1. Combat Lifesaver Re-certification Course Welcome SSG Scaliatine SGT McNamara

2. Combat Lifesaver Re-certification Course Task: Re-certify Combat Lifesaver skills IAW ISO826 (CLS Instructors Booklet) Conditions: Given performance check list on four tasks (I.V., Measure/Monitor Pulse, Restore Breathing, Stop bleeding on a limb) Standards: Receive a go on all tasks

3. Combat Lifesaver Re-certification Course  Watch your head, LOW CEILING  Use the hand rail when on stairs  Don’t lean back on chairs  No “horseplay”

4. Combat Lifesaver Re-certification Course Perform First Aid to Clear an Object stuck in the throat of a Conscious Casualty This slide show presentation was built with the help of FM21-11 (First Aid for Soldiers). Page 2-1, of your Buddy-Aid book, has the Task Conditions & Standards for this Lesson Follow along in your book. The wording may not be exact, the skills and information are.

5. Combat Lifesaver Re-certification Course Evaluate the Casualty Steps in a Primary Survey 1.Mask and Treat a Chemical Agent Casualty 2.Check the Casualty for Responsiveness 3.Check the Casualty’s Airway 4.Check the Casualty’s Breathing 5.Check the Casualty’s Circulation 6.Check the Casualty for Bleeding 7.Treat for Chemical Agent Poisoning (if appropriate) 8.Check the Casualty for Shock

6. Combat Lifesaver Re-certification Course Evaluate the Casualty Steps in a Secondary Survey 1.Check the Casualty for Fractures 2.Check the Casualty for Burns 3.Check the Casualty for Closed Head Injury (concussion) 4.Check the Casualty for Environmental Injuries 5.Check the Casualty for Other Wounds/ Fractures 6.Check the Casualty for Combat Stress Reaction

7. Combat Lifesaver Re-certification Course Airway Obstructions In order for oxygen from the air to flow to and from the lungs, the upper airway must be unobstructed. a. Upper airway obstructions often occur because— (1) The casualty’s tongue falls back into his throat while he is unconscious as a result of injury, cardiopulmonary arrest, and so forth. (The tongue falls back and obstructs, it is not swallowed.) (2) Foreign bodies become lodged in the throat. These obstructions usually occur while eating (meat most commonly causes obstructions). Choking on food is associated with— Attempting to swallow large pieces of poorly chewed food. Drinking alcohol. Slipping dentures.

8. Combat Lifesaver Re-certification Course (3) The contents of the stomach are regurgitated and may block the airway. (4) Blood clots may form as a result of head and facial injuries.

9. Combat Lifesaver Re-certification Course Upper airway obstructions may be prevented by taking the following precautions: (1) Cut food into small pieces and take care to chew slowly and thoroughly. (2) Avoid laughing and talking when chewing and swallowing. (3) Restrict alcohol while eating meals. (4) Keep food and foreign objects from children while they walk, run, or play. (5) Consider the correct positioning/maintenance of the open airway for the injured or unconscious casualty.

10. Combat Lifesaver Re-certification Course Upper airway obstruction may cause either partial or complete airway blockage. Partial airway obstruction. The casualty may still have an air exchange. A good air exchange means that the casualty can cough forcefully, though he may be wheezing between coughs. You, the rescuer, should not interfere, and should encourage the casualty to cough up the object on his own. A poor air exchange may be indicated by weak coughing with a high pitched noise between coughs. Additionally, the casualty may show signs of shock (for example, paleness of the skin, bluish or grayish tint around the lips or fingernail beds) indicating a need for oxygen. You should assist the casualty and treat him as though he had a complete obstruction

11. Combat Lifesaver Re-certification Course Complete airway obstruction. A complete obstruction (no air exchange) is indicated if the casualty cannot speak, breathe, or cough at all. He may be clutching his neck and moving erratically. In an unconscious casualty a complete obstruction is also indicated if after opening his airway you cannot ventilate him.

12. Combat Lifesaver Re-certification Course Types of airway Blockages Partial Blockage with Good Air Exchange Partial Blockage with Poor Air Exchange Complete Blockage

13. Combat Lifesaver Re-certification Course Treatment of airway Blockages Partial Blockage with Good Air Exchange o Encourage coughing Partial Blockage with Poor Air Exchange o Get help, administer Abdominal Thrusts Complete Blockage o Get help, administer Abdominal Thrusts

14. Combat Lifesaver Re-certification Course Clearing a conscious casualty’s airway obstruction can be performed with the casualty either standing or sitting, and by following a relatively simple procedure. WARNING Once an obstructed airway occurs, the brain will develop an oxygen deficiency resulting in/unconsciousness. Death will follow rapidly if prompt action is not taken.

15. Combat Lifesaver Re-certification Course

17. NOTE The manual thrust with the hands centered between the waist, and the rib cage is called an abdominal thrust (or Heimlich maneuver). The chest thrust (the hands are centered in the middle of the breastbone) is used only for an individual in the advanced stages of pregnancy, in the markedly obese casualty, or if there is a significant abdominal wound.

18. Combat Lifesaver Re-certification Course

23. Look at Practical Exercise on Page 2-6 DO NOT write in BOOK

24. Combat Lifesaver Re-certification Course Find a Partner, Practice this skill Use Checklist found on page 2-9 in your Buddy-Aid Book DO NOT write in BOOK

25. Combat Lifesaver Re-certification Course Perform Mouth-to-Mouth Resuscitation Task Conditions & Standards are listed on Page 3-1 Buddy-Aid Book

26. Combat Lifesaver Re-certification Course Evaluate the Casualty Steps in a Primary Survey 1.Mask and Treat a Chemical Agent Casualty 2.Check the Casualty for Responsiveness 3.Check the Casualty’s Airway 4.Check the Casualty’s Breathing 5.Check the Casualty’s Circulation 6.Check the Casualty for Bleeding 7.Treat for Chemical Agent Poisoning (if appropriate) 8.Check the Casualty for Shock

27. Combat Lifesaver Re-certification Course Evaluate the Casualty Steps in a Secondary Survey 1.Check the Casualty for Fractures 2.Check the Casualty for Burns 3.Check the Casualty for Closed Head Injury (concussion) 4.Check the Casualty for Environmental Injuries 5.Check the Casualty for Other Wounds/ Fractures 6.Check the Casualty for Combat Stress Reaction

28. Combat Lifesaver Re-certification Course What is Mouth-to-Mouth Resuscitation ???? Perform Mouth-to-Mouth Resuscitation

29. Combat Lifesaver Re-certification Course 1.Check for Responsiveness 2.Position the Casualty for Mouth-to-Mouth Resuscitation 3.Open the Casualty’s Airway 4.Check for Breathing, while maintaining an Open airway 5.Initiate Mouth-to-Mouth Resuscitation 6.Perform a Finger Sweep 7.Administer Modified Abdominal Thrusts 8.Administer Modified Chest Thrusts 9.Feel for Pulse 10.Continue Mouth-to-Mouth Resuscitation 11.Monitor the Casualty Perform Mouth-to-Mouth Resuscitation

30. Combat Lifesaver Re-certification Course 1.Check for Responsiveness Ask Casualty “Are you OK?” Call for help HELP ! Perform Mouth-to-Mouth Resuscitation

31. Combat Lifesaver Re-certification Course 2.Position the Casualty for Mouth-to-Mouth Resuscitation On his back (Supine) Roll if needed, protect head and spine Avoid Injury Perform Mouth-to-Mouth Resuscitation

32. Combat Lifesaver Re-certification Course 3.Open the Casualty’s Airway Head Tilt / Chin Lift Jaw Thrust Perform Mouth-to-Mouth Resuscitation

33. Combat Lifesaver Re-certification Course 4.Check for Breathing, while maintaining an Open airway Look  Rise & Fall of the Chest / Abdomen Listen  For sounds of breathing Feel  For breath on the side of your face Perform Mouth-to-Mouth Resuscitation

34. Combat Lifesaver Re-certification Course 5.Initiate Mouth-to-Mouth Resuscitation Maintain an Open Airway Close Casualty’s Nose Administer Two Full Breaths Evaluate Effectiveness of the Ventilation Perform Mouth-to-Mouth Resuscitation

35. Combat Lifesaver Re-certification Course If Breaths do NOT go in: Re-tilt the Airway and try again If Breaths still do NOT go in: ASSUME THERE IS AN AIRWAY BLOCKAGE Perform Finger Sweeps and Manual Thrusts as needed Perform Mouth-to-Mouth Resuscitation

36. Combat Lifesaver Re-certification Course 6.Perform a Finger Sweep, if needed Use only if you see a foreign body in the mouth Look at Page 3-8 Perform Mouth-to-Mouth Resuscitation

37. Combat Lifesaver Re-certification Course 7.Administer Modified Abdominal Thrusts Artificial Cough Find the correct position Press inward and upward After thrust do a Finger Sweep (if needed) Repeat Thrust, Finger Sweeps, and Ventilations until AIR GOES IN (Don’t focus on the object, the goal is to get the Air in) Perform Mouth-to-Mouth Resuscitation

38. Combat Lifesaver Re-certification Course 8.Administer Modified Chest Thrusts Used w/ Casualty who has a serious abdominal wound, a Casualty who is noticeably pregnant, or a Casualty who is extremely Overweight Page 3-10 & 3-11 has pictures Perform Mouth-to-Mouth Resuscitation

39. Combat Lifesaver Re-certification Course 9.Feel for Pulse Carotid is best place Middle & Index fingers 5 to 10 Seconds DO NOT USE YOUR THUMB NO PULSE ?, CPR is NOT a CLS Skill Did you know ? Medics, on the Battle Field, will only do CPR for one minute before leaving the Casualty to treat other wounded soldiers. Perform Mouth-to-Mouth Resuscitation

40. Combat Lifesaver Re-certification Course 10.Continue Mouth-to-Mouth Resuscitation Stop:  When breathing is restored  Medical personnel take over  You must go get help (no pulse)  You must continue the Battle  You are too exhausted to Continue 11. Monitor the Casualty Perform Mouth-to-Mouth Resuscitation

41. Combat Lifesaver Re-certification Course Practical Exercise is on Page 3-15 Remember: DO NOT WRITE IN BOOKS Perform Mouth-to-Mouth Resuscitation

42. Combat Lifesaver Re-certification Course Practice on the Manikins Use Checklist on Pages 3-20, 3-21 & 3-22 Perform Mouth-to-Mouth Resuscitation

43. Combat Lifesaver Re-certification Course Questions ????

44. Combat Lifesaver Re-certification Course Perform First aid for Bleeding of an Extremity Page 4-1 in Buddy-Aid book

45. Combat Lifesaver Re-certification Course Evaluate the Casualty Steps in a Primary Survey 1.Mask and Treat a Chemical Agent Casualty 2.Check the Casualty for Responsiveness 3.Check the Casualty’s Airway 4.Check the Casualty’s Breathing 5.Check the Casualty’s Circulation 6.Check the Casualty for Bleeding 7.Treat for Chemical Agent Poisoning (if appropriate) 8.Check the Casualty for Shock

46. Combat Lifesaver Re-certification Course Evaluate the Casualty Steps in a Secondary Survey 1.Check the Casualty for Fractures 2.Check the Casualty for Burns 3.Check the Casualty for Closed Head Injury (concussion) 4.Check the Casualty for Environmental Injuries 5.Check the Casualty for Other Wounds/ Fractures 6.Check the Casualty for Combat Stress Reaction

47. Combat Lifesaver Re-certification Course Task: Apply a Field Dressing, elevation and manual pressure, a pressure dressing, and a Tourniquet, as needed, to a wound on a Casualty’s limb Conditions: Given a simulated Casualty with bleeding from a limb and needed Supplies Standards: Score a GO on the Performance Checklist Perform First aid for Bleeding of an Extremity

48. Combat Lifesaver Re-certification Course All Bleeding stops eventually Stop it before it runs out Perform First aid for Bleeding of an Extremity

49. Combat Lifesaver Re-certification Course

50. Dressing: Material placed directly over a wound Bandage: Material used to Hold Dressing Field Dressing: Carried by all Soldiers Perform First aid for Bleeding of an Extremity

51. Combat Lifesaver Re-certification Course Step # 1: Expose the Wound Use Caution with Burns or if in a Chemical Environment Perform First aid for Bleeding of an Extremity

52. Combat Lifesaver Re-certification Course Step # 2: Apply & Secure a Field Dressing Expose the Wound Prepare Dressing Open Dressing Apply to wound Secure dressing Tie tails in Non-Slip Knot Pictures on page 4-3 show it all Perform First aid for Bleeding of an Extremity

53. Combat Lifesaver Re-certification Course Step # 3: Apply Manual Pressure Direct Pressure for 5 to 10 Minutes Step # 4: Elevate the Injured Limb Do this at the same time as Applying Pressure DO NOT elevate a suspected Fracture Perform First aid for Bleeding of an Extremity

54. Combat Lifesaver Re-certification Course Hold And Wrap

55. Combat Lifesaver Re-certification Course Step # 5: Apply a Pressure Dressing Only on a wound of the Arm or Leg Placed on top of the field dressing Pictures on Page 4-6 Perform First aid for Bleeding of an Extremity

56. Combat Lifesaver Re-certification Course Need a hand ??? How about a Tourniquet ?

57. Combat Lifesaver Re-certification Course Step # 6: Determine if a Tourniquet is Needed Only when all else Fails Not on wounds to the Head, Neck, Chest Not used on amputation of part of Hand or Foot Is used on amputation of Upper Arm, Forearm, Thigh or Lower leg Perform First aid for Bleeding of an Extremity

58. Combat Lifesaver Re-certification Course Step # 7: Gather Materials for Making a Tourniquet Tourniquet Bands Rigid Object Securing Materials Padding Perform First aid for Bleeding of an Extremity

59. Combat Lifesaver Re-certification Course Step # 8: Select Tourniquet Site Upper Arm Thigh Above the Joint, as Close to Joint as Possible Not over a Fracture Perform First aid for Bleeding of an Extremity

60. Combat Lifesaver Re-certification Course Step # 9: Apply a Tourniquet ONLY USED AS LAST RESORT Fold it as seen on Page 4-9 Apply it to a Limb as seen on Page 4-11 An Arm Amputation as seen on Page 4-10 A Leg Amputation as seen on Page 4-12 Perform First aid for Bleeding of an Extremity

61. Combat Lifesaver Re-certification Course Application Of Tourniquet (Tying of Half-Knot)

62. Combat Lifesaver Re-certification Course Application of Tourniquet (Positioning Stick)

63. Combat Lifesaver Re-certification Course Application Of Tourniquet (Full-Knot on Stick)

64. Combat Lifesaver Re-certification Course Secure Stick

65. Combat Lifesaver Re-certification Course Step # 10: Dress an Amputation Read Paragraph 4-11 on Page 4-12 Perform First aid for Bleeding of an Extremity

66. Combat Lifesaver Re-certification Course Step # 11: Mark the Casualty “T” and time of Tourniquet application Do not cover tourniquet Monitor Casualty and Treat for Shock Perform First aid for Bleeding of an Extremity

67. Combat Lifesaver Re-certification Course Test your Knowledge Do the Practical Exercise on Page 4-13 DO NOT WRITE IN BOOKS Perform First aid for Bleeding of an Extremity

68. Combat Lifesaver Re-certification Course Find your Partner Use the Performance Checklist on Page 4-20 & 4-21 Perform First aid for Bleeding of an Extremity

69. Combat Lifesaver Re-certification Course QUESTIONS ?? Perform First aid for Bleeding of an Extremity

70. Combat Lifesaver Re-certification Course Following are some photos If you have a weak stomach or do not like the sight of blood do not look at these pictures!

71. Combat Lifesaver Re-certification Course

76. Measure and Monitor a Casualty’s Pulse

77. Combat Lifesaver Re-certification Course Evaluate the Casualty Steps in a Primary Survey 1.Mask and Treat a Chemical Agent Casualty 2.Check the Casualty for Responsiveness 3.Check the Casualty’s Airway 4.Check the Casualty’s Breathing 5.Check the Casualty’s Circulation 6.Check the Casualty for Bleeding 7.Treat for Chemical Agent Poisoning (if appropriate) 8.Check the Casualty for Shock

78. Combat Lifesaver Re-certification Course Evaluate the Casualty Steps in a Secondary Survey 1.Check the Casualty for Fractures 2.Check the Casualty for Burns 3.Check the Casualty for Closed Head Injury (concussion) 4.Check the Casualty for Environmental Injuries 5.Check the Casualty for Other Wounds/ Fractures 6.Check the Casualty for Combat Stress Reaction

79. Combat Lifesaver Re-certification Course Task, Conditions & Standards found on page 18-1 in Medical Tasks book Measure & Monitor a Casualty’s Pulse

80. Combat Lifesaver Re-certification Course Step #1 Locate the pulse site Carotid Radial NOTE: DO not palpate both of the Casualty’s Carotid Arteries at the same time Other sites: Posterior Tibial, Temporal, Brachial, Femoral, Popiteal, Dorsalis Pedis & Apical. Look at the picture on page 18-3 for locations. Measure & Monitor a Casualty’s Pulse

81. Combat Lifesaver Re-certification Course Step #2 Palpate the pulse site Use Middle and Ring fingers Do not use your thumb Count the beats felt in one minute Do not cheat, IE: 30 seconds x 2 Normal: 60-80 Beats per Minute (BPM) Tachycardia: Over 100 BPM Bradycardia: Less then 50 BPM Measure & Monitor a Casualty’s Pulse

82. Combat Lifesaver Re-certification Course Step #2 (cont) Classify the Strength of the Pulse Regular: Easy to feel, Even Beats, Normal Force Bounding: Easily detected due to large amount of blood pumping Weak: Difficult to detect due to loss of blood Absent: You guessed it; NO PULSE FOUND Measure & Monitor a Casualty’s Pulse

83. Combat Lifesaver Re-certification Course Step #3 Monitor the Casualty’s Pulse Count as needed Periodically Report Abnormal readings or changes Measure & Monitor a Casualty’s Pulse

84. Combat Lifesaver Re-certification Course Try the Practical Exercise on Page 18-6 Measure & Monitor a Casualty’s Pulse DO NOT WRITE IN BOOKS

85. Combat Lifesaver Re-certification Course Initiate an Intravenous Infusion Read the Task, Conditions, Standards on Page 17-1 of Medical Book

86. Combat Lifesaver Re-certification Course

99. Turn to Page 17-1 in Medical Book. Read to page 17-13

100. Combat Lifesaver Re-certification Course Take the practical examination (Written) on page 17-14 DO NOT WRITE IN BOOK

101. Combat Lifesaver Re-certification Course Watch this demonstration then pair off do the Skill, using the checklist from page 17-19 (medical book)

102. Combat Lifesaver Re-certification Course Questions ??? See you next year !!!