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Community Emergency Response Team

Field Manual 001

Tactical First Aid

First Edition - May 4, 2016

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Introduction ……………………………………………………………………………………..3

Secure and Evaluate a Casualty …………………………………………………………………4

Treating Injuries By Type ……………………………………………………………………….7

Breathing ………………………………………………………………………………..7

Treating Shock …………………………………………………………………………11

Bleeding ………………………………………………………………………………..13

Burns …………………………………………………………………………………..16

Evacuate a Casualty …………………………………………………………………………..19

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Introduction

Tactical first aid focuses on providing immediate, life-saving aid in an environment

where help from professional medical technicians is unavailable. The objective of this field

manual is to teach the responder:

1. How to secure a casualty from sustaining further injury,

2. How to evaluate a casualty,

3. How to treat wounds by type,

4. How to care for shock, and

5. How to evacuate a casualty.

The primary objective of the Community Emergency Response Team is to prepare for

any threat posed to the community and to respond appropriately. However, tactical first aid

stands on shaky legal grounds. Before performing aid to a casualty who is not a member of this

CERT (which includes family members), always ask for clear permission to perform the aid if

possible. If the casualty is unconscious or delirious, consent cannot be granted; therefore, the

responder must make a personal decision whether to perform the aid or not. When seeking

consent, explain who you are and a brief of your qualifications. Not only will this give the

casualty information to make a decision — if the wound is not life-threatening — but it will also

reassure the casualty.

Finally, the decision to perform tactical first aid should not be made half-heartedly. If the

responder decides to perform aid, the responder must be prepared to handle all types of injury.

When performing tactical first aid, it may be necessary to remove clothing, even of the opposite

sex. The responder must decide that saving a life is more important than any obstacle that arises.

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Secure and Evaluate a Casualty

The first step to treating an injury is to secure the casualty from further harm. This will

depend on individual circumstances, since every danger is unique. In the unlikely event that the

responder will be taking fire from an enemy when the casualty is injured, the first task of the

responder is to return fire and defeat the enemy. Treating a casualty is pointless if the enemy

prevails to kill or capture both the responder and the casualty. Most likely, however, the

responder will deal with injuries sustained from the effects of a natural disaster. In this event, it

is important to secure the casualty from further harm.

Moving a casualty should be the last, most extreme resort for securing him/her; spinal

injuries are difficult to detect, especially when first arriving to perform aid. Instead, objects or

circumstances which threaten the casualty should be removed and made safe. If a tree limb

hangs precariously over the casualty, safely remove the limb or secure the limb so that it will not

strike the casualty. It is of paramount importance to develop your ability to recognize and

respond to danger quickly.

After securing the casualty from further harm, the next step is to evaluate the casualty. It

is important to determine the extent of the injuries so that the responder can treat the most

serious wounds first.

1. As you approach the casualty, form a general impression of the injuries and chances

of survival.

1.1. If the casualty is already dead or if there is no aid you can provide to prevent

the casualty from dying, you may have to move on to other casualties whom you can

treat.

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1.2. Make an immediate assessment concerning the priority of treatment: what is

the most immediate life-threading wound?

2. Check for Responsiveness

2.1. There are four levels of responsiveness: Alert, Verbal, Pain, and Unresponsive

(AVPU).

2.2. A casualty is alert if they are in a normal state of responsiveness.

2.3. Verbal responsiveness means that a casualty responds to voice.

2.4. Pain responsiveness means that a casualty only responds to pain. This is

checked if the casualty is not alert and does not respond to voice commands. Check

this by running the knuckle of the middle finger down the center of the chest with

some force, if possible. If a wound prevents this method, find some other way to

inflict a small level of pain to induce a response, such as hand movement, groans, foot

movement, etc.

2.5. Unresponsiveness means that the casualty does not respond at all.

2.6. If the casualty is responsive, ask the casualty for permission to provide aid and

ask questions to determine immediate life-threatening injuries.

3. Check for Breathing

3.1. Checking the casualties breathing is the first step in evaluation.

3.2. Place your head over the casualty’s chest with your ear approximately one inch

from the face and eyes looking at the chest. This is the Look-Listen-Feel method.

Look for movement of the chest. Listen for breath entering and exiting mouth/nose.

Feel the exhalation on your cheek.

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3.3. If casualty is not breathing, immediately cease evaluation and restore

breathing. This will be further discussed in following sections.

3.4. Remove chest clothing and check for a penetrating chest wound.

4. Check for Bleeding

4.1. Obvious sources of bleeding are easy to identify. Check for severed or

lacerated limbs. Check for blood-soaked spots on clothing. Check for entry or exit

wounds.

4.2. Pass hands over any area of the body you cannot see to check for bleeding. If

a casualty is on their back, pass hands over the shoulders and down the back.

4.3. It may be necessary to remove clothing in order to find sources of bleeding.

4.4. Identify life-threatening bleeding. This means check for bleeding that

produces significant blood loss in a short time. Check for spurting, entry or exit

wounds, and severed or severely lacerated limbs. Treat these wounds immediately.

5. Check for Fractures

5.1. Look for visible bones; these are open fractures.

5.2. Check for swelling, discoloration, deformity, and unusual body positions in

order to find closed fractures.

6. Check for Burns

6.1. Check for reddened, blistered, or charred skin. Look for singed clothing.

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Treating Injuries By Type

1. Breathing

1.1. If casualty has a mild airway obstruction (able to speak or cough forcefully,

wheezing between coughs), do not interfere except to encourage casualty.

1.2. If casualty has a severe airway obstruction (inability to speak or breathe, silent

cough, cyanosis), perform abdominal or chest thrusts.

1.2.1. Abdominal Thrusts

1.2.1.1. Stand behind casualty

1.2.1.2. Wrap your arms around casualty’s waist

1.2.1.3. Make a fist with one hand

1.2.1.4. Place the thumb side of the fist against the abdomen slightly above

the navel and well below the tip of the breastbone.

1.2.1.5. Grasp the fist with the other hand

1.2.1.6. Give quick backward and upward thrusts. Each thrust should be a

separate and distinct movement. Thrusts should be continued until

obstruction is expelled or casualty becomes unconscious.

1.2.2. Chest Thrusts

1.2.2.1. Stand behind casualty

1.2.2.2. Wrap arms under casualty’s armpits and around the chest

1.2.2.3. Make fist with one hand

1.2.2.4. Place thumb side of fist on middle of breastbone

1.2.2.5. Grasp fist with other hand

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1.2.2.6. Give backwards thrusts. Each thrust should be performed slowly

and distinctly until obstruction is expelled or casualty becomes

unconscious.

1.3. If casualty becomes unconscious, lay him/her down and begin mouth-to-mouth

resuscitation.

1.4. Restoring Breathing

1.4.1. If a casualty is unconscious and not breathing, it is necessary for the

responder to restore breathing if possible. This is always the first step. A person

will die in three minutes if they are unable to breathe.

1.4.2. First you must safely place the casualty on his/her back if they are not

already in that position.

1.4.3. Open the airway.

1.4.3.1. Head-tilt/chin-lift method

1.4.3.1.1. Kneel at level of casualty’s shoulders.

1.4.3.1.2. Place one hand on casualty’s forehead and apply firm,

backward pressure with palm to tilt head back.

1.4.3.1.3. Place fingertips of other hand under the bony part of the

lower jaw and lift, bring chin forward.

1.4.3.2. Jaw-Thrust Method - if spinal injury is suspected

1.4.3.2.1. Kneel above casualty’s head looking toward feet

1.4.3.2.2. Rest your elbows on ground

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1.4.3.2.3. Place one hand on each side of casualty’s lower jaw at angle

of jaw, below ears.

1.4.3.2.4. Stabilize casualty’s head with forearms

1.4.3.2.5. Use index fingers to push the angles of the casualty’s lower

jaw forward

1.4.4. Give Breaths to Ensure an Open Airway

1.4.4.1. Insert face shield if available

1.4.4.2. Maintain airway and gently pinch nose closed, using hand on

casualty’s forehead.

1.4.4.3. Take normal breath and place your mouth, in an airtight seal,

around casualty’s mouth.

1.4.4.4. Give two breaths, one second each, taking a breath between them

while watching for chest to rise and fall and listening/feeling for

exhalation.

1.4.4.5. If chest does not rise, reposition casualty’s head slightly farther

backward and repeat breaths

1.4.4.6. If chest does not rise, perform chest compressions. Kneel close to

casualty’s body. Locate nipple line placing the heel of one hand on the

lower half of the sternum. Place heel of other hand on top of first hand,

extending or interlacing fingers. Straighten and lock elbows with

shoulders directly above hands. Apply pressure to depress sternum 1.5 to

2 inches, without bending elbows, rocking, or allowing shoulders to sag.

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1.4.4.7. Look for the object causing the obstruction between breaths and

compressions, and attempt to remove it if possible.

1.4.4.8. Reopen airway and repeat breaths. If chest does not rise, repeat

breaths and compressions until airway is clear.

1.4.4.9. If chest rises, check for a pulse for 5 to 10 seconds by placing two

fingers in the groove of casualty’s throat beside the Adam’s apple on the

side closest to you. DO NOT use your thumb.

1.4.4.10. If pulse is found but casualty not breathing, continue mouth-to-

mouth. Give breaths every 5 to 6 seconds, check pulse and breathing

every 2 minutes. Continue until casualty’s breathing returns.

1.4.4.11. If no pulse is found, you must perform cardiopulmonary

resuscitation (CPR).

1.4.4.11.1. Position your hands and body for chest compressions

1.4.4.11.2. Give 30 compressions by pressing straight down to depress

breastbone 1.5 to 2 inches. Come straight up and completely release

pressure. Time allowed for release should equal the time required

for compression.

1.4.4.11.3. Give 30 compressions in about 23 seconds (100 per minute).

DO NOT remove the heel of your hand or reposition your hand

between compressions.

1.4.4.11.4. Give two breaths at one second each.

1.4.4.11.5. Repeat for five cycles or 2 minutes.

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1.4.4.11.6. Reassess casualty. Check for pulse for 3 to 5 seconds. If

pulse is present, check breathing. If casualty is breathing, place

casualty in recovery position and monitor casualty.

1.4.4.11.7. If pulse is absent, continue CPR. If pulse is present but

casualty is not breathing, continue mouth-to-mouth resuscitation.

1.4.4.11.8. Recheck pulse every 2 minutes. Continue CPR until pulse

returns, you are relieved by a physician, or you are too tired to

continue. If you become too tired, get another qualified responder to

relieve you if possible.

2. Treating Shock

2.1. Shock is a life-threatening medical condition of low blood perfusion to muscle

tissue resulting in cell injury and inadequate muscle function.

2.2. Check the casualty for signs and symptoms of shock. These symptoms may

not all be present simultaneously. Symptoms vary per person. If shock is suspected at

all, it must be treated immediately.

2.2.1. Sweaty but cool skin

2.2.2. Pale skin

2.2.3. Restlessness or nervousness.

2.2.4. Thirst

2.2.5. Severe bleeding [almost always leads to shock]

2.2.6. Confusion

2.2.7. Rapid breathing

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2.2.8. Blotchy blue skin

2.2.9. Nausea and/or vomiting

2.3. Position casualty.

2.3.1. Move casualty to cover, if cover is available and the situation permits.

2.3.2. Lay casualty on his/her back or in the recovery position (on his/her side)

unless a sitting position will allow the casualty to breathe easier.

2.3.3. Elevate the casualty’s feet higher than the heart using a stable object so

the feet will not fall.

2.4. Loosen clothing at the neck, waist, or anywhere it is binding. DO NOT loosen

clothing if in a chemical environment.

2.5. Splint the limb, if necessary.

2.5.1. Apply a splint if one or more bones in the limb have been fractured.

2.5.2. Apply a splint to the arm, forearm, thigh, or leg when a severe wound is

present even if the limb is not fractured.

2.6. Prevent the casualty from getting chilled or overheating.

2.6.1. Cover casualty to avoid loss of body heat and, in cold weather, place

cover under as well as over the casualty. Use a poncho or field blanket, or

improvise a cover. Thick vegetation can serve as a cover.

2.6.2. Place casualty under a permanent or improvised shelter in hot weather to

shade him/her from direct sunlight.

2.7. Calm and reassure the casualty.

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2.7.1. Take charge and show self-confidence. This is especially important

when treating strangers and children.

2.7.2. Assure the casualty that he/she is being taken care of. DO NOT give

false promises. If professional help is impossible to get, do not tell the casualty

that a doctor is on the way. Instead, assure the casualty that you will take care of

him/her as long as necessary until he/she gets better.

2.8. Watch the casualty closely for life-threatening conditions and check for other

injuries, if necessary. Seek medical aid from a professional if available.

3. First Aid for Bleeding of an Extremity

3.1. All bodily fluids should be considered infectious. Always observe your own

safety by wearing gloves and eye protection, and avoiding ingestion and direct contact

with the fluid.

3.2. The three methods of controlling bleeding are direct pressure, pressure

dressing, and tourniquet. Once bleeding is controlled, check distal pulse

3.3. If bleeding is not life-threatening, apply direct pressure.

3.3.1. Expose the wound.

3.3.2. Place a sterile gauze or dressing over the injury site and apply fingertips,

palm, or entire surface of one hand and apply direct pressure.

3.3.3. If bleeding is profuse, apply pressure with one hand while procuring a

sterile dressing with the other. Larger wounds require a larger surface area of

pressure and usually more pressure as well.

3.3.4. Pack large, gaping wounds with sterile gauze and apply direct pressure.

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3.4. If direct pressure does not control the bleeding, apply a pressure dressing.

3.4.1. Open the plastic dressing package

3.4.2. Apply the dressing, white (sterile, non-adherent pad) side down, directly

over the wound.

3.4.3. Wrap the elastic tail (bandage) around extremity and run the tail through

the plastic pressure bar. If wound is not on an extremity (i.e., on the abdomen,

chest, groin, etc.) you must use an abdominal pressure dressing, large enough to

wrap the bandage around the body.

3.4.4. Reverse tail while applying pressure and continue to wrap remainder of

tail around the extremity, continuing to apply pressure directly over the wound.

3.4.5. Secure the plastic closure bar to the last turn of the wrap

3.4.6. Check the emergency bandage to make sure that it is applied firmly

enough to prevent slipping without cause a tourniquet-like effect.

3.4.7. If skin distal to the injury becomes cool, blue, numb, or pulseless

(indicating loss of blood flow), the bandage must be loosened immediately.

3.5. If a pressure dressing does not control bleeding, apply a tourniquet.

3.5.1. You should have a tourniquet in your first aid kit, but a belt makes an

excellent improvised tourniquet. You can also use a strip of cloth the width of

the hand and a stick for a twisting device.

3.5.2. If, in the unlikely event, you are under enemy fire, a tourniquet is the

primary method of controlling bleeding. Under fire, there is not time to attempt

to control bleeding with direct pressure or a pressure dressing. NEVER

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UNDER ANY CIRCUMSTANCE remove a tourniquet once it is applied. Only

qualified medical doctors can safely do so. Removing a tourniquet could send a

blood clot to the heart or brain, causing death.

3.5.3. These instructions are for a Combat Application Tourniquet (CAT)

3.5.4. Pull the free end of the self-adhering band through the buckle and route

through the friction adapter buckle.

3.5.5. Place CAT 2-3 inches above wound on the injured extremity. The CAT is

ONLY applied to extremities. NEVER apply the CAT or any tourniquet to the

neck.

3.5.6. Pull the self-adhering band tight around the extremity and fasten it back

on itself as tightly as possible.

3.5.7. Twist the windlass until the bleeding stops. This will cause significant

pain to the casualty. You must be mentally prepared to inflict this pain in order

to save his/her life. The casualty will cry out and may beg you to stop. This

pain is necessary to cut off blood flow to the wound, and will fade as the area

loses feeling.

3.5.8. Lock the windlass in place within the windlass clip.

3.5.9. Secure the windlass with the windlass strap.

3.5.10. Assess for absence of distal pulse

3.5.11. Place a “T” and the time of the application on the casualty with a

permanent marker. Place this above the tourniquet and on the casualty’s

forehead.

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3.5.12. Secure CAT in place with tape

3.5.13. Initiate treatment for shock as needed.

3.5.14. If possible and safe to do so, evacuate casualty to a medical facility

immediately.

4. First Aid for Burns

4.1. Eliminate the source of the burn

4.1.1. Synthetic materials, such as nylon, may melt and cause further injury.

4.1.2. Thermal burns. Remove the casualty from the source of the burn. If

clothes are on fire, cover casualty with a field jacket or any large piece of non

synthetic material and roll him/her on the ground to put out flames.

4.1.3. Electrical burns. DO NOT touch the casualty or the electrical source

with your bare hands. The human body is an excellent conductor. If the

casualty is in contact with the electrical source, turn the electricity off if

possible. If this is not possible, use a nonconductive material (rope, clothing, or

dry wood) to drag or push the casualty away from the electrical source.

4.1.4. Chemical burns. Blisters caused by a blister agent are actually burns.

DO NOT try to decontaminate skin where blisters have already formed. If

blisters have not formed, decontaminate skin if possible.

4.1.4.1. Remove liquid chemicals from burned casualty by flushing with as

much water as possible.

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4.1.4.2. Remove dry chemicals by carefully brushing them off with a clean,

dry cloth. If large amounts of water are available, flush the area.

Otherwise, DO NOT apply water.

4.1.4.3. Smother burning white phosphorous with water, a wet cloth, or wet

mud. Keep the area covered with wet material.

4.2. Uncover the burn, unless in a chemical environment. Exposure could cause

additional harm.

4.2.1. Cut clothing covering the burned area. DO NOT attempt to remove

clothing that is stuck to the wound. Additional harm could result.

4.2.2. Gently lift away clothing covering the burned area.

4.2.3. If casualty’s hands or wrists have been burned, remove jewelry (rings,

watches, etc.) and place them in HIS/HER pockets.

4.3. Apply dressing to the burn.

4.3.1. If the burn is caused by white phosphorous, the dressing must be wet.

4.3.2. Do not place dressing on face or genitals.

4.3.3. Do not break blisters.

4.3.4. Do not apply grease or ointment to the burns.

4.3.5. Apply the dressing/pad, white side down, directly over wound.

4.3.6. Wrap the tails (or the elastic bandage) so that the dressing/pad is

covered. Secure tails or remainder of bandage with a knot over the outer edge of

the dressing, NOT directly over wound.

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4.3.7. Ensure dressing is applied lightly over the burn but firmly enough to

prevent slipping.

4.3.8. Electricity often leaves entry and exit burns. Both burns should be

treated.

4.4. If casualty is conscious and not nauseated, give him/her small amounts of

water to drink.

4.5. Watch casualty closely for life-threatening conditions, check for other injuries,

and treat for shock.

4.6. Evacuate casualty to a medical facility if safe and possible to do so. If it is not

possible to move casualty, then seek aid from a professional.

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Evacuate a Casualty

In an emergency situation, it may be necessary for the responder to evacuate a casualty to

a medical facility. It is important to learn how to do so safely. If a spinal injury is suspected, DO

NOT move the casualty. It is better to keep the casualty motionless than to risk death or severe

injury by moving him/her. This section will go over carries and drags used to move a casualty.

The goal should be to transport a casualty into a vehicle so that he/she can be moved to a medical

facility. If it is impossible to reach a medical facility, or it is not safe to do so, then transport the

casualty to shelter.

1. Hawes carry

1.1. Used to move a conscious casualty to cover or shelter.

1.2. Grasp the injured person’s wrist with his/her arm over one shoulder and lean

forward, raising him/her off the ground.

1.3. When performed correctly, the responder still has a free hand to open doors or,

if necessary, employ a weapon.

2. Fireman’s carry.

2.1. Use for an unconscious or severally injured casualty

2.2. Kneel at casualty’s uninjured side.

2.3. Place casualty’s arms above his/her head.

2.4. Cross the ankle on the injured side over opposite ankle

2.5. Place one of your hands on the should further from you and your other hand on

his/her hip or thigh.

2.6. Roll casualty toward you onto his/her abdomen

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2.7. Straddle casualty

2.8. Place your hands under casualty’s chest and lock them together

2.9. Lift casualty to his/her knees as you move backward

2.10. Continue to move backward, thus straightening the legs to lock the knees

2.11. Walk forward, bringing casualty to standing position but tilted slightly

backward to prevent knees from buckling

2.12. Maintain constant support of the casualty with one arm. Free your other arm,

quickly grasp his/her wrist, and raise the arm high

2.13. Instantly pass your head under the casualty’s raised arm, releasing it as you

pass under it

2.14. Move swiftly to face the casualty

2.15. Secure your arms around his/her waist

2.16. Immediately place your foot between his/her feet and spread them

approximately 6-8 inches apart

2.17. Again grasp the casualty’s wrist and raise the arm high above your head

2.18. Bend down and pull casualty’s arm over and down your shoulder brining his/

her body across your shoulders. At the same time pass your arm between his/her legs.

2.19. Grasp casualty’s wrist with one hand while placing your other hand on your

knee for support

2.20. Rise with casualty correctly positioned. Your other hand is free for use as

needed.

3. Neck Drag.

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3.1. Tie the casualty’s hands together at wrist. If conscious, the casualty may clasp

his/her hands together around your neck.

3.2. Straddle the casualty in a kneeling face-to-face position.

3.3. Loop casualty’s hands over and/or around your neck

3.4. Crawl forward, looking ahead, dragging casualty with you.

3.5. Use this method when concealment is essential, or if in an enclosed space (an

attic or crawlspace for example).

4. Cradle-drop drag

4.1. With casualty on his/her back, kneel at the head

4.2. Slide your hands, palms up, under casualty’s shoulders

4.3. Get a firm grip of the armpits

4.4. Partially rise, supporting casualty’s head on one of your forearms. You may

bring your elbows together and let casualty’s head rest on both forearms if necessary.

4.5. With casualty in semi-sitting position, rise and drag him/her backwards

4.6. If going up or down steps, support casualty’s head and body, letting hips and

legs drop from step to step.

If it is possible, the easiest method to transport a casualty is by a litter. You can create a

makeshift litter from two tree limbs (or poles, etc.) and securing a tarp or other strong, flexible

material to this frame. Leave room to grasp the limbs or poles to carry the litter. Always be

careful when placing a casualty on a litter.