FIRST AID

BASIC LIFE SUPPORT 1 HANDOUT

The objective of this lesson is to familiarize the soldier on basic life saving techniques in a
battlefield setting.

A. Basic First Aid Measure

(1) Open the airway and restore breathing

(a) Assessment of and positioning the casualty

1. Check for responsiveness: establish whether he casualty is conscious

by gently shaking him and asking, “Are You OK? “

2. Call for help.

3. Position the unconscious casualty so that he is lying on his back and

on a firm surface.

a. Straighten the casualty’s leg. Take the casualty’s arm that is

nearest to you and move it so that it is straight and above his head. Do the same to the other
arm.

b. Kneel beside the casualty with your knees near his shoulders,
Place one hand behind the head and the neck for support. With your other hand, grasp the
casualty under his far arm.

c Roll the casualty towards you using a steady, even pull. His
head and neck should stay in line with his back.

d Return casualty’s arm to his side. Straighten his legs.

Reposition yourself so that you are now kneeling at the level of the casualty’s shoulder.
However. If neck injury is suspected and the jaw thrust technique will be used, kneel at the
casualty’s head, looking toward his feet.

(2) Opening the airway of an unconscious or not breathing casualty

(a) Call for help and then position the casualty. Move the casualty on his back.

(b) Open the airway using the jaw-thrust or head tilt/chin lift method

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 1. Jaw thrust method. This method may be accomplished by the rescuer
grasping the angles of the casualty’s lower jaw and lifting with both hands, one on each side,
displacing the jaw forward. The rescuer’s elbow should rest on the surface on which the
casualty is lying. The head should be carefully supported without lifting it backwards or
turning it from side to side. If this is unsuccessful, the head should be tilted back very slightly.
The jaw thrust is the safest first approach to opening the airway of the casualty who has a
suspected neck injury because in most cases it can be accomplish without extending the
neck.

2. Head tilt/ chin-lift method. Place one hand on the casualty’s forehead
and apply firm, backward pressure with the palm to tilt head back. Place the finger tips of the
other hand under the bony part of the lower jaw and lift, bringing the chin forward. The thumb
should not be used to lift the chin.

3. Check for breathing

a Look for the rise and fall of the chest.

b Listen for the air escaping during exhalation by placing your ear
near the casualty’s mouth.

c Feel for the flow of air on your cheek

d Perform rescue breathing if the casualty does not resume

breathing spontaneously.

(3) Rescue Breathing.

(a) Mouth to mouth method.

1. If the casualty is not breathing, place your hand on his forehead, and
pinch his nostril his nostril together with the thumb and index finger of this hand. Let this
same hand exerts pressure on this forehead to maintain the backward head tilt and maintain
an open airway. With your other hand, keep your fingertips on the bony part of the lower jaw
near the chin and lift.

2. Take a deep breath and place it your mouth around the casualty
mouth.

3. Blow two full breaths into the casualty’s mouth, taking a breath of
fresh air each time before you blow. Watch out of the corner of your eye for the casualty’s
chest to rise. If the chest rises, sufficient air is getting into the casualty’s lungs.

a Take corrective action immediately by reestablishing the airway.

Make sure the air is not leaking from the mouth or out of the casualty’s pinch nose.

b Reattempt to ventilate.

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 c If the chest still does not rise, take necessary action to open an
obstructed airway.

4. After giving two slow breaths, which cause the chest to rise, attempt to
locate a pulse on the casualty. Feel for a pulse on the side of the casualty’s neck closest to
you by placing the first two fingers (index and middle fingers) of your hand on the groove
beside the casualty’s Adam’s apple (carotid pulse). (Your thumb should not be used for pulse
taking because you may confuse your pulse beat with that of the casualty.) Maintain the
airway by keeping your other hand on the casualty’s forehead. Allow 5 to 10 seconds to
determine if there is a pulse.

a If signs of circulation are present and a pulse is found and the

casualty is breathing—STOP; allow the casualty to breathe on his own. If possible, keep him
warm and comfortable.

b If the pulse is found and the casualty is not breathing, continue

rescue breathing.

c If a pulse is not found, seek medical trained personnel for help

as soon as possible.

(b) Mouthto-nose method: Use this method if you cannot perform mouthto-
mouth rescue breathing because the casualty has a severe jaw fracture or mouth wound or
his jaws are tightly closed by spasms. The mouthto-nose method is performed in the same
way as the mouthto-mouth method except that you blow into the nose while you hold the lips
closed with one hand at the chin. You then remove your mouth to allow the casualty to
exhale passively. It may be necessary to separate the casualty’s lips to allow the air to
escape during exhalation.

(4) Airway obstruction:

(a) Upper airway obstructions often occur because—

1. The casualty’s tongue falls back into his throat while he is

unconscious. The tongue falls back and obstructs the airway; it is not swallowed by the
casualty.

2. Foreign bodies become lodged in the throat. These obstructions

usually occur while eating. Choking on food (usually meat) is associated with—

a Attempting to swallow large pieces of poorly chewed food.

b Drinking alcohol

c Slipping dentures

3. The contents of the stomach are regurgitated and may block the
airway.

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 4. Blood clots may form as a result of head and facial injuries.

(b) Upper airway obstruction may cause either partial or complete airway
blockage.

1. Partial airway obstruction. The casualty may still have an air

exchange. A good air exchange means that the casualty can cough forcefully, though he
may be wheezing between coughs. You, the rescuer, should not interfere, and should
encourage the casualty to cough up the object obstructing his airway on his own. A poor air
exchange may be indicated by weak coughing with a high pitched noise between coughs.
Further, the casualty may show signs of shock indicating a need for oxygen. You should
assist the casualty and treat him as though he had a complete obstruction.

2. Complete airway obstruction. A complete obstruction (no air

exchange) is indicated if the casualty cannot speak, breathe, or cough at all. He may be
clutching his neck and moving erratically. In an unconscious casualty, a complete obstruction
is also indicated if after opening his airway you cannot ventilate him.

(5) Opening the Obstructed Airway—Conscious Casualty

(a) Ask the casualty if he can speak or if he is choking. Check for the universal
choking sign.

(b) If the casualty can speak, encourage him to attempt to cough; the casualty
still has a good air exchange. If he is able to speak or cough effectively, DO NOT interferes
with his attempts to expel the obstruction.

(c) Listen for high pitched sounds when the casualty breathes or coughs (poor
air exchange). If there is poor air exchange or no breathing, CALL FOR HELP and
immediately deliver manual thrusts (either an abdominal or chest thrust)

1. Apply abdominal thrusts. This can be accomplished by using the

following procedures:

a. Stand behind the casualty and wrap your arms around his
waist.

b. Make a fist with one hand and grasp it with the other. The
thumb side of your fist should be against the casualty’s abdomen, in the midline and slightly
above the casualty’s navel, but well below the tip of the breastbone.

c . Press the fists into the abdomen with a quick backward and
upward thrust.

d. Each thrust should be a separate and distinct movement.

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 2. Apply chest thrusts. An alternate technique to then abdominal thrust
is the chest thrust. This technique is useful when then casualty has an abdominal wound,
when the casualty is pregnant, or when the casualty is so large that you cannot wrap your
arms around the abdomen. To apply chest thrusts with casualty sitting or standing:

a. Stand behind the casualty and wrap your arms around his
chest with your arms under his armpits.

b. Make a fist with one hand and place the thumb side of the fist
in the middle of the breastbone (take care to avoid the tip of the breastbone and the margins
of the ribs).

c. Grasp the fist with the other hand and exert thrusts.

d. Each thrust should be delivered slowly, distinctly, and with the

intent of relieving the obstruction.

e. Perform chest thrusts until the obstruction is expelled or the

casualty becomes unresponsive.

f. If the casualty becomes unresponsive, call for help as you

proceed with steps to open the airway and perform rescue breathing.

(6) Opening the Obstructed Airway—Casualty Lying Down or Unresponsive

(a) Open the airway and attempt rescue breathing.

(b) If still unable to ventilate the casualty, abdominal or chest thrusts.

1. To perform the abdominal thrusts:

a. Kneel astride the casualty’s thighs

b. Place the heel of one hand against the casualty’s abdomen (in
the midline slightly above the navel but well below the tip of the breastbone). Place your
other hand on top of the first one. Point your fingers toward the casualty’s head.

c. Press into the casualty’s abdomen with a quick, forward and

upward thrust. You can use your body weight to perform the maneuver. Deliver each thrust
quickly and distinctly.

d. Repeat the sequence of abdominal thrusts, finger sweep, and

rescue breathing (attempt to ventilate) as long as necessary to remove the object from the
obstructed airway.

e. If the casualty’s chest rises, proceed to feeling for pulse.

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 2. To perform chest thrusts:

a. Place the unresponsive casualty on his back, face up, and

open his mouth. Kneel close to the side of the casualty’s body.

1- Locate the lower edge of the casualty’s ribs with your

fingers. Run the fingers up along the rib cage to the notch.

2- Place the middle finger on the notch and the index finger
next to the middle finger on the lower edge of the breastbone. Place the heel of the other
hand on the lower half of the breastbone next to the two fingers.

3- Remove the fingers from the notch and place that hand
on top of the positioned hand on the breastbone, extending or interlocking the fingers.

4- Straighten and lock your elbows with your shoulders

directly above your hands without bending the elbows, rocking, or allowing the shoulders to
sag. Apply enough pressure to depress the breastbone 1 1/2 to 2 inches, and then release
the pressure completely. Do this 6 to 10 times. Each thrust should be delivered quickly and
distinctly.

b Repeat the sequence of chest thrust, finger sweep, and rescue

breathing as long as necessary to clear the object from the obstructed airway.

c If the casualty’s chest rises, proceed to feeling for his pulse.

3. If you still cannot administer rescue breathing due to an airway

obstruction, then remove the airway obstruction using the procedures:

a. Place the casualty on his back, face up, turn the unresponsive
casualty as a unit, and call out for help.

b. Perform finger sweep, keep casualty face up, use tonguejaw lift
to open mouth.

c. Open the casualty’s mouth by grasping both his tongue and

lower jaw between your thumb and fingers and lifting (tongue jaw lift). If you are unable to
open his mouth, cross your fingers and thumb (crossed finger method) and push his teeth
apart by pressing your thumb against his upper teeth and pressing your finger against his
lower teeth.

d. Insert the index finger of the other hand down along the inside
of his cheek to the base of the tongue. Use a hooking motion from the side of the mouth
toward the center to dislodge the foreign body.

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 a. Stop the bleeding and protect the wound

(1) Entrance and Exit Wounds: Before applying the dressing, carefully examine the
casualty to determine if there is more than one wound. A missile may have entered at one
point and exited at another point. The EXIT wound is usually LARGER than the entrance
wound.

(2) Field Dressing

(a) Use the casualty’s field dressing; remove it from the wrapper and
grasp the tails of the dressing with both hands.

(b) Hold the dressing directly over the wound with the white side down.
Pull the dressing open and place it directly over the wound.

(c) Hold the dressing in place with one hand. Use the other hand to wrap
one of the tails around the injured part, covering about onehalf of the dressing. Leave
enough of the tail for a knot. If the casualty is able, he may assist by holding the dressing in
place.

(d) Wrap the other tail in the opposite direction until the remainder of the
dressing is covered. The tails should seal the sides of the dressing to keep foreign material
from getting under it.

(e) Tie the tails into a nonslip knot over the outer edge of the dressing.
DO NOT TIE THE KNOT OVER THE WOUND. In order to allow blood to flow to the rest of
an injured limb, tie the dressing firmly enough to prevent it from slipping but without causing
a tourniquet like effect; that is, the skin beyond the injury should not becomes cool, blue, or
numb.

(3) Manual Pressure

(a) If bleeding continues after applying the sterile field dressing, direct
manual pressure may be used to help control bleeding. Apply such pressure by placing a
hand on the dressing and exerting firm pressure for 5 to 10 minutes. The casualty may be
asked to do this himself if he is conscious and can follow instructions.

(b) Elevate an injured limb slightly above the level of the heart to reduce
the bleeding.

(c) If the bleeding stops, check shock; administer first aid for shock as
necessary. If the bleeding continues, apply a pressure dressing.

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 (4) Pressure Dressing: Pressure dressings aid in blood clotting and compress the
open blood vessel. If bleeding continues after the application of a field dressing, manual
pressure, and elevation, then a pressure dressing must be applied as follows:

(a) Place a wad of padding on top of the field dressing, directly over the
wound. Keep the injured extremity elevated.

(b) Place an improvised dressing (or cravat, if available) over the wad of
padding. Wrap the ends tightly around the injured limb, covering the previously placed field
dressing.

(c) Tie the ends together in a nonslip knot, directly over the wound site.
DO NOT tie so tightly that it has a tourniquet-like effect. If bleeding continues and all other
measures have failed, or if the limb is severed, then apply a tourniquet. Use the tourniquet as
a LAST RESORT. When the bleeding stops, check for shock; administer first aid for shock as
necessary.

(5) Digital Pressure: (often called “pressure points”) is an alternative method to control
bleeding. This method uses pressure from the fingers, thumbs, or hands to press at the site
or point where a main artery supplying the wounded area lies near the skin surface or over
bone. This pressure may help shut off or slow down the flow of blood from the heart to the
wound and is used in combination with direct pressure and elevation. It may help in
instances where bleeding is not easily controlled, where a pressure dressing has not yet
been applied, or where pressure dressings are not readily available.

(6) Tourniquet: is a constricting band placed around an arm or leg to control bleeding.
A service member whose arm or leg has been completely amputated may not be bleeding
when first discovered, but a tourniquet should be applied anyway. This absence of bleeding
is due to the body’s normal defenses (contraction or clotting of blood vessels) as a result of
the amputation, but after a period of time bleeding will start as the blood vessels relax or the
clot may be knocked loose by moving the casualty. Bleeding from a major artery of the thigh,
lower leg, or arm and bleeding from multiple arteries (which occurs in a traumatic
amputation) may prove to be beyond control by manual pressure. If the pressure dressing
under firm hand pressure becomes soaked with blood and the wound continues to bleed,
apply a tourniquet.

(a) Improvising a Tourniquet. In the absence of a specially designed

tourniquet, a tourniquet may be made from a strong, pliable material, such as gauze or
muslin bandages, clothing, or cravats. An improvised tourniquet is used with a rigid stick-like
object. To minimize skin damage, ensure that the improvised tourniquet is at least 2 inches
wide.

(b) Placing the Improvised Tourniquet.

1. Place the tourniquet around the limb, between the wound and
the body trunk (or between the wound and the heart). Never place it directly over a wound, a
fracture, or joint. Tourniquets, for maximum effectiveness, should be placed on the upper
arm or above the knee on the thigh.

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 2. The tourniquet should be well-padded. If possible, place the
tourniquet over the smoothed sleeve or trouser leg to prevent the skin from being pinched or
twisted. If the tourniquet is long enough, wrap it around the limb several times, keeping the
material as flat as possible. Damaging the skin may deprive the surgeon of skin required to
cover an amputation. Protection of the skin also reduces pain.

(c) Applying the Tourniquet.

1. Tie a halfknot. (A halfknot is the same as the first part of tying a

shoe lace.)

2. Place a stick (or similar rigid object) on top of the half knot.

3. Tie a full knot over the stick

4. Twist the stick until the tourniquet is tight around the limb
and/or the bright red bleeding has stopped. In the case of amputation, dark oozing blood
may continue for a short time. This is the blood trapped in the area between the wound and
tourniquet.

5. Fasten the tourniquet to the limb by looping the free ends of the
tourniquet over the ends of the stick. Then bring the ends around the limb to prevent the stick
from loosening. Tie them together on the side of the limb.

6. DO NOT cover the tourniquet—you should leave it in full view.

If the limb is missing (total amputation), apply a dressing to the stump. All wounds should
have a dressing to protect the wound from contamination.

7. Check and treat for shock.

8. Seek medical aid.

b. Check for shock and administer first aid

(1) Shock: The term shock has a variety of meanings. In medicine, it refers to a
collapse of the body’s cardiovascular system which includes an inadequate supply of blood
to the body’s tissues. Shock stuns and weakens the body. When the normal blood flow in the
body is upset, death can result. Early recognition and proper first aid may save the casualty’s
life.

(2) Causes and Effects

(a) There are three basic mechanisms associated with shock. These are:

1. The heart is damaged and fails to work as a pump.

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 2. Blood loss (heavy bleeding) causes the volume of fluid within
the vascular system to be insufficient.

3. The blood vessels dilate (open wider) so that the blood within
the system (even though it is a normal volume [the casualty is not bleeding or dehydrated]) is
insufficient to provide adequate circulation within the body.

(b) Shock may be the result of a number of conditions. These include—

1. Dehydration.

2. Allergic reaction to foods, drugs, insect stings, and snakebites.

3. Significant loss of blood.

4. Reaction to the sight of a wound, blood, or other traumatic

scene.

5. Traumatic injuries, such as—

a Burns.

b Gunshot or shrapnel wounds.

c Crush injuries.

d Blows to the body (which can cause broken bones or

damage to internal organs).

e Head injuries.

f Penetrating wounds (such as from a knife, bayonet,

missile).

(3) Signs and Symptoms of Shock

(a) Sweaty but cool skin (clammy skin).

(b) Weak and rapid pulse.

(c) Paleness of skin (in dark-skinned individuals they may have a grayish
look to their skin).

(d) Restlessness, nervousness.

(e) Thirst.

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 (f) Loss of blood (bleeding).

(g) Confusion (or loss of awareness).

(h) Faster-than-normal breathing rate.

(i) Blotchy or bluish skin (especially around the mouth and lips).

(j) Nausea and/or vomiting.

(4) First Aid Measures for Shock: the first aid procedures administered for shock are
identical to procedures that would be performed to prevent shock. When treating a Casualty,
assume that shock is present or will occur shortly. By waiting until actual signs and
symptoms of shock are noticeable, the rescuer may jeopardize the casualty’s life.

(a) Position the Casualty. DO NOT move the casualty or his limbs if
suspected fractures have not been splinted.

1. Move the casualty to cover, if cover is available and the

situation permits.

2. Lay the casualty on his back.

3. Elevate the casualty’s feet higher than the level of his heart.
Use a stable object (field pack or rolled up clothing) so that his feet will not slip off.

4. Loosen clothing at the neck, waist, or wherever it may be

binding.

5. Prevent chilling or overheating. The key is to maintain body

temperature. In cold weather, place a blanket or other like item over him to keep him warm
and under him to prevent chilling. However, if a tourniquet has been applied, leave it
exposed (if possible). In hot weather, place the casualty in the shade and protect him from
becoming chilled; however, avoid the excessive use of blankets or other coverings.

6. Calm the casualty. Throughout the entire procedure of

providing first aid for a casualty, the rescuer should reassure the casualty and keep him
calm. This can be done by being authoritative (taking charge) and by showing
selfconfidence. Assure the casualty that you are there to help him.

7. Seek medical help.

(b) Food and/or Drink. When providing first aid for shock, DO NOT give
the casualty any food or drink. If you must leave the casualty or if he is unconscious, turn his
head to the side to prevent him from choking if he vomits.

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 (c) Evaluate Casualty. Continue to evaluate the casualty until medical
personnel arrives or the casualty is transported to an MTF.

c. First Aid for Fractures

(1) A fracture is any break in the continuity of a bone. Fractures can cause total
disability or in some cases death by severing vital organs and/or arteries. On the other hand,
they can most often be treated so there is a complete recovery. The potential for recovery
depends greatly upon the first aid the individual receives before he is moved. First aid
includes immobilizing the fractured part in addition to applying lifesaving measures when
necessary. The basic splinting principle is to immobilize the joints above and below the
fracture.

(2) Kinds of Fractures

(a) Closed Fracture: A closed fracture is a broken bone that does not break the
overlying skin. The tissue beneath the skin may be damaged. A dislocation is when a joint,
such as a knee, ankle, or shoulder, is not in the proper position. A sprain is when the
connecting tissues of the joints have been torn. Dislocations and sprains (swelling, possible
deformity, and discoloration) should be treated as closed fractures.

(b) Open Fracture. An open fracture is a broken bone that breaks (pierces) the
overlying skin. The broken bone may come through the skin or a missile such as a bullet or
shell fragment may go through the flesh and break the bone.

(3) Signs and Symptoms of Fractures: Indications of a fracture are deformity,

tenderness, swelling, pain, inability to move the injured part, protruding bone, bleeding, or
discolored skin at the injury site. A sharp pain when the service member attempts to move
the part is also a sign of a fracture.

(4) Purposes of Immobilizing Fractures: A fracture is immobilized to prevent the

sharp edges of the bone from moving and cutting tissue, muscle, blood vessels, and nerves.
This reduces pain and helps prevent or control shock. In a closed fracture, immobilization
keeps bone fragments from causing an open wound, which can become contaminated and
subject to infection.

(5) Splints, Padding, Bandages, Slings, and Swathes

(a) Splints. Splints may be improvised from such items as boards, poles, sticks,
tree limbs, or cardboard. If nothing is available for a splint, the chest wall can be used to
immobilize a fractured arm and the uninjured leg can be used to immobilize (to some extent)
the fractured leg.

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 (b) Padding. Padding may be improvised from such items as a jacket, blanket,
poncho, shelter half, or leafy vegetation.

(c) Bandages. Bandages may be improvised from belts, rifle slings, kerchiefs,
or strips torn from clothing or blankets. Narrow materials such as wire or cord should not be
used to secure a splint in place. The application of wire and/or narrow material to an
extremity could cause tissue damage and a tourniquet effect.

(d) Slings. A sling is a bandage suspended from the neck to support an upper
extremity. If a bandage is not available, a sling can be improvised by using the tail of a coat
or shirt or pieces of cloth torn from such items as clothing and blankets. The triangular
bandage is ideal for this purpose. Remember that the casualty’s hand should be higher than
his elbow, and the fingers should be showing at all times. The sling should be applied so that
the supporting pressure is on the uninjured side.

(e) Swathes. Swathes are any bands (pieces of cloth or load bearing equipment
[LBE]) that are used to further immobilize a splinted fracture. Triangular and cravat bandages
are often used and are called swathe bandages. The purpose of the swathe is to immobilize;
therefore, the swathe bandage is placed above and/or below the fracture—not over it.

(6) Procedures for Splinting Suspected Fractures: Before beginning first aid
procedures for a fracture, gather whatever splinting materials are available. Ensure that
splints are long enough to immobilize the joint above and below the suspected fracture. If
possible, use at least four ties (two above and two below the fracture) to secure the splints.
The ties should be square knots and should be tied away from the body on the splint.
Distal pulses of the affected extremity should be checked before and after the application of
the splint.

(a) Evaluate the Casualty. Be prepared to perform any necessary lifesaving

measures. Monitor the casualty for development of conditions that may require you to
perform necessary lifesaving measures.

(b) Locate the Site of the Suspected Fracture.

1. Ask the casualty for the location of the injury.

2. Look for an unnatural position of the extremity.

3. Look for a bone sticking out (protruding).

(c) Prepare the Casualty for Splinting the Suspected Fracture.

1. Reassure the casualty. Tell him that you will be providing first aid for
him and that medical help is on the way.

2. Loosen any tight or binding clothing.

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 3. Remove all jewelry from the injured part and place it in the casualty’s
pocket. Tell the casualty you are doing this because if the jewelry is not removed and
swelling occurs later, he may not be able to get it off and further bodily injury could result.

4. Boots should not be removed from the casualty unless they are
needed to stabilize a neck injury or there is actual bleeding from the foot.

(d) Gather Splinting Materials. If standard splinting materials (splints, padding,

and cravats) are not available, gather improvised materials. If splinting material is not
available and the suspected fracture CANNOT be splinted, then swathes or a combination of
swathes and slings can be used to immobilize the extremity.

(e) Pad the Splints. Pad the splints where they touch any bony part of the body,
such as the elbow, wrist, knee, ankle, crotch, or armpit areas. Padding prevents excessive
pressure on the area, which could lead to circulation problems.

(f) Check the Circulation Below the Site of the Injury.

1. Note any pale, white, or bluishgray color of the skin, which may
indicate impaired circulation. Circulation can also be checked by depressing the toe or
fingernail beds and observing how quickly the color returns. A slower return of color to the
injured side when compared with the uninjured side indicates a problem with circulation. The
fingernail bed is the method to use to check the circulation in a dark-skinned casualty.

2. Check the temperature of the injured extremity. Use your hand to

compare the temperature of the injured side with the uninjured side. The body area below
the injury may be colder to the touch indicating poor circulation.

3. Question the casualty about the presence of numbness, tightness,

cold, or tingling sensations.

(g) Apply the Splint in Place.

1. Splint the fracture in the position found. DO NOT attempt to reposition

or straighten the injury. If it is an open fracture, stop the bleeding and protect the wound.
Cover all wounds with field dressings before applying a splint. Remember to use the
casualty’s field dressing, not your own.

2. Place one splint on each side of the fracture. Make sure that the
splints reach, if possible, beyond the joints above and below the fracture.

3. Tie the splints. Secure each splint in place above and below the
fracture site with improvised (or actual) cravats. Improvised cravats, such as strips of cloth,
belts, or whatever else you have, may be used. With minimal motion to the injured areas,
place and tie the splints with the bandages. Push cravats through and under the natural body
curvatures, and then gently position improvised cravats and tie in place. Use square
knots. Tie all knots on the splint away from the casualty. DO NOT tie cravats directly over the
suspected fracture site.

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 (h) Check the Splint for Tightness.

1. CHECK to be sure that bandages are tight enough to securely hold

splinting materials in place, but not so tight that circulation is impaired.

2. RECHECK the circulation after application of the splint. Check the

skin color and temperature. This is to ensure that the bandages holding the splint in place
have not been tied too tightly. A fingertip check can be made by inserting the tip of the finger
between the bandaged knot and the skin.

3. MAKE any necessary adjustment without allowing the splint to

become ineffective.

(i) Apply a Sling. An improvised sling may be made from any available non
stretching piece of cloth, such as a battle dress uniform (BDU) shirt or trousers, poncho, or
shelter half. Slings may also be improvised using the tail of a coat, belt, or a piece of cloth. A
trousers belt or LBE may also be used for support. A sling should place the supporting
pressure on the casualty’s uninjured side. The supported arm should have the hand
positioned slightly higher than the elbow showing the fingers.

1. Insert the splinted arm in the center of the sling

2. Bring the ends of the sling up and tie them at the side (or hollow) of
the neck on the uninjured side.

3. Twist and tuck the corner of the sling at the elbow

(j) Apply a Swathe. You may use any large piece of cloth, service member’s
belt, or pistol belt, to improvise a swathe.

1. Apply swathes to the injured arm by wrapping the swathe over the
injured arm, around the casualty’s back, and under the arm on the uninjured side. Tie the
ends on the uninjured side.

2. A swathe is applied to an injured leg by wrapping the swathe around

both legs and securing it on the uninjured side.

(k) Seek Medical Assistance. Notify medical personnel, watch closely for
development of lifethreatening conditions and/or impaired circulation to the injured extremity.

LO 15