MICopy 3

DEPARTMENT OF THE ARMY FIELD MANUAL

FIRST AIDFOR

SOLDIERS

DEPARTMENT OF THE ARMY . MARCH 1954

*FM 21-11

FIELD MANUAL DEPARTMENT OF THE ARMYNo. 21-11 J WASHINGTON 25, D. C., 8 March 1954

FIRST AID FOR SOLDIERS

CHAPTER 1. INTRODUCTION Paragraph Page

Purpose and scope ----------- 1 5General --------------------- 2 5The 3 lifesaver steps in first aid 3 7

CHAPTER 2. INJURIES REQUIRING SPE-CIAL FIRST AID MEAS-URES

General --------------------- 4 20Chest wounds -------------- 5 20Belly wounds ------------- 6 21Jaw wounds -------- ---- 7 23Head wounds-------------- 8 23Severe burns -----------. 9 26Fractures -------------------- 10 26Use of morphine ------------- 11 39

CHAPTER 3. CHEMICAL INJURIES

General --------------------- 12 42Protective equipment --------- 13 43Detection and recognition ...... 14 45War gases ------------------- 15 45Incidental gases ---------- 16 59Oxidizers -.- 17 60Propellant fuels -------------- 18 63

CHAPTER 4. COMMON EMERGENCIES

Special first aid kits --------- 19 71Minor wounds and burns ---- 20 71Foreign body in the eye ------ 21 73

*This manual supersedes FM 21-11, 1 August 1946, including C 1,18 February 1949, and C 2, 4 March 1949; DA Training Circular 15,1952, and DA Training Circular 4, 1953.

Paragraph PageCHAPTER 4. Foreign body in the ear, nose, or

throat --- - - -- -------- 22 73Care of feet -- - - - 23 74Snake bite --------- --- - 24 77Poison plants -- - - 25 81Unconsciousness ------------ 26 81Effects of heat --------------- 27 82Effects of cold -..........- 28 84Drowning -- ----- 29 87Electric shock --------------- 30 98Carbon monoxide poisoning --- 31 100

CHAPTER 5. TRANSPORTATION OF SICKAND WOUNDED

General ------ ---------- 32 103Improvised litters ---------- - 33 103Carries ----- ----- 34 106

For sale by the Superintendent of Documents, U. S. Government Printing OfficeWashington 25, D. C. - Price 40 cents

~~~~

n'J

I

/. I4

4~~~~~~~~~~~~~~~~~~4

1 1I p

;·.~~~~~~~~~~~~~~~~~~~z

,, · ~~~~~~~~~~~~~p

1 a

4~~~~i~~ o_4

CHAPTER 1

INTRODUCTION

1. Purpose and ScopeThe purpose of this manual is to provide the basic

fundamentals of first aid care and treatment whichyou can apply to yourself or to another soldier beforethe arrival of trained medical personnel. It includesinstructions in first aid measures to take for specialinjuries such as chest and belly wounds; commonemergencies, such as snake bite and drowning; in-juries resulting from contact with chemicals, such aswar gases and propellant fuels and oxidizers; andhow to transport the sick and wounded so as not toaggravate their condition or endanger their life.

2. Generala. First aid is the care given casualties before

regular medical or surgical treatment can be admin-istered by trained individuals. The Army MedicalService has the finest equipment available, and itspersonnel have been trained in the most modernmethods of saving life and easing pain. However,trained personnel cannot be every place at once;there may be a time when YOU will have to dependon your own knowledge to save YOUR OWN LIFEor the LIFE OF SOMEONE else. You can save alife if you know what to do and what not to do, andif you act quickly and calmly. If you are injured,

5

don't lose your head and just call for help. Usefirst aid measures and then seek medical help assoon as possible. KEEP CALM. BE GENTLE.

b. Your job is to fight! Fighting is your primarymission. Anything you can do to keel) yourself andothers in fighting condition is part of that mission.It isn't all luck that most casualties return to theirunits to fight again. It is the result of correct firstaid and excellent medical care. You can protect your-self and others by knowing first aid.

c. What equipment do you have to give first aid?You are issued a first aid pouch containing a dress-ing. Know howo and wohen to use it. Have it withyou at all times. A good soldier checks his rifle eachday. He should be just as careful about checkinghis first aid pouch and packet (fig. 2).

d. Take a good look at the wounds, but keep yourhands off (fig. 3)!

Wounds are the most common conditions needingfirst aid. Always look for more than one wound.The missile may have come out at the opposite side.Before you treat a wound, you must see all of it tofind out exactly where it is, how large it is, and howmuch it is bleeding. Usually it is best to cut or tearthe clothing along the seam from the wound. Pullingclothing over the wound always increases the dangerof infection. Moving the wounded parts may makethe wound worse and cause needless pain. KEEPTHE WOUND CLEAN. Keep your hands awayfront lthe wound. Cover the wound with a dressingimmediately to prevent infection.

6

.FIRST AID POUCH

. i'

The three lifesaver steps in first aid are: STOPTHE BLEEDING! PROTECT THE WOUND!PREVENT OR TREAT SHOCK! You shouldmemorize these three steps and learn the simple

memorize these three steps an lear the simple7

methods of carrying them out. Now is the time tolearn. Prompt and correct first aid for wounds willnot only speed healing, but will often save a life-andthat life Nay be yours!

Figture S. Keep your hands off!

a. Lifesaver Step One. Stop the Bleeding.(1) (a) To stop bleeding, first apply pressure to

the wound with a dressing. Uncontrolledbleeding causes shock and finally death.Place the opened dressing (fig. 4) againstthe wound and apply firm pressure. Usethe wounded snan's dressing-not yowrown. Use an additional dressing, if nec-essary, to cover the wound. Wrap thetails of the dressing around the wounded

8

part and tie the ends to hold the dressingfirmly. If the wound is on the arm or legand bleeding continues, raise the arm orleg.

(b) Have the man lie down with his woundedarm or leg raised. If you think there isa broken bone, do not raise the arm or leg.Moving a broken arm or leg is painful

Figure 4. Stop the Bleeding!

and dangerous and will increase shock.When the arm or leg is raised, blood willnot flow into it so fast; therefore, bleedingfrom the wound will be slowed. Ofcourse, some blood will always flowthrough the arm or leg, so you will stillhave to use the bandage and pressure.

(2) In the case of a wound or wounds of the armor leg, IF THE BLEEDING DOES NOTSLOW DOWN considerably in a few min-utes, it is time to try something else-atourniquet. When pressure and elevation

9

fail to stop bleeding from a limb (arm orleg) or when blood is gushing from awound, a tourniquet should be appliedquickly. However, never apply a tourni-quet unless blood is gushing from a woundor until all other methods of stopping bleed-ing have failed. A tourniquet should betightened only enough to stop arterial bleed-ing. Veins will continue to bleed until thelimb has been drained of blood already pres-ent in it, and this is not aided by furthertightening of the tourniquet.

(a) The tourniquet should always be placedbetween the wound and the heart, in mostcases as low as possible above the wound;however, in case of bleeding below theknee or elbow, it should be placed justabovethese joints. When possible, protectthe skin by putting the tourniquet over thesmoothed sleeve or trouser leg.

(b) Once a tourniquet has been applied, thewounded man should be seen by a medi-cal officer as soon as possible. The tour-niquet should not be loosened by anyoneexcept a medical officer prepared to stopthe hemorrhage or bleeding by othermeans and prepared to replace the bloodvolume adequately. Repeated loosenzingof the tourniquet by inexperienced per-sonnel is extremely dangerous and canresult in considerable blood loss and en-danger the life of the patient. (See fig. 5for instructions in applying a tourni-

10

quet.) Inspect the tourniquet frequentlyto see if it has slipped or if there is anysign of further bleeding. In extremelycold weather, extremities such as the armsor legs with tourniquets applied are sub-ject to cold injury, and therefore shouldbe protected from the cold.

b. Lifesaver Step Two. Protect the Wouind. Thefirst-aid dressing protects wounds from the outside.It keeps dirt and germs out. It protects woundsfrom further injury (fig. 6). When applying thefirst-aid dressing, be careful to keep hands andforeign matter out of the wound.

c. Lifesaver Step Three. Prevent or Treat Shock.(1) Shock is a condition of great weakness of

the body. It can result in death. It maygo along with any kind of wound; theworse the wound, the more likely is it thatshock will develop. Severe bleeding causesshock. A person in shock may tremble andappear nervous; he may be thirsty; he maybecome very pale, wet with sweat, and maypass out.

(2) Shock may not appear for some time afteran injury. Treat the wounded man forshock before he has a chance to, get it.

(3) To prevent or treat shock, make the soldiercomfortable. Take off his pack and any-thing else he is carrying. Loosen his beltand clothes. Handle him very gently. Donot move him more than absolutely neces-sary. If he is lying in an abnormal posi-tion, make sure no bones are broken before

11

O Make a loop around the limb

( Pass a stick, scabbard or bayonet under the loop

Figure 5. Apply a toutrniquet this way.

12

(D Tighten tourniquet just enough to stop bleeding

O Bind free end to limb to keep tourniquet from unwinding

Figure 5.-Continued.

13

0THE MENAG 1Fly THERF^ TlAtA IPACKT Il- NEAN KEE IT TAT

N',' WtAY. DO XOTS ¶C aT IDE OF THE DRESS-ING WNICH WES NEXT

TO THE vo:

Figure 6. Protect the wooud.

14

0 Tear off paper and grab bandage by folded ends. Pull open.

0 Place soft thick center dressing on wound without allowing it totouch anything else

Figure 6'.-Continued.

15

O Wrap the bandage around the injured part and tie the eldssecurely

Figure 6.-Conltinued.

you straighten him out. If there is no headwound, lower his head and shoulders or ifpossible raise his legs to increase the flowof blood to his brain. Soldiers with headwounds are treated as described in para-graph 8. If the ground slants, turn himgently so that his feet are uphill and hishead downhill: Keep the man warm bywrapping him with a blanket, coat, or pon-cho. Place something under him to protecthim from the cold ground. If he is uncon-scious, place him face down with his headturned to one side, to prevent choking incase he should vomiit (fig. 7). If he is

16

conscious, replace body fluids of the soldierby giving fluids by mouth. Warm stimu-lants such as coffee, cocoa, or tea are excel-lent. Do not give fluids to an unconscioussoldier or to a soldier with a belly wound.

291776 °-54-2

17

V~~~'K

180,-~~~~~D

a

z

I8

a

1 8

Go 94

=) 00

M 0.4~~~~~~~~~~~~~~~~~~~~

z~ V2

8 2

:.11

9 0 ~ ~~~~~~~~1

G) m~~~~~~~

I',

N

I-I~ ~ ~

-x'

a1

.21

~~~~~js ~ ~ ~ ~~~P

I

a

1 9

CHAPTER 2

INJURIES REQUIRING SPECIAL FIRSTAID MEASURES

4. GeneralThe three lifesaving steps, which you have just

learned, apply to the treatment of all injuries. How-ever, there are certain types of injuries which, inaddition, require special first-aid measures. Theseare chest wounds, belly wounds, jaw and face wounds,burns, and fractures (broken bones).

5. Chest Wounds-Cover Up Airtighta. Chest wounds through which air is being sucked

in and blown out of the chest cavity are particularlydangerous. The chest wound itself is not as danger-ous as the air which goes through it into the chestcavity. This air squeezes the lung, thereby col-lapsing it and preventing proper breathing (fig.

8(s).b. The life of the soldier may depend upon how

quickly the wound is made airtight. Have thepatient forcibly exhale (breathe out), if possible, andimmediately apply a dressing which is large enoughto cover the wound and stop the flow of air. Packthe dressing firmly over the wound (fig. 8®).Cover the dressing with a large piece of raincoat orother material to help make the wound airtight.Bind this covering securely with belts or strips of

20

torn clothing (fig. 8(). Encourage the man to lieon his injured side so that the lung on his uninjuredside can receive more air. If he wishes, let him situp. This position may ease his breathing.

() AN AIR SUCKING CHESTWOUND CAUSES THE LUNGTO COLLAPSE

O PRESS THE DRESSINGFIRMLY OVER WOUNDTO STOP THE FLOW OFAIR

i COVER COMPLETELY WITHSOME MATERIAL AND BINDSECURELY

Figure 8. Chest wounds.

6. Belly Wounds-Cover Wound and Treat for Shock(fig. 9)

a. Do's.(1) Cover the wound with the sterile dressing

from a first aid packet and fasten securely.

21

(2) Treat the wounded soldier for shock.b. Do Not's.

(1) Don't try to replace any organs, such as in-testines, protruding from the belly. If youdo, you will cause infection and severeshock. However, if it is necessary to movean exposed intestine onto the belly in orderto cover the wound adequately, then do so.

(2) Don't give (or take) food or water. Any-thing taken by mouth will pass out from theintestine and spread germs in the belly. (If

- DON 'T TRY TO REPLACE/gP a nPROTRUDING ORGANS

( BANDAGE SECURELYAND TREAT FOR SHOCK.

DO NOT GIVE FOOD ORWATER BY MOUTH

Figure 9. Belly wotunds.

22

evacuation is delayed, the lips may be moist-ened with a wet handkerchief.)

7. Jaw Wounds-Prevent Choking on BloodIf a soldier is wounded in the face or neck, he will

need special treatment to prevent his choking onblood. Bleeding from the face and neck is usuallysevere because of the many blood vessels in theseparts. First, stop the bleeding by exerting pressurewith a sterile dressing. Then bind the dressing soas to protect the wound. If the jaw is broken, placethe absorbent part of the dressing over the woundand tie the tails over the top of the head to lendsupport. An additional dressing may be used to tieunder the chin for added support, but allow enoughfreedom for free drainage from the mouth. Themouth should not be bandaged shut. To avoid chok-ing on blood a man may sit up with his head heldforward and down, or he may lie face down. Thesepositions will allow the blood to draii out of hismouth instead of down his windpipe. Remember totreat for shock but do not use the face-up, head-lowshock position (fig. 10).

8. Head Wounds-Do Not Give Morphine(fig. 11)

a. A head wound may consist of one of the follow-ing conditions or of a combination of them: a cutor bruise of the scalp, fracture of the skull and injuryto the brain, and/or injury to the blood vessels ofthe scalp, skull, and brain. Usually, serious skullfractures and brain injuries occur together. It willbe easy for you to discover a scalp wound because ofthe profuse bleeding. A scalp wound may need noth-

23

ing more than the treatment outlined in paragraph3; however, if there is internal injury of the head, itwill be more difficult for you to discover.

b. Check for head wounds if a soldier-(1) Is now or has recently been unconscious.

O STOP BLEEDING BY EXERTING PRESSUREWITH A DRESSING.

O TIE A DRESSING TO PROTECT THE WOUNDAND SUPPORT THE FRACTURE

O KEEP THE FACE DOWN AND TREAT FOR SHOCK

l'igtlre 10. Jaw vwoUilds.

24

DO NOT GIVE MORPHINE

Figure 11. Head woounds.

(2) Has blood or other fluid escaping from thenose or ears.

(3) Has a slow pulse.(4) Has a headache.(5) Is vomiting.(6) Has had a convulsion.

c. Do not give morphine to soldiers with headwounds. Morphine hides signs or symptoms thatmedical officers should see in order to know what todo for the patient. It also causes breathing to slowdown and may even cause it to stop. Do not placethe soldier's head in a position lower than the restof his body. A man with a head wound should bepromptly evacuated on a litter. If the man is un-conscious, he should be kept flat on his back. If thepatient is unconscious, examination of the mouthshould be made for false teeth or other objects whichmight cause choking. If he is unconscious, movehim face down and lying on his abdomen or on hisside to prevent his having any difficulty in breathing.

25

9. Severe Burns-Prevent Shock and InfectionSevere burns are more likely to cause shock than

other severe wounds. Follow the procedure outlinedin paragraph 3c (3) to prevent shock. There is alsoa great danger of infection. Do not pull clothesaway from the burned area; instead, cut or tear theclothes and gently lift them off. Do not try to re-move pieces of cloth that stick to the skin. Carefullycover the burned area with sterile dressings. If nosterile dressing is available, leave the burn uncovered.Never break blisters or touch the burn. It is espe-cially important to treat for shock and to prevent in-fection. The victim should drink lots of waterbecause severe burns cause a great loss of body fluids.There is also a great loss of the body salts. There-fore, if possible, add two salt tablets or 1/4 teaspoonfulof loose salt to each canteenful of water. Three ormore canteenfuls should be drunk in 24 hours(fig. 12).

10. Fractures-Prevent Shock and Further InjuryA fracture is a broken bone.a. Signs.

(1) These are the signs of a broken bone-(a) Tenderness over the injury with pain on

movement.(b) Inability to move the injured part.(c) Unnatural shape (deformity).(d) Swelling and discoloration (change in

color of the skin).(2) A fracture may or may not have all these

signs. If you aren't sure, give the woundedinan the benefit of the doubt and treat theinjury as a fracture.

26

O PROTECT THE BURN WITH A STERILE DRESSINGOR LEAVE UNCOVERED.

® PREVENT SHOCK AND INFECTION. GIVE SALT

GIVE PLENTY OF WATER -- IF POSSIBLEWITH SALT

Figure 12. Bourns.

27

b. Kinds. There are two main kinds of fractures:

(1) A closed fracture or a break in the bonewithout a break in the overlying skin.

(2) An open fracture or broken bone that is ex-posed to contamination through a break inthe skin. Open fractures may be caused bybroken bones piercing the skin or by mis-siles which pierce the flesh and break thebone (fig. 13).

c. Greatest Care. If you think a person has abroken bone, handle him with a greatest care. Roughor careless handling causes pain and increases thechances of shock. Furthermore, the broken ends ofthe bone are razor-sharp and can cut through muscle,blood vessels, nerves, and skin (fig. 14). Remember-don't move a man with a fracture unless it is neces-sary. If you do, be gentle and keep the fracturedpart from moving. If there is a wound with a frac-ture, apply a dressing as you would for any otherwound. If there is bleeding, it must be stopped.Stop bleeding as described in paragraph 3a. Do notapply a tourniquet over the site of the fracture.

d. Splinting for Fractures.

(1) Most fractures require splinting. Personswith fractures of long bones should besplinted "where they lie" before any move-ment or transportation is attempted.Proper splinting greatly relieves -the painof a fracture and often prevents or lessensshock. Fixing the fragments of a brokenbone by use of splints prevents the jaggededges of the bone from tearing blood vesselsand nerves. In a closed fracture (one in

28

O CLOSED FRACTURE

I OPEN FRACTURE

G OPEN FRACTURE PRODUCED BY MISSILE

Figure 13. Kiinds of fractures.

29

ROUGH HANDLING CAN CHANGE

THIS CLOSED FRACTURE

INTO

THIS OPEN FRACTURE

Figure 14. Effects of rough handling.

30

which there is no break in the skin), properapplication of a split will prevent the bonefrom piercing the skin and changing it intoan open fracture. If the fracture is open,splinting will prevent further injury to thewound and the introduction of more infec-tion.

(2) First aid in the field may require improvisingsplints from any material that is handy.The following pages will describe the way toapply temporary splints.

Figure 15. Broken leg.

e. Splints for Fractured Bones of Leg, Hip, orThigh.

(1) The quickest way to splint the broken bone ina leg is to tie both legs together above andbelow the break (fig. 15). In this way, theuninjured leg will serve as a splint for thebroken bone. You can use a belt, cartridgebelt, rifle sling, strips of cloth, or handker-chiefs tied together. Do not move a manwith a fractured bone of the leg unless it isnecessary to get him off a road or away fromenemy fire. If you must move him, tie his

31

legs together first, grasp him by the shoul-ders and pull him in a straight line. Donot roll him or move him sideways.

(2) If you have time, you can make a good splintfor the lower leg by using two long sticks orpoles (fig. 16). Roll the sticks into a foldedblanket from both sides. This pads the legand forms a trough in which the leg rests.Bind the splint firmly at several places.Splints for fractures of the bones of the legshould extend from a point above the knee toto a little below the foot. If the broken boneis in the thigh or hip, the inside splintshould extend from the crotch to a little be-low the foot and the outside splint shouldextend from the armpit to a little below thefoot. Always be sure that the ends of thesticks or poles are well padded.

f. Splints-for Fracturzed Bones of the Arm.

(1) When possible, keep the fractured bone ofthe arm from moving by supporting thearm with splints. This reduces pain andprevents damage to the tissues. Temporarysplints can be made from boards, branches,bayonets, scabbards, etc. Splints should al-ways be padded with some soft material toprotect the limb from pressure and rubbing.Bind splints securely at several places aboveand below the fracture but not so tightlyas to stop the flow of blood. It is well toapply two splints, one on either side of thearm. If an injured elbow is bent, do not tryto straighten it; if straight, do not bend it.

32

G LEG SPLINT IMPROVISED WITHBLANKET AND POLES

® SPLINT APPLIED FOR FRACTUREDLEG, KNEE OR ANKLE

P SPLLINT APPLIED FOR FRACTUREDTHIGH OR HIP

Figure 16. Impnprovised leg splint.

Figure 17 shows examples of splints cor-rectly applied to the wrist or forearm, up-per arm, and elbow to support the fracturedbone and to prevent it from moving.

(2) A sling is the quickest way to support afractured bone of the arm or shoulder, a

291776°-54-- 333

sprained arm, or an arm with a painful in-jury. The arm should be bound snugly tothe body to prevent movement. You canmake a sling by using any material that willsupport all or a portion of the lower armand hold it close to the body (fig. 18).

/ SPLINTS FOR A BROKENWRIST OR FOREARM

H A/~ © SPLINTS FOR ABROKEN UPPER ARM

SINGLE STRAIGHT SPLINTFOR A FRACTURE NEARTHE ELBOW WHEN THEELBOW CANNOT BE EASILYBENT

Figure 17. Splints for a broken arm.

34

Q TURN THE JACKET OR SHIRTUP OVER THE INJURED ARMAND BUTTON IN PLACE.

f ®\ (BINDING THE ARM TO THECHEST WITH A BELT OR

L CARTRIDGE BELT GIVESADDITIONAL SUPPORT.

G SUPPORT THE FOREARM IN A -

SLING MADE FROM A BELTOR STRIPS OF CLOTHINGAND BIND THE ARM TO THECHEST.

Figure 18. Slings for an injured arm or shoulder.

g. Broken back.

(1) It is often impossible to be sure a man has

a broken back. Be suspicious of any backinjury, especially if the back has been

sharply struck or bent, or the person has

35

fallen. The most important thing to re-member is that if the sharp bone frag-ments are moved, they may cut the spinalcord. This will cause permanent paralysisof the body and legs (fig. 19).

( IN THIS POSITION, BONE FRAGMENTS CUTTHE SPINAL CORD

OIN THIS POSITION, BONE FRAGMENTS ARE INPROPER PLACE AND WON'T CUT THE SPINAL CORD

Fiigure 19. Brolken back.

(2) For a Broken Back.(a) Do.

1. Place a low roll, such as a bath towel orclothing, under the middle of the backto support it and bend it backwards.

2. If the man must be moved, lift him ontoa litter or board without bending hisspine forward. It is best to have atleast four men for this job (fig. 20).

3. If the man is in a face-down position, he

36

may be carried face down in a blanket(fig. 44).

4. Keep the patient's body alignmentstraight and natural at all times andkeep the air passages free.

Figure 20. Support a broken back.

(b) Don't.1 Don't move the patient unless absolutely

necessary.2 Don't raise his head even for a drink of

water.3 Don't twist his neck or back.4 Don't carry him in a blanket face up.

37

h. Broken Neck. A broken neck is extremely dan-gerous. Bone fragments may cut the spinal cordjust as in the case of a broken back. Keep the pa-tient's head straight and still. Moving him maycause his death.

(1) Keep the head and neck motionless by plac-ing large stones or packs at each side of thehead as support (fig. 21). Place a rolledblanket under the neck for support andpadding. Raise the shoulders in order toplace the roll under the neck. Don't bendthe neck forward. Don't twist or raise thehead at all.

(2) A good way to keep the head in the rightposition is to immobilize the neck with ahigh collar. A high collar tends to lengthenthe neck and raise the chin so as to arch theneck backward. A simple collar can bemade from an artillery shell container.Cut the cardboard cylinder into a collarabout five inches high. Split it on one side,pull it apart, and place it around the neck.Fasten the collar with adhesive'tape. Asimilar type of splint can be made by wrap-ping a folded shirt, jacket, or newspaperaround the neck. Use a belt, string, orstrip of cloth to hold it in place, but be surenot to choke the patient (fig. 21).

(3) If the man must be moved, get help. Oneperson should support the man's head andkeep it straight while others lift him.Transport him on a hard stretcher or board.

(4) Never turn a man over who has a brokenneck!

38

L-J

Figure 21. Broken neck.

11. Use of Morphinea. Few battle casualties have pain severe enough

to warrant the use of morphine. Morphine whenavailable and authorized for issue to non-medicalpersonnel such as tank crews and patrols should beused only in case of severe pain. Use morphine withcaution. Pain can often be relieved by simple meas-ures such as keeping the casualty quiet and warm,splinting an injured arm or leg, and by carefullychanging his position. If these measures fail andsevere pain continues, give morphine. Morphine notonly relieves pain, but helps decrease shock. It putsan injured man in better condition to be moved.

39

b. Caution-Don't Use Morphine (fig. 22):(1) Within two hours of a previous injection.(2) When soldier is unconscious.(3) When soldier has a head injury.(4) When soldier is breathing less than 12 times

a minute.(5) When soldier has a fractured neck.(6) When soldier is in shock.(7) When soldier has chest wounds and has dif-

ficulty with breathing.c. (1) Morphine comes in small metal collapsible

tubes with sterile needles called syrettes.(See fig. 23 for instruction in the use of

morphine syrettes.) Inject the morphine

WITHIN 2 HOURS OF A WREN SOLDIER HASPREVIOUS INJECTION A FRACTURED NECK

WHEN SOLDIER HASA HEAD INJURY WHEN SOLDIER HAS CHEST WOUNDS

AND HAS DIFFICULTY IN BREATHING

MORPHIN•

WHEN SOLDIER BREATHES LESS WHEN SOLDIER ISTRAN 12 TIMES A MINUTE IN SHOCK

WHEN SOLDIER IS UNCONSCIOUS

Figure 22. Don't Use Morphine.

40

under the skin at the wrist, abdomen, leg,

ankle, or back, whichever area happens to

be exposed. In cold weather, morphine

should be given in a warm area of the body

to speed absorption of the morphine by the

body.

® REMOVE NEEDLE COVER, PUSH IN'WIR LOOP TO BREAI SEAL

G PAINT SKIN WITH IODINE

) INJECT NEEDLE DEEP INTO ARM OR

DON'T TOUCH NEEDLE, REMOVE LEG MUSCLE. SQUEEZE OUT ALL THE

WIRE LOOP. MORPHINE. REMOVE NEEDLE.

Figulre 23. Use of morphine syrette.

(2) If the syrette contains 30 mgm or 1/2 grain

of morphine, give only one half of the

syrette. If the syrette contains 16 mgm or

1/4 grain, give the contents of the whole

syrette. In view of small stature or size

of an individual, satisfactory relief of pain

may be obtained in smaller dosages such

as 1/8 or 1/ grain (8 or 10 mgm).41

CHAPTER 3

CHEMICAL INJURIES

12. Generala. Gasoline, ammonia, and nitroglycerin are all

examples of common chemicals. A chemical mayexisf in the form of a liquid, a solid, or a gas. It maybe a liquid which vaporizes into a gas, or it may bea solid which gives off vapors; for example, gasolineis a vaporizable liquid; ammonia is a gas; and TNTis a solid. Some chemicals are more injurious tothe body than others. As liquid, they may irritate,inflame, burn, freeze, or destroy tissue. As vapors,they may irritate, inflame, and damage the skin,nose, lungs, or other parts of the respiratory tract.In either form, they may be absorbed into the bloodstream and cause a general disturbance to the body'sfunction.

b. You may come in contact with chemicals eitherthrough active combat with an enemy who uses wargases and/or through accidents in handling chemicalsof one type or another during service support activi-ties. You must be prepared both to protect yourselfand others against the injurious effects of chemicalsand to give first aid treatment if necessary.

c. (1) Alcohol should not be used in the presenceof chemical poisons.

(2) Water is the most useful single counter-measure for the great majority of chemical

42

contaminators with the possible exception ofthe risk of spreading liquid blister gas onthe skin.

(3) In decontaminating skin after contact withany chemical warfare agent, remove excessliquid (or solid) by gentle blotting with ahandkerchief or suitable item and then flushthe skin with water.

13. Protective Equipmenta. You are provided with equipment that will pro-

tect you against poisonous gases. You are issued suchequipment as the protective mask, protective oint-ment for the skin, and BAL eye ointment for theeyes (fig. 24). When considered necessary, you mayalso be provided with protective clothing, protectivecovers, and dubbing for your shoes; amyl nitriteampules to couniteract the effects of certain bloodpoisons; and atropine injection devices as an anti-dote for nerve gas poisoning.

b. Your protective mask is THE most importantpiece of protective equipment you will receive.

c. Know how to apply protective measures prop-erly, how to use this equipment correctly, and how toprevent further contamination if the gas is still pres-ent. One good rule to follow is "Keep your protectivemask on unless you are sure the area is clear ofgas."

d. Protective ointment is used to neutralize liquidblister gases which have fallen on the skin. Pro-tective ointment should not be used after symptomsof a blister gas burn appear, as it will only aggravatethe burn. It may be used prior to exposure to blister

43

USE PROTECTIVE OINTMENT FOR THE SKIN

USE BAL EYE OINTMENT FOR THE EYES

Figure 24. Protective measures.

44

gases as a protective coating on exposed skin. DONOT use protective ointment in the eyes.

e. BAL eye ointment is used only to remove lewis-ite (a blister gas) from the eyes, DO NOT use BALin the eyes unless severe eye pain is present. De-contaminate the face before masking. Blister gasesother than lewisite must be flushed out withWATER.

14. Detection and RecognitionYou must know how to detect and identify poison-

ous gas. This subject is covered in detail in FM2140, Defense Against CBR Attack, and FM 2141,Soldier's Manual for Defense Against CBRWarfare.

15. War GasesWar (poisonous) gases are produced by many dif-

ferent kinds and combinations of chemicals and maybe classified according to the primary effect theyproduce, such as blister gases, choking gases, bloodpoisons, tear gases, vomiting gases, nerve gases, in-cendiaries, and screening smokes. The protectivemask should be put on at once whenever any chemicalwarfare agent is detected, or as soon as symptomsproduced by such an agent are recognized. If con-tamination of the eye has occurred, the eye shouldimmediately be flushed with water and then the pro-tective mask should be put on.

a. Standard Decontamination Procedure. Liquidblister gases and liquid nerve gases act on the skinextremely fast. Since most of these liquid war gases,as well as all other CBR agents (biological, radio-logical), have no special smell or color, IMMEDI-

45

ATE ACTION must be taken to remove them. Youcannot wait for current slow detection devices to tellyou which kind of gas it is. Use the followingSTANDARD DECONTAMINATION PROCE-DURE until you are sure just what gas it is.

(1) If agent is in the EYES and on the FACE:(a) Rinse eyes and face with WATER.(b) Blot off any remaining agent, and apply

protective ointment.(c) If EYES hurt, use BAL.

(2) MASK.(3) Rinse exposed SKIN with WATER.(4) Blot off remaining agent, if any.(5) Apply OINTMENT (removes blister gas).(6) Tear away contaminated portions of cloth-

ing. Use above procedure wherever theagent has soaked through to the skin.

(7) If symptoms of nerve gas poisoning appear,inject ATROPINE.

b. Nerve Gases. Nerve gases may be absorbed intothe body's system through breathing, through theskin, or through the intestines (from eating contam-inated food or drinking contaminated water).

(1) Put on your protective mask at once if anyof the following conditions are noticed:

(a) A feeling of tightness or constriction inyour chest.

(b) Difficulty in breathing, either drawing ina breath or in exhaling.

(c) The light appears to be getting dimmerthan usual, for no apparent reason.

(d) The eyes of other individuals in the vicin-ity have very small pinpoint-sized pupils.

46

(e) A drawing, slightly painful sensation isfelt in your eyes.

(f) There is a twitching of the muscles.(g) A faint, sweetish, fruity odor, which can-

not be accounted for.

(2) If you are exposed to nerve gas and difficultyin breathing or twitching of your musclesdevelops, take an injection of atropine atonce. If no other signs develop and thedifficulty in breathing is relieved, one in-jection is enough. The atropine will notrelieve the twitchings of your muscles, butthese are not dangerous. If other signsdevelop, especially increased tightness of thechest or difficulty in breathing, take a secondatropine injection. If you are not relievedin 10 minutes, take a third injection.NEVER TAKE MORE THAN THREEINJECTIONS! Additional atropine, ifneeded, will be given by medical personnel.Instructions for your use of either the atro-pine ampin or the atropine syrette are givenin h and i below. Atropine ampins orsyrettes and the protective ointment kitshould be protected against freezing incold weather by carrying these items inan inner pocket where body heat will pre-vent freezing.

(3) If the atropine causes the breathing to be-come free and easy again, you may carry onwith your duties. Dryness of the month isa good sign. This means that enough atro-pine has been taken to overcome the danger-

47

ous effects of nerve gas. Atropine injectionsdo not relieve the effects of nerve gas vaporon the eyes. Such signs as hurting of theeyes, difficulty in focusing the vision on closeobjects, and headaches are annoying but notdangerous. You may carry on with yournormal duties if there is no difficulty inbreathing.

(4) Remove at once liquid nerve gas that getson your skin or clothing. Blot-do not rub-the excess liquid off the skin with one ofthe cloths found in the Protective OintmentKit, a handkerchief, or a piece of outerclothing. Discard the contaminated cloth.Wash the area by pouring water from thecanteen over the contaminated portion. Thedanger from nerve gas contamination of theskin is that it is absorbed by the skin. Nervegas does not irritate the skin, and its pres-ence may not be immediately noticed. Itsprincipal hazard is absorption through theskin followed by poisoning the body. Thebreathing of vapor concentration of liquidnerve gas is also dangerous and the pro-tective mask. should.be used. while decon-taminiating the skin.

(5) Liquid nerve gas in the eyes must be removedimmediately since the absorption into thesystem of nerve gas from the eye is veryrapid. Tilt your head back so that youreyes are looking straight upward, hold yourbreath, and slowly pour water into the con-taminated eye to flush it out. Hold the eye

48

open and pour water into it slowly for atleast 30 seconds. Have someone observe youreyes for one minute. If the pupil getssmaller, take an injection of atropine at onceand follow the procedure outlined in (2)above if further signs of difficulty in breath-ing develop.

(6) Never drink water from open sources inany area where a nerve gas attack occurreduntil it has been tested and certified safeto drink. Never eat food which has beenunder nerve gas attack unless in sealed metalcans or until tested and certified free ofcontamination. Taking food or water con-taminated with nerve gas causes an increasedflow of saliva in the mouth, and there maybe colicky pains in the abdomen. If thesesymptoms or if tightness of the chest anddifficulty in breathing occur, take an injec-tion of atropine at once and follow theprocedure outlined in (2) above if you arenot relieved.

(7) When wounded or severely poisoned bynerve gas, you may be unable to help your-self. In such case you will have to get some-one else to help you in adjusting your pro-tective mask, in decontamination, and ingiving atropine. During nerve gas attacksyou should always be on the alert for thosewho may have been overcome. Wrhen find-ing someone who has been overcome or isunable to help himself, take immediate first-aid measures as enumleratted in preceding

291776--54 -- 449

subparagraphs. The victim's protectivemask should be put on immediately. If thevictim is having convulsions, three injec-tions of atropine must be given at once withno delay between injections. Victims whoare still alive but not breathing should begiven artificial respiration, using one of themethods described in paragraph 29. Arti-ficial respiration must be continued untilspontaneous respiration begins. This mayrequire from a half hour to an hour, orlonger.

c. Blister Gases. Blister gases are of two maintypes, those which contain arsenicals and those whichdo not. Arsenicals cause burning pain on contact.The non-arsenicals, such as mustard, cause no pain.Both produce inflammation, blisters, and tissue de-struction if permitted to remain unneutralized incontact with the skin. Blister gases can injure thelungs.

(1) If a liquid blister gas, such as liquid mus-tard, gets on your skin, blot off the liquidwith the gauze which comes with each tubeof protective ointment. Do not rub themustard into your skin or spread it. Dis-card the gauze after using. Next, applysome protective ointment over the area andrub into your Skin. Wipe off the excessointment with clean gauze. Apply somefresh ointment and allow it to remain. Thismust be done within a few minutes after ex-posure, the sooner the better.(2) Since arsenical blister gas is the onlyagent which causes immediate pain and is

50

also the only agent for which BAL is anantidote, the use of BAL should be based onthe pain factor. If a blister gas should getin the eyes, the following self-aid procedureshould be followed:

(a) If there is no pain, flush the eye withwater from the canteen for 30 seconds.

(b) If the eye hurts, flush with water fromthe canteen for 30 seconds, then applyBAL. Apply the BAL ointment insidethe lower lid, close the eye and gently rubthe closed eye for 30 seconds to spreadthe ointment inside the eye. M5 protec-tive ointment should never be applied tothe eyes, and in decontaminating the face,care should be exercised to keep M5 pro-tective ointment off the eyelids.

d. Choking Gases. If exposed to a choking gassuch as phosgene, put on your protective mask atonce and continue your mission unless there is diffi-culty in breathing, nausea and vomiting, or morethan the usual shortness of breath on exertion. Thenrest and wait for medical aid.

e. Blood Poisons. Blood poisoning can causerapid, severe interference with respiration. Maskimmediately upon detection. Blood gas effects arecounteracted by amyl nitrite, an ampule of whichshould be crushed and placed under the mask. Ifsoldier is unconscious, two ampules are needed. Ifrespiration stops, artificial respiration should begiven (as in par. 29).

f. Tear Gases. Tear gases cause an increased flowof tears and intense eye strain. They may also irri-

51

tate the skin. Do not rub your eyes. The effects oftear gas are temporary and disappear when freshair is reached or if a protective mask is put on.The mission you are performing should be con-tinued.

g. Vomiting Gases. The sneezing, nausea, sali-vating, and vomiting caused by these gases are notdangerous. If you are exposed, put on your pro-tective mask. Lift the protective mask away fromyour face in order to vomit; then replace the maskimmediately.

h. Use of the Atropine Anmpin.(1) Remove the ampin from its plastic cone-

shaped cover (fig. 250).

T TWIST AND REMOVE THE NEEDLE

) REMOVE THE AMPIN FROM ITSPLASTIC CONE-SHAPED COVER

) INJECT THE NEEDLE DEEP INTO KEEP BOTTOM OF AMPIN UP ANDA MUSCLE BREAK THE TIP OF THE AMPIN

Figiure 25. Use of the atropine anmpin.

52

(2) Twist and remove the needle cover (fig.25®).

(3) Tilt the needle vertical to the skin surfaceand plunge the needle straight into a thickmuscle (buttock, thigh, upper arm, etc.)with a quick jab (fig. 2506). The needleshould be inserted at least half its lengthunder the skin surface. If possible openthe clothing enough to expose the skin overthe large muscle selected. If this cannotbe done under conditions, of extreme cold,give the injection through the clothing be-cause speed is essential.

(4) KEEP BOTTOM OF AMPIN UP andbreak the tip of the ampin (fig. 250).After the solution has entered the muscle,remove the needle with a quick pull.

i. Use of the Atropine .Syrette.(1) Remove the syrette from its plastic con-

tainer (fig. 26()).(2) Unscrew and remove needle cover (fig.

260).(3) Keeping needle end up and holding the

syrette by the threads, push wire loop downfirmly until the inner seal breaks. Beforepulling wire out check the opening of theseal by gently squeezing until a small dropappears at the end of the needle. Thenpull the wire out and discard (fig. 26().

(4) Tilt the needle vertical to the skin surfaceand plunge the needle straight into a thickmuscle (buttock, thigh, upper arm, etc.)with a quick jab (fig. 26(). The needle

53

P z

o4 -__

3

U,

0

®Io

®~~

no2

0-

0.

54 ~ ~ ~ ~ ~ ~ Yrm

arg

FA

Z SVsan Fpq

p qu0 C

C 5

E- U

Z i

55

should be inserted at least half its lengthunder the skin surface. If possible openthe clothing enough to expose the skin overthe large muscle selected. If this cannotbe done under conditions of extreme coldgive the injection through the clothingbecause speed is essential.

(5) Squeeze tube slowly from sealed end untilempty (fig. 260). The tube must be com-pletely emptied. Use as many squeezes asnecessary to empty the tube completely.Remove the needle from the muscle with aquick pull.

j. Incendiaries. The principal incendiaries fromwhich you must learn to protect yourself are whitephosphorus, thermite, magnesium, combustible oils,and napolm.

(1) Clothing that has been struck by pieces ofburning phosphorus should be removed im-mediately before the phosphorus burnsthrough to the skin. Burning pieces ofphosphorus on the skin should be put outimmediately with water from your canteen,a wet cloth, or urine and removed from theskin (fig. 27). To prevent further burning,wet a copper sulphate pad, if available, withwater and apply it to the phosphorus.Wring the copper sulphate solution out ofthe pad onto the phosphorus. Remove thephosphorus particles by gently rubbingthem with the copper sulphate pad. Ifcopper sulphate pads are not available, keepthe phosphorus submerged in water or cov-

S6

ticles. You can use your knife, bayonet,stick, or other available object to removethe phosphorus particles. Get medicaltreatment as soon as possible.

57

(2) Particles of thermite on the skin should becooled immediately with water from yourcanteen and removed. Thereafter, use samefirst-aid treatment as for other heat burns(see pars. 9 and 20).;^

(3) Particles of mgnesium on the skin burnquickly and deeply and usually must beremoved by trained,personnel using localanesthesia. Get mnedical treatment immedi-ately.

(4) If a soldier is burned by the combustibleoils in flame throwers, oil incendiary bombs,or napalm, you should use the same first-aidtreatment for burns as that for other 'heatburns (see pars. 9 and 20). The heat andirritating gases given off by these combus-tible oils may cause lung damage whichmust be treated by medical personnel.

k. Screening Smokes.(1) Exposure to high concentrations of screen-

ing smokes, such as HC mixture, may causeirritation of the nose and throat, coughing,choking; and suffocation. Put on your pro-tective mask as soon as any of these sensa-tions start. Long exposure to low concen-trations of these smokes may also causeheadache, fever, and chest and muscularpains. If nausea, vomiting, or difficulty inbreathing occurs; get medical aid as soon ascombat conditions permit. Take aspirin toease general discomfort.

(2) If a liquid smoke screen agent gets on theskin, wash it off with water. If liquid

58

splash or spray gets into the eye, hold theeye open and flush out with water.

(3) Exposure to petroleum oil smoke or whitephosphorus smoke is harmless.

1. Cautiozn: The protective mask should not beused in smoke for long periods, especially in smokefrom oil fires. In all instances in which the protec-tive mask has been used in smoke concentrations thecanister should be replaced before reusing the mask.The protective mask will provide only limited pro-tection against smoke dependent upon the type andconcentration of the smoke. The canister of theprotective mask does not generate oxygen but filterssmoke out of the air.

16. Incidental Gasesa. Hydrogen Sulfide. This gas has the odor of

rotten eggs. Exposure to this gas in low concentra-tion chiefly affects the eyes, causing swollen eyelids,itchiness, smarting, pain, photophobia (eye sensi-tivity to light), and blurring of the vision. Exposureto high concentration of hydrogen sulfide may causeserious damage to the respiratory organs. Very highconcentrations cause unconsciousness, convulsions,and cause breathing to cease. If you are exposed tothis gas, get out of the area to fresh air immediately.If you cannot leave the area, put on the protectivemask. When a man is unconscious and not breathing,give artificial respiration (par. 29). Other first-aidmeasures include keeping the victim lying down andquiet, massaging the arms and legs, keeping the vic-tim warm, and giving stimulants (coffee or tea). Inall cases of severe exposure, get medical attention assoon as possible.

59

b. Ammonia. This gas causes violent, burningpain in the eyes and nose, tears, sneezing, nausea,vomiting, pain in the chest and abdomen, chokingsensation, and cough. Get fresh air immediately.To remove eye irritation wash eyes thoroughly withwater for at least 5 minutes. Drink diluted citrusfruit juice for abdominal pain. Give artificial respi-ration for unconsciousness or severe breathing diffi-culty, and get medical aid immediately.

17. Oxidizersa. Red and White Fuming Nitric Acid.

(1) Solutions of red and white fuming nitricacid cause severe chemical burns when incontact with skin or eyes. Remove the acidimmediately by washing skin and eyes withlarge amounts of clean water for at least15 minutes, and follow by application of aweak solution of bicarbonate of soda andwater or use the bicarbonate of soda andwater solution without washing the skin andeyes. Troops exposed to a known hazard ofthis acid should obtain the first-aid itemfrom a medical installation such as a dis-pensary or an aid station and keep the itemconstantly and readily available. Afterneutralizing or washing the contaminatedskin, treat acid burn as stated for any otherburn (pars. 9 and 20), and secure medicalattention.

(2) If solution of red and white fuming nitricacid is swallowed, immediately, dilute theacid by drinking large amounts of water.

60

Try not to vomit. Get medical treatmentimmediately.

(3) The fumes of the nitric acids (the nitrogenoxides) are in many ways more dangerousthan obvious liquid skin contact becauseafter inhalation their harmful effects mayshow up long after the exposure has oc-curred; also, amounts not immediately ir-ritating may cause serious illness later. Asoldier should leave the area without delay,if possible, or put on the protective maskat once. The fumes of nitric acid maycause irritation of the eyes, choking burningin the chest, violent cough, spitting of yel-low spit, headache, and vomiting. Thesesymptoms may be relieved by getting tofresh uncontaminated air immediately, fol-lowing which you may continue with yournormal duties. However, seek immediatemedical attention in the presence of contin-ued difficulty in breathing, nausea and vom-iting, or more than the usual shortness ofbreath on exertion. If medical attention isnot available, rest quietly until help arrives.

b. Hydrogen Peroxide.(1) Solution of hydrogen peroxide in contact

with skin and eyes will usually cause irri-tation but it will be temporary if skin andeyes are quickly cleansed and rinsed withwater. Additionally, affected skin may becovered with vaseline or vaseline gauze.

(2) Hydrogen peroxide vapors irritate the mu-cous membranes of the nose and throat,

61

causing coughing and excessive nasal andthroat secretion. Fine droplets (mists) ofstrong hydrogen peroxide solution may beinjurious to the nose, throat, and especiallyto the eye. The damaging effects on the eyemay develop long after the exposure. Getfresh air immediately or put on an approvedtype protective breathing apparatus.

(3) First-aid treatment for severe skin burnscaused by hydrogen peroxide is the same asthat for an ordinary thermal burn (par. 9and 20).

c. Liquid Oxygen.

(1) Liquid oxygen is nontoxic and does not pro-duce irritating fumes. When it comes incontact with the skin, it freezes the tissues,producing an effect very similar to a burnor a scald. Remove from the skin immedi-ately. Rinse the skin with water. If pos-sible use warm water. If contamination issufficient to cause a burn, first remove theliquid oxygen and then treat as any ordinarythermal burn (see par. 9 and 20). Severeskin exposure usually requires medicalattention.

(2) Remove contamination from the eyes by im-mediately washing with large amounts ofclean water. Get prompt medical attention.

(3) Remove contaminated clothing immedi-ately.

(4) Remove body contamination by taking along shower, for at least 15 minutes.

62

18. Propellant Fuelsa. Aniline.

(1) Aniline is a flammable, colorless, oily liquidwhich darkens on exposure to light or air.It has a burning taste and a characteristicodor. It is a poisonous liquid and also givesoff toxic vapors.

(2) Contact with the skin causes severe irrita-tion. If allowed to remain, it will be ab-sorbed into the blood stream through theskin. The vapor causes irritation of thethroat and lungs, leading to sore throat anddeep cough. Taken internally, it will causepoisoning. A sense of well-being is oftenexperienced in the early stages of exposure.As the amount of exposure increases, thelips burn blue, and bluish tinges appear onthe fingernail beds, the tongue, the mouth,and lining of the eyelids. This is followedby headache and drowsiness, sometimes withnausea and vomiting. Stupor and uncon-sciousness may follow. Recognition of thebluish tinge in dark-skinned races can bestbe accomplished by examination of thetongue and the lining of the mouth andeyelids.

(3) If you are exposed to this chemical, takeimmediate action. Wash liquid anilinefrom the skin with large amounts of wateror a 5-percent solution of acetic acid orvinegar. Troops exposed to a known haz-ard of aniline should obtain these first-aiditems from a medical installation such as

63

a dispensary or an aid station and keepthe items constantly and readily available.If aniline vapors are present, evacuate thearea immediately or remove them by ven-tilation. If the vapors cannot be removedby ventilation or the area cannot be evacu-ated, put on your protective mask immedi-ately.

(4) Remove eye contamination by washing withlarge amounts of clean water. If anilinegets into the ear, flush it with 3 percentacetic acid solution or vinegar. Removecontaminated clothing immediately andsoak them in a diluted acetic acid solutionor vinegar. If acetic acid solution or vine-gar is not available, use clean water. Inall cases of severe exposure, or if aniline isaccidentally swallowed, get immediate med-ical attention.

(5) If any of the symptoms of aniline poisoningoccur, such as severe headache, drowsiness,nausea, and vomiting; remove the victim tofresh air, keep quiet, give a mild stimulantsuch as black coffee (never alcohol), andkeep warm. Give artificial respiration tovictims who are not breathing.

b. Ethyl Alcohol. Do Not Drink.

(1) E/thyl alcohol is a highly intoxicating liquidwhich evaporates quickly and is flammable.Like water in appearance, ethyl alcoholcannot be distinguished from other morepoisonous alcohols, such as methyl alcohol,by its odor and burning taste. It may con-

64

tain certain toxic substances which havebeen added to it to make it unfit for humanconsumption.

(2) The vapors of this liquid cause severe irri-tation to the eyes and upper respiratorytract. Wear an approved form of respira-tory protective equipment in areas wherethere is likely to be a high concentration ofthese vapors.

(3) If ethyl alcohol is spilled into the eyes,wash it out immediately with large amountsof clean water. If the symptoms persists,get medical attention.

(4) This liquid has little effect on the skin.However, remove contaminated clothingand bathe contaminated skin areas becauseprolonged contact causes irritation of theskin.

c. Furfuryl Alcohol. Do Not Drink.(1) Furfuryl alcohol is a straw yellow to dark

amber liquid with a brine-like odor and bit-ter taste. It is poisonous if absorbed fromprolonged skin contact or taken internally.Drinking this alcohol is very dangerous.

(2) If furfuryl alcohol is spilled on the skin orin the eyes, it will cause irritation. Removeimmediately by washing with large amountsof clean water.

(3) Although it does not vaporize quickly inclosed spaces at high temperatures, trouble-some concentrations of vapor may gatheror collect which cause irritation to thethroat and lungs.

201-76°--54--56&

(4) Remove contaminated clothing and rinseaffected skin areas with water. -

d. Methyl Alcohol. (Wood Alcohol) Do NotDrink.

(1) Methyl alcohol is a highly poisonous chemi-cal. It is colorless like water. It has anodor very much like ethyl alcohol, and thesense of smell should not be relied upon todistinguish between these two alcohols. Itevaporates quickly and is flammable.

(2) This chemical may enter your body by yourbreathing the vapors, by absorption throughthe skin, or by drinking it; and, in smallamounts, it will cause headache, nausea,vomiting, and irritation of the mucous mem-branes. Larger amounts in the blood causedizziness, staggering walk, severe cramps,sour stomach, blindness, convulsions, coma,and death. Swallowing a snmall anount ofthis chemical may cause death.

(3) When working in closed spaces with thischemical, provide adequate ventilation oruse some approved form of respiratory pro-tective equipment.

(4) Wash contaminated skin areas with largeamounts of clean water. Remove contami-nated clothing.

(5) If this chemical is accidentally swallowed;get medical attention immediately. Ifmedical attention cannot be obtained at once,large amounts of epsom salts with largelarge amounts of water may be taken inorder to assist in the elimination of as much

66

as possible of the chemical from the stom-ach. Troops exposed to a known hazard ofthis chemical should obtain this first-aiditem from a medical installation such as adispensary or an aid station and keep theitem constantly and readily available. Getmedical attention as soon as possible.

e. Hydrazine.

(1) Hydrazine is a colorless, alkaline, fumingliquid which is odorless or may have theodor of ammonia. It is flammable, highlyexplosive, and corrosive. Hydrazine ispoisonous to humans by breathing, by skincontact, and if taken internally. Skin con-tact results in an intense burning sensation.If you are exposed to moderate or heavyconcentrations of vapors, they will causeimmediate violent irritation of the nose andthroat, itching, burning, and swelling of theeyes; and prolonged exposure may causetemporary blindness. If you are exposedto mild concentrations of these vapors, signsmay not appear until 3 to 4 hours later inthe form of the same eye and nose effectsas described above.

(2) Remove skin contamination by washingwith large amounts of clean water, followedby an application of boric acid paste.Troops exposed to hydrazine should obtainthis first-aid item from a medical installa-tion such as a dispensary or an aid stationand keep the item constantly and readilyavailable.

67

(3) In any concentration of vapors, use aclosed breathing apparatus. Remove vic-tims overcome by poisonous fumes from thearea. Give artificial respiration to thosenot breathing.

(4) Remove eye contamination by washing withlarge amounts of water or 3 percent boricacid solution if available.

(5) Remove contaminated clothing and bathethe skin area with clean water or 5 percentacetic acid solution.

(6) Remove whole body contamination by tak-ing a long shower for at least 15 minutes.

(7) In all cases of exposure to hydrazine, re-ceive medical attention promptly.

f. Hydrocarbon Fuels.(1) Hydrocarbon fuels are flammable com-

pounds (gasoline, jet propulsion fuels, kero-sene, heptane, butane, octane, pentane, etc.).All of these fuels produce essentially thesame effects in varying degrees. They giveoff vapors at normal temperatures which,when mixed with proper air mixtures, areignitable by spark or flame. The vaporsgiven off are heavier than air and, therefore,tend to collect in storage areas. Hydro-carbons are poisonous, both in inhalationand absorption through the skin. In addi-tion to the poisonous qualities due to hydro-carbon content, aviation gasoline containstetraethyl lead and jet fuels contain aro-matics, both of which are also poisonousby inhalation, skin absorption, or if takeninternally.

68

(2) If you do not immediately remove hydro-carbon fuels which have come in contactwith your skin, it will become red and irri-tated and later will blister. Long exposureof the skin to hydrocarbon fuel can resultin death of the tissue with scarring anddeformity. Contact with the eyes causesimmediate irritation, redness, and largeamounts of tears.

(3) Whenever any of these hydrocarbons comein contact with the skin or eyes, wash themout with large amounts of water. Keepareas where concentrations of hydrocarbonvapors are likely to gather well ventilatedor use some form of self-contained breath-ing apparatus.

(4) When hydrocarbon poisoning is apparent,get medical attention immediately. In themeantime get the victim into fresh air, keepwarm, quiet, and lying down. If he is un-conscious or having breathing difficulty,give him a few sniffs of aromatic spirits ofammonia and apply artificial respiration(par. 29). When consciousness has beenregained, give stimulants (coffee or tea).

g. Solid Propellants.

(1) Solid double base propellants contain nitro-cellulose and nitroglycerin. Nitroglycerincauses unpleasant and serious effects uponexposure, such as flushing of the face, mod-erate to severe headache, rapid pulse, nauseaand vomiting, colicky pains, diarrhea, ir-regular breathing, and unconsciousness.

69

Not all of these symptoms will appear. Anyone or several may appear, but the mostcommon is headache. In cases of severepoisoning, victims may be delirious, mayhave convulsions, or collapse.

(2) If any of the above signs occur after ex-posure to these chemicals, keep the victimlying down with the legs raised and the headlowered, provide plenty of fresh air, givestimulants (coffee or hot tea), and alternatehot and cold applications to the chest. Ifthe victim is having breathing difficulty,apply artificial respiration. Get iymmediatemedical attention.

(3) If exposed to either of these chemicals, donot drink even the smallest amount of alco-hol. Alcohol makes the signs more severeand dangerous.

(4) After handling these materials, wash thehands thoroughly before eating, smoking,or drinking, to prevent taking the chemicalinto. the stomach.

70

CHAPTER 4

COMMON EMERGENCIES

19. Special First-Aid KitsIn addition to the first-aid pouch with packet

which every soldier carries, special first-aid kits willoften be available. These are for use in commonemergencies like small burns, cuts, and eye injuries.First-aid kits supplied to many motor vehicles (fig.28) contain tourniquets, iodine swabs, adhesive plas-ter, sterile petrolatum gauze, eye ointment, anddressings. Learn to use them correctly and effi-ciently. Directions are included with each kit.

20. Minor Wounds and Burnsa. (1) Small wounds such as cuts, usually do

not bleed very much and will stop bleedingonce a dressing has been applied. Infectionis the principal danger, so any break in theskin should be protected. Do not touch awound with your fingers or allow clothes totouch it. Keep it clean.

(2) Apply a dressing over the wound. Thereare various sized dressings in motor vehicleand other first-aid kits. Pick out a sizewhich is large enough to cover the woundcompletely. Be careful not to touch the in-side of the dressing with your fingers.

71

il

et-- ·

i72

72

b. Small burns are a frequent injury; and suchburns, unless properly protected, often become in-fected. Burns may be caused by dry heat, hotliquids, chemicals, radiation (sunburn), or electricity.Severe sunburn requires the same first-aid measuresas other burns. If a first-aid kit containing sterilegauze is available, apply the gauze over the burnas a dressing. Cover the burned area with an addi-tional dry dressing of suitable size. If no sterilegauze is available, cover the burn with the dressingfrom your first-aid packet. If no sterile dressing isavailable, leave the burn uncovered.

21. Foreign Body in the EyeIf a particle gets in your eye, do not rub the eye.

Close it for a few minutes and tears may wash awaythe object. If not, have someone examine the eyeand remove the particle as shown in figure 29.

22. Foreign Body in the Ear, Nose, or Throata. Never probe with a pin, wire, or stick for an

object in your ear. Let the medical officer get itout. An insect in the ear may be removed simplyby means of attracting it with a flashlight held tothe ear or it may be killed with a few drops ofoil or water. Many other objects may be flushedout that way. However, if the object is somethingwhich swells when wet (such as a bean), do not putwater into the ear (fig. 300).

b. Probing into the nose will merely jam a foreignbody tighter. Try to loosen it by gently blowingyour nose (fig. 30(0)). If this doesn't work, waituntil you see a medical officer. Objects in the noseare usually not dangerous.

73

c. If you can reach a foreign body in your throatwith your finger, you may pick it out. Hold yourhead down when you do this. Be careful not to pushthe object farther down (fig. 300).

( IF THE OBJECT IS NOT IN THELOWER LID, INSPECT UPPER LID.

INSPECT THE EYEBALL AND LOWER GRASP THE EYELASHES WITH THUMBLID. GENTLY REMOVE OBJECT WITH AND INDEX FINGER. PLACE A MATCHA MOIST CLEAN CORNER OF HAND- STICE OR SMALL TWIG OVER THE LID.KERCHIEF.

( PULL THE LID UP OVER THE STICK.EXAMINE INSIDE OF LID WHILE THEMAN LOOKS DOWN. GENTLY REMOVETHE PARTICLE WITH A CLEAN CORNEROF A HANDKERCHIEF.

Figure 29. Rentovilng an object fro-m the eye.

23. Care of Feeta. Soldiers have to use their feet constantly. Pre-

vention of foot trouble is the best first aid for feet.b. Keep your feet clean. After a bath, thor-

oughly dry the feet and especially between the toes toprevent "athlete's foot." For itching or redness be-

74

Figu, re SO.- Removing foreign bodies from the ear, nose,

or throat.

tween the toes, apply GI foot powder twice daily

(fig. 31).If it does not improve, see your medical officer. Don't

try to treat it yourself. Don't cut a callus or corn

as this may cause a serious infection. Report to your

medical officer instead.

75

c. To avoid ingrown toenails, keep your toenailsclean and short; cut thefv, straight across.

d. Dust your feet with GI foot powder after bath-ing and before a march. Foot powder absorbs per-spiration and prevents chafing.

e. Put on clean socks every day, if possible. Don'twear socks that have holes or poorly darned spots inthem or socks that don't fit properly.

Pi.7/

Figure 31. Prevent athlete's foot.

76

f. Break in shoes before wearing them on a march.g. If a blister develops and medical care is not

available, follow the directions given in figure 32.

24. Snake Bitea. Poisonous snake bites must be given immediate

attention. The person who is bitten should be asquiet as possible and not walk or run about. If youcan, kill and keep the snake so that it can be identi-fied and so that proper medicine can be given thevictim by a medical officer. However, giving firstaid immediately and avoiding overexertion is themost important thing to do.

b. (1) 'If a person is bitten on arm or leg, applya loose tourniquet (constricting band) asdirected in paragraph 3a(2) (a). Tight-en the tourniquet (constricting band) justenough to make the veins stand out prom-inently under the skin. After the first hourthe band may be loosened for approximately1 minute in every 30 minutes.

(2) Make a cross-cut over each fang mark longenough and deep enough to allow free bleed-ing-about 1/4 inch long and 1/4 inch deep.Suck the poison from the wound, spitting itout frequently. Snake poison is harmlessin the mouth unless there are cuts. Suc-tion should be kept up for at least 1 hourwith the constricting band on. A snake-bite victim can do all these things for him-self (fig. 33) if he can comfortably reachthe fang marks with his mouth. If not, hemust have assistance.

77

2

E-

0

2

Da.4

W2

N

N.

0:

E-GO 4

Nn

4

w

0.94

04I DoF.

2

2

2

78

10

®

40

'-4

Ed X

g~

~9~79

ox

CO

r o

"~~E i3

i N

LP

79

c. If the bite is on a part of the body where itis impossible to apply a band, make the cross inci-sions and apply suction just the safie. After givingfirst aid, obtain medical help as soon as possible.

d. If a snake bite kit is available, the suction de-vice in the kit may be used to suck poison from thecrosscuts.

® NME CROSS INCISIONS

O APPLY TOURNIQUET

ESUCK OUT POISON

Figh.ure 33. First aid for snake bite.

80

25. Poison PlantsPoison ivy, poison oak, and poison sumac cause

skin irritation. Learn to recognize these plants, soyou will know when you have touched them and canstart first aid before a rash appears. The sooneryou give first aid for exposure, the milder the effectswill be. Poison ivy is a creeper having three leaveson each stem. The leaves are shiny and pointed andhave prominent veins. Poison oak and poison sumacare shrubs or small trees. If you discover that youhave been exposed to a poison plant, wash the affectedparts of your body promptly and thoroughly withwater and strong soap. GI soap is very good. Therash starts with redness and intense itching. Laterlittle blisters appear. If a rash has already devel-oped, do not wash it. Avoid scratching, for it willmake the condition worse. Get medical attention.

26. Unconsciousness

a. It is often impossible to find out the cause ofunconsciousness. Bleeding, heatstroke, or head in-juries may have been the cause. Give the victim thefirst aid which this manual indicates for such con-ditions (pars. 3a, 8, and 27).

b. If you aren't sure of the cause, keep the personlying down. Do not move him unless it is absolutelynecessary, and then do so very carefully. If he iscold, see that he gets warm. If he has suffered theeffects of excessive heat, give him first aid accordingto paragraph 27. Do not pour liquids into the mouthof an unconscious person. If you do, you may chokehim. Remove from his mouth false teeth, chewinggum, or other objects which might choke him. Take

291776°--54 681

off his equipment. Loosen his clothing. Get a medi-cal officer.

c. If the man has merely fainted, he will regainconsciousness in a few minutes. Let him lie quietly.Loosen his clothing. Apply a wet, cool cloth to hisface. If he is about to faint or has actually faintedwhile sitting up, lower his head between his kneesso that blood may flow to his head. Hold him sothat he does not fall and injure himself.

27. Effects of HeatThe effects of heat can often be prevented by keep-

ing living and working quarters as cool as possible,by keeping the head and body covered when in thesun; by wearing light, loose-fitting clothes; by takingplenty of salt with food; and by drinking enoughwater to which salt tablets have been added.

a. HEAT EXHAUSTION results from excessiveloss of water and salt by the body. This conditionis caused by heavy sweating. Paleness, dizziness,and faintness are symptoms of heat exhaustion.For first aid, remove the soldier to a shade, loosenhis clothing, and give him salt and water if he isconscious.

b. HEATSTROKE, a very serious condition witha high death rate, is characterized by very high bodytemperature and unconsciousness. In hot surround-ings a stoppage of sweating with hot dry skin shouldserve as a warning. The person is bright pink incolor and may become delirious: Treat him by low-ering his body temperature, using shade, removingclothing and immersing him in or sprinkling himwith cool or cold water and fanning him with his

82

Figure 34. Heatstroke.

shirt (fig. 34). Get the aid of a medical officerimmediately.

c. HEAT CRAMPS occur when a person has beensweating a great deal and hasn't been taking extraamounts of salt. He may be seized with musclecramps, especially of the intestines, abdominal wall,arms, or legs. Frequently he vomits and is veryweak. Give him large amounts of salt water.

d. If a Man is Knocked Out by Heat-(1) Carry him to a cool shady place and remove

his clothing.(2) Sprinkle him with lots of cool water.(3) Keep fanning him with his shirt (fig. 34).(4) When he becomes conscious, give him cool

salt water to drink. (Make this by dis-

83

solving two salt tablets or 1/4 teaspoon oftable salt in a canteen of water. He shoulddrink three to five canteensful in 12 hours.)

e. While first aid is being given, get medical helpor arrange to get the victim to medical help.

28. Effects of Cold

a. Trench foot is a serious condition resulting fromcold and moisture. It is so named because it oftenfollows prolonged standing in cold wet trenches orfoxholes. Merely wearing wet socks and footgearfor a long time will also cause it. Trench foot may beso serious that the feet have to be amputated. Youcan prevent trench foot. This is the way:

(1) Avoid standing in water, snow, or mud-soaked areas as much as possible. If thetrench or foxhole contains water, bail itout or put some stones or branches at thebottom on which to stand. If you lie down,try to prop your feet up on a large rock oryour pack. This position will keep yourfeet dry and will help remove congestiondue to long periods of standing.

(2) Exercise your feet and legs whenever pos-sible. If you can't do anything else, moveyour toes and ankles about in your shoes.Avoid cramped positions.

(3) Massage your feet at least once every day.Do it yourself or "pair off" with anothersoldier and massage each other's feet. Agentle massage for several minutes will helpwarm your feet and restore the flow of blood.Put on dry socks.

84

(4) Clean and dry your feet and socks at leastonce daily. You should carry an extra pairof dry woolen socks and put them on as soonas you can after your feet become wet andcold. Dry your feet thoroughly, especiallybetween the toes, and dry your socks and theinside of your shoes or boots as much aspossible (fig. 35).

(5) Avoid tight shoes, socks, and combat shoestraps, for these will interfere with bloodcirculation. It is important that footgearbe loose fitting and waterproof. Socksshould be large enough not to bind yourfeet.

b. Frostbite, or freezing of a part of the body, canbe avoided by wearing warm and loose clothing andkeeping dry. Proper footgear and Imittens are espe-cially important. If any part of your clothing be-comes wet, dry it or change it at once. Rememberthat you can get overheated and perspire in coldclimates, and that this perspiration will freeze in-side your clothes later on. Avoid this by wearinglighter clothing when you are exercising, or by open-ing your clothing to allow air circulation, so that themoisture will escape. Do not touch cold metal, suchas your mess gear or canteen, with your bare handsor lips. Skin immediately freezes to such surfaces;to release it, warm the metal.

(1) If a part of your body gets frostbitten, itbecomes grayish or white and loses feeling.Frequently there is no pain, so keep watch-ing your face and hands and those of yourcompanions for signs. The face, hands,

85

(D AVOID STANDING IN WATER, SNOW OR MUD, EXERCISE YOUR FEETWHENEVER POSSIBLE

MASSAGE YOUR FEET ( DRY YOUR SHOES OR HBOS AID 80C1S ASONCE DAILY OFTEN AS POSSIBLE.

Figure 3S. Prevent trencch foot.

86

and feet are the parts most frequently frost-bitten.

(2) To thaw a frostbitten part, put it next toa warm part of your own body or next tothe warm part of someone else's body. Forexample, put your left hand under yourright armpit; then cover the part with extraclothing or blankets.

(3) If pain becomes too severe while a part isthawing, slow the thawing by exposing thepart to cool air.

(4) Do not rub or bend a frostbitten part ofthe body. Do not rub it with snow or ice.Do not dip it into warm water or bring itclose to a fire.

(5) A room into which a frostbitten person isbrought should be only moderately warm.Wrap the person in blankets and give himwarm drinks.

(6) After the part has thawed, wrap it in steriledressings. Put it in an elevated position(arm in a sling), and keep it at rest. Donot open blisters. Get a medical officer(fig. 36).

29. Drowninga. General Principles of Artificial Respiration.

In performing any method of artificial respiration,you must always keep certain general principles inmind.

(1) Time is of prime importance. Secondscount. Begin at once. Do not take timeto move the victim to a better place; do notdelay artificial respiration to loosen cloth-

87

THAW A FROZEN PART NEXT TO A WARMAREA OP BODY

( WEAR WARM DRY CLOTHING

( BANDAGE THE PART, RAISE IT ANDKEEP IT MOTIONLESS

Figure 36. Frostbite.

ing, to warm the victim, or to give stimu-lants. These measures are secondary; themost important thing to do is to get air intothe victim's lungs.

(2) Qnickly sweep your fingers through the vic-tim's mouth to clear out froth and debris,and draw his tongue forward.

88

(3) The victim's body should be positioned toallow fluids to drain from the respiratorypassages. His head should be extended, notbent forward, and the chin should not sag.

(4) Begin artificial respiration and continue itrhythmically, without interruption, untilthe victim starts natural breathing or is pro-nounced dead. A smooth rhythm is desira-ble, but split-second timing is not essential.

(5) Do not wait for a mechanical resuscitator;but when an approved model is available,use it. However, the mechanical resusci-tator is no more effective than a properlyperformed "push-pull" manual technique,which is immediately available and accom-plishes adequate ventilation. The most im-portant advantages of good mechanicalresuscitators are that they require less skillto operate, they are not fatiguing, they cansupply 100 percent oxygen, and they can beemployed when physical manipulation ofthe body is impossible or would be harm-ful, as during surgical procedures; in acci-dent cases with extensive burns, brokenvertebrae, ribs, arms; for victims trappedunder debris or excavations, overturned ve-hicles; and during transportation of the vic-tim. Furthermore, some resuscitators sig-nal when the airway is obstructed and drawexcess fluid from the respiratory passage ofthe victim.

(6) If the victim begins to breathe on his own,adjust your timing to assist him. Do not

89

fight his attempts to breathe. Synchro-nize your efforts with his.

(7) As soon as the victim is breathing for him-self, or when additional help becomes avail-able, see that his clothing is loosened (or,if wet, removed), that he is kept warm, andis being treated for shock. Do not, how-ever, interrupt rhythmical artifical respira-tion to do this.

b. Back-Pressure Arni-Lift Method. (This meth-od should be your first choice.)

(1) Place the victim in a face-down (prone)position. Bend his elbows and place hishands upon each other. Turn his face toone side and place his cheek upon his hands.

.(2) Kneel at the head of the victim on eitheryour right or left knee. Place your kneeclose to the victim's arm and just to theside of his head. Place your opposite footnear his elbow. If it is more comfortable,you may kneel on both knees, one on eitherside of the victim's head.

(3) Place your hands on the flat of the victim'sback in such a way that the heels of thehands lie just below a line running betweenthe armpits. With the tip of the thumbsjust touching, spread your fingers down-ward and outward (fig. 37().

(4) Rock forward until your arms are approxi-mately vertical and allow the weight of theupper part of your body to exert slow,steady, even pressure downward on yourhands. This forces air out of the victim's

90

lungs. Your elbows should be kept straightand pressure exerted almost directly down-ward on his back. Do not exert sudden ortoo much pressure, and do not place yourhands high on his back or shoulder blades

(fig. 370).(5) Release the pressure by "peeling" your

hands from the victim's back without giv-ing any extra push with the release. Rockslowly backward and grasp the victim'sarms, just above his elbows (fig. 37().

(6) Draw his arms upward and toward you.When doing this, do not bend your elbows;keep your arms straight; and, as you rockbackward, the victim's arms will naturallybe drawn upward and toward you (fig.37(). Put just enough lift on the arms tofeel resistance and tension at the victim'sshoulders. The arm lift pulls on the vic-tim's chest muscles, arches his back, and re-lieves the weight on his chest; this allowsair to be sucked into his lungs.

(7) Gently replace the victim's arms on theground to complete the cycle.

(8) This cycle should be repeated about ten totwelve times per minute at a steady uniformrate to the rhythm of (1) Press- (2) Re-lease- (3) Lift- (4) Release-. Longercounts of equal length should be given tothe "Press" and "Lift" steps; the releaseperiods should be as short as possible.

(9) Remember that either or both of your kneesmay be used; or you may shift knees during

91

bd~~~~~~~~~~~~b

I~~~~~~

U)

NA~~~~b

o

U)j

m E~~~~~~~~~~~~~E

0 -

Q~~~

92

the procedure with no break in the steadyrhythm. Observe how you rock forwardwith the back-pressure and backward withthe arm-lift. This rocking motion helps tosustain the rhythm and adds to the ease ofoperation.

(10) If you get tired and another person isavailable, you can "take turns." Be sure,however, that you do not break rhythm inchanging.

c. Back-Pressure Hip-Lift Method. (Use thismethod when the victim has arm injuries.)

(1) Place the victim in the face-down (prone)position with his elbows bent. Turn hisface to one side and rest it on the back ofone hand. His other hand is placed along-side and above his head.

(2) Kneel on either your right or your left kneeat the level of the victim's hips. Straddlehim and place your foot on the ground nearhis opposite hip. Thus your heel is directlyopposite your kneeling knee.

(3) Now place your hands, with fingers spread,on the victim's midback just below his shoul-der blades. Your two thumbs point towardeach other and are one or two inches fromhis spine, with the fingers pointed outward(fig. 38(). Lean forward and allow theweight of the upper part of your body toexert slow, steady, even pressure downwardon your hands (fig. 380). This forces airout of the victim's lungs. Keep your elbowsstraight and exert pressure almost directly

93

downward. Do not exert sudden or toomuch pressure, and do not place your handshigh on the victim's back or his shoulderblades.

(4) Now release the pressure by quickly remov-ing your hands. This is done by "peeling"your hands from the victim's back withoutgiving an extra push with the release.

(5) As you release, rock backward and graspthe victim's hips. This will be several inchesbelow his waist. Do not grasp his waist.Just slip your fingers under his hip boneswhere they touch the floor (fig. 38®).

(6) Now lift both hips upward and toward you,approximately four to six inches from theground (fig. 38()). This allows his abdo-men to sag downward; his diaphragm de-scends, and air is sucked into his lungs. Besure to keep your arms straight as you lift.In this way the work of lifting is done withyour shoulders and back instead of withyour arms. Do not bend your elbows as youlift the victim's hips.

(7) Gently replace (do not just drop) the vic-tim's hips on the ground in their originalposition. You are now ready to repeat thecycle.

(8) This cycle should be repeated about ten totwelve times per minute at a steady uniformrate to the rhythm of (1) Press-(2) Re-lease-(3) Lift- (4) Release-. Longercounts of equal length should be given tothe active "Press" and "Lift" steps; the

94

release periods should be as short as pos-sible.

'(9) (a) If the knee on which you began theprocedure becomes tired or uncomfort-able, you may switch to the opposite kneewith practically no break in the steadyrhythm. The best time for changingknees is immediately following thePress-Release-phases.

(b) Continue the complete routine as long aspossible. If you become tired, you maycontinue the back-pressure phase aloneat a slightly faster rate (12 to 15 timesper minute) resuming the hip-lift as soonas possible, or performing a hip-lift aftereach second, third, or fourth back-pres-sure or as often as possible.

,(c) If a second person is available, he can"take over" with practically no break inthe rhythm. He does this by "comingin" on the side opposite where you arekneeling. He begins the "Press-Release"after one of the "Lift-Release" phases,while you move away. The relief oper-ator should be in position by the time thenext hip-lift phase of the cycle is due.

d. Chest-Pressure Arm-Lift Method (ModifiedSilvester). (Use this method when the victim can-not be placed face down.)

(1) Place the victim in a face-up position withhis arms folded on his chest. Raise his chinupward and turn his head to the side. Ifavailable, place a small object such as a block

95

02 0

o~~~~~~~~~~~~~G

j. z~~~~~~~~~~

Z e

96

96

or bundle of clothing beneath his shouldersso that his head will drop backward. (Takegreat care to make sure that the air passagesare clear when using this method. If a sec-ond man is available, have him hold thevictim's tongue forward. If necessary, tiethe tongue in position or stick a pin throughit to hold it out of the mouth.)

(2) Kneel on either knee at the victim's head.Place a knee on one side of his head and theother foot on the opposite side of the head.(If the patient is on an operating table orsome other high support, stand at his head.)

(3) Take the victim's arms just above his wristsand place them over the lower ribs (fig.390). Rock forward and exert steady uni-form pressure almost directly downwarduntil you meet firm resistance (fig. 390).This pressure forces air out of the lungs.

(4) Move his arms slowly outward from hisbody and upward above his head. Continuethis motion of his arms and sweep themabove his head and backward as far as pos-sible (fig. 39(). Be sure to keep his armsstraight throughout this maneuver as youraise them first vertically upward and thenabove his head. Lifting and stretching ofthe arms increases the chest size and drawsair into the lungs.

(5) Slowly replace his arms on his chest andrepeat the complete cycle.

(6) The cycle should be repeated about ten totwelve times per minute at a steady uniform

291776°-54 797

rate to the rhythm of (1) Press--(2) Lift-(3) Stretch--(4) Release-. Longer countsof equal length should be given to the"Press," "Lift," and "Stretch" steps; the"Release" period should be as short aspossible.

(7) If you become tired or uncomfortable onone knee, you may quickly switch to theother knee. If it is more comfortable, youmay kneel on both knees, although the for-ward and backward motion is easiest to ob-tain while kneeling on one knee only.

(8) When a second man is available, he maytake over the chest-pressure arm-lift withpractically no break in the rhythm. Thisis done by the first man moving off to oneside while the replacement comes in fromthe other side. When the second man isready, the victim's arms are released duringthe "Stretch" and the new operator takesthem and continues in the same rhythm.

e. Follow-Up Care in Artificial Respiration.When the victim is breathing normally, wrap himin a blanket. He should remain lying down untilhe is seen by a physician or his recovery seems as-sured. When he is conscious, give him a warm drink,such as coffee or tea.

30. Electric Shocka. Electric shock accidents frequently result from

contact with a "live" wire and occasionally occurwhen a person is struck by lightning.

b. If a person has come in contact with an electriccurrent, turn off the switch if it is nearby, but do not

98

(i GRASP THE PATIET 'S ARMS

ROCK FORWARD AD EXERT STEADY PRESSUREDOIIIARD

M OVE THE ARMS SLOLY OlUTWARD UPWARD ABOVETHE HEAD AND BACKWARD AS FAR AS POSSIBLE.

Figure 39. Chest-pressure arm-lift method of artificial

respiration.

99

waste time looking for it. Use a dry wooden pole,dry clothing, dry rope, or some other material whichwill not conduct electricity, to remove the personfrom the wire. If a pole is not handy, simply draghim off the wire by means of a loop of dry cloth(fig. 40qO). Don't touch the wire or man with yourbare hands or you will also -get a shock.

c. Electric shock causes breathing to cease, so startartificial respiration immediately after freeing theperson from the wire. Keep it up for at least 2 hours,just as for drowning (fig. 40Q).

31. Carbon Monoxide Poisoninga. Carbon monoxide gas has no odor and kills

without warning. Poisoning from this gas usuallyis caused by breathing motor vehicle exhaust gas.It frequently occurs when an engine is run withgarage doors closed or when a person sits in a ve-hicle with the windows closed and the motor run-ning, especially when the exhaust becomes clogged,as with snow. The same gas is formed by stovesin poorly ventilated shelters (fig. 41).

b. The symptoms may be dizziness, weakness,headache, vomiting-then unconsciousness.

c. If a person is overcome with carbon monoxide,get him into fresh air and start artificial respirationimmediately. Keep him quiet.

d. There is no excuse for carbon monoxide poison-ing. It results from carelessness. Prevent it.

100

)REMOVE FROM WIRE

(® GIVE ARTIFICIAL RESPIRATION

Figure 40. Electric shock.

101

I--

0~~~~~~

ov

1I~~~~~~~~

1~~~c oIt ~ ~ ~ ~ l

O-

5,, ~ ) _\e DII y

102 ~ ~ ~ 4

CHAPTER 5

TRANSPORTATION OF SICK AND WOUNDED

32. GeneralKnowing how to move seriously injured persons is

one of the most important parts of first aid. Carelessor rough handling not only may increase the serious-ness of an injury, but also may even cause the vic-tim's death. Unless there is a good reason for im-mediately moving an injured person, do not transporthim until a litter or ambulance is available. Some-times when the situation is urgent and you knowthat no medical facilities are available, you will haveto move the victim yourself. That is why you shouldknow the different ways of carrying casualties. Al-ways give necessary first aid before attempting tomove the wounded soldier. If the casualty has abroken bone, never attempt to move him unless youhave splinted it.

33. Improvised LittersUsing a litter not only makes it easier for you to

carry the casualty, but also makes the journey saferand more comfortable for him. If the distance islong or if the patient has a fracture of the leg, hip,back, neck, or skull, he must not be moved except ona litter. A litter can be improvised from many dif-ferent things.

a. Pole and Blanket Litter. A blanket, shelter

103

half, tarpaulin, or other material may be used forthe litter bed. The poles may be made from suchobjects as strong branches, tent poles, rifles, and skis(fig. 42).

() OPEN A BLANKET, LAY ONE POLE 3 PLACE THE SECOND POLE ACROSSLENGTHWISE ACROSS THE CENTER THE CENTER OF THE NIm FOLD.AND FOLD BLANKET OVER IT.

( FOLD THE FREE EDGES OF TSE BLANKETOVER THE SECOND POLE.

Figure 1/2. Pole and blanket litter.

b. Pole and Jacket Litter. Obtain two or threeblouses, shirts, or field jackets. Button them up andturn inside out so that the lining is outside and thesleeves inside. Pass a pole through each sleeve (fig.43).

c. Door or Board Litter. Use any plane-surfacedobject of suitable size, such as cots, window shutters,doors, benches, ladders, boards, or poles tied together.Pad the litter if possible (fig. 43).

d. Pole and Sack Litter. Rip open the bottomsor cut the corners of sacks, bags, bedticks, or mat-tress covers. Pass two poles through them (fig. 44).

104

POLE AND JACKET LITTER

DOOR OR BOARD LITTER

Figure 43. Pole and jacket litter and door or board litter.

105

POLE AND SACK LITTER

BLANKET ROLL LITTER

Figure 44. Pole and sack litter andc blanket roll litter.

e. Blanket Roll Litter. If no poles can be ob-tained, roll a blanket, shelter half, or tarpaulin fromboth sides toward the center. Use the rolls as gripswhen carrying a patient (fig. 44).

34. CarriesSeveral ways by which a casualty may be moved

without a litter are shown below. Some of thesecarries require only one man; others require two.Methods of dragging a casualty when under enemyfire are also shown. Use the carry which is easiestfor you and which is best for the situation. Do not

106

I ugs

O( Turn the man face down on the ground and support his head onhis arm

() Place hands on man's shoulders

Figure 4/5. Firemlan's carry.

107

attempt to carry a nan woho has a broken back orneck.

a. Fireman's Carry. The fireman's carry is theeasiest method for one man to carry another (fig. 45).

b. Alternate Methods. After getting a man offthe ground by using the first three steps of the fire-man's carry, you can use any of the following one-man carries:

(1) Supporting Carry. Grasp the wrist of theman's uninjured arm and draw his armaround your neck. Then the man can walk,

® Straddle the man and(placing your hands underhis armpits) lift him to a ( Support the man by arm around

standing position his waist and step to his front

Figure 45.-Coltinued.

108

®( Grasp the man's right handwith your left hand. Bend atthe waist, pulling his right armaround the back of your neck sothat his body comes across your

back

® Grasp his legs at the kneeswith your right arm. Lift O Then grasp the man's right hand,the man off the ground as leaving your left hand free-this isyou straighten up. Hold his the position of carry. A man can be

knees in your right hand carried some distance in this manner

Figure 45.-Continued.

109

using you as a crutch. This carry is usefulwhen the man is only slightly hurt, as infoot and ankle injuries (fig. 46).

(2) Arms Carry. This is good for short dis-tances. Carry the patient high to lessen

Figure 46. Supporting c,arry.

fatigue. Do not use this carry when theman has a broken leg (fig. 47).

[(3) Saddle-Back Carry. After getting the manup, keep a hold on his arm and step in frontof him. Have the man encircle your neckwith his arms; then stoop, clasp your handsbeneath his thighs, and raise him upon yourback (fig. 48).

(4) Pack-Strap Carry. After raising the man,step in front of him. Grasp his wrists withyour hands and hoist him so that his arm-

110

Figure 47. Arms carry.

Ill

Figure 48. Saddle-back carry.

111

pits are over your shoulders. This is a goodway to carry an unconscious man. Do notuse it if the man has any broken bones(fig. 49).

( aFigure 49. Pack-strap carry.

c. Back Lift and Carry. For this carry, the manmust be conscious and able to stand on one leg. Afterraising him to a standing position, place yourselfback to back with him. Have him stretch out hisarms sideways. Bend backward, put your handsunder his arms, and grip his upper arms. Bendforward, pulling him onto your back (fig. 50).

d. Pistol-Belt Carry (fig. 51).e. The Neck Drag. Tie the man's hands together

and loop them around your neck. This enables you

112

Figlre 50. Back lift and carry.

to crawl along, dragging the man, who may be un-conscious. The advantage of this method is thatboth you and the man you are carrying can remainlow on the ground; thus you are protected. Neverattempt to drag a man with a broken neck or back(fig. 52).

f. Pistol Belt Drag. Extend two pistol belts andjoin them in one continuous sling. After placingthe man on his back, pass a loop of the sling over hishead and work it into position across his chest andunder his armpits. Then cross the sling straps atthe man's shoulder, forming another loop. Lieslightly forward on your stomach beside the man.Slip the second loop of the sling over your arm andshoulder. Place your arm which is nearest the man's

291776°-54--8113

Link together two pistol belts into a continuous belt. Place itunder the man's thighs and hips so that a loop extends from each

side.

® Lie between the man's outstretched legs. Thrust your armsthrough the belt loops. Grasp the man's right hand with your left

hand and his right leg with your right hand.

® Then rolling toward the left side, turn face downward, carryingthe wounded man onto your back. Adjust slings before proceeding.If the man has an injury on the left side, grasp the man's left hand

with your right hand nnd his left leg with your left hand.

Fig/ure 51. Pistol-belt carry.

114

A Then rise to a kneeling position. The continuous belt will holdthe man in place.

® Place one hand on yourknee for support, thenstand up. The man is nowsupported on your shoul-

ders.

Figure 51.-Continued

115

® Your hands are freeto help you climb steepbanks and get overother obstacles. Bothyou and the man youcarry can fire rifles.

Figu-re 51-Continued.

head underneath his head to protect it during move-ment. Then advance by crawling, dragging the manwith you. This carry permits both you and the mancarried to remain on the ground, protected fromenemy fire. It can be used only for very short dis-tances (fig. 53).

116

Figure 52. Neck drag.

Figtre 53. Pistol-belt drag.

117

BY ORDER OF THE SECRETARY OF THE ARMY:

M. B. RIDGWAY,General, United States Army,

OFFICIAL: Chief of Staff.WM. E. BERGIN,

Major General, United States Army,The Adju taent General.

DISTRIBUTION:

Active Army:

Tech Svc (1) ; Admin & Tech Svc Bd (1); AFF (5);AA Comld (5) ; OS Maj Comd (10) ; Sec (5) ; BaseComd (2); MDW (5); Log Comd (2); A (5);CHQ (2); Div (10) ; Brig (2) ; Regt (5); Bn(2) except 8 (15) ; Co (2) ; FT (2); USMA (25);Sch (100); PMS & T (2); Dep (2); Tng Div(100); Army Hosp (5); US Army Hosp (5);RTC (10); Pers Cen (1); POE (2), OS SupAgencies (1); PRGR (1); Ars (1) ; Dspln Bk (2);Rct Dist (1); Rct Sta (1); Ind Sta (1); Disp(5); Lab (2); Div Engr (1); Engr Dist (1); Mil)ist (1) ; MAAG (2) ; Mil Mis (2); T/O & E 8-

510A (15), 8-520A (4), 8-580A (15), 8-581A (10),8-590A (15), 8-750 (5).

NG: Same as Active Army except one copy to each unit.USAR: Same as Active Army except one copy to each

unit.For explanation of distribution formula, see SR 310-90-1.

U S. GOVERNMENT PRINTING OFFICE: 1954118