other foot ailments develop, have them treated at once. Fingernails. Keep fingernails trimmed and clean. Hair.K eep your hair neatly trimmed andw ash it often. Bunk linen. Change it at least weekly. Exercise and sleep . Daily exercise improves bodily functions, increasing muscle tone and physical endurance. Even aboard small ships, it’s possible to exercise in some manner. Get as much sleep asw atch and work conditions permit. Diet. Navy food is good and wholesome. It provides a well-balanced diet. Don’t beaf inicky eater, even though you don’tlike some foods. Learn to eatav ariety of foods; try toa void putting more on your tray than you care to eat. ORAL HYGIENE Many dental disorders begin with theb uildup of bacterial plaque that remains undisturbed around the teeth. The purpose of personal oralh ygiene is to remove this plaqueb uildup. Plaque can be removed by proper tooth brushing and flossing techniques. There are three common dental conditions that are caused by poor dental hygiene: 1.T ooth decay 2. Reddening of the gums 3. Gum and bone disease Any of these can cause the loss ofa tooth;b ut with proper oralh ygiene, these conditions can be controlled or prevented. Tooth decay can be reduced by cutting down on sweets and by brushing properly. F or most people, cavities and gum and bone disease occur primarily between the teeth. No toothbrush can effectively cleanse these areas or the areas behind the last tooth in each arch.Y ou must use dental floss to clean such hard-to-reach areas.You should floss at least oncea day, either just before or just after brushing. Unwaxed dental floss should be used in most cases. Dental cleansing d evices, oral irrigators, and commercial mouthwashes are aids to oral hygiene. They may be used in addition to— but not in place of—toot h brushing and flossing. If these devices are electrically powered, they must be safety checked by electrical safety personnel before use. NOTE Oral irrigation may be harmful for individuals with cardiovascular problems. In addition to all of these procedures, you should also have a dental checkupe very6 months or at least oncea year. Your dental technician or dentist can show you the proper way to brush and floss your teeth. SEXUALLY TRANSMITTED DISEASES Sexually transmitted diseases (STDs) are illness caused by organisms that are transmitted through sexual intercourse or by forms of other intimate body contact with an infected person. The disease germs that cause syphilis and gonorrhea arev ery fragile and can live for only short periods of time outside the body. Venereal disease is not spread from inanimate objects such as toilet seats, drinking glasses, bed linens, or clothes. Syphilis and gonorrhea are the two most common sexually transmitted diseases in the United States. Syphilis has had thew orst reputation,b ut it is gonorrhea that is out of control. Syphilis Syphilis can attack any tissue or organ of the body and is especially damaging to the brain, spinal cord, blood vessels, and heart. A painless sore, called a chancre, is thef irst sign of syphilis. The sore usually appears on or around the sex organs about9 to 90 days after contact with an infected person. The chancre will heal withina few weeks,e ven without treatment. Other signs of syphilis that may develop either before or after the chancre goesa way area rash that may cover any part of the body; white, glistening spots in the mouth; and fever, sore throat, and headaches. The rash 14-30 Student Notes:

and other signs may not appear or may be so slight as to be unnoticed. After these signs disappear, the germs may stay hidden for 10 to 20 years. If untreated, the disease causes mental illness, blindness, heart disease, ore ven death. Syphilis is not inherited,b uta pregnantw oman with the disease can give it to her unborn child. These babies are born with congenital syphilis. A baby with congenital syphilis may be born dead or deformed. Congenital syphilis can be prevented if it is detected and treated in time. The signs of syphilis may resemble many other diseases, or the signs may be slight and be unnoticed. The disease can be detected bya blood test for syphilis. Gonorrhea If you have gonorrhea and don’tget treatment, you may become sterile. Gonorrhea can damage the sperm ducts in males and thef allopian tubes in females. In men andw omen, gonorrhea may result in crippling arthritis, meningitis, or heart disease. The signs of gonorrhea in males usually appear3 to 5 days after sexual contact with an infected partner. Most men have apus discharge from the sex organ and a painful,b urning sensation during urination.W omen rarely have painful symptoms until gonorrhea has seriously damaged their reproductive system. There may be some vaginal discharge or burning during urination,b utw omen will usually have no symptoms and will not know that they have gonorrhea until a sexual partner has been infected. If you havesyphilis or gonorrhea,a cure is as near as your medical department. But early treatment is important. These diseases can be curede ven in people who havehad the disease fora long time,b ut the damage to the reproductive organs may be irreversible. NOTE Self-treatment or pills from a friend are extremely dangerous. Genital Herpes Infection Genital herpes is an increasingly common viral infection that produces recurrent, painful genital sores similar to cold sores that occur around the mouth. At this time, there is no known cure for genital herpes; the infected person may have recurrences of lesions throughout life. Individuals should avoid sexual intercourse when the sores are present because the herpes virus is infectious in this phase of the disease. Acquired Immune Deficiency Syndrome The Acquired Immune Deficiency Syndrome (AIDS)w asf irst reported in the United States in mid 1981. AIDS isa serious illness anda public health problem. It’sthe number one priority of the U.S. Public Health Service. AIDS isa serious condition characterized by a defect in natural immunity (defense) against disease. People who ha ve AIDS are vulnerable to serious illnesses that aren’t a threat to anyone whose immune system is functioning normally. These illnesses are referred to as “opportunistic” infections or diseases. Investigators have discovered the virus that causes AIDS. The virus is called either human immune virus (HIV); humanT -lymphotropic virus, type III (HTLV-3); lymphadenopathy associated virus (LAV ); or AIDS-related virus (ARV). Most people infected with the AIDS virus have no symptoms and feel well. Some develop symptoms that may include tiredness; fever; loss of appetite and weight; diarrhea; night sweats; and swollen glands (lymph nodes), usually in the neck, armpits, or groin. Anyone with these symptoms should seea doctor if the symptoms continue for more than 2 weeks AIDS is spread by sexual contact, needle sharing, or less commonly, through blood or its components. The risk of getting AIDS is increased by having multiple sexual partners, either homosexual or heterosexual, and sharing needles with people who use illicit drugs. The occurrence of the AIDS in hemophilia patients and persons receiving transfusions providese vidence of transmission through blood. It may be transmitted from infected mother to infant before, during, or shortly after birth. 14-31 Student Notes:

Prevention Usinga condom during sex offers some protection. Birth control pills offer no protection against STDs. If you had the disease once and have been successfully treated, that does not grant you immunity against contracting an STD again. If you have been diagnosed as having an STD and are receiving treatment at the present time, don’t attempt to hide the name(s) of your sexual partners. The chances are that one of them infected you or have been infected by you. They deserve the benefit of treatment too. The health department will contact the persons named and treat them. These steps, which are done confidentially, can help in stopping an outbreak of a sexually transmitted disease. REVIEW 10 QUESTION Q1. List some of the reasons why personalh ygiene is important. a. b. c. d. Q2. List the three most common dental conditions caused by poor dental hygiene. a. b. c. Q3. What methods should you use toa void dental problems? a. b. c. Q4. What are the two most common sexually transmitted diseases? a. b. Q5. How is the Acquired Immune Deficiency Syndrome (AIDS) spread? a. b. c. SUMMARY In this chapter, you have learned some of the basic steps and procedures required when administeringf irst aid. You may never have the need to use these procedures, but if the situation should arise, by following the procedures outlined, and with additional training, you may be ina position to render what could be life-saving assistance. You also learned the recommendedw ays of transporting injured personnel so they can receive proper medical attention. Personalh ygiene is an important part of living closely together. Ashipmate noto verly concerned with keeping himself or herself clean and squareda w ay could affect your physical well-being,b ut could also affect the morale ofa great number of crew members. Keeping yourself clean and squareda way will benefit you and the people you come into contact with on a daily basis. Another topic covered here is sexually transmitted diseases. Being attracted toa member of the opposite sex isa natural reaction. Bea ware of the possibility that if you engage in multiple sexual relations, you could become infected with one of the sexually transmitted diseases discussed in this chapter. Being responsible in your sexual relations and using approved protective measures will goa longw ay toward protecting yourself. 14-32 Student Notes:

REVIEW 1 ANSWERS A1. The primary purpose off irst aid is to safe lives, prevent further injury, and limit infection. A2. The primary tasks to take when you administer first aid are to— a. maintain breathing, b. stop bleeding and maintain circulation, and c. prevent or treat shock. A3. The general first-aid rule for— a. shock is to place the victim on his/her back with the head slightly lower than the feet b. broken bones is tok eep the person still until you immobilize the injured part c. transport of injured persons is on the litter with the litter carried feet first REVIEW 2 ANSWERS A1. Thef irst-aid treatment for respiratoryf ailure is artificial ventilation. A2. Artificial ventilation should be administered only when natural breathing has stopped. NEVER give artificialv entilation toa person who is still breathing. A3. The three types of artificial ventilation are— a. Mouth to mouth b. Mouth to nose c. Back pressure/arm lift A4. Cardiac arrest is the complete stoppage of heart function. A5. To be effective, CPR must be started within 4 minutes of the onset of cardiac arrest. A6. When you use the one-rescuer technique of CPR, the ratio of compressions tov entilations is 15 compressions to 2v entilations. A7. When you use the two-rescuer technique of CPR, the ratio of compressions tov entilations is 5 compressions to 1 ventilation. A8. The symptoms of airway blockage are— a. Inability of the victim to speak b. Exaggerated breathing efforts c. Skin turning blue A9. The four methods you can use to cleara person’s airway are— a. Standing abdominal thrust b. Reclining abdominal thrust c. Standing chest thrust d. Reclining chest thrust REVIEW 3 ANSWERS A1. The three types of bloodv essels the body uses to circulate blood are— a. Arteries—large vessels that carry blood away from the heart b. Veins—la rgev essels that carry blood back to the heart c. Capillaries—a connecting network of smallerv essels between the arteries and the veins A2. Hemorrhage is severe enough to endanger life when arteries or veins are cut. A3. A loss of 2 pints of blood is usually enough to cause shock. A4. Blood carried by— a. Capillaries is brick red b. Veins is dark red c. Arteries is bright red A5. The onlyw ay to stop serious bleeding is the application of pressure. 14-33

A6. A constricting band is a pad,a band, and a devicef or tightening the band so that the bloodv essels will be compressed. Only use a constricting band when hemorrhage can’t be controlled any other way. Constricting bands are used above thew ound. They aren’t used for wounds on the head, neck, or body. A7. Whena constricting band ora battle dressing has been applied, only medical personnel should release/remove it. A8. A battle dressing is a combination compress and bandage, in whicha sterile gauze pad is fastened to a gauze, muslin, or adhesive bandage. A9. When applyinga battle dressing, you should make sure that the dressing covers the entire wound. REVIEW 4 ANSWERS A1. Shock is a condition where the blood circulation is seriously disturbed. A2. The symptoms of shock in a person are— a. Weak and rapid pulse b. Shallow, rapid, and irregular breathing c. Lower temperature—th e arms, face, and legs feel cold to the touch d. Sweating e. Pale skin color; however, in some cases, it may be bluish or reddish f. Dilated (enlarged) pupils g. Thirst and an feeling of weakness, faintness, or dizziness A3. True, you shouldk eep an injured personw arm enough to be comfortable,b ut notw arm enough to become overheated. A4. If you suspect thata person is in shock, you shouldk eep the person lying flat on his/her back with the feet slightly elevated (raised) so that the position encourages the blood to flow back to the brain. REVIEW 5 ANSWERS A1. In the Navy, the most frequent suicide victim is an enlisted male between 17 and 24y ears old and in paygrades E-1 through E-6. A2. The most common causes of suicide are— a. Breakup of a close relationship b. Death of a loved one c. Loss of social or financial status d. Effects of drugs and/or alcohol A3. Depression is often associated with suicide. A4. Some actions you can take if you believe someone is suicidal are— a. Take all threats seriously b. Confront the problem c. Answer cries for help d. Let the person know you care e. Listen f. Get professional help g. Don’t leave the person alone REVIEW 6 ANSWERS A1. Burns are defined as follows: a. First-degree burn— Mildest burn. Slight redness, tenderness, and increased temperature of the burned area. b. Second-degree burn— More serious than first-degree burn. Inner skin may be damaged, blistering, severe pain, some dehydration, and possible shock. c. Third-degree burn— Most serious burn. Skin is destroyed and possibly tissue and muscle beneath it. Skin may be charred or white and lifeless (from scalds). Somef orm of shock will result. 14-34

A2. By immersing theb urned area in coldw ater or by applying cold compresses, you minimize pain andr educe theb urning effect in deeper layers of the skin. A3. Ifab urn covers more than 20% ofa victim’s body, you should apply sterile, dry bandages. A4. When treatingb urns you should NEVER apply petrolatum gauze, break blisters or apply butter, lard, or Vaseline™ . REVIEW 7 ANSWERS A1. The three most important signs of heatstroke are— a. Dry, hot skin b. Constricted pupils c. Very high body temperature (usually above 105ºF) A2. The three most important signs of heat exhaustion are— a. Moist, clammy skin b. Dilated pupils c. Normal or subnormal temperature A3. The aim off irst-aid treatment for heatstroke or heate xhaustion is tor educe body temperature. A4. True, in case of heatstroke/heate xhaustion, you should transport the victim toa medicalf acility as soon as possible. REVIEW 8 ANSWERS A1. Fractures are— a. Closed fracture b. Open fracture A2. The symptoms of a fractured leg or arm include— a. Pain and tenderness b. Discoloration of the skin c. Creaking or cracking d. Inability to use the part e. Motion at points other than joints f. Swelling g. Deformity A3.T o give first aid to someone witha fractured leg or arm, you should— a. Get medical aid as soon as possible b. Don’t move the victim until splints have been applied, unless the victim’s life is in danger c. Treat for shock d. Don’t try tof inda fracture by grating the ends of the bone together e. Don’t try to set a broken bone f. If a long bone in the leg is fractured, carefully straighten the leg so it can be immobilized g. Apply splints A4. The types of fractures that should be treated by medical personnel are— a. Jaw b. Ribs c. Spine A5.Y ou should never move aperson who might have a fractured spine or neck because moving that person might cause permanent paralysis. A6. The symptoms a victim might have with a sprained or strained leg include— a. Pain, lameness, stiffness, or pressure b. Pain on movement c. Swelling and tenderness 14-35

d. Discoloration e. Witha strain,a distinct gap at the site of the injury A7. Thef irst aid that should be given toa victim suspected of havinga sprained or strained leg includes treating all sprains as fractures until ruled out by X-rays. REVIEW 9 ANSWERS A1. One of the easiestw ays to carry an unconscious person is to use the fireman’s lift/carry. A2. When rescuinga person who has received an electric shock, you should not touch the victim’sbody, wire, or any other object that may conduct electricity. A3. You should carrya stretcher with the victim’s feetf irst so ther ear stretcher bearer can see the victim for signs of breathing difficulty. A4.T o transport an injured person from engine-room spaces, a Neil Robertson stretcher is usually used. A5. Emergency rescue lines are used when an injured person must be transported and no other means is available. REVIEW 10 ANSWERS A1. Personalh ygiene is important for the following reasons: a. Close living quarters b. Well-being of the crew c. Reduced chance of illness d. Morale increase A2. The three most common dental conditions caused by poor dental hygiene are— a. Tooth decay b. Reddening of the gums c. Gum and bone disease A3.T o avoid dental problems, you should— a. Brush your teeth b. Floss your teeth c. Have dental checkups every 6 months A4. The two most common sexually transmitted diseases are— a. Syphilis b. Gonorrhea A5. AIDS is spread through— a. Sexual contact b. Needle sharing by drug users c. Transfusions 14-36

CHAPTER 15 SURVIVAL As you learned in earlier chapters, being a professional Sailor is dangerous. These dangers aren’t limited to just your job in the Navy. In times of conflict, your ship or shore station may be in contact with an enemy force or ship. Regardless of your rate, rating, or duty station, you may need to stay alivein thew ater until you can reach land or be rescued.Y ou must have the knowledge required to live in thef ield with limited equipment (survival) and toa void the enemy (evasion). If captured, you also have the responsibility to flee from the enemy (escape) if possible. This chapter contains information on the principles and techniques of sea survival,e vasion, land survival, and escape that have been used successfullyw orldwide. The information given here is by no means all-inclusive, but should serve to help you if the need arises. SURVIVAL AT SEA Learning Objectives: When youf inish this chapter, you will be able to— • Recall the methods and procedures for abandoning ship. • Identify the techniques for swimming through oil, flames, and debris. • Recognize the techniques for using clothing and buoyant objects to stay afloat. • Recognize the procedures used to care for and use personal floatation devices and the use of lifeboats and associated survival gear. • Recall the characteristics of, use of, and adjustment to CO 2 inflatable and inherently buoyant life preservers. • Identify the responsibilities and authority of the senior person in a survival situation. Survival at sea depends on your knowledge, self-control, training, and equipment. The time to learn as much as possible about survival and rescue at sea is before you abandon ship, not after youf ind yourself in thew ater. The information for survival at sea is general in nature and applies to all Navy ratings. ABANDONING SHIP Having to abandon ship isn’tpleasant.Your “home” is gone along with most of your possessions and possibly some of your shipmates.You don’tknow how long you mustw ait for rescue. However, with the proper knowledge and training, frightening aspects can be greatly reduced. Don’t panic and don’t give up hope. Remember, the Navy knows you’re missing and is searching for you. Also, remember that thousands of persons havesurvived ships sinking in bothw artime and peacetime. If time permits, the crew will abandon the ship in a planned and orderly manner. In the prepare- to-abandon-ship stage, all personnel go topside and muster at their abandon ship stations, don life jackets, and rig lines and ladderso ver the side. Bearing and distance to the nearest land, sea and wind conditions, andw ater temperature are passedo ver the 1MC (ship’s general announcing system). When the order to abandon ship is given, all boats are lowered and lifeboats are released. The crew members then goo ver the side and board them as quickly as possible. Know Escape Routes Many survivors have reported that their shipmates were lost because they were unable to get topside before the ship sank. In many of these cases, the compartments in which personnel were trapped were not cut off—the individuals only thought they were. Once on boarda particular ship, most Sailors learn the easiestw ays from their berthing compartments to their stations and automatically use these routes day after day. The habit of using the same hatches and ladders day after day becomes so strong thata person finds it difficult to use other routes. This habit is 15-1 Withouta decisive naval force we can do nothing definitive, and with it, everything honorable and glorious. —Geo rge Washington