Emergency Care Nursing

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BANDAGING

Bandaging is both a science and an art. The proper bandage, properly applied, can

aid materially in the recovery of the patient. A carelessly or improperly applied bandage can

cause discomfort to the patient and may imperil his life. Thus, it is important that enlisted

men of the Medical Department should become familiar with the various bandages and be

able to apply them properly. The following pages will aid the student and the teacher; but the

art of bandaging can be mastered only by constant practice.

USE OF BANDAGES

Bandages are employed to hold dressings, to secure splints, to create pressure, toimmobilize (make immovable) joints and in correcting deformity. Bandages should never be

used directly over a wound. They should only be used over a dressing.

- To support fractured bones

- To immobilize dislocated shoulder or jaw

- To apply pressure, stop bleeding and improve venous blood flow

- To secure dressing in place

- To retain splints in place

PRINCIPLES AND PRCEDURES

- Wash hands(wear gloves when necessary)

- Assist to assume comfortable position on bed or chair and support the body part to

be bandaged.

- Always stand in front of the part/victim to be bandaged except when applying a

bandage to the head, eye and ear.

- Be sure the bandage is rolled firmly.

- Make sure the body part to be bandaged is clean and dry.

- Assess skin before applying bandage for any breakdown.

- Observe circulation by noting pulse, surface temperature, skin color and sensation

of the body part to be wrapped.

- Always start bandaging from inner to outer aspect and far to near end.

When bandaging a joint, ensure flexibility of the joint. (Except immobilization of joint

is required)

- Always start and end with two circular turns.

- Cover the area 2 inches above and 2 inches below the affected area

- Overlap turns and slightly stretch the bandage.

- Cover 2/3 of the previous turn.

- Where possible, leave fingertips or toe tips exposed for observation(adequacy of

blood circulation)

- End the bandage on the outer side of the body. Do not end bandage on wound or at

the back of the body.

TYPES OF BANDAGES

1. Triangular bandage

-could be used on many parts of the body to support and immobilize.

2. Crape Bandage

-type of woven gauze which has the quality of stretching.

3. Gauze/cotton bandage

-lightly woven cotton material. Frequently used to retain dressings fingers,

hands, toes, feet, ears, eyes, head.

4. Adhesive bandage

-used to retain dressing and also used where application of pressure to an area is

needed.

METHODS OF APPLYING BANDAGES

- Circular

- Spiral

- Spi ra l Reverse

- Figure of E ight

- Recurrent

-

I. CIRCULAR TURN



Purpose: Used chiefly to anchor bandages and to terminate bandages. Usually are not

applied directly over a wound because of the discomfort the bandage would cause.

1. Hold the bandage in your dominant hand, keeping the roll uppermost, and unroll the

bandage about 8cm. This length of unrolled bandage allows good control for

placement and tension.

2. Apply the end of the bandage to the part of the body to be bandaged. Hold the end

down with the thumb of the other hand.

3. Encircle the body part a few times or as often as needed, making sure that each

layer overlaps ½ -2/3 of the previous layer. This provides even support to the area.

4. The bandage should be firm, but not too tight. Ask the client if the bandage feels

comfortable. A tight bandage can interfere with blood circulation, whereas a loose

bandage does not provide an adequate protection.

5. Secure the end of the bandage with tape or a safety pin over an uninjured area. Pins

can cause discomfort when situated over an injured area.

II. SPIRAL TURNS

Purpose: Used to bandage parts of the body that are fairly uniform in circumference, for

example, the upper arm or the upper leg.

1. Make two circular turns. Two circular turns anchor the bandage.

2. Continue spiral turns at about a 30 degree angle, each turn overlapping the

proceeding one by 2/3 the width of the bandage.

3. Terminate the bandage with 2 circular turns and secure the end as described for

circular turns.

III. SPIRAL REVERSE TURNS

Purposes: Used to bandage cylindrical parts of the body that are not uniform in

circumference, for example, the lower leg or forearm.

1. Anchor the bandage with 2 circular turns, and bring the bandage upward at about a

30 degree angle.

2. Place the thumb of your free hand on the upper edge of the bandage. The thumb

will hold the bandage while it is folded on itself.

3. Unroll the bandage about 15cm (6 inches), and then turn your hand so that the

bandage falls over itself.

4. Continue the bandage around the limb, overlapping each previous turn by 2/3 the

width of the bandage. Make the bandage turn at the same position on the limb so

that the turns of the bandage will be aligned.

5. Terminate the bandage with 2 circular turns and secure the end as described for

circular turns.

IV. RECURRENT TURNS

Purposes: Used to cover distal parts of the body, for example, the ends of a finger, the skull

or the stump of an amputation.

1. Anchor the bandage with two circular turns,.

2. Fold the bandage back on itself, and bring it centrally over the distal end to be

bandaged.

3. Holding it with the other hand, bring the bandage back over the end to the right of

the center bandage but overlapping it 2/3 the width of the bandage.

4. Bring the bandage back to the left side, also overlapping the first turn by 2/3 the

width of the bandage.

5. Continue this pattern of alternating right and left until the area is covered. Overlap

the preceding turn by two-thirds the bandage width each time.

6. Terminate the bandage with two circular turns. Secure appropriately.

V. FIGURE 8 TURNS

Purposes: Used to bandage an elbow, knee or ankle, because they may permit some

movement after application.

1. Anchor the bandage with two circular turns.

2. Carry the bandage above the joint, around it and below it, making a figure eight.

3. Continue above and below the joint, overlapping the previous turn by two-thirds the

width of the bandage.

4. Terminate the bandage and above the joint with two circular turns and then secure

appropriately.

TRIANGULAR AND CRAVAT BANDAGES

The triangular bandage, also known as the handkerchief bandage, is used for the

temporary or permanent dressing of wounds, fractures, dislocations, etc., and for slings. It is

very valuable in first-aid work since it is quickly and easily applied, stays on well, and can be



improvised from any kind of cloth, such as a piece of a shirt, an old sheet, a large

handkerchief, etc. Unbleached muslin is generally used in making triangular bandages,

although linen, wool, silk; etc., will answer the purpose. In making triangular bandages a

square of material about 3 by 3 feet, or slightly more, is folded diagonally to make one

bandage or may be cut along the fold to make two bandages. The long side of the triangle is

called the "base," the point opposite the base is called the "apex", and the points at each end

of the base are called the "ends" or "extremities." These bandages may be used either as a

triangle or as a cravat, the latter being made from the triangle by bringing the apex to the

base and folding it upon itself a sufficient number of times to obtain the width desired. The

names of the-various triangular and cravat bandages indicate the part of the body to which

the bandage is applied.

PROCEDURES

I. TRIANGLE OF FOREHEAD OR SCALP (fronto-occipital)

- Used to retain dressings on the forehead or scalp.

1. Place middle of base of triangle so that edge is just above eyebrows and bring apex

backward, allowing it to drop over back of head (occiput).

2. Bring ends of triangle around to back of head, above ears, and cross them over apex

at occiput.

3. Carry ends around to forehead and tie them in square knot.

4. Turn up apex of bandage toward top of head. Pin with safety pin or tuck in behind

crossed part of bandage.

II. TRIANGULAR ARM SLING (brachio-cervical triangle)

-Used for fractures or injuries of hand, wrist, and forearm.

1. Arm to be put in sling should first be bent at elbow so that little finger is about a

hand's breadth above level of elbow.

2. Drop one end of triangle over shoulder on injured side and let bandage hang down

over chest with base toward hand and apex toward elbow.

3. Slip bandage between body and arm. Carry lower end up over shoulder on injured

side.

4. Tie the two ends, by square knot, at back of neck. Knot should be on either side of

neck, not in middle, where it could cause discomfort when patient is lying on back.

5. Draw apex of bandage toward elbow until snug, bring it around elbow to front, and

fasten with safety pin or adhesive tape.

III. TRIANGULAR ARM SLING

- Another version of this sling is frequently used where it is desirable to support the

forearm, without pressure on the collarbone or shoulder of the injured side.

2. Start as in (1).

3. and pass lower end of bandage under injured shoulder. Ends of fingers shouldextend slightly beyond base of triangle.

4. Tie ends. Secure apex to sling at elbow by tucking in or with safety pin.

IV. SHOULDER-ARMPIT

- (bis-axillary) Used to hold dressings in the armpit (axilla) or on the shoulder.

1. Place middle of cravat in armpit over dressing.

2. Carry ends upward and over top of shoulder.

3. Cross ends lnd bring them across back and chest respectively to opposite armpit

where they are tied.

V. TRIANGLE OF CHEST OR BACK

- Used to retain dressings on burns or wounds.

1. Drop apex of triangle over shoulder on injured side. Bring bandage down over chest

(or back) to cover dressing and so that middle of base of bandage is directly below

injury. Turn up a cuff at base.

2. Carry ends around body and tie in square knot.

3. Bring apex down and tie to one of ends of first knot.

VI. TRIANGLE OF SHOULDER

- Used to retain dressings on shoulder. Requires two bandages, one a triangle, and the

other a cravat.

1. Place center of cravat at base of neck on injured side, and tie just forward of

opposite

armpit.

2. Place apex of open triangle under cravat at base of neck and over dressing on

injured

shoulder and upper arm.

3. Tuck apex under cravat at neck.

4. Cross ends of base and tie around arm; secure apex to cravat at neck by tucking in

6r

with safety pin.

VII. TRIANGLE OF FOOT

- Used to retain dressings of considerable size on the foot.

1. Center foot upon bandage at right angles to base. Heel should be well forward.

2. Carry apex of triangle over toes, and cover back of foot to ankle.

3. Tuck excess fullness of bandage into small pleats on both sides of foot.

4. Cross each half of bandage toward opposite sides of ankle. Bring ends of triangle

around ankle. Tie ends in square knots.

VIII. TRIANGLE OF HAND

- Used to retain dressings of considerable size on the hand.

1. Place middle of base of triangle well up on palmar surface of wrist.

2. Carry apex around ends of fingers and cover back (dorsum) of hand to wrist.

3. Tuck excess fullness of bandage into small pleats on both sides of fingers.

4. Cross each half of bandage toward opposite sides of wrist.

5. Bring ends of triangle around wrist.

6. Tie ends in square knot.

FOLDING TRIANGULAR BANDAGES

- for storage and shipment

1. Bandage unfolded.

2. Fold once left to right.

3. Fold ends right to left.



4. Fold apex down to form square.

5. Fold in half, right to left.

6. Fold down through center

Cravat Bandaging

A triangular bandage can be folded into a strip for easy application during emergencies.

CRAVAT FOR HEAD OR EAR

INDICATION: The purpose of this bandage is to apply pressure to control hemorrhage from

wounds of scalp, or to hold dressings on wounds of ear or lower scalp. (Applied when thevictim has wound on the forehead)

1. Cover the wound with a dressing and place the middle of the bandage over the

wound as illustrated below.

2. Cross both ends of the bandage and gently pull and wrap them in opposite

directions around the head as illustrated.

3. As illustrated below, tie both ends in square knot, making sure that it is fully tight.

CRAVAT FOR JAW OR CHEEK

INDICATION: The cravat of jaw (mento-vertico-occipital cravat) is used to hold dressings on

the chin, cheeks, and scalp, and as a temporary support to immobilize a fractured or

dislocated jaw. (Applied when there is a fractured jaw or wound on the ear of the victim)

1. After making a triangular bandage into a cravat of proper width, place it under the

chin and carry ends upward with one end longer than the other.

2. Bring longer end over the top of head. Cross both ends on side of head. (Ends shouldnow be of equal length)

3. Pass ends around head in opposite directions and tie with square knot on other side

of head on primary turn of cravat.

CRAVAT FOR THE EYES

INDICATION: The cravat bandage of the eye is used to hold a dressing over the eye. Two

cravats are required. (Applied when there is wound or injury in either of the victim’s eye,

laceration of the eyelids, or lacerated eyeball.)

1. Lay center of first cravat over top of head with the front end falling over uninjured

eye. Bring second cravat around head, over eyes, and over loose ends of first

cravat.

2. Tie in front. Bring ends of first cravat over top of head, tying there and pulling

second cravat up and away from uninjured eye.

SHOULDER-ARMPIT CRAVAT

INDICATION: The shoulder – armpit cravat (bis-axillary) is used to hold dressings in the armpit

(axilla) or on the shoulder. (Applied when there is wound or injury over the shoulders, burns,

or shoulder dislocation.)

1. Place cravat over dressing in armpit so the front end is longer than the back.

2. Carry the ends upward. Bring ends across each other over top of shoulder.

3. Cross ends over back and chest respectively to opposite armpit.

4. Tie ends just in front of uninjured armpit.

CRAVAT OF THE ELBOW

INDICATION: The cravat of elbow is used to hold dressings around the elbow. (Applied when

there is sprain on either right or left elbow of the victim)

1. Bend the arm to approximately 90 degrees and at the elbow and place the mid-portion of the cravat bandage at the elbow bringing and holding the ends of the

bandage upwards.

2. Cross both bandage ends and gently rolled extending both ends downward.

3. Roll both ends gently around the arm and pull both ends opposite the elbow and tie

it in square knot.

CRAVAT OF OPEN PALM

INDICATION: (Applied when there is vertical wound on either right or left palm of the victim.)

1. Apply a dressing to the wounded area and lay the mid of the cravat bandage over

the palm with the ends hanging on both sides.

2. Bring the end of the cravat from the little finger across back of the hand rolling it

upward over the base of the thumb; gently and slightly pull it downward across the

palm.

3. Hold the thumb end of the cravat and roll it across the back of the hand and pull it

over the palm towards the hollow portion of the palm in between the thumb and thepalm.

4. Take both ends to the back of the wrist of the hand and roll them crossing each

other, and then roll them up over the wrist and cross the both ends again.

5. Roll both ends at the back of the hand and tie with a square knot at the top of the

wrist.

CRAVAT OF CLOSE PALM (Applied when there is burned on the hand)

1. Lay the mid of the bandage over the wrist Hold the thumb end of the cravat and roll

it across the back of the hand rolling it upward over the base of the thumb, covering

only the four fingers; gently and slightly pull it downward.

2. Hold the other end of the bandage, roll it across the back of the hand rolling it in

between the thumb and index finger take both ends to the back of the wrist, cross

the ends, then roll them up over the wrist and cross it again.

3. Roll both ends at the back of the hand and tie with a knot at the top of the wrist

CRAVAT OF THE KNEE

INDICATION: The cravat of knee is used to hold dressings around the knee. (Applied when

there is wound in either right or left knee of the victim.)



1. Bend the leg to approximately 90 degrees at the knee and place the middle of the

cravat bandage at the upper portion of the knee bringing and holding both ends of

the bandage downward.

2. Cross both bandage ends and gently rolled extending both ends downwards.

3. After rolling the bandage, at the same time pull both ends, tie both ends tightly

opposite the knee in square knot, and tuck in the remaining ends.

CRAVAT OF THE LEG

INDICATIONS: The cravat of leg is used to hold dressings around the leg.

1. Place center of cravat over dressing.

2. Begin ascending turns with upper end, and descending turns with lower end, with

each turn covering two-thirds of preceding turn until dressing is covered.

3. Terminate by tying both ends in square knot.

CRAVAT ANKLE WRAP

INDICATION: The cravat ankle wrap is used to hold dressings around the ankle.

1. Place the middle of the cravat under the heel of the foot.

2. Then bring the bandage up in back of the heel and around to the front of the ankle.

3. Now criss-cross it in a sort of figure-eight form around the ankle.

4. Tie it firmly in front of the ankle.

SPLINTING

Splint - Any device used to immobilize a fracture or dislocation. It can be soft or rigid,

commercially manufactured or improvised from virtually any object that can provide stability.

Splints are used to support and immobilize suspected fractures, dislocations, or sever

sprains; to help control bleeding; to help control pain; and to prevent further damage to

tissues from the movement of bone ends.

RULES FOR SPLINTING

Do not splint if it will cause more pain for the victim.

Both before and after you apply the splint, assess the pulse and sensation below the

injury. You should evaluate these signs every 15 minutes after applying the splint to

make sure the splint is not impairing the circulation.

Immobilize the joints both above and below the injury.

Splint an injury in the position you found it. If there is no distal pulse or movement,

you may attempt to return the bone to its normal alignment by placing one hand above

the injury and another below. Then pull with gentle traction while moving the injury

back toward the correct anatomical position.

Remove or cut away all clothing around the injury site with a pair of bandage scissor

so you won’t accidentally move the fractured bone ends and complicate the injury.

Remove all jewelry around the fracture site.

Cover all wounds, including open fractures, with sterile dressing before applying a

splint, then gently bandage. Avoid excessive pressure on the wound.

If there is a severe deformity or the distal extremity is cyanotic or lacks pulses, align

the injured limb with gentle traction before splinting, following the guidelines above.

Never intentionally replace protruding bone ends.

Pad the splint to prevent pressure and discomfort to the victim.

Apply the splint before trying to move the victim

When in doubt, splint the injury.

If the victim shows sign of shock, align the victim in the normal anatomical position

and arrangw for immediate transport without taking the time to apply a splint.

TYPES OF SPLINTS

1. Rigid Splint

Are commercially manufactured splints made of wood, aluminum, wire,

plastic, cardboard or compressed wood fibers

2. Traction Splints

Gently pulling the direction opposite the injury, alleviating pain, reducing

blood loss and minimizing further injury.Traction splints are not intended to reduce

the fracture, but simply to immobilize the bone ends and prevent further injury. A

traction splint should be used only for a broken thigh, and should be performed onlyby EMTs or those who have had special training in applying traction splints.

3. Pneumatic (Air) Splints

Are soft and pliable before being inflated but rigid once they are applied

and filled with air. Air splints should only be used on fractures where there is no

deformity, but immobilization is needed. A similar type of splint is the vacuum

splint,

4. Improvised splints

It can be improvised from a cardboard box, cane, ironing board, rolled up

magazine, umbrella, broom handle, catcher’s shin guard, or any other similar

object.

You can also use a self splint( also called an anatomical splint) by tying or

taping an injured part to an adjacent uninjured part. Ex. Splint a finger to a finger a

toe to a toe, a leg to the other leg, or an arm to the chest. An effective improvised

splint must be

Light in weight, but firm and rigid

Long enough to extend past the joints and prevent movements on either

side of the fracture

as wide as the thickest part of the fractured limb



Padded well so the inner surface is not in contact with the skin

HAZARDS OF IMPROPER SPLINTING

IMPROPER SPLINTING CAN:

Compress the nerves, tissues and blood vessels under the splint, aggravating the

existing injury and causing new injury

Delay the transport of a victim who has a life threatening injury.

Reduce distal circulation, threatening the extremity.

Aggravate the bone or joint injury by allowing movement of the bone fragments or

bone ends or by forcing bone ends beneath the skin surface

Cause or aggravate damage to the tissues, nerves, blood vessels, or muscles as a

result of excessive bone or joint movement.

LOWER ARM AND WRIST

The lower arm, including the wrist and hand is common area for fractures.

There are two bones in the lower arm, the radius and the ulna.

If a fracture is suspected in either one or both of these bones, the victim should be seated

and the part protected by fixation.

1. Two wooden padded splints are needed. These splints should be long enough to

extend from the elbow down the ar, beyond the palm and figertips for an armfracture.

The splints should extend from the middle of the lower arm and beyond the

fingertips for a wrist injury, fracture or sprain.

2. One splint should be on the palm side and the other splint opposite, so that the arm

is centered between the splints.

3. The splints should be secured with roller gauze, elastic bandage, several neckties, or

two or three triangular bandages folded as cravats.

The fingertips should remain exposed at all times.

4. The injured arm should be placed in an arm sling with the fingertips exposed and

the arm should be elevated.

5. Another triangular bandage should be folded as a cravat, and the injured area

secured to the body.This bandage should surround the body from a midpoint in the

upper arm.

6. The victim should remai quiet, sitting or reclining, until suitable transportation is

provided.

UPPER ARM - HUMERUS

This bone is not as commonly fractured as the lower arm bones or the wrist. Such a

fracture would be indicated by pain from motion, swelling, and tenderness in the area.

1. The victim should be seated and quiet until transportation is provided.

2. Padded wooden splints should be placed on both sides of the arm, one from the

armpit down the inside and past the elbow joint, the second from the shoulder

down the outside of the arm and past the elbow joint.

3. The splints should be secured reasonably tight with triangular bandages folded as

cravats, or with neckties or roller-type bandages.

4. The arm should be placed in an arm sling with fingertips exposed and the arm

reasonably elevated.

5. Two cravats should be used to secure the arm to the body, surrounding the body

from a midpoint of the upper arm, and then tying the cravat ends on the opposite

side of the body.

ELBOW JOINT

This is important joint and protection should be given to prevent damage to the tissues that

surround it. Henderson states that such fractures may result in varying degrees of permanent

disability. If the elbow is fractured, there may be dislocation the first-aider should.

1. Place the victim in lying position to guard against shock.

2. The arm including the elbow should remain in position it was found.

3. If the arm is straight, splint with wooden splint from the armpit and beyond the

fingertips, placing the splint on the other s ide.

4. If the arm is bent, secure the arm to the body by means of an arm sling and by

cravats to maintain the bent position.

5. Provide suitable transportation to medical help.

6. If fracture is compound, cover the wound with dressing; then apply the splints. The

wound should be left for the physician to treat.

FINGEREach of the four fingers has three bones, and the thumb two bones. The fracturing of a finger

is rather common. When it occurs it is evident because there are pain, deformity, swelling

and inability to use the part. Finger injuries are common in physical activities, especially

football, basketball, and baseball.

If the finger is injured, it could be a sprain, a dislocation, or fracture. Only and x-ray can tell

for certain the nature of injury. In all three situations, splinting will protect.

1. Have the victim sit down and put his injured finger in an extended position.

2. Place a tongue blade, finger stall, or some firm material as a splint from the palm of

the hand to beyond the fingertip on the underside.

3. Secure the splint with a roller gauze or muslim strips.

4. Transport the victim to medical help for x-ray and treatment.

5. If it is a evident that the finger is dislocated, place the hand in a downward position

and exert a steady pull to position the finger.

LOWER LEG – TIBIA AND FIBULA The larger bone of the lower leg is the tibia, and if it is fractured it will be evident, as the

victim will immediately cease to use the part. However, persons have been known to

continue activity after a fracture of the small bone, the fibula. If the two bones are fractured,

the victim will be disabled immediately.

1. Place the victim in a reclining position.

2. Use ice packs or cold to limit swelling and bleeding.



3. Place the injured leg between two padded splints, one extending from the groin

(between the legs), and the second splint corresponding with the first in position

but on the outside of the leg.

4. Secure the splints with four or five triangular bandages, folded as cravats but not

tight enough to limit circulation.Place the victim on a litter and transport him to

the hospital in a reclining position, preferably keeping the injured leg in an

elevated position.

KNEE CAP OR PATELLA

The most common fracture of the knee occurs at the kneecap, as a result of a crushing

below. The great majority of such accidents are sustained in automobile accidents when the

person riding next to the driver is thrown forward against the dashboard.

Knee fractures also result from athletic injuries and other crushing blows. The seat belt has

proven to be the best device for preventing this type of accident in the automobile crash.

Fractured kneecaps are indicated by swelling and pain in the joint. The victim will not attempt

to straighten the knee and it is frequently possible to feel the parts of the broken bone, the

patella.

1. Place the victim in a lying-down position (supine) and protect against shock.

2. Apply cold compresses or ice packs to the injured area to limit swelling and bleeding

3. Place a padded wooden splint, six inches wide and thick enough to support, from the

buttocks to beyond the heel and the underneath side of leg

4. Secure the extended leg which has been placed upon the splint with four or five

triangular bandages, folded as cravats

5. Place the splinted leg in an elevated position and wait for transportation ‘

6. Transport to a hospital and medical help in a lying position

UPPER LEG - FEMURThe upper leg has only one bone, the femur. This bone supports the entire body

weight when a person stands. If the shaft or main portion of the femur is fractured or broken,

the individual will be immobilized at once. The upper end of the femur terminates into a

round ball-like part which fits into the pelvis to form a ball-and-socket joint, the hip joint. It is

not uncommon for the head of the femur to be broken off, especially In older persons, Such

injuries would be the most difficult to ascertain without the x-ray. Fracture of the femur or

upper leg can be protected by either fixation or traction splinting.

1. Keep the victim down and protect for shock.

2. Straighten the leg as gently as possible.

3. Place a padded wooden splint from the armpit on the injured side to six to twelve

inches beyond the feet.

4. Place a second padded wooden splint between the legs, from the groin to some six

to twelve inches beyond the feet. Pad the area over the crest of the ileum to

lessen pressure on the greater trochanter of the femur.

5. Secure the two splints with six to eight triangular bandages folded as cravats. Placethree or four of these cravats around the two splints and the injured leg,

between the ankle and the groin; then with two or three additional cravats tie

around the torso and the long splint.

6. Secure the two legs together, from hip to feet with two or three more triangular

bandages as cravats.

7. Keep the victim down and comfortable until transportation is available to medical

help.

PELVIS OR HIP

Fractures of the pelvis are most common in older people and usually result from

falls. Fractures of the pelvis to persons of all ages are common in crushing-type injuries, such

as result from automobile accidents. If there is any likelihood of a fracture to this area, the

victim should not be permitted to get on his feet. It is dangerous because bone fragments

could penetrate the bladder, reproductive organs, intestines, blood vessels, and nerves.

Indications of a fractured pelvis are pain, inability to lift or move the leg, false position of the

leg and/or foot, and a deep bruise. Frequently the leg and foot assume a turned-out position.

The first-aid protection for a fracture of the pelvis is the use of fixation splinting.

1. Place the victim in a lying-down position (supine) and gently straighten the leg. The

victim should be protected against shock.

2. Place a padded splint, a board six to twelve inches wide and at least an inch thick,

beneath the victim on the injured side. The splint should extend several inches

beyond the head and the feet.

3. Place a folded blanket or pad between the victim’s legs.

4. With three triangular bandages folded as cravats, secure the leg to the splint, with

three more cravats, secure the upper body or torso to the splint.

5. With two or three additional cravats, secure the two legs, going around the legs,

splint, and folded blanket.

6. Transport the victim to the hospital in an ambulance or other suitable conveyance.

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SPINAL INJURY

VICTIM ASSESSMENT To assess a responsive victim:

1. Note the mechanism of injury- especially the type of movement and amount of force

that was involved in the injury. Even if a victim can move or walk around, spinal

injury may exist- so always suspect spinal injury if the mechanism of injury

suggests it.

2. Ask:

Does your neck or back hurt? Pain from a spinal injury often radiates from

the neck to the arms, from the upper back to the ribs, and from the lower back

to the legs- so pain maybe confined to the neck or back.

What happened?

Where does it hurt?

Can you move your hands and feet?

Can you feel me touching your fingers?

Can you feel me touching your toes?

Can you feel which toe I am pinching?



Can you feel which finger I am pinching?

3. Inspect the back for contusions, deformities, lacerations, punctures, penetrations,

and swelling. If necessary, cut clothing away so you can see the area clearly.

4. Palpate gently for areas of tenderness or deformity.

5. Assess equality of strength in the victim’s extremities.

Have the victim grip and squeeze both your hands; note differences in

strengths.

Have the victim gently push his/her feet against your hands; note strengthand equality.

To assess an unresponsive victim:

1. Note the mechanism of injury. If the mechanism of injury suggests spinal injury and

the victim is unconscious, assume spinal injury has occurred.

2. Inspect for contusions, deformities, lacerations, punctures, penetrations, or swelling;

palpate for areas of deformity.

3. Ask others at the scene about the mechanism of injury and the victim’s mental

status before you arrived in the scene.

FIRST AID CARE FOR SPINAL INJURY

The general rule for management of spinal injury is to support and immobilize the spine, the

head, the torso, and the pelvis. Your goal is to end up with a victim who is properly

immobilized on a backboard. It is better to overtreat than to risk further injury.

Activate the EMS system; then:

1. The first priority is to establish and maintain an open airway and adequate

ventilation. Use the modified jaw-thrust technique to open the airway and provide

rescue breathing if breathing is inadequate.

2. Establish and maintain in-line stabilization.

Place the head in a neutral line-position unless the victim complains of pain

or the head is not easily moved in position.

If you encounter resistance, stabilize the neck in the position in which you

found it.

Place the head in alignment with the spine.

Maintain a constant manual in-line stabilization until the victim is properly

secured to a backboard with the head immobilized.

Prevent movement of the victim’s head by one of the following methods:

Having a person hold the head and neck in a neutral in-line position.

Kneel with the victim’s head held firmly between your knees.

Perform the initial assessment; check pulse and circulation; perform CPR if

necessary, but do not move the victim. Control hemorrhage, but never try to stop the

flow of blood or fluid from the ears, nose, or mouth. Never apply pressure to a bleeding

head wound if you suspect skull fracture.

Complications of Spinal Injury

Inadequate Breathing Effort

Respiratory paralysis may occur with spine injury, and death may occur rapidly if

respiratory assistance is delayed. The diaphragm may continue to function even if the chest

wall muscles are paralyzed; a victim who is breathing with the diaphragm alone will have

shallow breathing with little movement of the chest or abdomen.

Paralysis

There is usually weakness, loss of sensation, or paralysis below the level of injury. In the

conscious victim, paralysis of the arms or legs is considered the most reliable sign of spinal

injury.

NECK AND BACK

The procedures for caring for a victim of a broken back are the same as those listed for one

with a broken neck, with this important exception: The victim must be transported in the

face-down position.

Injuries to the back and neck should receive the utmost protection. Careless handling can

injure the spinal cord and cause paralysis or death. First-aiders should not attempt to move

the victim until sufficient help is available and a rigid platform is at hand for use as a litter.

Planking is available and a rigid platform is at hand for use as a litter. Planking is preferable

because of the ease in securing the triangular bandages which are used as cravats. Such a

platform can be made with a minimum of effort, or in an emergency a door can be used as

the rigid-type litter. The first-aider can make several checks to determine where the back is

injured. Back and neck injuries can be protected by the first-aider by applying fixation

splinting:

1. Prepare a rigid platform from two boards longer than the victim’s body and

strong enough to support his weight without bending. Three or four cross

boards, three or four inches wide, should be placed at the location where

the feet, knees, hips, and shoulders of the victim will be. These boards

should be nailed together, leaving a reasonable space between the twolong boards for the cravats o secure the injured victims to the rigid litter.

2. If possible, pad the boards with a blanket.

3. Place the victim on the stretcher, face down for a back injury, face up for a

neck injury. There should be sufficient people to easily lift the victim and to

keep his head and body straight without and bending, twisting, or jarring.



The lifter should carefully rehearse, one person sould give command, and

then all should work as a unit. Special consideration should be given to the

head and neck to prevent possible turning, twisting, or falling. It is

advisable for one person to maintain the position of the head by applying a

steady pull.

4. Secure the victim firmly by tying the legs, hips, torso, head and neck. The

arms can be folded across the body and secured at the wrists.

5. Pad on each side with pillows, paper, clothing, wrapped bricks, sand bags,

etc,.to keep the head in position. Nothing should be placed between the

litter and the head. Place padding beneath the body curves.

6. Carefully place the victim in an ambulance on his rigid platform litter;

transport slowly and carefully to the hospital and medical staff. If possible,

the hospital should be advised that a back and neck injury victim is in

transit.

TRANSPORT A CASUALTY USING A ONE-MAN CARRY

One-man manual carries are used to move a casualty when the time or materials

needed to make a litter are not available and/or other personnel are not available to assist

you in moving the casualty. If the casualty is conscious, tell him what you are going to do and

get him to help you as much as possible.

CHOOSE AN APPROPRIATE ONE-MAN CARRY

When choosing a one-man carry, consider the casualty's injuries, the military

situation, the distance to be covered, the weight of the casualty, your s trength andendurance, and obstacles to be encountered.

BASICS

TURN A CASUALTY

• Some carries require the casualty to be in a prone position; others require him to be

in a supine position.

• Kneel at the casualty's uninjured side.

o If you are in a chemical environment, squat--do not kneel.

• Place the casualty's arms above his head and cross his far ankle over the near one.

RAISE A CASUALTY TO A STANDING POSITION

Some one-man carries requires the casualty be raised to a standing position. If the

casualty is conscious, you may be able to assist him to stand up. If the casualty is

unconscious, however, you need to raise him to a standing position without his help.


Regular Method

• Position the casualty in a prone position.

• Straddle the casualty, slip your hands under his chest, and lock your hands together.

• Lift the casualty and begin walking backward until he is on his knees.

• Continue walking backward until his legs are straight and his knees are locked.


• Walk forward and bring the casualty to a standing position. Keep the

casualty tilted slightly backward so his knees will remain locked. If his knees

do not remain locked, walk backward until they lock and then move forward

until the casualty is in the standing position.

• Grasp one of the casualty's wrists and raise his arm. Use your other arm to

hold the casualty erect.


• Move under the casualty's arm to his front, lower his arm, and put both of

your arms around the casualty's waist to support the casualty. Interlock the

fingers of your hands.

• Place your foot between the casualty's feet and spread them so his feet are

about six to eight inches apart.


Alternate Method

• This method is used if it will be safer for the casualty due to his injuries.

• Position the casualty in a prone position.

• Kneel on one knee at the casualty's head, facing the casualty's feet.

o If you are in a chemical environment, squat--do not kneel.

• Put your hands under his armpits, down his sides, and across his back.




• Rise, lifting the casualty to his knees. Keep the casualty's head from snapping back.

• Lower your arms, secure a hold on the casualty, and raise him to a standing position

with his knees locked.

• Put your arms around the casualty's waist, interlock your fingers, and tilt his body

slightly backward to keep his knees from buckling.

• Place your foot between his feet and spread them so his feet are six to eight inches

apart.

TYPES OF ONE MAN CARRY

Fireman's Carry

• Used to quickly move an unconscious or conscious casualty.

• Can be used to move the casualty a moderate or long distance.

• Leaves one of the bearer's arms free to carry a rifle, move around obstacles,

etc.

PERFORM THE FIREMAN'S CARRY

1. Raise the casualty to a standing position.

2. Grasp the casualty's wrist and lift his arm over his head while continuing to support

the casualty with your other arm.

a. If the casualty has an injured arm, grasp the wrist of the uninjured arm.

3. Bend at the waist and kneel, pulling the casualty over your shoulder. At the same

time, slip your arm from his waist, pass the arm between the casualty's legs, and

grasp behind the casualty's knee.

4. Move the hand grasping the casualty's wrist to the hand at the casualty's knee.

5. Grasp the casualty's wrist with the hand behind the casualty's knee, thus freeing the

hand that previously held the wrist.

6. Place your free hand on your knee and push on your knee to slowly rise to a

standing position. This will help to prevent back strain.

7. Adjust the casualty's body so his weight is distributed comfortably.

8. Move forward, carrying the casualty.

Support Carry

• Used only with a conscious casualty who can walk or at least hop on one leg.

• Can be used to move a casualty a long distance or until the casualty tires.

PERFORM THE SUPPORT CARRY

1. Position the casualty in a sitting position.

2. Bend down at the casualty's side so you are facing in the same direction as the

casualty.

a. If the casualty has an injured leg, position yourself with the injured leg next

to you.

3. Bring the casualty's near arm over your shoulder and grasp his wrist with your hand

that is away from the casualty.

4. Put your inside arm around the casualty's waist.

5. Stand up, helping the casualty to rise to a standing position also.

6. Assist the casualty to walk or hop on one leg.

7. Adjust your walking motion as needed to help the casualty maintain his balance.

Arms Carry

• Used to move a conscious or unconscious casualty.

• Used to move a casualty a short distance

PERFORM THE ARMS CARRY


2. Slide one of your arms under the casualty's arm, behind his back, and under his

other arm.

3. Move to the casualty's side, bend down, and place your other arm behind thecasualty's knees.

4. Lift the casualty from the ground and stand erect.

5. Carry the casualty high on your chest to lessen fatigue.



Saddleback / Piggy Back Carry

• Used only for a conscious casualty who can put his arm around your neck.

• Can be used to move a casualty a moderate or long distance.

PERFORM THE SADDLEBACK CARRY

1. Raise casualty to a standing position or have the casualty stand up.

2. Grasp the casualty's wrist and lift his arm over his head while continuing to

support the casualty with your other arm.

3. Turn so your back is to the casualty and bring his arm over your shoulder.

Support the casualty's waist with your other arm, if needed.

4. Grasp the casualty's other wrist and lift his arm over your shoulder or have the

casualty put his other arm around your neck

5. Have him grasp one of his wrists with his other hand.

6. Stoop and move your arms around the outside of the casualty's thighs.

7. Bring your hands inside the casualty's thighs to your sides, lifting his thighs.

8. Stand up and clasp your hands together in front of you.

9. Adjust the casualty to make the weight distribution more comfortable.

10. Walk forward.

Pack-Strap Carry

• Used for a conscious or unconscious casualty.

• Can be used to move a casualty a moderate distance.

• Not used if the casualty has a broken arm.

PERFORM THE PACK-STRAP CARRY


2. Grasp one of the casualty's wrists and lift his arm above his head while

continuing to support the casualty's waist with your other arm.

3. Turn so your back is to the casualty. Bring the casualty's raised arm over your

shoulder as you turn.

4. Bend your knees somewhat so your shoulder fits under his arm.

5. Release his waist, grasp his other wrist, and bring that arm over your other

shoulder.

6. Hold both wrists so his hands are in a palms down (palms toward your body)

position. Twisting his hands could result in injury to the casualty's joints when

he is lifted and carried.

7. Bend forward and lift the casualty as high on your back as possible.

8. Walk forward, keeping bent so the casualty's weight is balanced on your backand his feet are not dragging.

Drags

Neck Drag


• Used to move a casualty for a short distance.

• Keeps rescuer close to the ground

• Used when moving behind a low wall, under a vehicle, or through a culvert.

•

Not used if the casualty has a broken arm.

PERFORM THE NECK DRAG

1. Position the casualty on his back.

2. Tie the casualty's hands together with material which will not cut his wrists, such as

a field dressing or a cravat. Do not tie the materials tight enough to interfere with

the blood circulation.

a. If the casualty is conscious, tell him to interlock his fingers.

3. Face the casualty's head and straddle his hips on your knees.

4. Loop the casualty's arms around your neck.

5. Crawl forward on your hands and knees, dragging the casualty beneath.

a. Keep the casualty's head from dragging on the ground.

Cradle Drop Drag




• Used to move a casualty up or down steps or low drops or to quickly move a

casualty from a life-threatening situation.

PERFORM THE CRADLE DROP DRAG

1. Position the casualty on his back.

2. Kneel at the casualty's head.

3. Slide your hands (palms up) under his shoulders and grasp the clothing under hisarmpits.

4. Partially rise, pulling the casualty to a semi-sitting position.

5. Support his head on one of your arms.

a. If possible, bring your elbows together and use both forearms to support

the head.

6. Rise to a stooped position.

7. Walk backward, dragging the soldier backward.

8. If you go down steps, let his hips and legs drop from step to step.

Shoulder drag

• The shoulder drag is accomplished by placing the victim in a supine position

(laying on his back), grasping shoulders, and dragging him in the desired

direction

Clothing Drag

1. Tie the patient's wrists together if you have something quickly available. If nothing is

available, tuck the hands into the waist band to prevent them from being pulled

upwards.

2. Clutch the patient's clothing on both sides of the neck to provide a support for the

head.

3. Pull the patient towards you as you back up, watching the patient at all times. Thepulling force should be concentrated under the armpits and NOT the neck.

Blanket Drag

1. Lay a blanket lengthwise beside the patient.

2. Kneel on the opposite side of the patient and roll the patient toward you.

3. As the patient lies on their side while resting against you, reach across and

grab the blanket.

4. Tightly tuck half of the blanket lengthwise under the patient and leave the

other half lying flat.

5. Gently roll the patient onto their back.

6. Pull the tucked portion of the blanket out from under the patient and wrap

it around the body.

7. Grasp the blanket under the patient's head to form a support and means

for pulling.

8. Pull while backing up and while observing the patient at all times.

TWO MAN CARRY

SEAT CARRY

- Is a method of lifting and moving a victim in which two rescuers form a “seat” with their

arms

Version one: The hammock variation

1. Raise the victim to a sitting position. Each

first aider steadies the victim by positioning

an arm around the victim’s back.

2. Each first aider slips another arm to the

victim’s thighs, then clasp the risk of the

other first aider. One pair of arms should

make a seat and the other should make a

back rest.

3. Slowly raise the victim from the ground

moving in unison.

Version two: The interlocking wrist variation

1. Both the rescuers face each other, with their handsout.

2. Each rescuer takes their left hand and grabs their

right wrist.



3. Keeping the hands in this position, each rescuer grabs the other's left wrist with the

right hand. This should

4. provide a sturdy base upon which the victim may sit. The victim should place his/her

arms around the shoulders of each rescuer.

EXTREMITY LIFT

- Is a method of lifting and carrying a victim in which 2 rescuers carry the victim by the

extremities . Do not use this method if the victim has back or any serious injuries.

1. One first aider kneels at the victims head, the other kneels at the

victims knees.

2. The person at the head places one hand under each of the victims

shoulders; and grasps the victims wrists.

3. The person on the victim’s knees pulls the victim to a sitting position

by pulling on the victims wrist, the person at the head assist by

pushing the victims shoulders and supporting the back.

4. The person at the knees slips his hands beneath the victims knees

5. Both first aiders crouch on their feet and simultaneously stands in one

fluid motion.

CHAIR LITTER CARRY

If the victim has no contraindicating injuries and if a chair is available, you can use this

method.

-The chair carry, can be used to move a victim away from a

position of danger. The victim is seated on a chair and the chair is

carried by two people. This is a good method to use when you

must carry a victim up or down steps or through narrow, winding

passageways.

• Do not attempt if the casualty has an injured neck,

back, or pelvis!

• Sit the victim on a chair.

• One first aider carries the back of the chair while the

other carries the legs; the chair itself is used a litter.

• Be sure that the chair is sturdy enough to support the weight of the victim.

Modified Two-Man Arms Carry

1. Two litter bearers kneel on one knee by the

victim’s side (opposite side from litter).

2. One bearer slips his arms under the victims

back and waist.

3. The other bearer slips his

hands under the victim’s

hips and knees.

4. Both bearers lift in unison

upon command from the

leader.

THREE MEN CARRY

FLAT LIFT AND CARRY (THREE

RESCUERS)

The three-rescuer flat lift and carry, when three rescuers lift and carry the victim to

a stretcher, is an effective way to move a severely injured victim who cannot sit in a chair or

when a cot cannot be moved close to the victim. It has the advantage

of permitting you to move the victim through narrow passages and

downstairs. Use this method only if the victim does not have spinal

injury.

1. Three first-aiders line-up on the least injured side of the

victim; if one first aider is noticeably taller, that person

stands at the victims shoulder; another stands at the victims

hips, and the third at the victims knees.



2. Each first aider kneels on the knee closest to the victims feet.

3. The f irst-aider at the victims

shoulder works his or her hand

underneath the victim’s neck and

shoulders; the next first aider’s

hands go underneath the victim’s

hips and pelvis; and final first-

aider’s hands go underneath the

victims knees.

4. Moving in unison, the firs-aiders

raise the victim to knee level and

slowly turn the victim toward

themselves until the victim rests on

the bends of their elbows.

5. Moving in unison, all three rise to a

standing position and walk with the

victim to a place of safety or to the

stretcher. To place the victim on

the stretcher, simply reverse the

procedure.

This move can also be done with

four first aiders: position them at the victims

head, chest, hips, and knees. Support is

then given to the head, chest, hips, pelvis,

knees and ankles.

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Emergency Care Nursing

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