TEAM MEDIC

CASUALTY DRILLS

AIDE MEMOIRE
ARMY CODE 64410

FIRST EDITION
DECEMBER 2007

© Crown Copyright
ALL RIGHTS RESERVED

WARNING
Disposable gloves to be worn where
possible to prevent cross infection
of blood borne diseases

WARNING
 MASTER DRILL DRILL 1
MULTIPLE CASUALTIES
START HERE

You must triage 1. Assess the priority

UNDER EFFECTIVE ENEMY FIRE all casualties 2. Write it on casualty’s cheek
before treatment or where visible
3. Move to next casualty
YES
START
WIN FIRE FIGHT HERE

Walking? YES Write T3

IF ACCESS TO CASUALTY POSSIBLE
NO • Self/buddy tourniquet for severe
NO
limb bleeding
• Roll unconscious casualty face down Airway opening STILL
(head to one side) to maintain Breathing? NO procedures
DEAD
NONE
airway/drainage

THEN STARTS
BREATHING

C
FIRE FIGHT WON
CONTROL THE INCIDENT

¾ prone position Write T1

ASSESS YES
A Safety: self, casualty, weapons
Casualties: how many,
how bad?
Catastrophic Limb Bleeding: use tourniquet Write T1

NO

C
COMMUNICATE
Breathing under 10 or over 30/min Write T1
Send initial SITREP Rate
10-30/min

T
missing or over 120/min Write T1
TRIAGE Pulse Rate
under 120/min Write T2

Two or more Casualties: One Casualty:

Drill 1 Drill 2 go to DRILL 2

MASTER DRILL DRILL 1

 DRILL 2 DRILL 3

INJURED SOLDIER UNRESPONSIVE SOLDIER

<C> COMBAT INJURY NON-COMBAT INJURY

CATASTROPHIC BLEEDING

LIMB OTHER Check the Airway Check the Airway

Open mouth, look inside, Open mouth, look inside,
and pick out any debris, and pick out any debris,
suction if required. suction if required.
Check for breathing for Check for breathing for
• Pack wound with YES YES
Apply CAT tourniquet up to 10 secs up to 10 secs
field dressing.
OR HemCon as needed
• Press hard into the
wound with fingers/ NO BREATHING STARTS
knuckles BREATHING
NO BREATHING
• Apply HemCon

Head-Tilt
Chin Lift
YES YES Jaw Thrust

NO Then Jaw Thrust

Check for breathing for up
Chin Lift
Check for breathing for up
Place in ¾
to 10 secs to 10 secs
prone position

STILL NO STILL NO

A B C BREATHING BREATHING

Shake and shout, Check breathing Check for Bleeding, Go to Drill 4

any response? YES OK Breaks and Burns
Dificulty
NO Difficulty

GO TO BASIC
Go to Drill 3A LIFE SUPPORT
GO TO GO TO GO TO
Drill 3 Drill 4 Drill 5

DRILL 2 DRILL 3
 DRILL 4 DRILL 5
DIFFICULTY BREATHING BLEEDING

If not already done check the AIRWAY, open mouth and look inside. Conduct a TRaPS assessment remembering
Pick out any debris and do suction as required. “Blood on the Floor and Four More”.
DO NOT remove embedded foreign objects
If difficulty continues consider the following reasons:
IF BLEEDING
1. Apply an Emergency Bandage to the wound
Chemical Contamination 2. For large wounds pack the wound with a dressing or use
Follow CBRN Drills HemCon / tourniquet
3. Apply pressure through the dressing into the wound
Airway Burn 4. Secure the dressing in place
5. Elevate bleeding limb (above heart level)
• Swelling 6. Apply indirect pressure to the artery
• Burn in the mouth or tongue
blisters
• Coughing up sooty spit IF STILL BLEEDING
• Hoarse voice Apply a second Emergency Bandage OVER the first.
If not already used consider HemCon or Tourniquet.
Maintain Airway and treat with
sips of water
• If tourniquet applied during care under fire, gently release
EARLY EVAC ESSENTIAL tourniquet and assess if bleeding can be controlled by
pressure through dressings and elevation
Conduct RIBS Assessment
Rate: • If tourniquet is still required write T where visible and
Count the respiratory rate? Lower than 10 or more than record time
30
Injuries:
Expose the chest and neck ABDOMINAL WOUNDS
Look and feel for holes, bruising and tenderness • Do not push protruding organs back into place
Back: • Do not give any food or drink
Slide hands under back check for injuries • If organs protruding apply wet dressing
Log roll - 3 people • If no protrusions apply firm dry dressing and
Sides: support casualty in comfortable position
Check under the arms for injury

INTERNAL BLEEDING SUSPECTED go to Drill 10

Treat Injuries Found If there is a rapid or absent radial pulse and
no external bleeding.
If reduced level of response
place in ¾ prone position
Pain relief if required go to Drill 8

go to DRILL 5 go to DRILL 6

DRILL 4 DRILL 5
 DRILL 6 DRILL 7

FRACTURES BURNS

Apply water to cool the burn within

10 mins for at least 10 min
Treat fractures and dislocations the same
Suspect a fracture or dislocation if there is:
• History of trauma DO NOT cover the whole
• Bruising body in cold water
• Pain
• Swelling over a bone or joint
• Reduced or loss of movement
• Deformity of the bone or joint
THEN

Is there a Fracture? NO go to Drill 7

If NO airway burns consider Go to Drill 8
pain relief

YES
THEN

Consider pain relief go to Drill 8

• Lightly cover skin burns with field dressing(s)

• If phosphorous present – remove
THEN • Cover phosphorous burns with a wet dressing and
keep wet
• Protect from the environment:
Cold and Direct sunlight

Re-align and
immobilise the limb

go to DRILL 7
go to DRILL 9

DRILL 6 DRILL 7
 DRILL 8 DRILL 9 COLD
PAIN RELIEF COLD SOLDIER

Think about hypothermia when the individual :

NO -- 1 2 3 4 5 6 7 8 9 10 -- Worst • Has been exposed to cold and wet
PAIN PAIN • Is unresponsive and their treatment is delayed
• Is pale and cold to touch

1. Remove from the cold, strip off any wet clothing and dry body
Pain score of 5 NO 2. Keep warm in sleeping bag/other insulator
Reassess
or more 3. Move into a building, or a running vehicle
in 10 min
4. If conscious give warm drinks and hot food (if no further injury)
YES
Physical:
Psychological: Is the casualty hypothermic?
• Dress wounds AND (cold to touch)
• Splint fractures • Distraction
• Cool and cover burns • Reassurance YES
• Self control
Is the casualty shivering?
AND

Pharmacological: Hypothermia is severe

Hypothermia is mild

DO NOT give Morphine without medical advice if there is:

• A reduced level of response
• Difficulty breathing Is the casualty conscious? Re-warm and
• A head injury k

1. Place Morphine auto-injector against upper thigh, remove

safety pin, press and hold for 10 seconds, then remove auto- Are there signs of life?
injector, then break needle off NO
2. On the cheek write ‘M’ and the time using 24 hour clock YES
Start BLS avoid rough
Handle gently to avoid causing handling & be cautious
YES Heart Rhythm Problems of suction: You may
THEN cause Heart Rhythm
Problems

Bleeding: Breaks: Burns: Insulate from further heat loss and

Drill 5 Drill 6 Drill 7
go to DRILL 10
nd
Reassess pain score after 30 min and before giving 2 dose
Adapted from JSP 539 (2003)

DRILL 8 DRILL 9 Cold

 DRILL 9 HOT DRILL 10

HOT SOLDIER EVACUATION RULES

Life threatening considerations:

• Unresponsive
Think about heat illness when the individual: • Upper airway burn
• Has done heavy exercise • Breathing difficulties
• Is tired and confused • Severe external bleeding
• Is red, and hot to touch • Tourniquet applied
• Signs of internal bleeding T1

All Walkers T3
Symptoms: Agitation, nausea or vomiting, staggering or loss of
coordination, cramps, disturbed vision, confusion, dizziness,
collapse or loss of consciousness
All Others T2

STOP activity

Lie the casualty down in the shade. Elevate feet if

Reassess:
conscious. Strip to underwear, sponge or spray casualty
<C> Bleeding still controlled
with cool water and fan the skin.
A – Still clear and protected
B – Respiratory rate still between 10 & 30
C – Still has a radial pulse
D – AVPU any changes
A – Alert
V – Voice
Give water to drink if the Place the unconscious P – Pain
casualty is conscious casualty in the recovery U – Unresponsive
position
• Monitor pain score – consider 2nd Morphine
• Alternate Recovery Position after 30 min
• Protect from the environment
Evacuate to medical
care as quickly as
possible
Prepare MIST Handover:
M - Mechanism of injury
I - Injuries found or suspected
S - Signs initially and now
T – Treatment: what have you done
go to DRILL 10

Adapted from JSP 539 (2003)

DRILL 9 HOT DRILL 10

 DRILL 3A BASIC LIFE SUPPORT

NO SIGNS OF LIFE

CHECK
RESPONSIVENESS Shake and shout
TRAUMA

OPEN AIRWAY Head tilt / Chin lift

If unresponsive
and breathing
NO YES place in
recovery CHECK BREATHING Look, listen and feel
position Abnormal or Absent No longer than 10 sec

MEDICAL CAUSE Send or go for help

UNDER
ELECTROCUTION EFFECTIVE YES
DROWNING FIRE
IF APPROPRIATE
30 CHEST Rate 100 a minute
COMPRESSIONS
Do not start BASIC
LIFE SUPPORT
YES NO OR
2 RESCUE BREATHS Change rescuer every 2
30 COMPRESSIONS minutes
Stop BASIC LIFE to prevent fatigue
SUPPORT

SIGNS OF LIFE CONTINUE CPR

INJURIES Recovery Position
OBVIOUSLY YES 100 per minute
INCOMPATIBLE
WITH LIFE
Check patient only if
go to Basic Life they begin to breath
NO normally
Support
30 2

DRILL 3A BASIC LIFE SUPPORT

 CUF (CARE UNDER FIRE) NOTES
THIS SHOULD BE LEARNED AND REMEMBERED: IF YOU NEED TO
READ A GUIDELINE WHILST UNDER FIRE YOUR TRAINING HAS
FAILED

ALL PERSONNEL (INCLUDING CASUALTIES WHERE ABLE) TO

RETURN AND MAINTAIN FIRE TO SUPPRESS THE ENEMY

BOTH MEDIC AND ONLY THE CASUALTY IN

CASUALTY IN THE THE OPEN: MEDIC IN
OPEN COVER

IF CASUALTY UNABLE TO
DEPLOY SMOKE RETURN EFFECTIVE FIRE,
UPWIND IF TELL THEM TO LIE AS STILL
AVAILABLE AS POSSIBLE

CONSIDER: PLAN RESCUE, CONSIDERING:

TOURNIQUET FOR SUPPORT FROM FRIENDLY

CATASTROPHIC FORCES
HAEMORRHAGE
USE OF VEHICLES
ROLL CASUALTY FACE USE OF SMOKE
DOWN (POSTURAL
AIRWAY OPENING) UNTIL BEST USE OF COVER
READY TO MOVE USE OF ROPE LINE
QUICKEST ROUTE

EVACUATE TO
COVER

CUF (CARE UNDER FIRE) NOTES

 INITIAL SITREP
YOU MUST ALWAYS START AT THE MASTER DRILL
CASUALTY NUMBERS:

START AT THE TOP OF EACH PAGE AND WORK DOWN YOUR GRID REFERENCE:

THE FOLLOWING RULES APPLY:

DIRECTIONS TO
RED BOXES ARE BLUE BOXES ARE
ANOTHER DRILL
WARNINGS ACTIONS

GREY ARROWS ARE

YELLOW BOXES ARE GENERAL DIRECTIONS
ADVICE

BLS = BASIC LIFE SUPPORT

INSTRUCTIONS FOR USE