SEAL Survival Guide (74 page)

Practice scene-size up. For example, let’s say there has just been an earthquake and you hear someone screaming under the rubble of a large building. Fight the urge to run in and help, because a small aftershock may cause the rest of the building to collapse on you.

Initial Assessment

Once you have decided the area is relatively safe, you may begin the
initial assessment
on your patient, which is a set of procedures used to discover and treat the individual’s most immediate and life-threatening conditions. The steps of the initial assessment put in place a systematic approach and help you to make decisions about priorities and the types of care that each of the injured needs. Identify the person with the most life-threatening condition; that person must be treated immediately before you move on to the next portion of the initial assessment. For example, you must restore a person’s breathing
before you attend to their broken leg or the injuries of any other breathing victim.

If you have surgical gloves (which should be in your go bag and in your vehicle), put them on before you begin treating the injured.

TRIAGE

You may find yourself at an MCI (mass casualty incident) where there are several injured people and you are the only one who can help. How do you decide whom to help first?
Triage
is a system used for sorting patients to determine the order in which they will receive care. This will require you to make some tough decisions, but it will also allow you to provide care for and save the ones that you can.

Triage Categories

Priority 1: The injured who need
immediate
care (major bleeding or very poor vital signs indicative of internal bleeding).

Priority 2: The injured whose care can be
delayed
(minor bleeding).

Priority 3: Those with
minor
injuries who need help less urgently (fracture).

Priority 4: The “
expectant,
” who are beyond help (deceased or fatal injury).

IMMEDIATE PRIORITIES FOR TREATING THE INJURED

As I said in
Part One
, “Whatever you do in training, you will do under stress.” It is so important to practice the following skill set because when you arrive on a scene with injuries, it will be extremely stressful. Your immediate priorities will be:

1. Restore breathing and heartbeat if absent.

2. Stop any bleeding.

3. Protect wounds and stabilize fractures or dislocations.

4. Treat for shock.

ABC

When approaching an injured person, call out to them to see if you get a response. This will give you several indications as to their current condition. For example, if a person can answer and talk, you know immediately that he is breathing and conscious. If the victim is unresponsive or unconscious, then begin your ABCs.
ABC
is an acronym you must remember for survival medicine; it stands for
“airway, breathing, circulation.”
When you begin to treat an injured person, first check that the
A
irway is open, that the person is
B
reathing, and that there is a pulse or other signs of
C
irculation. Periodically check with the American Red Cross and the American Heart Association for any changes or modifications to the information in this section. Methods and standards are updated annually.

A: AIRWAY

If a victim is facedown, you must carefully roll him over. Place one hand on the back of the victim’s neck and the other on his hip, and gently roll the victim over onto his back. If you suspect a back or neck injury, then try to get others to help. Keep the injured’s head, neck, and back in alignment as much as possible as you roll the person until faceup.

To open the injured’s airway, you must use a head tilt (even if you suspect back or neck injury):

1. Kneel beside the victim and place one of your hands on their forehead while you gently tilt the victim’s head back.

2. Place the fingers of your other hand on the cusp, or bony part, of the victim’s chin (not on the throat).

3. Carefully lift the chin straight up, keeping the head tilted back. Try to do so without closing the person’s mouth. If you think the victim might have a spinal injury, use the jaw thrust method.

4. Check to make sure there is nothing obstructing the victim’s throat or interfering with breathing. The tongue may have curled up at the back of the throat. Using what’s called a finger sweep, clear the mouth of all obstructions and move the tongue out of the airway if needed.

B: BREATHING

Once you determine that the airway is open, listen for any indication of breathing for five to ten seconds. This can be done by placing your ear next to the victim’s mouth or pressing your cheek against their lips in an effort to hear or feel breathing. As you are doing this, watch the chest to see if it is rising and falling.

C: CIRCULATION

Then monitor for signs of circulation by placing your index and middle fingers in the groove of the windpipe, which is located just beneath the angle of the jaw. You can also check if there is a pulse by placing two fingers on the inside of the wrist at about one inch above the base of the thumb, or under the armpits.

Rescue Breathing

If an
adult
stops breathing but still has signs of circulation, call for EMS (emergency medical services) and then begin rescue breathing. If a
child or infant
stops breathing but has signs of circulation, perform rescue breathing for two minutes before calling for EMS. Then resume rescue breathing. If the victim is not breathing and has no signs of circulation, perform
CPR.

RESCUE BREATHING ON AN ADULT

1. Pinch victim’s nose closed with your fingers, and put your mouth over their mouth.

2. Exhale two full, slow breaths, each for one to one and a half seconds.

3. Then withdraw and wait for the victim’s lungs to deflate.

4. If you don’t hear air exhaling, then reposition the person’s head, mindful of possible spinal cord injury, and try the procedure again.

5. Check for any signs of breathing and circulation, and then continue the method, waiting about ten seconds between each attempt.

RESCUE BREATHING ON AN INFANT

1. Place your mouth over both the infant’s nose and mouth.

2. Blow in two gentle puffs.

3. If you feel no exchange of air, reposition infant’s head and retry.

4. Observe and listen or feel to see if there is breathing and circulation.