FIELD MEDICAL SERVICE TECHNICIAN

STUDENT HANDBOOK

“THE BEST FORM OF TROOP WELFARE

IS TOUGH, REALISTIC TRAINING”

VERSION 4.0
 Command Philosophy

My philosophy is basic…provide the highest quality service possible to every person you encounter.
We are an institution of higher learning; we need to be the best with everything we do.

We are preparing the next generation of heroes for the greatest fighting force on the planet - the
8404 Hospital Corpsman assigned to the United States Marine Corps. They operate at the tip-of-the-
spear providing combat medicine to our operational forces; they are critical to the success of the Navy
& Marine Corps Medicine Team.

What each one of us does on a daily basis matters, regardless of our job. We all contribute to the
mission. No one job is more important than the other. If just one link (team member) in this chain fails to perform a portion of
the mission to standard, we all fail. You have the ability to make a positive difference in peoples’ lives every day. Every member
of this team should ask themselves, “Am I living by our core values and making decisions that are consistent with these values
when I interact with students, staff and the American public.”

Key points:
- Know your chain of command and how to use it. You have not exhausted your chain of command at FMTB-West until the
issue reaches me.
- If you are lacking something to perform your mission, bring it to the attention of leadership so we can promptly address it.
- Any safety issue should immediately be brought to leadership.
- Continually strive to improve processes; ask for help before it’s too late (in all aspects of your life and career).
- If you see a problem, fix it or bring it to the attention of someone who can. Don't ignore it.
- Supporting each other is just as important as supporting the mission.
- Continue the relentless pursuit of customer satisfaction; feedback is a valuable tool in life and career.
- Basic military courtesy should be a part of everyday life.
- Always strive to do the right thing, even when no one is looking or when tempted to take the “easy” wrong.

As a leader, I believe all members of the team are important. Our civilian shipmates are essential to the success of our mission.
As a military leader, I believe, as the Sailor creed says, “I proudly serve my country's Navy combat team with Honor, Courage
and Commitment. I am committed to excellence and the fair treatment of all”.

I cannot over emphasize the importance of leadership from E-1 to O-6, everyone has a part; I expect officers to lead from the
front by setting the example. Be sure that regularly scheduled performance counseling sessions are conducted for military and
civilian employees. Cover the good which should be sustained as well as the areas which need improvement. Although I like to
be informed, I believe in allowing leaders to lead, managers to manage. A big part of my job is to provide you the support
systems necessary for you to accomplish your mission. Tell me what you need and don't worry how it will be resourced. Let me
worry about that.
Expectations of leaders at all levels:
- Take care of your people.
- Set the example of how the team should think and act because all will be watching you to model your behavior.
- Know your people - keep them informed, be sensitive to their needs, make their lives as predictable as possible.
- Develop your subordinates, military and civilian, so that they will be ready to lead others with high quality, effective
leadership skills.
- Don’t ask your staff to do anything you aren’t willing to do yourself.
- Set the example in military bearing: weight, uniform, physical fitness or civilian professional appearance.
- Live the Navy Core Values: honor, courage, commitment.
- Reward individuals for going above and beyond; we do not thank our people enough.
- Work hard, but don’t forget to have fun, too.

I have my “pet peeves” like anyone else. These are the things that will cause an emotional response on my part. In fairness, I’ll
share those with you now. My trigger points include:

- Inconsistent and/or unfair treatment of others.

- Rudeness/Disrespect/Inconsiderate/Taking Advantage
- Not giving the chain of command the opportunity to fix a problem before you take it outside the facility.
- Answering with, “Because we’ve always done it that way,” when there is no understanding as to the rationale for a
process/action. This usually indicates lack of motivation or no consideration of potential improvements.
- Trying to cover up an honest mistake rather than admit to it and learn from it.
- Blaming others for your mistakes or errors.
- Having no initiative to improve your work area. You should strive to leave an area better than you found it.

Take pride in your profession. We are all here as volunteers; let’s strive to do our very best. I am honored to be here, to lead
you, to serve with you; I promise to give you my best.

DAN CORNWELL
CAPT/MSC/USN
COMMANDING OFFICER

Vision
To be the best training command within the United States Marine Corps; producing the best trained, best prepared, and battle
ready Fleet Marine Force Hospital Corpsman. He will be prepared to meet the challenges of present and future operational
environments.

Mission
Develop, coordinate, resource, execute and evaluate training and education concepts, policies, plans and programs to ensure
the Fleet Marine Force Hospital Corpsman is prepared for assignment with the operational forces.
BnO 1050.4B

4. Execution

a. Standards of Conduct. All students assigned to FMTB-W

will conduct themselves in a mature and professional manner.
Their conduct and attitude will exemplify the highest standards
and core values of the Navy and Marine Corps.

(1) Accountability. Daily formations will be conducted

in order to maintain accountability. All students will be
present for every formation, unless excused by FMTB-W staff
chain of command.

(2) Consumption of Alcohol. Consumption or storage of

alcoholic beverages by students is prohibited in or around all
FMTB-W facilities, to include the BEQ. The legal drinking age
in the state of California, as well as Marine Corps Base (MCB)
Camp Pendleton, is 21 years of age. All establishments whose
primary business is the sale of alcohol (i.e. bars) are off
limits to students under the age of 21. Students are not
allowed to consume alcohol while in a duty status. Consumption
of alcohol less than eight (8) hours prior to assuming duty or
beginning training is prohibited. Students must be fit for duty
at all times.

(3) Controlled Substances (Drugs). The use, possession,

sale or distribution of: prescribed medications, illegal drugs,
steroids, synthetic drugs, or controlled substances are
prohibited in the U.S. Military. It is detrimental to
operational readiness and is inconsistent with Navy-Marine Corps
core values and will not be tolerated. FMTB-W maintains an
aggressive Substance Abuse Program, in accordance with reference
(a).

(4) Use of Tobacco Products. Students will not use

tobacco products during the training day, to include night study
and duty. Tobacco products are defined as: cigars, cigarettes,
snuff, or chewing tobacco. Designated tobacco use areas for
student use after normal working hours is behind building 210825
(FMTB-W Student Barracks). Use of tobacco products in TA-6577
will only be authorized by the Range Safety Officer (RSO) and
allowed at the discretion of the Platoon Advisors. Smoking will
only be allowed in the designated smoking area while in TA-6577.
Violation of this order is punishable under the UCMJ.

(5) Weapons. Personal weapons of any type are not

authorized. A weapon is defined as anything that is expressly
manufactured to enable one to cause bodily harm to another
 BnO 1050.4B

individual, this includes knives with a blade of over three (3)

inches. If a student reports on board with a personal weapon,
it must be registered with the S-4 department, where it will be
locked and stored until their departure from FMTB-W. All
firearms will be registered with the base Provost Marshalls
Office (PMO) and turned over to the armory. Students who turn
in a personal weapon will receive a receipt for their weapon.
While in the field for training, a knife with a blade less than
three (3) inches is authorized.

(a) Weapon safety is paramount at FMTB-W. Weapon

safety handling rules will be enforced at all times.

(b) Horseplay with any weapon while assigned to

FMTB-W will not be tolerated.

(c) Violation of the weapon safety handling rules

is punishable under the UCMJ.

(6) Pornography. Pornographic material is prohibited in

all FMTB-W facilities. All pornographic material found will be
confiscated in accordance with reference (b) and destroyed.

b. Uniform Regulations. Students will adhere to uniform

regulations as per reference (c), to include the following:

(1) Uniforms will be kept clean and worn appropriately.

(2) Boots will be scrubbed or polished daily.

(3) Dog tags will be worn and military identification

cards will be carried at all times.

(4) Navy grooming standards will be strictly enforced.

(a) Hair will be worn neatly and closely trimmed.

Hair will be cut on a weekly basis, typically on the day prior
to the work week commencing.

(b) The face will be clean-shaven every morning

after reveille, to include non-duty and non-training days.

(5) A combination of Navy Working Uniforms and Marine

Corps Combat Utility Uniform Marine Pattern (MARPAT) will be
authorized while in a training status.

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BnO 1050.4B

c. Civilian Attire. Civilian attire is authorized for

those students in Phase III or Phase III Alpha liberty status.
While on liberty, all students will abide by the Civilian Attire
Policy as set forth by MCB Camp Pendleton. The following dress
code will also apply:

(1) All articles of clothing will be in good

condition.

(2) Clothing will fit appropriately and not expose

underwear. Sagging pants will not be worn under any
circumstance.

(3) Clothing with rude or offensive slogans will not

be worn.

(4) Physical Training (PT) gear is not authorized to be

worn as liberty attire (exceptions are when in the barracks
area, while out exercising or when traveling to or from the
gym).

(5) Body piercings are prohibited per reference (c).

(6) Students will not wear earrings while on base.

d. Barracks. Students are reminded that their actions and

standard of conduct in such close quarters impacts those around
them. Inconsiderate, sloppy, and unsanitary behavior/conditions
will not be tolerated. Students will refer to Standard
Operating Procedures for Student Barracks, reference (d), for
rules and regulations.

e. Leave

(1) Annual Leave. Normally annual leave will not be

granted to students while they are in a training status. Annual
leave may be granted on a case-by-case basis by the Commanding
Officer if sufficient justification exists.

(2) Emergency Leave. Students will be authorized

emergency leave per reference (e). The office of the American
Red Cross must officially verify the facts regarding any
circumstances requiring a student’s immediate presence. The
party requesting the student’s presence initiates this
verification through their local Red Cross Office. The Red
Cross Office will contact FMTB-W, who will then relay the
request and any pertinent information to the student. Once

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 BnO 1050.4B

verification is received, the Commanding Officer will adjudicate

the emergency leave request.

(3) Missed Training. Missing more than two training

days, cumulative, will result in a recommendation to the
Commanding Officer for recycle into the next convening Field
Medical Service Technician (FMST) class.

f. Liberty. The Commanding Officer has the authority to

modify a student’s liberty status at any time. The Operations
Officer has by-direction authority to place students on Phase I,
II or III liberty based on criteria as set forth in this order.

(1) Force Preservation Program. All Students will be

assigned a “Force Preservation Buddy,” in writing, per reference
(f). This is to ensure the safety, accountability and policing
of each other while on liberty.

(2) Liberty Buddy. A “Liberty Buddy” is defined as

another student in the current class that agrees to check out/in
on liberty together and remain together for the duration of the
liberty period. If a student’s “Liberty Buddy” is not in the
same phase of liberty, both will adhere to the lower phase
liberty guidelines.

(3) Mexico. Liberty in Mexico is prohibited for all

student personnel at FMTB-W regardless of rank or liberty
status.

(4) Brown Bagger Status. Students with a local off-

base residence, within a 50 mile radius of FMTB-W, may be given
“Brown Bagger” status upon approval by the Commanding Officer,
or delegated authority, on a case-by-case basis. This status is
for those students who meet criteria for Phase III or Phase III
Alpha liberty. Students who are approved to reside off base
during training are not required to have a “Liberty Buddy,” but
are still required to meet all requirements for muster and
maintain a “Force Preservation Buddy.”

(5) Phases of Liberty. All students will be placed into

one of three phases of liberty, with a subcategory for personnel
E-4 and below with less than two years of active service in
accordance with reference (g).

(a) Phase I. Phase I liberty is limited to Pacific

View Plaza and Camp Del Mar (20 and 21 Area) of MCB Camp
Pendleton. This liberty status is for students who demonstrated

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BnO 1050.4B

behavior that has a potential to place themselves or others at

risk in accordance with reference (f). This phase of liberty
will only be assigned by the Commanding Officer, or delegated
authority, on a case by case basis. The guidelines for Phase I
Liberty are:

1. Utility uniform must be worn.

2. All students will to sign out/in the liberty

log book with the Officer of the Day (OOD). They are required
to be aware of their “Force Preservation Buddy,” as well as his
location, and will be required to make phone contact with him by
noon on non-training days. If they are unable to contact their
buddy, they must immediately notify the OOD.

3. The student may visit anywhere aboard

Pacific View Plaza (20 Area) and Camp Del Mar (21 Area).

4. The student will not leave the 20 or 21 Area

for any reason without an approved request chit from the
Operations Officer, or delegated authority. Examples of
acceptable reasons to leave the 20 or 21 Area, with an approved
request chit, are medical appointments or legal appointments.

5. Liberty will expire at 2030 Sunday through

Thursday. Students will remain in the barracks, BLDG 210825,
until the morning muster.

6. Liberty will expire at 2200 Fridays,

Saturdays, and holidays. Students will remain in the barracks,
BLDG 210825, until the 0800 morning muster.

7. Musters will be conducted at commencement

and expiration of liberty by the OOD.

(b) Phase II. Phase II liberty is limited to MCB

Camp Pendleton. The purpose of Phase II liberty is for students
to focus on successfully completing this course. All students
who check into the command will initially be placed in Phase II
liberty. The criteria and guidelines for Phase II liberty are:

1. Criteria. Beyond the initial check in,

students will automatically be placed in Phase II liberty status
for any one of the following criteria:

a. Failure to pass an academic test or

practical application.

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 BnO 1050.4B

b. Failure to pass either component of the

Physical Fitness Assessment (PFA).

c. Failure to complete any hike.

2. Guidelines

a. Utility uniform must be worn.

b. The student may visit anywhere onboard

MCB Camp Pendleton.

c. All students will sign out/in the

liberty log book with the Officer of the Day (OOD). They are
required to be aware of their “Force Preservation Buddy,” as
well as his location, and will be required to make phone contact
with him by noon on non-training days. If they are unable to
contact their buddy, they must immediately notify the OOD.

d. Liberty will expire at 2030 Sunday

through Thursday. Students will remain in the barracks, BLDG
210825, until the morning muster.

e. Liberty will expire at 2200 Fridays,

Saturdays, and holidays. Students will remain in the barracks,
BLDG 210825, until the 0800 morning muster.

f. Musters will be conducted at the

commencement and expiration of liberty by the OOD.

(c) Phase III. This liberty status is for students

with acceptable conduct and performance. Phase III liberty
commences at the end of the training day and expires at muster
of the next training day. The criteria and guidelines for Phase
III liberty are:

1. Criteria

a. Must not be on academic probation.

b. Must pass both components of the PFA.

c. Must pass all hikes.

d. No disciplinary infractions.

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BnO 1050.4B

2. Guidelines

a. Liberty will only commence when secured

by S-3 staff.

b. Students will adhere and report for all

required musters.

c. Students E-3 and below leaving MCB Camp

Pendleton need to sign out/in the liberty log book with the OOD
accompanied by a “Liberty Buddy.” No “Liberty Buddy” is
required on board MCB Camp Pendleton, however, must still sign
out/in with the OOD. They are required to be aware of their
“Force Preservation Buddy,” as well as his location, and will be
required to make phone contact with him by noon on non-training
days. If they are unable to contact their buddy, they must
immediately notify the OOD.

d. Students E-4 and above, and those

students approved as “Brown Baggers,” leaving 21 Area or MCB
Camp Pendleton need to sign out/in the liberty log book with the
OOD. They are required to be aware of their “Force Preservation
Buddy,” as well as his location, and will be required to make
phone contact with him by noon on non-training days. If they
are unable to contact their “buddy,” they must immediately
notify the OOD.

e. During regular liberty and/or weekend

liberty, specific mileage restrictions are:

(1) 50 miles during training/duty days.

(2) 200 miles for 48 hour liberty.

(3) 300 miles for 72/96 hour liberty.

f. Students must adhere to MCB Camp

Pendleton Civilian Attire Policy while on liberty.

g. Students may be placed into Phase I or

II liberty based on upon a failure to comply with Phase III
criteria and/or guidelines.

(d) Phase III Alpha. This liberty status is for

students E-4 and below who have less than two years of active
service, however, maintain acceptable conduct and performance.

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 BnO 1050.4B

Phase III Alpha liberty commences at the end of the training

day. The criteria and guidelines for Phase III Alpha liberty
are:

1. Criteria

a. Must not be on academic probation.

b. Must pass both components of the PFA.

c. Must pass all hikes.

d. No disciplinary infractions.

2. Guidelines

a. Liberty will only commence when secured

by S-3 staff.

b. Students will adhere and report for all

required musters.

c. Students leaving MCB Camp Pendleton will

sign out/in the liberty log book with the OOD accompanied by a
“Liberty Buddy.” No “Liberty Buddy” is required on board MCB
Camp Pendleton, however, must sign out/in with the OOD. They
are required to be aware of their “Force Preservation Buddy,” as
well as his location, and will be required to make phone contact
with him by noon on non-training days. If they are unable to
contact their buddy, they must immediately notify the OOD.

d. Students approved as “Brown Baggers,”

leaving MCB Camp Pendleton need to sign out/in the liberty log
book with the OOD. They are required to be aware of their
“Force Preservation Buddy,” as well as his location, and will be
required to make phone contact with him by noon on non-training
days. If they are unable to contact their “buddy,” they must
immediately notify the OOD.

e. Liberty will expire at 2030 Sunday

through Thursday. Students will remain in the barracks, BLDG
210825, until the morning muster. This does not apply to
students approved as “Brown Baggers.”

f. Liberty will expire at 2200 Fridays,

Saturdays, and holidays. Students will remain in the barracks,

8
BnO 1050.4B

BLDG 210825, until the 0800 morning muster. This does not apply
to students approved as “Brown Baggers.”

g. Musters will be conducted at the

commencement and expiration of liberty by the OOD.

h. With the exception of those students

approved as “Brown Baggers,” overnight liberty must be approved
by the Operations Officer or delegated authority. This request
must be in writing, utilizing enclosure (1).

i. Students must adhere to MCB Camp

Pendleton Civilian Attire Policy while on liberty.

j. Students may be placed into Phase I or

II liberty based on upon a failure to comply with Phase III
Alpha criteria and/or guidelines.

(5) Academic Probation. Academic probation is for those

students that have failed to pass a written test and/or
practical application. Those students will automatically be
placed in Phase II liberty if in a Phase III liberty status.
Guidance for those students placed on Academic Probation are as
follows:

(a) One Time Failure. Students that have failed one

test or one practical application will be placed on Academic
Probation until successfully passing the next test or practical
application (retest does not apply). Students with one test
failure (written or practical) will remain in Phase II liberty
and will be required to attend mandatory night study until
successfully passing the next corresponding test for which they
failed (written or practical).

(b) Two Time Failure. Students that have failed two

written tests or two practical applications will be placed on
Academic Probation until the successful completion of Casualty
Assessment. Students with two test failures (written or
practical) will be required to attend mandatory night study.
Students who are already on Phase II liberty will remain on
Phase II liberty.

(c) Three Time Failure. Students that have failed

three academic tests, or three practical application labs, will
result in the student being recycled into the next convening
FMST class. Students that are academically recycled are
required to participate in all portions of the curriculum and

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 BnO 1050.4B

will be required to attend mandatory night study. Academically

recycled students will remain on Academic Probation and will be
placed in a Phase II liberty status until reassigned to 4th
Platoon.

g. Special Liberty. Special liberty is defined as any

liberty granted outside of normal liberty during a training day.
Special liberty must be submitted two weeks prior to the
requested date and will be considered on a case-by-case basis.
Requests for special liberty will be forwarded to:

(1) Operations Officer for 24 to 72 hour liberty.

(2) Commanding Officer for 96 hour liberty.

h. Physical Training. The purpose of unit PT is to

establish or strengthen unit camaraderie, esprit de corps,
military professionalism, and preparation for entry into the
operating forces. It is the personal responsibility of each
student to ensure that they remain constantly ready for the
rigors of combat. Remedial PT will be held for those students
failing to meet Navy standards for physical fitness per
reference (h), and will be assigned to Phase II liberty.

i. Privately Owned Vehicles (POV). Student vehicles must

pass a safety inspection conducted by FMTB-W staff and are
required to be registered on base. Students will adhere to
California driving laws and base regulations when operating a
vehicle.

(1) Automobiles. Students must provide a valid state

driver’s license, proof of insurance and registration. Drivers
25 and under must show proof of completing the Navy/Marine Corps
Driver’s Improvement Course. Students are authorized to
maintain and drive a POV only while on liberty.

(2) Motorcycles. Students will NOT be permitted to

operate a motorcycle, dirt bike or ATV while attached to FMTB-W.
FMTB-W is an intermediate command, and per reference (i),
personnel in a student status will not be able to complete the
training requirements necessary to operate a motorcycle aboard
Camp Pendleton until reaching their permanent activity. In
accordance with reference (i), personnel also will NOT operate a
motorcycle off-base while in a student status.

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BnO 1050.4B

j. Cell Phone Use. Cellular phones are authorized only

while on liberty. Cell phones are not authorized to be carried
in uniform during the training day, to include night study and
duty. On a case-by-case basis, if a situation exists that
warrants communication outside of liberty hours, students may be
permitted to maintain their cell phone with approval from the
Platoon Leader. Cell phone use in this circumstance will solely
be at the discretion of the Platoon Advisors.

k. Personal Electronic Devices. Personal electronic

devices are authorized only while on liberty. These include,
but are not limited to: video cameras, personal music players,
digital cameras, and laptops.

l. Administrative Matters. Students requiring assistance

regarding administrative matters, (i.e. pay problems, dependency
applications, travel matters, promotions, lost ID cards, powers
of attorney, etc.), must submit a Personnel Action Request
through their Platoon Advisors.

(1) Mailing Address. Students who wish to receive or

send mail can use the following address:

RANK, NAME
PLT NUMBER
Field Medical Training Battalion-West
Box 555243
Camp Pendleton, CA 92055-5243

(2) Basic Allowance for Housing(BAH)/ Basic Allowance

for Subsistence(BAS). Unmarried personnel will not be permitted
to receive BAH/BAS while in a student status. Individual cases
may be reviewed by the command; however, off-base housing
arrangements will not be made without command approval.

m. FMTB-W prides itself in training the finest Hospital

Corpsmen in the Fleet. All students shall conduct themselves in
a mature, responsible and professional manner at all times.
Students are a direct representative of FMTB-W and the United
States Navy.

5. Administration and Logistics. Directives issued by this

battalion are published and distributed electronically.

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 FMTB-W OVERNIGHT LIBERTY REQUEST
E-4 and below with less than 2 years active service.

Class#__________ PLT:__________ Date of request:__________

Rank:________ Name:____________________________________ Age:_______
From (date/time): _______________ @ ________ To: _______________ @ _______
Liberty Buddy Rank, Name, Age:_________________________________________
Reason for Request:___________________________________________________

Contact Information
Cell Phone #:_______________________ Buddy Cell #:______________________
Name of Hotel/Motel/Primary Occupant of Residence & Address:

Phone #:________________ Dist(miles) from FMTB:_________

Mode of Travel:_____________ If POV, Inspected: Y / N Arrive Alive Card: Y / N

I, ______________________, have read and understand Battalion Order 1050.4B. I understand

that if any information provided in this request is fabricated or designed to be misleading and/or
if the information changes and I fail to notify the FMTB OOD (760-124-3456) constitutes a
violation of the UCMJ. I understand that changes may result in a revocation of overnight
privileges for the given period of time. I understand that consumption of alcohol is NOT
permitted in, or on the grounds of the BEQ, Bldg 210825, to include the parking area; or by those
under the age of 21.
Signature:__________________________________ Date _________________
Command Approval
Command Approving Signature:_________________________________________
Print rank/name and Date
Approved: Not Approved:
Enclosure (1)
 FMST Student Phase Liberty Matrix

PHASE III
ALPHA
PHASE I PHASE II PHASE III (E-4 AND
BELOW, <2YRS)

(M-TH) 50 MI (M-TH) 50 MI
LIBERTY 20/21 AREA MCB CAMP 48HR 200 MI *48HR 200 MI
PENDLETON *72-96HR 300 MI
PARAMETERS 72-96HR 300 MI

APPROPRIATE APPROPRIATE
UNIFORM OF THE UNIFORM OF THE CIVILIAN ATTIRE, CIVILIAN ATTIRE,
UNIFORM DAY, DAY, UNIFORM OF THE UNIFORM OF THE
PT GEAR PT GEAR DAY, PT GEAR DAY, PT GEAR

SU – 0800 & 2030 SU – 0800 & 2030 SU – 0800 & 2030

M - 2030 M - 2030 REPORT DURING M - 2030
TU - 2030 TU - 2030 PRESCRIBED TU - 2030
MUSTER TIMES W - 2030 W - 2030 TRAINING/DUTY W - 2030
TH - 2030 TH - 2030 HOURS TH - 2030
F - 2200 F - 2200 F - 2200
SA – 0800 & 2200 SA – 0800 & 2200 SA – 0800 & 2200

LIBERTY ALL E-3 AND ALL STUDENTS

BUDDY NOT REQUIRED ON NOT REQUIRED ON BELOW LEAVING LEAVING MCB CAMP
BOARD MCB CAMP BOARD MCB CAMP MCB CAMP PENDLETON (NOT
PENDLETON PENDLETON PENDLETON (NOT BROWN BAGGERS)
BROWN BAGGERS)

REASSIGNMENT CO
OF LIBERTY XO
OPERATIONS OFFICER

*WITH APPROVED OVERNIGHT LIBERTY CHIT.

Enclosure (2)
 STUDENT GUIDELINES
SCOPE:
U

Welcome to Field Medical Training Battalion! Whether you are a seasoned Sailor, or have just
graduated from Hospital Corpsman “A” school, there is a great purpose for your training here. Your
respective course is designed to challenge you. The purpose of this document is to prepare you for
the day-to-day operations at FMTB. You will be asked to spend a good portion of your day,
including personal time, in preparation for upcoming events. This information will help you
succeed at FMTB, so it is imperative that you read the entire guide.

TOPICS:
U

Morning reveille
Formations
Leadership positions/roles
Sick call procedures
Uniform standards
Field day
Exams/study/mandatory and remedial study
Navy PRT/USMC PFT
Corrective Lens Eyewear
Special Items to purchase
Discipline/Respect
Personal awards
Civilian attire
Off-limit establishments
Prohibited possession and consumption of alcoholic beverages
Prohibited access to berthing areas
Parking of POVs
Students Mailing Address and Emergency Telephone Numbers
Student Liberty
Smoking Policy
Student Watchstanding

A. MORNING REVEILLE: Reveille will be at 0500 and all brown baggers will be on deck by
U

0515 unless otherwise specified. Reveille may be earlier for events such as field training,
conditioning hikes, obstacle courses, and practical training. Attention to the schedule, listening, and
understanding of information being passed by advisors, instructors and staff is your responsibility.
The schedule for the upcoming days and weeks will be posted in your barracks. Stay flexible, the
schedule is subject to change.

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B. FORMATIONS: Every student will muster in formation 15 minutes prior to any scheduled
event. The morning formation is usually scheduled for 0530. The morning report will be delivered
by the Company First Sergeant to the respective platoon advisor following morning formation.
After chow, students need to prepare for departure at 0630 (or earlier) to commence the training day.
Students shall be in their classroom seats 15 minutes prior to the start of class, e.g., 0715 in seats for
a 0730 class. Everyone, including brown baggers (individuals collecting Basic Allowance for
Housing and authorized to reside in the local community with family), will be present for morning
muster and all personnel will march to chow. At the morning formation, the Platoon Sergeants will
conduct daily uniform inspections. The following will be checked during uniform inspections:
clean and serviceable uniform, blackened collar devices, clean boots, and personal grooming to
standards, etc.

C. LEADERSHIP POSITIONS/ROLES: All leaders, regardless of their position, must set the
example. If you have questions concerning your role and position, ask your platoon advisors.
Remember, leaders are not born, but made. Use this training opportunity to develop and perfect
your leadership skills. As always, leaders are held to a higher standard of conduct, professionalism,
and accountability.

D. CHAIN OF COMMAND

1. Fire Team Leader: Within each squad, Fire Team Leaders are reponsible for the execution
of task-oriented direction and coordination, inherent and routine fire team responsibilities within
the squad, and the fire teams welfare, readiness, and understanding of orders and mission to
successfully achieve objectives.

2. Squad Leader: The Squad Leader is reponsible for the execution of task-oriented direction
and routine squad responsiblities within the platoon, and for the squad’s welfare, readiness, and
understanding of orders and mission to successfully achieve objectives.

3. Platoon Sergeant: The Platoon Sergeant is responsible for performing the duties given by the
Company Gunnery Sergeant, Company First Sergeant or Platoon Advisors. He must ensure full
compliance with the instructions. The platoon sergeant is responsible for holding platoon
formation, conducting musters, keeping all the troops well-informed, and for marching the platoon
to and from all destinations. Assistance with calling close order drill is available from the Platoon
Advisors. The Platoon Sergeant will count all personnel, including weapons when carried, and
report them on the morning muster sheet.

4. Company Gunnery Sergeant: The Company Gunny reports, and is responsible to the
Company First Sergeant. The Company Gunny normally is the second highest ranking student in the
company. His function is to set the example, ensure the morale, good order and discipline are kept
at a high state throughout the course of instruction. The Company Gunny will assign tasks to the
Platoon Seageants in order to accomplish the mission. Additional responsibilities include, but are
not limited to:

2
  All tasks handed down by the platoon advisors
 Compiling morning reports
 Organizing company formations
 Supervise and ensure company field days and morning clean up are completed
 Establish and manage the Duty squad, Fire and Security, and Roving Patrol watch bills
 Organize and manage company level working parties
 Prepare and submit MRE rosters for brown baggers
 Conduct company gear survey. Status reports and any problems that arise will be directed
to the Platoon Advisors.

5. Company First Sergeant: The Company First Sergeant reports to the platoon advisors. The
Company First Sergeant is usually the most senior Sailor in the class and is responsible for the entire
company. The Company First Sergeant is to set the example and ensure that morale and discipline,
are both kept at a high state throughout the course of instruction. The Company First Sergeant will
ensure that the Platoon Sergeants are responsible for all tasks passed down by the Platoon Advisors.
He will ensure that there is full accountability of the company and gear is maintained at all times.

6. Platoon Advisor: Each platoon has Marine Corps and Navy advisors who are responsible for
the overall coordination, function, accountability, readiness, mentoring, and counseling of all
students assigned to the platoon.

E. SICK CALL PROCEDURES:

1. The Staff Independent Duty Corpsman (IDC) will hold student sick call on duty days from
0800-1100. If a student requires medical attention, he is to notify a respective Platoon Corpsman
the night prior, or the morning of. It is then the responsibility of the Platoon Corpsman to determine
if the requesting student needs to attend sick call. Administrative medical needs will not be seen
during sick call hours; they will be screened by the Platoon Corpsman and briefed to the Staff IDC
so he/she may determine a time to resolve them.

2. If a student requires urgent medical attention after working hours, he is to notify the Platoon
Corpsman (if available) who will notify the Officer of the Day (OOD). If the Platoon Corpsman is
not available, then the student will contact the OOD directly. The OOD will then arrange for the
appropriate transportation to Naval Hospital Camp Pendleton. In the event of a life-threatening
medical emergency, IMMEDIATELY call 911 and then notify the OOD directly.

3. All platoons will have two (2) Platoon Corpsman designated by the Staff IDC. Their
responsibilities will include; routine medical treatment of minor illness/injuries, screening students
prior to sick call, and assisting the Staff IDC during sick call operations as directed by the Staff IDC.

F. UNIFORM STANDARDS: The camouflage utility uniforms will always be clean and
serviceable and collar devices will be blackened at all times. If collar devices start to chip, you can
purchase collar device paint. Utility name tapes will be ordered and sewn on at no-charge (free) at
base cleaners or at the cash sales office. Boots will be cleaned everyday. The utility uniform or any
portion thereof will not be worn off-base. However, the complete utility uniform may be worn
while stopping at a drive-through window (not inside), and can be worn to and from work. You
3
may wear the utility uniform anywhere on base. The complete list of appropriate uniform wear can
be seen in the Utility Uniform and Individual Combat Equipment lessons in your Student
Handbook.

G. FIELD DAY: Field day will be conducted when directed or when dictated by the schedule.
The platoon barracks are normally inspected the following morning. Daily cleanup assignments will
be delegated by the Platoon Sergeants and Squad Leaders. As always, daily maintenance of the
barracks will result in an easier field day. Barracks trash will be emptied in the dumpster, at a
minimum, three-times daily (prior to 0615, 1800, and 2045 daily). The barracks and all common-
spaces are subject to inspection at any time.

H. EXAMS/STUDY AND MANDATORY NIGHT STUDY:

1. The written tests are broken into five (5) different blocks.

2. All-hands mandatory night study will be held for the whole company the night prior to each
test.

3. First time test failures will be placed on Phase II liberty and mandatory night study until they
pass the next consecutive block.

4. Two (2) time test failures will be placed on Phase II liberty and mandatory night until they
pass Casualty Assessment at the end of the course.

5. Three (3) time test failures may be academically disenrolled or recycled.

6. Mandatory night study will normally be held Sunday through Thursday from 1800-2000.

7. The senior student will march the mandatory night study group to the school house. The
Education Petty Office (EPO) will report to the OOD when everyone is accounted for.

I. NAVY PFA / USMC PFT: It is your responsibility to be prepared for the Navy's Physical
Fitness Assessment (PFA) and Marine Corps Physical Fitness Test (PFT). No time is alloted in the
training to conduct a remedial physical training program. It is recommended that you PT on your
own in safe conditions. Regardless of what you've been told, your participation and performance in
daily physical training, the PFA, conditioning hikes, and the PFT are factored into your overall
course performance. Although the PFA/PFT are unofficial, a failure of the PFA/PFT may result in
disenrollment from FMTB. The only training that will prepare you for the PFA/PFT is to do the sit-
ups, push ups, pull ups, and runs. Failure to successfully complete the Navy Physical Readiness
Test or to be within Navy weight and percent body-fat standards prior to graduation constitutes a
course failure. All failures will be disenrolled or recycled.

J. REQUIRED ITEMS TO BRING: There is a requirement for all students to bring or purchase
selected items essential for training and for duty with the Fleet Marine Force. These items are not
issued and the best place to purchase them is at the Exchange upon your reporting to FMTB. The
items to be purchased are:

4
 1. Key locks –x5
2. Flashlight with red lens
3. Corrective lens eyewear (in addition to contacts if worn)
4. Standard Navy PT gear
5. Boot bands-x4 sets
6. Rank insignias-x4 sets
7. Shower shoes
8. White mesh laundry bag
9. White body towel-x2

K. DISCIPLINE/RESPECT: At no time will anyone disrespect another shipmate. If a problem

arises, it should be brought to the Platoon Advisors attention and they will resolve the issue. Do not
misconstrue training, guidance, accident prevention, and leadership for hazing. It is incumbent upon
all members of this command to conduct themselves in such a manner that they, at all times and
under all circumstances, set the best possible example for subordinates, peers and seniors. Every
interaction between seniors and subordinates is an experience that should enhance the development
of each as members of the Navy or Marine Corps. All members of this command by their actions
must avoid creating a perception of inappropriate conduct or behavior that may be viewed as a
violation of this order. Therefore, military personnel are required and expected to conduct
themselves in a proper manner at all times, whether in uniform or civilian attire. Unseemly conduct
while in and out of uniform tends to reflect discredit upon the Navy and the Marine Corps and may
be considered an infraction of the Uniform Code of Military Justice (UCMJ). This is a formal
Marine Corps School and we represent the Navy’s finest on a Marine Corps Base.

L. PERSONAL AWARDS: There are three personal awards that can be achieved at FMTB. If
you are motivated, you can earn more than one of them.

1. Honor Graduate: Awarded to the person with the highest overall Grade Point Average.
Recycled students are not eligible for this award.

2. Platoon High PFA/PFT: Awarded to the student with the highest combined PRT/PFT score
from each platoon.

3. Motivational Awardee: Awarded to the student from each platoon who displays the most
motivation, professionalism, and leadership. Students will vote for their platoon’s award winner.

M. CIVILIAN ATTIRE: When you leave this base you will be in proper civilian attire. Pants
and shorts with pockets are acceptable as long as they are not fraying and in disrepair. Belts and
shoes or tennis/running sneakers/shoes are to be worn. White or green undershirts are unacceptable
as liberty attire. Remember you represent the Navy, in and out of uniform, so take pride in your
personal bearing and appearance.

5
 1. You are NOT permitted to enter the Marine Corps Exchange or visit the ATM on base in PT
gear.

2. You are NOT authorized to mix civilain clothes and footwear with utilities or other uniform
items at any time.

N. OFF LIMIT ESTABLISHMENTS: Upon reporting, you will be advised of social and
commercial establishments which are off-limits to military personnel. Military personnel may
subject themselves to personal risk if they use the off-limits facilities. If found at these
U

establishments you may be charged for a violation of the UCMJ. Lists of off-limits establishments
U

are posted on command bulletin boards and your platoon leadership will have copies.

O. PROHIBITED POSSESSION AND CONSUMPTION OF ALCOHOL:

1. The legal drinking age in the State of California is 21.

2. Driving under the influence (DUI) carries harsh penalties, regardless of the outcome in the
civilian court. Members charged with drinking under age or DUI shall be referred for evaluation
and counseling for substance abuse and lose their base driving privileges. Regardless of the
outcome in civilian court, members charged with DUI will receive Non-Judicial Punishment at a
minimum.

3. The possession and consumption of alcholic beverages in a privately owned vehicle is strictly
prohibited while on, or assigned to, the Camp Pendleton, Camp Del Mar and Field Medical
Training Battalion. Additionally, no alcoholic beverages are authorized on the grounds, parking
areas, or buildings, training areas or barracks of Field Medical Training Battalion.

P. PROHIBITED ACCESS TO BERTHING AREAS:

1. Only students assigned to a barracks wing are authorized to enter or visit students in that, or
any other barracks.

2. Visitors will be logged in by the DNCO and will remain on the quarterdeck. Visitors are not
permitted in the squad bays or lounges.

3. Unauthorized persons subject to the Uniform Code of Military Justice who enter any barracks
to which they are not authorized to enter shall be prosecuted, and all other persons not subject to the
Uniform Code of Military Justice shall be arrested and charged in Federal Court for treaspassing and
unauthorized entrance. Students that inappropriately allow, authorize, or who do not report an
unauthorized entry may be subjected to the same disciplinary action.

4. Members of the opposite sex are not allowed in berthing spaces other than those designated
for their own gender. While on duty or in an emergency, a member of the opposite sex may enter a
berthing space only after announcing their presence and allowing ample time to ensure that
members in the space are clothed.

6
Q. PARKING OF PRIVATELY OWNED VEHICLES (POVs): Students will park all vehicles
in the student parking area at the barracks. At no time will a student drive his or her vehicle to the
school house.

R. STUDENT MAILING ADDRESS AND EMERGENCY TELEPHONE NUMBERS:

1. Mailing Address: U

Student Name (Rank, Full Name, USN or USNR)

(FMST CLASS # ) (PLATOON #)
BOX 555243
Camp Pendleton, CA 92055

2. EMERGENCY Telephone Numbers: The following telephone numbers are for

U U

EMERGENCY purposes only:

OOD: COM: (760) 725-2559, CELL: (760) 213-1897

STUDENT DNCO: (760) 725-2325

S. SMOKING/DIPPING POLICY: Smoking or use of chewing tobacco/dipping is not authorized

during training hours, and only at other times if in authorized and designated areas onboard Field
Medical Training Battaliion.

T. STUDENT WATCHSTANDING: See attached/integrated Student Watchstander Guide.

7
 TO LEARN MORE ABOUT FIELD MEDICAL
1B

TRAINING BATTALION, CAMP PENDLETON, AND

ALL TRAINING PROGRAMS, CHECK OUT OUR
WEBSITE AT:

http://www.tecom.marines.mil/fmtbw/Home.aspx

1
 UNITED STATE MARINE CORPS
TRAINING COMMAND
3300 RUSSELL ROAD
QUANTICO, VIRGINIA 22134-5001

IN REPLY REFER TO:

5800
B052
OCT 1 2003

TRAINING COMMAND GENERAL ORDER 01- 03

From: Commanding General, Training Command

To: Distribution List

Subj: PROHIBITED ACTIVITIES

Ref: (a) Uniform Code of Military Justice, 10 U.S. Code 801, et seg.

1. Purpose. This order prohibits conduct that, in addition to those proscribed at the reference, is
to the prejudice of good order and discipline of this command, is of a nature likely to bring
discredit upon this command and the United States Marine Corps, is harmful to the health and
well-being of members of the command, or is detrimental to command relations with other
military and organizations as well as civilian agencies and communities.

2. Applicability. This order is applicable to all US military personnel assigned or attached to

this command, or any of its subordinate commands, units and organizations.

3. Definitions. As used in this order, "permanent personnel" refers to any member, regardless of
service, who is involved in training or providing support to student personnel. For purposes of
this order, "student personnel" is defined as all persons, regardless of service, in one of the
following categories:

a. Awaiting training or course entry;

b. Attending training or educational programs; or

c. Completed, eliminated, or discharged from training and awaiting reassignment or

discharge.

4. Prohibited activities. In addition to those offenses proscribed by the reference, the following
activities are also prohibited:

2
Subj: PROHIBITED ACTIVITIES

a. Fraternization. Professional relationships are essential to the effective operation of any

military command or organization. Any unprofessional relationship with a student or a member
of the student's immediate family can compromise the integrity and leadership of the staff in a
training environment. Accordingly, permanent personnel and student personnel will refrain from
any unprofessional relationship. Permanent personnel and student personnel will not, while on
duty or in leave or liberty status, associate with each other in an informal, personal or intimate
manner which reflects a familiarity that is inappropriate for the workplace. Permanent personnel
and student personnel will not engage in any conduct that creates an actual or perceived conflict
of interest between their military duties and their personal activities.

b. Underage drinking. No person, either permanent personnel or student personnel, will

provide alcohol to permanent personnel or student personnel under 21 years old. This
includes buying or sharing alcohol, or condoning its use by any permanent personnel or
student personnel under 21 years old. Additionally, no person under the age of 21 years,
either permanent personnel or student personnel will buy, possess, share, provide or
consume alcohol.

c. Integrity violations. No permanent personnel or student personnel will knowingly use

unauthorized assistance in submitted work designated to represent one's own efforts or to
knowingly fail to indicate properly any authorized assistance received. No permanent personnel
or student personnel will submit another person's work, whether published or unpublished, or
ideas by claiming them as one's own and not giving proper reference to that work. Further, no
permanent personnel or student personnel will knowingly condone any of these actions taken by
other permanent personnel or student personnel.

5. Punitive Order. This order is punitive. Persons subject to the Uniform Code of Military
Justice who violate any portion of this order may be court-martialed or receive adverse
administrative action, or both.

6. Subordinate Command Responsibilities. Commanders and supervisors are expected to

exercise good judgment in reinforcing this General Order and they will ensure that all personnel
are briefed on its prohibitions and requirements.

7. Effective date. This General Order is effective immediately, and will remain in effect until
rescinded by the Commanding General, Training Command.

3
 FMTB BARRACKS REGULATIONS AND GUIDELINES

A. BARRACKS PROTOCOL:
1. Lounge is closed during working hours. Lounge television will be secured at 2200 Sunday
through Thursday and 2400 Friday and Saturday. The study lounge will always remain open for
STUDYING.

2. No eating, drinking (except water), dipping smoking, or open flames (candles, incense) in
the squad bays. Eating is only allowed at the smoking pit or in the student lounge.

3. No hot plates or cooking appliances are permitted in the barracks.

4. No hair cutting inside the berthing spaces or the heads.

5. No sleeping on top of the rack with your uniform on.

6. DO NOT enter or exit through the fire exit doors.

7. All personnel will wear proper attire when leaving the squad bay.

8. English will be the only language spoken in mixed company.

9. All lockers will remain secured/locked at all times. Secure all personal items.

10. No alcohol on or in the barracks surrounding grounds. This includes the parking lot.

11. Absolutely no members of the opposite sex are allowed in berthing that is intended for the
opposite gender (with the exception of duty personnel).

12. The duty cell phone is not for personal use. Only duty personnel are allowed in the duty
hut, all other business will be conducted outside.

13. The storage room in the duty hut is not for personal use; do not leave any gear behind.

14. Keep feet off the lounge furniture.

15. Shoes and 782 gear are not to be washed in the washing/drying machines.

16. Report any discrepancies through the student chain of command.

17. Any violators of barracks regulations are subject to punishment under the UCMJ.

18. Any matters concerning the barracks or it’s furniture should be directed to the BEQ
manager.

4
 STUDENT WATCHSTANDER RESPONSIBILITIES

A. General:

1. The Company First Sergeant, Company Gunnery Sergeant, Platoon Sergeants will not stand
duty. All other E-4 through E-6 personnel will stand the Duty Non- Commissioned Officer
(DNCO) and Assistant Duty Non- Commissioned Officer (ADNCO) watch. All E-1 through E-3
personnel will stand the fire and security or “rover” watch.

2. The Company Gunnery Sergeant will submit a watchbill to the watchbill coordinator every
Thursday morning by 0800 for the following training week. While in garrison, the watch bill will
consist of one (1) DNCO, one (1) ADNCO and four (4) rovers. The watchbill must be initialed
by all watchstanders before submission. The watchbill will be posted at the quarterdecks of
Valor Hall and Devil Doc Hall.

3. While on in duty status, the DNCO is a direct representative of the Commanding Officer.
The DNCO will exercise the necessary authority and control to ensure routine functioning of
school activities and facilities within established guidelines.

4. Any matter that is not withing established guidelines nor covered by routine procedures,
which require immediate action will be referred to the OOD at (760) 725-2559.

5. All watchstanders shall be thoroughly familiar with all guidelines and orders pertaining to
their post.

B. Period of Duty:

1. On normal working days, the duty crew will assume the duty at 1700 until 0500 the
following morning. Members of the 4th Platoon will assume the duty throughout training day.

2. Duty turn over will be at 0600 on weekends and holidays.

3. All duty personnel are restricted to Camp Del Mar during their 24-hour watch period even
if they are a brown bagger.

C. Uniform:

1. All duty personnel will wear the camouflage utility uniform and duty belt.

D. Duty Swaps:

1. All requests for duty swaps must be submitted five (5) days prior to the actual duty day.
Requests will be routed through the platoons scribe and signed by the Platoon Sergeant and
before coming to the watchbill coordinator. Emergency situations will be dealt with accordingly.

5
 STUDENT PFA/PFT, HIKE & ACADEMIC FAILURE POLICY

A. PFA/PFT REQUIREMENTS:

1. All students are required to pass a standard Navy PFA and participate in a standard Marine
Corps PFT while attending FMTB.

2. Any student who does not meet BCA requirements upon check-in will be recommended for
recycle to the next convening class.

3. Students will have two opportunities to pass the Navy PRT. Failure of both will result in
recommendation administrative recycle to the next convening class.

B. HIKE REQUIREMENTS:

1. Each class will have a four (4), six (6), seven (7) and eight (8) mile conditioning hike.

2. Failure to pass three (3) of the four (4) conditioning hikes (passing the eight (8) mile hike is
mandatory) will result in recommendation for administrative recycle or disenrollment.

3. Any student who does not participate in two (2) hikes, or the eight (8) mile hike, due to
medical reasons, will be recommended for medical recycle or disenrollment.

C. ACADEMIC REQUIREMENTS:

1. There will be five (5) test blocks throughout the class that students must pass with an 80%
or better.

2. If a student fails a test, they will be issued a re-test the following morning. All passed re-
tests will be counted as 80% towards the student’s final average.

3. Failure of two (2) tests will result in a Student Professional Development Review Board.

4. Failure of a third test, to include re-test failures, will result in recommendation for
academic recycle or disenrollment.

NOTE: Recycling to the next convening class or disenrollment from the school may result in
the loss of student’s advanced training/”C” School, co-location assignments and eligibility for
special programs and career incentives.

6
 RULES AND REGULATIONS FOR ALL FIELD EVOLUTIONS

A. FIELD PROTOCOL:

1. All students will adhere to the following rules and regulations while in the field:

a. Students requiring medications must inform their Platoon Corpsman two (2) days prior
to step off.

b. Identification card will be carried and identification tags will be worn.

c. No headbands or scarves will be worn on the head at any time

d. Tobacco use in the field will be designated by the Range Safety Officer (RSO).

e. Nutrition is paramount!!! EAT your Meal Ready-to-Eat (MRE) and STAY hydrated!!!

f. Accountability reports of personnel and weapons will be given to the Platoon Advisors
after every evolution.

g. A Blank Firing Apparatus (BFA) will be affixed on the M4 carbine at all times!!!
Remember muzzle awareness!!!

h. Use designated trash receptacles only.

i. Student leadership will always have a memo book and something to write with.

j. All students will strickly adhere to the “buddy system” while in the field. At no time
will any student be alone in the field.

7
 OPERATIONAL RISK MANAGEMENT

Operational Risk Management (ORM) is the process of dealing with the risk associated within
military operations, which includes risks assessment. Risk decision-making and implementation
of effective risk controls.

ORM is a tool for identifying hazards, assessing risks, developing and implementing controls to
prevent safety mishaps. Every individual should be able to make effective risk management
decisions, based on experience, judgement and situational awareness.

Safety is paramount and our number one concern here at Field Medical Training Battalion. It is
important to obey the guidelines established for you to prevent any unforseen mishaps. You will
encounter a very dynamic training environment here and your attention to detail could help
prevent an injury. Below are specific points of concern involving ORM for FMTB.

Know your Environment

Assess the Situation
Universal Precautions
Sharp Hazards
Risk of Infection
Using Proper Body Mechanics

For further information and details regarding Operational Risk Management, see OPNAVINST
3500.39A and/or MCO 3500.27A

Point of contact: http//:www.safetycenter.navy.mil

8
 FIELD MEDICAL TRAINING BATTALION

MISSION STATEMENT

Develop, coordinate, resource, execute and evaluate training and education concepts, policies,
plans and programs to ensure the Fleet Marine Force Hospital Corpsman is prepared for
assignment with the operational forces.

VISION STATEMENT

To be the best training command within the United States Marine Corps; producing the best
trained, best prepared, and battle ready Fleet Marine Force Hospital Corpsman. He will be
prepared to meet the challenges of present and future operational environments.

9
 MILITARY SONGS

ANCHORS AWEIGH

Stand Navy out to sea, fight our battle cry;

We'll never change our course, so vicious foe steer shy-y-y.
Roll out the TNT, Anchors aweigh! Sail on to victory
And sink their bones to Davy Jones, hooray!

Anchors aweigh, my boys, anchors aweigh.

Farwell to foreign shores, we sail at break of day-ay-ay-ay.
Through our last night ashore, drink to the foam,
Until we meet once more. Here's wishing you a happy voyage home.

Blue of the mighty deep, gold of God's great son.

Let these our colors be till all of time be done, done, done, done.
On the seven seas we learn Navy's stern call:
Faith, courage, service true, with honor, over honor, over all.

MARINE HYMN

From the halls of Montezuma to the shores of Tripoli

We fight our country's battles in the air on land and sea
First to fight for right and freedom and to keep our honor clean
We are proud to claim the title of United States Marine

Our flag's unfurled to every breeze from dawn to setting sun

We have fought in every clime and place where we could take a gun
In the snow of far off northern lands and in sunny tropic scenes
You will find us always on the job The United States Marines

Here's health to you and to our Corps which we are proud to serve
In many a strife we've fought for life and never lost our nerve
If the Army and the Navy ever look on heaven's scenes
they will find the streets are guarded by United States Marines

10
 COURSE ACCREDITATION

This course is accredited by:

COUNCIL ON OCCUPATIONAL EDUCATION

41 PERIMETER CENTER EAST, NE SUITE 640
ATLANTA, GA 30346

All questions related to FMST college credit and Sailor-Marine American Council On Education
Registry Transcript (SMART), may be directed to the Commission of the Council on
Occupational Education, 41 Perimeter Center East, NE, Suite 640, Atlanta, GA 30346, (800)
917-2081.

GRIEVANCE PROCEDURES FOR STUDENTS

Students may utilize the following chain of command to submit program

grievances or issues regarding curriculum, quality of instruction and facilities,
student services and safety:

Student Leadership
Platoon Advisors
Platoon Leader
Company Chief
Chief Instructor (CI)
Operations Chief
Operations Officer
Command Master Chief
Executive Officer
Commanding Officer
Commanding General, Training Command.

All personnel reserve the right to directly communicate grievances or seek assistance from the
Commanding Officer as exercised through the formal process of Request Mast as outlined in
Battalion Order 1700.1E.

11
 STUDY TECHNIQUES

Attending class is essential!

Concentrating during class and effective study out of class is also necessary.
Study along the way - after each class - not just before a test.

BE ACTIVE IN YOUR STUDYING!

Just reading your text or notes over and over again is not effective and just does
not work well.

BE ACTIVE IN YOUR STUDYING!

Pretend you are making out the test - literally make up and write down possible
questions and possible answers. The process is the important part here, not the
final product. This will both help you to focus on important points in the text and
notes and help you to understand and remember the material better.

BE ACTIVE IN YOUR STUDYING!

Try making and using flash cards to study definitions and principles. The process
of making the cards and using them is the important part, not the product.

BE ACTIVE IN YOUR STUDYING!

Using as many of your senses as possible while you study is helpful: Read a
section of your text or notes and then

1) Write a summary of those notes from memory - then check yourself and do it
again.

2) Summarize the material out-loud, even if (or especially when) no-one else is
there.

BE ACTIVE IN YOUR STUDYING!

Study with others along the way - set up a regular study group. Talk about the
subject material. I recommend that you do this along the way but not the night
before the test.

Don't stay up late studying the night before the test. This backfires. You will not be rested and
your brain will not work well during the test. Get a good night's sleep the night before the test. If
you study effectively along the way you will be prepared and only need to review a little the night
before the test. It is a gigantic mistake to wait until the night before the test for your most serious
studying. Stay away from other students who are not serious about their studying.

Try different techniques. Find what works for you. The general principle here is to
BE ACTIVE IN YOUR STUDYING! Find some new techniques that work better
than your current techniques. One definition of insanity is trying the same thing

12
over and over again. And expecting different results (e.g., just reading the notes
over and over again and expecting a better grade.)
- Adapted from Dr. Ray L. Winstead
BE ACTIVE IN YOUR STUDYING!

http://nsm1.nsm.iup.edu/rwinstea/study.shtm

http://campushealth.unc.edu/healthtopics/academic-success/avoiding-studying-traps.html

http://www.columbia.edu/cu/augustine/study/intense.html

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 ABOUT MULTIPLE CHOICE EXAMS

Multiple-choice exams have standard formats. Typically, the question has a "root" which poses a
problem, followed by a series of alternatives, which are the answer and related alternatives.

1. READ or LISTEN carefully to all the directions about the exam.

2. READ through exam once. Answer all the questions you know. Don't dwell on the tough ones
at this point; take advantage of the time you have to think through the question.

3. READ each question fully and try to identify key terms.

4. After reading each question, try to think of the answer WITHOUT looking at the alternative
answers given (i.e. cover The answers with paper BEFORE reading the question).

5. Then read all choices to find the correct one (DON'T stop after the one you think is right,
without reading the others. There could be a better answer. The directions on the exam usually
state that you are to "select the BEST answer."

6. Eliminate the alternatives that are obviously wrong.

7. Correct answers will read as a true statement when you match the question and the answer.

8. When you have answered all the questions that you could do readily, go through exam again
and work on the remaining questions. Spend a reasonable amount of time on each question, but
move on if you get stuck.

9. Don't just guess at the answer for any of which you are unsure. Try to at least narrow down
your options by eliminating one or two of the alternatives.

10. Save time at the end to double-check your answers (check that your answers are the ones you
think are correct and that you haven't filled in the wrong circles by mistake) and try the tough
questions again. If you are not penalized for incorrect answers, do not leave any blank answer on
your sheet.

Compiled by H. Addy from:

* Drewes, F. and K.L.D. Milligan. 2002. How to Study Science. 3rd ed. McGraw-Hill, Boston,
MA
* Ellis, D.B. 1985. Becoming a Master Student , 5th ed. College Survival Inc., Rapid City, SD
* McKeachie, W.J. 1986. Teaching Tips, 8th ed. D.C. Heath & Co., Lexington, MA
* Nilson, L.B. 1998. Teaching at its best. Anker Publ. Co., Bolton, MA.
* and hard-won personal experience

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 HOSPITAL CORPS HISTORY
The U. S. Navy Hospital Corps: A Century of Tradition, Valor, and Sacrifice

Few military organizations can look upon their histories with the same degree of pride and, in
some cases awe, as can members of the Navy Hospital Corps. In its century of service, the
Hospital Corps has proven itself ready to support Marines and Sailors by giving them aid
whenever and wherever necessary. As the years have progressed, the tools and techniques used
by Hospital Corpsmen and their forerunners have evolved, but the level of dedication has
remained a strong current running through the Corps' history.

Revolutionary War

The first direction given to the organization of Navy medicine consisted of only one article in the
Rules for the Regulation of the Navy of the United Colonies of North America of 1775.
Article 16 stated:

"A convenient place shall be set apart for sick or hurt men, to be removed with
their hammocks and bedding when the surgeon shall advise the same to be
necessary: and some of the crew shall be appointed to attend to and serve
them and to keep the place clean. The cooper shall make buckets with covers
and cradles if necessary for their use."

Interestingly, the cooper or barrel-maker, whose skills could be used to make bedpans, had a
more detailed job description than did any kind of trained medical assistant.

A typical medical section was usually limited to two, perhaps three men: the surgeon, the
surgeon's mate, and possibly an enlisted man. The surgeon was a physician. The surgeon's mate,
usually a doctor as well, held status like that of a modern Warrant Officer
but signed only for a particular cruise. Although usually viewed within the history of the
Medical Corps, surgeon’s mates’ position and responsibilities appear more to be equivalents to
senior Hospital Corpsmen.

Few things changed in medical techniques and organization between 1775 and 1814, the
period covering America's first naval wars. Among the less dramatic responsibilities of
caring for the non-combat ill and injured was feeding and personal care of the sick. The
simple daily ration of porridge or "loblolly" was sure to be carried down to those in the
medical space by untrained attendants.

15
Surgeon’s Mate and Loblolly Boy

Congress approved an act on March 2, 1799, which copied the words of the Continental
Congress's medical department article 16 of 1775 exactly. As a result, there was still no title or
job description for enlisted medical personnel. The nickname "loblolly boy" was in common use
for so many years that it became the official title in Navy Regulations of 1814. The loblolly boy's
job, described in the regulations of 1818, included the following:

The surgeon shall be allowed a faithful attendant to issue, under his direction, all
supplies and provisions and hospital stores, and to attend the preparation of
nourishment for the sick.

The surgeon's mates shall be particularly careful in directing the loblolly boy to keep the
cockpit clean, and every article therein belonging to the Medical Department.

The surgeon shall prescribe for casual cases on the gun deck every morning at 9
o'clock, due notice having been previously given by his loblolly boy by ringing of a bell.

The U.S. Navy’s first loblolly boy of record was John Wall, who signed aboard the U.S.S.
Constellation on June 1, 1798. The ship sailed with a surgeon, George Balfour, and a surgeon’s
mate, Isaac Henry, as well. Eight months later, in February 1799, Capt. Thomas Truxton won a
decisive victory against the French frigate L’Insurgente in the Caribbean. This would have been
Loblolly Boy Wall’s first opportunity to care for shipmates wounded in battle.

Other loblolly boys who are documented in Navy records include Alexander Wood, who
served aboard the U.S.S. Essex in 1802 and John Domyn aboard the frigate Philadelphia in 1803.
Domyn and the rest of the crew of the Philadelphia were captured at Tripoli by
Algerian pirates in October 1803 and remained captive until June 1805. Further, there was a 16
year-old loblolly boy aboard the U.S.S. Eagle, Joseph Anderson, about 1800.
Anderson has the distinction of being the first known African-American loblolly boy.

Surgeon’s Steward and Loblolly Boy

A new, senior enlisted medical rate, surgeon's steward, was introduced in the ensuing
decades. The term is first seen in 1841 in Navy pay charts, but it appears that the new billet was
only allowed on larger ships. By 1 April 1843, the Navy Department issued an order allowing
surgeon's steward to be assigned to brigs and schooners. The relative importance of medical
Sailors was hereby increased. Surgeon's stewards would rank second in seniority among the
ship's petty officers, next only after the master-at-arms. Herman Melville, famed author of Moby
Dick, gives a description of the surgeon's steward aboard the frigate U.S.S. United States in
White Jacket, his account of Navy life in 1843:

"An official, called the surgeon's steward, assisted by subordinates, presided over the place [sick
bay]...He was always to be found at his post, by night and by day."
Melville’s detailed description of the ship’s medical department notes that "Pills," the

16
surgeon’s steward’s nickname, performed a variety of duties. He assisted in preparing and
passing surgical instruments during an operation. He also ran the ship's apothecary shop, which
he opened for an hour or so in the morning and in the evening. Melville remembered how he
went to the steward several times when he felt a need for medicine, only to be given his freshly-
ground, bitter-tasting powders in a plain tin cup. While he commented on the unpleasant taste
and after-effects, Melville also noted that the potion was free of charge.

Surgeon’s Steward and Nurse

The year 1861 brought a horrible civil war to this country. With the massive increase in the
Navy, changes and developments in the medical department were sure to ensue. On 19 June
1861, a Navy Department circular order established a new name for the loblolly boy.

"In addition to a surgeon's steward, 1 nurse would be allowed for ships with a
complement of less than 200; 2 nurses would be allowed for ships with a
complement of more than 200; and sufficient nurses would be allowed on
receiving ships in a number proportionate to the necessities of the vessel."

While the shipboard medical department may have only changed titles of personnel, new
techniques in mass care of the sick and wounded were developed. A captured sidewheel
steamer was repaired and modified to care for patients. Revisions to the ship were to
include bathrooms, kitchens, laundries, even elevators and facilities to carry 300 tons of ice. On
26 December 1862, the U.S.S. Red Rover became the first Navy vessel specifically
commissioned as a hospital ship. The medical complement included 30 surgeons and male
nurses, as well as four nuns.

While the Civil War was often not as intense at sea services as it was for the Army, there
were a number of terrible battles which necessitated a competent medical department. Pvt.
Charles Brother, a Marine stationed aboard Admiral David Farragut's flagship U.S.S.
Hartford, recalls such an account in his 1864 diary. After the admiral cursed the sea mines
awaiting his fleet in Mobile Bay ("Damn the torpedoes!"), Farragut directed the Hartford into the
fight. Heavy Confederate fire from the Confederate ram Tennessee ensued. As would often be the
case during combat action, Navy medical personnel risked becoming casualties from hostile fire.
In their attempts to minister to battle casualties, medical personnel are themselves targets and
sometimes do not even have the chance to render aid. Pvt. Brother noted, the shell from the ram
burst as it came through killing the Docts Stew'd [sic] instantly...Very few were slightly
wounded, all were either killed instantly or horribly mangled. Our cockpit [sick bay] looked more
like a slaughterhouse than any thing else. Admiral Farragut's after-action report listed a grisly
count of 25 killed and 28 wounded on his ship.

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Apothecary and Bayman

Post-war reductions in the size of the Navy brought new classifications to enlisted medical
personnel. The title surgeon's steward was abolished in favor of three grades of
apothecaries in 1866. Those selected as apothecaries had to be graduates of a course in
pharmacy, or to possess the knowledge by practical experience. The Apothecary, First
Class ranked with a warrant officer, while the second and third class were petty officer
equivalents. The three rates were reduced one petty officer apothecary on 15 March 1869.

Nurse, as a title for junior enlisted medical personnel, was replaced by the title "bayman,"
one who manned the sick bay, in the early 1870s. U.S. Navy Regulations of 1876 used the title
officially, and it remained a valid for 22 more years.

Charles Shaffer began a 50-year career in Navy medicine in 1897 as a bayman. His career
path was typical for one enlisting in the medical field. Shaffer was required to enlist as a
landsman (seaman apprentice), earning $16 a month. It was not until transfer to his first
command that Shaffer's rating was changed to bayman. And since the naval hospitals used
civilian male nurses as opposed to baymen, Shaffer would go to a ship.
With his new title, Bayman Shaffer's pay was upped to $18 a month. His uniform now bore two
strips of piping on the cuff and a "watch mark," a half-inch white stripe sewn around the shoulder
seam of the blue jumper (blue on white uniforms) denoting him as deck force or non-
engineering personnel. This stripe was worn on either the left or right shoulder seam, depending
on whether the individual was assigned to the port or starboard watch. Prior to the establishment
of the Hospital Corps, no specific medical insignia was worn by junior personnel.

Shaffer's senior counterpart, the apothecary, was wearing new insignia as well, that of the
newly-created (1893) Chief Petty Officer. Its three chevrons and three arcs were surmounted by
an eagle, and had a caduceus in the angle of the chevrons. An eagle whose wings extended
horizontally surmounted the arcs. The rating badge described in the 1894 uniform regulations
established the style which has continued, virtually unaltered, to the present day.

An apothecary of the 1890s mixed and dispensed all medication aboard ship. He was
responsible for all medical department reports, supply requests, and correspondence. The
apothecary administered anesthesia during surgery and would be the primary instructor for new
baymen. Some of the medical skills were easily learned, though. "As a rule, baymen became
skillful at bandaging," Shaffer noted, "perhaps due to their previous training in seamanship."

Their responsibilities did not end there, however. During shipboard surgery, the bayman
focused an electric light on the incision site while the surgeon did his work on what was
listed as the "combination writing and operating table". He sterilized surgical instruments by
boiling, then storing them in a solution of 5 percent phenol. Bandages and dressings were
sterilized by baking them in a coffee can in the ship's oven. Sick bay itself was prepared for
surgery by wiping the entire room down with "a weak bichloride solution". On days when the
ship's routine called for scrubbing bags and hammocks, a bayman was responsible for washing

18
those of the sick. He assisted in the maintenance of medical department records, and had to paint
the ship's medical spaces when required.

In the last two decades of the 1800s, many in the naval medical establishment called for
reforms in the enlisted components of the medical department. Medicine had by now
progressed far more as a science, and civilian hospitals all had teaching schools for their
nurses. Foreign navies had trained medical Sailors, and the U. S. Army had established its
own Hospital Corps of enlisted men on 1 March 1887. Navy Surgeon General J. R. Tryon
argued, in his annual report of 1893, against the practice of assigning landsmen to the
medical department with nothing more than on-the-job-training. He advocated the urgent
need for an organized hospital corps.

Physicians in the fleet were equally certain of the need for changes. Surgeon C. A. Sigfried of the
U.S.S. Massachusetts made his views known in his report to the Surgeon General in 1897.

“The importance of improving the medical department of our naval service is more
and more apparent, in view of the recent advances in the methods and rapidity of
killing and wounding. The great want is a body of trained bay men or nurses, and
these should be better paid and of better stamp and fiber. Now and then we procure
a good man, and proceed with his training as a bay man. He soon finds opportunity
for betterment in some one of the various departments of the ship, in the matter of
pay and emolument, either in some yeoman's billet or in some place where his
meager $18 per month can be suddenly increased to $30, $40, or even $60 per
month. The bay man, who should be an intelligent, sober man, and well trained in
many things pertaining to nursing, dieting, ambulance, and aids to wounded, and
have a moderate amount of education, finds his pay at present among the lowest in
the ship's company; even the men caring for storerooms get more per month.”

Hospital Corpsman: Hospital Steward and Hospital Apprentice

Arguments for a professional, well-trained group of individuals to provide medical care for the
Navy finally paid off. Unfortunately, it took the imminent danger of combat in the
Spanish-American War to spur Congress into action. Within a bill aimed at building the
armed forces was a section to provide for the Navy's long-needed Hospital Corps. It was
approved by President William McKinley on 17 June 1898. From that date to the present,
either generically or by rating title, medical Sailors have been called "Hospital Corpsmen."

The Hospital Corps would again change the rate titles. The Hospital Apprentice would be the
equivalent of an apprentice seaman, the Hospital Apprentice First Class was a Third Class
Petty Officer, and the hospital steward was a Chief Petty Officer. Pharmacists were Warrant
Officers, the first of a line of commissioned Hospital Corpsmen that continued until the
establishment of the Medical Service Corps following World War II.

Early history of the Corps set a pace of conspicuous service and involvement that would

19
continue to the present. Before there was even a Hospital Corps School, Hospital Apprentice
Robert Stanley was serving with the U.S. contingent at Peking. Actions by a Chinese political
group that was opposed to foreign presence in China, the so-called Boxers, prompted attacks on
foreign embassies in July 1900. During this action, Hospital Apprentice Stanley volunteered for
the dangerous mission of running message dispatches under fire. For his bravery, Stanley became
the first in a long line of Hospital Corpsmen to receive the Medal of Honor.

In order to ensure that the members of the new Hospital Corps were adequately trained in
the disciplines pertinent to both medicine and to the Navy, a basic school for Corpsmen was
established at the U. S. Naval Hospital Norfolk (Portsmouth), VA. Originally called the School
of Instruction, it opened 2 September 1902. Its curriculum included anatomy and physiology,
bandaging, nursing, first aid, pharmacy, clerical work, and military drill. The first class of 28
Corpsmen was graduated on 15 December 1902. Hospital Apprentice Max Armstrong, at the top
of the alphabetical list of graduates, was naturally given his diploma first and has been heralded
as the Navy's first graduate Hospital Corpsman.

The school continued for a brief time and was then moved to the Naval Hospital in
Washington, DC, staying in existence there until 1911. For the next three years there was
no basic school for Corpsmen, but the concept was revived in 1914. The next two Hospital Corps
Training Schools were opened in Newport, RI and on Yerba Buena Island, CA.

Development of the Navy's Hospital Corps training courses would prepare the first
generation of Hospital Corpsmen for arduous duty, both in peace and war. A graduate of the
Hospital Corps School’s sixth class, Hospital Steward William Shacklette, would find himself
aboard the U.S.S. Bennington in San Diego harbor on 21 July 1905. When the ship's boiler
exploded, Shacklette was burned along with almost half the crew. The other half was killed
outright. He rescued and treated numerous of his shipmates and was awarded the Medal of Honor
for his bravery. Another young Corpsman, Hospital Apprentice First Class William Zuiderveld of
Michigan, landed at Vera Cruz, Mexico in 1914 as part of a force of Navy and Marine Corps
personnel. During intense street fighting in which he was wounded himself, Zuiderveld, a
graduate of the 16th class of the School of Instruction, risked his life on several occasions to aid
wounded shipmates. He, too, received the Medal of Honor.

Hospital Corps: Hospital Apprentices and Pharmacist’s Mates

The next revision in the structure of the Hospital Corps would come by act of Congress on
August 29, 1916. Under this plan, the rates would be hospital apprentices, second class and first
class (both of whom wore a red cross on the sleeve), pharmacist's mates, third, second, and first,
and chief pharmacist's mate. The officer contingent of the Hospital Corps would include the two
warrant officer ranks of pharmacist and chief pharmacist. The reorganization would allow for a
massive increase, five-fold, in the size of the Hospital Corps.

At the start of 1917 the Hospital Corps counted 1,700 men in its ranks. A concerted effort to
recruit and train new personnel enabled the Corps to reach its authorized strength of 3 ½ percent

20
of the Navy and Marine Corps, or 6,000 men. But as these plans came to fruition, the United
States entered World War I in April. By the end of 1918, the Corps would peak at about 17,000.

Hospital Corps: Pharmacist’s Mates in World War I

The massive war increase in Hospital Corps strength necessitated additional schools to
train the newcomers. Hospital Corps School, Great Lakes, IL was established in January
1913. Wartime schools were created in Minneapolis at the University of Minnesota, in New York
at Columbia University, and at the Philadelphia College of Pharmacy. A school for Naval
Reserve Force Hospital Corpsmen was set up at Boston City Hospital. Other crashcourse schools
for shipboard personnel were conducted at a number of other civilian hospitals. Hospital
Corpsmen that were needed to serve as medical department representatives on small vessels such
as destroyers were trained at the Pharmacist's Mate School at Hampton Roads, Virginia, the
forerunner of the Independent Duty Hospital Corpsman School.

Hospital Corpsmen were assigned to the multitude of duty types and locations needed to support
a Navy involved in a world war. Naval hospitals were opened and staffed. Ships and aircraft
squadrons were given medical support. At sea, the dangers of the new war were ever present.
When the troop transport USS Mount Vernon was torpedoed by a German U-boat, Pharmacist’s
Mate First Class Roger Osterheld contends with over 50 casualties, over half of whom were
killed.

Naval training facilities and shore establishments needed Hospital Corpsmen as well as did
occupation forces in Haiti and other bases around the world. But World War I provided the
Hospital Corps a role that would afford it some of the most gruesome and dangerous challenges
it would ever face: duty with the Marine Corps.

Assignment to Marine Corps units was not completely new. Hospital Corpsmen were
serving with Marine occupational forces in Cuba, Haiti, and Santo Domingo at the outbreak of
the war and had seen other similar service. It was the change of the Marine Corps' role, to one of
expeditionary forces in a large scale ground war that changed what Hospital Corpsmen would do.
Sick call and preventive medicine were continuous roles that remained unchanged. Facing
artillery, mustard gas, and machine gun fire were new experiences.

Two to four Hospital Corpsmen were assigned to each rifle company. A First or Second Class
Petty Officer would act as the company Hospital Corpsman and the others as platoon
Hospital Corpsmen. In the trenches and more fixed locations, postes de secours or company aid
stations were established by these contingents. A battalion aid station would have from five to
seven Hospital Corpsmen and a Chief. The Senior Chief Pharmacist's Mate and six to eight more
Hospital Corpsmen would serve at the regimental aid station.

These Hospital Corpsmen lived and worked in arduous battle conditions. In one occurrence, a
predawn mustard gas attack on the 6th Marines at Verdun in April 1918 had devastating
consequences: 235 of the 250 in one company succumbed to the gas and had to be evacuated.
The two company Hospital Corpsmen worked furiously to treat these patients despite their own

21
gas injuries. One died and the other was permanently disabled. Assaults on German positions
offered Hospital Corpsmen further chances to show their commitment. Their performance in
woods well known to Marines would cause the 5th regiment's Commanding Officer to write,
"there were many heroes who wore the insignia of the Navy Hospital Corps at the Bois de
Belleau."

In all, some 300 Hospital Corpsmen, doctors, and dentists served with the 5th Marine Regiment,
the 6th Marine Regiment, and the 6th Machine Gun Battalion, assigned to the
Army's 2nd Infantry Division. Their professionalism and heroism were reflected in some of the
statistics they compiled. During their time in Europe, in the bloody engagements such as Meuse-
Argonne and Belleau Wood, they treated over 13,000 casualties. Eighteen of their own were
killed and 165 were either wounded or injured by mustard gas.

A heritage of valorous service with the Marines was born. Two Hospital Corpsmen received the
Medal of Honor. Other decorations to Hospital Corpsmen included 55 Navy Crosses, 31 Army
Distinguished Service Crosses, 2 Navy Distinguished Service Medals, and 237 Silver Stars. A
hundred foreign personal decorations were granted to Navy Hospital Corpsmen, and 202 earned
the right to wear the French Fourragère shoulder aiguillette permanently. Their 684 personal
awards make the Hospital Corps, by one account, the most decorated American unit of World
War I.

Following the war there was an inevitable decrease in the strength of the armed forces.
Despite the loss of Hospital Corpsmen, there were still missions to perform. Nicaragua was
added to the list of occupational duties to which the Marines and their Hospital Corpsmen were
assigned in 1927. Ships and naval hospitals still required Hospital Corps staff. Dedicated
members of the Hospital Corps remained in the service, doing what they loved, despite the lack
of advancement opportunity. In the years between the wars, time in rate from pharmacist’s mate
second class to pharmacist’s mate first class was 8 years.

Hospital Corps: Pharmacist’s Mates in World War II

World War II became the period of Hospital Corps’ greatest manpower, diversity of duty,
and instance of sacrifice. Between 1941 and 1945, the ranks of this small organization
swelled from its pre-war levels of near 4,000 to over 132,000 personnel. This increase
came to fulfill new responsibilities with new technologies at new duty stations. In the face of
great adversity, the Hospital Corps would cement its reputation for effectiveness and bravery.

The Navy’s fleet expanded to thousands of ships and the Marine Corps grew from a few
regiments to six divisions. A two ocean war produced horrific numbers of casualties. The
Hospital Corps would have to grow to meet the needs of casualty collection, treatment, and
convalescence. To educate the influx of new Sailors, Hospital Corps Training School at
Portsmouth, VA was augmented by a temporary school at Naval Hospital Brooklyn, NY. The
school at Great Lakes was recreated in 1942, and others were started at Farragut, ID and at
Bainbridge, MD in 1943. A separate Hospital Corps Training School was established for women
at Bethesda, MD in January, 1944. Specialized schools were opened to train pharmacist’s mates

22
for independent duty and for service with the Marines. Additionally, courses were established to
instruct personnel on new equipment and techniques in dozens of developing medical fields.

Shore-based duty sent Hospital Corps personnel to hospitals and dispensaries in the United States
and abroad. Advance base hospitals on newly-captured Pacific islands formed a crucial link in
the chain of evacuation from battle sites. Those facilities in Hawaii or England received
casualties from their respective fronts. Stateside hospitals watched over wounded service
personnel as their recuperation continued. Hospital Corpsmen made the treatment of American
casualties possible at each of these by providing technical support and direct patient care.

Duty on surface ships afforded Hospital Corpsmen numerous challenges and abundant
environments in which to face them. Hospital ships required the services of personnel in
much the same way as shore-based hospitals, except that those on ship were afloat and
subject to attack. Other classes of vessels, such as landing ships, tank (LSTs) and patrol
craft, escort and rescue (PCERs) became large floating clinic/ambulances which required
additional Hospital Corps personnel.

Combatant ships and transports in the Atlantic, Pacific, and Mediterranean theaters took
casualties from ships, aircraft, and submarines throughout the war, necessitating the
service of well-trained Hospital Corpsmen. Casualties could be staggering on attacked
ships. In one example, the aircraft carrier USS Bunker Hill sustained 392 killed and 264
wounded when it was hit by two kamikazes.

Role of submarine Hospital Corpsmen developed into one of great importance. Hospital
Corpsmen treated 549 survivors of air or sea calamities, U.S. and enemy alike. In one case, three
Sailors were seriously wounded, the submarine’s C.O. wrote, "the Chief Pharmacist’s Mate is
particularly commended for his quick and efficient action in caring for these three wounded
shipmates...He has been recommended for promotion and the Bronze Star Medal."

The most dramatic accomplishments of submarine Hospital Corpsmen were three who had
to do surgery while submerged. Pharmacist’s Mate First Class Wheeler "Johnny" Lipes
performed a successful appendectomy aboard the USS Seadragon on 11 September 1942.
Lipes, who had been a surgical technician, used improvised instruments made from mess
deck utensils and instructed assistants as the procedure went on in the officers’ wardroom.
PhM1c Harry Roby performed the same act on the USS Grayback as did PhM1c Thomas Moore
aboard USS Silversides, both in December 1942. Approximately 300 Hospital Corpsmen sat out
all but the early days of the war when they were captured by the Japanese who invaded the
Philippines. In prisoner of war camps and huddled in POW "hell ships", they endured
malnutrition, disease, torture, and brutality. One hundred thirty-two Hospital Corpsmen died as
prisoners during World War II, a death rate almost 20 percent higher than among other American
POWs. Hospital Corpsmen served on the beaches not only in the island campaigns of the Pacific,
but in Europe as well. Teams of Navy medical personnel formed aid stations with beach
battalions at Sicily and Normandy, treating Army and allied wounded under fire. Hospital
Corpsmen ensured the survival of these casualties until they could reach hospitals in
England.

23
Of all the Hospital Corpsmen in World War II, Fleet Marine Force personnel endured,
perhaps, the most grueling side of war. As they swarmed numerous beaches in the Pacific, they
became targets themselves as they braved fire to reach downed comrades. At Guadalcanal,
Tarawa, Peleliu, Saipan, Tinian, Kwajalein, Iwo Jima, and Okinawa, Hospital Corpsmen bled
and died, often in greater numbers than the Marines for whom they cared. Hospital Corps
casualties in the 4th Marine Division at Iwo Jima, for example, were 38 percent.

Pharmacist's Mate First Class Ray Crowder made notes of his combat experiences in his
diary:

“Most of the men who had been wounded previously were hit again...I was hit by a
piece of shrapnel in my leg but I overlooked it until later. As soon as I could get
my wits together...I began to do what I could for the guys. Two of the men were
screaming with shock. Darkness had already fallen and I couldn't see what I was
doing. All that I could do was to feel the blood and try to get a pressure bandage put over
it to stop the bleeding.”

Pharmacist’s Mate Second Class John H. Bradley’s heroism with the 28th Marines on Iwo Jima
is typical of acts repeated by Hospital Corpsmen throughout the war. On seeing a
wounded Marine, Bradley rushed to his aid through a mortar barrage and heavy machine
gun fire. Although other men from his unit were willing to help him with the casualty, Bradley
motioned them to stay back. Shielding the Marine with his own body, the Hospital Corpsman
administered a unit of plasma and bandaged his wounds. Through the gunfire, he then pulled the
casualty 30 yards to safety.

PhM2c Bradley was awarded the Navy Cross for his valor, but he is not usually remembered for
this act. Days later, he and five Marines were captured in Joe Rosenthal’s photograph of the
second flag raising on Mt. Suribachi. The image was reproduced more than perhaps any photo in
history. It was the theme for the Marine Corps War Memorial in Arlington, VA and made
Bradley the first U.S. Navy Sailor to appear on a postage stamp. His likeness as a dedicated
American serviceman is the most famous in the Hospital Corps’ history.

Members of the Hospital Corps treated some 150,000 combat casualties during the war.
This does not include thousands of others, those plagued by disease and injured in the line of
duty, who were aided by their medical shipmates. The cost of this service was high: 1,170
Hospital Corpsmen were killed in action and thousands more were wounded. But their valor in
doing their jobs was great. Hospital Corpsmen earned 7 Medals of Honor, almost half of those
awarded to Sailors in the war. In addition, they earned 66 Navy Crosses, 465 Silver Star Medals,
and 982 Bronze Star Medals.

A New Hospital Corps:

Massive reorganization of the armed forces took place after World War II. A new
Department of Defense was established, and the Army-Navy Medical Service Corps Act

24
removed commissioned allied health and medical administration officers from the Hospital
Corps. This law also provided for a separate Dental Technician rating, which remained a
component of the Hospital Corps until 1972. Women in the Hospital Corps had previously been
WAVES, or members of the Women’s Reserve, U.S. Naval Reserve. New legislation permitted
women to enlist in the Regular Navy, and HM1 Ruth Flora became the first Hospital Corpsman
to do so on 12 July 1948.

Effective 2 April 1948, the Navy changed the names and insignia of the Hospital Corps. The new
titles were Hospital Recruit, Hospital Apprentice, Hospitalman, Hospital Corpsman Third,
Second, and First Class, and Chief Hospital Corpsman. The red Geneva cross, which had marked
Corpsmen for 50 years, was replaced in the rating badge with the original mark of the winged
caduceus. The rates of Senior Chief and Master Chief Hospital Corpsman were added in 1958.

Hospital Corpsmen in Korea

As part of a United Nations force, Marines were committed to the Korean peninsula when South
Korea was invaded by its northern neighbor in the summer of 1950. Within the first year,
Hospital Corpsmen had participated in the dramatic landing at Inchon and the frigid retreat from
the Chosin Reservoir. By the summer of 1951, a stalemated line of opposing forces took static
positions. For the next two years, the war would be reminiscent of World War I, with bunkers,
trenches, raids and artillery fire. The slow war of attrition was nonetheless lethal. In late March
1953, 3,500 Chinese Communist Forces soldiers attacked three outposts--Reno, Vegas, and
Carson--of 40 Marines and one Hospital Corpsmen each. Out of this fighting came two Medals
of Honor and numerous other decorations. In the Nevada Cities Outpost battles, most of the
Hospital Corpsmen who were involved at the small unit level were either killed or wounded.

Although only one Marine division was involved in the war, the Hospital Corps lost 108
killed in action. Disproportionate to their numbers was their heroism. In Korea, Hospital
Corpsmen earned 281 Bronze Star Medals, 113 Silver Star Medals, and 23 Navy Crosses.
All five enlisted Navy Medals of Honor were awarded to Navy Hospital Corpsmen serving with
the Marines.

Hospital Corpsmen in Vietnam

American military commitment in Southeast Asia grew in the decades following World War II.
As early as 1959, a few Hospital Corpsmen provided medical support for U. S. military personnel
as part of the American Dispensary at the U.S. Embassy. Four years later, in 1963, Navy Station
Hospital, Saigon was created. Ninety Hospital Corpsmen would staff the facility, which provided
care for U. S. and allied (Australian, New Zealand, Filipino, and South Korean) military, as well
as South Vietnamese civilians. These medical personnel conducted routine medical care and
treated the victims of combat and terrorist actions until the hospital was transferred to the Army
in 1966.

A new hospital was constructed in 1965 at Naval Support Activity Da Nang. A staff of 485
Hospital Corpsmen worked with doctors and nurses to care for combat casualties. The

25
hospital, which was designed primarily to care for Marines in the I Corps sector, treated
23,467 patients in 1968 alone. Although not on the front lines, the Hospital Corpsmen here
were subjected to routine rocket and mortar attacks.

Hospital Corpsmen were assigned aboard ships of various kinds, providing off-shore
medical support to U. S. forces. The largest commitment here was on the hospital ships
USS Repose and USS Sanctuary. Some 200 Hospital Corpsmen, representing the gamut of
technical specialties, worked on each ship. Teams of 20 Hospital Corpsmen served on LPH class
amphibious ships. Others supported the Riverine force on APB class base ships.

U. S. State Department initiatives and the Medical Civic Action Program (MEDCAP)
provided medical support for Vietnamese civilians. Beyond routine aid and treatment, the
Hospital Corpsmen working through these programs provided guidance in sanitation and
preventive medicine throughout South Vietnam.

By far the Hospital Corps’ largest contribution in Vietnam was with Marine Corps units.
Starting with the 50 who landed with the Marines at Da Nang in 1965, the enlisted medical
component would grow to 2,700 Hospital Corpsmen assigned to 1st and 3d Marine Divisions, 1st
Marine Air Wing, and other combat support units. Two medical battalions and two hospital
companies operated field hospitals, collecting and clearing units, and dispensaries which treated
the flow of combat casualties from the field. Closer support was provided at the battalion aid
station (BAS) level, where casualties could be stabilized before evacuation to more definitive
care. The BAS was often bypassed because of the exceptional medical evacuation capabilities of
helicopter medical evacuation (MEDEVAC).

The most dangerous role of the Hospital Corpsman in Vietnam was in the field. Special
units, such as Navy SEAL teams and Marine reconnaissance units took medical Sailors
with them, as did the artillery, air, and infantry elements of the Marine Corps. Most of the 53
Hospital Corpsmen assigned to an infantry battalion served with rifle companies, one or two men
per platoon of about 40. These Sailors patrolled with their Marines, risked the same dangers, and
rendered the aid that saved the lives of thousands.

Contributions of Hospital Corpsmen in Vietnam were noteworthy, as they cared for over
70,000 combat Navy and Marine Corps combat casualties and countless military and
civilian sick call patients. Their valor was great. HM3 Donald E. Ballard, HM3 Wayne M. Caron,
and HM2 David R. Ray earned the Medal of Honor for heroism. HM3 Robert R. Ingram received
his Medal of Honor for Vietnam in 1998. Additionally, 30 Hospital Corpsmen received the Navy
Cross, 127 the Silver Star Medal, and 290 the Bronze Star Medal. The names of 638 Hospital
Corpsmen were killed in action there, more than in any other war except World War II. Too
many more--4,563--would earn the Purple Heart.

HM2 Chris Pyle wrote the following letter home before assignment with 1st Marine Division in
Vietnam.

26
 “Many people have died to save another. The Navy Corpsman has had more honors
bestowed on him than any other group. My life has but one meaning, to save or help
someone. Soon I will be going over to Vietnam. I have my fears and beliefs, but they lay
hidden under my emotions. That’s why God has made me so. Someday I will see before
me a wounded marine. I will think of all kinds of things, but my training has prepared me
for this moment. I really doubt if I will be a hero, but to that Marine I will be God. I am
hoping that no one will die while I am helping him; if so, some of myself will die with
him. Love for fellow man is great in my book. It’s true they make me mad at times but no
matter who it is, if he’s wounded in the middle of a rice paddy, you can bet your bottom
dollar that whatever God gave me for power, I will try until my life is taken to help save
him, and any other.”

Five months later, on 28 May 1969, HM2 Pyle was killed in action.

Hospital Corpsmen in Beirut

A different part of the world would beckon Hospital Corpsmen in the 1980s, southwest Asia. The
objective was a "peacekeeping" mission in Beirut, Lebanon, in which U.S. forces participated
with those of France, Italy, and the Great Britain in a Multinational Force. Here, Hospital
Corpsmen from the ships of a Mediterranean Amphibious Ready Group and a Marine
Amphibious Unit were assigned to stop a bloody, eight-year old factional civil war. By the end of
August, 1983, the peacekeepers had become targets and responded in a ground war that was all
but unknown back in the U.S.

Firefights at isolated outposts soon produced casualties, and Hospital Corpsmen responded
under fire to treat their wounded Marines. When a mortar round hit one of the Marine
positions, one Hospital Corpsman, HN Victor Oglesby, found himself with five wounded
Marines, his platoon sergeant dead, and his platoon commander barely alive. Two months
later, on 23 October a uniformed suicide truck bomber attacked the headquarters of 1st
Battalion, 8th Marines. The truck bomb unleashed the largest non-nuclear blast ever
detonated, and killed 241 Americans. Almost the entire battalion aid station--15 Hospital
Corpsmen and the battalion surgeon--were killed. The casualty count for the Hospital Corps
would be the next costly after World War I. One of the three Hospital Corpsmen who survived
the blast, HM3 Donald Howell, tended to wounded Marines while trapped in the rubble and
wounded himself. The relief unit for the 24th Marine Amphibious Unit would not arrive in
Lebanon until they had invaded the small Caribbean nation of Grenada.

Hospital Corpsmen in the Persian Gulf War

The 1990-91 Iraqi invasion of Kuwait gained a strong response from the U.S. and the world.
Preparations were made to drive the Iraqi Army out of the tiny country, and Corpsmen were
readied to respond to the needs of their shipmates. Hospital Corpsmen around the globe reacted,
as their ships, stations, and Marines deployed or prepared to receive casualties. In fact, the first
Navy casualty of the war was a Hospital Corpsman. Of the vast number of Naval Reservists

27
called to active duty, the largest single group activated was Hospital Corpsmen. Of an inventory
of just over 12,000 Hospital Corpsmen in the Naval Reserve, 6,739 were recalled to active duty.
The largest group of them, 4,617, served at medical treatment facilities and casualty receiving
centers. 1,142 went to Marine Corps units, 841 to Fleet Hospitals 6 and 15, 471 of them were
assigned to the hospital ships Mercy and the Comfort.

Hospital Corpsmen in Somalia

U.S. forces would again try to bring stability to a troubled land: Somalia. Hospital Corpsmen
there faced both bullets and the needs of a starving populace. One, HM3 Timothy E. Quinn,
wrote a letter describing his experiences in February 1993. "I was on a foot patrol that got pinned
down by automatic weapons fire, and here I am tucked up against a tree trying to get small..." He
continued, "I go out to orphanages and do simple sick call and such...the people there tell us that
food is now plentiful, and that no one is dying of hunger anymore, but now the medical problems
are much more apparent."

Hospital Corpsmen in 1998

In its first century, the Hospital Corps has compiled a truly honorable legacy of valor and
sacrifice. In addition to the wars and conflicts recounted here, Hospital Corpsmen have
responded to natural disasters, military accidents, and other peacetime emergencies.
Moreover, they have maintained the regular health of their Sailors and Marines, giving
immunizations, conducting preventive medicine efforts, and holding sick call. Today, the
23,000 regular and 6,000 reserve members of the Navy Hospital Corps continue to serve
around the globe. They are assigned to naval hospitals and clinics, to surface ships and
submarines. They fly search and rescue missions and deploy with Seabees. They maintain
constant battle readiness with Marine Corps units and SEAL teams.

Hospital Corpsmen have always had the job of maintaining the health of their shipmates.
Their innumerable instances of heroism, of consciously exposing themselves to danger to
save lives, are not spectacular because they were required to act. Their displays of courage have
been noteworthy because these men and women cared about their shipmates.

Next portion added at FMTB – Article by Cpl. Anthony R. Blanco

15th MEU (SOC) combat Corpsman uphold proud legacy

Ever since the birth of the Corps in 1775, Marines and Sailors have served side-by-side on naval
vessels beginning their long and adventurous history.

Rich within that history is the bond between the Marine and the Hospital Corpsman. Only twenty
three short years after the first Marines began their sea service, Navy Corpsman stepped up and
began providing the medical care of Marines. To this day Navy Corpsmen, also known as ‘Doc,
have saved countless numbers of Marines’ lives during every American conflict since 1798.

28
The Navy Corpsmen attached to the 15th Marine Expeditionary Unit (Special Operations
Capable) are no different from the past Corpsmen and still carry the special Marine Corps and
Navy bond.

Marines and Sailors recently debarked from the Tarawa Amphibious Ready Group in support of
United States and Coalition forces building up in Kuwait. Navy Corpsmen are here to support
any action necessary and that includes adding another page to their illustrious history with their
participation in Operation Enduring Freedom and the possible confrontation with Iraq to destroy
potential weapons of mass destruction.

During World War II, Navy Corpsmen performed emergency medical treatment on wounded
Marines while under heavy enemy fire.

In 1945, the Secretary of the Navy, James Forrestal, commended Corpsmen when he said, “The
Hospital Corpsmen saved lives on all the beaches Marines stormed. … You Corpsmen performed
foxhole surgery while shell fragments clipped your clothing, shattered the plasma bottles from
which you poured new life into the wounded, and sniper’s bullets were aimed at the (red cross)
brassards on your arms.”

Seven Navy Corpsmen received the Medal of Honor, the nation’s highest award, and 67
Corpsmen received the Navy Cross, the Navy’s second highest award, by performing above and
beyond the call of duty during World War II.

Although Corpsmen don’t usually have a degree in medical science and are younger than most
doctors, they are doing more than what some doctors only dream about, according to Chief David
D. Jones, 37, the BLT 2/1 medical chief, who is a native of Brooklyn N.Y. Jones has spent 12 of
is 18 years in the Navy with Marine Corps units.

By working in an environment where a fighting hole or a bunker could be the operating room,
the Navy implemented Field Medical Service Schools at Marine Corps Base Camp Pendleton,
Calif., and Marine Corps Base Camp Lejeune, N.C., in 1950 to better train Corpsmen in the field.
Before Corpsmen can attach to an infantry unit they must complete the course, according to HM2
(FMF) Tommy L. Johnson, who is a Hospital Corpsman with Trailer Platoon, Battalion Landing
Team 2/1, 15th MEU (SOC). Johnson, whose previous duty assignment was at Siganelli Naval
Air Station, Italy, said he was looking forward to working with an infantry Marine unit.

“When I got orders to [Camp Horno on Camp Pendleton], I was excited because I got the
opportunity to work with the best fighting force in world,” the 23-year-old Richmond, Calif.,
native said.

Because medical doctors don’t fight on the front line with the Marine units, Corpsmen are
challenged by making-on-the-spot life-saving decisions.

In Vietnam, approximately 16 percent of casualties on the front lines were critically injured and it
was up to the Corpsman to save the lives of those Marines, according to Navy Lt. Michael B.

29
Humble, 30, the BLT 2/1 surgeon, who is a native of Russellville, Ky. “I trust them to make
[important] decisions,” Humble said. “I believe that the Marines fight better when they know that
they have a Corpsman there. It’s a comforting feeling knowing that someone is behind you
willing to take care of you.”

Johnson, who worked for the Navy before coming to a Marine unit, said he wanted to raise the
bar and test himself to hang with an infantry unit. “I wanted to bring myself to another level,”
Johnson said. “When I walk into a [Naval] hospital and other Corpsmen see me wearing my Fleet
Marine Force badge, they look at me with pride.”

Even Marines in his unit know that he’ll be there to take care of them, whether in battle or back
home at Pendleton. “I love field Corpsmen because they do everything we do and they have to
know more than we do,” said Sgt. Iradj M. Navai, 26, a squad leader with Trailer Platoon, BLT
2/1, who is a native of San Clemente, Calif. “He (Johnson) went out of his way and gave us all
medical blow out kits so we could perform self-aid and buddy-aid if he wasn’t available during
combat.” A “blow out” kit is a medical kit that contains a variety of field medical dressings and
bandages.

Johnson also takes the opportunity during down time to teach his Marines basic medical care.

“In the field, my Marines come first,” Johnson said. “They depend on me and I know that my
Marines are going to take care of me if I become injured.” Corpsmen throughout history have
proved they are vital to the healthcare of Marines during combat. Lt. Gen. Lewis B. “Chesty”
Puller, said to his Corpsmen during the Korean War, “You guys are the Marines’ doctors; there’s
no better in the business than Navy Corpsmen.”

As many Marines agree with Chesty, Navai puts Corpsmen on a different level.

“They keep us alive in combat, they are our angels,” Navai said. “If you get scared or hurt, all
you have to say is ‘Corpsman up’ and there’s your angel.”

COMBAT CORPSMEN
Cpl. Anthony R. Blanco
15th Marine Expeditionary Unit (Special Operations Capable)

30
INTRO TO USMC
 INTRODUCTION TO THE USMC

Rank Structure of USMC 1-1

FMST 101

Marine Corps History 1-12

FMST 102

USMC Organizational Structure and Chain of Command 1-21

FMST 103

Traits and Principles of USMC Leadership 1-30

FMST 104

USMC Uniform Regulations 1-43

FMST 105

Individual Combat Equipment 1-52

FMST 106

Code of Conduct and Rights of POW’s 1-64

FMST 107

Recognize Combat Stress Disorders 1-74

FMST 108

M16/M4 Service Rifle Familiarization 1-87

FMST 109

Review Questions 1- 103

 UNITED STATES MARINE CORPS
FIELD MEDICAL TRAINING BATTALION
BOX 55243
CAMP PENDLETON, CA 92055-5243

FMST 101

Rank Structure of the USMC

TERMINAL LEARNING OBJECTIVE

1. Without the aid of references, describe common terms, sayings, and quotations used in the
Marine Corps without omitting key components. (HSS-MCCS-2025)

ENABLING LEARNING OBJECTIVES

1. Without the aid of reference and in writing, identify the different ranks within the Navy
and Marine Corps within 80% accuracy, in accordance with the Marine Corps Common Skills
Handbook. (HSS-MCCS-2025a)

2. Without the aid of reference and in writing, identify the job descriptions within the Navy
and Marine Corps ranks within 80% accuracy, in accordance with the Marine Corps Common
Skills Handbook. (HSS-MCCS-2025b)

1-1
1. ENLISTED RANKS

Categorized into three groups

-Junior Enlisted
-Non-Commissioned Officers
-Staff Non-Commissioned Officers

Junior Enlisted

PAYGRADE MARINE CORPS NAVY

Private Hospitalman Recruit
NONE NONE
E-1

Roles: 1. Entry level Marine/Sailor

2. Platoon member responsible to their fireteam leader.
3. An HR may be assigned as a Platoon Corpsman or General Duty Corpsman within an
aid station.

Private First Class Hospitalman Apprentice

E-2

Roles: 1. Entry level Marine/Sailor

2. Platoon member responsible to their fireteam leader.
3. An HA may be assigned as a Platoon Corpsman or General Duty Corpsman within an
aid station.

Lance Corporal Hospitalman

E-3

Roles: 1. Entry level or experienced Marine/Sailor

2. Platoon member responsible to their fireteam leader.

1-2
 3. Experienced Lance Corporals can assume the duties as a fireteam leader.
4. An HN may be assigned as a Platoon Corpsman or General Duty Corpsman within an
aid station.
5. Experienced HNs maybe assigned as Senior Line Corpsman.

Non-Commissioned Officer / NCO

PAYGRADE MARINE CORPS NAVY

Corporal Hospital Corpsman Third
Class

E-4

Roles: 1. Experienced Marine assigned as fireteam leader or squad leader

2. An HM3 may be assigned as a Platoon Corpsman or hold the Senior Line Corpsman
position.
3. Within an aid station, an HM3 may be assigned a commodity such as Physicals PO,
Supply PO, PMR, etc.

Sergeant Hospital Corpsman Second

Class

E-5

Roles: 1. Experienced Marine assigned as squad leader, but can assume duties as Platoon
Sergeant.
2. An HM2 at the company level is assigned as the Senior Line Corpsman.
3. Within an aid station, an HM2 will have added responsibilities ranging from
Administration PO to Assistant LPO.

1-3
 Staff Non-Commissioned Officer / SNCO

PAYGRADE MARINE CORPS NAVY

Staff Sergeant Hospital Corpsman First
Class

E-6

Roles: 1. Senior Marine assigned as Platoon Sergeant, but can assume duties as Platoon
Commander.
2. An HM1 is assigned to the aid station with administrative responsibilities.
3. Leading Petty Officers are tasked with the day to day operations of the aid station.

PAYGRADE MARINE CORPS NAVY

Gunnery Sergeant Chief Hospital Corpsman

E-7

Roles: 1. Senior Marine assigned as Company Gunnery Sergeant; can assume role as Company
1stSgt.
2. The Chief of an aid station is responsible for all sailors within a unit as well as the
functioning of the aid station.
3. The Chief reports directly to the SgtMaj and the Battalion Commander.

1-4
PAYGRADE MARINE CORPS NAVY
Master Sergeant Senior Chief Hospital
(Technical Expert) Corpsman

E-8

First Sergeant
(Administrative)

PAYGRADE MARINE CORPS NAVY

Master Gunnery Sergeant Master Chief Hospital
(Technical Expert) Corpsman

E-9

PAYGRADE MARINE CORPS NAVY

Sergeant Major Command Master Chief
(Administrative)

E-9

1-5
 PAYGRADE MARINE CORPS NAVY
Sergeant Major of the Master Chief Petty Officer of
Marine Corps the Navy
(MCPON)

E-9

2. OFFICER RANKS

Marine Corps Officers wear gold or silver rank insignias on the shoulder lapel of their
coats or overcoats. They also wear small replicas of the insignia on their shirt collar.
The color and shape of the insignia varies with their rank.

Officer ranks within the Marine Corps are categorized into three (3) groups
-Company Grade: W1 to W5 and O-1 to O-3
-Field Grade: O-4 to O-6
-General Grade: O-7 to O-10

Company Grade

PAYGRADE MARINE NAVY

Background is GOLD There are no W-1 Warrant Officers in the Navy
and markings are
SCARLET.

W-1

1-6
PAYGRADE MARINE NAVY
Background is GOLD Background is GOLD
and markings are SCARLET and markings are BLUE

W-2

PAYGRADE MARINE NAVY

Background is SILVER Background is SILVER
and markings are and markings are BLUE
SCARLET

W-3

PAYGRADE MARINE NAVY

Background is SILVER Background is SILVER
and markings are and markings are BLUE
SCARLET

W-4

1-7
 PAYGRADE MARINE NAVY
Background is SILVER Background is SILVER
and markings are SCARLET and markings are BLUE

W-5

NOTE: W-1 in the Marine Corps is known as Warrant Officer. W-2 through W-5 are called
Chief Warrant Officers.

PAYGRADE MARINE NAVY

nd
2 Lieutenant Ensign

O-1 (Bar is
Gold)

PAYGRADE MARINE NAVY

1st Lieutenant Lieutenant Junior Grade

O-2 (Bar is
Silver)

PAYGRADE MARINE NAVY

Captain Lieutenant

O-3 (Bars are

Silver)

1-8
 Field Grade

PAYGRADE MARINE NAVY

Major Lieutenant Commander

O-4 (Leaf is
Gold)

PAYGRADE MARINE NAVY

Lieutenant Colonel Commander

O-5 (Leaf is
Silver)

PAYGRADE MARINE NAVY

Colonel Captain
O-6
(Eagle is Silver)

General Grade Officers

PAYGRADE MARINE NAVY

Brigadier General Rear Admiral
(lower half)
O-7

PAYGRADE MARINE NAVY

Major General Rear Admiral
(upper half)
O-8

1-9
 PAYGRADE MARINE NAVY
Lieutenant General Vice Admiral
O-9

PAYGRADE MARINE NAVY

General Admiral

O-10

Senior Officers

Each branch of the Armed Forces has a senior officer grade of their respective branches
of the service:

-Marines: Commandant of the Marine Corps

-Navy: Chief of Naval Operations
-Army: Chief of Staff of the U.S. Army
-Air Force: Chief of Staff of the U.S. Air Force

REFERENCE
Marine Corps Common Skills Handbook

1-10
 Rank Structure Review
Match the Marine Corps rank with the proper name. (Not every name will be used)

Captain

Private

Lance Corporal

First Sergeant

Sergeant

Major General

Lieutenant General

Colonel

1-11
 UNITED STATES MARINE CORPS
FIELD MEDICAL TRAINING BATTALION
BOX 555243
CAMP PENDLETON, CA 92055-5243

FMST 102

Marine Corps History

TERMINAL LEARNING OBJECTIVES.

1. Without the aid of references, describe common terms, sayings, and quotations used in the
Marine Corps without omitting key components. (HSS-MCCS-2025)

1. Without the aid of references, identify significant events in Marine Corps history without
omitting key components. (HSS-MCCS-2026)

ENABLING LEARNING OBJECTIVES.

1. Without the aid of reference and in writing, identify Marine Corps terminology within 80%
accuracy, in accordance with the Marine Corps Common Skills Handbook. (HSS-MCCS-2025c)

2. Without the aid of reference and in writing, identify historical significance of different
places in Marine Corps history within 80% accuracy, in accordance with the Marine Corps
Common Skills Handbook. (HSS-MCCS-2026a)

3. Without the aid of reference and in writing, identify historically significant individuals in
Marine Corps history within 80% accuracy, in accordance with the Marine Corps Common
Skills Handbook. (HSS-MCCS-2026b)

4. Without the aid of reference and in writing, identify historically significant Battles in
Marine Corps history within 80% accuracy, in accordance with the Marine Corps Common
Skills Handbook. (HSS-MCCS-2026c)

5. Without the aid of reference and in writing, identify historically significance of

Pathbreakers in Marine Corps history within 80% accuracy, in accordance with the Marine
Corps Common Skills Handbook. (HSS-MCCS-2026d)

1-12
1. MARINE CORPS TERMINOLOGY.
The United States Marine Corps holds deep regard for its history, traditions, and honor. This
history and tradition includes, and is to some extent defined by the heroic actions and sayings of
past and present Marine Warriors. These actions and statements made by Marines or people
observing Marines have become part of the Marine Corps Warrior Ethos. We use them to
remember what Marines have done and how they have influenced our warrior culture in a very
positive way. The terminology that Marines use depict a very specific time in our history that is
drawn upon by young and old Marines alike; to instill pride in our service. Here are the terms
that are used by every Marine:

a. First to Fight. Marines have been in the forefront of every American war since the
founding of the Marine Corps. They entered the Revolution in 1775, just before the Declaration
of Independence was signed. They have carried out more than 300 landings on foreign shores.
They have served everywhere, from the poles to the tropics. Their record of readiness reflects
pride, responsibility, and challenge.

b. Leathernecks. The nickname Leathernecks dates back to the leather stock, or neckpiece
worn as part of the Marine uniform during the years 1775 to 1875. Back then, the leather bands
around their throats ensured that Marines kept their heads erect. Descended from the stock, the
standing collar is hallmark of the Marine blues, whites, and evening dress. Like its leather
ancestor, the standing collar regulates stance and posture, proclaiming the wearer as a modern
“leatherneck”.

c. Devil Dogs. The term was coined during the Battle of Belleau Wood in 1918 in which the
Germans received a thorough indoctrination in the Marines’ fighting ability. Fighting through
“impenetrable” woods and capturing “untakeable” terrain, their persistent attacks delivered with
unbelievable courage soon had the Germans calling the Marines “Teufelhunden”, which are
fierce fighting dogs of legendary origin. The term is belovedly translated “devil dogs”.

d. Espirit de Corps. The “spirit” of a unit is commonly reflected by all of its members. It
implies devotion and loyalty to the Marine Corps, with deep regard for its history, traditions, and
honor. It is the epitome of pride in the unit.

e. Uncommon valor was a common virtue. Refers to the victories in World War II,
especially at Iwo Jima, the largest all-Marine battle in history. Admiral Nimitz spoke this not
only to the Marines fighting on Iwo Jima, but to the entire Marine Corps’ contribution to the war
stating, “Uncommon valor was a common virtue.”

f. Semper Fidelis. The Marine Corps Motto Semper Fidelis is Latin for Always Faithful.

1-13
2. SIGNIFICANT EVENTS. As we look back into the history of the Marine Corps we see that
there are many places that Marines have gone and fought. Like the Hymn says “we have fought
in every clime and place, where we could take a gun.” These are some of the significant places
that Marines hold as milestones in their history.

a. Tun Tavern. The Marine Corps was created on 10 November 1775 in Philadelphia,
Pennsylvania at Tun Tavern by a resolution of the Continental Congress, which "raised two
battalions of Marines." Captain Samuel Nicholas became the commander of these two battalions
and is traditionally considered the first Commandant of the Marine Corps.

b. Derna, Tripoli. In 1805 Marines stormed the Barbary pirates’ stronghold at Derna on the
“Shores of Tripoli.” Marines raised the “Stars and Stripes” for the first time in the Eastern
Hemisphere.

c. Belleau Wood. Marines fought one of their greatest battles in history at Belleau Wood,
France during World War I. Marines helped crush a German offensive at Belleau Wood which
threatened Paris. In honor of the Marines who fought there, the French renamed the area “the
Wood of the Brigade of Marines.” German intelligence evaluated the Marines as “storm
troops”—the highest rating on the enemy fighting scale. In reference to the Marine’s ferocious
fighting ability, German troops called their new enemy “Teufelhunden” or “Devildogs,” a
nickname in which Marines share pride in to this day.

d. The Chosin Reservior. After pushing far into North Korea during November of 1950,
Marines were cut off after the Chinese Communist Forces entered the war. Despite facing a 10-
division force sent to annihilate them, Marines smashed seven enemy divisions in their march
from the Chosin Reservoir. The major significance of this retrograde movement was that
Marines brought out all operable equipment, properly evacuated their wounded and dead, and
maintained tactical integrity.

e. Kuwait.

(1) 1990 - Following the invasion of Kuwait by Iraqi forces, Operation Desert Shield was
launched. This joint military operation was designed to halt the advance of Iraqi forces and to
position multinational forces assembled for possible offensive operations to expel the invading
force. This operation validated the Marine Corps Maritime Prepositioning Force (MPF) concept
and enacted the plan of tailoring units to accomplish a mission as part of a Marine Air Ground
Task Force (MAGTF).

(2) 1991 - Operation Desert Storm was launched after the Iraqi government refused to
comply with United Nations resolutions. Marine aviation was heavily used when the air phase
commenced in January of 1991. When massive bombing failed to dislodge Iraqi forces, Marine
ground forces swept into Kuwait and liberated the country, causing severe damage to the Iraqi
military capability.

1-14
3. HISTORICALLY SIGNIFICANT MARINES.

a. Presley Neville O’Bannon. First Lieutenant O'Bannon is remembered for heroism in the
battle for the harbor fortress of Derna (Tripoli) in the Mediterranean. O'Bannon's Marines were
the first U.S. forces to hoist the flag over territory in the Old World. The "Mameluke" sword,
carried by Marine officers today, was presented to O'Bannon in 1805.

b. Archibald Henderson. Brevet Brigadier General Archibald Henderson became

Commandant in 1820 and held his command for 39 years until his death in 1859. General
Henderson led the Corps through the Indian Wars, the War with Mexico, the opening of China,
and the disorders in Central America. The "Grand Old Man of the Marine Corps," as he is often
called, introduced higher standards of personal appearance, training, discipline, and strived to
have the Marine Corps known as a professional military force, capable of more than just sea and
guard duties.

c. Daniel Daly. Sergeant Major Daly is recognized for earning two Medals of Honor: (1)
Chinese Boxer Rebellion and (2) First Caco War in Haiti. When his unit had been pinned down
and their attack was stalled during the Battle of Belleau Wood, then Gunnery Sergeant Daly
yelled to his men, "Come on, you sons of a b-----, do you want to live forever?"

d. Smedley D. Butler. Major Butler is recognized for earning two Medals of Honor: (1)
Veracruz and (2) First Caco War in Haiti. By the end of 1916, the Marine Corps was recognized
as a national force in readiness and for leadership gained from continual combat and
expeditionary experience.

e. John A. Lejeune. Major General Lejeune served as 13th Commandant of the Marine
Corps, 1920-1929. LeJeune was the first Marine officer ever to command an army division in
combat in France during World War I (1918). 2nd Marine Division is now stationed aboard
Camp LeJeune, N.C.

f. Lewis B. ("CHESTY") Puller. Lieutenant General Puller served in Nicaragua through

several periods of political unrest and rebellious activity. Puller and a force of about 32 Marines
became famous for their ability to engage rebel groups and bandits while scouring the jungles in
a wide area of Nicaragua to the Honduran border. Puller became known as the "Tiger of the
Mountains" (1930). The Marine Corps' mascot, an English bulldog named "Chesty," is named
for this brave and fine Marine Corps officer. Puller is also the highest decorated Marine in
history with 5 Navy Crosses.

g. Ira H. Hayes. The Fifth Amphibious Corps of Marines, commanded by Major General
Harry Schmidt, was assigned to take Iwo Jima. Corporal Ira Hayes, a Pima Indian, was one of
the Marines immortalized in the now famous photograph taken of the second flag raising
incident on Mount Suribachi shortly after the Japanese stronghold was taken on 23 February
1945.

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 h. Opha Mae Johnson. Private Johnson became the Marine Corps' first enlisted woman on
13 August 1918. Her enlistment was a reflection of the dramatic changes in the status of women
brought about by the entry of the United States into World War I. Marine Reserve (F) was the
official title by which the Marine Corps' first enlisted women were known. They were better
known as "skirt Marines" and "Marinettes."

i. Jason Dunham. Is the first Marine to be awarded the Medal of Honor (posthumously) since
the Vietnam War. Cpl Dunham fought with 3rd Bn 7th Marines, while operating in the town of
Karabilah, Iraq. While responding to his Battalion Commanders convoy that had been
ambushed, Cpl Dunham’s squad approached an SUV and found rifles and RPGs. When the
driver attempted to run away Cpl Dunham fought him to the ground. At this point the insurgent
dropped an armed grenade at his feet. Cpl Dunham called out the grenade and attempted to
cover it with his helmet and body. Cpl Dunham died eight days later in Bethesda, Maryland. No
other members of his squad was seriously injured that day.

j. Dakota Meyer. Sgt Meyer is the first living Marine recipient of the Medal of Honor since
the Vietnam War. While serving with Marine Embedded Training Team 2-8 in the Kunar
Province, Afghanistan, Sgt Meyer was on patrol to engage in a local Shurah. While providing
security, the main body came under intense direct and indirect fire from houses and fortified
positions. Upon hearing that four U.S. team members were cut off, Sgt Meyer moved into the
kill zone to locate them. While looking for the Marines, Sgt Meyer and his gun truck evacuated
over two dozen Afghan Soldiers. During this evacuation Sgt Meyer received shrapnel wounds to
his arm. After making five different trips into the kill zone during the six hour battle, Sgt Meyer
and other Marines located the missing Marines and were able to remove them from the battle
field.

4. SIGNIFICANT BATTLES IN MARINE CORPS HISTORY

a. Battle of Chapultepec. In 1847 during the Mexican War, Marines occupied the “Halls of
Montezuma” during the Battle of Chapultepec in Mexico City. The royal palace fell to invading
Marines, who were among the first United States troops to enter the capital. Today Marine
NCOs wear a red stripe on their dress blue trousers known as the “blood stripe” in honor of the
fighting that took place during the battle.

b. The Battle of Wake Island. In December 1941, following the air attack on Pearl Harbor,
the Japanese struck Wake Island. Despite being heavily outnumbered, the Marines mounted a
courageous defense before finally falling on 23 December. This small force of Marines caused
an extraordinary number of Japanese casualties and damage to the invading force.

c. Island-hopping campaign of WW II

(1) The Battle of Guadalcanal – On 7 August 1942, the 1st Marine Division landed on the
beaches of Guadalcanal in the Solomon Islands and launched the first United States land
offensive of World War II. This battle marked the first combat test of the new amphibious
doctrine, and also provided a crucial turning point of the war in the Pacific by providing a base to

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launch further invasions of Japanese-held islands. Amphibious landings followed on the
remaining Solomon Islands including New Georgia, Choiseul (feint), and Bougainville.

(2) The Battle of Tarawa - The Gilbert Islands were the first in the line of advance for the
offensive in the Central Pacific. The prime objective was the Tarawa Atoll and Betio Island
which had been fortified to the point that the Japanese commander proclaimed it would take a
million Americans 100 years to conquer. On 20 November 1943, Marines landed and secured
the island within 76 hours, but paid a heavy price in doing so. Because of an extended reef,
landing crafts could not reach land causing Marines to be offloaded hundreds of yards from the
beaches. This led to heavy losses from enemy fire. Additionally, many Marines drowned while
attempting to wade ashore.

(3) The Battle of the Mariana Islands - Due to the need for airfields by the Air Force and
advanced bases for the Navy, the Marianas were invaded. Landings on the islands of Saipan,
Guam, and Tinian accomplished this. During June and July of 1943, Lieutenant General Holland
M. Smith led a combined invasion force of Marines and soldiers that totaled over 136,000. This
was the greatest number of troops to operate in the field under Marine command to date.

(4) The Battle of Iwo Jima - On 19 February 1945, Marines landed on Iwo Jima in what was
the largest all-Marine and bloodiest battle in Marine Corps history. The Marine Corps suffered
over 23,300 casualties. The capture of Iwo Jima greatly increased the air support and bombing
operations against the Japanese home islands. Of the savage battle, Admiral Chester W. Nimitz
said, "Among the Americans who served on Iwo Jima Island, uncommon valor was a common
virtue."

(5) The Battle of Okinawa - In April of 1945, Marines and Soldiers landed and secured the
island of Okinawa. This marked the last large action of World War II. Due to the death of the
Army commander, Major General Roy S. Geiger assumed command of the 10th Army.

d. Significant Battles during Operation Iraqi Freedom

(1) Battle of Nasiriyah - The city of Nasiriyah was home to key bridges needed to cross the
Euphrates River for the advancement of Coalition Forces throughout Iraq. In March 2003 RCT-
1 with elements from the United Kingdom assaulted and seized control of the bridges. Once
gained, Coalition Forces started a neighborhood sweep clearing Ba’athist fighters from the area.

(2) Battle of Najaf - Najaf was a key target of Coalition Forces as it was the main hub of
activity in the southern region of the country. Throughout the war Najaf was a heavily contested
area that came under control after a three week period of intense fighting in August 2004. The
fighting was centered around Wadi as-Salam Cemetery. The fighting ended when senior Iraqi
cleric Grand Ayatollah Ali Al-Sistani negotiated an end to the fighting, giving control to
Coalition Forces and promising cooperation with security measures.

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 (3) 1st Battle for Fallujah - Occurred in the Spring of 2004 after a convoy protected by
private security forces was hit and the contractors were killed, burnt and hung from the bridges
in Fallujah. The initial assault was quick and fierce, successfully gaining a foothold in the city.
During the fighting misinformation was publicized by the press about Marines purposefully
killing civilians. Do to international pressure officials pulled Marines out of the city. All
allegations of civilians being targeted were proven false.

(4) 2nd Battle for Fallujah - During the months following the 1st Battle for Fallujah the
insurgency took a firm hold of the city and began to prepare for a head to head fight with
Coalition Forces. Operation Phantom Fury started on November 8th, 2004. The fighting was the
hardest since the Vietnam War. Intense house to house fighting went on for over a month and a
half. December 23rd, 2004 the last of the fighters were killed in the city. Comparisons to the
battle of Hue City and the Pacific Island Hopping Campaign have been drawn to the fighting in
Fallujah.

(5) Battle for Ramadi - After the fall of Fallujah in 2004, the insurgency in Iraq moved to
the city of Ar Ramadi. In 2006 Marines moved to push out all insurgency in the city. However,
fighting was intense and frequent. Three months after the assault on Ramadi, insurgents killed a
man called Abu Ali Jassim, a Sunni sheik that promoted Iraqis joining the police force. After the
murder the insurgents hid the body in a field instead of returning it for a proper burial, violating
Islamic law. Following this, 20 tribes from the Al Anbar province organized a movement called
Anbar Awakening. The tribes soon turned against the insurgents and pushed them out of the
suburbs of the city, giving them no place to hide and fight from effectively giving control to
Coalition and local security forces.

e. Significant Battles of Operation Enduring Freedom. After Osama bin Laden had taken
credit for the terrorist attacks against the United States on 9/11, America wanted to destroy his
terrorist group. Since the group and Bin Laden were based in Afghanistan, America started an
aerial and ground campaign to overthrow the Taliban controlled government and find Osama Bin
Laden.

(1) Nawa - In July 2009, 1st Bn, 5th Marines occupied the district as part of Operation Strike
of the Sword. The Helmand Province was considered to be one of the key centers of the Taliban
movement. Over the next 2 years Marines partnered with Afghan Security Forces in order to
hold elections in which no Taliban attacks occurred. Since then, the Nawa District became one
of the first districts to be turned completely over to Afghan Security Forces.

(2) Marjah - In February 2010, Marines from 6th Marine Regiment and other Coalition
Forces moved to occupy the District of Marjah. This was believed to be the last Taliban
stronghold in the Helmand Province. The district was built by American contractors in the 1950s
and Brig. Gen. Nicholson, commander of the 2nd Marine Expeditionary Brigade, said “The
United States built Marjah, We’re going to come back and fix it.”

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 (3) Sangin - A town in the northern area of Helmand Province, was taken over by elements
of 1 and 3rd Bn, 7th Marines. After months of fighting and turning over the AO to 3rd Bn, 5th
st

Marines, the town was cleared of Taliban fighters. Due to heavy numbers of casualties, Echo
Co. 2nd Bn, 9th Marines and Echo Co. 2nd Bn, 8th Marines came to aid 3/5’s operations.

5. PATHBREAKERS IN MARINE CORPS HISTORY.

a. Montford Point Marines. From 1942 to 1949, after President Roosevelt issued Executive
Order No. 8802 establishing the fair employment practice that began to erase discrimination in
the Armed Forces. This Order created the opportunity for African Americans to be recruited into
the Marine Corps. During the first 7 years these Marines were segregated from normal recruit
training sites, and were sent to Montford Point (since renamed Camp Johnson) which is aboard
Camp Lejeune, N.C. Approximately 20,000 Marines were trained during those years.

b. Navajo Code Talkers. Code Talkers were young Navajo men who transmitted secret
communications on the battlefields of WWII. At a time when America's best cryptographers
were falling short, these modest sheepherders and farmers were able to fashion the most
ingenious and successful code in military history. They drew upon their proud warrior tradition
to brave the dense jungles of Guadalcanal and the exposed beachheads of Iwo Jima. Serving with
distinction in every major engagement of the Pacific theater from 1942-1945, their unbreakable
code played a pivotal role in saving countless lives and hastening the war's end.

c. Women Marines. In 1918, the Secretary of Navy allowed women to enroll for clerical
duty in the Marine Corps. Officially, Opha Mae Johnson is credited as the first woman Marine.
Johnson enrolled for service on August 13, 1918; during that year some 300 women first entered
the Marine Corps to take over stateside clerical duties from battle-ready Marines who were
needed overseas. The Marine Corps Women's Reserve was established in February 1943. June
12th, 1948, Congress passed the Women's Armed Services Integration Act and made women a
permanent part of the regular Marine Corps.

REFERENCES:
Marine Corps Common Skills

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 Marine Corps History Review

1. Identify the significance of the Belleau Wood.

2. When and where was the Marine Corps founded?

3. Who is the “Grand Old Man of the Marine Corps”?

4. What was the significance of the battle of Nasiriyah?

5. Who was the the Marine Corps' first enlisted woman?

6. In which battle were Marines immortalized from the now famous photograph taken of the
second flag raising incident on Mount Suribachi?

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 UNITED STATES MARINE CORPS
FIELD MEDICAL TRAINING BATTALION
BOX 555243
CAMP PENDLETON, CA 92055-5243

FMST 103

USMC Organizational Structure and Chain of Command

TERMINAL LEARNING OBJECTIVES

(1) Without the aid of references, identify the mission of the Marine Corps without
omitting key components.(HSS-MCCS-2031)

(2) Without the aid of references, identify the location of major Marine units without
omitting key components. (HSS-MCCS-2032)

(3) Without the aid of references, describe Marine Air-Ground Task Force (MAGTF)
organizations, without omitting key components. (HSS-MCCS-2033)

ENABLING LEARNING OBJECTIVES

(1) Without the aid of reference and in writing, identify the significance of the National
Security Act of 1947 within 80% accuracy, in accordance with the Marine Corps Common
Skills Handbook. (HSS-MCCS-2031a)
(2) Without the aid of reference and in writing, identify the location of the three Marine
Expeditionary Forces within 80% accuracy, in accordance with Marine Corps Common Skills
Handbook. (HSS-MCCS-2032a)
(3) Without the aid of reference, given a description or title, identify the two parallel
Chains of Command within the Marine Corps, within 80% accuracy, in accordance with
MCDP 1-0 Marine Corps Operations. (HSS-MCCS-2033a)
(4) Without the aid of reference, given a description or title, identify the four broad
categories of the Marine Corps, within 80% accuracy, in accordance with MCDP 1-0 Marine
Corps Operations. (HSS-MCCS-2033b)
(5) Without the aid of reference, given a description or title, identify the four core
elements within a Marine Air Ground Task Force (MAGTF), within 80% accuracy, in
accordance with MCO 3120.8 Policy for the Organization of Fleet Marine Forces for Combat.
(HSS-MCCS-2033c)
(6) Without the aid of reference, given a description or title, identify the different types of
Marine Air Ground Task Forces (MAGTFs), within 80% accuracy, in accordance with MCO
3120.8 Policy for the Organization of Fleet Marine Forces for Combat. (HSS-MCCS-2033d)

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1. THE SIGNIFICANCE OF THE NATIONAL SECURITY ACT OF 1947

a. The United States Marine Corps - was created on November 10, 1775 by a resolution of
the Continental Congress which authorized two battalions of Marines. On July 11, 1798, the
Marine Corps was established as a separate service and in 1834 was made a part of the
Department of the Navy. The National Security Act of 1947, as amended, sets forth the present
structure, missions, and functions of the Marine Corps.

b. The Secretary of the Navy - is the head of the Department of the Navy. Under the
direction, authority, and control of the Secretary of Defense, the Secretary of the Navy is
responsible for the policies and control of the Department of the Navy, including its
organization, administration, operation, and efficiency. The United States Marine Corps is an
integral part of the Department of the Navy and is, at all times, subject to its laws and
regulations.

c. Commandant of the Marine Corps - The authority of the Commandant of the Marine
Corps flows from the reassignment and delegation of authority vested in the Secretary of the
Navy. The Commandant of the Marine Corps commands the United States Marine Corps and is
the senior officer of the United States Marine Corps. Succession to duties of the Commandant of
the Marine Corps during absence, disability, or temporary vacancy in that office is detailed in the
U.S. Navy Regulations.

d. The Mission Of The Marine Corps

(1) The Marine Corps shall be organized, trained, and equipped to:

(a) Provide Fleet Marine Forces of combined arms, together with supporting air
components, for service with the United States Fleet in the seizure or defense of advanced naval
bases and for the conduct of such land operations as may be essential to the prosecution of a
naval campaign.

(b) Provide detachments and organizations for service on armed vessels of the Navy, and
security detachments for the protection of naval property at naval stations and bases.

(c) Develop, in coordination with the Army, Navy, and Air Force, the doctrines, tactics,
techniques, and equipment employed by landing forces in amphibious operations. The Marine
Corps shall have primary interest in the development of those landing force doctrines, tactics,
techniques, and equipment which are of common interest to the Army and the Marine Corps.

(d) Provide, as required, Marine forces for airborne operations, in coordination with the
Army, the Navy, and the Air Force and in accordance with doctrine established by the Joint
Chiefs of Staff.

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 (e) Develop, in coordination with the Army, the Navy, and the Air Force doctrines,
procedures, and equipment of interest to the Marine Corps for airborne operations which are not
provided for by the Army.

(f) Be prepared, in accordance with integrated joint mobilization plans, for the expansion
of the peacetime components to meet the needs of war.

(g) Perform such other duties as the President may direct.

2. MARINE EXPEDITIONARY FORCES

a. Three Standing MEFs - Each MEF is comprised of a Command Element, Marine

Division, Marine Aircraft Wing and a Marine Logistics Group.

(1) I Marine Expeditionary Force (I MEF)

(a) 1st Marine Division (1st MARDIV)- Camp Pendleton, CA

(b) 3rd Marine Aircraft Wing (3rd MAW)- Miramar, CA

(c) 1st Marine Logistics Group (1st MLG)- Camp Pendleton, CA

(2) II Marine Expeditionary Force (II MEF)

(a) 2nd Marine Division (2nd MARDIV)- Camp Lejeune, NC.

(b) 2nd Marine Airwing (2nd MAW)- Cherry Point, NC.

(c) 2nd Marine Logistics Group (2nd MLG)- Camp Lejeune, NC.

(3) III Marine Expeditionary Force (III MEF)

(a) 3rd Marine Division (3rd MARDIV)- Camp Butler, Okinawa, Japan.

(b) 1st Marine Aircraft Wing (1st MAW)- Futenma, Okinawa, Japan.

(c) 3rd Marine Logistics Group (3rd MLG)- Camp Butler, Okinawa, Japan.

3. TWO PARALLEL CHAINS OF COMMAND IN THE MARINE CORPS

a. Service Chain of Command is used for things that are specifically inherent to the Marine
Corps. Examples would include anything from purchasing new tanks to establishing rules for the
use of tuition assistance. These topics, whether large or small, only affect the Marine Corps. The
top portion of the service chain is listed below:

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 (1) President
(2) Secretary of Defense
(3) Secretary of the Navy
(4) Commandant of the Marine Corps

b. Operational Chain of Command is used to direct forces in conjunction with operational or

functional missions. Often times this involves other services outside the Marine Corps. The
Operational Chain of command break down is listed below:

(1) President
(2) Secretary of Defense
(3) Commanders of Combatant Commands

4. FOUR BROAD CATEGORIES OF THE MARINE CORPS

a. Headquarters, U.S. Marine Corps – Headquarters, US Marine Corps (HQMC) consists of

the Commandant of the Marine Corps and those staff agencies that advise and assist him in
discharging his responsibilities prescribed by law and higher authority. The Commandant is
directly responsible to the Secretary of the Navy for the total performance of the Marine Corps.
This includes the administration, discipline, internal organization, training requirements,
efficiency, and readiness of the service.

b. Operating Forces - “The heart of the Marine Corps.” It comprises the forward presence,
crisis response, and fighting power that the Corps makes available to US unified combatant
commanders. The Marine Corps has permanently established two combatant command-level
service components in support of unified commands with significant Marine forces assigned: US
Marine Corps Forces Atlantic (MARFORLANT) and US Marine Corps Forces Pacific
(MARFORPAC).

(1) Marine Corps Forces Atlantic (MARFORLANT) - Headquarters at Norfolk, VA.

The war fighting arm of MARFORLANT is the II Marine Expeditionary Force (II-MEF). Dual
hatted commanding all Marine Forces in US European Command (CINCUSEUCOM), and US
Southern Command (CINCUSSOCOM).

(a) Marine Corps Security Forces (MCSF) – at Naval installations.

(b) Marine Corps Embassy Security Group (MCESG) – detachments at Embassies and
Consulates around the globe.

(2) Marine Corps Forces Pacific (MARFORPAC) - Headquarters at Camp H.M. Smith,
HI. The war fighting arm of MARFORPAC is the I Marine Expeditionary Force (I-MEF) and
the III Marine Expeditionary Force (III-MEF). MARFORPAC commands all Marine Corps
operational and shore based commands in the Pacific theater and dual hatted commanding all
Marine Forces in the central theater (MARFORCENT).

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 c. Marine Corps Reserve (MARFORRES) - The United States Marine Corps Reserve
(MARFORRES) is responsible for providing trained units and qualified individuals to be
mobilized for active duty in time of war, national emergency, or contingency operations, and
provide personnel and operational tempo relief for active component forces in peacetime.
MARFORRES, like active forces, consists of a combined arms force with balanced ground,
aviation, and combat service support units. MARFORRES is organized under the Commander,
MARFORRES. Their headquarters is located in New Orleans, LA.

d. Supporting Establishments

The Marine Corps supporting establishments consist of those personnel, bases, and activities that
support the Marine Corps Operating Forces.

(1) Marine Corps Recruiting Command

(2) Marine Corps Combat Development Command

(3) Marine Corps Systems Command

(4) Training Activities and Formal Schools

5. FOUR CORE ELEMENTS OF MARINE AIR-GROUND TASK FORCE (MAGTF)

The MAGTF is a balanced, air-ground combined arms task organization of Marine Corps forces
under a single commander, structured to accomplish a specific mission. It is the Marine Corps’
organization for missions across the range of military operations. It is designed to fight while
having the ability to prevent conflicts and control crisis. MAGTF’s are flexible, task-organized
forces that are capable of responding rapidly to a broad range of crisis and conflict situations.
The MAGTF is primarily organized and equipped to conduct amphibious operations as part of
naval expeditionary forces. MAGTF's are also capable of sustained combat operations ashore.
Each MAGTF, regardless of size or mission has the same basic structure.

a. Command Element (CE)

(1) Role - It is task organized to provide command and control capabilities (including
intelligence and communications) necessary for effective planning, direction, and execution of
all operations.

b. Ground Combat Element (GCE)

(1) Role - Its mission is to execute amphibious assault operations and such operations as
may be directed.

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c. Aviation Combat Element (ACE)

(1) Role - Its mission is task organized to provide a flexible and balanced aviation
organization that is capable of providing the full range of aviation operations, without the
requirement for pre-positioned support control, and logistical facilities.

d. Logistics Combat Element (LCE)

(1) Role - It is a composite grouping of functional components that provides Logistics

Combat Support above the organic capability of supported units to all elements of the MEF.

6. TYPES OF MAGTF

There are four (4) basic MAGTF organizations (Marine Expeditionary Force, Marine
Expeditionary Brigade, Marine Expeditionary Unit and Special Purpose MAGTF.

a. Marine Expeditionary Force (MEF)

(1) Definition of Capabilities - The largest standing (Exists in peacetime and wartime)
MAGTF, approximately 20,000 to 90,000 personnel. The MEF is the principal Marine Corps
war fighting organization. It is capable of missions across the range of military operations,
through amphibious assault and sustained operations ashore in any environment. Commanded
by a Lieutenant General or Major General

b. Marine Expeditionary Brigade (MEB)

(1) Definition of Capabilities - This is a medium sized, approximately 3,000 to 20,000

personnel, Infantry reinforced, non-standing MAGTF that is task organized to respond to a full
range of crisis, from forcible entry to humanitarian assistance. MEB’s are not a standing force
and formed only in times of need. An example is post 9/11, the 4th MEB and 2nd MEB were
formed to respond to combat and peacekeeping contingencies in Afghanistan and Iraq. The
MEB is commanded by a Brigadier General.

(2) MEB- is comprised of a Command Element, Marine Regiment, Marine Aircraft Group
and Combat Logistics Regiment.

(a) 1st Marine Expeditionary Brigade (1st MEB) - Camp Pendleton, CA

(b) 2nd Marine Expeditionary Brigade (2nd MEB) - Camp Lejeune, NC

(c) 3rd Marine Expeditionary Brigade (3rd MEB) - Camp Butler, Okinawa, Japan

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 c. Marine Expeditionary Unit, Special Operations Capable (MEU/SOC)

(1) Definition of Capabilities - The standard forward deployed Marine expeditionary

organization. MEU (SOC) is task organized to be a forward deployed presence and designed to
be the “First on the scene” force. MEU (SOC) is capable of a wide range of small scale
contingencies to include non-combatant evacuation, clandestine recovery, maritime interdictions,
specialized demolitions, tactical recovery of aircraft and/or personnel, gas/oil platform seizure,
humanitarian/civic actions, and other military operations other than war. Approximately 1,500
to 3,000 personnel and commanded by a Colonel.

(2) MEU is comprised of a Command Element, Marine Infantry Battalion, Composite

Marine Air Squadrons (fixed and rotary wing) and Combat Logistics Battalion.

(a) 11th, 13th and 15th Marine Expeditionary Units- Camp Pendleton, CA

(b) 22nd, 24th and 26th Marine Expeditionary Units- Camp Lejeune, NC

(c) 31st Marine Expeditionary Unit- Camp Hansen, Okinawa, Japan

d. Special Purpose Marine Air-Ground Task Force (SPMAGTF)

(1) Definition of Capabilities - The SPMAGTF is a non-standing MAGTF temporarily

formed to conduct a specific mission. It is normally formed when a standing MAGTF is
unavailable or inappropriate. Their designation derives from the mission they are assigned, the
location in which they will operate, or the name of the operation in which they will
participate.(i.e. SPMAGTF Somalia, Hurricane Katrina etc…)

(2) SPMAGTF is comprised of Command Element and Composites of MARDIV, MAW

and MLG.

e. Functional Areas Of Operation Within MAGTF Elements

The functional areas within MAGTF elements are balanced and structured to accomplish a
specific mission. The functional areas provide support via administrative, intelligence,
operational, logistical and communicative. Functional areas fall under Headquarters and Service
of these prospective elements.

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f. Marine Division, Marine Aircraft Wing and Marine Logistics Group)

(1) G-1 Administration (Manpower, Records, Legal)

(2) G-2 Intelligence (Security)

(3) G-3 Operations (Training)

(4) G-4 Logistics (Supply)

(5) G-6 Communications (Computers, Radios)

g. Marine Regiment, Marine Aircraft Group and Combat Logistics Regiment Marine
Battalion, Marine Air Squadron, and Combat Logistics Regiment

(1) S-1 Administration (Manpower, Records, Legal)

(2) S-2 Intelligence (Security)

(3) S-3 Operations (Training)

(4) S-4 Logistics (Logistics)

(5) S-6 Communications (Computers, Radios)

REFERENCES:
Health Service Support Operations MCWP 4-11.1
Marine Corps Manual
Marine Corps Operations MCDP 1-0
National Security Act of 1947 (revised in 1952)
Organization of Marine Corps Forces MCRP 5-12
Policy for the Organization of Fleet Marine Forces for Combat MCO 3120.8

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 USMC Organizational Structure and Chain of Command Review

1. How many standing Marine Expeditionary Forces are there? Where are they located?

2. Explain the difference between the Service and Operational chains of command?

3. Explain the four broad categories of the Marine Corps?

4. What are the four core elements of the Marine Air Ground Task Force (MAGTF)? Explain
the roles of each element?

5. What are the four types of MAGTF’s? Explain the differences between them?

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 UNITED STATES MARINE CORPS
FIELD MEDICAL TRAINING BATTALION
BOX 555243
CAMP PENDLETON, CA 92055-5243

FMST 104

Traits and Principles of Marine Corps Leadership

TERMINAL LEARNING OBJECTIVE

1. Without the aid of references describe Marine Corps leadership without omitting key
components. (HSS-MCCS-2027)

ENABLING LEARNING OBJECTIVES

1. Without the aid of references, given a description or list, identify Marine Corps leadership
traits within 80% accuracy, in accordance with MCRP 6-11B. (HSS-MCCS-2027a)

2. Without the aid of references, given a description or list, identify Marine Corps leadership
principles within 80% accuracy, in accordance with MCRP 6-11B. (HSS-MCCS-2027b)

1-30
INTRODUCTION

“Leadership is intangible, hard to measure and difficult to describe. Its quality would seem to
stem from many factors. But certainly they must include a measure of inherent ability to control
and direct, self-confidence based on expert knowledge, initiative, loyalty, pride and sense of
responsibility. Inherent ability cannot be instilled, but that which is latent or dormant can be
developed. Other ingredients can be acquired. They are not easily learned. But leaders can be
and are made.”

General C. B. Cates, 19th Commandant of the Marine Corps

Lt. Gen. Lewis “Chesty” Puller

Steadily he worked his way up the ranks proving his outstanding leadership qualities. He
received a direct commission and he began collecting awards for valor. By the time he retired
from the Corps in 1951 he had earned more awards than any Marine in history; five Navy
Crosses, the Distinguished Service Cross, the Silver Star, two Legions of Merit with “V” device,
the Bronze star with “V” device, the Bronze Star, the Air Medal and the Purple Heart.

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1. FOURTEEN LEADERSHIP TRAITS

The traits and principles of leadership are the basic fundamentals that Marines use to develop
their own leadership abilities and that of their subordinates. There are fourteen (14) leadership
traits. The fourteen leadership traits can be remembered with the acronym
JJDIDTIEBUCKLE:

Justice

Definition - Giving reward and punishment according to the merits of the case in question. The
ability to administer a system of rewards and punishments impartially and consistently.

Significance - The quality of displaying fairness and impartiality is critical in order to gain the
trust and respect of subordinates and maintains discipline and unit cohesion, particularly in the
exercise of responsibility.

Example - Fair appointment of tasks by a squad leader during field day.

Judgment

Definition - The ability to weigh facts and possible courses of action in order to make sound
decisions.

Significance - Sound judgment allows a leader to make appropriate decisions in the guidance and
training of his/her Marines and the employment of his/her unit. A Marine who exercises good
judgment weighs pros and cons accordingly when making appropriate decisions.

Example - A Marine properly apportions his/her liberty time in order to relax as well as to study.

Dependability

Definition - The certainty of proper performance of duty.

Significance - The quality that permits a senior to assign a task to a junior with the understanding
that it will be accomplished with minimum supervision.

Example - The squad leader ensures that his/her squad falls out in the proper uniform without
having been told to by the platoon sergeant.

Initiative

Definition - Taking action in the absence of orders.

Significance - Since an NCO often works without close supervision; emphasis is place on being
a self-starter. Initiative is a founding principle of Marine Corps Warfighting philosophy.

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Example - In the unexplained absence of the platoon sergeant, an NCO takes charge of the
platoon and carries out the training schedule.

Decisiveness

Definition - Ability to make decisions promptly and to announce them in a clear, forceful
manner.

Significance - The quality of character which guides a person to accumulate all available facts in
a circumstance, weigh the facts, choose and announce an alternative which seems best. It is
often better that a decision be made promptly than a potentially better one be made at the
expense of more time.

Example - A leader, who sees a potentially dangerous situation developing, immediately takes
action to prevent injury from occurring.

Tact

Definition - The ability to deal with others in a manner that will maintain good relations and
avoid offense. More simply stated, tact is the ability to say and do the right thing at the right
time.

Significance - The quality of consistently treating peers, seniors, and subordinates with respect
and courtesy is a sign of maturity. Tact allows commands, guidance, and opinions to be
expressed in a constructive and beneficial manner. This deference must be extended under all
conditions regardless of true feelings.

Example - A Marine discreetly points out a mistake in drill to a NCO by waiting until after the
unit has been dismissed and privately asking which of the two methods are correct.

Integrity

Definition - Uprightness of character and soundness of moral principles. The quality of

truthfulness and honesty.

Significance - A Marine’s word is his/her bond. Nothing less than complete honesty in all of
your dealings with subordinates, peers, and superiors is acceptable.

Example - A Marine who uses the correct technique on the obstacle course, even when he/she
cannot be seen by the evaluator.

Enthusiasm

Definition - The display of sincere interest and exuberance in the performance of duty.

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Significance - Displaying interest in a task, and an optimism that it can be successfully
completed, greatly enhances the likelihood that the task will be successfully completed.

Example - A Marine who leads a chant or offers to help carry a load that is giving someone great
difficulty while on a hike despite being physically tired, he encourages his fellow Marines to
persevere.

Bearing

Definition - Creating a favorable impression in carriage, appearance, and personal conduct at all
times.

Significance - The ability to look, talk, and act like a leader whether or not these manifestations
indicate one’s true feelings.

Example - Wearing clean, pressed uniforms, and shining boots and brass. Avoiding profane and
vulgar language. Keeping a trim, fit appearance.

Unselfishness

Definition - Avoidance of providing for one’s own comfort and personal advancement at the
expense of others.

Significance - The quality of looking out for the needs of your subordinates before your own is
the essence of leadership. This quality is not to be confused with putting these matters ahead of
the accomplishment of the mission.

Example - An NCO ensures all members of his unit have eaten before he does, or if water is
scarce, he will share what he has and ensure that others do the same.

Courage

Definition - Courage is a mental quality that recognizes fear of danger or criticism, but enables a
Marine to proceed in the face of danger with calmness and firmness.

Significance - Knowing and standing for what is right, even in the face of popular disfavor. The
business of fighting and winning wars is a dangerous one; the importance of courage on the
battlefield is obvious.

Example - Accepting criticism for making subordinates field day for an extra hour to get the job
done correctly.

Knowledge

Definition - Understanding of a science or an art. The range of one’s information, including

professional knowledge and understanding of your Marines.

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Significance - The gaining and retention of current developments in military and naval science
and world affairs is important for your growth and development.

Example - The Marine who not only knows how to maintain and operate his assigned weapon,
but also knows how to use the other weapons and equipment in the unit.

Loyalty

Definition - The quality of faithfulness to country, Corps, unit, seniors, subordinates and peers.

Significance - The motto of our Corps is Semper Fidelis, Always Faithful. You owe unswerving
loyalty up and down the chain of command.

Example - A Marine displaying enthusiasm in carrying out an order of a senior, though he may
privately disagree with it.

Endurance

Definition - The mental and physical stamina measured by the ability to withstand pain, fatigue,
stress, and hardship.

Significance - The quality of withstanding pain during a conditioning hike in order to improve
stamina is crucial in the development of leadership. Leaders are responsible for leading their
units in physical endeavors and for motivating them as well.

Example - A Marine keeping up on a 10-mile forced march even though he/she has blisters on
both feet.

2. MARINE CORPS 11 LEADERSHIP PRINCIPLES

Know Yourself and Seek Self Improvement

(1) This principle of leadership should be developed by the use of leadership traits.
Evaluate yourself by using the leadership traits and determine your strengths and weaknesses.

(2) You can improve yourself in many ways. To develop the technique of this principle:

(a) Make an honest evaluation of yourself to determine your strong and weak personal
qualities.

(b) Seek the honest opinions of your friends or superiors.

(c) Learn by studying the causes for the success and failures of others.

(d) Develop a genuine interest in people.

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 (e) Master the art of effective writing and speech.

(f) Have a definite plan to achieve your goal.

b. Be Technically And Tactically Proficient

(1) A person who knows their job thoroughly and possesses a wide field of knowledge.
Before you can lead, you must be able to do the job. Tactical and technical competence can be
learned from books and from on the job training. To develop this leadership principle of being
technically and tactically proficient, you should:

(a) Know what is expected of you then expend time and energy on becoming proficient at
those things.

(b) Form an attitude early on of seeking to learn more than is necessary.

(c) Observe and study the actions of capable leaders.

(d) Spend time with those people who are recognized as technically and tactically
proficient at those things.

(e) Prepare yourself for the job of the leader at the next higher rank.

(f) Seek feedback from superiors, peers and subordinates.

c. Know Your People And Look Out For Their Welfare

(1) This is one of the most important of the leadership principles. A leader must make a
conscientious effort to observe his Marines and how they react to different situations. A Marine
who is nervous and lacks self-confidence should never be put in a situation where an important
decision must be made. This knowledge will enable you as the leader to determine when close
supervision is required.

(2) To put this principle in to practice successfully you should:

(a) Put your Marines welfare before you own.

(b) Be approachable.

(c) Encourage individual development.

(d) Know your unit’s mental attitude; keep in touch with their thoughts.

(e) Ensure fair and equal distribution of rewards.

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 (f) Provide sufficient recreational time and insist on participation.

d. Keep Your Personnel Informed

(1) Marines by nature are inquisitive. To promote efficiency and morale, a leader should
inform the Marines in his unit of all happenings and give reasons why things are to be done.
This is accomplished only if time and security permits. Informing your Marines of the situation
makes them feel that they are a part of the team and not just a cog in a wheel. Informed Marines
perform better.

(2) The key to giving out information is to be sure that the Marines have enough
information to do their job intelligently and to inspire their initiative, enthusiasm, loyalty, and
convictions.

(3) Techniques to apply this principle are:

(a) Whenever possible, explain why tasks must be done and the plan to accomplish a
task.

(b) Be alert to detect the spread of rumors. Stop rumors by replacing them with the truth.

(c) Build morale and espirit de corps by publicizing information concerning successes of
your unit.

(d) Keep your unit informed about current legislation and regulations affecting their pay,
promotion, privileges, and other benefits.

e. Set The Example

(1) A leader who shows professional competence, courage and integrity sets high personal
standards for himself before he can rightfully demand it from others. Your appearance, attitude,
physical fitness and personal example are all on display daily for the Marines and Sailors in your
unit. Remember, your Marines and Sailors reflect your image!

(2) Techniques for setting the example are to:

(a) Show your subordinates that you are willing to do the same things you ask them to do.

(b) Maintain an optimistic outlook.

(c) Conduct yourself so that your personal habits are not open to criticism.

(d) Avoid showing favoritism to any subordinate.

(e) Delegate authority and avoid over supervision, in order to develop leadership among
subordinates.

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 (f) Leadership is taught by example.

f. Ensure That The Task Is Understood, Supervised, and Accomplished

(1) Leaders must give clear, concise orders that cannot be misunderstood, and then by close
supervision, ensure that these orders are properly executed. Before you can expect your men to
perform, they must know what is expected of them.

(2) The most important part of this principle is the accomplishment of the mission. In order
to develop this principle you should:

(a) Issue every order as if it were your own.

(b) Use the established chain of command.

(c) Encourage subordinates to ask questions concerning any point in your orders or
directives they do not understand.

(d) Question subordinates to determine if there is any doubt or misunderstanding in

regard to the task to be accomplished.

(e) Supervise the execution of your orders.

(f) Exercise care and thought in supervision. Over supervision will hurt initiative and
create resentment; under supervision will not get the job done.

g. Train Your Marines And Sailors As A Team

(1) Teamwork is the key to successful operations. Teamwork is essential from the smallest
unit to the entire Marine Corps. As a leader, you must insist on teamwork from your Marines.
Train, play and operate as a team. Be sure that each Marine knows his/her position and
responsibilities within the team framework.

(2) To develop the techniques of this principle you should:

(a) Stay sharp by continuously studying and training.

(b) Encourage unit participation in recreational and military events.

(c) Do not publicly blame an individual for the team’s failure or praise just an individual
for the team’s success.

(d) Ensure that training is meaningful, and that the purpose is clear to all members of the
command.

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 (e) Train your team based on realistic conditions.

(f) Insist that every person understands the functions of the other members of the team
and the function of the team as part of the unit.

h. Make Sound And Timely Decisions

(1) The leader must be able to rapidly estimate a situation and make a sound decision based
on that estimation. Hesitation or a reluctance to make a decision leads subordinates to lose
confidence in your abilities as a leader. Loss of confidence in turn creates confusion and
hesitation within the unit.

(2) Techniques to develop this principle include:

(a) Developing a logical and orderly thought process by practicing objective estimates of
the situation.

(b) When time and situation permit planning for every possible event that can reasonably
be foreseen.

(c) Considering the advice and suggestions of your subordinates before making decisions.

(d) Considering the effects of your decisions on all members of your unit.

i. Develop A Sense Of Responsibility Among Your Subordinates

(1) Another way to show your Marines you are interested in their welfare is to give them the
opportunity for professional development. Assigning tasks and delegating authority promotes
mutual confidence and respect between leader and subordinates. It also encourages subordinates
to exercise initiative and to give wholehearted cooperation in accomplishment of unit tasks.
When you properly delegate authority, you demonstrate faith in your Marines and increase
authority, and increase their desire for greater responsibilities.

(2) To develop this principle you should:

(a) Operate through the chain of command.

(b) Provide clear, well thought out directions.

(c) Give your subordinates frequent opportunities to perform duties normally performed
by senior personnel.

(d) Be quick to recognize your subordinates’ accomplishments when they demonstrate

initiative and resourcefulness.

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 (e) Correct errors in judgment and initiative in a way, which will encourage the
individual to try harder.

(f) Give advice and assistance freely when your subordinates request it.

(g) Resist the urge to micro manage.

(h) Be prompt and fair in backing subordinates.

(i) Accept responsibility willingly and insist that your subordinates live by the same
standard.

j. Employ Your Command Within its Capabilities

(1) A leader must have a thorough knowledge of the tactical and technical capabilities of the
command. Successful completion of a task depends upon how well you know your unit’s
capabilities. If the task assigned is one that your unit has not been trained to do, failure is very
likely to occur. Failures lower you unit’s morale and self esteem. Seek out challenging tasks for
your unit, but be sure that your unit is prepared for and has the ability to successfully complete
the mission.

(2) Techniques for development of this principle are to:

(a) Avoid volunteering your unit for tasks that are beyond their capabilities.

(b) Be sure that tasks assigned to subordinates are reasonable.

(c) Assign tasks equally among your subordinates.

(d) Use the full capabilities of your unit before requesting assistance.

k. Seek Responsibilities And Take Responsibility

(1)For professional development, you must actively seek out challenging assignments. You
must use initiative and sound judgment when trying to accomplish jobs that are required by your
grade. Seeking responsibilities also means that you take responsibility for your actions.
Regardless of the actions of your subordinates, the responsibility for decisions and their
application falls on you.

(2) Techniques in developing this principle are to:

(a) Learn the duties of your immediate senior, and be prepared to accept the
responsibilities of these duties.

(b) Seek a variety of leadership positions that will give you experience in accepting
responsibility in different fields.

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 (c) Take every opportunity that offers increased responsibility.

(d) Perform every task, no matter whether it is top secret or seemingly trivial, to the best
of your ability.

(e) Stand up for what you think is right. Have courage in your convictions.

(f) Carefully evaluate a subordinate’s failure before taking action against that
subordinate.

(g) In the absence of orders, take the initiative to perform the actions you believe your
senior would direct you to perform if present.

REFERENCES:
Marine Corps Manual
MCRP 6-11B

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 Traits and Principles of Marine Corps Leadership Review

1. Define the Marine Corps 14 Leadership Traits? Remember the acronym

JDIDTIEBUCKLE:

2. Define the Marine Corps 11 Leadership Principles?

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 UNITED STATES MARINE CORPS
FIELD MEDICAL TRAINING BATTALION
BOX 555243
CAMP PENDLETON, CA 92055-5243

FMST 105

USMC Uniform Regulations

TERMINAL LEARNING OBJECTIVE

1. Given commander's guidance, with or without arms, clothing and field equipment, civilian
attire and an inspector, stand a personnel inspection to ensure readiness, serviceability,
cleanliness, and personal appearance of personnel and equipment. (HSS-MCCS-2035)

ENABLING LEARNING OBJECTIVE(S)

1. Without the aid of references, given a MARPAT uniform item and ownership marking
locations, select the proper wear for each item, with no discrepancies, IAW MCO P1020.34
series. (HSS-MCCS-2035a)

2. Without the aid of references, given a prescribed uniform, stand a uniform inspection with a
passing grade, IAW NAVPERS 15665 series or MCO P1020.34 series. (HSS-MCCS-2035d)

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1. CAMOUFLAGED UTILITY UNIFORM
Navy personnel assigned to Marine Corps units are issued the digital woodland or desert utility
uniform. Wearing of the utility uniform does not require compliance with Marine Corps
grooming regulations unless you are Marine regs.

Items issued - Standard issue to Navy personnel serving with Marine Corps units.

Infantry Combat boots 1 pair

Jungle boots(hot weather) 1 pair
Utility cap (without EGA) 1 Woodland 1 Desert
Booney/ Field Cover 1 Woodland 1 Desert
Camouflage utility blouse 2 Woodland 2 Desert
Camouflage utility trousers 2 Woodland 2 Desert
Cushion sole socks 3 pairs
HM/RP collar insignia 2 each
Rank collar insignia 2 each
Name-tapes 4 sets each
Green undershirt 6 each

Wear

(1) Proper wear of the Camouflage Utility Uniform

(a) Design - The camouflage utility uniform is designed for field wear and should be
loose-fitting and comfortable. The item selected should be fitted loosely to allow for some
shrinkage without rendering the garment unusable.

(b) Blouse - The camouflage blouse will not be tucked into the trousers. The utility
blouse should always be kept buttoned and large or heavy objects should not be carried in the
pockets. At the option of local commanders, sleeves may be rolled up or down depending on
time of year or weather. The woodland uniform will be worn in the winter with sleeves unrolled.
The desert uniform will be worn in the summer months with sleeves rolled up. When sleeves are
worn “up” they will have a three inch fold terminating about two inches above the elbow.

(c) Trousers – Trousers will be worn around the waist, and the bottom of the leg should
reach the floor when not wearing boots. While wearing boots the trousers will be bloused using
boot bands to hold in place..

(d) Cover - All personnel, E-4 and above, will wear a subdued cap device on their utility
garrison cover/ 8 point cover. No device will be worn over the Eagle Globe and Anchor.

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 (e) Belt - The Navy black web belt and buckle may be worn with the camouflage uniform
by those enlisted personnel ( E-1 thru E-6 ). Navy E-7and above will wear the khaki web belt
with gold buckle. The Marine Corps Martial Arts Program has a designated belt ranking system.
Only those individuals who attend this course and qualify, are authorized to wear the appropriate
belt.

(f) Sweater - Navy officer and enlisted personnel may wear the green (Wooley Pully) or
green service sweater with the camouflage utility uniform. The sweater will be worn underneath
the camouflage utility blouse with sleeves down.

(g) Raingear - Navy personnel will wear organizational rainwear as issued by the Marine
Corps, with the camouflage utility uniform.

(h) Boots – Only USMC issued boots with Eagle Globe and Anchor embossed on the
outside of the heel will be worn. Boots will be laced left over right as you look down at it. There
will be an identification tag worn in the left boot laces between the 2nd and 3rd eyelet, tucked into
leather flap.

(1) Insignia

(a) The rating insignia - is worn on the left side of the collar, centered and bisecting the
angle of the point of the collar. The lower outside edge of the insignia will be equally spaced ½
inch from both sides of the collar.

Figure 1. HM Rating Insignia

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 (b) The rank insignia - is worn on the right side of the collar, centered and bisecting the
angle of the point of the collar. The lower outside edge of the insignia will be equally spaced ½
inch from both sides of the collar.

Figure 2. E-2 and E-3

Figure 3. E-4 through E-6

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 Figure 4. E-7 through E-9

(c) Breast insignia - will be centered on the pocket on a horizontal (parallel to the ground)
line, even with the highest point of the service tape, a second device will be worn 1/8 inch above
the 1st device.

Figure 5. Breast Insignia

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c. Unauthorized wear of the utility uniform

(1) The wearing of the camouflaged utility uniform and its policies are much like the Navy’s
Working Uniform. Members are prohibibited from wearing the utility uniform as a liberty
uniform off-base or during inappropriate circumstances such as:

(a) At restaurants, pizza parlors, bars, lounges, etc.

(b) When dealing with public officials (police, courthouse, attorneys, etc.)

(c) While attending classes or activities, or conducting business at education facilities

(d) At commercial airports / bus stations for travel or entering pick up/drop off areas

(e) At retail/rental stores, shopping malls, and shops for shoppping or paying bill

(f) At grocery stores/supermarkets

(g) At movie theaters, mini-golf, or other similar entertainment, recreational or sporting

activities

d. Grooming standards/personal appearance

Members will present the best possible image at all times and continue to set the example in
military presence. Members are prohibited from:

(1) Mutilation of the body or any body parts in any manner.

(2) Attaching, affixing or displaying objects, articles, jewelry or ornamentation to, through
or under skin, tongue or any other body part. Female members may not wear earings in utility
uniform.

(3) Tattoos or brands on the neck and head. On other areas of the body, tattoos or brands
that are prejudicial to good order and discipline and morale or are of a nature to bring discredit
upon the Marine Corps are also prohibited.

(4) Eccentric or faddish styles of hair, jewelry, or eyeglasses. The good judgement of all
members at all levels is key to enforcement of Marine Corps standards with this issue.

(5) Chewing gum, chewing tobacco, cigerettes or the consumption of food while in
formation or walking in uniform

(6) Articles that are not authorized for wear as a part of a regulation uniform will not be
worn exposed with the uniform such as: pens, watch chains, backpacks / bags, barrettes / hair
ribbons, CD / MP3 players or other similar items.

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 (7) Pagers and cell phones are not authorized for wear on a regulation uniform unless
specifically authorized.

(8) Sunglasses will be conservative in nature and will not be worn indoors or in formations
unless authorized by a medical representitive.

(9) The wear of clothing articles not specifically designed to be normally worn as headgear
(e.g. bandannas, doo rags) is strictly prohibited in civilian attire and regulation uniform.

(10) No part of a prescribed uniform, except those items not exclusively military in
character, will be worn with civilian clothing.

e. Care - During washing, drying and finishing cycles, use the lowest possible setting so that
at no time will the garment be exposed to temperatures greater than 130 degrees. Some laundry
facilities may not press utilities due to potential damage from automated presses. Thus, any
pressing required will be the individuals responsibility. The use of starch, sizing and any process
that involves dry cleaning or a steam press will adversely affect the treatments and durability of
the uniform and is not recommended. These uniforms are designed as a wash and wear uniform.
A hand iron set on a low heat may be used.

f. Marking - Enlisted Sailors will plainly and indelibly mark every article of uniform clothing
with the owner’s name (except for organizational clothing).

(1) Size - Marks will be of a size appropriate to the article of clothing and the space
available for marking and will consist of block leters not more than ½ inch in size. Marking
machines, stencils, name tapes, or stamps, may be used.

(2) Color - Names are marked in black, on light colored material and utilities, and in white
on dark material. Marks will be placed so that they do not show when the clothing is worn.

(3) Location - The precise location for marking the following gear is as follows:

(4) Duffel bag - On the outside of the bag on the bottom

(5) Web belt - On buckle side only, as near to the buckle end as possible

(6) Cap - Inside, on the sweatband to the left

(7) Coats and overcoats - Inside, on the neckband

(8) Drawers - Outside immediately below the waistband, near the front

(9) Gloves - Inside, at the wrist

(10) Shoes and boots - Inside, near the top

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 (11) Socks - Outside, on top of the foot

(12) Utility blouse - Name-tape sewn above right breast pocket, service tape sewn above left
breast pocket

(13) Trousers - Name-tape sewn above right rear pocket

(12) Undershirt - Inside back, near the neck-band under the tag

2. STAND A UNIFORM INSPECTION

Inspection criteria- the inspection criteria covers ten different areas of the uniform. Each
area is graded for servicability, proper marking, and proper fitting. Each hit is counted and added
up for a total score. No hits is an Outstanding, 1 hit is Excellent, 2 hits is Above Average, 3 hits
is Below Average, 4 hits is Unsatisfactory and a failure of the Uniform inspection. The areas that
are inspected are:

(1) Cover – This gets checked for serviceabilty, cleanliness, proper fit, proper marking,
loose threads hanging down and anything else that does not keep with the good appearance of the
uniform.

(2) Dogtags – These will be checked to ensure the member is wearing them, the correct
information on the dogtag and they are clean.

(3) Blouse – This is checked for serviceabilty, cleanliness, proper fit, proper marking, loose
threads hanging down, rating badge and service stripes.

(4) Undershirt – The undershirt is checked for cleanliness, proper marking and proper fit.

(5) Belt – The belt will be checked for serviceability and cleanliness, proper length, buckle
appearance, military alignment and that it is properly marked.

(6) Hygiene – Hygiene will be inspected for proper shave, clean and cut fingernails, fresh
haircut, and trimmed mustache.

(7) Trouser – Trousers will be checked for serviceability, proper fit, proper markings, and
loose threads.

(8) Shoes – Shoes will be checked for servicability and proper lacing.

(9) Military Knowledge – Inspector will ask basic military knowledge pertaining to the
individual being inspected.

REFERNCES: MCO P1020.34

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 FIELD MEDICAL TRAINING BATTALION
INSPECTION CHECKLIST
(NAVY UNIFORM) v3.0

FMST CLASS PLT DATE

INSPECTOR’S RANK/NAME
SAILOR’S RANK/NAME

COVER HYGIENE
UNSERV/DIRTY IMPROPER SHAVE
IMPROPER FIT FINGERNAILS DIRTY/LONG
NOT MARKED HAIRCUT
LOOSE THREADS MUSTACHE
OTHER (SPECIFY) OTHER (SPECIFY)

DOGTAGS RIBBONS
MISSING UNSERV/DIRTY
OTHER (SPECIFY) IMPROPER SPACING
SEQUENCE/ATTACHMENTS
CENTERING
BLOUSE OTHER (SPECIFY)
UNSERV/DIRTY
IMPROPER FIT
NOT MARKED TROUSER
LOOSE THREADS UNSERV/DIRTY
RATING BADGE/SERVICE IMPROPER FIT
STRIPE NOT MARKED
OTHER (SPECIFY) LOOSE THREADS
OTHER (SPECIFY)

UNDERSHIRT
UNSERV/DIRTY SHOES
IMPROPER FIT UNSERV/DIRTY
NOT MARKED NOT LACED PROPERLY
OTHER (SPECIFY) OTHER (SPECIFY)

BELT MILITARY KNOWLEDGE

UNSERV/DIRTY SAT
IMPROPER LENGTH UNSAT
BUCKLE SCRATCHED
MILITARY ALIGNMENT
NOT MARKED
OTHER (SPECIFY)

REMARKS:

GRADE:
OUTSTANDING (NO DISCREPANCY)
EXCELLENT (1) ABOVE AVERAGE (2)
BELOW AVERAGE (3)
UNSATISFACTORY (4)

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 UNITED STATES MARINE CORPS
FIELD MEDICAL TRAINING BATTALION
BOX 555243
CAMP PENDLETON, CA 92055-5243

FMST 106

Individual Combat Equipment

TERMINAL LEARNING OBJECTIVE(S)

1. Given a MARPAT reversible tarpaulin or two-man tent, in an operating environment, and

while wearing individual field equipment, construct a field expedient shelter to protect against
the effects of weather. (HSS-MCCS-2023)

2. Given commander's guidance, with or without arms, clothing and field equipment, civilian
attire and an inspector, stand a personnel inspection to ensure readiness, serviceability,
cleanliness, and personal appearance of personnel and equipment. (HSS-MCCS-2035)

3. Given an Individual First Aid Kit (IFAK) and references, inventory an Individual First Aid
Kit (IFAK) to ensure it is complete and serviceable. (HSS-MED-2001)

ENABLING LEARNING OBJECTIVE(S)

1. Without the aid of references, given combat equipment, select the proper wear for each
item, with no discrepancies, IAW MCO P1020.34 series. (HSS-MCCS-2035b)

2. Without the aid of references, given combat equipment, select the proper maintenance for
each item, with no discrepancies, IAW MCO P1020.34 series. (HSS-MCCS-2035c)

3. With the aid of reference, given a MARPAT reversible tarpaulin and other materials,
construct a field expedient shelter to protect against the effects of weather in accordance with
MCRP 3-02H. (HSS-MCCS-2023a)

4. With the aid of reference, given a two-man tent, construct a field expedient shelter to
protect against the effects of weather in accordance with MCRP 3-02H. (HSS-MCCS-2023b)

5. Without the aid of reference, give an Individual First Aid Kit (IFAK), identify the
components of the IFAK within 80% accuracy and in accordance with the User's Instruction for
the IFAK. (HSS-MED-2001a)

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1. INDIVIDUAL COMBAT EQUIPMENT

a. Family of Load Bearing Equipment (FILBE) - FILBE is a Modular Load-Bearing

system designed to enhance the survivability and lethality of the modern Marine. FILBE is a
replacement for the ILBE system and components of the Integrated Individual Fighting system
including the Improved Load Bearing Equipment (ILBE). The FILBE issue that you will receive
here at FMTB-W consist of the following:

(1) USMC New Pack – (See figure 1) The USMC new pack is a modular system that can
be configured into two different torso length patterns: the Normal and Long. It has a large main
pouch that can be closed to allow for a sleeping system compartment and a radio pouch. It has a
draw string close top. The lid is has a water resistant zipper at the base to allow access to the
radio pouch. Two other zippers allow access to the storage compartments in the lid, it also has
buckles that allow the day pack to be attached to the top. The pack is equiped with Pouch
Attachment Ladder System (PALS).

Figure 1: USMC New Pack

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 (2) Patrol Pack – (See figure 2) Utilized to sustain an individual for 24-48 hour periods.
Has buckles to attach it to the top of the pack. Also has Pouch Attachment Ladder System
(PALS) for the attachment of external pouches.

Figure 2: Patrol Pack

(3) Combat Lifesaver Kit (CLS) – (See figure 3) the Combat Lifesaver Kit (CLS) contains
medical supplies that, in addition to what Marines already carry in their Individual First Aid Kits
(IFAKS), provide life-saving trauma care for critically wounded Marines and Sailors. CLS-
trained Marines are issued the CLS Kit to increase the trauma support available to their
teams/squad in situations where a Corpsman is not immediately available to provide aid. The
items in the partable lightweight bag enable a CLS-trained Marine to treat extremity
hemorrhaging and sucking chest wounds, and to clear a wounded warfighter’s airway.

Figure 3: CLS Kit

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 (4) USMC Sub Belt – (See figure 4) Sized belt and detachable suspenders with MOLLE
webbing used to configure ammunition pouches, grenade pouches, IFAK, and other items so that
the individual may design load out for specific purposes. Designed to integrate with current
USMC pack and other load bearing systems.

Figure 4: Load Bearing Vest

(5) Improved Modular Tactical Vest – (See figure 5) A scaleable vest that offers
protection to the front, back, flanks with the insertion of ESAPI plates and also has neck and
groin protection. Has MOLLE webbing used to configure ammunition pouches, grenade
pouches, IFAK, and other items so that the individual may design load out for specific purposes.
Can be used with the LBV or without.

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 Figure 5: Improved Modular Tactical Vest

(6) Lightweight Helmet with cover – (See figure 6) Improved fit over old helmet with
more comfortable pads as well as chin strap. Cover is a reversable MARPAT cover that will be
changed in accordance with what uniform is being worn at the time. Can be used with a NVG
mounting plate.

Figure 6: Helmet and Cover

(7) Three-Sleeping System - Comes in two sizes, one that fits Marines up to 6 feet tall and
another for taller Marines. The top of the new bag can be pulled tight around the face and
features two snaps that cover the chin for better protection against the cold and wind. The
waterproof bivy can be pulled over the head for added warmth and is designed with a flexible
wire to keep the bag off of the face. The sleeping bag weighs only 2.4 pounds and offers
protection down to 10 degrees provided Marines layer their clothes properly.

(8) Additional Equipment:

(a) Canteen w/ Cover – The canteen covers are used to carry the plastic water canteens
and metal cup. The covers have two small pockets attached for carrying water purification
tablets.

(b) ISO Mat - A foam padding used to support the sleeping system.

(c) Sustainment Pockets - Attached to outside of the pack as needed for additional load
capability.

(d) Hydration bladder – Can hold 70 oz. of water. Used to drink on the move.

(e) Repair Kit – Utilized to repair the equipment as needed.

(f) Elbow/Knee pads – Issued to Marines to protect knees and elbows from trips and falls
while on operations.

(g) Gortex top/bottom – MARPAT water proof gear issued for inclement weather.

(h) Poly pro top/bottom – warming layers issued and worn under the MARPAT uniform.

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 (i) Tan fleece – Tan warming layer to be used under MARPAT blouse.

(j) Cap fleece – Warming garment to be used to cover head during cold hours. Not
usually worn during the day.

(k) Water proofing bag – Improved water proof storage bags to be used in conjunction
with WP bag.

(l) Patrol sling – Used to secure weapon to body during a multitude of activities.

(m) Parade sling – Green sling used for parades and shooting on the rifle range.

(n) Ess glasses/goggles – Eye protection issued to every Marine and sailor to be used at
all times during training as well as any time forward deployed.

(o) E-tool w/ carrier – Standard folding entrenching tool. Used to dig fighting holes.

(p) Tarp – A waterproof tarp to cover gear or to make a field expediant shelter or field
expediant bed roll.

(q) Poncho Liner – Lightweight blanket that will supplement sleeping system or be used
in a field expediant bed roll.

(r) Magazine Pouches – MOLLE adaptable pouches to store magazines in place so that
the shooter can manipulate the weapon to achieve maximum lethality.

(s) Gloves – Issued to all Marines to protect hands.

(t) Compression Sack – Black sack with limiting straps to tighten down sleeping systems
and be able to store them in packs while using the least amount of space.

2. CARE AND MAINTENANCE OF COMBAT EQUIPMENT

a. Scrape dirt and dust from the item using a brush that will not cut the fabric.

b. Hose or wash the item in a pail of water. Rinse thourghly with clean water.

c. Do not use chlorine bleach, yellow soap, cleaning fluids, or solvents that will discolor or
deteriorate the item.

d. Dry the item in the shade or indoors. Do not dry in direct sunlight, direct heat or open
flame.

e. Do not launder or dry item in home or commercial washers and dryers. Do not attempt to
dye or repair. Turn in for repair or replacement.

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 f. Remember, extremely dirty or damaged equipment can eventually fail to perform its
intended function.

3. FIELD EXPEDIENT SHELTER

a. Shelter Site Selection

(1) When you are in a survival situation and realize that shelter is a high priority, start
looking for shelter as soon as possible. As you do so, remember what you will need at the site.
Two requisites are:

(a) It must contain material to make the type of shelter you need.

(b) It must be large enough and level enough for you to lie down comfortably.

(c) When you consider these requisites, however, you cannot ignore your tactical
situation or your safety. You must also consider whether the site—

1. Provides concealment from enemy observation.

2. Has camouflaged escape routes.

3. Is suitable for signaling, if necessary.

4. Provides protection against wild animals and rocks and dead trees that might fall.

5. Is free from insects, reptiles, and poisonous plants.

(d) You must also remember the problems that could arise in your environment. For
instance—
1. Avoid flash flood areas in foothills.

2. Avoid avalanche or rockslide areas in mountainous terrain.

3. Avoid sites near bodies of water that are below the high water mark.

(e) In some areas, the season of the year has a strong bearing on the site you select. Ideal
sites for a shelter differ in winter and summer. During cold winter months you will want a site
that will protect you from the cold and wind, but will have a source of fuel and water. During
summer months in the same area you will want a source of water, but you will want the site to be
almost insect free.

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 (f) When considering shelter site selection, use the word BLISS as a guide.

1. B - Blend in with the surroundings.

2. L - Low silhouette.

3. I - Irregular shape.

4. S - Small.

5. S - Secluded location.

b. Tarp Lean-To (See figure 7)

(1) It takes only a short time and minimal equipment to build this lean-to. You need a tarp,
2 to 3 meters of rope or parachute suspension line, three stakes about 30 centimeters long, and
two trees or two poles 2 to 3 meters apart. Before selecting the trees you will use or the location
of your poles, check the wind direction. Ensure that the back of your lean-to will be into the
wind. To make the lean-to:

(a) Cut the rope in half. On one long side of the poncho, tie half of the rope to the corner
grommet. Tie the other half to the other corner grommet.

(b) Option: Attach a drip stick to each rope about 2 inches from the grommet. These drip
sticks will keep rainwater from running down the ropes into the lean-to.

(c) Tie the ropes about waist high on the trees (uprights). Use a round turn and two half
hitches with a quick-release knot.

(d) Spread the tarp and anchor it to the ground, putting sharpened sticks through the
grommets and into the ground.

(e) If you plan to use the lean-to for more than one night, or you expect rain, make a
center support for the lean-to. Place a stick upright under the center of the lean-to. This method
will restrict your space and movements in the shelter.

(f) For additional protection from wind and rain, place some brush, your rucksack, or
other equipment at the sides of the lean-to.

(g) To reduce heat loss to the ground, place some type of insulating material, such as
leaves or pine needles, inside your lean-to. Note: When at rest, you lose as much as 80 percent
of your body heat to the ground.

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 (h) To increase your security from enemy observation, lower the lean-to’s silhouette by
making two changes. First, secure the support lines to the trees at knee height (not at waist
height) using two knee-high sticks in the two center grommets (sides of lean-to). Second, angle
the poncho to the ground, securing it with sharpened sticks, as above.

Figure 7: Tarp Lean-To

c. Tarp Tent (See figure 8)

(1) This tent provides a low silhouette. It also protects you from the elements on two sides.
It has, however, less usable space and observation area than a lean-to, decreasing your reaction
time to enemy detection. To make this tent, you need a tarp, two 4 to 5-meter ropes, six
sharpened sticks about 12 inches long, and two trees 2 to 3 meters apart. To make the tent:

(a) Cut the rope into equal halves

(b) Tie a 2-meter rope to the center grommet on each side of the tarp.

(c) Tie the other ends of these ropes at about knee height to two trees 2 to 3 meters apart
and stretch the tarp tight.

(d) Draw one side of the tarp tight and secure it to the ground pushing sharpened sticks
through the grommets.

(e) Follow the same procedure on the other side.

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 (f) If you need a center support, use the same methods as for the tarp lean-to. Another
center support is an A-frame set outside but over the center of the tent. Use two 90- to 120-
centimeter-long sticks, one with a forked end, to form the A-frame.

Figure 8: Tarp Tent

d. Two Man Tent (See figure 9)

(1) A two-man, three-season, free standing, double wall tent. The tent has a vapor
permeable tent body with a fully water proof reversible rain fly. All tent floor and rain fly seams
are factory taped for water fastness.

(a) Ventilation for use in arid desert and humid

conditions to minimize build up of condensation.

(b) Rain fly prevents escape of light and provides

protection against visual and infrared detection.

(c) Rain fly can be used in conjunction with tent

or separate as a “hooch”.

(d) Set up by one or two people in under 5 minutes.

Figure 9: Two Man Tent

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5. INDIVIDUAL FIRST AID KIT (IFAK) The IFAK increases individual Marines or Sailors
capabilities to provide Self-Aid/Buddy-Aid and provides interventions for leading causes of
death on the battlefield, to include severe hemorrhage and and gunshot wounds.

a. Adhesive Bandage – Quantity 5. 2x4.5in.

b. Adhesive Bandage – Quantity 10. 3/4x3in.

c. Burn Dressing – Quantity 1. Saturated with water gel; individually wrapped.

d. Dressing Burn, First Aid – Polyester overall; triangular; sterile.

e. Tape, Combat Medic Reinforced – 2x100 inches; sealed in a 1.5 nylon pouch.

f. Water Purification Tablet, Chlorine – micropur MP1; 1 strip of 10 tabs.

g. Bacitracin Ointment - .0312 ounces in a single packet.

h. Bandage, Gauze – Quantity 2. White cotton rolled, 7/8x2x3 in.

i. Bandage, Gauze, Impregnated – Quantity 2. Guaze, hemostatic agent, combat gauze, 3 in

x 4 yds.

j. Card Casualty Response Two-Sided – Two sided card used at point of injury to document
tactical combat casualty care, plastic paper, attaches with an elastic strap.

k. Chest Wound Kit Sterile W/O Needle – Penetrating chest injury kit, sterile, for
penetrating chest injuries, general chest wounds and exit wounds, general chest wounds and exit
wounds, includes one Bolin chest seal.

l. Dressing, Compression – Quantity 2, H bandage, 6x1.5x3 in.

m. Tourniquet, nonpneumatic; Combat Application – Quantity 1, one handed,

30.5x1x1/8in.

FREFERENCES:
First Aid MCRP 3-02G
Marine Corps Drill and Ceremonies Manual NAVMC 2691 W/CH 1
Marine Corps Uniform Regulations MCO P1020.34G W/CH 1-4
Rifle, 5.56-mm, M-16 TM 9-1005-319-10
Survival, Evasion, and Recovery MCRP 3-02H
Uniform Fitting and Alteration TM-10120-15/1B
User's Instructions for the Individual First Aid Kit IFAK

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 Individual Combat Equipment Review

1. When considering shelter site selection, we use the acronym BLISS as a guide. What does
this acronym mean?

2. Describe the purpose of the Load Bearing Vest?

3. Explain the process of cleaning and careing for combat equipment?

4. Explain the different types of field expedient shelters?

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 UNITED STATES MARINE CORPS
FIELD MEDICAL TRAINING BATTALION
BOX 555243
CAMP PENDLETON, CA 92055-5243

FMST 107

Code of Conduct and the Rights of POW's

TERMINAL LEARNING OBJECTIVES

1. Without the aid of references, describe the Code of Conduct without omitting key
components. (HSS-MCCS-2028)

2. Without the aid of references describe your rights as a Prisoner of War (POW) without
omitting key components. (HSS-MCCS-2029)

3. Without the aid of references describe your obligations as a Prisoner of War (POW)
without omitting key components. (HSS-MCCS-2030)

ENABLING LEARNING OBJECTIVES

1. Without the aid of reference and in writing, identify the origin of the Code of Conduct
within 80% accuracy and in accordance with NAVMC 2681. (HSS-MCCS-2028a)

2. Without the aid of reference and in writing, identify the six articles of the Code of Conduct
within 80% accuracy and in accordance with NAVMC 2681. (HSS-MCCS-2028b)

3. Without the aid of reference and in writing, identify the origin of POW rights within 80%
accuracy and in accordance with MCRP 5-12.1A. (HSS-MCCS-2029a)

4. Without the aid of reference and in writing, identify the 12 rights of POW's within 80%
accuracy and in accordance with MCRP 5-12.1A. (HSS-MCCS-2029b)

5. Without the aid of reference and in writing, identify responsibilities of a POW with 80%
accuracy and in accordance with MCRP 5-12.1A. (HSS-MCCS-2030a)

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1. ORIGIN OF THE CODE OF CONDUCT. The Code of Conduct for members of the
Armed Forces of the United States was first promulgated by President Dwight D. Eisenhower
Aug. 17, 1955. The code, including its basic philosophy, was reaffirmed on July 8, 1964 in
DoD Directive No. 1300.7. In March 1988, President Ronald Reagan issued Executive Order
12633, amending the code with language that is gender-neutral. The code, although first
expressed in written form in 1955, is based on time honored concepts and traditions that date
back to the days of the American Revolution.

Purpose. As a member of the armed forces of the United States, you are protecting your
nation. It is your duty to oppose all enemies of the United States in combat or, if a captive, in a
prisoner of war compound. Your behavior is guided by the Code of Conduct, which has evolved
from the heroic lives, experiences and deeds of Americans from the Revolutionary War to the
Southeast Asian Conflict. Your obligations as a U.S. citizen and a member of the armed forces
result from the traditional values that underlie the American experience as a nation. These
values are best expressed in the U.S. Constitution and Bill of Rights, which you have sworn to
uphold and defend. You would have these obligations-to your country, your service and unit and
your fellow Americans-even if the Code of Conduct had never been formulated as a high
standard of general behavior.
The Code is not intended to provide guidance on every aspect of military life. For that
purpose there are military regulations, rules of military courtesy, and established customs and
traditions. The Code of Conduct is in no way connected with the Uniform Code of Military
Justice (UCMJ). The UCMJ has punitive powers; the Code of Conduct does not.

2. ARTICLES OF THE CODE OF CONDUCT (CoC). The six articles of the Code of
Conduct as related to Medical Personnel and/or Chaplains.

a. Article I - I am an American, fighting in the forces which guard my country and

our way of life. I am prepared to give my life in their defense.
Medical personnel who are exclusively engaged in the medical service and chaplains who fall
into the hands of the enemy are considered “retained personnel,” not POWs. This allows
flexibility to perform their job; but, does not relieve their obligation to abide by the CoC. They
are still held accountable for their actions.

b. Article II - I will never surrender of my own free will. If in command, I will

never surrender the members of my command while they still have the means to resist.
No additional flexibility for medical personnel or chaplains; however, still are subject to lawful
capture. They may only resort to arms in self-defense or in defense of their charges attacked in
violation of the Geneva Convention. They must refrain from aggressive action and may not use
force to prevent their capture or that of their unit. On the other hand, it is perfectly legitimate for
a medical unit to withdraw in the face of the enemy.

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 c. Article III - If I am captured I will continue to resist by all means available. I
will make every effort to escape and to aid others to escape. I will accept neither parole nor
special favors from the enemy.
Since medical personnel and chaplains are “retained personnel” and not considered POWs, the
terms of the Geneva Conventions require the enemy to allow them to continue to perform their
medical and religious duties for the benefit of the POWs and must take every opportunity to do
so.
If the captor permits the performance of these professional functions for the POW community,
then special latitude is authorized under the CoC in regards to escape. As individuals, medical
personnel and chaplains do not have a duty to escape or to actively aid others in escaping as long
as they are being treated as “retained personnel” (although history shows that this is rarely the
case and medical personnel and chaplains must be prepared to be treated as other POWs).
d. Article IV - If I become a prisoner of war, I will keep faith with my fellow
prisoners. I will give no information or take part in any action which might be harmful to
my comrades. If I am senior, I will take command. If not, I will obey the lawful orders of
those appointed over me and will back them up in every way.
Medical personnel shall not assume command over nonmedical personnel and chaplains will not
assume command over military personnel of any branch.
e. Article V - When questioned, should I become a prisoner of war, I am required
to give name, rank, service number, and date of birth. I will evade answering further
questions to the utmost of my ability. I will make no oral or written statements disloyal to
my country and its allies or harmful to their cause.
The requirement for medical and chaplain personnel to communicate with a captor in connection
with their professional responsibilities is subject to certain restraints. For example, when
questioned, a POW is only to provide name, rank, service number, and date of birth. Also, a
POW must resist, avoid, or evade, even when physically and mentally coerced, all enemy efforts
to secure statements or actions that may further the enemy’s cause.
f. Article VI - I will never forget that I am an American, fighting for freedom,
responsible for my actions, and dedicated to the principles which made my country free. I
will trust in my God and in the United States of America.
All members of the Armed Forces, including medical personnel and chaplains, are responsible
for their action at all times and they must fulfill their responsibilities and survive captivity with
honor. Failure to abide by these requirements could possibly subject a service member to
disposition under the UCMJ.

3. ORIGIN OF POW RIGHTS.

The 1949 Geneva Conventions for the Protection of War Victims have been ratified by
the United States and came into force for this country on 2 February 1956. Respectively, each
of the Hague Conventions of 1899 and 1907 and each of the Geneva Conventions of 1864, 1906,
and 1929 will, of course, continue in force as between the United States and such of the other
parties to the respective conventions as have not yet ratified or adhered to the later, superseding
convention(s) governing the same subject matter.

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 Moreover, even though States may not be parties to, or strictly bound by, the 1907 Hague
Conventions and the 1929 Geneva Convention relative to the Treatment of Prisoners of War, the
general principles of these conventions have been held declaratory of the customary law of war
to which all States are subject. For this reason, the United States has adopted the policy of
observing and enforcing the terms of these conventions.
Purpose of POW rights. Is inspired by the desire to diminish the evils of war by:

- Protecting both combatants and noncombatants from unnecessary suffering.

- Safeguarding certain fundamental human rights of persons who fall into the hands
of the enemy, particularly prisoners of war, the wounded and sick, and civilians.

- Facilitating the restoration of peace.

POW rights stems from the Laws of War as outlined in the Geneva Conventions.

The nine principles of the law of war are:

(1) Fight only enemy combatants.

(2) Do not harm enemies who surrender: disarm them and turn them over to your
superior.

(3) Do not kill or torture prisoners.

(4) Collect and care for the wounded, whether friend or foe.

(5) Do not attack medical personnel, facilities, or equipment.

(6) Do not destroy more than the mission requires.

(7) Treat all civilians humanely.

(8) Do not steal; respect private property and possessions.

(9) Do your best to prevent violations of the law of war; report all violations to
your superiors, a military lawyer, a chaplain, or provost marshal.

4. THE 12 RIGHTS OF POW’s.

a. The right to receive sanitary, protective housing and clothing.

- Prisoners of war shall be quartered under conditions as favorable as those for the
forces of the Detaining Power who are billeted in the same area. The said conditions shall make
allowance for the habits and customs of the prisoners and shall in no case be prejudicial to their
health.

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 - Clothing, underwear, and footwear shall be supplied to POWs in sufficient quantities
by the Detaining Power which shall make allowance for the climate of the region where the
prisoners are detained.

b. The right to receive a sufficient amount of food to sustain good health.

- The basic daily food rations shall be sufficient in quantity, quality, and variety to
keep POWs in good health and prevent loss of weight or the development of nutritional
deficiencies. Account shall also be taken of the habitual diet of the prisoners. The

- Detaining Power shall supply work POWs with such additional rations necessary for
the labor on which they are employed.

- Sufficient drinking water shall be supplied to POWs. The use of tobacco shall be
permitted. Prisoners of war shall be associated with the preparation of their meals; they may be
employed for that purpose in the kitchens. Furthermore, they shall be given the means of
preparing themselves the additional food in their possession. Adequate premises shall be
provided for messing. Collective disciplinary measures affecting food are prohibited.

c. The right to receive adequate medical care.

- Every camp shall have an adequate infirmary where POWs may have the attention
they require as well as appropriate diet. Isolation wards shall, if necessary, be set aside for cases
of contagious or mental disease. Prisoners of war suffering from serious disease or whose
condition necessitates special treatment, a surgical operation, or hospital care must be admitted
to any military or civilian medical unit where such treatment can be given, even if their
repatriation is contemplated in the near future. Special facilities shall be afforded for the care to
be given to the disabled, in particular to the blind, and for their rehabilitation pending
repatriation.

- Prisoners of war shall have the attention, preferably, of medical personnel of the
power on which they depend and, if possible, of their nationality. Prisoners of war may not be
prevented from presenting themselves to the medical authorities for examination. The detaining
authorities shall, upon request, issue to every prisoner who has undergone treatment, an official
certificate indicating the nature of his or her illness or injury and the duration and kind of
treatment received. A duplicate of this certificate shall be forwarded to the Central Prisoners of
War Agency. The costs of treatment, including those of any apparatus necessary for the
maintenance of POWs in good health, particularly dentures and other artificial appliances and
spectacles shall be borne by the Detaining Power.

- Medical inspections of POWs shall be held at least once a month. They shall include
the checking and the recording of the weight of each POW. Their purpose shall be, in particular,
to supervise the general state of health, nutrition, and cleanliness of prisoners and detect
contagious diseases, especially tuberculosis, malaria, and venereal disease. For this purpose, the

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most efficient methods available shall be employed, e.g., periodic mass miniature radiography
for the early detection of tuberculosis.

d. The right to receive necessary facilities for proper hygiene.

- Prisoners of war may be interned only in premises located on land and affording
every guarantee of hygiene and healthfulness. Except in particular cases, which are justified by
the interest of the prisoners themselves, they shall not be interned in penitentiaries. Prisoners of
war interned in unhealthy areas, or where the climate is injurious for them, shall be removed as
soon as possible to a more favorable climate.

e. The right to practice religious faith.

- Prisoners of war shall enjoy complete latitude in the exercise of their religious
duties, including attendance at the service of their faith on condition that they comply with the
disciplinary routine prescribed by the military authorities. Adequate premises shall be provided
where religious services may be held.

f. The right to keep personal property except weapons, military equipment, and
military documents.

- All effects and articles of personal use except arms, horses, military equipment, and
military documents shall remain in the possession of POWs, likewise their metal helmets and gas
masks and like articles issued for personal protection. Effects and articles used for their clothing
or feeding shall likewise remain in their possession, even if such effects and articles belong to
their regulation military equipment. At no time should POWs be without identity documents.
The Detaining Power shall supply such documents to POWs who possess none.

- Badges of rank and nationality, decorations, and articles having above all a personal
or sentimental value may not be taken from POWs. Sums of money carried by POWs may not
be taken away from them except by order of an officer, after the amount and particulars of the
owner have been recorded in a special register, and an itemized receipt has been given legibly
inscribed with the name, rank, and unit of the person issuing the said receipt. Sums in the
currency of the Detaining Power of which are changed into such currency at the prisoner's
request shall be placed to the prisoner's credit.

g. The right to send and receive mail.

- Prisoners of war shall be allowed to send and receive letters and cards. If the
Detaining Power deems it necessary to limit the number of letters and cards sent by each POW,
the said number shall not be less than two letters and four cards monthly, exclusive of the capture
cards provided for in Article 70, and conforming as closely as possible to the models annexed to
the present convention. Further limitations may be imposed only if the Protecting Power is
satisfied that it would be in the interests of the POWs concerned to do so owing to difficulties of
translation caused by the Detaining Power's inability to find sufficient qualified linguists to carry
out the necessary censorship.

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 - If limitations must be placed on the correspondence addressed to POWs, they may
be ordered only by the power on which the prisoners depend, possibly at the request of the
Detaining Power. Such letters and cards must be conveyed by the most rapid method at the
disposal of the Detaining Power; they may not be delayed or retained for disciplinary reasons.
Prisoners of war who have been without news for a long period, are unable to receive news from
their next of kin, or given news by the ordinary postal route, as well as those who are at a great
distance from their homes shall be permitted to send telegrams, the fees being charged against
the POW's accounts with the Detaining Power or paid in the currency at their disposal. They
shall likewise benefit by this measure in cases of urgency. As a general rule, the correspondence
of POW shall be written in their native language. The parties to the conflict may allow
correspondence in other languages. Sacks containing POW mail must be securely sealed and
labeled so as clearly to indicate their contents, and must be addressed to offices of destination.

h. The right to receive packages containing no contraband items such as food,

clothing, educational, religious, and recreational materials.

- Prisoners of war shall be allowed to receive, by post or by any other means,

individual parcels or collective shipments containing in particular foodstuffs, clothing, medical
supplies, and articles of a religious, educational, or recreational character which may meet their
needs; including books, devotional articles, scientific equipment, examination papers, musical
instruments, sports outfits, and materials allowing POWs to pursue their studies or their cultural
activities.

- Such shipments shall in no way free the Detaining Power from the obligations
imposed upon it by virtue of the present convention. The only limits which may be placed on
these shipments shall be those proposed by the Protecting Power in the interest of the prisoners
themselves, by the International Committee of the Red Cross, or any other organization giving
assistance to the prisoners, in respect of their own shipments only, on account of exceptional
strain on transport or communications.

i. The right to select a fellow POW to represent you.

- In all places where there are POWs, except in those where there are officers, the
prisoners shall freely elect by secret ballot every 6 months, and also in case of vacancies,
prisoners' representatives entrusted with representing them before the military authorities, the
Protecting Powers, the International Committee of the Red Cross, and any other organization
which may assist them. These prisoners' representatives shall be eligible for reelection.

- In camps for officers and persons of equivalent status or in mixed camps, the
senior officer among the POWs shall be recognized as the camp prisoners' representative. In
camps for officers, he or she shall be assisted by one or more advisers chosen by the officers; in
mixed camps, his or her assistants shall be chosen from among the POWs who are not officers
and shall be elected by them.

- Officer POWs of the same nationality shall be stationed in labor camps for POWs
to carry out the camp administration duties for which the POWs are responsible. These officers

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may be elected as prisoners' representatives under the first paragraph of this article. In such a
case, the assistants to the prisoners' representatives shall be chosen from among those POWs
who are not officers.

- Every representative elected must be approved by the Detaining Power before he

or she has the right to commence his or her duties. Where the Detaining Power refuses to
approve a POW elected by his or her fellow POWs, it must inform the Protecting Power of the
reason for such refusal.

- In all cases, the prisoners' representative must have the same nationality, language,
and customs as the POWs whom he or she represents. Thus, POWs distributed in different
sections of a camp, according to their nationality, language or customs shall have for each
section their own prisoners' representative in accordance with the foregoing paragraphs.

j. The right to receive humane treatment.

- Prisoners of war must at all times be humanely treated. Any unlawful act or
omission by the Detaining Power causing death or seriously endangering the health of a POW in
its custody is prohibited and will be regarded as a serious breach of the present convention. In
particular, no POW may be subjected to physical mutilation or to medical or scientific
experiments of any kind, which are not justified by the medical, dental, or hospital treatment of
the prisoner concerned and carried out in his or her interest.

k. The right to have a copy of the Geneva Convention and its annexes, including
any special agreements, posted where it can be read. The Geneva Convention and its
annexes, etc., must be written in the proper language and available upon request.

- Every POW camp shall be put under the immediate authority of a responsible
commissioned officer belonging to the regular Armed Forces of the Detaining Power. Such
officer shall have in his or her possession a copy of the present convention. He or she shall
ensure that its provisions are known to the camp staff and the guard and shall be responsible,
under the direction of his government, for its application.

- In every camp, the text of the present convention and its annexes and the contents
of any special agreement provided for in Article 6, shall be posted, in the prisoners' own
language, in places where all may read them. Copies shall be supplied, on request, to the
prisoners who cannot have access to the copy which has been posted.

l. Explain the right to have a copy of all camp regulations, notices, orders, and
publications about POW conduct posted where it can be read. Regulations, notices, etc.,
must be in the proper language for POWs to understand and available upon request.

- Regulations, orders, notices and publications of every kind relating to the conduct
of POWs shall be issued to them in a language which they understand. Such regulations, orders,
and publications shall be posted in the manner described above and copies shall be handed to the

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prisoners' representative. Every order and command addressed to POWs individually must
likewise be given in a language which they understand.

5. RESPONSIBILITIES OF A POW.

Every prisoner of war, when questioned on the subject, is bound to give only four
items of information.

(1) Name
(2) Rank
(3) Service number (social security number)
(4) Date of birth

If one willfully infringes this rule, they may render themselves liable to a restriction of the
privileges accorded to ones rank or status.

Lawful obedience to rules and regulations.

Obey lawful rules and regulations.

Responsibility to perform paid labor. (As required).

- Labor that is not military

- Not degrading
- Not dangerous
- Not unhealthy

Responsibility to maintain military discipline, courtesy, and rendering of honors.

- Maintain military discipline in accordance with the rules and regulations governing the
armed forces.

- Maintain courtesy and honors to all officers regardless of the branch of the service (U.S.
or allied nation).

REFERENCES
NAVMC 2681 Code of the US Fighting Force
MCRP 5-12 .1A The Law of Land Warfare

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 Code of Conduct and the Rights of POW's Review

1. Define the purpose of the Code of Conduct.

2. Explain the six articles of the code of conduct.

3. Explain the origin and purpose of POW rights.

4. Explain the responsibilities of a POW.

5. Are medical personnel considered POW’s or retained personnel under the Articles of the Code
of Conduct?

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 UNITED STATES MARINE CORPS
FIELD MEDICAL TRAINING BATTALION
BOX 555243
CAMP PENDLETON, CA 92055-5243

FMST 108

Recognize Combat Stress Disorders

TERMINAL LEARNING OBJECTIVE

1. Given personnel in any environment, Manage Combat and Operational Stress to strengthen,
mitigate, identify, treat, and reintegrate personnel. (8404-COSC-2001)

ENABLING LEARNING OBJECTIVES

1. Without the aid of reference, given a description or list, define the functions of OSCAR
Team Members, within 80% accuracy, per MCO 5351.1. (8404-COSC-2001a)

2. Without the aid of reference, given a description or list, identify sources of Combat Stress
and Operational Stress, within 80% accuracy, per MCO 5351.1. (8404-COSC-2001b)

3. Without the aid of reference, given a description or list, list the five core leader values of
Combat Operational Stress Control, within 80% accuracy per MCO 5351.1. (8404-COSC-
2001c)

4. Without the aid of reference, given a description or list, describe the four stress Zones that
make up the Combat Operational Stress Control Continuum, within 80% accuracy, per
MCO 5351.1. (8404-COSC-2001d)

5. Without the aid of reference, given a description or list, describe how to use the Combat
Operational Stress Flow Chart, within 80% accuracy, per MCO 5351.1. (8404-COSC-2001e)

6. Without the aid of reference, given a description or list, define the four Primary Aid aspects
of Combat Operational Stress First Aid, within 80% accuracy, per MCO 5351.1. (8404-
COSC-2001f)

7. Without the aid of reference, given a description or list, define the three Secondary Aid
aspects of Combat Operational First Aid, within 80% accuracy, per MCO 5351.1. (8404-
COSC-2001g)

8. Without the aid of referencs, given a description or list, define the importance of an After
Action Review, to reduce further injury or illness, per MCO 5351.1. (8404-COSC-2001h)

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1. FUNCTIONS OF OSCAR TEAM MEMBERS OSCAR teams are formed at the battalion
level (units of app. 1000 Marines) across the Corps. Each unit trains a team of approximately 50
OSCAR mentors, derived from both the battalion headquarters unit and subordinate units. It is
also supported by extenders and mental health professionals (MHPs) from internal or local
sources, as available. The team’s task is to help the unit commander prevent, identify, and
manage COS problems as early as possible. The member of the OSCAR team are:

a. Mentors – consist of selected Marines with combat zone deployment experience, who are
strong role models and are willing to assist and mentor other Marines with COS problems. The
battalion headquarters element would typically assign its executive officer, sergeant major, and
selected Marines to serve as OSCAR mentors; likewise, each company in the battalion would
typically assign its executive officer, first sergeant, and selected Marines. Mentors are
responsible for identifying, supporting, and advising Marines with COS issues as early as
possible, providing leadership through example and referring them to OSCAR extenders and
MHPs when problems persist. The reason for putting Marines on the front line is not only to
empower leaders to help Marines recognize and recover from stress problems and get back in the
fight more quickly, but also to free up MHPs from taking care of cases not requiring mental
health treatment. Putting Marines on the front line also reduces stigma by giving Marines initial
contacts they can trust—their brothers in arms who have “been there and done that.”

b. Extenders - consist of medical staff, chaplains, licensed counselors, corpsmen, religious

program specialists, and other professionals who “extend” the capabilities of OSCAR MHPs by
bridging the gap between MHPs and Marine mentors. The individuals assigned or invited to be
part of the battalion team will depend on the type of unit and local support available. For
example, OSCAR teams in infantry battalions have battalion medical and religious ministry
assets plus company corpsmen organic to them; these would typically be assigned to participate
with their respective battalion OSCAR teams. Most supporting establishment commands,
however, do not have such assets organic to their command and must rely on external resources,
such as installation medical and religious ministry services, for support. Some remote commands
must rely on other military services or civilian resources to assist. These battalions would be
advised to invite providers with whom they have or would like to have a good working
relationship to be part of their OSCAR team to facilitate familiarization and mutual
understanding of missions. Extenders provide professional support within their respective
scopes of practice. Examples include medical treatment of sleep problems, anxiety, depression,
counseling for marital problems, anger management, burnout, loss, inner conflict, anxiety,
depression, and other non-complicated mental health issues commonly addressed by primary care
physicians, chaplains, and licensed counselors. Corpsmen and religious support specialists have
limited specialty skills as extenders but function as peer mentors alongside their Marines.

c. Mental Health Personnel - consists of psychiatrists, psychologists, mental health nurse

practitioners, and licensed clinical social workers embedded in operational units to provide
formal mental health services. The individuals assigned or invited to be part of the battalion team
also depend on the type of unit and support available. Each infantry division generally includes
three mental health professionals and four psychological technicians on their table of
organization. Each infantry regiment typically includes two mental health professionals and two

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psychological technicians, all available on a shared basis to their respective battalions. However,
outside of the infantry divisions, commands must generally rely on external mental health
resources, such as installation mental health services, for support. Some remote commands must
rely on other military services or civilian resources to assist their teams. In such cases, these
commands would be advised to invite external MHPs with whom they have or would like to have
a good working relationship to be an informal part of their OSCAR team and facilitate
familiarization and mutual understanding of missions. Mental health personnel assigned to
operational units provide not only direct clinical services, but also spend a significant portion of
their time in the field with the Marines they support during training and deployment.

(1) Organic OSCAR mental health personnel augment the following capabilities for their
commanders:

(a) Psychological health surveillance of unit members and units as a whole.

(b) Preventive psychological health training. Early interventions to promote recovery for
individuals and units from life-threat or losses.

(c) Clinical mental health services in forward operational environments where such
services would be otherwise unavailable.

(d) Professional coordination of comprehensive mental health care services in garrison

before and after deployments to ensure readiness.

(e) Clinical mental health services in garrison as an adjunct to those provided by medical
treatment facilities.

(f) Psychological health support for medical and religious ministry personnel who are at
high risk for stress-related problems.

(2) The OSCAR mental health personnel also support their command’s psychological health
through the following specific functions and tasks:

(a) Advise commanders and other members of the chain of command on their leadership
of psychological health, resilience, and COSC.

(b) Become known to their Marines and trusted by them through repeated contact and the
sharing of adversity.

(c) Learn as much as possible about the stressors their Marines face, how they normally
cope with stressors, and how Marine leaders manage and mitigate stressors.

(d) Educate and train Marines and Marine leaders in evidence based methods for
preventing, identifying, and managing adverse stress reactions.

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 (e) Consult with primary care medical officers and corpsmen on the management of
adverse stress reactions that require further care.

(f) Consult with Marine Corps chaplains regarding their stress management functions.

(g) Consult with military leaders on the management of unit-level stress challenges.

(h) Work closely with their command element, maintaining an awareness of ongoing
operations and paying particular attention to events and operations likely to generate COS
casualties.

(3) To be effective, the OSCAR MHPs cannot retreat to a familiar clinical setting
surrounded by medical and mental health colleagues. The OSCAR MHP must learn to be
comfortable in the world of the Marine. Similarly, Marine leaders must learn to communicate
with their mental health professionals, consider heir guidance, and incorporate the information
and technologies they bring into the culture of the unit. Because of the shortage of mental health
manpower resources, OSCAR team members must also balance the competing priorities of
providing preventive services in operational or training environments with providing direct
clinical care.

2. SOURCES OF COMBAT AND OPERATIONAL STRESS (COSC)

a. Operational Stress - defined as: Changes in physical or mental functioning or behavior

resulting from the experience or consequences of military operations other than combat, during
peacetime or war, and on land, at sea, or in the air.

b. Combat Stress – defined as: Changes in physical or mental functioning or behavior

resulting from the experience of lethal force or its aftermath. These changes can be positive and
adaptive or they can be negative, including distress or loss of normal functioning.

Shell shock, as combat stress was called during World War I, often was viewed as a coward’s
reaction to fighting. There were little or no selection processes to filter out those with psychiatric
illnesses before entering the military. As a result, some mental illnesses were exacerbated or
developed and led to responses as drastic as death penalties for desertion. The few men who
were diagnosed with combat fatigue were evacuated home, often when it was too late for
recovery. Many developed chronic psychiatric conditions. World War II saw some changes, for
instance in the US, there was more pre-recruitment screening. The problem of combat stress was
grudgingly accepted as a part of warfare and by the end of WWII, psychiatrists were stationed
within many units. Another major change was men were no longer moved away from the front
to receive treatment, except for logistical reasons or in severe cases. In Korea there was even a
mobile psychiatric unit conducting “stress control operations” near the front. Male culture still
had difficulty dealing with man’s emotional response to war. Vietnam underlined this and
despite progress, there remained little overall acknowledgement of combat stress. Many men
turned to drugs such as marijuana, heroin, and alcohol or found other potentially dangerous
methods to self-treat issues. The lack of engagement with such a central issue cost many men

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their lives on the battle field, in conflict zones, and with post traumatic disorders ending in
suicide after the war ended.

3. FIVE COSC CORE LEADER FUNCTIONS. Commanders and leaders will employ the five
COSC core leader functions: Strengthen, Mitigate, Identify, Treat, and Reintegrate to increase
individual and unit readiness. Employing the five COSC core leader functions and utilizing the
Stress Continuum provides the Marine Corps framework for understanding, recognizing and
dealing with combat and operational stress reactions.. Methods for incorporating the COSC core
leader functions are as follows:

a. Strengthen. Strengthening Marines enhances resilience against combat and operational

stress and aids in the prevention of stress injuries and illness. Individuals enter military service
with a set of pre-existing strengths and vulnerabilities based on genetic makeup, prior life
experiences, personality style, family support systems, among other factors. Commanders of
military units can do much to enhance the psychological resilience of unit members and their
families. Strengthening falls into three main categories: training, social/unit cohesion and
leadership aligned to physical, mental, social and spiritual domains.

b. Mitigate. Mitigation is the use of techniques to minimize the impact of stressors that
cannot be removed including balancing the need to intentionally stress Marines during training
and missions with reducing stressors that are not essential to training or mission accomplishment.

c. Identify. Since even the best preventive efforts cannot eliminate all stress reactions and
injuries that might affect occupational functioning or health, effective COSC requires continuous
monitoring of stressors and stress outcomes.

(l) Leaders must know the individuals in their units, including their specific strengths and
weaknesses, and the nature of the challenges they face, both in the unit and in their personal
lives. Most importantly, leaders must monitor which stress zone of the Stress Continuum unit
members are in on a day-to-day basis. Marines and Sailors should recognize their own stress
reactions, injuries, and illnesses; and they must be able to recognize small changes in behavior
that may indicate a stress reaction. Leaders must recognize when a Marine's confidence in him or
herself, or his or her peers or leaders is shaken, or when units have lost effectiveness because of
challenges to the unit.

(2) Stigma, particularly self-stigma, can be a barrier to acknowledging stress injuries or

illness and seeking assistance. Therefore, the best and most reliable method of ensuring that
everyone who needs assistance gets it is for small unit leaders to continually monitor the personal
and professional performance of their subordinates, and for peers to watch out for each other.

d. Treat. While Marine leaders do not provide direct clinical treatment, they are responsible
for leadership interventions including facilitating discussions and knowing appropriate resources,
as well as referring to the appropriate level of care those affected by stress. The tools available
for the treatment of stress reactions include: self-aid, peer-to-peer, support from a Marine leader,

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chaplain, corpsman, or medical officer and definitive medical or psychological treatment.
Although some forms of treatment can only be delivered by trained medical or mental health
providers, others require little special training and can be applied very effectively by a peer,
family member, leader, or chaplain. Regardless of what level or type of treatment is available for
any given Marine or Sailor, the overall responsibility for ensuring appropriate and timely care for
injuries or illnesses rests with leaders and their commanders. This is done through coordination
with appropriate level of care and follow-through with the Marine or Sailor and the care provider
including maintenance and after-care.

e. Reintegrate. Commanders support Marines and Sailors during reintegration back into the
force following formal mental health treatment. Reintegration is aligned to the maintenance of all
Marines but includes two important factors: addressing command climate regarding stigma and
establishing confidence. This includes continually monitoring fitness for duty and worldwide
deployment, and mentoring the Marine during their recovery process by restoring the confidence
of the stress-injured Marine, his or her peers and the unit. Reintegrating Marines preserves the
investment made in the training of the individual and upholds our Core Values. Stigma is
dispelled when other members of the unit see previously injured Marines return to full duty.

4. FOUR ZONES OF COMBAT AND OPERATIONAL STRESS CONTINUUM

a. The Stress Continuum (see figure 1) is a model that identifies how Sailors and Marines
react under stressful situations. It is the foundation of Navy and Marine Corps efforts to promote
psychological health.

b. The continuum is a color-coded map to identify behaviors that might arise from serving in
combat, in dangerous peacekeeping missions and in the highly charged day-to-day work that is
required of today’s military. While its primary use is for individual service members, the
continuum also is a valuable tool to track behaviors of military families and commands.

c. Common Behaviors of the Four Zones

(1) GREEN (READY): Not stress-free, but mastering stress with good coping skills. Ready
to go!

-Remain calm, steady, confident

-Exhibit ethical and moral behavior
-Eat healthfully, exercise regularly and get proper sleep
-Keep a sense of humor and remain active socially, spiritually
-Use alcohol in moderation, if at all
-Get the job done and show respect for fellow warriors

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 (2) YELLOW (REACTING): Reacting to life’s normal stressors. Mild and reversible!
-Feel anxious, fearful, sad, angry, grouchy, irritable or mean
-Cut corners on the job
-Are negative or pessimistic
-Lose interest, energy or enthusiasm
-Have trouble concentrating
-Become excessive in spending, Internet use, playing computer games, etc.

(3) ORANGE (INJURED): Stress injuries damaging the mind, body or spirit. Temporarily
non-mission ready!
-Lose control of emotions or thinking
-Have nightmares, sleep problems, obsessive thinking
-Feel guilt, shame, panic or rage
-Abuse alcohol or drugs
-Change significantly in appearance or behavior
-Lose moral values

(4) RED (ILL): Stress injuries that become stress illnesses. Only diagnosed by health
professionals! These are Orange Zone behaviors that persist, get worse, or get better and then
come back worse. The service member cannot function properly.

(a) All medical disorders in individuals exposed to combat or other operational or

traumatic stress are found in the Red Zone. These include posttraumatic stress disorder (PTSD),
major depression, certain anxiety disorders and substance abuse disorders. The distinction
between Orange Zone stress injury and Red Zone stress illness can only be made by a medical or
mental-health professional.

(b) Red Zone illnesses are very treatable. The majority of Sailors and Marines who are
treated finish their tours of duty and many continue to serve. Early treatment is the key.

d. Resilience to stress is the underlying theme of the continuum— building it, maintaining it
and restoring it when necessary. The more resilience shown by a service member the easier it is
to stay in the Green Zone.

e. The American Psychological Association has identified some individual attributes, or

personal skills, that may contribute to an individual’s ability to cope with life stressors. These
attributes include:

– The capacity to make realistic plans and take steps to carry them out. (Judgment,
and Decisiveness)
– A positive view of yourself and confidence in your strengths and abilities.
(Bearing)
– Skills in communication and problem solving.(Tact, Knowledge, and Initiative)
– The capacity to manage strong feelings and impulses. (Dependability, Tact,
Selflessness)

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 Figure 1: Combat and Operational Stress Continuum

5. COSC Decision Flowchart (see figure 2) is a simple tool for leaders to determine where a
Marine falls on the stress continuum and shows what to do to mitigate or, if necessary, treat the
injury or illness. The Decision Flowchart is applicable at all stages of the deployment cycle. The
lists of stress symptoms on the far right, highlighted by the Yellow, Orange, and Red brackets,
give the leader or Marine some indications of typical problems at each level of function. The
diamonds in the middle specify decisions needed to determine the severity of the stress problem,
and the boxes on the left indicate what action needs to be taken for each level of severity. It can
also be used by individual Marines to evaluate themselves or their buddies who have symptoms
of deployment-related stress. This is used by leaders to determine what actions should be taken
with Marines experiencing combat stress problems.

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 Figure 2: Combat Operational Stress Decision Flowchart

6. PRIMARY AID ASPECTS (See figure 3)

a. Check to see if action is required. This is the initial estimation of the reaction and includes
asking the Marine if they need assistance. Those who are injured by stress may not be aware of
their reaction, so it might be necessary for someone else to ask. In addition, stigma can be an
obstacle to asking for assistance. Stress zones and needs change over time and risks from stress
injuries may last a long time after the event, so this is a step that is applicable away from
immediate danger.

b. Coordinate the next steps. This could include calling someone over to assist or informing
those who need to know. It is also the first step to obtaining other needed sources of support or
care.

c. Seek cover and get to safety. Get out of the line of fire, if needed, or away from the
stressor. This may be necessary if a person in an immediate life-threatening situation is impaired
in decision making or has frozen or panicked. This sense of "freezing" may put themselves or
other people in danger. They may require someone else to make decisions on their behalf until
they can recover.

d. Calm the Marine. The Marine will refocus more quickly if they are calm. Also, the longer
stress hormones remain elevated, the more potential damage there is to the brain. Lowering
stress hormone levels decreases the risk of long-term stress injury. The Marine providing

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assistance should create an environment of safety to promote recovery. Methods of calming
include tactical breathing and progressive muscle relaxation.

7. SECONDARY AID ASPECTS (See figure 3)

a. Connect with the Marine. Bring the Marine back to reality in order to obtain mission focus.
This also prevents the sense of isolation that allows negative feelings to continue and hamper
future recovery. The goal is to avoid alienation that can cause a loss of trust, energy and self-
confidence. Leaders can utilize AAR as supporting tools after the event.

b. Restore competence and ability. Stress injury or illness causes loss or a change in normal
functioning and abilities. At a minimum, this step should enable the Marine to move under their
own power and care for themselves safely. Higher-level skills can be exercised and restored
once the immediate issue is addressed.

c. Restore confidence. Allow the Marine to resume the mission when they are ready to do so.
Encourage the Marine in order to restore his or her sense of self-confidence; these are critical
steps that will help ensure that the Marine will be a valuable team member in the future.

d. Secondary aid may occur quickly during the event, but may also occur in more detail over
time if required.

Figure 3. 7 C’s of Stress First Aid

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8. AFTER ACTION REVIEWS

Every leader will ensure their Marines are afforded the opportunity to discuss with their peers
and immediate supervisors, in an atmosphere of trust and honesty, perceptions and reactions after
significant operational or training events. Such discussions promote recovery from
combat/operational stress reactions and can prevent them from developing into long-term issues.
AAR is a tool for small unit leaders to identify Marines who might be in need of individual
support.

AAR Goals

(1) Reviewing the facts, as best known to members of the small unit, surrounding operational
or training events particularly where there have been casualties or loss of life. This promotes a
common perception and understanding of the action and facilitates the sharing of lessons learned.

(2) Encouraging (but not forcing) Marines to share their personal experiences with each other
of the action under discussion, including what they believe they did well and what they could
improve.

(3) Relieving, as much as possible, inappropriate or excessive self-blame or anger among unit
Marines for unavoidable failures.

(5) Establishing common perceptions among unit members of the meaning of what happened,
and what purpose was served by the unit's actions and sacrifices.

(6) Restoring any damaged confidence among unit members in their leaders, equipment, peers
or themselves through honestly and tactfully evaluating events and what will be done to prevent
similar situations in the future, where possible.

(7) Identifying Marines according to the Stress Continuum, including those who show signs of
a stress injury, so progress toward healing and recovery can be monitored, and a referral to
resources can be initiated if required.

AAR Procedures

(1) Conduct AAR at the small unit level, such as squads or other similarly sized team.

(2) Facilitated by the small unit's senior leaders, such as a squad leader, who should be
OSCAR trained.

(3) Conduct AAR within 72 hours of each action, but not before post-action rest and
replenishment.

(4) No one outside the small unit should be present during an AAR, other than members of the
immediate chain of command who were involved in the action or the unit chaplain if requested.

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 (5) All Marines should be required to attend every AAR their unit conducts, but they should
not be required to speak if they choose not to.

(6) Each AAR should take between 15 to 60 minutes to conduct; but be flexible, do not rush
or artificially prolong it.

AAR Responsibilities. Leaders are responsible for conducting AAR. The following
considerations apply:

(1) Listen to your Marines and try to understand their experiences and perceptions.

(2) Provide positive mentoring by honestly sharing experiences with subordinates, in a calm
and self-controlled manner.

(3) Assist junior Marines make sense out of what happened, including why sacrifices were
made, and what good came from their efforts.

(4) If a Marine leader feels unable to conduct an AAR in their unit for whatever reason, he or
she should discuss this with their most trusted superior. After the most stressful operational
events, then an AAR may be most difficult to conduct, is exactly when Marines need it most.

(5) Memorials - In addition to the critical role of memorials as tribute and remembrance of
the fallen, memorials are important events for identifying stress reactions, honoring sacrifice and
core values, building unit cohesion, and supporting Marines and their families.

REFERENCES:
MCBUL 6490
MCO 5351.1

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 Recognize Combat Stress Disorders Review

1. Define operational and combat stress?

2. Define the “functions”of the OSCAR team members?

3. What are the five COSC core leadership functions?

4. Explain the four zones within the Operational Stress continuum?

5. What are the seven C’s of stress first aid?

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 UNITED STATES MARINE CORPS
FIELD MEDICAL TRAINING BATTALION
BOX 555243
CAMP PENDLETON, CA 92055-5243

FMST 109

M16/M4 SERVICE RIFLE FAMILIARIZATION

TERMINAL LEARNING OBJECTIVE.

1. Given a service rifle/Infantry Automatic Rifle (IAR), sling, magazines, cleaning gear,
individual field equipment, and ammunition, perform weapons handling procedures
with a service rifle/Infantry Automatic Rifle (IAR) in accordance with the four safety
rules. (HSS-MCCS-2004)

2. Given a service rifle and cleaning gear, maintain a service rifle to ensure the weapon
is complete, clean, and serviceable. (HSS-MCCS-2005)

3. Given a service rifle that has stopped firing and ammunition, perform corrective
action with a service rifle to return the weapon to service. (HSS-MCCS-2006)

ENABLING LEARNING OBJECTIVES.

1. Without the aid of reference, given a list of choices, identify the characteristics of
the service carbine, within 80 percent accuracy, per MCRP 3-01A. (HSS-MCCS-2004a)

2. Without the aid of reference, given a list of choices, identify the four safety rules for
the service carbine, within 80 percent accuracy, per MCRP 3-01A. (HSS-MCCS-2004c)

3. Without the aid of reference, given a list of choices, identify the components of the
service carbine, within 80 percent accuracy, per MCRP 3-01A. (HSS-MCCS-2004b)

4. Without the aid of reference, given a list of choices, identify the weapon conditions
for the service carbine, within 80 percent accuracy, per MCRP 3-01A. (HSS-MCCS-
2004d)

5. Without the aid of reference, given a list of choices, identify the ammunition for the
service carbine, within 80 percent accuracy, per MCRP 3-01A. (HSS-MCCS-2004e)

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6. Without the aid of reference, given a service carbine, disassemble the service
carbine, to 100 percent accuracy, per MCRP 3-01A. (HSS-MCCS-2005b)

7. Without the aid of reference, given a service carbine and necessary cleaning gear,
clean the service carbine so that it is clean, serviceable, and passes a functions check,
per MCRP 3-01A.(HSS-MCCS-2005c)

8. Without the aid of reference, given a service carbine, assemble the service carbine,
to 100 percent accuracy, per MCRP 3-01A. (HSS-MCCS-2005d)

9. Without the aid of reference, given a list of choices, describe the procedures to
perform a function check of the service carbine, to 100 percent accuracy, per MCRP
3-01A. (HSS-MCCS-2005e)

1-88
1. CHARACTERISTICS The M16A4 Service rifle/M4 Service Carbine (M4 Service
Carbine is the TO issue weapon for Corpsman),(see figures 1-3). They are a caliber
5.56mm, magazine-fed, gas-operated, air-cooled, shoulder-fired weapons that can be
fired either in automatic three-round bursts or semiautomatic single shots as determined
by the position of the selector lever.

(Figure 1. M16)

(Figure 2. M4)

M16A4 M4 Carbine
5.56 mm Caliber 5.56 mm
8.79 pounds Weight (w/30 round magazine) 6.9 pounds
29.75 inches w/butt stock closed
39 5/8 inches Length (w/compensator)
33 inches w/butt stock open
800 rounds per minute 800 rounds per minute
Cyclic rate of fire
(approximately) (approximately)
Maximum effective rates of fire:
45 RPM Semiautomatic 45 RPM
90 RPM Burst 90 RPM
12 – 15 RPM Sustained rate of fire 12 – 15 RPM
Maximum effective range:
550 meters Individual/point targets 500 meters
800 meters Area targets 600 meters
3534 meters Maximum range 3600 meters

(Figure 3, Characteristics of each service rifle)

1-89
2. SAFETY RULES

The following rules apply to all weapon systems at all times without exception.

SAFETY RULE #1 Treat every weapon as if it were loaded

a. Never trust your memory or make any assumptions about a weapon's safety
status. Always confirm what condition your weapon is in if there is ever any
doubt.
b. Check your weapon for ammunition whenever it has been out of your
possession.
c. Never hand a weapon to anyone without clearing it. Clearing is a procedure
for ensuring there is no ammunition in the weapon. Whenever you assume
control of a weapon from someone, your first action is to clear it, even if you
have witnessed its clearing.
d. Never move in front of a weapon held by someone else.
e. Never engage in or tolerate horseplay with or around weapons.

SAFETY RULE #2 Never point a weapon at anything you do not intend to shoot
a. Always be aware of muzzle direction and your surroundings. This ensures
you will not unintentionally point your weapon at anything other than an
intended target.
b. Be aware of the maximum range of your weapon. If you do not know what is
beyond your vision in any unprotected direction, do not point your weapon in
that direction.
c. Never allow the muzzle of your weapon to point at any part of your body.

SAFETY RULE #3 Keep your finger straight and off the trigger until you are
ready to fire
a. Never be guilty of a negligent discharge.
b. A common reaction to a sudden shock or loss of balance while handling a
weapon is an unintentional tightening of the grip. If your finger is off the
trigger, you will eliminate the potential for firing a shot accidentally.

SAFETY RULE #4 Keep the weapon on safe until you intend to fire
The SAFE position on the selector lever is a built-in feature that has only one
function. That function is to prevent inadvertent firing of the rifle.

a. When patrolling or walking it is possible for the trigger to be unintentionally

depressed by objects (e.g., branches, wire, gear) encountered en route.
Keeping the weapon on safe ensures the weapon will not fire if the trigger is
accidentally engaged.
b. Never trust anyone else regarding a weapon's safety status.

1-90
 3. COMPONENTS Before taking your rifle apart, you should know the nomenclature
(names) of all externally visible parts. Using your own rifle, find and learn the
nomenclature of all outside parts. Then, as you disassemble the rifle, learn the
nomenclature of all internal parts (see figure 4).

Figure 4. Components of External Parts

1-91
4. WEAPONS CONDITIONS

Condition Four
Magazine removed
Bolt forward
Chamber empty
Ejection port cover closed
Weapon on safe
Condition Three
Magazine inserted
Bolt forward
Chamber empty
Ejection port cover closed
Weapon on safe
Condition Two
Not applicable for the M16/M4
Condition One
Magazine inserted
Bolt forward
Round in the chamber
Ejection port cover closed
Weapon on safe

5. AMMUNITION (see figure 5)

Four types of ammunition are authorized for use with the M16/M4 service rifle: ball
(M193 and M855), tracer (M196 and M856), dummy (M199), and blank (M200)

Figure 5. Ammunition
1-92
M193 Ball: This ammunition is a 5.56mm center fire cartridge with a 55-grain gilded
metal jacket, lead alloy core bullet. The primer and case are waterproofed. The M193
ball ammunition has no identifying marks.

M855 Ball:
This ammunition is the primary ammunition for the M16A2 rifle. Identified by a green
tip, its 5.56mm center fire cartridge has better penetration than the M193. It has a 62-
grain gilded-metal jacket bullet. The rear two-thirds of the core of the projectile is lead
alloy and the front one-third is a solid steel penetrator. The primer and case are
waterproofed.

M196 and M856 Tracer

This ammunition has the same basic characteristics as ball ammunition. Identified by a
bright red tip, its primary uses include observation firing, incendiary effect, and signaling.
Tracer ammunition should be intermixed with ball ammunition in a ratio no greater than
1:1. The preferred ratio is one tracer to four balls (1:4) to prevent metal fouling in the
bore.

M199 Dummy
This ammunition has six grooves along the side of the case. It contains no propellants or
primer. The primer well is open to prevent damage to the firing pin. The dummy
cartridge is used during dry fire and other training purposes.

M200 Blank
This ammunition has the case mouth closed with a seven-petal rosette crimp. It contains
no projectile. Blank ammunition, identified by its violet tip, is used for training purposes.

6. DISASSEMBLY: Before you disassemble the rifle ensure the weapon is on safe
(see figure 6).
Clearing the M16/M4 Carbine Service Rifle (Safety Features/Precautions)
- Attempt to point the selector lever to safe. If the weapon is not cocked, the selector
lever cannot be pointed to safe.
- Remove the magazine from the weapon by
grasping it with the left hand, press the magazine
release button with your right index finger, and pull
the magazine straight down (see figure 5).
- Lock the bolt carrier to the rear by grasping the
charging handle, pressing the charging handle latch,
and pull the charging handle all the way to the rear.

- Press in on the bottom of the bolt catch with

the thumb or forefinger. Allow the bolt carrier Figure 6. Selector Switch on Safe
to move slowly forward until the bolt engages
the bolt catch. Return the charging handle to its forward position.

1-93
– Inspect the receiver and chamber by looking through the ejection port to ensure
these areas do not contain ammunition.
The rifle is clear and safe only when:
There is no round in the chamber
The magazine is out
The bolt carrier is locked to the rear
The selector lever is in the safe position

Disassembly - When the weapon is clear you can disassemble the weapon by doing
the following:
Allow the bolt carrier to go forward by depressing the upper portion of the bolt
catch.
Remove the sling and place the rifle on the table or a flat surface, muzzle to the
left, weapon on the right side.
Remove the hand guards
Place the butt of the weapon against a flat surface and pull down on the slip ring
until the lower lip of one hand guard is clear.
Pull out and down on the hand guard until the upper lip is cleared of the hand
guard cap.
Repeat the same operation to remove the other side of the hand guard.
Considerable pressure is required to remove the hand guard from the slip ring.
Detach the upper receiver from the lower receiver (see figure 7).
Press out the take down pin from left to right until the upper receiver swings free
of the lower receiver.
Press out the receiver pivot pin.
Separate the upper and lower receiver groups.
Place the lower receiver group on the table.

Figure 7. Detach upper and lower receiver

1-94
Removing the charging handle and the bolt carrier group
Hold the upper receiver group with the muzzle and
carrying handle up. Grasp the charging handle.
Press the charging handle. Latch and pull the
charging handle three inches to the rear to withdraw
the bolt carrier from the receiver (see figure 8).
Grasp the bolt carrier and pull it out from the receiver.
When the bolt carrier is removed, the charging handle
can be removed from its groove in the receiver.
Place the upper receiver on the table.

Figure 8. Removing the bolt carrier

Disassemble the bolt carrier group (see figure 9)
Press out the fire-retaining pin from right to left.
Elevate the front of the bolt carrier and allow the firing pin to drop free from its
recess in the bolt. Rotate the
bolt until the cam pin is clear of
the bolt carrier key and remove
the cam pin by rotating the head
90 degrees (1/4 turn) in either
direction. Lift out of well in the
bolt and bolt carrier. After the
cam pin is removed, the bolt can
be removed from its recess in
the bolt carrier and disassembly
of the bolt carrier group is
complete.
Remove the buffer assembly
Push down on the buffer
retainer. Allow the buffer
Figure 9. Bolt Carrier Group
assembly to move forward slowly until it is clear of the buffer
retainer. Depress the hammer to the rear (downward) to allow the buffer assembly to
clear the hammer. Remove the buffer assembly and the action spring.

1-95
7. CLEAN THE SERVICE RIFLE
Normal care and cleaning will result in proper functioning of all parts of the weapon.
Improper maintenance causes stoppages and malfunctions. Only "issued" cleaning
materials should be used. These cleaning materials are carried in the compartment
provided in the stock of the weapon on the M16 or in the cleaning kit for the M4
Carbine. Do not use any abrasive material to clean the rifle. Cleaner Lubricant and
Preservative (CLP) is the only authorized lubricant for the M16/M4 Carbine rifle.
Cleaning and lubrication of the upper receiver
Clean the upper receiver until free of powder.
After cleaning, coat the interior surfaces of the upper receiver with CLP. Pay
particular attention to shiny surfaces which indicate areas of friction.
Cleaning and lubrication of the barrel
Attach a bore brush to the cleaning rod, dip it in CLP, and brush the bore
thoroughly.
Brush from the chamber to the muzzle using straight-through strokes.
Push the brush through the bore until it extends beyond the muzzle compensator.
Continue this process until the bore is free of carbon and fouling (never reverse
the direction of the brush while in the bore).
Remove the brush from the cleaning rod and dry the bore with clean patches.
Do NOT attempt to retract the patch until it has been pushed all the way out of the
muzzle compensator.
CAUTION: The cleaning rod is to be supported by hand, one section at a time, to
prevent flexing and damage to the bore.
Cleaning the chamber
Attach the chamber-cleaning brush to a section of the cleaning rod.
Dip it in CLP, and insert it in the chamber.
Scrub in a circular motion.
Remove the brush and dry the chamber thoroughly with clean patches.
Clean the locking lugs in the barrel extension, using a small bristle brush dipped
in CLP to remove all carbon deposits.
Clean the protruding exterior of the gas tube in the receiver with the bore brush
attached to a section of the cleaning rod.
After cleaning, lubricate the bore and locking lugs in the barrel extension by
applying a light coat of CLP to prevent corrosion and pitting. If the hand guards
have been removed, rub a light coat of CLP on the surface of the barrel.
Place one or two drops of CLP on the front sight post.

1-96
 Cleaning and lubrication of the bolt carrier group
Thoroughly clean all parts with a patch or an all-purpose brush dipped in CLP.
Clean the locking lugs of the bolt, using an all purpose brush and CLP.
Ensure that all carbon and metal filings are removed; then wipe it clean with dry
patches and lubricate lightly.
Use an all-purpose brush dipped in CLP to scrub the extractor to remove carbon
and metal filings; also clean the firing pin recess and the firing pin.
When dry and before final assembly, apply a coat of CLP to the bolt body, rings
and carrier key.
When bolt carrier group is reassembled, apply a liberal amount of CLP to all
exterior surfaces with particular emphasis to the friction points (i.e., rails and cam
area). Put one drop of CLP in the cam pin track and two drops in the gas ports.
Cleaning and lubrication of the lower receiver group
Wipe any particles of dirt from the trigger mechanism with a clean patch or brush
and place a drop of CLP on each of the pins for lubrication. Components of the
lower receiver group can be cleaned with CLP and a brush.
Use a scrubbing action to remove all carbon residue and foreign material and then
drain the CLP from lower receiver and wipe dry.
Cleaning and lubrication of the magazine
Disassemble the magazine, being careful not to stretch or bend the spring.
Scrub the inside of the magazine with a bristle brush, dipped in CLP, and wipe it
dry.
The magazine is made of aluminum and does not need any lubrication.
Scrub the spring clean of any foreign material using an all-purpose brush dipped
in CLP.
Wipe dry and apply a very light coat of CLP to the spring.

8. ASSEMBLY OF THE Ml6/M4 CARBINE RIFLE

Lower receiver group assembly
Press hammer to the rear (downward).
Insert the buffer assembly into the recess in the stock of the weapon.
Depress the buffer retainer so that the buffer assembly will insert into the recess
completely.
Release the pin so the buffer assembly is locked into place.
Set the bolt carrier group down on the table.

1-97
Bolt carrier group assembly
Insert the bolt through the front end of the carrier with the extractor facing at the
11 o’clock position.
Insert the cam pin into the carrier and rotate it ¼ turn.
Insert the firing pin through the rear of the carrier and let it drop into the recess
for the firing pin.
Insert the firing pin retainer pin into the carrier from left to right.
Set the bolt carrier group down on the table.
Upper receiver group and charging handle assembly
Replace the charging handle by placing the charging handle inside the upper
receiver. This is done by lining up the grooves on the charging handle with the
slots in the upper receiver and pushing it in about one inch. Then, insert the bolt
carrier group, with the carrier key resting in the charging handle, into the upper
receiver until they lock into place.
Assembly of major parts
Align the upper receiver with the lower receiver together, push in the pivot, and
take down pins to lock the receivers together.
Insert the top of each hand guard cap and pull down on the slip ring so the bottom
lip of the hand guard will slip in and lock in place when you release the slip ring.
Lock the bolt to the rear by pulling on the charging handle and pressing the bolt
catch and letting the carrier go forward slowly until the bolt catch engages the bolt
carrier group.
Return the charging handle to the original position. Place the selector lever on
safe.
Replace the sling on the weapon.

1-98
9. FUNCTION CHECK A function check of the rifle consists of checking the
operation of the rifle while the selector lever is in each position; Safe, Semi, and
Burst
1. Pull the charging handle to the rear and release
2. Place selector lever on SAFE
3. Pull trigger – Hammer should not fall
4. Place selector lever on SEMI
5. Pull the trigger and hold to the rear – Hammer should fall
6. Pull the charging handle to the rear and release
7. Release trigger and pull to the rear again – Hammer should fall
b. Place selector lever on BURST
1. Pull charging handle to the rear and release
2. Pull trigger and hold to the rear – Hammer should fall
3. Pull charging handle to the rear three times and release
4. Release the trigger and pull again – Hammer should fall

10. WEAPONS TRANSPORTS Transport carries are used when no immediate threat
is present. They are also beneficial when both hands are needed.

Strong Side Sling Arms (see figure 10)

a. Release the pistol grip of the rifle
b. Lower the butt stock of the rifle and bring the rifle to a
vertical position
c. With the right hand, grasp the sling above the left forearm.
d. Guide the rifle around the right shoulder with the left hand
and extend the right arm through the sling
e. Place the sling on the right shoulder and apply downward
pressure on the sling with the right hand to stabilize the
rifle on the shoulder.
f. Release the hand guard

Figure 10 Strong Side Sling Arms

1-99
 Weak Side Sling Arms (Inclement Weather) (see figure 11)
a. Release the pistol grip of the rifle
b. Lower the butt stock of the rifle and bring the rifle to a
vertical position
c. Rotate the rifle outboard until the pistol grip is pointing
toward the body
d. Reach over the left forearm and grasp the sling with the right
hand.
e. Rotate the muzzle down with the left hand while sliding the
right hand up the sling. Place the sling on the left shoulder
f. Grasp the sling with the left hand and apply downward
pressure to stabilize the rifle on the shoulder.
g. Release the hand guard

Figure 11 Weak Side Sling Arms

Cross Body Sling Arms

The cross body transport is used when both hands are required for work, such as digging
a fighting hole. It is employed with the web sling. The rifle is slung across the back with
the muzzle up or down. Normally, the weapon will be carried with the muzzle down to
prevent pointing the muzzle in an unsafe direction, unless the situation dictates otherwise.
To assume this transport
a. Muzzle Down (Weak Side) (see figure 12)
1) With your right hand, grasp the sling.
2) With your left hand, grasp the hand guards.
3) Pull up on the rifle with both hands.
4) Slide the sling over your head.
5) Position the rifle so it is comfortable across your back.

Figure 12 Cross Body Muzzle Down

1-100
 b. Muzzle Up (Strong Side) (see figure 13)
1) With your left hand, grasp the sling.
2) With your right hand, grasp the pistol grip.
3) Pull up on the rifle with both hands.
4) Slide the sling over your head.
5) Position the rifle so it is comfortable across your back

Figure 13 Cross Body Muzzle Up

REFERENCES
MCO 3574.2K
1-101
 M16/M4 Review

1. Describe the characteristics of the M16/M4 Service Rifle.

2. Describe the difference between weapons condition 3 and condition 1.

3. List the differences between the M16 and the M4 Carbine.

4. What product is used to clean the service rifle?

1-102
 Introduction to the USMC
Review Questions

NOTE: The following questions are offered for review purposes. This is NOT intended as
a sole source of test preparation. Remember all test questions are based on an ELO and
any ELO can be used to create a test question.
1. A MEF is commanded by what ranking officer?
2. What year was the Marine Corps founded?
3. What are the characteristics of weapon condition four of the M16/ M4 service rifle?
4. What is combat stress?
5. When was the Code of Conduct promulgated?
6. On which side of the collar, right or left, is the rank insignia worn?
7. Who is the most highly decorated Marine in history?
8. What pre-deployment steps can be taken to prevent combat stress?
9. What is the maximum effective rate of fire for a semiautomatic service rifle?
10. If a person has more than one warfare device, how far apart are they worn on the MCCUU?
11. Commanders of combatant commands come under which chain of command?
12. What are the four core elements of a MAGTF?
13. When was the battle of Guadalcanal?
14. What is the maximum effective range of individual/point targets of the M4 service rifle?
15. What factors decrease the risk of combat stress?
16. Who was in the battle of Nawa?
17. What is the maximum effective range of individual/point targets of the M16 service rifle?
18. What steps can be taken during deployment to prevent combat stress?
19. Where is 2nd Marine Aircraft Wing (2nd MAW) geographically located?
20. What is the approximate size of a MEF?
21. What are the four items of information a POW is bound to give if captured?
22. A leader who avoids profane and vulgar language displays what leadership trait?
23. How far from the edge of the collar is the collar device worn?
24. An E-8 in the Marine Corps who is a technical expert is a ________.
25. Who is the most senior officer of the Marine Corps?
26. When was the Marine Corps Women’s Reserve established?
27. What are the four broad categories of the Marine Corps?
28. The certainty of proper performance of duty is the definition of which Marine Corps
leadership trait?
29. What are the characteristics of the M16/ M4 service rifle?

1 - 103
 Introduction to the USMC
Review Questions
30. What personal factors increase the risk of combat stress?
31. What is the Marine Corps equivalent to a Navy Commander?

1 - 104
PREVENTIVE MEDICINE
 PREVENTIVE MEDICINE

Treat Dehydration 2-1

FMST 201

Treat Environmental Heat Injuries 2-7

FMST 202

Manage Environmental Cold Injuries 2-15

FMST 203

Perform Care of the Feet 2-24

FMST 204

Perform Water Purification for Individual Use 2-34

FMST 205

Supervise Field Waste Disposal 2-39

FMST 206

Manage Envenomation Injuries 2-45

FMST 207

Review Questions 2-62

 UNITED STATES MARINE CORPS
FIELD MEDICAL TRAINING BATTALION
BOX 555243
CAMP PENDLETON, CA 92055-5243

FMST 201
Treat Dehydration Casualties

TERMINAL LEARNING OBJECTIVE

1. Given a casualty, equipment and supplies, treat dehydration casualties within the scope of
care reducing the risk of further injury or death. (8404-MED-2017)
ENABLING LEARNING OBJECTIVES
1. Without the aid of reference, given a description or list, identify the predisposing factors
associated with dehydration, within 80% accuracy, in accordance with the Pre-Hospital
Trauma Life Support, Current Military Edition. (8404-MED-2017a)
2 . Without the aid of reference, given a description or list, identify signs and symptoms of
dehydration, within 80% accuracy, in accordance with the Pre-Hospital Trauma Life Support,
Current Military Edition. (8404-MED-2017b)
3 . Without the aid of reference, given a description or list, identify the treatments for
dehydration casualties, within 80% accuracy, in accordance with the Pre-Hospital Trauma Life
Support, Current Military Edition. (8404-MED-2017c)
4 . Without the aid of reference, given a description or list, identify preventive measures for
dehydration, within 80% accuracy, in accordance with the Pre-Hospital Trauma Life Support,
Current Military Edition. (8404-MED-2017d)
5 . Without the aid of reference, given a description or list, identify the treatment of
hyponatremia, within 80% accuracy, in accordance with the Pre-Hospital Trauma Life Support,
Current Military Edition. (8404-MED-2017e)

2-1
OVERVIEW
Water is the largest component of the human body, accounting for 45% to 70% of body
weight. It is a fundamental component of all cells and is used to carry out normal functions in
the body such as circulation of blood, respiration and elimination of waste. Water is the basis of
blood, lymphatic fluids, perspiration, mucous, saliva, and digestive juices. Water lubricates the
joints, moisturizes the skin, provides moisture to all of the muscles and internal organs and helps
regulate body temperature.
Excessive changes in the normal body water balance resulting from either
overconsumption of water or fluid loss alter homeostasis, producing specific signs and
symptoms. Dehydration is loss of water and important blood salts like potassium (K+) and
sodium (Na+). Vital organs such as the kidneys, brain and heart cannot function without a
minimum amount of water and salt. Acute dehydration can be a serious outcome of both heat
and cold exposure, but it is also seen as a dangerous side effect of diarrhea, vomiting and fever.

1. PREDISPOSING FACTORS
Key factors that contribute to dehydration include:
Alcohol consumption
Medications (especially for high blood pressure, colds or diarrhea)
Higher Body Mass Index/ Low level of physical fitness
Inadequate diet
Improper clothing
Medical Conditions (fevers, vomiting, diarrhea, heat rash or sunburn)
Age (Thermoregulatory capacity decreases with age)
Fatigue/lack of sleep
Lack of recent experience in a hot environment or improper acclimatization

2. SIGNS AND SYMPTOMS OF DEHYDRATION

Dehydration is divided into mild, moderate, and severe based upon its severity. With mild to
moderate levels of dehydration, individuals experience fatigue, headache, decreased heat
tolerance, cognitive deterioration, reduction in strength and aerobic physical capacity.

The following are the most common signs and symptoms of dehydration although each
individual may experience symptoms differently:

Less frequent urination and dark color urine

Thirst
Fatigue
Light-headedness
Headaches
Dizziness
Dry skin, decreased turgor (see figure 1)
Confusion Figure 1.
Dry mouth and mucous membranes
Increased heart rate and breathing

2-2
 Casualties experiencing severe dehydration may exhibit any of the previous signs and
symptoms along with:
Weak, rapid pulse
Cold hands or feet
Hypotension
Dysuria
Lethargy
Cyanotic lips

3. TREATMENT OF DEHYDRATION
Identify the cause and treat it. (i.e. vomiting/diarrhea)
Assess the level of dehydration based on signs or symptoms.
Re-hydrate the patient:
Oral re-hydration - drinking fluids usually relieves mild dehydration.
IV fluids - used for moderate to severe dehydration. We will discuss types of IV fluids
later in the course.

4. PREVENTIVE MEASURES FOR DEHYDRATION

A common finding in dehydration casualties is that the individuals consume no fluid or low
volumes of fluid during daily activities. We all lose body water daily through sweat, tears,
urine, water vapor exhaled through respirations and stool. During heat exposure, body water
is primarily lost as sweat. Individuals can sweat approximately 1 liter per hour. The key to
avoiding the onset of heat illness is to maintain a body fluid balance and to minimize
dehydration during daily activities. A key point to remember is that individuals normally do
not perceive thirst until a deficit of approximately 2% body weight loss has resulted from
sweating. So an individual weighing 200 pounds would not recognize being thirsty until he or
she has lost 4 pounds of sweat! The following are examples of some measures to prevent
dehydration:
Before activity - Drink extra fluid to produce urine output that is clear to straw color.
During activity - Take several fluid breaks per hour, drinking approximately 1 quart of
fluid per hour (do not exceed 12 canteens per day).
Maintain a balanced diet - You can recover fluid loss from the foods you eat as well as
from the fluids you drink. Fruits and vegetables can be a significant source of fluid intake.
MRE’s are formulated to provide the important electrolytes while in the field.
Avoid diuretic beverages - minimize consumption of alcohol, coffee, tea and carbonated
beverages with caffeine.
Educate troops - education of troops is the key to prevention. There are many myths
regarding hydration handed down from Marine to Marine. You need to stress that once troops
are properly acclimatized to hot conditions, it is necessary to continue to properly hydrate.
Hydration is a daily requirement. Just because they drank enough water yesterday does not

2-3
 decrease their need for today. Troops should not use salt tablets to assist with dehydration
unless directed to by a medical officer.

5. HYPONATREMIA
Exertional hyponatremia and water intoxication can occur when sodium and water loss in
sweat results in dehydration and sodium depletion. Low sodium concentration disturbs the
osmotic balance across the blood-brain barrier resulting in a rapid influx of water into the
brain, which in turn causes cerebral edema. As with similar signs and symptoms of
intracranial pressure (ICP) in head trauma, a progression of neurologic symptoms with
hyponatremia will occur, such as:
Headache
Malaise
Nausea
Confusion/mental status changes
Seizures
Coma
Permanent brain damage
Death
Hyponatremia is typically seen in individuals during prolonged activity in hot environments,
drinking water that exceeds sweat rate, failing to replace sodium loss from sweat. When
trying to prevent dehydration, the casualty overhydrates solely with water creating an over
dilution of sodium in the blood. Typically, these casualties have not consumed electrolyte
drinks or have consumed energy food supplements containing no salt or in quantities
insufficient to balance the loss of sodium in sweat.
Risk factors that may predispose a person to hyponatremia are:
Exercise duration of greater than 4 hours or slow running/exercise pace
Low body weight (especially females)
Overhydration
Nonsteroidal anti-inflammatory drugs
Extreme hot or cold environments
The first step in treatment is recognizing the disorder and determining the severity. Mild
symptoms should be managed by observing the patient and waiting for normal diuresis of
excess fluid. Symptomatic patients should be placed in an upright position to maintain their
airway and minimize any positional effect on ICP. Treatment of hyponatremia should only be
performed by a medical officer. If you suspect a casualty has hyponatremia, TACEVAC as
soon as possible.

2-4
 Prevention of hyponatremia can be accomplished by educating troops on the importance of
maintaining a proper balance of fluid and electrolytes in the field. MRE’s provide a proper
nutritional balance of sodium and electrolytes and should be consumed in their entirety
throughout training.

REFERENCE
Pre-hospital Trauma Life Support, Current Military Edition

2-5
 Dehydration Review

1. List predisposing factors for dehydration.

2. List signs and symptoms of dehydration.

3. Describe how to re-hydrate an individual.

4. Describe preventive measures for dehydration casualties.

5. Define hyponatremia.

2-6
 UNITED STATES MARINE CORPS
FIELD MEDICAL TRAINING BATTALION
BOX 555243
CAMP PENDLETON, CA 92055-5243

FMST 202
Manage Environmental Heat Injuries

TERMINAL LEARNING OBJECTIVES

1. Given a casualty in any environment, treat environmental heat injuries to reduce the risk of
further injury or death. (8404-MED-2013)

ENABLING LEARNING OBJECTIVES

1. Without the aid of reference, given a description or list, identify the predisposing factors
associated with heat injuries, within 80% accuracy, per the Prehospital Trauma Life Support,
Current Military Edition. (8404-MED-2013a)

2. Without the aid of reference, given a description or list, identify the proper treatments of
heat injuries, within 80% accuracy, per the Prehospital Trauma Life Support, Current Military
Edition. (8404-MED-2013b)

3. Without the aid of reference, given a description or list, identify the proper methods of
cooling the heat casualty, within 80% accuracy per the Prehospital Trauma Life Support,
Current Military Edition. (8404-MED-2013c)

4. Without the aid of reference, given a description or list, identify preventive measures for
heat injuries, within 80% accuracy, per the Prehospital Trauma Life Support, Current Military
Edition. (8404-MED-2013d)

2-7
OVERVIEW

High internal temperatures produce stress on the body, which, if not effectively
counterbalanced, may result in heat injury or death. Environmental as well as physiological
factors influence the body's thermal equilibrium mechanism. Heat injuries can occur
anywhere and at anytime of the year, depending upon physical activity and clothing worn.
However, heat injuries most frequently occur during warm weather training and operations
due to exposure to high temperatures, high humidity and sunlight. Sweating increases daily
water requirements as well as electrolyte replacement. Dehydration leads to added heat
stress, increased susceptibility to heat injury, reduced work performance and degraded
mission capability.

Body temperature is regulated by the thermoregulatory center in the hypothalamus. The

hypothalamus receives input from various thermal receptors located throughout the body.
From this input, it can then tell the body to either conserve body heat or increase heat
dissipation by increasing cardiac output, respiratory rate, vasodilatation and perspiration.
Normal body temperature range is usually 97.6 - 99.6F.

1. PREDISPOSING FACTORS ASSOCIATED WITH HEAT INJURIES

Chronic Conditions

Fitness and Body Mass Index - Low levels of physical fitness will reduce tolerance to
heat exposure. Being physically fit provides a cardiovascular reserve to maintain cardiac
output as needed to sustain thermoregulation.

Age - Thermoregulatory capacity and tolerance to heat diminish with age. However, this
state can be improved by maintaining a low body weight and high level of physical
fitness.

Medical Conditions - Medical conditions that can increase the risk for heat intolerance
and heat illness are diabetes mellitus, thyroid disorders and renal disease. Cardiovascular
disease and circulatory problems that increase cutaneous blood flow and circulatory
demand are aggravated by heat exposure.

Previous History of Heat Injury - Personnel who have a history of heat injury are highly
susceptible to repeated heat injury because the hypothalamus has been damaged. Even
after the patient recovers, the body may not repair the hypothalamus to its former
effectiveness, therefore, the patient will become more sensitive to heat stressors.

Skin Trauma - The skin is the largest organ of the body. It serves as a layer of protection,
controls the invasion of microorganisms, maintains fluid balance, and helps regulate
temperature. Personnel suffering from skin conditions that hamper the heat regulatory
mechanism (sunburn, heat rash, windburn, and dermatologic disease) have an increased
risk of heat related injuries.

2-8
 Medications - The use of specific prescription or
over-the-counter medications can place individuals at Increased Heat Production
a greater risk for heat illness (see figure 1). Certain Thyroid hormone
medications can increase metabolic heat production, Cyclic antidepressants
Hallucinogens (e.g. LSD)
suppress body cooling, reduce cardiac reserve, and Cocaine
alter renal electrolyte and fluid balance. Sedative and Amphetamines
narcotic drugs will affect mental status and can affect Decreased Thirst
logical reasoning and judgment, suppressing Haloperidol (anti-psychotic medication)
decision-making ability, when the individual is Angiotensin-converting enzyme (ACE)
inhibitors (BP medication)
exposed to heat. Decreased Sweating
Antihistamines (allergy medications)
Transient Conditions Anticholinergics
Beta blockers (BP medication)
Transient conditions include those affecting Increased Water Loss
individuals who travel from cooler climates and are Diuretics
not heat-acclimated to warmer climates. Other Alcohol
transient factors are common illnesses including Nicotine
colds, fever, vomiting and diarrhea, along with poor
Figure 1 Medication Risk Factors
dietary and fluid intake.
2. TYPES OF HEAT INJURIES

Heat Cramps – short-term, painful muscle contractions frequently seen in the calf muscles
but also in the voluntary muscles of the abdomen and extremities.

Cause – muscle fatigue, body water loss and large sodium loss. Commonly observed
following prolonged physical activity in warm to hot temperatures.

Signs and Symptoms

- Muscle cramps and tenderness

- The skin is usually moist, pale and warm
- Core temperature may be normal or slightly elevated
Treatment
- Rest in a cool environment
- Prolonged stretching of the affected muscles
- Consuming oral fluids and food containing sodium (sports drinks, electrolyte
pouches, salty snacks)

Heat Exhaustion - the most common heat-related disorder. A systemic reaction to

prolonged heat exposure (hours to days) and is caused by excessive heat strain with
inadequate water intake.

Cause – Results from cardiac output that is insufficient to support the increased
circulatory load caused by competing blood flow, reduced plasma volume and sweat-
induced depletion of salt and water.

2-9
 Signs and Symptoms - Any of the signs and symptoms of heat cramps may accompany
heat exhaustion along with:
- Frontal headache
- Decreased urine output
- Drowsiness
- Nausea
- Vomiting
- Light-headedness
- Anxiety
- Fatigue
- Irritability
- Decreased coordination
- Orthostatic hypotension
- Moist, pale, clammy skin
- Rectal temp usually below 104 F (temp not always a reliable finding)

Treatment

- Move to cooler location

- Loosen or remove clothing
- Assess vital signs
- Oral rehydration with electrolyte fluids is preferred
- IV fluids if patient is unable to consume liquids by mouth
- Active cooling by wetting head and torso with water and fanning
- Transport if patient is unconscious or does not recover rapidly

Heat Stroke - severe, life-threatening condition; a true medical emergency!

Cause - It is a total failure of the thermoregulatory mechanism, resulting in an excessive

rise in body temperature.

Signs and Symptoms - Heatstroke is characterized by an elevated core temperature of

104 F or greater and mental status changes such as confusion, disorientation,
combativeness or unconsciousness.

Classic Heatstroke - a disorder of children, the elderly and sick patients.

- Dry, hot, red skin

Exertional Heatstroke - typically seen in men age 15-45 with poor physical fitness or
lack of heat acclimation who are involved short-term, strenuous physical activity
during a hot humid environment.

- Sweat soaked and pale skin at the time of the collapse

2-10
 Treatment
- Remove patient from the source of heat
- Immediately begin cooling the patient
- Maintain ABC’s
- Give a 500 mL fluid challenge and reassess vital signs. Do not exceed 1-2 liters
within the first hour.
- Monitor core temperature every 5 to 10 minutes. Active cooling should stop when
the rectal temperature reaches 102.2 F.
- TACEVAC

3. METHODS OF COOLING THE BODY

Immersion
- Fastest method of cooling; uses conduction.
- Immerse the patient in a tub filled with ice water (usually not available in a field
environment).
- Requires constant monitoring of the patient during the procedure.
Direct Cooling
- Apply ice packs on head, trunk and extremities.
- Place ice water towels/sheets over the casualty.

Room Temperature Water Misting

- Remove excess clothing and wet the patient down from head to toe.
- Provide fanning of the skin causing evaporation and convective heat loss.
- Most effective method when cold water or ice is not available.
4. PREVENTIVE MEASURES FOR HEAT INJURIES

Education of Personnel

- Most important prevention measure.

Physical Conditioning and Health

- A person’s physical condition has been directly related to their susceptibility to heat
related incidents

Proper Water Intake

- During hot weather operations, sweating can cause loss of body water in excess of 1
liter per hour. Personnel must be educated on drinking liberal quantities of water.
- Water alone will not prevent an individual from becoming a heat casualty. Sodium and
potassium must be replaced along with water. Personnel must be educated that an
adequate diet (MRE's/Messhall) is essential for proper water/electrolyte balance. (See
lesson on Dehydration Casualties).

2-11
 Proper Acclimatization
- In some areas this may take from two to four weeks (3 weeks optimal)
- Gradual introduction of physical training program
Proper Clothing
- When situation permits, wear the least allowable amount of clothing
- Avoid skin exposure to direct sunlight (burned skin is less able to regulate body
temperature)
- Clothing should be loose fitting to permit air circulation, especially at the neck, arms,
waist and lower legs
Work Schedules

- Tailor work schedules to the situation with careful consideration to heat/humidity index,
acclimatization time, type of work and place.

5. HEAT CONDITION FLAG WARNING SYSTEM

Wet Bulb Globe Temperature (WBGT) Index - This index uses the combination of a dry
bulb for ambient temperature, wet bulb for humidity measurement, black globe for radiant
heat and air movement to provide a more accurate impact of the environmental conditions. It
is NOT the same as regular air temperatures. The WBGT can be monitored hourly and the
corresponding colored flag placed on a flagpole outdoors for all personnel to see. Where
appropriate, adjustments of clothing, physical activity, work/rest cycles and fluid intake can
then be made based on these conditions. (See figure 2)

Flag Warning System - Color-coded flags are used to help prevent heat casualties during
hot weather. These flags will be prominently displayed by all commands so that every one
can see them, particularly in areas where physical training takes place.

White Flag (78 F to 81.9 F) – Extremely intense physical exertion may precipitate heat
injuries therefore caution must be taken.

Green Flag (82 F to 84.9 F) - heavy exercises for unacclimatized personnel will be
conducted with caution and under constant supervision.

Yellow Flag (85 F to 87.9 F) - strenuous exercises, such as marching at standard

cadence, will be suspended for unacclimatized troops in their first 3 weeks. Outdoor
classes in the sun will be avoided.

Red Flag (88 F to 89.9 F) - all physical training will be halted for those troops who
have not become thoroughly acclimatized by at least 12 weeks of living and working in
the area. Those troops who are thoroughly acclimatized may carry on limited activity not
to exceed 6 hours per day.

Black Flag (90 F and above) - all nonessential strenuous physical activity will be halted
for all units.

2-12
 Easy Work Moderate Work Hard Work
 Walking Loose Sand at 2.5
mph, No Load

 Weapon Maintenance  Walking Hard Surface at 3.5

mph, <40 lb Load  Walking Hard Surface
 Walking Hard Surface at at 3.5 mph, > 40 lb
2.5 mph, <30 lb Load  Calisthenics Load

 Marksmanship Training  Patrolling  Walking Loose Sand at

2.5 mph with Load
 Drill and Ceremony  Individual Movement
Techniques, i.e., Low Crawl  Field Assaults
 Manual of Arms or High Crawl

 Defensive Position
Construction

Easy Work Moderate Work Hard Work

Heat WBGT Water Water Water
Category Index, Fº Work/Rest Work/Rest Work/Rest
Intake Intake Intake
(min) (min) (min)
(qt/hr) (qt/hr) (qt/hr)
1 78° - 81.9° NL ½ NL ¾ 40/20 min ¾
2 82° - 84.9° NL ½ 50/10 min ¾ 30/30 min 1
(GREEN)
3 85° - 87.9° NL ¾ 40/20 min ¾ 30/30 min 1
(YELLOW)
4 88° - 89.9° NL ¾ 30/30 min ¾ 20/40 min 1
(RED)
5 >90° 50/10 min 1 20/40 min 1 10/50 min 1
(BLACK)
 The work/rest times and fluid replacement volumes will sustain performance and hydration for at least 4 hrs
of work in the specified heat category. Fluid needs can vary based on individual differences (± ¼ qt/hr) and
exposure to full sun or full shade (± ¼ qt/hr).
 NL = no limit to work time per hr.
 Rest = minimal physical activity (sitting or standing) accomplished in shade if possible.
 CAUTION: Hourly fluid intake should not exceed 1½ qts. Daily fluid intake should not exceed 12 qts.
 If wearing body armor, add 5°F to WBGT index in humid climates.
 If doing Easy Work and wearing NBC (MOPP 4) clothing, add 10°F to WBGT index.
 If doing Moderate or Hard Work and wearing NBC (MOPP 4) clothing, add 20°F to WBGT index.

Figure 2 WGBT Index Chart

REFERENCES

Pre-hospital Trauma Life Support, Current Military Edition

2-13
 Heat Injuries Review

1. List two chronic and two transient predisposing factors associated with heat injuries.

2. List five signs or symptoms of heat exhaustion.

3. Identify the significant differences between heat stroke and heat exhaustion.

4. Name 3 ways to prevent heat injuries.

5. List and describe the three methods of cooling a patient suffering from a heat injury.

2-14
 UNITED STATES MARINE CORPS
FIELD MEDICAL TRAINING BATTALION
BOX 555243
CAMP PENDLETON, CA 92055-5243

FMST 203

Manage Environmental Cold Injuries

TERMINAL LEARNING OBJECTIVES

1. Given a casualty in an operational environment, treat environmental cold injuries reducing

the risk of further injury or death. (8404-MED-2014)

ENABLING LEARNING OBJECTIVES

1. Without the aid of reference, given a description or list, identify the risk factors associated
with cold injuries, within 80% accuracy, per the Prehospital Trauma Life Support, current
military edition. (8404-MED-2014a)

2. Without the aid of reference, given a description or list, identify proper management for
cold injuries, within 80% accuracy, per the Prehospital Trauma Life Support, current military
edition. (8404-MED-2014b)

3. Without the aid of reference and given a list of symptoms, identify the stages of
hypothermia, within 80% accuracy, per the Prehospital Trauma Life Support, current military
edition. (8404-MED-2014c)

4. Without the aid of reference, given a description or list, identify treatment for hypothermia,
per the Prehospital Trauma Life Support, current military edition. (8404-MED-2014d)

5. Without the aid of reference, given a description or list, identify preventive measures for
cold injuries, within 80% accuracy, per the Prehospital Trauma Life Support, current military
edition. (8404-MED-2014e)

2-15
OVERVIEW

Throughout history the most celebrated and extreme reports of cold related injuries have
been in the field of military endeavors. From Hannibal losing half of his 46,000-man army
crossing the Pyrenean Alps to frostbite and hypothermia, and the tens of thousands of cases
of trench foot during World War I, we have learned much. Mild to severe cold weather
conditions caused 13,970 unintentional hypothermia related deaths in the US between 1978
and 1998, with 6,857 of these deaths occurring in persons 65 years of age or older. When
adjusted for age, death from hypothermia occurred approximately 2.5 times more often in
men than women.

Cold injury is defined as tissue injury produced by exposure to cold. Cold itself is not the
only factor in determining whether injury will occur. Duration of exposure, humidity, wind,
altitude, clothing, medical conditions, behavior, and individual variability all contribute to
the injury. Cold injuries can occur at nonfreezing and freezing temperatures. Trench foot,
frostbite and hypothermia are the cold injuries of greatest military significance.

1. RISK FACTORS

Fatigue

Slow metabolic rate and inability to increase physical activity puts poorly conditioned
personnel at increased risk. Mental and physical fatigue may cause apathy, leading to
neglect of cold weather protection principles.

Age/Rank

Most cold injuries are suffered by military personnel from 17-25 years of age. The exact
reason is unknown although these troops are generally “front line” troops who experience
more exposure and are generally less experienced dealing with the cold. Decreased
incidence of cold injury among higher ranks is a reflection of a combination of
experience, less exposure and receptivity to training.

Nutrition

Poor nutrition or incomplete meals contribute to cold injury. During cold weather
operations, encourage personnel to eat well-balanced meals (Meals Ready to Eat (MRE)
or cold weather rations).

Discipline, Training, Experience

Well-trained and disciplined personnel are better able to care for themselves through
personal hygiene, care of the feet, changing clothing and other simple, effective
preventive measures. Personality and motivation are significant in determining
adaptability. In intense cold, such as -25° F, the mind, as well as the body, is adversely
affected. An individual becomes numb and indifferent to nonessential tasks. Essential
tasks require more time to complete and are more difficult to accomplish. Lack of cold
weather experience can greatly increase susceptibility.

2-16
 Race/Geographic Origin

Military studies suggest that dark-skinned individuals and those from warmer regions are
more susceptible to cold injuries. This relationship in race and cold is related to the
greater susceptibility of pigmented cells to freeze compared with non-pigmented cells.
However, with proper training and experience, a Sailor or Marine can compensate or
overcome this predisposition.

Dehydration

Dehydration occurs very easily in the cold, particularly with increased physical activity.
As with exposure to heat, adherence to proper fluid hydration while working in cold
environments is necessary to minimize dehydration and the associated physical fatigue
and cognitive changes. (See lesson on Dehydration Casualties)

Medication

Medications that cause vasoconstriction, increase urinary output or produce sweating

should be avoided.

Tobacco/Caffeine/Alcohol

Tobacco and caffeine products (tea/coffee) cause vasoconstriction and poor circulation.
Alcohol is a vasodilator, and because of its anesthetic effects, intoxicated subjects neither
feel the cold nor respond to it appropriately.

Environmental Factors

Weather and temperature are predominant factors that will modify the rate of body heat
loss. Freezing temperatures are not necessary for cold injury. Humidity affects the rate
of freezing and nonfreezing injuries. Precipitation and wind also greatly accelerate body
heat loss.

Activity

Too much or too little activity may cause or contribute to cold injuries. Over activity
creates large amounts of heat loss through rapid and deep breathing, and perspiration
trapped in clothing reduces its insulating value. Conversely, immobility causes decreased
heat production with resultant cooling in the extremities.

2. TYPES OF COLD INJURIES

Chilblains (Pernio)

Small skin lesions that are itchy, tender and appear as red or purple bumps which occur
on the extensor skin surface of the finger or any exposed skin surface (e.g. ears, face)
from chronic cold exposure.

2-17
 Cause - Cold causes constriction of the small arteries and veins in the skin and re-
warming results in leakage of blood into the tissues and swelling of the skin.

Symptoms
- Usually occur several hours after exposure to cold
- Appear as nodular plaques (patches on the skin)
- Intense pruritus (itching)
- Burning paresthesia (numbness)
Treatment
- Supportive in nature
- Gradually re-warm the exposed area at room temperature
- Wash and dry the affected area
- Apply a dry, soft sterile bandage
- Symptoms usually subside with elimination of cold
Solar Keratitis (Snow Blindness)
Cause - Ultraviolet burns to the skin and eyes from exposure to dry air or bright reflections
from the snow. Corneal burns can occur within an hour but do not become apparent for 6 to
12 hours.

Signs and Symptoms

- Excessive tearing
- Pain
- Redness
- Swollen eye lids
- Photophobia
- Headache
- Gritty sensation in the eyes
- Blurred vision

Treatment
- Prevent further ultraviolet exposure (sunglasses). If no sunglasses are available,
patch affected eye.
- Topical ophthalmic anesthetic drops to provide symptomatic relief.
- Oral analgesics (NSAIDS, but do not put local analgesics into the eyes)
- Do NOT put steroid medications into the eye.
- TACEVAC as the operational environment permits.
Frostbite: Defined as the actual freezing of tissue fluids in the skin and subcutaneous
tissues. Ice crystals form between and inside the cells with resulting tissue destruction. The
most susceptible body parts are those areas farthest from the body’s core, such as the hands,
fingers, feet, toes and male genitalia.

Cause - Tissue does not freeze at 32F because cells contain electrolytes that prevent
tissue from freezing until skin temperature reaches approximately 28F. When the tissue
does freeze, ice crystals form and causes damage to surrounding tissue.

2-18
Depending upon wind velocity and air temperature, the exposure time necessary to
produce frostbite varies from a few minutes to several hours.

Classification and Signs and Symptoms of Frostbite - frostbite is classified by depth of

injury and clinical presentation. The degree of cold injury, just like burn injuries, in
many cases will not be known for at least 24 to 72 hours. There are four degrees on
injury based on physical findings.

First-Degree frostbite - an epidermal injury limited to skin that has brief contact with
cold air or metal.
- Skin appears white or yellowish plaque at site of injury
- No blister or tissue loss
- Skin thaws quickly, feels numb and appears red with surrounding edema
- Healing occurs in 7 – 10 days

Second-Degree frostbite - involves all the epidermis and superficial dermis.

- Initially appears similar to first-degree however frozen tissues are deeper

- Tissue feels stiff to the touch, but gives way to pressure
- Thawing is rapid, results in superficial skin blister that has clear or milky
fluid after several hours
- Surrounded by erythema and edema
- No permanent loss of tissue
- Healing occurs in 3 to 4 weeks
Third-Degree frostbite - involves the epidermis and dermis layers.
- Frozen skin is stiff with restricted mobility
- After tissue thaws, skin swells leaving blood-filled blister, indicating vascular
trauma to deep tissue (hemorrhagic bulla)
- Skin loss occurs slowly leading to mummification and sloughing of tissue
- Healing is slow
Fourth-Degree frostbite – involves full thickness frozen tissue completely through
dermis with muscle and bone involvement.
- No mobility to frozen tissue and only passive movement when thawed
- Poor skin perfusion
- Blisters and edema do NOT develop; will see early signs of necrotic tissue
- Slow mummification process will occur along with sloughing of tissue and auto-
amputation of nonviable tissue.
Treatment (Superficial Frostbite) - Casualties with first and second-degree frostbite
should be placed with the affected area against a warm body surface, such as covering the
casualty’s ears with warm hands or placing affected fingers into armpits or groin region.

Treatment (Deep Frostbite) - Management of casualties with third and fourth-degree

frostbite includes:
- Move to warm shelter and provide supportive care

2-19
 - If prolonged transport (1-2 hours) thaw in warm water bath at a temp no greater
than 102°F. If re-freezing is a concern, do not thaw.
- Cover with loose, dry sterile dressing that is non-compressive and non-adherent
- Do NOT allow casualty to walk on affected feet
- Fingers and toes should be separated and protected with sterile cotton gauze
- Do NOT drain blisters in the field
- Provide pain meds as needed
- Start IV and give 250 mL bolus of warm saline to treat dehydration and reduce
blood viscosity
- Do NOT give alcohol or cigarettes because of their vasoconstrictive properties
- Do NOT use direct heat source greater than 102°F on the affected area
- Do NOT allow the thawed part to refreeze.
- TACEVAC ASAP

3. STAGES OF HYPOTHERMIA

Hypothermia

A condition in which the core body temperature is below 95°F. Hypothermia renders a
casualty unable to generate sufficient heat production to return to homeostasis.
Hypothermia can occur in environments with temperatures well above freezing.
Inadequate clothing and physical exhaustion contribute to the loss of body heat and the
development of hypothermia.

Hypothermia, acidosis, and coagulopathy constitute the “triad of death” in trauma

patients. The mortality in combat casualties with hypothermia is double that of
normothermic casualties with similar injuries. Hypothermia occurs regardless of the
ambient temperature; hypothermia can, and does, occur in both hot and cold climates.

Causes
- Prolonged exposure to cold and/or wet conditions
- Inadequate clothing/protection
- Dehydration and/or inadequate nutrition
- Poor physical condition; slow metabolic rate and inability to increase physical
activity puts the poorly conditioned at increased risk.
- Resuscitation with cold fluids or blood after traumatic injuries

Mild Hypothermia

Individual response to cold varies. In general, body temperatures above 93 to below 97
F constitute mild hypothermia. In this temperature range, the casualty is in an excitation
(responsive) stage. The casualty will be shivering and usually show signs of altered LOC
such as confusion, slurred speech, altered gait and clumsiness. The body will attempt to
retain and generate heat by increasing heart rate, blood pressure and cardiac output. The
respiratory rate will increase, which, in the long run, only cools the body more by
breathing in cold air and losing moisture through respirations.

2-20
 Shivering - body’s main mechanism to generate heat. Shivering increases the
metabolic rate by increasing muscle tension, which leads to repeated bouts of
muscular contraction and relaxation.

Moderate Hypothermia

Moderate hypothermia occurs when the core temperature is between 86 and 93 F. The
patient will probably not complain of feeling cold, shivering will be absent and the LOC
will be greatly decreased. Paradoxical undressing may be observed before the patient
loses consciousness. The patient in this stage is at risk for lethal cardiac dysrhythmias.

Severe Hypothermia
When the core temperature is below 86 F, the patient is in severe hypothermia. The
casualty will be unconscious with no response to pain. Vital signs will be barely
detectable or non-detectable. Without immediate and intensive treatment, this patient
will die!

4. TREATMENT OF HYPOTHERMIA

“A patient is not dead until they are warm and dead.” This phrase was created after
many patients survived prolonged hypothermic events and received CPR in the field. No
matter what your initial impression of the casualty in the field, do NOT withhold basic or
advanced life support until core temperature has returned to normal.

- Move casualty to a warm shelter to prevent further heat loss

- Remove wet clothing if situation allows
- Loosen or remove constrictive clothing
- Cover patient’s head and body with warm blankets or sleeping bags
- Administer warmed oxygen if available
- Warm water bath (water temperature between 100F and 108F)
- Hot, sweet drinks (if conscious)
- Monitor vital signs. Observe for cardiac abnormalities
- Monitor core temperature rectally
- Warm IV solutions (Pre-warm solution in warm water or between MRE heaters)
- TACEVAC

5. PREVENTION MEASURES

Education
- Education of troops and leaders is the number one preventive measure.
- Because of the difficulty, time and energy required to actively re-warm casualties,
significant attention should be paid to preventing hypothermia from occurring in the
first place.

2-21
 Activity Levels

- Activity should be maintained at a steady, constant rate.

- Quick bursts of activity and long periods of inactivity should be avoided.

Buddy System
- Train personnel to observe each other for symptoms.
- Train personnel to re-warm extremities (fingers/toes) by holding (not rubbing) their
buddy’s hands/feet.
Personal Measures

- The Marine Corps uses the acronym “COLD” to describe the cold weather protection
principles and preventive measures:

C - Keep clothing CLEAN and free of oil and dirt. Oily and dirty clothing quickly
loses its insulating effectiveness.

O - Avoid OVERHEATING. There are more heat exhaustion cases in a cold

environment because of overdressing for the type of work performed.
Overdressing and over-exertion cause an increase in body heat production and
decrease heat dissipation. As the body temperature increases, there is a
corresponding increase in perspiration, which causes saturation of clothes with
sweat. Both conditions lead to cold injuries.

L - LAYER correctly. Clothes should be loose to trap air between the layers, which
produces the insulating effect necessary for survival in the cold. Tight and
constricting clothing produces cold injuries. There can be as many as seven
layers of clothing used to protect personnel in a cold environment.

D - Keep clothing DRY. If clothing becomes wet so does the skin, which will
promote cooling and frostbite. Change wet clothing at the first opportunity.

REFERENCES

Pre-hospital Trauma Life Support, current military edition

2-22
 Cold Injuries Review

1. Explain the effect that age and rank have on an individual’s chance for developing
hypothermia.

2. Describe the symptoms for Chilblains.

3. List three signs or symptoms of Moderate Hypothermia.

4. Define the acronym C.O.L.D.

2-23
 UNITED STATES MARINE CORPS
FIELD MEDICAL TRAINING BATTALION
BOX 555243
CAMP PENDLETON, CA 92055-5243

FMST 204

Perform Care of the Feet

TERMINAL LEARNING OBJECTIVE

1. Given water and hygiene items, perform individual field hygiene to prevent injuries,
maintain health and preserve the fighting force to accomplish the mission. (HSS-MCCS-2024)

ENABLING LEARNING OBJECTIVE

1. Without the aid of reference, given a description or list, identify the anatomy of the foot,
within 80% accuracy, in accordance with FM 21-18 Foot Marches. (HSS-MCCS-2024e)

2. Without the aid of reference, given a description or list, identify common foot disorders,
within 80% accuracy, in accordance with FM 21-18 Foot Marches. (HSS-MCCS-2024f)

3. Without the aid of reference, given a description or list, identify preventive measures for
foot disorders, within 80% accuracy, in accordance with FM 21-18 Foot Marches. (HSS-
MCCS-2024g)

2-24
1. ANATOMY OF THE FOOT

The feet are flexible structures of bones, joints, muscles, and soft tissues that let us stand
upright and perform activities like walking, running, and jumping. The feet are divided into
three sections (see fig 1):
The forefoot contains the five toes (phalanges) and the five longer bones (metatarsals).
The midfoot is a pyramid-like collection of bones that form the arches of the feet. These
include the three cuneiform bones, the cuboid bone, and the navicular bone.
The hindfoot forms the heel and ankle. The talus bone supports the leg bones (tibia and
fibula), forming the ankle. The calcaneus (heel bone) is the largest bone in the foot.
Muscles, tendons, and ligaments run along the surfaces of the feet, allowing the complex
movements needed for motion and balance. The Achilles tendon connects the heel to the calf
muscle and is essential for running, jumping, and standing on the toes.

Figure 1. Anatomy of the Foot

Figure 1. Anatomy of the foot

2-25
2. TYPES OF COMMON FOOT DISORDERS

Blister - a blister is a defense mechanism of the body. When the epidermis layer of the skin
separates from the dermis, a pool of fluid collects between these layers while the skin re-
grows from underneath. Blisters can be caused by chemical or physical injury. An example
of chemical injury would be an allergic reaction. Physical injury can be caused by heat,
frostbite, or friction.
Causes
- Improperly conditioned feet
- Heat and moisture
- Improperly fitting boots and/or socks
- Friction and pressure
Signs and Symptoms
- Fluid collection under the skin
- Mild edema and erythema around the site
- Sloughing of tissue exposing sub dermal tissue layer
- Localized discomfort and/or pain
Treatment
Small blisters usually need no treatment
- Clean area with soap and water
- Monitor for signs and symptoms of infection
- Apply a protective barrier (moleskin bandage) around the blister, to prevent further
irritation
Closed, Large blisters (if affecting individuals gait)
- Wash the area around the blister with Betadine solution or alcohol pad
- Drain as close to the edge of the blister as possible to allow for drainage, and then
apply gentle pressure to the blister dome expelling the clear fluid
- Apply moleskin (donut) to skin surrounding the blister, using tincture of benzoin as
an adhesive.
- DO NOT PUT ANY ADHESIVE DIRECTLY ON THE BLISTER
- Dust entire foot with foot powder to lessen friction and prevent adhesive from
adhering to the socks
- Monitor for signs and symptoms of infection
Open blisters
- Wash with Betadine solution or clean with soap and water
- Remove any loose skin with a surgical blade or scissors
- Apply moleskin (donut) to cover skin surrounding the blister, using tincture of
benzoin as an adhesive.
- Place a small amount of antibiotic ointment over wound
- Cut a telfa pad and place over open blister
- Apply moleskin over entire treated area to include surrounding skin
- Monitor for signs and symptoms of infection

2-26
Athletes Foot (Tinea Pedis) - tinea pedis is a chronic fungal infection of the feet, often
referred to as athlete’s foot. Athlete’s foot is very common and usually begins in early
adulthood. Men are more often affected than women. Once affected, recurrences are
common.
Causes
- Hot humid weather, excessive sweating and occlusive footwear
- Contact with contaminated footwear and floors
- Poor foot hygiene
Signs and Symptoms
- Reddened, cracked and peeling skin
- Itching, burning and stinging sensation usually between the toes
- Sore, purulent, weeping rash
Treatment
- Apply anti-fungal foot powder daily during work hours – i.e. Miconazole
- Apply anti-fungal ointment daily during rest hours – i.e. Clotrimazole
- Treatment should be continued for 1 week after clearing has occurred
- If the patient fails to respond to treatment, refer patient to medical officer
Ingrown Toenails - an ingrown nail occurs when the nail border
or corner presses on the surrounding tissue. This condition is
painful and often results in an infection once the skin is broken
(see figure 2).
Causes
- The most common causes are improper trimming of
toenails and poor hygiene.
- Trauma to the nail plate or toe
- Improperly fitted footwear
- Abnormally shaped nail plate
Figure 2. Infected Ingrown Toenail
Signs and Symptoms
- Pain along the margin(s) of the toenail. The great toe is the most common toe
affected.
- Localized edema
- There may be signs of infection (drainage of pus, blood or watery discharge tinged
with blood)
Treatment
- Trim a small point off the corner of the nail to relieve the pressure. Remove any
dead skin that may have accumulated in the nail groove.
- Elevate the end of the nail to prevent further irritation of the soft tissue. Proper
trimming should correct ingrown toenail. If not…
- Surgically correct a chronic ingrown toenail at the BAS, by complete or partial
removal of toenail, under the supervision of a clinician.
- If there are signs of infection, antibiotics should be considered.

2-27
Corns and Calluses (see figure 3) - a callus
is a thickening of the outer layer of skin, in
response to pressure or friction that serves
as a protective mechanism to prevent skin
breakdown. A corn is similar to a callus
except it involves a discrete pressure spot,
typically over a bone, whereas a callus can
form anywhere.
Causes
- Tight fitting shoes, due to chronic
friction and sheering pressure
- Deformed and crooked toes Figure 3. Corns and Calluses
- Prolonged walking on a downward slope
Signs and Symptoms
- Thickened, dry skin over prominent bones (corn)
- Large patches of thickened, dry skin over friction areas from walking (calluses)
- Pain on direct pressure against the corn
- Skin breakdown and possible infection with continued irritation
Treatment
- Debridement of excessive buildup of skin
- Apply pads and devices to the toes to relieve pressure (mole skin, corn pads, etc.)
- Fix the cause (improperly fitted boots)
- In extreme cases, refer to a medical officer

Bunion (see figure 4) - a bunion is an enlargement at the 1st metatarsal head of the great toe,
which deviates laterally. Often there is no bump, but rather an angulation of the first
metatarsal that makes the head of this bone more prominent.
Causes
- A minor bone deformity, called hallux valgus, in which the joint at the base of the
big toe projects outward while forcing the tip of the toe to turn inward toward the
other toes. As a result of the pressure on the deformity, the surrounding tissue
thickens.
- This condition may be hereditary.
- Poorly fitted or excessively worn shoes.
Signs and Symptoms
- Thickened lump on the medial side of the
foot at the base of the great toe
- Erythema
- Pain near first metatarsal head
- Joint stiffness

Figure 4. Bunion (left)

2-28
 Treatment
- Wear comfortable, properly fitted shoes with plenty of room in the toe area
- Use of a special toe pad or corrective sock that straightens the big toe
- Non-steroidal, anti-inflammatory medications (NSAIDS)
- Orthotics
- In severe cases, surgery may be required

Plantar Fasciitis (see figure 5) - also known as heel spurs or heel bursitis. Plantar fasciitis is
one of the most common foot problems. The plantar fascia’s main function is to anchor the
plantar skin to the bone, thus protecting the longitudinal arch of the foot. The plantar fascia
is strained from overuse, causing pain along the sole of the foot, particularly where the fascia
connects to the heel.
Causes
- Overuse in the physically active or a sudden increase in the volume or intensity of
training
- Abnormal joint mechanics
- Tightness of the Achilles tendon
- Shoes with poor cushioning
- Abnormal foot anatomy
- Obesity
- Excess weight
- Improper shoes
- Bio-mechanical problems (mal-alignment of the heel)
Signs and Symptoms
- Tenderness along the medial fascia
- Constant pain that is worse in the morning upon rising or after physical activity
- Tearing and pulling sensation
- Altered gait
Treatment
- Stretching and strengthening exercises (lower leg muscles)
- RICE (Rest, Ice, Compression, Elevation)
- NSAIDS
- Heel and arch supports (orthotics)

Figure 5. Plantar Fasciitis

2-29
Plantar Warts (see figure 6) - warts that are
located on the sole of the foot are called
plantar warts. A plantar wart can be found as
a single lesion or grouped together. Most
common areas include the ball of the foot and
heel, where increased pressure and irritation is
common. Warts are often ignored until they
become painful.
Cause
- Caused by the Human Papilloma
Virus (HPV)
Signs and Symptoms
- Plantar warts have tiny dots in the center. These Figure 6. Plantar Wart
dots are often black from dried blood, due to
irritation. Small plantar corns are sometimes mistaken
for warts.
- Tenderness
Treatment
- Shave down callus over wart and apply salicylic acid paste (metaplast).
- Apply dressing to keep paste isolated over wart. Apply donut bandage to relieve
pressure.
- Leave paste in place for 3 days.
- Repeat treatment in one week.
- Refer to medical officer if no improvement.

Trench Foot/Immersion Foot (see figures 7a and 7b) - a

medical condition caused by prolonged exposure of the
feet to damp and cold. Trench Foot was given its
current name after it was found frequently among World
War I troops who had been confined for long periods in
trenches filled with standing water. Immersion foot
describes a more severe variant of trench foot usually
seen in downed pilots and shipwrecked Sailors.

Causes
- Prolonged exposure to wet and cold conditions
or outright immersion of feet in water at 32-
50° F
- Condition can occur on hands due to damp or
cold gloves

Figure 7a. Immersion (Trench) Foot

2-30
 Signs and Symptoms (EARLY)
- Initially foot is pale, mottled, numb, pulseless and immobile
- After rewarming, severe burning pain and
return of sensation
Signs and Symptoms (LATE 2-7days)
- Limb becomes hyperemic (increased amount
of blood flow, skin will be warm and red).
Numbness, edema, ulceration, and gangrene
may develop.
Treatment
- Treatment is supportive
- Keep feet clean, warm, dry, and bandaged
- Gentle rewarming
- Elevate affected extremity to reduce edema
- Consider antibiotics if there are signs of
infection
- Avoid wearing boots
- Do not drain blisters in the field
- Refer to medical officer
- TACEVAC severe cases Figure 7b. Immersion (Trench) Foot

Metatarsal Stress Fracture (see figure 8) - a stress fracture is an incomplete break in the bone
often seen in intense training programs around week four, when bone absorption exceeds
bone-building activity. The most common stress fracture in the foot, known in the military
as “March Fracture,” is the second and third metatarsals.
Causes
- Repetitive stress on a metatarsal due to malposition or abnormal foot structure or
mechanics (i.e. flatfoot)
- Increased levels of activity, especially without proper conditioning
- Obesity
Signs and Symptoms
- Edema in dorsum of foot
- Tenderness at the top of the foot during and after exercise
Treatment
- Treat as a fracture
- RICE
- NSAIDS
- Rest for two or three weeks until the pain is gone
- Slow return to activity to avoid recurring injury
- Refer to medical officer

Figure 8. Metatarsal Stress Fracture

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3. PREVENTIVE MEASURES
Improperly fitting boots and socks are common causes of foot problems such as blisters, corns
and calluses. Use the following preventive measures to educate and supervise personnel on
proper foot care and wear. Improper foot hygiene will also lead to foot disorders such as
ingrown toenail and athlete’s foot.
Before Marches
1. Carefully fit new boots.
2. Bring a pair of socks/orthotics you intend to wear with the boots to the store.
3. The toe box should be roomy enough so you can wiggle your toes.
4. The ball of your foot should rest on the widest part of the sole.
5. The forefoot should not be wider than the boot.
6. Determine the boot length; there should be a ½ inch between the end of the longest toe
and the end of the boot.
7. Socks should fit snugly on the foot without excess material over toes and the heel.
8. Trim toenails short and straight across.
During Marches
1. Keep feet clean and dry and use foot powder.
2. Wear clean, dry, unmended, well-fitting socks.
3. If a person wants to wear two pairs of socks, the outer pair should be ½ a size larger to
comfortably fit over the inner sock.
4. During halts, lie with feet elevated at rest points.
5. If time permits, massage the feet, apply foot powder, change socks and take care of
blisters.
6. Relieve swelling feet by slightly loosening the bootlaces where they cross the arch.
After Marches
1. EARLY ATTENTION IS ESSENTIAL!
2. Wash and dry feet.
3. Treat any blisters, abrasions, corns and calluses.
4. If red, swollen, tender skin develops along the edges of the foot, the foot requires
aeration, elevation, rest and wider foot wear.

REFERENCES
Foot Marches, FM 21-18
2-32
 Care of the Feet Review

1. Describe the appropriate treatment for large blisters.

2. Describe the difference between a corn and a callus.

3. List the signs and symptoms of plantar fasciitis.

4. “March Fracture” generally involves which two bones?

2-33
 UNITED STATES MARINE CORPS
FIELD MEDICAL TRAINING BATTALION
BOX 555243
CAMP PENDLETON, CA 92055-5243

FMST 205
Perform Water Purification for Individual Use

TERMINAL LEARNING OBJECTIVES

1. Given water and hygiene items, perform individual field hygiene to prevent injuries,
maintain health and preserve the fighting force to accomplish the mission. (HSS-MCCS-2024)
ENABLING LEARNING OBJECTIVES
1. Without the aid of reference, given a description or list, identify sources of water in a field
environment, within 80% accuracy, in accordance with NAVMED P-5010 Manual of Naval
Preventive Medicine. (HSS-MCCS-2024a)
2. Without the aid of reference, given a description or list, identify factors affecting sources of
water, within 80% accuracy, in accordance with NAVMED P-5010 Manual of Naval Preventive
Medicine. (HSS-MCCS-2024b)
3. Without the aid of reference, given a description or list, identify the procedures for water
purification for individual use, within 80% accuracy, in accordance with NAVMED P-5010
Manual of Naval Preventive Medicine. (HSS-MCCS-2024c)
4. Without the aid of reference, given a description or list, identify water testing requirements,
within 80% accuracy, in accordance with NAVMED P-5010 Manual of Naval Preventive
Medicine. (HSS-MCCS-2024d)

2-34
OVERVIEW
Safe water, in sufficient quantities, is essential. Insufficient quantity or quality of water is not
only debilitating to the individual but will have a significant impact on unit operational
readiness. Water that is not properly treated and disinfected can spread bacterial diseases such as
cholera, shigellosis, typhoid, and paratyphoid fever. Untreated water can also transmit viral
hepatitis, gastroenteritis and parasitic diseases such as amoebic dysentery, giardiasis and
schistosomiasis. All personnel must be familiar with and follow proper water discipline. This
includes drinking only water that has been properly treated, protected, and distributed. Every
individual is responsible for ensuring that potable water does not become contaminated from
careless or improper handling and being vigilant for the protection of a water supply from
intentional or unintentional attack.
1. WATER SOURCES AND CHARACTERISTICS
Water may be obtained from various sources in the field to include the following:
Salt Water is considered the best source of water, if accessible, due to the fact that it is
generally less contaminated than other sources and there is an unlimited supply. When
considering salt water, however, the water must be desalinated and disinfected before it is
used. This requires the use of a reverse osmosis water purification unit (ROWPU). Salt
water cannot be purified for individual use.
Ground Water is water procured from wells and springs. Ground water is generally less
susceptible to chemical and biological pollution than other sources and is considered the best
source of water during an NBC attack. The quantity and quality may be hard to determine
without proper equipment. Adequate disinfectant is required. Ground water may or may not
be used for individual use, depending on its accessibility.
Surface Water is water procured from lakes, rivers, streams, and ponds. Moving or large
bodies of water are generally considered less contaminated due to the aeration which
significantly decreases growth of bacteria, algae, and fungus. Of the sources of water,
surface water is the easiest to procure for individual use due to it being readily accessible.
Adequate disinfectant is required.
Rain Water is water procured from rain, snow, or ice. This source should only be used
when other sources of water are not available. It is not considered a reliable source due to
the fluctuation in annual rainfall which results in inadequate quantities. Adequate
disinfectant is required.
2. FACTORS AFFECTING SOURCES OF WATER
Water Quantity - the source should provide an adequate supply of potable water for all
personnel for the expected length of stay.
Water Quality - water source should be free of significant contamination such as sewage,
naturally occurring toxic elements and any NBC warfare agents. The water should not be
objectionable due to turbidity, color, odor, or taste. Ensure source is protected from possible
organic contamination by sewage fallout or runoff from latrines, showers, motor pools, etc.
Accessibility - the water source should be accessible and able to be treated with available
resources.

2-35
3. PROCEDURES FOR INDIVIDUAL WATER PURIFICATION
Types of Water Containers
Canteen - intended for individual use. Typical issued canteen is 1 quart but can also
come in a 2 quart size.
Jerry Can - 5 gallon container that must be labeled “Potable Water Only” if used for
drinking water since they have various uses.
Lyster Bag - 36 gallon hanging bag used for hand washing.
Water Bull - 400 gallon insulated mobile potable water container that provides easily
accessible water to troops.
Iodine tablets - intended to disinfect water contained in small containers such as canteens or
water jugs. The tablets are subject to deterioration in storage. They must be inspected for signs
of physical change before they are used; otherwise, they may not disinfect the water. Iodine
tablets that are completely yellow or brown, that stick together, or crumble easily are no
longer effective and must not be used. Iodine tablets in good condition will be solid and steel
gray in color. The procedures for disinfecting small quantities of water with these tablets are
as follows:
Water in canteens
(1) Fill the canteen with the cleanest, clearest water available.
(2) Add two iodine tablets to each 1-qt canteen full of water, or four tablets to 2-qt
canteens. Tincture of iodine, 2 percent, may be used in place of the tablets. Five drops of
the liquid are equivalent to one iodine tablet.
(3) Put the cap on the canteen. Shake the canteen to dissolve the tablets.
(4) Wait 5 min, loosen the cap slightly and tip the canteen over to allow leakage around
the canteen threads.
(5) Tighten the cap and wait an additional 25 min before drinking.
Personal hydration systems
(1) Use four iodine tablets for 70 to 72 ounce water reservoirs and six for 100 to 102
ounce reservoirs.
(2) Allow 30 min of contact time before drinking the water.
Chlorine bleach - Household bleach is normally a 5 percent chlorine solution.
(1) Add two drops of bleach per quart of water to be disinfected and let it stand for 30
min before drinking. If a dropper is not available, wet a cloth or stick with bleach and
allow it to drip into the water.
(2) Use four drops for a 70-oz reservoir, and six drops for the 100-oz reservoir. Mix the
added bleach in the reservoir water and let it stand for 30 min before drinking it.
Micropur - the next generation of chemical water treatment. It's safer than iodine tablets and
has no unpleasant taste. It is the only disinfectant system currently available that is effective
against Cryptosporidium and viruses.

2-36
 Water in canteens
(1) Fill the canteen with the cleanest, clearest water available.
(2) Add one tablet to 1-qt canteen full of water
(3) Put the cap on the canteen. Shake the canteen to dissolve the tablet.
(4) Wait 5 min, loosen the cap slightly and tip the canteen over to allow leakage around
the canteen threads.
(5) Allow 30 min of contact time before consuming for clear water; 4 hours for cold or
cloudy water.
Personal hydration systems
(1) Use two tablets for 70 to 72 ounce water reservoirs and three for 100- or 102-oz
reservoirs.
(2) Allow 30 min of contact time before consuming for clear water; 4 hours for cold or
cloudy water.
Boiling - this method should only be used in emergency situations and only with small
quantities of water, i.e. canteen cup. Bringing the water to a vigorous boil for five minutes
will kill pathogens such as Giardia and E. coli. This method does not provide for residual
disinfectant capabilities and should not be used to store large quantities of water.
4. WATER TESTING
Frequency
- All bulk water supplied to personnel for drinking must be tested daily for Free
Available Chlorine (FAC). FAC is the portion of the total chlorine remaining in
chlorinated water that will react chemically with undesirable or pathogenic organisms.
- Perform weekly bacteriological testing.
Procedure for daily testing
- Add 1 DPD #1 (Diethylphenyline Diamine) tablet to water sample.
- Shake gently until tablet is dissolved.
- Use color comparator to determine the FAC.
Range
- 2.0 -5.0 ppm FAC for field water supplies

REFERENCES
Manual of Naval Preventive Medicine, NAVMED P-5010
2-37
 Water Purification Review

1. List the three factors associated with selecting a water source.

2. Of the four sources of water, which is best suited for individual use?

3. What are the drawbacks to using boiling as a method of decontamination?

4. What is the total time needed to disinfect one standard canteen of water using iodine tablets?

2-38
 UNITED STATES MARINE CORPS
FIELD MEDICAL TRAINING BATTALION
BOX 555243
CAMP PENDLETON, CA 92055-5243

FMST 206

Supervise Field Waste Disposal

TERMINAL LEARNING OBJECTIVES

1. Given water and hygiene items, perform individual field hygiene to prevent injuries,
maintain health and preserve the fighting force to accomplish the mission. (HSS-MCCS-2024)
ENABLING LEARNING OBJECTIVES
1. Without the aid of reference, given a description or list, identify the four types of field
waste, within 80% accuracy, in accordance with NAVMED P-5010 Manual of Naval Preventive
Medicine. (HSS-MCCS-2024h)
2. Without the aid of reference, given a description or list, identify the guidelines for latrine
placement, within 80% accuracy, in accordance NAVMED P-5010 Manual of Naval Preventive
Medicine. (HSS-MCCS-2024i)
3. Without the aid of reference, given a description or list, identify the types of field sanitation
devices used for human waste disposal, within 80% accuracy, in accordance with NAVMED
P-5010 Manual of Naval Preventive Medicine. (HSS-MCCS-2024j)
4. Without the aid of reference, given a description or list, identify the types of field sanitation
devices used for liquid waste disposal, within 80% accuracy, in accordance with NAVMED P-
5010 Manual of Naval Preventive Medicine. (HSS-MCCS-2024k)
5. Without the aid of reference, given a description or list, identify the types of field sanitation
devices used for garbage disposal, within 80% accuracy, in accordance with NAVMED P-5010
Manual of Naval Preventive Medicine. (HSS-MCCS-2024l)
6. Without the aid of reference, given a description or list, identify the types of field sanitation
devices used for rubbish disposal, within 80% accuracy, in accordance with NAVMED P-5010
Manual of Naval Preventive Medicine. (HSS-MCCS-2024m)

2-39
OVERVIEW
Historically, in every conflict the US has been involved in, only 20% of all hospital admissions
have been from combat injuries. The other 80% have been from diseases not related to battle,
commonly referred to as Disease Non Battle Injury (DNBI). Excluded from these figures are
vast numbers of service members with decreased combat effectiveness due to DNBI not serious
enough for hospital admission. Preventive medicine measures are simple, common sense actions
that any service member can perform and every leader must know. The application of preventive
medicine measures can significantly reduce time lost due to DNBI. The intent of this lesson is
not to make you preventive medicine experts. You will have access to them through the
Environmental Preventive Medicine Units (EPMU) that deploy in times of war or conflict. This
class is to give you knowledge of the basic skills necessary to employ safe preventive medicine
practices for your Marines.

1. WASTE
Definition - all types of liquid and solid material excreted from the body as useless or
unnecessary as a result of living activities of humans or animals.
Types of Waste
Human waste (black water): Liquid waste containing human urine, fecal matter and
blood or body fluids.
Liquid Waste (Gray Water): Liquid waste containing water used for bathing or liquid
waste from kitchen operation.
Garbage: Any kind of non-liquid organic materials resulting from food service
operations.
Rubbish: Waste consisting of non-organic materials such as boxes, cans, paper, or
plastics.

2. GUIDELINES FOR LATRINE PLACEMENT

When determining the location for latrines, give consideration to protecting food and water
supplies from contamination as well as providing convenient accessibility.
- 100 feet from the nearest water source
- 100 yards from food service areas
- 50 feet from berthing areas

3. FIELD SANITATION DEVICES USED FOR HUMAN WASTE DISPOSAL

The devices for disposing human waste in the field vary with the tactical situation, length of
stay, soil conditions, water table, weather conditions, availability of material and
environmental regulations.

2-40
Cat Hole - used when troops are on the march, during short halts.
- Dug 12” in diameter and 12” deep
- Covered immediately after use

Straddle Trench (see figure 1) - used in temporary

bivouac sites for one to three days. Four trenches
required for 100 people.
- 1ft wide, 2 ½ ft deep, 4ft long
- Additional trenches will be 2 ft apart
- Wooden planks on sides for traction
- Each person covers their excreta after use

Figure 1 Straddle Trench

Burn Barrel Latrine (see figure 2) - the burn-barrel is a commonly used device for
human waste disposal in the field. Best employed in areas where the water table is high or
the ground does not permit digging. 8 seats required for 100 people.
- Encourage personnel to use other devices for urination since additional fuel is
needed to burn urine and feces.
- Enclosed building constructed of plywood or other suitable material
- Contains 2 or 4 seats over 55 gallon drums cut in half
- Prime each drum with 3 inches of diesel fuel
- Burn out when drums are 1/2 to 2/3 full
- 4 parts diesel to 1 part gasoline until contents are covered
- Bury ashes at a depth of 12”

Figure 2 Burn-Barrel Latrine

2-41
 Urine Soakage Pit (see fig 3) - temporary latrine
used is sandy soils. One pipe can accommodate 20
men.
- Dug 4 ft square by 4 ft deep
- Filled with large rocks, rubble, bricks, etc
- Insert 6 pipes of one inch diameter at an angle
- Ventilation shaft at ends
- Cover ends of each tube with a funnel and mesh
material
Figure 3 Urine Soakage Pit

Chemical Toilets - obtained as a contracted service. Requirements for chemical toilets:

- 1 to 15 personnel 1
- 16 to 35 personnel 2
- 36 to 55 personnel 3
- 56 to 80 personnel 4
- 61 to 110 personnel 5
- 111 to 150 personnel 6
- Over 150 Add 1 toilet for each additional 40 persons

4. FIELD SANITATION DEVICES USED FOR LIQUID WASTE DISPOSAL

Liquid waste disposal methods are primarily designed to maximize the evaporation of the
waste. Using items such as rocks increases the surface area and allows the waste to dissipate
quickly. Liquid kitchen or bathing waste disposal methods include:
Soakage pits - are constructed identical to the urine soakage pit (without tubes). One pit
can accommodate 200 men.
Evaporation beds - are used in hot dry climates and are constructed in mounds and
ridges.

5. FIELD SANITATION DEVICES FOR GARBAGE DISPOSAL

Every individual generates some type of garbage. The bigger the unit, the bigger the
problem! It is important that you are able to make appropriate recommendations to the unit
commander regarding the disposal of solid waste. The tactical situation must also be
considered.
Garbage pit - the preferred method of garbage disposal for short overnight stops. A
standard four feet by four feet pit will service 100 people per day.
Garbage trench - for longer stays, a garbage trench is used. The trench measures two
feet wide by four feet deep and is extended as needed.

2-42
6. FIELD SANITATION DEVICES FOR RUBBISH DISPOSAL
Methods for rubbish disposal vary depending on the field situation. When tactical reasons do
not permit the rubbish to be hauled off to a disposal site, the following methods can be used:
Garbage pit - for short stay rubbish is buried in pits with the garbage, taking care to
flatten cans and break down boxes.
Incineration - in camps where the length of stay is expected to be over a week, rubbish is
burned and the ash buried. Barrel incinerators are commonly used and must be at least
50 yards and downwind from the camp.

REFERENCES
Manual of Naval Preventive Medicine, NAVMED P-5010
Field Hygiene and Sanitation, MCRP 4-11.1

2-43
 Field Waste Review

1. Describe the four types of waste.

2. How far should latrines be place away from the

nearest water source
food service areas
berthing areas

3. Describe a burn-barrel latrine.

4. What are the two devices used for liquid waste disposal?

5. Describe a garbage pit.

6. Give three requirements when using incinerators.

2-44
 UNITED STATES MARINE CORPS
FIELD MEDICAL TRAINING BATTALION
BOX 555243
CAMP PENDLETON, CA 92055-5243

FMST 207

Manage Envenomation Injuries

TERMINAL LEARNING OBJECTIVES

1. Given a casualty in any environment, treat envenomation injuries to reduce the risk of
further injury or death. (8404-MED-2015)

ENABLING LEARNING OBJECTIVES

1. Without the aid of reference, given a description or list, identify common definitions
associated with envenomation injuries, within 80% accuracy, in accordance with FM 4-25.11
First Aid. (8404-MED-2015a)

2. Without the aid of reference, given a description or list, identify types of venomous snakes,
within 80% accuracy, in accordance with FM 4-25.11 First Aid. (8404-MED-2015b)

3. Without the aid of reference, given a description or list, identify the proper treatment of
venomous bites, within 80% accuracy, in accordance with FM 4-25.11 First Aid. (8404-MED-
2015c)

4. Without the aid of reference, given a description or list, identify the management of
arthropod envenomation, within 80% accuracy, in accordance with FM 4-25.11 First Aid.
(8404-MED-2015d)

5. Without the aid of reference, given a description or list, identify the treatment for
anaphylactic shock, within 80% accuracy, in accordance with FM 4-25.11 First Aid. (8404-
MED-2015e)

2-45
1. DEFINITIONS

Envenomation - an injury or illness caused by the poisonous secretion of an animal, such as

a snake, spider or scorpion, usually transmitted by a bite or sting.

Hemotoxin - toxin that destroys red blood cells, disrupts blood clotting, can severely damage
internal organs and causes tissue degeneration.

Neurotoxin - toxin that damages, destroys or impairs nerve tissue and disrupts the brain
function.

Cytotoxin - typically attacks only a specific type of cell, muscle group or organ.

2. TYPES OF VENOMOUS SNAKES

Snake venom affects the human body in a number of ways, depending on the snake, the type
of venom, and how much venom is released. Different snakes produce different types of
venom, and even within a snake species, the components of venom appear to vary, depending
on geographic location. This is why it is important to be able to identify the snake species
involved when one is bitten.

Crotalinae Subfamily

The Crotalinae, commonly known as Pit Vipers, are a subfamily of venomous vipers found in
Asia and the Americas. They are distinguished by the presence of a heat-sensing pit organ
located between the eye and the nostril on either side of the head. The pit is a highly
sensitive organ capable of picking up the slightest
temperature variance.

Venom

- Hemotoxic

Characteristics (see figure 1)

- Retractable fangs

- Heat sensing pit located below the nostril

- Large triangular shaped head

- Slit-like pupils

Examples

- Rattlesnakes (U.S. through Central and South

America) Figure 1. Pit Viper Anatomy

- Saw-Scaled Viper (Pakistan, throughout the Middle East to Africa)

- Water Moccasin (Southern and eastern US)

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 - Copperhead (Eastern U. S.)

- Habu (Southeast Asia, including Okinawa)

Signs and Symptoms

- Symptoms vary depending on the type of snake and the amount of venom deposited

- Excruciating pain at the bite site

- Discoloration and tissue swelling usually begins five to ten minutes after the bite and
may continue for up to an hour with enough severity to break the skin

- Destruction of blood cells and other tissue cells, may present as hematuria

- Tingling or numbness

- Headache

- Nausea/vomiting

- Death may occur within 6-48 hours if left untreated. Even with treatment, there is the
possibility of loss of affected extremity.

Colubrinae Subfamily

The Colubrinae are a subfamily of the largest family of snakes, which includes about two-
thirds of all snakes worldwide. Most are completely harmless to man; the Boomslang is the
only one that has caused human deaths.

Venom

- Hemotoxic

Characteristics (see figure 2)

- Fixed fangs in rear of mouth

- Egg-shaped head

- Large eyes

Figure 2. Boomslang

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 Signs and Symptoms

- Symptons may not manifest until hours after the bite

- Hemmorrhaging to the gums, nose or other orifices

- Headache

- Nausea

- Blood in the stool, urine or saliva

- Death due to internal bleeding

Example

- Boomslang (Sub-Saharran Africa)

Elapinae Subfamily

Members of this family are found in the tropical and subtropical regions of the world and are
represented on every continent with the exception of Antartica.

Venom

- Neurotoxic

Characteristics

- Front, fixed, hollow fangs

- Round pupils

- Head width is proportionate to body size

Signs and Symptoms

- Stiffness, muscle aches, and spasms

- Severe headache, blurred vision, and drowsiness

- Moderate to severe pain to the affected limb

- Nausea, vomiting, and diarrhea

- Chills with rapid onset of fever

- Respiratory paralysis and death

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 Examples

- Coral Snakes (Southern US, through South America, and parts of Asia) see figure 3.

- Cobra (South Asia through Middle East and North Africa) see figure 4.

- Krait (South Asia, including Pakistan) see figure 5.

Figure 3. Coral Snake Figure 4. Cobra Figure 5. Krait

Hydrophiinae Subfamily. Also known as sea snakes, this group of venomous snakes
inhabit marine environments (see figure 6). Though they evolved from terrestrial ancestors,
most are extensively adapted to a fully aquatic life and are unable to move on land. They are
found in warm coastal waters from the Indian Ocean to the Pacific.

Venom

- Neurotoxic

Characteristics

- Fixed fangs

- Flat paddle-like tail Figure 6. Sea Snake

- Most are brightly colored

Signs and Symptoms

- Since both Elapinae and Hydrophiinae secrete neurotoxins, their signs and symptoms
are mostly similar.
- Bites are usually painless and may not even be noticed when contact is made. Teeth
may remain in the wound.

- There is usually little or no swelling.

- The most important symptoms are rhabdomyolysis (rapid breakdown of skeletal muscle
tissue) and paralysis. Early symptoms include:

- Headache

- Thick-feeling tongue

- Thirst

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 - Sweating

- Vomiting

- Symptoms that can occur after 30 minutes to several hours post-bite include:

- Generalized aching

- Stiffness and tenderness of muscles all over the body.

- Paralysis of voluntary muscles. Paralysis of muscles involved in swallowing and

respiration can be fatal.

- After 6 to 12 hours the result of muscle breakdown can lead to cardiac arrest.

3. TREATMENT OF A SNAKE BITE

Diagnosing a Snake Bite

- Fang Marks may be present as one or more well defined punctures, or as a series of
small lacerations or scratches, or there may not be any noticeable or obvious markings
where the bite occurred. The absence of fang marks does not exclude the possibility of
envenomation, especially if a juvenile snake is involved.

- Rattlesnake envenomation - fang marks are invariably present and are generally seen on
close examination. Bleeding may persist from the fang wounds. The presence of fang
marks does not always indicate envenomation; rattlesnakes, when striking in defense,
will frequently elect not to inject venom with the bite, resulting in a “dry bite.”
Younger rattlesnakes tend to dispense all of their venom, as opposed to a larger, older
rattlesnake dispensing either none or a small amount.

- Snake venoms are complex chemical mixtures of proteins, which have mostly
enzymatic properties. Some snake venom may include elements that produce both a
hemotoxic and neurotoxic effect. The quantity, lethality and composition vary with the
species and the age of the snake, the geographic location and the time of the year.
Venom is highly stable and is resistant to temperature changes, drying, and drugs.

Manifestations of signs and symptoms of envenomation are necessary to

confirm diagnosis of a snake venom poisoning.

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Treatment

- Most definitive care for envenomation is anti-venom.

- Keep the victim calm and reassured. If possible, allow the limb to rest in a neutral
position level with the victim’s heart.

- Locate the bite site. If the bite is on the hands or feet, immediately remove any rings,
bracelets, watches or any constricting items from the extremity.

- If the bite is on an arm or leg, place a constricting band above and below the bite (see
figure 7). If the bite is on the hand or foot, place a single band above the wrist or ankle.
The band should be tight enough to stop the flow of blood near the skin, but not tight
enough to interfere with circulation.

- Apply a splint and check distal pulses.

- Monitor and TACEVAC.

Things You Should Not Do: Figure 7 Constricting Band

- DO NOT cut or incise the bite site.

- DO NOT apply ice or heat to the bite site.

- DO NOT apply oral (mouth) suction.

- DO NOT remove dressings/elastic wraps.

- DO NOT try to kill snake for identification as this may lead to others being bitten.

- DO NOT have the victim eat or drink anything.

Prevention of Snake Bites

- LEAVE THE SNAKE ALONE!! This is the best way to avoid a snakebite.

- Most snakes will only bite if threatened. Most snake bites occur when the victim is
attempting to catch, kill or play with a snake.

- Keep hands out of areas that you cannot see (i.e. holes, under rocks and under logs).

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4. ARTHROPOD ENVENOMATION

An arthropod is an invertebrate animal having an exoskeleton, a segmented body and jointed

appendages. Arthropods include insects, arachnids and crustaceans. The arthropod body
plan consists of repeated segments, each with a pair of appendages. They are so versatile that
they have become the most species-rich members of all ecological guilds in most
environments. They have over a million described species, making up more than 80% of all
described living animal species.

Common Wasp and Bees - primary effect is from the strong histamine reaction they
cause. Honey bees only sting once and leave the stingers and venom sac embedded in the
skin. Wasps, hornets and bumble bees can sting multiple times.

Signs and Symptoms

- Pain

- Itching/burning sensation

- Wheal (raised, inflamed skin)

- If patient is allergic, monitor for anaphylactic reaction

Treatment

- Stingers should be removed immediately to prevent more venom from entering the
victim. Remove the stinger by scraping across the skin with a knife blade or similar
object. Do NOT use tweezers to grasp stinger, this only injects the remaining venom
into the victim.

- Apply ice to the affected area

- Apply Hydrocortisone Cream 1% to affected area BID (twice a day)

- Monitor for Anaphalaxis

Ants - some species of ants, especially the fire ant, can bite
repeatedly (see figure 8). Some also have stingers at the tip of
their abdomen.

Signs and Symptoms

- Pain

- Itching/burning sensation

- Vesicles on skin Figure 8. Fire Ant Bites

2-52
 - Multiple bites can produce the following signs and symptoms:
- Vomiting
- Diarrhea
- Generalized edema
- Hypotension due to vasodilation

Treatment

- Apply ice to the affected area

- Apply Hydrocortisone Cream 1% to affected area BID (twice a day)

- Monitor for anaphylaxis

Millipedes - some millipedes secrete a toxin on their skin, other

large species can squirt secretions from distances up to 32
inches (see figure 9). They secrete their toxin as a defensive
mechanism.

Signs and Symptoms

Figure 9. Millipede
- Dermatitis (itching and burning) that begins with a brown stain on the skin.

- Secretions in the eye can cause immediate pain, lacrimation and blurry vision.

Treatment

- Wash skin with soap and water to remove secretions.

- If toxin is secreted in the eyes, irrigate with water or saline; an ophthalmologic

evaluation is mandatory.

- Monitor for anaphylaxis

Centipedes - any centipede whose fangs can penetrate

human skin can cause local envenomation. Contrary to
popular folklore, centipedes do not inject venom with
their feet or head. Their injury is caused by a bite (see
figure 10).

Signs and Symptoms

- Burning pain, tenderness

- Erythema (redness)
Figure 10. Centipede
- Local swelling

- Superficial necrosis and ulceration may sometimes occur

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 Treatment

- NSAIDS

- Infiltrate area with lidocaine or other anesthetic

- Monitor for anaphylaxis

Caterpillars - venomous caterpillars have venom in hollow hairs all over their bodies
(see figure 11). Their venom is purely defensive.

Signs and Symptoms

- Dermatitis (severe burning, pain)

- Erythema and edema

- Conjunctivitis

- Necrosis Figure 11. Caterpillar

Treatment

- Use scotch tape to remove hairs from skin.

- Do not rub area

- Monitor for anaphylaxis

Black Widow Spider - glossy black with a red hourglass on

the underside of the abdomen. Only the bite of the female is
poisonous but all have a red hourglass pattern on the abdomen
(see figure 12).

Venom

- Neurotoxic

Signs and Symptoms Figure 12. Black Widow Spider

- Initial pain is not severe, but severe local pain rapidly develops

- Pain gradually spreads over the entire body and settles in the abdomen and legs

- Weakness

- Sweating

- Excessive salivation

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 - Rash may occur

- Tremors

- Nausea/vomiting

- Respiratory muscle weakness combined with pain may lead to respiratory arrest

- Anaphylactic reactions can occur but are rare

- Symptoms usually regress after several hours and are usually gone in a few days

Treatment

- Clean site with soap and water

- Intermittent ice for 30 minutes each hour

- Supportive care and antibiotics if needed

Brown Recluse Spider - they are small, light brown and have a dark brown violin design
on the top of their thorax (see figure 13).

Venom

- Hemotoxic

- Cytotoxic

Signs and Symptoms

- Painless bite. Most often, the victim does not know they have been bitten.

- A painful red area with a cyanotic center appears after a few hours. If prompt
treatment is not initiated, and sometimes in spite of, tissue damage can occur. The
following represents the aftermath of a Brown Recluse Spider bite (see figure 14).

Figure 13. Brown Recluse Spider

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 A B C

D E F
Figure 14. (From top left to right in order). A) Day three after initial spider bite. B) Notice swelling and erythemia
indicating infection. C) Extreme erythemia and underlying tissue damage. D) Day 6, after antibiotic treatment. E)
After incision and draining. F) Day 10, the wound looks as bad as it will look. Although it will be months before it is
completely healed. Only time will tell if any permanent damage to the skin, muscles, or nerves.

Treatment

- Cold compresses intermittently

- Provide supportive care as necessary

- Refer to Medical Officer as it is necessary to excise all the indurated (hardened) skin
and fascia before healing will begin

- Tetanus prophylaxis and antibiotics are necessary to control secondary infection

- Anaphylactic reactions may occur

Scorpions - Scorpions are predatory arthropod animals that have eight legs and are easily
recognized by the pair of grasping claws and the narrow, segmented tail, often carried in a
characteristic forward curve over the back, ending with a venomous stinger. Scorpions
range in size from 9 mm to 21 cm and are found widely distributed over all continents.
Scorpions number about 1,752 described species. Scorpion venom has a fearsome
reputation and about 25 species are known to have venom capable of killing a human
being.

2-56
Venom

- Neurotoxic

Signs and Symptoms

- Erythema and edema Figure 15. Scorpion

- Local pain and/or parasthesia (an abnormal touch sensation such as burning or
prickling often in the absence of external stimulus) at site of sting.

- Cranial nerve dysfunction - blurred vision, wandering eye movements,

hypersalivation, trouble swallowing, tongue twitching/spasms, problems with upper
airway, and slurred speech.

- Somatic skeletal neuromuscular dysfunction - jerking of extremity(ies), restlessness,

and severe involuntary shaking that may be mistaken for a siezure.

Treatment

- Based on the level of envenomation

- Ice applied to the site for 30 minutes each hour until symptoms subside

- Oral analgesics

- Monitor for anaphylaxis

Prevention of Arthropod Envenomation

- Leave them alone

- Avoid nesting sites and hives

- Personnel with known allergies should carry an Epi-pen or Ana-kit

- Shake out sleeping bags and clothing and check boots before putting them on.

- Wear shoes

- Many scorpions inhabit brush and debris piles in search of prey. If you come in
contact with this type of material, it is wise to wear gloves.

- Remove wood and rubbish piles around camp

- Cracks and recesses in rural desert dwellings should be filled

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5. ANAPHYLACTIC SHOCK

Definition - life threatening reaction to an allergen. This reaction may have a rapid and
severe onset. Without immediate emergency medical care, the patient may die.

Causes - exposure to an allergen that causes

hypersensitivity reaction. Such exposure can be POINT TO REMEMBER:
introduced to the body by the following: Anaphylactic Shock is NOT just
caused by insect stings. It may
- Injections (tetanus antitoxin, penicillin) also be caused by the other
reasons!
- Stings (honeybee, wasp, yellow jacket, hornet)

- Ingestion (medications and foods such as shellfish, chocolate, peanuts,etc.)

- Inhalation (dusts, pollen)

- Absorption (certain chemicals)

Signs and Symptoms

All signs & symptoms get progressively worse:

- Skin (Itching, redness and hives)

- Respiratory depression

- Sense of fullness in the throat, anxiety, chest tightness, shortness of breath and
lightheadedness

- Decreased level of consciousness (LOC), respiratory distress and circulatory collapse

- In general, signs and symptoms begin within 60 minutes of exposure to an allergen.

One-half of anaphylactic deaths occur within the first hour. The faster the onset of
symptoms, the more severe the reaction.

Treatment

- Maintain ABC’s

- Diphenhydramine Hydrochloride (Benadryl), a single injection of 25-50mg IM, used for

skin allergies, urticaria and other mild anaphylactic reactions to allergens.

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 - Epinephrine Injection - the most valuable drug for the emergency treatment of severe
allergic reactions such as asthma attacks characterized by wheezing, dyspnea and inability
to breathe. Other symptoms may include bronchoconstriction, sneezing, hoarseness,
urticaria, erythema and pruritis.

- Epi-pen autoinjector delivers a single dose of 0.3 mg epinephrine IM

- Repeat in five minutes if no improvement

- Fluid Resuscitation

- Documentation of the amount of medications and the times they were given is necessary
in order to prevent an overdose of medication.

- TACEVAC

REFERENCES
FM 4-25.11 First Aid

2-59
 Envenomation Review

1. Describe the difference between a hemotoxin and a neurotoxin.

2. Identify three characteristics of Pit Vipers.

1)

2)

3)

3. Name four signs or symptoms of an Elapinae bite.

1)

2)

3)

4)

4. What is the most definitive care for a venomous snake bite?

2-60
5. Describe the treatment for a bee/wasp sting.

6. List three signs or symptoms of scorpion envenomation.

1)

2)

3)

7. What are the two medications used to treat anaphylaxis? Which is the most valuable for
severe reactions?

1)

2)

2-61
 Preventive Medicine
Review Questions

NOTE: The following questions are offered for review purposes. This is NOT intended as
a sole source of test preparation. Remember all test questions are based on an ELO and
any ELO can be used to create a test question.
1. A chronic fungal infection of the feet would be known as what?
2. What are the most common causes of ingrown toenails?
3. What are the characteristics and examples of the Elapinae family of snakes?
4. What are the four types of waste?
5. What are the causes of blisters?
6. What causes exertional hyponatremia?
7. What are the stages of hypothermia?
8. What are the common causes of dehydration?
9. What are the physiological (host) predisposing factors associated with heat injuries?
10. What is the normal range of the body's temperature?
11. What are the predisposing factors of cold injuries?
12. What is the total time needed to disinfect a canteen using iodine tablets?
13. What are the characteristics and examples of the Colubrinae family of snakes?
14. What is the primary device for human waste disposal in the field?
15. What are the four sources of water?
16. Muscle cramps and tenderness in the extremities and abdomen, moist, pale, and warm skin,
and a normal or slightly elevated core temperature are signs and symptoms of what?
17. What is the maximum amount of fluids you should drink per day?
18. What is plantar fasciitis?
19. Which heat injury is a severe, life-threatening condition; a true medical emergency?
20. What are the environmental factors that contribute to cold injuries?
21. What are the two methods of water disinfection?
22. What are the characteristics of the Hydrophinnae family of snakes?
23. What are the signs and symptoms of Black Widow spider bites?
24. Why are cat holes immediately covered after use?
25. What are the three classification levels of dehydration?
26. What are the causes of heat exhaustion?
27. What is the most important prevention measure for managing heat injuries?
28. Where does Chilblains (Pernio) usually occur?
29. What does the acronym COLD stand for?

2 - 62
 Preventive Medicine
Review Questions
30. What is the cause of Immersion foot (Trench foot)?
31. What are the four colored flags of the heat condition flag warning system?
32. What are the characteristics and examples of the Crotalinae family of snakes?
33. When treating snake bites, what are the common DON'Ts?
34. What causes anaphylactic shock?
35. What type of bee/wasp can only sting once and why?

2 - 63
 MARINE CORPS
FUNDAMENTALS
 MARINE CORPS FUNDAMENTALS

Field Communication 3-1

FMST 301

Five Paragraph Order 3-15

FMST 302

Individual Movement Techniques 3-23

FMST 303

Patrolling 3-30
FMST 304

Land Navigation 3-54

FMST 305

Improvised Explosive Devises (IED) 3-68

FMST 306

M50 Field Protective Mask 3-83

FMST 307

Don Mission-Oriented Protective Posture (MOPP) Gear 3-103

FMST 307a

Manage Chemical Agent Casualties 3-109

FMST 308

Manage Biological Agent Casualties 3-119

FMST 309

Manage Radiological Agent Casualties 3-127

FMST 310

Review Questions 3-134

 UNITED STATES MARINE CORPS
FIELD MEDICAL TRAINING BATTALION
BOX 555243
CAMP PENDLETON, CA 92055-5243

FMST 301

Field Communications

TERMINAL LEARNING OBJECTIVE.

1. Given a SL-3 complete VHF radio with a fill, a frequency or net ID, and a distant station,
while wearing a fighting load, operate a VHF field radio to establish communication with the
distant station. (HSS-MCCS-2015)
ENABLING LEARNING OBJECTIVES
1. Without the aid of reference, and in writing, identify the nomenclature of the VHF field
radio, within 80% accuracy, per MCRP 3-40-3_ Multi-Service Communications Procedures.
(HSS-MCCS-2015b)

2. Without the aid of reference, and in writing, identify the components of the VHF field
radio, within 80% accuracy, per MCRP 3-40-3_ Multi-Service Communications Procedures.
(HSS-MCCS-2015a)

3. Without the aid of reference and given a list, identify VHF radio assembly procedures
without error, per MCRP 3-40-3_ Multi-Service Communications Procedures. (HSS-MCCS-
2015c)

4. Without the aid of reference and given a list, identify proper phonetic terms within 80%
accuracy and per MCRP 3-40-3_ Multi-Service Communications Procedures. (HSS-MCCS-
2015d)

5. Without the aid of reference and in writing, identify the control functionality of the VHF
radio controls in order to transmit field communications per MCRP 3-40-3_ Multi-Service
Communications Procedures. (HSS-MCCS-2015e)

6. Without the aid of reference and given a list of steps, sequence the procedures to load
single channel frequencies on a VHF field radio without any errors, per MCRP 3-40-3_ Multi-
Service Communications Procedures. (HSS-MCCS-2015f)

7. Without the aid of reference and given a list, identify trouble shooting procedures to
reestablish field communications per TM 11-5820-890-10-6. (HSS-MCCS-2015g)

3-1
1. NOMENCLATURE OF THE SINCGARS (AN/PRC-119A) The Single Channel Ground
& Airborne Radio Systems (SINCGARS). This radio is in a family of VHF-FM combat net
radios designed to provide the primary means of command and control for combat, combat
service, and combat service support units.
Single Channel (SC) Mode – When using the single channel mode of operation, the radio
communicates using a single frequency. For the SINCGARS radio, this single channel can
be selected by use of the Receiver-Transmitter keyboard (like a telephone keypad). The
advantage of SINCGARS is that eight (8) individual single channel frequencies can be
loaded into the radio, and the operator can select any one of those channels by flipping a
switch.
Frequency Hopping (FH) Mode – Another method of secure transmissions is using the
SINCGARS in the FH mode. This mode reduces the enemy’s capability to jam your traffic
or to use direction-finding equipment to establish your location. When properly loaded
with data, the SINCGARS hops (cycles) through more than 100 frequencies per second
during transmissions in the FH mode. When communicating in the FH mode, the
communicating stations must be on the same net. This means that they both must be
operating on the same time (clock) and have the same data loaded and on the same hop-set
(channel). Up to six (6) channels can be loaded for FH operations at any given time.
Remote Operations – The SINCGARS radio can be operated by the use of remote
equipment

Retransmission – The radio is capable of conducting retransmission operations in

conjunction with other radios. Because of the SINCGARS capabilities (SC and FH) the
retransmit function allows a wider use of retransmitting functions than with older radios.
Frequency Range – The SINCGARS operates in the VHF range from 30.000 to 87.975
MHz.
Range – One of the features of the SINCGARS radio is the operator’s ability to select the
power output of the radio by use of a selector switch. This feature allows you to reduce your
electronic footprint by operating in a lower power or to reach far away stations using a higher
setting. The switch has four positions: LO, M, HI, and PA. The maximum transmission ranges
for each of the settings is as follows:
(1) LO (low power) – 200 to 400 meters
(2) M (medium power) – 400 meters to 5 kilometers
(3) HI (high power) – 5 kilometers to 10 kilometers
(4) PA (power amplifier) – 10 kilometers to 40 kilometers.
Only vehicle-mounted radios equipped with a power amplifier can utilize this setting. Manpack
and vehicle radios not equipped with the power amplifier can only use settings LO, M, and HI.
When using the SINCGARS radio, the operator should always attempt communication with the
lowest setting first, thereby reducing the radios electronic signature. Once communication is
established, the operator should maintain the lowest possible setting. PA should only be used
when necessary to achieve communication.

3-2
2. COMPONENTS OF THE MANPACK CONFIGURATION (AN/PRC-119A)
The Manpack configuration is made up of the following components: (Figure 1)
1. Receiver-Transmitter (RT) – This is the common item of all of the configurations. The
RT is actually the SINCGARS radio itself
2. Handset- This is used for transmitting voice communication. The handset looks the same
as the handsets you may have worked with operating other radios.
3. Manpack Antenna- The antenna radiates/receives the signals.
4. Battery Box – The battery box connects to the bottom of the RT and provides housing for
the battery that powers the RT in the Manpack configuration.
5. Battery – Connects to a fitting in the battery box and supplies primary power to the RT
for operation.
6. Field Pack – The pack carries the RT and the components.

ANTENNA

HANDSET

BATTERY
BATT BOX

RT + FIELD PACK
Figure 1 Components

3. ASSEMBLY OF THE AN/PRC-119 (Figures 2-3) Visually inspect battery box for dirt and
damage. If the battery has been previously used, note battery life if it is written on the battery.
a. Stand RT on front panel guards, place battery box on RT and secure it to latches
b. Place battery in battery box and mate connectors
c. Close battery box cover and secure latches
d. Return radio in upright position

3-3
 e. If used battery was installed, enter the battery life condition into the radio by
performing the following
(1) Set FCTN to LD
(2) Press BATT then CLR
(3) Enter number recorded on side of battery
(4) Press STO
(5) Set FCTN switch to SQ ON
f. Screw whip antenna into base, only hand tighten

g. Carefully mate antenna base with RT antenna connector. Make sure you line up the
grooves and only hand tightened. It is important not to tighten by other means.

h. Attach handset by lining up red dots and then pressing and turning clockwise.

Figure 2 Figure 3

4. PHONETIC TERMS. The phonetic alphabet identifies spoken letters through a set of easily
understood words. Each of these words begins with the letter being identified. The phonetic
alphabet is used to:

A: ALPHA D: DELTA G: GOLF J: JULIET M: MIKE

B: BRAVO E: ECHO H: HOTEL K: KILO N: NOVEMBER

C: CHARLIE F: FOXTROT I: INDIA L: LIMA

3-4
 O: OSCAR R: ROMEO U: UNIFORM X: X-RAY

P: PAPA S: SIERRA V: VICTOR Y: YANKEE

Q: QUEBEC T: TANGO W: WHISKEY Z: ZULU

Transmit isolated letters such as E5K, which is transmitted ECHO-FIFE-KILO.

a. Transmit each letter of an abbreviation such as ITB, which is transmitted INDIA-TANGO-

BRAVO.

b. Spell unusual or difficult words such as HOSE, which is transmitted HOTEL-OSCAR-

SIERRA-ECHO.

c. The following list depicts the pronunciation of each letter in the phonetic alphabet:

Phonetic Numerals. The specific pronunciation of numerals has been determined in order to
avoid misinterpreted transmissions. The following are the pronunciations of the phonetic
numerals 0 through 9:

0: ZE-RO 3: TREE 6: SIX 9: NINER

1: WUN 4: FOW-ER 7: SEV-EN
2: TOO 5: FIFE 8: ATE

Procedure Words (Pro Words). Procedure words are pronounceable words or phrases, which
have been assigned a meaning for the purpose of expediting message handling over radios or
field telephones. Understanding the following PROWORDS and their respective definitions is
the key to clear and concise communication procedures.

This Is: This transmission is from the station whose designation immediately follows.

Over: This is the end of my transmission to you, and a response is necessary. Go ahead and
transmit.

Out: This is the end of my transmission to you and no answer is required or expected. Since the
phrases OVER and OUT have opposite meanings, they are never used together.

Roger: I have received your last transmission satisfactorily and understand it.

Wilco: I have received your last transmission and will comply. Since the meaning of ROGER is
included in that of WILCO, these two prowords are never used together.

Say Again: I did not receive or understand your last transmission, repeat all of your last
transmission, or use with ALL AFTER or ALL BEFORE. Do not substitute SAY AGAIN for
REPEAT, which is a proword specific to call for fire.

3-5
Say Again: I am repeating the transmission or portion indicated.

All After: The portion of the message to which I have referred is all that which follows
_____________________.

All Before: The portion of the message to which I have referred is all that which precedes
____________________.

Wait Over: I must pause for a few seconds.

Wait Out: I must pause for longer than a few seconds. I will call you back.

Read Back: Repeat this entire transmission back to me.

I Read Back: The following is my response to your instruction to read back.

Correction: I have made an error in this transmission. Transmission will continue with the last
word correctly sent.

Radio Check: I want a response indicating the strength and readability of my transmission.

(1) A response of ROGER indicates transmission is loud and clear.

(2) A response of WEAK BUT READABLE indicates a weak signal but I can understand.

(3) A response of WEAK AND GARBLED indicates a weak signal and unreadable.

(4) A response of STRONG BUT GARBLED indicates a strong signal but unreadable.

5. FUNCTIONALITY OF THE AN/PRC-119 CONTROLS

Although the SINCGARS radio demands more of the operator than turning the radio on, operator
tasks primarily involve entering data using the keyboard, turning knobs and following
instructions from the net control station. In order to operate the radio, the operator needs to
understand terminology of the radio so that when he receives instructions over the radio, he can
follow them. Additionally, the primary function of each control will aid the operator in
achieving a properly functioning radio.
NOTE: Anytime the operator moves a switch to a setting with a box around the letters, the knob
must first be pulled before it is turned. This feature ensures that the knob is not accidentally
moved to the position.

3-6
Receiver-Transmitter (RT) - Most of the controls that the operator will use are placed on the
face of the RT.(See fig. 4)

(1) FCTN (function) Switch – The function switch sets the RT function. The
function switch has four operating positions (SQ ON, SQ OFF, REM and RXMT) and five other
positions (STBY, TST, LD, Z-FH and OFF). The function of each position is as follows:
(a) SQ ON (squelch on) – This turns on the RT and the squelch. This
feature will prevent the rushing noise from being heard in the handset/helmet. This is the normal
operating position for the SINCGARS radio.
(b) SQ OFF (squelch off) – This turns on the RT but not the squelch.
This position is used when communicating in the SC mode with radios having a different squelch
system.
(c) REM (remote) – This position actually disables all of the RTs front
panel controls and allows the remote device used with the radio to have complete access to the
controls.
(d) RXMT (retransmit) – This position is used when the radio is
operating in the retransmit mode.

ANT CHAN 2 3 AUD/FILL

1 4 HUB COMSEC
MAN 5 SIG LOW TD
CUE 6 HI CT RV
MODE
FH LO PT Z
M HI SC FH-M
LO PA
RF PWR CMSC * SYNC
FREQ HUB
1 2 3
VOL
SQ DATA ERF WHSP
ON OFF 4 5 6 OFST AUD/DATA
LD RXMT CHG LOUT
TST REM 7 8 9 TIME

STBY Z-FH LOAD BATT

RXMT OFF CLR
0
STO
CALL
FCTN

NOTE: PULL TO TURN

Figure 4. Face of Receiver Transmitter

(e) STBY (stand by) - The STBY position will cut the primary
(battery/vehicle) power to the RT. The RTs battery (hub battery) will maintain the memory of
the radio including frequencies and times. This position is used as an alternative to OFF when
the operator is concerned about conserving power during non-operating periods, but wants to
retain all of the data loaded for operations occurring in the near future (same day).
(f) TST (test) - When this position is selected, the RT conducts a self-
test of its internal circuits. At the completion of the test, the radio will display results.
Whenever the radio is put into operation, the operator should conduct a self-test.
(g) LD (load) - Putting the radio in this position allows the operator to
load frequencies, data and COMSEC into the radio. In order to load any of this information into

3-7
the radio for use, the operator must ensure that LD is positioned so the radio will receive the
input.
(h) Z-FH (zero-FH) - Placing the function switch in this position and
waiting five (5) seconds will clear all of the frequency hopping (FH) data within the radio.
(i) OFF - Turns off all of the power to the RT. When the radio is in
the OFF position for more than five (5) seconds, the memory is completely cleared. This switch
is used when it is the operator’s intent to take the radio completely out of action.

Mode Switch - Sets the receiver-transmitter mode. The mode switch has three (3) settings that
allow the operator to select the mode of operation.
(1) SC (single channel) - Placing the mode switch in this position places the
RT in the single channel mode of operation.
(2) FH (frequency hopping) - This position allows the operator to use the RT
in the FH mode.
(3) FH-M (frequency hopping master) - This setting places the RT in
frequency hopping master mode. This mode is used only by the net control station (NCS). The
NCS is basically the foundation of a FH net. If more than one station use the FH-M mode, then
communication can be lost. Operators do not use this position.

COMSEC Switch - Sets the RT to the COMSEC mode. This switch has five (5) settings that allow the operator
to use or manage COMSEC data.
(1) PT (plain text) - Placing the switch at this setting places the RT in the
plain text, not a secure, mode of transmission.
(2) CT (cipher text) - This setting allows the operator to use cipher, secure,
transmissions when placed to this position.
(3) TD (time delay) - Places the RT in secure mode. This setting is used when
necessary to compensate for transmission delays due to the distance between communication
links. This setting is also used when operating some data devices with the SINCGARS in order
to compensate for the data rate differences.
(4) RV (receive variable) - This setting is used when receiving remote fill of
the COMSEC key.
(5) Z (zero) - Used to clear the COMSEC fills. When turned to Z, the fills in
channel 1-5 are instantly cleared. After 5 seconds in the Z position, the key in channel 6 is
cleared.

CHAN (channel) Switch - Selects manual, preset and cue frequencies. Operating this switch
allows the operator access to any of the frequencies loaded into the channels. This switch is the
means that the operator changes frequencies that are preset.

3-8
 (1) MAN (manual) - This position selects the loaded manual frequency. The
manual frequency is used during FH operations and will be discussed later.
(2) CUE - This setting selects the loaded CUE frequency. This frequency is
also used in FH operations and will be discussed later.
(3) 1 through 6. These are the channels that may be loaded with operating
frequencies or hopsets. COMSECs are also loaded into these channels.

RF Switch - Adjusts power level of transmissions. As earlier discussed, the SINCGARS has a
variable power output. This is the switch that enables the operator to change the power output of
the radio.

SIG (signal) Display - Shows appropriate signal strength. The signal display is contained in the
left hand part of the LED (Light emitting diode) display. There is a bar that lights from LO to HI
adjacent to the letters. The RF switch setting determines the signal output that is displayed on
the SIG display.

HUB/LOW (Hold Up Battery) Display - Indicates the power level of the HUB battery. The
hub battery is the source of energy for the stand by mode. This indicator notifies the operator
when the HUB battery is low, empty or missing. A diamond shape symbol will flash if the HUB
battery is weak. If the diamond shaped symbol appears as a steady light, the battery is extremely
weak or missing.

DIM Control- Adjusts display brightness. The knob is turned clockwise to brighten the display
and counterclockwise to dim the display.
VOL/WHSP (volume/whisper) control - Adjusts audio volume. Clockwise increases volume,
counterclockwise to decrease volume. Pulling the knob out allows the operator to receive as
normal, but give the operator the additional feature of being able to talk very softly and still
transmit.

Keyboard Display - Displays keyboard information and other data to the operator. A variety of
information is displayed in response to keyboard functions and operation of the radio.
Keyboard - Used for entering, holding and checking data. By using the knobs and the keyboard
in conjunction, the operator is able to complete all functions required when operating the radio.
The keyboard is laid out similar to a telephone keypad. Some of the keys have dual functions.

(1) FREQ (frequency) Button - This button is used to check the data entered
in the RT. Additionally, this button is used to load and clear the frequencies.
(2) ERF (electronic remote fill) Button - Used only by the NCS (net control
station) to transmit fills to other stations.
(3) OFST (offset) Button - This button is used during SC operations when it
becomes necessary to offset SC frequencies.

3-9
 (4) TIME Button - This button is used by the NCS to load and check the FH
time clock. A requirement of operating an FH net is that all stations have the same time set. The
NCS is responsible for this, and the time button is one of the NCS tools.
(5) BATT (battery) Button - This button is used with the Manpack
configuration to check the battery life of the primary battery. This button, when pressed, will
show the life remaining on the battery.
(6) CALL Button - The call button is used to communicate with the remote
when running remote operations.
(7) STO (store) Button - This button is used for data loading. Pushing this
button when required transfer data from the holding (temporary) memory to the permanent
memory. When loading ERF data this button is used.
(8) LOAD Button - This button will load information into the holding
memory and retrieve information from the permanent memory into the holding memory.
(9) CLR (clear) Button - Clears data from the keyboard display if a mistake
was made.
(10) LOUT (lockout) Button - Used by the NCS when managing an FH net.
(11) CHG (change) Button - This button is used in conjunction with other
buttons in order to change data when required.
(12) SYNC (late entry) Button - During FH operations, this button is used
when performing late entry procedures.
(13) DATA Button - The SINCGARS radio can operate in the data mode
where this button selects the data rate. During this period of instruction, we will only discuss the
voice mode of operation.
(14) CMSC (COMSEC) Button - Pressing this button causes the COMSEC
key to be displayed.
(15) Number Buttons - Used to enter numerical data such as SC frequencies,
and channel numbers.
AUD/FILL (audio/fill) Connector - Connects to fill devices or handsets. When loading FH
data or COMSEC data, the fill device is hooked to this connector via cable. Handsets can be
attached to this connector as necessary.
AUD/DATA (audio/data) Connector - Connects to external data devices during data operations
and handsets during normal operations.
ANT (antenna) connector - Connects to the manpack antenna or vehicle antenna cable. If the
RT is to be functioning with PA, the antenna connector connects the RT to the PA. The PA will
connect to the antenna.
RXMT (retransmit) Connector - Connects to another RT during retransmit operations.

3-10
6. LOADING SINGLE CHANNEL FREQUENCIES ON THE SINCGARS RADIO
The most basic of SINCGARS operation is operating the radio in the single channel (SC) mode.
When operating in the SC mode, the user is using the radio to communicate on a single
frequency. The procedures for loading SC frequencies require setting the proper switches,
pressing the correct number keys and storing the information in the channel desired. As
discussed earlier, the SINCGARS radio is capable of accepting up to 8 single channel
frequencies. Those frequencies are loaded in the manual, cue and 1 through 6 channels. The
procedures for loading frequencies into the channels are identical with the exception of which
channel is selected during the procedure. The first channel we will load is the manual channel.
TURNING ON THE RT (Receiver-Transmitter)

(1) Place mode switch to SC

(2) Place RF power switch to desired level

(3) Place channel switch to MAN

(4) Place COMSEC switch to CT

(5) Place volume switch to desired level

(6) Move FCTN switch to TST, complete test by following instructions on display
window. When test is complete move FCTN switch to either STBY or SQ ON.
Loading SC Frequencies - Following are the procedures for loading single channel frequencies.
The procedures are to be performed in order. In order to load additional channels with
frequencies, go to step (3), change to the desired channel and repeat steps (4) through (8).
Continue repeating those steps for each new channel desired.
(1) Set COMSEC switch to (P.T.) Plain Text prior to load.
(2) Set the function switch to load - The load setting allows the operator to
input data to the radio.
(3) Set the mode switch to single channel (SC) - When loading single channel
frequencies, the setting is appropriately set on SC.
(4) Set channel switch to desired channel - This step is different for each
channel loaded. This setting will change the manual frequency. Turn the channel switch to the
desired channel to change other frequencies.
(5) Press FREQ (frequency) button on keypad - This procedure displays the
current frequency of the channel selected, or "00000" if there is not a frequency currently entered
into the channel.
(6) Press the CLR (clear) button - After pressing the FREQ button and
displaying the current frequency, pressing the CLR button will clear that frequency and display
five lines "_ _ _ _ _". At this point, the radio is ready to accept frequencies.

3-11
 (7) Enter the numbers of the new (desired) frequency - Using the keypad, the
display will show each number replacing a line as you enter the number. If you make a mistake,
push the CLR button and the five blank lines will reappear. An important note is that if there is
no keyboard action for 7 seconds, the display will go blank, and you will have to reenter the
numbers.
(8) Press the STO (store) button- The display will blink and the frequency you
just entered is moved to the permanent memory in the channel selected.
(9) Set function switch to SQ ON or OFF (squelch on) - Placing the radio in
SQ ON puts the radio into the normal SC operating position. Now the operator can call another
channel using the handset.
Transmitting with the SINCGARS radio - When the push-to-talk button is activated (handset
or helmet), the operator talks, and the radio transmit in the voice mode. The radio will transmit
on the frequency that is entered into the channel that is selected on the channel switch.
Transmissions should be no longer than 3 to 5 seconds.
(1) Changing Channels - In order to transmit on a different frequency, the
operator simply moves the channel switch to the channel containing the desired frequency. Each
time that the channel switch is turned to a new channel, the frequency entered into that channel is
displayed for the operator's reference.
Clearing Single Channels - When the radio is turned OFF for more than 5 seconds, the memory
is cleared. If the operator desires to clear a SC of a frequency without turning the radio OFF,
thus clearing all channels, the following procedures are used
(1) Set the MODE switch to SC
(2) Set the CHAN switch to the channel to be cleared. The frequency will be
displayed allowing the operator to confirm that the frequency is to be cleared.
(3) Press the FREQ button
(4) Press the CLR button. The display will show five blank lines.
(5) Press the LOAD button, the press the STO button.
(6) Pressing STO will enter NO, or a cleared, frequency into the RT.

7. TROUBLESHOOTING THE AN/PRC-119 CONTROLES

The troubleshooting tables found in TM11-5820-890-10-6 Pg’s. 58-74 allow you to check out
common malfunctions of your equipment. The table lists the common malfunctions which you
may find during the operation or maintenance of the radio, or its components. You should
perform the tests/inspections and corrective actions in the order listed. This outline cannot list all
malfunctions that may occur, or all the tests, inspections and corrective actions. If a malfunction
is not listed, or is not corrected by listed corrective actions, notify your supervisor.

3-12
REFERENCES
MCRP 3-40-3
TM11-5820-890-10-6

3-13
 Field Communication Review

1. What does it mean when the squelch is switched to the “on” position?

1. What happens to the memory in a SINCGARS if it is turned off for more than 5 seconds?

2. Define the term “over” as it relates to Field Communication.

3. Provide the phonetic term for the following letters:

G-
O-

R-
E-
D-

S-
O-
X-

3-14
 UNITED STATES MARINE CORPS
FIELD MEDICAL TRAINING BATTALION
BOX 555243
CAMP PENDLETON, CA 92055-5243

FMST 302

Five Paragraph Order

TERMINAL LEARNING OBJECTIVE

1. Given an operational environment and a Commander's order, utilize operation orders to

provide adequate medical support for the mission. (8404-HSS-2001)

ENABLING LEARNING OBJECTIVE(S)

1. Without the aid of reference, given a description or list, identify the components of a five
paragraph order, within 80% accuracy, in accordance with MCWP 3-11.2 Marine Rifle Squad.
(8404-HSS-2001a)

2. Without the aid of reference, given a description or list, identify the components of a
warning order, within 80% accuracy, in accordance with MCWP 3-11.2 Marine Rifle Squad.
(8404-HSS-2001b)

3. Without the aid of reference, given a description or list, identify the components of a
fragmentary order, within 80% accuracy, in accordance with MCWP 3-11.2 Marine Rifle
Squad. (8404-HSS-2001c)

3-15
1. FIVE PARAGRAPH ORDER

a. Orders generally adhere to the five paragraph format though each will differ due to time
and information available or required.

b. Order Writing Process – The development of the combat order within BAMCIS begins at
the receipt of the mission. It does not end with combat, but continues throughout and after the
fight in anticipation of the next mission. It includes the techniques by which orders and
instructions are organized, sequenced, and transmitted from leaders to subordinates. The combat
order is a continuing process with accomplishment of the mission as its main goal. There are
many types of orders, however we will discuss the three basic types of orders.

(1) BAMCIS – Six (6) troop leading steps by which a leader receives, plans, and executes
his mission. Troop leading steps are a logical and orderly process for making the best use of
time, facilities, and personnel in preparing for and executing an assigned mission. It can be
viewed as elements of planning and decision making cycle.

(a) Begin Planning

(b) Arrange for Reconnaissance and Coordination

(c) Make Reconnaissance

(d) Complete Plan

(e) Issue Order

(f) Supervise

c. FIVE PARAGRAPH ORDER FORMAT

The purpose of the five-paragraph order is to issue an order in a clear and concise manner by a
thorough orientation of the area of operations. A five-paragraph order gives subordinates the
essential information needed to carry out the operation. The order converts the leader’s plan into
action, gives direction to the efforts of his unit, and provides specific instructions to subordinate
elements. At the rifle company level and below, orders are most commonly issued orally with
the aid of a terrain model.

(1) SMEAC The acronym used for the five-paragraph order format.

(a) Orientation - Prior to issuing an order, the unit leader orients his subordinate leaders
to the planned area of operation using a terrain model, map, or when possible, the area of
operation. Keep the orientation simple and brief.

(b) Situation - The situation paragraph contains information on the overall status and
disposition of both friendly and enemy forces. The situation paragraph contains three
subparagraphs.

3-16
 1. Enemy Forces - This subparagraph contains essential information concerning the
enemy’s composition, disposition, and strength based on its size, activity, location, unit, time,
and equipment. While focusing on enemy forces there are two (2) acronyms that will assist you
with the information you must recall.

a. SALUTE This acronym is an established method to remember how and what to

report about the enemy. The purpose of SALUTE is to focus thinking about identifying and
locating enemy weaknesses that can be exploited.

(1) Size – Enemy squad, platoon...

(2) Activity – Enemy digging in, bivouacking

(3) Location – Six-digit grid if possible

(4) Unit – Type and designation

(5) Time – When the enemy was last observed

(6) Equipment – Equipment they possess

b. DRAW-D - This acronym use to assist the leader in determining the enemy’s
capabilities and limitations.

(1) Defend

(2) Reinforce

(3) Attack

(4) Withdraw

(5) Delay

2. Friendly Forces - Contains essential information concerning the mission of the next
higher unit, location and mission of adjacent units, and mission of non-organic supporting units.
Information in this subparagraph can be remembered with the acronym HAS:

a. Higher

b. Adjacent

c. Supporting

d. Attachments and Detachments - Units attached or detached from a squad by

higher headquarters, including the effective time of attachment or detachment.

3-17
 (b) Mission - Provides a clear and concise statement of what the unit must accomplish.
The mission statement is the heart of the order and should answer the following five (5)
questions:

1. Who

2. What

3. When

4. Where

5. Why

(c) Execution - Contains the “how to” information needed to conduct the operation. The
paragraph is divided into three subparagraphs:

1. Concept of Operations - This is a general explanation of the tactical plan; includes a

brief scheme of maneuver from start to conclusion, type of attack and fire support plan.

2. Tasks - The specific mission to be accomplished by each subordinate element of the

unit will be listed in a separate numbered subparagraph. It is the subordinate’s unit mission
statement.

3. Coordinating Instructions - The specific instructions and tasks that apply to two or
more units; includes order of movement, planned combat formations, tactical and fire control
measures (i.e. phase lines and checkpoints) and any other tasks that pertain to the mission.

(d) Administration and Logistics - This paragraph contains information or instructions

pertaining to rations and ammunition, location of the distribution point, corpsman, aid station,
handling of prisoners of war, other administrative and supply matters. This is also known as the
four (4) B’s.

1. Beans

2. Bullets

3. Band-Aids

4. Bad Guys

(d) Command and Signal - This paragraph contains instructions and information relating
to command and communication functions. It contains two (2) subparagraphs:

1. Command - Identifies the chain of command and their location before, during, and
after the operation.

3-18
 2. Signal - Gives signal instructions for the operation such as frequencies, call signs,
pyrotechnics, emergency signals, radio procedures, brevity codes, challenge and password.

2. WARNING ORDER

a. Warning Order - Warning orders give advance notice of an order or action.

(1) Purpose - to provide subordinates with maximum time available to prepare for an
operation or action. Warning orders are either oral or written and must adhere as closely as
possible at battalion and company level.

(2) Information - The format below contains the minimum items of information for
inclusion in the warning order.

(a) Situation – A brief statement of the situation.

(b) Mission – Mission of the patrol.

(c) General Instructions

1. General and special organization. General tasks are assigned to units and teams.
Specific details of tasks are given in the patrol leader’s order.

2. Uniform and equipment common to all. The patrol leader specifies camouflage
measures to be taken and the identification to carried.

3. Weapons, ammunition, and equipment. These items are assigned to units and
teams. Subordinate leaders make further assignments to teams and individuals.

4. Chain of command. A chain of command is established when the patrol includes

personnel from outside the squad.

5. A time schedule for the patrol’s guidance. The patrol leader addresses all events
from the present until the patrol departs. He also designates the place and uniform for receiving
the patrol order, conducting inspections, and rehearsals.

(d) Specific Instructions

1. To subordinate leaders. The patrol leader gives out all information concerning the
drawing of ammunition, equipment, ordnance, water, and rations; identifies the personnel he
wants to accompany him on his reconnaissance; and gives guidance on any special preparation
he believes will be necessary during the conduct of the mission, such as practicing stream
crossings.

3-19
 2. To special purpose teams or key individuals. The patrol leader should address
requirements of designated personnel or teams, such as having point men, pacers, and navigators
make a thorough map study and check their equipment.

3. Fragmentation Order

a. Fragmentation orders are issued when the time element precludes issuance of a complete
order.

b. Purpose - to ensure continuous action as a situation develops or as decisions are made.

Fragmentation orders omit elements found in a complete order that have not changed since the
order was given or the order is unavailable or incomplete at the time of issuance.

c. Information - Fragmentation orders follow the sequence of the related standard order. At a
minimum, they contain two (2) paragraphs from the five paragraph order format.

(1) Mission Statement – the second paragraph of the five paragraph order format. This will
include the same kind of information as if you were preparing the whole order.

(2) Execution Statement – This is the HOW of the operation and should be as descriptive as
possible given time constraints.

d. The commander uses the fragmentation order extensively in fast moving situations.
Fragmentation orders are supplemented by visits, messages, and other fragmentation orders until
the action is completed or a complete order is issued.

REFERENCES:
MCWP 3-11.2

3-20
 ACRONYMS OPERATION ORDER
1. SITUATION
BEGIN PLANNING a. Enemy Forces: Situation, capabilities, Indications
b. Friendly Forces: Mission and location of higher,
PLAN USE OF AVAILABLE TIME adjacent and supporting units. State the higher units
INITIAL ESTIMATE OF THE SITUATION POME
MISSION c. Mission of units in direct support
ENEMY SIZE DEFEND d. Attachments and Detachments: Units attached to or
ACTIVITY REINFORCE detached from your unit by higher headquarters, and
LOCATION ATTACK effective time
UNIT WIITHDRAW
TIME DELAY 2. MISION
EQUIPMENT Simply state the mission

TERRAIN AND WEATHER: KEY TERRAIN 3. EXECUTION

OBSERVATION AND FIELDS OF FIRE In the first subparagraph give general summary of the
COVER AND CONCEALMENT tactical plan or operational concept
OBSTACLES In succeeding subparagraph assign missions to each
AVENUES OF APPROACH organic and attached unit
In the next to last subparagraph designate and assign
TROOPS AND FIRE SUPPORT AVAILABLE missions to reserve (not normally used at platoon level)
Assign a POME
PRELIMINARY PLAN DECIDE POINT
OF
4. ADMINISTRATIVE AND LOGISTICS
MAIN Supply, evacuation, transportation, service, personnel
EFFORT and miscellaneous

ARRANGE FOR 5. COMMAND AND SIGNALS

MAKE RECONNAISSANCE AND COORDINATION a. Signal Instructions and information
COMPLETE PLAN b. Command posts, location of commander

ISSUE ORDER
ORIENTATION
SITUATION
A. GENERAL
B. ENEMY FORCES (SALUTE/DRAWD)
C. FRIENDLY FORCE: Higher
ADJACENT
SUPPORTING
D. ATTACHMENTS AND DETACHMENTS
E. ASSUMPTIONS

MISSION: WHO, WHAT, WHEN, WHERE, WHY

EXECUTION: GIVE TASKS AND POINT OF MAIN EFFORT
ADMINISTRATION AND LOGISTICS:
BEANS, BULLETS, BANDAGES, BAD GUYS
COMMAND AND SIGNAL
SUPERVISE

3-21
 5 Paragraph Order Review

1. A warning order must consist of how many paragraphs? What are they?

2. Define the acronym SMEAC?

3. What questions should be answered in the “M” portion of SMEAC?

4. Under which paragraph would you find information about medical support?

3-22
 UNITED STATES MARINE CORPS
FIELD MEDICAL TRAINING BATTALION
BOX 555243
CAMP PENDLETON, CA 92055-5243

FMST 303

Individual Movement Techniques

TERMINAL LEARNING OBJECTIVE(S)

1. Given an individual weapon, as a member of a unit, perform individual movement

techniques to arrive at the objective. (HSS-MCCS-2013)

2. Given an operational environment, camouflage materials, individual field equipment, an

individual weapon, and while wearing an assault load camouflage self and equipment to avoid
detection and preserve the fighting force to accomplish the mission. (HSS-MCCS-2022)

ENABLING LEARNING OBJECTIVE(S)

1. Without the aid of reference while wearing individual combat equipment, perform
individual actions during fire and movement, in accordance with the Marine Rifle Squad,
MCRP 3-11.2. (HSS-MCCS-2013g)

2. Without the aid of reference while wearing individual combat equipment, perform the
techniques for negotiating obstacles, in accordance with the Marine Rifle Squad, MCRP 3-
11.2. (HSS-MCCS-2013h)

3. Without the aid of reference, given a description or list, identify types of cover, concealment,
and camouflage, without any errors, per FM 21-75, Combat Skills of the Soldier and STP 21-1-
SMCT, Soldiers Manual of Common Tasks. (HSS-MCCS-2022a)

3-23
1. METHODS OF MOVEMENT:

a. LOW SILHOUETTE MOVEMENTS - The rush is not always the best movement to use.
Sometimes you will find yourself using one of the three types of crawls. The situation will
dictate what type of crawl you will use. The three types of movements are: High, Low, and Back
crawl.

(1) High Crawl - The high crawl permits faster movement and still allows for a low
silhouette. Use this crawl when there is good concealment but enemy fire prevents you from
getting up.

(a) Keep your body off the ground and rest on your forearms and lower legs. Carry the
weapon at modified port arms with one hand on the stock and the other on the rail cover/heat
shield. Keep the muzzle off the ground. Keep your knees well behind your buttocks so your
body will stay low.

(b) To move alternately advance your right elbow and left knee, then your left elbow and
right knee.

(2) Low Crawl - The low crawl gives you the lowest silhouette. Use it to cross places
where the concealment is very low and enemy fire or observation prevents you from getting up.

(a) Keep your body flat against the ground. With your firing hand, hook your weapon
sling at the upper sling swivel using your thumb. Let the rail cover/heat shield rest on your
forearm, keeping the muzzle off the ground, and let the weapon butt drag.

(b) To move push your arms forward and pull your firing leg forward. Then pull with
your arms and push with your leg. Continue this throughout the movement.

(c) Look forward by bending your neck, keeping the side of the helmet on the ground. Do
not lift up your head.

(d) Be sure your dust cover is closed and don’t stick the muzzle of your rifle in the dirt.
You will want your weapon to function when you close with the enemy.

(3) Back Crawl - This will be used so that you can crawl under wire obstacles that the
enemy sets up on the battlefield or around his defensive positions.

(a) To crawl under a wire obstacle, slide head first on your back. Use your weapon to
push the wire away from your body, grasp the hand guards palm up. Push forward with your
heels and keep your head slightly off the deck so you’re not pushing dirt. Wiggle your shoulders
to assist in movement. Rest the muzzle of the weapon on your helmet. To keep the wire from
snagging on your clothes and equipment, let it slide along your weapon. Feel ahead with your
free hand to find the next strand of wire and any tripwire or mines. Do not pull yourself through
by tugging on the wire; it may be booby-trapped.

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b. RUSHING

(1) Individual Rush - The rush is the fastest way to move from one position to another.
Each rush should last from 3 to 5 seconds. (Remember, think to yourself “I’m up, he sees me,
I’m down.”) The rushes are kept short to keep enemy machine gunners or rifleman from
tracking you. However, do not stop and hit the ground in the open just because 5 seconds have
passed. Always try to hit the ground behind cover. If you hit the deck in the open, you are only
presenting the enemy with an easy, stationary target. Before moving, pick out your next covered
and concealed position and the best route to it. Start your movement from the prone position as
follows:

(1) Slowly raise your head and pick your next position and the route to it.

(2) Slowly lower your head.

(3) Draw your arms into your body (keeping your elbows in).

(4) Pull your right leg forward.

(5) Raise your body by straightening your arms.

(6) Get up quickly.

(7) Run to the next position. Don’t run in a straight line; zigzag to confuse anyone trying to
track you.

(8) When you are ready to stop moving; plant both feet.

(9) Drop to your knees.

(10) Fall forward, breaking the fall with the butt of your rifle.

(11) Move to a prone position.

(12) If you do not make it to your next position, high crawl to the Covered position and
assume a good prone posture sighting in down range.

(13) If you have been firing from one position for some time, the enemy may have spotted
you and may be waiting for you to come up from behind cover. Before rushing forward, roll and
crawl a short distance from your position. By coming up from another spot, you may fool an
enemy who is aiming at one spot, waiting for you to rise. When the route to your position is
through an open area, rush by zigzagging. If necessary, hit the ground, roll right or left, then
rush again.

(2) Team Rushes - Occur when fire teams rush in a series of alternating team rushes. Fire team
rushes are movement by one part of the team during cover by fire by the other part of the team.
Generally, first the Rifleman and Team Leader will move ahead, being covered by the Automatic and
Assistant Automatic Riflemen, then the Automatic and Assistant Automatic Riflemen will move up to

3-25
the Rifleman and Team Leader, being covered by the Rifleman and Team Leader. The process is
repeated until no forward progress is possible without serious risk to the entire fire team. This
theoretically increases the safety of the team members during movement

(a) Team member assignment “on my command” - When the fire team leader directs individuals
to rush.

(b) Rushing without verbal commands - Rushing when you are the furthest fire team member
back or when you are rushing in buddy teams and your buddy has completed their rush and it is your
turn.

c. Fire and Movement - Is individuals, fire teams and squads providing cover fire while other
individuals, fire teams or squads advance toward the enemy or assault the enemy position.

d. Fire and Maneuver - The process whereby elements of a unit establish a support by fire position
to engage the enemy, while another element maneuvers to an advantageous position from which to close
with and destroy, or capture the enemy.

2. NEGOTIATING OBSTACLES

a. Small Wall - Encountering short wall-like obstructions in your direction of movement

(1) Approach the wall at the alert carry. Brace your lead foot up against the wall and search
the other side keeping the muzzle above the wall.

(2) “Short-stock” the weapon; Keep the muzzle above the bulkhead.

(3) Take a step back from the wall and step over with your lead foot first.

b. Large Wall - Used when there is no way to get around the wall.

(1) Approach and brace your shoulder against the wall. “Wall, body, weapon.” Stay
approx. 12-18 inches away from the wall to avoid ricochets.

(2) Carefully and stealthily feel the top edge of the wall for traps using the “piano feel”
method for a length of 6 to 8 feet giving yourself enough room to go over the wall.

(3) Very quickly take a step back from the wall and “turkey peek” the other side to see if it
is clear of obstacles and the enemy.

(4) With your weapon in your firing hand, reach up and grab the top of the wall placing the
weapon on top and simultaneously swing your legs on top. Keep a low profile while rolling over
the wall and quickly seek cover on the other side.

c. Tangle Foot - Used when encountering ankle level wire.

(1) Day walk through the tangle foot “boot top high.”

3-26
 d. Clearing Culverts - Used when encountering tunnels or similar openings.

(1) Both members will pie away from and converge together on the culvert entrance
ensuring the muzzle stays out of the culvert.

(2) Utilize two Marines/Sailors by placing one on each side of the culvert entrance. Each
member will check for booby traps by “piano feeling” from their 12 o’clock to their 6 o’clock
around the culvert entrance.

(3) While communicating one member will enter the culvert while the other remains outside
to cover.

(4) Member inside the culvert will walk to the end at will “piano feel” the outside opening.

(5) Once the opening has been cleared the member will yell “CLEAR” to the other member
and exit the culvert providing cover. The other member will then make their way through the
culvert.

e. Wire – Various methods are used to maneuver when encountering wire on the battlefield.
The speed of advance will determine the method used.

(1) Back Crawl – Used to crawl under wire obstacles the enemy sets up on the battlefield or
around defensive positions.

(2) Breeching - Used for rapid access through wire obstacles through cutting or use of
explosives to open a hole in the wire for crossing. The enemy situation will determine which
method should be used. Cut the bottom strands until you can crawl through but do not cut the
entire obstacle unless it is necessary.

(3) Bridging – Used for rapid access over obstacles. The goal is to lay material over the top
of the wire forming a make shift bridge allowing troop movement over the obstacle.

f. Danger Areas - A danger area is any place where one may be exposed to enemy
observation or fire. Some danger areas that you may have to cross are open areas, trails, and
enemy positions. Avoid these areas whenever possible and if they must be passed or crossed,
use speed and caution.

g. Booby Traps - Always assume an obstacle or danger area is booby trapped. Attempt to go
around them. If you cannot go around, visually and physically inspect them before
crossing.

(1) When visually inspecting an obstacle, look for obvious signs such as trip wires or
something attached to it. Then physically check the obstacle by feeling for wire, glass, or
anything unusual.

(2) When visually inspecting a danger area, look for trip wires, mounds, depressions, or
anything unusual.

3-27
3. COVER, CONCEALMENT AND CAMOUFLAGE
Each Marine/Sailor must use terrain to give themselves cover and concealment. They must
supplement natural cover concealment, and comouflage.

a. Cover - Protection from the fire of enemy weapons. It may be natural or man made.

(1) Natural cover can be trees, logs, stumps, ravines, hollows, reverse slopes

(2) Man-made cover includes fighting holes, trenches, walls, rubble, abandoned equipment

b. Concealment - Anything that can hide a person from enemy. Concealment does not
protect you from enemy fire, i.e. brush.

c. Camouflage - Anything that keeps yourself, equipment, and position from looking like
what they really are.

(1) Movement

(2) Shadows

(3) Fighting Positions-not where enemy expects to find them

(4) Shiny Object/Light Source

(5) Shape (familiar shapes)-breakup outlines

(6) Colors-easily detected if contrasting

(7) Dispersion

REFERENCES:
MCRP 3-11.2
STP 21-1-SMCT

3-28
 Individual Movement Techniques Review

1. Explain the different types of low silhouette moevment?

2. Explain the different types of rushes?

3. Explain the difference between Fire and Movement and Fire and Maneuver?

4. Explain the difference between cover, concealment and camouflage?

3-29
 UNITED STATES MARINE CORPS
FIELD MEDICAL TRAINING BATTALION
BOX 555243
CAMP PENDLETON, CA 92055-5243

FMST 304

Patrolling

TERMINAL LEARNING OBJECTIVE(S)

1. Given an individual weapon, as a member of a unit, perform individual movement

techniques to arrive at the objective. (HSS-MCCS-2013)

2. Given a command or situation, communicate using hand and arm signals to exchange non-
verbal signals proficiently. (HSS-MCCS-2012)

ENABLING LEARNING OBJECTIVE(S)

1. Without the aid of reference and in writing, select the definition of a patrol, in accordance
with the Marine Rifle Squad, MCRP 3-11.2. (HSS-MCCS-2013a)

2. Without the aid of reference and in writing, identify the two types of patrols, in accordance
with the Marine Rifle Squad, MCRP 3-11.2. (HSS-MCCS-2013b)

3. Without the aid of reference and in writing, identify the organizational elements of a
patrol, in accordance with the Marine Rifle Squad, MCRP 3-11.2. (HSS-MCCS-2013c)

4. Without the aid of reference and in writing, identify fire team formations, in accordance
with the Marine Rifle Squad, MCRP 3-11.2. (HSS-MCCS-2013d)

5. Without the aid of reference and in writing, identify squad formations, in accordance with
the Marine Rifle Squad, MCRP 3-11.2. (HSS-MCCS-2013e)

6. Without the aid of reference and in writing, identify the types of special signals, in
accordance with the Marine Rifle Squad, MCRP 3-11.2. (HSS-MCCS-2013f)

7. Without the aid of references, identify commonly used hand and arm signals without
omission per MCWP 3-11.2 w/Ch 1. (HSS-MCCS-2012a)

8. Without the aid of references, perform hand and arm signals, to exercise control and pass
information per MCWP 3-11.2 w/Ch 1. (HSS-MCCS-2012b)

3-30
1. DEFINITION OF A PATROL

A patrol is a detachment of ground forces sent out by a larger unit for the purpose of gathering
information or carrying out a destructive, harassing, or security mission.

Patrols vary in size, depending on the type, its mission, and its distance from the parent unit.
While most combat patrols should be platoon-sized, reinforced with crew-served weapons, the
Marine rifle squad is ideally suited for patrols.

2. TWO TYPES OF PATROL

Patrols are classified according to the nature of the mission assigned. The two(2) types are
Combat and Reconnaissance.

Combat Patrols - Usually assigned missions to engage in combat. They gather information as a
secondary mission.

R.A.C.E.S.

R –Raid. Raid Patrols destroy or capture enemy personnel or equipment, destroy installations, or
free friendly personnel who have been captured by the enemy.

A –Ambush. Ambush Patrol conduct ambushes of enemy patrols, carrying parties, foot columns,
and convoys.

C –Contact. Contact patrols establish and/or maintain contact with friendly or enemy forces.

E –Economy of Force. Economy of Force patrols perform limited objective missions such as
seizing and holding key terrain to allow maximum forces to be used elsewhere.

S –Security. Security patrols detect infiltration by the enemy, kill or capture infiltrators, and
protect against surprise or ambush.

Reconnaissance Patrols – Missions for reconnaissance patrols include gaining information

about the location and characteristics of friendly or hostile positions and installations, routes,
stream/river crossings, obstacles, or terrain; identification of enemy units and equipment; enemy
strength and disposition; movement of enemy troops or equipment; presence of mechanized
units; presence of nuclear, bio-logical, and chemical equipment or contaminated areas; and
unusual enemy activity. The types of reconnaissance patrols are:

Area Reconnaissance – An area reconnaissance is a directed effort to obtain detailed information

concerning specific terrain or enemy activity within a specific location. The objective of the
reconnaissance may be to obtain timely information about a particular town, bridge, road
junction, or other terrain feature or enemy activity critical to operations. Emphasis is placed on
reaching the area without being detected.

Zone Reconnaissance – A zone reconnaissance is a directed effort to obtain detailed information

concerning all routes, obstacles (to include chemical or biological contamination), terrain, and
enemy forces within a particular zone defined by specific boundaries.

3-31
Route Reconnaissance – A route reconnaissance is a reconnaissance along specific lines of
communications, such as a road, railway, or waterway, to provide information on route
conditions and activities along the route.

Reconnaissance of routes and axes of advance precede the movement of friendly forces. Lateral
routes and terrain features that can control the use of the route must be reconsidered.

Considerations include traffic ability, danger areas, critical points, vehicle weight and size
limitations and locations of obstacle emplacements.

The route reconnaissance is narrower in scope than the zone reconnaissance. The limits of the
mission are normally described by a line of departure, a specific route, and a limit of advance.

3. ORGANIZATIONAL ELEMENTS OF A PATROL

The Platoon Commander - Designates a patrol leader, who is normally, one of his squad
leaders, and gives him/her a mission. The patrol leader then establishes their patrol units required
to accomplish the mission.

Patrol Units - Patrol units are subdivisions of patrols. Personnel are assigned to units based on
the mission of the patrol and the individuals within the patrol.

Special Organization - Patrol units are further subdivided into teams, each of which performs
essential, designated tasks. (EPW team, Litter team, Search team)

Elements of Combat Patrols

(1) Patrol Headquarters - This is the command group of the patrol. It is composed of the
patrol leader, and other support personnel essential to the patrol such as the radio operator,
corpsman, and forward observer.

(2) Assault Elements - Engage the enemy at the objective.

(3) Security Elements - Secures the objective rally point, isolates the objective, and covers
the patrols return from the objective area.

(4) Support Elements - Provides supporting fires for the assault unit attack, and covering
fires if required, for its withdrawal

Elements of Reconnaissance Patrols

(1) Patrol headquarters - The command group of the patrol. It consists of the same personnel
as a combat patrol.

(2) Recon Element - Maintains surveillance over the objective.

(3) Security Element - Provides early warning, secures the objective rally point, and
protects the reconnaissance unit.

3-32
4. TYPES OF FIRE TEAM FORMATIONS

Fire Team Column – It consist of a rifleman, fire team leader, automatic rifleman and assistant
automatic rifleman. It is mainly used when you want speed and good control of your people.
(See Fig. 1)

(1) Advantages:

(a) Permits fire and maneuver to the flanks

(b) Permits rapid controlled movement

(2) Disadvantages:

(a) Vulnerable to fire from the front

(b) The ability to fire to front is limited

Figure 1. Fire Team Column

Fire Team Wedge - Diamond shape with the rifleman leading followed by the assistant
automatic rifleman to his right, the fire team leader parallel to the assistant automatic rifleman,
and-to the rifleman’s left. The automatic rifleman brings up the rear and directly behind the
rifleman. (See fig. 2)

(1) Advantages:

(1) It is easily controlled

(2) Provides all around security

(3) Fire is adequate in all directions

(4) It is flexible

3-33
 (1) Disadvantages:

(1) It can not move as fast as a column

Figure 2. Fire Team Wedge

Skirmishers (Left) - This is a staggered formation starting with the rifleman on the right, the
automatic rifleman is to the left and parallel to the rifleman. The assistant automatic rifleman is
behind the automatic rifleman and to his left, and the fire team leader is parallel to the assistant
automatic rifleman and in between the automatic rifleman and the rifleman. Skirmishers (right)
is a mirror image of the Skirmishers (left). (See fig. 3)

(1) Advantages:

(a) Permits maximum firepower to the front

(b) Used when the location and strength of the enemy are known, during the assault,
mopping up, and crossing short open areas.

(2) Disadvantages:

(a) It is extremely difficult to control

(b) Movement is slow

(c) The ability to fire to the flanks is limited

3-34
 Figure 3. Skirmishers (Left and Right)

Echelon (Left and Right) - This formation is similar to skirmisher right and left except that one
flank is angled to the rear. (See fig. 4)

(1) Advantages:

(a) Permits fire to the front and one flank

(b) It is used mainly to protect exposed flanks

(2) Disadvantages:

(a) It is extremely difficult to control

(b) Movement is slow

Figure 4. Echelon (Left and Right)

3-35
5. TYPES OF SQUAD FORMATIONS

Column - The same as a fire team column except all the fire teams are included one behind the
other. (See fig. 5)

(1) Advantages:

(a) Permits rapid and easily controlled movement

(b) Permits fire and maneuver to the flanks (same as fire team)

(2) Disadvantages:

(a) Vulnerable to fire from the front

(b) The ability to fire to the front is limited

Figure 5. Fire Team in Column

Squad Line - The squad line places all three (3) fire teams abreast or on line and is normally
used in the assault during rapid crossing of short, open areas. (See fig. 6)

(1) Advantages:

(a) Maximum firepower is concentrated to the front

(2) Disadvantages

(a) The ability to return fire to the flanks is limited

(b) Movement is slow

3-36
 Figure 6. Squad Line

Echelon (Left and Right) - This formation is the same as for fire team except all fire teams are
included. (See fig. 7)

(1) Advantages:

(a) It is used mainly to protect exposed flanks

(b) Provides heavy firepower to the front and in the direction of echelon

(2) Disadvantages:

(a) Difficult to control

(b) Movement is slow

Figure 7. Echelon (Left/Right)

Squad Wedge -The squad wedge places one (1) fire team in the front of the formation followed
by another fire team to the right and diagonally to the rear, with the last fire team to the left and
parallel to the second fire team. (See fig. 8)

(1) Advantages:

(a) It is easily controlled

3-37
 (b) Provides all around security

(c) It is flexible

(d) Fires adequately in all directions. (Same as fire team)

(2) Disadvantages:

(a) It cannot move as fast as a column. (Same as fire team)

Figure 8. Squad Wedge

Squad Vee - The squad vee is an inverted squad wedge. (See fig. 9)

(1) Advantages:

(a) Facilitates movement into squad line

(b) Provides excellent firepower to the front and to the flank

(c) Used when the enemy is to the front and his strength and location are known. May
be used when crossing large open areas.

(2) Disadvantages

(a) It cannot move as fast as a column

Figure 9. Squad Vee

3-38
6. TYPES OF SPECIAL SIGNALS

Whistle

(1) Advantages/Uses

(a) Is an excellent and quick way a unit leader can transmit a message from one place to
another.

(b) It provides a fast means of transmitting a message to a large group

(2) Disadvantages

(a) It must be prearranged and understood. It may by misinterpreted.

(b) Its effectiveness may be reduced by normal noise, which exist on the battlefield.

Pyrotechnics - Devices used to transmit command or information. Flares and smoke grenades
are considered pyrotechnics.

(1) Purpose - It is used as a ground to ground or ground to air signaling device. It is used to
identify units on the ground to other ground units and to air support. It can also be used to screen
the movement of small units for short periods of time.

(a) Smoke Grenades

1. Body - Sheet metal

2. Color- Olive drab with yellow markings

3. Filler - Red, green, yellow, white and violet smoke

4. The color on the top will indicate the color of the smoke

(1) Advantages and Uses

(a) Used to mark enemy positions

(b) Signals to attack, withdraw, shift or cease-fire

(c) Mark landing zone

(2) Disadvantages

(a) Used by only one unit at a time

3-39
 (b) Be sure your signal does not already have another set of meanings

(c) Gives away your position

Hand and Arm Signals - The most commonly used form of signaling is the hand and arm
method. It must be remembered that the hand and arm signals are orders or commands that must
be carried out.

(1) Advantages and Uses

(a) The noise of the battle does not hinder the use of the hand and arm signals.

(b) Used when silence must be maintained

(2) Disadvantages

(a) The signal must be seen

(b) Must be aware of other members location

7. COMMON HAND AND ARM SIGNALS

Decrease Speed - Extend the arm horizontally sideward, palm to the front, and wave arm
downward several times, keeping the arm straight. Arm does not move above the horizontal
plane.

Figure 10

Change Direction - Extend arm horizontally to the side, palm to the front

Figure 11

3-40
Enemy In Sight - Hold the rifle horizontally, with the stock on the shoulder, the muzzle pointing
in the direction of the enemy.

Figure 12

Range - Extend the arm fully towards the leader or men for whom the signal is intended with fist
closed. Open the fist exposing one finger for each 100 meters of range.

Figure 13

Commence Fire - Extend the arm in front of the body, hip high, palm down, and move it
through a wide horizontal arc several times.

Figure 14

Fire Faster - Execute the Commences Fire signal rapidly.

Figure 15

3-41
Fire Slower - Execute the Commences Fire signal slowly.

Figure 16

Cease Fire - Raise the hand in front of the forehead, palm to the front, and swing the arm and
forearm up and down several times in the front of the face.

Figure 17

Assemble - Raise the arm vertically to the full extent of the arm, finger’s extended and joined,
palm to the front, and wave in large horizontal circles.

Figure 18

3-42
Form Column - Raise either arm to the vertical position. Drop the arm to the rear, making
complete circles in a vertical plane parallel to the body.

Figure 19

Are You Ready - Extend the arm toward the leader for whom the signal is intended, hand raised,
fingers extended and joined, raise arm slightly above horizontal, palm facing outward.

Figure 20

I Am Ready - Execute the signal, are you ready.

Figure 21

3-43
Shift - Raise the hand that is on the side toward the new direction across the body, palm to the
front; then swing the arm in a horizontal arc, extending arm and hand to point in the new
direction.

Figure 22

Echelon - Face the unit being signaled, and extend one arm 45 degrees above the other arm 45
degrees below the horizontal, palms to the front. The lower arm indicates the direction of
echelon.

Figure 23

Skirmisher - Raise both arms laterally until horizontal, arms and hands extended, palms down.
If it is necessary to indicate the direction, move in the desired direction at the same time.

Figure 24

3-44
Wedge - Extend both arms downward and to the side at an angle of 45 degrees below the
horizontal plane, palms to the front.

Figure 25

Vee - Extend arms at an angle of 45 degrees above the horizontal plane forming the letter ‘V’
with the arms and torso.

Figure 26

Fireteam - Place the right arm diagonally across the chest.

Figure 27

3-45
Squad - Extend the arm and hand toward the squad leader, palm of the hand down, distinctly,
moving the hand up and down several times from the wrist holding the arm steady.

Figure 28

Platoon - Extend both arms forward, palm of the hands down and make large vertical circles
with hands.

Figure 29

Figure 29

Close Up - Start signal with both arms extended horizontally, palm forward, and bring hands
together in front of the body momentarily.

Figure 30

3-46
Open Up or Extend - Start signal with arms extended in the front of the body, palms together,
and bring arms to the horizontal position, palms forward.

Figure 31

Disperse - Extend either arm vertically overhead, wave the hand and arm to the front, left, right,
and rear, the palm toward the direction of each movement.

Figure 32

Leaders Join Me – Extend arm toward the leaers and beckon leaders with finger as shown.

Figure 33

3-47
I Do Not Understand - Raise both arms horizontally at the hip level, bend both arms at elbows,
palms up, and shrug shoulders in the manner of universal “I don’t understand.”

Figure 34

Forward - Face and move to the desired direction of march, at the same time extend the arm
horizontally to the rear, then swing it overhead and forward in the direction of movement until it
is horizontal, palm down.

Figure 35

Halt - Carry the hand to the shoulder, palm to the front then thrust the hand upward vertically to
the full extent of the arm and hold it in the position until the signal is understood.

Figure 36

3-48
Freeze - Make the signal for a halt and make a fist with the hand.

Figure 37

Dismount, Down, Take Cover - Extend arm sideward at an angle of 45 degrees above
horizontal, palm down, and lower it to the side.

Figure 38

Mount – With the hand extended downward at the side with the palm out, raise arm sideward
and upward to an angle of 45 degrees above the horizontal. Repoear until understood.

Figure 39

3-49
Disregard Previous Command – Face the unit or individual being signaled, then raise both
arms and cross them over the head, palms to the front.

Figure 40

Right (Left) Flank – Extend both arms in direction of desired movement.

Figure 41

Double Time - Carry the hand to the shoulder, fist closed rapidly thrust the fist upward vertically
to the full extent of the arm and back to the shoulder several times.

Figure 42

3-50
Hasty Ambush (LEFT OR RIGHT) - Raise fist to shoulder level and thrust it several times in
the desired direction.

Figure 43

Rally Point - Touch the belt buckle with one hand and then point to the ground.

Figure 44

Objective Rally Point - Touch the belt buckle with one hand, point to the ground, and make a
circular motion.

Figure 45

Pace Count – Tap the heel of the boot repeatedly with an open hand.

Figure 46

3-51
Head Count – Tap the back of the helmet repeatedly with and open hand.

Figure 47

Danger Area – Draw the right hand, palm down, across the neck in a throat-cutting motion from
left to right.

Figure 48

REFERENCES:
Marine Rifle Squad MCWP 3-11.2
Marine Rifle Squad MCWP 3-11.2 w ch1
Scouting and Patrolling MCWP 3-11.3
Visual Signals FM 21-60

3-52
 Patrolling Review

1. The acronym R.A.C.E.S. is used when defining the different mission of a Combat Patrole.
Explain the acronym R.A.C.E.S.

2. Explain the different types of Reconnaissance Patrols?

3. Describe the different organzational elements of Combat and Reconnaissance Patrols?

4. Describe the advantages and disadvantages of fire team formations?

5. Describe the advantages and disadvantages of squad formations?

3-53
 UNITED STATES MARINE CORPS
FIELD MEDICAL TRAINING BATTALION
BOX 555243
CAMP PENDLETON, CA 92055-5243

FMST 305

Land Navigation

TERMINAL LEARNING OBJECTIVE

1. Given a military topographic map, protractor, and objective, navigate with a map and
compass to arrive within 100 meters of the objective. (HSS-MCCS-2014)

ENABLING LEARNING OBJECTIVES

1. Without the aid of reference, given a list, identify the information contained on a military
map, without any errors, per Map Reading and Land Navigation, FM 3-25.26. (HSS-MCCS-
2014a)

2. Without the aid of reference, given a list, identify the purpose of the 5 basic colors on a
map, without any errors, per Map Reading and Land Navigation, FM 3-25.26. (HSS-MCCS-
2014b)

3. Without the aid of reference, given a list, identify the purpose of contour lines on a
military map, without any errors, per Map Reading and Land Navigation, FM 3-25.26. (HSS-
MCCS-2014c)

4. Without the aid of reference and given a list, identify the procedure for measuring distance
on a military map, with no discrepancies, per Map Reading and Land Navigation, FM 3-25.26.
(HSS-MCCS-2014d)

5. Without the aid of reference, given a military map, protractor, compass, and a set of 8 digit
grid coordinates, locate a position on a map, without omission, per Map Reading and Land
Navigation, FM 3-25.26. (HSS-MCCS-2014e)

6. Without the aid of reference, utilize a lensatic compass, per Map Reading and Land
Navigation, FM 3-25.26. (HSS-MCCS-2014f)

7. Without the aid of references, given a military map and a lensatic compass, orient the map to
the ground, without omission, per Map Reading and Land Navigation, FM 3-25.26. (HSS-
MCCS-2014g)

8. Without the aid of references, given a military map, lensatic compass, and a minimum of an 8
digit grid coordinate, locate specific points on a land navigation course, without omission, per
Map Reading and Land Navigation, FM 3-25.26. (HSS-MCCS-2014h)
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1. INFORMATION CONTAINED ON A MILITARY MAP
Purpose - the purpose of a map is to provide information on the existence, the location, and
the distance between ground features.
Definition - a geographic representation of the earth’s surface drawn to scale as seen from
above.
- Shows us what an area actually looks like without being there
- A clear and handy reference tool
Characteristics of a Map
- Designed to show us common information
- Location of ground objects
- Populated areas
- Routes of travel
- Communication Lines
- Extent of vegetation cover
- Elevation and relief of the earth's surface
Care and Importance
Maps are printed on paper and require protection from water, mud and tearing. When
you mark on your map, use lighter lines, which are easily erased, without smearing. If
trimming the map, be careful not to cut any of the marginal information. Maps must be
protected because they can hold tactical information, such as:
- Friendly positions
- Friendly supply points
Map Illustrations

Symbols
- The mapmaker uses standard symbols
- They represent natural and manmade features
- Resemble as closely as possible, the actual features but as viewed from above
Marginal Information - instructions that are placed around the outer edges of the map are
known as margin of information. All maps are not the same, so every time a different map is
used, you must examine the margin of information carefully:
Sheet Name - found in two places: The center of the upper margin and the lower right
margin

Contour Interval - appears in the center lower margin and states the vertical distance
between adjacent contour lines on the map

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 Grid Box- The grid reference box is normally located in the center of the lower margin. It
contains instructions for composing a grid reference.
Declination Diagram - located in the lower margin and indicates the angular relationship of
true north, grid north and magnetic north (see figure 1):

Figure 1. Declination Diagram

- True North - a line from any position on the earth's surface connects at the North Pole.
Unlike grid lines, all lines of longitude are true north lines.
- Magnetic North - direction to the North Magnetic Pole, as indicated by the north-
seeking needle of a magnetic compass. The North Magnetic Pole is located in Canada
at Hudson Bay.
- Grid North - north that is established by the vertical grid lines on the map. The
variation between grid north and true north is due to the curvature of the earth.
Grid Magnetic (GM) Angle - the GM angle is an important factor in map reading. The GM
angle is used to convert magnetic azimuth to grid azimuth and vice versa:

Grid azimuth - determined with a protractor and is measured from grid north.
Magnetic azimuth - taken from a compass and measured from magnetic north.
Legend - located in the lower left margin. Illustrates and identifies some of the symbols on
the map. Every time a map is used, refer to the legend to prevent errors in symbol
identification (see figure 2). Other information found in the legend is the Sheet Name, Sheet
Number, Series Name, Edition Number, Index to Boundaries, Index Adjoining Sheets, and
Series Number.

Figure 2. Legend
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 Bar Scale - located at the center bottom of the margin, below the map face. Special "rulers,”
ground distance may be measured directly without having to convert the map scale ratio.
Normally, the scale for meters, yards, statute miles (land) and nautical miles (sea). Easy to
use, but notice that "zero" is not at the end of the scale (see figure 3).

Figure 3. Bar Scale

2. MAP COLORS - To ease the identification of features on the map, the topographic symbols
are usually printed in different colors, with each color identifying a class of features. The colors
vary with different types of maps, but on a standard, large scale, topographic map, there are five
basic colors.

Black - used to identify the majority of cultural or man-made features, such as

buildings, bridges, and roads not shown in red
Red - main roads, built up areas, and special features such as dangerous or restricted
areas
Blue - is for water features: lakes, rivers, swamps, and streams
Green - identifies vegetation such as woods and orchards
Red Brown - all landforms such as contours, fills, and cuts
NOTE: Occasionally other colors may be used to show special information. These, as a rule,
will be indicated in the margin of information.

3. CONTOUR LINES - Contour lines indicate elevation and relief on maps. A line
representing an imaginary line on the ground, along which all points are at the same elevation.
Each contour line represents an elevation above sea level and the amount of the contour interval
is given in the marginal information. On most maps, the contour lines are printed red-brown,
starting at zero elevation. Every fifth contour line is a heavier brown line. These heavy lines are
known as index contour lines. Also, the elevation will be given along this heavy brown line.
- The spacing of the lines indicates the nature of the slope. This has important military
significance.

- The closer the contour lines the steeper the terrain.

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Land Formations
Hill - a point or small area of high ground (see figure 4).

Figure 4

Valley - a stream course, which has at least, a limited extent of level ground bordered on
the sides by higher ground. Contours indicate a valley that is a “U" shape, and the curve
of the contour crossing always points up (see figure 5).

Figure 5

Draw - a less developed stream in which there is essentially no level ground and
therefore, little or no maneuver room within its confines. The ground slopes upward on
each side and towards the head of the draw. Contour lines indicating a draw are 'V"
shaped, with the point of the 'V" toward the head of the draw (see figure 6).

Figure 6

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Ridge - a line of high ground, normally with minor variations along its crest. The ridge is
not simply a line of hills but rather the ridge crest are higher than the ground on both
sides of the ridge (see figure 7).

Figure 7

Saddle - a dip or low point along the crest of a ridge. A saddle is not necessarily the
lower ground between two hilltops; it may simply be a dip or break along an otherwise
level ridge rest (see figure 8).

Figure 8

Depression - a low point or sinkhole surrounded on all sides by higher ground (see figure
9).

Figure 9

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 Cliff - a vertical, or near vertical, slope. When a slope is so steep that it cannot be shown
at the contour interval, it is shown by a ticked line carrying contours. The ticks always
point toward lower ground (see figure 10).

Figure 10

4. MEASURING DISTANCE
Straight Line Distance - to measure line distance between two points:
- Lay a straight strip of paper on the map so the edge touches the center of both points.
- Make a tick mark on the edge of the paper at each point.
- Lay the paper strip along the scale that corresponds to the unit of measure you are
working with.
- Place the right tick mark of the paper strip on the largest full unit on the primary scale
(to the right of zero), allowing the remainder to fall on the extension of the scale (to the
left of zero).

Curved or Irregular Distance - to measure distance along a winding road, stream, or any other
curved line:
- Make a tick mark near one end of the irregular line to be measured.
- Align the paper strip along the center of the first straight portion of line.
- Make a tick mark at the other end of that portion on both the paper strip and the map.
- Keeping both tick marks together, pivot the strip at the second tick mark until another
straight portion of that line is aligned.
- Continue this process until the measurement is completed, then place the paper strip on
the appropriate bar scale and determine the distance measured.

Pace Count
When navigating, one must know his or her pace count to accuratlry record distance covered:
- Record your count in 100-meter increments.
- Step off with your left foot and count every time it hits the deck.
- Record your 100-meter increments by putting a knot in a rope or piece of string.
(Example: A student is walking an azimuth of 25°. That person must travel in this
direction for 500 meters. The students pace count is 65 paces for 100 meters. To figure
out how many paces the student must take – multiply your pace count by the distance.)
DISTANCE divide by 100 x Pace Count (65).

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5. LOCATE POSITION ON A MAP (see figure 11)
In order to locate the position on a map or navigate, there are certain tools that need to be
utilized. One of these tools is the protractor. There are several types of protractors. All of
them divide the circle into units of angular measure, and each has a scale around the outer
edge and an index mark.

- The index mark is the center of the protractor circle from which all directions are
measured.

- The military protractor contains two scales; one in degrees (inner scale) and one in mils
(outer scale).

- This protractor represents the azimuth circle.

- The degree scale is graduated from 0° to 360°; each tick mark on the degree scale
represents one degree. A line from 0° to 180° is called the base line of the protractor.
Where the base line intersects the horizontal line, between 90° and 270°, is the index or
center of the protractor.

- When using the protractor, the base line is always oriented parallel to a north-south grid
line. The 0° or 360° mark is always toward the top or north on the map and the 90°
mark is to the right.

Figure 11. Protractor

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The grid system
System which tells the reader where specific locations or points are (see figure 12). A network
of lines, in the form of squares, placed on the face of the map. These squares are somewhat like
the blocks formed by the street system of a city. The "streets" in a grid all have very simple
names. The names are all numbers. Every tenth line is made heavier in weight. This will help
you find the line you are looking for. Each grid line on the map has its own number. These
numbers appear within the map on the line itself. Four digit numbers identify a 1000 square
meter grid square. Six digits identify a 100-meter grid square. Eight digits identify a 10-meter
grid square. To locate a point by grid reference is a simple matter. We follow a simple rule of
map reading: READ RIGHT AND UP

4 Digit Step 1 4 Digit Step 2

READ UP
507

6 Digit Step 3 8 Digit Step 4

Figure 12. Grid System

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6. LENSATIC COMPASS The primary instrument used to determine and maintain direction
during land navigation.
Parts of the Compass (see figure 13)
- Thumb loop - Graduated straight edge
- Short luminous line - Lens
- Luminous sighting dots - Fixed index line
- Luminous magnetic arrow, "Magnetic North" - Bezel ring
- Sighting slot - Cover
- Sighting wire - Rear sight
- Floating Dial – in both mils and degrees - Base

Figure 13. Lensatic Compass

Compass Precautions
- Handle the compass with care. The dial is set with a delicate balance and shock could
damage it.
- Reading should never be taken near visible masses of metal or electrical circuits.
- In cold weather, always carry the compass in its carrier outside your outer layer of
clothing. If it is carried inside your clothing close to your body, it will fog when
exposed to the cold air.
Compass terms and concepts
Azimuth - an angle measured in a clockwise direction from a north base line.
Grid Azimuth
- The heading due east is an azimuth of 90°
- South - 180°
- West - 270°
- North - 360 or 0°. When using an azimuth, the point from which the azimuth
originates is imagined to be the center of the azimuth circle.

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 Obtaining a Grid Azimuth
- On your map draw a line connecting two points
Point A represents your present location
Point B represents your destination
- Place the index of the protractor on point A.
- Ensure the 0° and the 180° base line is parallel with the vertical grid lines on your
map.
- Read the azimuth from the degree (inside) scale; this is the grid azimuth from point
A to point B.
Back Azimuth
- Back azimuth is the reverse direction of a forward azimuth.
- It is comparable to doing an about face. To obtain a back azimuth from an azimuth
less than 180°, add 180°. If the azimuth is 180° or more, subtract 180.

LESS
ADD
MORE
SUBTRACT

Methods For Holding The Compass - The lensatic compass is used to determine or follow
magnetic azimuth both day and night. There are two recommended positions for holding the
compass when navigating:
Compass-to-Cheek Method - Recommended when determining the azimuth to a distant
object.
- Raise the cover (with the sighting wire) straight up and raise the sight (lens) to an
angle about 45° above the compass glass.
- Turn the thumb loop all the way down and put your thumb through it. Form a loose
fist under the compass to steady it with your other hand, and raise up to eye level.
- Look through the sighting slot, and align the compass by centering the sighting wire
in the sighting slot.
- Keeping the compass level and the sights aligned, rotate your entire body until the
sighting wire is aligned on a distant object.
- Now glance down through the lens and read the magnetic azimuth under the fixed
index line on the glass.
Center-Hold Position (see figure 14)
- Recommended holding position for a predetermined azimuth, both during the day
and night (you do not need to remove your helmet, weapon, grenades, or magazines
as long as they are not near the compass).
- Open the cover until it forms a straight edge.
- Pull the eyepiece to the rear most position.
- Next, place your thumb through the thumb loop.
- Form a steady base with your remaining fingers.
- Using your other hand, form a solid base for your compass.

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 - To measure an azimuth, simply turn your entire body toward the object. While
pointing the compass cover directly at the object, look down and read the azimuth
from beneath the black index line.

Figure 14. Center-Hold Position

Compass Use at Night

- All the luminous features on the compass will be used.
- The lensatic compass has two glass faces, one under the other. The top glass (bezel
ring) rotates; each click means it has turned three degrees.
- Turn the bezel 30 clicks to the left (counter clockwise); this is a total of 90°.
- Using the center-hold method, rotate your body and compass until the magnetic
north seeking arrow is directly aligned under the short luminous line on the bezel
ring. Your compass is now set on magnetic azimuth of 90°.
- Now all you have to do to march on this azimuth line at night is keep the magnetic
north seeking arrow and the short luminous line aligned and follow the direction of
the luminous dots on the cover of the compass.

7. ORIENTATION OF A MAP
A map is oriented when it is in position with north and south corresponding to north and
south on the ground.
Orienting a map with a compass
- With the map in a horizontal position, the compass straight edge is placed parallel to a
north-south grid with the cover of the compass pointing toward the top of the map.
- This will place the black line on the dial of the compass parallel to grid north.
- Since the needle on the compass points to magnetic north, we have a declination
diagram on the face of the compass formed by the index line and the compass needle.
- Rotate the map and compass until the direction on the declination diagram formed by
the black index line and the compass needle match the directions shown on the
declination diagram printed on the margin of the map. The map is then oriented.
- If the magnetic north arrow on the map is to the left of grid north, the compass reading
will equal the GM angle (given in the declination diagram).
- If the magnetic north is to the right of the grid north, the compass reading will equal
360 minus the GM angle.

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 Orienting Without A Compass: Terrain Association
- When a compass is not available, map orientation requires a careful examination of the
map and the ground to find linear features common to both, such as roads, railroads,
fence lines, power lines, etc.
- By aligning the feature on the map with the same feature on the ground, the map is
oriented.
- Orientation by this method must be checked to prevent the reversal of directions that
may occur if only one linear feature is used. Aligning two or more of these features
may prevent this reversal.

Determining location by map and compass

Basic method for determining locations on a map
Inspection and Estimation
- Usually the easiest
- Carefully survey road systems and topographical features in the immediate
vicinity.

Orient the map to the ground

- Identify some prominent characteristic such as a road, junction, bridge, stream
etc., which you can see on the ground and unmistakably identify on your map.

90° Offset method

To bypass enemy positions or obstacles and stay oriented, detour around the obstacle by
moving at right angles for specified distances. Use this formula:
Right add 90°; Left subtract 90° (RALS) (see figure 15)

o
Figure 15. 90 Offset Method

REFERENCES
Map Reading and Land Navigation, FM 3-25.26, Ch 2, 6, 9, 10, 11
ITS, (May 2001), Pgs 1-18-1 through 1-18-42
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 Land Navigation Review

1. List and describe the three different types of north?

2. A six digit grid coordinate gets you to within how many meters of your intended target?

3. Identify the two methods for holding a compass?

4. Describe the purpose of a contour line?

5. Explain the different methods of measuring distance on a map?

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 UNITED STATES MARINE CORPS
FIELD MEDICAL TRAINING BATTALION-WEST
BOX 555243
CAMP PENDLETON, CALIFORNIA 92055-5243

FMST 306

Improvised Explosive Device

TERMINAL LEARNING OBJECTIVE(S)

(1) Given an operating environment with an IED threat, during daylight and limited
visibility, identify indicators of improvised explosive devices (IED) to identify an IED threat.
(HSS-MCCS-2017)

(2) Given a mission, Commander's guidance and intent, rules of engagement, escalation of
force criteria, and an emplaced improvised explosive device (IED), while serving as an
individual in a small unit, react to an emplaced improvised explosive device (IED) to clear
individual sector while preventing casualties. (HSS-MCCS-2016)

(3) Given a mission, Commander's guidance and intent, rules of engagement (ROE),
escalation of force criteria, non-lethal deterrents, and a simulated suicide improvised explosive
device (SIED), while serving as an individual in a small unit, react to a suicide improvised
explosive device (SIED) to prevent friendly casualties and damage to property. (HSS-MCCS-
2018)

ENABLING LEARNING OBJECTIVE(S)

(1) Without the aid of reference and in writing, select the definition of an IED within 80%
accuracy, in accordance with MCIP 3-17.01. (HSS-MCCS-2017a)

(2) Without the aid of reference and in writing, identify primary indications of an IED
within 80% accuracy, in accordance with MCIP 3-17.01. (HSS-MCCS-2017b)

(3) Without the aid of reference and in writing, identify common employment techniques
of an IED within 80% accuracy, in accordance with MCIP 3-17.01. (HSS-MCCS-2017c)

(4) Without the aid of references and in writing, identify how to operate in an IED
environment per the references. (HSS-MCCS-2016a)

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 (5) Without the aid of reference while wearing individual combat equipment, react to an
IED attack, in accordance with JIEDDTF 05-23. (HSS-MCCS-2016b)

(6) Without the aid of reference and in writing, define Rules of Engagement within 80%
accuracy, in accordance with MCIP 3-17.01. (HSS-MCCS-2018a)

(7) Without the aid of reference and in writing, define Escalation of Force criteria within
80% accuracy, in accordance with MCIP 3-17.01. (HSS-MCCS-2018b)

(8) Without the aid of reference and in writing, identify the tactics to react to a Suicide
Bomber, in accordance with MCIP 3-17.01. (HSS-MCCS-2018c)

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1. DEFINITION OF AN IED

a. Improvised Explosive Devices: are those devices placed or fabricated in an improvised

manner incorporating destructive, lethal, noxious, pyrotechnic, or incendiary chemicals and
designed to destroy, incapacitate, harass, or distract. They may incorporate military weapons,
but are normally devised from non-military components.

b. Component of an IED: IED’s can vary widely in shape and form. IEDs share a common
set of components which consist of the casing, initiating system, and main charge.

(1) Casings can range in size from a cigarette pack to a large truck or airplane. The
container is used to hide the IED and possibly provide fragmentation. Countless containers have
been used as casings, including soda cans, animal carcasses, plastic bags, and vests or satchels
for suicide bombers.

(2) Initiating Systems cause the main charge to function. It can be a simple hard wire (for
command detonation) or a radio frequency (RF) device, such as a cell phone or a toy car remote
control. The initiator almost always includes a blasting cap and batteries as a power source for
the detonator. Any type of battery can be used (9-volt, AA, or car batteries). Initiating systems
are triggered in three ways.

(a) Time - Timed IEDs are designed to function after a preset delay, allowing the enemy
to make his escape or to target military forces which have created a pattern.

(b) Command - Command-initiated IEDs are a common method of employment and

allow the enemy to choose the optimal moment of initiation. They are normally used against
targets that are in transit, or where a routine pattern has been established. The most common
types of command-initiated methods are with command wires or radio-controlled devices, such
as cordless telephones and remote car openers.

(c) Victim - Victim-actuated IED is initiated by the actions of its victim(s). There are
various types of initiation devices, to include pull or trip, pressure, pressure release, movement-
sensitive, light-sensitive, proximity, and electronic switches.

(3) Main Charge

(a) High Explosive - Main charges are the most commonly encountered in theater.
Common explosives used are military munitions, usually 122mm or greater. These items are
easiest to use and provide a ready-made fragmentation effect. May be configured with multiple
main charges placed in short or long distances for simultaneous detonation. Common hardware,
such as ball bearings, bolts, nuts, or nails can be used to enhance the fragmentation. Propane
tanks, fuel cans, and battery acid can and have been added to IEDs to propagate their blast and
thermal effects.

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 (b) Chemical - A chemical IED is a main charge with a chemical payload in conjunction
with an explosive payload. Chemical IEDs are fabricated to kill or incapacitate victims with a
chemical, rather than explosive, effect. Some indicators for chemical IEDs are smaller blasts,
odor, gas cloud, and liquid on or near the suspected IED.

c. Booby Traps are explosive or non-explosive materials and devices, deliberately placed to
cause casualties when an apparently harmless object is disturbed or a normally safe act is
performed.

d. Mines are explosives designed to destroy or damage ground vehicles, boats, or aircraft, or
to wound, kill, or otherwise incapacitate personnel. They may be detonated by the actions of its
victims, by the passage of time, or by controlled means.

2. IED DETECTION There are many ways to detect IED’s. The best means of detection is
your situational awareness. Examples of indicators, locations, and considerations of IEDs
include:

a. Primary IED Indicators - The primary indication of an IED will be a change in the
baseline (something new on the route that was not there the previous day). Vigilant observation
for these subtle indicators can increase the likelihood of IED detection. Some examples of
possible roadside IED indicators may include:

(1) Unusual behavior patterns or changes in community patterns, such as noticeably fewer
people or vehicles in a normally busy area, open windows, or the absence of women or children.

(2) Vehicles following a convoy for a long distance and then pulling to the roadside.

(3) Personnel on overpasses.

(4) Signals from vehicles or bystanders (flashing headlights).

(5) People videotaping ordinary activities or military actions. Enemies using IEDs often
document their activities for use as recruitment or training tools.

(6) Suspicious objects.

(7) Metallic objects, such as soda cans and cylinders.

(8) Markers by the side of the road, such as tires, rock piles, ribbon, or tape that may
identify an IED location to the local population or serve as an aiming reference for the enemy
triggering the IED (such as light poles, fronts or ends of guardrails, and road intersections).

(9) New or out of place objects in an environment, such as dirt piles, construction, dead
animals, or trash.

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 (10) Graffiti symbols or writing on buildings.

(11) Signs that are newly erected or seem out of place. Obstacles in the roadway to channel
traffic.

(12) Exposed antennas, detonating cord, wires, or ordnance.

(13) Wires laid in plain site may be part of an IED or designed to draw friendly force
attention before detonation of the real IED.

b. Location of IEDs - IEDs may be placed anywhere enough space exists or can be created to
hide or disguise the IED. Whenever possible, devices are located where they can exploit known
US patterns, such as the use of a main supply route, or vulnerabilities, such as soft-skinned
vehicles or chokepoints. Common areas of IED placement may include:

(1) Previous IED sites.

(2) Frequently traveled or predictable routes, such as roads leading to bases and along
common patrol routes.

(3) Boundary turnaround points (pattern).

(4) Medians, by the roadside (usually within 10 feet), or buried under the surface of any
type of road, often in potholes and covered with dirt or reheated asphalt.

(5) Trees, light posts, signs, overpasses, and bridge spans that are elevated.

(6) Unattended vehicles, carts, or motorcycles (attached or installed in them).

(7) Hidden inside guardrails or under any type of material or packaging.

(8) Potential incident control points (ICPs).

(9) Abandoned buildings or structures (sometimes partially demolished).

(10) Hidden behind cinder blocks, or piles of sand to direct blast into the kill zone.

(11) Animal carcasses and deceased human bodies.

(12) Fake bodies or scarecrows in coalition uniforms.

(13) At the edge of town.

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 c. Vehicle Borne IED/Suicide VBIED - VBIED is a parked vehicle in a high traffic area
with the intent of causing the most damage. An SVBIED is when the driver is willing to give
their own life in the process of detonating his explosives. These are very successful because the
enemy is mobile and is able to choose a time and place with great flexibility. This
unpredictability makes them difficult to identify.

(1) Driver Indicators:

(a) A lone male driver is the historical standard for VBIED operations; however, there
could be any number of people in the vehicle if an unsuspecting person is driving the VBIED.
Some VBIEDs have two to three people and females are sometimes used as a distraction.

(b) Ignoring orders to stop, attempting to circumvent a security checkpoint, or attempting

to maneuver too close to coalition assets.

(c) Unusual appearance. The enemy may be uncharacteristically clean-shaven and have
very short haircuts. Cutting the hair is part of the purifying ritual that many follow prior to an
attack.

(d) Age in mid-twenties. The average Middle Eastern suicide terrorist is about 24-25
years old, but this may vary in each unique situation.

(e) Driving erratically; driving too slow or too fast.

(f) Wearing inappropriate dress for the environment.

(2) Vehicle Indicators:

(a) Noticeable sagging of the vehicle.

(b) An additional antenna for radio-controlled devices.

(c) Darkened or covered windows to conceal either the vehicle's contents or actions of the
driver.

(d) Recent painting of vehicle to cover body alterations.

(e) Crudely covered holes made in the vehicle to hide explosives.

(f) New welding marks.

(g) No license plates.

(h) Escorted by unusual security detail for type of vehicle.

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 (i) New tires on an old vehicle.

(j) Anything unusual in factory-build compartments.

(k) New or shiny bolts and/or screws.

(l) Unusual scratches, possibly made by screwdrivers, wrenches, or similar tools.

(m) Signs of tampering, such as broken parts or bent sheet metal.

(n) Areas and components cleaner or dirtier than surrounding areas.

(o) Wire and tape stored in the vehicle.

(3) Situation Indicators:

(a) Camera crew in the area.

(b) Observing the same vehicle more than once.

(c) Absence of normal routine for that Area of Operation (AO).

(d) Odd traffic patterns.

(e) Person(s) observed conducing reconnaissance.

(f) Vehicle testing local defenses (i.e. drives at a high speed towards traffic control point
and then breaks off).

3. EMPLOYMENT TECHNIQUES - IEDs can be used in a variety of ways. There are some
Tactics Techniques Procedures that the enemy has used to hinder the mobility efforts of coalition
forces, though enemy TTPs constantly change and adapt in an effort to stay ahead of coalition
TTPs. The enemy also incorporates the use of small arms fire in conjunction with the IED attack
to harass forces and increase the lethality of attacks.

a. Disguised static IEDs - Have been concealed with a variety of things (trash, boxes, tires,
etc.) and placed in, on, above, or under where potential targets appear. Multiple IEDs have also
been daisy chained, or linked together with detonation cord or electrical wire so that all charges
detonate simultaneously, in order to achieve simultaneous explosions.

b. Thrown or projected IEDs (improvised grenades or mortars) have also been used against
coalition forces. One TTP targets convoys as they drive under and overpass, attempting to drop
IED’s in the back of vehicles as the pass under. Convoys must be aware of the 360-degree threat
while traveling. Changing speeds and dispersion will help mitigate the threat to some extent.

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 c. Hoax IED -These include something that resembles an actual IED, but has no charge or
fully functioning initiator device. A fake IED along a given rout and seen by the lead vehicle in
a convoy will cause the convoy to stop. Stopping for the hoax IED may leave the convoy in the
kill zone of the real IED. Hoax IED’s are also used to learn coalition procedures, monitor time,
delay or harass activities in support of the mission.

d. The Basic IED Attack - In the basic attack, the enemy will place IEDs along routes on
either side of the road awaiting foot patrols or convoys to approach in order to cause the most
damage to personnel or vehicles.

e. The "Broken-down" Vehicle Attack - This attack uses a simulated broken down vehicle
placed on the side of the road to cause convoys to change their intended route. The broken down
vehicle is staged along either side of the road, blocking one or all of the trafficable lanes. This
causes the convoy to be directed between the broken down vehicle and an emplaced IED.

f. Coordinated Attack - Numerous enemies work together to emplace and IED along a route,
usually in an urban area. The enemy is usually located where they have the best escape route as
to not be seen or caught. Once the IED’s have been detonated, the enemy breaks contact and
blends in with the population.

g. Ramming Convoys - The enemy has been known to ram their vehicle (possibly an
SVBIED) in the rear or side of a convoy as they pass in order to slow or cause the convoy to
come to a complete stop.

h. Motorcycles - Motorcycles are used by the enemy in areas of decreased mobility to harass
convoys and possibly throw IEDs or grenades in the rear of vehicles.

4. OPERATIONS IN AN IED ENVIRONMENT – There are several things that can be done
to counter the effects of an IED. Wearing all personnel protective gear available, to include
ballistic eye protection, Kevlar helmets, body armor with plates, and hearing protection is the
most basic. Other simple, but critical force protective measures include, wearing seatbelts when
moving and ensuring that all personnel have as much of their body inside the vehicle as possible
to reduce the possibility of being struck by shrapnel or being exposed to the initial blast.

a. Pre-movement Rehearsals - Operating units must be prepared to react quickly and

efficiently to any attack. Study updated maps, as a significant number of IEDs are set up in the
exact same location of previous attacks. Remember that IED attacks may be one part of a
complex attack. The unit must be prepared to react to any threat after the IED detonates and
move out of the kill zone as quickly as possible.

b. Patrolling - One of the most important things a unit or person can do to protect themselves
is to limit predictability. Vary routes, movement techniques, and TTPs for dealing with different
situations. Never forget that the enemy is always watching. Patrols should change direction and
speed at seemingly random intervals, especially in areas of previous IED attacks.

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5. REACTING TO AN IED - There are certain things every member of the unit can do to
counter specific attacks. Every member of the patrol should be alert and constantly aware of the
situation around them. Know the authorized Escalation of Force (EOF) and Rules of
Engagement (ROE).

a. Counter VBIED/SVBIED Techniques - The key to surviving a VBIED/SVBIED attack is

standoff and cover. Know that a SVBIED can come from any direction. Units have been
attacked by vehicles turning into a patrol from oncoming traffic, moving in a convoy, or in firm
base attacks. Maintain an aggressive security posture and have a plan for dealing with civilian
traffic. When dealing with VBIED/SVBIED attacks, it is important to:

(1) Have a plan to deal with approaching vehicles. Decide if they will be allowed to pass or
not and have a plan for the EOF.

(2) Be aware of danger areas/choke points such as turnoffs that force patrol to slow down.

(3) Watch merging traffic as VBIEDs have been used near on and off ramps to get close to
coalition vehicles.

c. Actions at Halts - if a patrol or convoy must stop during movement avoid clustering
vehicles and vary the vehicle interval between elements; establish your own local security and
employ techniques to create standoff. Most importantly, do not remain at one site too long and
conduct 5 to 25 meter checks as described below.

(1) 5 to 25 meter checks. Depending on the length of time of the halt, the area to clear
varies from 5 to 25 meters. At every halt, no matter how short, the crew must clear 5 meters
around the vehicle while still inside the vehicle. For extended halts, teams must clear 25 meters
around the patrol or convoy.

(a) 5 meter checks:

1. Identify a position to halt.

2. Visually check the area 5 meters around your vehicles.

3. Look for disturbed earth and suspicious objects, loose bricks in walls, and security
ties on streetlights or anything out of the ordinary.

4. Search at ground level and continue up above head height. Then conduct a physical
check for a radius of 5 meters around your position. Be systematic, take your time, and show
curiosity. If the tactical situation permits, use a white light or infrared (IR) light at night.

5. If in an armored vehicle, remain mounted during your 5-meter check to take

advantage of the vehicle’s protection.

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 (b) 25 meter checks:

1. Add to the 5-meter check when the patrol or convoy leader decides to occupy an
area for any length of time.

2. Once 5-meter checks are done, continue visually scanning out to 25 meters.

3. Conduct a physical search for a radius of 25 meters around your position.

4. Look for IED indicators and anything out of the ordinary.

d. Actions on Contact Should you be part of a patrol or convoy that finds an IED, the five
"Cs" will help to ensure that the situation can be dealt with quickly and safely. Remember, an
IED that is found is still an IED attack. By finding the IED, you have just disrupted the enemy’s
attack. Do not forget about the enemy’s other forms of attack, RPGs, small arms fire, mortars,
and secondary IED. Enemy IED site = Enemy ambush site. You are in the kill zone!

(1) IED’s Found Before Detonation - A simple set of guidelines should be use when
encountering a suspected IED are the five "Cs". These are Confirm, Clear, Call, Cordon, and
Control.

(a) Confirm - Always assume the device will explode at any moment. From a safe
distance, look for IED indicators while attempting to confirm the suspected IED. Use all tools at
your disposal, to include moving to a better vantage point and using optics to look for tell-tale
signs of an IED. Never ask civilians to remove an IED and do not attempt to do the job of
explosive ordnance disposal (EOD) or engineers.

(b) Clear - Evacuate the area to a safe distance (terrain will dictate) but do not set a
pattern. Keep in mind some threats require more standoff than others. Assess whether your
distance and cover is adequate and direct people out of the danger area. Sweep the area for any
secondary devise or trigger person. Once scene is safe, question, search, and detain as needed.
Do not allow anyone to enter your cordon other than those responsible for rendering the IED safe
(EOD).

(c) Call/Check - Let your higher headquarters know what you have found. When you
move to a new location, all personnel should conduct 5 and 25 meter checks for secondary IEDs.
Always assume a found IED is bait and the real IED is near your “secure” location.

(d) Cordon - Establish blocking positions to prevent vehicle and foot traffic from
approaching the IED. Establish 360 degree inner and outer cordon to secure and dominate the
area. Most likely, the enemy is watching and waiting to make his move.

(e) Control - Control the area until EOD arrives. Clear and set up an entry control point
(ECP) for first responders. Do not let others go forward to “inspect” the IED. Make
contingency plans for coordinated attacks.

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 (2) IED Detonation - Immediate actions differ when an IED is actually detonated. The
enemy may often combine the IED attack with a direct fire ambush to increase the lethality of
the attack. If an ambush does accompany an IED attack, the priority shifts to address the direct
fire and then conducting the 5 C’s. It is important to keep several things in mind when dealing
with IED detonation:

(a) Respond quickly and aggressively in accordance with ROE

(b) Immediately scan outward. The biggest mistake Marines can make is focusing
inwards toward the site of the IED detonation and forgetting about the enemy.

(c) Move out of kill zone

(d) Search for additional IED’s

(e) Treat/Evacuate casualties

(f) Report situation

(g) Expect follow on attacks

(3) Chemical IED - Coalition forces have had several encounters with IEDs also having
chemical filler in conjunction with the explosive. Due to the complexity of manufacturing exact
payloads the chemical effect is difficult to achieve. Units must be aware of the capabilities, and
know what to do in the event of a chemical attack. Specifically:

(a) Move upwind, to high ground at least 240 meters away from release point.

(b) Normal combat uniform provides some protection; individual protective suits, masks
and gloves will provide additional protection.

(c) Detectors will alarm but best warning comes from your sense of sight and smell.

e. What NOT To Do with Suspected IEDs

(1) Never approach a suspected IED. Establish standoff by using binoculars and spotting
scopes from multiple angles to confirm the presence of an IED. When in doubt, back off and call
EOD.

(2) Do not pick up det cord. Det cord is an explosive and the presence of it alone is enough
to call EOD. Do not trace or pull on det cord.

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 (3) Do not directly trace command wire (CW). The enemy has placed trip wires and other
IEDs under/in the vicinity of command wires. When a command wire is located, rather than
walking parallel to or over the wire to locate the initiation point, work in an “S” pattern, crossing
the CW until the initiation point is located.

(4) Do not focus on the “found” IED. An IED, once found, is not going to move. Conduct
secondary sweeps (5 to 25) and set in cordons. Always think a couple steps ahead and have a
plan for any possible encounters that may arise. Again, once positive IED indicators are found
move to safe distances and call EOD.

6. RULES OF ENGAGEMENT - Definition of Rules of Engagement are directives issued by a

competent military authority which delineate the circumstances and limitations under which the
United States forces will initiate and/or continue to conduct engagements with other forces.
(JPUB 1-02)

7. ESCALATION OF FORCE (EOF)

a. Escalation of Force (EoF) principles assist Marines and Sailors in the application of force
consistent with Rules of Engagement (ROE) and mission accomplishment in the contemporary,
complex operating environment. They guide Leaders in Military Decision Making Process
(MDMP), training, rehearsals, and mission execution where the application of force is a critical
element. EoF principles leverage available force options (lethal and nonlethal) to set the
conditions for desired outcomes (commander's intent) while reducing unnecessary death and
collateral damage during the application of force. Escalation of Force principles include:

(1) EoF principles are NOT limitations on self-defense, do NOT apply to Declared Hostile
Forces, are NOT a substitute for, but are a part of, ROE.

(2) EoF principles further follow self-defense rules, may minimize the loss of life and
unnecessary suffering, and are part of mission analysis.

(3) Escalation of Force is NOT a step by step process, but a range of options.

(4) The inherent right of unit commanders to exercise self-defense in response to a hostile
act or demonstrated hostile intent still applies in off-base situations or off-vessel in foreign areas.

b. Signaling procedures for a target not immediately positively identified as a hostile threat
are:

(1) Daylight signaling procedures – use of:

(a) Signs in local language

(b) Bull horn

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 (c) Colored flags or paddles

(d) Pop-up flares

(e) Warning shots

(f) Disabling shots

(g) Lethal shots

(2) Night and limited visibility signaling procedures – use of:

(a) Spotlights

(b) Pop-up flares

(c) Warning shots

(d) Disabling Shots

(e) Lethal shots

8. SUICIDE BOMBERS (personal borne IED-PBIED) - Most suicide attacks involve

SVBIEDs, and include casualty rates from tens to hundreds. There has been an increasing trend
for suicide bombers to attack with an explosive vest, belt, or baggage. U.S. and Coalition Forces
have been attacked within the perimeter of a base; civilians have been attacked at polling stations
and police recruitment drives. With better techniques used to reduce the effectiveness of
VBIEDs, the potential for the enemy to adapt and use suicide bombers increases.

a. PBIED Design - If the charges used by bombers are effectively packaged and concealed, a
suicide bomber can carry up to 45 pounds of explosives; however, most suicide belts are
designed to hold smaller amounts, up to 12 pounds. It should be noted that fragment producing
materials are often incorporated into the design of these belts/vests.

b. PBIED Indicators - Include individuals who deliberately ignore orders to stop or attempt to
circumvent a security checkpoint, those wearing too much clothing for the prevailing weather
conditions, one with suspicious bulges in his/her clothing, carrying packages/bags or wearing
satchels/backpacks, and an individual handling wires, switches, an actuator, or a "dead man's"
switch.

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 b. Counter Suicide Bomber Techniques

(1) Evacuate the area immediately. Safe distances will depend on the mass of explosive
carried by the bomber and the amount and type of fragmentation used.

(2) “Close and negotiate” tactics should not be attempted, as suicide bombers are usually
trained to avoid surrender at all costs.

(3) A “fail safe” cell phone or radio-controlled initiator could be used in the event that the
bomber is incapacitated or hesitates. This tactic would normally involve a second suspect with a
line-of-sight view of the bomber and should always be considered.

(4) If a “deadly force” response is taken, bullet impact may initiate/detonate the explosive
charge(s). Firing on the suspect should only be undertaken from protective cover.

(5) If the suspect is neutralized and there is no explosion, do not administer first aid. Wait
for EOD to render safe the explosive charge.

REFERENCE - TITLE PUBLICATION ID

Explosive Hazard Operations FM 3-34.210
Joint Improvised Explosive Device Defeat JIEDDTF 05-23
Organization Tactics, Techniques and Procedures
Handbook MAGTF Counter-Improvised Explosive Device MCIP 3-17.02
Operations
Marine Rifle Squad MCWP 3-11.2
Prehospital Trauma Life Support (PHTLS).
National Association of Emergency Medical
Technicians: current edition.

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 Improvised Explosive Device Review

1. Define the major components common to the different types of IED’s?

2. Define the different types of IED’s found on the battlefield?

3. Explain the different indicators one should be aware of to aid in the detection of IED’s?

4. Explain the indicators and design of a PBIED?

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 UNITED STATES MARINE CORPS
FIELD MEDICAL TRAINING BATTALION
BOX 555243
CAMP PENDLETON, CA 92055-5243

FMST 307

The M-50 Field Protective Mask

TERMINAL LEARNING OBJECTIVES.

1. Given a CBRN environment, a Joint Service Field Protective Mask (SL-3 complete), CBRN
alarm and CBRN incident indicator, or an order to mask, employ the Joint Service General
Purpose Mask (JSGPM) within a time limit of nine seconds of the issuance of the alarm,
CBRN incident indicator, or an order. (HSS-CBRN-2001)

ENABLING LEARNING OBJECTIVES.

1. Without the aid of reference, given a description or list, identify the components of the Joint
Service General Purpose Mask (JSGPM), without any errors, in accordance with CBRN
Protective Equipment Technical Manuals. (HSS-CBRN-2001a)

2. Without the aid of reference, given a description or list, identify procedures to disassemble
the Joint Service General Purpose Mask in accordance with CBRN Protective Equipment
Technical Manuals. (HSS-CBRN-2001b)

3. Without the aid of reference, given a description or list, identify procedures to assemble the
Joint Service General Purpose Mask in accordance with CBRN Protective Equipment
Technical Manuals. (HSS-CBRN-2001c)

4. Without the aid of reference, given a description or list, identify procedures to fit the Joint
Service General Purpose Mask, to ensure proper seal and fitment in accordance with CBRN
Protective Equipment Technical Manuals. (HSS-CBRN-2001d)

5. Without the aid of reference, given a Joint Service General Purpose Mask and exposure to
irritant gas in a gas chamber or simulated combat environment, don and clear the gas mask
within a time limit of 9 seconds.(HSS-CBRN-2001e)

6. Without the aid of reference, given a description or list, identify procedures to clean the
Joint Service General Purpose Mask, within 80% accuracy in accordance with CBRN
Protective Equipment Technical Manuals. (HSS-CBRN-2001f)

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1. COMPONENTS OF THE M50 FIELD PROTECTIVE MASK

The M50 Joint Service General Purpose Mask (JSGPM) is designed to provide 24 hours of
continuous head-eye-respiration for protection against chemical/biological (CB), radiological
particulates, and toxic industrial chemicals (TIC), and improve overall mission performance of
the warfighter. The M50 will fulfill all of the functional requirements for inter-service and
service-unique mission.

STUDENT NOTE
By design, the mask is a “Filtered Air” mask, meaning that there is no external or “Supplied” air
supplied to the mask. The Field Protective Mask is not effective in small spaces when the
oxygen content of the air is too low (below 19.5% in the environment). The FPM does not act as
a breathing device; this is why it is not a “GAS MASK” but referred to as a Field Protective
Mask.

Characteristics of the M50 JSGPM

- Used to protect the individual’s face, eyes and lungs against field concentration of CBRN
agents.
- WILL NOT protect the wearer against industrial gases such as ammonia or carbon
monoxide.
- Allows the wearer the capability of drinking water while worn.
- Comes in three (3) sizes: small, medium and large. The size mark is located on the top
left portion of the mask.

Faceblank The faceblank assembly is the foundation of the FPM. The following
components are molded/assembled into the faceblank: face seal; chin cup; head harness tabs; a
flexible, single piece eyelens made of polyurethane; openings for the front module assembly,
filter mount assemblies and a storage receptacle for the drink coupler. Buckles are attached to
the head harness tabs for attaching the head harness. (See Figure 1)

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 Figure 1

Nosecup. The nosecup assists in controlling the flow of air throughout the mask to minimize
fogging of the eyelens during breathing. The nosecup size (S, M, L)and internal drink tube
alignment arrow are located on the left interior side of the nosecup. (See Figure 2)

Figure 2

Head Harness. Constructed of elasticized side straps with a skullcap attached by loops to the
brow strap slots. The temple and cheek straps are attached to buckles on the faceblank. (See
Figure 3)

Figure 3

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Front Module. The front module consists of a plastic housing (Front Module Main Body)
that integrates the inlet/outlet disk valve and drink system components. (See Figure 4)

Figure 4

Outlet Valve Cover Assembly. The outlet valve cover assembly fits over the front module
main body protecting the drinking system and outlet disk valve. It has a communications port
cover to protect the communications port. The design of the cover provides a direct speech
capability. (See Figure 5)

Figure 5

Inlet/Outlet Disk Valve. There are three inlet/outlet disk valves in the facepiece assembly.
One is between the outlet valve cover assembly and the front module main body assembly. It
serves as an outlet disk valve and releases exhaled air and prevents unfiltered air from
entering the mask. The other two are located in the interior of the facepiece assembly and are
attached to the rear of the left and right filter mounts. They serve as inlet disk valves and
permit filtered air to enter the mask. (See Figure 4 & 6)

Figure 6

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Self-sealing Disk valve. There are two self-sealing disk valves in the facepiece assembly.
They are located on the exterior of the facepiece assembly and attach to the front of the filter
mounts. The M61 filters attach to the filter mounts using a twist and lock mechanism. When
the filter is attached to the filter mount, it opens the self-sealing disk valve permitting filtered
air to pass through the inlet disk valve during inhalation. When the filter is removed, the self-
sealing disk valve closes, preventing air from entering into the mask. The self-sealing disk
valves are clear in color for identification purposes. (See Figure 4 & 7)

Figure 7

Drinking System. The drinking system is integrated into the mask and consists of an external
drink tube fitted with a drink coupler to link to the water canteen and an internal drink tube
fitted inside the mask. A lever opens the drink tube safety shutoff valve and causes the
internal drink tube to swing to the wearer’s mouth. (See Figure 8)

Figure 8

Internal Drink Tube. The internal drink tube is attached directly to the shutoff valve spindle
on the inside of the facepiece assembly. The length of the tube can be cut to fit the warfighter.
(See Figure 9)

Figure 9

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Filter Mounts, Left and Right. The filter mounts are designed to allow quick installation
and removal of the M61 filter, and integrates an inlet/outlet disk valve (black), a self-sealing
disk valve (clear) and the air deflectors. (See Figure 10)

Figure 10

Air Deflectors. Air Deflectors are attached to each filter mount clamp ring inside of the
facepiece assembly. The air deflectors direct filtered incoming air to assist in eyelens
defogging. (See Figure 10 & 1)

Figure 11

Mask Carrier. The Mask Carrier provides for storage and carriage of the M50 FPM and its
components. The carrier protective sleeve is used to prevent sand, dust, and other particles
that could potentially damage the mask from entering the carrier. (See Figure)

Figure 12

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Individual Equipment Carrier Bag. The individual equipment carrier bag provides for the
storage of select Additional Authorization List (AAL) items. (See Figure 13)

Figure 13

Clear Outsert Assembly. The Clear Outsert assembly provides the eyelens protection
against scratching or other damage. It clips over the eyelens using outsert locking tabs that
will not interfere with vision. The Clear Outsert is issued with an Outsert Pouch which can
also be used to clean the mask. The clear outsert will be stowed attached to the mask. Use of
the clear outsert or sunlight outsert provides the additional ballistic protection required for
Navy flight deck and well deck operations. (See Figure 14)

Figure 14

Waterproofing Bag. The waterproofing bag is used to keep the mask dry when required by
climate and mission. (See Figure 15)

WARNING
DO NOT place food in waterproofing bag. Food may become contaminated and cause
illness or death.

Figure 15

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Water Canteen Cap. The water canteen cap replaces the M1 canteen cap and provides the
capability to connect the drink coupler to the war-fighter’s canteen for drinking purposes.
(See Figure 16)

Figure 16

M61 filters. Twin M61 filters, one installed on each side of the mask, provide protection
from CBRN agents. The M61 filters contain an activated carbon media and a high efficiency
particulate filter. A time patch assembly is located on the back of the M61 filter. Filter
alignment marks are applied to both the M61 filters and the facepiece assembly. Once
exposed to suspected contamination the filters will require replacement. Sealed and packaged
canisters have a five year shelf life. Filter service life indicator turns blue to indicate when
unpackaged filters are no longer serviceable due to prolonged exposure to humidity. Any
signs of physical damage i.e. cracked or broken then the filters should be replaced.
(See Figure 1 & 17)

Figure 17
Faceform. The faceform is placed in the mask to minimize any possible deformation of the
faceseal during storage and shipment. Position the Face Form so the beard on the Face Form
matches the beard of the Facepiece Assembly. Pull all four straps to achieve a snug fit. (See
Figure 18)
STUDENT NOTE
DO NOT discard the faceform. It is to be
retained and used whenever storing the mask
assembly for more than 30 days.

Figure 18

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 Mask Carrier Extension Strap. The mask carrier extension strap is a component of the M50
System and is used to facilitate the mask carrier shoulder carry configuration. (See Figure 19)

Figure 19

Vision Correction Assembly. The Vision Correction Assembly consists of a Vision Support
Frame that attaches to the inside of the mask and is used to mount and adjust the Vision
Correction Spectacle Support Frame containing the war-fighter’s corrective lens as required.
(See Figure 20)

Figure 20

2. DISASSEMBLE THE M50 MASK

Remove clear/sunlight/laser outserts.

- Grasp the top and bottom of the outsert with both hands.
- Gently rotate the bottom of the outsert up and away from the facepiece assembly.

Remove outlet valve cover.

- Remove drink tube coupler from receptacle.
- Unwrap external drink tube.
- Turn the drink tube lever to a horizontal position.
- Grasp outlet valve cover from underneath the communications port and lift.

Remove outlet valve disk. Pinch center of the outlet disk valve between the thumb and
middle finger, and pull gently away from the mounting post.

Remove M61 filters.

- Grip the filter side tabs on the M61 Filter and squeeze inward.
- Twist the filter towards the front of the mask, and lift it from the filter mount.

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 STUDENT NOTE
Filters do not decontaminate or neutralize contamination: they merely collect and contain it.
Therefore, contaminated filters are hazardous. Replacing and disposing of these filters require
care to prevent a hazard to personnel or spread of contamination. Contaminated filter disposal
will be conducted in accordance with service directed procedures during peacetime and
wartime situations.

Remove self-sealing disk valves. Pinch the center of the self-sealing disk valve and pull
gently away from the mounting post.

Remove drink coupler.

- Remove drink tube coupler from storage location and unwrap external drink tube.
- With one hand grasp the drink tube coupler; with the other hand grasp the external drink
tube and pull off the drink tube coupler.

Remove internal drink tube.

- Turn drink tube lever on front module assembly upward.
- Grasp internal drink tube and firmly pull.
- Turn drink tube lever downward to place internal drink tube coupler in stowed position.

Remove air deflectors.

- Reach into facepiece and move the nosecup to one side exposing the air deflector.
- Gently pull the air deflector off the filter mount clamp ring exposing the inlet disk valve.
- Repeat on the other side.

Remove inlet valve disks. Pinch valve gently with thumb and middle finger, and pull away
from the mounting post.

Remove head harness.

- Undo the two brow strap hook and pile fasteners at the top of the head harness skullcap
and pull the brow straps through the slots.
- Lift the clamp plates of the pivoting buckles and pull the temple straps through and out of
the buckles.
- Remove the cheek straps.

3. ASSEMBLE THE M50 MASK

Install head harness.

- Slide the two brow straps through the brow strap slots; fold straps over the slots and
fasten to head harness brow strap covers at the top of the skullcap.
- Lift clamp plates of buckles and thread the temple straps through the pivoting buckles;
push the temple straps through the buckle opening, loop over and push the folded end
down through the slot between the clamp bar and the retaining bar; leave clamp plates
open.
- Thread the cheek straps through the buckles by pushing the folded end of the cheek straps
through the wide opening; then push it back through the narrow opening (front slot).

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 Install inlet disk valves.
- Check that the disk valve and seat are clean.
- Fold back the nosecup to expose center hole of the filter mount assembly.
- Position the outlet disk valve.
- Gently press the center of the disk until fully seated on the mounting post.

Install air deflectors. Move nosecup and position the air deflector over the filter mount
clamp ring ensuring air deflector is aligned over the alignment posts and press. (See Figure
21)

Filter mount clamp ring

alignment post
Figure 21
Install internal drink tube.
- Turn drink tube lever on front module assembly upward.
- Install drink tube on drink tube coupler and press.
- Adjust to fit.
- Place internal drink tube in stowed position.
- Check for proper alignment to achieve proper fit.

Install drink coupler.

- Align the external drink tube with the drink tube coupler.
- Push the drink tube over the drink tube coupler.

Install self-sealing disk valves.

- Check the valve seat and valve mounting post for cleanliness and damage.
- Position self-sealing disk valve on mounting post.
- Gently press the center of the disk until seated on post.
STUDENT NOTE
Ensure a self-sealing valve disk function check is performed after replacement of the disk valves.
~ Don the mask
~ Remove either the left or right M61 Filter
~ Place your hand over the filter air inlet passages of the filter remaining
~ Breathe in, mask should collapse against your face
~ Replace filter and check the other side
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Install M61 filters.
- Pick up the filter with the side tabs facing toward the bottom.
- Align the single filter alignment tab with the double alignment marking on the facepiece
assembly ensuring the filter is directly over the self-sealing disk valve and press until the
filter is snug against the mask.
- While pressing the filter to the filter mount, turn it toward the back until the single
alignment tab is aligned with the single alignment marking on the facepiece assembly and
the tabs click.

Install outlet disk valve.

- Visually inspect the disk.
- Align over the valve mounting post.
- Gently press the center of the disk until fully seated on the mounting post.

Install outlet valve cover.

- Turn drink tube lever to clear the outlet valve cover.
- Align the outlet valve cover over the communications port.
- Gently snap into place.
- Close communications port door by pushing on the raised tab until it clicks.
- Reinstall drink components.

Install clear/sunlight/laser outserts. Align the locking tabs on the ends of the outsert with
the outsert receptacles and gently rotate the outsert down pushing the locking tabs into the
outsert receptacles.

WEARING THE CARRIER

There are three authorized methods to wear the Field Protective Mask carrier: the waist belt
configuration, shoulder sling configuration, and Modular Lightweight Load Carrying
Equipment (MOLLE) 1 or 2 Fighting Load Carrier (FLC) configuration.

Waist Belt Configuration.

- Extend both ends of waist straps and leg straps.
- Adjust straps to approximate length. Place mask carrier on left side and wrap waist strap
around waist and clip the buckle. Pull end of waist strap and adjust waist strap to proper
size.
- Wrap leg strap behind and around leg and clip the buckle. Pull end of leg strap and
adjust leg strap to proper size.

WAIST BELT CONFIGURATION

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Shoulder Sling Configuration.
- Extend both straps to maximum length.
- Attach extension strap to leg strap.
- Insert waist strap clip into the end of waist strap clip buckle. Place mask carrier
overhead and left arm so mask carrier is on left side.
- Wrap leg strap around waist and clip the buckle. Pull end of leg strap and adjust to proper
size.

SHOULDER SLING CONFIGURATION

Fitting And Adjusting The FPM. There are no special tools for sizing the FPM. You will
have to use your judgment and on proper fitting.

(1) Fitting
- Loosen head harness so that strap ends are approximately one inch from buckles.
- Pull head harness over front of mask.
- Hold hair back from sealing area and place chin in the chin pocket. (Hair affects the
seal of the mask.)
- Have Marine slip head harness over head while holding mask against face.

(2) Adjusting
- Have Service Member hold mask tightly against face.
- Center skullcap on back of Marine's head and have Marine hold in place.
- Place finger or thumb under buckle of forehead strap. Then give strap end short,
sharp tugs until buckle feels snug. Adjust other forehead strap in same manner.
- Place finger or thumb under buckle of cheek strap and adjust cheek strap until it
feels snug. Adjust other cheek strap in same way.
- Have Service Member release mask. Mask should not slip down. If mask slips,
readjust forehead straps and cheek straps until mask remains in place.
- Place finger or thumb under buckle of temple strap and adjust temple strap until
buckle feels snug against finger. Repeat adjustment on other temple strap.

3-95
 (3) Checking For Fit. Check the following to ensure a proper fit.
- Edge of mask comes up on forehead but not into hairline and within one inch of ear.
- Temple straps and cheek straps do not cut into ears.
- Service Member's pupils are within the center one-third area of the eyelens. Adjust
optical inserts if required.
- Mask does not press flesh so tightly that eyes are partly closed.
- Bottom of mask does not cut into throat.
- Skin in front of ear is not wrinkled.
- Nosecup does not obscure vision.
- If mask still does not meet above standards, try another size mask.

5. DONNING, DRINKING AND DOFFING THE FIELD PROTECTIVE MASK

The donning and clearing of the mask should be done within 9 seconds. In order to prepare
your M50 FPM you should pre-fit the mask and store it in the carrier.

Donning Procedures
- Stop breathing and close your eyes. Do not take another breath or open your eyes
until the mask has been donned and cleared.
- Remove your helmet. Put helmet between your legs or hold your rifle between your legs
and put helmet on the muzzle.
- Take off your glasses if you are wearing them.

- With your left hand grasp the mask carrier flap tab and pull to open mask carrier flap.

- With your right hand, grasp mask and remove it from carrier.
- Put your chin in chin pocket and press mask snugly against your face.

3-96
- Grasp the head harness tab and pull head harness over your head. Be sure your ears are
between the temple straps and cheek straps. Pull down the head harness at the back as far
as possible so that the brow straps are tight and temple straps are approximately parallel
to the ground.

- Tighten the cheek straps one at a time or both at the same time, ensuring straps lay flat
against your head.
- Seal the outlet valve by placing one hand over the outlet valve cover assembly. Blow out
hard to ensure that any contaminated air is forced out around the edges of the mask
assembly.

- Conduct a negative pressure test. With both hands cover M61 filters and breathe in.
Mask should collapse against your face and remain so while you hold your breath. If it
does, your mask is airtight. If the mask does not collapse, check for hair, clothing, or
other matter between mask and your face and clear again.
- Resume breathing. Give the hand and arm signal while shouting GAS! GAS! GAS!

3-97
 STUDENT NOTE
The purpose of the audio and visual alarm after donning your mask is to warn other personnel
around you. Even if they cannot hear you shout GAS! GAS! GAS!, the visual hand and arm
signal will pass the alarm to them. You will receive a more detailed class on audio and visual
alarms later in the course.

- If wearing the MOPP ensemble, pull integrated hood up and secure fasteners.
- Put on helmet and pick up rifle.

STUDENT NOTE
When putting on your helmet, be sure not to break the seal between your mask and the side of
your face, as contaminated air could leak into your mask.

- Close carrier.
- Continue your mission.

Drinking Water While Masked. Being able to drink with masked is vital. Without this
ability, individuals could quickly dehydrate. Using a buddy for assistance makes drinking
while masked a lot easier to accomplish.

Before attempting to drink from your canteen while masked, consider the following:
- Do not connect the drink tube to your canteen until the top of the canteen cap has been
checked for contamination and verified to be clean. If you don’t do this first, chemical
agents could be swallowed resulting in sickness or death.
- Ensure your plastic water canteen is filled before entering a contaminated area. Or, if in
a contaminated area, fill your canteen inside a protected shelter.
- Check that the canteen has a water canteen cap.

While performing the following steps, be careful not to break your seal. If necessary, use two
fingers on the front voicemitter to hold the mask firmly in place against your face.

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- Following the steps below to drink water from your canteen while masked:
- Steady mask with one hand and pull drink coupler out of coupler receptacle below the
front module main body.
- Open retaining strap on water canteen cap.
- Push drink coupler into canteen cap so that seal snaps into the groove in the cap.
- Turn drink tube lever on front module assembly upward, until it stops and is fully
opened, to position internal drink tube in front of mouth and grasp internal drink tube
between your lips.
- Blow air to create positive pressure. You should feel some resistance.

1. If no resistance is felt and air continues to flow through drinking system, stop
drinking. You have a leak.

2. If a blockage is felt, the system may be clogged or the quick disconnect coupling
is not properly inserted into the cap.

- If resistance is felt, raise and invert canteen and drink water.

- Once pressure has decreased, position canteen right side up and re-pressurize canteen.
- Once drinking has been completed, the drinking system may be disconnected. To do
this, lower the canteen, blow into it to remove all water from the drinking system and
to re-pressurize the canteen. Disconnect the quick disconnect coupling from the M1
cap and stow the canteen and external drinking tube.

DOFFING PROCEDURES. These steps are intended to be done in an uncontaminated

environment and when given the command “All Clear, Unmask”.
- Remove helmet.

- If wearing MOPP ensemble, pull un-secure fasteners and pull down integrated hood.
- Loosen cheek straps completely by placing your thumbs behind the buckles and pulling
forward so straps become loose.
- Grasp the front of the mask and lift it off your head.
- Stow mask.
- Make sure the facepiece is dry and clean.
- Check that the inside of the carrier is free of dirt, trash and other material.
- Grab the cheek straps and carefully pull the head harness over the front of the mask.
- Grasp the mask carrier flap tab and pull to open mask carrier flap.
- Grasp the mask by the front module assembly and place in mask carrier, eyelens first,
covered by head harness skullcap, and facing away from the body.

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 - Replace your helmet, continue with mission.

6. MAINTAINING THE M50 FPM

Cleaning The M50 FPM. It is the members responsibility to maintain the mask. The
cleaning of the M50 FPM should be done anytime the mask is soiled or as needed. There are
two levels of cleaning. The first is light cleaning conducted after normal operations; the
second is heavy cleaning conducted prior to mask turn-in, sanitizing, transfer to another
warfighter, or after extensive operational use. First you must disassemble the M50 FPM as
described in previous section.

STUDENT NOTE
DO NOT stow mask in carrier until it is completely dry, and DO NOT use hot or boiling
water to clean the mask. Damage to the mask may result. Use warm (comfortable to the
touch) water. Use only mild toilet soap to clean mask.

- Light Cleaning.

- Dip an outsert pouch in warm soapy water and wring pouch almost dry. Clean outlet
valve cover assembly, outlet disk valve, inlet disk valves, air deflectors, self-sealing
disk valves, audio frequency amplifier adapter and head harness with the outsert
pouch.

- Rinse by dipping the outsert pouch in warm clear water, wring pouch almost dry and
wipe the mask and components with the clean water. Allow to air dry.

- Heavy Cleaning.

- The Organizational level technician or other trained person will provide a pail with
warm (comfortable to the touch) water for cleaning mask components. (If the
Organizational level technician or other trained person feels it is necessary, a pail
with soap and water may be provided for cleaning and a pail of water will be
provided for rinsing the mask components).

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 - Immerse the mask in the water. Agitate until all sand, dirt and foreign debris has been
removed.
- Rinse in clean, warm water.
- Dry facepiece with a dry outsert pouch and allow to air dry. Hang head harness to air
dry.
- Clean eyelens and outserts with dry outsert pouch.
- Clean the audio frequency amplifier adapter, if installed, with outsert pouch.

STUDENT NOTE
DO NOT use toilet soap in water when cleaning the drinking system.

- Clean the drinking system.

- Fill the canteen with clean, potable water.

- Reinstall the dry outlet disk valve and outlet valve cover assembly.
- Open retaining strap on the water canteen cap.
- Connect the drink coupler to the canteen cap and turn the drink lever on the front
module assembly upward until it stops and is fully opened to open the drink tube
shutoff valve.
- Hold the mask upside down with the internal drink tube facing away from the mask
and allow water to flow through the drinking system. Repeat the process twice.
- Remove the water canteen cap (while still attached to the drink coupler) to drain any
remaining water.
- Remove the drink coupler from the water canteen cap.
- Close the retaining strap on the water canteen cap.
- Turn the drink lever on the front module assembly downward until it stops and is
fully closed to close the drink tube shutoff valve.
- Place water canteen cap back on canteen.
- Re-assemble the remainder of the mask once all parts are completely dry.

Cleaning The Mask Carrier And Individual Equipment Carrier.

- Empty pockets and contents from bag.

- Shake bag upside down to remove dirt and foreign matter.
- Use a dry brush to remove as much loose dirt, sand, and foreign matter as possible from
the interior of the bag. Make sure you clean the pockets and seams.
- Use a dry brush to remove excess dirt, sand, and foreign matter from the exterior of the
bag.
- Soak brush in pail of cool water.
- Shake brush to remove excess water.
- Clean bag with brush and cool water.
- Hang bag to air dry.

REFERENCES
Unit Maintenance Manual for Joint Service General Purpose Mask M-50

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 M-50 Field Protective Mask Review

1. Describe the problem with not performing preventative maintenance on the M50?

2. List three accessory items associated with the M-50 Field Protective Mask?

3. Identify the first step in donning your gas mask once you have received word of possible
contamination?

4. Once the order is given to don mask, how long do you have to don your gas mask?

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 UNITED STATES MARINE CORPS
FIELD MEDICAL TRAINING BATTALION
BOX 555243
CAMP PENDLETON, CA 92055-5243

FMST 307a

Don Mission-Oriented Protective Posture (MOPP) Gear

TERMINAL LEARNING OBJECTIVE

1. Given a CBRN environment, a field protective mask (SL-3 complete), CBRN alarm and
CBRN incident indicator, or an order to mask, employ the Field Protective Mask (FPM)
within a time limit of nine seconds of the issuance of the alarm, CBRN incident indicator, or
an order. (HSS-CBRN-2001).

ENABLING LEARNING OBJECTIVES

1. Without the aid of references, given a description or title, select the definition of Mission
Oriented Protective Posture, within 80% accuracy, per NBC Decontamination, FM 3-5.
(HSS-CBRN-2001e)

2. Without the aid of references, given a list, identify the limitations of Mission Oriented
Protective Posture, within 80% accuracy, per NBC Decontamination, FM 3-5. (HSS-
CBRN-2001f)

3. Without the aid of references, given a description or title, identify the levels of Mission
Oriented Protective Posture, within 80% accuracy, per NBC Decontamination, FM 3-5.
(HSS-CBRN-2001g)

4. Without the aid of references, given a description or list, identify the methods of chemical
agent detection, within 80% accuracy, per NBC Decontamination, FM 3-5. (HSS-CBRN-
2001h)

5. Without the aid of references, given a description or list, identify the methods of personal
decontamination, within 80% accuracy, per NBC Decontamination, FM 3-5. (HSS-CBRN-
2001i)

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1. MISSION-ORIENTED PROTECTIVE POSTURE (MOPP)
Definition - MOPP is a flexible system of protection against chemical agents, which is used
to facilitate mission accomplishment. Because of body heat buildup and basic human needs,
the over garment cannot be worn forever. MOPP does give the commander a range of
choices regarding the level of chemical protection. Choices range from no protection at all to
full protection.

2. LIMITATIONS OF MOPP
Heat Exhaustion - individuals in protective gear working at a heavy rate may experience heat
exhaustion at any time, especially during periods of high temperatures.

Work Rate - factors such as breathing resistance, an increase in body temperature, as well as
psychological and physiological stress will reduce the total amount of work individuals can
perform.

Five Senses - the senses and their related functions such as manual dexterity, visual acuity
and voice communication will operate with less efficiency.

Personal Needs - individuals can not be in full chemical protection for indefinite periods and
still attend to certain personal needs such as caring for wounds, personal hygiene, sleep and
elimination of body waste.

Eating - it is impossible to eat with a gas mask on. The ability of troops to eat in an NBC
environment depends on the type and extent of contamination.

3. LEVELS OF MOPP There are four levels of MOPP.

MOPP Level 1 - this level of protection is established when the general warning is given and
the threat of NBC warfare exists.
- Over garment is worn open or closed
- Over boots are carried
- Mask is carried
- Gloves are carried

MOPP Level 2 - this level of protection should be established during tactical situations that
require units to cross terrain where the previous use of chemical agents is unknown.
- Over garment is worn open or closed
- Over boots are worn
- Mask is carried
- Gloves are carried

3-104
 MOPP Level 3 - this level of protection should be established when units are on the move
and a chemical attack is possible.
- Over garment is worn and closed
- Over boots are worn
- Mask is worn; hood is open or closed, based on temperature
- Gloves are carried

MOPP Level 4 - this level of protection should be established when a unit will be operating
within an area of contamination, or if there is an imminent threat of attack.
- Over garment is worn and closed
- Over boots are worn
- Mask and hood are worn and closed
- Gloves are worn

4. NBC DETECTION EQUIPMENT

The chemical agent detection devices utilized by the armed forces include the following:
M8 Chemical Agent Detector Paper
Purpose - the purpose of M8 paper is to identify the type of chemical agent present in
liquid form on the battlefield.

Supplied - the M8 detection paper is supplied in a booklet and carried within the M40
field protective mask carrier.

Instructions For Use

- When an unknown liquid, suspected of being a chemical agent is encountered,
immediately don the M40 field protective mask and protective suit.

- When all protective clothing has been put on obtain the M8 paper booklet from the
carrier.

- Remove a half sheet from the booklet, and if possible, affix the sheet to a stick (to
use as a handle).

- Blot the paper onto the unknown liquid and wait for 30 seconds for a color reaction
to occur. The resulting color may then be compared to the colors on the inside of
the front cover of the booklet to identify the type of liquid agent encountered.

3-105
M9 Chemical Agent Detector Paper (See figure 1)
Purpose - used to detect the presence of liquid
nerve and blister chemical agents. However,
M9 chemical agent detector paper does not
identify either the specific agent or the type of
agent encountered.

Supplied - M9 detector paper comes in a

thirty-foot-long (30’) and two-inch (2”) wide
roll strip in the form of a tape.
Figure 1. M9 Chemical Agent Detector Paper
Instructions For Use
- The tape is placed around a sleeve and a trouser leg of the overgarments. (NOTE:
The tape contains an indicator dye that is a potential carcinogen. Avoid contact
with the skin. Gloves should be worn during application,.)
- The tape is a dull off-white or cream color in the absence of liquid agent. The
indicator chemical, when dissolved in liquid agent turns a reddish color.
- When the service member sees the tape turn a reddish color, immediately don your
protective mask and alert others.
- If there is a possibility of skin contamination, immediately decontaminate the
suspected area.
- False positive results can occur if liquid insecticides are on the surface being tested.
Antifreeze and petroleum products will also cause false positive reactions.

M256A1 Chemical Agent Detector Kit

Purpose - the M256A1 chemical agent detector kit is used to detect and identify chemical
agents present, either as a liquid or as a vapor.
Supplies - the kit consists of a booklet of M8 paper to detect agents in liquid form and
twelve (12) foil-wrapped detector tickets containing eel enzymes as reagents to detect
even very low concentrations of chemical vapors.
Instructions For Use - instructions for the use of this kit appear on the outside of each foil
package. There is also an instruction booklet in the kit. The kit detects the following
agents: nerve, blister and blood agents.

- Following the accompanying instruction, the testing can be completed in

approximately 20 minutes.

- During testing it is important to keep the ticket out of direct sunlight. Sunlight
speeds up the evaporation of the reagents. The ticket, when testing, must be kept
stationary during all parts of the test.

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5. PERSONAL DECONTAMINATION
M291 Skin Decontaminating Kit (See figure 2)
Purpose - to absorb and then neutralize liquid
chemical agents present on the skin.

Supplied - the kit comes with six identical

packets each containing a mixture of activated
resins in the form of applicator pads.
Figure 2. M291 Skin Decontaminating Kit
Instructions For Use
- Remove a packet from the kit.
- Remove the applicator pad and apply an even coating of resin powder while
scrubbing the entire skin area suspected to be contaminated.
- One applicator pad will decontaminate both hands and the face if necessary.
- If the face must be decontaminated, then the neck (including the throat area) and the
ears must also be decontaminated using a second applicator pad.
- The black resin powder residue will provide a visual confirmation of the
thoroughness of application.
- The resin will not cause skin irritations, even after prolonged contact with skin.
- Care must be taken in keeping the resin out of the eyes, mouth, and open wounds.

REFERENCE
NBC Decontamination, FM 3-5, Pgs. 2-1 through 2-5

3-107
 MOPP Review

1. List the five limitations of MOPP?

2. Are gloves worn or carried in MOPP Level 3?

3. Which types of agents can be detected by the M256A1 Kit?

4. Describe the relationship of the M256A1 kit and direct sunlight?

3-108
 UNITED STATES MARINE CORPS
FIELD MEDICAL TRAINING BATTALION
BOX 555243
CAMP PENDLETON, CA 92055-5243

FMST 308

Manage Chemical Agent Casualties

TERMINAL LEARNING OBJECTIVE

1. Given a casualty and the absence of a CBRN team, necessary medical equipment andsupplies,
manage CBRN injuries to prevent further injury or death within the scope of care. (HSS-
CBRN-2007)

ENABLING LEARNING OBJECTIVE

1. Without the aid of reference and in writing, identify the procedures for managing chemical
agent casualties, within 80% accuracy, per the Medical Management of Chemical Casualties,
current edition.(HSS-CBRN-2007a)

3-109
1. TYPES OF CHEMICAL WARFARE AGENTS
Nerve Agents - nerve agents are a class of phosphorus-containing organic chemicals
(organophosphates) that disrupt the mechanism by which nerves transfer messages to organs.
The disruption is caused by blocking acetylcholinesterase, an enzyme that normally relaxes
the activity of acetylcholine, a neurotransmitter.
Examples
GA - Tabun
GB - Sarin
Nerve Agents:
GD - Soman Colorless/ Light Brown
VX Fruity Odor
Descriptions of Nerve Agents
- Colorless to light brown liquid
- Nonpersistent
- Faint fruity odor
- May be inhaled, ingested and absorbed through the skin
- Most toxic chemical agents
Signs/Symptoms of Nerve Agents
- Can appear in seconds to hours depending on the agent and amount of exposure
- Massive secretions (rhinorrhea, lacrimation, incontinence, diaphoresis, etc.)
- Chest tightness
- Headache above the eyes with blurred vision
- Localized muscle twitching (which can progress into convulsions)
- Constricted pupils
- Respiratory arrest
- Death will result if left untreated
Nerve Agent Treatment
Treatment of Nerve Agents MARK 1 Kit:
- Don protective mask Atropine
- Decontaminate exposed skin 2PAM-Chloride
- Intramuscularly, inject MARK I Kit: Pretreatment:
- The MARK 1 Kit includes two Pyridiostigmine
autoinjectors, one of 2mg Atropine
Sulfate and the other of 600 mg 2 PAM- 30mg/PO/TID for 14 Days
Chloride. The steps for administering the
MARK 1 Kit are as follows:

a. Grasp the Atropine autoinjector like a pen. Remove yellow cap. Press green
tip against the meaty portion of the thigh and hold in place for 10 seconds
(See figure 1).

3-110
 Figure 1. Injecting the MARK 1 Kit

b. Grasp the 2 PAM-Chloride autoinjector like a pen. Remove gray cap.

c. Press black tip against the meaty portion of the thigh and hold in place for 10
seconds.
d. If signs/symptoms are mild, member can administer their own kit.
e. One kit may be given every 10 minutes until improvement is seen or a total of
three kits have been given.
f. If signs/symptoms are severe, (member is unable to inject themselve) give all
three kits immediatley then inject 10mg Diazepam.
g. If symptoms continue after three kits have been administered, medical
personnel may administer repeated Atropine (2mg) injections at three to five
minute intervals and should be titrated to a reduction of secretions and to a
decrease in respiratory distress.

Prevention (Pretreatment) for Nerve Agents

- Pyridiostigmine is a drug that inhibits nerve agents from binding to 20-40% of the
enzyme acetylcholinesterase. (See figure 2)

- Dosage -30 mg every eight hours not to exceed fourteen days. Comes in a blister
pack with 21 tablets, each 30mg.

3-111
 Figure 2. Pyridiostigmine Blister Pack

Vesicants (Blister Agents) - the exact mechanism by which they produces tissue injury is not
known
Examples
HD - Distilled Mustard
HN - Nitrogen Mustard
Lewisite
Phosgene Oxide

Descriptions of Blister Agents

- Light yellow to brown oily liquid that becomes a vapor at high temperatures
- Persistent
- Odor:
- Distilled Mustard (HD) – garlic or
horseradish
Remember those “Fishy
- Nitrogen Mustard (HN) - smells fishy HNs”??? These memory tricks
- Lewisite (L) - smells like geraniums will help you! Be creative! Create
- Phosgene Oxide - smells pepperish/ pungent your own!
odor
- Heavier than water
- May be absorbed through the skin (especially moist areas)

Signs/Symptoms of Blister agents

- Appear any where from 2 - 48 hours after contamination
- Erythemic skin with blisters, and necrosis where the agent touches
- Nausea and vomiting
- Edema of the eyes, eyelids, and corneal scarring
- If ingested or systemic, intense pain in the GI tract and diarrhea

3-112
 Treatment for Blister Agents
- Don protective mask
- Decontaminate exposed skin
- Flush eyes with copious amounts of water to prevent scarring of the Cornea
- Apply Vasoline to the eyes to prevent adhesions
- Apply Calamine lotion to reduce burning and itching of skin
- Consider giving Morphine for pain if needed
- Use antibiotics and IV fluid replacement as required

Blood Agents - blood agents react with metal complexes of body to prevent intracellular oxygen
utilization.

Examples
- AC - Hydrogen Cyanide
- CK - Cyanogen Chloride

Descriptions of Blood Agents

- Colorless liquids dispersed in gas form
- Smells like bitter almonds or peach pits
- Must be inhaled

Signs/Symptoms of Blood Agents

- Hyperpnea (Rapid Breathing)
- Anxiety, agitation, vertigo
- Weakness
- Nausea / Vomiting
- Cherry red skin, may be streaked
- Unconsciousness and seizures within 30 seconds of exposure
- Respiratory arrest and death within two to four minutes if treatment is delayed

Treatment of Blood Agents

- Don protective mask
- Decontaminate exposed skin. Move to fresh air
- Vigorously treat symptomatically
- Administer IV Sodium Nitrite (10ml) followed by IV Sodium Thiosulfate (50ml)
- Second treatment with each of the two antidotes may be given at up to half the
original dose, if needed
Choking Agents - break down the alveolar capillary membranes resulting in pulmonary
edema.
Examples
- CG - Phosgene
- DP - Diphosgene
- CL – Chlorine

3-113
 Descriptions of Choking Agents
- Colorless liquid to white cloud which turns into a vapor
- Smells like freshly mown hay, grass, or corn
- Must be inhaled
- Contaminated food is of little consequence. Agent has no effect on body when
ingested.
- Rapidly becomes nontoxic in water

Signs/Symptoms of Choking Agents

- Headache and eye irritation
- Coughing and choking / shortness of breath
- Substernal ache with sensation of pressure
- Two to six hours after exposure the following may appear:
- Dyspnea
- Cyanosis
- Pneumonia - late sign
- Pulmonary edema, red frothy sputum may be observed
- Hypoxia
- Hypotension
- Death

Treatment of Choking Agents

- Don protective mask
- Establish a patent airway
- Provide rest, warmth, and sedation
- No known antidote for choking agents
- Give oxygen, if available
Vomiting Agents
Examples
- DA - Diphenylchlorarsine
- DC - Diphenylcyanarsine
- DM – Adamsite

Descriptions of Vomiting Agents

- Color:
- DA and DC have a white smoke color
- DM has a canary yellow smoke color
- Odor of burning fireworks / shoepolish
- Crystalline solids, dispersed as a gas
- Must be inhaled

3-114
 Signs/Symptoms of Vomiting Agents
- Appear 30 seconds to 2 minutes after exposure
- Severe headache
- Intense burning in the throat / salivation
- Chest tightness and pain
- Lacrimation / irritation
- Coughing, sneezing, nausea, and vomiting

Treatment of Vomiting Agents: Treatment is symptomatic.

- Don Protective Mask
- Get to fresh air as soon as possible
- Lift mask only to vomit
- Untreated symptoms usually subside within 30 minutes to 3 hours. - - Vigorous
exercise will lessen and shorten the symptoms.

Lacrimators/Tear Agents
Examples ‘CS’ gas is what you will be
- CS - Ochlorobenzylmalonitrile exposed to in the Gas
- CN – Chloracetophenone Chamber!
Descriptions of Lacrimators
- Crystalline solids or liquids dispersed in the air as vapors or white smoke
- Strong pepper odor for CS and apple blossom odor for CN
- Absorbed through the eyes, nasal passages and skin pores

Signs/Sypmtoms of Lacrimators
- Pain and burning to the eyes
- Profuse tearing and photophobia
- Rhinorrhea (snotty nose), epistaxis (nose bleed)
- Chest tightness, coughing and dyspnea
- Blepharospasm (spasm around the eye)
- CS can cause severe burns starting with stinging sensation, erythema and then blister
formation

Treatment of Lacrimators
- Don protective mask
- Get to fresh air as soon as possiable
- Heavy contaminants should be flushed from the eyes with copious amounts of water

Incapacitating Agents – These agents produce their effects mainly by altering or disrupting
the higher regulatory activity of the peripheral nervous system and central nervous system

3-115
 Examples
- BZ - Buzz Gas
- Agent 15

Descriptions of Incapacitating Agents

- Odorless and non-irritating
- Highly potent
- Rate of action – delayed by 30 minutes to 4 hours

Signs/Symptoms of Incapaciating Agents

Dry as a Bone, Hot as a
- Dry mouth and skin, “dry as a bone”
- Hyperthermia, “hot as a hare” Hare, Red as a Beet, Mad as
- Skin red from cutaneous vasodilation, “red as a a Hatter, Blind as a Bat
beet”
- Slowing of mental activity with slurred speech. Disorientation and hallucinations,
“mad as a hatter”
- Dilated pupils, “blind as a bat”

Treatment of Incapacitating Agents: treatment is supportive in nature

- Clear the airway as needed
- Treat for heat stroke
- Give PO fluids only if the victim can drink unassisted
- Approach with caution, the individual could become dangerous
- Remove all weapons
- Restrain as needed
- Physostigmine 45mcg / kg IM. After one hour, perform mental status exam and
repeat dose as needed

2. NATO CHEMICAL WARNING MARKER - a triangular sign measuring 11"x 8" x 8"
with yellow background, and red letters spelling " GAS". (See figure 3)

Figure 3. NATO Chemical Warning Marker

REFERENCE
Medical Management of Chemical Casualties, Current Edition

3-116
 Chemical Agent Review

1. List four Nerve agents.

2. Describe how Blood agents effect the body.

3. List three Vomiting agents.

4. Describe the signs and symptoms associated with a lacrimator agent.

3-117
 UNITED STATES MARINE CORPS
FIELD MEDICAL TRAINING BATTALION
BOX 555243
CAMP PENDLETON, CA 92055-5243

FMST 309

Manage Biological Agent Casualties

TERMINAL LEARNING OBJECTIVE

1. Given a casualty and the absence of a CBRN team, necessary medical equipment and
supplies, manage CBRN injuries to prevent further injury or death within the scope of care.
(HSS-CBRN-2007)

ENABLING LEARNING OBJECTIVES

1. Without the aid of reference and in writing, identify the procedures for treating biological
agent casualties, within 80% accuracy, per the Medical Management of Biological Casualties,
current edition. (HSS-CBRN-2007b)

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1. GENERAL GROUPS OF BIOLOGICAL AGENTS
Definition: The intentional use of living infectious microorganisms or toxins, derived from
living organisms, to cause death or disease in humans, animals or plants. Laboratory analysis
is the only definite way to confirm biological agent exposure.
Groups of Biological Agents
Bacteria - free living microorganisms that are naturally occurring or engineered. They
work by overcoming the body's defense mechanism by invading cells. Most are killed by
antibiotics.
Examples:
Anthrax
Plague
Brucellosis
Virus - an infectious agent, smaller than bacteria, that lacks independent metabolism and
is able to replicate only within a host cell. Viruses produce diseases that do not respond
to antibiotics. Supportive care is the only treatment.
Examples:
Smallpox
Venezuelan Equine Encephallitis (VEE)
Viral Hemorrhagic Fever (VHF)
Biological Toxins - A poisonous substance produced within living cells or organisms. .
Toxins do not grow or replicate, but have been classified biological agents by the United
States due to their ability to be biochemically engineered.
Examples:
Botulism
Ricin
Mycotoxins
Staphylococcal enterotoxin B

2. CHARACTERISTICS OF BIOLOGICAL AGENTS

Bacterial Agents
Anthrax (Bacillus anthracis) - an acute bacterial infection of the skin, lungs or
gastrointestinal tract. Anthrax is endemic worldwide. Anthrax was weaponized in 1950.
Causes of Anthrax
- Primarily a disease of plant eating animals. Cattle, sheep and horses are the
most common domesticated animal hosts.
- Cutaneous infection occurs when handling infected animal tissue, contaminated
hair, wool, hides or products made from infected slaughtered animals.
- Respiratory infection results from inhaling anthrax spores.
- Intestinal infection results from ingesting infected meat.

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 Signs and Symptoms of Anthrax: Signs usually present within 48 hours. The
incubation period for anthrax is hours to 7 days.

Cutaneous: on the skin

- Begins as a papule followed by the formation of a fluid filled vesicle
- Normally appears on hands and forearms first
- The vesicle typically dries and forms a coal-black scab. This scab is usually
surrounded by mild to moderate edema (sometimes with small secondary
vesicles).
- Pain is unusual, and if present, is caused by secondary infection

Inhalation: in the lungs

- Gradual and nonspecific onset of fever, malaise, fatigue, nonproductive
cough and mild chest discomfort
- Initial symptoms are followed by a short period of improvement (hours to 2-
3 days)
- Abrupt onset of severe respiratory distress with dyspnea, diaphoresis, stridor
and cyanosis
- Septicemia, shock and death usually follow within 24-36 hours after onset of
respiratory distress

Gastrointestinal: in the intestines

- Presents with severe sore throat or a local oral or tonsillar ulcer
- Nonspecific symptoms of nausea, vomiting and fever
- Followed by severe abdominal pain with hematemesis and diarrhea

Treatment for Anthrax:

- Ciprofloxacin 400mg IV every 8-12 hours or 500mg by mouth twice daily for
four weeks
- Employ standard precautions for handling, treating, and moving all active cases
Prevention - Prophylactic vaccination series

Plague - caused by the bacterium Yersinia pestis which naturally infects rodents in certain
parts of the world. There are three main types of plague: Bubonic, Pneumonic and
Septicemic.
Causes of Plague
- The primary mode of transmission is flea bites
- A secondary source of infection is through aerosolized droplets of sputum from
an infected person

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 Signs and Symptoms of Plague
Bubonic
- Acute onset fever, malaise, headache, nausea/vomiting
- Swollen lymph nodes in the groin or axilla region
- May have lesion at flea bite site
- Bubonic plague may progress spontaneously to the septicemic form with
organisms spreading to the lungs and producing pneumonic disease
Pneumonic
Acute onset of fever, chills and malaise
Hemoptysis
Nausea/vomiting/diarrhea and abdominal pain
Dyspnea, stridor and cyanosis
Death is caused by respiratory failure and circulatory collapse
Almost always fatal if not treated within 24 hours
Septicemic Plague
- Fever, chills, malaise, nausea, vomiting and diarrhea
- Purpura (a rash from destroyed blood cells leaking into the skin)
- Acrocyanosis (discoloration of the extremities)
- Abdominal pain
- 25% of bubonic plaques progress to septicemic plague
Treatment for Plague
- Quarantine the casualty for the first 48 hours
- Maintain standard precautions for bubonic plague patients and droplet
precautions for pneumonic plague patients
- Streptomycin 30mg / kg / day IM in two divided doses for 10 -14 days
- Doxycycline 200mg IV then 100mg IV BID, until clinically improved then
100mg PO BID for a total of 10-14 days
- Vigorous fluid resuscitation
Prevention - prophylactic vaccination series

Viral Agents
Smallpox - a systemic viral disease caused by the variola virus. Endemic smallpox was
declared globally eradicated in 1980 by the World Health Organization (WHO). The only
WHO approved repositories of the variola virus are in the Centers for Disease Control
and Prevention (CDC) in Atlanta, GA and in the CDC’s counterpart, Vector, in Koltsovo,
Russia.

Causes of Smallpox
- Contact with infected respiratory discharge
- Contact with infectious bed linens or clothing of casualties
- Contact with drainage from wound

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 Signs and Symptoms of Smallpox
- Sudden onset of nonspecific symptoms:
Fever
Headache
Backache that lasts 2-3 days
Vomiting
Malaise

- Two to three days after initial onset, a rash appears. It starts with face, hands
and forearms, moves to the lower extremities and then to the trunk. Lesions will
appear as minute macules, then papules, vesicles, pustules and finally scabs.
Scabs form at 8 - 14 days and slough off at 14 - 28.
- Casualty is infectious throughout the entire term of the disease until the scab
separates and falls off.
- All lesions occur simultaneously
Treatment for Smallpox
- Quarantine the casualty and maintain strict sterile procedures
- Supportive care
Prevention of Smallpox
- Prophylaxis: Vaccination of vaccinia virus. Revaccination should be carried out
every 10 years for personnel who are at risk of infection.
- There are no routine immunizations of US forces for smallpox. When the threat
indicates, senior leadership may direct vaccination of personnel.
Biological Toxins
Botulism - a biological toxin caused by the bacterium Clostridium botulinum. It is the
most toxic substance to man. Due to its incredible potency and relative ease of
manufacture, botulism toxin is considered a likely threat. Botulism acts as a neurotoxin.
Causes of Botulism
- Inhalation
- Ingestion
Signs and Symptoms of Botulism
- Blurred vision
- Dry mouth
- Dysphagia (difficulty swallowing)
- Diplopia (seeing double)
- Muscular weakness
- Symmetrical flaccid paralysis (Loss of tone and reflexes)
- Respiratory arrest (caused by flaccid paralysis of the diaphragm)

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 Treatment for Botulism
- Rest
- Oxygen, if available
- Cricothyroidotomy, if needed
- Mechanical ventilation
- IV and IM administration of trivalent botulinum antitoxin (ABE)

Ricin - a toxin made from the mash that is left over after processing Castor beans for oil.
Castor bean processing is a worldwide activity; therefore, the raw materials for making
ricin are readily available. The toxin may be either inhaled or ingested. Ricin acts
directly on cells by inhibiting protein synthesis, which causes cellular death and tissue
necrosis.

Signs and Symptoms of Ricin

Inhalation
- Acute onset of fever
- Respiratory Distress
- Hypoxia
- Cough
- Malaise (discomfort, weakness, fatigue)
- Myalgia (tenderness in the muscles)
- Pulmonary edema within 18-24 hours
- Death occurs within 36 to 72 hours
Ingestion
- Severe vomiting
- Abdominal cramping
- Diarrhea
- Shock
- Renal failure
- Circulatory collapse
Treatment for Ricin
- An antitoxin is NOT available.
- Give supportive care
- Isolation is not required

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3. FOUR PHASES OF DEFENSIVE MEASURES AGAINST BW AGENTS
Pre-attack Phase of Biological Warfare
- Train and inform personnel of possible agents. The key here is PRE,
- Discourage rumors. something you want to do
- Practice good sanitation and hygiene. BEFORE the attack!
- Ensure immunizations are up to date.
- Protect supplies and equipment.
Attack Phase of Biological Warfare
Signs of attack include: The key here is ATTACK,
- Aircraft spraying or dropping objects. things that you would
- Lobbing of low blast shells or bombs, expect to see during an
smoke or mist of unknown origin attack or what to do during
- Dead animals with no visible cause the attack!
- Rapid increase of patients at sick call

Defensive measures include:

- Stop breathing and don protective mask.
- Give the alarm.
- Remain under cover, and move outside only after cloud has passed or “ALL
CLEAR” is sounded.
- Cover exposed skin.
Post-Attack Phase of Biological Warfare
CONTINUE to practice an increased level of good health, field sanitation and hygiene
discipline. Keep wounds, cuts, and scratches
clean by using soap, water and utilize available The key here is POST,
first aid. Don't consume local foods. things to do AFTER the
Eat and drink only approved food and water. attack!
Do not bathe in lakes, ponds and streams.
Do not touch animals, especially dead ones.
Observe BW contamination markers.
Decontamination Phase
Designate an area for the decontamination station.
Establish and operate the station.
Provide personnel for monitoring teams.
Post NATO Biological Warning Markers.
A triangular shaped marker measuring 11" x 8" x
8" with blue background and red letters spelling
"BIO". (See figure 1.) Figure 1. NATO Biological Warning Marker

REFERENCE
Medical Management of Biological Casualties, Current Edition

3-125
 Biological Agents Review

1. List the signs and symptoms of inhalation anthrax.

2. When and where does the smallpox rash develop?

3. Identify three facts about Botulism.

4. List three actions to avoid during the “Post-Attack” phase of biological warfare.

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 UNITED STATES MARINE CORPS
FIELD MEDICAL TRAINING BATTALION
BOX 555243
CAMP PENDLETON, CA 92055-5243

FMST 310

Manage Radiological Warfare Casualties

TERMINAL LEARNING OBJECTIVE

1. Given a casualty and the absence of a CBRN team, necessary medical equipment and
supplies, manage CBRN injuries to prevent further injury or death within the scope of care.
(HSS-CBRN-2007)

ENABLING LEARNING OBJECTIVES

1. Without the aid of reference and in writing, identify the procedures for treating
radiological warfare casualties, within 80% accuracy, per the Medical Management of
Radiological Casualties, current edition. (HSS-CBRN-2007c)

3-127
1. FOUR TYPES OF NUCLEAR BLASTS (See figure 1)
High Altitude Burst
Characteristics
- Detonation of a weapon at an altitude above 100,000 ft.
- Fireball is much larger and expands much more rapidly than a surface or subsurface
burst.
- Ionizing radiation can travel for hundreds of miles before being absorbed.
- Causes severe disruption in communication and leads to an electromagnetic pulse
(EMP), which can significantly degrade or destroy electronic and critical medical
equipment.

Air Burst
Characteristics
- An explosion in which a weapon is detonated at an altitude below 100,000 feet but
high enough that the fireball does not contact the surface of the earth.
- Airbursts may cause considerable damage; thermal burns to exposed skin may be
produced many kilometers away from the burst.
- Eye injuries may be produced at even a much greater distance than that of thermal
burns.
- Tactically, airbursts are the most likely to be used against ground forces.

Surface Burst
Characteristics
- An explosion in which a weapon is detonated on or slightly above the surface of
the earth so that the fireball actually touches the land or water surface.
- The area affected by the blast, thermal radiation, and initial nuclear radiation will be
less extensive than an air burst of similar yield.
- It produces the greatest amount of fallout over a much larger area than that which is
affected by blast and thermal radiation.

Subsurface Burst
Characteristics
- An explosion in which the point of detonation is beneath the surface of land or
water.
- Cratering of the ground will generally result:
- If the subsurface burst does not penetrate the surface, the only other hazard will
be from ground or water shock.
- If the burst is shallow enough to penetrate the surface, blast, thermal and initial
nuclear radiation effects will be present, but less than a surface burst of
comparable yield.
- If the burst penetrates the surface, fallout will be heavy.

3-128
Fireball
Induction

Figure 1. Types of Nuclear Blasts

2. COMMON TYPES OF NUCLEAR INJURIES

Two Types of Blast Injuries:
Although there are many effects of a standard blast (see block 4 “Blast Injuries”) the following
information divides the types of injuries that may result from a nuclear explosion into two types,
primary and secondary.
Primary Blast Injury (Direct) - these types of injuries are caused by the direct action of the shock
wave on the human body after the detonation of a nuclear device.
- Injuries occur immediately after detonation due to over pressure from the rapid expansion of
air.
- If the patient is in close proximity to ground zero, the initial blast wave is usually lethal.
- Sub-lethal exposures to the initial blast wave can result in damage to bones, muscles, lungs,
gastrointestinal system and ruptured eardrums.

Secondary Blast Injury (Indirect) - these injuries are caused by indirect wind forces greater than
several kilometers per hour seconds after the primary detonation of a nuclear device.
- Injuries occur as a result of collapsing buildings, flying timber and other debris
impacting the body or physical displacement of the body against objects or structures.
- More injuries are caused by indirect blast wind drag forces than by the shock wave.

3-129
Treatment of Blast Injuries from a Nuclear Attack:
Blunt trauma - blunt trauma with nuclear detonation will be anywhere from mild to severe.
Injuries occur as a result of debris put into motion from blast and its following winds. Injuries
such as fractures, spinal injury, head and torso blunt trauma, and penetrating injuries should be
expected. Care for these injuries as you would in a non-contaminated environment.

Pressure Trauma - the greatest concern with pressure trauma is

injury to the lungs. Damage to the alveoli causes swelling, The five acknowledged nuclear
fluid accumulation, and possibly pulmonary emboli.
Pulmonary embolism occurs as a result of air escaping the powers possess about 31,000
damaged lungs directly into the bloodstream. Treatment of nuclear warheads. India has not
suspected pressure trauma to the lungs includes:
formally placed their nuclear
- 100% oxygen, positive pressure if needed.
- If pulmonary embolus is suspected, place the patient on their arsenal on a delivery system.
left side to slow down the movement of the emboli. Pakistan has.

Thermal Injuries from a Nuclear Attack - thermal radiation emitted by a nuclear detonation
causes two types of burns:
Flash Burns (Direct)
Flash Burns results from thermal radiation (infrared) emanating from the fireball
of a nuclear explosion. Exposed skin and extremities facing the explosion will be burned
Flame Burns (Indirect)
Flame burns are caused by exposure to fires from the environment, particularly
from ignition of clothing. This could be the predominant cause of burns depending on the
number of and characteristics of flammable objects in an environment.

Eye Injuries: the initial thermal pulse from nuclear detonation can cause eye injuries in the form
of flash blindness and retinal scarring
Flash blindness
Flash blindness results from looking in the general direction but not directly at a brilliant flash of
intense light energy. It is a condition in which a flash of light swamps the eyes and depletes the
pigmentation from the retinal receptors. Flash blindness is a temporary condition that usually
last for several seconds but not more than two minutes when exposure occurs during daylight.
The blindness will be followed by a darkened after image that lasts for several minutes. If
exposure occurs at nighttime, blindness can last from 15 to 30 minutes before full nighttime
adaptation occurs.
Retinal Scarring
Retinal Scarring develops from a burn to the retina from looking directly at the fireball. It is a
relatively uncommon injury, but can cause blind spots and permanent blindness.

3-130
3. DIAGNOSIS OF LEVELS OF EXPOSURE
Radiation Absorbed Dosage (RAD) - the method for measuring radiation dosage. Accurate and
prompt diagnosis of a casualty is based primarily upon the clinical picture presented by the
individual.
Mild - vomiting does not occur by the end of the fourth hour after exposure.
Severe - vomiting within two hours.
Deadly - vomiting within the first hour accompanied by explosive diarrhea.

4. SIGNS AND SYMPTOMS OF RADIATION EXPOSURE

90% of those exposed to a significant dose of ionizing radiation will exhibit the following
symptom within two to six hours after exposure:
- Nausea - Hyperthermia (rise in body temperature)
- Vomiting - Erythema (reddening of the skin)
- Diarrhea - Hypotension
- Fatigue - Neurological Dysfunction
- Malaise (mental confusion, convulsion, coma)
- Anorexia (loss of appetite)
5. TREATMENT FOR RADIATION EXPOSURE
Treatment for radiation casualties with no physical injuries is supportive in nature.
Treatment for radiation exposure is based on managing life threatening injuries, burns, blunt
trauma, controlling hemorrhage, pressure trauma, and the signs and symptoms displayed, not on
the amount of radiation received.
Pain management - morphine is the drug of choice. It should be given in doses of 10mg (auto-
injector) every 4-6 hours.
Infection - administer antibiotics to manage any infection after radiation exposure, such as
penicillin and ampicillin. You will need to use 3 times the normal dosage of the antibiotics and
Oral antifungal agents. Normal recovery time is from 8 to 15 weeks.
6. PERSONNEL PROTECTION MEASURES
In a tactical environment, the following are immediate protective measures to observe during a
surprise nuclear attack:
- Drop flat on the ground, face down, with head toward blast if possible or to the bottom of your
fighting hole.
- Close your eyes and don’t look at the explosion
- Protect or cover exposed skin by putting hands and arms under or near the body and keeping
your helmet on
- Keep your head down
- While in fighting hole, cover head with arms, place face against legs and place fingers in ears
- Stay down for 90 seconds after the shock wave has passed
- Don your field protective mask
- If warned of imminent attack, proceed to shelter or foxhole

3-131
7. DECONTAMINATION PROCEDURES - decontamination of radiological particles should
be done away from the scene and further away from radioactive fallout exposure at a
decontamination station. It should be continually done until the radioactivity has been reduced
to a safe level.
- Early removal of radioactive “contamination” will reduce radiation burns, radiation dosage and
the chances of inhaling or ingesting radioactive material.
Steps for self-decontamination include:
Spot clean first using a cotton swab or gauze for moist areas and tape for dry areas to remove
radioactive “hot spots” (concentration of Radioactivity)
Carefully remove contaminated clothing and garments
Deposit contaminated clothing and garments in a garbage bag or disposable container for
disposal by burial at sea or in deep pits or trenches
Carefully bathe or flush contaminated wounds with sterile water
Apply impermeable dressing over any uncontaminated cut, scratch, or wound
Shower thoroughly with soap and water. Scrub the entire body with a soft bristle brush giving
special attention to hairy areas, nails, body orifices, and skin folds
If areas become tender from excessive washing, gently rub skin with a small amount of lanolin
or ordinary hand or face cream
Repeat procedures again if any contamination remains

REFERENCES
Hospital Corpsman NAVEDTRA 14295
Medical Management of Radiological Casualties, Current Edition
Webster’s II New Riverside Dictionary, pg 135, 806
Marine Corps MCRP 4 – 11.1B
Field Manual 8-9 - NATO Handbook on the Medical Aspects of NBC Defensive Operations
AMedP-6(B)

3-132
 Radiological Review

1. What type of burst is most likely to be used against ground forces? What types of injuries
would it likely cause?

2. Describe “flash blindness”.

3. Describe the signs and symptoms of mild, severe, and deadly levels of radiation exposure.

4. Describe the recommended antibiotic therapy to be administered following radiation

exposure.

3-133
 Marine Corps Fundamentals
Review Questions

NOTE: The following questions are offered for review purposes. This is NOT intended as
a sole source of test preparation. Remember all test questions are based on an ELO and
any ELO can be used to create a test question.

1. What is the definition of a patrol?

2. What are the two types of patrols?
3. What are the components of the M-50 Field Protective Mask?
4. What are the four types of nuclear blasts?
5. What information is contained in a warning order?
6. What are the components of the manpack configuration (AN/PRC-119A)?
7. What are the parts of the compass?
8. What are the four safety rules of any weapon?
9. What are the characteristics of weapon condition one for the M16/ M4 service rifle?
10. What is the purpose of a warning order?
11. What are the components of an IED?
12. What is the definition of Mission-Oriented Protective Posture (MOPP)?
13. What are the general groups of biological agents?
14. What are the limitations of MOPP?
15. What are the organizational elements of a patrol?
16. What are the missions of a combat patrol?
17. What are the two settings of the COMSEC switch of the receiver-transmitter?
18. What information is contained in an operation order?
19. What information is contained in a fragmentation order?
20. What are the appropriate actions at halts to check for IEDs?
21. What are the missions of a reconnaissance patrol?
22. What is the purpose of a fragmentation order?
23. In the phonetic alphabet, how is the letter J expressed?
24. What is the purpose of a map?
25. What is the purpose of the 5 paragraph order?
26. What do you NOT want to do with suspected IEDs?
27. What are the colors used on a map?
28. What is the purpose of contour lines on a map?
29. What is the acronym used for the five-paragraph order format?

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 Marine Corps Fundamentals
Review Questions
30. In the phonetic alphabet, how is the letter W expressed?
31. What is the definition of an IED?
32. What are the four types of fire team formations?
33. What are the five types of combat squad formations?
34. What are the three types of special patrolling signals?
35. What is the treatment of blood agents?
36. What is the purpose of the M291 Skin Decontaminating kit?
37. What is Botulism and what causes it?
38. How is Ricin treated?

3-135
COMBAT MEDICINE
 COMBAT MEDICINE
Introduction to Tactical Combat Casualty Care 4-1
FMST 401

Manage Shock Casualties 4-6

FMST 402

Manage Hemorrhage 4-16

FMST 403

Maintain Airway 4-28

FMST 404

Perform Emergency Cricothyroidotomy 4-35

FMST 405

Manage Respiratory Trauma 4-45

FMST 406

Manage Abdominal Injuries 4-62

FMST 407

Manage Musculoskeletal Injuries 4-69

FMST 408

Manage Head, Neck and Face Injuries 4-85

FMST 409

Tactical Fluid Resuscitation 4-101

FMST 410

Perform Casualty Assessment 4-119

FMST 411

Medication Appendix 4-132

Review Questions 4-134

 UNITED STATES MARINE CORPS
FIELD MEDICAL TRAINING BATTALION
BOX 555243
CAMP PENDLETON, CA 92055-5243

FMST 401

Introduction to Tactical Combat Casualty Care

TERMINAL LEARNING OBJECTIVE

1. Given a casualty in a tactical environment, perform Tactical Combat Casualty Care to

reduce the risk of further injury or death. (8404-MED-2010)

ENABLING LEARNING OBJECTIVES

1. Without the aid of reference, given a description or list, define the principles of Tactical
Combat Casualty Care (TCCC), within 80% accuracy, per Prehospital Trauma Life Support,
current Military Edition. (8404-MED-2010a)

2. Without the aid of reference, given a description or list, define the first phase of TCCC,
within 80% accuracy, per Prehospital Trauma Life Support, current Military Edition. (8404-
MED-2010b)

3. Without the aid of reference, given a description or list, define the second phase of TCCC,
within 80% accuracy, per Prehospital Trauma Life Support, current Military Edition. (8404-
MED-2010c)

4. Without the aid of reference, given a description or list, define the third phase of TCCC,
within 80% accuracy, per Prehospital Trauma Life Support, current Military Edition. (8404-
MED-2010d)

4-1
OVERVIEW
Tactical Combat Casualty Care (TCCC) was developed to emphasize the need for continued
improvement in combat pre-hospital care. The Committee on Tactical Combat Casualty Care
(CoTCCC) was established in 2001 and is part of the Defense Health Board. CoTCCC is a
standing multi-service committee charged with monitoring medical developments in regards to
practice, technology, pharmacology and doctrine. New concepts in hemorrhage control, airway
management, fluid resuscitation, analgesia, antibiotics and other lifesaving techniques are
important steps in providing the best possible care for our Marines and Sailors in combat.

The TCCC guidelines are published every 4 years in the Prehospital Trauma Life Support
manual. It has been recognized that TCCC guidelines and curriculum will need to change more
often than the 4-year cycle of the PHTLS textbook publication. The National Association of
Emergency Medical Technicians (NAEMT) will include the updated TCCC guidelines and
curriculum on its website as they are approved as a way to help get this new information out to
the combat medical personnel in the military that need it.

1. PRINCIPLES OF TACTICAL COMBAT CASUALTY CARE (TCCC)

The principles of Tactical Combat Casualty Care are fundamentally different from those of
traditional civilian trauma care, where most medical providers and medics train. These
differences are based on both the unique patterns and types of wounds that are suffered in
combat and the tactical conditions medical personnel face in combat. Unique combat wounds
and tactical conditions make it difficult to determine which intervention to perform at what time.
Besides addressing a casualty’s medical condition, responding medical personnel must also
address the tactical problems faced while providing care in combat. A medically correct
intervention at the wrong time may lead to further casualties. Put another way, “good medicine
may be a bad tactical decision” which can get the rescuer and the casualty killed. To
successfully navigate these issues, medical providers must have skills and training oriented to
combat trauma care, as opposed to civilian trauma care.

The specifics of casualty care in the tactical setting will depend on the tactical situation, the
injuries sustained by the casualty, the knowledge and skills of the first responder, and the
medical equipment at hand. In contrast to a hospital Emergency Department setting where the
patient IS the mission, on the battlefield, care of casualties sustained is only PART of the
mission. TCCC recognizes this fact and structures its guidelines to accomplish three primary
goals:

1. Treat the casualty

2. Prevent additional casualties

3. Complete the mission

In thinking about the management of combat casualties, it is helpful to divide care into three
distinct phases, each with its own characteristics and limitations.

4-2
2. FIRST PHASE OF TCCC

Care Under Fire - care rendered at the scene while both the Corpsman and the casualty are
still under effective hostile fire. The risk of additional injuries from hostile fire at any
moment is extremely high. The need for medical care must be weighed against the need to
move to cover and to suppress hostile fire rapidly.

If the casualty is responsive they should be directed to move to cover and/or apply a
tourniquet if needed. Casualties, who are able, should remain engaged as combatants. If the
casualty is unable to move and unresponsive, risking additional lives by exposure to fire to
move the casualty may not be warranted.

Immediate control of extremity hemorrhage with a tourniquet is the most important life-
saving intervention in Care Under Fire and is the only medical care that should be rendered
before the casualty is moved to cover.

Available medical equipment is limited to that carried by the Corpsman and casualty,
however the only medical equipment needed during this phase is a CoTCCC recommended
tourniquet.

3. SECOND PHASE OF TCCC

Tactical Field Care - care rendered once the Corpsman and casualties are no longer under
effective hostile fire. This also applies to situations in which an injury has occurred on a
mission, but there has been no hostile fire.

Available medical equipment is still limited to that carried into the field by mission personnel
but now there is more time to fully assess the casualty and reassess any treatment provided in
the Care Under Fire phase. Time to evacuation may vary from minutes to hours.

Priorities of Tactical Field Care

- Disarm all casualties with an altered mental status

- Obtain airway

- Assess and treat external hemorrhaging

- Manage shock/fluid resuscitation

- Hypothermia prevention

- Pain relief/antibiotics

4-3
4. THIRD PHASE OF TCCC

Tactical Evacuation (TACEVAC) - casualties are transported to a higher level of care.

Tactical evacuation care encompasses both medical evacuation (MEDEVAC) and casualty
evacuation (CASEVAC).

CASEVAC platforms are typically armed tactical assets that bear no Red Cross
markings. They provide unregulated movement from the point of injury to the first point
of advanced medical care.

MEDEVAC refers to regulated casualty movement using dedicated medical evacuation

platforms (ground vehicles, rotary wing aircraft, etc) that are crewed by medical
personnel.

Additional personnel and medical equipment should be provided in this phase which allows
for an enhanced level of medical care compared to the first two phases. Electronic
monitoring systems capable of providing blood pressure, heart rate and pulse oximetry may
be available during evacuation.

TACTICAL COMBAT CASUALTY CARE

Throughout Block 4, each lesson will reinforce the principles of TCCC. At the end of each
lesson you will find a gray box that will highlight the critical task that you will be expected
to perform during your Casualty Assessment Performance Evaluation.

REFERENCE:

Prehospital Trauma Life Support (PHTLS), current Military Edition

4-4
 Intro to TCCC Review Questions

1. What are the three goals of TCCC?

1)

2)

3)

2. What is the first phase of TCCC?

3. What is the only life-saving intervention done during Care Under Fire?

4. Which phase of TCCC is Tactical Field Care?

5. List four priorities of Tactical Field Care.

1)

2)

3)

4)

6. What does TACEVAC encompass?

7. Which phase of TCCC has the most readily available medical equipment?

4-5
 UNITED STATES MARINE CORPS
FIELD MEDICAL TRAINING BATTALION
BOX 555243
CAMP PENDLETON, CA 92055-5243

FMST 402

Manage Shock Casualties

TERMINAL LEARNING OBJECTIVES

1. Given a casualty in an operational environment, treat for shock to reduce the risk of
further injury or death. (8404-MED-2001)

ENABLING LEARNING OBJECTIVES

1. Without the aid of reference, given a description or list, identify standard medical
terminology related to the cardiovascular system, within 80% accuracy, per Prehospital
Trauma Life Support, Current Military Edition. (8404-MED-2001a)

2. Without the aid of reference, given a description or list, identify the anatomy of the
cardiovascular system, within 80% accuracy, per Prehospital Trauma Life Support, Current
Military Edition. (8404-MED-2001b)

3. Without the aid of reference, given a description or list, identify the different types of shock,
within 80% accuracy, per Prehospital Trauma Life Support, Current Military Edition. (8404-
MED-2001c)

4. Without the aid of reference, given a list of types of shock, identify the signs and symptoms
of each type of shock, within 80% accuracy, per Prehospital Trauma Life Support, Current
Military Edition. (8404-MED-2001d)

5. Without the aid of reference, given a list, identify the appropriate treatment of each type of
shock, within 80% accuracy, per Prehospital Trauma Life Support, Current Military Edition.
(8404-MED-2001e)

6. Without the aid of reference, given a simulated shock casualty and a Corpsman Assault Pack,
manage simulated shock casualties, to prevent further injury or death, per Pre-Hospital Trauma
Life Support, Current Military Edition. (8404-MED-2001f)

4-6
OVERVIEW
Shock is regarded as a state of generalized cellular hypoperfusion in which delivery of oxygen to
the cells is inadequate to meet metabolic needs. There is no laboratory test to diagnose shock.
The initial step for managing shock in the injured patient is to recognize its presence. By far, the
most common cause of shock in the trauma casualty is hemorrhage and the safest approach in
managing the trauma casualty in shock is to consider the cause of it as being hemorrhagic until
proven otherwise.

1. CARDIOVASCULAR SYSTEM TERMINOLOGY

Systolic Blood Pressure (SBP) - the force of the blood against blood vessels produced by
ventricular contraction. (Normal systolic B/P = 120-140 mmHg)
Diastolic Blood Pressure (DBP) - the pressure remaining in the blood vessels while the heart
is refilling. (Normal diastolic B/P = 60-80 mmHg)
Preload - the amount of blood returning into the heart from the systemic circulatory system
(venous return).
Afterload - the resistance to blood flow that the heart must overcome to pump blood out to
the arterial system.
Stroke Volume - amount of blood pumped by the heart with each contraction.
Capillary Refill Test - quick test performed on the nail beds as an indicator of tissue
perfusion (normal = less than 3 seconds).
Nervous System - autonomic nervous system is divided into two components:
Sympathetic nervous system (controls the fight-or-flight response): The goal of this
system is to maintain sufficient amounts of oxygenated blood to critical areas while
shunting blood away from nonessential areas. Response includes:
- Heart beats faster and stronger
- Increases ventilations
- Constricts blood vessels of nonessential organs
- Dilates blood vessels of muscles
Parasympathetic nervous system (rest and digest): Division of the nervous system that
maintains normal body functions. Response includes:
- Heart beats slower
- Decreases ventilations
- Increases dilation of blood vessels to nonessential organs

4-7
 Metabolism – energy produced in the body by oxygen and glucose
Aerobic metabolism describes the use of oxygen by the cells. This is the body’s main
combustion process. Cells in the body do not contain an alternate power source.
Anaerobic metabolism occurs without the use of oxygen. It is the back-up power system
in the body and uses stored body fat as its energy source. The lack of perfusion in cells
by oxygenated blood results in anaerobic metabolism and decreased function for organ
survival. If anaerobic metabolism is not reversed, cells cannot continue to function and
will die.

2. ANATOMY OF THE CARDIOVASCULAR SYSTEM

The cardiovascular system consists of the heart (a pump), the blood (circulating fluid), and
the vascular system (the container that holds the blood).
Pump - the heart is a muscle composed of four chambers, the right side receives blood
from the body and the left side pumps blood to
the body (see figure 1). For the heart to work
effectively, an adequate amount of blood must
be present in the ventricles (preload). When
the preload is decreased, the heart muscles are
not stretched enough and the stroke volume is
reduced. Too much blood in the heart creates a
state of increased afterload, also reducing the
stroke volume.
Fluid - blood is composed of many substances.
Red blood cells (RBC) contain hemoglobin and
carry oxygen. White blood cells (WBC) are
used by the body to fight infection. Platelets in
the blood are essential for clotting. The
volume of fluid within the container must equal
the capacity of the vascular system in order to
properly perfuse the tissues of the body. Figure 1. Flow of blood
Container - arteries, veins, and capillaries are the highways
that take the blood throughout the body. The aorta is the largest artery in the body. At
the smallest level, the capillaries may be no bigger than a single cell wide. The size of
the entire “container” is controlled by muscles in the walls of the arteries and veins.
These muscles are under the control of the brain via the sympathetic nervous system. By
expanding and contracting the vessels, the size of the container is altered.

4-8
3. TYPES OF SHOCK
Shock is classified by its cause. Shock can occur in three ways that are associated with
failure of some component of the cardiovascular system, the pump, volume, and container.
The major types of shock are: Hypovolemic, Distributive, and Cardiogenic (see figure 2).

The Three Types of Shock

Hypovolemic Distributive Cardiogenic
Neurogenic Septic Psychogenic
Skin Temp Cool, Clammy Warm, Dry Cool, Clammy Cool, Clammy Cool, Clammy
Skin Color Pale, cyanotic Pink Pale, Mottled Pale Pale, Cyanotic
Vital Sign

Blood Drops Drops Drops Drops (briefly) Drops

Pressure
LOC Altered Lucid Altered Altered (briefly) Altered
Cap Refill Slowed Normal Slowed Slowed (briefly) Slowed

Figure 2. Signs Associated with Types of Shock

Hypovolemic Shock - a state of shock caused by any loss of fluid volume either by blood
loss, dehydration, burns, etc. The container has retained its normal size but the fluid volume
has decreased, creating an imbalance. The most common cause of hypovolemic shock on the
battlefield is due to massive hemorrhage which causes hemorrhagic shock.
The amount of blood that can be lost
before death occurs will vary from What happened to ABC’s????
individual to individual. The average adult The brain can go four to six minutes without oxygen before
blood volume is 5 to 6 liters. Normally, a permanent damage or death. Death from massive
loss of 25-40% of the person's total blood hemorrhage may occur within two minutes.
volume will create a life-threatening
condition. Massive hemorrhage may be fatal within 60-120 seconds. In a tactical
environment, treatment should not be delayed. Controlling major hemorrhage should be
the first priority over securing an airway.
Signs and symptoms seen with hemorrhagic shock are usually linked with the amount of
blood lost and the casualty’s internal reaction to this blood loss. DO NOT rely on BP as the
main indicator of shock! More attention should be paid to the casualty’s mental status,
quality of distal pulses, and tachycardia. Hemorrhagic shock, which is hypovolemic shock
resulting from blood loss, can be categorized into four classes, depending on the severity of
hemorrhage. Remember these parameters are only guidelines and should not be taken as
absolute amounts of associated blood loss (see figure 3).

4-9
 CLASSIFICATIONS OF HEMORRHAGIC SHOCK
Class I Class II Class III Class IV
Amount of Blood Loss <750ml 750-1500ml 1500-2000ml >2000ml
(<15%) (15%- 30%) (30%- 40%) (>40%)
(% total blood volume)
Heart rate Normal or >100 >120 >140
minimally
increased
Pulse (quality) Normal Thready Thready/ very No Radial/
weak thready Carotid
Capillary Refill Normal Delayed Delayed Delayed
(3-5 (>5 seconds) (>5 seconds)
seconds)
Respiratory Rate Normal 20-30 30-40 >35
SBP Normal Normal Decreased Greatly Decreased
(<80 mmHg) (approx. 60
mmHg)
Skin Color Pink Pale White White extremities/
extremities/ Ashen Gray/
Ashen Gray Cyanotic
Skin Temperature Cool Cool, Moist Cool Cold Extremities
Extremities
Mental Status Normal Anxiety Severe Anxiety Lethargic
Fright Confused Unconscious

Figure 3. Classes of Hemorrhagic Shock

Class I Shock - this stage has few clinical manifestations. The casualty's body is able to
compensate to maintain homeostasis.
Class II Shock - although the circulating blood volume is reduced, compensatory
mechanisms such as the sympathetic nervous system are able to maintain blood pressure
and tissue perfusion at a level sufficient to prevent cellular damage.
Class III Shock - at this point, unfavorable signs begin to “A tactically relevant definition
appear. The body’s compensatory systems can no longer of shock is: (1) unconsciousness
maintain adequate perfusion. The classic signs of shock or altered mental status
(tachycardia, tachypnea, and confusion) become obvious. (confused or drowsy) not due to
You can see the importance of catching the casualty in the coexisting TBI or drug therapy;
early stages of shock because by the time the casualty gets and/or (2) abnormal (i.e., weak
to this stage, he or she is in significant trouble. or absent radial pulse."
PHTLS 7th Ed. P. 623

4-10
 Class IV Shock - this is a severe stage of shock! These casualties truly have only minutes
to live. Survival depends on immediate control of hemorrhage (surgery for internal
hemorrhage) and aggressive resuscitation.
Signs and Symptoms
See figure 2.
Treatment
As stated in the Manage Hemorrhage lesson, you must stop the bleeding. Depending on
which phase of field care you are in; Care Under Fire phase use a tourniquet for life-
threatening extremity hemorrhage and Tactical Field Care phase use direct pressure
and/or a hemostatic dressing. Once the bleeding is stopped, obtain vascular access; give
resuscitative fluids, and CASEVAC (see Combat Fluid Resuscitation lesson).
Distributive (Vasogenic) Shock - shock that occurs when the vascular container (blood
vessels) dilate (enlarge) without a proportional increase in fluid volume. As a result, the
hearts preload decreases, and cardiac output falls. There is still the same amount of blood in
the blood vessels but they are dilated too much and not enough blood is returning to the
heart. Causes can be from spinal cord trauma, simple fainting, severe infections, or allergic
reactions.
Septic Shock - life threatening infections occurring primarily in a hospital setting. Toxins
are released into the bloodstream and cause blood vessels to dilate. Septic shock and
hypovolemic shock have many similar signs and symptoms. Septic shock is virtually
never encountered within minutes of an injury. You should focus on prevention of septic
shock. The Committee on Tactical Combat Casualty Care recommends administering the
oral antibiotic moxifloxacin and the parental (injectable) antibiotic ertapenum at the time
of injury to prevent wound infections. You will learn more about medications during the
lesson on Casualty Assessment.
Signs and Symptoms
See figure 2.
Treatment
It usually takes between 5-7 days for septic shock to develop. However, you may
be called on to care for a casualty who sustained an injury and did not promptly
seek medical attention. If so, your primary focus should be to CASEVAC the
casualty to a higher echelon of care. Additionally, the casualty will require IV
antibiotic therapy with a broad spectrum antibiotic.

Neurogenic Shock - shock caused by an injury that interrupts the spinal cord's
sympathetic nervous system pathway, resulting in significant dilation of peripheral
arteries. Because of the loss of sympathetic control of the vascular system which controls
the smooth muscle in the walls of the blood vessels, the peripheral vessels dilate below
the level of injury.

4-11
 Signs and Symptoms (see figure 2 and below)
- Injuries consistent with spinal injury
- Bradycardia with hypotension (low heart rate with low blood pressure should be
a red flag, start suspecting neurogenic shock)
- The casualty with neurogenic shock, in the absence of traumatic brain injury, is
alert, orientated, and lucid (clear in the mind) when in the supine (laying down
on back) position
Treatment
- Maintain ABC’s
- Spinal Immobilization (if mechanism of injury causes a high suspicion of
spinal injury)
- Oxygen therapy to keep oxygen saturation >92% (if available)
- Obtain IV access and give fluids, if necessary
- Trendelenburg position (head down, feet elevated)
- Keep patient warm
- CASEVAC
Psychogenic (Vasovagal) Shock - also known as vasovagal syncope or fainting, this
occurs when there is stimulation of the tenth cranial nerve (vagus nerve) which produces
bradycardia and hypotension. If the bradycardia and hypotension are severe enough,
cardiac output falls, resulting in insufficient blood flow to the brain and the casualty loses
consciousness. Usually, normal blood pressure is quickly restored before systemic
impairment of perfusion occurs. Common causes are fear, receiving unexpected bad
news, or the sight of blood.
Signs and Symptoms (see figure 2 and below)
The periods of bradycardia and vasodilation are generally limited to minutes.
Treatment
Because it is a self-limited condition, a vasovagal episode is unlikely to result in
true “shock” and normal blood pressure is quickly restored when the casualty is
placed in a horizontal position.

Cardiogenic Shock - failure of the heart to adequately pump blood throughout the body,
resulting from causes that can be categorized as either intrinsic (a result of direct damage to
the heart itself, a heart attack, for instance) or extrinsic (related to a problem outside the
heart, a tension pneumothorax, for example). In this scenario, the container is the correct
size and is filled with the right amount of fluid, it’s the pump that is not functioning properly.
Intrinsic Causes: Any injury that weakens the cardiac muscle will affect its output. The
damage may result from a myocardial infarction or from a direct bruise to the heart
muscle from a blunt cardiac injury that prevents the heart from pumping properly.
Signs and Symptoms (see figure 2 and below)
- Abnormal pulse (irregular rate and rhythm)
- Chest pain
- Shortness of breath
- Nausea and vomiting

4-12
 Treatment
- Maintain ABC’s
- Obtain IV access
- Oxygen therapy to keep oxygen saturation >92% (if available)
- CASEVAC

Extrinsic Causes: External factors that cause the heart not to work properly (i.e., tension
pneumothorax and cardiac tamponade)
Signs and Symptoms
Tension Pneumothorax:
- Chest trauma
- Shortness of breath/dyspnea
- Tachycardia
- Cyanosis
- Decreased/absent lung sounds on affected side
- Jugular vein distention/tracheal deviation (late sign)
Cardiac Tamponade:
- Chest Trauma
Why do we learn
- Shortness of breath/dyspnea something that we can’t
- Tachycardia treat?
- Cyanosis Answer: Use these signs and
- Distant heart tones symptoms of cardiac tamponade as
- Narrowing pulse pressure a way for ruling out tension
Treatment pneumothorax.
- Maintain ABC’s
- Oxygen therapy to keep oxygen saturation >92% (if available)
- CASEVAC
- Specific treatment for a tension pneumothorax is needle decompression, which
will be discussed in a future lesson.

Volume Resuscitation
Although volume resuscitation of a trauma casualty in shock makes sense, no research has
demonstrated improved survival of critically injured trauma casualties when IV fluid therapy
has been administered in the field. In fact, one researcher found that IV fluids administered
in the field were beneficial only when three conditions existed:
a. the casualty is bleeding at a rate of 25 to 100 mL/min
b. the IV fluid administration rate is equal to the bleeding rate
c. the scene time and transport time exceed 30 minutes
Transport of the trauma casualty should never be delayed to start an IV.
You will receive training on the type of vascular access (PO, IV, or IO) to start and the type
of fluids to give in the lesson on Tactical Fluid Resuscitation.

4-13
 CASUALTY ASSESSMENT AND SHOCK CASUALTIES
Care Under Fire Phase: There are many things that cause shock, the most common is
uncontrolled hemorrhage. If the casualty has life-threatening extremity hemorrhage, use a
tourniquet. For non-extremity hemorrhage, use direct pressure with a hemostatic dressing like
Combat Gauze.

Tactical Field Care Phase: Shock is very difficult to treat in a hospital setting let alone in a
field or combat environment. Don BSI. Reassess treatment started during Care Under Fire
Phase to control the hemorrhage. Assess airway and intervene if necessary. Complete a head to
toe assessment using DCAP-BTLS noting and treating additional injuries. Determine if vascular
access is required (see Tactical Fluid Resuscitation lesson) and give fluids if necessary. If the
casualty is able to drink fluids, they should be encouraged to do so. Consider pain medications
and give antibiotics if warranted. Reassess all care provided. Document care given, prevent
hypothermia, and CASEVAC.

REFERENCES
Pre-Hospital Trauma Life Support, Current Military Edition

4-14
 Shock Review

1. List the three major types of shock.

2. Describe the signs or symptoms associated with Class III Shock.

3. List the two medications administered to prevent a casualty from developing septic shock.

4. Which is more important for a casualty in shock, IV fluid or rapid transport? Why?

4-15
 UNITED STATES MARINE CORPS
FIELD MEDICAL TRAINING BATTALION
BOX 555243
CAMP PENDLETON, CA 92055-5243

FMST 403

Manage Hemorrhage

TERMINAL LEARNING OBJECTIVE

1. Given a casualty in an operational environment, standard field medical equipment and
supplies, treat hemorrhage to prevent further injury or death. (8404-MED-2002)

ENABLING LEARNING OBJECTIVE

1. Without the aid of references, given a description or list, identify the types of hemorrhage,
within 80% accuracy, per Prehospital Trauma Life Support, current Military Edition. (8404-
MED-2002a)

2. Without the aid of references, given a description or list, identify the signs and symptoms of
hemorrhage, within 80% accuracy, per Prehospital Trauma Life Support, current Military
Edition. (8404-MED-2002b)

3. Without the aid of references, given a description or list, estimate the amount of blood loss,
within 80% accuracy, per Prehospital Trauma Life Support, current Military Edition. (8404-
MED-2002c)

4. Without the aid of references, given a description or list, identify the methods of
hemorrhage control, within 80% accuracy, per Prehospital Trauma Life Support, current
Military Edition. (8404-MED-2002d)

5. Without the aid of references, given a description or list, apply a tourniquet to stop the
bleeding, per Prehospital Trauma Life Support, current Military Edition. (8404-MED-2002e)

6. Without the aid of references, given a simulated casualty with life-threatening hemorrhage
and a Corpsman Assault Pack, manage simulated hemorrhage, to prevent further injury or
death, per Prehospital Trauma Life Support, current Military Edition. (8404-MED-2002f)

4-16
OVERVIEW

Historically, 20% of all injured combatants die on the battlefield. Of that 20%,
approximately 65% will die of massive, multiple trauma and are probably not salvageable.
Based on the data from the Vietnam conflict, over 60% of battlefield casualties died of
exsanguination (bleeding out) within 3 to 5 minutes and could have been saved with timely
intervention. In order to continue to decrease these statistics, you must be able to rapidly
identify and manage internal and external hemorrhage. You must also recognize the type of
bleeding, apply the appropriate hemorrhage control techniques, understand the varying
degrees of risk associated with types of hemorrhage, and understand how to estimate blood
loss.

1. TYPES OF HEMORRHAGE
Hemorrhage is defined as blood escaping from arteries, veins or capillaries.
Arterial - if an artery near the surface is damaged, bright red blood will gush out in
spurts that are synchronized with the heartbeat.
Venous - blood from the veins is dark red. Venous bleeding is characterized by a
steady, even flow.
Capillary - capillary blood is usually brick red in color. If capillaries bleed, the blood
oozes out slowly.
External Hemorrhage - Loss of blood from wounds that damage the large vessels of the
extremities are a common source of massive external hemorrhage in combat. The cause of
external hemorrhage can be varied depending on the setting in which the injury has taken
place. Some of these causes include, but are not limited to, gunshots, stabbings, shrapnel,
vehicle accidents and blasts. The importance for you lies in the identification of life
threatening hemorrhage versus non-life threatening hemorrhage. The difference between life
threatening and non-life threatening exists in the amount of blood loss and the class of shock
of the patient.
Signs and Symptoms
- Massive blood loss
- Obvious sign and symptoms of shock
- Class III or IV shock

Internal Hemorrhage - Blood loss into the chest or abdomen cannot be controlled in the field.
Despite aggressive treatment and fluid resuscitation, casualties with major internal vascular
injuries frequently die in the field. The patient with severe internal hemorrhage may develop
hypovolemic shock before the extent of the blood loss is realized. Internal hemorrhage
requires immediate surgical intervention at a higher capability of care. Bleeding, however
slight, from any body orifice is serious, as it usually indicates an internal source of
hemorrhage that may not be readily evident. Signs that may indicate serious internal injury
(or disease) would include bleeding from the mouth, rectum or blood in the urine.
Nonmenstrual bleeding from the vagina is always significant. Internal hemorrhage can be
caused by the following examples of injuries: blunt trauma, concussion injuries from blasts,
vehicle accidents, falling from heights, collapsing buildings and closed fractures (bones or
bone fragments lacerate arteries or large veins).

4-17
 The FMST may see:
- Hematemesis (vomiting of bright red blood)
- Hemoptysis (coughing up of bright red blood)
- Melena (black tarry stools)
- Hematochezia (bright red blood from the rectum)
- Hematuria (blood in the urine)
- Ecchymosis (bruising)
- Rapidly forming hematoma and edema
- Rigidity with or without rebound tenderness upon palpation in abdomen
- Signs of shock

2. ESTIMATING BLOOD LOSS (EBL) (see Figure 1)

Gather a quick estimation of blood loss based on the following factors:

- Look for blood surrounding the patient.
- Inspect clothing for blood saturation.
- Inspect bandage saturation for associated blood loss. See Figure 1 for amount of blood
each dressing will hold when fully saturated.
- Determine level of shock

Small Battle Medium Battle Abdominal Battle

Large Battle Dressing
Dressing Dressing Dressing
Amount of
300 ml 750 ml 1000 ml 2500 ml
estimated blood

*EBL About 6% About 15% About 20% About 50%

*Amounts are based on the average adult blood volume of about 5 liters.

Figure 1. Estimating Blood Loss Based On Saturation of Dressings

Massive hemorrhage may

be fatal within 60 – 120
seconds. Treatment should
not be delayed and
controlling major
hemorrhage should be the
first priority over securing
the airway.

4-18
3. METHODS OF HEMORRHAGE CONTROL
Direct Pressure
Direct pressure, applied over a bleeding site, is the initial technique used to control external
hemorrhage for non life-threatening bleeding. Most external hemorrhage is readily
controlled by direct pressure at the bleeding site, even carotid and femoral bleeding!
Performing direct pressure correctly requires two hands pushing against the casualty’s
wound, while lying on a flat and hard surface. You must lean into delivery of direct pressure
and never let up on it to check the wound. If you need to perform other procedures, a
pressure dressing can be made using bandages and ace wraps. If direct pressure fails to
control extremity hemorrhage, the next step is to use a tourniquet. The only time a tourniquet
will be the first step in controlling hemorrhage is in the Care Under Fire phase.
Bandages and Dressings
A bandage is any material used to hold a dressing in place. It can be applied to wrap or bind
a body part or dressing. The bandage also provides additional pressure to the dressing or
splint and protects and covers the dressing completely.
Things to keep in mind about bandages/dressings
- Ensure the dressing is tight enough.
- Provide pressure over the entire wound.
- Dressings must cover the entire wound, bandages must cover entire dressing.
- Leave the fingers and toes exposed
- Assess circulation and neurological status using PMS:
Pulse (check pulses in extremities)
Motor (movement)
Sensation (can the patient feel you touching them?)
- If hemorrhage continues:
DO NOT remove the first pressure dressing; apply a second one over the first
The following provides brief information regarding the types of bandages and dressings that
you may encounter:
Kerlix gauze Aspirin use on the battlefield?
Advantages: The use of aspirin or any other blood
- Extremely absorbent thinner while in a combat setting can lead
- Weave of material makes roll semi-stretchable to increased blood loss not only during
surgical procedures, but also when injured
- Sterile
on the battlefield. Aspirin is not sold over
- Good for packing cavities the counter at exchange outlets while
deployed, nor should it be given to Marines
Disadvantages: or Sailors without a doctor’s order. Be sure
- Looses bulk when wet to educate your Marines and other Sailors
- Catches debris and snags very easily on this topic.

4-19
 Ace wrap
Advantages:
- Can be applied quickly
- Gives pressure to the entire affected area
- Provides excellent support for sprains and strains

Disadvantages:
- Can decrease peripheral circulation
Cravats or Triangular Bandages (37”x37”x52”)
Advantages:
- Versatile
- Come in small packages with safety pins
- Can be used as a tourniquet
Disadvantages:
- Has very little absorbency
Combination Dressing/bandage (see Figures 2 & 3)
Cinch Tight, Sterile Compression Bandage (8” x 10”) (See Figure
2) These pressure dressings are four-inch wide elastic wraps with an
8”x10” absorbent cotton pad attached close to the end of one side of
the elastic wrap. On the other side of the absorbent pad, in the middle
on the elastic wrap side, is a steel S-hook that allows for self-
application of the dressing and gives it the ability to be applied
tightly. Finally, at both ends of the elastic wrap are Velcro strips
that allow for ease of securing the dressing. Figure 2. Cinch tight dressing

Instructions for use

- Open and remove bandage.
- Unroll the bandage and place absorbent pad on wound with hook on top.
- Anchor elastic wrap onto Velcro strip at bandages edge.
- Feed elastic bandage through hook and pull to secure absorbent pad in place.
- Wrap the elastic bandage tightly in the direction through which it was pulled.
- Press the Velcro strip at the very end onto the bandage to secure it.

NOTE: Cinch Tight Dressings are being phased out and replaced with the “H” Bandage.
“H” Bandage Combat Dressing (See Figure 3)
These pressure dressing bandages are 4” wide elastic wraps
with 8” x 10” absorbent cotton pad attached close to the end
of one side of the elastic wrap. On the other side of the
absorbent pad, in the middle on the elastic wrap side is a
hard plastic H-anchor that allows for wrapping the dressing
around the anchor to apply pressure directly over wound. It
also gives it the ability for self-application. Pressure
dressings can be applied to extremity, chest, abdominal, and
head wounds. Figure 3. “H” Bandage

4-20
 Instructions for use
- Open and remove pressure dressing.
- Place pressure dressing over injury with steady pressure, isolating Velcro end.
- Pull draped elastic end and secure to Velcro end.
- Feed wrap through lower leg of H anchor, pulling firmly.
- Wind wrap back around injury site and feed wrap through upper leg of H –
anchor, pulling firmly.
- Continue wrapping elastic wrap around injury site, keeping the wrap tight.
- Firmly attach Velcro end of wrap and secure with plastic hooks on sides of
wrap.
- For fractures of the arm, the elastic wrap can be used as a sling or swathe.

Expedient (Improvised) Dressing and Bandages

- Patients clothing.
- Patients equipment.
- Your only limitation is YOUR imagination!!!!

Hemostatic Agents
The recommended hemostatic agent dressing of choice by the CoTCCC is
QuikClot Combat Gauze (see Figure 4). Celox Gauze and ChitoGauze may
also be used if Combat Gauze is not available. A hemostatic agent causes
the wound to develop a clot that stops the flow of blood and will remain
within the wound until removed by medical personnel. It is applied to
wounds with moderate to severe bleeding (venous or arterial). Hemostatic
agents have strengths and liabilities and carry with them the requirement for
specific training for all members of the combat team. Hemostatic agents are
the first line treatment of life threatening hemorrhage in a tactical setting that
is not amenable to tourniquet placement.

Figure 4. Combat Gauze

QuikClot Combat Gauze
Combat Gauze is tailored to the needs of combat and tactical medical
personnel. It combines surgical gauze with an inorganic material that stops arterial and
venous bleeding in seconds. It creates no heat, is inert and non-allergenic. It can be fit to
any size or shape wound, including penetrating wounds. Combat Gauze comes in rolls four
yards long by three inches wide. Remember, hemostatic agents are only to be used when in
the Tactical Field Care Phase of TCCC.
Application Procedures: (see Figure 5)
- Expose injury by opening or cutting away clothing.
- Remove excess blood from wound while preserving any clots that may have formed, if
possible.
- Locate the source of the most active bleeding.

4-21
 - Remove Combat Gauze from package and pack it tightly into the wound directly over
the site of the most active bleeding. (More than one roll of Combat Gauze may be
required to control the hemorrhage.)
- Combat Gauze may be re-packed or adjusted in the wound to ensure proper placement.
- Apply direct pressure quickly with enough force to stop the bleeding.
- Hold direct pressure for a minimum of 3 minutes.
- Reassess for bleeding control.
- Once applied, Combat Gauze is not to be removed (except by proper medical authority).
If bleeding continues, reinforce would with another roll of Combat Gauze and hold
pressure.
- Leave Combat gauze in place and secure with a pressure dressing.
- Document, place empty package near wound, and transport patient.

Figure 5. Application Procedures

4. TOURNIQUET APPLICATION
In civilian trauma care the use of a tourniquet is
reserved for when direct pressure fails; this is not
the case in Care Under Fire. The initial treatment
for an extremity hemorrhage in a tactical setting is a
tourniquet. A pressure dressing can be used later in
the care process of a combat casualty. The standard
“web belt through the buckle” tourniquet issued by
the military during Vietnam was not highly regarded
by the combat medic community. The U.S. Army
Institute of Surgical Research identified the Combat
Application Tourniquet (CAT) as the one best suited
for battlefield use and is the CoTCCC recommended
tourniquet. This tourniquet can be rapidly applied Figure 6. Casualty who was saved using a tourniquet
with one hand to one’s own or another’s
extremities. This tourniquet is issued throughout all U.S. combatant forces. If the CAT is
not available, the provider should be able to make a “field expedient” tourniquet. The use of
the tourniquet in a combat setting is not limited to solely the CAT; there may be other brands

4-22
of tourniquets. While it may have a different name, the principles of use are similar. The
goal is to stop arterial bleeding in an extremity to prevent loss of life. Imagine trying to
control the bleeding of the casualty in figure 4 without a tourniquet!

Characteristics of the CAT (see Figure 7)

- US Army Institute of Surgical Research
and CoTCCC recommended
- Lightweight
- Easy to apply and use

Figure 7. CAT Tourniquet

SOF-T Tourniquet (see Figure 8)

- Special Operations Forces Tactical
Tourniquet
- Also recommended by the CoTCCC
- True 1-1/2 inch constriction band
- Aluminum windlass rod
- Application remains the same, regardless of
location

Figure 8. SOF-T Tourniquet

Field Expedient Tourniquet (see Figure 9)

- If CAT is unavailable, choose a material about two inches (2”) wide.

- Material such as rope, wire and string should
NOT be used because they can cut into flesh.
- Tie a strong windlass (stick) to a cravat or other
strong material.
- Slide one or two rings on each side of the
cravat.
- Tie the cravat around the affected limb, two to
four inches above the wound, loosely. (This
will allow the windlass to turn, creating
circumferential pressure to stop the bleed.)
- Twist the windlass until the hemorrhage is
Figure 9. Improvised Tourniquets
4-23
 controlled.
- Slide the ring to the windlass and secure windlass to the ring(s).

Tourniquet Application
Application site - a tourniquet should be applied
approximately 2-3 inches above the What about those Rings???
hemorrhaging wound, directly on the skin. Examples of good rings to use:
However, during Care Under Fire, this may not - Key chain rings
- Sport drink rings
be possible. Place the tourniquet proximal to - Boot laces tied into a ring
the wound, over the clothing due to tactical - Anything that is in a ring shape with the
requirements. However, once out of the Care approximate diameter of 1-2 inches
Under Fire Phase, reassess tourniquet
application by exposing site and placing tourniquet 2-3 inches above the wound, directly on
the skin. Do NOT place a tourniquet below the knee or elbow or over a joint due to there
being two bones, i.e., Tibia/Fibula below the knee, and Radius/Ulna below the elbow, which
can splint the hemorrhaging vessel and make it impossible to control the bleed.
Application tightness - apply tourniquet tight enough to block arterial flow. Generally, the
bigger the limb, the tighter the tourniquet. So a leg will require more pressure to control
bleeding than an arm will. If injured limb is still present, check distal pulse to ensure it is
occluded.
Other considerations - it may be necessary to use more than one tourniquet to control severe
bleeding. A second tourniquet should be applied just proximal to the first, if needed.
Another thing to remember is that a tourniquet will be painful for the conscious casualty to
tolerate but don’t stop tightening until the hemorrhage is controlled. Pain management
should be considered provided the casualty does not have signs of Class III or IV shock. You
must document placement of a tourniquet by placing a “T” and the time of application on the
casualty’s forehead or other conspicuous spot. After application, do not cover a tourniquet
under any condition, leave it exposed to ease monitoring for continued hemorrhage.
Converting a Trouniquet to a Dressing
Tourniquet use is the first line of hemorrhage control while in the Care Under Fire phase.
Only when in the Tactical Field Care phase should you even consider converting a tourniquet
to a pressure dressing. Do NOT convert a tourniquet to a pressure dressing under the
following conditions:

- The casualty is in Class III or IV shock (you will learn what this is in the Shock lesson).
- There has been a complete amputation below the tourniquet.
- There is no one to monitor the casualty for rebleeding.
- Tourniquet has been in place for more than 6 hours.
- Short transport time to surgical intervention.

4-24
 CASUALTY ASSESSMENT AND HEMORRHAGE CONTROL
Care Under Fire Phase: Hemorrhage control is the only intervention performed during this
phase! You must be able to recognize “life-threatening” hemorrhage. For extremity hemorrhage,
use a tourniquet. For non-extremity hemorrhage, use direct pressure. NO HEMOSTATIC AGENT
USED DURING THIS PHASE!

Tactical Field Care Phase: During this phase, reassess your treatment performed during Care
Under Fire Phase to control the hemorrhage. Don BSI. Assess the airway and intervene if
necessary. Complete a head to toe assessment using DCAP-BTLS (deformities, contusions,
abrasions, punctures, burns, tenderness, lacerations, and swelling) noting and treating additional
injuries. Determine if vascular access is required (see Tactical Fluid Resuscitation lesson) and give
fluids if necessary. If the casualty is able to drink fluids, they should be encouraged to do so.
Consider pain medications and give antibiotics if warranted. Reassess all care provided. Document
care given, prevent hypothermia, and TACEVAC.

References:
Prehospital Trauma Life Support, current Military Edition
Committee on Tactical Combat Casualty Care Meeting Minutes, 22-24 July 2008
MCRP 3-02G

4-25
User’s Instructions for the IFAK

4-26
 Field Medical Training Battalion
HEMORRHAGE CONTROL
PERFORMANCE EXAMINATION CHECKLIST v3.0

STUDENT (Rank Last Name, First Name) PLT

PROCEDURAL STEPS FOR PERFORMING HEMORRHAGE 1ST 2ND 3RD

CONTROL P F P F P F
*State the indication for applying a tourniquet (life-threatening extremity
hemorrhage)
Apply pressure to slow bleeding
*Apply tourniquet 2-3 inches proximal to the hemorrhage site. (Do not
apply over a joint, below the knee or below the elbow)
*Pass self-adhering band through the inside AND outside slit of the friction
adaptor buckle.
Pull the self-adhering band tight and securely fasten the band back on itself.

*Twist the Windlass Rod until the bleeding stops.

*Lock the rod in place with the Windlass Clip.

Secure the rod with the Windlass Strap. Grasp the strap, pull it tight, and adhere it to
the opposite hook on the Windlass Clip.
Document the time of placement; mark the patient’s forehead with “T”

GRADING CRITERIA 1ST 2ND 3RD

Total Non-Critical Items (3 or greater constitutes a failure)

Total Critical Items (Any critical items missed constitutes a failure)

“Stop & Think” (2 allowed for critical items, third constitutes a failure)

1st Evaluator: 2nd Evaluator: 3rd Evaluator:

PASS / FAIL PASS / FAIL PASS / FAIL

Student signature: Student signature: Student signature:

Notes: Notes: Notes:

4-26
 Hemorrhage Review

1. List four signs or symptoms of internal hemorrhage.

1. Identify the appropriate treatment for life threatening hemorrhage during “Care Under Fire”.

2. Where on the extremities should a tourniquet NOT be placed?

4. During which phase of TCCC is the use of hemostatic agents authorized?

4-27
 UNITED STATES MARINE CORPS
FIELD MEDICAL TRAINING BATTALION
BOX 555243
CAMP PENDLETON, CA 92055-5243

FMST 404

Maintain Airway

TERMINAL LEARNING OBJECTIVE

1. Given a casualty in an operational environment, manage respiratory trauma to reduce the
risk of further injury or death. (8404-MED-2003)

ENABLING LEARNING OBJECTIVES

1. Without the aid of reference, given a description or list, identify standard medical
terminology related to the airway, within 80% accuracy, per Prehospital Trauma Life Support,
Current Military Edition. (8404-MED-2003a)

2. Without the aid of reference, given a description or list, identify the anatomy of the airway,
within 80% accuracy, per Prehospital Trauma Life Support, Current Military Edition. (8404-
MED-2003b)

3. Without the aid of reference, given a description or list, identify the signs and symptoms of a
compromised airway, within 80% accuracy, per Prehospital Trauma Life Support, Current
Military Edition. (8404-MED-2003c)

4. Without the aid of reference, given a description or list, identify treatments for a
compromised airway, within 80% accuracy, per Prehospital Trauma Life Support, Current
Military Edition. (8404-MED-2003d)

4-28
OVERVIEW

Airway management plays a prominent role in the management of trauma patients. The
failure to maintain oxygenation and ventilation causes secondary brain injury, compounding
the primary brain injury produced by the initial trauma. Cerebral oxygenation and oxygen
delivery to other parts of the body provided by adequate airway management and ventilation
remain the most important components of prehospital patient care. Inability of the
respiratory system to provide oxygen to the cells or inability of the cells to use the oxygen
supplied results in anaerobic metabolism and can quickly lead to death.

1. AIRWAY TERMINOLOGY (see Figure 1)

Pharynx – Muscle lined with mucous running from the back of the soft palate to the upper
end of the esophagus; divided into three sections
-Nasopharynx
-Oropharynx
-Hypopharynx
Nasal Septum – Separates the left and right airways of the nose
Nares – External openings of nasal cavity
Larynx (voicebox) – Cartilaginous box located above the trachea, containing vocal cords and
muscles that make them work
Epiglottis – Leaf-shaped structure that acts like a gate, directing air into the trachea and
solids/liquids into the esophagus
Trachea (windpipe) – Main trunk of the system of tubes air passes to and from the lungs

2. ANATOMY OF THE AIRWAY

Upper Airway
- Consists of the nasal cavity and oral cavity
Lower Airway
- Consists of the trachea, its branches and the lungs.
On inspiration, air travels through the upper
airway and into the lower airway. The actual gas
exchange occurs in the alveoli. The alveoli are
where the circulatory and respiratory systems
meet.

Figure 1. The Airway

4-29
3. SIGNS & SYMPTOMS OF AIRWAY COMPROMISE
Trauma can affect the respiratory system’s ability to adequately provide oxygen and
eliminate carbon dioxide. Hypoventilation, or inadequate ventilation in order to perform gas
exchange, is one of the most common respiratory problems. If left untreated, hypoventilation
results in CO2 build-up, acidosis, and eventually death. Management involves improving the
patient’s ventilation rate and depth by correcting existing airway problems and assisting
ventilation as appropriate.
Decreased Neurological Function
Decreased minute volume can be caused by two clinical conditions related to decreased
neurological function:
- Flaccidity of the tongue
- Decreased level of consciousness
If a patient is supine, the base of the tongue will fall backward and occlude the
hypopharynx. To prevent the tongue from occluding or to correct this problem
when it occurs, maintaining an open airway must be assured in any supine
patients with a diminished LOC, regardless of whether signs of ventilatory
compromise exist. A decreased LOC will also affect ventilatory drive and may
reduce the rate of ventilation, the volume of ventilation, or both.
Mechanical Obstruction
Another cause of decreased minute volume is mechanical airway obstruction. The source
of these obstructions may be neurologically influenced or purely mechanical in nature.
Foreign objects in the airway may be objects that were in the patient’s mouth at the point
of injury:
- Teeth
- Gum
- Tobacco
- Bone
- Blood
- Vomit
Outside objects may also threaten airway patency:
- Glass
- Rocks
- Debris
Management of mechanical airway obstructions can be extremely challenging. Foreign
bodies may become lodged and create occlusions. Crush injuries and edema may be
present. Patients with facial injuries often present with blood and vomit. Treatment of
these problems is aimed at immediate recognition of the obstruction and the steps taken
to ensure airway patency.

4-30
Assessment of the Airway
- Look for obvious injuries; continue to talk to the casualty
o Talking suggests an open airway
- Be aware of patient’s LOC while in the supine position
- Patient may need to remain in the position found if they are maintaining their own
airway in order to avoid aspiration
Conducting a Physical Examination
- Look
- Listen
- Feel, feel
Look
- Look at the casualty’s face, neck , nose and lips for:
o Cyanosis or edema
o Any obvious injuries
o Blood or any debris
- Open the casualty’s mouth and look for foreign objects or abnormalities
o Broken teeth
o Tobacco or food products
o Debris
- Look for bilateral, normal chest rise and fall during breathing
o Be aware of unilateral chest rise/fall
o Any paradoxical movement of the chest wall
- Look for use of accessory muscles and increased work of breathing
Listen
- Listen for the presence or absence of breath sounds
o Listen to the quality of the respirations
o Listen for any tachypnea or bradypnea
o Listen for the rhythm and depth of respirations
- Listen for any sounds signaling a compromise to the upper airway
o Tongue occluding the hypopharynx causing a snoring sound
o Blood or vomit causing gurgling noises
o Any foreign bodies lodged in the airway

4-31
 Feel, Feel
- Placing your hand on the casualty’s chest and lowering your ear to their mouth
provides you with multiple senses to check the respiratory system. In combat, one or
more of these senses may be diminished due to explosions, gunfire, night operations,
etc.
o Feel for warm breath against your face when casualty exhales
o Feel for equal chest rise and fall with your hand as casualty breathes

4. TREATMENTS FOR A COMPROMISED AIRWAY

Manual Maneuvers of the Airway
The tongue is connected to the mandible and moves forward with it. Any maneuver that
moves the mandible forward will pull the tongue out of the hypopharynx. This can be
accomplished using 2 different methods:
- Trauma Jaw Thrust
- Trauma Chin Lift
Manual Clearing of the Airway
The first step in airway management is a quick visual inspection of the oropharyngeal
cavity. Foreign material or other objects may be found in the mouth of a trauma patient.
These can be swept from the mouth using a finger, but should be avoided in low-light
situations or when the object is lodged deep in the airway. Positioning the patient on
their side will allow gravity to assist in clearing any secretions or objects.

Nasopharyngeal Airway (NPA)

The NPA (see Figure 2) is a soft, rubberlike device that is inserted through one of the
nares and then along the curvature of the posterior wall of the nasopharynx and
oropharynx. This adjunct is used for both conscious and unconscious patients who are
unable to maintain their own airway. When inserted, this adjunct can cause bleeding.

Figure 2. Inserting a Nasopharyngeal Airway

4-32
King Laryngeal Tracheal Tube (King LT airway)
The King LT (see Figure 3) is a single lumen, blindly inserted airway created as an alternate to
tracheal intubation or mask ventilation, resulting in minimal airway trauma with little training
necessary. This adjunct is used only for unconscious patients, as the presence of an intact gag
reflex may cause gagging or vomiting when inserted (see Figure 4). The King LT is latex-free
and can be autoclaved up to 50 cycles.

Figure 3. King LT

Figure 4. King LT Placement

CASUALTY ASSESSMENT AND AIRWAY MANAGEMENT

Care Under Fire Phase: Treatment of the airway is deferred during this phase of care.

Tactical Field Care Phase: During this phase, reassess your treatment performed during Care
Under Fire Phase to control the hemorrhage. Don BSI. Assess the airway and intervene if
necessary. Use the least invasive airway that will provide treatment. Monitor breathing and look
for signs and symptoms of airway compromise. Reassess all care provided. Document care given,
prevent hypothermia, and TACEVAC.

REFERENCE:

Pre-Hospital Trauma Life Support, current military edition

4-33
 Maintain Airway Review

1. Identify the three sections of the pharynx.

2. Identify four types of mechanical airway obstructions.

3. Identify the two manual airway maneuvers.

4. Identify the contraindication for using a King LT airway.

4-34
 UNITED STATES MARINE CORPS
FIELD MEDICAL TRAINING BATTALION
BOX 555243
CAMP PENDLETON, CA 92055-5243

FMST 405

Perform Emergency Cricothyroidotomy

TERMINAL LEARNING OBJECTIVE

1. Given a casualty in an operational environment, standard field medical equipment and
supplies, perform emergency cricothyroidotomy to restore breathing, within the scope of
care, reducing risk of further injury or death. (8404-MED-2008)

ENABLING LEARNING OBJECTIVES

1. Without the aid of references, given a description or list, identify important anatomical
landmarks for an emergency cricothyroidotomy, within 80% accuracy, per Prehospital
Trauma Life Support, Current Military Edition and Emergency Medicine, current edition.
(8404-MED-2008a)
2. Without the aid of references, given a description or list, identify the indications for
performing an emergency cricothyroidotomy, within 80% accuracy, per Prehospital Trauma
Life Support, Current Military Edition and Emergency Medicine, current edition. (8404-MED-
2008b)
3. Without the aid of references, given a description or list, identify the proper equipment for
performing an emergency cricothyroidotomy, within 80% accuracy, per Prehospital Trauma
Life Support, Current Military Edition and Emergency Medicine, current edition. (8404-MED-
2008c)
4. Without the aid of references, given a description or list, identify the procedural sequence
for performing an emergency cricothyroidotomy, within 80% accuracy, per Prehospital
Trauma Life Support, Current Military Edition and Emergency Medicine, current edition.
(8404-MED-2008d)
5. Without the aid of references, given a description or list, identify potential complications of
an emergency cricothyroidotomy, within 80% accuracy, per Prehospital Trauma Life Support,
Current Military Edition and Emergency Medicine, current edition. (8404-MED-2008e)
6. Without the aid of references, given a casualty and a Corpsman Assault Pack, perform an
emergency cricothyroidotomy, to prevent further injury or death, per the FMST Performance
Examination Checklist. (8404-MED-2008f)

4-35
1. ANATOMICAL LANDMARKS (see Figure 1)
Trachea - also known as the windpipe. It is the cartilaginous and membranous tube
descending from, and continuous with, the lower part of the larynx to the bronchi.
Thyroid Cartilage - also known as the “Adam’s Apple.” The thyroid cartilage is located in
the upper part of the throat. The thyroid cartilage tends to be more prominent in men than
women.
Cricoid Cartilage - located approximately ¾-inch inferior to the thyroid cartilage. The
cricoid and thyroid cartilage form the framework of the larynx.
Cricothyroid Membrane - soft tissue depression between the thyroid and cricoid cartilage.
This membrane connects the two cartilages and is only covered by skin.
Carotid Arteries - two principal arteries of the neck.
Jugular Veins - two principal veins of the neck.
Esophagus - muscular tube extending downward from the pharynx to the stomach. The
esophagus lies posterior to the trachea.
Thyroid Gland - largest endocrine gland, the thyroid gland is situated in front of the lower
part of the neck. Consists of a right and left lobe on either side of the trachea.

Jugular Vein

Thyroid Cartilage

Cricothyroid Membrane

Cricoid Cartilage

Carotid Artery

Thyroid Gland

Trachea

Trachea
Figure 1. Anatomical Landmarks

4-36
2. INDICATIONS
Definition - Emergency cricothyroidotomy is a surgical procedure where an incision is made
through the skin and cricothyroid membrane. This allows for the placement of a tracheal
tube into the trachea when control of the airway is not possible by other methods.
There are many reasons an emergency cricothyroidotomy may be required. Listed below are
a few of the most common reasons:
Obstructed airway and/or swelling of tissues will usually prevent the passage of an
endotracheal tube through the airway. Therefore, a surgical airway distal to the
obstruction is required. Causes of an obstructed airway include facial and oropharyngeal
edema from burns or foreign objects (food or teeth).
Congenital deformities of the oropharynx or nasopharynx will inhibit or prevent
nasotracheal or orotracheal intubation.
Trauma to the head and neck would preclude the use of an ambu-bag, oropharyngeal
airway, nasopharyngeal airway and endotracheal tube insertion.
- Massive midface trauma
- Facial fractures (mandible fracture)
- Nasal bone fractures
- Cribiform fractures
Cervical spine fractures in a patient who needs an airway but whose intubation is
unsuccessful or contraindicated.
Contraindications - Massive trauma to the larynx
3. PROPER EQUIPMENT
There are several types of pre-packed kits but you can also put together your own. CoTCCC
has not recommended a specific emergency cric kit but has defined a set of preferred features
for surgical airway kits.
- Scalpel: # 10 blade
- Antiseptic (Alcohol or Povidone-Iodine)
- 6 – 7 mm endotracheal tube with 10cc syringe for balloon cuff
- Means to secure tube (securing ribbon, tape or sutures)
- Instrument to expose and define the opening (Trach Hook or Curved Kelly hemostats)
- Gauze (Petroleum and sterile)
- Bag-valve-mask (BVM) and oxygen source, if available

4-37
4. PROCEDURAL STEPS
Step 1 - Assess patient
Assess airway, LLF, attempt other airways. Make the decision to perform emergency
cricothyroidotomy.
Step 2 - Gather equipment
Ensure all equipment is available and assemble prior to starting the procedure.
Step 3 - Prepare and position patient
The patient should be placed in a supine position, with the neck placed in the neutral
position. Stand to one side of the patient at the neck. If you are right handed, stand to the
right side of the patient; left handed, to the left.
Step 4 - Locate the cricothyroid membrane
Palpate the thyroid and cricoid cartilage for orientation. The cricothyroid
membrane is in the hollow between the two cartilages. If time permits, quickly
cleanse the site with alcohol or betadine swabs.
Step 5 - Make incision
- Stabilize the thyroid cartilage using the thumb and middle finger of your non-dominant
hand to hold the skin taut.
- Using the scalpel, make a vertical incision through the skin approximately 1 inch long
over the cricothyroid membrane. (See Figure 2)
- Visualize the cricothyroid membrane.
- Enter cricothyroid membrane by making a horizontal incision through the cricothyroid
membrane. (See Figure 3)
- DO NOT make the incision more than ½ inch deep or you may perforate the
esophagus.

Figure 2. Vertical Incision Figure 3. Horizontal Incision

4-38
 Step 6 - Open Incision
- Use Trach Hook or curved Kelly hemostats to open incision.
Step 7 - Insert Tube
- Lubricate and insert the endotracheal tube into the opening.
- Ensure the tube is inserted no more than 3 to 4 inches so the tube does not slip
down the right main-stem bronchus with any movement.
- Inflate balloon with 10cc’s of air.
Step 8 - Check for proper placement
- Connect a bag-valve-mask device or manually ventilate patient with two breaths.
- Check for breath sounds. If no ventilations are heard, pull the tube out
and reinsert it.
- Recheck for breath sounds to ensure tube is positioned correctly.
- If breath sounds are absent on the left side only, the tube has been inserted
down the right main-stem bronchus and should be pulled back a few centimeters.
This typically occurs with the use of the endotracheal tube.
- Recheck for breath sounds to ensure tube is positioned
correctly.
- Connect to Oxygen Supply (if available)
Step 9 - Secure Dressing
- Secure the tube with ribbon, sutures and/or tape.
- Apply petroleum gauze followed by sterile gauze. (See
Figure 4)
Step 10 - Monitor Patient Figure 4. Y-cut Gauze

- Continuously reassess and monitor patient.

- 1 breath every 5 seconds if patient is not breathing on their own.
5. ASSOCIATED COMPLICATIONS
Hemorrhage - The most common complication.
Causes
- Minor bleeding may be caused by lacerating superficial capillaries in the skin.
- Significant bleeding may be caused by the laceration of major vessels (carotid
arteries and the jugular veins) within the neck.

4-39
 Treatment
- Minor bleeding is treated with direct pressure and the application of a simple
pressure dressing.
- Significant bleeding - treated same as minor. However, if unable to control the
bleeding, the vessel may need to be ligated (tied off).
Esophageal perforation - the creation of a hole between the esophagus and trachea.
Causes
- Creating an incision too deep through the cricothyroid membrane.
- Forcing the ET tube through the cricothyroid membrane and into the esophagus.
Treatment
- Requires surgical repair at higher echelon of care.
Subcutaneous emphysema - the presence of free air or gas within the subcutaneous tissues.
Upon palpation, a crackling sensation may be felt as the air is pushed through the tissue.
Causes
- Creating too wide of an incision will allow air entrapment under the skin.
- Air leaking out of the insertion site may get trapped under the skin.
Treatment
- No treatment is necessary; will resolve spontaneously within a few days.
- The placement of petroleum gauze dressing around the incision/insertion site
will help reduce the incidence of subcutaneous emphysema.

FYI
Why Don’t We Learn How to Intubate? (PHTLS Manual)

1. No studies have examined the ability of well-trained but relatively inexperienced military
medics to accomplish endotracheal intubation.
2. Many Corpsmen and Medics have never performed an intubation on a live casualty or even
a cadaver.
3. Standard endotracheal intubation techniques entail the use of a tactically compromising
white light in the laryngoscope.
4. Endotracheal intubation can be extremely difficult in a casualty with maxillofacial injuries.

4-40
 CASUALTY ASSESSMENT AND EMERGENCY CRICOTHYROIDOTOMY

Care Under Fire Phase: In the absence of life-threatening hemorrhage, there is no care given for a
casualty who needs a surgical cricothyroidotomy in this phase.
Tactical Field Care Phase: Cricothyroidotomy is a skill you may use during the Tactical Field Care
phase. The need to perform an emergency cricothyroidotomy is made after you have attempted to
control the airway with other, less invasive methods (i.e. NPA). Remember, once the patient has
received a cricothyroidotomy, they are now totally dependent upon you and now become much more
difficult to manage in a tactical environment.

REFERENCES
Prehospital Trauma Life Support, current Military Edition
Emergency Medicine, current edition

4-41
 Field Medical Training Battalion
EMERGENCY CRICOTHYROIDOTOMY
PERFORMANCE EXAMINATION CHECKLIST v3.0
STUDENT (Rank, Last Name, First Name) PLT

PROCEDURAL STEPS FOR PERFORMING AN EMERGENCY 1ST 2ND 3RD

CRICOTHYROIDOTOMY P F P F P F
* State the indications for an emergency cricothyroidotomy (obstructed airway,
congenital deformities, trauma to head/neck, cervical spine fracture)
* State the contraindications for an emergency Cricothyroidotomy (massive
trauma the larynx or cricoid cartilage)
* Assess patient and make decision to perform emergency cricothyroidotomy.
(ABC’s, LLF, Failed attempts at all other airway management)
Assemble and check equipment (Scalpel #10 blade, ET tube, 10 cc syringe, tape,
Curved Kelly hemostats/Trach Hook, gauze)
Prepare patient (Place patient in supine or semi-recumbent position and place neck
in neutral position)
* Locate landmarks (palpate thyroid and cricoid cartilages, locate cricothyroid
membrane)
Cleanse the incision site with alcohol or betadine

Stabilize the thyroid cartilage using your non-dominant hand

Make 1 inch, vertical incision over the cricothyroid membrane

Visualize cricothyroid membrane

Make ½ inch, horizontal incision to cut through the cricothyroid membrane

Open incision with blunt dissection

* Insert endotracheal tube into the incision, directing the tube distally down the
trachea (no more than 3 - 4 inches)
Inflate balloon with 10cc’s of air
* Ventilate patient with two breaths & check for proper placement (Auscultate
epigastric area - If patient has epigastric sounds, remove and retry, observe
for bilateral rise/fall of chest, misting or fogging in E.T. tube and auscultate for
breath sounds bilaterally)
Lung sounds on right side only (deflate cuff, pull back ¼- ½ inch, re-inflate cuff,
recheck placement
Secure tube
Apply dressing (petroleum gauze on insertion site, dry sterile dressing over
petroleum gauze)
Reassess & monitor patient (if not breathing on own, 1 breath every 5 seconds,
suction as necessary)
State complications of cricothyroidotomy (hemorrhage, esophageal perforation
subcutaneous emphysema)

4-42
 Field Medical Training Battalion
EMERGENCY CRICOTHYROIDOTOMY
PERFORMANCE EXAMINATION CHECKLIST v3.0

GRADING CRITERIA 1ST 2ND 3RD

Total Non-Critical Items (5 or greater constitutes a failure)

Total Critical Items (Any critical items missed constitutes a failure)

“Stop & Think” (2 allowed for critical items, third constitutes a failure)

1st Evaluator: 2nd Evaluator: 3rd Evaluator:

PASS / FAIL PASS / FAIL PASS / FAIL

Student signature: Student signature: Student signature:

Notes: Notes: Notes:

4-43
 Cricothyroidotomy Review
1. List the four indications for an emergency cricothyroidotomy.

2. List the ten steps in performing an emergency cricothyroidotomy.

1) 6)

2) 7)

3) 8)

4) 9)

5) 10)

3. Identify the three common complications from performing an emergency cricothyroidotomy.

4. What equipment is necessary to perform an emergency cricothyroidotomy?

5. Identify the anatomical landmarks below

4-44
 UNITED STATES MARINE CORPS
FIELD MEDICAL TRAINING BATTALION
BOX 555243
CAMP PENDLETON, CA 92055-5243

FMST 406

Manage Respiratory Trauma

TERMINAL LEARNING OBJECTIVES

1. Given a casualty in an operational environment, manage respiratory trauma to reduce the
risk of further injury or death. (8404-MED-2003)

2. Given a casualty with a tension pneumothorax in an operational environment, equipment and

supplies, perform a needle thoracentesis reducing the risk of further injury or death. (8404-
MED-2009)

ENABLING LEARNING OBJECTIVES

1. Without the aid of reference, given a description or list, identify standard medical
terminology related to the respiratory system, within 80% accuracy, per Prehospital Trauma
Life Support, current Military Edition. (8404-MED-2003e)

2. Without the aid of reference, given a description or list, identify the anatomy of the
respiratory system, within 80% accuracy, per Prehospital Trauma Life Support, current Military
Edition. (8404-MED-2003f)

3. Without the aid of reference, given a description or list, identify the signs and symptoms of
respiratory trauma, within 80% accuracy, per Prehospital Trauma Life Support, current
Military Edition. (8404-MED-2003g)

4. Without the aid of reference, given a description or list, identify treatments for chest
injuries, within 80% accuracy, per Prehospital Trauma Life Support, current Military Edition.
(8404-MED-2003h)

5. Without the aid of reference, given a simulated casualty with a chest injury and Corpsman
Assault Pack, manage the simulated casualty, to prevent further injury or death, per Prehospital
Trauma Life Support, current Military Edition. (8404-MED-2003i)

6. Without the aid of reference, given a description or list, identify important anatomical
landmarks for needle thoracentesis, within 80% accuracy, per the Prehospital Trauma Life
Support, current Military Edition. (8404-MED-2009a)

7. Without the aid of reference, given a description or list, identify the indications for needle
thoracentesis, within 80% accuracy, per the Pre-Hospital Trauma Life Support Manual, current
Military Edition. (8404-MED-2009b)
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8. Without the aid of references, given a description or list, identify the proper equipment for
performing needle thoracentesis, within 80% accuracy, per the Pre-Hospital Trauma Life
Support Manual, current Military Edition. (8404-MED-2009c)

9. Without the aid of references, given a description or list, identify the procedural sequence
for performing needle thoracentesis, within 80% accuracy, per the Pre-Hospital Trauma Life
Support Manual, current Military Edition. (8404-MED-2009d)

10. Without the aid of reference, given a description or list, identify the potential complications
when performing needle thoracentesis, within 80% accuracy, per the Pre-Hospital Trauma
Life Support Manual, current Military Edition. (8404-MED-2009e)

11. Without the aid of references, given a simulated casualty and a Corpsman Assault Pack,
perform a needle thoracentesis, to prevent further injury or death, per the FMST Performance
Examination Checklist. (8404-MED-2009f)

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1. RESPIRATORY SYSTEM TERMINOLOGY
Dyspnea - Difficult or labored breathing.
Wheeze - A form of rhonchus, characterized by a whistling respiratory sound. It is caused by
the movement of air through a narrowed airway.
Stridor - A harsh shrill respiratory sound.
Hyperventilation - An increase in the rate and depth of normal respirations. Responsible for
`increasing oxygen levels and decreasing carbon dioxide levels.
Hypoventilation - Loss of ventilatory drive, usually from decrease neurological function most
often after a TBI. This can also be cause by an upper or lower airway obstruction, and
decreased expansion of the lungs.
Tachypnea – An abnormally rapid rate of respiration.
Bradypnea - An abnormally slow rate of respiration, usually less than 8 breaths per minute.
Hypoxia - An insufficient concentration of oxygen in the tissue in spite of an adequate blood
supply.
Apnea - Total cessation of breathing, also known as respiratory arrest.
Subcutaneous emphysema - The presence of free air or gas in the subcutaneous tissues. The
face, neck, or chest may appear swollen with painful skin and produce a crackling sound
(“Rice Krispies”).

2. ANATOMY OF THE RESPIRATORY SYSTEM

Thorax (Chest Cavity) (see Figure 1)

The skeletal portion of the thorax is a bony cage

formed by the sternum, costal cartilages, ribs and the
bodies of the thoracic vertebrae.

Ribs
- Joined in the posterior with the thoracic
spine and anterior with the sternum via the
costal cartilage.
- A nerve, an artery and a vein are located along the underside Figure 1. Thorax
of each rib.
- Intercostal muscles connect each rib with the one above.

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 Diaphragm - The primary muscle of respiration.
Pleura (see Figure 2)
The pleura are thin membranes separated by a small amount of fluid, which creates
surface tension and causes them to cling together, counteracting the lung’s natural
tendency to collapse.

Parietal pleura - a thin membrane that lines the inner side of the thoracic cavity.

Visceral pleura - a thin membrane that covers the outer surface of each lung.

Figure 2. Pleura
Lungs (see Figure 3)

- The lungs occupy the right and left halves of the thoracic cavity.
- The left lung is divided into two lobes.
- The right lung is larger than the left lung and is divided into three lobes.

Alveoli - the smallest components of the lungs. They are small saclike structures through
which the exchange of carbon dioxide and oxygen take place.

Figure 3. Lungs
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 Mediastinum
The area in the middle of the thoracic cavity in which all the other organs and structures
of the chest cavity lie. It encases the:
- Heart
- Great vessels (aorta, superior/inferior vena cava)
- Trachea (windpipe)
- Mainstem bronchi (there are two bronchi- a right and left)
- Esophagus (lies directly behind the trachea)

3. SIGNS & SYMPTOMS OF RESPIRATORY TRAUMA

Chest injuries are the second leading cause of trauma deaths each year, although the vast
majority of all thoracic injuries (90% of blunt trauma and 70 to 85% of penetrating trauma)
can be managed without surgery. Traumatic chest injuries can be caused by a variety of
mechanisms; however, these injuries are usually classified as either blunt or penetrating.
Penetrating Injuries - caused by forces distributed over a small area (i.e., gunshot wounds
or stabbings). Most often, the organs injured are those that lie along the path of the
penetrating object.
Blunt Trauma - caused by forces distributed over a larger area, and many injuries occur
from deceleration, bursting, or shearing forces. Conditions such as pneumothorax,
pericardial tamponade, flail chest, pulmonary contusion and aortic rupture should be
suspected when the mechanism of injury involves rapid deceleration, including motor
vehicle collisions, falls, sport injuries and crush injuries.

Assessment of Respiratory Trauma - besides the overall mechanism of injury, casualties

are asked of any symptoms they may be experiencing if they are conscious and able to
communicate. Victims of chest trauma will likely be experiencing chest pain, which may be
sharp, stabbing, or constricting. Frequently, the pain is worse with respiratory efforts or
movement. The casualty may experience shortness of breath and may feel apprehensive or
lightheaded if shock is developing.
The next step in assessment is a physical examination. The components to the physical
examination include: observation, auscultation, and palpation.

Observation - casualty is observed for pallor of the skin and sweating, which may indicate
shock. The presence of cyanosis (bluish discoloration of skin, especially around the mouth
and lips) may be evident in advanced hypoxia.

- Observe frequency of respirations (rate, rhythm, and depth), and the appearance of having
trouble breathing (gasping, contractions of the accessory muscles in the neck, or nasal
flaring.)

- Look for signs of trachea deviation and distended jugular veins.

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- The chest is examined for contusions, abrasions, lacerations, and whether the chest wall
expands symmetrically with breathing. Identify whether any portion of the chest wall moves
paradoxically with respiration (instead of moving out during inspiration, does it collapse
inward and vice versa during exhalation)?

Auscultation - the entire chest is evaluated to identify decreased breath sounds on one side
compared to the other which may indicate pneumothorax or hemothorax on the examined
side. Pulmonary contusions may result in abnormal breath sounds (crackles).

Palpation - by gently pressing the chest wall with hands and fingers, assessment for the
presence of tenderness, crepitus (either bony or subcutaneous emphysems), and bony
instability of the chest wall is performed.

Management of Specific Injuries

Rib fracture - occurs when pressure is applied with enough force to exceed the strength of
the rib. Remember that any fractured rib can cause associated injuries to nearby
structures.
Causes - blunt trauma, crushing injuries to the chest.
Signs and Symptoms
- Pain at the site with inhalation/exhalation
- Shortness of breath
- Deformity
- Crepitus
- Bruising to area
Treatment
- Anticipate potential complications such as tension pnuemothorax, pericarditis,
or cardiac tamponade.
- Simple rib fractures usually require no treatment other than analgesics.
- Multiple rib fractures may require immobilization of the arm on affected side to
protect the ribs.
- Encourage coughing and deep breathing despite associated pain. This is to
prevent the collapse of the lung tissue and preventing the exchange of CO2 and
O2 (atelectasis).
- Avoid any taping or bandaging that encircles the chest.
- Monitor and TACEVAC as necessary.

Flail chest - a condition of the chest wall due to two or more adjacent ribs being fractured
in at least two or more places. The flail segment moves paradoxically in with inspiration
and out during expiration (see Figure 4)
Causes - blunt trauma to the chest wall, especially an impact into the sternum or the
lateral side of the thoracic wall.

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 Signs and Symptoms
- Localized chest pain, aggravated by breathing or coughing
- Rapid shallow respirations
- Tenderness and/or bony crepitus with palpation
- Subcutaneous emphysema
Treatment
- Immobilize flail segments upon inhalation using strips of tape.
- If you suspect respiratory failure, give positive pressure ventilation using a bag
valve mask.
- Administer analgesics
- Administer oxygen if available.
- TACEVAC to the next capability of care.

As a result of paradoxical
chest wall movement during
inspiration, the flail segment
of the rib cage moves inward
(instead of outward), which
results in reduced air intake.

Figure 4. Flail Chest

Pneumothorax - a simple pneumothorax is caused by the presence of air in the pleural

space. The air separates the two pleural surfaces, causing the lung on the involved side to
collapse as the separation expands. As air continues to build up and pressure in the space
increases, the size of the lung on the affected side continues to decrease. Eventually, the
lung may partially or totally collapse.
Causes
- Penetrating trauma from either chest wall injury or abdominal injuries that cross
the diaphragm.
- Blunt trauma
- Spontaneous (with no apparent cause)

Signs and Symptoms

- Pleuritic chest pain
- Tachypnea/dyspnea
- Decreased or absent breath sounds on the injured side
- Decreased chest wall motion

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 Treatment
- Place patient in sitting up or Semi-Fowlers position
- Use BVM if hypoxia is present
- Administer oxygen if available
- If caused by a wound, apply an occlusive dressing to the site
- Monitor for signs and symptoms of a tension pneumothorax
- TACEVAC ASAP
Tension Pneumothorax (see Figure 5) - A type of pneumothorax in which air can enter
the pleural space but cannot escape via the route of entry. This is the second leading
cause of preventable death on the battlefield. This leads to an increase of pressure in the
pleural space and eventual collapse of the lung. This pressure forces the mediastinum to
the opposite side, which results in two serious consequences: (1) breathing becomes
increasingly difficult and (2) cardiac blood flow is severely decreased.

Compressed vessels

Compressed lung

Wound site
Compressed
superior vena
cava

Compressed
heart
Pleural space
filled with air Collapsed lung

Diaphragm

Figure 5. Tension Pneumothorax

Cause - chest injuries.

In some cases, the only signs
Signs and Symptoms
of a developing tension
Early signs pneumothorax are
- Unilateral (one sided) decreased or absent compromised oxygenation,
breath sounds
- Dyspnea
tachycardia, tachypnea, and
- Tachypnea unilateral decreased or
absent breath sounds.

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 Progressive signs
- Increased dyspnea
- Increased tachypnea
- Increased difficulty ventilating

Late signs
- Jugular vein distention (JVD)
- Tracheal deviation
- Signs of acute hypoxia
- Narrowing pulse pressures
- Signs of uncompensated shock
Treatment
- Treat all chest injuries
- Perform needle thoracentesis
- Administer oxygen therapy if available
- Pain management
- Monitor and TACEVAC
Open Pneumothorax (Sucking Chest Wound) - a collection of air or gas in the pleural
space causing the lung to collapse. An open wound allows air to enter when the
intrathoracic pressure is negative and blocks the air’s release when the intrathoracic
pressure is positive; creating a “sucking chest wound,” that has the potential to cause a
tension pneumothorax.
Causes - most often the result of gunshot wounds, but they can also occur from
impaled objects, stabbings, and occasional blunt trauma.
Signs and Symptoms
- Pain at the injury site
- Chest wall trauma
- Shortness of breath
- Tachypnea
- Subcutaneous emphysema
- Decreased chest wall motion
- May hear a moist sucking or bubbling sound as air moves in and out of the chest
wall defect.
Treatment
- The immediate treatment is to seal the wound with an occlusive dressing. This
intervention helps to restore air flow into the lung during inspiration, but could
lead to the development of a tension pneumothorax. If an exit wound is present
tape it on all four sides.
- Assess both anterior and posterior torso for penetrating trauma.
- Monitor for signs and symptoms of tension pneumothorax. If signs of
increasing respiratory distress develop, the dressing over the wound should be
removed to allow for decompression of any accumulating tension. If this is
ineffective, needle decompression and positive pressure ventilation (if available)
should be considered if not already employed.

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 - Administer oxygen if available
- Place patient on affected side
- Pain management
- Monitor and TACEVAC
Hemothorax - the accumulation of blood in the pleural space caused by a laceration of the
great vessels within the chest that can significantly compromise respiratory efforts by
compressing the lung and preventing adequate ventilation.
Causes - Penetrating or blunt trauma
Signs and Symptoms
- Shortness of breath
- Chest pain
- Tachypnea
- Signs of shock (pallor, confusion, tachycardia, hypotension)
- Decreased breath sounds on affected side
- Hemoptysis (coughing up blood)
- Decreased chest wall motion
Treatment
- Place patient in the Fowler’s position
- Treat any chest injuries
- Treat for shock
- Administer O2, if available
- Pain management
- Monitor and TACEVAC
Hemopneumothorax - often with penetrating trauma, a pneumothorax is associated with a
hemothorax, and an accumulation of air, blood, and fluid within the pleural cavity.
Causes - penetrating trauma to the chest wall, the great vessels, or the lung.
Signs and Symptoms
- Tachypnea
- Decreased breath sounds
- Signs of shock
Treatment
- Place patient in Fowler’s position
- Perform needle thoracentesis to relieve pressure. If blood is withdrawn,
immediately remove needle and catheter.
- Administer oxygen, if available
- Treat for shock
- Monitor and TACEVAC

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NEEDLE THORACENTESIS
Needle thoracentesis is a procedure where a needle and catheter are inserted through the chest
wall into the pleural space. The catheter provides a pathway for the release of accumulated
pressure within the pleural space. This procedure helps reduce pressure on the heart, lungs and
major vessels within the chest cavity that have compromised the patient’s breathing and
circulation.
4. ANATOMICAL LANDMARKS (See Figure 6)

Mid-Clavicular Line (MCL)

- Imaginary line that dissects the middle of A A
the clavicle on the right or left side

2nd Intercostal Space

- Space between the 2nd and 3rd rib.
- From the MCL, palpate down. The first
space immediately after the clavicle is the B
1st intercostal space. Continuing down,
the first space below the next rib is the
2nd intercostal space.

An acceptable alternative location

is the 4th or 5th intercostal space at
the anterior auxiliary line. This
A – Mid-Clavicular Lines B– 2nd Intercostal Space
method will not be taught during
Figure 6. Needle Thoracentesis Anatomical Landmarks
FMST; however you will learn
this technique at follow-on
training.

5. INDICATIONS
Tension Pneumothorax
- Any casualty with thoracic injury is at risk for developing a tension pneumothorax.
- Casualties at particular risk are those who have a penetrating wound to the chest
and those with signs of rib fracture.
- There are no significant contraindications for needle thoracentesis with penetrating
chest trauma.

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6. PROPER EQUIPMENT
- 14-gauge, 3.25-inch needle/catheter
- Antiseptic solution (if available)
- Gloves

7. PROCEDURAL STEPS
Assess Casualty and Make Decision - based on mechanism of injury (MOI) and a noted
increase in difficulty breathing.
- Inspect - look for bilateral rise and fall of the chest during respirations.
- Auscultate - listen to the lung fields at the mid-clavicular and mid-axillary lines
bilaterally if tactical situation allows (it may be hard to hear in a combat setting).
- Palpate - feel for flail segments or crepitus.
Assemble and Check Equipment - Gather 14-gauge, 3.25-inch needle/catheter, alcohol
swab and gloves.

Prepare Patient
- Position the patient in upright position (if possible)
- Explain the procedure to the patient, if conscious
- Expose the anterior chest

Identify Landmarks **ON THE AFFECTED SIDE**

- Midclavicular line
- 2nd Intercostal space

Perform the Procedure

- Cleanse the area
- Insert catheter - Firmly insert the needle into the skin over the top of the third rib
into the second intercostal space at a 90 degree angle.
- Puncture the parietal pleura - Ensure the chest cavity has been penetrated, as
evidenced by feeling a "pop" as the needle enters the chest cavity. The pressure
may be so great that a rush of air may be encountered.
- Remove needle - secure catheter to chest wall.

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 Reassess the Patient
- Inspect, Auscultate, and Palpate (IAP) Chest
- Visually inspect the neck
- Monitor the patient’s response to the needle thoracentesis (respiratory rate, lung
sounds, and skin color)
- Be ready to insert a 2nd catheter if the patient does not improve.

8. COMPLICATIONS
Hemothorax - blood within the pleural space. May be caused when the needle
punctures any vessels within the chest wall.
Cardiac Tamponade - pressure on the heart that occurs when blood or fluid builds up in
the space between the heart muscle and the pericardium. Ensuring that the insertion site
for the needle is at or lateral to the nipple line will help avoid this complication.
Subcutaneous emphysema - released air becomes trapped within the subcutaneous
tissue. Feels like “Rice Krispies” underneath the skin.
Misdiagnosis - performing a needle thoracentesis on a casualty with non-penetrating
torso trauma could result in a pneumothorax if not already present.

i. F
FYI!!!
Defense Health Board (DHB) Needle
Decompression of Tension Pneumothorax TCCC
Guidelines 2012-05:
Cardiopulmonary resuscitation on the battlefield for
victims of blast or penetrating trauma who have no
pulse, no ventilations, and no other signs of life will
not be successful and should not be attempted.
However, casualties with torso trauma or
polytrauma who have no pulse or respirations
during Tactical Field Care should have bilateral
needle decompression performed to ensure they
do not have a tension pneumothorax prior to
discontinuation of care.

4-57
 CASUALTY ASSESSMENT AND RESPIRATORY TRAUMA
Care Under Fire Phase: In the absence of life-threatening hemorrhage from the respiratory
system, the material in this section is unlikely to be addressed in the Care Under Fire phase.

Tactical Field Care Phase: During this phase, you will be required to assess the quality of
breathing, which will require you to expose the casualty’s chest. Consider needle thoracentesis if
warranted. Needle thoracentesis is a skill that is used during the Tactical Field Care phase in the
treatment of respiratory trauma. If a casualty has a torso injury and difficulty breathing, you
should perform a needle thoracentesis. Remember, a tension pneumothorax can develop at any
time after an injury, not just immediately after, so continuous assessment of the casualty is
necessary. Don PPE. Note and treat all respiratory injuries. Complete a head to toe assessment
using DCAP-BTLS noting and treating additional injuries. Determine if vascular access is
required (see Tactical Fluid Resuscitation lesson) and give fluids if necessary. If the casualty is
able to drink fluids, they should be encouraged to do so. Consider pain medications and give
antibiotics if warranted. Reassess all care provided. Document care given, prevent hypothermia,
and TACEVAC.

REFERENCE
Prehospital Trauma Life Support, current Military Edition

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 Field Medical Training Battalion
NEEDLE THORACENTESIS
PERFORMANCE EXAMINATION CHECKLIST v3.0

STUDENT (Rank Last Name, First Name) PLT

PROCEDURAL STEPS FOR PERFORMING A NEEDLE 1ST 2ND 3RD

THORACENTESIS P F P F P F
* State the indication for a needle thoracentesis (tension pneumothorax)
State the possible complications of a needle thoracentesis (hemothorax, cardiac
tamponade, subcutaneous emphysema)
* Assess casualty and make decision to decompress (ABC’s, LLF, S/SX of
pneumothorax)
Assemble and check equipment (14-gauge, 3.25-inch needle/catheter, alcohol)

Prepare patient (position, explain, expose)

nd
* Identify landmarks (midclavicular line, 2 intercostal space, equal/lateral to
nipple line)
Cleanse the area

* Insert catheter at 90-degree angle and puncture the parietal pleura

* Remove needle (allow lung to decompress)

Secure catheter to chest

Reassess & monitor patient for improvement (decrease in respiratory difficulty)

GRADING CRITERIA 1ST 2ND 3RD

Total Non-Critical Items (3 or greater constitutes a failure)

Total Critical Items (Any critical items missed constitutes a failure)

“Stop & Think” (2 allowed for critical items, third constitutes a failure)

1st Evaluator: 2nd Evaluator: 3rd Evaluator:

PASS / FAIL PASS / FAIL PASS / FAIL

Student signature: Student signature: Student signature:

Notes: Notes: Notes:

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 Respiratory Trauma Review

1. Identify five structures found in the mediastinum.

2. Identify the appropriate treatment for a simple rib fracture.

3. Identify the two serious consequences of a tension pneumothorax.

4. Identify the treatment for a sucking chest wound.

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5. Identify the major landmarks used in performing a needle thoracentesis.

6. What are the indications for a needle thoracentesis? Contraindications?

7. List the equipment needed to perform a needle thoracentesis.

8. Explain the acronym IAP and what you are specifically looking for before making the
decision to perform a needle thoracentesis.

9. Explain how and where to insert the needle/catheter.

10. Identify the possible complications of performing a needle thoracentesis.

4-61
 UNITED STATES MARINE CORPS
FIELD MEDICAL TRAINING BATTALION
BOX 555243
CAMP PENDLETON, CA 92055-5243

FMST 407

Manage Abdominal Injuries

TERMINAL LEARNING OBJECTIVE

1. Given a casualty in an operational environment, treat abdominal injuries reducing the risk
of further injury or death. (8404-MED-2006)

ENABLING LEARNING OBJECTIVES

1. Without the aid of reference, given a description or title, identify anatomy of the major
abdominal organs, within 80% accuracy, per Prehospital Trauma Life Support, current Military
Edition. (8404-MED-2006a)

2. Without the aid of reference, given a description or title, identify the significance of the
types of organs in abdominal injuries, within 80% accuracy, per Prehospital Trauma Life
Support, current Military Edition. (8404-MED-2006b)

3. Without the aid of reference, identify the two major mechanisms of abdominal trauma,
within 80% accuracy, per Prehospital Trauma Life Support, current Military Edition. (8404-
MED-2006c)

4. Without Without the aid of reference, given a description or list, identify the signs and
symptons of abdominal injuries, within 80% accuracy, per Prehospital Trauma Life Support,
current Military Edition. (8404-MED-2006d)

5. Without the aid of reference, given a description or list, identify the proper treatment of
abdominal injuries, within 80% accuracy, per Prehospital Trauma Life Support, current
Military Edition. (8404-MED-2006e)

6. Without the aid of reference, given a simulated casualty with abdominal injuries and a
Corpsman Assault Pack, manage simulated abdominal injuries, to prevent further injury or
death, per Prehospital Trauma Life Support, current Military Edition. (8404-MED-2006f)

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OVERVIEW
Unrecognized abdominal injury is one of the major causes of death in the trauma casualty. Early
deaths from severe abdominal trauma typically result from massive blood loss caused by either
penetrating or blunt injuries. The abdomen contains the major organs of digestion and excretion.
The abdominal cavity is located below the diaphragm; its boundaries include the anterior
abdominal wall, the pelvic bones, the vertebral column, and the muscles of the abdomen and
flanks. Many organs lie in both the abdomen and the pelvis. The simplest and most common
method of describing the portions of the abdomen is by quadrants. In this system, the abdomen
is divided into four equal parts by two imaginary lines that intersect at right angles at the
umbilicus. The abdomen can further be divided to more specifically identify a region of the
abdomen (see Figure 1).

1. MAJOR ABDOMINAL ORGANS AND THEIR LOCATIONS

Right Upper Quadrant (RUQ)
Colon - the part of the large intestine that extends from the cecum to the rectum.
Right Kidney - one of a pair of organs situated in the body cavity near the spinal column
that excrete waste products. The kidneys are bean-shaped organs that consist chiefly of
nephrons by which urine is secreted, collected, and discharged through the ureter to the
bladder.
Pancreas - a large lobulated gland that secretes digestive enzymes and the hormones
insulin and glucagon. Only a small portion of the pancreas is located in the RUQ.
Liver - a large, very vascular, glandular
organ that secretes bile and causes important
changes in many of the substances contained
in the blood.
Gallbladder - a membranous muscular sac in
which bile from the liver is stored.
Left Upper Quadrant (LUQ)
Colon - see above.
Left Kidney - see above.
Pancreas - see above for function. Most of
the pancreas is located in the LUQ.
Spleen - a highly vascular, ductless organ
that is located in the left abdominal region
near the stomach or intestine and is
concerned with final destruction of red blood Figure 1. Areas of the Abdomen
cells, filtration and storage of blood, and
production of lymphocytes. Severe bleeding is consistent with injury to this organ.
Stomach - muscular, distensible, saclike portion of the alimentary tube between the
esophagus and the colon.

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 Right Lower Quadrant (RLQ)
Ascending Colon - see above. Ascending means to move upwards.
Small Intestine - the part of the intestine that lies between the stomach and colon; it
consists of duodenum, jejunum, and ileum. It secretes digestive enzymes, and is the chief
site for the absorption of digested nutrients.
Major artery and vein for right leg - iliac artery and vein.
Appendix - a small sac extending from the large intestine.
Left Lower Quadrant (LLQ)
Descending Colon - see above. Descending means to move downwards.
Small Intestine - see above.
Major artery and vein for left leg - iliac artery and vein.

2. SIGNIFICANCE OF ABDOMINAL ORGANS

The abdominal organs can be classified as either "hollow" or "solid" organs, depending on
their function.
Solid Organs - solid masses of tissue (liver, spleen, pancreas and kidneys)
Significance - highly vascular organs where injury may cause severe bleeding.
Hollow Organs - gastrointestinal/urinary tract through which materials pass. The stomach,
intestines, and bladder are hollow organs.
Significance - injury to these organs may cause septicemia and toxicity.

3. MECHANISMS FOR ABDOMINAL INJURY

Assessing the patient for abdominal injuries begins with knowledge of the MOI. Numerous
mechanisms lead to the compression and shearing forces that may damaged abdominal
organs. A casualty may experience considerable deceleration forces when involved in motor
vehicle crashes, struck or run over by a vehicle, or after falling from a significant height.
Any protective gear worn by the casualty should be noted. Abdominal injuries can be caused
by blunt or penetrating trauma.
Blunt Trauma - Blunt trauma often poses a greater threat to life because potential injuries
are more challenging to diagnose than those caused by penetrating trauma. The injuries to
abdominal organs result from either compression or shearing forces. In compression
incidents, the organs of the abdomen are crushed between solid objects. Shearing forces
create rupture of the solid organs or rupture of blood vessels in the cavity because of the
tearing forces exerted against their supporting ligaments. The liver and spleen can shear and
bleed easily and blood loss can occur at a rapid rate. Increased intra-abdominal pressure
produced by compression can rupture the diaphragm, causing the abdominal organs to move
upward into the pleural cavity.
Penetrating Trauma - A foreign object enters the abdomen and opens the peritoneal cavity
to the outside. Penetrating trauma, such as a gunshot or stab wound, is more readily visible
than blunt trauma. Multiple organ damage can occur in penetrating trauma, although it is
less likely with a stab wound than with a gunshot wound. A mental visualization of the

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potential trajectory of a missile, such as a bullet or the path of a knife blade, can help identify
possible injured internal organs.

4. SIGNS AND SYMPTOMS

History of the injury can be obtained from the patient or from bystanders. If the injury is
penetrating, questions should focus on the type of weapon, number of times shot or stabbed,
and amount of blood at the scene.

Unless there are associated injuries, casualties with abdominal trauma generally present
with a patent airway. When abnormalities are found in the assessment of the abdomen, it
should be exposed and examined in greater detail. This involves inspection and palpation
of the abdomen looking and feeling for soft
tissue injuries and distention. The most reliable indicator of
intra-abdominal bleeding is the
Soft tissue injuries include contusions, presence of shock from an
abrasions, stab or gunshot wounds, obvious unexplained source.
bleeding, and unusual findings such as
evisceration or impaled objects. Palpation of the abdomen is undertaken to identify areas
of tenderness. Ideally, palpation is begun in an area where the casualty does not
complain of pain. Then, each of the abdominal quadrants is palpated. While palpating a
tender area, the provider may note that the casualty “tenses up” the abdominal muscles in
that area. This reaction, called voluntary guarding, serves to protect the patient from
pain.

Involuntary guarding represents rigidity or spasm of the abdominal wall muscles when
the casualty is distracted. Deep or aggressive palpation of an obviously injured abdomen
should be avoided because palpation may dislodge blood clots and/or promote existing
hemorrhage and may increase spillage of contents of the GI tract if perforations are
present. Great care during palpation should also be exercised if there is an impaled
object. Casualties with altered mental status, such as those with a traumatic brain injury
(TBI) may have unreliable examination.

Auscultation of bowel sounds is generally not a helpful field assessment tool. Time
should not be wasted trying to determine their presence or absence because this
diagnostic sign will not alter the field management of the casualty.

The assessment of abdominal injuries can be difficult, especially with the limited
diagnostic capabilities of the field setting. An index of suspicion for abdominal injuries
should develop from a variety of sources of information, including mechanism of injury
(MOI), findings from the exam, and input from the casualty or bystanders. Some signs
that raise the index of suspicion are:

– MOI consistent with rapid deceleration or significant compression forces

– Soft tissue injuries to the abdomen, flank, or back

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 – Shock without an obvious cause

– Level of shock greater than explained by other

injuries FYI: Only about 15% of
casualties with stab wounds
– Significant abdominal tenderness on palpation to the abdomen will require
or with coughing surgical intervention, but
85% of casualties with
– Involuntary guarding gunshot wounds will need
surgery for definitive
– Diminished or absent bowel sounds management of their injuries.

5. TREATMENT OF INJURIES
The key aspects of field management of abdominal trauma are to recognize the presence of
potential injury and initiate transport to a higher echelon of care.
Blunt Trauma
Treatment for blunt trauma to the abdomen includes maintaining the ABCs of the patient,
collecting vital signs, gathering information for a history, treating for shock, and placing the
patient in the supine position with the knees slightly flexed. Remember that with a patient
with blunt trauma you need to keep them calm so that you can perform your duties and not to
strongly palpate the abdomen because you do not
know the extent of the internal injuries. The final
step in treating blunt abdominal trauma is to
TACEVAC the patient, as the definitive treatment
that patient needs is beyond your scope of care.
Impaled objects (see Figure 2) Because removal of
an impaled object may cause additional trauma and
because the object’s distal end may be actively
controlling the bleeding, removal of it in the field
environment is contraindicated. The impaled
object should neither move nor be removed. If
bleeding occurs around it, direct pressure should be
applied around the object to the wound with a bulky Figure 2. Impaled knife in chest
dressing that stabilizes the object and prevents
movement.
Evisceration (see Figure 3) A section of intestine or other abdominal organ is displaced
through an open wound and protrudes externally outside the abdominal cavity. Efforts
should focus on protecting the protruding segment of intestine or other organ from damage.
If the intestine or some of the other abdominal organs become dry, cell death will occur.
Therefore the eviscerated abdominal contents should be covered with a sterile dressing that
has been moistened with saline. These dressings should be periodically remoistened with

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 saline to prevent them from drying out. Wet dressings may be covered with a large, dry
dressing to keep the casualty warm.

FYI! Under normal

circumstances,
treatment of
eviscerated bowel
requires only a moist
sterile dressing.
Abdominal contents
normally do not need
to be reinserted into
the abdominal cavity.
Figure 3. Evisceration of bowel

CASUALTY ASSESSMENT AND ABDOMINAL INJURIES

Care Under Fire Phase: In the absence of life-threatening hemorrhage from the abdomen, the
material in this section is unlikely to be addressed in Care Under Fire.

Tactical Field Care Phase: During this phase, you will be required to inspect the abdomen
using DCAP-BTLS for any signs of injury. Don BSI. Note and treat all abdominal injuries.
Complete a head to toe assessment using DCAP-BTLS noting and treating additional injuries.
Determine if vascular access is required (see Tactical Fluid Resuscitation lesson) and give fluids
if necessary. If the casualty is able to drink fluids, they should be encouraged to do so. Consider
pain medications and give antibiotics if warranted. Reassess all care provided. Document care
given, prevent hypothermia, and TACEVAC.

REFERENCE
Prehospital Trauma Life Support, current Military Edition

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 Abdominal Review

1. Which quadrant contains the appendix?

2. Identify the solid organs and explain their significance.

3. Describe the appropriate treatment for an impaled object.

4. Describe the appropriate treatment for an abdominal evisceration.

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 UNITED STATES MARINE CORPS
FIELD MEDICAL TRAINING BATTALION
BOX 555243
CAMP PENDLETON, CA 92055-5243

FMST 408

Manage Musculoskeletal Injuries

TERMINAL LEARNING OBJECTIVE

1 . Given a casualty in an operational environment, standard field medical equipment and
supplies, treat musculoskeletal injuries to reduce the risk of further injury or death. (8404-
MED-2004)
ENABLING LEARNING OBJECTIVES
1 . Without the aid of reference, given a description or list, identify the anatomy of the
musculoskeletal system, within 80% accuracy per Prehospital Trauma Life Support, current
Military Edition. (8404-MED-2004a)

2 . Without the aid of reference, given a description or list, identify the management of soft
tissue injuries, within 80% accuracy, per Prehospital Trauma Life Support, current Military
Edition. (8404-MED-2004b)

3 . Without the aid of reference, given a description or list, identify the management of
fractures, within 80% accuracy, per Prehospital Trauma Life Support, current Military Edition.
(8404-MED-2004c)

4 . Without the aid of reference, given a description or list, identify the principles of splinting,
within 80% accuracy, per Prehospital Trauma Life Support, current Military Edition. (8404-
MED-2004d)

5 . Without the aid of reference, given a simulated casualty with musculoskeletal injuries and a
Corpsman Assault Pack, manage the simulated casualty, per Prehospital Trauma Life Support,
current Military Edition. (8404-MED-2004e)

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1. ANATOMY OF THE MUSCULOSKELETAL SYSTEM
Understanding the gross anatomy and physiology of the human body is the foundation on
which assessment and management are based. Without a good grasp of the structures of the
bones and muscles, one will not be able to relate kinematics and superficial injuries to
injuries that are internal.
Skeletal System – the mature human body has approximately 206 bones separated into
categories by shape.
Long bones – femur, humerus, ulna, radius, tibia and fibula What happended to the
Short bones – metacarpals, metatarsals and phalanges “irregular bones”
Flat bones – sternum, ribs and scapulas - This is a more
generalized category that
Sutural bones – variable and irregularly shaped bones in the contains bones that do not
sutures between the bones of the skull fall into the long, short or
flat classification.
Sesamoid bones - located within tendons; patella is the largest
Muscular System – the human body has more than 700 individual
muscles, which are categorized by function. (See Figure 1)
Skeletal (voluntary) – muscle fiber is striated, or striped, and is under the control of the
individual's will. Skeletal muscle tissues are usually attached to bones. When muscle
fibers are stimulated by an action of a nerve fiber, the fibers contract and relax. This
interaction between muscle and nervous fibers produces movement.
Smooth (involuntary) – muscle fibers are
smooth, or non-striated, and are not under the
control of the individual's will. Smooth muscle
tissue is found in the walls of hollow organs,
such as the stomach, intestines, blood vessels,
and urinary bladder. Smooth muscle tissues are
responsible for the movement of food through
the digestive system, constricting blood vessels,
and emptying the bladder.
Cardiac – muscle cells are striated and are
joined end to end, resulting in a complex
network of interlocking cells. Cardiac muscles
are involuntary muscles and are located only in
the heart. These tissues are responsible for
pumping blood through the heart chambers and
into certain blood vessels.
Figure 1. Three Types of Muscles

Osseous Connective Tissue – this type of tissue, known as "bone tissue" is dense fibrous
connective tissue that forms tendons, ligaments, cartilage, and bones. These tissues form the
supporting framework of the body. (See Figure 2)

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 Tendon – a band of tough, inelastic, fibrous tissue that connects a muscle to a bone
Ligament – a band of tough, fibrous tissue connecting bone to joint

Figure 2. Osseous Connective Tissue

2. MANAGEMENT OF SOFT TISSUE INJURIES

Causes of Wounds (Kinematics of Trauma) – Although it is not always necessary to know
what agent or object has caused the wound, it is helpful. Of special concern in wartime
setting is the velocity of wound-causing missiles (bullets or shrapnel). A low-velocity
missile damages only the tissues with which it comes into contact. On the other hand, a high-
velocity missile can do enormous damage by forcing the tissues and body parts away from the
track of the missile with a velocity only slightly less than that of the missile itself. These
tissues, especially bone, may become damage-causing missiles themselves, thus accentuating
the destructive effects of the missile.
Having classified the wound into one or more of the general categories listed, the FMST will
have a good idea of the nature and extent of the injury, along with any special complications
that may exist. This information will aid in the treatment of the casualty.
Open Soft Tissue Injuries – an injury in which the skin is interrupted, or broken, exposing
the tissues underneath.
Abrasions – Occur when skin is rubbed or scrapped off. (See Figure 3)
Treatment:
- Hemorrhage is usually so minimal that
primary treatment may only require cleansing
of the wound.
- Small bandages may be applied, but tactical
situations will usually preclude applying field
dressings that are needed for more serious
injuries.
- A large amount of dirt may be ground into the Figure 3. Abrasion
wound, therefore secondary treatment measures
should focus on preventing or stopping infections.

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Lacerations – Torn skin with ragged irregular edges and masses of torn tissue
underneath. (See Figure 4)

Treatment: Figure 4. Laceration

- Generally the same as for

abrasions
- Control hemmorhage
- If major tendons and muscles are completely severed, immobilize limb to
prevent further damage.
- Treat for shock
Avulsion - An injury in which flaps of skin are torn loose or completely pulled off. (See
Figure 5)
Treatment
- Control bleeding
- Apply field dressing to avulsed area.
- Prevent further contamination
- Ensure avulsed flap is lying flat and that it is aligned
in its normal position.
- Make every effort to preserve the avulsed part (wrap
the part in a saline or water soaked field dressing, Figure 5. Avulsion
pack wrapped part in ice, whenever possible. Be
careful to avoid direct contact between the tissue and ice.)
- Transport the avulsed part with the patient, but keep it well protected from
further damage and out of view of the patient.
- Immobilize extremity or body part as indicated by the severity of the avulsion.
Traumatic Amputations - Non-surgical removal of a limb or other appendage of the
body. Because blood vessels are elastic they tend to spasm and retract into surrounding

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 tissue. With complete amputations there is less bleeding then with partial or degloving
cases. (See Figure 6)
Treatment
- If life-threatening bleeding is present,
apply a tourniquet immediately
- If there is non life-threatening bleeding, a
pressure dressing may be used. More than
one may be necessary to gain control of
bleeding.
- Make every effort to preserve the
amputation. Figure 6. Traumatic Amputation
- Wrap amputated part in sterile dressing, place in ice and send with patient
- TACEVAC
Closed Soft Tissue Injuries – An injury where there is no open pathway from the outside to
the injured site. Examples include strains, sprains and dislocations.
Strain - Injury to a muscle or tendon resulting from over stretching or over exertion. The
chief symptoms of a strain are pain, lameness or stiffness moderate swelling at the place
of injury, discoloration due to the escape of blood from injured blood vessels into the
tissues, possible loss of power, and a distinct gap felt at the site.
Treatment
- Supportive strapping or bandaging
- Immobilize by splinting so that affected muscle is in relaxed position, if injury is
severe.
- R.I.C.E. (Rest, Ice, Compression, Elevation)
Sprain - A joint injury resulting in partial tearing or stretching of supporting ligaments.
Symptoms of a sprain include pain or pressure at the joint, pain upon movement, swelling
and tenderness, possible loss of movement, and discoloration. Treat all sprains as
fractures until ruled out by X-rays. (See Figure 7)

4-73 Sprain
Figure 7. Ankle
Treatment
- Treat like a fracture
- Supportive strapping or bandaging
- R.I.C.E. (Rest, Ice, Compression, Elevation)
- Pain management
- TACEVAC
Dislocation - When a bone is forcibly displaced from its joint. In some cases, the bone
slips back quickly into its normal position, but at other times it becomes locked in the
new position and remains dislocated until it is put back into place. A dislocation is likely
to bruise or tear the muscles, ligaments, blood vessels, tendons, and nerves near a joint.
Rapid swelling and discoloration, loss of ability to use the joint, severe pain and muscle
spasms, possible numbness and loss of pulse below the joint, and shock are characteristic
symptoms of dislocations. (See Figure 8)

Figure 8. Dislocation

Treatment
- Attempt to reduce only if no pulse is present in the extremity
- Splint as found to immobilize injured part
- Pain management
- Treat for shock
- TACEVAC
Complications
- Hemorrhage caused by seperated bone ends tearing muscle tissue and laceration
of blood vessels.

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 - Nerve damage due to the cutting or pinching of nerves by seperated bone ends or
muscle injury.

3. MANAGEMENT OF FRACTURES
TYPES OF FRACTURES
Open Fracture – A broken bone that breaks the overlying skin.
The bone may protude through the skin. (See Figure 9)
Penetrating objects such as bullets may go through the flesh and
break the bone.
Closed Fracture - A broken bone with no skin penetration. The
tissue beneath the skin may be damaged. (See Figure 10)
SIGNS AND SYMPTOMS OF FRACTURES Figure 9. Open Fracture
Inability to move the extremity
Discoloration
Deformity
Edema
Pain with or without movement
Protruding bone
Crepitus (crunching, grating sound/feeling)
Any injury that may indicate fracture (i.e. gun shot wound)
GENERAL TREATMENT FOR FRACTURES – The following
guidelines can be applied to any type of fracture, regardless of
location. Figure 10. Closed Fracture

Control hemorrhage
Treat for shock
Check distal pulses before and after splinting
Immobilize the fracture using splints
Recheck PMS
Relieve pain (whenever possible)
Reductions of fractures are not done in the field, unless distal pulses are not present
Document treatment
Monitor and TACEVAC

4. PRINCIPLES OF SPLINTING
TYPES OF SPLINTS – Splints are used to immobilize a portion of the body, prevent further
damage and alleviate pain.
Rigid Splints – cannot be changed in shape. The injured body part must be positioned to
fit the splint. Examples include board splints made of wood, plastic, or metal.
Formable Splints - Formable splints can be molded into various shapes and
combinations to accommodate the shape of the injured extremity. Examples include

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vacuum splints, pillows, blankets, cardboard splints, SAM splints and wire ladder splints.
(See Figure 11)

Figure 11. SAM Splint

Improvised Splints – Improvised splints are made from any available material that can
be used to stabilize a fracture. Examples include sticks, branches and poles.
Anatomical Splints - Use of the casualty’s body as a splint. Examples include securing
the legs together, securing the arm to the body, and taping the fingers together. (See
Figure 14)

Figure 12. Anatomical Splint

Manufactured Splints – Designed for specific injuries and specific applications.

Examples include the traction splint and pneumatic air splints. (See Figures 13 and 14)

Figure 13. Traction Splint Figure 14. Pneumatic Air Splint

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 Bandages in Splinting - Bandages can be used to wrap or bind a body part. Bandages
hold splints in place, apply additional pressure, and protect the casualty from further
harm.
Sling - a bandage suspended from the neck to support an upper extremity. When
using a sling, position the hand higher then the elbow and never cover the fingers.
Swathe - Any band or piece of cloth used to further immobilize a fracture.

GENERAL GUIDELINES FOR SPLINTING

Control hemorrhage and treat for shock.
Expose fracture site.
Establish distal pulse prior to splinting.
If bone is exposed, ensure to cover the ends with sterile dressing prior to splinting.
Splint fracture in position found.
Attempt to straighten a deformed limb only if it is a closed injury with no distal pulses.
Do not try to reposition or put back an exposed bone.
Move the fractured part as little as possible while applying the splint.
Immobilize the splint above and below the fracture.
Reassess distal pulses after splint is secured.
When in doubt, treat all injuries as a possible fracture.
TACEVAC as needed.

TECHNIQUES FOR SPLINTING FRACTURES

There are various ways and techniques to immobilize fractures. The FMST must be able to
apply the basic splints for the most common fractures:
Fractured Jaw
- Apply a bandage to immobilize jaw (Modified Barton). (See Figure 15).
- The bandage should pull the lower jaw forward
- Support should be on the head, not behind neck.
- Do not lay casualties with lower jaw fractures on their back. Doing so may cause
airway obstruction.

Figure 15. Immobilizated Jaw

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Fractured Clavicle
- Immobilize using figure eight bandage. (See Figure 16)
- Bend casualty’s arm on injured side, forearm across chest.
- Palm should be turned in, thumb pointed up.
- Hand should be raised 4 inches above elbow.
- Support using a cravat to cradle the arm & tie around the body for immobilization
(Sling and Swath). (See Figure 17)

Figure 16. Immobilizated Clavicle

Figure 17. Sling and Swathe

Fractured Humerus
- Check for distal pulse
- If fracture is located on the upper arm near shoulder, place padding in the armpit,
bandage arm securely to body (See Figure 18).
- If fracture is located in the middle of upper arm, use splint on outside of arm.
- Splint the injury to the body using a full arm wrap (Kerlex or cravat wrap). Support
with sling (See Figure 19).
- If fracture is near elbow, splint in position found. Support with sling.
- Re-check distal pulse.

Figure 18. Upper Arm Splint 1

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 Figure 19. Upper Arm Splint 2

Fractured Forearm
- Check for distal pulse
- If only one bone in the forearm is broken, the other may be used as a splint.
- Apply two splints (rigid or formable), one on top and one on the bottom.
- Ensure that the splints cover from wrist to elbow (rigid or formable splint). (See
Figure 20)
- Use bandages to hold splints in place.
- Re-check distal pulse
- Place casualty’s forearm across the chest, palm turned in and thumb pointing up
- Support with sling

Figure 20. Forearm Splint

Fracture Wrist/Hand
- Check radial pulse
- Splint in position of function leaving fingers exposed (formable splint). (See Figure
21)
- Re-check radial pulse
- Support with sling

Figure 21. Wrist/Hand Splint

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Fractured Ribs
- Assess ABCs for possible complications
- Ordinarily, simple rib fractures are NOT bound, strapped or taped if the victim is
reasonably comfortable. They may only require analgesics.
- Multiple fractures may require immobilization by strapping the arm of the injured
side to the chest to limit motion.
- Arm should be against the chest, palm flat, thumb up and forearm raised to a 45
degree angle. (See Figure 22)
- Secure arm to chest using swath bandage.
- For multiple fractures, you may attempt to immobilize flail segments using tape.
(See Figure 23)
- NEVER encircle the chest with any type of constricting bandage. This will only
make breathing more difficult!

Figure 22. Rib Splint

Figure 23. Flail Segments

Fractured Pelvis
- Check distal pulse
- Place patient in position of comfort (legs straight or knees bent)
- Place pillow or padding between the legs to immobilize hip
- Wrap sheet (or poncho) snuggly around pelvis for support
- Tie knees and ankles together for greater stability (Figure 24)
- Re-check distal pulse

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 Figure 24. Pelvis Splint

Fractured Femur
- Check distal pulse
- Using four (4) cravats to secure injured leg to the uninjured leg (anatomical splint)
(See Figure 25)
- Secure thighs together
- Secure another cravat directly above and below the knees
- Using a figure 8 wrap, secure ankles & feet together
- Re-check distal pulse
**NOTE: Consider traction splinting for midshaft fractures.

Figure 25. Femur Splint

Fractured Patella
-Check distal pulse
- Splint in position of comfort
- Place splint underneath the entire leg. Ensure you have padding at least under the
knee and ankle.
- Secure splint in four places (See Figure 26):
Just below knee
Just above knee
Around the ankle
Around the thigh
- Re-check distal pulse

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 Figure 26. Patellar Splint

Fractured Tibia/Fibula
- Check distal pulses
- If only one bone is broken, the other can act as a splint
- Utilize the stirrup method with the SAMS splint (See Figure 27)
- Apply splint on both sides of tibia and fibula
- Use kerlex bandage to secure splint
- Immobilize from knee to ankle
- Re-check distal pulse

Figure 27. Stirrup Splint

Fractured Ankle/Foot
- Check pedal pulse
- Splint injury (See Figure 28)
- Wearing boots: use figure 8 with a cravat to secure ankles together.
- Without boots: Wrap ankle with a bandage (kerlex), then use a figure 8 wrap with a
cravat to secure ankles and feet together.
- Re-check pedal pulse

Figure 28. Ankle/Foot Splint

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 Spinal Injury - The first priority is to ensure the casualty is in a safe location. Next, the
FMST may begin spinal immobilization procedures.
Indications for spinal immobilization:
High speed vehicle crash (>30mph)
Falls from great heights (2-3x body height)
Direct, blunt neck trauma
Blast injury
Spinal Immobilization:
To be effective, the casualty must be immobilized from the head to the pelvis.
Do not block the casualties airway
Use a C-Collar to immobilize the neck
If available secure casualty to a long spine board
If full immobilization is not possible- prevent excessive, unnecessary movement
of the casualty.
NOTE: Remember to treat all life-threatening injuries first prior to treating fractures. Not all
casualties will require evacuation.

CASUALTY ASSESSMENT AND MUSCULOSKELETAL INJURIES

Care Under Fire Phase: If the casualty has a life-threatening hemorrhage, apply a tourniquet.
No other musculoskeletal injuries will be treated during this phase of care.

Tactical Field Care Phase: During this phase, you will be required to inspect the casualty for
any signs of injury. Don BSI. Complete a head to toe assessment using DCAP-BTLS. Note all
musculoskeletal injuries and treat if time permits. Note and treat additional injuries. Determine
if vascular access is required (see Tactical Fluid Resuscitation lesson) and give fluids if
necessary. If the casualty is able to drink fluids, they should be encouraged to do so. Consider
pain medications and give antibiotics if warranted. Reassess all care provided. Document care
given, prevent hypothermia, and TACEVAC.

REFERENCE

Prehospital Trauma Life Support, current Military Edition

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 Musculoskeletal Injuries Review

1. List four examples of long bones.

1)
2)
3)
4)

2. What is the treatment for an avulsion injury?

3. Explain the definition of a sprain.

4. List four signs/symptons of a fracture.

1)
2)
3)
4)

5. Describe a formable splint and and example.

6. What are the steps for splinting a fractured tibia or fibula?

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 UNITED STATES MARINE CORPS
FIELD MEDICAL TRAINING BATTALION
BOX 555243
CAMP PENDLETON, CA 92055-5243

FMST 409
Manage Head, Neck, and Face Injuries

TERMINAL LEARNING OBJECTIVE

1. Given a casualty in an operational environment, equipment and supplies, treat head, neck,
and facial injuries to reduce risk of further injury or death. (8404-MED-2005)

ENABLING LEARNING OBJECTIVES

1. Without the aid of reference, given a description or list, identify the anatomy of the head,
within 80% accuracy, per Prehospital Trauma Life Support, current Military Edition. (8404-
MED-2005a)

2. Without the aid of reference, given a description or list, identify the types of head injuries,
within 80% accuracy, per Prehospital Trauma Life Support, current Military Edition. (8404-
MED-2005b)

3. Without the aid of reference, given a description, select the appropriate treatment for a
head injury, within 80% accuracy, per Prehospital Trauma Life Support, current Military
Edition (8404-MED-2005c)

4. Without the aid of reference, given a description or list, identify the anatomy of the neck,
within 80% accuracy, per Prehospital Trauma Life Support, current Military Edition. (8404-
MED-2005d)

5. Without the aid of reference, given a description or list, identify the types of neck injuries,
within 80% accuracy, per Prehospital Trauma Life Support, current Military Edition. (8404-
MED-2005e)

6. Without the aid of reference, given a description or list, select the appropriate treatment for
a neck injury, within 80% accuracy, per Prehospital Trauma Life Support, current Military
Edition. (8404-MED-2005f)

7. Without the aid of reference, given a description or list, identify the anatomy of the face,
within 80% accuracy, per Prehospital Trauma Life Support, current Military Edition. (8404-
MED-2005g)

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8. Without the aid of reference, given a description or list, identify the types of facial injuries,
within 80% accuracy, per Prehospital Trauma Life Support, current Military Edition. (8404-
MED-2005h)

9. Without the aid of reference, given a description or list, select the appropriate treatment for
a facial injury, within 80% accuracy, per Prehospital Trauma Life Support, current Military
Edition. (8404-MED-2005i)

10. Without the aid of reference, given a simulated casualty with head, face, and/or neck injuries
and standard field medical equipment and supplies, manage the simulated casualty, to prevent
further injury or death, per Prehospital Trauma Life Support, current Military Edition. (8404-
MED-2005j)

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 Parietal Bone
Frontal Bone

Ethmoid Bone

Occipital Bone

Temporal Bone

Sphenoid Bone
Figure 1. Anatomy of the Head

1. ANATOMY OF THE HEAD

Head (see Figure 1)
Cranial Vault - the part of the skull that contains the brain. Divided into six sections:

Occipital - the posterior lobe of each cerebral hemisphere that bears the visual cortex
and has the form of a 3-sided pyramid
Temporal - a large lobe of each cerebral hemisphere that is situated in front of the
occipital lobe and contains a sensory area associated with the organ of hearing
Parietal - forming the upper posterior wall of the head
Frontal - the anterior division of each cerebral hemisphere
Sphenoid - a winged compound bone of the base of the cranium
Ethmoid - a light spongy cubical bone forming much of the walls of the nasal cavity
and part of those of the orbits
The brain is protected and
Brain - divided into three major areas:
cushioned by aprroximately 75
Cerebrum - The largest of the three subdivisions ml of an internal fluid called
of the brain, superiorly situated and sometimes Cerebral Spinal Fluid (CSF).
called the “gray matter.” It controls willful The CSF also combats infection
movement and sensory information such as and cleanses the brain and
hearing, speech, visual perception, emotions and spinal cord.
personality.

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 Cerebellum - situated posterior to the brain stem and is sometimes called the “little brain”
or “white matter.” It coordinates the various activities of the brain, particularly
movement, coordination and balance.
Brain Stem - broken down into four parts which connect the spinal cord to the brain and
cranial nerves:

Medulla - the most inferior part of the stem which contains the center that regulates
respiratory rate, blood pressure, heart rate, breathing, swallowing and vomiting.
Pons - sleep center and respiratory center.
Midbrain - regulates muscle tone.
Reticular Activating System - scattered throughout the brain stem and is important in
arousing and maintaining consciousness.

2. TYPES OF HEAD INJURIES

Soft Tissue Injuries
Definition - injury to the overlying skin of the scalp,
which may be in combination with injury to the skull,
brain and/or face. (See figure 2)
Causes
- Penetrating trauma (rifle, impaled objects,
missile wounds)
- Blunt trauma (MVA, blast)
Signs and Symptoms
- Profuse bleeding no matter how minor the
injury
- Lacerations
- Avulsions
- Pain
- Anxiety
- Edema
- Ecchymosis
- Signs/symptoms of hypovolemic shock
Figure 2. Injury to scalp

Skull Injuries
Open Skull Injuries
Definition - injury where cerebral substance is visable through a scalp laceration.
Open head injuries usually combine lacerations of the scalp, fragmentation of the
skull from fractures, and lacerations of the membranes that cover the brain. The brain
may be relatively untouched, or it may be extensively bruised or lacerated.

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 Causes
- Penetrating trauma
- Blunt trauma

Signs and Symptoms

- Profuse bleeding no matter how minor the injury
- Crepitus
- Edema
- Depressions
- Deformities
- Visualize skull or bony fragments
Closed Skull Injuries
Definition - in closed head injuries there may or may not be lacerations of the scalp,
but the skull is intact, and there is no opening to the brain. Injury to the brain itself
may be far more extensive in a closed head injury because more of the injuring force
is transmitted deeper into the brain due to pressure build-up (see figure 3).
Causes
- Coup-Contrecoup - also known as a deceleration injury. It occurs when the
brain strikes the frontal lobe of the skull, then is thrown back against the
occipital lobe of the skull (or in the reverse order), causing the brain to bounce
off both sides of the cranial vault, resulting in soft tissue damage.
- Blunt Trauma - rising intracranial pressure (ICP) produces complications
because the brain is enclosed and pressure cannot be relieved.

Figure 3. Closed Head Injury Figure 4. Pupils

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Signs and Symptoms
- Crepitus around injury site
- Headache
- Neurological symptoms:
- Altered LOC
- Restlessness
- Unequal pupils (see figure 4)

- Bruising, such as:

Raccoon Eyes (see figure 5) - discoloration of the soft tissue under the eyes
indicates basilar skull fracture.

Battle’s Sign (see figure 6) - discoloration of the soft tissue behind the ear
indicates temporal bone fracture. This is a late sign and may not be readily
seen.

- Drainage - drainage of cerebral spinal fluid from the ears, nose, or eyes. Blood
or fluid (CSF) in the ears or nose may indicate a skull fracture.
- Bradycardia
- Increased systolic blood pressure
- Nausea/vomiting
- Decreased Respirations/Cheyne Stokes breathing pattern
- Deformity of the skull (see figure 7).

Figure 5. Raccoon Eyes Figure 6. Battle’s Sign

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 Figure 7. Skull Injuries

Figure 7. Skull Injuries

Brain Injuries
Definition - results from contusion, hemorrhage and/or edema. Damage to the brain and
associated intracranial hemorrhage may occur with or without scalp lacertions
or skull fractures. If the cranial vault is intact, the resultant swelling or bleeding produces
more brain injury by increasing the intracranial pressure.
Causes
- Blunt trauma
- Penetrating trauma
- Coup-Contrecoup injuries
Signs and Symptoms – in addition to the signs and symptoms for closed skull injuries, the
following signs and symptoms may also indicate a brain injury:
- Unusual behavior patterns. You must be careful not to misinterpret these symptoms
for a psychiatric casualty. (This is the number one indicator of an injury.)
- Altered level of consciousness
- Paralysis
- Convulsions/seizures
- Hyperthermia

Determining Level of Consciousness - The Glasgow Coma Scale (GCS) (see figure 8 below)
is a quick and easy method for determining level of consciousness. It is a simple method for
determining cerebral function and is predictive of casualty outcome. The GCS score is
divided into three sections – eye opening, best verbal response, and best motor response. A
score of less than 8 indicates a major injury, 9 to 12 indicates a moderate injury, and 13 to 15
indicate a minor injury. A score of 8 or below is an indication the casualty should be
intubated. In the case of operating in a tactical setting, a GCS of less than 8 means to provide
some means of an artificial airway (i.e. oral airway, nasal airway, or emergency
cricothyroidotomy).

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 Eye Opening
Spontaneous eye opening 4
Eye opening on command 3
Eye opening to painful stimulus 2
No Eye opening 1

Best Verbal Response

Answers appropriately (oriented) 5
Gives confused answers 4
Inappropriate responses 3
Makes unintelligible noises 2
Makes no verbal response 1

Best Motor Response

Follows command 6
Localizes painful stimuli 5
Withdrawal to pain 4
Responds with abnormal flexion to
painful stimuli (decorticate) 3
Responds with abnormal extension
to pain (decerebrate) 2
Gives no motor response 1
Total ________

Figure 8. Glasgow Coma Scale (GCS)

3. TREATMENT OF HEAD INJURIES

- Provide and maintain patent airway
- Apply c-spine precautions
- Hemorrhage control. Cover open wounds securely enough to aid in the clotting process
without pressing skull fragments or impaled objects inward by using donut o-ring.
- Fluid resusciatate to maintain a palpable radial pulse (Do not want to raise intracranial
pressure)
- Do not remove foreign bodies or impaled objects
- Check for drainage of CSF from the wound, nose, or ears. Do not pack or suction nose
and/or ears if CSF leakage is suspected. Do not let patient clear their nose by blowing. If
the casualty has drainage from their nose, check to see if it is CSF by:
- Use the Halo, or Target Test to check for CSF. Dip a 4 x 4 in the drainage then
lay it flat and wait a few minutes. If there is CSF in the blood, the blood will
collect in the center, while the CSF remains to the outside creating a halo around
the blood.
- Give nothing by mouth (NPO) NO PAIN MEDICATIONS!
- TACEVAC in the High Fowler’s position NO PAIN MEDICATIONS!
- Do NOT give pain medications NO PAIN MEDICATIONS!

NOTE: There is a high mortality rate associated with head trauma. All head trauma patients
are assumed to have a cervical spine injury until proven otherwise.

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4. ANATOMY OF THE NECK
Structures
Esophagus - passage from the mouth to the stomach
Trachea (windpipe) - air passage from the larynx to the lungs made of connective tissue
and reinforced with 15-20 C-shaped cartilaginous rings
Thyroid gland - stimulates the metabolism of all cells
Larynx (voicebox) - the first part of the trachea which contains the vocal cords
Pharynx - area that extends from the soft palate to the esophagus/trachea
Epiglottis - leaf shaped structure that acts like a gate, directing air to the trachea and
solids and liquids into the esophagus
Vasculature
Arteries - left/right common carotid (carry blood to brain)
Veins - left/right internal and external jugular (carry blood away from brain to heart)
Cervical Spine
Vertebrae - seven cervical vertabrae
Spinal Cord - protected by the cervical vertebrae

5. TYPES OF NECK INJURIES

Trauma of any kind to the neck is signifigant because of the risk of associated injuries to the
respiratory tract, the alimentary tract (especially the esophagus), the major vascular structures,
major nerves and the cervical spine.
Structures
Definition - injury to associated anatomy of the neck most commonly the trachea and
esophagus.
Causes
- Blunt trauma
- Penetrating trauma
Signs and Symtpoms
- Subcutaneous emphysema
- Hematemesis
- Hemoptysis
- Dysphagia (difficulty swallowing)
- Dyspnea
- Hoarseness
- Deformity

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 Vasculature
Definition - injury to the carotid arteries and/or the jugular veins. These are the most
commonly injured structures of the neck.
Causes
- Blunt trauma
- Penetrating trauma
Signs and Symptoms
- Hemorrhage
- Hemoptysis
- Hematemesis
Cervical Spine
Definition - fractures of the cervical vertebrae which are
very susceptible to injury because of the relation and
position of the skull. These fractures may result in
irreversible spinal cord injury.
Causes
- Compression injury (see figure 9).
- Flexion, hyperextension and hyperrotation
- Lateral bending
Figure 9. Compression Injury
Signs and Symptoms
- Deformity
- Head fixed in an abnormal position The only definitive
- Muscle spasms diagnosis for C-spine injury
- Parasthesia in the arms
- Pain is x-ray. Patient should
- Paralysis or other neural deficits remain in C-collar until x-
rays are read!
6. TREATMENT FOR NECK INJURIES
- Consider C-spine
- Control hemorrhage with a pressure dressing.
FYI!
Apply pressure only to the affected vessels. Cricothyroidotomy may be
- Consider cricothyroidotomy if airway is necessary if neck trauma
compromised. causes blood to be present
- Administer fluids (see Combat Fluid Resucitation on the vocal cords, thus
lesson) causing laryngo-spasms.
- NO PAIN MEDICATIONS!
- TACEVAC

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7. ANATOMY OF THE FACE (see figure 10)
The facial bones form the stucture of the face in the anterior skull but do not contribute to the
cranial vault.
The major facial bones are:
- Nasal
- Zygomatic - a bone of the face below the eye that in mammals forms part of the
zygomatic arch and part of the orbit
- Right/left Maxilla - bones that lie on each side of the upper jaw
- Mandible (jawbone) - the lower jaw.

Figure 10. Major Facial Bones

8. TYPES OF FACIAL INJURIES

Generally serious because of the danger of hemorrhage due to the vast blood supply of the
area and obstruction of the respiratory passages.
Soft Tissue Injuries
Definition - damage to the soft tissues of the face without bone injuries
Causes
- Blunt trauma
- Penetrating trauma
Signs and Symptoms
- Massive hemmorhage even with minor wounds
- Edema
- Laceration
- Ecchymosis
- Avulsion

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Bone Injuries (Maxillofacial and Mandibular)
Definition - fracture of the major bones of the face (maxillofacial and mandibular). These
fractures require great force and may be open or closed.
Causes
- Blunt trauma
- Penetrating trauma
Signs and Symptoms
- Lacerated gums may indicate an underlying fracture
- Casualty cannot open mouth without pain
- Misaligned teeth
- Difficulty swallowing
- Pain at fracture site
- Edema
- Facial asymmetry
- Epistaxis (Nose bleed)
- Ecchymosis
- Lacerations
- Visual disturbances
- Limited ocular movements
- Crepitus
Eye Injuries
Definition - injuries to the eyes that may be associated with other forms of head injury.
Causes
- Blunt trauma
- Penetrating trauma
- Burns
- Foreign objects-debris
Signs and Symptoms
- Loss of vision
- Pain
- Anxiety
- Hemorrhage
- Subconjunctival hemmorrhage
- Orbital bony deformity
- Intraorbital deformity
Fractured Nose - prior to control of bleeding, you must determine that there is no cerebral
spinal fluid escaping. If fluid is escaping, treat as a skull fracture. Signs and symptoms will
include blood or CSF from the nose and bruising.

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9. TREATMENT OF FACIAL INJURIES
Soft tissue injuries
- Consider C-spine
- Assess and secure airway
- Hemorrhage control
- Fluid resuscitation protocol for associated shock
Bone injuries
- Maintain open airway. Consider use of Nasopharyngeal
Airway (NPA) (see figure 11)
- Control hemorrhage
- NO PAIN MEDICATIONS! Figure 12. Modified Barton Bandage
- Cold pack
- Modified Barton bandage for mandibular fracture (see figure 12)
- TACEVAC

Figure 11. Nasophryngeal Airway (NPA)

Eye injuries
- In combat, only patch the affected eye. Member can function effectively with one eye.
Member becomes a litter patient if both eyes are covered.
- If the injury to the eye is clearly a minor one, the best advice is to REFRAIN FROM
INTERFERENCE. A minor eye injury improperly cared for can easily become a major
eye injury.
Treatment of penetrating eye injuries
- Check casualties vision
- Cover eye immediately with a rigid eye shield – NOT a pressure patch
- Have casualty take 400 mg moxifloxacin in his/her Combat Pill Pack
- Give IV/IM antibiotics if unable to take PO meds
Treatment for chemical burns of the eye
- Hold the face under running water with eyes open (see figure 13)
- Flush eyes 5-10 minutes for acid burns Figure 13. Irrigating The Eye
- Flush eyes 20 minutes for alkali
- TACEVAC

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Treatment for thermal burns of the eye
- Cover eye with loose dry dressing
Treatment for light injuries
- Cover eye with loose dressing (see figure 14).
Treatment for impaled object
- Make thick dressing and cut hole in center the size of eye
opening
- Pass dressing over impaled object (see figure 15)
- Position crushed cup over dressing and bandage in place
- Elevate head to decrease intraocular pressure
Figure 14. Simple Cravat Bandage For The
Treatment for lacerations involving the eye Eye

- If only eyelid is lacerated, direct pressure or a

pressure dressing will stop bleeding.
- If the eyeball itself is lacerated, do not use
pressure, but cover with a loose dressing.
Treatment for protruding globe
- DO NOT attempt to place eye back in socket
- Apply bulky dressing around eye, moist gauze
over the globe and cover with a cup secured in
place.
Figure 15. Dressing Over Impaled Object
Treatment of nose injuries
- Hemorrhage Control
- Pinching nostrils. (Do not tilt patient head back due to postnasal drainage)
- Apply ice to bridge of nose
- Splint by padding
- Monitor and TACEVAC

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 CASUALTY ASSESSMENT AND THE HEAD, NECK, AND FACE

Care Under Fire Phase: In the absense of life-threatening hemorrhage from the Head, Neck, or
Face, the material in this section is unlikely to be performed in Care Under Fire phase.

Tactical Field Care Phase: During Tactical Field Care you will be required to inspect the head,
neck, and face for any signs of injury. This includes looking for bone deformity and soft tissue
injuries, signs of closed head trauma, and also consider the possibility of Traumatic Brain Injury
(TBI). Don BSI. You must visually inspect the eyes, ears, nose, and throat. Assess the airway and
intervene if necessary. Complete a head to toe assessment using DCAP-BTLS noting and treating
additional injuries. Determine if vascular access is required (see Tactical Fluid Resuscitation
lesson) and give fluids if necessary. If a head injury is suspected, it is NOT recommended to give
casualty fluids by mouth. Consider pain medications and give antibiotics, if warranted. Reassess
all care provided. Document care given, prevent hypothermia, and TACEVAC.

REFERENCE
Prehospital Trauma Life Support, current Military Edition

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 Head, Neck, and Face Review

1. Identify the function of the Cerebellum.

2. List the six key points for treatment of a neck wound.

3. List the appropriate treatment for a single eye injury in a combat situation.

4. What is the hallmark sign of a concussion.

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 UNITED STATES MARINE CORPS
FIELD MEDICAL TRAINING BATTALION
BOX 555243
CAMP PENDLETON, CA 92055-5243

FMST 410

Tactical Fluid Resuscitation

TERMINAL LEARNING OBJECTIVE

1. Given a casualty, equipment and supplies, start fluid resuscitation reducing the risk of
further injury or death. (8404-MED-2007)

ENABLING LEARNING OBJECTIVES

1. Without the aid of reference, given a description or list, define medical terminology
associated with fluid resuscitation, within 80% accuracy, per Prehospital Trauma Life Support,
current Military Edition. (8404-MED-2007a)

2. Without the aid of reference, given a description or list, identify the routes for giving fluid,
within 80% accuracy, per Prehospital Trauma Life Support, current Military Edition. (8404-
MED-2007b)

3. Without the aid of reference, given a description or list, identify the different types of IV
solutions, within 80% accuracy, per Prehospital Trauma Life Support, current Military Edition.
(8404-MED-2007c)

4. Without the aid of reference, given a description or list, identify how to properly administer
IV fluids, within 80% accuracy, per Prehospital Trauma Life Support, current Military Edition.
(8404-MED-2007d)

5. Without the aid of reference, given a description or list, identify the potential complications
of initiating IV therapy, within 80% accuracy, per Prehospital Trauma Life Support, current
Military Edition. (8404-MED-2007e)

6. Without the aid of reference, given a description or list, identify how to properly administer
intraosseous (IO) fluids, within 80% accuracy, per Prehospital Trauma Life Support, current
Military Edition. (8404-MED-2007f)

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7. Without the aid of reference, given a description or list, identify potential complications of
initiating an intraosseous device, within 80% accuracy, per Prehospital Trauma Life Support,
current Military Edition. (8404-MED-2007g)

8. Without the aid of reference, given a patient and a Corpsman Assault Pack, initiate
peripheral IV access, with successful infusion, per the Performance Examination Checklist.
(8404-MED-2007h)

9. Without the aid of reference, given a training aid and a Corpsman Assault Pack, initiate
intraosseous access in order to infuse fluid, to prevent further injury or death, per the
Performance Examination Checklist. (8404-MED-2007i)

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INTRODUCTION
In civilian settings, it is common practice to establish intravenous (IV) access in all individuals
who have suffered significant trauma in the prehospital setting. In tactical military settings, this
practice has a number of disadvantages such as imposing costs in both time and equipment. The
practice of starting IV access on all casualties preemptively had been outdated by the availability
of intraosseous (IO) techniques.
In this lesson, we will discuss the principles of fluid resuscitation in a tactical situation and the
decision making process of when to give fluids by mouth, through an IV or through the
intraosseous route. Finally, we will discuss what types of fluids and how much fluid to give to a
casualty on the battlefield.

1. TERMINOLOGY
Homeostasis - a state of physiological equilibrium produced by a balance of functions and
chemical composition within the body. Homeostasis is usually maintained as long as the
fluid volume and chemical composition of the fluid compartments stay within narrow limits
or within a state of equilibrium.
Electrolyte - an element or compound that, when melted or FYI…Both muscle tissue and
dissolved in water or another solvent, disassociates into neurons are considered
ions and is able to carry an electric current. Fluids electric tissues of the body.
containing these electrolytes and water are called Muscle contraction is
crystalloids. dependent upon the presence
of calcium (Ca2+), sodium
Crystalloids - aqueous solutions of mineral salts or other (Na+), and potassium (K+).
water-soluble molecules. This solution does not have Without sufficient levels of
oxygen carrying or blood clotting capabilities. these key electrolytes, muscle
Colloids - contain larger insoluble molecules, such as weakness or severe muscle
gelatin; blood itself is a colloid. These solutions are all contractions may occur.
hypertonic in nature.
Isotonic - a solution that triggers the least amount of water movement from the vascular
system in to or out of the cells or surrounding tissue
Hypotonic - a solution that causes water to leave the vascular system and enter the cells or
surrounding tissue compartments
Hypertonic - a solution that draws water from the surrounding cells and tissue compartments
back into the vascular system.

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2. ROUTES FOR FLUID RESUSCITATION
Oral Hydration - Trauma surgeons attached to forward-
deployed Medical Treatment Facilities (MTFs) have noted
that many casualties are kept on nothing by mouth (NPO)
status for prolonged periods in anticipation for eventual
surgery. Patients in a combat environment often operate in
a state of mild dehydration. Once injured, they can easily
develop greater levels of dehydration. The combination of
dehydration and hemorrhage greatly increases the risk of
mortality. There is very little evidence of emesis during
surgery of patients that received oral hydration following
injury. Therefore, oral fluids are recommended for all
casualties with a normal level of consciousness and the
ability to swallow, including those with penetrating torso Figure 1. Casualty with Abdominal Wound
trauma (see figure 1). Drinking Water

Indications
Injured casualty with normal level of consciousness and ability to swallow
Contraindications
Decreased level of consciousness
Intravenous Access - If the casualty does not have a normal level of consciousness, the care
provider may start fluid resuscitation by the IV or IO method.
Indications
- Uncontrolled hemorrhage
- Diarrhea or vomiting
- Burns
- Unable to tolerate fluids by mouth
- To give IV medications
Contraindications
- Absence of signs and symptoms of the above indications
Intraosseous Access - Battlefield casualties may have a traumatic amputation precluding IV
access in an extremity. An IO device offers an alternate route for the administration of fluids
in these types of casualties. This device is not meant to replace IV infusion; it is to be used
when IV access cannot be obtained.
Indications
- Unable to obtain IV access
Contraindications
- Absence of signs and symptoms of the above indications

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3. TYPES OF INTRAVENOUS SOLUTIONS
There are several fluid resuscitation strategies used for the management of trauma patients.
The primary methods we will discuss are:
- Large volumes of crystalloid
- Colloid solutions
- Whole blood or blood products
Crystalloids - Solutions that are isotonic are effective for volume replacement for a short
period of time. These solutions do not have any oxygen carrying capacity and contain no
proteins. Within 30 to 60 minutes after administration, only about 1/4 to 1/3 remains in the
cardiovascular system. The remainder becomes edema in the soft tissues
and organs. FYI…A
The rule of thumb is that most patients with hemorrhagic shock generally casualty infused
receive adequate crystalloid resuscitation when about 300 ml has been with 1000 ml of
infused for every 100 ml of lost blood volume. The two most common LR will only
crystalloids used in the treatment of shock are Lactated Ringer’s (LR) have 200 ml
and Normal Saline (NS). remaining in the
vascular system
LR - the crystalloid solution of choice for the management of shock after 1 hour.
because its composition is most similar to blood plasma. It contains
specific amounts sodium, potassium, calcium, chloride and lactate ions.
NS - an acceptable alternative solution with 0.9% sodium chloride (NaCl)
Colloids - Synthetic colloid solutions draw fluid from the interstitial and intercellular spaces
into the intravascular space, thereby producing volume expansion larger than the volume of
fluid that was infused. This effect is sustained for 8 hours. These solutions do not transport
oxygen. Hextend is the fluid of choice for volume replacement due to trauma in a
tactical situation.
Hextend - Synthetic colloid solution used as a volume expander. Benefits are that it is a
smaller, lighter package that is easily carried and it improves perfusion without
overloading the patient with a crystalloid solution.
For casualties in shock (defined by a weak or absent peripheral pulses or altered mental
status in the absence of brain injury) bolus 500 ml Hextend. If no improvement is noted
in 30 minutes, administer another 500 ml. Do not use more than 1,000 ml.
For casualties suffering from both shock and Traumatic Brain Injury (TBI), give fluids
only until the radial pulse is restored (titrate).
Whole Blood - Because of its ability to transport oxygen, blood is the fluid of choice for
severe hemorrhagic shock. Unfortunately this is impractical for first responder care due to
issues of blood typing and refrigerator. Blood and blood products are typically available at
the forward resuscitative care capability (i.e. Medial Battalion). In combat, type O-negative
(universal donor) is supplied and can be given without prior cross-typing.

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 Not in Shock In Shock Traumatic Brain Injury
(Normal peripheral pulse and (Altered mental status and weak or (TBI) and weak or absent
mentation) absent peripheral pulse) pulse

- IV Fluids are not needed. - Administer a 500mL IV bolus of - Altered mental status cannot be
Hextend. used as clinical guideline for
- If the casualty is conscious, he
shock.
can drink fluids. - If after 30 minutes the casualty
is still in shock, administer - Resuscitate to restore the radial
another 500mL IV bolus of pulse.
Hextend.
* Do not administer more than
1000mL of Hextend.
- If shock continues, decide
whether to continue
resuscitation depending on the
logistical and tactical situation.

4. EQUIPMENT REQUIRED TO INITIATE A PERIPHERAL IV

While there is no standardized set of equipment, there are certain items needed to start an IV.
It will be your responsibility to have these items together and “ready to go” if needed in a
hasty situation.
Equipment
Needle/catheter - 18 gauge catheter preferred in the field setting due to ease of insertion
IV Solution - based on the needs of the casualty
Administration set - many different types used; be familiar with your specific equipment
Constriction band - distends the veins to make access easier
Alcohol - or betadine prep pads to cleanse the site
Tape - to secure the catheter in place; tegaderm can be used
Initiating a Peripheral IV
You have all started IV’s in the past. Below is a review of what steps to take when
inserting an IV. You will all have a chance to start an IV in the practical application at
the end of the lesson.
1) Determine the need for fluid replacement
2) Assemble and check equipment
3) Prepare the patient
4) Select and cleanse site
5) Insert IV
6) Remove constriction band

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 7) Connect the fluid administration set
8) Administer fluid
9) Secure the IV

5. POTENTIAL COMPLICATIONS OF IV THERAPY

No medical treatment is without risk. As a care provider, your first priority is to do no harm.
With that said, there are times when your best treatment will result in outcomes that were not
desired. Listed below are the most common complications of IV therapy and their treatment.
Infiltration (see figure 2) - escape of fluid from the vein into the tissue when the
needle/catheter dislodges from the vein.
Symptoms
- Edema
- Localized pain or discomfort
- Coolness to touch at the site of cannulation
- Blanching of the site
- IV flow slows or stops

Treatment
- Discontinue IV
- Select an alternate site Figure 2. Infiltration
- Apply a warm compress to the affected area
- Elevate the limb
Prevention
- Secure the catheter properly
- Limit movement of the limb
Phlebitis (see figure 3) - inflammation of a vein due to bacterial, chemical, or mechanical
irritation.
Symptoms Reddened area
- Pain along the course of the vein
- Redness appears as a streak above vein and above
the IV site
- Warm to touch
- Vein feels hard or cordlike
Treatment
- Discontinue IV
- Warm compress to the affected area
- Antibiotics Figure 3. Phlebitis

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 Prevention
- Ensure aseptic technique when starting IV
- Place date/time when catheter was inserted on the tape
- Rotate infusion sites based on local policies (usually every 72 hours)
Circulatory Overload (systemic) - an effect of increased fluid volume which can lead to heart
failure and pulmonary edema as a result of infusing too much IV fluid or too rapidly.
Symptoms
- Headache
- Venous distention
- Dyspnea
- Increased blood pressure
- Cyanosis
- Anxiety
- Pulmonary edema
Treatment
- Slow down the flow rate
- Place patient in High Fowlers position
Prevention
- Monitor and control flow rate
Air Embolism - air circulating in the blood when introduced through IV tubing.
Symptoms
- Cyanosis
- Hypotension
- Weak and rapid pulse
- Shortness of breath
- Tachypnea
Treatment
- Place patient on left side in Trendelenburg position, so that air in the right ventricle
floats away from the pulmonary air flow tract.
- Administer oxygen
- Notify Medical Officer
- Monitor vital signs
Prevention
- Flush IV line thoroughly to remove air prior to insertion
- Monitor tubing during therapy
- Avoid introducing air through any syringe or extension tubing

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 Systemic Infection (see figure 4) - due to poor aseptic
technique or contamination of equipment.
Symptoms
- Sudden rise in temperature and pulse
- Chills and shaking
- Blood pressure changes
Treatment
- Look for other sources of infection
- DC IV and restart in other limb Figure 4. Infection caused by IV
- Notify MO and anticipate antibiotic treatment
Prevention
- Ensure aseptic technique when starting IV
- Place date/time when catheter was inserted on the tape
- Rotate infusion sites based on local policies (usually every 72 hours)

6. INTRAOSSEOUS FLUID ADMINISTRATION

Overview
IO infusion devices provide a quick (can be placed in 60
seconds), reliable fluid access when peripheral IVs
cannot be started. IO infusion is the medical process of
getting fluids, emergency drugs, and even blood into a Figure 5. Cross Section of Bone
patient’s circulatory system by delivering them into the
marrow space inside a bone (see figure 5). The IO space is a specialized area of the
vascular system where blood flow is rapid and continues even during shock. Drugs and
fluids infused via the IO route reach the central circulation as quickly as those
administered through standard IV access.

Anatomy
The sternum consists of the manubrium, the body and the
xiphoid process (see figure 6). At the top of the manubrium is
the jugular notch, which is used as a reference point for
intraosseous placement. The sternum makes an ideal IO site for
several reasons:
- It is very easy to locate and readily accessible
- It is protected from trauma by the flak vest
- It is thinner and easier to penetrate than other bones.
- Most importantly, fluids infused into the sternum reach the
circulatory system more rapidly.
Figure 6. Sternum

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Equipment
There are several different manufactures of IO devices. The Committee on Tactical Combat
Casualty Care (CoTCCC) concluded that the First Access for Shock and Trauma (FAST1) is the
IO device best suited for trauma care on the battlefield. Features such as speedy access, a
protected infusion site, and a depth-control mechanism make the FAST1 ideal for emergency
use.

Components of the FAST1

Target/Strain-Relief Patch (see figure 7)
The Target/Strain-Relief Patch is a foam patch with an adhesive back. The key features of the
patch are the locating notch, a hole indicating the target zone, a band of Velcro fastening, and a
connector tube with a female luer on each end. The patch is placed on the patient with the
locating notch matching the patient’s jugular notch and the target zone over the patient’s midline.
The adhesive backing prevents the patch from becoming displaced. The target zone, a circular
hole, indicates the location of the designated insertion site.

Figure 7. Target/Strain-Relief Patch

Introducer (see figure 8)

The introducer is a hand-held tool. The bone probe cluster,
stylet, infusion tube, and depth control mechanism are
mounted inside the introducer handle. The bone probe
needles are covered by a plastic sharps cap that is removed
before use. The introducer allows the operator to push the
flexible infusion tube through the skin, tissue, and anterior
cortical bone of the manubrium. The force required to
penetrate the bone is provided entirely by the operator, it is
not spring loaded or battery operated. The depth control
mechanism automatically separates the infusion tube from the
Introducer body at a pre-set depth, preventing the operator from Figure 8. The Introducer
over or under penetrating the patient’s bone.

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Infusion Tube (see figure 9)
The Infusion Tube is the primary component of the FAST1
System. It consists of a steel portal (the sharp tip which
penetrates the bone), a length of flexible infusion tubing, and
luer connector. When the tube is inserted by the introducer,
the steel portal penetrates the anterior cortical bone of the
manubrium. After insertion, the fluid delivery port is within
the marrow space of the bone. The entire steel portal is
subcutaneous. The tubing delivers drugs or fluids into the
manubrial marrow space. The flexibility of the tubing allows
it to move with the patient’s skin. The Infusion Tube is Figure 9. Infusion Tube
connected to the fluid source via the connector tube on the patch.

Protector Dome (see figure 10)

The Protector Dome is a clear plastic cover with Velcro
fastening, which mates with the ring on the Target/Relief Patch.
After drugs or fluids have begun to flow into the patient, the
Dome is placed over the patch. The Velcro secures the dome in
position over the site. This is the final step in placing the FAST1
system. The dome covers and protects the infusion site.

Figure 10. Protector

Sharps Protection (see figure 11) Dome

Before use, the bone probe cluster and stylet are covered by a clear plastic Sharps Cap. After
use, the retracted bone probe needles and stylet tip are pushed into the foam-filled Sharps Plug.
This reduces the risk of accidental needle stick injury. For additional protection, the pre-use cap
should be placed over the post-use plug once the needles have been fully inserted into the plug.

Figure 11. Sharps Protection

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SEQUENCE FOR INITIATING THE FAST1
a. Cleanse insertion site b. Align finger with jugular notch and place patch,
using aseptic technique. verifying patch is midline.

c. Place Introducer in target on d. Insert Introducer perpendicular to the

patch. Hold with a firm grasp. manubrium. Use continuous increasing pressure
to insert.

e. Remove Introducer. Pull straight f. Connect Infusion Tube to Target Patch

back. Tube.

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 g. Cap introducer using post-use h. Connect to I.V. tubing.
cap supplied.

i. Place Dome once all items are

connected.

Points to remember when inserting the FAST1

1. Don’t pull back and re-push.
2. Don’t use extreme force.
3. Insert Introducer perpendicular to sternum.

7. POTENTIAL COMPLICATIONS OF THE FAST1 INSERTION

The sternal notch cannot be located.
Probable Cause: Extreme obesity or abnormal sternal anatomy.
Recommended Action: Abort the procedure. Proper targeting requires accurate location
of the patient’s sternal notch. Employ an alternative method of vascular access.
The patch has been incorrectly placed.
Probable Cause: Operator error during application, movement of the skin over the
manubrium during application, or patient movement after placement.
Recommended Action: Return the patient to his/her original position. If the patch is still
incorrectly positioned, remove it and reposition. During placement, ensure
that the skin over the sternum is not stretched away from its normal position.

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The patch will not adhere to the skin.
Probable cause: Wet skin or thick body hair.
Recommended Action: Shave or dry skin and clean using aseptic technique. The patch
can also be taped down using the extended tabs. If the Patch becomes detached during
use, it should be taped to the skin.
The Bone Probe Cluster is fully pushed in, but the Introducer does not release.
Probable Cause: Excessively thick tissue, extreme misplacement, or irregular anatomy.
Recommended Action: Pull Introducer back; the Infusion Tube may be in place,
although the Introducer could not release due to tissue thickness. Verify by withdrawing
marrow, and proceed. Re-attempt with a new FAST1. If second attempt fails, seek
alternative method of vascular access.
Introducer does not release with high applied force.
Probable Cause: Extreme bone hardness or technique error.
Recommended Action: Without pulling back on the Introducer, check that the Introducer
is perpendicular to the manubrium surface and that force is being applied directly along
the Introducer axis. Some patients may have a very hard bone; if control of the
Introducer cannot be maintained, find alternate method of vascular access.
The Introducer releases but the Infusion Tube falls out of the patient.
Probable Cause: The Infusion Tube did not adequately penetrate the anterior cortical
bone of the manubrium due to excessive tissue thickness or very hard bone.
Recommended Action: Re-attempt with a new FAST1 device.
Low or no flow through Infusion Tube.
Probable Cause: There is a severe kink in the tubing, there is a line blockage, or the
portal failed to penetrate the manubrium.

Recommended Action: Check for kinked tubing. If no kink can be found, attempt to
clear the line by pushing in 10 cc’s of fluid. If this fails to improve the flow rate, use an
alternative method of vascular access.
Leakage at the insertion site.
Probable Cause: Fluids are leaking from inside the manubrium past the tip of the
Infusion Tube.
Recommended Action: A small amount of leakage sometimes occurs and is commonly
acceptable in IO infusion. The operator must judge whether the patient is receiving an
adequate amount of drugs or fluids. If leakage is excessive, an alternative method of
vascular access should be used.

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 CASUALTY ASSESSMENT AND FLUID RESUSCITATION
Care Under Fire Phase: The material in this section is unlikely to be addressed in Care Under
Fire.

Tactical Field Care Phase: Knowing when it is necessary to start an IV or IO is critical in the
Casualty Assessment process. Using the PO route when available saves you time by not starting
unnecessary IVs on casualties that do not need it and saves valuable resources for casualties who
do. Using the “minimal fluid resuscitation” technique also increases the casualty’s chances of
survival by not overloading them with unnecessary fluid. Remember to don proper BSI when
performing fluid resuscitation.

REFERENCES
FAST1 Intraosseous Infusion System for Adult Patients User’s Manual, Pyng Medical Corp
Prehospital Trauma Life Support, current Military Edition

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 Field Medical Training Battalion
INTRAVENOUS FLUID RESUSCITATION
PERFORMANCE EXAMINATION CHECKLIST v3.0
STUDENT (Rank, Last Name, First Name) PLT

1ST 2ND 3RD

PROCEDURAL STEPS FOR PERFORMING AN IV STICK
P F P F P F
Determine the need for fluid replacement (i.e. uncontrolled hemorrhage,
diarrhea/vomiting, burns, unable to tolerate fluids by mouth, to give IV meds)
Assemble and check equipment (18g needle/catheter, IV solution,
administration set, tape, constriction bandage, alcohol, 2x2 gauze, gloves)
Prepare patient & select site

Cleanse site

* Insert IV

* Remove constriction band

Connect fluid administrative set

* Administer fluid and monitor flow

Secure IV

Discontinue IV

GRADING CRITERIA 1ST 2ND 3RD

Total Non-Critical Items (3 or greater constitutes a failure)

Total Critical Items (Any critical items missed constitutes a failure)

“Stop & Think” (2 allowed for critical items, third constitutes a failure)

1st Evaluator: 2nd Evaluator: 3rd Evaluator:

PASS / REM PASS / REM PASS / FAIL

Student signature: Student signature: Student signature:

Notes: Notes: Notes:

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 Field Medical Training Battalion
INTRAOSSEOUS FLUID RESUSCITATION
PERFORMANCE EXAMINATION CHECKLIST v3.0
STUDENT (Rank Last Name, First Name) PLT

PROCEDURAL STEPS FOR PERFORMING AN INTRAOSSEOUS 1ST 2ND 3RD

FLUID RESUSCITATION P F P F P F
* State reason for selecting to perform IO procedure.

Assess patient and make decision to perform IO

Assemble and check equipment (alcohol, FAST1 Kit)

Cleanse insertion site using aseptic technique.

* Align finger with jugular notch and place patch verifying patch is midline.

Place introducer in target area on patch; hold with a firm grasp.

* Insert introducer perpendicular to manubrium; use continuous increasing
pressure to insert.
Remove introducer by pulling straight back.

* Connect infusion tube to target patch; connect IV tubing.

Place dome over infusion tube and secure.

GRADING CRITERIA 1ST 2ND 3RD

Total Non-Critical Items (3 or greater constitutes a failure)

Total Critical Items (Any critical items missed constitutes a failure)

“Stop & Think” (2 allowed for critical items, third constitutes a failure)

1st Evaluator: 2nd Evaluator: 3rd Evaluator:

PASS / FAIL PASS / FAIL PASS / FAIL

Student signature: Student signature: Student signature:

Notes: Notes: Notes:

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 Tactical Fluid Resuscitation Review

1. What is the definition of an isotonic solution?

2. What is the preferred fluid resuscitation route for a patient with a normal level of consciousness
and the ability to swallow?

3. What is the indication for using the intraosseous route?

4. What are the two most common crystalloids used in the treatment of shock?

5. What is the fluid of choice for a trauma patient in a tactical situation?

6. What gauge needle/catheter is used for IVs in the field setting?

7. Name three potential complications of IV therapy.

8. What is used as a reference point (landmark) for intraossesous placement?

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 UNITED STATES MARINE CORPS
FIELD MEDICAL TRAINING BATTALION
BOX 555243
CAMP PENDLETON, CA 92055-5243

FMST 411

Perform Casualty Assessment

TERMINAL LEARNING OBJECTIVE

1. Given a patient in an operational environment, perform patient assessment to identify chief
complaint and initiate proper treatment within the scope of care. (8404-MED-2011)

ENABLING LEARNING OBJECTIVES

1. Without the aid of reference, given a description or list, identify the procedures for Care
Under Fire, within 80% accuracy, per the Prehospital Trauma Life Support Manual, current
Military Edition. (8404-MED-2011a)

2. Without the aid of reference, given a description or list, identify the procedures for Tactical
Field Care, within 80% accuracy, per the Prehospital Trauma Life Support Manual, current
Military Edition. (8404-MED-2011b)

3. Without the aid of reference, given a description or list, identify the procedures for Tactical
Evacuation, within 80% accuracy, per the Prehospital Trauma Life Support Manual, current
Military Edition. (8404-MED-2011c)

4. Without the aid of reference, given a casualty and a Corpsman Assault Pack, perform
casualty assessment, to prevent further injury or death, per the Prehospital Trauma Life Support
Manual, current Military Edition. (8404-MED-2011d)

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OVERVIEW
Casualty Assessment (CASAS) is a systematic process for assessment of the trauma casualty
and is essential for recognizing life-threatening conditions, identifying injuries, and
determining priorities of care based on assessment findings. Using this systematic approach
you will be able to assess, prioritize, and treat each trauma casualty and ensure injuries are
not missed.
This lesson will go through all the steps of a complete CASAS; however you will not use
every step, every time. The number of steps you complete is based on the tactical situation,
the casualty and the time and resources available.
1. PHASE 1 – CARE UNDER FIRE
During this phase, the Corpsman and casualty are still under hostile fire. The first step in
saving a casualty is usually to control the tactical situation. Very limited medical care
should be attempted while the casualty and the unit are under hostile fire. Suppression of
hostile fire and moving the casualty to a safe position are major considerations at this point.
Remember: “The best medicine on the battlefield is fire superiority.” Casualties who have
sustained injuries that are not life threatening and have the ability to help should continue to
assist in suppressing the hostile fire. It may also be critical for you to help suppress hostile
fire before attempting to provide care.
Casualties whose wounds do not prevent them from moving to cover should do so to avoid
exposing other care givers to unnecessary hazard. If the casualty is unable to move and is
unresponsive, the casualty is likely beyond help. Risking the lives of rescuers is not advised.
If a casualty is responsive and unable to move, a
rescue plan should be developed as follows:
- Determine the potential risk to the rescuers. Did
the casualty trip a booby trap or mine? Where is
fire coming from? Is it direct or indirect? Are
there electrical, fire, chemical, water,
mechanical, or other environmental hazards?
- Consider assets. What can rescuers provide in
the way of covering fire, screening, shielding,
and rescue equipment?
- Make sure all understand their role in the rescue
and which movement techniques are to be used
(i.e., drag, carry, rope, stretcher). The fastest
method for moving a casualty in the Care Under Fire Figure 1. Two Person Drag
phase is the two person drag (see figure 1). This
drag can be used in buildings, shallow water, snow, and down stairs.
- Management of an impaired airway is temporarily deferred until the casualty is safe,
thereby minimizing the risk to the rescuer and avoiding the difficulty of managing the
airway while dragging the casualty. Early control of severe hemorrhage is vital.
However, the tactical situation dictates that you must maintain firepower supremacy so
only life-threatening bleeding warrants any intervention during Care Under Fire.

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 Situation - Determines tactical situation. Return fire to suppress hostile fire. Direct and
expect the casualty to return fire if capable.
Help - Verbally direct casualty and/or buddy to apply tourniquet if casualty and rescuer
are separated
Injury - Determines MOI if possible
Patient quantity - Determines the number of patients vs. supplies. Is there need for triage?
Are there Marines or other HMs available?
Spinal precautions (if warranted)
Level
Of
Consciousness - Mental Status – AVPU (A – Alert, V – Verbal commands, P – Painful
stimuli, U – Unresponsive)
Manage hemorrhage
Identify life-threatening hemorrhage
Apply tourniquet
Move patient to safe location
Reassess tourniquet

2. PHASE 2 - TACTICAL FIELD CARE

During this phase, the Corpsman and casualty are no longer under hostile fire. This also
applies to situations in which an injury has occurred on a mission, but hostile fire has not
been encountered. However, medical equipment is still limited. Medical care during this
phase is directed towards more in-depth evaluation and treatment of the casualty, focusing on
those conditions not addressed during the Care Under Fire phase of treatment. While the
casualty and rescuer are now in a somewhat less hazardous situation, evaluation and
treatment is still dictated by the tactical situation. Casualties who show signs of an altered
mental status should be disarmed immediately.

Airway Assessment
Casualties that are conscious and can talk, scream, or yell can be presumed to have a
patent airway. For unconscious casualties, initial attempts to open the airway should be
done using the trauma jaw thrust (for casualties whom you suspect C-spine injury) or
trauma chin lift.
Once the airway is open, visually inspect for anything that may potentially cause
obstruction. Examples include broken teeth, blood, vomit or tissue swelling. Remember
the most common cause of airway obstruction in an unconscious casualty is the tongue.

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 Clear any obstructions with a finger sweep and insert a nasopharyngeal airway (NPA)
to keep the airway open. Reassess your interventions to ensure the casualty has an open
airway. The standard method of “Look, Listen and Feel” can be used to ensure the
patient is breathing. If the previously mentioned methods fail to establish an airway,
surgical cricothyroidotomy is indicated.
Remember to reassess any intervention performed to determine the effectiveness of the
procedure performed. Regardless of the method used to establish an airway, you must
also judge the quality and adequacy of the ventilations.
Respiration
The goal of this step is to rule out chest FYI!!! If a casualty is found to be
wounds that either have become, or
could potentially develop into, a tension in cardiopulmonary arrest on the
pneumothorax. Needle thoracentesis is battlefield as a result of combat
indicated if the casualty has difficulty trauma, CPR is NOT recommended.
breathing and penetrating trauma to
U U

the chest area.

The only way for you to identify penetrating trauma is to EXPOSE the area. This
includes removing tactical gear such as flak jackets and uniform tops. Once exposed you
may also discover larger wounds, such as sucking chest wounds, that will need to be
treated with an occlusive dressing before moving on to the next step in the casualty
assessment process. Inspecting the area includes looking at the posterior. Examining the
posterior is not simply the back; remember that rectal bleeding is a sign of internal
hemorrhage. This should be checked as well. Reassess ALL interventions following a
log roll!
Needle decompression should provide immediate relief. An occlusive dressing should
not make a sucking sound upon inspiration.
Circulation
Check for the presence and quality of pulses. Determining the presence and quality
(weak / strong) of a radial pulse will affect decisions made later during casualty
assessment.
Perform a blood sweep of the casualties entire body by gently sliding your hands
underneath the casualty and pulling them back, feeling for any bleeding that was not
controlled during “Care Under Fire”. Control it at this time.
Assess for the possibility of tourniquet conversion. Tourniquets that were placed due to
the time constraints of “Care Under Fire” should be converted to a pressure dressing or
Combat Gauze as appropriate. (See Hemorrhage Control lesson if you need to review.)

Head to Toe Assessment (DCAP-BTLS)

Deformities Contusions Abrasions Punctures
Burns Tenderness Lacerations Swelling
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Again, all life threatening injuries should have been identified and treated by this time. The
goal at this stage is to identify and address any additional wounds. You may also identify
signs or symptoms that will affect the long term evacuation or treatment of the patient as
well. It is important that you carefully inspect the entire casualty. Using the head to toe
method described below ensures you do not miss anything.
Head
Check the skull, eyes, ears, nose and mouth for any potential findings. At this time you
should also reassess any treatments that have been performed.
Neck
Check the neck to include the C-spine for any irregularities. Jugular vein distension and
tracheal deviation are very late signs of tension pneumothorax (a condition you should
have treated earlier). If, however, these are encountered at this stage, perform a needle
decompression immediately.
Chest
In addition to checking for DCAP-BTLS, you should also attempt to auscultate the chest
if the tactical situation permits. Simple rib fractures and flail chest segments should be
treated at this time. Reassess any previous treatments, including needle decompression or
occlusive dressings, which may have already been performed.
Abdomen
In addition to inspecting for DCAP-BTLS you should also palpate for Tenderness,
Rigidity or Distension. Abdominal eviscerations should be treated appropriately. Signs
of internal hemorrhage, while not treatable on the battlefield, may affect your decision
during tactical evacuation.
Pelvis
If the patient’s pelvic area is obviously deformed, DO NOT PALPATE IT, as you will
likely cause further instability and damage.
Extremities
Since you are already at the pelvis, palpate the lower extremities first then the upper
extremities using the same process (DCAP-BTLS)
Note and treat any minor injuries not already addressed. Reassess any major
interventions already performed, especially tourniquets or pressure dressing.
Consider Fluid Resuscitation
Casualties that do not exhibit signs of shock do not require and should not be given IV or
IO fluid. They should be encouraged to drink fluids by mouth.
All casualties who exhibit signs of tactically relevant shock (weak pulse and/or altered
level of consciousness) should have IV access started using an 18-gauge catheter.
Consider the IO route for casualties who require fluid resuscitation but IV access can not
be obtained. Administer enough fluid to restore a radial pulse. If giving Hextend, give
500 cc’s, wait 30 minutes, and then give another 500 cc’s if needed. Do NOT give more
than 1000 cc’s of Hextend to any patient.
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Prevent Hypothermia
At this point all life
threatening issues should
have been identified and
treated. You should
begin to take precautions
against hypothermia.
Preventing hypothermia The Blizzard Rescue Blanket (NSN 6352-01-524-6932)
is for more than just comes in many colors, including tactical green. It is
patient comfort, it is an lightweight and extremely effective in preventing
important lifesaving step. hypothermia.
Hypothermia interferes
with the body’s blood clotting mechanism and increases mortality.
As soon as all life-threatening injuries are addressed, the patient should have all of their
wet clothing removed and replaced with dry clothes or a Blizzard Rescue Blanket.
Unless prohibited by wounds, cover the head, as it is a prime source of heat loss. Good
hemorrhage control and fluid resuscitation will also help restore the casualty’s ability to
generate heat.
Monitor Vital Signs
Pain Management
Conscious casualties who remain operationally engaged should be given Mobic (15mg
PO qd) and Tylenol Bi-layer Caplet (650 mg 2 PO q8h).
Casualties who cannot continue to remain operationally engaged but have no need for an
IV should be given Oral Transmucosal Fentanyl Citrate (OTFC) provided as a “lozenge
on a stick” taped to their finger. Reassess the patient every 15 minutes for respiratory
depression.
Those who are out of the fight and require an IV should be administered morphine 5mg
(IV or IO). This can be given every 10 minutes as necessary. The patient should be
monitored for signs of respiratory depression. You should have Naloxone (Narcan) on
hand before administering either OTFC or morphine.
Promethazine (Phenergan) 25 mg IV/IO/IM may be administered to counteract the
nausea associated with Morphine or OTFC.
Immobilization
Splint any extremities that need it.
Antibiotics
If the patient can tolerate oral medications, administer Moxifloxacin 400mg, PO qd. If
not, administer either cefotetan (2g IM/IV/IO) or ertapenem (1g IM/IV/IO). (For more
information on giving medications, see the medication appendix at the end of this block.)

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 Patient Turnover
Document the patient’s initial wounds, treatments performed, and response to any
treatments. Ensure this, along with the most recent set of vital signs, is transferred with
the patient.
3. PHASE 3 - TACTICAL EVACUATION CARE (TACEVAC)
During this phase, casualties should be ready for transport to a higher level of care. Since
casualty movement following Tactical Field Care may be either CASEVAC or MEDEVAC,
the third phase of TCCC has been re-designated Tactical Evacuation Care to include both
possibilities. This phase presents the opportunity to bring in additional medical equipment
and personnel, allowing for expanded diagnostic and therapeutic measures.

Factors to be Considered
Casualty movement may be difficult up to this point. Improvised litters should be padded,
and field-expedient materials should be replaced with conventional supplies as soon as
possible.
Patients with torso trauma must be closely monitored during this phase. Expansion of the
intrapleural gas may result in tension pneumothorax due to the lower pressure at altitude. All
casualties with injuries that interfere with breathing, or have a low O2 saturation should be
given oxygen during TACEVAC.
Efforts to prevent heat loss and, if needed, to actively re-warm the casualty should continue
during TACEVAC. The casualty must be aggressively protected against cold stress during
the evacuation, given the potential for heat loss due to windchill and the lower temperatures
encountered at altitude.
Documentation
The following should be documented and maintained with the casualty:
- All wounds received (location, severity, status)
- Treatments rendered (type of treatment, effectiveness)
- Responses (verbal, medication, etc.)

This is also an excellent time to document and maintain thorough vital signs.
- Pulse rate
- Respiratory rate
- Blood pressure
- SPO2
Continual and thorough reassessment of the casualty is CRUCIAL at this point!

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 ZMIST REPORT
The ZMIST report is given on an individual casualty basis as a means to prioritize and lead
to more effective treatment.

- Zap Number
Given at the unit level, this number identifies the casualty, their gear and their personal
information.

- Mechanism of Injury
What caused the injury? IED blast? Gunshot wound?

- Injuries Sustained
What is the extent of the injuries? Where are they located?

- Signs & Symptoms

What signs and symptoms are the casualties showing?

- Treatments Rendered
What treatments have been done? Are they effective? How are they performing?

REFERENCE
Prehospital Trauma Life Support (PHTLS), current Military Edition

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 Field Medical Training Battalion
CASUALTY ASSESSMENT - TRAUMA
PERFORMANCE EXAMINATION CHECKLIST v3.0

STUDENT (Last Name, First Name, MI.) PLT

1ST 2ND 3RD

CARE UNDER FIRE P F P F P F

* Determines tactical situation. Return fire to suppress hostile fire. Direct and
expect the casualty to return fire if capable.
Verbally direct casualty and/or buddy to apply tourniquet if casualty and rescuer are
separated
Determines MOI if possible
Determines the number of patients vs. supplies. Is there need for triage? Are there
Marines or other HMs available?
Spinal Precautions (if warranted)
Level of Consciousness/Mental Status – AVPU
(A – Alert, V – Verbal commands, P – Painful stimuli, U – Unresponsive)
* Identify and control external life threatening extremity hemorrhage

* Apply tourniquet

* Move patient off the “X”

1ST 2ND 3RD

TIME: (2 MINUTE MAX TIME LIMIT)

TACTICAL FIELD CARE 1ST 2ND 3RD

MASSIVE HEMORRHAGE / AIRWAY MANAGEMENT P F P F P F
* Reassess tourniquet / massive hemorrhage scan (anything missed on the
“X” / unable to apply tourniquet on)
Continually talks to patient to ensure airway

* Opens airway with trauma jaw thrust or trauma chin lift

* Inspect mouth for potential obstructions and clears airway as required

* Look, listen, and feel (5- 10 Seconds)

Insert appropriate airway adjunct

* Reassess airway - Look, listen, and feel (5- 10 Seconds)

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 Field Medical Training Battalion
CASUALTY ASSESSMENT - TRAUMA
PERFORMANCE EXAMINATION CHECKLIST v3.0

1ST 2ND 3RD

RESPIRATORY MANAGEMENT
P F P F P F
* Assess breathing (rate, rhythm, depth)

* Expose chest and inspect for life threatening wounds

Palpate (Crepitus, fractured ribs, flail segments, subcutaneous emphysema)

*Treat thoracic life threatening injuries

* Reassess or apply occlusive dressing

* Log roll and check for exit wounds (beware of spinal integrity)

Posterior assessment (DCAP-BTLS) (Bright red blood in rectum)

* Treat posterior life threatening wounds

* Ensures spinal integrity

Place patient on litter or spine board if available

* Needle thoracentesis

* Reassess all interventions

1ST 2ND 3RD

CIRCULATORY MANAGEMENT
P F P F P F
* Assess for presence of carotid pulse
* Blood sweep (identify and treat major bleeding and/or reassesses prior
interventions - head to toe)
* Assess for bilateral radial pulses (rate and quality)
Estimate palpated blood pressure (Radial = systolic of 80 mmHg, femoral = systolic
of 70 mmHg, carotid = systolic of 60 mmHg)
Peripheral Perfusion (Skin color, temperature, condition, and <2-3 Sec capillary refill)

IV fluid consideration (Based on vital signs, titrate to radial pulses)

FULL BODY ASSESSMENT Deformities, Contusions, Abrasions, 1ST 2ND 3RD
Punctures/Penetrations, Burns, Tenderness, Lacerations, & Swelling (DCAP-BTLS)
P F P F P F
HEAD ASSESSMENT
Skull (Inspects and palpates the scalp, skull & facial bones, Battle’s sign)

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 Field Medical Training Battalion
CASUALTY ASSESSMENT - TRAUMA
PERFORMANCE EXAMINATION CHECKLIST v3.0

1ST 2ND 3RD

HEAD ASSESSMENT (cont.)
P F P F P F
Ears (Blood, CSF, injury)

Eyes (PERRLA-EOMI, injury, raccoon eyes)

Nose (Blood, CSF, injury)

Mouth (Broken teeth, obstructions, odor)

1ST 2ND 3RD

NECK ASSESSMENT
P F P F P F
Posterior (Step offs, deviations)

Anterior (JVD, Tracheal deviation)

1ST 2ND 3RD

ABDOMEN ASSESSMENT
P F P F P F
Inspect (Pulsating masses, bruising, distention, and eviscerations)

Palpate – All (4) quadrants (Distension, rigidity, and facial grimace)

Treat / Reassess abdominal injuries

1ST 2ND 3RD

PELVIS ASSESSMENT
P F P F P F
Inspect (Bruising, obvious injury, meatus / perineum for blood)

Palpate (Squeeze medially and roll down pelvis to check for potential fractures)

Treat / Reassess pelvis injuries

1ST 2ND 3RD

LOWER EXTREMITIES ASSESSMENT
P F P F P F
Inspect (Obvious injuries)
Palpate (Bone crepitus, assess PMS {Movement/sharp/dull test /distal pulse}, note
facial grimace)
Treat / Reassess lower extremity injuries / Split all fractures
(Possible conversion of tourniquet to pressure dressing as indicated)

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 Field Medical Training Battalion
CASUALTY ASSESSMENT - TRAUMA
PERFORMANCE EXAMINATION CHECKLIST v3.0

1ST 2ND 3RD

UPPER EXTREMITIES ASSESSMENT
P F P F P F
Inspect (Obvious injuries)
Palpate (Bone crepitus, assess PMS {Movement/sharp/dull test /distal pulse}, note
facial grimace)
Treat / Reassess upper extremity injuries
(Possible conversion of tourniquet to pressure dressing as indicated)
1ST 2ND 3RD
REASSSESMENT
P F P F P F
Consider pain medications PRN

Interventions, LOC, ABCs

TACTICAL EVACUATION 1ST 2ND 3RD
OVERALL GENERAL IMPRESSION P F P F P F
ZMIST report

Identify transport priority

Reassess fluid intervention requirements

1ST 2ND 3RD

TIME: (12 MINUTE MAX TIME LIMIT)

Scenario
Total number of non-critical steps missed
(Score greater than 10 constitutes a failure)
Critical steps missed (Any critical step missed constitutes a failure)
1st Evaluator: 2nd Evaluator: 3rd Evaluator:

PASS / FAIL PASS / FAIL PASS / FAIL

Student signature: Student signature: Student signature:

Notes: Notes: Notes:

4-130
 Casualty Assessment Review

1. List and briefly describe the three phases of Tactical Combat Casualty Care (TCCC).

2. Management of a compromised airway would be taken care of during what phase of TCCC?

3. Briefly describe why prevention of hypothermia is so important for the casualty.

4. Describe why patients who can stay in the fight should not be given morphine.

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 MEDICATION APPENDIX

Medications Used During

Tactical Combat Casualty Care (TCCC)

Pain Relief
The Committee on Tactical Combat Casualty Care (CoTCCC) recommends the following
medications be used in providing pain relief to casualties. The choice of which
medications to use is based on the patients ability to remain in the fight.
Mobic (meloxicam) is a Non Steroidal Anti-Inflammatory Drug (NSAID) given for
pain relief. This drug is usually given as soon as possible following injury to casualties
who are still able to fight. The CoTCCC recommends this drug be supplied to individual
operators as part of a Combat Pill Pack. This drug was chosen because it has no
documented platelet dysfunction, meaning that unlike other NSAID’s such as Motrin, it
does not interfere with the body’s natural blood clotting abilities. Although it takes up to
five hours to reach its maximum level of effectiveness, it has a long duration time and is
stable even at high temperatures.
Tylenol (acetaminophen) 8-Hour Bi-layer Caplets is an analgesic and antipyretic
(fever lowering) medication intended to be given with at the same time Mobic is given.
The outer layer of the caplet is designed to dissolve quickly to provide quick relief. The
CoTCCC recommends this medication because it acts quickly and helps to bridge the gap
until the Mobic takes effect. It also should be issued to operators as part of the Combat
Pill Pack and should be given to casualties who need pain relief for their injuries but are
still able to participate in combat operations.
Morphine is an Opiod (narcotic) and is considered the “gold standard” of analgesia. It
should only be administered to a casualty out of the fight who already has IV access
established. Dosage should be 5mg given every 10 minutes until pain relief is achieved.
Because patients who receive narcotics often suffer from nausea and vomiting, Phenergan
(promethazine) should also be administered. Narcan (naloxone) should also be on hand
whenever narcotics are used in the event the patient suffers from respiratory depression.
Oral Transmucosal Fentanyl Citrate (OTFC) is an Opiod (narcotic) that provides a
means of delivering effective, rapid onset pain relief without starting an IV. This
medication is produced in a lozenge form. It should be given only to patients who can no
longer participate in combat operations. It should be administered by taping the
“lozenge-on-a-stick” to the patient’s finger and placing the lozenge in the patient’s
mouth. Once analgesia is achieved the patient may pass out and the lozenge will fall out
of his or her mouth. Similar to morphine, promethazine may be needed to reduce nausea
and Narcan should be on hand.

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Phenergan (promethazine) is given to reduce nausea. It is administered IV, IO, or
IM in dosages of 25 mg or 50 mg.
Narcan (naloxone) is an Opiod reversal agent. It is designed to prevent or reverse the
effects of narcotics such as morphine or OTFC. It should be administered in an initial
dose of 0.2 mg IV, IO, or IM (up to 10 mg total).

Antibiotics
Infection is a late cause of morbidity (sickness) and mortality (death) in battlefield
wounds. For this reason the CoTCCC has recommended casualties receive antibiotic
treatment as soon as possible. The biggest challenge for you is the logistical
requirements that prevent you from carrying a wide variety of items. The CoTCCC
identified the antibiotics that provided the most “bang for the buck”. The following
medications were chosen for their, broad coverage, minimal side effects, resistance to
heat or cold, simple dosage requirements, and minimal storage requirements.
Avelox (moxifloxacin) is the oral antibiotic of choice. The dosage is one 400 mg
tablet by mouth, once a day. This should be administered to all casualties who can
tolerate oral medications as soon after injury as possible.
Cefotan (cefotetan) is the parenteral (injectable) antibiotic drug of choice. The dosage
is either 2 grams IV/IO delivered over the span of 3 to 5 minutes or 2 grams IM. This
should be given to casualties who can not take oral medications. This includes casualties
who are unconscious or those who have significant facial wounds. Patients in
hypovolemic shock should not be given antibiotics orally because reduced blood flow to
the stomach impairs the body’s ability to process oral medications.
Invanz (ertapenum) is the recommended alternative to cefotetan in the event it is not
available (as has been the case). The dosage is 1 gram administered IV, IO, or IM. This
should be given to casualties who can not take oral medications. This includes casualties
who are unconscious or those who have significant facial wounds. Patients in
hypovolemic shock should not be given antibiotics orally because reduced blood flow to
the stomach impairs the body’s ability to process oral medications.

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 Combat Medicine
Review Questions

NOTE: The following questions are offered for review purposes. This is NOT intended as
a sole source of test preparation. Remember all test questions are based on an ELO and
any ELO can be used to create a test question.

1. What are the anatomical landmarks for a cricothyroidotomy?

2. What are the components of the cardiovascular system?
3. What are the three basic groups that IV solutions fall into?
4. What causes a Flail Chest?
5. What are the three types of muscles in the body?
6. What major abdominal organs are in the Right Upper Quadrant?
7. What is the initial treatment of a life threatening extremity wound?
8. The skeletal portion of the thorax is formed by what?
9. What are the three types of head injuries?
10. What are the 10 procedural steps of performing an emergency cricothryoidotomy?
11. What are two serious consequences of Tension Pneumothroax?
12. What plasma substitute is the IV fluid of choice for volume replacement due to trauma in a
tactical situation?
13. What is the Hemostatic agent used on the battlefield?
14. Which lung is larger than the other and is divided into three lobes?
15. What are the major types of facial injuries?
16. Treatment for strains and sprains includes R.I.C.E. What does R.I.C.E stand for?
17. What is the second leading cause of preventable death on the battlefield?
18. What is homeostasis?
19. Where should a tourniquet NEVER be placed?
20. What major abdominal organs are in the Right Lower Quadrant?
21. For which type of injury is a Modified Barton bandage used?
22. How much blood is in the average adult?
23. What is the difference between a strain, sprain, and dislocation?
24. What are the four classifications of hemorrhagic shock?
25. What major abdominal organs are in the Left Upper Quadrant?
26. What is the most common complication associated with emergency cricothyroidotomy?
27. What are the two types of bruising associated with closed skull injuries?
28. What anatomical landmarks are necessary in order to perform needle thoracentesis?

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 Combat Medicine
Review Questions
29. What are the classifications of abdominal organs?
30. What are the causes of cervical spine neck injuries?
31. What is Phlebitis?
32. What are the three phases of Tactical Combat Casualty Care?
33. What are the four types of bones in the body?
34. What is the definitive management of hemorrhagic shock?
35. What are the three types of distributive shock?
36. What are signs and symptoms of intrinsic cardiogenic shock?
37. What major abdominal organs are in the Left Lower Quadrant?
38. What are signs and symptoms of vasculature neck injuries?
39. What are the procedural steps for needle thoracentesis?
40. What is subcutaneous emphysema?
41. What causes an Open Pneumothorax (Sucking Chest Wound)?
42. What are the three types of hemorrhage and what are their distinguishing traits?

4-135
COMPONENTS OF
FIELD MEDICINE
 COMPONENTS OF FIELD MEDICINE

Blast Related Injuries 5-1

FMST 501

Traumatic Brain Injury (TBI) 5-6

FMST 502

Manage Burn Casualties 5-14

FMST 503

Conduct Triage 5-25

FMST 504

Coordinate Casualty/Tactical Evacuation 5-32

FMST 505

Perform Aid Station Procedures 5-52

FMST 506

Medical Support for Military Operations in Urban Terrain (MOUT) 5-63

FMST 507

Review Questions 5-69

 UNITED STATES MARINE CORPS
FIELD MEDICAL TRAINING BATTALION
BOX 555243
Camp Pendleton, CA 92055-5243

FMST 501

Blast Related Injuries

TERMINAL LEARNING OBJECTIVE.

1. Given a mission, Commander's guidance and intent, rules of engagement, escalation

of force criteria, and a simulated exploded improvised explosive device (IED), while
serving as an individual in a small unit, react to an exploded improvised explosive
device (IED) to prevent further casualties and resume the mission. (HSS-MCCS-
2019)

ENABLING LEARNING OBJECTIVE(S).

1. Without the aid of reference and in writing, identify the five categories of blast
effects on the human body, within 80% accuracy per Prehospital Trauma Life Support,
Current Military Edition. (HSS-MCCS-2019a)

2. Without the aid of reference and in writing, identify the pattern of injuries from an
explosive device, within 80% accuracy per Prehospital Trauma Life Support, Current
Military Edition. (HSS-MCCS-2019b)

3. Without the aid of reference and in writing, identify the wounding effects of
fragmentation, within 80% accuracy per Prehospital Trauma Life Support, Current
Military Edition. (HSS-MCCS-2019c)

4. Without the aid of reference and in writing, identify the wounding effects of blast
overpressure, within 80% accuracy per Prehospital Trauma Life Support, Current
Military Edition. (HSS-MCCS-2019d)

5-1
 1. Identify the Five Categories of Blast Effects

a. The term “blast injuries” refers to the general injuries caused by an explosive force.

b. The five categories of blast injury effects are known as primary, secondary, tertiary,
quaternary and quinary. It is important to understand the effects of each, as well as the
mechanism of injury and injuries associated with all five.

Effect Impact Mechanism of Injury Injuries

Primary Direct blast Overpressure; Interaction Pulmonary

effects (over- and of blast wave with body;
under- Stress and Sheer Waves Tympanic
pressurization Membrane

Hollow-viscus
Injuries
Secondary Projectiles Fragments from the Fragmentation
propelled by exploding weapon as well Injuries
explosions as from the environment
(debris, vehicle metal, Penetrating Trauma
rocks etc)
Tertiary Body propelled Displacement of body and Penetrating
onto hard surface structural collapse
Blunt Trauma

Crush Injuries
Quaternary Heat and Burns Burns
Combustion
Flames Toxicity Inhalation Injuries

Asphyxiation
Quinary Additives Contamination Depends on additive
(Chemicals,
Radiation etc)

2. Pattern of Injuries

a. Casualties from explosions on the battlefield are generally segregated into two
categories, military and civilian. While military casualties are predominately young and
otherwise healthy, civilian casualties may be very young or very old. A large percentage
of those will be in relatively poor health.

b. Military casualties will be more likely to wear protective gear. Therefore, they will
be less likely to suffer injuries to the upper torso and head.

5-2
 c. Most wounds are non-critical, soft tissue or skeletal injuries. Up to 70% of all
mortalities involve head injuries.

3. Wounding Effects of Fragmentation

a. Fragmentation injuries are the most common form of injury in a terrorist bombing.
Fragments include debris from the munitions itself, the environment surrounding the
explosive (sticks, rocks, trash etc) and, in the case of suicide bombers, human body parts.

b. Treatment of fragmentation wounds will be based on the body area involved and the
extent of the injury.

c. Limbs are by far the most commonly affected body area, accounting for 70% of the
injuries from explosive devices. Primary and secondary effects of the blast may require
the patient to receive emergency treatments to prevent exsanguination. As with all war
wounds, extremity wounds from explosions will need antibiotics to prevent systemic
infection.

d. While eyes are extremely resistant to primary effects of blasts, they are susceptible
to secondary and tertiary effects. Explosions that cause shattering of glass have a high
incidence of causing penetrating eye injuries. The majority of eye injuries are caused by
inadequate eye protection, such as polycarbonate goggles.

4. Wounding Effects of Blast Overpressure

a. Physics of Blast Waves

(1) Stress waves are supersonic, longitudinal pressure waves. These waves create
high potential for injuries, especially in gas filled organs such as the lungs, ears and
intestines.

(2) Sheer waves are lower velocity transverse waves with longer duration than stress
waves. These waves cause tissue in the body to move back and forth.

b. Lung Injuries occur when the victim experiences overpressure of greater than 40
psi. Increases in pressure of 200 psi in an open air environment are almost universally
fatal. Lung injuries are the most common cause of death related to the primary blast
effect.

c. Ear Injuries can occur from as little as 5-15 psi of overpressure. For this reason it is
imperative that all blast injury casualties be examined for possible tympanic membrane
rupture. Blast induced deafness may heighten the patient’s anxiety. It may be permanent
or spontaneously resolve in a matter of hours.

5-3
 d. Gastrointestinal Injuries are more likely to occur in patients of blasts detonated
inside a building than those exposed to explosions in an open air environment. Of all
abdominal blast injuries, intestinal perforation is the most common. Symptoms include
pain in the abdomen, rectum and testes. Signs and symptoms may be difficult to
appreciate early in the chain of care.

e. Solid Organ injuries are rare in open air blasts but have been reported in underwater
blasts.

f. Central Nervous System injuries to include Traumatic Brain Injuries (TBI) are a
significant issue associated with blast injuries. Moderate to sever TBI accounts for 71%
of the early deaths associated with explosions and 52% of later deaths. Mild TBI is
associated with long term issues such as memory loss, irritability and decreased cognitive
functions. For this reason ALL PERSONEL INVOLVED IN AN EXPLOSIVE
ATTACK SHOULD BE REFERRED TO THE MEDICAL OFFICER FOR
DOCUMENTATION AND EVALUATION.

REFERENCES:
PreHospital Trauma Life Support (PHTLS). Current Edition

5-4
 Blast Related Injuries Review

1. Identify the five categories of blast effects on the human body?

2. Explain the pattern of injury consistent with a blast victim?

3. Identify the wounding effects fragmentation has on different parts of the body?

4. Describe the wounding effects of blast overpressure?

5-5
 UNITED STATES MARINE CORPS
FIELD MEDICAL TRAINING BATTALION
BOX 555243
CAMP PENDLETON, CA 92055-5243

FMST 502

Evaluate Traumatic Brain Injury

TERMINAL LEARNING OBJECTIVE

1. Given a casualty in an operational environment, evaluate traumatic brain injuries to reduce

the risk of further injury or death. (8404-MED-2016)

ENABLING LEARNING OBJECTIVES

1. Without the aid of reference and in writing, identify the mandatory events requiring TBI
evaluation, within 80% accuracy, per Prehospital Trauma Life Support, Current Military
Edition. (8404-MED-2016a)

2. Without the aid of reference and in writing, identify the signs and symptoms of TBI, within
80% accuracy, per Prehospital Trauma Life Support, Current Military Edition. (8404-MED-
2016b)

3. Without the aid of reference and in writing, identify the components of the Military Acute
Concussion Evaluation (MACE), within 80% accuracy, per Prehospital Trauma Life Support,
Current Military Edition. (8404-MED-2016c)

4. Without the aid of reference and in writing, identify the required data for the significant
activity (SIGACT) report, within 80% accuracy, per Prehospital Trauma Life Support, Current
Military Edition. (8404-MED-2016d)

5-6
OVERVIEW

It is DoD policy that:

a. DoD shall identify, track, and ensure the appropriate evaluation and treatment of Service
members exposed to potentially concussive events, to include blast events.

b. Service members exposed to a potentially concussive event shall be medically assessed as

close to the time of injury as possible.

c. Medically documented mTBI/concussion in Service members shall be clinically evaluated,

treated, and managed according to the most current DoD clinical practice guidance for the
deployed environment found at the Defense Centers of Excellence for Psychological Health and
Traumatic Brain Injuries (DCoE) website.

d. Recurrent concussion shall be managed according to the most current DoD clinical practice
guidance for the deployed setting.

e. Potentially concussive events, results of concussion screening, and diagnosed concussions

shall be appropriately documented, to the maximum extent possible in the Service member’s
electronic health record.

1. MANDATORY EVENTS REQUIRING TBI EVALUATION

Events requiring mandatory rest periods and medical evaluations and reporting of exposure
of all involved personnel include, but are not limited to:

a. Involvement in a vehicle blast event, collision, or rollover.

b. Presence within 50 meters of a blast (inside or outside).

c. A direct blow to the head or witnessed loss of consciousness.

d. Exposure to more than one blast event (the Service member’s commander shall direct a
medical evaluation).

2. SIGNS & SYMPTOMS

TBI can be divided into 2 categories:

a. Primary Brain Injury

b. Secondary Brain Injury

5-7
 Primary Brain Injury
- Direct trauma to the brain and associated structures (Contusions, hemorrhages,
lacerations)

Secondary Brain Injury

- The ongoing injury process from primary injury
- Management of TBI is focused to limit or stop these secondary mechanisms (ICP,
hypoxia, hypotension and inadequate cerebral blood flow)

Mild TBI
- Loss of consciousness is brief, usually a few seconds/minutes
o Loss of consciousness does not have to occur
- Testing and scans of the brain may appear normal
- Most common: 75%-85% of all brain injuries are mild
- 90% of individuals recover within 6-8 weeks

Moderate TBI
- Loss of consciousness lasts from a few minutes to a few hours
- Confusion lasts from days to weeks
- Physical, cognitive, and/or behavioral impairments last for months or are permanent
- EEG/CAT/MRI are positive for brain injury

Severe TBI
- Prolonged unconscious state or coma lasts days, weeks or months
- Categories include:
o Coma
o Vegetative State
o Persistent
o Minimally Responsive State
o Locked-in Syndrome
Commanders or their representatives are required to assess all Service members involved in
potentially concussive events, including those without apparent injuries, as soon as possible
using the Injury/Evaluation/Distance (I.E.D.) checklist (see Figure 1).

Figure 1 IED Checklist

5-8
3. MILITARY ACUTE CONCUSSION EVALUATION

5-9
5-10
4. REQUIRED DATA FOR THE SIGACT REPORT

After the I.E.D. assessment is complete, record the results for each individual involved in the
event and submit as part of the significant activities (SIGACT) report required for blast-
related events. The line commander is responsible to ensure all reports are completed as
operational conditions permit, preferably within 24 hours. The minimum required data fields
for the monthly reports are:

5-11
 a. Date of potentially concussive event.

b. Type of potentially concussive event triggering evaluation.

c. SIGACT number (if applicable).

d. Personal identifier (e.g., DoD identification number or Battle Roster Number).

e. Service member’s name.

f. Unit name, unit identification code, and home duty station.

g. Combatant Command in which the event occurred.

h. Service member’s distance from the blast when applicable.

i. The disposition following the medical evaluation (return to duty after 24 hours,
commander’s justification to return to duty prior to 24 hours, or did not return to duty after
24 hours).

REFERENCE:

DoD Instruction 6490.11 - DoD Policy Guidance for Management of Mild Traumatic Brain
Injury/Concussion in the Deployed Setting

5-12
 Evaluate Traumatic Brain Injury Review Questions

1. What are the mandatory events requiring TBI evaluation?

1)

2)

3)

4)

2. What are the 2 categories of TBI?

1)

2)

3. What are the symptoms of mild TBI?

4. What does “IED” stand for?

I–

E–

D–

5. What is the total score for a MACE exam?

6. What is the final data needed for the SIGACT report?

5-13
 UNITED STATES MARINE CORPS
FIELD MEDICAL TRAINING BATTALION
BOX 555243
CAMP PENDLETON, CA 92055-5243

FMST 503
Manage Burn Casualties

TERMINAL LEARNING OBJECTIVES

1. Given a casualty in an operational environment and a combat assault pack, treat burns to reduce the risk of
further injury or death. (8404-MED-2012)

ENABLING LEARNING OBJECTIVES

1. Without the aid of reference and given a description or list, identify the anatomy of the
skin, within 80% accuracy, per the Pre-Hospital Trauma Life Support, Current Military Edition.
(8404-MED-2012a)

2. Without the aid of reference and given a description or list, identify the different types of
burns, within 80% accuracy per the Pre-Hospital Trauma Life Support, Current Military Edition.
(8404-MED-2012b)

3. Without the aid of reference and given a description or list, identify the degree of burns,
within 80% accuracy per the Pre-Hospital Trauma Life Support, Current Military Edition. (8404-
MED-2012c)

4. Without the aid of reference and given a description or list, determine the percent of body
surface burned per the Pre-Hospital Trauma Life Support, Current Military Edition. (8404-
MED-2012d)

5. Without the aid of reference and given a description or list, identify the appropriate
treatment for burns, within 80% accuracy per the Pre-Hospital Trauma Life Support, Current
Military Edition. (8404-MED-2012e)

5-14
1. ANATOMY OF THE SKIN
The most important function of the skin is to be
a protective barrier against the outside
environment. The skin also prevents fluid loss
and helps regulate body temperature. Skin is
composed of three layers: the epidermis,
dermis, and subcutaneous tissue (see figure 1).
Epidermis - the outermost layer, is made up
entirely of epithelial cells with no blood
vessels
Dermis - a framework of connective tissues
containing blood vessels, nerve endings,
sebaceous glands, and sweat glands
Subcutaneous Tissue - is a combination of
elastic and fibrous tissue as well as fat deposits Figure 1. Anatomy of the Skin

2. TYPES OF BURNS
Burn injuries have many causes on and off the battlefield. Burns are generated by exposure
to extreme heat, a biologic reaction from chemicals, or energy transfer through cells from
electrocution or radiation. Many weapons and munitions cause burn injuries. Some, such as
incendiary and flame munitions, are designed to cause high heat and burning. Others, such
as high explosives, bombs, and mines cause burns secondarily to their primary effect.
Thermal (see figure 2) - thermal burns are the most common type of burn on the modern
battlefield. They can result from exposure to flame weapons, incendiary weapons, munitions
or from explosions from fuel sources (gasoline, diesel, and jet fuel). These weapons are
designed to burn at very high temperatures and incorporate napalm, thermite, magnesium,
and white phosphorous.

- The primary effect of incendiary and flame munitions against personnel are to cause
severe burns.
- Burns to the airway are also possible, particularly if the casualty is in an enclosed space
(bunker, ship compartment, or armored vehicle). Airway burns
may result in rapid, life-threatening swelling and obstruction of
the upper airway. Monitor the casualty for the following signs
and symptoms:
- Stridor
- Oropharyngeal swelling
- Hoarseness
- Difficulty swallowing
- Carbonaceous sputum (blackened sputum)
- Singed nasal or facial hair Figure 2. Thermal burn to legs
- Dyspnea

5-15
Electrical Burns (see figure 3) - electrical injuries are devastating injuries that can easily be
underappreciated. In many cases the extent of tissue damage does not accurately reflect the
magnitude of the injury. Tissue destruction and necrosis are excessive compared with the
apparent trauma because most of the
destruction occurs internally as the electricity
is conducted through the casualty. The
casualty will have external burns at the points
of contact with the electrical source as well as
grounding point. As the electricity courses
through the casualty’s body, deep layers of
tissue are destroyed despite seemingly minor
injuries on the surface. Electrical and crush
injuries share many similarities. In both
injuries there is massive destruction of large
muscle groups with resultant release of both
potassium and myoglobin. The release of
potassium from large muscles causes a significant Figure 3. Electrical burn to foot
increase in the serum level, which often results in
cardiac arrhythmias. All electrical burns are considered a cardiac emergency and the casualty
should be TACEVAC’d to a higher echelon of care. Also, when myoglobin is released into the
bloodstream in consderable amounts, it can be toxic to the kidneys and can cause kidney failure.
Other signs and symtoms include:
- Tympanic membranes may rupture causing hearing loss.
- Intense muscle contractions (tetany) can result in fractures at multiple levels of the
spine. Casualties with electrical injuries should have their spine immobilized.
- Intercranial bleeds and long bone fractures may also occur.
Circumferential Burns (see figure 4) - a circumferential burn is a burn that encircles the trunk of
the body (chest) or an extremity (arm or leg). Circumferential
burns are capable of producing a life or limb threatening
condition. They can create a tourniquet-like effect that can
render an arm or leg pulse-less. Circumferential burns of the
chest can constrict the chest wall to such a degree that the
casualty suffocates from inability to breath. Therefore, all
circumferential burns should be handled as an emergency and
casualties TACEVAC’d immediately. Escharotomies are
surgical incisions made through the burn eschar to allow
expansion of the deeper tissue and decompression of previously
compressed and often occluded vascular structures.
Figure 4. Circumferential burn to foot

Radiation Burns - burns associated with nuclear blasts. Radiation is a hazardous material. The
initial priorities are to remove the casualty from the source of contamination, remove
contaminated clothing, and irrigate the casualty with water.
- Skin that is exposed to an explosion is burned by the infrared rays emitted at detonation.
- Clothing or shelter can offer some protection.
- Secondary injuries will include first and second degree burns.
- The majority of burns are caused by contact with the secondary sources that ignited
5-16
 such as buildings and clothing.
- If the doses of ionizing radiation are high enough to cause burns to the skin, systemic
effects may overshadow the burn itself.
Chemical - injuries from chemicals are often the result of prolonged exposure to the
offending agent. This is contrasted with thermal injuries, where the duration of exposure is
usually very brief. You may encounter casualties who have suffered chemical burns caused
by weapons, chemicals used to fuel or maintain equipment, or chemical spills following
damage to civilian installations. The severity of a chemical injury is determined by four
factors: nature of the chemical, concentration of the chemical, duration of contact, and MOI
of the chemical. Chemical agents are classified as:
Acids:
- chemicals with a pH between 7 (neutral) and 0 (strong)
- Found in cleaners and swimming pool acidifiers
Bases (alkali):
- chemical with a pH between 7 and 14
- found in fertilizer, industrial cleaners, the structual bonds of cement/concrete, and
the most common cause of alkali burns in garrison are the batteries used in our
radios
- Alkali burns are usually more serious than acid burns, because alkalis penetrate
deeper and burn longer
Organic:
- Contains carbon
- Phenols, creosote and petroleum products such as gasoline

3. DEGREE OF BURNS
The severity of a burn is determined by the depth of the burn and the extent of the total body
surface area (TBSA) burned. The severity of all burns will vary depending on the source of
the burn, duration of exposure, and location of the burn.
Depth: The depth of the burn is related to how deeply the skin is damaged (see figure 5).
Estimation of burn depth can be deceptively difficult. Often, a burn that appears to be a
partial-thickness burn (second degree) will prove to be third degree burn in 24 to 48
hours. Therefore it is often wise to withhold final judgment of burn depth for up to 48
hours after injury.

Figure 5. Depth of Burns

5-17
Superficial Burn/First-Degree Burn (see figure 6) - first-degree
burns involve only the epidermis and are characterized as being
red and painful. These wounds heal typically within a week and
the casualty will not scar.
Signs and Symptoms:
- Dry, red and inflamed skin
- Painful to touch
- The burned area blanches with pressure
- Minimal swelling (if present)

Figure 6. First Degree burn on

hand
Partial Thickness Burns/Second-Degree Burn
(see figure 7) - burns that involve the epidermis
and varying portions of the underlying dermis.
Second-degree burns will appear as blisters or as
denuded, burned areas with a glistening or wet
appearing base. These wounds will be painful.
Because remnants of the dermis survive, these
burns are often capable of healing in 2 to 3
weeks.
Figure 7. Second Degree Burn

Signs and Symptoms:

- Skin is moist, with reddened areas
- Blisters or open weeping wounds
- Deep, intense pain
- Edema will be moderate
- Fluid loss may be significant depending on the extent of the burn

Full Thickness Burn/Third-Degree Burn (see figure

8) - third-degree burns involve all three layers of skin
and may have several appearances. Most casualties
will have pain because areas of third-degree burn are
usually surrounded by second-degree burns.
- Signs and Symptoms:
- Skin has a dry, leathery appearance
- The skin can range in color from white,
yellow, cherry red, brown, or charred
- Severe pain around periphery of burn, but
little to no pain near center of burn. Figure 8. Third Degree burn of lower leg
- No capillary refill at affected area

5-18
 Fourth-Degree/Complete Burn (see figure 9) -
fourth-degree burns are those that not only burn all
layers of the skin, but also burn underlying fat,
muscles, bone or internal organs.

Figure 9. Fourth Degree burn on arm

4. BURN SIZE ESTIMATION

Estimation of burn size is necessary to begin to resuscitate the casualty appropriately and
prevent the complications associated with hypovolemic shock. The most widely applied
method is known as the “Rule of Nines.”

Rule of Nines: This method applies the principles that major regions of the body in adults
are considered to be 9% of the total body surface area (TBSA) (see figure 10). The genital
area and palms of the hand (not including the digits) represent 1%.

Front of head
is 4.5% and
back of head
is 4.5% for a
total of 9% Front of arm
is 4.5% and
back of arm
is 4.5% for a
total of 9%

Figure 10. Rule of Nines

Rule of Palms: This method assumes that the palm size of the patient represents
approximately 1% of the TBSA. TBSA is estimated by counting the number of the patient’s
“palms” it takes to completely cover the burn area. The Rule of Palms is helpful for
estimating the TBSA of small or irregular shaped burns and small children.

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6. TREATMENT OF BURNS
The initial step in the care of a burn casualty is to stop the burning process. The most
effective and appropriate method of terminating the burning is irrigation with large volumes
of room-temperature water. In the tactical environment however, access to large volumes of
water is not always practical. You can also smother any flames with a jacket, blanket, or any
other available material. Rolling the casualty on the ground is also effective. Remove all
clothing and jewelry; these items retain residual heat and will continue to burn the casualty.
However, DO NOT pull away clothing that is stuck to the wound.
Airway - the heat from the fire can cause edema of the airway above the level of the vocal
cords and can occlude the airway, so be prepared for a possible surgical airway. Careful and
continuous evaluation of the airway is required. O2 should be given, if available.
Breathing - as with any trauma casualty, breathing can be adversely affected by such
problems as broken ribs, pneumothoraces (collapsed lung), and open chest wounds. In the
event of circumferential chest wall burns, pulmonary compliance may decrease to such an
extent that it inhibits the casualty’s ability to inhale. In such cases, prompt TACEVAC of
casualty to higher level of care in order to perform escharotomies of the chest wall is critical.
Circulation - evaluation of circulation includes the determination of blood pressure,
evaluation of circumferential burns, and establisment of intravenous access. Accurate
measurement of blood pressure becomes difficult or impossible with burns to the extremities.
Blood pressure can be estimated by palpating for distal pulses. Even if the casualty has
adequate blood pressure, distal limb perfusion may be critically reduced because of
circumferential injuries. Burned extremities should be elevated, when tactically prudent,
during transport to reduce the degree of swelling in the affected limb.
Two large-caliber IV catheters are required for burns that cover more than 20% of the TBSA.
Ideally, the IV should not be placed through or adjacent to burned tissue; however, placement
through the burn is appropriate if no alternative sites are available or consider the
intraosseous (IO) route.
Detailed Assessment - perform your assessment, keeping in mind that burns themselves are
not immediately fatal and can wait until other priorities are addressed. Therefore, assess for
additional injuries, such as associated blast, missile or fragment wounds and treat
appropriately.
Hypothermia - burn casualties are not able to retain body heat and are extremely susceptible
to hypothermia. Make every effort to preserve body temperature. Apply several layers of
blankets. Keep passenger compartment of the TACEVAC vehicle or fuselage of the aircraft
warm, regardless of the time of year. As a general rule, if you as the provider treating the
burn casualty are not uncomforable, the ambient temperature is not warm enough.
Estimate the Depth and Extent of the Burn - use the “Rule of Nines” or the “Rule of Palms”
noted above.
Dressing the burn - before TACEVAC, the wounds should be dressed. The goal of the
dressing is to prevent ongoing contamination and prevent airflow over the wounds. Water-jel
dressings, if available, are preferred as they help to cool the burn. If not, dry sterile dressings
covering the entire burn are sufficient before TACEVAC of the casualty. Several layers of
blankets are then placed over the casualty to prevent hypothermia.
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Fluid resuscitation- Administration of large amounts of IV fluids is needed to prevent a burn
casualty from going into hypovolemic shock. After a burn, the casualty loses a substantial
amount of intravascular fluid from the edema, as well as the evaporative losses at the site of
the burn. Massive fluid shifts will occur and evaporative losses can be enormous.
The resuscitation of burn shock is aimed at not only restoring the lost volume but also
replacement of anticipated losses. When treating a burn casualty, the objective is to calculate
and replace the fluids that it is anticipated the casualty will lose over the first 24 hours after
the burn injury.
The use of LR solution is the best way to initially manage a burn casualty. The most
frequently used formula for calculating fluid replacement is the “Parkland formula.” The
Parkland formula delivers 4 ml/kg/% TBSA burned. Half this fluid will be administered in
the first 8 hours after injury and the remaining half of the volume over the next 16 hours. It
is important to remember the first half is administered with 8 hours from the time the
casualty was injured, not from the point the provider started to resuscitate the casualty. This
is especially important in the tactical situation where
there may be an initial delay in treatment. If the To Pop or Not to Pop, that is the
casualty presents for emergency care 3 hours after Question?
the injury with no or little fluids administered, the The blister on a burn does not provide
first half of the calculated total needs to be protection to the skin and limits the
administered over 5 hours. For example: ability to apply topical antibiotics. So
why don’t we pop them? Blisters
Parkland formula example = 4 mL X weight in should only be popped when you
kg X % TBSA burned have the capabilities to debride the
wound, provide pain medications, and
Parkland formula: 4 ml X 76 kg X 36% apply antibiotic ointments. Do not
open the blisters unless the above
76 kg casualty has sustained partial thickness capabilities are available.
burns to his anterior chest (9%) and abdomen
(9%), entire right arm (9%), and anterior right leg (9%). The injury occurred 30
minutes ago.
In this case, the casualty who weighs 76 kg has sustained burns over 36% of his body.
So, doing the math:
4 X 76 = 304; 304 X 36 = 10,944 mL (which can be rounded up to 11 liters)
Remember, half of this total should be administered in the first 8 hours following the
burn, so, the casualty will need 5 ½ liters in the first 8 hours. Keep in mind, the injury
occurred 30 minutes ago, so the entire 5 ½ liters should be administered over a period
of 7 ½ hours.
The remainder is administered over the remaining 16 hours:
5,500 mL divided by 16 (time remaining in one day) equals 343 ml per hour for the
next 16 hours.

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Although the Parkland formula is effective and widely used, the U.S. Army Institue of
Surgical Research developed the “Rule of 10” to simplify the process of calculating fluid
requirements for burn patients in the prehospial setting. Using the rule of 10, the percent of
BSA burned is calculated and rounded to the nearest 10. For example, a burn of 36% would
be rounded to 40%. The percent burn is then multiplied by 10 to get the number of mL per
hour of crystalloid. Thus, in the previous example, the calculation would be 40 X 10
equaling 400 mL per hour. This formula is used for adults weighing 40 to 70 kg. For each
10kg in body weight over 70kg, an additional 100 mL per hour is given.
While you may not be completely responsible for the care of severely burned patients for 24
hours, this example illustrates the need for burn patients to receive quick attention and
prompt evacuation to definitive care.

Burns to the Eyes (see figure 11)

Signs and Symptoms:
- Blurry vision
- Vision loss
- Pain
- Tearing
- Conjunctival erythema

Treatment:
- Thermal burn - irrigate with large
amounts of water.
- Chemical burn:
- Acids - irrigate for 5 - 10 minutes Figure 11. Burns to the eyes
- Alkalis - irrigate for 20 minutes
- Cover eyes with a dry sterile dressing. In a tactical situation, if the patient can
partially see out of the affected eye and can otherwise ambulate, defer dressing the
eye. Avoid dressing both eyes if only one eye is injured.

If evacuation is delayed
- Clean the burn area with diluted (1:10) Betadine solution and then rinse with saline.
- Remove loose nonviable tissue during cleaning process (this is very painful, especially
at the periphery of the burn so pain management should be considered).
- Apply Silvadene (or other bacteriostatic ointment) and cover with dry, loose, sterile
dressing, if available
- Gently clean and reapply Silvadene and a fresh dressing every 24 hours.

5-22
 Critical Burns Requiring Special Care - The American College of Surgeons Committee on
Trauma developed a list of burn injuries that are considered critical regardless of depth or
TBSA affected. Treatment in a specialized burn unit will improve the chances of survival
and reduce complications or disabilities for casualties with any of the following injuries:
- Inhalation injuries.
- Partial-thickness burns over greater than 10% of the TBSA.
- Full thickness burns in any age group.
- Any burn involving the face, hands, feet, genitalia, perineum, or major joints.
- Electrical burns, including lightning injury.
- Chemical burns.
- All burns complicated by injuries of the respiratory tract, other soft tissue injuries, and
musculoskeletal injuries.
Pain Management should be provided to burn victims, and small doses of narcotics should be
titrated intravenously (see the medication appendix at the end of Block 2 for more
information regarding pain medications). Vital signs and respiratory effort are monitored for
potential adverse effects. (Note: The use of narcotics is contraindicated in head and spinal
trauma.) Water immersion may be applied for 10-15 minutes for pain relief, however,
caution should be used as it may intensify shock.

CASUALTY ASSESSMENT AND BURNS

Care Under Fire Phase: Unless casualty also has life-threatening hemorrhage along with a
burn, there is no care given for burns in this phase.

Tactical Field Care Phase: During this phase, you will be required to inspect the burned area.
A burn can cause significant problems with the airway. If a casualty’s airway is jeopardized,
securing an airway is vital before edema sets in. Consider a surgical airway, if needed. Don
BSI. Complete a head to toe assessment using DCAP-BTLS noting and treating additional
injuries. Determine if vascular access is required (see Tactical Fluid Resuscitation lesson) and
give fluids if necessary. If the casualty is able to drink fluids, they should be encouraged to do
so. Consider pain medications and give antibiotics if warranted. Reassess all care provided.
Document care given, prevent hypothermia, and TACEVAC.

REFERENCE
Pre-Hospital Trauma Life Support, Current Military Edition.

5-23
 Manage Burn Casualties Review

1. Identify three charicteristics of a second degree burn.

2. Using the Rule of Nines, estimate the body surface area affected for a patient with burns to
the upper and lower back.

3. Using the Rule of Nines estimate the body surface area affected for a patient with burns to
the chest, abdomen and right front arm.

4. Describe the appropriate treatment for burns, assuming no delay in casulty evacuation.

5-24
 UNITED STATES MARINE CORPS
FIELD MEDICAL TRAINING BATTALION
BOX 555243
CAMP PENDLETON, CA 92055-5243

FMST 504

Conduct Triage

TERMINAL LEARNING OBJECTIVES

1. Given multiple casualties in a tactical environment, conduct triage to ensure patients are
treated according to category. (8404-HSS-2002)

2. Given multiple casualties in an operational environment, necessary medical equipment and

supplies, manage mass casualty incident to reduce the risk of further injury and death. (8404-
HSS-2003)

ENABLING LEARNING OBJECTIVES

1. Without the aid of reference, given a description or list, identify the purpose of tactical
triage, within 80% accuracy, per Prehospital Trauma Life Support, current Military Edition.
(8404-HSS-2002a)

2. Without the aid of reference and in writing, identify the principles of triage, within 80%
accuracy, per Prehospital Trauma Life Support, current Military Edition. (8404-HSS-2002b)

3. Without the aid of reference, given a descriptive list of injuries, identify the appropriate
triage category for specific injuries, in accordance with Prehospital Trauma Life Support,
current Military Edition. (8404-HSS-2002c)

4. Without the aid of reference, given a description or list of injuries, identify the procedures
for coordinating care for a mass casualty incident, per Prehospital Trauma Life Support,
current Military Edition. (8404-HSS-2003a)

5-25
1. TRIAGE

Triage is a French word meaning “to sort.” Casualties are sorted into groups based on their
immediate medical needs. Using a standardized approach to triage casualties helps combat
medics correctly segregate, treat, and prioritize evacuation in the shortest time possible. The
realities of combat dictate that battlefield triage must take place in an environment limited in
resources for treatment and transport. Triaging casualties merely establishes order of
treatment and movement. Although all casualties require treatment, triage aids in deciding
which casualties have the greatest probability of
survival and helps weigh the casualties need for Triage ensures the greatest care for
lifesaving interventions (LSIs), thus the greatest number and the maximal
determining priority and urgency for treatment utilization of medical personnel,
equipment, and facilities, especially in a
and evacuation.
mass-casualty incident (MCI).
Triage establishes the patients’ category. -PHTLS Manual, Current Edition
Although the type and extent of the wound may
offer clues as to the triage category a patient may fall into, it is their physiological state (how
well their body is working) that is the critical factor. For instance, a patient with a weak
radial pulse indicates an estimated systolic blood pressure of 80 mm/Hg. Studies of combat
related injuries indicate that 32% of these individuals will die. The absence of a radial pulse
indicates a systolic blood pressure of less than 50 mm/Hg. The same study reported that 92%
of these individuals will die. On the other hand, a separate trauma study indicated that no
casualty died if they presented during the first stages of triage with a palpable radial pulse
and the ability to follow simple commands.

2. PRINCIPLES OF TACTICAL TRIAGE

Accomplish the greatest good for the greatest number of casualties.
Employ the most efficient use of available resources.
Return personnel to duty as soon as possible.

3. THE FOUR CATEGORIES OF TACTICAL TRIAGE

Categories are color-coded and are recognized as follows:
Minimal (Green Tag)
Casualties in this category are often referred to as the “walking wounded.” These
casualties have minor injuries and can usually care for themselves with self-aid or buddy
aid. These casualties should still be employed for mission requirements (e.g. scene
security) or to help treat the more seriously wounded.
Examples include, but are not limited to - small burns, lacerations, abrasions, and small
fractures.

5-26
Delayed (Yellow Tag)
The delayed category includes wounded casualties who may need surgery, but whose
general condition permits a delay in surgical treatment without unduly endangering life or
limb. Sustaining treatment will be required (e.g. oral or IV fluids, splinting, antibiotics or
pain control).
Examples include, but are not limited to - those with no evidence of shock, who have
large soft tissue wounds, fractures of major bones, intra-abdominal and/or thoracic
wounds, or burns to less than 20% of total body surface area.
Immediate (Red Tag)
This category includes casualties who require immediate LSI and/or surgery. The key to
successful triage is to locate these individuals as quickly as possible. Casualties do not
remain in this category for an extended period of time. They are either found, triaged and
treated, or they will die!
Examples include, but are not limited to - hemodynamically unstable casualties with
airway obstruction, chest or abdominal injuries, massive external bleeding, or shock.
Expectant (Black Tag)
Casualties in this category have wounds that are so extensive that even if they were the
sole casualty and had the benefit of optimal medical resources, their survival would be
highly unlikely. Even so, expectant casualties should not be neglected. They should
receive comfort measures, pain medications (if possible) and they deserve re-triage as
appropriate.
Examples include, but are not limited to - unresponsive casualties with injuries such as
penetrating head trauma with obvious massive damage to the brain.
Triage in Tactical Combat Casualty Care
Because the tactical environment precludes an extensive array of monitoring equipment,
optimal battlefield treatment and evacuation rely on simple triage tools. Based on research
by the Committee on Tactical Combat Casualty Care, a triage decision algorithm has been
developed (see figure 1). Use of this algorithm begins with a cursory evaluation.
- Patients who can ambulate and follow instructions usually will fall into the minimal
category. Statements such as “If you can hear my voice get up and move behind the
building” (or any other place tactically correct) can triage a large portion of the casualties
in a short time.
- Patients with obvious signs of death can be initially placed in the expectant category.
- Casualties who do not fit either of the above categories will need further evaluation.
All casualties requiring an LSI are placed initially in the immediate category.
- Patients are placed in the delayed category if they can obey simple commands, possess
a normal radial pulse, and are not in respiratory distress.
- Once the LSI has been performed, the patient must be re-triaged. Triage is a
continuous process and frequent reassessment is required.

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 CARE UNDER FIRE

Casualty moved to
cover if feasible

Yes
Tourniquet indicated? Apply tourniquet

No
Continue with
fight/mission

TACTICAL FIELD CARE /

TACEVAC

Scene security and

establish CCP

Walking Obvious signs

wounded Perform cursory of death
Minimal Expectant
evaluation

Further evaluation
required

* Examples: applying a tourniquet for life-

threatening extremity hemorrhage or using Obvious LSI Yes
Combat Gauze for life-threatening external required?*
hemorrhage at a site where a tourniquet
cannot be applied. No
Casualty obeys No
commands?
If a casualty is unable to obey commands
and has weak or absent radial pulses, the
Yes
risk of mortality is 92%.
Abnormal
Radial pulse character Immediate

Normal
Casualty in Yes
respiratory distress?

No
Delayed

Figure 1. Triage Algorithm for Tactical Combat Casualty Care

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4. MASS CASUALTY TRIAGE
Medical personnel operating in a tactical environment must always be prepared to deal with a
mass casualty incident. Units must establish and rehearse plans for dealing with such a
situation. In a mass casualty situation those responsible for triage must remember that triage is
not treatment and constant reassessment is needed to identify casualties who may have
deteriorated or improved.
Essential Tasks for Mass Casualty Triage
- Secure the area and ensure scene safety
- Establish Command Post (CP), Casualty Collection Point (CCP) and routes of
access
- Estimate initial number, severity and additional hazards (e.g. smoke, NBC, etc)
- Assign initial triage categories
- Perform life-saving interventions (LSIs)
- Re-triage with an extended secondary survey as time permits
Triage Tags - Designed to communicate the triage category, treatment rendered, and other
medical information. By necessity, the information on the tag is brief. Triage tags are
usually placed on the casualty by the triage officer, although other members of the team
may place or add information to the tags.
H&H Combat Care Documentation Card (see figure 2) - provides immediate
access to vital life-saving information in the field.

Figure 2. Casualty Response Documentation Card

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 Medical Emergency Triage Tag (METTAG) (see figure 3) - Each triage tag is
coded with a unique sequential seven-character serial number used for
identification and tracking of the casualty. The serial number is located on the top
right and left diagonal tear-offs.

Figure 3. METTAG (MT-137)

References:
Prehospital Trauma Life Support (PHTLS), current Military Edition

5-30
 Triage Review
1. What is the purpose of tactical triage?

2. List the three principle of triage.

1)
2)
3)

3. Which category would each of the following injuries be triaged in:

1) Airway Obstruction ___________________
2) Penetrating head trauma ___________________
3) Burns less than 20% ___________________
4) Small fractures ___________________

4. Identify three priorities for mass casualty triage.

5. Using the triage algorithm, a patient with controlled hemorrhage that can obey simple
commands, has a normal radial pulse, and is not in respiratory distress would be placed in which
category?

5-31
 UNITED STATES MARINE CORPS
FIELD MEDICAL TRAINING BATTALION
BOX 555243
CAMP PENDLETON, CA 92055-5243

FMST 505

Coordinate Casualty/Tactical Evacuation (TACEVAC)

TERMINAL LEARNING OBJECTIVE

1. Given casualties in a tactical environment, evacuate casualties for medical treatment to

prevent further injury or death. (8404-HSS-2004)

ENABLING LEARNING OBJECTIVES

1. Without the aid of reference, given a description or list of capabilities, identify the
capabilities of the taxonomy of care, within 80% accuracy, per JP 4-02.1, Health Service
Support. (8404-HSS-2004a)

2. Without the aid of reference, given a description or list, identify common litters used as
TACEVAC platforms, within 80% accuracy, per Prehospital Trauma Life Support, Current
Military Edition. (8404-HSS-2004b)

3. Without the aid of reference, given a description or list, identify ground vehicles used as
TACEVAC platforms, within 80% accuracy, per FM 8-10-6, Medical Evacuation in the
Theater of Operations. (8404-HSS-2004c)

4. Without the aid of reference, given a description or list, identify aircraft used as
TACEVAC platforms, within 80% accuracy, per FM 8-10-6, Medical Evacuation in the
Theater of Operations. (8404-HSS-2004d)

5. Without the aid of reference, given a description or list, identify Casualty Receiving
Treatment Ships (CRTS) used as CASEVAC platforms, within 80% accuracy, per FM 8-10-
6, Medical Evacuation in the Theater of Operations. (8404-HSS-2004e)

6. Without the aid of reference, given a description or list, identify the casualty evacuation
categories, within 80% accuracy, per FM 8-10-6, Medical Evacuation in the Theater of
Operations. (8404-HSS-2004f)

7. Without the aid of references, given a description or list, identify the purpose of the 9 Line
evacuation communication process, within 80% accuracy, per FM 8-10-6, Medical Evacuation
in the Theater of Operations. (8404-HSS-2004g)

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8. Without the aid of reference, given the necessary equipment, transmit a 9 Line Evacuation
request, within 80% accuracy, per FM 8-10-6, Medical Evacuation in the Theater of Operations.
(8404-HSS-2004h)

9. Without the aid of reference, given multiple simulated casualties in a tactical environment,
standard field medical equipment and supplied, and individual combat equipment, perform
casualty evacuation, to prevent further injury or death, per FM 8-10-6, Medical Evacuation in
the Theater of Operations. (8404-HSS-2004i)

5-33
OVERVIEW
Tactical Evacuation Care (TACEVAC) is the third phase in the Tactical Combat Casualty Care
process. Tactical evacuation encompasses both medical evacuation (MEDEVAC) and casualty
evacuation (CASEVAC). The care delivered in the TACEVAC phase can more closely resemble
advanced trauma life support guidelines than that in the first two phases. With either vehicular
or air evacuation of wounded casualties from the battlefield, there is an opportunity for access to
additional medical equipment not available to the Corpsman during the first two phases. One
example is the use of pulse oximetry devices, which detect the percent of hemoglobin with
oxygen bound to it and gives you an indication of how well the casualty is breathing. It also
allows for early detection of pulmonary compromise or cardiovascular deterioration before
physical signs are evident. They are highly reliable and can apply across all ages and races. This
lesson will describe the taxonomy of care, different methods of casualty evacuation, and how to
call for an evacuation.

1. TAXONOMY OF CARE
The taxonomy of care outlines distinctive and overlapping care capabilities that enhance
performance in a military force. The level of care commences at the scene of the injury and
continues until the member receives definitive care and is discharged or returned to full duty.
While this course teaches you the skills needed to operate using the first responder, forward
resuscitative, and en route care capabilities, there are five capabilities in the taxonomy
continuum of healthcare which are used when evacuating the wounded from the battlefield
(see figure 1).

Figure 1. Taxonomy of Care

First Responder Capability - first aid and emergency care rendered at the point of initial injury
are the primary objectives of care at this level. Defined by its time requirements, first responder
care provides immediate medical care and stabilization to the patient in preparation for
evacuation to the next capability in the continuum of care. Examples of First Responder
Capabilities include:
- Self-aid/Buddy aid
- Battalion Aid Station (BAS)

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Forward Resuscitative Capability - builds on the First Responder Capabilities. Characteristics
include performing advance emergency medical treatment as close to the point of injury as
possible, stabilizing the patient, and saving life and limb. Stabilization ensures the patient can
tolerate evacuation. Examples of Forward Resuscitative Capabilities include:
Medical Battalion - provides surgical care for the MEF. Provides stabilizing surgical
procedures. Capable of holding patients up to 72 hours.
Casualty Receiving & Treatment Ships (CRTS) - part of an Expeditionary Strike Group
(ESG). They provide additional medical capabilities for receiving a mass casualty (up to 50
casualties).
Shock Trauma Platoon (STP) - small forward unit with one physician supporting the MEF
specializing in patient stabilization and evacuation. No surgical capability.
Forward Resuscitation Surgical Suite (FRSS) - staffed with 8 to 10 personnel (two surgeons,
one critical care nurse, one anesthesiologist, and four to six corpsmen). It consists of a two
tent surgical system that provides a fully powered, climate-controlled environment with
enough space for one operating room and one pre- and post-operative care room. The shelter
is equipped with cutting-edge surgical gear and takes less than one hour to set up or break
down.

Theater Hospitalization Capability - services are delivered via modular hospital configurations
and/or hospital ships required to sustain forces in theater. These capabilities deploy as modules
or multiple individual capabilities that provide increasing medical services in a more robust
theater. The care offered either returns the patient to duty or stabilizes the patient to ensure they
can tolerate evacuation to a definitive care facility. Services encompass primary inpatient and
outpatient care, emergent care, and enhanced medical, surgical, and ancillary capabilities,
including:
Fleet hospitals - deployable ground asset that is located away from enemy threat
providing up to 500 hospital beds, 80 ICU beds, and 6 OR’s.
Hospital ships (USNS Mercy and USNS Comfort) - deployable medical assets
providing up to 1,000 beds, 100 ICU beds, and 12 OR’s.

Definitive Capability - rendered to conclusively manage a patient’s condition and is usually

delivered from, or at, facilities in the homeland, but may be delivered in facilities outside the
homeland. This capability generally leads to rehabilitation, return to duty, or discharge from the
armed forces. Because this care is usually given outside the operational area, the most advanced
health care can be made available and accessible to the patient. It includes:
CONUS Military, Veteran’s and selected civilian hospitals - provide full
convalescent, restorative, and rehabilitative care to all patients returned to the
Continental United States (CONUS).
Overseas Medical Treatment Facilities - offers the surgical capability found in the
theater hospitalization capability, along with further definitive therapy for those
patients in the recovery phase who can be returned to duty within the theater
evacuation policy. A patient who cannot be returned to duty will be evacuated
through the en route care capability.

5-35
En Route Care Capability - en route care is the continuation of care during evacuation within
the continuum without clinically compromising the patient’s condition. This capability can take
one of three forms – medical evacuation (MEDEVAC) in which dedicated special medical non-
combatant platforms are used. The Air Force is the primary provider of MEDEVAC assets.
Casualty evacuation (CASEVAC) are primarily non-medical evacuation platforms, however,
some may have medical attendants such as a Hospital Corpsman or an Army Medic. The third
capability is Aeromedical evacuation. This type of evacuation is generally beyond the scope of
TCCC but it is typically used when transferring patients between medical treatment facilities.
This course deals specifically with CASEVAC, which involves the unregulated movement of
casualties aboard ships, land vehicle, or aircraft.

2. METHODS OF EVACUATION
The level of urgency and the tactical situation dictates the method of evacuation. Depending
upon which level of care you are in, Care Under Fire, Tactical Field Care, or Tactical Evacuation
Care, will dictate how the casualty is transported. The most common forms of evacuation are:
ambulatory, manual carries, litter evacuation, ground evacuation, air evacuation, or sea
evacuation. Regardless, the casualty should be made as comfortable as possible and kept warm
and dry. If an improvised litter is used, it should be padded and field-expedient material replaced
with conventional splints, tourniquets, and dressings as soon as feasible. A patient with minimal
injuries should be encouraged to stay in the fight if possible and to ambulate to an area where
care can be safely provided.
Manual Carries
Fireman’s Carry - Used for unconscious and conscious patients. (See figure 2)
1. Secure your arms around the patient's waist with their body lightly tilted
backward to prevent their knees from buckling. Place your right foot between
their feet and spread them six to eight inches apart.
2. With your left hand, grasp their right wrist and raise it over your head.
3. Bend at the waist and knees, pull the patient’s arm over and down your left
shoulder, bring their body across your shoulders. Pass your right arm between
their legs.
4. Place the patient’s right wrist in your right hand and your left hand on your left
knee for support in rising.
5. Rise with the patient correctly positioned with your left hand free.

Figure 2. Fireman’s Carry

5-36
One-man Supporting Carry - Conscious patients only. The patient is able to walk using you as a
crutch. (See figure 3)
1. Raise the patient from the ground as in the Fireman’s Carry.
2. With your left or right hand, grasp the patient’s left or right wrist and draw it
around your neck.
3. Place your left or right arm around their waste.

Figure 3. One-man Supporting Carry

Saddle-back Carry - Conscious patients only. (See figure 4)

1. Raise the patient to an upright position.
2. Support patient by waist and move to the front of the patient.
3. Have patient encircle arms around your neck.
4. Stoop, raise patient to your back and clasp hands beneath his thighs.

Figure 4. Saddl-back Carry

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Pack-strap Carry – Good for unconscious patients, however do not use if patient has fractures.
(See figure 5)
1. Raise the patient from ground as in Fireman’s Carry.
2. Support by wrist and move to front of patient.
3. Grasp patient’s wrist and hoist onto your back until their armpits are over your
shoulders.

Figure 5. Pack-strap Carry

Two-man Supporting Carry – Patient is conscious and has no suspected fractures. (See figure 6)
1. Same as One-man Carry, but done with two individuals.

Figure 6. Two-man Supporting Carry

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Two-man Carry – Used for placing patient on a litter or moving short distances. Similar to
performing a patient log roll. (See figure 7)
1. Two corpsmen kneel at one side of patient.
2. One places one arm beneath the hips and the other beneath the knees.
3. The second bearer places one arm beneath the shoulder and one beneath the
back.
4. Lift patient to knees, then stand up and carry at chest level to lessen fatigue.

Figure 7. Two-man Carry

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Fore-aft Carry – Used to carry an unconscious patient for short distances. (See figure 8)
1. With patient lying on their back, front bearer spreads legs of patient and steps
between legs with back towards patient, grasps legs behind the knees.
2. Rear bearer kneels at the head of the patient, places arms under the armpits
and clasps hands on their chest.
3. Bearers rise together.

Figure 8. Fore-aft Carry

Four Hand Carry – Patient must be conscious. (See figure 9)

1. Each bearer grasps their left wrist with the right hand and then each other’s
right wrist with the left hand.
2. Patient sits on the interlocked hands supporting themself by putting one arm
around each of the bearer’s necks.

Figure 9. Four Hand Carry

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Two Handed Seat Carry – Used for conscious patients with no fractures. (See figure 10)
1. With patient on their back, bearers on each side of the patient’s hips.
2. Bearers interlock their wrists behind the patient’s thighs and back.
3. Bearers rise together lifting patient.

Figure 10. Two Handed Seat Carry

Clothes Drag Carry – Used during “under fire” conditions. (See figure 11)
1. Grasp the patient’s shirt collar or gear and drag to safety.

Figure 11. Clothes Drag Carry

Types of litters - there are six commonly used litters within the FMF.
Talon Litter (See figure 12) - the Talon collapsible handle litter
was developed to meet the US Army’s urgent requirement to
provide casualty evacuation. The Talon litter allows a casualty
to be transported in one vehicle then transitioned to a standard
evacuation platform without the need to transfer a casualty from
one litter to another. This is the most commonly used litter.
Figure 12. Talon Litter

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Standard Army Litter (See figure 13) - the standard collapsible litter folds along the
long axis.

Stokes Litter (See figure 14) - affords maximum security for the patient when the
litter is tilted.

Figure 13. Standard Army Litter Figure 14. Stokes Litter

Pole-less Non-rigid Litter (See figure 15) -

this litter can be folded and carried by the
Field Medical Service Technician. It has
folds into which improvised poles can be
inserted for evacuation over long
distances.
Figure 15. Pole-less Non-rigid Litter

Miller (full body) Board (See figure 16) - the Miller

Board is constructed of an outer plastic shell with
an injected foam core. It is impervious to chemicals
and the elements and can be used in virtually every
confined-space rescue and vertical extrication. It
fits in stokes stretcher and will float a 250-pound
person.

Figure 16. Miller (full body) Board

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 Improvised Litters (See figure 17) - used for moving a casualty when a standard litter
is not available, the distance may be too great for manual carries, or the casualty may
have an injury that would be aggravated by manual transportation. These litters are to
be used in emergency situations only and must be replaced by standard litters at the
first opportunity.

Blouse / Flak Jacket Litter Rolled Blanket Litter

Figure 17. Improvised Litters

Procedures for Carrying Litters

1. When moving a patient, the litter bearers must make every movement deliberately
and as gently as possible. The command “steady” should be used to prevent undue
haste.
2. The rear bearers should watch the movements of the front bearers and time their
movements accordingly to ensure a smooth and steady action.
3. The litter must be kept as level as possible at all times, particularly when crossing
obstacles such as ditches.
4. Normally, the patient should be carried on the litter feet first, except when going
uphill or up stairs
5. When the patient is loaded on a litter, his individual equipment is carried by two of
the bearers or placed on the litter. When available, use Marines as your litter
bearers.

3. GROUND EVACUATION PLATFORMS

(See figure 26)
M997 Ambulance (See figure 18)- HMMWV
frame with armor protection for crew and
patients. It is capable of transporting up to 4
litter or 8 ambulatory patients.

Figure 18. M997 Ambulance

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 M1035 Ambulance (See figure 19) - HMMWV
frame with removable soft-top. It is capable of
transporting 2 litter and 3 ambulatory patients.

Figure 19. M1035 Ambulance

MK 23 7 Ton(See figure 20) - non-medical vehicle

that may be utilized for casualty transportation
when available. It is capable of transporting 10
litter or 20 ambulatory patients.

Figure 20. MK 23 7 Ton Truck

4. AIR EVACUATION PLATFORMS (See figure 26)
CH-46 Sea Knight (See figure 21)
- Dual rotor medium lift helicopter used to
transport personnel and cargo (being
phased out by the MV-22 Osprey Tilt
Rotor Aircraft).
- When configured for litter racks, able to
carry 15 litters or 22 ambulatory
patients.
Figure 21. CH-46 Sea Knight

UH-1 Huey (See figure 22)

- Light transport helicopter used to
transport personnel and cargo.
- When configured for litter racks, able to
carry 6 litters or up to 10 ambulatory
patients. Figure 22. UH-1 Huey

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 MV-22 Osprey(See figure 23)
- Tilt-rotor aircraft that takes off and lands
vertically but flies like a plane. This
aircraft is designed to eventually replace
the CH-46.
- When configured for litter racks, able to
carry 12 litters or 24 ambulatory casualties.

Figure 23. MV-22 Osprey

CH-47 Chinook (See figure 24)

- Dual rotor medium lift helicopter used to
transport personnel and cargo for the US Army.
- When configured for litter racks can carry 24
litter patients or 31 ambulatory patients.

Figure 24. CH-47 Chinook

UH-60 Blackhawk (See figure 25)

- Single rotor helicopter with multiple uses by not
only the Army but the Navy as well.
- Can carry up to 6 litter patients if litter
modification kit is installed.
- Can carry up to 7 ambulatory patients if litter
modification kit is not installed.
- Patients can be loaded from either side.

Figure 25. UH-60 Blackhawk

NOTE: The Marine Corps does not have dedicated CASEVAC aircraft. Any of its aircraft can
be utilized as a “lift of opportunity” upon completion of its primary mission. The use of
helicopter evacuation provides a major advantage because they greatly decrease the time
between initial care and definitive treatment thereby increasing the casualty’s chances of
survival. Figure 17 below reflects USMC assets as well as those available through the Army and
Air Force.

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 AIRCRAFT
TYPE SERVICE LITTER AMBULATORY ATTENDANTS
UH-60 Blackhawk USA 6 7 1 Medic
CH-47 Chinook USA 24 31 2 Medics
UH-1 Huey USMC 6 10 1 Corpsman
CH-46 Sea Knight USMC 15 22 2 Corpsmen
CH-53 Super Sea
USMC 24 37 2 Corpsmen
Stallion
MV-22 Osprey USMC 12 24 2 Corpsmen
MEDICAL GROUND VEHICLES
TYPE SERVICE LITTER AMBULATORY ATTENDANTS
USA/
4 8
M997 HMMWV USMC/ 1 Corpsman
USAF
USA/
2 3
M1035 HMMWV USMC/ 1 Corpsman
USAF
VEHICLES OF OPPORTUNITY (GROUND)
TYPE SERVICE LITTER AMBULATORY ATTENDANTS
MK 23
USMC 10 20 None
(7-Ton Truck)

Figure 26. Ground/Air CASEVAC Platform Data Description

5. CASUALTY RECEIVING TREATMENT SHIPS

Specific ships within an Amphibious Task Force are designated as Casualty Receiving
Treatment Ships (CRTS).

LHD/LHA - Amphibious Assault Ships with medical capabilities (See figure 27).
Mission
- Assault via helo, landing craft,
and amphibious vehicle.
- Primary amphibious landing
ships for MEF’s, MEB’s, and
MEU’s.
- Primary CRTS

Transport capabilities
- Flight deck with large internal
hangar deck and well deck.
- May receive casualties via
helicopter or waterborne craft. Figure 27. LHA Tarawa Class

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 Medical Capabilities
Largest medical capability of amphibious ships. When fully staffed,
capabilities include:
- 4 Operating Rooms
- 15 ICU Beds
- 45 Ward Beds
Hospital Ships (T-AH) (see figure 28)- the COMFORT and the MERCY are operated by the
Military Sealift Command and are designed to provide emergency, onsite care for US
combatant forces deployed in war and other operations. The T-AHs provide a mobile,
flexible, rapidly responsive afloat medical capability to acute medical and surgical care in
support of ATF; Marine Corps, Army, and Air Force elements; forward-deployed Navy
elements of the fleet; and fleet activities located in areas where hostilities may be imminent.
The T-AHs also provide a full-service hospital asset for use by other government agencies
involved in the support of disaster relief and humanitarian operations worldwide.

Transport Capabilities
- Flight deck capable of
receiving rotary wing
aircraft.

Medical Capabilities
- Operating Rooms (12)
- ICU Beds (100)
- Intermediate Care
Beds (400)
- Ward Beds (500)
- Ancillary capabilities
of lab, x-ray,
pharmacy, computerized tomography Figure 28. Hospital Ship
scanner, and blood storage.

6. CASEVAC CATEGORIES (See figures 29-31)

Once a patient has been triaged and stabilized at the BAS, should that patient require further
or additional medical treatment, he/she will be categorized for evacuation from the BAS to
the next higher capability of care. While evacuating patients, ensure that they are kept warm
to prevent hypothermia! The category levels are as follows:
Urgent Evacuation
- Evacuation to next higher capability of medical care is needed to save life or limb.
- Evacuation must occur within two hours.

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 Urgent Surgical Evacuation
- Same criteria as Urgent. The difference is that these patients need to be taken to a
facility with surgical capabilities.
Priority Evacuation
- Evacuation to next higher capability of medical care is needed or the patient will
deteriorate into the URGENT category.
- Evacuation must occur within four hours.
Routine Evacuation
- Evacuation to the next higher capability of medical care is needed to complete full
treatment.
- Evacuation may occur within 24 hours.
Convenience
- Used for administrative patient movement.
URGENT/URGENT SURGICAL - 2 Hours or Less
Life threatening injuries such as temporarily corrected hemorrhage, temporarily controlled
airway injuries, or temporarily controlled breathing issues.
Examples include (but not limited to) patients with:
Tourniquets Needle Decompression
Cricothyroidotomy Major Internal Bleeding
(Figure 29)

PRIORITY - 4 Hours or less

Potentially life threatening injuries such as compensated shock, fractures causing circulatory
compromise, and uncomplicated but major burns.

Examples include (but not limited to) patients with:

Compensated Shock Broken arm with loss of distal pulse
2nd degree burns to a large portion of the abdomen or extremities
(Figure 30)
ROUTINE - 24 Hours or less
Injuries so insignificant or extreme that chances of survival are not based on evacuation
time.
Examples include (but not limited to) patients with:
Abrasions Cardiac Arrest Massive Head Trauma
Small Fractures Frostbite 2nd /3rd degree burns >70% BSA
(Figure 32)

7. NINE LINE CASEVAC (See figure 33)

A nine-line evacuation request is a standard format used by the Armed Forces for
coordinating the evacuation of casualties. Evacuation request transmissions should be by the
most direct communication means available to the medical unit controlling evacuation assets.
The means and frequencies used will depend on the organization, availability, and location in
the area of operations as well as the distance between units.
The information must be clear, concise, and easily transmitted. This is done by use of the
authorized brevity code. The authorized brevity code is a series of phonetic letters, numbers,
and basic descriptive terminology used to transmit casualty information. These codes

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indicate the standard information required for an evacuation commonly known as the “9
Line”. This message is verbally transmitted in numerical “line” sequence utilizing the
following brevity codes:
Line 1 - Location - location of the Landing Zone (LZ) where the casualties are to be picked
up. This information will be transmitted in the form of an eight digit grid coordinate.
Line 2 - Radio Frequency, Call Sign - radio frequency and call sign that will be used by the
ground unit at the LZ. You should know this information before every operation.
Line 3 - Precedence (Urgent, Urgent Surgical, Priority, and Routine) - number of casualties
by precedence. Use the following codes:
Alpha - Urgent
Bravo - Urgent Surgical
Charlie - Priority
Delta - Routine
Echo - Convenience
Line 4 - Special Equipment - identifies any special equipment that will be needed, such as a
hoist in the case where a helo cannot land. Use the following codes:
Alpha - none
Bravo - hoist
Charlie - extraction equipment
Delta - ventilator
Line 5 - Number of Patients by Type - number of patients who are ambulatory and the
number of litter patients. This determines whether or not the helo should be configured to
carry litters. Use the following codes:
Lima - litter patients
Alpha - ambulatory patients
Line 6 - Security of Pickup Site - whether or not the enemy is near the LZ. If all of your
casualties are routine and the LZ is not secured, then you may not get your requested
CASEVAC approved. Use the following codes:
November - no enemy troops in area
Papa - possible enemy troops (approach with caution)
Echo - enemy troops in area (approach with caution)
X-Ray - enemy troops in area (armed escort required)

Line 7 - Method of Marking Pickup Site - methods that you will use to mark your LZ and
then ask the pilot to identify. Use the following codes:
Alpha - panels
Bravo - pyrotechnic signal
Charlie - smoke signal
Delta - none
Echo - other

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 Line 8 - Patient’s Nationality and Status - patients’ nationality and status. Use the following
codes:
Alpha - US military
Bravo - US civilian
Charlie - non US military
Delta - non US civilian
Echo - enemy prisoner of war
Line 9 - NBC Contamination - whether the LZ has been contaminated with NBC agents. Use
the following codes:
November - nuclear
Bravo - biological
Charlie - chemical

Example: During a routine patrol your platoon takes two casualties. One receives a gunshot wound to his
right arm. The other receives a gunshot wound to his abdomen and has signs and symptoms of shock
associated with internal hemorrhage. While you perform initial treatment, members of your platoon determine
that the closest potential landing zone for a helicopter is 300 feet to the West. Its grid location on the map is
DH 1234 5678. Your call sign is Blue Thunder and your unit is operating on the frequency 99.65. Your unit
commander informs you that the site is secure and will be marked with green smoke. The following would be
your nine line radio CASEVAC Request transmission:

Line 1: DH 12345678
Line 2: 99.65 Blue Thunder
Line 3: 1 Bravo, 1 Charlie
Line 4: Alpha
Line 5: 1 Lima, 1 Alpha
Line 6: November
Line 7: Charlie
Line 8: 2 Alpha
Line 9: None

Figure 33. Nine-Line Casualty Evacuation Request Example

REFERENCES
Prehospital Trauma Life Support, current edition
Medical Evacuation In A Theatre of Operations, FM 8-10-6, Chapters 5, 7-11
Health Service Support, JP 4-02, Chapter I

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 CASEVAC/TACEVAC Review

1. Identify three different facilities that fall under the Forward Resuscitative Capability.

2. How many litter patients can be carried in an M-997 vehicle.

3. Describe the difference between the Urgent and Urgent Surgical categories.

4. In relation to the Nine Line evacuation request, what are “authorized brevity codes”?

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 UNITED STATES MARINE CORPS
FIELD MEDICAL TRAINING BATTALION
BOX 555243
CAMP PENDLETON, CA 92055-5243

FMST 506

Perform Aid Station Procedures

TERMINAL LEARNING OBJECTIVES

1. In various environments, given standard field medical equipment and supplies, provide first
responder medical support to meet mission requirements. (8404-HSS-2005)
2. Given the requirement, identify the health services support elements within the Marine
Corps Operating Forces to support mission requirements. (HSS-MCCS-2034)

ENABLING LEARNING OBJECTIVES

1 . Without the aid of reference, given a description or list, identify the mission of the Aid
Station, within 80% accuracy, per Prehospital Trauma Life Support, Current Military Edition.
(8404-HSS-2005e)
2 . Without the aid of reference, given a description or title, identify the areas of responsibility
within the Aid Station in various environments, within 80% accuracy, per Prehospital Trauma
Life Support, Current Military Edition. (8404-HSS-2005f)
3 . Without the aid of reference, given a description or list, identify the medical support
responsibilities of the Aid Station in various environments, within 80% accuracy, per
Prehospital Trauma Life Support, Current Military Edition. (8404-HSS-2005g)
4 . Without the aid of reference, given a description or list, identify equipment used to
establish an Aid Station, within 80% accuracy, per Prehospital Trauma Life Support, Current
Military Edition. (8404-HSS-2005h)
5 . Without the aid of reference, given the requirement in a simulated combat scenario, operate
in an Aid Station, to meet mission requirements, per Prehospital Trauma Life Support, Current
Military Edition. (8404-HSS-2005i)
6 . Without the aid of reference and in writing, identify the HSS components of the MEF,
within 80% accuracy, in accordance with MCWP 4-11.1 Health Service Support Operations.
(HSS-MCCS-2034a)
7 . Without the aid of reference and in writing, identify the HSS components of the MAW,
within 80% accuracy, in accordance with MCWP 4-11.1 Health Service Support Operations.
(HSS-MCCS-2034b)

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8 . Without the aid of reference and in writing, identify the HSS components of the MARDIV,
within 80% accuracy, in accordance with MCWP 4-11.1 Health Service Support Operations.
(HSS-MCCS-2034c)
9 . Without the aid of reference and in writing, identify the HSS components of the MLG,
within 80% accuracy, in accordance with MCWP 4-11.1 Health Service Support Operations.
(HSS-MCCS-2034d)
10 . Without the aid of reference and in writing, perform Battalion Aid Station procedures,
within 80% accuracy, in accordance with MCWP 4-11.1 Health Service Support Operations.
(HSS-MCCS-2034e)

OVERVIEW
Health Service Support (HSS) of today's Marine Corps Operational Forces emphasizes the
provision of far-forward, mobile, medical support in the stabilization and evacuation of
casualties. The Aid Station is the HSS unit that will deliver these services to our Marine Corps
Forces (MARFOR) in sustaining the combat power of the force. Throughout this lesson, the
term Battalion Aid Station (BAS) is used to describe various Aid Stations. A true BAS is a term
used to describe an Infantry Battalion Aid Station. Know that there are many different Aid
Stations, i.e. BAS, Group Aid Station (GAS), Regimental Aid Station (RAS), etc., each with
different numbers of personnel assigned.

1. MISSION OF THE AID STATION

The overall mission of the aid station is to be the primary HSS source for a unit. The aid
station is broken down into two separate missions, one that will be fulfilled while in a
field/combat environment, and the other fulfilled while in garrison. While in a field/combat
environment, the mission of the Aid Station is to minimize the effect wounds, injuries, and
diseases have on a unit’s effectiveness, readiness and morale. Treatments such as surgical
airways, administration of IV fluids and antibiotics, as well as stabilization of wounds and
fractures are common. The mission of the Aid Station while in garrison is to keep the
Marines assigned ready for deployment. As such, responsibilities include conducting sick-
call, providing medical support during training, and undergoing continued medical training.

2. AREAS OF RESPONSIBILITY IN VARIOUS ENVIRONMENTS

Aid stations throughout the Marine Corps are staffed based on the mission of the individual
organization. Manpower requirements for each unit are listed on its Table of Organization
(T/O). Large units, such as Infantry Battalions, may have up to two medical officers (MO)
and 65 Corpsmen to support 1,000 Marines. Smaller units, such as Combat Engineer
Battalion or a Tank Battalion may only have one or no MO and a few Corpsmen but receive
additional support from a Headquarters Company. In the field, the BAS is co-located with
the command post. Around-the-clock operating capability is required. The BAS is manned
by Hospital Corpsmen of the battalion medical platoon under the direction of the battalion
surgeon.

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 Aid Station Group (Infantry Battalion) - a section of H&S Company, the aid station group is
headed by the Battalion Surgeon, and is capable of splitting into two sections to operate two
separate aid stations when necessary; the Assistant Battalion Surgeon heads the second aid
station.
Medical officer - there are two MOs within each medical battalion
- Battalion Surgeon
- Assistant Battalion Surgeon
Religious Ministry Team (RMT) - each BAS is assigned one RMT consisting of:
- Chaplain
- Religious Programs Specialist (RP)
Headquarters - there are 21 corpsmen headed by a Leading Chief assigned to the Aid
Station under the Assistant Battalion Surgeon
Line Company Corpsmen - there are 44 Corpsmen assigned to the line companies. They
are divided into four groups of 11 Corpsmen.

3. MEDICAL SUPPORT RESPONSIBILITIES IN VARIOUS ENVIRONMENTS

Within a garrison setting, the responsibility of the Aid Station includes:

Maintain medical and dental readiness - One of the most important missions of the BAS
while in garrison is to keep the unit medically and dentally prepared to deploy. Aid Stations
use a web based data tracking system known as the Medical Readiness Reporting System
(MRRS). Because it is web based, immunization information for Marines and Sailors can be
transferred electronically when they check-in to a new unit. This system provides an overall
readiness snapshot of the unit.
Conduct sick call - Aid stations act as the primary medical treatment facility for active duty
Sailors and Marines for that particular unit. Sick call will normally be conducted under the
direction of the MO or Independent Duty Corpsman (IDC). Responsibilities of the general
duty Corpsman include identifying the chief complaint and performing a routine patient
assessment to include vital signs. You may be expected to present the patient to the MO or
IDC to complete the assessment and develop the treatment plan. It is also the responsibility
of the sick call Corpsman to complete much of the official documentation.
Sick Call Procedures
Check in - Aid Stations generally have sick call hours each morning. Patients will
sign in and receive their medical record from the records office. Vital signs are taken
and documented on a Standard Form (SF) 600.
Patient encounter - is documented using the SOAP Note fashion (Subjective,
Objective, Assessment and Plan). You may be expected to complete and document
the first half of the note before presenting the patient to the IDC or MO at which time
the assessment will be made and a treatment plan will be developed.
Discharge - basic treatments that can be performed at the BAS will be accomplished
as required. Routine medications that are stocked in the BAS will be dispensed as

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 needed. The patient is given instructions on the remainder of the plan of care and
when they should report back for any follow up appointments.
Binnacle List - each morning a Binnacle List (Report of the Sick and Injured) is sent
to the company office detailing individuals who had been seen that day. It also lists
Marines who are Sick in Quarters or currently on Light Duty.
Disease Non Battle Injury - information from the Sick Call log is also transferred into
a Disease Non Battle Injury (DNBI) Report. This report breaks down the categories
of injuries and illness for the unit. It is forwarded up the chain and collected for the
major unit. This information can be used to track the spread of disease or identify
injury trends.
Administration - Aid Stations are the focal point of all medical administrative matters for the
unit. These include everything from simple light duty chits to complicated Physical Exam
Boards (Med Boards).
Supply - Aid Stations in garrison have limited amounts of consumable supplies. Unit funds
are used to provide office supplies and medical supplies needed to provide basic care for unit
personnel.
Provide medical coverage as needed for training - whenever Marines train, they will need
Corpsmen. Examples of events requiring medical coverage include weapons ranges, obstacle
courses, and physical fitness tests.
Provide training to non-medical personnel to enhance self/buddy aid and litter team
responsibilities - training programs such as Combat Life Saver are taught while in garrison.
A thorough training program for your Marines, to include sustainment training, will save
lives on the battlefield.

Within a field/combat setting, the responsibility of the Aid Station includes:

While in the field or combat operations, some of the responsibilities the BAS performed
while in garrison will continue. However, there are additional responsibilities the BAS and
the corpsman assigned to the BAS will assume. For instance;
- Conduct sick call
- Conduct Triage
- Treat casualties to minimize mortality, prevent further injury, and stabilize for further
evacuation.
- Record all casualties received and treated, and report them to the appropriate unit
section for preparation of casualty reports.
- Provide temporary shelter in conjunction with emergency treatment.
- Return patients to duty when possible.
- Transfer evacuees from the BAS to ambulance, helicopter, or other evacuation
transportation.
- Initiate treatment of combat stress casualties.
- Maintain deployment health records (DHR) of battalion personnel.
- Provide personnel replacement and medical re-supply for company level Hospital
Corpsmen.

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During combat operations, the BAS is structured to be able to split its personnel and supplies
into two BAS's (Alpha and Bravo) and "leapfrog" ahead as the battlefield advances, (see
figure 2). As Alpha BAS advances with the battalion, Bravo BAS will remain behind and
continue to provide medical care/evacuations until all patients have been evacuated, or until
relieved by medical support elements such as Medical Battalion Shock Trauma Platoon
(STP). This allows for continuity of care as the unit advances. Once the STP assumes all
casualties, Bravo BAS, personnel and supplies will rejoin Alpha BAS to form the complete
BAS (see figure 1).
1 MO
11 HM'S

ALPHA BAS

FORWARD BATTLE LINE

1 MO
10 HM'S

BRAVO BAS

STP

STP

Figure 1. BAS Employment during combat operations

The BAS does not have a patient holding capability. It is similar to a crude emergency room.
Depending on the tactical situation, the BAS can be assembled in a fully equipped General
Purpose (GP) tent or employed in a mobile configuration from two M1035s and two 7-ton
trucks. An individual’s privacy is a main concern while they are being treated. Any and all
practical measures necessary to provide patient privacy should be used. A Religious
Ministry Team (RMT) may be assigned to the BAS. The RMT is made up of a Chaplain and
a Religious Program Specialist (RP). Their job is to aid in the comfort of the sick and
wounded and to perform religious rites, as needed. This team can provide emotional support
for the wounded and can also assist the BAS personnel at the discretion of the Medical
Officer.
Sections of the BAS - the BAS can be broken down into five internal sections, which operate
as a whole in providing HSS to the Marine Infantry Battalion. (See figure 2)
Internal Security - provides perimeter security for the immediate BAS area, searches
patients for weapons, munitions, and booby traps prior to being admitted to the triage
area. AT NO TIME will any weapon or ammunition be allowed into the medical
treatment area.
Triage - sorts and records all incoming patients prior to entry into treatment area.
Limited emergency first aid and fluid replacement may be provided here while patients

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 are waiting to enter treatment area. Initiate and/or continue patient documentation of
treatment provided in this area. Also provides comfort/ease of pain to the dying.
Treatment Area - usually done in the GP tent, but could be any secure area assigned by
the Battalion Surgeon to treat patients. It’s where all the life saving treatment/procedures
are performed as directed by the MO or Senior Medical Department Representative.
Evacuation Area - staging area for patients awaiting evacuation, those requiring
continued monitoring or continued care. It is also the area where casualty reporting and
CASEVAC requests are made.
Expectant Area - area used to hold personnel with very serious injuries who are not
expected to survive. Supportive medical care is provided, i.e. pain medications, and
ministry and sacrament for the dying are provided appropriate for the casualties’ faith
group.

Figure 2. Typical Field BAS Setup

Responsibilities of Specific Personnel

Battalion Surgeon
One of the two medical officers in an infantry battalion is designated as the Battalion
Surgeon. The Battalion Surgeon is a special staff officer who advises the battalion
commander on matters pertaining to the health and medical care of battalion personnel. The
duties of the Battalion Surgeon include:
- Supervising patient treatment, planning, and organization.
- Education of the battalion medical staff.
- Other duties as the battalion commander may direct.
Assistant Battalion Surgeon
The other medical officer in an infantry battalion is designated as the Assistant Battalion
Surgeon. The primary job of the Assistant Battalion Surgeon is to:
- Direct, manage, and supervise the operation of the BAS.
- Perform such additional duties as may be assigned by the Battalion Surgeon.

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 Battalion Chief
Maintains the BAS to include:
- Administration, personnel, and logistical matters.
- Ensures that all battalion HSS commitments and operational requirements have the
appropriate medical and logistical support.
- Advises the Battalion Surgeon on all matters relating to the BAS or battalion
medical personnel.
Joint responsibilities of the Battalion Surgeon/Chief
- Organizing/Assignment of medical platoons personnel.
- Preparing HSS appendix to battalion's operational plan.
- Supervising and assisting in the collection, treatment, and evacuation of the sick and
injured.
- Develop HSS Standard Operation Procedures (SOP) in accordance with guidance by
higher authority.
- Conduct medical sanitation inspections.
- Maintaining and submitting appropriate records and reports.
- Train medical personnel in subjects relating to HSS.
- In the absence of a Preventive Medicine Technician, supervise instruction for non-
medical personnel in personal hygiene, preventive medicine, and field sanitation.
- Ensuring medical supplies and equipment are properly managed, and that a responsive
re-supply system is established to ensure adequate re-supply at garrison and combat
levels.

4. EQUIPMENT USED TO ESTABLISH AN AID STATION

Logistics is the military specialty dealing with the procurement, storage, distribution,
inventory, and maintenance of material. Supplies and equipment are divided into ten (X)
classes as annotated by roman numerals for management purposes. Class VIII supplies are
specifically medical related items. Careful consideration should be given to stock levels of
Class VIII materials (consumable and equipment) so as not to overstock. The following
information is crucial when medical planners develop HSS logistical support system:
- Concept of operation/scheme of maneuver
- Combat intensity
- Duration of the operation
- Casualty estimates
Supply Terminology
Table of Equipment (T/E) - a unit's T/E includes items necessary for basic support of the
organization and include:
- Tentage
- Vehicles
- Tools
- Communication equipment
- Nuclear, biological and chemical (NBC) gear
- Office equipment and supplies

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Authorized Medical Allowance List (AMAL) - a list of authorized allowances of
equipment and consumable supplies required to perform operational HSS. There are
many types of AMALs that can be requested based on the nature of the operation. Each
AMAL is composed of equipment and consumable supplies. The T/E assigned AMALs
for the BAS are designed to support one Infantry Battalion.
AMAL 635 (Equipment) - Aid Station equipment and reusable material supporting
HSS of the BAS. Examples include:
- Litters
- Litter stands
- Blankets
AMAL 636 (Consumable Items) - Consumable supplies required to provide HSS to
the BAS, to include, initial resuscitation, and stabilization of 50 casualties with major
wounds prior to evacuation, and re-supplying to the company line Corpsmen.
Examples include:
- Intravenous solutions
- Bandages
- Medications
Authorized Dental Allowance List (ADAL) - a list of authorized allowances of
equipment and consumable supplies required to perform a dental function. As with the
AMAL, there are various types of ADALs and they are also composed of equipment and
supplies.
ADAL 662 Field Dental Items - equipment and reusable material required
establishing a dental clinic in the field. Consumable supplies required providing
emergency, diagnostic, and preventive maintenance of dental care for 400 patients.

DD-1348 (see figure 3) - form used to requisition materials. It is used primarily by the
battalion corpsman in ordering supplies by line item only, e.g., IV fluids, bandages,
splints, etc., to re-stock the equipment and consumable AMAL/ADAL.

Figure 3. DD FORM 1348

Line Items- Items having a National Stock Number (NSN)

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5. HEALTH SERVICE SUPPORT (HSS) COMPONENTS OF THE MEF

MEF Commanders are responsible for coordinating and integrating HSS within their area of
operations. The MEF surgeon, medical planner, medical administrative officer, preventive
medicine officer, and hospital corpsmen are responsible for establishing HSS requirements
and ensuring the HSS systems established by MEF major subordinate commands from an
integrated and responsive network of support.

6. HEALTH SERVICE SUPPORT (HSS) COMPONENTS OF THE MAW

The medical staff of the Marine aircraft wing (MAW) headquarters has a wing surgeon,
medical administrative officer, an environmental health officer, industrial hygienist,
optometrist and hospital corpsmen. Medical staff responsibilities are similar to the MEF’s
but are more specifically related to the activities within the air combat element (ACE).

A MAW has four Marine aircraft groups (MAGs). Each MAG has a flight surgeon and
hospital corpsmen. Each MAG is supported by a Marine wing support squadron (MWSS)
that consists of their own flight surgeon and hospital corpsmen.

7. HEALTH SERVICE SUPPORT (HSS) COMPONENTS OF THE MARDIV

The medical staff of the division headquarters consists of a division surgeon, a medical
planner/administrator, a psychiatrist, and hospital corpsmen. The breakdown of HSS for
division is built to support the mission of each unit. Following are the components within
division.

Element Officer Enlisted

Division HQ 7 17
Infantry Regiment 11 201
Infantry Battalion 3 66
Tank Battalion 2 31
Assault Amphibian Battalion 2 21
Artillery Regiment 23 59
Artillery Battalion 5 13
Combat Engineer Battalion 2 26
Light Armored Reconnaissance Battalion 3 66
Headquarters Battalion 8 41
Force Reconnaissance Company 0 9

Figure 4. Components of the MARDIV

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8. HEALTH SERVICE SUPPORT (HSS) COMPONENTS OF THE MLG

Medical logistics group has the majority of the MEF’s medical capability. MLG is led by the
group surgeon who advises the MLG commander on all health relations within MLG. MLG
also has a health service support officer (HSSO) who is responsible for coordinating medical
support for both GCE and ACE.

MLG has a medical battalion with three surgical companies (Surg CO) and eight shock
trauma platoons (STP’s) MLG also has a dental battalion to provide field dentistry.

REFERENCES
Marine Corps Warfighting Publication (MCWP), 4-22 MED 021-6
Combat Health Support in Specific Environments, FM 8-10-1
Class VIII Supplies, MCO 6700.2
Hospital Corpsman, NAVEDTRA 14295
Emergency War Surgery Handbook NATO, 2004
Medical Evacuation in a Theater of Operations, FM 8-10-6
Organization of the Marine Corps Forces MCWP 5-12D

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 Aid Station Review

1. Describe the Disease Non Battle Injury Report (DNBI).

2. List five requirements of the BAS in combat.

3. What types of items are found on a Table of Equipment (T/E)?

4. Which AMAL contains consumable supplies? List three.

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 UNITED STATES MARINE CORPS
FIELD MEDICAL TRAINING BATTALION
BOX 555243
CAMP PENDLETON, CA 92055-5243

FMST 507

Medical Support for Military Operations in Urban Terrain (MOUT)

TERMINAL LEARNING OBJECTIVES

1. In various environments, given standard field medical equipment and supplies, provide first
responder medical support to meet mission requirements. (8404-HSS-2006)

ENABLING LEARNING OBJECTIVES

1. Without the aid of reference, identify the definition of urban warfare, within 80%
accuracy, per Prehospital Trauma Life Support, Current Military Edition. (8404-HSS-2006a)

2. Without the aid of reference, given a list, identify the potential health threats of MOUT,
within 80% accuracy, per Prehospital Trauma Life Support, Current Military Edition. (8404-
HSS-2006b)

3. Without the aid of reference, given a list, identify the special requirements of casualty
evacuation (CASEVAC) in MOUT, within 80% accuracy, per Prehospital Trauma Life
Support, Current Military Edition. (8404-HSS-2006c)

4. Without the aid of reference, given the requirement in a simulated combat scenario, operate
in a MOUT environment, to meet mission requirements, per Prehospital Trauma Life Support,
Current Military Edition. (8404-HSS-2006d)

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1. DEFINITION OF MOUT
Background - Throughout history, battles have been fought on urbanized terrain. Recent
examples are Beirut, Panama City, Mogadishu, and Iraq. It is impossible to develop one set
of tactics, techniques and procedures that can be applied to every scenario. Combatants and
medical providers are required to quickly adapt to each mission, terrain, and situation.
Military Operations in Urban Terrain (MOUT) Defined - Urban warfare, or Military
Operations in Urban Terrain (MOUT), is best defined as those military actions planned and
conducted on a terrain where man-made structures impact the tactical options available to the
commander. This terrain is characterized as a four-dimensional (air, buildings, streets, and
subways) battlefield with the following features:
- Considerable rubble.
- Ready-made fortified fighting positions.
- An isolating effect on all combatants.

2. POTENTIAL HEALTH THREATS IN MOUT.

a. The medical threats in MOUT present unique challenges to Health Services personnel.
Each of the tactical considerations requires a parallel plan for medical response.

b. Combat in urban terrain and the populations encountered can complicate the ability of
medical personnel to provide timely, sustainable support. The patient collection point must be
preplanned and established at relatively secure area accessible to both ground and air
ambulances.

c. Casualty rates are generally higher than conventional battles. Explosions are the most
frequent cause of injury in an urban setting. These explosions may be generated from tanks,
mortars, or improvised explosive devices (IED’s). These explosions are likely to produce blast
related injuries which are covered in a separate lesson. Small units may be spread out across a
large area. Unit training in the practice of “self-aid” and “buddy-aid” is essential. Each
combatant should be able to quickly and effectively apply a tourniquet, field dressing, and
hemostatic agent.

Other Potential Health Threats of MOUT include:

(1) Isolation and reduced response to casualties
(2) Imposition of civilian casualties and refugees
(3) Undefined lines of battle that delay medical treatment
(4) Mass casualty/casualty overload situations
(5) Communicable disease endemic to the area
(6) Lack of water and sanitation
(7) Combat stress
(8) NBC environment

5-64
Psychological Casualties
In addition to blast injuries, units are likely to experience an increase in psychological
injuries. This is due to lengthy exposure to factors resulting from a constant threat of a
hidden enemy. Prolonged fear of sniper fire and hidden IEDs along with the repeated
sight of the dead and dying are predominant factors leading to combat stress casualties.
Medical units should be
prepared to treat these
individuals.
Civilian Casualties
Medical units must be
prepared for the influx of
large numbers of civilian
casualties. Units should
prepare for the possibility
of geriatric and pediatric
patients. Large numbers of
civilians could overwhelm
the capabilities of military
medical units. Units
should, therefore, establish
a plan for this possibility AL TAQADDUM, Iraq– Servicemembers help triage injured
Iraqi civilians outside of Taqaddum’s medical facility after a
prior to engaging. suicide truck bomb exploded in northern Habbiniyah.

Infectious Disease
Areas experiencing urban combat are likely to have many infectious diseases in the area.
The problem will be worse due to poor general sanitation measures and limited amount of
public health services.
Animals: Diseases can also be carried by the many animals in the area (rats,
mice, dogs, etc.).
People: Interacting with the civilian populace or enemy prisoners of war can
expose you or your Marines to such diseases as malaria, tuberculosis or
leishmaniasis. Sexually transmitted diseases such as gonorrhea, syphilis, hepatitis,
and HIV may also be prevalent.
Water: Potable water will be limited. Troops in urban conflict can consume up to
5 quarts per day on a normal occasion and 12 quarts of water per day in extreme
heat environments. If the demand for water is greater than the ability to re-
supply, they may be tempted to drink water from local sources. This exposes
them to hepatitis, intestinal parasites, and industrial toxins.

5-65
3. CASUALTY EVACUATION
Moving casualties in an urban environment can be
difficult and time consuming. Moving a litter
patient only a few hundred yards could take an hour
or more. Ground evacuation vehicles will require
heavy armor that can withstand small arms fire as
well as rocket propelled grenades (RPG) and IEDs.
Helicopter evacuation is difficult due to the tight
operating environment. They too are susceptible to
small arms fire and RPG’s.
Special equipment requirements of CASEVAC
Simply finding casualties in an urban environment
can be difficult. Explosions can cause buildings to
crumble trapping patients inside. Vehicles can crash Twentynine Palms, CA- Marines from 3rd
due to explosions, hostile fire or operator error. Battalion, 5th Marine Regiment, carry a
Events such as these may lead to complicated rescue ‘casualty’ to safety in the urban assault lane of
efforts that require special equipment such as: axes, the training at Range 215. The MOUT facilities
were built to replicate the actual environment
crowbars, jacks, ropes, collapsible litters and cutting that Marines will face when deployed.
tools.

4. OPERATING IN A MOUT ENVIRONMENT

The military commander must take many
factors into consideration when planning
MOUT operations. Two of which, terrain and
rules of engagement, are discussed here:
Terrain
- Enemy observation positions are likely
in high, isolated structures such as
steeples or lone high-rise buildings.
- Assaulting forces can become quickly
isolated, confused and cut-off by a
FALLUJAH, Iraq - A vehicle gunner with 1st
tangle of unfamiliar structures.
Battalion, 6th Marine Regiment, looks out on the
- Small assaulting units are at a great city as his unit patrols the back alleyways of
disadvantage due to multiple floors, Fallujah. The unit typically patrols the city streets
rooms, stairways, and doors. The several times a day, maintaining a strong military
enemy may make great use of these presence and searching for insurgents and illegal
arms.
obstacles to inflict serious losses.

5-66
 Rules of Engagement (ROE) - “US Forces and allies operate with restrictive ROE, reflecting
the morals and values considered proper for a civilized society. Unfortunately, the tactical
advantage will often go to the belligerent, who disregards or actively endangers the safety of
civilians” (PHTLS 6th ed. P 586). Therefore, it is important to remember that every action
has consequences. ROE may change from day to day, or from situation to situation. ROE
are designed to:
- Avoid alienation of the local population.
- Reduce the risk of adverse world opinion.
- Preserve structures and facilities for future use.
- Preserve vital cultural facilities and grounds.

REFERENCE
Pre-Hospital Trauma Life Support, Current Military Edition

5-67
 MOUT Review

1. Describe the characteristics of the terrain associated with MOUT.

2. Identify the predominant factors that lead to combat stress casualties in a MOUT
environment.

3. List three sources of infectious disease that are found in a MOUT environment.

4. Identify some events that may lead to complicated CASEVAC efforts in a MOUT
environment.

5-68
 Components of Field Medicine
Review Questions

NOTE: The following questions are offered for review purposes. This is NOT intended as
a sole source of test preparation. Remember all test questions are based on an ELO and
any ELO can be used to create a test question.
1. What is the mission of the aid station?
2. What are the six most commonly used methods of evacuation?
3. What are the four categories of tactical triage?
4. What are the degrees of burns?
5. What does the acronym “HEADS” stand for?
6. On the nine-line CASEVAC request, what information is on line six?
7. What is the definition of urban warfare (MOUT)?
8. Who are the two medical officers in an aid station group?
9. What are some of the potential health threats of MOUT?
10. What are the two methods used to estimate burn size?
11. First aid and emergency care is the primary objective of which taxonomy of care level?
12. Restorative and rehabilitative care is the primary objective of which taxonomy of care level?
13. Why are military blast casualties less likely to suffer injuries to the upper torso and head?
14. What are the responsibilities of the aid station while in garrison?
15. What is the most common form of injury in a terrorist bombing?
16. When dealing with blast injuries, how can the absence of ruptured tympanic membranes help
rule out other injuries?
17. What are you the 2 categories of TBI?
18. What burn injuries are considered critical regardless of depth or TBSA affected?
19. What are the six commonly used litters within the FMF?
20. What are the five CASEVAC priority levels?
21. What are the five basic sections of the BAS?
22. What are the two types of blast waves?
23. Why might an electrical burn be underappreciated?
24. What are the special requirements of casualty evacuation in MOUT?
25. What are the routine patient assessment procedures (sick call)?
26. What the symptoms of severe TBI?
27. When dealing with blast injuries, what is the most commonly affected body area?
28. What is the most common type of burn on the modern battlefield?

5-69
WEAPONS
 Weapons Table of Contents

Weapons Handling 1
FMST WP 1

Fundamentals of Rifle Marksmanship 8

FMST WP 2

Shooting Positions 15
FMST WP 3

Combat Marksmanship Fundamentals 24

FMST WP 4

Data Book Analysis 30

FMST WP 5

Rifle Range Operations 41

FMST WP 6

Zero the Rifle Combat Optic 46

FMST WP 7

Zero the Back Up Iron Sights 54

FMST WP 8
 UNITED STATES MARINE CORPS
FIELD MEDICAL TRAINING BATTALION
BOX 555243
CAMP PENDLETON, CA 92055-5243

FMST WP1

Weapons Handling

TERMINAL LEARNING OBJECTIVES

1. Given a service rifle/Infantry Automatic Rifle (IAR), sling, magazines, cleaning gear,
individual field equipment, and ammunition, perform weapons handling procedures
with a service rifle/Infantry Automatic Rifle (IAR) in accordance with the four safety
rules. (HSS-MCCS-2004)
2. Given a service rifle and cleaning gear, maintain a service rifle to ensure the weapon
is complete, clean, and serviceable. (HSS-MCCS-2005)
3. Given a service rifle that has stopped firing and ammunition, perform corrective
action with a service rifle to return the weapon to service. (HSS-MCCS-2006)
4. Given a service rifle/Infantry Automatic Rifle (IAR), individual field equipment,
sling, and magazines, demonstrate weapons carries with a service rifle/Infantry
Automatic Rifle (IAR) in accordance with the four safety rules. (HSS-MCCS-2007)

ENABLING LEARNING OBJECTIVES

1. Without the aid of reference and given a service carbine, determine the condition of
the weapon without error, per MCRP 3-01A. (HSS-MCCS-2005a)

2. Without the aid of reference, given a service carbine, a magazine, ammunition, and
necessary equipment at an approved range, execute weapons commands for the service
carbine without safety violations, per MCRP 3-01A. (HSS-MCCS-2004f)

3. Without the aid of reference, identify the cycle of operation without error in
accordance with MCRP 3-01A. (HSS-MCCS-2006a)

4. Without the aid of reference, given individual field equipment, sling, and magazines,
perform immediate action with a service rifle to return the weapon to service without
violating safety rules and in accordance with MCRP 3-01A. (HSS-MCCS-2006b)

5. Without the aid of reference, given individual field equipment, sling, and magazines,
perform remedial action with a service rifle to return the weapon to service without
violating safety rules and in accordance with MCRP 3-01A. (HSS-MCCS-2006c)

6. Given the requirement, a service rifle/Infantry Automatic Rifle (IAR), individual field
equipment, and a magazine, execute the three weapons carries without violating the
safety rules and in accordance with MCRP 3-01A. (HSS-MCCS-2007a)
1. DETERMINING THE CONDITION OF A RIFLE
You must know the condition of your weapon at all times. Any time you take possession
of a weapon, you must determine its condition. Situations include taking charge of your
own weapon after it has been unattended (e.g., from the armory, out of a rifle rack, left in
a vehicle), coming across an unmanned rifle in combat, or taking charge of another
person’s weapon that is attended or unattended. The conditions are as follows:

Determine if a magazine is present

Ensure the weapon is on safe
Conduct a chamber check

A chamber check may be conducted at any time to determine if ammunition is present:

1. Pull the charging handle slightly to the rear and visually and physically inspect
the chamber.
2. Right-handed Individuals: Insert one finger of your left hand into the ejection
port and feel whether a round is present.
3. Left-handed Individuals: Insert the thumb of the right hand into the ejection port
and feel whether a round is present.
4. Release the charging handle and observe the bolt going forward.
5. Tap the forward assist.
6. Close the ejection port cover (if time and the situation permit).

2. WEAPONS COMMANDS
a. Commands – weapons commands dictate the specific steps to load, make ready,
and unload the M4 carbine. Six commands are used on the rifle range and in
weapons handling:
1. "Load" is the command used to take a weapon from Condition 4 to
Condition 3.
2. "Make Ready" is the command used to take a weapon from Condition 3 to
Condition 1.
3. "Fire" is the command used to specify when you may engage targets.
4. "Cease Fire" is the command used to specify when you must stop target
engagement.
5. "Unload" is the command used to take a weapon from any condition to
Condition 4.
6. "Unload, Show Clear" is the command used to require a second person to
check the weapon to verify that no ammunition is present before the rifle is
put into Condition 4. To execute this command, you must remove the
magazine, lock the bolt to the rear, and inspect the chamber to ensure that it
is empty. Then someone else must inspect and confirm that your weapon is
completely unloaded.
The commands are executed as follows:
Unload
On the command "Unload," perform the following steps to take the rifle from any
condition to Condition 4:

1. Ensure the rifle is on safe.

2. Remove the magazine from the rifle and retain it on your person.
3. Pull the charging handle to the rear to eject any ammunition in the chamber.
4. Lock the bolt to the rear.
5. Put the rifle on safe now if it would not go on safe earlier.
6. Ensure the chamber is empty and no ammunition is present.
7. Release the bolt catch and observe the bolt going forward on an empty
chamber.
8. Close the ejection port cover
9. Return the ejected round to the magazine.
10. Return the magazine to the magazine pouch and fasten the pouch.

Load
On the command "Load," perform the following steps to take the rifle from
Condition 4 to Condition 3:
1. Ensure the rifle is on safe.
2. Withdraw a magazine from the magazine pouch.
3. Fully insert the magazine into the magazine well until the magazine catch
engages the magazine. The magazine catch will “click” as it engages which
can be felt or heard by the shooter. Without releasing the magazine, tug
downward on the magazine to ensure it is seated.
4. Fasten the magazine pouch.

Make Ready
On the command "Make Ready," perform the following steps to take the rifle from
Condition 3 to Condition 1:
1. Pull the charging handle fully to the rear and release. Do not “ride” the bolt
forward. Allow the bolt to “slam” forward.
2. To ensure ammunition has been chambered, conduct a chamber check.
3. Close the ejection port cover (if time and the situation permit).
Fire
On the command "Fire," perform the following steps:
1. Aim the rifle, take the rifle off safe, and squeeze the trigger.
2. After completion of firing, lower the rifle sights to just below eye level so a
clear field of view is maintained until a new target has been identified or the
threat has been eliminated.
 Cease Fire
On the command "Cease Fire," perform the following:
1. Place your trigger finger straight and off the trigger.
2. Place the weapon on safe.

Unload, Show Clear

On the command "Unload, Show Clear", perform the following steps to take the
rifle from any condition to Condition 4:
1. Follow the procedures for unloading the weapon.
2. Have a second party inspect the rifle to ensure no ammunition is present.
3. After receiving acknowledgement that the rifle is clear, release the bolt
catch and observe the bolt going forward on an empty chamber.
4. Close the ejection port cover.
5. Return the ejected round to the magazine.
6. Return the magazine to the magazine pouch and fasten the pouch.

Weapons transfer procedures

Show Clear Transfer
When time and the tactical situation permit, the rifle should be transferred
using the Show Clear Transfer. To properly pass a rifle between individuals,
perform the following procedures:

The person handing off the rifle must

1. Ensure the rifle is on safe.

2. Remove the magazine if it is present.
3. Lock the bolt to the rear.
4. Visually and physically inspect the chamber to ensure there is no ammunition
present.
5. Leave the bolt locked to the rear and hand the weapon to the other person,
stock first with the muzzle elevated.

The person receiving the weapon must

Place the rifle in Condition 4 by performing the following procedures:
1. Ensure the rifle is on safe.
2. Visually and physically inspect the chamber to ensure there is no ammunition
present.
3. Release the bolt catch and observe the bolt going forward on an empty
chamber.
4. Close the ejection port cover.
 Condition Unknown Transfer
To properly take charge of a rifle when its condition is unknown, you must
perform the following procedures:
1. Ensure the rifle is on safe.
2. Conduct a chamber check to determine the condition of the weapon.
3. Remove the magazine and observe if ammunition is present in the magazine.
If time permits, count the rounds.
4. Insert the magazine into the magazine well.

4. CYCLE OF OPERATION
There are eight steps in the cycle of operation for the service carbine:
1. Firing – the ignition of the propellant within the cartridge case forcing the
projectile down and out the barrel.
2. Unlocking – the rotation of the bolt until the locking lugs no longer align with the
lugs on the barrel extension.
3. Extracting – the withdrawal of the cartridge case from the chamber by the
extractor claw and the rearward motion of the bolt.
4. Ejecting – the expulsion of the cartridge case by the ejector and spring.
5. Cocking – the resetting of the hammer on the sear as the bolt moves rearward
over the hammer.
6. Feeding – the stripping of a round from the magazine by the bolt.
7. Chambering – the pushing of the round into the chamber by the bolt.
8. Locking – the alignment of the locking lugs on the bolt as it rotates into the
chamber and lugs align with the lugs on the chamber.

5. IMMEDIATE ACTION
a. Stoppage:
A stoppage is an unintentional interruption in the cycle of operation. A
stoppage is normally discovered when the rifle will not fire. Most stoppages
can be prevented by proper care, cleaning, and lubrication of the rifle and
magazines.
b. Malfunction:
A malfunction is a failure of the rifle to fire satisfactorily or to perform as
designed. A malfunction does not necessarily cause an interruption in the cycle
of operation. An example of a malfunction is that the weapon fires on automatic
(burst) rather than semiautomatic even though the selector lever is set on SEMI.
The rifle will still fire, but it will not perform as designed. When a malfunction
occurs, the weapon usually has to be repaired by an armorer.
The Bolt is Forward or Ejection Port Cover Closed – to return the weapon to
operation:
1. Tap - Tap or strike upward on the bottom of the magazine to ensure it is fully
seated.
2. Rack - Pull the charging handle all the way to the rear and release it to ensure
a round is chambered.
3. Bang - Sight in and attempt to fire.

6. REMEDIAL ACTION
a. Indicator – The Bolt is Locked to the Rear – to return the weapon to
operation: Conduct a speed reload.

1. Press the magazine release button and remove the empty magazine and retain
it on your person if time permits.
2. Insert a filled magazine into the magazine well and tug downward on the
magazine to ensure it is properly seated.
3. Depress the bolt catch to allow the bolt to move forward and chamber a
round.
4. Sight in and attempt to fire.

b. Indicator – Obstruction in the Chamber Area – this usually indicates a

failure to eject or extract. It is also the procedure for removing any foreign
object that may be impeding function of the weapon. To return the weapon to
operation:
1. Remove the magazine.
2. Attempt to lock the bolt to the rear. If the bolt will not lock to the rear:
3. Rotate the rifle so the ejection port is facing down.
4. Hold the charging handle to the rear and shake the rifle to free the round(s).
5. If the rounds do not shake free, hold the charging handle to the rear and
strike the butt of the rifle on the ground or manually clear the round.
6. Reload.
7. Sight in and attempt to fire.

c. Indicator – Brass is Stuck Over and Behind the Bolt Face This stoppage
will prevent the bolt from moving and is caused by the weapon failing to feed
or extract properly. To return the weapon to operation:
1. Attempt to place the weapon on Safe.
2. Remove the magazine and place the butt stock on the deck.
3. Hold the bolt face to the rear with a sturdy, slender object (e.g., stripper
clip, knife, Multi-Tool). Maintain rearward pressure on the bolt and
simultaneously push forward on the charging handle to remove the
obstructing round.
4. Check the chamber area to ensure it is clear.
 5. Conduct a speed reload.
6. Sight in and attempt to fire, if applicable.

d. Audible Pop or Reduced Recoil – an audible pop occurs when only a portion
of the propellant is ignited, or only the primer is ignited. It is normally
identifiable by reduced recoil and a lower report. This is sometimes
accompanied by excessive smoke escaping from the chamber area

7. WEAPONS CARRIES
a. Tactical Carry (see figure 1) The tactical carry is used when no immediate
threat is present.
b. Alert Carry (see figure 2) The alert is used when enemy contact is likely
(probable).(ALERT TO THE DIRT)
c. Ready Carry (see figure 3) The ready is employed when contact
with the enemy is imminent.

TACTICAL CARRY ALERT CARRY READY CARRY

(Figure 1) (Figure 2) (Figure 3)

REFERENCES
MCRP 3-01 Rifle Marksmanship
 UNITED STATES MARINE CORPS
FIELD MEDICAL TRAINING BATTALION
BOX 555243
CAMP PENDLETON, CA 92055-5243

FMST WP2

Fundamentals of Rifle Marksmanship

TERMINAL LEARNING OBJECTIVE

1. Given a service rifle, individual field equipment, sling, magazines, ammunition, and
known distance targets, execute fundamental rifle marksmanship table 1A to strike the
target without any safely violations. (HSS-MCCS-2010)

ENABLING LEARNING OBJECTIVES

1. Given a service rifle, individual field equipment, sling, magazines, ammunition, and a
known distance target, apply the three elements of a good shooting position to achieve
effect on target in accordance with MCRP 3-01A. (HSS-MCCS-2010a)

2. Given a service rifle, individual field equipment, sling, magazines, ammunition, and a
known distance target, apply the seven factors common to all shooting positions to
achieve effect on target in accordance with MCRP 3-01A.(HSS-MCCS-2010b)

3. Given a service rifle, individual field equipment, sling, magazines, ammunition, and a
known distance target, apply the fundamentals of marksmanship to achieve effect on
target in accordance with MCRP 3-01A.(HSS-MCCS-2010c)
1. THREE ELEMENTS OF A SHOOTING POSITION

a. Bone Support - The body’s skeletal structure provides a stable foundation to

support the rifle’s weight and manage the recoil after a shot is fired. One of
the principles of bone support involves hard and soft tissue. This provides
maximum stability and recoil management.

b. Muscular Relaxation - Muscular relaxation helps to hold the body steady,

increases the accuracy of aiming and provides maximum use of bone support.

c. Natural Point of Aim - Natural point of aim is the point at which the rifle
sights settle when in a firing position. Move your body to settle the sights.
“DO NOT MUSCLE THE WEAPON.” If a shooter is doing this the shooter
should stop and reevaluate their position to get their natural point of aim.

2. SEVEN COMMON FACTORS TO ALL SHOOTING POSITIONS

a. Forward hand relaxed and elbow close to weapon

(1) Wrist should be straight and locked. This creates resistance on the
sling close to the muzzle. This allows for the front sight to be
stabilized.

(2) Elbow should be inverted under weapon as much as possible to allow

for maximal bone support and a consistent resistance to recoil.

(3) Forward elbow should not be on the ball of the elbow.

b. Butt of the weapon high in the pocket of the shoulder (see figure 1)

(1) Outboard tension is applied on sling by the support elbow to drive the
buttstock into the pocket of the shoulder.

(2) Buttstock is placed high in the shoulder to achieve proper stock weld.
This ensures that the shooters neck remains erect so that the shooter is
looking straight through the sights to acquire sight picture.

Figure 1. Buttstock High in the Shoulder

c. High firm pistol grip (see figure 2)
This should be consistent throughout course of fire and can be accomplished
by doing the following:

(1) Place the "V" formed between the thumb and index finger high on the
pistol grip directly behind the trigger.

(2) Place the fingers and thumb around the pistol grip in a location that
allows the trigger finger to rest naturally on the trigger.

(3) The shooter should also pull the weapon slightly to the rear into the
pocket of the shoulder.

Figure 2. High Firm Pistol Grip

d. Placement of the rear elbow

(1) Should be positioned naturally to provide balance and to create a

pocket in the shoulder for the rifle butt.

(2) Consistent shoulder placement will ensure that resistance to recoil

will remain constant.

e. Stock weld and eye relief (see figure 3) This consists of proper placement of
the shooters cheek against the stock. It should remain firm and consistent
from shot to shot, and can be accomplished by doing the following:

(1) Place the stock so it’s anchored under the shooter’s cheek bone.

(2) Ensure that shooter has proper eye relief, which is the distance of the
aiming eye in relation to the rear sight aperture (2 to 6 inches).

(3) Head will remain erect to allow aiming eye to look straight through
the rear sight aperture.
 Figure 3. Stockweld and Eye Relief

f. Breathing

(1) Natural respiratory pause - Inhale-Exhale-Pause-Shoot (see figure 4)

(2) Technique for Breath Control During Slow Fire:

(a) Assume a firing position

(b) Stop breathing at your natural respiratory pause and make final
adjustments to your natural point of aim.

(c) Breathe naturally, until your sight picture begins to settle.

(c) Take a slightly deeper breath.

(d) Exhale and stop breathing at the natural respiratory pause.

(e) Fire the shot during the natural respiratory pause.

(3) Techniques for Breath Control During Rapid Fire - There are two
methods that can be used:

(a) Breathing Between Shots

1 Assume a firing position.

2 Stop breathing at your natural respiratory pause.

3 Fire the shot during the natural respiratory pause.

4 Repeat until all five shots have been fired.

 (b) Holding the Breath

1 Assume a firing position.

2 Take a deep breath filling the lungs with oxygen.

3 Hold your breath and apply pressure to the trigger.

4 Fire the shots.

Figure 4. Natural Respiratory Pause

g. Controlled Muscular Tension - With the loop sling donned, muscular

tension is used to stabilize the rifle. However, excessive muscular tension
will result in trembling, shaking, and fatigue. Muscular tension should only
be applied to the point at which it allows the sights to settle.

3. APPLYING THE FUNDAMENTALS

a. Sight Alignment and Sight Picture (see figure 5)

(1) Sight Alignment - The relationship between the front sight post, rear
sight aperture, and aiming eye. This must be consistent from shot to
shot or it could result in a misplaced shot. The steps to acquiring
correct sight alignment are as follows:

(a) Center the tip of the front sight post vertically and horizontally
in the rear sight aperture.

(b) Imagine a horizontal line drawn through the center of the rear
sight aperture. The top of the front sight post will appear to
touch this line. Imagine a vertical line drawn through the center
of the rear sight aperture. The line will appear to bisect the
front sight post. This method causes the least amount of
inconsistency from shot to shot.
 (2) Sight Picture - The placement of the tip of the front sight post in
relation to the target, while maintaining sight alignment. Correct sight
alignment but improper sight placement on the target will cause the
bullet to impact the target incorrectly on the spot where the sights were
aimed when the bullet left the muzzle.

(a) The tip of the front sight post is placed at the center of the target
while maintaining sight alignment.

Figure 5. Sight Alignment and Sight Picture

b. Relationship Between the Eye and Sights - For accurate shooting, it is

important to focus on the tip of the front sight post throughout the sighting
and aiming process.

(1) While exhaling and bringing the front sight to the target, your focus
should be shifted repeatedly from the front sight post to the target until
the correct sight picture is obtained. Once sight picture is obtained,
your primary focus should be the tip of the front sight post. This
enables the detection of minute errors in sight alignment.

(2) During firing, your peripheral vision will include the rear sight and the
target. The rear sight and the target will appear blurry.

NOTE: The final focus must be on the tip of the front sight post with the
target appearing indistinct.

c. Trigger control - The skillful manipulation of the trigger that causes the
rifle to fire, while maintaining sight alignment and sight picture.

(1) Uninterrupted trigger control - When the trigger is moved straight to the
rear with a single, smooth motion.

(2) Interrupted trigger control - When the application of the trigger

pressure is interrupted, when an error in the aiming process is detected.
The applied pressure is kept on the trigger until the error is corrected.
 d. Factors Affecting Trigger Control

(1) Grip - Failure to have a firm grip causes the trigger to feel inconsistent
from shot to shot. As pressure is applied to the trigger, there is a
tendency to tighten the grip on the pistol grip. If the grip is firmly
established prior to applying trigger pressure, trigger control is
consistent from shot to shot.

(2) Trigger Finger Contact with the Trigger - You should keep the middle
of the trigger finger clear of the pistol grip. If the finger touches the
side of the pistol grip, it causes pressure to be applied at a slight angle
rather than straight to the rear. Side pressure applied, no matter how
slight, tends to pull the sights off the aiming point.

e. Breathing

Natural Respiratory Pause - A respiratory cycle (inhaling and exhaling) lasts

about four or five seconds. Between respiratory cycles there is a natural
pause of two to three seconds; this is the natural respiratory pause. During
the respiratory pause, muscles are relaxed and the rifle sights settle at their
natural point of aim. You should fire at this point.

f. Follow-Through - Follow-through is the continued application of the

fundamentals until the round has exited the rifle barrel. Your body has
absorbed the recoil and has settled back on your natural point of aim. Care
should be taken not to shift your position, move your head, or let the muzzle
of the rifle drop until the bullet has left the barrel. This is important so the
direction of your shot will not be disturbed. Proper follow-through reduces
the likelihood of errors. Once the follow through is completed, put the
weapon on safe and remove it from your shoulder during slow fire, or
continue with your next shot in the rapid fire.

REFERENCES
MCRP 3-01 Rifle Marksmanship
 UNITED STATES MARINE CORPS
FIELD MEDICAL TRAINING BATTALION
BOX 555243
CAMP PENDLETON, CA 92055-5243

FMST WP3

Shooting Positions

TERMINAL LEARNING OBJECTIVE

1. Given a service rifle, individual field equipment, sling, magazines, ammunition, and
known distance targets, execute fundamental rifle marksmanship table 1A to strike the
target without any safely violations. (HSS-MCCS-2010)

ENABLING LEARNING OBJECTIVES

1. Given a service rifle, individual field equipment, sling, magazines, ammunition, and a
known distance target, assume a prone position to achieve effect on target in accordance
with MCRP 3-01A and tables within MCO 3574.2K. (HSS-MCCS-2010g)
2. Given a service rifle, individual field equipment, sling, magazines, ammunition, and a
known distance target, assume a sitting position to achieve effect on target in
accordance with MCRP 3-01A and tables within MCO 3574.2K. (HSS-MCCS-2010d)
3. Given a service rifle, individual field equipment, sling, magazines, ammunition, and a
known distance target, assume a kneeling position to achieve effect on target in
accordance with MCRP 3-01A and tables within MCO 3574.2K. (HSS-MCCS-2010e)
4. Given a service rifle, individual field equipment, sling, magazines, ammunition, and a
known distance target, assume a standing position to achieve effect on target in
accordance with MCRP 3-01A and tables within MCO 3574.2K. (HSS-MCCS-2010f)
1. ASSUMING THE PRONE POSITION
Description The prone position is the steadiest of the four shooting positions providing
the shooter stability and control during firing. The prone position also provides the lowest
profile however, mobility and observation are reduced.

Moving Forward into Position

1. Stand erect, face the target, and spread your feet a comfortable distance apart
(approximately shoulder width).
2. Place your support (forward) hand on the handguard, your firing hand on the pistol
grip.
3. Lower yourself into position by dropping to both knees.
4. Shift your weight forward to lower your upper body to the ground using your firing
hand to break the forward motion.

Variations: The prone position has two variations:

Straight Leg Position with the Sling (see figure 1)
1. To assume the straight leg prone position with the sling, either move forward or drop
back into position.
2. Once on the ground, extend your support elbow in front of
you. Stretch your legs out behind you. Spread your feet a
comfortable distance apart with your toes pointing outboard
and the inner portion of your feet in contact with the ground.
3. As much of your body mass should be aligned directly behind
the rifle as possible.If your body alignment is correct, then
your whole body will absorb the weapon’s recoil and not just
your shoulder. Figure 1. Straight Leg Position
4. Grasp the pistol grip with your firing hand and place the rifle
butt in your firing shoulder pocket.
5. Lower your head and place your cheek firmly against the stock to allow the aiming
eye to look through the rear sight aperture.
6. Rotate your support hand up, slightly gripping the hand guard. The magazine must be
on the inside of your support arm.
7. Adjust the position of your support hand on the handguard to allow the sling to
support the weapon and the front sight to be centered in the rear sight aperture.
8. To adjust for a minor cant in the rifle, rotate the left or right by rotating the pistol grip
left or right.

Cocked Leg Position with the Sling (see figure 2)

1. To assume the cocked leg prone position with the sling, either move forward or drop
back into position.
2. Once on the ground, roll your body to the support side and extend your support elbow
on the ground. Your support leg is stretched out behind you, almost in a straight line.
This allows the mass of the body to be placed behind the rifle to aid in absorbing
recoil.
3. Turn the toe of your support foot inboard so the outside of your support leg and foot
are in contact with the ground. Bend your firing leg and draw it up toward your body
to a comfortable position. Turn your firing leg and foot outboard so the inside of your
firing boot is in contact with the ground. Cocking the leg will raise the diaphragm,
making breathing easier.
4. Grasp the pistol grip with your firing hand and place the rifle butt in your firing
shoulder pocket.
5. Lower your head and place your cheek firmly against the stock to allow the aiming
eye to look through the rear sight aperture.
6. Rotate your support hand up, slightly gripping the hand guard. The magazine must be
on the inside of your support arm.
7. Roll your body to the firing while lowering your firing elbow to the ground. Slide
both elbows outboard on the ground so there is outboard tension against the sling
(moving the elbows out tightens the sling). The firing shoulder is higher than the
support shoulder in the cocked leg position.
8. Adjust the position of your support hand on the handguard to allow the sling to
support the weapon and the front sight to be centered in the rear sight aperture.
9. To adjust for a minor cant in the rifle, rotate the left or right by rotating the pistol grip
left or right.

Figure 2. Cocked Leg Position

2. ASSUMING THE SITTING POSITION

MCO 3574.2K states the following requirements for the rifle sitting position:
1. The buttocks and feet or ankles will support the body's weight. No other portion of
the body will touch the ground.
2. Both hands, the sling, and one shoulder will support the rifle.
3. The arms may rest on the legs at any point above the ankles.
4. The magazine will be allowed to touch the clothing or the arm supporting the rifle,
and may be gripped along the sides but the bottom of the magazine may not be used
to support the weapon.
Description – the sitting position provides an extremely stable base and provides good
bone support. The sitting position provides better observation than the prone position
while still maintaining a fairly low profile.
Variations – there are three variations of the sitting position that can be adapted to the
individual shooter: crossed ankle, crossed leg, and open leg. Experiment with all the
variations and select the position that is easiest to assume and provides the most stability
for firing.
Crossed Ankle Sitting Position with the Loop Sling Apply the three elements and seven
factors to this position. To assume crossed ankle sitting position with the loop sling: (see
figure 3)

1. Position the body at approximately a 30-degree

angle to the target.
2. Place the support hand under the hand guard.
3. Bend at knees and break the fall with the firing
hand.
4. Push backward with the feet to extend the legs and
place the buttocks on the ground.
5. Cross the support ankle over the firing ankle.
6. Bend forward at the waist and place the support
elbow on the support leg below the knee. Figure 3. Crossed Ankle Sitting Position
7. Grasp the rifle butt with the firing hand and
place the rifle butt into the firing shoulder pocket.
8. Grasp the pistol grip with the firing hand.
9. Lower firing elbow to the inside of the firing knee.
10. Lower the head and place the cheek firmly against the stock to allow the aiming
eye to look through the rear sight aperture.
11. Move the support hand to a location under the hand guard, which provides
maximum bone support and stability of the weapon.

Crossed Leg Sitting Position with the Loop Sling Apply the three elements and seven
factors to this position. To assume crossed leg sitting position with loop sling: (see figure
4)
1. Position body at a 45- to 60-degree angle to target.
2. Place the support hand under the hand guard.
3. Cross the support leg over the firing leg.
4. Bend at the knees while breaking the fall with the firing hand.
5. Place the buttocks on the ground as close to the crossed legs
as you comfortably can.
6. Bend forward at the waist while placing the support Figure 4. Crossed Leg Sitting Position
elbow on the support leg into the bend of the knee.
7. Grasp the rifle butt with the firing hand and place the rifle butt into the firing
shoulder pocket.
8. Grasp the pistol grip with the firing hand.
9. Lower firing elbow to the inside of the firing knee.
10. Lower the head and place the cheek firmly against the stock to allow the aiming
eye to look through the rear sight aperture.
11. Move the support hand to a location under the hand guard that provides maximum
bone support and stability of the weapon.
 Open Leg Sitting Position with the Loop Sling
Apply the three elements and seven factors to this position. To assume the open leg
sitting position with the loop sling: (see figure 5)
1. Position the body at approximately a 30-degree angle to
the target.
2. Place the feet approximately shoulder width apart.
3. Place the support hand under the hand guard.
4. Bend at the knees while breaking the fall with the firing
hand.
5. Push backward with the feet to extend the legs and place
the buttocks on the ground. Figure 5. Open Leg Sitting Position
6. Place the support elbow on the inside of the support
knee.
7. Grasp the rifle butt with the firing hand and place the rifle butt into the firing
shoulder pocket.
8. Lower firing elbow to the inside of the firing knee.
9. Lower the head and place the cheek firmly against the stock to allow the aiming
eye to look through the rear sight aperture.
10. Move the support hand to a location under the hand guard which provides
maximum bone support and stability of the weapon.

3. ASSUMING THE KNEELING POSITION

Description – the kneeling position presents a medium silhouette, provides limited body
contact with the ground, forms a stable firing position, and provides mobility for quick
reaction. In the kneeling position a tripod of support is formed by the left foot, right foot,
and right knee, providing a stable foundation for shooting. The kneeling position presents
a higher profile to facilitate a better field of view as compared to the prone and sitting
positions.
Variations – the kneeling position has three variations: high kneeling, medium kneeling,
and low kneeling. Try each variation and choose a position that is natural and provides
balance, stability, and control during firing.
Assuming the Kneeling Position – the kneeling position can be assumed by either
moving forward or dropping back into position, depending on the combat situation. For
example, it may be necessary to drop back into position to avoid crowding cover, or to
avoid covering uncleared terrain.
Moving Forward into Position – to move forward into the kneeling position, step forward
toward the target with your left foot and kneel down on your right knee.

Dropping Back into Position – to drop back into the kneeling position, leave your left
foot in place and step backward with your right foot and kneel down on your right knee.
Assuming the kneeling position with the loop sling
High Kneeling Position (see figure 6)
1. Stand with your feet approximately shoulder width apart and face the target
approximately 45 degrees to the right of the line of fire.
2. Step forward with your left foot toward the target.
3. Place your left hand under the hand guard.
4. Kneel down on your right knee so your right lower leg is approximately parallel
to the gun-target line.
5. Keep your right ankle straight, with the toe of your boot in contact with the
ground and curled under by the weight of your body.
6. Place the right portion of your buttocks on your right heel, making solid contact.
7. Place your left foot forward to a point that allows your shin to be vertically
straight. Your left foot should be flat on the ground since it will be supporting the
majority of your weight.
8. Place the flat part of your upper left arm, just above the elbow, on your left knee
so it is in firm contact with the flat surface formed on top of your bent knee. This
means the point of your left elbow will extend just slightly past the left knee.
9. Lean slightly forward into the sling for support.
10. Grasp the rifle butt with your right hand and place the butt of the rifle into the
pocket of your right shoulder.
11. Grasp the pistol grip with your right hand.
12. Bend your right elbow to provide the least muscular tension possible and lower it
to a natural position.
13. Relax your weight forward and place your cheek firmly against the stock to obtain
a correct stock weld.
14. Move your left hand to a location under the hand guard, which provides
maximum bone support and stability for the weapon.

Figure 6. High Kneeling Position

Medium Kneeling Position – (see Figure 7) This is also
referred to as the bootlace kneeling position. Assume the
medium kneeling position in the same way as the high
kneeling position with the exception of the right foot. The
right ankle is straight and the foot is stretched out with the
bootlaces in contact with the ground.

Figure 7. Medium Kneeling Position

Low Kneeling Position – (see Figure 8) The low kneeling position is most commonly
used when firing from a forward slope. Assume the low kneeling position in the same
way as the high kneeling position with the exception of the placement of your right foot.
Turn your right ankle so the outside of the foot is in contact with the ground and the
buttocks are in contact with the inside of the foot.

Figure 8. Low Kneeling Position

Adjusting natural point of aim Natural point of aim can be achieved in the kneeling
position by making minor body adjustments.
Adjusting Up or Down – if the natural point of aim is above or below the desired aiming
point:
Vary the placement of the stock in the shoulder
1. Moving the stock higher in the shoulder lowers the muzzle of the weapon,
causing the sights to settle lower on the target.
2. Moving the stock lower in the shoulder raises the muzzle of the weapon,
causing the sights to settle higher on the target.
Vary the placement of the left hand in relation to the hand guards
1. Moving the left hand forward on the hand guards lowers the muzzle of the
weapon, causing the sights to settle lower on the target.
2. Moving the left hand back on the hand guards raises the muzzle of the
weapon, causing the sights to settle higher on the target.
Vary the placement of the left elbow on the knee
1. Moving the left elbow forward on the knee lowers the muzzle of the weapon,
causing the sights to settle lower on the target.
2. Moving the left elbow back on the knee raises the muzzle of the weapon,
causing the sights to settle higher on the target.
Adjusting Right or Left – natural point of aim can be adjusted right or left in the
kneeling position by adjusting body alignment in relation to the target.

4. ASSUMING THE STANDING POSITION

Description – the standing position is the quickest position to assume and the easiest to
maneuver from. It allows greater mobility than other positions. The standing position is
often used for immediate combat engagement. The standing position is supported by the
shooter’s legs and feet and provides a small area of contact with the ground. In addition
the body’s center of gravity is high above the ground. Therefore, maintaining balance is
critical in this position. The standing position can be easily assumed and acquired
quickly.

Assuming the Standing Position Using the Parade Sling (see figure 9)
1. Hold the rifle vertical with the barrel pointing upward.
2. Apply a parade sling with sling located on left side of the rifle.
3. Face the target approximately 90 degrees to the
right of the line of fire preferably on a level piece
of ground.
4. Spread your feet apart to a comfortable distance.
Normally, this distance will not exceed the width
of the shoulders. Distribute your weight evenly
over both feet and hips. Your legs should be
straight but your knees should not be locked.
5. Place your left hand under the hand guard in a
position to best support and steady the rifle. Figure 9. Standing Position
The left triceps may rest against the torso but
may not rest or be supported by equipment mounted on the cartridge belt.
6. Grasp the pistol grip with your right hand.
7. Place the toe of the butt stock in your right shoulder.
8. Position your left elbow across your upper torso. Most of the rifle’s weight is
held with your left arm resting naturally against your upper torso and should
be supported by bone structure, not muscle.
9. Hold your right elbow in a natural position.
 10. Bring the rifle sights up to eye level instead of lowering your head to the
sights. Ensure your head is erect. This allows you to look straight through the
sights. Eye relief will normally be increased in the standing position due to
the head being held more erect and depending on placement of the rifle butt.
11. Place the stock firmly against your cheek in the same place each time to
ensure consistency from shot to shot.
Adjusting Natural Point of Aim – natural point of aim can be achieved in the
standing position by making minor body adjustments.
If the natural point of aim is above or below the desired aiming point:

a. Vary the distance between the feet, either placing them wider apart or
closer together.

(1) Moving your feet further apart lowers the muzzle of the weapon,
causing the sights to settle slightly lower on the target. Care should be
taken not to move your feet too far apart because it may affect balance
and bone support.

(2) Moving your feet closer together raises the muzzle of the weapon,
causing the sights to settle higher on the target. Care should be taken
not to move your feet too close together because it may affect balance
and bone support.

b. Vary the placement of the butt stock in the shoulder.

(1) Moving the butt stock higher in the shoulder lowers the muzzle of
the weapon, causing the sights to settle lower on the target.

(2) Moving the butt stock lower in the shoulder raises the muzzle of
the weapon, causing the sights to settle higher on the target.

c. Vary the placement of the "V" formed by the left hand in relation to the
hand guards.

(1) Moving the left hand forward on the hand guards raises the
muzzle of the weapon, causing the sights to settle lower on the target.

(2) Moving the left hand back on the hand guards raises the muzzle
of the weapon, causing the sights to settle higher on the target.
If the natural point of aim is too far to the left or right of the desired aiming point:
The natural point of aim can be adjusted right or left in the standing position by varying
the placement of the feet in relation to the target.

REFERENCES
MCO 3574.2K and MCRP 3-01 Rifle Marksmanship
 UNITED STATES MARINE CORPS
FIELD MEDICAL TRAINING BATTALION
BOX 555243
CAMP PENDLETON, CA 92055-5243

FMST WP4

Combat Marksmanship Fundamentals

TERMINAL LEARNING OBJECTIVE.

1. Given a service rifle, individual field equipment, sling, magazines, ammunition, known
distance and moving targets execute basic combat rifle marksmanship table 2 to strike the
target without any safely violations. (HSS-MCCS-2011)

ENABLING LEARNING OBJECTIVES.

1. Given a service rifle, individual field equipment, sling, magazines, ammunition, moving and
known distance targets, compress the fundamentals of marksmanship to strike the target
without any safely violations. (HSS-MCCS-2011a)

2. Given a service rifle, individual field equipment, sling, magazines, ammunition, and known
distance targets, apply combat marksmanship fundamentals to strike the target without any
safely violations. (HSS-MCCS-2011b)
1. COMPRESSING THE FUNDAMENTALS. While the fundamentals of marksmanship are
applied in all shooting scenarios, the speed of their application is increased in combat to quickly
and effectively engage targets from various locations and distances. In combat, the fundamentals
of marksmanship must be applied in the shortest period of time possible while still achieving
accurate target engagement. There is no room for error or hesitation. The time required is
unique to each individual and his own capabilities.

The ultimate goal in quick engagement is to achieve sight alignment and sight picture
simultaneously, and to fire the shot at the moment sight alignment and sight picture are
acquired.

Executing your shots at a rapid but effective rate can be achieved only through practice and
experience. Eventually, you can become so skilled that you are not even conscious of the
separate steps you take to fire your shot.

You must know your abilities. Fire only as quickly as you are capable of firing accurately.
Do not exceed your shooting skills in an effort to get rounds quickly on target. Chances are
those rounds will be ineffective. In combat, you might not have a second chance. NEVER
fire with the weapon on Burst. There is no way to manage the recoil to maintain accuracy
beyond the first of the three rounds. Using Burst is a waste of ammunition.

2. APPLICATION OF COMBAT MARKSMANSHIP FUNDAMENTALS.

a. Aiming.

Sight Alignment/Sight Picture – in combat, the fundamentals are applied

simultaneously in a compressed time so sight alignment and sight picture are achieved
as the shot is fired. Although the target must be quickly engaged in combat, sight
alignment is still the first priority.

Sight Alignment and Distance to the Target – during combat, the fundamentals of
marksmanship must be applied in a time frame consistent with the size and distance to
the target. As the distance to the target increases, sight alignment becomes more
critical for accurate target engagement.

Long-range Engagements – at greater distances (i.e., over 100 yards), correct sight
alignment and sight picture are essential for accurate target engagement and should not
be compromised.
As the distance to the target increases, the front sight post covers more of the
target. Since you must see the target to engage it, there is a tendency to lower
the tip of the front sight post to acquire the target because it is natural to aim at
what you can see. This will cause your rounds to impact low on the target or
even to miss the target. You must make a conscious effort to aim center mass.
 Short-range Engagements – proper sight alignment is always your goal. However, as
the distance to the target decreases (i.e., 100 yards or less), perfect sight alignment is
not as critical to delivering effective shots on the target.

At very short ranges, a deviation in sight alignment can still produce accurate
results as long as the tip of the front sight post is in the rear sight aperture and
on the target.

A mental adjustment must be made to place the aligned sights on the target,
creating an acceptable sight picture as the trigger is pulled. Time, distance to
the target, and personal ability will dictate what this acceptable sight picture
is. Each individual must define an acceptable sight picture within his own
capability. As you become more proficient, your sight picture will become
more precise to center mass.

Weapons Presentation as an Aid to Achieving Sight Alignment/Sight Picture.

Presentation should help you achieve proper and consistent stock weld and eye relief.
This will aid in getting sight alignment quickly. Do not move your head down to meet
the stock of the weapon. Hold your head as erect as possible to allow the aiming eye
to see directly through the sights.

If the butt of the rifle is placed correctly and stock weld is correct, you should be
looking through the rear sight as your rifle is presented. As the rifle levels, pick up the
front sight and establish sight alignment and sight picture. With practice, this becomes
so automatic that it requires minimal effort to align the sights.

In combat, you will be looking at the target as you are presenting your rifle. As the
rifle settles, shift your focus back to the sights to place the tip of the front sight post on
the target and obtain sight picture. As you become more skilled through practice, sight
alignment and sight picture will appear to come together simultaneously.

‘0-2’ Rear Sight Aperture. The ‘0-2’ rear sight aperture is designed for close range
engagements under 200 meters and at night.

The ‘0-2’ sight has a larger aperture for rapid acquisition of targets because it allows for
a wider field of view. Therefore, the aperture can make aligning the sights more
difficult due to its larger size. However, at very close ranges, sight alignment is not as
critical to accuracy.

Flipping the larger ‘0-2’ aperture up will automatically give a zero at 200 yards when
the elevation knob is set on the 300-yard setting (8/3).
Breath Control. In combat, your breathing and heart rate will often be increased due to
physical exertion (e.g., running) or the stress of battle. Therefore, you must interrupt your
breathing cycle to create a pause (i.e., hold the breath) that is long enough to fire a shot.

Trigger Control. When a combat target appears, it must be engaged as quickly as you can
accurately fire. You must stay within your capabilities and strike a balance between speed
and accuracy to deliver well-aimed shots on target. Firing quickly but inaccurately is
ineffective and will give the enemy time to respond with his own fire. The goal in combat
is uninterrupted trigger control. You must be aggressive in applying uninterrupted trigger
control. Trigger control in combat is achieved by the following:

Maintain a firm grip on the weapon to increase stability and counter the effects of
recoil. Even with a tighter grip, the trigger finger must be able to operate independently
from the gripping hand so the trigger can be moved straight to the rear without
disturbing sight alignment.

As presentation of the weapon begins, the safety is disengaged and the trigger finger
begins moving toward the trigger.

When the trigger finger contacts the trigger, slight pressure may be applied.

As soon as the sight picture is achieved, the trigger is moved to the rear in one
continuous movement, taking care not to disturb sight alignment.

Follow-Through/Recovery. In fundamental marksmanship training, you practiced follow-

through to avoid altering the direction of the round by keeping your rifle as still as possible
until the round exited the barrel. In combat, recovery is important to get the rifle sights back
on the target for another shot. Recovery starts immediately after the round leaves the barrel.
Applying a consistent amount of muscular tension within the position throughout the shot
process will allow you to automatically recover the sights back on target. Applying
recovery techniques ensures the sights are on target as quickly as possible to fire another
shot.

Controlled Pair.

Definition. A controlled pair is two aimed shots fired upon a target in rapid succession;
sight picture is acquired for both shots. The range to the target will determine the rate of
fire, i.e., the closer to the target, the faster the rate of fire. The intent is to fire two shots
quickly so that the second shot is fired before the target can react to the first shot.

Purpose. In combat, it may not always be possible to eliminate a target in a single

engagement, regardless of how well the fundamentals are applied, because two shots
may not cause enough trauma to the body to eliminate the threat. Two aimed shots fired
in rapid succession to the target causes twice the amount of trauma, thereby increasing
the chance of incapacitation of the enemy.
 The size and distance to the target will affect how quickly two shots can be
delivered on the target. The speed at which two shots are fired is also dependent
on the ability of the Marine and how fast he can reacquire his front sight.

The Marine/Sailor must not compromise accuracy for speed; the key to successful
target engagement is to fire only as quickly as the Marine/Sailor can fire
effectively.

Technique. Controlled pair is the preferred technique of delivering two rapidly fired
shots at ranges of greater than fifteen yards.

Present your weapon to the target.

Acquire sight picture, fire a shot, and recover the sights back on target.

Reestablish sight picture and fire a second shot in rapid succession to the first.

Failure to stop drill.

Definition. A failure to stop drill is an assessment of the target following an

engagement in which the target is not incapacitated, followed by a single shot fired to
an alternate aiming area. A failure to stop drill is commonly executed following a pair
fired to the torso in which the target still poses a threat.

A failure drill is used when the torso shots have failed to stop or eliminate the
target. There may be numerous reasons why body shots may not have worked,
for example, body armor, psychological or physiological reactions to a violent
encounter, ballistic failure, drugs, etc.

An alternate aiming area is the head or the pelvic girdle. A shot in the ‘T-box’ of
the head is considered an incapacitating shot. A shot to the pelvic girdle is an
immobilizing shot, which means the target will go down, but it will not
necessarily be eliminated.

Technique

After firing a controlled pair to the torso, assess the situation.

If the target has not been eliminated, establish sight picture on the alternate
aiming area.

Fire a precision shot on the alternate aiming area.

Search and assess.

 Two Threats. Recognizing multiple adversaries and then determining the greater threat
forces you to consider what is the appropriate method of engagement. Because you are
now confronted with more than one life-threatening opponent, the speed that you
engage them with becomes critical.

Acquire sight picture and engage the first target with two shots to the torso. Do
not attempt to assess the first target yet; the immediate priority is to eliminate
both threats.

Immediately transition to the second target utilizing the recoil of the second torso
shot from the first target.

Acquire sight picture and engage with two shots to the torso.

Follow through back to the torso of the second target. Then and only then,
assess both targets.

Box Drill Using a Failure Drill. If two shots to the torso fail to eliminate one or both of
the threats, employ a box drill:

Acquire sight picture on the greatest threat and engage it two shots to the torso.

Immediately transition to the second target utilizing the recoil of the second torso
shot from the first target.

Acquire sight picture and engage with two shots to the torso.

Assess the target. If required, find an alternate aim point, get a clear sight picture
and fire a single shot on the target.

Utilize the recoil of the last shot and index your weapon to an alternate aim point
on the first target. Aim and fire a single shot. Follow through back to the same
alternate aim point and then assess both targets.

REFERENCES
MCO 3574.2K
MCRP 3-01 Rifle Marksmanship
 UNITED STATES MARINE CORPS
FIELD MEDICAL TRAINING BATTALION
BOX 555243
CAMP PENDLETON, CA 92055-5243

FMST WP5

Data Book Analysis

TERMINAL LEARNING OBJECTIVE.

1. Given a service rifle, individual field equipment, sling, magazines, ammunition, and known
distance targets, execute fundamental rifle marksmanship table 1A to strike the target without
any safely violations. (HSS-MCCS-2010)

ENABLING LEARNING OBJECTIVE(S).

1. Without the aid of reference, given a service rifle, individual field equipment, sling,
magazines, ammunition, known distance targets, data book and shot groups, record tri fire data
to establish a true zero in accordance with MCRP 3-01A.(HSS-MCCS-2010h)

2. Without the aid of reference, given a service rifle, individual field equipment, sling,
magazines, ammunition, known distance targets, and a data book, record slow fire data in
accordance with MCRP 3-01A. (HSS-MCCS-2010i)

3. Without the aid of reference, given a service rifle, individual field equipment, sling,
magazines, ammunition, known distance targets, and a data book, record rapid fire data in
accordance with MCRP 3-01A. (HSS-MCCS-2010j)

4. Without the aid of reference, given a service rifle, individual field equipment, sling,
magazines, ammunition, known distance targets, and a data book, compare true zeroes to ensure
data book is maintained in accordance with MCRP 3-01A. (HSS-MCCS-2010k)
Purpose of Data Book Analysis. Data book analysis is a careful shot by shot, group by group,
page by page review of the firing conducted during the day. Sizes, shapes, and locations of shot
groups are examined to provide clues in aiding the coach to confirm and refine a shooter’s true
zeros. Data book analysis provides clues into specific shooting problems a shooter may be
having, allowing the coach to identify weaknesses and correct performance.

1. RECORDING DATA FOR 200-YARD TRI-FIRE

Recording Data Before Firing. Recording information in the data book prior to firing
saves valuable time on the firing line that should be used to prepare for firing. Some information
can be recorded before going to the firing line. In the BEFORE FIRING section of the data book,
record the following:

Initial Sight Setting or Known BZO

a) Initial Sight Setting: Front Elev. Enter the front sight post setting by
recording the number of clicks up () or down () under FRONT ELEV. We will start with a 0
initial sight setting on our front sight post and carry this example throughout instruction.

b) Initial Sight Setting: Rear Elev. Circle the 200-yard setting for the rear
sight elevation knob, 8/3-2, under REAR ELEV.

c) Initial Sight Setting: Wind. Under the WIND column, the R represents
clicks right on the rifle from the initial sight setting and the L represents clicks left on the rifle.
Enter the rear sight windage knob setting by recording the number of clicks right (clockwise) or
left (counterclockwise) under WIND. In our example, we will start with a 0 initial sight setting
for our windage knob setting.

Wind. Prior to firing, check the wind. If wind conditions are present, a sight adjustment
will have to be made prior to firing to ensure shots group at the center of the target.

a) Direction. Determine the direction of the wind and draw an arrow through the
clock indicating the direction the wind is blowing. In our example, there is a wind blowing from
4:30 to 10:30.

b) Value. Look at the clock to determine if the wind is full, half, or no value
wind. Under VALUE, circle FULL or HALF to indicate the wind value. In our example, we will
circle HALF to indicate a half value wind.

c) Speed. Observe the flag on the range and circle the appropriate flag indicating
the wind’s velocity (SPEED). In our example, the wind is blowing at 10 MPH so we will circle
the flag blowing from right to left (4:30 to 10:30) above 10 MPH.
 d) Determine any Windage Adjustment. The chart beneath the flag indicates the
number of clicks on the rear sight windage knob to offset the effects of the wind at 200 yards.
Circle the number of clicks where the wind value and wind speed intersect. In our example, we
will circle 1 because the wind is HALF value, blowing 10 MPH.

Zero. Determine the zero you will place on your rifle to accommodate wind conditions
to begin firing at 200 yards. This ZERO will be the Initial Sight Setting or Known BZO plus the
rear sight windage setting to compensate for the effects of wind.

a) Front Elev and Rear Elev. Elevation adjustments are not affected by wind so
the same settings will be carried over from the Initial Sight Setting or Known BZO column.

b) Wind. Wind will affect the strike of the round right or left on the target.
Therefore, if wind is a factor, the rear sight windage knob must be adjusted to compensate for the
effects of wind.

(1) If the wind is blowing from the right, add the number of clicks circled by
moving the windage knob to the right. For example, our WIND setting from Initial Sight Setting
is 0, and the number of windage clicks circled is 1 for a 10 MPH right wind, so we will move the
windage knob 1 click right for a 1 R windage setting for our ZERO.

(2) Once the windage setting is determined, it is recorded in the WIND column
and the rear sight windage knob is adjusted to this setting to begin firing.

Recording Data During Firing

Fire the First String. Fire the first 3-shot string. While firing the string, make a
mental note of any shots called out of the group. Then immediately check the wind flag to see if
the speed or direction of the wind changed.

After the String is Fired. After firing the string, and when the target is marked, plot
all 3 shots with a dot precisely where they appear on the large target diagram in the block marked
PLOT (1ST 3-SHOT GROUP). In our example, we will plot our shot group outside the right
shoulder.
Sight Setting for 2d String. Make a sight adjustment if required. Triangulate the shot
group by drawing a line to form a triangle connecting all 3 shots. Locate the center of the
triangle. If the shots form a group, make the necessary sight adjustments off of the center of the
triangle. If shots do not form a group (i.e., a group that fits inside the center scoring ring) and do
not contain a poor shot, do not make a sight adjustment.

We will determine the sight adjustment by locating the center of the shot group and
using the grid lines on the “D”-MOD target in the data book. These grid lines represent the
number of inches to bring a shot group center. Looking at the shot group:
 a) Front Elev. Locate the closest horizontal grid line to the center of the plotted shot
group. Follow the line across to the numbered vertical scale to determine the number of inches
of elevation the shot group is off of target center. Calculate the number of clicks on your front
sight post to bring your shot group center. At 200 yards, 1 click adjustment on the front sight
post will move the strike of the round 2 1/2 inches.

(1) To move your shot group up, rotate the post clockwise (in the direction of the
arrow marked UP) or to the right.

(2) To move your shot group down, rotate the post counterclockwise or to the left.

(3) For example, our ZERO front sight post setting was 0, and the center of our 3-
shot group is approximately 7 inches or 3 clicks above target center. So we will rotate our front
sight post 3 clicks counterclockwise for a new setting of 3  and record this under SIGHT
SETTING FOR 2ND STRING.

b) Wind. Locate the closest vertical grid line to the center of the plotted shot group.
Follow the line down to the numbered horizontal scale to determine the number of inches of
windage the shot group is off of target center. Calculate the number of clicks on your rear sight
windage knob to bring your shot group center. At 200 yards, 1 click adjustment on the rear sight
windage knob will move the strike of the round 1 inch.

(1) To move your shot group to the right, rotate the rear sight windage knob
clockwise (in the direction of the arrow).

(2) To move your shot group to the left, rotate the rear sight windage knob
counterclockwise.

(3) For example, our ZERO windage setting was 1 R, and the center of our 3-shot
group was approximately 9 inches or 9 clicks to the right of target center, so we will rotate our
rear sight windage knob 9 clicks counterclockwise for a new windage setting of 8 L and record
this under SIGHT SETTING FOR 2ND STRING.

(4) Repeat steps 1 – 3 and fire the second 3-shot string. We will plot this group
center.

(5) Additional, Helpful Data. After firing a stage, record any data or information
that can be helpful in improving shooting in the future.
 Recording Data After Firing. In the AFTER FIRING section of the data book, record the
following:

Zero. Upon completion of firing, determine the elevation and windage to center the shot
group, if necessary, and record this sight setting in the ZERO block of the AFTER FIRING
section. In our example, because our 2nd 3-shot string was centered on the target, it will not be
necessary to make an additional sight adjustment. Enter the final elevation and windage
adjustment setting in the data book:

a) Front Elev. Under the column FRONT ELEV, record the final elevation setting
made on the front sight post. In our example, we will record 3  because our shot group was
centered vertically on the target.

b) Rear Elev. Under the column REAR ELEV, record 8/3-2.

c) Wind. Under the column WIND, record the final windage setting made on the rear
sight windage knob. In our example, we will record 8 L because our shot group was centered
horizontally on the target.

Wind. Calculate the prevailing wind.

a) Direction. In our example, the wind was fairly steady, blowing from 4:30 to
10:30.

b) Value. We will circle HALF to indicate a half value wind.

c) Speed. In our example, the wind was blowing at 10 MPH so we will circle the flag
blowing from right to left (4:30 to 10:30) above 10 MPH.

d) Determine any Windage Adjustment. We will circle 1 because the wind is HALF
value, blowing 10 MPH.

True Zero. A true zero is the established zero without the windage adjustments to
compensate for the effects of the wind. A true zero is calculated because, the next time you fire,
the wind conditions will probably be different. Therefore, the rear sight windage knob
adjustments made to compensate for a string of fire’s wind will not be the correct setting for
wind conditions during other strings or on other days.

a) Front Elev and Rear Elev. Because elevation adjustments are not affected by wind,
the same settings will be carried over from ZERO: 3  and 8/3-2.

b) Wind. Calculate the windage adjustment to compensate for today’s wind

conditions the same way it was calculated in the BEFORE FIRING information of the data book.
The only exception is now windage adjustments are being removed from the rifle rather than
added to the rifle.
 (1) Because the windage setting is being removed from the rifle, the number of
clicks of windage are subtracted right or left from the ZERO windage setting.

(2) If the wind is blowing from the right, subtract the number of clicks circled by
moving the windage knob to the left. For example, our WIND setting from our ZERO is 8 L, and
the number of windage clicks circled is 1, so we will move the windage knob 1 click left for a 9
L TRUE ZERO windage setting.

2. RECORDING DATA FOR SLOW FIRE STAGES

Recording Data Before Firing

True Zero. Record the sight settings determined from 200-yard tri-fire under TRUE
ZERO in the AFTER FIRING portion of the data book page.

Wind. Prior to firing, check the wind. In our example, the wind is blowing directly
at the shooter’s back so it is of no value. We will not have to fill out the rest of this block.

Zero. Because wind is not a factor, record the same settings as recorded in the
TRUE ZERO block.

Recording Data During Firing. The method for calling and plotting slow fire shots in the
data book is called “the shot behind method.” It allows the Marine to spend less time recording
data and more time firing on the target. This is because all the calling and plotting is done while
the target is in the pits being marked. This information is recorded in the DURING FIRING
portion of the data book page. The proper and most efficient method for recording data during
KD slow fire stages is as follows:

Fire the First Shot. Fire the first shot. Then immediately check the wind flag to see
if the speed or direction of the wind changed.

Call the Shot Accurately. As soon as the shot is fired and the target is pulled into the
pits, record the exact location where the tip of the front sight post was on the target at the exact
instant the shot was fired. Record this on the target provided under number 1 in the block
marked CALL.

Prepare to Fire the Second Shot. As soon as you have recorded the call for the first
shot, prepare to fire the second shot.

Look at Where the First Shot Hit. As the target reappears out of the pits, look where
the first shot hit the target. Remember this location so it can be plotted after firing the second
shot.
Fire the Second Shot. Fire the second shot. Then check the wind flag to see if the
wind changed speed or direction.
 Call the Second Shot and Plot the First Shot. As soon as the second shot is fired and
the target is pulled into the pits, record the call of the second shot. Now plot the precise location
of the first shot by writing the numeral 1 on the large target diagram provided in the block
marked PLOT.

Prepare to Fire the Third Shot. Repeat steps 1 through 6 until three shots have been
fired. Indicate each slow fire shot with the appropriate number (e.g., 1, 2, 3).

Make a Sight Adjustment if Required. Sight adjustments should be made off of a

shot group, not a single shot. Determine if a sight adjustment is necessary off of the first three
shots fired. If the shots form a group (i.e, a group that fits inside the center scoring ring), but are
not where they were called, make the necessary sight adjustment.

Elevation. If an elevation setting change is required, record it under Elevation

under CALL 3.

Wind. If a windage setting change is required, record it under Wind under

CALL 3.

In our example, shots #1, #2, and #3 were on call. No windage or front sight
elevation adjustments will be made.

Prepare to Fire the Fourth Shot. Repeat steps 1 through 8 until the final two shots
have been fired. Indicate each slow fire shot with the appropriate number (e.g., 4, 5).
a) In our example, we will plot shots #4, and #5 on call.

b) No sight adjustments will be made.

Recording Data After Firing

Zero. Since no additional sight adjustments were made, record the sight settings from the
ZERO block under BEFORE FIRING.

Wind. In our example, wind was not a factor.

True Zero. Because wind is not a factor, record the same settings as the ZERO block.

Coaches Analysis Slow Fire.

500 yrd line Slow Fire Example.

3. RECORDING DATA FOR RAPID FIRE STAGES The following procedure should be
used for recording data in the data book for KD rapid fire stages:

Recording Data Before Firing. In the BEFORE FIRING section of the data book, record
the following:

True Zero. The sight setting determined during 200-yard slow fire sitting is entered in
this block.

Front Elev. In our example, we will record a 3  setting on our front sight post.

Rear Elev. Because we are firing from 300 yards, we will enter 8/3 on our rear
sight elevation knob.

Wind. We finished 200-yard slow fire sitting with a 9 L setting on our rear
sight windage knob.

Wind. Prior to firing, check the wind. If wind conditions are present, a sight adjustment
will have to be made prior to firing to ensure shots group at the center of the target.

Direction. In our example, the wind is blowing from 3 o’clock to 9 o’clock.

Value. In our example, we will circle FULL to indicate a full value wind.

Speed. In our example, the wind is blowing at 10 MPH so we will circle the
flag blowing from right to left (3 o’clock to 9 o’clock) above 10 MPH.

Determine any Windage Adjustment. In our example, we will circle 6 because

the wind is FULL value, blowing 10 MPH.
Zero

Front Elev and Rear Elev. Since wind does not affect elevation, these settings
are the same as for TRUE ZERO.

Wind

(1) If the wind is blowing from the right, add the number of clicks circled by
moving the windage knob to the right; if the wind is blowing from the left, move the windage
knob to the left.

(2) For example, our WIND setting from TRUE ZERO is 9 L, and the number
of windage clicks circled is 6 for a 10 MPH right wind, so we will move the windage knob 6
clicks right for a 3 L windage setting for our ZERO.
 Recording Data During Firing. In the DURING FIRING section of the data book, record
the following:

Mentally Call Shots While Firing. While firing the rapid fire string, make a mental note
of any shots called out of the group.

After the String is Fired. After firing the rapid fire string, and when the target is
marked, plot all visible hits with a dot precisely where they appear on the large target diagram in
the block marked PLOT. In our example, we will plot our shot group centered on the target.

Recording Data After Firing. In the AFTER FIRING section of the data book, record the
following:

Zero. In our example, because our shot group was centered on the target and on call, it
will not be necessary to make a sight adjustment.

Front Elev. In our example, we made no elevation change so we will record 3 .

Rear Elev. The rear sight elevation knob is never moved off of 8/3 when firing at
300 yards so we will circle 8/3.

Wind. In our example, we made no windage change so we will record 3 L.

Wind. Calculate the prevailing wind.

Direction. In our example, the wind remained steady, blowing from 3 o’clock to
9 o’clock, so we will draw this direction on the clock.

Value. We will circle FULL to indicate a full value wind.

Speed. In our example, the wind is blowing at 10 MPH so we will circle the flag
blowing from right to left (3 o’clock to 9 o’clock) above 10 MPH.

Determine any Windage Adjustment. We will circle 6 because the wind is FULL
value, blowing 10 MPH.

True Zero

Front Elev and Rear Elev. Since wind does not affect elevation, these settings
are the same as for ZERO.

Wind

Because the windage setting is being removed from the rifle, the number of
clicks of windage are subtracted right or left from the ZERO windage setting. If the wind is
blowing from the right, subtract the number of clicks circled by moving the windage knob to the
left. For example, our WIND setting from our ZERO is 3 L, and the number of windage clicks
circled is 6 for a 10 MPH right wind, so we will move the windage knob 6 clicks left for a 9 L
windage setting for our TRUE ZERO.

4. COMPARING TRUE ZEROS ACROSS DATA BOOK PAGES

Purpose. For a shooter to have consistency in sight settings across positions, he must be
applying the fundamentals correctly and assuming stable firing positions incorporating the seven
factors. By comparing true zeros across positions and days of firing, the coach can determine
two things:

The coach can identify those shooters who need assistance in assuming solid
positions and applying the fundamentals.

For shooters who have a good grasp of the fundamentals and firing positions, the
coach can identify a needed sight adjustment change to center a shot group.

Compare TRUE ZEROs Across Positions. The coach analyzes the data book to look for
consistency in applying the fundamentals across positions and yard lines.

Troubleshoot Elevation Adjustments Between Positions. It is possible that minor

elevation adjustments will be required from position to position; these adjustments should be
made to the rear sight elevation knob (once a BZO has been firmly established). Because the
standing position is the least stable of the positions, the shooter has less stability of hold, which
can cause shots to impact higher on the target. In this case, the shooter may need to come down
1 click of elevation when he shoots standing.

Troubleshoot Windage Adjustments Between Positions. The shooter’s windage

setting for each position should be within 1 or 2 clicks of each other. A shooter with differences
of 4 or more clicks between positions may have problems incorporating the seven factors. The
coach should concentrate on the shooter’s performance during the next day’s firing. The coach
should analyze the shooter’s application of the fundamentals and his position through the seven
factors to determine if there is a problem with a particular position.

Compare TRUE ZEROs Across Days. The shooter should review each shooter’s true
zeros at the end of each day’s firing to identify and correct any shooting weaknesses.

A shooter with a good grasp of the fundamentals and consistent shooting positions will
have minimal sight adjustments (not more than 1-2 clicks of elevation and windage change,
usually in the same direction) from position to position and yard line to yard line. On the other
hand, the shooter with a poor grasp of the fundamentals and a weak shooting position may find
himself with rear sight elevation and windage settings from one side of the scale to the other.
 The shooter should identify and correct a zero change as training progresses. As a
shooter gets more comfortable and used to assuming positions and applying the fundamentals
across a couple of days of training, shooting positions often settle, muscles limber up, etc. A
slight change in zero from Day One to Qualification Day may be normal due to these factors and
should be made to move the shot group to center.

REFERENCES
MCRP 3-01A
 UNITED STATES MARINE CORPS
FIELD MEDICAL TRAINING BATTALION
BOX 555243
CAMP PENDLETON, CA 92055-5243

FMST WP6

Rifle Range Operations

1. RANGE PERSONNEL

Coaches - Coaches are the individuals on the range who instruct marksmanship.
This is their primary responsibility. Coaches are assigned to each firing point to
assist the shooter. If you have a problem, either on or off the firing line, seek
assistance from your coach. If you are in position on the firing line and raise your
hand, a coach will come to your assistance.

Block NCO - The block NCO assists the coach in determining alibis. The block
NCO will assist the coach when a shooter needs extra assistance.

Line SNCO - The line SNCO assists the range safety officer in operation of the
range. He enforces range safety regulations and monitors the conduct of fire.

Tower NCO - The tower NCO assists the line SNCO during range operations.
The tower NCO gives all line and firing commands. The tower NCO is located at
the center of the firing line where he can observe all firing positions. Commands
(to move on or off the firing line, load your rifle, fire your rifle, etc.) are given by
the tower NCO.

Range Safety Officer (RSO) - The RSO is responsible for the safe and efficient
operation of the range. The RSO has the final determination on alibis, should
there be any question.

Pit NCO - The pit NCO is responsible to the RSO for pit operations. He oversees
and controls all pit operations and enforces pit regulations. The pit NCO gives
commands and directs the pit operators during firing operations.
 Pit Operator - During live fire training, shooters are assigned to relays. When
not firing, shooters pull targets in the pits and function as pit operators. The pit
operator raises and lowers the target on command from the pit NCO. He must
work quickly but effectively to pull and mark the targets. Responsibilities of the
pit operator include:

1. Raising and lowering the target on command from the pit NCO.

2. During slow fire, when a shot hole appears on the target, the pit operator
lowers the target and places the appropriate spotter in the shot hole. White
spotters are placed in shot holes in the black areas of the target, and black
spotters are placed in shot holes in the white areas of the target. When the
spotter is moved to the next shot hole, the pit operator pastes the previous shot
hole with the appropriately colored paster.

3. Following a string of rapid fire, the pit operator raises and lowers the target at
the pit NCO's command and places the appropriately colored spotters in the
shot holes. At the pit NCO's command, the pit operator runs the target back to
show the shooter his shot group. He also removes the spotters and covers the
shot holes with the appropriately colored pasters when directed by the pit
NCO.

2. RANGE SAFETY

Safety on the Firing Line

a. Range commands are given by the tower NCO; however, in the event of an
emergency, anyone can call a "Cease Fire." Anyone observing a condition
that makes firing dangerous will immediately call "Cease Fire." Report the
unsafe condition to a coach, the tower NCO, the pit NCO, or the RSO.

b. Weapons will not be loaded except while on the firing line. Shooters will not
load weapons until the command to load is given by the tower NCO. \

c. Never shoot outside the right or left lateral limits of the range as indicated by
markers or pit flags. Never shoot at your target while the scoring disk is in
the air.

d. Weapons are always in Condition 4 except:

1. On the firing line when live fire is in progress.

2. When snapping-in. Snapping-in is allowed only in designated areas.

 e. On the command "Cease Fire," immediately place your weapon on safe, your
finger straight along the receiver, and wait for instructions from the tower.
Muzzles are pointed down range and shooters remain in position until the
"Unload, Show Clear" command is given and the weapons safety inspection
is complete. Upon completion of the weapons safety inspection, place the
weapon in Condition 4 before moving off the firing line.

f. Hearing protection must be worn at all times while on the firing line and the
ready line while firing is in progress.

Safety in the Pits

The pit NCO will enforce safety regulations and constantly remind pit operators
about safety.

a. The noise level must be kept to a minimum so the pit NCO can maintain
communications with the line and the pit operators.

b. Pit operators must move in a fast but safe and orderly manner.

c. Pit operators must not expose any part of their body above the red limiting
line on the overhang above the catwalk.

d. Pit personnel must remain inside the limiting lines in the pits at all times. DO
NOT CROSS ANY RED LINES IN THE PITS WHILE FIRING IS IN
PROGRESS, OR WITHOUT THE CONSENT OF THE PIT NCO!!!!!

e. Pit operators will make no attempt to snap-in, adjust their sights, clean their
weapons, or handle their weapons while working in the pits.

3. SCORING PROCEDURES

Shot Spotters - Shot spotters have a black side and a white side and are used to
mark the location of shot holes on the targets. They are placed on the target black
on white or white on black for easy sighting at a distance.

a. 3" spotters are used for 200- and 300-yard rapid fire stages and
triangulation fire.

b. 5" spotters are used for 200- and 300-yard slow fire stages. If the shot is
in or near the center of the aiming black, the shooter may request the
target be spotted with a 3" spotter instead of the 5" spotter.
Pasters - Pasters are black or white and are used to cover shot holes on the
targets. Once the spotters are removed from the target, the shot holes are covered
with the appropriate colored pasters. For economic purposes, each paster should
be torn in half. Only use half a paster to cover each individual shot hole.

Scoring Disk - The scoring disk is a 10 inch shot spotter that has a red side and a
black side and is used to indicate scoring on a target. This disk is used to indicate
to the shooter on the firing line the point value of the last shot fired. The scoring
disk is always displayed on the target with the red side facing the firing line.

a. To score a 5, place the disk in the lower left corner of the target.

b. To score a 4, place the disk in the lower right corner of the target.

c. To score a 3, place the disk in the upper right corner of the target.

d. To score a 2, place the disk in the upper right corner of the target.

e. To score a miss, place the disk at the 12 o’clock position on the target.

Rapid Fire
Count Shot Holes on Target - A command given by the pit NCO to a specific
target pit to count the number of hits on the target.

Excessive Hits on Target - The pit operator indicates he has more than 10 shots on
his target by signaling the pit NCO or the pit verifier. The target will be held in
the pits until the pit verifier acknowledges the excessive hits. At this time, the pit
verifier will have all shot holes pasted up and the target raised to half-mast with
the value disk placed in the appropriate spot for excessive hits.

Insufficient Hits on Target - The pit operator indicates he has fewer than 10 shots
on his target by signaling the pit NCO or the pit verifier. If a target has 8 hits or
less, the pit verifier will tell the pit operator to score for the number of rounds
impacting the target and run the target all the way up. If the target has 9 hits all in
the “aiming black” with no excessive hits on two targets to either side, the shooter
will be given the option of receiving an alibi or accepting the score for the 9 shots
fired.
4. PIT COMMANDS
Slow Fire
Mark
The shooter on line has shot. Pull the target down and look for the shot hole.

Disregard
Disregard the value of the last shot. The pit operator will line through this value
on his scorecard and initial it.

Re-disk
Re-disk the value of the last shot. The scoring disks must be held up at least three
seconds to allow the shooter enough time to see it.

Put the Target Back in the Air

Raise the target.

Inverted Spotter
Spotters must be white on black and black on white.

Straighten Target
Align the target in the target carriage.

Slow Target
The pit operator has been labeled as a slow target and is told he needs to speed up
his pit service. The pit operator should not take more than 20 seconds to pull and
mark a target. There are times when a slow target cannot be helped, for instance,
when a target goes down in the pits for repairs or verifiers are busy verifying
other targets.

Target in Repair
The target or target carriage has been broken and an attempt to repair it is
underway.

REFERENCES

MCO 3574.2 Marine Corps Combat Marksmanship Programs

 UNITED STATES MARINE CORPS
FIELD MEDICAL TRAINING BATTALION
BOX 555243
CAMP PENDLETON, CA 92055-5243

FMST WP 7

Zero the Rifle Combat Optic (RCO)

TERMINAL LEARNING OBJECTIVE

1. Given a service rifle, Rifle Combat Optic (RCO), sling, individual field equipment,
magazines, cleaning gear, ammunition, and a target, zero a Rifle Combat Optic (RCO) to a
service rifle to achieve Point of Aim (POA) equals Point of Impact (POI) at 100 meters. (HSS-
MCCS-2008)

ENABLING LEARNING OBJECTIVES

1. Without the aid of reference, identify the characteristics of a Rifle Combat Optic (RCO),
within 80% accuracy, and in accordance with TM 11064-OR/1. (HSS-MCCS-2008a)

2. Without the aid of reference, identify the nomenclature of a Rifle Combat Optic (RCO),
within 80% accuracy, and in accordance with TM 11064-OR/1. (HSS-MCCS-2008b)

3. Given a Rifle Combat Optic (RCO), maintain the RCO so that it is clean and serviceable,
in accordance with TM 11064-OR/1. (HSS-MCCS-2008c)

4. Given a service rifle and Rifle Combat Optic (RCO), mount the RCO, in accordance with
TM 11064-OR/1. (HSS-MCCS-2008d)

5. Given a service rifle, Rifle Combat Optic (RCO), sling, individual field equipment,
magazines, cleaning gear, ammunition, and a target, employ the Rifle Combat Optic (RCO) to
achieve Point of Aim (POA)/Point of Impact (POI), in accordance with TM 11064-OR/1. (HSS-
MCCS-2008e)

6. Without the aid of references, given a service rifle, Rifle Combat Optic RCO, sling,
magazines, individual field equipment, target, and data book, perform zeroing procedures to
achieve Point of Aim (POA)/Point of Impact (POI), in accordance with MCRP 3-01A and TM
11064-OR/1. (HSS-MCCS-2008f)
1. CHARACTERISTICS

The TA31RCO-A4 (AN/PVQ-31A) is an Rifle Combat Optic (RCO) designed for the M16A4,
M16A2 weapon systems.

The TA31RCO-M4 (AN/PVQ-31B) is an Rifle Combat Optic (RCO) designed for the M4
Carbine family.

The RCO provides the shooter with quick target acquisition at close combat ranges while
providing enhanced target identification and hit probability out to 800 meters utilizing the Bullet
Drop Compensator (BDC).

Both optics incorporate dual illumination technology using a combination of fiber optics and
self-luminous Tritium. This allows the aiming point to be always illuminated without the use of
batteries. The Tritium illuminates the aiming point in total darkness, and the fiber-optic self-
adjusts reticule brightness during daylight according to ambient light conditions.

The AN/PVQ-31 (Trijicon RCO 4x32) contains radioactive material for low-light illumination.
The radiation source is Hydrogen-3, commonly known as Tritium. Tritium is an odorless,
tasteless, colorless gas that reacts to the human body in the same manner as natural hydrogen.
The human body does not easily retain hydrogen or Tritium as a gas. However, the oxide, HTO,
which is formed by the burning of Tritium, is 10,000 times more hazardous. For this reason
great care should be taken to avoid flame in the presence of the AN/PVQ-31 with a Tritium lamp
which is broken or suspected of leaking. If the Tritium lamp in the AN/PVQ-31 breaks, follow
the procedures covered in maintenance. The AN/PVQ-31 is regulated under an EXEMPT
LICENSE from the United States Nuclear Regulatory Commission (NRC) held by Trijicon, Inc.
Trijicon, Inc prohibits disassembly of the scope.

Specifications

(1) Objective Lens 32mm

(2) Magnification 4 power

(3) Eye Relief 1.5 inches

(4) Field of View 36.7 ft at 100 yards

(5) Length 5.8 inches

(6) Weight 15.3 oz w/ mount

(8) Waterproof 66 feet

(9) Tritium .1 curies (Illuminates the sight. Useful up to 15 years.)

 (10) Range Up to 800m optimal

(11) Disassembly Strictly prohibited, Trijicon personnel only

2. NOMENCLATURE (see figure 1)

(1) Objective Lens

(2) Fiber Optic Light Collector

(3) Adjuster Cap Retention Wire and Crimp Sleeve

(4) Eye Piece

(5) MIL-STD-1913 Rail Adapter (TA51 Mount)

(6) Elevation Adjuster Cap

(7) Windage Adjuster Cap

Figure 1. Rifle Combat Optic

Identification - Location of the UID, NSN and serial number:

(1) On the right side of the RCO is the model number of the AN/PVQ-31. On the left side
is the National Stock Number (NSN). The UID is located above the NSN number and it contains
the Cage Code, Model and Serial Number.

(2) To further assist in identification, the model type will be noted at the bottom of the Field
of View when looking into the optic.

3. MAINTENANCE

It is recommended that the Tritium lamps be checked prior to deployment of the optic and every
6 months or immediately following any incident which might lead to lamp failure such as the
dropping of the AN/PVQ-31 onto a hard surface. To determine that the Tritium lamp is
functioning in either optic, enter a dark room and look through the optic. The Chevron should be
illuminated red. The illumination provided by the Tritium lamp is very faint and will be hard to
see without a dark-adapted eye. Remain in the dark room for approximately 10 minutes to adapt
your eyes to the dark. The reticule is illuminated in low light or complete darkness. If the
reticule does not appear to illuminate in the dark, contact your unit maintainer for confirmation.
When failure is confirmed, double bag the optic, mark the bag “possible contamination
warning,” and contact your unit Radiological Safety Officer (RSO) for further guidance.

The fiber optic light collector may exhibit small bubbles or milky lines. This is acceptable and
will not affect the performance of the AN/PVQ-31.

Trace amounts of silicone, on original models, may become visible at the point where the fiber
optic light collector enters the main housing. This is considered normal and will not affect the
performance of the AN/PVQ-31.

It is recommended that clean water be used to rinse foreign material from the external surfaces
and lenses. If water is unavailable, the AN/PVQ-31 comes with a cleaning tool (Lens Pen) that
does not require the use of water.

(1) Utilize the Lens Pen to remove all foreign material from the unit if fresh water is
unavailable. All foreign material must be removed before continuing.

(2) Remove the cap to expose the Felt Lens Cleaner. Ensure there is no foreign material on
the felt surface. Starting in the center of the lens, press the felt surface of the lens cleaner against
the lens and in a spiral motion, work from the center to the outside edge of the lens. Repeat if
necessary.
DO NOT:

(1) Use any type of solvent on the AN/PVQ-31 (RCO).

(2) Use anything other than water, soap, and/or the Lens Pen to maintain the AN/PVQ-
31(RCO).

(3) DO NOT DISASSEMBLE THE AN/PVQ-31.

4. MOUNTING THE AN/PVQ-31

There are two methods for mounting the optic:

Rail. The optic can be placed in any of the slots on the top of the receiver to allow for eye relief
adjustment. Once the ideal position has been determined, apply forward pressure on the optic
and tighten the knobs using finger pressure only. Then, add another quarter turn utilizing a coin
or bladed screwdriver. Do not tighten beyond this recommended method.

(1) Mark the Thumb Screw location with permanent marker or other means.

Carrying Handle - Align the forward mounting hole with the carrying handle mounting hole.
Once properly aligned, seat the optic into the carrying handle channel ensuring the whole
alignment is retained. Placing the optic into the carrying handle may require substantial
pressure. Use hands only. Do not use impact.

(1) Alignment is crucial, do not force screw set into the threaded hole of the optic. This
may damage the special thread. If resistance is met, check the optic and carrying handle
alignment and try again.

(2) The U shape will fit under the curved surface of the carrying handle. Use maximum
finger pressure only, to tighten the screw.

5. EMPLOYMENT

Bullet Drop Compensator - The entire reticule pattern is a Bullet Drop Compensator, designed
to compensate for the trajectory of the 5.56mm round from 100-800 meters without making
mechanical adjustments to the sight. When zeroed properly, the Point of Aim will equal Point of
Impact at the designated distance.

Ranging Features - The base of the Chevron and the horizontal stadia lines below the Chevron
represent 19” at the indicated range (19” is the average width of a man’s shoulders). Range your
target using the base of the Chevron for 300m and the width of the horizontal stadia lines for
400-800m.
 (1) Beyond 300m, determine which stadia line best fits the target’s shoulders and use that
‘crosshair’ as your Point of Aim. Because the BDC is calibrated for the correct trajectory, your
Point of Aim is your Point of Impact at each distance.

(2) The AN/PVQ-31 reticule includes a horizontal mil-scale graduated in 5 mil increments.
The distance from the center post to the first mil bar is 10 mils left side and 10 mils right side.
Due to the design of the optic, the right side of the mil scale will become blurry. This is normal.
The horizontal mil scale is primarily used for communicating target positions and other
relationships to team members within the small unit.

Scope Shadow

(1) Ensure you have a FULL Field of View (FOV) and proper Sight Alignment (no
shadow). Improper FOV or Sight Alignment (shadow) will result in improper shot placement.
To acquire the proper FOV, move your shooting eye closer or further from the eyepiece until you
have no shadow on the outer most portion of the optic’s view. To acquire proper Sight
Alignment, move your shooting eye vertically and horizontally until no shadow exists. Focus on
the reticule to acquire the necessary precision aim.

6. ZEROING

The AN/PVQ-31 is internally adjustable. The adjuster screws need only position the internal
roof prism. For this reason, a light tap on the adjusters, after an adjustment has been made, will
ensure proper seating of the internal mechanism and allow for an accurate zero. If a light tap to
the adjuster is not applied, the first round fired may be inaccurate. The AN/PVQ-31 is shipped
with a factory-centered position for the M16A4/M4 weapons. Normally this means that only
small adjustments are necessary. DO NOT adjust the optic to the extremes.

25 Meter Grouping Exercise - Firing the AN/PVQ-31 at 25 meters provides a Field Expedient
Zero. To acquire the Field Expedient Zero, use the tip of the 300-meter aiming post to acquire
POA/POI. This can be accomplished on any approved or field expedient target. At 25 meters,
moving the adjuster twelve (12) clicks will move the POI approximately one (1) inch.

(1) This is a field expedient zero only. Conduct zero at 100 meters using that method
immediately after grouping exercise.

Zeroing At 100 Meters - When zeroing the AN/PVQ-31 at 100 meters, the tip of the illuminated
Chevron is used to acquire Point of Aim/Point of Impact. This method ensures maximum
accuracy to 800 meters utilizing the Bullet Drop Compensator. Moving the adjuster three (3)
clicks will move the point of impact one (1) inch.
Triangulation - During the zeroing process, we will conduct triangulation firing. Meaning that
we will be firing five round shot groups and adjusting off the center of the impacts to achieve a
zero for the weapon. This is done by the following steps:

(1) Fire a five round shot group.

(2) Locate the center of your shot group.

(3) The point in the center of the shot group will be used to adjust your shot group to the
center of the target.

Adjusting The Sights - After triangulating your shot group optic adjustments are made in the
following manner:

Vertical Adjustment - Determine the vertical distance from the center of your shot group to
the center of the target by looking at the numbers to the left side of the graph on the RCO Zero
target. This number(s) represents the number of clicks needed to adjust the shot group to the
center of the target. Remove the top adjuster cap to expose the elevation adjuster. Moving the
adjuster in the direction of the arrow (clockwise) will move the strike of the bullet UP as
indicated on the adjuster.

(1) Adjustment increments are 1/3 inch per click at 100 meters. This means that three (3)
clicks are required to move the bullet impact one (1) inch on a target at 100 meters.

(2) This can be accomplished with the use of a coin, bladed screwdriver, or the extractor rim
of the 5.56mm casing. The amount of clicks can be detected through audible and physical
feedback.

(3) DO NOT adjust to the extreme ends of adjustment. Tap the adjuster after each
adjustment to ensure the internal mechanism is fully seated.

(4) The adjuster caps become watertight when screwed onto the scope with finger pressure.
Resistance can be felt when the cap contacts the O-ring seal. One half turn beyond that point is
sufficient.

Horizontal Adjustment - Determine the horizontal distance from the center of your shot
group to the center of the target by looking at the numbers at the bottom of the graph on the RCO
Zero target. This number(s) represents the number of clicks needed to adjust the shot group to
the center of the target. Remove the side adjuster cap to expose the elevation adjuster. Moving
the adjuster in the direction of the arrow (clockwise) will move the strike of the bullet RIGHT as
indicated on the adjuster.

(1) Adjustment increments are 1/3 inch per click at 100 meters. This means that 3 clicks are
required to move the bullet impact one inch on a target at 100 meters.
 (2) This can be accomplished with the use of a coin, bladed screwdriver, or the extractor rim
of the 5.56mm casing. The amount of clicks can be detected through audible and physical
feedback.

(3) DO NOT adjust to the extreme ends of adjustment. Tap the adjuster after each
adjustment to ensure the internal mechanism is fully seated.

REFERENCES:
MCRP 3-01A
TM 11064-OR/1
 UNITED STATES MARINE CORPS
FIELD MEDICAL TRAINING BATTALION
BOX 555243
CAMP PENDLETON, CA 92055-5243

FMST WP 8

Zero the Back Up Iron Sights

TERMINAL LEARNING OBJECTIVE. Given a service rifle, individual field equipment,

sling, magazines, ammunition, and a target BZO the Back Up Iron Sight (BUIS) to a service
rifle to achieve Point of Aim (POA) equal Point of Impact (POI) at 300 meters. (HSS-MCCS-
2009)

ENABLING LEARNING OBJECTIVES.

1. Given a service rifle, individual field equipment, sling, magazines, ammunition, and a target,
apply the elements of zeroing the service rifle to achieve Point of Aim (POA) equal Point of
Impact (POI) at 300 meters and in accordance with MCRP 3-01A. (HSS-MCCS-2009a)

2. Given a service rifle, individual field equipment, sling, magazines, ammunition, and a target,
apply the types of zeroes to the service rifle to achieve Point of Aim (POA)/ Point of Impact
(POI) at 300 meters and in accordance with MCRP 3-01A. (HSS-MCCS-2009b)

3. Given a service rifle, individual field equipment, sling, magazines, ammunition, and a target,
manipulate the sighting system on the service rifle to achieve Point of Aim(POA)/ Point of
Impact (POI) at 300 meters and in accordance with MCRP 3-01A. (HSS-MCCS-2009c)

4. Given a service rifle, individual field equipment, sling, magazines, ammunition, and a target,
manipulate windage and elevation settings on the service rifle to achieve Point of Aim (POA)/
Point of Impact (POI) at 300 meters and in accordance with MCRP 3-01A. (HSS-MCCS-2009d)

5. Given a service rifle, individual field equipment, sling, magazines, ammunition, and a target,
perform a grouping exercise to achieve Point of Aim (POA)/ Point of Impact (POI) at 300
meters.(HSS-MCCS-2009e)
1. ELEMENTS OF ZEROING. To accurately engage targets, the strike of the bullet must
coincide with your point of aim on the target. This must be done while compensating for the
effects of weather and the range to the target. This is accomplished by adjusting the sights on
your rifle to achieve point of aim/point of impact. This process is called zeroing and it is a
critical element of accurate target engagement.

a. Line Of Sight. Line of sight is a straight line beginning at the center of the eye,
passing through the center of the rear sight aperture, and then across the tip of the front sight post
to the exact point of aim on the target.

b. Point Of Aim. The point of aim is the precise point where the tip of the front sight
post is placed on the target while maintaining sight alignment.

c. Centerline Of Bore. Centerline of the bore is an imaginary straight line beginning at

the chamber end of the barrel, proceeding out of the muzzle, and continuing on indefinitely.

d. Trajectory. A bullet does not follow a straight line to the target. Instead, a bullet
travels in a curved path, or arc, which is called the bullet trajectory.

(1) This trajectory occurs because of the earth's gravity, which pulls the bullet down
toward the ground as soon as the bullet leaves the rifle's barrel. The rate of this curvature
increases as the bullet's speed decreases.

(2) To compensate for this effect so that the bullet will impact the target, the muzzle
of the rifle must be elevated by applying elevation to the rifle sights.

(3) The greater the distance to the target, the higher the bullet's trajectory must be to
impact the target. The greater the distance to the target, the greater the elevation that must be
applied to the sights in order to impact the same spot on the target.

e. Range. Range is the known distance from the rifle to the target.

2. TYPES OF ZEROS

a. Zero. A zero is the elevation and windage settings required to place a single shot, or
the center of a shot group, in a predesignated location on a target at a specific range, from a
specific firing position, under specific weather conditions.

b. True Zero. A true zero is the elevation and windage settings required to place a single
shot, or the center of a shot group, in a predesignated location on a target at a specific range, from
a specific firing position, under ideal weather conditions (i.e., no wind).
 c. Battlesight Zero (BZO). A BZO is the elevation and windage settings required to
place a single shot, or the center of a shot group, in the center of a target at 300 yards/meters,
under ideal weather conditions (i.e., no wind). A BZO is the sight settings placed on your rifle for
combat. In combat, your rifle’s BZO setting will enable engagement of point targets from 0 – 300
yards/meters in a no wind condition. 8/3 is the rear sight elevation setting for the M-16A2 BZO.
6/3 is the rear sight elevation knob setting for the M-16A4 & M-4 Carbine.

3. SIGHTING SYSTEM The sighting system of the service rifle/carbine consists of a front
sight post, a rear sight apertures with windage knob, and a rear sight elevation knob. Moving
each of these sights one graduation or notch is referred to as moving one "click" on the sight
system.

a. Front Sight. The front sight consists of a square, rotating sight post with a four-
position, spring-loaded detent. The front sight post is moved up or down when zeroing the rifle
for elevation. Depress the detent and rotate the post to adjust for elevation up or down.

(1) Moving the Front Sight Post. To raise the strike of the bullet, rotate the post
clockwise (in the direction of the arrow marked UP) or to the right. When rotated clockwise, the
front sight post moves down into the front sight housing. It causes the shooter to raise the
weapon’s muzzle weapon to realign the tip of the front sight post in the center of the rear sight
aperture. To lower the strike of the bullet, rotate the post counterclockwise or to the left. When
rotated counterclockwise, the front sight post moves up and out of the front sight housing. It
causes the shooter to lower the weapon’s muzzle to realign the front sight post tip in the rear
sight aperture’s center.

b. Rear Sight. The rear sight consists of two sights. Rear sight elevation knob, and a rear
sight windage knob.

(1) Rear Sight Elevation. The rear sight elevation knob is used to move the strike of
the round up or down, and to adjust for elevation or range to the target. The knob has an index
on the left side which indicates the settings for a specific range to target. To adjust for elevation
or range rotate the knob so the desired setting is aligned with the index on the left side of the
receiver. Each number on the knob represents a distance from the target in 100 yard increments.

(2) Rear Sight Windage. The rear sight windage knob is used to move the strike of
the round left or right. To move the strike of the round right, rotate the knob clockwise (in the
direction of the arrow). To move the strike of the round left, rotate the knob counterclockwise.

(3) Rear Sight Aperture. The rear sight aperture consists of two separate sights.
One aperture is for normal range and the other aperture is for short range limited visibility
engagement (0 to 200 yards with a larger aperture size). The normal range aperture is unmarked
and is used for zeroing and in most firing situations (i.e. KD course). The limited visibility
aperture is the larger aperture. It may be used for engagement of targets closer than 200 yards,
and target engagement during limited visibility, or when a greater field of view is desired. This
large aperture is marked ‘0-2’ and is used only in conjunction with your established BZO.
4. WINDAGE AND ELEVATION RULES

a. Definition. The windage and elevation rules define how far the strike of the bullet will
move on the target for each click of the front/rear sight elevation or rear sight windage knob for
each 100 yards of range to the target. This is based off of its predetermined minute of angle set
by the manufacture.

b. Principles. The easiest way to understand the windage and elevation rules is to first
analyze where the bullet struck the target. If an adjustment needs to be made up or down to hit
the center of the target, adjust the elevation on your rifle. If an adjustment needs to be made right
or left to hit the center of the target, adjust the windage. As a coach you need to understand not
just when to help your shooters with their adjustments, but also how much of an adjustment they
need to make.

(1) Front Sight Elevation Rule. This rule applies to elevation adjustments using the
front sight post. These adjustments are represented at 100 yards.

(a) M-16 A2 & M-16 A4. One click of front

sight elevation adjustment will move the strike of the bullet on the target approximately 1 ¼
inches.

(b) M4 Carbine. One click of front sight elevation adjustment will move the
strike of the bullet on the target approximately 2 inches.

(2) Rear Sight Elevation Rule. This rule applies to elevation adjustments using the
rear sight. These adjustments are represented at 100 yards.

(a) M-16 A2. One click of rear sight elevation adjustment will move the
strike of the bullet on the target approximately 1 inch.

(b) M-16 A4 & M4 Carbine. One click of rear sight elevation adjustment will
move the strike of the bullet on the target approximately ½ an inch.

(3) Rear Sight Windage Rule. This rule applies to windage adjustments using the
rear sight. These adjustments are represented at 100 yards.

(a) M-16 A2 & M-16 A4. One click of rear sight windage adjustment will
move the strike of the bullet on the target approximately ½ an inch.

(b) M4 Carbine. One click of rear sight windage adjustment will move the
strike of the bullet on the target approximately ¾ an inch.
5. GROUPING EXERCISE

a. Zeroing at 300 yards. When a rifle is zeroed at 300 yards, the bullet will cross the line
of sight twice. The bullet will cross the line of sight first on its upward path of the trajectory at
36 yards, and again farther down range at 300 yards (point of aim/point of impact). When the
bullet’s trajectory intersects the line of sight at 36 yards and 300 yards, the rifle is considered to
be zeroed to hit a target at the exact point of aim at both of these ranges. That is why there is an
alternate method for zeroing the rifle at 36 yards when a 300-yard range is not available.

(1) Establishing Initial Sight Settings. To begin the zeroing process the rifle sights
are placed on a known BZO previously established or on initial sight settings.

(a) Front Sight Post. To set the front sight post to initial sight setting, depress
the front sight detent and rotate the front sight post until the base of the front sight post is flush
with the front sight housing.

(b) Rear Sight Elevation Knob.

1 M-16 A2. Rotate the rear sight elevation knob counterclockwise

until the rear sight assembly is bottomed out. Rotate the rear sight elevation knob clockwise
until the number 8/3 aligns with the index mark located on the left side of the upper receiver.

2 M-16 A4 & M4 Carbine. Rotate the rear sight elevation knob

counterclockwise until the rear sight assembly is bottomed out. Rotate the rear sight elevation
knob clockwise until the number 6/3 aligns with the index mark located on the left side of the
upper receiver.

(b) Windage Knob. To set the windage knob to initial sight setting, rotate the
windage knob until the index line located on the top of the large rear sight aperture aligns with
the centerline on the windage index scale located on the moveable base of the rear sight
assembly.

(2) Steps to Zeroing the Rifle.

(a) Fire 5 Round Shot Group. Fire 5 shots at the center dog target from the
prone position in a time limit of 60 seconds.

(b) Mark the Target. The target will be lowered to the pits and marked
indicating your 5-shot group.

(c) Plot the Group. When the target is raised from the pits, plot the 5-shot
group in the data book.

(d) Circle the Shot Group. Circle the 5 round shot group. Locate the center
of the group and make the necessary elevation and windage adjustments.
 (e) Fire 2nd 5 Shot Group. When the target appears fire a well-aimed 5-shot
group in a time limit of 60 seconds.

(f) Mark the Target. The target will be lowered to the pits and marked
indicating your 5-shot group.

(g) Plot the Group. When the target is raised from the pits, plot the 5-shot
group in the data book.

(h) Circle the Shot Group. Circle the 5 round shot group. Locate the center
of the group and make the necessary elevation and windage adjustments.

(i) Fire 3d 5 Shot Group. When the target appears fire a well-aimed 5-shot
group in a time limit of one minute. This last group is to confirm the sight adjustments that were
made.

(3) Final Steps. Once you confirm adjustments and sight settings, there needs to be
an adjustment determined for the wind (if present) and taken off the sight settings. This setting
becomes the zero setting for the rifle, and must be recorded in the data book.

REFERENCES
MCRP 3-01A
APPENDIX
 ACRONYMS AND GLOSSARY

AA BN Assault Amphibious Battalion

AAV Assault Amphibian Vehicle

ABCs Airway, Breathing, Circulation

ACE Aviation Combat Element

Acidosis A disturbance in the acid base balance of the body in

which there is an accumulation of acid; as in diabetic
acidosis or renal disease

ACLS Advanced Cardiac Life Support

Acute Rapid onset, opposite of chronic

ADAL Authorized Dental Allowance List

Aerobic Requiring oxygen

Afterload The pressure in which the heart must pump blood out
with each beat

Alkalosis Acid-base disturbance in which there is an

accumulation of basic substances. pH is elevated

Alveoli Small sacs extended from the lungs where 02 & C02
exchange takes place

AMAL Authorized Medical Allowance List

A.M.P.L.E A mnemonic used in taking a history meaning allergies,

medications, past illnesses, last meal, & events
preceding the injury

Anaerobic Absence of oxygen

Analgesics Pain medications

Anorexia Loss of appetite

Antecubital In front of elbow

Anteroposterior Front to back

Anticoagulant A substance which prevents blood clotting

Antiseptic Inhibitor of bacterial growth or germ killing cleanser

Anuria No urine output

Apathy Without emotion, indifference or sluggish

Apex The top, the end or the tip of a structure such as the
apex of the heart

Apnea Not breathing

Arrhythmia Abnormal rhythm of the heart sometimes resulting in

inadequate blood flow

Aseptically Free from sepsis or infection

ASMRO Armed Services Medical Regulating Office

ASP Ammunition Supply Point

Asphyxia An increase in carbon dioxide and or lack of oxygen in

the blood

Aspirate To remove or withdraw by suction

Ataxia Muscular incoordination

ATLS Advanced Trauma Life Support

Auscultate Listening for sounds in body cavities

A.V.P.U. A mnemonic meaning the patient is Alert, responds to

Verbal stimuli by following simple commands i.e.,
patient can’t talk but responds when you give a
command to wiggle their fingers, Painful i.e., sternum
chest rub, or totally Unresponsive

Avulsion To pull; a wound caused by tearing away

B

BAMCIS Begin the planning, Arrange recon, Make recon,

Complete the plan, Issue the order and Supervise.
5 troop leading steps

BAS Battalion Aid Station

BDE Brigade

Bilateral Pertaining to two sides of the body

Blanch To turn white or remove color

Blunt Trauma Trauma in which a force does not penetrate or break

through the skin

BLT Battalion Landing Team

BMU Beach Master Unit

BN Battalion

Bolus A mass injection of medication given rapidly

Bradycardia Decreased heart rate, usually less then 60 beats per

minute

Bradypnea Decreased respirations, usually less then 8 breathes per

minute

BSA Body Surface Area

Btry Artillery Battery

BUMED Bureau of Medicine and Surgery

Cardiac Tamponade A collection of blood in the sac surrounding the heart

interfering with efficient function of the heart

Cardiogenic Originating in the heart

CASEVAC Casualty Evacuation

CASREP Casualty Report

CAT Combat Action Tourniquet

CATF Commander Amphibious Task Force

CAX Combined Arms Exercise

CE Command Element

CSF Cerebral Spinal Fluid

CEB Combat Engineer Battalion

Cerebellum Responsible for coordinated body actions & movements

such as, running and standing on your head. Plays an
essential role in posture, balance & coordination. Also
known as the “little brain”

Cerebral spinal fluid Protects and cushions the brain & spinal cord. CSF also
cleanses the brain and helps to fight infection

Cerebrum The largest part of the brain, which controls

consciousness, memory, sensations, emotions &
voluntary movements. Also known as “Gray Matter”

CG Commanding General

CHF Congestive Heart Failure

Chilblains Mild cold injury, prelude to frost bite

CINCNAVEUR Commander in Chief, Naval Forces Europe

CINCPAC Commander in Chief, Pacific

CINCPACFLT Commander in Chief, U.S Pacific Fleet

CINCSOC Commander in Chief, Special Operations Command

CINCUSNAVEUR Commander in Chief, U.S Naval Forces Europe

CJTF Commander, Joint Task Force

CLF Commander, Landing Force

COMM Communications

Comminuted Broken into multiple pieces

COMNAVSURFLANT Commander, Naval Surface Force, Atlantic

COMNAVSURFPAC Commander, Naval Surface Force, Pacific

Conduction The transfer of sound waves, heat, nervous impulses, or

electricity through direct contact

Contraindication Any condition that renders a particular treatment or

medication improper

Contralateral Opposite side

Contusion Injury of tissue without breaking the skin

Convection Transmission of heat in liquids or gases by a circulation

carried on by the heated particles

Convulsion Involuntary muscle movement

CP Command Post

Crepitation A crackling or grating sound

Cricoid Lowermost cartilage of the larynx

Cricothyroidotomy An incision through the cricoid and Thyroid cartilage to

make an alternative airway

Crystalloid A substance capable of forming crystals such as sodium

chloride

CSSD Combat Service Support Detachment

Cutaneous Referring to the skin

Cyanosis Bluish coloration of the skin resulting from lack of

oxygen

D
D5W An intravenous solution that consists of 5% dextrose in
water, used for fluid replacement and caloric
supplementation in patients who cannot maintain
adequate oral intake. D5W is not the first fluid of
choice to treat dehydration in the field

D50W An intravenous solution of 50% dextrose in water used

for adults with hypoglycemic (low blood sugar)
emergencies, usually given as a 50 ml bolus

D-Day The unnamed day on which a particular operation

commences or is to commence

Debridement The removal of foreign objects or dead tissue in a

wound

Demarcated Outlines, clearly defines

Diarrhea Frequent passage of watery bowel movements

Diastolic Blood Pressure The pressure remaining in the blood vessels while the
heart is at rest

Dilated Open or enlarged

Displacement The movement of supporting weapons from one firing

position to another

Dissipation Dispersion, break up

Distal Far away, opposite of proximal or close

Diuretic A substance which increases the excretion of urine

DIV Division

Dorsum The upper portion of an appendage or part

Draw-D Used in a defensive position. Meaning Defend,

Reinforce, Attack, & withdraw

DSO Division Surgeons Office

DTG Date, Time, Group

Dyspnea Difficulty breathing

Dysuria Difficult or painful urination

EBL Estimated Blood Loss

Ecchymosis Bruising, hemorrhagic spot often due to blunt trauma

Echelon formation One of the four types of fire team formations, similar to
skirmisher right and left except that one flank is angled
to the rear

Edema Accumulation of fluid

Emphysema Distension of tissue due to presence of gas

Enteric Within or pertaining to the intestines

Envelopment An attack made on one or both of the enemy’s flanks or

rear, usually accompanied by an attack to his front

EOD Explosive Ordinance Disposal

Erythema Redness of the skin caused by grouping capillaries

ESB Engineering Support Battalion

Eschar Mass dead tissue mostly associated with burns

Etiologic Cause or origin

Exsanguination Loss of blood – implying total blood loss

Exudate Excretion of puss, fluid or matter through vessel walls

into adjoining tissue

Fascia Connective Tissue

FEBA Forward Edge of the Battle Area

FEX Field Exercise

Fistula An abnormal tube-like passage from a normal cavity or
tube to a free surface or to another cavity

Flaccid Relaxed or absent muscle tone

Flail Excessive mobility such as an unstable chest wall

fracture

Flank Area on the side between the ribs and pelvic bone
(ileum)

Fleet Marine Force (FMF) A balanced force of combined arms comprising of land,
air, and sea service elements of the U.S Marine Corps

FO Forward Observer

FDA Food and Drug Administration

FOD Foreign Object Damage

FPM Field Protective Mask

Frag Fragmentation

FREQ Frequency

GAS Group Aid Station

Gavage Force feeding into the stomach with a tube

GCE Ground Combat Element

Gingivitis Inflammation of the gingival tissue may be surrounding

one tooth or groups of teeth

Glottis The sound producing apparatus of the larynx including

vocal cords and is protected by the epiglottis

GMO General Medical Officer

GP General Purpose

Grimace A painful expression

GSW Gunshot Wound

Harassing Fire Fire designed to disturb the enemy troops to curtail

movement and promote threat of losses to lower morale

HE High Explosive

Hematoma A tumor or swelling containing blood

Hematuria Discharge of blood in urine

Hemodynamic Refers to circulation

Hemoptysis Refers to coughing up blood

Hemorrhage Bleeding from a ruptured vessel either internal or

external

Hemothorax Blood in the chest cavity

Hespan A hypertonic plasma substitute

H-Hour The specific hour on D-day that an operation

commences

Hyper Excessive or elevated

Hyperemic An excess of blood in a part; engorgement

Hyperresonance Increased resonance when an area is percussed

Hyperventilation An increase in the rate and depth of normal respirations.

Responsible for increased oxygen levels & decreased
carbon dioxide levels

Hypo Decrease

Hypoesthesia Decreased sensation or feeling

Hyponatremia Low sodium level in the blood

Hypothalamus Portion of the brain that regulates the body’s core
temperature

Hypovolemic Too low volume

Hypoxia An insufficient concentration of oxygen in the tissue in

spite of an adequate blood supply

IFAK Individual First Aid Kit

IM Intramuscular

Immersion The submersion of a person in water

Incontinence The inability to control excretory functions

Infusion Therapeutic introduction of fluid into a vein

Interstitial Spaces The space between organs or tissue

Intra Within

Intubation The insertion of a tube into a hollow space, i.e. larynx

Ischemic Local & temporary decreased circulation

Involuntary muscle Also known as smooth muscle, produces slow long-

term contractions of which the individual is unaware.
Smooth muscle occurs in hollow organs, such as the
stomach, intestine, blood vessels, and bladder.

Ionizing Radiation Radiations that has sufficient energy to remove

electrons from atoms

ITA Initial Trauma Assessment

J

JJDIDTIEBUCKLE Acronym for the fourteen leadership traits: Justice,

Judgment, Dependability, Initiative, Decisiveness, Tact,
Integrity, Enthusiasm, Bearing, Unselfishness, Courage,
Knowledge, Loyalty, Endurance

JVD Jugular Vein Distention

Kilogram 2.2 lbs; metric weight

KOCOA Key Terrain, Observation and Fields of Fire, Cover &

Concealment, Obstacles, and Avenues of Approach

KVO Keep Vein Open. Used when administering an I.V

LAR BN Light Armored Reconnaissance Battalion

Larynx The enlarged upper end of the trachea; the organ of

voice or the “voice box”

Latent Quite or not active

Lavage Irrigation of an organ or cavity

LCE Logistics Combat Element

LOC Level of Consciousness

Lysis Destruction or decomposition, as of a chemical or cell

Lucent Able to readily pass through, the opposite of opaque

Lucid Conscious

MACG Marine Air Control Group

MAGTF Marine Air Ground Task Force

MAG Marine Air Group

Malposition In the wrong place or alignment

Malaise Feeling of weakness or uneasiness

Malposition Poor positioning

Mandible Lower jawbone

MARDIV Marine Division

MARFOR Marine Forces

MARFORLANT Marine Forces-Atlantic

MARFORPAC Marine Forces-Pacific

MARFORORES Marine Corps Reserve

Mastoid Process of temporal bone behind the ear

MAW Marine Aircraft Wing

Maxilla The upper jaw bone

MCO Marine Corps Order

MCSF Marine Corps Security Forces

MEB Marine Expeditionary Brigade

Mediastinum Midline structure that divides the thoracic cavity into

two portions. It includes the trachea, esophagus,
thymus, heart and great vessels. The lungs are located
on either side of this midline structure

Medulla The most inferior part of the “brain stem” which

contains the center that regulates respiratory rate, blood
pressure, heart rate, breathing, swallowing and
vomiting

MEF Marine Expeditionary Force

Messentery A peritoneal fold covering the greater part of the small
intestine and connecting the intestine to the posterior
abdominal wall

METTAG Medical Emergency Triage Tag (NATO Card

METTAG 137), provides a quick reliable method of
assessing casualties and assigning them with an
appropriate triage/evacuation priority

Metatarsal Bone located on the top of the foot

Midbrain One of the four parts of the brain stem. The midbrain
regulates muscle tone.

MEU Marine Expeditionary Unit

MLG Marine Logistics Group

MMART Mobile Medical Augmentation Readiness Team

MOI Mechanism Of Injury

MOLLE Modular Lightweight Load-Carrying Equipment

MOPP Mission-Oriented Protective Posture- MOPP is a

flexible system of protection against chemical agents

Morbidity The rate at which an illness or abnormality occurs in a

particular area or within a population

Mortality Death rate or condition of being deceased

Myocardium Heart muscle

MWHS Marine Wing Headquarters Squadron

MWSG Marine Wing Support Group

NCA National Command Authorities

NCO Non-Commissioned Officer

NBC Nuclear, Biological, Chemical

Necrosis Death to areas of tissue or bone surrounded by healthy
tissue

Neuralgia Nerve pain

Neuritis Nerve inflammation

Neurogenic Originating in nerve tissue

Neuropathy Any disease of the nerves

NPA Nasopharyngeal Airway

NPO Nothing by mouth

Oblique At an angle, slanted or diagonal

Occlusive dressing A dressing that closes or seals a wound so that it is air

tight

OP Observation Post

OPA Oropharyngeal Airway

Open Fracture Fracture in which the bone has pierced through the skin

Oropharynx The portion of the pharynx between the soft palate and
the epiglottis

Orthostatic Refers to an erect position

OSMEAC Acronym for the five-paragraph order format:

Orientation, Situation, Mission, Execution,
Administration and Logistics, and Command and
Signal

Pallor Paleness of the skin

Palpate To examine by touching

Paradoxical Movement Commonly seen in flail chest when one section of the
ribs goes in the opposite direction of the majority with
respirations

Paresis Partial or incomplete paralysis

Paresthesia Abnormal sensation such as numbness or tingling

Parietal Of or pertaining to the outer wall of a cavity or organ

Patency Refers to being open

Patrol A detachment of ground, sea or air forces sent by a

larger unit for the purpose of gathering information or
carrying out a destructive, harassing, mopping-up or
security mission

Percussion Examination by tapping

Percutaneous Through the skin

Perfusion Supplying an organ or tissue with nutrients by fluid

Periapical Abscess Results from infection of pulpal tissue causing pulp to

become necrotic

Pericardium The membrane sac surrounding the heart

Perineum The external region between the anus and the scrotum
(male) or vaginal opening (female)

Peritoneum The membrane lining the abdominal cavity and

covering the abdominal organs

PERRLA Pupils Equal, Round, Reactive to Light,

Accommodation

Phlebitis Inflammation of a vein or veins

Pleural A delicate serous membrane enclosing the lung

PMS Pulse Motor Sensation

Pneumothorax A collection of air or gas in the pleural space causing

one or both lungs to collapse
Pons One of the four parts of the brain stem, the sleep center
and respiratory center

Preload The volume & pressure of blood coming into the heart

Prolapse Falling or dropping down

Proximal Close or near, opposite of distal

Pulmonary Edema Effusion of serous fluid around the lungs

Pulse Pressure The difference between the systolic & diastolic blood
pressure

Purpura A small hemorrhage in the skin, mucous membrane, or

serosal surface, which may be caused by various
factors, including blood disorders, vascular
abnormalities and trauma

Purulent Drainage that contains pus

Pyrotechnics Devices used to transmit command or information, such

as flares and smoke grenades

RAD Radiation Absorbed Dosage, the method for measuring

radiation exposure dosage

RAS Regimental Aid Station

Resilient Bounce or spring back, durable

Reticular Activating System One of the four parts of the brain stem, the reticular
activating system is scattered throughout the brain stem
and is important in arousing and maintaining
consciousness

R.I.C.E. Acronym for treatment consisting of Rest, Ice,

Compression, and Elevation

Rupture To break apart

RDD Radioactive Dispersive Device

Radioactivity The property possessed by some elements or isotopes of

spontaneously emitting energetic particles such as alpha
or beta particles, often accompanied by gamma rays, by
the disintegration of their atomic nuclei

RT Receiver-Transmitter, the common item of all

SINCGARS, the actual SINCGARS radio itself

RTA Rapid Trauma Assessment

Sagittal Plane A plane dividing the body into right

And left sides

SALUTE Used as an intelligence report when calling in an enemy

sighting. Meaning Size, Activity, Location, Unit, Time,
and Equipment

S.A.M.P.L.E Acronym used for obtaining medical history during

emergency care, consist of: Signs and symptoms,
Allergies, Medications, Pertinent past history, Last oral
intake, and Events leading to problem

Saphenous veins Two veins, one short, one long, in lower

leg, which join near the knee

Scapula Shoulder blade

Sector of Fire An area, limited by boundaries, assigned to a unit

or to a weapon to cover by fire

Septicemia Widespread destruction of tissues due to absorption of

disease-causing bacteria or their toxins from the
bloodstream

Shock An abnormality of the circulatory system that

Results in inadequate organ perfusion

SINCGARS Single Channel Ground & Airborne Radio Systems

Skin Wheals Localized edema of the body surface

Spicule Sharp point

Splenomegaly Enlargement of the spleen

SPMAGTF Special Purpose Marine Air Ground Task Force

Stenosis A constriction or narrowing

Sternomastoid Muscle from sternum to clavicle to mastoid bone

Stridor A harsh or shrill repertory sound audible from a

distance

Stupor A state of dullness; mind and senses are slowed

Stylet A slender wire used for guiding or clearing a tube

Or needle

Subclavian A large vein below the collar bone (clavicle)

Subcostal Below the rib

Subcutaneous Under the layers of the skin

Systemic Refers to the whole body as opposed to a part

Systolic Blood Pressure The force of blood against blood vessels produced by
ventricular contraction.

S1 Personnel Office (Regimental / Battalion level)

S2 Intelligence section (Regimental / Battalion level)

S3 Training and Operations (Regimental / Battalion level)

S4 Supply and Logistics (Regimental / Battalion level)

S6 Communications

Tachycardia Increased heart rate, usually greater then 100 beats per
minute

Tachypnea Increased respirations, usually more then 25 breaths per

minute
TBSA Total Body Surface Area

TCCC Tactical Combat Casualty Care (broken into 3 phases:

care under fire, tactical field care, and combat casualty
evacuation care)

T/E Table of Equipment

T/O Table of Organization

Thoracentesis Surgical perforation of the thorax

Tibia Small bone of lower leg

Thorax Also known as the Thoracic cage is the part of the body
between the base of the neck and the diaphragm.
Divided into 3 parts; the manubrium, the body & the
xiphoid process

Thrombosis Formation of a blood clot

Tibia Large bone in lower leg

Trachea Tube-like structure from larynx to the bronchial tubes,
conveys air to the lungs

Translucent Clear, transparent

Triage To group or treat by order of severity

Turbidity Cloudy or the inability to see through something such

as a liquid

Turgor The state of normal swelling and tension in living cells

Ulceration The formation of a crater like lesion on the skin or

mucus membranes

Unilateral Refers to one side

Ureter One of a pair of tubes that carry urine from the kidney
to the bladder
V

Vee Formation Squad Vee, an inverted squad wedge, facilitates

movement into a squad line and provides excellent
firepower to the front and to the flank

VEE Venezuelan Equine Encephalitis – An acute viral

disease transmitted from horsed to humans by a variety
of mosquito vectors, has potential for use as a
biological warfare agent

Vein A vessel carrying blood to the heart.

Ventricle A small cavity

Vertigo A sensation of faintness or inability to maintain balance

in a standing or seated position

VHF Viral Hemorrhagic Fever, caused by several viruses

typically found in animals and infecting humans, some
types cause a severe, usually fatal infection
characterized by fever, widespread bleeding, and organ
failure (has potential for use as a biological warfare
agent)

VHF (radio) Very High Frequency (SINCGARS are VHF-FM radios

that operate in the VHF range from 30.000 to 87.975
MHz)

Voluntary muscle Also called striated muscle or skeletal muscle tissue, it

is attached to the skeleton and responsible for the
voluntary movement of bones

Wedge formation A diamond shaped fire team formation which

provides all around security and flexibility

WBGT Wet Bulb Globe Temperature

 12 CRANIAL NERVES

I OLFACTORY Smell

II OPTIC Vision

III OCULOMOTOR Eyelid & eyeball movement, pupil constriction

IV TROCHLEAR Downward & lateral eye movements

V TRIGEMINAL Sensations of face, scalp & teeth also chewing

movements

VI ABDUCENS Turns eyes outward

VII FACIAL Facial expressions, sense of taste

VIII ACOUSTIC Hearing & sense of balance

IX GLOSSOPHARYNGEAL Sensation of throat, taste, swallowing movements

and secretions of saliva.

X VAGUS Sensations of the throat, larynx, thoracic &

abdominal organs. (gag reflex)

XI ACCESSORY Shoulder movements & movements of the head

XII HYPOGLOSSAL Tongue movements

COMMON MEDICAL PREFIXES

A, an- Without, not, lack of, or absence of

Anti- Against

Brady- Slow

Cardi- Heart

Cephalo- Head

Cerebr- Cerebrum
Chol- Bile

Contra- Against, opposed of

Cyst- Bladder

Colo- Colon

Derm- Skin

Dys- Difficult or painful

Endo- Inner, inside

Enter- Intestine

Epi- upon, outside

Gastr or Gastro- Stomach

Genito- Reproduction organs

Glyco- Sugar

Gyno or GYN- Female

Hem or Hemo- Blood

Hemi- Half

Hepat or Hepato- Liver

Hydro- Water

Hyper- Above, high

Hypo- Below

Inter- Between

Leuko- White

Macro- Large

Mal- Bad or abnormal

Micro- Small

Mye- Muscle

Naso- Nasal

Nephro- Kidney

Oligo- Few or small

Opthalm- Eye

Oro- Mouth

Oste- Bone

Oto- Ear

Para- Beside

Per- Through

Peri- Around

Pharyng- Throat

Phleb- Vein

Poly- Many

Pneumo- Relating to the lung, breath or air

Post- After

Pre- Before

Procto- Anus

Pulmo- Lung

Pyel- Pelvis

Retro- Backward, behind

Rhino- Nose
Semi- Half

Sub- Under

Supra or Super- Above

Tachy- Rapid, swift

Thorac- Chest or thorax

Thromb- Clot or lump

Topo- Surface

Trans- Across

Uro- Urine

Vaso- Vessels

COMMON MEDICAL SUFFIXES

-algia Pain

-astenia Weakness

-cardia Heart

-centesis Puncturing

-cyte Cell

-ectomy Surgical removal of an organ or part

-emia Blood

-emesis Vomiting

-esthesia Perceive, feel

-exia Appetite

-genic Causing

-graph or gram Write or record

-iasis A condition or process

-itis Inflammation or swelling

-megally Enlarge

-meter Measure

-ology The study of

-oma Tumor

-osis Disease, condition or abnormal increase

-ostio Bone

-ostomy or stomy Artificial opening

-paresis Weakness

-pathy Disease

-phasia Speech

-phobia Fear

-plasty Surgical repair

-plegia Paralysis or stroke

-pnea Breathing

-ptosis Falling

-rythmia Rhythm

-rrhagia Bursting forth

-scop To look at or observe

-tomy Surgical incision

-uria Urine
Movements
Movements
Planes of the Body