The Mammoth Book of Secrets of the SAS & Elite Forces

by Jon E. Lewis

  Loosen any tight clothing around his neck.

  3 Inflate his chest: Pinch his nose, take a deep breath and breathe hard into his mouth, hard enough to make his chest rise. Then remove your mouth and allow his chest to fall. Repeat every six seconds and continue until he begins to breathe. If EAR is still not working, check that his airway is still clear and that his neck is extended properly.

  Don’t be squeamish

  The most difficult part of EAR is getting started. The casualty may have other injuries; there may be blood and vomit in and around his mouth. He may even be dead. But apart from a quick wipe around his mouth there is no time to be lost; without prompt EAR, the casualty will die.

  When the heart stops

  If a casualty has stopped breathing his heart may have stopped too. When you first examine the casualty, check his pulse by feeling the side of his windpipe; you should be able to feel the carotid artery at work. This is the best place to check, as a weak pulse is difficult to detect at the wrist.

  Combining EAR and ECC

  If someone’s heart has stopped beating; their breathing will soon cease and you will have to carry out artificial respiration as well as cardiac massage. Ideally, two people should treat the casualty; one doing EAR and the other External Cardiac Compression (ECC). However, you might have to do both on your own until help arrives. If you do, then use 15 compression of the heart to two expansions of the chest. Remember to keep the airway clear.

  External Cardiac Compression

  1 Check pulse: Check the casualty’s pulse at his carotid artery and if there is no pulse commence ECC. NEVER perform ECC on someone whose heart is still beating.

  2 Position: Position the casualty as for EAR; neck extended and airway clear. Now find the lower end of the sternum (breastbone).

  3 Your hands: With both your hands palm down, place one on top of the other with the fingers interlaced. Place the heel of the lower hand three fingers width up from the bottom of the sternum.

  4 Commence compression: Push down with the weight of your body, pushing the casualty’s breastbone towards his spine. Lift your hand to allow the chest to recoil. Repeat 60 times per minute, checking the pulse every fifth push.

  WARNING

  You must never practise External Cardiac Compression on a real person because it is very dangerous. Never start or continue to give cardiac massage to a casualty whose heart is beating, no matter how faintly.

  CONTROLLING BLEEDING

  When you’ve got the casualty breathing again, you can turn your attention to controlling any bleeding; the second most common cause of death from injury. Bleeding may be in the form of a slow ooze from the very smallest of blood vessels, or a much more rapid loss from a major vessel. If it’s spurting out, it is coming from an artery and this is very serious.

  Occasionally, bleeding stops of its own accord, either from retraction of the blood vessels or clotting of the blood, but this is likely only with small or superficial wounds.

  First steps

  These simple measures will help to control bleeding in most cases. Points 2 and 4 apply to injured limbs. The most important factor in dealing with bleeding is speed! But make sure that you are treating the most serious wound. Check over the whole body and, in the case of gunshot wounds, do not expect the exit hole to be in line with the entry point.

  1 Place the casualty in a comfortable position: This reduces the blood flow as his heart will be making less effort to pump blood.

  2 Raise the limb: This also reduces the bleeding but think careful before doing this in case you cause further injury, if in doubt, don’t!

  3 Apply pressure to the bleeding wound: This will often stop the bleeding completely; place a dressing over the wound and apply pressure with the palm of your hand. Make sure the dressing is big enough, and use a sterile one if available; but any piece of clean material will do. If you can’t find a dressing big enough to cover the wound, press it down where the bleeding is worst. If bleeding continues despite pressure, apply a second dressing on top of the first. Do not lift the first one to see what is happening! You can apply up to three dressings, and none should be removed until the casualty gets to hospital.

  4 Immobilize the limb

  Pressure Points

  Any place where an artery crosses a bone close to the skin is a pressure point, pressure applied at these areas will, in theory, interrupt the blood flow. If the pressure point is between the heart and the bleeding point, you may be able to stop the flow altogether.

  In practice, only two pressure points are of much use; the brachial and femoral areas. Direct, firm pressure at these points can be used to stop bleeding in the arms and legs. To carry out the procedure:

  1 Place the thumb or fingers over the pressure point.

  2 Apply sufficient pressure to stop the blood flow and hence the bleeding.

  3 After 15 minutes, slowly release the pressure.

  4 If bleeding has stopped dress the wound.

  5 If bleeding starts again, repeat the process.

  The release of pressure after 15 minutes is essential to allow blood to reach the tissues beyond the pressure point; if this is not done they may be damaged. Resist the temptation to release pressure in under 15 minutes to see how you are getting on, as bleeding will not yet have been controlled.

  Internal bleeding

  Internal bleeding is harder to deal with. It may have been caused by a severe blow to the abdomen, a crush injury to the chest, or by the blast effects of an explosion. Also if a bone is broken, especially a large one such as the femur (thigh bone) there will be bleeding in the surrounding tissue. Internal bleeding can cause any or all of the following symptoms.

  1 Pallor

  2 Cold, clammy skin

  3 Rapid, weak pulse

  4 Restlessness and weakness

  Treatment is difficult and depends on rapid evacuation to hospital. In the meantime, talk to the casualty and make him as warm and comfortable as you can.

  TREATING SHOCK

  Shock is a term that is very often misused and misunderstood. How often have you heard of people being admitted to hospital suffering from shock after an accident? In the vast majority of cases they are suffering from no such thing. What has actually happened is they have had a nervous reaction to the accident; they are not suffering from shock in the medical sense of the word.

  True shock is a major cause of death after injury, and is the reaction of the body to a loss of circulating body fluid, which in most injury cases means a loss of blood. In the case of burns the casualty may lose a substantial amount of fluid from the burn itself.

  Recognising the symptoms

  A casualty suffering from shock will show several of these symptoms

  1 Paleness

  2 Cold and clammy skin

  3 A fast, weak pulse

  4 Rapid, shallow breathing

  5 Anxiety

  6 Faintness, giddiness and blurred vision

  7 Semi-consciousness or unconsciousness

  He will also have a low blood pressure although it is unlikely that you will be able to measure this.

  These signs are the result of the body’s attempt to keep up the blood pressure and so maintain an adequate supply of blood to essential organs such as the brain.

  Unfortunately the signs of a purely nervous reaction can be very similar; people can be pale sweating and indeed sometimes unconscious. If in doubt treat for shock.

  Treatment

  There is very little the first-aider can do: evacuation to proper medical assistance is essential, as the casualty will need intravenous fluids or blood. But while waiting for this, you can take some immediate steps.

  1 Lie the casualty down

  2 Make sure his airway is clear

  3 Look for and stop any bleeding

  4 Raise his legs above the level of his head

  5 Support any injured limbs with splinting

  6 Protect the casualty from exposure to wind and rain

  7 NEVE
R give the casualty alcohol

  8 Reassure the casualty

  Raise the casualty’s legs so that they are higher than his heart, but check his legs for fractures first.

  Keep the casualty warm. Remember to insulate him from the cold ground; don’t just pile a blanket on top

  If you are forced to leave the casualty or if he is unconscious, tilt his head to one side so that he will not choke if he vomits.

  BATTLESHOCK

  This is a temporary psychological reaction to the stress of battle which can produce similar symptoms to shock; heavy casualties or prolonged bombardment can cause physically sound soldiers to become unable to fight effectively. During World War I “shell shock” was not sufficiently understood, and some victims found themselves charged with cowardice. In fact, if detected early and treated as far forward as possible, battleshock can be overcome. Those most at risk are inexperienced troops or newly arrived replacements who are not yet “part of the team”. However, courage can be a consumable resource, and if a combat veteran exhausts his reserves he too can fall prey to battleshock.

  Symptoms

  Most people in action will show some signs of fear, so sweating or trembling are not reliable indicators of impending battle-shock. Watch for the following:

  1 Physical symptoms without actual injury

  2 Severe restlessness

  3 Overwhelming despair

  4 Panic reaction to sound

  5 Indecision among officers or NCOs

  Treatment

  Casualties from battleshock are best treated forward rather than sent to the rear away from their own unit. Respite from the worst of the battle, sleep, hot drinks and the chance to relive experiences with friends all help repair the psychological damage. Getting a casualty busy with some simple but useful task is also helpful. Avoid medication or alcohol.

  HYSTERIA

  A fatal combination of youth, inexperience and poor discipline can lead to some troops becoming hysterical and going berserk. Treatment is:

  1 Remove the casualty’s weapons and make them safe.

  2 Administer Diazepam tablet from the cap of the casualty’s Combopen. Repeat at 30-minute intervals if necessary.

  3 If tactically necessary, administer morphine.

  4 Casevac the victim. The stretcher bearers should take the casualty’s personal weapon.

  5 At all times be calm and reassuring

  CHEST WOUNDS

  Chest injuries can be very serious and must be recognized and treated urgently; prompt evacuation to proper medical care is essential. You can treat superficial injuries like any other wound, with a clean dressing, but watch out for these serious problems.

  CRUSH INJURIES

  The casualty may have fractured ribs, often in several places. At the site of the injury the chest wall will no longer be rigid, and breathing becomes difficult as the chest is no longer effective in pumping air in and out of the lungs. Worse, air could be getting moved from one side of the chest and back again rather than up and down the windpipe. The casualty tries to overcome this by taking deeper breaths, which only makes matters worse.

  Recognising the symptoms

  Look for the following

  1 Abnormal movement of the chest

  2 Painful and difficult breathing

  3 Distress and anxiety

  4 Cyanosis (blueness) of the lips and mouth

  5 Signs of shock.

  Treatment

  The aim of the treatment is to stop the abnormal movement of the chest wall. If the casualty is unconscious, you should:

  1 Check and clear his airway

  2 Place him in the three-quarters prone position

  3 Place a hand over the injured area to provide support

  4 Place a layer of padding over the area and secure it with a firm, broad bandage.

  5 Treat for shock

  If he is conscious, carry out steps 3 and 4 with him sitting upright.

  OPEN CHEST WOUNDS

  If the wound is severe enough there may be a hole in the chest wall. Air will get in and the lung will collapse, and air will go in and out of the hole instead of up and down the windpipe.

  Recognising the symptoms

  Look for the following:

  1 Shallow and difficult breathing

  2 The sound of air being sucked in and out of the chest wall

  3 Bloodstained fluid bubbling from the wound

  4 Cyanosis of the lips and mouth

  5 Signs of shock

  Treatment

  The aim is to prevent the air going in and out of the chest wall. Quite simply, you must plug the hole. Whether the casualty is conscious or unconscious you should:

  1 Make sure his airway is clear

  2 Seal the hole in his chest by placing a large dressing over the wound and fixing it in place with a firm, broad bandage. Make sure it completely covers the wound forming a seal.

  3 Place the casualty on the injured side to help maintain the seal.

  4 Treat for shock.

  BLEEDING INTO THE CHEST

  Crush or open wounds may be accompanied by bleeding into the chest. It may also happen without obvious external signs of injury, particularly following an explosion when the casualty suffers what is known as blast injury.

  Recognising the signs

  You should suspect bleeding into the chest if the casualty:

  1 Shows signs of shock

  2 Is coughing up blood

  3 Has difficulty in breathing

  Treatment

  Unfortunately there is very little a first-aider can do about internal bleeding into the chest apart from general measures for the treatment of shock. The important thing is to recognize that there is a problem and to arrange for urgent evacuation

  TREATING ABDOMINAL WOUNDS

  The abdomen, the part of the body between the chest and the pelvis is often mistakenly referred to as the stomach. The stomach is just one of the contents of the abdomen; other important organs are the bowels, liver, spleen, kidneys and bladder. An abdominal injury may result in severe shock and the majority of cases will require surgery.

  As well as injury to internal organs there may be considerable internal bleeding. A further cause of trouble is infection, which is particularly likely if the gut is penetrated or torn.

  WARNING:

  Casualties with abdominal wounds should not be given anything by mouth.

  First aid treatment is very simple. All you can do is make the patient comfortable and cover the wound.

  Recognising the symptoms

  An abdominal wound is usually obvious and part of the guts may be sticking out. There may be severe bruising to the abdomen or lower chest, back or groin. The injury may be the result of a direct blow or the casualty may have suffered a blast injury. Other signs are:

  1 Pain or tenderness in the abdomen

  2 Vomiting, which may contain blood

  3 Tense abdominal muscles

  4 Shock

  Treatment

  Make the casualty lie down on his back with his knees drawn up. This will help to relax the muscles and ease the strain on the abdomen. If the patient is not suffering too much shock, the head and shoulders may also be raised.

  Cover the wound with a clean dressing. If any guts or tissues are sticking out, don’t try to push them back in; just leave them as they are and cover with the dressing. Also don’t try to remove the debris from the wound or you make matters worse.

  Do not give the casualty any food or drink, but protect him from further injury and from wind and rain and keep him warm. Arrange for speedy evacuation.

  TACKLING BURNS

  Burns are the last of the four Bs. They are an increasingly common type of injury, particularly in tactical military situations where damage to vehicles often results in fire or explosions. Burns range from the superficial and small to those involving extensive tissue damage.

  NEVER APPLY BUTTER OR SIMILAR FAT; THIS WILL INSULATE THE AREA AND CAUSE FURTHER DAMAGE.


  People with extensive deep burns may eventually die from them, but the great majority of fire deaths result from damage to the lungs by smoke and fumes or by the heat of the fire. People who have this sort of damage may have little or nothing in the way of visible breathing. In these cases you should try expired air resuscitation until medical help can be obtained, but unfortunately this is often unsuccessful. However, that’s no reason for not trying.

  TYPES OF BURN

  Burns used to be described as first, second, or third degree, but this system is no longer used; burns are now classified as superficial, or deep. Superficial burns will appear red, swollen and tender.

  SIX STEPS FOR DEALING WITH BURNS

  1. If the casualty’s clothing is on fire, lay him down and extinguish the flames with water, a fire bucket or similar heavy material that will cut off the air from the fire.

  2. Cool the burn area using clean water or other harmless liquid for example milk, beer etc. It is important to stop the “cooking” effect of the heat; do not apply fat, cream or ointments.

  3. Cover the burn with a sterile dressing

  4. Do not break any blisters or remove burnt clothing (unless it is hot)

  5. If the casualty has facial burns, make a mask with a clean dry cloth, and cut holes for nose, mouth and eyes.

  6. Immobilize a badly burned limb as for a fracture.

  Your first priority is to extinguish the flames if the casualty is on fire. Use water if available, or a blanket to smother the flames. If indoors and the building is not at risk, stay inside. Rushing out would only make the flames worse.

  Wrap the casualty in a heavy material which will not catch fire and lay him on the ground. Then remove any clothing which has been soaked in boiling fluid, but leave cooled, dry burnt clothing alone.