STP 21-1-SMCT - APPLY A DRESSING TO AN OPEN HEAD WOUND


081-831-1033



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CONDITIONS


Given a casualty who has an open head wound. The casualty is breathing. A canteen of water and the casualty's first aid packet are available.


STANDARDS


Apply a dressing to the wound following the correct sequence without causing further injury to the casualty. Make sure that the casualty is properly positioned and that the dressing is secure without applying unnecessary pressure.


TRAINING AND EVALUATION



Evaluation Preparation


Setup:
Use the same field dressing repeatedly. Have another soldier act as the casualty. Use a moulage or otherwise simulate a wound to the forehead, back of the head, side of the head, cheek, or top of the head. Brief the casualty on how to answer the soldier's questions during step 1. You can have a canteen of water available and have the casualty say that he or she is thirsty to see if the soldier knows what to do.

Brief Soldier:
Tell the soldier to do, in order, all necessary first aid steps to treat the casualty's wound. Tell the soldier that a chemical environment does not exist. After the soldier completes step 4, ask him or her how often the casualty's level of consciousness should be checked and what should be done if the casualty falls asleep. Score step 5 based upon the soldier's responses. Do not evaluate step 7 in the simulated mode.


Evaluation Guide




















Performance Measure
Results


1. Check the casualty's level of consciousness.


    a. Ask the casualty questions such as--


      (1) "What is your name?"

      (2) "Where are you?"

      (3) "What is today's date (day, month, year)?"


    b. Report incorrect answers, inability to answer, or changes in answers to medical personnel when they arrive.


    WARNING
    DO NOT MOVE THE CASUALTY IF IT IS SUSPECTED THAT HE OR SHE HAS SUSTAINED A NECK, SPINE, OR SEVERE HEAD INJURY WHICH PRODUCES ANY SIGNS AND/OR SYMPTOMS OTHER THAN MINOR BLEEDING. (SEE THE TASK EVALUATE A CASUALTY, TASK NUMBER 081-831-1000.)

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2. Position the casualty.


    a. The casualty is conscious or has a minor scalp wound.


      (1) Have him or her sit up unless unable or other injuries prohibit sitting.

      (2) If the casualty is lying down and is not accumulating fluids in the throat, raise his or her head slightly.

      (3) If the casualty is bleeding into the mouth or throat, turn his or her head to the side or position the casualty on his or her side (the side opposite the site of the injury, if applicable).


      WARNING
      IF IT IS NECESSARY TO TURN A CASUALTY WITH A SUSPECTED NECK OR SPINAL INJURY, GET ASSISTANCE TO ROLL THE CASUALTY GENTLY ONTO HIS OR HER SIDE, KEEPING THE HEAD, NECK, AND BODY ALIGNED WHILE PROVIDING SUPPORT FOR THE HEAD AND NECK.

    b. The casualty is unconscious or has a severe head injury.


      (1) Treat as having a potential neck or spinal injury. Immobilize and do not move the casualty unless absolutely necessary.

      (2) If the casualty is choking and/or vomiting, or is bleeding into the mouth or throat, position the casualty on his or her side (the side opposite the site of the injury, if applicable).



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3. Expose the wound by removing the casualty's helmet, if necessary.


NOTE: In a chemical environment:


    a. If the casualty's mask and hood are not breached, do not apply a dressing. If the "all clear" has not been given, do not remove the casualty's mask to treat the wound.

    b. If the casualty's mask or hood has been breached and the "all clear" has not been given, attempt to repair the breach with tape or wet cloth stuffing. Do not apply a dressing.

    c. If the casualty's mask or hood has been breached and the "all clear" has been given, remove the mask to apply a dressing.


    WARNING
    DO NOT TRY TO CLEAN THE WOUND. DO NOT PUT UNNECESSARY PRESSURE ON THE WOUND. DO NOT TRY TO PUSH BRAIN MATTER BACK INTO THE HEAD.

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4. Apply the casualty's field dressing to the wound.


    a. Forehead or the back of the head.


      (1) Apply the dressing, white side down, directly over the wound with the tails extending toward the sides of the head.

      (2) Wrap the tails, one at a time, around the head in opposite directions, making sure that the tails cover the dressing but not the eyes or ears.

      (3) Tie the tails at the side of the head using a nonslip knot.


    b. Top of the head.


      (1) Apply the dressing, white side down, directly over the wound.

      (2) Wrap one tail down under the chin, up in front of the ear, and over the dressing to a point just above and in front of the opposite ear.

      (3) Wrap the other tail down under the chin in the opposite direction and up the side of the head to meet the first tail.

      (4) Cross the tails.

      (5) Wrap one tail across the forehead above the eyebrows to a point just above and in front of the opposite ear.

      (6) Wrap the other tail above the ear, low over the back of the head, and above the opposite ear to meet the other tail.

      (7) Tie the tails using a nonslip knot.


    c. Side of the head or cheek.


      (1) Apply the dressing, white side down, directly over the wound with the tails extending up and down.

      (2) Wrap the top tail over the top of the head, down in front of the ear, under the chin, and up over the dressing to a point just above the ear.

      (3) Wrap the other tail in the opposite direction to meet the first tail.

      (4) Cross the tails and complete the procedure as in steps 4b(5) through 4b(7).


      WARNING
      DO NOT GIVE THE CASUALTY ANY FOOD OR DRINK.


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5. Monitor the casualty.


    a. Check the casualty's level of consciousness every 15 minutes.

    b. If the casualty falls asleep, awaken him or her every 15 minutes.

    c. Note any changes from earlier checks.


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6. Perform steps 1 through 5 in the correct sequence.

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7. Watch the casualty closely for life-threatening conditions and check for other injuries, if necessary. (See the task Evaluate A Casualty, task number 081-831-1000.)

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REFERENCE



4-25.11 First Aid

IS0821 SELF-AID BUDDY AID

IS0831 TREATING WOUNDS AND FRACTURES

MF 8-5348 EMERGENCY TREATMENT OF HEAD INJURIES