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Surgical Procedures (268)

Approach for Thoracotomy Based on Injury Type
Critical Source: NATO Emergency War Surgery
Thoracotomy Approach:

For suspected lung wounds: Perform a formal posterior lateral thoracotomy through the fifth or sixth interspace.
For heart wounds: Use an anterior thoracotomy in the **fifth intercostal space on the...
thoracotomy approach, lung wound surgery, heart injury, anterior thoracotomy, posterior lateral thoracotomy
Assigning Anesthesiologists in Forward Surgical Units
Critical Source: NATO Emergency War Surgery
Objective: Ensure optimal anesthetic management for emergency surgery in combat scenarios.

Procedure:
1. Assign thoroughly trained and proficient anesthesiologists and nurse anesthetists to forward surgical units where lifesaving...
anesthesia, emergency surgery, forward surgical units, anesthesiologists, nurse anesthetists, trauma care
Consideration of Amputation in Severe Radiological Contamination
Critical Source: Emergency War Surgery
Amputation should be seriously considered when:

1. Contamination burden is high: Severe radiological contamination may lead to radionecrosis.
2. Radionecrosis is likely: In cases where tissue death is inevitable, amputation can prevent...
amputation, radionecrosis, radiological contamination, surgical intervention
Indications for Formal Thoracotomy in Combat Casualties
Critical Source: NATO Emergency War Surgery
Indications for Performing a Formal Thoracotomy:

1. An opacified hemithorax on X-ray.
2. Initial drainage of 1,500 ml of blood, followed by 500 ml or more in the next hour.
3. **Drainage of 200 to 300 ml of blood per hour for more...
thoracotomy, chest trauma, surgical intervention, battlefield surgery, hemithorax opacification, massive airleak, pericardial tamponade
Intraoperative Management During Thoracotomy
Critical Source: NATO Emergency War Surgery
Intraoperative Steps:

1. General anesthesia with controlled positive pressure ventilation through a secure airway is required for all thoracotomies.
2. Perform debridement of partially detached lung tissue and **ligation of bleeding...
intraoperative thoracotomy, debridement, ligation of vessels, chest tube insertion, antibiotic coverage
Intraoperative Management of Trauma Patients
Critical Source: NATO Emergency War Surgery
Objective: Ensure effective intraoperative care for trauma patients during emergency surgery.

Procedure:
1. Monitor and restore homeostasis, including maintaining an effective airway, evacuating secretions, and providing...
intraoperative care, trauma surgery, anesthetic drugs, airway management, postoperative care
Management of Clotted and Infected Hemothorax
Critical Source: NATO Emergency War Surgery
Clotted Hemothorax Management:

Surgical removal is indicated if the clotted hemothorax is less than 7 to 10 days old.
• If older, delay thoracotomy for 4 to 5 weeks, then perform a pleural decortication.

**Infected Hemothorax...
clotted hemothorax, infected hemothorax, pleural decortication, foreign body removal
Management of Combined Thoracic and Abdominal Injuries
Critical Source: NATO Emergency War Surgery
Combined Thoracoabdominal Injury Management:

• About 20% of trunk wounds involve both the chest and abdomen, with 50% caused by a single missile.
• The abdominal component is usually more severe; treat with laparotomy and...
combined thoracoabdominal injury, laparotomy, diaphragm closure, missile wound
Management of Heart Wounds During Thoracotomy
Critical Source: NATO Emergency War Surgery
Heart Wound Management:

1. Apply digital pressure to control hemorrhage from small wounds.
2. Insert bolstered mattress sutures to secure the wound.
3. Ensure that suture placement does not incarcerate an epicardial coronary artery;...
heart wound surgery, coronary artery ligation, mattress sutures, epicardial injury
Management of Large Open Chest Wounds
Critical Source: NATO Emergency War Surgery
Large Open Chest Wound Management:

1. Perform debridement and ensure airtight closure of the musculofascial layer.
2. Remove rib fragments and smooth rib ends to prevent future lung laceration.
3. Evaluate the **lung...
chest wall wound management, debridement, rib fragment removal, airtight closure
Management of Penetrating Chest Trauma Involving the Esophagus or Trachea
Critical Source: NATO Emergency War Surgery
Penetrating Trauma to Esophagus/Trachea:

Rare, but if present, may require defunctionalization during thoracotomy.
• A gastric patch can be used to close a low esophageal wound.
Post-traumatic pneumatocele should be...
esophageal injury, tracheal trauma, pneumatocele, gastric patch, bronchoscopy
Management of Vascular Injuries in the Neck and Mediastinum
Critical Source: NATO Emergency War Surgery
Procedure:

1. Suspect vascular injury in cases of penetrating neck wounds or unexplained hematoma formation.
2. Airway control and hemostasis are the initial priorities in managing vascular injuries.
3. If a **gradually enlarging...
vascular injury, neck wound, carotid artery, jugular vein, surgical exploration, anastomosis, shunt, ligation
Median Sternotomy Procedure and Indications
Critical Source: Emergency War Surgery
Indications:

• Suspected cardiac injury in an unstable patient.

• Positive pericardiocentesis/subxiphoid pericardial window.

• Suspected injury to the great vessels in the chest.

• Suspected distal tracheal injury.

Procedure:

• In the...
median sternotomy, cardiac injury, emergency surgery, sternum incision, mediastinal drainage
Operative Management of UXO in Casualties
Critical Source: Emergency War Surgery
Procedure:

1. Prepare the operative area with precautions:
- Sandbag the area.
- Use flak vests and eye protection for surgeons and staff.
2. Avoid triggering stimuli during surgery:
- No electromagnetic devices (e.g., defibrillators,...
UXO surgery, war surgery, trauma management, operative procedures
Perform Open Circular Amputation in Combat Conditions
Critical Source: NATO Emergency War Surgery
Procedure:

1. Make a circumferential incision through the skin and deep fascia at the lowest viable level. Allow this layer to retract without further dissection.

2. Divide the muscle bundles exposed at the new proximal level of the retracted...
open circular amputation, combat surgery, surgical procedure, stump management, wound closure
Perform Open Circular Amputation in Emergency Situations
Critical Source: NATO Emergency War Surgery
Procedure:

1. Ensure the patient is under general anesthesia or adequate sedation.
2. Make a skin incision around the limb at the level of amputation, ensuring that it extends beyond the anticipated margin of necrotic tissue.
3. Use...
open circular amputation, emergency surgery, limb loss, prosthetic fitting
Perform an Emergency Amputation of a Leg in an Austere Situation
Critical Source: Survival and Austere Medicine
Procedure:

1. Assess the situation: Amputation should only be performed to save a life, typically due to massive gangrene, overwhelming infection, or non-viable limb tissue.

2. Prepare for surgery:
- Use a tourniquet above the...
amputation, leg amputation, emergency surgery, field amputation, stump care, wound management
Post-Operative Handling of Chemical/Biological UXO
Critical Source: Emergency War Surgery
Procedure:

1. The decision to remove a chemical/biological UXO is a command decision.
2. Immediately after removal, hand the UXO over to explosive ordnance disposal (EOD) personnel for safe disposal.
3. Ensure all personnel are...
UXO removal, EOD handling, war surgery, chemical UXO
Resuscitative Thoracotomy Incision and Procedure
Critical Source: Emergency War Surgery
Procedure:

• With the patient supine, make an incision in the left inframammary fold starting at the lateral border of the sternum extending to the midaxillary line (Fig. 16-3).

• The procedure should be abandoned upon the discovery of...
resuscitative thoracotomy, incision, heart injury, great vessels, emergency surgery, bleeding control, cardiac function restoration
Sewing the Rectal Sphincter
Critical Source: A Book for Midwives
Steps to Sew a Torn Rectal Sphincter

WARNING! Before attempting to repair a torn rectal sphincter, check if the wall of the rectum itself has torn. Do not attempt to repair the rectal wall yourself; seek immediate medical help.

1....
rectal sphincter repair, rectal tear, chromic gut, Vicryl suture, interrupted stitches, fascia closure, medical help required
Administer Intravenous Broad Spectrum Antibiotics for Vascular Injuries
Critical Source: NATO Emergency War Surgery
Procedure:

1. Initiate intravenous broad spectrum antibiotic therapy as soon as possible after injury.
2. Continue the antibiotics throughout the operation and for approximately 24 hours afterward, assuming there is no continued source...
antibiotics,broad spectrum,vascular injuries,infection prevention,surgical protocol
Assess Need for Surgery in Noma
Critical Source: Where There is No Dentist
The child will likely need surgery to release the scar.

Without this surgery, the child may not be able to open his mouth properly.

Send the child for medical help when the infection is finished and the wound starts to close.

You may also...
noma, surgery, jaw wiring, scar release
Assessment and Initial Treatment of Pelvic Injuries
Critical Source: Emergency War Surgery
Procedure for Assessment and Initial Treatment of Pelvic Injuries:

Assessment:
The pelvis usually remains stable, but missile and fragmentation wounds can cause fracture.
• The **colon, small intestine, rectum, and genitourinary...
pelvic injury assessment, hemorrhage control, hollow visceral injury, debridement, penetrating wounds
Avoiding Subxiphoid Pericardial Window in Unstable Patients
Critical Source: Emergency War Surgery
Warning:

Subxiphoid pericardial window should not be attempted in an unstable patient.

• Unstable patients with penetrating injuries suspicious for cardiac injury should undergo immediate median sternotomy/thoracotomy.
subxiphoid pericardial window, unstable patient, cardiac injury, median sternotomy
Compartment Pressure Monitoring for Fasciotomy Decision-Making
Critical Source: NATO Emergency War Surgery
Objective: Use compartment pressure measurements to guide fasciotomy decisions.

Procedure:
1. Measure compartment pressures in affected limbs.
2. A pressure between 30–40 mm Hg should increase vigilance and prompt consideration of...
compartment pressure monitoring, fasciotomy threshold, pressure measurement
Examination and Initial Management of Pharyngeal and Esophageal Wounds
Critical Source: NATO Emergency War Surgery
Procedure:

1. Thorough examination of the pharynx and esophagus is essential, especially in cases of neck injury.
2. Use endoscopy to identify small lesions that may be overlooked during initial assessment.
3. Be vigilant for any...
pharynx, esophagus, neck injury, endoscopy, surgical exploration, double-layer closure, drainage, nasogastric intubation
Fasciotomy Technique and Incision Placement
Critical Source: NATO Emergency War Surgery
Objective: Properly perform fasciotomy to relieve compartment syndrome.

Procedure:
1. For the lower leg, make two incisions:
- A posteromedial incision (10–12 cm) to open the superficial and deep posterior compartments.
- An...
fasciotomy technique, incision placement, lower leg decompression, forearm and hand fasciotomy
Indications for Fasciotomy During Arterial Repair
Critical Source: NATO Emergency War Surgery
Objective: Identify when fasciotomy should be considered during arterial repair.

Procedure:
1. Consider fasciotomy at the time of arterial repair if any of the following are present:
- Concomitant major venous injury.
- Delay greater...
fasciotomy indications, compartment syndrome, venous injury, edema, nerve symptoms
Manage Thrombosis After Vascular Repair
Critical Source: NATO Emergency War Surgery
Procedure:

1. Monitor for thrombosis at or distal to the vascular repair in the early postoperative period.
2. If thrombosis occurs and limb viability is threatened, consider a second operation to restore blood flow.
3. Avoid additional...
thrombosis,vascular repair,limb viability,secondary surgery,chronic insufficiency
Management of Lung Parenchymal Injuries
Critical Source: Emergency War Surgery
Procedure:

Tube thoracostomy alone is adequate treatment for most simple lung parenchymal injuries.
Large air leaks not responding to chest tubes or that do not allow adequate ventilation will require open repair (see...
lung injury,pneumothorax management,thoracotomy
Management of Open Blunt Pelvic Injuries
Critical Source: Emergency War Surgery
Procedure for Management of Open Blunt Pelvic Injuries:

Immediate hemorrhage control by packing.
Aggressive and thorough debridement.
Pelvic stabilization, which may involve external fixator placement or other methods.
-...
open blunt injury, pelvic hemorrhage control, debridement, colostomy, emergency surgery
Missed Intra-Abdominal Injury Identification and Management
Critical Source: NATO Emergency War Surgery
Procedure for Identifying and Managing Missed Intra-Abdominal Injury

1. Ensure Adequate Operative Incision: Use a generous midline incision to allow full exposure of the abdomen. Quadrant incisions should only be used if the trajectory of...
missed intra-abdominal injury, surgical exploration, abdominal imaging, peritonitis, wound trajectory
Perform Debridement of Open Injuries
Critical Source: NATO Emergency War Surgery
Debridement:
1. Make generous incisions to allow better exploration of the wound, removal of foreign material (clothing, soil, vegetation, and accessible metal fragments), and complete excision of devitalized tissue.
2. Remove small, detached...
debridement,wound cleaning,foreign material removal,devitalized tissue
Perform Surgical Fasciotomy for Compartment Syndrome
Critical Source: NATO Emergency War Surgery
Procedure:

1. Perform surgical fasciotomy as soon as compartment syndrome is diagnosed to relieve pressure within the affected compartments.
2. Ensure adequate decompression of all involved muscle compartments in the leg or forearm.
3. Monitor...
fasciotomy,compartment syndrome,surgery,decompression
Perform Vascular Repair and Fasciotomy
Critical Source: NATO Emergency War Surgery
Vascular repair and fasciotomy:
1. These are the only appropriate definitive procedures performed at the time of initial wound surgery.
2. Address vascular injuries through 'wounds of election'.
3. Perform fasciotomies routinely following...
vascular repair,fasciotomy,wound management
Resection for Severe Parenchymal Lung Injury
Critical Source: Emergency War Surgery
Procedure:

• Resection for bleeding may be indicated with severe parenchymal injury.
• Anatomic resections are not indicated and simple stapled wedge excisions recommended.
• Uncontrolled parenchymal/hilar bleeding, or complex hilar...
lung resection,wedge excision,hilar injury management
Supraclavicular Approach for Mid to Distal Subclavian Artery Injury
Critical Source: Emergency War Surgery
Procedure:

1. Make an incision 2 cm above and parallel to the clavicle.
- Begin at the sternal notch and extend laterally 8 cm.

Indication:
• Mid to distal subclavian artery injury.
supraclavicular approach,subclavian artery injury,surgical procedure,emergency surgery
Surgical Approaches for Vascular Repair
Critical Source: Emergency War Surgery
Step-by-step procedure:

1. Use longitudinal incisions directly over the injured vessel.
2. Obtain proximal and distal control of the vessel using a tourniquet (e.g., BP cuff) if needed.
3. This step is essential for safe surgical access...
vascular repair, incision, tourniquet, surgical approach
Suturing Techniques for Vascular Repair
Critical Source: Emergency War Surgery
Step-by-step procedure:

1. Use 5-0 or 6-0 Prolene suture material for most repairs.
2. For small arteries, use 7-0 Prolene.
3. Ensure all sutures are tension-free to prevent complications such as aneurysm formation.
4. After...
vascular suture, Prolene, tension-free repair, bleeding test
Thoracic Injury Surgical Approach
Critical Source: Emergency War Surgery
Procedure:

1. Perform supraclavicular approach as above.
2. Perform a partial median sternotomy to the fourth intercostal space.
3. At the fourth intercostal interspace, incise the skin laterally in the submammary fold to the anterior axillary...
thoracic injury,surgical approach,emergency surgery
Thoracoabdominal Incision for Combined Thoracic and Abdominal Injuries
Critical Source: Emergency War Surgery
Procedure:

• The resuscitative thoracotomy can be continued medially and inferiorly across the costal margin into the abdominal midline to complete a thoracoabdominal incision.
• Alternatively, a separate abdominal incision can be made.
• With...
thoracoabdominal incision,combined injury,surgical procedure
Tractotomy for Bleeding Tracts in the Lung
Critical Source: Emergency War Surgery
Procedure:

• Open any bleeding tracts (through and through lung penetrations) with a GIA stapler and ligate bleeding points.

Warning:
• Do not simply close the entrance and exit points of penetrating tracts in the lung. With positive...
tractotomy,lung penetration,bleeding tract management
Trap Door Procedure for Proximal Left Subclavian Artery Injury
Critical Source: Emergency War Surgery
Procedure:

• Make an incision in the submammary fold to the anterior axillary line.
• Divide the sternum laterally and continue in the 4th intercostal space (ICS) to the anterior axillary line.
• The internal mammary artery will be divided and...
trap door procedure,left subclavian artery injury,surgical approach,emergency surgery
Vascular Repair and Avoidance of Nerve/Tendon Repairs in Battlefield Casualties
Critical Source: NATO Emergency War Surgery
Objective: Address vascular injuries while avoiding unnecessary procedures that may compromise recovery.

Steps:
1. Perform vascular repairs as indicated during the acute phase of treatment.
2. Do not perform nerve or tendon repairs...
vascular repair, nerve repair avoidance, battlefield surgery
Achieve Hemostasis to Prevent Bleeding and Infection
High Priority Source: Medical Survival Wound Closure Manual
Procedure:

1. Use mechanical, thermal, or chemical methods to control bleeding during the procedure.
2. Ensure complete hemostasis before wound closure to allow clear visibility for accurate tissue approximation.
3. Clamp or ligate vessels...
hemostasis, bleeding control, surgical closure
Administer Local Anticoagulation During Vascular Surgery
High Priority Source: NATO Emergency War Surgery
Procedure:

1. Use heparin for anticoagulation of the distal arterial tree during surgery.
2. Dose heparin carefully, using between 1,500 to 3,000 units at a concentration of 100 units per cc of physiologic saline for lower extremity...
heparin,anticoagulation,vascular surgery,dextran,volume overload
Closure of the Colon Wounds
High Priority Source: Medical Survival Wound Closure Manual
Procedure:

1. Use absorbable VICRYL* or chromic gut sutures, or nonabsorbable sutures for closure.
2. Place interrupted or continuous sutures through the submucosa, into the muscularis, and through the serosa.
3. Avoid penetration of...
colon closure,wound healing,absorbable suture
Closure of the Small Intestine Wounds
High Priority Source: Medical Survival Wound Closure Manual
Procedure:

1. Use absorbable VICRYL* or chromic gut sutures for closure.
2. Place interrupted or continuous sutures through the submucosa, into the muscularis, and through the serosa.
3. Avoid penetration of the mucosa to prevent...
small intestine closure,absorbable suture,wound healing
Closure of the Stomach Wounds
High Priority Source: Medical Survival Wound Closure Manual
Procedure:

1. Use absorbable VICRYL* or PROLENE* sutures for closure.
2. Place interrupted or continuous sutures through the submucosa, into the muscularis, and through the serosa.
3. Avoid penetration of the mucosa to prevent leakage.
4....
stomach closure,absorbable sutures,wound healing
Configure Surgical Suites for Efficient Operation
High Priority Source: NATO Emergency War Surgery
The surgical suites are most often configured with operating tables in a single large room. The arrangement functions very efficiently, in spite of an increased noise level.
operating room setup, surgical suite configuration
Contraindications for Fast Absorbing Surgical Gut Sutures
High Priority Source: Medical Survival Wound Closure Manual
General Contraindications:
• These sutures should not be used where prolonged approximation of tissue under stress is required.
• They are designed to absorb rapidly and must be used on dermal tissue only, not internal tissue.
• Use is...
contraindications, surgical gut suture, wound dehiscence, allergic response, tissue inflammation
Debride and Irrigate Open Joint Injuries
High Priority Source: NATO Emergency War Surgery
Procedure:

1. Remove all loose bony fragments, detached or badly damaged cartilage, foreign bodies, clots, and devitalized tissue from the joint.
2. Utilize biplanar radiographs to assess the injury extent and guide debridement.
3. Thoroughly...
debridement,joint irrigation,wound cleaning,surgery
Debridement and Management of Ruptured Blebs and Suppurative Eschars
High Priority Source: NATO Emergency War Surgery
Procedure:

1. Perform superficial debridement of ruptured blebs.
2. Remove suppurative eschars (infected dead tissue) and partially detached nails.
3. Pay close attention to circumferential eschars or those where vascular...
debridement, ruptured blebs, suppurative eschars, bivalving, amputation, skin grafting
Debridement of Hand Injuries
High Priority Source: NATO Emergency War Surgery
Procedure for Debridement of Hand Injuries

### Equipment and Setup
• Work with an assistant, good lighting, and adequate time.
• Operate while seated, with the draped extremity extended and the hand resting on a suitable support.
• Use the...
debridement, hand injury, surgical procedure, tourniquet use, nerve repair, wound exploration, tissue preservation
Decide When to Perform an Amputation
High Priority Source: NATO Emergency War Surgery
Objective: Determine when amputation is necessary to preserve life.

Indications for Emergency Amputation:
1. Massive injuries where the extremity is obviously nonviable due to severe mangled tissue.
2. **Severe involvement of skin,...
amputation, emergency surgery, trauma, limb preservation, sepsis, infection, vascular gangrene, clostridial myositis
Determine the Level of Amputation
High Priority Source: NATO Emergency War Surgery
Objective: Decide at which level to perform the amputation based on injury severity and viability.

Guidelines for Determining Amputation Level:
1. Amputate at the lowest possible level of viable tissues, preserving as much distal tissue...
amputation level, tissue viability, flap construction, below-the-knee amputation, compartment syndrome
Evaluate Open Injuries of Bones and Joints
High Priority Source: NATO Emergency War Surgery
Evaluation:
1. Initially determine the extent of the wound and of the structures involved.
2. In high-velocity missile wounds, tissues and structures at some distance from the actual wound tract may be damaged and require debridement.
evaluation,open injuries,bones,joints,wound assessment
Evaluate for Hip Joint Involvement in Pelvic and Lower Abdominal Injuries
High Priority Source: NATO Emergency War Surgery
Procedure:

1. Carefully evaluate penetrating wounds of the lower abdomen and pelvic area for involvement of the hip joint.
2. If there is any evidence that the hip has been penetrated, perform arthrotomy, exploration, irrigation, and...
hip injury,pelvic wound evaluation,arthrotomy,posterior approach
Evaluation and Management of Renal Injuries in Combat Settings
High Priority Source: Emergency War Surgery
Evaluation and Management of Renal Injuries in Combat Settings

• Most renal injuries, except for those of the renal pedicle, are not acutely life threatening. Undiagnosed or improperly treated injuries, however, may cause significant...
renal injury evaluation, combat trauma, IVP procedure, renal contusion, kidney function assessment
Important Warning: Do Not Resterilize Sutures
High Priority Source: Medical Survival Wound Closure Manual
WARNING: Surgical sutures are labeled as disposable, single-use medical devices, and they must not be resterilized unless explicitly stated by the manufacturer.

### Steps:
1. Verify that all suture products from ETHICON are clearly labeled...
do not resterilize, disposable devices, sterilization reprocessor, product integrity, warning label
Linear Salpingotomy for Unruptured Ectopic Pregnancy
High Priority Source: Emergency War Surgery
Procedure:

1. Identify an unruptured ampullary/isthmic ectopic pregnancy.
2. Perform a linear salpingotomy, making an incision along the fallopian tube to extract the ectopic gestation.
3. Leave the tubal incision open to heal by...
linear salpingotomy, unruptured ectopic pregnancy, tubal incision
Maintain Sterile and Aseptic Technique During Procedures
High Priority Source: Medical Survival Wound Closure Manual
Procedure:

1. Ensure all surgical instruments, surfaces, and personnel are sterilized before beginning any procedure.
2. Use sterile gloves, gowns, masks, and drapes to maintain a sterile field.
3. Avoid unnecessary movement or contact with...
sterile technique, aseptic procedure, infection prevention, surgical hygiene
Manage Extraperitoneal Bladder Injuries
High Priority Source: Emergency War Surgery
Diagnosis:

• Cystography reveals a dense, flame-like extravasation of contrast medium in the pelvis on postevacuation film.

Management Steps:

1. Most extraperitoneal ruptures can be managed with **Foley catheter drainage for 10–14...
extraperitoneal bladder injury, foley catheter, rectal injury, surgical repair
Management of Retroperitoneal Injuries
High Priority Source: Emergency War Surgery
Left medial visceral rotation: Moves the colon, pancreas, and small bowel to expose the aorta rapidly. Proximal aortic control can be rapidly obtained with compression or a clamp on the aorta at the hiatus, or through the left chest.

**Right...
retroperitoneal injury,vascular control,aortic compression,Kocher maneuver,hematoma management
Management of Simple, Isolated Colon Injuries in Indigenous Populations and Enemy Combatants
High Priority Source: Emergency War Surgery
For simple, isolated colon injuries in indigenous populations or enemy combatants (patients who cannot be readily evacuated), diversion with colostomy should be the procedure of choice, especially at Level 2. The often poor nutritional...
colon injury,colostomy,emergency surgery,debridement,anastomosis,damage control
Managing Large Abdominal Wall Defects with Marlex Mesh Prosthesis
High Priority Source: NATO Emergency War Surgery
Procedure:

1. Assess the abdominal wall defect to determine if it is large enough to require a prosthesis.
2. If a primary closure is attempted, ensure that tension on the wound edges is minimized to avoid necrosis and respiratory...
abdominal wall defect, marlex mesh, surgical closure, wound management, abdominal surgery
Managing Major Renal Trauma
High Priority Source: Emergency War Surgery
Procedure for Managing Major Renal Trauma:

Overview:
• Major injuries include deep cortical lacerations (with or without urinary extravasation), shattered kidneys, renal vascular pedicle injuries, or total avulsion of the renal pelvis.
-...
renal trauma, kidney injury, vascular control, nephrectomy, renal debridement, laparotomy, urinary diversion
Perform Arthrotomy for Penetrating Joint Injuries
High Priority Source: NATO Emergency War Surgery
Procedure:

1. For all penetrating injuries of a joint, perform a formal arthrotomy as soon as possible after injury in an operating room.
2. If feasible, extend the existing wound to facilitate access; otherwise, make a separate standard...
arthrotomy,joint injury,surgery,wound management
Perform Intraosseous (IO) Infusion
High Priority Source: Emergency War Surgery
Procedure for Intraosseous (IO) Infusion

Contraindications:
• Trauma or infection at insertion site.
• Recent IO device at the same site.
• Fracture of insertion bone.
• Recent sternotomy.

Devices and Procedure:
• **Devices...
IO infusion, intraosseous access, emergency IV, battlefield procedure, trauma care
Performing a Double-Layer Closure on Gastrointestinal Tract Wounds
High Priority Source: Medical Survival Wound Closure Manual
Procedure:

1. Place the first layer of interrupted sutures through the submucosa, into the muscularis, and through the serosa.
2. Add a second layer of interrupted sutures through the serosa for additional reinforcement.
3. Use...
double-layer suture,gastrointestinal closure,wound reinforcement
Performing a Fasciotomy on the Calf
High Priority Source: Emergency War Surgery
Procedure:

Step 1: Identify compartments
• The calf has four compartments:
- Lateral compartment: peroneal brevis and longus.
- Anterior compartment: extensor hallucis longus, extensor digitorum communis, tibialis anterior, and...
fasciotomy, calf surgery, two-incision technique, tibialis posterior
Performing a Fasciotomy on the Upper Extremity
High Priority Source: Emergency War Surgery
Procedure:

Step 1: Identify compartments
• The arm has two compartments: anterior flexors (biceps, brachialis) and posterior extensors (triceps).

Step 2: Make incisions
• Make a lateral skin incision from the deltoid insertion...
fasciotomy, upper extremity, arm surgery, compartment syndrome, radial nerve protection
Performing a Single-Layer Closure on Gastrointestinal Tract Wounds
High Priority Source: Medical Survival Wound Closure Manual
Procedure:

1. Use interrupted sutures placed approximately 1/4" (6mm) apart.
2. Pass the suture through the submucosa, into the muscularis, and through the serosa.
3. Ensure that the submucosal layers are sutured in apposition...
gastrointestinal closure,single-layer suture,wound closure,submucosal suturing
Performing an Emergent Total Abdominal Hysterectomy
High Priority Source: Emergency War Surgery
Procedure:

1. Ligate or cauterize round ligaments (refer to Fig. 19-1 for anatomical reference).
2. Incise the anterior leaves of broad ligaments bilaterally, then continue across the midline to incise the vesicouterine fold.
3....
abdominal hysterectomy, emergency surgery, gynecologic trauma, uterine artery ligation, adnexa removal, supracervical hysterectomy
Pitfalls of Blind Clamping in Hemorrhage Control
High Priority Source: Emergency War Surgery
- Blind clamping into the wound is more likely to cause additional injury than to control bleeding.
Risk–Benefit Decision: Judgment that other measures are not successful should be exercised before applying clamps in a wound. Field wound...
blind clamping, surgical pitfalls, hemorrhage management
Prepare for Amputation Procedure
High Priority Source: NATO Emergency War Surgery
Objective: Ensure proper preparation of the limb and surgical field before performing an amputation.

Steps to Prepare:
1. Prep and drape the limb to provide circumferential operative access.
2. Elevate the limb during prepping and...
amputation preparation, surgical field prep, tourniquet use, limb elevation, tissue preservation
Prevent and Manage Ischemic Contracture After Vascular Injury
High Priority Source: NATO Emergency War Surgery
Procedure:

1. Restore perfusion as soon as possible after an arterial injury to prevent ischemic contracture.
2. If circulation is restored, monitor for muscle swelling that may lead to compartment syndrome.
3. Perform fasciotomies...
ischemic contracture,fasciotomy,compartment syndrome,muscle necrosis,vascular injury
Preventing and Managing Dehiscence in Postoperative Abdominal Wounds
High Priority Source: NATO Emergency War Surgery
Objective: Prevent dehiscence (wound opening) in postoperative abdominal wounds through proper surgical technique and patient management.

Procedure:
1. Use Retention Sutures: Place retention sutures 2 to 3 cm apart, through all layers...
dehiscence prevention,retention sutures,wound management,ileus management,nasogastric decompression
Remove Necrotic Tissue and Foreign Materials
High Priority Source: Medical Survival Wound Closure Manual
Procedure:

1. Thoroughly debride all devitalized tissue from the wound site.
2. Remove any foreign materials such as dirt, metal, glass, or other debris that may be present in traumatic wounds.
3. Ensure complete removal of necrotic tissue to...
debridement, necrotic tissue removal, foreign body extraction
Repair of Parenchymatous Organ Lacerations
High Priority Source: Medical Survival Wound Closure Manual
Repair of Parenchymatous Organ Lacerations

1. Locate and ligate large vessels, particularly arteries, within the spleen, liver, or kidney before attempting to close a laceration.
2. If hemorrhage is not present, use only small size sutures...
parenchymatous organ repair, omentum tacking, vessel ligation, liver resection
Retraction of Colostomy Management
High Priority Source: NATO Emergency War Surgery
Procedure for Correcting Retracted Colostomy or Ileostomy

1. Assess the Cause of Retraction: Determine if retraction is due to inadequate mobilization during initial surgery, tension on the bowel, or failure to secure the mesenteric segment...
colostomy retraction, ileostomy retraction, bowel mobilization, surgical reoperation, stoma construction
Salpingectomy for Damaged Fallopian Tubes
High Priority Source: Emergency War Surgery
Procedure:

1. Assess the damage to the fallopian tube caused by a ruptured ectopic pregnancy or penetrating abdominal trauma.
2. If there is significant damage to the tube, perform a salpingectomy due to the risk of subsequent or...
salpingectomy, ectopic pregnancy, fallopian tube damage, mesosalpinx ligation
Selecting Appropriate Suture Materials for Vessel Anastomoses
High Priority Source: Medical Survival Wound Closure Manual
When performing vessel anastomoses, choose suture materials that minimize tissue reaction and thrombus formation. The following are recommended:

Preferred synthetic sutures:
Nylon
Polypropylene

These materials are inert and reduce...
vessel anastomoses, suture materials, polypropylene, nylon, ethibond excel, proleene, pronoval, silk, pds ii, infection resistance
Selecting Sutures for Urinary Tract Surgery
High Priority Source: Medical Survival Wound Closure Manual
When performing urinary tract surgery, the following suture considerations apply:

Material Choice:
Nonabsorbable sutures are not suitable as they can incite the formation of calculi. Avoid using them in this area.

**Preferred...
urinary tract surgery, absorbable sutures, monocryl, pds ii, vicryl, chromic gut, healing time, tensile strength
Stump Wound Closure Management
High Priority Source: NATO Emergency War Surgery
Procedure:

1. The timing and method of wound closure require significant surgical judgment.

2. Delayed primary closure is not indicated in open circular amputations.

3. Continued traction may result in the skin eventually closing over the...
stump closure, wound management, amputation recovery
Suturing Vascular Prostheses and Artificial Heart Valves
High Priority Source: Medical Survival Wound Closure Manual
When suturing vascular prostheses or artificial heart valves, the following considerations apply:

Material Choice:
Coated polyester sutures are preferred for fixation of vascular prostheses and heart valves as they retain their strength...
vascular prostheses, heart valves, coated polyester sutures, pledgets, ethibond excel, valve replacement
Timing of Reoperative Abdominal Surgery in War Casualties
High Priority Source: NATO Emergency War Surgery
Objective: Determine the optimal timing for reoperative abdominal surgery to manage complications effectively.

Procedure:
1. Monitor First Three Weeks Post-Operation: The highest incidence of reoperations occurs within the first three...
reoperation timing,evacuation protocol,postoperative complications,surgeons evaluation
Understanding Surgical Needle Design and Functionality
High Priority Source: Encyclopedia of Knots
Surgical Needles are essential tools used in medical procedures to place sutures with minimal trauma to tissue. They must be:

Sharp enough to penetrate tissue with minimal resistance.
Rigid yet flexible, able to resist bending but...
surgical needles, suture placement, needle design, ductility, strength, swaged sutures, stainless steel, ETHICON, ETHALLOY
Wedge Resection for Corneal/Interstitial Ectopic Pregnancy
High Priority Source: Emergency War Surgery
Procedure:

1. Identify an unruptured or ruptured corneal/interstitial ectopic pregnancy.
2. Perform a wedge resection of the uterine cornuum, removing the affected portion of the uterus and fallopian tube (salpingectomy).
3. Ensure that...
wedge resection, corneal ectopic pregnancy, interstitial ectopic pregnancy
Absorption Rate of Surgical Gut Sutures in Infected Tissues
High Priority Source: Medical Survival Wound Closure Manual
Surgical gut sutures may be used in the presence of infection, although they are absorbed more rapidly under these conditions.

Impact on Absorption: Infection accelerates the absorption rate, which can affect the tensile strength...
infection, surgical gut absorption, tissue condition, tensile strength
Administer Local Anesthesia for Genital Sewing
High Priority Source: A Book for Midwives
To numb the genitals before sewing:

• Inject up to 10 ml of 1% lidocaine without epinephrine in the torn tissue.
Or, inject up to 20 ml of 0.5% lidocaine without epinephrine in the torn tissue.
Or, spray topical lidocaine...
lidocaine, anesthetic, genital sewing, local anesthesia, midwifery, medical procedure
Adverse Reactions and Complications of Coated VICRYL Sutures
High Priority Source: Medical Survival Wound Closure Manual
Procedure:

1. Potential adverse effects:
- Include wound dehiscence, failure to provide adequate wound support in areas subject to expansion, stretching, or distension.
- May also fail to provide adequate support in elderly,...
adverse reactions, coated vicryl sutures, wound dehiscence, infection, suture extrusion
Adverse Reactions and Risks Associated with Coated VICRYL Plus Antibacterial Sutures
High Priority Source: Medical Survival Wound Closure Manual
Procedure:

1. Monitor for adverse effects:
- Adverse reactions may include wound dehiscence, inadequate wound support in patients with conditions that delay healing (e.g., elderly, malnourished, or debilitated), infection, and localized...
adverse effects, wound dehiscence, suture extrusion, allergic reaction, needle sticks
Adverse Reactions and Risks Associated with MONOCRYL Sutures
High Priority Source: Medical Survival Wound Closure Manual
Procedure:

1. Potential Adverse Effects:
- Wound dehiscence.
- Failure to provide adequate wound support in closures where expansion, stretching, or distention occur.
- Failure to provide adequate wound support in elderly,...
MONOCRYL suture adverse reactions, wound dehiscence, infection, needle safety
Closing the Galea and Dura Mater with Sutures
High Priority Source: Medical Survival Wound Closure Manual
Procedure:

1. Use an interrupted suture technique to close the galea and dura mater.
2. Ensure proper closure of the galea, which is very vascular and hemostatic, to prevent scalp hematoma.
3. For the dura mater:
- Drain some...
galea,dura mater,sutures,scalp hematoma,cerebrospinal fluid drainage,patch insertion
Closure with Retention Sutures
High Priority Source: Medical Survival Wound Closure Manual
Procedure for Closure with Retention Sutures

Overview:
Retention sutures are used to reinforce abdominal wounds and prevent dehiscence due to intra-abdominal pressure from activities like coughing, vomiting, or distention. They are...
retention sutures, abdominal wound closure, surgical techniques, nonabsorbable suture material, bolster bumper, postoperative care
Cutting Secured Sutures
High Priority Source: Medical Survival Wound Closure Manual
Cutting Secured Sutures

• Once the knot has been securely tied, the ends must be cut.
• Before cutting, ensure both tips of the scissors are visible to avoid inadvertently cutting tissue beyond the suture.
• Run the tip of the scissors lightly...
cutting sutures,suture removal,knot cutting,scissors technique
Definition and Characteristics of Absorbable Surgical Sutures
High Priority Source: Encyclopedia of Knots
Procedure:

1. Understand the definition of absorbable surgical sutures, as defined by the United States Pharmacopeia (U.S.P.).
2. Recognize that absorbable sutures are made from **collagen derived from healthy mammals or synthetic...
absorbable sutures, U.S.P. definition, collagen, synthetic polymers, antimicrobial agents
Delayed Wound Closure of Hand Injuries
High Priority Source: NATO Emergency War Surgery
Procedure for Delayed Wound Closure of Hand Injuries

### Timing and Preparation
1. Perform delayed closure several days after initial debridement, ensuring the wound is free of sepsis and necrotic tissue.
2. Avoid primary closure in most...
delayed closure, wound healing, hand injury, Kirschner wires, fracture stabilization
Documenting Surgical Procedures in Emergency War Surgery
High Priority Source: NATO Emergency War Surgery
Objective: Ensure accurate and complete documentation of surgical procedures for postoperative care and future reference.

Procedure:
1. Record Indications for Operation: Clearly document the reasons for performing the operation,...
documentation,surgery notes,hospital summaries,operation records,postoperative management

+ 168 more procedures. Get the full library in the app.

Infection Control (156)

Activate Institutional Pandemic Influenza Plans During Outbreak
Critical Source: HHSPandemicInfluenzaPlan
Objective: Implement institutional pandemic plans when an influenza outbreak occurs.

Procedure:
1. Activate the facility’s pandemic response plan based on predefined triggers (e.g., confirmed cases, public health alerts).
2. Identify and...
pandemic plan activation, infection control, healthcare response protocols
Administer IV Antibiotics for Open-Joint Injuries
Critical Source: Emergency War Surgery
Objective: Prevent infection in open-joint injuries by administering IV antibiotics.

### Action Steps:
1. Start IV antibiotics as soon as possible after wounding (ASAP).
2. Continue postoperative administration of IV antibiotics for **48...
IV antibiotics, open-joint injury, infection prevention, postop care
Aerosol-Generating Procedures and PPE Use During Pandemic Influenza
Critical Source: HHSPandemicInfluenzaPlan
Aerosol-Generating Procedure Guidelines:

• For procedures that may generate small particles of respiratory secretions (e.g., endotracheal intubation, bronchoscopy, nebulizer treatment, suctioning), use the following PPE:
- Gloves,...
aerosol-generating procedures, PPE use, N-95 respirator, pandemic influenza, infection control
Hand Hygiene and PPE Use for Healthcare Providers During Pandemic Influenza
Critical Source: HHSPandemicInfluenzaPlan
Hand Hygiene Recommendations:

• Perform hand hygiene after touching blood, body fluids, secretions, excretions, or contaminated items.
• Perform hand hygiene between patient contacts and after removing gloves.
• Use **alcohol-based...
hand hygiene, PPE use, infection control, pandemic influenza, healthcare providers
Implement Infection Control Precautions for Hospitalized Patients with Suspected Pandemic Influenza
Critical Source: HHSPandemicInfluenzaPlan
Procedure:

1. If the patient is hospitalized:
- Implement infection control precautions for pandemic influenza, including Respiratory Hygiene/Cough Etiquette (see Table and Supplement 4).
- Place the patient on **Droplet...
infection control, droplet precautions, hospitalization, pandemic influenza
Infection Control Precautions for Patients with Novel or Seasonal Influenza
Critical Source: HHSPandemicInfluenzaPlan
Standard and Droplet Precautions:

• Use Standard Precautions (hand hygiene, PPE, safe work practices) when caring for patients.
• Apply Droplet Precautions in addition to Standard Precautions for patients with novel or seasonal...
standard precautions, droplet precautions, infection control, respiratory hygiene, pandemic influenza
Infection Control and Cohorting of Pandemic Influenza Patients
Critical Source: HHSPandemicInfluenzaPlan
Cohorting Guidelines:

• Follow cohorting strategies as outlined in Supplement 4.
Laboratory confirmation is recommended before cohorting patients with influenza infection.

Infection Control Measures:
• Use Standard and...
cohorting patients, infection control, pandemic influenza, standard precautions, droplet precautions
Infection Control and Precautions for Novel Influenza Cases in the Home
Critical Source: HHSPandemicInfluenzaPlan
Procedure:

1. Initiate Standard and Droplet Precautions if either clinical or epidemiological criteria are met.
2. Notify the state or local health department about the case immediately.
3. Collect and send specimens for novel...
infection control, novel influenza, pandemic, precautions, home care
Infection Prevention and Control Plan Development
Critical Source: Home Health Emergency Preparedness
Procedure:

1. Develop a comprehensive infection prevention and control plan that addresses:
- Rapid spread of disease from bioterrorism or natural causes (e.g., pandemic influenza).
- Policies for the rapid procurement of personal...
infection prevention plan, ppe training, n95 respirator, syndromic surveillance, emergency infection control
Initiate Prophylaxis for Open Injuries
Critical Source: NATO Emergency War Surgery
Prophylaxis:
1. Initiate parenteral antibiotic treatment and tetanus prophylaxis at the earliest opportunity.
2. Use broad-spectrum antibiotic coverage for both Gram-negative and Gram-positive organisms.
3. All open war wounds require a 0.5 cc...
prophylaxis,antibiotics,tetanus,wound infection
Isolating Patients with Novel Strain Influenza Infections
Critical Source: HHSPandemicInfluenzaPlan
Procedure:

1. Determine isolation location:
- Isolate patients at home, in a community facility, or in a hospital depending on clinical needs and public health requirements.
- Admit the patient to a hospital if clinically indicated,...
patient isolation, infection control, hospital admission, public health coordination
Management of Infected Bone or Joint Injuries
Critical Source: NATO Emergency War Surgery
Procedure for Managing Infected Bone or Joint Injuries:

1. Early medical evacuation from the battlefield is preferred to prevent frank infection.
2. If infection has already occurred:
- Perform wide exposure for excision of...
infected bone injury,septic joint,wound irrigation,antibiotic use,surgical debridement
Prepare for Infection Control in Burn Wound Management
Critical Source: Planning Guidance Nuclear Detonation FEMA
Action: Implement infection control protocols for burn wound management.

Details:
• Burns are highly susceptible to infection and require immediate debridement (removal of dead tissue) within hours to days after injury.
• Regular...
burn infection,debridement,wound care,infection control,nuclear detonation
Prevent the Spread of Germs Between Patients
Critical Source: Where There is No Dentist
Why it's important: You must not spread germs from a sick person to a healthy person.

Steps to follow:
1. Always ensure that your instruments are clean and sterilized before using them on another patient.
2. An instrument with blood on it...
germ spread,hepatitis,HIV,AIDS,instrument reuse
Preventing Infection by Keeping Germs Away
Critical Source: A Book for Midwives
Keeping germs away is essential to prevent infection and ensure safe medical procedures.

### Steps to Prevent Infection:
1. Understand the source of germs:
- Germs are tiny organisms that cause sickness.
- They live in blood, stool,...
germs,hygiene,infection control,clean environment,sterilization
Antibiotic Discipline in Infection Management
High Priority Source: Emergency War Surgery
Antibiotic discipline must be enforced:

Fever or leukocytosis should prompt a thorough search for infection.
• Use antibiotics only for:
- Short-course prophylaxis, when documented.
- Documented infection.
- **Empiric...
antibiotic use,sepsis,leukocytosis,fever,infection control
Apply Droplet Precautions and Patient Placement in Healthcare Settings
High Priority Source: HHSPandemicInfluenzaPlan
Procedure:

1. Place patients with suspected or confirmed pandemic influenza in a single room with private bathroom if available.
2. **If a single room is not available, place the patient in a room with other patients with the same infection...
droplet precautions, patient placement, infection control, healthcare settings, pandemic influenza
Biocontainment Levels for Influenza Virus Handling
High Priority Source: HHSPandemicInfluenzaPlan
Procedure:

1. During Interpandemic and Pandemic Alert Periods, use BSL-3 with enhancements when handling Highly Pathogenic Avian Influenza (HPAI) viruses or other influenza viruses with pandemic potential.
2. During the **Pandemic...
BSL-3, BSL-2, biocontainment, HPAI, influenza virus handling
Clean and Disinfect Patient-Occupied Rooms in Healthcare Settings
High Priority Source: HHSPandemicInfluenzaPlan
Procedure:

1. Perform thorough cleaning of all surfaces in the patient's room, including high-touch areas such as doorknobs, bedrails, and medical equipment.
2. **Use an EPA-registered disinfectant that is effective against influenza...
environmental cleaning, disinfection, infection control, healthcare settings, pandemic influenza
Cohort Residents and Staff in Units with Known or Suspected Pandemic Influenza Cases
High Priority Source: HHSPandemicInfluenzaPlan
Procedure:

1. Cohort residents and staff on units with known or suspected cases of pandemic influenza.
cohorting,pandemic influenza,nursing homes
Community-Wide Infection Control Measures
High Priority Source: HHSPandemicInfluenzaPlan
Procedure:

1. Implement community-wide infection control measures such as:
- Enhanced cleaning and disinfecting of public spaces
- Promotion of hand hygiene and respiratory etiquette
- Enforcement of mask-wearing in crowded areas
2....
community infection control, hygiene promotion, public health measures
Contain Infectious Respiratory Secretions in Healthcare Settings
High Priority Source: HHSPandemicInfluenzaPlan
Objective: Minimize the spread of respiratory secretions from symptomatic individuals.

Procedure:
1. Instruct persons with flu-like symptoms (fever, cough, sore throat, etc.) to practice respiratory hygiene/cough etiquette (see Box...
respiratory hygiene, cough etiquette, infection control, masks
Control of Nosocomial Pandemic Influenza Transmission
High Priority Source: HHSPandemicInfluenzaPlan
Surveillance and Control Measures

• Once patients with pandemic influenza are admitted to the hospital, nosocomial surveillance should be heightened for evidence of transmission to other patients and healthcare personnel. (Once pandemic...
nosocomial transmission, infection control, pandemic influenza, hospital protocols
Dispose of Solid Waste Properly in Healthcare Settings
High Priority Source: HHSPandemicInfluenzaPlan
Procedure:

1. Place all solid waste generated from patients with suspected or confirmed pandemic influenza into designated, leak-proof containers labeled for infectious waste.
2. **Ensure that waste is disposed of according to local...
solid waste, infection control, healthcare settings, pandemic influenza
Handle Linen and Laundry in Healthcare Settings
High Priority Source: HHSPandemicInfluenzaPlan
Procedure:

1. Use dedicated laundry carts or containers for transporting linen from patients with suspected or confirmed pandemic influenza.
2. Wear appropriate PPE when handling soiled linen, including gloves and gowns if necessary.
3....
linen, laundry, infection control, healthcare settings, pandemic influenza
Hospitalization and Infection Control for Novel Influenza Patients
High Priority Source: HHSPandemicInfluenzaPlan
Procedure:

1. Hospitalization should be based on clinical factors including the potential for infectiousness and the ability to practice adequate infection control.

2. If hospitalization is not clinically warranted, and treatment and infection...
home isolation, hospitalization criteria, infection control
Hospitalization of Pandemic Influenza Patients
High Priority Source: HHSPandemicInfluenzaPlan
Patient Placement

• Limit admission of influenza patients to those with severe complications who cannot be cared for outside the hospital setting.
• Admit patients to either a single-patient room or an area designated for cohorting of patients...
pandemic influenza, hospitalization, cohorting, infection control, patient transport, visitor guidelines
Identify Common Microorganisms Causing Battlefield Infections
High Priority Source: Emergency War Surgery
### Common Microorganisms Causing Battlefield Infections

Gram-positive cocci: staphylococci, streptococci, and enterococci.

Gram-negative rods: _Escherichia Coli_, _Proteus_, and _Klebsiella_.
- _Pseudomonas_, _Enterobacter_,...
battlefield infections, microorganisms, clostridial myonecrosis, gas gangrene, staphylococci, streptococci, enterococci, Escherichia Coli, Proteus, Klebsiella, Pseudomonas, Enterobacter, Acinetobacter, Serratia, Salmonella, Shigella, Vibrio, Candida
Identify Unusual or Unexpected Pandemic Developments
High Priority Source: HHSPandemicInfluenzaPlan
Procedure:

1. Monitor for unusual or unexpected developments during the pandemic outbreak.
2. Evaluate whether changes in infection control practices are needed based on new evidence.
3. Assess if modifications to case detection,...
unusual developments, infection control, surveillance modifications
Implement Droplet Precautions for Pandemic Influenza Patients
High Priority Source: HHSPandemicInfluenzaPlan
Procedure:

1. Place patients with known or suspected pandemic influenza on droplet precautions for a minimum of 5 days from the onset of symptoms.
2. For immunocompromised patients, extend droplet precautions to the **duration of their...
droplet precautions, pandemic influenza, infection control, patient placement, PPE, contact precautions
Implement Hand Hygiene Practices in Healthcare Settings
High Priority Source: HHSPandemicInfluenzaPlan
Procedure:

1. Wash hands with soap and water for at least 20 seconds when visibly soiled or after potential exposure to bodily fluids.
2. Use alcohol-based hand rubs (with at least 60% alcohol) if hands are not visibly soiled.
3....
hand hygiene, infection control, healthcare settings, pandemic influenza
Implement Infection Control Measures During Pandemic Influenza
High Priority Source: HHSPandemicInfluenzaPlan
Procedure:

1. Apply infection control measures to prevent transmission of influenza in healthcare settings, especially when a pandemic begins and vaccines or antiviral drugs are not widely available.

2. Use standard precautions,...
pandemic influenza, infection control, healthcare settings, transmission prevention, PPE, isolation protocols
Implement Infection Control Measures for Healthcare Workers During Pandemic Influenza
High Priority Source: HHSPandemicInfluenzaPlan
Procedure:

1. Assess Risk Exposure:
- Identify healthcare workers who are at increased risk of exposure to pandemic influenza due to their roles and patient interactions.

2. **Enforce Special Precautions:
- Ensure the use of personal...
healthcare workers,pandemic influenza,infection control,mental health,vaccination,antiviral drugs,psychosocial support
Implement Infection Control Precautions for Suspected Novel Influenza
High Priority Source: HHSPandemicInfluenzaPlan
Steps to Implement Infection Control Precautions:

1. Place the patient on Droplet Precautions for a minimum of 14 days, unless there is full resolution of illness or another etiology has been identified before that period has...
infection control, droplet precautions, novel influenza, respiratory hygiene, cough etiquette
Implement Institutional Surveillance for Pandemic Influenza
High Priority Source: HHSPandemicInfluenzaPlan
Objective: Heighten surveillance efforts to detect and respond to pandemic influenza early.

Procedure:
1. Increase monitoring of potential influenza cases within the facility, including staff and patients.
2. Use standardized reporting...
pandemic surveillance, infection control protocols, healthcare monitoring
Implement Personnel Screening in Residential Facilities During Pandemic Influenza
High Priority Source: HHSPandemicInfluenzaPlan
Procedure:

1. Implement a system to screen all personnel for influenza-like symptoms before they come on duty.
2. Send symptomatic personnel home until they are physically able to return to duty.
personnel screening,pandemic influenza,nursing homes
Implement Respiratory Hygiene/Cough Etiquette in Healthcare Settings
High Priority Source: HHSPandemicInfluenzaPlan
Procedure:

1. Encourage patients and healthcare personnel to cover their mouths and noses with tissues when coughing or sneezing.
2. Provide tissues and no-touch disposal containers for used tissues.
3. **Promote hand hygiene after...
respiratory hygiene, cough etiquette, infection control, healthcare settings, droplet transmission
Implement Visitor Restrictions in Residential Facilities During Pandemic Influenza
High Priority Source: HHSPandemicInfluenzaPlan
Procedure:

1. Post visual alerts at the entrance to the facility in appropriate languages, restricting entry by persons who have been exposed to or have symptoms of pandemic influenza.
2. Assign personnel to verbally and visually screen...
visitor restrictions,pandemic influenza,screening,nursing homes
Increase Resident Surveillance for Pandemic Influenza in Residential Facilities
High Priority Source: HHSPandemicInfluenzaPlan
Procedure:

1. Early in the progress of a pandemic, increase resident surveillance for influenza-like symptoms.
2. Notify state or local health department officials if a case(s) is suspected.
resident surveillance,pandemic influenza,nursing homes
Infection Control Practices for Healthcare Personnel During Pandemic Influenza
High Priority Source: HHSPandemicInfluenzaPlan
Procedure:

1. Apply standard and droplet precautions during patient care in healthcare settings (e.g., hospitals, nursing homes, outpatient offices, emergency transport vehicles) as they are the same as for other human influenza viruses.
2....
infection control, healthcare personnel, pandemic influenza, standard precautions, droplet precautions
Infection Control for Home Health Care During Pandemic Influenza
High Priority Source: HHSPandemicInfluenzaPlan
Standard and Droplet Precautions for Home Health Care:

• Healthcare providers should follow Standard Precautions (hand hygiene, PPE use) when entering homes with individuals who have influenza-like illness.
• Apply Droplet Precautions,...
home health care, infection control, droplet precautions, mask use, pandemic influenza
Isolate Infected Persons in Healthcare Settings
High Priority Source: HHSPandemicInfluenzaPlan
Objective: Prevent the spread of pandemic influenza by isolating infected individuals.

Procedure:
1. Confine patients to a defined area appropriate for the healthcare setting (e.g., isolation rooms, designated areas).
2. **Limit contact...
isolation, infection control, healthcare settings, pandemic influenza
Isolation of Potentially Infectious Individuals
High Priority Source: Survival and Austere Medicine
Action Steps:
1. Immediately isolate anyone showing symptoms such as fever or diarrhea, especially in austere environments.
2. For diarrheal illness, simple hand washing is usually sufficient for the caregiver.
3. For **febrile...
isolation,barrier precautions,infectious disease
Limit Movement Within Residential Facilities During Pandemic Influenza Outbreaks
High Priority Source: HHSPandemicInfluenzaPlan
Procedure:

1. Limit movement within the facility, for example:
- Temporarily close the dining room and serve meals on nursing units.
- Cancel social and recreational activities.
movement restriction,pandemic influenza,nursing homes
Manage Penetrating Abdominal Injuries with Antibiotics
High Priority Source: NATO Emergency War Surgery
Procedure for Managing Penetrating Abdominal Injuries:

1. Administer antibiotics promptly: The earliest possible parenteral administration of antibiotics is mandatory in all casualties with penetrating abdominal injuries.
2. **Use...
penetrating abdominal injury, antibiotic administration, cefoxitin use
Management of Close Contacts of Infected Patients
High Priority Source: HHSPandemicInfluenzaPlan
Procedure:

1. Identify and monitor close contacts of individuals infected with novel strains of influenza.
2. Provide guidance on self-isolation, symptom monitoring, and hygiene practices to close contacts.
3. Offer chemoprophylaxis (antiviral...
close contact management, chemoprophylaxis, infection control, public health monitoring
Management of Infections in Neutropenic Patients Following Radiation Exposure
High Priority Source: NATO Emergency War Surgery
Procedure:

1. Recognize the risk of opportunistic infections:
- Understand that gram-negative bacteria (e.g., *Escherichia coli*, *Pseudomonas aeruginosa*) and *Staphylococcus aureus* are common pathogens in immunosuppressed patients.
...
neutropenia,infection management,antibiotic use,wound infection,radiation exposure
Notify Public Health Departments of Laboratory Exposures and Illnesses
High Priority Source: HHSPandemicInfluenzaPlan
Procedure:

1. Local and/or state public health departments should be notified promptly of any laboratory exposures or illnesses in workers who have been exposed to avian influenza A viruses.
2. This ensures that appropriate measures are taken...
public health notification, laboratory exposure, avian influenza A virus
Preoperative and Postoperative Antibiotic Use for Intestinal Injuries
High Priority Source: NATO Emergency War Surgery
Procedure:

When managing suspected intestinal injuries (including the colon), follow these steps:

1. Administer preoperative antibiotics if intestinal injury is suspected.
2. Postoperative antibiotic use beyond 12 hours is questionable...
antibiotics, intestinal injury, preoperative care, postoperative infection
Prepare Antimicrobial Stockpile Distribution Plan
High Priority Source: Planning Guidance Nuclear Detonation FEMA
Objective: Ensure availability and distribution of antimicrobials following a nuclear detonation.

Procedure:
1. Coordinate with local medical professionals to identify available antimicrobial resources in the Strategic National Stockpile...
antimicrobials,SNS,user-managed inventories,ARS,hematopoietic syndrome,infection control,nuclear detonation
Prepare for Antimicrobial Distribution from SNS
High Priority Source: Planning Guidance for Response to Nuclear Detonation May 2022 FEMA
Objective: Ensure adequate antimicrobial supply distribution during a nuclear detonation.

Procedure Steps:
1. Coordinate with local medical professionals to identify the types and quantities of antimicrobials needed in response to...
antimicrobials,SNS,distribution,nuclear detonation,medical response
Proper Hand Hygiene in Healthcare Settings
High Priority Source: HHSPandemicInfluenzaPlan
Purpose: To reduce transmission of infectious agents through proper hand hygiene.

Procedure:
1. When hands are visibly soiled or contaminated with respiratory secretions:
- Wash hands thoroughly with soap (either non-antimicrobial or...
hand hygiene, infection control, standard precautions, alcohol-based hand sanitizer, soap and water, PPE removal
Proper Use and Disposal of Gloves During Patient Care
High Priority Source: HHSPandemicInfluenzaPlan
Procedure:

1. Wear a single pair of patient care gloves for contact with blood and body fluids, including during hand contact with respiratory secretions (e.g., providing oral care, handling soiled tissues).
2. Use gloves made of **latex,...
glove use, glove disposal, infection control, PPE, standard precautions
Proper Use and Disposal of Masks (Surgical or Procedure)
High Priority Source: HHSPandemicInfluenzaPlan
Procedure:

1. Wear a mask when entering a patient’s room.
2. A mask should be worn once and then discarded immediately.
3. If patients are cohorted in a common area or multiple rooms on a nursing unit, and multiple patients must be...
mask use, mask disposal, infection control, PPE, droplet precautions
Protect Healthcare Workers from Pandemic Influenza Exposure
High Priority Source: HHSPandemicInfluenzaPlan
Objective: Safeguard healthcare personnel from exposure to pandemic influenza virus.

Procedure:
1. Wear a surgical or procedure mask during close contact with infectious patients.
2. Use contact and airborne precautions, including...
PPE, infection control, healthcare workers, pandemic influenza
Recognize Common Patterns of Infection in Battlefield Casualties
High Priority Source: Emergency War Surgery
### Common Patterns of Infection

Skin, soft tissue, muscle, and bone: Primarily due to staphylococcal, streptococcal, and clostridial species. These infections include wound abscess, cellulitis, septic arthritis, osteomyelitis,...
battlefield infection patterns, wound abscess, cellulitis, septic arthritis, osteomyelitis, necrotizing fasciitis, gas gangrene, tetanus toxemia, meningitis, encephalitis, abscess, empyema, pneumonia, peritonitis, systemic sepsis
Standard and Respiratory Droplet Isolation Precautions
High Priority Source: Emergency War Surgery
Procedure:

Standard precautions:
• Wash hands after patient contact.
• Use gloves when touching blood, body fluids, secretions, excretions, or contaminated items.
• Wear a mask, eye protection, and gown during procedures likely to generate...
standard precautions, droplet precautions, isolation, infection control
Sterile Technique Procedure
High Priority Source: Medical Survival Wound Closure Manual
Purpose: To exclude microorganisms from the operative wound and field to prevent infection.

Procedure:
1. Wash hands thoroughly with soap and water before donning sterile gloves and gowns.
2. Set up a sterile field using sterile towels,...
sterile technique, infection control, surgical procedures
Sterilize Instruments with Steam Under Pressure (Pressure Cooker Method)
High Priority Source: Where There is No Dentist
Procedure:

Step 1: Use a strong pot with a tight-fitting lid. Make sure to create a small hole in the lid so steam can escape when pressure becomes too great.
Step 2: A pressure cooker is ideal for this method, as it has a...
pressure cooker sterilization, steam under pressure, dental instruments, infection control
Sterilizing Equipment to Prevent Disease Spread
High Priority Source: Where There is no Doctor a Village Health Care Handbook
Procedure:

1. Gather necessary materials: clean water, soap, a container for boiling, and the equipment to be sterilized.
2. Wash the equipment thoroughly with soap and water to remove visible dirt or debris.
3. **Boil the equipment in...
sterilizing equipment,HIV,prevention,disease control
Support Infection Control Measures During Pandemic Influenza Outbreak
High Priority Source: HHSPandemicInfluenzaPlan
Objective: Provide guidance on infection control measures for healthcare and non-healthcare settings.

Procedure:
1. Work with HHS to develop and distribute updated infection control protocols for all sectors (e.g., hospitals, schools,...
pandemic infection control, PPE protocols, public health guidance
Use Personal Protective Equipment (PPE) for Standard and Droplet Precautions in Healthcare Settings
High Priority Source: HHSPandemicInfluenzaPlan
Procedure:

1. Wear a facemask when entering the room of a patient with suspected or confirmed pandemic influenza.
2. Use gloves if there is potential contact with bodily fluids, secretions, or contaminated surfaces.
3. **Wear eye...
PPE, standard precautions, droplet precautions, infection control, healthcare settings
Administer Antibiotics for Thoracic Injuries
High Priority Source: NATO Emergency War Surgery
Procedure:

1. Identify the casualty with a confirmed or suspected thoracic injury (e.g., pneumothorax, hemothorax).
2. Select an appropriate antibiotic based on local resistance patterns and the likelihood of infection (e.g.,...
antibiotics, thoracic injury, infection control, trauma care
Administer Post-Exposure Prophylaxis with Oseltamivir
High Priority Source: HHSPandemicInfluenzaPlan
Procedure:

1. Use oseltamivir for post-exposure prophylaxis in cases of known or suspected laboratory exposure to live avian influenza virus, including highly pathogenic strains.
2. Ensure appropriate healthcare personnel are available during...
post-exposure prophylaxis, oseltamivir, emergency department, CDC
Antibiotic Use in War Wounds
High Priority Source: Emergency War Surgery
Procedure for Antibiotic Use in War Wounds:

Antibiotics are not a replacement for surgical treatment.
• They are therapeutic, not prophylactic, in war wounds.
• Administer antibiotics for **all penetrating wounds as soon as...
war wounds, antibiotic use, infection control, surgical treatment, wound management
Care for Pandemic Influenza Patients in the Home
High Priority Source: HHSPandemicInfluenzaPlan
Procedure:

• Most patients with pandemic influenza can be cared for at home by household members.
Designate a primary caregiver, ideally someone without underlying health conditions that increase risk of severe disease.
• Emphasize basic...
home care, pandemic influenza, infection control, primary caregiver, masks
Compare Effectiveness of Different Infection Control Policies During Pandemics
High Priority Source: HHSPandemicInfluenzaPlan
Procedure:

To compare the effectiveness of different infection control policies during pandemics:

1. Identify and document various infection control measures used in different regions or countries.
2. Evaluate outcomes such as transmission...
infection control policies, pandemic effectiveness, transmission rates, resource requirements
Disposal of Solid Waste for Pandemic Influenza Patients
High Priority Source: HHSPandemicInfluenzaPlan
Procedure:
1. Contain and dispose of solid waste (medical and non-medical) in accordance with:
- Facility procedures
- Local or state regulations
2. Wear gloves when handling waste and waste containers.
3. Perform hand hygiene...
solid waste disposal, infection control, pandemic influenza
Enforce Individual Health Protection Measures
High Priority Source: STP 21 24 Army Warrior Leader Skills Level 2 3 and 4
Procedure: Enforce Individual Health Protection Measures

Steps:
1. Ensure that all personnel follow health and safety protocols, such as wearing protective gear and practicing good hygiene.
2. Monitor for signs of illness or injury and...
health protection, infection control, medical protocols, personal safety
Environmental Cleaning and Disinfection in Healthcare Settings
High Priority Source: HHSPandemicInfluenzaPlan
Purpose: To maintain a clean environment to prevent the spread of pandemic influenza virus.

Procedure:
1. Cleaning principles:
- Follow standard infection control practices for cleaning and disinfecting environmental surfaces.
2....
environmental cleaning, disinfectant use, infection control, CDC guidelines
Evaluate Infection Control Measures in Healthcare Settings for Pandemic Influenza
High Priority Source: HHSPandemicInfluenzaPlan
Procedure:

To evaluate infection control measures to prevent or minimize the spread of pandemic influenza within healthcare settings:

1. Implement standard precautions, including hand hygiene, PPE use, and respiratory etiquette.
2. Monitor...
infection control, healthcare settings, PPE, hand hygiene, isolation protocols
Follow Infection Control Precautions During Emergency Transport of Pandemic Influenza Patients
High Priority Source: HHSPandemicInfluenzaPlan
Procedure:

1. Follow standard and droplet precautions when transporting symptomatic patients.
2. Consider routine use of surgical or procedure masks for all patient transport when pandemic influenza is in the community.
infection control,emergency transport,pandemic influenza
Follow Routine Cleaning of Emergency Vehicles and Equipment During Pandemic Influenza Outbreaks
High Priority Source: HHSPandemicInfluenzaPlan
Procedure:

1. Follow standard operating procedures for routine cleaning of the emergency vehicle and reusable patient care equipment.
cleaning protocols,emergency transport,pandemic influenza
Hand Hygiene for Pandemic Influenza Care
High Priority Source: HHSPandemicInfluenzaPlan
Procedure:

1. Perform hand hygiene after the following actions:
- Touching blood, body fluids, secretions, excretions, or contaminated items.
- Removing gloves.
- Between patient contacts.
2. Hand hygiene includes both:
-...
hand hygiene, infection control, pandemic influenza, medical procedures
Handling Dishes and Eating Utensils in Healthcare Settings
High Priority Source: HHSPandemicInfluenzaPlan
Purpose: To safely manage dishes and eating utensils used by patients with pandemic influenza.

Procedure:
1. Reusable dishes and utensils:
- Wash reusable dishes and utensils in a dishwasher using recommended water temperatures (see...
dish handling, infection control, PPE gloves, food safety
Handling Patient-Care Equipment in Healthcare Settings
High Priority Source: HHSPandemicInfluenzaPlan
Purpose: To safely manage used patient-care equipment that may be contaminated with pandemic influenza virus.

Procedure:
1. Personal protective measures:
- Wear gloves when handling and transporting used patient-care equipment.
2....
equipment handling, infection control, EPA disinfectant, PPE gloves
Handling of Linen, Laundry, and Eating Utensils for Pandemic Influenza Patients
High Priority Source: HHSPandemicInfluenzaPlan
Procedure:
1. Follow standard precautions when handling linen, laundry, dishes, and eating utensils.
2. Ensure that all items are handled in a manner that minimizes the risk of contamination.
3. Adhere to facility procedures for...
linen handling, laundry, eating utensils, pandemic influenza
Implement Aerosol-Generating Procedure Precautions for Influenza Patients
High Priority Source: HHSPandemicInfluenzaPlan
Procedure:

To implement precautions during aerosol-generating procedures (AGPs) for influenza patients, follow these steps:

1. Identify AGPs that may increase the risk of airborne transmission, such as endotracheal intubation, suctioning,...
aerosol-generating procedures,influenza,N95 respirators,PPE,negative pressure rooms
Implement Airborne Precautions for Infectious Patients
High Priority Source: LDS Preparedness Manual
Procedure:
1. Place the patient in an airborne isolation room (AIR) with monitored negative air pressure relative to the corridor, and ensure there are 6 to 12 air changes per hour (ACH).
2. Exhaust air must be directly outside or...
airborne precautions, airborne isolation room, HEPA filter, N-95 respirator, infection control
Implement Community-Wide Infection Control Measures During Pandemic Influenza
High Priority Source: HHSPandemicInfluenzaPlan
Procedure:

1. Promote respiratory hygiene and cough etiquette:
- Cover the nose and mouth with a tissue or elbow when coughing or sneezing.
- Use tissues to contain respiratory secretions.
- Dispose of used tissues in the nearest...
respiratory hygiene,cough etiquette,mask use,hand hygiene,infection control,pandemic influenza
Implement Droplet Transmission Prevention Measures
High Priority Source: HHSPandemicInfluenzaPlan
Procedure:

1. Understand droplet transmission:
- It occurs when large respiratory droplets (containing the virus) are expelled by an infected person through coughing, sneezing, or talking.
- These droplets generally travel only short...
droplet transmission, prevention measures, face masks, infection control, healthcare settings
Implement Infection Control in Community Settings During Pandemic Influenza
High Priority Source: HHSPandemicInfluenzaPlan
Objective: Reduce transmission of pandemic influenza in the community through social distancing and infection control measures.

Procedure:
1. Promote social distancing, including:
- Avoiding public gatherings (e.g., movies, religious...
community infection control, social distancing, mask use, high-risk individuals, public health education
Implement Infection Control in Schools and Workplaces During Pandemic Influenza
High Priority Source: HHSPandemicInfluenzaPlan
Objective: Reduce transmission of pandemic influenza in schools and workplaces through infection control measures.

Procedure:
1. Keep sick students, faculty, and workers away from others while they are infectious.
2. Promote **respiratory...
school infection control, workplace infection control, respiratory hygiene, cough etiquette, hand hygiene
Implementing Environmental Cleaning and Disinfection for Pandemic Influenza Patients
High Priority Source: HHSPandemicInfluenzaPlan
Procedure:
1. Use EPA-registered hospital detergent-disinfectant for cleaning surfaces.
2. Follow standard facility procedures for cleaning and disinfection of environmental surfaces.
3. Emphasize cleaning/disinfection of **frequently...
environmental cleaning, disinfectant, pandemic influenza, infection control
Implementing Infection Control Measures in Healthcare Facilities During Pandemic Influenza
High Priority Source: HHSPandemicInfluenzaPlan
Overview

To prevent or control outbreaks of influenza in healthcare facilities, the following strategies should be implemented:

1. Vaccination: Ensure vaccination of both patients and healthcare personnel.
2. Early Detection: Identify...
infection control, healthcare facilities, pandemic influenza, isolation, vaccination, antivirals, barrier precautions
Infection Control Principles for Pandemic Influenza
High Priority Source: HHSPandemicInfluenzaPlan
Overview

Supplement 4 provides guidance on infection control principles to limit the spread of pandemic influenza. These principles are applicable to other infectious agents that spread via respiratory droplets and include:

• Selection and use...
infection control principles, healthcare settings, pandemic influenza, PPE, hand hygiene, environmental disinfection, hospital care, community settings
Infection Control Recommendations for Healthcare Settings During Pandemic Phases
High Priority Source: HHSPandemicInfluenzaPlan
Overview

The infection control recommendations outlined below are generally applicable throughout all pandemic phases. However, in some cases, the recommendations may be modified as the situation progresses from limited cases to widespread...
healthcare settings, infection control, pandemic phases, resource availability, community impact
Manage Influenza Patients at Home to Limit Transmission
High Priority Source: HHSPandemicInfluenzaPlan
Procedure:

1. Physically separate the patient with influenza from non-ill persons in the home as much as possible.
2. The patient should not leave the home during the infectious period (i.e., 5 days after symptom onset), unless absolutely...
isolation at home, infectious period, cough etiquette, masks
Manage Other Household Members During Pandemic Influenza Outbreaks
High Priority Source: HHSPandemicInfluenzaPlan
Procedure:

Unexposed individuals who are not essential for patient care should avoid entering the home during active illness.
• If entry is necessary, they should:
- Avoid close contact with the ill person.
• Household members should...
household members, isolation, primary caregiver, symptom monitoring
Management of Seasonal Influenza Cases During Pandemic Alert Periods
High Priority Source: HHSPandemicInfluenzaPlan
Procedure:

1. Continue Standard and Droplet Precautions for patients with seasonal influenza confirmed by culture or RT-PCR.
2. Continue antiviral treatment for a minimum of 5 days, unless otherwise indicated.
3. **Treat complications...
seasonal influenza, pandemic, infection control, home care
Masking and Separation of Persons with Respiratory Infection Symptoms
High Priority Source: HHSPandemicInfluenzaPlan
Procedure:
1. During periods of increased respiratory illness in the community, offer masks to persons who are coughing:
- Use procedure masks (with ear loops) or surgical masks (with ties).
2. Encourage coughing individuals...
masking, respiratory infection, separation, pandemic influenza
Notify Receiving Facility of Pandemic Influenza Patient During Emergency Transport
High Priority Source: HHSPandemicInfluenzaPlan
Procedure:

1. Notify the receiving facility that a patient with possible pandemic influenza is being transported.
notify facility,emergency transport,pandemic influenza
Optimize Vehicle Ventilation During Emergency Transport of Pandemic Influenza Patients
High Priority Source: HHSPandemicInfluenzaPlan
Procedure:

1. Optimize the vehicle’s ventilation to increase the volume of air exchange during transport.
2. When possible, use vehicles that have separate driver and patient compartments that can provide separate ventilation to each...
vehicle ventilation,emergency transport,pandemic influenza
PPE for Managing Pandemic Influenza with Increased Transmissibility
High Priority Source: HHSPandemicInfluenzaPlan
Recommended PPE During Outbreaks of High-Transmissibility Strains:

• The addition of airborne precautions, including respiratory protection (an N95 filtering face piece respirator or other appropriate particulate respirator), may be considered...
PPE,pandemic influenza,increased transmissibility,N95 respirator,infection control
Patient Resuscitation During Pandemic Influenza Care
High Priority Source: HHSPandemicInfluenzaPlan
Procedure:

1. Avoid unnecessary mouth-to-mouth contact during patient resuscitation.
2. Use a mouthpiece, resuscitation bag, or other ventilation devices to prevent contact with the mouth and oral secretions.
patient resuscitation, infection control, pandemic influenza, medical procedures
Precautions for Early Stages of a Pandemic
High Priority Source: HHSPandemicInfluenzaPlan
Early Pandemic Precautions:

• Early in a pandemic, it may not be clear that a patient with severe respiratory illness has pandemic influenza.

Recommended Actions:

• Implement precautions consistent with all possible etiologies, including...
pandemic influenza,early stages,infection control,healthcare personnel,precautions
Preventing Influenza Transmission at Home
High Priority Source: Flu Home Treatment
Procedure:

1. Personal Protective Equipment (PPE):
- Wear latex gloves and an N-95 face mask when caring for someone with the flu.
- Change gloves, masks, and clothes after leaving the sick person’s area.

2. **Hygiene...
flu prevention, infection control, home care, PPE, N-95 mask, latex gloves, hygiene, disinfectant
Proper Hand Hygiene for Dental Procedures
High Priority Source: Where There is No Dentist
Hand hygiene is crucial to prevent the spread of infections during dental procedures. Follow these steps:

1. Wash your hands thoroughly with soap and water before touching any part of a patient's mouth or handling instruments.
2. **Use an...
hand hygiene,dental procedures,infection control,gloves
Provide Oxygen Support During Emergency Transport of Pandemic Influenza Patients
High Priority Source: HHSPandemicInfluenzaPlan
Procedure:

1. Oxygen delivery with a non-rebreather face mask can be used to provide oxygen support during transport.
2. If needed, positive-pressure ventilation should be performed using a resuscitation bag-valve mask.
oxygen support,emergency transport,pandemic influenza
Recognize Symptoms of Influenza in Healthcare Settings
High Priority Source: HHSPandemicInfluenzaPlan
Objective: Identify individuals with influenza symptoms to implement appropriate infection control measures.

Procedure:
1. Monitor for flu-like symptoms, including:
- Fever
- Headache
- Myalgia (muscle pain)
- Prostration...
flu symptoms, infection control, healthcare settings, pandemic influenza

+ 56 more procedures. Get the full library in the app.

Infectious Diseases (148)

Administer Emergency Treatment for Meningitis
Critical Source: Where There is no Doctor a Village Health Care Handbook
Get medical help fast—every minute counts! If possible take the person to a hospital. Meanwhile:

Inject ampicillin every 6 hours, 500 mg. for children or 1 g. for adults (see p. 352). If possible, also give chloramphenicol (see p. 356)....
meningitis,treatment,ampicillin,chloramphenicol,streptomycin,artesunate,quinine
Recognize Signs of Meningitis in Children and Adults
Critical Source: Where There is no Doctor a Village Health Care Handbook
Signs of meningitis include:

Fever
Severe headache
Stiff neck, with the child lying with his head and neck bent back
Inability to put the head between the knees due to stiffness
Bulging fontanel in babies under a...
meningitis,symptoms,fever,stiff_neck,vomiting,seizures,tubercular_meningitis
Respond to Rabies Exposure
Critical Source: Where There is no Doctor a Village Health Care Handbook
Procedure:

Isolate the Animal: If you suspect an animal that has bitten someone has rabies, tie or cage it for a week.
Clean the Bite: Clean the bite thoroughly with soap, water, and hydrogen peroxide. Do not close the wound; leave...
rabies, prevention, exposure, animal bite, anti-rabies injections, isolation
Administer Antibiotics for Acute Abdomen without Ampicillin
Critical Source: Where There is no Doctor a Village Health Care Handbook
If ampicillin is not available:

1. Option 1: Inject penicillin (crystalline), 5 million Units immediately; then 1 million units every 4 hours.
2. Also give metronidazole, 1 g every 12 hours.
3. If possible, also give...
penicillin,ceftriaxone,metronidazole,ciprofloxacin,acute abdomen,antibiotics,emergency treatment
Administer Antibiotics for Pneumonia
Critical Source: Where There is no Doctor a Village Health Care Handbook
Procedure:

• Administer one of the following antibiotics based on availability and patient age:
- Penicillin (p. 351): For general use.
- Cotrimoxazole (p. 357): Alternative option.
- Erythromycin (p. 354): Suitable for those...
pneumonia, antibiotics, penicillin, cotrimoxazole, erythromycin, amoxicillin, dosage
Administer Chloramphenicol for Severe Infections
Critical Source: Where There is no Doctor a Village Health Care Handbook
Procedure:

1. Identify symptoms: Look for signs of severe bacterial infections such as meningitis, typhoid fever, or sepsis.
2. Consult a health worker: Chloramphenicol is a powerful antibiotic and should be used only when necessary to...
chloramphenicol,antibiotics,treatment,medicine,health care
Administer Medicines for Malaria
Critical Source: Where There is no Doctor a Village Health Care Handbook
Procedure:

1. Identify symptoms: Look for fever, chills, headache, muscle aches, and fatigue.
2. Consult a health worker: Malaria treatment requires careful selection of drugs based on local resistance patterns.
3. **Administer the...
malaria,medicine,treatment,drugs,health care
Administer Medicines for Tuberculosis (TB)
Critical Source: Where There is no Doctor a Village Health Care Handbook
Procedure:

1. Identify symptoms: Look for persistent cough lasting more than 2 weeks, fever, night sweats, weight loss, and fatigue.
2. Consult a health worker: TB treatment must be supervised to ensure effectiveness and prevent drug...
tuberculosis,tb,medicine,drugs,health care
Analyze and Treat Malaria
Critical Source: Where There is no Doctor a Village Health Care Handbook
Steps for analyzing and treating malaria:

1. If you suspect malaria or have repeated fevers:
- If possible, go to a health center for a blood test.
- In areas where falciparum malaria occurs, seek treatment immediately.

2. **In areas...
malaria,treatment,blood test,falciparum,quinine,artesunate,cerebral malaria
Diagnosis of Clostridial Myonecrosis (Gas Gangrene)
Critical Source: NATO Emergency War Surgery
Procedure for Diagnosing Clostridial Myonecrosis

1. Clinical Evaluation: Assess the patient for signs and symptoms consistent with clostridial myonecrosis:
- Rapid deterioration in a previously stable casualty.
- Disproportionate pain...
clostridial myonecrosis, gas gangrene, diagnosis, wound infection, clostridia
Identifying Noma (Cancrum Oris)
Critical Source: Where There is No Dentist
Procedure:

1. Look for the following signs in a child or adult:
- A simple gum infection that has spread to the face.
2. Confirm if all of these conditions are present:
- (1) The individual is undernourished, anemic (lacks iron), and...
Noma, Cancrum Oris, Vincent’s Infection, anemia, undernourishment, HIV, measles, malaria
Managing Female Genital Cutting (Excision)
Critical Source: Where There is no Doctor a Village Health Care Handbook
Female genital cutting (excision) is a dangerous practice that can cause severe complications, including infection, difficulty during childbirth, and even death. If this has occurred:

1. Wash away blood clots to locate the exact source of...
female genital cutting, excision, emergency care, infection control
Managing Tetanus with Antitoxins and Immune Globulin
Critical Source: Where There is no Doctor a Village Health Care Handbook
Procedure:

1. Identify the need: Use tetanus antitoxin or immune globulin for managing tetanus, especially in cases of wound contamination or incomplete vaccination history.
2. Administer tetanus antitoxin:
- Inject 1000-5000 units...
tetanus treatment, antitoxin administration, immune globulin use
Preventing the Spread of Contagious Diseases
Critical Source: Survival and Austere Medicine
Procedure:

1. Practice strict hygiene: Wash hands frequently with clean water and soap or use alcohol-based sanitizers if available.
2. Isolate sick individuals: Keep those with contagious diseases (e.g., pneumonia, cholera) away from...
contagious diseases,hygiene,sanitation,vaccination,disease prevention
Rabies Prevention and Response
Critical Source: Student manual 2005
What is Rabies?
• Rabies is a virus that infects the central nervous system and is always fatal if left untreated.
• It can be transmitted through bites, scratches, or contact with infected animal saliva on open wounds, eyes, nose, or...
rabies, prevention, response, vaccine, HDCV, animal bite
Recognize and Handle Rabies Exposure
Critical Source: Student manual 2005
Rabies is a serious animal disease that can be transmitted to humans, primarily by saliva from infected animals.

Symptoms in animals: Aggression, disorientation, paralysis, and excessive salivation.
Symptoms in humans: Fever,...
rabies, exposure, transmission, medical emergency, animal disease
Recognize and Respond to Botulism Symptoms
Critical Source: USMC Winter Survival Course Handbook
Procedure:

1. Be aware that botulism is often caused by improper storage of meats.
2. Monitor for early symptoms such as vomiting and diarrhea.
3. Watch for progression to more severe symptoms, including impaired vision and descending...
botulism, food poisoning, paralysis, treatment
Recognize and Respond to Tularemia Infection
Critical Source: USMC Winter Survival Course Handbook
Procedure:

1. Be aware that tularemia is a life-threatening disease found worldwide and can be transmitted through uncooked meats or handling contaminated meats with open sores.
2. Monitor for symptoms such as fever, skin ulcers, swollen lymph...
tularemia, antibiotic treatment, infection, symptoms
Recognizing and Managing Measles in Children
Critical Source: Where There is no Doctor a Village Health Care Handbook
Overview:

Measles is a severe viral infection, especially dangerous for children who are poorly nourished or have tuberculosis.

Signs of measles (appearing 10 days after exposure):
• Initial signs: **fever, runny nose, red sore...
measles, black measles, Koplik’s spots, isolation, fever, rash
Recognizing the Signs of Noma
Critical Source: Where There is No Dentist
Procedure:

Early signs (in the mouth):
1. Sore mouth with itching gums.
2. Swollen, sore gums.
3. Gums bleed when eating or cleaning teeth.
4. Bad breath and frequent spitting.

Progression to the jaw:
5. Loose teeth.
6. Loose pieces of...
Noma signs, dark red swelling, black spot on cheek, loose teeth, bone loss, mouth infection
Treat Underlying Illnesses for Noma
Critical Source: Where There is No Dentist
Assume the child has malaria and begin treating with antimalarial drugs (see *Where There Is No Doctor*, pages 364 to 367).

Look for any other illnesses and treat them, especially:
Measles
Tuberculosis
malaria, measles, tuberculosis, noma, underlying illness
Treating Noma (Cancrum Oris)
Critical Source: Where There is No Dentist
Procedure:

1. Start treatment immediately to prevent the hole from getting larger.
2. A larger hole leads to a tighter scar, which can impair the child’s ability to open their mouth and chew properly.
3. Give fluids:
- Start with the...
Noma treatment, milk-oil drink, dehydration, fluid administration, scar prevention
Treatment for Anthrax Infection
Critical Source: LDS Preparedness Manual
Procedure:

1. Administer antibiotics immediately if anthrax is suspected or confirmed.
2. Use Ciprofloxacin as the primary treatment option.
3. Tetracycline can be used as an alternative antibiotic.
4. **Monitor for symptoms such as...
anthrax treatment, ciprofloxacin, tetracycline, anthrax symptoms
Treatment for Plague Infection
Critical Source: LDS Preparedness Manual
Procedure:

1. Administer antibiotics immediately if plague is suspected or confirmed.
2. Use streptomycin as the primary treatment option.
3. Doxycycline and Chloramphenicol can be used as alternative antibiotic treatments.
4....
plague treatment, streptomycin, doxycycline, plague symptoms
Treatment for River Blindness
Critical Source: Where There is no Doctor a Village Health Care Handbook
### Treatment of River Blindness
Seek medical testing and treatment early:
- Especially in areas where river blindness is known to occur.

Ivermectin (Mectizan):
- The best medicine for river blindness.
- May be available at no...
ivermectin, treatment for river blindness, mectizan, diethylcarbamazine, suramin
Treatment for Small Pox Infection
Critical Source: LDS Preparedness Manual
Procedure:

1. Administer intravenous hydration immediately if smallpox is suspected or confirmed.
2. Provide nutrition support to maintain caloric intake and prevent malnutrition.
3. **Monitor for symptoms such as malaise, fever,...
smallpox treatment, antiviral drugs, smallpox symptoms
Administer ART Medicines to HIV-Positive Mothers During Labor and Birth
High Priority Source: A Book for Midwives
Giving ART medicines to the mother during labor and birth can prevent the baby from becoming infected with HIV (see page 495).
HIV,ART,labor,birth,prevention
Administer Antibiotics for Infected Herpes Sores
High Priority Source: Where There is No Dentist
Procedure:

1. If the sores are infected, administer one of the following antibiotics based on allergies:
- Amoxicillin: Give 500 mg, 3 times a day for 7 days.
- Doxycycline (for those allergic to amoxicillin): Give **100...
herpes infection treatment, antibiotic use, amoxicillin dosage, doxycycline, erythromycin
Administer Medicines for Leprosy
High Priority Source: Where There is no Doctor a Village Health Care Handbook
Procedure:

1. Identify symptoms: Look for skin patches that are lighter or darker than the surrounding skin, loss of sensation in affected areas, and thickened nerves.
2. Consult a health worker: Leprosy treatment requires long-term...
leprosy,medicine,treatment,drugs,health care
Administer Tetanus Vaccination for Prevention
High Priority Source: Where There is no Doctor a Village Health Care Handbook
Vaccination is the surest protection against tetanus. Both children and adults should be vaccinated at the nearest health center (see p. 147). For complete protection, the vaccination should be repeated once every 10 years. **Vaccinating women...
tetanus,vaccination,prevention,immunization,newborns,pregnancy
Avoid Exposure to Parasites in Animal Scat
High Priority Source: USMC Winter Survival Course Handbook
Procedure:

1. Be aware that certain parasites found in animal scat can infect humans if handled unprotected.
2. Recognize that Raccoon Roundworm can be present on scat for at least 30 days, while Fox Roundworm is only present for about 7...
animal scat, parasite infection, raccoon roundworm, fox roundworm
Differentiate Between Syphilis and Chancroid for Accurate Treatment
High Priority Source: A Book for Midwives
Procedure:

1. Be aware that syphilis and chancroid can look very similar.
2. If you are unsure whether the person has syphilis or chancroid, or if they may have both:
- Administer benzathine penicillin (as per standard treatment...
syphilis vs chancroid, dual treatment, antibiotic combination
Differentiation of Clostridial Infections from Other Conditions
High Priority Source: NATO Emergency War Surgery
Procedure for Differentiating Clostridial Infections

1. Clostridial Cellulitis vs. Myonecrosis: Identify the following differences:
- Clostridial Cellulitis:
- Gas in subcutaneous tissue, not muscle.
- No involvement of...
differentiation, clostridial infection, gas gangrene, anaerobic cellulitis, anoxic gangrene
Identify and Respond to Biological Agents
High Priority Source: Medical NBC Battlebook
Biological Agent – A microorganism (or toxin derived from it) which causes disease in man, plants or animals or which causes deterioration of material.

Procedure:
1. Identify signs and symptoms consistent with biological agent exposure...
biological agent, infection control, decontamination, public health, biological warfare
Identify and Understand Cholera (Vibrio cholerae) Characteristics
High Priority Source: Medical NBC Battlebook
Characteristics of Cholera:

• Caused by *Vibrio cholerae*, a short, curved, gram-negative bacillus.
• Acquired through consumption of water or food contaminated with the organism.
• Organism multiplies in the small intestine and secretes an...
cholera, vibrio cholerae, characteristics, biological warfare, water contamination
Manage Hepatitis Symptoms and Provide Care
High Priority Source: Where There is no Doctor a Village Health Care Handbook
Procedure:

Do not use any medicines, including acetaminophen, as they can harm the liver.

• Ensure the patient rests and drinks lots of liquids to stay hydrated.

• If the patient refuses most food, provide **orange juice,...
hepatitis, rest, hydration, vomiting management, diet, alcohol avoidance
Managing Bacterial Infections Without Antibiotics
High Priority Source: Survival and Austere Medicine
Procedure:

1. Assess the infection severity: Determine if it is a superficial wound, skin infection, or systemic (e.g., pneumonia).
2. Clean the affected area thoroughly: Use clean water and antiseptic solutions to prevent further...
antibiotics,bacterial infection,without antibiotics,infection management
Managing Typhoid Fever
High Priority Source: Where There is no Doctor a Village Health Care Handbook
Typhoid fever is caused by the bacterium *Salmonella typhi* and spreads through contaminated food or water. Here's how to manage it:

### **Symptoms of Typhoid Fever:
• High, persistent fever (often reaching 103°F/39.4°C)
• Weakness and...
typhoid,fever,vaccine,management,symptoms
Prevent Mother-to-Child Transmission of HIV
High Priority Source: A Book for Midwives
Procedure:

Avoid breastfeeding if the mother is HIV-positive.
Seek antenatal care and follow medical advice for preventing transmission during pregnancy and childbirth.
Administer antiretroviral therapy (ART) as prescribed to...
mother-to-child transmission, HIV prevention, breastfeeding
Prevent TB Transmission in the Household
High Priority Source: Where There is no Doctor a Village Health Care Handbook
Procedure:

Test for TB: If someone in the house has tuberculosis (TB), ensure that the whole family is tested for TB using a Tuberculin test.
Vaccinate Children: Have children vaccinated against TB with the B.C.G. vaccine.
-...
tuberculosis, tb, prevention, transmission, household, isolation, vaccination, nutrition
Prevent Tubercular Meningitis in Newborns of TB-Infected Mothers
High Priority Source: Where There is no Doctor a Village Health Care Handbook
For prevention of tubercular meningitis, newborn babies of mothers with tuberculosis should be vaccinated with B.C.G. at birth. Dose for the newborn is 0.05 ml. (half the normal dose of 0.1 ml.). For other suggestions on prevention of TB, see...
tubercular_meningitis,B.C.G.vaccine,newborns,TB_prevention
Provide Treatment for Kaposi’s Sarcoma in the Mouth
High Priority Source: Where There is No Dentist
Procedure:

1. Seek advice from a health worker or doctor experienced with HIV-related conditions.
2. If the person is on antiretroviral therapy (ART), they are less likely to develop this condition and it may not worsen.
3. In some...
Kaposi’s sarcoma treatment, HIV management, ART therapy
Quarantine Procedures for Biological/Chemical Agents
High Priority Source: LDS Preparedness Manual
Procedure:

1. Isolate the affected individual(s) immediately to prevent spread of biological or chemical agents.
2. Follow quarantine guidelines specific to the agent involved, as outlined in this manual:
- Aflatoxin: Quarantine for...
quarantine, biological agents, chemical agents, isolation, infectious diseases
Recognize Clinical Features of Cholera
High Priority Source: Medical NBC Battlebook
Clinical Features of Cholera:

• May present as mild diarrhea or a fulminant disease with:
- Profuse watery diarrhea (fluid losses exceeding 5 to 10 liters per day)
- Vomiting, often early in the illness, which may complicate...
cholera symptoms, watery diarrhea, vomiting, dehydration, shock
Recognize Signs of Dengue (Breakbone Fever)
High Priority Source: Where There is no Doctor a Village Health Care Handbook
Signs of dengue include:

• Sudden high fever with chills.
• Severe body aches, headache, and sore throat.
• Person feels very ill, weak, and miserable.
• After 3 to 4 days, the person may feel better for a few hours to 2 days.
• Then illness...
dengue,breakbone fever,rash,body aches,severe dengue,bleeding,hospital
Recognize Signs of Malaria in Adults
High Priority Source: Where There is no Doctor a Village Health Care Handbook
Signs of malaria in adults include:

1. Three stages of an attack:
- Stage 1: Begins with chills.
- Stage 2: Followed by fever, often reaching 40°C or higher.
- Stage 3: The person begins to sweat and experiences...
malaria,fever,chills,spleen,anemia,cerebral malaria,children,signs
Recognize Signs of Malaria in Children
High Priority Source: Where There is no Doctor a Village Health Care Handbook
Signs of malaria in children include:

• Anemia and paleness can begin within a day or two.
• Cerebral malaria may cause seizures followed by periods of unconsciousness.
• The palms may show a blue-gray color.
• Breathing may be rapid and...
malaria,children,cerebral malaria,anemia,paleness,seizures
Recognize and Respond to Salmonella Infection
High Priority Source: USMC Winter Survival Course Handbook
Procedure:

1. Be aware that *Salmonella* bacteria are found in the intestinal tracts of many animals including poultry, swine, cattle, and household pets.
2. Monitor for symptoms such as diarrhea, fever, and abdominal cramps.
3. Understand that...
Salmonella, food poisoning, infection, treatment
Recognize the Global Impact of Pandemic Influenza
High Priority Source: HHSPandemicInfluenzaPlan
Procedure:

1. Understand that pandemic influenza has the potential to pose disease control challenges unmatched by any other natural or intentional infectious disease event.
2. Recognize that the global spread and impact of a pandemic can...
global pandemic impact, disease control, public health response
Recognizing and Managing Tetanus (Lockjaw)
High Priority Source: Where There is no Doctor a Village Health Care Handbook
Tetanus is a serious infection caused by bacteria that enters the body through wounds. It can lead to muscle stiffness and spasms, often starting in the jaw. Here's how to recognize and manage it:

### **Signs of Tetanus:
• Stiffness in the jaw...
tetanus,vaccine,wound,lockjaw,management
Recognizing and Managing Tuberculosis (TB)
High Priority Source: Where There is no Doctor a Village Health Care Handbook
Tuberculosis is a bacterial infection that primarily affects the lungs but can also affect other parts of the body. Here's how to recognize and manage it:

### **Symptoms of TB:
• Persistent cough lasting more than 3 weeks
• Coughing up blood or...
tuberculosis,tb,vaccine,management,symptoms
Seek Medical Treatment for Tick-Borne Diseases
High Priority Source: USMC Winter Survival Course Handbook
Procedure:

1. If symptoms of any tick-borne disease (e.g., Lyme Disease or Rocky Mountain Spotted Fever) are suspected, seek medical treatment immediately.
2. Do not attempt to self-treat serious infections that may lead to chronic illness or...
tick-borne disease, medical treatment, Lyme disease, Rocky Mountain Spotted Fever
Administer Cotrimoxazole to Prevent Infections in HIV-Positive Individuals
High Priority Source: A Book for Midwives
Procedure:

Prescribe cotrimoxazole daily for individuals with HIV who are starting to show signs of illness (e.g., mouth sores, weight loss, rashes, frequent colds).
Monitor for adverse effects, such as allergic reactions or...
cotrimoxazole, HIV treatment, infection prevention
Administer Diloxanide Furoate for Amebic Abscess or Dysentery
High Priority Source: Where There is no Doctor a Village Health Care Handbook
Diloxanide furoate (Furamide) is used to treat amebic abscess and dysentery. Follow these steps:

1. Determine the patient's age and weight.
2. Dosage for adults:
- Take 500 mg (1 tablet) three times a day with meals for 10 days.
3....
diloxanide furoate, amebic abscess, dosage, medical emergency, infectious diseases
Administer Medicines for Amebas and Giardia
High Priority Source: Where There is no Doctor a Village Health Care Handbook
Procedure:

1. Identify symptoms: Look for diarrhea, abdominal pain, bloating, and weight loss.
2. Consult a health worker: These infections require specific treatment to avoid complications.
3. Administer the medication:
-...
amebas,giardia,treatment,medicine,drugs
Administer Medicines for Gonorrhea and Chlamydia
High Priority Source: Where There is no Doctor a Village Health Care Handbook
Procedure:

1. Identify symptoms: Look for signs such as painful urination, discharge from the penis or vagina, and abdominal pain.
2. Consult a health worker: If possible, seek guidance from a trained medical professional before...
gonorrhea,chlamydia,antibiotics,medicines,health care
Administer Medicines for Skin Problems
High Priority Source: Where There is no Doctor a Village Health Care Handbook
Procedure:

1. Identify symptoms: Look for rashes, sores, itching, or inflammation on the skin.
2. Consult a health worker: These conditions may require specific treatment based on the cause (infection, allergy, etc.).
3. **Administer...
skin problems,treatment,medicine,drugs,health care
Administer Medicines for Vaginal Infections
High Priority Source: Where There is no Doctor a Village Health Care Handbook
Procedure:

1. Identify symptoms: Look for itching, burning, unusual discharge, and pain during urination.
2. Consult a health worker: These infections may require specific treatment based on the cause (yeast, bacterial, or...
vaginal infections,treatment,medicine,drugs,health care
Administer Metronidazole for Amebic Dysentery
High Priority Source: Where There is no Doctor a Village Health Care Handbook
Metronidazole is used to treat amebic dysentery. Follow these steps:

1. Determine the patient's age and weight.
2. Dosage for adults:
- Take 750 mg (3 tablets) three times a day for 5 to 10 days.
3. **Dosage for children aged 8-12...
metronidazole, amebic dysentery, dosage, medical emergency, infectious diseases
Administer Metronidazole for Chronic Giardia Infection (6 Months or Longer)
High Priority Source: Where There is no Doctor a Village Health Care Handbook
Metronidazole is used to treat chronic giardia infections lasting 6 months or longer. Follow these steps:

1. Determine the patient's age and weight.
2. Dosage for adults:
- Take 750 mg (3 tablets) three times a day for 10 days.
3....
metronidazole, chronic giardia infection, dosage, medical emergency, infectious diseases
Administer Metronidazole for Guinea Worm Infection
High Priority Source: Where There is no Doctor a Village Health Care Handbook
Metronidazole is used to treat guinea worm infections. Follow these steps:

1. Determine the patient's age and weight.
2. Dosage for adults and children aged 8-12 years:
- Take 250 mg (1 tablet) three times a day for 10 days.
3. **Dosage...
metronidazole, guinea worm infection, dosage, medical emergency, infectious diseases
Administer Metronidazole for Trichomonas Vaginal Infection
High Priority Source: Where There is no Doctor a Village Health Care Handbook
Metronidazole is used to treat trichomonas vaginal infections. Follow these steps:

1. For severe infection:
- Take 8 tablets (2 g) by mouth in one single dose.
2. For mild infection:
- Use a vaginal insert of 2 tablets (500 mg)...
metronidazole, trichomonas infection, vaginal infection, dosage, medical emergency, infectious diseases
Administer Quinacrine for Trichomonas Infections (along with Metronidazole)
High Priority Source: Where There is no Doctor a Village Health Care Handbook
Quinacrine (mepacrine) is used in combination with metronidazole to treat trichomonas infections. Follow these steps:

1. Determine the patient's age and weight.
2. Dosage for adults:
- Take 30 mg of quinacrine once a day for 7...
quinacrine, trichomonas infection, dosage, medical emergency, infectious diseases
Administer Sulfas or Sulfonamides for Common Infections
High Priority Source: Where There is no Doctor a Village Health Care Handbook
Procedure:

1. Identify symptoms: Look for signs of bacterial infections such as urinary tract infections, respiratory infections, or skin infections.
2. Consult a health worker: Sulfonamides are effective but should be used under...
sulfas,sulfonamides,antibiotics,treatment,medicine
Administer Treatment for Chancroid
High Priority Source: A Book for Midwives
Procedure:

Option 1: Erythromycin Oral Treatment
1. Administer 500 mg erythromycin by mouth, 4 times a day for 7 days.

Option 2: Ceftriaxone Injection
1. Inject 250 mg ceftriaxone into the muscle, as a single...
chancroid treatment, erythromycin, ceftriaxone, antibiotic administration
Define and Implement Quarantine Procedures
High Priority Source: Medical NBC Battlebook
Quarantine is the restriction of activities of persons who have been exposed to a communicable disease during the period of communicability in order to prevent disease transmission during the incubation period.

### Steps for Implementing...
quarantine,communicable disease,incubation period,disease transmission
Distinguish Pandemic Influenza from Seasonal Influenza
High Priority Source: HHSPandemicInfluenzaPlan
Procedure:

1. Recognize that pandemics are rare and unpredictable events, unlike seasonal influenza.
2. Understand that only three pandemics occurred in the 20th century: 1918, 1957, and 1968.
3. Know that pandemics occur when a **new...
pandemic vs seasonal flu, novel influenza A, immunity, vaccine updates
Identify Animal Reservoirs of Influenza Viruses
High Priority Source: HHSPandemicInfluenzaPlan
Procedure:

1. Recognize that wild birds are the primary reservoir for influenza A viruses, as they host a greater number of subtypes (15) compared to other species.
2. Understand that animal influenza viruses typically do not infect humans...
animal reservoirs, influenza A, wild birds, H5N1, avian flu, pandemic prevention
Identify and Treat Bubos (Lymphogranuloma Venereum)
High Priority Source: Where There is no Doctor a Village Health Care Handbook
Signs of bubos:

In men: Large, dark lumps in the groin that open to drain pus, scar up, and open again.
In women: Lymph nodes similar to those in men or painful, oozing sores in the anus.

Treatment for bubos:

• See a health...
bubos, lymphogranuloma venereum, treatment, infection, sexual health
Identify and Understand Brucellosis (Brucella species) Characteristics
High Priority Source: Medical NBC Battlebook
Characteristics of Brucellosis:

• Caused by four bacterial species: *Brucella melitensis*, *B. abortus*, *B. suis*, and *B. canis*.
• Virulence for humans decreases in the order listed above.
• Bacteria are small, gram-negative, aerobic,...
brucellosis, brucella species, characteristics, biological warfare, aerosol route
Identify and Understand Common Infectious Diseases and Their Causes
High Priority Source: Where There is no Doctor a Village Health Care Handbook
### Identify and Understand Common Infectious Diseases and Their Causes

| Organism that causes the sickness | Name of the sickness | How it is spread or principal medicine enters the body |
|---|---|---|
| Bacteria (microbes or germs) |...
bacteria,virus,fungus,parasites,infections,disease,cold,flu,malaria,tuberculosis,pneumonia,diarrhea,antibiotics,transmission,pathogens
Identify and Understand _Clostridium perfringens_ Toxins Characteristics
High Priority Source: Medical NBC Battlebook
Characteristics of *Clostridium perfringens* Toxins:

• A common anaerobic bacterium associated with three disease syndromes:
- Gas gangrene or clostridial myonecrosis
- Enteritis necroticans (pig-bel)
- Clostridial food poisoning
-...
clostridium perfringens, alpha toxin, biological warfare, aerosol delivery
Lyme Disease Prevention and Awareness
High Priority Source: Student manual 2005
What is Lyme Disease?
• A bacterial infection spread by the bite of deer ticks (Ixodes dammini).
• Caused by *Borrelia burgdorferi* bacteria, which can be transmitted to humans from infected mice or other animals.

Symptoms:
• Early...
Lyme disease, prevention, ticks, antibiotics, deer tick
Maintain Health and Immune Function in Individuals with HIV
High Priority Source: A Book for Midwives
Procedure:

Eat a nutritious diet to support overall health and immune function.
Take multivitamin supplements as recommended by healthcare providers.
Avoid exposure to tuberculosis (TB) by staying away from individuals with...
HIV management, nutrition, TB prevention
Managing Tuberculosis of the Skin or Lymph Nodes
High Priority Source: Where There is no Doctor a Village Health Care Handbook
### Managing Tuberculosis of the Skin or Lymph Nodes

Symptoms:
• Painless tumors, chronic skin patches, ulcers, or warts.
• TB may develop slowly and recur over months or years.
• Lymph nodes in the neck or behind the collarbone may become...
tuberculosis, skin TB, lymph nodes, scrofula
Monitor Immune Function with CD4 Count Testing
High Priority Source: A Book for Midwives
Procedure:

Schedule regular CD4 count tests to monitor immune system strength in individuals living with HIV.
Interpret results based on the CD4 cell count: a count below 350 indicates the need for antiretroviral therapy (ART).
-...
CD4 count, ART initiation, immune monitoring
Prevent Spread of HIV Through Safe Needle Use
High Priority Source: A Book for Midwives
Procedure:

Avoid sharing needles or any sharp instruments that may be contaminated with blood.
Use only sterilized tools for procedures such as piercings, acupuncture, tattoos, scarring, or circumcision.
• **Dispose of used needles...
needle safety, HIV prevention, sterilization
Prevent Spread of HIV Through Safe Sex Practices
High Priority Source: A Book for Midwives
Procedure:

Use condoms with any sex partner who has HIV or whose HIV status is unknown.
Avoid sexual contact with individuals known to have HIV unless both partners are HIV-negative and completely faithful to each other.
• **Get...
HIV, AIDS, condom use, safe sex, HIV testing
Prevent and Treat Trichinosis Infection
High Priority Source: USMC Winter Survival Course Handbook
Procedure:

1. Be aware that trichinosis is caused by a parasite found in the muscle tissue of wild swine and bears.
2. Thoroughly cook all meats, especially game, to destroy the parasite.
3. Monitor for symptoms such as fever, muscle pain,...
trichinosis, parasite, cooking meat, treatment
Prevent the Spread of STIs
High Priority Source: A Book for Midwives
Prevent the Spread of STIs

To prevent the spread of STIs:

Avoid sexual contact with someone who is infected.
Use condoms consistently and correctly during all types of sexual activity, including vaginal, anal, and oral sex.
-...
STIs, prevention, condoms, transmission, sexual health
Protect Against Acquired Immune Deficiency Syndrome (AIDS)
High Priority Source: STP 21 24 Army Warrior Leader Skills Level 2 3 and 4
Procedure:

To protect against acquired immune deficiency syndrome (AIDS), follow these steps:

1. Practice safe sex by using condoms or other barrier methods during sexual activity.
2. Avoid sharing needles or other injection equipment with...
AIDS, HIV, prevention
Protective Measures When Handling Animal Carcasses or Scat
High Priority Source: Student manual 2005
General Precautions for Trappers:

Wear protective gear: Always wear latex or other protective gloves, eye protection, and protective coveralls when handling carcasses or scat.
Hygiene practices: Wash hands and arms thoroughly with...
protective gear, hygiene, disinfection, rabies, infectious diseases, trapper safety
Provide Support and Care for Women with STIs
High Priority Source: A Book for Midwives
Provide Support and Care for Women with STIs

If a woman comes to you for help with an STI, it is important to:

1. Keep her information confidential. She may not return if she feels judged or exposed.
2. Do not criticize her. Judgment...
STI care, confidentiality, support, treatment access
Provide Symptomatic Care for AIDS Patients
High Priority Source: Where There is no Doctor a Village Health Care Handbook
Treatment for HIV and AIDS focuses on managing symptoms and preventing complications since there is no cure. The following are symptomatic care procedures:

1. For diarrhea: Use Rehydration Drink (see p. 152)
2. **For yeast infection in...
AIDS treatment, symptomatic care, diarrhea management, thrush treatment, fever management, cough treatment, shingles, antiretroviral therapy, ART
Recognize Clinical Features of Brucellosis
High Priority Source: Medical NBC Battlebook
Clinical Features of Brucellosis:

• Incubation period: 3–4 weeks (may range from 1 week to several months).
• Presents as an acute, non-specific febrile illness with the following symptoms:
- Chills
- Sweats
- Headache
- Fatigue
-...
brucellosis, clinical features, symptoms, complications, fatality rate
Recognize Clinical Features of _Clostridium perfringens_ Toxins
High Priority Source: Medical NBC Battlebook
Clinical Features of *Clostridium perfringens* Toxins:

Aerosolized alpha toxin would cause a serious acute pulmonary insult.
• Effects of absorbed alpha toxin may include:
- Vascular leakage
- Hemolysis (destruction of red blood...
clostridium perfringens, alpha toxin effects, pulmonary insult, thrombocytopenia
Recognize Kaposi’s Sarcoma in the Mouth
High Priority Source: Where There is No Dentist
Procedure:

1. Look for painless red, brown, or purple patches that resemble swollen bruises.
2. These patches can appear anywhere in the mouth, including on the roof of the mouth (palate).
3. The color is more visible inside the mouth than...
Kaposi’s sarcoma, HIV signs, mouth lesions, oral cancer
Recognize Signs of AIDS in a Person
High Priority Source: Where There is no Doctor a Village Health Care Handbook
Signs of AIDS are related to the weakening of the immune system. These signs may vary, but they often resemble more severe and prolonged versions of common illnesses. If a person shows three or more of these symptoms and becomes increasingly...
AIDS, HIV, symptoms, immune system, weight loss, diarrhea, fever, thrush, swollen lymph nodes, rashes, warts, TB, shingles
Recognize Symptoms of Bird Flu in Humans
High Priority Source: LDS Preparedness Manual
Symptoms of bird flu in humans can range from mild to severe and include:

Typical flu-like symptoms: Fever, cough, sore throat, muscle aches.
More severe complications: Eye infections, pneumonia, acute respiratory distress syndrome...
bird flu symptoms,avian influenza symptoms,flu symptoms,pneumonia,ARDS
Recognize and Prevent Tularemia Infection
High Priority Source: Student manual 2005
Definition: A bacterial disease of rabbits and rodents that can be transmitted to humans through cuts or scratches while skinning infected animals.

Action Steps:
1. Wear protective gloves and clothing when handling wild animals, especially...
tularemia, bacterial disease, infection prevention, wildlife handling
Recognize and Respond to Chancroid Infection
High Priority Source: A Book for Midwives
Procedure:

Signs of chancroid include:
1. One or more soft, painful sores on the genitals or anus that bleed easily.
2. Enlarged, painful glands (buboes) in the groin area.
3. A slight fever may also be present.

**Important...
chancroid symptoms, genital sores, buboes, fever
Recognize and Respond to Early Signs of Syphilis
High Priority Source: A Book for Midwives
Procedure:

1. Identify the first sign of syphilis, which is a sore that may look like:
- A pimple
- A blister
- An open sore

2. This sore appears 2 to 5 weeks after sexual contact with an infected person.
3. The sore is full of germs...
syphilis, signs of syphilis, early symptoms, sore, genital sores, infection spread
Recognize and Respond to Later Signs of Syphilis
High Priority Source: A Book for Midwives
Procedure:

1. Weeks or months after the initial sore, look for these signs:
- Sore throat
- Mild fever
- Mouth sores
- Swollen joints
- Rash on the hands, feet, belly, and sides of the body

2. During this stage, syphilis germs...
syphilis, later symptoms, rash, fever, contagious, complications
Recognize and Respond to Rocky Mountain Spotted Fever
High Priority Source: USMC Winter Survival Course Handbook
Procedure:

1. Be aware of an incubation period between 2-14 days after a tick bite.
2. Monitor for initial flu-like symptoms such as fever, headache, muscle and joint pain, nausea, and vomiting.
3. Look for the development of a rash, which is a...
Rocky Mountain Spotted Fever, tick bite, rash, treatment
Recognize and Understand Malaria Symptoms and Transmission
High Priority Source: Where There is no Doctor a Village Health Care Handbook
Malaria is an infection of the blood that causes chills and high fever. Malaria is spread by mosquitoes. The mosquito sucks up the malaria parasites in the blood of an infected person and injects them into the next person it bites. People with...
malaria,symptoms,chills,fever,mosquitoes,HIV,risk_factors
Recognizing and Managing Sexually Transmitted Infections (STIs)
High Priority Source: A Book for Midwives
Steps to Recognize and Manage STIs:

1. Identify common symptoms of STIs, such as unusual vaginal discharge, sores on the genitals, itching, burning during urination, or pain during intercourse.
2. Conduct diagnostic tests for specific...
STIs, sexually transmitted infections, chlamydia, gonorrhea, syphilis, herpes, HIV/AIDS
Treat Bird Flu in Humans with Prescribed Medications
High Priority Source: LDS Preparedness Manual
Prescription medications approved for human flu viruses may be effective in treating or preventing bird flu infections, based on laboratory studies.

However, flu viruses can develop resistance to these drugs, so their effectiveness is not...
bird flu treatment,avian influenza medication,antiviral drugs,resistance,clinical trials
Treat STIs Promptly and Completely
High Priority Source: A Book for Midwives
Treat STIs Promptly and Completely

Treat STIs as soon as possible. Early treatment is more effective and less costly than later treatment.
Treat both the infected person and their sexual partner(s). Treating only one person will not...
STI treatment, medication compliance, partner treatment
Treating Sore Throat and Preventing Rheumatic Fever
High Priority Source: Where There is no Doctor a Village Health Care Handbook
Overview:

For most sore throats (common cold or flu), do not use antibiotics. Treat with gargles and acetaminophen.

However, for strep throat, which is common in children and young adults, treat with penicillin. Signs of strep...
sore throat, strep throat, penicillin, rheumatic fever, isolation, antibiotics
Treatment of Skin Leishmaniasis
High Priority Source: Where There is no Doctor a Village Health Care Handbook
To treat skin leishmaniasis (cutaneous leishmaniasis), follow these steps:

Steps:
1. Clean the sore with cool, boiled water.
2. Apply a hot, moist cloth to the sore (not so hot that it burns the skin) for 10 to 15 minutes.
3. **Repeat...
leishmaniasis, skin leishmaniasis, tropical sore, heat treatment for sores

+ 48 more procedures. Get the full library in the app.

Pregnancy Complications (135)

Managing Bleeding After the Placenta is Born
Critical Source: A Book for Midwives
Procedure:

1. Assess the amount and type of bleeding:
- Note whether it is bright red or dark (clotted) blood.
2. Apply firm pressure to the uterus:
- Use one hand to press on the fundus of the uterus, encouraging it to...
postpartum hemorrhage, uterine contractions, oxytocin use, retained placenta
Managing Bleeding During Labor
Critical Source: A Book for Midwives
Procedure:

1. Assess the amount and source of bleeding:
- Determine if it is vaginal bleeding or from a laceration.
2. Ensure the mother is in a safe position, such as lying on her back with her legs elevated to help control blood...
bleeding during labor, midwife, pregnancy complications, emergency childbirth
Recognize and Manage Eclampsia During Pregnancy
Critical Source: Where There is no Doctor a Village Health Care Handbook
Eclampsia is sudden seizures during pregnancy or childbirth, very dangerous for both mother and baby. To manage eclampsia:

1. Seek immediate medical attention if a pregnant woman experiences seizures.
2. Ensure the woman is in a safe position...
eclampsia, pregnancy complication, seizure management
Recognize and Respond to Convulsions (Eclampsia) in Pregnancy
Critical Source: A Book for Midwives
When a woman has a convulsion, she may have some or all of these signs:

Rolling eyes
Twitching hands and face
Stiff, rigid, or shaking body
Blue skin
Loud, bubbly sound while breathing
Unconsciousness

She...
convulsions, eclampsia, pregnancy complications, seizures in pregnancy
Recognize and Respond to Torn Womb
Critical Source: A Book for Midwives
### Recognize and Respond to Torn Womb

If you suspect a torn womb, get the mother to the hospital immediately — even if it is very far away!

#### Causes of Torn Womb:
• Previous cesarean surgery.
• Having had 5 or more babies.
• The...
torn womb, uterine rupture, shock, emergency medical help, cesarean surgery, oxytocin
Recognize and Respond to Tubal Pregnancy
Critical Source: A Book for Midwives
Procedure:

1. Identify symptoms: Constant pain in the belly during the first 3 months of pregnancy.
2. Understand the risk: A tubal pregnancy occurs when the fertilized egg implants in the fallopian tube instead of the womb. This is...
tubal pregnancy, ectopic pregnancy, internal bleeding, emergency response, shock treatment
Recognizing Signs of Molar Pregnancy
Critical Source: A Book for Midwives
Procedure:

1. Identify potential signs of molar pregnancy: Look for the following indicators:
- No heartbeat can be heard.
- No baby can be felt during examination.
- The mother experiences severe nausea throughout pregnancy.
-...
molar pregnancy,tumor,pregnancy complications,emergency
Recognizing and Responding to Bleeding During Labor
Critical Source: A Book for Midwives
Procedure:

Normal Signs of Bleeding:
• Some blood from the mother’s vagina is normal.
• The mucus plug can appear very red and bloody-looking.

Warning Signs of Excessive Bleeding:
• Blood clots are present.
• Bright red blood is...
bleeding during labor, placenta previa, emergency childbirth, midwifery, shock treatment
Respond to Bleeding During Pregnancy
Critical Source: Where There is no Doctor a Village Health Care Handbook
Procedure:

1. If a woman begins to bleed during pregnancy, even slightly:
- Have her lie quietly and avoid any physical activity.
- Immediately send for a health worker or medical professional.
2. **Do not perform a vaginal...
bleeding,pregnancy,placenta previa,emergency,hospitalization
Administer Antibiotics for Bladder or Kidney Infection in Pregnant Women
Critical Source: A Book for Midwives
Antibiotic treatment options:

Amoxicillin (500 mg): Give by mouth, 3 times a day for 7 days.
• If the woman is allergic to amoxicillin:
- Cotrimoxazole (960 mg): Give by mouth, 2 times a day for 7 days. This contains 160 mg...
antibiotics,pregnant women,kidney infection,bladder infection
Assess and Respond to Vaginal Bleeding During Pregnancy
Critical Source: A Book for Midwives
Procedure:

1. Ask the mother if she has any bleeding from the vagina.

2. Identify healthy signs of vaginal bleeding during pregnancy:
- No bleeding.
- Very light bleeding or spotting for a few days during the first months, with...
vaginal bleeding,pregnancy,placenta previa,miscarriage,medical help
Assessing Heavy Bleeding History and Medical Center Birth Recommendation
Critical Source: A Book for Midwives
Procedure:

1. Inquire about heavy bleeding in previous pregnancy or birth:
- Determine if the mother experienced significant blood loss during a past pregnancy or delivery.
2. Gather details on prior bleeding episode:
- Ask her to...
heavy bleeding,pregnancy history,postpartum hemorrhage,medical center birth
Assessing Previous Infant Mortality and Maternal Health Risks
Critical Source: A Book for Midwives
Procedure:

1. Inquire about infant mortality in previous pregnancies:
- Determine if the mother had a baby who was sick or died before, during, or after a previous birth.
2. Investigate potential causes of infant death:
- Check...
infant mortality,pregnancy history,Rh incompatibility,maternal health risks
Checking for HIV During Pregnancy
Critical Source: A Book for Midwives
Procedure:

1. Administer an HIV test to the pregnant woman during prenatal visits.
2. Check for signs of HIV infection, such as persistent fatigue, weight loss, or recurrent infections.
3. Document the results and provide counseling...
HIV testing,pregnancy,HIV treatment,PMTCT,antiretroviral therapy
Handle Bleeding Before Second Twin is Born
Critical Source: A Book for Midwives
Purpose: Address bleeding after the first twin is born but before the second.

Procedure:
1. Recognize the cause: This may indicate early separation of the placenta (see page 184 of the source text).
2. **Act immediately to deliver the...
placental abruption, postpartum hemorrhage, second twin delivery, emergency intervention
Handle Delayed Contractions After First Twin is Born
Critical Source: A Book for Midwives
Purpose: Address delayed labor after the first twin is born.

Procedure:
1. Encourage contractions to resume:
- Let the first baby breastfeed, as this can stimulate contractions.
- If the baby will not breastfeed, massage the...
delayed contractions, twins delivery, placental separation, infection risk, medical help required
Handle a Sideways (Transverse) Second Twin
Critical Source: A Book for Midwives
Purpose: Address the situation when the second twin is in a sideways position.

Procedure:
1. If medical help is available nearby: Go to the medical center immediately for delivery by cesarean section.
2. **If medical help is far away...
sideways twin, transverse position, baby turning, cesarean delivery
Identify High-Risk Birth Situations Requiring Medical Attention
Critical Source: Where There is no Doctor a Village Health Care Handbook
Procedure:

Look for the following signs that indicate a high-risk birth situation, which may require the presence of a doctor or skilled midwife in a hospital:

1. Early labor pains: If regular labor pains begin more than 3 weeks before the...
high-risk birth, medical attention, pregnancy complications, pre-eclampsia, anemia, multiple births, breech position, hospital delivery
Identify Risks in Twin Births
Critical Source: A Book for Midwives
Purpose: Identify potential complications during twin births.

Procedure:
1. Assess the following risk factors:
- Prematurity and low birth weight: Twins are more likely to be born early and small.
- Cord prolapse: Especially...
twin births, complications, placental abruption, cord prolapse, infection risk, breech position, transverse position, medical center delivery
Identifying and Managing Pain in the Womb During Labor
Critical Source: A Book for Midwives
Procedure:

Signs of Abnormal Pain:
• The mother feels pain between contractions, and her womb remains hard.
• She experiences unusual pain during contractions.

Possible Causes:
• The placenta is detached from the wall of the...
pain during labor, womb pain, placental abruption, midwifery, emergency childbirth
Manage Severe Anemia During Pregnancy
Critical Source: Where There is no Doctor a Village Health Care Handbook
Procedure:

1. If a pregnant woman shows signs of severe anemia (extreme weakness, pale skin, fatigue):
- Encourage her to eat a diet rich in iron and protein, but this may not be sufficient.
2. Seek medical help immediately for...
anemia,pregnancy,iron deficiency,blood transfusion,hospital delivery
Managing Emergencies During Pregnancy and Birth
Critical Source: A Book for Midwives
Procedure:

Steps:
1. Prepare for potential emergencies during pregnancy, labor, and birth by having a plan in place.
2. Ensure access to emergency services and medical facilities in case of complications.
3. Educate expectant mothers on...
emergency,pregnancy,birth plan,medical intervention
Managing a Baby in Sideways Position During Pregnancy
Critical Source: A Book for Midwives
Procedure:

• If the baby is sideways (not head down or head up) by 8 months, try lifting the mother’s hips as described for breech babies.
• If the baby does not turn to a head-down position, **arrange for a hospital birth via cesarean...
sideways baby, cesarean delivery, pregnancy complications, midwifery
Monitor Baby’s Heartbeat After Waters Break
Critical Source: A Book for Midwives
Procedure:

After the bag of waters breaks:

1. Listen to the baby’s heartbeat immediately.
2. If the baby’s heartbeat drops below 100 beats per minute, get medical help immediately.
3. This is a sign that the baby may be in distress and...
baby heartbeat after waters break, midwife procedure, pregnancy complications
Provide Emergency Care for Incomplete Abortion or Miscarriage
Critical Source: A Book for Midwives
Procedure:

1. Assess the situation:
- Check if the woman is bleeding heavily (soaking through more than one pad per hour) or showing signs of shock (faintness, dizziness, pale skin).
- Look for signs of infection such as fever,...
incomplete abortion, miscarriage, emergency care, medical help, bleeding, shock
Recognize Signs of Heavy Bleeding During Pregnancy
Critical Source: A Book for Midwives
Procedure:

1. Monitor for heavy bleeding from the vagina.
2. Note if the bleeding is bright red or dark, and whether it is continuous or intermittent.
3. Check for clots or tissue in the blood.
4. Assess for...
heavy bleeding, pregnancy, medical emergency, detached placenta, placenta previa, tubal pregnancy
Recognize and Respond to Malaria in Pregnant Women
Critical Source: A Book for Midwives
Procedure:

Pregnant women are at higher risk for severe malaria complications such as anemia, miscarriage, early birth, stillbirth, or death.
• If a pregnant woman shows signs of malaria (chills, fever), she should be treated...
malaria in pregnancy, chloroquine safety, malaria complications
Recognizing Preeclampsia Symptoms in Pregnant Women
Critical Source: A Book for Midwives
Procedure:

1. Monitor for symptoms: Watch for severe headaches, sudden swelling (especially in the face and legs), and high blood pressure.
2. Assess medical history: Check if the patient has a history of preeclampsia or previous...
preeclampsia,symptoms,pregnancy,midwife,high blood pressure
Recognizing Warning Signs of Bleeding During Pregnancy
Critical Source: A Book for Midwives
Procedure:

1. Be alert for bleeding during pregnancy, especially:
- In the first 6 months, if accompanied by cramps.
- If bleeding is heavy or occurs without pain (especially in early pregnancy).
2. Watch for warning signs such...
pregnancy bleeding,warning signs,abortion,miscarriage,placental abruption
Recognizing and Managing Convulsions During Labor
Critical Source: A Book for Midwives
Procedure:

1. Identify signs of convulsions: Look for sudden, uncontrollable muscle spasms or seizures during labor.
2. Ensure safety: Move the mother to a safe place away from any objects that could cause injury.
3. **Protect her...
convulsions, pre-eclampsia, labor complications, emergency care
Transport a Woman to a Medical Center in Emergency Situations
Critical Source: A Book for Midwives
When to Transport:
• If the mother has very heavy bleeding, pre-eclampsia, very long labor, high fever, or other serious problems.

Why Transport:
• The midwife may not be able to save her life at home or in a small clinic.
-...
transport, medical center, emergency, pre-eclampsia, heavy bleeding, long labor, high fever
Assess for Unusual Pain in Pregnancy
High Priority Source: A Book for Midwives
Procedure:

1. Ask the mother if she has any unusual pain in the belly, back, or legs.
2. Look for healthy signs: These are not emergencies and may be normal:
- Mild, irregular cramps high in the belly, all over the belly, or inside...
unusual pain in pregnancy, healthy signs, warning signs, miscarriage, blood clot, infection, placenta abruption, tubal pregnancy
Assessing Early Birth History and Bacterial Vaginosis Risk
High Priority Source: A Book for Midwives
Procedure:

1. Inquire about early birth history:
- Determine if the mother had a baby born more than a month early in a previous pregnancy.
2. Check for bacterial vaginosis (BV):
- Ask if she has signs of BV, which can lead to...
early birth,bacterial vaginosis,pregnancy history,preterm labor
Assessing Large Baby History and Diabetes Risk
High Priority Source: A Book for Midwives
Procedure:

1. Inquire about large baby history:
- Determine if the mother previously gave birth to a baby weighing over 4 kilograms (9 pounds).
2. Evaluate previous birth difficulty:
- Ask if the birth was difficult or if there...
large baby,pregnancy history,diabetes testing,birth complications
Assessing Placenta History and Bleeding Risk Management
High Priority Source: A Book for Midwives
Procedure:

1. Inquire about placental complications in previous births:
- Determine if the mother had difficulty with her placenta not coming out easily during a past birth.
2. **Evaluate risk of similar complications in current...
placenta history,postpartum bleeding,medical center birth,pregnancy risks
Assessing Prolonged Labor History for Current Birth Risks
High Priority Source: A Book for Midwives
Procedure:

1. Ask about labor duration:
- For first-time mothers, determine if previous labor lasted longer than 24 hours.
- For mothers with prior births, check if labor lasted more than 12 hours.
2. Inquire about pushing stage:
...
prolonged labor,pregnancy history,birth complications,anemia,medical advice
Assessing Slow Womb Growth in Pregnancy
High Priority Source: A Book for Midwives
Procedure for Assessing Slow Womb Growth in Pregnancy

When a pregnant woman's womb is growing too slowly, consider the following potential causes and actions:

1. Check for high blood pressure:
- If you have equipment to measure blood...
womb growth, pregnancy complications, fetal movement, amniotic fluid, high blood pressure
Assessing Small Baby History and Potential Risk Factors
High Priority Source: A Book for Midwives
Procedure:

1. Inquire about small baby birth history:
- Determine if the mother previously gave birth to a baby weighing less than 2.5 kilograms (5 pounds).
2. Check for early birth in prior pregnancy:
- If the baby was born...
small baby,pregnancy history,anemia,pre-eclampsia,medical center birth
Checking the Baby's Health in Pregnancy
High Priority Source: A Book for Midwives
Procedure for Checking the Baby’s Health in Pregnancy

If there is a concern that the baby may have died or is not growing properly, follow these steps:

1. Confirm fetal viability:
- If the mother has not felt any movement for 2 days...
fetal viability, stillbirth, emotional support, medical help
Handling Dizziness During Pregnancy and Shock
High Priority Source: A Book for Midwives
Procedure:

Steps:
1. Monitor for dizziness during late pregnancy or signs of shock (e.g., fainting, rapid heartbeat).
2. If dizziness occurs, sit down immediately to prevent falls.
3. Ensure adequate hydration and rest to manage...
dizziness,pregnancy,shock,emergency care
Identifying Fistula History and Birth Location Recommendations
High Priority Source: A Book for Midwives
Procedure:

1. Ask about fistula history:
- Determine if the mother had a long labor that resulted in a vaginal fistula (an opening in the tissue of the vagina).
2. Recommend hospital birth for fistula history:
- If she has a...
fistula,vaginal fistula,hospital birth,pregnancy history
Managing Birth by Operation (Cesarean Surgery)
High Priority Source: A Book for Midwives
Procedure:

1. Prepare the environment:
- Ensure a clean, sterile field for surgery.
- Gather all necessary surgical tools and equipment.
2. Administer anesthesia:
- Provide appropriate pain relief to the mother (local or...
cesarean surgery, cesarean delivery, surgical birth, emergency childbirth
Managing Long Labor
High Priority Source: A Book for Midwives
Procedure:

1. Monitor the progress of labor closely:
- Track the frequency and duration of contractions.
- Note any changes in the baby’s position or signs of distress (e.g., decreased fetal movement).
2. **Ensure hydration and...
long labor, midwife, pregnancy complications, fetal distress
Prepare for Twin Birth at Home
High Priority Source: A Book for Midwives
Procedure:

1. If a twin birth is expected to occur at home:
2. Ensure that two highly skilled midwives are present during the birth.
3. Monitor the mother closely for signs of early labor or complications.
4. Have a plan in place for emergency...
twin birth,home delivery,midwife preparation
Preparing the Mother for Labor
High Priority Source: Where There is no Doctor a Village Health Care Handbook
Procedure for Preparing the Mother for Labor:

1. As the due date approaches, visit the mother more frequently.
2. If she has had other children, ask about her previous labor experiences (e.g., duration and any complications).
3. **Rest...
labor preparation, pain management, breathing techniques, emergency delivery, hospital transfer
Prevent Transmission of Gonorrhea or Chlamydia to a Baby During Birth
High Priority Source: Where There is no Doctor a Village Health Care Handbook
Procedure:

1. Identify risk in pregnant women:
- If a pregnant woman has gonorrhea or chlamydia and is not treated before giving birth, the infection may get into the baby’s eyes and cause blindness.
2. **Administer treatment to infected...
gonorrhea, chlamydia, pregnancy, newborn infection, eye infection prevention
Provide Guidance to Women with Diabetes During Pregnancy
High Priority Source: A Book for Midwives
Procedure:

1. Educate the woman about the risks of diabetes during pregnancy (e.g., large babies, birth defects, complications for the baby).
2. Recommend a balanced diet rich in healthy foods and avoid candy and sugar.
3. **Encourage...
diabetes,pregnancy,diet,exercise,medication,birth planning
Recognize and Respond to Severe Nausea and Vomiting in Pregnancy
High Priority Source: A Book for Midwives
Procedure:

1. Monitor for warning signs of severe nausea and vomiting:
- Mother has severe vomiting, or is unable to keep even water in her stomach.
- Mother can only urinate a little bit, or stops urinating, or her urine is very...
severe vomiting,pregnancy,dehydration,parasites,medical advice,IV fluids
Recognizing and Managing Early Birth Risks
High Priority Source: A Book for Midwives
Procedure:

Steps:
1. Identify risk factors for early birth, such as a history of preterm labor or multiple pregnancies.
2. Monitor for signs of preterm labor, including regular contractions, back pain, and vaginal bleeding.
3. Seek...
early birth,pregnancy,preterm labor,medical care
Recognizing and Responding to Signs of Kidney Infection During Pregnancy
High Priority Source: A Book for Midwives
Procedure:

1. Identify symptoms of a kidney infection:
- Pain or pressure in the lower back or side (flank pain)
- Fever, chills, or shaking
- Nausea and vomiting
- Frequent urination or burning sensation when urinating
-...
kidney infection, pregnancy, midwife, urinary tract infection
Recognizing and Responding to a Miscarriage
High Priority Source: Where There is no Doctor a Village Health Care Handbook
Symptoms of a miscarriage:
• Heavy bleeding after missing one or more periods
• Presence of large blood clots
• Painful cramps

What to do if a miscarriage is suspected:
1. Rest immediately and take ibuprofen (see page 379) or codeine...
miscarriage, symptoms, treatment, heavy bleeding, infection prevention, IUD removal, medical help
Respond to Meconium in the Waters
High Priority Source: A Book for Midwives
Procedure:

If meconium is present in the waters:

1. If the waters are very light yellow or green and there are no other warning signs, it may be old stool and the baby could still be OK.
2. Monitor the baby’s heartbeat throughout labor and...
meconium in waters, response to meconium, midwife procedure, pregnancy complications
Respond to the Bag of Waters Breaking
High Priority Source: A Book for Midwives
Procedure:

When the bag of waters breaks, follow these steps:

1. Assess the situation:
- Determine if there is a big gush or slow leak of fluid.
- Note the time the water broke.

2. Monitor for labor onset:
- If labor has not...
bag of waters breaks, infection risk, labor onset, medical center, midwife procedure
Safe Abortion Methods and Considerations
High Priority Source: A Book for Midwives
Procedure:

1. If a woman is seeking to end a pregnancy safely, ensure that she receives care from a qualified healthcare provider.
2. There are three safe methods of abortion, depending on the stage of pregnancy:
- **Vacuum...
safe abortion methods, vacuum aspiration, D&C, medication abortion
Safety Precautions for Attempting to Turn a Breech Baby
High Priority Source: A Book for Midwives
Procedure:

Only attempt massage or manual turning if you have been trained in safe techniques and can access medical help.
Do not attempt to turn the baby by pushing on the womb, as this is very dangerous and may cause harm to both...
breech baby, safety precautions, midwifery, pregnancy complications
Seek Medical Help if Twins Are Suspected
High Priority Source: A Book for Midwives
Procedure:

1. If you suspect the mother is carrying twins, even if only one heartbeat can be heard:
2. Seek immediate medical help at a hospital or medical center.
3. A sonogram (ultrasound) should be used to confirm the presence of...
twins,medical help,sonogram,pregnancy risks
Understand Stage 1 of Labor (Dilation)
High Priority Source: A Book for Midwives
Definition:
Stage 1 of labor begins when contractions start to open the cervix and ends when the cervix is completely open.

Characteristics:
• This stage is usually the longest part of labor but varies in duration for each birth.
• It...
stage 1 labor, dilation, contractions, pain in womb, bleeding during labor
Watch for Warning Signs During Pregnancy and Birth
High Priority Source: A Book for Midwives
The following chapters on labor and birth list many warning signs. Most warning signs tell you to watch closely and wait to see what happens. Some warning signs may go away. Other signs are very serious.

• If a woman has a **very serious...
warning signs,pregnancy complications,midwife intuition
When to Arrange for Hospital Birth with Breech Baby
High Priority Source: A Book for Midwives
Procedure:

• If a breech baby is going to be born at home, it is important for a very skilled midwife to be present.
• Do not attempt to deliver a breech baby at home in the following situations:
- This is the mother’s first baby.
-...
breech baby, home birth, midwifery, hospital transfer
When to Seek Medical Help During Pregnancy or Childbirth
High Priority Source: A Book for Midwives
Knowing when to get medical help is crucial for midwives and pregnant women.

### Signs That Require Immediate Medical Attention:
Hemorrhage (heavy bleeding)
Infection (signs include fever, chills, foul-smelling discharge)
-...
hemorrhage,infection,pre-eclampsia,seek medical help,midwife procedures
Assess and Respond to Weakness in Pregnancy
High Priority Source: A Book for Midwives
Procedure:

1. Ask the mother if she feels weak or tired all of the time, especially after the 4th month.

2. Identify healthy signs:
- Mother has plenty of energy.
- It is normal for a pregnant woman to feel sleepy in the first 3...
weakness in pregnancy,anemia,nutrition,depression,labor complications
Assessing General Health of a Pregnant Woman
High Priority Source: A Book for Midwives
Procedure:

1. Inquire about current health status: Ask if the woman is currently experiencing any health issues that may affect her pregnancy.
2. Identify high-risk conditions: Look for conditions such as diabetes, HIV/AIDS, bladder or...
pregnancy health, high-risk conditions, prenatal care
Assessing Infection History and Vaginal Infection Screening
High Priority Source: A Book for Midwives
Procedure:

1. Inquire about infection history during or after previous births:
- Determine if the mother had a fever or infection of the womb in a past pregnancy or birth.
2. Evaluate increased risk for current pregnancy:
- Note...
infection history,vaginal infection,pregnancy risks,screening procedures
Assessing Past Pregnancy and Birth History for Potential Complications
High Priority Source: A Book for Midwives
Procedure:

1. Ask the woman to recount each of her past pregnancies and births, including both positive and negative experiences.
2. Inquire about any complications she may have experienced in previous pregnancies or births, such as:
...
pregnancy history, past complications, anemia, pre-eclampsia, eclampsia, diabetes, high blood pressure
Assessing Previous Cesarean Surgery and Its Implications for Current Pregnancy
High Priority Source: A Book for Midwives
Procedure:

1. Inquire about previous cesarean surgery: Determine if the woman has had a prior cesarean section.
2. Explain surgical procedure: Describe that during a cesarean, the doctor makes an incision in the abdomen and uterus to...
cesarean surgery, VBAC, uterine rupture
Assessing and Managing a Fast Pulse in Pregnant Women
High Priority Source: A Book for Midwives
Procedure:

1. Check the mother's pulse rate:
- Use your fingers to feel the pulse at the wrist or neck.
- Count how many beats you feel in 60 seconds.
- If the pulse is 100 beats per minute or more, proceed with further...
fast pulse,pregnant women,anemia,infection,heart trouble,stress,medical advice
Assessing the Position of the Baby During Pregnancy
High Priority Source: A Book for Midwives
Procedure:

Steps to Assess the Position of the Baby During Pregnancy:

1. Feel the mother’s abdomen:
- Use your hands to gently palpate the mother’s belly and determine where the baby is positioned.
2. **Listen for the baby’s...
fetal position, breech baby, transverse position, external cephalic version, prenatal checkups
Check for Signs of Diabetes in Pregnant Women
High Priority Source: A Book for Midwives
Procedure:

1. Ask the woman if she has a history of diabetes in a past pregnancy.
2. Inquire if any previous babies were born very large (more than 4 kilograms or 9 pounds), ill, or died at birth with no known cause.
3. **Assess for...
diabetes,pregnancy,womb size,urination frequency,thirst,yeast infections,wound healing
Check the Color and Contents of the Waters
High Priority Source: A Book for Midwives
Procedure:

When the bag of waters breaks:

1. Observe the color of the waters.
2. If they are clear or slightly pink, this is normal. White dots may also be present.
3. If the waters are yellow or green, this is a warning sign and may...
meconium in waters, check water color, midwife procedure, pregnancy complications
Checking Baby’s Heartbeat During Pregnancy
High Priority Source: A Book for Midwives
Procedure:

1. Use a stethoscope or Doppler device to listen for the baby's heartbeat.
2. Locate the heartbeat by feeling for the area where it is most audible, typically on the mother’s abdomen.
3. Listen for the swishy sound of the...
baby's heartbeat,prenatal checkups,Doppler device,stethoscope,heartbeat monitoring
Detecting Fetal Heartbeat and Movement
High Priority Source: Where There is no Doctor a Village Health Care Handbook
Procedure for Detecting Fetal Heartbeat and Movement:

1. After the 5th month of pregnancy, listen for the baby’s heartbeat and check for movement.
2. Listening Method:
- Place your ear against the mother's belly to hear the heartbeat...
fetal heartbeat, fetal movement, pregnancy monitoring, breech birth, fetoscope
Determine When to Go to the Birth
High Priority Source: A Book for Midwives
Procedure:

You should go to the mother when any of these occur:

Labor contractions begin.
The bag of waters breaks.
The mother feels she needs you.

If you arrive and find the mother is in very early labor (and you live...
when to go to birth, early labor, medical help proximity, midwife procedure
Determining if the Baby is Vertical in Pregnancy
High Priority Source: A Book for Midwives
Procedure for Determining if the Baby is Vertical in Pregnancy

To check whether the baby is vertical (head or bottom down) during pregnancy:

1. Assess timing:
- Most babies are vertical by 7 months.

2. Use palpation technique:
...
fetal position vertical, sideways baby, cesarean delivery
Differentiate Between Pregnancy-Related and Non-Pregnancy-Related Belly Pain
High Priority Source: A Book for Midwives
Procedure:

1. Assess the mother for any pain that may be unrelated to pregnancy.
2. Look for signs of non-pregnancy-related illnesses: These include:
- Appendicitis: Fever, pain on the right side of the belly, and lack of appetite.
...
non-pregnancy-related pain, appendicitis, parasites, ulcers, medical evaluation
Evaluating Rapid Womb Growth
High Priority Source: A Book for Midwives
Procedure:

1. Identify signs of rapid womb growth: If the womb is growing more than 2 finger widths per month or more than 1 centimeter per week, consider potential causes.

2. Consider possible causes:
- **Multiple pregnancy...
rapid womb growth,twins,diabetes,pregnancy complications
Identifying Indications for Medical Center Delivery After Previous Cesarean Surgery
High Priority Source: A Book for Midwives
Procedure:

1. Assess timing of previous cesarean: If the prior cesarean was less than 2 years ago, recommend delivery in a medical center.
2. Evaluate baby’s size and position: If this pregnancy involves a large baby or difficult birth...
cesarean surgery, VBAC risks, hospital delivery
Identifying the Baby’s Position in Pregnancy
High Priority Source: A Book for Midwives
Procedure for Identifying the Baby’s Position in Pregnancy

To determine the baby's position during pregnancy:

1. Use two methods:
- Feel the mother’s belly.
- Listen to where the baby’s heartbeat is strongest.
- Both methods may...
fetal position, breech baby, twin pregnancy, prenatal checkup
Managing Alcohol Consumption During Pregnancy and Breastfeeding
High Priority Source: A Book for Midwives
Procedure:

Steps:
1. Avoid alcohol consumption entirely during pregnancy and breastfeeding.
2. Educate expectant mothers on the risks of alcohol to fetal development and infant health.
3. Provide support for women who struggle with alcohol...
alcohol,pregnancy,breastfeeding,fetal development
Managing a Breech Baby During Pregnancy
High Priority Source: A Book for Midwives
Procedure:

1. Monitor the baby’s position:
- Regularly check for breech position through physical examination or ultrasound.
- Keep track of any changes in the baby’s position throughout pregnancy.

2. **Consider external cephalic...
external cephalic version, breech delivery, cesarean section, pregnancy management
Monitor Time Since Waters Broke and Prevent Infection
High Priority Source: A Book for Midwives
Procedure:

Once the bag of waters breaks:

1. The baby should be born within 24 hours after the waters break.
2. Labor should start within 12 hours after the waters break to avoid infection.
3. While waiting for labor, help the mother...
time since waters broke, infection prevention, midwife procedure, pregnancy complications
Performing a Pelvic Exam During Labor
High Priority Source: A Book for Midwives
Procedure:

1. Prepare the environment:
- Ensure privacy and comfort for the patient.
- Gather necessary tools: gloves, lubricant, speculum (if needed), and a clean surface for placing instruments.

2. Explain the procedure to the...
pelvic exam, labor, midwife, pregnancy complications, cervical dilation
Positioning Mother to Encourage Breech Baby to Turn
High Priority Source: A Book for Midwives
Procedure:

1. Lift the mother’s hips:
- The mother should lie on her back with a soft object (e.g., a pillow) under her hips.
- This position lifts the baby out of the pelvis, allowing it to turn and put its head down.
- Perform...
breech baby, fetal position, turning baby, pregnancy, midwifery
Prevent HIV Transmission During Pregnancy
High Priority Source: Where There is no Doctor a Village Health Care Handbook
Procedure:

1. If the mother is HIV-positive, she should consult a health worker experienced in HIV care.
2. Medicines can help prevent transmission of HIV to the baby during pregnancy or childbirth.
3. Refer to page 398 for more...
HIV,pregnancy,transmission,antiretroviral drugs,health worker
Preventing and Treating Malaria in Pregnancy
High Priority Source: A Book for Midwives
Overview: Malaria can cause anemia and other serious complications during pregnancy.

Procedure:
1. Prevention:
- Use insecticide-treated mosquito nets.
- Apply insect repellent to exposed skin.
- Eliminate standing water around...
malaria, anemia, pregnancy, prevention, treatment
Recognize Signs of Bladder Infection in Pregnant Women
High Priority Source: A Book for Midwives
Signs of bladder infection include:

• No obvious symptoms (some women may have a bladder infection without any signs)
• Frequent urination
• Burning sensation while urinating
• Itching or burning may also indicate vaginal infections or sexually...
bladder infection,pregnant women,symptoms,urinary tract infection
Recognize Signs of Kidney Infection in Pregnant Women
High Priority Source: A Book for Midwives
Signs of kidney infection include:

• Any signs of bladder infection (e.g., frequent urination, burning sensation)
• Cloudy or bloody urine
• Pain in the lower back, especially on one side
• Fever
• Feeling very sick or weak

Note: Pain...
kidney infection,pregnant women,symptoms,back pain,urine changes
Recognize and Respond to Signs of Diabetes During Pregnancy
High Priority Source: A Book for Midwives
Procedure:

1. Monitor for increased thirst, frequent urination, and unexplained weight loss during pregnancy.
2. Check for blurred vision or fatigue, which may be signs of high blood sugar levels.
3. Be alert to **nausea or...
diabetes during pregnancy, gestational diabetes, high blood sugar, hypoglycemia, medical monitoring
Thump Test to Detect Excess Amniotic Fluid
High Priority Source: A Book for Midwives
Procedure:

1. Prepare for the thump test: Have a helper place their hand along the middle of the mother’s belly.

2. Perform the test:
- Place one hand on one side of the mother’s belly.
- Use your other hand to gently thump the...
amniotic fluid,thump test,pregnancy assessment
Understanding and Managing Complications from Past Abortions
High Priority Source: A Book for Midwives
Procedure:

1. Ask the woman if she has had any abortions in the past, whether they were safe or unsafe.
2. **If she had complications such as heavy bleeding, infection, or scarring after an abortion, inform her that this may increase her...
past abortions, complications from abortion, uterine scarring
Addressing Disabilities Affecting Thinking or the Brain During Pregnancy
Standard Source: A Book for Midwives
Procedure:

Steps:
1. Identify any pre-existing disabilities affecting thinking or the brain.
2. Consult with a healthcare provider to assess potential risks during pregnancy.
3. Ensure proper prenatal care and monitoring for both mother and...
disabilities,pregnancy,brain function,alcohol consumption
Assessing Exposure to Toxins and Medications in Relation to Birth Defects
Standard Source: A Book for Midwives
Procedure:

1. Ask about exposure history: Inquire if the woman has been exposed to toxic chemicals, drugs, or medications during this pregnancy.
2. Refer to specific pages: Direct the woman to pages 45–47 of the book for more detailed...
toxic chemicals, drugs, birth defects
Assessing Nutrition and Its Impact on Birth Defects
Standard Source: A Book for Midwives
Procedure:

1. Evaluate nutritional status: Ask about the woman's diet and whether she has been experiencing poor nutrition.
2. Refer to specific pages: Direct her to pages 33–39 for more detailed information on how nutrition affects...
nutrition, birth defects, prenatal care
Assessing Past Medical History for Potential Pregnancy Complications
Standard Source: A Book for Midwives
Procedure:

1. Inquire about past medical history: Ask if the woman has ever had conditions such as hepatitis, kidney infection, pre-eclampsia, frequent fevers, or tuberculosis.
2. Recommend medical consultation: Advise her to see a...
past medical history, pregnancy complications, prenatal care
Assessing Womb Size Discrepancy with Due Date
Standard Source: A Book for Midwives
Procedure:

1. Check if the due date is incorrect: If the measured womb size does not match the expected size based on the last menstrual period (LMP), consider that the LMP may be inaccurate.

2. **Consider possible reasons for...
womb size,due date discrepancy,pregnancy assessment
Avoid Using Medicines to Induce Labor at Home
Standard Source: A Book for Midwives
Procedure:

If labor has not started within the expected time after the waters break:

1. You can try a home method to help labor start or get stronger (see page 191 for details).
2. **Do not give the mother medicines like oxytocin or...
induce labor safely, oxytocin use, midwife procedure, pregnancy complications
Calculating the Estimated Date of Delivery (EDD)
Standard Source: Where There is no Doctor a Village Health Care Handbook
Procedure for Calculating the Estimated Date of Delivery:

1. Start with the first day of the mother's last menstrual period.
2. Calculation Method:
- Subtract 3 months from that date.
- Add 7 days to the result.
3. **Example...
estimated delivery date, EDD calculation, last menstrual period, pregnancy timeline
Determine Heartbeat Rhythms to Identify Twins
Standard Source: A Book for Midwives
Procedure:

1. Locate the heartbeat of one baby.
2. Have a helper listen for other places where the heartbeat is easy to hear.
3. If the helper hears a heartbeat, have her listen in one location while you listen in another.
4. Tap the rhythm of...
heartbeat rhythm,twins,detection method
Identify Signs of Twin Pregnancy
Standard Source: A Book for Midwives
Procedure:

• Observe if the womb grows faster or larger than normal.
• Check if two heads or two bottoms can be felt when palpating the mother’s belly.
• Attempt to hear two distinct heartbeats, especially in the last few months of pregnancy....
twins,pregnancy signs,heartbeats,womb growth
Nutritional Guidelines During Pregnancy and Postpartum
Standard Source: A Book for Midwives
Procedure:

Steps:
1. Ensure a balanced diet rich in essential nutrients such as folic acid, calcium, iron, and vitamins.
2. Consume foods that promote healthy pregnancy outcomes, including leafy greens, lean proteins, whole grains, and...
nutrition,pregnancy,diet,postpartum
Perform a Simple Urine Test for Diabetes
Standard Source: A Book for Midwives
Procedure:

1. Ask the woman to urinate into a clean container (e.g., a pot or cup).
2. Leave the container outside in an area where ants can access it.
3. Observe if ants are attracted to the urine.
4. **If ants climb into the...
urine test,diabetes,sugar detection,ants

+ 35 more procedures. Get the full library in the app.

Wound Care (128)

Apply Sterile Dressing After Surgical Cricothyroidotomy
Critical Source: TCCC 17 13 Tactical Combat Casualty Care
Objective: Apply a sterile dressing to the incision site to prevent infection and irritation.

Procedure:
1. Use one of the following methods:
- Method 1: Make a V-shaped fold in a 4- by 4-inch gauze pad and place it under the...
sterile dressing, wound care, TCCC
Apply Dressings to Open Circular Amputation Stump
Critical Source: NATO Emergency War Surgery
Procedure:

1. Place a layer of sterile fine-mesh gauze soaked with Betadine over the wound.

2. Dress the recess of the stump loosely with fluffed gauze or other suitable material.

3. Apply a stockinette for skin traction to the skin above the...
amputation dressing, stump care, wound management, traction application
Leave Wounds Open After Debridement
Critical Source: NATO Emergency War Surgery
Leave wound open:
1. After debridement of war wounds, leave the wound open.
2. Control bleeding points but do not attempt wound closure.
3. Drains are usually unnecessary.
open wound,wound management,debridement
Perform Proper Suturing Techniques for Wound Closure
Critical Source: Medical Survival Wound Closure Manual
Common Suturing Techniques: The choice of technique depends on the wound location, depth, and tension.

Ligatures: Used to tie off blood vessels or tissues. Ensure tightness without causing tissue necrosis.
Primary Suture Line: Used...
suturing techniques,wound closure,continuous sutures,interrupted sutures,purse-string
Primary Surgical Wound Care in Emergency War Surgery
Critical Source: Emergency War Surgery
Primary Surgical Wound Care

Limited longitudinal incisions.
Excision of foreign material and devitalized tissue.
Irrigation.
LEAVE WOUND OPEN—NO PRIMARY CLOSURE.
Antibiotics and tetanus prophylaxis.
• **Splint for...
wound care, debridement, irrigation, no primary closure, muscle viability, emergency surgery
Proper Knot Tying Techniques for Secure Suture Placement
Critical Source: Medical Survival Wound Closure Manual
Knot Tying: Secure knots are essential to prevent suture slippage and ensure proper wound closure.

Knot Security: A well-tied knot should not slip or come loose under tension. The number of throws (turns) in a knot determines its...
knot tying,square knot,surgeon's knot,deep tie,instrument tie
Select Appropriate Suturing Materials Based on Wound Characteristics
Critical Source: Medical Survival Wound Closure Manual
Suture Selection Procedure: Choosing the right suture material is critical for optimal wound healing and minimizing complications.

Absorbable vs. Nonabsorbable Sutures: Absorbable sutures are used in tissues that will heal quickly, such...
suture selection,wound characteristics,synthetic absorbable,nonabsorbable sutures
Select and Use Appropriate Surgical Needles for Wound Closure
Critical Source: Medical Survival Wound Closure Manual
Surgical Needle Selection: Choosing the right needle is essential for effective wound closure and minimizing tissue trauma.

Needle Design Principles:
- Needle Eye: The size of the eye should match the suture material being used....
surgical needles,needle design,needle types,needleholders
Apply Nonocclusive Dressing and Immobilize Extremity
High Priority Source: NATO Emergency War Surgery
Nonocclusive dressing and immobilization:
1. Cover the wound with a sterile, bulky, nonocclusive dressing.
2. Immobilize the extremity using plaster splints or a plaster cast that is immediately bivalved.
3. In some cases, external skeletal...
nonocclusive dressing,immobilization,plaster splint
Apply a Dressing to a Hand Wound
High Priority Source: NATO Emergency War Surgery
Procedure:

1. Use well-fluffed gauze applied evenly and snugly over a layer of fine-mesh gauze.
2. Do not use petrolatum-impregnated gauze, as it impedes healing.
3. Ensure the deeper parts of the wound are not plugged.
4. Spread...
dressing,application,wound care,fingers,hand injury
Classify Wounds for Proper Management
High Priority Source: Medical Survival Wound Closure Manual
Classification of Wounds: Understanding the type and severity of a wound is essential for appropriate treatment. Wounds can be classified based on several factors:

Type of Injury: Lacerations, punctures, abrasions, avulsions, or burns.
-...
wound classification,wound healing types,priority intention,second intention,delayed closure
Clean an Open Wound in a Survival Situation
High Priority Source: Medical Emergencies
Procedure:

1. Remove or cut clothing away from the wound to avoid further contamination.
2. Look for an exit wound if the injury was caused by a sharp object, gunshot, or projectile.
3. Thoroughly clean the skin around the wound...
open wounds,cleaning wounds,survival first aid,wound infection prevention,sterile treatment,bandaging wound
Closure of Facial Wounds Without Tension
High Priority Source: NATO Emergency War Surgery
Closure

• Closure must be accomplished without tension.
• It is begun intraorally and proceeds outwardly.
• When the parotid duct is found severed, primary repair should be considered.
• If primary repair is not deemed practical:
...
facial wound closure,catheter placement,salivary fistulae,submandibular gland injury
Debridement of Facial Wounds
High Priority Source: NATO Emergency War Surgery
Debridement

• Tissues should be handled very gently with fine instruments.
• The facial tissues have a high blood supply and resistance to infection, so only minimal excision of skin is necessary (1–2 mm of the wound edges).
• Trimming is...
debridement,wound excision,facial wound care,bone removal
Dress Amputation with Preserved Flaps
High Priority Source: NATO Emergency War Surgery
Procedure:

1. Ensure the flaps are held in their intended position by the dressing.

2. Leave the major area of the amputation widely open.

3. Do not allow any element of the flap to be suspended loosely within the dressing.

4. **Avoid...
preserved flaps, amputation dressing, flap management
Handling Contaminated or Infected Wounds
High Priority Source: Medical Survival Wound Closure Manual
Procedure:

1. Identify contaminated wounds by the presence of microorganisms that have not yet overwhelmed the body's natural defenses.
2. Recognize infection when contamination levels exceed the tissue’s ability to defend against invading...
contaminated wounds, infected wounds, secondary intention healing, nonabsorbable monofilament nylon sutures, PROXI-STRIP skin closures, infection prevention
Initial Wound Surgery Preparation
High Priority Source: NATO Emergency War Surgery
Preparation of the Surgical Field

• The surgical field is prepared as usual.
• Ingrained dirt is removed by gentle scrubbing with a soft brush.
The eyebrows are not shaved.
surgical field preparation,wound surgery,initial wound care,dirt removal
Perform Debridement of Wounds in Survival Medicine
High Priority Source: Survival and Austere Medicine
Procedure for Debridement of Wounds in Survival Medicine

1. Make an incision:
- Make an incision in the skin and fascia long enough to give good exposure.
- Incisions should be made over the wound (both entrance and exit wounds in...
debridement,wound care,tissue viability,4 C's,foreign bodies,irrigation,haemostasis,fasciotomy
Primary Wound Closure for Maxillofacial Injuries
High Priority Source: NATO Emergency War Surgery
Primary Wound Closure

Maxillofacial injuries are an exception to the general rule that soft-tissue wounds should not be closed at initial surgery.
Primary closure of facial injuries is preferred over delayed primary closure.
• This...
primary wound closure,maxillofacial injuries,multidisciplinary team,wound repair
Proper Needle Handling and Placement Techniques for Suturing
High Priority Source: Medical Survival Wound Closure Manual
Needle Handling Tips: Proper handling of surgical needles is essential to ensure safe and effective wound closure.

Needle Placement in Tissue:
- Insert the needle at a shallow angle (approximately 15–30 degrees) to avoid tearing the...
needle handling,placement techniques,surgical safety
Recognize and Respond to Hemorrhage (Severe Bleeding)
High Priority Source: Where There is no Doctor a Village Health Care Handbook
Hemorrhage refers to severe or dangerous bleeding that can occur from a wound, internal injury, or other medical condition.

Immediate action is required:
1. Apply direct pressure to the wound with a clean cloth or bandage.
2. Elevate the...
hemorrhage, severe bleeding, first aid
Redebridement and Wound Closure Procedure
High Priority Source: NATO Emergency War Surgery
Procedure for Redebridement and Wound Closure:

1. After the wound has been debrided, irrigated, and appropriately dressed:
- Inspect the wound 4 to 10 days later unless clinical conditions require an earlier appraisal.
- Intervening...
redebridement,wound closure,delayed primary closure,debriding wound,post-operative care
Repair of Severed Facial Nerve Branches
High Priority Source: NATO Emergency War Surgery
Repair of Severed Facial Nerve Branches

• The repair should be accomplished using fine suture material and magnification.
• All branches proximal to a vertical line extending downward from the lateral canthus should be repaired...
facial nerve repair,suture material,magnification,watertight closure
Selecting and Maintaining Suture Material and Needles for Long-Term Use
High Priority Source: Survival and Austere Medicine
Procedure:

1. Stock up on suture material: Non-absorbable sutures can be stored for long periods, so it is ideal to stockpile in advance or scavenge.
2. Consider alternatives to commercial sutures: Alternatives are discussed in the...
sutures,needles,cotton thread,gut material,sterilization,test strength
Soft-Tissue Wound Management in War Injuries
High Priority Source: Emergency War Surgery
Procedure for Soft-Tissue Wound Management in War Injuries:

All war wounds are contaminated and should not be closed primarily.
• The goal is to save lives, preserve function, minimize morbidity, and prevent infections through early and...
soft tissue injury, war wound management, surgical debridement, infection prevention, battlefield medicine
Use of Flaps for Large Facial Defects
High Priority Source: NATO Emergency War Surgery
Flap Use in Large Facial Defects

• In rare cases when a defect is so large that closure is impossible without tension or distortion, a flap may be used.
• All skin flaps must be carefully approximated and held in position by suturing...
flap use,wound defect,closure without tension,surgical flap
Administer Lidocaine for Postpartum Tears and Sensitive Areas
High Priority Source: Where There is no Doctor a Village Health Care Handbook
Purpose: To numb sensitive areas (fingers, toes, penis, ears, nose) or postpartum tears before suturing.

Materials Needed:
• Lidocaine without epinephrine
• Syringe and needle
• Alcohol swabs
• Clean gauze

Procedure:
1. **Clean the...
lidocaine without epinephrine, postpartum tears, sensitive area anesthesia
Administer Lidocaine for Wound Anesthesia
High Priority Source: Where There is no Doctor a Village Health Care Handbook
Purpose: To numb a wound before sewing it to reduce pain.

Materials Needed:
• Lidocaine (2% with or without epinephrine)
• Syringe and needle
• Alcohol swabs
• Clean gauze

Procedure:
1. Clean the area around the wound thoroughly...
lidocaine, anesthetic, wound care, sewing wounds, numbing agent
Adverse Effects of Surgical Gut Sutures
High Priority Source: Medical Survival Wound Closure Manual
### Adverse Effects of Surgical Gut Sutures

Potential Adverse Effects
• Wound dehiscence.
• Variable rates of absorption over time (depending on such factors as the type of suture used, the presence of infection and the tissue site).
• Failure...
adverse effects, wound dehiscence, allergic response, infection risk, broken needle consequences
Apply Buried Sutures for Internal Support
High Priority Source: Medical Survival Wound Closure Manual
Procedure:

1. Identify the tissue layer: Locate the deeper layers of tissue that need internal support, such as muscle or fascia.
2. Insert the suture: Pass the needle through the tissue from one side to the other, taking equal bites on...
buried sutures,internal support,tissue closure
Apply Continuous Sutures for Wound Closure
High Priority Source: Medical Survival Wound Closure Manual
Procedure:

1. Prepare the wound site: Clean the area thoroughly with antiseptic solution to reduce the risk of infection.
2. Select appropriate suture material: Use a single strand of non-absorbable or absorbable suture material,...
continuous sutures,wound closure,suture techniques,running stitches
Apply Deep Sutures for Internal Tissue Repair
High Priority Source: Medical Survival Wound Closure Manual
Procedure:

1. Identify the tissue layer: Locate the deeper layers of tissue that need repair, such as muscle or fascia.
2. Insert the suture: Pass the needle through the deeper tissue layer from one side to the other, taking equal bites...
deep sutures,internal repair,tissue closure
Apply Purse-String Sutures for Inverted Tissue Repair
High Priority Source: Medical Survival Wound Closure Manual
Procedure:

1. Identify the tissue layer: Locate the lumen or opening that needs to be inverted, such as the stump of the appendix or intestinal openings.
2. Insert the suture: Pass the needle around the entire perimeter of the opening,...
purse-string sutures,inverted repair,tissue closure
Apply Retention Sutures for Tension Support
High Priority Source: Medical Survival Wound Closure Manual
Procedure:

1. Identify the tissue layer: Locate the deeper layers of tissue that need tension support, such as muscle or fascia.
2. Insert the suture: Pass the needle through the tissue from one side to the other, taking equal bites on...
retention sutures,tension support,wound reinforcement
Apply Secondary Suture Line for Reinforcement
High Priority Source: Medical Survival Wound Closure Manual
Procedure:

1. Identify the primary suture line: Locate the initial layer of sutures that have been applied to the wound.
2. Insert secondary sutures: Place additional sutures approximately 2 inches from each edge of the wound, parallel...
secondary suture line,reinforcement,wound support
Apply Subcuticular Sutures for Skin Layer Repair
High Priority Source: Medical Survival Wound Closure Manual
Procedure:

1. Identify the tissue layer: Locate the dermis, beneath the epithelial layer.
2. Insert the suture: Pass the needle through the dermal layer from one side to the other, taking equal bites on each side.
3. **Secure the...
subcuticular sutures,skin repair,tissue closure
Apply Through-and-Through Sutures for Abdominal Wall Repair
High Priority Source: Medical Survival Wound Closure Manual
Procedure:

1. Identify the tissue layer: Locate the peritoneal cavity and abdominal wall layers that need repair.
2. Insert the suture: Pass the needle through all layers of the abdominal wall, including the peritoneum, from one side to...
through-and-through sutures,abdominal repair,tissue closure
Assess Patient Factors Affecting Wound Healing
High Priority Source: Medical Survival Wound Closure Manual
### Assess Patient Factors Affecting Wound Healing

Overview:
Before and during wound management, it is essential to evaluate the patient's overall health status as it significantly affects the speed of the healing process. The following factors...
patient factors,wound healing,age,weight,nutrition,dehydration,immune response,chronic disease,radiation therapy
Contraindications for Surgical Gut Sutures
High Priority Source: Medical Survival Wound Closure Manual
### Contraindications for Surgical Gut Sutures

This suture should not be used in the following situations:
• Where extended approximation of tissue is required.
• In patients with known sensitivities or allergies to collagen or chromium, as...
contraindications, collagen allergy, chromium sensitivity, extended tissue approximation
Eliminating Dead Space in a Wound
High Priority Source: Medical Survival Wound Closure Manual
Definition of Dead Space:
• Dead space occurs when portions of the wound beneath the skin edges are not closely approximated, or when air or fluid is trapped between layers of tissue.
• This is especially common in fatty tissues that lack...
dead space,wound infection,drain,application,pressure dressing
Environmental Management of Lesions in Definitive Care Facilities
High Priority Source: NATO Emergency War Surgery
Procedure:

1. Place the patient on surgically clean sheets.
2. Expose all lesions to air at normal room temperature.

Details:
• This helps prevent further contamination and promotes healing.
lesion management, surgical sheets, air exposure
Field Expedient Vacuum Assisted Wound Closure (VAC) System for Skin Grafts
High Priority Source: Emergency War Surgery
Procedure:

Step 1: Prepare materials
• Use the following items:
- Adaptec (nonadherent gauze).
- JP drains.
- Ioban.
- Benzoin.

Step 2: Apply graft and dressing
• Staple the skin graft to the edges of the wound.
• Apply...
skin graft dressing, field expedient VAC, Silvadene application, nonadherent gauze
Field Expedient Vacuum Assisted Wound Closure (VAC) System for Soft Tissue and Extremity Wounds
High Priority Source: Emergency War Surgery
Procedure:

Step 1: Prepare materials
• Use the following items:
- Laparotomy sponges.
- Jackson-Pratt (JP) drains.
- Ioban.
- Benzoin.
- Adaptec (nonadherent gauze for skin grafts).
- Sterile perforated IV bags.

**Step 2: Apply...
vacuum assisted closure, field expedient VAC, wound dressing, JP drains, laparotomy sponges
Identify and Classify Wound Types for Appropriate Closure
High Priority Source: Medical Survival Wound Closure Manual
Objective: Correctly classify wounds to determine the appropriate closure method.

### Wound Classification Categories:
1. Clean Wounds:
- Uninfected operative wounds made under aseptic conditions.
- No inflammation or entry into...
wound classification,clean wound,clean-contaminated wound,contaminated wound,dirty wound,wound closure
Irrigate Wounds to Reduce Infection Risk
High Priority Source: Survival and Austere Medicine
Procedure:

1. Gather materials:
- Sterile normal saline (preferred)
- Sterile water (if saline is unavailable)
- Irrigation device or syringe
- Basin or container for waste

2. Prepare the wound area by cleaning it with antiseptic...
irrigation,wound care,surgery,sterile saline,infection prevention
Managing Food and Regime for Severe Wounds
High Priority Source: The Household Cyclopedia
For animals with severe wounds:

1. Ensure the environment is cool and airy.
2. Keep the area quiet to avoid disturbing the animal.
3. Provide cold drinks freely, but in small quantities at a time.
4. Feed sparingly with lighter quality food that is...
animal nutrition, wound management, laxatives, bleeding treatment
Optimal Suture Qualities for Effective Wound Closure
High Priority Source: Medical Survival Wound Closure Manual
Procedure:

1. Ensure the suture material has high uniform tensile strength, allowing the use of finer sizes.
2. Confirm that the suture retains high tensile strength _in vivo_ to securely hold the wound during healing and is rapidly...
suture qualities,wound closure,tissue compatibility
Place Stitches for Optimal Tissue Approximation
High Priority Source: Medical Survival Wound Closure Manual
Procedure:

1. Identify the wound edges: Locate the two sides of the wound that need to be brought together.
2. Insert the needle: Pass the needle through the tissue from one side of the wound to the other, taking equal bites on each...
stitch placement,tissue approximation,wound closure
Post-Injury Care for Lower Extremity Injuries in Definitive Care Facilities
High Priority Source: NATO Emergency War Surgery
Procedure:

1. Keep the patient at bed rest.
2. Elevate the injured part on surgically clean sheets under a foot cradle.
3. Use sterile pledgets of cotton to separate the toes.
4. Avoid bearing-weight on injured feet until mature...
post-injury care, lower extremity, bed rest, elevation, sterile pledgets
Proper Skin Wound Closure Using Sutures
High Priority Source: Medical Survival Wound Closure Manual
Procedure for Proper Skin Wound Closure Using Sutures:

1. Select Appropriate Suture Material:
- Use a very sharp needle to minimize tissue trauma.
- Consider using coated VICRYL* RAPIDE suture, which is rapidly absorbed and eliminates...
skin,wound closure,sutures,epithelialization,healing,tensile strength,removal,monofilament
Recognize the Role of Collagen in Wound Healing
High Priority Source: Medical Survival Wound Closure Manual
Objective: Understand how collagen contributes to wound strength and healing.

### Collagen Function in Healing
Chief constituent of connective tissue, collagen is essential for tensile strength and pliability of healing wounds.
-...
collagen,wound healing,fibroblasts,granulation tissue,tensile strength
Select Appropriate Sutures Based on Clinical Indication and Healing Time
High Priority Source: Medical Survival Wound Closure Manual
Step 1: Assess the Wound Type and Location
Absorbable sutures are ideal for internal wounds, deep tissue repair, or areas where suture removal is impractical (e.g., abdominal incisions).
Nonabsorbable sutures are preferred for skin...
suture selection, wound closure techniques, medical materials, suture handling
Selecting Appropriate Suture Material Based on Wound Characteristics
High Priority Source: Medical Survival Wound Closure Manual
Procedure:

1. Assess the type of wound and the tissue involved.
2. Determine the amount of tension on the wound, number of layers for closure, depth of suture placement, anticipated edema, and timing of suture removal.
3. Choose between...
sutures,wound closure,tissue strength,suture selection
Stage-Based Assessment and Treatment of Bedsores
High Priority Source: Survival and Austere Medicine
Procedure:

1. Categorize the bedsore based on its severity:
- Stage I: Reddened area that does not blanch.
- Stage II: Blisters or open sores with surrounding redness and irritation.
- Stage III: Crater-like wound with...
bedsores, stages of bedsores, wound care, treatment, nutrition
Tape Closure of Wounds in Emergency War Surgery
High Priority Source: NATO Emergency War Surgery
Procedure:

1. Assess the wound for viability and ensure that all devitalized tissue has been excised as much as possible.
2. Apply tape closure over the wound edges, ensuring even compression to decrease skin edema.
3. Avoid using needles or...
tape closure,wound care,emergency surgery,no anesthesia,nursing personnel
Understand the Absorption Process of Absorbable Sutures
High Priority Source: Medical Survival Wound Closure Manual
Step 1: Recognize Two Stages of Absorption
Stage 1: Gradual loss of tensile strength over the first several weeks postimplantation. This occurs as the suture begins to degrade.
Stage 2: Considerable overlap with Stage 1,...
absorbable suture absorption, tensile strength loss, suture degradation
Understand the Characteristics and Uses of Nonabsorbable Sutures
High Priority Source: Medical Survival Wound Closure Manual
Step 1: Recognize Material Composition
Nonabsorbable sutures are made from nonbiodegradable materials such as:
- Metal (e.g., stainless steel wire)
- Synthetic polymers (e.g., nylon, polyester, polypropylene)
- Organic fibers (e.g.,...
nonabsorbable sutures, wound closure materials, medical device attachment
Understand the Phases of Healing by Primary Intention
High Priority Source: Medical Survival Wound Closure Manual
Objective: Recognize and understand the three phases of healing by primary intention.

### Phase 1: Inflammatory (Preparative) Phase
• Occurs during the first few days after injury.
• Characterized by:
- Inflammatory response with...
healing phases,wound healing,primary intention,granulation tissue,collagen formation
Whirlpool Bath Treatment for Superficial Contamination and Debridement
High Priority Source: NATO Emergency War Surgery
Procedure:

1. Administer a whirlpool bath at 98.6°F (37°C).
2. Add either povidone iodine or hexachlorophine to the whirlpool water.
3. Perform this treatment twice daily.
4. Encourage the patient to perform **active motion on the...
whirlpool bath, debridement, povidone iodine, hexachlorophine, active motion
Wound Inspection and Dressing in Tactical Combat Casualty Care
High Priority Source: TCCC 17 13 Army Tactical Combat Casualty Care
- Inspect and dress known wounds.
Check for additional wounds, such as scalp lacerations.
wound inspection, dressing wounds, scalp lacerations
Absorption and Tensile Strength Characteristics of Coated VICRYL Plus Antibacterial Suture
Standard Source: Medical Survival Wound Closure Manual
Procedure:

1. Mechanism of Absorption: The suture is absorbed through hydrolysis, where the copolymer degrades into glycolic and lactic acids, which are subsequently absorbed and metabolized by the body.

2. Tensile Strength Timeline:
...
absorption,tensile strength,VICRYL Plus Antibacterial,suture degradation,wound closure
Apply Honey to Wounds and Ulcers
Standard Source: Survival and Austere Medicine
Procedure:

1. Clean the wound or ulcer area thoroughly with water.
2. Pack the wound/ulcer generously with raw, unpasteurized honey.
3. Cover the wound with a sterile dressing.
4. Change the dressing daily:
- Cleanse the wound area with a...
honey,wound care,ulcer treatment,topical antimicrobial,burns,sterile dressing,Echinacea root
Avoiding Excessive Tension on Sutures
Standard Source: Medical Survival Wound Closure Manual
Procedure:

1. Avoid applying excessive tension to the suture material during tying or placement.
2. Excessive tension may cause breaking of the suture and may cut tissue.
3. Practice in avoiding excessive tension leads to successful use of...
suture,tension,excessive,breaking,cutting,tissue
Avoiding Extra Ties on Secure Knots
Standard Source: Medical Survival Wound Closure Manual
Procedure:

1. Extra ties do not add to the strength of a properly tied and squared knot.
2. They only contribute to its bulk, which may be problematic with some synthetic materials.
3. Use standard surgical techniques for flat and square ties,...
knot,ties,bulk,synthetic,strength,security
Avoiding Granny Knots During Square Knot Tying
Standard Source: Medical Survival Wound Closure Manual
Procedure:

1. Ensure that the strands of a square knot are not inadvertently incorrectly crossed.
2. Incorrect crossing may result in a granny knot, which is not recommended due to its tendency to slip under stress.
3. Use proper technique and...
granny,knot,slip,stress,error,tying
Cleaning and Debriding Soft Tissue Wounds
Standard Source: Emergency War Surgery
Procedure for Cleaning and Debriding Soft Tissue Wounds

• Gently cleanse wounds with saline and light scrub solutions.
• Carefully remove foreign bodies from the wound prior to closure.
• **Sharply debride devascularized wound edges...
cleaning,wounds,debridement,foreign bodies,saline
Correct Method for Knot Tying to Avoid Weakening Sutures
Standard Source: Medical Survival Wound Closure Manual
Procedure:

1. Use a seesaw motion or avoid sawing one strand down over another until the knot is formed.
2. This may weaken sutures and cause them to break during or after tying.
3. Pull the two ends of the suture in opposite directions with...
knot,tying,sutures,weakening,breaking,tension
How Surgical Gut Sutures Are Supplied
Standard Source: Medical Survival Wound Closure Manual
### How Surgical Gut Sutures Are Supplied

Available Sizes and Formats:
• U.S.P. sizes 7-0 through 3 (metric sizes 0.7-7.0) in a variety of lengths with and without permanently attached needles on LIGAPAK* dispensing reels.
• U.S.P. sizes 0...
suture packaging, sterilization guidelines, calculus formation risk, hypersensitivity warnings
Identify and Differentiate Absorbable vs. Nonabsorbable Sutures
Standard Source: Medical Survival Wound Closure Manual
Absorbable sutures are those that degrade in tissues over time, typically losing their tensile strength within 60 days. They may be made from natural materials like collagen or synthetic polymers. These sutures are absorbed by the body through...
absorbable sutures, nonabsorbable sutures, wound closure, suture types, medical materials
Identify and Monitor Bedsores for Early Detection
Standard Source: Survival and Austere Medicine
Procedure:

1. Check the skin daily for signs of bedsores such as reddened areas that do not blanch (turn white when pressed), blisters, sores, or craters.

2. Pay close attention to high-risk areas: hips, ischium, sacrum, heels, and...
bedsores, early detection, skin monitoring, risk factors, pressure sores
Identify and Use Hemostats for Wound Repair
Standard Source: Survival and Austere Medicine
Purpose: To clamp bleeding blood vessels or hold tissue during wound repair.

Description:
Hemostats are similar in shape to needle holders but have tips designed to clamp onto tissue. They use a ratchet mechanism to lock the clamps in place...
hemostat,wound repair,blood vessel clamping,instrument use
Immobilization of the Approximated Wound
Standard Source: Medical Survival Wound Closure Manual
Purpose:
• Adequate immobilization of the approximated wound is mandatory after surgery for efficient healing and minimal scar formation.

Scope of Immobilization:
• The entire anatomic part does not need to be immobilized, only the...
immobilization,wound healing,scar formation,tension,sutures
Inspect and Dress Wounds
Standard Source: TCCC 17 13 Army Tactical Combat Casualty Care
Title: Inspect and Dress Wounds

Procedure:
1. Inspect all known wounds and dress them appropriately.
2. Check for additional wounds (e.g., scalp lacerations).
wound inspection, wound dressing, additional wounds
Maintaining Traction During Knot Tying
Standard Source: Medical Survival Wound Closure Manual
Procedure:

1. After the first loop is tied, maintain traction on one end of the suture strand.
2. This prevents loosening of the throw if being tied under any tension.
3. Ensure that the knot remains secure and tight during the tying process.
knot,traction,tension,suture,strand
Managing Postoperative Distraction Forces
Standard Source: Medical Survival Wound Closure Manual
Definition of Postoperative Distraction Forces:
• The patient's postoperative activity can place undue stress on a healing incision.

Specific Risks:
• Abdominal fascia may be placed under excessive tension after surgery if the patient:
-...
postoperative activity,stress on incision,abdominal fascia,wound classification,clean wounds
Managing Tissue Reaction to Closure Materials
Standard Source: Medical Survival Wound Closure Manual
When foreign materials such as sutures are implanted in tissue, the tissue will react. This reaction can range from minimal to moderate depending on the type of material used. The reaction may be more severe if complicated by infection, allergy, or...
tissue reaction,sutures,edema,scarring,ischemic necrosis
Positioning for Secure Knot Placement
Standard Source: Medical Survival Wound Closure Manual
Procedure:

1. The surgeon should not hesitate to change stance or position in relation to the patient.
2. This allows for secure and flat knot placement.
3. Proper positioning ensures that knots are tied correctly and without complications.
knot,positioning,surgeon,patient,placement
Proper Final Tension on Knot Throws
Standard Source: Medical Survival Wound Closure Manual
Procedure:

1. Apply final tension on the final throw of a knot as nearly horizontal as possible.
2. This ensures that the knot is securely tied and flat.
3. Avoid uneven or excessive tension to prevent complications.
knot,tension,final,throw,horizontal
Proper Tying of Sutures to Avoid Tissue Strangulation
Standard Source: Medical Survival Wound Closure Manual
Procedure:

1. Ensure that sutures used for approximation are not tied too tightly.
2. Tight tying may contribute to tissue strangulation.
3. Maintain proper tension during the tying process to avoid complications.
suture,tying,tissue,strangulation,tension
Proper Use of Coated VICRYL Plus Antibacterial Suture for Wound Closure
Standard Source: Medical Survival Wound Closure Manual
Procedure:

1. Indications for Use: Use Coated VICRYL Plus Antibacterial Suture for general soft tissue approximation and/or ligation, except for ophthalmic, cardiovascular, and neurological tissues.

2. Preparation: Ensure the suture is...
sutures,absorbable,wound closure,VICRYL Plus Antibacterial,triclosan,coated suture
Protection of Newly Epithelialized Areas and Management of Hyperhydrotic States
Standard Source: NATO Emergency War Surgery
Procedure:

1. Provide continued protection to newly epithelialized areas until normal keratinization has occurred.
2. After normal keratinization, implement special skin care for residual hyperhydrotic states (excessive...
epithelialization, keratinization, hyperhidrosis, skin care
Selecting and Using a Fabric Tape Measure for Wound and Edema Measurement
Standard Source: Survival and Austere Medicine
Objective: Choose the appropriate measuring tool to assess wounds and edema.

Tools to Consider:
Fabric tape measures: These are more practical than rigid rulers in austere environments, as they can wrap around extremities for accurate...
fabric tape measure, wound measurement, edema monitoring, bandage fit, medical tool selection
Storing and Delivering Sutures Using the RELAY* System
Standard Source: Medical Survival Wound Closure Manual
Procedure:

The RELAY* suture delivery system is designed to store and deliver sutures in a time-efficient manner, reducing unnecessary handling and ensuring proper inventory control. Follow these steps:

1. Storage:
- Most suture...
RELAY* suture delivery system,inventory control,suture storage,modular storage,ETHICON
Subcutaneous Fat Wound Closure Procedure
Standard Source: Medical Survival Wound Closure Manual
Procedure for Subcutaneous Fat Wound Closure

1. Assess wound depth and tissue type: Confirm that the wound involves subcutaneous fat, which has low tensile strength due to its high water content.
2. Prevent dead space formation:...
subcutaneous fat,wound closure,sutures,VICRYL*,dead space prevention
Subcuticular Tissue Wound Closure Procedure
Standard Source: Medical Survival Wound Closure Manual
Procedure for Subcuticular Tissue Wound Closure

1. Minimize scarring: Suture the subcuticular layer of tough connective tissue to hold skin edges in close approximation.
2. Use continuous short lateral stitches: Take continuous short...
subcuticular tissue,wound closure,sutures,MONOCRYL*,scarring prevention
Surgeon’s or Friction Knot Tying Technique
Standard Source: Medical Survival Wound Closure Manual
Procedure:

1. Use the surgeon's or friction knot technique for tying specific suture materials such as VICRYL*, Coated VICRYL*, ETHIBOND* _EXCEL_, ETHILON*, MERSILENE*, NUROLON*, PRONOVA*, and PROLENE*.
2. This method may also be performed...
surgeon,knot,friction,suture,tying,one-hand
Treat Bed Sores in Immobilized Patients
Standard Source: Where There is no Doctor a Village Health Care Handbook
Procedure:

1. Follow all prevention steps outlined above.
2. Clean the sores three times daily with cool, boiled water mixed with mild soap. Gently remove any dead tissue and rinse thoroughly with cool, boiled water.
3. **Apply a paste...
bed sores, pressure sores, treatment, wound care, infection prevention
Treating Infected Wounds with Hot Soaks or Compresses
Standard Source: Where There is no Doctor a Village Health Care Handbook
Procedure:

1. Prepare a hot water solution (not scalding) in a clean container.
2. Soak a clean cloth or gauze in the hot water and apply it to the infected wound for 10–15 minutes.
3. Repeat this process several times per day until the...
infected wounds,hot soaks,compresses,tetanus
Treating Infected Wounds with Soap and Clean Water
Standard Source: Where There is no Doctor a Village Health Care Handbook
Procedure:

1. Wash the wound thoroughly with soap and clean water.
2. Ensure that all debris, dirt, or foreign objects are removed from the wound.
3. Rinse the wound under running water if possible to ensure complete cleaning.
4. If...
infected wounds,wound care,soap,clean water,tetanus
Treating Wounds with Thick Whitish Discharge
Standard Source: The Household Cyclopedia
When the wounded part begins to discharge a whitish, thick matter and fills up:

1. Continue the general treatment and dressings previously mentioned.
2. Allow the animal better provision if it is free of fever.
3. Permit gentle exercise once the...
wound care, ointment modification, animal treatment, fever management
Treating an Infected Wound with Sugar Therapy
Standard Source: Survival and Austere Medicine
Procedure for Treating an Infected Wound Using Sugar Therapy:

1. Prepare the wound area: Ensure the wound is clean and free of debris.
2. Pack the wound with granulated sugar: Make sure that the entire wound is filled with sugar,...
sugar therapy,wound treatment,infected wound,granulated sugar,povidone iodine,oil of cloves
Two-Hand Square Knot Tying Technique
Standard Source: Medical Survival Wound Closure Manual
Procedure:

1. Use the two-hand square knot technique for tying most suture materials.
2. This method is easiest and most reliable for surgical gut, virgin silk, surgical cotton, and surgical stainless steel.
3. Standard technique of flat and...
square,knot,tying,two-hand,suture,materials
Understanding Surgical Gut Suture Absorption and Tensile Strength Loss
Standard Source: Medical Survival Wound Closure Manual
### Understanding Surgical Gut Suture Absorption and Tensile Strength Loss

When surgical gut suture is placed in tissue, a moderate tissue inflammation occurs which is characteristic of foreign body response to a substance. This is followed by a...
surgical gut suture, absorption rate, tensile strength loss, infection effects, tissue site impact
Understanding Wound Disruption
Standard Source: Medical Survival Wound Closure Manual
Wound disruption refers to the separation of wound edges. This can occur due to various factors such as infection, excessive tension on the wound, or improper closure techniques.
wound disruption, wound separation, wound healing complications
Using Maggots for Wound Debridement (Maggot Debridement Therapy)
Standard Source: Survival and Austere Medicine
Overview:
Maggot debridement therapy (MDT) is a medical procedure used to clean wounds by using sterile maggots. It is particularly effective in treating chronic ulcers and other non-healing wounds.

Procedure Steps:
1. **Obtain Sterile...
maggot therapy,wound cleaning,sterile maggots,maggot debridement,MDT,wound care,chronic ulcers
Using Retention Suture Bolsters and Bridges to Prevent Complications
Standard Source: Medical Survival Wound Closure Manual
Procedure for Using Retention Suture Bolsters and Bridges

1. Use Bolsters: Use sterile 2[1]/2-inch (6cm) lengths of [3]/16-inch (0.48cm) diameter surgical latex tubing with a [1]/32-inch (0.08cm) wall to sheath the suture.
2. **Thread...
retention suture bolster, wound pressure relief, surgical complication prevention
Using Water for Healing Purposes
Standard Source: Where There is no Doctor a Village Health Care Handbook
Procedure:

1. Use clean water for washing wounds:
- Rinse the wound under running water to remove dirt and debris.
2. Apply a clean cloth or gauze to the wound:
- Press gently to stop bleeding if necessary.
3. **Soak the wound in...
water for healing, wound care, hydration, infection prevention
Adjusting Retention Suture Bridge Tension
Standard Source: Medical Survival Wound Closure Manual
Procedure for Adjusting Retention Suture Bridge Tension

1. Pass the Retention Suture Through Holes: Pass the retention suture through appropriate holes in the bridge.
2. Place Suture with Tension Over Capstan: Place the suture with...
retention suture bridge, wound tension adjustment, surgical tool
Apply Fine Clay as a Dressing for Sores and Foul Discharges
Standard Source: The Household Cyclopedia
Materials:
• Fine clay
• Water

Procedure:
1. Soften the fine clay in water, ensuring it is free from gritty particles.
2. Apply the softened clay, layer by layer, to the affected part until it reaches a thickness of about a line...
clay dressing,wound treatment,foul discharge,sores,Dr. Schreber
Apply Tegaderm® Dressing to a Saline Lock
Standard Source: STP 21 1 Army Warrior Skills Level 1 Soldiers Manual of Common Tasks
Purpose: To apply an occlusive dressing (Tegaderm®) over a saline lock to protect it and prevent contamination.

Materials Required:
• Tegaderm® dressing
• Sterile gloves
• Alcohol wipes or solution

Procedure:
1. Clean the area around...
Tegaderm dressing,saline lock,application procedure,occlusive dressing,sterile application,wound care

+ 28 more procedures. Get the full library in the app.

Dental Care (85)

Handle a Root Pushed into the Sinus
Critical Source: Where There is No Dentist
When to Use This Procedure:
If an upper tooth's root has been pushed into the sinus (nasal cavity).

Procedure:
1. Do not attempt to locate or remove the root yourself, as this can cause further complications.
2. **Cover the socket with...
sinus root removal, dental emergency, upper tooth extraction, sinus infection
Remove Loose Teeth and Dead Bone in Noma
Critical Source: Where There is No Dentist
Use a local anesthetic (Chapter 9) if needed.

Gently remove loose teeth and dead bone, usually with little bleeding.

If gums are loose, join them with a suture (see pages 161 to 163).
noma, loose teeth, dead bone, local anesthetic, suture
Cavity and Abscess Management
High Priority Source: Where There is No Dentist
What is a Cavity?

‘Cavities’ are holes in teeth. Cavities are made by the infection called tooth decay. If you have a black spot on your tooth, it might be a cavity. If that tooth hurts some of the lime, such as when you eat, drink, or...
cavity treatment,tooth abscess,oral infection,dental emergency,pain management
Relieve Toothache and Treat Abscesses at Home
High Priority Source: Where There is no Doctor a Village Health Care Handbook
Steps to relieve pain:
1. Clean the cavity thoroughly by removing all food particles from the affected area.
2. Rinse mouth with warm salt water to reduce inflammation and kill bacteria.
3. Take a pain reliever, such as aspirin, for...
toothache relief, abscess treatment, dental infection management
Administer Local Anesthetic Injection for Dental Procedures
High Priority Source: Where There is No Dentist
Purpose: Administer local anesthetic to numb a tooth and reduce pain during dental procedures.

Steps:
1. Understand Nerve Locations: To give effective injections, you must know the location of nerves in the mouth. This skill is best...
local anesthetic injection, dental procedures, nerve location, syringe types, sterilization
Examination and Diagnosis of Dental Problems
High Priority Source: Where There is No Dentist
Steps for Examination and Diagnosis:

1. Wear protective equipment, such as gloves and a mask, to prevent the spread of infection.
2. Check the gums for signs of inflammation, bleeding, or recession by gently touching them with your...
examination, diagnosis, dental problems, oral health
Identify and Recognize Thrush (Oral Candidiasis)
High Priority Source: Where There is No Dentist
Thrush, also known as oral candidiasis, is a fungal infection that appears in the mouth.

Signs of Thrush:
• White, yellow, or red patches on the inside of the mouth. These are often found behind the bottom front teeth but can appear on...
thrush,candidiasis,oral infection,signs,symptoms
Improvising a Dental Drill for Austere Situations
High Priority Source: Survival and Austere Medicine
Purpose: Create an improvised dental drill to remove decay from teeth in the absence of commercial equipment.

Materials Needed:
• A small tapered metal tip (e.g., head of a small nail or tack)
• A pulley system (can be made using bicycle...
improvised dental drill, survival dentistry, no power drill, manual tooth drilling
Keep the Cavity Dry During Cement Filling
High Priority Source: Where There is No Dentist
Procedure:
1. Place cotton between the cheek and gums to keep the area dry.
2. For lower teeth, place some cotton under the tongue.
3. Use any available type of cotton: gauze, wool, or rolls.
4. Change the cotton whenever it becomes wet to...
keep cavity dry,cotton placement,dental procedure
Manage Infection from New Tooth Growth
High Priority Source: Where There is No Dentist
When a new tooth is cutting through the gums and causing infection:

Signs of concern:
- Toothache at the back of the jaw.
- Difficulty opening the mouth properly.
- Bad taste coming from the back of the mouth.
- Sore throat.
- Skin...
new tooth infection, gum infection, dental care, warm salt water rinse, aspirin, penicillin
Preventing and Managing Cavities and Toothaches
High Priority Source: Where There is No Dentist
Procedure:

To prevent cavities and manage toothaches:

1. Maintain good oral hygiene: Brush twice daily with fluoride toothpaste and floss regularly to remove plaque.
2. Limit sugar intake: Avoid frequent consumption of sugary foods and...
cavities, toothache, dental sealants, plaque removal, fluoride
Recognize and Treat Early Signs of Gum Disease
High Priority Source: Where There is No Dentist
Signs of early gum disease:
• Gums are red instead of pink.
• Gums are loose rather than tight against the teeth.
• Gums between teeth appear round instead of pointed.
• Gums bleed when brushing or flossing.
• Feel for **tartar under...
gum disease, early signs, red gums, bleeding gums, tartar, oral hygiene, nutrition, HIV, dental care
Remove Decay for Cement Filling
High Priority Source: Where There is No Dentist
Procedure:
1. Lift out some, but not all, of the soft decay from the cavity.
2. If the tooth is painful, inject local anesthetic to numb the area.
3. Do not remove all of the decay on the bottom of the cavity; leave some as long as it can be...
remove decay,cavity preparation,dental filling
Remove a Broken Lower Root
High Priority Source: Where There is No Dentist
When to Use This Procedure:
If you can see the broken root of a lower tooth and it is accessible.

Procedure:
1. Use a straight elevator (or curved elevator if available) with the blade facing downward.
2. If the broken root is from a...
broken root removal, lower tooth extraction, dental emergency, root extraction
Removing an Object from Under the Gum
High Priority Source: Where There is No Dentist
Procedure:

1. If the gum between two teeth is red and swollen, something may be caught inside the gum pocket.
2. Ask what the person has been eating; the object may be a fish bone, mango string, or a sharp piece of tartar.
3. **First...
foreign object removal, gum foreign body, dental emergency, epulis treatment
Atraumatic Restorative Treatment (ART) for Dental Fillings in Austere Conditions
Standard Source: Survival and Austere Medicine
Purpose: Provide a permanent or long-lasting dental filling without the use of a drill, suitable for survival or austere situations.

Materials Needed:
• Glass ionomer (e.g., Fuji IX GP)
• Cotton pledgets and absorptive gauze
• Mouth...
ART technique, glass ionomer filling, dental restoration, no drill filling, survival dentistry
Coordinate Emergency Dental Services with the MEDPLT
Standard Source: STP 21 24 Army Warrior Leader Skills Level 2 3 and 4
Objective: Coordinate emergency dental services to ensure Soldiers receive timely care.

Steps:
1. Identify Soldiers who require immediate dental attention (e.g., toothaches, broken teeth).
2. Contact the battalion MEDPLT and request...
emergency dental care, MEDPLT coordination, tooth injury
Create Custom Dental Instruments from Available Materials
Standard Source: Where There is No Dentist
Here are a few ideas for making dental instruments at low cost using materials available where you live.

General Construction Method:
Each instrument has two parts: a handle and a working piece at the end. Join them together:
• With...
DIY,dental instruments,mirror,probe,tweezers,crafting,preparedness
Dental Services and Operational Readiness
Standard Source: TCCC 17 13 Tactical Combat Casualty Care
Dental services provide:

1. Operational dental care to prevent loss of trained manpower due to dental disease or injury.
2. Ensure that soldiers are fit for duty by maintaining oral health.
3. Prevent long-term medical complications from...
dental care, operational readiness, oral health
Gather Required Instruments and Filling Materials
Standard Source: Where There is No Dentist
In many places, government medical stores can provide most of the instruments as well as cement filling material. If this is not possible, a dentist may be able to help you to order what you need.

### Instruments

Most dental instruments look...
dental instruments,filling materials,cement filling tools
Gold Film Filling Technique for Permanent Dental Restoration
Standard Source: Survival and Austere Medicine
Purpose: Provide a permanent dental filling using gold film in austere or survival situations.

Materials Needed:
• Thin gold film (available from historical dental supplies)
• Dental pick or small instrument

Procedure:
1. **Drill the...
gold film filling, survival dentistry, manual dental restoration, no drill filling
Manage a Tooth with a Cavity to Prevent Pain and Abscesses
Standard Source: Where There is no Doctor a Village Health Care Handbook
Actions to take:
1. Avoid sweet foods that can worsen the cavity.
2. Brush teeth well after every meal, especially focusing on the affected tooth.
3. Seek immediate dental care from a trained professional if possible, as early...
tooth cavity care, prevent abscess, dental emergency
Managing Dental Emergencies Without Professional Care
Standard Source: Survival and Austere Medicine
Procedure:

1. Assess the dental issue: Determine if it is a toothache, abscess, or broken tooth.
2. Clean the affected area: Use clean water and antiseptic solutions to prevent infection from spreading.
3. **Apply pain relief...
tooth extraction,dental care,abscess management
Post-Filling Care Instructions for Patient
Standard Source: Where There is No Dentist
Procedure:

1. Explain to the person how to care for their temporary cement filling:
- Avoid eating anything for at least 1 hour to allow the cement to harden and strengthen.
- Avoid using the filled tooth for biting or chewing until a...
post-filling care, abscess detection, temporary filling instructions
Prepare and Maintain Dental Instruments for Multiple Patients
Standard Source: Where There is No Dentist
When treating several people on the same day, you will need to clean some instruments at the same time that you are using others. Therefore, it is necessary to have several of each kind of instrument to ensure that the instrument you need will be...
instruments,dental,mirror,probe,cotton pliers,sterilization,preparedness
Prevent Tooth Loss for Survival
Standard Source: Survival and Austere Medicine
Objective: Prevent tooth loss to maintain the ability to chew food, which is essential for survival.

Procedure:
1. Maintain Oral Hygiene: Regularly clean teeth using dental floss and a plastic explorer or pick/cleaner to prevent...
tooth loss prevention, dental hygiene, survival, chewing ability, cavities, temporary fillings, oral health
Recognizing and Managing Sore Bleeding Gums
Standard Source: Where There is No Dentist
Procedure:

To identify and manage sore bleeding gums:

1. Identify symptoms: Look for red, swollen, or tender gums that bleed easily during brushing or flossing.
2. Check for plaque buildup: Use a mirror to inspect your teeth and gums...
sore gums, bleeding gums, gingivitis, oral inflammation, mouthwash
Remove Bone Chips and Flesh Tags from a Socket
Standard Source: Where There is No Dentist
When to Use This Procedure:
If small pieces of bone or tags of flesh are loose inside the socket after an extraction.

Procedure:
1. Gently reach into the socket using the end of an elevator or spoon instrument.
2. **Feel for any loose...
bone chip removal, socket cleaning, dental extraction aftercare, oral hygiene
Set Up for Cement Filling Procedure
Standard Source: Where There is No Dentist
Materials Needed:
• Clean cloth
• Syringe and needle (with local anesthetic if needed)
• Instruments: mirror, probe, tweezers, spoon, filling tool, mixing tool
• Oil of cloves (eugenol) and zinc oxide
• Cotton rolls, gauze, or cotton wool
-...
setup,cement filling,dental tools,cotton,glass mixing
Smooth Upper and Lower Teeth to Reduce Bite Pressure
Standard Source: Where There is No Dentist
To reduce the bite pressure from teeth that are biting too hard, follow these steps:

Use appropriate tools: Use either a dental worker’s drill, a small file, or a hard stone.
Step 1: Smooth the inside edge of the upper tooth.
-...
teeth, dental care, bite pressure, smoothing teeth, upper tooth, lower tooth
Sterilizing Dental Instruments Without Heat
Standard Source: Where There is No Dentist
Steps to Sterilize Instruments:

1. Wash all instruments thoroughly with soap and water before sterilization.
2. Soak the instruments in a disinfectant solution, such as chlorhexidine gluconate or another approved disinfectant, for at...
sterilizing instruments, disinfectant solution, pressure cooker, autoclave, dental hygiene
Use Chlorhexidine Gluconate Mouthwash for Oral Infections
Standard Source: Where There is No Dentist
Chlorhexidine gluconate (0.2%) is a non-alcoholic mouthwash that helps reduce oral infections.

Procedure:
1. Hold some of the solution in your mouth for 1 minute, twice a day.
2. Ensure it covers the entire inside of the mouth.
3....
chlorhexidine mouthwash,oral infection,treatment
Use Povidone Iodine for Oral Infections
Standard Source: Where There is No Dentist
Povidone iodine (1%) is a brown-colored liquid that kills germs and can be used to treat oral infections.

Procedure:
1. Hold some of the solution in your mouth for 1 minute, twice a day.
2. Ensure it covers the entire inside of the...
povidone iodine,oral infection,application
Using Hydrogen Peroxide for Severe Gum Infections
Standard Source: Where There is No Dentist
Procedure:

For more serious gum disease with painful gums that bleed easily:

1. Consult a dental worker to explain the condition and provide professional treatment, such as scraping teeth and removing tartar.
2. At home, clean your teeth...
hydrogen peroxide,gum infection,dental care,oral hygiene,severe gum disease
Assess the Sore Area by Touching It
Standard Source: Where There is No Dentist
### Assess the Sore Area by Touching It

To determine the severity of a dental issue, use tactile examination:

1. Gently press against each tooth in the area of pain:
- Check if any tooth is loose.
2. **Rock the loose tooth backward and...
tactile dental examination, abscess detection, gum bleeding, tartar assessment
Check for High Cement Fillings
Standard Source: Where There is No Dentist
Procedure:

1. Ask the person to gently close their teeth after removing all cotton.
2. Ensure that the teeth come together normally and do not hit first against the cement filling.
3. Look for signs of a high filling:
- If the cement...
high filling check, dental alignment, carbon paper, cement adjustment
Cleaning Teeth for Children
Standard Source: Where There is No Dentist
Steps to Clean a Child’s Teeth:

1. Use a soft toothbrush designed for children.
2. Brush the front and back of each tooth gently in circular motions.
3. Clean between teeth using waxed floss, especially important for children who...
cleaning teeth, children, dental hygiene, fluoride toothpaste, CHILD-to-child program
Daily Teeth Cleaning Procedure
Standard Source: Where There is No Dentist
Why Clean Your Teeth?

If you do not clean properly, the food that is left on your teeth can hurt the teeth as well as the gums near them.

Where Problems Start

• Grooves on top of teeth
• Between the teeth
• Near the gums

Bits of food...
teeth cleaning,dental hygiene,brush making,tooth care,oral health
Ensure Proper Fit of Cement Filling Before Discharge
Standard Source: Where There is No Dentist
Procedure:

1. Verify that the filled tooth fits properly against the other teeth before allowing the person to leave your clinic.
2. Ensure there is no excessive pressure on the cement filling, as this can cause it to crack or break.
3. If...
proper fit check, dental discharge, cement integrity
Examine Inside the Mouth for Dental Issues
Standard Source: Where There is No Dentist
### Examine Inside the Mouth for Dental Issues

After noting external signs, perform a detailed internal examination of the mouth:

1. Look at the teeth:
- Is a new tooth growing in?
- Is any tooth loose?
- Is there a dark (dead) tooth...
mouth examination, dental inspection, gum disease, sores inside mouth
Explain the Procedure for Scaling Teeth
Standard Source: Where There is No Dentist
Steps:

1. Inform the person what you are going to do.
2. Mention potential outcomes, such as some bleeding and possibly pain.
3. Offer reassurance that you can stop or inject local anesthetic if needed.
4. Emphasize hygiene:...
scaling teeth, dental procedure, explain procedure, hygiene, pain management
Feel Under the Gum for Tartar
Standard Source: Where There is No Dentist
Steps:

1. Identify rough spots on the root of the tooth — this indicates tartar.
2. Check all sides of the tooth, as tartar can form anywhere inside the gum pocket.

Two methods to check for tartar:
a. Use a probe: Slide the...
tartar detection, gum inspection, dental tools, cotton gauze, probe use
Hold and Use the Scaler Correctly
Standard Source: Where There is No Dentist
Steps:

1. Hold the scaler almost like a pen for better control.
2. Use your third finger as a stabilizer by resting it against a tooth to steady your hand.
3. Avoid cutting the gums: The ends of the scalers are sharp, so be gentle...
scaler technique, dental tool use, gum protection, hand positioning
Identify Swelling on the Face as a New Molar or Abscess
Standard Source: Where There is No Dentist
Procedure:

1. When you observe swelling on the face, check for the following signs to determine if it is due to a new molar growing in or an abscess:
- Look at the tooth for a cavity.
- Examine the gums beside the affected tooth...
swelling face, molar growth, abscess, dental infection, third molar
Initial Assessment of a Dental Patient
Standard Source: Where There is No Dentist
### Initial Assessment of a Dental Patient

When evaluating a patient for dental issues, follow these steps:

1. Observe the person's age:
- Age can influence common dental problems.
2. Look at the face for signs of swelling or soreness:
...
dental assessment, initial evaluation, swelling, sores, age-based dental issues
Perform Scaling and Cleaning in Austere Environments
Standard Source: Survival and Austere Medicine
Scaling and cleaning is an essential part of dental care when professional services are unavailable. Follow these steps:

1. Use a scaler or dental pick: These tools can be used to remove plaque and mineralised deposits that accumulate at...
scaling, cleaning, plaque removal, dental pick, oral hygiene
Post-Tartar Removal Care and Instructions for the Patient
Standard Source: Where There is No Dentist
Procedure:

1. Talk to the person about what you have done and what to expect.
2. Inform them that the gums will be sore for the next few days, which is normal.
3. Explain how to make the gums strong and tough again:
- **Clean...
post-dental-care, gum healing, oral hygiene instructions, dental follow-up
Prepare Cement Filling Material
Standard Source: Where There is No Dentist
Materials Needed:
• Zinc oxide (powder)
• Oil of cloves (eugenol) (liquid)

Procedure:
1. Purchase zinc oxide and oil of cloves in bulk to save money, as these are the main ingredients for temporary filling material.
2. Consider using...
cement filling material,zinc oxide,oil of cloves,I.R.M.,dental care
Prepare for Dental Scaling Procedure
Standard Source: Where There is No Dentist
Objective: Gather all necessary tools and set up an optimal environment for scaling teeth.

Steps:
1. Gather instruments: Ensure you have the following items available:
- Scalers
- Mirror
- Probe
- Tweezers
- Sharpening...
scaling teeth, dental care, tartar removal, gum healing, dental instruments
Prevent and Treat Gum Inflammation (Pyorrhea)
Standard Source: Where There is no Doctor a Village Health Care Handbook
Causes of gum inflammation:
• Poor oral hygiene
• Malnutrition (lack of vitamins)

Prevention and treatment steps:
1. Brush teeth thoroughly after each meal, especially focusing on removing food that gets stuck between the teeth.
2....
gum inflammation treatment, pyorrhea prevention, oral hygiene tips
Proper Daily Oral Hygiene Routine for Teeth Care
Standard Source: Boy Scout Handbook 1911
Objective: Maintain clean, healthy teeth and gums to prevent decay and disease.

Steps:
1. Brush teeth twice daily, with special attention given to the evening brushing.
2. Use a toothbrush and toothpaste or powder for...
oral hygiene, tooth brushing, dental care, food particles removal, dentist visit
Remove False or Plastic Teeth Before Treatment
Standard Source: Where There is No Dentist
Before using any dental treatments, always remove false or plastic teeth (dentures). This ensures that the treatment can be applied effectively and safely to the natural teeth and gums.
dentures,remove teeth,treatment preparation
Remove Loose Cement Pieces Around a Tooth
Standard Source: Where There is No Dentist
Procedure:

1. Inspect the area around the tooth carefully to look for any loose pieces of cement.
2. Use the end of your probe to gently reach into the gum pocket and lift out any pieces of cement caught there.
3. **Wipe off your probe...
cement removal, tooth care, gum soreness, dental procedures
Scalping Tartar from a Tooth
Standard Source: Where There is No Dentist
Procedure:

1. Hold the end of the scaler tight against the side of the tooth and pull the scaler with a firm short stroke.
2. Try to break free as much tartar as possible at once, because the remaining tartar becomes smooth and harder...
tartar removal, dental scaler, tooth cleaning, gum care, oral hygiene
Scoring Teeth for Oral Hygiene Assessment
Standard Source: Where There is No Dentist
Procedure:

1. Select 4 teeth: one back tooth and one front tooth—two on the top and two on the bottom.
2. Use the same 4 teeth for each person being assessed.
3. Examine each of the selected teeth for food residue near the gums.
- A **clean...
oral hygiene, tooth scoring, dental assessment, food residue, teeth cleaning
Sharpen and Clean Scaling Instruments
Standard Source: Where There is No Dentist
Purpose: Ensure scaling instruments are sharp and sterile for effective and safe dental care.

Steps:
1. Check Sharpness Regularly: Feel the cutting edge of the scaler to ensure it is sharp. If it cannot cut your fingernail, it needs...
scaling instruments, sharpening scalers, sterilization, dental tools, oral hygiene
Temporary Dental Filling Using IRM (Zinc Oxide and Eugenol)
Standard Source: Survival and Austere Medicine
Purpose: Provide temporary relief for cavities by covering exposed nerve endings.

Materials Needed:
• Zinc oxide powder
• Eugenol (oil of cloves)

Procedure:
1. Mix the Ingredients: Combine zinc oxide and eugenol to form a firm...
temporary filling, zinc oxide eugenol, IRM, cavity treatment, dental care
Types of Fillings and Their Uses
Standard Source: Where There is No Dentist
There are two kinds of fillings:

A permanent filling is made to last for many years. To place one requires special equipment and skills. An experienced dental worker can shape the cavity with a dental drill so it can hold the filling material...
permanent filling,temporary filling,cement filling,types of fillings
Understand the Structure of the Gum Pocket and Tartar Formation
Standard Source: Where There is No Dentist
Key Information:

• The gum pocket is a space that forms around each tooth. It can be shallow or deep.
• A deep gum pocket indicates long-term infection.
Tartar starts forming deep inside the gum pocket, even if some tartar above...
gum pocket anatomy, tartar formation, infection prevention, dental structure
Apply Fluoride Toothpaste to Treat a Sensitive Tooth
Reference Source: Where There is No Dentist
Procedure:

1. Use cotton rolls to place between the lip and gum on each side of the affected tooth.
2. Dry the sensitive tooth using cotton.
3. Locate the small groove causing pain on the tooth.
4. Apply a smear of fluoride toothpaste directly...
fluoride toothpaste, sensitive tooth treatment, dental care, pain relief
Cleaning and Disinfecting Dental Instruments After Use
Reference Source: Where There is No Dentist
Procedure:

1. Scrape off any dried cement from the filling and mixing tools.
2. Scrub the instruments with soap and water to remove all debris.
3. Submerge the cleaned instruments in disinfectant for 20 minutes (see page 89 for...
instrument cleaning, disinfection, dental tools maintenance
Create a Toothbrush from a Stick
Reference Source: Where There is No Dentist
Procedure:

1. If you do not have a toothbrush, find a suitable stick.
2. Ensure the stick is clean and free of splinters.
3. Use the stick as a makeshift toothbrush to brush your teeth with clean water.

Notes:
• This method can be used in...
toothbrush alternative, stick toothbrush, dental hygiene, emergency dental care
Identify Signs of a Tooth Cavity
Reference Source: Where There is No Dentist
Signs of a tooth cavity include:

Pain when drinking water or eating something sweet.
A hole (or black spot) on the tooth, or between two teeth.
Pain if food gets caught inside the hole.
No pain when you tap the tooth.
tooth cavity, dental signs, tooth pain, black spot on tooth
Implement Preventive Dentistry Practices in Austere Environments
Reference Source: Survival and Austere Medicine
Preventive dentistry is crucial for maintaining oral health, especially in austere or survival situations. Follow these steps:

1. Brush teeth daily: Use a soft-bristled toothbrush and fluoride toothpaste. Brush all surfaces of the teeth,...
preventive dentistry, brushing, flossing, oral hygiene, sugar avoidance
Maintain Oral Hygiene Through Regular Brushing
Reference Source: Where There is No Dentist
Procedure:

1. Clean your teeth at least once a day.
2. Use a toothbrush to carefully brush every part of each tooth—outside, inside, and top.
3. Be very careful to push your brush between your teeth, as this is where germs and food collect...
oral hygiene, brushing teeth, dental care, toothbrush, cavities, gum disease
Maintain a Healthy Diet for Oral Health
Reference Source: Where There is No Dentist
Procedure:

To maintain healthy teeth and gums, follow these steps:

1. Eat only good healthy foods: Consume a balanced diet rich in vitamins and minerals that support dental health.
2. Avoid sugary and acidic foods: These can contribute...
diet, oral health, healthy foods, cavities, tooth enamel, vitamin C, calcium
Make and Use Dental Floss from String
Reference Source: Where There is No Dentist
Materials needed: Thin string, wax

Steps:
1. Soak thin string in hot wax to make it stronger and easier to slide between teeth.
2. Remove excess wax by pulling the string between your fingers, ensuring it is not too thick or...
dental floss, string, waxing, makeshift floss
Oral Examination for Dental Problems
Reference Source: Where There is No Dentist
Procedure:

1. Whenever you conduct a health examination, make sure to examine the mouth.
2. Ask the person if they are currently experiencing any dental problems or have had them recently.
3. Write down all findings so that you can remember...
oral examination, dental diagnosis, health clinic
Provide Dental Services to Prevent Loss of Trained Manpower
Reference Source: TCCC 17 13 Army Tactical Combat Casualty Care
Objective: Provide dental care to prevent the loss of trained manpower due to dental disease or injury.

Procedure:
1. Routine Dental Care: Administer routine dental care and treatment for soldiers in the field and at MTFs.
2....
dental care,preventive dentistry,oral hygiene,emergency dental treatment
Replace a Missing Tooth with a False Tooth
Reference Source: Where There is No Dentist
Why It's Important:
After a tooth is lost, the surrounding teeth can shift into the open space, weakening the bone around their roots. Over time, this can lead to additional teeth becoming loose and needing removal.

Procedure:
1....
false teeth, dental care, tooth replacement, plastic tooth, oral health
Temporary vs Permanent Fillings: Patient Education and Follow-Up
Reference Source: Where There is No Dentist
Procedure:

1. Inform the patient that a cement filling is only a temporary measure and can last up to 6 months.
2. Emphasize the importance of seeking professional dental care for a permanent filling, as the person will need to see a...
permanent filling education, temporary vs permanent fillings, dental follow-up
Treat Sores at the Corners of the Mouth in Children
Reference Source: Where There is no Doctor a Village Health Care Handbook
Symptoms: Narrow sores at the corners of children’s mouths.

Cause: Often due to malnutrition, especially a lack of vitamins and proteins.

Treatment:
1. Provide foods rich in vitamins and protein, such as milk, meat, fish, nuts,...
mouth corner sores treatment, child malnutrition, vitamin deficiency in children
Understand the Benefits of a Filling
Reference Source: Where There is No Dentist
A filling can help a person in three ways:

• It stops food, air, and water from entering the cavity. This will stop much discomfort and pain.
• It stops the decay from growing deeper. This can prevent a tooth abscess.
• It can save the tooth, so...
filling,benefits of filling,tooth preservation
Cleaning Between Teeth Using Thread or Dental Floss
Reference Source: Where There is No Dentist
Procedure:

1. Use thin but strong thread or string (such as cotton rope from fishing nets or dental floss).
2. Wrap the ends of the string around the middle finger of each hand.
3. Use your thumb and fingers to guide the string between two...
dental floss, thread cleaning, gum care
Cleaning Between Teeth Using a Palm Leaf Stem
Reference Source: Where There is No Dentist
Procedure:

1. Remove the stem from a palm leaf.
2. Use the thinner end of the stem to gently move it in and out between the teeth.
3. Rub the stem against one tooth, then the other, to clean both sides of the teeth.

Details:
• This method...
palm leaf stem, dental hygiene, alternative cleaning methods
Cleaning Between Teeth Using a Toothbrush
Reference Source: Where There is No Dentist
Procedure:

1. Push the hairs of a toothbrush between the teeth.
2. Sweep away any bits of food that are trapped between the teeth.

Details:
• This method is simple and effective for removing debris from between teeth.
• Ensure the...
cleaning between teeth, toothbrush, dental hygiene
Create a Natural Toothbrush from Available Materials
Reference Source: Where There is no Doctor a Village Health Care Handbook
Materials needed: A twig or stick, rough towel.

Steps:
1. Use a twig: Sharpen one end to clean the teeth and chew on the other end to use between the teeth as a brush.
2. Use a rough towel: Tie a piece of rough towel around the end...
toothbrush alternative, natural toothbrush, twig brush, rough towel brush
Encourage Hands-On Learning for Dental Care
Reference Source: Where There is No Dentist
Objective: To enhance learning through participation and practical experience.

Procedure:
1. Allow students to take part in the learning process by engaging them in activities that let them see, touch, and do things related to dental...
hands-on-learning,toothbrush-making,dental-hygiene
Encourage Older Children to Help Younger Siblings with Dental Care
Reference Source: Where There is No Dentist
Objective: To promote peer learning and support within families.

Procedure:
1. Involve older children in teaching younger siblings about dental care, such as encouraging them to eat healthy foods like fruits instead of candy.
2....
peer-learning,dental-education,family-support
Engage Students by Building on Their Existing Knowledge
Reference Source: Where There is No Dentist
Objective: To create a meaningful learning experience about teeth and gums.

Procedure:
1. Talk with students to find out what they already know about teeth and gums, as well as any questions they might have.
2. Use simple language...
teeth,gums,learning,strategy,education
Fluoride Application for Cavity Prevention
Reference Source: Where There is No Dentist
Steps to Apply Fluoride for Cavity Prevention:

1. Use fluoride toothpaste once a week as an effective and inexpensive method of cavity prevention.
2. Fluoride can be sourced from various places:
- Drinking water (especially in areas with...
fluoride application, cavity prevention, fluoridated toothpaste, natural fluoride sources, dental hygiene
Integrate Dental Care Education with Other Subjects
Reference Source: Where There is No Dentist
Objective: To provide a broader understanding of dental care by connecting it to other areas of study.

Procedure:
1. Teach about teeth and gums alongside other subjects, such as nutrition, farming methods, and social studies.
2....
interdisciplinary-learning,health-surveys,dental-nutrition
Make a Natural Toothpaste Using Common Ingredients
Reference Source: Where There is no Doctor a Village Health Care Handbook
Materials needed: Salt, baking soda (bicarbonate of soda), water.

Steps:
1. Mix salt and bicarbonate of soda in equal amounts to create a tooth powder.
2. Wet the brush before applying the powder to help it stick.
3. Use this mixture to rub...
natural toothpaste, salt and baking soda paste, alternative dental care
Model Good Oral Hygiene Practices for Students
Reference Source: Where There is No Dentist
Objective: To set a positive example for students by practicing good oral hygiene habits.

Procedure:
1. Clean your own teeth carefully every day, and encourage your children to do the same.
2. Demonstrate proper brushing techniques...
oral-hygiene-modeling,family-example,dental-health-habits
Proper Technique for Cleaning Teeth
Reference Source: Where There is No Dentist
Steps to Clean Teeth Thoroughly:

1. Use a brush with soft hairs. A stiff or hard brush can hurt the gums and is not effective.
2. Begin by scrubbing the outside, inside, and top of each tooth carefully.
3. After scrubbing, use your tongue to...
tooth cleaning, brushing technique, dental hygiene, soft bristles, fluoride, food particles, oral care

Chemical Exposure (68)

Administer Antidotal Treatment for Cyanide Poisoning
Critical Source: Medical NBC Battlebook
Procedure:

1. Administer methemoglobin-forming agents:
- Use compounds that produce methemoglobin (metHB), such as amyl nitrite, sodium nitrite, or hydroxocobalamin.
- These agents help fix the cyanide ion and prevent it from binding...
cyanide antidote,methemoglobin formation,hydroxocobalamin,dicobalt edetate,chemical treatment protocols
Administer Atropine for Nerve Agent Poisoning (Self Aid/Buddy Aid)
Critical Source: Medical NBC Battlebook
Procedure:

1. Recognize symptoms of nerve agent poisoning, such as:
- Unexplained nasal secretion
- Salivation
- Tightness of the chest
- Shortness of breath
- Constriction of pupils
- Muscular twitching
- Nausea and...
atropine,nervous agent poisoning,self aid,buddy aid,nerve agent treatment
Administer Benzodiazepines for Nerve Agent-Induced Convulsions
Critical Source: NATO Emergency War Surgery
Objective: Reduce the morbidity associated with convulsions caused by nerve agents.

Procedure:
1. Administer benzodiazepine anticonvulsants, such as Valium (diazepam), to manage convulsions.
2. Suggested doses:
- 5 mg IM of...
benzodiazepines, convulsions, Valium, nerve agent treatment
Do Not Administer Nerve Agent Antidote Unless Necessary
Critical Source: Full First Aid Manual FM 2111
Procedure:

Do not inject a nerve agent antidote until you are sure it is needed.
• Only use the MARK I or ATNAA for self-aid and buddy aid as issued. Do not administer the CANA unless specifically indicated.
nerve agent antidote administration, MARK I, ATNAA, CANA, do not inject unless necessary
Evacuation from TIC Hazard Area
Critical Source: Medical NBC Battlebook
Procedure:

1. Immediate Evacuation: In the case of a massive release of an industrial chemical, immediate evacuation is the most important action.

2. Escape Path: Escape the path of toxic industrial chemicals (TICs) immediately to...
evacuation, TIC, toxic industrial chemical, respirator use, immediate escape
First Aid for Cyanogen Agent Exposure
Critical Source: FM 4 25 11 First Aid
Procedure:

1. If exposed to hydrogen cyanide:
- Put on your mask immediately if you experience sudden stimulation of breathing or detect the odor of bitter almonds.
- If possible, stop breathing until the mask is securely on,...
first aid, cyanogen agents, hydrogen cyanide, mask use, medical emergency
Manage Airway Obstruction in Nerve Agent Casualties
Critical Source: NATO Emergency War Surgery
Objective: Clear airway obstruction and ensure adequate oxygenation in casualties with nerve agent exposure.

Procedure:
1. Clear secretions from the airway using suction if available, or use prone turning for postural drainage if...
airway management, nerve agent, suction, intubation, cricothyrotomy
Pharmacological Treatment of Nerve Agent Poisoning with Atropine and Oximes
Critical Source: Medical NBC Battlebook
Procedure:

1. Atropine Sulfate Administration:
- Administer atropine sulfate as an essential drug for treating nerve agent poisoning.
- It relieves symptoms such as rhinorrhea, salivation, tightness in the chest, and dyspnea.
- In...
atropine,oximes,diazepam,nervous agent treatment,pharmacological treatment
Post-Exposure Treatment for Nerve Agents
Critical Source: Survival and Austere Medicine
Procedure:

1. Administer Atropine immediately upon suspicion of nerve agent exposure (e.g., high-risk situation + unexplained salivation, excess nasal secretions, shortness of breath, muscle twitching).
2. Give 2 mg IM injection, and...
atropine, oxime treatment, pralidoxime, obidoxime, diazepam, nerve agent, post-exposure
Prioritize Treatment for Chemical or Mixed Casualties
Critical Source: NATO Emergency War Surgery
Objective: Determine treatment priorities for casualties with combined injuries (e.g., chemical/nuclear exposure, trauma, illness).

Procedure:
1. Treat respiratory failure and control massive hemorrhage.
2. **Administer chemical agent...
treatment priorities, chemical exposure, trauma, shock, decontamination, antidote
Protect Against Hexachloroethane (HC) Smoke Exposure
Critical Source: Medical NBC Battlebook
Procedure:

1. Wear a protective mask whenever exposure to HC smoke is possible.
2. Avoid inhalation of HC smoke, as it can cause potentially fatal pulmonary edema due to the presence of zinc chloride and HCl vapor.
3. If exposed:
-...
hexachloroethane, hc smoke, respiratory irritant, zinc chloride, protective mask, pulmonary edema
Protect Against White Phosphorus (WP) Smoke Exposure
Critical Source: Medical NBC Battlebook
Procedure:

1. Wear a respirator to protect against WP smoke.
2. If exposed to WP fragments:
- Immediately remove from the source of exposure and smother or flood the area to prevent continued burning.
3. Treat burns caused by...
white phosphorus, wp smoke, respiratory irritant, eye protection, burns
Recognize and Respond to Cyanogen Agent Exposure
Critical Source: Medical NBC Battlebook
Procedure:

1. Identify exposure symptoms:
- Initial signs include violent convulsions, rapid deep breathing, followed by cessation of respiration within one minute.
- Slowing heart rate leading to death may occur in high...
cyanogen agents,cyanide exposure,hydrogen cyanide,first aid for chemical exposure,convulsions,respiratory failure
Seeking Medical Assistance for Blood Agent Exposure
Critical Source: FM 4 25 11 First Aid
Procedure:

1. If you suspect exposure to blood agents (e.g., hydrogen cyanide or cyanogen chloride), seek medical assistance immediately.
2. Do not delay treatment, as blood agents can cause rapid and potentially fatal effects.
3....
blood agents, medical assistance, first aid, chemical exposure
Administer Pralidoxime for Organophosphate Poisoning
Critical Source: Survival and Austere Medicine
Procedure:

1. Use Pralidoxime as an antidote for organophosphate poisoning, either in vials or autoinjectors.
2. Administer the medication via IM injection if available.
3. Ensure that the dose is appropriate based on the severity of...
pralidoxime, organophosphate poisoning, antidote, IM injection, vial administration
Administer Sodium Nitrite for Hydrogen Cyanide Poisoning
Critical Source: NATO Emergency War Surgery
Procedure:

1. Immediately remove the casualty from the contaminated atmosphere to prevent further inhalation of hydrogen cyanide.
2. Administer sodium nitrite intravenously (IV) in a dose of 10 ml of 3% solution.
3. Monitor for signs of...
hydrogen cyanide, sodium nitrite, sodium thiosulfate, antidote, chemical exposure
Cooling Measures for Anticholinergic Poisoning
Critical Source: Full First Aid Manual FM 2111
Procedure:

1. Assess the casualty for signs of elevated body temperature and dry mucous membranes.
2. Initiate immediate cooling measures, including:
- Spraying with cool water
- Using air circulation (fanning)
- Applying...
cooling measures, anticholinergic poisoning, heatstroke, first aid, chemical exposure
Decontaminate and Treat Blister Agent Exposure
Critical Source: Survival and Austere Medicine
Procedure for Decontaminating and Treating Blister Agent Exposure

1. Protect yourself from contamination before assisting the patient.
2. Remove the patient from the exposure area to prevent further contact with blister agents such as...
blister agents, mustard gas, lewisite, decontamination, eye irrigation, antihistamines, BAL, dimercarprol, treatment, emergency medicine
Decontaminate and Treat Cyanide Exposure
Critical Source: Survival and Austere Medicine
Procedure for Decontaminating and Treating Cyanide Exposure

1. Remove the patient from the exposure area to prevent further inhalation or contact with cyanide.
2. Decontaminate the patient thoroughly, following standard decontamination...
cyanide exposure, decontamination, hydroxycobalamine, sodium nitrite, sodium thiosulphate, Eli Lily kit, treatment, emergency medicine
Diagnosis of Phosgene Inhalation Injury
Critical Source: NATO Emergency War Surgery
Procedure:

1. Assess symptoms: Look for signs such as tearing, cough, chest discomfort, dyspnea, or tachypnea.
2. Detect odor: Note the characteristic smell of freshly mown grass (phosgene), but be aware that this may not be a reliable...
phosgene diagnosis, chemical injury, pulmonary edema, cyanosis, respiratory symptoms
Handling Thickened Chemical Agents in Wounds
Critical Source: Emergency War Surgery
Procedure:

1. Recognize thickened agents as chemical agents mixed with other substances to increase persistency (may remain in the environment for over 24 hours).
2. For casualties with thickened nerve agents in wounds:
- **Survival...
thickened agents, mustard agent, nerve agents, wound care
Identify and Understand Nerve Gas Agents
Critical Source: Survival and Austere Medicine
Procedure:

1. Recognize the three types of chemical weapons: Nerve Gas, Blood agents, and Blister agents.
2. For Nerve Gas, identify common agents such as:
- GA (tabun)
- GB (sarin)
- GD (soman)
- GF (cyclohexyl...
nerve gas, chemical weapons, symptoms, acetylcholine, tabun, sarin, soman, VX
Observation Protocol for Phosgene Exposure
Critical Source: NATO Emergency War Surgery
Procedure:

1. Identify exposure: Confirm that the casualty has been exposed to phosgene, diphosgene, or chlorine gas.
2. Monitor symptoms: Even if the casualty shows only mild symptoms (e.g., dyspnea, upper respiratory irritation),...
phosgene exposure, observation protocol, chemical injury, respiratory irritation, pulmonary edema
Ongoing Management of Nerve Agent Exposure
Critical Source: Survival and Austere Medicine
Procedure:

1. In the absence of immediate medical care, continue Atropine administration to maintain atropinization for up to 24 hours (usually 1–2 mg every 1–4 hours).
2. If possible, refer to reputable NBC or toxicology references...
ongoing management, nerve agent, atropine continuation, medical evacuation, supportive care
Phosphorus Pentoxide Inhalation Injury and Prognosis
Critical Source: NATO Emergency War Surgery
Procedure:

1. Identify exposure: Confirm that the casualty has inhaled phosphorus pentoxide (associated with white phosphorus munitions).
2. Assess clinical signs: Note that phosphorus pentoxide produces a clinical picture similar to...
phosphorus pentoxide injury, irreversible alveolar damage, chemical burn, pulmonary edema
Pre-Treatment for Nerve Agent Exposure
Critical Source: Survival and Austere Medicine
Procedure:

1. Administer Pyridostigmine at a dose of 30 mg every 8 hours as pre-treatment to minimize the effects of nerve agents.
2. This is only recommended if there is a high risk of exposure and some warning time is available.
3....
pre-treatment, pyridostigmine, nerve agent, prophylaxis, Gulf War 1
Proper Use of Nerve Agent Antidote Kits (MARK I and ATNAA)
Critical Source: FM 4 25 11 First Aid
Procedure:

• You will be issued three MARK Is or three ATNAAs and one CANA.
• Each MARK I consists of:
- One atropine autoinjector.
- One pralidoxime chloride (2 PAM Cl) autoinjector.
• Each ATNAA consists of a multichambered autoinjector...
MARK I, ATNAA, CANA, antidote kit, chemical agent
Protect Against Chlorosulphonic Acid (CSA) Smoke Exposure
Critical Source: Medical NBC Battlebook
Procedure:

1. Wear a respirator in all concentrations of CSA smoke that cause cough, eye irritation, or skin prickling.
2. Avoid contact with water when handling CSA due to the risk of intense heat generation and acid scattering.
3. If...
chlorosulphonic acid, cs smoke, respiratory irritant, eye irritation, protective clothing
Protect Against Titanium Tetrachloride (FM) Smoke Exposure
Critical Source: Medical NBC Battlebook
Procedure:

1. Wear goggles or a respirator when FM smoke is falling to prevent droplets from entering the eyes.
2. Use full protective clothing when handling liquid FM to avoid contamination of eyes and skin.
3. If exposed:
-...
titanium tetrachloride, fm smoke, respiratory irritant, eye protection, acid burns
Protective Measures Against Cyanogen (Blood) Agents
Critical Source: FM 4 25 11 First Aid
Procedure:

1. Wear your protective mask with a fresh filter to protect against field concentrations of cyanogen agents (hydrogen cyanide, cyanogen chloride).
2. If exposed to liquid hydrogen cyanide, also wear protective overgarments in...
cyanogen agents, hydrogen cyanide, protective mask, blood agent, first aid
Recognizing Signs and Symptoms of Cyanogen Agent Exposure
Critical Source: FM 4 25 11 First Aid
Procedure:

1. Monitor for the following signs and symptoms after exposure to cyanogen agents:
- Tears (lacrimation)
- Eye, nose, or throat irritation
- Sudden stimulation of breathing (inability to hold breath)
- Nausea
-...
cyanogen agents, symptoms, first aid, chemical exposure
Recognizing Symptoms of Nerve Gas Poisoning
Critical Source: LDS Preparedness Manual
Procedure:

If you suspect exposure to nerve gas or other deadly gases, be aware of the following symptoms:

1. A feeling of tightness or constriction in the chest.
2. An unexplained runny nose.
3. Small, pin-point size pupils.
4. A drawing,...
nerve gas poisoning, chemical agent symptoms, biological agents, emergency response, chemical exposure, medical emergency
Self-Aid for Choking Agent Exposure
Critical Source: FM 4 25 11 First Aid
Procedure:

1. Put on your protective mask immediately if you experience any of the signs/symptoms listed in the previous procedure.
2. If some phosgene is inhaled, continue with **normal combat duties unless symptoms such as difficulty...
self aid, choking agents, phosgene, mask use, medical emergency
Treatment of Phosgene Inhalation Injury
Critical Source: NATO Emergency War Surgery
Procedure:

1. Enforced rest: Ensure the casualty remains at complete rest to minimize exertion and reduce oxygen demand.
2. Oxygen administration: Provide oxygen with air admixed to 40% to help conserve limited supplies while improving...
phosgene treatment, pulmonary edema management, oxygen therapy, PEEP breathing, mechanical ventilation
Use of Military Autoinjectors for Nerve Agent Exposure
Critical Source: Survival and Austere Medicine
Procedure:

1. If available, use military autoinjectors as first aid/initial therapy for nerve agent exposure.
2. Common brands include:
- Combopen (UK): 500 mg Pralidoxime, 2 mg Atropine, 10 mg Avizafone
- Combopen (Aust): 220...
autoinjector, Combopen, Mark 1, pralidoxime, atropine, nerve agent treatment
Administer Physostigmine for BZ (Quinuclidinyl Benzilate) Exposure
High Priority Source: NATO Emergency War Surgery
Procedure:

1. Immediately remove firearms and other weapons from the casualty to ensure safety.
2. Administer physostigmine intramuscularly (IM) in doses of 2 to 3 mg, repeated every 45 minutes as needed.
3. For persistent CNS...
BZ, physostigmine, quinuclidinyl benzilate, delirium, chemical exposure
Assess the Dose of Chemical Agent Received
High Priority Source: Medical NBC Battlebook
Procedure:

1. Determine whether the casualty was exercising or at rest during exposure.
2. Identify if the casualty was in the open or under cover at the time of exposure.
3. Note how long the chemical agent was inhaled for and the interval...
dose assessment, chemical exposure, inhalation time, decontamination
Classify Chemical Agents by Persistence
High Priority Source: Medical NBC Battlebook
Procedure:

1. Distinguish persistent agents: These agents remain hazardous for considerable periods (days) after delivery and may present a contact hazard or slowly vaporize to produce an inhalation hazard.
2. **Identify nonpersistent...
persistent agents, nonpersistent agents, chemical persistence
Decontamination After Hazardous Material Exposure
High Priority Source: FEMA Are You Ready
Procedure:

1. Follow decontamination instructions from local authorities.
- You may be advised to take a thorough shower, or you may be advised to stay away from water and follow another procedure.
2. **Seek medical treatment for unusual...
decontamination,hazardous materials exposure,chemical exposure,emergency procedures
Decontamination and Initial Treatment for Vesicant Gas Exposure
High Priority Source: NATO Emergency War Surgery
Procedure:

1. Remove all contaminated clothing immediately to prevent further exposure.
2. Lavage the skin with copious amounts of water to remove the vesicant agent from exposed areas.
3. Debride vesicles during the lavage...
vesicant gases, decontamination, skin lavage, topical chemotherapy, burn treatment
Decontamination of Chemical Casualties
High Priority Source: Emergency War Surgery
Procedure:

1. Remove MOPP gear from the casualty.
2. Perform initial skin and wound decontamination using a 0.5% hypochlorite solution before any further treatment.
3. Remove bandages, flush wounds, and replace with clean...
decontamination, chemical agents, hypochlorite solution, MOPP gear, wound care
Decontamination with Tincture of Green Soap
High Priority Source: Survival and Austere Medicine
Procedure:

1. Use tincture of green soap (or another mild soap) to decontaminate suits and bodies in an austere situation.
2. Exercise caution when decontaminating others to avoid spreading contaminants or causing harm.
3. Ensure thorough...
decontamination, green soap, chemical exposure, tincture, first aid, decontaminate
Diagnose Blister Agent Exposure
High Priority Source: NATO Emergency War Surgery
Diagnosis:

• The diagnosis of chemical skin injury is straightforward once blisters have appeared, but early and correct recognition can be difficult.

Key signs and symptoms include:

1. Early effects:
- Eye inflammation and upper...
blister agents, mustard gas, lewisite, chemical exposure, diagnosis, skin injury
Identify Routes of Chemical Agent Exposure
High Priority Source: Medical NBC Battlebook
Procedure:

1. Recognize inhalation injury: Chemical agents can enter the body through the respiratory tract, including the mucosa of the nose and mouth to the alveoli of the lungs.
2. Assess skin absorption risk: Vapors and droplets of...
chemical exposure, inhalation injury, skin absorption, vapor penetration
Managing Blisters Caused by Chemical Agents
High Priority Source: Full First Aid Manual FM 2111
Procedure:

1. Do not decontaminate the skin where blisters have formed, as the chemical agent has already been absorbed.
2. If blisters are present over a wide area of the body, consider this a serious burn and **seek medical assistance...
blisters, chemical agents, decontamination, vomiting, medical assistance
Post-Surgical Decontamination of Instruments and Linen
High Priority Source: Emergency War Surgery
Procedure:

1. Place all surgical instruments that have come into contact with possible chemical contamination in a container of 5% hypochlorite solution for 10 minutes before normal cleansing and sterilization.
2. Check **reusable...
post-surgical decontamination, linen, instruments, chemical agents
Protect Against Blister Agents (Vesicants)
High Priority Source: Medical NBC Battlebook
Procedure:

1. Wear full protective ensemble including a mask, NBC protective overgarment, gloves, and overboots to prevent exposure to blister agents such as sulfur mustard (HD), nitrogen mustard (HN), lewisite (L), and phosgene oxime...
blister agents, vesicants, sulfur mustard, nitrogen mustard, lewisite, phosgene oxime, protection, detection, chemical exposure
Protective Measures Against Choking Agents
High Priority Source: FM 4 25 11 First Aid
Procedure:

1. Wear your protective mask at all times when there is a risk of exposure to choking agents (phosgene, diphosgene, chlorine, chloropicrin).
2. Ensure the mask has a fresh filter and is properly sealed to the face.
3. If...
choking agents, phosgene, protective mask, chemical exposure, first aid, medical emergency
Provide First Aid for Incapacitating Agent Exposure
High Priority Source: FM 4 25 11 First Aid
Procedure:

1. Ensure Airway Clearance: If the casualty is stuporous or comatose, ensure that respiration is unobstructed.
2. Position Casualty Safely: Turn the casualty on his side to prevent aspiration if vomiting occurs.
3....
incapacitating agents,first aid,decontamination,chemical exposure,cooling,heatstroke
Questioning Casualties for Chemical Exposure
High Priority Source: Medical NBC Battlebook
Procedure:

1. Determine whether the casualty was wearing full protective equipment at the time of exposure.
2. Inquire if there were any aircraft or artillery bombardments in the area during the attack.
3. Ask if there was evidence of spray,...
questioning casualties, protective equipment, detection equipment, symptoms, self-injection device
Recognize a Chemical Casualty
High Priority Source: Medical NBC Battlebook
Procedure:

1. Identify individuals who suddenly become casualties without being wounded or who show incapacitation beyond what is expected from their injuries.
2. Consider chemical exposure if the casualty exhibits symptoms that are...
chemical casualty, recognition, symptoms, exposure, detection equipment, psychomimetic agent, choking agents
Recognize and Manage Belladonna-Type Drug Exposure (e.g., Atropine, Scopolamine)
High Priority Source: NATO Emergency War Surgery
Procedure:

1. Identify symptoms such as widely dilated pupils, tachycardia, dry mouth, hot dry skin, decreased intestinal motility, and bladder tone.
2. Monitor for CNS effects including **inattention, confusion,...
atropine, scopolamine, belladonna-type drugs, anticholinergic toxicity, physostigmine
Treat Toxic Fumes Exposure from Teflon Coated Armor Interiors
High Priority Source: Emergency War Surgery
Procedure:

1. Identify exposure to toxic fumes (e.g., phosgene-like byproducts) from Teflon-coated interiors of armored vehicles.
2. Monitor for signs of chemical injury, including:
- Irritation at mucous membranes
- Pulmonary edema
3....
toxic fumes, phosgene exposure, Teflon, war surgery
Types of Chemical Casualties on the Battlefield
High Priority Source: Medical NBC Battlebook
Procedure:

1. Identify conventional casualties (those with no chemical injury but may have contaminated clothing or equipment).
2. Recognize direct chemical casualties, which include:
- Individuals with only a chemical injury.
-...
types of casualties, conventional, direct, indirect, combat stress reaction, antidote side effects, heat casualty
Understand Chemical Agent Toxicity and Dosage Terminology
High Priority Source: Medical NBC Battlebook
Procedure:

1. Define dose: The quantity of the compound received by an individual, typically expressed as milligrams of agent per kilogram of body weight (mg/kg).
2. Explain LCt50: The lethal concentration time (LCt)50 is the Ct that...
dose, LCt50, ICt50, chemical toxicity
Use of Hypochlorite Solution for Decontamination
High Priority Source: Emergency War Surgery
Procedure:

1. Mix household bleach (which is 5% sodium hypochlorite) with water in a ratio of 1 part bleach to 9 parts water to create a 0.5% hypochlorite solution.
2. Use the 0.5% solution for skin decontamination, but avoid...
hypochlorite solution, decontamination, chemical agents, safety precautions
Wound Exploration and Debridement for Chemical Casualties
High Priority Source: Emergency War Surgery
Procedure:

1. Wear appropriate protective gear, including well-fitting, thin butyl rubber gloves or double latex surgical gloves.
2. Change gloves frequently to ensure no contamination occurs during the procedure.
3. Use a **no-touch...
wound exploration, debridement, chemical exposure, protective gear
Assess Meteorological Factors on Chemical Agent Effectiveness
High Priority Source: Medical NBC Battlebook
Procedure:

1. Evaluate wind impact: Wind disperses agents rapidly in open country but may leave dangerous concentrations in protected areas like woods, trenches, dug-outs, and built-up areas.
2. Analyze temperature effects: High...
meteorological factors, wind impact, temperature effects, rainfall impact, atmospheric stability
Evaluate Chemical Agent Densities for Dissemination and Persistence
High Priority Source: Medical NBC Battlebook
Procedure:

1. Assess vapor density: The vapor densities of all chemical agents (except AC) are greater than that of air.
2. Analyze liquid density: The liquid densities of all chemical agents (except AC) are greater than that of...
vapor density, liquid density, chemical agent behavior
Manage CNS Excitants (e.g., LSD) Exposure
High Priority Source: NATO Emergency War Surgery
Procedure:

1. Identify signs of hyperexcitability such as inappropriate behavior, restlessness, fear, perceptual aberrations, and schizoid-like symptoms.
2. Administer sedative barbiturates or chlorpromazine to manage agitation in...
LSD, CNS excitants, sedation, chlorpromazine, benzodiazepines
Manage Fluid Intake for Incapacitating Agent Exposure
High Priority Source: FM 4 25 11 First Aid
Procedure:

1. For incapacitating agents (e.g., anticholinergic drugs BZ type), do not give fluids freely.
2. Provide fluids sparingly, if at all, due to the risk of:
- Vomiting
- Temporary urinary retention caused by...
fluid management, anticholinergic agents, dehydration prevention
Protect Against Fog Oil Smoke Exposure
High Priority Source: Medical NBC Battlebook
Procedure:

1. Wear a respirator if exposed to fog oil smoke for prolonged periods.
2. If skin exposure occurs:
- Shower with soap and water and change clothes.
3. Avoid repeated inhalation of fog oil droplets, as they can accumulate...
fog oil, respiratory irritant, oil pneumonia, decontamination
Protect Against Vomiting Agents Using Protective Equipment
High Priority Source: Medical NBC Battlebook
Procedure:

1. Wear full individual protective equipment to ensure complete protection against vomiting agents.
2. Use the standard protective mask and ordinary field clothing for adequate protection during exposure to field...
vomiting agents, protective equipment, chemical exposure, first aid, medical treatment
Protection and Decontamination from Hydrocarbon Fumes
High Priority Source: Medical NBC Battlebook
Procedure:

1. Avoid Exposure: Avoid entering areas where hydrocarbon fumes may be present, especially in confined spaces.

2. Use of Respirators: Use a respirator with appropriate filters to protect against hydrocarbon fumes. Ensure the...
hydrocarbon,fumes,protection,decontamination,respirator,ventilation
Recognize and Treat Medical Effects of CN Riot Control Agent
High Priority Source: Medical NBC Battlebook
Procedure:

1. Identify symptoms such as a burning sensation in the eyes, skin, or respiratory tract, which may reach their peak within minutes.
2. Move the affected individual to fresh air, where symptoms will typically resolve within...
CN, medical effects, treatment, eye exposure, chemical burns
Management of Incapacitation Agents (BZ and Indoles)
Standard Source: Emergency War Surgery
Procedure:

1. Ensure safety by immediately removing firearms and other weapons from the casualty.
2. Provide close observation for the casualty to monitor symptoms.
3. Administer physostigmine as follows:
- Immediate dose:...
BZ agent, indoles, physostigmine, incapacitation agents
Off-Gassing from Chemically Contaminated Wounds
Standard Source: Emergency War Surgery
Procedure:

Step 1: Recognize that the risk of vapor off-gassing from chemically contaminated fragments and cloth in wounds is very low.
Step 2: During surgical exploration, off-gassing from a wound will be negligible or...
off-gassing, chemical contamination, surgical exploration
Decontaminate Skin Exposed to CS Riot Control Agent
Standard Source: Medical NBC Battlebook
Procedure:

1. Remove contaminated clothing immediately and dispose of it properly.
2. Wash the affected skin with water for at least 15 minutes. If available, use soap for the skin.
3. Avoid using oil-based lotions, as they may...
CS, riot control agent, skin decontamination, chemical exposure, sodium bicarbonate

Infections (67)

Avoid Using Home Remedies for Serious Infections
Critical Source: Where There is no Doctor a Village Health Care Handbook
Do not use home remedies alone to treat serious infections. Seek modern medical treatment immediately.

• Diseases such as pneumonia, tetanus, typhoid, tuberculosis, appendicitis, and postpartum fever require prompt medical attention.
• Do not...
serious infections, medical treatment, pneumonia, typhoid
Manage Deep Tissue/Fascia Infections in the Oral Cavity
Critical Source: Survival and Austere Medicine
Procedure:

1. Identify symptoms: Rapid spread of infection through loose tissue planes to other areas in the neck, leading to tissue breakdown, bleeding, and airway obstruction.
2. Perform immediate incision & drainage at...
deep tissue infection, fascia infection, airway obstruction, antibiotic therapy
Necrotizing Soft Tissue Infection Management
Critical Source: Emergency War Surgery
Procedure:

1. Diagnose necrotizing soft tissue infections based on:
- History of severe unexpected wound pain.
- Palpable or radiographic evidence of soft tissue gas (air in subcutaneous tissues and/or muscle).
- Absence of...
necrotizing infection,debridement,antibiotics,gas gangrene
Recognizing and Responding to Serious Vaginal Infections or Cancer Signs
Critical Source: Where There is no Doctor a Village Health Care Handbook
Procedure:

1. Look for watery, brown, or gray discharge streaked with blood, along with a bad smell, and pain in the lower belly.
2. If these symptoms are present, seek medical help immediately.
3. If there is fever, use...
serious infection,cancer,vaginal discharge,pain,bad smell
Tetanus Treatment for Established Tetanus
Critical Source: Emergency War Surgery
Procedure:

1. Administer IV antibiotics:
- Options: Penicillin G (24 million U/d), doxycycline (100 mg bid), or metronidazole (500 mg q6h) for 7 days.

2. Give tetanus immune globulin (TIG):
- Administer as needed, especially if...
tetanus treatment, muscle spasm, wound debridement, IV antibiotics, diazepam
Administer Medication for Pelvic Infection (PID)
Critical Source: A Book for Midwives
Procedure:

A woman with a pelvic infection should take three medications at once:

For chlamydia:
• Give 500 mg erythromycin by mouth, 4 times a day for 14 days, or
• Give **500 mg amoxicillin by mouth, 3 times a day for 14...
pelvic infection,pid,treatment,medications,chlamydia,gonorrhea,metronidazole
Administering Medicine for Wounds That Go Into the Gut
Critical Source: Where There is no Doctor a Village Health Care Handbook
MEDICINE FOR A WOUND THAT GOES INTO THE GUT (Also for appendicitis or peritonitis)
gut wound,appendicitis,peritonitis,medicine administration
Diagnose and Treat Infections in ICU Patients
Critical Source: Emergency War Surgery
Differential diagnosis of ICU infections includes the following conditions:

Pneumonia (nosocomial or aspiration)
Central venous catheter infection: Remove the catheter if suspected.
Urinary tract infection (UTI)
• **Wound or...
icu infections,pneumonia,catheter infection,sepsis,broad-spectrum antibiotics
Intraabdominal Infection Prophylaxis and Treatment
Critical Source: Emergency War Surgery
Procedure:

1. Prevention (start ASAP, continue for 24 hours post-op):
- Single agent: Cefotetan (1.0 g q12h), ampicillin/sulbactam (3 g q6h), or cefoxitin (1.0 g q8h).

2. Triple-agent regimen:
- Ampicillin (2 g q6h) + anaerobic...
intraabdominal infection, prophylaxis, abscess drainage, IV antibiotics
Manage Apical Abscess/Cellulitis
Critical Source: Survival and Austere Medicine
Procedure:

1. Identify symptoms: Look for fever, pain, abscess/pus pocket, or swelling at the gum tissue joining the lip.
2. Incise and drain the infection through the gum to the level of the bone.
3. **Insert a small improvised...
apical abscess, cellulitis, infection management, incision drainage, antibiotics
Prevent Eye Infections in Newborns from STIs
Critical Source: A Book for Midwives
To prevent eye infections caused by chlamydia or gonorrhea in newborns:

• Apply antibiotic ointment to each baby’s eyes immediately after birth.

Note: This is a standard procedure for all newborns, especially if the mother has an STI.
newborn eye infection prevention, antibiotic ointment, STI prevention in infants
Prevent and Manage Sepsis in Premature Infants
Critical Source: Emergency War Surgery
Procedure:

1. Identify risk factors for sepsis:
- Premature infants have an incomplete immune system, increasing their risk of sepsis by 60-fold.
- All elective surgery in infants under 30 days requires **48 hours of prophylactic...
sepsis, premature infant, antibiotic prophylaxis, elective surgery, infection control
Recognize and Respond to Signs of Pelvic Infection (PID)
Critical Source: A Book for Midwives
Procedure:

Signs of pelvic infection include:
1. Pain in the lower belly
2. High fever (more than 38°C or 100.4°F)
3. Feeling very ill or weak
4. Bad-smelling green or yellow discharge from the vagina
5. **Pain or bleeding...
pelvic infection,pid,symptoms,medical emergency,fever,vaginal discharge
Watch for Signs of Vaginal Infection in the Mother
Critical Source: A Book for Midwives
Procedure:

1. Monitor the mother for signs of vaginal infection after birth.
2. Look for symptoms such as:
- Unusual discharge (especially if it is foul-smelling or greenish/yellowish)
- Itching or burning sensation in the genital area
...
vaginal infection signs,foul discharge,itching,burning sensation
Administer Medication for Trichomonas (Trich)
High Priority Source: A Book for Midwives
Procedure:

If the woman is pregnant:
• She should wait until after the end of the third month for treatment.
• After the third month:
- Give 400 to 500 mg metronidazole by mouth, 2 times a day for 7 days.
- Treat the woman’s...
trichomonas,trich,treatment,metronidazole,pregnancy
Administering Erythromycin as an Alternative to Penicillin
High Priority Source: Where There is No Dentist
Procedure:

1. Use erythromycin only if the patient is allergic to penicillin.

2. First dose is double the regular dose, taken all at once.

3. Subsequent doses are given every 6 hours for 5 days.

4. **Take erythromycin with...
erythromycin dosage, antibiotic alternative, penicillin allergy
Administering Oral Penicillin for Infections
High Priority Source: Where There is No Dentist
Procedure:

1. Determine the patient's weight. Adults and children over 25 kg (60 pounds) receive full dose; children under 25 kg receive half the dose.

2. First dose is double the regular dose, taken all at once.

3. **Subsequent doses...
penicillin dosage, antibiotic administration, infection treatment
Differential Diagnosis of ICU Infections
High Priority Source: Emergency War Surgery
In critically ill patients, identifying the source of infection is crucial for appropriate treatment.

### Common Infections in ICU Patients:
Pneumonia (nosocomial or aspiration).
Central venous catheter infection – remove the...
ICU infections,differential diagnosis,pneumonia,catheter infection,UTI
Intraabdominal Infection Prevention and Treatment
High Priority Source: Emergency War Surgery
Procedure:

1. Prevention of intraabdominal infections:
- Administer antibiotics starting as soon as possible post-surgery, continuing for 24 hours after surgery.
- Single-agent regimens:
- Cefotetan: 1.0 g every 12 hours.
...
intraabdominal infection,prevention,treatment,antibiotics
Pneumonia Treatment in Emergency War Surgery
High Priority Source: Emergency War Surgery
Procedure:

1. Diagnose pneumonia:
- Use radiographic findings of a new pulmonary infiltrate that does not clear with chest physiotherapy, combined with fever or leukocytosis and sputum analysis showing bacteria and leukocytes.

2....
pneumonia treatment, ventilator-associated pneumonia, IV antibiotics, sputum analysis
Post-Operative Wound Infection Management
High Priority Source: Emergency War Surgery
Procedure:

1. Open the wound and drain any infected fluid:
- Use sterile technique to prevent further contamination.

2. Debride necrotic tissue present in the wound area.

3. Leave the wound open to allow healing by...
post-operative infection, wound debridement, IV antibiotics, surgical drainage
Pulmonary Infection (Empyema) Management in Emergency War Surgery
High Priority Source: Emergency War Surgery
Procedure:

1. Diagnose empyema:
- Use radiographic findings such as loculations, air/fluid levels, or pleural aspirate.

2. Initial treatment with chest tube placement:
- Insert a chest tube to drain fluid and reduce pressure in...
empyema treatment, chest tube placement, IV antibiotics, thoracotomy
Pulmonary Infection Management in Trauma Patients
High Priority Source: Emergency War Surgery
Procedure:

1. Empyema management:
- Initial treatment: Insert a chest tube to drain fluid.
- If unsuccessful, proceed with thoracotomy to remove infected tissue and drain the empyema.
- Administer IV antibiotics such as cefotaxime,...
pneumonia,empyema,treatment,antibiotics
Recognise and Treat Common Infections - Pneumonia
High Priority Source: Survival and Austere Medicine
Procedure:

1. Identify symptoms of pneumonia, such as fever, chills, cough with phlegm, shortness of breath, chest pain, and fatigue.
2. Provide rest and hydration, ensuring that the infected person drinks plenty of fluids to thin mucus...
pneumonia treatment, infection recognition, respiratory symptoms
Recognize and Respond to Infected Womb
High Priority Source: A Book for Midwives
### Recognize and Respond to Infected Womb

An infected womb occurs when harmful germs get inside the womb and make the mother sick. The signs of an infected womb are similar to other infections (see page 179 for details on treating...
infected womb, uterine infection, fever, shock, antibiotics, medical help
Recognize and Respond to Signs of Trichomonas (Trich)
High Priority Source: A Book for Midwives
Procedure:

Signs of trichomonas include:
Bubbly gray or yellow discharge
Bad-smelling discharge
Red and itchy genitals and vagina
Pain or burning while urinating

If these signs are present, the woman should be...
trichomonas,trich,symptoms,medical emergency,vaginal discharge
Treat Chlamydia in Adults
High Priority Source: A Book for Midwives
Treatment for chlamydia should be given to both the infected person and their sexual partner(s). The following medications are recommended:

Erythromycin: 500 mg by mouth, 4 times a day for 7 days
Amoxicillin: 500 mg by mouth, 3...
chlamydia treatment, STI medication, erythromycin, amoxicillin
Treat Gonorrhea in Adults
High Priority Source: A Book for Midwives
Treatment for gonorrhea should be given to both the infected person and their sexual partner(s). The following medications are recommended:

Ceftriaxone: 125 mg injected into a muscle, one time only
Cefixime: 400 mg by mouth, one...
gonorrhea treatment, STI medication, ceftriaxone, cefixime
When to Use Antibiotics for Dental Infections
High Priority Source: Survival and Austere Medicine
Procedure:

1. Drain any abscess or pus collection present in the affected area.
2. Use antibiotics only if the patient is systemically unwell, such as:
- High fever
- Chills or shakes
- Nausea or vomiting
- Gross local...
antibiotic use, dental infection, penicillin, erythromycin
Administer Doxycycline for Infection After Abortion
High Priority Source: A Book for Midwives
Procedure:

Indication: For infection after abortion.

1. Dose: Give 100 mg by mouth twice a day for 10 days.
2. Form: Use tablets of 50 or 100 mg.

Important Notes:
• Do not take with milk, dairy products, or antacids.
• Take...
doxycycline, infection after abortion, antibiotic, dosage, administration
Administer Erythromycin for Bacterial Infections
High Priority Source: Where There is no Doctor a Village Health Care Handbook
Erythromycin is an antibiotic used to treat bacterial infections such as pneumonia and skin infections. Follow these steps:

1. Confirm the patient has been diagnosed with a bacterial infection by a healthcare provider.
2. Take one tablet of...
erythromycin, bacterial infection treatment
Administer Ethambutol for Tuberculosis Treatment
High Priority Source: Where There is no Doctor a Village Health Care Handbook
Ethambutol is used to treat tuberculosis (TB) in combination with other medications. Follow these steps:

1. Confirm the patient has been diagnosed with TB by a healthcare provider.
2. Take one tablet of ethambutol with water, preferably after a...
ethambutol, tuberculosis treatment
Administer Metronidazole for Bacterial and Parasitic Infections
High Priority Source: A Book for Midwives
Procedure:

1. Use metronidazole in the form of tablets (200, 250, 400, or 500 mg), inserts (500 mg), injection (500 mg in 100 ml vial), or suspension (200 mg in 5 ml).
2. Administer as directed by a healthcare provider for bacterial infections,...
metronidazole, bacterial infection, parasitic infection, midwife procedure
Administer Procaine Penicillin for Infections
High Priority Source: A Book for Midwives
Procedure:

1. Dose: Inject 1.2 million Units of procaine penicillin into the muscle.
2. Frequency: Repeat after 12 hours if needed.

Important Notes:
• Procaine penicillin is used to treat womb and other infections.
• It should be...
procaine penicillin, antibiotic treatment, infection management, womb infections
Cellulitis Treatment in Emergency Settings
High Priority Source: Emergency War Surgery
Procedure:

1. Administer IV antibiotics targeting streptococcal and staphylococcal species:
- IV nafcillin.
- Cefazolin.
- In patients allergic to penicillin: clindamycin or vancomycin.

2. Monitor the patient for signs of systemic...
cellulitis,treatment,antibiotics,staphylococcal
Cellulitis Treatment in Emergency War Surgery
High Priority Source: Emergency War Surgery
Procedure:

1. Administer IV antibiotics targeting streptococcal and staphylococcal species:
- Options: Nafcillin, cefazolin, clindamycin (for penicillin-allergic patients), or vancomycin.

2. Monitor for signs of progression:
-...
cellulitis treatment, IV antibiotics, streptococcus, staphylococcus
Identify Symptoms of Chlamydia in Women
High Priority Source: A Book for Midwives
Chlamydia is a sexually transmitted infection (STI) that may cause the following symptoms in women:

• Yellow or green discharge from the vagina or anus
• Pain or burning when urinating
• Fever
• Lower abdominal pain
• Pain or bleeding during...
chlamydia symptoms, STI signs, vaginal infection
Identify Symptoms of Gonorrhea in Women
High Priority Source: A Book for Midwives
Gonorrhea is another serious STI that may cause the following symptoms in women:

• Yellow or green discharge from the vagina or anus
• Pain or burning when urinating
• Fever
• Lower abdominal pain
• Pain or bleeding during sex
• No signs at...
gonorrhea symptoms, STI signs, vaginal infection
Manage Gingival/Periodontal Abscess
High Priority Source: Survival and Austere Medicine
Procedure:

1. Identify symptoms: Infection between the gum and tooth; usually on the cheek side.
2. The tooth is typically sensitive to percussion but not heat or cold.
3. Perform incision & drainage of the abscess.
4. Apply...
gingival abscess, periodontal infection, incision drainage, dental first aid
Managing Infections After Abortion or Miscarriage
High Priority Source: A Book for Midwives
Procedure:

To manage and prevent infections after an abortion or miscarriage:

1. Monitor for Signs of Infection:
- Watch for symptoms such as fever, foul-smelling discharge, severe pain, or unusual bleeding.
- If any signs are...
post-abortion infection,miscarriage care,hygiene,antibiotics
Treat Infection Inside the Saliva Gland (Sialadenitis)
High Priority Source: Where There is No Dentist
Procedure:

Symptoms to Watch For:
• Swelling near the spit gland (in front of the ear or under the jaw).
• Pain that worsens when hungry, seeing, or smelling food.
• Redness and swelling at the duct opening with tenderness upon...
sialadenitis treatment, saliva gland infection, stone removal, penicillin use, heat application
Treating Breast Infection (Mastitis) with Antibiotics
High Priority Source: A Book for Midwives
Procedure for Treating Breast Infection (Mastitis):

• Administer 500 mg dicloxacillin by mouth, 4 times a day for 7 days.

If dicloxacillin is unavailable or the woman is allergic to penicillin, administer **500 mg erythromycin by...
mastitis,breast infection,antibiotics,dicloxacillin,erythromycin
Treating Neonatal Conjunctivitis
High Priority Source: Where There is no Doctor a Village Health Care Handbook
Procedure for Treating Neonatal Conjunctivitis:

1. Clean the baby's eyes with a clean, damp cloth or gauze soaked in warm water.
2. Gently wipe from the inner corner of the eye outward to avoid spreading infection.
3. Apply an antibiotic...
neonatal conjunctivitis,eye infection,baby care,antibiotic ointment
Treating a Pointing Swelling with Heat and Sterile Techniques
High Priority Source: Where There is No Dentist
Procedure:

1. If the swelling is ‘pointing’ (i.e., it has formed an abscess), open it with a sharp sterile knife to release pus.

2. Cover the wound with a sterile dressing to keep it clean and prevent infection.

3. If unable to...
abscess treatment, heat therapy, sterile technique
Administer Erythromycin for Infections During Pregnancy
Standard Source: A Book for Midwives
Procedure:

Indication: For treating infections during pregnancy or when allergic to penicillin.

1. Dose: Take erythromycin as directed by a healthcare provider, typically in divided doses.
2. Form: Use tablets of appropriate...
erythromycin, antibiotic, pregnancy, penicillin allergy, dosage
Administer Miconazole for Bacterial Vaginosis or Trichomonas
Standard Source: A Book for Midwives
Procedure:

Dosage Option 1: Give 400 to 500 mg by mouth 2 times a day for 7 days.
Dosage Option 2: Put a 500 mg insert high in the vagina every night for 7 nights.
Indication: For bacterial vaginosis (see p. 328) or...
miconazole,bacterial vaginosis,trichomonas
Administer Miconazole for Infection After Birth
Standard Source: A Book for Midwives
Procedure:

Dosage: Give 400 to 500 mg by mouth 3 times a day until fever has been gone for 48 hours.
Indication: For infection after birth (see p. 271).

Warnings and Contraindications:
• Stop using miconazole if it irritates...
miconazole,infection after birth,antifungal
Administer Miconazole for Pelvic Infection
Standard Source: A Book for Midwives
Procedure:

Dosage: Give 400 to 500 mg by mouth 3 times a day for 14 days.
Additional Medication: You must give other antibiotics too.
Indication: For pelvic infection (see p. 325).

Warnings and Contraindications:
• Stop...
miconazole,pelvic infection
Administer Miconazole for Prevention After Invasive Procedure
Standard Source: A Book for Midwives
Procedure:

Dosage: Give 1 g by mouth 1 time only.
Additional Medication: Also give amoxicillin.
Indication: To prevent infection in the womb after an invasive procedure (see p. 231).

Warnings and Contraindications:
• Stop...
miconazole,invasive procedure,prevention
Administer Miconazole for Womb Infection During Pregnancy
Standard Source: A Book for Midwives
Procedure:

Dosage: Give 400 to 500 mg by mouth 3 times a day for 7 to 10 days.
Indication: For womb infection in pregnancy (see p. 179).
Notes: This is not recommended during the first 3 months of pregnancy.

**Warnings and...
miconazole,womb infection,pregnancy,antifungal
Administer Miconazole for Yeast Infection of the Vagina
Standard Source: A Book for Midwives
Procedure:

Dosage: Put a 200 mg insert high in the vagina every night for 3 nights.
Indication: For yeast infections of the vagina (see p. 327).

Other Drugs That May Work:
• Gentian violet.
• Nystatin.

**Warnings and...
miconazole,yeast infection,vagina
Administering Medicines for Chlamydia
Standard Source: Where There is no Doctor a Village Health Care Handbook
Title: Administering Medicines for Chlamydia

Content:
Indication: Used for the treatment of chlamydia infections.
Dosage: Take 500 mg every 12 hours, or as directed by a healthcare provider.
Instructions:
- Swallow the...
chlamydia treatment, antibiotic administration, infection management
Apply Gentian Violet for Yeast Infections in a Baby’s Mouth (Thrush)
Standard Source: A Book for Midwives
Procedure:

1. Use a 0.25% liquid gentian violet solution.
2. Wipe the baby’s mouth and the mother’s nipples with the solution once a day.
3. Continue this for up to 5 days or as directed by a healthcare provider.
4. Important: Stop using if...
gentian violet, yeast infection, thrush, baby mouth infection, midwife procedure
Identify and Treat an Abscess
Standard Source: Where There is No Dentist
Title: Identify and Treat an Abscess

Content:
An abscess is a sac of pus caused by an infection, such as a boil. To treat an abscess:
1. Clean the area with soap and water to reduce the risk of spreading infection.
2. **Apply warm...
abscess,treatment,infection,warm compresses,drainage
Manage Pericoronitis
Standard Source: Survival and Austere Medicine
Procedure:

1. Identify symptoms: Infection of the gum overlying a partially erupted tooth (e.g., wisdom tooth), often in the back of the mouth.
2. Look for signs such as muscle spasm in the chewing muscles and **no drainage or...
pericoronitis, wisdom tooth infection, gum cleaning, dental first aid
Managing Sudden Mild Diarrhea Without Fever
Standard Source: Where There is no Doctor a Village Health Care Handbook
For sudden, mild diarrhea with no fever (possibly due to viral infection or 'intestinal flu'):

Drink plenty of liquids to prevent dehydration.
Avoid anti-diarrhea medicines like kaolin and pectin (_Kaopectate_), diphenoxylate...
diarrhea,mild,virus,intestinal flu,medicine
Managing Vaginal Infections During Pregnancy
Standard Source: A Book for Midwives
Procedure:

Steps to Manage Vaginal Infections During Pregnancy:

1. **Identify Symptoms:
- Look for signs such as unusual vaginal discharge (especially if it smells bad), pain, or burning.
- Check for any visible signs of infection...
vaginal infection, pregnancy, gonorrhea, hygiene, antibiotics
Recognise and Treat Common Infections - Urinary Tract Infection (UTI)
Standard Source: Survival and Austere Medicine
Procedure:

1. Identify symptoms of a urinary tract infection, such as frequent urination, burning sensation during urination, cloudy or strong-smelling urine, and lower abdominal pain.
2. Provide rest and hydration, ensuring that the...
urinary tract infection, treatment, UTI symptoms
Recognize and Treat Infections
Standard Source: Where There is no Doctor a Village Health Care Handbook
Infection is a sickness caused by bacteria or other germs that may affect part of the body or all of it.

Common signs include:
• Fever.
• Redness, swelling, or pain in an affected area.
• Pus or discharge from wounds.

Treatment includes:
-...
infection, bacterial infection, treatment
Treating Navel Infection in Newborns
Standard Source: Where There is no Doctor a Village Health Care Handbook
Procedure for Treating Navel Infection in Newborns:

1. Clean the infected area with warm water and mild soap.
2. Gently pat the area dry with a clean cloth or gauze.
3. Apply an antiseptic solution, such as diluted alcohol or iodine, to the...
navel infection,newborn care,antiseptic,application,hygiene
Apply Miconazole Nitrate Cream for Fungal Skin Infection or Yeast Vaginitis
Standard Source: Personal Wilderness Medical Kit
Indication: Treating fungal skin infection or yeast vaginitis
Dose:
• For fungal skin infection: Apply BID-QID to affected area
• For yeast vaginitis: 1 mL intravaginally daily
Instructions:
1. Use miconazole nitrate cream, 2% (e.g.,...
miconazole cream, fungal infection treatment, Monistat
Preventing Infections During Pregnancy and Childbirth
Standard Source: A Book for Midwives
Procedure:

To prevent infections during pregnancy and childbirth, follow these steps:

1. Maintain Hygiene:
- Wash hands frequently with soap and water.
- Use isopropyl alcohol or household bleach for cleaning surfaces and...
infection prevention,pregnancy,hygiene,STIs,Pap test,IUDs
Recognise and Treat Common Infections - Viral Flu
Standard Source: Survival and Austere Medicine
Procedure:

1. Identify symptoms of viral flu, such as fever, cough, sore throat, runny or stuffy nose, body aches, headache, fatigue, and sometimes vomiting or diarrhea.
2. Isolate the infected person to prevent the spread of the virus...
viral flu treatment, infection recognition, flu symptoms
Recognize and Treat Fungal Infections (Ringworm, Thrush, Vaginal Yeast)
Standard Source: Where There is no Doctor a Village Health Care Handbook
Recognize and Treat Fungal Infections

Fungal infections such as ringworm, thrush, and vaginal yeast infections are common and can be treated with proper care.

### Signs of Fungal Infections:
Ringworm (Tinea): Red, circular patches on the...
fungal infection, ringworm, thrush, yeast infection, treatment
Treatment for Bacterial Infections (Thick, Milky Discharge with Rancid Smell)
Standard Source: Where There is no Doctor a Village Health Care Handbook
Procedure:

1. Douche with vinegar-water solution (see page 241) or use a povidone-iodine (Betadine) solution: mix 6 teaspoons of Betadine in 1 liter of water.
2. Insert a clove of garlic into the vagina each night for **2...
bacterial infection,betadine,vaginal discharge,treatment
Treatment for Yeast Infections (Moniliasis/Candida)
Standard Source: Where There is no Doctor a Village Health Care Handbook
Procedure:

1. Douche with vinegar-water solution (see page 241) or use a dilute gentian violet solution: mix 2 teaspoons of gentian violet in half a liter of water.
2. Use nystatin vaginal tablets, miconazole, or...
yeast infection,candida,nystatin,vaginal inserts,treatment
Vaginal Wash for Infections (Douche with Vinegar-Water)
Standard Source: Where There is no Doctor a Village Health Care Handbook
Procedure:

1. Prepare the solution by mixing 6 teaspoons of distilled vinegar with 1 liter of boiled, cooled water.
2. Use a clean tube or syringe to slowly introduce the solution into the vagina, ensuring that the tube does not go more...
vaginal wash,douche,vinegar-water,infection,treatment,trichomonas

Wound Closure (58)

Closure of Abdominal Incisions Using Fascial Sutures
High Priority Source: Medical Survival Wound Closure Manual
Procedure for Closure of Abdominal Incisions Using Fascial Sutures

1. Assess the wound: Determine the depth and integrity of the fascia. If fascia is absent or weak, consider using synthetic graft material such as PROLENE* polypropylene...
fascia closure, abdominal incision, suture technique, PROLENE, PDS II, wound healing
Contraindications for Use of VICRYL Knitted and Woven Mesh
High Priority Source: Medical Survival Wound Closure Manual
Procedure for Understanding Contraindications for Use of VICRYL Knitted and Woven Mesh

1. Absorbable nature: Both VICRYL knitted and woven mesh are absorbable, making them unsuitable for use in situations requiring extended wound or organ...
VICRYL mesh contraindications, medical emergency, surgical procedure
Muscle Handling During Abdominal Incisions
High Priority Source: Medical Survival Wound Closure Manual
Procedure: Proper Handling of Muscle Tissue During Abdominal Incisions

1. Incision type: Choose between cutting, splitting (separating), or retracting the muscle based on incision location and surgical needs.
2. **Preserve blood supply and...
muscle handling, abdominal incision, muscle retraction, infection management
Smead-Jones Far-and-Near Technique for Abdominal Closure
High Priority Source: Medical Survival Wound Closure Manual
Procedure: Smead-Jones Far-and-Near Technique for Abdominal Closure

1. Indication: Use this technique for rapid and strong closure of abdominal wounds with minimal risk of wound disruption or late complications.
2. Suture material: Use...
Smead-Jones technique, abdominal closure, figure-of-eight sutures, PDS II
Use of Synthetic Graft Material in Fascial Repair
High Priority Source: Medical Survival Wound Closure Manual
Procedure for Using Synthetic Graft Material in Fascial Repair

1. Indication: Use synthetic graft material (e.g., PROLENE* polypropylene mesh) when fascia is absent, weak, or unable to bear the stress of healing.
2. Graft placement:...
synthetic graft, fascial repair, PROLENE mesh, wound closure
Absorption and Strength Characteristics of VICRYL Woven Mesh
High Priority Source: Medical Survival Wound Closure Manual
Procedure for Understanding Absorption and Strength Characteristics of VICRYL Woven Mesh

1. Absorption rate: The absorption of VICRYL woven mesh is minimal until about six weeks post-implantation, with essentially complete absorption...
VICRYL woven mesh, absorption rate, strength characteristics, medical emergency, surgical procedure
Using Curved Needles for Wound Closure
High Priority Source: Medical Survival Wound Closure Manual
Procedure:

1. Select appropriate curvature: Choose from 1/4, 3/8, 1/2, or 5/8 circle curvatures based on the tissue being sutured and the accessibility of the wound site.

2. Grasp the needle securely: Hold the curved needle with a...
curved needle, wound closure, 1/4 circle, 3/8 circle, 1/2 circle, 5/8 circle, tissue suturing
Using Straight Needles for Wound Closure
High Priority Source: Medical Survival Wound Closure Manual
Procedure:

1. Grasp the needle securely: Use a needleholder to hold the straight needle firmly.

2. Pull suture taut: Grasp the suture and pull it straight and taut while holding the needle in the needleholder.

3. **Release...
straight needle, wound closure, suture release, CONTROL RELEASE, microsurgery, ophthalmology
Adverse Reactions and Contraindications for MERSILENE Mesh
Standard Source: Medical Survival Wound Closure Manual
Procedure:

1. Risk of adverse reactions:
- Use in contaminated or infected wounds may lead to fistula formation and/or extrusion of the mesh.
2. Contraindications:
- Do not use in infants or children with future growth potential...
MERSILENE mesh,fistula formation,extrusion,contaminated wounds
Apply PDS II (Polydioxanone) Suture for Wound Closure
Standard Source: Medical Survival Wound Closure Manual
Procedure:

1. Ensure the wound is clean and free from debris, blood, and contaminants.
2. Use sterile gloves, instruments, and suture material to prevent infection.
3. Hold the PDS II suture with forceps or a needle holder, ensuring proper...
pds ii suture,wound closure,polydioxanone,synthetic absorbable suture
Apply Skin Closure Tapes for Wound Closure
Standard Source: Medical Survival Wound Closure Manual
### Procedure: Apply Skin Closure Tapes for Wound Closure

Overview:
Skin closure tapes are used as an alternative to sutures or staples when tensile strength and resistance to infection are not critical factors. They provide rapid...
skin closure tapes,wound closure,application procedure,adhesive tape usage,alternative to sutures
Contraindications for PRONOVA Suture Use
Standard Source: Medical Survival Wound Closure Manual
Procedure:

PRONOVA sutures are contraindicated in the following situations:

Steps:
1. No known contraindications exist for PRONOVA suture use, except as outlined below.
2. Avoid using PRONOVA sutures in patients with a known...
PRONOVA suture,contraindications,wound closure,surgical use
Contraindications for Skin Staple Use
Standard Source: Medical Survival Wound Closure Manual
When to Avoid Using Skin Staples

Do not use skin staples when it is not possible to maintain at least a 5 mm distance from the stapled skin to underlying bones, vessels, or internal organs.
• This applies to both the PROXIMATE and...
skin staple contraindications, wound closure safety, medical device limitations
Indications for Use of MERSILENE Mesh
Standard Source: Medical Survival Wound Closure Manual
Procedure:

1. Use in hernia repair: MERSILENE mesh is indicated for the repair of hernias and other fascial deficiencies that require a reinforcing or bridging material.
2. Contaminated wound use:
- Use with caution in contaminated...
MERSILENE mesh,hernia repair,contaminated wounds,pediatric use
MONOCRYL Suture Specifications and Use
Standard Source: Medical Survival Wound Closure Manual
Procedure:

1. Material description: MONOCRYL is a monofilament synthetic absorbable suture made from a copolymer of glycolide and epsilon-caprolactone.
2. Properties:
- Nonantigenic, nonpyrogenic, and elicits only a slight tissue...
MONOCRYL suture,size specifications,soft tissue approximation
Proper Placement and Closure of VICRYL Woven Mesh
Standard Source: Medical Survival Wound Closure Manual
Procedure for Proper Placement and Closure of VICRYL Woven Mesh

1. Position the mesh: Place the VICRYL woven mesh over the defect, ensuring that it is larger than the defect if preferred by the surgeon.
2. Suture placement: Use...
VICRYL woven mesh, suture placement, wound closure, medical emergency, surgical procedure
Proper Placement of MERSILENE Mesh in Wounds
Standard Source: Medical Survival Wound Closure Manual
Procedure:

1. Mesh extension beyond suture line: Ensure a minimum of 6.5mm (1/4 inch) of mesh extends beyond the suture line.
2. Suturing technique:
- Place nonabsorbable sutures at intervals of 6.5 to 12.5mm (1/4 to 1/2 inch)...
MERSILENE mesh,wound closure,suture technique
Proper Resterilization of Unused MERSILENE Mesh
Standard Source: Medical Survival Wound Closure Manual
Procedure:

1. Check sterility status: Ensure the MERSILENE mesh has been removed from its original package and is unused.
2. Conventional stream autoclaving:
- Use a conventional steam autoclaving process at 250°F (121°C) for 20...
MERSILENE mesh,restirilization,sterile product,ETHICON,INC
Proper Use of PRONOVA Suture for Wound Closure
Standard Source: Medical Survival Wound Closure Manual
Procedure:

PRONOVA suture is a nonabsorbable, monofilament suture that resists infection and is suitable for use in contaminated or infected wounds. It is not subject to degradation by tissue enzymes and is gradually encapsulated by fibrous...
PRONOVA suture,wound closure,nonabsorbable suture,surgical procedure
Adverse Reactions Associated with Surgical Stainless Steel Suture Use
Standard Source: Medical Survival Wound Closure Manual
Procedure:

Potential adverse effects associated with the use of surgical stainless steel suture include:

1. Wound dehiscence – The wound may reopen after closure.
2. Allergic response – Patients sensitive to 316L stainless steel,...
surgical stainless steel suture, adverse reactions, wound dehiscence, infection, needle breakage
Disposal and Safety Precautions for Skin Staple Devices
Standard Source: Medical Survival Wound Closure Manual
Important Disposal and Safety Guidelines

Dispose of all opened products: Whether used or unused, discard the device after use. Do not resterilize it, as this may compromise its integrity and lead to unintended injury.
• **Special disposal...
device disposal, safety precautions, medical waste handling
Understanding Absorbable Suture Types
Standard Source: Medical Survival Wound Closure Manual
Absorbable suture refers to sutures that are broken down and eventually absorbed by either hydrolysis (synthetic absorbable sutures) or digestion by lysosomal enzymes elicited by white blood cells (surgical gut and collagen). These types...
absorbable suture, hydrolysis, lysosomal enzymes, surgical gut, collagen
Understanding B & S Gauge for Sutures
Standard Source: Medical Survival Wound Closure Manual
B & S gauge is a standard used in hospitals to identify wire diameter. ETHICON stainless steel suture products are labeled with both B & S gauge and U.S.P. size, ensuring compatibility across different surgical tools.
b&s gauge, wire diameter, ethicon suture labeling
Understanding Buried Sutures
Standard Source: Medical Survival Wound Closure Manual
Buried sutures are stitches made and tied so that they remain completely under the surface of the tissue. This technique is used to reduce visible scarring and prevent irritation from exposed suture material.
buried sutures, subcuticular closure, hidden stitches
Understanding Cardiovascular Sutures
Standard Source: Medical Survival Wound Closure Manual
Cardiovascular sutures are swaged sutures designed to meet the specific needs of heart and blood vessel surgery. These sutures are engineered for strength, flexibility, and compatibility with delicate tissues.
cardiovascular sutures, heart surgery, blood vessel repair
Understanding Catgut Sutures
Standard Source: Medical Survival Wound Closure Manual
Catgut is an outmoded term for surgical gut suture, which refers to a type of absorbable suture derived from animal tissue. These sutures are now largely replaced by synthetic alternatives.
catgut, surgical gut, outdated terminology
Understanding Chromic Surgical Gut
Standard Source: Medical Survival Wound Closure Manual
Chromic surgical gut is a type of gut suture that has been treated with chromium salts to resist digestion by lysosomal enzymes. This treatment provides uniform controlled absorption, making it suitable for applications where prolonged...
chromic surgical gut, chromium salts, lysosomal enzymes, controlled absorption
Understanding Compound Curved Needles
Standard Source: Medical Survival Wound Closure Manual
Compound curved needles are designed with two curvatures: a tight curve at the tip and a more gradual curve through the body. These needles are used for precise positioning of sutures, particularly in corneal/scleral closure and...
compound curved needle, precise positioning, corneal closure, skin suturing
Understanding Continuous Suture Technique
Standard Source: Medical Survival Wound Closure Manual
Continuous suture technique involves using a single suture strand passed back and forth between the two edges of the wound to close a tissue layer, with the suture tied only at each end of the suture line. This method is efficient for...
continuous suture technique, single strand closure, wound approximation
Understanding Microsurgery Sutures
Standard Source: Medical Survival Wound Closure Manual
Microsurgery sutures are used in surgeries where an operating microscope is employed to visualize very small structures such as blood vessels and nerves. These sutures allow for precise handling and placement during delicate procedures.
microsurgery,sutures,precision,operating microscope
Understanding Surgical Needles (ETHICON)
Standard Source: Medical Survival Wound Closure Manual
Surgical needles from ETHICON are eyeless needles permanently attached (swaged) to suture strands. This design enhances the efficiency and precision of suturing during wound closure procedures.
ethicon surgical needles, swaged needles, eyeless needles
Understanding the Chromicizing Process
Standard Source: Medical Survival Wound Closure Manual
Chromicizing is the ETHICON process for producing chromic gut. Each ribbon of surgical gut is bathed in a chromium salt solution before spinning into strands to provide uniform controlled absorption. This ensures predictable and...
chromicizing, ethicon process, chromium salt solution, uniform absorption
Use of VICRYL* Knitted Mesh for Wound Support
Standard Source: Medical Survival Wound Closure Manual
Procedure:

VICRYL* knitted mesh is used as a temporary buttress to provide support during the healing process.

1. Indications – Used in abdominal wound closure, particularly where additional reinforcement is needed.
2. **Material...
vicryl knitted mesh, wound support, abdominal closure, absorption rate
Identify and Classify Nonabsorbable Sutures According to U.S.P.
Reference Source: Medical Survival Wound Closure Manual
Procedure:

1. Examine the suture material for classification based on composition and construction.
2. Class I sutures are composed of silk or synthetic fibers, available in monofilament, twisted, or braided constructions.
3. Class II...
nonabsorbable sutures,classification,usp classification,suture types
Proper Use of the PROXIMATE PLUS MD Skin Stapler
Reference Source: Medical Survival Wound Closure Manual
Procedure for Applying Skin Staples Using the PROXIMATE PLUS MD Skin Stapler

1. Verify compatibility: Ensure all instruments and accessories are compatible before use (refer to Warnings and Precautions).
2. Sterile technique: Remove the...
skin stapler use, PROXIMATE PLUS MD, wound closure, medical device application
Proper Use of the PROXIMATE Skin Staple Extractor
Reference Source: Medical Survival Wound Closure Manual
Procedure for Removing Skin Staples Using the PROXIMATE Skin Staple Extractor

1. Verify compatibility: Ensure all instruments and accessories are compatible before use.
2. Sterile technique: Using sterile technique, remove the device...
skin staple removal, PROXIMATE extractor, wound closure, medical device use
Staple Dimensions for PROXIMATE Skin Stapler
Reference Source: Medical Survival Wound Closure Manual
Dimensions of Staples Used with the PROXIMATE Skin Stapler

Regular staples: Diameter: 0.53 mm, Span: 5.7 mm, Leg Length: 3.9 mm.
Wide staples: Diameter: 0.58 mm, Span: 6.9 mm, Leg Length: 3.9 mm.
staple dimensions, PROXIMATE device, wound closure specifications
Understanding Monocryl* (Poliglycaprone 25) Suture
Reference Source: Medical Survival Wound Closure Manual
Monocryl* is an ETHICON trademark for a monofilament synthetic absorbable suture made from a copolymer of glycolide and e-caprolactone. It is used in surgical procedures where absorbable sutures are required.
monocryl,poliglycaprone,suture,absorbable
Understanding MIL Unit Measurement
Reference Source: Medical Survival Wound Closure Manual
The MIL is a unit of linear measurement equivalent to 0.001 inch. It is frequently used to express the diameter of surgical needles.
mil,measurement,surgical needle,diameter
Understanding Multifilament Sutures
Reference Source: Medical Survival Wound Closure Manual
A multifilament is a strand made of more than one twisted or braided filament. This type of suture material has different handling and absorption properties compared to monofilament sutures.
multifilament,braided,filament
Understanding Multipass Needle Technology
Reference Source: Medical Survival Wound Closure Manual
The Multipass Needle is an ETHICON trademark for a patented coating process that enhances needle performance over multiple penetrations, making it suitable for repeated use in surgical procedures.
multipass,needle,coating,ETHICON
Understanding Nylon Suture Material
Reference Source: Medical Survival Wound Closure Manual
Nylon is a synthetic suture material made of polyamide polymer. It has specific handling and absorption properties that make it suitable for various surgical applications.
nylon,polyamide,suture
Understanding OB-GYN Sutures
Reference Source: Medical Survival Wound Closure Manual
OB-GYN sutures are needle/suture combinations specifically useful in obstetric and gynecological operations. They are designed for use in these specialized surgical fields.
ob-gyn,sutures,obstetric,gynecology
Understanding Ophthalmic Sutures
Reference Source: Medical Survival Wound Closure Manual
Ophthalmic sutures are small gauge sutures attached to ultrafine needles that meet the exacting needs of ophthalmic surgery, where precision is critical.
ophthalmic,sutures,precision
Understanding PC Prime* Needle (PC) Technology
Reference Source: Medical Survival Wound Closure Manual
The PC Prime needle is a conventional cutting needle with a geometry that reduces the angle of the cutting edge, requiring less force to penetrate tissue and minimizing tissue trauma in precision cosmetic surgery.
pc prime,needle,cutting edge,tissue trauma
Understanding Plastic Surgery Sutures
Reference Source: Medical Survival Wound Closure Manual
Plastic surgery sutures are specifically designed to assist the surgeon in obtaining excellent cosmetic results in plastic and reconstructive surgery. They are tailored for use in these procedures.
plastic surgery,sutures,cosmetic
Understanding Pledgets in Cardiovascular Surgery
Reference Source: Medical Survival Wound Closure Manual
Pledgets are small pieces of TFE polymer felt used as a buttress under sutures in cardiovascular surgery to provide additional support and prevent suture pull-through.
pledgets,polymer,buttress,surgery
Understanding Polybutylate Coating for Sutures
Reference Source: Medical Survival Wound Closure Manual
Polybutylate is a nonabsorbable, nonreactive polyester lubricant developed by ETHICON, INC., as a coating for ETHIBOND EXCEL sutures to improve handling and reduce friction during use.
polybutylate,lubricant,suture
Understanding Polypropylene Buttons for Orthopaedic Procedures
Reference Source: Medical Survival Wound Closure Manual
Polypropylene buttons are synthetic material made into buttons used in orthopaedic procedures such as tendon repair. Sutures are tied over buttons to relieve underlying skin of excessive pressure.
polypropylene,buttons,tendon repair,relief
Understanding Polypropylene Material
Reference Source: Medical Survival Wound Closure Manual
Polypropylene is a synthetic material made of an isotactic crystalline stereoisomer of a linear hydrocarbon polymer that will not absorb fluids, making it suitable for nonabsorbable suture applications.
polypropylene,synthetic,nonabsorbable
Understanding Precision Cosmetic Needle (PC) Technology
Reference Source: Medical Survival Wound Closure Manual
The Precision cosmetic needle is a conventional cutting needle specially polished and carefully honed for aesthetic plastic surgery to ensure minimal tissue trauma and optimal results.
precision,cosmetic,needle,aesthetic
Understanding Proxi-Strip* Skin Closures
Reference Source: Medical Survival Wound Closure Manual
Proxi-Strip* is an ETHICON trademark for adhesive strips used for skin closure. They are designed to provide a secure and minimally invasive method of closing wounds.
proxi-strip,adhesive,skin closure,wound
Understanding the Needle/Suture Junction (Swage)
Reference Source: Medical Survival Wound Closure Manual
The Needle/suture junction (swage) is the point at which eyeless needles and suture strands are joined. This connection must be strong to ensure proper performance during suturing.
swage,needle,suture,junction
Using a Needleholder in Suturing
Reference Source: Medical Survival Wound Closure Manual
A Needleholder is a surgical instrument used to hold and drive a surgical needle during suturing procedures. It provides better control and reduces the risk of needlestick injuries.
needleholder,surgical instrument,control
Understanding Multi-Strand Packages
Reference Source: Medical Survival Wound Closure Manual
A Multi-strand package contains multiple swaged sutures of the same type supplied in a single packet for convenience and efficiency during surgical procedures.
multi-strand,package,suture
Understanding Overwrap Packaging for Sutures
Reference Source: Medical Survival Wound Closure Manual
The Overwrap is the exterior packet that protects the sterility of inner suture packets. It ensures that the sutures remain sterile until they are used.
overwrap,sterility,packet
Understanding Package Inserts for Sutures
Reference Source: Medical Survival Wound Closure Manual
A Package insert is a complete product information sheet inserted in every box of wound closure products, as required by the FDA to provide users with essential details about the product.
package insert,FDA,product info
Directions for Using High Viscosity DERMABOND Adhesive
Reference Source: Medical Survival Wound Closure Manual
Objective: Correctly apply high viscosity DERMABOND adhesive to a wound.

Procedure:
1. Thoroughly cleanse the wound, following standard surgical practice (i.e., anesthetize, irrigate, debride, obtain hemostasis, and close deep...
DERMABOND adhesive, wound closure, high viscosity, application procedure

Postpartum Care (55)

Administer Ergometrine for Heavy Bleeding After Childbirth
Critical Source: A Book for Midwives
Procedure:

Indication: For heavy bleeding after childbirth.

1. Dose by Mouth: Give 0.2 mg every 6 to 12 hours.
2. Dose by Injection: Inject 0.2 mg in the muscle every 6 to 12 hours.
3. Form: Use tablets of 0.2 mg or vials for...
ergometrine, heavy bleeding after childbirth, postpartum hemorrhage, dosage, administration
Administer Medications for Postpartum Hemorrhage
Critical Source: Where There is no Doctor a Village Health Care Handbook
Title: Administer Medications for Postpartum Hemorrhage

Procedure:
1. Use ergonovine or ergometrine maleate (Ergotrate, Methergine):
- Inject 0.2 mg intravenously every 15-30 minutes as needed.
2. Use oxytocin (Pitocin):
-...
postpartum hemorrhage,Ergotrate,Methergine,Pitocin,Cytotec
Administer Oxytocin to Control Postpartum Bleeding
Critical Source: Where There is no Doctor a Village Health Care Handbook
Procedure:

1. If a woman is experiencing heavy bleeding before or after the placenta has come out:
- Inject 10 units of oxytocin (e.g., _Pitocin_) into the muscle as soon as possible.
- If the bleeding does not stop within **15...
oxytocin, postpartum bleeding, ergonovine, misoprostol, emergency childbirth care
Administering Medication to Stop Postpartum Bleeding
Critical Source: A Book for Midwives
### Steps:
1. Inject 10 Units of Oxytocin:
- Inject the medication into the side of the thigh muscle.
- This dose can be repeated in 20 minutes if bleeding does not stop.

2. Alternative Medications for Bleeding:
- **Inject 0.2...
oxytocin injection, ergometrine administration, misoprostol use, postpartum hemorrhage treatment
Guide the Placenta Out by the Cord in an Emergency
Critical Source: A Book for Midwives
When to use: If the mother is bleeding heavily and cannot push the placenta out herself.

Warning: Pulling on the cord is dangerous. Only do this if you know the placenta has separated.

**Steps to guide the placenta out by the...
placenta delivery, cord guidance, postpartum bleeding, emergency, womb contraction
Identifying 4th Degree Tears
Critical Source: A Book for Midwives
Characteristics of a 4th degree tear:
• The tear goes into the vagina, perineum, muscle, rectal sphincter, and into the rectum.

Actionable Information:
• **If a mother has a 4th degree tear through her rectum, get medical help right...
4th degree tear,identification,postpartum care
Manage Postpartum Hemorrhage
Critical Source: Emergency Childbirth
Procedure:

1. Massage the uterus gently to keep it hard.
2. Have the woman lie flat, and elevate the bottom of the bed.
3. Apply a cold pack (such as a small towel dipped in cold water and wrung out) on the lower tummy to...
hemorrhage, postpartum, shock, uterine massage, cold pack, sanitary napkins, baby nursing
Manual Removal of the Placenta in Emergencies
Critical Source: A Book for Midwives
WARNING! Taking out the placenta by hand is very dangerous. It can cause serious infection, or tear the cervix, the placenta, or the womb, and cause worse bleeding. Taking the placenta out by hand is very painful for the mother, and can easily...
manual removal of placenta, postpartum hemorrhage, emergency midwifery, oxytocin injection, infection prevention
Administer Oxytocin to Assist Placental Delivery
Critical Source: A Book for Midwives
When to use: If the mother cannot push out the placenta by herself or is bleeding heavily.

Before administering oxytocin:
• Gently feel the mother’s belly to ensure there is not a second baby in the womb.

How to administer oxytocin:
1....
oxytocin, placenta delivery, postpartum bleeding, injection, misoprostol
Apply Internal Vaginal Pressure to Control Postpartum Bleeding
Critical Source: A Book for Midwives
Procedure:

1. Scrub your hands thoroughly and put on sterile gloves.
2. Explain the procedure to the mother so she understands what is happening.
3. Make your hand as small as possible and insert it into the vagina, moving it to the back of the...
vaginal pressure, internal uterine compression, postpartum hemorrhage, midwife technique
Check for Heavy Bleeding After Birth
Critical Source: A Book for Midwives
Procedure:

1. Assess Uterine Contractions:
- Check the womb immediately after the placenta is born.
- Recheck every 5 to 10 minutes for the first hour, then every 15 to 30 minutes for the next 1 to 2 hours.
- If the womb feels...
heavy bleeding, postpartum care, uterine contractions, shock signs, blood loss monitoring
Examination of the Afterbirth (Placenta)
Critical Source: Where There is no Doctor a Village Health Care Handbook
Action: When the afterbirth comes out, pick it up and examine it to see if it is complete.

Procedure:
1. Use gloves or plastic bags on your hands to handle the placenta.
2. Check for any signs of tearing or missing pieces.
3. If the...
afterbirth examination, placenta check, postpartum care, incomplete placenta
Immediate Breastfeeding of Newborn Baby
Critical Source: Where There is no Doctor a Village Health Care Handbook
Action: Place the baby at its mother’s breast as soon as the baby is born.

Purpose: This helps to make the afterbirth come out sooner and to prevent or control heavy bleeding.

Notes:
• Ensure the baby is positioned correctly for...
breastfeeding, newborn, postpartum care, afterbirth, bleeding prevention
Manage a Torn Vagina After Birth
Critical Source: A Book for Midwives
Procedure:

1. If the mother is bleeding heavily and the womb is hard, suspect that she may have a tear in her vagina.
2. Use a gloved hand to feel inside the vagina and check for any tears or lacerations.
3. If you are able to sew the tear, do...
vaginal tear management, postpartum hemorrhage, midwife care, suturing technique
Managing Delayed Placental Delivery
Critical Source: Where There is no Doctor a Village Health Care Handbook
Action: If the placenta is delayed in coming out:

Procedure:
1. Do not pull on the cord, as this could cause dangerous hemorrhage (heavy bleeding).
2. If the mother is not losing much blood, do nothing and wait.
3. Sometimes the...
delayed placenta, postpartum hemorrhage, uterine massage, placental delivery
Managing Postpartum Bleeding
Critical Source: A Book for Midwives
Procedure:

1. Monitor for heavy bleeding after birth:
- If bleeding soaks through more than one pad per hour, or if you pass large clots, seek immediate medical help.
2. Look for signs of abnormal bleeding, such as:
- Bleeding...
postpartum bleeding,heavy bleeding,emergency care,medical help,uterine contractions
Monitor the Mother After Postpartum Bleeding Interventions
Critical Source: A Book for Midwives
Procedure:

1. Keep applying pressure to the womb until it becomes firm and the bleeding has stopped.
2. Monitor the mother closely for any signs of shock, such as rapid heartbeat, low blood pressure, or confusion.
3. If the mother shows any...
monitoring postpartum hemorrhage, signs of shock, midwife care
Monitor the Mother’s Womb for Postpartum Complications
Critical Source: A Book for Midwives
Procedure:

1. Monitor the mother's womb in the first few weeks after birth to ensure it is healing properly.
2. Watch for signs that the womb is not shrinking or stopping bleeding, which may indicate complications such as retained placental...
womb monitoring,postpartum bleeding,womb infection signs,retained placenta
Recognize and Monitor Postpartum Hemorrhage
Critical Source: Where There is no Doctor a Village Health Care Handbook
Objective: Identify signs of severe postpartum hemorrhage.

Monitor the mother’s bleeding after childbirth. A small amount of blood loss is normal, but if it continues heavily or in a slow trickle for an extended period, this may indicate...
hemorrhage, postpartum bleeding, shock signs, internal bleeding, pulse monitoring
Recognize and Respond to Postpartum Heavy Bleeding
Critical Source: A Book for Midwives
Objective: Identify signs of heavy bleeding after birth and take immediate action.

Procedure:
1. Monitor the mother closely during stage 3 (delivery of the placenta) for any signs of heavy bleeding.
2. If the mother begins to bleed heavily,...
postpartum bleeding, heavy bleeding after birth, womb contraction, placenta delivery, midwife intervention
Sewing Tears After Birth
Critical Source: A Book for Midwives
Procedures for sewing tears after birth:

1. Sew tears as soon as you can after the birth so they will heal well.
2. It is best to sew a tear within 12 hours of the birth.
3. If you cannot sew within 12 hours:
- For **1st or 2nd degree...
sewing tears,postpartum care,emergency procedures
Active Management of the Third Stage of Labor
High Priority Source: A Book for Midwives
Procedure:

When to use this procedure:
• To reduce postpartum hemorrhage and ensure safe delivery of the placenta.

Steps:
1. Administer oxytocin or other uterotonic medications immediately after birth: This helps the womb contract...
active management,third stage labor,placenta delivery,uterotonic drugs,postpartum hemorrhage
Administer Medication for Postpartum Bleeding
High Priority Source: A Book for Midwives
Procedure:

1. If rubbing the womb does not stop the bleeding, administer one of the following medications:
- Oxytocin (as per dosage instructions)
- Ergometrine (as per dosage instructions)
- Misoprostol (as per dosage...
oxytocin, ergometrine, misoprostol, postpartum hemorrhage, uterine stimulation
Administer Medicines to Help the Womb Contract After Birth
High Priority Source: A Book for Midwives
Procedure:

When to use this procedure:
• To help the womb contract and push out any remaining tissue after birth.

Medications available:
Oxytocin: Can be given before or after the placenta is born.
Misoprostol: Can be given...
oxytocin,misoprostol,ergometrine,womb contraction,placenta delivery,postpartum bleeding
Administer Oxytocics for Postpartum Hemorrhage
High Priority Source: Where There is no Doctor a Village Health Care Handbook
Procedure:

1. Identify the need: Use oxytocics only if a mother is experiencing heavy bleeding after childbirth and the baby has already been delivered.
2. Check contraindications: Ensure that the mother does not have any conditions...
oxytocics, postpartum hemorrhage, medical emergency, childbirth, heavy bleeding
Administering Ergometrine to Help the Womb Contract
High Priority Source: A Book for Midwives
Procedure:

1. Administer ergometrine to help the womb contract.

Details:
• This method is used when there is a need for the womb to contract, particularly in cases of postpartum bleeding or incomplete abortion.
• Ensure that the mother is...
ergometrine, womb contraction, postpartum care, midwifery procedures
Administering Ergometrine to Stop Bleeding from the Womb
High Priority Source: A Book for Midwives
Procedure:

1. Administer ergometrine to stop bleeding from the womb.

Details:
• This method is used when there is a need to control postpartum or post-abortion bleeding.
• Ensure that the mother is monitored closely during and after...
ergometrine, stopping womb bleeding, postpartum care, midwifery procedures
Administering Oxytocin to Help the Placenta Come Out
High Priority Source: A Book for Midwives
Procedure:

1. Assess the situation: Ensure that the placenta has not already been delivered and that there is no immediate danger to the mother.
2. Prepare oxytocin: Use a syringe or injection device as instructed by medical guidelines....
oxytocin, placenta delivery, postpartum care, medical emergency
Apply Two-Hand Pressure on the Belly for Postpartum Bleeding
High Priority Source: A Book for Midwives
Procedure:

1. If bleeding is very heavy and rubbing the womb has not stopped it, apply two-hand pressure to the mother’s belly.
2. Scoop up the womb with both hands, fold it forward, and squeeze it hard between your hands.
3. Cup one hand over...
two-hand pressure, postpartum hemorrhage, uterine compression, midwife technique
Assessing Whether a Tear Needs to Be Stitched
High Priority Source: A Book for Midwives
Steps to assess whether a tear needs stitching:

1. Wash your hands well (see page 53) and then put on sterile gloves.
2. Judge how long the tear is and how much of the tissue is torn.
- Look at the tear from the outside.
- Gently...
tear assessment,stitching,postpartum care,medical emergency
Care for Mother and Baby After Delivery
High Priority Source: Emergency Childbirth
Procedure:

1. Check the amount of vaginal bleeding; a small amount (1 to 2 cups) is expected.
2. Place sanitary pads or other sanitary material around birth areas.
3. Cover both mother and baby but avoid overheating them.
4. Monitor the...
mother care, baby monitoring, vaginal discharge, hygiene, postpartum rest
Monitor the Mother’s Legs for Redness, Hardness, or Swelling
High Priority Source: A Book for Midwives
Procedure:

1. Check the mother's legs regularly in the first few weeks after birth.
2. Look for signs of redness, hardness, or swelling, which may indicate a blood clot (thrombophlebitis) or other circulatory issues.
3. If any of these symptoms...
leg swelling,redness,hardness,blood clot signs
Monitoring the Mother's Womb and Bleeding After Birth
High Priority Source: A Book for Midwives
Objective: Monitor the mother’s womb and bleeding to detect complications early.

Healthy Signs:
• The mother should bleed about the same amount as a normal monthly period or less.
• Bleeding should stop after 2–3 weeks, though it may last...
womb monitoring, postpartum bleeding, womb contraction, shock signs
Prevent Postpartum Bleeding with Medication
High Priority Source: Where There is no Doctor a Village Health Care Handbook
Procedure:

1. Some authorities recommend giving all women a single dose of oxytocin, ergonovine, or misoprostol after childbirth to help prevent heavy bleeding.
2. This practice may treat some women unnecessarily with...
prevent postpartum bleeding, oxytocin, ergonovine, misoprostol, midwife protocols
Prioritize Care for Mother and Baby After Birth
High Priority Source: A Book for Midwives
Procedure:

After the baby is born, decide who needs care first based on their condition:

1. If the mother is healthy and not bleeding heavily, prioritize caring for the baby.
2. If the mother has risk signs, such as heavy bleeding,...
mother-baby care prioritization, postpartum emergency, neonatal and maternal health
Rub the Womb to Control Postpartum Bleeding
High Priority Source: A Book for Midwives
Procedure:

1. Teach the mother and her family how to check the womb for firmness.
2. Rub the womb in a circular motion until it becomes hard. This helps stimulate contractions and reduce bleeding.
3. Use one hand to cup over the top of the...
womb rubbing, postpartum bleeding, uterine massage, contraction stimulation, midwife technique
Watch for Leaking Urine or Stool in the Mother
High Priority Source: A Book for Midwives
Procedure:

1. Monitor the mother for any signs of leaking urine or stool after birth.
2. This may indicate a neurological issue or injury during childbirth that affects bladder or bowel control.
3. If this occurs, seek medical assistance...
urinary leakage,stool leakage,bladder control,bowel control
Addressing a Mother Who Cannot or Will Not Eat/Drink After Birth
High Priority Source: A Book for Midwives
Procedure:

1. If the mother cannot or will not eat or drink after 2 to 3 hours:
- Check for illness: Look for signs of bleeding (see page 236), infection (see page 271), and other symptoms that may be affecting her appetite.
-...
refusal to eat, postpartum depression, nutritional needs, postpartum care
Monitor the Mother During the First Few Hours After Birth
High Priority Source: A Book for Midwives
Procedure:

1. Observe for signs of recovery and healing:
- The mother’s uterus should begin to contract and become firm after birth.
- These contractions are normal and help reduce postpartum bleeding.

2. **Monitor the mother’s...
postpartum monitoring,breastfeeding,urination,meconium,uterine contractions
Support the Mother During and After Delivery
High Priority Source: Emergency Childbirth
Procedure:

1. Stay with the mother until relieved by competent personnel.
2. Continually reassure the mother to keep her calm, as this is a relatively dangerous period for her due to the risk of hemorrhage and shock.
3. Ensure that she...
emotional support, mother monitoring, postpartum care, reassurance
Understand Childbirth Fever and Its Consequences
High Priority Source: Where There is no Doctor a Village Health Care Handbook
Childbirth fever (also called childbed fever, womb infection, postpartum infection, or puerperal infection) is the fever and infection that mothers sometimes develop after childbirth.
childbirth fever,womb infection,puerperal infection
Using Misoprostol to Help the Placenta Come Out
High Priority Source: A Book for Midwives
Procedure:

1. Assess the situation: Ensure that the placenta has not already been delivered and that there is no immediate danger to the mother.
2. Prepare misoprostol: Use the correct dosage based on clinical guidelines, typically 400...
misoprostol, placenta delivery, postpartum care, medical emergency
Using Misoprostol to Stop Bleeding from the Womb
High Priority Source: A Book for Midwives
Procedure:

1. Assess the situation: Ensure that the patient is experiencing postpartum hemorrhage and is a suitable candidate for misoprostol use (e.g., no contraindications such as allergy or hypersensitivity).
2. Prepare misoprostol:...
misoprostol, postpartum hemorrhage, womb bleeding, medical emergency
Help the Mother Urinate After Birth
Standard Source: A Book for Midwives
Procedure:

1. Ask the mother to urinate within the first 2 to 3 hours after birth.

2. If she is too tired to get up and walk, help her squat over a bowl on the bed or floor, or allow her to urinate into a towel or thick cloth while lying...
urinate after birth, postpartum urination, full bladder, catheter insertion
Managing Urinary Incontinence After Birth
Standard Source: A Book for Midwives
Procedure:

Steps to Manage Urinary Incontinence After Birth:

1. **Assess the Situation:
- Check if the mother is experiencing leaking freely after birth or difficulty urinating.
- Look for signs of infection such as pain, burning, or...
urinary incontinence, postpartum care, catheter, infection prevention
Assess and Address Dehydration in a Postpartum Mother
Standard Source: A Book for Midwives
Procedure:

Step 1: Check for signs of dehydration (see page 159).

Step 2: Provide the mother with large amounts of water and other fluids to drink.

Note: If she continues to have a fever, this may indicate an infection. Refer to...
dehydration, postpartum care, fluid intake, infection signs
Avoid Use of Vitamin K for Postpartum Bleeding
Standard Source: Where There is no Doctor a Village Health Care Handbook
Objective: Understand that vitamin K is not effective in controlling postpartum hemorrhage.

Do not give vitamin K to adults who are experiencing heavy bleeding after childbirth, miscarriage, or abortion. It is only helpful for...
vitamin K, postpartum hemorrhage, ineffective treatment
Identify the Umbilical Cord Vessels
Standard Source: A Book for Midwives
Purpose: To identify the umbilical cord vessels for proper care and monitoring.

1. Carefully examine the end of the umbilical cord.
2. Look for 3 holes1 large hole (vein) and 2 small holes (arteries). These represent the blood...
umbilical cord,vessels,arteries,vein,birth monitoring
Managing and Assisting in the Birth of the Placenta (Stage 3 of Labor)
Standard Source: A Book for Midwives
Procedure:

1. Monitor for signs that the placenta has separated:
- Look for a gush of blood from the vagina.
- Observe if the umbilical cord lengthens or shortens, or slips out.
- Check if the uterus becomes firm and rises in the...
placenta birth, stage 3 labor, postpartum care, retained placenta, uterine contraction
Postpartum Diet and Cleanliness for the Mother
Standard Source: Where There is no Doctor a Village Health Care Handbook
Procedure:

Step 1: Nutritious Diet:
- The mother should eat every kind of nutritious food she can get. She does not need to avoid any type of food.
- Especially good foods include milk, cheese, chicken, eggs, meat, fish, fruits,...
postpartum care, mother's health, diet, cleanliness, breastfeeding
Postpartum Self-Care Procedures for the Mother
Standard Source: A Book for Midwives
Objective: Help the mother care for herself after childbirth to prevent infections and promote healing.

Steps:
1. Get plenty of rest. This is crucial for recovery, especially in the first few weeks after birth.
2. **Eat a variety of...
postpartum care, rest, nutrition, hygiene, infection prevention, family planning
Recognize and Respond to Postpartum Hemorrhage
Standard Source: A Book for Midwives
Procedure:

When to use this procedure:
• To identify and manage postpartum hemorrhage (excessive bleeding after childbirth).

Signs of postpartum hemorrhage:
• Heavy vaginal bleeding that soaks more than one pad per hour.
• A drop in...
postpartum hemorrhage, heavy bleeding, oxytocin, uterine massage, placenta delivery, shock, emergency care
Supporting a Family After the Loss of a Baby
Standard Source: A Book for Midwives
Procedure:

1. Recognize that grief and emotional distress are normal after losing a baby.
2. Provide emotional support to the mother, father, and other family members by listening and acknowledging their feelings.
3. Respect **cultural...
grief support,breast engorgement,postpartum care,cultural practices
Breastfeeding Support and Management for Midwives
Reference Source: A Book for Midwives
Breast is best:

• Encourage the mother to breastfeed as soon as possible after birth, ideally within the first hour.
• Explain the benefits of breastfeeding, including nutrition, immunity, and bonding between mother and baby.

**How to...
breastfeeding support, midwife procedures, lactation management
Checking the Placenta and Umbilical Cord After Delivery
Reference Source: Emergency Childbirth + A Book for Midwives
1. Whether the placenta comes out by itself or you guide it out, check to see that it is all there.

• Usually the placenta comes out whole, but sometimes a piece of it is left inside the womb. This can cause bleeding or infection later.
• To...
placenta, umbilical cord, delivery, postpartum care, infection prevention, sterile conditions

Animal Health (52)

Understanding the Cattle Plague (Rinderpest) and Its Stages
Critical Source: The Household Cyclopedia
Overview:
• The cattle plague, also known as rinderpest, is a virulent, contagious, febrile disease that does not recur in affected animals.

Stages of the Disease:
1. Incubation Period (3–4 days):
- The animal's blood and humors are...
cattle plague, rinderpest, animal disease, contagious typhus
Recognizing Symptoms of Ox Typhus Fever in Livestock
Critical Source: The Household Cyclopedia
Procedure:

1. Observe for early signs:
- Watch for changes in gait, behavior, or appetite.
- Note any unusual signs such as reduced activity, dispiritedness, or irregular rumination.
2. Monitor feeding and grazing habits:
- If...
ox typhus fever, cattle symptoms, animal illness signs, livestock disease recognition
Treatment for Farcy in Animals
Critical Source: The Household Cyclopedia
Procedure:

1. Open the ulcers and gently touch the inside of the edges with powdered verdigris using a camel's hair pencil.
2. Administer the following ball:
- White arsenic: 8 grains, or corrosive sublimate: 6 grains
-...
farcy, animal treatment, ulcers, veterinary care
Treatment for Inflammation of the Lungs in Horses
Critical Source: The Household Cyclopedia
Procedure:

1. Bleed the animal copiously as soon as symptoms are detected.
2. Repeat the bleeding after six hours if fever or rapid breathing persists.
3. Apply a blister to the sides and use a rowel on the chest for...
lung inflammation, horse treatment, bleeding, veterinary care
Distinguish Ox Typhus (Cattle Plague) from Pleuro-Pneumonia in Cattle
High Priority Source: The Household Cyclopedia
Procedure:

To distinguish ox typhus (cattle plague) from pleuro-pneumonia in cattle, observe the following symptoms:

1. Onset of Symptoms:
- In pleuro-pneumonia, the attack is generally insidious (gradual onset).
- In **ox...
ox typhus,cattle plague,pleuro-pneumonia,disease distinction,animal health
Preventive Measures to Control Disease Spread in Livestock
High Priority Source: The Household Cyclopedia
Procedure:

1. Remove and destroy all infectious materials:
- All articles that have come into contact with a diseased animal or its discharges, especially dung, must be regarded as infectious.
- These items should be burned or buried...
disease prevention, livestock health, infectious materials, cattle care, hygiene practices
Remedies for Treating Cattle Plague as Reported by U.S. Consul in Liverpool (1866)
High Priority Source: The Household Cyclopedia
Procedure:

1. First remedy:
- Ingredients:
- 1 oz. Peruvian bark
- 1 oz. gentian
- 1 oz. ground ginger
- 2 drs. sulphate of iron
- 4 table-spoonfuls molasses
- 1 glass brandy or whisky
- Dose:...
cattle plague, treatment, remedies, livestock health
Treat Convulsions in Horses
High Priority Source: The Household Cyclopedia
Symptoms of Convulsions:
• Horse raises its head higher than usual.
• Ears are pricked up or thrust back.
• Neck is stiff and immovable.
• Skin appears tight.
• Horse stands in a straddling posture, pants, and breathes with...
convulsions,bloodletting,worms,bots
Treat Strangles in Horses
High Priority Source: The Household Cyclopedia
Procedure:

1. Identify the swelling between the jawbone and the root of the tongue.
2. If a large tumor appears under the jaw:
- Apply a suppurating poultice.
3. When the tumor is ripe:
- Open it, squeeze out the matter, and apply...
strangles treatment, horse care, veterinary treatment
Treat Thrush in Horses
High Priority Source: The Household Cyclopedia
Procedure:

1. Remove the shoe and pare off all ragged parts to expose the diseased areas.
2. Clean the frog thoroughly.
3. Apply a solution of blue vitriol to the affected area.
4. Shortly after, pour some melted tar ointment into...
thrush treatment, hoof care, horse care, veterinary treatment
Treat Vives in Horses
High Priority Source: The Household Cyclopedia
Procedure:

1. Identify the disease: A long swelling of the parotid gland beginning at the root of the ears and descending downwards.
2. If it is painful and inflamed:
- Apply a poultice.
3. If it suppurates:
- Open the...
vives treatment, horse care, veterinary treatment
Treating Worms in Dogs
High Priority Source: The Household Cyclopedia
To treat worms in dogs:

1. Symptoms: Worm infestations can cause fits and may be fatal if the worms reach the nostrils or windpipe.
2. Treatment Options:
- For intestinal worms: Use powdered glass mixed with butter or lard, rolled into a...
worms in dogs,dog deworming,cowhage,powdered glass,turpentine avoidance
Treatment for Film or Cataract in Animals
High Priority Source: The Household Cyclopedia
Procedure:

There is no remedy for film or cataract other than an operation performed by a surgeon. Various washes and remedies recommended by authors are ineffective.

Notes:
• This condition requires surgical intervention.
• No home...
film, cataract, animal surgery, veterinary care
Treatment for Foundered Feet in Horses
High Priority Source: The Household Cyclopedia
Procedure:

1. Remove the shoe from the affected hoof.
2. Perform a free bleed from the thigh vein.
3. Administer purges two or three times as needed.
4. Keep the horse's hair trimmed closely and maintain cleanliness in the...
foundered feet, horse treatment, bleeding, veterinary care
Treatment for Molten Grease or Dysentery in Horses
High Priority Source: The Household Cyclopedia
Procedure:

1. Bleed and purge moderately as needed.
2. Feed the horse regularly but with a reduced allowance of food.
3. Use back-raking and administer large injections for treatment.

Notes:
• Molten grease or dysentery...
molten grease, dysentery, horse treatment, veterinary care
Treatment for Pollevil in Horses
High Priority Source: The Household Cyclopedia
Procedure:

1. Bring the swelling to a head by using a suppurating poultice, made as follows:
- Take four handsful of bran and three medium-sized turnips.
- Boil them until soft, then beat them together.
- Boil again in...
pollevil, horse treatment, suppurating poultice, veterinary care
Administer Medicine for Distemper in Full-Grown Dogs
High Priority Source: The Household Cyclopedia
Ingredients:
• Opium: 3 grains
• Tartar emetic: 5 grains

Procedure:
1. Administer the mixture of opium and tartar emetic to a full-grown dog at night.
2. Repeat every third night until recovery, ensuring the dog is kept warm and fed with...
dog,distemper,opium,tartar emetic
Administer Medicine for Full-Grown Pointers with Distemper
High Priority Source: The Household Cyclopedia
Ingredients:
• Jalap powder: 30 grains
• Calomel: 8 grains
• Gum-water: small amount

Procedure:
1. Make a pill by mixing jalap powder and calomel with gum-water.
2. Administer the pill to a full-grown pointer every morning on an empty...
dog,distemper,jalap,calomel
Administer Purgative Drink for Frenzy or Inflammation of the Brain in Cattle
High Priority Source: The Household Cyclopedia
Procedure:

1. Prepare the following ingredients:
- Glauber salts: 1 pound
- Tartarized antimony: 1 drachm
- Camphor: 2 drachms
- Treacle: 4 ounces

2. Mix all the ingredients together in a pitcher.

3. Pour 3 pints of boiling water...
frenzy,cattle,inflammation_brain,purgative_drink
Maintaining Poultry Health and Preventing Disease
High Priority Source: Practical Pointers On The Care of Lifestock
Procedure:

1. Disinfect the poultry house thoroughly before winter quarters are prepared, using a strong solution of Pratts Poultry Disinfectant to kill all germs.
2. Keep the house clean by removing damp or soiled litter and replacing...
disinfection, lice treatment, poultry disease prevention, ventilation, Pratts Poultry Regulator
Prevent and Treat Hoven or Blown in Cattle
High Priority Source: The Household Cyclopedia
Procedure for Prevention:

1. Avoid feeding cattle on rich succulent food for extended periods.

2. Ensure that cattle do not overeat by limiting their time in pastures with abundant grass.

3. After grazing, move the animals to a fold yard or...
hoven,cattle,treatment,purging_drink
Treat Canker in Horses
High Priority Source: The Household Cyclopedia
Procedure:
1. Cut away all diseased parts of the affected area.
2. If necessary, draw out any frogs (a term referring to a part of the hoof).
3. Prepare and apply the following liniment for canker:
- Warm 6 ounces of tar.
- Mix...
canker,tar,oil of vitriol,lunar caustic,green ointment
Treat Distemper in Cattle
High Priority Source: The Household Cyclopedia
Procedure:
1. Examine the cow's mouth for pimples or swellings on the tongue or within the skin.
2. If any signs of distemper are found, immediately house the cow and keep her warm.
3. Administer warm tarwater: 1 gallon for large cattle, 3...
cattle,distemper,tarwater,gruel
Treat Eye Inflammation in Horses
High Priority Source: The Household Cyclopedia
Procedure:
1. Scarify the inside of the upper and lower brow with a lancet, and also scarify the distended vessels of the eye itself.
2. Treat the inflammation as you would treat a human being with the same condition.
3. Keep the horse on a...
eye inflammation,sugar of lead,white vitriol,bleeding,scarify
Treat Redwater in Cattle
High Priority Source: The Household Cyclopedia
Ingredients:
• Armenian bole: 1 ounce
• Dragon's blood: 1/2 ounce
• Castile soap: 2 ounces
• Alum: 1 drachm
• Hot ale or beer: 1 quart

Procedure:
1. Dissolve all ingredients in a quart of hot ale or beer.
2. Let the mixture stand until it...
cattle,redwater,armenian bole,castile soap
Treat Sand-Crack (Superficial Injury)
High Priority Source: The Household Cyclopedia
Procedure:

1. Remove the shoe and carefully assess the extent of the injury.
2. If the crack is superficial:
- Fill it with the composition described below.
- Keep the foot cool and moist.
3. If the crack has extended to the...
sand-crack, hoof care, veterinary treatment, foot injury
Treat Wind Galls in Horses
High Priority Source: The Household Cyclopedia
Procedure:

1. Identify the swellings on each side of the back sinew above the fetlock.
2. Avoid puncturing them, as this may cause an incurable lameness.
3. Apply tight bandages to the affected area.
4. Frequently moisten the parts...
wind galls treatment, horse care, veterinary treatment
Treating Distemper in Dogs
High Priority Source: The Household Cyclopedia
To treat distemper in dogs:

1. Symptoms: Look for symptoms such as a runny nose and eyes, short dry cough, weight loss, weakness, and lethargy.
2. Progression: The condition may progress to brain-related issues like fits, paralysis of the...
distemper in dogs,dog treatment,canine distemper,magnesia,sulphur
Treating Mange in Dogs
High Priority Source: The Household Cyclopedia
To treat mange in dogs:

1. Symptoms: Mange is similar to the itch in humans and can cause severe discomfort.
2. Treatment Steps:
- Wash the affected areas with soft soap.
- Apply sulphur ointment to the skin.
3. Important Note:...
mange in dogs,dog mange,sulphur ointment,skin treatment
Treatment for Hoof-bound in Horses
High Priority Source: The Household Cyclopedia
Procedure:

1. Cut down several lines from the coronet to the toe, all around the hoof.
2. Fill the cuts with a mixture of tallow and soap.
3. Remove the shoes if possible.
4. If feasible, turn the horse into a wet meadow to...
hoof-bound, horse treatment, tallow and soap, veterinary care
Treatment for Laxity in Horses
High Priority Source: The Household Cyclopedia
Procedure:

1. Do not attempt to stop the discharge too suddenly or too soon, as this can be fatal.
2. Begin treatment with a mild purging ball consisting of:
- Rhubarb powder: 1 ounce
- Magnesia: half an ounce
-...
laxity, horse treatment, purging ball, veterinary care
Treatment for Mallenders in Horses
High Priority Source: The Household Cyclopedia
Procedure:

1. Wash the cracks in the kneejoint with warm soap-suds and a sponge.
2. Rinse the area with vulnerary water twice daily.
3. Wipe the parts dry after washing.
4. Apply citrine ointment or white lead cerate to the...
mallenders, horse treatment, vulnerary water, veterinary care
Administer Herbal Drink to Treat Jaundice in Neat Cattle
Standard Source: The Household Cyclopedia
Procedure:

1. Prepare the following ingredients:
- Cummin-seeds, anise-seeds, and turmeric root: 2 ounces each
- Grains of paradise and salt of tartar: 1 ounce each

2. Reduce all the above to powder.

3. Slice 1 ounce of Castile soap and...
jaundice,cattle,treatment,herbal_drink,bloodletting
Administering Purgative Balls for Horses
Standard Source: The Household Cyclopedia
Procedure:

1. Ingredients for Purgative Balls:
- Barbadoes aloes: 7 1/2 ounces
- Castile soap: 1 1/2 ounces
- Powdered ginger: 1 1/2 ounces
- Oil of aniseed: 5 drachms
- Syrup: sufficient quantity to make 6 balls, each being...
horse,purge,balls,aloes,ginger
Astringent Drink After Looseness in Horses
Standard Source: The Household Cyclopedia
Procedure:

1. Ingredients for Astringent Drink:
- Pomegranate shell (powdered): 1 ounce
- Prepared testaceous powder: 1 ounce
- Dover's powders: 2 drachms
- Powdered ginger: 2 drachms

2. Preparation and Administration:
-...
horse,astringent,looseness,pomegranate,testaceous
Cough Drink for Horses
Standard Source: The Household Cyclopedia
Procedure:

1. Ingredients for Cough Drink:
- Barbadoes tar: 1 ounce
- Gum ammoniac: 1 ounce
- Yolk of an egg: 1
- Nitre: 1 ounce
- Ginger: half an ounce
- Tincture of opium: 1 ounce

2. Preparation and Administration:
...
horse,cough,drink,tar,gum ammoniac
Drink for Inflammatory Fever in Horses
Standard Source: The Household Cyclopedia
Procedure:

1. Ingredients for Inflammatory Fever Drink:
- Tartar emetic: 1 drachm
- Camphor: 1 drachm (rubbed into powder)
- Spirit of wine: a few drops

2. Preparation and Administration:
- Mix the tartar emetic and camphor...
horse,fever,tartar emetic,camphor
Drink to Check Over-Purging in Horses
Standard Source: The Household Cyclopedia
Procedure:

1. First Recipe for Over-Purging Drink:
- Ingredients:
- Prepared chalk: 1 ounce
- Ginger: 1 ounce
- Aniseeds: 1 ounce
- Essential oil of peppermint: 15 drops
- Rectified spirit of wine: 1/2 an ounce
...
horse,over-purging,drink,chalk,aniseed
Fever Ball for Horses
Standard Source: The Household Cyclopedia
Procedure:

1. Ingredients for Fever Ball:
- Antimonial powder: 1 drachm
- Tartarized antimony: 1 drachm
- Camphor: 1 drachm
- Nitre: 2 drachms
- Castile soap: 2 drachms
- Barbadoes aloes: 2 drachms
- Syrup of buckthorn:...
horse,fever,ball,antimony,camphor
Powerful Mixture for Fevers in Horses
Standard Source: The Household Cyclopedia
Procedure:

1. Ingredients for Powerful Mixture:
- Tartar emetic: 1 ounce
- Calcined hartshorn: 1 ounce

2. Preparation and Administration:
- Mix and grind the ingredients in a mortar to a fine powder.
- Store the mixture in...
horse,fever,tartar emetic,hartshorn
Prepare Tar-Water for Cows
Standard Source: The Household Cyclopedia
Ingredients:
• Tar: 1 quart
• Water: 4 quarts

Procedure:
1. Mix 1 quart of tar with 4 quarts of water and stir well for ten to twelve minutes.
2. Let the mixture stand briefly before pouring off for use.
3. Do not reuse the same tar more...
cattle,tarwater,tar,water
Purgative Drink for Horses
Standard Source: The Household Cyclopedia
Procedure:

1. Ingredients for Purgative Drink:
- Epsom salts: 4 ounces
- Nitre: 1/2 an ounce
- Coarse sugar: two tablespoonsful
- Castor oil: 10 ounces

2. Preparation and Administration:
- Dissolve the Epsom salts,...
horse,purge,drink,Epsom salts,castor oil
Treat Acute Cough in Horses
Standard Source: The Household Cyclopedia
Procedure:
1. Take a quart of blood from the horse's neck.
2. Administer the following ball for cough:
- Venice soap: ½ ounce
- Nitre: ½ ounce
- Tartar emetic: 10 grains
- Opium: 10 grains
3. Mix these ingredients...
acute cough,venice soap,nitre,tartar emetic,opium,castor oil
Treat Diabetes in Horses
Standard Source: The Household Cyclopedia
Procedure:
1. Administer the following ball for diabetes:
- Peruvian bark: 4 drachms
- Ginger: 1 drachm
2. If costiveness occurs after administration, give a pint of castor oil.
3. Repeat this treatment as necessary.
diabetes,peruvian bark,ginger,castor oil
Treat Garget in Cows
Standard Source: The Household Cyclopedia
Procedure:
1. Anoint the affected area of the udder three times a day with an ointment made from camphor and blue ointment.
2. If the disorder is severe, administer half a drachm or more of calomel mixed in warm beer using a horn or bottle for...
cattle,garget,camphor,calomel
Treat Sit-Fasts on Horses
Standard Source: The Household Cyclopedia
Procedure:

1. Use a pair of pincers to remove the sit-fasts radically.
2. Ensure no part is left behind, as they will grow again.
3. Dress the wound with green ointment.
sit-fasts, horse care, veterinary treatment
Administer Paste-Ball for Broken-Winded Horses
Standard Source: The Household Cyclopedia
Ingredients:
• Assafoetida: 2 ounces
• Powdered squills: 2 drachms
• Linseed powder: 1 ounce
• Honey: as much as needed to make a mass

Procedure:
1. Mix all ingredients together until the mass is formed.
2. Divide the mixture into four...
paste-ball,broken-winded horses,assafetida,powdered squills,honey
Preparing Horses for Physic
Standard Source: The Household Cyclopedia
Procedure:

1. Preparation Steps:
- Give the horse two or three mashes of scalded bran and oats with warm water for three to four days prior to administering a purge.
- This softens the feces and promotes the operation of the...
horse,physic,preparation,bran,mash,purge
Treat Cold in Horses
Standard Source: The Household Cyclopedia
Procedure:
1. Take a quart of blood from the horse's neck.
2. Administer warm mashes with a scruple of nitre (a small quantity, typically about 1 grain) mixed in.
3. Purge the horse using castor and linseed oil.
4. Ensure the stable...
cold in horses,bloodletting,warm mashes,nitre,castor oil
Treat Ring Bone (Recent)
Standard Source: The Household Cyclopedia
Procedure:

1. If the ring bone is recent, blister the part.
2. For old affection, recourse must be had to firing.
ring bone, blistering, animal health, veterinary care
Treat Sallenders on Horses
Standard Source: The Household Cyclopedia
Procedure:

1. Apply the same treatment as mallenders (see procedure for mallenders).
2. Note that sallenders differ from mallenders only in being located at the bend of the hock-joint.
sallenders, horse care, veterinary treatment
Identify and List Diseases in Horses
Reference Source: The Household Cyclopedia
The following is a list of 63 diseases that can affect horses:

1. Glanders
2. Slabbering
3. Parrot-mouth
4. Lower jaw fistula
5. Upper jaw fistula
6. Blindness
7. Jaw fistula
8. Lopped ears
9. Rabbit ears
10....
horse diseases, equine health, animal medical conditions, veterinary procedures

Reproductive Health (50)

Recognize Danger Signs After an Abortion
Critical Source: Where There is no Doctor a Village Health Care Handbook
Danger signs following an abortion include:

Fever
Pain in the belly
Heavy bleeding from the vagina

These signs could indicate complications such as infection, severe bleeding, or other life-threatening conditions. If any of...
abortion,danger signs,fever,belly pain,heavy bleeding,medical help
Steps to Remove an IUD (Medical Procedure)
Critical Source: A Book for Midwives
Procedure:

1. Wash hands thoroughly and put on sterilized gloves.
2. Perform a bimanual exam to check for pregnancy and assess the womb's position.
3. Insert a speculum into the vagina.
4. Use a long swab or ring forceps...
IUD removal steps, medical procedure, reproductive health
Inducing Abortion Using Herbal Methods
High Priority Source: Survival and Austere Medicine
Warning: This procedure involves potentially dangerous actions that can lead to severe complications or death. It is highly recommended to consult a trained medical professional for any form of abortion.

If you are considering using herbal...
abortion, herbal methods, reproductive health, emergency medicine
Injection to Numb the Cervix for MVA
High Priority Source: A Book for Midwives
Objective: Administer a local anesthetic to reduce discomfort during MVA.

Steps:
1. Select Appropriate Anesthetic:
- Choose a safe and effective local anesthetic, such as lidocaine or bupivacaine.
2. Prepare the Injection Site:
...
manual vacuum aspiration, cervical numbing, local anesthesia, pain management
Recognizing Signs That the IUD May Be Malfunctioning or Removed
High Priority Source: A Book for Midwives
Procedure:

• If the woman cannot feel the strings of the IUD during a monthly check, she must seek immediate medical help.
• A health worker should use forceps to reach inside the womb or perform a sonogram to locate the IUD.
-...
IUD removal signs, pregnancy symptoms, reproductive health
Recognizing Signs of Infection After IUD Insertion
High Priority Source: A Book for Midwives
Procedure:

• Watch for the following signs of infection:
- Very heavy bleeding.
- Blood between monthly periods (a little spotting can be normal in the first month).
- Abnormal vaginal discharge.
- **Pelvic or abdominal...
IUD infection signs, reproductive health
Surgical Abortion in an Austere Situation
High Priority Source: Survival and Austere Medicine
Warning: This procedure involves potentially dangerous actions that can lead to severe complications or death. It is highly recommended to consult a trained medical professional for any form of abortion.

In an austere situation with limited...
surgical abortion, reproductive health, emergency medicine, austere conditions
Contraindications for IUD Insertion
High Priority Source: A Book for Midwives
Procedure:

Do not insert an IUD in a woman who:

• Has an STI (e.g., chlamydia, gonorrhea). If inserted during an STI, it can spread to the womb and cause serious infections.
• Recently had an infection in her womb, or has had an...
IUD contraindications, reproductive health, medical procedures, STI screening
History and Removal of the Dalkon Shield IUD
High Priority Source: A Book for Midwives
Procedure:

• The Dalkon Shield was an unsafe IUD used in the 1970s that caused serious health complications for users.
• It is no longer produced, but some women may still have it in their wombs and should have it removed immediately...
Dalkon Shield removal, unsafe IUD history
Managing Post-Abortion Care
High Priority Source: A Book for Midwives
Procedure:

1. Provide emotional support to the woman after an abortion:
- Listen actively and validate her feelings.
- Offer reassurance that it is normal to feel a range of emotions.
- Encourage her to seek professional counseling if...
post-abortion care, emotional support, physical recovery, infection signs, tetanus prevention
Recognizing Danger Signs with an IUD
High Priority Source: A Book for Midwives
Procedure:

A woman with an IUD should seek medical help immediately if any of the following danger signs appear:

Late or missed monthly bleeding, or unusual spotting between periods
Persistent abdominal pain that does not...
IUD, danger signs, reproductive health, infection symptoms
Recognizing and Responding to Post-Abortion Complications
High Priority Source: A Book for Midwives
Procedure:

1. Monitor for signs of excessive bleeding after an abortion:
- Track the amount of blood loss (e.g., using sanitary pads).
- If bleeding is heavy (soaking through more than two pads per hour), seek immediate medical help.

2....
post-abortion complications, infection signs, shock symptoms, incomplete abortion, tetanus prevention
Removing the IUD
High Priority Source: A Book for Midwives
Procedure:

• The Copper T IUD can remain in place for up to 10 years, but other types may not be effective for this long.
• Any IUD can be removed at any time if desired by the woman.
• After removal, a woman can become pregnant...
IUD removal, reproductive health
Training and Legal Considerations for MVA
High Priority Source: A Book for Midwives
Objective: Ensure that midwives are properly trained and legally allowed to perform MVA.

Steps:
1. Understand Infection Prevention and Pelvic Exams:
- Before learning MVA, ensure you have a solid understanding of infection prevention...
manual vacuum aspiration, training requirements, legal considerations, infection prevention
Adjusting the Inserter to Match Uterine Size
Standard Source: A Book for Midwives
Steps to Adjust the Inserter:

1. Look at the IUD inside the package.
2. The inserter tube has a small movable gauge on it in the package.
3. Move the gauge on the tube to the same size as the womb by pushing on the gauge while the sterile IUD...
inserter adjustment, uterine sizing, IUD placement
Assessing a Woman for STI Before IUD Insertion
Standard Source: A Book for Midwives
Procedure:

1. Ask the woman if she has any signs of an STI. Signs include:
- Bad-smelling discharge from the vagina.
- Pain, itching, or burning in the vagina.
- Pain, itching, or burning when urinating.
- Sores on the vagina or...
IUD insertion, STI screening, reproductive health, medical procedures
Assessing the Uterus Before IUD Insertion
Standard Source: A Book for Midwives
Steps to Assess the Womb:

1. Feel the woman’s womb (see page 384).
2. Find the position and size of the womb.
3. Make sure the woman is not pregnant.
4. Ensure the womb is not enlarged or in pain.

Important Notes:
• This step is crucial to...
uterus assessment, IUD eligibility, midwifery examination
Checking the IUD for Proper Placement
Standard Source: A Book for Midwives
Procedure:

Wash hands thoroughly before beginning.
• Insert a finger into the vagina and locate the cervix.
• Feel for the strings of the IUD coming from the cervical opening.
• If the strings cannot be felt, this may indicate...
IUD check, strings, cervical exam, reproductive health
Community Engagement to Prevent Unsafe Abortions
Standard Source: A Book for Midwives
Objective: Work with the community to prevent unsafe abortions and promote women's health.

Steps:
1. Identify the root causes of unsafe abortions in your community, such as lack of access to family planning services or harmful cultural...
unsafe abortions, community engagement, reproductive health, family planning, legal reform, education
Grasping the Cervix and Straightening the Womb
Standard Source: A Book for Midwives
Steps to Grasp the Cervix:

1. Grasp the cervix with a tenaculum and close the tenaculum slowly.
2. Pull the cervix gently to straighten the womb.
3. The womb must be straight while inserting the sound and IUD.
4. If this is painful for the...
cervix grasping, womb straightening, IUD insertion technique
Hand Hygiene and Sterilization for IUD Insertion
Standard Source: A Book for Midwives
Steps to Prepare Hands and Instruments:

1. Follow the instructions on page 53 to scrub your hands with soap and water.
2. Let your hands dry in the air and then put on sterilized gloves.

Important Notes:
• Hand hygiene is critical to...
hand hygiene, sterilization, IUD insertion protocol
Informed Consent and Education Before IUD Insertion
Standard Source: A Book for Midwives
Procedure:

1. Explain the process of IUD insertion to the woman.
- Inform her that it may cause some discomfort but should not be extremely painful.
- Let her know you will stop if she experiences excessive pain or requests to stop...
informed consent, IUD insertion, patient education, reproductive health
Inserting the Speculum and Cleaning the Cervix
Standard Source: A Book for Midwives
Steps to Insert the Speculum and Clean the Cervix:

1. Gently insert a sterilized speculum (see page 377).
2. Clean the cervix with antiseptic using a long swab or a ring forceps and sterile gauze dipped into antiseptic.

Important Notes:
-...
speculum insertion, cervical cleaning, IUD preparation
Measuring the Uterus with a Sterile Sound
Standard Source: A Book for Midwives
Steps to Measure the Womb:

1. Insert a sterile sound through the opening of the cervix and into the womb.
2. Hold the sound only by the handle, and carefully insert it into the cervix.
3. Do not let it touch anything but the cervix — this will...
uterus measurement, sterile sound insertion, IUD sizing
Preparing the Patient for IUD Insertion
Standard Source: A Book for Midwives
Steps to Prepare the Woman:

1. Have the woman lie on her back with her knees bent and open.
2. Help the woman relax by taking deep breaths with her, speaking quietly, or putting a reassuring hand on her shoulder.

Important Notes:
• Ensure...
IUD preparation, patient positioning, midwifery care
Supporting a Woman After an Abortion
Standard Source: A Book for Midwives
Procedure:

1. Provide emotional support:
- Encourage the woman to express her feelings and listen without judgment.
- Reassure her that it is normal to feel sadness, relief, or anxiety after an abortion.

2. Offer practical assistance:
...
emotional support, physical recovery, complication monitoring, follow-up care
Trimming the IUD Strings and Post-Insertion Care
Standard Source: A Book for Midwives
Steps to Trim the Strings and Complete the Procedure:

1. Cut the strings so that about 2 centimeters hang out of the cervix.
2. Gently remove the tenaculum and the speculum.
3. Put all the instruments and gloves in bleach solution or another...
IUD string trimming, post-insertion care, midwifery hygiene
Understanding IUD Bleeding Patterns and Risks
Standard Source: A Book for Midwives
Procedure:

• The Copper T IUD may cause:
- Heavier monthly bleeding
- More painful cramping
- Increased risk of anemia due to blood loss
• The Mirena IUD may cause:
- Lighter or no monthly bleeding
- Irregular bleeding and...
IUD, bleeding patterns, risks, reproductive health
Administer Emergency Contraception (Birth Control Pills) and Understand Birth Control Pill Use, Side Effects, and Limitations
Standard Source: Where There is no Doctor a Village Health Care Handbook + A Book for Midwives
Procedure for Administering Emergency Contraception with Birth Control Pills

1. A woman should take a high dose of birth control pills as soon as possible — within 5 days of having sex.
2. The sooner the pills are taken, the more effective...
emergency contraception, birth control pills, contraception, hormonal contraception, side effects, pregnancy prevention, STI protection
Disadvantages and Risks of Using an IUD
Standard Source: A Book for Midwives
Procedure:

Potential disadvantages include:

No protection against STIs or HIV: Women using an IUD must use condoms for STI prevention (see Chapter 18).
Need for medical assistance: A woman cannot insert or remove the IUD...
IUD risks, reproductive health, medical procedures, STI prevention
Identifying and Managing Infertility in Men and Women
Standard Source: Where There is no Doctor a Village Health Care Handbook
Infertility can occur due to problems with either the man or woman.

Men: Issues may include low sperm count, poor sperm motility, or blockages.
Women: Problems such as blocked fallopian tubes, hormonal imbalances, or ovulation...
infertility,treatment,options,reproductive health
Implementing Effective and Ethical Family Planning Programs
Standard Source: A Book for Midwives
Steps to Implement Effective and Ethical Family Planning Programs:

1. Offer a wide choice of family planning methods for both men and women, ensuring clear information about the benefits and risks of each method.
2. **Provide thorough...
family planning, reproductive health, informed consent, health worker training, coercion prevention, shared responsibility
Inserting an IUD: Preparing the Patient and Performing the Procedure
Standard Source: A Book for Midwives
Help a woman decide if the IUD is right for her:

• Discuss the benefits and risks of using an intrauterine device (IUD) with the woman.
• Explain how long the IUD can remain in place, typically up to 5–10 years depending on the type.
• Address...
IUD insertion, intrauterine device procedure, midwife reproductive care
Inserting the Copper T IUD
Standard Source: A Book for Midwives
Steps to Load and Insert the IUD:

Loading the IUD into the Inserter Tube:
1. Open the package halfway, starting on the side away from the IUD, and push the rod to the side of the package to get it out of the way.
2. With one hand, hold the...
IUD insertion, Copper T IUD, Inserter tube, Sterile procedure, Midwifery, Contraception
Selecting a Family Planning Method Considering STI Risk
Standard Source: A Book for Midwives
When helping a woman choose a family planning method, consider her risk of sexually transmitted infections (STIs), including HIV.

Steps to Consider:
1. Discuss the importance of STI protection along with pregnancy prevention.
2. Explain that...
family planning,stis,hiv,pregnancy prevention,condoms,birth control,iuds,effectiveness ratings
The Sponge Method for Contraception
Standard Source: Where There is no Doctor a Village Health Care Handbook
The sponge method is a home-based contraceptive method that can be used when no other method is available. It is not harmful, but it is not 100% effective and does not protect against HIV or other STIs.

### Materials Needed:
• A...
sponge method,contraception,home remedy,family planning
Understanding Family Planning Methods for Child Spacing
Standard Source: Where There is no Doctor a Village Health Care Handbook
Overview:
Family planning allows parents to decide when and how many children they want. This is important for the health of both the mother and child.

Why Family Planning Matters:
• Prevents pregnancy-related deaths in young women (under...
family planning, child spacing, contraception, reproductive health, maternal mortality, family planning methods
Administer Contraceptives and Family Planning Methods
Reference Source: Where There is no Doctor a Village Health Care Handbook
Title: Administer Contraceptives and Family Planning Methods

Procedure:
1. Use oral contraceptives (birth control pills):
- Take one pill daily at the same time each day.
2. Use emergency pills:
- Take 1-2 tablets within 72...
contraceptives,family planning,birth control,pills,IUD,implants
Advantages of Using an IUD for Contraception
Reference Source: A Book for Midwives
Procedure:

Benefits of using an IUD include:

High effectiveness: Very few women with IUDs become pregnant.
Reversible: The IUD can be removed at any time if the woman wishes to conceive.
Convenience: Once inserted, it...
IUD benefits, contraception, reproductive health, medical procedures
Breastfeeding for Family Planning
Reference Source: Where There is no Doctor a Village Health Care Handbook
Breastfeeding can be an effective method of family planning only if the following three conditions are met:

1. The woman’s baby is less than 6 months old.
2. The woman has not had her monthly bleeding since giving birth.
3. The woman is...
breastfeeding,family planning,contraception,conditions,infant feeding
Identify and Understand a Woman's Sexual and Reproductive Parts
Reference Source: A Book for Midwives
Understanding the anatomy of a woman's sexual and reproductive parts is essential for midwives and healthcare providers. Here are the key components:

Clitoris: A very sensitive spot that can give sexual pleasure when touched.
• **Outer...
anatomy,vagina,clitoris,urethra,anus,reproductive parts,midwife knowledge
Informing the Woman About IUD Insertion Aftercare
Reference Source: A Book for Midwives
Procedure:

• Explain to the woman that she may experience bleeding or cramps for 1 or 2 days after insertion.
• Inform her that her monthly bleeding might be heavier than usual for a few months, and this is normal.
• Provide...
IUD aftercare, bleeding, cramps, monthly checkups, reproductive health
Preventing Infertility Through Lifestyle and Health Choices
Reference Source: A Book for Midwives
Procedure:

1. Avoid sexually transmitted infections (STIs) to prevent scarring in the reproductive system of both men and women that can lead to infertility.
2. Manage or treat illnesses such as diabetes, tuberculosis, malaria, and...
infertility,preventable causes,STIs,dangerous chemicals,lifestyle choices,fertility evaluation
Understand the Anatomy of the Womb, Tubes, and Ovaries
Reference Source: A Book for Midwives
The following are key reproductive organs involved in pregnancy:

Womb (Uterus): A hollow muscle located inside the pelvis. It is where the baby grows during pregnancy, and monthly bleeding comes from it.
Tubes (Fallopian Tubes):...
womb,tubes,ovaries,cervix,vagina,reproductive anatomy,midwife knowledge
Understand the Process of Conception and Pregnancy
Reference Source: A Book for Midwives
Conception occurs through the following process:

1. Ovulation: About once a month, one of the woman’s ovaries releases a tiny egg into the fallopian tube.
2. Sperm Production: Men produce sperm in their testicles. During ejaculation,...
conception,pregnancy,fertilization,ovulation,sperm,zygote,midwife knowledge
Understand the Structure and Function of the Pelvis
Reference Source: A Book for Midwives
The pelvis is a bony structure located below the belly. It has the following characteristics:

Shape: The pelvis is shaped like a bowl with a hole in the bottom.
Function during birth: During childbirth, the baby passes through this...
pelvis,bowl shape,pregnancy,labor,anatomy
Understanding Sterilization as a Family Planning Method
Reference Source: A Book for Midwives
Sterilization:

1. Sterilization is a permanent surgical procedure that makes it almost impossible to have a baby.
2. It is only suitable for individuals who do not want to have any more children.
3. The surgery is performed at medical...
sterilization,permanent contraception,family planning,reversal surgery,HIV protection
Using the Counting Days Method for Family Planning
Reference Source: A Book for Midwives
How to Use the Counting Days Method:

1. This method is only suitable for women with regular menstrual cycles that last between 26 and 32 days.
2. The woman must avoid sexual intercourse from the **8th day of her cycle through the 19th day of...
counting days method,family planning,contraception,menstrual cycle,sterility,vasectomy
Vasectomy Procedure for Male Sterilization
Reference Source: A Book for Midwives
Vasectomy:

1. A vasectomy is a simple surgical procedure that takes about 10 minutes.
2. A health worker makes a small cut in the skin of the testicles and inserts a tool to cut the tubes that carry sperm from the testicles to the...
vasectomy,male sterilization,family planning,sperm removal
Understanding the Menstrual Period in Women
Reference Source: Where There is no Doctor a Village Health Care Handbook
Procedure:

1. Educate women and midwives about the menstrual cycle, including its typical duration (28 days) and length of bleeding (3–6 days).

2. Explain that variations are normal, as cycles can differ significantly between...
menstrual cycle, irregular periods, reproductive health, adolescent girls, midwife education

Dental Health (50)

Avoid Sugary Drinks and Feeding Bottles for Children
High Priority Source: Where There is No Dentist
Objective: Prevent tooth decay in children by avoiding sugary drinks and feeding bottles.

1. Do not buy fizzy drinks such as Coca-Cola or Fanta, which contain high levels of added sugar that can rapidly cause tooth decay.
2. **Avoid...
child dental health, sugary drinks, feeding bottles, tooth decay prevention
Maintain Children's Oral Hygiene Through Daily Care
High Priority Source: Where There is No Dentist
Objective: Ensure children maintain clean teeth to promote long-term oral health.

1. Teach older children how to brush their own teeth properly, showing them the correct technique and emphasizing the importance of regular cleaning.
2....
children's oral hygiene, tooth brushing, dental care for children
Treat Vincent’s Infection of the Gums (Trench Mouth)
High Priority Source: Where There is No Dentist
Objective: Treat Vincent’s infection in both adults and children to prevent severe complications.

Steps:
1. Prevention is key, especially for weak or sick children. Teach mothers how to clean their children's teeth and encourage them to...
vincent's infection, trench mouth, penicillin treatment, oral hygiene for children
Encourage Fresh Food Consumption for Better Dental Health
Standard Source: Where There is No Dentist
Objective: Promote the consumption of fresh, natural foods over processed and sugary alternatives to improve dental health.

1. Buy fresh fruits and vegetables from local markets instead of relying heavily on store-bought, processed...
fresh food, dental health, nutrition, tooth decay prevention
Examine Teeth for Health Issues
Standard Source: Where There is No Dentist
### Procedure: Examine Teeth for Health Issues

Steps to examine teeth for health issues:
1. Look for the following signs of dental problems:
- A new tooth (check for proper alignment and development)
- Black spots on teeth (indicate...
teeth examination,cavities,black spots,loose tooth,dark tooth,infection,gum sore
Examine for Sores in the Mouth
Standard Source: Where There is No Dentist
### Procedure: Examine for Sores in the Mouth

Steps to examine for sores in the mouth:
1. Look for sores under the smooth skin on the inside of the lips and cheeks.
2. Check for sores under the tongue and along its sides.
3. Use the images...
mouth sores,viral sores,cancer sores,dental examination
Explain the Process of Gum Disease Leading to Tooth Loss
Standard Source: Where There is No Dentist
### Understanding How Infected Gums Cause Teeth to Fall Out

A. When gum disease is beginning, a small red `pocket’ forms where the tooth meets the gum. Germs and food collect in the gum and make acid. This makes the gums sore.

B. As a...
gum disease,tooth loss,bone infection,germ attack,dental analogy
Follow-Up Care After Initial Treatment of Vincent’s Infection
Standard Source: Where There is No Dentist
Objective: Continue care after the initial treatment to ensure full recovery and prevent recurrence.

Steps:
1. One week later, scrape away any remaining tartar from the teeth.
2. Use the person's own brush to demonstrate how to clean...
follow-up dental care, tartar removal follow-up, oral hygiene maintenance
Identify Consequences of Untreated Tooth and Gum Problems
Standard Source: Where There is No Dentist
Procedure:

1. Observe the following signs of untreated tooth and gum problems:
- a) The black hole on the tooth grows bigger, forming a sore on the gums near the root.
- The tooth hurts whenever touched.
- b) Red, loose gums...
tooth abscess, advanced gum disease, untreated dental problems, tooth removal, infection
Leverage Community Learning to Spread Dental Health Knowledge
Standard Source: Where There is No Dentist
Objective: Encourage the spread of dental health knowledge through community learning and peer teaching.

1. Be a role model by practicing good oral hygiene habits yourself, such as brushing regularly and avoiding sugary foods.
2. **Teach...
community education, peer teaching, oral hygiene habits
Managing Gum Disease at Home
Standard Source: Where There is No Dentist
Gum disease is a serious condition that can lead to tooth loss if not managed properly. Here's how to manage it at home:

1. Brush your teeth thoroughly twice a day, using a soft-bristled brush and fluoride toothpaste.
2. Floss daily to...
gum disease,dental care,oral hygiene,noma,antimicrobial mouthwash
Promote Healthy Dental Traditions in the Community
Standard Source: Where There is No Dentist
Objective: Help family and friends recognize and use healthy traditions for better dental health.

1. Identify existing healthy traditions within your community that promote good oral hygiene, such as natural foods or traditional cleaning...
dental health, community education, traditional practices, oral hygiene
Assess the Health of Your Teeth and Gums
Standard Source: Where There is No Dentist
Procedure:

1. Inspect your teeth and gums regularly by looking in a mirror.
- Check for any signs of decay, discoloration, or swelling.
- Examine the gums around each tooth to ensure they are firm and not receding.
2. **Examine your...
teeth inspection, gum health, dental problems, early detection, children's oral health
Building New Ideas Onto Existing Knowledge for Oral Health Education
Standard Source: Where There is No Dentist
Procedure for Building New Ideas Onto Existing Knowledge for Oral Health Education:

1. Identify existing practices and beliefs in the community that are related to oral health, such as traditional cleaning methods or dietary habits.

2....
health education, cultural practices, oral hygiene, teaching methods, public health
Conducting a Community Oral Health Survey
Standard Source: Where There is No Dentist
Procedure for Conducting a Community Oral Health Survey:

1. Prepare a simple survey form with questions such as:
- How many children and adults in your community have problems with their teeth or gums?
- Are there any common oral...
oral health, community survey, dental issues, oral hygiene, public health
Demonstrate the Role of Roots in Holding Teeth Firmly
Standard Source: Where There is No Dentist
### Using an Animal Jaw Bone to Illustrate Tooth Root Structure

Have the students look for an old jaw bone from a dog or other animal.
• Notice that bone goes around every root of every tooth and holds it tightly.
• Break away some of the...
animal jaw bone,tooth root structure,bite strength,chewing teeth
Diagnose Before Treating Dental Issues
Standard Source: Where There is No Dentist
Why it's important: You must make a good diagnosis to treat a problem so it goes away and does not return. For example, if you see a sore on the face, do not assume it is just a surface infection—check whether it is caused by pus draining from...
diagnosis,dental treatment,abscess,root cause,health worker
Explain the Structure of a Tooth and Its Root System
Standard Source: Where There is No Dentist
### Understanding Tooth Anatomy

When you look inside someone’s mouth, you see only the top part of each tooth. The bottom part, its root, is inside the bone under the gum.

The roots of the tooth hold it in the bone just like the roots of a...
tooth anatomy,root system,dental health,gum disease,bone connection
Identify Cavities and Gum Disease in a Sick Boy
Standard Source: Where There is No Dentist
Procedure:

1. Observe the inside of a sick boy's mouth.
- Check the color of his teeth: Are they yellow or have black spots?
- These black spots indicate cavities .
- Examine the gums: What color are they? Are they pointed,...
cavities, gum disease, dental health, sick boy, oral hygiene
Identify Signs of Tooth Decay and Cavities
Standard Source: Where There is No Dentist
Procedure:

1. Inspect the mouth for visible signs of dental issues:
- Look for black spots on teeth, which may indicate cavities.
- Identify dark-colored teeth, which could be a sign that the tooth is dead or dying.
- Check...
tooth decay,cavities,dental health,abscess,gum bubble,sugar,bacteria
Identifying Causes of Tooth Pain
Standard Source: Where There is No Dentist
Objective: Help individuals understand the common causes of tooth pain.

Steps:
1. Recognize physical damage. A broken or loose tooth can cause significant pain and discomfort.
2. Look for cavities. Cavities are the most common cause...
tooth pain causes, cavities, broken teeth, gum disease, toothache prevention
Learning From the Community to Improve Oral Health Education
Standard Source: Where There is No Dentist
Procedure for Learning From the Community to Improve Oral Health Education:

1. Get involved in community activities such as local meetings, cultural events, and social gatherings.

2. Engage with community members through conversations...
community engagement, oral health education, cultural sensitivity, dental care, public health
Managing Swollen Gums in Epilepsy Patients
Standard Source: Where There is No Dentist
When you see swollen gums, find out what medicines the person is taking. If possible, change to a different drug. If the person must continue using diphenylhydantoin (Dilantin), explain how to prevent this swelling of the gums. Show the person...
swollen gums,epilepsy,Dilantin,oral hygiene,dental care
Position the Person for Dental Examination
Standard Source: Where There is No Dentist
### Procedure: Position the Person for Dental Examination

Steps to position the person:
1. Use a low chair and lift up the person’s chin so that you do not have to bend over as far when looking into the mouth.
2. An even better way is to...
positioning,dental examination,comfort
Prepare Instruments for Dental Examination
Standard Source: Where There is No Dentist
### Procedure: Prepare Instruments for Dental Examination

Steps to prepare instruments:
1. Gather the following three essential instruments:
- A wooden tongue blade to hold back the cheek, lips, and tongue.
- A small mirror to allow a...
instrument preparation,dental tools,hygiene
Provide Guidance for Gum Disease Management
Standard Source: Where There is No Dentist
Objective: Help a person manage gum disease by removing plaque and tartar, and maintaining oral hygiene.

Steps:
1. Explain the cause of gum disease to the individual and emphasize that stopping it requires removing plaque and tartar from...
gum disease, oral hygiene, salt water rinse, tartar removal, dental care in emergencies
Recognizing and Responding to a Loose Tooth
Standard Source: Where There is No Dentist
A tooth may be loose for several reasons:

Baby teeth becoming loose between 6 and 12 years old is normal if the gums are healthy and there is no cavity.
• A tooth might be loose because it is broken or sick from an abscess or gum disease....
loose tooth,dental abscess,gum disease,baby teeth,permanent teeth
Set Up Proper Lighting for Dental Examination
Standard Source: Where There is No Dentist
### Procedure: Set Up Proper Lighting for Dental Examination

Steps to set up proper lighting:
1. Examine people in a light and bright place.
2. Use natural sunlight by examining outside or inside a room facing the window.
3. If necessary,...
lighting,dental examination,visibility
Understand How Germs Cause Tooth Decay
Standard Source: Where There is No Dentist
Acid makes holes in the teeth. The acid is made when sweet foods mix with germs in your mouth.

It is not possible to prevent cavities or gum problems by trying to kill all of the germs in your mouth. There are too many—and some germs are good...
tooth decay cause, plaque formation, acid production, dental hygiene
Using Storytelling to Address Misconceptions About Oral Health During Pregnancy
Standard Source: Where There is No Dentist
Procedure for Using Storytelling to Address Misconceptions About Oral Health During Pregnancy:

1. Identify common misconceptions in the community, such as the belief that dental problems are inevitable during pregnancy.

2. **Create a story...
pregnancy, oral health, storytelling, public education, dental myths
Conduct a Classroom Project on Tooth Decay Prevalence
Reference Source: Where There is No Dentist
- Count the number of students with cavities.
• Count the number of teeth having cavities. Show the students how to look for them on the tops, sides and between the teeth.
• Find out the person’s age.

Have the students write on the blackboard what...
tooth decay survey, classroom project, dental health education
Demonstrate How Sweet Foods Stick to Teeth
Reference Source: Where There is No Dentist
- Cut several different kinds of food with a knife.
• Vegetables and meat do not stick to the knife.
• Sweet foods, like chocolate and jam buns, do stick to the knife. They stick to your teeth the same way.

Pour some cola or juice in a dish, and...
sweet food, teeth, stickiness, dental hygiene, plaque formation
Examine Tooth Structure and Decay
Reference Source: Where There is No Dentist
- Try to find some old teeth. Ask the students to keep their own baby teeth when they fall out. (Note: in some countries this is not acceptable.) Your dental worker can save you some teeth that were taken out at the clinic.

Scrape the outer cover...
tooth decay, dental structure, experiment, root scraping
Explore the Interior of a Tooth and Cavity Formation
Reference Source: Where There is No Dentist
- Look inside a tooth for the space where the nerve and blood vessel used to be. See how close they were to the tooth’s hard outer cover. Look for a small hole at the end of the root. That is the place where the nerve and blood vessel enter the...
tooth cavity, nerve structure, dental anatomy, decay spread
Play the 'Scatter!' Game to Teach Oral Hygiene
Reference Source: Where There is No Dentist
Here is a game called “Scatter!” that students can play outside. You need:

• Five ‘bases’ (a tree, rock, or the corner of a house can be a base) in a half circle, 12 meters apart. Each base must have a ‘monitor’ who stays at the base. Note:...
oral hygiene game, plaque removal activity, dental education
Prevent Cavities and Sore Gums Through Diet
Reference Source: Where There is No Dentist
Prevent cavities and sore gums by eating good food and carefully cleaning your teeth.

### Recommended Foods:
Vegetables, especially those with dark green leaves.
Fruits, like banana, guava, oranges, and papaya.
Peas and beans,...
cavities, sore gums, diet, dental health, food for teeth, prevention
Self-Treatment for Infected Gums
Reference Source: Where There is No Dentist
If you have sore, bleeding gums, you can do much to treat the infection yourself:

1. Clean your teeth with a soft brush gently and more often (see page 71).
2. Eat more fresh fruits and vegetables.
3. **Rinse your mouth with warm salt...
infected gums,gum disease,self-treatment,dental care,oral hygiene
Teach and Learn Together with School Children
Reference Source: Where There is No Dentist
Objective: Encourage active participation in learning about teeth and gums.

Procedure:
1. Share ideas instead of always giving information. Involve children in the learning process by asking questions and encouraging them to express...
teaching, learning, dental health, classroom engagement, children education
Write a Statement on the Care of the Teeth
Reference Source: Boy Scout Handbook 1911
Procedure:

1. Write a detailed statement explaining how to properly care for teeth.
- Include brushing techniques, frequency of brushing, flossing methods, and the importance of dental checkups.
- Emphasize avoiding sugary foods and...
teeth care, dental hygiene, brushing, flossing, cavities
Explain the Frequency of Tooth Regrowth in Humans
Reference Source: Where There is No Dentist
### Understanding How Often Teeth Grow In

This section discusses how often teeth grow in, but no specific procedure is provided for this topic. Further information or actionable steps are not included in the text.
tooth regrowth,dentition cycle,tooth development
Identifying and Locating Bacterial Colonies on Teeth
Reference Source: Where There is No Dentist
To help identify bacterial colonies on teeth:

Use food dye, betel nut, or berry juices to stain the colonies of germs.
- First, wash your hands thoroughly.
- Older students can rub berries on the teeth of younger ones.
- Have them...
bacterial colonies,teeth staining,dental hygiene,germ detection
Teeth and Space Counting Activity for Children
Reference Source: Where There is No Dentist
Objective: Teach children how to count teeth and spaces ready for new teeth.

Steps:
1. Examine each other's mouths. Help students identify baby teeth and permanent teeth, with special attention to the first permanent molars at the back...
teeth counting, space counting, dental activity, children's teeth, oral health education, tooth development
Understand Dental Cavities and Their Causes
Reference Source: Where There is no Doctor a Village Health Care Handbook
Cavity is a hole or spot of decay in a tooth where bacteria have gotten in and destroyed part of the tooth.
cavity,tooth decay,dental health
Understanding Plaque Formation on Teeth
Reference Source: Where There is No Dentist
- Plaque is a film or coating of germs that can form on the teeth, mix with food and make acid.
• You cannot see plaque unless you stain it.
plaque, dental hygiene, tooth film
Compare Animal Teeth to Understand Diet and Function
Reference Source: Where There is No Dentist
Objective: Help students understand how the shape of teeth relates to an animal's diet.

### Steps:
1. Collect samples or pictures of teeth from different animals (e.g., wild cat, goat).
2. Have students observe the differences in tooth shapes...
animal teeth, dental comparison, diet and teeth
Compare Front and Back Teeth in Students to Understand Their Functions
Reference Source: Where There is No Dentist
Objective: Help students understand the different roles of front and back teeth.

### Steps:
1. Have each student find a partner and observe the shape of their front and back teeth.
2. Discuss with the class how these different types of teeth...
front and back teeth, dental function, eating with teeth
Conduct a Food Experiment to Demonstrate Tooth Function
Reference Source: Where There is No Dentist
Objective: Help students understand how different teeth are used for eating various foods.

### Steps:
1. Ask students to bring different kinds of food (e.g., guava, mango, maize) to class.
2. Have them eat the food using only their front teeth...
tooth function, dental education, food experimentation
Create Visuals for Foods Eaten with and Without Teeth
Reference Source: Where There is No Dentist
Objective: Help students understand the role of teeth in eating.

### Steps:
1. Have students draw pictures of foods that require teeth to eat (e.g., mango, maize) and foods that can be eaten without teeth (e.g., soft fruits, soups).
2. Discuss...
food for teeth, dental education, eating without teeth, oral health
Explain the Role of Different Types of Teeth in Eating
Reference Source: Where There is No Dentist
Objective: Teach students about the different types of teeth and their functions.

### Steps:
1. Explain that there are two main types of teeth:
- Front teeth (incisors): Sharp edges used to cut food into pieces.
- **Back teeth...
types of teeth, incisors, molars, dental anatomy
Teach Students to Identify Sounds Made by Teeth
Reference Source: Where There is No Dentist
Objective: Help students understand how different sounds are made using teeth.

### Steps:
1. Have students practice saying words that use specific sounds made with teeth:
- 'v' and 'f': Words like *friend* or *fever*. The lower lip...
teeth sounds, dental education, speech development, oral health

Radiation Exposure (47)

Decontaminate After Exposure to Radioactive Material
Critical Source: FEMA Are You Ready
Procedure:

1. Remove and bag contaminated clothing, isolating the bag away from you and others.
2. Shower thoroughly with soap and water to remove radioactive material from your skin and hair.
3. Wash all exposed body parts, including...
decontamination, radiation exposure, RDD, radiological dispersion device
Emergency Handling of Radiation Contaminated Patients
Critical Source: Life After Doomsday
Procedure:

1. Check for contamination: Use a radiation survey meter to check the patient on the stretcher for radioactive contamination.
2. Provide immediate life-saving care: If the patient is seriously injured, provide emergency...
radiation contamination,decontamination,wound care,emergency handling
Understanding the Impact of Nuclear Radiation on Personnel
Critical Source: FM 5 103 Survivability
Nuclear radiation damages cells throughout the body and may cause symptoms such as headaches, nausea, vomiting, and diarrhea (radiation sickness). The severity depends on the extent of initial exposure.

• Once the dose is known, initial...
nuclear radiation effects, radiation sickness, cumulative exposure, dose determination
Assess and Manage Dose-Response for Whole Body Irradiation
Critical Source: Medical NBC Battlebook
Procedure:

1. Understand the dose-response relationship for whole body irradiation:
- Low dose rate exposures (fallout) have a different response than prompt exposure.
2. Identify clinical responses based on radiation doses:
-...
whole body irradiation, dose-response, LD50, hematopoietic syndrome, gastrointestinal syndrome, CNS syndrome, combined injury
Assess and Monitor Lymphocyte Counts for Radiation Exposure
Critical Source: Medical NBC Battlebook
Procedure:

1. Monitor lymphocyte counts within 24 hours post-exposure.
- Mild lymphocyte depression may be observed.
2. Check lymphocyte, platelet, and granulocyte counts at 48 hours post-exposure.
- A count of more than 1.7x 10⁹...
lymphocyte counts, radiation exposure, bone marrow depletion, cytokine therapy, metaphase analysis, surgical procedures, thrombocytopenic purpura
Assessing Long-Term Health Risks from Radiation Exposure
Critical Source: Medical NBC Battlebook
Procedure:

1. Understand that long-term health risks include an increased likelihood of fatal cancer, beginning approximately two years post-exposure.
2. Estimate the total lifetime risk as 4-7% per 100 cGy (1000 mSv), in...
long-term cancer risk, teratogenesis, mutagenesis, radiation health effects
Follow-Up for Evacuees Who Cannot Be Adequately Decontaminated
Critical Source: FEMA REP Program Manual Dec 2019
Procedure for Follow-Up of Evacuees Who Cannot Be Adequately Decontaminated:

1. Assess Individuals Who Could Not Be Decontaminated:
- Conduct a follow-up assessment to determine the reason why an evacuee could not be adequately...
follow-up, decontamination failure, radiation exposure, referral process, medical support
Manage Surgical Procedures in Radiation Injury Patients
Critical Source: Medical NBC Battlebook
Procedure:

1. Perform all surgical procedures within the first 36-48 hours after irradiation.
2. Avoid any additional surgery until at least 6 weeks post-exposure.
3. **Assess for signs of bone marrow depletion and radiation-induced...
surgical procedures, radiation injury, bone marrow transplant, wound management, aggressive therapy
Management of Internal Contamination with Radioactive Material
Critical Source: NATO Emergency War Surgery
Objective: Prevent or reduce internal contamination from radionuclides through early intervention and appropriate treatment.

Procedure:
1. Identify the type of contamination:
- Internal contamination: Radionuclides remain in the...
radioactive contamination, radionuclides, potassium iodide, chelating agents, internal contamination, radiation exposure, blocking agents, dilution, excretion, NCRP Report No. 65
Monitor and Manage Hematopoietic Syndrome in Radiation Exposure
Critical Source: Medical NBC Battlebook
Procedure:

1. Assess for hematopoietic syndrome symptoms:
- Monitor for moderate to severe loss of lymphocytes, granulocytes, and platelets.
2. Follow lymphocyte counts every 6 hours during the first few days post-exposure.
3....
hematopoietic syndrome, radiation exposure, cytokine therapy, metaphase analysis, alimentary nutrition, bone marrow transplant
Nuclear Casualty Treatment Protocol
Critical Source: FM 3 4 NBC Protection
Procedure:

Blast, thermal radiation, and nuclear radiation can all cause casualties during a nuclear attack.
Treat blast injuries and thermal burns as conventional casualties, following standard first aid procedures.
• **Radiation...
radiation casualty, nuclear injury, first aid limitations
Use Dose Estimation Techniques for Radiation Exposure
Critical Source: Planning Guidance for Response to Nuclear Detonation May 2022 FEMA
Objective: Estimate radiation dose received by victims to guide medical decisions.

Procedure:
1. Utilize geographic dosimetry, which involves noting where a person was located over time on official dose maps created by IMAAC (as...
dose estimation, radiation exposure, geographic dosimetry, lymphocyte depletion, dicentric chromosome analysis
Administer Alginate to Reduce Strontium Absorption
High Priority Source: Medical NBC Battlebook
Procedure:

1. Identify exposure to strontium isotopes through ingestion or contamination.
2. Administer alginate as soon as possible after exposure.
- This will reduce the absorption of strontium from the gut.
3. **Monitor for any...
alginate,strontium absorption,radiation treatment
Administer Chelating Agents for Radioisotope Elimination
High Priority Source: Medical NBC Battlebook
Procedure:

1. Identify the type of radioisotope exposure.
- This is critical as different chelating agents are effective against different isotopes.
2. **Administer calcium or zinc DTPA (diethylenetriamine pentaacetic acid) soon after...
chelating agents,dtpa,radiation elimination,radioisotope removal
Administer Prussian Blue to Reduce Cesium Absorption
High Priority Source: Medical NBC Battlebook
Procedure:

1. Identify exposure to cesium isotopes through ingestion or contamination.
2. Administer orally administered Prussian Blue as soon as possible after exposure.
- This will reduce the absorption of cesium from the gut.
3....
prussian blue,cesium absorption,radiation treatment
Assess Radiation Exposure States (RES) and Risk Criteria
High Priority Source: Medical NBC Battlebook
Procedure for Assessing Radiation Exposure States (RES) and Risk Criteria:

### Step 1: Understand RES Categories and Dose Ranges
RES-0 Units: No exposure. Acceptable risk levels:
- Negligible Risk < 75 cGy
- Moderate Risk < 100...
radiation exposure, RES categories, risk criteria, radiation dose, medical effects, performance degradation
Assessing Combat Effectiveness After Radiation Exposure
High Priority Source: Medical NBC Battlebook
Procedure for Assessing Combat Effectiveness Based on Radiation Dose and Time Postexposure

1. Determine the radiation dose received by personnel:
- Use dosimeters or other measurement tools to assess exposure levels.
- Compare the...
radiation exposure, combat effectiveness, radiation dose, time postexposure, medical advisors, subhuman primate studies, AFRRI, performance degradation
Establish Medical Facilities for Radiological Emergencies
High Priority Source: FEMA REP Program Manual Dec 2019
Procedure:

1. Identify and establish a list of primary and backup hospitals/medical facilities that are capable of treating potentially contaminated, injured, or exposed individuals.
- Ensure at least one hospital is located outside the...
radiological emergency, medical facility, dosimetry procedures, radiation exposure, decontamination, hospital capabilities
Evacuation and Initial Response to Radioactive Commodities Accidents
High Priority Source: Medical NBC Battlebook
Procedure for Evacuation and Initial Response to Radioactive Commodities Accidents

1. Notify all personnel not directly involved to vacate the area. If possible, evacuate to an area that is upwind of the accident.

2. **Hold your breath...
radioactive commodities, evacuation, RSO, decontamination, radiation safety
Handle Medical Emergencies in the Hot Zone (HZ)
High Priority Source: Planning Guidance for Response to Nuclear Detonation May 2022 FEMA
Objective: Prioritize lifesaving operations over radiological concerns when medical emergencies occur.

Steps to Take:
1. Medical Emergencies Take Precedence: If a medical emergency occurs within the HZ, prioritize lifesaving actions and...
medical emergency, radiation exposure, HZ, LDZ, MDZ
Impact of Radiation Dose Rate on Health Risks
High Priority Source: Medical NBC Battlebook
Procedure:

1. Recognize that higher radiation dose rates result in proportionally greater health risks compared to the same total dose delivered over a longer period.
2. This is due to increased biological damage per unit time, even if...
dose rate impact, radiation health risks, biological damage
Internal Irradiation: Understanding Radiation Injury from Radioactive Materials
High Priority Source: Medical NBC Battlebook
Understanding Internal Irradiation

When radioactive materials are incorporated into the body and retained, significant radiation injury can occur in specific tissues or the whole body depending on the type and amount of isotopes deposited and...
internal irradiation, radiation injury, inhalation, ingestion, transcutaneous absorption, isotopes, biological pathways, radioactive materials, decontamination, whole-body irradiation
Maintain Radiation Exposure Records at Unit Level
High Priority Source: Medical NBC Battlebook
Procedure:

1. All units must maintain radiation exposure records (RES) based on readings obtained at the platoon level.
2. Battalion S1, in coordination with the battalion NBC staff, maintains RES records for all assigned and attached units.
3....
radiation exposure, records, unit level, platoon, dosimetry, NBC staff, FM 3-3-1
Maintain and Report Battalion-Level Radiation Exposure Records
High Priority Source: Medical NBC Battlebook
Procedure:

1. The battalion maintains records on the status of each platoon, company, and attached elements.
2. An overall battalion status is reported to the S3 or placed on the daily briefing chart.
3. The battalion forwards the company and...
battalion records, brigade, dosimetry, NBC personnel, FM 3-3-1, radiation exposure
Manage Individual Dosimetry Until DT236s Are Issued to All Soldiers
High Priority Source: Medical NBC Battlebook
Procedure:

1. As an interim measure until the Army issues DT236 individual dosimeters to each soldier, assume that a soldier's dose is the same as the platoon or similar-sized unit to which they are assigned.
2. When reassigned or evacuated...
individual dosimetry, DT236, RES status, soldier reassignment, radiation exposure
Manage Unit Dosimetry and Tactical Dosimeters
High Priority Source: Medical NBC Battlebook
Procedure:

1. Data from each platoon-size element are passed to the unit NBC defense team.
2. The defense team averages readings from tactical dosimeters (IM93s or DT236s) on a daily basis and keeps an informal record at platoon and company...
dosimetry, DT236, IM93, unit management, tactical dosimeters, radiation exposure
Minimize Radiation Exposure
High Priority Source: FEMA Are You Ready
Three ways to minimize radiation exposure:

1. Time: Limit the amount of time spent near a radioactive source.
2. Distance: Increase the distance between yourself and the source of radiation, as radiation intensity decreases with...
radiation safety,exposure reduction,emergency protocols
Overhydration and Diuretics for Tritium Elimination
High Priority Source: Medical NBC Battlebook
Procedure:

1. Identify exposure to tritiated water (tritium).
2. Administer overhydration to reduce the biological half-life of tritium in the body.
3. **Use diuretics to increase urine output and accelerate elimination of tritium...
tritium elimination,overhydration,diuretics,radiation treatment
Peacetime Radiation Dose Limits and Exceptions
High Priority Source: Medical NBC Battlebook
Procedure:

1. During peacetime, radiation doses must not be exceeded except in cases where human lives are at risk.
2. The RES category 1E covers a wide range of doses, with its lower level (25 cGy = 250 mSv) being the...
peacetime dose limits, RES category 1E, NATO operational standards
Principle of Keeping Radiation Doses as Low as Reasonably Achievable (ALARA)
High Priority Source: Medical NBC Battlebook
Procedure:

1. Keep all radiation doses as low as reasonably achievable to minimize individual risk and maintain operational flexibility.
2. This principle applies to both military personnel and civilians exposed to radiation.
3. Implement...
ALARA principle, radiation dose reduction, risk minimization
Response to Broken Tritium Source Incident
High Priority Source: Medical NBC Battlebook
Procedure for Response to a Broken Tritium Source Incident

1. Inform all personnel to vacate the area and move upwind from the device. This minimizes exposure risk.

2. Notify the local RSO immediately. The RSO must oversee all...
tritium source, decontamination, bioassay, RSO, radiation safety
Response to Depleted Uranium (DU) Incidents
High Priority Source: Medical NBC Battlebook
Procedure for Response to Depleted Uranium (DU) Incidents

1. Refer to TB 9-1300-278 and CTT Task 031-503-1017 for safe response procedures. These documents detail the proper handling of DU incidents involving army tank munitions.

2....
depleted uranium, DU incident, evacuation distance, bioassay, RSO
Skin Contamination Decontamination Protocol
High Priority Source: Medical NBC Battlebook
Procedure:

1. Immediate Action: If skin contamination is detected:
- Begin decontamination as soon as possible to prevent ingestion and irradiation of the skin.

2. Decontamination Termination Criteria:
- Stop decontamination when...
skin decontamination,radiation exposure,decontamination protocol,nuclear safety
Use REMM for Dose Estimation Based on Vomiting and Lymphocyte Count
High Priority Source: Planning Guidance for Response to Nuclear Detonation May 2022 FEMA
Objective: Estimate radiation dose using the Radiation Emergency Medical Management (REMM) tool.

Procedure:
1. Access REMM, a resource available at [www.remm.hhs.gov](http://www.remm.hhs.gov).
2. Use the REMM mobile app to estimate...
REMM, radiation dose estimation, vomiting time, lymphocyte count, mobile app
Assessing Delayed Effects of Radiation Exposure
High Priority Source: Medical NBC Battlebook
Procedure for Assessing Delayed Effects of Radiation Exposure

1. Understand the nature of delayed effects:
- Delayed effects may appear months to years after irradiation.
- These effects can involve almost all tissues or organs and...
delayed effects, radiation exposure, cancer risk, BEIRV committee, USACHPPM, nuclear medical science officers
Assessing RF Exposure Levels and Their Medical Implications
High Priority Source: Medical NBC Battlebook
Objective: Understand the medical effects of radiofrequency (RF) exposure based on thermal overload, SAR thresholds, and permissible exposure limits (PELs).

Procedure:
1. Understand Thermal Overload Mechanism:
- RF energy is...
RF exposure, SAR threshold, thermal overload, permissible exposure limits, PELs
Calculate Effective Half-Life of Radioactive Materials
High Priority Source: Medical NBC Battlebook
Procedure:

1. Determine the biological half-life (Tb) and radiological half-life (Tr) of the radioactive material.
2. Use the following formula to calculate the effective half-life (Te):
- Effective half-life = (Biological half-life...
effective half-life,biological half-life,radiological half-life
Conduct Radiological Bioassay for Radioactive Material Detection
High Priority Source: Medical NBC Battlebook
Radiological bioassay is the determination of the kind, quantity, or concentration and location of radioactive material in the human body by direct measurement or analysis of materials excreted or removed from the body.

Procedure:
1....
radiological bioassay, radioactive material detection, radiation exposure, gamma spectroscopy, internal contamination
Conversion Between Millisieverts (mSv) and Centigray (cGy) for Whole Body Gamma Irradiation
High Priority Source: Medical NBC Battlebook
Procedure:

1. Use Millisieverts (mSv) as the preferred unit of measurement for radiation dose.
2. If mSv is not available, use Centigray (cGy) with the following conversion: 1 cGy = 10 mSv.
3. Apply this conversion only to **whole...
mSv to cGy conversion, radiation units, gamma irradiation
Defining Priority and Critical Tasks in Radiation Exposure Scenarios
High Priority Source: Medical NBC Battlebook
Procedure:

1. Priority tasks are those missions aimed at averting danger to persons or preventing damage from spreading.
2. Critical tasks are those missions focused on saving human life.
3. In radiation exposure scenarios,...
priority tasks, critical tasks, radiation response
Identify and Understand Radiological Hazards
High Priority Source: Medical NBC Battlebook
Procedure:

1. Identify sources of radiological hazards, such as:
- Radiological dispersal weapons
- Industrial and medical sources
- Commodities containing radioactive material

2. Understand the health risks associated with...
radiological hazards, radiation exposure, medical nbc battlebook, radiological dispersal weapons, nuclear medical science officer
Interpret Radiation Dose Limits and Functions
High Priority Source: Medical NBC Battlebook
Procedure for Interpreting Radiation Dose Limits and Their Corresponding Functions

1. Understand the Spectrum of Radiation Limits (CentiGray):
- This table provides a reference for radiation dose thresholds and their associated...
radiation dose limits, centigray, LD 50/60, STANAG 2083, ICRP 63, NCRP, EPA, occupational exposure
Skin Contamination and Natural Peeling Process
High Priority Source: Medical NBC Battlebook
Procedure:

1. Understanding Skin Behavior: The skin is an effective barrier but not completely impermeable to radioactive substances.
- Radioactive materials can penetrate the horny layer of the skin, potentially reaching deeper...
skin peeling,radiation decay,natural decontamination,skin exposure
Understanding RF Shock and Burn Effects at Low Frequencies
High Priority Source: Medical NBC Battlebook
Objective: Recognize the risks of RF shock and burns from low-frequency (below 100 MHz) exposure.

Procedure:
1. Identify Exposure Risks:
- At frequencies below 100 MHz, RF shocks or burns may occur due to contact with radiating...
RF shock, RF burn, low frequency exposure
Understanding Whole Body Radiation Dose Distribution
High Priority Source: Medical NBC Battlebook
Procedure:

1. Recognize that whole body radiation exposure results in a uniform dose across the entire body.
2. This procedure assumes effective respiratory protection and other protective measures are implemented to prevent intake of...
whole body radiation, dose distribution, respiratory protection, uniform exposure
Understand Natural Background Levels of Radiation
Standard Source: Medical NBC Battlebook
Procedure:

1. Recognize that radiation exists naturally, with an average annual exposure for U.S. citizens being 0.350 cGy.

2. Understand the components of natural background radiation, which includes:
- External sources such as...
natural background radiation, radiation levels, medical nbc battlebook, radioactive material handling safety
Use of Potassium Iodide for Thyroid Protection After Nuclear Exposure
Reference Source: Emergency War Surgery + Medical NBC Battlebook
Potassium iodide may be used to prevent the thyroid from absorbing radioactive isotopes after a nuclear reactor accident or exposure to radioiodine. It should be administered as soon as possible following exposure, ideally within hours of...
potassium iodide, thyroid protection, radioiodine exposure, nuclear accident

Obstetrics (46)

Assisting with Breech Delivery - Handling the Baby's Legs
Critical Source: A Book for Midwives
The legs usually come out by themselves. If they are not coming, put your fingers inside the mother and gently pull down the legs. Do not pull on the baby.
breech delivery,baby legs,delivery assistance
Assisting with Breech Delivery - Positioning and Shoulder Delivery
Critical Source: A Book for Midwives
You may want to have a helper put pressure on the mother’s pubic bone (not her belly). This is to keep the baby’s head tucked in, not to push the baby out. Carefully move the baby’s body down to deliver the top shoulder. Hold the baby by the hips or...
breech delivery,shoulder delivery,baby positioning
Deliver a Baby and Afterbirth
Critical Source: Survival and Austere Medicine
Procedure:

1. Ensure the mother is in a comfortable position, ideally lying on her back with her legs supported.
2. Monitor the baby’s head as it crowns, ensuring that it does not get stuck or cause tearing.
3. **Encourage the mother to...
deliver baby, birth procedure, afterbirth delivery
Delivering Twins - Ensuring Safe Delivery and Cervix Management
Critical Source: A Book for Midwives
If you cannot get to a hospital, keep the mother from pushing until you are sure that the cervix is fully open (see pages 339 to 340). Ask the mother to lie down — the cord may be less likely to prolapse. Use the instructions on pages 216 to 218 for...
twins delivery,cervix management,safe birth
Final Steps in Breech Delivery - Turning the Baby and Delivering the Head
Critical Source: A Book for Midwives
The baby must now turn to face the mother’s bottom. Hold the baby with your arm, and put one finger in the baby’s mouth. Put your other hand on the baby’s shoulders, with one finger on the back of the baby’s head to keep it tucked in. The baby’s...
breech delivery,baby head delivery,slow birth
Manage a Post-Partum Bleed
Critical Source: Survival and Austere Medicine
Procedure:

1. Assess the amount and severity of bleeding, determining whether it is mild or life-threatening (e.g., heavy flow, clots, dizziness).
2. Position the mother on her back with her legs elevated to improve blood flow to vital...
post-partum bleed, manage bleeding, uterine hemorrhage
Managing Obstructed Labour and Malpositioned Baby in an Austere Environment
Critical Source: Survival and Austere Medicine
Overview: In cases of obstructed labour or a malpositioned baby where a caesarean section is not possible, delivering the baby in pieces may be necessary to save the mother’s life.

Procedure Steps:
1. Assess the situation: Determine if...
obstructed labour, emergency childbirth, baby delivery in pieces, survival medicine, maternal health
Managing a Breech Delivery - Ensuring Cervix is Fully Open Before Pushing
Critical Source: A Book for Midwives
Do not let the mother push until you are sure that her cervix is completely open. Even after she has a strong urge to push, she should wait through a few more contractions to be sure.

When the cervix is open, encourage the mother to push in a...
breech delivery,cervix open,pushing,birth procedures
Managing a Footling Breech Delivery - Safety Precautions and Medical Intervention
Critical Source: A Book for Midwives
A footling breech is more dangerous than the frank or complete breech. Footling breech babies have a very high chance of prolapsed cord (the cord coming out before the baby).

It is much safer for a footling breech to be born in a medical center....
footling breech,prolapsed cord,medical intervention
Managing the Umbilical Cord During Breech Delivery
Critical Source: A Book for Midwives
Loosen the cord a little by gently pulling a bit of it out of the vagina. In general, do not touch the cord much.

Wrap the baby in a clean blanket or cloth to keep her warm. If the baby gets cold, she may try to take a breath inside the mother, and...
umbilical cord,baby warmth,breech delivery
Perform an Emergency Cesarean Section
Critical Source: Emergency War Surgery
Indications for Emergency Cesarean Section:

• Fetal heart rate drops below 100 and stays down for more than 2 minutes.
• Acute uterine hemorrhage persisting for more than a few minutes (suggestive of placental abruption or previa).
-...
cesarean section, emergency c-section, obstetric emergency, uterine hemorrhage, fetal heart rate, placental abruption, previa, surgical procedure
Performing a Caesarean Section Under Local Anaesthesia
Critical Source: Survival and Austere Medicine
Overview: A caesarean section can be performed under local anaesthesia (local infiltration) with or without sedation in an austere environment. This method is viable in low-tech settings, though it may not eliminate all discomfort.

**Procedure...
caesarean section, local anaesthesia, obstetric surgery, emergency childbirth, survival medicine
Performing a Cesarean Section
Critical Source: A Book for Midwives
Cesarean surgery (cesarean section) is performed when the life of the baby or mother is in danger. This includes situations such as:

1. The baby is in an impossible birth position.
2. There is a detached placenta or a prolapsed cord.
3. The...
cesarean section, c-section, surgical birth, maternal health, obstetric emergency
Performing a Sympathectomy to Aid Childbirth
Critical Source: Survival and Austere Medicine
Overview: A sympathectomy involves surgically dividing the symphysis pubis (the joint connecting the pubic bones) to widen the pelvis and allow for easier delivery of the baby. This is an advanced procedure that should be performed with...
sympathectomy, childbirth emergency, pelvic surgery, obstetric procedure, survival medicine
Assessing and Managing a Baby That Does Not Fit Through the Mother's Pelvis
Critical Source: A Book for Midwives
If the baby is in a difficult position or is too big to pass through the mother’s pelvis, the baby cannot come out. The mother will labor until the womb tears and she dies of bleeding inside, or until she and the baby die of exhaustion. Even if...
baby not fitting pelvis, difficult birth position, cesarean surgery, pelvic deformity, maternal exhaustion
Managing a Baby That Lies Sideways in the Womb
Critical Source: A Book for Midwives
A baby that lies sideways in her mother’s womb cannot be born in this position.

The baby may turn easily (see page 369). But only try to turn a baby if:
• The mother has had babies before.
• Her contractions are more than 15 to 20 minutes...
baby sideways position, cesarean surgery, unsafe baby position, turning baby
Managing a Baby in a Difficult or Impossible Birth Position
Critical Source: A Book for Midwives
Labor is usually shortest when the baby is head down, facing the mother’s back. If the baby is in another position she may be difficult or impossible to deliver.

### Baby Faces the Mother’s Stomach (Posterior)
If a baby faces forward, she can...
baby position, posterior birth, face first, forehead first, difficult delivery
Proper Technique for Performing an Episiotomy
Critical Source: A Book for Midwives
Steps to perform an episiotomy correctly:

1. Wash your hands well (see page 53) and put on sterile gloves.
2. Wait until the vagina is bulging open and you can see the baby’s head pushing out.
3. Insert fingers into the vagina to...
episiotomy,procedure,midwife,birth,delivery,surgical technique
Suture a Vaginal Tear
Critical Source: Survival and Austere Medicine
Procedure:

1. Assess the tear’s severity and location, ensuring that it is not deep or involving major blood vessels.
2. Clean the area thoroughly with sterile saline solution or clean water to prevent infection.
3. **Apply an...
suture vaginal tear, vaginal injury treatment
When to Perform an Episiotomy
Critical Source: A Book for Midwives
Purpose: Determine when an episiotomy is necessary during childbirth.

Indications for Episiotomy:
Breech presentation: If the baby is in a breech position and needs to be delivered quickly.
Placental abruption: If there is...
episiotomy, childbirth, breech, cord prolapse, placental abruption, female genital cutting
Administer Ergometrine for Postpartum Hemorrhage
High Priority Source: Where There is no Doctor a Village Health Care Handbook
Ergometrine is used to treat postpartum hemorrhage by stimulating uterine contractions. Follow these steps:

1. Confirm the patient has been diagnosed with postpartum hemorrhage by a healthcare provider.
2. Administer one tablet of ergometrine...
ergometrine, postpartum hemorrhage treatment
Assess Risks of Breech Births
High Priority Source: A Book for Midwives
Breech births carry significant risks for both the mother and baby:

Cord prolapse: More likely when the amniotic sac ruptures, potentially cutting off oxygen to the baby.
Head entrapment: The baby’s head may become stuck at the cervix...
breech birth, cord prolapse, head entrapment, medical center, midwife, obstetric risks
Assess Uterine Size Before MVA
High Priority Source: A Book for Midwives
4. When the woman tells you she is ready, follow the steps on page 384 to do a bimanual exam. Feel the size of the womb. The womb should be the right size for the number of weeks the woman has told you that she was pregnant.

• If her womb is...
uterine size assessment, MVA eligibility, midwifery exam
Assisted Vaginal Delivery Procedure
High Priority Source: Emergency War Surgery
Procedure:

• Once the patient begins pushing, flex the hips to optimally open the pelvis.
• The patient may be on her back or tilted slightly to the left.
• Assistants should support the legs during pushing and relax them between...
vaginal delivery,perineum cleaning,episiotomy,lidocaine,betadine
Clean Cervix Before MVA Procedure
High Priority Source: A Book for Midwives
7. Dip a piece of sterile gauze held with the ring forceps, or a long swab, into antiseptic. Use the gauze or swab to wash the cervix.
cervical cleaning, antiseptic use, MVA preparation
Grasp Cervix and Prepare for Aspiration
High Priority Source: A Book for Midwives
8. Ask the woman to breathe deeply and relax. When she is ready, grasp the cervix with a tenaculum or a ring forceps. Close the tenaculum and pull it a little to straighten the womb. This can be very uncomfortable for the woman, so be gentle and...
cervix grasping, tenaculum use, MVA procedure
Guard Against Unnecessary Medical Interventions During Labor
High Priority Source: A Book for Midwives
Procedure:

1. Protect the mother from unnecessary medical interventions:
- Avoid administering drugs or procedures that are not medically necessary.
- Some midwives and doctors may believe that more drugs, tools, or exams will make...
labor intervention,drug use,dangerous drugs,medical overuse,informed consent
Identify and Monitor Placental Separation After Birth
High Priority Source: A Book for Midwives
Procedure:

1. Observe the umbilical cord immediately after birth:
- If the cord is thick, blue, and pulsing, it is still passing blood to the baby. Do not cut the cord.
- If the cord is thin, white, and not pulsing, it is...
placenta separation,birth,umbilical cord,cutting cord,postpartum care
Inspection and Repair of Vaginal and Cervical Lacerations
High Priority Source: Emergency War Surgery
Procedure:

• Following delivery of the placenta, inspect the vagina and cervix for lacerations.
• Use downward digital pressure on the posterior vagina and fundal pressure (by an assistant, if available) to facilitate visualization of...
laceration repair,vicryl suture,cervix inspection
Maintain Sterility During MVA Procedure
High Priority Source: A Book for Midwives
5. Take off your gloves, wash your hands, and put on new, sterile gloves. This will allow you to keep all the tools for the MVA sterile as you do the procedure.
sterility during MVA, glove change, midwifery hygiene
Management of Periurethral Tears and Hematomas
High Priority Source: Emergency War Surgery
Procedure:

1. Patients with a periurethral tear may require urethral catheterization.
2. In addition to lacerations, hematoma in the vulva, vagina, or retroperitoneum may occur.
3. Refer to gynecologic trauma management for further treatment.
periurethral tear, urethral catheterization, hematoma management
Perineal Preparation and Anesthesia for Delivery
High Priority Source: Emergency War Surgery
Procedure:

1. Clean the perineum with sterile Betadine solution.
2. If this is the patient’s first delivery, anesthetize the perineum with lidocaine in case an episiotomy is needed.
3. Prophylactic episiotomy has little support but may be...
perineal cleaning, lidocaine anesthesia, episiotomy
Positioning and Support During Delivery
High Priority Source: Emergency War Surgery
Procedure:

1. Once the patient begins pushing, flex the hips to optimally open the pelvis.
2. The patient may be on her back or tilted slightly to the left.
3. Assistants should support the legs during pushing and relax them between...
delivery positioning, hip flexion, leg support
Post-Placental Care and Oxytocin Administration
High Priority Source: Emergency War Surgery
Procedure:

• Following delivery of the placenta, the patient should be started on an infusion of lactated Ringer’s with 20 units of oxytocin (Pitocin).
• If there is no IV access, oxytocin can also be given IM.
• If there is no oxytocin...
oxytocin administration,placenta inspection,postpartum hemorrhage
Prepare for MVA with Lighting and Hygiene
High Priority Source: A Book for Midwives
2. Shine a light on the woman’s genitals so you can see well. You may need a helper to hold the light.

3. Wash your hands with soap and water for several minutes (see page 53). Let your hands dry in the air.

• Put clean plastic gloves on...
MVA preparation, lighting, hand hygiene, midwifery procedure
Prevent Fistulas During Prolonged Labor
High Priority Source: A Book for Midwives
Procedure:

If a woman has been in labor for many hours, do not keep waiting. Get medical help immediately.

Details:
• A fistula can occur when a woman is in labor for an extended period.
• Prompt medical intervention is crucial to prevent...
fistula prevention,labor,pregnancy,medical help
Recognize and Respond to Spontaneous Abortion (Miscarriage)
High Priority Source: Where There is no Doctor a Village Health Care Handbook
Spontaneous abortion refers to the miscarriage, which is the natural loss of a pregnancy before the 20th week.

Signs and symptoms:
• Vaginal bleeding, often heavy.
• Cramping or pain in the lower abdomen.
• Passage of tissue from the...
spontaneous abortion, miscarriage, pregnancy loss, vaginal bleeding
Shoulder Delivery and Post-Delivery Care
High Priority Source: Emergency War Surgery
Procedure:

• After delivery of the head, the operator’s hands are placed along the parietal bones, and the patient is asked to push again to allow delivery of the anterior shoulder.
Gentle downward traction should allow the shoulder...
shoulder delivery,towel wrapping,pubis traction
Symphysiotomy Procedure
High Priority Source: A Book for Midwives
Symphysiotomy is a procedure where a cut is made in the middle of the mother’s pubic bone to widen the pelvis and allow for vaginal birth. It is used when the pelvis is too small for a normal vaginal delivery.

Procedure:

1. A surgical...
symphysiotomy, pelvic surgery, obstetric procedure, vaginal delivery assistance
Umbilical Cord Clamping and Cutting
High Priority Source: Emergency War Surgery
Procedure:

• Once the fetus delivers, the cord should be doubly clamped and cut.
• The placenta usually delivers within 15 minutes of delivery, but may take up to 60 minutes.
• Delivery of the placenta is heralded by **uterine...
cord clamping,placenta delivery,uterine fundal elevation
Umbilical Cord Clamping and Placental Delivery Management
High Priority Source: Emergency War Surgery
Procedure:

1. Once the fetus delivers, doubly clamp and cut the umbilical cord.
2. The placenta usually delivers within 15 minutes of delivery but may take up to 60 minutes.
3. Signs of placental delivery include uterine fundal elevation,...
cord clamping, placental delivery, uterine massage
Understand the Risks of Performing an Episiotomy
High Priority Source: A Book for Midwives
Understanding the risks of performing an episiotomy is crucial for midwives and healthcare providers:

• The cut can become infected.
• The cut can go through a blood vessel and cause heavy bleeding.
• The cut can be very painful for the mother...
episiotomy,risks,midwife,delivery,birth,complications
Identify Breech Positions in a Pregnant Patient
High Priority Source: A Book for Midwives
There are three types of breech positions:

Frank breech: The baby’s legs are straight up against the chest.
Complete breech: The baby’s legs are folded, with knees bent and feet near the head.
Footling breech: One or both feet...
breech, frank breech, complete breech, footling breech, pregnancy, childbirth
Preventing and Managing Vaginal Tears During Birth
High Priority Source: A Book for Midwives
Procedure:

Steps to Prevent and Manage Vaginal Tears During Birth:

1. **Prepare the Perineum:
- Use warm cloths around the vaginal opening during the final stages of labor to help stretch the tissues.
- Encourage the mother to push...
vaginal tears, birth, perineum care, postpartum healing
Understand Breech Delivery
High Priority Source: Where There is no Doctor a Village Health Care Handbook
Breech delivery is a type of birth in which the baby comes out buttocks or legs first.
breech delivery,pregnancy,birth complications
Administering Enemas During Labor
Standard Source: A Book for Midwives
### Administering Enemas During Labor

Purpose of enemas:
• Speed labor (enemas can make contractions stronger).
• Wash stool out of the intestines (this may make labor less painful).
• Hydrate a person who does not have enough fluids in her...
enema administration,labor preparation,rectal fluids,midwifery techniques

Airway Management (46)

Alternative Intubation Techniques for Difficult Airway
Critical Source: Emergency War Surgery
Procedure:

After three unsuccessful attempts at direct laryngoscopy, abandon the technique and try alternatives:

### Tactile Intubation
Requires no instruments.
No light use—good in light control situations.
• Slide hand closest to...
difficult airway, tactile intubation, lighted stylet, fiberoptic intubation, alternative airways, laryngeal mask airway
Blind Nasal-Tracheal Intubation Procedure
Critical Source: Emergency War Surgery
Contraindications: Coagulopathy, midface trauma, basilar skull fracture, and suspected elevated intracranial pressure.

Prepare the nasopharynx and larynx (as conditions allow):
- Spray vasoconstrictor into the nostril that appears...
nasal-tracheal intubation, airway management, emergency surgery, blind intubation
Clearing Airway Obstruction in Maxillofacial Injuries
Critical Source: NATO Emergency War Surgery
Procedure:

1. Assess and position the patient to allow gravity-assisted drainage of secretions, blood, or foreign bodies from the airway.
2. Visually inspect the airway for obstructions such as blood, secretions, broken teeth, dentures,...
airway obstruction, maxillofacial injury, suction, intubation, cricothyroidotomy, tracheostomy
Confirm and Secure Endotracheal Tube Placement
Critical Source: Emergency War Surgery
After intubation, ensure the endotracheal tube (ETT) is correctly placed and secured:

• Advance the ETT between the vocal cords, withdraw the stylet, and advance the ETT to 20–21 cm at the teeth for adult females, 22–23 cm for adult males....
ETT placement, airway confirmation, tube securing, intubation verification
Create a Surgical Airway via Cricothyroidotomy
Critical Source: NATO Emergency War Surgery
Procedure for Creating a Surgical Airway via Cricothyroidotomy:

1. Identify the cricoid cartilage: Palpate upward in the neck with the tip of the index finger to locate the cricoid cartilage.
2. Locate the cricothyroid dimple: Place the...
cricothyroidotomy, surgical airway, emergency airway management, battlefield surgery
Dilate and Access the Trachea for Surgical Cricothyroidotomy
Critical Source: TCCC 17 13 Tactical Combat Casualty Care
Objective: Dilate the opening to insert the endotracheal tube (ETT) safely into the trachea.

Procedure:
1. Relocate the cricothyroid membrane by touch and sight after making the incision.
2. Stabilize the larynx with one hand.
3. Make a...
trachea access, airway management, TCCC
Direct Laryngoscopy Technique
Critical Source: Emergency War Surgery
Direct laryngoscopy is a key step in intubation. Follow these steps:

• Ensure the patient is in the optimal 'sniffing' position, unless contraindicated by cervical spine injury.
• Open the mouth by **scissoring the right thumb and middle...
laryngoscopy, direct laryngoscopy, airway management, Macintosh blade, Miller blade, BURP maneuver, vocal cords visualization
Establish Airway in Trauma Patients
Critical Source: Emergency War Surgery
Objective: Move tongue, pharyngeal soft tissues, and secretions out of airway until a formal airway is established.

Procedure:
1. Place the patient in the lateral or prone position (rescue position).
2. Use one of the following methods...
airway management, chin lift, jaw thrust, oropharyngeal airway, nasopharyngeal airway, cricothyrotomy, trauma airway
Insert Endotracheal Tube (ETT) for Surgical Cricothyroidotomy
Critical Source: TCCC 17 13 Tactical Combat Casualty Care
Objective: Insert the ETT into the trachea to establish an airway.

Procedure:
1. Dilate the opening with a hemostat or scalpel handle.
2. Hook the cricothyroid membrane with a **prefabricated cricothyroid hook or bent 18-gauge...
ETT insertion, airway management, TCCC
Insert Endotracheal Tube for Airway Management
Critical Source: survival personal wilderness medical kit
Procedure:

1. Assess the patient's condition and confirm that they require airway management due to an obstructed airway or respiratory failure.
2. Check the expiration date of the endotracheal tube (6.5 mm) to ensure it is still...
endotracheal tube insertion,airway management,emergency ventilation,tube size,dose
Insert King Laryngeal Tube (LT)
Critical Source: TCCC 17 13 Tactical Combat Casualty Care
Necessary Equipment: King LT, water-based lubricant, and a syringe.

Steps:
1. Prepare the casualty:
- Place the casualty’s head in the "sniffing" position.
- Preoxygenate the casualty if equipment is available.

2. **Prepare the...
King LT insertion, airway management, laryngeal tube, emergency airway, tactical casualty care
Locate Cricothyroid Membrane for Surgical Cricothyroidotomy
Critical Source: TCCC 17 13 Tactical Combat Casualty Care
Objective: Accurately locate the cricothyroid membrane to perform a safe and effective surgical cricothyroidotomy.

Procedure:
1. Place the nondominant hand on the thyroid cartilage (Adam’s apple).
2. Slide the finger down toward the...
cricothyroid membrane location, airway management, TCCC
Make Incision for Surgical Cricothyroidotomy
Critical Source: TCCC 17 13 Tactical Combat Casualty Care
Objective: Make a precise incision to access the cricothyroid membrane safely.

Procedure:
1. Use a cutting instrument in the dominant hand (e.g., scalpel No. 10 or 15).
2. Make a **1.5-inch vertical incision through the skin over the...
incision technique, airway management, TCCC
Manage Airway Compromise from Facial Edema or Trauma
Critical Source: Emergency War Surgery
Procedure:

1. Assess for airway compromise due to facial trauma or edema (immediate or delayed onset).
2. Ensure ABCs (Airway, Breathing, Circulation) are prioritized in all cases of maxillofacial injury.
3. If airway obstruction is...
airway compromise,facial trauma,edema,swelling,intubation,tracheostomy
Manage Airway Compromise in Facial Injuries
Critical Source: Emergency War Surgery
Title: Manage Airway Compromise in Facial Injuries

Content:

Recognize signs of airway obstruction, such as inspiratory stridor, which may be caused by:
- Blood or edema from injury.
- Tongue obstruction due to mandible fracture.
...
airway management,facial injury,airway obstruction,cervical spine immobilization,stridor,mandible fracture,maxilla fracture
Monitor and Adjust ETT Placement for Surgical Cricothyroidotomy
Critical Source: TCCC 17 13 Tactical Combat Casualty Care
Objective: Continuously monitor the casualty’s breathing and adjust the ETT as needed.

Procedure:
1. If the patient is breathing spontaneously, ensure that the tube is not obstructed and continually assess the need for assisted...
ETT monitoring, airway management, TCCC
Opening the Airway of an Unconscious or Not Breathing Casualty
Critical Source: FM 4 25 11 First Aid
Procedure:

1. Call for help and then position the casualty. Move (roll) the casualty onto his back (Figure 2-1C). Refer to paragraph 2-3 c for information on positioning the casualty.

2. Perform a finger sweep. If foreign material or...
opening airway, head tilt chin lift, jaw thrust, first aid, medical emergency
Perform Cricothyroidotomy for Airway Obstruction
Critical Source: NATO Emergency War Surgery
Objective: Establish a temporary airway in patients with unmanageable airway obstruction.

Procedure:
1. Confirm that the patient is unresponsive to intubation due to trauma, bleeding, or anatomical injury (e.g., laryngotracheal edema,...
cricothyroidotomy, airway obstruction, emergency intubation, tracheostomy, trauma airway management
Perform Cricothyroidotomy in Extreme Airway Emergencies
Critical Source: NATO Emergency War Surgery
Procedure for Cricothyroidotomy

1. Identify the inferior border of the thyroid cartilage by palpation.
2. Locate the cricoid cartilage, which is a smaller protuberance just below the thyroid cartilage.
3. Palpate the taut membrane separating...
cricothyroidotomy, emergency airway, tracheal access, trauma surgery
Perform Cricothyrotomy in Emergency Situations
Critical Source: NATO Emergency War Surgery
Procedure:

1. Identify the cricothyroid membrane, located below the thyroid cartilage and above the cricoid cartilage.
2. Use a scalpel to make a horizontal incision through the skin and subcutaneous tissue over the cricothyroid membrane.
3....
cricothyrotomy, airway management, emergency surgery, battlefield medicine
Perform Emergency Surgical Airway (Cricothyroidotomy) Using Cric-Key
Critical Source: TCCC 17 13 Army Tactical Combat Casualty Care
Procedure for Performing an Emergency Surgical Airway (Cricothyroidotomy) Using the Cric-Key

### Steps:
1. Assemble and test all necessary equipment. Ensure that the Cric-Key, Melker airway cannula, scalpel, cotton tape, dressing, Ambu bag,...
cricothyroidotomy,Cric-Key,Melker cannula,emergency airway,airway management,TCCC
Perform Emergency Tracheostomy
Critical Source: NATO Emergency War Surgery
Procedure for Emergency Tracheostomy

1. Ensure adequate lighting and proper patient positioning:
- The patient lies supine with the shoulders elevated by sandbags or folded towels to extend the neck.
2. Administer local anesthesia (1 to 2...
tracheostomy, emergency airway, tracheal incision, airway management, trauma surgery
Perform Surgical Cricothyroidotomy
Critical Source: TCCC 17 13 Army Tactical Combat Casualty Care
### Surgical Cricothyroidotomy

#### Necessary Equipment:
• Prefabricated cricothyroidotomy kit.
• If unavailable, an improvised kit should include:
- Cutting instrument (e.g., scalpel No. 10 or 15)
- Forceps or tracheal hook
-...
surgical cricothyroidotomy, airway management, emergency intubation, battlefield medicine, trauma care
Position Casualty for Surgical Cricothyroidotomy
Critical Source: TCCC 17 13 Tactical Combat Casualty Care
Objective: Properly position the casualty to facilitate a safe and effective cricothyroidotomy.

Procedure:
1. Place the casualty in the supine position (lying on their back).
2. Use a rolled blanket or poncho under the casualty’s neck...
casualty positioning, airway management, cricothyroidotomy, TCCC
Prepare Incision Site for Surgical Cricothyroidotomy
Critical Source: TCCC 17 13 Tactical Combat Casualty Care
Objective: Prepare the incision site to reduce infection risk and ensure a clean surgical field.

Procedure:
1. If the casualty is conscious, administer local anesthesia at the incision site.
2. Clean the skin over the cricothyroid...
incision site preparation, airway management, TCCC
Provide Rescue Breathing with ETT for Surgical Cricothyroidotomy
Critical Source: TCCC 17 13 Tactical Combat Casualty Care
Objective: Provide rescue breathing if the casualty is not breathing spontaneously.

Procedure:
1. Once the tube is correctly placed, begin rescue breathing if necessary and tactically appropriate:
- Connect the tube to a **bag valve...
rescue breathing, airway management, TCCC
Remove Bloody Secretions from Airway
Critical Source: NATO Emergency War Surgery
Objective: Clear airway obstruction caused by bloody secretions.

Procedure:
1. Assess the airway for signs of obstruction (e.g., gurgling, ineffective coughing).
2. Suction the airway using a suction device with a Yankauer tip or...
airway management, suctioning, cricothyroidotomy, tracheostomy, airway obstruction
Surgical Cricothyrotomy Procedure
Critical Source: Emergency War Surgery
Procedure:

### Step-by-Step:
1. Identify the cricothyroid membrane (between the cricoid ring and thyroid cartilage).
2. Prep skin widely.
3. Grasp and hold trachea until airway is completely in place.
4. Make a vertical SKIN incision down...
surgical cricothyrotomy, airway management, emergency intubation, tracheostomy
Use of Eschmann Stylet or Gum Elastic Bougie (GEB) for Intubation
Critical Source: Emergency War Surgery
Eschmann stylet or Gum Elastic Bougie (GEB) can be used to assist in intubation when direct visualization is difficult. Follow these steps:

• Blindly guide the tip of the stylet beneath the epiglottis, then anteriorly through the vocal...
Eschmann stylet, Gum Elastic Bougie (GEB), intubation assistance, airway management, tracheal placement, bougie use
Verify ETT Placement and Air Exchange for Surgical Cricothyroidotomy
Critical Source: TCCC 17 13 Tactical Combat Casualty Care
Objective: Confirm that the ETT is correctly placed in the trachea and air exchange is occurring.

Procedure:
1. Check for air exchange: Listen and feel for air passage through the tube; look for fogging inside the tube.
2. Confirm...
ETT verification, airway management, TCCC
Critical Criteria for NPA Insertion
Critical Source: TCCC 17 13 Army Tactical Combat Casualty Care
Do Not:
• Aim the NPA toward the top of the head during insertion.
• Perform the procedure in a manner that could be dangerous to the casualty (e.g., forcing the tube, improper technique).

Consequences of Violating These Criteria:
• Aiming...
NPA safety, airway management errors, critical criteria for NPA insertion
Endotracheal Intubation in Burn Patients
Critical Source: NATO Emergency War Surgery
Purpose: Ensure airway patency and prevent acute airway obstruction in burn patients.

Indications for endotracheal intubation:
1. Acute laryngeal or upper airway edema or obstruction.
2. Inability to handle secretions.
3....
endotracheal intubation, airway management, burn patients, smoke inhalation, tracheostomy
Manage Airway for Conscious and Unconscious Casualties
Critical Source: TCCC 17 13 Army Tactical Combat Casualty Care
Title: Manage Airway for Conscious and Unconscious Casualties

Procedure:
1. Allow a conscious casualty to assume any position that best protects the airway, including sitting up.
2. Place an unconscious casualty in the recovery...
airway management, recovery position, cricothyroidotomy, conscious casualty, unconscious casualty
Perform Airway Management for Unconscious Casualty With Airway Obstruction
Critical Source: US Marine Corps Wilderness Medicine
Procedure:
1. Attempt endotracheal intubation to secure the airway.
2. If endotracheal intubation is unsuccessful, attempt other airway devices such as a Combitube or laryngeal mask airway.
3. If all attempts fail, perform a...
airway obstruction, cricothyroidotomy, endotracheal intubation, emergency airway management
Perform Nasal Intubation with Caution in Facial Trauma Patients
Critical Source: Emergency War Surgery
Procedure:

1. Assess the patient for facial trauma (e.g., Le Fort fractures) before attempting nasal intubation.
2. Prepare equipment: endotracheal tube, laryngoscope, and suction devices.
3. Use extreme caution during insertion to...
nasal intubation,facial trauma,airway management,critical care
Insert Nasopharyngeal Airway (NPA)
High Priority Source: TCCC 17 13 Tactical Combat Casualty Care
Objective: To demonstrate the recommended procedure for insertion of an NPA.

Materials Required:
• Student checklist
• Airway simulator
• NPA
• Surgical lubricant

Performance Steps:
1. Assess the upper airway for visible...
nasopharyngeal airway, NPA insertion, airway management, trauma care, first aid, emergency medical procedures
Laryngeal Mask Airway (LMA) Insertion and Use
High Priority Source: Emergency War Surgery
Important Warnings:
Do NOT use in penetrating upper airway trauma or central airway obstruction (foreign body).

### Procedure:
1. Insert the LMA blindly without a laryngoscope.
2. The LMA rests over the laryngeal inlet.
3. May be used...
laryngeal mask airway, fastrach lma, airway management, emergency intubation
Perform Rapid Sequence Intubation (RSI)
Standard Source: Emergency War Surgery
Procedure:

1. Ensure the patient is in a supine position with the head slightly extended.
2. Pre-oxygenate the patient using 100% oxygen for at least 3 minutes via a non-rebreather mask or bag-valve-mask device.
3. Administer a sedative (e.g.,...
Rapid Sequence Intubation, RSI, Intubation, Airway management, Pediatric intubation, Sedation, Neuromuscular blockade
Rapid Sequence Intubation Medication Dosages
Standard Source: Emergency War Surgery
Rapid Sequence Intubation Medication Dosages

Fentanyl: 2.0–2.5 µg/kg IV bolus, then titrate to effect.
Morphine: 5–10 mg IV bolus to load, then 2 mg q5min to effect.
Dilaudid (Hydromorphone): 1–2 mg IV to load, then 0.5 mg...
Rapid Sequence Intubation, Fentanyl, Morphine, Dilaudid, Vecuronium, Rocuronium, Pancuronium, Versed, Midazolam
Airway Management for Unconscious Casualty Without Airway Obstruction
Reference Source: TCCC 17 13 Tactical Combat Casualty Care + TCCC 17 13 Army Tactical Combat Casualty Care
Procedure for Airway Management in an Unconscious Casualty Without Airway Obstruction:

1. Perform the chin lift/jaw thrust maneuver.
2. Insert a nasopharyngeal airway (NPA) if needed.
3. Place the casualty in the recovery position...
airway management, unconscious casualty, chin lift, jaw thrust, nasopharyngeal airway, recovery position
Insert a Nasopharyngeal Airway (NPA) to a Casualty
Reference Source: TCCC 17 13 Tactical Combat Casualty Care + STP 21 1 Army Warrior Skills Level 1 Soldiers Manual of Common Tasks + The Ultimate Survival Kit Checklist
Purpose: To maintain an open airway in an unconscious casualty.

Procedure:
1. Lubricate the NPA with water or sterile gel before insertion.
2. Keep the casualty in a face-up position.
3. Push the tip of the casualty’s nose upward gently to...
Nasopharyngeal Airway, NPA, Airway Management, Unconscious Casualty, TCCC, Emergency Medical Procedure
Manage the Difficult Airway in Emergency Situations
Reference Source: Emergency War Surgery
Initial airway management for a difficult airway should include:

• Provide airway management with jaw-thrust, facemask oxygenation, and assess the situation.

Causes of Failed RSI:
- Inadequate time for induction agents to work.
-...
difficult airway, RSI failure, jaw-thrust, facemask oxygenation, airway management, surgical airway, laryngeal mask airway (LMA), awake intubation
Managing Laryngotracheal Injuries
Reference Source: Emergency War Surgery
Procedure for Managing Laryngotracheal Injuries:

1. Avoid endotracheal intubation if laryngotracheal separation is suspected (e.g., massive crepitis over the larynx/trachea) in an otherwise stable airway, as this may cause further injury or...
laryngotracheal injury, airway management, tracheotomy, cricothyroidotomy, lidocaine, emergency surgery
Orotracheal Intubation
Reference Source: Emergency War Surgery
Objective: Establish a secure airway via orotracheal intubation.

Procedure:
1. Ensure the patient is in a position that allows for optimal visualization of the vocal cords (e.g., head extended, neck flexed slightly) or **supine position...
orotracheal intubation, airway management, endotracheal tube, laryngoscope, emergency procedure
Perform Rapid Sequence Intubation (RSI) in Adults
Reference Source: Emergency War Surgery
Rapid Sequence Intubation (RSI) is a critical procedure used to secure the airway quickly and safely, especially in emergency situations. Follow these steps:

1. Ensure a safe environment and confirm the need for intubation:
- Confirm...
Rapid Sequence Intubation, RSI, Intubation, Airway management, Emergency procedures
Position the Head for Intubation in Children
Reference Source: Emergency War Surgery
- The child’s larynx is positioned more anterior in the neck compared to adults.
• This necessitates a more forward head position during intubation to improve visualization of the airway.

Note: Proper positioning is critical to ensure...
intubation, children, head position, airway management, larynx anatomy

Dental Procedures (46)

Understanding and Managing a Tooth Abscess
Critical Source: Where There is No Dentist
A tooth abscess is a serious infection that can occur in the tooth or surrounding tissues. To manage a tooth abscess:

1. Rinse the mouth with warm salt water to reduce swelling and discomfort.
2. Apply a cold compress to the affected area to...
tooth abscess,dental infection,emergency care,pain management
Follow the Eight-Step Process for Tooth Extraction
Critical Source: Where There is No Dentist
Steps to Follow:

1. Explain what you are going to do.
• Clearly explain why a tooth must be removed and how many teeth will be extracted.
• Begin only when the patient understands and agrees.

2. Inject local anesthetic.
• Use the...
tooth extraction steps, local anesthetic injection, post-extraction care, dental procedure protocol
Administer Local Anesthetic Carefully During Tooth Extraction
High Priority Source: Where There is No Dentist
When administering local anesthetic during tooth extraction:

Inject slowly in the correct location to ensure the tooth becomes numb and avoid causing pain.
• If the person reports continued pain, it is likely accurate. Inject again as...
local anesthetic, pain management, dental instruments, patient communication, baby tooth extraction
Administering Local Anesthetics for Dental Procedures
High Priority Source: Where There is No Dentist
Procedure:
1. Prepare the local anesthetic (e.g., lidocaine) and necessary equipment (e.g., syringe, needle).
2. Clean the injection site with antiseptic to prevent infection.
3. Inject the anesthetic slowly into the target area, ensuring proper...
local anesthetic,dental procedures,epinephrine,needle,syringe
Assess Patient Health Before Tooth Extraction
High Priority Source: Where There is No Dentist
Before extracting a tooth, ask the following questions to assess the patient’s health:

Do you bleed a lot when your skin is cut? If yes, the person may bleed excessively during and after the extraction.
• **Do you have swollen feet and...
tooth extraction, patient assessment, dental health, medical history, bleeding risk, heart disease, allergies, diabetes, pregnancy
Identify and Manage Special Cases Before Tooth Extraction
High Priority Source: Where There is No Dentist
Before extracting a tooth, identify the following special cases and take appropriate measures:

Persons who bleed a lot: Ensure they understand how to prevent bleeding afterward (see page 161). Consider placing a suture to hold the gums...
heart disease, anticoagulants, allergies, diabetes, pregnancy, infection prevention, penicillin
Prepare Instruments and Environment Before Extraction
High Priority Source: Where There is No Dentist
Preparation Steps:

Lay out instruments: Place the following on a clean cloth ahead of time:
- Syringe, needle, and local anesthetic.
- Forceps.
- Elevator.
- Spoon instrument.
- Cotton gauze.

Hygiene Steps:

• **Hand...
instrument preparation, hand hygiene, gloves, infection prevention, dental extraction setup
Prepare the Extraction Area and Position the Patient Correctly
High Priority Source: Where There is No Dentist
Preparation Steps:

Lighting: Work in a well-lit area with sunlight or lamp light. Use a dental mirror to direct more light into the mouth.
Chair: Use a chair with a high back to support the person’s head.
Positioning:
- For...
extraction positioning, lighting for dental procedures, patient positioning, upper lower tooth extraction
Select and Use the Four Basic Dental Instruments
High Priority Source: Where There is No Dentist
Tools Required:

Spoon or probe: Used to separate the gum from the tooth.
Elevator: Used to loosen a tooth or lift out a broken root.
Forceps (upper and lower universal forceps): Used to pull out the tooth. There is one for...
dental instruments, tooth extraction, spoon probe, elevator, forceps, upper lower universal forcep, cowhorn forcep, hawk’s bill forcep, curved elevators
Treating a Tooth Abscess Before Infection Reaches the Bone
High Priority Source: Where There is No Dentist
Procedure:
1. Identify signs of an abscess, such as pain, swelling, or pus.
2. Treat the abscess immediately to prevent infection from spreading to the bone.
3. Use antibiotics if prescribed by a healthcare provider (e.g., amoxicillin or...
abscess,treatment,bone,infection,antibiotics,pain relief
Apply Local Anesthetic and Manage Bleeding After Tooth Extraction
High Priority Source: Where There is No Dentist
Steps to Apply Local Anesthetic and Manage Bleeding After Tooth Extraction:

1. Administer local anesthetic as needed for the procedure.
2. Once finished, ask the person to bite on cotton gauze until the bleeding stops.
3. If small tags of...
local anesthetic, tooth extraction, bleeding management, cotton gauze, sterile scissors
Avoid Injecting Local Anesthetic into Swollen Areas
High Priority Source: Where There is No Dentist
Do not inject local anesthetic into an area that is swollen:

• This can spread the infection.
• Pus inside the swelling may stop the local anesthetic from working properly.

Instead:
• Treat the swelling first (see page 94).
• Take out the...
swollen area, infection prevention, avoid injection in swelling
Extract the Tooth Using Forceps
High Priority Source: Where There is No Dentist
Objective: Safely remove the tooth using forceps without breaking it.

Steps:
1. Push your forceps as far up the tooth as possible, ensuring that the beaks of the forceps hold onto the root under the gum.
2. Use your other hand to support...
tooth extraction, forceps use, dental removal, root movement
How to Place a Suture After Tooth Extraction
High Priority Source: Where There is No Dentist
Materials Required:
• Sterile needle and thread
• Hemostat (to hold the needle)
• Scissors (to cut the thread)
• Tongue blade or dental mirror
• Cotton gauze
• Extra cotton gauze for the patient to take home
• Aspirin or acetaminophen (for pain...
suture placement, tooth extraction, dental care, wound closure, post-extraction care, first aid for teeth
Identify Nerve Injection Points for Dental Anesthesia
High Priority Source: Where There is No Dentist
To deaden a nerve with an injection of local anesthetic:

• Inject near the small nerve branch going inside the root of a tooth.
• Inject near the main nerve trunk before it divides into small branches.

Note: Smaller nerves branch...
nerve injection points, dental anesthesia, local anesthetic
Inject Local Anesthetic for Lower Teeth
High Priority Source: Where There is No Dentist
To inject local anesthetic for lower teeth:

• The lower jaw bone is thicker.
• Inject near the roots of a lower tooth, but note that the anesthetic may not reach its nerve as easily.
• For young children or very loose lower front teeth in...
lower tooth injection, lower jaw anesthesia
Loosen the Tooth with a Straight Elevator
High Priority Source: Where There is No Dentist
Objective: Loosen the tooth before extraction to reduce the risk of breaking it.

Steps:
1. Hold the straight elevator properly by placing your first finger against the next tooth while turning the handle.
2. Insert the blade between the bad...
tooth loosening, straight elevator, dental extraction, prevent breaking tooth
Manage Dislocated Jaw During or After Tooth Extraction
High Priority Source: Where There is No Dentist
Steps to Manage a Dislocated Jaw:

1. If the jaw was dislocated during tooth extraction:
- The jaw has been pushed out of position and is not able to go back again.
2. Refer to page 113 for care instructions on a dislocated jaw.
3. **MOST...
dislocated jaw, dental extraction, jaw care, emergency treatment
Manage Painful Socket After Tooth Extraction
High Priority Source: Where There is No Dentist
Steps to Manage a Painful Socket After Tooth Extraction:

1. The socket area often hurts for a day or so after the tooth has been removed.
2. Aspirin or acetaminophen is usually enough to relieve the pain (see page 94).
3. If there is a...
pain management, dry socket, aspirin, acetaminophen, dental pain
Manage Swelling After Tooth Extraction
High Priority Source: Where There is No Dentist
Steps to Manage Swelling After Tooth Extraction:

1. If the tooth was hard to take out or if it took a long time:
- Hold a cloth wet with cold water against the face to prevent swelling.
2. If there is already swelling:
- Apply a...
swelling management, cold compress, hot compress, dental swelling, infection
Order Metal Syringe Kit for Dental Procedures
High Priority Source: Where There is No Dentist
Order the following items to create a metal syringe kit:

1. Syringe: Aspirating dental cartridge syringe, 1.8 ml (1ml=1cc)
2. Needles: Disposable needles for dental cartridge syringe (27 gauge, long). One box contains 100 needles, each...
metal syringe, dental kit, lidocaine, epinephrine, 27 gauge needles
Proper Technique for Injecting Local Anesthetic
High Priority Source: Where There is No Dentist
To administer local anesthetic safely and effectively:

Inject slowly and carefully. This allows the anesthetic to spread properly and reduces discomfort.
• You can then treat a bad tooth without hurting the person.
safe injection technique, local anesthetic administration
Separate the Gum from the Tooth
High Priority Source: Where There is No Dentist
Objective: Separate the gum from the tooth before extraction to prevent tearing and excessive bleeding.

Steps:
1. Use an instrument to slide along the side of the tooth into the gum pocket.
2. At the deepest part of the pocket, locate where...
gum separation, tooth extraction, dental procedure, prevent tearing, bleeding control
Sterilize Dental Instruments After Use
High Priority Source: Where There is No Dentist
Steps to Sterilize Dental Instruments:

1. Clean each instrument with soap and water, using a brush.
2. Be careful to scrub away all bits of old dried blood.
3. To kill germs, place the instruments into a **covered pot of boiling water for...
instrument sterilization, dental hygiene, tetanus prevention, boiling water, infection control
Stop Bleeding After Tooth Extraction
High Priority Source: Where There is No Dentist
Objective: Control bleeding after tooth extraction to promote healing and prevent infection.

Steps:
1. Squeeze the sides of the socket (the hole left after the tooth is removed) back into place.
2. Cover the socket with cotton gauze and...
post-extraction bleeding control, socket compression, gauze use
Treating Pain from a Dry Socket
High Priority Source: Where There is No Dentist
Treatment for dry socket:

First, clean out the socket:
- Squirt warm water inside the socket with a clean syringe.
- After the person spits out the water, squirt water inside once more.
- Use a blunt needle so that it does not hurt...
dry socket,dental pain,dental dressing
Use the Cow-Horn Forcep for Lower Molars
High Priority Source: Where There is No Dentist
Objective: Safely extract lower molars using a cow-horn forcep without damaging adjacent teeth.

Steps:
1. Fit the points of the cow-horn forcep under the gum, between the tooth’s roots.
2. Squeeze the handles gently and move them up and...
cow-horn forcep, lower molar extraction, baby tooth warning
Administering Local Anesthetic Injection for Back Teeth
Standard Source: Where There is No Dentist
### Procedure: Administering Local Anesthetic Injection for Back Teeth

Step 1: Wash your hands thoroughly. See page 86 for handwashing instructions.

Step 2: Locate the injection site:
• Place your thumb beside the last molar tooth.
• Feel...
local anesthetic, injection technique, dental procedures, back teeth, numbing, children, pressure anesthesia
Assemble Advanced Dental Kit
Standard Source: Survival and Austere Medicine
Objective: Create an advanced dental kit for survival and austere medicine scenarios.

### Components Required:
1. Dental Mirror
2. Explorer/Probe, Double-Ended #5
3. Angle Point Tweezers
4. **Excavator, Double-Ended #38/39 or...
advanced,dental kit,survival,austere medicine,dental tools
Select Appropriate Dental Instruments for Tooth Extraction
Standard Source: Where There is No Dentist
When purchasing or selecting dental instruments for tooth extraction:

Only a few instruments are necessary for most extractions. Refer to page 155 for the list of basic tools required.
• Use the proper name for each instrument when...
dental instruments, tool selection, proper terminology, instrument names
Understanding and Managing Tooth Decay
Standard Source: Where There is No Dentist
Tooth decay refers to damage to the tooth caused by acid; it results in cavities. To manage tooth decay:

1. Maintain good oral hygiene by brushing teeth twice daily with fluoride toothpaste.
2. Floss regularly to remove plaque from between...
tooth decay,cavities,oral hygiene,dental care
When to Remove a Tooth
Standard Source: Where There is No Dentist
Procedure:

1. Evaluate the tooth for pain that persists or wakes the person at night.
2. Check if the tooth is loose and causes pain when moved.
3. Determine if the tooth has a broken root or an exposed nerve from a broken top.
4. Only remove...
tooth extraction criteria, pain evaluation, tooth looseness, broken root, professional supervision
Apply Dental Cement to a Cavity
Standard Source: Where There is No Dentist
Procedure:

1. Remove the cotton from the cavity and check that it is dry.
2. If the cotton around the tooth is wet, change it.
3. Press some cement into the cavity using your filling tool:
- Put a small ball of cement on the end of...
applying dental cement, cavity filling, interproximal cavities, gum protection
Choosing the Right Filling Material and Placement
Standard Source: Where There is No Dentist
Procedure:

1. Select a strong filling material made of metal or plastic.
2. Ensure that the material is suitable for long-term use in the mouth.
3. The material must be able to withstand chewing and saliva exposure without breaking apart.
4....
filling material selection, dental filling placement, durability, special instruments, cavity preparation
Mix Dental Cement Properly
Standard Source: Where There is No Dentist
Procedure:

1. Mix the cement on a piece of smooth glass.
2. Place separately onto the glass a pile of zinc oxide powder and a few drops of eugenol liquid.
3. Use a mixing tool to pull a small amount of the powder into the liquid and mix...
dental cement mixing, zinc oxide eugenol, consistency test, smooth glass
Operating a Dental Drill and Managing Heat
Standard Source: Where There is No Dentist
Procedure:

1. Ensure the dental drill is properly powered (either by compressed air or foot treadle).
2. Use water spray to keep the tooth cool during drilling.
3. If the drill does not have an inbuilt sprayer, an assistant should manually...
dental drill operation, heat management, water spray, assistant assistance, nerve protection
Prepare a Tooth Cavity for Filling
Standard Source: Where There is No Dentist
Procedure:

1. Remove all decay from the edge of the cavity using a scraping tool.
2. If the edge is thin and weak, break it deliberately with the end of your instrument to create stronger sides for the cement to hold onto.
3. Use a spoon...
tooth cavity preparation, dental filling, decay removal, local anesthetic, cotton gauze
Preparing a Cavity for Permanent Filling
Standard Source: Where There is No Dentist
Procedure:

1. Use the dental drill to remove all decay from the cavity.
2. Shape the hole in the tooth so that it can firmly hold the permanent filling material.
3. Continue drilling until the entire cavity is fully opened and visible.
4....
cavity preparation, calcium hydroxide paste, decay removal, permanent filling, dental drill use
Shape and Finish Dental Cement Filling
Standard Source: Where There is No Dentist
Procedure:

1. Remove the extra cement before it gets too hard.
2. Press the flat side of the filling tool against the cement and smooth it towards the edge of the cavity.
3. As you smooth the cement, shape it to look like the top of a...
finishing dental filling, shaping cement, gum health, smooth surface
Using Bicycle-Powered Compressed Air for Dental Drills
Standard Source: Where There is No Dentist
Procedure:

1. Use a bicycle to generate compressed air.
2. Connect the compressed air to a high-speed dental drill.
3. Local volunteers can pump the air while waiting for their own dental treatment.
4. This method is commonly used in remote...
bicycle-powered drill, compressed air, dental procedures, remote areas, volunteer assistance
Using Foot Treadle-Powered Drills for Dental Work
Standard Source: Where There is No Dentist
Procedure:

1. Use a foot treadle to power the dental drill.
2. This method is similar to how sewing machines are operated.
3. It is commonly used in countries such as India and Guatemala.
4. Ensure that the drill is cooled properly, either...
foot treadle drill, dental procedures, water cooling, heat management, low-cost solutions
Understanding and Using a Spatula for Mixing Dental Cement
Reference Source: Where There is No Dentist
A spatula is an instrument used for mixing cement for fillings. To use it:

1. Ensure the spatula is clean and sterile.
2. Place the dental cement powder into a mixing dish.
3. Add the appropriate amount of liquid (as specified by the...
spatula,dental cement,mixing,fillings
Understanding Numbness and Anesthesia in Teeth
Reference Source: Where There is No Dentist
- Numb means without feeling; anesthetized.
• When teeth and the gums around them are numb, they cannot feel pain.
numbness, anesthesia, dental procedures
Understanding Permanent Filling and Teeth
Reference Source: Where There is No Dentist
- Permanent filling is a filling using a special metal or ceramic material that lasts for years.
Permanent teeth are the 32 adult teeth which grow into the mouth to replace the baby teeth.
permanent filling, permanent teeth, dental restoration
Understanding and Using a Tongue Depressor
Reference Source: Where There is No Dentist
A tongue depressor is a piece of wood used to keep the tongue out of the way when examining or treating the teeth. To use it:

1. Ensure the tongue depressor is clean and sterile.
2. Gently place the depressor under the patient’s tongue,...
tongue depressor,oral examination,dental tools
Using Ligature Wire for Tooth Attachment
Reference Source: Where There is No Dentist
- Ligature wire is a thin, strong wire that bends easily and is used to attach a loose tooth to a strong tooth.
ligature wire, loose tooth, dental attachment

Hemorrhage Control (45)

Administer Life-Saving Hemorrhage Control in Combat
Critical Source: STP 21 1 Army Warrior Skills Level 1 Soldiers Manual of Common Tasks
Objective: Stop severe bleeding to prevent death from hemorrhage.

Steps:
1. Assess the tactical situation and determine if it is safe to apply a tourniquet.
2. Identify the source of severe bleeding, such as from a limb or...
tourniquet application, hemorrhage control, combat bleeding management
Administer Tranexamic Acid (TXA) for Hemorrhagic Shock
Critical Source: TCCC 17 13 Army Tactical Combat Casualty Care
Procedure:
1. Assess the casualty for signs of hemorrhagic shock, such as hypotension or altered mental status.
2. Establish IV access using an 18-gauge catheter and saline lock in a field setting.
3. Administer TXA as soon as...
tranexamic acid, hemorrhagic shock, battlefield resuscitation
Apply Compression Bandage for Hemorrhage Control
Critical Source: NATO Emergency War Surgery
Procedure:

1. Assess the injury: Identify whether the hemorrhage is from an arterial or venous source.
2. Apply a compression bandage: Place a well-placed compression bandage over the wound to control bleeding.
3. **Use a tourniquet if...
compression bandage,tourniquet,arterial hemorrhage,venous hemorrhage,hemorrhage control
Apply Digital Ligation to Control Major Bleeding
Critical Source: Medical Emergencies
Procedure:

1. Apply firm pressure with a finger or two on the bleeding end of the vein or artery.
2. Maintain this pressure until the bleeding stops or slows down enough to apply additional measures such as a pressure bandage, elevation, or...
digital ligation, finger compression, hemorrhage control, emergency stop bleeding
Apply a Tourniquet for Life-Threatening Extremity Bleeding During Care Under Fire
Critical Source: TCCC 17 13 Tactical Combat Casualty Care
Procedure:

1. Assess the casualty for signs of massive hemorrhage from a compressible wound or life-threatening extremity bleed.
2. Apply a CoTCCC-approved tourniquet:
- Place it over clothing, high and tight (above the wound).
-...
tourniquet, hemorrhage control, life-threatening bleed, CoTCCC-approved tourniquet, massive hemorrhage
Avoid Applying Pressure to the Neck or Using Tourniquets on the Neck
Critical Source: Medical Emergencies
Procedure:

1. Never apply pressure directly to the neck, as it can cause unconsciousness or death due to restricted blood flow to the brain.
2. Never place a tourniquet around the neck, even in life-threatening situations.
3. If...
neck injury, tourniquet safety, neck bleeding, avoid neck compression
Control External Bleeding Using Direct Pressure
Critical Source: Medical Emergencies
Procedure:

1. Apply firm direct pressure over the wound using a clean cloth, gauze, or any suitable material.
2. Maintain this pressure for at least 30 minutes to allow the blood to clot and seal off the damaged surface.
3. If bleeding...
direct pressure, bleeding control, pressure dressing, wound care, hemorrhage
Control External Bleeding in Vascular Injury
Critical Source: Emergency War Surgery
Step-by-step procedure:

1. Apply direct pressure to the bleeding wound immediately.
2. Avoid blind or imprecise placement of vascular clamps in a bloody field.
3. If necessary, use a temporary tourniquet (BP cuff) placed proximal to the...
external bleeding, tourniquet, direct pressure, vascular injury
Control Hemorrhage from Laceration of Internal Maxillary Artery (IMA) and Branches
Critical Source: Emergency War Surgery
Procedure:

1. Assess for significant hemorrhage due to laceration of the internal maxillary artery (IMA) or its branches, which is common in mid-face fractures.
2. Apply direct pressure to the wound using sterile gauze or a clean...
IMA laceration,blood control,hemorrhage management,facial trauma
Control Major Bleeding from Neck Wounds
Critical Source: NATO Emergency War Surgery
Objective: Control external hemorrhage from neck wounds using external pressure.

Procedure:
1. Apply direct, firm manual pressure to the bleeding wound with a clean cloth or gauze.
2. Maintain pressure for at least 5 minutes, unless...
neck wound, hemorrhage control, external pressure, venous bleeding, trauma management
Control Massive Hemorrhage Using Tourniquets and Hemostatic Dressings
Critical Source: TCCC 17 13 Army Tactical Combat Casualty Care
Objective: Control massive hemorrhage in a casualty.

Steps:
1. Assess the casualty for an unrecognized hemorrhage and control all sources of bleeding.
2. Use one or more CoTCCC-recommended limb tourniquets, if necessary, to stop...
tourniquet,hemostatic dressing,massive hemorrhage,combat gauze,celox gauze,chitogauze,xstat sponges,junctional tourniquet
Hemorrhage Control - Internal Torso Bleeding
Critical Source: Emergency War Surgery
- Internal hemorrhage may occur from chest, abdomen, pelvis, and closed extremity fractures.
• High mortality if the casualty is not expeditiously transported and salvage surgical procedures performed.
• Controlled (hypotensive) resuscitation...
internal bleeding, torso trauma, surgical control, hypotensive resuscitation
Manage Severe Bleeding
Critical Source: Medical Emergencies
Procedure:

Step 1. Identify signs of severe bleeding:
• Loss of 1 liter of blood: moderate symptoms of shock.
• Loss of 2 liters: severe shock, extreme danger to the body.
• Loss of 3 liters: usually fatal.

Step 2. Apply direct...
severe bleeding, hemorrhage control, direct pressure, elevation, shock symptoms
Under Fire Hemorrhage Management
Critical Source: Emergency War Surgery
- Get the patient out of the line of fire — prevent further injury.
• Control obvious external bleeding once out from under fire.
• If you must remain under fire, stop external bleeding with use of a tourniquet.

• **Do not endanger the casualty...
under fire, battlefield medicine, tourniquet use, emergency care
Use Military Anti-Shock Trousers (MAST) for Hemorrhage Control and Pelvic Stabilization
Critical Source: Emergency War Surgery
Indication: For hemorrhage control from massively injured or mangled lower extremities, and temporary stabilization of pelvic fractures.

Procedure:
1. Apply the Military Anti-Shock Trousers (MAST) to control hemorrhage in cases of...
MAST application, pelvic fracture stabilization, hemorrhage control, emergency surgery
Use of Pneumatic Tourniquet for Arterial Injury Control
Critical Source: NATO Emergency War Surgery
Procedure:

1. Assess the location of the injury: Ensure that the extremity arterial injury is distal enough to permit the use of a pneumatic tourniquet.
2. Apply the tourniquet only when necessary:
- Do not inflate the tourniquet...
pneumatic tourniquet,arterial injury control,blood loss reduction
Use of Vascular Clamps for Hemorrhage Control
Critical Source: NATO Emergency War Surgery
Procedure:

1. Apply direct pressure: During surgery, apply direct pressure over the traumatized artery by an assistant both proximally and distally to provide temporary control of hemorrhage.
2. Expose injured vessels: Use an anatomical...
vascular clamps,balloon-tipped catheters,hemorrhage control,noncrushing clamps
Apply Dressings and Bandages for Hemostasis and Wound Protection
Critical Source: Emergency War Surgery
Indication: To promote hemostasis, protect wounds from contamination, immobilize tissues, and provide psychological support to the patient.

Procedure:
1. Control all bleeding before applying a dressing or bandage.
2. Assess **neurologic...
dressing application, wound protection, hemostasis, emergency care
Apply Limb Splints to Reduce Bleeding from Fractures and Soft Tissue Injury
Critical Source: Emergency War Surgery
Indication: To reduce bleeding associated with fractures and soft tissue injury.

Procedure:
1. Apply limb splints to align, stabilize, and return the limb to its natural length.
2. This reduces movement of fractured bones and damaged...
limb splinting, fracture stabilization, emergency care, trauma management
Apply the Anti-shock Garment for Hemorrhage Control
Critical Source: A Book for Midwives
Procedure:

1. Assess the situation: Confirm that the woman is experiencing severe hemorrhage due to causes such as ectopic pregnancy, ruptured uterus, or other postpartum complications.
2. Prepare the garment: Ensure the Anti-shock...
anti-shock garment, hemorrhage control, maternal emergency, shock treatment, midwifery procedures
Avoid Prolonged Tourniquet Use to Prevent Limb Loss
Critical Source: Emergency War Surgery
Procedure:

1. Avoid using a tourniquet for more than 2 hours as it may increase the risk of limb loss.
2. Make a risk–benefit decision: Do not avoid using a tourniquet in order to save a limb and then lose a life.
3. Use of a tourniquet...
tourniquet risks, limb loss prevention, prolonged tourniquet use
Control External Bleeding Using Elevation
Critical Source: Medical Emergencies
Procedure:

1. Raise the injured extremity (arm or leg) as high above the heart's level as possible.
2. This helps slow blood loss by aiding the return of blood to the heart and lowering the pressure at the wound site.
3. Note: Elevation...
elevation, bleeding control, extremity elevation, snakebite treatment
Control of Bleeding in Tactical Combat Casualty Care
Critical Source: TCCC 17 13 Tactical Combat Casualty Care
Control of bleeding takes precedence over infusing fluids.

1. Start an 18-gauge IV or saline lock, if indicated.
2. An IO device is an alternative route for administering fluids when fluid resuscitation is required and IV access cannot be...
tactical combat casualty care,txa,fluid resuscitation,hextend,shock,bleeding control,tourniquet removal
Controlling Hemorrhage in Maxillofacial Injuries
Critical Source: NATO Emergency War Surgery
Procedure:

1. Apply digital pressure directly to the bleeding site until permanent control can be achieved.
2. Clamp the bleeding vessel under full visualization, not blindly, to avoid damaging surrounding anatomical structures.
3....
hemorrhage control, digital pressure, clamping, ligation, external carotid artery
Field Hemostatic Dressings Considerations
Critical Source: Emergency War Surgery
- Use should be delayed until after a trial of conventional dressings.

• Do not use on minor injuries.

• Use on internal wounds is not yet recommended.

• Must apply pressure to the bleeding site after application.

• Risk of...
field dressings,conventional dressings,application,deep wounds
Manage Bleeding in Casualty with Controlled or Uncontrolled Hemorrhage
Critical Source: US Marine Corps Wilderness Medicine
Procedure:
1. Assess the type and severity of bleeding.
2. If tourniquets are in place and bleeding is controlled, consider removing them to allow for better wound assessment and management.
3. Apply direct pressure to the wound using...
bleeding control, tourniquet removal, direct pressure, uncontrolled hemorrhage
Managing Coagulopathy in Hemorrhagic Shock
Critical Source: Emergency War Surgery
- Blood loss, massive fluid resuscitation, and drop in body temperature may lead to inability to form clot.

Keep patient warm (above 34 ° C).

• Use warm fluids.

• Use crystalloid fluids sparingly.

• Transfuse with **fresh whole...
coagulopathy,fluid resuscitation,warm fluids,whole blood
QuikClot Application and Considerations
Critical Source: Emergency War Surgery
- QuikClot is a granular zeolite that absorbs fluid and causes hemostasis.

• It has handling properties similar to sand.

• When applied, it can generate significant heat during the absorption process.

• Blood and clot should be wiped out of...
QuikClot,application,heat generation,wound preparation,hemostasis
Reassess Tourniquets and Bandages for Massive Hemorrhage During Transport
Critical Source: TCCC 17 13 Army Tactical Combat Casualty Care
Procedure:

1. Continually reassess all tourniquets and bandages for bleeding from vehicular vibrations in cases of massive hemorrhage.
tourniquet reassessment, massive hemorrhage, transport
Reinforcement of Dressings
Critical Source: Emergency War Surgery
- Do not remove the first dressing if at all possible.

• If the dressing becomes thoroughly saturated, reevaluate the wound for a source of bleeding amenable to direct pressure.

• Consider advanced hemostatic agents or a proximal...
reinforcement,dressings,blood loss,saturation
Use of Hemostatic Agents in Field Conditions
Critical Source: Emergency War Surgery
- Two agents are recommended by the US Tactical Combat Casualty Care Committee: 1) HemCon, 2) QuikClot.

• If standard measures such as elevation and pressure dressings do not control bleeding, it is recommended that a tourniquet be used...
field conditions,HemCon,QuikClot,tourniquet,application guidelines
Administer Lidocaine for Severe Nosebleed
High Priority Source: Where There is no Doctor a Village Health Care Handbook
Purpose: To help control severe nosebleeds by constricting blood vessels.

Materials Needed:
• Lidocaine with epinephrine
• Cotton swabs or gauze

Procedure:
1. Soak a small amount of lidocaine with epinephrine into some cotton.
2....
nosebleed treatment, lidocaine with epinephrine, hemorrhage control
Avoid Prolonged Use of MAST to Prevent Complications
High Priority Source: Emergency War Surgery
Procedure:

1. Avoid prolonged use of MAST as it may lead to compartment syndrome and ischemic limbs.
2. Monitor the patient closely for signs of respiratory compromise, which can occur due to diaphragmatic elevation.
3. Be aware that...
MAST complications, compartment syndrome, aircraft use
Control Epistaxis with Anterior Pack
High Priority Source: Emergency War Surgery
Procedure:

1. Assess for epistaxis (nosebleed) due to nasal fracture or trauma.
2. Prepare materials: gauze, balloon tampon, or nasal packing device.
3. Insert the anterior pack into the nasal cavity, ensuring it is firmly packed to...
epistaxis,nasal fracture,blood control,nosebleed,packing
Control Hemorrhage from Facial and Scalp Lacerations
High Priority Source: Emergency War Surgery
Procedure:

1. Assess for facial or scalp lacerations with significant bleeding.
2. Apply direct pressure to the wound using sterile gauze or a clean cloth.
3. Elevate the head if possible to reduce blood flow to the area.
4. **Use...
facial laceration,blood control,tamponade,scalp injury,hemostasis
Control Scalp Bleeding with Direct Pressure and Compression Dressings
High Priority Source: Emergency War Surgery
Indication: Scalp bleeding due to the rich vasculature of the scalp.

Procedure:
1. Apply direct pressure to control scalp bleeding.
2. If direct pressure cannot be maintained, apply a compression dressing.
3. For severe cases, use...
scalp bleeding control, direct pressure, compression dressing, emergency surgery
Recognized Pressure Points for Hemorrhage Control
High Priority Source: Emergency War Surgery
|Bleeding Site|Hand|Forearm|Arm|Leg|Thigh|
|---|---|---|---|---|---|
|Artery|Radial/Ulnar|Brachial|Axillary|Popliteal|Femoral|
|Pressure Point|Wrist|Inner upper arm|Axilla|Behind knee|Below groin crease|
pressure points, hemostasis, arterial compression
Use Pneumatic Antishock Garment for Intra-abdominal Hemorrhage
High Priority Source: NATO Emergency War Surgery
Procedure for Using a Pneumatic Antishock Garment (PASG):

1. Apply the PASG: Place the garment over the casualty and inflate both the extremity and abdominal compartments.
2. Set pressure to at least 40 mm Hg: Ensure that the pressure...
pneumatic antishock garment, PASG, intra-abdominal hemorrhage
Convert Tourniquets in Austere Environments
High Priority Source: TCCC 17 13 Tactical Combat Casualty Care
Procedure for Converting a Tourniquet:

1. Assess the Time Since Application: Determine how long ago the tourniquet was applied.
- If less than 2 hours have passed, attempt conversion.
- If between 2 and 6 hours have passed, conversion...
tourniquet conversion, hemorrhage control, tccc, military medical procedures
Apply a Tourniquet for Hemorrhage Control
Standard Source: Emergency War Surgery + NATO Emergency War Surgery
Indication: A tourniquet should be applied if previous hemorrhage control techniques fail.

Procedure:
1. Apply a tourniquet early to stop ongoing blood loss, rather than waiting for other methods to fail.
2. Use a tourniquet as a first-line...
tourniquet, hemorrhage control, combat surgery, emergency care, direct pressure, field medical card
Clamp a Damaged Vessel for Hemorrhage Control
Reference Source: Emergency War Surgery
Indication: If there is continued bleeding and a damaged vessel can be readily identified.

Procedure:
1. If there is continued bleeding and a damaged vessel can be readily identified, use a hemostat to clamp the vessel.
2. Use a...
clamp, vessel, hemostat, hemorrhage control, emergency surgery
Control Hemorrhage Using Pressure Points
Reference Source: Emergency War Surgery
Procedure:

1. Identify the pressure points on the body:
- Armpit (Axillary artery): Apply firm pressure to the inner side of the upper arm, just below the armpit.
- Thigh (Femoral artery): Apply pressure midway between the groin...
pressure points, hemorrhage control, axillary artery, femoral artery, radial artery, popliteal artery, tourniquet
Controlled Resuscitation (Hypotensive Resuscitation) in Hemorrhage Control
Reference Source: Emergency War Surgery
- Controlled resuscitation (also known as hypotensive resuscitation) is a method of hemorrhage control.

• The needs of organ perfusion must be carefully balanced against the risk of increased bleeding as blood pressure rises.

• Excessive fluid...
controlled resuscitation, hypotensive resuscitation, hemorrhage control, fluid resuscitation, blood pressure management
Hemorrhage Control: External Hemorrhage from Extremity Wounds
Reference Source: Emergency War Surgery + NATO Emergency War Surgery
- Direct pressure at the site of injury is the most effective and preferred method of hemorrhage control.
• Apply direct pressure using a clean dressing or cloth, and maintain pressure until bleeding stops. Avoid removing extremity dressings...
hemorrhage control, direct pressure, external hemorrhage, extremity wounds, impaled foreign bodies, elevation, point compression
Use of Hemostatic Agents in Hemorrhage Control
Reference Source: Emergency War Surgery
- Hemostatic agents are available in several forms:

- Powders: placed in the wound, then covered with a dressing.

- Dressings: impregnated with hemostatic agents.

- Injectables:

- Intravenous: augment clotting...
hemostatic agents, powders, dressings, injectables, tourniquet, hemorrhage control

Infectious Disease (44)

Clinical Evaluation of Patients with Influenza-Like Illness During Interpandemic and Pandemic Alert Periods
Critical Source: HHSPandemicInfluenzaPlan
Procedure for Clinical Evaluation of Patients with Influenza-Like Illness During Interpandemic and Pandemic Alert Periods:

1. Screening for Risk Factors:
- Question patients who require hospitalization for an influenza-like illness (with...
clinical evaluation, influenza-like illness, pandemic alert period, novel influenza, diagnostic testing, PPE, RT-PCR, viral culture
Establish Standards for Home and Non-Hospital Isolation and Quarantine
Critical Source: HHSPandemicInfluenzaPlan
Procedure:

1. Develop clear standards and tools for managing cases and contacts in non-hospital settings.
2. Ensure these standards include guidelines for safe isolation, hygiene practices, and communication with public health authorities.
3....
isolation protocols, quarantine guidelines, home care
Implement Isolation and Infection Control for H5N1 Patients
Critical Source: HHSPandemicInfluenzaPlan
Isolation Protocols:

Immediate isolation: All suspected or confirmed cases of avian influenza A (H5N1) should be placed in strict airborne and droplet precautions, including:
- Use of N95 respirators by healthcare workers.
-...
isolation,H5N1,infection control,N95 respirators,airborne precautions,droplet precautions
Managing Ill Passengers During Pandemic Alert Period
Critical Source: HHSPandemicInfluenzaPlan
Procedure:

• State and local health departments should follow advance protocols for managing arriving ill passengers who meet clinical and epidemiologic criteria for infection with a novel strain of influenza.

• If an ill passenger with...
ill passenger management, pandemic alert period, infection control, ambulance transport, novel influenza
Provide Supportive Care for H5N1 Patients
Critical Source: HHSPandemicInfluenzaPlan
Supportive Care Protocols:

Respiratory support: Provide oxygen therapy or mechanical ventilation as needed, especially in patients with ARDS.
- Use non-invasive ventilation (e.g., CPAP) initially if possible.
- Transition to invasive...
supportive care,H5N1,ARDS,oxygen therapy,mechanical ventilation,fluid management,nutritional support
Recognize and Monitor Symptoms of Avian Influenza A (H5N1) Infection
Critical Source: HHSPandemicInfluenzaPlan
Clinical Presentation of H5N1 Infection:

Common symptoms: Fever, headache, malaise, myalgia, sore throat, cough, rhinorrhea.
Less common symptoms: Conjunctivitis, gastrointestinal distress (e.g., diarrhea).
Severe symptoms:...
avian influenza,H5N1,fever,cough,lymphopenia,ARDS,pneumonia,encephalitis,gastrointestinal symptoms
Recognize and Respond to Plague (Yersinia pestis) Infection
Critical Source: Medical NBC Battlebook
Procedure:

Step 1: Identify Symptoms of Bubonic Plague
• Look for the following signs:
- Acute onset with malaise, high fever, and tender lymph nodes.
- Inguinal, cervical, or axillary lymphadenitis (bubo) that is tender, fluctuant, and...
plague,yersinia pestis,bubonic,pneumonic,chemoprophylaxis,isolation,doxycycline,tetracycline,ceftriaxone
Report Suspected Cases of Novel Influenza
Critical Source: HHSPandemicInfluenzaPlan
Procedure:

1. Follow the guidance provided in Supplement 1 for reporting suspected cases of novel influenza.

2. Ensure timely communication with local and state health departments to facilitate appropriate public health responses.
case reporting, novel influenza, public health
Administer Plague Vaccine and Considerations
High Priority Source: Medical NBC Battlebook
Procedure:

Step 1: Administer the Formalin-Inactivated (Licensed) Y. pestis Vaccine
• This vaccine is produced in the United States and has been extensively used.
• It is not effective against aerosol challenge, even though it provides...
plague,vaccine,formalin-inactivated,doxycycline,tetracycline,ceftriaxone,chemoprophylaxis,aerosol challenge
Avian Influenza A (H5N1) Testing Considerations for Hospitalized or Ambulatory Patients
High Priority Source: HHSPandemicInfluenzaPlan
Procedure:

Testing for avian influenza A (H5N1) should be considered on a case-by-case basis in consultation with state and local health departments for hospitalized or ambulatory patients who meet the following criteria:

1. Documented...
avian influenza, H5N1 testing, pandemic flu, medical emergency, infectious disease
Classify Patients During the Pandemic Period Based on Clinical Criteria
High Priority Source: HHSPandemicInfluenzaPlan
Procedure:

1. Determine if pandemic influenza is present in the locality:
- If pandemic influenza has arrived in a specific area, clinical criteria alone are sufficient for classification.
2. **Evaluate patients with ILI (influenza-like...
pandemic influenza, classification, clinical criteria, ILI, suspected case
Dealing with Public Health Emergencies and Disease Outbreaks
High Priority Source: Life After Doomsday
Procedure:

1. Stay informed about public health threats. Be aware of outbreaks such as polio, bubonic plague, or other infectious diseases that may affect your community.

2. Practice good hygiene and sanitation. Wash hands frequently,...
disease outbreak, public health emergency, polio, bubonic plague, survival
Evaluate High-Risk Groups with Atypical Symptoms for Novel Influenza
High Priority Source: HHSPandemicInfluenzaPlan
Procedure:

1. Identify high-risk groups who may present with atypical symptoms of novel influenza, including:
- Young children
- Elderly patients
- Patients in long-term care facilities
- Persons with underlying chronic...
atypical symptoms, high-risk groups, novel influenza, young children, elderly patients
Evaluate Patients for Possible Novel Influenza Infection
High Priority Source: HHSPandemicInfluenzaPlan
Clinical Criteria: To suspect human infection with a novel influenza virus, the following must be met:

Fever (temperature >38°C) plus one of the following:
- Sore throat
- Cough
- Dyspnea (shortness of breath)

> Note: Lower...
novel influenza, evaluation criteria, pandemic, ILI, fever, cough, dyspnea, exposure risk, laboratory testing
Identify Suspected Cases of Pandemic Influenza Virus Infection
High Priority Source: HHSPandemicInfluenzaPlan
Procedure:

1. Assess for fever:
- Confirm that the patient has a temperature greater than 38°C (100.4°F).
2. Check for respiratory symptoms:
- Look for either of the following:
- Sore throat
- Cough
-...
pandemic influenza, suspected case, fever, cough, sore throat, dyspnea, clinical criteria
Treating Typhoid Fever with Medication and Care
High Priority Source: Where There is no Doctor a Village Health Care Handbook
Procedure:

Seek medical help immediately for proper diagnosis and treatment.
• Administer one of the following antibiotics based on local availability:
- Ciprofloxacin (see page 356)
- Chloramphenicol (see page 356)
-...
typhoid fever treatment, antibiotic use, fever management, dehydration prevention
Understand Pandemic Influenza Characteristics and Historical Context
High Priority Source: HHSPandemicInfluenzaPlan
Pandemic influenza is a rare but severe form of influenza A that causes greater morbidity and mortality compared to seasonal influenza. It occurs when a new strain of pandemic influenza virus emerges in the human population, causes...
pandemic influenza, influenza A, historical pandemics, Spanish Flu, Asian Flu, Hong Kong Flu
Understanding Pandemic Influenza Transmission
High Priority Source: Flu Home Treatment
Procedure:

1. Transmission Routes:
- Airborne transmission occurs through coughing or sneezing.
- Contact transmission happens when touching contaminated surfaces or objects and then touching the mouth, nose, or eyes.

2....
pandemic flu, transmission routes, asymptomatic spread, virus survival, infection control, home care
Assess Risk Factors for Infection and Person-to-Person Transmission of Pandemic Influenza
High Priority Source: HHSPandemicInfluenzaPlan
Procedure:

To assess risk factors for infection and person-to-person transmission:

1. Identify demographic, behavioral, and environmental factors associated with increased susceptibility to pandemic influenza.
2. Analyze patterns of...
risk factors, transmission, pandemic influenza, public health interventions, asymptomatic carriers
Define Close Contact for Novel Influenza Transmission
High Priority Source: HHSPandemicInfluenzaPlan
Procedure:

1. For persons in or visiting affected areas:
- Define close contact as touching live poultry (well-appearing, sick, or dead) or consuming uncooked poultry products, including blood.
- For animal or market workers: define...
close contact, poultry exposure, novel influenza transmission
Determine Molecular Basis of Virulence in Humans and Animals
High Priority Source: HHSPandemicInfluenzaPlan
Objective: Determine the molecular basis of virulence in humans and animals.

Procedure:
1. Study the genetic and molecular factors that contribute to viral virulence.
2. Use experimental models to understand how these factors affect disease...
molecular basis,virulence,humans,animals,experimental models,disease severity
Evaluate Change in Natural History of Disease and Effect of Antiviral Drugs During Pandemics
High Priority Source: HHSPandemicInfluenzaPlan
Procedure:

To evaluate the change in natural history of disease and effect of antiviral drugs during pandemics:

1. Compare the clinical course, severity, and outcomes of pandemic influenza strains to previously circulating strains.
2. Assess...
antiviral drugs, natural history, pandemic influenza, drug resistance, risk/benefit assessment
Evaluate Effect of Early Use of Antiviral Drugs in High-Risk Patients During Pandemic Influenza
High Priority Source: HHSPandemicInfluenzaPlan
Procedure:

To evaluate the effect of early use of antiviral drugs in high-risk patients during pandemic influenza:

1. Identify high-risk patient groups, such as those with chronic respiratory conditions, immunocompromised individuals, and...
antiviral drugs, high-risk patients, early treatment, disease severity, drug efficacy
Evaluate Impact of Vaccination on Pathogenesis and Transmission of Pandemic Influenza
High Priority Source: HHSPandemicInfluenzaPlan
Procedure:

To evaluate the impact of vaccination on pathogenesis and transmission of pandemic influenza:

1. Monitor vaccinated individuals for signs of infection, including viral shedding and disease progression.
2. Compare transmission rates...
vaccination impact, pathogenesis, transmission rates, viral shedding, herd immunity
Evaluate Role of Mutations in Antiviral Drug Resistance Using Reverse Genetics
High Priority Source: HHSPandemicInfluenzaPlan
Objective: Evaluate the role of mutations and constellations of mutations in antiviral drug resistance.

Procedure:
1. Use a reverse genetics system to create viruses with specific mutations associated with drug-resistant phenotypes.
2....
mutation,constellation,antiviral resistance,reverse genetics,virus replication
Evaluate and Test Outpatients with Strong Epidemiologic Risk Factors for Novel Influenza
High Priority Source: HHSPandemicInfluenzaPlan
Procedure:

1. Consider further evaluation and diagnostic testing for outpatients who have strong epidemiologic risk factors and present with mild or moderate illness.

2. Refer to Box 2 in the source document for additional details on...
epidemiologic risk factors, novel influenza, outpatient testing
Evaluation of Travel-Related Cases During Pandemic Alert Period
High Priority Source: HHSPandemicInfluenzaPlan
Procedure:

• During the Pandemic Alert Period, travel-related cases of infection with novel strains of influenza may be detected:
- After entry into the United States
- Reported during transit by airline or cruise ship personnel before...
travel-related cases, pandemic alert period, novel influenza, clinical management, supplement 1
Examine Molecular Basis of Influenza Transmission Among Animals and Humans
High Priority Source: HHSPandemicInfluenzaPlan
Objective: Examine the molecular basis of transmission of influenza viruses among animals and humans.

Procedure:
1. Study the structural diversity of sialosides expressed at the surface of airway epithelial cells in avian and mammalian...
viral transmission,molecular basis,sialosides,mucins,Hemagglutinin (HA),zoonotic outbreaks
Examine Reasons Behind High Lethality of the 1918 Influenza Pandemic
High Priority Source: HHSPandemicInfluenzaPlan
Objective: Examine the reasons behind the high lethality of the 1918 influenza pandemic.

Procedure:
1. Study the genetic and molecular characteristics of the 1918 virus.
2. Investigate factors that contributed to its high mortality rate,...
1918 pandemic,viral virulence,host immune response,pathogenicity,mortality rate
Identify Genetic Mutations Correlated with Antiviral Resistance
High Priority Source: HHSPandemicInfluenzaPlan
Objective: Identify genetic mutations that correlate with antiviral resistance in influenza viruses.

Procedure:
1. Conduct studies to examine the molecular biology and epidemiology of pathogenic viruses in avian reservoirs.
2. Use the...
genetic mutations,antiviral resistance,influenza genome sequencing,drug resistance,molecular biology
Identify High-Risk Individuals for Novel Influenza Exposure
High Priority Source: HHSPandemicInfluenzaPlan
Procedure:

1. Identify individuals with high risk of exposure to a novel influenza virus, such as:
- Poultry workers from affected areas
- Caregivers of patients with laboratory-confirmed novel influenza
- Employees in laboratories...
high-risk exposure, novel influenza, epidemiologic evidence, early symptoms, pandemic flu
Identify and Characterize Intracellular Trafficking of Influenza Virus Proteins
High Priority Source: HHSPandemicInfluenzaPlan
Objective: Identify and characterize the intracellular trafficking of influenza virus proteins, nucleic acids, and complexes in avian and mammalian systems.

Procedure:
1. Use advanced imaging techniques to track the movement of viral...
intracellular trafficking,viral replication,imaging techniques,avian,mammalian cells
Recognize and Respond to Q Fever Infection
High Priority Source: Medical NBC Battlebook
Procedure:

Step 1: Identify Symptoms of Q Fever
• Look for the following signs:
- Incubation period of 10–20 days.
- Self-limiting febrile illness lasting 2 days to 2 weeks.
- Frequent occurrence of pneumonia, often...
q fever,coxiella burnetii,vaccine,tetracycline,isolation,quarantine,pneumonia,endocarditis
Research Role of Other Viral Proteins in Influenza Pathogenesis
High Priority Source: HHSPandemicInfluenzaPlan
Objective: Research the role of other viral proteins in the pathogenesis of influenza.

Procedure:
1. Investigate the function and contribution of non-surface proteins such as nucleoprotein (NP) and matrix protein (M1) to viral replication...
viral proteins,pathogenesis,nucleoprotein (NP),matrix protein (M1),virulence,transmission
Study Viral Evasion Mechanisms of the Innate Immune Response
High Priority Source: HHSPandemicInfluenzaPlan
Objective: Study how influenza A and B viruses evade the innate immune response.

Procedure:
1. Investigate mechanisms by which influenza viruses modulate the host's innate defenses.
2. Use experimental models to understand viral evasion...
viral evasion,innate immune response,influenza A,B,virus-host interactions
Understand Mechanisms of Influenza Virus Emergence in Humans and Animals
High Priority Source: HHSPandemicInfluenzaPlan
Objective: Understand how novel subtypes of influenza viruses emerge in humans and animals.

Procedure:
1. Study the molecular biology and epidemiology of pathogenic viruses in avian reservoirs.
2. Focus on defining the molecular basis of...
influenza,virus,evolution,pandemic,emergence,molecular biology,epidemiology
Administer Q Fever Vaccine and Considerations
Standard Source: Medical NBC Battlebook
Procedure:

Step 1: Administer the Formalin-Inactivated Whole Cell Vaccine
• The vaccine is available for immunization of at-risk personnel on an investigational basis.
• A single dose provides:
- Complete protection against naturally...
q fever,vaccine,formalin-inactivated,immunization,contraindications,necrosis,adverse reactions
Interpreting Rapid Influenza Test Results Based on Disease Prevalence
Standard Source: HHSPandemicInfluenzaPlan
Procedure:

1. Understanding predictive values:
- The positive and negative predictive values of rapid tests vary based on the prevalence of influenza in the community.
2. Low disease prevalence (beginning/end of flu season):
-...
predictive value, disease prevalence, false positive, false negative, rapid test interpretation
Treating Brucellosis with Antibiotics
Standard Source: Where There is no Doctor a Village Health Care Handbook
Procedure:

• If brucellosis is suspected, seek medical advice immediately due to the risk of misdiagnosis and the need for long-term treatment.
• Administer tetracycline: 250 mg capsules taken four times a day for three weeks. See...
brucellosis, tetracycline, cotrimoxazole, antibiotic treatment, undulant fever
Understand Antigenic Shift and Its Role in Pandemics
Standard Source: HHSPandemicInfluenzaPlan
What is Antigenic Shift?

Shift refers to the process by which influenza viruses replace their surface proteins hemagglutinin (H) and neuraminidase (N) with significantly different versions.

Effects of Shift:

• This results...
shift,pandemic,novel,virus,immunity,epidemic,outbreak
Understand Antigenic Drift and Its Impact on Influenza Viruses
Standard Source: HHSPandemicInfluenzaPlan
What is Antigenic Drift?

Drift refers to the process by which influenza viruses undergo genetic mutations that lead to changes in the viral proteins hemagglutinin (H) and neuraminidase (N).

Effects of Drift:

• This...
drift,mutation,virus,strain,variant,vaccine,update,immunization
Understand Influenza Virus Types and Their Impact
Standard Source: HHSPandemicInfluenzaPlan
Understanding Influenza Virus Types:

• The influenza virus is classified into two types: A and B, with type C not causing disease in humans.
Type A viruses are responsible for pandemics, while type B viruses cause seasonal...
influenza,pandemic,virus,A,B,H3N2,H1N1,epidemic,drift,shift
Understanding Rapid Influenza Diagnostic Tests
Standard Source: HHSPandemicInfluenzaPlan
Procedure:

1. Purpose of rapid tests: These are screening tests for influenza virus infection and provide results within 30 minutes.
2. FDA-approved tests: At least ten rapid influenza tests have been approved by the FDA (see Appendix...
rapid test, influenza, sensitivity, specificity, specimen collection, clia waiver
Accessing Influenza Information from CDC
Reference Source: HHSPandemicInfluenzaPlan
Procedure:

1. Visit the [CDC influenza website](www.cdc.gov/flu) for detailed information about influenza.
2. Contact the CDC Flu Information Line at:
- 800-CDC-INFO (English and Spanish)
- 800-243-7889 (TTY).

**Additional...
cdc, influenza, diagnostics, information, resources

Infectious Disease Management (44)

Antiviral Use for Containment of Disease Clusters
Critical Source: HHSPandemicInfluenzaPlan
Procedure:

1. Identify and isolate clusters of novel influenza cases in the community.
2. Administer antivirals (oseltamivir or zanamivir) to all confirmed and suspected cases within 48 hours of symptom onset.
3. **Provide prophylaxis...
disease containment, antiviral use, cluster management, oseltamivir, zanamivir
Clinical Evaluation During the Pandemic Period for Suspected Influenza Cases
Critical Source: HHSPandemicInfluenzaPlan
During the Pandemic Period, the focus of evaluation should be on:

1. Rapid detection and triage of suspected pandemic influenza cases.
2. Clinical assessment, including symptoms such as fever, cough, sore throat, and respiratory...
pandemic period, clinical evaluation, triage, epidemiologic criteria
Criteria for Evaluation of Patients with Possible Pandemic Influenza
Critical Source: HHSPandemicInfluenzaPlan
When evaluating patients for possible pandemic influenza, consider the following:

1. Clinical symptoms such as fever, cough, sore throat, and respiratory distress.
2. Epidemiologic factors, including recent travel to areas with reported...
pandemic influenza, evaluation criteria, triage, clinical symptoms
Managing Streptococcal Myonecrosis
Critical Source: NATO Emergency War Surgery
### Procedure for Managing Streptococcal Myonecrosis

Overview:
Streptococcal myonecrosis is a severe infection caused by anaerobic streptococci, leading to tissue necrosis and gas formation. It resembles subacute clostridial gas...
streptococcal myonecrosis, gas gangrene, surgical management, antibiotic regimen, wound infection, necrotizing fasciitis, tissue necrosis, deep muscle infection, emergency surgery
Provide Prophylaxis to Healthcare Workers in Critical Units
Critical Source: HHSPandemicInfluenzaPlan
Procedure:

1. Identify healthcare workers in emergency rooms (ER), intensive care units (ICU), emergency medical services (EMS), and dialysis settings.
2. Administer prophylactic antiviral medications to these individuals to prevent...
healthcare workers,prophylaxis,pandemic influenza,critical units
Administer Antiviral Medications for Severe Influenza Patients
High Priority Source: HHSPandemicInfluenzaPlan
Procedure:
1. Administer antiviral medications as per current guidelines found in Supplement 7.
2. Ensure that supportive care is provided to severe influenza patients, including monitoring of vital signs and hydration status.
3. Rapidly...
antiviral, severe influenza, secondary complications, CDC reporting, drug resistance
Administer Early Antiviral Treatment for High-Risk Populations
High Priority Source: HHSPandemicInfluenzaPlan
Procedure:

1. Identify individuals in high-risk groups, such as the elderly and those with underlying medical conditions.
2. Administer antiviral medications at the earliest signs of influenza infection.
3. Ensure treatment is initiated within...
antiviral,early treatment,pandemic influenza,high-risk populations
Antiviral Prophylaxis for Contacts of Novel Influenza Cases
High Priority Source: HHSPandemicInfluenzaPlan
Procedure:

1. Identify close contacts of confirmed or suspected novel influenza cases.
2. Administer antivirals (oseltamivir or zanamivir) to eligible individuals within 48 hours of exposure.
3. **Determine the duration of...
antiviral prophylaxis, contact tracing, oseltamivir, zanamivir, drug resistance
Antiviral Use for Treatment of Novel Influenza Cases
High Priority Source: HHSPandemicInfluenzaPlan
Procedure:

1. Administer antivirals as soon as possible after symptom onset, ideally within 48 hours.
2. Use oseltamivir or zanamivir based on the patient's age and condition.
3. Monitor for adverse effects, including...
antiviral use, novel influenza treatment, oseltamivir, zanamivir, drug resistance
Avoid Use of Ribavirin and Immunomodulatory Therapies for Severe Influenza
High Priority Source: HHSPandemicInfluenzaPlan
Procedure:
1. Do not use ribavirin or immunomodulatory therapies (e.g., steroids) for the treatment of severe influenza.
2. These agents are not approved by the FDA and are investigational at this time.
3. These treatments may cause severe...
ribavirin, steroids, FDA approved, adverse effects, severe influenza
Clinical Evaluation for Pandemic Influenza
High Priority Source: HHSPandemicInfluenzaPlan
Procedure:

1. Assess symptoms:
- Check if the patient has a temperature greater than 38°C.
- Evaluate for presence of cough, sore throat, or dyspnea.
2. Determine eligibility for further evaluation:
- If either symptom is...
pandemic influenza, clinical evaluation, infection control, hospitalization, antiviral treatment, home isolation
Continue Antiviral Treatment and Isolation for Negative Novel Influenza Test Results with High Clinical Suspicion
High Priority Source: HHSPandemicInfluenzaPlan
If a patient tests negative for novel influenza but clinical suspicion remains high:

1. Continue antiviral treatment as per guidelines, even if test results are negative.
2. Maintain isolation precautions, including Standard and Droplet...
negative test results, clinical suspicion, false negatives, infection control
Continue Antiviral Treatment and Isolation for Novel Influenza Patients
High Priority Source: HHSPandemicInfluenzaPlan
If a patient is confirmed to have an infection with a novel influenza virus, healthcare personnel should:

1. Continue antiviral treatment as prescribed.
2. Maintain isolation precautions, including Standard and Droplet Precautions.
3....
novel influenza, antiviral treatment, isolation precautions, infection control
Decide on Inpatient or Outpatient Management for Suspected Pandemic Influenza Cases
High Priority Source: HHSPandemicInfluenzaPlan
Procedure:

1. Decide on inpatient or outpatient management based on the physician’s clinical assessment of the patient and availability of hospital beds and personnel.
2. Guidelines on cohorting and infection control for admitted patients...
inpatient management, outpatient care, pandemic influenza, clinical assessment
Develop Protocols for Case Surveillance and Management
High Priority Source: HHSPandemicInfluenzaPlan
Develop protocols, tools, and databases for:

1. Case surveillance
2. Clinical evaluation and management
3. Contact tracing, monitoring, and management
4. Reporting criteria

These protocols should include:
• Tools to track cases...
case surveillance, contact tracing, protocols, databases, clinical evaluation
Discontinuation of Antiviral Therapy and Isolation Precautions for Pandemic Influenza
High Priority Source: HHSPandemicInfluenzaPlan
Criteria for Discontinuing Antiviral Therapy and Isolation Precautions:

1. Alternative Diagnosis Confirmed: Use a test with high positive-predictive value to confirm an alternative diagnosis.
2. Clinical Manifestations Explained: Ensure...
antiviral therapy, isolation precautions, pandemic influenza, alternative diagnosis, discontinuation criteria
Ensure Provision of Essential Services During Isolation and Quarantine
High Priority Source: HHSPandemicInfluenzaPlan
Plan to ensure provision of essential services and supplies to persons in isolation and quarantine, keeping in mind the special needs of children.

Services and supplies include:
1. Food and water
2. Shelter
3. **Medicines and medical...
essential services, food supply, mental health, child care, medical support
Establish Clinical Procedures for Pandemic Influenza Management
High Priority Source: HHSPandemicInfluenzaPlan
Objective: Develop clinical procedures for the initial screening, assessment, and management of patients with suspected novel influenza during a pandemic.

Steps:
1. Collaborate with the medical community to establish standardized protocols...
clinical procedures, pandemic influenza, screening, assessment, management, novel virus, community-acquired pneumonia
Establish Procedures for Delivering Medical Care and Services During Isolation or Quarantine
High Priority Source: HHSPandemicInfluenzaPlan
Establish procedures for delivering medical care, food, and services to persons in isolation or quarantine. Examples of services that will require the help of non-traditional partners include:

• **Training for responders and healthcare workers,...
medical care delivery, PPE training, non-traditional partners, public health mobilization
Follow Local Health Department Recommendations for Reporting Suspected Pandemic Influenza Cases
High Priority Source: HHSPandemicInfluenzaPlan
Procedure:

1. When a patient meets the criteria for a suspected case of pandemic influenza, healthcare personnel should:
- Follow local and state health department recommendations on reporting.
- Refer to Supplement 1 for guidance...
pandemic influenza, reporting, health department, suspected case
Healthcare Provider Actions During Interpandemic and Pandemic Alert Periods
High Priority Source: HHSPandemicInfluenzaPlan
Procedure:

Steps:
1. Be aware of case definitions for novel influenza A (H5N1) and other novel influenza viruses, including procedures for:
- Screening patients for suspected cases.
- Implementing infection control measures.
-...
healthcare provider actions, novel influenza case definitions, specimen collection, infection control, antiviral regimens
Identify and Manage Complications of Influenza in High-Risk Patients
High Priority Source: HHSPandemicInfluenzaPlan
Procedure:
1. Recognize that major clinical presentations and complications related to seasonal human influenza occur more commonly in persons with underlying medical conditions such as chronic respiratory or cardiovascular disease, and in...
complications, high-risk patients, pneumonia, chronic disease, influenza management
Implement Outbreak Control Measures in Closed Settings
High Priority Source: HHSPandemicInfluenzaPlan
Procedure:

1. Identify closed settings where an outbreak of pandemic influenza may occur (e.g., nursing homes, prisons).
2. Implement strict infection control measures to prevent the spread of illness within these settings.
3. Limit visitor...
outbreak control,closed settings,pandemic influenza,infection prevention
Initial Screening and Assessment of Patients with Suspected Novel Influenza During Interpandemic and Pandemic Alert Periods
High Priority Source: HHSPandemicInfluenzaPlan
Procedure for Initial Screening and Assessment of Patients with Suspected Novel Influenza During Interpandemic and Pandemic Alert Periods

### Overview
This procedure outlines the steps to be taken by clinicians during the *Interpandemic*...
novel influenza, interpandemic period, pandemic alert period, screening criteria, clinical management, antiviral therapy, respiratory illness, laboratory diagnosis
Managing Patients Infected with Novel Strains of Influenza and Their Contacts
High Priority Source: HHSPandemicInfluenzaPlan
Procedure:

1. Define novel strains:
- Use the term "novel strains of influenza" to refer to avian or animal influenza strains that can infect humans (e.g., H5N1) and new or reemergent human viruses causing disease outbreaks.

2. **Detect...
novel influenza strains, patient management, public health coordination, pandemic alert phases
Understand Risk Levels During Pandemic Alert Period (Phase 5)
High Priority Source: HHSPandemicInfluenzaPlan
Procedure:
1. A novel influenza A virus has been detected in humans in larger clusters, indicating that the virus is becoming better adapted to spread among people.
2. During this period, the risk of human infection with a novel influenza A...
phase 5, pandemic alert period, virus spread, human infection, risk assessment
Administer Antiviral Treatment to Pandemic Societal Responders
High Priority Source: HHSPandemicInfluenzaPlan
Procedure:

1. Identify pandemic societal responders, including healthcare workers without direct patient contact and utility, waste management, mortuary, and transportation workers.
2. Administer antiviral treatment within 48 hours of symptom...
pandemic societal responders,antiviral treatment,essential services,pandemic influenza
Implement Home Management for Patients with Suspected Pandemic Influenza
High Priority Source: HHSPandemicInfluenzaPlan
Procedure:

1. For patients cared for at home:
- They should be separated from other household members as much as possible.
2. All household members should:
- Carefully follow recommendations for hand hygiene.
- Place tissues...
home management, pandemic influenza, infection control, hand hygiene
Manage Patients with Confirmed Seasonal Influenza
High Priority Source: HHSPandemicInfluenzaPlan
For patients confirmed to have seasonal human influenza:

1. Maintain Standard and Droplet Precautions as per infection control guidelines.
2. Continue antiviral treatment for a full course, typically 5 days, unless otherwise indicated by...
seasonal influenza, antiviral treatment, droplet precautions, infection control
Collect Data on Antiviral Drug Distribution
Standard Source: HHSPandemicInfluenzaPlan
Objective: Ensure optimal use of antiviral drugs during an influenza pandemic by collecting data.

Steps:
1. Track distribution of state or federal supplies of antiviral drugs.
2. Monitor occurrence of adverse events following...
antiviral drugs,distribution data,adverse events,pandemic monitoring
Conduct Global Surveillance for Neuraminidase Resistance
Standard Source: HHSPandemicInfluenzaPlan
Objective: Monitor neuraminidase inhibitor resistance on a global scale.

Steps:
1. The Neuraminidase Inhibitor Susceptibility Network (NISN) will conduct global surveillance for neuraminidase resistance during a pandemic.
2. NISN...
NISN,neuraminidase resistance,WHO surveillance
Conduct Studies on Antiviral Drug Effectiveness
Standard Source: HHSPandemicInfluenzaPlan
Objective: Evaluate the effectiveness of antiviral drugs during a pandemic.

Steps:
1. Federal agencies will conduct studies in collaboration with state and local health departments to assess:
- The effectiveness of antiviral therapy and...
antiviral effectiveness,studies,pandemic evaluation
Define Infectious Disease and Communicable Disease
Standard Source: Home Health Emergency Preparedness
- Infectious disease: A disease caused by a microorganism and therefore potentially infinitely transferable to new individuals. An infectious disease may or may not be communicable.

Communicable disease: An infectious disease that is...
infectious disease, communicable disease, contagious disease, health definitions
Enhance Adverse Event Detection During Pandemics
Standard Source: HHSPandemicInfluenzaPlan
Objective: Improve detection of serious adverse effects during a pandemic.

Steps:
1. Implement active monitoring for adverse events observed at emergency rooms through the **National Electronic Injury Surveillance System Cooperative...
adverse event detection,NEISS-CADE,MedWatch education
Monitor Antiviral Drug Distribution and Use
Standard Source: HHSPandemicInfluenzaPlan
Objective: Ensure equitable distribution of antiviral drugs to priority groups.

Steps:
1. Develop strategies to monitor drug distribution and use by health departments.
2. Assess whether:
- Drugs are being effectively targeted to...
drug distribution,equity monitoring,priority groups
Monitor Antiviral Drug Resistance
Standard Source: HHSPandemicInfluenzaPlan
Objective: Track the development of resistance to antivirals during a pandemic.

Steps:
1. CDC will work with state and local partners to monitor the development of resistance to antivirals.
2. Monitor for resistance to M2 inhibitors,...
antiviral resistance,CDC monitoring,M2 inhibitors
Recognize Risk of Novel Influenza in Persons with Severe Respiratory Disease or Influenza-Like Illness
Standard Source: HHSPandemicInfluenzaPlan
Procedure:
1. Clinicians should recognize that human influenza A and B viruses, as well as other respiratory viruses, circulate year-round globally.
2. Human influenza activity may occur year-round in subtropical and tropical regions, and...
novel influenza, respiratory disease, seasonal outbreaks, travelers, global circulation
Report Adverse Events Related to Antivirals
Standard Source: HHSPandemicInfluenzaPlan
Objective: Ensure proper reporting of serious adverse events associated with antiviral drugs.

Steps:
1. Report serious adverse events to the FDA using the MedWatch monitoring program.
2. State and local health departments should:
-...
adverse event reporting,MedWatch,FDA,AERS
Surveillance for Antiviral Resistance in Later Pandemic Stages
Standard Source: HHSPandemicInfluenzaPlan
Objective: Monitor antiviral resistance during the later stages of a pandemic.

Steps:
1. Surveillance for antiviral resistance may be particularly important during the later stages of the pandemic, especially if M2 agents have been...
pandemic surveillance,M2 inhibitor resistance,treatment re-evaluation
Test Drug Susceptibilities During Pandemic
Standard Source: HHSPandemicInfluenzaPlan
Objective: Assess the susceptibility of influenza viruses to antiviral drugs during a pandemic.

Steps:
1. CDC will test drug susceptibilities of viruses isolated from different age groups and geographic regions throughout the...
drug susceptibility testing,CDC,RT-PCR,viral culture
Understand Risk Levels During Interpandemic and Pandemic Alert Periods
Standard Source: HHSPandemicInfluenzaPlan
Procedure:
Interpandemic Period (Phases 1 and 2):
1. A novel influenza A virus has been detected in animals but not in humans.
2. The risk of human infection with a novel influenza A virus strain is extremely low during these phases.
3....
risk levels, interpandemic, pandemic alert periods, human infection, animal-to-human transmission
Understand the Difference Between Isolation and Quarantine
Standard Source: Home Health Emergency Preparedness
Isolation applies to persons who are known to be ill with a contagious disease. Quarantine applies to those who have been exposed to a contagious disease but who may or may not become ill. This distinction is important for planning and...
isolation, quarantine, infectious disease, contagious disease, health emergency
Utilize Existing Drug-Monitoring Systems for Surveillance
Standard Source: HHSPandemicInfluenzaPlan
Objective: Use existing systems to improve population-based surveillance of adverse events.

Steps:
1. CDC, FDA, and AHRQ will explore the use of existing drug-monitoring systems that have access to individual health utilization...
drug monitoring systems,AHRQ,CDC,FDA surveillance
Management of Hemorrhagic Fevers (Hanta, Ebola, Lassa, Rift Valley, HFRS)
Standard Source: Emergency War Surgery
Procedure:

• Except for yellow fever, quarantine is not mandatory; however, person-to-person transmission is possible, so universal precautions are recommended.
• Medical evacuation may increase morbidity and mortality, thus treatment...
hemorrhagic fever, Ebola, Lassa, Rift Valley, HFRS, universal precautions, medical evacuation, MTF

Pandemic Preparedness (43)

Administer Antiviral Drugs to Hospitalized Patients with Influenza
Critical Source: HHSPandemicInfluenzaPlan
Procedure:

1. Identify patients admitted to acute care facilities with a clinical diagnosis of influenza (laboratory confirmation not required).
2. Exclude patients admitted for conditions consistent with bacterial superinfections...
antiviral drugs,hospitalized patients,influenza treatment,pandemic preparedness,medical ethics
Implement Pandemic Influenza Surveillance and Response Actions During the Pandemic Period in the United States
Critical Source: HHSPandemicInfluenzaPlan
Procedure:

1. Perform all actions outlined for the pandemic period outside the United States.
2. Implement activities to increase hospital capacity, including:
- Expanding bed availability
- Increasing staff numbers through recruitment or...
pandemic period,United States,hospital capacity,resource sharing,respiratory hygiene,cough etiquette,pandemic strain detection
Pandemic Response Planning for Respiratory Diseases
Critical Source: UK National Risk Register 2025
Procedure:

1. Assess the Pandemic Scenario:
- Identify the type of pathogen (virus, bacteria, fungi, etc.) responsible for the pandemic.
- Determine the transmission route (respiratory, blood and sexual, touch, oral, or...
pandemic,response planning,respiratory disease,healthcare demand,long-term recovery,pandemic waves,flexible response capabilities
Activating the Facility’s Pandemic Influenza Response Plan
Critical Source: HHSPandemicInfluenzaPlan
Procedure:

1. Activate the facility’s pandemic influenza response plan following initial detection of pandemic influenza anywhere in the world.

2. Align activation with the level of pandemic activity, as outlined in Table (referenced...
pandemic response plan,hospital surveillance,antiviral treatment,infection control,staff training
Develop and Distribute Pandemic Vaccines and Antiviral Drugs
Critical Source: HHSPandemicInfluenzaPlan
Procedure:

1. Initiate vaccine development: Begin research and clinical testing for vaccines that may provide complete or partial protection against potential pandemic viral strains.
2. Stockpile antiviral drugs: Increase and diversify...
vaccine development, antiviral drugs, pandemic preparedness, distribution guidelines
Estimate Pandemic Illness and Healthcare Utilization Based on Historical Data
Critical Source: HHSPandemicInfluenzaPlan
To estimate the potential impact of a pandemic influenza outbreak, use historical data from past pandemics:

1. Illness Rate: Assume 30% of the overall population will develop illness during a pandemic.
- School-aged children: ~40% illness...
pandemic planning,illness rate,healthcare utilization,viral shedding,transmission risk,pandemic waves
Planning Elements for Provision of Care in Hospitals During Pandemic Alert Periods
Critical Source: HHSPandemicInfluenzaPlan
Overview:

The planning elements for provision of care in hospitals during interpandemic and pandemic alert periods are critical to ensuring a coordinated and effective response.

Key Planning Elements:
1. Hospital Surveillance:
-...
planning elements,hospital surveillance,communication protocols,education training,triage procedures,facility access,occupational health,vaccine administration,surge capacity,security,mortuary management
Preparing for a Pandemic
Critical Source: LDS Preparedness Manual
Procedure:

• Stockpile essential supplies including at least 30 days of food and water, medications, and personal hygiene items.
• Develop a communication plan with family members to stay in touch during an outbreak.
• Identify local...
pandemic, preparedness, hygiene, medical supplies, emergency plan
Quarantine for Epidemics
Critical Source: LDS Preparedness Manual
Procedure:

• If quarantined:
- Stay in a separate room from others if possible.
- Use a dedicated bathroom if available, and clean it frequently.
- Avoid sharing personal items like dishes, towels, or clothing.
- Wash hands often with...
quarantine, epidemic, hygiene, isolation, preparedness
Steps to Take When Pandemic Influenza is Reported in the United States
Critical Source: HHSPandemicInfluenzaPlan
Procedure:

1. Identify when pandemic influenza cases begin in the community, as outlined in Supplement 1.

2. Isolate and treat all patients with potential pandemic influenza using protocols detailed in Supplements 4, 5, and 8.

3....
pandemic in US,isolation protocols,surge capacity,staff supplementation,equipment supply
Address Medical Challenges of Pandemic Influenza
High Priority Source: HHSPandemicInfluenzaPlan
Purpose: Help healthcare partners manage the medical challenges associated with pandemic influenza.

Steps:
1. Develop protocols for evaluating and managing large numbers of patients during a pandemic.
2. Implement strategies to mitigate...
healthcare,challenges,pandemic,influenza,antiviral,vaccine,protocols
Administer Antiviral Treatment to Healthcare Workers Within 48 Hours of Symptom Onset
High Priority Source: HHSPandemicInfluenzaPlan
Procedure:

1. Identify healthcare workers (HCWs) and emergency medical service (EMS) providers who have direct patient contact, including but not limited to:
- Doctors, nurses, technicians, therapists
- EMS providers
- Laboratory...
antiviral treatment, healthcare workers, pandemic influenza, early treatment, occupational health clinic
Administer Pre-Pandemic Stockpiled Vaccine to Critical Groups
High Priority Source: HHSPandemicInfluenzaPlan
Procedure:

1. Consider administration of pre-pandemic stockpiled vaccine, if available, to pre-defined groups critical to the pandemic response.
- This could provide partial immune protection and/or prime the immune system for a...
pre-pandemic,vaccine,critical groups,immune protection,adverse events
Antiviral Drug Distribution and Use During Influenza Pandemic
High Priority Source: HHSPandemicInfluenzaPlan
Overview:

This procedure outlines the distribution and use of antiviral drugs for treatment and prophylaxis during an influenza pandemic. The recommendations focus on preparedness planning, including procurement, distribution to priority...
antiviral drugs, influenza pandemic, distribution, use, preparedness planning, prophylaxis, treatment, priority groups, legal preparedness, data collection
Assessing Adult Patients for Outpatient Treatment During a Pandemic Using Severity Scores
High Priority Source: HHSPandemicInfluenzaPlan
To assess adult patients for outpatient treatment during a pandemic, use severity scoring systems such as the Pneumonia PORT Severity Index (PSI) and CURB-65 system. These tools help determine which patients can be safely treated at home rather than...
Pneumonia PORT Severity Index, CURB-65 system, outpatient treatment, pandemic influenza, medical assessment
Assessing Morbidity and Mortality Risks During a Pandemic
High Priority Source: HHSPandemicInfluenzaPlan
Procedure:

1. Identify high-risk groups: Focus on infants, the elderly, and individuals with pre-existing health conditions as they are most likely to experience severe illness or death during a pandemic.
2. Consider historical data:...
morbidity,mortality,pandemic,high-risk groups,epidemiology
Develop Improved Drugs Against Influenza
High Priority Source: HHSPandemicInfluenzaPlan
Objective: Develop improved drugs against influenza.

Procedure:
1. Conduct research on the structure and function of influenza virus proteins to identify new therapeutic targets.
2. Evaluate existing and potential new antiviral drugs for...
drug development, antiviral drugs, influenza research, therapeutic targets
Distribution of Pandemic Vaccines or Antiviral Drugs and Liability Protections
High Priority Source: HHSPandemicInfluenzaPlan
Procedure:

1. Mobilize resources: The Federal Government may mobilize the PHS Commissioned Corps to distribute vaccines or antiviral drugs.
2. Distribute through appropriate channels: Medications can be distributed to Federal agencies,...
vaccine distribution, antiviral drugs, liability protection, pandemic response
Establishing Alternative Care Sites During Pandemic Influenza
High Priority Source: HHSPandemicInfluenzaPlan
Procedure:

1. Identify alternative care sites such as school gymnasiums, armories, and convention centers when hospital capacity is overwhelmed due to a pandemic.

2. Address infection control and patient care needs, including:
- Bed...
alternative care sites,pandemic influenza,hospital capacity,emergency response,infection control
Establishing a Community-Based Isolation Facility During a Pandemic
High Priority Source: HHSPandemicInfluenzaPlan
Procedure:

1. Identify and evaluate potential sites for isolation facilities in advance of an outbreak, including:
- Existing structures: community health centers, nursing homes, apartments, schools, dormitories, hotels.
- Temporary...
isolation facility,pandemic preparedness,community-based isolation,public health planning
Evaluate Immune Response to Infection and Vaccination
High Priority Source: HHSPandemicInfluenzaPlan
Objective: Evaluate the immune response to infection and vaccination.

Procedure:
1. Conduct studies on how the human immune system responds to influenza virus infections.
2. Analyze the effectiveness of vaccines in eliciting protective...
immune response, vaccine efficacy, immunology studies
Federal Government Purchase of Pandemic Vaccines or Antiviral Drugs
High Priority Source: HHSPandemicInfluenzaPlan
Procedure:

1. Assess availability: Determine if pandemic vaccines or antiviral drugs are available.
2. Consider purchase: If available, the Federal Government may consider purchasing these medical supplies.
3. **Follow legal...
vaccine purchase, antiviral drugs, federal government, pandemic response
HHS Actions During WHO Phases 1 and 2: Interpandemic Period
High Priority Source: HHSPandemicInfluenzaPlan
Objective: Assess preparedness status and identify actions needed to fill gaps.

### Key Activities:
1. Planning and Coordination
- Coordinate with Federal, state and local, tribal, and private-sector authorities and organizations, and...
HHS, WHO phases 1 and 2, pandemic preparedness, surveillance, vaccine development, antiviral drugs, coordination
Hospitalization Indicators for Children with Community-Acquired Pneumonia (CAP)
High Priority Source: HHSPandemicInfluenzaPlan
To determine if a child requires hospitalization due to community-acquired pneumonia (CAP), use the following indicators:

For Infants:
• Temperature >38.5°C
• Respiratory rate (RR) >70 breaths per minute
• Chest retractions (indrawing)
• Nasal...
community-acquired pneumonia, hospitalization indicators, children, pandemic influenza, medical assessment
Identify Disease-Control Issues Requiring Real-Time Guidance During a Pandemic
High Priority Source: HHSPandemicInfluenzaPlan
Purpose: Identify disease-control issues that will require real-time guidance during a pandemic.

Steps:
1. Review the list of disease-control issues identified in Box 1 of the _Public Health Guidance for State and Local Partners_.
2....
disease control,real-time guidance,pandemic,protocols,stakeholders
Identify and Engage Community Partners for Pandemic Response
High Priority Source: HHSPandemicInfluenzaPlan
Procedure:

1. Identify key community partners involved in pandemic influenza response, including:
- Emergency medical technicians (first responders)
- Public relations
- Local law enforcement
- Security personnel
- Materials...
community partners,pandemic response,emergency medical technicians,public relations,local law enforcement,security,materials management,education and training,occupational health,funeral service,healthcare safety net providers,diagnostic imaging,information technology
Implement Antiviral Drug Use During Pandemic Influenza
High Priority Source: HHSPandemicInfluenzaPlan
Procedure:

1. Use antiviral drugs effective against the circulating pandemic strain for treatment and possibly prophylaxis during an influenza pandemic.

2. Prioritize treatment over prophylaxis due to the greater effectiveness of...
antiviral drugs,pandemic influenza,treatment,prophylaxis,oseltamivir,zanamivir,stockpile,healthcare facilities
Implement Pandemic Influenza Surveillance and Response Actions During the Alert Period
High Priority Source: HHSPandemicInfluenzaPlan
Procedure:

1. Conduct education and training sessions for healthcare staff on pandemic influenza preparedness.
2. Implement hospital surveillance for influenza by:
- Monitoring patient symptoms consistent with influenzalike illness
-...
pandemic alert period,education and training,hospital surveillance,infection control,preparedness
Implementing Containment Measures During Pandemic Alert Period
High Priority Source: HHSPandemicInfluenzaPlan
Procedure for Implementing Containment Measures During Pandemic Alert Period

1. Focus on containment at the source:
- Identify and isolate confirmed cases of novel influenza.
- Monitor close contacts of infected individuals for...
containment, quarantine, isolation, pandemic, public health, hand hygiene, cough etiquette
Managing Close Contacts During a Pandemic Influenza Outbreak
High Priority Source: HHSPandemicInfluenzaPlan
Procedure for Managing Close Contacts During a Pandemic Influenza Outbreak

### Overview
In most situations, it will not be possible to trace and quarantine close contacts of suspected or confirmed cases within 48 hours due to the average...
contact tracing,pandemic influenza,quarantine,public health,monitoring,incubation period,novel strain
National Recommendations for Antiviral Use During a Pandemic
High Priority Source: HHSPandemicInfluenzaPlan
Objective: Establish national guidelines for the prioritization and distribution of antivirals during an influenza pandemic.

Procedure:
1. Identify Priority Groups: Refer to Part 1 Appendix D for a list of priority groups for receiving...
antiviral distribution, pandemic influenza, priority groups, HHS plan
Planning for Disease Control and Containment
High Priority Source: HHSPandemicInfluenzaPlan
Procedure:

1. Develop a comprehensive plan that includes:
- Identification of key stakeholders (public health officials, healthcare providers, law enforcement)
- Allocation of resources (personal protective equipment, medical supplies,...
disease control, containment planning, pandemic preparedness, resource allocation, legal preparedness
Prioritize High-Risk Groups for Pandemic Influenza Response
High Priority Source: HHSPandemicInfluenzaPlan
Procedure:

1. Identify high-risk groups based on their risk of influenza-related hospitalization and death.
2. Consider the likelihood of vaccine response when prioritizing these groups.
3. Use information from prior pandemics where possible,...
high-risk groups,priority,vaccination,antiviral treatment,healthcare workers,nursing home residents
Protecting Children <6 Months of Age During Pandemic Influenza
High Priority Source: HHSPandemicInfluenzaPlan
Rationale for Vaccine Strategy:

• Influenza vaccine is poorly immunogenic in children <6 months.
• The vaccine is currently not recommended for this group.
• Influenza antiviral medications are not FDA-approved for use in children <1 year...
children under 6 months,pandemic influenza,vaccine strategy,antiviral medications,household contacts
Protecting Severely Immunocompromised Persons During Pandemic Influenza
High Priority Source: HHSPandemicInfluenzaPlan
Definition of Severely Immunocompromised Persons:

• Includes persons who are undergoing or have recently undergone bone marrow transplantation.
• Others with severe immunodeficiency (e.g., AIDS patients with CD4 counts <50, children with SCID...
severely immunocompromised,pandemic influenza,vaccine strategy,antiviral medications,healthcare workers
Support Basic Research on Influenza Virus Proteins
High Priority Source: HHSPandemicInfluenzaPlan
Objective: Support basic research on the structure and function of influenza virus proteins.

Procedure:
1. Conduct studies to understand the molecular basis of virulence in humans and animals.
2. Investigate factors that influence the...
basic research, virus proteins, molecular basis, transmission factors
Use of Antivirals in Management of Cases of Novel Influenza
High Priority Source: HHSPandemicInfluenzaPlan
Purpose:

This procedure outlines the use of antiviral drugs for managing cases of novel influenza strains during an influenza pandemic.

Types of Influenza Infections:

1. Interpandemic (seasonal) strains: These are normal seasonal...
novel influenza strains, antiviral use, management of cases, seasonal influenza, avian flu H5N1, early detection, pandemic potential
Compensation for Persons Injured by Pandemic Vaccines or Antivirals
High Priority Source: HHSPandemicInfluenzaPlan
Procedure:

1. Identify eligibility: If a person is injured following administration of a vaccine or antiviral medication in connection with their employment, they may be eligible for compensation.
2. Federal employees: Compensation may...
injury compensation, vaccine injury, antiviral injury, worker’s compensation
Implement Passive Monitoring for Pandemic Influenza Contacts
High Priority Source: HHSPandemicInfluenzaPlan
Passive Monitoring is a method used to monitor contacts of pandemic influenza patients. The procedure involves the following steps:

1. Self-Assessment: The contact is asked to perform self-assessment at least twice daily.
2. **Symptom...
passive monitoring,pandemic influenza,contact tracing,self-assessment,symptom reporting
Implementing Pandemic Influenza Vaccine Strategy for Nursing Home Residents
High Priority Source: HHSPandemicInfluenzaPlan
Rationale for Vaccine Prioritization Strategy:

• This group was not prioritized for vaccine due to:
- Poor response to vaccination as indicated by medical literature.
- Occurrence of outbreaks even with high vaccination rates.
- Other...
vaccine strategy,nursing home residents,pandemic influenza,antiviral medications,healthcare workers
NVAC Recommendations on Pandemic Antiviral Drug Use
High Priority Source: HHSPandemicInfluenzaPlan
Procedure:

Key Considerations for Antiviral Drug Use During a Pandemic:
1. The primary goal of a pandemic response is to decrease health impacts, including severe morbidity and death.
2. Minimizing societal and economic impacts are...
antiviral drug use, pandemic response, NVAC recommendations, health impacts, societal impact
Implement Active Monitoring without Explicit Activity Restrictions for Pandemic Influenza Contacts
Standard Source: HHSPandemicInfluenzaPlan
Active Monitoring without Explicit Activity Restrictions is a method used to monitor contacts of pandemic influenza patients with more frequent oversight. The procedure involves the following steps:

1. Evaluation: A healthcare or public...
active monitoring,pandemic influenza,contact tracing,healthcare worker evaluation,noncompliant management
Prioritizing Vaccination for Children During a Pandemic
Standard Source: HHSPandemicInfluenzaPlan
Procedure:

Reasons for Prioritizing Children:
1. Public engagement sessions indicated that many participants felt children should have high priority for vaccination.
2. Children play a major role in transmitting infection, and vaccinating...
vaccination priority, children, pandemic influenza, transmission reduction, FluMist

Infection Prevention (40)

Clean and Sterilize Tools Used in Birth or Medical Procedures
Critical Source: A Book for Midwives
Purpose: To ensure all medical tools are free from germs to prevent infection.

### Steps:
1. Soak used tools in a bleach solution for at least 20 minutes (see page 57 of the source text).
2. Clean your tools thoroughly after soaking:
...
clean tools,sterilize tools,disinfectant solution,bleach solution,infection prevention
Immunization and Infection Prevention in Burn Patients
Critical Source: Emergency War Surgery
Objective: Prevent tetanus and infection in burn patients.

### Steps:
• Ensure adequate immunization against tetanus for all burn victims.
• If arrival at the burn center will take longer than 24 hours, administer a **5-day course of...
tetanus immunization, burn infection prevention, antibiotic treatment, subeschar clysis
List of Tools That Must Be Sterilized
Critical Source: A Book for Midwives
Purpose: To ensure that all tools used in invasive procedures are sterilized to prevent infection.

### Tools That Require Sterilization:
Syringes and needles
Scissors or razor blade for cutting the cord
• **Materials for sewing...
sterilize tools,tool list,infection prevention,medical instruments
Sterilization Methods for Medical Tools
Critical Source: A Book for Midwives
Purpose: To provide multiple methods for sterilizing medical tools to ensure they are free from germs.

### Available Sterilization Methods:
1. Baking: Place the tool in an oven at a high temperature (e.g., 200°C) for sufficient time to kill...
sterilization methods,baking,pressure steaming,boiling,disinfectant chemicals
Cleaning and Sterilizing Tools to Prevent Infection
High Priority Source: A Book for Midwives
Procedure:

1. Clean tools thoroughly after each use to remove any visible dirt or debris.
2. Sterilize tools using appropriate methods (e.g., boiling, chemical sterilization) to kill germs on them.
3. Ensure that all tools used for...
tool sterilization, infection control, medical equipment cleaning, midwife procedures
Cleaning the Birth and Exam Space to Prevent Infection
High Priority Source: A Book for Midwives
Procedure:

1. Clean the area where births and exams occur regularly to remove dirt, blood, or other contaminants.
2. Use clean water and appropriate cleaning agents (e.g., soap, disinfectants) for thorough cleaning.
3. Ensure that surfaces...
birth space cleaning, exam room sanitation, infection prevention, midwife procedures
Hand Hygiene for Infection Prevention
High Priority Source: A Book for Midwives
Procedure:

1. Wash your hands often with soap and clean, flowing water.
- If soap is unavailable, use ash (not dirt).
- Ensure all soap or ash is rinsed off thoroughly.
- Use running water, not water in a bowl, to avoid...
hand hygiene, infection prevention, midwife procedures, germ control, medical safety
Infection Prevention in Extremity Fractures
High Priority Source: Emergency War Surgery
Procedure:

1. Prevention Strategies:
- Irrigate and debride wounds as soon as feasible to prevent infection.
- Use broad-spectrum cephalosporin (cefazolin 1 g every 8 hours) for IV antibiotics throughout the evacuation chain.
-...
infection prevention,cefazolin,femur fracture,antibiotics,wound irrigation
Prevent Infections from Reused Needles and Syringes
High Priority Source: Where There is no Doctor a Village Health Care Handbook
Never inject more than 1 person with the same needle or syringe without disinfecting it first. Unclean needles and syringes can spread germs that cause HIV, hepatitis, and other serious diseases. Dirty needles and syringes can also cause...
needles,syringes,sterilization,infections,HIV,hepatitis
Preventing Infection During Childbirth
High Priority Source: Where There is no Doctor a Village Health Care Handbook
Procedure:

1. Maintain strict cleanliness in the birthing area (wash hands and use clean materials).
2. Ensure all instruments used during delivery are sterilized.
3. Monitor for signs of infection such as fever, foul-smelling discharge, or...
childbirth infection prevention, postpartum infection management, hygiene during childbirth
Preventing Infection During Postpartum Care in Emergencies
High Priority Source: A Book for Midwives
### Steps:
Give 1 g amoxicillin by mouth, 1 time only.
Give 1 g metronidazole by mouth, 1 time only.

### Important Notes:
• These antibiotics should be given if it will take more than 1 hour to get medical help.
• You will need to...
amoxicillin administration, metronidazole use, postpartum infection prevention
Protect Yourself from Infection as a Midwife
High Priority Source: A Book for Midwives
Midwives must take precautions to protect themselves and their patients from infections.

1. Avoid contact with blood, urine, stool, or other body fluids that may carry germs like HIV or hepatitis B.
2. If you come into contact with these...
midwife safety, infection prevention, PPE, bloodborne pathogens
Safe Disposal of Waste to Prevent Infection Spread
High Priority Source: A Book for Midwives
Procedure:

1. Dispose of all waste products safely, including blood-soaked materials, used tools, and other contaminated items.
2. Use designated containers for biohazardous waste (e.g., sharps containers, sealed bags).
3. Ensure that waste...
waste disposal, biohazard management, infection control, midwife procedures
Sterilize Equipment to Prevent Infection Spread
High Priority Source: Where There is no Doctor a Village Health Care Handbook
Any time the skin is cut or pierced, it should be done only with equipment that has been sterilized. Here are some ways to sterilize equipment:

Boil for 30 minutes. (If you do not have a clock, add 1 or 2 grains of rice to the water. When...
sterilization,equipment,boiling,pressure_steaming,bleach,ethanol
Sterilizing Reusable Syringes and Needles
High Priority Source: A Book for Midwives
Procedure:

1. Wear protective gloves: Put on a pair of heavy gloves to protect your hands from germs.

2. Disinfect with bleach solution:
- Draw 5% bleach solution into the syringe barrel through the needle.
- Squirt out the...
syringe,needle,sterilization,bleach,boiling,infection prevention
Wearing Protective Clothing to Prevent Infection Spread
High Priority Source: A Book for Midwives
Procedure:

1. Always wear protective clothing (e.g., gloves, gowns) when handling bodily fluids or during exams.
2. Ensure that the protective clothing is clean and not torn before use.
3. Change protective clothing between patients or...
protective clothing, infection prevention, midwife procedures, medical safety
Administer Amoxicillin for Preventing Infection After an Invasive Procedure
High Priority Source: A Book for Midwives
Indication: For preventing infection after an invasive procedure.

Procedure:
1. Give 1 g amoxicillin by mouth, once only.
2. Also give metronidazole as part of the regimen.

Available Forms: Tablets of 250 and 500 mg; liquid for...
amoxicillin, infection prevention, invasive procedure antibiotic use
Antibiotic Administration for Open Combat Wounds
High Priority Source: TCCC 17 13 Army Tactical Combat Casualty Care
Procedure for Antibiotic Administration:

1. If the casualty can swallow, administer 400 mg of moxifloxacin from the CWPP.
2. If the casualty cannot swallow (due to shock or unconsciousness), refer to a medic immediately.
moxifloxacin, antibiotic administration, open wound infection prevention
How to Maintain Hand Hygiene During Care
High Priority Source: A Book for Midwives
Notes provide important but non-critical information:

• _Note:_ Clean hands do not stay clean for long.
• If you touch anything other than the mother’s genitals, you must wash your hands again immediately.
hand hygiene,cleanliness,infection prevention
How to Recognize and Respond to Warning Boxes in the Book
High Priority Source: A Book for Midwives
Warning boxes provide critical safety information:

• When you see a warning box, it indicates that immediate action is required to avoid danger.
• Example:
- _WARNING!_ Do not insert an IUD for a woman who has signs of infection. The...
warning,book,safety,medical procedures
Implement Hygiene and Sanitation Practices to Prevent Illness
High Priority Source: Where There is no Doctor a Village Health Care Handbook
To prevent illness and injury, follow these steps:

1. Practice good personal hygiene:
- Wash hands thoroughly with soap and water before eating, after using the toilet, and after handling waste.
- Keep nails short and clean.
- Cover...
hygiene,sanitation,disease prevention,community health
Monitor the Mother for Infection
High Priority Source: A Book for Midwives
Procedure:

Steps:
1. Observe the mother closely for signs of infection, such as fever, redness, swelling, or unusual discharge.
2. Check the genitals, belly, and legs for any signs of infection or irritation.
3. If any signs of...
infection monitoring,postpartum infection,signs of infection,mother's health
Prepare Underpadding for Birth or Procedure on the Floor
High Priority Source: A Book for Midwives
Purpose: To protect the mother and baby from germs and dirt when birthing or performing a procedure on the floor.

### Steps:
1. Find suitable underpadding materials, such as banana leaves, cloth rags, or sacks.
2. **Clean the underpadding...
underpadding,disinfectant solution,boiling,clean tools,infection prevention
Prevent Infection by Keeping Germs Away
High Priority Source: A Book for Midwives
Procedure:

1. Maintain hygiene: Wash hands frequently with soap and water, especially before touching a patient or handling medical tools.
2. Avoid cross-contamination: Do not touch multiple patients without washing your hands in...
hygiene,barriers,clean environment,midwife,infection prevention
Prevent Infection by Keeping Sick People Away from Births
High Priority Source: A Book for Midwives
Procedure:

1. Identify sick individuals: Look for signs of illness such as sore throat, cough, fever, or any other symptoms that may be caused by germs.
2. Keep sick people away: Ensure that anyone who is sick stays away from women who...
infection prevention,sick people,births,midwife,germs
Preventing Infection in Maxillofacial Wounds
High Priority Source: NATO Emergency War Surgery
Procedure:

1. Administer antibiotic therapy early to prevent or control serious infection.
2. Maintain oral hygiene, with special attention to the teeth and surrounding soft tissues.
3. For patients with extensive intraoral wounds,...
infection prevention, antibiotic therapy, oral hygiene, nasogastric tube, maxillofacial wound
Preventing and Managing Infection from Snakebites
High Priority Source: Medical Emergencies
Procedure:

1. Clean the bite area thoroughly with water and soap to reduce the risk of infection.
2. If infection appears:
- Keep the wound open and clean.
3. Use heat after 24 to 48 hours to help prevent the spread of local...
snakebite infection prevention, wound cleaning, heat application, fluid intake
Promote Vaccination to Prevent Disease
High Priority Source: Where There is no Doctor a Village Health Care Handbook
Vaccination is an effective way to prevent serious diseases. Follow these steps:

1. Identify available vaccines:
- Consult with local health workers or clinics to determine which vaccines are recommended for your area.
- Common vaccines...
vaccination,disease prevention,immunization
Use Protective Measures to Prevent Infection Spread
High Priority Source: A Book for Midwives
Procedure:

1. Treat everyone as potentially infectious: Assume that all individuals may carry germs in their body fluids, even if they appear healthy.
2. Wear protective clothing: Use gloves and other protective gear during any...
protective clothing,sterilization,health,midwife,infection prevention
Assess General Health During a Dental Examination
Standard Source: Where There is No Dentist
Steps to assess general health during a dental examination:

1. Ask about symptoms: Inquire about the person’s overall health, including signs that may indicate HIV such as fevers, night sweats, persistent fatigue, weight loss, or...
HIV symptoms, general health assessment, tuberculosis, cancer screening
Proper Use and Disposal of Sterile Packaged Equipment
Standard Source: A Book for Midwives
Procedure:

1. Use directly from the packet: Gauze, compresses, gloves, and other equipment in sterile packets can be used directly out of the packet without additional sterilization.

2. Maintain sterility: Once something is removed...
sterile,packet,equipment,disposable,sterilization,gloves,gauze,infection prevention
Protect Yourself During a Dental Examination
Standard Source: Where There is No Dentist
Steps to protect yourself during a dental examination:

1. Wear protective eyewear: Use glasses or goggles that allow clear vision.
2. Cover your nose and mouth: Wear a clean cloth or mask, changing it several times a day. Before...
dental examination, infection prevention, HIV transmission, protective gear, hygiene practices
Sterile Storage and Sterilization of Razor Blades
Standard Source: A Book for Midwives
Procedure:

1. Store sterile razor blades: Wrap the sterile packet containing a razor blade in clean paper or cloth, or keep it in a clean dry box to maintain sterility.

2. Avoid contamination: If the packet gets wet or dirty, do not...
razor blade,sterile storage,sterilization,infection prevention
Tetanus Prophylaxis in Cold Injury Patients
Standard Source: NATO Emergency War Surgery
Objective: Administer appropriate tetanus prophylaxis to cold injury patients.

Procedure Steps:
1. Assess immunization status: Determine if the casualty has previously received a tetanus toxoid vaccination.
2. **Administer booster...
tetanus booster, cold injury prophylaxis, infection prevention, military tetanus protocol
Administer Chemoprophylaxis for Infection Prevention
Standard Source: Medical NBC Battlebook
Chemoprophylaxis is the administration of a chemical to prevent the development of an infection or the progression of an infection to active manifest disease.

Procedure:
1. Identify individuals at risk of exposure to infectious agents...
chemoprophylaxis, infection prevention, antimicrobial resistance, medical supervision, biological warfare agents
Community Education on STI Prevention
Standard Source: A Book for Midwives
Objective: Help prevent the spread of sexually transmitted infections (STIs) in your community.

Steps:
1. Talk to women you care for about STIs, even if they feel embarrassed. Knowledge can save lives.
2. During prenatal checkups, **ask...
STI prevention, community education, infection control, sexual health, midwifery
Safe Handling of Used Needles
Standard Source: A Book for Midwives
Procedure:

1. Carry needles carefully with the point away from your body.
2. Do not leave needles lying around to prevent accidental exposure to germs.
3. Use each needle only once, then throw it away in a designated sharps...
needle safety, infection prevention, sharps disposal, blood exposure, medical hygiene
Sterilize Metal Tools Using Baking
Standard Source: A Book for Midwives
Sterilize Metal Tools Using Baking

1. Wash and rinse all the tools well.
2. Wrap the cleaned tools in 4 layers of clean cloth or heavy paper.
3. Secure the wrapped tools by tying them shut with string.
4. Place the wrapped packet into a...
sterilize tools,baking,metal tools,disinfect,heat sterilization
Sterilize Tools Using Boiling
Standard Source: A Book for Midwives
Sterilize Tools Using Boiling

1. Wash and rinse all tools thoroughly.
2. Submerge the cleaned tools in a pot of water.
3. Bring the water to a boil over a heat source.
4. Once boiling, start counting 20 minutes for sterilization.
5. Use...
boiling,sterilize tools,disinfect,heat sterilization
Sterilize Tools Using Steaming
Standard Source: A Book for Midwives
Sterilize Tools Using Steaming

1. Use a steaming pot, which consists of three parts: one pot on the bottom to boil water, one pot in the middle with holes in its bottom (the steamer), and a lid.
2. Fill the bottom pot with a small amount of...
steaming,sterilize tools,disinfect,heat sterilization

Gastrointestinal Illnesses (38)

Recognize Danger Signs of Vomiting Requiring Immediate Medical Help
Critical Source: Where There is no Doctor a Village Health Care Handbook
Danger signs with vomiting—seek medical help quickly!

Dehydration that increases and cannot be controlled (p. 152)
Severe vomiting lasting more than 24 hours
Violent vomiting, especially if vomit is dark green, brown, or...
vomiting,danger signs,medical help,dehydration,obstruction,blood vomiting
Recognize Signs of Acute Abdomen
Critical Source: Where There is no Doctor a Village Health Care Handbook
Look for the following signs to suspect acute abdomen:

Continuous severe gut pain that keeps getting worse.
Constipation and vomiting, with no or little diarrhea.
Swollen, hard belly that is tender to touch. The person may try...
acute abdomen,symptoms,gut pain,constipation,vomiting,abdominal swelling
Recognize Signs of Appendicitis
Critical Source: Where There is no Doctor a Village Health Care Handbook
Signs of appendicitis include:

Steady pain in the belly that gets worse and worse.
• The pain often begins around the navel (bellybutton) but moves to the lower right side of the abdomen.
• May be accompanied by **loss of...
appendicitis,abdominal pain,bellybutton,constipation,vomiting,surgery,emergency treatment
Recognize Signs of Obstructed Gut
Critical Source: Where There is no Doctor a Village Health Care Handbook
Signs of an obstructed gut include:

Sudden vomiting with great force, sometimes shooting out a meter or more.
• Vomit may contain green bile or look and smell like feces.
Steady, severe pain in the belly that worsens on...
obstructed gut,vomiting,bile,abdominal pain,constipation,surgery,emergency treatment
Treating Diarrhea Like Rice Water (Cholera)
Critical Source: Where There is no Doctor a Village Health Care Handbook
Procedure:

Treat dehydration continuously with Rehydration Drink.
• In severe cases, give doxycycline or tetracycline for adults, and erythromycin for children only if necessary.
• Use a cholera bed to manage the patient:
-...
cholera,rice water diarrhea,dehydration,rehydration drink,cholera bed
Make an Oral Rehydration Solution at Home
Critical Source: Survival and Austere Medicine
Ingredients for Oral Rehydration Solution:
1/4 tsp Salt (Sodium Chloride)
1/4 tsp Lite Salt (Potassium Chloride)
1/4 tsp Baking Soda
2 1/2 tbsp Sugar

Instructions:
1. Combine all the ingredients in a clean...
oral rehydration solution, ORS, homemade, dehydration treatment, survival medicine
Recognize and Manage Dysentery
Critical Source: Where There is no Doctor a Village Health Care Handbook
Dysentery is diarrhea with mucus and blood, usually caused by an infection. To manage dysentery:

1. Stay hydrated with oral rehydration solution (ORS) or clean water.
2. Avoid eating solid foods until the symptoms subside.
3. Monitor for signs...
dysentery, infection, dehydration
Recognize and Treat Dehydration from Diarrhoea
Critical Source: Survival and Austere Medicine
Recognizing Dehydration:
• Look for signs such as dry mouth, sunken eyes, reduced urine output, and lethargy.

Treating Dehydration:
1. Replace lost fluids and electrolytes – this is the basis of any treatment.
2. If IV fluids are...
dehydration, treatment, oral rehydration, gastroenteritis, fluid replacement
Prevent Gastroenteritis Through Hygiene and Water Safety
High Priority Source: Survival and Austere Medicine
Preventive Actions for Gastroenteritis:

1. Wash hands thoroughly after defecation, before handling food, dealing with the sick, or caring for babies and infants.
2. Boil all drinking water unless you are certain of its purity.
3. These...
gastroenteritis, prevention, hand washing, water safety, dehydration, diarrhoea
Treating Severe Diarrhea with Blood and Fever (Shigella Dysentery)
High Priority Source: Where There is no Doctor a Village Health Care Handbook
Procedure:

• Give ciprofloxacin to adults: 500 mg twice a day for 3 days.
Pregnant women and children under 18 years old should not use ciprofloxacin.
• For children under 8 weeks old, **seek medical help...
severe diarrhea,blood,fever,shigella,ciprofloxacin,azithromycin
When to Avoid Enemas and Laxatives
High Priority Source: Where There is no Doctor a Village Health Care Handbook
Never use an enema or laxative in the following situations:

1. If a person has a severe stomach-ache or any other sign of appendicitis or ‘acute abdomen’ (see p. 93), even if he passes days without a bowel movement.
2. If a person has a...
enema, laxative, appendicitis, acute abdomen, dehydration, children, contraindications
Identify Amebic Abscess Symptoms
High Priority Source: Where There is no Doctor a Village Health Care Handbook
Symptoms of an amebic abscess include:

• Tenderness or pain in the right upper belly (right hypochondrium)
• Pain may extend into the right chest and is worse when the person walks

Note: This should be compared with gallbladder pain,...
amebic abscess, liver pain, right upper belly pain, coughing brown liquid
Identify and Understand Diarrhea and Dysentery
High Priority Source: Where There is no Doctor a Village Health Care Handbook
Identify and Understand Diarrhea and Dysentery

When a person has loose or watery stools, he has diarrhea. If mucus and blood can be seen in the stools, he has dysentery.

Diarrhea can be mild or serious. It can be **acute...
diarrhea,dysentery,mucus,blood,stools,acute,chronic
Treat Giardia Infection
High Priority Source: Where There is no Doctor a Village Health Care Handbook
Treatment for giardia infection includes:

• Severe cases are best treated with metronidazole (see p. 368).
Quinacrine (Atabrine, see p. 369) is cheaper and often works well but causes worse side effects.
• Giardia infections sometimes...
giardia treatment, metronidazole, quinacrine, Atabrine
Treating Severe Diarrhea with Fever (No Blood)
High Priority Source: Where There is no Doctor a Village Health Care Handbook
Procedure:

Give lots of Rehydration Drink to treat dehydration.
• If the person is very ill and does not improve within 6 hours, seek medical help.

Additional steps:
• Check for signs of typhoid fever. If present, treat...
severe diarrhea,fever,typhoid,malaria,rehydration drink
Administer Medications for Hemorrhoids
Standard Source: Where There is no Doctor a Village Health Care Handbook
Title: Administer Medications for Hemorrhoids

Procedure:
1. Use suppositories for hemorrhoids:
- Insert one suppository into the rectum as needed.

Warnings:
• Avoid use in patients with anal fissures or rectal bleeding.
-...
hemorrhoids,suppositories,rectal treatment
Administer Omeprazole for Ulcer Treatment
Standard Source: Where There is no Doctor a Village Health Care Handbook
Purpose: To calm pain and help heal ulcers.

Materials Needed:
• Omeprazole (Prilosec) in powder form or capsules (10 mg, 20 mg, or 40 mg)
• Two antibiotics: either amoxicillin or tetracycline; and metronidazole

Procedure:
1. **Take...
omeprazole, ulcer treatment, prilosec, antibiotics, amoxicillin, metronidazole
Avoid Harmful Antacids and Medicines for Ulcer Management
Standard Source: Where There is no Doctor a Village Health Care Handbook
Overview:
Some antacids and medicines can worsen ulcers or cause additional problems.

Steps to Avoid Harmful Substances:
1. Avoid sodium bicarbonate (baking soda) and Alka-Seltzer. These may quickly calm acid indigestion but can lead to...
sodium bicarbonate, Alka-Seltzer, aspirin, ibuprofen, corticosteroids, acetaminophen, antacid safety
Identify Amebic Dysentery Symptoms
Standard Source: Where There is no Doctor a Village Health Care Handbook
Symptoms of amebic dysentery include:

• Diarrhea that comes and goes, sometimes alternating with constipation
• Cramps in the belly and frequent bowel movements, even when little or nothing—or just mucus—comes out
• Many loose (but usually not...
amebic dysentery, symptoms, diarrhea, blood in stool, fever, bacterial infection, Shigella, amebas
Identify Giardia Infection Symptoms
Standard Source: Where There is no Doctor a Village Health Care Handbook
Symptoms of giardia infection include:

• Yellow, bad-smelling diarrhea that is frothy (full of bubbles) but without blood or mucus
• Swollen belly with gas and discomfort
• Mild intestinal cramps
• Frequent farting and burping, often with a...
giardia symptoms, frothy diarrhea, sulfur burps, no fever
Identify and Treat the Underlying Cause of Empacho (Stomach Blockage)
Standard Source: Where There is no Doctor a Village Health Care Handbook
Empacho, also known as impaction, refers to a blocked or obstructed gut. In some cultures, it may be used to describe any illness causing stomach pain or diarrhea. However, true gut obstruction is rare and should not be treated with...
empacho, gut obstruction, stomach blockage, treatment, medical diagnosis
Manage Heartburn, Acid Indigestion, or Ulcer Pain
Standard Source: Where There is no Doctor a Village Health Care Handbook
Overview:
Whether stomach or chest pain is caused by heartburn, acid indigestion, or an ulcer, the following steps can help calm the pain and prevent it from returning.

Steps to Manage Symptoms:
1. Eat small meals and frequent snacks....
heartburn, acid indigestion, ulcer, antacid, water intake, diet modification, aloe vera, stress management
Managing Diarrhea with ORS and Clear Liquid Diet
Standard Source: Flu Home Treatment
Procedure:

1. Administer ORS fluids to the patient if experiencing diarrhea.
2. Encourage consumption of a clear liquid diet, such as water, broth, or electrolyte solutions.
3. Provide diphenhydramine and/or loperamide for cramps if...
diarrhea,ORS,clear liquid diet,diphenhydramine
Treating Nausea and Vomiting with ORS and Meclizine
Standard Source: Flu Home Treatment
Procedure:

1. Give the patient sips of clear liquid diet if experiencing nausea or vomiting.
2. Administer ORS fluids to help maintain hydration.
3. Provide Meclizine 25mg every 4 hours as needed for relief from nausea and...
nausea,vomiting,ORS,Meclizine
Treating Yellow, Bad-Smelling Diarrhea with Bubbles or Froth (Giardia Infection)
Standard Source: Where There is no Doctor a Village Health Care Handbook
Procedure:

• Provide plenty of liquid, nutritious food, and rest.
• For severe giardia infections:
- Use metronidazole as per the recommended dose.
- Alternatively, use quinacrine (Atabrine) which is cheaper but has...
yellow diarrhea,bubbles,froth,giardia,metronidazole,quinacrine
Administer Antidiarrheal for Diarrhea
Standard Source: Personal Wilderness Medical Kit
Procedure:

1. Assess the patient's symptoms, such as diarrhea, abdominal cramps, or dehydration.
2. Check the dosage instructions: 2 tablets initially, then 1 tablet after each loose bowel movement up to a maximum of 7 per day.
3....
antidiarrheal, loperamide, diarrhea treatment
Administer Antiemetic Medication for Nausea and Vomiting
Standard Source: Personal Wilderness Medical Kit
Procedure:

1. Assess the patient's symptoms, such as nausea, vomiting, or abdominal discomfort.
2. Check the dosage instructions: 1 tablet every 4 hours as needed.
3. Administer the medication orally with water or another suitable...
antiemetic, prochlorperazine, nausea treatment
Administer Loperamide for Diarrhea
Standard Source: survival personal wilderness medical kit
Procedure for Administering Loperamide Tablets for Diarrhea

Steps:
1. Recognize diarrhea symptoms: Look for signs such as frequent loose stools and abdominal cramping.
2. Check medication availability: Ensure you have loperamide 2...
loperamide,antidiarrheal,stool control,abdominal cramps
Managing Gastroenteritis (Vomiting and Diarrhea)
Standard Source: Survival and Austere Medicine
Procedure:

**Steps to manage gastroenteritis:

1. Hydrate the patient: Provide small sips of water or oral rehydration solutions frequently to prevent dehydration.
2. Avoid irritants: Do not give solid food, dairy products, or sugary...
gastroenteritis, dehydration, hydration, loperamide, rest
Prevent and Manage Diarrhea and Constipation in Outdoor Settings
Standard Source: The Complete Outdoorsmans Handbook
Procedure:

1. Prevention:
- Ensure access to clean water and proper sanitation facilities.
- Maintain a balanced diet with sufficient fiber and hydration.
- Avoid sudden changes in food intake or consumption of unfamiliar...
diarrhea,constipation,outdoor,first aid,gastrointestinal
Treating Chronic Diarrhea (Long-Term or Recurrent)
Standard Source: Where There is no Doctor a Village Health Care Handbook
Procedure:

• Ensure the child eats more nutritious food more frequently.
• If the diarrhea continues despite this, seek medical help.

Notes:
• Chronic diarrhea may be caused by malnutrition or chronic infections, such as...
chronic diarrhea,nutrition,ameba,gardia
Use Honey for Internal H. pylori Treatment
Standard Source: Survival and Austere Medicine
Procedure:

1. For an acute case of H. pylori:
- Consume a tablespoon of raw honey every 1-2 hours for approximately one week.
2. After the acute phase, continue with:
- A tablespoon of raw honey three times daily for another week to...
honey,H. pylori treatment,gastric ulcers,digestive health
Administer Meclizine for Motion Sickness
Reference Source: survival personal wilderness medical kit
Procedure for Administering Meclizine Tablets for Motion Sickness

Steps:
1. Recognize motion sickness symptoms: Look for signs such as nausea, dizziness, and sweating.
2. Check medication availability: Ensure you have meclizine 25...
meclizine,antihistamine,motion sickness relief,dizziness control
Administer Sodium Bicarbonate for Occasional Stomach Upset or Heartburn
Reference Source: Where There is no Doctor a Village Health Care Handbook
Purpose: To relieve occasional stomach upset, heartburn, or acid indigestion.

Materials Needed:
• ½ teaspoon of sodium bicarbonate (baking soda)
• Water

Procedure:
1. Mix ½ teaspoon of sodium bicarbonate with a small amount of...
sodium bicarbonate, heartburn, antacid, stomach upset, baking soda
Administer TransDerm Scop® for Motion Sickness
Reference Source: survival personal wilderness medical kit
Procedure for Administering TransDerm Scop® Transdermal Patches for Motion Sickness

Steps:
1. Recognize motion sickness symptoms: Look for signs such as nausea, dizziness, and sweating.
2. Check medication availability: Ensure you...
transderm scop,motion sickness prevention,scopolamine patch,dizziness control
Use Calcium Carbonate for Occasional Acid Indigestion or Heartburn
Reference Source: Where There is no Doctor a Village Health Care Handbook
Purpose: To relieve occasional acid indigestion or heartburn.

Materials Needed:
• Calcium carbonate tablets (350 mg or 850 mg)

Procedure:
1. When symptoms occur, chew one 850 mg tablet or two 350 mg tablets.
2. If symptoms...
calcium carbonate, heartburn, antacid, acid indigestion
Administer Laxatives for Constipation
Reference Source: Where There is no Doctor a Village Health Care Handbook
Title: Administer Laxatives for Constipation

Procedure:
1. Use milk of magnesia (magnesium hydroxide):
- Take 30 mL (about 2 tablespoons) once or twice daily, preferably with water.
- If no relief after 24 hours, increase to 60...
constipation,laxatives,milk of magnesia,Epsom salts,mineral oil,glycerin suppositories,Dulcolax
Administer Medications for Mild Diarrhea
Reference Source: Where There is no Doctor a Village Health Care Handbook
Title: Administer Medications for Mild Diarrhea

Procedure:
1. Use kaolin with pectin:
- Take 2-4 tablespoons of the suspension every 4 hours as needed.
- Continue until diarrhea subsides, but do not exceed 7 days without...
diarrhea,kaolin with pectin,mild diarrhea

Surgery (35)

Abdominal Closure in Emergency War Surgery
Critical Source: Emergency War Surgery
Abdominal closure procedures include:

Leave the fascia open.
Vacuum pack (preferred technique — easy, keeps patient dry, allows for expansion).

With fascia open, place fully plastic-covered (bowel bag, X-ray cassette bag, Ioban...
abdominal closure, emergency surgery, vacuum pack, fascia open
Assessment and Management of Colon Injury in Emergency War Surgery
Critical Source: Emergency War Surgery
### Colon Injury Management Procedure

Overview:
Simple, isolated colon injuries are uncommon. In indigenous populations or enemy combatants (patients who cannot be readily evacuated), diversion with colostomy should be the procedure of...
colon injury,colostomy,emergency surgery,damage control,primary repair
Assessment and Management of Intraoral Penetrating Injuries
Critical Source: Emergency War Surgery
Procedure:

1. For penetrating injuries to the oral cavity lateral to the tonsillar fossa, suspect occult internal carotid artery injury.
2. Perform neurologic testing/monitoring and consider CT scanning and/or angiography for...
intraoral injury, tonsillar fossa, carotid artery injury, sentinel bleed, CT scan
Control of Contamination in Emergency War Surgery
Critical Source: Emergency War Surgery
Control of contamination proceeds as injuries are encountered, utilizing clamps, primary repair or resection without reanastomosis.

• With multiple enterotomies, if the area of injury represents less than 50% of the length of the small bowel, a...
contamination control, emergency surgery, enterotomies, resuscitation
Control of Exsanguinating Hemorrhage from Zone 3 Injuries
Critical Source: Emergency War Surgery
Procedure:

Injury Location: Base of the skull (Zone 3) injuries causing exsanguinating hemorrhage.

Steps:
1. Insert a directed catheter (Fogarty or Foley) into the injured vessel.
2. Inflate the catheter and leave it in place for...
zone 3 hemorrhage, fogarty catheter, exsanguinating bleed, skull base injury
Control of Hemorrhage in Emergency War Surgery
Critical Source: Emergency War Surgery
Control of hemorrhage is best done with ligation, shunting, or repair of injured vessels as they are encountered.

• The primary goal is hemorrhage control, not maintenance of blood flow.
• For the patient in extremis, **clamping or shunting...
hemorrhage control, ligation, shunting, emergency surgery, vascular injury repair
Exploration to Determine Extent of Injury in Emergency War Surgery
Critical Source: Emergency War Surgery
Exploration to determine extent of injury includes:

Rapidly achieve hemostasis.
• Perform only essential resections or pack solid organs to diminish blood loss.
• Close or divert all hollow viscus injuries.
• Rapidly terminate the...
exploration, injury assessment, emergency surgery, hemostasis
Management of Penetrating Intraoral Injuries with Risk of Internal Carotid Injury
Critical Source: Emergency War Surgery
Procedure:

Injury Type: Penetrating intraoral injuries lateral to the tonsillar fossa.

Steps:
1. Be aware that these injuries carry a significant risk of causing occult internal carotid artery injury.
2. Perform neurologic testing...
intraoral injury, internal carotid artery risk, sentinel bleed, carotid blowout prevention
Management of Retroperitoneal Injuries in Emergency War Surgery
Critical Source: Emergency War Surgery
### Retroperitoneal Injury Management Procedure

Overview:
Retroperitoneal injuries require careful assessment and management to avoid complications such as uncontrolled hemorrhage or unnecessary exploration.

**Anatomical Exposure...
retroperitoneal injury,aortic control,exploration,zones of retroperitoneum,vessel exposure
Management of Unreconstructable Tracheal Injuries
Critical Source: Emergency War Surgery
Procedure:

Injury Type: Unreconstructable tracheal injuries (significant segmental loss or >50% diameter loss).

Steps:
1. Place an endotracheal tube through the defect to maintain airway patency.

Details:
• This is a temporary...
tracheal injury management, endotracheal tube placement, airway patency
Managing Gallbladder and Bile Duct Injuries in Emergency War Surgery
Critical Source: NATO Emergency War Surgery
Objective: Properly treat injuries to the gallbladder, hepatic artery, portal vein, and common bile duct.

Procedure Steps:
1. Gallbladder Injury:
- Treat with cholecystectomy (surgical removal of the gallbladder).
2. **Hepatic Artery...
gallbladder injury, bile duct repair, hepatic artery injury, cholecystectomy, emergency surgery, trauma care
Managing Liver Injuries in Emergency War Surgery
Critical Source: NATO Emergency War Surgery
Objective: Control bleeding and manage liver injuries in a combat or emergency setting.

Procedure Steps:
1. Assess the injury severity:
- Minor lacerations or perforations that have stopped bleeding require no specific therapy.
-...
liver injury, hemostasis, Pringle maneuver, emergency surgery, trauma care, abdominal injury
Perform Abbreviated Thoracotomy for Hemostasis and Air Leak Control
Critical Source: Emergency War Surgery
Procedure:

1. Assess the patient for exsanguination or significant air leak.
2. Use large staplers in a nonanatomic wedge resection to rapidly achieve hemostasis and control of air leaks in exsanguinating patients.
3. In pulmonary...
thoracic injuries, abbreviated thoracotomy, hemostasis, air leak control, vascular injury, tracheal injury, esophageal injury
Suspecting Vertebral Artery Injury in Posterolateral Neck Wounds
Critical Source: Emergency War Surgery
Procedure:

Injury Type: Suspected vertebral artery injury.

Steps:
1. Suspect a vertebral artery injury if bleeding continues from a posterolateral neck wound despite pressure on the carotid artery.
2. Perform preoperative angiography...
vertebral artery injury, posterolateral neck wound, angiography, bone wax use
Therapeutic Packing in Emergency War Surgery
Critical Source: Emergency War Surgery
Resuscitative vs Therapeutic Packing:

Resuscitative packing is manual compression of the bleeding site as an initial measure in controlling or minimizing blood loss.
Therapeutic packing provides long-term tamponade of liver, pelvic,...
therapeutic packing, resuscitative packing, emergency surgery, tamponade
Austere Field and Military Surgical Considerations for Damage Control
Critical Source: Emergency War Surgery
- Due to severe physiological insult, the typical civilian damage control patient requires 2 surgeons and 1 nurse, at a minimum, at the bedside for the first 6 hours.

• An example of the magnitude of the ICU problem that may be encountered is a...
austere field,military surgery,damage control,tactical considerations
Conduct of Relaparotomy and Missed Injury Considerations
Critical Source: Emergency War Surgery
- It is to be presumed that injuries were missed.

A complete laparotomy must be performed in search of missed injury.

• The surgeon must exercise caution and sound judgment before performing full reconstruction of the GI tract because the...
relaparotomy, missed injury, abdominal compartment syndrome, bleeding, transfusion
Execute the Three Phases of Damage Control Surgery
Critical Source: Emergency War Surgery
Objective: Understand and execute the three phases of damage control surgery.

Phases of Damage Control:
1. Primary operation and hemorrhage control: Focus on stopping bleeding and stabilizing the patient immediately.
2. **Critical care...
damage control phases, hemorrhage control, resuscitation, reoperation
Managing Liver Injuries with Direct Pressure and Packing
Critical Source: Emergency War Surgery
Procedure for Managing Liver Injuries:

1. Apply direct pressure to the injury site.
2. Use packing to control bleeding, ensuring it is placed above the dome of the liver to displace it into view.
3. Perform aggressive resuscitation...
liver injury, direct pressure, packing, Pringle maneuver, coagulopathy, damage control, retrohepatic injury, atrio-caval shunt
Measure Intra-Abdominal Pressure Using Bladder Pressure
Critical Source: Emergency War Surgery
Procedure:

1. Place 100–150 cc of sterile saline in the bladder and clamp the foley catheter.
2. Access the needle port on the catheter and attach to a pressure monitor (central venous pressure transducer).
3. Alternatively, access the...
intra-abdominal pressure, abdominal compartment syndrome, bladder pressure measurement, foley catheter, pressure monitor
Planned Reoperation Timing and Criteria
Critical Source: Emergency War Surgery
- Packs should be left in place until the patient’s hemodynamics are stable and all major sites of hemorrhage have had time to clot.

• Reoperation should be scheduled when the probability of achieving definitive organ repair and complete fascial...
planned reoperation, timing criteria, surgery, abdominal compartment syndrome, hemodynamics
Repair of Esophageal Injuries and Post-Operative Care
Critical Source: Emergency War Surgery
Procedure:

1. Repair esophageal injuries using a single-layer technique.
2. Place closed suction drains at the surgical site.
3. Ensure that the drain tip is not placed near a concomitantly repaired carotid artery to avoid...
esophageal repair, esophageal injury, tracheal injury, muscle flap interposition, post-op radiograph
Repair of Esophageal Injuries with Drain Placement
Critical Source: Emergency War Surgery
Procedure:

Injury Type: Esophageal injuries.

Steps:
1. Repair the injury using a single-layer technique.
2. Place closed suction drains to prevent accumulation of secretions or blood.
3. Ensure that the drain tip is not placed near a...
esophageal repair, drain placement, tracheal injury, fistula prevention
Summary Points on Damage Control and Indications
Critical Source: Emergency War Surgery
- Damage control is not a procedure of last resort. The consideration of damage control techniques should be made at the initiation of operative intervention in any multitrauma casualty and reconsidered during any case where extensive injuries are...
damage control, indications, ISS score, coagulopathy, abdominal compartment syndrome
Abdominal Wound Closure Techniques
High Priority Source: NATO Emergency War Surgery
Procedure:

1. Use a strong monofilament, nonabsorbable suture for secure closure.
2. Take large 'bites' of fascia during suturing.
3. Choose between interrupted or running sutures, with the latter being more expeditious.
4. In...
abdominal wound closure,nonabsorbable suture,fascia bites,retain sutures,delayed closure
Constructing Diverting Colostomies for Rectal Injuries
High Priority Source: NATO Emergency War Surgery
Procedure:

1. Construct a diverting end colostomy with a separate mucus fistula for rectal injuries.
2. Stomas may be flush, and should be matured at the primary operation by sewing the ends of the colon circumferentially to the...
diverting colostomy,mucus fistula,stoma maturation,loop colostomy,fascial fixation
Controlling Biliary Tract Injuries
High Priority Source: Emergency War Surgery
Procedure for Managing Biliary Tract Injuries:

1. Treat gallbladder injuries by performing a cholecystectomy.
2. Repair common bile duct injuries using a T-tube:
- Use a No. 4-0 or smaller absorbable suture on the biliary...
biliary tract injury, cholecystectomy, T-tube repair, choledochoenterostomy, tube choledochostomy
Exploring the Abdomen in Combat Surgery
High Priority Source: NATO Emergency War Surgery
Procedure:

1. Begin with a systematic plan to explore the abdomen, similar to an aviator's pre-flight checklist to ensure no important step is missed.
2. Ensure that the entire abdominal cavity has been explored before concluding any...
abdominal exploration, combat surgery, laparotomy, systematic plan, evisceration, exposure
Managing Injuries to the Left Upper Quadrant Organs
High Priority Source: NATO Emergency War Surgery
Procedure:

1. Carefully explore the left upper quadrant to ensure the integrity of the diaphragm, anterior and posterior wall of the stomach, and esophageal hiatus.
2. Palpate the kidney and search for a retroperitoneal hematoma.
3. Close...
left upper quadrant, diaphragm injury, gastric perforation, esophageal injury, retroperitoneal hematoma, nasogastric suction
Managing Renal Injuries in Combat Surgery
High Priority Source: NATO Emergency War Surgery
Procedure:

1. Diagnose renal injury based on a high index of suspicion, hematuria, or evidence of fragments traversing the kidney.
2. Explore penetrating injuries to the kidney and obtain hemostasis.
3. In some cases, perform a nephrectomy if...
renal injury, nephrectomy, hematuria, Gerota's fascia, penetrating trauma, blunt trauma
Managing Spleen Injuries in Combat Surgery
High Priority Source: NATO Emergency War Surgery
Procedure:

1. Inspect the spleen but avoid mobilizing it unless there is evidence of bleeding.
2. In civilian practice, splenectomy is rarely performed for trauma; however, in combat surgery, moderate injuries may necessitate removal if...
splenic injury, splenectomy, hemostasis, antibiotic prophylaxis, vaccination, combat surgery
Repairing Small-Bowel Injuries
High Priority Source: Emergency War Surgery
Procedure for Repairing Small-Bowel Injuries:

1. Debride wound edges to freshly bleeding tissue.
2. Close enterotomies in one or two layers:
- A skin stapler is a rapid alternative to manual suturing.
3. For multiple enterotomies...
small bowel injury, enterotomy repair, skin stapler, resection, anastomosis
Set Up Adequate Lighting for Surgical Procedures
High Priority Source: Survival and Austere Medicine
Procedure:

1. Assess the available light sources:
- If electric power is available, use overhead lighting or directed torches (flashlights) to illuminate the surgical area.
- Use reflectors to focus light directly into the wound or...
lighting,surgery,operating conditions,visibility
Surgical Prep for Groin and Upper Thigh
High Priority Source: Emergency War Surgery
Procedure:

Preparation Area: The groin and upper thigh should be surgically prepped for greater saphenous vein interposition graft or patch angioplasty.

Details:
• This preparation is critical for procedures involving the greater...
groin prep, upper thigh prep, saphenous vein surgery, vascular surgery
Stoma Site Selection and Construction for Intestinal Stomas
High Priority Source: NATO Emergency War Surgery
Procedure:

1. Select the stoma site based on anatomy and abdominal wall injuries.
2. Ensure future appliance fitting is considered in site selection.
3. Preserve stoma vascularity to avoid the need for re-laparotomy.
4. Prefer the...
stoma site selection,Brooke ileostomy,elevation,vascularity,preservation

Burn Injuries (35)

IV Therapy for Burn Patients (Baxter's Parkland Formula)
Critical Source: US Marine Corps Wilderness Medicine
Procedure:

1. Administer Ringer’s Lactate according to the Baxter’s (Parkland) formula:
- 4 ml × weight in kg × % TBSA burned = total volume of LR given in first 24 hours.
2. **Half of the solution is administered in the first 8...
IV therapy, parkland formula, burn resuscitation
Initial Care and ABC Management for Burn Injuries
Critical Source: US Marine Corps Wilderness Medicine
Procedure:

1. Establish an airway.
2. Administer oxygen once the airway is secured.
3. If qualified, consider intubation earlier rather than later.
4. Assess for associated injuries, such as fractures, lacerations, or inhalation...
ABC management, burn injuries, airway management, inhalation injury
Primary Survey for Burn Casualties
Critical Source: Emergency War Surgery
Do not be distracted by the burn! The priorities of management for burn casualties are the same as those for other injured patients, with the addition of burn pathophysiology.

Airway management: Include cervical spine control if...
primary survey,burn casualties,airway management,inhalation injury,escharotomy,circulation,burn injuries
Stop the Burning Process in Burn Injuries
Critical Source: US Marine Corps Wilderness Medicine
Procedure:

1. Remove the patient from heat immediately.
2. Remove all clothing affected by hot liquids.
3. Shut off electricity if present (very important).
4. Flush the affected area with clean water for 10 to 15 minutes if...
burn treatment, stop burning process, chemical burn, heat injury, first aid for burns
Thoracic Escharotomy for Circumferential Chest Burns
Critical Source: Emergency War Surgery
Perform immediate thoracic escharotomy as a life-saving procedure to permit adequate chest excursion (see Fig. 28-1).

• **The dashed lines indicate the preferred sites for escharotomy incisions. The bold lines in the figure indicate the...
thoracic escharotomy,circumferential chest burns,chest excursion,incision technique,burn management
Assess Burn Injury Severity and Depth
Critical Source: Planning Guidance Nuclear Detonation FEMA
Objective: Determine the severity and depth of burn injuries to guide appropriate medical treatment.

Procedure:
1. Evaluate the depth of the burn:
- Superficial (1st degree): Involves only the epidermis (surface of the skin)....
burn injury assessment, burn depth classification, TBSA measurement, nuclear detonation medical response
Burn Wound Infection Management and Monitoring
Critical Source: Emergency War Surgery
Objective: Identify and manage early signs of infection in burn wounds.

Procedure:
1. Daily inspection by a surgeon is essential to identify early complications such as infection.
2. Monitor for sterile, chemical cellulitis,...
infection management,burn wound infection,cellulitis,sepsis,Sulfamylon,subeschar clysis
Corneal Abrasion Management in Burn Patients
Critical Source: Emergency War Surgery
Objective: Prevent complications from corneal abrasions in burn patients.

Procedure:
1. Aggressively treat corneal abrasions to prevent full-thickness ulceration and blindness.
2. Apply antibiotic ointments every 4 hours,...
corneal abrasion,burn eye care,antibiotic ointment
Definitive Treatment of White Phosphorus Injuries
Critical Source: NATO Emergency War Surgery
Procedure for Definitive Treatment of White Phosphorus Injuries:

1. Rinse wounds with copper sulfate solution:
- Use a dilute (1%) freshly mixed solution of copper sulfate to rinse the wound.
- This forms a blue-black cupric phosphide...
white phosphorus,copper sulfate,wound debridement,safety handling
Immediate Care of Chemical Burns and White Phosphorus Injury
Critical Source: NATO Emergency War Surgery
Procedure for Immediate Care of Chemical Burns and White Phosphorus Injury:

1. Remove the chemical agent immediately:
- Wash the affected area with copious amounts of water as soon as possible.
2. **Treat embedded phosphorus...
chemical burns,white phosphorus,wound care,immediate treatment
Monitor Burn Patient in ICU Setting
Critical Source: Emergency War Surgery
Objective: Ensure proper monitoring and management of burn patients in an ICU setting.

Procedure:
1. Insert two intravenous catheters (IVs) for fluid administration.
2. Place a Foley catheter to monitor urine output.
3. **Use...
ICU monitoring,burn patient,vital signs,urine output,fluid input/output,gastric ileus
Monitor and Manage Burned Extremities During Resuscitation
Critical Source: Emergency War Surgery
Procedure:

1. Carefully monitor the extremities throughout the resuscitation period.
2. Elevate the burned extremity.
3. Exercise burned extremities hourly to prevent contractures and maintain mobility.
4. **Evaluate pulses and...
escharotomy,burned extremities,pulse evaluation,Doppler flowmetry,fluid resuscitation,compartment syndrome
Responding to Thermal Injuries from a Nuclear Detonation
Critical Source: Planning Guidance for Response to Nuclear Detonation May 2022 FEMA
### Procedure: Responding to Thermal Injuries from a Nuclear Detonation

Overview:
Thermal radiation from nuclear detonations can cause two types of burns—flash burns and flame burns. Flash burns occur due to direct exposure to the intense heat...
nuclear burn injuries, flash burns, flame burns, thermal radiation burns, post-nuclear burn care
Resuscitation Management for Burn Patients in the First 24 Hours
Critical Source: Emergency War Surgery
Objective: Monitor and adjust resuscitation based on urine output and other indicators.

Procedure:
1. Monitor urine output hourly, which is the most important indicator of resuscitation adequacy:
- Target: 30–50 mL/h in adults or...
urine output,LR infusion rate,over-resuscitation,base deficit,tachycardia,glycosuria,osmotic diuresis,IV insulin
Triage Burn Injuries in a Radiation Emergency
Critical Source: Planning Guidance for Response to Nuclear Detonation May 2022 FEMA
Objective: Prioritize burn casualties based on %TBSA and age for resource allocation.

Steps:
1. Assess %TBSA:
- Casualties with burns >40% TBSA may require intense treatment but have a higher risk of mortality, especially in older...
burn triage, radiation emergency, medical resource allocation, TBSA prioritization
Assess Burn Center Capacity and Identify Gaps in Burn Treatment Support
High Priority Source: Planning Guidance for Response to Nuclear Detonation May 2022 FEMA
Objective: Determine the availability of burn beds and identify gaps in burn treatment support within your community.

Procedure:
1. Research nearby burn centers to understand their locations, capacities, and available resources.
2....
burn centers,burn beds,capacity assessment,nuclear detonation,burn treatment gaps
Assessing Burn Injury Severity Using the Rule of Nines
High Priority Source: NATO Emergency War Surgery
Procedure for Assessing Burn Injury Severity Using the Rule of Nines:

1. Understand the Rule of Nines: The rule of nines is a method used to estimate the total body surface area (TBSA) affected by burns in adults.

2. **Breakdown of Body...
burn injury, rule of nines, body surface area estimation, burn severity assessment, TBSA, thermal injury
Assessing and Managing Electric Injuries in Extremities
High Priority Source: NATO Emergency War Surgery
Procedure for Assessing and Managing Electric Injuries in Extremities:

1. Assess the injury:
- Look for signs of brawny, deep induration in a limb.
- Check for vascular impairment (e.g., decreased pulse, pallor).
2. **Perform...
electric injury,fasciotomy,resuscitation,amputation,burns,limb salvage
Coordinate with Burn Treatment Experts for Resource Planning
High Priority Source: Planning Guidance for Response to Nuclear Detonation May 2022 FEMA
Objective: Collaborate with burn treatment experts to understand available resources and treatment options.

Procedure:
1. Identify local and regional burn treatment experts, including physicians, nurses, and other medical professionals...
burn treatment experts,resource planning,nuclear detonation,burn care coordination
Initial Treatment of Extensive Burns
High Priority Source: NATO Emergency War Surgery
Initial Treatment of Extensive Burns:

1. Assess the patient's airway, breathing, and circulation (ABCs). Ensure that the airway is clear and provide supplemental oxygen if necessary.
2. **Cool the burn wound immediately with running water...
burn treatment, initial burn care, extensive burns, first aid for burns, fluid resuscitation
Management of Ileus in Burn Patients
High Priority Source: NATO Emergency War Surgery
Management of Ileus in Burn Patients

Ileus is common in patients with thermal injuries involving 20% or more of the total body surface area.
• Perform nasogastric intubation and drainage to prevent emesis and aspiration in these...
ileus, burn injury, nasogastric intubation
Perform Secondary Survey for Burn Patients
High Priority Source: Emergency War Surgery
Objective: Identify nonthermal injuries in burn patients during the secondary survey.

Procedure:
1. Conduct a thorough head-to-toe examination to identify any nonthermal injuries, including:
- Corneal abrasions
- Tympanic membrane...
secondary survey,burn patient,nonthermal injuries,corneal abrasion,tympanic membrane rupture,diagnostic peritoneal lavage
Post-Escharotomy Wound Care and Monitoring
High Priority Source: Emergency War Surgery
Procedure:

1. After escharotomy, cover wounds, including the escharotomy incisions, in burn cream.
2. The patient may still develop a true intramuscular, subfascial compartment syndrome requiring fasciotomy.
3. Monitor for signs of...
escharotomy,wound care,fasciotomy,burned extremities,plaster bivalving
Tetanus and Antibiotic Prophylaxis for Burn Patients
High Priority Source: Emergency War Surgery
Objective: Provide tetanus prophylaxis and antibiotic treatment to prevent infection in burn patients.

Procedure:
1. Ensure adequate immunization against tetanus for all burn victims.
2. If the patient is expected to arrive at a burn...
tetanus prophylaxis,antibiotics,burn infection prevention
Understanding the Pathophysiology of Thermal Injury
High Priority Source: NATO Emergency War Surgery
Procedure:

1. Recognize that thermal injury results in cell death by coagulation necrosis, regardless of the etiologic agent.
2. Identify areas of cell death and damage where capillary permeability is increased, leading to:
- Loss of...
pathophysiology,thermal injury,coagulation necrosis,capillary permeability,fluid resuscitation
Administer Tetanus Treatment for Burn Patients
High Priority Source: NATO Emergency War Surgery
Administer Tetanus Treatment for Burn Patients

For patients who have been actively immunized against tetanus:
- Administer a booster dose of tetanus toxoid.
For patients not previously immunized:
- Administer **hyperimmune...
tetanus, burn injury, immunization, booster dose
Antibiotic Administration for Burn Patients
High Priority Source: NATO Emergency War Surgery
Antibiotic Administration for Burn Patients

Administer penicillin to all burn patients during the first 5 days post-burn to prevent beta-hemolytic streptococcal burn wound infection, unless specifically contraindicated.
• After day 5,...
penicillin, burn wound infection, antibiotic use
Assessing Depth of Thermal Injury Using Clinical Criteria
High Priority Source: NATO Emergency War Surgery
Procedure:

1. Determine the depth of thermal injury using clinical criteria as outlined in Table 1 (not provided here, but typically includes visual and tactile indicators).
2. Differentiate between second-degree and third-degree burns...
thermal injury,burn depth,second-degree burns,third-degree burns,topical chemotherapy,thermonuclear explosion
Burn Wound Debridement and Care
High Priority Source: NATO Emergency War Surgery
Burn Wound Debridement and Care

Perform wound care only after hemodynamic stability is achieved.
General anesthesia is not required or recommended during the initial debridement phase due to vascular instability and hypovolemia.
-...
wound care, debridement, burn injury
Coordinate with the American Burn Association for Mass Casualty Burn Incidents
High Priority Source: Planning Guidance for Response to Nuclear Detonation May 2022 FEMA
Objective: Identify burn centers and best practices regarding mass casualty burn incidents through coordination with the American Burn Association.

Procedure:
1. Identify local and regional planners involved in emergency preparedness.
2....
American Burn Association, burn centers, mass casualty, nuclear detonation, emergency planning
Thermal Stress Prevention in Burn Patients
High Priority Source: Emergency War Surgery
Objective: Prevent thermal (cold) stress in burn patients.

Procedure:
1. Keep the environment as warm as possible, ideally above 85°F (29.4°C), to prevent hypothermia and thermal stress in burn victims.
thermal stress,burn patient care,hypothermia prevention
Treatment of Fractures in Burn Patients
High Priority Source: NATO Emergency War Surgery
Treatment of Fractures in Burn Patients

Fractures associated with thermal injuries should be treated using skeletal traction or external fixation to allow exposure of the burn wound for treatment.
• Avoid applying a **cast over an...
fracture, burn injury, skeletal traction
Understand Burn Injury Metrics for Effective Planning
High Priority Source: Planning Guidance Nuclear Detonation FEMA
Action: Understand the metrics used to assess burn injuries.

Details:
Burn Surface Area (TBSA): Measured as a percentage of total body surface area (%TBSA).
Burn Depth: Characterized by the depth of tissue damage, which affects...
TBSA,burn depth,burn metrics,nuclear detonation
Avoid Colostomy for Specific Burn Locations
Standard Source: NATO Emergency War Surgery
Avoid Colostomy for Specific Burn Locations

Do not perform colostomy in patients with burns of the buttocks, perineum, or upper thigh, even if an abdominal operation is required to treat associated injuries.
• Performing a colostomy...
colostomy, burn injury, anal stricture
Pain Management for Burn Patients
Standard Source: NATO Emergency War Surgery
Pain Management for Burn Patients

Restlessness and agitation can often be relieved by ensuring adequate oxygenation.
Analgesia is usually minimal, except in patients with extensive partial-thickness burns.
• If analgesia is...
pain management, analgesia, burn injury

Antibiotics (34)

Administer Chloramphenicol for Newborns (If No Other Option Is Available)
Critical Source: Where There is no Doctor a Village Health Care Handbook
Dosage:
• Give 5 mg (¼ ml or 5 drops of the mixture) per kg of body weight, 4 times a day.

Example:
• A 3 kg baby would receive 15 mg (15 drops of the mixture) 4 times a day, totaling about ¼ capsule per day.

**Important...
chloramphenicol, newborns, antibiotic use, blood disorders, emergency dosage
Isolate Penicillin-Producing Fungi for Antibiotic Production
Critical Source: Survival and Austere Medicine
Materials Required:
• Pure culture of penicillium fungi (ideally obtained in advance)
• Basic laboratory equipment
• Nutrient medium for fungal growth

Procedure:
1. Obtain Culture: Ideally, obtain a pure culture of the...
penicillin production, fungal culture, antibiotic synthesis, survival medicine
Administer Chloramphenicol for Babies Aged 1 Month to 2 Years
High Priority Source: Where There is no Doctor a Village Health Care Handbook
Dosage:
• Give 12 mg (½ ml of the mixture or 1/20 part of a capsule) per kg of body weight, at each dose.

Example:
• A 5 kg baby would receive 60 mg (½ teaspoon of mixture or ¼ capsule) at each dose.

Important Notes:
• Do...
chloramphenicol, infant dosage, babies, antibiotic use, blood disorders
Administer Chloramphenicol for Typhoid and Serious Infections
High Priority Source: Where There is no Doctor a Village Health Care Handbook
Indication: Use only for typhoid, peritonitis, meningitis, septicemia, or severe childbirth fever when safer antibiotics are unavailable.

Dosage for Adults:
• 500 to 750 mg (2 to 3 capsules) 4 times a day. This totals up to **12 capsules...
chloramphenicol, typhoid, peritonitis, meningitis, antibiotic dosage, newborns, contraindications
Administer Gentamicin for Serious Infections
High Priority Source: Where There is no Doctor a Village Health Care Handbook
Gentamicin is an injectable antibiotic used to treat very serious infections such as septicemia in a newborn and infection after giving birth.

### Important Precautions:
• This medicine should only be given by an experienced health...
gentamicin, serious infection, antibiotic, injection, precautions, safety
Manufacture Sulfa Antibiotics (Sulphanilamide)
High Priority Source: Survival and Austere Medicine
Materials Required:
• Basic laboratory equipment
• Organic chemistry reagents
• Access to a detailed procedure guide (e.g., http://orgchem.colorado.edu/courses/3341LMS05/SulfLM41S05.pdf)

Procedure:
1. Gather Materials: Ensure you have...
sulfa antibiotics, sulphanilamide, survival medicine, bacterial infection treatment
Selecting the Most Useful Antibiotics in Limited Access Situations
High Priority Source: Survival and Austere Medicine
Procedure:

1. Prioritize antibiotics based on availability and effectiveness:
- First choice: A broad-spectrum penicillin, such as Amoxycillin + Clavulanic Acid (Augmentin©).
- Second choice: A quinolone antibiotic, such...
antibiotic selection, antibiotic guide, broad-spectrum penicillin, quinolone, cephalosporin
Synthesize Chloramphenicol from Acetophenone
High Priority Source: Survival and Austere Medicine
Materials Required:
• Acetophenone
• Streptomyces Venezuela (or other suitable bacteria)
• Basic laboratory equipment
• Chemical reagents for synthesis

Procedure:
1. Obtain Starting Materials: Ensure you have access to acetophenone and...
chloramphenicol synthesis, acetophenone, antibiotic production, survival medicine
Administer Benzathine Benzylpenicillin for Syphilis in Infants
High Priority Source: A Book for Midwives
Procedure:

1. Determine the condition: Confirm syphilis diagnosis through blood test.
2. Inject approximately 150,000 Units of benzathine benzylpenicillin into a muscle (intramuscular injection) once only.
3. **Alternative dosage based...
syphilis,benzathine benzylpenicillin,muscle injection,infants,allergy warning
Administer Ceftriaxone for Infections
High Priority Source: A Book for Midwives
Procedure:

1. Verify indication: Use ceftriaxone for infections such as gonorrhea, pelvic infection, kidney infections, or serious infections after abortion, childbirth, or miscarriage.
2. Prepare injection site: Choose an appropriate...
ceftriaxone,muscle injection,gonorrhea,pelvic infection,newborn treatment
Administer Doxycycline for Bacterial Infections
High Priority Source: Where There is no Doctor a Village Health Care Handbook
Doxycycline is an expensive form of tetracycline used to treat the same illnesses as tetracycline. It should be taken by mouth twice a day, and can be taken with food or milk.

### Dosage:
Adults: 100 mg (1 tablet) per dose
-...
doxycycline,dosage,bacterial infections,administration,adults
Administer Tetracycline for Bacterial Infections
High Priority Source: Where There is no Doctor a Village Health Care Handbook
Tetracycline is a broad-spectrum antibiotic used to treat various bacterial infections, including diarrhea, dysentery, sinusitis, respiratory infections, typhus, brucellosis, cholera, trachoma, chlamydia, and pelvic inflammatory disease. It...
tetracycline,dosage,bacterial infections,administration,children,adults
Assemble a First Aid Kit for Bacterial Infections
High Priority Source: Where There is no Doctor a Village Health Care Handbook
To assemble a first aid kit that includes medicines for bacterial infections, include the following:

1. Penicillin: Include 250 mg tablets of Penicillin to treat bacterial infections.
2. Cotrimoxazole (Sulfamethoxazole and Trimethoprim):...
penicillin,ampicillin,cotrimoxazole,bacterial infection,treatment
Determining When to Discontinue Antibiotic Use
High Priority Source: Survival and Austere Medicine
Procedure:

1. Generally stop antibiotics after 48 hours following the resolution of major symptoms, assuming the infection is responding well.

2. If a patient does not respond to treatment, consider the following possibilities:
...
discontinuing antibiotics, antibiotic resistance, infection response, sepsis
Administer Azithromycin for Chlamydia
Standard Source: Where There is no Doctor a Village Health Care Handbook
Azithromycin is used to treat chlamydia.

### Dosage:
• Give 1 g, by mouth, one time only.

### Important Precautions:
• This medicine should be administered with care and only when necessary.
• It is not recommended for use in...
azithromycin, chlamydia, antibiotic, dosage, mouth, precautions
Administer Ciprofloxacin for Infections
Standard Source: Where There is no Doctor a Village Health Care Handbook
Ciprofloxacin is a powerful antibiotic used to treat infections that have become resistant to penicillin and other antibiotics. It can be used to treat chancroid, shigella, typhoid, peritonitis, and appendicitis.

### Dosage for Adults:
-...
ciprofloxacin, antibiotic, dosage, adults, children, precautions
Administer Clindamycin for Infections
Standard Source: Where There is no Doctor a Village Health Care Handbook
Clindamycin is used in conjunction with ciprofloxacin for certain infections.

### Dosage:
• Give clindamycin by mouth, 3 times a day.
• Each dose should be:
- Adults: 150–400 mg per dose.
- Children 8–12 years: 150–300 mg...
clindamycin, antibiotic, dosage, adults, children, precautions
Administer Cotrimoxazole for Bladder Infection or UTI
Standard Source: Where There is no Doctor a Village Health Care Handbook
Dosage:

• Take two 480 mg. tablets of cotrimoxazole 2 times a day.

Duration:

• Continue taking for 3 days.
cotrimoxazole, bladder infection, UTI, dosage
Administer Cotrimoxazole for Brucellosis, Ear Infections, Diarrhea with Blood and Fever (Shigella), Impetigo, Chronic Bronchitis with Fever, and Respiratory Infections (Pneumonia)
Standard Source: Where There is no Doctor a Village Health Care Handbook
Dosage:

• Take 2 times a day for 5 to 7 days.

Each dose:

• Adults and children over 9 years: 2 tablets of 400 mg. sulfamethoxazole with 80 mg. trimethoprim.
• Children 4 to 8 years: 1 tablet of 400 mg. sulfamethoxazole...
cotrimoxazole, brucellosis, ear infection, shigella, impetigo, bronchitis, pneumonia, dosage
Administer Cotrimoxazole for Chancroid and Shigella (with or without HIV)
Standard Source: Where There is no Doctor a Village Health Care Handbook
Dosage:

• Take the same doses as listed above for brucellosis, ear infections, diarrhea with blood and fever (shigella), impetigo, chronic bronchitis with fever, and respiratory infections (pneumonia).

Duration:

• Continue taking for...
cotrimoxazole, chancroid, shigella, HIV, dosage
Administer Cotrimoxazole for Children with HIV
Standard Source: Where There is no Doctor a Village Health Care Handbook
Dosage:

Children 6 to 14 years old: Take 1 tablet of 480 mg. cotrimoxazole once a day.
Children 6 months to 6 years old: Take ½ tablet of 480 mg. cotrimoxazole once a day.
Children under 6 months old: Take **¼...
cotrimoxazole, HIV children, dosage
Administer Cotrimoxazole for HIV Prevention of Diarrhea, Pneumonia, and Other Infections
Standard Source: Where There is no Doctor a Village Health Care Handbook
Dosage:

• Take 480 mg. dose of cotrimoxazole 2 times every day with lots of water.

Duration:

• Continue taking for the duration needed to prevent infections.

Important: This helps people with HIV live longer, healthier lives.
cotrimoxazole, HIV prevention, dosage
Administer Cotrimoxazole for Kidney Infections
Standard Source: A Book for Midwives
Procedure:

1. Determine dosage based on age and condition:
- For adults with kidney infections: 960 mg (160 mg trimethoprim + 800 mg sulfamethoxazole) by mouth twice a day for 7 days.
- For children of mothers with HIV:
- Babies...
cotrimoxazole, kidney infection, sulfamethoxazole, trimethoprim, HIV prevention, sulfa allergy
Administer Cotrimoxazole for Typhoid or Whooping Cough
Standard Source: Where There is no Doctor a Village Health Care Handbook
Dosage:

• Take the same doses as listed above for brucellosis, ear infections, diarrhea with blood and fever (shigella), impetigo, chronic bronchitis with fever, and respiratory infections (pneumonia).

Duration:

• Continue taking for...
cotrimoxazole, typhoid, whooping cough, dosage
Administer Dicloxacillin for Breast or Skin Infections
Standard Source: A Book for Midwives
Procedure:

1. For breast infection (see p. 289):
- Give 500 mg by mouth four times a day for 7 days.

2. Other drugs that may work: Erythromycin.

Important Notes:
• Dicloxacillin is an antibiotic of the penicillin family...
dicloxacillin, breast infection, penicillin allergy, yeast infection, skin infection
Administer Doxycycline for Chlamydia
Standard Source: Where There is no Doctor a Village Health Care Handbook
Doxycycline is used to treat chlamydia.

### Dosage:
• Give 100 mg, by mouth, 2 times a day for 7 days.

### Important Precautions:
• This medicine should be administered with care and only when necessary.
• It is not recommended...
doxycycline, chlamydia, antibiotic, dosage, mouth, precautions
Administer Ertapenam for Traumatic Injury
Standard Source: TCCC 17 13 Tactical Combat Casualty Care
Indications: Traumatic injury.

Dosage: 1 gram (gm) intravenous (IV) antibiotic.

Availability: Available in both the Combat Medic and Tactical Combat Medical Care MES.

Instructions: Administer via IV. Ensure proper IV access and...
ertapenam,Invanz,traumatic injury,IV antibiotic
Administer Moxifloxacin for Eye Injury or Other Traumatic Injuries
Standard Source: TCCC 17 13 Tactical Combat Casualty Care
Indications: Eye injury or other traumatic injury.

Dosage: 400 mg oral tablet antibiotic.

Availability: Available in both the Combat Medic and Tactical Combat Medical Care MES.

Instructions: Ensure the casualty is conscious and...
moxifloxacin,eye injury,traumatic injury,antibiotic
Administer Spectinomycin for Gonorrhea
Standard Source: Where There is no Doctor a Village Health Care Handbook
Spectinomycin is used to treat gonorrhea.

### Dosage:
• Give 2 g, one injection, one time only.

### Important Precautions:
• This medicine should be administered by an experienced health worker.
• **Pregnant or breastfeeding...
spectinomycin, gonorrhea, antibiotic, dosage, injection, precautions
Avoid Sulfathiazole Due to Higher Risk of Side Effects
Standard Source: Where There is no Doctor a Village Health Care Handbook
Note: Sulfathiazole is similar in use and cost to other sulfas but is not recommended due to a higher risk of side effects.

Important Notes:
• Use only if no alternative is available.
• Follow the same dosage guidelines as for other...
sulfathiazole, sulfas, side effects, antibiotic alternatives
Stop Clindamycin Immediately if Diarrhea Occurs
Standard Source: Where There is no Doctor a Village Health Care Handbook
Important Risk:

• If you are taking clindamycin and start to have diarrhea, stop taking it immediately.
• It can cause serious problems.
clindamycin, diarrhea, risk
Use Cephalosporins for Serious Infections
Standard Source: Where There is no Doctor a Village Health Care Handbook
Important:

• Cephalosporins are powerful antibiotics that work against many different kinds of bacteria.
• They are often expensive and not widely available. For that reason, they are usually not the first choice in this book unless...
cephalosporins, antibiotics, serious infections
Use Clindamycin for Infections (with Caution)
Standard Source: A Book for Midwives
Procedure:

1. Administer clindamycin only when absolutely necessary and under medical supervision.
2. Monitor for side effects, such as gastrointestinal disturbances, including diarrhea or colitis.
3. **Avoid use in breastfeeding...
clindamycin, antibiotic use, colitis risk, breastfeeding caution
Use Clindamycin for Infections Resistant to Penicillin
Standard Source: Where There is no Doctor a Village Health Care Handbook
Important:

• Clindamycin is a strong antibiotic of the lincosamide family that is used to treat many kinds of infections.
• It is especially useful for treating infections that have become resistant to penicillin, such as bone infections.
• It...
clindamycin, penicillin resistant infections, dosage

Pregnancy And Childbirth (32)

Assessing Maternal and Fetal Risk in Austere Environments
High Priority Source: Survival and Austere Medicine
Procedure:

1. Evaluate maternal health status:
- Check for pre-existing conditions such as diabetes, hypertension, or previous caesarean sections.
- Assess nutritional status and overall physical condition of the mother.
2. **Assess...
maternal risk, fetal death rate, childbirth risks, austere environment, pregnancy complications
Maintain Hygiene and Prepare Equipment for Birth Attendant
High Priority Source: Where There is no Doctor a Village Health Care Handbook
### Maintain Hygiene and Prepare Equipment for the Birth Attendant

• The midwife or birth attendant should:
- Wash the mother’s belly, genitals, buttocks, and legs well with soap and warm water.
- Ensure the bed is in a clean place with enough...
hygiene during labor, equipment preparation for birth, infection prevention, midwife duties
Prepare Alcohol for Hand Rubbing After Washing
High Priority Source: Where There is no Doctor a Village Health Care Handbook
Purpose: To disinfect hands after washing during childbirth.

Procedure:
1. Obtain alcohol (preferably 70% or higher concentration).
2. Store it in a clean, sealed container until needed.
3. Use the alcohol to rub hands thoroughly after...
alcohol, hand disinfection, childbirth hygiene
Prepare Antiseptic Soap for Handwashing and Cleaning
High Priority Source: Where There is no Doctor a Village Health Care Handbook
Purpose: To maintain hygiene during childbirth.

Procedure:
1. Obtain an antiseptic soap (or any clean soap if antiseptic is unavailable).
2. Store it in a clean, dry place until needed.
3. Use the soap to wash hands and clean the mother’s...
antiseptic soap, handwashing, childbirth hygiene
Prepare Clean Cloths and Rags for Delivery
High Priority Source: Where There is no Doctor a Village Health Care Handbook
Purpose: To ensure hygiene during childbirth.

Procedure:
1. Collect a large number of very clean cloths or rags.
2. Ensure they are washed and dried thoroughly before use.
3. Store them in a clean, dry place until needed.
4. Use them for...
clean cloths, delivery preparation, childbirth hygiene
Prepare Clean Cotton for Use During Delivery
High Priority Source: Where There is no Doctor a Village Health Care Handbook
Purpose: To use as padding or for cleaning during childbirth.

Procedure:
1. Obtain clean cotton (such as gauze or cotton pads).
2. Store it in a clean, dry place until needed.
3. Use the cotton to pad surfaces or clean wounds if necessary...
clean cotton, childbirth tools, delivery preparation
Prepare Two Bowls for Handwashing and Afterbirth Examination
High Priority Source: Where There is no Doctor a Village Health Care Handbook
Purpose: To maintain hygiene during childbirth.

Procedure:
1. Obtain two clean bowls.
2. One bowl is used for washing hands before handling the baby or cutting the umbilical cord.
3. The second bowl is used to catch and examine the...
bowls for delivery, childbirth hygiene, afterbirth examination
Prepare Two Ribbons or Strips of Clean Cloth for Tying the Umbilical Cord
High Priority Source: Where There is no Doctor a Village Health Care Handbook
Purpose: To safely tie the umbilical cord during delivery.

Procedure:
1. Obtain two clean ribbons or strips of cloth (approximately 20 cm long each).
2. Ensure they are made from a non-irritating material such as cotton.
3. Wrap and seal...
umbilical cord tying, childbirth tools, sterilization
Prepare a Birth Kit with Essential Supplies
High Priority Source: A Book for Midwives
Procedure:

When you think a mother’s labor is near, be sure you have all the supplies and tools you will need for the birth. The mother may have some of these supplies at her home, but a midwife should bring the rest. It is recommended that...
birth kit, midwife supplies, pregnancy, childbirth, emergency supplies, sterilization
Prepare a Clean Scrub Brush for Hand and Nail Cleaning
High Priority Source: Where There is no Doctor a Village Health Care Handbook
Purpose: To ensure proper hand hygiene during childbirth.

Procedure:
1. Obtain a clean scrub brush with soft bristles.
2. Store it in a clean, dry place until needed.
3. Use the scrub brush to thoroughly clean hands and fingernails before...
scrub brush, hand hygiene, childbirth tools
Prepare for the Birth of the Baby During Second Stage of Labor
High Priority Source: Where There is no Doctor a Village Health Care Handbook
### Prepare for the Birth of the Baby During Second Stage of Labor

• When the birth opening stretches and the baby’s head begins to show, the midwife or helper should have everything ready for the birth.
• At this time, the mother should **try...
birthing positions, delivery procedures, infection prevention, midwife duties during labor
Prevent Long Labor to Avoid Fistulas
High Priority Source: A Book for Midwives
Objective: Prevent long labor that can lead to fistulas by identifying and addressing contributing factors.

Procedure:
1. Recognize signs of prolonged labor, such as labor lasting more than a day or complications during childbirth.
2....
fistula prevention, prolonged labor, maternal health, early marriage, nutrition, access to healthcare
Recognize Signs That Labor is Near
High Priority Source: Where There is no Doctor a Village Health Care Handbook
Procedure:

1. Monitor baby’s position:
- A few days before labor begins, the baby moves lower in the womb.
- This may make breathing easier but increase the frequency of urination due to pressure on the bladder.
- In first births,...
labor signs, mucus discharge, contractions, water breaking, false labor, practice contractions, childbirth preparation
Recognize the Health Risks of Drug Use During Pregnancy
High Priority Source: Where There is no Doctor a Village Health Care Handbook
Overview:
Using drugs during pregnancy can have serious consequences for both the mother and the unborn child.

Steps to Address Drug Use in Pregnant Women:
1. Educate About Risks:
- Inform pregnant women about how drug use (e.g.,...
drug use during pregnancy, prenatal care, health risks, needle sharing, hepatitis, HIV/AIDS
Prevent Brain Damage During Birth by Choosing a Safe Midwife
High Priority Source: Where There is no Doctor a Village Health Care Handbook
Procedure:

1. Choose a midwife carefully to ensure safe delivery practices.
2. Do not allow the midwife to use medicines to speed up the birth or give strength to the mother before the baby is born, as this can increase the risk of...
midwife, brain damage, spastic child, birth complications, safe delivery
Prevention of Tearing During Birth
High Priority Source: Where There is no Doctor a Village Health Care Handbook
Procedure:

• The mother should try to stop pushing when the baby’s head is coming out. This gives her birth opening time to stretch.
• In order not to push, she should pant (take many rapid breaths).
• When the birth opening is stretching, the...
tearing,during_birth,midwife,warm_compresses,pregnancy
Advocate for Patient-Centered Birth Practices
Standard Source: A Book for Midwives
Objective: Work to change unnecessary, disrespectful, or harmful hospital practices during childbirth.

Procedures:
1. Identify and challenge unnecessary medical interventions such as:
- Shaving pubic hair before a normal birth (not...
advocacy,birth practices,episiotomy,hospital policies,midwifery,pregnancy,patient-centered care
Encourage the Mother to Urinate Regularly During Labor
Standard Source: A Book for Midwives
Procedure:

1. Encourage the mother to urinate at least once every 2 hours during labor.
2. If the mother’s bladder is full, her contractions may get weaker and her labor longer. A full bladder can also cause pain, problems with pushing out the...
urinate,labor,bowel,midwife,pregnancy,bladder,contractions
Preparation for Twin Births
Standard Source: Where There is no Doctor a Village Health Care Handbook
Procedure:

• The mother should be within easy reach of a hospital after the seventh month of pregnancy.

Signs that a woman is likely to have twins:

1. The belly grows faster and the womb is larger than usual, especially in the last months...
twins,pregnancy,delivery,hospital,preparation
Recognize and Respond to Signs of Dehydration in a Woman in Labor
Standard Source: A Book for Midwives
Signs of dehydration:
• Dry lips
• Sunken eyes
• Loss of stretchiness of the skin (test by lifting the skin on the back of her hand with two fingers; if it does not fall right back to normal, she is dehydrated)
• Mild fever (up to 38°C or...
dehydration,labor,signs,symptoms,pregnancy,midwifery
Estimate Due Date Using Last Monthly Bleeding
Standard Source: A Book for Midwives
To estimate a due date using the last monthly bleeding, follow these steps:

1. Confirm eligibility:
• Ask the woman three questions:
- Has your monthly bleeding been mostly regular, once every 4 weeks (once every month)?
- **Was your...
due date, pregnancy, last menstrual period, LMP, medical emergency
Estimate Due Date Using the Moon
Standard Source: A Book for Midwives
If calendars are not available, you can estimate the due date using the moon:

1. Confirm eligibility:
• Ensure that her monthly bleeding is usually about one moon (4 weeks) apart.

2. Use lunar cycles to estimate due date:
• If her last...
lunar cycle, due date estimation, pregnancy, medical emergency
Help a Woman in Labor Stay Hydrated by Drinking at Least 1 Cup of Liquid Each Hour
Standard Source: A Book for Midwives
Why it's important:
A woman in labor uses up the water in her body quickly. She should drink at least 1 cup of liquid each hour to avoid dehydration, which can make labor longer and harder, cause exhaustion, and affect both mother and...
hydration,labor,dehydration,drinking,fluids,pregnancy,midwifery
Prepare Emotionally and Physically for Labor
Standard Source: A Book for Midwives
As labor approaches, a woman may feel different emotionally or physically:

• She may feel dreamy, very quiet, or more aware of her body.
• Some women may have a strong urge to stay home and wait for labor to begin.
• It is normal to want to clean...
emotional signs of labor, physical preparation, rest before labor, family support during pregnancy
Prepare a Cereal Drink for Laboring Mothers
Standard Source: A Book for Midwives
Ingredients:

• 1 liter of clean water
• Half a level teaspoon of salt
• 8 heaping teaspoons (or 2 handfuls) of powdered cereal (e.g., rice, maize, wheat flour, sorghum, or cooked and mashed potatoes)

Instructions:

1. In 1 liter of clean...
cereal drink,labor,nutrition,pregnancy,hydration,salt,rice,midwife
Recognize Signs That Labor Will Start Soon
Standard Source: A Book for Midwives
There are several signs that indicate labor may begin soon:

• The baby may drop lower in the mother’s belly, especially about 2 weeks before birth (though this may happen later for women who have given birth before).
• The mother may feel more...
labor signs, contractions, show, baby dropping, stool changes, cervical mucus plug
Recognize the Sign of Show (Bloody Mucus Discharge)
Standard Source: A Book for Midwives
Show is a sign that the cervix is beginning to open and labor may start in 1-2 days:

• It appears as bloody mucus discharge from the vagina.
• It may come out all at once, like a plug, or leak slowly over several days.
• This indicates that the...
show, cervical mucus plug, bloody discharge, labor signs
Understand the Difference Between Practice and Labor Contractions
Standard Source: A Book for Midwives
There are two types of contractions:

Practice Contractions:
• Occur throughout pregnancy.
• Usually felt high in the belly or all over the belly.
• Are mild, irregular, and may stop if the mother changes position or activity (e.g., sitting down...
practice contractions, labor contractions, contraction differences, pregnancy signs
Understand the Role of Stool Changes Before Labor
Standard Source: A Book for Midwives
Many mothers experience loose stool (diarrhea) in the days leading up to labor:

• This is a normal and natural process that helps clean out the body.
• It prepares the mother for the physical demands of labor and birth.
• The mother should not be...
stool changes before labor, bowel movements in pregnancy, digestive system during labor
Understanding Fetal Development During Pregnancy
Standard Source: A Book for Midwives
Procedure:

1. After fertilization, the sperm and egg combine to form a single cell that multiplies and grows into a baby.
2. The mother’s blood provides oxygen from the air she breathes and nutrition from the food she eats to the baby through...
fetal development,pregnancy,placenta,umbilical cord,amniotic fluid,first trimester,second trimester,third trimester
Walking to Encourage Labor
Standard Source: A Book for Midwives
Procedure:

1. Start walking regularly during late pregnancy to help encourage labor.
2. Walk at a comfortable pace, avoiding overexertion.
3. Continue walking until contractions begin or until the body signals that it is time for...
walking, labor, pregnancy, childbirth, midwifery
Encourage the Mother to Rest Between Contractions
Reference Source: A Book for Midwives
Procedure:

1. Encourage the mother to rest between contractions, even when labor first begins.
2. When she is not having a contraction, let her body relax, take deep breaths, and sometimes sit or lie down.
3. In early labor, she may be able to...
rest,labor,birth,midwife,pregnancy,contractions,relaxation

Infectious Disease Surveillance (32)

Conducting Hospital Surveillance During the Pandemic Period
Critical Source: HHSPandemicInfluenzaPlan
Procedure:

During the Pandemic Period, hospitals must:

1. Implement surveillance mechanisms in emergency departments to detect increases in influenza-like illness during early stages of the pandemic.
2. Monitor employee absenteeism for...
pandemic surveillance, emergency department monitoring, employee absenteeism tracking, health data reporting
Contacting CDC Emergency Response Hotline for Suspected Avian Influenza Cases
Critical Source: HHSPandemicInfluenzaPlan
Procedure:

1. Health departments should call the CDC Emergency Response Hotline at 770-488-7100 to report a suspected case of infection with:
- Avian influenza A (H5N1), or
- Any other novel influenza virus.
2. This hotline is...
cdc hotline, avian flu reporting, emergency response protocol
Enhance All Influenza Surveillance Components During a Pandemic Period
Critical Source: HHSPandemicInfluenzaPlan
Procedure:

Enhance all components of influenza surveillance during the pandemic period, including virologic, outpatient, hospitalization, and mortality surveillance.
• Ensure that data collection is timely and comprehensive to support...
enhance surveillance, pandemic period, state and local health departments
Provide Technical Support to Track Pandemic Virus and Gather Epidemiologic Data
Critical Source: HHSPandemicInfluenzaPlan
Procedure:

Provide technical support to ministries of health and the WHO (World Health Organization) as requested.
• Assist in tracking the pandemic virus and gathering epidemiologic data on risk factors for infection or severe...
technical support, WHO, HHS, epidemiologic data
Analyze Influenza Surveillance Data on a Regular and Timely Basis
High Priority Source: HHSPandemicInfluenzaPlan
Procedure:

Analyze influenza surveillance data regularly and in a timely manner.
• Use advanced analytical tools to identify trends, outbreaks, or anomalies.
• Share findings with relevant stakeholders for informed...
surveillance data analysis, HHS, timely reporting
CDC Assistance with Case Investigation for Confirmed Novel Influenza Cases
High Priority Source: HHSPandemicInfluenzaPlan
Procedure:

1. If infection with a novel influenza virus is confirmed, states may request CDC assistance with a case investigation.
2. The investigation aims to:
- Identify the source of infection,
- Determine the course of illness.
3....
cdc case investigation, source tracing, contact monitoring
Completing CDC Case Screening and Report Form for Novel Influenza Cases
High Priority Source: HHSPandemicInfluenzaPlan
Procedure:

1. After the initial telephone report to the CDC Emergency Response Hotline, health department officials should complete a CDC case screening and report form.
2. The form can be obtained from the Hotline or from Epi-X.
3. The...
cdc case reporting form, influenza case documentation, health department protocol
Coordinate and Maintain the National Influenza Surveillance System
High Priority Source: HHSPandemicInfluenzaPlan
Procedure:

Coordinate all components of the National Influenza Surveillance System.
• Ensure that the system is maintained and updated regularly to reflect current public health needs.
• Collaborate with state and local partners for...
national influenza surveillance system, HHS, coordinate, maintain
Enhanced Surveillance for Avian Influenza A (H5N1)
High Priority Source: HHSPandemicInfluenzaPlan
Procedure:

1. Implement enhanced surveillance by state and local health departments, hospitals, and clinicians to identify patients at increased risk for avian influenza A (H5N1).

2. Test for avian influenza A (H5N1) in hospitalized...
avian influenza H5N1, enhanced surveillance, travel history, lab testing
Establish Outpatient Surveillance for Influenza-Like Illness (ILI)
High Priority Source: HHSPandemicInfluenzaPlan
Procedure:

Surveillance for outpatient visits for ILI is conducted via the Sentinel Provider Network (SPN), a collaborative effort among state health departments, healthcare providers, and CDC. The following steps should be taken:

1. **Recruit...
outpatient surveillance, ILI, Sentinel Provider Network (SPN), CDC collaboration, BioSense system, emergency department monitoring, phone surveys
Implement Enhanced Surveillance for Pandemic Influenza Virus Detection
High Priority Source: HHSPandemicInfluenzaPlan
Procedure:

1. Distribute CDC recommendations to healthcare providers in the state for enhanced surveillance of pandemic influenza virus detection.
2. Facilitate specimen collection and testing at the local level as recommended by CDC...
enhanced surveillance,pandemic influenza,specimen testing,virus detection,CDC guidelines
Implement Enhancements to the National Influenza Surveillance System
High Priority Source: HHSPandemicInfluenzaPlan
Procedure:

Implement enhancements to improve the effectiveness of the National Influenza Surveillance System.
• Work with state and local partners to identify areas for improvement.
• Explore options for additional enhancements, such...
enhance, national influenza surveillance system, HHS, state and local partners
Implement Virologic Surveillance for Influenza Pandemic
High Priority Source: HHSPandemicInfluenzaPlan
Procedure:

During an influenza pandemic, laboratories must be prepared to handle increased testing demands. The following steps should be taken:

1. Equip and train laboratories to use RT-PCR for routine influenza testing and to detect...
virologic surveillance, influenza pandemic, RT-PCR testing, laboratory capacity, CDC collaboration
Implementing Hospital Surveillance for Novel Influenza Strains
High Priority Source: HHSPandemicInfluenzaPlan
Procedure:

During the Interpandemic and Pandemic Alert Periods, healthcare providers and facilities must:

1. Be on alert for suspected cases of infection with novel strains of influenza, including avian or animal strains (e.g., H5N1) that can...
hospital surveillance, novel influenza strains, biosafety levels, health department reporting, pandemic alert period
Issue Updated Case Definitions and Guidance for Laboratory Testing and Enhanced Surveillance
High Priority Source: HHSPandemicInfluenzaPlan
Procedure:

Issue updated case definitions and guidance for laboratory testing and enhanced surveillance.
• Ensure that all stakeholders are informed of the latest protocols and procedures.
• Collaborate with state and local health...
case definitions, laboratory testing, HHS, updated guidance
Monitor Pandemic Impact Using Surveillance Systems
High Priority Source: HHSPandemicInfluenzaPlan
Procedure:

1. Use data from multiple systems, including SPN (Sentinel Provider Network), hospitalization surveillance, state and territorial epidemiologists’ assessments, the 122 Cities Mortality Reporting System, NNDSS (National Notifiable...
pandemic impact,health surveillance,data systems,CDC guidelines,mortality reporting
Recognizing Symptoms of Influenza for Pandemic Surveillance
High Priority Source: HHSPandemicInfluenzaPlan
Procedure:

Healthcare providers should be familiar with the symptoms of influenza to aid in detection during a pandemic:

1. Common symptoms include:
- Fever
- Headache
- Myalgia (muscle pain)
- Prostration (extreme exhaustion)
...
influenza symptoms, atypical presentations, pandemic detection, respiratory disease differentiation
State and Local Health Department Reporting to CDC for Novel Influenza Cases
High Priority Source: HHSPandemicInfluenzaPlan
Procedure:

1. State and local health departments should immediately report to the CDC any influenza cases that meet all of the following criteria:
- Test positive for a novel influenza subtype, or
- Meet the enhanced surveillance...
cdc reporting, novel influenza case definition, state health department protocol
Surveillance for Influenza Viruses (Virologic Surveillance)
High Priority Source: HHSPandemicInfluenzaPlan
Procedure:

• Conduct virologic surveillance to detect and track the introduction of pandemic influenza viruses.
• Monitor changes in the virus, including development of antiviral resistance.
• Use laboratory-based methods for accurate...
virologic surveillance, influenza viruses, HHS
Surveillance for Influenza-Associated Illness and Deaths (Disease Surveillance)
High Priority Source: HHSPandemicInfluenzaPlan
Procedure:

• Conduct disease surveillance to detect increases in influenza-like illness (ILI) in the community.
• Monitor the pandemic’s impact on health, including tracking outpatient visits, hospitalizations, and deaths.
• Identify...
disease surveillance, influenza-associated illness, HHS
Assist USDA in Monitoring New Influenza Strains in Poultry and Swine
High Priority Source: HHSPandemicInfluenzaPlan
Procedure:

Monitor new influenza strains that may emerge in poultry and swine populations.
• Provide assistance to the USDA (United States Department of Agriculture) as requested.
• Use surveillance methods tailored for animal...
USDA, poultry, swine, influenza strains, HHS
Help Identify and Characterize Influenza Strains Collected by the U.S. WHO Collaborating Laboratory Network
High Priority Source: HHSPandemicInfluenzaPlan
Procedure:

Identify influenza strains collected by the U.S. WHO Collaborating Laboratory Network.
Characterize these strains to understand their genetic, antigenic, and pathogenic properties.
• Share findings with relevant...
WHO collaborating laboratory network, identify, characterize, HHS
Improve Capacity for Rapid Identification of Unusual Influenza Strains
High Priority Source: HHSPandemicInfluenzaPlan
Procedure:

• Enhance the capacity to rapidly identify unusual influenza strains.
• Use advanced diagnostic tools and methods to detect atypical or novel strains.
• Collaborate with relevant agencies, such as those referenced in **Supplement...
rapid identification, unusual influenza strains, public health laboratory
Lab Confirmation of Influenza Cases
High Priority Source: HHSPandemicInfluenzaPlan
Procedure:

1. Confirm influenza cases using laboratory methods such as rapid diagnostic tests, antigen detection, culture, or PCR.

2. Avoid relying solely on point-of-care rapid diagnostic test kits during times when influenza is not...
lab confirmation, rapid diagnostic tests, PCR testing, influenza surveillance
Transition to Scaled-Back Surveillance During Pandemic Evolution
High Priority Source: HHSPandemicInfluenzaPlan
Procedure:

1. Conduct enhanced surveillance during the introduction, initial spread, and first waves of a pandemic.
2. Monitor for changes in the virus, including its transition into a routinely circulating influenza A subtype as more...
scaled-back surveillance,pandemic evolution,transition,circulating virus,CDC communication
Veterinary Surveillance for Avian Influenza in the United States
High Priority Source: HHSPandemicInfluenzaPlan
Procedure:

1. Surveillance for avian influenza is conducted by:
- State and local authorities,
- The poultry industry, and
- The U.S. Department of Agriculture (USDA) Animal and Plant Health Inspection Service (APHIS), as detailed...
avian flu surveillance, veterinary testing, usda aphis protocol
Assessing Influenza-Like Illness (ILI) Activity Levels
Standard Source: HHSPandemicInfluenzaPlan
Procedure:

1. Determine ILI activity level based on the following criteria:
- No activity: No increase in ILI, and no lab-confirmed cases.
- Sporadic: Not increased ILI, or isolated lab-confirmed cases, or a lab-confirmed...
influenza surveillance, ILI activity levels, regional definitions, institutional outbreaks, lab confirmation
Conduct Animal Surveillance for Influenza
Standard Source: HHSPandemicInfluenzaPlan
Objective: Understand the prevalence, ecology, and spread of influenza virus subtypes in animal reservoirs.

Procedure:
1. Monitor domestic poultry (especially in Asia) for outbreaks associated with human disease.
2. Coordinate surveillance...
animal surveillance, influenza, avian flu, swine, poultry, HPAI, quarantine, OIE, WHO
Coordinate with International Agencies for Influenza Surveillance and Reporting
Standard Source: HHSPandemicInfluenzaPlan
Objective: Enhance global influenza surveillance through international collaboration.

Procedure:
1. Work with the World Health Organization (WHO) to conduct limited systematic influenza surveillance in swine.
2. Collaborate with the Office...
international collaboration, WHO, OIE, equine influenza, avian surveillance, USDA
Expand Surveillance of Influenza Viruses in Poultry, Swine, and Wild Migratory Birds
Standard Source: HHSPandemicInfluenzaPlan
Objective: Expand surveillance efforts to better understand the spread and evolution of influenza viruses.

Procedure:
1. Increase monitoring of influenza viruses in poultry, swine, and wild migratory birds both within the U.S. and...
surveillance expansion, poultry, swine, wild birds, molecular evolution, live bird markets
Implement Influenza Surveillance in Wild Birds and Migratory Species
Standard Source: HHSPandemicInfluenzaPlan
Objective: Monitor influenza A viruses in wild birds and migratory species to detect potential threats.

Procedure:
1. Conduct annual surveillance of influenza viruses in wild migrating birds in North America.
2. Collaborate with the...
wild birds, migratory birds, surveillance, influenza A, baseline activity, pandemic detection
Isolate and Subtype Influenza Viruses Year Round
Standard Source: HHSPandemicInfluenzaPlan
Procedure:

Isolate influenza viruses throughout the year.
Subtype identified influenza viruses to determine their classification.
• Ensure that this process is conducted consistently, regardless of season or...
isolate, subtype, influenza viruses, public health laboratory

Parasitic Infections (31)

Treating Trichinosis with Medication and Medical Help
High Priority Source: Where There is no Doctor a Village Health Care Handbook
Procedure:

1. Seek immediate medical help if trichinosis is suspected.
2. Administer albendazole or mebendazole as directed by a healthcare professional.
3. Follow the dosage instructions carefully, which can be found on pages 373 and 374 of...
trichinosis treatment, albendazole, mebendazole, medical help
Understanding Trichinosis and Its Life Cycle
High Priority Source: The Household Cyclopedia
Trichina is a minute, slender, transparent worm that resides in the muscles of humans and other mammals. Here's its life cycle:

1. Ingestion: After being ingested by humans or animals through infected flesh, the trichinae are released from...
trichinosis,trichina,worm infection,muscle parasite
Administer Suramin for Adult Worm Infections
High Priority Source: Where There is no Doctor a Village Health Care Handbook
Procedure:

1. Verify eligibility: Ensure the patient does not have pre-existing kidney problems. If swelling of the feet or other signs of urinary poisoning occur during treatment, stop using this medicine immediately.

2. **Prepare the...
suramin, worm infection, kidney toxicity, intravenous injection, parasitic treatment
Avoid Thiabendazole for Roundworm Infections
High Priority Source: Where There is no Doctor a Village Health Care Handbook
Procedure for Avoiding Thiabendazole in Roundworm Treatment

1. Do not use thiabendazole to treat roundworm infections: This medication can cause dangerous side effects, including worms migrating to the nose or mouth.
2. **Recognize signs of...
thiabendazole, unsafe medication, roundworm treatment
Management of Guinea Worm Infection
High Priority Source: Where There is no Doctor a Village Health Care Handbook
To manage a guinea worm infection:

Steps:
1. Do not pull the worm out, as this can cause severe pain and infection.
2. Soak the affected area in clean, fresh water to help the worm come out naturally.
3. Keep the wound clean with...
guinea worm, parasitic infection, waterborne disease, wound care
Administer Diethylcarbamazine for River Blindness (Onchocerciasis)
Standard Source: Where There is no Doctor a Village Health Care Handbook
Purpose: Treat river blindness caused by *Onchocerca volvulus* when ivermectin is not available.

Instructions:
1. Check eligibility: Use only under the direction of an experienced health care worker. Avoid use in pregnant women.
2....
diethylcarbamazine, river blindness, onchocerciasis, dosage, medical treatment
Administer Ivermectin for Scabies or Strongyloides
Standard Source: Where There is no Doctor a Village Health Care Handbook
Purpose: Treat scabies or strongyloides infection.

Instructions:
1. Check eligibility: Do not give to children under 5 years or weighing less than 15 kg, pregnant or breastfeeding women, or persons with meningitis or other serious...
ivermectin, scabies, strongyloides, dosage, medical treatment
Administer Mebendazole for Roundworm Infection
Standard Source: Where There is no Doctor a Village Health Care Handbook
Procedure for Administering Mebendazole to Treat Roundworms

1. Confirm the infection: Ensure that roundworms have been identified through stool examination.
2. Determine the correct dosage:
- Refer to page 373 of *Where There is No...
mebendazole, roundworm treatment, vermox, dosage instructions
Administer Metrifonate for Schistosomiasis Causing Blood in the Urine
Standard Source: Where There is no Doctor a Village Health Care Handbook
Metrifonate _(Bilarcil)_ is a much cheaper medicine that can be used to treat schistosomiasis causing blood in the urine _(S. hematobium)_. It should be administered under the direction of an experienced health worker.

### Warnings:
• **Avoid...
metrifonate,schistosomiasis,blood in urine,medicine,dosage,administration,parasite
Administer Niclosamide for Tapeworm Infection
Standard Source: Where There is no Doctor a Village Health Care Handbook
Niclosamide _(Yomesan)_ is an effective and less expensive treatment for most types of tapeworm infection. It works against tapeworms in the gut but not against cysts outside the gut.

### Dosage:
Adults and children over 8 years: 2 g (4...
niclosamide,tapeworm,medicine,dosage,administration,parasite
Administer Oxamniquine for Schistosomiasis (S. mansoni) in Children
Standard Source: Where There is no Doctor a Village Health Care Handbook
Purpose: Treat schistosomiasis causing blood in the stools in South and Central America.

Instructions:
1. Check eligibility: Ensure the child is not pregnant (not applicable to children), but ensure no contraindications apply.
2. **Take...
oxamniquine, schistosomiasis, S. mansoni, dosage, children, medical treatment
Administer Praziquantel for Schistosomiasis (Blood Flukes, Bilharzia)
Standard Source: Where There is no Doctor a Village Health Care Handbook
Praziquantel _(Biltricide, Droncit)_ is effective against all forms of schistosomiasis. It should be administered under the direction of an experienced health worker.

### Warnings:
Avoid use: Pregnant women and children under 4 years old...
praziquantel,schistosomiasis,blood flukes,medicine,dosage,administration,parasite
Administer Praziquantel for Tapeworm Infection
Standard Source: Where There is no Doctor a Village Health Care Handbook
Praziquantel _(Biltricide, Droncit)_ is effective in treating most types of tapeworms but is more expensive than niclosamide.

### Warnings:
Avoid use: Pregnant women and children under 4 years old should avoid taking praziquantel if...
praziquantel,tapeworm,medicine,dosage,administration,parasite
Apply Benzyl Benzoate for Scabies or Lice
Standard Source: Where There is no Doctor a Village Health Care Handbook
Benzyl benzoate is used to treat both scabies and head lice.

### For Head Lice:
• Wash and dry hair and scalp thoroughly before applying benzyl benzoate.
• Use enough to thoroughly wet the dry hair and skin.
• Leave the medicine on for 24...
benzyl benzoate,scabies,lice,treatment,application,dosage for children
Apply Permethrin for Scabies or Lice
Standard Source: Where There is no Doctor a Village Health Care Handbook
Permethrin is used to treat scabies and lice. It comes in various forms depending on the condition being treated.

### For Scabies:
• Wash and dry body thoroughly, then apply permethrin from the neck down, including the soles of the feet, and...
permethrin,scabies,lice,treatment,medicated shampoo
Prevent Hookworm Infection by Avoiding Barefoot Walking
Standard Source: Where There is no Doctor a Village Health Care Handbook
Avoid walking barefoot to prevent hookworm infection.

Steps:
1. Wear shoes or protective footwear at all times, especially in areas where hookworm is common.
2. Ensure that children do not go barefoot.
3. Hookworms enter the body through...
hookworm prevention, barefoot walking, anemia
Prevent Trichinosis Through Proper Cooking of Meat
Standard Source: Where There is no Doctor a Village Health Care Handbook
Procedure:

1. Cook pork and other meats thoroughly to ensure that no part remains raw.
2. Avoid feeding scraps or leftovers from butchering to pigs unless the meat has been cooked first.
3. Ensure that all meat is sourced from reputable...
trichinosis prevention, meat cooking, pork, hygiene
Treating Hookworm Infections
Standard Source: Where There is no Doctor a Village Health Care Handbook
Steps to treat hookworm infections:

1. Medication: Use mebendazole, albendazole, or pyrantel for treatment. For dosage instructions and precautions, refer to pages 373 to 375 of the book.
2. Treat anemia:
- Encourage consumption of...
hookworm, treatment, mebendazole, anemia, prevention, latrines
Treating Scabies and Lice Infections
Standard Source: Where There is no Doctor a Village Health Care Handbook
Procedure:

1. Apply Benzyl Benzoate Cream or Lotion:
- Apply to the entire body from the neck down.
- Leave on for 24 hours before washing off with warm water.

2. Use Permethrin (Acticin, Elimite, Nix):
- Apply permethrin...
scabies,lice,permethrin,crotamiton,ivermectin,sulfur,vaseline
Treating Scabies in a Family or Sexual Contacts
Standard Source: Where There is no Doctor a Village Health Care Handbook
Procedure:

1. Treat all affected individuals: If one person has scabies, treat everyone in their family and all sexual contacts.
2. Maintain personal cleanliness:
- Bathe and change clothes daily.
- Cut fingernails very short to...
scabies,treatment,permethrin,lindane,crotamiton,sulfur powder,ivermectin,prevention
Treating Tapeworm Infection with Medication
Standard Source: Where There is no Doctor a Village Health Care Handbook
Procedure:

1. Administer niclosamide (Yomesan) or praziquantel as directed.
2. Follow the dosage instructions carefully, which can be found on page 375 of the book.
3. Ensure the patient completes the full course of treatment to eliminate the...
tapeworm treatment, niclosamide, praziquantel, medication
Treating Worm Infections
Standard Source: Where There is no Doctor a Village Health Care Handbook
Procedure:

1. Take Mebendazole (Vermox):
- Take mebendazole orally as prescribed, typically once daily with food.
- Continue treatment for at least 2 weeks after symptoms disappear.

2. Take Albendazole (Zentel):
- Take...
worms,mebendazole,albendazole,piperazine,thiabendazole
Administer Mebendazole for Roundworm, Whipworm, Hookworm, and Strongyloides Infections
Standard Source: Where There is no Doctor a Village Health Care Handbook
Procedure:

1. Give 1 tablet of mebendazole (100 mg) to the patient twice a day, in the morning and evening, for 3 days (total of 6 tablets).
2. For trichinosis, give 200–400 mg of mebendazole three times a day for **3...
worm treatment, mebendazole, roundworm, whipworm, hookworm, strongyloides, trichinosis, parasitic infection
Administer Mebendazole for Worm Infections (Pinworms)
Standard Source: Where There is no Doctor a Village Health Care Handbook
Procedure:

1. Give 1 tablet of mebendazole (100 mg) to the patient once.
2. If pinworms are still present after 2 weeks, repeat the dose.

Warnings:
• Do not give mebendazole to women in their first 3 months of pregnancy or...
worm treatment, mebendazole, pinworms, parasitic infection, dosage instructions
Apply Pyrethrins with Piperonyl (RID) for Lice Treatment
Standard Source: Where There is no Doctor a Village Health Care Handbook
Procedure:

1. Ensure the patient's hair is dry.
2. Apply the liquid solution containing pyrethrins and piperonyl butoxide directly to the hair until it is completely wet. Do not use on eyebrows or eyelashes.
3. Wait for 10 minutes,...
lice treatment, pyrethrins, piperonyl butoxide, RID, lice removal, nits, parasitic infection
Identify Common Intestinal Worms in Stools
Standard Source: Where There is no Doctor a Village Health Care Handbook
Procedure for Identifying Common Intestinal Worms in Stools

1. Examine stools (feces) visually: Look for visible worms or segments.
2. Recognize common types seen in stools:
- Roundworms (Ascaris): 20 to 30 cm long, pink or...
intestinal worms, stool examination, roundworms, pinworms, tapeworms
Prevent Amebic Infection Through Sanitation and Hygiene Practices
Standard Source: Where There is no Doctor a Village Health Care Handbook
Procedure:

1. Practice good sanitation by ensuring that drinking water sources are clean and free from contamination.
2. Wash hands thoroughly with soap before handling food and after using the toilet.
3. Avoid consuming food or water that may...
amebic infection prevention, sanitation, hygiene, water safety
Prevent Tapeworm Infection Through Proper Cooking of Meat
Standard Source: Where There is no Doctor a Village Health Care Handbook
Procedure:

1. Ensure that all meat, especially pork, is cooked thoroughly.
2. Check the center of roasted meat or cooked fish to make sure no parts are still raw.
3. Avoid eating undercooked pork, beef, or other meats and fish that may contain...
tapeworm, prevention, meat cooking, pork, hygiene
Treating Pinworm Infections in Children
Standard Source: Where There is no Doctor a Village Health Care Handbook
Steps to treat pinworm infections:

1. Wear tight clothing at night: Have the child wear tight diapers or pants while sleeping to prevent scratching around the anus.
2. Maintain hygiene:
- Wash the child’s hands and buttocks (anal...
pinworms, treatment, hygiene, mebendazole, piperazine, Vaseline, family treatment
Treating Whipworm Infections (Trichuris)
Standard Source: Where There is no Doctor a Village Health Care Handbook
Steps to treat whipworm infections:

1. Medication: If the worms cause symptoms such as diarrhea or rectal prolapse, administer mebendazole. For dosage instructions, refer to page 374 of the book.
2. Treating rectal prolapse:
- Turn...
whipworm, treatment, mebendazole, rectal prolapse, prevention
Prepare Sulfur in Petroleum Jelly or Lard Ointment for Scabies
Reference Source: Where There is no Doctor a Village Health Care Handbook
If other treatments are unavailable, sulfur in petroleum jelly (Vaseline) or lard can be used to treat scabies.

### Preparation:
• Mix 1 part of sulfur with 20 parts of Vaseline, mineral oil, or lard to form a 5 percent sulfur ointment.

###...
sulfur,petroleum jelly,scabies,treatment,ointment preparation

Evacuation Procedures (31)

Evacuation of Critically Injured Patients
Critical Source: NATO Emergency War Surgery
Procedure:

1. Critical Casualty Handling: The critically injured (those requiring the greatest care) will continue through the evacuation or general hospital chain.
2. Air Evacuation: These patients will be air-evacuated expeditiously...
critical injury,air evacuation,priority care,definitive care
Medical Evacuation Precedence Categories
Critical Source: TCCC 17 13 Tactical Combat Casualty Care
### Procedure: Determine Medical Evacuation Precedence Categories

Evacuation Priority Rules:
Urgent and Urgent-Surgery Cases (Priority I and IA) should be evacuated before priority or routine precedence casualties.
• **Non-Medical...
medical evacuation precedence, CASEVAC, Priority I, Priority IA, Priority II, Priority III, Priority IV
Medical Evacuation for BW Agents
Critical Source: Emergency War Surgery
Procedure:

• If plague, smallpox, and the hemorrhagic fevers can be excluded, patients may be evacuated using standard precautions and disease-specific precautions.
Plague and smallpox are internationally quarantinable...
BW agents, medical evacuation, quarantine, smallpox, plague
Perform Medical Evacuation (CASEVAC)
Critical Source: Full First Aid Manual FM 2111
Medical evacuation is the timely and efficient movement of wounded, injured, or ill service members from the battlefield to a medical treatment facility (MTF). During this process:

1. En route medical care is provided by trained medical...
medical evacuation, CASEVAC, en route care, military evacuation
Aeromedical Evacuation Process in Combat Operations
High Priority Source: NATO Emergency War Surgery
Objective: Ensure rapid and efficient evacuation of casualties from the battlefield to medical treatment facilities.

Procedure:
1. Initial Wounding Phase: At the point of initial wounding, where medical capability is limited to...
aeromedical evacuation, rotary-wing air ambulance, triage, patient removal, evacuation chain
Aeromedical Evacuation Validation and Considerations
High Priority Source: Emergency War Surgery
Procedure:

1. Patients entering the USAF AE system must be validated for evacuation by the supporting flight surgeon.
2. Consider the type of evacuation assets used, as they may affect the patient’s medical condition (e.g., flying...
aeromedical evacuation, USAF validation, pressurized cabin, medical equipment request
Contact Information for PMRC (Patient Movement Readiness Center)
High Priority Source: Emergency War Surgery
Procedure:

1. Use the following contact information to reach the PMRC:
- Commercial:
- Global-Scott AFB, IL: 1-800-303-9301 or 1-800-874-8966.
- EUCOM Theater-Ramstein Air Force Base, Germany: 011-49-6371-47-2264 or 2235.
...
PMRC,contact_info,DSN,commercial,military
Determine Evacuation Precedence Based on Medical Condition
High Priority Source: Emergency War Surgery
Procedure:

1. Assess the patient's medical condition to determine the appropriate evacuation precedence:
- Urgent: Immediate AE is required to save life, limb, or eyesight.
- Priority: Prompt medical care is not available locally;...
evacuation,precedence,urgent,priority,routine,AE,MEDEVAC
Evacuation Policy for Combat Zone Hospitals
High Priority Source: NATO Emergency War Surgery
Procedure:

1. Combat Zone Hospital Stay Limitation: Casualties in a combat zone hospital are restricted to a maximum stay of 7 days.
2. Communication Zone Hospital Stay Limitation: If evacuation is not possible within 7 days, the...
evacuation policy,combat zone hospital,communication zone facility,return-to-duty,medical holding companies
Evacuation of Burn Patients
High Priority Source: NATO Emergency War Surgery
Procedure for Evacuation of Burn Patients

1. Ensure patency of the airway throughout the evacuation process.
2. Administer continued appropriate fluid administration via a secure intravenous pathway during movement.
3. If any...
burn patient evacuation, air transport, ground transport, fluid administration, gastric decompression, documentation, surgical personnel
Evacuation of Contaminated Casualties with Combined Injuries
High Priority Source: Medical NBC Battlebook
Procedure:

1. Carefully observe contaminated casualties during evacuation to a surgical unit.
2. Continue autoinjector treatment if signs of poisoning persist or worsen during transit.
3. Be aware that evacuating contaminated patients...
contaminated casualties,evacuation,combined injuries,autoinjector treatment,poisoning
Evacuation of Injured Patients via Helicopter Ambulance
High Priority Source: NATO Emergency War Surgery
Procedure for Evacuation of Injured Patients via Helicopter Ambulance:

1. Assess the clinical status of the casualty: Determine if the patient is stable enough for evacuation.
2. Evaluate flying time and distance: Ensure that the...
helicopter evacuation, casualty transport, field aeromedical evacuation, trauma care
Initiate Evacuation Request and Coordination
High Priority Source: Emergency War Surgery
Procedure:

1. The surgeon initiates the evacuation according to established procedures.
2. Support patient administration personnel provide administrative details and coordination for the evacuation.
3. For patients evacuated from...
evacuation request, PMRC coordination, USAF assets, brigade surgeon, MTF evacuation
Report a Patient for Aeromedical Evacuation (AE)
High Priority Source: Emergency War Surgery
Procedure:

1. The originating physician consults with the local Flight Surgeon (FS) to determine the en route care plan and timing of evacuation.
2. Ensure that the patient is stable for transport, including:
- Secure airway
-...
report_patient_for_evacuation, ae_reporting, pmrc_contact, medical_stabilization
Review Medical Evacuation Policy for NBC Agents and Infectious Diseases
High Priority Source: Medical NBC Battlebook
Procedure:

1. Review the policy for medical evacuation out of the theater for casualties from NBC agents.
2. Ensure that the policy addresses both contaminated casualties and those exposed to infectious diseases.
3. Be aware that...
NBC agents,evacuation policy,infectious diseases,quarantine plans
Submit a 9-Line Request with MIST Report
High Priority Source: TCCC 17 13 Tactical Combat Casualty Care
Procedure for Submitting a 9-Line Request with MIST Report:

1. Prepare the MIST Report: Gather information on each casualty using the following categories:
- Mechanism of Injury (MOI): Describe how the injury occurred.
-...
9-line request, mist report, casualty evacuation, tccc, military medical procedures
Tactical Evacuation Care Basic Management Plan
High Priority Source: TCCC 17 13 Army Tactical Combat Casualty Care
Title: Tactical Evacuation Care Basic Management Plan

Procedure:
1. Reassess the principles of tactical field care (TFC) as needed.
2. Perform manual carries using appropriate equipment:
- Warrior Aid and Litter Kit (WALK)
-...
tactical evacuation care, manual carries, WALK kit, Sked litter
Transmit a MEDEVAC Request Using the MEDEVAC Request Format
High Priority Source: STP 21 24 Army Warrior Leader Skills Level 2 3 and 4
Procedure for Transmitting a MEDEVAC Request

1. Follow the procedure provided in the explanation column of the MEDEVAC request format to transmit other required information.
2. **Pronounce letters and numbers according to appropriate...
MEDEVAC,request format,radio procedures,brevity codes,evacuation unit
Coordinate Aeromedical Evacuation (AE) System Operations
High Priority Source: Emergency War Surgery
Procedure:

1. Establish command and control (C2) for casualty movement by air transport.
2. Ensure availability of AE personnel and equipment for inflight supportive patient care and flight line support operations.
3. Set up an...
ae_system_operations, aeromedical_evacuation, coordination, c2
Determine Patient Evacuation Precedence
High Priority Source: Emergency War Surgery
Procedure:

1. Identify the type of evacuation asset being used (e.g., Army MEDEVAC, Navy AE, Air Force AE).
2. Refer to Table 4-1 for precedence guidelines:
- Urgent: Within 2 hours (Army), ASAP (Navy/Air Force). Indication:...
evacuation_precedence, medical_evacuation, emergency_surgery, triage
Documentation During Evacuation of Burn Patients
High Priority Source: NATO Emergency War Surgery
Procedure for Maintaining Documentation During Evacuation

1. Keep a detailed record of the patient’s premovement and inflight course to ensure continuity of medical care.
2. Include in the documentation:
- Administered fluids...
documentation, medical record, continuity of care, evacuation, burn patient
Evacuation Considerations for Maxillofacial Casualties
High Priority Source: NATO Emergency War Surgery
Procedure: Prepare a maxillofacial casualty for evacuation after initial treatment.

Preparation Checklist:

1. The patient must be afebrile, without evidence of active infection, and should be comfortable, taking adequate...
maxillofacial evacuation,intermaxillary fixation,tracheostomy care,CSF leak,evacuation orders
General Considerations for Mountain Casualty Evacuations (APASSNGG)
High Priority Source: US Marine Corps Wilderness Medicine
Procedure:

Follow the APASSNGG acronym to guide casualty evacuation in a summer mountainous environment:

1. Apply Essential First Aid: Provide immediate care such as splinting fractures, applying pressure bandages, etc.

2. Protect...
mountain casualty evacuation,apassngg,first aid,protect from elements,relay points,warming stations,litter teams,gear management
Helicopter Evacuation in Contaminated Environments
High Priority Source: Medical NBC Battlebook
Procedure:

1. Be mindful of helicopter rotorwash when evacuating patients in contaminated environments.
2. Avoid landing helicopters too close to decontamination stations, especially upwind, as any trace of contaminants in the rotorwash...
helicopter evacuation,rotorwash,decontamination stations,contaminated environments
Intratheater Medical Evacuation Procedure
High Priority Source: NATO Emergency War Surgery
Intratheater medical evacuation involves moving patients between hospitals within the same theater of operations. This includes:

1. Between combat zone hospitals
2. Between communication zone hospitals
3. **From combat zone hospitals to...
intratheater medical evacuation, intertheater medical evacuation, MRO responsibilities, aeromedical evacuation, patient transport
Medical Holding Company Operations
High Priority Source: NATO Emergency War Surgery
Procedure:

1. Function of Medical Holding Companies: These facilities are designed to provide minimal self-care for casualties who no longer require daily medical attention.
2. Staffing and Equipment: They operate with austere staffing...
medical holding companies,convalescence,austere staffing,self-care
Optimize Use of Contaminated Ambulances for Evacuation
High Priority Source: Medical NBC Battlebook
Procedure:

1. Prioritize use of already contaminated ambulances (medical or nonmedical) before using uncontaminated resources to transport contaminated casualties.
2. **Use ground ambulances instead of air ambulances in contaminated...
ambulances,evacuation,decontamination,contaminated casualties,resource optimization
Prepare for Evacuation of Injured Personnel Using Aircraft
High Priority Source: Emergency War Surgery
Procedure:

• Use aircraft (fixed or rotary wing) to transport casualties from areas with inadequate medical care to MTFs where definitive treatment is available.
• Ensure that evacuation includes en route care by trained medical personnel,...
aeromedical transport, aircraft evacuation, en route care
Use of Ground and Air Vehicles in Contaminated Areas for Evacuation
High Priority Source: Medical NBC Battlebook
Procedure:

1. Determine the relative positions of contaminated areas, forward line of troops, and threat air defense systems to decide where helicopters may be used.
2. Some helicopters may be restricted to contaminated areas, depending...
ground vehicles,air vehicles,evacuation routes,dirty routes,contaminants
Historical Examples of Evacuation Successes
Standard Source: NATO Emergency War Surgery
Procedure:

1. Arab-Israeli War (1973): More than 4,000 stable casualties were evacuated approximately 150 miles from the Sinai to central Israel for definitive care. Most arrived within 24 hours of being wounded.
2. Falklands Campaign:...
historical evacuation,Arab-Israeli War,Falklands Campaign,Lebanon bombing,evacuation success
Patient Evacuation Under NBC Conditions
Standard Source: FM 3 5 NBC Decontamination
- When evacuating patients under NBC conditions, the unit commander must decide how many evacuation assets to commit to enter the contaminated area.
• If most or all of a supported force is operating in a contaminated area, most or all...
patient evacuation,nbc conditions,ambulance decon,medical assets

Infectious Disease Preparedness (31)

Administer Neuraminidase Inhibitor Therapy for High-Risk Individuals
Critical Source: HHSPandemicInfluenzaPlan
Strategy: Administer neuraminidase inhibitor therapy within 48 hours of symptom onset to high-risk individuals.

Rationale: Studies show that neuraminidase inhibitor therapy reduces complications and hospitalizations from influenza in...
neuraminidase inhibitor, early treatment, high-risk influenza, pandemic response
Administer Neuraminidase Inhibitor Therapy to Outpatients at Increased Risk of Severe Morbidity or Mortality from Influenza
Critical Source: HHSPandemicInfluenzaPlan
Strategy: Administer neuraminidase inhibitor therapy within 48 hours of symptom onset to outpatients identified as being at increased risk of severe morbidity or mortality from influenza.

Rationale: Timely treatment is essential for...
increased-risk influenza treatment, outpatient care, neuraminidase inhibitor
Assessing the Risk of a Pandemic Influenza Outbreak
Critical Source: HHSPandemicInfluenzaPlan
Assessing the Risk of a Pandemic Influenza Outbreak

The current threat exists in the form of the H5N1 virus, which is spreading widely and rapidly in domestic and migratory fowl across Asia and Europe. As of October 2005, this strain has...
H5N1 virus, bird flu, viral mutation, pandemic risk assessment
HHS Responsibilities During Pandemic Influenza Response
Critical Source: HHSPandemicInfluenzaPlan
Procedure:

1. Work with U.S. and global partners to characterize new pandemic viruses in terms of antigenicity, RNA sequence, and drug sensitivities, and monitor changes over time.
2. Work with state and local public health laboratories to...
viral characterization, diagnostic test availability, seed strain selection, vaccine development support
HHS Responsibilities in Pandemic Influenza Preparedness and Response
Critical Source: HHSPandemicInfluenzaPlan
Procedure:

1. Monitor preparedness and laboratory capacity for seasonal influenza and assess surge capacity.
2. Provide technical support to the WHO Influenza Network and ministries of health and agriculture, as requested, in analyzing novel...
HHS responsibilities, biosafety guidelines, respiratory specimen handling, pandemic alert strain diagnostics
Understanding the Pandemic Influenza Threat
Critical Source: HHSPandemicInfluenzaPlan
Understanding the Pandemic Influenza Threat

Influenza A viruses have infected many different animals including ducks, chickens, pigs, whales, horses, and seals. Influenza A viruses normally seen in one species can sometimes cross over and cause...
pandemic influenza, H5N1 virus, viral mutation, infectious disease threat, public health emergency
Assessing the Impact of Influenza Pandemics on Public Health Systems
High Priority Source: HHSPandemicInfluenzaPlan
Understanding the impact of influenza pandemics is crucial for effective preparedness.

• Annual influenza seasons in the U.S. result in approximately 36,000 deaths, 226,000 hospitalizations, and between $1 billion and $3 billion in...
influenza,pandemic,public health impact,death statistics,hospitalization rates,medical costs,1918 pandemic,1957 pandemic,1968 pandemic
Clinical and Hospital Laboratory Actions During Pandemic Period
High Priority Source: HHSPandemicInfluenzaPlan
Procedure:

1. Scale up operations to manage increased numbers of requests for influenza testing.
2. Send selected specimens from possible pandemic influenza patients to state or local health departments.
pandemic influenza testing scale-up, specimen submission to health departments
Comparing Pandemic Spread Rates Across Eras
High Priority Source: HHSPandemicInfluenzaPlan
Historical data show how pandemic influenza spread rates have changed over time due to modern travel and globalization.

• The 1957 pandemic took 4-5 months to reach the U.S. after being detected in China.
• The 1968 pandemic reached...
pandemic spread rates,1957 pandemic,1968 pandemic,SARS outbreak,modern travel impact
Goals of Diagnostic Testing During Pandemic Influenza
High Priority Source: HHSPandemicInfluenzaPlan
Procedure:

The goals of diagnostic testing during a pandemic are:

1. Identify the earliest U.S. cases of pandemic influenza (whether the pandemic begins in the United States or elsewhere).
2. Support disease surveillance to monitor the...
diagnostic testing goals, RT-PCR, rapid antigen tests, antiviral resistance monitoring
Identify Outpatients at Increased Risk of Severe Morbidity or Mortality from Influenza
High Priority Source: HHSPandemicInfluenzaPlan
Definition: This group includes:

Children aged 6-23 months and adults over 65 years old.
• Individuals with underlying illnesses defined by the ACIP as associated with increased risk of complications from influenza (e.g., chronic...
increased-risk influenza, outpatient care, ACIP guidelines
Prepare Clinical and Hospital Laboratories for Influenza Pandemic
High Priority Source: HHSPandemicInfluenzaPlan
Procedure:

1. Collaborate with state and local health departments to address laboratory surge capacity issues.
2. Train personnel in the management of respiratory specimens during an influenza pandemic.
3. Send clearly labeled specimens from...
laboratory surge capacity, respiratory specimen management, ILI surveillance, novel influenza virus, pandemic preparedness
State and Local Public Health Laboratory Actions During Pandemic Period
High Priority Source: HHSPandemicInfluenzaPlan
Procedure:

1. Scale up operations to manage increased numbers of requests for influenza testing.
2. Work with federal partners to provide healthcare providers and clinical laboratories with guidelines on all aspects of specimen management and...
specimen management guidelines, pandemic virus monitoring, vaccine development studies
State and Local Public Health Laboratory Responsibilities During Pandemic Influenza
High Priority Source: HHSPandemicInfluenzaPlan
Procedure:

1. Work with federal partners to enhance laboratory-based monitoring of seasonal influenza virus subtypes (see Supplement 1).
2. Conduct testing for novel subtypes of influenza viruses only if BSL-3 biocontainment conditions with...
BSL-3 biocontainment, ILI surveillance, seasonal influenza monitoring, pandemic preparedness
Understanding H5N1 Avian Influenza Threats
High Priority Source: HHSPandemicInfluenzaPlan
Overview: The H5N1 avian influenza virus poses a significant pandemic threat due to its widespread presence, increasing deadliness, and potential for human infection. Here are key factors contributing to the risk:

Widespread Presence: The...
H5N1, avian influenza, pandemic threat, WHO phases, H9N2, H7N7, H7N3, surveillance, vaccine development
Understanding Modern Trends That Increase Pandemic Risk
High Priority Source: HHSPandemicInfluenzaPlan
Modern trends increase the potential for pandemics to cause more severe illness and death than in previous centuries.

Global population growth and urbanization: Larger populations living in densely populated areas allow viruses to spread...
globalization,population trends,international travel,aging population,chronic disease,pandemic risk
Conduct Serological Studies for Cross-Species Transmission
High Priority Source: HHSPandemicInfluenzaPlan
Objective: Assess cross-species transmission and subsequent human-to-human transmission.

Procedure:
1. Identify individuals in close contact with animal reservoirs of influenza viruses.
2. Collect blood samples from these individuals to...
serology, cross-species transmission, human-to-human transmission, animal reservoirs, influenza
Define Immunological Markers for Pandemic Protection
High Priority Source: HHSPandemicInfluenzaPlan
Objective: Identify immunological markers that correlate with protection against influenza in high-risk populations.

Procedure:
1. Focus on populations at highest risk, such as the elderly, immunocompromised individuals, and those with...
immunological markers, protection indicators, high-risk populations, pandemic immunity, vaccine efficacy
Define Serologic Correlates of Immunity for Influenza
High Priority Source: HHSPandemicInfluenzaPlan
Objective: Identify immune markers that correlate with protection against influenza.

Procedure:
1. Collect blood samples from individuals who have been vaccinated or infected with influenza.
2. Analyze these samples to identify immune...
serologic correlates, immune markers, influenza immunity, vaccination response, protection indicators
Determine Population Effects of Vaccines on Pandemics
High Priority Source: HHSPandemicInfluenzaPlan
Objective: Study the impact of vaccination programs during annual influenza epidemics and future pandemics.

Procedure:
1. Collect data from populations that have received seasonal flu vaccines.
2. Analyze how these vaccines affect the...
vaccine impact, population effects, pandemic modeling, cost savings, vaccination programs
Develop Analytical and Computational Models for Pandemic Response
High Priority Source: HHSPandemicInfluenzaPlan
Objective: Create models to predict the impact of interventions on pandemic spread and resource allocation.

Procedure:
1. Identify key variables that influence the spread of influenza (e.g., transmission rates, vaccination coverage,...
computational modeling, pandemic response, resource allocation, intervention strategies, influenza spread
Develop Immune Modeling Centers for Pandemic Response
High Priority Source: HHSPandemicInfluenzaPlan
Objective: Create centers that simulate human immune responses to adjuvants and immune modulators.

Procedure:
1. Establish specialized research facilities focused on modeling the human innate immune response.
2. Use advanced computational...
immune modeling centers, adjuvant testing, immune modulators, pandemic simulations, innate immunity
Develop Serological Assays for Immune Response Assessment
High Priority Source: HHSPandemicInfluenzaPlan
Objective: Create assays to assess immune responses and identify mechanisms behind strong or weak responses to influenza vaccines.

Procedure:
1. Identify key immune markers that can be measured using serological methods (e.g., antibody...
serological assays, immune response assessment, vaccine efficacy, pandemic diagnostics, assay development
Establish a Database of Influenza Subtypes and Sequences
High Priority Source: HHSPandemicInfluenzaPlan
Objective: Create a centralized database for tracking influenza subtypes and related data.

Procedure:
1. Collect genetic sequences from various influenza strains, including pandemic and seasonal variants.
2. Record clinical information...
influenza subtypes, genetic sequencing, clinical data, geographic tracking, pandemic database
Evaluate Antiviral Drugs and Social Distancing in Influenza Outbreaks
High Priority Source: HHSPandemicInfluenzaPlan
Objective: Assess the effectiveness of antiviral drugs and social distancing measures during influenza outbreaks.

Procedure:
1. Monitor the use of antiviral medications (e.g., oseltamivir, zanamivir) in treating patients with seasonal or...
antiviral drugs, social distancing, drug resistance, outbreak management, influenza transmission
Evaluate Immunotherapies for Novel Influenza Viruses
High Priority Source: HHSPandemicInfluenzaPlan
Objective: Assess the effectiveness of established and new immunotherapies in treating infections caused by novel influenza viruses.

Procedure:
1. Identify existing immunotherapies that may be effective against novel influenza strains...
immunotherapies, novel influenza viruses, monoclonal antibodies, convalescent plasma, pandemic treatment
Evaluate New Adjuvants for Pandemic Influenza Vaccines
High Priority Source: HHSPandemicInfluenzaPlan
Objective: Test the effectiveness of new adjuvants in improving vaccine immunogenicity.

Procedure:
1. Identify potential new adjuvants that may enhance immune responses to influenza vaccines.
2. Conduct preclinical studies using cell...
new adjuvants, vaccine immunogenicity, clinical trials, pandemic preparedness, adjuvant testing
Examine Influenza Transmission in Healthcare Settings
High Priority Source: HHSPandemicInfluenzaPlan
Objective: Study how influenza spreads within healthcare facilities and evaluate protective measures.

Procedure:
1. Monitor outbreaks of influenza in hospitals, clinics, and long-term care facilities.
2. Evaluate the effectiveness of...
healthcare transmission, PPE effectiveness, vaccination of healthcare workers, infection control, influenza outbreaks
Optimize Immunological Assays for Pandemic Response
High Priority Source: HHSPandemicInfluenzaPlan
Objective: Improve the accuracy and reliability of assays used to measure immune responses to influenza vaccines.

Procedure:
1. Identify current limitations in existing immunological assays (e.g., variability, cost, time required).
2....
immunological assays, vaccine testing, immune markers, assay optimization, pandemic diagnostics
Study Immune Responses in Special Populations for Pandemic Vaccines
High Priority Source: HHSPandemicInfluenzaPlan
Objective: Understand how special populations respond to influenza vaccines and identify factors that may lead to vaccine failure.

Procedure:
1. Identify special populations such as the elderly, immunocompromised individuals, pregnant...
special populations, vaccine response, immune parameters, high-risk groups, pandemic preparedness
Stay Informed About Infectious Disease Outbreaks
Standard Source: Sweden In Case of Crisis or War
If an infectious disease has begun to spread:

1. Stay up to date on information from your municipality, regional infectious disease specialist, and government agencies.
2. Help reduce the spread of the disease by following recommendations...
infectious disease,outbreak,preparedness,municipality,government agencies

Nuclear Cbrn (31)

Minimize Radiation Exposure in Fallout Areas
Critical Source: Planning Guidance Nuclear Detonation FEMA
Procedure:

External radiation exposure is a significant health concern in fallout areas.
High radiation doses can cause acute health effects, including death, and increase the risk of cancer over time.
Minimizing dose levels...
radiation exposure, fallout areas, decontamination, beta burns, sheltering from radiation
Plan for Acute Medical Care in the Aftermath of a Nuclear Detonation
Critical Source: Planning Guidance for Response to Nuclear Detonation May 2022 FEMA
Procedure:

1. Anticipate overwhelming numbers of casualties following a nuclear detonation.
2. Prepare medical systems to handle large-scale emergencies, including:
- Immediate lifesaving care for tens or hundreds of thousands of...
nuclear detonation,acute care,medical response,casualty management,nuclear emergency
Understanding Nuclear Weapon Yield and Casualty Impact
Critical Source: NATO Emergency War Surgery
Understanding the energy yield of nuclear weapons is critical for assessing potential casualties and medical response requirements.

1. Nuclear weapon yields are measured in kilotons or megatons of TNT equivalent:
- A 20-kiloton weapon...
nuclear weapon,yield,casualty impact,thermal radiation,blast radiation,ionizing radiation
Conduct Rescue in Fallout Contaminated Areas
Critical Source: Medical NBC Battlebook
Procedure:

1. Be prepared to conduct rescue efforts in the presence of fallout contamination or with the possibility of future fallout.
2. Ensure radiation monitors are available to evaluate radiation dose rates and verify stay times.
3. Have...
fallout contamination, radiation monitoring, rescue squads, radiological hazards, safety stay times
Decontamination After Radiation Exposure
Critical Source: FEMA Are You Ready
If you believe you have been exposed to nuclear radiation:

Change clothes and shoes immediately.
• Place contaminated clothing in a plastic bag, seal it, and store it out of the way.
Take a thorough shower to remove any radioactive...
radiation exposure,decontamination,plastic bag,shower,washing food
Establish and Operate Medical Centers (MCs) During a Nuclear Detonation
Critical Source: Planning Guidance Nuclear Detonation FEMA
Objective: Set up and manage medical centers (MCs) to triage, stabilize, and provide initial care before transferring patients.

Procedure Steps:
1. Location Selection: Position MCs in the surrounding local area, upwind of the initial...
Medical Centers, Triage, Stabilization, Radiation Injury, Gross Decontamination, Myeloid Cytokines
Implement Collective Protection for Medical Units in NBC Conditions
Critical Source: Medical NBC Battlebook
Procedure:

1. Use collective protection to medically manage severely toxic or injured decontaminated casualties without requiring medical personnel to wear individual protective equipment.
2. Ensure that the medical unit can make full use...
collective protection, medical units, vapor hazard, contaminated environment
Implement General Operational Guidance in NBC Conditions
Critical Source: Medical NBC Battlebook
Procedure:

1. Follow the US Army’s general operational guidance for operations in an NBC environment: See, Shield, Shape, Move, and Strike.
2. Refer to the latest draft of FM 100-5 for detailed information on this guidance.
3. Use the...
NBC conditions, operational guidance, US Army, FM 100-5, Health Service Support
Implement Medical Triage Procedures for NBC Casualties
Critical Source: Medical NBC Battlebook
Procedure:

1. Review and update mass casualty procedures in medical treatment facilities to account for the special implications of NBC weapons.
2. Consider the total radiation dose from a nuclear blast when determining triage categories...
medical triage, NBC casualties, combined injuries, radiation dose
Operate Assembly Centers (ACs) During a Nuclear Detonation
Critical Source: Planning Guidance Nuclear Detonation FEMA
Objective: Provide initial screening, decontamination, and basic medical care at assembly centers (ACs).

Procedure Steps:
1. Location Selection: Establish ACs at predetermined sites or allow spontaneous formation in areas affected by...
Assembly Centers, Gross Decontamination, Radiation Assessment, Myeloid Cytokines
Operate Evacuation Centers (ECs) During a Nuclear Detonation
Critical Source: Planning Guidance Nuclear Detonation FEMA
Objective: Transition patients from initial care sites to evacuation centers for further treatment and transport.

Procedure Steps:
1. Location Selection: Establish ECs in areas that can accommodate the movement of stabilized patients...
Evacuation Centers, Decontamination, Patient Transport, Myeloid Cytokines
Operate Expert Centers for Severe Radiation and Burn Injuries
Critical Source: Planning Guidance Nuclear Detonation FEMA
Objective: Provide specialized care to patients with severe radiation or thermal injuries.

Procedure Steps:
1. Location Selection: Establish expert centers (ECs) in facilities equipped to handle complex cases, including burn centers and...
Expert Centers, Radiation Injury, Burn Care, ARS Management, Telemedicine
Plan Medical Unit Operations for Nuclear Battlefield Conditions
Critical Source: Medical NBC Battlebook
Procedure:

1. Align with Supported Forces:
- Plan and operate medical units based on the nature and functions of the forces they support.

2. Account for Unique Nuclear Battlefield Challenges:
- Prepare to handle significantly...
medical unit mobility,nuclear battlefield,fallout operations,evacuation planning
Plan for Medical Unit Replacement in Nuclear Scenarios
Critical Source: Medical NBC Battlebook
Procedure:

1. Assess Risk to Medical Units:
- Recognize that entire medical units, including large hospitals, may be lost or rendered non-functional due to large-scale personnel and equipment losses from nuclear attacks.

2. **Disperse...
medical unit replacement,nuclear attack,hospital dispersal,contingency planning
Prepare Medical Assets for NBC Threat Conditions
Critical Source: Medical NBC Battlebook
Procedure:

1. Apply NBC protection, detection, and decontamination procedures to maximize and sustain unit capabilities.
2. Plan for medical support that can regenerate or reconstitute supported units severely debilitated by NBC attacks.
3....
NBC threat, medical assets, hospital dispersion, whole unit replacement
Assessing Biological Effects of Thermal Radiation from a Nuclear Detonation
High Priority Source: Medical NBC Battlebook
Overview: Thermal radiation causes burns in two ways: flash burns (direct absorption) and flame burns (indirect action of fires).

Flash Burns:
• Thermal radiation travels outward in a straight line, so intensity decreases rapidly...
thermal radiation, flash burns, flame burns, clothing protection, firestorms
Assessing Eye Injuries from a Nuclear Detonation
High Priority Source: Medical NBC Battlebook
Overview: The initial thermal pulse can cause flash blindness and retinal scarring.

Flash Blindness:
• Caused by the brilliant flash of light from the detonation, which swamps the retina and bleaches out visual pigments, producing...
eye injury, flash blindness, retinal scarring, safe separation distance, nuclear detonation
Assessing Medical Effects from a Nuclear Detonation
High Priority Source: Medical NBC Battlebook
Overview: The physiological effects of nuclear weapons result from blast, thermal radiation, ionizing radiation (initial or residual), or a combination.

Key Considerations:
• For weapons less than 10 KT, ionizing radiation is the...
nuclear detonation, medical effects, blast injuries, thermal radiation, ionizing radiation
Casualty and Damage Assessment in Nuclear Warfare
High Priority Source: Medical NBC Battlebook
Objective: Accurately estimate casualties and damage to ensure adequate medical support.

Steps:
1. Use Casualty Prediction Systems:
- Utilize casualty prediction systems such as NATO AMedP-8 (Draft) for estimating nuclear detonation...
casualty assessment, damage estimation, nuclear war, radiation exposure
Coordinate Rescue and Damage Control with Medical Operations
High Priority Source: Medical NBC Battlebook
Procedure:

1. Recognize that rescue operations, damage control, and medical operations are complementary and must be closely coordinated.
2. Ensure that medical unit personnel remain focused on primary patient care duties and are not used for...
rescue operations, damage control, coordination, medical personnel, basic first aid
Establish Medical Liaison for Nuclear Response Planning
High Priority Source: Medical NBC Battlebook
Procedure:

1. Establish close liaison with the following units:
- G3 (Operations)
- G4 (Supply and Logistics)
- Chemical Officer
- G6 (Communications)
- Unit Surgeons
2. Gather information on:
- Unit size, location, and...
liaison, nuclear response planning, medical coordination, G3, G4, Chemical Officer, G6, Surgeons
Establish Medical Readiness Policies for NBC Threats
High Priority Source: Medical NBC Battlebook
Procedure:

1. Implement policies on chemoprophylaxis, pre-treatment, and vaccines based on the specific NBC threat in each area of operations.
2. Ensure these policies are disseminated to all medical units operating in the affected areas.
medical readiness, chemoprophylaxis, vaccines, NBC threat
Implement Surgical Protection for Contaminated Wounds
High Priority Source: Medical NBC Battlebook
Procedure:

1. Use butyl rubber gloves when performing surgery on contaminated wounds to minimize danger to medical and nursing staff.
2. If butyl rubber gloves are unavailable, use two pairs of latex rubber gloves, washed frequently in...
surgical protection, contaminated wounds, butyl rubber gloves, hypochlorite solution
Medical Planning for Nuclear War - Staff-Level Activities
High Priority Source: Medical NBC Battlebook
Objective: Prepare medical resources and procedures prior to nuclear war to minimize casualties and ensure effective medical operations.

Steps:
1. Organize the Medical Support System:
- Determine the organizational structure that...
nuclear war, medical planning, staff-level activities, casualty management, logistics
Plan for Evacuation of Large Numbers of Casualties
High Priority Source: Medical NBC Battlebook
Procedure:

1. Prepare for the possibility of evacuating a large number of casualties from theater due to nuclear weapon use.
2. Ensure that evacuation plans are integrated into regular operational planning.
3. Coordinate with all medical and...
casualty evacuation, theater operations, medical logistics, coordination
Understanding Blast Injuries from a Nuclear Detonation
High Priority Source: Medical NBC Battlebook
Overview: Two types of blast forces occur in a nuclear detonation: direct blast wave overpressure and indirect blast wind drag.

Direct Blast Injury:
• The human body is resistant to static overpressure, but sublethal pressures can...
blast injury, nuclear detonation, overpressure, wind drag, flying objects
Establish Minimal Treatment Facilities for Casualties
High Priority Source: Medical NBC Battlebook
Procedure:

1. All hospitals should be prepared to establish and operate a continuous minimal treatment facility as part of the regular operational plan.
2. This facility is intended to house patients who cannot return to duty but do not require...
minimal treatment facility, casualty management, self-care, hospital operations
Establish Mutual Medical Support Plans with Allied Forces
High Priority Source: Medical NBC Battlebook
Procedure:

1. Establish mutual medical support plans between allied forces operating in adjacent sectors.
2. Ensure these plans are simple, easily implemented, and periodically reviewed and revised to align with changes in troop levels and...
allied forces, mutual medical support, NATO STANAGs, ACE Directive 80-64
Post-Emergency Actions After a Nuclear Power Plant Incident
High Priority Source: FEMA Are You Ready
After a nuclear power plant emergency:

Seek medical treatment for any unusual symptoms such as nausea that may be related to radiation exposure.
• Follow the instructions provided in Part 5 of this guide for recovering from a disaster.
post-emergency,medical treatment,radiation symptoms,disaster recovery
Protect Supplies from NBC Contamination
High Priority Source: Medical NBC Battlebook
Procedure:

1. Keep equipment and supplies in unopened, sealed, or covered containers until required for use in the presence of an NBC threat.
2. Use chemical agent resistant material to protect against liquid contamination.
3. Even...
NBC contamination, supply protection, chemical resistant material, sealed containers
Use NATO Casualty Prediction Guidelines for NBC Weapons
High Priority Source: Medical NBC Battlebook
Procedure:

1. Use NATO publication AMedP-8 to determine casualty predictions for various NBC weapons in tactical situations.
2. Apply the data from this publication during planning and training exercises to prepare for potential casualties.
NATO, casualty prediction, NBC weapons, AMedP-8

First Aid (30)

Perform First Aid for Nerve-Agent Injuries Based on Skin Exposure or Symptoms
Critical Source: STP 21 24 Army Warrior Leader Skills Level 2 3 and 4
### Procedure: Perform First Aid for Nerve-Agent Injuries Based on Skin Exposure or Symptoms

Steps:
1. If the Soldier's skin is exposed or nerve-agent symptoms are observed, perform first aid for nerve-agent injuries.
2. Administer appropriate...
nerve-agent first aid,atropine,pralidoxime chloride,CBRN medical response
Check Soldiers Sleeping in MOPP4 for Breathing and Consciousness
Critical Source: STP 21 24 Army Warrior Leader Skills Level 2 3 and 4
### Procedure: Check Soldiers Sleeping in MOPP4 for Breathing and Consciousness

Steps:
1. Observe the Soldiers to ensure that they are breathing.
2. Try to wake the Soldiers if they do not appear to be breathing.
3. Perform the task **Evaluate...
MOPP4,breathing check,consciousness evaluation,casualty evaluation
Check Soldiers' Masks for Broken Seals and Take Corrective Actions
Critical Source: STP 21 24 Army Warrior Leader Skills Level 2 3 and 4
### Procedure: Check Soldiers' Masks for Broken Seals and Take Corrective Actions

Steps:
1. Wake the Soldiers and have them reseal their masks if the seal appears to be broken.
2. Direct a Soldier to observe another Soldier for symptoms of...
mask seal check,nerve-agent poisoning,first aid,CBRN protection
Intraosseous Access with the Sternal EZ-IO Needle Set
Critical Source: TCCC 17 13 Army Tactical Combat Casualty Care
Procedure for Intraosseous (IO) Access Using the Sternal EZ-IO Needle Set

### Overview
The Sternal EZ-IO needle set is used to obtain IO vascular access in adults when standard IV access is not readily available and rapid fluid...
intraosseous access, sternal ez-io needle set, emergency vascular access, tccc, military medical procedures, first aid, trauma care
Provide Tactical Combat Casualty Care (TCCC) by Combat Medics
Critical Source: TCCC 17 13 Army Tactical Combat Casualty Care
Objective: Provide immediate tactical combat casualty care to operational casualties.

Procedure:
1. Combat Medic Role: Combat medics are trained and equipped to provide TCCC for operational casualties in the field.
2. **Advanced Trauma...
TCCC,combat medic,trauma management,immediate care
Triage and Treatment of Injuries in Nuclear Detonation Scenario
Critical Source: Planning Guidance for Response to Nuclear Detonation May 2022 FEMA
Title: Triage and Treatment of Injuries in Nuclear Detonation Scenario

Procedure:
1. Establish a triage station at the firehouse or other safe location to assess and categorize injured individuals.
2. **Prioritize care based on injury...
triage station,injury treatment,nuclear detonation,radiation safety,EOC coordination,first aid resources
Avoid Contamination During Venipuncture Procedure
High Priority Source: STP 21 1 Warrior Skills Level 1
Steps:

1. Do not touch the exposed needle or catheter.

_Note: This step is critical to prevent contamination and ensure a safe procedure for both the casualty and the provider.
contamination prevention, IV insertion, first aid
Combat Medic and Advanced Trauma Management Roles
High Priority Source: TCCC 17 13 Tactical Combat Casualty Care
Combat medics are responsible for:

1. Providing Tactical Combat Casualty Care (TCCC) to operational casualties.
2. Physicians and physician assistants assigned to units are trained and equipped to provide advanced trauma management.
3....
combat medic, advanced trauma, TCCC protocol
Establish a Saline Lock for Intravenous Access
High Priority Source: STP 21 1 Army Warrior Skills Level 1 Soldiers Manual of Common Tasks
Conditions: A casualty is in hypovolemic shock from a severe loss of blood or a medic or medical professional requests that you establish a saline lock. Bleeding has been controlled. Supplies not carried by you will be provided by medical...
saline lock, IV access, hypovolemic shock, medical procedure, first aid, combat lifesaver
Familiarize with TCCC Medical Equipment
High Priority Source: TCCC 17 13 Army Tactical Combat Casualty Care
Objective: Ensure all personnel are familiar with the Improved First Aid Kit (IFAK)/Joint First Aid Kit (JFAK) and other commonly used rescue equipment.

Procedure:
1. Understand IFAK/JFAK: All Service members must be trained in the use...
IFAK, JFAK, TCCC, first aid kit, medical equipment, combat casualty care
Perform Venipuncture for IV Insertion
High Priority Source: STP 21 1 Army Warrior Skills Level 1 Soldiers Manual of Common Tasks
Procedure:

Note: Cleanliness is the main reason for wearing gloves when you initiate an IV. You and your casualty may be smeared with dirt, sand, mud, or blood. The gloves will reduce the chance of various possible infections resulting from...
venipuncture, IV insertion, medical emergency, first aid, gloves, infection prevention, bloodborne diseases, catheter, needle, saline lock, Tegaderm dressing
Prepare IV Infusion Site for Casualty
High Priority Source: STP 21 1 Warrior Skills Level 1
Steps:

1. Ask the casualty (if conscious) to clench and relax his/her fist several times, and then keep the fist clenched. If the casualty is unconscious, place the limb below the level of the heart.

2. **Feel the vein with your fingertips...
IV infusion, preparing site, first aid, medical emergency
Provide Medical Treatment for Casualties and Routine Sick Call Care
High Priority Source: TCCC 17 13 Army Tactical Combat Casualty Care
Objective: Provide medical treatment to recover, resuscitate, stabilize, and prepare casualties for evacuation, as well as provide routine sick call care.

Procedure:
1. Resuscitation and Stabilization: Administer necessary measures to...
sick call,medical treatment,TCCC,ADTMC guide,casualty stabilization
Referring to Acute Medical Care Guidelines for Nuclear Detonation Response
High Priority Source: Planning Guidance Nuclear Detonation FEMA
Objective: Direct responders to appropriate medical care resources and procedures.

Steps:
1. Identify Casualty Types: Categorize casualties based on injury severity (e.g., non-life-threatening, life-threatening) using triage...
triage protocols,acute medical care,nuclear detonation,response guidelines,ESF coordination
Sewing a Tear or Episiotomy
High Priority Source: A Book for Midwives
Procedure for Sewing a Tear or Episiotomy

General Rules:
• Only trained midwives should perform this procedure.
• Use sterile tools and materials to prevent infection.
• Ensure the patient is in a comfortable position, typically on her back...
sewing tear, episiotomy, stitching, perineal repair, midwifery procedure
Understand IFAK Generation II Contents
High Priority Source: TCCC 17 13 Army Tactical Combat Casualty Care
Objective: Ensure all personnel understand the contents of the IFAK Generation II.

Procedure:
1. Review Kit Contents: The IFAK Generation II contains the following items:
- U.S. Army IFAK
- Combat Application Tourniquet (2)
-...
IFAK Generation II, first aid kit contents, combat casualty care, medical equipment
Understand and Use the Improved First Aid Kit (IFAK)/Joint First Aid Kit (JFAK)
High Priority Source: TCCC 17 13 Tactical Combat Casualty Care
Overview: All Service members must be familiar with the contents and use of the IFAK and JFAK for self-aid and buddy aid. These kits are essential in tactical environments.

Key Points:
1. The IFAK Generation I is issued to every Service...
IFAK, JFAK, first aid kit, tourniquet, chest seal, eye shield, medical equipment, combat casualty care
Wear Gloves for IV Insertion to Prevent Infection
High Priority Source: STP 21 1 Warrior Skills Level 1
Steps:

1. Put on your gloves.

_Note: Cleanliness is the main reason for wearing gloves when you initiate an IV. In battle; you and your casualty may be smeared with dirt, sand, mud, or blood. The gloves will reduce the chance of...
gloves, IV insertion, infection prevention, first aid
Develop Supplemental Lists of Hospitals and Medical Facilities for Contaminated Individuals
High Priority Source: FEMA REP Program Manual Dec 2019
Procedure:

1. Create a supplemental list that includes the location of public, private, and military hospitals within the state or contiguous states.
2. Ensure each entry on the list indicates whether the facility is capable of providing...
supplemental medical facility list, contaminated individual support
Establish Onsite First Aid Capability with Medical Equipment and Supplies
High Priority Source: FEMA REP Program Manual Dec 2019
Procedure:

1. Ensure the onsite location has a fully equipped first aid station.
2. Stock the first aid station with medical equipment and supplies as specified in the Emergency Medical Services Systems Act of 1973, including but not...
first aid, medical supplies, onsite medical capability
Identify and Maintain Primary and Backup Offsite Medical Facilities
High Priority Source: FEMA REP Program Manual Dec 2019
Procedure:

1. Identify primary and backup offsite medical facilities that can provide care for contaminated or injured individuals.
2. Ensure these facilities are located within the state or contiguous states, as required by **FEMA REP Program...
offsite medical facilities, backup medical support
Medical Treatment and Sick Call Procedures
High Priority Source: TCCC 17 13 Tactical Combat Casualty Care
Medical treatment includes the following:

1. Provide measures to recover, resuscitate, stabilize, and prepare casualties for evacuation.
2. Include routine sick call care for minor illnesses or injuries.
3. For units without Level I and Level...
sick call, medical treatment, ADTMC guide, minor injury care
Normal Vital Signs for People at Rest
Standard Source: First Aid in Armed Conflicts
The following are normal values for people at rest:

| Category | Adult (over 12 years) | Child (6 to 12 years) | Baby (1 to 5 years) | Newborn (less than 1 year)...
vital signs, normal pulse, blood pressure, respiratory rate, fever effects
Treating Pain with Anesthetics for Wound Closure
Standard Source: Where There is no Doctor a Village Health Care Handbook
Procedure:

1. Apply Lidocaine (Lignocaine, Xylocaine):
- Apply lidocaine cream or gel to the skin around the wound as directed by the manufacturer.
- Wait 5-10 minutes before cleaning or closing the wound for numbing effect.
lidocaine,wound closure,numbing cream
Assemble and Use a Casualty Bag
Standard Source: Canadian Military Basic Cold Weather Training
Procedure:

1. Understand the Purpose: A casualty bag is used to carry medical supplies and equipment during cold weather operations for treating injured personnel.

2. Contents of the Casualty Bag:
- First aid kit (bandages,...
casualty bag, first aid kit, cold weather medical supplies, emergency equipment, military medical procedures
Gargling with Salt and Soda Water Solution for Sore Throat
Standard Source: Flu Home Treatment
Procedure:

1. Add 1 tsp of salt and ¼ tsp of baking soda to a cup of hot but not scalding water.
2. Gargle with the solution as needed for relief from sore throat.

Notes:
• This is an effective home remedy for sore throat.
• Ensure...
gargling,salt,baking soda,sore throat,home remedy
Proper Use and Protection of Distinctive Emblems in Armed Conflicts
Standard Source: First Aid in Armed Conflicts
The distinctive emblem is a visible sign of protection conferred by international humanitarian law on certain persons, objects, and areas during armed conflicts. It must be used for:

• Medical and religious personnel (both military and civilian)
-...
distinctive emblem, protection, international humanitarian law, misuse reporting, red cross, red crescent
Use Home Remedies with Caution
Standard Source: Where There is no Doctor a Village Health Care Handbook
Do no harm. Only use home remedies if you are sure they are safe and know exactly how to use them.

• Many home remedies have great value but others may be risky or harmful.
• Use caution when applying any remedy, whether traditional or...
home remedies, caution, safety, first aid
Using Charcoal for Medical Purposes
Standard Source: Survival and Austere Medicine
Overview: Standard charcoal can be used in the treatment of diarrhoea and other gastrointestinal issues, though it is not as effective as activated charcoal in poisoning cases.

Procedure:
1. Use standard charcoal (not activated) to treat...
charcoal use, diarrhoea treatment, standard charcoal, activated charcoal, medical uses
Understanding and Using the Third Protocol Emblem (Red Crystal)
Reference Source: First Aid in Armed Conflicts
On 8 December 2005, a Diplomatic Conference adopted Protocol III additional to the Geneva Conventions, which recognizes an additional distinctive emblem: the red crystal.

• The red crystal is composed of a **red frame in the shape of a...
third protocol emblem, red crystal, geneva conventions, international humanitarian law

Infectious Disease Prevention (29)

Administer ART Medicines for Mother and Baby (Option 1)
High Priority Source: A Book for Midwives
Action: If the mother is not taking ART for her own health, she and her baby should take the medicines listed in Option 1 to prevent HIV from passing to the baby.

Details for the Mother During Pregnancy:
• Starting as soon as possible from...
ART, HIV prevention, mother-to-child transmission, baby medication, pregnancy, AZT, NVP, 3TC
Continue ART for Pregnant Women and Administer Baby Medication
High Priority Source: A Book for Midwives
Action: A woman who is already on ART when she becomes pregnant should continue taking it. When her baby is born, the baby will also need to be given medicine for a few weeks.

Details:
• Even if a woman with HIV is not taking ART for her...
ART, HIV prevention, mother-to-child transmission, baby medication, pregnancy
Heating Breastmilk to Prevent HIV Transmission
High Priority Source: A Book for Midwives
Procedure:

1. Place a jar of breast milk in a pot of water.
2. Bring the water to a boil.
3. Immediately remove the pot from the heat.
4. Let the milk cool before feeding it to the baby with a cup or bottle.

Important Notes:
• Breast milk...
breastmilk, heating, HIV prevention, infant feeding, infection control
Individual Protection During Pandemics
High Priority Source: LDS Preparedness Manual
Procedure:

1. Treat All External Contact as Potentially Infected: Any individual who must interact with the outside world during a pandemic (e.g., influenza) should treat all contact as potentially infectious.
2. Education and Training:...
individual protection,pandemic,protective equipment,education training
Protect Children from Tuberculosis (TB)
High Priority Source: Where There is no Doctor a Village Health Care Handbook
Purpose: To prevent the spread of tuberculosis among children.

Procedure:
1. People with long-term coughing or other signs of TB should cover their mouths when coughing.
2. They should never sleep in the same room as children.
3. They...
tuberculosis prevention, TB vaccination, child protection
Provide Post-Exposure Antiviral Prophylaxis to Close Contacts
High Priority Source: HHSPandemicInfluenzaPlan
Procedure:

1. Identify close contacts of a confirmed or suspected case of avian influenza A (H5N1) or novel strain.
2. Determine if post-exposure antiviral prophylaxis is necessary and feasible, in consultation with CDC.
3. Administer...
post-exposure prophylaxis, close contacts, oseltamivir, zanamivir, seasonal influenza vaccination
Assessing Travel Risk for Avian Influenza Exposure
High Priority Source: HHSPandemicInfluenzaPlan
Procedure:

1. Determine if a person has recently visited or lived in an area affected by highly pathogenic avian influenza A outbreaks in domestic poultry or where a human case of novel influenza has been confirmed.
2. Check if the person had...
avian influenza, travel risk, poultry contact, close contact, OIE, WHO, CDC
Avian Influenza (Bird Flu) Overview and Prevention
High Priority Source: LDS Preparedness Manual
Procedure:

1. Understand Avian Influenza (H5N1): Learn about avian influenza, particularly the H5N1 strain that has infected birds in Asia and some humans.
2. Access Educational Resources: Refer to information from reputable sources...
avian influenza,H5N1,bird flu,prevention,WHO guidelines
Consider Timing of ART Medicines During Pregnancy
High Priority Source: A Book for Midwives
Action: The effects of ART medicines on developing babies during the first 3 months of pregnancy are not well known.

Important Notes:
• Unless the woman is already taking ART medicines for her HIV, it may be better to start giving them...
ART, pregnancy, first trimester, HIV prevention, breastfeeding
Ensure Prompt Treatment for Infectious Diseases in Children
High Priority Source: Where There is no Doctor a Village Health Care Handbook
Purpose: To prevent the spread of infectious diseases and ensure timely recovery.

Procedure:
1. Treat children who have infectious diseases as soon as possible.
2. Follow all guidelines of cleanliness mentioned in this chapter.
3. Teach...
child treatment, infectious disease management, hygiene education
Evaluating Exposure to Other Avian Influenza A Viruses
High Priority Source: HHSPandemicInfluenzaPlan
Procedure:

1. The epidemiologic criteria for novel influenza are based on recent human cases of avian influenza A (H5N1), but they apply to any novel influenza A virus strain, including other avian influenza viruses.
2. Other avian influenza A...
avian influenza H7N7, H7N3, H9N2, H7N2, human disease, epidemiologic link
Evaluating Travelers for Novel Influenza Infection During Interpandemic and Pandemic Alert Periods
High Priority Source: HHSPandemicInfluenzaPlan
Procedure:

1. Clinicians should recognize that human influenza viruses circulate worldwide year-round, including in countries with outbreaks of avian influenza A (H5N1) among poultry.
2. During the Interpandemic and Pandemic Alert Periods,...
traveler evaluation, influenza-like illness, pandemic alert period, human influenza, avian influenza H5N1
Identify High-Risk Groups for Influenza Complications
High Priority Source: HHSPandemicInfluenzaPlan
Groups at risk for complications of influenza should be identified to prioritize vaccination and medical care. The following groups are recognized by the Advisory Committee on Immunization Practices (ACIP) as being at higher risk for...
high-risk groups, influenza complications, ACIP guidelines, immunization practices, chronic conditions, Reye syndrome, pregnant women, children under 2 years
Identifying Occupational Risks for Novel Influenza Infection
High Priority Source: HHSPandemicInfluenzaPlan
Procedure:

1. Identify persons at occupational risk for infection with a novel strain of influenza, including:
- Workers on farms or live poultry markets
- Poultry processors or handlers infected with known or suspected avian...
occupational risk, avian influenza, OSHA, poultry workers, lab workers, healthcare workers
Isolate Sick Children from Healthy Ones
High Priority Source: Where There is no Doctor a Village Health Care Handbook
Purpose: To prevent the spread of infectious diseases among children.

Procedure:
1. A sick child should sleep apart from healthy children.
2. Children with sores, itchy skin, or lice should always sleep separately from those who are...
isolation, sick children, infectious disease prevention, hygiene
Prevent Malaria Through Mosquito Bite Avoidance
High Priority Source: A Book for Midwives
Procedure:

Remove standing water from around homes and avoid areas where mosquitoes breed.
Use mosquito repellent when mosquitoes are active.
Apply local remedies such as citronella oil on the skin to repel mosquitoes.
-...
malaria prevention, mosquito repellent, treated bed nets, standing water removal
Preventing Measles in Children
High Priority Source: Where There is no Doctor a Village Health Care Handbook
Procedure:

• Isolate children with measles from other children, including siblings.
• Take extra precautions to protect poorly nourished children or those with tuberculosis or chronic illnesses.
• Prevent others from entering a house where...
measles prevention, isolation, vaccination, child nutrition
Reduce Risk of Arthropod-Borne Diseases in Deployed Forces
High Priority Source: NAVMED P 5010 US Navy Manual of Preventive Medicine
Procedure:

1. Implement Insect Repellent Use:
- Provide and enforce the use of insect repellents containing DEET or other effective ingredients.
- Apply repellent to exposed skin and clothing as directed by medical personnel.

2....
arthropod borne diseases, malaria prevention, insect repellent, protective clothing, mosquito control
Support Individuals in Practicing Safer Sex
High Priority Source: A Book for Midwives
Procedure:

1. Identify barriers to safer sex practices:
- Recognize that some individuals may not use condoms due to:
- Lack of autonomy or control over sexual decisions.
- Cultural beliefs or stigma around condom use.
-...
condom use barriers, HIV education, communication about safer sex
Understand the Risks of Different Sexual Activities
High Priority Source: Where There is No Dentist
Procedure:

1. Identify High-Risk Activities: The following activities carry a higher risk of HIV transmission:
- Unprotected anal or vaginal sex.
- Having sex with multiple partners.
- Engaging in sexual activity when the vagina is...
HIV risk,sexual activity risks,safe sex practices,risk reduction
Assess Risk of H5N1 Infection in Humans
Standard Source: LDS Preparedness Manual
Overview: The H5N1 virus typically does not infect humans, but there is a risk from close contact with infected poultry or contaminated surfaces. Cases have been reported in Asia and Europe.

Procedure:
1. Monitor for exposure: Identify...
H5N1 risk assessment, bird flu prevention, human infection risk, infectious disease monitoring
Identifying Close Contact During Disease Transmission
Standard Source: HHSPandemicInfluenzaPlan
Purpose: To understand what constitutes close contact during disease transmission and its implications for infection risk.

Definition of Close Contact:
• A person who has cared for or lived with the ill person or had a high likelihood of...
close contact definition, disease transmission, infection control, pandemic influenza plan
Prevent Infectious Disease Outbreaks in Confined Environments
Standard Source: Survival and Austere Medicine
Prevent infectious disease outbreaks in confined environments by following these steps:

1. Maintain strict hygiene practices, especially hand washing and food preparation, to prevent contamination from gut bacteria and viruses.
2. **Use...
hygiene, hand washing, disinfectant, infectious disease prevention, confined environment, disposable utensils, dishwashing
Prevent Influenza Pandemic Infection Through Precautions
Standard Source: Survival and Austere Medicine
Procedure:

To reduce the risk of catching influenza, including during a pandemic or bird flu outbreak, follow these steps:

1. Avoid large crowds to minimize exposure to infected individuals.
2. Wear an N95 rated mask in public spaces...
influenza pandemic,bird flu,precautions,avoid infection,N95 mask,hand hygiene
Prevent Typhoid Through Water and Food Hygiene
Standard Source: Where There is no Doctor a Village Health Care Handbook
Procedure:

1. Ensure that water and food are not contaminated by human feces.
2. Follow the guidelines of personal and public hygiene as outlined in Chapter 12.
3. Construct and use latrines to prevent contamination.
4. Maintain a safe distance...
typhoid prevention, water hygiene, food safety, latrines, disaster preparedness
Prevent Typhus Through Hygiene and Pest Control
Standard Source: Where There is no Doctor a Village Health Care Handbook
Procedure:

1. Maintain cleanliness in the household and community.
2. De-louse all family members regularly to prevent lice transmission.
3. Remove ticks from dogs and keep them out of the house.
4. Eliminate rats by using cats or traps (avoid...
typhus prevention, lice control, rat removal, flea elimination
Proper Coughing And Hand Washing Etiquette
Standard Source: Flu Home Treatment
Proper Coughing And Hand Washing Etiquette

To reduce the spread of virus:
1. Cover your nose and mouth with a tissue or handkerchief when coughing or blowing your nose.
2. Wash hands after having any contact with a sick person.
3....
coughing etiquette, hand washing, virus prevention, hygiene, flu home treatment
Understanding CDC Travel Notices During Disease Outbreaks
Standard Source: HHSPandemicInfluenzaPlan
Purpose: To understand the different types of CDC travel notices and their implications for travelers.

Types of Travel Notices:
1. In the News: Notification by CDC of a disease of public health significance affecting a traveler or...
CDC travel notices, disease outbreak, travel precautions, health warnings, pandemic influenza plan
Prevent HIV Transmission Through Safer Sex Practices
Reference Source: Where There is No Dentist + A Book for Midwives
Procedure:

1. Educate on transmission routes:
- Explain that HIV spreads through body fluids such as blood, semen, vaginal wetness, and breast milk.
- Emphasize that it can be transmitted during unprotected sex, sharing unsterile...
HIV, safer sex, condom use, prevention, testing, transmission

Labor And Delivery (29)

Instrumental Birth Using Forceps or Vacuum Extractor
Critical Source: A Book for Midwives
Indications:

• When a baby is stuck in the vagina and needs to be delivered quickly.
• In life-threatening emergencies for the mother or baby.

Tools Used:

1. Forceps: Grab the baby’s head and pull it out of the birth canal.
2....
forceps, vacuum extractor, instrumental birth, HIV risk, emergency delivery
Address Pelvic Incompatibility Between Mother and Baby
High Priority Source: A Book for Midwives
Procedure:

1. If the baby is unable to fit through the mother’s pelvis, this may cause labor to slow or stop completely.
2. The size of the outside of the mother’s hips does not determine whether the baby can pass through the pelvis; it...
pelvic incompatibility, difficult birth, midwife intervention, emergency delivery
Assess Birth Progress and Determine Need for Medical Intervention
High Priority Source: A Book for Midwives
Procedure:

1. Monitor the speed of the birth carefully.
2. If the birth is taking too long, take the woman to a medical center immediately. This is one of the most important actions a midwife can take to prevent serious...
birth progress, medical intervention, midwife, labor monitoring, prolonged labor, emergency delivery
Change Mother’s Position to Facilitate Birth Progress
High Priority Source: A Book for Midwives
Procedure:

1. If the mother is not making progress during labor, change her position.
2. The most effective position for facilitating birth is squatting, as it opens the pelvis and uses gravity to help the baby move down.
3. Provide...
position change during labor, squatting position, midwife intervention, gravity-assisted birth
Handle Difficult or Impossible Birth Positions
High Priority Source: A Book for Midwives
Procedure:

1. If the baby is in a difficult or impossible birth position, refer to page 190 for detailed descriptions and guidance.
2. If the baby is lying facing the mother’s stomach, consider positioning the mother in either the...
difficult birth position, impossible birth position, baby positioning, midwife intervention
Identify Causes of Slow or Stuck Birth and Provide Solutions
High Priority Source: A Book for Midwives
Procedure:

1. If the baby is not born after 1 or 2 hours of strong contractions and good pushing, investigate the cause of the slow or stuck birth.
2. Possible causes include:
- The mother is afraid.
- The mother is...
slow birth, stuck birth, labor complications, midwife intervention, difficult birth position
Identify Warning Signs of a Too-Long Labor
High Priority Source: A Book for Midwives
### Identify Warning Signs of a Too-Long Labor

Labor is considered too long when:

For women who have given birth before: Strong contractions last more than 12 hours.
For first-time mothers: Strong contractions last more than...
prolonged labor, warning signs of long labor, complications of long labor, fetal position issues, maternal exhaustion
Monitor Baby's Heartbeat During Stage 2 of Labor
High Priority Source: A Book for Midwives
Procedure:

1. Listen to the baby’s heartbeat during stage 2 of labor, which is usually lower in the mother’s belly, near the pubic bone.

2. Note the heart rate: It is normal for the heartbeat to be as slow as 70 beats per minute during...
baby heartbeat, stage 2 labor, fetal heart rate, midwife procedure, maternal position change
Monitor Signs of Progress During Stage 1 Labor
High Priority Source: A Book for Midwives
### Monitor Signs of Progress During Stage 1 Labor

Watch for these signs to determine whether labor is progressing normally:

Contractions: Get longer, stronger, and closer together.
Uterus Feel: The womb feels harder during...
labor progress, stage 1 labor, pushing during labor, cervical dilation, signs of progress in labor
Administering Oxytocin in a Medical Center
High Priority Source: A Book for Midwives
Never administer oxytocin at home to start or strengthen labor.

Oxytocin can be safely given in a medical center where:

1. The mother and baby can be closely monitored.
2. Surgery is available if complications arise.
3. The baby has been in...
oxytocin, medical center, labor induction, IV administration, monitoring
Monitoring for Warning Signs During Labor and Delivery
High Priority Source: A Book for Midwives
Procedure:

1. Watch closely for any signs that may indicate complications during labor.
2. Look for prolonged pushing without progress or signs of fetal distress (e.g., slow heart rate).
3. Monitor the mother’s physical and emotional state — if...
warning signs during labor, fetal distress, complications in childbirth
Providing Nutritional Support to an Exhausted Mother During Labor
High Priority Source: A Book for Midwives
Objective: Help prevent exhaustion in a mother during labor by providing nourishment.

### Actions to Take:
1. Offer fluids and nutrients:
- Give the mother weak tea with lots of sugar or honey, fruit juice, or rehydration drinks (see...
exhaustion during labor, nutritional support, rehydration drinks, traditional remedies, active labor, late labor
Recognize and Manage Stage 2 of Labor
High Priority Source: A Book for Midwives
Stage 2 is the part of labor when the mother pushes the baby out of the womb and down the vagina, and the baby is born.

• Stage 2 begins when the cervix is completely open and ends when the baby is outside of the mother.
• It is normal for...
stage 2 labor,midwife,birth process
Encouraging Proper Pushing Posture During Labor
Standard Source: A Book for Midwives
Procedure:

1. Ensure the mother keeps her mouth and legs relaxed and open during each push.
2. She should keep her chin down on her chest and her bottom down to facilitate proper alignment of the baby’s head.
3. If the mother is pulling up...
proper pushing posture, labor techniques, childbirth assistance
Encouraging the Mother During Labor and Delivery
Standard Source: A Book for Midwives
Procedure:

1. If a mother has difficulty pushing, do not scold or threaten her.
2. Never insult or hit a woman to make her push — this can slow the birth and cause emotional trauma.
3. Instead, explain how to push well and provide clear...
emotional support during labor, childbirth encouragement, positive reinforcement
Hold-the-Breath Pushing Technique During Labor
Standard Source: A Book for Midwives
Procedure:

1. The mother takes two deep breaths and holds the second one.
2. During the contraction, she pushes as hard and long as possible while keeping her chin on her chest.
3. This method is particularly effective if the baby is coming...
hold-the-breath pushing, labor techniques, childbirth assistance
Prepare for Birth Arrival and Initial Care
Standard Source: A Book for Midwives
Objective: Ensure a clean and safe environment for birth.

Steps to follow when arriving at the birth site:

1. Assess the mother’s condition:
- Ask how she is feeling.
2. Ensure cleanliness:
- Make sure the birth area is...
birth preparation,clean environment,sterilization,hands washing,mother hygiene,emergency access
Supporting a Mother with Fear or Tension During Labor
Standard Source: A Book for Midwives
Objective: Help reduce fear and tension in a mother during labor to promote smoother progression.

### Causes of Tension:
• Physical pain of labor
• First baby
• Previous loss of a child
• Unwanted pregnancy
• Lack of support from...
fear during labor, tension in labor, emotional support, relaxation techniques, breathing during labor, reassurance, midwife care
Supporting the Mother During Difficult Pushing
Standard Source: A Book for Midwives
Procedure:

1. If the mother is tense or having trouble pushing, ask her to open her mouth and relax her jaw.
2. Encourage her to change positions if needed, such as sitting on a birthing ball or leaning forward.
3. Insert a gloved finger about...
supporting labor, childbirth assistance, perineal relaxation
Apply Acupressure Near the Big Toe During Labor
Standard Source: A Book for Midwives
Do not use this point if the mother is bleeding.

If the first two methods (the leg above the ankle and the hand) do not work after about 5 or 10 minutes, or if the mother is especially tense or angry, try applying pressure near the big toe.

-...
acupressure,big toe,labor,midwife,pain relief
Apply Forehead Stroking for Tension Relief During Labor
Standard Source: A Book for Midwives
Gently stroke upwards on the forehead, especially if the mother is very tense.

• This technique can help reduce tension and promote relaxation during labor.
forehead stroking,labor,midwife,tension relief
Apply Pressure Below the Ankle Bone to Encourage Labor Progress
Standard Source: A Book for Midwives
Press this point below the ankle bone to bring down a baby who is very high in the pelvis.

• This technique may help encourage the baby to descend into the birth canal.
ankle pressure,labor,midwife,baby descent
Apply Pressure to the Bottom of the Foot for Fear Relief During Labor
Standard Source: A Book for Midwives
If nothing else works, press in here (the bottom of the foot), very hard.

• This point can help a woman who is very afraid.
• Watch the labor closely. If acupressure massage is going to work, you will usually see contractions start or get stronger...
foot pressure,labor,midwife,fear relief
Apply Pressure to the Top of the Shoulders During Labor
Standard Source: A Book for Midwives
Press hard for about half a minute (or count to 30) on the top of the shoulders.

• Stop for 2 or 3 minutes and then press again.
• Keep trying like this for a while.
• This point is also good to press after the birth if the mother has a breast...
shoulder pressure,labor,midwife,breast infection
Change Position Every Hour During Labor
Standard Source: A Book for Midwives
Help the woman move during labor by allowing her to squat, sit, kneel, or take other positions. Changing positions helps the cervix open more evenly.

Standing and walking can make labor go faster.
Swaying, rocking, or dancing can...
position change,labor,delivery,cervix,relaxation,back position
Help the Mother Relax During Stage 1 Labor
Standard Source: A Book for Midwives
Objective: Reduce fear and tension in the mother during stage 1 labor.

Strategies to help the mother relax:

• Reassure the woman that the pain she is experiencing is normal.
• Help her relax her body through emotional support and physical...
relaxation techniques,labor support,touch,massage,cold/hot cloths,fear reduction
Recognize and Respond to Stage 1 Labor Contractions
Standard Source: A Book for Midwives
Objective: Identify and manage stage 1 labor contractions.

Stage 1 of labor has three parts:

1. Light labor:
- Contractions are mild, short (about 30 seconds), and occur every 15 to 20 minutes.
- Felt low in the belly or back.
...
stage1,labor,contractions,active labor,light labor,latelabor,cervix opening
Understand Normal Labor Patterns in Stage 1
Reference Source: A Book for Midwives
Objective: Recognize that labor patterns vary and are still considered normal.

Normal labor patterns include:

• Labors that start with weak contractions and gradually become strong over several hours.
• Labors that begin slowly and then...
normal labor patterns,cervix opening,variations in labor,strong contractions,slow progress
Manage the Mother’s Bowels and Bladder During Labor
Reference Source: Where There is no Doctor a Village Health Care Handbook + A Book for Midwives
Procedure:

1. The mother should keep her bowels and bladder empty during labor, as fullness can interfere with the birth process.
2. A full bladder can slow or even stop labor completely and may lead to complications such as fistula or...
bladder management, labor complications, catheter insertion, bowel management, urination during labor

Biological Agents (29)

Administer Antibiotic Therapy for Biological Casualties
Critical Source: Medical NBC Battlebook
Antibiotic Therapy:

1. Start antibiotics early: Administer broad-spectrum antibiotics to all biological casualties as soon as possible, even without a confirmed diagnosis.
2. Select appropriate antibiotics: Use antibiotics based on the...
antibiotic therapy,biological casualties,broad-spectrum antibiotics,early administration,dose adjustment
Administer Passive Immunotherapy for SEB Exposure
Critical Source: Medical NBC Battlebook
Procedure:

1. Determine eligibility for passive immunotherapy:
- Only applicable if administered within 4-8 hours post-exposure to SEB.

2. Administer the treatment as directed by medical personnel:
- Passive immunotherapy is a...
passive immunotherapy, SEB treatment, biological agent, medical emergency
Differentiate Between Botulinum Toxin, Nerve Agent, and Atropine Intoxication
Critical Source: Medical NBC Battlebook
Differentiation Table:

| Feature | Botulinum Toxin | Nerve Agent | Atropine Intoxication |
|---|---|---|---|
| Mental status | Usually normal | Disorientation, agitation, coma, seizures | Disorientation, excitation, agitation, irritability,...
botulinum toxin,nerve agent,atropine intoxication,differentiation table,clinical symptoms
Identify and Manage Infective Dose and Diagnostic Assays for Biological Agents
Critical Source: Medical NBC Battlebook
Infective Dose and Diagnostic Table:

| Agent | Infective Dose (Aerosol) | Diagnostic Samples | Diagnostic Assay | Patient Isolation Precautions |
|---|---|---|---|---|
| Anthrax | 8000-50,000 spores | Blood | Gram stain, Ag-ELISA, serology:...
infective dose,diagnostic assays,biological agents,sample collection,isolation precautions
Identify and Manage Tularemia (Francisella tularensis) Exposure
Critical Source: Medical NBC Battlebook
Overview:
Tularemia is a zoonotic disease caused by _Francisella tularensis_, a gram-negative bacillus. It can be transmitted through skin inoculation, mucous membrane exposure, insect bites, inhalation of contaminated dust, or ingestion of...
tularemia,Francisella tularensis,biological warfare,aerosol exposure,typhoidal tularemia,pneumonic tularemia,vaccine effectiveness,antibiotic treatment,skin inoculation,contaminated water
Identify and Respond to Biological Agents Using Operational Data Tables
Critical Source: Medical NBC Battlebook
Procedure for Identifying and Responding to Biological Agents Based on Medical NBC Battlebook Tables

### Step 1: Understand the Disease Characteristics from Tables
• Use Table 4-F (Bacteria), **Table 4-G (Rickettsiae, Chlamydia,...
biological agents, anthrax, botulinum toxin, vaccination, antimicrobial therapy, antisera, dissemination methods, incubation time, medical response
Implement Isolation Procedures for Biological Casualties
Critical Source: Medical NBC Battlebook
Isolation Procedures (Barrier Nursing):

1. Adhere to isolation principles: Use personal protective equipment (PPE) such as gloves, gowns, masks, and eye protection when caring for biological casualties.
2. Prevent cross-infection:...
isolation procedures,biological casualties,PPE,cross-infection prevention,waste disposal
Recognize and Respond to Botulinum Toxin Infection Symptoms
Critical Source: Medical NBC Battlebook
Procedure:

1. Monitor for initial symptoms:
- Look for signs such as ptosis (drooping eyelid), generalized weakness, lassitude (extreme tiredness), or dizziness.
- These may appear 24-36 hours to several days after...
Botulinum toxin symptoms, respiratory failure, cranial nerve dysfunction, antitoxin administration
Recognize and Respond to Staphylococcal Enterotoxin B (SEB) Exposure Symptoms
Critical Source: Medical NBC Battlebook
Procedure:

1. Identify symptoms of SEB exposure:
- Sudden onset of fever (up to 103-106 °F)
- Chills
- Headache
- Myalgia (muscle pain)
- Nonproductive cough
- In severe cases: dyspnea (difficulty breathing), retrosternal...
SEB, Staphylococcal Enterotoxin B, symptoms, biological agent, medical emergency
Recognize and Respond to Trichothecene Mycotoxin Exposure (Yellow Rain)
Critical Source: Medical NBC Battlebook
Overview:
Trichothecene mycotoxins, such as T-2 toxin, are potent inhibitors of protein synthesis and can cause severe health effects upon inhalation, ingestion, or dermal contact. These toxins have been associated with historical incidents like...
trichothecene mycotoxins,yellow rain,T-2 toxin,alimentary toxic aleukia,vitamin C treatment,biological warfare,skin lesions,hemorrhage,lethality reduction
Administer Antiviral Therapy for Biological Casualties
High Priority Source: Medical NBC Battlebook
Antiviral Therapy:

1. Use ribavirin: Administer ribavirin as a broad-spectrum antiviral drug for certain viral threats such as Lassa fever, HFRS, Crimean-Congo hemorrhagic fever, and Rift Valley fever.
2. **Follow compassionate use...
antiviral therapy,biological casualties,ribavirin,compassionate use protocols,viral activity limitations
Administer Botulinum Toxin Antitoxin and Prophylaxis
High Priority Source: Medical NBC Battlebook
Procedure:

1. Assess exposure risk:
- Determine if the individual has been exposed to botulinum toxin via aerosol or other means.
- Confirm that a biological weapon attack is imminent or cases have just been diagnosed.

2. **Select...
Botulinum toxin, antitoxin administration, pentavalent vaccine, biological warfare, respiratory failure
Administer Prophylactic Antibiotics for Anthrax Exposure
High Priority Source: Medical NBC Battlebook
Procedure:

1. Assess exposure risk:
- Determine if the individual has been exposed to anthrax spores via aerosol or other means.
- Confirm that a biological weapon attack is imminent or cases have just been diagnosed.

2. **Select...
Anthrax, antibiotic prophylaxis, ciprofloxacin, doxycycline, biological warfare, inhalation anthrax
Administer Supportive Measures for Biological Casualties
High Priority Source: Medical NBC Battlebook
Supportive Measures:

1. Lower temperature: Use cooling methods such as cold packs, fans, or immersion in cool water to reduce fever.
2. Relieve pain: Administer analgesics according to established medical protocols and patient...
supportive measures,biological casualties,temperature reduction,pain relief,respiratory support,IV access,symptomatic treatment
Administer Vaccination for Biological Defense
High Priority Source: Medical NBC Battlebook
Vaccination:

1. Use fully licensed vaccines: Administer vaccines such as anthrax, cholera, plague, and smallpox vaccines to prevent biological agent exposure.
2. Use IND products with consent: For agents like botulinum toxoid, Q fever,...
vaccination,biological defense,fully licensed vaccines,IND products,vaccine availability
Collecting Human Tissue Samples for Biological Agent Detection
High Priority Source: Medical NBC Battlebook
Procedure:

1. Collect blood cultures using routine media to detect bacterial agents.
2. Obtain both aerobic and anaerobic cultures routinely.
3. Take cultures and impression smears from involved lymph nodes, sputum, pleural fluid, cerebrospinal...
biological agents, specimen collection, human tissue samples, blood cultures, convalescent sera
Contacting Technical Expert POCs for BW Incidents
High Priority Source: Medical NBC Battlebook
Procedure:

1. Contact the following organizations in response to a BW incident:
- A. Corps (or appropriate) Chemical Officer: In charge of NBC defense for the unit.
- B. Technical Escort Unit: For transportation of suspected...
points of contact, BW incident response, technical experts, biological agents
Detecting Biological Warfare Agents Using Laboratory Methods
High Priority Source: Medical NBC Battlebook
Procedure:

1. Isolation of the etiologic agent by culture: Possible in two days for some agents.
2. Detection of toxin: Use mass spectroscopy, animal inoculation, or other methods.
3. Antibody detection: Specific immunoglobulin may...
BW detection, laboratory methods, biological agents, toxin identification
Provide Supportive Care in Austere Environments
High Priority Source: Survival and Austere Medicine
Supportive care is essential for maintaining organ function following biological agent exposure. In austere situations, resources are limited, so supportive care must be simplified:

1. Hand Ventilation: If a patient requires ventilation,...
supportive care,austere environment,biological agents,ventilation,IV fluids
Recognize and Respond to Rift Valley Fever (RVF) Exposure
High Priority Source: Medical NBC Battlebook
Procedure:

Step 1: Identify Symptoms of RVF Infection
Incubation Period: Monitor for an incubation period of 2–5 days, followed by a febrile illness lasting approximately the same duration.
Common Symptoms: Fever, conjunctival...
rift valley fever symptoms, prevention of rift valley fever, rift valley fever vaccine, biological warfare agent rvf
Recognize and Respond to Venezuelan Equine Encephalitis (VEE) Symptoms
High Priority Source: Medical NBC Battlebook
Procedure:

1. Monitor for symptoms: Watch for sudden onset of generalized malaise, spiking fever, rigor, severe headache, photophobia, and myalgia in the legs and lumbosacral area.
2. Observe additional symptoms: Look for nausea,...
Venezuelan Equine Encephalitis, VEE, symptoms, biological warfare, quarantine, medical response
Administer Investigational Vaccines for Venezuelan Equine Encephalitis (VEE)
High Priority Source: Medical NBC Battlebook
Procedure:

1. Identify appropriate vaccines: Use investigational vaccines such as TC-83 or C-84 for VEE prophylaxis.
2. Administer TC-83 vaccine: This is a live, attenuated cell-culture-propagated vaccine and should be administered...
VEE vaccine, TC-83, C-84, prophylaxis, biological warfare
Handling and Shipping Specimens for Biological Agent Testing
High Priority Source: Medical NBC Battlebook
Procedure:

1. Keep samples for microbiological or toxicological analysis as cold as possible, preferably frozen.
2. Do not freeze formalin-fixed material.
3. Consult the technical expert POC at the identification laboratory for specific...
specimen handling, shipping, biological agents, transport media, cold storage
Identifying and Collecting Food/Water/Plant/Insect Samples for BW Detection
High Priority Source: Medical NBC Battlebook
Procedure:

1. Collect food, water, plant, and insect samples by PM or Veterinary Food Inspection units.
2. Ensure that these samples are collected in a manner that supports the identification of biological agents.
3. Follow standard protocols...
food/water/plant/insect sampling, biological agents, sample collection protocols
Labeling and Documentation of Specimens for Biological Agent Testing
High Priority Source: Medical NBC Battlebook
Procedure:

1. Label each container with the following information:
- Patient's name or animal/plant/insect number.
- Numerical identifier.
- Type of specimen.
- Date of collection.
2. Include a brief description of the illness and...
specimen labeling, documentation, chain of custody, biological agents, sample handling
Submitting Specimens for Biological Agent Testing
High Priority Source: Medical NBC Battlebook
Procedure:

1. Ensure that the laboratory officer, in coordination with the veterinarian, preventive medicine officer, or physician, submits suspect specimens correctly and expeditiously to an appropriate diagnostic laboratory.
2. For unusual or...
specimen submission, biological agents, chain of custody, laboratory protocols
Classify Biological Agents by Type
Standard Source: Medical NBC Battlebook
Objective: Understand the classification of biological agents for detection, identification, and treatment.

Types of Biological Agents:
1. Bacteria: Free-living organisms that reproduce by division; often respond to antibiotics.
2....
bacteria,virus,rickettsiae,chlamydia,fungi,toxin,biological agent classification
Understand Biological Agent Terminology
Standard Source: Medical NBC Battlebook
Objective: Gain familiarity with key terms related to biological warfare and defense.

Definitions:
1. Biological Agent (BA): A microorganism or toxin derived from a microorganism that causes disease in humans, animals, plants, or...
biological agent,biological defense,biological warfare,biological weapon,toxin
Understand Characteristics of Biological Agents
Standard Source: Medical NBC Battlebook
Objective: Recognize the key characteristics that influence the use and impact of biological agents as weapons.

Characteristics:
1. Incubation Period: Time between exposure to a biological agent and the appearance of symptoms.
2....
incubation period,infectivity,lethality,pathogenicity,stability,toxicity,transmissibility,virulence

Triage (28)

Identify Priority Levels for Trauma Patients in a Wilderness Setting
Critical Source: US Marine Corps Wilderness Medicine
Objective: Determine the priority level of trauma patients based on injury severity.

### First Priority:
Exsanguinating hemorrhage
Major internal hemorrhage (thoracic, abdominal, and pelvic)
Visceral injuries/evisceration
-...
trauma triage, wilderness medicine, injury priority, shock, hemorrhage, burns
Identify and Apply NATO Triage Category Codes for Casualties
Critical Source: US Marine Corps Wilderness Medicine
Procedure:

1. Immediate Treatment (Group T1) - RED Tag:
- Identify casualties requiring emergency life-saving surgery.
- Examples include:
- Respiratory obstruction
- Accessible hemorrhage
- **Emergency...
nato triage codes, immediate treatment, delayed treatment, minimal treatment, expectant treatment, red tag, yellow tag, green tag, blue tag
Implement Triage Principles for Battle Casualties
Critical Source: NATO Emergency War Surgery
Triage is a critical process used to sort and assign treatment priorities to casualties in mass casualty situations, ensuring that the greatest number of soldiers receive care and survive.

### Key Objectives of Triage:
• Provide the...
triage, casualty sorting, battlefield medicine, emergency surgery, resource allocation, medical priorities
Perform Triage Using Scarce Resources Project Guidelines
Critical Source: Planning Guidance Nuclear Detonation FEMA
Procedure:

1. Assess the patient's injuries and conditions based on the following priority order:
- Mechanical trauma (e.g., fractures, lacerations)
- Burn injuries, assessed by burn depth and %TBSA (total body surface area...
nuclear detonation, triage, radiation injury, burn injuries, mechanical trauma, combined injuries, cytokine therapy, resource allocation
Sorting of Casualties - Triage Procedures
Critical Source: NATO Emergency War Surgery
Triage Procedures for Sorting Casualties

1. Assess the casualty's condition: Determine if the casualty is alive or deceased.
2. Classify casualties based on urgency: Use a triage system to prioritize treatment:
- Immediate (Red):...
casualty sorting, triage procedures, emergency war surgery, medical triage
Triage in a Mass Casualty Situation
Critical Source: NATO Emergency War Surgery
Objective: Prioritize casualties based on injury severity and potential for survival.

Procedure:
1. Assess each casualty immediately upon arrival.
- Identify life-threatening injuries (e.g., uncontrolled bleeding, airway obstruction,...
triage,mass casualty,emergency surgery,priority classification,casualty sorting
Administer the Trauma Score for Wilderness Medicine Triage
Critical Source: US Marine Corps Wilderness Medicine
Objective: Calculate a patient's Trauma Score to estimate survival probability.

### Steps:
1. Respiratory Rate (RR):
- 12–29 min = 4 points
- 10–12 min = 3 points
- 6–9 min = 2 points
- 1–5 min = 1 point
-...
trauma score, survival probability, triage tool, wilderness medicine
Critical Information for Triage Decision Making
Critical Source: Emergency War Surgery
Critical Information for Triage Decision Making

The following information is of critical importance in reaching a triage decision:

1. Initial Vital Signs:
- Pulse (rate and quality): A casualty with normal mentation and radial pulse...
vital signs,pattern of injury,response to intervention,triage criteria
Determine Casualty Classification for Triage
Critical Source: US Marine Corps Wilderness Medicine
Procedure:

1. Evaluate the casualty:
- Assess the need for immediate resuscitation.
- Determine if emergency surgery is required.
- Identify if the injury is so severe that surgical intervention would be futile (e.g., obvious...
casualty classification,NATO triage categories,immediate,delayed,minimal,expectant,wilderness medicine
Distribution of Combat Injuries and Triage Categories
Critical Source: Emergency War Surgery
Distribution of Combat Injuries and Triage Categories

The following data from the Vietnam War indicate the numerical distribution of diagnoses seen in low-intensity light-infantry combat:

30%—Minor or superficial wounds: Minor burns,...
combat injuries,triage distribution,vietnam war,injury statistics
Injury Type Distribution in Combat (OIF/OEF 2003–2004)
Critical Source: Emergency War Surgery
Injury Type Distribution in Combat (OIF/OEF 2003–2004)

The following table summarizes the frequency and percentage of injury types observed in combat operations:

| Type of Injury | Frequency | Percent...
combat injuries,injury types,oif oef statistics,penetrating injuries
Manage Post-Operative Care During Mass Casualty Events
Critical Source: Emergency War Surgery
Procedure:

• As casualties clear the operating room (OR) suites, the pace of surgical interventions will slow.
• ICU and ward care will become the primary focus for patient management.
• Initially undertriaged patients (~10%) may be identified...
post-operative care, mass casualty management, staff fatigue, triage
Perform Triage at the Division Level
Critical Source: NATO Emergency War Surgery
Procedure:

1. Assess all casualties for immediate life-threatening injuries (e.g., airway obstruction, hemorrhage, tension pneumothorax).
2. Categorize casualties into two groups:
- **Group 1: Casualties requiring early surgical...
triaige, evacuation priority, division level care, casualty management
Symptoms Indicative of Radiation Injury for Triage Purposes
Critical Source: NATO Emergency War Surgery
Overview: Use the following symptoms to classify patients into radiation injury categories during triage.

Procedure Steps:
1. Nausea and Vomiting:
- Occur with increasing frequency as radiation exceeds 100–200 cGy.
- Onset may be...
radiation symptoms, triage indicators, erythema, hypotension, neurologic dysfunction
Triage Decision Making Using a Field Triage Tool
Critical Source: Emergency War Surgery
Triage Decision Making Using a Field Triage Tool

The following decision tree is an example of a triage tool that may be used in the field as an initial decision-making aid:

1. Check if the casualty is walking and nonemergent:
- If...
triage,decision making,field triage tool,casualty classification
Triage of Nuclear Weapons Casualties
Critical Source: NATO Emergency War Surgery
Overview: When dealing with nuclear weapons casualties, follow the principles of mass casualty management: triage, evacuation, and standardized care interventions.

Procedure Steps:
1. Prioritize treatment of conventional injuries first, as...
nuclear triage, radiation casualties, mass casualty management, evacuation priority, conventional injuries
Assess External Factors for Triage Decision Making
High Priority Source: Emergency War Surgery
External factors must be considered even if the surgeon/medic has limited knowledge or control over them. These include:

Tactical situation and mission:
- The decision to commit scarce resources cannot rely solely on current tactical,...
external factors,tactical situation,resupply,time,evacuation,MTF,autotriage,damage control,resource constraints
Assess Internal Factors for Triage Decision Making
High Priority Source: Emergency War Surgery
Internal factors are known to the surgeon/medic and should be factored into triage decisions. These include:

Medical supplies:
- Include equipment, drugs, oxygen, dressings, sutures, sterilization capability, blood, etc.
- **Immediate...
internal factors,medical supplies,space capability,personnel,stress,resource management,logistics,OR tables,ICU beds,diagnostic equipment
Assessing Initial Vital Signs for Triage Decisions
High Priority Source: Emergency War Surgery
Assessing Initial Vital Signs for Triage Decisions

To make accurate triage decisions, assess the following vital signs:

1. Pulse: Evaluate both rate and quality (e.g., weak, thready, or absent).
2. Mentation: Determine if the casualty...
vital signs,triage,pulse,mentation,breathing
Assessing Response to Initial Intervention for Triage Decisions
High Priority Source: Emergency War Surgery
Assessing Response to Initial Intervention for Triage Decisions

Evaluate the casualty's response to initial resuscitative efforts:

1. Shock state improvement: If the patient shows signs of improved perfusion (e.g., increased pulse...
response to intervention,shock state,fluid resuscitation,triage,priority
Classify Casualties into Emergent, Nonemergent, and Expectant Categories for Surgical Triage
High Priority Source: Emergency War Surgery
### Classify Casualties into Emergent, Nonemergent, and Expectant Categories for Surgical Triage

In practice, casualties should be divided into three categories:

Emergent: Require urgent surgery within minutes to several hours of arrival...
casualty classification, surgical triage, emergency war surgery, battlefield triage, medical triage, expectant casualties, emergent casualties, nonemergent casualties, combat stress, BICEPS mnemonic
Establish Pre-Evacuation Triage Diversion Plans
High Priority Source: Emergency War Surgery
Procedure:

• Before a mass casualty event occurs, establish diversion plans for casualties to other facilities such as sister services, local national assistance, or local NATO assets.
• These options should be pre-determined and communicated...
triage, diversion plans, casualty management, medical evacuation
Establish Pre-Mass Casualty Triage Facilities and Diversion Options
High Priority Source: Emergency War Surgery
Procedure:

• Before a mass casualty event, establish diversion options such as sister service units, local national assistance, or local NATO assets.
• These options should be pre-established to ensure efficient patient flow during the event.
-...
triage, diversion, mass casualty, pre-established
Evaluating Pattern of Injury for Triage Decisions
High Priority Source: Emergency War Surgery
Evaluating Pattern of Injury for Triage Decisions

Assess the type and distribution of injuries to determine triage priority:

1. Nonfatal extremity injuries: These are common on the modern battlefield and generally classified as...
pattern of injury,triage,extremity injuries,soft tissue,burns,fractures,amputations,head injuries,vascular repair
Perform Initial Casualty Self-Aid or Buddy-Aid
High Priority Source: US Marine Corps Wilderness Medicine
Procedure:

1. Assess the injury:
- Determine if self-aid or buddy-aid is sufficient to stabilize the casualty.
- If the injury is minor (e.g., small laceration, mild pain), apply basic first aid such as cleaning the wound and applying...
self-aid,buddy-aid,casualty,stabilization,triage,wilderness
Perform Triage Using IDME Categories
High Priority Source: TCCC 17 13 Tactical Combat Casualty Care
Triage will be performed at all levels. Traditional categories of triage are:

1. Immediate: Requires attention within minutes to 2 hours upon arrival to avoid death or major disability. Injuries include airway obstruction or potential...
triage,IDME,immediate,delayed,minimal,expectant
Understanding Combat Injury Distribution for Triage Planning
High Priority Source: Emergency War Surgery
Understanding Combat Injury Distribution for Triage Planning

Based on historical data from combat scenarios (e.g., Vietnam War, Iraq/Afghanistan), the following injury distribution can guide triage planning:

### **Vietnam War Data...
combat injury distribution,triage planning,vietnam war,oif/oef data,penetrating injuries,blast injuries
Conduct Pre-Event Triage Scenario Exercises
High Priority Source: Emergency War Surgery
Procedure:

• Before an actual mass casualty situation occurs, conduct exercises simulating various triage scenarios.
• These exercises should evaluate the performance of personnel, supplies, and equipment.
• Practice moving litters without...
pre-event training, triage exercises, personnel readiness

Infectious Disease Control (28)

Isolate and Evaluate Symptomatic Quarantined Individuals
Critical Source: HHSPandemicInfluenzaPlan
Procedure:

1. Separation from Others: If a quarantined person develops symptoms suggestive of influenza, immediately separate them from others in quarantine.

2. Medical Evaluation: Ensure the symptomatic individual receives immediate...
isolation protocol, medical evaluation, quarantine data collection
Prohibit Nonessential Arrivals During Extensive Transmission
Critical Source: HHSPandemicInfluenzaPlan
Procedure:

1. Implement a ban on nonessential travel to and from areas with extensive influenza transmission.
2. Coordinate with government agencies and transportation authorities to enforce the restriction.
3. Provide clear communication...
travel ban, nonessential arrivals, quarantine, containment, public health
Cancel or Limit Nonessential Travel to Affected Countries
High Priority Source: HHSPandemicInfluenzaPlan
Procedure:

1. Coordinate with airline and travel industry partners to cancel or limit nonessential travel to countries experiencing extensive influenza transmission.
2. Provide clear communication to the public about the reasons for the...
travel restrictions, nonessential travel, public health, containment, quarantine
Implement Individual Containment Measures During Pandemic Period
High Priority Source: HHSPandemicInfluenzaPlan
Procedure:

1. Isolate individuals with suspected or confirmed pandemic influenza from healthy persons using infection control measures described in Supplement 4.
2. If healthcare capacity is overwhelmed or home isolation is not feasible,...
patient isolation,pandemic containment,infection control,alternative facilities,public health guidance
Implement Medical Screening at Exit Points in the United States
High Priority Source: HHSPandemicInfluenzaPlan
Procedure:

1. Establish medical screening at exit points (e.g., airports) for outbound travelers.
2. Screen individuals for symptoms such as fever, cough, or difficulty breathing.
3. Provide guidance on infection prevention measures to all...
exit screening, outbound travelers, infection control, public health, quarantine
Implementing Quarantine to Reduce Transmission During Pandemics
High Priority Source: HHSPandemicInfluenzaPlan
Quarantine is necessary even if symptomatic individuals are rapidly isolated due to delays in symptom recognition and the insidious nature of disease onset.

### Reasons for Delays in Isolation:
1. Insidious onset of symptoms: Early symptoms...
quarantine,pandemic,infection control,symptom delay,transmission reduction,SARS
Isolate and Quarantine Ill Passengers and Their Contacts
High Priority Source: HHSPandemicInfluenzaPlan
Procedure:

1. Isolate ill passengers immediately upon arrival at the port of entry.
2. Identify and quarantine close contacts of ill passengers to prevent further transmission.
3. Ensure that isolation and quarantine areas are equipped with...
isolation, quarantine, contact tracing, containment, infection control
Minimize Household Exposure During Quarantine
High Priority Source: HHSPandemicInfluenzaPlan
Procedure:

1. Reduce Contact: Quarantined persons should minimize interactions with other household members to prevent exposure during the interval between symptom development and recognition.

2. Precautions: Implement the following...
household exposure prevention, PPE use, separate room
Monitor Quarantined Individuals for Influenza Symptoms
High Priority Source: HHSPandemicInfluenzaPlan
Procedure:

1. Daily Monitoring: Monitor each quarantined person daily, or more frequently if feasible, for the following:
- Fever
- Respiratory symptoms (e.g., coughing, difficulty breathing)
- Other early influenza disease...
quarantine monitoring, influenza symptoms, compliance check, hotline access
Quarantine Duration and Final Assessment for Influenza
High Priority Source: HHSPandemicInfluenzaPlan
Procedure:

1. Duration of Quarantine: Based on current data, the recommended duration of quarantine for influenza is generally 10 days from the time of exposure (may be adjusted during a pandemic).

2. Final Assessment: At the end...
quarantine duration, final assessment, return to normal activities
Active and Passive Symptom Monitoring During Quarantine
High Priority Source: HHSPandemicInfluenzaPlan
Procedure:

1. Monitoring Types: Persons in quarantine may be assessed for symptoms using either active or passive monitoring.

2. Active Monitoring: Active monitoring can help overcome delays resulting from the insidious onset of...
symptom monitoring, active vs passive, quarantine evaluation
Establish Influenza Hotlines and Clinics for Early Detection
High Priority Source: HHSPandemicInfluenzaPlan
Procedure:

1. During the later phases of a Pandemic Alert or in communities experiencing disease clusters, establish influenza hotlines.
2. Encourage all members of the affected community to monitor their symptoms (e.g., take temperature once...
influenza hotline,pandemic detection,community triage,temperature monitoring,public health clinic
Evaluate Ill Travelers with Public Health Workers or CDC Quarantine Officers
High Priority Source: HHSPandemicInfluenzaPlan
Procedure:

1. Notify public health officials if an ill passenger is identified.
2. Arrange for a state or local public health worker and/or CDC quarantine officer to evaluate the ill traveler.
3. Conduct a thorough assessment of symptoms,...
quarantine officer, public health worker, evaluation, isolation, containment
Implement Active Monitoring with Activity Restrictions (Quarantine)
High Priority Source: HHSPandemicInfluenzaPlan
Procedure:

1. Definition and Purpose:
- The contact remains separated from others for a specified period (up to 10 days after potential exposure), during which s/he is assessed on a regular basis (in person at least once daily) for signs...
quarantine, active monitoring, pandemic influenza, infectious disease control, isolation protocols
Implement Enhanced Disease Surveillance at Ports of Entry
High Priority Source: HHSPandemicInfluenzaPlan
Procedure:

1. Enhance surveillance for potential imported influenza cases at all ports of entry.
2. Monitor travelers for symptoms such as fever, cough, and respiratory illness.
3. Collect data on travel history and exposure to infected...
disease surveillance, ports of entry, influenza, imported cases, public health
Implement Targeted Chemoprophylaxis for Disease Clusters
High Priority Source: HHSPandemicInfluenzaPlan
Procedure:

1. Investigate disease clusters to identify affected individuals and communities.
2. Administer antiviral treatment to persons with confirmed or suspected pandemic influenza.
3. Provide drug prophylaxis to all likely exposed persons...
chemoprophylaxis,pandemic influenza,disease clusters,antiviral treatment,public health intervention
Implement Working Quarantine for Essential Workers
High Priority Source: HHSPandemicInfluenzaPlan
Procedure:

1. Definition and Purpose:
- Employees are permitted to work but must observe activity restrictions while off duty.
- Monitoring for influenza-like illness before reporting for work is usually required.
- This may change...
working quarantine, essential workers, pandemic influenza, PPE use, infectious disease control
Monitor Arriving Passengers for Fever and Respiratory Symptoms
High Priority Source: HHSPandemicInfluenzaPlan
Procedure:

1. Conduct active monitoring of all arriving passengers for signs of illness.
2. Use temperature screening devices to detect fever in travelers.
3. Ask passengers about symptoms such as cough, sore throat, or difficulty...
temperature screening, symptom monitoring, public health, quarantine, containment
Provide Infection Control Guidance to Crew Members
High Priority Source: HHSPandemicInfluenzaPlan
Procedure:

1. Train crew members on infection control procedures.
2. Ensure that ill passengers are separated from other travelers as much as possible.
3. Provide the ill passenger with a mask or tissues to prevent viral spread via...
infection control, crew training, mask use, isolation, PPE
Quarantine for Diseases Spread by Non-Airborne Routes
High Priority Source: HHSPandemicInfluenzaPlan
Quarantine is not limited to airborne diseases and can be used for any disease spread from person to person, including those transmitted through close personal contact or contaminated objects.

### Key Considerations:
• **Definition of...
quarantine,non-airborne transmission,disease control,SARS,pandemic influenza,smallpox
Request Information on Ill Passenger’s Symptoms and Travel History
High Priority Source: HHSPandemicInfluenzaPlan
Procedure:

1. Interview ill passengers upon arrival to gather detailed information.
2. Ask about symptoms such as fever, cough, difficulty breathing, or other respiratory issues.
3. Inquire about recent travel history, including locations...
ill passenger, travel history, symptoms, quarantine, public health
Arrange for In-Flight Pandemic Influenza Education and Awareness Campaigns
Standard Source: HHSPandemicInfluenzaPlan
Procedure:

1. Coordinate with airline industry partners to show videos or air public announcements about pandemic influenza on airplanes and cruise ships.
2. Ensure that the content is accurate, informative, and includes prevention...
airline education, pandemic awareness, infection control, public health, prevention
Conducting Visual Inspections and Passenger Evaluations at Points of Entry
Standard Source: HHSPandemicInfluenzaPlan
Procedure:

1. Deploy CDC staff to meet flights arriving from areas with reported infectious disease outbreaks (e.g., SARS).
2. Conduct visual inspections of all passengers for signs of illness, such as fever, coughing, or difficulty...
visual inspection, contact tracing, infectious disease control, SARS outbreak, quarantine measures
Distribute Targeted Health Education Messages to Outbound Travelers
Standard Source: HHSPandemicInfluenzaPlan
Procedure:

1. Develop and distribute targeted health education messages to outbound travelers.
2. Provide information on how to prevent the spread of influenza, including hand hygiene, mask use, and avoiding close contact with sick...
health education, outbound travelers, prevention, infection control, public health
Implementing Pre-departure and Arrival Screening for Infectious Diseases
Standard Source: HHSPandemicInfluenzaPlan
Procedure:

1. Implement pre-departure temperature and symptom screening at points of origin to identify individuals who may be ill before they travel.
2. At arrival points, conduct arrival screening, which includes:
- Asking...
pre-departure screening, arrival screening, quarantine measures, SARS outbreak, infectious disease control
Implementing Travel Notifications and Health Alert Notices During a Pandemic
Standard Source: HHSPandemicInfluenzaPlan
Procedure:

1. Issue travel notifications to inform the public about potential health risks associated with international travel.
2. Distribute Travel Health Alert Notices to arriving passengers from areas affected by infectious diseases...
travel health alert notices, pandemic response, infectious disease control, SARS outbreak, quarantine measures
Managing Travel-related Risk of Disease Transmission During a Pandemic
Standard Source: HHSPandemicInfluenzaPlan
Procedure:

1. Develop and implement travel-related response matrices to guide actions during an influenza pandemic or other infectious disease outbreak.
2. Use the matrix as a reference for:
- Inbound travel protocols (e.g., screening,...
travel risk matrix, pandemic response, infectious disease control, quarantine measures, contact tracing
Understanding Differences in Transmission Patterns Between Influenza and SARS-CoV for Pandemic Planning
Standard Source: HHSPandemicInfluenzaPlan
Procedure:

1. Recognize that influenza has a much shorter incubation period and intergenerational period compared to SARS-CoV, which poses significant challenges for case isolation, contact tracing, and quarantine.
2. Understand that...
influenza transmission, SARS-CoV comparison, pandemic planning, public health strategies, infectious disease control

Radiation Protection (27)

Implement Protective Actions During a Civil Nuclear Incident
Critical Source: UK National Risk Register 2025
Procedure:

1. Immediately implement protective actions to safeguard public health and safety following a radiological release.
2. Coordinate with emergency services, local authorities, and national agencies to manage the incident...
radiological protection, nuclear incident, emergency response
Protect Against Radiation Fallout
Critical Source: Planning Guidance Nuclear Detonation FEMA
Objective: Reduce radiation exposure from fallout by following protective actions.

Procedure:
1. Reduce time spent in radioactive areas:
- Stay inside shelter as long as possible to minimize exposure to outdoor radiation.
2....
radiation fallout,nuclear detonation,shielding,distance from source
Using Thyroid Blocking Agents (TBA) During a Nuclear Event
Critical Source: TACDA Emergency Food And Water
Procedure:

1. Start taking TBA tablets as soon after the nuclear attack as possible to block radioactive iodine uptake by the thyroid.
2. Consult your physician for proper dosages, especially if any family members have pre-existing thyroid...
thyroid blocking agents, radiation protection, iodine uptake prevention, nuclear disaster preparedness
Understand NAIRA - Nuclear Accident and Incident Response and Assistance
Critical Source: Medical NBC Battlebook
NAIRA stands for Nuclear Accident and Incident Response and Assistance, which is a program or protocol designed to manage and respond to nuclear accidents or incidents.

Key Objectives:
• Coordinate emergency response efforts during...
NAIRA,Nuclear Accident Response,Radiation Assistance,Nuclear Incident Management
Understand Neutron Radiation and Its Effects on the Body
Critical Source: Medical NBC Battlebook
Neutron radiation is a form of ionizing radiation, which can cause significant damage to biological tissues.

Key Effects:
• Neutrons have high penetrating power, making them difficult to shield against compared to other types of...
Neutron Radiation,Ionizing Radiation,Radiation Effects,Biological Damage
Use of Chelating Agents for Metal Removal in Radiation Injuries
Critical Source: Emergency War Surgery
Chelating agents may be used to eliminate metals from the bloodstream before they reach target organs:

1. Identify metal exposure: Determine which heavy metals are present (e.g., lead, mercury).
2. Administer appropriate chelator: Use a...
chelating agents, metal removal, radiation injury, heavy metals
Using the AN/PDR-75 Dosimeter (DT-236 and CP-696 Reader)
Critical Source: Medical NBC Battlebook
Procedure:

1. The AN/PDR-75 consists of the DT-236 wristwatch dosimeter and the CP-696 Computer Reader.

2. The DT-236 uses scintillation to detect gamma radiation and a solid-state semiconductor for neutron detection.

3. To obtain...
AN/PDR-75, DT-236, CP-696 reader, gamma and neutron detection
Administer Potassium Iodide (KI) to Emergency Workers
High Priority Source: FEMA REP Program Manual Dec 2019
Procedure:

1. Monitor for radioactive iodine in the atmospheric release.
2. If radioactive iodine is projected or detected, initiate KI administration for emergency workers.
3. Ensure distribution methods and timeframes are clearly defined in...
KI administration, emergency workers, radiation exposure, thyroid blocking agent, emergency response
Administer Potassium Iodide (KI) to Institutionalized Populations
High Priority Source: FEMA REP Program Manual Dec 2019
Procedure:

1. Identify institutionalized populations within the plume exposure pathway EPZ that cannot be evacuated quickly.
2. Ensure institutional staff are trained and prepared to administer KI to patients or residents.
3. Develop clear...
KI administration, institutionalized populations, radiation emergency, thyroid blocking agent, hospital patients
Determine When to Administer Potassium Iodide (KI) to General Public
High Priority Source: FEMA REP Program Manual Dec 2019
Procedure:

1. Evaluate if radioactive iodine is present in the atmospheric release.
2. Project thyroid dose for a one-year-old child using radiation modeling tools.
3. If the projected thyroid dose exceeds 5 rem, administer KI as a...
KI administration, radiation emergency, thyroid blocking agent, potassium iodide, public exposure
Inhalation Protection in Radiological Contaminated Areas
High Priority Source: Medical NBC Battlebook
Inhalation Protection in Radiological Contaminated Areas

1. Use full-face masks: Clothing must be worn with an efficient full-face mask to achieve reasonable protection against particulate aerosols, especially those containing very small...
inhalation protection, full-face mask, radiation hazards
Interpreting Dosimeter Readings from the AN/PDR-75 and IM Series Dosimeters
High Priority Source: Medical NBC Battlebook
Procedure:

1. The AN/PDR-75 provides a digital readout of cumulative neutron and gamma radiation doses, with a range of 0–999 cGy.

2. The IM-9E/PD has a range of 0–0.2 cGy (gamma) and displays readings in increments of 10 mR.

3. The...
dosimeter readings, calibration, temperature range, radiation monitoring
Protective Clothing Procedures in Radiological Contaminated Areas
High Priority Source: Medical NBC Battlebook
Protective Clothing Procedures in Radiological Contaminated Areas

1. Wear protective clothing: Protective clothing generally consists of coveralls made of closely woven material.
2. Double-layer protection: Two pairs of such coveralls...
protective clothing, decontamination, radiological hazards, radiation protection
Using the IM-147/PD Dosimeter
High Priority Source: Medical NBC Battlebook
Procedure:

1. The IM-147/PD is a single barrel low range 'quartz fiber,' self-indicating pocket dosimeter used for measuring gamma radiation.

2. It has a range of 0–50 R (gamma) and must be charged using the **PP-1578A/PD radiac meter...
IM-147/PD, dosimeter, gamma radiation, low range, quartz fiber
Using the PP-4276/PD Radiac Detector Charger
High Priority Source: Medical NBC Battlebook
Procedure:

1. The PP-4276/PD is used to charge the IM-143/PD Series Dosimeter.

2. It consists of a charger receptacle, internal battery, high voltage generator with variable output control, and provisions for illuminating the scale of...
PP-4276/PD, charger, IM-143/PD, dosimeter charging
Document KI Ingestion and Declination in Radiation Emergencies
High Priority Source: FEMA REP Program Manual Dec 2019
Procedure:

1. Develop standardized forms for documenting ingestion of radioprotective drugs (KI) by individuals.
2. Maintain records of all individuals who have received or declined KI during an emergency.
3. Ensure that documentation is...
KI documentation, radiation emergency, record keeping, public health, declination forms
Proper Use and Placement of Thermoluminescent Dosimeters (TLDs)
High Priority Source: Medical NBC Battlebook
Procedure:

1. Wearing Instructions:
- TLD badges must be worn on the trunk portion of the body (below the shoulders and above the hips), outside clothing, on the area nearest to the radiation source.
- The dosimeter window must face...
TLD, thermoluminescent dosimeter, placement, radiation monitoring
Provide Manufacturer Instructions for KI Administration
High Priority Source: FEMA REP Program Manual Dec 2019
Procedure:

1. Ensure that all personnel administering KI are trained on manufacturer instructions for proper use.
2. Include manufacturer guidelines in plans/procedures for reference during emergencies.
3. Provide training to emergency workers,...
KI administration guidelines, manufacturer instructions, training protocols, radiation emergency, public health
Stockpile Stable Iodine Tablets for Radiation Emergencies
High Priority Source: UK National Risk Register 2025
Procedure:

1. Acquire stable iodine tablets: Ensure a ready stockpile of stable iodine tablets is available in advance of any potential nuclear emergency.
2. Store properly: Keep the tablets in a cool, dry place and ensure they are...
stable iodine,radiation protection,nuclear emergency,stockpile
Understand Neutron - Definition and Properties
High Priority Source: Medical NBC Battlebook
Neutrons are electrically neutral particles associated with the nucleus of an atom. They have a mass number of 1 and are denoted by the symbol n.

Key Characteristics:
• Neutrons play a critical role in nuclear reactions, including...
Neutron,Radiation,Nuclear Physics,Ionizing Radiation
Understanding and Use of Thermoluminescent Dosimeters (TLDs)
High Priority Source: Medical NBC Battlebook
Procedure:

1. Functionality:
- TLDs detect radiation by forming a crystalline structure that traps electrons when exposed to ionizing radiation.
- When heated, the trapped electrons are released and emit light proportional to the...
TLD, thermoluminescent dosimeter, cumulative dose
Use and Maintenance of Pocket Dosimeters
High Priority Source: Medical NBC Battlebook
Procedure:

1. Initial Setup and Use:
- Recharge the pocket dosimeter to ensure it has a full electrical charge.
- Wear the dosimeter on the trunk portion of the body, not in a radiation shielded area.
- Read the dosimeter...
pocket dosimeter, leakage check, radiation exposure, maintenance, emergency procedure
Using Chelating Agents for Metal Contaminants in Radiation Exposure
High Priority Source: Emergency War Surgery
Chelating agents may be used to remove metals from the bloodstream before they reach target organs.

• These are typically administered under medical supervision and after stabilizing the patient’s ABCs (airway, breathing, circulation).
chelating agents, metal removal, radiation exposure
Using Mobilizing Agents for Internal Contaminants in Radiation Exposure
High Priority Source: Emergency War Surgery
Mobilizing agents are used to increase the excretion of internal contaminants.

• These should be administered after stabilizing the patient’s ABCs (airway, breathing, circulation).
mobilizing agents, internal contaminants, radiation exposure
Understand Non-Ionizing Radiation - Characteristics and Examples
Standard Source: Medical NBC Battlebook
Non-ionizing radiation refers to radiation that lacks sufficient energy to remove electrons from atoms, making it less harmful than ionizing radiation.

Common Types:
Laser radiation: Used in various medical, industrial, and...
Non-Ionizing Radiation,Laser,Radiofrequency,Safety Measures
Understanding and Use of Chemical Dosimeters
Standard Source: Medical NBC Battlebook
Procedure:

1. Functionality:
- Chemical dosimeters measure radiation exposure by detecting chemical changes caused by ionizing radiation.
- Radiation produces acids in the system, which can be measured via visible color changes,...
chemical dosimeter, gamma radiation, pH measurement
Understanding and Use of Film Badge Dosimeters
Standard Source: Medical NBC Battlebook
Procedure:

1. Functionality:
- Film badges use the effect of radiation on photographic film to record dose.
- After developing the film, optical density is compared to a calibration curve to determine exposure levels.

2. **Film Types...
film badge, optical density, gamma radiation

Contraception (27)

Absolute Contraindications for Hormonal Methods
High Priority Source: A Book for Midwives
Women who should not use any hormonal method:

• Women who have ever had cancer of the breast or uterus.
• Women who might be pregnant already.
• Women with very heavy monthly bleeding, monthly bleeding that lasts more than 8 days,...
hormonal contraception, contraindications, cancer, pregnancy, heavy bleeding
Warning Signs That Require Immediate Medical Attention While Taking Birth Control Pills
High Priority Source: A Book for Midwives
Procedure:

If a woman experiences any of the following signs while taking birth control pills, she should seek medical advice immediately:

Chest pain and shortness of breath (may indicate a blood clot or heart-related issue)
-...
warning signs, medical attention, chest pain, shortness of breath, headaches, numbness, leg pain, blood clot risk
Administer Progestin-Only Emergency Contraception
Standard Source: A Book for Midwives
Procedure for Administering Progestin-Only Emergency Contraception

1. A woman should take 0.75 mg levonorgestrel by mouth.
2. Another dose of 0.75 mg levonorgestrel should be taken 12 hours later.
3. This method is preferred in some...
progestin-only emergency contraception, levonorgestrel dosage, post-coital contraception
Contraindications for Estrogen-Containing Contraceptives
Standard Source: A Book for Midwives
Women who should not use estrogen-containing methods:

• Women with high blood pressure that is not controlled by medicine.
• Women with diabetes.
• Women with epilepsy.
• Women who have ever had a **stroke, paralysis, or heart...
estrogen contraception, contraindications, progestin only, breastfeeding, blood pressure
Monitor and Respond to Implant-Related Complications
Standard Source: A Book for Midwives
Procedure:

1. Monitor women with implants for the following signs of dangerous health problems:
- Arm pain near the implant
- Pus, redness, or bleeding around the implant
- Implant coming out
- **Monthly bleeding stops...
implant complications, medical monitoring, contraception side effects
Recognizing and Responding to IUD-Related Infections
Standard Source: Where There is no Doctor a Village Health Care Handbook
Procedure:

1. Watch for signs of infection such as fever, pain in the lower abdomen, or unusual vaginal discharge.
2. If any of these symptoms occur, seek immediate care from a trained health worker.
3. Do not delay treatment, as...
IUD infection,PID,signs of infection,IUD complications
Using the Mucus Method for Fertility Awareness
Standard Source: A Book for Midwives
Overview: The mucus method involves observing changes in cervical mucus to determine when a woman is fertile.

How to Use the Mucus Method:
1. Check daily: Examine the vaginal mucus at the same time every day, ideally before having...
mucus method, cervical mucus observation, fertility signs, natural family planning
Administer High-Dose Birth Control Pills (Group 4)
Standard Source: A Book for Midwives
Procedure:

1. Use high-dose pills that contain higher amounts of estrogen (50 micrograms ethinyl estradiol) and most are also higher in progestin.
2. These may be used for women who experience spotting or missed periods with low-dose pills,...
high dose pills, spotting treatment, increased estrogen
Administer and Understand Injectable Contraceptives
Standard Source: Where There is no Doctor a Village Health Care Handbook + A Book for Midwives
Procedure:

1. A trained health worker administers a hormone shot (e.g., _Depo Provera_, _Noristerat_, _Lunelle_, or _Cyclofem_) to a woman to prevent pregnancy.
2. The injection lasts 1 to 3 months, depending on the type of injectable...
injectable contraceptives, Depo Provera, Noristerat, Lunelle, Cyclofem, contraception, hormone shot, progestin-only, combined injection
Fertility Awareness Method (Natural Family Planning)
Standard Source: A Book for Midwives
Overview: Fertility awareness involves tracking a woman’s body signs to determine when she is fertile and avoiding sexual intercourse during that time to prevent pregnancy.

Key Considerations:
• This method does **not protect against HIV...
fertility awareness, natural family planning, NFP, contraception, menstrual cycle tracking
Overview of Hormonal Contraception Methods
Standard Source: A Book for Midwives
Hormonal methods include:

Birth control pills: Contain estrogen and progestin (some contain only progestin).
Injections: May contain both estrogen and progestin or only progestin.
Implants: Usually contain only progestin.
-...
hormonal contraception, birth control pills, implants, injections, IUD
Proper Use of Spermicide
Standard Source: A Book for Midwives
How to use spermicide:

1. Application: The woman puts the spermicide in her vagina using an applicator for foam or jelly, or with her fingers for tablets (suppositories).
2. Timing: Spermicide should be inserted into the vagina no more...
spermicide, contraception, Nonoxynol 9, HIV prevention, safe sex
Use a Contraceptive Sponge
Standard Source: A Book for Midwives
Procedure for Using the Contraceptive Sponge

1. Wet the sponge with clean water before inserting it into the vagina.
2. Insert the sponge deep into the vagina using a finger.
3. Leave the sponge in place for at least 6 hours after sex but...
contraceptive sponge, spermicide use, vaginal contraception
Using Condoms for Family Planning
Standard Source: A Book for Midwives
Procedure:

1. Select a condom: Choose a latex or polyurethane condom that fits snugly.
2. Check the expiration date: Ensure the condom is not expired.
3. Open the package carefully: Avoid tearing the condom with teeth or nails.
4....
condoms, family planning, contraception, HIV prevention, pregnancy
Using Contraceptive Suppositories (Neo Sampoon)
Standard Source: Where There is no Doctor a Village Health Care Handbook
Procedure:

1. Wash hands thoroughly with soap and water.
2. Open the package containing the suppository tablet.
3. Insert the suppository deep into the vagina, near the cervix, 15 minutes before sexual intercourse.
4. Follow...
contraceptive suppositories,Neo Sampoon,insertion instructions
Breastfeeding as a Contraceptive Method (Lactational Amenorrhea Method)
Reference Source: A Book for Midwives
Overview: Breastfeeding can be used as a natural contraceptive method under specific conditions. This method is effective only if the following criteria are met:

1. The baby is less than 6 months old.
2. The woman has **not had any monthly...
breastfeeding, contraception, lactational amenorrhea method, LAM, postpartum fertility, exclusive breastfeeding
Common Side Effects of Hormonal Contraception
Reference Source: A Book for Midwives
Side effects from hormonal methods may include:

Nausea
Headaches
Weight gain
Swelling of the breasts
Changes in monthly bleeding patterns

Important Note: These side effects are usually not dangerous but can be...
hormonal contraception, side effects, nausea, headaches, weight gain
How to Make a Homemade Sponge for Contraception
Reference Source: A Book for Midwives
Materials needed:
• 2 tablespoons or 1 teaspoon or 1 spoon of vinegar
• 1 cup of clean boiled water
• 4 spoons of boiled water
• A piece of sponge about the size of an egg
• Lemon juice or salt (optional)

Steps:
1. Mix the solution:...
homemade sponge, contraception, vinegar, lemon juice, salt, family planning, midwife
How to Take a 21-Pill Packet of Birth Control
Reference Source: Where There is no Doctor a Village Health Care Handbook
Procedure:

1. Start on the first day of your period, counting that day as day 1.
2. Take one pill every day for 21 days, at the same time each day.
3. After finishing the packet, wait 7 days before starting a new packet.
4....
birth control pills, 21-day packet, contraception, menstrual cycle, period timing
Insert Implants for Long-Term Contraception
Reference Source: A Book for Midwives
Procedure:

1. A trained health worker inserts small, soft tubes of progestin under the skin of a woman’s arm to prevent pregnancy.
2. The implants are effective for 3 to 5 years, depending on the type used.
3. After this time, the implants must...
implants, long-term contraception, progestin, family planning, hormonal contraception
Perform Essure Tubal Ligation (Non-Surgical Method)
Reference Source: A Book for Midwives
Procedure for Essure Tubal Ligation

1. A tiny, flexible metal and plastic coil is inserted through the vagina and uterus into each fallopian tube.
2. Scar tissue grows over these inserts over time, permanently blocking the tubes.
3. This method...
essure, non-surgical sterilization, contraception, fallopian tubes
Perform Tubal Ligation (Traditional Method)
Reference Source: A Book for Midwives
Procedure for Traditional Tubal Ligation

1. A trained health worker inserts a tool through the skin near the belly button.
2. The tool is used to cut or tie the fallopian tubes that carry the woman’s eggs to her womb.
3. The procedure takes...
tubal ligation, sterilization, contraception, fallopian tubes, medical procedure
Use the Mucus Method to Avoid Pregnancy
Reference Source: Where There is no Doctor a Village Health Care Handbook
Overview: This method helps avoid pregnancy by observing changes in vaginal mucus throughout the menstrual cycle. It is most effective for women with regular cycles and no vaginal infections.

Steps:
1. **Daily Observation of Vaginal...
mucus method, contraception, pregnancy prevention, vaginal mucus observation
Encouraging Male Involvement in Family Planning
Reference Source: A Book for Midwives
Key actions for midwives to encourage male involvement:
Educate men on the importance of family planning and how it benefits both partners.
Promote shared responsibility by encouraging men to use condoms and support their partner's...
male involvement, family planning, midwife education, shared responsibility, contraception
How to Take Birth Control Pills Correctly
Reference Source: A Book for Midwives
Procedure:

1. Start the first pill on the first day of monthly bleeding.
- If that is not possible, take the first pill anytime within the first 7 days after the start of monthly bleeding.
2. Take one pill every day:
- For a...
birth control pills, oral contraceptives, low-dose pills, 28-day packet, 21-day packet, hormone pills, sugar pills, backup contraception, effectiveness, timing of pill intake
Ineffective and Dangerous Family Planning Methods
Reference Source: A Book for Midwives
Commonly used but ineffective methods:
Wearing charms or using spells/prayers will not prevent pregnancy.
Urinating after sex may help prevent urinary tract infections but does not prevent pregnancy.
• **Douching (washing out the...
ineffective contraception, douching, charms, spells, urinating after sex
Understanding Contraceptive Implants and Their Functionality
Reference Source: Where There is no Doctor a Village Health Care Handbook
Contraceptive implants are long-acting reversible contraception methods that prevent pregnancy by stopping the release of eggs from the ovaries and thickening cervical mucus to block sperm.

### Types of Implants:
Jadelle: Contains 2...
contraceptive implants,jadelle,implanon,norplant,hormone contraception,long-acting contraception,menstrual changes,removal of implants,fertility return

Ocular Injuries (27)

Perform Lateral Canthotomy/Cantholysis
Critical Source: Emergency War Surgery
Do not perform such procedures if the eyeball structure has been violated. If the eye is sliced open, apply a Fox shield for protection and seek immediate ophthalmic surgical support.

### Steps:
1. Inject **2% lidocaine with 1:100,000...
lateral canthotomy, cantholysis, eye injury, orbital pressure, emergency surgery
Enucleation in the Absence of an Ophthalmologist
Critical Source: NATO Emergency War Surgery
Procedure:

1. Enucleation should only be performed if:
- The globe is completely disorganized, or
- The patient has no light perception using the brightest available light source.
2. Confirm that the injury involves an **extensive...
enucleation procedure, globe removal, silicone sphere insertion
Immediate Treatment of an Open Globe Injury
Critical Source: Emergency War Surgery
Procedure:

1. Apply a rigid eye shield (do not use a pressure patch) over the injured eye.
2. Do not apply any pressure to or manipulate the eye.
3. Avoid applying topical medications to the eye.
4. Start **quinolone antibiotic...
open globe treatment, eye shield, antibiotic therapy, tetanus, ophthalmologist referral
Initial Management of Ophthalmic Injuries in Forward Areas
Critical Source: NATO Emergency War Surgery
Procedure:

1. Administer only first aid and initial treatment, including foreign body removal if applicable.
2. Do not remove any penetrating foreign bodies protruding from the globe or conjunctival fornices to prevent extrusion of ocular...
eye injury, ophthalmic trauma, forward area treatment, evacuation protocol, ocular foreign body removal
Managing Retrobulbar (Orbital) Hemorrhage
Critical Source: Emergency War Surgery
Management of Retrobulbar Hemorrhage:

Recognize the condition by looking for:
- Severe eye pain.
- Proptosis (bulging of the eye).
- Vision loss.
- Decreased eye movement.
• Marked lid edema may make proptosis hard to detect.
-...
retrobulbar hemorrhage,lateral canthotomy,eye pain,proptosis
Orbital Fracture and Retrobulbar Hemorrhage Management
Critical Source: NATO Emergency War Surgery
Procedure:

1. Perform a lateral canthotomy and cantholysis of the inferior crus of the lateral canthal tendon if retrobulbar hemorrhage is suspected.
2. If intraocular pressure or visual acuity does not improve, perform an incision...
orbital fracture management, retrobulbar hemorrhage treatment, canthotomy procedure
Recognize and Treat Retrobulbar (Orbital) Hemorrhage
Critical Source: Emergency War Surgery
Procedure:

1. Identify symptoms:
- Severe eye pain, proptosis, vision loss, decreased eye movement.
- Note that marked lid edema may obscure proptosis.
2. Immediate intervention: Perform a lateral canthotomy to relieve...
retrobulbar hemorrhage, proptosis, lateral canthotomy, eye pressure, vision loss
Treatment of Ocular Burns in Forward Areas
Critical Source: NATO Emergency War Surgery
Procedure:

1. For nonalkali chemical burns, irrigate with tap water or saline for 10 to 15 minutes under topical anesthesia.
2. For white phosphorus burns:
- Instill 0.5% copper sulfate solution to identify particles.
-...
chemical eye burn, alkali burn treatment, white phosphorus injury, irrigation protocol
Identify Severe Eye Injuries
High Priority Source: Emergency War Surgery
Procedure:

Assess for associated injuries:
• Look for shrapnel wounds of the face, which may indicate an intraocular foreign body (IOFB).
• Check for lid lacerations and assess for underlying globe laceration.

**Evaluate...
severe eye injury, ocular trauma, open globe, hyphema, proptosis
Lid Laceration Repair by Non-Ophthalmologist Surgeon
High Priority Source: NATO Emergency War Surgery
Procedure:

1. Ensure precise realignment of the lid anatomy (levator muscle, tarsal plate, medial canthal tendon).
2. Use 6-0 black silk sutures for lacerations through the skin horizontal to the lid margin.
3. For lid margin...
lid laceration repair, nonophthalmologist surgery, suture technique
Manage Hyphema to Prevent Vision Loss
High Priority Source: Emergency War Surgery
Procedure:

1. Check for open globe injury: If suspected, treat accordingly.
2. Avoid rebleeds:
- Avoid aspirin or NSAIDs.
3. Limit activity:
- No strenuous activity (bedrest) for 14 days.
- No reading for 7 days.
4....
hyphema, intraocular pressure, eye injury, acetazolamide, mannitol
Manage Orbital Floor (Blowout) Fractures
High Priority Source: Emergency War Surgery
Orbital floor (blowout) fractures are usually the result of a blunt injury to the globe or orbital rim, often associated with head and spine injuries. Blowout fractures may be suspected on the basis of:
• Enophthalmos
• Diplopia
• Decreased...
orbital fracture, blowout fracture, eye trauma, emergency treatment, CT scan
Management of Lid Lacerations with Tissue Loss Greater Than 25%
High Priority Source: Emergency War Surgery
Procedure for Managing Lid Lacerations with Tissue Loss Greater Than 25%

### Step-by-Step Procedure:
1. Assess Tissue Loss: If tissue loss exceeds 25%, a flap or graft is required.
2. Check for Orbital Fat in the Wound: If orbital fat...
eyelid avulsion, tissue graft, canalicular injury, ocular trauma
Management of Ocular Injuries in Corps/Communications Zone Hospitals (No Ophthalmologist Available)
High Priority Source: NATO Emergency War Surgery
Procedure:

1. Irrigate lid and conjunctival debris with any sterile irrigating solution, including water.
2. Apply topical ophthalmic antibiotics such as:
- Gentamycin sulfate,
- Chloramphenicol,
- Neomycin sulfate-polymixin B...
ophthalmic care without ophthalmologist, antibiotic application, gauze dressing protocol
Managing Hyphema (Blood in the Anterior Chamber)
High Priority Source: Emergency War Surgery
Management of Hyphema to Prevent Vision Loss:

• Be alert for a possible open globe injury, and treat it if suspected.
• Avoid rebleeding by following these steps:
- Avoid aspirin or NSAIDs.
- Rest in bed for 14 days (no...
hyphema,eye injury,intraocular pressure,acetazolamide,mannitol
Managing Hyphema or Vitreous Hemorrhage
High Priority Source: NATO Emergency War Surgery
Procedure:

1. Place the patient on bedrest with the head elevated to reduce intraocular pressure.
2. Apply a monocular patch over the affected eye to minimize movement and further trauma.
3. Prepare the patient for **immediate...
hyphema management, vitreous hemorrhage, bedrest, monocular patch, evacuation protocol
Nadbath Block for Ophthalmic Injuries
High Priority Source: NATO Emergency War Surgery
Procedure:

1. Inject 1.0 cc of 2% Xylocaine using a 23- to 27-gauge needle no longer than 10 mm.
2. Locate the triangular space formed by:
- The ear anteriorly,
- The mandible inferiorly,
- The mastoid process posteriorly.
3....
Nadbath block, facial nerve anesthesia, ocular protection, lid reflex prevention
Primary Closure of Corneal/Scleral Lacerations by Non-Ophthalmologist Surgeon
High Priority Source: NATO Emergency War Surgery
Procedure:

1. Use magnification (loupes or operating microscope) for precise closure.
2. Avoid introducing instruments into the eye through the wound.
3. Repair corneal lacerations first, using 7-0 silk sutures and fine ophthalmic...
corneal laceration closure, nonophthalmologist technique, silk suture use
Recognize and Manage Open Globe Injuries
High Priority Source: Emergency War Surgery
Procedure:

1. Identify the cause of open globe injury:
- May result from penetrating or blunt eye trauma.
2. Understand potential complications:
- Loss of vision due to disruption of ocular structures or secondary infection...
open globe diagnosis, imaging, endophthalmitis, intraocular foreign body
Repair of Marginal Lower-Eyelid Laceration with Less Than 25% Tissue Loss
High Priority Source: Emergency War Surgery
Procedure for Repairing a Marginal Lower-Eyelid Laceration with Less Than 25% Tissue Loss

### Step-by-Step Procedure:
1. Freshen Irregular Laceration Edges: Create a pentagonal wedge by removing as little tissue as possible (see Figure...
lid laceration, eyelid repair, surgical suture, ocular injury
Subconjunctival and Systemic Antibiotic Regimen for Ocular Infections
High Priority Source: NATO Emergency War Surgery
Procedure:

1. Administer subconjunctival injection of:
- Gentamycin 40 mg + Cephaloridine 100 mg, or
- Gentamycin 40 mg + Methicillin 100 mg.
2. Use topical proparacaine (0.5%) for anesthesia.
3. Administer via a small-volume...
subconjunctival injection, antibiotic regimen, systemic antibiotics for eye infections
Lacrimal Excretory System Stenting for Canaliculi Lacerations
High Priority Source: NATO Emergency War Surgery
Procedure:

1. Identify lacerations of the canaliculi during wound repair.
2. Insert a silicone tubing stent into the canaliculi to maintain patency.
3. If silicone is unavailable, use fine silver wire (e.g., 3-0 or 4-0 Bowman probe)...
canaliculi laceration repair, lacrimal stent insertion, silicone tubing use
Lacrimal Gland Prolapse Management
High Priority Source: NATO Emergency War Surgery
Procedure:

1. Identify prolapsed orbital lobe of the lacrimal gland (pinkish-gray in color, distinct from creamy-yellow orbital fat).
2. Irrigate and reposited the prolapsed lobe into its fossa.
3. Use a 4-0 chromic suture passed...
lacrimal gland prolapse, orbital lobe repossession, chromic suture technique
Triage Patients With Eye Injuries
High Priority Source: Emergency War Surgery
Procedure:

1. Prioritize ABCs (airway, breathing, and circulation) and life-threatening injuries before addressing eye injuries.
2. Soldiers with mild eye injuries may be treated by nonspecialized personnel and returned to duty.
3. Soldiers...
triage, eye injuries, ocular trauma, evacuation, medical emergency
Managing Superficial Corneal Foreign Bodies
Standard Source: NATO Emergency War Surgery
Procedure:

1. Administer local anesthesia using either 0.5% Opthaine, 0.5% Opthetic (Proparacaine hydrochloride), or 0.5% Pontocaine (Tetracaine hydrochloride).
2. Use a sharp-pointed instrument such as a large needle or eye spud to...
corneal foreign body removal, eye irrigation, antibiotic ointment, patching, evacuation criteria
Handling Subconjunctival Hemorrhage Without Vision Impairment
Standard Source: NATO Emergency War Surgery
Procedure:

1. Perform a thorough ophthalmoscopy through a well-dilated pupil to assess for any signs of intraocular damage.
2. If no blood is found in the anterior chamber or vitreous humor, and there is no decrease in visual acuity, no...
subconjunctival hemorrhage, ophthalmoscopy, no treatment required, vision assessment
Management, Recognition, and Prevention of Laser Eye Injuries
Standard Source: Emergency War Surgery + Medical NBC Battlebook
Procedure for Management, Recognition, and Prevention of Laser Eye Injuries:

### Prevention:
Preventive Measures: Wear eye protection designed for the appropriate light wavelengths if there is a known laser threat.

### Recognition:
1....
laser eye injury, corneal burn, retinal damage, eye protection, ophthalmologist, visual impairment, first aid

Diagnostics (25)

Conduct Initial Diagnostic Testing for Novel Influenza Patients
High Priority Source: HHSPandemicInfluenzaPlan
Procedure:

1. The general work-up should be guided by clinical indications and patient status.

2. Initial diagnostic testing may include the following:
- Pulse oximetry
- Chest radiograph
- **Complete blood count (CBC) with...
novel influenza, diagnostic testing, respiratory pathogens
Develop New Technologies for Detecting Emerging Influenza Subtypes
High Priority Source: HHSPandemicInfluenzaPlan
Objective: Develop more new technologies and platforms that allow for the detection and discrimination of newly emerging influenza virus subtypes.

Actions:
• Expand the use of molecular techniques to rapidly diagnose respiratory agents,...
emerging subtypes,molecular techniques,detection technologies,public health labs
Develop Rapid and Reliable Diagnostic Tests for Influenza Viruses
High Priority Source: HHSPandemicInfluenzaPlan
Objective: Support the development of rapid and reliable diagnostic tests for the identification and characterization of epidemic and pandemic influenza viruses.

Actions:
1. Develop new rapid antigen detection methods for use on...
influenza,diagnostics,rapid tests,subtype identification,molecular techniques,Flu Chip
Diagnosis and Imaging for Head Injuries
High Priority Source: Emergency War Surgery
Diagnostic Considerations for Head Injuries

Plain films:
- More useful in penetrating than blunt trauma.
- May reveal burst fractures of the skull indicating perforating force.
Computed tomography (CT):
- Essential for...
head injury imaging, CT scan for brain trauma, fragment path reconstruction
Prepare Subtype-Specific Reference Antisera for Avian Influenza Viruses
High Priority Source: HHSPandemicInfluenzaPlan
Procedure:

1. Identify avian influenza hemagglutinin (HA) and neuraminidase (NA) proteins from all relevant subtypes.
2. Generate subtype-specific reference antisera, including both monoclonal and polyclonal antibodies.
3. Validate the...
antisera,reference,virus,diagnostics
Evaluate Characteristics of Diagnostic Tests for Pandemic Influenza
High Priority Source: HHSPandemicInfluenzaPlan
Procedure:

To evaluate the characteristics of diagnostic tests for pandemic influenza:

1. Assess sensitivity, specificity, and accuracy of various diagnostic methods (e.g., PCR, rapid antigen tests, serology).
2. Compare performance across...
pandemic influenza, diagnostic tests, PCR, rapid antigen, sensitivity, specificity
Improve Diagnostic Tools for Influenza Surveillance
High Priority Source: HHSPandemicInfluenzaPlan
Procedure:

1. Develop improved rapid diagnostic tests for influenza that provide quick and accurate results.
2. Enhance laboratory assays to detect and subtype influenza viruses more rapidly and sensitively.
3. Implement high-capacity methods...
rapid diagnostic tests,virus subtyping,antiviral susceptibility testing,laboratory assays,epidemiological surveillance
Interpret Negative Test Results for Novel Influenza
High Priority Source: HHSPandemicInfluenzaPlan
Procedure:

1. Interpret negative test results on a case-by-case basis, in consultation with the local health department.

2. Consider the following criteria when evaluating whether to discontinue novel influenza-directed management:
-...
negative test results, diagnostic interpretation, novel influenza
Perform Real-Time RT-PCR for Influenza Detection
High Priority Source: HHSPandemicInfluenzaPlan
Procedure:

1. Collect respiratory specimens from patients suspected of having influenza.
2. Extract viral RNA from the specimen using standard protocols.
3. Use reverse transcriptase (RT) to synthesize a complementary DNA (cDNA) copy of the...
RT-PCR, influenza detection, viral RNA extraction, real-time PCR, diagnostic testing
Performing a Microneutralization Test for Avian Influenza A (H5N1) Antibodies
High Priority Source: HHSPandemicInfluenzaPlan
Procedure:

1. Prepare the microneutralization test kit:
- Ensure all reagents and materials are available, including the avian influenza A (H5N1) virus strain.
- Use a suitable dilution buffer for serum samples.

2. **Mix virus with...
microneutralization test, avian influenza A (H5N1), antibody detection, BSL-3, diagnostic assay
Using Rapid Diagnostic Tests for Influenza A and B Detection
High Priority Source: HHSPandemicInfluenzaPlan
Procedure:

1. Select the appropriate rapid test kit:
- Choose a CLIA-waived rapid diagnostic test that is FDA-approved (e.g., Directigen Flu A+B, FLU OIA A/B, QuickVue Influenza A/B, NOW Flu A Test, etc.).

2. **Collect specimen...
rapid diagnostic test, influenza A/B detection, CLIA-waived, office setting, antigen testing
Detect Bile in Urine Using the Iodine Ring Test
Standard Source: Survival and Austere Medicine
Procedure:

1. Fill a test tube three-fourths full with urine.
2. Carefully layer 10% alcoholic iodine solution over the top of the urine, creating two distinct layers (urine at the bottom and iodine on top).
3. Observe for the appearance of...
iodine ring test,bile detection,liver disease,gallbladder disease
Detect Proteins or Carbonates/Phosphates in Urine by Boiling and Acid Test
Standard Source: Survival and Austere Medicine
Procedure:

1. Fill a test tube three-fourths full with urine.
2. Boil the upper portion of the urine (not the entire sample) for approximately 5 minutes.
3. Observe for any cloudiness that forms:
- If cloudiness disappears after boiling,...
protein detection,carbonates,phosphates,urine boiling test,acetic acid test
Impact of User Modifications on Test Performance
Standard Source: HHSPandemicInfluenzaPlan
Modifications by the user can affect test performances and increase false-positive and/or false-negative rates. Such modifications include:
• Using specimens for which the test is not optimized.
• Using swabs that did not come with the rapid...
test performance,user modifications,specimen compatibility
Interpret Urine Color and Odor for Diagnostic Clues
Standard Source: Survival and Austere Medicine
Procedure:

1. Visually inspect the urine sample:
- Pink, red, or red-orange urine may indicate the presence of blood (hematuria), though it can also be caused by foods like beets, blackberries, or rhubarb.
- Green or blue-green...
urine color,urine odor,disease detection,maple syrup urine disease,phenylketonuria,glucose detection
Perform Urinalysis Using Multi-Function Dip Stix
Standard Source: Survival and Austere Medicine
Procedure:

1. Collect a clean catch urine sample:
- Begin urinating into the toilet.
- Stop, then start again into a sterile specimen container.
- Stop again and continue urinating into the toilet.
2. Dip the multi-function test strip...
urinalysis,test strips,dip stix,urine testing,diagnosis
Perform the Three-Glass Urine Test for Localizing Infection
Standard Source: Survival and Austere Medicine
Procedure:

1. Prepare three clean containers (glasses), with at least one container having a capacity of at least 500 ml.
2. Collect urine in the following manner:
- First glass: Collect the first 5 ml of urine.
- Second glass: Collect...
three-glass test,urine infection localization,urethral infection,kidney infection
Selecting Influenza Diagnostic Tests
Standard Source: HHSPandemicInfluenzaPlan
Selection of a test should take into consideration several factors:
• The types of specimens that are considered optimal for that test.
• Tests with high sensitivity and specificity will provide better positive and negative predictive...
test selection,specimen type,test sensitivity,sensitivity and specificity
Collecting Autopsy Specimens for Influenza A (H5) Detection via IHC Staining
Standard Source: HHSPandemicInfluenzaPlan
Procedure Overview: Collect and submit autopsy specimens to CDC for immunohistochemical (IHC) staining to detect influenza A (H5) viruses. Proper tissue collection increases the likelihood of virus detection.

Steps:
1. If influenza is...
autopsy specimens, influenza A (H5), IHC staining, tissue collection, CDC submission
Completing the Influenza Specimen Inventory Sheet for CDC Submission
Standard Source: HHSPandemicInfluenzaPlan
Procedure Overview: Complete and include the influenza specimen inventory sheet with all submitted specimens to CDC.

Steps:
1. Ensure that the CDC case ID number is included on the inventory sheet and on all materials sent to CDC.
2....
specimen inventory sheet, CDC submission, influenza surveillance, case ID number
Conduct Serologic Tests for Influenza (Hemagglutination Inhibition - HAI)
Standard Source: HHSPandemicInfluenzaPlan
Procedure:

1. Collect serum specimens from patients suspected of having influenza or for epidemiological surveillance.
2. Perform hemagglutination inhibition (HAI) testing to detect antibodies against specific influenza virus strains.
3....
serologic tests, HAI test, influenza antibody detection, immune response testing
Provide Medical Laboratory Support for Disease Diagnosis and Therapy Monitoring
Standard Source: TCCC 17 13 Army Tactical Combat Casualty Care
Objective: Provide limited laboratory support for disease diagnosis and monitoring of therapy.

Procedure:
1. Limited Facilities: Ensure that medical laboratories have the necessary equipment and personnel to perform basic diagnostic...
medical lab support,disease diagnosis,point-of-care diagnostics,microscopy training
Shipping Influenza Specimens to CDC for Reference Testing
Standard Source: HHSPandemicInfluenzaPlan
Procedure Overview: Properly ship influenza specimens to CDC for reference testing following specific guidelines.

Steps:
1. Contact the CDC Emergency Response Hotline (770-488-7100) before sending specimens for influenza A reference...
shipping influenza specimens, CDC reference testing, shipping regulations, specimen inventory sheet
Understand Influenza Diagnostic Assays and Methods
Standard Source: HHSPandemicInfluenzaPlan
Procedure:

1. Recognize the most commonly used diagnostic assays for influenza detection:
- Rapid antigen tests
- Reverse-transcription polymerase chain reaction (RT-PCR)
- Viral isolation
- **Immunofluorescence assays...
influenza diagnostics, RT-PCR, rapid antigen tests, viral isolation, IFA, serology
Understand the Use of a Stethoscope in Diagnosis
Reference Source: Where There is no Doctor a Village Health Care Handbook
Stethoscope is an instrument used to listen to internal body sounds such as the heartbeat, breath sounds, and bowel sounds.

What to do:
1. Place the diaphragm of the stethoscope on the patient’s chest or back for auscultation.
2. Listen...
stethoscope, auscultation, heart sounds, lung sounds

Abdominal Injuries (25)

Identify and Manage Acute Abdomen Emergency
Critical Source: Where There is no Doctor a Village Health Care Handbook
Acute abdomen is an emergency condition characterized by severe pain in the belly, often accompanied by vomiting and no diarrhea. This may require surgical intervention.

### Signs and Symptoms:
• Severe abdominal pain
• Vomiting (no diarrhea)
-...
acute abdomen, abdominal emergency, surgical intervention, severe pain, vomiting, no diarrhea
Identify and Treat Peritonitis
Critical Source: Where There is no Doctor a Village Health Care Handbook
Procedure:

1. Recognize symptoms: Look for signs of peritonitis, such as severe abdominal pain that worsens when the person tries to lie with their legs straight, a hard and rigid abdomen, fever, and nausea.
2. Assess severity:...
peritonitis, abdominal pain, inflammation, emergency treatment
Immediate Actions for Suspected Appendicitis or Peritonitis
Critical Source: Where There is no Doctor a Village Health Care Handbook
Procedure:

1. Seek medical help immediately:
- If possible, take the person to a facility where surgery can be performed.
2. Do not give anything by mouth, including food, liquids, or enemas.
3. Only if signs of dehydration appear...
appendicitis, peritonitis, dehydration, rehydration drink, emergency care
Management of Penetrating Abdominal Injuries to the Colon
Critical Source: NATO Emergency War Surgery
Procedure:

When managing penetrating abdominal injuries to the colon, follow these steps:

1. Do not close the injured colon. This is a critical rule in combat injuries.
2. Choose between two options for management:
- Perform a...
colon injury, abdominal trauma, colostomy, hemicolectomy, exteriorization, wound management
Managing Deep Abdominal Wounds from Gunshots
Critical Source: Where There is no Doctor a Village Health Care Handbook
Any wound that goes into the belly or gut is dangerous. Seek medical help immediately. But in the meantime:

• Cover the wound with a clean bandage.

• If the guts are partly outside the wound, cover them with a clean cloth soaked in lightly...
deep abdominal wound,gunshot injury,gut exposure,shock treatment,antibiotics
Classify Patient Based on Further Evaluation Findings
Critical Source: NATO Emergency War Surgery
Procedure:

1. Perform further evaluations to identify signs of intra-abdominal injury.
2. If the patient presents with any of the following, classify as Priority I:
- Bloody urine
- Bloody nasogastric aspirate
- **Blood in...
further evaluation, bloody urine, free air, intra-abdominal foreign bodies, priority I
Classify Patient Based on Injury Probability
Critical Source: NATO Emergency War Surgery
Procedure:

1. Classify the patient into one of three priorities based on clinical findings:
- Priority I: Definite intra-abdominal injury.
- Priority II: High probability of intra-abdominal injury.
- Priority III: Low...
patient classification, intra-abdominal injury, priority I, priority II, priority III
Classify Patient Based on Inspection Findings
Critical Source: NATO Emergency War Surgery
Procedure:

1. Inspect the patient for signs of evisceration (e.g., omentum, stool, bile, or urine leaking from a penetrating wound).
2. If there is evidence of loss of tissue from the abdominal wall, classify as Priority I.
3. Look for...
inspection, evisceration, abdominal distension, altered mental state, priority classification
Indications for Laparotomy Procedure
Critical Source: Emergency War Surgery
### Indications for Laparotomy – Who, When, and Where

Who Needs Surgery:
• Patients with:
- Penetrating abdominal wounds (as described in the box above)
- Other penetrating truncal injuries with potential for peritoneal penetration and...
laparotomy,indications,penetrating injuries,blunt abdominal trauma,stability,aeromedical evacuation
Initial Evaluation of Abdominal Wounds in Combat Casualties
Critical Source: NATO Emergency War Surgery
Objective: Determine the probability of intra-abdominal injury and prepare for surgical intervention.

### Actions:
1. Systematic Evaluation:
- Evaluate patients rapidly yet carefully, considering the unique challenges of combat...
intra-abdominal injury,combat casualty evaluation,hypovolemia,exploratory laparotomy
Manage Pancreatic Injuries in Trauma Patients
Critical Source: NATO Emergency War Surgery
Procedure:

1. All pancreatic injuries require drainage, generally closed suction drainage.
2. For simple, superficial, blunt, or penetrating injuries, closed suction drainage may suffice.
3. **For deeper injuries involving major...
pancreatic injury, drainage, Roux-en-Y anastomosis, pancreaticoduodenectomy, fistula management
Managing Abdominal Injuries: Initial Assessment and Actions
Critical Source: First Aid in Armed Conflicts
Aims of the First Aider:
• If you find a wound on the front of the casualty’s abdomen, check for a corresponding entry or exit hole on the back or sides.
• Minimize shock.
• Minimize the risk of infection.
• Because there is a tendency for...
abdominal injury, shock management, infection prevention, vomiting management
Perform Diagnostic Peritoneal Lavage (DPL) for Blunt Abdominal Trauma
Critical Source: Emergency War Surgery
Procedure:

1. Indication: Use DPL when ultrasound (US) or CT scan are not available, or as a triage tool in blunt abdominal trauma.
2. Equipment Required:
- DPL kits (e.g., Arrow AK-09000, Baxter Lazarus-Nelson MLNK9001)
-...
diagnostic peritoneal lavage,dpl,blunt abdominal trauma,emergency surgery,field expedient substitution,war surgery
Perform Initial X-ray Evaluation for Abdominal Injuries
Critical Source: NATO Emergency War Surgery
Procedure:

1. Obtain simple KUB (Kidney-Ureter-Bladder) and lateral films of the abdomen.
2. Use these X-rays to search for radiopaque fragments.
3. Note that X-rays are only valuable if they show positive findings (e.g., foreign bodies, free...
x-ray, abdominal injury, radiopaque fragments, intravenous pyelogram, exploratory laparotomy
Perform Wound Exploration for Abdominal Injuries
Critical Source: Emergency War Surgery
Procedure:

1. Indication: Use wound exploration in stable patients with normal or equivocal physical examination after blast injuries or IEDs.
2. Equipment Required:
- Surgical instruments and lighting (ideally in the operating...
wound exploration,abdominal injuries,blast injuries,ieds,exploratory laparotomy,emergency surgery
Suspect Duodenal Injury in Trauma Patients
Critical Source: NATO Emergency War Surgery
Procedure:

1. Assess for signs of duodenal injury, including:
- Presence of missiles or missile tracks near the duodenum.
- Blood in the nasogastric tube and retroperitoneum.
- Air in the region of the duodenum.
2. **Consider...
duodenum injury, trauma, Kocher maneuver, nasogastric tube, suction drainage
Test for Appendicitis or Peritonitis Using Cough and Abdominal Pressure
Critical Source: Where There is no Doctor a Village Health Care Handbook
Procedure:

1. Have the person cough and observe if this causes sharp pain in the belly.
2. If no sharp pain occurs, proceed with the following steps:
- Slowly but forcefully press on the abdomen a little above the left groin until it hurts...
appendicitis, peritonitis, rebound pain, abdominal examination
Assess and Manage Gastrointestinal Injury from Blast Injuries
High Priority Source: NATO Emergency War Surgery
Objective: Identify signs of gastrointestinal injury caused by blast injuries and provide appropriate care.

Procedure:
1. Evaluate for signs of peritoneal irritation, such as involuntary guarding, rebound tenderness, and absent bowel...
gastrointestinal injury, visceral rupture, peritoneal irritation, abdominal X-ray, bowel perforation
Determine Indications for Laparotomy in Abdominal Injuries
High Priority Source: Emergency War Surgery
Procedure:

1. Identify patients who require surgery, including:
- Patients with penetrating abdominal wounds.
- Patients with other penetrating truncal injuries with potential for peritoneal penetration and clinical signs/symptoms of...
laparotomy, indications, abdominal injuries, forward surgical team, aeromedical evacuation
Diagnose Abdominal Injury Through History and Physical Examination
High Priority Source: Emergency War Surgery
Procedure:

1. Document a focused history, including:
- Time of injury
- Mechanism of injury
- Previous treatments employed
- Any drugs administered

2. Inspect the chest and abdomen thoroughly, especially in cases of...
abdominal injury, history, physical examination, laparotomy, penetrating injuries
Diagnosis of Abdominal Injury Procedure
High Priority Source: Emergency War Surgery
### Diagnosis of Abdominal Injury

Steps to Follow:

1. Document a focused history, including:
- Time of injury
- Mechanism of injury
- Previous treatments employed
- Any drugs administered

2. Inspect the chest and abdomen...
abdominal injury,laparotomy,diagnosis,penetrating injuries,physical examination
Interpret Ultrasound Views for Abdominal Injury Assessment
High Priority Source: Emergency War Surgery
Procedure:

1. Use a typical portable sonography device, as shown in Fig. 17-1.

2. Examine the abdomen through four standard locations (sonographic windows), as depicted in Fig. 17-2:
- Right upper quadrant (RUQ)
- Left upper quadrant...
ultrasound views, abdominal injury assessment, FAST interpretation
Perform Abdominal Ultrasound (FAST) for Trauma Assessment
High Priority Source: Emergency War Surgery
Procedure:

1. Use focused abdominal sonography for trauma (FAST) whenever available and when abdominal injury is suspected.

2. Equipment requirements:
- A 3.5 to 5 MHz curved probe is optimal.

3. **Examine the abdomen through four...
FAST, abdominal ultrasound, trauma assessment, focused sonography
Use CT Scan for Abdominal Injury Diagnosis in Stable Patients
Standard Source: Emergency War Surgery
Procedure:

1. Indication: Use CT scan for defining injured anatomy in stable patients with suspected abdominal injury.

2. Equipment Required:
- CT scanner and contrast material.

3. Procedure:
- Administer contrast if...
CT scan, abdominal injury, imaging, hollow organ leak, stable patient
Managing Penetrating Abdominal Injuries in Combat
Reference Source: Emergency War Surgery
Penetrating injuries below the nipples, above the symphysis pubis, and between the posterior axillary lines must be treated as abdominal injuries and mandate exploratory laparotomy.

**Posterior truncal penetrating injuries from the tip of the...
penetrating abdominal injury, exploratory laparotomy, combat trauma, retroperitoneal injury, intra-abdominal injury

Infection Treatment (24)

Administer Antibiotics for Infection After Early Pregnancy Loss
Critical Source: A Book for Midwives
Medicines to give on the way to medical help:

Inject 2 g ampicillin in the muscle, then reduce the dose to 1g, 4 times a day.
Inject 300 mg gentamicin in the muscle, 1 time a day (or 5 mg gentamicin for each kg the woman weighs).
-...
antibiotics, infection treatment, medical emergency, ampicillin, gentamicin, metronidazole, doxycycline
Administer Antibiotics for Womb Infection
Critical Source: A Book for Midwives
Procedure: Administer antibiotics as follows:

1. Gentamicin: Inject 80 mg in the muscle, 3 times a day for about 5 days.
2. Ampicillin: Give 2 g in the muscle or by mouth for the first dose, then give 1 g by mouth or injection 4 times a...
womb infection, gentamicin, ampicillin, metronidazole, antibiotics, postpartum care
Diagnosing and Treating Noma (Cancrum Oris)
Critical Source: Where There is No Dentist
Procedure:

1. Identify symptoms of noma, including severe facial swelling, ulcers, and tissue necrosis.
2. Assess the patient's nutritional status, as malnutrition is a contributing factor (page 121-124).
3. Administer antibiotics...
noma,cancrum oris,diagnosis,treatment
Immediate Actions for Maternal Fever and Infection
Critical Source: A Book for Midwives
Procedure:

1. Treat fever immediately as all infection in labor is dangerous.
2. Provide the mother with fluids such as water, rehydration drinks (see page 160), or herbal teas that lower temperature.
3. Give the mother a **sponge bath with...
fever treatment, infection management, maternal dehydration, rehydration, IV fluids
Administer Injections for Severe Infections
High Priority Source: Where There is No Dentist
Injections may be necessary in cases of severe infections when oral medication is not sufficient.

General Guidelines:
• It is always safer to take medicine by mouth, but injections are sometimes required for severe infections.
• Learn proper...
injection technique,severe infection,medicine administration
Administering Medication for Malaria Prevention and Treatment During Pregnancy
High Priority Source: A Book for Midwives
Procedure for Administering Medication to Prevent and Treat Malaria During Pregnancy

Overview:
Malaria is a serious infection that can be particularly dangerous during pregnancy. It may lead to complications such as anemia, miscarriage, or...
malaria prevention, malaria treatment during pregnancy, antimalarial drugs
Alternative Antibiotic Treatment if Injection Not Possible
High Priority Source: A Book for Midwives
If you cannot inject medicines or do not have the above medicines, give these by mouth instead:

Give 3.5 g ampicillin by mouth, 1 time only.
Give 100 mg doxycycline by mouth, 2 times a day for 10 days.
alternative antibiotics, oral treatment, infection management
Help a Woman with an Infection After Early Pregnancy Loss
High Priority Source: A Book for Midwives
Steps to help a woman with infection:

1. Remove tissue from the womb if present: Use one of the methods on pages 407 and 408 to empty the womb.
2. Give antibiotics: See below for specific dosages.
3. Prevent tetanus infection: Read...
infection treatment, early pregnancy loss, antibiotics, rehydration, plant medicine
Treating Clostridium Infections
High Priority Source: Survival and Austere Medicine
Procedure for Treating Clostridium Infections:

1. Identify the specific *Clostridium* species:
- C. perfringens/C. septicum: Common cause of gangrene.
- Treat with penicillins or metronidazole.
- **C. tetani...
Clostridium, gangrene, tetanus, botulism, C. difficile, metronidazole, penicillins
Administer Amoxicillin for Chlamydia Infections
High Priority Source: A Book for Midwives
Indication: For chlamydia infections.

Procedure:
1. Give 500 mg amoxicillin by mouth, three times daily, for a duration of 7 days.

Available Forms: Tablets of 250 and 500 mg; liquid for injection (125 or 250 mg per 5 ml); syrup...
amoxicillin, chlamydia treatment, antibiotic use
Administer Amoxicillin for Infection After Genital Cutting
High Priority Source: A Book for Midwives
Indication: For infection after genital cutting.

Procedure:
1. Give 500 mg amoxicillin by mouth, three times daily, for a duration of 10 days.

Available Forms: Tablets of 250 and 500 mg; liquid for injection (125 or 250 mg per...
amoxicillin, post-genital cutting infection treatment, antibiotic use
Administer Antibiotics Safely and Effectively
High Priority Source: Where There is No Dentist
To use antibiotics for infection:

General Guidelines:
1. Penicillin: Use only if the person is not allergic to it. Always keep epinephrine (Adrenalin) ready in case of an allergic reaction.
2. Erythromycin: Can be taken as tablets or...
antibiotic use,penicillin,erythromycin,nystatin,tetracycline,allergic reaction
Administer Erythromycin for Baby with Chlamydia
High Priority Source: A Book for Midwives
Procedure:

1. Use erythromycin syrup (30 mg per dose).
2. Administer by mouth 4 times a day for 14 days.
3. Ensure the baby is not allergic to macrolide family drugs.
4. Tablets should not be broken; they are coated for protection...
erythromycin,baby,chlamydia,antibiotic administration
Administer Erythromycin for Breast Infection, Chlamydia, or Chancroid
High Priority Source: A Book for Midwives
Procedure:

1. Use erythromycin tablets (500 mg).
2. Administer by mouth 4 times a day for 7 days.
3. Ensure the patient is not allergic to macrolide family drugs.
4. Tablets should not be broken; they are coated for protection against...
erythromycin,breast infection,chlamydia,chancroid,antibiotic administration
Administer Erythromycin for Infection After Genital Cutting
High Priority Source: A Book for Midwives
Procedure:

1. Use erythromycin tablets (500 mg).
2. Administer by mouth 4 times a day for 10 days.
3. Ensure the patient is not allergic to macrolide family drugs.
4. Tablets should not be broken; they are coated for protection against...
erythromycin,genital cutting infection,antibiotic administration
Administer Erythromycin for Newborn Eye Care
High Priority Source: A Book for Midwives
Procedure:

1. Use 0.5% or 1% erythromycin ointment.
2. Apply the ointment once only, within 2 hours of birth.
3. Ensure the application is done carefully to prevent contamination.
4. Follow instructions for proper administration as...
erythromycin,newborn eye care,antibiotic administration,macrolide allergy
Administer Erythromycin for Syphilis or Pelvic Infection
High Priority Source: A Book for Midwives
Procedure:

1. Use erythromycin tablets (500 mg).
2. Administer by mouth 4 times a day for 14 days.
3. Ensure the patient is not allergic to macrolide family drugs.
4. Tablets should not be broken; they are coated for protection against...
erythromycin,syphilis,pelvic infection,antibiotic administration
Administer Gentamicin for Infection in a Newborn
High Priority Source: A Book for Midwives
Procedure:

1. Use gentamicin injection (4 mg per kg of the baby’s weight).
2. Administer by muscle injection, once a day for 7 days.
3. Ensure the patient is not allergic to aminoglycoside family drugs.
4. Provide plenty of fluids...
gentamicin,newborn infection,antibiotic administration
Managing Medication for Infections During Pregnancy and Postpartum
High Priority Source: A Book for Midwives
Procedure for Managing Medications to Treat Infections During Pregnancy and Postpartum

Overview:
Infections such as bacterial vaginosis (BV), chlamydia, gonorrhea, and yeast infections must be treated carefully during pregnancy and...
pregnancy infections, bacterial vaginosis, chlamydia, gonorrhea, yeast infection treatment
Treating Bacteroides Infections
High Priority Source: Survival and Austere Medicine
Procedure for Treating Bacteroides Infections:

1. Identify the infection type: Commonly caused by *Bacteroides sp.* following injury to the bowel or wound contamination, leading to abscess formation.
2. First-line treatment:
-...
Bacteroides, infection treatment, metronidazole, chloramphenicol, cefotaxime, Zosyn, imipenem
Administer Hyperbaric Oxygen Therapy for Clostridial Myonecrosis
Standard Source: NATO Emergency War Surgery
Procedure:

1. Indication: Use hyperbaric oxygen therapy (HBOT) as an adjunct to surgical treatment in patients with clostridial myonecrosis who show signs of systemic toxicity.

2. Equipment Required: A hyperbaric chamber capable of...
hyperbaric oxygen therapy,clostridial myonecrosis,infection treatment,surgical debridement,antibiotics
Contraindications and Limitations of Hyperbaric Oxygen Therapy
Standard Source: NATO Emergency War Surgery
Procedure:

1. **Identify Contraindications:
- HBOT is not effective for infections caused by anaerobic Streptococci, *Escherichia coli*, or *Klebsiella* species.
- It should not be used as a standalone treatment but only in conjunction...
hyperbaric oxygen therapy,contraindications,limitations,infection treatment,surgical debridement
Treating Chlamydia Infections
Standard Source: Survival and Austere Medicine
Procedure for Treating Chlamydia Infections:

1. Identify the infection type: Caused by *Chlamydia sp.*, including:
- *C. pneumonia*: Responsible for atypical pneumonia.
- *C. trachomatis*: Causes sexually transmitted disease (STD)...
Chlamydia, atypical pneumonia, tetracyclines, macrolides, doxycycline, azithromycin
Treating Mycoplasma Pneumoniae Infections
Standard Source: Survival and Austere Medicine
Procedure for Treating Mycoplasma Pneumoniae Infections:

1. Identify the infection type: Caused by *Mycoplasma pneumoniae*, responsible for atypical pneumonia.
2. First-line treatment:
- Administer macrolides (e.g., azithromycin...
Mycoplasma pneumoniae, atypical pneumonia, macrolides, tetracyclines, azithromycin, doxycycline

Trauma Surgery (24)

Assess and Manage Penetrating Neck Trauma
Critical Source: Emergency War Surgery
Introduction

• Vascular injuries occur in 20% of penetrating neck trauma cases, while aerodigestive tract injuries occur in 10%.
• Mortality is primarily due to exsanguinating hemorrhage.
• Esophageal injury may lead to...
penetrating neck trauma, vascular injury, aerodigestive injury, neck zones, surgical strategy, clinical signs, emergency surgery
Diagnosing Tracheobronchial Tree Injury
Critical Source: Emergency War Surgery
Suspect tracheobronchial tree injury with the following signs and symptoms:

• Massive air leak
• Frothy hemoptysis
• Pneumomediastinum

Confirm diagnosis via bronchoscopy.

Airway control is paramount.

Preferred surgical approach:...
tracheobronchial injury,airway control,bronchoscopy,median sternotomy,absorbable suture
Establishing Priorities for Care in Multiple Injuries
Critical Source: NATO Emergency War Surgery
Procedure:

1. Assess Casualty Thoroughly: Evaluate casualties who are seen by medical personnel for the first time at a hospital carefully, reassessing the accuracy of findings and response to previous treatment with each admission along...
multiple injuries,priority for treatment,casualty evaluation
Initial Hospital Evaluation of Casualty in Shock State
Critical Source: NATO Emergency War Surgery
Procedure:

1. Assess Airway, Bleeding Control, and Blood Volume Restoration:
- Ensure airway is clear.
- Control any external bleeding.
- Begin fluid administration immediately to restore blood volume.

2. **Gather Casualty...
shock, resuscitation, initial evaluation, casualty assessment, airway management, bleeding control, fluid administration, capillary refill test, hidden blood loss, chest wound, thoracostomy, IV infusion, hematocrit
Alternative Repair for Old Esophageal Injuries
Critical Source: Emergency War Surgery
For esophageal injuries too old for primary repair:

1. Close the injury over a large T-tube, converting it to a controlled fistula.
2. Widely drain the mediastinum using chest tubes or closed suction catheters placed nearby.
3. After a mature...
T-tube repair,controlled fistula,mediastinum drainage
Determine Indications for Blood Transfusion in Trauma Patients
Critical Source: NATO Emergency War Surgery
Objective: Identify when blood transfusion is indicated based on volume loss and clinical status.

Procedure:
1. Limit blood transfusions to cases of severe and ongoing hemorrhage where blood loss exceeds 30% of total blood volume (i.e.,...
blood transfusion, hematocrit, oxygen delivery, trauma surgery, volume loss
Esophageal Injury and Repair
Critical Source: Emergency War Surgery
Procedure:

1. Diagnose esophageal injury early; it may be asymptomatic in 25% of cases.
2. Missed injuries can lead to significant late morbidity/mortality.
3. Use air insufflation during exploration to aid identification of the...
esophageal injury,repair,muscle flap,drainage,barium swallow
Managing Esophageal Injury in a Forward Location
Critical Source: Emergency War Surgery
Isolated thoracic esophageal injuries are rare and usually diagnosed incidentally with other intrathoracic injuries.

Diagnostic clues include:

• Pain
• Fever
• Leucocytosis
• Cervical emphysema
• Hamman’s sign
• Chest X-ray (CXR) evidence...
esophageal injury,chest tube,nasogastric tube,IV antibiotics,primary repair
Managing Internal Jugular Vein Injury
Critical Source: Emergency War Surgery
Procedure:

1. Repair the internal jugular vein preferably by lateral suture.
2. If ligation is necessary, ensure that the contralateral internal jugular vein is patent.
3. Control airway immediately via intubation or tracheotomy (avoid...
internal jugular vein injury,larynx,trachea,suture,ligation,airway control,stent
Repairing Diaphragmatic Injuries
Critical Source: Emergency War Surgery
All diaphragmatic injuries should be closed.

For simple small lacerations (<2 cm):

• Reapproximate with interrupted nonabsorbable 0 or 1-0 horizontal mattress sutures.

For larger lacerations (>2 cm):

1. Approximate as above.
2....
diaphragmatic repair,nonabsorbable suture,pleural contamination,empyema
Surgical Repair of Intrathoracic Esophageal Injury
Critical Source: Emergency War Surgery
Preferred approach for intrathoracic esophageal injury: Posterolateral thoracotomy (right for upper esophagus, left for lower esophagus).

Steps for repair:

1. Locate the injury by mobilizing the esophagus.
2. Perform primary repair with a...
esophageal repair,posterolateral thoracotomy,absorbable suture,chest tube,gastrostomy tube
Tracheal Injury and Reconstruction
Critical Source: Emergency War Surgery
Procedure:

1. Debride small anterior tracheal wounds.
2. Insert a tracheostomy tube through the wound after debridement.
3. Repair simple lacerations with absorbable monofilament suture.
4. Resect up to 5 cm of trachea, ensuring proximal...
tracheal injury,reconstruction,tracheostomy,suture,mobilization
Assess Hemodynamic Response to Initial Fluid Infusion
High Priority Source: NATO Emergency War Surgery
Objective: Determine the patient's hemodynamic response to initial fluid infusion.

Procedure:
1. Monitor the patient for a prompt normalization of blood pressure and sustained hemodynamic stability after the initial fluid bolus.
2. If the...
hemodynamic response, fluid bolus, volume loss, surgical intervention, trauma surgery
Connect Chest Tubes to Underwater Seal and Suction
High Priority Source: NATO Emergency War Surgery
Procedure:

1. Assess the casualty for chest injuries or signs of pneumothorax (e.g., shortness of breath, decreased breath sounds).
2. Prepare the underwater seal system, ensuring it is functional and free from damage.
3. **Insert a...
chest tubes, underwater seal, suction, thoracic injury, pneumothorax
Management of Hindfoot Injuries
High Priority Source: Emergency War Surgery
Objective: Properly manage injuries to the hindfoot, including fractures and penetrating wounds.

Steps:
Severely comminuted open fractures of the talus: May require talectomy; refer to higher levels of care for decision-making.
-...
hindfoot injury, talus fracture, heel pad wound, gunshot wound, debridement approach
Post-Definitive Hemorrhage Control Resuscitation Endpoints
High Priority Source: Emergency War Surgery
Objective: Ensure adequate resuscitation after definitive hemorrhage control has been achieved.

Procedure Steps:
1. Achieve the following endpoints:
- Systolic blood pressure (SBP) > 120 mm Hg.
- Mean arterial pressure (MAP) > 70...
resuscitation endpoints, post-hemorrhage control, urine output, acidosis correction, hypothermia prevention
Repair of Major Vein Injuries in Combat Zones
High Priority Source: NATO Emergency War Surgery
Procedure:

1. Assess for major vein injuries, particularly to the iliac, common femoral, superficial femoral, and popliteal veins.
2. Repair these veins whenever possible to prevent complications such as edema and post-phlebitic...
vein repair, major vein injury, saphenous vein graft, post-phlebitic syndrome, combat surgery
Selection of Vascular Conduit or Patch Material in Trauma Surgery
High Priority Source: NATO Emergency War Surgery
Procedure:

1. Choose the appropriate conduit or patch material for vascular repair:
- Greater saphenous vein from the uninjured extremity is preferred due to its durability and suitability.
2. If not available, use the **lesser...
vascular conduit, saphenous vein, synthetic grafts, PTFE, trauma surgery
Stabilization of Unstable Fractures Before Vascular Repair
High Priority Source: NATO Emergency War Surgery
Procedure:

1. Assess for unstable fractures that may compromise vascular repairs.
2. Regain bone length and rapidly realign and stabilize fractures prior to vascular repair.
3. Avoid internal fixation, as it increases the risk of...
unstable fractures, vascular repair, external fixation, dislocation reduction, combat surgery
Manage Injuries to the Toes
High Priority Source: Emergency War Surgery
Procedure:

1. Preservation of the Great Toe:
- Make every effort to preserve the great toe due to its critical role in gait and function.

2. Amputation of Lateral Toes:
- Amputation of lateral toes is generally well-tolerated and...
toe injury, great toe preservation, lateral toe amputation
Management of Concomitant Nerve Injuries in Vascular Trauma
High Priority Source: NATO Emergency War Surgery
Procedure:

1. Identify concomitant nerve injuries associated with vascular trauma, especially in the upper extremity.
2. Avoid immediate repair of nerve injuries in combat zones due to limited resources and high risk of infection or...
nerve injury, vascular trauma, combat surgery, nonresorbable suture, delayed repair
Management of Toe Injuries
High Priority Source: Emergency War Surgery
Objective: Preserve function and minimize disability in toe injuries.

Steps:
Preserve the great toe: Make every effort to save the great toe due to its critical role in foot function.
Amputation of lateral toes: Generally...
toe injury, great toe preservation, lateral toe amputation
Oral Rehydration Fluids for Dehydration and Hemorrhage
Standard Source: Emergency War Surgery
Objective: Provide oral rehydration fluids in appropriate clinical contexts.

Procedure Steps:
1. Indication: Use for dehydration controlled hemorrhage or burns (only on the third day).
2. Composition of fluid:
- Nonsterile...
oral rehydration, dehydration management, fluid of opportunity
Evaluate for Bladder Injuries in Trauma Patients
Reference Source: Emergency War Surgery
Indications for suspecting bladder injury:

• Lower abdominal gunshot wounds
• Pelvic fractures with gross hematuria
• Inability to void following abdominal or pelvic trauma

Consideration of Injury Location:

• Bladder disruptions can occur...
bladder injury, trauma patient, cystogram, pelvic fracture, hematuria, urethral integrity

Eye Injuries (24)

Identify Danger Signs for Eye Injuries and Conditions
Critical Source: Where There is no Doctor a Village Health Care Handbook
Danger signs requiring immediate medical attention:

1. Any injury that cuts or ruptures (goes through) the eyeball.

2. Painful, grayish spot on the cornea, with redness around the cornea (corneal ulcer).

3. **Great pain inside the...
eye injury, corneal ulcer, glaucoma, retinoblastoma, cataract
Treatment of Corneal Ulcer and Bacterial Keratitis
Critical Source: Emergency War Surgery
Procedure for Treating Corneal Ulcer or Bacterial Keratitis

1. Administer quinolone drops, such as Ocuflox, with the following schedule:
- 1 drop every 5 minutes for 5 doses initially
- Then 1 drop every 30 minutes for **6...
corneal ulcer, bacterial keratitis, quinolone drops, ophthalmologist referral
Treatment of Severe Chemical Eye Injuries
Critical Source: Emergency War Surgery
Procedure for Treating Severe Acid or Alkali Chemical Injuries to the Cornea

1. If severe chemical injury is suspected, based on signs such as:
- Pronounced chemosis
- Limbal blanching
- Corneal opacification
2. Administer...
severe chemical injury, prednisolone drops, scopolamine drops, ophthalmologist referral
Examination and Diagnosis of Ocular Injuries
Critical Source: NATO Emergency War Surgery
Procedure:

1. Record the circumstances of injury and type of wounding agent:
- This is essential for proper diagnosis and management.

2. **Suspect penetrating ocular injury in every wound to the eye or upper portion of the face until...
ocular examination,penetrating injury,topical anesthesia,lid retraction,visual acuity assessment
Irrigation of Chemical Eye Injuries
Critical Source: Emergency War Surgery
Procedure for Immediate Irrigation of Chemical Injuries to the Cornea

1. Immediately begin copious irrigation with normal saline (NS), lactated Ringer’s (LR), or balanced salt solution for 30 minutes.
2. If no sterile...
chemical eye injury, irrigation, pH testing, fluorescein test, corneal damage
Treatment of Mustard Eye Injuries
Critical Source: Emergency War Surgery
Procedure for Treating Mustard (Lewisite) Eye Injuries

1. Apply ophthalmic ointments, such as 5% boric acid ointment, to provide lubrication and minimal antibacterial effects.
2. Apply sterile petrolatum jelly between the eyelids to...
mustard eye injury, boric acid ointment, petrolatum jelly
Treatment of Nerve Agent Ocular Symptoms
Critical Source: Emergency War Surgery
Procedure for Treating Ocular Symptoms from Nerve Agents

1. Apply 1% atropine sulfate ophthalmic ointment, repeating as needed every several hours for 1–3 days.
2. Monitor the patient closely and refer to an ophthalmologist if symptoms...
nerve agent, atropine ointment, ocular symptoms
Assessing Intraocular Tension in Eye Injuries
High Priority Source: NATO Emergency War Surgery
To assess intraocular tension:

1. Use very gentle digital palpation with the tips of the index fingers.
2. Perform ballottement of the globes through the upper, closed eyelids.
3. First test the tone of the unaffected eye, then...
intraocular tension assessment, eye injury evaluation, ocular trauma detection
Assessing Laser Eye Injury Based on Wavelength
High Priority Source: NATO Emergency War Surgery
Procedure for Assessing Laser Eye Injury Based on Wavelength

1. Identify the type of laser injury based on wavelength:
- Ultraviolet (below 400 nm): Absorbed primarily by the cornea and lens.
- Look for signs such as corneal...
laser injury, eye injury, wavelength, cornea damage, retinal burn
Assessing Laser Irradiance and Its Impact on the Eye
High Priority Source: NATO Emergency War Surgery
Procedure for Assessing Laser Irradiance and Its Impact on the Eye

1. Understand irradiance:
- Irradiance is the concentration of energy per unit area, measured in watts per square centimeter.
- It increases as the distance from the...
irradiance, laser exposure, optical devices, corneal burn, retinal necrosis
Assessing Light Perception in Eye Injuries
High Priority Source: NATO Emergency War Surgery
To assess light perception in an injured eye:

1. Use a very bright light source.
2. Alternate the light between in front of and away from the eye.
3. Shield the other eye completely to prevent any light from reaching it.
4. Carefully question...
light perception, eye injury assessment, ocular trauma, spurious response detection
Considering Eye Salvage in Severe Ocular Injuries
High Priority Source: NATO Emergency War Surgery
When considering the possibility of salvaging an injured eye:

1. Unless total disruption is evident, consider the possibility of salvaging the eye.
2. This may be possible even with questionable light perception, as vitreous hemorrhage can...
eye salvage considerations, ocular trauma management, vitreous surgery, enucleation decision
Identifying Corneal and Scleral Lacerations in Eye Injuries
High Priority Source: NATO Emergency War Surgery
To identify corneal and scleral lacerations:

1. Look for loss of the anterior chamber and distortion of the pupil, which are signs of corneal laceration.
2. Note iris incarceration or prolapse through the wound, common in corneal...
corneal laceration identification, scleral laceration detection, ocular trauma assessment
Initial Management of Ocular Injuries in Battlefield Conditions
High Priority Source: NATO Emergency War Surgery
Procedure:

1. Assess the severity of the injury:
- Minor injuries may be treated on-site and the casualty sent back to his unit.
- Serious injuries require prompt evacuation for specialized care.
- The distinction between minor and...
ocular injury,battlefield treatment,eye trauma,initial management,vision salvage
Inspecting the Anterior Chamber of the Eye
High Priority Source: NATO Emergency War Surgery
To inspect the anterior chamber of the eye:

1. Use a bright light placed near the cornea.
2. Direct the light from the temporal to nasal side.
3. Use a +18D refracting lens or the **high plus (black numbered) lenses on the...
anterior chamber inspection, eye injury assessment, ocular trauma, hyphema detection
Manage Bleeding Behind the Cornea (Hyphema)
High Priority Source: Where There is no Doctor a Village Health Care Handbook
Procedure:

1. Assess the situation:
- If there is pain and loss of sight, immediately refer the person to an eye specialist.
- If the pain is mild and there is no loss of sight, proceed with the following steps:

2....
hyphema, eye injury, bleeding behind cornea, glaucoma, patch eyes, rest in bed
Manage Corneal Frostbite
High Priority Source: US Marine Corps Wilderness Medicine
Procedure for Managing Corneal Frostbite:

1. Apply antibiotic ointment to the affected eye(s) immediately after exposure.

2. Do not patch the eyes, as this can increase the risk of infection or further damage.

3. **Avoid rubbing or...
corneal frostbite,cold injury,eye protection,wind chill,snowmobiling,vision loss
Managing Flash Blindness and Retinal Burns from Nuclear Detonation
High Priority Source: Emergency War Surgery
Flash blindness may occur due to sudden exposure to intense light energy from a nuclear detonation. Retinal burns can also occur, leading to scarring and permanent altered visual acuity.

1. Assess vision immediately: Look for signs of...
flash blindness, retinal burns, nuclear detonation, ocular injury
Treat a Corneal Ulcer or Scar
High Priority Source: Where There is no Doctor a Village Health Care Handbook
Procedure:

1. Identify a corneal ulcer: A painful, grayish or less shiny patch on the cornea that may result from injury or infection.
2. Apply antibiotic eye ointment 4 times a day for 7 days (see p. 378 of the source text).
3. If...
corneal ulcer,corneal scar,antibiotic ointment,surgery,transplant,vision loss
Treatment of Mild Chemical Eye Injuries
High Priority Source: Emergency War Surgery
Procedure for Treating Mild Chemical Injuries to the Cornea

1. After irrigation and pH normalization:
- If no epithelial defect is present, treat with artificial tears.
2. If an epithelial defect is present (confirmed by...
mild chemical injury, antibiotic ointment, epithelial defect, fluorescein test
Understanding Continuous vs Pulsed Laser Effects on the Eye
High Priority Source: NATO Emergency War Surgery
Procedure for Understanding Continuous vs Pulsed Laser Effects on the Eye

1. Differentiate between continuous and pulsed lasers:
- Continuous wave lasers: Constant emission of energy, varying from fractions of a watt to kilowatts.
...
continuous laser, pulsed laser, thermal injury, mechanical injury, retinal tear
Prevent and Treat Snow Blindness
High Priority Source: USMC Winter Survival Course Handbook
Definition:
Snow blindness is a sunburn of the cornea.

Causes:
High altitude increases exposure to ultraviolet (UV) rays, which are the primary cause of snow blindness.
Snow reflects UV rays, increasing their intensity and...
snow blindness, corneal sunburn, UV protection, eye injury, sunglasses, field expedient
Prevent and Treat Snow Blindness in Cold Weather Conditions
High Priority Source: FM 31 70 Basic Cold Weather Manual
Causes:
• Reflection of ultraviolet rays from snow, ice, or water surfaces.
• Increased risk at high altitudes or after a fall of new snow.

Symptoms:
• Sensation of grit in the eyes
• Pain in and over the eyes (worsened by eye movement)
-...
snow blindness, eye protection, cold weather, first aid for snow blindness
Treating Snowblindness
Standard Source: FM 3 97 61 Military Mountaineering
Procedure for Treating Snowblindness:

1. Patch both eyes with cold compresses for 24 hours to reduce pain and inflammation.
2. Use topical anesthetics such as Tetracaine Ophthalmic to relieve eye discomfort.
3. **Avoid rubbing the...
snowblindness,treatment,cold compresses,topical anesthetic,pain medication

Decontamination Procedures (24)

Decontaminate Buddy's Hood and Mask for CB Contamination
High Priority Source: STP 21 24 Army Warrior Leader Skills Level 2 3 and 4
Procedure: Decontaminate Buddy 2's hood and mask for chemical-biological (CB) contamination.

Steps:
1. Use the M291 decontaminating kit to clean all exposed surfaces of Buddy 2's hood and mask.
2. Ensure that all decontamination is thorough...
decontaminate,Buddy,hood,mask,CB,warrior skills
Decontaminate Individual Gear for CB Contamination
High Priority Source: STP 21 24 Army Warrior Leader Skills Level 2 3 and 4
Procedure: Decontaminate individual gear for chemical-biological (CB) contamination without assistance.

Steps:
1. Use the M291 decontaminating kit to clean all exposed surfaces of your gear, including the hood, mask, and outerwear.
2....
decontaminate,gear,CB,chemical-biological,individual,warrior skills
Decontaminate Individual Gear for Chemical or Biological Contamination
High Priority Source: STP 21 1 Warrior Skills Level 1
Steps:

1. Remove and discard the chemical protective helmet cover.
2. Cover the gear with STB slurry paste.
3. Brush or rub the STB slurry paste into the material.
4. Shake the excess off gently.
5. **Set the gear aside on an...
chemical decontamination,biological decontamination,STB slurry paste,MOPP gear exchange
Decontaminate the Mask and Hood (Chemical or Biological Contamination)
High Priority Source: STP 21 1 Warrior Skills Level 1
Steps:

1. The buddy uses M295 to decontaminate the exposed parts of the mask, instructing the Soldier to put two fingers on the voicemitter to avoid breaking the seal.
2. **The buddy starts at the eye lens outserts and wipes all exposed...
mask decontamination,M295,hood seal,voicemitter
Decontamination of Equipment in Radiological Contaminated Areas
High Priority Source: Medical NBC Battlebook
Decontamination of Equipment in Radiological Contaminated Areas

1. Conduct a radiation survey: Before decontamination, perform a radiation survey of the equipment.
2. Use appropriate cleaning methods: In most cases, household cleaning...
equipment decontamination, radiation survey, cleaning methods
Extensive Decontamination Procedures for Radiologically Contaminated Patients
High Priority Source: Medical NBC Battlebook
Extensive Decontamination Procedures for Radiologically Contaminated Patients

1. Scrubbing persistent contamination: Use a mild detergent or diluted strong detergent to scrub areas of persistent contamination.
2. Skin integrity caution:...
wound decontamination, skin protection, waste management
Patient Decontamination in Radiological Contaminated Areas
High Priority Source: Medical NBC Battlebook
Patient Decontamination in Radiological Contaminated Areas

1. Initial decontamination: Ninety to ninety-five percent of contamination can be removed by simply removing the patient’s outer clothing and shoes.
2. **Handling contaminated...
patient decontamination, radiological hazards, monitoring
Set Up Decontamination Area with Proper Drainage and Ventilation
High Priority Source: NATO Emergency War Surgery
A decontamination area should be set up under shelter, and provided with temperature-controllable water and drainage away from the hospital. If prevailing winds exist, this area should be downwind from the hospital. A separate area nearby is...
decontamination setup, drainage, wind direction, waste disposal
Move to the Assembly Area
High Priority Source: STP 21 24 Army Warrior Leader Skills Level 2 3 and 4
Procedure: Move to the assembly area after decontamination.

Steps:
1. Ensure that all gear is properly secured and functioning before moving.
2. Follow designated routes or paths to the assembly area to avoid re-contamination.
3. Maintain a...
move,assembly area,warrior skills
Put on Gloves
High Priority Source: STP 21 24 Army Warrior Leader Skills Level 2 3 and 4
Procedure: Put on gloves during decontamination.

Steps:
1. Ensure that the gloves are completely uncontaminated and stored in a sealed container or bag.
2. Open the package containing the gloves without touching the outside of the package...
put on,gloves,warrior skills
Put on Overboots
High Priority Source: STP 21 24 Army Warrior Leader Skills Level 2 3 and 4
Procedure: Put on overboots during decontamination.

Steps:
1. Ensure that the overboots are completely uncontaminated and stored in a sealed container or bag.
2. Open the package containing the overboots without touching the outside of the...
put on,overboots,warrior skills
Put on an Uncontaminated Overgarment
High Priority Source: STP 21 24 Army Warrior Leader Skills Level 2 3 and 4
Procedure: Put on an uncontaminated overgarment during decontamination.

Steps:
1. Ensure that the overgarment is completely uncontaminated and stored in a sealed container or bag.
2. Open the package containing the overgarment without...
put on,overgarment,uncontaminated,warrior skills
Remove Buddy's Jacket
High Priority Source: STP 21 24 Army Warrior Leader Skills Level 2 3 and 4
Procedure: Remove Buddy 2's jacket safely during decontamination.

Steps:
1. Ensure that you are wearing full protective gear to avoid exposure to contaminants.
2. Grasp the back of Buddy 2's jacket and carefully pull it over their head,...
remove,Buddy,jacket,warrior skills
Remove Buddy's Rubber Gloves
High Priority Source: STP 21 24 Army Warrior Leader Skills Level 2 3 and 4
Procedure: Remove Buddy 2's rubber gloves safely during decontamination.

Steps:
1. Ensure that you are wearing full protective gear to avoid exposure to contaminants.
2. Grasp the wrist portion of Buddy 2's rubber gloves and carefully pull...
remove,Buddy,rubber gloves,warrior skills
Remove Buddy's Trousers
High Priority Source: STP 21 24 Army Warrior Leader Skills Level 2 3 and 4
Procedure: Remove Buddy 2's trousers safely during decontamination.

Steps:
1. Ensure that you are wearing full protective gear to avoid exposure to contaminants.
2. Grasp the waistband of Buddy 2's trousers and carefully pull them down,...
remove,Buddy,trousers,warrior skills
Roll Buddy's Hood
High Priority Source: STP 21 24 Army Warrior Leader Skills Level 2 3 and 4
Procedure: Roll Buddy 2's hood properly after decontamination.

Steps:
1. Ensure that the hood is completely dry and free of contamination before rolling it.
2. Carefully roll the hood from the bottom up, ensuring that no part of the hood...
roll,Buddy,hood,warrior skills
Secure the Gear
High Priority Source: STP 21 24 Army Warrior Leader Skills Level 2 3 and 4
Procedure: Secure the gear during decontamination.

Steps:
1. Ensure that all gear is properly placed on the helmet and secured with any necessary fasteners or straps.
2. Check that all zippers, ties, and closures are fully closed and secure...
secure,gear,warrior skills
Secure the Hood
High Priority Source: STP 21 24 Army Warrior Leader Skills Level 2 3 and 4
Procedure: Secure the hood during decontamination.

Steps:
1. Ensure that the hood is completely uncontaminated and stored in a sealed container or bag.
2. Open the package containing the hood without touching the outside of the package to...
secure,hood,warrior skills
Cut and Remove BDU Jacket and Trousers
Standard Source: FM 3 5 NBC Decontamination
1. To cut and remove the BDU jacket and trousers, follow the procedures for removing the protective overgarment as described in paragraph 8-32 and 8-33.

Procedure Recap from Paragraphs 8-32 and 8-33:
• Dip scissors in a 5 percent chlorine...
BDU,removal,cutting,chlorine solution,waste bag
Cut and Remove Overgarment Jacket
Standard Source: FM 3 5 NBC Decontamination
CAUTION: Bandages may have been applied to control severe bleeding; therefore, they are treated like tourniquets. Only medical personnel will remove bandages, tourniquets, and splints.

1. Before cutting the overgarment jacket and trousers,...
overgarment,jacket,cutting,decontamination,scissors,chlorine solution,bandages,tourniquets
Cut and Remove Overgarment Trousers
Standard Source: FM 3 5 NBC Decontamination
1. Cut both trousers legs starting at the ankle as shown in Figure 8-5, page 8-8.
2. Keep the cuts near the inside of the legs, along the inseam, to the crotch.
3. With the left leg, cut all the way to the waist, avoiding the pockets.
4. With the...
overgarment,trousers,cutting,decontamination,chlorine solution,bandages,tourniquets
Cut and Remove Undergarments
Standard Source: FM 3 5 NBC Decontamination
1. Follow the procedures for cutting away the protective overgarment and rolling it away from the patient (see paragraph 8-32 and 8-33).
2. If the patient is wearing a brassiere, cut it between the cups.
3. Cut both shoulder straps where they attach...
undergarments,removal,cutting,waste bag,brassiere
Remove Combat Boots
Standard Source: FM 3 5 NBC Decontamination
1. Cut the bootlaces along the tongue.
2. Remove the boots by pulling them toward you.
3. Place the boots in the contaminated-waste bag.
4. Do not touch the patient's skin with your contaminated gloves when removing his boots.
combat boots,removal,cutting,waste bag
Remove Outer Gloves
Standard Source: FM 3 5 NBC Decontamination
1. Before touching the patient, the patient-decon team decontaminates its gloves with a 5 percent chlorine solution.
2. Lift the patient's arms up and out of the cutaway sleeves unless detrimental to his condition.
3. Grasp the fingers of the...
gloves,removal,decontamination,chlorine solution,waste bag

Skin Conditions (23)

Apply Podophyllin for Genital Warts Treatment
Standard Source: Where There is no Doctor a Village Health Care Handbook
Procedure:

1. Protect the healthy skin around the warts with petroleum jelly (Vaseline) or another greasy ointment.
2. Apply the podophyllin solution (containing 10–25% podophyllin mixed with benzoin) directly to the warts.
3. Allow the...
genital warts treatment, podophyllin, skin irritation, warts removal, genital health
When to Seek Medical Help for Skin Problems
Standard Source: Where There is no Doctor a Village Health Care Handbook
If a skin problem is serious or gets worse in spite of treatment, seek medical help.

Many skin problems can be helped by keeping the body clean. Try to wash once a day with mild soap and clean water. If the skin becomes too dry, wash less often...
skin problem, medical help, treatment failure, hygiene, dry skin, petroleum gel, glycerin, vegetable oils, loose clothing
Administer Fluocinolone Acetonide Cream for Allergic Rash/Insect Bites
Standard Source: Personal Wilderness Medical Kit
Indication: Allergic rash or insect bites
Dose: Apply to affected area four times daily as needed
Instructions:
1. Use fluocinolone acetonide cream, 0.2% (e.g., *Valisone®*, *Benisone®*, *Lidex®*, *Kenalog®*, *Aristocort®*,...
fluocinolone cream, allergic rash treatment, insect bite relief
Administer Pramosone Cream for Itching
Standard Source: Personal Wilderness Medical Kit
Indication: Itching
Dose: Apply to affected area every 4 hours as needed
Instructions:
1. Use Pramosone® cream, 1% or *Aveeno®* cream
2. Apply a thin layer to the affected area every 4 hours as needed for itching
Warnings:
-...
pramosone cream, itching relief, Aveeno
Identify Measles on the Skin
Standard Source: Where There is no Doctor a Village Health Care Handbook
Symptoms:
• Small reddish spots or a rash over the whole body; fever.
• After a few days of fever, small pinkish spots appear on the body; the person is very sick.

Possible Condition:
Measles.

Action:
• Refer to page 311 for...
measles, skin condition, rash
Identify and Treat Scabies (Seven Year Itch)
Standard Source: Where There is no Doctor a Village Health Care Handbook
Symptoms:
• Very itchy little bumps that can appear all over the body.
• Most common on:
- Between the fingers
- On the wrists
- Around the waist
- On the genitals
- Between the toes
• Usually does not appear on head and face—except...
scabies, seven year itch, skin condition
Removing Anbury or Wart
Standard Source: The Household Cyclopedia
To remove an anbury or wart:

1. Tie a strong silk thread or two to three horse-hairs around the neck of the wart.
2. Gradually tighten the thread until the wart falls away.
3. Dip a piece of tow in alumwater and bind it on the spot for a full...
wart removal, alumwater treatment, green ointment
Treat Cold Sores and Fever Blisters on the Lips
Standard Source: Where There is no Doctor a Village Health Care Handbook
Procedure:

1. Apply ice to the blisters for several minutes, several times a day to reduce pain and speed healing.
2. Use alum, camphor, or bitter plant juices (e.g., Cardon cactus) on the sores as a topical treatment.
3. Consider...
cold sore, fever blister, herpes, acyclovir, ice treatment
Treating Skin Rashes in Emergencies
Standard Source: Medical Emergencies
Procedure:

1. Determine the cause of the rash if possible.
2. If the rash is moist, keep it dry using a compress made from vinegar or tannic acid derived from tea, boiling acorns, or the bark of a hardwood tree.
3. **If the rash is...
rash,treatment,skin care,natural remedies,wound care
Recognize and Monitor Eczema Symptoms in Children and Adults
Reference Source: Where There is no Doctor a Village Health Care Handbook
Signs of eczema:

In small children: A red patch or rash forms on the cheeks or sometimes on the arms and hands. The rash consists of small sores or blisters that ooze or weep (burst and leak fluid).

In older children and adults:...
eczema, rash, skin condition, children, adults
Identify Advanced Stage of Syphilis on the Skin
Reference Source: Where There is no Doctor a Village Health Care Handbook
Symptoms:
• Large circles with a thick border that do not itch.

Possible Condition:
Advanced stage of syphilis.

Action:
• Refer to page 237 for further information and treatment.
syphilis, skin condition, advanced stage
Identify Allergic Reaction on the Skin
Reference Source: Where There is no Doctor a Village Health Care Handbook
Symptoms:
• Very itchy rash, bumps, or patches.
• They may appear and disappear rapidly.

Possible Condition:
Allergic reaction.

Action:
• Refer to page 203 for further information and treatment.
allergic reaction, skin condition, rash
Identify Chickenpox on the Skin
Reference Source: Where There is no Doctor a Village Health Care Handbook
Symptoms:
• Small blisters over the whole body with some fever.

Possible Condition:
Chickenpox.

Action:
• Refer to page 311 for further information and treatment.
chickenpox, skin condition, blisters
Identify Common Warts on the Skin
Reference Source: Where There is no Doctor a Village Health Care Handbook
Symptoms:
• Small warts, not very large.

Possible Condition:
Common warts (virus infection).

Action:
• Refer to page 210 for further information and treatment.
common warts, skin condition, virus infection
Identify Contact Dermatitis on the Skin
Reference Source: Where There is no Doctor a Village Health Care Handbook
Symptoms:
• Blisters with bumps and much itching and weeping (oozing).

Possible Condition:
Contact dermatitis (like poison ivy or sumac).

Action:
• Refer to page 204 for further information and treatment.
contact dermatitis, poison ivy, blisters
Identify Herpes Zoster (Shingles) on the Skin
Reference Source: Where There is no Doctor a Village Health Care Handbook
Symptoms:
• A patch of painful blisters that appears only on one part of the body, often in a stripe or cluster.
• A gray or black bad-smelling area with blisters and air pockets that spread.

Possible Condition:
• **Herpes zoster...
herpes zoster, shingles, blisters
Identify Ringworm on the Skin
Reference Source: Where There is no Doctor a Village Health Care Handbook
Symptoms:
• Small rings that continue to grow or spread and may itch.

Possible Condition:
Ringworm (fungus infection).

Action:
• Refer to page 205 for further information and treatment.
ringworm, fungus infection, skin condition
Identify Skin Cancer on the Skin
Reference Source: Where There is no Doctor a Village Health Care Handbook
Symptoms:
• Small rings, sometimes with a small pit in the middle, found on the temple, nose, or neck.

Possible Condition:
Cancer of the skin.

Action:
• Refer to page 211 for further information and treatment.
skin cancer, skin condition, small rings
Identify Tuberculosis of the Skin
Reference Source: Where There is no Doctor a Village Health Care Handbook
Symptoms:
• Large warts (more than 1 cm.), often on arms or feet.

Possible Condition:
A type of tuberculosis of the skin.

Action:
• Refer to page 212 for further information and treatment.
tuberculosis, skin condition, large warts
Identify Yaws on the Skin
Reference Source: Where There is no Doctor a Village Health Care Handbook
Symptoms:
• Wart-like growths on the penis, vagina, or around the anus.
• Bumpy, wart-like growths on other parts of the body.

Possible Condition:
Yaws.

Action:
• Refer to page 202 for further information and treatment.
yaws, skin condition, bacterial infection
Recognize and Manage Chilblain
Reference Source: Emergency War Surgery
Chilblain results from intermittent exposure to temperatures above freezing, usually accompanied by high humidity and moisture for 1–6 hours.

Symptoms:
• Swelling, tingling pain, and numbness with pink-to-red flushing of skin (especially...
chilblain, symptoms, management, cold injury, skin condition
Recognize and Manage Dandruff
Reference Source: Where There is no Doctor a Village Health Care Handbook
Dandruff is characterized by oily white or grayish flakes or scales in the hair, often due to seborrhea of the scalp. To manage dandruff:

1. Wash the scalp regularly with a mild shampoo.
2. Use over-the-counter medicated shampoos containing...
dandruff, seborrhea, scalp care, skin condition
Treating Pimples and Blackheads (Acne)
Reference Source: Where There is no Doctor a Village Health Care Handbook
### Treating Pimples and Blackheads

To manage pimples and blackheads:

1. Wash the face: Wash the face twice a day with soap and hot water.

2. Wash hair regularly: If possible, wash the hair every 2 days to reduce oil buildup.

3. **Expose...
acne, pimples, blackheads, tetracycline

Neonatal Care (23)

Respond to Baby Not Urinating or Passing Stool Within First 24 Hours
Critical Source: A Book for Midwives
If the baby does not urinate or pass stool within the first 24 hours of birth, this may indicate a blockage in the urethra or intestines. Get medical help immediately.
baby, urinate, stool, first 24 hours, blockage, medical help
Using a Respirator for Newborns
Critical Source: A Book for Midwives
Respirators are used to assist very sick or premature babies who have difficulty breathing on their own.

Procedure:

1. Connect the baby to a respirator, which delivers oxygen and assists with breathing.
2. Monitor the baby’s heart rate,...
respirator use, neonatal ventilation, newborn breathing assistance
Administer Eye Medicine to Prevent Blindness in Newborns
Critical Source: A Book for Midwives
If a mother has chlamydia or gonorrhea (see page 323), she may pass it to her baby during birth. The infection gets into the baby’s eyes and can cause blindness. Unless the mother has had a test to show that she does not have these infections,...
baby,eye drops,erythromycin,tetracycline,povidone-iodine,silver nitrate,blindness prevention
Assess and Respond to a Baby Who is Pale or Blue After Birth
Critical Source: A Book for Midwives
Procedure:

If a baby is very pale or stays blue after the first few minutes of life:

1. Check if it is normal: It can be OK for a baby’s hands or feet to stay a little blue for many hours, but it is not normal for a baby’s body to stay...
baby,pale,blue,breathing,oxygen,warmth,medical help,neonatal care
Care for a Small or Early Baby Immediately After Birth
Critical Source: A Book for Midwives
Procedure:

When delivering a small or early baby at home, follow these steps:

1. Prepare warm blankets and have them ready as soon as the baby is born.
2. Dry the baby thoroughly immediately after birth to prevent hypothermia.
3....
premature baby, early birth, neonatal care, skin-to-skin contact, hypothermia prevention
Assess Baby's Condition After Birth with Stool in Amniotic Waters
High Priority Source: A Book for Midwives
If the waters were green or yellow, it means the baby passed stool in the womb. If stool gets into the baby’s lungs, it can damage them. You can tell if the baby is in danger of this happening by the baby’s condition when he is born:

• **If the...
stool in amniotic waters, baby condition assessment, neonatal care, medical emergency
Care for Very Small Babies (Under 2.5 kg / 5.5 lbs)
High Priority Source: A Book for Midwives
Very small babies have a higher risk of infection, breathing problems, and jaundice. They may also struggle with breastfeeding and digestion.

What to do:

1. Keep the baby warm by placing them skin-to-skin against the mother’s body...
very small baby, care, warmth, breast milk, jaundice, infection, breathing problems
Checking Baby’s Eyes for Potential Blindness
High Priority Source: A Book for Midwives
Procedure:

1. Check the baby’s eyes for signs of potential blindness.

Details:
• This is done to identify any eye conditions that may affect vision in the baby, such as those caused by chlamydia or gonorrhea.
• Use a fetoscope or other...
baby eye examination, potential blindness, neonatal care, midwifery procedures
Checking Baby’s Feet for Swelling or Abnormalities
High Priority Source: A Book for Midwives
Procedure:

1. Check the baby’s feet for swelling or abnormalities.

Details:
• This is done to identify any potential issues with the baby's feet, such as swelling or other physical abnormalities.
• Use a fetoscope or other appropriate...
baby foot examination, swelling, neonatal care, midwifery procedures
Checking a Baby’s Sutures and Fontanels
High Priority Source: A Book for Midwives
Steps to Check a Baby's Sutures and Fontanels:

1. Gently feel the sutures with your fingers. The front suture should stop at or near the top of the forehead.
2. Notice if the sutures are a normal width or unusually wide.
3. **Gently...
checking,sutures,fontanels,baby,hydrocephalus,medical procedure
Monitor Large Babies (Over 4 kg / 9 lbs)
High Priority Source: A Book for Midwives
Watch large babies carefully for the first two days after birth.

• If they appear tired, weak, or sick, they may have low blood sugar.
Babies born to mothers with diabetes are more likely to experience this issue.

What to do:...
large baby, low blood sugar, diabetes, breastfeeding, warmth
Using Heart Monitors on Newborns
High Priority Source: A Book for Midwives
Heart monitors are used to track a baby’s heart rate and other vital signs.

Procedure:

1. Attach the heart monitor to the baby’s chest using adhesive sensors.
2. Monitor the baby’s heart rate, blood pressure, and oxygen levels...
heart monitor, neonatal vital signs, medical monitoring
Using a Feeding Tube for Newborns
High Priority Source: A Book for Midwives
Feeding tubes are used to provide nutrition to babies who are too weak to breastfeed or feed on their own.

Procedure:

1. Insert the feeding tube through the baby’s nose and into the stomach.
2. Administer either formula or breast milk...
feeding tube, neonatal nutrition, infant feeding assistance
Using an Incubator for Newborns
High Priority Source: A Book for Midwives
Incubators are used to keep small or sick newborns warm and stable in medical facilities.

Procedure:

1. Place the baby inside a temperature-controlled incubator.
2. Monitor the baby’s vital signs, including body temperature and oxygen...
incubator use, neonatal care, newborn warming, medical equipment
Using an Oxygen Hood or Tent for Newborns
High Priority Source: A Book for Midwives
Oxygen hoods or tents are used to provide extra oxygen to a baby who is having trouble breathing.

Procedure:

1. Place the baby inside an oxygen hood or tent that delivers a controlled flow of oxygen.
2. Monitor the baby’s respiratory rate...
oxygen hood, neonatal respiration, respiratory support, newborn care
Assess Baby’s Weight Without a Scale
Standard Source: A Book for Midwives
Estimate baby weight by touch:

• Most healthy babies weigh between 2.5 and 4 kilograms (5.5 to 9 pounds).

• You can estimate the baby's weight by holding them and comparing their weight to what you consider normal for a baby. This helps...
baby weight, estimate, scale, touch, normal weight range
Identifying and Monitoring Caputs and Hematomas in Newborns
Standard Source: A Book for Midwives
Steps to Identify and Monitor Caputs and Hematomas in Newborns:

1. Look for swelling on the baby’s head.
2. If the swelling crosses a suture line, it is likely a caput. A caput usually goes away in 1 or 2 days.
3. **If the swelling does...
caput,hematoma,baby,newborn,jaundice,monitoring
Measuring a Baby's Length
Standard Source: A Book for Midwives
Steps to Measure a Baby’s Length:

1. Use a tape measure.
2. Measure the baby from the top of her head to the bottom of her heel.
3. Record the measurement. Most babies are between 45 and 53 centimeters (18 to 21 inches). Babies who...
measuring,baby,length,medical procedure
Measuring a Baby’s Head Circumference
Standard Source: A Book for Midwives
Steps to Measure a Baby’s Head Circumference:

1. Use a tape measure.
2. Measure the baby’s head, just above the ears.
3. Record the measurement. The normal size for a baby’s head is 35 centimeters (13 to 14 inches). A very large or...
measuring,baby,head circumference,medical procedure
Weighing a Baby Using a Hanging Scale with Adjustment Knob
Standard Source: A Book for Midwives
Steps to Weigh a Baby Using a Hanging Scale with an Adjustment Knob:

1. Attach a cloth to the scale. Adjust the scale to 0.
2. Adjust the scale so that it is at 0. Weigh the cloth. Write down how much the cloth weighs (the number that...
weighing,baby,hanging scale,adjustment knob,medical procedure
Weighing a Baby Using a Standing Scale
Standard Source: A Book for Midwives
Steps to Weigh a Baby Using a Standing Scale:

1. Weigh yourself and write down the weight.
2. Get off the scale.
3. Get back on the scale holding the baby without his clothes or blankets. Write down the weight.
4. **Subtract your...
weighing,baby,standing scale,medical procedure
Identify Causes of Small Babies
Standard Source: A Book for Midwives
Common causes of small babies include:

• Mothers who did not get enough food or care during pregnancy.
• Mothers who had to do very hard work during pregnancy.
• Mothers who did not receive good medical care during pregnancy.
• Mothers who...
small babies, causes, maternal nutrition, smoking, chemicals, multiple births
Weigh a Baby Using a Scale
Reference Source: A Book for Midwives
To weigh a baby with a scale:

• If you have access to a scale, use it to determine the baby’s exact weight.
• Instructions for making your own scale can be found on page 445 of this book.
weigh baby, scale, homemade scale, page 445

Newborn Care (23)

Managing Low Temperature in Baby
Critical Source: A Book for Midwives
Procedure:

• Monitor the baby’s temperature regularly and ensure it is within the normal range (36.5°C to 37.5°C or 97.7°F to 99.5°F).
• If the baby's temperature is below normal, take immediate action to warm them.
• Use a warm blanket or...
baby temperature, hypothermia, midwife, newborn care
Recognize and Respond to Signs of Infection in Newborns
Critical Source: A Book for Midwives
When to use: If the baby shows signs of infection.

Symptoms to watch for:
• A low temperature (36.5°C or below)
• Inability to keep warm even when wrapped in blankets
• High fever lasting more than 4 hours
• Breathing rate over 60 breaths...
infection in newborns, signs of infection, antibiotic administration
Recognizing and Responding to Illnesses in Newborns
Critical Source: Where There is no Doctor a Village Health Care Handbook
### Recognizing and Responding to Illnesses in Newborns

Why prompt action is critical:
Diseases that take days or weeks to kill adults can kill a baby in hours. Immediate attention is essential.

**Signs of serious illness or birth...
newborn illness,birth complications,emergency symptoms,vitamin K,urination issues
Respond to Newborn with Breathing Difficulties or Rapid Breathing
Critical Source: A Book for Midwives
When to use: If the baby has trouble breathing or takes more than 60 breaths per minute.

Procedure:
Keep the baby warm.
• Check for signs of infection (see page 277).
• Lay the baby with her head lower than her bottom to help fluids...
respiratory distress, newborn breathing issues, suctioning baby
Administering Medicines to Newborns Safely
Critical Source: Where There is no Doctor a Village Health Care Handbook
### Administering Medicines to Newborns Safely

Important guidelines:
• Many medicines are dangerous for newborns, especially if they are premature or underweight (less than 2 kilograms).
• Use only **medicines that are specifically...
newborn medications,safe dosing,medicine administration,baby safety
Assess Newborn Breathing Rate
Critical Source: A Book for Midwives
When to use: To check for breathing difficulties in a newborn.

Procedure:
1. Count the baby’s breaths for one full minute by watching her belly rise and fall.
2. A normal breathing rate is between 30 and 60 breaths per minute while...
breathing rate, newborn respiration, abnormal breathing
Assessing a Newborn's Heartbeat
Critical Source: A Book for Midwives
Procedure:

1. Use a stethoscope or place 2 fingers over the baby’s heart to listen to the heartbeat.
2. Count the number of beats for 6 seconds, then multiply by 10 (or add a “0”) to get the beats per minute. For example, if you...
heart rate,newborn,heartbeat,stethoscope,rescue breathing,medical help
Check and Respond to Newborn Temperature Abnormalities
Critical Source: A Book for Midwives
When to use: To detect and treat low body temperature in newborns.

Procedure:
• A healthy baby’s temperature is around 37°C (98.6°F).
• To check the baby’s temperature, gently place the silver end of a thermometer into her armpit and...
hypothermia in newborns, temperature monitoring, baby warming techniques
Managing Fever or Low Temperature in Newborns
Critical Source: Where There is no Doctor a Village Health Care Handbook
Procedure:

1. Monitor the baby’s temperature closely.
2. If the baby has low temperature (below 35°C) or high fever (above 39°C), take immediate action:
- Remove all clothing from the baby.
- Sponge the baby with cool (not cold)...
newborn fever, low temperature, dehydration, rehydration drink
Managing Vomiting in Newborns
Critical Source: Where There is no Doctor a Village Health Care Handbook
Procedure:

1. Normal vomiting (bringing up small amounts of milk) is common and can be managed by:
- Burping the baby after feeding by holding him against your shoulder and gently patting his back.
- Sitting the baby upright for a...
vomiting in newborns, gut infection, obstruction, dehydration
Monitor Newborn Heart Rate and Respond to Abnormalities
Critical Source: A Book for Midwives
When to use: To check for heart rate irregularities in a newborn.

Procedure:
• A normal heart rate is between 120 and 160 beats per minute, though it may range from 100 to 180.
• If the heartbeat is too fast, consider infection (see...
heart rate monitoring, newborn tachycardia, bradycardia in infants
Recognizing and Responding to a Baby Who Stops Sucking Well
Critical Source: Where There is no Doctor a Village Health Care Handbook
Procedure:

1. If the baby stops sucking well or refuses to nurse:
- If more than 4 hours pass without nursing, this is a danger sign.
2. Check for signs of illness such as sleepiness, unusual crying, or changes in movement.
3. Possible...
feeding refusal in newborns, bacterial infection, tetanus
Treating Infection Around the Navel Cord
Critical Source: Where There is no Doctor a Village Health Care Handbook
Procedure:

1. If pus or a bad smell is coming from the baby’s navel (cord), this indicates a possible infection.
2. Soak the cord in alcohol and leave it open to the air to promote healing.
3. **If the skin around the cord becomes hot and...
navel infection, newborn care, tetanus, bacterial infection, cord care
Administer Immediate Care for Low Blood Sugar in Newborns
High Priority Source: A Book for Midwives
When to use: If a newborn is very weak, especially if the baby is very big or small, born after a difficult or long labor, or if the mother has diabetes.

Symptoms to watch for: The baby may stay cold or tremble.

Procedure:
1....
low blood sugar, newborn care, breastfeeding, hypoglycemia in infants
Administer Vitamin K for Newborn Bleeding
High Priority Source: Where There is no Doctor a Village Health Care Handbook
Title: Administer Vitamin K for Newborn Bleeding

Procedure:
1. Indications: If a newborn child begins to bleed from any part of his body (mouth, cord, anus), this may be caused by a lack of vitamin K.
2. Dosage and Administration:...
vitamin K, newborn bleeding, injection, underweight babies
Assessing a Newborn’s Muscle Tone
High Priority Source: A Book for Midwives
Procedure:

1. Observe the baby’s posture:
- Good muscle tone: Arms and legs are tight and close to the body, with elbows and knees bent.
- Weak muscle tone (limp): Arms and legs are loose and open.
2. A baby may be born...
muscle tone,newborn assessment,skin to skin,oxygen support
Assessing a Newborn’s Reflexes
High Priority Source: A Book for Midwives
Procedure:

1. Check for the following reflexes in a newborn:
- Grimace reflex: The baby should make a face when suction is applied to their mouth and nose.
- Moro reflex: When startled by a loud noise or sudden movement, the...
reflexes,newborn assessment,grimace,moro,sneeze
Identify and Respond to Signs of Weakness or Limpness in a Newborn Baby
High Priority Source: A Book for Midwives
Procedure:

Step 1: Monitor the baby for signs of weakness, limpness, or lack of responsiveness in the first few hours after birth.

Signs to Watch For:
• The baby is unusually weak, slow, or limp.
• Does not wake up from time to time to...
newborn weakness, hypoglycemia, infection in newborns
Monitoring Weight Gain in Newborns
High Priority Source: Where There is no Doctor a Village Health Care Handbook
Procedure:

1. Monitor the baby’s weight gain closely during the first weeks of life.
2. In the first few days, it is normal for a baby to lose some weight.
3. After the first week, a healthy baby should gain about 200 g per week.
4. By...
weight gain in newborns, failure to thrive, feeding issues
Proper Breastfeeding Practices for Newborns
High Priority Source: Where There is no Doctor a Village Health Care Handbook
### Proper Breastfeeding Practices for Newborns

Why breast milk is best:
• Breast milk has a better balance of nutrients than any other milk (fresh, canned, or powdered).
• It is clean and helps prevent diarrhea and other sicknesses.
• The...
breastfeeding,newborn care,nutrition,milk production,baby health
Administer Tetracycline Ointment for Newborn Eye Care
High Priority Source: A Book for Midwives
Procedure:

1. Apply tetracycline ointment to the eyes of a newborn within 2 hours of birth (see page 261 of the source text).
2. Use 1% ointment in each eye, applying it once only.

Important Notes:
• Tetracycline is used...
tetracycline ointment, newborn eye care, blindness prevention, midwife procedure
Assessing a Newborn’s Color
High Priority Source: A Book for Midwives
Procedure:

1. Observe the baby’s skin color immediately after birth:
- Most babies are initially blue or purple, but should turn to a more normal pinkish color within 1–2 minutes.
2. For darker-skinned babies, check the...
skin color,newborn assessment,oxygenation,dusky,pale
Cutting the Navel Cord
High Priority Source: Where There is no Doctor a Village Health Care Handbook
Procedure for Cutting the Navel Cord:

1. Clean your hands thoroughly with soap and water.
2. Use a clean, sharp blade or scissors to cut the umbilical cord as close to the baby's body as possible.
3. Apply gentle pressure to the cut end of the...
cutting navel cord,newborn care,umbilical cord,hygiene,infection prevention

Wound Management (23)

Debride Soft Tissue Wounds in Combat Injuries
Critical Source: NATO Emergency War Surgery
Objective: Remove all foreign material, detached or severely disrupted muscle, and establish open drainage to reduce infection risk and promote healing.

Procedure Steps:
1. Assess the wound: Identify areas of crushed muscle, detached...
debridement,wound management,combat injury,muscle removal,antibiotics,soft tissue wounds
Incising and Draining Wounds in Emergency War Surgery
Critical Source: NATO Emergency War Surgery
Objective: Relieve mechanical pressure and establish open drainage of wounds.

Procedure:
1. Make generous incisions of the wound to relieve mechanical pressure and ensure adequate drainage.
2. Remove easily accessible foreign bodies and...
incising wounds,drainage,wound management,emergency surgery
Nonclosure of Wounds Following Debridement in Emergency War Surgery
Critical Source: NATO Emergency War Surgery
Objective: Leave wounds widely open following debridement to prevent complications.

Procedure:
1. Do not primarily close any war wound after debridement, except for the following exceptions:
- Sucking chest wounds
- Joint capsules
...
nonclosure,wound management,debridement
Perform Prompt Surgical Debridement for War Wounds
Critical Source: NATO Emergency War Surgery
Procedure:

1. Assess the wound immediately after injury to determine the extent of tissue damage.
2. Remove all nonviable tissue, including crushed and lacerated tissue, using sterile instruments.
3. Excise devitalized tissue...
surgical debridement,war wounds,infection prevention,tissue viability,wound closure
Administering Antibiotics for Wound Infection Prevention
High Priority Source: NATO Emergency War Surgery
Objective: Establish an adequate blood level of penicillin or an antibiotic with a similar spectrum as soon as possible after wounding.

Procedure:
1. Administer antibiotics promptly following injury to prevent infection.
2. Choose an...
antibiotics,wound infection prevention,penicillin,war surgery
Assessing Muscle Viability in Wound Debridement
High Priority Source: NATO Emergency War Surgery
Procedure for Assessing Muscle Viability During Wound Debridement:

1. Observe Color:
- Nonviable muscle typically appears dark in color.
- Viable muscle may retain a more normal or reddish hue.

2. Check Consistency:
-...
muscle viability, wound debridement, 4c's, tissue assessment, nonviable muscle, surgical guidelines
Closure of Wounds for Extremity Fractures
High Priority Source: Emergency War Surgery
Procedure:

1. Avoid primary closure in the initial management of wounds associated with extremity fractures.
2. Approximate tissues loosely using one or two retention sutures to cover nerves, vessels, and tendons without creating...
wound closure,extremity fractures,surgical approximation,delayed closure
Delayed Primary Wound Closure in Emergency War Surgery
High Priority Source: NATO Emergency War Surgery
Objective: Perform delayed primary wound closure when appropriate.

Procedure:
1. Delayed primary wound closure is usually performed in a communication zone hospital 4 to 10 days after debridement, but may be done at the forward hospital if...
delayed closure,wound management,tape closure
Excising Entrance and Exit Wounds for Soft Tissue Injuries
High Priority Source: NATO Emergency War Surgery
Objective: Properly excise entrance and exit wounds to facilitate surgical exposure and drainage.

Procedure:
1. Excise the entrance and exit wounds with a narrow margin of skin oriented parallel to the underlying muscle fibers.
2. Ensure...
excising wounds,soft tissue injuries,surgical exposure
Identify the Most Common Pattern of Battlefield Injury
High Priority Source: Emergency War Surgery
The most common pattern of injury seen on a conventional battlefield is the patient with multiple small fragment wounds of the extremity.

This type of injury is typically caused by explosive munitions and results in multiple penetrating wounds...
fragment wounds,battlefield injuries,extremity injuries
Incising Fascia and Managing Muscle Tissue in Soft Tissue Injuries
High Priority Source: NATO Emergency War Surgery
Objective: Incise fascia and manage muscle tissue to inspect the wound track and remove foreign bodies.

Procedure:
1. Through the entrance and exit wounds, generously incise the fascia parallel to the muscle fibers in both directions.
2....
incising fascia,muscle management,wound inspection
Initial Wound Management for Extremity Fractures
High Priority Source: Emergency War Surgery
Procedure:

1. Immediate Actions:
- Irrigate and debride the wound as soon as feasible to prevent infection.
- Document neurovascular status of the extremity and check repeatedly during transport.
- Begin IV antibiotics (e.g.,...
wound debridement,extremity fracture,antibiotics,compartment release,bone fragment retention
Manage Wound Closure in Open Joint Injuries
High Priority Source: NATO Emergency War Surgery
Procedure:

1. Leave the wound open following debridement and irrigation.
2. Depending on contamination levels, consider closing the synovium while leaving the capsule or soft tissue open.
3. If closure of the synovium is not feasible due to...
open wound management,joint dressing,synovium closure,wound care
Understand the Pathophysiology of War Wounds
High Priority Source: Emergency War Surgery
To effectively care for patients on a battlefield, surgeons must understand the pathophysiology of war wounds. This includes knowledge of how different weapons cause injuries and the patterns of injury seen in conventional warfare.
war wounds,pathophysiology,battlefield medicine,conventional warfare
Wound Incision/Excision for Extremity Fractures
High Priority Source: Emergency War Surgery
Procedure:

1. Follow guidelines from the soft tissue injury section when performing incisions.
2. Make longitudinal incisions to obtain adequate exposure of the wound and underlying structures.
3. Incise fascia longitudinally to...
wound excision,extremity fractures,surgical debridement,bone fragment management
Analyze Anatomical Distribution of Penetrating Wounds (%)
High Priority Source: Emergency War Surgery
The following table shows the anatomical distribution of penetrating wounds across various conflicts:

|Conflict|Head and Neck|Thorax|Abdomen|Limbs|Other|
|---|---|---|---|---|---|
|World War I|17|4|2|70|7|
|World War...
anatomical distribution,wound statistics,battlefield injuries
Analyze Epidemiological Data on Battlefield Injuries
High Priority Source: Emergency War Surgery
Two major epidemiological studies were conducted during the 20th century to understand injury patterns and outcomes:

Bougainville Campaign (World War II): A medical team collected data on injured soldiers primarily from infantry units on the...
epidemiological studies,battlefield injuries,WWII,Vietnam War
Applying Dressings to Wounds in Emergency War Surgery
High Priority Source: NATO Emergency War Surgery
Objective: Apply a dressing that facilitates drainage without causing additional pressure or necrosis.

Procedure:
1. Lay dry sterile gauze lightly in the wound as a wick.
2. Ensure that the gauze is not packed into the wound, as this can...
dressing application,wound care,sterile gauze
Classify Conventional Weapons by Type
High Priority Source: Emergency War Surgery
Conventional war weapons can be divided into two main categories:

1. Explosive munitions: These include artillery, grenades, mortars, bombs, and hand grenades.
2. Small arms: These include pistols, rifles, and machine guns.

Understanding...
conventional weapons,explosive munitions,small arms,battlefield injuries
Compare Injury Distribution by Weapon Type in WWII and Vietnam
High Priority Source: Emergency War Surgery
The following table compares the percentage of injuries caused by different weapons during the Bougainville Campaign (World War II) and the Vietnam...
injury distribution,battlefield statistics,WWII,Vietnam War
Initial Surgical Debridement and Irrigation of War Wounds
Standard Source: Emergency War Surgery
Procedure:

1. Begin surgical debridement within 6 hours of injury to remove all dead, contaminated, or foreign material from the wound.
2. Thoroughly irrigate the wound with a sterile solution to ensure removal of all debris and bacterial...
debridement, wound irrigation, war wounds, antibiotics, infection prevention
Fasciotomy Wound Management
Reference Source: Emergency War Surgery
Procedure:

Step 1: Debride wound
• Following the fasciotomy, remove all devitalized tissue from the wound.

Step 2: Leave wound open
• Leave the fasciotomy wound open and cover with sterile dressings.

Note: This is standard for...
fasciotomy, wound management, debridement, sterile dressing, war wound
Wound Debridement and Irrigation Protocol
Reference Source: Emergency War Surgery
Procedure for Wound Management After Initial Surgery

• The wound undergoes a planned second debridement and irrigation in 24–72 hours, and subsequent procedures until a clean wound is achieved.

• Between procedures, there may be better...
wound management, debridement, irrigation, secondary intention, delayed closure, war wounds

Antibiotic Use (23)

Administer Antibiotics for Infected Wounds and Tetanus Prevention
Critical Source: Where There is no Doctor a Village Health Care Handbook
Procedure:

Antibiotic administration guidelines:
• For severe infections, administer:
- Penicillin or ampicillin (especially if the person has not been vaccinated against tetanus).
- Metronidazole.
• If no penicillin is available,...
tetanus prevention,penicillin use,metronidazole administration
Administer Penicillins for Neisseria Meningitidis Infections
Critical Source: Survival and Austere Medicine
Procedure:

1. Identify infection caused by *Neisseria meningitidis* (e.g., bacterial meningitis, septicaemia).
2. Administer Penicillins as the first-line antibiotic.
3. Alternative options include Cephalosporins, Quinolones,...
Neisseria meningitidis,bacterial meningitis,septicaemia,Penicillins,Cephalosporins,Quinolones,Co-trimoxazole,Tetracyclines
Avoiding Tetracycline for Pregnant Women and Children Under 8
Critical Source: Where There is no Doctor a Village Health Care Handbook
Do not give tetracycline to pregnant women or children under 8 years old. It can damage new teeth and bones (see page 355).
tetracycline, pregnant women, children under 8, bone damage, teeth damage
Use of Chloramphenicol for Severe Illnesses Only
Critical Source: Where There is no Doctor a Village Health Care Handbook
Chloramphenicol should be used only for certain severe or life-threatening illnesses, such as typhoid fever. It is a dangerous drug and never use it for mild illness. Additionally, do not give chloramphenicol to newborn children,...
chloramphenicol, typhoid fever, newborn children, whooping cough
Administering Antibiotics for Battlefield Infections
High Priority Source: Emergency War Surgery
Use the following antibiotics and dosages based on likely pathogens:

| Antibacterial Spectrum | Agent | Dosage |
|---------------------------|----------|------------|
| MRSA, Staphylococcus aureus (not methicillin resistant),...
battlefield antibiotics,wound infection treatment,pathogen-specific dosing,MRSA antibiotic use
Administering Penicillin or Ampicillin with Adrenalin Readiness
High Priority Source: Where There is no Doctor a Village Health Care Handbook
Before injecting penicillin or ampicillin, always have ready ampules of Adrenalin (epinephrine) to control an allergic reaction if one occurs. This is crucial for managing potential severe allergic reactions such as anaphylaxis.
penicillin, ampicillin, adrenalin, epinephrine, allergic reaction
Streptomycin Use for Tuberculosis and Specific Infections
High Priority Source: Where There is no Doctor a Village Health Care Handbook
Use streptomycin (and products that contain it) only for tuberculosis, always together with other anti-tuberculosis medicines. Streptomycin in combination with penicillin can be used for deep wounds to the gut, appendicitis, and other...
streptomycin, tuberculosis, appendicitis, deep wounds, respiratory infections
Toxicity and Use of Streptomycin Group Medicines
High Priority Source: Where There is no Doctor a Village Health Care Handbook
All medicines in the streptomycin group (including kanamycin and gentamicin) are quite toxic. They should be used only for certain very serious infections for which these medicines are recommended, as they may do more harm than good if...
streptomycin group, kanamycin, gentamicin, toxicity, serious infections
Administer Co-trimoxazole for Escherichia Coli Infections
High Priority Source: Survival and Austere Medicine
Procedure:

1. Identify infection caused by *Escherichia coli* (e.g., urinary tract infections, gastroenteritis).
2. Administer Co-trimoxazole as the first-line antibiotic.
3. Alternative options include Quinolones, Cephalosporins,...
Escherichia coli,E. coli,urinary tract infection,gastroenteritis,Co-trimoxazole,Quinolones,Cephalosporins
Administer Flucloxacillin for Staphylococcus Infections
High Priority Source: Survival and Austere Medicine
Procedure:

1. Identify infection caused by *Staphylococcus aureus* (e.g., boils, abscesses, wound infections).
2. Administer Flucloxacillin as the first-line antibiotic.
3. If resistance is suspected (MRSA), switch to Vancomycin.
4....
Staphylococcus,aureus,Flucloxacillin,Augmentin,Cephalosporins,vancomycin,MRSA,wound infection,boils,abscesses
Administer High-Dose Amoxicillin for Neisseria Gonorrhoeae Infections
High Priority Source: Survival and Austere Medicine
Procedure:

1. Identify infection caused by *Neisseria gonorrhoeae* (e.g., gonorrhoea).
2. Administer a single high-dose of Amoxicillin as the first-line antibiotic.
3. Alternative options include Augmentin, Cephalosporins, and...
Neisseria gonorrhoeae,gonorrhoea,Amoxicillin,Augmentin,Cephalosporins,Quinolones
Administer Penicillins for Streptococcus Infections
High Priority Source: Survival and Austere Medicine
Procedure:

1. Identify infection caused by *Streptococcus pneumoniae* or *Streptococcus pyogenes* (e.g., pneumonia, sore throat, impetigo).
2. Administer Penicillins as the first-line antibiotic.
3. Alternative options include...
Streptococcus,pneumoniae,pyogenes,Penicillins,Cephalosporins,Quinolones,pneumonia,sore throat,impetigo,necrotising fasciitis
Administer Quinolones for Proteus Species Infections
High Priority Source: Survival and Austere Medicine
Procedure:

1. Identify infection caused by *Proteus species* (e.g., urinary tract infections, peritonitis).
2. Administer Quinolones as the first-line antibiotic.
3. Alternative options include Cephalosporins, and other antibiotics...
Proteus species,urinary tract infection,peritonitis,Quinolones,Cephalosporins
Alternative Antibiotics for Penicillin Allergies
High Priority Source: Where There is no Doctor a Village Health Care Handbook
For persons who are allergic to penicillin, use another antibiotic such as erythromycin or a sulfa drug. Refer to pages 354 and 356 of the source text for more information on these alternatives.
penicillin allergy, erythromycin, sulfa drug
Determining When an Antibiotic Is Not Working
High Priority Source: Where There is no Doctor a Village Health Care Handbook
If the antibiotic you are using does not seem to help, consider the following possibilities:

1. The illness is not what you think—you may be using the wrong medicine. Try to find out more exactly what the illness is and use the right...
antibiotic resistance, ineffective antibiotic, medical help, wrong diagnosis
Limit Antibiotic Use to Prevent Development of Drug-Resistant Bacteria
High Priority Source: Where There is no Doctor a Village Health Care Handbook
Reason: Overuse of antibiotics leads to drug-resistant bacteria, making infections harder to treat. Action: Save antibiotics for serious infections only. Avoid using broad-spectrum antibiotics like ampicillin for minor issues. If a health...
drug resistance, typhoid, chloramphenicol, antibiotic overuse, health workers
Administer Augmentin for Moxella Catarrhalis Infections
Standard Source: Survival and Austere Medicine
Procedure:

1. Identify infection caused by *Moxella catarrhalis* (e.g., ear infections, sinusitis, chronic bronchitis exacerbations).
2. Administer Augmentin as the first-line antibiotic.
3. Alternative options include Cephalosporins,...
Moxella catarrhalis,ear infection,sinusitis,chronic bronchitis,Augmentin,Cephalosporins,Quinolones,Co-trimoxazole,Tetracyclines
Avoid Unnecessary Use of Antibiotics to Prevent Disruption of Natural Bacterial Balance
Standard Source: Where There is no Doctor a Village Health Care Handbook
Reason: Antibiotics can kill beneficial bacteria in the body, leading to infections like thrush or moniliasis. Action: Avoid using antibiotics for minor infections such as mild skin infections or respiratory issues. Treat these with...
natural balance, thrush, moniliasis, beneficial bacteria, antibiotic overuse
Do Not Use Antibiotics for Diarrhea Unless Prescribed by a Health Worker
Standard Source: Where There is no Doctor a Village Health Care Handbook
Reason: Most cases of diarrhea can be managed with hydration and nutrition alone. Action: Do not use antibiotics to treat diarrhea unless advised by a health worker. In most cases, they may even be harmful. Focus on providing plenty of clean...
diarrhea, antibiotic use, hydration, health workers, nutrition
Limit Use of Antibiotics to Avoid Poisoning and Allergic Reactions
Standard Source: Where There is no Doctor a Village Health Care Handbook
Reason: Overuse of antibiotics can cause poisoning or allergic reactions. Action: Do not take antibiotics unless absolutely necessary. If symptoms are mild, treat them with rest, hydration, and proper nutrition instead. Always consult a...
antibiotics, poisoning, allergic reactions, overuse, health workers
Antibiotics Are Not Effective for the Common Cold
Standard Source: Where There is no Doctor a Village Health Care Handbook
Antibiotics do no good for the common cold. Use antibiotics only for infections they are known to help. This is a critical point to avoid unnecessary use of antibiotics and reduce the risk of resistance.
common cold, antibiotic resistance, ineffective use, antibiotics
Understanding and Use of Broad-Spectrum Antibiotics
Standard Source: Where There is no Doctor a Village Health Care Handbook + Emergency War Surgery
Administer broad spectrum antibiotic pre-op, continue for 24 hours. Redose short half-life antibiotics intraoperatively and consider redosing antibiotics with large amounts of blood loss. **Do not use tetracycline, ampicillin, or another...
broad-spectrum antibiotics, narrow-spectrum antibiotics, pre-operative care, antibiotic administration, penicillin
Using Probiotics to Restore Gut Flora After Antibiotics
Standard Source: Where There is no Doctor a Village Health Care Handbook
Eating yogurt or curdled milk helps replace necessary bacteria killed by antibiotics like ampicillin and return the body’s natural balance to normal. This is especially important after prolonged antibiotic use.
yogurt, curdled milk, probiotics, gut flora, ampicillin

Radiation Injury (23)

Assessment of Fatal Radiation Dose and Prodromal Symptoms
Critical Source: Medical NBC Battlebook
Procedure for Assessing Fatal Radiation Dose and Associated Prodromal Symptoms

1. Definition of Fatal Dose: Casualties who have received a potentially fatal radiation dose will likely experience specific prodromal symptoms.
2. **Symptoms to...
fatal radiation dose, prodromal symptoms, clinical evaluation, diagnosis
Diagnosis of Radiation Sickness in Casualties
Critical Source: Medical NBC Battlebook
Procedure for Diagnosing Radiation Sickness in Casualties

1. Clinical Picture: The diagnosis is primarily based on the patient's clinical presentation.
2. History of Exposure: A precise history may be difficult to obtain, especially in...
radiation sickness, diagnosis, dosimetry, lymphocyte counting, mass casualty
Initial Treatment for Patients with Whole Body Radiation Injury
Critical Source: NATO Emergency War Surgery
Initial Treatment for Patients with Whole Body Radiation Injury

The primary determinants of survival among most patients receiving intermediate (serious but not uniformly fatal if treated) radiation doses are the management of microbial...
whole body radiation injury, initial treatment, gastrointestinal distress, antiemetics, fluid and electrolyte replacement, triage, cardiovascular support, immunomodulators, leukopenia, stem cell regeneration, platelet transfusions, bone marrow transplants, wound management, neutropenic patient
Triage Classification for Radiation Injury Patients
Critical Source: Medical NBC Battlebook
Procedure for Triage Classification of Radiation Injury Patients

1. Radiation Injury Unlikely:
- No symptoms associated with radiation injury.
- Patients should be triaged based on severity of conventional injuries.
- If free of...
triage, radiation injury classification, lymphocyte analysis, mass casualty
Triage Guidelines for Combined-Injury Patients with Radiation Exposure
Critical Source: Medical NBC Battlebook
Procedure for Triage of Combined-Injury Patients with Radiation Exposure

1. Initial Treatment Assumption: All combined-injury patients should be treated as if no significant radiation injury is present.
2. **Prioritize Life-Threatening...
combined injuries, triage guidelines, radiation exposure, life-threatening injuries
Diagnosis and Treatment of Patients with Combined Injuries
Critical Source: Medical NBC Battlebook
Diagnosis and Treatment of Patients with Combined Injuries

1. Conventional Injuries First: Conventional injuries should be treated first, since no immediate life-threatening hazard exists for radiation casualties who can ultimately...
combined injuries, conventional injuries, surgical timing, radiation casualties
Medical Problems and Complications of Radiation Injury in Nuclear War
Critical Source: Medical NBC Battlebook
Medical Problems and Complications of Radiation Injury in Nuclear War

None: No medical problems for low dose ranges.
Potential for delayed traumatic and surgical wound healing, minimal clinical effect:
- Significant medical care...
radiation injury, medical problems, complications, CNS symptoms, LD100
Provide First Aid for Thermal and Blast Injuries from Nuclear Detonation
Critical Source: Full First Aid Manual FM 2111
Procedure:

1. Assess the casualty for visible injuries such as burns, hemorrhage, or fractures.
2. Provide first aid based on the observed injuries:
- For burns, cool the burn under running water for at least 10 minutes or until pain...
nuclear detonation, thermal injury, blast injury, radiation injury, first aid, burns, hemorrhage, fractures, decontamination
Recognize Symptoms of Radiation Injury
Critical Source: FEMA REP Program Manual Dec 2019
Excessive exposure to ionizing radiation can lead to a range of symptoms, depending on the dose and duration of exposure.

Early symptoms: Nausea, fatigue, vomiting, and diarrhea.
Intermediate symptoms: Loss of hair (epilation),...
radiation injury,symptoms,exposure effects
Recognize and Respond to Acute Radiation Syndrome (ARS) Based on Dose Ranges
Critical Source: Planning Guidance Nuclear Detonation FEMA
Objective: Recognize ARS symptoms based on radiation dose ranges and respond accordingly.

Dose Range Effects (Table 5):
|Dose Range, Gy (rad)|Prodromal Phase Severity|Manifestation of Illness|Prognosis (without...
ARS dose ranges, radiation injury prognosis, ARS symptoms, medical response to radiation exposure
Assess and Document Radiation Exposure for Triage Purposes
High Priority Source: Planning Guidance Nuclear Detonation FEMA
Objective: Assess and document radiation exposure to aid in triage and medical follow-up.

Steps:
1. Record the physical location of the individual at the time of exposure. This helps determine potential radiation dose levels based on...
triage, radiation exposure assessment, medical history documentation, ARS triage, biodosimetry
Disposition of Radiation Injury in Nuclear War (Without and With Medical Care)
High Priority Source: Medical NBC Battlebook
Disposition of Radiation Injury in Nuclear War (Without and With Medical Care)

|Dose range<br>(cGy)|Disposition Without Medical<br>Care|Disposition Medical Care|
|---|---|---|
|0 to 70|Duty|Duty|
|70 to 150|Restricted duty....
radiation injury, disposition, medical care, evacuation, AMedP-6(C)
Identify Individuals at Risk for Acute Radiation Syndrome (ARS)
High Priority Source: Planning Guidance Nuclear Detonation FEMA
Objective: Identify individuals who may have been exposed to high doses of radiation and are at risk for ARS.

Criteria for ARS Risk:
High radiation dose (>0.75 Gy [>75 rad])
• **Penetrating radiation (reaching internal organs, not...
acute radiation syndrome, ARS, radiation injury, hematopoietic subsyndrome, gastrointestinal subsyndrome, cutaneous subsyndrome, neurovascular subsyndrome
Management of Infection in Radiation Injury Patients
High Priority Source: Medical NBC Battlebook
Management of Infection in Radiation Injury Patients

1. Treatment Duration: It is recommended that either:
- The treatment continue until the granulocytes return to more than 500, or
- Treat for just 2 weeks and stop even if the white...
infection management, radiation injury, granulocytes, white cell count, FM 8-9
Medical Aspects of Radiation Injuries
High Priority Source: Emergency War Surgery
Procedure:

1. Understand the signs and symptoms associated with radiation exposure:
- Nausea
- Vomiting
- Diarrhea
- Hyperthermia
- Erythema
- Hypotension
- CNS dysfunction

2. **Recognize the lethal dose of radiation...
LD50/60,radiation injury,medical care,war surgery
Medical Aspects of Radiation Injury in Nuclear War (Antiemetic Pretreatment and Medical Treatment)
High Priority Source: Medical NBC Battlebook
Medical Aspects of Radiation Injury in Nuclear War (Antiemetic Pretreatment and Medical Treatment)

|Dose range<br>(cGy)|Antiemetic<br>Pretreatment|Indicated Medical Treatment|
|---|---|---|
|0 to 70|Not...
radiation injury, antiemetic pretreatment, medical treatment, GI decontamination, AFRRI
Medical Response to Nuclear Radiation (Performance and Disposition)
High Priority Source: Medical NBC Battlebook
Medical Response to Nuclear Radiation (Performance and Disposition)

|Performance (mid range dose)|Medical Care and Disposition|
|---|---|
|Combat effective.|No medical care, return to duty.|
|Combat effective.|No medical care, return to...
nuclear radiation, medical response, performance, disposition, FM 8-9
Recognize Overlapping Symptoms of ARS Subsyndromes at Different Dose Levels
High Priority Source: Planning Guidance Nuclear Detonation FEMA
Objective: Recognize overlapping symptoms from different subsyndromes based on radiation dose levels.

Key Observations:
At lower doses (e.g., 1–2 Gy): GI symptoms may resolve before hematopoietic symptoms manifest. This can complicate...
ARS subsyndrome overlap, radiation injury symptoms, multiorgan ARS treatment
Symptoms and Onset of Radiation Injury Based on Dose Range
High Priority Source: Medical NBC Battlebook
Symptoms and Onset of Radiation Injury Based on Dose Range

|Dose range (cGy free in air)|Onset and duration of initial symptoms|
|---|---|
|0 to 70|From 6 to 12 hours: none to slight incidence of transient headache and nausea; vomiting...
radiation injury, dose range, symptoms onset, FM 8-9, FM 8-10-7
Treatment of Radiation Injured Patients
High Priority Source: Emergency War Surgery
Procedure:

1. Provide fluid and electrolyte replacement for gastrointestinal losses.
2. Administer cytokines to immunocompromised patients, following granulocyte counts.
3. Implement restricted duty:
- No further radiation...
radiation injury treatment, cytokine therapy, lymphocyte count, medical care, radiation exposure
Triage of Radiation Injured Patients
High Priority Source: Emergency War Surgery
Procedure:

1. Assess conventional injuries first, then modify triage based on the level of radiation injury.
2. Preliminary diagnosis of radiation injury is only made for patients exhibiting symptoms such as:
- Nausea
- Vomiting
...
radiation injury, triage, medical emergency, LD50/60, radiation exposure
Understand the Four Time Phases of Acute Radiation Syndrome (ARS)
High Priority Source: Planning Guidance Nuclear Detonation FEMA
Objective: Understand and recognize the four time phases of ARS to guide medical response.

Four Time Phases of ARS:
1. Prodromal Phase:
- Occurs within minutes to hours after exposure.
- Symptoms include nausea, vomiting, fatigue,...
ARS time phases, radiation injury progression, medical response to ARS
Dosimetry for Radiation Injury Patients
High Priority Source: Medical NBC Battlebook
Dosimetry for Radiation Injury Patients

1. Purpose of Dosimetry: Dosimetry for an individual patient should only be considered as an aid to diagnosis and prognosis.

2. Clinical Condition and Laboratory Investigations: The patient’s...
dosimetry, radiation injury, diagnosis, prognosis, laboratory investigation

Disease Prevention (22)

Control Vector-Borne Diseases Through Surveillance and Chemical Treatment
High Priority Source: NAVMED P 5010 US Navy Manual of Preventive Medicine
Objective: Prevent vector-borne diseases by identifying vectors, applying chemical controls, and using physical barriers.

Steps:
1. Surveil for vectors and breeding sites: Identify the types of arthropods present (e.g., mosquitoes,...
vector-borne diseases, chemical control, mosquito nets, repellents, vaccines
Prevent Venomous Animal Bites Through Education and Anti-Venom Stockpiling
High Priority Source: NAVMED P 5010 US Navy Manual of Preventive Medicine
Objective: Prevent venomous animal bites through troop education and the availability of anti-venoms.

Steps:
1. Review medical intelligence on local venomous species: Identify which venomous animals are present in the area of operation...
venomous animals, anti-venoms, education, medical intelligence
Control Respiratory Diseases Through Isolation and Hygiene
High Priority Source: NAVMED P 5010 US Navy Manual of Preventive Medicine
Objective: Reduce the spread of respiratory diseases through isolation, ventilation, education, and personal protection.

Steps:
1. Isolate known or suspected cases: Separate individuals showing symptoms such as fever, coughing, or...
respiratory diseases, isolation, ventilation, PPE, immunization
Implement Environmental Health Controls to Reduce Disease Morbidity in Deployed Forces
High Priority Source: NAVMED P 5010 US Navy Manual of Preventive Medicine
Procedure:

1. Restrict Access to Local Foods:
- Limit consumption of local food sources that may be contaminated or unsafe.
- Ensure all food is inspected and approved by medical personnel before consumption.

2. **Adhere to Good Food...
environmental health, food sanitation, water purification, MREs, fly control, disease prevention, military deployment
Manage Risks for Contracting Diseases or Parasites Including Rabies, West Nile Virus, Tularemia, Lyme Disease, Mange, and Trichinosis
High Priority Source: Student manual 2005
Managing risks for contracting diseases or parasites:

Understand the risk of infectious diseases: Wild animals can carry a variety of infectious diseases that may cause illness in humans. Some diseases are specific to certain species of...
rabies,west nile virus,tularemia,lyme disease,mange,trichinosis,disease prevention,wildlife safety
Prevent Intestinal Diseases Through Hygiene and Sanitation
High Priority Source: NAVMED P 5010 US Navy Manual of Preventive Medicine
Objective: Prevent intestinal diseases by maintaining proper hygiene, sanitation, food handling, and water treatment.

Steps:
1. Maintain personal hygiene: Wash hands frequently with soap and clean water, especially before preparing or...
intestinal diseases, hygiene, sanitation, food safety, water treatment
Prevent Parasitic Diseases Through Sanitation and Hygiene Practices
High Priority Source: NAVMED P 5010 US Navy Manual of Preventive Medicine
Objective: Prevent parasitic infections by maintaining sanitation, cooking food properly, and avoiding exposure to contaminated environments.

Steps:
1. Maintain proper sanitation practices:
- Ensure all human waste is disposed of in...
parasitic diseases, sanitation, food safety, hygiene education
Prevent Zoonotic Diseases Through Avoidance of Infected Animals and Medical Intelligence
High Priority Source: NAVMED P 5010 US Navy Manual of Preventive Medicine
Objective: Prevent zoonotic diseases by avoiding contact with infected animals and using medical intelligence.

Steps:
1. Avoid contact with sick or dead animals: Stay away from animals that are behaving abnormally, dead animals, or...
zoonotic diseases, medical intelligence, animal avoidance
Prevent and Control Disease Transmission in the Field
High Priority Source: FM 21 10 Field Hygiene and Sanitation
Procedure:

1. Practice good personal hygiene by washing hands regularly with soap and water or using alcohol-based hand sanitizers.
2. Maintain clean living conditions by keeping sleeping areas, food preparation areas, and latrines...
hygiene practices,disease prevention,sanitation,food storage,medical care
Prevent and Control Sexually Transmitted Diseases (STDs) Through Education and Condom Use
High Priority Source: NAVMED P 5010 US Navy Manual of Preventive Medicine
Objective: Reduce the incidence of sexually transmitted diseases through education, abstinence, and condom use.

Steps:
1. Educate troops on STD prevention: Provide training on safe sexual practices, including the importance of...
STDs, condom use, education, treatment guidelines
Preventing Disease in Poultry Flocks
High Priority Source: Practical Pointers On The Care of Lifestock
Procedure:
1. Select only healthy and vigorous birds for your flock.
2. Reject weaklings or physically unfit birds.
3. Maintain proper management to keep the birds in a high state of vitality.
4. Implement sanitary measures to prevent contagious...
disease prevention, poultry health, sanitation
Promote Good Nutrition to Prevent Disease
High Priority Source: Where There is no Doctor a Village Health Care Handbook
Good nutrition helps the body resist sickness. Poor nutrition weakens immunity and increases susceptibility to diseases such as:

• Severe diarrhea (especially in children)
• Measles (more dangerous in malnourished populations)
• Tuberculosis...
nutrition and immunity, disease prevention, malnutrition effects, immune system health
Understanding Communicable Diseases and Their Transmission
High Priority Source: NAVMED P 5010 US Navy Manual of Preventive Medicine
Understanding Communicable Diseases and Their Transmission

Communicable diseases are those that are transmitted from a carrier to a susceptible host. They may be transmitted:

1. Directly from an infected person or animal.
2. Indirectly...
communicable diseases, transmission, prevention, disease control, reservoir, portal of entry, susceptible host
Educate Children About Local Diseases and Diarrhoea Prevention
Standard Source: Safe Water Manual
Steps:
1. Inform children about prevalent local diseases, with a focus on diarrhoea.
- Explain that diarrhoea causes the body to lose liquid and can be fatal if not treated.
2. Emphasize prevention methods:
- Drinking safe water
-...
diarrhoea, disease prevention, children education, hygiene practices
Educate Community on HIV Prevention
Standard Source: Where There is No Dentist
Title: Educate Community on HIV Prevention

Procedure:
1. Think of yourself as a teacher to improve community health and help prevent the spread of HIV.
2. Share knowledge with others, as it can have a more lasting impact than your skills as...
HIV prevention, education, community health, discrimination, ARVs, dental worker
Examples of Non-Infectious Diseases and Their Causes
Standard Source: Where There is no Doctor a Village Health Care Handbook
Non-infectious diseases can be caused by various factors:

### Problems Caused by Something That Wears Out or Goes Wrong Within the Body:
• Rheumatism
• Heart attack
• Epileptic seizures
• Stroke
• Migraine headaches
• Cataract
• Cancer

###...
non-infectious diseases, examples, causes, mental illness, malnutrition
Explain the Health Risks of Dirty vs. Clean Households
Standard Source: Safe Water Manual
Steps:
1. Compare the two images and explain the health implications.
2. Highlight that families in dirty households are at higher risk of illness due to poor water handling and hygiene practices.
3. Emphasize that families in clean households...
health risks, household comparison, disease prevention
Prevent Schistosomiasis by Avoiding Contaminated Water Practices
Standard Source: Where There is no Doctor a Village Health Care Handbook
Procedure:

To prevent schistosomiasis, follow these steps:

1. Use latrines properly: Ensure that all individuals in the community use latrines for defecation and urination.
2. Avoid urinating or defecating near water sources: This...
schistosomiasis, prevention, latrines, water contamination, snail control
Prevent and Treat Pediculosis (Lice Infestation)
Standard Source: NAVMED P 5010 US Navy Manual of Preventive Medicine
Objective: Prevent and treat lice infestations through proper hygiene and treatment protocols.

Steps:
1. Maintain personal hygiene: Wash clothing, bedding, and headgear regularly in hot water to kill lice and nits.
2. **Avoid sharing...
lice infestation, pediculosis, insecticides, hygiene education
Prevent and Treat Scabies Through Hygiene and Medication
Standard Source: NAVMED P 5010 US Navy Manual of Preventive Medicine
Objective: Prevent and treat scabies through proper hygiene practices and the use of appropriate medications.

Steps:
1. Maintain personal hygiene: Wash clothing, bedding, and undergarments in hot water to kill mites and eggs.
2. **Avoid...
scabies, mites, topical treatment, hygiene education
Understanding Infectious Diseases and Their Causes
Standard Source: Where There is no Doctor a Village Health Care Handbook
Infectious diseases are caused by bacteria and other organisms (living things) that harm the body. They are spread in many ways. Here are some of the most important kinds of organisms that cause infections and examples of sicknesses they...
infectious diseases, bacteria, viruses, fungi, parasites, disease transmission
Understanding the Causes of Sickness in Different Contexts
Standard Source: Where There is no Doctor a Village Health Care Handbook
When a baby gets diarrhea, different people may explain it based on their perspectives:

People in small villages may believe it is due to actions by parents or because they have angered a god or spirit.
A doctor may attribute it to an...
sickness, causes, diarrhea, infection, public health, education, water systems

Pain Management (22)

Administer Ketamine for Moderate to Severe Pain in Conscious or Unconscious Casualties
High Priority Source: TCCC 17 13 Tactical Combat Casualty Care
Indications: Moderate to severe pain in a conscious or unconscious casualty.

Dosage: 50 mg intranasal; or 20 mg IV, IM, or intraosseous (IO) infusion.

Availability: Available in both the Combat Medic and Tactical Combat Medical Care...
ketamine,pain management,dose administration
Administer Morphine Sulfate for Pain Management
High Priority Source: survival personal wilderness medical kit
Procedure:

1. Assess the patient's condition and confirm that they are experiencing pain.
2. Check the expiration date of the morphine sulfate vial (10 mg/mL, 1 mL) to ensure it is still valid.
3. Prepare the syringe: Use a 1 cc or...
morphine sulfate,pain management,IV administration,IM administration,dose
Administer Oral Analgesics Appropriately
High Priority Source: TCCC 17 13 Tactical Combat Casualty Care
Purpose: To ensure the correct administration of oral analgesics in a tactical combat casualty care (TCCC) setting.

Procedure:
1. Administer Tylenol or meloxicam as appropriate for pain management.
2. Ensure that the casualty is conscious...
oral analgesics, TCCC, pain management
Managing Pain Without Modern Medications
High Priority Source: Survival and Austere Medicine
Procedure:

1. Assess the pain level and source: Determine if it is due to an injury (e.g., broken leg), surgery, or chronic condition.
2. Apply cold compresses: Use ice packs wrapped in cloth to reduce swelling and numb the area for...
pain relief,herbal remedies,pain management without drugs
Pain Management in Tactical Combat Casualty Care
High Priority Source: TCCC 17 13 Army Tactical Combat Casualty Care
Analgesia on the battlefield should generally be achieved by one of the three following options:

• If there is mild to moderate pain and/or the casualty is able to fight, give the casualty the TCCC combat wound pill pack (CWPP).
• If...
ketamine, pain management, OTFC, ondansetron
Administer Codeine for Cough or Pain Relief
Standard Source: Where There is no Doctor a Village Health Care Handbook
Procedure:

1. For cough relief in adults, administer 7 to 15 mg of codeine as needed, following the instructions on the medication label.
2. For severe pain in adults, administer 30 to 60 mg of codeine every 4 hours, but only...
codeine, cough suppressant, pain relief, narcotic
Administer Local Anesthetic Before Sewing a Tear
Standard Source: A Book for Midwives
Procedure:
• If you sew a tear immediately after birth, the woman’s genitals may still be numb, and anesthetic may not be needed.
• However, if possible, numb the area before sewing.

Precautions:
• Ask the mother if she has ever had this...
local anesthetic, midwifery pain management, surgical numbing
Administering Pain Relief Medication
Standard Source: Where There is No Dentist
Procedure:

1. Give pain relief medication to reduce discomfort.

2. Use aspirin or acetaminophen (paracetamol).
- Aspirin comes in 300 mg tablets and is usually cheaper, but may cause stomach pain if not taken with food, milk, or...
aspirin dosage, acetaminophen use, pain relief, dental emergency
Administering a Cervical Numbing Injection
Standard Source: A Book for Midwives
Materials needed:
• Sterilized 22-gauge spinal needle or needle extender
• Local anesthetic with no epinephrine (e.g., 1% lidocaine)

Procedure steps:
1. Preparation and assessment:
- Ask the woman if she has had this type of...
cervical numbing injection, lidocaine, anesthetic, midwifery procedure, pain management
Assemble a First Aid Kit for Fever and Pain Relief
Standard Source: Where There is no Doctor a Village Health Care Handbook
To assemble a first aid kit that includes medicines for fever and pain relief, include the following:

1. Aspirin: Include 300 mg (5 grain) tablets of Aspirin to treat fever and pain.
2. Acetaminophen: Include 500 mg tablets of Acetaminophen...
aspirin,acetaminophen,fever,pain relief
Assessing and Managing Pain in Different Body Areas
Standard Source: Where There is no Doctor a Village Health Care Handbook
Procedure for Assessing and Managing Pain in Different Body Areas:

1. Ask the patient about their pain:
- Determine the location, intensity, duration, and any associated symptoms.
- Note if the pain is constant or intermittent, sharp...
pain management, back pain, chest pain, abdominal pain, eye pain, joint pain, leg pain, tooth pain, urinary pain
Treating Pain with Analgesics
Standard Source: Where There is no Doctor a Village Health Care Handbook
Procedure:

1. Take Aspirin:
- Take aspirin orally as directed by the manufacturer.
- Typically taken every 4-6 hours for pain relief, but not exceeding the maximum daily dose.

2. Use Child’s Aspirin (Acetylsalicylic Acid):
-...
aspirin,acetaminophen,ibuprofen,migraine,ergotamine
Administer Acetaminophen for Mild to Moderate Pain
Standard Source: TCCC 17 13 Tactical Combat Casualty Care
Indications: Mild to moderate pain in a conscious casualty able to swallow.

Dosage: Two 625 milligram (mg) bilayer caplets every 8 hours.

Availability: Available in the Tactical Combat Medical Care Medical Equipment Set...
acetaminophen,Tylenol,pain management,dosage
Administer Acetaminophen for Pain/Fever
Standard Source: Personal Wilderness Medical Kit
Indication: Pain or fever
Dose: i-ii tablets (325 mg each) PO every 4 hours as needed
Instructions:
1. Take acetaminophen tablets, 325 mg (e.g., *Tylenol®*)
2. Administer i-ii tablets by mouth every 4 hours as needed for pain or...
acetaminophen, pain relief, fever reduction, Tylenol
Administering Fentanyl for Pain Management
Standard Source: Emergency War Surgery
Procedure for Administering Fentanyl for Pain Management:

1. Assess the patient’s pain level and vital signs:
- Ensure that the patient is in a stable condition before administering fentanyl.

2. **Determine the appropriate dosage based...
fentanyl,dosage,pain,management
Assessing Pain Using the 0-10 Scale
Standard Source: Survival and Austere Medicine
Pain Assessment using the 0–10 Scale:

Step 1: Ask the patient to rate their pain on a scale from 0 to 10.
- 0 (zero): Complete absence of pain.
- 10 (ten): The worst pain the person has ever experienced or can imagine, often...
pain assessment,pain scale,0-10 scale,pain management,austere medicine
Determine Correct Dose of Pain Medication Based on Age and Weight
Standard Source: Where There is No Dentist
Before giving any pain medication such as aspirin (300 mg tablets) or acetaminophen (500 mg tablets), consider the sick person’s weight and age. The smaller children are, the less medicine they need.

Dosage Guidelines:
1. Babies: Only use...
dose calculation,pain medication,acetaminophen,aspirin,children,dosage guidelines
Managing Body Aches and Pains Associated with Flu
Standard Source: Flu Home Treatment
Procedure:

1. Identify the presence of body aches or pains in the patient.
2. Administer acetaminophen at the recommended dose for adults (two 500mg tablets up to four times daily as needed).
3. Alternatively, administer ibuprofen...
body aches treatment, acetaminophen for pain, ibuprofen for pain
Administer Acetaminophen (Paracetamol)
Reference Source: Where There is no Doctor a Village Health Care Handbook
Procedure for Administering Acetaminophen (Paracetamol)

Overview:
Acetaminophen is used to relieve pain and reduce fever. It should be taken with food or after eating to avoid stomach upset.

Dosage Guidelines:
• Adults: 325–650 mg...
acetaminophen, paracetamol, pain relief, fever reduction, dosage guidelines
Administer Aspirin (Acetylsalicylic Acid)
Reference Source: Where There is no Doctor a Village Health Care Handbook
Procedure for Administering Aspirin (Acetylsalicylic Acid)

Overview:
Aspirin is used to relieve pain, reduce fever, and prevent blood clots. It should be taken with food or after eating to avoid stomach upset.

Dosage Guidelines:
-...
aspirin, acetylsalicylic acid, pain relief, fever reduction, dosage guidelines
Administer Fentanyl Citrate Transmucosal Lozenge for Moderate to Severe Pain
Reference Source: TCCC 17 13 Army Tactical Combat Casualty Care
Indications: Moderate to severe pain in a conscious casualty able to place the lozenge in the mouth.

Administration Steps:
1. Tape the lozenge to the casualty’s index finger.
2. Direct it into the mouth.
3. Advise the casualty not to bite...
fentanyl, transmucosal lozenge, pain management, medication administration
Administer Paracetamol for Pain and Fever Relief
Reference Source: A Book for Midwives
Procedure:

1. Dose: Take 500 to 1000 mg of paracetamol by mouth.
2. Frequency: Repeat every 4 to 6 hours as needed.
3. Maximum Daily Dose: Do not exceed 4000 mg in a 24-hour period.

Important Notes:
• Paracetamol is used to...
paracetamol, acetaminophen, pain relief, fever reduction, medication dosage

Chemical Biological Radiological (22)

Check Soldiers' Protective Clothing for Problems and Take Corrective Action
Critical Source: STP 21 24 Warrior Leader Skills Level 2 3 4
Procedure:

1. Check the Soldiers' protective clothing for problems.
2. If the Soldiers' skin is not exposed and no symptoms are observed, fasten or adjust the protective clothing.
3. If the Soldiers' skin is exposed or they appear to be...
protective clothing,decontamination,M291,nerve agent,first aid
React to a Chemical Hazard and Administer Nerve Agent Antidote
Critical Source: STP 21 1 Army Warrior Skills Level 1 Soldiers Manual of Common Tasks
Procedure:

1. Put on your protective mask immediately upon identifying a chemical hazard.
2. If you or the casualty is affected by nerve agent poisoning:
- Ensure that three sets of MARK I nerve agent antidote autoinjectors or three...
nerve agent antidote,autoinjector,chemical hazard,first aid,self-aid,buddy aid
Classify and Predict Chemical Attack Types
High Priority Source: Medical NBC Battlebook
Objective: Classify chemical attacks into Type A or Type B to predict hazard areas.

Procedure:
1. Type A Attacks (Air-Contaminating Agents): Use non-persistent agents such as G-agents that create a vapor hazard.
2. **Type B Attacks...
chemical attack types, Type A, Type B, hazard area prediction
Establish Sample Management SOP for NBC Agents
High Priority Source: Medical NBC Battlebook
Procedure:

1. Develop a Standard Operating Procedure (SOP) for sample management within the theater.
- The SOP must include:
- Who is responsible for sample collection, transportation, and analysis.
2. Ensure that the SOP is...
NBC agents, sample management, chain of custody, SOP, technical escort unit
Predict Chemical Hazard Areas
High Priority Source: Medical NBC Battlebook
Objective: Determine the likely location and extent of chemical hazard areas following an attack.

Procedure:
1. Identify the means of delivery (e.g., aircraft, rocket, bomblets, shell, spray, bomb, missiles, cannon, generator).
2. Classify...
hazard prediction, chemical attack, meteorological factors, NATO ATP-45
Understand Persistent and Non-Persistent Chemical Agents
High Priority Source: Medical NBC Battlebook
Persistant chemical agents continue to present a hazard for considerable periods after delivery, while non-persistent agents disperse rapidly and pose an immediate but short-term hazard.

Key Differences:
Persistent agents:...
Persistent Chemical Agents,Non-Persistent Chemical Agents,Chemical Warfare,Nerve Agents
Conduct a Chemical Vulnerability Assessment
High Priority Source: Medical NBC Battlebook
Objective: Estimate friendly casualties and consequences from enemy or terrorist chemical attacks to recommend vulnerability reduction measures.

Procedure:
1. Perform a systematic analysis of potential threats and vulnerabilities.
2....
chemical vulnerability assessment, risk reduction, threat analysis, chemical attack
Interferents for the Chemical Agent Monitor (CAM)
High Priority Source: Medical NBC Battlebook
Procedure:

1. Identify common interferents: The following items may interfere with CAM readings:
- M258A1 decontamination kit: High interference on H bar, no interference on G bar.
- M280 DKIE: High interference on H bar, no...
CAM interferents, chemical monitor, false readings, decontamination
Interpreting CAM Levels and Hazard Indicators
High Priority Source: Medical NBC Battlebook
Procedure:

1. Understand the CAM level indicators:
- One to three bars: Low vapor hazard.
- Four to six bars: High vapor hazard.
- Seven to eight bars: Very high vapor hazard.
2. Use with caution: The number of bars...
CAM levels, hazard indicators, chemical monitoring, decontamination
ROTA Hazard Prediction Methods for Chemical Releases
High Priority Source: Medical NBC Battlebook
Procedure:

Use Table 5-C: ROTA Hazard Prediction Methods to estimate exclusion areas based on the type and quantity of toxic industrial chemicals (TIC) released from a bulk storage tank:

|Hazard Case|**Prediction...
ROTA hazard, exclusion areas, TIC release, chemical storage tank, hazard prediction
Recognize and Identify Chemical Agent Contamination
High Priority Source: Medical NBC Battlebook
Objective: Mark contaminated areas with standardized signs for easy identification.

Procedure:
1. Use standard NATO contamination signs that are a right-angled isosceles triangle (base ≈28 cm, sides ≈20 cm).
2. The primary color...
contamination signs, chemical identification, NATO standards
Recognize and Identify Toxic Industrial Chemicals (TIC)
High Priority Source: Medical NBC Battlebook
Objective: Identify industrial settings that may contain hazardous chemicals.

Procedure:
1. Assess the type of industry to determine potential hazards:
- Pharmaceutical Manufacturers: May handle reactive, toxic chemicals,...
toxic industrial chemicals, TIC identification, industrial hazards
Understand Nicotinic Effects on the Nervous System
High Priority Source: Medical NBC Battlebook
Nicotinic effects refer to the actions of nicotine on nerve fibers at autonomic ganglia and neuromuscular junctions.

Key Mechanisms:
• At low doses, nicotine increases activity by stimulating nicotinic acetylcholine receptors.
• At...
Nicotinic,Nicotine,Nerve Receptors,Nerve Agent Effects
Understand Nicotinic Receptor Function and Its Medical Implications
High Priority Source: Medical NBC Battlebook
Nicotinic receptors are ligand-gated ion channels that respond to the neurotransmitter acetylcholine and nicotine.

Key Functions:
• Found in both the central nervous system (CNS) and peripheral nervous system (PNS), nicotinic receptors...
Nicotinic Receptors,Nicotine Poisoning,Nerve Agent Effects,CNS Function
Using M9 Chemical Agent Detection Paper
High Priority Source: Medical NBC Battlebook
Procedure:

1. Cut the paper from the 30-foot roll into short strips when needed in the field.
2. Attach the paper to the body, vehicles, shelters, or other equipment using the adhesive backing.
3. Monitor for color changes: The...
M9 paper, chemical detection, nerve agent, blister agent, decontamination, field use
Using the Improved Chemical Agent Monitor (ICAM)
High Priority Source: Medical NBC Battlebook
Procedure:

1. Operate the ICAM: The ICAM is a hand-held, soldier-operated device used to monitor chemical agent contamination on personnel and equipment after an attack.
2. Detect agents: It detects vapors of chemical agents by sensing...
ICAM, chemical monitor, postattack detection, decontamination
Using the Improved Chemical Monitor – Advanced Point Detector (ICAM-APD)
High Priority Source: Medical NBC Battlebook
Procedure:

1. Operate the ICAM-APD: The ICAM-APD is a heavier, more advanced version of the ICAM and weighs 12 pounds.
2. Alarms: It has both audible and visual alarms to alert users to chemical agent contamination.
3. **Use in...
ICAM-APD, chemical monitor, advanced detection, decontamination
Using the M256A1 Chemical Agent Detector Kit
High Priority Source: Medical NBC Battlebook
Procedure:

1. Unpack the kit: The M256A1 consists of a carrying case, 12 sampler-detectors, instructor cards, and M8 chemical agent detector paper.
2. Test for chemical agents in air: Use the sampler-detector to test for nerve or...
M256A1 kit, chemical detection, air testing, decontamination, field use
Apply Standard Placard Marking for Hazardous Materials
Standard Source: Medical NBC Battlebook
Objective: Use standardized placards to warn of hazardous materials during transport.

Procedure:
1. Use placards on large items such as trucks, pallets of hazardous materials, and storage areas.
2. Ensure each placard is at least **273 mm...
hazardous material placards, UN marking standards, transport safety
Casualty Estimate for Initial Chemical Hazards
Standard Source: Medical NBC Battlebook
Procedure:

Use Table 5-B: Casualty Estimate for Initial Chemical Hazards to estimate casualties based on the type of munition, target radii, and protective measures (MOPP levels):

|Type/Munitions|Target Radii (meters)|**Percent...
casualty estimate, chemical munitions, MOPP levels, nonpersistent agents, persistent agents
Using the M272 Water Testing Kit for Chemical Agents
Standard Source: Medical NBC Battlebook
Procedure:

1. Unpack the kit: The M272 is a lightweight portable water testing kit used to detect and identify harmful chemical warfare agents in raw or treated water.
2. Conduct tests: Each kit can conduct 25 tests per agent, but it is...
M272 kit, water testing, chemical agents, field use
Chemical Risk Assessment Procedure for Medium Risk Situations
Standard Source: Medical NBC Battlebook
Procedure:

1. Continue steps 1-8 from the Low Risk procedure.
2. Increase NBC defense training to ensure readiness for higher threat scenarios.
3. Actively employ chemical detection capabilities such as sensors and monitoring...
medium risk, chemical detection, antidotes, MOPP levels, dispersion plan

Vaccination (21)

Develop Domestic Vaccine Production Capacity
Critical Source: HHSPandemicInfluenzaPlan
Objective: Ensure sufficient domestic vaccine production capacity to provide vaccine for the entire U.S. population as soon as possible after a pandemic begins.

Procedure:
1. Work with the pharmaceutical industry to expand domestic vaccine...
vaccine_production,pandemic_preparedness,pharmaceutical_industry
Develop Investigational Live Attenuated Influenza Virus Vaccines for All 16 HA Subtypes
Critical Source: HHSPandemicInfluenzaPlan
Procedure:

1. Identify all 16 antigenic subtypes of hemagglutinin (H1 to H16) from influenza viruses.
2. Develop live attenuated vaccine candidates for each subtype, ensuring they are safe and effective in preclinical studies.
3. Conduct...
live attenuated,vaccine,HA subtypes
Develop Mass Vaccination/Delivery Techniques
Critical Source: HHSPandemicInfluenzaPlan
Procedure:

1. Research and develop new methods for mass vaccination during a pandemic.
2. Evaluate techniques such as needle-free delivery systems, automated injection devices, or mobile vaccination units.
3. Conduct field trials to assess the...
mass,vaccination,delivery,techniques
Procure and Distribute Pandemic Vaccine
Critical Source: HHSPandemicInfluenzaPlan
Objective: Procure and distribute vaccine directed against the pandemic strain to priority groups based on pre-approved state plans.

Procedure:
1. Work with the pharmaceutical industry to procure vaccine specific to the pandemic influenza...
pandemic_vaccine_distribution,priority_groups,state_plans
Support Production and Evaluation of Investigational Pandemic Vaccines
Critical Source: HHSPandemicInfluenzaPlan
Procedure:

1. Identify investigational lots of pandemic vaccines that are likely to be of greatest risk.
2. Conduct safety assessments on these vaccine candidates, including toxicity studies and evaluation of adverse effects in various...
investigational,vaccine,safety,immunogenicity,priority
Develop Common Protein Vaccines for Influenza
High Priority Source: HHSPandemicInfluenzaPlan
Procedure:

1. Identify conserved protein targets across multiple influenza strains.
2. Design and synthesize vaccines based on these common proteins to provide broad protection.
3. Conduct preclinical studies in animal models to assess...
common,protein,vaccine,development
Develop Gene-Based Vaccines Against Influenza
High Priority Source: HHSPandemicInfluenzaPlan
Procedure:

1. Identify suitable gene sequences from influenza viruses that can be used as vaccine targets.
2. Design and synthesize DNA or RNA-based vaccines encoding these genes.
3. Conduct preclinical studies to assess the immunogenicity and...
gene-based,vaccine,development,synthesis
Develop New Influenza Vaccines with Broader Protection
High Priority Source: HHSPandemicInfluenzaPlan
Procedure:

1. Research and identify new vaccine platforms that may offer longer-term or broader protection against influenza viruses.
2. Evaluate the potential of universal vaccines targeting conserved viral proteins such as M2, NP, or HA stalk...
universal,vaccine,conserved,proteins,long-term
Develop and Test New Vaccine Candidates for Influenza
High Priority Source: HHSPandemicInfluenzaPlan
Procedure:

1. Identify new vaccine candidates through applied research programs supported by NIH, private sector companies, and international laboratories.
2. Conduct clinical trials to test the safety and efficacy of these vaccine...
influenza,vaccine development,clinical trials,prototypic vaccine reference strains,live attenuated vaccine
Enhance Immunogenicity of Inactivated Influenza Vaccines
High Priority Source: HHSPandemicInfluenzaPlan
Procedure:

1. Administer inactivated influenza vaccines using new delivery systems to improve immunogenicity.
2. Increase the dose of inactivated vaccines for better effectiveness, especially for very young and very old individuals.
3. Combine...
inactivated vaccine,adjuvants,dose enhancement,vaccine delivery systems,broad-spectrum protection
Evaluate Strategies for Enhancing Influenza Vaccine Yield
High Priority Source: HHSPandemicInfluenzaPlan
Procedure:

1. Assess current manufacturing processes for influenza vaccine production.
2. Identify bottlenecks or inefficiencies in the production workflow.
3. Evaluate potential strategies to improve yield, such as optimizing cell culture...
influenza,vaccine,yield,manufacturing,strategies
Explore Highly Conserved Viral Genes as Vaccine Targets
High Priority Source: HHSPandemicInfluenzaPlan
Procedure:

1. Identify highly conserved viral genes across multiple influenza strains (e.g., M2, NP, or HA stalk regions).
2. Design vaccine candidates targeting these conserved regions to potentially provide broader protection.
3. Conduct...
conserved,viral,genes,vaccine,target
Produce Purified Reference Antigens for All 16 Influenza Hemagglutinins and Selected Neuraminidases
High Priority Source: HHSPandemicInfluenzaPlan
Procedure:

1. Identify all 16 hemagglutinin (HA) subtypes of influenza viruses.
2. Isolate and purify reference antigens from each HA subtype, ensuring consistency in quality and quantity.
3. Select neuraminidase (NA) molecules for which...
reference antigens,HA subtypes,NA molecules
Assess Cellular Immunity and Cross-Protection from Vaccination
High Priority Source: HHSPandemicInfluenzaPlan
Procedure:

1. Conduct studies to evaluate the role of cellular immunity in protection against influenza viruses.
2. Measure T-cell responses using assays such as ELISPOT or flow cytometry.
3. Assess cross-protection between different vaccine...
cellular,immunity,cross-protection,vaccine
Assess Potency of Existing Vaccines Against Multiple Strains
High Priority Source: HHSPandemicInfluenzaPlan
Procedure:

1. Analyze the genetic sequences of existing influenza vaccines to determine their target antigens (e.g., HA and NA from different strains).
2. Conduct laboratory studies to assess the potency of these vaccines against a wide range...
existing,vaccine,potency,strains,HI tests
Compare Different Vaccine Delivery Systems for Mass Vaccination During Pandemics
High Priority Source: HHSPandemicInfluenzaPlan
Procedure:

To compare different vaccine delivery systems for mass vaccination during pandemics:

1. Evaluate traditional methods such as in-person clinic-based vaccinations.
2. Assess the effectiveness of mobile vaccination units and community...
vaccine delivery systems, mass vaccination, mobile units, digital tools, scalability
Determine Factors That Influenced Pandemic Influenza Vaccination Strategies
High Priority Source: HHSPandemicInfluenzaPlan
Procedure:

To determine factors that influenced pandemic influenza vaccination strategies:

1. Analyze decision-making processes used to prioritize vaccine distribution (e.g., high-risk groups, healthcare workers).
2. Evaluate the availability...
vaccine strategies, distribution factors, public perception, logistical challenges
Determine Rates and Risk Factors for Adverse Events to Pandemic Influenza Vaccine
High Priority Source: HHSPandemicInfluenzaPlan
Procedure:

To determine rates and risk factors for adverse events to pandemic influenza vaccine:

1. Monitor vaccinated individuals for any adverse effects, including allergic reactions, fever, or systemic symptoms.
2. Track the frequency of...
adverse events, vaccine safety, risk factors, adverse event monitoring
Evaluate Efficacy of Pandemic Influenza Vaccine
High Priority Source: HHSPandemicInfluenzaPlan
Procedure:

To evaluate the efficacy of pandemic influenza vaccine:

1. Conduct clinical trials to assess how well the vaccine prevents infection, reduces disease severity, and lowers mortality rates.
2. Monitor vaccinated individuals for immune...
pandemic influenza vaccine, efficacy, immune response, disease severity, population groups
Evaluate Safety and Immunogenicity of Pandemic Influenza Vaccines in Various Populations
High Priority Source: HHSPandemicInfluenzaPlan
Procedure:

To evaluate the safety and immunogenicity of different doses of pandemic influenza vaccines:

1. Administer varying vaccine doses to different population groups, including children, adults, elderly, pregnant women, and individuals...
pandemic influenza vaccine, safety, immunogenicity, population groups, antibody titers
Monitor Long-Term Sequelae of Vaccination
High Priority Source: HHSPandemicInfluenzaPlan
Procedure:

1. Conduct long-term follow-up studies on individuals who have received influenza vaccines.
2. Monitor for potential adverse effects, including non-infectious diseases such as cardiovascular or neurological conditions.
3. Analyze...
long-term,sequelae,vaccine,safety

Cold Injuries (20)

Prevent and Treat Cold-Weather Injuries in Mountain Environments
Critical Source: FM 3 97 61 Military Mountaineering
Procedure:

1. Stay warm:
- Wear layers of clothing, including a moisture-wicking base layer, an insulating middle layer, and a waterproof outer layer.
2. Avoid wet clothing:
- Change into dry clothes immediately if exposed to rain...
frostbite,hypothermia,cold injury,treatment
Recognize and Manage Frostbite (Deep Cold Injury)
Critical Source: Emergency War Surgery
Frostbite results from crystallization of water in the skin and adjacent tissues exposed to temperatures below freezing.

Symptoms:
• Skin initially becomes numb and feels stiff or woody.
• Mottled, bluish, yellowish, “waxy,” or “frozen.”
-...
frostbite, deep cold injury, first aid, frostbite grading
Identify and Recognize Frostbite Symptoms
Critical Source: Emergency War Surgery
Frostbite occurs when water in the skin and adjacent tissues crystallizes due to exposure to temperatures below freezing. The severity depends on temperature and duration of exposure.

Symptoms include:

• Initial symptoms: **Numbness,...
frostbite symptoms, cold injury, frostbite grading, deep frostbite
Identify and Understand Cold Weather Terms: Frostbite
Critical Source: Canadian Military Basic Cold Weather Training
Frostbite is a cold injury caused by the freezing of tissues.

• It can lead to permanent tissue damage, loss of function, or even amputation in severe cases.
• Prevention includes proper clothing, shelter, and awareness of exposure...
frostbite,cold injury,tissue freezing,prevention strategies
Long-Term Care for Trenchfoot/Immersion Foot
Critical Source: USMC Winter Survival Course Handbook
Healing Process:
• In the rear (medical facility), healing of trenchfoot usually takes at least two months, and may take almost a year in severe cases.
Severe cases may require amputation.

Important Note: _Trenchfoot is...
trenchfoot recovery, immersion foot healing, long-term care, amputation risk
Managing Hypothermia
Critical Source: Emergency War Surgery
Procedure for Managing Hypothermia:

1. Assess the severity of hypothermia:
- Identify the grade based on core body temperature and symptoms:
- Mild: Shivering, rapid breathing, and increased heart rate.
- Moderate: Slowed...
hypothermia,treatment,first aid,cold injury
Risks of Using Protective Mask in Extreme Cold Weather for Chemical Protection
Critical Source: FM 31 70 Basic Cold Weather Manual
Procedure:

1. Advise troops that the facepiece of the protective mask will not protect the face from cold.
2. The danger of frostbite increases when the mask is worn during extreme cold weather for protection against chemical agents.
protective mask,cold weather,frostbite risk,chemical protection
Classify Cold Injuries Based on Severity and Type
High Priority Source: NATO Emergency War Surgery
Cold is the primary cause of cold injuries, though wetness, duration of exposure, and other factors can influence severity. These injuries form a continuum rather than distinct categories. The spectrum of cold injury from least to most severe...
cold injuries,classify,cold exposure,chilblain,trench foot,immersion foot,frostbite,hypothermia
Identify and Understand Cold Weather Terms: Cold Injury
High Priority Source: Canadian Military Basic Cold Weather Training
Cold injury is an inclusive term applied to injuries resulting from cold.

• The most common types are:
- Frostbite
- Trenchfoot
- Immersion foot
- Chilblains

Understanding the different types of cold injury is essential...
cold injury,frostbite,trenchfoot,immersion foot,chilblains
Prevent Cold Casualties Based on Windchill Levels
High Priority Source: Canadian Military Basic Cold Weather Training
Procedure:

• At windchill levels reaching 14°F to 20°F, individuals must take personal responsibility for their protection.
• At windchill levels between 18°F to 30°F, the section or platoon commander is responsible for taking action to...
cold casualties,windchill levels,individual responsibility,commander action,cold weather hazards
Recognize and Respond to Frostbite
High Priority Source: NAVMED P 5010 US Navy Manual of Preventive Medicine
Procedure:

1. Identify symptoms: Look for a sharp, pricking sensation followed by numbness and the appearance of yellow/white hardened skin on exposed areas such as cheeks, nose, ears, chin, forehead, fingers, or toes.
2. **Avoid further...
frostbite,cold injury,numbness,tissue damage,medical attention
Prevent and Treat Frostbite During Snowmobiling
High Priority Source: The Complete Outdoorsmans Handbook
Procedure:

1. Watch for frostbite signs, especially in temperatures of zero or below (or above zero with strong wind). Look for telltale white spots on exposed areas like ears, cheeks, or noses.
2. Use the buddy system to monitor...
frostbite prevention, treating frostbite, cold injury, buddy system
Recognize and Respond to Immersion Syndrome
High Priority Source: NAVMED P 5010 US Navy Manual of Preventive Medicine
Procedure:

1. Identify symptoms: Look for pale, wrinkled skin on any extremity that has been exposed to damp conditions.
2. Dry the affected area completely: Do not allow moisture to remain on the skin as it can lead to tissue...
immersion syndrome,cold injury,tissue damage,drying skin,medical attention
Identify Trenchfoot/Immersion Foot
Standard Source: USMC Winter Survival Course Handbook
Definition: Trenchfoot/Immersion Foot is a cold-wet injury to the feet or hands caused by prolonged (generally 7–10 hours) exposure to water above freezing temperatures.

Causes: The major risk factors are:
• Wet conditions
• Cold...
trenchfoot, immersion foot, cold injury, symptoms, identification
Manage Immersion Foot
Standard Source: US Marine Corps Wilderness Medicine
Procedure for Managing Immersion Foot:

1. Dry the affected extremity thoroughly using clean, dry towels or cloth.

2. Gently rewarm the extremity by placing it in a warm (not hot) environment, such as near a heat source or under...
immersion foot,trenchfoot,cold injury,wet feet,non-freezing injury,rewarming,edema,blisters
Prevent Cold Injuries
Standard Source: Medical Emergencies
Procedure:

1. Take preventive measures to avoid cold injuries.
2. Treat any injury or sickness that occurs as soon as possible to prevent it from worsening.
3. Use the buddy system and be aware of signs and symptoms of cold-related...
cold injury,prevention,buddy system
Manage Chilblains (Pernio)
Standard Source: US Marine Corps Wilderness Medicine
Procedure for Managing Chilblains:

1. Apply gentle heat to the affected area using warm compresses or by rubbing with hands in a slow, circular motion.

2. Massage the affected skin gently to improve circulation and reduce...
chilblains,pernio,cold injury,wet skin,non-freezing injury,topical steroids,itching
Recognize and Manage Frostnip (Superficial Cold Injury)
Standard Source: Emergency War Surgery
Frostnip is a superficial cold injury where exposed skin appears red or minimally swollen. Tissue is not actually damaged, but it signals an imminent likelihood of frostbite developing.

Symptoms:
• Exposed skin appears red or minimally...
frostnip, superficial cold injury, first aid
Recognize and Manage Pernio (Chilblain Progression)
Standard Source: Emergency War Surgery
Pernio is a continuum of events from chilblain, resulting from exposure for >12 hours to cold and/or wet conditions. Tight-fitting footwear can shorten exposure time and increase severity.

Symptoms:
• Swelling is more severe; pain is more...
pernio, cold injury progression, skin necrosis, first aid
Recognize and Manage Trench Foot (Non-Freezing Cold Injury)
Reference Source: Emergency War Surgery
Trench foot occurs from prolonged exposure to cold, wet conditions or immersion in water at temperatures as high as 17°C for more than 12 hours, or shorter durations near freezing. Shorter duration at or near 0 °C results in the same...
trench foot, non-freezing cold injury, cold exposure, hyperhidrosis, numbness, pain management

Infant Care (20)

Feeding an Infant with Expressed Breast Milk (EBM) When Latching is Not Possible
Critical Source: Survival and Austere Medicine
Objective: Provide nutrition to an infant who cannot latch onto the breast.

Procedure:
1. Express breast milk using a manual or electric pump, or manually by milking the breasts in a manner similar to milking cows.
2. Store EBM...
expressed breast milk, infant feeding, latching issues, survival
Exclusive Breastfeeding Guidelines for the First Six Months
High Priority Source: A Book for Midwives
WARNING! Breast milk is the best and only food a baby needs for the first 6 months. If a mother gives a baby formula, water, teas, or cereals before 6 months, the baby will suck at the breasts less. This makes the mother have less milk....
exclusive breastfeeding,breast milk only,first six months
Inducing Lactation in Non-Breastfeeding Women for Survival Situations
High Priority Source: Survival and Austere Medicine
Objective: Induce lactation in a non-breastfeeding woman to provide milk for an infant.

Procedure:
1. Select a non-breastfeeding woman who has previously breastfed (especially if she had a longer breastfeeding period).
2. Perform...
induce lactation, non-breastfeeding woman, survival infant care
Kangaroo Care for Small, Early, and Underweight Babies
High Priority Source: Where There is no Doctor a Village Health Care Handbook
To provide warmth and protection to a small, early, or underweight baby (weighing less than 2 ½ kg or 5 pounds), follow these steps:

Steps:
1. Place the baby naked, with or without a diaper or nappy, upright inside your clothing against...
kangaroo care, small babies, underweight infants, infant warmth, breastfeeding, baby care
Alternative Methods of Feeding When Breastfeeding Is Not Possible
High Priority Source: A Book for Midwives
Procedure:

If a mother is infected with HIV, very sick, or has adopted a child, she may not be able to breastfeed. In such cases, alternative feeding methods can be used:

1. Formula Feeding:
- Formula is only safe when the family has...
formula feeding, alternative feeding methods, infant nutrition, HIV prevention, animal milk preparation
Assessing Breast Milk Sufficiency in Infants
High Priority Source: Survival and Austere Medicine
Objective: Determine if an infant is receiving adequate breast milk.

Procedure:
1. Monitor the infant’s general contentment and observe for signs of distress or irritability.
2. Track weight gain over time using a scale, ensuring...
breastfeeding, infant nutrition, weight gain, milk sufficiency, survival
Cleaning and Sterilizing Feeding Equipment for Baby Formula
High Priority Source: A Book for Midwives
Procedure:

To ensure the safety of baby formula feeding:

1. Wash all equipment (cup, spoon, bottle, rubber nipples, and containers) thoroughly with clean water.
2. Boil the cleaned items in water for 20 minutes before each use to sterilize...
sterilizing baby equipment, cleaning formula tools, midwife procedures
Preparing Animal Milk Formula for Baby Feeding
High Priority Source: A Book for Midwives
Procedure:

To prepare animal milk formula for feeding a baby:

For cow, goat, or camel milk:
1. Mix 100 ml of fresh milk with 50 ml of clean water.
2. Add 10 g (2 tsp) of sugar to the mixture.

For sheep or buffalo milk:
1....
animal milk formula, baby feeding, infant nutrition, midwife procedures
Storing Prepared Formula and Animal Milk Safely
High Priority Source: A Book for Midwives
Procedure:

To store prepared formula and animal milk safely:

1. Never leave prepared formula, opened tinned milk, or animal milk at room temperature for more than 2 hours.
2. If refrigerated, formula can be stored in a cold...
formula storage, milk safety, baby feeding guidelines
Utilize Breast Milk for Infant Nutrition
High Priority Source: Where There is no Doctor a Village Health Care Handbook
Objective: Provide optimal nutrition to infants through breast milk.

Procedure:
1. Encourage breastfeeding as the cheapest, healthiest, and most complete food for a baby.
2. Ensure the mother consumes plenty of plant foods, which...
breastfeeding, infant nutrition, breast milk benefits
Ensure Proper Nutrition for Newborns to Prevent Slow Development
Standard Source: Where There is no Doctor a Village Health Care Handbook
Procedure:

1. Recognize signs of slow development in the first months of life, such as poor growth and delayed mental or physical milestones.
2. Provide adequate nutrition, especially during the critical early months when the brain...
newborn nutrition, slow development, breast milk, infant care
Risks of Using Baby Formula
Standard Source: A Book for Midwives
Milk substitutes do not have all the benefits of breast milk and are not safe for most babies:

Less nutritious: Does not provide the same level of nutrients as breast milk.
Harder to digest: Can cause more digestive discomfort in...
baby formula,risk,contamination,digestion,nutrition
Benefits of Breastfeeding
Standard Source: A Book for Midwives
Breast milk has all the nutrition a baby needs and provides many other benefits:

Protects the baby against illnesses: Diarrhea, pneumonia, diabetes, and cancer.
Helps the baby feel safe: Sucking on the breast close to the mother...
breastfeeding,breast milk,nutrition,benefits,infant care
Breastfeeding While Working Outside the Home
Standard Source: A Book for Midwives
When a mother works away from home, it can be hard for her to give her baby only breast milk during the first 6 months. If possible, the mother can bring her baby with her to work, or someone can bring the baby when it is time for her to feed.

In...
working mothers,breastfeeding while working,lactation breaks
Effective Breastfeeding Positions
Standard Source: A Book for Midwives
Chest to chest, chin to breast

The mother’s back is straight. The baby’s head is supported and in a straight line with the rest of his body. Use pillows or some rolled-up cloth under the baby.

The baby suckles the breast, not just the nipple....
breastfeeding positions,effective feeding postures,baby positioning
Establish Breastfeeding Frequency and Duration
Standard Source: A Book for Midwives
A mother should feed her baby whenever he is hungry, day and night. Many new babies will suckle every 1 to 2 hours. The more the baby suckles, the more milk the mother will make.
breastfeeding frequency,breastfeeding duration,milk production
Initiate Breastfeeding Within an Hour of Birth
Standard Source: A Book for Midwives
Help mothers start breastfeeding within an hour of the baby’s birth. The first yellow-colored milk, called colostrum, is just what a new baby needs. It has the right nutrition and provides extra protection against infection. Colostrum also...
breastfeeding,colostrum,newborn care,initiate breastfeeding
Nutritional Guidelines for Breastfeeding Mothers
Standard Source: A Book for Midwives
To heal after a birth, and to make breast milk, a woman should eat as much or more as when she was pregnant. And she should eat a wide variety of foods including fruits and vegetables and foods rich in protein and fats — like nuts, beans, cheese,...
breastfeeding diet,nutrition for lactating mothers,healthy eating during breastfeeding
Proper Holding and Positioning During Breastfeeding
Standard Source: A Book for Midwives
A woman may have a difficult time learning to feed her first baby. You can help by encouraging her to keep trying and showing her the right positions for breastfeeding. A good position helps the baby attach better to the breast, feed better, and...
breastfeeding position,baby holding techniques,nipple care
Recognize and Encourage Baby’s Readiness to Feed
Standard Source: A Book for Midwives
A baby will usually show she is ready to feed by moving toward her mother's breast or by smacking her lips. If the baby has a hard time breastfeeding at first, the mother can put a few drops of milk on the baby’s lips and on her nipple to encourage...
baby readiness,breastfeeding techniques,encouraging feeding

Aeromedical Evacuation (20)

Handling of NBC (Nuclear, Biological, Chemical) Patients During Aeromedical Evacuation
Critical Source: Emergency War Surgery
Procedure:

1. Externally decontaminate nuclear and chemical casualties before transport.
2. Allow time for off-gassing of residual chemical agents.
3. For biological casualties, consider the nature of the agent, its transmission mechanism, and...
NBC patients,aeromedical evacuation,decontamination,off-gassing,quarantinable diseases,plague,smallpox,casualty management
NBC Environment Patient Movement During Aeromedical Evacuation
Critical Source: Emergency War Surgery
Procedure:

1. Externally decontaminate nuclear and chemical casualties before evacuation.
2. Allow time for off-gassing of residual chemical agents.
3. For biological casualties, movement depends on the nature of the agent, its transmission...
nbc environment,aeromedical evacuation,decontamination,quarantine
Cabin Altitude Restrictions for Specific Medical Conditions
High Priority Source: Emergency War Surgery
Procedure:

1. Apply Cabin Altitude Restriction (CAR) for the following conditions:
- Penetrating eye injuries with intraocular air.
- Free air in any body cavity.
- Severe pulmonary disease.
2. For decompression sickness and arterial...
cabin altitude restriction,pneumothorax,intraocular air,free air,body cavity,severe pulmonary disease,decompression sickness,gas embolism,oxygen administration
Management of Pneumothorax During Aeromedical Evacuation
High Priority Source: Emergency War Surgery
Procedure:

1. Insert a chest tube for all pneumothoraces, even small or asymptomatic lesions.
2. Ensure a Heimlich valve or collection system is in place prior to patient transfer to the flight line.
3. Monitor the patient closely during...
pneumothorax,chest tube,Heimlich valve,aeromedical evacuation
Neurosurgical Patient Management During Aeromedical Evacuation
High Priority Source: Emergency War Surgery
Procedure:

1. Adjust ventilator settings to meet increased oxygen demands at altitude for neurosurgical patients.
2. Monitor for hypoxia, which may worsen neurological injury.
3. Ensure adequate oxygenation and consider supplemental oxygen if...
neurosurgical patients,oxygen management,aeromedical evacuation,ventilator settings,hypoxia
Prepare Patient for Aeromedical Evacuation
High Priority Source: Emergency War Surgery
Procedure:

1. Ensure the medical evacuation request includes a requirement for surgical equipment and/or providers.
2. Confirm that the patient is sufficiently stabilized for the anticipated mode and duration of travel.
3. Verify that...
aeromedical evacuation, patient stabilization, IV lines, chest tubes, blankets, litter straps, medical records
Request for AE Mission
High Priority Source: Emergency War Surgery
To initiate an Aeromedical Evacuation (AE) mission, the originating physician must submit a request. This includes details such as movement timing, destination, and suggested support therapies.

Validation Process:
• The validating Flight...
AE mission,request,validation,clearance,CCATT,PMRC,flight surgeon,AE category
Critical Care Air Transport Team (CCATT) Composition and Roles
High Priority Source: Emergency War Surgery
The Critical Care Air Transport Team (CCATT) is composed of the following members:

### Intensivist Physician
• Capable of providing short-term life-support, including advanced airway management, ventilator management, and limited invasive...
CCATT,intensivist,cardiopulmonary technician,burn transport team,aeromedical evacuation
Determine Evacuation Precedence for Patients from Level II MTFs or FST
High Priority Source: Emergency War Surgery
Procedure:

1. The brigade surgeon (or designee) determines the evacuation precedence for all patients requiring evacuation from a Level II MTF or forward surgical team (FST).
2. This determination is made in consultation with the...
evacuation precedence, Level II MTF, FST, PMRC, USAF AE system
Determining Patient Movement Precedence and Requirements for Aeromedical Evacuation
High Priority Source: Emergency War Surgery
To determine patient movement precedence and requirements for aeromedical evacuation (AE), follow these steps:

1. Consultation with Local Flight Surgeon (FS) and AE Liaison: Begin by discussing the case with the local FS and AE liaison to...
movement precedence,AE category,CCATT,PMI,aeromedical evacuation
Oxygen Management During Aeromedical Evacuation
High Priority Source: Emergency War Surgery
Procedure:

1. Recognize that ambient partial pressure of oxygen decreases with increasing altitude.
2. At sea level, a healthy person has an oxygen saturation of 98%–100%.
3. At a cabin altitude of 8,000 ft, this drops to 90%, which...
oxygen saturation,cabin altitude,oxygen administration,aeromedical evacuation
Patient Positioning During Aeromedical Evacuation for Traumatic Brain Injury Patients
High Priority Source: Emergency War Surgery
Procedure:

1. For traumatic brain injury patients, position the head forward during takeoff to minimize increases in intracranial pressure.
2. Position the head rearward during landing to reduce gravitational stress on the brain.
traumatic brain injury,aeromedical evacuation,patient positioning,intracranial pressure
Requesting an Aeromedical Evacuation Mission
High Priority Source: Emergency War Surgery
To request an aeromedical evacuation (AE) mission, follow these steps:

1. Submit a Request: The originating physician at the MTF submits a request for AE movement, including details such as timing, destination, and suggested support...
AE mission,request,validation,clearance,PMRC,MTF,CCATT,aeromedical evacuation
Tailor Vital Signs Monitoring for Aeromedical Evacuation
High Priority Source: Emergency War Surgery
Procedure:

1. Adjust vital signs (VS) monitoring requirements based on altitude effects, limited mobility, decreased staffing enroute, and unpredictable evacuation times.
2. Modify the frequency of wound and neurovascular checks according to...
vital signs monitoring,aeromedical evacuation,wound care,neurovascular checks,Foley catheter,NG tube,IV antibiotics,fasciotomy,escharotomy,endotracheal tube,bivalve cast,neurovascular documentation
Humidity Management During Aeromedical Evacuation
Standard Source: Emergency War Surgery
Procedure:

1. Recognize that airplane cabin humidity is very low at altitude.
2. Monitor for increased evaporative losses and provide additional fluids to patients, especially those with large burns or risk of mucous plugging.
low humidity,aeromedical evacuation,evaporative losses,fluid management,burn patients,mucous plugging
Noise Management During Aeromedical Evacuation
Standard Source: Emergency War Surgery
Procedure:

1. Recognize that noise on aircraft can interfere with communication and patient evaluation.
2. Use noninvasive blood pressure (NIBP) and arterial line for auscultation, as it is impossible due to noise.
3. Provide hearing protection...
noise management,aeromedical evacuation,communication issues,hearing protection,medical alarms
Ostomy Patient Care During Aeromedical Evacuation
Standard Source: Emergency War Surgery
Procedure:

1. Vent collection bags for ostomy patients to prevent excess gas from dislodging the bag from the stoma wafer.
2. Use a straight pin to create two holes in the bag above the wafer ring.
ostomy care,aeromedical evacuation,gas management,bag venting
Patient Positioning to Mitigate Gravitational Stress During Flight
Standard Source: Emergency War Surgery
Procedure:

1. Position traumatic brain injury patients with head forward during takeoff and rearward during landing.
2. This helps minimize transient increases in intracranial pressure caused by gravitational stress.
gravitational stress,aeromedical evacuation,patient positioning
Thermal Stress Management During Aeromedical Evacuation
Standard Source: Emergency War Surgery
Procedure:

1. Plan for cabin temperature changes during transport:
- Winter missions: 15 °C (59 °F) to 25 °C (77 °F).
- Summer missions: 20 °C (68 °F) to 35 °C (95 °F).
2. Monitor patients for thermal stress and provide...
thermal stress,aeromedical evacuation,cabin temperature,winter missions,summer missions
Air Splint Use During Aeromedical Evacuation
Standard Source: Emergency War Surgery
Procedure:

1. Avoid using air splints if alternate devices are available.
2. If air splints must be used, monitor them closely during flight due to expansion at altitude.
3. Make necessary adjustments to the splint as needed throughout the...
air splints, aeromedical evacuation, altitude, monitoring, adjustments

Trauma Management (20)

Classify Casualties Based on Response to Fluid Resuscitation in Hemorrhagic Shock
Critical Source: Emergency War Surgery
Objective: Categorize casualties based on their response to fluid resuscitation for appropriate management.

Procedure:
1. Responders:
- Casualties who show a sustained response to fluids likely have stopped bleeding but may still...
fluid response,casualty classification,blood transfusion,hemorrhagic shock
Handle Unexploded Ordnance (UXO) in Casualties
Critical Source: Emergency War Surgery
Procedure:

1. Identify UXOs embedded in the casualty without exploding (e.g., rockets, grenades, mortar rounds).
2. Notify explosive ordnance disposal immediately!
3. Triage the casualty as nonemergent, place them far from others, and...
UXO management, unexploded ordnance, war surgery, trauma care
Emergency Management of Cranocerebral Injury Patients
Critical Source: NATO Emergency War Surgery
Procedure:

1. Protect the airway: Ensure that the airway is secured before proceeding with other interventions.
2. Treat or prevent shock:
- Insert two large-bore venous catheters.
- Infuse plasma, normal saline, or lactated...
emergency management,cranocerebral injury,shock treatment,anticonvulsants,antibiotics
Manage Pelvic Fractures and Hemorrhage Control
Critical Source: Emergency War Surgery
Procedure:

1. Assess the injury: Look for signs of pelvic instability, pain in the pelvis or lower back, and possible external bleeding.
2. Apply a pelvic binder or splint:
- Use a commercial pelvic binder or improvised materials...
pelvic fracture,hemorrhage control
Managing Patients with Multiple Injuries in Emergency War Surgery
Critical Source: NATO Emergency War Surgery
Procedure:

1. Recognize that patients with multiple injuries are at extremely high risk despite optimal medical treatment.
2. Provide respiratory support using mechanical ventilators to counteract pulmonary insufficiency and fatigue, especially...
multiple injuries, mechanical ventilation, fluid administration, pulmonary insufficiency, trauma management
Perform External Fixation for Pelvic Fractures
Critical Source: Emergency War Surgery
Procedure:

1. Assess the patient: Look for signs of pelvic instability, pain in the pelvis or lower back, and possible external bleeding.
2. Prepare the site: Clean the skin with antiseptic solution and drape the area to maintain...
external fixation,pelvic fracture
Triage for Cranocerebral Injury Patients
Critical Source: NATO Emergency War Surgery
Procedure:

1. Assess neurological condition: Monitor for subtle changes in state of consciousness, as these may indicate impending intracranial disaster.
2. Prioritize airway management: Clear and maintain the airway, even if this...
triage,cranocerebral injury,airway management,neurological assessment,priority triage
Determine Mechanism of Injury: Penetrating or Blunt Trauma Above Collarbones
High Priority Source: First Aid in Armed Conflicts
### Determine Mechanism of Injury: Penetrating or Blunt Trauma Above Collarbones

In armed conflict or other situations of violence, you must immediately determine whether the casualty has suffered blunt or penetrating trauma – a closed or...
mechanism of injury, blunt trauma, penetrating trauma, cervical spine care, armed conflict, first aid
Identify and Manage Ballistic Injuries from Defeated Armor
High Priority Source: Emergency War Surgery
Procedure:

1. Recognize ballistic injuries resulting from defeated armor, which may include:
- Penetrating missile wounds (Fig. 1-9d)
- Fragment wounds combined with superficial burns to exposed skin (face, neck, forearms, and hands)
2....
ballistic injuries, defeated armor, trauma management, war surgery
Manage Definitive Care for Trauma Patients
High Priority Source: NATO Emergency War Surgery
Procedure for Managing Definitive Care in Trauma Patients

1. Definitive care of each injury will be discussed in subsequent chapters.

2. Most combat casualties are young, healthy individuals; however, senior personnel and civilian...
definitive care, trauma management, ample history, patient reevaluation, vital signs monitoring, recordkeeping
Managing Hypermetabolic Response in Trauma Patients
High Priority Source: NATO Emergency War Surgery
Procedure for Managing Hypermetabolic Response in Trauma Patients

1. Assess the severity of injury: The extent of hypermetabolism is proportional to the severity of injury.
2. Monitor oxygen consumption: Following resuscitation, oxygen...
hypermetabolism, trauma, insulin, glucose production, gluconeogenesis, protein mobilization, nutritional support, sepsis
Manage Blast Overpressure Injuries in Confined Spaces
High Priority Source: Emergency War Surgery
Procedure:

1. Identify blast overpressure injuries from explosions in confined spaces.
2. Monitor for signs of ear injury, including ruptured tympanic membranes (common in armored crewmen casualties).
3. Provide supportive care and consider...
blast overpressure, ear injury, trauma management, war surgery
Assess and Manage Cervical Spine Injury in Head and Facial Trauma Patients
Standard Source: Emergency War Surgery
Procedure:

1. Assume the presence of cervical spine injury in patients with head trauma, especially those with closed head injuries.
2. In patients with facial trauma, up to 10% may also have a C-spine injury; therefore, assess for cervical...
cervical spine injury, head trauma, facial trauma, immobilization, radiographic evaluation, CT scan
Cervical Spine Immobilization and Management in Trauma
Standard Source: Emergency War Surgery
Procedure for Cervical Spine Immobilization and Management:

1. All potentially unstable cervical spine injuries should be immobilized using a rigid collar, unless halo immobilization is required.
2. In acute combat settings, **halo...
cervical spine immobilization, halo use, Gardner-Wells traction, penetrating trauma, nonpenetrating trauma, osseous instability
Control Bleeding and Assess for Occult Hemorrhage in Traumatic Shock
Standard Source: Emergency War Surgery
Objective: Control external bleeding and identify hidden sources of blood loss.

Procedure:
1. Apply direct pressure to all visible wounds using sterile gauze or clean cloth.
2. Use tourniquets if necessary for severe extremity...
bleeding control, occult hemorrhage, traumatic shock, tourniquet, FAST exam, surgical intervention
Crush Syndrome Recognition, Management, and Prevention
Standard Source: Emergency War Surgery
Procedure: Crush Syndrome Recognition, Management, and Prevention

1. Recognition of Crush Syndrome (CS):
- History:
- Suspect in patients with a history of being trapped for a prolonged period (hours to days) in scenarios...
Crush Syndrome, Rhabdomyolysis, Acute Kidney Injury, Fluid Resuscitation, Myoglobinuria, War Surgery
Management of External Genitalia Injuries
Standard Source: Emergency War Surgery
### External Genitalia Injuries

The management of wounds to the penis, scrotum, testes, or spermatic cord should be as conservative as possible and consists of hemorrhage control, debridement, and early repair to prevent deformity.

-...
external genitalia injuries, penis injury management, scrotal injury, partial scrotal avulsion, Buck’s fascia repair
Use Corticosteroids in Trauma Patients
Standard Source: Emergency War Surgery
Corticosteroids are rarely indicated after major trauma and have no proven benefit for closed head injury or sepsis.

### Indications for Corticosteroid Use:
Proven adrenocortical deficiency, which is rare among battlefield casualties.
-...
corticosteroids, trauma patients, adrenocortical deficiency, spinal cord injury, closed head injury, sepsis
Initial Evaluation and Management of Penetrating Foot Injuries
Reference Source: Emergency War Surgery
Objective: Assess and manage penetrating injuries of the foot to prevent prolonged morbidity and disability.

Steps:
1. Assess the zone of injury: Both open and closed injuries may be more extensive than initially apparent. Look for...
foot injury, penetrating wound, compartment syndrome, debridement, vascular assessment, neurological assessment
Management of Vulvar Injuries and Hematomas
Reference Source: Emergency War Surgery
Vulvar Injuries

Lacerations:
- Superficial, clean lacerations less than 6 hours old can be primarily closed with absorbable suture. Debridement of obviously devitalized tissue is recommended.
- Deep lacerations should be examined and...
vulvar injuries, hematomas, lacerations, urethral injury, anal laceration, absorbable suture, antibiotics

Respiratory Illnesses (20)

Recognize and Respond to an Asthma Attack
High Priority Source: Where There is no Doctor a Village Health Care Handbook
Title: Recognize and Respond to an Asthma Attack

Content:

Signs of an asthma attack:
- Difficulty breathing, especially when exhaling (listen for a hissing or wheezing sound).
- The skin behind the collar bones and between the...
asthma, breathing difficulty, wheezing, rescue inhaler, controller medication, prednisolone, epinephrine, mebendazole
Administer Prednisone for Allergies or Asthma
High Priority Source: survival personal wilderness medical kit
Procedure for Administering Prednisone Tablets for Allergy/Asthma

Steps:
1. Recognize allergy/asthma symptoms: Look for signs such as difficulty breathing, swelling, and persistent coughing.
2. Check medication availability: Ensure...
prednisone,corticosteroid,allergy treatment,asthma relief
Administering Salbutamol for Respiratory Conditions
High Priority Source: Where There is no Doctor a Village Health Care Handbook
Procedure:

1. Identify the need: Use salbutamol (a bronchodilator) for asthma attacks or other respiratory conditions where airway constriction is present.
2. Dosage: Administer 1-2 puffs of a metered-dose inhaler, with a maximum of 4...
salbutamol, asthma treatment, bronchodilator, inhaler use
Identify and Treat the Underlying Cause of a Persistent Cough
High Priority Source: Where There is no Doctor a Village Health Care Handbook
Purpose: Determine the cause of a persistent cough and treat it appropriately.

Steps:
1. Monitor symptoms closely, such as the presence of blood, pus, or smelly phlegm in the cough, weight loss, or continual difficulty breathing.
2. If...
persistent cough, underlying cause, health worker, tuberculosis, pneumonia, chronic bronchitis
Recognize and Respond to Rales in Respiratory Sounds
High Priority Source: Medical NBC Battlebook
Rales are abnormal respiratory sounds heard during auscultation that indicate some pathological condition, such as pneumonia or pulmonary edema.

### Action Steps:
Listen carefully for crackling or bubbling sounds in the lungs using a...
rales,respiratory sounds,pathological conditions,pneumonia
Treating Cough and Respiratory Infections with Hot Water Vapors
High Priority Source: Where There is no Doctor a Village Health Care Handbook
Procedure:

1. Boil clean water in a pot or kettle.
2. Place the person near the steam, ensuring they can breathe in the vapors comfortably (e.g., using a towel to direct the steam toward their face).
3. Encourage the person to inhale deeply...
cough,asthma,breathing,pneumonia,hot water vapors
Prevent Asthma Attacks and Manage Daily Care for Asthma Patients
Standard Source: Where There is no Doctor a Village Health Care Handbook
Title: Prevent Asthma Attacks and Manage Daily Care for Asthma Patients

Content:

Avoid triggers that cause asthma attacks:
- Avoid eating or breathing things to which the person is allergic (see page 166).
- Keep the home clean...
asthma prevention, allergen avoidance, hydration, controller medication, air quality, smoking cessation
Treating Sore Throat or Tonsillitis with Warm Salt Water Gargles
Standard Source: Where There is no Doctor a Village Health Care Handbook
Procedure:

1. Prepare a warm salt water solution by dissolving one teaspoon of salt in a cup of warm water.
2. Have the person gargle with this solution several times per day to help reduce throat pain and inflammation.
3. Ensure that the...
sore throat,tonsillitis,warm salt water,gargle
Treating Stuffy Nose with Salt Water Sniffing
Standard Source: Where There is no Doctor a Village Health Care Handbook
Procedure:

1. Prepare a warm salt water solution by dissolving one teaspoon of salt in a cup of warm water.
2. Have the person sniff this solution into their nose several times per day to help relieve nasal congestion.
3. Ensure that the...
stuffy nose,salt water,sniffing,treatment
Use Codeine for Severe Dry Coughs That Interfere with Sleep
Standard Source: Where There is no Doctor a Village Health Care Handbook
Purpose: Provide relief from severe dry coughs that prevent sleep.

Instructions:
1. For a severe dry cough that does not allow the person to sleep, administer a syrup containing codeine (see page 383 for details on dosage and...
codeine, dry cough, sleep, aspirin, phlegm, wheezing
Administer Oxymetazoline Nasal Spray for Congestion
Standard Source: Personal Wilderness Medical Kit
Indication: Nasal congestion
Dose: i spray twice daily as needed
Instructions:
1. Use oxymetazoline nasal spray (e.g., *Afrin®*)
2. Administer i spray in each nostril twice daily as needed for nasal congestion
Warnings:
• Do...
nasal spray, congestion relief, Afrin
Loosen Mucus and Ease Cough with Hydration and Steam
Standard Source: Where There is no Doctor a Village Health Care Handbook
Purpose: Help loosen mucus and ease coughing by increasing hydration and using steam inhalation.

Steps:
1. Drink lots of water to help thin out mucus and make it easier to expel. This is more effective than any medicine for easing a...
cough, mucus, steam inhalation, hydration, asthma, eucalyptus, vaporub
Administer Bronchodilators for Asthma
Reference Source: Where There is no Doctor a Village Health Care Handbook
Title: Administer Bronchodilators for Asthma

Procedure:
1. Use salbutamol (Albuterol):
- Inhale 2 puffs every 4-6 hours as needed for acute asthma symptoms.
- Do not exceed a total of 8 puffs in 24 hours without consulting a...
asthma,salbutamol,Albuterol,beclomethasone,prednisolone,prednisone
Administer Salt & Soda Saline Solution for Runny Nose
Reference Source: Flu Home Treatment
To treat a runny nose using a salt & soda saline solution, follow these steps:

1. Mix ¼ tsp of salt and ¼ tsp of baking soda into a cup of clean water.
2. Use the solution to spray it into the nose as a mist for optimal...
salt solution,baking soda,nasal irrigation,runny nose,children's care
Recognize and Respond to Rhinorrhea (Nasal Discharge)
Reference Source: Medical NBC Battlebook
Rhinorrhea is the free discharge of a thin nasal mucus. It can be caused by allergies, infections, or environmental irritants.

### Action Steps:
Monitor for other symptoms, such as fever or congestion.
Avoid allergens or irritants...
rhinorrhea,nasal discharge,allergies,infections
Treating Upper Respiratory Tract Infections
Reference Source: Survival and Austere Medicine
Procedure:

**Steps to treat upper respiratory tract infections:

1. Rest and hydration: Ensure the patient gets adequate rest and drinks plenty of fluids (water, herbal teas, broths) to thin mucus.
2. Humidify the air: Use a humidifier...
upper respiratory infection, nasal irrigation, pain management, rest, hydration
Treating a Stuffy or Runny Nose in Newborns and Adults
Reference Source: Where There is no Doctor a Village Health Care Handbook
Procedure for Treating a Stuffy or Runny Nose:

1. Use a saline nasal spray to help loosen mucus and clear the nasal passages.
2. Gently suction the nose using a bulb syringe if necessary, especially in newborns.
3. Apply a warm compress to the...
stuffy nose,runny nose,nasal congestion,saline spray,bulb syringe
Use Antihistamines for Runny Nose in Children
Reference Source: Flu Home Treatment
Diphenhydramine (generic name for Benadryl®) is an effective antihistamine for treating runny nose in children. Follow these steps:

1. Use commercial children’s Benadryl, which is available as an **oral tablet that melts in the child's...
antihistamine,Benadryl,children's medicine,sedation,runny nose
Administer Cough Medications
Reference Source: Where There is no Doctor a Village Health Care Handbook
Title: Administer Cough Medications

Procedure:
1. Use codeine:
- Take 15-30 mg every 4-6 hours as needed for cough relief.
- Do not exceed a total daily dose of 120 mg without consulting a healthcare provider.

Warnings:
-...
cough,codeine,cough medication
Administer Nasal Decongestants for Stuffy Nose
Reference Source: Where There is no Doctor a Village Health Care Handbook
Title: Administer Nasal Decongestants for Stuffy Nose

Procedure:
1. Use nose drops with ephedrine or phenylephrine:
- Apply 2-3 drops in each nostril every 4 hours as needed.
- Do not use for more than 7 days without consulting a...
stuffy nose,nasal decongestants,ephrine,phenylephrine

Hypothermia (20)

Administer Hot Fluids to a Conscious Hypothermic Victim
Critical Source: Medical Emergencies
Procedure:

1. If the victim is conscious, give them hot, sweetened fluids.
2. Use honey or dextrose as the best sources of calories.
3. If unavailable, use sugar, cocoa, or a similar soluble sweetener.

Notes:
• This helps...
hypothermia,hot fluids,treatment
Avoid Rapid Rewarming of Hypothermic Victim
Critical Source: Medical Emergencies
Procedure:

1. Do not rewarm the victim too rapidly, as this can cause circulatory problems and heart failure.
2. Focus on warming the core area rather than the limbs to avoid complications.
3. Be aware of "after drop," which is a sharp...
hypothermia,rewarming,after drop
Recognize Signs and Symptoms of Hypothermia
Critical Source: USMC Summer Survival Course Handbook
Procedure:

1. Monitor for the following signs and symptoms:
- Altered mental status (the brain is affected by cold):
- Confusion, slurred speech, strange behavior, irritability, impaired judgment, hallucinations, or fatigue.
-...
hypothermia symptoms, altered mental status, shivering cessation
Recognize and Respond to Hypothermia
Critical Source: USMC Winter Survival Course Handbook
Procedure for Recognizing and Responding to Hypothermia:

### Signs and Symptoms of Hypothermia:
Altered mental status: confusion, slurred speech, strange behavior, irritability, impaired judgment, hallucinations, or fatigue.
• **Loss of...
hypothermia, cold weather injury, survival, hypothermia symptoms, rewarming, body temperature, first aid for hypothermia
Recognize and Respond to Hypothermia (General Cooling)
Critical Source: FM 4 25 11 First Aid
Title: Recognize and Respond to Hypothermia (General Cooling)

Content:
Hypothermia occurs when the body loses heat faster than it can produce it, leading to a core temperature below 95°F. It can be caused by prolonged exposure to cold...
hypothermia symptoms, first aid for hypothermia, rewarming techniques, cold injury prevention
Rewarm Hypothermic Victim in Warm Water Bath
Critical Source: Medical Emergencies
Procedure:

1. Immerse the trunk area only of the victim in warm water (37.7 to 43.3 degrees C or 100 to 110 degrees F).
2. This should be done only in a hospital environment, due to the risk of cardiac arrest and rewarming...
hypothermia,warm water bath,treatment
Treat Hypothermia with Warm Water Enemas
Critical Source: Medical Emergencies
Procedure:

1. If possible, give the victim warm water enemas to get heat to the inner core.
2. This method may not be feasible in a survival situation.

Notes:
• This is an effective way to rewarm the body's core.
• It should only be...
hypothermia,warm water enema,treatment
Treat Hypothermia with a Warmed Sleeping Bag
Critical Source: Medical Emergencies
Procedure:

1. Wrap the victim in a warmed sleeping bag.
2. Place another person who is already warm into the same sleeping bag with the victim, and both should be naked.
3. Monitor the situation carefully to avoid further hypothermia in...
hypothermia,warm sleeping bag,treatment
Identify Causes of Hypothermia
Critical Source: USMC Summer Survival Course Handbook
Procedure:

1. Identify contributing factors to hypothermia:
- Ambient temperature (outside air temperature).
- Wind chill, which affects individuals who are improperly clothed.
- Wet clothing, which increases heat loss.
...
hypothermia causes, cold exposure factors, survival risks
Identify Signs of Hypothermia (Loss of Body Heat)
Critical Source: Where There is no Doctor a Village Health Care Handbook
Title: Identify Signs of Hypothermia (Loss of Body Heat)

Signs to look for:
1. Uncontrolled shivering
2. Slow or unclear speech
3. Stumbles when he walks
4. Cannot think clearly
5. Feels very tired
6. In cold climates,...
signs of hypothermia, loss of body heat symptoms, cold exposure signs, hypothermia identification
Manage a Hypothermia Casualty in Cold Weather Environments
Critical Source: US Marine Corps Wilderness Medicine
Procedure:

1. Recognize signs of hypothermia:
- Shivering, confusion, slurred speech, slow breathing, weak pulse, and loss of coordination.

2. Remove the casualty from cold exposure:
- Move them to a sheltered area away from wind...
hypothermia, rewarming, cold weather, first aid, survival
Recognize the Body's Response to Cold
Critical Source: USMC Summer Survival Course Handbook
Procedure:

1. Understand how the body responds to cold:
- Step 1: Blood vessels at the skin surface constrict, reducing blood flow near the surface of the body.
- This reduces heat loss to the environment.
- Step 2: More...
cold response, body heat regulation, shivering, hypothermia prevention
Understand the Definition and Risk of Hypothermia
Critical Source: USMC Summer Survival Course Handbook
Procedure:

1. Define hypothermia:
- It is a condition where the body’s core temperature falls to 95°F (35°C) or less.
- It is the number one killer in survival situations.

2. Clarify common misconceptions:
- Hypothermia...
hypothermia definition, survival risks, core temperature
Understand the Lethality of Hypothermia
Critical Source: US Marine Corps Wilderness Medicine
Understanding the Lethality of Hypothermia:

• Hypothermia is potentially lethal with a mortality rate greater than 50% in severe cases.
• In cases complicated by trauma, the mortality rate can approach 100%.
• The most common cause of death in...
hypothermia mortality rate, ventricular fibrillation, hypothermia severity
Identify Hypothermia Definition
High Priority Source: US Marine Corps Wilderness Medicine
Definition of Hypothermia: A fall in core body temperature to 95°F (35°C) or less.

• This is a critical threshold for diagnosing hypothermia and should be used as the standard definition.
• Core body temperature must be measured using rectal or...
hypothermia definition, core body temperature, hypothermia diagnosis
Recognize and Treat Hypothermia
High Priority Source: Student manual 2005
Procedure for Recognizing and Treating Hypothermia

### Symptoms of Hypothermia
• Shivering (initial sign)
• Confusion or disorientation
• Clumsiness or uncoordinated movements
• Slurred speech
• Drowsiness or lethargy
• Weak pulse
• Slow,...
hypothermia,treatment,symptoms,prevention,cold weather,outdoor safety,trapping
Understanding and Identifying Hypothermia
High Priority Source: Student manual 2005
Procedure:

1. Recognize the signs of hypothermia, which include shivering, slurred speech, confusion, drowsiness, loss of coordination, and eventually unconsciousness.

2. Assess the environment to determine if the individual is exposed...
hypothermia, cold exposure, symptoms, treatment, emergency response
Recognize Incidence of Hypothermia
High Priority Source: US Marine Corps Wilderness Medicine
Incidence of Hypothermia:

Common Misconception: Hypothermia is often thought to occur only in extremely cold environments.
Reality: Greater than 50% of hypothermia cases occur at ambient temperatures of 50°F or greater.
-...
hypothermia incidence, urban hypothermia, male to female ratio
Use Proper Thermometers for Hypothermia Diagnosis
High Priority Source: US Marine Corps Wilderness Medicine
Proper Thermometer Use for Hypothermia:

• Many standard clinical thermometers do not register low enough temperatures to accurately diagnose hypothermia.
• A low-reading rectal thermometer (NSN 6515-00-139-4593) is available through the...
low-reading thermometer, hypothermia diagnosis, rectal temperature measurement
Identify Signs and Symptoms of Moderate Hypothermia
Standard Source: STP 21 1 Army Warrior Skills Level 1 Soldiers Manual of Common Tasks
### Identify Signs and Symptoms of Moderate Hypothermia

Look for the following signs and symptoms:

(a) Glassy eyes.
(b) Slow and shallow breathing.
(c) Very weak or absent pulse.
(d) Increasing stiffness and lack of...
hypothermia, signs, symptoms, moderate

Dental Injuries (20)

Administer Antibiotics and Pain Relief for Dental Injuries
Critical Source: Where There is No Dentist
Steps to Administer Medication:

1. Give penicillin by injection (see page 204) for 5 days to prevent infection inside the bone.
2. Provide pain relief as needed:
- For mild to moderate pain, give aspirin at a dose of **600 mg...
penicillin injection, aspirin dosage, codeine for pain, dental infection prevention
Manage Pain in the Jaw Joint Due to Fracture
Critical Source: Where There is No Dentist
Procedure:

1. Determine if a fracture is the cause of the pain by checking for signs such as swelling, bruising, or misalignment.
2. If an X-ray confirms a fracture, seek expert help immediately, as a dentist can wire the teeth to allow...
jaw fracture, dental fracture, X-ray for jaw pain, wiring teeth for healing
Manually Realign a Dislocated Lower Jaw
Critical Source: Where There is No Dentist
Procedure:

1. Support the person’s head by having them sit on the floor with their head against a wall.
2. Kneel in front of the person, placing your fingers under their jaw (outside the mouth) and your thumbs beside their last molar...
dislocated jaw, realign jaw, manual realignment, dental emergency, first aid for dislocation
Stop Bleeding from a Facial Injury
Critical Source: Where There is No Dentist
Steps to Stop Bleeding:

1. Wipe away dried blood from the person's face and inside their mouth.
2. Identify the source of bleeding.
3. Sew any deep cuts on the face, referring to _Where There Is No Doctor_, page 86 for guidance.
4....
stop bleeding, facial injury, dental trauma, jaw fracture, ligature wire, local anesthetic
Assess and Prioritize Dental Trauma with ABC Evaluation
High Priority Source: Survival and Austere Medicine
When dealing with dental trauma, first assess the patient using the ABCs (Airway, Breathing, Circulation). Any blow or force strong enough to cause dental injury may also result in serious head, facial, or neck injuries, including potential...
dental trauma, abc evaluation, head injury, neck injury, cervical spinal injury
Full Wiring of the Mandible for Fractures or Multiple Tooth Involvement
High Priority Source: Survival and Austere Medicine
Procedure:

1. Gather materials: small lengths of wire suture (or fine fuse wire).
2. Create a small loop in the center of each piece of wire.
3. Wrap the wire in a figure 8 pattern around two teeth, with the small loop facing outwards over the...
mandible wiring,dental fractures,multiple tooth involvement,jaw wiring,temporary splinting
Identify and Address Sores on the Face (Noma)
High Priority Source: Where There is No Dentist
Procedure:

Identification:
• Look for sores on the cheek or under the chin. These may indicate a tooth or gum problem, such as Noma, a severe gum infection.

Action Steps:
• Refer to pages in this book that detail Noma and its...
noma identification, facial sores, gum infection, dental referral, oral hygiene
Dental Extraction Procedure
High Priority Source: Survival and Austere Medicine
Procedure:

1. Administer a local anesthetic block to numb the area around the tooth to be extracted.
2. Use proper instruments such as Maxillary Universal Forceps (150), Mandibular Universal Forceps (151), and a periosteal elevator to grasp and...
dental extraction,tooth removal,local anesthetic,forceps,periosteal elevator
Extracting a Tooth When There Is Swelling
High Priority Source: Where There is No Dentist
Procedure:

1. Assess for swelling. If there is swelling, treat it first before removing the tooth.

2. Administer an antibiotic. Oral penicillin is preferred unless immediate danger exists (e.g., fever or swelling pressing against the...
tooth extraction, swelling treatment, antibiotic use, dental emergency
Follow-Up Care for a Reimplanted Permanent Tooth
High Priority Source: Where There is No Dentist
Procedure for Follow-Up Care After Reimplanting a Permanent Tooth

After reimplanting the tooth:

1. Tell the person with the injured tooth to return several times for follow-up care.
2. The tooth may die several months or even years...
follow-up care, reimplanted tooth, x-ray, dental monitoring
Handle a Loose Tooth Caused by Gum Disease or an Old Abscess
High Priority Source: Where There is No Dentist
Procedure for Handling a Loose Tooth Due to Gum Disease or an Old Abscess

If the tooth is loose because of gum disease or an old abscess that has eaten the bone around its roots:

1. Take out the tooth, especially if it also hurts.
2....
gum disease, loose tooth, abscess, dental extraction
Stabilizing Loose Teeth with a Splint
High Priority Source: Where There is No Dentist
Procedure for Stabilizing Loose Teeth:

1. If the bone around the roots of the teeth is cracked, those teeth will be loose. Do not take the teeth out until the bone is healed. Otherwise, bone will come out with the teeth and there will...
loose teeth, splint, ligature wire, dental stabilization, jaw bone healing
Treating Torn Gums with Broken Bone and Bleeding
High Priority Source: Where There is No Dentist
Treatment:

1. With wire, hold the broken parts of the bone together.
2. Send the person to an experienced dental worker.

See page 110 for further instructions.
torn gums,broken bone,dental injury
Control Bleeding from a Tooth Socket
Standard Source: Where There is No Dentist
Procedure:

1. Apply cotton to the wound: Have the person bite firmly against a piece of cotton to control bleeding.
2. Avoid harmful actions: Advise the person not to smoke, rinse with salt water, or spit for 1–2 days after tooth...
tooth extraction, bleeding control, dental wound, cotton application, post-extraction care
Intra-oral Splinting Using Cotton Fiber and Temporary Filling Mix
Standard Source: Survival and Austere Medicine
Procedure:

1. Gather materials: cotton fibers and temporary filling mix.
2. Mix the cotton fibers into the temporary filling material until a fibrous consistency is achieved.
3. Mold the mixture to create a splint between the injured tooth and...
cotton fiber,temporary filling mix,dental splint,tooth dislocation,intra-oral splinting
Intra-oral Splinting Using Wire Suture Material
Standard Source: Survival and Austere Medicine
Procedure:

1. Gather materials: wire suture material or reasonably heavy gauge fuse wire.
2. Clean the affected area and neighboring teeth to ensure proper adhesion.
3. Apply adhesive (such as dental glue) to the wire and attach it to the...
intra-oral splinting,wire suture,dental fractures,tooth dislocation,temporary splint
Managing a Loose Tooth with Bleeding Gums
Standard Source: Where There is No Dentist
Treatment:

Hold the tooth with wires, or if the root is broken,
Take out the tooth.

See pages 112 and 157 for further instructions.
loose tooth,bleeding gums,dental injury
Treat Continued Bleeding from a Tooth Socket
Standard Source: Where There is No Dentist
Procedure:

1. Check blood pressure: Measure the person’s blood pressure (see *Where There Is No Doctor*, pages 410–411). If it is high, administer medication to lower it, which may help reduce bleeding.
2. Inspect the wound: Examine the...
continued bleeding, blood pressure check, suture application, tea leaves treatment, cactus juice use
Handle a Knocked-Out Baby Tooth
Standard Source: Where There is No Dentist
Procedure for Handling a Knocked-Out Baby Tooth

When a baby tooth is knocked out:

1. Do not attempt to put the tooth back into the socket.
2. Tell the child to bite on some cotton to stop the bleeding.
3. **Wait for the permanent tooth to...
baby tooth, knocked out, dental injury, first aid for teeth
Identify Signs of a Loose Tooth Caused by Another Tooth Biting Too Hard
Reference Source: Where There is No Dentist
Procedure for Identifying Signs of a Loose Tooth Due to Another Tooth Biting Too Hard

Signs that another tooth is biting too hard against the loose tooth include:

• You can feel the tooth move when the upper and lower teeth meet.
• The...
loose tooth, dental misalignment, bite force

International Humanitarian Law (20)

Describe the authority of a Commander to use medical buildings for other than medical purposes, in cases of urgent military necessity
Standard Source: STP 21 1 Warrior Skills Level 1
Procedure:

(n) Describe the authority of a Commander to use medical buildings for other than medical purposes, in cases of urgent military necessity.

Details:
• This procedure involves explaining the circumstances under which a...
commander authority, medical buildings, military necessity, Geneva Convention
Describe the emblem or distinctive sign of the medical service of an Armed Force
Standard Source: STP 21 1 Warrior Skills Level 1
Procedure:

(x) Describe the emblem or distinctive sign of the medical service of an Armed Force.

Details:
• This procedure involves explaining the specific emblem or distinctive sign used to identify the medical service of an armed...
medical service emblem, Geneva Convention, international humanitarian law
Describe the enemy's obligation to restore medical buildings to the other side and to return captured medical material, stores, and equipment
Standard Source: STP 21 1 Warrior Skills Level 1
Procedure:

(m) Describe the enemy's obligation to restore medical buildings to the other side and to return captured medical material, stores, and equipment.

Details:
• This procedure involves explaining the obligations of an enemy...
enemy obligation, medical buildings, Geneva Convention, return of supplies
Describe the prisoner of war status of the wounded and sick and the aircraft crew captured by the enemy after an involuntary landing of the medical aircraft because of mechanical failure or inclement
Standard Source: STP 21 1 Warrior Skills Level 1
Procedure:

(w) Describe the prisoner of war status of the wounded and sick and the aircraft crew captured by the enemy after an involuntary landing of the medical aircraft because of mechanical failure or inclement weather.

Details:
-...
prisoner of war, wounded and sick, Geneva Convention, international humanitarian law
Describe the private property status and the right of requisition of real and personal property of aid societies
Standard Source: STP 21 1 Warrior Skills Level 1
Procedure:

(o) Describe the private property status and the right of requisition of real and personal property of aid societies.

Details:
• This procedure involves explaining the legal status of aid society property under international...
aid societies, property status, requisition rights, Geneva Convention
Describe the prohibition against medical aircraft flying over enemy territory or enemy-occupied territory
Standard Source: STP 21 1 Warrior Skills Level 1
Procedure:

(t) Describe the prohibition against medical aircraft flying over enemy territory or enemy-occupied territory.

Details:
• This procedure involves explaining the legal prohibitions regarding the operation of medical aircraft...
medical aircraft, flight prohibition, Geneva Convention, international humanitarian law
Describe the protected status of medical aircraft
Standard Source: STP 21 1 Warrior Skills Level 1
Procedure:

(p) Describe the protected status of medical aircraft.

Details:
• This procedure involves explaining the legal protections afforded to medical aircraft under international humanitarian law, particularly the Geneva...
medical aircraft, protected status, Geneva Convention, international humanitarian law
Describe the provisions of the Geneva Convention for the Amelioration of the Condition of the Wounded and Sick in the Armed Forces in the Field on establishing hospital zones and localities in order t
Standard Source: STP 21 1 Warrior Skills Level 1
Procedure:

(l) Describe the provisions of the Geneva Convention for the Amelioration of the Condition of the Wounded and Sick in the Armed Forces in the Field on establishing hospital zones and localities in order to shield the wounded and...
Geneva Convention, hospital zones, protection of wounded, international humanitarian law
Describe the required protective markings that must be displayed on medical aircraft
Standard Source: STP 21 1 Warrior Skills Level 1
Procedure:

(s) Describe the required protective markings that must be displayed on medical aircraft.

Details:
• This procedure involves explaining the specific protective markings that must be displayed on medical aircraft in...
medical aircraft, protective markings, Geneva Convention, international humanitarian law
Describe the requirement for medical aircraft to fly at heights, times, and on routes specifically agreed upon between the conflicting parties
Standard Source: STP 21 1 Warrior Skills Level 1
Procedure:

(r) Describe the requirement for medical aircraft to fly at heights, times, and on routes specifically agreed upon between the conflicting parties.

Details:
• This procedure involves explaining the specific requirements for...
medical aircraft, flight requirements, Geneva Convention, international humanitarian law
Describe the requirement for medical aircraft to land upon request from the enemy
Standard Source: STP 21 1 Warrior Skills Level 1
Procedure:

(u) Describe the requirement for medical aircraft to land upon request from the enemy.

Details:
• This procedure involves explaining the legal requirements for medical aircraft to comply with landing requests made by enemy...
medical aircraft, landing requirement, Geneva Convention, international humanitarian law
Describe the right of medical aircraft to continue the flight after examination by the enemy
Standard Source: STP 21 1 Warrior Skills Level 1
Procedure:

(v) Describe the right of medical aircraft to continue the flight after examination by the enemy.

Details:
• This procedure involves explaining the legal rights of medical aircraft to continue their mission after being...
medical aircraft, flight continuation, Geneva Convention, international humanitarian law
Describe what other medical service emblems are recognized by the Geneva Convention
Standard Source: STP 21 1 Warrior Skills Level 1
Procedure:

(y) Describe what other medical service emblems are recognized by the Geneva Convention.

Details:
• This procedure involves explaining the additional medical service emblems that are recognized under international...
medical service emblems, Geneva Convention, international humanitarian law
Describe when and where these medical service emblems must be displayed
Standard Source: STP 21 1 Warrior Skills Level 1
Procedure:

(aa) Describe when and where these medical service emblems must be displayed.

Details:
• This procedure involves explaining the specific circumstances and locations where medical service emblems must be displayed, as...
medical service emblems, display requirements, Geneva Convention
Describe whether medical personnel being armed and using these arms to defend themselves and the sick and wounded deprive the medical unit or establishment of its protection
Standard Source: STP 21 1 Warrior Skills Level 1
Procedure:

(h) Describe whether medical personnel being armed and using these arms to defend themselves and the sick and wounded deprive the medical unit or establishment of its protection.

Details:
• This procedure involves analyzing...
armed medical personnel, protection status, Geneva Convention, self-defense
Describe whether the Star of David, used by the State of Israel, is specifically recognized by the Geneva Conventions
Standard Source: STP 21 1 Warrior Skills Level 1
Procedure:

(z) Describe whether the Star of David, used by the State of Israel, is specifically recognized by the Geneva Conventions.

Details:
• This procedure involves explaining the recognition status of the Star of David as a...
Star of David, Geneva Convention, international humanitarian law
Describe whether the medical unit or establishment being protected by a picket, sentries, or an escort in the absence of armed orderlies deprives the medical unit or establishment of its protection
Standard Source: STP 21 1 Warrior Skills Level 1
Procedure:

(i) Describe whether the medical unit or establishment being protected by a picket, sentries, or an escort in the absence of armed orderlies deprives the medical unit or establishment of its protection.

Details:
• This...
medical unit protection, sentries, Geneva Convention, non-armed personnel
Describe the requirement for medical personnel to carry a special identification card bearing the medical emblem
Standard Source: STP 21 1 Army Warrior Skills Level 1 Soldiers Manual of Common Tasks
Procedure:

(ac) Describe the requirement for medical personnel to carry a special identification card bearing the medical emblem.

Details:
• Medical personnel must carry an official identification card displaying the medical emblem at...
medical ID card, Geneva Convention
Describe whether finding small arms and ammunition taken from the wounded and sick but not yet turned over to the proper service at the medical unit or establishment deprives the medical unit or estab
Standard Source: STP 21 1 Army Warrior Skills Level 1 Soldiers Manual of Common Tasks
Procedure:

(j) Describe whether finding small arms and ammunition taken from the wounded and sick but not yet turned over to the proper service at the medical unit or establishment deprives the medical unit or establishment of its...
small arms, ammunition, wounded and sick, medical unit, protection
Displaying Distinctive Emblems on First Aid Facilities
Standard Source: First Aid in Armed Conflicts
Procedure for Displaying Distinctive Emblems on First Aid Facilities in Armed Conflicts:

1. Select an Emblem: National Societies may display one of the following distinctive emblems as an indicative device on their First Aid facilities:
...
distinctive emblems,first aid facilities,international humanitarian law,red cross,red crescent,red crystal,red lion and sun

Surgery Procedures (19)

Consider Damage Control for Duodenal Injuries Early and Often
Critical Source: Emergency War Surgery
Early consideration for damage control surgery should be considered (see Chapter 12, Damage Control Surgery). Missed injuries of the duodenum have devastating morbidity. Bile staining or hematoma in the periduodenal tissues mandates full...
duodenal injury,damage control,surgery
Drain All Pancreatic Injuries Regardless of Ductal Injury Identification
Critical Source: Emergency War Surgery
Any injury to the pancreas/duct requires drainage. Even if ductal injury is not identified, it should be presumed and drained.
pancreatic drainage,surgery,trauma
Major Pancreatic Head Injuries Require Drainage Only in Austere Environments
Critical Source: Emergency War Surgery
Major injuries to the head of the pancreas may require pancreaticoduodenectomy, which SHOULD NEVER BE ATTEMPTED in an austere environment but instead treated by the principles of damage control surgery— DRAIN, DRAIN, DRAIN.
pancreaticoduodenectomy,damage control,surgery
Abdominal Closure Procedure
High Priority Source: Emergency War Surgery
Abdominal Closure Procedure

Close fascia if possible.

- Massive swelling associated with large amounts of blood loss and resuscitation and large injuries may necessitate temporary closures (see Chapter 12, Damage Control Surgery)....
abdominal closure, surgical procedure, battlefield wounds, fascia closure, retention sutures
Close Duodenal Wall Around a Tube Duodenostomy
High Priority Source: Emergency War Surgery
Close duodenal wall around a tube duodenostomy. Use a No. 2-0 absorbable suture (Vicryl). Use the largest malecot catheter available.
duodenostomy,surgery,absorbable suture
Create Roux-en-Y Anastomosis for Major Duodenal Injuries
High Priority Source: Emergency War Surgery
Bring up a Roux-en-Y jejunal limb and create an anastamosis between the limb and the injury (Fig. 17-7).
roux-en-y anastomosis,surgery,duodenal repair
Divide Ligamentous Attachments of the Liver for Exposure
High Priority Source: Emergency War Surgery
Divide the ligamentous attachments of the liver to improve exposure in the right upper quadrant or upper midline.
liver exposure,surgery,ligament division
Drain All Injuries with Closed-Suction Drains
High Priority Source: Emergency War Surgery
Widely drain all injuries with closed-suction drains. Any method used to close the pylorus will last only 14–21 days. The possibility of injury to the biliary and pancreatic ducts should be considered when injuries involve the 2nd portion of the...
drainage,surgery,trauma
Duodenum Injury Management and Repair
High Priority Source: Emergency War Surgery
Injuries to the Duodenum are associated with massive upper abdominal trauma. Early consideration for damage control surgery should be considered (see Chapter 12, Damage Control Surgery).

• **Missed injuries of the duodenum have devastating...
duodenum injury,repair,surgery,damage control
Extend Incision for Improved Liver Exposure
High Priority Source: Emergency War Surgery
Improve exposure to the liver by extending the incision into the inferior sternum and across into the lower right chest (thoracoabdominal).
incision extension,liver exposure,surgery
Fold Left Lateral Segment of the Liver for Exposure
High Priority Source: Emergency War Surgery
Fold the left lateral segment of the liver down and to the right to improve exposure at the gastroesophageal junction.
liver folding,exposure,gastroesophageal
Identify Organ and Hollow-Viscus Injuries
High Priority Source: Emergency War Surgery
Identify all organ and hollow-viscus injuries.

Eviscerate the small bowel to increase workspace.

Divide the ligamentous attachments of the liver to improve exposure in the right upper quadrant or upper midline.

• **Fold the left...
organ injuries,hollow viscus,surgery,exposure
Pack All Quadrants and Control Hemorrhage
High Priority Source: Emergency War Surgery
Quickly pack all 4 quadrants while looking for obvious injuries.

Control hemorrhage.

Assess physiologic status.

- Considering casualty physiology, create operative plan to control contamination and complete operation.

-...
hemorrhage,packing,surgery,physiology
Pancreatic Injury Management and Drainage
High Priority Source: Emergency War Surgery
Any injury to the pancreas/duct requires drainage.

• Even if ductal injury is not identified, it should be presumed and drained.

• Resect clearly nonviable pancreatic body/tail tissue.

• Transection or near-transection of the pancreatic duct...
pancreatic injury,drainage,surgery,damage control
Perform Laparotomy Through Midline Incision
High Priority Source: Emergency War Surgery
Perform laparotomy through a midline incision.

• When wide exposure is needed, extend the incision superiorly just lateral to the xiphoid process and inferior to the symphysis pubis.
laparotomy,midline incision,surgery,exposure
Repair Minor Duodenal Injuries Primarily
High Priority Source: Emergency War Surgery
Minor injuries can be repaired primarily. Major injuries should be repaired if the lumen will not be narrowed by more than 50%. Options for closing injuries of greater than 50%:
duodenal repair,surgery,repair techniques
Stomach Injury Repair Procedures
High Priority Source: Emergency War Surgery
The stomach is a vascular organ and will do well after almost any repair.

Always enter the lesser sac to determine posterior wall injuries.

Encircle the distal esophagus with a Penrose drain to provide traction and improve...
stomach injury,repair,surgery,esophagus
Treat Transection or Near-Transection of the Pancreatic Duct
High Priority Source: Emergency War Surgery
Transection or near-transection of the pancreatic duct can be treated by: Distal end of proximal pancreas segment oversewn/stapled. Proximal end of distal segment oversewn/stapled and entire distal segment left in-situ. Distal segment resection...
pancreatic duct repair,surgery,trauma
Use Penrose Drain for Traction in High Midline Stomach Injuries
High Priority Source: Emergency War Surgery
Encircle the distal esophagus with a Penrose drain to provide traction and improve visibility in high midline injuries.
penrose drain,stomach surgery,traction

Surgical Tools (19)

Selecting and Maintaining Surgical Instruments for Long-Term Use
High Priority Source: Survival and Austere Medicine
Procedure:

1. Assess usage frequency: If you anticipate using surgical instruments only a few times, cheaper options may suffice.
2. Avoid low-quality instruments: Low-cost scissors will lose their edge quickly and become difficult to...
surgical,instruments,quality,long-term,improvised,metalworker
Enhancing Needle Control with Ribbed and Flattened Needles in Surgical Procedures
High Priority Source: Medical Survival Wound Closure Manual
Procedure:

1. Understand the purpose of ribbing and flattening on curved needles:
- Longitudinal ribbing or grooves on the inside or outside curvatures of curved needles provide a crosslocking action in the needleholder for added...
ribbed needles, flattened needles, needleholder control, surgical precision, crosslocking action
Selecting Appropriate Surgical Needle Alloys Based on Strength and Ductility
High Priority Source: Medical Survival Wound Closure Manual
Procedure:

1. Understand the importance of alloy selection for surgical needles:
- The type of metal alloy used in surgical needles significantly affects their strength, ductility, and performance during procedures.
- ETHICON...
needle strength, ductility, surgical yield, alloy selection, tissue trauma
Understanding the Importance of Needle Sharpness and Taper Ratio in Surgical Procedures
High Priority Source: Medical Survival Wound Closure Manual
Procedure:

1. Understand the importance of needle sharpness:
- Sharpness is especially important in delicate or cosmetic surgery, as it reduces scarring.
- The sharper the needle, the less scarring that will result from tissue...
needle sharpness, taper ratio, tissue penetration, surgical control, synthetic membrane testing
Use Surgical Tools and Techniques in Emergency Situations
High Priority Source: Survival and Austere Medicine
Procedure:

1. Select appropriate tools: Choose surgical instruments based on the procedure (e.g., scalpel, forceps, clamps).
2. Perform knot-tying techniques: Use standard surgical knots such as square knots or surgeon's knots for...
surgical tools, knot-tying, retractor use, bleeding control
Using Coated Needles to Improve Surgical Performance and Reduce Tissue Trauma
High Priority Source: Medical Survival Wound Closure Manual
Procedure:

1. Understand the benefits of needle coatings:
- Most ETHICON needles are coated with a micro-thin layer of silicone or similar lubricants.
- This coating significantly improves ease of needle penetration through tissue and...
needle coatings, silicone lubricant, tissue trauma reduction, surgical efficiency, needle insertion
Selecting and Using a Needleholder Properly
Standard Source: Medical Survival Wound Closure Manual
Needleholder Selection and Use Guidelines:

1. Choose the appropriate size: A very small needle should be held with small, fine jaws. The larger and heavier the needle, the wider and heavier the jaws of the needle-holder should be.
2....
needleholder, surgical tools, suture, medical emergency
Relay* Suture Delivery System Usage
Standard Source: Medical Survival Wound Closure Manual
Purpose: To deliver single strand and multistrand sutures in a tangle-free manner.

Description: The RELAY* Suture Delivery System is designed to provide delivery of one suture at a time, with one-step arming, individual needle parks, and...
relay suture system, surgical tools, suture delivery
Reverse Cutting Needle Usage
Standard Source: Medical Survival Wound Closure Manual
Purpose: To facilitate tissue approximation with minimal cutout.

Description: Needles produced by ETHICON have triangular shapes throughout their entire length and cutting edges along the outside needle curvature to prevent tissue cutout....
reverse cutting needle, tissue approximation, surgical tools, ETHICON
Safety Organizer Tray Usage
Standard Source: Medical Survival Wound Closure Manual
Purpose: To deliver multistrand products in a tangle-free manner.

Description: The Safety Organizer Tray is an ETHICON design for a suture tray that delivers multistrand products. It offers single strand delivery and a singulated needle...
safety organizer tray, surgical tools, multistrand delivery
Side-Flattened Needles Usage
Standard Source: Medical Survival Wound Closure Manual
Purpose: To increase strength and reduce bending when penetrating vascular prostheses or calcified tissues.

Description: Side-flattened needles are stainless steel alloy needles designed to increase strength and reduce bending when...
side-flattened needles, vascular prostheses, surgical tools
Single Strand Delivery Procedure
Standard Source: Medical Survival Wound Closure Manual
Purpose: To deliver one straight suture at a time from the RELAY suture delivery system.

Procedure:
1. Open the RELAY suture delivery system and locate the single strand of suture material.
2. Pull the suture strand through the needle park...
single strand delivery, surgical tools, suture delivery
Surgical Gut Suture Usage
Standard Source: Medical Survival Wound Closure Manual
Purpose: To provide absorbable suture material for tissue approximation.

Description: Surgical gut is an absorbable suture made from the serosal layer of beef intestine or submucosal layer of sheep intestine. It is commonly used in surgical...
surgical gut suture, absorbable suture, tissue approximation
Suture Book Usage
Standard Source: Medical Survival Wound Closure Manual
Purpose: To contain multiple sutures during a procedure.

Description: A Suture Book is a sterile towel folded by the scrub person and used to contain multiple sutures during a surgical procedure. It helps organize suture materials and keep...
suture book, surgical tools, suture organization
Swaged Suture Usage
Standard Source: Medical Survival Wound Closure Manual
Purpose: To provide a strand of material with an eyeless needle attached by the manufacturer.

Description: A Swaged Suture is a strand of suture material with an eyeless needle attached by the manufacturer. It is designed for use in...
swaged suture, eyeless needle, surgical tools
Taper Point Needle (TP) Usage
Standard Source: Medical Survival Wound Closure Manual
Purpose: To create the smallest possible hole in tissue during suture placement.

Description: A Taper Point Needle (TP) is a needle with a body that gradually tapers to a sharp point, making the smallest possible hole in tissue. It is...
taper point needle, minimal tissue trauma, surgical tools
Tensile Strength of Suture Material
Standard Source: Medical Survival Wound Closure Manual
Purpose: To understand the strength and durability of suture material.

Description: Tensile strength refers to the amount of tension or pull, expressed in pounds, which a suture strand will withstand before it breaks. It is an important...
tensile strength, suture durability, surgical tools
Understanding and Using Blunt Point Needles in Medical Procedures
Standard Source: Medical Survival Wound Closure Manual
Blunt Point (BP) Needles Overview:

Purpose: Blunt point needles are designed to dissect friable tissue without cutting it, making them ideal for use on delicate organs such as the liver and kidney.

Design Features: They have a...
blunt point needles, surgical tools, liver suturing, kidney suturing, safety considerations, ETHIGUARD needle, ribbed design, swaged needle
Using TAPERCUT Surgical Needles for Dense Tissue Closure
Reference Source: Medical Survival Wound Closure Manual
Procedure:

1. Identify tissue type: Use TAPERCUT needles on dense, tough tissues such as sclerotic or calcified tissue, fascia, periosteum, and tendon.
2. Understand needle design: The TAPERCUT needle has a reverse cutting edge tip with...
TAPERCUT needle, surgical tools, dense tissue closure, calcified tissue, vascular anastomosis, modified TAPERCUT CC

Poisoning (18)

Identify and Avoid Angel’s Trumpet (Jimson Weed)
Critical Source: Poisonous Plants
Angel’s trumpet, also known as jimson weed, is a highly toxic plant related to petunias, tomatoes, and potatoes. It contains active ingredients such as atropine, hyoscyamine, and scopolamine, which are classified as deliriants or...
angel's trumpet, jimson weed, atropine, poisoning, identification, avoidance
Identify and Avoid Bushman’s Poison (Wintersweet)
Critical Source: Poisonous Plants
Bushman’s poison, also known as wintersweet, is a highly toxic plant that has been used by the Khoisan of South Africa to poison arrows. The plant produces pleasantly scented flowers and tasty plum-like berries, but its milky sap...
bushman's poison, wintersweet, poisoning, identification, avoidance
Identify and Avoid Castor Bean Plants
Critical Source: Poisonous Plants
Castor bean plants are highly toxic, with just one tiny castor bean being enough to kill an adult within a few minutes. The lethal compound in the plant is ricin, which is removed during the production of castor oil to make it safe (but...
castor bean, ricin, poisoning, identification, avoidance
Identify and Avoid Monkshood (Wolfsbane)
Critical Source: Poisonous Plants
Monkshood, also known as wolfsbane, is a highly toxic plant that was historically used by farmers to exterminate wolves. It contains aconitine, a potent neurotoxin that can cause severe symptoms such as tingling, numbness, and paralysis...
monkshood, wolfsbane, aconitine, poisoning, identification, avoidance
Identify and Avoid Rosary Pea Seeds
Critical Source: Poisonous Plants
Rosary pea seeds are among the most dangerous plants on earth due to their high toxicity. The seeds contain a potent lectin called abrin, which is fatal if chewed and swallowed. The seeds can be easily identified by their **bright red color...
rosary pea, abrin, poisoning, identification, avoidance
Identify and Avoid Snakeroot (Tremetol Poisoning)
Critical Source: Poisonous Plants
Snakeroot, also known as white snakeroot, is highly toxic to livestock such as cattle and sheep. When these animals consume the plant, their milk and bones become saturated with a toxin called tremetol, which can lead to **milk...
snakeroot, tremetol, milk sickness, poisoning, identification, avoidance
Identify and Avoid Water Hemlock (Most Poisonous Plant in North America)
Critical Source: Poisonous Plants
Water hemlock is considered the most poisonous plant in North America, with all parts of the plant being deadly toxic. Even a small mouthful can kill an adult, and ingesting even a little bit of the juice will make a person seriously ill. It...
water hemlock, poisoning, identification, avoidance, most poisonous plant
Recognize and Treat Carbon Monoxide Poisoning
Critical Source: USMC Winter Survival Course Handbook
Title: Recognize and Treat Carbon Monoxide Poisoning

Content:
Carbon Monoxide (CO) is a heavy, odorless, colorless, tasteless gas resulting from incomplete combustion of fossil fuels. It replaces oxygen in the body, leading to...
carbon monoxide poisoning, CO, gas, ventilation, headache, dizziness, coma, rescue breathing
Responding to an Unconscious Poison Victim
Critical Source: Family Emergency Handbook
Procedure:

1. Place the person on their side.
2. Watch and listen for breathing by looking for movement in the chest.
3. DO NOT induce vomiting.
4. Shout at, tap, and shake the victim to check responsiveness.
5. Call for emergency services...
unconscious poisoning, first aid, emergency response
Treating Poisoning
Critical Source: Boy Scout Handbook 1911
Procedure for Treating Poisoning

1. Administer an emetic immediately to rid the stomach of the poison.
2. Summon a doctor at once, and if possible, have the messenger inform them of the type of poison taken so they can bring the proper...
poisoning, first aid, emetic, antidote, emergency treatment
Administer Immediate First Aid for Pesticide Poisoning
Critical Source: Where There is no Doctor a Village Health Care Handbook
If the person is not breathing, quickly perform mouth-to-mouth breathing (see page 80 for detailed instructions).

If the person is breathing, follow these steps:

1. Do not make the person vomit if you do not know what kind of...
pesticide poisoning, first aid, vomiting, charcoal, egg whites, skin washing
Handling Swallowed Household Chemicals or Poisons
Critical Source: Family Emergency Handbook
Procedure:

1. If the person is conscious, ask questions to determine what type of poison was swallowed.
2. Give milk or water:
- For an adult: give one to two cups.
- For a child: give one-half to one cup.
3. **Induce vomiting only...
swallowed poison, first aid, chemical ingestion, vomiting instructions
Immediate Actions for Suspected Poisoning in a Child
Critical Source: Where There is no Doctor a Village Health Care Handbook
If you suspect poisoning, act immediately:

• If the child is unconscious, lay him on his side. If he stops breathing, give him mouth-to-mouth breathing (see page 80).

• If the child is awake and alert, give him plenty of water or...
poisoning, child, first aid, vomiting, activated charcoal, medical help
National Poison Control Center Number
Critical Source: FEMA Are You Ready
The telephone number for the National Poison Control Center is:

1-800-222-1222

This number is available 24/7 and provides immediate assistance in cases of poisoning or exposure to hazardous substances.
poison control,emergency contact,toxic exposure
Prevent and Manage Poisoning in Children
Critical Source: Where There is no Doctor a Village Health Care Handbook
Procedure:

Prevention Measures:
Keep all poisons out of reach of children.
• Never store kerosene, gasoline, or other poisons in cola or soft drink bottles, as children may try to drink them.

**Common Poisons to Watch...
child poisoning prevention, common poisons, first aid for poisoning, emergency care, toxic substances
Recognizing Symptoms of Toxic Poisoning
Critical Source: FEMA Are You Ready
Procedure:

Symptoms to watch for include:
Difficulty breathing.
Irritation of the eyes, skin, throat, or respiratory tract.
Changes in skin color.
Headache or blurred vision.
Dizziness.
• **Clumsiness or lack...
toxic poisoning, symptoms, medical emergency, chemical exposure
Responding to Poison Exposure
Critical Source: Family Emergency Handbook
Procedure:

1. Ensure your own safety and the safety of the victim.
2. Call for an ambulance immediately if needed.
3. Identify the poison container(s) and keep them to show the doctor or read the information when calling the Poison Control...
poisoning, first aid, emergency response, chemical exposure, antidotes
Administering Charcoal, Powdered or Activated
High Priority Source: Where There is no Doctor a Village Health Care Handbook
Title: Administering Charcoal, Powdered or Activated

Content:
Indication: Used for the treatment of poisoning or drug overdose.
Dosage: Administer 1 gram per kilogram of body weight, up to a maximum of 50 grams in adults.
-...
activated charcoal, poisoning treatment, overdose management

Triage Procedures (18)

Use Radiation Triage Cards for Resource Allocation Planning
Critical Source: Planning Guidance for Response to Nuclear Detonation May 2022 FEMA
Triage cards are critical tools that exemplify how response varies in a scarce resource environment. While planners are not expected to perform triage themselves, radiation triage cards help illustrate the importance of resource management.

For...
radiation triage cards, resource allocation, radiation dose thresholds, triage decisions
Immediate Life-Saving Tasks During Triage
High Priority Source: First Aid in Armed Conflicts
While conducting triage, the following actions should be taken:

1. Perform immediate life-saving tasks: This includes stopping severe bleeding, ensuring airway patency, and providing basic resuscitation if needed.
2. **Do not delay urgent...
life_saving,immediate_care,triage,priority
Implement Re-Triage as Resource Availability Changes
High Priority Source: Planning Guidance for Response to Nuclear Detonation May 2022 FEMA
Critical to triage decisions is re-triage as the resource setting changes. A person initially triaged as expectant may be reclassified as immediate if there is an influx of resources and personnel.

This process ensures that patients...
re-triage, resource changes, triage reclassification, dynamic resource management
Implement Triage System in Planning Documents
High Priority Source: Planning Guidance for Response to Nuclear Detonation May 2022 FEMA
Objective: Identify and document a specific triage system within planning documents for use by responder organizations.

Procedure:
1. Review existing medical triage systems, such as the Simple Triage and Rapid Treatment (START) or other...
triage system, START triage, resource scarcity, medical planning, responder training
Implementing Triage Systems in Resource Scarcity Environments
High Priority Source: Planning Guidance Nuclear Detonation FEMA
Procedure for Implementing Triage Systems During Resource Scarcity:

1. Identify and Select an Appropriate Triage System:
- Choose a triage system that aligns with the specific needs of your locality, considering resource availability and...
triage,resource scarcity,crisis standards of care,emergency planning,mass casualty
Resolving Disagreements During Triage
High Priority Source: First Aid in Armed Conflicts
Disagreements may arise within a triage team about the category assigned to a casualty:

1. Immediate resolution: Any disagreement must be resolved immediately by the team leader or site management representative.
2. **Follow established...
disagreement,resolution,team_leader,triage,decision_making
Triage Categories for Treatment and Evacuation
High Priority Source: First Aid in Armed Conflicts
Casualties are categorized into four priority levels during triage:

### Category 1 (Urgent - Life-Threatening Conditions)
For treatment: Conditions that can be stabilized with immediate, simple measures.
For evacuation:...
triage,categories,urgency,evacuation,treatment
Triage Priority Assignment Based on Location and Accessibility
High Priority Source: First Aid in Armed Conflicts
When triaging casualties in armed conflicts, consider the location and accessibility of each casualty:

1. Assess the terrain: If a casualty is located in an area with rough or difficult-to-navigate terrain, this may impact the time and...
triage,priority,location,accessibility,casualty
Triage Re-Assessment and Adaptation of Priority Levels
High Priority Source: First Aid in Armed Conflicts
Triage is not a one-time assessment; it must be re-evaluated regularly:

1. Re-assess the situation: Regularly check for changes in casualty conditions, security status, resource availability, and medical facility capacity.
2. **Factors to...
re_assessment,priority_changes,triage,dynamic_process
Triage Tagging and Documentation
High Priority Source: First Aid in Armed Conflicts
After assigning a triage category to a casualty, the following steps must be taken:

1. Write down the assigned category: This is done on a card that is attached to a visible part of the casualty’s body.
2. Use colored tags if available:...
tagging,documentation,triage,casualty,priority
Triage of Combat Casualties into Four Categories
High Priority Source: NATO Emergency War Surgery
Procedure for Triage of Combat Casualties:

1. Identify and classify casualties into four categories based on the severity of their injuries:
- Immediate: Casualties requiring immediate resuscitative treatment (e.g., shock from...
triage,combat casualty classification,immediate,delayed,minimal,expectant
Two-Stage Triage Process for Treatment and Evacuation
High Priority Source: First Aid in Armed Conflicts
There are two successive triage processes in armed conflicts:

1. Priority of Treatment: This determines the order in which casualties receive immediate medical care based on the severity of their injuries.

2. Priority of Evacuation: This...
triage,treatment,evacuation,priority,armed_conflict
Understand Trauma Triage Systems in Normal Conditions
High Priority Source: Planning Guidance for Response to Nuclear Detonation May 2022 FEMA
In normal conditions with adequate resources, planners should understand the trauma triage systems used by first responders and hospital systems. Commonly used systems include:

Simple Triage and Rapid Treatment (START)
JumpSTART (for...
trauma triage, START, SALT, DIME, JumpSTART, normal conditions
Casualty Tracking and Identification Methods
High Priority Source: Emergency War Surgery
Forehead Marking: Use an indelible marker to place numbers on the casualty’s forehead for easy tracking.

Administrative Support: If resources allow, station administrative personnel at every entry/exit point of the triage area to assist...
casualty tracking, forehead marking, triage identification
Establishing an Ideal Triage Area
High Priority Source: Emergency War Surgery
Purpose: To set up an effective triage area for rapid casualty evaluation and movement.

### Requirements for an Ideal Triage Area
Proximity to the receiving area (e.g., LZ, ground evacuation, decontamination area).
One-way flow...
triage area setup, casualty flow, triage procedures, emergency medical setup
Initial Triage Office Setup and Staffing
High Priority Source: Emergency War Surgery
Ideal Personnel: Ideally, a surgeon experienced in combat trauma should be assigned to the initial triage office. However, in small forward surgical units where this is not possible, another person with clinical experience must be trained for...
initial triage office, triage staffing, combat trauma, casualty tracking
Initial Triage and Patient Tracking
High Priority Source: Emergency War Surgery
Purpose: To rapidly identify and track casualties for efficient treatment.

### Triage Procedures
• Use an indelible marker to place numbers on the casualty’s forehead for easy tracking. Any reproducible, simple method is acceptable.
-...
initial triage, casualty tracking, triage office setup
Triage Procedures in Emergency War Surgery
Standard Source: Emergency War Surgery
Procedure for Conducting Triage in Emergency War Surgery:

Triage is the process of sorting patients based on the severity of their injuries to prioritize treatment and allocate resources effectively.
• In a war or emergency setting,...
triage, emergency war surgery, mass casualty events, patient prioritization, medical resource allocation

Altitude Sickness (18)

Neurological Abnormalities in Untreated HACE
Critical Source: Emergency War Surgery
Title: Neurological Abnormalities in Untreated High Altitude Cerebral Edema (HACE)

Procedure:
1. Be aware that untreated HACE can lead to a variety of focal and generalized neurological abnormalities, including:
- Visual changes
-...
HACE neurological symptoms, papilledema, coma, seizures
Early Signs and Symptoms of HACE
Critical Source: Emergency War Surgery
Title: Early Signs and Symptoms of High Altitude Cerebral Edema (HACE)

Procedure:
1. Recognize early signs that resemble AMS but are more severe. These may include:
- Severe headache
- Nausea
- Vomiting
- Extreme lassitude...
HACE early signs, severe headache, vomiting, lassitude
Progressing Signs and Symptoms of HACE
Critical Source: Emergency War Surgery
Title: Progressing Signs and Symptoms of High Altitude Cerebral Edema (HACE)

Procedure:
1. Monitor for mental status changes, such as:
- Confusion
- Disorientation
- Drowsiness
- Impaired mentation
2. **Observe for truncal...
HACE progressing signs, mental status changes, truncal ataxia, cyanosis
Recognize and Manage Symptoms of Acclimatization in Mountain Environments
Critical Source: FM 3 97 61 Military Mountaineering
Procedure:

1. Monitor for symptoms:
- Headache, dizziness, nausea, fatigue, shortness of breath, and insomnia are common signs of acclimatization.
2. Rest and hydrate:
- Allow the body time to adjust by reducing physical activity...
acclimatization,altitude sickness,symptoms,management
Post-Descent Treatment for HAPE
High Priority Source: Emergency War Surgery
Title: Post-Descent Treatment for High Altitude Pulmonary Edema (HAPE)

Procedure:
1. After descent to a lower elevation, ensure the patient receives adequate oxygenation.
2. Administer supplemental oxygen at an MTF (Medical...
post-descent HAPE treatment, supplemental oxygen, nifedipine continuation, non-invasive care
Recognize and Manage Symptoms of Acute Mountain Sickness (AMS) and Related Illnesses
High Priority Source: FM 3 97 61 Military Mountaineering
Objective: Identify symptoms of acute mountain sickness (AMS), high-altitude pulmonary edema (HAPE), and high-altitude cerebral edema (HACE), and take appropriate action.

Symptoms of AMS:
• Headache
• Nausea or vomiting
• Fatigue
-...
acute mountain sickness, AMS, HAPE, HACE, altitude illness
Recognize and Treat Chronic Mountain Sickness (CMS) in Mountain Environments
High Priority Source: FM 3 97 61 Military Mountaineering
Procedure:

1. Identify symptoms of CMS:
- Watch for persistent headaches, fatigue, dizziness, shortness of breath, and poor sleep quality.
2. Descend to a lower altitude if possible:
- The most effective treatment is to descend...
chronic mountain sickness,CMS,treatment,mountain health
Acclimatization Process at High Altitude
High Priority Source: US Marine Corps Wilderness Medicine
Objective: Understand the physiological changes that occur during acclimatization to high altitude.

### Factors Influencing Acclimatization:
Degree of hypoxic stress (altitude)
Rate of ascent
• **Individual physiology (genetic...
acclimatization, altitude sickness, hypoxia, HVR, HAPE, HACE, erythropoietin, polycythemia, CMS
Administer Acetazolamide for Altitude Acclimatization
High Priority Source: US Marine Corps Wilderness Medicine
Procedure:

1. Use acetazolamide (Diamox) to aid in altitude acclimatization:
- It is a carbonic anhydrase inhibitor active in the brain, lung, and kidney.
2. Mechanism of action in the kidney:
- Inhibits uptake of bicarbonate...
acetazolamide, altitude acclimatization, carbonic anhydrase inhibitor, side effects, contraindications
Manage Thromboembolic Events at High Altitudes
High Priority Source: US Marine Corps Wilderness Medicine
Procedure:

1. Recognize risk factors for thromboembolic events:
- Increased frequency of thromboembolic disease occurs at higher altitudes.
2. Identify contributing factors:
- Volume depletion due to dehydration and polycythemia...
thromboembolic events, high altitude, dehydration, polycythemia, prevention
Prevent Altitude Illness Through Gradual Ascent
High Priority Source: Emergency War Surgery
Gradual acclimation is essential to prevent altitude illness.

Staged ascent: Soldiers should ascend to intermediate altitudes and remain there for 3 or more days before ascending further.
Graded ascent: Limit daily altitude gain to...
acclimatization, altitude illness, staged ascent, graded ascent, acclimation
Prevention and Management of Thromboembolic Events at High Altitude
High Priority Source: Emergency War Surgery
Thromboembolic events are more common at very high altitudes (>4,200 m [13,700 ft]). Prevention includes the following:

Maintain adequate hydration to reduce risk factors such as dehydration and venous stasis.
• **Avoid conditions that...
thromboembolic prevention, hydration, heparin use, altitude thrombosis management
Understand the Role of Hydration in HAPE and HACE
High Priority Source: FM 3 97 61 Military Mountaineering
Procedure:

1. Recognize that hydration plays a critical role in managing both High-Altitude Pulmonary Edema (HAPE) and High-Altitude Cerebral Edema (HACE).

2. Understand the physiological impact of dehydration:
- HAPE and HACE...
hydration,HAPE,HACE,blood viscosity,vascular leakage
Management of High-Altitude Peripheral Edema
Standard Source: Emergency War Surgery
High-altitude peripheral edema is a common condition that can be managed with the following steps:

Diagnosis: Based on association of characteristic peripheral edema with ascent to high altitude; recurs consistently with repeat ascents;...
peripheral edema treatment, furosemide, acetazolamide, altitude edema management
Management of High-Altitude Pharyngitis and Bronchitis
Standard Source: Emergency War Surgery
High-altitude pharyngitis and bronchitis are common at altitudes over 5,486 m (18,000 ft).

Symptoms: Sore throat, chronic cough, severe cough spasms (severe enough to cause rib fractures).
Causes: Environmental factors such as...
pharyngitis treatment, cough management, altitude bronchitis, balaclava use
Management of Subacute Mountain Sickness (SAMS)
Standard Source: Emergency War Surgery
Subacute mountain sickness is a prolonged condition that occurs after weeks to months at high altitudes.

Common symptoms: Sleep disturbances, anorexia, weight loss, fatigue, daytime somnolence, and subnormal mentation.
• **Caused by...
SAMS management, oxygen therapy, acetazolamide, altitude prolonged sickness treatment
Recognize and Monitor for High Altitude Retinal Hemorrhages
Standard Source: US Marine Corps Wilderness Medicine
Procedure:

1. Assess individuals ascending above 18,000 feet for signs of retinal hemorrhage.
- Up to 60% may develop asymptomatic retinal hemorrhages.
2. Perform fundoscopic exam if symptoms are present:
- Look for hyperemia of...
retinal hemorrhage, high altitude, fundoscopic exam, visual acuity, carbon monoxide poisoning
Administer Acetazolamide for Altitude Sickness Prevention and Treatment
Standard Source: Personal Wilderness Medical Kit
Indication: Preventing or treating altitude sickness (AMS) or high-altitude pulmonary edema (HAPE)
Dose:
• For prevention: ¼ tablet (62.5 mg) PO twice daily
• For treatment of AMS/HACE: 250 mg PO twice daily
Instructions:
1. Use...
acetazolamide, altitude sickness prevention, Diamox

Pediatrics (17)

Caring for Babies with Diarrhea
Critical Source: Where There is no Doctor a Village Health Care Handbook
Procedure:

No medicine may be needed, but special care is essential.
• Focus on preventing dehydration:
- Provide frequent small amounts of Rehydration Drink.
- Monitor the baby closely and ensure they are drinking...
baby diarrhea,dehydration,rehydration drink,pediatric care
Recognize and Manage Dehydration in Babies
Critical Source: Where There is no Doctor a Village Health Care Handbook
Dehydration is a condition where the body loses more liquid than it takes in. It is especially dangerous for babies. To recognize dehydration:

1. Look for signs such as dry mouth, sunken eyes, decreased urine output, and irritability.
2. If...
dehydration, baby care, oral rehydration
Limit Peripheral IV Access Attempts in Children in Shock
Critical Source: Emergency War Surgery
- Limit peripheral IV access attempts to 2 within 60 seconds for children in shock.
• If unsuccessful, immediately proceed to:
- Saphenous vein cutdown, or
- Intraosseous (IO) infusion.

Note: This is critical to ensure timely...
IV access,shock,pediatrics,saphenous vein,cutdown,IO infusion
Protecting Newborns from Gonorrhea and Chlamydia to Prevent Blindness
High Priority Source: Where There is no Doctor a Village Health Care Handbook
Procedure:

1. Prevent eye infections in newborns:
- Protect the eyes of all newborn babies from gonorrhea and chlamydia, as these infections can cause blindness.
- Refer to page 221 for detailed guidance on preventing and treating...
newborn_blindness,gonorrhea,chlamydia,eye_protection,neonatal_care
Recognize and Manage Diarrhea in Infants and Children
High Priority Source: Where There is no Doctor a Village Health Care Handbook
Diarrhea is frequent runny or liquid stools. To manage diarrhea:

1. Ensure the person stays hydrated with oral rehydration solution (ORS) or clean water.
2. Avoid giving dairy products, fatty foods, or sugary drinks during an episode of...
diarrhea, dehydration, infant care
Calculate Daily Fluid Requirements for Children Based on Weight
High Priority Source: Emergency War Surgery
To calculate daily fluid requirements for children based on weight:

1. For children weighing 0–10 kg: Use the formula: 120 mL/kg/day (after the first week of life).
2. For children weighing 11–20 kg: Use the formula: **1,000 mL + 50...
fluid requirements,children,pediatrics,weight-based,emergency
Calculate Infant Formula Requirements for Oral Intake
High Priority Source: Emergency War Surgery
To estimate the amount of infant formula needed to provide 120 kcal/kg/day:

• Use the formula: Infant’s weight (kg) × 22 = Amount (in cc) of formula needed every 4 hours.

Note: Breast milk is always preferred for infants, but if not...
infant formula,nutrition,pediatrics,kcal intake
Estimate Daily Caloric and Protein Requirements for Children by Age Group
High Priority Source: Emergency War Surgery
Daily caloric and protein requirements based on age:

| Age (years) | kcal/kg body weight | Protein (g/kg body weight) |
|------------------|--------------------------|-------------------------------|
| 0–1 | 90–120 ...
caloric requirements,pediatrics,nutrition,protein intake
Monitor Diaphragmatic Function in Infants During Emergencies
High Priority Source: Emergency War Surgery
- Infants primarily breathe using their diaphragm.

• Any increase in intraabdominal pressure or other conditions that restrict diaphragmatic movement can significantly impair respiration.

• This is critical to monitor during trauma,...
respiration,diaphragm,infants
Pediatric Care in Emergency Situations
High Priority Source: Emergency War Surgery
Procedure:

1. Familiarize yourself with the unique challenges of caring for pediatric casualties in both wartime and non-war scenarios.
2. Ensure proper diagnostic evaluation and resuscitation using equipment appropriate for...
pediatric care, resuscitation, medical equipment, child casualties
Pediatric Use of Oseltamivir and Other Antivirals
High Priority Source: HHSPandemicInfluenzaPlan
Procedure:

None of the available influenza antivirals are currently FDA approved for use in children under 1 year old.

Details:
• The safety and efficacy of oseltamivir have not been studied in children <1 year for treatment or...
oseltamivir, pediatric use, off-label medication, antiviral safety, under one year old
Recognize the Impact of Diaphragmatic Movement on Respiration in Infants
High Priority Source: Emergency War Surgery
- Infants breathe primarily with their diaphragm.
• Any increase in intraabdominal pressure or conditions that limit diaphragmatic movement can significantly inhibit respiration.

Note: This is particularly important during abdominal trauma,...
respiration,pediatrics,diaphragmatic movement,abdominal pressure
Understand Normal Vital Signs by Age Group in Children
High Priority Source: Emergency War Surgery
Normal vital signs for children based on age:

| Age | Weight (kg) | Respiratory Rate | Pulse | Blood Pressure (systolic)...
vital signs,pediatrics,normal ranges,age groups
Identify and Address Birth Defects
Standard Source: Where There is no Doctor a Village Health Care Handbook
Birth defects are physical or mental problems a child is born with, such as a hare lip, club foot, or an extra finger or toe. To identify birth defects:

1. Look for visible abnormalities during pregnancy or at birth.
2. Consult a healthcare...
birth defect, congenital condition, pediatric care
Recognize and Manage Diaper Rash in Infants
Standard Source: Where There is no Doctor a Village Health Care Handbook
Diaper rash is reddish, irritated patches between a baby’s legs caused by urine in his diapers (nappy) or bedding. To manage diaper rash:

1. Clean the affected area gently with warm water and pat dry.
2. Apply a barrier cream such as zinc oxide...
diaper rash, infant care, skin irritation
Recognize and Understand Hare Lip in Newborns
Reference Source: Where There is no Doctor a Village Health Care Handbook
Hare lip is a split in the upper lip that extends from the mouth up to the nose, resembling the appearance of a hare or rabbit. Some babies are born with this condition.

This is a congenital (present at birth) deformity and may require medical...
hare lip, cleft lip, newborn, congenital deformity
Checking Baby's Temperature for Fever
Reference Source: A Book for Midwives
Procedure:

1. Check the baby’s temperature to detect fever.

Details:
• This is done to identify any signs of infection or other health issues in the baby.
• Use a thermometer to measure the baby's temperature accurately.
• Ensure that the...
baby temperature, fever detection, thermometer use, newborn health, infection signs

Childbirth (17)

Caring for the Cut Umbilical Cord Stump
Critical Source: Where There is no Doctor a Village Health Care Handbook
After cutting the umbilical cord:

Keep the cord stump clean and dry at all times.
• Wash your hands before touching the cord stump.
• If the cord becomes dirty or has a lot of dried blood, clean it gently with medical alcohol, strong...
cord care,tetanus prevention,infection signs,cleanliness
Caring for the Newborn Immediately After Birth
Critical Source: Where There is no Doctor a Village Health Care Handbook
Immediately after birth:

Put the baby’s head down so that mucus comes out of his mouth and throat. Keep this position until he begins to breathe.
Keep the baby below the level of the mother until the umbilical cord is tied (this helps...
newborn care,birth procedures,warmth,premature baby,mucus removal
Managing Labor and Delivery - Proper Pushing Techniques for the Mother
Critical Source: Where There is no Doctor a Village Health Care Handbook
During labor:

Push hard when necessary to assist with delivery.
Avoid pushing too hard if possible. Instead, take many short, fast breaths to help prevent tearing of the birth canal (see p. 269).
• The baby’s head usually comes out face...
labor,pushing techniques,birth canal,tearing,feces removal
Managing Shoulder Dystocia During Delivery
Critical Source: Where There is no Doctor a Village Health Care Handbook
If the baby’s shoulders get stuck after the head is delivered:

• The midwife should take the baby’s head in her hands and lower it very carefully to allow one shoulder to come out.
• Then, she can raise the head slightly to help the...
shoulder dystocia,delivery,midwife,birth complications
Resuscitating a Newborn Baby
Critical Source: Emergency Childbirth
Procedure:

1. If the baby does not breathe spontaneously, very gently clear the mouth of mucous with your finger.
2. Stimulate crying by gently rubbing its back.
3. If all this fails, give extremely gentle mouth-to-mouth resuscitation:
...
newborn resuscitation,mouth-to-mouth,breathing,stimulate crying,mucous clearance
Assisting with the Baby's Delivery and Initial Care
Critical Source: Emergency Childbirth
Procedure:

1. As the baby’s head emerges, it is usually face down. It will then turn so that the nose is toward the mother’s thigh.
2. Cradle the baby’s head in your hands. Do not pull or exert any pressure on the baby’s body.
3. Help the...
baby delivery,shoulders,umbilical cord,clean cloth,record time,drain fluid
Managing the Second Stage of Labor During Emergency Childbirth
Critical Source: Emergency Childbirth
Procedure:

1. Stay Calm and Reassure the Mother: Keep a calm demeanor to help reduce her anxiety. Provide emotional support and be prepared to administer first aid if needed.

2. Prepare for First Aid: Be ready to perform respiratory...
emergency childbirth, second stage of labor, delivery procedures, breathing technique, infection prevention
Managing the Third Stage of Labor (Afterbirth Delivery)
Critical Source: Emergency Childbirth
Procedure:

1. The placenta or afterbirth is expelled by the womb in a period of a few minutes to several hours after the baby is born.
2. No attempt should be made to pull it out using the umbilical cord.
3. Immediately following the...
third stage labor,afterbirth,placenta delivery,womb massage,bleeding control
Supporting the Baby During Delivery
Critical Source: Emergency Childbirth
Procedure:

1. As the baby is coming down the birth canal, massage the perineum with warm olive oil (or with your hand if no oil is available) to keep it red or pink. Avoid areas that turn white as they are more prone to tearing.
2. Apply...
delivery,baby,perineum,massage,umbilical cord,sterile,gauze,washcloth,contraction,afterbirth
Cleaning the Newborn Baby After Birth
High Priority Source: Where There is no Doctor a Village Health Care Handbook
To clean the newborn:

• Use a warm, soft, damp cloth to gently remove any blood or fluid from the baby’s body.
• It is better not to bathe the baby until after the umbilical cord has fallen off. Once it has dropped off, **bathe him daily in...
newborn hygiene,warm cloth,bathing,cord care
Managing the Mother’s Emotional State During Transition
High Priority Source: Emergency Childbirth
Procedure:

1. Recognize that during transition (the end of the first stage), the mother may feel tired, irritable, or even want to change her mind about childbirth.
2. Provide reassurance and encouragement that these feelings are normal and...
emotional support during childbirth, transition stage labor, psychological care in labor
Managing the Second Stage of Labor and Delivery
High Priority Source: Emergency Childbirth
Procedure:

1. Recognize that contractions during the second stage may come further apart.
2. Encourage the mother to bear down (push) with each contraction when she feels the urge.
3. Instruct her to take a deep breath as each contraction...
second stage labor, pushing techniques, childbirth delivery process
Post-Delivery Care and Encouraging Breastfeeding
High Priority Source: Emergency Childbirth
Procedure:

1. The mother will probably want to hold the baby. This is desirable.
2. If the umbilical cord is long enough, allow her to hold the baby in her arms.
3. If the cord is short, support the baby on the mother’s abdomen and help her...
post-delivery care,breastfeeding,umbilical cord,cutting cord,afterbirth
Recognize and Manage the First Stage of Labor During Emergency Childbirth
High Priority Source: Emergency Childbirth
Overview: In the first stage of labor during emergency childbirth, the mother's womb contracts to open and bring the baby down to the birth canal. This is a critical time for both the mother and any helpers to remain calm and provide...
labor, first stage, childbirth, emergency, contractions, dilation, backache, cramping
Supporting the Mother During First Stage of Labor
High Priority Source: Emergency Childbirth
Procedure:

1. Encourage the mother to walk or stand if it feels comfortable to her, as this may help shorten labor.
2. Allow her to eat or drink small amounts of food, fruit juice, or suck on ice chips if she becomes hungry or thirsty.
3. Do...
support during labor, first stage of childbirth, emotional support for mother
Teaching Relaxation Techniques During Labor
High Priority Source: Emergency Childbirth
Procedure:

1. Instruct the mother to go limp like a rag doll and breathe deeply, making her tummy rise and fall (abdominal breathing).
2. Begin each contraction with a deep breath to keep both the mother and baby oxygenated.
3. Encourage the...
relaxation during labor, breathing techniques for childbirth, pain management in labor
Timing Contractions During First Stage of Labor
High Priority Source: Emergency Childbirth
Procedure:

1. Place a hand on the mother’s abdomen just above the umbilicus.
2. As contractions begin, feel for a hardening ball in the uterus.
3. Time the interval from when the uterus begins to harden until it completely relaxes.
4. Record...
contraction timing, labor progress, first stage of labor, childbirth procedures

Chest Injuries (17)

Emergency Chest Opening for Penetrating Chest Wounds
Critical Source: NATO Emergency War Surgery
Procedure:
1. Assess the casualty for penetrating or perforating chest wounds and recent loss of vital signs.
2. Immediately open the unprepared chest of an unanesthetized casualty in an attempt to control hemorrhage.
3. **Administer...
penetrating chest wounds,emergency chest opening,war surgery
Manage Penetrating Chest Wounds
Critical Source: TCCC 17 13 Tactical Combat Casualty Care
Necessary Equipment: Prefabricated chest seal or any airtight material (plastic wrap).

Steps:
1. Expose the wound(s):
- Cut or unfasten the clothing that covers the wound and expose the casualty’s torso from the umbilicus to the...
penetrating chest wound management, occlusive seal, chest injury treatment, tactical casualty care
Managing Deep Chest Wounds from Gunshots
Critical Source: Where There is no Doctor a Village Health Care Handbook
Chest wounds can be very dangerous. Seek medical help at once.

• ♦ If the wound has reached the lungs and air is being sucked through the hole when the person breathes, cover the wound at once so that no more air enters. Spread Vaseline or...
deep chest wound,gunshot injury,air leak,shock treatment
Needle Chest Decompression
Critical Source: TCCC 17 13 Army Tactical Combat Casualty Care
### Needle Chest Decompression

Necessary equipment: Large-bore needle with catheter (10- to 14-gauge, at least 3.25 inches in length) and tape.

#### Steps:
1. Locate the second intercostal space (between the second and third ribs) at the...
needle chest decompression, tension pneumothorax, needle insertion site, midclavicular line, anterior axillary line
Recognition and Treatment of Tension Pneumothorax in Combat
Critical Source: Emergency War Surgery
Procedure for Immediate Recognition and Treatment of Tension Pneumothorax

• **Immediate recognition and treatment of tension pneumothorax is the single most important and lifesaving intervention in the treatment of chest injuries in...
tension pneumothorax, decompression, chest injury, battlefield trauma, tracheal shift, hypotension, hyperresonance
Remove Air from Pleural Space (Tension Pneumothorax)
Critical Source: NATO Emergency War Surgery
Objective: Relieve tension pneumothorax to restore normal lung function.

Procedure:
1. Identify signs of tension pneumothorax, such as tracheal deviation, decreased breath sounds on the affected side, and hypoxia.
2. **Insert a...
tension pneumothorax, needle decompression, chest tube insertion, pleural drainage
Remove Blood from Pleural Space (Hemothorax)
Critical Source: NATO Emergency War Surgery
Objective: Drain blood from the pleural space to prevent complications such as tension hemothorax.

Procedure:
1. Identify signs of hemothorax, including decreased breath sounds, hypotension, and tachycardia.
2. Insert a chest tube...
hemothorax, chest tube insertion, pleural drainage, blood removal
Assessing and Managing Blunt Chest Trauma with Flail Chest
Critical Source: NATO Emergency War Surgery
Procedure for Assessing and Managing Blunt Chest Trauma with Flail Chest:

1. Identify the condition:
- Look for signs of multiple rib fractures, especially in a flail chest configuration.
- This is common in both combat casualties and...
flail chest, blunt trauma, rib fractures, pulmonary contusion, thoracic injury
Manage Open Pneumothorax
Critical Source: Emergency War Surgery
Procedure:

1. Assess the injury: Look for an open chest wound with air escaping from the lungs (visible bubbles or hissing sound).
2. Apply a sterile occlusive dressing: Cover the wound completely with a large, sterile dressing.
3....
open pneumothorax,chest injury,first aid
Managing Chest Injuries in Combat Situations
Critical Source: NATO Emergency War Surgery
Objective: Provide immediate care for chest injuries sustained during conventional land warfare.

Overview:
• Approximately 15% of combat injuries involve the thoracic viscera or chest wall.
• Two-thirds of these cases have the thoracic...
chest injuries, thoracic trauma, combat wounds, hemothorax, pneumothorax, emergency surgery
Remove Pus from Pleural Space (Empyema)
Critical Source: NATO Emergency War Surgery
Objective: Drain pus from the pleural space to treat empyema.

Procedure:
1. Identify signs of empyema, such as fever, chest pain, and decreased breath sounds on one side.
2. Insert a chest tube through an incision made in the fifth...
empyema, pleural drainage, chest tube insertion, pus removal
Assessing Chest Trauma Signs and Symptoms
High Priority Source: First Aid in Armed Conflicts
Listen:
• Casualty complains about breathing difficulties or a painful chest, especially when trying to breathe normally.
• Gurgling or crackling breath sounds.
• Sucking sounds followed by the sound of rushing air.

Talk:
• Conscious...
chest trauma, breathing difficulties, rib fracture, sucking wounds, shock
Manage Flail Chest Injuries in Emergency Situations
High Priority Source: Emergency War Surgery
Flail Chest:

• A flail chest (entire segment of the chest wall floating due to fractures of a block of ribs, with two fractures on each rib) requires treatment based on severity of underlying lung injury.

• Treatment options include:
-...
flail chest, intercostal nerve block, Marcaine, airway intubation
Managing Retained Missiles in Thoracic Injuries
High Priority Source: NATO Emergency War Surgery
Procedure for Managing Retained Missiles in Thoracic Injuries:

1. Identify the condition:
- Retained missiles can cause two types of complications: infection and embolism.
- They may act as a nidus for infection, leading to empyema or...
retained missile, thoracic injury, infection, embolism, surgical removal
Recognizing and Managing Hemopneumothorax in Thoracic Injuries
High Priority Source: NATO Emergency War Surgery
Procedure for Recognizing and Managing Hemopneumothorax in Thoracic Injuries:

1. Identify the condition:
- Look for signs of hemopneumothorax, which commonly occurs after penetrating wounds to the lung.
- Expect this condition due to...
hemopneumothorax, thoracic injury, chest trauma, penetrating wound, pulmonary contusion
Treat Open Pneumothorax in Emergency Settings
High Priority Source: Emergency War Surgery
Open Pneumothorax:

• An open pneumothorax (hole in the chest wall) is treated by:
- Placing a chest tube and sealing the hole.
- Alternatives include:
- One-way valve chest dressings.
- A **square piece of plastic dressing...
open pneumothorax, chest tube, one-way valve, plastic dressing
Recognizing and Managing Trapped Lung and Empyema in Thoracic Injuries
High Priority Source: NATO Emergency War Surgery
Procedure for Recognizing and Managing Trapped Lung and Empyema in Thoracic Injuries:

1. Identify the condition:
- Trapped lung is a chronic complication of thoracic trauma that can lead to significant morbidity.
- It results from...
trapped lung, empyema, pleural space infection, thoracic trauma, fibrosis

Air Evacuation Procedures (17)

Circulating Blood Volume and Oxygenation During Air Evacuation
Critical Source: NATO Emergency War Surgery
Circulating Blood Volume and Oxygenation During Air Evacuation

1. Hematocrit is not a reliable indicator of circulating blood volume.
2. The casualty may be hypovolemic or hypervolemic during the first 3 to 4 days post-injury.
3. After...
blood volume, oxygenation, pO2, air evacuation
Abdominal Surgery Patient Evacuation Guidelines
High Priority Source: NATO Emergency War Surgery
Abdominal Surgery Patient Evacuation Guidelines

1. Premature evacuation of casualties shortly after abdominal surgery carries a high morbidity.
2. Patients with wounds and injuries of the abdomen are best retained at the facility where they...
abdominal surgery, evacuation guidelines
Burn Patient Evacuation Guidelines
High Priority Source: NATO Emergency War Surgery
Burn Patient Evacuation Guidelines

1. Burn patients may be transferred at any time during their care, but transfer is unwise until the blood volume has been restored and the patient's condition is stable.
2. The best time for this category...
burn patient, evacuation guidelines
Catheter Care During Air Evacuation
High Priority Source: NATO Emergency War Surgery
Catheter Care During Air Evacuation

1. Indwelling catheters in use before transfer should be left in place during transfer.
2. Provide instructions for specific care en route, both at the staging area and on the aircraft, to the medical...
catheter care, air evacuation, urinary output
Chest Tube Management During Air Evacuation
High Priority Source: NATO Emergency War Surgery
Chest Tube Management During Air Evacuation

1. Avoid evacuating patients with chest tubes in place by air, or within 72 hours after removal of the tube.
2. Confirm absence of pneumothorax via chest X-ray just before movement.
3. If...
chest tube, air evacuation, pneumothorax, Heimlich valve
Cranial Tongs Usage During Air Evacuation
High Priority Source: NATO Emergency War Surgery
Cranial Tongs Usage During Air Evacuation

1. Ensure proper seating of the tongs.
2. Maintain traction using a closed system, preferably with a spring device such as the Collins' spring.
3. If a spring device is unavailable, use...
cranial tongs, air evacuation, traction system, Collins' spring
Hypothermia Blanket Management During Air Evacuation
High Priority Source: NATO Emergency War Surgery
Hypothermia Blanket Management During Air Evacuation

1. Continue hypothermia blanket therapy en route if required before evacuation.
2. Equipment is normally available aboard the aircraft to continue such treatment.
3. Failure to follow...
hypothermia blanket, air evacuation, convulsions, fever
Maxillofacial Injury Patient Evacuation Guidelines
High Priority Source: NATO Emergency War Surgery
Maxillofacial Injury Patient Evacuation Guidelines

1. During transportation, these patients should be placed in a semiprone position on the litter.
2. If there are or may develop upper respiratory difficulties, perform **tracheostomy...
maxillofacial injury, evacuation guidelines
Nasogastric Tube Management During Air Evacuation
High Priority Source: NATO Emergency War Surgery
Nasogastric Tube Management During Air Evacuation

1. Ensure nasogastric suction is maintained during flight, especially for patients requiring it at ground level.
2. Be aware that **air swallowing due to anxiety or pain, and reduced...
nasogastric tube, air evacuation, gas expansion, vomiting, aspiration
Plaster Cast Management During Air Evacuation
High Priority Source: NATO Emergency War Surgery
Plaster Cast Management During Air Evacuation

1. Bivalve all circular plaster casts before movement to allow for soft tissue swelling and rapid emergency access in case of secondary hemorrhage or need for evacuation through emergency...
plaster cast, bivalve, air evacuation, emergency access
Skin Traction During Air Evacuation
High Priority Source: NATO Emergency War Surgery
Skin Traction During Air Evacuation

1. Use a stockinette glued to the skin to maintain traction during evacuation.
2. Place rubber tubing between the stockinette and a plaster-incorporated wire loop to apply traction.
3. The surgeon...
skin traction, air evacuation, stockinette, rubber tubing
Stryker Frame Usage During Air Evacuation
High Priority Source: NATO Emergency War Surgery
Stryker Frame Usage During Air Evacuation

1. Such frames may be used for transfers by air.
2. Patients should be turned during travel as ordered by the referring surgeon.
stryker frame, air evacuation, patient turning
Tracheostomy Care During Air Evacuation
High Priority Source: NATO Emergency War Surgery
Tracheostomy Care During Air Evacuation

1. Use properly sized tracheostomy tubes.
2. When using mechanical respirators, use cuffed tracheostomy tubes.
3. Due to the low humidity (5–20%) in aircraft cabins, use a **humidification...
tracheostomy care, air evacuation, humidification device, mucous plugs, tracheal care
Vascular Injury Patient Evacuation Guidelines
High Priority Source: NATO Emergency War Surgery
Vascular Injury Patient Evacuation Guidelines

1. Patients with vascular injuries require special attention and immobilization.
2. Casts should be bivalved to provide emergency access to the area.
3. Primary repair or graft cases should...
vascular injury, evacuation guidelines
Dressing Change Guidelines for Combat Wounds
High Priority Source: NATO Emergency War Surgery
Dressing Change Guidelines for Combat Wounds

1. A patient who has had a debridement of a combat wound is considered to have a clean wound.
2. Dressings should not be changed without good reason, except in an operating room at the time of...
dressing change, combat wound
Medical Attendant Guidelines for Air Evacuation
High Priority Source: NATO Emergency War Surgery
Medical Attendant Guidelines for Air Evacuation

1. Medical attendants assigned to accompany seriously ill patients should accompany them to the destination hospital.
2. The attendant provides clinical services en route and is a vital link...
medical attendant, air evacuation
Medication Management During Air Evacuation
High Priority Source: NATO Emergency War Surgery
Medication Management During Air Evacuation

1. Certain medications such as antibiotics, narcotics, and analgesics should have a recorded 'stop order' to avoid undesirable extension of therapy.
2. It is essential that the physician ordering...
medication management, air evacuation

Pregnancy Care (16)

Checking for Signs of Danger in Pregnancy
Critical Source: Where There is no Doctor a Village Health Care Handbook
Objective: Identify danger signs that require immediate medical attention.

1. Monitor the mother’s pulse and blood pressure:
- Take her pulse at each visit to establish a baseline.
- If available, use a blood pressure cuff (see page...
danger signs, pre-eclampsia, blood pressure, protein in urine, medical help
Creating an Emergency Plan with Family Members
Critical Source: A Book for Midwives
Procedure:

1. Involve the woman’s partner or close family members in developing a plan for emergency care.
2. Ensure that the woman has permission to seek medical help if needed, especially in communities where male consent is required.
3....
emergency plan, family education, warning signs during pregnancy
Assessing the Growth and Position of the Baby in the Womb
High Priority Source: Where There is no Doctor a Village Health Care Handbook
Objective: Monitor fetal growth and position to identify complications.

1. Feel the mother’s womb at each visit:
- Or teach her how to do it herself.
2. Measure the size of the womb:
- Each month, note how many finger widths the...
fetal growth, baby position, womb measurement, twins, amniotic fluid
Identifying Women in Need of Extra Support
High Priority Source: A Book for Midwives
Procedure:

1. Identify women who may require additional care:
- Single mothers or those without a supportive partner.
- Young mothers who were forced into early marriage.
- Women with abusive partners or those living in unsafe...
single mothers, abusive partners, extra support during pregnancy
Using a Fetoscope to Monitor Fetal Health
High Priority Source: Where There is no Doctor a Village Health Care Handbook
Objective: Use a fetoscope to listen to the baby’s heartbeat and assess fetal health.

1. Obtain or create a fetoscope:
- A fetoscope is a device used to hear the baby's heartbeat.
2. Use it during pregnancy visits:
- Listen for...
fetoscope, fetal heartbeat, pregnancy monitoring, fetal health
Assessing Access to Pregnancy Care
Standard Source: A Book for Midwives
Procedure:

1. Determine if the pregnant woman can attend her pregnancy checkups.
- If not, assess whether you can visit her regularly for prenatal care.
2. Evaluate the distance to the nearest maternity center, clinic, or hospital.
-...
pregnancy care, access to medical help, emergency communication, prenatal checkups
Assessing Maternal Nutrition and Anemia During Pregnancy
Standard Source: Where There is no Doctor a Village Health Care Handbook
Objective: Evaluate the mother's nutritional status and anemia during pregnancy.

1. Check for signs of poor nutrition or anemia:
- Observe if the mother appears well-nourished.
- Look for signs of anemia (e.g., pale skin, fatigue).
2....
anemia, nutrition, pregnancy, iron supplements, folic acid, vitamin C, morning sickness, heartburn
Avoid Harmful Substances During Pregnancy and Breastfeeding
Standard Source: A Book for Midwives
Why it matters: Certain substances can be harmful to both the mother and baby during pregnancy and breastfeeding.

Substances to avoid:
Drugs and medications that are not prescribed by a healthcare provider.
Poisonous chemicals,...
harmful_substances,pregnancy,breastfeeding
Identifying and Managing Common Pregnancy Problems
Standard Source: Where There is no Doctor a Village Health Care Handbook
Objective: Recognize and manage common non-serious pregnancy issues.

1. Ask the mother about any common problems:
- Examples include nausea, fatigue, or back pain.
2. Reassure her that these are not serious:
- Provide comfort and...
common pregnancy problems, reassurance, non-serious issues, maternal care
Learning a Pregnant Woman’s Health History
Standard Source: A Book for Midwives
Learning a Pregnant Woman’s Health History

To provide good care to a pregnant woman, it is essential to learn about her general health, past health, and history of pregnancies and births. This information helps ensure the safety of both the...
pregnancy, health history, medical questions, midwifery care, regular checkups
Prenatal Checkup: Monitoring the Mother and Baby's Health
Standard Source: A Book for Midwives
Talk with the mother:

• Ask about her general well-being, including any new symptoms or concerns.
• Inquire about changes in appetite, sleep patterns, or emotional state.
• Discuss any recent stressors or events that may affect her health or...
prenatal checkup, monitoring mother and baby health, midwife procedures
Evaluating Work Conditions During Pregnancy
Standard Source: A Book for Midwives
Procedure:

1. Assess the woman’s work environment:
- Determine how much she works at home and outside the home.
- Identify if her job exposes her to potential dangers, such as chemicals or physical strain.
2. Ensure she has adequate time...
work during pregnancy, safety at work, rest during pregnancy
Supporting Family and Partners in Pregnancy Care
Standard Source: A Book for Midwives
Procedure:

1. Encourage partners and family members to be actively involved in the pregnancy.
2. Teach them how they can support the pregnant woman:
- Help with housework and childcare for other children.
- Ensure she has access to...
family support during pregnancy, partner involvement, emotional support
Maintain Oral Health During Pregnancy
Reference Source: A Book for Midwives
Why it matters: Healthy teeth support overall health, especially during pregnancy. Unhealthy teeth may lead to gum infections and increase the risk of early birth.

Steps to protect your teeth:
1. Eat calcium-rich foods such as dairy...
oral_health,pregnancy,tooth_cleaning,dental_care
Managing Sexual Activity During Pregnancy
Reference Source: A Book for Midwives
Managing Sexual Activity During Pregnancy

Pregnant women may experience changes in their desire for sexual activity. Both increased and decreased interest are normal.

Sex is not dangerous for the baby during pregnancy.
• If sex is...
pregnancy, sexual activity, safer sex, infection prevention, condoms, early labor
Prenatal Care for Pregnant Women
Reference Source: A Book for Midwives
Procedure for Providing Prenatal Care:

1. Start prenatal care as soon as a woman knows she is pregnant. This ensures early detection of any potential health issues.
2. Schedule regular checkups (at least 4 during pregnancy). More...
prenatal care, antenatal checkups, maternal health, midwife guidance

Patient Care (16)

Register Patients Requiring Life Support Equipment with Utility Companies and Emergency Offices
Critical Source: Home Health Emergency Preparedness
Procedure:

1. Any patient requiring power for life support equipment must be registered with the local utility companies.
2. The same patients must also be registered with local emergency offices.
3. This registration ensures that during a...
life support registration, utility companies, emergency offices
Optimizing Patient Care Therapeutic Protocols for Avian Flu
High Priority Source: Bird Flu Summit Brochure
Procedure:

1. Develop patient care protocols that outline the best practices for treating individuals infected with avian flu.
2. Ensure that protocols include guidelines for antiviral administration, supportive care, and monitoring of...
patient care, avian flu treatment, therapeutic protocols
Admit When You Do Not Know the Answer to a Question
High Priority Source: A Book for Midwives
### Admit When You Do Not Know the Answer to a Question

Steps:
1. If you do not know the answer to a question, be honest and admit it.
2. Avoid making up information or pretending to have knowledge that you do not possess.
3. Let the person...
honesty in healthcare, admitting knowledge gaps, midwife communication skills
Assign Patient Priority Code and Provide Emergency Planning Materials on Admission
High Priority Source: Home Health Emergency Preparedness
Procedure:

1. On admission, the admitting nurse will assign each patient a priority code based on their emergency rating.
2. The nurse will obtain a list of contact numbers from the patient and family.
3. The nurse will discuss emergency...
patient admission, priority code, emergency planning materials
Elevating the Head of the Bed for Breathing and Comfort
Standard Source: Survival and Austere Medicine
Elevating the head of the bed can improve breathing in patients with conditions such as pneumonia, asthma, or emphysema, and helps keep the airway clear. It also makes eating and drinking easier.

### Methods to Elevate:
• Use **blocks under the...
elevate head, breathing assistance, airway clearance, eating comfort, bed elevation techniques
Maintaining Personal Hygiene for Patients with Limited Mobility
Standard Source: Survival and Austere Medicine
Personal hygiene is crucial for patients who may be unable to reach certain areas of their body due to injury, arthritis, or other limitations.

### Steps:
1. Provide regular bed baths (every 3-4 days) and daily wiping with a damp cloth to...
personal hygiene, bed baths, oral care, fingernail trimming, patient mobility limitations
Managing Bodily Functions for Patients in Care
Standard Source: Survival and Austere Medicine
Bodily functions, including elimination (urine, feces, sweat) and vomiting, must be managed carefully to maintain hygiene and comfort.

### Considerations:
• Provide assistance with elimination needs such as urine, feces, and perspiration.
-...
bodily functions, elimination management, emesis handling, patient hygiene, vomit care
Obtain and Maintain a List of Vendors for Patient Medical Supplies
Standard Source: Home Health Emergency Preparedness
Procedure:

1. A list of vendors who supply each patient’s medical supplies must be obtained.
2. This list should be kept in the patient’s chart, both in paper and electronic formats.
3. The information should be updated regularly to ensure...
vendor list, medical supplies, patient chart
Proper Patient Positioning for Comfort and Functionality
Standard Source: Survival and Austere Medicine
Proper patient positioning is essential to maintain skin integrity, prevent loss of limb function, and ensure comfort. Improper positioning can lead to pressure sores and prolonged recovery times.

### Steps:
1. Alternate the patient's position...
patient positioning, pressure sores, limb function, comfort, pillows, elevation, swelling reduction
Provide Clear and Compassionate Care to Women During Health Consultations
Standard Source: A Book for Midwives
### Provide Clear and Compassionate Care to Women During Health Consultations

Steps:
1. Explain what you are doing during each health consultation with a woman (e.g., during pregnancy or other care visits).
2. Clearly explain the reasons behind...
compassionate care, patient communication, midwife consultation techniques
Provide Respectful and Compassionate Care to All Patients
Standard Source: A Book for Midwives
### Provide Respectful and Compassionate Care to All Patients

Steps:
1. Treat every person with respect and dignity during all interactions.
2. As a midwife or health worker, be especially mindful of how your words and actions affect the people...
compassionate care, patient respect, midwife communication techniques
Be Kind and Show Compassion to Patients and Families
Standard Source: Where There is no Doctor a Village Health Care Handbook
Objective: Provide emotional support and care to patients and their families.

Steps:
1. Show kindness through actions such as a friendly word, a smile, or a hand on the shoulder.
2. Treat others as equals, regardless of your...
kindness in healthcare, patient empathy, family support, compassionate care
Patient Positioning and Turning for Spinal Injuries
Standard Source: Emergency War Surgery
Procedure for turning patients with spinal injuries:

Turn Patient Appropriately: Use Stryker, Foster, or similar frame and turn patient every 4 h.
spinal injury, patient turning, Stryker frame, Foster frame
Address Difficult Subjects with Openness and Sensitivity
Reference Source: A Book for Midwives
Procedure:

1. Recognize that some women may feel uncomfortable discussing sensitive topics such as family problems, sexuality, or sexual health.
2. Approach these subjects with honesty, openness, and sensitivity to create a safe environment for...
sensitive topics, open communication, patient comfort
Empower Women to Take the Lead in Their Care
Reference Source: A Book for Midwives
Procedure:

1. Acknowledge that every woman has the right to make decisions about her own body and health.
2. Encourage women to take an active role in their care and decision-making processes.
3. Provide information, resources, and support to...
empowerment, patient autonomy, active participation
Provide Respectful Care to Women in Vulnerable Situations
Reference Source: A Book for Midwives
Procedure:

1. Recognize that some women may have experienced disrespectful treatment due to factors such as age, work, ethnicity, religion, financial status, disability, or other reasons.
2. Approach these women with empathy and respect,...
respectful care, vulnerable women, non-judgmental approach, patient autonomy

Pregnancy Health (16)

Avoid Smoking, Alcohol, and Other Drugs During Pregnancy and Breastfeeding
Critical Source: A Book for Midwives
Procedure:

1. Pregnant women should avoid smoking, alcohol, and other drugs, as they can harm both the mother and baby.
2. Smoking is dangerous for anyone but particularly harmful during pregnancy:
- It reduces blood flow to the baby...
smoking,alcohol,drugs,pregnancy,breastfeeding,addiction
Avoid Contact with People with Rubella or Other Sicknesses During Pregnancy
High Priority Source: A Book for Midwives
Procedure:

1. Stay away from people who are sick or have rashes, especially during pregnancy.
2. This helps protect the pregnant woman and her baby from becoming ill.
3. Some sicknesses, such as rubella (German measles), can cause...
rubella,pregnancy,sicknesses,avoid contact,health risks
Avoid Exposure to Chemicals and Fumes During Pregnancy and Breastfeeding
High Priority Source: A Book for Midwives
Procedure:

1. Pregnant women and those who are breastfeeding should avoid exposure to strong chemicals and fumes, including:
- Cleaning agents
- Pesticides used in fields or at home
2. These substances can be dangerous for both the...
chemicals,fumes,pregnancy,breastfeeding,toxic exposure
Avoid Restrictive Food Practices During Pregnancy
High Priority Source: A Book for Midwives
Why it matters:
Restricting certain foods during pregnancy based on myths or beliefs can lead to nutrient deficiencies and harm both the mother and baby.

Action Steps:
1. Encourage a diverse diet that includes all food groups (main,...
pregnancy nutrition, food myths, balanced diet
Avoid Taking Medicines During Pregnancy and Breastfeeding
High Priority Source: A Book for Midwives
Procedure:

1. Pregnant women should avoid taking medicines unless absolutely necessary, as they can pass through the blood to the baby.
2. Some medicines that are safe for adults or children can be dangerous to a developing baby,...
medicines,pregnancy,breastfeeding,safety,plant medicines
Screen for Syphilis During Pregnancy
High Priority Source: A Book for Midwives
Procedure:

1. Every pregnant woman should get a blood test to check for syphilis.
2. This is especially important if she has ever had sores on her genitals.
3. Untreated syphilis during pregnancy can lead to:
- Premature birth
- Deformed...
syphilis during pregnancy, blood test, prenatal screening, stillbirth, deformities
Avoid Exposure to Measles and German Measles During Pregnancy
High Priority Source: Where There is no Doctor a Village Health Care Handbook
Stay far away from children with measles, especially german measles (rubella). Rubella can cause serious harm to the developing baby (see p. 312).
measles,rubella,pregnancy,infection,baby safety
Avoid Medicines During Pregnancy Unless Necessary
Standard Source: Where There is no Doctor a Village Health Care Handbook
Avoid taking medicines unless recommended by a health worker or doctor. Some medicines can harm the developing baby. If you think you might be pregnant and need medicine, inform your health worker. You may take acetaminophen or antacids...
medicines,pregnancy,safety,acetaminophen,antacids,HIV testing
Avoid Smoking and Drinking During Pregnancy
Standard Source: Where There is no Doctor a Village Health Care Handbook
Do not smoke or drink during pregnancy. Both smoking and drinking are harmful to the mother and can harm the developing baby.
smoking,alcohol,pregnancy,harm,baby
Maintain Personal Hygiene During Pregnancy
Standard Source: Where There is no Doctor a Village Health Care Handbook
Keep clean by bathing or washing regularly and brushing your teeth every day. Avoid using vaginal douches, especially in the last month of pregnancy.
hygiene,pregnancy,bathing,tooth brushing,vaginal douches
Maintain Proper Nutrition During Pregnancy
Standard Source: Where There is no Doctor a Village Health Care Handbook
Eat enough to gain weight regularly, especially if you are thin. Eat well with food rich in proteins, vitamins, and minerals, particularly iron (see Chapter 11). Avoid greasy foods and eat smaller meals more frequently. Include...
nutrition,pregnancy,iron,proteins,vitamins,minerals,folic acid,anemia,malnutrition
Manage Low Back Pain During Pregnancy
Standard Source: Where There is no Doctor a Village Health Care Handbook
Low back pain is common in pregnancy and can be managed by: - Exercising regularly. - Standing and sitting with a straight back (see p. 174). Avoid heavy lifting or prolonged standing.
back pain,pregnancy,exercise,posture
Manage Swelling of the Feet During Pregnancy
Standard Source: Where There is no Doctor a Village Health Care Handbook
Swelling of the feet is common in late pregnancy due to pressure from the baby. To manage: - Rest with your feet up at different times during the day (see p. 176). - Eat less salt and avoid salty foods. - Drink tea made from **maize silk...
swelling,pregnancy,corn silk,rest,salt reduction
Use Iodized Salt During Pregnancy
Standard Source: Where There is no Doctor a Village Health Care Handbook
Use iodized salt to increase the chances that the child will be born alive and will not have learning difficulties. However, do not use very much salt to avoid swelling of the feet and other problems.
iodized salt,pregnancy,nutrition,child development
Manage Acid Indigestion and Heartburn During Pregnancy
Reference Source: Where There is no Doctor a Village Health Care Handbook
Burning or pain in the pit of the stomach or chest (acid indigestion and heartburn): - Eat small amounts of food at a time. - Drink water often. - Take antacids, especially those with calcium carbonate (see p. 381). - Suck on hard candy....
acid indigestion,heartburn,pregnancy,antacids,calcium carbonate
Manage Nausea and Vomiting During Pregnancy
Reference Source: Where There is no Doctor a Village Health Care Handbook
Nausea or vomiting is common in the second or third month of pregnancy. To help: - Eat something dry like crackers or dry bread before going to bed and upon waking up. - Avoid large meals; eat smaller amounts more frequently. - Avoid greasy...
nausea,vomiting,pregnancy,mint tea,antihistamine

Neurology (16)

Immediate Treatment for Severe Head Injury
Critical Source: Emergency War Surgery
Procedure:

1. Immediate intubation with adequate ventilation:
- This is the most critical first-line treatment for a severely head-injured patient.
2. Evacuation to the nearest neurosurgeon:
- Avoid diagnostic delays and initiate...
intubation for head injury, evacuation to neurosurgeon, cerebral resuscitation
Management of Traumatic Brain Injury (TBI)/CNS
Critical Source: Emergency War Surgery
Traumatic brain injury (TBI) management:

• Identify potential intracranial surgical lesions for possible emergent craniotomy.
• Prevent hypoxemia: Maintain O2 saturation > 92%, PaO2 > 100 mm Hg, and intubate patients with...
TBI,cerebral perfusion pressure,ICP,CPP,hypoxemia prevention
Understand the Signs and Management of Stroke
Critical Source: Where There is no Doctor a Village Health Care Handbook
Stroke is a sudden loss of consciousness or ability to move due to bleeding or clot in the brain.

What to do:
1. Call for emergency help immediately if stroke symptoms are present (e.g., facial drooping, slurred speech, weakness on one side...
stroke, cerebrovascular accident, brain clot, emergency
ICU Management for Patients with GCS < 12
Critical Source: Emergency War Surgery
Objective: Provide ICU management for patients with a Glasgow Coma Scale (GCS) score less than 12 to prevent secondary brain injury.

Procedure Steps:
1. Maintain PaO2 at a minimum of 100 mm Hg.
2. **Keep PCO2 between 35 and 40 mm...
ICU management,GCS < 12,secondary brain injury,PaO2,PCO2,phenytoin,broad-spectrum antibiotics,coagulopathy,ICP monitoring
Identifying and Managing Penetrating Head Injuries
Critical Source: Emergency War Surgery
Procedure:

1. Assess for penetrating injuries:
- Look for entry wounds through the upper neck, face, orbit, or temple.
2. Reconstruct fragment path:
- Use plain films and computed tomography (CT) to determine the trajectory of...
penetrating head injury management, fragment path reconstruction, transorbital injury assessment
Neurosurgical Damage Control for Brain Injuries
Critical Source: Emergency War Surgery
Procedure:

1. Early intracranial pressure (ICP) control:
- Use appropriate interventions to reduce ICP.
2. Cerebral blood flow (CBF) preservation:
- Ensure adequate cerebral perfusion through hemodynamic support.
3. **Prevention...
ICP control, CBF preservation, secondary cerebral injury prevention
Ventricular Catheter Placement for ICP Monitoring
Critical Source: Emergency War Surgery
Procedure:

• Make an incision just at or anterior to the coronal suture, approximately 2.5–3 cm lateral to the midline.
• Perform a twist drill craniostomy, nick the underlying dura, and insert a ventricular catheter into the frontal...
ventricular catheter placement,ICP monitoring,catheter insertion,nasion,epicanthus,tragus
Ventricular Catheter Placement for Intracranial Pressure Monitoring
Critical Source: Emergency War Surgery
Objective: Place a ventricular catheter to monitor and reduce intracranial pressure (ICP) in patients with severe head injury.

Procedure Steps:
1. Make an incision just at or anterior to the coronal suture, approximately 2.5–3 cm...
ventricular catheter placement,ICP monitoring,craniostomy,catheter insertion,head injury
Assessing Prognosis in Brain Injuries
High Priority Source: Emergency War Surgery
Procedure:

1. Evaluate the patient's level of consciousness:
- Good prognosis is indicated if the patient responds to simple commands and does not deteriorate.
- Grave prognosis applies to patients who are immediately comatose,...
brain injury prognosis, neurological assessment, head trauma evaluation
Supportive Medical Therapy for Head Injuries
High Priority Source: Emergency War Surgery
Objective: Provide supportive care for patients with head injuries to prevent complications and promote recovery.

Procedure Steps:
1. Use supportive medical therapy as the primary treatment, reserving ICP monitoring, ventriculostomy, or...
supportive care,head injury,magnesium,ICP monitoring,delayed hemorrhage,blast over-pressure,cognitive deficits
Administer Ergotamine with Caffeine for Migraine Relief
High Priority Source: Where There is no Doctor a Village Health Care Handbook
Ergotamine with caffeine is used to treat severe migraines. Follow these steps:

1. Confirm the patient has been diagnosed with a migraine by a healthcare provider.
2. Take one tablet of ergotamine with caffeine as directed, preferably after a...
ergotamine with caffeine, migraine treatment
Classification of Combat Head Injuries
High Priority Source: Emergency War Surgery
Procedure:

1. Blunt (closed head injury):
- No penetration of the skull.
2. Penetrating injuries:
- Include the following subtypes:
- Penetrating with retained fragments.
- Perforating.
- Guttering (grooving the...
combat head injury types, penetrating brain injury, blast over-pressure CNS injury
Common Vectors of Penetrating Injury
High Priority Source: Emergency War Surgery
Common Vectors of Penetrating Brain Injuries

Trans-suboccipital:
- Entry through the subocciput region.
Transfrontal:
- Entry through the frontal region.
Transorbital:
- Entry through the orbit (eye socket).
-...
penetrating brain injury vectors, transorbital injury, infratemporal injury
Traditional Classification of Head Injuries in Combat
High Priority Source: Emergency War Surgery
Procedure:

1. Open injuries:
- Most commonly encountered brain injuries in combat.
2. Closed injuries:
- More common in civilian settings, but may occur more frequently in military operations other than war.
3. **Scalp...
open head injury, closed head injury, scalp injury management
Understand Spasticity and Its Effects
Standard Source: Where There is no Doctor a Village Health Care Handbook
Spastic refers to chronic abnormal muscle contractions caused by brain damage (e.g., cerebral palsy). This can lead to:

Scissoring of the legs: Legs may cross like scissors due to constant muscle tension.
Limited mobility:...
spasticity, cerebral palsy, muscle stiffness, brain damage
Recognize and Respond to Spasms
Standard Source: Where There is no Doctor a Village Health Care Handbook
Spasm is a sudden, uncontrollable muscle contraction that can occur in various parts of the body:

Gut spasms: Cause cramps or colic.
Bronchial spasms: Occur during asthma attacks.
Muscle spasms: Seen in tetanus (e.g., jaw...
spasm, muscle contraction, tetanus, asthma, cramps

Hypothermia Treatment (16)

Hospital Rewarming Techniques for Hypothermia
Critical Source: US Marine Corps Wilderness Medicine
Procedure:

1. Warmed IVF (Intravenous Fluids):
- Administer intravenous fluids that have been warmed to body temperature.
- This helps increase core body temperature and restore circulation.

2. Warmed/Humidified Oxygen:
-...
rewarming,hypothermia,treatment,warmed ivf,warm oxygen,bear hugger,accl,extracorporal blood rewarming,lavage,peritoneal lavage,thoracic lavage,mediastinal lavage,core temperature,shock protocols
Treatment of Severe Hypothermia with Hemodynamic Instability
Critical Source: Emergency War Surgery
Cardiopulmonary bypass with rewarming is the ideal technique for severe hypothermia with hemodynamic instability because it provides core rewarming while ensuring circulatory stability.

• This method should be used when available, as it...
severe hypothermia treatment, cardiopulmonary bypass, hemodynamic instability
Assessment of Vital Signs in Severe Hypothermia
Critical Source: US Marine Corps Wilderness Medicine
Objective: Accurately assess vital signs in severely hypothermic victims before initiating CPR.

Steps:
1. Thorough Pulse Assessment: Check for pulses for 30-45 seconds to determine if there is any viable cardiovascular activity.
2....
vital signs assessment, hypothermia, pulse check, CPR
Core Rewarming Techniques for Hypothermic Patients
Critical Source: Emergency War Surgery
Limit active rewarming to the body’s center/core only.

Heated (40 °C–45 °C), humidified air/O2 is the method of choice.
• Use a Norwegian personal heater pack (charcoal heater) with a warming tube placed into an insulation wrap.
-...
core rewarming, hypothermia treatment, Bair Hugger, heated air, CPR for hypothermia
Initial Field Treatment for Hypothermia
Critical Source: US Marine Corps Wilderness Medicine
Objective: Provide immediate care to hypothermic victims in the field.

Steps:
1. ABC’s (Airway, Breathing, Circulation): Ensure airway is clear and breathing is unobstructed. Check circulation and manage any life-threatening...
hypothermia, field treatment, ABCs, C-spine precautions, insulation, vapor barrier, rewarming
Management of Hypothermic Victims with Altered Consciousness
Critical Source: US Marine Corps Wilderness Medicine
Objective: Prevent further complications in hypothermic victims who are unconscious.

Steps:
1. Do Not Administer ETOH (Ethanol): Under no circumstances should alcohol be given to a hypothermic victim, as it enhances heat loss and is...
alcohol contraindication, hypothermia, altered consciousness, NPO
Monitoring and Management During Hypothermia Resuscitation
Critical Source: Emergency War Surgery
- Monitor core temperature via esophageal (preferred) or rectal probes.
• Carefully correct acid/base balance.
• Rewarm the core to 32 °C (90 °F) and attempt cardioversion (360 J). Continue rewarming and repeat. Defibrillate after every...
core temperature monitoring, defibrillation for hypothermia, potassium management
Prehospital Treatment for Hypothermic Patients
Critical Source: Emergency War Surgery
Awake patients:

Remove wet clothing, dry the patient, and insulate them.
Administer oral sugar solutions to hydrate.
• If no other option is available, walk out or transport to MTF (Medical Treatment Facility). Note: This may...
hypothermia, prehospital treatment, rewarming, IV fluids, D5NS
Rewarming Methods Based on Core Temperature
Critical Source: Emergency War Surgery
- Patients with core temperature (rectal) above 30 °C can generally be rewarmed externally using methods such as warm blankets or warm-water torso immersion.
• Patients below 30 °C rectal should be considered more fragile and will often require...
external rewarming, internal rewarming, lavage fluids
Field Rewarming Techniques for Mild Hypothermia or Delayed CASEVAC
High Priority Source: US Marine Corps Wilderness Medicine
Objective: Provide rewarming in the field when evacuation is not immediately possible.

Steps:
1. Sleeping Bag Rewarming Technique: Use a proper sleeping bag to insulate and gradually rewarm the victim. Ensure the bag is dry and not...
field rewarming, sleeping bag, hot packs, hypothermia
Four Ideal Rewarming Strategies in the Field
High Priority Source: US Marine Corps Wilderness Medicine
Objective: Implement effective rewarming strategies based on available resources.

Steps:
1. Sleeping Bag Rewarming: Use a dry sleeping bag to insulate and warm the victim gradually.
2. Water Bath/Counter Current Rewarming: Immerse...
rewarming strategies, IV fluids, water bath, airway rewarming
Rewarming Techniques in a Basic Aid Station (BAS)
High Priority Source: US Marine Corps Wilderness Medicine
Objective: Provide rewarming techniques for hypothermic casualties in limited medical environments.

Steps:
1. Passive External Rewarming: Use a non-pre-warmed sleeping bag or blanket to insulate the victim and allow gradual warming.
2....
rewarming techniques, passive rewarming, active rewarming, IV fluids
Treating Hypothermia in Adults
High Priority Source: Where There is no Doctor a Village Health Care Handbook
Procedure for Treating Hypothermia in Adults:

1. Move the person to a dry, sheltered area protected from wind.
2. Remove wet clothing and replace it with dry clothing or wrap them in dry blankets.
3. Cover the head, feet, and hands...
hypothermia, treatment, warming, cold exposure, first aid, emergency care
Treating Hypothermia in Children
High Priority Source: Where There is no Doctor a Village Health Care Handbook
Procedure for Treating Hypothermia in Children:

1. Move the child to a dry place protected from wind.
2. Remove wet clothing and wrap them in dry blankets or clothing.
3. Cover the head, feet, and hands to retain body heat.
4. **Use...
hypothermia in children, treatment, warming, cold exposure, first aid, emergency care
Treating Hypothermia in Vulnerable Individuals (Babies, Sick, or Weak Persons)
High Priority Source: Where There is no Doctor a Village Health Care Handbook
Procedure for Treating Hypothermia in Vulnerable Individuals:

1. Recognize the risk: Babies, sick children, elderly, malnourished, or weak individuals are at higher risk of hypothermia.
2. Move to a warm, protected place and keep the...
hypothermia in vulnerable individuals, treatment, warming, cold exposure, first aid, emergency care
Treatment of Mild Stable Hypothermia
High Priority Source: Emergency War Surgery
Insulation is key for mild stable hypothermia.
• Use heat lamps, warmed IV fluids, and warmed forced air (Bair Hugger). Hair dryers have been used as a jury-rigged alternative to Bair Huggers.
• Consider **arteriovenous anastomoses...
mild hypothermia treatment, AVA warming, Bair Hugger, heat lamps

Tactical Casualty Care (16)

Care Under Fire Basic Management Plan
Critical Source: TCCC 17 13 Tactical Combat Casualty Care
### Care Under Fire Basic Management Plan

Action Steps:
1. Return fire and take cover.
2. Direct or expect the casualty to remain engaged as a combatant, if appropriate.
3. **Direct the casualty to move to cover and apply self-aid, if...
care under fire, hemorrhage control, tourniquet application, tactical field care
Perform Tactical Field Care
Critical Source: STP 21 1 Army Warrior Skills Level 1 Soldiers Manual of Common Tasks
Objective: Provide medical care when no longer under direct enemy fire.

Steps:
1. Assess the tactical situation and ensure that you are no longer under effective hostile fire.
2. Check for airway, breathing, and circulation (ABCs)...
tactical field care, first aid under fire, casualty evacuation, ABCs assessment, shock management
Provide Care Under Fire
Critical Source: STP 21 1 Army Warrior Skills Level 1 Soldiers Manual of Common Tasks
Objective: Provide immediate care under enemy fire.

Steps:
1. Return fire as directed or required before providing medical treatment.
2. Determine if the casualty is alive or dead.
3. Provide tactical care to the live casualty:
...
care under fire, tactical field care, hemorrhage control, tourniquet application, enemy fire suppression
Tactical Field Care Basic Management Plan - Massive Hemorrhage Management
Critical Source: TCCC 17 13 Tactical Combat Casualty Care
### Tactical Field Care Basic Management Plan - Massive Hemorrhage Management

Action Steps:
1. Assess for an unrecognized hemorrhage and control all sources of bleeding.
2. **Use one or more CoTCCC-recommended limb tourniquets, if...
hemorrhage control, tourniquet application, hemostatic dressing, junctional tourniquet
Administer Parenteral Antibiotics for Battlefield Wounds
Critical Source: TCCC 17 13 Tactical Combat Casualty Care
Recommended parenteral antibiotics for POI care are:
Ertapenem: 1 gram (gm)
Cefotetan: 2 grams (gm)

### Indications and Use
• These antibiotics are used to treat multidrug-resistant bacteria.
Ertapenem is effective...
ertapenem,cefotetan,moxifloxacin,battlefield antibiotics,parenteral administration,penetrating injuries
Disarming Casualties With Altered Mental Status
Critical Source: TCCC 17 13 Tactical Combat Casualty Care
### Disarming Casualties With Altered Mental Status

Action Steps:
1. Immediately disarm casualties with an altered mental status.
altered mental status, disarming casualty
FASTResponder Insertion Procedure
Critical Source: TCCC 17 13 Tactical Combat Casualty Care
Procedure for FASTResponder Insertion:

Step 1: Expose and Clean the Site
• Expose the sternum and clean the infusion site.
Maintain aseptic technique throughout the procedure.
• Administer local anesthetic if the patient is conscious...
FASTResponder insertion, aseptic technique, IV line connection, protective dome
FASTResponder Removal Procedure
Critical Source: TCCC 17 13 Tactical Combat Casualty Care
Procedure for FASTResponder Removal:

• Turn off the source of fluid and disconnect.
• Pull on the infusion tube to remove it from the patient. Peel off the target foot and dress the site per standard protocol.
• Discard the infusion tube and...
FASTResponder removal, physician/nurse, continuous motion, tubing stretch
Implement PAWS Acronym for Casualty Care
Critical Source: TCCC 17 13 Tactical Combat Casualty Care
PAWS (Pain, Antibiotics, Wounds, Splinting) is an acronym used by TCCC-trained individuals to help remember additional casualty care issues. It ensures that pain management, antibiotics administration, wound assessment and treatment, and...
PAWS acronym,pain management,battlefield antibiotics,wound assessment,splinting,penetrating eye trauma,combat ready clamp,junctional tourniquet,tracheostomy
Manage Penetrating Eye Trauma in the Field
Critical Source: TCCC 17 13 Army Tactical Combat Casualty Care
Indication: Suspected penetrating eye trauma.

Procedure:
1. Perform a rapid field test of visual acuity to assess initial vision.
2. Apply a rigid shield over the affected eye, taped securely, to prevent further injury.
3....
penetrating eye trauma, moxifloxacin, rigid shield, tccc, eye injury
Tactical Field Care Basic Management Plan - Airway Management for Casualty With Airway Obstruction or Impending Airway Obstruction
Critical Source: TCCC 17 13 Tactical Combat Casualty Care
### Tactical Field Care Basic Management Plan - Airway Management for Casualty With Airway Obstruction or Impending Airway Obstruction

Action Steps:
1. Perform the chin lift/jaw thrust maneuver.
airway obstruction, chin lift, jaw thrust
Control Junctional Hemorrhage and Stabilize the Pelvis
High Priority Source: TCCC 17 13 Army Tactical Combat Casualty Care
Indication: Suspected pelvic disruption or junctional hemorrhage (e.g., from IEDs, land mines).

Procedure:
• Use one of the following devices to control junctional hemorrhage and stabilize the pelvis:
- Combat Ready Clamp (CRoC)
-...
junctional hemorrhage, pelvic stabilization, crorc, jett, sam tourniquet, tccc
FASTResponder Device Precautions
High Priority Source: TCCC 17 13 Tactical Combat Casualty Care
Precautions for FASTResponder Use:

• The FASTResponder is designed to penetrate 6 mm into the manubrium. Qualified professionals should determine any appropriate or necessary exceptions, either inclusions or exclusions, to the criterion for...
FASTResponder, precautions, manubrium, infusion tube, sternum fracture, midline sternotomy scars
FASTResponder Warnings and Safety Considerations
High Priority Source: TCCC 17 13 Tactical Combat Casualty Care
Warnings for FASTResponder Use:

Safety in patients with very severe osteoporosis has not been proven.

• Insertion in sites other than the manubrium may result in ineffective infusion and/or serious injury to the patient.

• Reuse of...
FASTResponder, warnings, osteoporosis, cross-contamination, needle stick
Understand TCCC Overview
High Priority Source: TCCC 17 13 Army Tactical Combat Casualty Care
Overview of Tactical Combat Casualty Care (TCCC):

Origin: Developed in 1996 by special operations forces.
Purpose: Evidence-based and battlefield-proven guidelines to reduce deaths at the point of injury (POI).
Adoption:...
TCCC, tactical combat casualty care, military medicine, battlefield triage, MARCH, PAWS
Continuum of Care - Understanding Medical Facilities
Standard Source: TCCC 17 13 Army Tactical Combat Casualty Care
Continuum of Care

It is important for TCCC-trained individuals to understand the continuum of care. Having an understanding of different facilities in the immediate area can factor into MEDEVAC plans. In accordance with JP 4-02, the following...
continuum of care, medical evacuation planning, facility roles

Medications (15)

Avoid Use of Hydroxyquinoline-Based Anti-Diarrhea Medicines
High Priority Source: Where There is no Doctor a Village Health Care Handbook
Hydroxyquinoline-based anti-diarrhea medicines, such as clioquinol, di-iodohydroxyquinoline, halquinol, broxyquinoline (Diodoquin, Enteroquinol, Amicline, Quogyl) and other brand names, are dangerous and have been **prohibited in many...
hydroxyquinoline,clioquinol,dangerous medications,diarrhea treatment
Administering Chloramphenicol
High Priority Source: Where There is no Doctor a Village Health Care Handbook
Title: Administering Chloramphenicol

Content:
Indication: Used for the treatment of bacterial infections such as typhoid fever and meningitis.
Dosage: Take 500 mg every 6 hours, or as directed by a healthcare provider.
-...
chloramphenicol, bacterial infection treatment, antibiotic administration
Avoid Anabolic Steroids for Children's Growth
High Priority Source: Where There is no Doctor a Village Health Care Handbook
Anabolic steroids, such as nandrolone decanoate (Durabolin, Deca-Durabolin, Orabolin), stanozolol (Cetabon), oxymetholone (Anapolon), ethylestrenol (Organaboral) and other brand names, are sometimes mistakenly used in tonics to help children...
anabolic steroids,children's growth,permanent side effects
Avoid Long-Term Use of Corticosteroids for Minor Aches and Pains
High Priority Source: Where There is no Doctor a Village Health Care Handbook
Corticosteroids, such as prednisolone and dexamethasone, are powerful anti-inflammatory drugs that should only be used in severe cases, such as:

• Severe asthma attacks
• Severe arthritis
• Severe allergic reactions

However, they are often...
corticosteroids,steroid misuse,immune suppression,bone weakness
Avoid Use of Butazone-Based Arthritis Medicines
High Priority Source: Where There is no Doctor a Village Health Care Handbook
Butazones, such as oxyphenbutazone (Amidozone) and phenylbutazone (Butazolidin), are used for treating joint pain (arthritis). However, they can cause:

• A dangerous and sometimes deadly blood disease called agranulocytosis
• Damage to...
butazone,arthritis medicine,dangerous blood disease
Avoid Vitamin B12 and Liver Extract Injections for Anemia Unless Prescribed by a Specialist
High Priority Source: Where There is no Doctor a Village Health Care Handbook
Vitamin B12 and liver extract injections are not effective in treating anemia or weakness except in rare cases. They also carry risks when injected. Injectable iron (e.g., Inferon) should also be avoided.

These treatments should only be...
vitamin b12,liver extract,injections for anemia,specialist prescription
Avoiding Harmful Medicines for Diarrhea
High Priority Source: Where There is no Doctor a Village Health Care Handbook
For most cases of diarrhea no medicines are needed. However, some medicines can be harmful or ineffective:

Anti-diarrhea medicines with kaolin and pectin (e.g., _Kaopectate_) make stools thicker but do not correct dehydration or control...
diarrhea,medicine,avoid,harmful,antibiotics
Administer Ephedrine for Hypotension or Asthma
Standard Source: Where There is no Doctor a Village Health Care Handbook
Ephedrine is used to treat low blood pressure and asthma symptoms. Follow these steps:

1. Confirm the patient has been prescribed ephedrine by a healthcare professional.
2. Take one tablet of ephedrine with water, preferably after a meal.
3....
ephedrine, hypotension treatment, asthma medication
Use Enteroquinol for Parasitic Infections
Standard Source: Where There is no Doctor a Village Health Care Handbook
Enteroquinol is used to treat intestinal parasites such as Giardia and amoebiasis. Follow these steps:

1. Confirm the patient has been diagnosed with a parasitic infection by a healthcare provider.
2. Take one tablet of enteroquinol with water,...
enteroquinol, giardia treatment, amoebiasis, parasitic infection
Administer Efavirenz
Standard Source: Where There is no Doctor a Village Health Care Handbook
Efavirenz is an antiretroviral medication used to treat HIV. Follow these steps:

1. Ensure the patient has been prescribed efavirenz by a healthcare professional.
2. Take the tablet with food or a snack to reduce stomach upset.
3. Swallow the...
efavirenz, HIV treatment, antiretroviral, medication administration
Administering Cafergot (Ergotamine with Caffeine)
Standard Source: Where There is no Doctor a Village Health Care Handbook
Title: Administering Cafergot (Ergotamine with Caffeine)

Content:
Indication: Used for the treatment of migraines.
Dosage: Take 1 tablet every 30 minutes, up to a maximum of 4 tablets in 24 hours.
Instructions:
- Swallow...
cafergot, ergotamine, caffeine, migraine treatment, medication administration
Administering Calcium Carbonate
Standard Source: Where There is no Doctor a Village Health Care Handbook
Title: Administering Calcium Carbonate

Content:
Indication: Used for the treatment of hypocalcemia or as an antacid.
Dosage: Take 500 mg every 4 to 6 hours, not exceeding 2 grams per day unless directed by a healthcare...
calcium carbonate, hypocalcemia treatment, antacid, medication administration
Administering Ceftriaxone
Standard Source: Where There is no Doctor a Village Health Care Handbook
Title: Administering Ceftriaxone

Content:
Indication: Used for the treatment of bacterial infections such as pneumonia, urinary tract infections, and skin infections.
Dosage: Take 1 gram every 12 hours, or as directed by a...
ceftriaxone, bacterial infection treatment, antibiotic administration
Administering Cephalosprins
Standard Source: Where There is no Doctor a Village Health Care Handbook
Title: Administering Cephalosprins

Content:
Indication: Used for the treatment of bacterial infections such as respiratory tract infections and urinary tract infections.
Dosage: Take 250 mg every 6 hours, or as directed by a...
cephalosprins, bacterial infection treatment, antibiotic administration
How to Use the List of Medicines
Standard Source: A Book for Midwives
Step 1: Locate the alphabetical list of medicines starting with 'A' through 'Z'.

Step 2: Look up a medicine by its generic (scientific) name in the alphabetical list.

Step 3: If you are looking for information about a specific health...
medicine list, health problem index, generic names, medication use, medical reference

Vascular Injuries (15)

Assessment and Management of Major Vascular Injuries in Combat Zones
Critical Source: NATO Emergency War Surgery
Procedure for Assessing and Managing Major Vascular Injuries in Combat Casualties

1. Initial Field Assessment:
- Identify signs of major vascular injury, such as severe hemorrhage, loss of distal pulses, or signs of compartment...
vascular injuries, combat casualty management, emergency surgery, tourniquet use, resuscitation, amputation, evacuation
Diagnosing Vascular Injuries Using Clinical Signs and Symptoms
Critical Source: NATO Emergency War Surgery
Procedure for Diagnosing Vascular Injuries:

1. Assess for the 5 Ps of arterial injury:
- Pain: Severe, unrelenting pain in the affected limb.
- Pallor: Pale or mottled appearance of the skin due to lack of blood flow.
-...
vascular injuries,doppler instrument,diagnosis,5Ps,pallor,pulselessness
Immediate Surgical Exploration for Arterial Injury
Critical Source: Emergency War Surgery
Procedure:

• Conduct a detailed physical examination.
• Identify hard signs of arterial injury, including:
- Pulsatile external bleeding
- Enlarging hematoma
- Absent distal pulses
- A thrill/bruit
- Ischemic limb
• If any of...
arterial injury, surgical exploration, ischemia, vascular trauma, emergency surgery
Surgical Repair of Arterial Injuries
Critical Source: NATO Emergency War Surgery
Procedure for Surgical Repair of Arterial Injuries:

1. Assess the injury type and severity:
- Determine if the artery has a small, clean-cut laceration or extensive damage.
2. Choose appropriate repair method:
- For small...
surgical repair, arterial injury, anastomosis, vascular clamps, thrombus removal
Understanding the Nature of Vascular Injuries in Combat
Critical Source: NATO Emergency War Surgery
Procedure for Understanding and Managing Vascular Injuries Caused by High-Velocity Projectiles

1. Nature of Injuries:
- Recognize that vascular injuries on the battlefield are often caused by high-velocity projectiles, which can cause...
high-velocity projectile injuries, temporary cavitation, vascular thrombosis, multiple trauma management, surgical repair considerations
Administer Initial Medical Treatment for Vascular Injury
Critical Source: Emergency War Surgery
Administer IV antibiotics, tetanus toxoid, and analgesia. In most long-bone fractures, resuscitation and fracture alignment will restore distal flow.
IV antibiotics, tetanus toxoid, analgesia administration
Graft Coverage for Exposed Vein Grafts
Critical Source: Emergency War Surgery
Graft coverage: Exposed vein grafts will desiccate, leading to graft blow-out and potential exsanguination. They must be covered by soft tissue or muscle; superficial muscles such as sartorius or gracilis in the thigh may be mobilized to cover a...
graft coverage, desiccation prevention
Incision and Vessel Control in Vascular Repair
Critical Source: Emergency War Surgery
Longitudinal incisions usually directly over injured vessel followed by proximal and distal control. A tourniquet (eg, blood pressure cuff) may occasionally be useful to obtain proximal control or to improve intraoperative visualization.
vessel control, incision technique
Interposition Graft for Vascular Repair
Critical Source: Emergency War Surgery
Interposition graft: Required if the vessel cannot be primarily repaired without undue tension.

Autogenous vein grafts preferred, usually the contralateral greater saphenous vein (GSV).
- Harvest vein from the contralateral limb, if...
interposition graft, autogenous vein use, prosthetic grafts
Steps to Perform After Vessel Control in Vascular Repair
Critical Source: Emergency War Surgery
Once control is obtained, perform the following steps:

Debride injured vessels to macroscopically normal wall.
• Pass balloon catheters proximal and distal to remove any residual thrombus.
• Flush both directions with heparinized...
vessel debridement, thrombus removal, heparinized saline flush
Vascular Injuries: Historical Context and Types in Combat
Critical Source: Emergency War Surgery
Understanding the history and types of vascular injuries is crucial for effective treatment in combat scenarios:

Historical context:
- World War II: Popliteal artery injuries were routinely ligated with a 73% amputation rate.
...
vascular injuries,combat,wounds,popliteal artery,history,low velocity missile,high velocity missile,blunt trauma,knee dislocation
Evaluation of Soft Signs for Arterial Injury
High Priority Source: Emergency War Surgery
Procedure: Evaluate the following soft signs that may indicate arterial injury and require additional diagnostic evaluation:

• Proximity of wound to major vessels
• History of hemorrhage/shock
• Nonexpanding hematoma
• Diminished pulse
-...
soft signs, arterial injury evaluation, vascular assessment
Conservative Management of Arterial Injuries
High Priority Source: NATO Emergency War Surgery
Procedure for Conservative Management of Arterial Injuries:

1. Assess the injury:
- Look for signs of arterial injury, such as a pulsating hematoma or lack of external hemorrhage.
- Determine if both artery and vein are injured (which...
arterial injuries, conservative management, false aneurysm, arteriovenous fistula, nonoperative treatment
Identify Types of Wounds Causing Vascular Injuries in Combat
High Priority Source: Emergency War Surgery
Procedure:

• Identify the types of wounds commonly associated with vascular injuries in combat:

1. Low-velocity missile damage: Directly affects blood vessels lying in its path.

2. High-velocity missile blast effect: Causes...
combat wounds, vascular injuries, missile injuries, blunt trauma, popliteal artery injury
Recognize and Understand Historical Trends in Vascular Injury Management
Standard Source: Emergency War Surgery
Procedure:

• Review historical trends in vascular injury management:

1. World War II: Popliteal artery injuries were routinely ligated with a 73% amputation rate.

2. Korean War: Formal repair of peripheral arterial injuries...
vascular injuries, historical trends, popliteal artery ligation, amputation rates

Radiation Injuries (15)

Casualty Management in Nuclear Theater
Critical Source: Emergency War Surgery
If nuclear weapons are employed within the theater, the entire medical evacuation and treatment system will be severely overburdened. Some system of classification and sorting of casualties must be added to the normal procedures of evacuation...
nuclear,casualty management,classification,sorting,evacuation
Identify Radiation Syndromes Based on Dose and Clinical Presentation
Critical Source: NATO Emergency War Surgery
Overview: Radiation sickness can manifest in three distinct syndromes based on the dose of radiation sustained. These syndromes are determined by the organ system most seriously affected.

### Syndrome Types
1. Neurovascular Syndrome:
...
radiation syndrome, neurovascular, gastrointestinal, hematopoietic, bone marrow depression, radiation sickness, dose response, combat medicine
Implement Radiation Triage Systems in a Nuclear Detonation Scenario
Critical Source: Planning Guidance Nuclear Detonation FEMA
Procedure for Implementing Radiation Triage Systems During a Nuclear Detonation

1. Understand Existing Trauma Triage Systems: Familiarize yourself with the trauma triage systems used in your area under normal circumstances, such as:
-...
nuclear detonation, radiation triage, trauma triage systems, START, SALT, DIME, EAST tool, resource allocation, triage cards
Recognize and Respond to Neurovascular Subsyndrome (N-ARS)
Critical Source: Planning Guidance Nuclear Detonation FEMA
Procedure:

1. Identify symptoms of N-ARS:
- Headache
- Nausea and vomiting
- Confusion or altered mental status
- Fever
- Hypotension (low blood pressure)
- Seizures
- Coma

2. Understand the cause:
- N-ARS is...
neurovascular subsyndrome,N-ARS,radiation brain injury,palliative care,supportive treatment,corticosteroids,anti-seizure medications
Decontamination for Radiation Illness Casualties
Critical Source: FM 4 25 11 First Aid
Procedure:

1. Identify the casualty as a radiological exposure case based on signs and symptoms such as nausea, vomiting, and malaise.
2. Move the casualty to a safe area away from contamination sources.
3. Begin decontamination immediately:
...
radiation illness, decontamination, first aid, nuclear detonation
Diagnosis and Treatment of Patients with Combined Injuries from Nuclear Detonation
Critical Source: NATO Emergency War Surgery
Procedure:

1. Assess for combined injuries:
- Identify patients who have sustained radiation injury along with burns, traumatic injuries, or other physical injuries.
- Note that the clinical phase of radiation sickness may occur...
combined injuries,nuclear detonation,radiation injury,wound healing,infection control,surgical timing
Ensure Availability of Triage and Standards for Radiation and Combined Injuries
Critical Source: Planning Guidance for Response to Nuclear Detonation May 2022 FEMA
Objective: Ensure that medical facilities near damage zones have appropriate triage protocols and standards for radiation and combined injuries.

Procedure:
1. Identify medical facilities located in or near potential damage zones, such as...
radiation injury triage, combined injuries, medical standards of care, nuclear detonation response
Management of Burn Patients with Radiation Injury in Nuclear Warfare
Critical Source: NATO Emergency War Surgery
Management of Burn Patients with Radiation Injury in Nuclear Warfare

Burn patients who have associated radiation injury will develop bone marrow depression during the course of their illness. These patients cannot be recognized upon admission,...
burn patients, radiation injury, bone marrow depression, leukopenia, surgical treatment
Recognize and Respond to Cutaneous Radiation Subsyndrome (C-ARS)
Critical Source: Planning Guidance Nuclear Detonation FEMA
Procedure:

1. Identify symptoms of C-ARS:
- Early signs: Skin erythema (reddening of the skin)
- Later symptoms: Blisters, ulcers, itchiness, tingling, epilation (hair loss), erythema, and edema (swelling caused by fluid buildup)

2....
cutaneous radiation subsyndrome,C-ARS,radiation burns,skin injury,treatment,fluid replacement,antibiotics,surgical excision
Understanding Radiation Injuries from Nuclear Detonations
Critical Source: NATO Emergency War Surgery
Understanding Radiation Injuries from Nuclear Detonations

The detonation of a nuclear weapon produces large amounts of ionizing radiation in two basic forms: electromagnetic (gamma) radiation, which travels at the speed of light and is highly...
ionizing radiation, gamma radiation, neutron radiation, fission products, fallout activity, residual radiation
Use Dose Assessment Methods for Radiation Exposure
Critical Source: Planning Guidance Nuclear Detonation FEMA
Procedure:

1. Understand the importance of dose assessment in determining triage, transport, use of countermeasures, and whether in- or outpatient management is required.
2. Identify available tools and data sources that can be used to...
dose assessment, radiation exposure, geographic dosimetry, lymphocyte depletion, dicentric chromosome analysis, biodosimetry, REMM app
Coordinate with Medical Professionals for Cytokine Availability and Regional Cooperation
High Priority Source: Planning Guidance Nuclear Detonation FEMA
Procedure:

1. Coordinate with local and regional medical professionals to determine the availability of cytokines, which are critical in treating radiation injuries.
2. Develop plans for regional cooperation, especially considering that...
cytokines, regional cooperation, radiation injuries, medical supplies, coordination
Recognize and Respond to Beta Burns from Radiation Exposure
High Priority Source: Planning Guidance Nuclear Detonation FEMA
Procedure:

1. Identify beta burns, which are severe sunburn-like injuries caused by beta radiation from particles deposited on the skin.
2. Assess the severity of the burn based on symptoms such as redness, blistering, and pain.
3....
beta burns,radiation injury,sunburn,skin exposure,nuclear emergency
Understand Treatment Options for H-ARS with Bone Marrow Transplants
High Priority Source: Planning Guidance Nuclear Detonation FEMA
Procedure:

1. Recognize that Hematopoietic Acute Radiation Syndrome (H-ARS) can be treated using bone marrow transplants, which involve infusions of hematopoietic stem cells.
2. Understand the limitations and requirements associated...
H-ARS, bone marrow transplant, hematopoietic stem cells, radiation treatment
Use of Prussian Blue for Radionuclide Removal in Radiation Injuries
Standard Source: Emergency War Surgery
Prussian blue is used to remove radionuclides from the capillary bed surrounding the intestine and prevent their reabsorption:

1. Delay treatment: Administer prussian blue only after the patient is stable.
2. Treat ABCs first: Ensure...
Prussian Blue, Radionuclide Removal, Radiation Injuries, ABCs, Stabilization

Healthcare Planning (15)

Develop Staffing Strategies for Pandemic Influenza Response in Healthcare Facilities
Critical Source: HHSPandemicInfluenzaPlan
Procedure:

1. Assign responsibility for the assessment and coordination of staffing during an emergency.

2. Estimate minimum number and categories of personnel needed to care for a single patient or small group of patients with...
staffing strategies,pandemic influenza,emergency staffing,retired healthcare personnel,cross-training,Mutual Aid Agreements,MOU/As,healthcare facilities
Plan for Surge Capacity in Healthcare Facilities During Pandemic Influenza
Critical Source: HHSPandemicInfluenzaPlan
Procedure:

1. Assess emergency staffing needs and increased demand for isolation wards, ICUs, assisted ventilation services, and consumable/durable medical supplies.

2. Use FluSurge software (available at...
surge capacity,healthcare facilities,pandemic influenza,FluSurge software,resource allocation,ICU beds,ventilators
Close Units with Nosocomial Transmission During Pandemic Influenza Outbreaks
High Priority Source: HHSPandemicInfluenzaPlan
Objective: Contain outbreaks within healthcare facilities.

Procedure:
1. Identify units where nosocomial transmission has occurred and close them immediately.
2. Cohort staff and patients in affected areas to prevent further spread of...
unit closure, nosocomial transmission, pandemic planning
Cohort Patients Admitted with Influenza During Pandemic Outbreaks
High Priority Source: HHSPandemicInfluenzaPlan
Objective: Prevent nosocomial transmission of influenza within hospitals.

Procedure:
1. Group patients diagnosed with influenza together in designated areas of the hospital.
2. Ensure that these areas are isolated from other patient...
patient cohorting, pandemic planning, infection control
Consider Furlough or Reassignment of High-Risk Staff During Pandemic Influenza Outbreaks
High Priority Source: HHSPandemicInfluenzaPlan
Objective: Protect vulnerable staff from complications of influenza.

Procedure:
1. Identify high-risk staff, such as pregnant employees and those with chronic health conditions.
2. Consider furloughing or reassigning these individuals to...
staff reassignment, pandemic planning, high-risk employees
Defer Elective Admissions and Procedures During Pandemic Influenza Outbreaks
High Priority Source: HHSPandemicInfluenzaPlan
Objective: Preserve hospital resources for critical care during a pandemic.

Procedure:
1. Postpone non-urgent elective admissions, surgeries, and procedures until the local influenza epidemic subsides.
2. Communicate with patients about...
elective procedures, pandemic planning, healthcare resource management
Discharge Patients as Soon as Possible During Pandemic Influenza Outbreaks
High Priority Source: HHSPandemicInfluenzaPlan
Objective: Reduce hospital occupancy and free up resources for critical care.

Procedure:
1. Discharge patients who are stable and no longer require inpatient care, provided it is safe to do so.
2. Ensure that discharge plans include...
patient discharge, pandemic planning, healthcare resource management
Establish Segregated Waiting Areas for Influenza Patients
High Priority Source: HHSPandemicInfluenzaPlan
Objective: Prevent spread of influenza within healthcare facilities.

Procedure:
1. Designate specific waiting areas for individuals exhibiting symptoms of influenza.
2. Ensure these areas are physically separated from general waiting areas...
segregated waiting areas, influenza symptoms, healthcare facility, pandemic planning
Implement Phone Triage to Reduce ED Visits
High Priority Source: HHSPandemicInfluenzaPlan
Objective: Minimize unnecessary visits to emergency departments during a pandemic.

Procedure:
1. Establish a dedicated phone triage line for patients with potential influenza symptoms.
2. Train staff to assess the severity of symptoms over...
phone triage, emergency department, pandemic planning, influenza symptoms
Limit Points of Entry to Healthcare Facilities During Pandemic
High Priority Source: HHSPandemicInfluenzaPlan
Objective: Control access and reduce the risk of influenza transmission.

Procedure:
1. Reduce the number of entry points into the facility to only essential locations (e.g., main entrance, emergency department).
2. Assign clinical staff to...
entry point control, pandemic influenza, healthcare facility, infection prevention
Limit Visitor Access During Pandemic Influenza Outbreaks
High Priority Source: HHSPandemicInfluenzaPlan
Objective: Minimize the risk of influenza transmission within healthcare facilities.

Procedure:
1. Restrict visitor access to only essential individuals (e.g., family members required for patient support).
2. Screen all visitors at the...
visitor screening, pandemic influenza, healthcare facility, infection control
Monitor for Nosocomial Transmission of Influenza in Hospitals
High Priority Source: HHSPandemicInfluenzaPlan
Objective: Identify and contain outbreaks within healthcare facilities.

Procedure:
1. Implement a surveillance system to track cases of influenza among patients and staff.
2. Investigate any suspected or confirmed cases of nosocomial...
nosocomial transmission, infection control, pandemic planning
Provide Antiviral Prophylaxis to Staff During Pandemic Influenza Outbreaks
High Priority Source: HHSPandemicInfluenzaPlan
Objective: Reduce the risk of influenza transmission among healthcare workers.

Procedure:
1. Distribute antiviral prophylaxis to staff based on HHS recommendations (see Supplement 7).
2. Ensure that all staff are informed about the purpose,...
antiviral prophylaxis, staff protection, pandemic planning
Redirect Personnel Resources to Support Patient Care During Pandemic Influenza Outbreaks
High Priority Source: HHSPandemicInfluenzaPlan
Objective: Ensure adequate staffing for critical care during a pandemic.

Procedure:
1. Reassign non-essential staff (e.g., administrative, physical therapy) to support critical hospital services.
2. Recruit community volunteers, such as...
staff reallocation, pandemic planning, healthcare resource management
Access Resources for Healthcare Planning During Pandemic Influenza Outbreaks
High Priority Source: HHSPandemicInfluenzaPlan
Objective: Utilize available tools and resources to support pandemic planning.

Procedure:
1. Access the Council of State and Territorial Epidemiologists website (http://www.cste.org/specialprojects/Influenzaplans/StateMap.asp) for...
pandemic planning tools, healthcare resources, WHO guidelines

Chemical Decontamination (15)

Decontamination of Lewisite
Critical Source: Medical NBC Battlebook
Procedure for Decontamination of Lewisite

1. Same as Mustard: The procedure for decontaminating Lewisite is the same as that used for mustard.
2. Adsorption or Chemical Inactivation: Use adsorbing powders, ointments, solutions, or...
lewisite,mustard,adsorption,organic solvents
Decontamination of Vesicants on Mucous Membranes and Eyes
Critical Source: Medical NBC Battlebook
Procedure for Decontamination of Vesicants on Mucous Membranes and Eyes

1. Immediate Flushing: Affected tissues should be flushed immediately with water from a canteen.
2. Eye Irrigation: Use copious amounts of water, or if available,...
vesicants,eyes,mucous membranes,flushing,sodium bicarbonate
Decontamination of Vesicants on Skin
Critical Source: Medical NBC Battlebook
Procedure for Decontamination of Vesicants on Skin

1. Adsorption or Chemical Inactivation: Use adsorbing powders, ointments, solutions, or organic solvents with chlorinating compounds.
2. Avoid Water for Mustard: **Mustards should not...
vesicants,mustard,skin,adsorption,organic solvents
Decontaminants for Specific Agents
Critical Source: Medical NBC Battlebook
Procedure for Selecting Decontaminants Based on Agent Type

Nerve Agents: Use STB slurry, household bleach (10% solution), lye or washing soda, DS2, steam and ammonia in confined areas, hot soapy water, M258 series kit, or M291.
• **Blood...
decontaminants,nerve agents,blood agents,blister agents,biological toxins
Immediate Decontamination Techniques
Critical Source: Medical NBC Battlebook
Procedure for Immediate Decontamination (Level 1)

1. Skin Decon: Perform skin decontamination before 1 minute of exposure.
2. Personal Wipe Down: Conduct within 15 minutes by individual or crew.
3. Operator Spray Down: Not specified...
immediate decon,skin wipe down,operator spray
Decontamination of Incapacitating Agents
High Priority Source: Medical NBC Battlebook
Procedure for Decontamination of Incapacitating Agents

1. Skin Cleansing: Complete cleansing of the skin with soap and water should be done at the earliest opportunity.
2. Delayed Symptoms: Symptoms may appear as late as 36 hours after...
incapacitating agents,soap and water,epidemic preparation
Operational Decontamination Techniques
High Priority Source: Medical NBC Battlebook
Procedure for Operational Decontamination (Level 2)

1. MOPP Gear Exchange: Conduct within 6 hours by the unit to provide temporary relief from MOPP4 and limit liquid agent spread.
2. Vehicle Wash Down: Performed by battalion crew or...
mopp gear exchange,vehicle wash down,logistical delay
Decontamination of Choking Agents
High Priority Source: Medical NBC Battlebook
Procedure for Decontamination of Choking Agents

1. No Need for Decontamination: Due to their physical and chemical properties, choking agents do not remain in liquid form long enough to require decontamination.
2. **Exception in Cold...
choking agents,decontamination,cold climate
Decontamination of Hydrogen Cyanide
High Priority Source: Medical NBC Battlebook
Procedure for Decontamination of Hydrogen Cyanide

1. No Need for Decontamination: Due to its physical properties, hydrogen cyanide does not remain in liquid form long enough to require decontamination.
2. Same for Related Agents: The...
hydrogen cyanide,decontamination,cyanogen chloride
Decontamination of Riot Control Agents
High Priority Source: Medical NBC Battlebook
Procedure for Decontamination of Riot Control Agents

1. Move to Fresh Air: Exposed persons should move to fresh air, away from others, face into the wind with eyes open and breathe deeply.
2. Inspect Clothing: Check clothing and...
riot control agents,fresh air,clothing inspection,washing
Decontamination of Vomiting Agents
High Priority Source: Medical NBC Battlebook
Procedure for Decontamination of Vomiting Agents

1. Wash Eyes and Skin: Use water to wash the eyes and skin.
2. Brush Clothing: Thoroughly brush clothing to remove residue.
vomiting agents,washing,brushing clothing
Thorough Decontamination Techniques
High Priority Source: Medical NBC Battlebook
Procedure for Thorough Decontamination (Level 3)

1. Detailed Equipment/Aircraft Decon: Conduct when mission allows reconstitution by decon platoon to achieve long-term MOPP reduction with minimal risk.
2. Detailed Troop Decon: Performed...
thorough decon,equipment decon,unit decon
Use M13 Portable Decontaminating Apparatus
High Priority Source: Medical NBC Battlebook
Procedure for Using M13 Portable Decontaminating Apparatus:

1. Identify Contaminated Area: Confirm that a large area (e.g., vehicles or crew-served weapons larger than a .50 caliber machine gun) is contaminated and requires...
M13, portable decontamination, DS2, vehicles
Use M291 Skin Decontamination Kit
High Priority Source: Medical NBC Battlebook
Procedure for Using M291 Skin Decontamination Kit:

1. Identify Contamination: Confirm that the skin is contaminated by a chemical or biological agent.
2. Open Packet: Tear open one of the six individual packets contained in the...
M291, skin decontamination, chemical agents, biological agents, nontoxic
Use M295 Decontamination Kit for Individual Equipment
High Priority Source: Medical NBC Battlebook
Procedure for Using M295 Decontamination Kit:

1. Identify Contaminated Equipment: Confirm that the individual's chemical-biological protective gear (mask, hood, gloves, footwear, helmet, rifle, and load-bearing equipment) is...
M295, equipment decontamination, chemical agents, biological agents, sorptive resin

Preventive Medicine (15)

Conduct Medical Planning for Unit Deployments
High Priority Source: NAVMED P 5010 US Navy Manual of Preventive Medicine
Medical planning is where good preventive medicine starts. PREVMED personnel must take the initiative to become actively involved in the pre-deployment planning phase of all unit deployments. Once operations begin, it is difficult, if not...
medical planning, preventive medicine, pre-deployment, health threats, DNBI prevention
Coordinate Preventive Medicine Program through MEDPLT
High Priority Source: STP 21 24 Army Warrior Leader Skills Level 2 3 and 4
Steps:

1. Coordinate the preventive medicine (PVTMED) program through the medical platoon.
2. Ensure that field sanitation teams are established and trained in environmental sanitation, limited control of animal reservoirs, and disease...
preventive medicine program, field sanitation team, mental health control, combat lifesaver program, emergency dental services
Obtain Medical Intelligence and Disease Vector Risk Assessments
High Priority Source: NAVMED P 5010 US Navy Manual of Preventive Medicine
Medical information or intelligence may be obtained from departments within the operating unit or from other commands prepared to provide such support. Marine Corps sources include G2/4, S2/4, the unit surgeon’s office, and the medical battalion...
medical intelligence, VECTRAPS, DISRAPS, disease vector risk assessment
Prepare and Submit an After Action Report (AAR)
High Priority Source: NAVMED P 5010 US Navy Manual of Preventive Medicine
An After Action Report (AAR) provides information to the CO about the course of events during the deployment and presents problems as they occurred. It also includes observations, recommendations, recognition of above-par or below-par areas, and...
AAR, after action report, PMT documentation, deployment review
Prepare the Health Services Appendix to OPLAN
High Priority Source: NAVMED P 5010 US Navy Manual of Preventive Medicine
The Health Services Appendix to the Logistics/Combat Service Support Annex of the OPLAN is the document which contains all the information necessary for providing health service support during the operation. The health services appendix has the...
health services appendix, OPLAN, medical resupply, MEDEVAC, MMARTs
Supervise Compliance with Preventive Medicine Measures
High Priority Source: STP 21 24 Army Warrior Leader Skills Level 2 3 and 4
### Supervise Compliance with Preventive Medicine Measures

#### Conditions:
You are a unit leader. Your unit is deployed to the field. You have the equipment authorized by your table of organization and equipment (TOE), field sanitation...
preventive medicine, field sanitation team, heat injuries, cold injuries, arthropods, foodborne diseases, waterborne diseases, toxic industrial materials
Advise Command on Health Risks and Recommend Actions to Reduce Them
Standard Source: NAVMED P 5010 US Navy Manual of Preventive Medicine
Procedure:

1. Identify potential health risks based on environmental conditions, unit activities, and past incidents.
2. Assess the impact of identified risks on personnel health, operational readiness, and mission success.
3. **Prepare...
health risks, preventive medicine, risk mitigation, unit readiness
Develop and Enforce a Unit Sleep Plan for Soldiers
Standard Source: STP 21 24 Warrior Leader Skills Level 2 3 4
Procedure:

1. Create a sleep plan that ensures each Soldier receives at least 4 hours of uninterrupted sleep in a 24-hour period.
2. Coordinate with unit leadership to schedule sleeping times that align with operational requirements.
3. Ensure...
sleep plan,uninterrupted sleep,sleeping areas,compliance monitoring
Enforce Food and Water Safety Standards
Standard Source: STP 21 24 Warrior Leader Skills Level 2 3 4
Procedure:

1. Ensure that all food and water sources meet established safety standards.
2. Implement measures to prevent contamination of food and water supplies, including:
- Proper storage of food items.
- Regular inspection of water...
food safety,water safety,contamination prevention,storage,inspection
Establish Field Sanitation Teams to Preserve Unit Health and Reduce DNBI Incidents
Standard Source: STP 21 24 Warrior Leader Skills Level 2 3 4
Procedure:

1. Establish field sanitation teams.
- The purpose is to preserve the unit's health and reduce incidents of disease nonbattle injury (DNBI).
2. Ensure that these teams are responsible for:
- Environmental sanitation.
-...
field sanitation teams,DNBI,environmental sanitation,epidemiology,sanitation engineering,pest management
Implementation of Preventive Medicine (AR 40-5 and DA Pam 40-11)
Standard Source: STP 21 24 Warrior Leader Skills Level 2 3 4
Procedure:

1. Locate the AR 40-5 publication titled *Preventive Medicine*, dated 22 July 2005, and the DA Pam 40-11 publication with the same title and date.

2. Review the procedures outlined in AR 40-5 and DA Pam 40-11 to understand...
Preventive Medicine,AR 40-5,DA Pam 40-11,military health
Maintain a Preventive Medicine Journal
Standard Source: NAVMED P 5010 US Navy Manual of Preventive Medicine
A Preventive Medicine Journal is the key document in which all occurrences, actions and results are recorded. The journal is to be started by the PMT at the time of assignment to a unit. The journal format consists of two sections:

1. **The...
preventive medicine journal, PMT documentation, daily routines, health records
Plan and Enforce Personnel Hygiene Measures
Standard Source: STP 21 24 Warrior Leader Skills Level 2 3 4
Procedure:

1. Develop a hygiene plan that includes:
- Handwashing protocols.
- Personal cleanliness standards.
- Sanitation of living quarters and common areas.
2. Ensure that all personnel are trained on proper hygiene practices.
3....
personnel hygiene,handwashing,personal cleanliness,sanitation,living quarters
Supervise Implementation of Preventive Medicine Policies During Field Training Exercises (FTX) or Normal Training Sessions
Standard Source: STP 21 24 Army Warrior Leader Skills Level 2 3 and 4
Overview: Ensure that Soldiers are aware of the major components of the medical threat to field forces and that personnel are trained on and follow individual PMMs necessary to prevent DNBI. Enforce Army tobacco use policies, ensure FST training...
preventive medicine policies, field training exercise, FTX, PMMs, DNBI, tobacco use policy, FST training, division-level PM section, corps-level PM unit
Access USACHPPM Resources for Preventive Medicine and Health Promotion
Standard Source: Medical NBC Battlebook
Procedure:

1. Visit the official website of the Center for Health Promotion and Preventive Medicine (USACHPPM) at [http://chppm-www.apgea.army.mil/](http://chppm-www.apgea.army.mil/) for information on preventive medicine, public health, and...
USACHPPM, preventive medicine, public health, contact information

Allergic Reactions (14)

Administer Adrenalin (Epinephrine)
Critical Source: Where There is no Doctor a Village Health Care Handbook
Procedure for Administering Adrenalin (Epinephrine)

Overview:
Adrenalin is used to treat severe allergic reactions (anaphylaxis) and cardiac arrest. It should be administered as soon as possible after symptoms appear.

**Dosage...
adrenalin, epinephrine, anaphylaxis treatment, cardiac arrest, emergency medication
Administer Epinephrine for Severe Allergic Reactions
Critical Source: Where There is no Doctor a Village Health Care Handbook
Title: Administer Epinephrine for Severe Allergic Reactions

Procedure:
1. Use epinephrine (Adrenaline, Adrenalin):
- Inject 0.3 mg intramuscularly into the outer thigh as soon as possible after symptoms appear.
- Repeat every...
anaphylaxis,epinephrine,Adrenaline,Adrenalin
Recognize and Respond to Allergic Shock from Injections
Critical Source: Where There is no Doctor a Village Health Care Handbook
Procedure for Recognizing and Managing Allergic Shock:

### Signs of Allergic Shock:
• Cool, moist, pale, gray skin (cold sweat)
• Weak, rapid pulse or heartbeat
• Difficulty breathing
• Loss of consciousness

### Immediate Actions:
1....
allergic shock, epinephrine, adrenalin, antihistamine, penicillin, injection reaction
Administer Promethazine for Allergic Shock
High Priority Source: A Book for Midwives
Procedure:

1. Determine if the patient is experiencing an allergic shock (see page 466 of the source text).
2. Inject promethazine intramuscularly at a dose of 50 mg.
3. Repeat the injection every 6 hours as needed, but do not...
promethazine, allergic shock, injection, dosage, midwife procedure
Treat Systemic Poison Ivy Rash with Steroids
High Priority Source: Plant Identification
Procedure:

1. If the rash becomes systemic (spreading to areas not in contact with Poison Ivy):
- Seek medical attention immediately.
2. A healthcare professional may prescribe steroids, such as cortisone, to suppress the immune...
systemic rash, steroids treatment, cortisone, systemic poison ivy, medical emergency
Administer Antihistamine Before Tetanus Antitoxin or Immunoglobulin
High Priority Source: A Book for Midwives
Procedure:

1. Identify patients who may be allergic to tetanus antitoxin or immunoglobulin (e.g., those with a history of allergies).
2. **Administer an antihistamine such as diphenhydramine 15 minutes before giving the tetanus antitoxin or...
antihistamine, tetanus antitoxin, allergy prevention, midwife procedure
Administer Diphenhydramine for Mild to Moderate Allergic Reaction
High Priority Source: A Book for Midwives
Procedure:

Indication: For mild to moderate allergic reaction.

1. Dose: Administer 25 mg by mouth every 6 hours until signs of the allergic reaction subside.
2. Form: Use tablets or capsules (25 or 50 mg), syrup (12.5 mg per 5 ml),...
diphenhydramine, allergic reaction, antihistamine, dosage, administration
Recognizing and Managing Allergic Reactions
High Priority Source: Where There is no Doctor a Village Health Care Handbook
Procedure:

1. Identify symptoms of an allergic reaction: These may include itching rashes or hives (page 203), runny nose, itchy eyes, difficulty breathing, asthma-like symptoms, or severe reactions such as anaphylaxis (see page 70).
2....
allergic reaction management, anaphylaxis, antihistamines, epinephrine
Administer Promethazine for Moderate Allergic Reaction
Standard Source: A Book for Midwives
Procedure:

1. Determine if the patient is experiencing a moderate allergic reaction (see page 465 of the source text).
2. Administer promethazine by mouth at a dose of 25 mg.
3. Repeat the dose every 6 hours as needed, but do not...
promethazine, allergic reaction, moderate allergy, dosage, midwife procedure
Administer Antihistamine for Allergies or Sedation
Standard Source: Personal Wilderness Medical Kit
Procedure:

1. Assess the patient's symptoms, such as allergic reactions, itching, or sedation needs.
2. Check the dosage instructions: 1-2 tablets every 4 hours as needed.
3. Administer the medication orally with water or another...
antihistamine, diphenhydramine, allergy treatment
Administer Antihistamine for Motion Sickness or Allergies
Standard Source: Personal Wilderness Medical Kit
Procedure:

1. Assess the patient's symptoms, such as dizziness, nausea, or allergic reactions.
2. Check the dosage instructions: 1 tablet three times a day as needed.
3. Administer the medication orally with water or another...
antihistamine, meclizine, motion sickness treatment
Administer Antihistamines for Allergic Reactions and Vomiting
Standard Source: Where There is no Doctor a Village Health Care Handbook
Title: Administer Antihistamines for Allergic Reactions and Vomiting

Procedure:
1. Use promethazine (Phenergan):
- Take 25-50 mg every 4-6 hours as needed.
- Do not exceed a total daily dose of 300 mg without consulting a...
antihistamines,promethazine,Benadryl,chlorpheniramine,Dramamine,vomiting
Administer Corticosteroid for Allergies or Asthma
Standard Source: Personal Wilderness Medical Kit
Procedure:

1. Assess the patient's symptoms, such as allergic reactions, asthma exacerbations, or inflammation.
2. Check the dosage instructions: 50 mg orally once a day.
3. Administer the medication orally with water or another...
corticosteroid, prednisone, allergy treatment
Administer Medications for Allergic Shock
Standard Source: A Book for Midwives
Procedure:

Indication: For allergic shock.

Diphenhydramine Administration:
1. Dose: Inject 50 mg into the muscle.
2. Repeat: If signs of shock do not improve, repeat the injection in 4 hours.
3. Form: Use ampules for...
allergic shock, diphenhydramine, hydrocortisone, injection, midwife procedure

Fever Management (14)

Managing Very High Fevers (Over 40°C)
Critical Source: Where There is no Doctor a Village Health Care Handbook
Steps to manage very high fever:

1. Move the person to a cool place.

2. Remove all clothing.

3. Fan the person to promote cooling.

4. Pour cool (not cold) water over the person, or apply cloths soaked in cool water on their...
high fever, emergency treatment, children, medication dosage, enema administration
Abnormal Body Temperatures and Their Implications
High Priority Source: Survival and Austere Medicine
Abnormal body temperatures and their implications:

105°F (40.6°C): Very high in adults, potentially life-threatening. Can cause damage to the brain, blood, muscles, and kidneys.
Over 100°F (37.8°C): Should be addressed...
abnormal temperature, fever danger, temperature management
Manage Fever in Children
High Priority Source: Flu Home Treatment
Fever management is critical to avoid complications such as seizures or brain injury. Follow these steps:

1. Monitor the child’s temperature regularly using an accurate method (see How To Take Your Child's Temperature Accurately for...
fever management,acetaminophen,sponge bath,children's fever,temperature control
Managing High Fever (Above 104°F)
High Priority Source: Flu Home Treatment
Procedure:

1. Monitor the patient’s temperature continuously.
2. If the fever exceeds 104°F, initiate immediate cooling measures.
3. Ensure the patient is well hydrated with fluids.
4. Apply tepid water sponge baths to reduce body...
high fever management, temperature emergency, cold packs, hydration
Non-Pharmaceutical Fever Reduction Methods
High Priority Source: Survival and Austere Medicine
Non-pharmaceutical methods to reduce fever:

### General Principles:
Utilize the body’s natural cooling mechanisms: Evaporation (sweating), radiation, and conduction.

### Steps:
1. Reduce coverings over the body, such as clothing and...
non-pharmaceutical fever reduction, natural cooling methods, fever treatment
Respond to a Fever in the Mother
High Priority Source: A Book for Midwives
Procedure:

1. Identify the cause of the fever:
- It may be due to sickness (e.g., flu or malaria) or an infection (e.g., bladder or womb infection).
- A mild fever can also result from dehydration.
2. Treat the underlying cause of the...
fever treatment, paracetamol dosage, dehydration management, medical emergency
How to Lower a Fever Using Paracetamol
Standard Source: A Book for Midwives
To lower a fever using paracetamol:

• Give 500 to 1000 mg paracetamol by mouth, every 4 to 6 hours.
• This is typically administered as tablets.
• Always follow the instructions provided in the medicine boxes.
paracetamol,fever,medicine administration
Managing Fever in Adults and Children
Standard Source: Where There is no Doctor a Village Health Care Handbook
Steps to manage fever:

1. Uncover the person completely. For small children, undress them completely and leave them naked until the fever subsides.

2. Do not wrap the child in clothing or blankets, as this can raise the fever further....
fever, management, children, adults, medication, hydration, treatment
Recognize and Respond to Fever in Children
Standard Source: Where There is no Doctor a Village Health Care Handbook
Fever is not a sickness, but a sign of many different sicknesses. A high fever (over 39°C or over 102°F) can be a sign of a dangerous problem, especially in a small child. Monitor the child’s temperature closely and seek medical help if the...
fever,child health,temperature monitoring,hydration
Take Your Child’s Temperature Accurately
Standard Source: Flu Home Treatment
Accurate temperature measurement is essential for effective fever management. Follow these steps:

1. For children under 3 years old, use a rectal or tympanic (ear) thermometer.
2. For children over 3 years old, use a **digital oral...
temperature measurement,child's thermometer,rectal temperature,ear thermometer,oral thermometer
Administering Ibuprofen for Fever in Adults
Standard Source: Flu Home Treatment
Procedure:

1. Determine if the patient is an adult.
2. Administer 2 to 4 tablets (400mg to 800mg) of ibuprofen every four to six hours as needed.
3. Do not exceed this dose for either drug.
4. If the fever does not respond sufficiently...
ibuprofen, fever treatment, adult dose, fever management
Combination Use of Acetaminophen and Ibuprofen for Fever in Adults
Standard Source: Flu Home Treatment
Procedure:

1. Determine if the patient is an adult.
2. Administer both acetaminophen and ibuprofen at their respective recommended doses simultaneously.
3. This combination has an additive effect of benefit without increasing risk.
4....
acetaminophen and ibuprofen combination, fever treatment, adult dose
Keep Your Child Comfortable With a Fever
Standard Source: Flu Home Treatment
Comfort measures are essential for managing fever in children. Follow these steps:

1. If the child is shivering, keep her warm until shivering stops.
2. If the child is not shivering, remove warm clothing and encourage drinking plenty...
child comfort,fever care,washcloth,tepid water,acetaminophen use
Treating Chills in a Patient with Fever
Reference Source: Flu Home Treatment
Procedure:

1. Identify the presence of chills (shivering) in the patient.
2. Provide an extra blanket or hot water bottle to keep the patient warm.
3. Monitor for improvement in symptoms and comfort level.
4. If chills persist, ensure...
chill treatment, fever management, warmth for chills

Diagnosis (14)

Lymphocyte Assay for Radiation Injury Diagnosis
Critical Source: NATO Emergency War Surgery
Overview: Lymphocyte levels can be used as a biological dosimeter to assess the severity of radiation injury.

Procedure Steps:
1. Obtain an initial blood sample for lymphocyte count from any patient classified as 'radiation injury possible'...
lymphocyte assay, radiation dose assessment, biological dosimeter, pancytopenia
Clinical Criteria for Novel Influenza Case Detection During Pandemic Alert Periods
High Priority Source: HHSPandemicInfluenzaPlan
Procedure:

1. Identify illness with all of the following criteria:
- Temperature >38°C (100.4°F)
- Cough, sore throat, or dyspnea
- Requiring hospitalization; or nonhospitalized with an epidemiological link to a confirmed case.
2....
clinical criteria, novel influenza, pandemic, case detection
Diagnose Fractures Using a Tuning Fork and Stethoscope
High Priority Source: Survival and Austere Medicine
Procedure for Diagnosing Fractures in an Austere Environment:

1. Gather Equipment: Ensure you have a 128 MHz tuning fork, a stethoscope (or a cone formed from rolled paper as a substitute), and a method to apply sound waves.

2. **Identify...
tuning fork, stethoscope, fracture diagnosis, austere medicine, bone examination, low-tech diagnostics
Evaluate Alternative Diagnoses for Suspected Novel Influenza Cases
High Priority Source: HHSPandemicInfluenzaPlan
Steps to Evaluate Alternative Diagnoses:

1. Use laboratory tests with high positive predictive value (e.g., blood culture, viral culture, PCR, _Legionella_ urinary antigen, pleural fluid culture, transthoracic aspirate culture) for...
alternative diagnosis, co-infection, novel influenza, high predictive value tests
Identify and Differentiate Diseases with Similar Symptoms in Children
High Priority Source: Where There is no Doctor a Village Health Care Handbook
When a child slowly becomes thin and wasted, while his belly gets more and more swollen, it is important to consider the following possible causes:

Malnutrition (see page 112)
Roundworms (page 140) – usually occurs together with...
child, thinness, swollen belly, malnutrition, roundworms, tuberculosis, urinary infection, liver problems, spleen problems, leukemia, diagnosis
Recognizing the Signs of Typhoid Fever in the First Week
High Priority Source: Where There is no Doctor a Village Health Care Handbook
Procedure:

• Look for symptoms similar to a cold or flu, such as:
- Headache and sore throat.
- Dry cough.
- Gradual increase in fever, reaching up to 40°C by day six.
- A relatively slow pulse compared to the level of fever.
-...
typhoid fever signs, temperature progression, pulse monitoring, first week symptoms
Recognize and Address Confusion in Disease Naming
High Priority Source: Where There is no Doctor a Village Health Care Handbook
Many common names for illnesses were used before modern medicine was understood. These traditional or folk disease names may not match the medical terms used by trained health workers.

It is important to identify diseases using the terminology...
folk disease, traditional names, medical terminology, diagnosis, confusion in naming, health worker terms
Decide the most likely cause of a health problem
Standard Source: A Book for Midwives
Procedure:

1. Analyze collected information: Review all symptoms, patient history, and physical signs.
2. Compare with possible causes: Match observed signs to the list of potential causes identified earlier.
3. **Make an educated...
likely cause, diagnosis, medical assessment
List all possible causes of a health problem
Standard Source: A Book for Midwives
Procedure:

1. Consider multiple factors: Think about all potential causes that could lead to the patient’s symptoms.
2. Use common knowledge: Include both common and rare causes based on clinical experience and available information.
3....
possible causes, health problems, diagnosis
Look for signs to identify the likely cause of a health problem
Standard Source: A Book for Midwives
Procedure:

1. Ask targeted questions: Inquire about symptoms, lifestyle, and any changes in the patient’s condition.
2. Observe physical signs: Look for visible signs such as pale eyelids, gums, or other indicators that may point to an...
signs, diagnosis, physical examination
Perform Gram Staining for Bacterial Identification
Standard Source: Survival and Austere Medicine
Purpose: Perform Gram staining to differentiate between gram-positive and gram-negative bacteria from samples such as urine, pus, sputum, CSF, or bacterial cultures.

Materials Required:
• Microscope
• Crystal violet stain
• Iodine...
gram stain,bacteria identification,microscope,staining procedure,differential staining,crystal violet,iodine solution,decoloriser,safranine,gram positive,gram negative,bacterial cultures
Recognizing the Signs of Brucellosis
Standard Source: Where There is no Doctor a Village Health Care Handbook
Procedure:

• Look for gradual onset symptoms such as:
- Increasing tiredness and weakness.
- Loss of appetite.
- Headache, stomach ache, and joint pain.
• Monitor for fever patterns, which may be mild or severe with chills in the...
brucellosis signs, fever patterns, lymph node swelling, undulant fever
Start with a doubt when assessing a patient's health issue
Standard Source: A Book for Midwives
Procedure:

1. Admit uncertainty: Begin by acknowledging what you do not know about the patient’s condition.
2. Avoid assumptions: Do not assume the cause of the problem based on limited information.
3. Be open to learning: Recognize...
doubt, uncertainty, diagnosis, medical assessment
Collect and Use Medical History for Diagnosis
Standard Source: Where There is no Doctor a Village Health Care Handbook
Medical history is the information obtained by asking questions about a person’s illness or health condition.

This includes:
• When the sickness began.
• How it progresses (gets better or worse).
• What seems to help or worsen the condition.
-...
medical history, patient interview, health assessment

Diagnostic Procedures (14)

Perform Intraoperative Arteriogram for Vascular Injury Assessment
Critical Source: NATO Emergency War Surgery
Procedure:

1. Obtain a single-shot, hand-injected intraoperative arteriogram to assess arterial injuries.
2. Use Radio-Conray 60 contrast material injected through a 19-gauge needle.
3. Inject between **15 to 30 cc of full-strength...
arteriogram,vascular injury,contrast injection,imaging,radio-conray
Arteriography for Radiographic Confirmation of Intracranial Hematomas
High Priority Source: NATO Emergency War Surgery
Objective: Confirm the presence and location of intracranial hematomas using arteriography.

Procedure:
1. Puncture the common carotid artery with an 18- or 20-gauge needle under sterile conditions.
2. Inject 10 cc of low-concentration...
cerebral arteriography, radiographic confirmation, intracranial hematoma diagnosis
Diagnostic Studies for Hospitalized Adults with CAP During Pandemic Periods
High Priority Source: HHSPandemicInfluenzaPlan
Procedure:

• For hospitalized patients, consider the following diagnostic studies:
1. Blood cultures
2. Pneumococcal urine antigen testing
3. Pleural fluid aspiration with Gram stain and culture

Details:
• These tests...
blood cultures, urine antigen testing, pleural fluid aspiration, ICU diagnostics, CAP
Medical Laboratory Support and Diagnostic Procedures
High Priority Source: TCCC 17 13 Tactical Combat Casualty Care
Medical laboratory support includes:

1. Limited facilities, equipment, and personnel for analyzing body tissues and fluids.
2. Used to assist in disease diagnosis and monitoring of therapy.
3. The Special Forces medical sergeant is...
laboratory support, point-of-care diagnostics, disease diagnosis
Obtain Appropriate Specimens for Etiologic Diagnosis in Adults with CAP During Pandemic Periods
High Priority Source: HHSPandemicInfluenzaPlan
Procedure:

• Obtain appropriate specimens for etiologic diagnosis whenever such an etiology would alter clinical care.
• The most common etiologies of post-influenza bacterial community-acquired pneumonia are _S. pneumoniae_ and _S. aureus_,...
CAP, diagnostic testing, S. pneumoniae, S. aureus, CA-MRSA, pandemic preparedness
Perform Cystography for Bladder Evaluation
High Priority Source: Emergency War Surgery
Technique:

1. Ensure urethral integrity (see Urethral Injuries section).
2. Use a 3-film technique:
- Scout film: Plain KUB focusing on the pelvis.
- Full-bladder radiograph: After retrograde filling of the bladder with...
cystography, bladder evaluation, radiopaque contrast, pelvic trauma
Performing a Blood Count Using a Hemacytometer
High Priority Source: Survival and Austere Medicine
Overview: A hemacytometer is used to count blood cells (white, red, and platelets) in a laboratory setting. This procedure requires specific equipment and careful technique.

Equipment Needed:
• Microscope
• Hemacytometer (graded slide with...
blood count, hemacytometer, white blood cell count, red blood cell count, platelet count, hematocrit test, survival medicine, diagnostic procedure
Performing a Hematocrit Test in Austere Conditions
High Priority Source: Survival and Austere Medicine
Overview: A hematocrit test is used to determine the percentage of red blood cells in whole blood and can be performed with minimal equipment.

Equipment Needed:
• Capillary tube
• Anticoagulant (e.g., sodium citrate or heparin)
• Clay-like...
hematocrit test, red blood cell volume, survival medicine, diagnostic procedure
Preparing a Hemacytometer for Blood Cell Counting
High Priority Source: Survival and Austere Medicine
Overview: Proper preparation of the hemacytometer is essential to ensure accurate blood cell counts.

Equipment Needed:
• Hemacytometer (graded slide with etched squares)
• Graded pipettes
• Cover slip
• Diluted sample (blood diluted in...
hemacytometer preparation, blood cell counting, survival medicine, diagnostic procedure
Use Rapid Malaria Testing in High-Risk Areas
High Priority Source: A Book for Midwives
Procedure:

• In areas where malaria is common, use rapid diagnostic tests to confirm the presence of malaria.
• Midwives can be trained to use these tests for quick and accurate diagnosis.
• This helps ensure that only those who need...
malaria testing, rapid diagnostic tests, midwife training
Understand and Use ELISA (Enzyme Linked Immunosorbent Assay)
Standard Source: Medical NBC Battlebook
ELISA is an immunological test that uses enzyme-linked antiglobulins and substrate bound to the walls of polystyrene tubes.

### Procedure:
1. Prepare reagents: Ensure all necessary components are available, including antigen-coated...
ELISA, enzyme-linked immunosorbent assay, diagnostic test, antigen detection
Understanding Lab Tests in Medical Care
Standard Source: A Book for Midwives
Procedure:

1. Explain the purpose of lab tests:
- Laboratories use tools such as microscopes and trained personnel to test blood, urine, stool, and tissue for sicknesses or health conditions.
2. **Identify situations where lab tests are...
lab tests, diagnostic procedures, medical testing
Use X-rays for Dental Evaluation
Standard Source: Where There is No Dentist
X-rays are used in the following scenarios:

• For knocked-out teeth, to assess damage and determine if the tooth can be reimplanted.
• To look at a new tooth growing in, especially in children or individuals with dental development...
x-rays, dental evaluation, knocked-out teeth, pregnancy warning
Performing a Pap Test for Infections and Cancer
Standard Source: A Book for Midwives
Supplies needed:

• Spatula with two points
• Long swab or glass slide
• Fixative (95% ethyl alcohol)
• Cytobrush
• Hairspray (as an alternative to fixative if necessary)

Procedure steps:

1. Insert a speculum into the woman's vagina to...
pap test,cervix,vagina,tissue sample,speculum,slide,fixative,ethyl alcohol,hairspray,laboratory

Amputations (14)

Amputation Procedures in Emergency War Surgery
Critical Source: Emergency War Surgery
Procedure for Amputations:

1. Assess the patient thoroughly to determine if amputation is necessary due to severe trauma, infection, or irreparable damage.
2. Administer anesthesia and sedation as required for the procedure.
3....
amputation procedures, emergency surgery, tourniquet use, wound closure, post-operative care
Handling Blast Injuries in Amputation Procedures
Critical Source: Emergency War Surgery
Special Considerations for Blast Injuries:

Blast forces may drive debris proximally along fascial planes. This can necessitate extending incisions proximally parallel to the axis of the extremity to ensure adequate surgical...
blast injury, decontamination, stump closure, fascial planes
Indications for Amputation in Battlefield Settings
Critical Source: Emergency War Surgery
Indications for amputation include:

1. Partial or complete traumatic amputation.
2. Irreparable vascular injury or failed vascular repair with an ischemic limb.
3. Life-threatening sepsis due to severe local infection, including...
amputation indications, battlefield surgery, vascular injury, sepsis, prosthetic fitting
Initial Care for Patients with Major Amputation
Critical Source: Emergency War Surgery
Objective: Preserve life, prepare the patient for evacuation, and leave options for definitive treatment.

• Focus on life-threatening injuries associated with amputations (e.g., exsanguination, sepsis, vascular injury).
• Do not prioritize...
amputation, emergency care, battlefield surgery, life-threatening injury, evacuation
Length Preserving Amputation Technique (Open Circular Amputation)
Critical Source: Emergency War Surgery
Two-stage procedure:

Initial Stage:
• Complete the amputation at the lowest possible level of bone, preserving as much limb length as possible.
• Prepare the patient for evacuation to a higher level of care.

Reconstructive Stage:
-...
length preserving amputation, open circular amputation, prosthetic stump, flap of opportunity
Principles of Amputations in the Forward Area
Critical Source: NATO Emergency War Surgery
Procedure:

Follow these principles when performing amputations in a forward area:

1. Purpose of amputation:
- Perform amputations to save lives.

2. Level of amputation:
- Amputate at the lowest possible level of viable tissue.
...
amputation principles, forward area, emergency amputation, stump care, pain management
Surgical Preparation for Amputation in Battlefield Settings
Critical Source: Emergency War Surgery
Preparation Steps:

Prepare the entire limb, as planes of injury may be much higher than initially evident.
• Use a tourniquet if placed prehospital for hemorrhage control; ensure it is fully within the surgical field.
• Excise nonviable...
surgical preparation, tourniquet use, nerve ligation, flap preservation
Amputation Level Selection in Combat Surgery
High Priority Source: Emergency War Surgery
Procedure for Amputation Level Selection in Combat Surgery

Primary Symes (ankle disarticulation) has a high failure rate due to heel pad necrosis during transport. The wound should simply be debrided, retaining the clean hindfoot (talus...
amputation,combat surgery,wound debridement,transtibial stump,fractures
Apply Continuous Traction During Evacuation for Amputation Stump
High Priority Source: NATO Emergency War Surgery
Procedure:

1. Prepare the traction device:
- Use a wire ladder splint.
- Incorporate it into a cast to create a customized traction device.
- Place rubber tubing between the wire ladder splint and the stockinette to provide...
traction, amputation, evacuation, splint, rubber tubing, stockinette
Applying Transportation Casts for Amputation Patients
High Priority Source: Emergency War Surgery
Procedure for Applying a Transportation Cast to Maintain Traction and Support Soft Tissues

Apply a well-padded transportation cast, ensuring it is integral with skin traction maintained by an outrigger.
• **Use the cast to maintain...
transportation cast, amputation care, skin traction, outrigger application
Performing Primary Knee Disarticulation with Stump Preservation
High Priority Source: Emergency War Surgery
Procedure for Performing Primary Knee Disarticulation with Stump Preservation

Avoid primary knee disarticulation due to the risk of skin and tendon retraction, which may necessitate a higher amputation level.
• **Retain even a very short...
knee disarticulation, transtibial stump, fracture treatment, amputation planning
Performing Primary Symes Amputation with Debridement
High Priority Source: Emergency War Surgery
Procedure for Performing Primary Symes Amputation with Debridement

Debride the wound thoroughly, ensuring that only clean tissue is retained.
Retain the clean hindfoot, specifically the talus and calcaneus, to avoid...
primary symes, amputation, debridement, heel pad necrosis, talus, calcaneus
Preventing Hemorrhage Post-Amputation
High Priority Source: Emergency War Surgery
Procedure for Preventing Hemorrhage Following Amputation

Ensure a tourniquet is readily available at the bedside or during transport for the first week following injury.
• **Monitor for signs of bleeding and be prepared to apply the...
hemorrhage prevention, tourniquet use, post-amputation care
Managing Pain Following Amputation
High Priority Source: Emergency War Surgery
Procedure for Managing Pain After Amputation

Ensure adequate analgesia is available and administered as needed, especially during dressing changes.
Counsel the patient on phantom limb pain management strategies, including...
pain control, phantom limb pain, analgesia administration

Burn Treatment (14)

Assessing Circulation in Burn Patients Using an Ultrasonic Flowmeter
Critical Source: NATO Emergency War Surgery
Purpose: To assess the adequacy of circulation in burn patients.

Procedure:
1. Use an ultrasonic flowmeter to detect pulsatile flow in the distal palmar arch vessels (upper limb) or pedal vessels (lower limb).
2. Perform sequential...
escharotomy,circulation assessment,burn patients,ultrasonic flowmeter,vascular compromise
Performing Escharotomies for Truncal Burns to Improve Ventilation
Critical Source: NATO Emergency War Surgery
Purpose: To relieve chest wall restriction caused by circumferential truncal burns and improve ventilatory exchange.

Procedure:
1. Make an escharotomy incision along the anterior axillary line in patients with circumferential truncal...
truncal burn,ventilation improvement,chest wall restriction,escharotomy technique
Performing an Escharotomy on a Burned Limb
Critical Source: NATO Emergency War Surgery
Purpose: To relieve vascular compression caused by circumferential full-thickness burns.

Procedure:
1. Make an initial escharotomy incision in the midlateral line of the involved extremity.
2. If distal blood supply is not improved,...
escharotomy,burn treatment,vascular decompression,incision technique
Tangential Excision of Burn Wounds on Extremities
Critical Source: Emergency War Surgery
Procedure for Tangential Excision of Burn Wounds on Extremities:

1. Preparation:
- Ensure the patient is exsanguinated and a pneumatic tourniquet is applied to limit blood loss.
2. Excision Tool Selection:
- Use a Weck knife for...
tangential excision,burn wound,extremities,epinephrine,lactated ringer's,tourniquet,hemostasis
Application and Securing of Skin Grafts
High Priority Source: Emergency War Surgery
Procedure for Application and Securing of Skin Grafts:

1. Meshing the Graft (if applicable):
- If a mesher is available, mesh the harvested split-thickness skin using a ratio of 1.5:1 or 2:1 for the arms.
- For the hands, use unmeshed...
skin graft,application,securing,meshing,splinting,burn treatment
Apply Silver Sulfadiazine Burn Cream for Initial Wound Treatment
High Priority Source: NATO Emergency War Surgery
Procedure:

1. Assess the burn wound: Confirm that the patient has a fresh thermal injury and no established bacterial infection.
2. Prepare the cream: Use silver sulfadiazine burn cream, which contains a 1% suspension of silver...
silver sulfadiazine burn cream, initial wound treatment, bacterial control, neutropenia, Pseudomonas, Enterobacter cloacae
Apply Sulfamylon Burn Cream to Heavily Contaminated or Established Burn Wounds
High Priority Source: NATO Emergency War Surgery
Procedure:

1. Assess the burn wound: Confirm that the patient has heavily contaminated burn wounds or is received several days post-burn with a dense bacterial population.
2. Prepare the cream: Use Sulfamylon burn cream, which contains...
Sulfamylon burn cream, mafenide acetate, burn wound treatment, bacterial infection, post-burn hyperventilation, acidosis, debridement
Handle Laser Burns
High Priority Source: STP 21 1 Warrior Skills Level 1
Procedure for Handling Laser Burns

1. Move the casualty away from the source: Ensure that the casualty is removed from the laser source while avoiding eye contact with the beam.
2. Wear appropriate eye protection: If possible, wear...
laser burn, eye protection, first aid
Indications for Fasciotomy in Burn Patients
High Priority Source: NATO Emergency War Surgery
Purpose: To determine when fasciotomy is necessary to relieve vascular compromise.

Procedure:
1. Consider fasciotomy only in the following cases:
- Patients with high-voltage electric injuries.
- Patients with burns involving deep...
fasciotomy,burn treatment,vascular decompression,surgical intervention
Use Silver Nitrate Soaks as an Alternative to Antimicrobial Creams
High Priority Source: NATO Emergency War Surgery
Procedure:

1. Assess availability: Confirm that topical antimicrobial creams are not available.
2. Prepare the soaks: Use multilayered occlusive gauze dressings saturated with a 0.5% solution of silver nitrate.
3. Apply the soaks:
...
silver nitrate soaks, alternative to antimicrobial creams, electrolyte replacement, bacterial control, transeschar losses
Application of Topical Antimicrobial Agents for Burn Wound Care
High Priority Source: NATO Emergency War Surgery
Procedure:

1. Assess the tactical and logistical situation to determine whether treatment will be provided in a forward area or at a definitive care facility.
2. If treatment must continue in a forward area, begin topical chemotherapy...
topical chemotherapy, mafenide acetate, silver sulfadiazine, burn wound care, antimicrobial agents
Burn Wound Excision Policy in Military Settings
High Priority Source: NATO Emergency War Surgery
Burn wound excision is not recommended in military settings due to several critical factors:

1. Blood loss: Surgical excision of burned tissue can result in up to 9% blood volume loss per each 5% of body surface area excised, placing...
burn,wound,excision,military,burn treatment
Splinting of Extremities After Burn Graft Application
High Priority Source: Emergency War Surgery
Procedure:

1. General Splinting for Extremities:
- Splint the extremity with the axilla at 90° horizontal using bedside troughs or an airplane splint.
- Ensure the elbow is fully extended.
2. **Specific Splinting for Hands and...
splinting,burn graft,hand position,wrist extension,contracture prevention
Chemical Burn Initial Treatment
Reference Source: Emergency War Surgery
Chemical Burn Initial Treatment

Immediate removal of the offending agent is critical.

Brush any dry materials off the skin surface before performing copious water lavage.

• For alkali burns, lavage may need to be continued...
chemical burn, initial treatment, alkali burn, resuscitation, water lavage

Postoperative Care (14)

Postoperative Evaluation and Stabilization of Trauma Patients
Critical Source: NATO Emergency War Surgery
Objective: Ensure the patient is stable before transfer to an intermediate or minimal care ward.

Procedure:
1. Before transferring a trauma patient, the anesthetist must confirm that:
- Vital signs have stabilized
- **Essential...
postoperative evaluation, vital signs stabilization, reflex return, drug depression abatement, quality assurance
Postoperative Management for Amputations
Critical Source: NATO Emergency War Surgery
Procedure:

1. To prevent flexion contracture of the hip following transfemoral amputations, keep the patient in the prone position as much as possible until they become familiar with active range of motion exercises.

2. When lying supine,...
amputation recovery, postoperative care, phantom limb pain, hip contracture prevention
Postoperative Ventilatory Support for Trauma Patients
Critical Source: NATO Emergency War Surgery
Indication: Required in trauma patients with compromised respiratory function post-surgery.

Procedure:
1. Use volume-cycled ventilators capable of delivering inspired oxygen concentrations up to 100% and providing positive...
ventilatory support, trauma patients, volume-cycled ventilators, PEEP
Monitoring for Postoperative Complications After Arterial Repair
High Priority Source: NATO Emergency War Surgery
Objective: Identify early signs of complications that may require intervention.

Procedure:
1. Monitor the patient closely for the following signs:
- Acute renal insufficiency: Decrease in urinary output.
- Wound infection:...
complication monitoring, renal insufficiency, wound infection, clostridial myositis, muscle necrosis
Postoperative Management for Chest Casualties in Combat Zones
High Priority Source: NATO Emergency War Surgery
Objective: Ensure adequate pulmonary ventilation and prevent complications such as 'wet lung' syndrome.

### Steps:
1. Maintain Pulmonary Ventilation:
- Monitor and ensure patients can ventilate adequately.
- Use a volume-cycled...
chest injuries,pulmonary ventilation,wet lung syndrome,diuretic agents,air evacuation,fluid overload
Postoperative Monitoring and Critical Care Support
High Priority Source: NATO Emergency War Surgery
Indication: To ensure optimal recovery and manage complications in postoperative surgical patients.

Procedure:
1. Ensure availability of blood gas measurement capabilities, including arterial or central venous oxygen tension...
blood gas monitoring, critical care specialists, postoperative recovery
Postoperative Pain Management in Surgical Patients
High Priority Source: NATO Emergency War Surgery
Indication: To manage postoperative pain effectively and reduce complications.

Procedure:
1. Administer small doses of narcotics or analgesics intravenously (IV) during the immediate recovery period for optimal effect.
2. Use **regional...
pain management, regional blocks, hypoxia, oxygen supply
Application of Pressure Dressings and Suture Removal for Maxillofacial Wounds
High Priority Source: NATO Emergency War Surgery
Procedure:

• After repair of maxillofacial wounds, a pressure dressing is applied whenever possible and left in place for at least 48 hours.
Sutures are removed on the fourth or fifth day.
pressure dressing, suture removal, maxillofacial wounds
Monitor Post-op Pulses for Graft Thrombosis
High Priority Source: Emergency War Surgery
Procedure:

1. Check palpable pulses obtained in the operating room (OR) post-operatively to ensure they remain palpable.
2. Watch for changes in pulse even if Doppler signals are still present, as this may indicate graft thrombosis and...
pulses,graft thrombosis,heparin,DVT prophylaxis,edema
Postoperative Dietary Management for Maxillofacial Patients
High Priority Source: NATO Emergency War Surgery
Procedure:

Patients without intermaxillary fixation may be given all ordinary fluids and soft foods which require little or no chewing.
• If intermaxillary fixation has been used, the diet must be thin enough to suck through a tube....
dietary management, intermaxillary fixation, postoperative nutrition
Postoperative Management of Hand Injuries
High Priority Source: NATO Emergency War Surgery
Procedure:

1. After surgery or injury treatment, elevate the hand and arm to reduce swelling.
2. Enforce movement of all uninvolved joints to maintain mobility and prevent stiffness.
hand elevation,joint movement,post-op care
Postoperative Management of Ileus
High Priority Source: NATO Emergency War Surgery
Procedure:

1. Monitor for ileus postoperatively, which is a normal period of motor inertia without secretory function.
2. Use nasogastric suction to minimize abdominal distention.
3. Provide **parenteral fluids, electrolytes, and...
ileus,nasogastric suction,parenteral support,anastomotic leak,intra-abdominal infection
Lip and Nostril Care During Intermaxillary Fixation
Standard Source: NATO Emergency War Surgery
Procedure:

• If it is necessary to protect the lips from the wires used in intermaxillary fixation, pieces of soft wax are useful.
Lubrication of the lips and nostrils will help to prevent fissures and ulcers.
lip protection, soft wax, nostril lubrication
Postoperative Limb Positioning and Care
Standard Source: NATO Emergency War Surgery
Objective: Ensure proper postoperative care after arterial repair.

Procedure:
1. Keep the injured limb at or slightly above the level of the heart to promote venous return and reduce swelling.
2. If the extremity has been flexed, gradually...
postoperative care, limb positioning, contracture prevention, muscle exercises, ambulation

Fractures (14)

Manage Fat Embolism Syndrome in Patients with Long-Bone Fractures
Critical Source: NATO Emergency War Surgery
Objective: Provide supportive care for patients at risk of fat embolism syndrome following long-bone fractures.

Procedure:
1. Monitor all patients with long-bone fractures for signs of fat embolism, such as respiratory distress, altered...
fat embolism syndrome, long-bone fracture complications, respiratory support
Debride and Irrigate Open Fractures
Critical Source: NATO Emergency War Surgery
Objective: Prevent infection and optimize wound healing in open fractures.

Procedure:
1. Perform immediate debridement of all devitalized tissue, foreign bodies, and contaminants from the wound.
2. Thoroughly irrigate the wound using a...
open fracture debridement, wound irrigation, infection prevention
How to Set a Broken Wrist
Critical Source: Where There is no Doctor a Village Health Care Handbook
Objective: Safely set a broken wrist to align the bones properly.

### Steps:
1. Gently Pull the Hand:
- Use a slow, steady force for 5–10 minutes, gradually increasing pressure to separate the bones.
2. **Align and Straighten...
wrist fracture, bone setting, immobilization
Immobilize a Broken Bone to Prevent Further Damage
Critical Source: Where There is no Doctor a Village Health Care Handbook
Objective: Immobilize a broken bone to prevent further injury and promote healing.

### Steps:
1. Keep the Bone in Fixed Position using splints, strips of bark, or cardboard sleeves.
2. Do Not Move the Person until the bone is...
bone fracture, immobilization, splinting, pain relief
Apply External Fixators for Complex Fractures and Wounds
High Priority Source: NATO Emergency War Surgery
Objective: Stabilize complex fractures or wounds with external fixators.

Procedure:
1. Apply an external fixator only if performed by a trained surgeon familiar with its use, indications, and complications.
2. Use the fixator in cases of...
external fixator application, pin placement, wound management
Assess Neurovascular Status of Injured Extremities
High Priority Source: NATO Emergency War Surgery
Objective: Establish and record the neurovascular status of all injured extremities.

Procedure:
1. Perform a detailed neurological examination to assess motor function, sensation, and reflexes in the affected limb.
2. Evaluate vascular...
neurovascular assessment, extremity injury, fracture management
Avoid Internal Fixation in Initial Wound Management of War Injuries
High Priority Source: NATO Emergency War Surgery
Objective: Minimize the risk of infection and complications associated with internal fixation in war wounds.

Procedure:
1. Avoid using internal fixation devices (e.g., screws, plates) for fractures resulting from war injuries during the...
internal fixation contraindication, war wound management, external immobilization
Identify and Treat Open and Closed Fractures
High Priority Source: Medical Emergencies
Overview:

There are two types of fractures: open (compound) and closed.

Open Fracture Signs/Symptoms:
• Bone protrudes through the skin
• Complicated by an open wound

Treatment for Open Fractures:
• After setting the fracture, treat...
open fracture,closed fracture,treatment,immobilization,splinting,nerve damage,blood vessel compression
Reduce and Align Fractures with Initial Splinting
High Priority Source: NATO Emergency War Surgery
Objective: Stabilize fractures to prevent further injury and facilitate healing.

Procedure:
1. Reduce the fracture by manually aligning the bone fragments as closely as possible, ensuring that the neurovascular status is not compromised...
fracture reduction, splinting, alignment
Transport Patients with Fractures Using Appropriate Methods
High Priority Source: NATO Emergency War Surgery
Objective: Ensure safe and effective transportation of patients with fractures.

Procedure:
1. Use a Velpeau dressing or sling and swath for transport in cases of humeral fractures or shoulder girdle injuries, especially if brachial artery...
transport methods, immobilization during evacuation, fracture management
Apply and Bivalve Plaster Casts for Immobilization
High Priority Source: NATO Emergency War Surgery
Objective: Provide immobilization while allowing access to the wound.

Procedure:
1. Apply a circular plaster cast to immobilize the joints above and below the fracture.
2. Immediately bivalve (split) the cast along its length to allow for...
plaster cast application, bivalving, immobilization
Elevate and Cool Injured Extremities to Reduce Swelling
High Priority Source: NATO Emergency War Surgery
Objective: Minimize swelling and improve patient comfort in injured extremities.

Procedure:
1. Elevate the injured limb above the level of the heart, if possible, to facilitate venous return and reduce edema.
2. Apply ice packs or cold...
swelling reduction, elevation, ice application
Healing Time for Broken Bones
High Priority Source: Where There is no Doctor a Village Health Care Handbook
Objective: Understand the healing time and care requirements for broken bones.

### Healing Guidelines:
Children’s bones heal rapidly; older people's bones may not heal completely.
• A broken arm should be kept in a cast for about...
bone healing time, cast duration, fracture care
Prevent Skin Breakdown in Patients with Plaster Casts or Splints
High Priority Source: NATO Emergency War Surgery
Objective: Avoid complications such as pressure sores and skin breakdown in patients with casts or splints.

Procedure:
1. Ensure that all plaster casts and splints are properly padded to reduce pressure on the skin.
2. Monitor patients for...
skin breakdown prevention, cast care, pressure sores

Biological Warfare (14)

Dissemination of Biological Agents - Aerosol Delivery
High Priority Source: Medical NBC Battlebook
Procedure:

1. Aerosol delivery is the most important route for BW attacks.
2. Infectious organisms can decay over time, depending on environmental factors and the nature of the organism.
3. Optimal aerosol use occurs during **late night to...
biological warfare,aerosol delivery
Dissemination of Biological Agents - Agent Survival and Secondary Aerosols
High Priority Source: Medical NBC Battlebook
Procedure:

1. Agent survival can lead to the delayed generation of secondary aerosols from previously contaminated surfaces.
2. Particles may adhere to individuals (e.g., skin or clothing), creating additional but less significant...
biological warfare,agent survival
Dissemination of Biological Agents - Alimentary Exposure (Ingestion)
High Priority Source: Medical NBC Battlebook
Procedure:

1. Direct contamination of consumables, such as drinking water, foodstuffs, or medications, is a method for disseminating infectious agents.
2. This method is suitable for sabotage activities and may target specific...
biological warfare,alimentary exposure
Dissemination of Biological Agents - Dermal Exposure (Percutaneous)
High Priority Source: Medical NBC Battlebook
Procedure:

1. Intact skin is an effective barrier for most biological agents, but mucous membranes and damaged skin allow entry.
2. Agents entering through the skin may cause skin lesions, or in rare cases, enter the **systemic...
biological warfare,dermal exposure
Dissemination of Biological Agents - General Overview
High Priority Source: Medical NBC Battlebook
Procedure:

1. Understand that dissemination is the process by which infectious diseases or toxins are dispersed to cause disease or intoxication.
2. The same routes of entry as in natural disease spread (e.g., **inhalation, ingestion,...
biological warfare,dissemination,inhalation
Dissemination of Biological Agents - Person-to-Person Spread
High Priority Source: Medical NBC Battlebook
Procedure:

1. Humans can act as carriers and spread BW agents through direct contact (skin or clothing) or aerosol droplet spread (e.g., sneezing, coughing).
2. This method is particularly effective for agents that are **highly...
biological warfare,person-to-person spread
Dissemination of Biological Agents - Vector-Borne Attacks
High Priority Source: Medical NBC Battlebook
Procedure:

1. Vector-borne attacks involve releasing infected arthropods (e.g., mosquitoes, ticks, fleas) to spread diseases.
2. These vectors can be mass-produced and deployed in areas where the target disease is not naturally...
biological warfare,vector-borne attack
Duration of Impact of Possible Biological Weapons Agents
High Priority Source: Medical NBC Battlebook
Procedure:

1. Refer to Table 4-B for the duration of impact of various biological agents:
- Bacterial (e.g., anthrax): 12 hours - 21 days
- Rickettsial (e.g., Q fever): 3 - 21 days
- Viral (e.g., Rift Valley fever):...
biological warfare,agent duration
Identify Characteristics of a BW Attack - Illness in Animals and Humans
High Priority Source: Medical NBC Battlebook
Procedure:

1. Monitor for an increased number of sick or dead animals, especially across multiple species (e.g., horses, cows, dogs) at the same time as human illnesses.
2. Note that most BW agents can infect a wide range of hosts,...
biological warfare,BW attack,animal illness
Identify Characteristics of a BW Attack - Own-Goals and Hang-Fires
High Priority Source: Medical NBC Battlebook
Procedure:

1. Be aware that initial BW attacks may fail, leading to unusual disease events in the opposition.
2. An Own-Goal occurs when an attack is triggered prematurely (e.g., a bomb detonating before reaching its target).
3. A...
biological warfare,BW attack,own-goal,hang-fire
Identify Characteristics of a BW Attack - Unusual Disease Pattern
High Priority Source: Medical NBC Battlebook
Procedure:

1. Observe the disease pattern for deviations from natural epidemics.
2. Note that in naturally occurring outbreaks, disease incidence typically increases over weeks or months, whereas in a BW attack, it may increase...
biological warfare,BW attack,disease pattern
Identify Characteristics of a BW Attack - Unusual Geographic Distribution
High Priority Source: Medical NBC Battlebook
Procedure:

1. Note the geographic spread of casualties.
2. Recognize that certain agents, like toxins, are effective on smaller targets, while others (e.g., anthrax) can be disseminated over large areas.
3. Look for a high...
biological warfare,BW attack,geographic distribution,anthrax
Identify Characteristics of a BW Attack - Unusual Number of Casualties
High Priority Source: Medical NBC Battlebook
Procedure:

1. Monitor for an unexpected large number of casualties occurring within a short period.
2. If 48-72 hours pass with a high number of casualties, consider the possibility of a microorganism-based attack.
3. If casualties...
biological warfare,BW attack,casualties,microorganism,toxin
Threat Potential of BW Agents to Drinking Water
High Priority Source: Medical NBC Battlebook
Procedure:

1. Refer to Table 4-C for the threat potential of BW agents to drinking water:
- Anthrax: Yes, stable in water for up to 2 years (spores), resistant to chlorine.
- Brucellosis: Probable, stable for 20-72 days,...
biological warfare,water threat

Orthopedic Injuries (13)

Management of Compartment Syndrome in Vascular Injury Patients
Critical Source: Emergency War Surgery
Step-by-step procedure:

1. Fasciotomy is indicated for the following conditions:
- A delay of 4–6 hours after vessel injury.
- Combined vein and artery injury.
- Arterial ligation.
- Concomitant fracture/crush, severe...
compartment syndrome, fasciotomy, vascular injury, muscle necrosis
Resuscitation and Fracture Alignment for Long-Bone Fractures
Critical Source: Emergency War Surgery
Step-by-step procedure:

1. In most long-bone fractures, resuscitation is the priority.
2. Align the fractured bone to restore distal blood flow.
3. This step helps prevent complications such as compartment syndrome and ischemia.
4. Ensure...
long-bone fracture, resuscitation, alignment, vascular flow
Apply Velpeau Cast for Shoulder/Humeral Shaft Fractures
High Priority Source: Emergency War Surgery
Procedure:

1. Preparation:
- Use the Velpeau technique (external fixator is an acceptable alternative, but without direct visualization there is a high risk of iatrogenic injury to the radial nerve and vascular structures. Review anatomy...
Velpeau cast,application,shoulder fracture,humeral shaft fracture,external fixator,radial nerve injury,plaster stabilization,bivalving
Foot Compartment Syndrome: Medial Approach and Fasciotomy Wound Management
High Priority Source: Emergency War Surgery
A medial approach to the foot is used for releasing compartments and managing fasciotomy wounds as follows:

• Make a medial approach through the medial compartment, reaching across the central compartment into the interosseous compartment...
foot,compartment syndrome,medial approach,fasciotomy,wound management,devitalized tissue,sterile dressing
How to Set a Dislocated Shoulder
High Priority Source: Where There is no Doctor a Village Health Care Handbook
Procedure:

1. Have the injured person lie face down on a firm surface with their arm hanging over the edge.
2. Pull down on the arm toward the floor using strong, steady force for 15 to 20 minutes.
3. Gently let go. The shoulder should ‘pop’...
dislocated shoulder, first aid, medical emergency, orthopedic injury, repositioning
Shoulder Exploration Technique
High Priority Source: Emergency War Surgery
Procedure for Shoulder Exploration:

1. Position the patient in a semilateral position, which allows both anterior and posterior approaches to the glenohumeral joint.

2. Use an anterior deltopectoral approach (see Figure 245a,b,c,d):
...
shoulder exploration, anterior deltopectoral approach, open joint injuries, surgical management, amputations
Bivalve Casts to Prevent Compartment Syndrome
High Priority Source: Emergency War Surgery
Procedure:

1. Definition of Bivalving:
- When a cast is bivalved, it is completely split longitudinally along opposing sides of the cast.
- Splitting the cast into anterior and posterior halves is preferred.

2. Purpose:
- The...
bivalving cast,compartment syndrome,padding split,soft tissue swelling,cast modification
Conduct a Thorough History for Wilderness Orthopedic Injuries
High Priority Source: US Marine Corps Wilderness Medicine
Objective: Gather critical information to help diagnose orthopedic injuries in the wilderness.

Steps:
1. Determine the mechanism of injury, including:
- High vs. low-velocity accident
- Direction of force applied
- Nature of...
history,mechanism of injury,wilderness orthopedic injuries,diagnosis
Foot Stabilization Using K-wires and Casts/Splints
High Priority Source: Emergency War Surgery
Stabilize the foot using temporary fixation methods as follows:

K-wires can be utilized for temporary stabilization of the foot.

• A bivalved cast or splint is adequate for transport to a site of more definitive care.
foot,stabilization,K-wires,bivalved cast,splint,transport
Identify Mandible Fractures in Trauma Patients
High Priority Source: NATO Emergency War Surgery
Procedure:

1. Assess patient history and mechanism of injury: Look for blunt trauma to the face, jaw, or chin.
2. Clinical examination:
- Check for restriction of normal jaw movements.
- Assess for abnormal mobility of the jaws.
...
mandible fracture, jaw fracture, facial bone injury, trauma assessment, condylar neck fracture
Initial Management of Mandibular Fractures in Combat Hospitals
High Priority Source: NATO Emergency War Surgery
Procedure:

1. Assess the nature, location, and severity of the fracture, as well as the condition of existing dentition.
2. Determine treatment approach based on clinical findings:
- Mild fractures: May be managed with dietary...
mandible fracture treatment, intermaxillary fixation, combat hospital protocols, open reduction, internal fixation
Perform a Physical Examination for Wilderness Orthopedic Injuries
High Priority Source: US Marine Corps Wilderness Medicine
Objective: Conduct a physical examination to assess signs and symptoms of orthopedic injuries in the wilderness.

Steps:
1. Observe the casualty for:
- Swelling
- Discoloration and bruising
- Obvious deformity or angulation
-...
physical examination,wilderness orthopedic injuries,diagnosis
Management of Midfoot Injuries
Reference Source: Emergency War Surgery
Objective: Properly manage injuries to the midfoot including tarsal and metatarsal fractures.

Steps:
Approach for tarsal and metatarsals: Use dorsal longitudinal incisions.
Compartment release: Perform through longitudinal...
midfoot injuries, tarsal fractures, metatarsal fractures, compartment release, dorsal longitudinal incisions, plantar medial incision

Heat Related Illnesses (13)

Airway and Hemodynamic Management in Heatstroke Patients
Critical Source: Emergency War Surgery
Airway control is essential. Vomiting is common, so endotracheal intubation should be used in any patient with reduced level of consciousness or inability to protect the airway. Provide supplemental oxygen when available.

**Hypotensive...
airway control, intubation, inotropic support, dopamine, dobutamine, cerebral edema, mannitol
Medication and Fluid Management for Heatstroke Patients
Critical Source: Emergency War Surgery
Aspirin and acetaminophen should NOT be given to casualties of heatstroke.

Aggressive fluid resuscitation is not required, but initial hydration may include:
1 L in the first 30 minutes, with an additional **2 L or more in the next 2...
fluid management, dextrose, overhydration risks, shivering treatment, diazepam, chlorpromazine
Recognize and Treat Heatstroke (Hyperthermia)
Critical Source: US Marine Corps Wilderness Medicine
Heatstroke is a true medical emergency with historically high mortality rates if not treated promptly.

### Diagnosis:
• Traditionally requires:
- Core temperature > 104°F (41°C)
- Altered mental status
- **Cessation of...
heatstroke, hyperthermia, emergency treatment, cooling
Heat Exhaustion: Clinical Presentation and Treatment
Critical Source: Emergency War Surgery
Clinical presentation of heat exhaustion includes:
• Thirst, headache, dyspnea, lightheadedness (orthostatic dizziness), profound physical fatigue, anorexia, confusion, anxiety, agitation, mood change, chills, piloerection, nausea, vomiting.
-...
heat exhaustion, dehydration, parenteral fluids, potassium replacement, active cooling
Treating Sunstroke
Critical Source: Boy Scout Handbook 1911
Procedure for Treating Sunstroke

1. Recognize symptoms: The patient will be unconscious, with a red face, large pupils, very hot and dry skin (no perspiration), and a full but slow pulse.
2. Remove the patient to a cool place.
3....
sunstroke, heat exhaustion, first aid, emergency treatment, cold water application
Treating Heat Exhaustion
High Priority Source: Boy Scout Handbook 1911
Procedure for Treating Heat Exhaustion

1. Recognize symptoms: The patient will be weak and depressed but not unconscious. Face is pale with clammy sweat, breathing and pulse are weak.
2. Remove the patient to a cool place and have them...
heat exhaustion, first aid, emergency treatment, stimulants, hydration
Managing Heat Cramps and Heat Exhaustion
High Priority Source: Where There is no Doctor a Village Health Care Handbook
Managing Heat Cramps and Heat Exhaustion

Steps:
1. Move the affected person to a cool, shaded area immediately.
2. Have them lie down and elevate their legs slightly if possible.
3. Provide cool water or an electrolyte solution to drink...
heat cramps, heat exhaustion, managing heat illness, heat safety
Recognize and Treat Heat Exhaustion
High Priority Source: US Marine Corps Wilderness Medicine
Heat exhaustion occurs due to severe body salt loss and dehydration from sweating, leading to inadequate blood pressure maintenance.

### Recognition Challenges:
• Early signs may be mistaken for malingering.
• Symptoms like headache,...
heat exhaustion, dehydration, rehydration, treatment
Stay Safe During a Heat Emergency
Standard Source: FEMA Are You Ready
During a heat emergency, follow these guidelines:

1. Stay indoors as much as possible and limit exposure to the sun.
2. If air conditioning is not available, stay on the lowest floor out of the sunshine.
3. **Consider spending the...
heat emergency, hydration, public buildings, heat safety
Differentiate Between Heat Exhaustion and Heat Stroke
Standard Source: Where There is no Doctor a Village Health Care Handbook
Key Differences:

| Feature | Heat Exhaustion | Heat Stroke |
|--------|------------------|-------------|
| Skin Condition | Sweaty, pale, cool skin | Dry, red, hot skin |
| Pupils | Normal size | Large pupils |
| Fever | Usually...
heat exhaustion vs heat stroke, symptoms comparison, first aid
Treating Heat Cramps in Hot Weather
Standard Source: Where There is no Doctor a Village Health Care Handbook
Procedure:

Step 1: Put a teaspoon of salt in a liter of boiled water and drink it. Repeat once every hour until the cramps are gone.
Step 2: Have the person sit or lie down in a cool place and gently massage the painful...
heat cramps treatment, salt solution for heat cramps, first aid for heat illness
Identify and Respond to Heat Cramps
Reference Source: FEMA Are You Ready
Procedure:

1. Recognize symptoms: Muscular pains and spasms due to heavy exertion.
2. Stop activity immediately: If heat cramps occur, rest in a cool place and avoid further physical exertion.
3. Hydrate with water or sports drinks:...
heat cramps, hydration, muscle pain, sports drinks, medical attention
Sunburn: Clinical Presentation and Management
Reference Source: Emergency War Surgery
Clinical presentation:
• Reduces thermoregulatory capacity of skin.
• Systemic effect includes hyperthermia.
• Preventable.

Management: Affected individuals should be kept from significant heat strain until the burn has healed.
sunburn, thermoregulatory capacity reduction, hyperthermia prevention, heat strain avoidance

Infectious Disease Treatment (13)

Administer Antiviral Medication for Treatment of Avian Influenza A (H5N1) or Novel Strain
Critical Source: HHSPandemicInfluenzaPlan
Procedure:

1. Isolate the patient as described in Supplement 4.
2. Treat the patient according to the clinical algorithm provided in Supplement 5 for the Pandemic Alert Period.
3. Administer oseltamivir or zanamivir, which are...
antiviral treatment, oseltamivir, zanamivir, avian influenza H5N1, pandemic flu, neuraminidase inhibitors
Administer Doxycycline for Pneumonic Plague
Critical Source: Survival and Austere Medicine
Procedure:

1. Identify symptoms of pneumonic plague: fatigue, fever, cough, shortness of breath, and malaise.
2. Administer doxycycline as the primary treatment option.
3. Alternatively, use ciprofloxacin if doxycycline is...
pneumonic plague, doxycycline, ciprofloxacin, infection control, rodent population control
Managing Whooping Cough (Pertussis) in Children
Critical Source: Where There is no Doctor a Village Health Care Handbook
Procedure:

• Watch for symptoms that appear a week or two after exposure to whooping cough.
• Early signs include fever, runny nose, and cough similar to a cold.
• After 2 weeks, the child may begin to experience severe coughing fits (whooping)...
whooping cough treatment, baby safety, vaccination, pertussis
Provide Supportive Care for Encephalomyelitis
Critical Source: Survival and Austere Medicine
Procedure:

1. Identify symptoms of encephalomyelitis: fever, headache, and severe photophobia (aversion to light).
2. Administer supportive care, which includes managing fever, hydration, and neurological monitoring.
3. Monitor for...
encephalomyelitis, supportive care, alphavirus infection, biological attack
Provide Supportive Care for Smallpox
Critical Source: Survival and Austere Medicine
Procedure:

1. Identify symptoms of smallpox: fever, rigors (uncontrolled shaking), malaise, headache, and vomiting.
2. After a couple of days, look for the development of a pustular rash on the hands, face, and trunk.
3. **Administer...
smallpox, supportive care, isolation protocols, bioterrorism
Provide Supportive Care for Viral Hemorrhagic Fever (VHF)
Critical Source: Survival and Austere Medicine
Procedure:

1. Identify symptoms of viral hemorrhagic fever: GI bleeding, petechiae, and bleeding from mucous membranes.
2. Administer supportive care, which includes maintaining hydration, managing fever, and controlling bleeding.
3....
viral hemorrhagic fever, supportive care, isolation protocols, shock management
Administer Ceftazidime and Doxycycline for Melioidosis and Glanders
High Priority Source: Survival and Austere Medicine
Procedure:

1. Identify symptoms of melioidosis: pneumonia with associated septicaemia or localized lesions.
2. Administer ceftazidime as the primary treatment for acute infection.
3. Administer doxycycline to prevent recurrence...
melioidosis, ceftazidime, doxycycline, infection control, biological attack
Administer Doxycycline and Rifampicin for Brucellosis
High Priority Source: Survival and Austere Medicine
Procedure:

1. Identify symptoms of brucellosis: fever, headache, sweating, chills, back pain.
2. Administer doxycycline in combination with rifampicin as the primary treatment for brucellosis.
3. Monitor patients for adverse effects...
brucellosis, doxycycline, rifampicin, infection control, biological attack
Treat H5N1 Infection in Humans
High Priority Source: LDS Preparedness Manual
Overview: The H5N1 virus is resistant to certain antiviral drugs but may respond to others.

Procedure:
1. Seek immediate medical care: If you suspect infection, contact a healthcare provider or go to the nearest emergency room...
H5N1 treatment, antiviral drugs, oseltamavir, zanamavir, bird flu medical care
Administer Doxycycline or Chloramphenicol for Q Fever
High Priority Source: Survival and Austere Medicine
Procedure:

1. Identify symptoms of Q fever: high fevers, chills, sweats, and headache.
2. Administer doxycycline as the primary treatment for Q fever.
3. If doxycycline is unavailable or contraindicated, use chloramphenicol as an...
q fever, doxycycline, chloramphenicol, infection control, biological attack
Administer Medication for Typhus Infection
High Priority Source: Where There is no Doctor a Village Health Care Handbook
Procedure:

1. If typhus is suspected, seek medical advice immediately.
2. Special tests may be required to confirm the diagnosis.
3. Administer tetracycline: adults should take 2 capsules of 250 mg four times a day for seven days (see page...
typhus treatment, tetracycline dosage, chloramphenicol use
Managing German Measles (Rubella)
High Priority Source: Where There is no Doctor a Village Health Care Handbook
Procedure:

• Keep the child in bed and provide rest.
• Administer acetaminophen or ibuprofen for fever or pain if necessary.
Pregnant women who have not had rubella or are unsure of their immunity should avoid contact with children...
rubella treatment, pregnant women, vaccine
Managing Mumps in Children
High Priority Source: Where There is no Doctor a Village Health Care Handbook
Procedure:

• Monitor for symptoms that appear 2–3 weeks after exposure to mumps.
• Watch for fever and pain when opening the mouth or eating.
• After 2 days, look for swelling below the ears at the angle of the jaw (often starting on one side...
mumps treatment, swelling management, meningitis, hearing problems

Ear Injuries (12)

Assessment and Initial Management of Inner Ear Trauma
High Priority Source: NATO Emergency War Surgery
Procedure:

1. Identify symptoms of inner ear trauma, which may include:
- Total hearing loss
- Severe vertigo
- High-pitched tinnitus
- Facial nerve palsy
2. Provide symptomatic treatment, including:
- Rest and monitoring...
inner ear trauma, vertigo management, basilar skull fracture, antibiotic administration
Assessment and Treatment of Ear Injuries in Combat
High Priority Source: NATO Emergency War Surgery
Injuries of the Ear in Combat

• Injuries of the ear are common in combat and may be confined to the external ear, such as contusions, lacerations, or avulsions.
Blast injuries of the middle or inner ear may cause deafness,...
ear injury, blast injury, deafness, acoustic trauma, hearing impairment
Extraction of Extraneous Bodies from the Ear
High Priority Source: The Household Cyclopedia
Procedure for Extracting Foreign Objects from the Ear

1. Assess the situation: Determine if the object is visible and accessible. If not, do not attempt removal yourself.
2. Prepare tools: Gather a flashlight, tweezers (if the object is...
foreign body removal, ear extraction, first aid for ear injuries
Handling Total Avulsion of the Auricle
High Priority Source: NATO Emergency War Surgery
Procedure:

1. Debride the cartilage of all overlying tissue.
2. Buried subcutaneously in a suitable area (e.g., abdominal wall) for future reconstruction.

Notes:
• This procedure is critical for potential later reconstruction.
-...
total auricle avulsion, cartilage storage, ear reconstruction
Managing External Otitis in Tropical and Subtropical Climates
High Priority Source: NATO Emergency War Surgery
Procedure:

1. Thoroughly cleanse the external canal.
2. Apply broad-spectrum topical antibiotics, and use a wick to allow better penetration of medication into the swollen canal.
3. Implement water precautions to prevent further...
external otitis, tropical infections, ear canal treatment
Managing Partial Avulsion of the Auricle
High Priority Source: NATO Emergency War Surgery
Procedure:

1. Perform careful surgical debridement and reapproximation as soon as possible.
2. If a portion of the auricle is missing:
- Approximate the anterior and posterior layers of skin over exposed cartilage.
3. **Do not suture...
auricle avulsion, partial avulsion, ear reconstruction
Managing Thermal Injury to the Auricle
High Priority Source: NATO Emergency War Surgery
Procedure:

1. Carefully cleanse the affected area.
2. Apply topical antibacterial agents, such as mafenide (Sulfamylon), on fine mesh gauze.
3. Use a mesh dressing to protect the entire head.
4. Avoid using pillows to prevent...
thermal injury, auricle burn, topical antibiotics
Treating Hematoma of the Auricle
High Priority Source: NATO Emergency War Surgery
Procedure:

1. Evacuate the hematoma surgically.
2. Apply a sterile pressure dressing to the affected area.
3. Remove the dressing at least every 48 hours and inspect for recurrence of the hematoma.

Notes:
• Recurrence is...
auricle hematoma, surgical evacuation, pressure dressing
Treating Lacerations of the Auricle
High Priority Source: NATO Emergency War Surgery
Procedure:

1. Debride the auricle carefully, removing only devitalized tissues.
2. Close the laceration in layers, ensuring:
- Cartilage is realigned using absorbable suture material.
- Skin and subcutaneous tissues are closed...
auricle laceration, ear trauma, surgical closure, debridement
Treating Lacerations of the External Auditory Meatus
High Priority Source: NATO Emergency War Surgery
Procedure:

1. If a laceration is recognized early:
- Perform precise initial suture repair.
2. For lacerations or fractures through the bony portion of the external auditory canal:
- Cleanse the area as aseptically as possible.
-...
external auditory meatus laceration, ear canal injury, otolaryngologist referral
Assessment and Management of Tympanic Membrane Injury
Standard Source: NATO Emergency War Surgery
Procedure:

1. Examine the ear under aseptic conditions using good illumination if injury is suspected.
2. Avoid instrumentation, drops, or syringing if rupture has occurred.
3. Leave wax in situ, unless pain, deafness, or both...
tympanic membrane injury, middle ear trauma, aseptic examination, sterile packing, cholesteatoma prevention
Management of Barotrauma in the Ear
Standard Source: NATO Emergency War Surgery
Procedure:

1. Recognize barotrauma in flying personnel, especially during descent.
2. Assess symptoms, which may include:
- Mild to severe pain
- Hearing loss
- Vertigo
3. Administer topical and systemic nasal decongestants...
barotrauma management, Valsalva maneuver, nasal decongestants, middle ear pressure equalization

Postpartum Complications (12)

Preventing Heavy Bleeding (Mother)
Critical Source: A Book for Midwives
Procedure:

1. Monitor the mother for excessive vaginal bleeding after birth.
2. Ensure she is lying on her back with her legs elevated to promote blood flow.
3. Apply firm pressure to the perineum or use a sterile pad to absorb blood.
4. If...
postpartum hemorrhage, uterine bleeding, midwifery care, emergency response
Responding to Shock in a Bleeding Mother
Critical Source: A Book for Midwives
When someone bleeds heavily, she may go into shock. If a mother is bleeding before or after the placenta comes out, watch for these signs:

• Feeling faint, dizzy, weak, or confused
• Pale skin and cold sweats
• Fast pulse (over 100 beats per...
shock, postpartum bleeding, medical help, anti-shock garment, rehydration drink
Identify Risk Factors for Infection and Excessive Bleeding
Critical Source: A Book for Midwives
Infection can occur when:

• Tissue from the pregnancy is still inside the woman’s womb after the miscarriage or abortion (see page 409).
• Germs get into the womb during an abortion, when something that was not sterilized is used in the...
infection,excessive bleeding,tissue retention,sterilization,womb injury
Identify and Manage Fistula After Birth
Critical Source: A Book for Midwives
Procedure: Identify and manage a fistula:

Signs of a fistula:
• Leaking urine or stool freely from the woman.

Causes:
• A hole in the skin inside the vagina, caused during labor by the baby’s head pressing hard on the skin between the...
fistula, postpartum care, urine leakage, stool leakage
Managing a Protruded Uterus After Placental Delivery
Critical Source: A Book for Midwives
1. Scrub your hands and arms up to the elbows (see page 53) and put on sterile gloves.

2. Quickly pour antiseptic solution (like povidone iodine) over the womb if you have any.

3. Gently but firmly put the womb back through the vagina...
prolapsed uterus, uterine inversion, postpartum hemorrhage, placental delivery, midwifery procedures
Recognize Signs of Incomplete Abortion
Critical Source: A Book for Midwives
Warning signs of incomplete abortion include:

1. Tissue coming out of the womb.
- During a pelvic exam, you might see pieces of tissue coming out of the cervix or feel that the womb is still enlarged because of tissue inside it.
2....
incomplete abortion,tissue retention,fever,vaginal smell,belly pain
Recognize Warning Signs of Complications After Miscarriage or Abortion
Critical Source: A Book for Midwives
Warning signs that require immediate medical attention include:

1. Strong cramping in the lower belly.
2. Swollen or hard lower belly.
3. Heavy bleeding, large clots of blood, or bleeding for more than 2 weeks.
4. **High temperature...
miscarriage,abortion,warning signs,heavy bleeding,infection,temperature,pulse
Recognize and Respond to Abnormal Post-Abortion or Miscarriage Bleeding
Critical Source: A Book for Midwives
Procedure:

When to seek help immediately:
• Bleeding is heavy, more than regular monthly bleeding.
• Blood is bright red with few clots (indicating fresh blood flow).
• Bleeding continues for more than a couple of days or beyond 2 weeks.
-...
abortion,bleeding,miscarriage,shock,uterus,contraction,tissue,removal
Treat Incomplete Abortion Using Available Methods
Critical Source: A Book for Midwives
Methods to treat incomplete abortion include:

1. Manual Vacuum Aspiration (MVA).
2. Medicines.
3. Forceps or other methods to remove tissue from the cervix, if MVA and medicines are not available or effective.

These options help...
incomplete abortion,MVA,medicines,forceps,tissue removal
Ask About the Pregnancy and Abortion Method
High Priority Source: A Book for Midwives
Steps to take when assessing a woman after miscarriage or abortion:

1. Ask how the pregnancy ended.
- If the woman had a miscarriage or if her abortion was provided by a trained health worker who used sterile tools, she is less likely to...
pregnancy history,abortion method,sterile tools,injury,communication
Recognize and Monitor Childbirth Fever Symptoms
High Priority Source: Where There is no Doctor a Village Health Care Handbook
### Recognize and Monitor Childbirth Fever Symptoms

Symptoms of childbirth fever:
Onset: Begins a day or more after giving birth.
Initial symptoms: Slight fever, which often rises later.
Other signs: Foul-smelling vaginal...
childbirth fever, postpartum infection, symptoms, monitoring, vaginal discharge
Inspecting the Bottom of the Placenta for Abnormalities
High Priority Source: A Book for Midwives
1. The bottom of the placenta (the side that was attached to the womb wall) has many lumps. Sometimes the bottom of the placenta will have hard white spots or dark patches. This is not dangerous.

2. To check this side, cup your hands and...
placental inspection, placenta abnormalities, postpartum care, midwifery procedures

Nutrition (12)

Adjusting Diet for Medical Conditions
High Priority Source: Survival and Austere Medicine
Procedure for Adjusting Patient Diet Based on Medical Needs

1. Assess the patient’s medical condition and determine any dietary restrictions or requirements.
2. Provide soft foods such as mashed vegetables, ground meats, and soft breads if the...
diet adjustment, medical nutrition, soft diet, food for recovery, dietary requirements
Manage Diarrhea in Enteral Nutrition Patients
High Priority Source: Emergency War Surgery
Diarrhea associated with enteral nutrition can be managed by:

1. Decreasing the osmolarity of the enteral solution, which may reduce gastrointestinal irritation.
2. Adding fiber to the formula, if tolerated, to improve bowel function...
enteral nutrition,diarrhea management,fiber addition,loperamide
Provide Nutritional Support in Battlefield ICU Patients
High Priority Source: Emergency War Surgery
Nutritional support is essential for critically injured patients to prevent catabolism and protein wasting, especially within 24–48 hours post-injury.

### Nutritional Guidelines:
Caloric requirement: 25–30 kcal/kg/day.
• **Protein...
enteral nutrition,parenteral nutrition,caloric intake,battlefield ICU,nutritional support
Avoid Injecting Vitamins and Use Food Instead
Standard Source: Where There is no Doctor a Village Health Care Handbook
Do not inject vitamins. Injections are more dangerous, more expensive, and usually no more effective than pills.

Many people waste money on syrups, tonics, and 'elixirs' that contain vitamins, but these often lack the most important...
vitamin injections,nutrition over supplements,food rich in vitamins
Implement Early Enteral Nutrition in Trauma Patients
Standard Source: Emergency War Surgery
Early enteral nutrition is essential for trauma patients to prevent catabolism and protein wasting due to systemic inflammation.

Guidelines for nutritional support:

1. Initiate enteral feeding within 24–48 hours of injury, if...
early enteral nutrition,tpn,protein wasting,catabolism,nutritional support
Prevent Aspiration During Enteral Feeding
Standard Source: Emergency War Surgery
Aspiration during enteral feeding can lead to severe complications such as pneumonitis and must be prevented through proper technique.

### Prevention Strategies:
1. Keep the head of the bed elevated at all times during feeding.
2. **Feed...
aspiration prevention,gastric residuals,enteral feeding,positional management
Provide Nutritious Diet for Postpartum Mothers
Standard Source: Where There is no Doctor a Village Health Care Handbook
Objective: Ensure new mothers receive a nutritious diet to support recovery and milk production.

Procedure:
1. Eat the most nutritious foods available, including:
- Main food (staples like rice, beans)
- Body-building foods such...
postpartum nutrition, maternal health, dietary restrictions, milk production
Correct Misconceptions About Diet and Illness
Standard Source: Where There is no Doctor a Village Health Care Handbook
Objective: Address harmful dietary misconceptions that may affect health.

Procedure:
1. Fruits like oranges and guavas are not bad for people with colds, flu, or coughs. In fact, they provide vitamin C which can help fight...
diet and illness, vitamin C benefits, food misconceptions
Provide Special Diets for Specific Health Problems
Standard Source: Where There is no Doctor a Village Health Care Handbook
Objective: Tailor diets to address specific health conditions.

Procedure:
1. Consult a healthcare provider or trained individual if the person has specific health problems (e.g., diabetes, malnutrition, digestive issues).
2. Adjust the...
special diets, health conditions, nutritional balance
Provide Appropriate Nutrition for Children Over One Year Old
Reference Source: Where There is no Doctor a Village Health Care Handbook
Objective: Ensure children over one year old receive a balanced diet that supports growth and health.

Procedure:
1. Offer the same foods as adults, but continue to breastfeed or provide milk whenever possible.
2. Include **main...
child nutrition, breastfeeding, helper foods, candy avoidance, dietary balance
Update Nutrition Advice for Poorly Nourished Children
Reference Source: Where There is no Doctor a Village Health Care Handbook
Procedure:

1. Assess the child's nutritional status by observing signs of malnutrition such as weight loss, weakness, and delayed growth.
2. Prioritize energy-rich foods over protein-rich foods in the child’s diet. Energy-rich foods...
nutrition,children,malnutrition,energy-rich foods,protein-rich foods
Understand the Role of Sucrose and Sugars in Nutrition
Reference Source: Where There is no Doctor a Village Health Care Handbook
Sucrose is a complex sugar derived from sugarcane or beets that provides energy but requires more effort for the body to use than glucose.

Sugars are sweet foods like honey, fruit, and table sugar that provide quick energy.

**What to...
sucrose, sugars, nutrition, energy, diabetes

Decontamination (12)

Decontamination Procedures for Radiation Victims
Critical Source: Emergency War Surgery
No healthcare provider has ever been injured with radiation while performing ABCs on a radiation victim.

Clothing removal: Removing the casualty’s clothing can remove up to 90% of radiological contamination.

• **Surface...
radiation decontamination, clothing removal, wound irrigation, PPE, amputation
Decontamination Procedures for Radiological Contamination
Critical Source: Emergency War Surgery
Decontamination is critical in managing radiological injuries from nuclear detonation:

1. Remove clothing: This can remove up to 90% of radiological contamination.
2. Irrigate open wounds: Copiously irrigate with normal saline for...
radiological decontamination, nuclear fallout, wound irrigation, protective gear
Coordinate Casualty Decontamination Support
Critical Source: Medical NBC Battlebook
Procedure:

1. MTFs (Medical Treatment Facilities) must coordinate with surrounding units to provide augmentees in case of contaminated casualties.
2. Ensure that all personnel involved in decontamination are trained and equipped for the...
casualty decontamination, MTF coordination, augmentees, NBC incident
Decontamination of Radiation Casualties in the Field
High Priority Source: NATO Emergency War Surgery
Overview: Decontamination is essential for radiation casualties to reduce contamination risks to medical personnel and prevent internalization of radioactive particles.

Procedure Steps:
1. Initial Decontamination in the Field:
-...
radiation decontamination, field procedures, skin integrity, protective gear
Immediate Patient Decontamination at Unit Level
High Priority Source: FM 3 5 NBC Decontamination
Procedure for Immediate Patient Decontamination at Unit Level:

1. Identify Contaminated Patients: Recognize contaminated and uncontaminated patients on the NBC battle space.
2. Perform Initial Decon by Soldier or Team Members: The...
patient decon, unit level decon, MOPP gear exchange, contamination tag, nerve agent antidote
Patient Decontamination at Battalion Aid Station (BAS)
High Priority Source: FM 3 5 NBC Decontamination
Procedure for Patient Decontamination at the BAS:

1. Evacuate Contaminated Patients: If battle conditions prevent decon procedures forward, evacuate the patient to the BAS before decon.
2. Decon Before Admission: Contaminated patients...
BAS decon, contaminated patient evacuation, medical supervision, nonmedical personnel team
Patient Decontamination at Medical Company’s Clearing Station
High Priority Source: FM 3 5 NBC Decontamination
Procedure for Patient Decontamination at the Medical Company’s Clearing Station:

1. Receive Patients from BAS or Other Areas: The clearing station may receive patients from the BAS or directly from other areas who may be contaminated.
2....
clearing station decon, medical company procedures, nonmedical team
Patient Decontamination at the Hospital
High Priority Source: FM 3 5 NBC Decontamination
Procedure for Patient Decontamination at the Hospital:

1. Location Considerations: Hospitals should be located away from tactical or logistical targets to the maximum extent possible.
2. Decon Before Admission: Patients evacuated from...
hospital decon, CPSs, persistent agent contamination, patient evacuation
Ambulatory Patient Decontamination and Evacuation
High Priority Source: FM 3 5 NBC Decontamination
Procedure:

1. All ambulatory patients requiring EMT (Emergency Medical Treatment) or AMT (Advanced Medical Treatment) in the clean treatment area of the BAS (Battle Assembly Site) will be decontaminated.
2. Stable patients not requiring...
ambulatory patient, decon procedures, protective overgarment, PPW, chlorine solution
Patient Transfer and Litter Reuse
High Priority Source: FM 3 5 NBC Decontamination
Procedure:

1. Three team members lift the patient off the decon litter (refer to step 5 for lifting procedures).
2. While the patient is elevated, another team member removes the litter from the stands and returns it to the decon area.
3. A...
litter reuse, mask removal, decon procedures, chlorine solution
Remove the LCE (Local Contamination Equipment)
High Priority Source: FM 3 5 NBC Decontamination
Procedure:

1. Remove the LCE by unfastening or unbuttoning all connectors or tie straps.
2. Place the equipment in a plastic bag.
3. Put the plastic bag in the designated storage area for later decontamination.

Notes:
• This procedure...
LCE removal, decon equipment, storage, chlorine solution
Transfer Patient to Hot Line
High Priority Source: FM 3 5 NBC Decontamination
Procedure:

1. Ensure the patient's clothing has been cut away, and their skin, bandages, and splints have been decontaminated.
2. Transfer the patient to the hot line and place the litter on the litter stands.
3. A third team member will assist...
patient transfer, hot line, decontamination, NBC agents, chlorine solution

Fluid Resuscitation (12)

Administer Specific Intravenous Fluids for Hemorrhagic Shock
Critical Source: Emergency War Surgery
Objective: Administer appropriate fluids to expand intravascular volume in hemorrhagic shock.

Procedure:
1. Lactated Ringer’s (LR):
- Administer 1,000 mL to expand intravascular volume by ~250 mL within 1 hour.
2. 6% Hetastarch:...
LR,hetastarch,HTS,fluid resuscitation,hemorrhagic shock
Establish IV Access and Administer Tranexamic Acid (TXA) in Combat Settings
Critical Source: TCCC 17 13 Tactical Combat Casualty Care
Procedure:

1. Assess the casualty for signs of shock or need for intravenous (IV) medications.
2. Establish IV access using an 18-gauge catheter and saline lock:
- Secure it with transparent wound-dressing film.
3. **Administer...
IV access, TXA administration, fluid resuscitation, intraosseous access, shock management
Use Intraosseous (IO) Device for Fluid Resuscitation When IV Access Is Not Possible
Critical Source: TCCC 17 13 Army Tactical Combat Casualty Care
Procedure:
1. Assess the casualty and determine that IV access is not possible due to trauma or other complications.
2. Select an appropriate site for IO insertion, such as the tibia or humerus in adults, or the proximal tibia in...
intraosseous device, fluid resuscitation, battlefield resuscitation
Administer Fluid Resuscitation Based on Hemorrhage and Shock Status
Critical Source: US Marine Corps Wilderness Medicine
Procedure:
1. For casualties with no hemorrhage or controlled hemorrhage without shock, administer Lactated Ringer's at a rate of 250cc/hr.
2. For casualties with controlled hemorrhage and shock, administer **Hespan 1000cc...
fluid resuscitation, Lactated Ringer's, Hespan, hemorrhage management, shock treatment
Administer IV or IO Fluids for Burns >20% TBSA
Critical Source: TCCC 17 13 Army Tactical Combat Casualty Care
Procedure:

1. For burns over 20 percent of TBSA, initiate IV or IO fluids as soon as possible with lactated Ringers (LR), normal saline (NS), or Hextend solution.
2. If Hextend solution is used, use no more than **1,000...
tbsa burns, fluid resuscitation, hextend solution
Administer Lactated Ringer's Solution for Shock Resuscitation
Critical Source: NATO Emergency War Surgery
Procedure:

1. Select Fluid: Use lactated Ringer's solution as the resuscitation fluid of choice.
2. Determine Volume: Administer 1,000 to 2,000 cc of lactated Ringer's solution, infused as rapidly as possible.
3. **Alternative Rule of...
lactated ringer's solution, shock resuscitation, fluid challenge, crystalloid solution, hemorrhage management
Fluid Resuscitation for Hemorrhagic Shock in Tactical Combat Casualty Care
Critical Source: TCCC 17 13 Army Tactical Combat Casualty Care
If the casualty is not in shock, oral fluids are permissible if the casualty is conscious and can swallow.

If the casualty is in shock, resuscitate with:
Whole blood,
Freeze-dried plasma, or
• A **500 milliliter (ml) bolus of...
Hextend, fluid resuscitation, shock, SBP, whole blood
Administering Resuscitation Fluid Rectally in Survival Situations
High Priority Source: Survival and Austere Medicine
Procedure:

1. Assess the situation: Ensure that the person is unconscious, shocked, or dehydrated and that the cause of the problem is not severe diarrhoea.

2. Position the person: Place them on their side with the buttocks raised on...
rectal fluid resuscitation, survival medicine, dehydration treatment, emergency hydration, intravenous alternative
Start Intravenous Access for Casualty in Medical Emergency
High Priority Source: US Marine Corps Wilderness Medicine
Procedure:
1. Insert an 18-gauge IV catheter or place a saline lock if not already done.

Details:
• This procedure is essential for casualties requiring fluid resuscitation, medication administration, or blood transfusion.
• Ensure...
IV access, intravenous catheter, saline lock, fluid resuscitation
Use of Osmotic Diuretics in Burn Patients
High Priority Source: NATO Emergency War Surgery
Purpose: Use osmotic diuretics to manage oliguria in specific burn patients.

Indications for osmotic diuretics (e.g., mannitol):
1. Significant electric injury, increasing the risk of acute renal failure due to hemochromogens.
2....
osmotic diuretics, mannitol, burn patients, oliguria, hemochromogens, fluid resuscitation
Administer Hetastarch for Hemorrhage or Burns
High Priority Source: TCCC 17 13 Tactical Combat Casualty Care
Indications: Hemorrhage or burns.

Dosage: 500 ml intravenous (IV) bag.

Availability: Available in both the Combat Medic and Tactical Combat Medical Care MES.

Instructions: Administer via IV. Ensure proper IV access and monitor for...
hetastarch,hemorrhage,burns,IV fluid
Administer Sodium Chloride for IV or IO Flush
Standard Source: TCCC 17 13 Tactical Combat Casualty Care
Indications: IV or IO flush (500 ml or 1,000 ml normal saline is an alternative IV fluid). Three percent sodium chloride is a hypertonic solution for the treatment of increased intracranial pressures.

Dosage: 10 ml...
sodium chloride,IV flush,hypertonic solution

Cold Injuries Prevention (12)

Identify and Understand Types of Cold Injuries
High Priority Source: NAVMED P 5010 US Navy Manual of Preventive Medicine
Types of Cold Injuries:

1. Frostbite (Freezing Injury): Occurs when skin and underlying tissues freeze, leading to damage or death of cells.
- Superficial Frostbite: Affects only the top layer of skin; symptoms include numbness,...
frostbite,frostnip,hypothermia,trenchfoot,cold injuries types
Implement Cold Injury Prevention Program
High Priority Source: NATO Emergency War Surgery
Procedure for Implementing a Comprehensive Cold Injury Prevention and Control Program:

1. Command Responsibility: Ensure that all levels of command, including staff and technical personnel, fully understand the risks and potential losses...
cold injury, hypothermia, prevention, clothing, military, survival
Implement Cold Injury Prevention Strategies
High Priority Source: NAVMED P 5010 US Navy Manual of Preventive Medicine
Prevention Strategies for Cold Injuries:

1. Dress Appropriately:
- Wear multiple layers of clothing, including a moisture-wicking base layer, an insulating middle layer, and a windproof outer layer.
- Cover all exposed skin to prevent...
cold injury prevention,dress appropriately,stay dry,maintain body heat,avoid alcohol,tobacco use,monitor signs,educate individuals,proper shelter,equipment,weather conditions
Prevent Cold Injuries Through Physiological Awareness
High Priority Source: NAVMED P 5010 US Navy Manual of Preventive Medicine
Physiological Factors Influencing Cold Injury Risk:

1. Body Fat Percentage: Individuals with lower body fat are more susceptible to cold injuries due to reduced insulation.
2. Age and Gender: Children, elderly individuals, and females...
physiological factors,cold injuries prevention,body fat,age,gender,alcohol,smoking,medications
Prevent Cold Injuries Using Insulated Vapor-Barrier Boots
High Priority Source: NATO Emergency War Surgery
Procedure:

1. Select appropriate footwear: Use insulated vapor-barrier boots designed to prevent cold injuries.
2. Ensure proper fit: The boots should be snug but not constricting, allowing for adequate circulation while providing...
insulated,vapor-barrier,boots,cold,injury,prevention,trench,foot,frostbite
Apply Proper Preventive Medicine Measures for Cold Injuries
Standard Source: STP 21 1 Warrior Skills Level 1
### Procedure: Apply Proper Preventive Medicine Measures for Cold Injuries

#### Purpose:
To protect against cold injuries such as frostbite and trench foot.

#### Steps:
1. Wear layers of loose clothing.
- This helps trap body...
cold injury prevention,frostbite,trench foot,warmth,layered clothing,blood circulation
Identify Contributing Factors to Cold Injuries
Standard Source: FM 4 25 11 First Aid
Procedure:

1. Recognize Environmental Conditions: Understand that contributing factors include moderately cold temperatures combined with wet or windy conditions.
2. Assess Individual Readiness: Evaluate the individual's level of...
contributing factors, cold injuries, personal hygiene, exercise, foot care, hand care, protective clothing
Prevent Cold Injuries in Moderately Cold Conditions
Standard Source: FM 4 25 11 First Aid
Procedure:

1. Understand Risk Factors: Recognize that cold injuries are most likely to occur when conditions are moderately cold, but accompanied by wet or windy conditions.

2. Maintain Discipline and Training: Ensure all service...
cold injuries, prevention, frostbite, hypothermia, cold weather, protective clothing, personal hygiene
Prevent Freezing Dry Cold Injuries
Standard Source: NAVMED P 5010 US Navy Manual of Preventive Medicine
Procedure:

1. Maintain whole body insulation.
- Wear multiple layers of clothing to trap heat and protect against subfreezing temperatures.
- Use materials that provide good thermal insulation, such as wool or synthetic fibers.

2....
freezing cold injuries,dry cold injuries,whole body insulation,wind chill,body heat loss,cold exposure prevention
Prevent Non-Freezing Wet Cold Injuries
Standard Source: NAVMED P 5010 US Navy Manual of Preventive Medicine
Procedure:

1. Keep clothing and exposed extremities dry.
- Avoid prolonged exposure to cold water, dampness, or high humidity.
- Use waterproof outer layers to prevent moisture from penetrating clothing.
- Change into dry clothing...
cold injury prevention,wet cold injuries,non-freezing cold injuries,humidity,body heat loss,protective gear
Understand Environmental Factors Affecting Cold Injury Risk
Standard Source: NAVMED P 5010 US Navy Manual of Preventive Medicine
Procedure:

1. Assess ambient air temperature.
- Understand that body heat loss increases as temperatures decrease.
- Be aware that cold injuries can occur even in the 50 degree F. range depending on other factors.

2. **Monitor...
environmental factors,cold injury risk,ambient temperature,humidity,wind velocity,body heat loss,field conditions
Prevent Cold Injuries in Military Operations
Standard Source: NATO Emergency War Surgery
Objective: Minimize the occurrence of cold injuries during military operations.

Procedure:
1. Train soldiers for cold weather operations: Ensure all personnel are trained to operate effectively in cold environments, including techniques...
cold injury prevention, military operations, cold weather training, dry clothing, shelter, hydration, thermoregulation

Nerve Agent Poisoning (12)

Administer Antidote Treatment Nerve Agent Autoinjector (ATNAA) with Buddy Assistance
Critical Source: Full First Aid Manual FM 2111
Procedure for Administering ATNAA with Buddy Assistance:

1. Assess the casualty's condition: Ensure the casualty is experiencing symptoms of nerve agent poisoning and is unable to self-administer the antidote.
2. Select injection site:
...
buddy aid, nerve agent, autoinjector, injection site, thigh, buttock, paralysis, first aid
Administering MARK I Antidote for Nerve Agent Poisoning
Critical Source: FM 4 25 11 First Aid
Procedure:

1. Obtain one MARK I from your protective mask carrier, pocket of the MOPP overgarment, or other location as specified in your unit tactical standing operating procedure (TSOP).
2. Check injection site: The injection site is...
MARK I, nerve agent poisoning, self-administration, atropine, 2 PAM Cl, injection site, antidote
Choosing the Correct Injection Site for Nerve Agent Antidote Administration
Critical Source: FM 4 25 11 First Aid
Procedure:

1. Determine body type: If you are not thinly built, use the outer thigh muscle as the injection site. This is located about a hand’s width above the knee to a hand’s width below the hip joint (Figure 7-6).
2. **If you are thinly...
injection site, thigh, buttock, nerve agent poisoning, antidote administration
Precautions for Administering Nerve Agent Antidotes
Critical Source: FM 4 25 11 First Aid
Procedure:

1. Wear protective gear at all times when administering antidotes to prevent exposure.

2. Do not cover or hold the needle end with your hand, thumb, or fingers—you might accidentally inject yourself.

3. **Ensure injection...
precautions, nerve agent antidote, self-administration, injection site safety
Preventing Accidental Self-Injection During Nerve Agent Antidote Administration
Critical Source: FM 4 25 11 First Aid
Procedure:

1. Never cover or hold the needle end with your hand, thumb, or fingers during administration.
2. Ensure that the injection is administered directly into the muscle, not through the skin or into a body part such as the...
accidental injection, safety, nerve agent antidote administration
Administer CANA Injection
Critical Source: STP 21 1 Army Warrior Skills Level 1 Soldiers Manual of Common Tasks
Steps to Administer the CANA Injection:

1. Push the injector into the muscle with firm, even pressure until it functions.
2. Hold the injector in place for at least 10 seconds.
CANA injection, nerve agent antidote, administration procedure
Mask the Casualty During Nerve Agent Exposure
Critical Source: STP 21 1 Warrior Skills Level 1
Steps:

• Ensure the casualty is wearing a mask to prevent further inhalation of nerve agent.
Note: This step is essential for both self-aid and buddy aid scenarios.
masking casualty, nerve agent exposure, protective gear
Perform Sequence of Steps for Nerve Agent Antidote Administration
Critical Source: STP 21 1 Warrior Skills Level 1
Steps:

• Perform steps 1 through 12 in the correct sequence:
1. Identify mild symptoms.
2. React to chemical hazard.
3. Administer nerve agent antidote.
4. Decontaminate skin if necessary.
5. Put on remaining protective clothing.
6....
sequence of steps, nerve agent antidote, emergency protocol
React to Chemical Hazard During Nerve Agent Poisoning
Critical Source: STP 21 1 Army Warrior Skills Level 1 Soldiers Manual of Common Tasks
Steps to React to a Chemical Hazard:

• Immediately mask up using the mask carrier.
• Ensure that all protective clothing is worn as per MOPP (Mission Oriented Protective Posture) guidelines.
• Avoid further exposure to the chemical agent.
chemical hazard response, MOPP guidelines, mask up
Seek Medical Aid After Nerve Agent Antidote Administration
Critical Source: STP 21 1 Army Warrior Skills Level 1 Soldiers Manual of Common Tasks
Steps to Seek Medical Aid:

1. Ensure the casualty is stable and has received appropriate initial treatment.
2. Immediately seek medical aid by contacting emergency services or a trained medical professional.
medical aid, nerve agent poisoning, emergency response
Disposal of Used Antidote Injectors After Nerve Agent Poisoning Treatment
High Priority Source: FM 4 25 11 First Aid
Procedure:

1. Bend the needle of each used injector by pressing on a hard surface to form a hook.
2. Attach all used injectors to the blouse pocket flap of BDO/JSLIST (Figure 7-9).
3. Ensure that all used injectors are securely fastened...
disposal, used injectors, nerve agent poisoning, safety protocols
Decontaminate Casualty's Skin (if Necessary)
High Priority Source: STP 21 1 Army Warrior Skills Level 1 Soldiers Manual of Common Tasks
Steps to Decontaminate the Casualty's Skin:

• Use appropriate decontamination procedures as outlined in task 031-503-1013.
• Ensure that all contaminated areas are thoroughly cleaned.
decontamination, skin cleaning, nerve agent antidote

Oral Health (12)

Assess and Refer for Persistent Sore or Suspected Oral Cancer
Critical Source: Where There is No Dentist
When to refer for medical help:

• If a sore in the mouth does not get better after proper care.
• If there is suspicion of oral cancer (e.g., persistent sores, unusual lumps, or changes in the mouth).

What to do:
1. Send the person for...
sore, oral cancer, medical referral, biopsy, persistent sore
Antibiotic Treatment for Severe Mouth Ulcers
Standard Source: Where There is No Dentist
Procedure:

Give antibiotics if both of the following are true:

• The skin around the ulcer is very swollen.
• You feel soft lumps (lymph glands) underneath the lower jaw bone.

Options for antibiotic treatment:

1. Amoxicillin:...
mouth ulcers,antibiotics,treatment,severe sores,lymph glands
Managing Dry or Painful Mouth and Throat in AIDS Patients
Standard Source: Where There is No Dentist
Steps to manage dry or painful mouth and throat:

1. Eat soft foods: Choose foods that are easy to chew and swallow, such as mashed potatoes, cooked vegetables, or well-cooked meats.
2. Cook foods until they are soft and tender: This...
dry mouth,painful throat,AIDS,easy to swallow,hydration,oral care
Oral Thrush Treatment Using Clotrimazole Vaginal Insert
Standard Source: Where There is No Dentist
Procedure:

1. Gently scrub the tongue and gums with a clean cloth or soft toothbrush 3 or 4 times a day.
2. Rinse the mouth with salt water and spit it out (do not swallow).
3. Cut or break a 100 mg clotrimazole vaginal insert into two...
thrush,clotrimazole vaginal insert,mouth infection,oral thrush,treatment
Oral Thrush Treatment Using Fluconazole (Stronger Medicine)
Standard Source: Where There is No Dentist
Procedure:

1. Take 400 mg of fluconazole by mouth.
2. The next day, take 200 mg of fluconazole once each day for 14 days.
3. If you do not feel better in 3 to 5 days, increase the dose to 400 mg once each day.

Important: Do...
thrush,fluconazole,mouth infection,oral thrush,treatment,strong medicine
Oral Thrush Treatment Using Nystatin Solution
Standard Source: Where There is No Dentist
Procedure:

1. Gently scrub the tongue and gums with a clean cloth or soft toothbrush 3 or 4 times a day.
2. Rinse the mouth with salt water and spit it out (do not swallow).
3. Put 2.5 ml (½ teaspoon) of nystatin solution in the mouth and...
thrush,nystatin solution,mouth infection,oral thrush,treatment
Treating Thrush in the Mouth
Standard Source: Where There is No Dentist
Procedure:

1. Identify and address underlying causes such as malnutrition, diabetes, anemia, or prolonged antibiotic use. Clean dentures thoroughly and remove them from the mouth for a while if necessary.

2. Cover white patches with **nystatin...
thrush, nystatin, gentian violet, dentures, antibiotics, oral infection, mouth sores
Treatment of Mouth Ulcers with Povidone Iodine
Standard Source: Where There is No Dentist
Procedure:

1. Clean the sores in the mouth using a cotton swab dipped in 1% povidone iodine.
2. Repeat this process as needed to keep the area clean and help the skin heal.
3. Use any of the methods described in the “General Treatment” box...
mouth ulcers,povidone iodine,treatment,oral sores,ulcer care
Managing Canker Sores in the Mouth
Standard Source: Where There is No Dentist
Procedure:

1. Recognize canker sores as white or yellow lesions with red borders on the cheeks, lips, tongue, or below the gums.

2. These sores typically resolve on their own within 10 days and are not accelerated by medication. However,...
canker sores, oral ulcers, salt water rinse, denture adjustment, penicillin
Treating Oral Sores with Sulfur and Petroleum Jelly
Standard Source: Where There is No Dentist
Procedure:

1. Wash the sores with soap and hot water.

2. Mix 1 part sulfur with 10 parts of petroleum jelly (Vaseline).

3. Smear some of the mixture on the sores 3–4 times a day.
sores,treatment,sulfur,petroleum jelly,Vaseline,oral care
Rinse Mouth for White Coating on Tongue or Roof of the Mouth
Reference Source: Where There is no Doctor a Village Health Care Handbook
Procedure:

1. Prepare a solution by mixing warm water with salt and bicarbonate of soda.
2. Use this solution to rinse the mouth several times a day.
3. This helps reduce the white coating caused by illness or fever.

Notes:
• The...
mouth rinse, white coating, tongue, fever, oral hygiene
Treating Sores at the Corners of the Mouth
Reference Source: Where There is No Dentist
Procedure:

1. Identify sores at the corners of the mouth as often caused by dehydration, malnutrition, or a poorly fitting denture.

2. Treat with nystatin if thrush is suspected (see page 105). If sores are around the mouth...
corners of mouth sores, dehydration, malnutrition, dentures, nystatin, oral infection

Animal Medical Procedures (11)

Cure for Swimming in the Head in Animals
High Priority Source: The Household Cyclopedia
Swimming in the Head is a disease that affects animals kept in poverty and starvation during winter and then moved to fertile pastures in spring. It causes an excess of blood and fluids pressing on contracted vessels.

Treatment Steps:
1....
swimming in the head, animal disease, bleeding, purging drink
Paunching Procedure
High Priority Source: The Household Cyclopedia
Paunching is a method used in dangerous cases to relieve internal pressure. Follow these steps:

1. Take a sharp penknife and gently introduce it into the paunch between the haunch bone and the last rib on the left side.
2. This will instantly...
paunching, animal emergency, fetid air evacuation, pitch plaster, opiate drink
Prepare Alterative Balls for Surfeit, Mange, etc.
High Priority Source: The Household Cyclopedia
Ingredients:
• Precipitated sulphur of antimony: 1 ounce (fine powder)
• Gentian root: 1 ounce (fine powder)
• Socotrine aloes: 1 ounce (fine powder)
• Nitre: 2 ounces
• Calomel (powdered): 2 drachms
• Honey or treacle: sufficient to make into...
alterative ball,surfeit,mange,honey,treacle
Prepare Astringent Ball for Profuse Staling
High Priority Source: The Household Cyclopedia
Ingredients:
• Galls (fine powder): 2 drachms
• Peruvian bark: 1/2 ounce
• Honey or treacle: sufficient to make into a ball

Procedure:
1. Mix the galls and Peruvian bark together.
2. Make into a ball using honey or...
astringent ball,staling,honey,treacle,urine reduction
Prepare Clyster for Convulsions
High Priority Source: The Household Cyclopedia
Ingredients:
• Linseed: 4 ounces
• Valerian root: 4 ounces
• Epsom salts: 4 ounces
• Assafoetida: 1/2 ounce
• Opium: 2 drachms
• Water: 3 quarts

Procedure:
1. Boil linseed and valerian root in 3 quarts of water until reduced to 4 pints.
2....
clyster for convulsions,colic treatment,valerian root,epson salts
Prepare Drink for Worms
High Priority Source: The Household Cyclopedia
Ingredients:
• Barbadoes aloes: 3 to 6 drachms (depending on size and strength)
• Wormseed (powdered): 1/2 an ounce
• Gentian (powdered): 1/2 an ounce
• Caraway seeds (powdered): 1 ounce
• Strong decoction of wormwood: 1 pint

Procedure:
1....
worms,drink,wormwood,barbadoes aloes
Prepare Mercurial Ball for Worms
High Priority Source: The Household Cyclopedia
Ingredients:
• Calomel: 1 drachm
• Castile soap: 1 drachm
• Wormseed (powdered): 1/2 an ounce
• Syrup of buckthorn: sufficient quantity

Procedure:
1. Mix the calomel, Castile soap, and wormseed together.
2. Beat them into a ball using syrup...
mercurial ball,worms,calomel,syrup of buckthorn
Prepare Pectoral Balls for Broken Wind
High Priority Source: The Household Cyclopedia
Ingredients:
• Barbadoes tar: 2 ounces
• Venioe turpentine: 2 ounces
• Castile soap: 2 ounces
• Squills (powdered): 1 ounce
• Nitre: 2 ounces
• Aniseeds and caraway seeds (fresh powdered): 1 ounce each
• Honey: sufficient quantity
• Liquorice...
pectoral ball,broken wind,barbadoes tar,turpentine,squills,honey
Prepare Restorative Balls after Jaundice
High Priority Source: The Household Cyclopedia
Ingredients:
• Gentian and caraway seeds (powdered): 8 ounces each
• Powdered ginger: 6 drachms
• Castile soap: 1 1/2 ounces
• Honey: sufficient to form into 6 balls

Procedure:
1. Mix the ingredients together.
2. Form them into six balls...
restorative ball,gentian,caraway seeds,honey,jaundice recovery
Prepare Restorative Balls for Profuse Staling
High Priority Source: The Household Cyclopedia
Ingredients:
• Gentian root (powdered): 1/2 an ounce
• Powdered ginger: 2 drachms
• Alum: 1 drachm
• Treacle: sufficient to make into a ball

Procedure:
1. Mix the gentian root, powdered ginger, and alum together.
2. Make into a ball using...
restorative ball,staling,gentian root,treacle
Prepare Stomach Drink after the Expulsion of the Worms
High Priority Source: The Household Cyclopedia
Ingredients:
• Aromatic spirit of ammonia: 1 ounce
• Sweet spirit of nitre: 1 ounce
• Gentian root (powdered): 1 1/2 ounces
• Peruvian bark (powdered): 1/2 an ounce
• Biera picra (powdered): 1/2 an ounce
• Horse-spice: 2 ounces
• Ale: 3...
stomach drink,worms recovery,horse restoration,gentian root

Anatomy (11)

Fascia Definition and Description
Standard Source: Medical Survival Wound Closure Manual
Fascia refers to areolar tissue layers under the skin (superficial fascia) or fibrous tissue between muscles and forming sheaths of muscles or investing other structures such as nerves or blood vessels (deep fascia).
fascia, superficial fascia, deep fascia, tissue layers, anatomy
Identify Arteries of the Human Body
Reference Source: The Household Cyclopedia
Procedure:

Identify and label the following arteries in the human body as illustrated:

• 1: Tarsal artery
• 2: Peroneal artery
• 3: Posterior tibial artery
• 4: Anterior tibial artery
• 5: Femoral artery
• 6: Iliac artery
• 7: Sacral artery
-...
human anatomy,artery identification,blood vessels
Identify Bones of the Arm and Shoulder
Reference Source: The Household Cyclopedia
Procedure:

Examine and identify the following bones in the arm and shoulder as illustrated:

Humerus (1): The long bone in the upper arm.
Radius (2): One of the two bones in the forearm, on the thumb side.
Ulna (3): One of the...
arm anatomy,bone identification,shoulder structure
Identify Bones of the Human Skeleton
Reference Source: The Household Cyclopedia
Procedure:

Examine and identify the bones in the human skeleton as illustrated:

• Identify major bones such as the skull, vertebrae, ribs, sternum, clavicle, scapula, humerus, radius, ulna, carpals,...
human skeleton,bone identification,anatomy
Identify Kidney Anatomy and Structures
Reference Source: The Household Cyclopedia
Procedure:

Examine and identify the following structures of the kidney as illustrated:

Suprarenal capsule (a): The outer covering of the adrenal gland, which sits atop the kidney.
Cortical substance of the kidney (b, b): The outer...
kidney anatomy,structure identification,renal system
Identify Nasal Fossae Anatomy
Reference Source: The Household Cyclopedia
Procedure:

Examine and identify the following structures of the nasal fossae as illustrated:

Last Lumbar Vertebra: The final vertebra in the lumbar region.
Ilium: Part of the pelvis, visible in this illustration.
• **Os Coccygis...
nasal anatomy,nasal fossae,structure identification
Identify Pelvis Anatomy
Reference Source: The Household Cyclopedia
Procedure:

Examine and identify the following structures of the pelvis as illustrated:

Ilium: The broad, flaring portion of the hip bone.
Ischium: The lower, posterior part of the hip bone.
Pubis: The anterior portion of the...
pelvis anatomy,bone identification,hip structure
Identify Salivary Glands and Related Structures
Reference Source: The Household Cyclopedia
Procedure:

Examine and identify the following structures related to the salivary glands as illustrated:

Parotid gland: The largest of the salivary glands, located near the ear.
Submaxillary gland (Submandibular gland): Located...
salivary glands,anatomy,structure identification
Identify Teeth and Their Positions in the Jaw
Reference Source: The Household Cyclopedia
Procedure:

Examine and identify the following types of teeth as illustrated:

Incisors (a, a): Front teeth used for cutting.
Canine (b, b): Sharp, pointed teeth used for tearing.
Premolars (c, c): Teeth between molars and...
dental anatomy,teeth identification,jaw structure
Identify Thoracic and Abdominal Cavities Anatomy
Reference Source: The Household Cyclopedia
Procedure:

Examine and identify the following structures in the thoracic and abdominal cavities as illustrated:

Heart (1): The muscular organ responsible for pumping blood.
Lungs (2, 2): Organs involved in respiration, drawn...
thoracic anatomy,abdominal cavities,organ identification
Understanding Mandible and Maxilla Bones
Reference Source: Where There is No Dentist
- Mandible is the lower jaw bone.
Maxilla is the upper jaw bone.
mandible, maxilla, jaw bones, dental anatomy

Medicine Safety (11)

Avoid the Most Dangerous Misuse of Medicine
Critical Source: Where There is no Doctor a Village Health Care Handbook
The most dangerous misuse of medicine causes many deaths each year. Be careful to avoid these common errors:

1. Chloramphenicol (Chloromycetin):
- Use only for very severe illnesses, like typhoid.
- **Never give it to newborn...
dangerous medicine misuse, chloramphenicol, oxytocin, gentamicin, penicillin safety
Avoid Injections for Mild Conditions
Critical Source: Where There is no Doctor a Village Health Care Handbook
Injections are not always better than oral medicines and may be more dangerous in some cases.

Example: Injections given to a child with mild polio (only signs of a cold) can lead to paralysis.
• Use injections only when absolutely...
injection safety, mild conditions, injection risks, polio treatment
Avoid Overuse of Gentamicin and Kanamycin in Newborns
Critical Source: Where There is no Doctor a Village Health Care Handbook
Overuse of gentamicin (Garamycin) and kanamycin can cause permanent hearing loss (deafness) in millions of babies.

• These antibiotics should be used only for life-threatening infections.
• For many newborn infections, ampicillin is a safer...
gentamicin, kanamycin, newborn safety, hearing loss, antibiotic use in babies
Avoid Using Dangerous Medicines for Mild Illnesses
Critical Source: Where There is no Doctor a Village Health Care Handbook
Never use a dangerous medicine for a mild illness.

Some medicines are much more dangerous than others. For example, chloramphenicol (Chloromycetin) can be extremely risky when used for simple illnesses like colds or diarrhea. It has been...
chloramphenicol, medicine safety, dangerous medicines, mild illness, newborns
Avoid Using Penicillin for Non-Infectious Conditions
High Priority Source: Where There is no Doctor a Village Health Care Handbook
Penicillin works only against certain types of infections and should not be used for non-infectious conditions like sprains, bruises, pain, or fever.

Do not use penicillin for colds.
• Injuries that do not break the skin (even if they...
penicillin use, infection treatment, non-infectious conditions, antibiotic misuse
Follow Guidelines for the Use of Medicine
High Priority Source: Where There is no Doctor a Village Health Care Handbook
Guidelines for the use of medicine:

1. Use medicines only when necessary.
2. Know the correct use and precautions for any medicine you use (see the GREEN PAGES).
3. Be sure to use the right dose.
4. If the medicine does not help, or...
medicine guidelines, safe medicine use, health worker consultation, correct dosage
Recognizing and Avoiding Unnecessary or Harmful Medicines
High Priority Source: A Book for Midwives
Some healers and health workers may recommend unnecessary, ineffective, or even dangerous treatments due to greed. Similarly, some companies may mislead the public by promoting medicines that do not work or cause harm. For example, the drug...
unnecessary_medicine,harmful_treatments,greed,DES
Correct Use of Western Medicines to Avoid Harm
Standard Source: A Book for Midwives
Western medicines are usually effective but can be expensive and have side effects. It is important to use them correctly and only when necessary. For example, unnecessary injections may cause abscesses or spread diseases like HIV if given with...
western_medicine,correct_use,safe_administration,side_effects
Assessing the Safety and Effectiveness of Medicines Before Use
Standard Source: A Book for Midwives
Before giving any medicine (traditional or Western), ensure it is safe and helpful by considering the following questions:

What is it used for?
What happens when you use it?
How often does it help make a problem better?
• **What...
safety,effectiveness,medicine,traditional,western
Understand Medicine Usage Guidelines and Safety
Reference Source: A Book for Midwives
Procedure:

• Learn about the proper timing for taking medicines (e.g., with food or on an empty stomach).
• Understand contraindications: certain medicines are not safe for specific individuals. For example:
- A woman with high blood pressure...
medicine safety,drug contraindications,ergometrine,blood pressure
Understand Generic and Brand Medicine Names
Reference Source: A Book for Midwives
Procedure:

• Know that medicines have two names: a generic (scientific) name and one or more brand names.
• The generic name is the same worldwide, while brand names vary by manufacturer.
• In this book, we use generic names. Any...
generic names,brand names,medicine substitution

Neonatal Assessment (11)

Assess Baby's Breathing Patterns and Rate
High Priority Source: A Book for Midwives
Procedure:

1. Observe the baby’s breathing closely.
2. If you notice that the skin between or under the ribs is sucking in during inhalation, this indicates difficulty breathing (see page 241).
3. Listen to the baby’s breathing...
breathing,rate,respiratory_rate,baby,medical_advice
Examine Baby's Genitals and Anus for Abnormalities
High Priority Source: A Book for Midwives
Procedure:

1. Inspect the baby’s genitals, noting that all babies’ genitals appear swollen after birth, especially if the baby was born breech.
2. Ensure the anus is an open passage and not covered by skin or tissue.
3. If the baby has...
genitals,baby,anus_abnormality,medical_advice
Assess Baby's Belly and Umbilical Hernia
High Priority Source: A Book for Midwives
Procedure:

1. Examine the baby’s belly visually for any abnormalities.
2. Observe how the area around the umbilical cord behaves when the baby cries; if the skin bulges outward, this may indicate an umbilical hernia.
3. If you suspect...
belly,umbilical_hernia,cord_infection,baby,medical_advice
Assess Baby's Testicles and Penis for Abnormalities (For Boys)
High Priority Source: A Book for Midwives
Procedure:

1. Examine the baby’s scrotum, which is the sac under the penis.
2. Inside the scrotum, you should be able to feel two smooth, firm testicles that will eventually produce sperm.
3. During pregnancy, these testicles form...
testicles,baby,penis_abnormality,medical_advice
Check Baby's Arms, Hands, and Shoulders for Injuries
High Priority Source: A Book for Midwives
Procedure:

1. Examine the baby’s arms and hands visually to ensure they look normal.
2. Observe whether the baby can move them normally.
3. Feel the shoulders, collarbone, and arms for any signs of injury such as lumps or deformities...
arm_injury,baby,broken_bone,medical_advice
Check Baby's Nose and Mouth for Breathing and Reflexes
High Priority Source: A Book for Midwives
First check if the baby can breathe easily through his nose:

• If not, try suctioning the baby (see page 213).

Then, gently stroke the baby’s cheek. He should turn his head toward your finger. This is called the rooting reflex.

Put a very...
baby,nose,mouth,breathing,rooting reflex,sucking reflex,medical help
Listen to Baby's Heart Sounds
High Priority Source: A Book for Midwives
Procedure:

1. If available, use a stethoscope or fetoscope to listen to the baby’s heart sounds.
2. Even if you are not skilled in identifying normal heart sounds, listen regularly and compare over time to recognize any changes.
3. If...
heart_sounds,listening,baby,medical_advice
Assess Baby's Eyes for Normalcy and Blood in the White Part
Standard Source: A Book for Midwives
Look at the baby’s eyes:

• Notice if they seem normal.
• Check if they move together.
• A little bit of blood under the surface of the white part of the eye is normal.
• The blood should go away in a few days.
baby,eyes,blood,assessment
Check Baby's Ears for Position and Potential Health Issues
Standard Source: A Book for Midwives
To check the baby’s ears:

1. Look straight into her face.
2. Imagine a line across her eyes.
3. Some part of each ear should be above this line.

If both ears are below the line, the baby may have kidney problems and you should get medical...
baby,ears,assessment,kidney issues,medical advice
Check Baby's Hearing
Standard Source: A Book for Midwives
To check the baby’s hearing:

1. Softly clap near the baby’s ear.
2. Most babies will move when they hear a sound.
3. If the baby does not seem to hear, get medical advice.
baby,hearing,test,medical advice
Check Baby's Neck for Swelling and Lumps
Standard Source: A Book for Midwives
Procedure:

1. Inspect the baby’s neck carefully for any signs of swelling or lumps.
2. Assess movement by checking if the baby’s head moves freely.
3. If you find any abnormalities, such as swelling, lumps, or restricted movement,...
neck,swelling,lumps,baby,medical_advice

Infection Management (11)

Manage Infection After Vascular Repair
Critical Source: NATO Emergency War Surgery
Procedure:

1. Recognize infection as a serious complication after vascular repair.
2. If the wound is infected and contains an arterial repair:
- Do not attempt secondary repair within the infected site.
3. Consider **bypassing the...
infection,vascular repair,wound infection,amputation,ligation
Recognizing and Managing Womb Infections After Birth
Critical Source: A Book for Midwives
Objective: Identify and manage signs of a postpartum womb infection to prevent life-threatening complications.

Healthy Signs:
• Normal body temperature around 37°C (98.6°F).

Warning Signs (Seek Immediate Help):
Fever of 38°C...
womb infection, postpartum fever, antibiotics, infection signs
Administer Broad-Spectrum Intravenous Antibiotics for Sepsis
Critical Source: Emergency War Surgery
Treatment: Broad-spectrum intravenous antibiotics are required until the source is identified and pathogens isolated.

Suitable regimens include:
Imipenem, 500 mg every 6 hours
Piperacillin and tazobactam (Zosyn), 3.375 g every 6...
antibiotics, sepsis treatment, imipenem, zosyn, ceftazidime, cefepime, gentamicin, ciprofloxacin, vancomycin, linezolid
Hip Wound Management and Considerations
Critical Source: Emergency War Surgery
Special Considerations for Hip Wounds:

• Open injuries of the hip joint are problematic due to:
- Difficulty in diagnosis.
- Highly virulent organisms leading to mortality or long-term morbidity.

• Violations of hollow viscus...
hip wounds,open hip injuries,difficulty diagnosis,virulent organisms,mortality,morbidity,hollow viscus contamination,joint exploration,presacral drainage
Identify and Eradicate the Source of Sepsis
Critical Source: Emergency War Surgery
Importance: Identifying and eradicating the source is the most important factor in determining the outcome.

Potential sources of occult infection include:
• An undrained collection of pus (e.g., wound infection, intraabdominal abscess,...
sepsis source identification, wound infection, abscess, ventilator pneumonia, urinary tract infection, fungal infection, catheter infection, cholecystitis
Management of Septic Shock
Critical Source: NATO Emergency War Surgery
Procedure for Managing Septic Shock in a Surgical Patient

1. Prompt Identification and Treatment of Infection:
- Identify the source of infection as soon as possible.
- If the infection is amenable to surgical control, perform...
septic shock, antibiotic therapy, fluid resuscitation, vasoconstrictive drugs, dopamine infusion, surgical debridement, crystalloid solution, colloid-containing fluids, Swan-Ganz catheter, pulmonary insufficiency, oxygen delivery
Post-Treatment Care After Removing Tissue from an Incomplete Abortion
Critical Source: A Book for Midwives
Procedure:

• Feel the womb from the outside to see if it is soft.
• Rub the womb every few hours to keep it hard (see page 224).
• Watch for signs of infection (see below).

Infection Signs and Treatment:
• A woman with an infection in the...
post-treatment care, infection signs, sepsis, shock, medical emergency
Recognize Signs of Joint Sepsis
Critical Source: Emergency War Surgery
Signs of Joint Sepsis:

Persistent swelling.
Marked pain.
Local warmth.
Fever.
Intense pain with restriction of the range of motion.

If any of these signs are present, immediate joint exploration/re-exploration is...
joint infection,joint sepsis,persistent swelling,marked pain,local warmth,fever,intense pain,restriction of motion
Recognizing and Treating Infected Wounds
High Priority Source: Where There is no Doctor a Village Health Care Handbook
Signs of an Infected Wound:

• The wound becomes red, swollen, hot, and painful.
• It has pus.
• Or it begins to smell bad.

Signs that the infection is spreading to other parts of the body:

• It causes fever.
• There is...
infected wound,signs of infection,wound care,lymph nodes
Recognizing and Managing Infected Joints in Arthritis Patients
High Priority Source: Where There is no Doctor a Village Health Care Handbook
Signs of Infection: If only one joint is swollen, feels hot, or if there is fever, it may be infected.

Management:
• Use an antibiotic such as penicillin (see p. 350 for dosage and administration).
• Seek medical help from a health...
infected joints, arthritis infection, antibiotic use
Treating Yeast Infection with Gentian Violet or Medicinal Inserts
Standard Source: A Book for Midwives
Procedure:

If natural remedies do not work, try the following treatments:

Gentian Violet Method:
- Use a 1% liquid gentian violet solution.
- Soak a clean piece of cotton in the solution to make a vaginal insert.
- Place the insert...
yeast infection, gentian violet, miconazole, nystatin, clotrimazole, vaginal treatment

Breastfeeding (11)

HIV and Breastfeeding Considerations
High Priority Source: A Book for Midwives
### Procedure: HIV and Breastfeeding Considerations

Steps:
1. Mothers who are breastfeeding should protect themselves from becoming infected with HIV.
2. Refer to page 334 of the source material for information on preventing HIV infection.
3....
HIV,breastfeeding,transmission,safety
Safe Breastfeeding Practices for Mothers with HIV
High Priority Source: A Book for Midwives
### Procedure: Safe Breastfeeding Practices for Mothers with HIV

Steps:
1. Give only breast milk for the first 6 months. Mixing breast milk with formula or other foods increases infection risk.
2. Stop breastfeeding completely after 6...
HIV,breastfeeding,safe practices,treatment
Managing a Painful Lump in the Breast (Abscess)
High Priority Source: A Book for Midwives
Procedure:

Breastfeed frequently every 1 or 2 hours, starting with the sore breast.
• If breastfeeding is not possible, remove milk by hand to prevent further blockage.
Stay in bed and keep the baby close so that feeding can...
abscess, breast lump, pain relief, vinegar remedy, cabbage leaves, breastfeeding with abscess
Medicines and Breastfeeding Safety
High Priority Source: A Book for Midwives
### Procedure: Medicines and Breastfeeding Safety

Steps:
1. If possible, breastfeeding mothers should avoid taking drugs or medicines.
2. Some medications are safe to take while breastfeeding; others are not.
3. Most of the medicines listed in...
medicines,breastfeeding,safety,drug labels
Feeding Small or Early Babies with Breast Milk
Standard Source: A Book for Midwives
### Procedure: Feeding Small or Early Babies with Breast Milk

Steps:
1. Most small and early babies require breast milk for nourishment.
2. If the baby is too weak to suckle directly from the breast, the mother should:
- Remove milk by...
small babies,early babies,breast milk,cup feeding
Managing Engorged (Swollen) Breasts
Standard Source: A Book for Midwives
Procedure:

Increase the frequency of breastfeeding both day and night, every 1 or 2 hours on both breasts.
Apply hot, wet cloths to the breasts for 15 to 20 minutes before each feeding to help soften the breast.
• **Use ice, cool...
engorged breasts, breast swelling, hot compresses, ice application, cabbage leaves
Breastfeeding Twins
Standard Source: A Book for Midwives
### Procedure: Breastfeeding Twins

Steps:
1. A mother can breastfeed both babies at the same time or one at a time.
2. The more a mother breastfeeds, the more milk her body will produce.
3. Mothers with twins require additional rest, food,...
twins,breastfeeding,milk production,support,positions
Breastfeeding While Pregnant
Standard Source: A Book for Midwives
### Procedure: Breastfeeding While Pregnant

Steps:
1. It is safe for a mother to breastfeed while pregnant or to breastfeed an older child and a new baby.
2. The mother should consume more food and get adequate rest.
3. Always feed the new baby...
pregnancy,breastfeeding,nutrition,rest
Breastfeeding While Sick
Standard Source: A Book for Midwives
### Procedure: Breastfeeding While Sick

Steps:
1. It is usually best for a mother to continue breastfeeding even when she is sick.
2. To prevent becoming more ill, the mother should:
- Drink plenty of fluids.
- Lie down while...
sickness,breastfeeding,fluid intake,rest
Managing Flat or Inverted Nipples for Breastfeeding
Standard Source: A Book for Midwives
Procedure:

If the breasts are very full, remove some milk by hand to make them softer.
Gently roll the nipple to help it stand out.
Cup a hand around the breast and pull back towards the chest. This can help the nipple pop...
flat nipples, inverted nipples, breastfeeding technique, hand expression, latching on
Addressing Fear of Not Having Enough Breast Milk
Reference Source: A Book for Midwives
Procedure:

Assure the mother that it is almost never true that a woman does not have enough breast milk.
Encourage frequent breastfeeding. The more a baby suckles, the more milk a mother’s breasts will make.
• **Do not give solid...
breast milk, breastfeeding, fear of not enough milk, baby weight gain, urination frequency, nutrition

Shock Management (11)

Recognize and Respond to Shock
Critical Source: Medical Emergencies
Procedure:

Step 1. Recognize signs of shock:
• Pale or clammy skin.
• Rapid, weak pulse.
• Shallow breathing.
• Confusion or loss of consciousness.
• Extreme thirst or dry mouth.

Step 2. Keep the victim calm and reassured to prevent...
shock symptoms, shock management, hypothermia prevention, body temperature regulation
Recognize and Respond to Shock After Abortion or Miscarriage
Critical Source: A Book for Midwives
Procedure:

Signs of shock:
Feeling faint, dizzy, weak, or confused.
Pale skin with cold sweat.
Fast pulse (over 100 beats per minute).
Fast breathing.
Dropping blood pressure.
• **Loss of...
shock,symptoms,treatment,fluids,rehydration
Restore Circulating Volume Deficits (Shock Management)
Critical Source: NATO Emergency War Surgery
Objective: Stabilize the casualty by restoring circulating volume in cases of shock.

Procedure:
1. Assess for signs of shock, such as hypotension, tachycardia, and altered mental status.
2. Start intravenous infusion using two or...
fluid resuscitation, shock management, IV infusion, crystalloid solution
Resuscitation and Surgical Intervention in Trauma Patients with Shock
Critical Source: NATO Emergency War Surgery
Procedure:

1. Initiate Vigorous Resuscitation: Administer fluids, blood products, and oxygen to stabilize patients in shock.
2. Assess for Non-Hemorrhagic Causes of Shock: Consider other causes of shock (e.g., drug overdose, poisoning,...
resuscitation,cardiac arrest,surgical intervention
Avoid Improper Use of Military Antishock Trousers (MAST)
Critical Source: NATO Emergency War Surgery
Procedure:
1. Do not use MAST for shock casualties if evacuation to a definitive medical treatment facility can be delayed.
2. If used, ensure proper inflation pressure does not exceed 100 mm Hg.
3. Monitor the casualty closely and...
military antishock trousers,shock management,compartment syndrome
Circulation Management and Shock Assessment
Critical Source: TCCC 17 13 Army Tactical Combat Casualty Care
Procedure for Circulation Management and Shock Assessment:

1. Assess the casualty for hemorrhagic shock.
2. If the casualty is not in shock, oral fluids are permissible if the casualty is conscious and can swallow.
3. If the casualty is in...
hemorrhagic shock, fluid administration, shock assessment
Initial Management of Hemorrhagic Shock in a Combat Casualty
Critical Source: Emergency War Surgery
Objective: Stabilize the patient by addressing hemorrhagic shock and maintaining perfusion.

Steps for Initial Management:
1. Treat hemorrhagic shock first.
2. Volume resuscitation to maintain systolic blood pressure (BP) > 90 mm...
hemorrhagic shock management, volume resuscitation, vasopressor use, combat casualty care
Manage Cardiovascular Response to Hypovolemia
Critical Source: NATO Emergency War Surgery
Procedure:

1. Identify signs of hypovolemic shock:
- Decreased cardiac filling pressures.
- Decreased systemic arterial pressure.
- Tachycardia.
- Increased systemic vascular resistance due to catecholamine release.
2. Monitor...
hypovolemia, shock management, catecholamines, vascular permeability, anesthetic agents
Manage Shock
Critical Source: SH 21 76 Ranger Handbook
Procedure for Managing Shock

Shock causes an inadequate flow of oxygen to the tissues. Shock can cause bleeding (hemorrhagic) or not (nonhemorrhagic). Signs and symptoms of shock can include increased pulse, increased respiration; and decreased...
shock management, IV initiation, airway management
Managing Shock in an Injured Person
Critical Source: Boy Scout Handbook 1911
Shock is a serious condition that can occur after severe injuries and may lead to death if not treated properly.

Action Steps:
1. Send for a doctor as soon as possible, unless the situation is clearly trivial.
2. While waiting for help,...
shock, first aid, trauma care, emergency response
Estimate Blood Volume Loss in a Combat Casualty
High Priority Source: Emergency War Surgery
Objective: Estimate the percentage of blood volume lost to guide resuscitation.

Blood Volume Estimation:
Blood volume is approximately 7% of body weight.
• For example, a 70 kg patient has a total blood volume of **4,900...
blood volume estimation, combat casualty, shock staging, clinical correlates

Child Health (11)

Recognize and Respond to Dehydration in Children
High Priority Source: Where There is no Doctor a Village Health Care Handbook
Title: Recognize and Respond to Dehydration in Children

Procedure:
1. Understand that dehydration occurs when the body loses more liquid than it takes in, often due to severe diarrhea or vomiting.
2. Be aware that dehydration is especially...
dehydration, children, diarrhea, rehydration, oral rehydration solution, emergency response
Recognizing Signs and Symptoms of Flu in Children
High Priority Source: Flu Home Treatment
One of the biggest challenges for parents is distinguishing between a cold and bird flu. If bird flu is not in your community, it is very unlikely that your child will be the first case.

The first signs of flu are often:
• A **runny...
flu symptoms in children, child flu signs, bird flu in kids, pediatric flu symptoms, distinguishing flu from cold
Manage Diarrhea in Children Without Unnecessary Medicines
High Priority Source: Where There is no Doctor a Village Health Care Handbook
For diarrhea in children, follow these steps:

1. Ensure the child drinks lots of liquids to prevent dehydration, such as clean water, oral rehydration salts (ORS), or diluted fruit juice.
2. Provide enough food, even if the child has a...
diarrhea management, child health, hydration, ORS, dehydration prevention
Managing Birth Defects and Supporting Parents of Children with Disabilities
High Priority Source: A Book for Midwives
Procedure:

Steps:
1. Identify any birth defects or disabilities in the child.
2. Provide emotional support to parents and families affected by these conditions.
3. Connect parents with appropriate medical resources and specialists.
4. Offer...
birth defects,parent support,disabilities,medical resources
Recognizing and Addressing Malnourishment in Children
High Priority Source: Where There is no Doctor a Village Health Care Handbook
Purpose: To identify signs of malnourishment and take action to improve a child's nutrition.

### Signs of Malnutrition:
Mild cases:
- Slower growth
- Loss of appetite
- Loss of energy
- Paleness (anemia)
- Desire to eat...
malnourishment, child nutrition, signs of malnutrition, treatment for malnutrition
Treating Flu in Children
High Priority Source: Flu Home Treatment
Many differences exist between the way a child and an adult respond to influenza. Many, but not all, of the drugs used for adults are also used for children, but the dose is different.

Dehydration and rehydration are critical in both,...
flu in children, pediatric flu treatment, dehydration in children, child flu management, pediatrician advice
Implement Guidelines of Cleanliness for Children's Health
Standard Source: Where There is no Doctor a Village Health Care Handbook
Follow these guidelines to maintain children's health through cleanliness:

1. Bathe children regularly and change their clothes often.
2. Teach children to wash hands at the following times:
- When they get up in the morning
-...
cleanliness,children's health,latrines,bathing,hookworm,sandals,handwashing,scabies,ringworm,infected children,water safety,bottle feeding
Preventing Malnutrition in Children Through Proper Nutrition
Standard Source: Where There is no Doctor a Village Health Care Handbook
Purpose: To prevent malnutrition by ensuring children receive adequate and balanced nutrition.

### Steps:
1. Provide enough food to the child on a regular basis.
2. Feed more often, especially for younger children or those recovering...
preventing malnutrition, child nutrition, balanced diet, vitamin intake
Providing Cow's Milk and Alternatives During Diarrhea in Children
Standard Source: Where There is no Doctor a Village Health Care Handbook
Cow’s milk, powdered milk, or canned milk can be good sources of energy and protein for children with diarrhea. Continue giving them unless they cause more diarrhea.

If milk worsens diarrhea:
1. Reduce the amount of milk given.
2. **Mix...
cow milk,powdered milk,canned milk,diarrhea,nutrition
Nutritious Food for Children Over 1 Year
Reference Source: Where There is no Doctor a Village Health Care Handbook
Children over 1 year should eat the same foods as adults but more often. This ensures they receive adequate nutrition and energy for growth and development.

### Recommended Foods:
Main food: Rice, maize, wheat, potatoes, or cassava (as...
child nutrition,balanced diet,nutrition for children,feeding guidelines
Nutritious Food for Children from 6 Months to 1 Year
Reference Source: Where There is no Doctor a Village Health Care Handbook
Children between 6 months and 1 year should be fed breast milk along with other nutritious foods. This combination ensures they receive enough calories, vitamins, and minerals for healthy growth.

### Recommended Foods:
Boiled cereals...
infant nutrition,complementary feeding,nutrition for children,breast milk

Blood Management (11)

Administer Blood Infusions for Exsanguinating Casualties
Critical Source: NATO Emergency War Surgery
Procedure:

1. Identify casualties with significant hemorrhage, such as those in shock or with signs of exsanguination (e.g., hypotension, tachycardia, altered mental status).
2. Assess the casualty's hemodynamic stability and determine...
blood transfusion, exsanguination, hemorrhage, shock management
Autotransfusion in Emergency Situations
Critical Source: Emergency War Surgery
Procedure:

• Collect blood into sterile containers (e.g., suction devices, chest tubes) from the patient.

• Return the collected blood to the patient through a blood filter.

Notes:

• This is useful for patients with internal bleeding or...
autotransfusion, field blood reinfusion, emergency transfusion techniques
Blood Collection in Emergency Situations Without a Prescreened Roster
Critical Source: Emergency War Surgery
- Establish blood types using local testing or previous donor history.

• Prefer prior blood donors over nondonors, as they have been tested for infectious diseases.

• Use 'dog tags' only as a last resort to determine blood type.

• In mass...
emergency blood collection, universal donor, mass casualty
Blood Typing and Crossmatching in Emergency Situations
Critical Source: Emergency War Surgery
Procedure:

• Use the white tile method for whole blood crossmatching.

- Mix a drop of donor blood with recipient serum on a white ceramic tile.

- Examine the mixture within 4 minutes using a hand lens if available.

- If no...
field crossmatching, blood typing, emergency transfusion
Storage of Emergency-Drawn Blood Units
Critical Source: Emergency War Surgery
Procedure:

• Store whole blood at room temperature for no longer than 24 hours.

• If stored warm for more than 24 hours, the risk of bacterial growth increases significantly, and clotting factors are lost.

• If stored at room temperature for...
blood storage, emergency blood preservation, field blood handling
Establishing a Prescreened Blood Donor Roster for Emergency Situations
High Priority Source: Emergency War Surgery
Procedure:

• Develop a current prescreened donor roster before deployment.

- Include blood type and Rh factor of each donor.

- Ensure donors are nonreactive to transfusion transmissible disease tests if available.

• Update the...
blood donor roster, prescreened donors, emergency blood management
Labeling and Transport of Blood Bags
High Priority Source: Emergency War Surgery
- Label the bag clearly with the donor’s blood type and identification information.

• Send tubes to a supporting laboratory (if available) for testing, even after-the-fact testing is useful for safety assurance or explanation of untoward events.
blood bag labeling, transport blood samples
Whole Blood Crossmatching Using the White Tile Method
High Priority Source: Emergency War Surgery
- Use a white ceramic tile to mix a drop of donor blood with recipient serum.

• Examine the mixture in 4 minutes for agglutination using a hand lens if needed.

• If no agglutination occurs, the blood is suitable for transfusion into that recipient.
crossmatching, white tile method
Record Keeping for Emergency Blood Transfusions
High Priority Source: Emergency War Surgery
- Keep a record of donors and patients transfused so they can be tested upon return to stateside.

• Document the number of units transfused, donor names, and outcomes.
emergency blood records, transfusion tracking
Future Blood Substitute Research (HBOCs)
Standard Source: Emergency War Surgery
Procedure:

• Hemoglobin-based oxygen-carrying compounds (HBOCs) are being investigated as potential blood substitutes.

• These compounds may be useful in deployed settings due to their stability at various temperatures and low-risk profile.

-...
HBOCs, blood substitutes, future medical technology
Future of Blood Substitutes in Emergency Situations
Standard Source: Emergency War Surgery
- The ideal fluid for shock management would provide volume expansion and oxygen-carrying capacity.

• Hemoglobin-based oxygen carrying compounds (HBOCs) may be suitable for deployed settings as they:

- Require no refrigeration.

- Have a shelf...
HBOC, blood substitute, future medicine

Spinal Injuries (11)

Application of Gardner-Wells Tongs
Critical Source: Emergency War Surgery
Procedure for Applying Gardner-Wells Tongs:

1. Inspect Insertion Site: Select a point just above the apex of each ear. Rule out depressed skull fracture in this area.
2. Shave and Prep Pin Insertion Site.
3. Inject Local Anesthetic:...
Gardner-Wells tongs, spinal traction, pin insertion, local anesthetic, skeletal traction, pin care
Assessing and Managing C-Spine Injuries in the Wilderness
Critical Source: US Marine Corps Wilderness Medicine
Procedure for Assessing and Managing C-Spine Injuries:

1. Identify High-Risk Activities for C-Spine Injury:
- Falls from significant height
- High-velocity accidents (e.g., skiing, snowboarding, snowmobiling)

2. **Anatomy of the...
c-spine injury, spinal precautions, neurovascular exam, wilderness medicine
Emergent Spine Surgery for Penetrating Injuries
Critical Source: Emergency War Surgery
Procedure for Emergent Spine Surgery for Penetrating or Closed Injuries of the Spinal Cord:

Indication: Emergent spine surgery is indicated only in the presence of neurological deterioration.
Penetrating Spine Injuries:
- Injuries...
penetrating spinal injury, emergent surgery, dural leak prevention, antibiotic treatment
Further Workup for Spinal Injuries
Critical Source: Emergency War Surgery
Procedure for Further Workup of Spinal Injuries:

• If satisfactory alignment cannot be obtained, further workup is necessary.
• Consider myelogram, CT scan, tomograms, and neurosurgical/orthopedic consultations.
myelogram, CT scan, tomograms, spinal injury workup, orthopedic consultation
Handle Suspected Spinal Injuries in Combat
Critical Source: STP 21 1 Army Warrior Skills Level 1 Soldiers Manual of Common Tasks
Objective: Safely manage a casualty with suspected spinal injury.

Steps:
1. Do not move the casualty unless to save his/her life if a broken neck or back is suspected.
2. Assess the tactical situation and determine if moving the...
spinal injury management, immobilization techniques, combat casualty care
Initial Management of Spinal Column Injuries
Critical Source: Emergency War Surgery
Procedure for initial management of spinal column injuries:

• When initially proned, obtain radiographs to ensure that the reduction is maintained.
• If reduction is not maintained when the patient is proned, rotate the patient only between the...
spinal injury, proning, radiographs, patient rotation
Initial Management of Spinal Injuries in Combat
Critical Source: Emergency War Surgery
Objective: Stabilize the spinal column to prevent neurologic deterioration.

Steps:
1. Perform initial spine stabilization immediately after ensuring airway, breathing, and circulation (ABCs) are maintained according to ATLS...
spinal injury, stabilization, emergency surgery, ATLS, battlefield trauma
Management of Thoracic and Lumbar Spine Injuries
Critical Source: Emergency War Surgery
Procedure for managing thoracic and lumbar spine injuries:

• Although the thoracic rib cage contributes considerable rotatory stability, it does not protect completely against injuries.
• The vascular supply of the spinal cord is most...
thoracic spine, lumbar spine, burst fracture, MRI, spinal decompression
Managing Suspected Spinal Column Fractures - Do Not Move Casualty
Critical Source: FM 4 25 11 First Aid
Procedure for Managing Suspected Spinal Column Fractures:

1. Assess the casualty: Be suspicious of any back injury, especially if the casualty has fallen or if his back has been sharply struck or bent.
2. Check for symptoms: If the...
spinal fracture, spinal injury, do not move, first aid, back injury, paralysis, emergency medical procedure
Administer Corticosteroids for Closed Spinal Cord Injuries
Critical Source: Emergency War Surgery
Indication: For closed spinal cord injuries, administer corticosteroids if treatment is initiated within 8 hours of injury.

Procedure:
1. Administer a 30 mg/kg bolus of methylprednisolone initially.
2. Continue with an infusion of **5.4...
corticosteroids, spinal injury, methylprednisolone, closed injury, emergency treatment
Transport of Casualties with Spinal Injuries in Combat
Critical Source: Emergency War Surgery
Objective: Safely transport casualties while prioritizing life preservation.

Key Considerations:
Preservation of life and medic safety is paramount.
Evacuation to a secure area takes precedence over spine immobilization.
-...
battlefield transport, spine immobilization, penetrating injury

Fracture Management (11)

Immobilize Maxilla Using Mandible as Splint
Critical Source: Emergency War Surgery
Procedure:

1. Assess for mandibular or mid-face fractures (e.g., Le Fort I, II, III) based on clinical signs such as mobility of the hard palate and mid-face.
2. Prepare materials: wires, arch bars, and wire cutters (**must be available...
maxilla immobilization,mmandible splint,wire fixation,Le Fort fracture,facial trauma
Apply a Low Hip Spica Transportation Cast
High Priority Source: Emergency War Surgery
Introduction

A transportation cast is used for immobilizing fractures during evacuation and not as definitive care. It must be bivalved before evacuation, except for hip spica casts which are univalved.

Indications
• Hip, femur, knee, and...
transportation cast, hip spica, femur fracture, knee fracture, tibia fracture, military medicine, emergency surgery
Cover Exposed Bone After Debridement
High Priority Source: NATO Emergency War Surgery
Procedure:

After conservative debridement of bone fragments has been completed, any remaining exposed bone must be covered by soft tissue. A mandibular stump can be covered by suturing mucous membrane to the skin edge. If the oral cavity has...
exposed bone, soft tissue coverage, mandibular stump, drainage
Jaw Immobilization Techniques
High Priority Source: NATO Emergency War Surgery
Procedure:

Immobilization of the jaws is necessary for accurate reestablishment of occlusion as well as early union of fractures. It also facilitates the healing of soft-tissue wounds, limits the spread of infection, and prevents...
jaw immobilization, archbars, intermaxillary fixation, external biphase splint
Tooth Management in Fractures
High Priority Source: NATO Emergency War Surgery
Procedure:

• Only teeth which are completely loose or fractured teeth with exposed pulp should be removed.
Firmly embedded teeth, even if they are near fracture lines, should be left in situ.
• Damaged teeth are useful for...
tooth management, fracture immobilization, residual molars
Apply Long Arm Cast for Elbow/Forearm Fractures
High Priority Source: Emergency War Surgery
Procedure:

1. Preparation:
- After treatment of open wounds, wrap the extremity in stockinette from the fingers to the axilla.

2. Alignment:
- Achieve gross alignment of fractures; precise reduction is not necessary.

3. **Webril...
long arm cast,elbow fracture,forearm fracture,stockinette,Webril,casting material,bivalving
Avoid Use of Certain Splints and Traction for Transportation
High Priority Source: Emergency War Surgery
Prohibited Practices

Portable skeletal traction should not be used for transportation. It is only suitable for definitive care.
Tobruk splint (a Thomas splint with circular plaster) should not be used. It is not appropriate for use...
splinting禁忌, traction禁忌, military medicine, emergency surgery
Label and Mark Transportation Casts for Fractures
High Priority Source: Emergency War Surgery
Procedure

1. Use an indelible marker to draw the fracture configuration on the cast.
2. Note the dates of surgery and wounding on the cast.
3. Ensure that the cast is labeled with these details for clarity during transport and subsequent...
cast labeling, fracture marking, military medicine, emergency surgery
Support and Positioning of Transportation Casts
High Priority Source: Emergency War Surgery
Procedure

1. After applying the cast, support it with towels, blankets, or pillows to relieve pressure on the back edge of the cast.
2. Ensure that the patient is positioned in a way that minimizes discomfort and prevents additional injury...
cast support, positioning, military medicine, emergency surgery
Apply Temporary External Fixation for Long Bone Fractures
Standard Source: Emergency War Surgery
Procedure:

1. Assess the patient's condition and determine if temporary external fixation is appropriate.
- Considerations include: vascular injury, polytrauma, or when casting is impractical (e.g., femur fracture with abdominal...
external fixation, long bone fractures, temporary stabilization, emergency surgery, pin insertion, soft tissue access
Apply a Long Leg Cast for Tibia and Ankle Fractures
Reference Source: Emergency War Surgery
Indications
• Proximal/mid/distal tibia and ankle fractures

Introduction
A long leg cast is used to immobilize fractures of the proximal, mid, or distal tibia and ankle. It provides support and stability during...
long leg cast, tibia fracture, ankle fracture, emergency surgery, immobilization

Hospital Operations (11)

Consult with Licensing Agencies on Expanding Bed Capacity
High Priority Source: HHSPandemicInfluenzaPlan
Procedure:

1. Consult with hospital licensing agencies on plans and processes to expand bed capacity during a crisis.
2. Ensure that staff, medical equipment, and supplies are available for each additional hospital bed.
3. Coordinate with...
bed expansion, hospital licensing, pandemic influenza
Determine Patient Transfer for Emergency Procedures
High Priority Source: HHSPandemicInfluenzaPlan
Procedure:

1. Evaluate whether patients requiring emergency procedures will be transferred to another hospital.
2. Coordinate with other hospitals and healthcare facilities to ensure capacity for receiving transfers.
3. Develop protocols for...
patient transfer, emergency procedures, hospital operations
Develop Criteria for Canceling Elective Surgical Procedures
High Priority Source: HHSPandemicInfluenzaPlan
Procedure:

1. Develop criteria or 'triggers' for temporarily canceling elective surgical procedures during a pandemic.
2. Determine which elective procedures will be postponed based on urgency and necessity.
3. Establish protocols for...
elective surgery, pandemic influenza, hospital operations
Develop Mutual Aid Agreements for Non-Influenza Patients
High Priority Source: HHSPandemicInfluenzaPlan
Procedure:

1. Develop Mutual Aid Agreements (MAAs) or Memoranda of Understanding/Agreement (MOU/As) with other local facilities that can accept non-influenza patients who do not require critical care.
2. Identify areas within the facility that...
mutual aid agreements, hospital operations, pandemic influenza
Develop Policies for Expediting Patient Discharge
High Priority Source: HHSPandemicInfluenzaPlan
Procedure:

1. Create policies and procedures to expedite the discharge of patients who do not require ongoing inpatient care.
2. Develop plans for transporting discharged patients home or to other facilities.
3. Establish a patient discharge...
patient discharge, hospital operations, bed capacity, pandemic influenza
Develop Policies for Shifting Patients Between Units
High Priority Source: HHSPandemicInfluenzaPlan
Procedure:

1. Develop policies and procedures for shifting patients between nursing units to free up bed space in critical-care areas.
2. Create protocols for cohorting pandemic influenza patients based on their stage of recovery and...
patient shifting, cohorting, hospital operations
Ensure Continuation of Essential Medical Services
High Priority Source: HHSPandemicInfluenzaPlan
Procedure:

1. Address how essential medical services will be maintained for persons with chronic medical problems served by the hospital (e.g., hemodialysis patients).
2. Develop a strategy for ensuring uninterrupted provision of medicines to...
essential medical services, chronic care, pandemic influenza
Evaluate and Improve Medical Supply Tracking Systems
High Priority Source: HHSPandemicInfluenzaPlan
Procedure:

1. Evaluate the existing system for tracking available medical supplies in the hospital.
2. Determine whether it can detect rapid consumption of items such as gloves, masks, and other personal protective equipment (PPE).
3. Improve...
supply tracking, medical supplies, pandemic influenza
Revise Admissions Criteria During Bed Capacity Limitations
High Priority Source: HHSPandemicInfluenzaPlan
Procedure:

1. Review current admissions criteria for times when bed capacity is limited.
2. Revise the criteria as needed to prioritize patients requiring inpatient care.
3. Coordinate with hospital leadership and healthcare providers to ensure...
bed capacity, admissions criteria, hospital operations, pandemic influenza
Stockpile Consumable Resources for Pandemic Duration
High Priority Source: HHSPandemicInfluenzaPlan
Procedure:

1. Consider stockpiling enough consumable resources such as masks (see Box 2) for the duration of a pandemic wave (6-8 weeks).
2. Assess anticipated needs for consumable and durable resources, including respiratory care equipment...
resource stockpiling, pandemic influenza, medical supplies
Track Bed Availability During a Pandemic
High Priority Source: HHSPandemicInfluenzaPlan
Procedure:

1. Discuss with local and state health departments how bed availability (including ICU beds and ventilators) will be tracked during a pandemic.
2. Implement systems to monitor real-time bed occupancy, including critical care...
bed tracking, pandemic influenza, hospital operations

Eye Health (11)

Recognize and Respond to Sudden Appearance of Flashes or 'Flies' in Vision (Mouches Volantes)
High Priority Source: Where There is no Doctor a Village Health Care Handbook
Action: Recognize signs of a potential medical emergency related to sudden vision changes.

Steps:
1. If an older person experiences small moving spots that look like tiny flies when looking at bright surfaces:
- These are usually...
mouches volantes, detached retina, vision changes, eye emergency
Assess and Respond to Double Vision
High Priority Source: Where There is no Doctor a Village Health Care Handbook
Action: Assess the cause of double vision and determine appropriate response.

Steps:
1. If double vision occurs suddenly, is chronic, or gradually worsens, it may indicate a serious problem (e.g., neurological issues, eye muscle...
double vision, eye muscle issues, malnutrition, neurological problems
Conducting an Ocular Examination After Suspected RF Exposure
High Priority Source: Medical NBC Battlebook
Objective: Ensure proper ocular evaluation for individuals exposed to high levels of RF radiation.

Procedure:
1. Determine Exposure Level:
- If it is suspected or determined that an individual has been exposed to RF radiation >5...
RF exposure ocular exam, eye examination, PELs
Prevent Xerophthalmia Through Nutrition and Vitamin A Supplementation
High Priority Source: Where There is no Doctor a Village Health Care Handbook
Action: Prevent xerophthalmia by ensuring adequate vitamin A intake.

Steps:
1. Breastfeed the baby up to 2 years of age, if possible.
2. After the first 6 months of life:
- Begin giving the child foods rich in vitamin A such as:
...
vitamin a, xerophthalmia prevention, nutrition for children, breastfeeding, eye health, retinol dosage
Recognize Signs and Symptoms of Snow Blindness
High Priority Source: USMC Summer Survival Course Handbook
Procedure:

Look for the following signs and symptoms in an individual who may be suffering from snow blindness:

1. Painful eyes.
2. A hot, sticky, or gritty sensation in the eyes (like sand in the eye).
3. Blurred vision.
4....
snow blindness symptoms, eye pain, uv exposure signs, cold weather health
Treating Eye Infections and Conjunctivitis
Standard Source: Where There is no Doctor a Village Health Care Handbook
Procedure:

1. Apply Antibiotic Eye Ointment:
- Apply antibiotic eye ointment to the affected eye as directed by the manufacturer.
- Use every 2-4 hours for several days or until symptoms subside.

2. **Use Tetracycline or Erythromycin...
conjunctivitis,antibiotic eye ointment,tetracycline,erythromycin,newborn eyes
Understand Cataracts and Their Effects on Vision
Standard Source: Where There is no Doctor a Village Health Care Handbook
Cataract is an eye problem in which the lens of the eye becomes cloudy, making it more and more difficult for the person to see. The pupil looks gray or white when you shine a light into it.
cataract,lens clouding,vision loss
Define and Recognize Retina Anatomy
Standard Source: Medical NBC Battlebook
The retina is the back inside portion of the eye where images are formed. It contains photoreceptor cells that convert light into neural signals, which are sent to the brain for processing.
retina,eye anatomy,photoreceptors,image formation
Prevention and Care of Eye Strain and Vision Health
Standard Source: Boy Scout Handbook 1911
Objective: Prevent eye strain and maintain good vision through proper habits and care.

Steps:
1. Avoid eye strain, which is a common cause of styes, redness, and other eye issues.
2. If experiencing **constant headaches, eye itching, or...
eye strain prevention, proper reading habits, vision testing, glasses fitting
Recognize and Respond to Sclera Anatomy
Reference Source: Medical NBC Battlebook
The sclera is the tough white outer coat of the eyeball that provides structural support and protection for the eye.
sclera,eyeball anatomy,eye structure,ocular protection
Understand the Treatment of a Sty
Reference Source: Where There is no Doctor a Village Health Care Handbook
Sty is a red, swollen lump on the eyelid caused by infection.

What to do:
1. Apply warm compresses to the affected area several times daily to reduce swelling and promote drainage.
2. Avoid squeezing or popping the sty as this can worsen...
sty, eyelid infection, warm compress, eye care

Malnutrition (11)

Recognize Severe Malnutrition in Children
High Priority Source: Where There is no Doctor a Village Health Care Handbook
Procedure:

1. Identify risk factors: Look for children who stopped breastfeeding early or suddenly and are not given sufficient high-energy foods often enough.
2. Observe signs of malnutrition: Severe malnutrition is usually...
severe malnutrition, marasmus, kwashiorkor, child health, nutrition deficiency
Prevent Severe Malnutrition in Children Through Proper Nutrition and Breastfeeding
High Priority Source: Where There is no Doctor a Village Health Care Handbook
Procedure:

Steps:
1. Educate caregivers: Teach mothers and other caregivers about the importance of proper nutrition for both themselves and their children.
2. Promote breastfeeding: Encourage exclusive breastfeeding for the first...
malnutrition,children,nutrition,breastfeeding,growth development
Provide Nutritional Treatment for Pellagra and Malnutrition
Standard Source: Where There is no Doctor a Village Health Care Handbook
Procedure:

1. Encourage the consumption of nutritious foods to cure pellagra:
- Include beans, lentils, groundnuts, or protein-rich foods such as chicken, fish, eggs, meat, or cheese in the daily diet.
2. When...
pellagra treatment, malnutrition diet, niacin, brewer's yeast, whole wheat vs maize
Recognize Mild Malnutrition in Children
Standard Source: Where There is no Doctor a Village Health Care Handbook
Procedure:

1. Observe growth patterns: Check if the child is not growing or gaining weight as fast as a well-nourished child.
2. Assess physical appearance: The child may appear small and thin but usually does not look sick.
3....
malnutrition, child nutrition, growth monitoring, early detection, mild malnutrition
Recognize and Address Pellagra Due to Nutritional Deficiencies
Standard Source: Where There is no Doctor a Village Health Care Handbook
Procedure:

Steps:
1. Identify symptoms: Look for signs of pellagra such as patches on the skin (especially on the arms), diarrhea, dementia, and other neurological symptoms.
2. Assess diet: Determine if the individual's diet lacks...
pellagra,nutritional deficiency,niacin,vitamin B3,malnutrition
Identify Skin Signs of Malnutrition in Adults (Pellagra)
Standard Source: Where There is no Doctor a Village Health Care Handbook
Procedure:

1. Look for dry and cracked skin on areas exposed to the sun, especially:
- The nape of the neck
- The arms
- The backs of the legs
2. Check for peeling sores on these same areas.
3. Note if there are...
pellagra, malnutrition, skin signs, dry cracked skin, dark marks, swollen ankles, malnourished children
Identify and Address Anemia Due to Iron Deficiency
Standard Source: Where There is no Doctor a Village Health Care Handbook
Procedure:

Steps:
1. Recognize symptoms: Look for signs of anemia such as fatigue, dizziness, pale skin, and weakness.
2. Assess diet: Determine if the individual's diet lacks iron-rich foods like red meat, beans, lentils, dark...
anemia,iron deficiency,nutrition,malnutrition,dietary changes
Identify and Address Goiter Caused by Iodine Deficiency
Standard Source: Where There is no Doctor a Village Health Care Handbook
Procedure:

Steps:
1. Recognize symptoms: Look for signs of goiter such as an enlarged thyroid gland (visible swelling at the base of the neck) or difficulty swallowing.
2. Assess diet: Determine if the individual's diet lacks...
goiter,iodine deficiency,nutrition,malnutrition,thyroid health
Identify and Address Skin Problems, Sores on the Lips and Mouth, or Bleeding Gums Due to Vitamin Deficiency
Standard Source: Where There is no Doctor a Village Health Care Handbook
Procedure:

Steps:
1. Recognize symptoms: Look for signs such as skin problems, sores on the lips and mouth, or bleeding gums.
2. Assess diet: Determine if the individual's diet lacks fruits, vegetables, and other foods rich in...
skin problems,sores,lips,mouth,bleeding gums,vitamin deficiency,nutrition,malnutrition
Recognize and Treat Rickets Caused by Vitamin D Deficiency
Standard Source: Where There is no Doctor a Village Health Care Handbook
Procedure:

Steps:
1. Identify symptoms: Look for signs of rickets in children, such as bowed legs, delayed growth, and soft or deformed bones.
2. Assess diet and sun exposure: Determine if the child's diet lacks vitamin D-rich foods...
rickets,vitamin D deficiency,nutrition,children,malnutrition,bone health
Recognizing Signs of Malnutrition in Children
Standard Source: Where There is no Doctor a Village Health Care Handbook
Procedure:

Look for the following signs of malnutrition in children:

1. Failure to grow or gain weight normally (see p. 297).
2. Slowness in walking, talking, or thinking.
3. Big bellies with thin arms and legs.
4. Common illnesses that last...
malnutrition,child,nutrition

Allergies (10)

Administer Adrenaline for Severe Allergic Shock
Critical Source: Where There is No Dentist
Title: Administer Adrenaline for Severe Allergic Shock

Content:
Adrenaline (also called epinephrine) is a drug used to treat severe allergic shock, also known as anaphylaxis.

Procedure:
1. Recognize the signs of anaphylaxis:...
adrenaline,epinephrine,anaphylaxis,auto-injector,emergency
Managing Allergic Reactions and Anaphylactic Reactions
Critical Source: Survival and Austere Medicine
Procedure:

**Steps to manage allergic reactions and anaphylaxis:

1. Identify the allergen: Remove the source of the allergy (e.g., food, insect sting) immediately.
2. Administer epinephrine (if available): Use an auto-injector (EpiPen)...
anaphylaxis, epinephrine, allergic reaction, emergency response
Recognize and Respond to Allergic Reactions (Anaphylaxis)
Critical Source: Where There is no Doctor a Village Health Care Handbook
Allergies can cause symptoms such as itching rash, hives, sneezing, difficulty breathing, or shock in certain people when exposed to specific allergens.

### Signs of Severe Allergic Reaction (Anaphylaxis):
• Difficulty breathing or wheezing
-...
anaphylaxis treatment, allergic reaction, epinephrine auto-injector
Respond to Severe Allergic Reaction (Anaphylaxis)
Critical Source: A Book for Midwives
Procedure:

• Identify signs of severe allergic reaction or anaphylaxis: pale skin, cold and sweaty skin, weak or rapid pulse, difficulty breathing, low blood pressure, loss of consciousness.
Immediately call for medical help.
• While...
anaphylaxis,severe allergy,adrenaline,diphenhydramine,hydrocortisone
Managing Penicillin Allergy and Alternatives
Critical Source: Survival and Austere Medicine
Procedure:

1. If you are allergic to penicillin, consider the following alternatives:
- Macrolide antibiotics such as Erythromycin can be used interchangeably in many cases where a penicillin-based antibiotic is indicated.
-...
penicillin allergy, erythromycin, ciprofloxacin, antibiotic alternatives
Recognize and Manage Allergies
High Priority Source: Where There is No Dentist
Title: Recognize and Manage Allergies

Content:
An allergy is a bad reaction after breathing in, eating, touching, or being injected with something. Reactions may include itching, sneezing, or difficulty breathing.

**Management...
allergy,reaction,antihistamines,avoidance,emergency
Administer Dimenhydrinate (Dramamine) for Allergies or Motion Sickness
High Priority Source: Where There is no Doctor a Village Health Care Handbook
Purpose: To treat allergies or motion sickness using dimenhydrinate.

Dosage Guidelines:
Tablets (50 mg.):
- Adults: 50 to 100 mg. (1 or 2 tablets), up to 4 times a day.
- Children 7–12 years: 25 to 50 mg. (½ to 1 tablet), up to 4...
dimenhydrinate,dramamine,motion sickness,antihistamine,dosage
Manage Allergies in Outdoor Environments During Late Summer and Early Fall
High Priority Source: The Complete Outdoorsmans Handbook
Procedure:

1. Preparation:
- Carry prescribed allergy medications (e.g., antihistamines, epinephrine auto-injectors) at all times if you have known allergies.
- Be aware of high pollen seasons (late summer and early fall) and avoid...
allergies,weed pollen,hayfever,outdoor,antihistamines
Administer Antihistamine for Mild Allergic Reaction
Standard Source: A Book for Midwives
Procedure:

• Identify signs of a mild allergic reaction: swelling of the lips or face, wheezing.
Give 25 mg diphenhydramine by mouth, 1 time.
Or give 25 mg promethazine by mouth, 1 time.
• If rash, itching, swelling, or wheezing has...
antihistamine,mild allergy,diphenhydramine,promethazine
Administer Chlorpheniramine for Allergy Symptoms
Standard Source: Personal Wilderness Medical Kit
Indication: Allergy symptoms
Dose: i tablet (8 mg) PO twice daily as needed
Instructions:
1. Take chlorpheniramine tablets, 8 mg (e.g., *Chlor-Trimeton®*)
2. Administer i tablet by mouth twice daily as needed for allergy...
chlorpheniramine, allergy relief, Chlor-Trimeton

Medication Administration (10)

When to Use Injections
High Priority Source: Where There is no Doctor a Village Health Care Handbook + A Book for Midwives
Only use injections when absolutely necessary. Injections are more dangerous than taking medicine by mouth, but they can be the most effective way to give a medicine in emergencies. Avoid unnecessary injections, as they may not help heal...
injections, medicine administration, emergency use, oxytocin, magnesium sulfate, antibiotics, vomiting, unconsciousness
When to Use Injections Instead of Tablets
High Priority Source: Survival and Austere Medicine
Injections are preferred over tablets in the following situations:

• When the patient cannot swallow or is nil by mouth (NPO).
• When a faster onset of action and higher blood levels of medication are needed, such as with **antibiotics for...
injections, tablets, medication administration, NPO, antibiotics, insulin
Crushing Tablets: What to Avoid
Standard Source: Survival and Austere Medicine
Do not crush or break the following types of tablets:

Slow release tablets (SR or CR) – these are designed to release medication slowly over time, and crushing them can destroy this mechanism.

For most other tablets, it is generally...
tablet crushing, slow release tablets, SR, CR, medication administration
Helping Patients with Difficulty Swallowing Pills or Capsules
Standard Source: Survival and Austere Medicine
For patients who have trouble swallowing pills or capsules that cannot be crushed, the following methods can help:

• Place the pill in a small amount of jam or crushed fruit (e.g., apple, pear, guava). Avoid citrus fruits due to their...
swallowing difficulties, jam administration, crushed fruit, medication administration
Administer Ferrous Sulfate for Anemia in Pregnancy and General Use
Standard Source: Where There is no Doctor a Village Health Care Handbook + A Book for Midwives
Procedure:

1. Use ferrous sulfate tablets (available in various strengths, including 200 mg, 300–325 mg, and 500 mg).
2. Administer by mouth with meals, throughout pregnancy or for general anemia treatment.
- For adults and children...
ferrous sulfate, anemia, pregnancy, vitamin C, iron deficiency, tablet dosage, side effects
Administering Medicines Using Dosage Blanks for Illiterate Patients
Standard Source: Where There is no Doctor a Village Health Care Handbook
Purpose: To ensure accurate administration of medicines to individuals who cannot read.

Materials Needed:
• Dosage blanks (as shown in the book)
• Pencil or pen
• Medicine container

Procedure:
1. Prepare the dosage blank:
- Fill...
dosage blanks, medication administration, illiterate patients, medical records
Administering Medicines at Correct Intervals
Standard Source: Where There is no Doctor a Village Health Care Handbook
How to take medicines based on frequency instructions:

• If directions say ‘1 pill every 8 hours’, take 3 a day: one in the morning, one in the afternoon, and one at night.
• If directions say ‘1 pill every 6 hours’, take **4 each...
medicine timing,dosage frequency,visual aids for medication,record keeping
How to Use Medicine Boxes in the Book
Standard Source: A Book for Midwives
Medicine boxes provide instructions on how to give medicines:

• Always read medicine boxes carefully before giving any medication.
• Refer to the green medicines pages starting on page 463 for detailed information about each medicine.
medicine,book,administration,pharmacology
Measuring Medications Using Teaspoons
Standard Source: Where There is no Doctor a Village Health Care Handbook
To measure medications accurately using teaspoons:

1. Use a standard teaspoon as the measuring tool.
2. Fill the teaspoon to the brim with liquid medication, ensuring it is level.
3. Pour the measured dose into the patient's mouth,...
measuring,teaspoons,medicine,dose,administration
Taking Medicines on Full or Empty Stomach
Standard Source: Where There is no Doctor a Village Health Care Handbook
When to take medicines on an empty stomach:

Penicillin, ampicillin, and tetracycline should be taken 1 hour before meals.
• It is better not to drink milk 1 hour before or after taking tetracycline.

**When to take...
stomach timing,medicine with food,water intake,sulfa medicine

Midwifery Care (10)

Avoid Judging Women and Their Choices
Standard Source: A Book for Midwives
Title: Avoid Judging Women and Their Choices

Procedure:
1. Refrain from making value judgments about a woman’s decisions regarding her health, pregnancy, or lifestyle.
2. Recognize that each woman has unique circumstances, beliefs, and...
non-judgmental care,cultural sensitivity,midwife ethics,maternal autonomy,health equity
Follow Your Own Advice in Midwifery Care
Standard Source: A Book for Midwives
Title: Follow Your Own Advice in Midwifery Care

Procedure:
1. Apply the same standards of care and advice to yourself as you would to your patients.
2. Practice what you preach by adhering to evidence-based practices, ethical guidelines,...
self-care,midwife ethics,professional integrity,modeling behavior,health leadership
Help People Help Themselves in Midwifery Care
Standard Source: A Book for Midwives
Title: Help People Help Themselves in Midwifery Care

Procedure:
1. Empower women and their families to take an active role in their health and well-being.
2. Provide education on self-care practices, nutrition, exercise, and mental health...
empowerment,self-care,midwife education,health autonomy,community resources
Keep Things Private (Confidential) in Midwifery Care
Standard Source: A Book for Midwives
Title: Keep Things Private (Confidential) in Midwifery Care

Procedure:
1. Ensure that all patient information is kept confidential and shared only with authorized individuals.
2. Respect the privacy of women by discussing sensitive topics...
patient confidentiality,midwife ethics,privacy protection,health rights,legal standards
Listen More Than You Talk During Care
Standard Source: A Book for Midwives
Title: Listen More Than You Talk During Care

Procedure:
1. Prioritize listening to the woman and her family’s concerns, fears, and preferences during all interactions.
2. Allow women to express their needs and feelings without interruption...
active listening,patient-centered care,midwife communication,maternal engagement,health outcomes
Provide Respectful and Compassionate Care
Standard Source: A Book for Midwives
Title: Provide Respectful and Compassionate Care

Procedure:
1. Treat all women and their families with dignity, respect, and empathy at every stage of care.
2. Listen actively to the concerns, fears, and preferences of each woman and her...
compassionate care,respectful communication,cultural competence,midwife ethics,maternal dignity
Recognize People Who Affect a Woman’s Health in Midwifery Care
Standard Source: A Book for Midwives
Title: Recognize People Who Affect a Woman’s Health in Midwifery Care

Procedure:
1. Identify the key individuals and groups that influence a woman’s health, including family members, partners, community leaders, and healthcare providers.
2....
stakeholder engagement,women’s health,midwife collaboration,gender equality,community involvement
Talk Openly About Difficult Subjects in Midwifery Care
Standard Source: A Book for Midwives
Title: Talk Openly About Difficult Subjects in Midwifery Care

Procedure:
1. Address sensitive topics such as sexual health, domestic violence, mental health, and reproductive rights with honesty and compassion.
2. Create a safe space for...
difficult conversations,sensitive topics,midwife communication,mental health,domestic violence
Work Together to Save Lives in Midwifery Care
Standard Source: A Book for Midwives
Title: Work Together to Save Lives in Midwifery Care

Procedure:
1. Collaborate with other midwives, healthcare workers, and community members to provide comprehensive care for women and babies.
2. Establish referral systems that ensure...
teamwork,midwife collaboration,emergency care,maternal safety,health coordination
Work to Improve Women’s Health in Midwifery Care
Standard Source: A Book for Midwives
Title: Work to Improve Women’s Health in Midwifery Care

Procedure:
1. Advocate for policies and programs that promote equitable access to healthcare services for women.
2. Address the social determinants of health, such as poverty,...
health advocacy,women’s rights,midwife activism,social determinants,maternal equity

Infant Health (10)

Administer ART and Cotrimoxazole for HIV-Positive Mothers and Babies
Critical Source: A Book for Midwives
Procedure:

• If the mother has HIV, ensure that the baby receives appropriate medical care to prevent transmission of the virus.
• Administer ART (antiretroviral therapy) within 72 hours after birth to protect the baby from becoming infected...
HIV, ART, cotrimoxazole, newborn health, HIV prevention
Recognizing Signs of Bacterial Infection in the Blood (Septicemia) in Newborns
Critical Source: Where There is no Doctor a Village Health Care Handbook
Procedure:

1. Understand septicemia:
- Newborns are at high risk for bacterial infection in the blood (septicemia), especially after the second day of life.
2. Look for signs of infection, which may include:
- Does not...
septicemia, newborn infection, bacterial infection, jaundice, fever, low temperature
Assessing a Baby for Signs of Pneumonia
Critical Source: Where There is no Doctor a Village Health Care Handbook
Procedure:

1. Check if the baby has difficulty breathing:
- If the nose is stuffed up, suck it out as shown on page 164.
- Look for signs of pneumonia, including:
- Fast breathing (50 or more breaths per minute)
...
pneumonia, baby, breathing difficulty, fast breathing, blue color, grunting, rib suction, bacterial infection
Assessing the Soft Spot (Fontanel) on a Baby’s Head
Critical Source: Where There is no Doctor a Village Health Care Handbook
Procedure:

1. Feel the soft spot on top of the baby’s head (fontanel).
2. If it is sunk in, the baby may be dehydrated.
3. If it is swollen, the baby may have meningitis.
4. Important:
- If a baby has both...
fontanel, soft spot, dehydration, meningitis, baby
Identify and Respond to a Sunk Soft Spot in an Infant
Critical Source: Where There is no Doctor a Village Health Care Handbook
Procedure:

1. Assess the soft spot (fontanelle): Check if it is sunken or swollen.

2. If the soft spot is sunken: This may indicate dehydration. Take immediate action:
- Administer Rehydration Drink as described above.
- Monitor...
fontanelle assessment, meningitis signs, infant dehydration, soft spot care
Observing a Baby’s Movements and Expression for Signs of Tetanus or Meningitis
Critical Source: Where There is no Doctor a Village Health Care Handbook
Procedure:

1. Watch the baby’s movements and facial expression:
- Look for stiffness of the body or strange movements, which may indicate tetanus, meningitis, or brain damage from birth.
2. If the baby’s muscles suddenly...
tetanus, meningitis, baby movements, stiffness, jaw reflex, knee reflex
Recognize Signs of Infection in a Baby
Critical Source: A Book for Midwives
Procedure:

• Monitor the baby for signs that may indicate an infection.
• Early recognition can help prevent complications and ensure timely medical intervention.

Action Steps:
1. Watch for any of these warning signs:
- The baby seems...
baby infection, fever, weakness, medical help
Checking a Baby’s Skin Color for Jaundice or Pneumonia
High Priority Source: Where There is no Doctor a Village Health Care Handbook
Procedure:

1. Examine the baby’s skin color:
- If the lips and face are blue, consider pneumonia, heart defect, or other congenital issues.
2. Look for jaundice (yellowing of skin):
- If the **face and whites of the eyes...
jaundice, yellow skin, baby, blue color, pneumonia, light exposure
Recognize and Respond to Forceful Vomiting in Babies
High Priority Source: A Book for Midwives
Procedure:

• Observe the baby’s vomiting pattern.
• If the baby vomits forcefully (like a “shoot”) each time she eats, this may indicate an infection or blockage in the digestive system.

Action Steps:
1. Monitor the baby for signs of...
forceful vomiting, baby health, infection, medical advice
Administering Breast Milk During Diarrhea in Infants
Standard Source: Where There is no Doctor a Village Health Care Handbook
Breast milk is the best food for babies and helps prevent and combat diarrhea. Keep giving breast milk when the baby has diarrhea.

Do not stop breastfeeding even if the baby has diarrhea.
breast milk,diarrhea,infants,nutrition

Military Medical Operations (10)

Deploy and Operate a Surgical Company for MEF Support
High Priority Source: Emergency War Surgery
Procedure:

• Provide surgical care for a Marine Expeditionary Force (MEF).
• Basis of allocation is 1 per infantry regiment.
• Capabilities:
- 3 ORs, 60-bed capacity.
- Patient holding time up to 72 hours.
- Perform...
surgical company,MEF,surgical care,OR capacity,patient holding time,stabilizing procedures,FRSS,rapid assembly,mobile surgery,chem/bio protection
Operate Level II MTFs in Emergency War Surgery
High Priority Source: Emergency War Surgery
Level II MTFs (Mobile Treatment Facilities) are operated by the treatment platoon of divisional/nondivisional medical companies/troops.

Key Features and Capabilities:
1. Basic/Emergency Treatment: Continued basic and emergency treatment...
Level II MTFs, emergency treatment, military medical facilities, packed RBCs, X-ray, laboratory, dental services
USMC Casualty Receiving and Treatment in Emergency War Surgery
High Priority Source: Emergency War Surgery
U.S. Marine Corps (USMC):

• USMC casualty receiving and treatment is integrated into the broader military medical system.
• The USMC relies on CRTSs, FSTs, and other mobile surgical teams for advanced care during combat operations.
• Medical...
USMC medical operations, casualty receiving, emergency war surgery
Aircraft Carrier (CVN) Battle Group Medical Operations in Emergency War Surgery
High Priority Source: Emergency War Surgery
Aircraft Carrier (CVN) Battle Group:

• Includes 1 OR, 40–60 beds, and 3 ICU beds.
• Staffed with 1 surgeon and 5 other medical officers.
• Usually consists of up to 9 ships, but only the CVN has physicians.
• Medical...
Aircraft Carrier Medical Operations, CVN Battle Group, military medical operations
Deploy and Operate Air Force Medical Support in Combat Zones
High Priority Source: Emergency War Surgery
Procedure:

• The Air Force provides medical support within combat zones.
• Specific details on Air Force medical capabilities are not provided in the text, but it is implied that they contribute to the overall medical infrastructure in the...
air force medical support,combat zone medical operations,mobile surgical teams,evacuation services,integrated care
Deploy and Operate Medical Assets on Aircraft Carrier (CVN) Battle Groups in Emergency War Surgery
High Priority Source: Emergency War Surgery
Aircraft Carrier (CVN) Battle Group Medical Assets: Designed to provide medical care for the aircraft carrier and its task force.

Key Features and Capabilities:
1. Medical Capacity: Includes 1 operating room, 40–60 beds, and 3 ICU...
Aircraft Carrier Battle Group, CVN medical assets, not casualty receiving ships
Mobile Field Surgical Team (MFST) Operations in Emergency War Surgery
High Priority Source: Emergency War Surgery
Mobile Field Surgical Team (MFST):

• Composed of a 5-person team: general surgeon, orthopedist, anesthetist, emergency medicine physician, and OR nurse/tech.
• Capable of performing 10 life/limb saving procedures in 24–48 hours from...
Mobile Field Surgical Team, MFST, military surgery
Deploy and Operate the Air Force Combat Support Hospital (CSH)
Standard Source: Emergency War Surgery
Objective: Provide hospitalization and outpatient services for all classes of patients in the theater.

Capacity and Structure:
• Applicable to 84-, 164-, and 248-bed hospital companies
• General, orthopedic, urologic, thoracic, OB/GYN,...
Air Force CSH, hospitalization capacity, EAC support, chem/bio protection
Deploy and Operate the Hospital Unit-Base (HUB) Module of a CSH
Standard Source: Emergency War Surgery
Objective: Provide infrastructure support for a Combat Support Hospital (CSH).

Capacity:
• Up to 236 patients, divided into:
- 36 ICU beds
- 140 Intermediate Care Wards (ICWs)
- 40 Minimal Care Wards
- 20 Neuropsychiatric (NP)...
HUB module, CSH infrastructure, chem/bio protection, deployment methods
Deploy and Operate the Medical Reengineering Initiative (MRI) Combat Support Hospital (CSH)
Standard Source: Emergency War Surgery
Objective: Provide hospitalization and outpatient services for all classes of patients in the theater.

Capacity:
• Up to 248 patients, divided into:
- An 84-bed hospital company
- A 164-bed hospital company
- Split base operations...
MRI CSH, hospitalization capacity, split base operations, military medical support

Head Injuries (10)

Assessing Head Injury Severity in the Wilderness
Critical Source: US Marine Corps Wilderness Medicine
Procedure for Assessing Head Injury Severity:

1. Identify Minor Injury Criteria:
- No loss of consciousness (LOC)
- LOC of less than 15 seconds with immediate return to full alertness
- Patient is not on medications that increase...
head injury, intracranial pressure, LOC, evacuation, field treatment
Classify Craniocerebral Injuries
Critical Source: NATO Emergency War Surgery
Procedure:

Use the following classification system to identify and manage craniocerebral injuries:

1. Classification based on injury type:
- Scalp injuries:
- Open: Punctured, lacerated, or avulsed.
- Closed: Contused...
craniocerebral injury, skull fracture, brain injury, classification, head trauma
Managing Bullet Wounds in the Head
Critical Source: Where There is no Doctor a Village Health Care Handbook
- ♦ Place the injured person in a ‘half sitting’ position.

• ♦ Cover the wound with a clean bandage.

• ♦ Give antibiotics (penicillin).

• ♦ Seek medical help.
bullet wound,head injury,antibiotics,penicillin
Recognize and Respond to Fractures of the Base of the Skull
Critical Source: First Aid and Management of Minor Injuries
These are open head injuries, because in fractures of the base of the skull infection may spread from the nose, ears or sinuses. Features of base-of-skull fractures are as follows:

Racoon eyes – bruising around both eyes following a blow to...
base skull fracture, racoon eyes, battle's sign, CSF leak, infection risk
Recognize and Respond to Open Head Injuries
Critical Source: First Aid and Management of Minor Injuries
These injuries are usually serious because there is communication between the inside of the skull and the outside world and hence the main danger is the risk of infection. A common scenario might be a large scalp laceration with an underlying skull...
open head injury, infection risk, antibiotics, brain exposure, skull fracture
Recognize and Respond to Signs of Closed Head Injuries with Internal Bleeding
Critical Source: First Aid and Management of Minor Injuries
Any head injury may result in loss of consciousness. If the head injury is serious a patient may never regain consciousness; conversely, a minor injury may result in a brief loss of consciousness with mild concussion (a temporary loss of brain...
closed head injury, internal bleeding, lucid interval, brain pressure, coma
Assess and Triage Patients with Head Injuries
Critical Source: Emergency War Surgery
Procedure for Assessing and Triage of Patients with Head Injuries:

1. Perform a primary assessment, focusing on airway, breathing, and circulation (ABCs).
2. Check vital signs as the most important initial step in patient evaluation.
...
patient assessment, head injury, Glasgow Coma Scale, neurovascular injuries, triage
Head Injury Management Overview
Critical Source: Emergency War Surgery
Procedure:

• Head injuries require prompt assessment and management.
• Evaluate for signs of traumatic brain injury, including altered mental status, focal neurological deficits, or signs of increased intracranial pressure (e.g., headache,...
head injury, traumatic brain injury, neurological exam, CT scan
Assess for Basilar Skull Fractures in Patients with Skull Base Injury
High Priority Source: Emergency War Surgery
Procedure:

• Assess the patient for evidence of basilar skull fractures (Battle’s sign, raccoon eyes). These signs are often occult and require careful examination.
• Ensure that the external auditory canal is examined. Do not instrument the...
basilar skull fracture, Battle’s sign, raccoon eyes, temporal bone fracture
Manage Scalp Hemorrhage in Head Injuries
High Priority Source: Emergency War Surgery
Procedure for Managing Scalp Hemorrhage in Head Injuries:

1. Control scalp hemorrhage immediately to prevent excessive blood loss.
- Use a head wrap, scalp clips, or surgical staples as temporary measures.
- Do not delay definitive...
scalp hemorrhage, head injury, wound irrigation, intracranial pressure, Glasgow Coma Scale

Snake Bites (10)

Identify Sea Snakes and Recognize Their Venomous Nature
Critical Source: Full First Aid Manual FM 2111
Procedure:

1. Identify sea snakes by their appearance:
- Found in warm water areas of the Pacific and Indian oceans, along coasts, and at river mouths
- Typically have a distinctive body shape with dark coloration
2. Note that...
sea snake identification, venomous effects
Recognize Symptoms of a Coral Snake, Cobra, Krait, or Mamba Bite
Critical Source: Full First Aid Manual FM 2111
Procedure:

1. Look for the following symptoms after a bite from coral snakes, cobras, kraits, or mambas:
- Minimal pain and swelling at the site of the bite (often leading people to underestimate its severity)
2. Monitor for delayed...
coral snake bite symptoms, cobra venom effects
Recognize Symptoms of a Pit Viper Bite
Critical Source: Full First Aid Manual FM 2111
Procedure:

1. Look for the following symptoms after a pit viper bite:
- Severe burning pain at the site of the bite
- Discoloration and swelling around the fang marks, which usually begins within 5 to 10 minutes after the bite
2....
pit viper bite symptoms, snake venom effects
Identify Coral Snake Bites
Critical Source: FM 4 25 11 First Aid
Procedure:

1. Look for the following characteristics of coral snakes:
- Brightly colored with bands of red, yellow (or almost white), and black completely encircling the body.
2. Remember the rule: **“Red on yellow will kill a fellow, Red on...
coral snake, identification, venomous snakes, first aid for coral snakes
Identify Coral, Cobra, Krait, and Mamba Snake Bites
Critical Source: FM 4 25 11 First Aid
Procedure for Identifying Coral, Cobra, Krait, and Mamba Snake Bites

1. Look for physical characteristics of these snakes:
- Short, grooved fangs
- Characteristic bite pattern (usually two puncture marks)

2. **Identify specific...
coral snake, cobra, krait, mamba, venomous snakes, first aid for snake bites
Identify Pit Viper Snake Bites
Critical Source: FM 4 25 11 First Aid
Procedure for Identifying Pit Viper Snake Bites

1. Look for physical characteristics of pit vipers:
- Thick bodies
- Slit-like pupils
- Flat, almost triangular-shaped heads
- Small, deep pits between the nostrils and eyes on...
pit viper, snake bite identification, venomous snakes, first aid for snake bites
Identify Sea Snake Bites
Critical Source: FM 4 25 11 First Aid
Procedure:

1. Look for the following characteristics of sea snakes:
- Found in warm water areas of the Pacific and Indian oceans, along coasts, and at the mouths of some larger rivers.
- Small fangs (only 1/4 inch long).
2. Note that...
sea snake, identification, venomous snakes, first aid for sea snakes
Identify Nonpoisonous Snakes
Standard Source: Full First Aid Manual FM 2111
Procedure:

1. Look for the following characteristics of nonpoisonous snakes:
- Oval-shaped heads
- Round eyes
- No fangs (they do not have teeth designed to inject venom)
2. Compare these features with those of poisonous...
nonpoisonous snakes, identification, snake bite prevention
Identify Poisonous Pit Vipers
Standard Source: Full First Aid Manual FM 2111
Procedure:

1. Look for the following features of pit vipers:
- Triangular-shaped heads
- Slit-like pupils
- Deep pits between the nostrils and eyes on each side of the head
2. These snakes include rattlesnakes, copperheads,...
pit vipers, identification, snake bite prevention
Identify Poisonous Snakes in the United States
Standard Source: Full First Aid Manual FM 2111
Procedure:

1. Identify the following poisonous snakes found in the United States:
- Rattlesnakes
- Copperheads
- Water moccasins (cottonmouth)
- Coral snakes
2. Look for distinguishing features such as:
-...
poisonous snakes, identification, snake bite prevention

Surveillance (10)

Hospital Surveillance for Pandemic Influenza
High Priority Source: HHSPandemicInfluenzaPlan
Objective: Implement surveillance systems to detect and monitor the introduction and spread of pandemic influenza within a hospital setting.

### Steps:
1. Establish protocols for identifying and reporting suspected or confirmed cases of...
hospital surveillance, pandemic influenza detection, illness monitoring, public health integration
Surveillance for Novel Strains of Influenza During the Pandemic Alert Period
High Priority Source: HHSPandemicInfluenzaPlan
Procedure:

1. During the Pandemic Alert Period, CDC will issue recommendations for enhanced surveillance to identify patients at increased risk for infection with a novel virus.

2. Novel influenza strains may include:
- Avian...
novel influenza strains, pandemic alert period, HAN, EpiX
Enhance Mortality Surveillance During Pandemic Influenza
High Priority Source: HHSPandemicInfluenzaPlan
Objective: Improve the collection of mortality data to monitor pandemic severity and guide response measures.

Steps:
1. Utilize existing systems such as the 122 Cities Mortality Reporting System for timely data on influenza deaths in...
mortality surveillance,pandemic influenza,death registration,NCHS,122 Cities Mortality Reporting System,HAN,Epi-X,epidemiology
Implement Enhanced Surveillance and Special Studies During Pandemics
High Priority Source: HHSPandemicInfluenzaPlan
Objective: Collect detailed data on age-specific disease severity and patient outcomes during a pandemic.

Steps:
1. Enhance national surveillance systems to collect more detailed information on severe disease rates, hospitalizations,...
enhanced surveillance,pandemic studies,epidemiology,outbreak investigation,HAN,CDC
Conduct Hospitalization Surveillance for Influenza-Related Cases
Standard Source: HHSPandemicInfluenzaPlan
Procedure:

1. Monitor hospitalizations associated with laboratory-confirmed influenza in children across 12 metropolitan areas.
- Use two surveillance networks to report patient-level data to CDC every 2 weeks.

2. **Emerging Infections...
hospitalization surveillance, EIP influenza project, NVSN, pediatric influenza monitoring
Conduct State-Level Influenza Activity Assessments Year-Round During Pandemics
Standard Source: HHSPandemicInfluenzaPlan
Objective: Maintain continuous surveillance of influenza activity at the state level during a pandemic.

Steps:
1. Continue weekly assessments of overall influenza activity levels (none, sporadic, local, regional, widespread) by state...
state influenza activity,map generation,epidemiology,pandemic surveillance,HAN,CDC
Implement Expanded Hospitalization Surveillance for Pandemic Influenza
Standard Source: HHSPandemicInfluenzaPlan
Objective: Expand hospitalization surveillance to monitor disease severity during a pandemic.

Steps:
1. Expand data collection to include laboratory-confirmed influenza-associated hospitalizations of both adults and children, not just...
hospitalization surveillance,pandemic influenza,data collection,BioSense,CSTE,nationally notifiable,epidemiology
Implement Mortality Surveillance for Influenza-Related Deaths
Standard Source: HHSPandemicInfluenzaPlan
Procedure:

1. Data Collection by Vital Statistics Offices:
- Vital statistics offices in 122 cities covering one-fourth to one-third of the U.S. population report weekly throughout the year.
- Report the total number of death...
mortality surveillance, P&I deaths, influenza mortality data, NCHS reporting, pediatric influenza deaths
Maintain Influenza Surveillance Coordinators in Health Departments
Standard Source: HHSPandemicInfluenzaPlan
Procedure:

1. All health departments in all 50 states, as well as Chicago, New York City, and Washington, DC, must have dedicated influenza surveillance coordinators.

2. Roles of the coordinators include:
- Maintaining the current...
surveillance coordinators, Sentinel Provider Network, CDC Influenza Branch
Implement Hospital Surveillance for Influenza
Reference Source: HHSPandemicInfluenzaPlan
Procedure:

1. Monitor laboratory-confirmed influenza-associated hospitalizations:
- For children aged <18 years, use the Emerging Infections Program (EIP) influenza project in 11 communities.
- Report findings to CDC on a **bi-weekly...
hospital surveillance, influenza monitoring, EIP, NVSN

Infectious Disease Containment (10)

Implement Community-Based Measures to Increase Social Distance
Critical Source: HHSPandemicInfluenzaPlan
Community-based measures to increase social distance include measures applied to whole neighborhoods, towns, or cities (e.g., snow days, establishment of fever clinics, and community-wide quarantine). This measure is used during large-scale...
community quarantine,social distance,fever clinics,snow days
Implement Widespread or Community-Wide Quarantine
Critical Source: HHSPandemicInfluenzaPlan
Widespread or community-wide quarantine refers to the closing of community borders or the erection of a real or virtual barrier around a geographic area (a cordon sanitaire) with prohibition of travel into or out of the area. This measure is...
community quarantine,cordon sanitaire,widespread quarantine,transmission prevention
Establish Influenza Clinics During Pandemic
High Priority Source: HHSPandemicInfluenzaPlan
Influenza clinics are special facilities that may be established during a pandemic to provide rapid medical assessment of potentially infected persons. Ill persons would be encouraged to call influenza hotlines that provide advice on whether to...
influenza clinics,pandemic response,rapid assessment,healthcare guidance
Implement Containment Measures for Specific Sites or Buildings
High Priority Source: HHSPandemicInfluenzaPlan
Containment measures that apply to use of specific sites or buildings include cancellation of public events (e.g., concerts, sports events, movies and plays), closure of office buildings, apartment complexes, or schools; and closure of subways...
site containment,building closure,social distancing,event cancellation
Implement Focused Measures to Increase Social Distance
High Priority Source: HHSPandemicInfluenzaPlan
Focused measures to increase social distance (or decrease social contact) includes measures applied to groups rather than individuals or whole communities (e.g., quarantine of groups of exposed persons and measures that apply to the use of...
social distance,focused measures,group containment,infection prevention
Implement Isolation for Infected Individuals
High Priority Source: HHSPandemicInfluenzaPlan
Isolation is the separation and restriction of movement or activities of ill infected persons (patients) who have a contagious disease, for the purpose of preventing transmission to others. This measure should be applied as soon as an individual...
isolation,contagious disease,transmission prevention,infected individuals
Implement Quarantine for Exposed Individuals
High Priority Source: HHSPandemicInfluenzaPlan
Quarantine is the separation and restriction of movement or activities of persons who are not ill but who are believed to have been exposed to infection, for the purpose of preventing transmission of disease. This applies to individuals who may...
quarantine,exposed individuals,infection prevention,transmission control
Quarantine of Close Contacts
High Priority Source: HHSPandemicInfluenzaPlan
Quarantine of close contacts refers to the quarantine of individuals exposed to patients with communicable diseases (e.g., family members, work or school mates, healthcare workers). This measure is aimed at preventing transmission from...
close contacts,quarantine,communicable diseases,infection prevention
Implement Self-Shielding Measures
High Priority Source: HHSPandemicInfluenzaPlan
Self-shielding refers to self-imposed exclusion from infected persons or those perceived to be infected (e.g., by staying home from work or school during an epidemic). This measure is used when individuals choose to avoid contact with...
self-shielding,self-isolation,exposure prevention,infection control
Isolate and Contain Typhoid Patients to Prevent Spread
Standard Source: Where There is no Doctor a Village Health Care Handbook
Procedure:

1. Isolate a person with typhoid in a separate room.
2. Ensure that no one else eats or drinks from the dishes used by the infected individual.
3. Burn or bury the stools of the infected person in deep holes.
4. Persons caring for...
typhoid isolation, hygiene practices, containment, ampicillin use

Laser Injuries (10)

Assess and Treat Laser Ocular Injuries
High Priority Source: Medical NBC Battlebook
Procedure for Assessing and Treating Laser Ocular Injuries

### Steps to Follow:

1. Recognize Symptoms of Laser Exposure:
- Look for reported symptoms such as:
- Temporary or permanent reduction in visual acuity.
- Seeing...
laser injury, eye injury, retinal damage, corneal burn, visual acuity, treatment, evacuation criteria, medical management
Carbon Dioxide Laser Effects and Hazards
High Priority Source: NATO Emergency War Surgery
Carbon Dioxide Laser (CO₂ Laser)

Wavelength: 10.6 µm.
Characteristics: Not visible to the human eye.
High Absorption Properties: Highly absorbed by water, glass, plastics, biological tissues (cornea and skin), organic...
carbon dioxide laser, CO2 laser, high-energy laser, corneal damage, skin char, optical lens opacification, glass shattering, uniform incineration, fuel ignition, troop morale, combat effectiveness
Neodymium-YAG Laser Effects and Hazards
High Priority Source: NATO Emergency War Surgery
Neodymium-YAG (Nd-YAG) Laser

Wavelength: 1,064 nm.
Spectrum: Operates near the infrared wavelength spectrum.
Visibility: Not visible to the human eye.
Common Usage: Most commonly used in pulsed mode.
• **Effects on Eye...
Nd-YAG laser, infrared laser, retinal tear, vitreous hemorrhage, retinal detachment, retinal necrosis
Ultraviolet Laser Effects and Hazards
High Priority Source: NATO Emergency War Surgery
Ultraviolet Lasers

Spectrum: Operated in the ultraviolet region of the spectrum.
Common Usage: Generally encountered in a laboratory setting.
Biological Effect: Induces photochemical reactions.
Pulsed Mode Effects: Can...
ultraviolet laser, photochemical reaction, tissue burn, corneal damage, skin burn, laboratory use
Visible Spectrum Lasers and Their Effects on the Eye
High Priority Source: NATO Emergency War Surgery
Lasers in the Visible Spectrum (Military Use)

Types of Lasers: Pulsed ruby (red, wavelength 694 nm), frequency doubled Nd-YAG (green, wavelength 532 nm), continuous wave argon (blue-green, wavelength 514 nm).
Common Effect: All...
visible spectrum lasers, ruby laser, Nd-YAG green laser, argon blue-green laser, retinal thermal burns, flash blindness, vitreous hemorrhage, pulsed laser exposure
Assessing Suspected Laser Exposure and Injury
High Priority Source: NATO Emergency War Surgery
Index of Suspicion for Laser Exposure

• Reports by combatants of observing bright flashes of light, experiencing sudden eye discomfort or poor vision, or feeling focal heat should alert the medical officer to the possibility of...
laser injury, corneal burn, retinal tear, eye discomfort, heat sensation
Evaluate Suspected Laser Injuries Using the Aidman Vision Screener
High Priority Source: Medical NBC Battlebook
Procedure for Evaluating Suspected Laser Injuries with the Aidman Vision Screener

### Steps to Follow:

1. Administer a Near Visual Acuity Test:
- Use a Snellen chart or a random E chart to assess visual acuity.
- Ensure that the...
Aidman Vision Screener, visual field test, Snellen chart, Amsler Grid, evacuation criteria, laser injury evaluation
Physical Examination for Laser Injuries
High Priority Source: NATO Emergency War Surgery
Physical Examination for Laser Injury

Surface and deep burns of the cornea and skin indicate that a high-energy CO₂ laser has been used.
Retinal hemorrhage probably implicates use of pulsed laser in the visible or near-infrared...
corneal burn, retinal hemorrhage, CO2 laser, pulsed laser, retinal burn
Psychological and Tactical Considerations for Laser Injuries
High Priority Source: NATO Emergency War Surgery
Psychological and Tactical Management of Laser-Injured Soldiers

Panic and hysteria may be the major difficulty encountered.
• The fear of blindness and witnessing blinding injuries in comrades can cause a major disruption of combat...
panic management, combat effectiveness, medical evacuation, retinal burn, visual function assessment
Recognize and Differentiate Laser Injuries from Other Eye Injuries
High Priority Source: Medical NBC Battlebook
Procedure for Recognizing and Differentiating Laser Injuries from Other Eye Injuries

### Steps to Follow:

1. Identify Common Symptoms of Laser Exposure:
- Look for symptoms such as:
- Temporary or permanent reduction in visual...
differentiate eye injuries, chemical agent injury, NBC injury, laser exposure symptoms, visual field test, Amsler Grid

Venomous Bite Assessment (10)

Assessing Hypotension and Shock in Rattlesnake Envenomation
Critical Source: US Marine Corps Wilderness Medicine
Procedure:

1. Monitor for hypotension (low blood pressure) and shock, which can occur rapidly in severe envenomation.

2. Early hypotension may be due to pooling of blood, while late-stage hypotension is often due to fluid loss.

3....
hypotension,shock,rattlesnake envenomation
Assessing Renal Failure in Rattlesnake Envenomation
Critical Source: US Marine Corps Wilderness Medicine
Procedure:

1. Monitor for oliguria (decreased urine output) or anuria (no urine output), which may occur due to:
- Hypotension and decreased glomerular filtration rate (GFR).
- Hemoglobinuria and myoglobinuria leading to renal...
renal failure,rattlesnake envenomation complications
Recognizing Hemorrhagic and Coagulopathic Effects of Rattlesnake Venom
Critical Source: US Marine Corps Wilderness Medicine
Procedure:

1. Monitor for signs of hemorrhage, including:
- Bleeding from wounds, gums (gingival bleeding), nosebleeds (epistaxis), blood in urine (hematuria), vomiting blood (hematemesis), black or tarry stools (melena), lower...
hemorrhage,coagulopathy,rattlesnake venom effects
Recognizing Necrosis and Tissue Destruction in Rattlesnake Envenomation
Critical Source: US Marine Corps Wilderness Medicine
Procedure:

1. Monitor for necrosis (tissue death) or tissue destruction, which can occur due to direct venom effects.

2. These symptoms may be prevented if adequate antivenin is administered within 2 hours of the bite.
necrosis,tissue destruction,rattlesnake envenomation treatment
Recognizing Paresis and Paralysis in Rattlesnake Envenomation
Critical Source: US Marine Corps Wilderness Medicine
Procedure:

1. Monitor for paresis (partial paralysis) or paralysis, which may occur with bites from the Eastern Diamondback or Mojave rattlesnakes.

2. These symptoms are uncommon with other types of rattlesnake bites.
paresis,paralysis,rattlesnake envenomation complications
Recognizing Pulmonary Edema in Severe Rattlesnake Envenomation
Critical Source: US Marine Corps Wilderness Medicine
Procedure:

1. Monitor for pulmonary edema, which is common in severe envenomation.

2. This condition results from toxin and inflammatory injury to pulmonary capillary membranes, as well as pooling of blood in the lung's major vessels and...
pulmonary edema,rattlesnake envenomation complications
Assessing Envenomation Symptoms Within 30 Minutes
High Priority Source: US Marine Corps Wilderness Medicine
Procedure:

1. Monitor for the following signs within 30 minutes of a snake bite:
- Pain that is burning and immediate in onset.
- Edema limited to subcutaneous tissues (no increase in intra-compartmental pressures).
- **Pain...
envenomation symptoms,pain assessment,edema,airway obstruction,snake bite monitoring
Assessing Systemic Symptoms of Rattlesnake Envenomation
High Priority Source: US Marine Corps Wilderness Medicine
Procedure:

1. Monitor for nausea and vomiting, which are common symptoms but may indicate severe envenomation if they occur early.

2. Observe for signs of systemic involvement such as:
- **Weakness, diaphoresis (sweating), chills,...
systemic symptoms,rattlesnake bite signs,nausea,vomiting,tingling
Identifying Petechiae and Vesicles in Untreated Rattlesnake Envenomation
High Priority Source: US Marine Corps Wilderness Medicine
Procedure:

1. Monitor for the development of petechiae (small red or purple spots on the skin) and vesicles (fluid-filled blisters) within 6 to 36 hours after a rattlesnake bite.

2. These symptoms are typically seen in **untreated...
petechiae,vesicles,rattlesnake envenomation signs
Recognizing Seizures in Rattlesnake Envenomation
High Priority Source: US Marine Corps Wilderness Medicine
Procedure:

1. Monitor for seizures, which are likely due to hypertension and hypoxia.
seizures,rattlesnake envenomation complications

Skin Infections (10)

Treating Gas Gangrene (Gangrene)
Critical Source: Where There is no Doctor a Village Health Care Handbook
Symptoms:

Gas gangrene is a very dangerous infection of a wound.

• It produces a foul-smelling gray or brown liquid, and the skin near the wound may have dark blisters. The flesh may contain air bubbles.

• The infection...
gas gangrene, wound infection, hydrogen peroxide, penicillin injection, seek medical help
Prevent Impetigo Infection in Children
Standard Source: Where There is no Doctor a Village Health Care Handbook
Procedure:

1. Follow personal cleanliness guidelines (p. 133) for all family members.
2. Bathe children daily and protect them from bedbugs and biting flies.
3. Treat scabies promptly if a child is infected.
4. **Isolate a child...
impetigo prevention, child hygiene, scabies treatment, infection control
Treat Impetigo Infection on the Skin
Standard Source: Where There is no Doctor a Village Health Care Handbook
Procedure:

1. Wash the affected area with soap and cooled, boiled water 3 to 4 times daily.
2. Gently soak off crusts during washing.
3. Apply gentian violet (p. 370) or an antibiotic cream containing bacitracin such as _Polysporin_...
impetigo treatment, skin infection, antibiotic use, gentian violet
Treat Small Sores with Pus from Insect Bites or Scratching
Standard Source: Where There is no Doctor a Village Health Care Handbook
Procedure:

1. Wash the sores well with soap and cooled, boiled water.
2. Gently soak off scabs during washing. Repeat this daily as long as there is pus.
3. Leave small sores open to air for healing.
4. Bandage large sores and...
pus sores treatment, infection prevention, skin care, antibiotic use
Treating Itching and Burning Skin Irritations with Cold Compresses
Standard Source: Where There is no Doctor a Village Health Care Handbook
Procedure:

1. Prepare a cold water solution in a clean container.
2. Soak a clean cloth or towel in the cold water and apply it to the affected area for 10–15 minutes.
3. Repeat this process several times per day until itching or burning...
itching,burning,cold compresses,skin irritations
Treating Sores and Skin Infections with Soap and Clean Water
Standard Source: Where There is no Doctor a Village Health Care Handbook
Procedure:

1. Wash the affected area thoroughly with soap and clean water.
2. Gently scrub the skin to remove any scabs, dirt, or debris from sores or infected areas.
3. Rinse the area under running water if possible to ensure complete...
sores,impetigo,ringworm,soap,clean water
Use Gentian Violet for Skin and Vaginal Infections
Standard Source: Where There is no Doctor a Village Health Care Handbook
Indication: Treating impetigo, skin sores with pus, yeast infections (Candida) in the mouth, nipples, vulva, or skin folds.

Preparation:
• Dissolve 1 teaspoon of gentian violet crystals in half a liter of water to make a...
gentian violet, yeast infection, impetigo, skin infection, vulva treatment
Use Povidone Iodine for Skin Infections and Dandruff
Standard Source: Where There is no Doctor a Village Health Care Handbook
Indication: Treating skin infections, dandruff, seborrhea (cradle cap), pimples, mild impetigo, ringworm, or tinea.

Preparation:
• Use soap with povidone iodine (Betadine) for better results.

Usage:
-...
povidone iodine, skin infection, dandruff, seborrhea, ringworm
Treating Ringworm and Other Fungus Infections
Standard Source: Where There is no Doctor a Village Health Care Handbook
Procedure:

1. Apply Ointments with Undecylenic, Benzoic, or Salicylic Acid:
- Use as directed on the package.
- Apply to affected areas twice daily until symptoms subside.

2. Use Sulfur and Vinegar Solution:
- Mix sulfur...
ringworm,fungus infection,tolnaftate,selenium sulfide,griseofulvin,nystatin,miconazole
Use of Water for Skin Infections Prevention
Standard Source: Where There is no Doctor a Village Health Care Handbook
Objective: Prevent skin infections through proper water use.

Steps:
1. Bathe often: Use clean water to bathe regularly and keep the skin clean.
2. Wash hands with soap and water: Especially after using the bathroom and before eating...
skin infection prevention, bathing, hygiene, water safety

Sterilization (10)

Flaming Instruments in an Open Flame
High Priority Source: Survival and Austere Medicine
Procedure for Flaming Instruments in an Open Flame:

1. Prepare Instrument: Ensure the instrument is clean and dry.
2. Heat in Open Flame: Hold the instrument over an open flame until it becomes red hot.
3. Limitations: This method...
flaming, open flame, instrument sterilization, emergency method
Flaming Instruments with Alcohol
High Priority Source: Survival and Austere Medicine
Procedure for Flaming Instruments with Alcohol:

1. Dip Instrument in Alcohol: Completely submerge the instrument in alcohol.
2. Ignite Alcohol: Set fire to the alcohol and allow it to burn off the instrument.
3. Limitations: This...
flaming, alcohol, instrument sterilization, emergency method
Sterilizing Dressings and Combos Using an Oven
High Priority Source: Survival and Austere Medicine
Procedure:

1. Prepare the items: Place the wrapped dressings and combos in a pan or cookie sheet.
2. Bake at high temperature: Bake them at 350° for 3 hours to sterilize.
3. Cool and store: Once cooled, store them in a plastic bag...
sterilize,dressings,combos,bake,oven,labeling,storage
Sterilizing Instruments by Boiling
Standard Source: Survival and Austere Medicine
Procedure for Sterilizing Instruments by Boiling:

1. Prepare Water: Use distilled or soft water to reduce rusting.
2. Submerge Instruments: Place instruments in the boiling water. Ensure they are fully submerged.
3. Boil Water:...
boiling, sterilization, instruments, sodium carbonate, altitude, rust prevention
Sterilizing Instruments in an Oven
Standard Source: Survival and Austere Medicine
Procedure for Sterilizing Instruments in an Oven:

1. Preparation: Ensure the oven is clean and dry.
2. Load Instruments: Place surgical instruments, high-temperature glass, or plastics into the oven. Textiles should not be sterilized...
oven sterilization, temperature settings, rust prevention, surgical instruments
Sterilizing Instruments with Ethanol
Standard Source: Survival and Austere Medicine
Procedure:

1. Prepare an ethanol solution of >70% (ideally >95%) for instrument sterilization.
2. Soak the instruments in the solution for at least 12 hours.
3. To shorten the time, add formaldehyde solution to the alcohol.
4....
ethanol, sterilization, instrument, alcohol, formaldehyde
Sterilizing Instruments with Polyvidone-Iodine (Betadine)
Standard Source: Survival and Austere Medicine
Procedure:

1. Mix 1 part 10% Betadine solution with 3 parts water.
2. Soak the instruments in this mixture for 15 minutes.

Notes:
• Military reports suggest it may be used to sterilize water, though details are limited.
• Not...
polyvidone-iodine, betadine, sterilization, instrument
Using Alternative Chemical Disinfectants for Instrument Sterilization
Standard Source: Survival and Austere Medicine
Procedure:

Tosylchloramide Chloramine T: Use a 2% solution (20g/litre) and soak instruments for 15 minutes.
Ethanol 70%: Mix 8 parts of 90% ethanol with 2 parts water, then soak for 15 minutes.
Isopropanol 70%:...
tosylchloramide chloramine t, ethanol, isopropanol, formaldehyde, glutaraldehyde
Sterilizing Textiles Using Solar Disinfection
Standard Source: Survival and Austere Medicine
Procedure for Sterilizing Textiles Using Solar Disinfection:

1. Prepare Textiles: Ensure the textiles are clean and dry.
2. Expose to Sunlight: Hang the textiles in full sunlight and fresh air.
3. Duration: Leave them exposed for 6...
solar disinfection, textile sterilization, sunlight exposure
Sterilizing Textiles by Ironing
Standard Source: Survival and Austere Medicine
Procedure for Sterilizing Textiles by Ironing:

1. Prepare Textiles: Ensure the textiles are clean and dry.
2. Heat the Iron: Set the iron to a very high temperature.
3. Lay Textile on Another Textile: Place the textile to be...
textile sterilization, ironing method, steam application

Anatomy Physiology (9)

Alimentary Apparatus - Diagram Reference
Reference Source: The Household Cyclopedia
This section provides a diagram reference for the alimentary apparatus, which includes the following structures:

• A: Esophagus.
• B: Stomach.
• C: Cardiac orifice.
• D: Pylorus.
• E: Small intestine.
• F: Biliary duct.
• G: Pancreatic duct.
-...
digestive system anatomy, alimentary canal diagram, stomach, intestines, liver, gallbladder
Anatomy of the Bones of the Hand - Diagram Reference
Reference Source: The Household Cyclopedia
This diagram illustrates the bones of the hand with the ends of the radius and ulna:

• 1: End of radius.
• 2: End of ulna.
• 3: Scaphoid bone.
• 4: Semilunar bone.
• 5: Cuneiform bone.
• 6: Pisiform bone.
• 7: Trapezium bone.
• 8: Trapezoid...
hand bones, hand anatomy diagram, metacarpal bones, phalanges
Anatomy of the Breast - Diagram Reference
Reference Source: The Household Cyclopedia
This section provides a diagram reference for the lactiferous ducts, which are dissected out and injected for anatomical study. This is useful for understanding breast anatomy, particularly in relation to milk production and secretion.
breast anatomy, lactiferous ducts, milk ducts, breast diagram
Anatomy of the Eye - Labeling Diagram
Reference Source: The Household Cyclopedia
The following are the labeled parts of the eye:

1. Cornea
2. Anterior chamber of the eye
3. Crystalline lens
4. Iris
5. Vitreous humor
6. Retina
7. Choroid
8. Sclerotic
9. Optic nerve
10. **Superior and inferior...
eye anatomy, eye parts, cornea, lens, retina, vitreous humor, choroid, sclerotic, optic nerve
Anatomy of the Hand - Muscle Function Diagram
Reference Source: The Household Cyclopedia
The following muscles in the hand perform specific functions:

Muscles 5, 6, 8: Bend the wrist on the bones of the forearm.
Muscle 7: Bends the second range of finger-bones on the first.
Muscle 11: Draws the thumb from the...
hand anatomy, hand muscles, wrist movement, finger flexion
Anatomy of the Larynx and Trachea - Diagram Reference
Reference Source: The Household Cyclopedia
This section provides a diagram reference for the cartilages of the larynx and epiglottis and the upper rings of the trachea, seen from behind. This is useful for understanding the anatomical structure of the upper respiratory system,...
larynx anatomy, trachea diagram, epiglottis, respiratory system
Chyle Vessels of the Mesentery - Diagram Reference
Reference Source: The Household Cyclopedia
This section provides a diagram reference for the chyle vessels of the mesentery. These vessels are responsible for transporting lymph and fat from the digestive system to the bloodstream.
chyle vessels, mesentery anatomy, lymphatic system
Dorsal Surface of the Left Foot - Diagram Reference
Reference Source: The Household Cyclopedia
This section provides a diagram reference for the dorsal surface of the left foot:

• 1: Astragalus, its upper articular surface.
• 2: Anterior extremity of the astragalus, which articulates with (4) the scaphoid bone.
• 3: Os calcis, or heel...
foot anatomy, foot diagram, bones of the foot, metatarsals, phalanges
Nervous - Cephalospinal Centres Diagram Reference
Reference Source: The Household Cyclopedia
This section provides a diagram reference for the nervous system, specifically the cephalospinal centres:

• A: Brain.
• B: Cerebellum.
• C: Cerebral protuberance (pons cerebelli).
• D: Medulla spinalis, showing laterally the roots of the...
nervous system anatomy, brain diagram, spinal cord, cephalospinal centres

Health Education (9)

Demonstrate Practical Health Actions to Learners
Standard Source: Where There is No Dentist
To ensure people can apply what they learn immediately:

Show rather than tell. For example, demonstrate how to clean a child’s teeth instead of just explaining it.
Involve learners in the process. Let them practice under your...
demonstration, practical skills, health education, habit formation
Conduct Health Education in Community Gatherings
Standard Source: Where There is No Dentist
To maximize the impact of health education:

Identify community gathering places and teach there instead of expecting people to come to a class.
Engage with local groups, such as women at health clinics, markets, or parents’ groups at...
community outreach, health education, public engagement
Deliver Health Messages Using Simple Language
Standard Source: Where There is No Dentist
To ensure effective communication of health information:

Use simple words. If complex terms are necessary, take the time to explain them thoroughly.
Teach when people are ready to learn. For example, a sick person is more likely to...
communication, health education, teaching techniques, simple language
Encourage Group Learning and Discussion
Standard Source: Where There is no Doctor a Village Health Care Handbook
Steps to Encourage Group Learning and Discussion:

1. Form Small Groups: Gather people in small groups to read through the book together.
2. Discuss One Chapter at a Time: Focus on one chapter per session, ensuring everyone understands...
group learning, peer teaching, role-playing, health education
Encourage Men to Participate in Women’s Health Care
Standard Source: A Book for Midwives
Procedure:

1. Identify men who can be partners in improving women's health, such as husbands, fathers, sons, community leaders, and spiritual leaders.
2. Involve these men in discussions about their role in supporting the health of women.
3....
men’s role,women's health,community engagement,health education
Encourage Self-Learning Through the Book
Standard Source: Where There is no Doctor a Village Health Care Handbook
Steps to Encourage Self-Learning Through the Book:

1. Have Users Look Up Their Own Problems: When someone comes for treatment, ask them to look up their or their child's problem in the book and find out how to treat it.
2. **Allow Time for...
self-learning, health education, user independence
Integrate Prevention and Treatment in Healthcare Delivery
Standard Source: Where There is no Doctor a Village Health Care Handbook
Start where your people are and work toward a balance between prevention and treatment that is acceptable to them. This balance will be largely determined by people’s present attitudes toward sickness, healing, and health. As you help them look...
prevention,treatment,health education,community engagement,patient cooperation
Teach Users How to Use the Book's Features
Standard Source: Where There is no Doctor a Village Health Care Handbook
Steps to Teach Users How to Use the Book's Features:

1. Explain the Table of Contents: Show users how to find specific chapters and sections.
2. Demonstrate the Index: Teach them how to look up terms and topics quickly.
3. **Highlight...
teaching, health education, book usage, prevention, health worker
Share Knowledge to Empower Community Health
Reference Source: Where There is no Doctor a Village Health Care Handbook
Objective: Educate the community on health prevention and management.

Steps:
1. Teach people how to prevent illness, including hygiene practices and healthy lifestyles.
2. Help individuals learn how to recognize symptoms of common...
health education, self-care, community teaching, home remedies, common medicine use

Labor Complications (9)

Avoid Using Oxytocin, Ergonovine, or Misoprostol to Hasten Childbirth
Critical Source: Where There is no Doctor a Village Health Care Handbook
Procedure:

1. Do not use oxytocin, ergonovine, or misoprostol to hasten childbirth or give strength to the mother during labor.
2. These medications are very dangerous for both the mother and child when used before birth.
3. Only a...
oxytocin misuse, ergonovine risks, misoprostol dangers, labor complications
Never Push on the Mother’s Belly During Labor
Critical Source: A Book for Midwives
WARNING!

Never push on the mother’s belly to hurry the birth.
• This can cause serious complications such as:
- The placenta separating from the womb
- Tearing of the womb
• These complications can be fatal for both the baby and the...
pushing on belly during labor, placenta detachment, womb tear, midwife warning
Torn Womb During Labor
Critical Source: A Book for Midwives
If the mother has a torn womb, take these steps:

Signs include:
- Contractions stopping
- Very strong, constant pain
- The baby’s heartbeat getting very slow and then stopping
Immediately treat the mother for shock (see...
torn womb during labor, shock treatment, midwife procedures
Watch for Prolapsed Cord During Labor
Critical Source: A Book for Midwives
Procedure:

Rarely, when the bag of waters breaks, the cord may come down the vagina in front of the baby’s head.
• The cord is more likely to slip past the baby’s head if:
- There is a lot of water.
- The baby is small or less than 8...
prolapsed cord, baby heartbeat, labor complication, vaginal cord, emergency signs
What to Do If Prolapsed Cord Is Detected
Critical Source: A Book for Midwives
Procedure:

If the baby is alive, you must act fast:
- The best thing is usually to keep the head off the cord and get the mother to a hospital for a cesarean surgery as soon as possible.

• If you cannot see the cord, **wash your hands...
prolapsed cord action, cesarean delivery, baby pulse check, knee-chest position, rescue breathing
Cutting a Circumcision Scar During Birth
Critical Source: A Book for Midwives
If the mother has been circumcised, you may need to cut open the scar of the circumcision before the baby’s head starts to crown.

Female genital cutting (FGC) causes scars that may not stretch enough to let the baby out.
• **You should...
circumcision scar cutting, FGC during birth, midwife procedures
Watch for Bleeding During Labor
Critical Source: A Book for Midwives
Watch for bleeding during stage 2 of labor:

• A small amount of blood from the vagina, especially bloody mucus, is normal and indicates that the baby is moving down.
• However, a gush of fresh blood can be a sign of:
- A detached...
bleeding during labor, placenta detachment, womb tear, midwife procedures
When to Seek Medical Help During Labor
Critical Source: A Book for Midwives
If there is no progress during labor, follow these steps:

1. Try different methods for bringing the baby down, such as:
- Better pushing
- Changing positions
- Emptying the bladder
- Drinking a rehydration drink
-...
labor progress, no progress, medical help, childbirth emergency, midwife procedures
Recognize Warning Signs During Labor That Require Immediate Medical Help
High Priority Source: A Book for Midwives
Purpose: Identify signs that require immediate medical attention during labor to ensure the safety of the mother and baby.

Warning Signs:
High fever (see page 179)
High blood pressure (see page 180)
Labor goes on too long...
warning signs during labor, high fever, high blood pressure, prolonged labor, heavy bleeding, emergency planning

Intravenous Care (9)

Administer Intravenous (IV) Fluids in Emergencies
Critical Source: A Book for Midwives
Procedure:

1. Recognize the need for IV fluids:
- If a woman loses a lot of blood during childbirth, or after a complicated miscarriage or abortion, she needs fluids fast to save her life.

2. Transport to medical center:
- Take...
IV administration, emergency fluids, intravenous care, medical emergency
Apply Constricting Band for Saline Lock or IV Infusion
High Priority Source: STP 21 1 Warrior Skills Level 1
Procedure:

1. Apply a constricting band approximately 2 inches above the selected infusion site.

Note: The purpose of the constricting band is to stop blood from flowing back to the heart, causing the vein to enlarge and become easier to...
constricting band application, IV preparation, venipuncture technique
Select Appropriate Site for Saline Lock or IV Infusion
High Priority Source: STP 21 1 Warrior Skills Level 1
Procedure:

1. Choose the infusion site based on the following criteria:
- Preferred sites are the veins in the crook of the elbow, as they are large, visible, and accessible.
- Alternative sites include the back of the hand or, if...
IV site selection, vein palpation, infusion site preparation
Establish Need for Saline Lock or IV Infusion
High Priority Source: STP 21 1 Warrior Skills Level 1
Procedure:

1. Determine if a saline lock or IV infusion is necessary based on the following conditions:
- Bleeding has been controlled and the casualty is in hypovolemic shock, or
- A combat medic or medical professional requests that you...
saline lock, IV infusion, hypovolemic shock, combat medic, medical professional
Obtain Required Supplies for Saline Lock or IV Infusion
High Priority Source: STP 21 1 Warrior Skills Level 1
Procedure:

1. Gather the necessary supplies.

Note: These supplies are not part of the individual first aid kit and must be obtained from a combat lifesaver aid bag or a combat medic aid bag.
supplies for IV, combat lifesaver aid bag, combat medic aid bag
Remove Catheter from Vein (if Necessary)
High Priority Source: STP 21 1 Army Warrior Skills Level 1 Soldiers Manual of Common Tasks
Procedure to Remove Catheter from Vein

1. Adjust the clamp on the tubing to stop the flow of fluid.
2. Loosen and remove the strip of tape securing the IV tubing to the casualty's limb.
3. Remove the catheter from the vein by...
catheter removal, IV site management, intravenous care
Inform Casualty About Saline Lock Procedure
Standard Source: STP 21 1 Warrior Skills Level 1
Procedure:

1. Clearly explain to the casualty that you are establishing a saline lock to allow for the administration of intravenous fluids.

Note: This step is important to ensure the casualty's cooperation and reduce anxiety.
casualty communication, saline lock explanation, IV preparation
Discontinue an IV with a Saline Lock
Standard Source: STP 21 1 Army Warrior Skills Level 1 Soldiers Manual of Common Tasks
Procedure to Discontinue an IV with a Saline Lock

1. Adjust the clamp on the tubing to stop the flow of fluid.
2. Loosen and remove the strip of tape securing the IV tubing to the casualty's limb.
3. Remove the IV catheter hub that...
discontinuing IV with saline lock, IV removal procedure, intravenous care
Establish a Saline Lock Using an Intravenous Training Device
Standard Source: STP 21 1 Warrior Skills Level 1 + STP 21 1 Army Warrior Skills Level 1 Soldiers Manual of Common Tasks
Overview: This procedure outlines how to establish a saline lock for venipuncture using an intravenous training device, as requested by medical personnel.

### Steps:
1. Expose the site: Expose the casualty's arm or hand where the...
saline lock, venipuncture, intravenous training device, medical procedure

Pharmacology (9)

Acquire Physicians' Desk Reference
High Priority Source: Survival and Austere Medicine
Title: *Physicians' Desk Reference*
Publisher: Thomson Healthcare
Format: Hardcover
ISBN: 1563634724
Price: New edition approx $93.00, discount offers through Amazon.com and others.
Description: Invaluable for medical...
drug reference,physicians desk reference,pharmacology
Identify and Understand Antibiotic Families
High Priority Source: A Book for Midwives
Procedure:

1. Recognize that antibiotics are grouped into families based on their chemical structure and function.
2. Identify common antibiotic families:
- Penicillins: amoxicillin, ampicillin, benzathine penicillin, benzylpenicillin,...
antibiotic families, penicillins, macrolides, antibiotic alternatives, allergies
Selecting Temperature-Stable Medications for Wilderness Medical Kit
High Priority Source: survival personal wilderness medical kit
Procedure:

1. Avoid medications that require refrigeration or controlled room temperature: These are not suitable for wilderness kits due to exposure to extreme temperatures.
2. Check drug stability under temperature extremes: Use...
temperature-stable medications, drug stability, expired drugs, tetracycline, WEMSI pharmacology
Understanding Medicine Dosage and Measurement
Standard Source: A Book for Midwives
How to Determine the Correct Dose of Medicines:

Tablets, capsules, inserts, and injectable medicines are measured in:
- Grams (g)
- Milligrams (mg)
- Micrograms (mcg or µcg)
- Units (U) or International Units (IU)

**Conversion...
dosage, measurement, medicine, milligrams, grams, micrograms, liquid, syringe, tablets, capsules
Administering Medicines by Route
Standard Source: A Book for Midwives
How to Administer Different Forms of Medicines:

Tablets, pills, capsules, and liquids are usually taken by mouth. In some cases, they may need to be inserted into the vagina or rectum.
Inserts (suppositories, pessaries) should...
medicine, administration, route, tablets, pills, capsules, injections, suppositories, ointments, syrups
Understanding Medication Expiry Dates and Long-Term Use
Standard Source: Survival and Austere Medicine
Important Note: The following information is for entertainment purposes only and should not be relied upon except in a life-threatening emergency.

• Medications do not necessarily become dangerous after their expiry date; they typically lose...
medication expiry, drug stability, prolonged use, FDA data, US military research
Understand the Use of Suppositories in Medicine
Reference Source: Where There is no Doctor a Village Health Care Handbook
Suppository is a bullet-shaped tablet inserted into the anus or vagina to deliver medication.

What to do:
1. Wash hands thoroughly before handling the suppository.
2. Insert the suppository gently into the rectum or vagina as far as...
suppository, rectal medication, vaginal medication, dosage
Understand Brand-Name Medicines
Reference Source: Where There is no Doctor a Village Health Care Handbook
Brand name is the trade name given to a product by a company. A brand-name medicine is sold under a special name and is often more expensive than the same generic medicine.
brand-name,medicine,pharmaceuticals
Understanding Oral Medication Administration
Reference Source: Where There is No Dentist
- Oral refers to something related to the mouth.
• An oral medicine is one taken by mouth.
oral medication, pharmacology, drug administration

Anesthesia (9)

Administer Battlefield Anesthesia
Critical Source: Emergency War Surgery
Battlefield Anesthesia Procedure

Overview:
- Battlefield anesthesia refers to the use of adequate amounts of anesthetic agents in a technologically austere environment.
- The goal is to minimize cardiovascular instability, amnesia,...
battlefield anesthesia, emergency surgery, airway management, IV sedation, battlefield medicine
Administer General Anesthesia in Critically Injured Patients
High Priority Source: NATO Emergency War Surgery
Procedure:

1. Assess Patient Condition: Use general anesthesia for critically injured patients with profound shock.
2. Focus on Hemodynamic Stability: Intraoperative management should prioritize achieving hemodynamic stability,...
general anesthesia, critical injury, shock management, hemodynamic stability
Regional Anesthesia Techniques for Battlefield Use
High Priority Source: Emergency War Surgery
- Superficial cervical plexus block
Axillary brachial plexus block
IV regional anesthesia
Wrist block
Digital nerve block
Intercostobrachial nerve block
Saphenous nerve block
Ankle block
• **Spinal...
regional anesthesia, battlefield anesthesia, ropivacaine, nerve block techniques
Administer Lidocaine for Local Anesthesia or Eclampsia Convulsions
High Priority Source: A Book for Midwives
Procedure:

1. Use lidocaine without epinephrine (check the label to ensure it is free of epinephrine).
2. For local anesthesia, inject 5 to 30 ml of a 1% solution into the skin.
3. For eclampsia convulsions, inject 10 grams of a 50% solution...
lidocaine, local anesthesia, eclampsia, midwife procedure
Administer Local Anesthesia for Minor Injuries
High Priority Source: NATO Emergency War Surgery
Procedure:

1. Select Appropriate Agent: Use lidocaine at 0.5 to 1.0% concentration, or any other local anesthetic listed in Table 9.
2. Limit Usage: Reserve this technique for minor injuries only, as it is not suitable for extensive...
local anesthesia, lidocaine, minor injuries, overdose management, medical facility
Administer Regional Anesthesia in Combat Situations
High Priority Source: NATO Emergency War Surgery
Procedure:

1. Assess Patient Suitability: Regional anesthesia is particularly appropriate for isolated extremity injuries.
2. Monitor Patients: In mass casualty situations, the anesthetist can safely administer multiple anesthetics at...
regional anesthesia, combat surgery, extremity injuries, vascular repair, Bier block
Conclusion of General Anesthesia - Extubation Criteria and Procedure
High Priority Source: Emergency War Surgery
When the patient is to be extubated:

• Decrease ventilation to allow spontaneous breathing.

• Ensure extubation criteria are met, which include:
- Reversal of muscle relaxation
- Spontaneous ventilation
- Response to commands
- Eye...
extubation criteria, spontaneous breathing, midazolam, narcotics, extubation readiness
Conclusion of General Anesthesia - Intubated Patient
High Priority Source: Emergency War Surgery
When the patient is to remain intubated:

• Terminate anesthetic agents but maintain sedatives and muscle relaxants.

• Administer Glycopyrrolate (Robinul) at 0.01–0.02 mg/kg IV over 3–5 minutes to decrease parasympathetic stimulation and...
intubated patient, anesthesia termination, glycopyrrolate, neostigmine, muscle relaxation reversal
Neuraxial Anesthesia Techniques and Considerations
High Priority Source: Emergency War Surgery
Types of Neuraxial Anesthesia:

• Subarachnoid block (SAB)
• Epidural block

Considerations for Use:

When the patient’s physical condition allows, spinal or epidural anesthesia is encouraged.

• The sympathectomy resulting from these...
neuraxial anesthesia, spinal block, epidural block, sympathectomy, trauma patient considerations

Blood Transfusion (9)

Administer Blood Transfusion for Classes III and IV Hemorrhage
Critical Source: NATO Emergency War Surgery
Procedure:

1. Indication: Administer blood transfusion to casualties with Classes III and IV hemorrhages or those with continuing hemorrhage.
2. Preferred Fluid: Whole blood is preferred due to its lower viscosity, faster infusibility,...
blood transfusion, type 0 blood, whole blood, transfusion reaction, cross-matched blood
Administering Blood Transfusions in Combat Zones
Critical Source: NATO Emergency War Surgery
Procedure:

1. When using packed red blood cells, administer every fourth unit with a unit of fresh frozen plasma to maintain coagulation.
2. Be aware that banked blood in combat zones is often near expiration date.
3. After infusing...
blood transfusion, combat zone, coagulation defects, hyperkalemia, calcium chloride, urine output, bicarbonate administration
Perform a Saline Cross Match for Blood Compatibility
Critical Source: Survival and Austere Medicine
Procedure:

1. Prepare the donor blood sample: Take a few drops of the donor blood to be cross matched and place it into a tube full of saline (0.9%).

2. Centrifuge the sample: Spin the tube with a centrifuge.

3. **Wash the red...
saline cross match,blood compatibility,test,agglutination,rouleaux,transfusion safety
Establish a Walking Blood Bank (WBB) Program
High Priority Source: TCCC 17 13 Tactical Combat Casualty Care
### Procedure: Establish a Walking Blood Bank (WBB) Program

1. Conduct Risk Assessment: Evaluate the potential for casualties and the feasibility of establishing a WBB program in austere conditions.
2. **Coordinate with Joint Blood Program...
walking blood bank, WBB program, ABO type-specific match, transfusion-transmitted infections, Joint Theater Trauma System
Perform a Cross Match Test for Blood Transfusion Safety
High Priority Source: Survival and Austere Medicine
Procedure for Performing a Cross Match Test:

1. Understand the Purpose: A cross match test ensures that donor blood is compatible with the recipient’s blood to prevent adverse reactions during a transfusion.

2. Gather Materials:
-...
cross match test,blood compatibility,saline cross match,albumin cross match,blood transfusion safety
Transfusion Therapy in Emergency War Surgery
High Priority Source: Emergency War Surgery
Objective: Administer blood products appropriately to manage hemorrhagic shock.

Indications: Severe hemorrhage requiring transfusion after definitive hemorrhage control has been achieved.

Procedure:
1. Type O Blood: Used as a...
transfusion therapy, blood products, artificial blood, type O universal donor, autotransfusion
Determine Blood Type Using Eldon Card
High Priority Source: Survival and Austere Medicine
Procedure for Determining Blood Type Using an Eldon Card:

1. Obtain an Eldon Card: These cards are pre-made and contain dried anti-A, anti-B, and anti-D sera. They cost approximately $6-$10 USD and have a shelf life of about three years...
blood typing,Eldon card,Anti-A,Anti-B,Anti-D,Rh+,Rh-,ABO typing,blood group compatibility
Understand the Risks of Fresh Whole Blood (FWB) Transfusion
High Priority Source: TCCC 17 13 Tactical Combat Casualty Care
### Procedure: Understand the Risks of Fresh Whole Blood (FWB) Transfusion

Risks Associated with FWB:
Transfusion-Transmitted Infections: Increased risk of infections such as HIV, hepatitis B and C, and syphilis.
• **Mission Impact on...
FWB risks, transfusion-transmitted infections, ABO typing errors, bacterial contamination
Blood Transfusion Procedure and Guidelines
Reference Source: Emergency War Surgery + A Book for Midwives
Transfusions are used to save the life of a woman who has lost a significant amount of blood after childbirth or due to other medical issues, such as an unsafe abortion. They are also critical in cases of severe blood loss, particularly when...
blood transfusion, IV line, packed red blood cells, PRBCs, whole blood, emergency, severe blood loss

War Surgery (9)

Adapting to Modern Warfare and Evacuation Strategies
High Priority Source: NATO Emergency War Surgery
Modern warfare is characterized by fast-moving, highly mobile, remote control tactics that require significant changes in the philosophy and management of war casualties. These changes include:

• The necessity to evacuate casualties earlier...
modern warfare,evacuation strategies,definitive surgery,tactical constraints,combat hospital
Differences Between War Surgery and Civilian Surgery
High Priority Source: NATO Emergency War Surgery
There are several key differences between war surgery and civilian surgery, which must be acknowledged:

1. Tactical Constraints:
• The tactical situation may impose major constraints upon the performance of indicated operations.
-...
war surgery,civilian surgery,differences,tactical constraints,aeromedical evacuation
Importance of Prevention in War Surgery
High Priority Source: NATO Emergency War Surgery
As with any medical endeavor, prevention is far more efficacious than treatment, particularly for wounds sustained in war. Unfortunately, there is no precedent to suggest that humans and nations have learned to coexist without armed...
prevention in war surgery,wound prevention,phased treatment,standardized procedures,national collaboration
Physical Requirements for Conducting War Surgery
High Priority Source: NATO Emergency War Surgery
To conduct effective war surgery, the following physical requirements must be met:

1. Personnel:
• An experienced surgeon.
• A trained anesthetist.
• Qualified operating room personnel.

2. Equipment and Facilities:
• Simple X-ray...
war surgery,equipment requirements,operating room personnel,surgical facilities,nato standards
Standardization of Emergency War Surgery Procedures Across NATO Nations
High Priority Source: NATO Emergency War Surgery
The NATO Handbook was created to standardize emergency war surgery procedures among allied nations. This initiative began in 1957 with the publication of the first Emergency War Surgery Handbook, developed by a committee from the United...
nato,national standardization,emergency war surgery,handbook,standardization agreement,stang 2068,mend program
Document Emergency Trauma Care Using Paper or Electronic Systems
Standard Source: Emergency War Surgery
Objective: Ensure accurate documentation of emergency trauma care at all levels of medical treatment.

Methods and Technology:
Paper Documentation: Used in immature battlefield environments. Each casualty’s chart must accompany the...
document trauma care,paper records,electronic systems,emergency war surgery
Record and Analyze Casualty Data by Injury Type and Body Region
Standard Source: Emergency War Surgery
Objective: Break down casualty data by injury type and body region to identify patterns and improve medical interventions.

Steps:
1. Record the type of injury for each casualty (e.g., penetrating, blunt, thermal).
2. Categorize injuries...
casualty data,injury analysis,body regions,emergency war surgery
Calculate Percentage Died Of Wounds (DOW)
Standard Source: Emergency War Surgery
Objective: Calculate the percentage of casualties who died after reaching a Basic Aid Station (BAS).

Formula:
Percentage DOW = [Number of died after reaching a BAS / Number of admitted] × 100

Definitions:
Died Of Wounds (DOW):...
dow,kia,percentage,died of wounds,emergency war surgery
Calculate Percentage Killed In Action (KIA)
Standard Source: Emergency War Surgery
Objective: Calculate the percentage of casualties who were killed before reaching a Basic Aid Station (BAS).

Formula:
Percentage KIA = [Number of killed before reaching a BAS / Number of casualties (killed + admitted)] ×...
kia,dow,percentage,killed in action,emergency war surgery

Nerve Agent Exposure (9)

Administer ATNAA Autoinjector for Nerve Agent Antidote (Self-Aid)
Critical Source: STP 21 1 Army Warrior Skills Level 1 Soldiers Manual of Common Tasks
Steps to Administer ATNAA Autoinjector:

1. Prepare to administer one ATNAA:
- Remove one ATNAA from your protective mask carrier, from the pocket of the MOPP suit, or from another location as specified by your unit SOP.
- Remove the...
ATNAA autoinjector,nerve agent antidote,self aid
Administer Atropine Injection to Nerve Agent Casualty (Buddy Aid)
Critical Source: STP 21 1 Warrior Skills Level 1
Procedure for Administering Atropine Injection to a Nerve Agent Casualty

Steps:
1. Prepare to administer one atropine injection.
2. Position yourself near the casualty's thigh.
3. Remove all three sets of autoinjectors and the single...
atropine injection,nerve agent,casualty aid,buddy aid
Administer NAAK Mark 1 for Nerve Agent Exposure
Critical Source: Medical NBC Battlebook
Procedure:

1. Recognize exposure symptoms: Look for signs of nerve agent poisoning, such as pinpoint pupils, excessive salivation, muscle twitching, and difficulty breathing.
2. Use the first NAAK injector set: The individual soldier...
NAAK Mark 1,CANA,Nerve Agent Antidote Kit,atropine,pralidoxime chloride,diazepam,nerve agent exposure
Administer Nerve Agent Antidote (Self-Aid) Using MARK I Autoinjector
Critical Source: STP 21 1 Army Warrior Skills Level 1 Soldiers Manual of Common Tasks
Steps to Administer Nerve Agent Antidote (Self-Aid):

1. Prepare to administer one atropine injection:
- Remove one set of MARK I from your protective mask carrier, from the pocket of the MOPP suit, or from another location as specified...
nerve agent antidote,MARK I autoinjector,self aid,atropine injection,2 PAM Cl injection
Administering Nerve Agent Antidote (MARK I or ATNAA) to a Casualty
Critical Source: FM 4 25 11 First Aid
Overview: This procedure outlines the steps for administering nerve agent antidotes (MARK I or ATNAA) as part of buddy aid. It is critical in cases where an individual has been exposed to a nerve agent and cannot self-administer...
nerve agent antidote, buddy aid, MARK I, ATNAA, CANA, injection site, self-aid
Buddy Aid for Nerve Agent Casualty (CANA Administration)
Critical Source: FM 4 25 11 First Aid
Overview: This procedure outlines the steps to administer CANA as part of buddy aid for a nerve agent casualty. It is essential in preventing convulsions and ensuring effective treatment.

Steps:
1. Obtain buddy’s CANA from your supply...
CANA administration, buddy aid, nerve agent casualty, convulsion prevention
Self-Aid for Nerve Agent Exposure (MARK I or ATNAA)
Critical Source: FM 4 25 11 First Aid
Overview: This procedure outlines the steps to self-administer nerve agent antidotes (MARK I or ATNAA) if exposed and capable of doing so. It is critical in preventing incapacitation from nerve agent poisoning.

Steps:
1. **Mask yourself...
self-aid, nerve agent exposure, MARK I, ATNAA, overdose prevention
Administer NAPP Tablets for Nerve Agent Pretreatment
High Priority Source: Medical NBC Battlebook
Procedure:

1. Obtain orders: Administer NAPP tablets only under direct orders from a medical authority or theater commander.
2. Determine timing: Take one 30mg Pyridostigmine Bromide tablet every eight hours, as directed.
3....
NAPP,Nerve Agent Pre-treatment Tablets,Pyridostigmine Bromide,pretreatment protocol
Use Testmate for Nerve Agent Detection
Standard Source: Medical NBC Battlebook
Procedure:

1. Prepare the device: Ensure the Testmate is powered on and calibrated according to manufacturer instructions.
2. Collect blood sample: Use a sterile lancet to obtain a small blood sample from the individual being tested.
3....
Testmate,acetylcholinesterase testing,nerve agent detection,FDA approved

Infectious Disease Testing (9)

Collect and Submit Specimens to CDC During Pandemic Influenza
High Priority Source: HHSPandemicInfluenzaPlan
Procedure:

1. Select the appropriate specimen type from the following list: Serum (acute), serum (convalescent), NP swab, NP aspirate/wash, bronchoalveolar lavage specimen (BAL), OP swab, tracheal aspirate, or tissue.

2. For each specimen...
specimen collection, CDC submission, influenza testing, pandemic flu, specimen types
Specimen Submission Guidelines for State/Local Laboratories
High Priority Source: HHSPandemicInfluenzaPlan
Procedure:

When to Submit Specimens to CDC:
• If a state or local laboratory tests a sample positive for H5 or another novel subtype.
• If a patient meets the clinical and epidemiologic criteria for possible infection with a potentially...
specimen submission CDC, H5N1 testing guidelines, influenza A(H5) PCR, BSL-3 facility
Testing for Human Cases of Avian Influenza
High Priority Source: HHSPandemicInfluenzaPlan
Procedure:

1. Identify suspected subtypes:
- State public health laboratories may conduct testing to identify suspected subtypes of avian influenza (e.g., H5, H7) if appropriate laboratory capacity and biocontainment equipment are...
avian influenza testing, H5N1, BSL-3, RT-PCR, CDC submission, public health labs
Testing for Human Influenza Strains with Pandemic Potential
High Priority Source: HHSPandemicInfluenzaPlan
Procedure:

1. Surveillance during Pandemic Alert Period:
- Diagnostic laboratories should be on alert for new human subtypes of influenza that might have pandemic potential.

2. Reporting unusual subtypes:
- State and local public...
pandemic influenza testing, novel strains, RT-PCR, BSL-2, CDC submission
Testing for Influenza A (H5N1) and BSL-3 Enhanced Conditions
High Priority Source: HHSPandemicInfluenzaPlan
Procedure:

1. If a specimen is confirmed positive for influenza A (H5N1) by RT-PCR, additional testing should be performed only under BSL-3 conditions with enhancements.
2. Immediately inform CDC’s Influenza Branch by contacting the...
H5N1 testing, BSL-3 enhanced conditions, CDC notification, select agent program
Interpretation of Rapid Diagnostic Test Results for Influenza
High Priority Source: HHSPandemicInfluenzaPlan
Procedure:

1. Understand that the reliability of rapid diagnostic tests depends on the conditions under which they are used.

2. Sensitivity and Specificity:
- Median sensitivity is generally ~70%–75% compared to viral culture.
-...
test interpretation, false positives, false negatives, influenza prevalence
Minimizing False Results in Rapid Diagnostic Testing for Influenza
High Priority Source: HHSPandemicInfluenzaPlan
Procedure:

1. Use rapid diagnostic tests with high sensitivity and specificity.

2. Collect specimens as early in the illness as possible, ideally within 4–5 days of symptom onset.

3. Follow the manufacturer’s instructions carefully,...
minimizing false results, specimen collection timing, viral culture submission
Collecting Nasopharyngeal Wash/Aspirate Specimens for Influenza Testing
Standard Source: HHSPandemicInfluenzaPlan
Procedure:

1. Have the patient sit with their head tilted slightly backward.
2. Instill 1 ml–1.5 ml of nonbacteriostatic saline (pH 7.0) into one nostril.
3. Flush a plastic catheter or tubing with 2 ml–3 ml of saline.
4. Insert the...
nasopharyngeal wash, specimen collection, influenza testing, respiratory specimens, infection control
Handling and Testing of Influenza Specimens in BSL-2 Conditions
Standard Source: HHSPandemicInfluenzaPlan
Procedure:

1. Commercial antigen detection testing for influenza may be conducted under BSL-2 containment conditions, provided a Class II biological safety cabinet is used.
2. **Clinical specimens from suspected novel influenza...
BSL-2 testing, influenza specimen handling, RT-PCR, infection control

Respiratory Illness (9)

Recognize and Respond to Adult Respiratory Distress Syndrome (ARDS)
Critical Source: NATO Emergency War Surgery
Objective: Recognize the signs of ARDS and initiate appropriate treatment.

Procedure:
1. Monitor for clinical signs, including:
- Tachypnea
- Increased respiratory effort
- Decreased PaO2 unresponsive to increased FiO2
- Dry...
ARDS, management, mechanical ventilation, PEEP, hypoxemia, hypercarbia
Identify and Manage Causes of Post-Traumatic Pulmonary Insufficiency
High Priority Source: NATO Emergency War Surgery
Objective: Identify and manage the causes of post-traumatic pulmonary insufficiency.

Procedure:
1. Assess for potential causes, including:
- Penetrating or perforating pulmonary injury
- Pulmonary contusion from blunt or blast...
pulmonary insufficiency, causes, management, ARDS, aspiration, fluid resuscitation
Use Salbutamol (Albuterol) Inhaler for Asthma Attacks
High Priority Source: Where There is no Doctor a Village Health Care Handbook
Procedure:

1. For mild wheezing, use 1 to 2 inhalations every 4 to 6 hours until the wheezing stops.
2. For more severe wheezing, increase the number of inhalations as needed.
3. Before exercise, use 2 puffs every 15-30 minutes...
salbutamol, albuterol, asthma attack, bronchodilator
Recognize and Manage Post-Traumatic Respiratory Alkalosis
High Priority Source: NATO Emergency War Surgery
Objective: Recognize post-traumatic respiratory alkalosis and manage appropriately.

Procedure:
1. Monitor for signs of respiratory alkalosis, including:
- Hyperventilation
- Decreased PaCO2 levels
- Increased respiratory rate
-...
post-traumatic respiratory alkalosis, management, hyperventilation, PaCO2, tachypnea
Use Beclomethasone for Asthma Management
High Priority Source: Where There is no Doctor a Village Health Care Handbook
Procedure:

1. Start using beclomethasone at the first sign of wheezing or chest tightness.
2. Follow the instructions on page 167 for proper usage and dosage.
3. Keep asthma medications at home to ensure they are always available in case of...
beclomethasone, asthma management, corticosteroid
Prepare Homemade Cough Syrup
Standard Source: Where There is no Doctor a Village Health Care Handbook
Procedure:

1. Gather ingredients such as honey, ginger root, and lemon juice.
2. Grate fresh ginger and mix it with a small amount of water or lemon juice to create a paste.
3. Add honey (about 1 tablespoon per cup of liquid) to the...
homemade cough syrup, honey, ginger, lemon juice
Use Water for Cough Relief
Standard Source: Where There is no Doctor a Village Health Care Handbook
Procedure:

1. Drink plenty of water throughout the day to help loosen mucus and soothe a cough.
2. Inhale steam from hot water (without burning yourself) to further loosen mucus and reduce coughing.
3. This method is more effective than...
cough relief, water, steam inhalation, mucus loosening
Use Decongestant Nose Drops (Ephedrine or Phenylephrine)
Reference Source: Where There is no Doctor a Village Health Care Handbook
Procedure:

1. Apply 1-2 drops of decongestant nose drops into each nostril, as shown in the book.
2. Repeat this 4 times a day, but do not use for more than 3 days or make it a habit.
3. This is especially useful if the person has or...
decongestant drops, ephedrine, phenylephrine, nasal congestion
Use Nasal Saline Solution for Stuffy Nose
Reference Source: Where There is no Doctor a Village Health Care Handbook
Procedure:

1. Prepare a saline solution by mixing ½ teaspoon of salt with 1 cup of warm water.
2. Sniff the solution into each nostril, allowing it to drain out naturally.
3. Repeat this process as needed throughout the day.
4. This...
nasal saline solution, stuffy nose, congestion relief

Heat Stress Prevention (9)

Maintain Adequate Water Intake in Hot Environments
Critical Source: NAVMED P 5010 US Navy Manual of Preventive Medicine
Maintain Adequate Water Intake in Hot Environments

1. Water is the most critical factor in preventing heat injury.
2. Individuals may lose more than one quart of water per hour through sweating in high heat environments.
3. Replace lost...
water intake, hydration, heat injury prevention
Adjust Work Schedules to Reduce Heat Stress Risk
High Priority Source: NAVMED P 5010 US Navy Manual of Preventive Medicine
Adjust Work Schedules to Reduce Heat Stress Risk

1. Schedule work during cooler hours of the day, such as early morning or evening, when possible.
2. Modify or suspend work in severe heat conditions, depending on factors like humidity,...
work schedule, heat stress prevention, thermal management
Assessing Heat Stress Using the WBGT Index
High Priority Source: NAVMED P 5010 US Navy Manual of Preventive Medicine
Purpose: Assess heat stress conditions using the Wet Bulb, Globe Temperature (WBGT) Index to prevent heat casualties.

Procedure:
1. The WBGT Index is calculated from three temperature measurements: wet bulb, dry bulb, and **globe...
WBGT index, heat stress, temperature measurement, body armor, heat casualty prevention
Interpreting WBGT Index Flag Conditions
High Priority Source: NAVMED P 5010 US Navy Manual of Preventive Medicine
Purpose: Interpret WBGT Index flag conditions to adjust work schedules and physical training.

Procedure:
1. White Flag (<80°F): Extremely intense physical exertion may precipitate heat exhaustion or heat stroke. Caution must be taken,...
WBGT flag conditions, heat stress limits, physical training adjustments
Monitor WBGT Index for Heat Injury Prevention
High Priority Source: NAVMED P 5010 US Navy Manual of Preventive Medicine
Monitor WBGT Index for Heat Injury Prevention

1. Carefully monitor the Wet Bulb Globe Temperature (WBGT) index, as it is essential to preventing heat injury.
2. Refer to Article 9-36 of this manual for detailed guidelines on...
WBGT index, heat injury prevention, environmental monitoring
Implement Shading and Hydration Strategies in Garrison Areas
High Priority Source: NAVMED P 5010 US Navy Manual of Preventive Medicine
Implement Shading and Hydration Strategies in Garrison Areas

1. Use camouflaged netting to reduce temperatures inside tents, dining areas, recreation spaces, and berthing.
2. Provide protected sources of cool drinking water throughout...
garrison area, shading techniques, hydration strategy
Implement a Heat Acclimatization Program
High Priority Source: NAVMED P 5010 US Navy Manual of Preventive Medicine
Implement a Heat Acclimatization Program

1. Gradually increase exposure to heat and physical exertion over time.
2. Ensure that acclimatization at one level of heat stress does not assume acclimatization at higher levels of heat stress.
3....
heat acclimatization, heat stress prevention, military training
Optimize Clothing for Heat Stress Environments
High Priority Source: NAVMED P 5010 US Navy Manual of Preventive Medicine
Optimize Clothing for Heat Stress Environments

1. Wear minimal allowable clothing, except when exposed to direct sunlight.
2. Clothing should be loose-fitting at the neck, arms, waist, and lower legs to allow air circulation.
3. In...
clothing for heat, heat stress prevention, military attire
Manage Salt Intake in Hot Environments
Standard Source: NAVMED P 5010 US Navy Manual of Preventive Medicine
Manage Salt Intake in Hot Environments

1. Salt (sodium chloride) is lost through sweat and must be replenished.
2. A normal diet with salt added to taste provides adequate sodium intake for most individuals.
3. **Salt supplements are not...
salt intake, electrolyte balance, heat stress prevention

Cold Weather Prevention (9)

Buddy System for Cold Injury Recognition and Treatment
High Priority Source: NAVMED P 5010 US Navy Manual of Preventive Medicine
Objective: Recognize early signs of cold injuries and provide immediate treatment.

Procedure:
1. Personnel must be trained to recognize signs of cold injury on others, such as blanching of the skin.
2. If blanching is observed,...
buddy system, frostbite recognition, cold injury treatment
Implement Preventative Measures for Cold Weather Health
High Priority Source: FM 31 70 Basic Cold Weather Manual
Preventative Measures for Cold Weather Health:

1. Accomplish regular body waste elimination.
2. Wash out insulated boots weekly, if possible.
3. **Use the 'buddy system' to maintain constant check for indications of frostbite or...
cold weather, frostbite prevention, dehydration, personal hygiene, buddy system
Care of the Feet in Cold Weather Operations
Standard Source: NAVMED P 5010 US Navy Manual of Preventive Medicine
Objective: Prevent cold injuries and fungal infections by maintaining foot hygiene.

Procedure:
1. Use cold weather, insulated, rubber boots (black or white) issued during cold operations.
2. Change socks frequently due to increased...
foot care, cold weather boots, fungal infection prevention, sock changes
Dietary Considerations for Cold Weather Operations
Standard Source: NAVMED P 5010 US Navy Manual of Preventive Medicine
Objective: Maintain internal body heat and hydration through proper nutrition.

Procedure:
1. Increase caloric intake, especially from carbohydrates, to support the production of internal body heat.
2. Ensure **adequate water...
cold weather diet, hydration in cold, caloric intake
Exercise to Maintain Circulation in Cold Weather Operations
Standard Source: NAVMED P 5010 US Navy Manual of Preventive Medicine
Objective: Prevent cold injuries by maintaining body heat and circulation.

Procedure:
1. Avoid immobilization of large muscle groups to generate internal body heat.
2. Perform movements such as wiggling fingers and toes to increase...
exercise in cold weather, circulation maintenance
Hand Protection in Cold Weather Operations
Standard Source: NAVMED P 5010 US Navy Manual of Preventive Medicine
Objective: Prevent cold injuries and maintain hand warmth.

Procedure:
1. Use mittens instead of gloves, as they provide better insulation and protection from the cold.
2. Keep a dry pair of mittens available at all times for use...
hand protection, mittens vs gloves, leather glove care
Maintaining Personal Hygiene in Cold Weather Operations
Standard Source: NAVMED P 5010 US Navy Manual of Preventive Medicine
Objective: Prevent skin diseases and maintain health through proper hygiene.

Procedure:
1. Maintain proper personal hygiene, even when field operations limit access to hot water or washing facilities.
2. Regularly clean the body,...
personal hygiene, cold weather, skin disease prevention
Proper Clothing for Cold Weather Operations
Standard Source: NAVMED P 5010 US Navy Manual of Preventive Medicine
Objective: Prevent cold injuries through appropriate clothing.

Procedure:
1. Wear clothing in layers to allow removal as needed to avoid sweating, which reduces insulation properties.
2. Outer layers should be wind-resistant.
3. Choose...
cold weather clothing, insulation, wind resistance, heat loss prevention
Use of Sunglasses and Sunscreen in Snow Conditions
Standard Source: NAVMED P 5010 US Navy Manual of Preventive Medicine
Objective: Protect eyes and skin from sun damage in snow environments.

Procedure:
1. Wear sunglasses during daylight hours, even on cloudy or overcast days, as UV radiation can still be harmful.
2. Use sunscreen to protect the skin...
sun protection in snow, sunglasses use, sunburn prevention

Drowning Rescue (9)

Managing Submersion Incidents in Cold Weather Environments
Critical Source: US Marine Corps Wilderness Medicine
Procedure:

Definition of a Submersion Incident:
• A submersion incident is a medical problem that occurs after a casualty has been submerged under water.

Key Definitions:
Drowning: Death by suffocation following submersion in...
submersion incident,cold water,drowning,near drowning,resuscitation,rewarming,prognostic signs,survival time,hyperventilation,buoyancy aid
Recognize and Respond to Submersion Drowning Events
Critical Source: US Marine Corps Wilderness Medicine
Procedure for Recognizing and Responding to Submersion Drowning Events

### Sequence of Events in Submersion Drowning:
1. Initial Panic: The victim experiences panic, followed by a violent struggle.
2. Gulping Air and Water: The victim...
submersion,drowning,pathophysiology,hypothermia,laryngospasm,wet drowning,dry drowning,fresh water,salt water,CPR,ACLS
Assessing the History of a Submersion Incident
High Priority Source: US Marine Corps Wilderness Medicine
To determine the cause of unconsciousness and guide treatment:

1. Determine if the casualty was found floating face down or rescued from water.
2. If near-drowning is unwitnessed or occurred after a dive, presume head injury and C-spine injury and...
submersion,history,drowning,C-spine precautions
Field Management of Submersion Incidents
High Priority Source: US Marine Corps Wilderness Medicine
To manage submersion incidents in the field:

1. Ensure safety of rescuers first.
2. Retrieve the casualty from water, if possible.
3. Prioritize ABCs (Airway, Breathing, Circulation):
- Establish an airway and check breathing and...
field management,drowning,CPR
Identifying Favorable Prognostic Signs in Submersion Victims
High Priority Source: US Marine Corps Wilderness Medicine
Favorable prognostic signs include:

1. Casualty is alert.
2. Basic or advanced life support is received at the scene.
3. Good response to initial resuscitation.
4. Hypothermic (cold water may be protective).
5. Older child or adult.
6. Brief...
prognosis,drowning,submersion
Identifying Signs and Symptoms of Submersion Injury
High Priority Source: US Marine Corps Wilderness Medicine
To identify signs and symptoms that may indicate the severity of submersion injury:

Respiratory signs and symptoms:
• Dyspnea
• Tachypnea (SOB)
• Sore throat
• Substernal burning
• Pleuritic chest pain
• Persistent cough
• Frothy sputum
-...
symptoms,drowning,submersion
Identifying Unfavorable Prognostic Signs in Submersion Victims
High Priority Source: US Marine Corps Wilderness Medicine
Unfavorable prognostic signs include:

1. Age under three years.
2. Fixed dilated pupils.
3. Submerged for five minutes or longer.
4. No resuscitation attempts for the first ten minutes.
5. Blood pH less than 7.10.
6. Cardio-pulmonary arrest as...
prognosis,drowning,submersion
Managing Gastric Distention in Submersion Victims
High Priority Source: US Marine Corps Wilderness Medicine
To manage gastric distention in submersion victims:

1. Anticipate vomiting and turn the patient's head to prevent aspiration.
2. Use suction if available.
3. Relieve gastric distention only when it interferes with CPR, as per American Heart...
gastric distention,drowning,CPR
Prognostic Predictors for Submersion Victims
High Priority Source: US Marine Corps Wilderness Medicine
To assess prognosis in submersion victims:

0–2 unfavorable prognostic indicators yield a greater than 90% survival rate.
3 or more unfavorable prognostic indicators yield less than a 5% survival rate.
Corm's Criteria (based on...
prognosis,drowning,Corm's Criteria

Nutritional Deficiencies (9)

Identify and Treat Night Blindness and Xerophthalmia (Vitamin A Deficiency)
Critical Source: Where There is no Doctor a Village Health Care Handbook
Procedure:

1. Recognize the condition:
- This eye disease is most common in children aged 1 to 5 years.
2. Assess symptoms:
- Early signs include night blindness, where the child has difficulty seeing in low light.
3. **Look...
vitamin A deficiency, night blindness, xerophthalmia, Bitot’s spots, corneal damage, child eye health
Treating Anemia in Noma Patients
High Priority Source: Where There is No Dentist
Procedure:

1. Administer iron supplements (ferrous sulfate) immediately:
- For children over 6 years: 200 mg (1 tab) 3 times a day with food.
- For children aged 3–6 years: 100 mg (½ tab) 3 times a day with food.
- For children...
anemia treatment, ferrous sulfate, iron deficiency, folic acid, deworming, Noma care
Administer Nutritional Supplements for Malnutrition and Anemia
High Priority Source: Where There is no Doctor a Village Health Care Handbook
Title: Administer Nutritional Supplements for Malnutrition and Anemia

Procedure:
1. Use powdered milk (dried milk):
- Mix 1-2 tablespoons of powdered milk with water or other fluids as needed.
2. Use mixed (or multi) vitamins:
...
malnutrition,anemia,powdered milk,vitamin A,iron sulfate,folic acid,B12,B6
Prioritize Nutritious Foods Over Vitamin Supplements
High Priority Source: Where There is no Doctor a Village Health Care Handbook
Procedure:

1. Eat a good mixture of foods, including vegetables and fruits, to obtain all necessary vitamins naturally.
2. Prefer nutritious foods (such as eggs) over buying vitamin pills, injections, syrups, or tonics.
3. If nutritious...
vitamin supplements, nutrition over pills, folic acid, vitamin B6, iodine deficiency
Assemble a First Aid Kit for Anemia Treatment
Standard Source: Where There is no Doctor a Village Health Care Handbook
To assemble a first aid kit that includes medicines for anemia treatment, include the following:

1. Iron (Ferrous Sulfate): Include 200 mg pills of Iron (ferrous sulfate). It is best if these pills also contain vitamin C and folic acid to...
iron,anemia treatment,folic acid,vitamin C
Recognize and Respond to Pernicious Anemia
Standard Source: Where There is no Doctor a Village Health Care Handbook
Procedure:

1. Identify symptoms: Look for signs of pernicious anemia, such as fatigue, weakness, pale skin, shortness of breath, and a sore or red tongue.
2. Understand the cause: Recognize that pernicious anemia is caused by a...
pernicious anemia, vitamin B12 deficiency, treatment, medical care
Use Iron Pots or Add Iron to Food for Anemia Prevention
Standard Source: Where There is no Doctor a Village Health Care Handbook
Procedure:

1. Cook foods such as beans in iron pots to increase the iron content of meals.
2. Alternatively, add a piece of old iron (e.g., a horseshoe) to the pan while cooking beans or other foods to enhance iron intake.
3. Adding...
anemia prevention, iron intake, cooking with iron, lemon juice method
Recognize and Treat Latido (Pulsing in the Stomach)
Standard Source: Where There is no Doctor a Village Health Care Handbook
Latido refers to a pulsing or “jumping” feeling in the pit of the stomach. It is actually the aorta, the large blood vessel coming from the heart, being felt through the abdominal wall. This can be seen and felt more easily in very thin...
latido, pulsing stomach, malnutrition, hunger, treatment
Understanding Malnutrition and Its Effects
Reference Source: Where There is No Dentist
- Malnutrition is a health problem caused by not eating enough of the foods that the body needs.
malnutrition, nutritional deficiency, health problems

Childbirth Complications (9)

Handling Breech Delivery During Childbirth
Critical Source: Where There is no Doctor a Village Health Care Handbook
Objective: Assist in a breech birth when the baby’s buttocks come out first.

### Steps:
1. Assess baby position: Confirm if the baby is in the breech position by feeling the mother’s belly and listening to the heartbeat (see p. 257 and p....
breech delivery, baby position, childbirth complications, repositioning baby, medical help
Managing Arm Presentation During Childbirth
Critical Source: Where There is no Doctor a Village Health Care Handbook
Objective: Address a situation where the baby’s hand comes out first during childbirth.

### Steps:
1. Recognize the complication: If the baby’s hand or arm comes out first, this is known as an arm presentation.
2. **Immediately seek medical...
arm presentation, childbirth complications, medical help, cesarean section
Managing Difficult Births
Critical Source: Where There is no Doctor a Village Health Care Handbook
Procedure:

1. Ensure the mother is in a comfortable position (usually on her back or side) with support from family members.
2. Encourage slow, deep breathing to help manage pain and relax muscles.
3. If the baby’s head is not visible after...
difficult birth management, obstructed labor, childbirth assistance
Managing Meconium Aspiration During Childbirth
Critical Source: Where There is no Doctor a Village Health Care Handbook
Objective: Prevent meconium aspiration in the newborn when it is present during delivery.

### Steps:
1. Recognize meconium presence: If the amniotic fluid contains a dark green (almost black) liquid, this indicates the baby has passed...
meconium aspiration, suction bulb, newborn care, childbirth complications
Managing Slow or Stopped Labor During Childbirth
Critical Source: Where There is no Doctor a Village Health Care Handbook
Objective: Help manage labor that has slowed down or stopped during childbirth.

### Steps:
1. Assess the situation: Determine if the woman is frightened or upset, as this can slow contractions.
2. Reassure and comfort: Talk to her, help...
slow labor, stopped labor, childbirth complications, baby position, dehydration, rehydration drink, breech delivery, cephalopelvic disproportion
Managing Twin Births During Childbirth
Critical Source: Where There is no Doctor a Village Health Care Handbook
Objective: Ensure safe delivery of twins.

### Steps:
1. Recognize the complication: If the mother is giving birth to twins, this is a more complex and dangerous process than delivering a single baby.
2. Seek immediate medical help: The...
twin birth, childbirth complications, hospital delivery, medical help
Managing Umbilical Cord Around Baby’s Neck During Childbirth
Critical Source: Where There is no Doctor a Village Health Care Handbook
Objective: Address a situation where the umbilical cord is wrapped tightly around the baby’s neck during delivery.

### Steps:
1. Identify the complication: If you notice the cord is wrapped tightly around the baby’s neck, take immediate...
cord around neck, childbirth complications, clamping cord, sterilized scissors
Correct Use of Oxytocics During Childbirth
High Priority Source: Where There is no Doctor a Village Health Care Handbook
Procedure:

1. Ensure the oxytocic medication is properly prepared and administered by a trained individual.
2. Administer the correct dosage as per guidelines (usually under medical supervision).
3. Monitor the mother for uterine contractions...
oxytocics use, postpartum hemorrhage management, childbirth medication
Managing Bleeding After Childbirth
High Priority Source: Where There is no Doctor a Village Health Care Handbook
Procedure:

1. Apply direct pressure to the bleeding area using a clean cloth or gauze.
2. If bleeding continues, add more layers of cloth or gauze on top without removing the existing ones.
3. Elevate the legs if possible to reduce blood flow...
bleeding after childbirth, postpartum hemorrhage, pressure application, shock management

Labor Delivery (8)

Avoid Encouraging Pushing Too Early
Critical Source: A Book for Midwives
Procedure:

Do not encourage the mother to push until she is overwhelmed by an urge to push, even if you know the cervix is fully open.

Risks of pushing too early:
• The baby will be blocked by a partially closed cervix and unable...
pushing too early, knee-chest position, labor complications
Identify Signs That Stage 2 of Labor Is Beginning
High Priority Source: A Book for Midwives
Procedure:

Look for these signs to determine if a mother is entering or has entered stage 2 of labor. If two or more of the following are present, she is likely ready to push:

1. The mother feels an uncontrollable urge to push, which...
stage 2 labor, signs of pushing, midwifery procedures, vaginal exam risks
Check the Baby’s Position Early in Labor
High Priority Source: A Book for Midwives
It is wise to check the baby’s position early on in labor.

What checking the baby’s position can tell you:
• If the baby is lying head down, and which way he faces
• If the baby is moving down through the mother’s pelvis

**Ideal baby...
baby position, labor, midwife, childbirth, fetal positioning
Describe What Happens During Stage 2 of Labor
High Priority Source: A Book for Midwives
Procedure:

During stage 2 of labor:

• The mother’s genitals bulge during contractions, and the anus may open slightly.
• Between contractions, her genitals relax.
• Each contraction (and each push) moves the baby further down the birth...
stage 2 labor process, crowning, baby delivery stages
Monitor Signs During Stage 1 of Labor
High Priority Source: A Book for Midwives
When you first arrive at a labor, or when the mother comes to you, you should check her and the baby thoroughly for both healthy and warning signs.

Signs to monitor:
Baby’s position: Check when you first see the mother in labor
• **Baby’s...
monitoring labor, midwife, vital signs, baby position, childbirth
Encourage Women to Use Low Sounds During Labor
Standard Source: A Book for Midwives
Making sounds in labor can help women to open. Not all women want to make noise, but encourage women to try.

Recommended sounds:
• Low sounds, like growling animal noises or humming
• Chanting or singing
• The woman can be as loud as she wants...
labor, sounds, breathing techniques, midwife, childbirth
Use Different Breathing Techniques During the First Stage of Labor
Standard Source: A Book for Midwives
The way a woman breathes can have a strong effect on how her labor will feel. In the first stage of labor, there are many kinds of breathing that may make labor easier.

Breathing techniques to try:
1. Slow, gentle breathing: Ask the woman...
breathing techniques, labor, midwife, childbirth, pain management
Knowing When to Do Nothing During Labor
Reference Source: A Book for Midwives
In many cases, the best thing for a woman in labor is to do nothing. A healthy woman is likely to have a healthy and happy birth. Most births go well without intervention.

When all is going well, simply watch and wait. Doing unnecessary...
do_nothing,labor,delivery,intervention,natural_birth

Pregnancy Discomforts (8)

Manage Cramps in Early Pregnancy
Standard Source: A Book for Midwives
Procedure:

1. Recognize normal cramping: Mild cramps similar to monthly bleeding cramps are common during the first three months of pregnancy due to womb growth.
2. Identify warning signs:
- Regular or constant cramps
- Very...
cramps,pregnancy early,warning signs,tubal pregnancy, miscarriage
Address Baby’s Kicks Causing Discomfort in Pregnancy
Standard Source: A Book for Midwives
Procedure:

1. Understand normal discomfort: Babies kicking hard or consistently in the same area may cause soreness but are not harmful.
2. Monitor fetal movement:
- The mother should feel regular kicks daily by the 6th or 7th...
fetal movement,discomfort,pregnancy,kicks
Managing Difficulty Sleeping During Pregnancy
Reference Source: A Book for Midwives
Procedure:

1. Establish a regular sleep schedule by going to bed and waking up at the same time each day.
2. Avoid screens (e.g., phones, computers) before bedtime, as blue light can interfere with sleep.
3. **Use relaxation...
difficulty sleeping,pregnancy,sleep schedule,relaxation techniques
Managing Food Cravings During Pregnancy
Reference Source: A Book for Midwives
Procedure:

1. Monitor cravings and ensure they are not leading to excessive consumption of unhealthy foods.
2. Choose nutrient-rich foods that satisfy cravings, such as fruits, nuts, or dairy products.
3. **Avoid excessive sugar...
food cravings,pregnancy,nutrition,balanced diet
Managing Heartburn During Pregnancy
Reference Source: A Book for Midwives
Procedure:

1. Eat smaller meals more frequently to reduce pressure on the stomach.
2. Avoid spicy, fatty, or acidic foods, which can trigger heartburn.
3. Stay upright after eating for at least 2-3 hours to prevent acid reflux.
4....
heartburn,pregnancy,diet,GERD
Managing Nausea During Pregnancy
Reference Source: A Book for Midwives
Procedure:

1. Eat small, frequent meals throughout the day instead of three large meals.
2. Avoid foods that trigger nausea, such as fatty or spicy foods.
3. Stay hydrated by drinking water or clear fluids in small amounts...
nausea,pregnancy,relief,hydration,ginger,vitamin B6
Managing Sleepiness During Pregnancy
Reference Source: A Book for Midwives
Procedure:

1. Prioritize rest by ensuring adequate sleep during the day and night.
2. Take short naps if needed to help manage fatigue without disrupting nighttime sleep.
3. Avoid caffeine, especially in the afternoon, as it can...
sleepiness,pregnancy,rest,naps,exercise
Relieve Sudden Pain from Ligaments in the Lower Belly
Reference Source: A Book for Midwives
Procedure:

1. Identify the cause: The pain is caused by sudden movement stretching the ligaments that hold the womb in place.
2. Apply gentle relief:
- Stroke the belly gently to soothe the area.
- Place a warm cloth on the...
ligaments,pain relief,warm cloth,pregnancy discomfort

Antibiotics Usage (8)

Administer Aminoglycosides with Caution
High Priority Source: A Book for Midwives
Aminoglycosides, such as gentamicin and streptomycin, are strong antibiotics used for severe infections when no safer drug is available. They can cause serious side effects and must be administered by injection. **Pregnant or...
aminoglycosides, gentamicin, streptomycin, antibiotic usage, injection, severe infection, pregnancy, breastfeeding
Administer Tetracycline and Doxycycline Safely
High Priority Source: A Book for Midwives
Tetracyclines, including doxycycline and tetracycline, are effective for treating many infections. They are low-cost and widely available. However, they should **not be taken by pregnant or breastfeeding women or children under 8 years...
tetracycline, doxycycline, antibiotic usage, pregnancy, breastfeeding, children under 8
Antibiotic Group Identification and Brand Names
High Priority Source: Where There is no Doctor a Village Health Care Handbook
Objective: Identify the group of an antibiotic based on its brand name or generic name.

### Steps:
1. Check the label on the antibiotic container for the generic name of the drug (e.g., _Paraxin ‘S’_ may contain chloramphenicol).
2....
antibiotic groups, brand names, generic names, drug identification, antibiotic safety
Identify Antibiotic Group and Usage Guidelines
High Priority Source: Where There is no Doctor a Village Health Care Handbook
Important: Never use an antibiotic unless you know to what group it belongs, what diseases it fights, and the precautions you must take to use it safely.

### Steps:
1. Check the label on the antibiotic container for the generic name of the...
antibiotic, usage guidelines, drug group identification, dosage instructions, antibiotic resistance
Proper Use of Antibiotics for Infections
High Priority Source: Where There is no Doctor a Village Health Care Handbook
Objective: Ensure antibiotics are used correctly and safely to treat infections.

### Steps:
1. Determine the infection you are treating by consulting this book or a healthcare professional.
2. Select an antibiotic that is recommended...
proper antibiotic use, infection treatment, dosage guidelines, adverse reactions, antibiotic resistance
Use Antibiotics Only When Necessary
High Priority Source: A Book for Midwives
Antibiotics should only be used when necessary. Overuse of antibiotics can lead to serious side effects such as nausea, vomiting, diarrhea, and vaginal yeast infections. Some antibiotics may cause more severe allergic reactions or other...
antibiotic overuse, resistance, side effects, viral infections, colds, hepatitis
Use Cephalosporins Safely During Pregnancy and Breastfeeding
Standard Source: A Book for Midwives
Cephalosporins, such as cefixime, ceftriaxone, and cephalexin, are effective for treating infections resistant to older antibiotics. They have fewer side effects than many other antibiotics but can be expensive and hard to find. They...
cephalosporins, cefixime, ceftriaxone, cephalalexin, antibiotic usage, pregnancy, breastfeeding, resistance
Use Sulfas (Sulfonamides) with Caution
Standard Source: A Book for Midwives
Sulfas, such as sulfamethoxazole (part of cotrimoxazole) and sulfisoxazole, are effective for treating many infections. They are cheap and widely available, but pregnant or breastfeeding women should prefer a different medicine....
sulfas, sulfonamides, cotrimoxazole, antibiotic usage, pregnancy, breastfeeding, allergies, resistance

Mental Health (8)

Addressing Emotional and Psychological Needs During Pregnancy and Postpartum
High Priority Source: A Book for Midwives
Procedure:

Steps:
1. Recognize the emotional challenges that may arise during pregnancy and postpartum (e.g., anxiety, depression).
2. Provide access to mental health resources such as counseling or support groups.
3. Encourage open...
emotional health,pregnancy,postpartum,mental health
Combat and Operational Stress Control Measures
High Priority Source: TCCC 17 13 Tactical Combat Casualty Care
Combat and operational stress control includes:

1. Providing doctrinal guidance for managing excessive stress in combat or operational environments.
2. Identifying command and leadership responsibilities to manage stressors.
3. Offering...
combat stress, mental health, leadership role
Recognize and Manage Delirium
High Priority Source: Where There is no Doctor a Village Health Care Handbook
Delirium is a state of mental confusion with strange movements and speech; it may come with high fever or severe illness. To manage delirium:

1. Ensure the person is in a calm, quiet environment.
2. Monitor for signs of infection, such as fever...
delirium, mental confusion, fever management
Addressing Health Beliefs That Can Harm Physical Wellbeing
Standard Source: Where There is no Doctor a Village Health Care Handbook
When a person strongly believes something will harm them, their fear can cause illness. For example:

• A woman who had a miscarriage and was still bleeding slightly was advised to drink orange juice (which contains vitamin C that helps strengthen...
belief,fear,health,orange juice,injections,witchcraft,mental health
Avoiding Harmful Beliefs About Witchcraft and Magic Centers
Standard Source: Where There is no Doctor a Village Health Care Handbook
Believing in witchcraft or the evil eye can lead to unnecessary suffering and illness. Here are some important points to consider:

• A ‘witch’ has no real power over other people, except for her ability to make them believe that she has.

• It is...
witchcraft,magic centers,belief,fear,mental health
Dealing with Beliefs in Witchcraft and the Evil Eye
Standard Source: Where There is no Doctor a Village Health Care Handbook
Believing that someone has the power to harm you can lead to illness. Anyone who believes they are bewitched or have been given the evil eye is really the victim of their own fears (see Susto, p. 24).

• A ‘witch’ has no real power over...
witchcraft,evil eye,belief,fear,mental health
Understanding the Role of Fear in Illness
Standard Source: Where There is no Doctor a Village Health Care Handbook
Fear can have a significant impact on physical wellbeing. For example:

• A woman who had a miscarriage and was still bleeding slightly became very ill after drinking orange juice due to her belief that it would make her sick.

• An injection of...
fear,health,belief,witchcraft,mental health
Recognize and Respond to _Susto_ (Fright/Hysteria)
Standard Source: Where There is no Doctor a Village Health Care Handbook
Overview:
_Susto_ is a condition caused by sudden fright, witchcraft, or evil spirits according to traditional beliefs in some cultures. It may manifest as nervousness, fear, strange behavior, inability to sleep, weight loss, and even...
susto,fright,hysteria,mental health,traditional beliefs,medical explanation

Neurological Injuries (8)

Performing Emergency Craniotomy for Evacuation of Acute Subdural and Epidural Hematomas
Critical Source: NATO Emergency War Surgery
Objective: Perform a craniotomy to evacuate acute subdural or epidural hematomas.

Procedure:
1. Prepare the patient for surgery, ensuring adequate anesthesia and monitoring.
2. Make an incision along the scalp in the frontotemporal-parietal...
craniotomy, subdural hematoma, epidural hematoma, brain injury management, surgical evacuation
Prevent Complications in Critical Care of Traumatic Brain Injury Patients
Critical Source: Emergency War Surgery
- Avoid hyperthermia, because this raises ICP.
• Take appropriate precautions (H2 blocker, heparin, and oral care) to prevent development of:
- Stress gastritis
- Deep venous thrombosis
- Aspiration pneumonitis
• If coagulopathy...
critical care, traumatic brain injury, coagulopathy management, hyperglycemia treatment, seizure prophylaxis, stress gastritis prevention
Assess and Document Facial Nerve Function in Patients with Skull Base or Temporal Bone Injury
High Priority Source: Emergency War Surgery
Procedure:

• Ensure that the facial nerve is assessed and documented on an awake patient and at the earliest convenience in a patient who has regained consciousness.
• Delineate between delayed onset and acute facial paralysis, as this is...
facial nerve, skull base injury, temporal bone injury, neurological assessment
Initial Assessment and Management of Nerve Injuries in the Neck
High Priority Source: NATO Emergency War Surgery
Procedure:

1. Identify and record nerve injuries, as they may require later repair.
2. Immediate repair is generally not recommended for traumatic nerve defects, except in cases involving the facial or spinal accessory nerves.
3. Even...
nerve injury, spinal accessory nerve, facial nerve, neurorrhaphy, missile wound, spinal cord injury
Managing Intracranial Pressure in Postoperative and Closed Injury Patients
High Priority Source: NATO Emergency War Surgery
Objective: Prevent secondary brain injury due to intracranial swelling or herniation.

Procedure:
1. Monitor intracranial pressure (ICP) if possible, as rising ICP can indicate:
- Expansion of a hematoma
- Late development of an...
intracranial pressure management, brain swelling, hyperventilation, mannitol administration, barbiturate coma
Recognizing Patients Requiring Operation for Intracerebral Hematomas
High Priority Source: NATO Emergency War Surgery
Objective: Identify patients requiring surgical intervention due to intracerebral hematomas.

Procedure:
1. Monitor neurological status closely for signs of deterioration, such as changes in consciousness or focal neurological deficits.
2....
intracerebral hematoma, neurological deterioration, craniectomy, intracranial pressure monitoring, closed injury management
Administer Systemic Steroids for Suspected Facial Nerve Paralysis
High Priority Source: Emergency War Surgery
Procedure:

• If there is no contraindication for systemic steroids, administer them for suspected facial nerve paralysis.
• Crush injuries to the facial nerve may present with delayed onset paralysis and the severity and course of the paresis...
steroids, facial nerve injury, crush injury
Management of Blast Over-Pressure CNS Injuries
Standard Source: Emergency War Surgery
Management of Blast Over-Pressure CNS Injuries

1. Recognize symptoms:
- Unconsciousness, confusion, headache, tinnitus, dizziness, tremors, increased startle response.
2. Monitor for increased ICP:
- May occur in severe cases...
blast over-pressure, CNS injuries, increased ICP, ICP monitors, ventriculostomies, magnesium therapy, level 4/5 facility, cognitive deficits

Renal Failure (8)

Administer Diuretics for ARF in Hemodynamically Stable Patients
Critical Source: Emergency War Surgery
Purpose: To increase urine output and manage fluid overload in hemodynamically stable ICU patients with profound oliguria or anuria.

Procedure:
1. Administer furosemide (Lasix) intravenously, starting at 40 mg IV bolus.
2. If no...
furosemide,chlorothiazide,metolazone,dialysis
Administer IV Fluids for ARF Due to Rhabdomyolysis
Critical Source: Emergency War Surgery
Purpose: To prevent further kidney damage and promote urine output in patients with rhabdomyolysis-induced acute renal failure (ARF).

Procedure:
1. Administer large volumes of intravenous (IV) fluid, starting at 300–800 mL/h.
2....
IV fluids,rhabdomyolysis,NaHCO3,urine alkalinization
Manage Acute Renal Failure Due to Rhabdomyolysis
Critical Source: Emergency War Surgery
Objective: Prevent further kidney damage and promote urine output in patients with rhabdomyolysis-induced ARF.

Procedure:
1. Administer large volumes of IV fluid, at a rate of 300–800 mL/h, to rehydrate the patient.
2. **Combine fluids...
rhabdomyolysis,IV fluid,sodium bicarbonate,urine alkalinization
Manage Acute Renal Insufficiency in Trauma Patients
Critical Source: NATO Emergency War Surgery
Managing Acute Renal Insufficiency in Trauma Patients

### Procedure Overview
Acute renal insufficiency is a life-threatening condition that may develop after trauma, especially from prolonged hypotension, crush injuries, burns, or hemolytic...
acute renal insufficiency, fluid resuscitation, hyperkalemia, dialysis, electrolyte management, oliguria, prerenal azotemia, mannitol, furosemide, calcium gluconate
Assess and Monitor Urinary Output in Trauma Patients
High Priority Source: NATO Emergency War Surgery
Assessing and Monitoring Urinary Output in Trauma Patients

### Procedure Overview
Urinary output is a critical indicator of renal function and overall patient status, especially in trauma patients. A decrease in urinary output may indicate...
urinary output, oliguria, anuria, acute renal failure, prerenal azotemia, mechanical obstruction, catheterization, intravenous pyelography, urine-specific gravity, hyperkalemia
Identify Causes of Acute Renal Failure (ARF)
High Priority Source: Emergency War Surgery
Objective: Determine the underlying cause of ARF to guide treatment.

Procedure:
1. Assess for hypovolemia, which can lead to prerenal azotemia.
2. Evaluate for acute tubular necrosis (ATN), caused by:
- Hypovolemia
- Sepsis
...
acute renal failure,hypovolemia,ATN,rhabdomyolysis,myoglobinuria,bilateral trauma
Indications for Dialysis in ARF
High Priority Source: Emergency War Surgery
Indications for dialysis in the casualty with acute renal failure (ARF):

Anuria beyond 8–12 hours.
Hypervolemia.
Hyperkalemia.
Acidosis.
Complications of uremia: mental status changes, pericardial rub.
• **Toxic...
dialysis, ARF, acute renal failure, anuria, hyperkalemia, acidosis, uremia
Monitor Renal Function Parameters
High Priority Source: Emergency War Surgery
Purpose: To assess kidney function and detect early signs of acute renal failure (ARF).

Procedure:
1. Monitor urine output regularly, especially in critically ill patients.
2. Measure blood urea nitrogen (BUN) levels to evaluate...
urine output,BUN,serum creatinine,electrolytes,acute renal failure

Gastrointestinal Health (8)

Manage Hepatic Failure in Critical Care Settings
Critical Source: Emergency War Surgery
Hepatic failure is a life-threatening condition with poor prognosis and requires immediate intervention to prevent exsanguination from coagulopathy.

### Signs of Hepatic Failure:
Hyperbilirubinemia (elevated bilirubin levels).
-...
hepatic failure,fresh frozen plasma,coagulopathy,bilirubin,prothrombin time,hypoalbuminemia
Diagnose and Treat Acalculous Cholecystitis in ICU Patients
High Priority Source: Emergency War Surgery
Acalculous cholecystitis is a serious condition that may occur in critically ill patients, especially those with right upper quadrant abdominal pain, abnormal liver function tests, or fever/leukocytosis of unclear origin.

### Diagnosis:
-...
acalculous cholecystitis,cholecystectomy,broad-spectrum antibiotics,gallbladder infection,ICU patients
Treating Severe Diarrhea and Dehydration
High Priority Source: Where There is no Doctor a Village Health Care Handbook
Procedure:

1. Prepare Rehydration Mix:
- Mix the following ingredients in a large container:
- 1 liter of clean water
- 1/2 teaspoon of salt (sodium chloride)
- 1 teaspoon of sugar
- Stir until the salt and sugar...
severe diarrhea,dehydration,rehydration mix,zinc supplements
Administer Metronidazole for Stomach Ulcers (in Combination with Other Medicines)
High Priority Source: Where There is no Doctor a Village Health Care Handbook
Metronidazole is used to treat stomach ulcers when combined with other medications. Follow these steps:

1. Determine the patient's age and weight.
2. Dosage for adults:
- Take 500 mg (1 tablet) three times a day for 10 to 14...
metronidazole, stomach ulcers, dosage, medical emergency, gastrointestinal health
Prevent Stress Gastritis in Trauma Patients
High Priority Source: Emergency War Surgery
Prevention of stress gastritis is critical in trauma patients at high risk, including those with severe head injuries, burns, mechanical ventilation, systemic anticoagulation therapy, or sepsis.

### Prevention Methods:
1. Administer...
stress gastritis,ranitidine,omeprazole,sucralfate,gastric protection,trauma patients
Treating Acid Indigestion and Stomach Ulcers
Standard Source: Where There is no Doctor a Village Health Care Handbook
Procedure:

1. Take Aluminum Hydroxide or Magnesium Hydroxide:
- Take aluminum hydroxide or magnesium hydroxide orally as directed by the manufacturer.
- Typically taken every 4-6 hours for relief of acid indigestion and heartburn.

2....
acid indigestion,stomach ulcers,aluminum hydroxide,magnesium hydroxide,sodium bicarbonate,calcium carbonate,omeprazole,ranitidine
Treating Gut Cramps with Antispasmodics
Standard Source: Where There is no Doctor a Village Health Care Handbook
Procedure:

1. Take Belladonna (with or without Phenobarbital):
- Take belladonna orally as directed by the manufacturer.
- Typically taken every 4-6 hours for relief of gut cramps and spasms.
belladonna,gut cramps,antispasmodics
Understand the Meaning of Bowel Movement
Reference Source: Where There is no Doctor a Village Health Care Handbook
Bowel movement refers to the process of defecation; it is the way solid waste is passed out of the body.
bowel movement,defecation,gastrointestinal health

Heat Injury Prevention (8)

Avoid Medications That Increase Heat Injury Risk
High Priority Source: Emergency War Surgery
Avoid Medications That Increase Heat Injury Risk

• Medications that affect thermoregulatory adaptations and increase the risk of heat injury include:
- Anticholinergics
- Antihistamines
- Diuretics
- Tricyclic antidepressants
- Major...
medications,thermoregulation,anticholinergics,beta blockers
Manage Salt Supplementation During Heat Acclimatization
High Priority Source: Emergency War Surgery
Manage Salt Supplementation During Heat Acclimatization

• In the first few days of acclimatization, sweat–salt conservation will not be fully developed.
• Salt depletion is a risk if soldiers are exposed during this time to sufficient heat or...
salt supplementation,acclimatization,sweat-salt conservation,ration consumption
Prevent Coincidental Illnesses to Reduce Heat Injury Risk
High Priority Source: Emergency War Surgery
Prevent Coincidental Illnesses to Reduce Heat Injury Risk

• Coincidental illnesses increase heat casualty risk through fever and dehydration.
• Fever reduces thermoregulatory capacity, increasing the risk of heat injury even after clinical...
coinidental illnesses,fever,dehydration,command supervision
Prevent Heat Injuries by Understanding Physiological Factors
High Priority Source: NAVMED P 5010 US Navy Manual of Preventive Medicine
Physiological factors that increase the risk of heat injuries include:

1. Illness: Personnel with acute or chronic diseases are more susceptible to heat injury.
2. Previous history: Individuals with a history of heat illness (e.g.,...
physiological factors, heat injury prevention, illness, dehydration, obesity, sickle cell trait
Prevent Heat Injury Through Acclimatization
High Priority Source: Emergency War Surgery
Prevent Heat Injury Through Acclimatization

• Acclimatization to heat requires 7–10 days.
• Predeployment training in artificially warm environments aids acclimatization.
• One hour of progressively more difficult exercise sufficient to...
acclimatization,heat injury prevention,exercise,thermoregulation,aerobic fitness
Prevent Heat Injury Through Hygiene and Skin Protection
High Priority Source: Emergency War Surgery
Prevent Heat Injury Through Hygiene and Skin Protection

Sunburn and other skin diseases of hot environments reduce the ability of the skin to thermoregulate.
• Sunburn must be prevented by adequate clothing, shade, and sunscreen.
• Skin...
sunburn,skin protection,hypothermia prevention,hygiene
Prevent Skin Injuries to Maintain Thermoregulation in Hot Environments
High Priority Source: Emergency War Surgery
Prevent Skin Injuries to Maintain Thermoregulation in Hot Environments

• Sunburn and other skin diseases of hot environments reduce the ability of the skin to thermoregulate.
• Prevent sunburn by using adequate clothing, shade, and sunscreen.
-...
sunburn,skin disease,thermoregulation,hypersensitivity,hygiene
Understand the General Principles of Heat Injury Prevention
High Priority Source: NAVMED P 5010 US Navy Manual of Preventive Medicine
Heat injuries are a major threat to field operations and can lead to serious harm or death if not properly managed. Key points include:

• The human body maintains internal temperature within a narrow range.
• High internal temperatures cause...
heat injury prevention, thermal regulation, heat stress, body temperature

Combat Medical Care (8)

Provide Definitive Care at Level 4 Combat Medical Care
Critical Source: NATO Emergency War Surgery
Objective: Provide definitive care and rehabilitation to casualties.

### Steps:
1. Treat casualties in a hospital located in the communications zone equipped for definitive care.
2. Rehabilitate casualties to duty status within a...
definitive care,rehabilitation,evacuation,zone of interior,reconstructive surgery
Provide Resuscitation and Initial Wound Surgery at Level 3 Combat Medical Care
Critical Source: NATO Emergency War Surgery
Objective: Provide resuscitation, initial wound surgery, and postoperative treatment to casualties.

### Steps:
1. Treat casualties in a medical installation equipped for resuscitation and initial wound surgery.
2. Provide surgical care...
resuscitation,wound surgery,forward surgical team,hospital care,nontransportable casualties
Follow Main Operational Principles for Providing Care in Armed Conflicts
High Priority Source: First Aid in Armed Conflicts
Objective: Provide the best possible care with the least possible delay during armed conflicts.

Steps:
1. Ensure safety and security:
- Use appropriate behavior and protective gear (e.g., gloves) to minimize risk to yourself and...
armed conflict, casualty care, triage, protective gear, communication, humanitarian approach
Provide Emergency Care at Level 2 Combat Medical Care
High Priority Source: NATO Emergency War Surgery
Objective: Evaluate and prioritize casualties for return to duty or continued evacuation.

### Steps:
1. Examine the casualty at an assembly point, clearing station, or brigade medical company.
2. Evaluate wounds and general status to...
casualty evaluation,priority determination,resuscitation,evacuation,light wounds
Provide First Aid at Level 1 Combat Medical Care
High Priority Source: NATO Emergency War Surgery
Objective: Provide essential emergency care to allow the return of the soldier to duty or prepare the casualty for evacuation.

### Steps:
1. Administer first aid by a "buddy" and provide emergency medical treatment by a trained medical...
first aid,buddy aid,emergency care,evacuation,field dressing,analgesic,IV fluids
Communicate and Document Care for Casualties in Armed Conflicts
High Priority Source: First Aid in Armed Conflicts
Objective: Ensure effective communication, reporting, and documentation of casualty care during armed conflicts.

Steps:
1. Communicate with a variety of people: Include casualties, local communities, and other medical personnel.
2....
communication, documentation, psychological support, local customs, triage
Maintain Readiness for Casualty Influx in Combat Medical Facilities
High Priority Source: NATO Emergency War Surgery
Objective: Ensure military medical treatment facilities are always ready to receive an influx of battle casualties or move according to tactical situations.

### Steps:
1. Keep medical facilities in a state of readiness at all times, even...
readiness,casualty influx,movement of casualties,tactical readiness,communication coordination
Implement Consultant System for Combat Surgery Evaluation
Standard Source: NATO Emergency War Surgery
Objective: Evaluate the effectiveness of combat surgery and provide feedback to forward medical treatment facilities.

### Steps:
1. Select consultants based on expertise in specific surgical specialties.
2. Evaluate end results from...
consultant system,surgical evaluation,feedback,professional meetings,war surgery conferences

Pandemic Response (8)

Developing Rapid Response Protocols for Avian Flu Outbreaks
Critical Source: Bird Flu Summit Brochure
Procedure:

1. Create a rapid response protocol that outlines immediate actions to be taken during an avian flu outbreak.
2. Define the roles and responsibilities of all stakeholders, including healthcare workers, public health officials,...
rapid response, avian flu, outbreak protocols, antivirals
Administer Combined Antiviral Treatment and Prophylaxis During Pandemic Alert Period
High Priority Source: HHSPandemicInfluenzaPlan
Procedure:

During the Pandemic Alert Period, consider implementing combined antiviral treatment for ill persons and targeted post-exposure prophylaxis of contacts to contain small disease clusters (e.g., institutional outbreaks or household...
antiviral treatment, prophylaxis, pandemic alert period, oseltamivir, influenza containment
Determine Antiviral Treatment Strategies During Pandemic Spread
High Priority Source: HHSPandemicInfluenzaPlan
Objective: Establish treatment decisions based on clinical features and epidemiologic risk factors, using updated knowledge of the pandemic virus.

Procedure:
1. Assess patients for clinical symptoms such as fever, cough, and respiratory...
antiviral treatment, pandemic influenza, clinical features, epidemiologic risk factors
Implement Post-Exposure Prophylaxis During Pandemic Influenza Outbreaks
High Priority Source: HHSPandemicInfluenzaPlan
Objective: Use post-exposure prophylaxis to control small disease clusters and protect high-risk individuals.

Procedure:
1. Administer post-exposure prophylaxis (generally for 10 days) in the following scenarios:
- To control outbreaks...
post-exposure prophylaxis, pandemic influenza, oseltamivir, drug resistance
Plan Antiviral Prophylaxis During Pandemic Influenza
High Priority Source: HHSPandemicInfluenzaPlan
Objective: Develop a strategy for antiviral prophylaxis based on available resources and risk factors.

Procedure:
1. Identify primary constraints:
- Limited supplies of antivirals
- Increased risk of side effects with prolonged use
...
antiviral prophylaxis, pandemic influenza, drug resistance, rimantadine, amantadine
Quarantine Groups of Exposed Persons During Pandemic Influenza
High Priority Source: HHSPandemicInfluenzaPlan
Procedure:

1. Identify groups for quarantine: Consider quarantining the following groups:
- Persons exposed to an influenza case via family members, public gatherings, or closed conveyances (e.g., airplanes, cruise ships).
-...
quarantine,pandemic influenza,exposed persons,public health measures
Target Antiviral Prophylaxis to Priority Groups During Pandemic Influenza
High Priority Source: HHSPandemicInfluenzaPlan
Objective: Ensure that antiviral prophylaxis is prioritized for groups at highest risk during the first wave of a pandemic.

Procedure:
1. Identify priority groups based on:
- Occupation (e.g., healthcare workers, essential community...
targeted prophylaxis, pandemic influenza, priority groups, first wave
Implement Community-Based Containment Measures During Pandemic Influenza
High Priority Source: HHSPandemicInfluenzaPlan
Procedure:

1. Assess the situation: Determine if disease transmission in the community is significant and sustained.
2. Engage with public health authorities: State and local public health authorities should consider implementing...
community-based containment measures,pandemic influenza,response planning,public health authorities

Injuries (8)

Emergency Care for a Broken or Cracked Bone in the Face or Jaw
Critical Source: Where There is No Dentist
Procedure:

1. Be sure the person can breathe.

• Lie him on his side so that his tongue and jaw fall forward.
• Later, carry him to the hospital in that position.
• If he goes in a car, be sure he sits with his head forward. His jaw and...
emergency care,broken bone,jaw injury,airway management,pain relief,penicillin
Managing Stiff Neck in Newborns and Adults
High Priority Source: Where There is no Doctor a Village Health Care Handbook
Procedure for Managing Stiff Neck:

1. Gently examine the neck to check for signs of swelling, redness, or tenderness.
2. Apply a warm compress to the affected area to help relieve stiffness and discomfort.
3. Avoid any sudden movements that may...
stiff neck,neck injury,warm compress,medical evaluation
Recognizing Signs of a Broken or Cracked Bone in the Face or Jaw
High Priority Source: Where There is No Dentist
Procedure:

Look for these signs to identify a broken or cracked bone:

• The person has had an injury.
• When teeth are closed, some upper teeth do not meet lower teeth.
• The person cannot open or close the mouth properly.
• There is bleeding...
broken bone,cracked bone,jaw injury,face injury,signs of fracture
Splinting a Suspected Broken Limb from a Bullet Wound
High Priority Source: Where There is no Doctor a Village Health Care Handbook
If there is any possibility that the bullet has hit a bone, the bone may be broken. Using or putting weight on the wounded limb (standing, for example) might cause a more serious break. If a break is suspected, it is best to splint the limb and not...
splinting,bullet wound,bone break,injury,first aid
Evisceration Definition and Description
High Priority Source: Medical Survival Wound Closure Manual
Evisceration is the protrusion of bowel through separated edges of an abdominal wound closure.
evisceration, abdominal wound, bowel protrusion, emergency surgery
Extrusion of Knots (Knot Extrusion or 'Spitting')
Standard Source: Medical Survival Wound Closure Manual
Extrusion of knots, also known as knot extrusion or 'spitting', is the body’s attempt to rid itself of nonabsorbable sutures or absorbable sutures that are not completely absorbed. Suture knots encapsulated by cells may work their way to...
knot extrusion, suture knots, foreign body reaction, extrusion
Treating a Nosebleed in Newborns and Adults
Standard Source: Where There is no Doctor a Village Health Care Handbook
Procedure for Treating a Nosebleed:

1. Sit upright and lean forward slightly to prevent blood from flowing down the throat.
2. Pinch the soft part of the nose just below the bridge, applying firm pressure for at least 10 minutes.
3. Apply a...
nosebleed,nasal injury,cold compress,pressure application
Managing Minor Musculoskeletal Injuries (Ankle Sprains)
Reference Source: Survival and Austere Medicine
Procedure:

**Steps to manage minor musculoskeletal injuries, such as ankle sprains:

1. Assess the injury: Check for swelling, pain, and mobility issues.
2. Apply RICE therapy:
- Rest: Avoid putting weight on the injured area.
...
ankle sprain, musculoskeletal injury, RICE therapy, pain management, immobilization

Insect Bites And Stings (8)

Treating a Brown Recluse Spider Bite
High Priority Source: Medical Emergencies
Procedure:

1. Identify the spider: Look for a small, light brown spider with a dark brown violin on its back.
2. Assess symptoms: Initially, there is little or no pain. Within a few hours, a painful red area with a mottled cyanotic...
brown recluse spider bite, ulcer treatment, infection prevention, systemic symptoms of brown recluse bite
Treating a Funnelweb Spider Bite
High Priority Source: Medical Emergencies
Procedure:

1. Identify the spider: Look for a large brown or gray spider found in Australia.
2. Assess symptoms: Symptoms are similar to those of a black widow spider bite, including severe local pain that spreads over the body and...
funnelweb spider bite, antivenin, CPR, infection prevention, symptoms of funnelweb spider bite
Treating a Scorpion Sting
High Priority Source: Medical Emergencies
Procedure:

1. Identify the scorpion: All scorpions are poisonous to some degree.
2. Assess symptoms:
- Severe local reaction only: Pain and swelling around the sting area, possible prickly sensation around the mouth,...
scorpion sting treatment, systemic symptoms of scorpion sting, CPR for scorpion sting, black widow spider bite treatment comparison
Treating a Tarantula Bite
High Priority Source: Medical Emergencies
Procedure:

1. Identify the spider: Look for a large, hairy spider found mainly in the tropics.
2. Assess symptoms: Pain and bleeding are certain, with infection likely due to the open wound caused by the bite.
3. **Treat as an open...
tarantula bite treatment, infection prevention, open wound care, systemic symptoms of tarantula bite
Prevent Insect Bites and Stings
Standard Source: Medical Emergencies
Prevention is key to avoiding insect bites and stings, which can lead to infections or serious diseases.

### Prevention Steps:
1. Keep immunizations up-to-date, including booster shots for diseases carried by insects.
2. **Avoid...
insect bites, prevention, ticks, mosquitoes, repellent, immunizations
Remove Attached Ticks Safely
Standard Source: Where There is no Doctor a Village Health Care Handbook
Procedure:

1. Check your body thoroughly after walking in areas where ticks are common.
2. Use tweezers to grasp the tick as close as possible to its mouth—the part sticking into the skin.
3. Pull gently but firmly until the tick...
tick removal, insect bites, infection prevention, tweezers, tick bite treatment
Prevent Ticks and Chiggers from Biting
Reference Source: Where There is no Doctor a Village Health Care Handbook
Procedure:

1. Dust sulfur powder on your body before entering areas where ticks or chiggers are common.
2. Focus on key areas: ankles, wrists, waist, and underarms.
3. Reapply the sulfur powder as needed during prolonged exposure to...
tick prevention, chigger prevention, sulfur powder, insect repellent
Remove Bedbugs and Prevent Infestation
Reference Source: Where There is no Doctor a Village Health Care Handbook
Procedure:

1. Wash bedding thoroughly in hot water.
2. Pour boiling water on cots and bed frames to kill bedbugs.
3. Sprinkle sulfur powder on mattresses, cloth furniture, and rugs.
4. Avoid using these items for 3 weeks after...
bedbug removal, sulfur powder, pest control, hygiene practices

Triage And Casualty Management (8)

Assign Medical Personnel to Triage Stations and Manage Patient Evaluation
High Priority Source: NATO Emergency War Surgery
Each litter station is attended by one medical officer, usually a surgeon, and one nurse. Here the casualty undergoes evaluation, fluid administration, tetanus toxoid injection, and assignment of an appropriate priority of care by the triage...
triage station personnel, patient evaluation, fluid administration
Assign Triage Officer with Absolute Authority for Casualty Prioritization
High Priority Source: NATO Emergency War Surgery
The triage officer, usually the Chief of Surgery, must be the most experienced of the surgeons, and must exercise absolute authority in all decisions involving the sorting and assignment of casualty priorities. He must continually monitor each...
triage officer role, casualty prioritization, resource management
Design Combat Hospital for Efficient Casualty Flow
High Priority Source: NATO Emergency War Surgery
To facilitate efficiency and optimize triage, evaluation, and definitive care under mass casualty conditions, certain features should be incorporated into the combat hospital's physical plant. The design should promote smooth casualty flow through...
casualty flow, hospital design, triage efficiency, mass casualty management
Design Triage Area with Adequate Space and Supplies
High Priority Source: NATO Emergency War Surgery
Adequate space in this area is of the utmost importance. Overcrowding contributes to confusion and unacceptable noise levels, and detracts from careful casualty evaluation. Each patient station must be accessible from all sides. Multiple stations...
triage area setup, supplies, patient stations, noise control
Ensure Single Casualty Flow Through Triage and Decontamination Areas
High Priority Source: NATO Emergency War Surgery
Each casualty should pass into the decontamination and triage areas one at a time. It is a mistake to have two or more helicopters discharging casualties simultaneously, although this is sometimes unavoidable when tactical aircraft assist in the...
single casualty flow, evacuation coordination, litter bearer management
Restrict Access to Triage Area and Manage Non-Essential Personnel
High Priority Source: NATO Emergency War Surgery
The triage area will rapidly develop into the site of greatest activity, usually attended with some degree of initial hyperexcitability and confusion among the staff. Access to this area should be restricted to the assigned medical officers, nurses,...
access control, triage area security, personnel management
Avoid Introducing Dead into Triage Area and Manage Evacuation of Deceased
High Priority Source: NATO Emergency War Surgery
Above all, the dead must not be introduced into the triage area. Not uncommonly, a casualty will expire en route, and, not infrequently, a unit commander will demand that his dead be evacuated in air ambulances along with the wounded. In either...
deceased management, dead evacuation, triage area protocol
Designate Area for Ambulatory Casualties and Manage Overflow
High Priority Source: NATO Emergency War Surgery
To ease congestion and confusion, ambulatory casualties should be evaluated in a separate area designated for minimal care. If the triage area needs to be cleared for new arrivals, wards should be made available to receive the spill over. The...
ambulatory casualty care, overflow management, ward designation

Crush Injury Management (8)

Indications for Early Amputation in Crush Injuries
Critical Source: NATO Emergency War Surgery
Procedure:

1. Early amputation is indicated when the limb is so severely crushed that it is obvious that function cannot be restored.
2. It is also indicated when it is the only emergency procedure that permits extrication of the victim...
amputation, crush injury, extrication, limb function loss
Crystalloid Solution Administration and Bicarbonate Addition in Crush Injuries
Critical Source: NATO Emergency War Surgery
Procedure:

1. Administer crystalloid solution at a rate of 500 cc/hour.
2. Add bicarbonate (44.5 mEq) to the crystalloid solution every other hour.
3. Monitor urine volume and pH hourly.
4. Evaluate **serum electrolytes,...
bicarbonate addition, crystalloid solution, urine monitoring, electrolyte evaluation
Decompression of Tense and Swollen Limbs in Crush Injuries
Critical Source: NATO Emergency War Surgery
Procedure:

1. Immediately decompress a tense and swollen limb by liberal incision of the fascia.
2. This measure is particularly urgent when the pressure of extravasated fluid impairs circulation.
3. Do not close debrided wounds or...
fasciotomy, decompression, crush injury, circulation impairment
Evacuation of Crush Injury Patients with Developing Renal Insufficiency
Critical Source: NATO Emergency War Surgery
Procedure:

1. The clinical features of crush syndrome may not become evident until just before the patient is to be evacuated on the basis of other injuries.
2. If renal insufficiency seems to be developing, the patient should be evacuated...
renal insufficiency, evacuation, dialysis, crush syndrome
Initiating Intravenous Therapy for Crush Injuries
Critical Source: NATO Emergency War Surgery
Procedure:

1. Initiate intravenous therapy immediately after extrication or even while the casualty is still trapped.
2. Use glucose-saline as the solution of choice; Ringer's solution may be used if glucose-saline is...
IV therapy, crush injury, diuresis, urinary catheter, fluid infusion
Management of Urinary Output and pH in Crush Injuries
Critical Source: NATO Emergency War Surgery
Procedure:

1. If urinary volume is less than 300 cc/hour, administer mannitol (1.0 g/kg body weight) IV.
2. If the arterial pH reaches 7.45 or urine pH is below 6.5, give acetazolamide (250 mg) IV.
3. Continue this therapy until...
urinary output, pH management, mannitol, acetazolamide, renal failure prevention
Splinting Major Soft-Tissue Injuries and Fractures in Crush Injuries
Critical Source: NATO Emergency War Surgery
Procedure:

1. Early splinting of major soft-tissue injuries and fractures is urgently important in crush injuries to minimize hypotension.
2. Keep the affected limb cool by exposure to air to reduce tissue metabolism.
3. Avoid...
splinting, crush injury, hypotension, tissue metabolism, potassium release
Use of Diuretics and Antibiotics in Crush Injuries
Critical Source: NATO Emergency War Surgery
Procedure:

1. If the desired urinary output cannot be achieved, consider using diuretics, preferably furosemide.
2. The majority of crush injury victims who do not receive IV therapy early enough and who do not respond to enforced...
furosemide, antibiotics, tetanus toxoid, infection prevention, renal failure

Urology (8)

Diagnosing Bladder Injury Using Cystogram
High Priority Source: NATO Emergency War Surgery
Procedure:

1. Suspect bladder injury when hematuria, entrance/exit wounds, or two-plane X-rays suggest this.
2. Perform a cystogram by instilling contrast into the bladder via an indwelling urethral catheter.
3. Take **two roentgen...
bladder injury,cystogram,hematuria,urethral catheter,extravasation
Management of Anterior Urethral Injury from Blunt Trauma
High Priority Source: NATO Emergency War Surgery
1. Minor nondisruptive urethral injuries from blunt trauma may be managed by gentle insertion of a 16 French Foley catheter for 7 to 10 days.
2. If difficulty in passing the catheter is encountered, or if there is an associated perineal or...
anterior urethral injury, blunt trauma, Foley catheter, suprapubic cystostomy
Management of Penetrating Anterior Urethral Injury
High Priority Source: NATO Emergency War Surgery
1. Perform exploration and debridement for penetrating wounds of the anterior urethra.
2. Small, clean lacerations may be repaired primarily using interrupted 4-0 chromic catgut sutures to reapproximate the urethral edges.
3. For most...
penetrating injury, marsupialization, urethral repair, debridement
Management of Wounds to the External Genitalia
High Priority Source: NATO Emergency War Surgery
1. Control hemorrhage in wounds of the penis, scrotum, testes, and spermatic cord.
2. Perform debridement as conservatively as possible.
3. Repair wounds as early as possible to prevent deformity.
4. In injuries of the penis:
- Suture tears of...
genitalia wounds, testicular injury, scrotal trauma, Buck's fascia
Repairing Bladder Injury
High Priority Source: NATO Emergency War Surgery
Procedure:

1. Approximate the edges of the bladder wound to ensure proper healing.
2. Use two layers of absorbable sutures for repair.
3. Insert an indwelling suprapubic catheter to maintain adequate decompression.
4. Place a **soft...
bladder repair,suprapubic catheter,absorbable sutures,decompression
Diagnosing Bladder Wounds in Lower Abdominal Trauma Cases
High Priority Source: NATO Emergency War Surgery
Procedure:

1. Consider bladder wounds in patients with:
- Lower abdominal wounds
- Gross hematuria
- Inability to void following abdominal or pelvic trauma
2. Ensure urethral integrity (see "Wounds of the Urethra" for details)
3....
bladder wound, cystography, hematuria, urethral integrity, postevacuation film
Diagnosing Ureteral Injuries in Retroperitoneal Hematoma Cases
High Priority Source: NATO Emergency War Surgery
Procedure:

1. Consider ureteral injury in all cases involving:
- Retroperitoneal hematoma
- Injuries to the fixed portions of the colon, duodenum, and spleen
2. Use IVR (Intravenous Pyelogram) for preoperative diagnosis.
3. If...
ureteral injury, retroperitoneal hematoma, IVR, indigocarmine, diagnosis
Managing Extraperitoneal Bladder Injuries
High Priority Source: NATO Emergency War Surgery
Procedure:

1. Identify extraperitoneal bladder injuries via cystography:
- Flame-like extravasation of contrast medium on the postevacuation film indicates injury
2. These are often caused by **laceration from bony fragments of a pelvic...
extraperitoneal bladder injury, pelvic fracture, foley catheter drainage

Diabetes (8)

Manage Diabetes in Children and Young Adults
High Priority Source: Where There is no Doctor a Village Health Care Handbook
Management for children and young adults:
• If the person is a child or young adult, he should be seen by an experienced health worker or doctor.
• They need special medicine (insulin) to control it.
child diabetes,insulin,management,young adult
Manage Diabetes in Adults Through Diet
Standard Source: Where There is no Doctor a Village Health Care Handbook
Diet for adults with diabetes:
• Fat people with diabetes should lose weight until their weight is normal.
Diabetics must not eat any sugar or sweets, or foods that taste sweet.
• Eat lots of high fiber foods, such as whole grain breads.
-...
diabetic diet,nutrition,adult diabetes
Understand the Role of Insulin in Diabetes Management
Standard Source: Where There is no Doctor a Village Health Care Handbook
Insulin is a substance produced by the pancreas that controls blood sugar levels.

People with diabetes may need insulin injections to manage their condition effectively.

Proper administration includes:
• Using sterile needles and syringes.
-...
insulin, diabetes, injection
Use Prickly Pear Cactus Sap for Adult Diabetes Management
Standard Source: Where There is no Doctor a Village Health Care Handbook
Prickly pear cactus sap preparation:
• Cut the cactus into small pieces and crush them to squeeze out the liquid.
• Drink 1 ½ cups of the liquid 3 times each day before meals.
prickly pear,nopal,cactus sap,dietary treatment
Prevent Infections and Injuries in Diabetic Patients
Standard Source: Where There is no Doctor a Village Health Care Handbook
Prevention measures for diabetics:
• Clean the teeth after eating.
• Keep the skin clean.
• Always wear shoes to prevent foot injuries.
• For poor circulation in the feet (dark color, numbness), rest often with the feet up.
• Follow the same...
foot care,disease prevention,skin hygiene
Recognize Early Signs of Diabetes
Standard Source: Where There is no Doctor a Village Health Care Handbook
Early signs of diabetes:
• Always thirsty
• Urinates (pees) often and a lot
• Always tired
• Always hungry
• Weight loss

Later, more serious signs:
• Itchy skin
• Periods of blurry eyesight
• Some loss of feeling in hands or feet
• Frequent...
diabetes,symptoms,early signs,urine test
Test for Diabetes Using Urine Strips (e.g., Uristix)
Standard Source: Where There is no Doctor a Village Health Care Handbook
Urine strip test:
• Use special paper strips (for example, _Uristix_).
• Dip the strips in the urine.
• If they change color, it has sugar in it.
urine strips,Uristix,test for diabetes
Test for Diabetes Using Urine Taste Test
Standard Source: Where There is no Doctor a Village Health Care Handbook
Urine taste test:
• If the urine tastes sweet to you, have 2 other persons taste it.
• Have them also taste the urine of 3 other people.
• If everyone agrees that the same person’s urine is sweeter, she is probably diabetic.
urine test,taste test,diabetes detection

Venipuncture Procedure (8)

Avoiding Reinsertion of the Needle into the Catheter
Critical Source: STP 21 1 Warrior Skills Level 1
WARNING:

After removing the needle, do not attempt to reinsert it into the catheter. Reinsertion could cause a portion of the catheter to be sheared off, enter the bloodstream, and move to the heart where it could cause cardiac arrest.
needle reinsertion danger, catheter safety, cardiac arrest prevention
Applying Pressure to the Vein After Catheter Insertion
High Priority Source: STP 21 1 Warrior Skills Level 1
Procedure:

1. With your nondominant hand, use a finger to press lightly on the skin just beyond the catheter tip.
2. This pressure helps decrease or stop the flow of blood from the vein after the needle has been removed.
pressure application, vein, catheter insertion
Applying a Saline Lock to Prevent Blood Loss
High Priority Source: STP 21 1 Warrior Skills Level 1
Procedure:

1. Quickly uncap and insert the male end of the saline lock adapter plug into the hub of the catheter.
2. Release pressure from over the vein. The saline lock will prevent the loss of blood from the catheter.
saline lock application, blood loss prevention, catheter management
Applying a Tegaderm® Dressing to the Venipuncture Site
High Priority Source: STP 21 1 Warrior Skills Level 1
Procedure:

1. Apply a Tegaderm® dressing to the site.
2. The dressing should cover 100 percent of the site, including:
- The insertion site
- The saline lock adapter plug.
dressing application, wound care, venipuncture site protection
Performing a Second Venipuncture Attempt
High Priority Source: STP 21 1 Warrior Skills Level 1
Procedure:

If the first attempt at venipuncture is not successful (no blood in the flash chamber):

1. Pull the catheter/needle unit back slightly, but do not pull the bevel above the skin surface.
2. **Attempt to direct the point of the...
venipuncture, second attempt, medical procedure, needle, catheter
Releasing the Constricting Band and Applying Pressure to the Vein
High Priority Source: STP 21 1 Warrior Skills Level 1
Procedure:

1. Tell the casualty to unclench his/her fist.
2. Without switching hands, release the constricting band from around the casualty's limb.
3. Continue to apply pressure to the vein with the other hand.
constricting band release, pressure application, vein compression
Removing the Flash Chamber and Disposing of the Needle
High Priority Source: STP 21 1 Warrior Skills Level 1
Procedure:

1. With your dominant hand, remove the flash chamber with the attached needle from the catheter.
2. Lay the flash chamber/needle aside.
3. Dispose of all used needles properly: In a combat situation, drive the needle into...
needle disposal, flash chamber removal, medical waste
Stabilizing the Flash Chamber and Inserting the Catheter
High Priority Source: STP 21 1 Warrior Skills Level 1
Procedure:

1. Stabilize the flash chamber with your dominant hand.
2. Grasp the catheter hub with your nondominant hand.
3. Thread the entire length of the catheter (up to the hub) into the vein.

CAUTION: Only the catheter is...
catheter insertion, flash chamber, medical procedure

Urinary Tract Infections (7)

Treating Inflamed Bladder in Animals
High Priority Source: The Household Cyclopedia
For inflamed bladder:

1. Make the animal drink large quantities of flaxseed tea, barley or rice water, or any mucilaginous liquid.
2. Frequently inject a portion of the same liquid into the animal.
3. Use bleeding as a treatment option when...
inflamed bladder treatment, castor oil, medicinal ball preparation
Treating Minor Urinary Infections with Water
High Priority Source: Where There is no Doctor a Village Health Care Handbook
Procedure:

1. Encourage the affected person to drink plenty of water throughout the day.
2. Ensure that the water is clean and safe for consumption.
3. Monitor symptoms such as pain, burning during urination, or frequent urination.
4. If...
urinary infection,women,water,hydration
Administer Phenazopyridine for UTI Symptoms
Standard Source: Personal Wilderness Medical Kit
Indication: Urinary tract infection symptoms
Dose: i tablet (200 mg) PO three times daily
Instructions:
1. Take phenazopyridine hydrochloride tablets, 200 mg (e.g., *Pyridium®*)
2. Administer i tablet by mouth three times daily...
phenazopyridine, UTI relief, Pyridium
Check for Signs of Bladder or Kidney Infection
Standard Source: A Book for Midwives
Procedure:

1. Understand the urinary system anatomy and function:
- The kidneys clean the blood and turn waste into urine.
- Urine travels down the kidney tubes to the bladder, where it is stored until urination occurs.
-...
bladder infection, kidney infection, urinary tract infection, UTI, pain during urination, protein in urine, lower belly pain
Identify Signs of Urinary Tract Infections
Standard Source: Where There is no Doctor a Village Health Care Handbook
Signs of urinary tract infections (UTIs) include:

Fever and chills or headache.
• Feeling as though the bladder does not empty completely.
Pain in the side or lower back (kidneys).
Painful urination and need to urinate...
urinary tract infection, signs of UTI, symptoms of UTI, medical emergency, kidney disease, fever, chills, headache, pain in the side, lower back pain, painful urination, frequent urination, blood in urine, swelling feet face
Managing Urinary Issues During Pregnancy
Standard Source: A Book for Midwives
Procedure:

Steps to Manage Urinary Issues During Pregnancy:

1. Monitor for signs of infection:
- Look for symptoms such as blood in urine, pain or burning during urination, and frequent urination.
- If protein is detected in the...
urinary issues, infection, pregnancy, catheter, urination, protein in urine
Administering Teas for Bladder Infection
Standard Source: A Book for Midwives
Procedure:

• Prepare a tea specifically formulated for bladder infection relief.
• Administer the tea as directed by a healthcare provider or midwife.
• Monitor the patient's symptoms to ensure improvement and adjust treatment if...
bladder infection, tea, midwife, treatment

Animal Medical Care (7)

Recognize and Manage Rupture (Hernia) in Horses
Critical Source: The Household Cyclopedia
### Description:
Rupture or hernia is the protrusion of a bowel or other part from its proper cavity.
• May be congenital, sometimes reduced during castration.
• Can also result from blows, kicks, or falls.

### Management:
1. If a...
rupture, hernia, strangulated, surgical aid, clyster, tobacco
Recognize and Manage Glanders in Horses
High Priority Source: The Household Cyclopedia
### Symptoms:
Discharge from one or both nostrils
Swelling of the gland under the jaw
• Progresses slowly, followed by ulceration
• May be mistaken for catarrh or influenza but is more rapid in onset
• Discharge is not offensive...
glanders, contagious disease, horse, isolation, ulceration, transmission to humans
Recognize and Manage Tetanus (Lock-Jaw) in Horses
High Priority Source: The Household Cyclopedia
### Symptoms:
• May follow puncture wounds of the foot (e.g., shoeing, docking, nicking, gelding)
• Occurs two to three weeks after injury or operation
• Sometimes follows violent exertion or exposure to cold

### Management:
1. If...
tetanus, lock-jaw, puncture wounds, opium clysters, sheepskin clothing
Prepare Mixture for Canker in the Mouth
Standard Source: The Household Cyclopedia
### Ingredients:
• Wine vinegar: 1/2 a pint
• Burnt alum: 1 ounce
• Common salt: 1 ounce
• Armenian bole: 1/2 an ounce

### Procedure:
1. Mix all ingredients together thoroughly.
2. Shake the mixture well in a bottle for use.

###...
canker, vinegar, alum, salt, Armenian bole, mouth treatment
Prepare Astringent Embrocation for Strains in Different Parts
Standard Source: The Household Cyclopedia
### Ingredients:
• Camphor: 2 drachms
• Strong rectified spirit of wine: 1/2 an ounce
• Nitre: 1 ounce
• Wine vinegar: 1/2 a pint
• Spirits of turpentine: 4 ounces
• White lead or Armenian bole (in powder): 1/2 an ounce
• Aqua fortis: 1 ounce

###...
embrocation, strain, camphor, spirit of wine, nitre, vinegar, turpentine, white lead, aqua fortis
Prepare Ointment for Greasy Heels
Reference Source: The Household Cyclopedia
### Ingredients:
• White ointment: 1 pound
• White vitriol: 1/2 ounce
• Blue vitriol: 1/2 ounce
• Sugar of lead: 1/2 ounce

### Procedure:
1. Mix all the ingredients together thoroughly.

### Application:
• Spread the ointment on **strong brown...
ointment, greasy heels, white ointment, vitriol, sugar of lead
Prepare Ointment for Scratched Heels
Reference Source: The Household Cyclopedia
### Ingredients:
• Hog's lard: 1 pound
• White lead: 4 ounces
• White vitriol: 1 ounce
• Sugar of lead: 1/2 ounce
• Olive oil: 3 ounces

### Procedure:
1. Grind all the powders (white lead, white vitriol, and sugar of lead) in a **marble...
ointment, scratched heels, hog's lard, white lead, vitriol, sugar of lead, olive oil

Prenatal Care (7)

Assessing Fetal Engagement in Late Pregnancy or Early Labor
High Priority Source: A Book for Midwives
Procedure: Assess whether the baby's head has engaged in the mother’s pelvis.

Steps:
1. Locate the mother’s pubic bone (the bony prominence at the front of the pelvis).
2. Feel for the baby’s head by gently palpating above the pubic...
fetal engagement, baby position, pelvis assessment, labor progress, midwifery
Performing Vaginal Exams During Labor
High Priority Source: A Book for Midwives
Procedure:

Steps to Perform a Vaginal Exam During Labor:

1. **Prepare the Environment:
- Ensure the room is clean and comfortable for the mother.
- Wash hands thoroughly before proceeding.

2. **Explain the Procedure:
- Inform the...
vaginal exam, labor, dilation, effacement, infection, prenatal care
Monitor and Track Blood Pressure During Prenatal Visits
Standard Source: A Book for Midwives
Procedure:

1. Check blood pressure at each prenatal visit.

2. Record the readings: Write down the systolic and diastolic numbers on a chart or piece of paper to track changes over time.

3. Assess for trends: If her blood pressure...
blood pressure tracking, prenatal care, high blood pressure in pregnancy, pre-eclampsia monitoring
Checking and Monitoring Blood Pressure in Pregnant Women
Standard Source: Where There is no Doctor a Village Health Care Handbook + A Book for Midwives
Procedure:

1. Understand normal blood pressure ranges during pregnancy:
- A healthy range is between 90/60 mmHg and 140/90 mmHg.
- Blood pressure should not increase significantly during pregnancy.

2. **Identify warning signs of...
blood pressure, pregnant women, monitoring, sphygmomanometer, midwives, pre-eclampsia
Determine Baby's Position During Prenatal Checkup
Standard Source: A Book for Midwives
Procedure:

To determine whether a baby is in a head-down or breech position during a prenatal checkup, follow these steps:

1. Locate the pubic bone: Find the mother’s pubic bone with your fingers. You can feel it just under the skin under...
baby position,breech position,prenatal checkup,head-down position,midwife techniques
Listening to the Baby’s Heartbeat During Prenatal Visits
Reference Source: A Book for Midwives
Procedure:

1. Start listening at 5 months of pregnancy and continue at each prenatal visit.
2. Use a fetoscope or stethoscope for clearer sounds. If unavailable, you can make a simple fetoscope from wood, clay, or a hollow bamboo tube...
baby heartbeat,prenatal checkups,fetoscope,stethoscope,heartbeat monitoring
Locating the Baby’s Heartbeat on the Mother’s Belly
Reference Source: A Book for Midwives
Procedure:

1. Determine the baby’s likely position based on how it feels during the examination.
2. Start listening near the area where you think the baby’s heart should be, typically around the mother’s bellybutton.
3. Listen in multiple...
baby position,heartbeat location,prenatal checkups,belly listening

Pregnancy Monitoring (7)

Checking the Baby During Pregnancy
High Priority Source: A Book for Midwives
Procedure:

1. Examine the baby’s position:
- Use a quarter-circle scale or other tools to determine if the baby is in a head-down (vertex) position.
- Note any signs that the baby may be breech (feet-first) or transverse...
baby checking, pregnancy monitoring, baby position, prenatal care, quarter-circle scale
Checking the Mother’s Body During Pregnancy
High Priority Source: A Book for Midwives
Procedure:

1. Examine the mother’s physical signs:
- Check for fast or slow pulse, which may indicate health issues such as shock or pre-eclampsia.
- Monitor for protein in the urine, a sign of bladder infection or...
mother checking, pregnancy monitoring, physical signs, infections, prenatal care
Managing Protein in the Urine During Pregnancy
High Priority Source: A Book for Midwives
Procedure:

1. Check for protein in the urine:
- Use a simple test or visual inspection to detect proteinuria, which may indicate a bladder infection or pre-eclampsia.

2. Monitor for associated symptoms:
- Look for signs such...
protein in urine, pre-eclampsia, bladder infection, prenatal monitoring
How to Estimate Due Date Based on Womb Measurement
Standard Source: A Book for Midwives
Procedure:

1. Use the finger or tape measure method to determine how many months pregnant the woman is.
2. If the womb measurement indicates that the woman is 7 months pregnant, estimate the due date as about 2 months from now (i.e., at 9...
due date estimation,womb measurement,last menstrual period,date discrepancy
How to Measure the Womb Using a Soft Tape Measure
Standard Source: A Book for Midwives
Procedure:

1. Have the mother lie on her back with support under her head and knees.
2. Use a soft cloth or paper measuring tape.
3. Place the 0 mark of the tape at the top of the pubic bone (where pubic hair begins).
4. Follow the curve of the...
tape measure,womb measurement,pregnancy monitoring,weeks to centimeters conversion
How to Measure the Womb Using the Finger Method
Standard Source: A Book for Midwives
Procedure:

1. Have the mother lie on her back with support under her head and knees.
2. Use your fingers to feel the top of the womb, which feels like a hard ball under the skin.
3. Walk your fingers up the side of the belly until you find the...
womb measurement,finger method,pregnancy monitoring,last menstrual period,due date estimation
Use of Sonograms and Ultrasounds in Pregnancy
Standard Source: A Book for Midwives
Sonogram (ultrasound) is used to:

• Confirm pregnancy with twins.
• Determine if the baby is breech.

Doppler (ultrasound fetoscope):

• Helps hear the baby’s heartbeat but does not take a picture.

Note: Ultrasounds are safe and...
sonogram, ultrasound, doppler, pregnancy monitoring, fetal heartbeat

Medication Use (7)

Do Not Take Too Much Medicine
High Priority Source: A Book for Midwives
Do not take too much:

Some people think that taking more medicine will heal the body faster. This is not true and can be dangerous! If you take too much medicine at one time or take a medicine too often, it may cause serious harm. See page...
overdose prevention, safe dosage guidelines, medication safety
Take the Full Amount of Medicines
High Priority Source: A Book for Midwives
Take the full amount:

Many medicines, particularly antibiotics (see page 470), must be taken for a number of days to work. A woman who is taking medicines must take them for the full number of days she is supposed to — even if she feels better...
full course of antibiotics, complete medication regimen, drug resistance prevention
Avoid Taking More Than One Medicine at the Same Time
Standard Source: A Book for Midwives
Avoid taking more than 1 medicine at the same time:

Some medicines can stop other medicines from working. Some medicines cause problems when they are taken with other medicines.

Avoid combination medicines (2 or more medicines in 1 tablet)....
drug interactions, combination medications, medication safety
Take Medicines Safely
Standard Source: A Book for Midwives
How to take medicines safely:

• Take the full amount.
• Do not take too much.
• Avoid taking more than 1 medicine at the same time.
• Know and watch for signs of problems.
• Know as much as you can about a medicine.
safe medication use, taking medicines safely, drug safety
Watch for Signs of Problems with a Medicine
Standard Source: A Book for Midwives
Know and watch for signs of problems with a medicine:

Many medicines have side effects. These are unintended effects of the medicine that are annoying or uncomfortable. Common side effects are nausea, stomach aches, headaches, or...
side effect monitoring, medication safety, adverse drug reactions
Avoid Unnecessary Combination Medicines
Standard Source: Where There is no Doctor a Village Health Care Handbook
Avoid unnecessary combination medicines as they are usually less effective, more expensive, and may do more harm than good. If someone prescribes combination medicines, ask them to prescribe only the medicine that is really necessary. Do not...
combination medicines, unnecessary medications, drug interactions, medication safety
Determine When to Use Medicines
Standard Source: A Book for Midwives
When to use medicines:

Only use a medicine when you know what is causing a problem and you are sure the medicine will help that problem. See page 13 to decide the cause and find the best treatment for a problem.

**Before giving a medicine to a...
medicine use, when to use medicines, medical decision making, midwife guidelines

Malaria Treatment (7)

Administer Artemisinin-based Combination Therapy (ACT) for Falciparum Malaria
Critical Source: Where There is no Doctor a Village Health Care Handbook
Overview:
Artemisinin-based Combination Therapy (ACT) is the recommended treatment for falciparum malaria, which is the most serious type of malaria. It involves combining an artemisinin derivative with a second medicine.

**Common ACT...
ACT, falciparum malaria treatment, artemether lumefantrine, artesunate combinations
Inject Quinine in Cases of Cerebral Malaria or Severe Vomiting
Critical Source: Where There is no Doctor a Village Health Care Handbook
Indication: Use for cerebral malaria (malaria affecting the brain) or severe vomiting when oral administration is not possible. Only use in emergencies.

Procedure:
1. Administer quinine injections only if the person has signs of...
quinine injection, cerebral malaria, emergency, children, adults
Administer Artemisinin for Malaria
Critical Source: A Book for Midwives
Procedure:

1. Dose: Give 300 mg of artesunate by mouth once a day.
2. Duration: Continue for 7 days.
3. Additional Medication: Always give another medicine with artemisinin (e.g., chloroquine, quinine, clindamycin).

**Important...
artemisinin, malaria treatment, artesunate, antimalarial drugs
Administer Quinine for Pregnant Women with Falciparum Malaria
Critical Source: Where There is no Doctor a Village Health Care Handbook
Indication: Use for treatment of falciparum malaria in women during the first 3 months of pregnancy. Combine with clindamycin.

Dosage using 300 mg tablets:
1. Give 2 tablets (600 mg) 3 times a day for 7 days.
2. Administer clindamycin:...
quinine, malaria treatment, pregnant women, clindamycin, dosage
Administer Chloroquine Phosphate for Non-Resistant Malaria Treatment
High Priority Source: Where There is no Doctor a Village Health Care Handbook
Indication: Use for non-resistant malaria.

Dosage using 250 mg tablets (which contain 150 mg chloroquine):
1. First dose:
- Adults: 4 tablets (1000 mg)
- Children 10–15 years: 3 tablets (750 mg)
- Children 6–9 years: 2 tablets (500...
chloroquine phosphate, malaria treatment, dosage, children, adults
Administer Mefloquine for Falciparum Malaria or Prevention
High Priority Source: Where There is no Doctor a Village Health Care Handbook
Mefloquine (Lariam) is used to treat falciparum malaria and can also be used alone for prevention.

### Dosage for Treatment:
1. Adults: Give 4 tablets on the second day of taking artesunate, then give 2 tablets on the third day...
Mefloquine,Lariam,malaria,falciparum,dosage,treatment,prevention,epilepsy,heart problems,pregnancy
Administer Artesunate and Clindamycin for Malaria Treatment After the Third Month of Pregnancy
Reference Source: A Book for Midwives
Procedure:

Give 300 mg of artesunate by mouth once a day for seven days.
Give 600 mg of clindamycin by mouth twice a day for seven days.
• This combination is safe after the first three months of pregnancy and effective in...
artesunate, clindamycin, malaria treatment, pregnancy, midwifery

Orthopedic Procedures (7)

Ankle Spanning Technique Using Pins and Frame
High Priority Source: Emergency War Surgery
Procedure for spanning an ankle using pins and a frame:

1. An assistant is required to help apply the frame and reduce the ankle.
2. General indications include open distal tibia fractures and open ankle wounds.
3. Insert pins on the **anterior...
ankle, spanning, pins, frame, tibia, calcaneus, vascular status, distal tibia fractures, open ankle wounds
Skeletal Traction Technique for Femur and Tibia Fractures
High Priority Source: Emergency War Surgery
Procedure for applying skeletal traction:

Indications:
• Patients expected to have more than one procedure in the same forward hospital prior to evacuation.
• Large casualty load.

Technique Steps:
1. Pin Preparation:
- Use large...
skeletal traction, femur fracture, tibia fracture, pin placement, Thomas splint, Bohler-Braun frame
Apply Bivalved Cast or Splint for Transport of Foot Injuries
High Priority Source: Emergency War Surgery
Procedure:

• A bivalved cast or splint is adequate for transporting patients with foot injuries to a site of more definitive care:

1. Ensure the cast or splint provides enough support to maintain alignment and prevent further...
bivalved cast, foot injury transport, splint application, orthopedic care
Use K-Wires for Temporary Stabilization of Foot Injuries
High Priority Source: Emergency War Surgery
Procedure:

K-wires can be used for temporary stabilization in foot injuries:

1. Insert the wires through appropriate points on the foot to provide stability without compromising circulation or nerve function.

2. This is a...
K-wires, temporary stabilization, foot injuries, orthopedic fixation
Apply External Fixation for Tibia Shaft Fractures
Reference Source: Emergency War Surgery
External Fixation for Tibia Shaft Fractures

• Palpate the anterior-medial border of the tibia.
• Place a 1-cm longitudinal incision over the midportion of the surface (Fig. 23-17). The pin closest to the fracture site should be outside the...
external fixation, tibia shaft fracture, pin placement, emergency surgery, war surgery
External Fixation for Knee Spanning Technique
Reference Source: Emergency War Surgery
External Fixation to Span the Knee

Indications: Proximal tibia fractures, distal femur fractures, extensive knee injuries, or vascular repairs in the popliteal fossa.

Preparation Steps:
1. Check the distal vascular status of the limb...
external fixation, knee spanning, proximal tibia fractures, distal femur fractures, vascular repairs
Foot Compartment Release: Double Dorsal Incision and Single Medial Fasciotomy Techniques
Reference Source: Emergency War Surgery
Procedure for Foot Compartment Release:

• To release the foot in cases of compartment syndrome, consider two primary techniques:

1. Double Dorsal Incision Technique:
- Make a double dorsal incision:
- The first incision is...
foot compartment release, double dorsal incision, medial fasciotomy, compartment syndrome, emergency surgery

Vascular Surgery (7)

Debridement and Thrombus Removal in Vascular Injury Repair
Critical Source: Emergency War Surgery
Step-by-step procedure:

1. Debride the injured vessel to macroscopically normal wall tissue.
2. Pass balloon catheters proximal and distal to remove any residual thrombus.
3. Flush both directions with heparinized saline (20 U/mL)...
debridement, thrombus removal, heparinized saline, vascular repair
Indications for Operation in Suspected Vascular Injury
Critical Source: Emergency War Surgery
Step-by-step procedure:

1. Hard signs of vascular injury (e.g., absence of pulse, distal pallor, or swelling) are an indication for surgery.
2. If soft signs are present (e.g., delayed capillary refill), confirm with **duplex US and/or...
vascular injury, hard signs, soft signs, surgery
Intraoperative Angiogram or Duplex US for Vascular Repair Evaluation
Critical Source: Emergency War Surgery
Step-by-step procedure:

1. Perform an intraoperative completion angiogram or duplex US to evaluate the technical adequacy of the repair.
2. Use full strength contrast (30–60 cc) and a 20 gauge Angiocath for injection.
3. Ensure...
angiogram, duplex US, vascular repair, contrast injection
Ligation of Artery in Vascular Injury Repair
Critical Source: Emergency War Surgery
Step-by-step procedure:

1. If all options for repair are unsuccessful or unavailable, ligate the artery.
2. Emphasize Save Life Over Limb as the guiding principle.
3. This is a last-resort measure to prevent exsanguination in...
arterial ligation, vascular injury, life-saving measure
Principles of Treatment for Arterial Injuries
Critical Source: NATO Emergency War Surgery
Procedure for the Principles of Treatment for Arterial Injuries:

1. Restoration of arterial flow is the primary objective:
- Immediate surgical intervention should be aimed at reestablishing blood flow to the affected limb.

2. **Use...
principles of treatment,arterial injury,surgical exploration,doppler instrument
Prolonged Shunting in Vascular Repair
Critical Source: Emergency War Surgery
Step-by-step procedure:

1. If standard techniques are unsuccessful or precluded by patient physiology or the tactical environment, use prolonged shunting for up to 72 hours.
2. Replace Silastic loops with suture and secure firmly.
3....
prolonged shunting, vascular repair, Silastic loops, perfusion monitoring
Graft Coverage in Vascular Repair
Critical Source: Emergency War Surgery
Step-by-step procedure:

1. Cover exposed vein grafts with soft tissue or muscle to prevent desiccation and blow-out.
2. Use superficial muscles such as the sartorius or gracilis in the thigh for coverage if possible.
3. If coverage is...
graft coverage, sartorius, gracilis, vascular repair

Burns (7)

Field Treatment for Burns
Critical Source: Medical Emergencies
Procedure:

1. Stop the burning process immediately:
- Remove clothing.
- Douse with water or sand.
- Roll on the ground to extinguish flames.
2. Cool the burned skin using ice or water.
3. For burns caused by **white...
burn treatment,first aid,wound care,emergency burn care
Administer Pain Relief and Fluids for Serious Burns
Critical Source: Where There is no Doctor a Village Health Care Handbook
Objective: Provide pain relief and hydration to a person with serious burns.

### Steps:
1. Comfort and Reassure the burned person to reduce fear and anxiety.
2. Give Pain Relief:
- Administer aspirin or acetaminophen for pain.
...
burns, pain relief, hydration, salt water bath, fluid intake, protein diet
Cover Burned Areas with Sterile Dressings and Consider HPMK for >20% TBSA
Critical Source: TCCC 17 13 Army Tactical Combat Casualty Care
Procedure:

1. Cover burned areas with dry, sterile dressings.
2. For burns over 20 percent TBSA, consider placing the casualty into an HPMK (Human Patient Movement Kit), body bag, or alternative.
sterile dressing, hpmk, tbsa burns
Managing Thermal/Flash Burns from Nuclear Detonation
Critical Source: Emergency War Surgery
Thermal/flash burns are caused by infrared radiation from a nuclear detonation, even at great distances. Management includes:

1. Assess burn severity: Determine the total body surface area (TBSA) affected.
2. Monitor for complications:...
thermal burns, flash burns, radiation exposure, burn management, nuclear detonation
Monitor Facial Burns for Airway and Inhalation Injury
Critical Source: TCCC 17 13 Army Tactical Combat Casualty Care
Procedure:

1. Aggressively monitor facial burns for airway status and potential inhalation injury.
facial burns, airway monitoring, inhalation injury
Prevent Contractures in Burns Around Joints
High Priority Source: Where There is no Doctor a Village Health Care Handbook
Objective: Prevent joint contractures and stiffness in burns around joints.

### Steps:
1. Apply Vaseline-Gauze Pads between burned surfaces (e.g., fingers, armpits) to prevent them from sticking together as they heal.
2. **Straighten Joints...
joint burns, contractures, Vaseline gauze, joint movement
Treating Minor Burns with Cold Water
High Priority Source: Where There is no Doctor a Village Health Care Handbook
Procedure:

1. Immediately hold the burned area under cold running water for at least 10–15 minutes or until the pain subsides.
2. Ensure that the water is clean and safe for use on burns.
3. Do not apply ice directly to the burn, as...
minor burns,cold water,treatment

Internee Care (7)

Handling of Internee Medical Records
High Priority Source: Emergency War Surgery
Handling of Internee Medical Records

Internee medical records are property of the US Government and must be handled in accordance with regulations:

1. **Medical records are not subject to HIPAA (Health Insurance Portability and Accountability...
HIPAA, DA Form 4254, AR 40-66
Medical Care Responsibilities for Internees
High Priority Source: Emergency War Surgery
What healthcare providers should do:

• Healthcare providers have a responsibility to report information that constitutes a clear and imminent threat to the lives and welfare of others.
• Internees should receive medical care equal to that of...
internees, medical care, Geneva Conventions, abuse reporting, medical records, recusal, AR 190-8, DA Form 4254, HIPAA, infectious disease, sanitation
Medical Information and Its Use
High Priority Source: Emergency War Surgery
Medical Information and Its Use

The detention facility chain of command requires medical information for the following purposes:

1. Supervising the general state of health, nutrition, and cleanliness of internees.
2. **Detecting contagious...
contagious diseases, health monitoring, duty clearance
Recusal Procedures for Healthcare Providers
High Priority Source: Emergency War Surgery
Recusal Procedures for Healthcare Providers

Healthcare providers who are asked to perform duties they feel are unethical should:

1. Request recusal first from their commander and chain of command.
2. If the chain of command is unable to...
recusal, ethics, chain of command
Reporting Medical Information to Chain of Command
High Priority Source: Emergency War Surgery
Reporting Medical Information to Chain of Command

Healthcare providers must report the following information to their commanders or designees:

1. Routine medical information.
2. Clear and imminent threats to lives and welfare.
3....
reporting, chain of command, abuse reporting
Specific Medical Requirements for Internees
High Priority Source: Emergency War Surgery
Specific Medical Requirements for Internees

Internees are entitled to medical treatment and must receive:

1. An examination upon arrival at the detention facility.
2. A **chest radiograph (or tuberculin skin test for children under 14...
medical examination, hygiene, AR 190-8
What Healthcare Providers Should Not Do
High Priority Source: Emergency War Surgery
What Healthcare Providers Should Not Do

Healthcare providers must avoid the following actions:

1. Being involved in any aspect of internee healthcare if they are charged with assisting in the interrogation process, including interpreting...
ethical guidelines, interrogation avoidance, Geneva Conventions

Neurosurgery (7)

Emergency Craniotomy for Intracranial Hematoma
Critical Source: Emergency War Surgery
Objective: Prevent infection and relieve/prevent intracranial hypertension in cases of space-occupying lesions, intracranial hematomas with significant midline shift, compound depressed fractures with neurological changes, or penetrating...
craniotomy, intracranial hematoma, neurosurgery, emergency surgery, head injury, dural closure, burr hole, hemostasis, antibiotic administration
Management of Intraoperative Brain Swelling in Cranocerebral Injury Surgery
Critical Source: NATO Emergency War Surgery
Procedure:

1. Monitor for massive brain swelling, an uncommon but serious complication during surgery.
2. Determine if the swelling is due to intracerebral hematoma, contralateral subdural hematoma, or anesthetic complications.
3. If no...
brain swelling, intracranial pressure monitoring, pentobarbital sodium, anesthetic complications
Closure of Dura and Scalp in Cranocerebral Injury Surgery
Critical Source: NATO Emergency War Surgery
Procedure:

1. Close the dura without tension.
2. Use dural grafts harvested from pericranium, temporalis fascia, or fascia lata if needed.
3. Close the scalp primarily without tension.
4. If necessary, use **rotation of scalp...
dural closure, scalp flap rotation, skin grafts, myocutaneous pedicle flap
Debridement and Wound Management for Cranocerebral Injury
Critical Source: NATO Emergency War Surgery
Procedure:

1. Remove devitalized scalp and foreign bodies.
2. Make incisions along lines that can be used to rotate the scalp if plastic repair is needed.
3. Preserve as much scalp as possible (Figure 29A).
4. **Remove contaminated...
debridement, cranocerebral injury, bone fragment removal, intraoperative ultrasound, wound management, high velocity injuries
Irrigation and Antimicrobial Treatment of Cranocerebral Wounds
Critical Source: NATO Emergency War Surgery
Procedure:

1. Copiously irrigate the brain with normal saline solution containing 1000 u/1 bacitracin at body temperature.
2. Use a concentrated bacitracin solution (500 u/cc) to irrigate the track.
3. Ensure complete irrigation and...
bacitracin irrigation, cranial wound treatment, antimicrobial solution, brain irrigation
Preoperative Preparation for Cranocerebral Injury Surgery
Critical Source: NATO Emergency War Surgery
Procedure:

1. Shave the head and inspect the wound.
2. Examine X-rays to determine the distribution of bone and metallic fragments.
3. Administer endotracheal intubation and general anesthesia, especially in most cases.
4....
cranocerebral injury, preoperative preparation, head shaving, wound inspection, x-ray examination, general anesthesia, sterile saline irrigation, patient positioning
Postoperative Imaging and Follow-Up for Cranocerebral Injury Patients
High Priority Source: NATO Emergency War Surgery
Procedure:

1. Obtain postoperative X-rays or CT scans to check for the presence of retained fragments.
2. Determine whether reoperation is necessary based on imaging results and anticipated follow-up neurosurgical and CT scan...
postoperative imaging, retained fragments, reoperation decision, ct scan follow-up

Cold Injury Prevention (7)

Recognize Risk Factors for Cold Injury
High Priority Source: FM 4 25 11 First Aid
Procedure:

1. Identify environmental factors that increase the risk of cold injury:
- Low temperatures and low humidity (dry cold) promote frostbite.
- Higher temperatures with moisture promote immersion syndrome.
-...
cold injury, frostbite, immersion syndrome, risk factors, prevention
Assess Risk Factors Based on Activity Levels and Substance Use
Standard Source: NAVMED P 5010 US Navy Manual of Preventive Medicine
Procedure:

1. Activity Assessment: Monitor for both excessive activity (which can lead to perspiration, reducing clothing insulation) and immobility (which decreases body heat production, especially in extremities).

2. **Drug and...
activity levels,substance use,cold injury prevention,alcohol,nicotine
Assess Risk Factors Related to Other Injuries and Psychological Factors
Standard Source: NAVMED P 5010 US Navy Manual of Preventive Medicine
Procedure:

1. Other Injuries: Evaluate for injuries that may result in significant blood loss, shock, or inactivity. These conditions reduce effective blood flow to extremities and increase the risk of cold injury.

2. **Psychological...
other injuries,psychological factors,cold injury prevention,passive individuals
Assess Risk Factors for Cold Injury Based on Age and Rank
Standard Source: NAVMED P 5010 US Navy Manual of Preventive Medicine
Procedure:

1. Age Assessment: Determine if the individual is within the usual age range of sailors and Marines. Age is not a significant factor in susceptibility to cold injury within this range.

2. Rank Assessment: Identify if the...
age,risk factors,cold injury,rank,sailors,marines
Evaluate Risk Factors Based on Geographic Origins and Nutrition
Standard Source: NAVMED P 5010 US Navy Manual of Preventive Medicine
Procedure:

1. Geographic Origins: Determine if the individual is from a warmer climate. Personnel from such climates may be predisposed to cold injury but can benefit from proper acclimatization.

2. Nutrition Assessment: Evaluate for...
geographic origins,nutrition,cold injury prevention,military ration
Evaluate Risk Factors Based on Previous Cold Injury and Fatigue
Standard Source: NAVMED P 5010 US Navy Manual of Preventive Medicine
Procedure:

1. Previous Cold Injury: Determine if the individual has a history of cold injury. Individuals with previous cold injuries are at higher risk for subsequent injuries but may be more proactive in taking protective measures.

2....
previous cold injury,fatigue,mental weariness,cold injury prevention
Assess Host Factors for Cold Injury Risk
Standard Source: NATO Emergency War Surgery
Overview: Certain host factors can increase an individual's risk of cold injury. Understanding these factors helps in prevention and management.

Host Factors to Consider:
1. Age: No significant evidence that age is a major factor in...
cold injury, frostbite, host factors, smoking, racial susceptibility, fatigue, drugs, prevention

Nerve Agent Treatment (7)

Administering Convulsant Antidote for Nerve Agents (CANA)
Critical Source: FM 3 4 NBC Protection
Purpose: Administer diazepam intramuscularly to a buddy incapacitated by nerve agent poisoning.

Components:
• CANA autoinjector containing 2 milliliters of diazepam
• Chemically hardened packaging

Procedure:
1. Retrieve the CANA...
CANA, convulsant antidote, diazepam autoinjector, nerve agent treatment, buddy aid
Administering NAAK for Nerve Agent Poisoning
Critical Source: FM 3 4 NBC Protection
Purpose: Provide immediate first-aid treatment for nerve agent poisoning.

Components:
• Two autoinjectors: one with atropine, one with pralidoxime chloride
• Plastic clip to hold injectors together

Procedure:
1. Retrieve the NAAK from...
NAAK, nerve agent poisoning treatment, atropine autoinjector, pralidoxime chloride autoinjector, first-aid for chemical exposure
Administering Nerve Agent Antidote via Self-Aid Injection in the Buttock
Critical Source: Full First Aid Manual FM 2111
Procedure:

1. Identify injection site: If you are thinly built, inject yourself into the upper outer quadrant of the buttock (see Figure 7-7). This avoids hitting a nerve that can cause paralysis.
2. Prepare autoinjector: Remove the...
self-aid, nerve agent antidote, buttock injection, MARK I autoinjector, upper outer quadrant
Buddy Evaluation and Aid for Nerve Agent Poisoning
Critical Source: Full First Aid Manual FM 2111
Procedure:

1. Assess the casualty: If a service member has self-administered one set of MARK I or ATNAA, evaluate them to determine if additional antidotes are required.
2. Determine need for further treatment: Check for signs and...
buddy aid, nerve agent poisoning, MARK I autoinjector, CANA administration
Administering Nerve Agent Antidote Using ATNAA (Self-Aid)
Critical Source: FM 4 25 11 First Aid
Procedure for Administering Nerve Agent Antidote Using ATNAA (Self-Aid):

1. Immediately Self-Administer One ATNAA:
- If you experience any or all of the nerve agent MILD symptoms, immediately self-administer one ATNAA following the...
atnaa self aid, nerve agent antidote, thigh injection, buttock injection, self-administration
Administering Nerve Agent Antidote Using CANA (Buddy Aid/Combat Lifesaver Aid)
Critical Source: FM 4 25 11 First Aid
Procedure for Administering Nerve Agent Antidote Using CANA (Buddy Aid/Combat Lifesaver Aid):

1. Massage Injection Site, Mission Permitting:
- Gently massage the injection site if allowed by mission requirements.

2. **Inject into Thigh...
cana buddy aid, nerve agent antidote, thigh injection, buttock injection, convulsions prevention
Buddy Assistance for Nerve Agent Antidote Administration
Critical Source: FM 4 25 11 First Aid
Procedure for Buddy Assistance in Administering Nerve Agent Antidote:

1. Evaluate the Individual:
- Determine if one ATNAA has already been used to ensure no more than three ATNAA are administered.

2. **Administer Additional Antidotes...
buddy aid, nerve agent antidote, convulsions prevention, squat not kneel, chemical agent safety

Infectious Disease Response (7)

Implement Disease Surveillance and Early Detection Procedures
Critical Source: UK National Risk Register 2025
Objective: Ensure timely identification of suspected cases during a pandemic.

Procedure Steps:
1. Establish disease surveillance systems that monitor for unusual patterns of illness or outbreaks.
2. Implement **early detection...
disease surveillance, early detection, contact tracing, diagnostic testing, pharmaceutical countermeasures, PPE stockpiling
Isolate Employee and Collect Respiratory Specimen at Designated Clinic
Critical Source: HHSPandemicInfluenzaPlan
Procedure:

1. Upon arrival at the designated clinic, the employee should be placed in a private room for isolation.
2. A healthcare provider must provide consultation and evaluation.
3. The healthcare provider should obtain a respiratory...
isolate employee, collect specimen, rapid antigen test, viral culture, pandemic influenza plan
Manage Employee at Home and Monitor for Influenza A or Avian Influenza
Critical Source: HHSPandemicInfluenzaPlan
Procedure:

1. If the employee is not sick enough to be hospitalized, they should remain at home under the care of a personal physician.
2. The employee should wait for results from the viral culture before resuming normal activities if...
manage at home, avian influenza monitoring, public health notification, pandemic influenza plan
Respond to an Outbreak of an Emerging Infectious Disease
Critical Source: UK National Risk Register 2025
Objective: Detect and manage outbreaks of new or re-emerging infectious diseases.

Procedure Steps:
1. Establish enhanced surveillance systems for early detection of emerging infectious diseases, including monitoring in both human and...
emerging infectious disease response, containment measures, diagnostic testing, UKHSA coordination, treatment protocols
Determine Employee's Return to Work or Further Medical Referral Based on Test Results
High Priority Source: HHSPandemicInfluenzaPlan
Procedure:

1. The healthcare provider should evaluate the following factors:
- Result of the rapid antigen test (e.g., influenza A positive).
- Status of oseltamivir prophylaxis.
- Clinical evaluation of the employee.
2. Based on these...
return to work, oseltamivir prophylaxis, infectious disease consultant, pandemic influenza plan
Evaluate Employee from Home During Working Hours and Coordinate with Healthcare Provider
High Priority Source: HHSPandemicInfluenzaPlan
Procedure:

1. The employee should notify their supervisor if they are unable to come to work.
2. The supervisor must discuss the situation with appropriate healthcare personnel to determine where and by whom the employee will be evaluated and...
evaluate from home, coordinate with physician, antigen detection, viral culture, pandemic influenza plan
Notify Supervisor and Contact Healthcare Provider After Working Hours
High Priority Source: HHSPandemicInfluenzaPlan
Procedure:

1. The employee should notify their supervisor immediately if they are ill after working hours.
2. The supervisor must inform others as the situation dictates to ensure proper response.
3. If the employee is acutely ill with symptoms...
after working hours, notify supervisor, contact healthcare provider, rapid testing, pandemic influenza plan

Laser Exposure (7)

Calculate Laser Divergence and Beam Spread
High Priority Source: Medical NBC Battlebook
Laser divergence describes how quickly a laser beam spreads out over distance. It is expressed in milliradians (mrad).

• A typical military laser has a beam that is 1 meter in diameter at 1 kilometer, and **2 meters in diameter at 2...
laser divergence,beam spread,milliradians
Classify Lasers Based on Biological Hazard Potential
High Priority Source: Medical NBC Battlebook
Lasers are classified based on their potential to cause biological damage to the eye or skin during intended use, following the ANSI Z136.1 standard.

| Class | Energy | Hazards |
|-------|--------|---------|
| Class 1 | Depends on...
laser classification,ANSI Z136.1,biological hazards
Determine Laser Wavelength and Its Effects on the Eye
High Priority Source: Medical NBC Battlebook
Laser radiation is produced in different parts of the electromagnetic spectrum, including ultraviolet (UV), visible, near infrared (NIR), and far infrared (FIR). The wavelength of a laser determines its potential to cause harm to biological...
laser,wavelength,eye damage,medical emergency
Identify Army Fielded Laser Systems and Their Specifications
High Priority Source: Medical NBC Battlebook
The following are army fielded laser systems with their descriptions:

| Nomenclature | Type | Description |
|--------------|------|-----------|
| ACP-1 | Pointing Laser | Air Commanders Pointer, Glove mounted |
| AIM-1 | Aiming and Pointing...
army laser systems,specifications,fielded lasers
Identify Common Laser Wavelengths and Mediums
High Priority Source: Medical NBC Battlebook
Lasers can produce radiation in the ultraviolet (UV), visible, and infrared (IR) regions of the spectrum. The following are common laser wavelengths and their associated mediums:

| CIE Band | Wavelength (nm) | Medium | Typical Operation...
common laser wavelengths,mediums,operation type
Understand Laser Power and Irradiance
High Priority Source: Medical NBC Battlebook
Laser power is the amount of energy emitted per unit of time, measured in watts (W). One watt equals one joule (J) of energy per second.

• A 1-watt laser emits 1 J of energy in 1 second, or 2 J in 2 seconds.
• Some lasers emit...
laser power,irradiance,watts,medical emergency
Understand Laser System Specifications and Hazards
High Priority Source: Medical NBC Battlebook
The following are laser system specifications with their wavelengths, nominal ocular hazard distances (NOHD), optical density (OD), and laser class:

| Nomenclature | Wavelength | Nominal Ocular Hazard Distance / Nominal Ocular Hazard Distance...
laser system specs,hazard distances,optical density,laser class

Blast Injury (7)

Anesthesia Considerations in Blast Injury Patients
Critical Source: NATO Emergency War Surgery
Procedure for Anesthesia Management in Blast Injury:

1. **Avoid inhalation anesthesia due to high morbidity in blast injury patients.
2. Use regional or spinal anesthesia where possible to reduce complications.
3. Keep airway pressures as low...
anesthesia, blast injury, regional anesthesia, spinal anesthesia, pleural complications
Hyperbaric Therapy for Air Embolism in Blast Injury Patients
Critical Source: NATO Emergency War Surgery
Procedure for Administering Hyperbaric Therapy to Manage Air Embolism:

1. **Prompt use of a compression chamber is lifesaving if air embolism is identified early.
2. Hyperbaric therapy reduces the size of bubbles and speeds their absorption.
3....
hyperbaric therapy, air embolism, blast injury, compression chamber
Management of Gastrointestinal Tract Injury from Blast Injuries
Critical Source: NATO Emergency War Surgery
Procedure for Managing Gastrointestinal Tract Injury in Blast Injuries:

1. **Treat gastrointestinal tract injury similarly to blunt trauma.
2. Hypovolemic shock without other obvious causes suggests visceral rupture; consider diagnostic...
gastrointestinal injury, visceral rupture, hypovolemic shock, nasogastric tube, delayed perforation
Managing Primary Blast Injury
Critical Source: NATO Emergency War Surgery
Procedure for Managing Primary Blast Injury:

1. Establish Airway, Control Hemorrhage, and Reverse Shock:
- Follow standard trauma care principles.
- Do not delay these steps due to the presence of blast injury.

2. **Fluid Management...
primary blast injury, air embolism, tympanic rupture, hyperbaric therapy, CPAP, positive pressure ventilation, gastrointestinal tract injury, hypovolemic shock, pleural complications
Positioning for Air Embolism Management
Critical Source: NATO Emergency War Surgery
Procedure for Positioning to Manage Air Embolism in Blast Injury:

1. **Place the individual in the prone position with the left side down.
2. Ensure that the back is at a 45° angle to the ground.
3. Keep the head lower than the feet.
4. This...
air embolism, positioning, blast injury, hyperbaric therapy
Respiratory Distress Management in Blast Injury Patients
Critical Source: NATO Emergency War Surgery
Procedure for Managing Respiratory Distress in Blast Injury:

1. **Administer supplemental oxygen immediately.
2. Evaluate the patient to determine if respiratory distress is due to pneumothorax or pulmonary parenchymal failure from blast injury...
respiratory distress, CPAP, blast injury, oxygen delivery, pulmonary parenchymal failure
Tympanic Rupture Treatment in Blast Injury Patients
High Priority Source: NATO Emergency War Surgery
Procedure for Treating Tympanic Rupture in Blast Injuries:

1. **Examine the ear and clear any debris from the external canal.
2. Do not attempt irrigation of the ear canal.
3. Most tympanic tears will heal spontaneously; about one fourth may...
tympanic rupture, blast injury, ear canal, surgical closure

Tactical Medical Training (7)

Conduct Practical Exercise Trauma Lane (Optional)
Standard Source: TCCC 17 13 Army Tactical Combat Casualty Care
Procedure:

1. Set up a trauma lane, which is an area designed to simulate real-world casualty care scenarios.
2. Use confined spaces such as office spaces, boats, ships, or fuselages to create realistic constraints.
3. Conduct practical...
trauma lane, practical exercises, medical training
Conduct TCCC-MP Skill-Set Training
Standard Source: TCCC 17 13 Army Tactical Combat Casualty Care
Procedure:

1. Identify the skills listed on the NAEMT website, which are within the scope of practice for medically trained Service members.
2. Deliver training sessions that incorporate these skills using practical exercises and...
TCCC-MP, skill training, medical training
Conduct TCCC-MP Written Posttest
Standard Source: TCCC 17 13 Army Tactical Combat Casualty Care
Procedure:

1. Administer the written posttest to evaluate student understanding after completing TCCC-MP training.
2. Use standardized testing materials provided by NAEMT or CoTCCC.
3. Ensure all students complete the test before...
TCCC-MP, written posttest, medical training
Identify Qualified Military TCCC Instructors
Standard Source: TCCC 17 13 Army Tactical Combat Casualty Care
Procedure:

1. Recognize that any military medic, medical technician, corpsman, or other medically trained personnel (officer or enlisted) can become a TCCC instructor.
2. Ensure that instructors are trained to conduct medicine in the Armed...
military TCCC instructor, medical training
Use Defense Medical Readiness and Training Institute (DMRTI) for TCCC-MP Instruction
Standard Source: TCCC 17 13 Army Tactical Combat Casualty Care
Procedure:

1. Access the DMRTI, which has NAEMT TCCC-affiliate faculty staff.
2. Use DMRTI resources to conduct training, practical exercises, and skill validation sessions.
3. Take advantage of mobile training team courses listed on the...
DMRTI, TCCC-MP training
Utilize Medical Simulation and Training Centers for TCCC-MP Instruction
Standard Source: TCCC 17 13 Army Tactical Combat Casualty Care
Procedure:

1. Identify locations of Medical Simulation and Training Centers at various Army installations.
2. Ensure that these centers have NAEMT TCCC-affiliate faculty designation to provide quality instruction.
3. Use these facilities...
simulation centers, TCCC-MP training
Utilize Trauma Lane for Additional TCCC Training
Standard Source: TCCC 17 13 Army Tactical Combat Casualty Care
Procedure:

1. Set up a trauma lane in a confined space (e.g., office, boat, ship, or fuselage) to simulate real-world conditions.
2. Use the trauma lane to provide additional training opportunities that replicate difficult evacuation...
trauma lane, TCCC training

Dehydration (7)

Prevent and Treat Dehydration in Children and Adults
Critical Source: Where There is no Doctor a Village Health Care Handbook
Prevent and Treat Dehydration in Children and Adults

When a person has watery diarrhea, act quickly:

Give lots of liquids to drink: Rehydration Drink is best. Or give a thin cereal porridge or gruel, teas, soups, or even plain...
rehydration drink,dehydration,treatment,home mix,sugar,salt,cereal
Recognize Signs of Dehydration in Children
Critical Source: Where There is no Doctor a Village Health Care Handbook
Recognize Signs of Dehydration in Children

Thirst is often a first, early sign of dehydration.
Little or no urine, and the urine is dark yellow.
Sudden weight loss.
Dry mouth.
Sunken, tearless eyes.
• **Sagging...
dehydration,child,signs,urine,dry mouth,sunken eyes
Recognize and Respond to Dehydration Symptoms
Critical Source: US Marine Corps Wilderness Medicine
Overview:

Dehydration can occur quickly in the wilderness and has progressive symptoms depending on the percentage of body fluid lost.

Symptoms by Severity:
5% loss: Thirst, irritability, nausea, weakness.
10% loss: Dizziness,...
dehydration symptoms, dehydration treatment, hydration levels, survival dehydration, water loss signs
Recognize and Prevent Dehydration in Cold Weather Conditions
High Priority Source: Canadian Military Basic Cold Weather Training
Procedure:

1. Understanding dehydration:
- Dehydration occurs when the body is deprived of water.
- Even in cold weather, the body loses fluids through perspiration (which may be hidden under clothing) and respiration.

2....
dehydration, symptoms, prevention, treatment, cold weather
Treating Diarrhea with Vomiting
High Priority Source: Where There is no Doctor a Village Health Care Handbook
If a person has diarrhea and is also vomiting, the risk of dehydration increases significantly, especially in small children.

Steps to manage:
1. Give Rehydration Drink (p. 152), tea, or soup even if the person vomits it again. Some...
diarrhea,vomiting,rehydration,dehydration
Identify Signs and Symptoms of Dehydration in Cold Weather
Standard Source: STP 21 1 Army Warrior Skills Level 1 Soldiers Manual of Common Tasks
### Identify Signs and Symptoms of Dehydration in Cold Weather

Look for the following signs and symptoms:

(1) Parched and dry mouth, tongue, and throat.
(2) Difficulty swallowing.
(3) Nausea (with or without vomiting).
(4)...
dehydration, cold weather, signs, symptoms
Recognize and Prevent Cold Weather Dehydration
Standard Source: FM 31 70 Basic Cold Weather Manual
Definition and Principle:
Dehydration means to lose or be deprived of water or the elements of water. A growing plant loses (uses) water in the growing process. If this water is not replaced by either natural means (rain) or by watering, the...
cold weather dehydration, prevention, symptoms, treatment, salt solution

Dental Health Education (7)

Referring Patients for Permanent Dental Treatment in Resource-Limited Settings
Standard Source: Where There is No Dentist
Objective: Guide patients to seek permanent dental treatment when temporary solutions are not sufficient.

Steps:
1. Evaluate the Need: Determine if a patient requires more advanced dental care beyond what can be provided locally (e.g.,...
permanent filling,dental referral,resource-limited settings,cost-effective care
Using Temporary Cement Fillings for Dental Care in Resource-Limited Settings
Standard Source: Where There is No Dentist
Objective: Provide temporary dental care using cement fillings when permanent treatment is not immediately accessible.

Steps:
1. Assess the Patient: Examine the patient’s teeth to identify cavities or other issues that require...
temporary filling,dental care,cavities,resource-limited settings
Creating a Puppet Show to Educate on Dental Health
Standard Source: Where There is No Dentist
Objective: Use puppet shows to educate children about dental health and the importance of treating cavities.

Steps:
1. Develop a Storyline: Create a narrative that highlights the consequences of untreated cavities and the benefits of...
puppet show,dental education,cavities,children's health,oral hygiene
Educating Children on Dental Health Through School Activities
Standard Source: Where There is No Dentist
Objective: Help school children learn about dental health through interactive activities and prevention education.

Steps:
1. Assess Needs: Visit a school and work with the teacher to identify immediate dental problems among students...
school activities,dental education,oral hygiene,children's health
Conduct a Group Activity to Demonstrate the Effects of Sticky Foods on Teeth
Reference Source: Where There is No Dentist
Steps:
1. Divide the class into groups of 4 to 8 students.
2. Give each student something sweet, sticky, and dark in color to eat, such as sweet chocolate biscuits.
3. Ask the students to look in each other’s mouths to see how easily the...
sticky food experiment, dental hygiene demonstration, group activity, tooth cleaning methods
Create Educational Posters About Healthy and Unhealthy Foods for Teeth
Reference Source: Where There is No Dentist
Steps:
1. Draw pictures of foods that are both good and bad for teeth.
2. Use these drawings to make posters and flannel-board stories.
3. Display the posters in the classroom or community area to educate others about dental...
educational posters, dental health, food illustration, oral hygiene education
Conduct a Tooth in the Coca-Cola Test
Reference Source: Where There is No Dentist
Procedure:

1. Prepare materials: Gather a tooth (from a model or diagram), a glass of Coca-Cola, and a timer.
2. Submerge the tooth: Place the tooth in the Coca-Cola and start the timer.
3. Observe changes: Check the tooth at...
tooth erosion,coca-cola test,dental education,acidic drinks

Dental Infections (7)

Emergency Treatment for Noma (Gangrene of the Face)
Critical Source: Where There is No Dentist
Immediate actions for Noma:

Get medical help as quickly as possible, ideally in a hospital.
• In the meantime, use the information on pages 122 to 124 for cleaning and treating the gangrene.

**Antibiotic treatment for adults who can...
noma,gangrene of face,penicillin G,clindamycin,erythromycin,metronidazole
Identify Signs of Noma (Gangrene of the Face)
Critical Source: Where There is No Dentist
Signs of Noma (gangrene of the face):

• The jaw bone becomes infected and spreads through the cheek to the face.
• Parts of the face and jaw rot away, producing a bad smell.
• This condition primarily affects very sick children aged 1–4 years...
noma,gangrene of face,jaw bone infection,rotting face,hiv
Identify Signs of Advanced Gum Infection
High Priority Source: Where There is No Dentist
Signs of advanced gum infection (especially in people with HIV):

• Red, raw ulcers of the gums.
• The roots of the teeth will show.
• Pieces of the jaw bone can be seen at the bottom of the ulcers.
• Some teeth are loose.
gum infection,hiv,advanced infection,jaw bone,loose teeth
Treating a Bad Tooth
High Priority Source: Where There is No Dentist
Procedure:

1. Extract the tooth (refer to Chapter 11 for instructions on tooth extraction).
2. Administer penicillin for 7 days (see page 94 of the source text for dosage and administration details).
3. After completing the penicillin...
tooth extraction, penicillin treatment, dental infection, pus, antibiotic resistance, X-ray, bone removal
Treating a Red, Bleeding Growth Inside a Tooth Cavity
High Priority Source: Where There is No Dentist
Treatment:

Take out the tooth, as it has an abscess.

See page 93 for further instructions.
tooth abscess,red growth,dental infection
Assessing a Bad Tooth
Standard Source: Where There is No Dentist
Procedure:

1. Ask the person to open their mouth.
2. Look for signs of an infected tooth in the area of the sore.
3. Check for the following:
- A large cavity
- A loose tooth
- A tooth that is darker in color than others (indicating it...
bad tooth, infected tooth, dental infection, cavity, pus, loose tooth, dark tooth
Treating Vincent’s Infection (Bleeding Gums and Bad Odor)
Standard Source: Where There is No Dentist
Steps to treat Vincent’s infection:

1. Rinse with a mixture of hydrogen peroxide and water.
2. Remove as much tartar as you can.

See pages 8 and 127 for further instructions.
Vincent’s infection,bad mouth odor,dental infection

Fungal Infections (7)

Apply Selenium Sulfide Lotion for Tinea Versicolor
High Priority Source: Where There is no Doctor a Village Health Care Handbook
Materials needed:
• Selenium sulfide lotion (1 or 2.5% concentration)

Steps:
1. Apply to affected area: Apply the selenium sulfide lotion directly to the skin where tinea versicolor is present.
2. Wash off after 30 minutes: Allow...
selenium sulfide, tinea versicolor
Apply Sodium Thiosulfate (‘Hypo’) for Tinea Versicolor
High Priority Source: Where There is no Doctor a Village Health Care Handbook
Materials needed:
• Sodium thiosulfate (‘hypo’)
• Water
• Cotton or cloth
• Vinegar

Steps:
1. Prepare the solution: Dissolve a tablespoon of sodium thiosulfate in ½ cup of water.
2. Apply to skin: Spread the solution on the affected...
sodium thiosulfate, hypo, tinea versicolor
Apply Sulfur and Vinegar Lotion for Fungal Infections
High Priority Source: Where There is no Doctor a Village Health Care Handbook
Materials needed:
• Sulfur powder
• White vinegar

Steps:
1. Mix the ingredients: Combine 5 parts sulfur with 100 parts white vinegar.
2. Apply to skin: Let the lotion dry on the affected area.
3. Alternative ointment: Mix 1 part...
sulfur, vinegar, ringworm, tinea, fungal infections
Prepare Ointments with Salicylic and Benzoic Acid for Fungal Infections
High Priority Source: Where There is no Doctor a Village Health Care Handbook
Materials needed:
• Salicylic acid
• Benzoic acid
• Petrolatum (Vaseline), mineral oil, lard, or 40% alcohol/rum

Steps:
1. Mix the ingredients: Combine 3 parts salicylic acid and/or 6 parts benzoic acid with 100 parts petrolatum,...
salicylic acid, benzoic acid, ointment, ringworm, tinea, fungal infections
Treating Fungal Infections (Ringworm, Tinea)
Standard Source: Where There is no Doctor a Village Health Care Handbook
Procedure:

1. Wash the infected area daily with soap and water.
2. Keep the affected areas as dry as possible, exposing them to air or sunlight whenever possible.
3. Change underwear or socks frequently, especially when sweaty, to...
ringworm treatment, tinea, sulfur and lard cream, griseofulvin, salicylic acid, tolnaftate
Administer Griseofulvin for Fungal Infections
Standard Source: Where There is no Doctor a Village Health Care Handbook
Griseofulvin is used for severe fungal infections of the skin and deep tinea infections of the scalp, as well as fungal infections of the nails. It should be used with caution and only when necessary due to its cost and potential side...
griseofulvin,fungal infections,skin infection,scalp infection,nail fungus,pregnant women,medicine dosage
Managing Tinea Versicolor (White Spots on the Face and Body)
Reference Source: Where There is no Doctor a Village Health Care Handbook
Procedure:

1. Recognize that tinea versicolor is a mild fungal infection that causes light or dark spots with irregular borders, typically found on the neck, chest, and back.
2. The spots may be slightly **scaly but usually do not...
tinea versicolor, white spots, fungal infection, mild treatment, antifungal creams

Sexually Transmitted Infections (7)

Identifying and Managing Pelvic Inflammatory Disease (PID) in Women with Gonorrhea or Chlamydia
High Priority Source: Where There is no Doctor a Village Health Care Handbook
Procedure:

1. Recognize symptoms of PID:
- If a woman has gonorrhea or chlamydia and experiences fever and pain in the lower abdomen, she may have pelvic inflammatory disease (PID).
- Refer to page 243 for more information on...
pelvic_inflammatory_disease,pid,gonorrhea,chlamydia,treatment,symptoms
Managing Co-Infections with Syphilis in Patients with Gonorrhea or Chlamydia
High Priority Source: Where There is no Doctor a Village Health Care Handbook
Procedure:

1. Consider syphilis testing and treatment:
- A person infected with gonorrhea or chlamydia may also have syphilis without showing symptoms.
- In some cases, it is advisable to provide the full treatment for syphilis even...
syphilis_co_infection,gonorrhea,chlamydia,treatment_limitations,multiple_infections
Recognize and Respond to Gonorrhea or Chlamydia Infection
High Priority Source: Where There is no Doctor a Village Health Care Handbook
Procedure:

1. Identify signs in men:
- Drops of pus from the penis.
- Painful swelling of the testicles.
2. Identify signs in women:
- Yellow or green discharge from the vagina or anus.
- Pain in the lower belly (pelvic...
gonorrhea, chlamydia, symptoms, transmission, treatment, sexually transmitted infections
Understanding and Managing Syphilis Infection
High Priority Source: Where There is no Doctor a Village Health Care Handbook
Procedure:

1. Recognize syphilis as a serious infection:
- Syphilis is a common, dangerous infection spread through sexual contact.
- It can progress to severe complications if not treated early, including damage to the heart, brain,...
syphilis,treatment,penicillin,complications,early_diagnosis
Treating Gonorrhea and Chlamydia with Appropriate Antibiotics
Standard Source: Where There is no Doctor a Village Health Care Handbook
Procedure:

1. Determine the correct antibiotic:
- In many areas, gonorrhea is now resistant to penicillin, so alternative antibiotics must be used.
- Consult local health authorities or medical professionals to identify which...
gonorrhea,chlamydia,treatment,antibiotic,resistance,medical_advice
Treating Sexual Partners of Individuals with Gonorrhea or Chlamydia
Standard Source: Where There is no Doctor a Village Health Care Handbook
Procedure:

1. Treat all sexual partners:
- Anyone who has had sexual contact with a person diagnosed with gonorrhea or chlamydia should also be treated, especially the spouses of infected men.
- Even if a partner shows no symptoms,...
partner_treatment,gonorrhea,chlamydia,reinfection,simultaneous_treatment
Preventing Sexually Transmitted Infections (STIs)
Standard Source: Where There is no Doctor a Village Health Care Handbook
Procedure:

1. Promote safe sexual practices:
- Encourage the use of condoms and other barrier methods to reduce the risk of STI transmission.
- Educate individuals on the importance of regular health check-ups and open communication...
stis_prevention,safe_sex,condoms,education,health_checkups

Disease Treatment (6)

Treating Apoplexy in Poultry
Standard Source: Practical Pointers On The Care of Lifestock
Procedure:
1. Identify affected birds showing symptoms of apoplexy such as sudden death or paralysis.
2. Reduce the amount of feed and limit corn intake to help manage weight and condition.
3. Supply Pratts Poultry Regulator to improve the...
apoplexy treatment, poultry health, disease management
Treating Aspergilosis in Poultry
Standard Source: Practical Pointers On The Care of Lifestock
Procedure:
1. Avoid using moldy grain and litter to prevent the growth of mold in air passages.
2. Disinfect poultry houses with Pratts Poultry Disinfectant to eliminate any existing mold spores.
3. Use Pratts Poultry Regulator to improve the...
aspergilosis treatment, poultry disease, mold prevention
Treating Bacillary White Diarrhoea in Poultry
Standard Source: Practical Pointers On The Care of Lifestock
Procedure:
1. Identify and isolate infected chicks showing symptoms such as white or creamy diarrhea.
2. Disinfect all areas with Pratts Poultry Disinfectant to prevent the spread of bacteria.
3. Administer Pratts White Diarrhoea Remedy in...
bacillary white diarrhoea treatment, poultry health, bacterial infection
Treating Bronchitis in Poultry
Standard Source: Practical Pointers On The Care of Lifestock
Procedure:
1. Keep affected birds dry to prevent further complications from bronchitis.
2. Administer a laxative to help clear any blockages or congestion in the respiratory system.
3. Treat with Pratts Bronchitis Remedy as directed to alleviate...
bronchitis treatment, poultry disease, respiratory health
Treating Chicken Pox or Sore Head in Poultry
Standard Source: Practical Pointers On The Care of Lifestock
Procedure:
1. Disinfect the poultry house and all equipment thoroughly with Pratts Poultry Disinfectant to eliminate bacteria and prevent spread of infection.
2. Treat affected birds with Pratts Sore Head (Chicken Pox) Remedy as directed to...
chicken pox treatment, poultry disease, skin infection
Treating Cholera in Poultry
Standard Source: Practical Pointers On The Care of Lifestock
Procedure:
1. Administer Pratts Chicken Cholera Remedy to the entire flock as a remedy and preventive measure.
2. Improve the general health of the flock by using Pratts Poultry Regulator to enhance their immunity and overall condition.
3....
cholera treatment, poultry disease, bacterial infection

Maternal Health (6)

Accessing 'Managing Complications in Pregnancy and Childbirth' from WHO
High Priority Source: A Book for Midwives
Procedure:

1. Contact the Department of Reproductive Health and Research at the World Health Organization (WHO) located at 1211 Geneva 27, Switzerland.
2. Call them at (41-22) 791-4447 or send an email to reproductivehealth@who.int for...
WHO manual, maternal health, complication management, midwifery education
Address the Challenges Faced by Midwives in Poor Communities
High Priority Source: A Book for Midwives
Procedure:

1. Identify and address systemic issues:
- Recognize that midwives in poor communities often face challenges such as low pay, lack of resources, and limited access to education or training.
- Work with local governments and...
midwives, systemic issues, emotional support, traditional midwives, maternal health
Support Midwives in Poor Communities
High Priority Source: A Book for Midwives
Procedure:

1. Recognize the importance of midwives' work:
- Acknowledge that midwives play a critical role in reducing maternal and infant mortality, especially in poor communities.
- Support midwives by ensuring they have access to...
midwives, support, financial assistance, respect, traditional midwives, maternal mortality, healthcare access
Accessing Emergency Obstetric Care through RPMM Network
High Priority Source: A Book for Midwives
Procedure:

1. Contact the Regional Prevention of Maternal Mortality Network (RPMM) at their office located in PO Box 1177 Mamprobi Accra, Ghana.
2. Call them at (233-21) 76-3284 or send an email to rpmm4ak@africaonline.com.gh for information...
RPMM Network, maternal mortality, emergency obstetric care, sub-Saharan Africa, midwifery resources
Accessing Safe Motherhood Resources through White Ribbon Alliance
High Priority Source: A Book for Midwives
Procedure:

1. Contact the White Ribbon Alliance for Safe Motherhood at their office located in 1050 17th Street, N.W., Suite 1000, Washington, DC 20036, USA.
2. Call them at (1-202) 775-9680 or send an email to wra2@whiteribbonalliance.org for...
White Ribbon Alliance, safe motherhood, maternal health, midwifery resources, global initiatives
Caring for High-Risk Mothers and Babies
Standard Source: Where There is no Doctor a Village Health Care Handbook
Identifying high-risk mothers:
• Single mothers
• Homeless individuals
• Poorly nourished women
• Very young mothers
• Women with mental delays
• Mothers who already have malnourished or sickly children

**What to do for high-risk mothers and...
high-risk mothers, maternal care, nutrition, mental health, proactive support

Nutrition And Health (6)

Address Maternal Food Insecurity in Families
High Priority Source: A Book for Midwives
Why it matters:
Women who prioritize feeding their family over themselves may not consume enough food, which can lead to malnutrition and serious health risks, especially during pregnancy or after childbirth.

Action Steps:
1. **Encourage...
maternal food insecurity, family nutrition, women's health
Ensure Equal Food Intake for Girls and Boys
Standard Source: A Book for Midwives
Why it matters:
Girls need as much food as boys to grow, learn, and work. Insufficient nutrition can lead to poor bone development, which may cause serious complications during labor when the girl becomes a woman and has babies.

**Action...
equal food intake, girl nutrition, bone development, child health
Avoid Alcohol and Tobacco for Growing Boys
Standard Source: Boy Scout Handbook 1911
Avoid Alcohol and Tobacco for Growing Boys

Alcohol and tobacco are not stimulants but rather narcotics that depress the body's functions.

• Alcohol dulls the nervous system, reduces physical performance, and impairs judgment. It is...
alcohol,tobacco,narcotics,growing boys,health
Promote Whole Foods Over Processed and Packaged Foods
Standard Source: A Book for Midwives
Why it matters:
Packaged and processed foods often contain high levels of sugar, salt, fat, and untested chemicals that can be harmful to health. They are not as nutritious as whole, fresh foods.

Action Steps:
1. **Encourage the consumption...
whole foods, processed food risks, nutrition education
Avoid Stimulants for Growing Boys
Reference Source: Boy Scout Handbook 1911
Avoid Stimulants for Growing Boys

Coffee and tea are stimulants that do not add strength or nutrition to the body. They merely force the body to work harder than it would naturally, leading to a reaction where the body becomes worse off as a...
coffee,tea,stimulants,growing boys,nutrition
Involve Family Members to Improve a Woman’s Nutrition
Reference Source: A Book for Midwives
Procedure:

1. Identify family members who may be affecting a woman's nutrition, such as her husband or children.
2. Engage the husband in discussions about the importance of adequate food intake for pregnant women.
3. Encourage the husband to...
family involvement,nutrition,pregnancy,health,community engagement

Childbirth Assistance (6)

Support the Vaginal Opening During Delivery
Critical Source: A Book for Midwives
Procedure:

1. Wash your hands well and put on sterile gloves.

2. Press one hand firmly on the perineum (the skin between the opening of the vagina and the anus). This hand will keep the baby’s chin close to his chest — making it easier...
vaginal opening support, childbirth assistance, perineum pressure, delivery procedure
When to Avoid Slowing the Birth of the Baby’s Head
Critical Source: A Book for Midwives
Procedure:

Do not slow the birth of the head if any of the following conditions are present:

- There has been a gush of blood before the birth (see page 205).
- There is a prolapsed cord (see page 176).
- The baby’s heartbeat is...
avoid slowing birth, emergency childbirth, prolapsed cord, fetal distress
Clear the Baby’s Nose and Mouth After Delivery
Critical Source: A Book for Midwives
Procedure:

• When the head is born, and before the rest of the body comes out, you may need to help the baby breathe by clearing her mouth and nose. If the baby has some mucus or water in her nose or mouth, **wipe it gently with a clean cloth...
clear baby’s airway, suctioning technique, meconium aspiration
Help the Mother Stop Pushing During Childbirth
Critical Source: A Book for Midwives
Procedure:

• The need to push can be very strong, so it is not always easy for the mother to stop. It is best to warn the mother that you are going to ask her to stop pushing before the baby crowns.

**When you want the mother to stop...
stop pushing during childbirth, breathing technique, controlled delivery
Slow the Birth of the Baby’s Head to Prevent Tearing
Critical Source: A Book for Midwives
Procedure:

• If the head is born slowly, the mother’s vagina has more time to stretch and may be less likely to tear.

To slow the birth of the head:
1. Help the mother stop pushing, or give very small pushes, right before the baby’s...
slow birth of the head, prevent tearing, childbirth technique
Use Very Warm Cloths to Prepare the Vaginal Area
High Priority Source: A Book for Midwives
Procedure:

1. Boil a pot of water for 20 minutes to kill any germs. If possible, add a little disinfectant (like iodine or betadine). If you do not have a disinfectant, add a little salt to the water. Let the water cool a little before you...
warm cloths during childbirth, perineal preparation, genital care, delivery assistance

Postpartum Hemorrhage (6)

Administer Ergonovine to Control Heavy Bleeding After Birth or Abortion
Critical Source: Where There is no Doctor a Village Health Care Handbook
For heavy bleeding after birth (postpartum hemorrhage), miscarriage, or abortion, give 1 ampule (0.2 mg.) of ergonovine by intramuscular injection or 1 tablet (0.2 mg.) by mouth.

In extreme emergencies, you can administer **1 ampule...
ergonovine,blood loss,postpartum hemorrhage,abortion,tablet,dose
Administer Oxytocin for Severe Bleeding After Birth (Postpartum Hemorrhage)
Critical Source: Where There is no Doctor a Village Health Care Handbook
For severe bleeding after birth, give 1 ml. (10 units) of oxytocin by intramuscular injection.

If severe bleeding continues, inject another 1 ml. in 15 minutes.

To prevent heavy bleeding after birth, give **1 ml. after the baby...
oxytocin,blood loss,postpartum hemorrhage,dose,pitocin
Remove Retained Placental Tissue Manually (Emergency Procedure)
Critical Source: A Book for Midwives
Purpose: To remove retained placental tissue when medical help is not immediately available and the mother is bleeding heavily.

Warning: This procedure should only be performed by a trained professional if no other options are available. It...
placental retention,manual removal,postpartum hemorrhage,sterile gloves
Manual Uterine Exploration for Retained Placenta
High Priority Source: Emergency War Surgery
Procedure:

• Initial management should include manual uterine exploration for retained placenta.
• Without anesthesia, this procedure is painful.
• An opened sponge is placed around the examiner’s fingers.
• Place the opposite hand on the...
uterine atony, postpartum hemorrhage, manual uterine exploration, retained placenta
Medication Administration for Uterine Atony
High Priority Source: Emergency War Surgery
Procedure:

• Medications should also be used if available.
Oxytocin may be given by IV bolus using 40 units in 1000 cc, or up to 10 units IM, but never by IV push.
• Although unlikely to be available, other medications that can be...
uterine atony, postpartum hemorrhage, oxytocin, methergine, dinoprostone, misoprostol
Nipple Stimulation for Oxytocin Release in Postpartum Hemorrhage
High Priority Source: Emergency War Surgery
Procedure:

• If no medication is available, the patient should be encouraged to breast feed or do nipple stimulation to increase endogenous oxytocin release.
uterine atony, postpartum hemorrhage, oxytocin release, nipple stimulation

Neonatal Resuscitation (6)

Administer Oxygen to a Baby Who Is Not Breathing Well
Critical Source: A Book for Midwives
Procedure:

1. Provide 5 liters (L) of oxygen per minute for 5 to 10 minutes.
2. If available, use a small oxygen mask and place it on the baby’s face.
3. If no mask is available, cup your hand loosely over the baby’s face, and...
oxygen, neonatal resuscitation, breathing, baby not breathing, medical emergency
Rescue Breathing for a Baby Who Is Not Breathing at All
Critical Source: A Book for Midwives
Procedure:

1. Lay the baby on her back on a firm surface (e.g., bed, table, floor). Keep the baby warm by placing a warmed cloth under and over her, leaving her chest exposed.
2. Position the baby’s head so it faces straight up to...
rescue breathing, neonatal resuscitation, baby not breathing, medical emergency
Neonatal Resuscitation Equipment Checklist
Critical Source: Emergency War Surgery
Procedure:

• Immediately following delivery, every infant should be assessed for need for resuscitation.
Equipment that may be needed includes:
- Warm towels
- Bulb syringe
- Stethoscope
- Flow-inflating or self-inflating bag with...
neonatal resuscitation, equipment checklist, epinephrine, naloxone
Neonatal Resuscitation Equipment Preparation
Critical Source: Emergency War Surgery
Procedure:

Immediately following delivery, every infant should be assessed for need for resuscitation.
• Equipment that may be needed includes:
- Warm towels
- Bulb syringe
- Stethoscope
- Flow-inflating or self-inflating bag with...
neonatal resuscitation, equipment preparation, epinephrine, naloxone
Neonatal Resuscitation Protocol for Term and Preterm Infants
Critical Source: Emergency War Surgery
Procedure:

• Nearly 90% of term babies are delivered without risk factors and with clear fluid, requiring only to be dried, suctioned and observed.
• If the baby is less than 36 weeks, or if there is meconium in the fluid at delivery,...
neonatal resuscitation, term infant, preterm infant, positive pressure ventilation, chest compressions, epinephrine, naloxone
Neonatal Resuscitation Termination Criteria
Critical Source: Emergency War Surgery
Procedure:

• If at any time during resuscitation the heart rate goes above 100, with good respiratory effort, tone and color, the baby may be moved to an observation status.
neonatal resuscitation, termination criteria, heart rate, observation status

Pediatric Urgent Care (6)

Assess and Monitor Genital Anatomy in Newborn Girls
High Priority Source: A Book for Midwives
Procedure:

1. Examine the girl’s genital area to ensure both outer and inner lips are present.
2. Check for a small opening to the vagina. If there is no visible opening, this may indicate an anatomical abnormality.
3. **Seek medical help...
genital exam girl, vaginal opening, newborn genital assessment, pediatric emergency
Assess and Monitor for Hip Dislocation in Newborns
High Priority Source: A Book for Midwives
Procedure:

1. Examine the baby’s hips by comparing both legs.
2. Look for these signs on the affected side:
- The upper leg partly covers part of the body.
- There are fewer skin folds than on the other side.
- The leg appears...
hip dislocation, newborn, baby hip exam, clicking hip, pediatric emergency
Examine the Baby’s Spine for Birth Defects
High Priority Source: A Book for Midwives
Procedure:

1. Turn the baby over and examine the spine carefully.
2. Look for any of these signs:
- Holes, sores, or cysts on the skin at the bottom of the spine (near the buttocks).
- Tufts of hair growing in unusual places along the...
spinal defect, baby spine exam, birth defect, pediatric emergency
Identify and Address Testicular Abnormalities in Newborns
High Priority Source: A Book for Midwives
Procedure:

1. Examine the baby’s scrotum to check if both testicles are present and located within the sac.
2. If one or both testicles are not in the scrotum, they may be high in the body (undescended testes).
3. This condition is more...
undescended testes, newborn genital exam, environmental toxins, pediatric emergency
Identify and Monitor Club Foot in Newborns
High Priority Source: A Book for Midwives
Procedure:

1. Examine the baby’s feet for any signs of club foot.
2. Look for a foot that turns inward and cannot be straightened easily.
3. If club foot is suspected, seek medical advice immediately, especially within the first few...
club foot, newborn foot deformity, pediatric emergency, clubfoot treatment
Manage a Dislocated Hip in Newborns
High Priority Source: A Book for Midwives
Procedure:

1. Keep the baby’s knees high and open to help realign the hip.
2. Use layers of diapers or other soft materials to support this position, like this:
...
dislocated hip management, newborn hip care, blood flow in legs, pediatric emergency

Tools And Equipment (6)

Create a 1-Minute Sand Timer
Reference Source: A Book for Midwives
Materials Needed:
• Glass tube
• Bunsen burner or small, very hot flame
• Fine sand
• Strainer
• Cork or rubber stopper (optional)
• Box for protection
• Cotton or cloth padding

Steps to Create a 1-Minute Sand Timer:
1. **Heat the Glass...
sand timer, homemade tools, medical equipment, midwifery, timing device
Create a Folding Scale
Reference Source: A Book for Midwives
Materials Needed:
• Metal or plywood strips
• Nuts and bolts
• Metal weight
• Hook

Steps to Create a Folding Scale:
1. Construct the Frame: Use metal or plywood strips for the frame, joined with nuts and bolts.
2. **Add Weight and...
folding scale, homemade scales, medical equipment, midwifery tools
Create a Homemade Due Date Calculator
Reference Source: A Book for Midwives
Materials Needed:
• Paper or cardboard
• Pencil or pen
• Ruler or measuring tool

Steps to Create a Homemade Due Date Calculator:
1. Reference Page 527: See page 527 of the book for a tool you can make that shows a woman’s likely due...
due date calculator, midwifery tools, homemade medical equipment, pregnancy tracking
Create a Homemade Stethoscope
Reference Source: A Book for Midwives
Materials Needed:
• Hollow tube (bamboo, wood, or clay)
• Rubber tube
• Suction bulb
• Plastic bottle

Steps to Create a Homemade Stethoscope:
1. Select the Tube: Use a hollow tube made of bamboo, 3–4 cm thick wood, or clay that is about...
homemade stethoscope, midwifery tools, medical equipment, listening device
Create a Quarter-Circle Scale
Reference Source: A Book for Midwives
Materials Needed:
• Plywood or sheet metal
• Reinforcement material (sheet metal)
• Metal weight (between 1–2 kg)
• Heavy pipe or scrap metal

Steps to Create a Quarter-Circle Scale:
1. Construct the Frame: If using plywood, reinforce...
quarter-circle scale, homemade scales, medical equipment, midwifery tools
Create a Water Timer
Reference Source: A Book for Midwives
Materials Needed:
• Glass or plastic tube
• Watch with second hand
• Ink, nail polish, or tape

Steps to Create a Water Timer:
1. Select and Prepare the Tube: Use a glass or plastic tube. The longer and thinner the tube, the more...
water timer, homemade tools, medical equipment, midwifery, timing device

Hiv Aids Treatment (6)

Recognizing and Responding to Serious Side Effects of ART
High Priority Source: A Book for Midwives
Overview:
Serious side effects from ART require immediate medical attention. These can indicate that a medication needs to be changed.

Signs of Serious Side Effects:
• Tingling or burning sensations in the hands and feet
• Fever
• Rashes
-...
serious side effects, ART, HIV treatment, medical attention, health worker
ART Combination 4 for Women with HIV (Not for Children)
Standard Source: A Book for Midwives
Overview:
Combination 4 is a recommended ART regimen for women with HIV and consists of specific medications.

Medications in Combination 4:
Tenofovir (TDF): 300 mg, once daily. *Side effects:* Kidney problems. *Use only by women over...
ART combination 4, HIV treatment, TDF, EFV, 3TC
Administering ART Combinations for Adults and Adolescents (Not for Children)
Standard Source: Where There is no Doctor a Village Health Care Handbook
Overview:
These are standard ART combinations used to treat HIV in adults and adolescents. They should be taken as prescribed by a health worker.

Dosage Instructions:
• Take medicines 2 times a day, with 12 hours between doses, unless...
ART combinations for adults, HIV treatment regimens
Avoiding Stavudine (d4T) in ART Combinations for Women with HIV
Standard Source: A Book for Midwives
Overview:
Stavudine (d4T) is not recommended for use in ART combinations for women with HIV due to its serious long-term side effects.

Steps to Avoid Stavudine:
1. Use Safer Alternatives: Replace stavudine with zidovudine (AZT) or other...
stavudine, d4T, ART, safer alternatives, HIV treatment
Managing Side Effects of Specific ART Medicines
Standard Source: Where There is no Doctor a Village Health Care Handbook
Overview:
Different ART medicines can cause specific side effects that need to be monitored and managed carefully.

Side Effects by Medicine:
AZT (Zidovudine): Anemia, low white blood cell count
- Monitor for signs of fatigue or...
ART side effects by medicine, managing ART complications
Managing Common Side Effects of ART
Reference Source: A Book for Midwives
Overview:
ART (Antiretroviral Therapy) can cause common side effects such as diarrhea, tiredness, headaches, and stomach problems like nausea, vomiting, stomach pain, or loss of appetite. These often improve over time.

**Steps to Manage Common...
ART, side effects, HIV treatment, managing symptoms, ART medication

Combat Injuries (6)

Conduct a Comprehensive Examination for Multiple Missile Wounds
Critical Source: NATO Emergency War Surgery
Procedure:

1. Remove all clothing from the casualty to ensure no injuries are overlooked.
2. Systematically assess potential injuries based on the type of missile, its trajectory, and other trauma sustained.
3. **Look for signs of...
missile wounds, multiple trauma, examination, combat injuries, shock assessment
Manage Injuries from Kinetic Energy Rounds
Critical Source: Emergency War Surgery
Procedure for Managing Injuries from Kinetic Energy (KE) Rounds

Overview:
Kinetic energy rounds contain a hard metal dart, often made of depleted uranium or tungsten, encased in a sabot. These projectiles can cause severe penetrating trauma...
kinetic energy round,depleted uranium,wound management,retain foreign body,heavy metal poisoning,triage,war surgery
Assess and Manage Injuries from Shaped-Charge Warhead Detonation
High Priority Source: Emergency War Surgery
Procedure for Assessing and Managing Injuries from Shaped-Charge Warhead Detonation

Overview:
Shaped-charge warheads produce two types of injuries: jet wounds and spall wounds. Jet wounds are caused by the high-velocity jet of molten metal,...
shaped charge, jet wounds, spall wounds, foreign bodies, trauma management, war injuries
Understanding Characteristics and Effects of Common Firearms in Emergency Situations
High Priority Source: Emergency War Surgery
Objective: Understand the characteristics and effects of common firearms to better assess and treat injuries caused by small arms.

### Key Information:
Small Arms Overview:
- Includes pistols, rifles, and machine guns.
- Trends since...
AK-47,M-16A1,NATO rifle,bullet trajectory,wound ballistics,emergency surgery,combat injuries
Understanding 7.62 mm NATO Wound Pathology in Tissue Simulant
High Priority Source: Emergency War Surgery
Objective: Understand the wound path caused by a 7.62 mm NATO bullet in tissue simulant.

### Procedure:
1. Recognize the projectile characteristics:
- The 7.62 mm NATO rifle cartridge is used in sniper rifles and machine guns with a...
7.62 mm NATO,wound path,tissue simulant,bullet trajectory,temporary cavity,yaw point,permanent cavity
Understanding M-16A1 Wound Pathology in Tissue Simulant
High Priority Source: Emergency War Surgery
Objective: Understand the wound path caused by an M-16A1 bullet in tissue simulant.

### Procedure:
1. Recognize the projectile characteristics:
- The M-16A1 fires a 55-grain full metal-jacketed bullet (M-193) at approximately 950 m/s...
M-16A1,wound path,tissue simulant,bullet trajectory,temporary cavity,yaw point,cannalure

Evacuation (6)

Mitigate Immediate Life-Threatening Situations Within the First 24 Hours
Critical Source: Planning Guidance Nuclear Detonation FEMA
Procedure:

1. Focus response actions in the first 24 hours on mitigating immediately life-threatening situations.
2. Prioritize moving people from the DRZ to locations with better shelter or lower radiation hazards if they are poorly...
evacuation,nuclear detonation,life-threatening situations
Evacuate a Casualty Using a Toboggan
High Priority Source: Canadian Military Basic Cold Weather Training
Procedure:

1. Assess the Situation: Ensure the casualty is stable and can be safely moved using a toboggan.

2. Prepare the Toboggan:
- Use a sturdy, flat surface (e.g., a wooden board or sled) as the toboggan.
- Secure any...
casualty evacuation, toboggan transport, cold weather evacuation, military casualty movement
Provide En Route Care During Aeromedical Evacuation
High Priority Source: Emergency War Surgery
Procedure:

• Maintain treatment initiated prior to evacuation and sustain the patient’s medical condition during transport.
• Ensure that en route care is provided by trained AE crewmembers and critical care air transport teams (CCATTs).
-...
en route care, aeromedical evacuation, patient monitoring
Coordinate Medical Evacuation (MEDEVAC) and Casualty Evacuation (CASEVAC)
High Priority Source: TCCC 17 13 Army Tactical Combat Casualty Care
Objective: Coordinate the collection, sorting, transporting, and en-route medical care of patients.

Procedure:
1. Integrate MEDEVAC Assets: Use dedicated MEDEVAC assets when available for evacuating casualties from lower to higher...
MEDEVAC,CASEVAC,evacuation,medical evacuation,coordination
Coordinate Medical Regulating for Patient Movement
High Priority Source: TCCC 17 13 Army Tactical Combat Casualty Care
Objective: Coordinate and control the movement of patients to appropriate military treatment facilities (MTFs) based on required specialty care.

Procedure:
1. Identify Patient Needs: Determine which patients require evacuation and...
medical regulating,patient movement,MTF coordination,evacuation planning
Understand Aeromedical Evacuation (AE) Definitions and Roles
High Priority Source: Emergency War Surgery
Procedure:

CASEVAC: Movement of a casualty by nonmedical personnel from the point of injury to medical treatment without en route care. This may lead to deterioration in patient condition.
MEDEVAC: Timely, efficient movement with en...
aeromedical evacuation, casevac, medevac, ae definitions

Gynecologic Trauma (6)

Management of Uterine Trauma
Critical Source: Emergency War Surgery
Procedure:

1. In cases of acute penetrating trauma involving the uterine fundus with minimal bleeding, manage expectantly without repair.
2. For damage to the uterine wall with active bleeding, repair using size 0 absorbable suture.
3. If...
uterine trauma management, uterine artery ligation, hysterectomy indication
Assessment and Inspection of Vaginal Trauma
High Priority Source: Emergency War Surgery
Procedure:

1. Perform a thorough inspection and palpation of the vagina and rectovaginal exam to detect vaginal trauma.
2. Evaluate for signs of lacerations, hematoma, or other injuries.
3. Determine if further **urologic...
vaginal trauma, inspection, palpation, rectovaginal exam, urologic injury, pelvic instability
Managing Ovarian Torsion
High Priority Source: Emergency War Surgery
Procedure for Managing Ovarian Torsion

1. Assess the ovary and fallopian tube to determine the extent of torsion.
2. Untwist the ovary and/or fallopian tube carefully to restore blood flow.
3. If the ovary appears healthy with some...
ovarian torsion,salpingo-oophorectomy,gynecologic emergency
Repair of Vaginal Lacerations
High Priority Source: Emergency War Surgery
Procedure:

1. Repair vaginal lacerations using the same guidelines as for vulvar lacerations.
2. Ensure proper alignment and approximation of tissue to promote healing and prevent complications such as dyspareunia or fistula formation.
3. Use...
vaginal laceration repair, absorbable suture, dyspareunia prevention
Treating Hemorrhage from Infundibulopelvic Ligament Injury
High Priority Source: Emergency War Surgery
Procedure for Treating Hemorrhage from Infundibulopelvic Ligament Injury

1. Identify the source of hemorrhage, which is typically due to penetrating abdominal trauma.
2. Perform ligation of the affected infundibulopelvic ligament to...
infundibulopelvic ligament injury,hemorrhage control,gynecologic emergency
Treating a Ruptured Ovarian Cyst
High Priority Source: Emergency War Surgery
Procedure for Treating a Ruptured Ovarian Cyst

1. Perform cystectomy by carefully shelling the cyst wall out of the ovary.
2. Identify any bleeding vessels, which are typically located at the base of the cyst.
3. Apply **cauterization or...
ruptured ovarian cyst,cystectomy,ovarian trauma,gynecologic emergency

Frostbite Treatment (6)

Identifying and Treating Severe Frostbite
Critical Source: Where There is no Doctor a Village Health Care Handbook
Procedure for Identifying and Treating Severe Frostbite:

Signs of severe frostbite:
• Numbness, followed by loss of feeling in the affected area.
• The skin becomes pale, hard, and may later turn black (p. 213).

**Treatment for severe...
severe frostbite, treatment, first aid, cold injury, emergency care
Proper Frostbite Rewarming Procedure
Critical Source: US Marine Corps Wilderness Medicine
Procedure for Proper Frostbite Rewarming:

1. Do not rewarm a frostbitten extremity if there is any chance of refreezing, as this increases tissue damage.
2. Rapid rewarming is the preferred method:
- Immerse the affected part in...
frostbite treatment, rewarming procedure, frostbite management, rapid thawing, tissue damage prevention
Splint and Protect Frostbitten Areas and Medevac Immediately
Critical Source: USMC Winter Survival Course Handbook
Do not attempt to rewarm frostbitten areas.

1. Splint the affected area to prevent further injury.
2. Protect the affected area from additional trauma or exposure.
3. Medevac as soon as possible, unless tactical circumstances...
frostbite, rewarming, splinting, medevac, cold injury, hypothermia
Management of Frostbite Vesicles and Post-Rewarming Care
High Priority Source: Emergency War Surgery
Vesicle Management:
Frostbite vesicles are typically left intact.
Debridement is not recommended, except in cases of severe infection.
• Early surgery should be delayed for at least 6 months, unless there is **massive tissue...
frostbite management, vesicle care, post-thaw complications, surgical considerations
Post-Thaw Care for Frostbite Injuries
High Priority Source: US Marine Corps Wilderness Medicine
Post-Thaw Care for Frostbite:

1. Assess tetanus status and ensure it is up to date.
2. Keep the injury clean and infection-free through meticulous care.
3. Administer daily whirlpool therapy (30-45 minutes) to aid recovery.
4....
post-thaw care, frostbite recovery, infection prevention, whirlpool therapy, physical therapy for frostbite
Treatment of Frozen Extremities in Frostbite
High Priority Source: Emergency War Surgery
Objective: Proper treatment of frozen extremities to prevent complications and promote recovery.

Key Considerations:
• The outcome is not directly related to the length of time frozen, but more importantly to the method of rewarming and any...
frostbite treatment, rewarming, splinting, whirlpool bath, debridement, hypothermia, extremity care, surgical fasciotomy, tetanus prophylaxis, antibiotics

Pediatric Surgery (6)

Close Rectus Fascia in Pediatric Patients Using Absorbable Sutures
High Priority Source: Emergency War Surgery
Procedure:

1. Use absorbable suture such as Vicryl or PDS (2-0) to close the rectus fascia, regardless of the type of incision used.

2. Ensure proper tension and alignment during closure to prevent complications such as wound...
rectus fascia closure, pediatric suture techniques, absorbable sutures in children
Perform Transverse Incisions in Infants During Surgery
High Priority Source: Emergency War Surgery
Procedure:

1. Use transverse incisions for infants to minimize the risk of postoperative dehiscence (wound separation) while still allowing adequate exposure.

2. Ensure proper technique and positioning to maintain surgical access without...
infant surgical incisions, transverse wound closure, pediatric surgery techniques
Prepare Pediatric Medical/Surgical Equipment Based on Age and Weight
High Priority Source: Emergency War Surgery
Procedure:

1. Arrange accessory pediatric medical/surgical equipment according to the age and weight of the patient, as outlined in Table 33-4.

2. Use the following equipment based on the patient's age and weight:
- **Airway/Breathing...
pediatric equipment, age-based medical supplies, weight-based surgical tools, newborn surgery, infant medical gear
Ensure Pediatric Support for Obstetric Missions
High Priority Source: Emergency War Surgery
Procedure:

1. Remember that if obstetrics is part of the mission, pediatric support will be required.
2. Ensure that trained personnel and appropriate equipment are available to manage both maternal and neonatal emergencies.
3....
obstetric missions with pediatric support, maternal and neonatal care in field settings
Use Absorbable Sutures for Closing Rectus Fascia in Infants and Children
High Priority Source: Emergency War Surgery
Procedure:

1. Use absorbable suture such as Vicryl or PDS (2-0) to close the rectus fascia, regardless of the type of incision used.

2. After closing the rectus fascia, close the skin using either staples or **absorbable...
absorbable sutures, rectus fascia closure, pediatric wound care
Use Peripheral Vascular Set as Alternative to Pediatric Surgical Set
High Priority Source: Emergency War Surgery
Procedure:

1. If a pediatric surgical set is not immediately available:
- Use a peripheral vascular set that contains instruments delicate enough to accomplish most tasks in newborns.

2. Ensure the instruments are suitable for use on...
alternative surgical tools, peripheral vascular set, newborn surgery, emergency pediatric care

Antibiotic Administration (6)

Administer Ampicillin by Injection for Severe Infections
Critical Source: Where There is no Doctor a Village Health Care Handbook
Procedure: Administer ampicillin by injection as follows:

1. Determine the patient's age and condition.
2. For adults, administer 500 mg (one vial) four times a day for 10 to 14 days.
3. For children aged 8 to 12 years, administer 250 mg (½...
ampicillin injection, severe infections, meningitis treatment
Administer Antibiotics for Battlefield Infections
High Priority Source: Emergency War Surgery
To administer antibiotics effectively in a battlefield setting:

1. Identify the likely pathogen based on the infection site and local epidemiology (e.g., MRSA, *Staphylococcus aureus*, *E. coli*, *Pseudomonas*, etc.).
2. **Select appropriate...
battlefield antibiotic, infection treatment, antibiotic dosing, battlefield MTF
Administer Amoxicillin by Mouth for Mild to Moderate Infections
High Priority Source: Where There is no Doctor a Village Health Care Handbook
Procedure: Administer amoxicillin by mouth as follows:

1. Determine the patient's age and condition.
2. For adults and children over 10 years old, give 250 mg (one capsule or two teaspoons of syrup) three times a day for 7 days.
3. For...
amoxicillin administration, oral dosage, broad-spectrum antibiotic
Administer Benzathine Benzylpenicillin for Mild to Moderately Severe Infections
High Priority Source: Where There is no Doctor a Village Health Care Handbook
Procedure: Administer benzathine benzylpenicillin as follows:

1. Determine the patient's age and condition.
2. For mild infections, administer a single injection of 1,200,000 U for adults and children over 8 years old, or 300,000 to...
benzathine benzylpenicillin, antibiotic administration, strep throat, rheumatic fever prevention
Administer Procaine Penicillin for Moderately Severe Infections
High Priority Source: Where There is no Doctor a Village Health Care Handbook
Procedure: Administer procaine penicillin as follows:

1. Determine the patient's age and condition.
2. For moderately severe infections, administer 600,000 to 1,200,000 U for adults, 600,000 U for children aged 8 to 12 years, 300,000 U...
procaine penicillin, antibiotic administration, moderately severe infections
Administer Antibiotics for Pediatric Patients
Reference Source: Emergency War Surgery
Procedure:

1. Calculate the dose based on the patient's weight:
- Ampicillin: 25–50 mg/kg IV every 8 hours. In newborns, adjust to every 12–18 hours.
- Gentamicin: 2.5 mg/kg IV every 8 hours. In newborns, adjust to every 12–18...
Ampicillin, Gentamicin, Pediatric Patients, IV Antibiotics, Emergency Surgery

Quarantine Procedures (6)

Widespread Community Quarantine (Cordon Sanitaire)
Critical Source: HHSPandemicInfluenzaPlan
Procedure:

1. Implement widespread community quarantine measures when the pandemic reaches a critical level.
2. Establish boundaries and checkpoints to control movement in and out of quarantined areas.
3. Ensure that essential supplies and...
community quarantine, cordon sanitaire, pandemic containment
Quarantine and Vaccination for BW Agent Exposure
Critical Source: Emergency War Surgery
Procedure:

• All contacts should be vaccinated within 7 days of exposure.
• Contacts must be quarantined together for at least 17 days following the most recent exposure.

Notes:
• This applies to individuals who have been in...
quarantine, vaccination, BW agents, smallpox, plague
Establishing Designated Quarantine Facilities
High Priority Source: HHSPandemicInfluenzaPlan
Procedure for Setting Up Community-Based Quarantine Facilities

1. Identify appropriate community-based quarantine facilities when affected persons cannot or choose not to be quarantined at home.
2. Ensure that these facilities meet the same...
quarantine, designated facilities, pandemic influenza, preparedness planning
Managing Working Quarantine for Essential Personnel
High Priority Source: HHSPandemicInfluenzaPlan
Procedure for Managing Working Quarantine

1. Apply working quarantine to healthcare workers or other essential personnel who are at occupational risk of influenza infection.
2. During off-duty hours, manage these individuals in the same way as...
working quarantine, essential personnel, pandemic influenza, psychological support
Evaluate Home for Quarantine Suitability
Standard Source: HHSPandemicInfluenzaPlan
Purpose: Ensure the home environment is suitable for quarantine to meet physical, mental, and medical needs.

Steps:
1. Evaluate the home before placing a person in quarantine.
2. Consider the following factors:
- Basic utilities:...
home quarantine, evaluation, suitability, pandemic influenza, quarantine preparation
Prepare for Quarantine in a Community-Based Facility
Standard Source: HHSPandemicInfluenzaPlan
Purpose: Ensure community-based facilities are suitable for quarantine to meet physical, mental, and medical needs.

Steps:
1. Identify and evaluate one or more community-based facilities as part of influenza preparedness planning.
2....
community quarantine, facility preparation, pandemic influenza, quarantine planning

Diarrhea Treatment (6)

Managing Diarrhoea with Oral Rehydration Solutions
Critical Source: First Aid in Armed Conflicts
Managing Diarrhoea with Oral Rehydration Solutions

Drink lots of liquids (3 or more litres a day):
- In 1 litre of clean water, put 1/2 a level teaspoon of salt and 8 level teaspoons of sugar (raw sugar or molasses can be used...
diarrhoea treatment, oral rehydration solution, dehydration prevention
Foods to Eat During Diarrhea
High Priority Source: Where There is no Doctor a Village Health Care Handbook
Recommended Foods for a Person with Diarrhea

When the person is vomiting or feels too sick to eat, they should drink:
• Watery mush or broth of rice,
• Maize powder,
• Potato water (with some mashed rice),
• Chicken, meat, egg, or bean broth,
-...
foods for diarrhea,nutrition,diet during illness,avoid foods,energy sources,body-building foods
Treating Diarrhea and Dehydration with Water
High Priority Source: Where There is no Doctor a Village Health Care Handbook
Procedure:

1. Encourage the affected person to drink plenty of liquids, especially clean water.
2. If available, use oral rehydration solutions (ORS) made from a mixture of salt, sugar, and clean water.
3. Avoid giving sugary drinks or...
diarrhea,dehydration,water,oral rehydration solutions
Treatment of Diarrhea: Prevent Dehydration and Meet Nutritional Needs
High Priority Source: Where There is no Doctor a Village Health Care Handbook
Treatment for Diarrhea

For most cases of diarrhea, no medicine is needed, but the following steps are essential:

1. Prevent or Control Dehydration
- A person with diarrhea must drink a lot of liquids.
- If diarrhea is severe or...
rehydration,dehydration,food for diarrhea,nutrition,child care,zinc supplements
Prevent and Treat Diarrhea with Water
High Priority Source: Where There is no Doctor a Village Health Care Handbook
Objective: Prevent and treat diarrhea through proper water use.

Steps:
1. Ensure safe drinking water:
- Protect wells and springs from contamination by using fences or walls around them.
- Use cement or rock to provide good...
diarrhea, rehydration, water safety, hygiene, children, dehydration
Administer Rehydration Drink for Diarrhea in Children
Standard Source: Where There is no Doctor a Village Health Care Handbook
Objective: Prevent dehydration from diarrhea in children.

Steps:
1. Give the child lots of Rehydration Drink (ORS) frequently, even if they are not thirsty.
2. If the child is not eating much, give them **a little food many times a...
rehydration drink, diarrhea treatment, children, ORS, dehydration prevention

Vital Signs (6)

Take Pulse in an Emergency
High Priority Source: Survival and Austere Medicine
Procedure:

1. In a medical emergency, remain calm and assess the situation.
2. Locate the pulse by placing two fingers on the carotid artery (side of the neck) or radial artery (wrist).
3. Count the number of beats for 15 seconds and multiply...
take pulse, emergency assessment
Reassessing Vital Signs
High Priority Source: US Marine Corps Wilderness Medicine
Procedure:

• Reassess the vital signs.

Steps:
1. Assess pulse rate, breathing rate, and pulse pressure.
2. Re-evaluate pupils and level of consciousness (GCS).
3. Evaluate extremities for motor and sensory deficits.

Details:
• Use a...
vital signs, reassessment, GCS
Check the Pulse
Standard Source: Survival and Austere Medicine
How to Check the Pulse:

1. Locate the pulse at one of these sites:
- The vertical notch of the neck next to the throat (carotid artery)
- The inside wrist (radial artery)
- In the groin
- Behind the knee
- On the top of the...
check pulse, carotid artery, radial artery, apical pulse, beats per minute
How to Take a Person's Pulse
Standard Source: Where There is no Doctor a Village Health Care Handbook
Procedure:

1. Put your fingers on the person’s wrist, avoiding using your thumb to feel for the pulse.
2. If you cannot find the pulse in the wrist, feel for it in the neck beside the voicebox.
3. Alternatively, put your ear directly on...
pulse, heartbeat, taking pulse, vital signs, medical emergency
Measuring Vital Signs at Home
Standard Source: Flu Home Treatment
Procedure:

1. Blood Pressure Measurement:
- Use an automated blood pressure monitor.
- Follow the instructions provided with the device for proper use.
- The pulse rate is displayed on the monitor readout.

2. **Pulse...
blood pressure, pulse, temperature, weight, respiratory rate, vital signs, home care, medical procedures
Measuring the Pulse
Standard Source: Survival and Austere Medicine
Steps to Measure the Pulse:

1. Locate the radial artery, which is found on the wrist, just below the thumb.
2. Use your index and middle fingers to gently press against the artery until you feel a pulse.
3. Count the number of beats for...
pulse measurement, radial artery, vital signs, heart rate

Infectious Disease Detection (6)

Educate Public Health Staff on Safe Specimen Collection and Management
High Priority Source: HHSPandemicInfluenzaPlan
Procedure:

1. Training and Education:
- State and local health departments should inform and educate public health staff (including laboratorians), local physicians, and hospital workers on safe and effective methods for specimen...
specimen collection, safety guidelines, public health education
Implement RT-PCR Testing for Novel Influenza Strains
High Priority Source: HHSPandemicInfluenzaPlan
Procedure:

1. Training and Incorporation of RT-PCR Protocols:
- As of October 2005, about 48 state and large local public health laboratories have received training in RT-PCR protocols for molecular detection of H1, H3, H5, and H7...
RT-PCR testing, novel influenza detection, public health laboratories, H1 H3 H5 H7 subtypes
Maintain Standard Specimen Handling Procedures During Pandemics
High Priority Source: HHSPandemicInfluenzaPlan
Procedure:

1. Consistency in Procedures:
- Procedures for specimen collection, handling, and shipping during a pandemic will be the same as those used for seasonal disease surveillance.

2. Increased Volume Anticipation:
-...
specimen handling procedures, pandemic volume management
Notify State Health Departments of Novel Influenza Specimens in Laboratories
High Priority Source: HHSPandemicInfluenzaPlan
Procedure:

1. Notification Requirements:
- State and local public health laboratories should contact laboratories in their jurisdictions that conduct RT-PCR influenza testing or that have BSL-3 containment facilities.

2. **Trigger for...
laboratory notification, BSL-3 containment, novel influenza specimens
Provide Information on Novel Influenza Specimen Handling and Contact Procedures
High Priority Source: HHSPandemicInfluenzaPlan
Procedure:

1. Communication with Healthcare Providers:
- State and local public health laboratories should provide hospitals and healthcare providers with information on how to contact the laboratory when a novel influenza subtype is...
specimen handling, contact procedures, public health laboratories, novel influenza
Report Novel Influenza Cases to CDC Using Established Mechanisms
High Priority Source: HHSPandemicInfluenzaPlan
Procedure:

1. Reporting Channels:
- State and local health departments that report laboratory-confirmed seasonal influenza cases to CDC use a variety of reporting mechanisms, including faxes, the Public Health Information System (PHLIS),...
CDC reporting, novel influenza cases, PHLIS, NREVSS

Influenza Preparedness (6)

Role of Healthcare Providers in Detecting and Managing Pandemic Influenza Cases
Critical Source: HHSPandemicInfluenzaPlan
Procedure:

Action: Healthcare providers play an essential role in the detection of initial cases of novel or pandemic influenza in a community.

Details: This includes early identification, isolation, and treatment of suspected...
healthcare providers, detection, isolation, treatment
Challenges in Detecting and Managing Pandemic Influenza Cases
High Priority Source: HHSPandemicInfluenzaPlan
Procedure:

Action: Clinicians face significant challenges in detecting and managing pandemic influenza cases.

Details: These include:
1. Quickly identifying and triaging cases based on limited clinical findings.
2. Containing...
challenges, detection, management, pandemic influenza
Report Atypical or Abnormal Cases During Pandemic Influenza Outbreaks
High Priority Source: HHSPandemicInfluenzaPlan
Procedure:

Action: Healthcare providers must report atypical cases, breakthrough infections while on prophylaxis, or any other abnormal cases throughout the duration of the pandemic to public health agencies.

Details: This includes...
atypical cases, reporting, healthcare providers, public health agencies
Report Pandemic Influenza Cases and Fatalities to Health Departments
High Priority Source: HHSPandemicInfluenzaPlan
Procedure:

Action: Healthcare providers must report pandemic influenza cases or fatalities as requested by health departments.

Details: This includes timely communication of confirmed or suspected cases, ensuring accurate data...
reporting, pandemic influenza, healthcare providers, health departments
Collect Specimens for Pandemic Influenza Surveillance
High Priority Source: HHSPandemicInfluenzaPlan
Procedure:

Action: Healthcare providers must collect recommended specimens for ongoing pandemic influenza surveillance and forward them to designated state and federal laboratories as requested.

Details: This includes following...
specimen collection, surveillance, healthcare providers, laboratories
Update Healthcare Providers on Pandemic Influenza Guidelines and Surveillance
High Priority Source: HHSPandemicInfluenzaPlan
Procedure:

Action: Healthcare providers must regularly consult updates on case definitions, screening, laboratory testing, and treatment algorithms for pandemic influenza.

Details: This includes staying informed through official...
healthcare providers, updates, pandemic influenza, guidelines

Radiation Contamination (6)

Assess Internal Contamination for High-Risk Individuals
High Priority Source: Planning Guidance Nuclear Detonation FEMA
Objective: Identify and assess individuals at higher risk of internal contamination following a nuclear detonation.

Procedure:
1. Prioritize first responders, pregnant individuals, and children for internal contamination screening.
2. Use...
internal contamination, bioassays, radiobioassays, nuclear detonation, radiation monitoring, urine analysis
Conducting a Bioassay for Internal Contamination
High Priority Source: Medical NBC Battlebook
When to Conduct a Bioassay:

• Whenever there is a possibility of internal contamination, such as:
- Being in or near a vehicle hit by a DU round
- After a vehicle has been hit by a DU round
- Climbing on vehicles before they are...
bioassay, internal contamination, DU exposure, radiological bioassay, USACHPPM, tritium breakage
Decontamination Procedures for Contaminated Deceased Bodies
High Priority Source: Planning Guidance Nuclear Detonation FEMA
Procedure for Decontamination of Contaminated Deceased Bodies

Overview: This procedure provides information and suggestions for decontamination procedures specifically developed for medical examiners and coroners (ME/Cs).

**Steps to...
decontamination procedures, contaminated deceased bodies, medical examiners, coroners, PPE, radiation safety
Handle Decedents Contaminated with Radioactive Materials
High Priority Source: Planning Guidance Nuclear Detonation FEMA
Procedure for Handling Decedents Contaminated with Radioactive Materials

Overview: This procedure outlines steps for handling decedents contaminated with radioactive materials, including nuclear detonation scenarios, radiological dispersal...
radioactive materials, decedents, nuclear detonation, radiological dispersal devices (RDD), morgue procedures, transportation guidance, decontamination protocols
Medical Examiner/Coroner on the Handling of a Body/Human Remains Potentially Radiologically Contaminated
High Priority Source: Planning Guidance Nuclear Detonation FEMA
Procedure for Medical Examiner/Coroner on Handling a Body/Human Remains Potentially Radiologically Contaminated

Overview: This procedure identifies precautions and provides guidance to medical examiners/coroners (ME/Cs) on the handling of...
medical examiner, coroner, radiologically contaminated remains, transportation incident, PPE, decontamination protocols
Handling and Reporting of Bioassay Results
High Priority Source: Medical NBC Battlebook
Processing of Bioassay Samples:

• The USACHPPM is responsible for providing bioassay support.
• Specimens are collected at medical treatment facilities by occupational health professionals and sent to the USACHPPM for analysis and dose...
dose assessment, bioassay reporting, medical treatment facility, NRC license manager, USAIRDC, 75 year archive

Radiation Safety (6)

Evaluate for Radiological Contamination Prior to or After Transport to Medical Facilities
Critical Source: FEMA REP Program Manual Dec 2019
Procedure:

1. Conduct a radiological assessment of all contaminated or injured individuals before transport to an offsite medical facility.
2. Use appropriate monitoring equipment (e.g., radiation detectors, contamination meters) to assess the...
radiological assessment, pre-transport evaluation
Implement Radiological Controls Capability for Contamination and Radiation Exposure
Critical Source: FEMA REP Program Manual Dec 2019
Procedure:

1. Develop protocols for the isolation of contaminated individuals to prevent spread of contamination.
2. Establish procedures for assessing contamination levels using appropriate radiological monitoring equipment.
3. Implement...
radiation exposure, contamination control, decontamination
Maintain Contact Information for Facilities Capable of Treating Overexposure to Radioactive Material
Critical Source: FEMA REP Program Manual Dec 2019
Procedure:

1. Compile a list of medical facilities capable of treating overexposure to radioactive material.
2. Include the following information for each facility:
- Name and address
- Contact person and phone number
- Special...
radioactive treatment, medical facility contact list
Compare Characteristics of Nuclear Radiation Types
High Priority Source: Medical NBC Battlebook
### Table 3-N: Characteristics of Nuclear Radiation

| Name and Symbol | What is it | Source |
|------------------|------------|--------|
| Alpha particle (α) | Helium nucleus | Decay of uranium and plutonium |
| Beta particle (β) | High-speed...
radiation characteristics, alpha, beta, gamma, neutron
Understand the Concept of Radioactivity and Activity Measurement
High Priority Source: Medical NBC Battlebook
Radioactivity is a spontaneous nuclear transformation that results in the formation of a different element and, usually, the release of excess energy as particulate and/or electromagnetic radiation. For example, tritium transforms into He-3 and...
radioactivity, activity measurement, bequerels, curies, specific activity
Understand the Types of Radiation and Their Characteristics
High Priority Source: Medical NBC Battlebook
A nucleus can decay by emitting several different types of particles. The most common forms of radiation are gamma, neutron, beta, and alpha. Many radioactive isotopes decay through various channels and emit several forms of...
gamma, neutron, beta, alpha, radiation types

Viral Infections (6)

Manage Smallpox Exposure and Patient Care
Critical Source: Medical NBC Battlebook
Procedure:

1. Identify symptoms:
- Initial prodrome includes generalized malaise, fever, rigors, headache, and backache lasting 2-3 days.
- Skin eruption follows with a progression of lesions from macules to papules to vesicles to...
smallpox, orthopoxvirus, vaccination, quarantine, disinfection, medical management
Administer Ribavirin for Prophylaxis Against Crimean-Congo Hemorrhagic Fever (CCHF)
High Priority Source: Medical NBC Battlebook
Procedure:

1. Identify high-risk exposure to CCHF virus, such as tick bites, crushing an infected tick, or handling viremic livestock.
2. Administer ribavirin either orally or intravenously based on the protocol and availability of the...
Crimean-Congo hemorrhagic fever,CCHF,ribavirin,prophylaxis,biological warfare agent
Recognize and Respond to Early Symptoms of Crimean-Congo Hemorrhagic Fever (CCHF)
High Priority Source: Medical NBC Battlebook
Procedure:

1. Monitor for symptoms appearing 3-12 days after potential tick exposure or contact with viremic livestock.
2. Watch for initial signs, including:
- Sudden onset of fever and chills
- Flushing, conjunctival injection,...
Crimean-Congo hemorrhagic fever,CCHF,symptoms,early recognition,ribavirin treatment
Administer Acyclovir for Shingles
High Priority Source: Where There is no Doctor a Village Health Care Handbook
Procedure:

1. Take 600–800 mg of acyclovir by mouth, 5 times a day, for 7 to 10 days.

Warnings:
Side effects may include headache, dizziness, nausea, vomiting, memory loss, and difficulty urinating. These are signs of...
shingles treatment, acyclovir, viral infection, dosage instructions
Treating Shingles (Herpes Zoster)
Standard Source: Where There is no Doctor a Village Health Care Handbook
Procedure:

1. Apply light bandages over the rash to protect it from friction caused by clothing.
2. Take aspirin for pain relief.
3. Use acyclovir to help prevent the spread of herpes blisters (see page 373).
4. Avoid using...
shingles treatment, acyclovir, pain relief, herpes zoster, antibiotics not effective
Managing a Cold or the Flu
Reference Source: Where There is no Doctor a Village Health Care Handbook
Overview: Colds and the flu are common viral infections that may cause runny nose, cough, sore throat, fever, and joint pain. They usually resolve on their own without medication.

Steps to Manage Symptoms:
1. Stay hydrated: Drink plenty...
cold, flu, viral infection, rest, hydration, aspirin, acetaminophen, antibiotics, prevention, complications

Head Injury (6)

Manage Acute Phase of Head Injury
Critical Source: NATO Emergency War Surgery
Procedure for Managing the Acute Phase of Head Injury:

1. Recognize acute phase injuries, which occur within a few hours of injury and are associated with massive sympathetic and parasympathetic discharges.
2. **Monitor for cardiac...
acute phase, head injury, cardiac arrhythmias, cerebral edema
Manage Subacute Phase of Head Injury
Critical Source: NATO Emergency War Surgery
Procedure for Managing the Subacute Phase of Head Injury:

1. Recognize subacute phase injuries, which occur within a few days of injury and are associated with enlargement of an intracranial mass, such as a hematoma or parenchymal...
subacute phase, intracranial mass, herniation, head injury
Provide Initial Care for Cranocerebral Injury
Critical Source: NATO Emergency War Surgery
Procedure for Providing Initial Care for Cranocerebral Injury:

1. Promptly recognize and treat secondary injuries, particularly those due to hypoxia and focal intracranial hematomas.
2. Ensure airway patency:
- Use intubation if...
initial care, cranocerebral injury, hypoxia, hematomas
Recognize and Treat Secondary Brain Injuries
Critical Source: NATO Emergency War Surgery
Procedure for Recognizing and Treating Secondary Brain Injuries:

1. Identify secondary brain injuries, which occur as a result of systemic or intracranial processes following the primary injury.
2. Monitor for signs of systemic events,...
secondary brain injury, intracranial pressure, cerebral edema, head injury
Identify and Manage Mild Traumatic Brain Injury (mTBI) Using MACE
High Priority Source: TCCC 17 13 Army Tactical Combat Casualty Care
Procedure:
1. Assess the casualty for signs of mild traumatic brain injury (mTBI), such as confusion, headache, or dizziness.
2. Use the Military Acute Concussion Evaluation (MACE) to evaluate the casualty:
- Complete the MACE...
mild traumatic brain injury, MACE, head injury management
Recognize and Treat Primary Closed Injuries
High Priority Source: NATO Emergency War Surgery
Procedure for Recognizing and Treating Primary Closed Injuries:

1. Identify primary closed injuries, which occur at the time of impact and produce parenchymal damage through shearing of axons and capillaries, particularly in white...
primary closed injuries, cerebral edema, delayed hematomas, head injury

Triage And Assessment (6)

Inspection of the Casualty in Emergency War Surgery
Critical Source: NATO Emergency War Surgery
Procedure:

1. Undress the casualty: Remove all clothing that may conceal wounds.
2. Ensure adequate illumination: Proper lighting is essential for a thorough examination.
3. Perform the exam with assistance: The surgeon must...
casualty inspection, abdominal wound, war surgery, intra-abdominal injury
Auscultation of the Abdomen in Emergency War Surgery
High Priority Source: NATO Emergency War Surgery
Procedure:

1. Listen for bowel sounds: This is an essential part of the evaluation.
2. Identify abnormal findings:
- Absent or significantly decreased bowel sounds are considered presumptive evidence of intra-abdominal injury in a...
abdominal auscultation, bowel sounds, intra-abdominal injury
Conducting a Patient History in Emergency War Surgery
High Priority Source: NATO Emergency War Surgery
Procedure:

1. Focus on observable and verifiable information: The surgeon should only rely on what can be seen or felt by the patient, such as:
- Presence, absence, or location of pain
- Allergies
- Time of last meal
2. **Evaluate...
patient history, emergency surgery, war trauma, triage, verification
Palpation of the Abdomen in Emergency War Surgery
High Priority Source: NATO Emergency War Surgery
Procedure:

1. Systematically search for tenderness: Examine each abdominal quadrant separately.
2. Ensure patient cooperation and attention: This is especially important with anxious or injured patients.
3. **Identify signs of...
abdominal palpation, intra-abdominal injury, pelvic fracture, femoral pulse assessment
Wilderness Patient Assessment in Cold Weather Environments
High Priority Source: US Marine Corps Wilderness Medicine
Procedure:

1. Perform a modified ATLS assessment: Use an organized and prioritized approach to assess the wilderness trauma victim.
2. Triage based on situation:
- If the number of patients and severity of injuries are within the...
wilderness assessment, triage, ATLS, cold weather, trauma victim
Reexamination of the Abdomen in Emergency War Surgery
High Priority Source: NATO Emergency War Surgery
Procedure:

1. Re-evaluate the abdomen after initial procedures: This includes:
- Insertion of urinary catheter and nasogastric tube
2. Watch for complications that may cause abdominal pain or tenderness:
- Acutely distended...
abdominal reexamination, post-procedure assessment

Herbal Medicine (6)

Administer Foxglove for Cardiac Conditions
High Priority Source: Survival and Austere Medicine
Procedure:

1. Understand the Use of Foxglove (Digitalis pupurea):
- Foxglove is a cardiac glycoside that improves heart pumping efficiency in cases of cardiac muscle failure and slows heart rate in atrial fibrillation.
- It has been...
foxglove,digitalis pupurea,cardiac glycoside,atrial fibrillation,infusion,overdose,trial and error
Identifying and Using Medicinal Plants (Coyote Willow and Yarrow)
Standard Source: US Marine Corps Wilderness Medicine
Identifying and Using Medicinal Plants (Coyote Willow and Yarrow)

Coyote Willow: Coyote Willow is a thick forming shrub with clustered stems and very narrow leaves. It habitates wet soils, especially riverbanks, sandbars, and silt...
medicinal plants, coyote willow, yarrow, survival medicine, herbal remedies
Administer Herbal Medications Safely
Standard Source: Survival and Austere Medicine
Procedure:

1. Identify the herb: Use the full scientific name, common names, and synonyms as listed in the source text.
2. Check for contraindications: Review the book's section on adverse reactions, interactions, and contraindications...
herb, dosage, contraindications, adverse reactions, herbal medicine
Preparing Medicinal Plant Remedies (Tea and Poultice)
Standard Source: US Marine Corps Wilderness Medicine
Preparing Medicinal Plant Remedies (Tea and Poultice)

Tea: To make a tea, place the plants in a container and pour in two cups of boiling water. Let the mixture steep for 20 minutes and drink.

Poultice: Place plant (Coyote Willow,...
medicinal plants, herbal remedies, poultice preparation, tea making, survival medicine
Utilizing Plant-Based Medications in Long-Term Disasters
Standard Source: Survival and Austere Medicine
Procedure:

1. Understand the Limitation of Evidence: Recognize that only a minority of plant-based medications have proven clinical efficacy, while many others rely on anecdotal evidence and case reports.

2. **Select Plants with Proven...
plant-based medications,long-term disaster,trial and error,botanical medicine,evidence-based efficacy
Identify Medicinal Plants and Their Uses
Reference Source: Survival and Austere Medicine
Procedure:

1. Refer to a reference table or guide that lists medicinal plants and their corresponding medications.
2. Identify the plant based on its name and associated medication:
- Erythroxylum coca → Cocaine (Local anaesthetic)
-...
medicinal plants,plant-derived medications,Erythroxylum coca,Atropa belladonna,Mucuna species,Ephedra sinica,Pilocarpus jaborandi,Cinchona ledeenana,Theobroma cacao,Chondodendron tomentosum,Daphne genkina

Temperature Measurement (6)

Best Site for Accurate Core Temperature Reading
Standard Source: Survival and Austere Medicine
The mouth is the best site for obtaining an accurate core temperature reading, as it reacts faster to rising temperatures than either the rectal or axillary sites.
core temperature, oral thermometer, temperature measurement
Measure Body Temperature Using a Thermometer
Standard Source: Where There is no Doctor a Village Health Care Handbook
How to Measure Body Temperature:

1. Choose the thermometer type: Either Centigrade (C.) or Fahrenheit (F.) can be used.
2. Position the thermometer correctly:
- For oral measurement, place the thermometer under the tongue and close...
temperature measurement, thermometer use, fever detection, normal temperature ranges, centigrade vs fahrenheit
Normal Body Temperature Ranges
Standard Source: Survival and Austere Medicine
Normal body temperature ranges:

Ideal: 98.6°F (37°C)
Generally accepted normal range for healthy persons: 98.0°F to 99.0°F
In the elderly, a normal body temperature may be up to 2 degrees below the general range, so 98.6°F...
normal body temperature, fever recognition, temperature ranges
Taking Axillary Temperature with an Oral Thermometer
Standard Source: Survival and Austere Medicine
Steps to take axillary temperature using an oral thermometer:

1. Shake down the thermometer to reset it.
2. Place the thermometer in the armpit, ensuring that the arm is held down against the body.
3. Wait for 11 minutes before...
axillary temperature, thermometer use, temperature measurement
How to Take a Temperature
Reference Source: Where There is no Doctor a Village Health Care Handbook
Steps to take a temperature:

1. Clean the thermometer well with soap and water or alcohol.
2. Shake it hard, with a snap of the wrist, until it reads less than 36 degrees.
3. Place the thermometer:
- Under the tongue (keep...
take temperature, thermometer use, body temperature measurement, fever detection
Understand the Centigrade Scale and Its Use in Measuring Temperature
Reference Source: Where There is no Doctor a Village Health Care Handbook
Centigrade (C.) is a measure or scale of heat and cold. A healthy person’s temperature (normal temperature) is 37° C. Water freezes at 0° C. and boils at 100° C.
centigrade,temperature scale,body temperature

Medicine Administration (6)

Administering Medicines to Small Children Safely
High Priority Source: Where There is no Doctor a Village Health Care Handbook
Objective: Administer medicines safely to small children without causing harm or choking.

### Steps:
1. Use syrups or suspensions when available – these are easier for young children to take than pills or capsules.
2. **If converting...
child medicine administration, syrup preparation, choking prevention, honey for children
Determining the Correct Dose of Medicine for Children Based on Adult Dosage
High Priority Source: Where There is no Doctor a Village Health Care Handbook
Objective: Calculate the correct dose of medicine for children when only adult dosages are available.

### Steps:
1. Use age or weight to determine dosage:
- For a child under 1 year: Give the same dose as for a 1-year-old, but...
child dosage calculation, adult to child medicine conversion, weight-based dosing
Adjusting Medicine Dosage When Tablet Sizes Differ
Standard Source: Where There is no Doctor a Village Health Care Handbook
Purpose: Adjust medicine dosage when different tablet sizes are available.

### Example with Tetracycline:
• If a prescription says: *Take tetracycline, 1 capsule of 250 mg. 4 times a day.*
• But you only have 50 mg capsules available:
-...
adjusting medicine dosage, tetracycline dosage, tablet strength conversion
Calibrating a Teaspoon to Measure 5 ml
Standard Source: Where There is no Doctor a Village Health Care Handbook
Objective: Ensure that the teaspoon used for medicine measures exactly 5 ml.

### Steps:
1. Buy a 5 ml measuring spoon – this is specifically designed to hold exactly 5 ml of liquid.
2. Use a plastic spoon from medicine packaging – many...
teaspoon calibration, measuring medicine, 5 ml measurement, medical tools
Understanding Penicillin Dosage Units
Standard Source: Where There is no Doctor a Village Health Care Handbook
Purpose: Understand how penicillin is measured in units and its relation to milligrams.

### Key Equivalences:
400,000 U (units) of penicillin = 250 mg.
• Penicillin may come in various forms: pills or injections, often labeled with...
penicillin units, penicillin dosage, units to milligrams conversion
Understanding Medicine Dosage Equivalents
Reference Source: Where There is no Doctor a Village Health Care Handbook
Purpose: Understand how different units of measurement (grams, milligrams, grains) are used to express medicine dosages.

### Key Equivalences:
1 gram (g) = 1000 milligrams (mg)
1 grain (gr.) = 65 mg
Examples:
- One adult...
dosage equivalents, grams to milligrams, medicine units, aspirin dosage, grains to milligrams

Medications And Treatments (6)

Use Intravenous (I.V.) Solutions Only for Severe Dehydration
High Priority Source: Where There is no Doctor a Village Health Care Handbook
Intravenous solutions should be used only for severe dehydration and given by someone who is well trained. When not administered correctly, they can cause dangerous infections or death (see p. 53).
IV solutions, severe dehydration, trained personnel, infections, death
Avoid Using Penicillin with Streptomycin Combination
High Priority Source: Where There is no Doctor a Village Health Care Handbook
Avoid using penicillin combined with streptomycin as a general rule. Never use it for colds or the flu because it is ineffective and can cause serious problems, including deafness or death. Overuse also makes it harder to cure tuberculosis or...
penicillin-streptomycin combination, colds, flu, deafness, death, tuberculosis
Never Inject Medicines Incorrectly Based on Labeling
High Priority Source: Where There is no Doctor a Village Health Care Handbook
Only well-trained health workers should inject medicines into veins. Never inject into a muscle (the buttock) medicine that says ‘for intravenous use only’. Also, never inject in the vein medicine that says ‘for intramuscular use only’.
IV use only, IM use only, incorrect injection, trained personnel, safety
Avoid Injecting Calcium into Veins or Buttocks
Standard Source: Where There is no Doctor a Village Health Care Handbook
Never inject calcium into a vein unless given very slowly, as it is extremely dangerous. An injection in the buttock may cause a large abscess. Untrained people should never inject calcium.
calcium injection, vein, buttock, abscess, untrained personnel
Avoid Injecting Chloramphenicol or Tetracycline
Standard Source: Where There is no Doctor a Village Health Care Handbook
Chloramphenicol and tetracycline do as much or more good when taken by mouth than injected. Use capsules or syrups rather than injections (see p. 355 and 356).
chloramphenicol, tetracycline, oral intake, injections, safety
Use Injectable Penicillin Only for Dangerous Infections
Standard Source: Where There is no Doctor a Village Health Care Handbook
Nearly all infections that require penicillin can be treated effectively with oral penicillin. Use injectable penicillin only for dangerous infections. Injected penicillin is more dangerous than oral forms.
penicillin, oral vs injectable, dangerous infections, safety

Anemia (6)

Seek Medical Help for Severe Anemia
Critical Source: Where There is no Doctor a Village Health Care Handbook
If the anemia is severe or does not improve:

Seek medical help, especially if the person is pregnant.
Severe anemia in pregnant women increases the risk of miscarriage and dangerous bleeding during childbirth.
seek medical help for anemia, severe anemia treatment
Treat Underlying Causes of Anemia
High Priority Source: Where There is no Doctor a Village Health Care Handbook
If the anemia is caused by:

Dysentery (diarrhea with blood)
Hookworm infection (see p. 142)
Malaria
Chronic diarrhea
Other diseases, these should also be treated.
treat underlying causes of anemia, hookworm, malaria, dysentery
Administer Iron Supplements for Anemia
High Priority Source: Where There is no Doctor a Village Health Care Handbook
For moderate or severe anemia:

Take ferrous sulfate pills (see p. 392). This is especially important for pregnant women.
Iron should be given by mouth, not injected, as injections can be dangerous and are no better than pills.
iron supplements, ferrous sulfate, anemia treatment
Prevent and Treat Anemia Through Diet
Standard Source: Where There is no Doctor a Village Health Care Handbook
To prevent or treat anemia:

Eat foods rich in iron: Meat, fish, chicken, liver, dark green leafy vegetables, beans, peas, lentils.
Cook in iron pots to increase iron intake (see p. 117).
• **Eat raw vegetables and fruit with...
iron-rich foods, anemia treatment, diet for anemia, cooking in iron pots
Identify Signs of Anemia
Standard Source: Where There is no Doctor a Village Health Care Handbook
Signs of anemia include:

Pale or transparent skin
Pale insides of eyelids
White fingernails
Pale gums
Weakness and fatigue
• In severe cases: Swollen face and feet, rapid heartbeat, and **shortness of...
anemia, signs of anemia, pale skin, fatigue, iron deficiency
Prevent Anemia in Women and Children
Standard Source: Where There is no Doctor a Village Health Care Handbook
To prevent anemia:

Women should eat foods rich in iron, especially during pregnancy.
Allow 2 to 3 years between pregnancies to regain strength and make new blood (see Chapter 20).
Children should be given iron-rich foods...
prevent anemia in women, prevent anemia in children, iron-rich diet for pregnancy

Tuberculosis (6)

Recognize and Respond to TB in Children
Critical Source: Where There is no Doctor a Village Health Care Handbook
Purpose: Identify signs of tuberculosis in children and ensure timely medical care.

Signs of TB in Young Children:
Steady weight loss, even without a noticeable cough.
Frequent fever that does not respond to common treatments.
-...
tb in children,treatment for children,health care,child health
Seek Medical Help for Suspected Tuberculosis
Critical Source: Where There is no Doctor a Village Health Care Handbook
Purpose: Ensure timely medical intervention for suspected tuberculosis.

Action Steps:
1. Immediately seek medical help at the nearest health center if you or someone else shows any signs of TB.
2. At the health center, a healthcare...
tb,treatment,medicines,health center,medical help
Understand TB Treatment Duration and Compliance
Critical Source: Where There is no Doctor a Village Health Care Handbook
Purpose: Ensure patients complete their full course of treatment to avoid drug resistance.

Action Steps:
1. TB treatment is a long process, typically lasting from 6 months to over a year, depending on the severity of the...
tb treatment duration,drug resistance,treatment compliance
Prevent TB Spread and Transmission
High Priority Source: Where There is no Doctor a Village Health Care Handbook
Purpose: Prevent the spread of tuberculosis to others in the community.

Action Steps:
1. Isolate individuals with active TB, especially those who are coughing or showing symptoms of lung TB, until they begin treatment and show...
tb,prevention,transmission,hiv,hygiene
Recognize Early Signs of Tuberculosis (TB)
High Priority Source: Where There is no Doctor a Village Health Care Handbook
Purpose: Identify early signs of tuberculosis to seek medical help promptly.

Signs of TB in Adults:
• A cough lasting longer than 3 weeks, often worse just after waking up.
Slight fever in the evening and night sweats.
-...
tuberculosis,tb,symptoms,early signs,health care,medical help
Support TB Patients with Nutrition and Rest
High Priority Source: Where There is no Doctor a Village Health Care Handbook
Purpose: Improve recovery outcomes for individuals diagnosed with tuberculosis.

Action Steps:
1. Provide a nutritious diet to the patient:
- Include energy-rich foods such as grains, legumes, and root vegetables.
- Ensure...
nutrition,tb,rest,recovery,health care

Contraception Methods (6)

Traditional Methods for Preventing Pregnancy (Not Recommended)
Standard Source: Where There is no Doctor a Village Health Care Handbook
Why Traditional Methods Are Not Reliable:

1. Examples of ineffective or harmful traditional methods:
- Washing out the vagina after sex.
- Urinating after sex.
2. Effectiveness: These methods are generally not effective in...
traditional contraception,washing vagina,urinating after sex,ineffective methods
Combined Contraceptive Methods for Increased Effectiveness
Reference Source: Where There is no Doctor a Village Health Care Handbook
To increase the effectiveness of contraception:

1. Use two methods together:
- Combine the counting days or mucus method with a physical barrier method such as condoms, diaphragms, spermicides, or sponges.
- If a man uses condoms and the...
contraception,combined methods,pregnancy prevention,condom use,diaphragm use
Implant Contraception Method (e.g., Implanon or Nexplanon)
Reference Source: Where There is no Doctor a Village Health Care Handbook
Procedure for Using Implant Contraceptives:

1. What it is: Small, soft tubes containing the hormone progestin that are inserted under the skin on the inside of a woman’s arm.
2. How long it works: Prevents pregnancy from 6 months to 5...
implant contraception,implanon,nexplanon,progestin,arm insertion
Injectable Contraceptive Method (Depo-Provera)
Reference Source: Where There is no Doctor a Village Health Care Handbook
Procedure for Using Injectable Contraceptives:

1. Who administers the injection: A trained health worker at a clinic or family planning center.
2. When to administer:
- The first injection can be given anytime when it is reasonably...
injectable contraception,depoprovera,contraceptive injections,monthly bleeding,health worker administration
Sterilization for Men (Vasectomy)
Reference Source: Where There is no Doctor a Village Health Care Handbook
Procedure for Male Sterilization (Vasectomy):

1. What it is: A surgical procedure that cuts and ties the tubes carrying sperm from the testicles to prevent pregnancy.
2. Who performs it: Done by a trained health worker at a clinic or...
vasectomy,male sterilization,permanent contraception,testicle function
Sterilization for Women (Tubal Ligation)
Reference Source: Where There is no Doctor a Village Health Care Handbook
Procedure for Female Sterilization (Tubal Ligation):

1. What it is: A surgical procedure that cuts and ties the fallopian tubes to prevent pregnancy.
2. Who performs it: Done by a trained health worker at a clinic or doctor’s office.
3....
tubal ligation,female sterilization,permanent contraception,fallopian tubes

Nerve Agent Poisoning Treatment (6)

Identify Severe Signs and Symptoms of Nerve Agent Poisoning
Critical Source: STP 21 1 Warrior Skills Level 1
Procedure:

1. Watch for the following severe signs and symptoms:
- Strange or confused behavior.
- Wheezing, difficulty in breathing (dyspnea), and coughing.
- Severely pinpointed pupils.
- Red eyes with tearing.
- Vomiting.
...
nerve agent poisoning symptoms, identification, first aid treatment, buddy aid
Mask a Nerve Agent Casualty
Critical Source: STP 21 1 Army Warrior Skills Level 1 Soldiers Manual of Common Tasks
Steps to Mask a Casualty:

Do NOT kneel at any time while providing aid to the casualty. Contact with the ground could force the chemical into or through the protective clothing.
- Reposition the casualty on his/her back, if necessary,...
masking procedure, chemical exposure, military first aid
Administer ATNAA Injection in the Buttock
Critical Source: STP 21 1 Warrior Skills Level 1
Procedure:

1. Inject into correct location: When injecting antidote in the buttock, be very careful to inject only into the upper, outer quarter of the buttock to avoid hitting the major nerve that crosses the buttocks. Hitting the nerve...
ATNAA injection, nerve agent antidote, buttock injection, injector use, decontamination
Do Not Administer Additional Injections Unless Necessary
Critical Source: STP 21 1 Warrior Skills Level 1
Procedure:

1. Assess self: If you are able to walk without assistance and know who you are and where you are, you will NOT need the second set of injections.

2. Seek buddy aid if needed: If you continue to have symptoms of nerve agent...
additional injections, nerve agent antidote, self-assessment, buddy aid
Decontaminate Skin if Necessary
High Priority Source: STP 21 1 Warrior Skills Level 1
Procedure:

1. Decontaminate skin: If necessary, decontaminate the skin.

_Note_: Information on this step is provided in task 031-503-1013.
skin decontamination, nerve agent poisoning, first aid treatment
Secure Used ATNAA Injector
High Priority Source: STP 21 1 Army Warrior Skills Level 1 Soldiers Manual of Common Tasks
Steps to Secure a Used ATNAA Injector:

1. Bend the needle: Use a hard surface (such as a rock or piece of metal) to bend the needle into a hook shape.
- Be careful not to tear protective gloves or clothing during this process.

2....
secure injector, dispose of needle, military medical procedure

Injections Administration (6)

Administer 2 PAM Cl Injection
High Priority Source: STP 21 1 Warrior Skills Level 1
Procedure for Administering 2 PAM Cl Injection:

1. Prepare the injector:
- Pull the large injector out of the clip.
- Form a fist around the autoinjector with the needle (black) end extending beyond the little finger.
- Drop the...
2 PAM Cl injection, administration procedure, military medical protocol, nerve damage prevention
Administer ATNAA Injection
High Priority Source: STP 21 1 Warrior Skills Level 1
Procedure for Administering ATNAA Injection:

1. Obtain the ATNAA:
- Obtain three or all remaining ATNAAs and one CANA from the casualty's protective mask carrier, from the pocket of the MOPP suit, or from another location as specified by...
ATNAA injection, medical emergency, antidote administration, injection site, safety precautions
Administer Atropine Injection
High Priority Source: STP 21 1 Warrior Skills Level 1
Procedure for Administering Atropine Injection:

1. Inject into the correct location: When injecting antidote in the buttock, be very careful to inject only into the upper, outer quarter of the buttock to avoid hitting the major nerve that...
atropine injection, medical emergency, antidote administration, injection site, safety precautions
Administering Injections: Overview and Types
High Priority Source: Survival and Austere Medicine
There are three common types of injections:

1. Subcutaneous Injection: Injected into the subcutaneous layer under the skin using a small short needle (24g). This is easy to perform, and medication is absorbed relatively quickly. Avoid this...
injections, subcutaneous, intramuscular, intravenous, adrenaline, allergic reaction, anaphylaxis
Secure Used Injectors After Administration
High Priority Source: STP 21 1 Warrior Skills Level 1
Procedure for Securing Used Injectors:

1. Bend the needle: Use a hard surface to bend each needle to form a hook.

2. Insert the needle into protective overgarment:
- Push the needle of each injector (one at a time) through one of...
secure used injectors, needle disposal, military medical protocol
Selecting Injection Site for ATNAA
High Priority Source: STP 21 1 Warrior Skills Level 1
Procedure for Selecting the Correct Injection Site for ATNAA:

1. Choose injection site:
- The injection can be given in any part of the lateral thigh muscle from about a hand's width above the knee to a hand's width below the hip joint.
...
ATNAA injection site selection, military medical protocol, safe administration

Infectious Disease Outbreaks (6)

Conduct Rapid Isolation and Contact Tracing for Outbreak Control
Critical Source: UK National Risk Register 2025
Procedure:

1. Identify confirmed cases through diagnostic testing and clinical assessment.
2. Isolate infected individuals immediately in designated facilities to prevent further transmission.
3. Trace all close contacts of...
isolation, contact tracing, outbreak control, quarantine, hygiene practices, monitoring
Develop and Distribute Diagnostic Tools for Rapid Testing
Critical Source: UK National Risk Register 2025
Procedure:

1. Establish a centralized diagnostic testing program to identify cases quickly.
2. Deploy both laboratory-based and rapid diagnostic tests, such as PCR and antigen tests, at multiple locations across the country.
3. **Ensure...
diagnostic testing, PCR tests, antigen tests, rapid testing, quality control
Implement Border Measures for Novel Pathogen Containment
Critical Source: UK National Risk Register 2025
Procedure:

1. Activate border screening protocols immediately upon detection of a novel respiratory-transmitted virus.
2. Isolate suspected cases at ports of entry and conduct rapid diagnostic testing.
3. Restrict travel from...
border measures, novel pathogen, containment, isolation, quarantine, PPE, infectious disease outbreak
Implement Non-Pharmaceutical Interventions During an Outbreak
Critical Source: UK National Risk Register 2025
Procedure:

1. Enforce social distancing measures, such as limiting large gatherings and encouraging remote work.
2. Promote the use of face masks in public spaces to reduce respiratory droplet transmission.
3. **Enhance hygiene...
non-pharmaceutical interventions, social distancing, face masks, hygiene practices, public health messaging
Implement a National Communications Plan for Public Awareness
High Priority Source: UK National Risk Register 2025
Procedure:

1. Develop a comprehensive communications strategy to inform the public about the outbreak and prevention measures.
2. Use multiple communication channels, including television, radio, social media, and community outreach...
public awareness, communication plan, misinformation, health messaging, community outreach
Prepare for Long-Term Recovery and Health System Impact Assessment
High Priority Source: UK National Risk Register 2025
Procedure:

1. Conduct a comprehensive assessment of the long-term impacts on the health and social care system after an outbreak.
2. Monitor and document all cases, including those with severe or prolonged symptoms, to understand the...
long-term recovery, health system impact, mental health support, healthcare infrastructure, community engagement

Burn Care (6)

Resuscitation Fluid Management in Burn Patients - Second 24 Hours
Standard Source: Emergency War Surgery
Objective: Administer appropriate resuscitation fluids during the second 24 hours postburn.

Procedure:
1. At the end of the first 24 hours postburn, discontinue Lactated Ringer's (LR) solution.
2. For the second 24 hours, use **5% albumin...
resuscitation, fluid management, burn patients, albumin, TBSA, Lactated Ringer's
Burn Excision and Grafting Patient Selection Guidelines
Reference Source: Emergency War Surgery
Burn Excision and Grafting: Patient Selection Guidelines

Do not attempt to autograft patients with grossly colonized or infected wounds.

• These patients are best treated with:
- Deep tangential excision.
- **Primary excision to...
burn excision, grafting, patient selection, infected wounds, gammairradiated allograft, partial thickness burns, full-thickness burns
Burn Patients and Hypermetabolic State Management
Reference Source: Emergency War Surgery
Procedure:

1. Recognize that burn patients manifest a hypermetabolic state, characterized by hyperthermia, tachycardia, and hypercatabolism.
2. This state may be difficult to distinguish from early sepsis; therefore, **stress ulcer...
burn patients, hypermetabolic state, stress ulcer prophylaxis, enteral nutrition, respiratory care, abdominal compartment syndrome
Burn Surgery Preparation in Theater of Operations
Reference Source: Emergency War Surgery
Burn Surgery Preparation in Theater of Operations

Perform several limited procedures (e.g., 10% TBSA or less at each operation) to limit physiologic stress.

• **Discuss and rehearse the plan for the operation with all personnel...
burn surgery, theater of operations, TBSA, PRBCs, antibiotics, anesthesia, donor sites
Estimate Fluid Resuscitation Needs Using Burn Size and Weight
Reference Source: Emergency War Surgery
Procedure:

1. Determine burn size using the Rule of Nines:
- The palm and fingers of one hand represent approximately 1% of TBSA.
- Only second- and third-degree burns are included in calculations.
- Overestimation is common, which...
fluid resuscitation, burn size, weight calculation, Rule of Nines, crystalloid volume
White Phosphorus Burn First Aid Treatment
Reference Source: Emergency War Surgery
White Phosphorus Burn First Aid Treatment

• Most cutaneous injury from white phosphorus burns is due to the ignition of clothing, and should be treated as a conventional burn.

Fragments of white phosphorus may be driven into soft...
white phosphorus burn, first aid, burn treatment, hypocalcemia, hyperphosphatemia, IV calcium, copper sulfate

Animal Treatment (5)

Preventive Measures for Hog Cholera and Swine Plague
Critical Source: Practical Pointers On The Care of Lifestock
Prevention of Hog Cholera and Swine Plague:

Use Pratts Disinfectant frequently to prevent the spread of disease.
• Use Pratts Hog Tonic regularly to build up the general health of the hog, giving it full disease-resisting power.
-...
hog cholera prevention,swine plague,pratts disinfecant,pratts hog tonic
Administer Pratts Hog Tonic to Sick Hogs
High Priority Source: Practical Pointers On The Care of Lifestock
Administering Pratts Hog Tonic:

• If the hogs are too sick to come to the feed, the tonic should be given as a drench.
Pull the cheek away from the teeth and pour the mixture in slowly.
• Care should be exercised, as hogs are easily...
pratts hog tonic,drenching,sick hogs,cholera treatment
Maintain Sanitation to Prevent Tuberculosis in Swine
High Priority Source: Practical Pointers On The Care of Lifestock
Preventing Tuberculosis in Swine:

Cause: Resulting largely from swine drinking the milk of tuberculous cattle.

Symptoms:
• Digestive disorders, such as diarrhoea and vomiting.
• A stunted condition and a staring coat.
• Breathing...
tuberculosis in hogs,pratts disinfecant,pratts hog tonic,sanitation measures
Treat Diarrhoea or Scours in Young Swine
High Priority Source: Practical Pointers On The Care of Lifestock
Treatment for Diarrhoea (Scours):

Symptoms: Very soft condition of the voidings which are sometimes almost watery.
• Usually occurs before the weaning stage, as a rule in swine not yet ten days old.

Actions to Take:
1. Spray the...
diarrhoea treatment,scours in pigs,pratts disinfecant,pratts hog tonic
Prevent and Treat Worms in Hogs
Standard Source: Practical Pointers On The Care of Lifestock
Worm Prevention and Treatment:

• There are four species of worms that live in the intestines of swine, resulting in more or less harm:
- Common Round Worm
- Pin Worm
- Whip Worm
- Thornheaded Worm

Preventive Measures:
1. Drain...
worm prevention,worm treatment,pratts hog tonic,hog parasites

Labor And Birth (5)

Managing Pushing During Stage 2 of Labor
Critical Source: A Book for Midwives
Procedure:

1. Support the mother during pushing:
- Ensure the mother is in a comfortable position (e.g., squatting or lying on her back).
- Provide emotional and physical support to help her relax and push effectively.

2. **Monitor...
pushing during labor, stage 2 of labor, delivery complications, episiotomy, cord around neck
Recognizing the Need for Emergency Care During Labor
Critical Source: A Book for Midwives
Purpose: To identify warning signs that may indicate a need for emergency care during labor.

Warning Signs to Watch For:
Abnormal Contractions: If contractions are too frequent, irregular, or not progressing as expected.
-...
emergency labor signs, fetal distress, maternal complications, transport to medical center
Keeping a Record of Events During Labor
Standard Source: A Book for Midwives
Purpose: To document all events that occur during labor for accurate record-keeping and continuity of care.

What to Record:
Time of Onset of Labor: When the woman first experiences regular contractions or other signs of labor...
labor chart, record keeping, documentation during labor
Cervix Changes During Pregnancy and Labor
Standard Source: A Book for Midwives
Purpose: To explain how the cervix changes during pregnancy and labor.

During Pregnancy:
• The cervix is long, firm, and closed. It is plugged with mucus to prevent infection and keep the baby safe inside the womb.
• Nothing can pass...
cervix changes, mucus plug, cervical dilation, labor signs
How Contractions Affect the Cervix and Baby During Labor
Standard Source: A Book for Midwives
Purpose: To explain how contractions work during labor to open the cervix and move the baby toward birth.

Mechanism of Contractions:
1. Pushing the Baby Down: Contractions push the baby’s head down hard against the cervix, helping it...
contraction mechanism, cervical dilation process, baby movement during labor

Newborn Health Assessment (5)

Responding to a Pale or Limp Newborn
High Priority Source: A Book for Midwives
Procedure:

1. If the baby appears pale and limp, this may be a sign of anemia or other serious conditions.
2. Seek medical help immediately as this is not normal for a newborn.
3. Do not delay treatment — prompt intervention can be...
pale newborn, limp baby, anemia, emergency care
Assessing Baby's Color After Birth
High Priority Source: A Book for Midwives
Procedure:

1. Observe the baby’s skin color within a few hours of birth.
2. A normal color should be achieved by this time.
3. If the baby remains blue in the hands and feet but is warm, it may be normal for 1–2 days after birth.
4. If the...
baby color assessment, blue baby, heart or lung issues, emergency care
Identifying and Responding to Birth Defects in Newborns
High Priority Source: A Book for Midwives
Procedure:

1. Examine the baby from head to toe for any signs of birth defects or disabilities.
2. Note if the baby has small, non-dangerous conditions like a cleft lip, or more serious issues such as spina bifida.
3. If you observe anything...
birth defects, newborn disabilities, medical help, parental support
Assessing a Very Red Newborn for Jaundice and Other Concerns
Standard Source: A Book for Midwives
Procedure:

1. If the baby appears very red, observe carefully for signs of jaundice over the next week.
2. Watch for changes such as yellowing skin, fast breathing, or difficulty breastfeeding.
3. Seek medical help immediately if any of...
very red baby, jaundice monitoring, newborn health, medical help
Assessing Baby's Skin for Normal Spots
Reference Source: A Book for Midwives
Procedure:

1. Carefully examine the baby’s skin for any spots or patches.
2. Note if the baby has large, dark patches on the lower back or bottom — these are normal and not harmful.
3. Check for red patches on the face — these are also normal...
baby skin assessment, normal spots, infection signs, newborn health

Lactation And Breastfeeding (5)

Common Difficulties While Breastfeeding
High Priority Source: A Book for Midwives
There are several common difficulties that may occur while breastfeeding. These include:

Sore or cracked nipples: This can be caused by improper latching or positioning of the baby. Ensure the baby is latched on correctly and try different...
breastfeeding difficulties, sore nipples, low milk supply, engorgement, mastitis
Sharing Breast Milk Safely
Standard Source: A Book for Midwives
Breastfeeding another woman's baby is a common practice. Many mothers do this for friends or family members when a mother needs to be away from her baby at feeding time. Sharing breast milk is free, easy, and can make ties between families...
sharing breast milk, HIV transmission, safe breastfeeding practices
Feeding Removed Milk to a Baby
Standard Source: A Book for Midwives
When feeding milk or formula to a young baby, use a very clean cup or spoon. Even newborn babies can drink from cups. Do not pour the milk into the baby’s mouth or she will choke. An older baby can drink from a cup or a feeding bottle.

• A baby...
feeding removed milk, baby feeding practices, safe bottle use
How to Save Breast Milk
Standard Source: A Book for Midwives
Breast milk should be saved in clean, boiled containers. Keep it covered in a cool place, away from sunlight.

• Breast milk can sit in a room for about 8 hours before it spoils — as long as the room is not very hot. It can be stored even longer if...
breast milk storage, preserving breast milk, safe milk handling
How to Remove Milk by Hand
Reference Source: A Book for Midwives
1. Wash a jar and lid with soap and clean water and leave them in the sun to dry.

- If possible, pour some boiling water into the jar and then pour it out just before using it. This will kill germs in the jar, and keep the milk safe.

2....
remove milk by hand, breastfeeding, lactation, breast pump, milk storage

Injections And Medication Administration (5)

When Injections Are Necessary for Emergencies
Critical Source: Where There is no Doctor a Village Health Care Handbook
In case of the following serious sicknesses, get medical help as fast as you can. If there will be any delay in getting help or in taking the sick person to a health center, inject the appropriate medicine as soon as possible:

Severe pneumonia:...
injections, emergencies, severe pneumonia, appendicitis, tetanus, meningitis, allergic shock
When Injections Are Not Appropriate or Required
High Priority Source: Where There is no Doctor a Village Health Care Handbook
Never give injections if you can get medical help quickly.

Never give an injection for a sickness that is not serious.

Never give an injection for a cold or the flu.

Never inject a medicine that is not recommended for the illness...
injection safety, when not to inject, sterilization, cold, flu
Administering Medicine from a Powdered Bottle
Standard Source: A Book for Midwives
Steps for Administering Medicine from a Powdered Bottle:

1. Clean the rubber top of the bottle: Use a sterile gauze or cloth soaked in alcohol to clean the rubber top.
2. Draw up the correct amount of sterile water: This is used to...
powdered bottle,medicine administration,clean rubber top,sterilize water,dilute powder,syringe preparation
Administering Medicine from an Ampule
Standard Source: A Book for Midwives
Steps for Administering Medicine from an Ampule:

1. Clean the ampule: Wipe the ampule clean with a cloth or some alcohol.
2. Break off the top of the ampule: Wrap a clean cloth around the top and break it off carefully.
3. **Insert the...
ampule,medicine administration,clean ampule,breaking ampule,needle insertion,syringe preparation
Assessing the Appropriateness of Injections Prescribed by Health Workers
Standard Source: Where There is no Doctor a Village Health Care Handbook
1. If a health worker or healer wants to give you an injection, ensure that:
- The medicine is appropriate for your condition.
- She takes all the necessary precautions (e.g., sterilization of equipment, proper technique).
2. If a doctor...
injections, health workers, medical prescriptions, sterilization, appropriate medicine

Antibiotics Administration (5)

Administer Ampicillin for Infection in Newborn Babies
Critical Source: A Book for Midwives
Procedure:

1. Dose Based on Age and Weight:
- For babies less than 1 week old: Inject 2 times a day.
- For babies 1 week old or more: Inject 3 times a day.
2. Dosage Based on Weight:
- Baby weighing 2 kg or less: Use 80 mg per...
ampicillin, newborn infection, antibiotic administration, neonatal care
Administer Benzylpenicillin for Tetanus in Newborns
Critical Source: A Book for Midwives
Procedure:

1. Dose: Inject 100,000 Units of benzylpenicillin into the muscle in the front of the thigh.
2. Frequency: Administer once only.

Important Notes:
• May cause yeast infection in women or diaper rash in children.
• Be...
benzylpenicillin, tetanus in newborns, antibiotic administration
Administer Ampicillin for Infection After Abortion
High Priority Source: A Book for Midwives
Procedure:

1. First Dose: Inject 2 g of ampicillin into the muscle.
2. Subsequent Doses: Administer 1 g by mouth or injected into the muscle, 4 times a day.
3. Duration: Continue until fever has been gone for 48 hours.
4....
ampicillin, infection after abortion, antibiotic administration
Administering Injectable Penicillin Safely
High Priority Source: Where There is no Doctor a Village Health Care Handbook
Procedure for Administering Injectable Penicillin Safely:

1. Confirm the need for injectable penicillin: Only use injectable penicillin for severe or dangerous infections (see page 70 for criteria).
2. Check for allergies: Ensure the...
penicillin, injectable, epinephrine, allergic shock, antibiotic administration
Using Penicillin by Mouth
High Priority Source: Where There is no Doctor a Village Health Care Handbook
Procedure for Using Penicillin by Mouth:

1. Confirm the infection is treatable with oral penicillin: Oral forms are suitable for many infections, but not for severe or life-threatening conditions (see page 70).
2. Check for allergies:...
penicillin, oral administration, dosage, antibiotic use, side effects

Hiv Aids Prevention (5)

Administering Medication to a Pregnant Woman and Newborn for HIV Prevention
Critical Source: Where There is no Doctor a Village Health Care Handbook
Overview: This procedure outlines the administration of antiretroviral medications to pregnant women and newborns to prevent mother-to-child transmission of HIV.

For the Mother During Pregnancy:
1. **Start as soon as possible from 14 weeks...
HIV prevention, AZT, NVP, zidovudine, nevirapine, pregnancy, breastfeeding, newborn, antiretroviral drugs
Administering Post-Exposure Prophylaxis (PEP) with ART for HIV Prevention
Critical Source: A Book for Midwives
Overview:
Post-exposure prophylaxis (PEP) using ART can be given to prevent HIV infection after exposure through rape or accidents, such as needle sticks or blood splashes.

Steps for Administering PEP:
1. Start Within 72 Hours: Begin...
PEP, HIV prevention, ART, post-exposure prophylaxis, medication regimen
Administering ART Medicines to Prevent HIV Transmission in Babies (Mother-to-Child)
High Priority Source: Where There is no Doctor a Village Health Care Handbook
Overview:
If the mother is on ART or not, she and her baby should take specific medicines to prevent transmission of HIV from mother to child.

For the Baby:
1. Start treatment at birth: Even if the mother is already on ART, the baby...
ART for babies, PMTCT/PPTCT treatment
Practice Safer Sex as a Health Worker to Prevent HIV Infection
High Priority Source: Where There is No Dentist
As a dental worker and health leader, practice safer sex with your own sexual partner:

• It is not enough just to give health education talks about the importance of practicing safer sex.
• You must also practice safer sex yourself to set a...
safer sex, HIV prevention, health worker responsibility, example setting
Preventing HIV Transmission from Mother to Baby (PMTCT/PPTCT)
High Priority Source: Where There is no Doctor a Village Health Care Handbook
Overview:
ART medicines can be used to prevent the transmission of HIV from an infected mother to her baby during pregnancy and breastfeeding.

Steps for PMTCT/PPTCT:
1. Administer ART to the mother: Even if she does not need it for her...
PMTCT/PPTCT, HIV transmission prevention in babies

Diabetes Management (5)

Seek Immediate Medical Assistance During a Diabetes Emergency
Critical Source: Diabetes Disaster Preparedness
Procedure:

1. If you are out of all medications, have no access to food, and cannot reach your doctor, take the following steps immediately:

Options for immediate help:
Go to the nearest hospital.
Contact the police...
emergency medical assistance, diabetes disaster, hospital visit, American Red Cross, police assistance
Call Your Doctor for Ketone Test Results and High Blood Sugar Symptoms
High Priority Source: Diabetes Disaster Preparedness
Procedure:

1. Check your ketone levels using a ketone test strip or device.
2. Monitor your blood sugar levels regularly throughout the day.
3. If your ketone test is moderate or high, or if you experience symptoms of high blood...
ketone test, high blood sugar, diabetes, insulin dosage, disaster preparedness
Extracting Insulin from Animal Pancreas for Survival Use
High Priority Source: Survival and Austere Medicine
Procedure:

1. Source Material Preparation: Obtain pancreases from suitable animals (preferably pigs, as porcine insulin is chemically closest to human insulin). Sheep or cow pancreases may also be used but are more likely to cause allergic...
insulin extraction, diabetes survival, porcine insulin, bovine pancreas yield, insulin production
Sick Day Rules for Diabetic Individuals During a Disaster
High Priority Source: Diabetes Disaster Preparedness
Steps to manage diabetes during illness or disaster:

1. Always take your insulin or pills on time or as close as possible. Never omit insulin unless instructed by your doctor. Insulin remains effective at room temperature (59° - 86°F)...
sick day rules, diabetes, ketone testing, hydration
Hot Weather Management for Diabetic Individuals
Standard Source: Diabetes Disaster Preparedness
Steps to manage diabetes during hot weather:

1. Stay indoors in air-conditioned or fan-cooled environments.
2. Avoid exercising outside during hot weather.
3. Wear light-colored cotton clothing to stay cool.
4. **Remain well...
hot weather, diabetes, hydration, emergency treatment, identification

Injury Mechanics (5)

Fragment Characteristics and Wound Patterns from Explosive Munitions
High Priority Source: Emergency War Surgery
Fragment Characteristics and Wound Patterns from Explosive Munitions

• Fragments from exploding munitions are generally smaller and irregularly shaped compared to bullets from small arms.
• Initial fragment velocities of up to 5,900 ft/s...
fragment wound, explosive munition, multiple injuries
Injury Probability Based on Distance from Explosive Detonation (Fig. 1-2)
High Priority Source: Emergency War Surgery
Injury Probability Based on Distance from Explosive Detonation (Fig. 1-2)

• The probability of sustaining a given trauma is related to the distance from the epicenter of the detonation.
• This relationship can be used to estimate injury...
distance from explosion, injury probability, blast mechanics
Explosive Munitions: Blast Injury Mechanism
Standard Source: Emergency War Surgery
Explosive Munitions: Blast Injury Mechanism

Blast injuries occur when a patient is close to the exploding munition, such as with a land mine.

• The blast effects are caused by overpressure waves or sonic shock waves that can damage...
blast injury, overpressure wave, thermobaric device, enclosed space blast
Understanding Projectile-Tissue Interaction: Temporary Cavity
Standard Source: Emergency War Surgery
Understanding Projectile-Tissue Interaction: Temporary Cavity

• The temporary cavity is a transient lateral displacement of tissue that occurs after the passage of the projectile.

• This cavity results from the elastic recoil of tissues...
temporary cavity, tissue displacement, projectile injury, elastic and inelastic tissues
Understanding the Role of Shock (Sonic) Waves in Projectile Injury
Standard Source: Emergency War Surgery
Understanding the Role of Shock (Sonic) Waves in Projectile Injury

• The shock or sonic wave, often mistaken for the temporary cavity, is measurable but has not been shown to cause direct tissue damage.

• This distinction is important for...
shock wave, sonic wave, projectile injury, tissue damage

Hand Injuries (5)

Surgical Technique for Hand Injuries
Critical Source: Emergency War Surgery
Key Surgical Techniques for Managing Hand Injuries:

Do not blindly clamp bleeding tissues, as nearby nerves may be injured.
• If unable to control bleeding with pressure, **isolate the vessel under tourniquet control and tie off or clamp...
surgical technique, hand injury, debridement, tourniquet use
Identify Hand Fascial Compartments for Compartment Syndrome Management
High Priority Source: Emergency War Surgery
Procedure:

• Understand the 10 separate fascial compartments of the hand:
- 4 Dorsal interossei
- 3 Volar interossei
- Thenar compartment
- Hypothenar compartment
- Adductor pollicis
• Use anatomical references...
fascial compartments, hand injuries, compartment syndrome
Expose Upper Extremities and Remove Constrictive Items
Standard Source: Emergency War Surgery
Procedure:

• Expose the casualty’s upper extremities.
• Immediately remove rings, watches, and other constrictive materials.
upper extremities, constrictive items, exposure, hand injuries
Perform Preliminary Neurologic Exam and Vascular Assessment of the Hand
Standard Source: Emergency War Surgery
Procedure:

• Perform a preliminary neurologic exam and document findings.
• Assess vascular status of the hand, including:
- Radial artery (Allen test)
- Ulnar artery (Doppler or other methods)
neurologic exam, vascular assessment, hand injuries, Allen test
Dressing and Splinting of Hand Injuries
Reference Source: Emergency War Surgery
Proper Dressing and Splinting Technique for Hand Injuries:

Splint the hand in the safe position (Fig. 26-4):
- Wrist extended 20°
- Metacarpophalangeal joints flexed 70°–90°
- Proximal and distal interphalangeal joints in full...
splinting, hand injury, emergency surgery, wound dressing, safe position

Gastrointestinal (5)

Recognize Severe Ulcer Complications and Seek Immediate Help
Critical Source: Where There is no Doctor a Village Health Care Handbook
Severe ulcer complications:
• If the ulcer is severe, it can cause vomiting, sometimes with fresh blood, or with digested blood that looks like coffee grounds.
• Stools with blood from an ulcer are usually black, like tar.

WARNING: Some...
ulcer complication,blood in vomit,black stools,emergency
Recognize Signs of Stomach Ulcers
High Priority Source: Where There is no Doctor a Village Health Care Handbook
Signs of stomach ulcers:
• Frequent or lasting acid indigestion is a warning sign of an ulcer.
An ulcer is a chronic sore in the digestive system, usually caused by bacteria. Too much acid in the stomach prevents it from healing.
• It may...
stomach ulcer,symptoms,bacteria
Recognize and Manage Gastrointestinal Reflux in Infants
High Priority Source: Emergency War Surgery
Procedure:

1. Identify reflux symptoms:
- Look for frequent emesis, especially in newborns.
- Note difficulty with digestion or feeding intolerance.

2. Monitor for complications:
- Reflux can lead to poor weight gain and may...
reflux, infant, gastrointestinal, emesis, NEC, feeding intolerance
Update Special Drinks for Diarrhea (Oral Rehydration Therapy)
High Priority Source: Where There is no Doctor a Village Health Care Handbook
Procedure:

1. Avoid using sugar-based drinks or ORS packets as the primary rehydration solution for diarrhea.
2. Use cereal-based drinks instead, which are more effective in preventing water loss and combating malnutrition.
3. **Prepare...
diarrhea,oral rehydration therapy,cereal-based drinks,sugar-based drinks
Update Stomach Ulcer Treatment Advice
Standard Source: Where There is no Doctor a Village Health Care Handbook
Procedure:

1. Avoid recommending milk as a treatment for stomach ulcers. Although it was previously thought to soothe the stomach, recent studies show that it may worsen symptoms.
2. Encourage drinking plenty of water instead of milk to...
stomach ulcer,treatment,milk,water,dietary advice

Pediatric Pharmacology (5)

Administer Mannitol for Pediatric Patients
Critical Source: Emergency War Surgery
Procedure:

1. Calculate the dose based on the patient's weight: 0.5–1.0 g/kg IV.
2. Administer intravenously (IV) as needed, typically in cases of increased intracranial pressure or acute kidney injury.

Notes:
• Monitor for adverse...
mannitol dosage, pediatric diuretic use, IV medication, intracranial pressure management in children
Administer Metronidazole for Pediatric Patients
Critical Source: Emergency War Surgery
Procedure:

1. Calculate the dose based on the patient's weight: 10 mg/kg IV.
2. Administer intravenously (IV) as needed for anaerobic infections or in combination with other antibiotics.

Notes:
• This is an antimicrobial agent used in...
metronidazole dosage, pediatric antibiotic use, IV medication, anaerobic infection treatment in children
Administer Succinylcholine Chloride for Pediatric Patients
Critical Source: Emergency War Surgery
Procedure:

1. Calculate the dose based on the patient's weight:
- For patients < 10 kg: Use 2 mg/kg IV.
- For patients > 10 kg: Use 1 mg/kg IV.

2. Administer intravenously (IV) as needed for rapid sequence intubation or...
succinylcholine dosage, pediatric neuromuscular blocker, IV medication, rapid sequence intubation in children
Administer Commonly Used Drugs and Dosages for Pediatric Patients
High Priority Source: Emergency War Surgery
Procedure:

1. Phenobarbital: Administer at a dose of 2–3 mg/kg IV.

2. Diazepam: Administer at a dose of 0.25 mg/kg IV.

3. Midazolam HCl: Administer at a dose of 0.1 mg/kg IV, with a maximum dose of 5 mg.

4....
pediatric drug dosages, emergency medication, IV administration, newborn pharmacology
Administer Acetaminophen for Pediatric Patients
High Priority Source: Emergency War Surgery
Procedure:

1. Calculate the dose based on the patient's weight: 15 mg/kg PO (by mouth).
2. Administer as needed for pain or fever management.

Notes:
• This is a common analgesic and antipyretic used in pediatric patients.
• Monitor for...
acetaminophen dosage, pediatric pain management, PO medication, fever treatment in children

Ethics And Law (5)

Classify and Protect Internees Under International Law
High Priority Source: Emergency War Surgery
Objective: Ensure proper classification and protection of internees under the Geneva Convention.

Procedure:
1. Classify all detainees as internees, including enemy prisoners of war (EPWs), retained personnel, civilian internees, and...
internee classification, Geneva Convention, GPW, GC, protection of detainees
Definition of Torture According to International Standards
High Priority Source: Emergency War Surgery
Procedure:

1. Torture is defined as any act by which severe pain or suffering, whether physical or mental, is intentionally inflicted by a public official on a person for purposes such as obtaining information, punishment, or...
torture, definition, international law, ethics, war surgery
Ethical Guidelines for Medical Personnel in Interrogation Procedures
High Priority Source: Emergency War Surgery
Procedure:

1. Do not participate in any medical procedures that assist in the interrogation of prisoners or detainees if such actions may adversely affect their physical or mental health, and are not in accordance with relevant...
medical ethics, interrogation, prisoners, detainees, torture, war surgery
Provide Medical Care to Internees According to Ethical Principles
High Priority Source: Emergency War Surgery
Objective: Ensure medical care is provided to internees in accordance with ethical standards and international law.

Procedure:
1. Adhere to the principles of medical ethics outlined in United Nations General Assembly Resolution 37/194...
medical ethics, Geneva Conventions, internees, EPW care, ethical treatment
Define Medical Personnel Under the Geneva Convention
High Priority Source: Emergency War Surgery
Objective: Clarify who is considered medical personnel under international law.

Procedure:
1. Identify individuals exclusively engaged in:
- The search for, or collection, transport, or treatment of the wounded or sick.
- The...
Geneva Convention, medical personnel definition, GWS, international law

Hypothermia Management (5)

Field Management of Hypothermic Individuals
Critical Source: NATO Emergency War Surgery
Procedure for Field Management of Hypothermic Individuals:

1. Remove Wet Clothing: Carefully strip the individual of all wet clothing to prevent further heat loss.
2. Insulate the Individual: Cover the person with dry, insulating...
hypothermia,rewarming,field management,warm drinks,fluid replacement,insulation,cardiac output,ventricular fibrillation
Recognize and Manage Hypothermia in Combat Situations
Critical Source: NATO Emergency War Surgery
Procedure for Recognizing and Managing Hypothermia in Combat Environments

### Signs and Symptoms of Hypothermia:
Shivering violently (especially in non-immersed individuals)
Diuresis (prolonged urination)
• **Decreased cerebral...
hypothermia, cold injury, rewarming, combat medicine, emergency surgery, fluid replacement, airway management, cardiac arrhythmias, acidosis, hyperkalemia
Identify and Manage Hypothermia in Trauma Patients
High Priority Source: TCCC 17 13 Army Tactical Combat Casualty Care
Procedure:
1. Assess the casualty for signs of hypothermia, such as shivering, confusion, or low body temperature (below 95°F/35°C).
2. Use the Hypothermia Prevention and Management Kit (HPMK) to manage hypothermia:
- Provide...
hypothermia, trauma management, HPMK
Hypothermia Prevention and Management in Trauma Patients
High Priority Source: Emergency War Surgery
Objective: Prevent hypothermia during resuscitation and treatment of trauma patients.

Indications: All trauma patients, especially those arriving hypothermic or in austere environments.

Procedure:
1. Prevent hypothermia by...
hypothermia prevention, trauma patient warming, forced-air warming, hypothermia management
Medical Treatment and Monitoring of Hypothermic Patients
Standard Source: Emergency War Surgery
Ventilate the patient and apply CPR if asystolic or in ventricular fibrillation.

• As the body cools, peripheral vasculature constricts, causing pooling of cold acidotic blood. Rewarming the periphery rather than the core can cause an...
hypothermia, core rewarming, ventricular fibrillation, Bretylium tosylate, CPR, monitoring

Wound Infection (5)

Treat an Infected Wound in a Survival Situation
Critical Source: Medical Emergencies
Procedure:

1. Apply a warm, moist compress directly to the infected wound for 30 minutes total per session.
2. Repeat this process three or four times daily until signs of infection subside.
3. Drain the wound by opening and gently...
infected wound treatment,maggot therapy,wound infection signs,survival wound care,draining infected wounds
Apply Hot Compresses to Infected Wounds
High Priority Source: Where There is no Doctor a Village Health Care Handbook
Procedure:

1. Apply hot compresses over the infected wound for 20 minutes, 4 times a day.
2. Alternatively, submerge the affected hand or foot in a bucket of hot water for treatment.
3. Keep the infected part **elevated above the level...
hot compresses,wound infection,treatment,gangrene warning
Understanding Battlefield Conditions That Promote Wound Infection
High Priority Source: Emergency War Surgery
Objective: Understand the factors on the battlefield that increase the risk of wound infection.

Contributing Factors:
Absence of sterile wounding agents: All foreign bodies (e.g., projectile fragments, clothing, dirt) are contaminated...
battlefield wound infection, risk factors, high-energy wounds, delayed evacuation
Evaluate Effectiveness of Debridement in Reducing Contamination
Standard Source: NATO Emergency War Surgery
Procedure:

1. Perform prompt debridement to remove damaged tissue and debris from wounds.
2. Collect wound wall cultures after debridement for microbiological analysis.
3. Assess the degree of contamination or colonization reduction...
debridement effectiveness, wound contamination reduction, prophylactic antibiotics
Understand Bacterial Contamination in War Wounds
Standard Source: NATO Emergency War Surgery
Procedure:

1. Recognize that war wounds are inherently contaminated at the time of injury and may be further contaminated during treatment.
2. Identify common bacterial contaminants:
- Clostridium species are commonly introduced...
war wound contamination, bacterial types, clostridium, staphylococcus, streptococcus, gram-negative bacilli

Chemical Exposure Treatment (5)

Administer Atropine and 2-PAM for Nerve Agent Exposure
Critical Source: Emergency War Surgery
Procedure:

1. Immediate administration of atropine sulfate:
- Inject atropine sulfate intramuscularly (IM) or intravenously (IV). The dose may require multiple injections, as much greater amounts than recommended by Advanced Cardiac...
nerve agents, atropine, 2-PAMCl, pralidoxime chloride, diazepam, chemical warfare treatment
Administer Atropine for Chemical Exposure (GB, GD, VX, H, HD, HS, HT, AC, CK, MDI)
Critical Source: LDS Preparedness Manual
Procedure:

1. Identify the chemical agent: Confirm exposure to GB (Sarin), GD (Soman), VX, H (distilled nitrogen mustard gas), HD/HS (mustard gas), HT (phosgene gas), AC (Hydrogen Cyanide), CK (Cyanogen Chloride), or MDI (Methyl...
atropine,pralidoxime,CPR,washing,body,decontamination,chemical exposure,nerve agents,mustard gas,phosgene,Hydrogen Cyanide,Methyl Isocyanate
Identify the Mechanism of Action and Treatment for Chemical Agents
Critical Source: Medical NBC Battlebook
### Identify the Mechanism of Action and Treatment for Chemical Agents

Procedure:
1. Refer to Table 5-N: Effects of Chemical Agents for the following information:
- Nerve Agents (GA, GB, GD, GF, VX): Mechanism is **anticholinesterase...
treatment protocols, chemical agents, antidotes, medical response
Treat Cyanide Exposure (Blood Agents AC and CK)
Critical Source: Emergency War Surgery
Procedure:

1. Immediate removal from contaminated atmosphere:
- Remove the casualty from the area of exposure to prevent further inhalation.
2. Administer 100% oxygen:
- Provide high-flow oxygen (O₂) to support respiration and...
cyanide, blood agents, sodium nitrite, sodium thiosulfate, hydrogen cyanide treatment
Decontaminate Casualty Exposed to Vesicants (Blister Agents)
Critical Source: Emergency War Surgery
Procedure:

1. Immediate decontamination of the casualty is top priority.
2. Remove agent droplets as expeditiously as possible using one of the following methods:
- Use the M-291 kit, which is extremely effective at inactivating...
vesicants, mustard, decontamination, M-291 kit, dimercaprol, blister agents

Casualty Evacuation (5)

Transport Casualty and Equipment in Combat
Critical Source: STP 21 1 Army Warrior Skills Level 1 Soldiers Manual of Common Tasks
Objective: Safely transport the casualty, weapon, and mission-essential equipment when tactical conditions permit.

Steps:
1. Assess the tactical situation to determine if it is safe to move the casualty.
2. **Ensure that the casualty's...
casualty transport, mission equipment handling, combat evacuation
Emergency Removal of a Casualty in Armed Conflict Situations
High Priority Source: First Aid in Armed Conflicts
### Procedure: Emergency Removal of a Casualty in Armed Conflict Situations

#### Overview
This procedure outlines how to safely and effectively remove a casualty from danger during armed conflict or other situations of violence. It is...
emergency removal,casualty evacuation,armed conflict,safety first aid,log roll
Understand the Chain of Casualty Care in Armed Conflicts
High Priority Source: First Aid in Armed Conflicts
The chain of casualty care is a structured path that ensures injured individuals receive appropriate medical attention at each stage until they reach specialized care. The stages are as follows:

1. On the spot: Immediate first aid provided...
chain of casualty care, first aid, armed conflicts, evacuation, triage, medical coordination
Prepare and Secure a Casualty on a SKED Litter
Standard Source: STP 21 1 Warrior Skills Level 1 + STP 21 1 Army Warrior Skills Level 1 Soldiers Manual of Common Tasks
**Procedure: Prepare a SKED Litter:

1. Remove the SKED from the pack and place it on the ground.
2. Unfasten the retainer strap, step on the foot end of the SKED, and unroll it completely to the opposite end.
3. Bend the SKED in half and back roll....
SKED Litter, Prepare, Secure Casualty, Evacuation, First Aid
Transport a Casualty Safely
Reference Source: STP 21 1 Warrior Skills Level 1 + STP 21 1 Army Warrior Skills Level 1 Soldiers Manual of Common Tasks
Conditions: You have evaluated and given first aid to a casualty. You need to move the casualty to get further medical aid and may have to remove him/her from a vehicle before transporting. Assistance from other Soldiers may be available. You...
transport, casualty, first aid, SKED litter, Talon litter, emergency medical aid

Diagnostic Testing (5)

Confirm Novel Influenza Using RT-PCR or Virus Isolation
Critical Source: HHSPandemicInfluenzaPlan
Steps to Confirm Novel Influenza:

1. RT-PCR is the primary method for confirming novel influenza, but it can only be performed at state public health laboratories and CDC.
2. Virus isolation from tissue cell culture with subtyping...
RT-PCR, virus isolation, BSL-3, rapid influenza test, diagnostic testing
Facilitate Development and Evaluation of Diagnostic Tests for Influenza
Critical Source: HHSPandemicInfluenzaPlan
Procedure:

1. Facilitate the development of diagnostic tests and devices that can accurately detect influenza.

2. Evaluate these tests to ensure they meet all necessary quality standards and regulatory requirements.

3. Approve or clear these...
diagnostic test development, evaluation process, quality standards, influenza detection
Diagnostic Work-Up for Pandemic Influenza Patients
High Priority Source: HHSPandemicInfluenzaPlan
Initial Diagnostic Testing Recommendations:

Pulse oximetry to assess oxygen saturation.
Chest radiograph for suspected pneumonia or respiratory complications.
Complete blood count (CBC) with differential to evaluate infection...
pandemic influenza, diagnostic work-up, pulse oximetry, chest x-ray, blood cultures, sputum culture, immunofluorescent testing
Implement Rapid Diagnostic Testing for Pandemic Influenza
High Priority Source: HHSPandemicInfluenzaPlan
Procedure:

1. Use highly accurate (sensitive and specific) rapid diagnostic tests to identify pandemic outbreaks in communities.
2. Collect patient specimens from suspected cases for testing.
3. Analyze test results to detect and characterize...
rapid diagnostic tests, influenza characterization, pandemic testing
Obtain Clinical Specimens for Pandemic Influenza Evaluation
High Priority Source: HHSPandemicInfluenzaPlan
Procedure:

1. Obtain clinical specimens for general evaluation as clinically indicated (see Box 2).
2. Once pandemic influenza has arrived in a community:
- Influenza testing will likely not be needed for most patients.
- Laboratory...
clinical specimens, diagnostic testing, pandemic influenza, virologic surveillance

Antiviral Drug Development (5)

Study Antiviral Drug Effects on Severe Influenza Complications
Critical Source: HHSPandemicInfluenzaPlan
Objective: Study antiviral drug effects on severe influenza complications.

Procedure:
1. Enroll patients hospitalized with severe influenza and monitor for complications such as pneumonia, acute respiratory distress syndrome (ARDS), or...
severe complications, antiviral effects, ARDS
Study Antiviral Drug Efficacy in Severely Ill Hospitalized Patients
Critical Source: HHSPandemicInfluenzaPlan
Objective: Study antiviral drug efficacy in severely ill hospitalized patients (including treatment started late in disease course).

Procedure:
1. Identify hospitalized patients with severe influenza infections who have not received early...
severe influenza, antiviral efficacy, late treatment
Evaluate Safety and Dosing in Infants with Influenza
High Priority Source: HHSPandemicInfluenzaPlan
Objective: Evaluate safety and dosing in infants with influenza, and alternative dosing regimens/formulations for infants and young children.

Procedure:
1. Conduct clinical trials in infants and young children to determine safe and...
infant dosing, pediatric safety, antiviral formulations
Conduct Clinical Trials for Resource-Sparing Antiviral Approaches
High Priority Source: HHSPandemicInfluenzaPlan
Objective: Conduct clinical trials of potentially resource-sparing approaches such as dose reduction and shortened treatment courses.

Procedure:
1. Design randomized controlled trials to evaluate the efficacy of reduced antiviral doses or...
resource-sparing strategies, dose reduction, clinical trials
Establish a Pregnancy Registry for Influenza Exposures and Outcomes
High Priority Source: HHSPandemicInfluenzaPlan
Objective: Establish a pregnancy registry to prospectively collect data on exposures and outcomes.

Procedure:
1. Develop a standardized protocol for enrolling pregnant women exposed to influenza or antiviral medications during pregnancy.
2....
pregnancy registry, fetal outcomes, antiviral safety

Laboratory Procedures (5)

Conducting RT-PCR Testing and Virus Isolation under BSL-3 Practices with Enhancements
High Priority Source: HHSPandemicInfluenzaPlan
Procedure:

1. Ensure all laboratory personnel are trained in Biosafety Level 3 (BSL-3) work practices with enhancements.
2. Use appropriate PPE, including full-body protective suits, respirators, and double gloves.
3. Conduct RT-PCR testing for...
BSL-3,virus isolation,RT-PCR testing,influenza,laboratory procedures,biosafety
Conducting Commercial Antigen Detection Testing for Influenza under BSL-2 Practices
Standard Source: HHSPandemicInfluenzaPlan
Procedure:

1. Ensure all laboratory personnel are trained in Biosafety Level 2 (BSL-2) work practices.
2. Use appropriate personal protective equipment (PPE), including lab coats, gloves, and face protection.
3. Conduct antigen detection...
BSL-2,antigen detection testing,influenza,laboratory procedures,biosafety
Using IFA Staining for Influenza Typing and Subtyping
Standard Source: HHSPandemicInfluenzaPlan
Procedure:

1. Conduct virus isolation using appropriate biosafety practices.
2. Pellet cells from the original clinical sample or use isolated viral material.
3. Apply immunofluorescence antibody (IFA) staining to identify influenza types (A,...
IFA staining,influenza typing,subtyping,laboratory procedures,biosafety
Using RT-PCR Subtyping for Influenza Typing and Subtyping
Standard Source: HHSPandemicInfluenzaPlan
Procedure:

1. Ensure all laboratory personnel are trained in RT-PCR subtyping techniques.
2. Use standardized protocols and primers/probes provided by CDC or APHL for typing and subtyping influenza viruses.
3. Prepare RNA from clinical...
RT-PCR subtyping,influenza typing,subtyping,laboratory procedures,biosafety
Using Serologic Tests for Retrospective Confirmation of Influenza Infection
Standard Source: HHSPandemicInfluenzaPlan
Procedure:

1. Collect patient sera from individuals suspected of having influenza infection.
2. Perform serologic tests such as enzyme-linked immunosorbent assay (ELISA), hemagglutination inhibition (HAI), or microneutralization assays to...
serologic tests,ELISA,HAI,microneutralization assay,influenza confirmation,laboratory procedures

Specimen Collection (5)

Collect and Handle Clinical Specimens for Novel Influenza Testing
Critical Source: HHSPandemicInfluenzaPlan
Steps to Collect and Handle Clinical Specimens:

1. If feasible, collect all of the following respiratory specimens:
- Nasopharyngeal swab
- Nasal swab, wash, or aspirate
- Throat swab
- Tracheal aspirate (for intubated...
specimen collection, novel influenza testing, viral transport media, health department notification
Collect Blood Components for Antibody Testing
Standard Source: HHSPandemicInfluenzaPlan
Materials Required:
• Serum separator tubes
• EDTA tubes (if available)
• Clotting tubes
• Sterile vials with external caps and internal O-ring seals
• Cold packs or dry ice (depending on shipping location)

Procedure Steps:
1. **Collect...
blood collection, antibody testing, serum separator tube, convalescent serum, shipping instructions
Collect Lower Respiratory Tract Specimens (Bronchoalveolar Lavage, Tracheal Aspirate, or Pleural Fluid Tap)
Standard Source: HHSPandemicInfluenzaPlan
Materials Required:
• Double-tube system
• Sterile vials with external caps and internal O-ring seals
• Formalin for fixing cell pellets
• Cold packs or dry ice (depending on shipping location)

Procedure Steps:
1. **Use Double-Tube...
lower respiratory tract specimen collection, bronchoalveolar lavage, tracheal aspirate, pleural fluid tap, formalin fixation, shipping instructions
Collect Nasopharyngeal or Oropharyngeal Swabs for Influenza Testing
Standard Source: HHSPandemicInfluenzaPlan
Materials Required:
• Sterile dacron or rayon swabs with plastic shafts
• Viral transport media (2 ml per vial)
• Sterile vials
• Cold packs or dry ice (depending on shipping location)

Procedure Steps:
1. **Select Appropriate Swab...
nasopharyngeal swab, oropharyngeal swab, specimen collection, influenza testing, viral transport media, shipping instructions
Collect Sputum Specimens for Influenza Testing
Standard Source: HHSPandemicInfluenzaPlan
Materials Required:
• Sterile screw-cap sputum collection cup or sterile dry container
• Cold packs or dry ice (depending on shipping location)

Procedure Steps:
1. Educate Patient: Explain the difference between sputum and oral...
sputum collection, influenza testing, specimen storage, shipping instructions

Respiratory Complications (5)

Identify and Manage Secondary Bacterial Pneumonia Following Influenza
Critical Source: HHSPandemicInfluenzaPlan
Objective: Recognize and treat secondary bacterial pneumonia as a complication of influenza.

Procedure:
1. Monitor for signs of initial improvement in influenza symptoms followed by a return of fever, productive cough, and pleuritic chest...
secondary pneumonia, bacterial infection, influenza complications, sputum analysis
Recognize and Respond to Mixed Viral-Bacterial Pneumonia from Influenza
Critical Source: HHSPandemicInfluenzaPlan
Objective: Identify and manage mixed viral-bacterial pneumonia as a complication of influenza.

Procedure:
1. Monitor for symptoms such as fever, productive cough, and pleuritic chest pain that may develop after an initial improvement in...
mixed pneumonia, viral-bacterial infection, influenza complications
Recognize and Respond to Primary Viral Pneumonia from Influenza
Critical Source: HHSPandemicInfluenzaPlan
Objective: Identify and manage primary viral pneumonia caused by influenza.

Procedure:
1. Monitor for abrupt onset of severe respiratory symptoms, including rapid progression to severe pulmonary disease within 1–4 days.
2. Look for physical...
primary viral pneumonia, influenza, hypoxia, hemoptysis
Recognize and Respond to Exacerbation of Chronic Respiratory Diseases During Influenza
High Priority Source: HHSPandemicInfluenzaPlan
Objective: Identify and manage exacerbations of chronic respiratory diseases caused by influenza.

Procedure:
1. Monitor for signs of worsening symptoms in individuals with pre-existing conditions such as COPD, including increased shortness...
influenza, exacerbation, COPD, respiratory disease, chronic illness
Recognize and Respond to Influenza-Related Sinusitis in Children and Adults
High Priority Source: HHSPandemicInfluenzaPlan
Objective: Identify and manage sinusitis caused by influenza.

Procedure:
1. Monitor for symptoms such as facial pain or pressure, nasal congestion, purulent nasal discharge, and fever.
2. Look for signs of sinus tenderness on physical...
sinusitis, influenza complications, nasal congestion

Triage And Evacuation (5)

Triage and Initial Care at Battalion Aid Station
Critical Source: NATO Emergency War Surgery
Procedure for Triage and Initial Care at Battalion Aid Station:

1. Assess Casualty Severity:
- Evaluate the casualty's condition based on the severity of injuries.
- Prioritize those with critical injuries (e.g., airway obstruction,...
triage,airway clearance,hemorrhage control,dressings,splints,evacuation,priority casualties
Documentation of Injuries and Treatments for Evacuation
Critical Source: NATO Emergency War Surgery
Procedure:

1. Record all injuries in detail, including the types of wounds sustained.
2. Document the treatments administered, such as airway management, hemorrhage control, resuscitation measures, and fracture immobilization.
3....
injury documentation, evacuation records, triage notes
Evacuation and Triage at Division Clearing Station
Critical Source: NATO Emergency War Surgery
Procedure for Evacuation and Triage at Division Clearing Station:

1. Re-Triage Casualties:
- Reassess casualties who have been evacuated from the collecting station.
- Identify those with urgent or immediate injuries that require...
re-triage,evacuation field hospital,stability,documentation,casualty tracking
Organize Survivors and Assist Casualties After Nuclear Detonation
Critical Source: Medical NBC Battlebook
Procedure:

1. Quickly assess the situation to identify injured or vulnerable individuals.
2. Gather survivors in a safe, centralized location away from potential fallout zones.
3. Provide immediate first aid to casualties as needed.
4. Assign...
nuclear casualties, triage, survival organization
Direct Individuals in Need of Medical Care to Appropriate Facilities
High Priority Source: Planning Guidance Nuclear Detonation FEMA
Procedure:

1. Direct individuals who require medical care to a medical treatment facility or designated medical triage station if established.
2. Ensure that response organizations are prepared to provide security for these facilities and...
medical care,triage,decontamination,security,transportation

Biological Threats (5)

Decontaminate After Exposure to a Biological Agent
Critical Source: FEMA Are You Ready
Action: If you are exposed to a biological agent:

Steps:
1. Remove and bag your clothes and personal items for disposal.
2. Follow official instructions for the safe disposal of contaminated items.
3. **Wash yourself with soap and...
decontamination, biological agent, medical assistance, quarantine, hygiene
Respond to Unusual Substances During a Biological Attack
Critical Source: FEMA Are You Ready
Action: If you become aware of an unusual and suspicious substance nearby:

Steps:
1. Move away quickly from the area.
2. Wash with soap and water to remove any potential contaminants.
3. Contact authorities immediately for...
unusual substance, biological attack, medical attention, authorities, hygiene
Conduct BW Risk Assessment
High Priority Source: Medical NBC Battlebook
Steps to Conduct a Biological Weapon (BW) Risk Assessment:

1. Determine Enemy Capabilities:
- Check if the enemy is capable of producing biological weapons.
- Verify if there are known agent stockpiles or bio munitions plants.
-...
BW risk assessment, biological threat, MOPP gear, immunization, detection posture, hygiene, medical preparedness
Conduct Epidemiological Survey to Determine Disease Origin
High Priority Source: Medical NBC Battlebook
Procedure:

1. Initiate survey when signs of illness occur that may indicate a biological warfare (BW) attack.
2. Assess disease incidence by comparing the number of individuals affected with the expected disease incidence for the area...
epidemiological survey,disease origin,biological warfare,medical surveillance
Recognize Early Signs of a Biological Attack
High Priority Source: Medical NBC Battlebook
Procedure:

1. Monitor for early symptoms, which may resemble the flu but can also include:
- Unusual number of cases with skin rash
- Jaundice
- Diarrhea
- Sore throat
- Pneumonia
- Mental abnormalities
-...
biological attack,early symptoms,disease surveillance,combined attacks

Chemical Contamination (5)

Decontamination Procedures for Nerve Agent Contamination on Face and Body
Critical Source: FM 4 25 11 First Aid
Procedure:

1. If your eyes and face become contaminated:
- Immediately try to get under cover to prevent further contamination.
- If no overhead cover is available, put your poncho over your head before beginning the...
nerve agent, decontamination, face contamination, protective mask, vomiting
Assessing Chemical Contamination in Food
High Priority Source: Medical NBC Battlebook
Procedure:

1. Identify the type of chemical agent involved (e.g., nerve, mustard, arsenical) and its properties.
2. Determine the food's composition: classify it into one of three groups:
- Group A: High water content, low fat,...
chemical contamination, food safety, nerve agents, mustard agents, arsenicals
Decontamination Procedures in Chemically Contaminated Areas
High Priority Source: Medical NBC Battlebook
Procedure:

1. Assess the Environment Type:
- Determine if you are in an uncontaminated area, a contaminated area with liquid and vapor hazards, or a vapor-only environment.

2. Respond to Liquid Hazards Immediately:
- If exposed...
decontamination, chemical agents, liquid hazard, vapor hazard, combined injuries, skin exposure, eye protection, agent-proof material
Effect of Chemical Agents on the Appearance of Food
High Priority Source: Medical NBC Battlebook
Procedure:

Use Table 5-E for reference:

|Agent|Taste|Smell|Color|
|---|---|---|---|
|Mustard|Affected|Garlic|Meat discolored|
|N-Mustard|Affected|Fishy|No discoloration|
|Arsenicals|Acid|Unpleasant|Meat & vegetables...
food appearance, chemical agents, toxicity signs
Monitoring Food for Chemical Contamination
High Priority Source: Medical NBC Battlebook
Procedure:

1. For volatile agents, place exposed food in a clean plastic bag and sample the air inside with suitable detection equipment.
2. For suspected arsenical contamination, suspend the food in water and test the water using a...
food monitoring, chemical agents, detection methods

Laser Injury Prevention (5)

Implement Active Laser Protection Measures
High Priority Source: Medical NBC Battlebook
Objective: Prevent injury from laser exposure using active protection techniques.

Procedure:
1. Use countermeasures and countermeasure systems, such as:
- Battlefield smoke screens to obscure the line of sight.
2. Employ **evasive...
active laser protection, countermeasures, evasive maneuvers, monocular optics, hardened optical systems
Implement Passive Laser Protection Measures
High Priority Source: Medical NBC Battlebook
Objective: Prevent injury from laser exposure using passive protection techniques.

Procedure:
1. Take cover to avoid direct line of sight with the laser beam.
2. Squint to reduce the amount of laser energy entering the eye.
3. Use...
passive laser protection, take cover, squint, protective gear, skin coverage
Prevent Laser Injuries Using Protective Eyewear
High Priority Source: Medical NBC Battlebook
Objective: Prevent ocular injury from laser radiation using appropriate protective eyewear.

Procedure:
1. Use Ballistic/Laser Protective Spectacles (B-LPS):
- Available in clear, snuggles, two wavelength laser protection, and 3...
laser injury prevention, protective eyewear, B-LPS, SPECS, SWDG, LBO, laser protection
Train Soldiers on Laser Safety and Protection
High Priority Source: Medical NBC Battlebook
Objective: Educate soldiers on laser safety to prevent injury.

Procedure:
1. Provide training on the risks of low-energy lasers, including potential eye and skin injuries.
2. Teach soldiers how to identify and avoid known or suspected...
laser training, eye safety, protective equipment use, education, awareness
Maintain and Use Laser Protective Eyewear Properly
High Priority Source: Medical NBC Battlebook
Objective: Ensure proper use and maintenance of laser protective eyewear to prevent injury.

Procedure:
1. Inspect eyewear regularly for damage or wear, especially lenses and frames.
2. Ensure compatibility with prescription lenses...
eyewear maintenance, PMCS, lens replacement, storage, compatibility

Radiation Detection (5)

Operate Army Dosimeters (PDR-75, IM-9E/PD, IM-93, IM-147)
High Priority Source: Medical NBC Battlebook
Procedure:

1. Inspect the dosimeter for any physical damage or signs of tampering.
2. Turn on the device by pressing the power button located on the side of the unit.
3. Verify that the display is functioning properly, ensuring it...
Army Dosimeters, PDR-75, IM-9E/PD, IM-93, IM-147, radiation monitoring
Operate the AN/UDR-13 Radiac Set for Radiation Detection
High Priority Source: Medical NBC Battlebook
Procedure:

1. Inspect the AN/UDR-13 radiac set to ensure all components are present and in working condition.
2. Turn on the device by pressing the power button located on the side of the unit.
3. **Verify that the display is...
AN/UDR-13 Radiac Set, radiation detection, dose rate measurement
Use ADM-300 Multi-Function Radiac for Radiation Detection
High Priority Source: Medical NBC Battlebook
Procedure:

1. Inspect the ADM-300 multi-function radiac to ensure all components are present and in working condition.
2. Turn on the device by pressing the power button located on the side of the unit.
3. **Verify that the display is...
ADM-300 Multi-Function Radiac, radiation detection, dose rate measurement
Use AN/PDR-77 and AN/VDR-2 Dosimeters for Radiation Detection
High Priority Source: Medical NBC Battlebook
Procedure:

1. Inspect the AN/PDR-77 or AN/VDR-2 dosimeter to ensure all components are present and in working condition.
2. Turn on the device by pressing the power button located on the side of the unit.
3. **Verify that the display is...
AN/PDR-77, AN/VDR-2, radiation detection, dose rate measurement
Use M28A1 RADIAC Calculator Set for Radiation Detection
High Priority Source: Medical NBC Battlebook
Procedure:

1. Inspect the M28A1 RADIAC calculator set to ensure all components are present and in working condition.
2. Turn on the device by pressing the power button located on the side of the unit.
3. Place the detector probe at...
M28A1 RADIAC calculator set, radiation detection, dose rate measurement, nuclear hazard

Respiratory Management (5)

Management of Tension Pneumothorax with Needle Chest Decompression (NCD)
Critical Source: TCCC 17 13 Tactical Combat Casualty Care
Procedure:

1. For a casualty with progressive respiratory distress and known or suspected torso trauma, consider a tension pneumothorax.
2. Perform needle chest decompression (NCD) on the side of the injury by:
- Removing the...
tension pneumothorax, needle chest decompression, NCD, respiratory distress
Decompress Tension Pneumothorax or Hemothorax in Casualty with Penetrating Chest Trauma
Critical Source: US Marine Corps Wilderness Medicine
Procedure:
1. Identify signs of tension pneumothorax (e.g., progressive respiratory distress, tracheal deviation, hypotension).
2. Perform a needle thoracostomy by inserting a 14-gauge needle into the second intercostal space at the...
tension pneumothorax, needle thoracostomy, chest trauma, hemothorax, oxygen administration
Insert Chest Tubes for Non-Improving Respiratory Status or Long Transport
Critical Source: TCCC 17 13 Army Tactical Combat Casualty Care
Procedure:

1. Consider chest tube insertion if the casualty has no improvement and/or if a long transport is anticipated.
chest tube insertion, respiratory status, transport
Administer Oxygen for Specific Casualty Types
High Priority Source: TCCC 17 13 Army Tactical Combat Casualty Care
Procedure:

1. Administer oxygen when possible for the following types of casualties:
- •*[Low oxygen saturation by pulse oximetry (shock, chest ] wound, etc.).
- •*[Injuries associated with impaired oxygenation.]
- •*[An...
oxygen administration, tbi, altitude
Use of Steroids in Burn Patients with Inhalation Injury
High Priority Source: NATO Emergency War Surgery
Purpose: Use steroids to manage unrelenting bronchospasm in burn patients.

Indication for Steroid Use:
Unrelenting bronchospasm despite other treatments.

Important Considerations:
• Administer large doses of steroids only...
steroids, bronchospasm, inhalation injury, infection risk, corticosteroid use

Chemical Injury (5)

General Principles of Management for Chemical Casualties
Critical Source: NATO Emergency War Surgery
Personal Hazards:
Do not become a casualty yourself. Protect yourself and instruct your personnel to do likewise.
• Prevent further injury of the casualty:
1. Apply his protective mask.
2. Cover him.
3. Administer treatment.
4....
chemical casualty management, decontamination, route of entry, nerve agents
Delayed Effects of Chemical Warfare Agents
High Priority Source: NATO Emergency War Surgery
Overview:
• Some CW agents produce immediate signs and symptoms, while others may have delayed effects depending on the agent concentration and duration of exposure (see Table 4).

Examples of Delayed Effects:
1. Mustards can...
delayed chemical effects, mustard gas, phosgene, delayed diagnosis
Identification and Diagnosis of Chemical Exposure
High Priority Source: NATO Emergency War Surgery
Initial Identification Guidance:
• Use Table 4, which provides rough initial identification guidance based on the time lag between CW agent exposure and onset of symptoms and signs.

Diagnostic Differentiation:
• Once early signs and...
chemical exposure, diagnosis, time lag symptoms, battlefield triage
Initial Care of Chemical Casualties
High Priority Source: NATO Emergency War Surgery
Objective: Provide updated guidance for initial care of chemical casualties to save life and limb and aid in the soldier's early return to duty.

Notes:
• These recommendations include current research views and should be considered as an...
chemical casualties, initial care, battlefield medicine, chemical warfare
Classification of Chemical Warfare (CW) Agents
High Priority Source: NATO Emergency War Surgery
Overview:
• Riot control agents (e.g., tear gas) are not considered CW agents since symptoms are transient and self-limiting.
• Certain extremely potent chemicals, such as mycotoxins and neurotoxins, are classified with the biological...
chemical agent classification, riot control agents, biological warfare agents

Training Procedures (5)

Conduct Triage System Training and Exercises
High Priority Source: Planning Guidance for Response to Nuclear Detonation May 2022 FEMA
Objective: Ensure responder organizations are trained in the selected triage system through exercises and training sessions.

Procedure:
1. Identify all responder organizations that will be involved in mass casualty incidents, including...
triage training, emergency drills, resource scarcity, responder preparedness
Training for Resuscitation and Operations in Emergency War Surgery
High Priority Source: NATO Emergency War Surgery
Procedure:

1. Recognize that resuscitation and operations are performed by teams of medical officers, corpsmen, nurses, and other support personnel.
2. Each medical officer or surgeon has the responsibility to continually train their supporting...
ATLS training, combat casualty care, team resuscitation, trauma training
Access TCCC-MP Resources and Guidelines
Standard Source: TCCC 17 13 Tactical Combat Casualty Care
Procedure:

1. Visit the NAEMT website at http://www.naemt.org/education/TCCC/guidelines_curriculum for training materials, guidelines, slides, and additional information.
2. Access the Defense Health Agency website at http://www.health.mil/tccc...
tccc, resources, guidelines, online materials
Becoming a TCCC-MP Instructor
Standard Source: TCCC 17 13 Tactical Combat Casualty Care
Procedure:

1. Complete the TCCC-MP course successfully.
2. Enroll in and complete the 6-hour online NAEMT instructor course.
3. Submit an NAEMT instructor application.
4. Have an NAEMT TCCC-affiliate faculty member monitor during the first TCCC...
tccc, instructor training, medical education
Review TCCC-MP Slides with Students
Standard Source: TCCC 17 13 Tactical Combat Casualty Care
Procedure:

1. Access the NAEMT TCCC-MP slides from the official website.
2. Present all slides to students in a structured manner, ensuring full comprehension of each topic.
3. Use instructor guides provided for each slide series to facilitate...
tccc, slides, training, medical education

Anesthesia Administration (5)

Administering Fentanyl for Analgesia and Anesthesia
High Priority Source: NATO Emergency War Surgery
Procedure:

1. Dosage Options:
- Intermittent bolus injection: 1 to 2 mcg/kg.
- Continuous infusion: 2 to 50 mcg/min, titrated based on blood pressure, pulse, or evidence of pain reaction.

2. Conversion Equivalents:
-...
fentanyl, analgesia, anesthesia, bolus injection, continuous infusion, muscle stiffness
Administering Isoflurane for Anesthesia Maintenance
High Priority Source: NATO Emergency War Surgery
Procedure:

1. Determine MAC (Minimum Alveolar Concentration):
- For isoflurane in oxygen, the MAC is 1.15.
- In a mixture of 70% nitrous oxide, the MAC is 0.5.

2. Maintain Inspired Levels:
- Keep inspired levels at **40%...
isoflurane, anesthesia maintenance, MAC, nitrous oxide, oxygen analyzer, respiratory depression
Administering Ketamine for Anesthesia and Analgesia
High Priority Source: NATO Emergency War Surgery
Procedure:

1. Induction Dosage:
- Administer an IV dose of 1 to 2 mg/kg.
- Rapid induction occurs within 30 seconds.

2. Effects of Ketamine:
- Produces intense analgesia and dissociative effects.
- May not require...
ketamine, anesthesia induction, analgesia, emergence reactions, bronchospasm, burn patient
Preoperative Medication Administration
High Priority Source: NATO Emergency War Surgery
Procedure:

1. Avoid intramuscular or subcutaneous administration of narcotics, sedatives, and other depressant drugs in forward areas due to uncertain absorption.
2. In head-injured casualties:
- Avoid depressant drugs as they may:
...
preoperative medication, narcotics administration, pain management, anticholinergics, IV dosing
Administering Midazolam to Reduce Ketamine Emergence Reactions
High Priority Source: NATO Emergency War Surgery
Procedure:

1. Indication:
- Use midazolam, a short-acting benzodiazepine, to reduce emergence reactions from ketamine.

2. Dosage Recommendations:
- Administer small amounts of midazolam in combination with ketamine.
- Specific...
midazolam, ketamine, emergence reactions, sedation, postoperative dysphoria

Splinting Immobilization (5)

Immobilizing Hip Joint or Femoral Fractures with Plaster Spica Cast
Critical Source: NATO Emergency War Surgery
Procedure:

1. Apply a bilateral plaster spica cast extending from the axilla to the toes on the affected side.
2. Position the knee at 10–15° of flexion, avoiding hyperextension or full extension.
3. On the unaffected side, extend...
hip immobilization, femoral fracture splinting, plaster spica cast, pelvic frame
Immobilizing Elbow Joint and Forearm Injuries
High Priority Source: NATO Emergency War Surgery
Procedure:

1. Apply a plaster cast extending from the proximal palmar crease to the axilla.
2. Position the elbow at approximately 90° of flexion, with the wrist and forearm in a neutral position.
3. Use a **sling or collar and...
elbow immobilization, forearm splinting, plaster cast, collar and cuff
Immobilizing Lower Leg and Ankle Injuries with Plaster Cast
High Priority Source: NATO Emergency War Surgery
Procedure:

1. Apply a plaster cast extending from the groin to the toes.
2. Position the knee in slight flexion, avoiding hyperextension or full extension.
3. Place the foot in **neutral dorsiflexion (at a right angle to the...
lower leg immobilization, ankle splinting, anterior tibia frame, plaster cast
Immobilizing Shoulder Joint and Humerus Injuries
High Priority Source: NATO Emergency War Surgery
Procedure:

1. For minor shoulder injuries, use a sling and swath or a Velpeau-type dressing.
2. For more severe injuries:
- Apply a well-padded plaster shoulder spica cast, extending from the shoulder to the forearm but **not...
shoulder immobilization, humerus splinting, Velpeau dressing, external fixator, plaster spica cast
Immobilizing Wrist Injuries with Short Arm Cast
High Priority Source: NATO Emergency War Surgery
Procedure:

1. Apply a short arm plaster cast extending from just below the elbow to the proximal palmar crease.
2. Position the wrist at approximately 30° of dorsiflexion.
3. If the thumb is included, position it so that the digits...
wrist immobilization, short arm cast, interphalangeal joints, external fixator

Nerve Injury (5)

Diagnose and Treat True Causalgia in Combat Situations
Critical Source: NATO Emergency War Surgery
Definition:
Causalgia is a severe burning pain often associated with autonomic changes, typically relieved by sympathetic block.

Clinical Features:
• Pain is all-consuming; patient does not tolerate any manipulation of the affected...
causalgia, sympathetic block, nerve injury, combat medicine, surgical sympathectomy
Identify and Respond to Missile Wounds Leading to Aneurysm or Arteriovenous Fistula Complicating Nerve Injury
Critical Source: NATO Emergency War Surgery
Symptoms to Watch For:
• Expanding mass in the shoulder and arm
• Presence of a thrill and/or bruit
• Progressive loss of function with severe pain

Clinical Considerations:
• Pain is similar to true causalgia (burning paresthesia, electric...
missile wounds, aneurysm, arteriovenous fistula, nerve injury, surgical exploration
Manage Blood Clot or Significant Soft Tissue Contusion in Missile Wounds
Critical Source: NATO Emergency War Surgery
Indications for Intervention:
• Missile wounds associated with a significant clot confined to closed spaces incorporating neural elements.

Closed Spaces of Concern:
• Popliteal and knee spaces
• Anterior compartment of the lower legs
-...
blood clot, soft tissue contusion, missile wound, decompression, fasciotomy, Volkmann’s contracture
Repair Sharply Transected Neural Elements in Military Settings
Critical Source: NATO Emergency War Surgery
Historical Context:
• Approximately 40% of nerve injuries treated by the military are not combat-related, but rather due to clean-cut transections from glass or sharp metal edges.

Indications for Repair:
• Soft-tissue wounds with...
nerve transection, acute repair, brachial plexus, sciatic nerve, surgical tools, nerve grafts
Remove Foreign Bodies Imbedded in Nerve Tissue Causing Severe Pain
High Priority Source: NATO Emergency War Surgery
Clinical Presentation:
• Shell fragments or other foreign bodies imbedded in nerve tissue are associated with severe pain and paresthesia.

Immediate Actions Required:
Relatively immediate surgical removal of the intraneural...
foreign body, nerve injury, shell fragment, pain management, Tegretol, Elavil

Facial Injuries (5)

Assessment and Initial Management of Zygomaticomaxillary Compound Fractures
High Priority Source: NATO Emergency War Surgery
Procedure:

1. Clinical Evaluation:
- Inspect for signs such as loss of cheek bone prominence, limitation of mandibular excursion, subconjunctival hematoma, sensory disturbance over the infraorbital nerve, and palpable bony step-off at...
zygomaticomaxillary fracture, facial bone injury, diplopia, enophthalmos, ocular examination, imaging, clinical evaluation
Diagnosis and Management of Le Fort II Fractures
High Priority Source: NATO Emergency War Surgery
Procedure:

1. Clinical Evaluation:
- Look for mobility of the dentition and maxilla transmitted to infraorbital rims and nasal bones.
- Assess for periorbital ecchymosis, edema, elongated face appearance, premature posterior...
Le Fort II fracture, mid-face fracture, cerebrospinal rhinorrhea, nasal packing, intermaxillary fixation
Management of Nasal-Orbital Ethmoid Fractures
High Priority Source: NATO Emergency War Surgery
Procedure:

1. Clinical Evaluation:
- Look for widening of the nasal bridge, increased intercanthal distance (normally about 34 mm in adult males), and almond-shaped medial palpebral fissure.
- Assess for significant edema, ecchymosis,...
nasal-orbital ethmoid fracture, medial canthal ligament, transnasal wiring, nasolacrimal duct stent
Management of Superior-Orbital-Fissure Syndrome
High Priority Source: NATO Emergency War Surgery
Procedure:

1. Clinical Evaluation:
- Look for ophthalmoplegia, ptosis, proptosis, fixed and dilated pupil, and sensory disturbances over the distribution of the ophthalmic division of V cranial nerve (supratrochlear and...
superior-orbital-fissure syndrome, ophthalmoplegia, cranial nerve injury, decompression surgery
Surgical Reduction and Stabilization of Zygomaticomaxillary Compound Fractures
High Priority Source: NATO Emergency War Surgery
Procedure:

1. Incision:
- Make an incision over the zygomaticomaxillary region at the lateral brow.

2. Elevation and Realignment:
- Use an appropriate elevator to pass behind and beneath the zygoma, elevate the fracture, and...
zygomaticomaxillary fracture surgery, orbital floor exploration, globe protector, interosseous wiring

Combat Surgery (5)

Hemostasis Management During Abdominal Surgery in Combat Conditions
Critical Source: NATO Emergency War Surgery
Overview: Effective hemostasis is essential during abdominal surgery, especially in combat environments where resources may be limited.

Steps:
1. Develop a plan for hemostasis before entering the peritoneal cavity.
2. If there is a...
hemostasis, abdominal surgery, combat conditions, laparotomy pads, thoracotomy, surgical assistant
Incision Technique for Abdominal Exploration in Combat Surgery
Critical Source: NATO Emergency War Surgery
Overview: A proper incision technique is critical for effective abdominal exploration during combat surgery.

Steps:
1. Perform a long midline incision, extending from the xiphoid process to the pubic symphysis.
2. Ensure that the...
abdominal incision, midline incision, abdominal exploration, combat surgery
Preparation of Patient for Operation in Combat Surgery
Critical Source: NATO Emergency War Surgery
Overview: Proper preparation is essential to ensure the patient is ready for surgery and to optimize outcomes.

Steps:
1. Insert two large-bore intravenous catheters as soon as the patient arrives in the receiving area.
2. **Take blood...
patient preparation, intravenous catheters, antibiotics, urinary catheter, nasogastric tube, associated injuries, endotracheal tubes, documentation
Consider Extenuating Circumstances in Combat Surgery
High Priority Source: NATO Emergency War Surgery
Overview: Surgeons must consider unique combat conditions when making decisions about patient care, especially for Priority II patients.

Key Considerations:
1. No inviolable rules: Surgical decisions should be flexible and adaptable to...
combat surgery, extenuating circumstances, patient classification, blood availability, evacuation methods, surgical assistance
Pre-Operative Preparation and Team Coordination in Combat Surgery
High Priority Source: NATO Emergency War Surgery
Overview: Surgeons must ensure optimal pre-operative conditions and team coordination to perform successful operations under combat circumstances.

Steps:
1. Ensure adequate illumination in the operating area before beginning the...
pre-operative preparation, team coordination, surgical assistant, illumination, suction availability, operation planning

Tactical Medical Support (5)

Deploying Medical Assets on Aircraft Carriers for Role 2 Navy Support
Critical Source: TCCC 17 13 Army Tactical Combat Casualty Care
The aircraft carrier battle group includes one operating room, 52 ward beds, and 3 intensive care beds. The staff includes one surgeon and five additional medical officers. Medical assets aboard aircraft carriers are intended for use by the...
aircraft carrier medical assets, role 2 navy
Deploying the EMEDS+10 Capability for Role 2 Air Force Support
Critical Source: TCCC 17 13 Army Tactical Combat Casualty Care
EMEDS+10 is the second increment of the EMEDS capability and builds on EMEDS HRT, adding six beds to EMEDS basic. EMEDS+10 provides medical, surgical, and critical care augmentation; laboratory service; additional bioenvironmental...
EMEDS+10, expeditionary medical support, role 2 air force
Deploying the Expeditionary Medical Support (EMEDS) Health Response Team (HRT) for Role 2 Air Force Support
Critical Source: TCCC 17 13 Army Tactical Combat Casualty Care
The expeditionary medical support (EMEDS) health response team (HRT) is the basic EMEDS capability consisting of 40 personnel. The HRT can stabilize and hold four patients for 24 hours. It provides medical and surgical support for an...
EMEDS HRT, expeditionary medical support, role 2 air force
Deploying the Mobile Field Surgical Team (MFST) for Role 2 Air Force Support
Critical Source: TCCC 17 13 Army Tactical Combat Casualty Care
The mobile field surgical team (MFST) consists of a five-person team: general surgeon, orthopedist, anesthetist, emergency medicine physician, and operating room nurse or technician. The MFST provides 10 lifesaving or limb-saving procedures in...
MFST, mobile field surgical team, tactical medical support, role 2 air force
Deploying the Surgical Company (SC) for Role 2 Marine Expeditionary Force Support
Critical Source: TCCC 17 13 Army Tactical Combat Casualty Care
A surgical company (SC) provides surgical care for the Marine Expeditionary Force. The SC provides stabilizing surgical procedures (damage control surgery) with four forward resuscitative surgical systems, four shock trauma platoons, and...
surgical company, marine expeditionary force, role 2

Pregnancy Dental Care (5)

Managing Dental Cavities During Pregnancy
High Priority Source: Where There is No Dentist
If a pregnant woman has cavities, the following steps should be taken:

1. Fill cavities as soon as possible to prevent further complications.
2. Maintain regular cleaning of teeth, even if gums are bleeding initially.
3. **Use warm salt...
cavity treatment,pregnancy,dental infection,vitamin c,salt water rinse
Tooth Extraction During Pregnancy
High Priority Source: Where There is No Dentist
If a pregnant woman requires tooth extraction due to an abscess or severe cavity, follow these steps:

1. Ensure the extraction is performed as early as possible in pregnancy if it is safe and necessary.
2. Use gentle techniques during the...
tooth extraction,pregnancy,dental abscess,anesthetic use,post-extraction care
Preventive Dental Care During Pregnancy
High Priority Source: Where There is No Dentist
To maintain dental health during pregnancy, follow these steps:

1. Clean your teeth every day using proper brushing techniques and fluoride toothpaste.
2. Eat a mixture of foods, especially a lot of fruits and vegetables, to ensure good...
dental care,pregnancy,tooth problems,gum health,vitamin c,salt water rinse,nutrition
Provide Dental Care for Pregnant Women
High Priority Source: Where There is No Dentist
Purpose: To ensure safe and effective dental care for pregnant women to protect both the mother and baby.

### Steps:
1. Ask about pregnancy status
- When talking to a woman, find out if she is pregnant.
- A pregnant woman’s gums are...
pregnant woman, dental care, X-ray precautions, tetracycline avoidance, blood pressure monitoring
Recognizing and Preventing Gum Bleeding During Pregnancy
High Priority Source: Where There is No Dentist
To prevent gum bleeding during pregnancy:

1. Brush teeth regularly with a soft-bristled brush and fluoride toothpaste.
2. Floss daily to remove plaque buildup that can cause gum irritation.
3. Rinse with warm salt water (see page 7) if...
gum bleeding,pregnancy,vitamin c,salt water rinse,plaque removal

Medicine Management (5)

Care for Your Medicine Kit
High Priority Source: Where There is no Doctor a Village Health Care Handbook
CAUTION: Keep all medicines out of the reach of children. Any medicine taken in large doses can be poisonous.

Be sure that all medicine is well labeled and that directions for use are kept with each medicine. Keep a copy of this book with...
medicine storage,kit maintenance,safety precautions
Update Medicines List Based on Local Availability and Effectiveness
High Priority Source: Where There is no Doctor a Village Health Care Handbook
When updating the list of medicines for use in a specific area:

1. Consult local health authorities to determine which medicines are currently available and effective in your region.
2. **Refer to the World Health Organization’s List of...
medicines,update,list,local,availability,effectiveness,WHO,essential drugs,warnings,dangerous medicines
Contents of the Home Medicine Kit
Standard Source: Where There is no Doctor a Village Health Care Handbook
Each family should have the following things in their medicine kit. These supplies should be enough to treat many common problems in rural areas.

Also include useful home remedies in your medicine kit.
kit contents,home remedies,essential supplies
Buying Supplies for the Medicine Kit
Standard Source: Where There is no Doctor a Village Health Care Handbook
Most of the medicines recommended in this book can be bought in the pharmacies of larger towns. If several families or the village got together to buy what they need at once, often the pharmacist may sell them supplies at lower cost. Or if medicines...
cost-effective purchasing,medicine procurement,pharmacy tips
Determine Appropriate Medicine Quantities for a Kit
Standard Source: Where There is no Doctor a Village Health Care Handbook
The amounts of medicines recommended for the medicine kits are the smallest amounts that should be kept on hand. In some cases there will be just enough to begin treatment. It may be necessary to take the sick person to a hospital or go for more...
medicine quantities,kit preparation,emergency supplies

Infant Nutrition (5)

Introduce Solid Foods to Babies from 6 Months to 1 Year of Age
High Priority Source: Where There is no Doctor a Village Health Care Handbook
### Instructions
1. Keep giving breast milk, if possible until the baby is 2 or 3 years old.
2. When the baby is 6 months old, start giving her other foods in addition to breast milk. Always give the breast first, and then the other...
introducing solids, baby nutrition, breast milk and solids
Prepare Nutritious Baby Feedings with Canned Evaporated Milk
High Priority Source: Where There is no Doctor a Village Health Care Handbook
### Ingredients
2 parts canned evaporated milk
3 parts boiled, cooled water
1 large spoonful sugar or oil for each large glass

### Instructions
1. Boil the water separately and cool it to a safe temperature.
2. Open the canned...
canned evaporated milk, baby feeding, infant nutrition, safe feeding practices
Prepare Nutritious Baby Feedings with Milk and Water
High Priority Source: Where There is no Doctor a Village Health Care Handbook
### Ingredients
2 parts boiled, cooled cow’s milk
1 part boiled, cooled water
1 large spoonful sugar or oil for each large glass

### Instructions
1. Boil the milk and water separately.
2. Cool both liquids to a safe temperature...
baby feeding, milk and water mixture, infant nutrition, safe feeding practices
Prepare Nutritious Porridge for Babies Without Milk
High Priority Source: Where There is no Doctor a Village Health Care Handbook
### Ingredients
Rice, cornmeal, or other cereal
Skinned beans, eggs, meat, chicken, or other protein sources
Sugar and oil (if available)

### Instructions
1. If milk is not available, prepare a porridge from rice, cornmeal, or...
porridge for infants, baby nutrition without milk, safe feeding practices
Preparing and Using Powdered Milk for Infants
High Priority Source: Where There is no Doctor a Village Health Care Handbook
Procedure:

• Identify the need for powdered milk when breast milk is not available, especially for infants.
• Ensure that powdered milk is used only under appropriate conditions to maximize its nutritional value.

**Preparation...
powdered milk,infants,nutrition,breast milk,formula preparation,sugar,oil

Eye Conditions (5)

Recognize and Respond to Acute Glaucoma
Critical Source: Where There is no Doctor a Village Health Care Handbook
Signs of Acute Glaucoma:

• Sudden severe headache or eye pain.
• Redness in the affected eye.
• Blurred vision.
• Hard eyeball (feels like a marble when touched).
• Nausea and vomiting may occur.
• Pupil of the affected eye is larger than that...
glaucoma, eye pain, blindness, emergency, pupil dilation, medical help
Recognize and Respond to Iritis (Inflammation of the Iris)
Critical Source: Where There is no Doctor a Village Health Care Handbook
Signs of Iritis:

• Pain in one eye only, which may begin suddenly or gradually.
• Excessive watering of the affected eye.
• Increased pain in bright light.
• Tenderness when touching the eyeball.
• No pus (unlike conjunctivitis).
• Blurred...
iritis, eye pain, redness, emergency, medical help, pupil irregularity
Recognize and Respond to Chronic Glaucoma
High Priority Source: Where There is no Doctor a Village Health Care Handbook
Signs of Chronic Glaucoma:

• No pain (often asymptomatic in early stages).
• Gradual loss of vision, starting from the side.
• Person may not notice the loss of vision until it is advanced.

Detection Method:

1. Have the person cover one...
chronic glaucoma, vision loss, eye drops, pilocarpine, medical help
Assess and Monitor for Strabismus (Cross Eyes or Lazy Eye)
Standard Source: Where There is no Doctor a Village Health Care Handbook
Procedure:

1. Observe if the child’s eye sometimes wanders but returns to normal vision at other times.
- If this is the case, usually no immediate action is required as the eye may grow straighter over time.
2. If the eye is always turned...
strabismus,lazy eye,cross eyes,eye alignment,vision check,patching,surgery,glasses
Recognize and Manage Cataracts
Standard Source: Where There is no Doctor a Village Health Care Handbook
Procedure:

1. Identify signs of cataracts:
- The lens behind the pupil becomes cloudy, making the pupil look gray or white when light is shone into it.
2. Assess the patient’s condition:
- Cataracts are common in older adults but...
cataract, cloudy lens, eye surgery, artificial lens, vision restoration

Cardiovascular Health (5)

Recognizing and Managing Heart Trouble in Older Adults
Critical Source: Where There is no Doctor a Village Health Care Handbook
Procedure:

1. Watch for signs of heart trouble such as shortness of breath without exercise, unexplained tiredness, weakness, dizziness.
2. Women may experience more fatigue, sleep problems, or chest discomfort rather than sharp pain.
3. If any...
heart trouble,shortness of breath,circulation
Manage Heart Disease with Medication and Lifestyle Changes
High Priority Source: Where There is no Doctor a Village Health Care Handbook
For individuals diagnosed with heart disease:

• Different heart conditions require specific medications that must be used carefully.
• It is crucial to receive the correct medication when needed.
• Avoid overexertion that causes chest pain or...
heart disease management, medication for heart health, hypertension treatment
Recognize Signs of Heart Problems
High Priority Source: Where There is no Doctor a Village Health Care Handbook
Signs of heart problems include:

• Anxiety and difficulty breathing after exercise; asthma-like attacks that get worse when lying down (cardiac asthma).
• Sudden, painful chest, left shoulder, or arm attacks during exercise that subside with...
heart attack, angina pectoris, cardiac asthma, chest pain, heart symptoms, cardiovascular health
Dietary Recommendations for People with Heart Problems
High Priority Source: Where There is no Doctor a Village Health Care Handbook
For people with heart problems:

• Avoid greasy foods and lose weight if overweight.
• Do not smoke or drink alcohol.
• If an older person experiences breathing difficulties or swollen feet, they should eat a low-salt diet for the rest of their...
heart diet, low salt diet, aspirin for heart health, cardiovascular nutrition
Understand Blood Pressure and Its Variability
Reference Source: Where There is no Doctor a Village Health Care Handbook
Blood pressure is the force or pressure of the blood upon the walls of the blood vessels (arteries and veins). It varies with the age and health of the person.
blood pressure,arteries,veins,health monitoring

Antibiotic Usage (5)

Administering Crystalline Penicillin (Short-Acting) for Severe Infections
Standard Source: Where There is no Doctor a Village Health Care Handbook
Purpose: Treat severe infections such as tetanus, severe pneumonia, badly infected wounds, gangrene, or syphilis.

Dosage Guidelines:
Adults and children over 8 years: 1 million U. every 4 hours for 10 to 14 days
• **Children aged 3 to...
crystalline penicillin, severe infections, dosage, injection
Administering Penicillin V for Serious Infections
Standard Source: Where There is no Doctor a Village Health Care Handbook
Purpose: Treat more serious infections such as severe pneumonia, badly infected wounds, gangrene, or syphilis.

Dosage Guidelines (Double the Mild Infection Dosage):
Adults and children over 12 years: 1000 mg. 4 times a day for 10...
penicillin V, serious infections, dosage, antibiotic treatment
Administering Penicillin V for Strep Throat (to Prevent Rheumatic Fever)
Standard Source: Where There is no Doctor a Village Health Care Handbook
Purpose: Treat strep throat and prevent rheumatic fever.

Dosage Guidelines:
Adults and children over 12 years: 500 mg. 2 times a day for 10 days
Children aged 6 to 12 years: 250 to 500 mg. 2 times a day for 10 days
• **Children...
penicillin V, strep throat, rheumatic fever prevention, dosage
Administering Procaine Penicillin (Intermediate-Acting) for Infections
Standard Source: Where There is no Doctor a Village Health Care Handbook
Purpose: Treat infections when injectable penicillin is needed, especially for most non-severe cases.

Dosage Guidelines:
Adults and children over 8 years: 1 million U. once daily for the duration of treatment (dose may vary depending...
procaine penicillin, intermediate-acting, dosage, injection
Choosing the Right Kind of Penicillin for Injection
Standard Source: Where There is no Doctor a Village Health Care Handbook
Purpose: Select the appropriate penicillin preparation based on infection severity and duration.

Types of Penicillin:
1. Short-acting penicillin (e.g., crystalline penicillin, benzylpenicillin):
- Acts quickly but does not last long
...
penicillin injection types, short-acting, intermediate-acting, long-acting

Tuberculosis Treatment (5)

Administer Isoniazid (INH) for TB Treatment
High Priority Source: Where There is no Doctor a Village Health Care Handbook
Overview: Isoniazid (INH) is used to treat and prevent tuberculosis (TB). It should be taken with caution due to potential side effects.

Dosage Instructions:
Adults: 300 mg. (3 tablets of 100 mg.) once daily.
Children: 50 mg....
isoniazid, INH, TB treatment, dosage, side effects, liver damage, vitamin B6
Administer Rifampicin for TB Treatment
High Priority Source: Where There is no Doctor a Village Health Care Handbook
Overview: Rifampicin is a powerful antibiotic used to treat TB and leprosy. It must be taken with other medications to prevent resistance.

Dosage Instructions:
Adults: 600 mg. (two 300 mg. tablets or four 150 mg. tablets) once daily,...
rifampicin, TB treatment, dosage, liver damage, contraceptive interaction
Administer Streptomycin for TB Treatment
High Priority Source: Where There is no Doctor a Village Health Care Handbook
Overview: Streptomycin is an injectable antibiotic used to treat tuberculosis.

Dosage Instructions:
• Available in vials containing 1 g. per vial.
• Administer as directed by a health worker, typically via injection.

**Side Effects &...
streptomycin, TB treatment, injection, dosage, kidney damage
Administering Combination Therapy for Tuberculosis (TB)
High Priority Source: Where There is no Doctor a Village Health Care Handbook
Overview: Tuberculosis must be treated with a combination of 4 anti-TB medicines at the same time to prevent drug resistance and ensure effective treatment.

Procedure:
1. Start with the following regimen for new cases of TB:
- Take...
TB treatment, combination therapy, drug resistance, isoniazid, rifampicin, ethambutol, pyrazinamide, streptomycin
Administer Vitamin B6 for Isoniazid-Induced Deficiency
High Priority Source: Where There is no Doctor a Village Health Care Handbook
Title: Administer Vitamin B6 for Isoniazid-Induced Deficiency

Procedure:
1. Indications: Persons with tuberculosis being treated with isoniazid may develop a lack of vitamin B6.
2. Prevention: Take 25 mg of vitamin B6 (pyridoxine)...
vitamin B6, isoniazid, tuberculosis, neurological symptoms, pyridoxine

Asthma Management (5)

Administer Epinephrine for Severe Asthma Attack
Critical Source: Where There is no Doctor a Village Health Care Handbook
Indication: Use epinephrine when there is trouble breathing during a severe asthma attack and other medicines are not available.

Dosage (using ampules of 1 mg. in 1 ml. of liquid):
Adults: Inject just under the skin: [1]/3 ml.
-...
epinephrine, asthma attack, severe breathing difficulty, dosage, emergency medication
Administer Prednisolone or Prednisone for Severe Asthma Attacks
High Priority Source: Where There is no Doctor a Village Health Care Handbook
Dosage:

First dose: Administer immediately.
Subsequent doses: Take every morning for 3 to 7 days.

Dosage by Age:
Adults and children over 8 years: 30–60 mg per dose.
Children aged 3–7 years: 20–40 mg per dose.
-...
prednisolone, prednisone, severe asthma, corticosteroids, dosage
Administer Liquid Oral Salbutamol for Asthma
High Priority Source: Where There is no Doctor a Village Health Care Handbook
Dosage:

Adults: 10 ml, 3 times a day.
Children (1 to 12 years): 5 ml, 3 times a day.
Babies: 2½ ml, 3 times a day.

Important Notes:
• If used very often, the body may become resistant, requiring more medication for the...
salbutamol, asthma, dosage, children, adults, pregnancy, side effects
Avoid Beta Blocker Medications for People with Asthma
High Priority Source: Where There is no Doctor a Village Health Care Handbook
Important Note:
• If you have asthma and heart problems, do not take beta blocker drugs like Atenolol, Metoprolol, Propranolol, or other “olol” ending heart medicines without consulting a doctor.
• These medications can worsen asthma...
beta blockers, asthma, heart medications, contraindications
Use Beclomethasone Inhaler for Asthma Prevention
Standard Source: Where There is no Doctor a Village Health Care Handbook
Dosage:

Children and Adults:
- 2 to 4 puffs, 2 times each day of the 50 mcg. inhaler.
- If using more than 4 puffs twice a day, switch to 1 to 2 puffs of the 250 mcg. inhaler for better cost-effectiveness and efficacy.

**Important...
beclomethasone, inhaler, asthma prevention, dosage, spacer

Injury Management (5)

Triage and Treatment of Mechanical Trauma in a Nuclear Detonation
Critical Source: Planning Guidance for Response to Nuclear Detonation May 2022 FEMA
Procedure:

1. Identify mechanical trauma injuries, which may include fractures, internal injuries, head trauma, and lacerations caused by the blast wave, building collapse, falling debris, or car accidents.
2. Assess for complications...
mechanical trauma,nuclear detonation,triage,treatment,austere conditions,medical response
Recognize and Respond to Combined Injuries from Radiation and Trauma
Critical Source: Planning Guidance Nuclear Detonation FEMA
Procedure:

1. Assess the patient for multiple injuries including radiation exposure, trauma, or burns.
2. Identify combined injury when a person has both radiation exposure and trauma/burns simultaneously.
3. **Triage patients with...
combined injury,radiation trauma,burns,triage,nuclear emergency
Injured Survivor Management in LDZ
High Priority Source: Planning Guidance for Response to Nuclear Detonation May 2022 FEMA
Action: Direct injured survivors to RTR (Radiation Triage, Treatment, and Transport) sites if they are mobile. Details:
• Most of the injuries incurred within the LDZ will not be life-threatening.
• The uninjured and those with minor...
RTR sites,injured survivors,self-treatment,first aid,LDZ
Assess and Manage Injuries from Antitank Landmines
Standard Source: Emergency War Surgery
Procedure for Assessing and Managing Injuries from Antitank Landmine Detonation

Overview:
Antitank landmines can cause a range of injuries, including blunt trauma, fractures, internal damage due to blast effects or the projectile created by...
antitank landmine, injuries, blunt trauma, fractures, internal damage, imaging, splints, tourniquets
Managing Combined Esophageal and Airway/Vascular Injuries
Reference Source: Emergency War Surgery
Procedure for Managing Combined Esophageal, Airway, and Vascular Injuries:

1. Separation with Healthy Tissue:
- All esophageal injuries combined with airway or vascular injury require separation with healthy tissue.
- Strap muscles...
esophageal injury, airway injury, vascular injury, strap muscles, sternocleidomastoid muscle

Parasitic Diseases (5)

Prevent Echinococcosis (Hydatid Disease) Infection
Standard Source: Student manual 2005
Prevent echinococcosis infection:

Avoid contact with infected animals, such as foxes, coyotes, dogs, and cats.
• The disease is caused by the larval stage of *Echinococcus multilocularis*, a microscopic tapeworm found in these animals.
-...
echinococcosis,hydatid disease,tapeworm infection
Prevent Giardiasis Infection
Standard Source: Student manual 2005
Prevent giardiasis infection:

Avoid drinking contaminated water, especially from sources that may be contaminated by beavers or other animals.
• Giardiasis is caused by a parasite that can be carried by many animals, including beavers.
-...
giardiasis,contaminated water,beaver parasite
Prevent Raccoon Roundworm Infection (Baylisascaris procyonis)
Standard Source: Student manual 2005
Prevent raccoon roundworm infection:

Avoid contact with raccoon feces, as the eggs can survive for years in the environment.
• Eggs are passed in raccoon feces and become infective to other animals and humans after 2–4 weeks.
• People...
raccoon roundworm,Baylisascaris procyonis,egg contamination
Prevent Sarcoptic Mange Transmission
Standard Source: Student manual 2005
Prevent sarcoptic mange transmission:

Avoid direct contact with infected animals, especially red foxes, coyotes, squirrels, raccoons, and domestic dogs.
Avoid contact with contaminated areas such as dens or burrows where mites may...
sarcoptic mange,parasitic mite,red fox infection
Prevent Trichinosis Infection
Standard Source: Student manual 2005
Prevent trichinosis infection:

Cook furbearer meat thoroughly until the juices run clear to kill any parasites.
• Freezing game meat, even for long periods, may not kill all worms.
• Curing (salting), drying, smoking, or microwaving meat...
trichinosis,raw meat infection,Thorough cooking

Medication Access (5)

Acquire Medications for Long-Distance Travel by Purchasing a Boat or Yacht
Standard Source: Survival and Austere Medicine
Objective: Legally obtain comprehensive medications by purchasing a boat or yacht that requires a medical kit.

Steps:
1. Consider purchasing a boat in countries like Australia, New Zealand, or the UK, where it is legally required to...
boat medical kit, yacht medication requirements, US public health service guidelines
Discuss Medication Needs with Your Doctor for Survival Preparedness
Standard Source: Survival and Austere Medicine
Objective: Legally obtain essential medications for survival situations by discussing your needs with a healthcare professional.

Steps:
1. Be honest and specific with your doctor about why you want to be prepared for any disaster,...
doctor consultation, medication access, survival preparedness, legal medication acquisition, drug prescription
Purchase Medications in Third World Countries with Caution
Standard Source: Survival and Austere Medicine
Objective: Obtain medications in third world countries while avoiding legal issues upon returning to your home country.

Steps:
1. Be aware that prescription medicines are available over the counter in many third-world countries, but...
third world medication purchase, drug importation laws, counterfeit medications
Request Essential Medications for Remote Travel or Trekking
Standard Source: Survival and Austere Medicine
Objective: Obtain a comprehensive medical kit by discussing travel plans with your doctor.

Steps:
1. Discuss your travel plans with your doctor, especially if you are going to the third world or doing isolated backpacking.
2. **Request...
remote travel medical kit, malaria prophylaxis, altitude sickness meds, antibiotic request
Use Veterinary Medications as a Last Resort for Survival Medicine
Standard Source: Survival and Austere Medicine
Objective: Obtain human-grade medications through veterinary sources when other options are unavailable.

Steps:
1. Understand that veterinary drugs are generally from the same batches and factories as human versions, with only...
veterinary medications, human-grade drugs, survival medicine alternatives

Insect Bites (4)

Recognize Symptoms of Black Widow or Scorpion Bites
High Priority Source: The Complete Outdoorsmans Handbook
Procedure:
1. Be aware that symptoms may include swelling, pain, nausea, and fever.
2. In more severe cases, the bite can cause speech difficulties and breathing problems.
3. Understand that allergic individuals,...
black widow symptoms, scorpion bite symptoms, allergic reactions, emergency signs
Prevent and Control Insect-Borne Diseases in the Field
Standard Source: FM 21 10 Field Hygiene and Sanitation
Procedure:

1. Use insect repellent containing DEET or other effective ingredients to protect against mosquitoes and ticks.
2. Wear protective clothing such as long sleeves, pants, and socks to reduce exposed skin.
3. **Treat clothing...
insect repellent,malaria prevention,mosquito nets,vector control,disease prevention
Prevent Chigger and Itch Mite Infestation
Reference Source: The Complete Outdoorsmans Handbook
Procedure:

1. Avoid walking through thick, lush vegetation where chiggers and itch mites are commonly found.
2. Keep pantlegs inside boots to prevent chiggers from crawling up the legs.
3. Dust exposed areas such as ankles, wrists, necklines,...
chiggers, itch mites, prevention, sulphur dusting, hot baths, insect ointments
Understand Chiggers and Their Effects on the Skin
Reference Source: Where There is no Doctor a Village Health Care Handbook
Chigger is a tiny, crawling spider or tick-like animal that buries its head under the skin and sucks blood.
chigger,tick,bite

Chemical Poisoning (4)

Identify and Manage Phosgene Exposure
Critical Source: Medical NBC Battlebook
Overview: Phosgene (CG) is a lung-damaging agent that causes pulmonary edema by increasing the permeability of alveolar capillaries. It may also cause mild eye and upper respiratory tract irritation.

Signs and Symptoms:
• Initially,...
phosgene, CG, lung-damaging agent, pulmonary edema, hypoxemia, oxygen therapy, evacuation protocols
Recognize Symptoms of Phosphine Poisoning
High Priority Source: US Army Storage And Sanitation
Purpose: Identify the symptoms of phosphine poisoning to enable timely medical intervention.

Procedure:
1. Slight Poisoning:
- Symptoms include:
- Sensation of tightness in the chest and diaphragm
- Vomiting
-...
phosphine poisoning symptoms, chemical toxicity signs, fumigation hazards
Prevent Herbicide Poisoning from Ingestion
High Priority Source: Medical NBC Battlebook
Procedure: Prevent herbicide poisoning from ingestion

1. Identify the herbicide type: Determine if the herbicide is 2,4-D, 2,4,5-T, cacodylic acid, or picloram.

2. Prevent further absorption:
- If a toxic dose has been ingested,...
herbicide poisoning,2,4-D,2,4,5-T,cacodylic acid,picloram,gastrointestinal distress,gastric lavage,activated charcoal,supportive therapy
Understand the Medical Effects of Choking Agents (Lung-Damaging Agents)
High Priority Source: Medical NBC Battlebook
Overview: Choking agents cause damage to lung tissue and primarily induce pulmonary edema. Examples include phosgene (CG), diphosgene (DP), chlorine (Cl), and chloropicrin (PS). Other substances like nitrous fumes, zinc chloride, PFIB, and HCl...
choking agents, lung-damaging agents, phosgene, diphosgene, chlorine, chloropicrin, PFIB, HCl

Nutrition Health (4)

Benefits of Eating Well During Pregnancy and Breastfeeding
Standard Source: A Book for Midwives
Eating well means eating enough food and eating a variety of healthy foods.

Eating well:
• helps a woman resist illness and stay healthy.
• keeps a woman’s teeth and bones strong.
• gives a woman strength to work.
• helps the baby grow well in...
benefits of good nutrition, maternal health during pregnancy, breastfeeding nutrition, healthy baby development
How to Encourage Pregnant Women to Eat More Food
Standard Source: A Book for Midwives
Pregnant women and women who are breastfeeding need to eat more than usual. The extra food gives them enough energy and strength, and helps their babies grow.

Some pregnant women feel nauseated and do not want to eat. But pregnant women need to...
pregnancy nutrition, eating more during pregnancy, nausea and food intake, maternal energy needs
How to Encourage Women to Eat Healthier Foods
Standard Source: A Book for Midwives
Talk to women about the food they eat. The earlier women start eating healthier foods, the better chance they have to stay healthy, to have normal births, and to have healthy babies.

To find out whether a woman is eating well, ask her what she...
eating well, nutrition advice, health conversation, food variety, maternal health
How to Encourage a Balanced Diet During Pregnancy
Standard Source: A Book for Midwives
It is important for pregnant women (like everyone else) to eat different kinds of food: main foods (carbohydrates), grow foods (proteins), glow foods (vitamins and minerals), and go foods (fats, oils, and sugar), along with plenty of...
balanced diet during pregnancy, food groups for pregnant women, nutrition variety, maternal health

Pregnancy Nutrition (4)

Ensure Daily Intake of Five Essential Vitamins and Minerals for Pregnant Women
High Priority Source: A Book for Midwives
Objective: Ensure pregnant women receive adequate amounts of iron, folic acid, calcium, iodine, and vitamin A.

Procedure:
1. Encourage pregnant women to consume foods rich in the following five essential vitamins and minerals:
- Iron:...
vitamins, minerals, pregnant women, nutrition
Enhance Iron Absorption Through Diet and Cooking Methods
High Priority Source: A Book for Midwives
Objective: Improve iron absorption in the body to prevent anemia.

Procedure:
1. Consume iron-rich foods with vitamin C sources such as citrus fruits or tomatoes, which enhance iron absorption.
2. Cook food in iron pots to increase iron...
iron absorption, vitamin C, cooking methods, anemia prevention
Making and Using an Iodine Solution for Preventing Goiter and Cretinism
Standard Source: A Book for Midwives
Overview: Iodine is essential to prevent goiter and cretinism in children.

Procedure:
1. Preparation of iodine solution:
- Add 1 drop of Lugol’s iodine to 1 glass of clean drinking water or milk.
2. Usage guidelines:
-...
iodine solution, goiter prevention, cretinism, pregnancy, nutrition
Dietary Sources of Calcium for Pregnant Women
Standard Source: A Book for Midwives
Overview: Calcium is essential for the development of strong bones in both the mother and baby.

Procedure:
1. Consume calcium-rich foods:
- Milk, curd, yogurt, cheese
- Ground sesame (tahini)
- Almonds
- Green leafy...
calcium, pregnancy, nutrition, bone development

Pregnancy Checkup (4)

Identify Warning Signs During Prenatal Checkup
High Priority Source: A Book for Midwives
Procedure:

1. Identify the most important warning signs to look for in a pregnant woman:
- Bleeding from the vagina (see page 112)
- Severe pain in the belly (see page 113)
- High fever (see page 120)
- **High blood...
warning signs in pregnancy, maternal emergency indicators, prenatal red flags
Assess the Mother's General Health During Prenatal Checkup
Standard Source: A Book for Midwives
Procedure:

1. While talking with the mother, observe her general health.
2. Look for healthy signs: The mother looks, sounds, and feels healthy and happy.
3. Look for warning signs: The mother looks, sounds, or feels unhealthy or...
maternal health assessment, general health check, prenatal evaluation
Assess Nausea or Vomiting in Pregnant Women
Standard Source: A Book for Midwives
Procedure:

1. Ask the mother if she has any nausea or vomiting.
2. Look for healthy signs: The mother has no nausea or vomiting, or mild nausea in the first 3 or 4 months.
3. If she reports nausea or vomiting beyond the first trimester or...
nausea in pregnancy, vomiting assessment, prenatal symptoms
Conduct a Prenatal Checkup Conversation with the Mother
Standard Source: A Book for Midwives
Procedure:

1. Start the checkup by talking to the mother.
2. Ask the mother how she has been feeling and how her pregnancy is going.
3. Find out if she has any complaints or questions.
4. Observe her general health during the conversation:
-...
pregnancy checkup, prenatal conversation, maternal health assessment

Temperature Checking (4)

Monitoring Fever in a Sick Person
Standard Source: Where There is no Doctor a Village Health Care Handbook
It is often wise to take a sick person’s temperature, even if he does not seem to have a fever. If the person is very sick, take the temperature at least 4 times each day and write it down.
fever monitoring, temperature tracking, fever documentation
Check the Mother's Temperature
Standard Source: A Book for Midwives
Procedure:

1. Use the back of one hand to feel the woman’s forehead and compare it to your own or another healthy person’s.
2. If the woman has a fever, her skin will feel hotter than that of a healthy person.
3. If you have a thermometer:
-...
temperature check, fever detection, thermometer use, mercury safety, medical emergency
Checking for Fever Without a Thermometer
Standard Source: Where There is no Doctor a Village Health Care Handbook
If there is no thermometer, you can get an idea of the temperature by putting the back of one hand on the sick person’s forehead and the other on your own or that of another healthy person. If the sick person has a fever, you should feel the...
fever check, thermometer alternative, temperature assessment
How to Use a Thermometer
Standard Source: Where There is no Doctor a Village Health Care Handbook
Every family should have a thermometer. Take the temperature of a sick person 4 times a day and always write it down.

How to read the thermometer (using one marked in degrees centigrade —°C):

• Turn the thermometer until you can see the...
thermometer use, reading thermometer, fever measurement

Obstetrics Delivery (4)

Apply Pressure Above the Pubic Bone During Delivery
Critical Source: A Book for Midwives
Procedure:

1. Quickly bring the mother to the edge of the bed. If she is on the floor, put something under her hips to raise them off the ground.
2. Help the mother grab her knees and pull them back as far as she can. Have helpers hold her legs...
pressure above pubic bone, delivery, obstetrics
Position Mother in Hands-and-Knees to Assist with Delivery
Critical Source: A Book for Midwives
Procedure:

1. Put the mother in the hands-and-knees position.
2. Cup your hands around the baby’s head and gently pull straight back while counting to 30.
3. When you see the shoulder, pull up and deliver normally.
4. If this does not work,...
delivery, hands-and-knees position, shoulder delivery, obstetrics
Pull Baby’s Arm Out of the Vagina During Delivery
Critical Source: A Book for Midwives
Procedure:

1. Put your hand inside the vagina and up along the baby’s back.
2. Move your hand around the baby’s body, bend the baby’s arm, and grasp his hand.
3. Pull the hand across the baby’s chest and out of the birth opening.
4....
arm extraction, collarbone break, obstetrics delivery
Push Baby’s Shoulder from the Inside During Delivery
Critical Source: A Book for Midwives
Procedure:

1. With the mother in the hands-and-knees position, put your gloved hand inside the vagina along the baby’s back.
2. Put your fingers on the back of the shoulder that is nearest to the mother’s back.
3. Push the shoulder forward...
shoulder delivery, internal maneuver, obstetrics

Vaccinations (4)

Administer BCG Vaccine at Birth (Where Appropriate)
High Priority Source: A Book for Midwives
Procedure:

1. Administer the BCG vaccine to all newborns in areas with high rates of tuberculosis (TB) to prevent severe, disseminated TB.
2. In other regions, administer the BCG vaccine only to babies whose mothers have active TB.
3. The...
BCG vaccine,TB prevention,newborn immunization,HIV positive contraindication
Administer Hepatitis B Vaccine at Birth
High Priority Source: A Book for Midwives
Procedure:

1. Administer the first dose of the Hepatitis B vaccine immediately after birth to all newborns.
2. The vaccine is part of a series (usually 3 doses, sometimes 4) and should be given as early as possible for maximum...
Hepatitis B vaccine,birth immunization,newborn vaccination,liver disease prevention
Administer Vaccinations to Children According to Recommended Schedules
High Priority Source: Where There is no Doctor a Village Health Care Handbook
Vaccinations protect children against serious diseases such as whooping cough, diphtheria, tetanus, polio, measles, tuberculosis, hepatitis, and rotavirus.

1. Follow the vaccination schedule shown on page 147, which outlines the appropriate...
child vaccinations,vaccine schedule,polio vaccine,tetanus vaccination,rotavirus,measles,diphtheria,whooping cough
Administer Tetanus Vaccine for Lifetime Protection
High Priority Source: A Book for Midwives
Procedure:

1. Administer 5 immunizations of 0.5 ml into the muscle of the upper arm.
- Injection 1: As soon as possible.
- Injection 2: 4 weeks after injection 1.
- Injection 3: 6 months after injection 2.
- Injection 4: 1...
tetanus vaccine, immunization schedule, upper arm injection, booster shot

Family Planning (4)

Evaluate Family Planning Methods Based on Key Factors
Standard Source: Where There is no Doctor a Village Health Care Handbook
When choosing a family planning method, consider the following factors:

1. Effectiveness in preventing pregnancy:
- How well does the method prevent pregnancy? Look for ratings like ★ (some), ★★ (good), or ★★★ (very good).
2. **Protection...
family planning, effectiveness, STI protection, safety, cost, availability, side effects
Use the Family Planning Method Chart to Compare Options
Standard Source: Where There is no Doctor a Village Health Care Handbook
The following chart provides a comparison of different family planning methods based on their effectiveness in preventing pregnancy and protection from STIs:

| Family Planning Method | Protection from Pregnancy | Protection from STIs |...
family planning chart, effectiveness comparison, STI protection, side effects, hormonal methods
Help Women Make Informed Family Planning Choices
Reference Source: A Book for Midwives
Steps to Help with Family Planning:

1. Explain the available family planning methods that are suitable for her.
2. Discuss the benefits and risks of each method based on her health, lifestyle, and preferences.
3. **Help her choose a...
family planning, contraception, midwife advice
Choosing a Family Planning Method
Reference Source: A Book for Midwives
Choosing a Family Planning Method

Before recommending a family planning method, consider the following factors:

1. Effectiveness: Does she want to be sure she will not get pregnant using this method?
2. Side Effects: Is she concerned...
family planning, birth control, contraception, method selection, partner involvement, cost considerations, STI prevention

Herpes Treatment (4)

Herpes and Pregnancy: Delivery Recommendations
Critical Source: A Book for Midwives
Procedure:

• A woman in labor with an active herpes sore should give birth in a hospital, usually by caesarean surgery.

Notes:
• This is to reduce the risk of transmitting herpes to the baby during delivery.
• Immediate treatment...
herpes, pregnancy, caesarean delivery, acyclovir, transmission
Acyclovir Dosage for First Herpes Outbreak
High Priority Source: A Book for Midwives
Procedure:

• Give 400 mg acyclovir by mouth, 3 times a day for 7 to 10 days.

Notes:
• This is the standard treatment for a first-time herpes outbreak.
• Ensure the patient has access to clean water and follows up with a healthcare...
acyclovir, herpes, first outbreak, dosage, treatment
Pain Relief for Herpes Outbreaks
Standard Source: A Book for Midwives
Procedure:

• Give 500 to 1000 mg paracetamol by mouth, every 4 hours.

Notes:
• This is a recommended pain relief option during herpes outbreaks.
• Avoid exceeding the maximum daily dose of paracetamol and consult with a healthcare...
paracetamol, herpes, pain relief, treatment
Home Remedies for Herpes Sores
Standard Source: A Book for Midwives
Procedure:

• Put ice on the sore as soon as you feel it. This may stop the sore from getting worse.
• Soak a cloth in cooled black tea or tea made of cloves, and hold the wet cloth on the sores.
• Sit in a pan or bath of **clean cool...
herpes, home remedies, sores, treatment, ice, black tea, witch hazel

Injections (4)

Administering Injections for Severe Infections
High Priority Source: Where There is No Dentist
Overview:
Injections described here are different from anesthetic injections. They must be administered into a large muscle in the buttocks or arm.

Steps to Administer Injections:
1. Prepare the Injection Site:
- Clean the injection...
injections, penicillin, crystalline penicillin, aqueous procaine penicillin, severe infection, administration technique
Risks of Injections
High Priority Source: A Book for Midwives
Injections can be dangerous and should only be used when necessary. Here are some risks:

Infection: The injection site can become infected and cause an abscess.
Allergic reactions: Some injected medicines can cause strong allergic...
risks of injections, infection, allergic reactions, midwife safety
Administering Injections Safely
Standard Source: Where There is no Doctor a Village Health Care Handbook
Administering Injections Safely

Steps:
1. Ensure the injection site is clean and disinfected with alcohol or another suitable antiseptic.
2. Use a new, sterile needle and syringe for each injection.
3. Choose an appropriate injection site...
injections, injection procedure, injection safety, administering injections, injection precautions
Understand Intramuscular Injections
Standard Source: Where There is no Doctor a Village Health Care Handbook
Intramuscular (IM) injection is an injection given into a muscle, usually in the arm or buttock.

It differs from intravenous (IV) injections, which are administered directly into a vein.

Proper administration includes:
• Cleaning the injection...
intramuscular injection, IM injection, administration

Urinary Catheterization (4)

How to Insert a Catheter
High Priority Source: Where There is no Doctor a Village Health Care Handbook
### How to Insert a Catheter

1. Boil the catheter (and any syringe or instrument you may be using) for 15 minutes.

2. Wash well under foreskin or between vaginal lips and surrounding areas.

3. **Wash hands—if possible with surgical soap...
catheter insertion, urinary catheter, sterile procedure, medical emergency, male catheterization, female catheterization
Inserting a Catheter for Urinary Retention
High Priority Source: A Book for Midwives
Purpose: Insert a catheter to relieve a full bladder when non-invasive methods have failed.

Materials Needed:
• Sterile catheter (never use a non-sterile one)
• Sterile gloves
• Disinfectant soap and boiled water (cooled)
• Sterile cloths...
catheter, urinary retention, midwife, sterile, insertion, emergency
Insertion of an Indwelling Urinary Catheter in Emergency War Surgery
High Priority Source: NATO Emergency War Surgery
Procedure:

1. Insert a urinary catheter if no urethral injury is suspected: This should be done promptly.
2. Assess for blood in the urine:
- Note the presence or absence of hematuria to help determine potential urethral or bladder...
urinary catheter, emergency surgery, hematuria assessment
Assisting a Woman to Urinate During Labor or Postpartum
Standard Source: A Book for Midwives
Purpose: Help a woman urinate when she is unable to do so, preventing complications like slowed labor or postpartum hemorrhage.

Steps:
1. Listen to running water to encourage urination.
2. Ask her to squat, which can help the...
urinate, labor, postpartum, bladder, catheter, midwife, emergency

Pelvic Exam Procedures (4)

Addressing Fear and Anxiety During a Pelvic Exam
Standard Source: A Book for Midwives
Steps to Address Fear and Anxiety:

1. Acknowledge the Woman’s Feelings:
- Recognize that some women may feel fear or anxiety, especially those who have had previous painful exams or a history of abuse.

2. Respectful Communication:
...
fear during exam, patient consent, abuse history, emotional support
Assessing the Woman’s Health History Before a Pelvic Exam
Standard Source: A Book for Midwives
Steps to Assess the Woman’s Health History:

1. Gather Information:
- Ask about her last menstrual cycle (when she had her last monthly bleeding).
- Determine if she is pregnant.
- Inquire about any signs of infection in the vagina...
health history assessment, pregnancy status, infection signs
Helping the Woman Relax During a Pelvic Exam
Standard Source: A Book for Midwives
Steps to Help the Woman Relax:

1. Communication:
- Explain clearly what you are doing and why.
- Remind her to take deep breaths and let her body relax.

2. Pacing and Comfort:
- Go slowly during the exam.
- Stop immediately...
relaxation during exam, pain management, communication with patient
Reducing Shame During a Pelvic Exam
Standard Source: A Book for Midwives
Steps to Reduce Shame and Promote Comfort:

1. Normalize the Experience:
- Explain that examining the genitals and vagina is a normal part of healthcare.
- Encourage the woman to ask questions about her body and the exam process.

2....
shame reduction, patient education, body normalization

Vaginal Procedures (4)

Checking Tissue After MVA (Step 19)
Standard Source: A Book for Midwives
Procedure:

To check if all tissue has been removed after MVA:

1. Look at the tissue from the womb to see if it is complete.
2. **It is important to know if you have removed all the tissue, because if any is left inside the womb it can...
MVA,tissue check,midwife,pregnancy removal
Disposing of Tissue After MVA (Step 20)
Standard Source: A Book for Midwives
Procedure:

To safely dispose of tissue after MVA:

1. Use the suggestions on page 67 to 69 to safely dispose of the bloody tissue.

Note: Proper disposal is essential to prevent infection and ensure safety for both the midwife and the...
MVA,tissue disposal,midwife,safety,disposal procedures
Handling Problems with MVA - Cannula Comes Out of Womb
Standard Source: A Book for Midwives
Procedure:

If the tip of the cannula comes out of the womb after the valve has been opened:

1. Even if it comes out just a little, the vacuum will be lost.
2. The syringe will not be able to remove any more tissue.
3. **You must solve...
MVA,cannula failure,midwife,problem solving
Responding to Vagal Reaction During MVA
Reference Source: A Book for Midwives
Procedure:

When a woman experiences a vagal reaction during an MVA:

1. Stop the MVA immediately.
2. Remove the cannula, tenaculum, and speculum.
3. Help the woman move off her back and onto her side.
4. **Keep her warm and...
vagal reaction,MVA,cannula,womb,midwife,procedure

Education Models (4)

Create a Birth Box and Birth Pants Model for Educational Purposes
Reference Source: A Book for Midwives
Materials Needed:
• Fabric or materials to create the birth box
• Fabric for birth pants

Steps:
1. Construct the birth box: Create a model of the birth box using appropriate materials that can simulate the birthing environment.
2....
birth box, birth pants, educational models, midwifery teaching tools
Create a Model Umbilical Cord for Educational Purposes
Reference Source: A Book for Midwives
Materials Needed:
• Cloth (52 cm long, 8 cm wide)
• Thread
• Soft stuffing material
• Thin fabric
• Strings or yarn
• Safety pin or sewing materials
• Doll

Steps:
1. Cut the cloth: Cut a long piece of cloth about 52 centimeters (20...
model, umbilical cord, educational materials, midwifery teaching tools
Create a Realistic Baby Doll for Educational Purposes
Reference Source: A Book for Midwives
Materials Needed:
• Papier maché or hard material (gourd, ball, wood, stone)
• Soft stuffing material
• Fabric
• Foam rubber, rags, or dried grass
• Paint and markers

Steps:
1. Make a hard head: Create a hard head with a hollow center...
baby doll, educational materials, midwifery teaching tools
Use Models to Demonstrate the Birth Process
Reference Source: A Book for Midwives
Materials Needed:
• Baby doll
• Placenta model
• Membranes model
• Womb model (with red circle)
• Pins and drawstrings

Steps:
1. Assemble the womb: Place the baby inside the membranes with the placenta, then put the membrane bag into...
birth simulation, educational models, midwifery teaching tools

Diabetes Preparedness (4)

Create a Diabetes Emergency Kit
High Priority Source: Diabetes Disaster Preparedness
Purpose: Ensure you have all necessary medical supplies for managing diabetes during a disaster.

Steps:
1. Store the following items in a safe, easily accessible location:
- Copy of emergency information and medical list
- Extra...
diabetes, emergency kit, disaster preparedness, medical supplies, insulin, blood sugar meter, glucagon, diabetes management
Manage Blood Sugar During a Disaster
High Priority Source: Diabetes Disaster Preparedness
Purpose: Maintain stable blood sugar levels during emergencies.

Steps:
1. Monitor blood sugar frequently, especially during the first 72 hours of a disaster.
2. Keep a blood sugar diary to track changes and patterns.
3. Use **urine...
blood sugar management, diabetes disaster, hypoglycemia prevention, ketone testing
Foot Care During a Disaster
High Priority Source: Diabetes Disaster Preparedness
Purpose: Prevent foot injuries and infections during emergencies.

Steps:
1. Wear protective clothing and sturdy shoes at all times, even in disaster zones.
2. Check your feet daily for signs of irritation, infection, open sores, or...
foot care, diabetes disaster, infection prevention, foot injury
Proper Storage and Handling of Insulin
High Priority Source: Diabetes Disaster Preparedness
Purpose: Maintain the effectiveness and safety of insulin during emergencies.

Steps:
1. Store unopened insulin at room temperature (59–86°F) for up to 28 days.
2. In-use insulin pens can be stored at room temperature, following...
insulin storage, diabetes management, emergency preparedness, insulin handling, syringe reuse

Injury Prevention (4)

Avoiding Compounding Injuries in Cold Injury Patients
High Priority Source: NATO Emergency War Surgery
Objective: Prevent further injury or complications in cold-injured casualties.

Procedure Steps:
1. Avoid physical manipulation: Do not rub, massage, or apply unguents to frozen parts as this may cause additional tissue damage.
2....
avoiding compounding injury, frostbite prevention, cold injury management, military trauma care
Common Parachute Injury Sites and Types
Standard Source: Emergency War Surgery
Injury Site/Type Distribution (%):

Ankle: 20%
Back: 11.1%
Knee: 10.7%
Head/Neck: 8.7%
Leg: 8.3%
Sprain/Strains: 37.7%
Contusions: 30.1%
Lacerations: 14.7%
Closed Fractures: 11.1%
-...
parachute, injury types, military, fractures, calcaneus
Contact USACHPPM for Laser/Radiofrequency Hazard Assistance
Standard Source: Medical NBC Battlebook
Procedure:

1. Identify the need for assistance related to laser or radiofrequency hazards, including their identification and protection measures.
2. Contact **USACHPPM (United States Army Center for Health Promotion and Prevention...
USACHPPM,laser hazard identification,radiofrequency hazard protection,United States Army Center for Health Promotion and Prevention Medicine
Assessing Parachute Injury Risk Factors
Standard Source: Emergency War Surgery
Factors Influencing Parachute Injuries:

Weather conditions: Wind intensity.
Time of day: Day or night jump.
Drop zone hazards/terrain: Obstacles, rough terrain, etc.
Low drop altitude: Proximity to the ground during...
parachute, injury risk factors, military, combat, drop zone hazards

Trauma Shock (4)

Classify Patients Based on Response to Fluids in Traumatic Shock
Critical Source: Emergency War Surgery
Objective: Determine the need for surgical intervention based on patient response to resuscitation.

Procedure:
1. Categorize patients into three groups based on fluid responsiveness:
- Responders: Patients who show a sustained...
fluid response, responders, transient responders, nonresponders, surgical intervention
Controlled Resuscitation Guidelines for Nonresponders in Traumatic Shock
Critical Source: Emergency War Surgery
Objective: Provide a structured approach to resuscitation when patients are not responding to initial interventions.

Procedure:
1. Assess the tactical scenario and consider whether resuscitation is futile (e.g., in combat or remote...
controlled resuscitation, nonresponders, blood transfusion, surgical intervention
Diagnose and Treat Tension Pneumothorax in Traumatic Shock
Critical Source: Emergency War Surgery
Objective: Identify and manage tension pneumothorax to prevent respiratory failure.

Procedure:
1. Assess for signs of tension pneumothorax, including:
- Sudden onset of dyspnea
- Tracheal deviation away from the affected side
...
tension pneumothorax, needle decompression, traumatic shock
Establish IV Access and Administer Intravenous Fluids in Traumatic Shock
High Priority Source: Emergency War Surgery
Objective: Restore intravascular volume and stabilize the patient.

Procedure:
1. Establish IV access using a large-bore catheter (e.g., 14- or 16-gauge) in a peripheral vein or central line if available.
2. **Administer fluids based on...
IV fluids, LR, hetastarch, HTS, traumatic shock

Shock Resuscitation (4)

Managing Shock and Resuscitation in Combat Situations
Critical Source: NATO Emergency War Surgery
Procedure:

1. Estimate blood loss as a starting point for resuscitation but rely on clinical parameters, not just estimates, to guide therapy.
2. Monitor urinary output (minimum objective: 50 cc/hour for adults; double this in...
shock management, resuscitation, infusion therapy failure, surgical intervention, crush injury
Resuscitation From Shock - Phase 1 Goals
Critical Source: Emergency War Surgery
Shock resuscitation is approached in two phases:

### First Phase Resuscitation Goals:
• Achieve a mean arterial pressure (MAP) of >60 mm Hg.
• Ensure a urine output of 0.5 cc/kg/h (at least 30 ccs/h).
• Maintain an **arterial oxygen...
resuscitation,shock,MAP,urine output,oxygen saturation,crystalloid solution
Vasopressor Use in Shock Resuscitation
Critical Source: Emergency War Surgery
Use vasopressors only after fluid boluses:

• Vasopressors should be considered only for achieving minimal acceptable blood pressure after:
- Fluid boluses have been administered.
- Adequate intravascular volume has been confirmed.
-...
vasopressors,dopamine,norepinephrine,cardiac dysfunction
Identify and Classify Types of Shock
Critical Source: NATO Emergency War Surgery
Objective: Accurately identify the type of shock a patient is experiencing to provide appropriate treatment.

Types of Shock:
1. Hemorrhagic Shock:
- Caused by significant blood loss leading to inadequate capillary perfusion.
-...
shock classification, hemorrhagic shock, septic shock, neurogenic shock, oligemic shock, resuscitation, battlefield medicine

Injury Assessment (4)

Assess Cranial Nerves and Consult Specialists for Facial Injuries
High Priority Source: Emergency War Surgery
Title: Assess Cranial Nerves and Consult Specialists for Facial Injuries

Content:

• Perform a cranial nerve examination to assess the following:
- Vision, gross hearing, facial sensation, facial muscle movement, tongue mobility,...
cranial nerve examination,ophthalmology consultation,NOE fracture
Avoid Nasal Instrumentation in NOE Fractures
High Priority Source: Emergency War Surgery
Title: Avoid Nasal Instrumentation in NOE Fractures

Content:

• If a naso-orbitoethmoid (NOE) fracture is present, do not instrument the nose if possible.
• There may be a tear in the dura, and instrumentation could contaminate...
NOE fracture,nasal instrumentation,dura tear,cerebrospinal fluid contamination
Identify Common Causes of Injuries in Armed Conflicts
High Priority Source: First Aid in Armed Conflicts
In armed conflicts, the type of situation determines the kinds of wounds you may encounter. Below is a summary of common causes and expected injuries:

|Cause of the injuries:|Expect to see:|
|---|---|
|Explosion<br>•|Blast and blunt...
armed conflict injuries, blast injury, fragmentation mine, gunshot wounds, slash wounds, tear gas, pepper powder
Parachute Injury Statistics and Impact
Standard Source: Emergency War Surgery
Peacetime Injuries:

Rate: 0.8% of jumpers.

Combat Injuries:

Historical rate: As high as 30% overall.
Majority of injuries: Minor.
Combat effectiveness impact: 8% to 10% of total jumpers are rendered either combat...
parachute injury statistics, fracture impact, spinal precautions

Genitourinary Injuries (4)

Basic Principles of Ureteral Repair
Critical Source: Emergency War Surgery
The following principles guide the repair of ureteral injuries:

Minimal debridement to preserve tissue viability.
Primary tension-free anastomosis using a 1 cm spatulated technique with **interrupted single-layer absorbable...
ureteral repair, anastomosis, stent placement, lengthening maneuvers
Types of Ureteral Repair Based on Injury Location and Extent
Critical Source: Emergency War Surgery
The type of repair depends on the following factors:

Anatomical segment (upper, middle, or lower third of the ureter)
Extent of segmental loss (short vs. long segment)
Other associated injuries
• **Clinical stability of the...
ureteroureterostomy, ureteroneocystostomy, Prolene suture, transverse cystotomy
Manage Anterior Urethral Injuries from Blunt or Penetrating Trauma
High Priority Source: Emergency War Surgery
Anterior urethral injuries may result from:

Blunt trauma, such as falls when astride an object (straddle)
Penetrating injuries

### Management of Minor Nondisruptive Injuries:
1. Insert a 16 French Foley catheter and leave it in...
anterior urethral injury, blunt trauma, penetrating wound, marsupialization, chromic suture
Manage Posterior Urethral Disruption Following Pelvic Fractures
High Priority Source: Emergency War Surgery
Posterior urethral disruption commonly occurs following pelvic fracture injuries. Signs include:

• Rectal examination revealing the prostate to have been avulsed at the apex

### Management:
1. If no injury is identified on retrograde...
posterior urethral injury, pelvic fracture, suprapubic cystostomy, prostatomembranous stricture

Respiratory Injuries (4)

Treat Tension Pneumothorax (PTX) in Combat Settings
Critical Source: TCCC 17 13 Tactical Combat Casualty Care
Procedure:

1. Assess the casualty for signs of tension pneumothorax, such as difficulty breathing, decreased breath sounds on one side, or cyanosis.
2. Seal open chest wounds with a vented chest seal to prevent further air entry into...
tension pneumothorax, needle chest decompression, chest wound sealing, ventilation support
Diagnose and Manage Blast Lung Injury
Critical Source: NATO Emergency War Surgery
Objective: Identify and manage blast lung injury caused by primary blast effects.

Procedure:
1. Assess for symptoms of pulmonary contusion, such as chest tightness, pain, hemoptysis, tachypnea, use of accessory muscles of respiration,...
blast lung, pulmonary contusion, chest X-ray, respiratory distress, ARDS, pneumothorax
Oxygen Therapy and Monitoring for Burn Patients with Inhalation Injury
Critical Source: Emergency War Surgery
- Patients with major burns and/or inhalation injury require supplemental oxygen, pulse oximetry, chest radiograph and arterial blood gas measurement.

• **Carbon monoxide (CO) poisoning causes cardiac and neurologic symptoms. Patients with CO...
oxygen therapy,pulse oximetry,chest radiograph,arterial blood gas,carbon monoxide poisoning,burn patients
Treat Respiratory Tract Injury from Blister Agents
Critical Source: NATO Emergency War Surgery
Respiratory Tract Treatment:

Inhalation of mustard vapor causes severe irritation of the upper respiratory tract, with symptoms including:
- Painful cough.
- Bloody sputum.
- Chest pain.
- Dyspnea (difficulty...
mustard gas, lewisite, respiratory injury, bronchopneumonia, antibiotic therapy

Casualty Management (4)

Supervise Casualty Evacuation and Personnel Management
High Priority Source: SH 21 76 Ranger Handbook
Duties of the Platoon Sergeant (PSG):

• Supervises and directs the patrol medic and patrol aid-litter teams in moving casualties to the rear.
• Maintains patrol status of personnel, weapons, and equipment.
• Consolidates and forwards the...
casualty evacuation,platoon sergeant,DA forms
Breakdown of Casualties by Injury Type and Body Region
Standard Source: Emergency War Surgery
Purpose: Analyze injury patterns to improve medical interventions.

Procedure Steps:
1. Categorize casualties based on the type of injury (e.g., penetrating, blunt, thermal).
2. Classify casualties by major body regions affected,...
injury analysis,casualty statistics,body region classification,medical interventions
Record Minimum Essential Data for Trauma Registry
Standard Source: Emergency War Surgery
Purpose: Ensure consistent and comprehensive data collection for trauma registry purposes.

Data Components to Record:
Standard postprocedure note content: Who did what, on whom, why, and a plan.
Demographics: Age, gender, rank,...
trauma registry,data collection,casualty documentation,minimum essential data
Use of Paper and Electronic Documentation for Trauma Care
Standard Source: Emergency War Surgery
Purpose: Ensure accurate and consistent documentation of emergency trauma care on the battlefield.

Procedure Steps:
1. At all levels of medical treatment (Level I through IV), document patient information using either **paper or electronic...
trauma documentation,paper records,electronic records,data aggregation

Respiratory Care (4)

Indications for Endotracheal Intubation and Mechanical Ventilation in Trauma Patients
Critical Source: Emergency War Surgery
Objective: Identify when endotracheal intubation and mechanical ventilation are necessary.

### Indications:
Airway obstruction due to trauma, edema, or excess secretions.
Apnea (cessation of breathing).
• **Excessive work of...
intubation, mechanical ventilation, airway obstruction, GCS, hypoxia, hypercarbia
Administer Oxygen and Monitor Ventilator Patients in Trauma Care
Critical Source: Emergency War Surgery
Objective: Ensure adequate oxygenation and monitor ventilated patients effectively.

### Steps:
1. Provide supplemental oxygen during the early phase of resuscitation:
- Use a nasal cannula for FIO2 up to 0.35.
- Use a **Venturi...
oxygen administration, ventilator monitoring, ABG analysis, FIO2 levels
Identify and Manage Acute Respiratory Distress Syndrome (ARDS) in Trauma Patients
Critical Source: Emergency War Surgery
Objective: Recognize ARDS early and manage it appropriately.

### Signs of ARDS:
Acute hypoxemia with a PaO2/FIO2 ratio < 200.
Progressive fall in pulmonary compliance, indicated by stiff lungs and increasing airway pressures.
-...
ARDS, hypoxemia, pulmonary compliance, ventilator management
Positioning for Breathing Difficulty
High Priority Source: Survival and Austere Medicine
Objective: Improve breathing by positioning the patient correctly.

Procedure:
1. Avoid lying flat as it worsens breathing difficulty.
2. Place the patient in a semi-sitting or upright position, which is optimal for breathing.
3....
breathing difficulty, positioning, respiratory care, chest infection

Cardiac Injuries (4)

Management of Penetrating Cardiac Injuries in Emergency War Surgery
Critical Source: Emergency War Surgery
Procedure:

1. Isolated punctures of the heart should be exposed (opening the pericardium) and occluded by finger pressure.
2. Other methods include the use of a Foley catheter or skin staples.
3. Use pledgeted horizontal mattress sutures (2-0...
penetrating cardiac injury,emergency surgery,pericardium repair,surgical suture
Perform Pericardiocentesis for Cardiac Tamponade
Critical Source: Emergency War Surgery
Procedure:

1. Assess the patient: Look for signs of cardiac tamponade (e.g., hypotension, muffled heart sounds, JVD). This is a life-threatening condition and requires immediate intervention.
2. Prepare the site: Clean the skin with...
pericardiocentesis,cardiac tamponade
Recognizing and Managing Pericardial Tamponade in Thoracic Injuries
Critical Source: NATO Emergency War Surgery
Procedure for Recognizing and Managing Pericardial Tamponade in Thoracic Injuries:

1. Identify the condition:
- Pericardial tamponade is a life-threatening complication of missile wounds to the heart.
- It occurs when blood collects...
pericardial tamponade, cardiac injury, thoracic trauma, missile wound, pericardiocentesis
Remove Blood from Pericardial Sac (Pericardial Tamponade)
Critical Source: NATO Emergency War Surgery
Objective: Relieve pericardial tamponade to restore cardiac function.

Procedure:
1. Identify signs of pericardial tamponade, such as hypotension, muffled heart sounds, and distended neck veins.
2. Perform a pericardiocentesis using...
pericardial tamponade, pericardiocentesis, cardiac decompression

Prisoner Of War Care (4)

Evacuation and Escort of Internees to MTF for Treatment
High Priority Source: Emergency War Surgery
Title: Evacuation and Escort of Internees to MTF for Treatment

Procedure:
1. Ensure that any internee evacuated to the MTF for treatment is escorted by an armed guard designated by the nonmedical (echelon) commander.
2. The guard must...
internee evacuation, MTF escort, medical transport
Medical Personnel Avoidance of General EPW Holding Areas
High Priority Source: Emergency War Surgery
Title: Medical Personnel Avoidance of General EPW Holding Areas

Procedure:
1. Ensure that medical personnel do not enter the general EPW holding area.
2. Have patients brought out to medical personnel for sick call and any required medical...
EPW holding area, medical personnel safety, sick call procedures
Final Medical Examination During Transfer or Repatriation of Internees
Standard Source: Emergency War Surgery
Title: Final Medical Examination During Transfer or Repatriation of Internees

Procedure:
1. Conduct another medical examination during the transfer, release, or repatriation of internees.
2. Document any ongoing medical, surgical, or wound...
final medical exam, transfer documentation, repatriation care
Develop Plans for Hunger Strike Management in Internees
Standard Source: Emergency War Surgery
Title: Develop Plans for Hunger Strike Management in Internees

Procedure:
1. Create contingency plans for managing prisoners who are on a hunger strike or refuse medical treatment.
2. Ensure that these plans include protocols for monitoring...
hunger strike, internee management, prisoner care, medical planning

Ethical Guidelines (4)

Prohibition of Participation in Torture or Cruel Treatment by Health Personnel
Critical Source: Emergency War Surgery
Principle 2

It is a gross contravention of medical ethics, as well as an offence under applicable international instruments, for health personnel, particularly physicians, to engage, actively or passively, in acts which constitute participation...
torture prohibition,medical ethics,cruel treatment,complicity
Prohibition of Unethical Professional Relationships with Prisoners and Detainees
High Priority Source: Emergency War Surgery
Principle 3

It is a contravention of medical ethics for health personnel, particularly physicians, to be involved in any professional relationship with prisoners or detainees the purpose of which is not solely to evaluate, protect or improve...
unethical relationships,professional ethics,prisoner care,health protection
Duty of Health Personnel to Protect Physical and Mental Health of Prisoners and Detainees
High Priority Source: Emergency War Surgery
Principle 1

Health personnel, particularly physicians, charged with the medical care of prisoners and detainees have a duty to provide them with protection of their physical and mental health and treatment of disease of the same quality and...
duty of care,prisoner health,mental health,standard of care
Military Physician as Commander’s Advisor for Medical Ethics
High Priority Source: Emergency War Surgery
- The military physician is the commander’s advisor for medical ethics. The physician should be alert for potential and actual ethical conflicts, and exert all efforts to remedy any perceived conflicts.

• As the patient’s advocate (in this case,...
medical ethics,patient advocate,moral distance,conflict resolution

Insect Bites Stings (4)

Identify and Handle Insect Bites from Black Widow and Brown Recluse Spiders
Critical Source: FM 4 25 11 First Aid
Overview:

Bites from black widow and brown recluse spiders can cause serious local or systemic effects. Proper identification and first aid are essential.

Black Widow Spider Bite:
Symptoms: Nervous system involvement, including...
black widow spider, brown recluse spider, bite treatment, tissue damage, muscle cramps
Recognize and Respond to Insect Bite/Sting Symptoms
Critical Source: FM 4 25 11 First Aid
Overview:

Insect bites and stings can cause a range of symptoms from mild irritation to life-threatening anaphylactic shock. Recognizing these signs is critical for proper treatment.

Less Serious Reactions (Mild):
Symptoms: Pain,...
insect bite, sting, anaphylaxis, black widow spider, brown recluse spider, symptoms, first aid
Provide First Aid for Black Widow Spider Bites
High Priority Source: Full First Aid Manual FM 2111
Purpose: To manage the effects of a black widow spider bite and reduce complications.

Procedure:
1. Recognize symptoms, which may include muscle cramps, rigid and nontender abdomen, sweating, nausea, vomiting, and breathing...
black widow spider, venom treatment, medical emergency
Identify the Insect Responsible for a Bite or Sting
Standard Source: Full First Aid Manual FM 2111
Purpose: Proper identification of the insect responsible for a bite or sting is critical, especially in cases involving allergic reactions.

Procedure:
1. Observe the casualty and the affected area to note any signs that may indicate the...
insect identification, sting, bite, first aid, medical emergency

Chemical Biological Exposure (4)

Administer Nerve Agent Antidote Using MARK I Kit
Critical Source: FM 4 25 11 First Aid
Procedure:

1. Identify the need for administration: If symptoms of nerve agent poisoning are present (e.g., difficulty breathing, unexplained headache, runny nose, etc.), immediately proceed with administration.

2. **Locate the MARK I...
nerve agent, antidote, MARK I, first aid, chemical exposure
Avoid Consuming Contaminated Food or Water
Critical Source: FM 4 25 11 First Aid
Procedure:

1. Recognize the risk: Swallowing water or food contaminated with nerve, blister, and other chemical agents and with some biological agents can be fatal.

2. Do not consume suspect items: Never consume water or food that is...
contaminated food, water contamination, chemical exposure, biological agent, first aid
Recognize and Respond to Chemical or Biological Agent Exposure
Critical Source: FM 4 25 11 First Aid
Procedure:

1. Be aware of signs of exposure: Watch for unusual symptoms such as unexplained headaches, runny nose, difficulty breathing, dimness of vision, eye irritation, sudden depression, anxiety, restlessness, dizziness,...
masking, chemical exposure, biological agent, first aid, emergency response
Classify Chemical and Biological Agents
High Priority Source: FM 4 25 11 First Aid
Procedure:

1. Understand classification of chemical agents: Chemical agents are classified according to the primary physiological effects they produce, such as blistering, choking, vomiting, and incapacitating agents.

2. **Understand...
agent classification, chemical agents, biological agents, first aid, emergency response

Vaccination Preparedness (4)

Understanding Vaccine Production Capacity and Requirements During a Pandemic
High Priority Source: HHSPandemicInfluenzaPlan
Procedure:

1. Estimate vaccine production capacity: Assume U.S.-based production can generate 3 to 5 million 15µg doses per week, with an initial delay of 3 to 6 months before the first doses are available.
2. **Account for dosage...
vaccine production,pandemic,dose requirements,NIH,H5N1
Develop Strategies for Rapid Vaccine Administration and Monitoring
High Priority Source: HHSPandemicInfluenzaPlan
Procedure:

1. Develop strategies to rapidly administer vaccines to priority populations (e.g., healthcare workers, first responders, vulnerable groups).
2. Establish mechanisms to monitor vaccine effectiveness and safety post-administration.
3....
rapid vaccine administration, monitoring effectiveness, priority populations
Develop Vaccine Reference Strain and Distribute to Manufacturers
High Priority Source: HHSPandemicInfluenzaPlan
Procedure:

1. Create a vaccine reference strain based on the novel influenza virus.
2. Distribute this reference strain to manufacturers for production of pandemic vaccines.
3. Ensure that all manufacturers have access to the necessary reagents...
vaccine reference strain, manufacturer distribution, pandemic vaccine
Obtain Investigational Vaccine Lots and Conduct Clinical Testing
High Priority Source: HHSPandemicInfluenzaPlan
Procedure:

1. Acquire investigational lots of candidate vaccines for novel influenza strains.
2. Conduct clinical testing on these vaccine lots to ensure safety and efficacy.
3. Document all findings from the clinical trials for regulatory...
investigational vaccine lots, clinical testing, novel influenza strains

Pandemic Influenza Treatment (4)

Administer Neuraminidase Inhibitors for Pandemic Influenza Treatment
Critical Source: HHSPandemicInfluenzaPlan
Procedure: Administer neuraminidase inhibitors (oseltamivir [Tamiflu®] or zanamivir [Relenza®]) to reduce the risk of pneumonia, hospitalization, and mortality during a pandemic influenza outbreak.

Steps:
1. Identify patients who are at...
oseltamivir, zanamivir, neuraminidase inhibitors, pandemic influenza treatment, antiviral drugs
Antiviral Resistance and Drug Selection During Pandemic Influenza
Critical Source: HHSPandemicInfluenzaPlan
Objective: Minimize the emergence of drug-resistant strains during pandemic influenza.

Key Considerations:
• Most current H5N1 viruses are resistant to M2 inhibitors (amantadine, rimantadine), and future strains may also develop...
antiviral resistance, drug selection, oseltamivir, zanamivir, M2 inhibitors, neuraminidase inhibitors
Antiviral Use During Pandemic Influenza: Treatment Strategy
Critical Source: HHSPandemicInfluenzaPlan
Objective: Optimize the use of limited antiviral stocks during a pandemic.

Key Considerations:
• Antivirals (e.g., oseltamivir, zanamivir) should be prioritized for treatment, not widespread prophylaxis, due to higher efficacy and lower...
antiviral use, pandemic influenza treatment, oseltamivir, zanamivir, drug resistance, early treatment, prophylaxis strategy
Antiviral Use in Containing Disease Clusters During Pandemic Influenza
High Priority Source: HHSPandemicInfluenzaPlan
Objective: Implement targeted antiviral use to contain disease clusters and reduce spread.

Key Considerations:
• Targeted use of antivirals may help contain small, well-defined disease clusters, potentially delaying or reducing the...
disease containment, targeted antiviral use, pandemic clusters, early intervention

Vaccines Antivirals (4)

Antiviral Drug Stockpile Management for Pandemic Influenza
High Priority Source: HHSPandemicInfluenzaPlan
Objective: Ensure adequate supply of antiviral drugs to treat pandemic influenza.

Procedure:
1. Current Stockpile: As of October 2005, the Strategic National Stockpile contains:
- 2.3 million treatment courses of oseltamivir...
antiviral stockpile,Tamiflu,Relenza,H5N1 resistance,strategic national stockpile
Vaccine Distribution Strategy During Pandemic Influenza
High Priority Source: HHSPandemicInfluenzaPlan
Objective: Ensure equitable and efficient distribution of limited pandemic influenza vaccine supplies.

Procedure:
1. Predefined Groups: HHS will direct vaccine distribution based on predefined priority groups (see Appendix D for...
vaccine distribution,pandemic influenza,HHS strategy,predefined groups,stockpile management
Cell-Based Influenza Vaccine Development Strategy
High Priority Source: HHSPandemicInfluenzaPlan
Objective: Expand U.S.-based influenza vaccine production capacity using cell-based technology.

Procedure:
1. Current Production Limitations: Traditional egg-based vaccine manufacturing is limited by:
- Reliance on millions of...
cell-based vaccine,HHS support,U.S. production,pandemic preparedness,vaccine manufacturing
Dose-Sparing Technologies for Influenza Vaccines
High Priority Source: HHSPandemicInfluenzaPlan
Objective: Reduce the amount of hemagglutinin (HA) antigen required per vaccine dose to increase supply during a pandemic.

Procedure:
1. Research Focus: HHS is studying methods to stimulate strong immune responses with less HA antigen,...
dose-sparing technology,HAS antigen,adjuvant,vaccine delivery,HA reduction

Pharmaceuticals (4)

Administer Amantadine for Influenza A Treatment in Children 1–6 Years Old
High Priority Source: HHSPandemicInfluenzaPlan
Procedure:

1. Calculate the child's weight in kilograms.
2. Administer 5 mg/kg body weight per day, up to a maximum of 100 mg/day.
3. Divide the dose into two divided doses daily.
4. Use syrup or tablet form as appropriate, based on...
amantadine, influenza A treatment, children dosage
Administer Oseltamivir for Influenza A and B Treatment in Children Weighing >40 kg
High Priority Source: HHSPandemicInfluenzaPlan
Procedure:

1. Administer 75 mg twice daily of oseltamivir.
2. Use tablet form as appropriate, based on the drug package insert and child's ability to swallow.
3. For patients with creatinine clearance <30 ml/min, reduce the dose as...
oseltamivir, influenza A and B treatment, children dosage
Administer Rimantadine for Influenza A Treatment in Adults 65 Years and Older
High Priority Source: HHSPandemicInfluenzaPlan
Procedure:

1. Administer 100 mg/day of rimantadine.
2. Divide the dose into two divided doses daily.
3. Use tablet or syrup form as appropriate, based on the drug package insert and patient's ability to swallow.

Important Notes:
-...
rimantadine, influenza A treatment, elderly dosage
Administer Zanamivir for Influenza A and B Treatment in Children 1–6 Years Old
High Priority Source: HHSPandemicInfluenzaPlan
Procedure:

1. Administer 10 mg twice daily of zanamivir.
2. Use the inhalation device provided with the medication.
3. Ensure proper instruction and demonstration of correct use of the device to the patient or caregiver.

**Important...
zanamivir, influenza A and B treatment, children dosage

Frostbite Prevention (4)

Prevent Frostbite in Cold Weather Operations
Critical Source: Canadian Military Basic Cold Weather Training
Frostbite causes casualties, and its effects should not be underestimated.

Key considerations:
• Ensure that personnel are trained to recognize the early signs of frostbite (numbness, tingling, pale or waxy skin).
• Emphasize the importance...
frostbite,cold,weather,prevention,survival
Prevent Frostbite in Severe Winter Conditions
High Priority Source: Canadian Military Basic Cold Weather Training
- Take precautions to prevent frostbite.
• Personnel who neglect to take precautions are severely punished.
• Locate heated medical aid stations closer than normal to combat units.
frostbite prevention, winter conditions, medical emergency
Prevent Frostbite by Wearing Appropriate Clothing
High Priority Source: Canadian Military Basic Cold Weather Training
Objective: Prevent frostbite through proper clothing and equipment.

Steps:
1. Wear enough clothing to protect against cold and wind.
2. Ensure that clothing and equipment do not restrict blood circulation.
3. Avoid touching cold metal with...
frostbite prevention, cold weather clothing, circulation protection, buddy system
Prevent Frostbite Using the Buddy System
Standard Source: Medical Emergencies
Procedure:

1. Use the buddy system when with others.
2. Check your buddy's face frequently, and ensure they check yours.
3. If alone, periodically cover your nose and lower part of your face with your mittened hand to prevent...
frostbite prevention,buddy system,cold weather,survival tips

Digestive Health (4)

Prevent Constipation in Cold Weather Environments
Reference Source: US Marine Corps Wilderness Medicine
Procedure:

1. Understand the risk: Constipation is a common issue in cold weather environments due to low-fiber diets, dehydration, and reduced physical activity.

2. Implement dietary strategies:
- Increase fiber intake by consuming...
constipation,cold weather,fiber,diet
Prevent and Treat Constipation in Cold Weather Conditions
Reference Source: Canadian Military Basic Cold Weather Training
Procedure:

1. Prevention:
- Maintain normal eating and drinking habits.
- Drink a sufficient amount of liquids to avoid dehydration.
- Avoid delaying the natural process of relieving waste.
- Take mild laxatives if needed,...
constipation, prevention, treatment, cold weather, laxatives
Use Epsom Salts for Constipation or Muscle Relaxation
Reference Source: Where There is no Doctor a Village Health Care Handbook
Epsom salts (magnesium sulfate) can be used to treat constipation or relax muscles. Follow these steps:

1. For constipation: Dissolve one teaspoon of Epsom salts in a glass of warm water and drink it on an empty stomach.
2. For **muscle...
epsom salts, constipation treatment, muscle relaxation
Relieve Constipation Through Hydration and Diet
Reference Source: Medical Emergencies
Procedure:

1. Increase fluid intake to at least 2 liters above your normal daily intake of 2 to 3 liters.
2. Consume foods that loosen the stool, such as fruits, if available.
3. Avoid delaying bowel movements, even in cold...
constipation, hydration, diet, bowel movement, dehydration

Radiation Hazards (4)

Management of Radiological Contamination Hazards in Nuclear Accidents
High Priority Source: Medical NBC Battlebook
Management of Radiological Contamination Hazards in Nuclear Accidents

1. Public health hazard assessment: The potential public health hazard is minimal, as the insolubility of radioactive materials precludes absorption from the...
inhalation risk, atmospheric resuspension, monitoring
Identify and Handle Iodine-125 Radiation Sources
High Priority Source: Medical NBC Battlebook
Procedure:

1. Understand the structure of iodine-125 sources:
- Iodine-125 is encapsulated in a 0.05 mm thick titanium tube welded at both ends to form a cylindrical capsule measuring 4.5 x 0.8 mm.
- It decays by electron capture...
iodine-125, radiation source, medical implant, titanium capsule, x-ray emission
Identify and Handle Medical and Research Radiation Sources (Table 3-D Summary)
High Priority Source: Medical NBC Battlebook
Procedure:

1. Review the following locations and radiation sources:
- Cancer Treatment Areas: Cobalt-60 and Cesium-137, with source strength of ~1 to several 10 Gy over several hours at about one meter if exposed.
- Found in therapy...
table 3-d, radiation sources, medical locations, cesium-137, cobalt-60, x-ray machines
Handle X-ray Machines and Accelerators Safely
Standard Source: Medical NBC Battlebook
Procedure:

1. Understand the operation of x-ray machines:
- X-ray units and accelerators produce x-rays only when the exposure switch is engaged.
- Once the switch is released or the pre-set exposure time is reached, **x-ray...
x-ray machine, accelerator, activation products, short half-life, safety handling

Chemical Agents (4)

Medical Treatment for BZ (3-Quinuclidinyl Benzilate) Exposure
High Priority Source: Medical NBC Battlebook
Procedure:

1. Administer physostigmine:
- Use physostigmine to reverse the effects of BZ in healthy individuals.
- Ensure proper administration as outlined in information paper MCMR-UV-ZB dated 9 Feb 1998.

2. **Provide symptomatic...
BZ treatment, physostigmine, delirium, heat stroke
Medical Treatment for LSD Intoxication
High Priority Source: Medical NBC Battlebook
Procedure:

1. Administer sedatives:
- Use diazepam (10-20 mg) intravenously or intramuscularly to sedate the patient.
- Alternatively, administer sodium amytal (200-400 mg) intravenously for sedation.

2. Monitor symptoms:
-...
LSD treatment, diazepam, hallucinations, sedation
Identify Incapacitating Agents in a Chemical Attack
Standard Source: Medical NBC Battlebook
Procedure:

1. Assess the situation:
- Look for signs of incapacitation such as confusion, disorientation, and altered mental states.
- Note if symptoms persist for hours or days after exposure (unlike riot control agents).

2. **Use...
incapacitating agents, chemical attack, BZ, LSD, detection, protection
Recognize Signs and Symptoms of Incapacitating Agents
Standard Source: Medical NBC Battlebook
Procedure:

1. Identify symptoms based on agent type:
- Anticholinergics (e.g., BZ): Restlessness, dizziness; failure to obey orders, confusion, erratic behavior; vomiting.
- Indoles (e.g., LSD): Dryness of mouth, tachycardia...
symptoms, BZ, LSD, anticholinergics, indoles, cannabinoids, anxiety reaction

Military Medical Procedures (4)

Forward Surgery Principles for Battlefield Casualties
Critical Source: NATO Emergency War Surgery
Objective: Provide initial surgical care to save life and limb, prevent infection, and render casualties transportable.

### Key Considerations
• Military surgery is performed under adverse battlefield conditions and focuses on emergency...
forward surgery, battlefield casualty care, phased wound management, military medical procedures, transportability, initial surgery, reparative surgery
Aid Station Medics' Role in Combat Casualty Care
High Priority Source: NATO Emergency War Surgery
Combat Casualty Care at Aid Stations:

1. Assisting the Battalion Surgeon and Physician Assistant: Aid station medics assist the battalion surgeon and physician assistant with both sick call and combat casualty care.
2. **Resuscitative...
aid station medics,resuscitation,sick call,combat casualty care
Battalion Surgeon's Role in First Role of Medical Care
High Priority Source: NATO Emergency War Surgery
Responsibilities of the Battalion Surgeon:

1. Supervision of Combat Medics: The battalion surgeon is responsible for supervising all combat medics assigned directly to maneuver platoons as well as those operating at the battalion aid...
battalion surgeon,first role of care,combat medics,training standards,aid station operation
Ambulance Section's Role in Casualty Transport
High Priority Source: NATO Emergency War Surgery
Transport Responsibilities of Ambulance Sections:

1. Casualty Evacuation from Battlefield to Aid Station: The ambulance section is responsible for transporting casualties from the battlefield to the aid station.
2. **Higher Role...
ambulance section,casualty transport,higher role ambulances,evacuation protocols

Combat Medical Operations (4)

Coordinate Force Health Protection Plan with Battalion Medical Platoon
High Priority Source: STP 21 24 Army Warrior Leader Skills Level 2 3 and 4
Steps:

1. Coordinate the force health protection plan with the battalion medical platoon (MEDPLT).
2. Ensure medical treatment at Level II.
3. Establish evacuation procedures.

Note: This coordination ensures that all aspects of health care...
force health protection plan, medical platoon coordination, level ii treatment, evacuation procedures
Establishing and Managing a Battalion Aid Station
High Priority Source: NATO Emergency War Surgery
### Procedure: Establishing and Managing a Battalion Aid Station

Overview: The battalion aid station must be strategically located, organized into functional areas, and equipped with essential medical supplies to provide effective casualty...
battalion aid station, medical support, triage, casualty care, combat medicine, field medical cards, Geneva Conventions, mobile medical unit
Integrate Combat Health Support into MDMP
High Priority Source: STP 21 24 Army Warrior Leader Skills Level 2 3 and 4
Steps:

1. Confirm patient evacuation (ground and air) routes from companies/troops to the aid station.
2. Confirm aid station locations.
3. Identify possible casualty lines of drift.
4. Verify casualty collection point locations.
5. Integrate...
coordinate medical support, mdmp integration, casualty evacuation routes, aid station locations, combat health support
Optimize Battlefield Medical System for Return to Duty
High Priority Source: NATO Emergency War Surgery
Objective: Minimize loss of life and limb while maximizing return to duty.

1. Balance medical capabilities with combat requirements.
- As medics increase technical capabilities, they require more complex equipment, which increases lift...
battlefield medicine,return to duty,casualty care,emergency surgery,war surgery

Burn Injury Treatment (4)

Burn Resuscitation Fluid Administration Protocol (First 24 Hours Post-Burn)
Critical Source: NATO Emergency War Surgery
Objective: Administer electrolyte-containing fluid in the first 24 hours post-burn to prevent organ failure while avoiding complications of fluid overload.

Procedure:
1. Fluid Selection: Use lactated Ringer's solution, which has a more...
fluid resuscitation,burn injury,electrolyte solution,lactated ringer's,children burn treatment
Evaporative Water Loss Estimation and Replacement in Burn Patients
High Priority Source: NATO Emergency War Surgery
Objective: Estimate and replace evaporative water loss to maintain hydration in burn patients.

Procedure:
1. Estimate Evaporative Water Loss:
- Use the formula: **evaporative water loss (ml/hr) = (25 + percent of body surface burned)...
evaporative water loss,burn resuscitation,hydration monitoring,sodium concentration
Potassium Management in Burn Patients (First 48 Hours Post-Burn)
High Priority Source: NATO Emergency War Surgery
Objective: Avoid potassium supplementation during the first 48 hours post-burn to prevent complications from elevated serum potassium levels.

Procedure:
1. Avoid Potassium Supplementation: Do not administer potassium supplements during...
potassium management,burn injury,potassium supplementation,hyperkalemia prevention
Whole Blood Administration in Burn Patients
High Priority Source: NATO Emergency War Surgery
Objective: Administer whole blood to maintain hematocrit levels between 30% and 35% later in the post-burn course.

Procedure:
1. Timing of Whole Blood Use: Begin administering whole blood later in the post-burn period, typically...
whole blood administration,burn treatment,hematocrit maintenance

Blast Injuries (4)

Understanding and Managing Blast Injuries from Nuclear Detonations
Critical Source: NATO Emergency War Surgery
Understanding and Managing Blast Injuries from Nuclear Detonations

Blast injuries caused by nuclear detonations are of two types: direct (due to overpressure effects) or indirect (due to drag forces of the winds accompanying the blast wave)....
nuclear blast injuries, overpressure effects, drag forces, missile injuries, thermal and indirect injuries
Assess Blast Injury Severity Based on Pressure Wave Characteristics
High Priority Source: NATO Emergency War Surgery
Objective: Use knowledge of blast wave characteristics to estimate the severity of primary injuries.

Procedure:
1. Understand that damage from a sharp rising blast wave depends on two key factors: peak pressure and duration of the...
pressure wave characteristics, blast injury severity, primary effects, peak pressure, duration of positive phase
Identify and Categorize Blast Injuries
High Priority Source: NATO Emergency War Surgery
Objective: Understand the different types of blast injuries to provide appropriate medical care.

Procedure:
1. Recognize primary blast injury, which is caused by the direct effect of the pressure wave on the body. This typically affects...
blast injury, primary blast injury, secondary blast injury, tertiary blast injury, thermal injury, pressure wave
Understand Pressure Wave Propagation and Effects
High Priority Source: NATO Emergency War Surgery
Objective: Understand how a pressure wave from an explosion behaves and its effects on the human body.

Procedure:
1. Recognize that the pressure wave moves outward at supersonic speed immediately after an explosion in air.
2. **Note...
pressure wave, blast wind, shock wave, reflection of pressure wave, lethal radius

Diagnostic Imaging (4)

Imaging and Diagnostic Studies in Trauma Patients with Multiple Injuries
Critical Source: NATO Emergency War Surgery
Procedure:

1. Obtain Appropriate X-rays: Perform imaging studies, including standard X-rays and special studies when indicated:
- Intravenous pyelograms or cystograms for abdominal and pelvic wounds.
2. **Assess for Intraperitoneal...
imaging studies,abdominal x-ray,intraperitoneal injuries
Perform X-Ray and Laboratory Evaluation for Head Injury Patients
Critical Source: NATO Emergency War Surgery
Procedure:

1. Obtain skull films:
- Take AP (anteroposterior), right, and left lateral views to localize fractures and fragments.
- If an irregular area of increased or overlapped bone density is observed, obtain a tangential X-ray...
skull x-ray, CT scan, lumbar puncture, intracranial hematoma, meningitis, CSF leakage, pneumocephalus
Use X-ray to Assess Thoracic Injuries and Determine Need for Additional Chest Tubes
High Priority Source: NATO Emergency War Surgery
Procedure:

1. Identify casualties with suspected thoracic injury, such as pneumothorax, hemothorax, or flail chest.
2. Prepare the casualty for an X-ray by positioning them appropriately (e.g., supine or upright) based on clinical...
chest x-ray, thoracic injury, air leak, pleural effusion, chest tubes
Duplex Ultrasound for Arterial Injury Evaluation
Reference Source: Emergency War Surgery
Procedure:
• Use color flow duplex ultrasonography to evaluate arterial injuries.

Advantages:
• Noninvasive
• Portable
• Painless
• Repeated exams are easily performed

Limitations:
• Highly operator-dependent
• May fail to detect...
duplex ultrasound, arterial injury, color flow ultrasonography, noninvasive imaging

Combat Medicine (4)

Diagnosing Thoracic Injury in Combat Casualty
Critical Source: NATO Emergency War Surgery
Procedure for Diagnosing Thoracic Injury in a Combat Casualty:

1. Assess for visible signs of injury:
- Look for one or more holes in the chest.
- Observe if the casualty is experiencing pain during breathing.
- Check for signs of...
thoracic injury, combat casualty, tension pneumothorax, chest X-ray, cardiac tamponade, dyspnea, shock, physical examination
Understand the Importance of Tactical Combat Casualty Care (TCCC) in Preventing Combat Deaths
Critical Source: TCCC 17 13 Tactical Combat Casualty Care
Background and Statistics:

• A study by COL Brian J. Eastridge demonstrated that 87% of Operation Iraqi Freedom (OIF) and Operation Enduring Freedom (OEF) combat deaths were prehospital cases.
• Of these prehospital deaths, **24% were...
tactical combat casualty care, tccc, combat death prevention, extremity hemorrhage, airway obstruction, junctional bleeding, truncal bleeding, tension pneumothorax
Maintain Health of Command for Mission Success
High Priority Source: NATO Emergency War Surgery
Objective: Ensure the health and readiness of the command to support mission accomplishment.

Procedure:
1. Establish direct communication with the supported unit commander to ensure alignment on medical support needs.
2. Ensure that all...
health maintenance,command support,medical readiness,tactical operations,flexibility,communication
Performing Combat Triage
Standard Source: Emergency War Surgery
Combat triage is the dynamic process of sorting casualties to identify the priority of treatment and evacuation based on severity of injury, available resources, and mission requirements.

### Objectives:
• Return the greatest possible...
combat triage, immediate, delayed, minimal, emergency surgery, casualty sorting

Trauma Injury (4)

Manage Crush Syndrome in Emergency Situations
Critical Source: NATO Emergency War Surgery
Objective: Provide immediate and long-term management for crush syndrome.

Procedure:
1. Stabilize the patient: Ensure airway, breathing, and circulation are maintained. Monitor for signs of shock or cardiac arrest.
2. **Avoid fluid...
crush syndrome, emergency management, hyperkalemia, renal failure, shock treatment
Identify and Assess Crush Syndrome Risk
High Priority Source: NATO Emergency War Surgery
Objective: Identify individuals at risk for crush syndrome.

Procedure:
1. Assess exposure history: Determine if the individual has been crushed beneath debris, run over, or had limbs compressed for an hour or more.
2. **Look for signs...
crush syndrome, traumatic rhabdomyolysis, risk assessment, entrapment, trauma injury
Interpret Laboratory Findings for Crush Syndrome
High Priority Source: NATO Emergency War Surgery
Objective: Interpret laboratory results to confirm crush syndrome.

Procedure:
1. Check hematocrit levels: Look for elevated hematocrit, indicating hemoconcentration due to plasma loss.
2. Assess electrolyte imbalances: Monitor serum...
crush syndrome, laboratory findings, CPK, myoglobinuria, electrolyte imbalance
Recognize Clinical Signs of Crush Syndrome
High Priority Source: NATO Emergency War Surgery
Objective: Identify clinical signs and symptoms indicative of crush syndrome.

Procedure:
1. Observe for early signs: Look for erythema at the margin of the affected area, blistering on adjacent skin, or paralysis caused by...
crush syndrome, clinical signs, swelling, oligemic shock, renal failure

Combat Medical Procedures (4)

Initial Management of Casualty by Combat Medic
Critical Source: NATO Emergency War Surgery
Objective: Do no further harm and evacuate the patient rapidly to a medical treatment facility.

Steps:
1. Cover wounds with sterile dressings.
2. Control hemorrhage using local compression.
3. Use a **tourniquet only if absolutely...
tourniquet, hemorrhage control, combat medic, fluid replacement, splinting
Managing Open Bone and Joint Injuries in Combat
Critical Source: NATO Emergency War Surgery
Objective: Preserve neurovascular function, prevent infection, and achieve full functional recovery.

Procedure Steps:
1. Immediate Treatment:
- Begin treatment exactly as for open soft-tissue injuries (refer to Chapter XVI).
-...
open injury, debridement, staged wound management, infection prevention, combat medicine
Resuscitation and Evacuation at Battalion Aid Station
Critical Source: NATO Emergency War Surgery
Objective: Stabilize the patient for evacuation to a forward support medical company clearing station or other designated receiving facility.

Steps:
1. Provide initial resuscitative care.
2. Stabilize the patient's condition.
3....
resuscitation, evacuation, medical treatment facility, stabilization
Historical Context of Vascular Injury Management in Combat
High Priority Source: NATO Emergency War Surgery
Objective: Understand the evolution and effectiveness of vascular injury treatment in military settings.

Procedure Steps:
1. Pre-Korean Conflict Era:
- Major vascular injuries were routinely treated by arterial ligation, resulting in...
vascular injury, arterial ligation, amputation rates, combat surgery, vascular repair

Sinus Injuries (4)

Management of Ethmoidal Sinus Injuries with CSF Rhinorrhea
High Priority Source: NATO Emergency War Surgery
Procedure: Manage injuries to the ethmoidal sinuses.

1. Perform partial ethmoidectomy if required for debridement of wounds.

2. If there is evidence of CSF rhinorrhea, seek neurosurgical consultation immediately.

Warning: CSF...
ethmoidal sinus injury,partial ethmoidectomy,CSF rhinorrhea,neurosurgical consultation
Management of Nasofrontal Duct Destruction in Frontal Sinus Injuries
High Priority Source: NATO Emergency War Surgery
Procedure: Manage destruction of the nasofrontal duct in frontal sinus injuries.

1. If the nasofrontal duct is destroyed, remove the mucosal lining of the frontal sinus.

2. Obliterate the sinus, preferably with fat harvested from the...
nasofrontal duct destruction,frontal sinus obliteration,fat grafting,CSF leak,neurosurgical consultation
Management of Maxillary Sinus Injuries
High Priority Source: NATO Emergency War Surgery
Procedure: Manage injuries to the maxillary sinuses.

1. Simple effusion of blood into the maxillary sinus is best left alone as it usually resolves on its own.

2. If infection develops, perform nasal antrostomy and lavage.

3. For...
maxillary sinus injury,nasal antrostomy,lavage,Caldwell-Luc approach,penicillin
Management of Simple Nondisplaced Fractures of the Frontal Sinus
Standard Source: NATO Emergency War Surgery
Procedure: Manage simple nondisplaced fractures of the anterior and posterior walls of the frontal sinus.

1. No specific therapy is required for simple, nondisplaced fractures of the anterior and posterior walls of the frontal sinus.

2. If the...
frontal sinus fracture,nondisplaced fracture,open reduction,wire fixation,packing material

Post-Operative Care (4)

Post-Operative Care for Liver Injuries in Emergency War Surgery
Critical Source: NATO Emergency War Surgery
Objective: Provide post-operative care to patients with liver injuries following emergency surgery.

Procedure Steps:
1. Temperature Management:
- Monitor and normalize the patient's temperature in the recovery room, as hypothermia is...
post-op care, liver injury recovery, temperature management, blood transfusion, antibiotic therapy
Dress and Immobilize Joint Injuries Post-Operatively
High Priority Source: NATO Emergency War Surgery
Procedure:

1. Dress the joint injury using the same principles as for fractures.
2. Apply an occlusive dressing if needed, ensuring it is secure but not overly tight.
3. Provide immobilization based on the severity of the injury and damage to...
joint dressing,immobilization,wound care,post-op management
Prevention of Contractures in Amputations
Standard Source: Emergency War Surgery
Procedure for Preventing Contractures Following Amputation

BK amputations (below-knee) are at risk for knee flexion contractures. These can be prevented by using a long leg cast.
Avoid splinting the knee in extension, as this...
contractures, amputations, BK amputation, AK amputation, long leg cast, hip extension, prone positioning
Provide Physiologic Support in Post-Op TASC Patients
Reference Source: Emergency War Surgery
Objective: Ensure survival by maintaining physiological stability post-thoracic and abdominal surgery.

Core rewarming: Use warmed resuscitative fluids, blankets, ventilator air, and the environment. Commercially available products such as...
TASC patients, core rewarming, acidosis reversal, coagulopathy correction, post-op care

Heat Illness (4)

Recognize and Respond to Heat-Related Illnesses
Critical Source: FEMA Citizen Preparedness Guide
Action: Know the signs of heat-related illnesses and respond appropriately.

Signs to Watch For:
Heat Cramps: Painful muscle spasms, usually in the legs or abdomen.
Heat Exhaustion: Heavy sweating, weakness, dizziness, nausea,...
heat stroke, heat exhaustion, first aid, emergency response
Recognize and Treat Heatstroke
Critical Source: NAVMED P 5010 US Navy Manual of Preventive Medicine
Procedure:

1. Identify symptoms: Look for confusion, disorientation, drowsiness, irrational behavior, hot and dry skin (or profuse sweating), collapse, loss of consciousness, convulsions, or coma.
2. **Immediately move the casualty to a...
heatstroke,treatment,emergency cooling,rectal temperature,IV fluids
Manage Heat Illnesses in a Wilderness Environment
High Priority Source: US Marine Corps Wilderness Medicine
Procedure:

1. Recognize signs of heat illness, including:
- Heat cramps, heat exhaustion, and heat stroke.
2. Provide immediate cooling for heat stroke:
- Move the casualty to a shaded area.
- Remove excess clothing.
- Apply...
heat illness, wilderness medicine, heat stroke, rehydration, prevention
Recognize and Treat Heat Cramps
Reference Source: NAVMED P 5010 US Navy Manual of Preventive Medicine
Procedure:

1. Identify symptoms: Look for painful, severe muscle cramps in the legs, arms, or abdominal wall.
2. Check body temperature: Ensure it remains normal (unless accompanied by heat exhaustion).
3. Stop exercise immediately...
heat cramps,treatment,hydration,electrolyte replacement,muscle cramps

First Aid Kit Design (4)

Assess the Location and Environmental Factors
High Priority Source: Personal Wilderness Medical Kit
Where will the people be going?

• For instance, there’s no need for altitude-related medications if they’re just in the Appalachian Mountains (where altitude illness is exceedingly rare), and no need for a snakebite kit if they’re hill-walking...
location, environmental factors, altitude illness, snakebite kit
Balance Competing Needs in Kit Assembly
High Priority Source: Personal Wilderness Medical Kit
Next comes a delicate balancing act.

• For example: reconciling the team doctor (who wants you to carry everything including four bags of IV fluids at 2.2 lbs. a bag) and the team members (fanatically weight-conscious backbacker-type ones who cut...
kit assembly, balancing needs, weight vs. functionality
Consider the Weight and Carrying Capacity
High Priority Source: Personal Wilderness Medical Kit
How much can they carry?

• If it’s a river rafting trip, a fairly heavy kit is OK, but if it’s for a long backpacking trip along the Appalachian Trail, where it’s usually possible to get to a road and to a hospital within a day or so, a lighter...
weight capacity, carrying ability, kit size
Identify the Number of People and Special Needs
High Priority Source: Personal Wilderness Medical Kit
Who will the kit provide for -- how many? And are there any special needs (e.g., pregnant women, diabetics, small children, dogs, horses)?

• For WEMSI, the kits will be used to provide initial care for the subjects of wilderness and backcountry...
number of people, special needs, diabetics, pregnant women, dogs, horses

Medication Management (4)

Accountability and Security for Medication Management in Wilderness Medical Kits
High Priority Source: Personal Wilderness Medical Kit
Procedure:

1. Prescription vs. Issuance by Physician:
- Physicians may prescribe medications individually to each WEMT, expecting them to use the kit primarily for personal use while in the wilderness.
- Alternatively, a physician can...
wilderness, medication security, OTC medications, scheduled drugs, DEA compliance, kit inspection, drug documentation
Create and Maintain a Wilderness Medical Kit Medication Reference Guide
High Priority Source: Personal Wilderness Medical Kit
Procedure:

1. Obtain Standing Orders:
- The physician medical director or prescribing physician should provide detailed standing orders for the use of medications in specific situations.
- A copy of these standing orders must be...
wilderness, medical kit, medication reference, standing orders, OTC medications, contraindications, dosages
Educate on the Risks of Overusing Medicines
Standard Source: Where There is no Doctor a Village Health Care Handbook
To help people understand the risks and consequences of overusing medicines:

1. Explain that most money spent on medicine would be better used for food to support overall health.
2. Highlight the risk of dependence, where people may rely...
medicine overuse, antibiotic resistance, health education, prevention, self-care
Educate People on the Sensible and Limited Use of Medicines
Standard Source: Where There is no Doctor a Village Health Care Handbook
To help people understand when medicines are needed and when they are not, follow these steps:

1. Explain that most sicknesses can be fought by the body itself with rest, good food, drinking lots of liquid, and simple home remedies.
2. **Avoid...
medicine use, health education, self-care, prevention, medication management

First Aid Kit Preparation (4)

Assess the Environment and Location
Standard Source: survival personal wilderness medical kit
Where will the people be going? This helps determine what medical supplies are necessary based on local conditions. For example, if you're in an area with no poisonous snakes (like Ireland or Britain), a snakebite kit may not be needed. If...
environment, location, snakebite kit, altitude-related illnesses
Determine Kit Users and Their Training Level
Standard Source: survival personal wilderness medical kit
Who is going to use the kit, and what is his or her level of training? This is crucial for selecting appropriate medical tools and medications. For example, if users are trained in accordance with the WEMSI WEMT Curriculum and have EMT-basic or...
kit users, training level, WEMSI, EMT-basic, EMT-paramedic
Estimate the Duration of Kit Use
Standard Source: survival personal wilderness medical kit
How long will the kit have to provide medical care for these people? This helps determine how much supplies you need and whether resupply is possible during the trip. For example, if the kit is intended for use in mountain or cave rescue...
duration, resupply, timeframe, rescue operations
Evaluate the Necessity of Specific Medical Items
Standard Source: survival personal wilderness medical kit
Not all medical items are necessary for every situation. For example, while an ampoule of 50% dextrose may be useful in some cases, it is heavy and fragile. In most wilderness scenarios, oral glucose or food can suffice for hypoglycemic patients....
specific items, necessity, dextrose ampoule, glucose test strips

Hypothermia Prevention (4)

Prevent Hypothermia in Casualties
Critical Source: TCCC 17 13 Army Tactical Combat Casualty Care
Objective: Prevent hypothermia during tactical field care and evacuation phases.

Procedure Steps:

1. Stop bleeding and resuscitate appropriately, using warm fluids if available.
2. Remove any wet clothes and replace with dry...
hypothermia prevention, casualty care, thermal management, tactical field care, evacuation care
Hypothermia Prevention in Tactical Combat Casualty Care
High Priority Source: TCCC 17 13 Tactical Combat Casualty Care
Minimize casualty environmental exposure and promote heat retention.

• Keep personal protective gear on, if feasible.
• Replace wet clothing, if possible.
• Get the casualty onto an insulated surface as soon as possible.
• Use **CoTCCC-approved...
tactical combat casualty care,hypothermia prevention,insulated surface,warm iv fluids
Prevent Hypothermia in Cold Weather
High Priority Source: FM 31 70 Basic Cold Weather Manual
Objective: Prevent hypothermia by avoiding rapid loss of body heat.

Procedure:
1. Protective Gear: Divers, boaters, and aviators operating in cold regions must be equipped with protective gear such as immersion suits and liferafts with...
hypothermia prevention, cold weather survival, protective gear, ice thickness testing, shelter construction
Hypothermia Prevention in Casualties
High Priority Source: TCCC 17 13 Army Tactical Combat Casualty Care
Procedure for Hypothermia Prevention:

1. Minimize casualty environmental exposure and promote heat retention.
2. Keep personal protective gear on, if feasible.
3. Replace wet clothing with dry clothing, if possible.
4. Get the casualty onto an...
hypothermia prevention, thermal protection, insulated surface, hypothermia kit

Triage And Reporting (4)

Understand Medical Triage Categories in Tactical Combat Casualty Care
High Priority Source: TCCC 17 13 Tactical Combat Casualty Care
Procedure:

1. Recognize that medical triage is a critical process for prioritizing care based on the severity of injuries and likelihood of survival.
2. Understand the four categories of triage used in tactical combat casualty care:
...
medical triage,tccc triage categories,immediate,delayed,minimal,expectant,combat casualty care
Understand the Structure and Function of the Joint Trauma System (JTS)
Standard Source: TCCC 17 13 Tactical Combat Casualty Care
Procedure:

1. Recognize that the Joint Trauma System (JTS) is responsible for collecting, analyzing, and using trauma data to improve military medical care.
2. Understand the JTS divisions:
- Data Acquisition: Mines medical...
jts,joint trauma system,data acquisition,military medical care,dodtr
Understand the TCCC Card and Its Use in MIST Reporting
Standard Source: TCCC 17 13 Tactical Combat Casualty Care
Procedure:

1. Recognize that the DD Form 1380 (TCCC Card) is used for documenting trauma care in a MIST format: Mechanism of Injury, Injuries, Signs/Symptoms, and Treatment.
2. Understand that the TCCC Card is used by medical personnel...
tccc card,mist report,dd form 1380,trauma documentation,jts
Understand the Role of the DODTR in Trauma Documentation
Standard Source: TCCC 17 13 Army Tactical Combat Casualty Care
Objective: Recognize the importance and function of the Department of Defense Trauma Registry (DODTR).

Procedure:
1. Acknowledge that the DODTR is the central repository for trauma-related injuries sustained by U.S./non-U.S. military...
dodtr,trauma registry,data collection,medical documentation

Tactical Medical Procedures (4)

Care Under Fire (CUF) - Return Fire
Critical Source: TCCC 17 13 Tactical Combat Casualty Care
Objective: Control massive hemorrhage while maintaining tactical engagement.

### Steps:
1. Return fire and continue the tactical mission to gain fire superiority.
2. Apply direct pressure to control extremity hemorrhage.
3. **Apply a...
care under fire, tourniquet application, hemorrhage control, tactical engagement
Tactical Evacuation Care (TEC) - Move Casualty for Evacuation
Critical Source: TCCC 17 13 Tactical Combat Casualty Care
Objective: Prepare the casualty for evacuation and document all interventions.

### Steps:
1. Move the casualty to a secure location for evacuation.
2. Re-evaluate the casualty and all medical interventions performed thus far.
3. **Affix...
tactical evacuation care, evacuation procedures, medical documentation, pelvic binder application
Tactical Field Care (TFC) - Move Casualty to Cover
Critical Source: TCCC 17 13 Tactical Combat Casualty Care
Objective: Provide advanced medical care while moving the casualty to cover.

### Steps:
1. Move the casualty to cover once enemy fire is no longer effective.
2. Disarm the casualty if their mental status is altered or they are receiving...
tactical field care, airway management, chest wound treatment, hypovolemic resuscitation
Conducting a Predeployment Site Survey for Medical Transition in Tactical Environments
High Priority Source: TCCC 17 13 Army Tactical Combat Casualty Care
### Procedure: Conducting a Predeployment Site Survey for Medical Transition in Tactical Environments

Overview:
A predeployment site survey is the initial contact on the ground made between an element of the incoming and current unit in...
predeployment site survey, relief in place (RIP), transfer of authority (TOA), medical transition guidelines, tactical environment

High Altitude Medical Conditions (4)

Medication Regimens for HAPE
High Priority Source: US Marine Corps Wilderness Medicine
Procedure:

1. Administer Nifedipine (a calcium channel blocker) as follows:
- Initial dose: 10mg PO.
- Subsequent dose: 30mg SR Q12h (SR = sustained release).
2. Consider Diamox (Acetazolamide) and **Decadron...
Nifedipine, Diamox, Decadron, Morphine, HAPE medication
Management of Systemic Edema at High Altitudes
Standard Source: US Marine Corps Wilderness Medicine
Procedure:

1. Recognize systemic edema in susceptible individuals (especially women) characterized by swelling of the face, hands, and feet without other symptoms.
2. This condition is usually tolerable, and descent is not necessary...
systemic edema, high altitude, salt restriction, HAPE, HACE
Treatment of Altitude Throat
Standard Source: US Marine Corps Wilderness Medicine
Procedure:

1. Recognize altitude throat, characterized by dryness and irritation of the mucous membranes in the throat and upper airway due to increased mouth breathing at high altitudes.
2. Treat with humidified air if available, or...
altitude throat, humidified air, salt water gargle, infection prevention
Management of High Altitude Flatus Expulsion (HAFE)
Reference Source: US Marine Corps Wilderness Medicine
Procedure:

1. Recognize HAFE, which is characterized by abdominal discomfort and the passage of colonic gas due to rapid expansion of intestinal gas at high altitudes.
2. Treat with anti-flatulence medications such as:
-...
HAFE, high altitude flatus expulsion, simethicone, gas-producing foods

Dental Anatomy (4)

Identifying Labial and Lingual Sides of Teeth
Reference Source: Where There is No Dentist
- Labial refers to the side of a tooth that is nearest the lips.
Lingual refers to the side of a tooth that is nearest the tongue.
labial, lingual, dental anatomy, teeth sides
Understanding Mesial and Distal Tooth Sides
Reference Source: Where There is No Dentist
- Mesial is the side of a tooth that faces the front of the mouth, opposite of ‘distal’.
mesial, distal, tooth sides, dental anatomy
Understanding Molar Teeth Anatomy
Reference Source: Where There is No Dentist
- Molars are the back teeth, used for grinding. They are the largest teeth in the mouth, with 2 or even 3 roots each.
molar teeth, dental anatomy, grinding teeth
Understanding Nerve Structure in Teeth
Reference Source: Where There is No Dentist
- Nerves are thin threads or strings that run from the brain to every part of the body and carry messages for feeling, pain, or movement.
• There is a nerve, along with a blood vessel, in every root of every tooth.
nerve structure, dental nerves, tooth anatomy

Diarrhea Management (4)

When to Seek Medical Help for Diarrhea and Dysentery
Critical Source: Where There is no Doctor a Village Health Care Handbook
In the following situations you should get medical help:

• if diarrhea lasts more than 4 days and is not getting better—or more than 1 day in a small child with severe diarrhea
• if the person shows signs of dehydration and is getting worse
-...
seek medical help,diarrhea,dysentery,dehydration,blood in stools
Administer Infant Syrup for Very Sick Infants with Diarrhea
Critical Source: Where There is no Doctor a Village Health Care Handbook
If the child is younger than 1 month, try to find a health worker before giving any medicine. If there is no health worker and the child is very sick, give him an ‘infant syrup’ that contains ampicillin: half a teaspoon 4 times daily (see p. 352)....
infant syrup,ampicillin,diarrhea management,infants
Administer Breast Milk and Rehydration Drink for Diarrhea in Children
High Priority Source: Where There is no Doctor a Village Health Care Handbook
Continue breastfeeding and also give sips of Rehydration Drink.

If vomiting is a problem, give breast milk often, but only a little at a time. Also give Rehydration Drink in small sips every 5 to 10 minutes (see Vomiting, p. 161).

If there...
breast milk,rehydration drink,diarrhea management,vomiting,children
Managing Diarrhea in Infants and Children
High Priority Source: Where There is no Doctor a Village Health Care Handbook
Managing Diarrhea in Infants and Children

Steps to Follow:
1. Assess the severity of diarrhea: Look for signs such as frequent watery stools, fever, vomiting, or blood in the stool.
2. Provide oral rehydration solution (ORS): Give...
infant diarrhea management, managing childhood diarrhea, oral rehydration for children

Respiratory Infections (4)

Recognize Pneumonia in a Person
High Priority Source: Where There is no Doctor a Village Health Care Handbook
Signs of pneumonia:

Sudden chills followed by high fever.
Rapid, shallow breathing, with grunts or wheezing. The nostrils may spread with each breath.
Fever (in newborns and very weak persons, there may be little or no...
pneumonia,fever,cough,breathing rate,chest pain,cold sores,newborns,children
Manage Chronic Bronchitis
High Priority Source: Where There is no Doctor a Village Health Care Handbook
Treatment for chronic bronchitis:

1. Stop smoking immediately.
2. Use an anti-asthma medicine with salbutamol (see page 384).
3. Take cotrimoxazole or amoxicillin every time the person has a cold or flu with fever.
4. If the person...
chronic bronchitis,stop smoking,salbutamol,cotrimoxazole,amoxicillin,hot water vapor,postural drainage
Recognize Symptoms of Post-Influenza Bacterial Community-Acquired Pneumonia
High Priority Source: HHSPandemicInfluenzaPlan
Symptoms to Watch For:

• Return of fever after initial improvement in influenza symptoms
• Productive cough
• Pleuritic chest pain

Diagnostic Findings:

• Lobar consolidation on chest x-ray (in adults)
• Sputum smear positive for...
post-influenza pneumonia, symptoms, diagnosis, bacterial infection, respiratory infection
Administer Antibiotics for Bronchitis
Standard Source: Where There is no Doctor a Village Health Care Handbook
When to use antibiotics:

• Only if bronchitis lasts more than a week and is not improving.
• If the person shows signs of pneumonia (see the following page).
• If the person already has a chronic lung problem.

Important note:...
bronchitis,antibiotics,pneumonia,chronic lung problem

Gynecological Issues (4)

Recognizing and Responding to Ectopic Pregnancy
Critical Source: Where There is no Doctor a Village Health Care Handbook
If a woman shows signs of ectopic pregnancy:

1. Severe pain in the lower belly, often on one side.
2. Irregular vaginal bleeding (may be lighter or heavier than normal).
3. Signs of early pregnancy such as missed period, nausea, or...
ectopic pregnancy,life-threatening,gynecological emergency
Responding to Complications from Abortion
Critical Source: Where There is no Doctor a Village Health Care Handbook
If a woman experiences complications after an abortion:

1. Fever, which may be high and persistent.
2. Vaginal bleeding with clots, possibly heavy or prolonged.
3. Belly pain, often severe and worsening over time.
4. **Difficulty...
abortion complications,life-threatening,post-abortion care
Assessing Causes of Lower Belly Pain in Women
Critical Source: Where There is no Doctor a Village Health Care Handbook
Identify potential causes of lower belly pain by asking the following questions:

1. Menstrual discomfort: Is the pain worse shortly before or during the period?
2. Bladder infection: Is urination very frequent or painful? This is one of...
lower belly pain,women's health,pelvic inflammatory disease,ectopic pregnancy,abortion complications
Identify Vaginal Discharge Caused by Trichomonas Infection
Standard Source: Where There is no Doctor a Village Health Care Handbook
A thin and foamy, greenish-yellow or whitish, foul-smelling discharge with itching. This is probably an infection of Trichomonas. It may burn to urinate. Sometimes the genitals hurt or are swollen. The discharge may contain blood.
vaginal discharge, trichomonas infection, gynecological symptoms, female health, reproductive tract infection

Vision Health (4)

Recognizing and Managing Glaucoma in Older Adults
High Priority Source: Where There is no Doctor a Village Health Care Handbook
Procedure:

1. Be aware that glaucoma is a serious eye condition that can cause blindness if untreated.
2. Watch for signs of glaucoma (see page 222) such as blurred vision, seeing halos around lights, or sudden vision loss.
3. If any symptoms...
glaucoma,eye health,blindness,older adults
Managing Cataracts and Floaters in Older Adults
High Priority Source: Where There is no Doctor a Village Health Care Handbook
Procedure:

1. Recognize that cataracts (clouding of the lens) are a common issue in older adults.
2. Be aware of 'flies before the eyes'—tiny moving spots in vision—which may indicate retinal issues or floaters.
3. Seek medical help if...
cataracts,floaters,vision changes,eye health
Managing Night Blindness in Newborns and Adults
Standard Source: Where There is no Doctor a Village Health Care Handbook
Procedure for Managing Night Blindness:

1. Identify the cause of night blindness by consulting a healthcare professional if possible.
2. Ensure that the individual is receiving adequate amounts of vitamin A, which is essential for vision...
night blindness,vitamin A deficiency,eye health,nutrition
Managing Farsightedness in Older Adults
Reference Source: Where There is no Doctor a Village Health Care Handbook
Procedure:

1. Recognize that farsightedness (difficulty seeing close objects) is common after age 40.
2. Encourage the use of glasses if vision problems are affecting daily activities.
3. Monitor for any changes in vision and seek medical help...
farsightedness,glasses,vision problems,older adults

Iv Infusion (4)

Warning: Air in IV Tubing Can Cause Cardiac Arrest
Critical Source: STP 21 1 Army Warrior Skills Level 1 Soldiers Manual of Common Tasks
Purpose: Highlight the critical importance of removing air from IV tubing.

Details:
• If you do not remove air from the tubing, it can enter the casualty's bloodstream and rapidly move to the heart. This may cause cardiac arrest, a...
air embolism, cardiac arrest, IV air removal, safety warning
Start an Intravenous Infusion
Critical Source: STP 21 1 Warrior Skills Level 1
Conditions: A casualty is in hypovolemic shock from combat injuries and has an abnormal mental status (AVPU) or no palpable radial (wrist) pulse, or a medic or medical professional requests that you start an intravenous (IV) infusion. Bleeding...
intravenous infusion, IV setup, hypovolemic shock, medical emergency, combat injuries
Inspect IV Supplies for Damage or Expiration
High Priority Source: STP 21 1 Army Warrior Skills Level 1 Soldiers Manual of Common Tasks
Purpose: Ensure IV supplies are safe and functional before use.

Steps:

1. Check IV solution bag:
- Verify the expiration date. Do not use outdated solutions.
- Inspect the clearness of the fluid. The solution must be...
IV solution, IV set, catheter/needle unit, expiration date, sterility check, damage inspection
Prepare IV Infusion Equipment
High Priority Source: STP 21 1 Army Warrior Skills Level 1 Soldiers Manual of Common Tasks
Purpose: Set up the IV infusion system properly to ensure safe administration of fluids.

Steps:

1. Obtain needed supplies: These are not part of your individual first aid kit but may be found in a combat lifesaver or medic's aid...
IV setup, air removal, IV bag positioning, tubing preparation

Radiation Injury Treatment (4)

Administering Cytokine Treatments for H-ARS Patients
Critical Source: Planning Guidance for Response to Nuclear Detonation May 2022 FEMA
Objective: Administer appropriate cytokine treatments to patients with Hematopoietic Acute Radiation Syndrome (H-ARS) following a nuclear detonation.

Procedure:
1. Identify Eligibility: Administer cytokines to victims of nuclear...
cytokine treatment,H-ARS,Radiation Injury Treatment Network (RITN),Leukine,Neulasta,Neupogen,NPlate,SNS,UMI
Understand and Manage H-ARS (Hematopoietic Acute Radiation Syndrome)
Critical Source: Planning Guidance for Response to Nuclear Detonation May 2022 FEMA
Procedure:

1. Recognize that H-ARS is the most critical subsyndrome of ARS for medical response.
- It occurs at lower doses (>2 Gy [200 rad]) and its treatment is essential to saving lives.
2. **Understand the pathophysiology of...
H-ARS management,Hematopoietic Acute Radiation Syndrome,treatment protocols,radiation dose effects,medical response planning
Coordinate Medical Discussions for Radiation Injury Treatment
High Priority Source: Planning Guidance for Response to Nuclear Detonation May 2022 FEMA
Procedure:

1. Initiate coordination between medical doctors and radiation injury treatment experts.
- This ensures healthcare systems understand how to identify and treat Acute Radiation Syndrome (ARS) effectively.
2. **Discuss the...
coordinate medical discussions,radiation injury treatment,ARS management,H-ARS treatment,DEARE mitigation
Understand FDA-Approved Cytokines for H-ARS Treatment
High Priority Source: Planning Guidance Nuclear Detonation FEMA
Procedure:

1. List Approved Cytokines: The following are FDA-approved cytokines for treating H-ARS symptoms:
- Leukine
- Neulasta
- Neupogen
- NPlate (approved in 2021 for platelet depletion caused by radiation...
FDA-approved cytokines,H-ARS,NPlate,Leukine,Neulasta,Neupogen

Radiation Injury Management (4)

Expert Center Patient Management and Referral Procedures
Critical Source: Planning Guidance for Response to Nuclear Detonation May 2022 FEMA
Objective: Provide specialized care for patients with severe radiation or thermal injuries.

Steps:
1. Screen Patients for Radiation Exposure: Conduct initial assessments at RTR sites and MCs before transferring to expert centers.
2....
Expert Center,Radiation Injury,Burn Care,ARS Management,RITN Consultation
Evacuation Center (EC) Transition and Transport Procedures
High Priority Source: Planning Guidance for Response to Nuclear Detonation May 2022 FEMA
Objective: Transition patients from initial care sites to expert facilities for complete treatment.

Steps:
1. Screen Patients: Conduct final assessments to determine the need for further medical intervention or transport.
2. **Triage...
Evacuation Center,Transport,Triage,Radiation Exposure,Decontamination
Medical Center (MC) Triage and Stabilization Procedures
High Priority Source: Planning Guidance for Response to Nuclear Detonation May 2022 FEMA
Objective: Triage, stabilize, and provide initial interventions for patients before discharging or routing to expert facilities.

Steps:
1. Triage Patients: Assess injuries (trauma, thermal burns, radiation, combined) and prioritize...
Medical Center,Triage,Stabilization,Radiation Injury,Gross Decontamination,Federal Medical System
Assembly Center (AC) Operations and Basic Care Procedures
High Priority Source: Planning Guidance for Response to Nuclear Detonation May 2022 FEMA
Objective: Provide ad hoc screening, basic medical care, triage, and gross decontamination for displaced individuals.

Steps:
1. Screen Individuals: Conduct initial assessments to identify injuries or radiation exposure.
2. **Perform...
Assembly Center,Gross Decontamination,Basic Medical Care,Triage,Radiation Screening

Radiation Preparedness (4)

Monitoring and Decontamination of Individuals and Items
Critical Source: FEMA REP Program Manual Dec 2019
Objective: Monitor for contamination and decontaminate individuals, equipment, and other items as necessary.

Steps:
1. Document and record all monitoring results (i.e., survey measurements and samples) accurately.
2. Make decisions on the...
decontamination process, monitoring protocol, sample collection, wastewater handling
Setup and Operation of a Radiological Emergency Area (REA)
Critical Source: FEMA REP Program Manual Dec 2019
Objective: Establish and operate an REA to manage contaminated individuals and prevent the spread of contamination.

Steps:
1. Notify the hospital to establish a REA through appropriate communication channels.
2. Ensure that medical...
REA setup, decontamination protocol, PPE doffing, contamination control
Establish Hospital/Medical Facility Plans/Procedures for Radiological Emergencies
High Priority Source: FEMA REP Program Manual Dec 2019
Procedure:

1. Identify the individual(s), by title/position, responsible for coordinating and updating hospital/medical facility plans/procedures.
2. Specify the number of radiologically trained medical personnel available, including a...
hospital plans, radiation emergency, medical facility procedures, RSO, REA, decontamination, dosimetry, radiological monitoring
Operational Check of Instruments and Equipment
High Priority Source: FEMA REP Program Manual Dec 2019
Objective: Ensure that all instruments and equipment used for radiation monitoring are functioning correctly and are calibrated properly.

Steps:
1. Obtain background measurements on a continuous basis using appropriate survey...
instrument check, equipment calibration, radiation monitoring, PPE, contamination control

Patient Assessment (4)

Assess Affected Area and Patients During Emergency
Critical Source: Home Health Emergency Preparedness
Procedure:

1. Determine the area struck by the emergency.
2. Identify which patients of the Agency are affected by the emergency.
3. Classify each patient based on priority (e.g., critical, urgent, non-urgent).
4. Create an assignment list for...
emergency assessment, patient classification, priority list
Complete a Patient Report Form for Medical Help
High Priority Source: Where There is no Doctor a Village Health Care Handbook
Procedure:

1. Fill out the Patient Report form to provide detailed information about the sick person when sending for medical help.

2. Name of the sick person: Write the full name of the individual who is unwell.
3. Age: Indicate...
patient report, medical help, symptoms, assessment, emergency form
Assessing a Sick Person's General Condition of Health
High Priority Source: Where There is no Doctor a Village Health Care Handbook
Procedure:

1. Observe the person’s overall appearance:
- Look for signs of fatigue, pallor, or unusual coloration.
- Check if they appear alert or confused.
2. Check for fever:
- Use a thermometer to measure body temperature.
...
health assessment, patient examination, vital signs, medical evaluation
Conduct a Patient Assessment in an Austere Environment
High Priority Source: Survival and Austere Medicine
Procedure for Conducting a Patient Assessment in an Austere Environment:

1. Understand the Components of Assessment:
- A patient assessment consists of three components: *history taking*, *clinical examination*, and *investigations*. In...
history taking,physical examination,austere medicine,clinical assessment,emergency diagnosis

Instrument Maintenance (4)

Disinfecting Dressings and Textiles
Standard Source: Survival and Austere Medicine
Procedure for Disinfecting Dressings and Other Textiles:

1. Autoclave/pressure cook: Use an autoclave or pressure cooker for sterilization.
2. Ironing method: Iron on a table covered with a drape that has been ironed and dampen each...
disinfection,textiles,dressings,sterilization
Sterilizing Rubber Items (Gloves, Tubing)
Standard Source: Survival and Austere Medicine
Procedure for Sterilizing Rubber Items:

1. Autoclave/pressure cook: Use an autoclave or pressure cooker.
2. Check for leaks: Blow into the gloves to ensure no leaks; if leaks are found, patch from the inside.
3. **Powder with talcum...
rubber items,sterilization,gloves,tubing
Sterilizing Surgical Instruments
Standard Source: Survival and Austere Medicine
Procedure for Sterilizing Surgical Instruments:

1. Choose sterilization method: Options for sterilizing instruments in order of preference are:
- Pressure cooker or autoclave (most effective)
- Oven (may damage instruments over time...
sterilization,surgical instruments,disinfection,tool maintenance
Sharpening Permanent Needles
Standard Source: Survival and Austere Medicine
Procedure for Sharpening Permanent Needles:

1. Prepare the sharpening stone: Place a drop of light oil (sewing machine, light machine, or gun oil) on a fine sharpening stone.
2. Sharpen the needle: Draw the bevel (flat part of tip) of...
sharpening,needles,medical instruments,tool maintenance

Microbiology Lab Techniques (4)

Classify Bacterial Morphology and Arrangement for Identification
Standard Source: Survival and Austere Medicine
Procedure:

After performing a Gram stain and observing under the microscope:

1. Classify bacteria based on shape and arrangement as follows:
- Cocci (spherical):
- Diplococci: Cocci that remain in pairs after division.
...
bacterial morphology, Gram classification, cocci, bacilli, diplococci, streptococci, tetrad, sarcinae, staphylococci
Grow Bacteria on Agar Plates for Culturing and Identification
Standard Source: Survival and Austere Medicine
Procedure:

1. Prepare an agar plate using a shallow dish with a lid (e.g., Petri dishes). If unavailable, improvise with any suitable container.
2. Dissolve 15 grams of agar or one pack of gelatine/jelly mix in **1/2 cup (125 ml) of...
agar plate preparation, bacterial culturing, Petri dish, agar gelatine, wire loop, incubation temperature
Heat-Fix a Bacterial Smear for Microscopy
Standard Source: Survival and Austere Medicine
Procedure:

1. Using the dropper bottle of distilled water, place a small drop of water on a clean slide by touching the dropper to the slide.

2. If the sample is from a wound:
- Ideally, culture the sample on an agar plate and transfer a...
heat fix, bacterial smear, microscopy preparation, slide preparation, Gram stain
Perform a Gram Stain on a Bacterial Smear
Standard Source: Survival and Austere Medicine
Procedure:

1. Flood the slide with crystal violet solution (0.3% crystal violet in 0.8% ammonium oxalate) and let it stand for one minute.
2. Gently wash off the excess stain with water. Shake off the excess water but do not blot dry...
Gram stain, bacterial classification, crystal violet, iodine solution, safranine, decoloriser

Herbal Treatment (4)

Apply a Poultice for Inflammation or Skin Conditions
Standard Source: Survival and Austere Medicine
Procedure:

1. Select fresh or finely crushed dried herbs suitable for the condition being treated (e.g., inflammation, bites, abscesses).
2. Place enough herbs in a glass dish or pot to cover the affected area.
3. Cover the herbs with enough...
poultice,application,herbs,inflammation,skin conditions
Prepare a Herbal Bolus/Suppository
Standard Source: Survival and Austere Medicine
Procedure:

1. Choose a dried powdered herb suitable for internal use (e.g., for digestive or systemic conditions).
2. Mix the herb with vegetable glycerine or cocoa butter until it reaches a consistency similar to bread dough.
3. If necessary,...
bolus,suppository,vegetable glycerine,cocoa butter,herb preparation
Prepare a Herbal Syrup for Coughs and Sore Throats
Standard Source: Survival and Austere Medicine
Procedure:

1. Prepare about a pint (approximately 473 ml) of decoction using herbs known to be effective for respiratory conditions (e.g., licorice root, wild cherry bark).
2. Add enough honey or edible glycerine to the decoction until it...
herbal syrup,coughs,sore throat,honey,licorice,wild cherry bark
Select and Use Herbs for Common Survival Illnesses
Reference Source: Survival and Austere Medicine
Procedure:

1. Review available herbal information from books or other reliable sources to identify herbs that are most useful in treating common illnesses in survival situations.
2. Choose both wildcrafted and homegrown herbs based on their...
herb selection,survival illnesses,common diseases,herbal knowledge

Vascular Repair (4)

Repair of Internal Carotid Artery Injury
Reference Source: Emergency War Surgery
Procedure:

Injury Type: Internal carotid artery injury.

Steps:
1. Repair the internal carotid artery primarily unless there is profound hemiplegia with deep coma (Glasgow Coma Scale <8).
2. All other carotid branches can be ligated...
internal carotid artery injury, emergency surgery, vascular repair, carotid ligation, end-to-end anastomosis, vein graft
Temporary Intraluminal Shunting in Vascular Repair
Reference Source: Emergency War Surgery
Step-by-step procedure:

1. Place proximal and distal vessel control using Silastic loops or a Rumel tourniquet.
2. Release proximal control to flush clot and place an Argyle shunt.
3. Perform distal thrombectomy with a Fogarty...
shunt placement, vascular repair, Argyle shunt, Fogarty catheter, heparinized saline, vessel control
Vascular Repair Principles in Emergency War Surgery
Reference Source: Emergency War Surgery
Procedure:

• Repair of vessels should follow the principles detailed in vascular repair: attempting primary repair if possible, with the use of prosthetics if primary repair is not feasible.
• Consider shunting as an alternative.

Note:
-...
vascular repair, emergency surgery, war surgery, primary repair, prosthetics, shunting
Vascular Repair Techniques Based on Injury Extent
Reference Source: Emergency War Surgery
Step-by-step procedure and types of repair based on injury extent:

1. Lateral suture repair is suitable for minimal injuries that do not compromise the lumen by more than 25%, will not result in a thrill, nor decrease pulse or Doppler...
vascular repair, lateral suture, patch angioplasty, end-to-end anastomosis, injury extent

Food Borne Illnesses (3)

Recognize High-Risk Vegetables for Disease Transmission
High Priority Source: US Army Preservation of Foods
Certain vegetables are more likely to be involved in the transmission of diseases due to their consumption patterns and growing conditions. These include:

Celery
Endive
Lettuce
Onions
Parsley
Radishes
-...
high-risk vegetables,disease transmission,watercress,typhoid fever,raw vegetables
Understand the Survival of Pathogens in Soil and Vegetables
High Priority Source: US Army Preservation of Foods
Pathogenic microorganisms can survive for extended periods in contaminated soil and on vegetables. For example:

• *Salmonella typhi* (the causative agent of typhoid fever) can remain viable in contaminated soil for 29 to 58 days.
• Coliform...
pathogen survival,soil contamination,coliform bacteria,salmonella typhi,vegetable safety
Classify Microbial Contaminants on Vegetables
High Priority Source: US Army Preservation of Foods
Microorganisms found on vegetables can be divided into two main groups:

1. Spoilage organisms: These are responsible for the deterioration of vegetable quality and shelf life.

2. Pathogenic organisms: These include disease-causing...
microbial contaminants,vegetables,pathogenic organisms,spoilage organisms,coliform bacteria

Communication Skills (3)

How to Understand Medical and Technical Language in the Book
Reference Source: A Book for Midwives
Medical terms are explained for clarity:

• Throughout this book, we use easily understood words for body parts and functions.
• If you encounter a medical or technical word you do not understand, look it up in the Index or the...
medical terminology,glossary,language understanding
How to Use Gender-Neutral Language in the Book
Reference Source: A Book for Midwives
Gender-neutral language is used for clarity:

• When referring to babies, we use 'she' or 'he' interchangeably instead of repeating 'he or she' each time.
gender neutral language,communication
Practice Active Listening in Patient Interactions
Reference Source: A Book for Midwives
Procedure:

1. Create a safe and non-judgmental space for the woman to express her thoughts and feelings.
2. Listen actively without interrupting or making assumptions about her situation.
3. Use open-ended questions to encourage the woman to...
active listening, patient communication, non-judgmental support

Midwifery Education (3)

Provide Lifelong Learning for Midwives
Standard Source: A Book for Midwives
Title: Provide Lifelong Learning for Midwives

Procedure:
1. Continuously seek knowledge and skills related to midwifery care, including both traditional practices and modern medical techniques.
2. Stay updated with the latest research,...
lifelong learning,midwife education,professional development,maternal health,continuing education
Share Knowledge with Health Workers and Midwives
Standard Source: A Book for Midwives
Title: Share Knowledge with Health Workers and Midwives

Procedure:
1. Actively share knowledge, skills, and experiences with other midwives and healthcare workers.
2. Participate in collaborative learning sessions to exchange information on...
knowledge sharing,midwife collaboration,healthcare education,maternal care,professional development
Share Knowledge with the Community
Standard Source: A Book for Midwives
Title: Share Knowledge with the Community

Procedure:
1. Educate community members about maternal and newborn health through workshops, seminars, or outreach programs.
2. Provide culturally appropriate information on pregnancy, childbirth,...
community education,midwife outreach,reproductive health,cultural sensitivity,maternal awareness

Education (3)

Conduct Community Health and Birth Education Classes
Standard Source: A Book for Midwives
### Conduct Community Health and Birth Education Classes

Steps:
1. Identify topics that the community would benefit from learning about, such as:
- How the body works.
- How to choose and use family planning.
- How to eat and care for...
community education, health classes, birth education, midwife training, teaching skills
Use Active Listening and Group Participation in Teaching
Standard Source: A Book for Midwives
### Use Active Listening and Group Participation in Teaching

Steps:
1. Begin by asking participants to share what they already know about a topic (e.g., STIs).
2. Encourage open discussion so that people can answer each other’s questions.
3....
active listening, group participation, health education, midwife teaching methods
Use Respectful and Inclusive Teaching Techniques
Standard Source: A Book for Midwives
### Use Respectful and Inclusive Teaching Techniques

Steps:
1. Show respect for the people you teach by ensuring your content is meaningful to their lives.
2. Sit in a circle with everyone on the same level during teaching sessions.
3. Be...
inclusive teaching, respectful communication, midwife education techniques

Pregnancy And Hiv (3)

Monitor for Complications in Pregnant Women with HIV
High Priority Source: A Book for Midwives
Procedure:

1. Be aware that pregnant women living with HIV are at higher risk for certain complications.
2. Monitor for the following potential issues:
- Miscarriage or stillbirth, especially late in pregnancy.
- Early birth...
HIV,pregnancy,complications,midwife,monitoring
Provide Respectful Care to Pregnant Women with HIV
High Priority Source: A Book for Midwives
Procedure:

1. Treat a pregnant woman with HIV with the same respect and care as any other woman.
2. Ensure confidentiality regarding her HIV status; do not discuss it with anyone (including colleagues) without her knowledge and consent.
3....
HIV,pregnancy,care,midwife,confidentiality,health monitoring
Administer Cotrimoxazole to Pregnant Women with HIV
Standard Source: A Book for Midwives
Procedure:

1. Identify a pregnant woman who is at least 3 months into her pregnancy and has HIV.
2. Prescribe cotrimoxazole (a low-cost antibiotic) for daily use to help prevent infections such as pneumonia, diarrhea, malaria, and others.
3....
cotrimoxazole,HIV,pregnancy,antibiotic,infection prevention

Pregnancy Healthcare (3)

Administer Tetanus Vaccinations to Pregnant Women
High Priority Source: A Book for Midwives
Procedure:

1. First Injection: Administer the first tetanus vaccination during the first prenatal visit.
2. Second Injection: Give the second injection earlier than 4 weeks after the first, and at least 4 weeks before the end of...
tetanus vaccination, pregnant women, prenatal care, maternal health, baby protection
Assess Medication Use During Pregnancy
High Priority Source: A Book for Midwives
Procedure:

1. Ask About Current Medications: Inquire if the pregnant woman is currently taking any medicines (modern or plant-based).
2. Avoid Harmful Medicines: Advise against using most modern and plant medicines during pregnancy, as...
pregnancy medications, safe drugs, prenatal care, drug safety
Use Safe Supplements and Tonics During Pregnancy
Standard Source: A Book for Midwives
Procedure:

1. Safe Supplements: Prenatal vitamins and iron pills are safe and beneficial during pregnancy.
2. Tonic Plants: Certain plant-based tonics can be used to support the mother’s health, such as:
- Stinging nettles (*Urtica...
safe herbs during pregnancy, prenatal supplements, tonic plants, herbal safety

Obstetrics Delivery Complications (3)

Check for and Manage a Nuchal Cord During Delivery
Critical Source: A Book for Midwives
Procedure:

1. Assess for a cord around the baby’s neck (nuchal cord): If there is a rest between the birth of the head and the birth of the shoulders, feel for the cord around the baby’s neck.

2. Loosen a loose nuchal cord:
- If the...
nuchal cord, delivery complications, obstetric emergency, midwifery procedures, cord around baby's neck
Recognize and Respond to a Baby Stuck at the Shoulders
Critical Source: A Book for Midwives
Procedure:

1. Identify signs of shoulder dystocia (baby stuck at the shoulders):
- The baby’s head may take lots of hard pushing to be born, instead of coming out smoothly after it crowns.
- The chin may not quite come out.
-...
shoulder dystocia, obstetric emergency, midwifery procedures, birth complications
Deliver the Baby’s Shoulders After Head Delivery
Critical Source: A Book for Midwives
Procedure:

1. After the baby’s head is born and he turns to face the mother’s leg:
- Wait for the next contraction.
- Ask the mother to give a gentle push as soon as she feels the contraction.
- Usually, the baby’s shoulders will...
shoulder delivery, obstetric procedures, midwifery techniques, birth complications

Infection Diagnosis (3)

Conduct Wound Biopsy for Infection Confirmation
High Priority Source: NATO Emergency War Surgery
Procedure:

1. Select areas of the wound that appear purulent or show new focal discoloration for biopsy.
2. Perform a wound biopsy, particularly in burn wounds or subcutaneous tissue injuries.
3. **Send a portion of the specimen to the...
wound biopsy, infection confirmation, microbiology culture, histologic examination
Identify Signs of Vaginal Infection
High Priority Source: A Book for Midwives
Procedure: Watch the mother for signs of vaginal infection:

Healthy signs:
• Any tears in the vagina are healing.
• The skin is not swollen or hot.

Warning signs:
• Pain in the vagina.
• Pus or a bad smell from the vagina.
• Swelling,...
vaginal infection, signs of infection, postpartum care
Diagnose Infection Using Clinical Signs
Standard Source: NATO Emergency War Surgery
Procedure:

1. Assess for classic signs of infection:
- Look for redness, swelling, heat, and pain in the affected area.
- Redness is due to hyperemia, often seen in skin or subcutaneous infections, including...
infection diagnosis, redness, swelling, fever, tachycardia, septicemia, wound inspection

Contraception And Sexual Health (3)

How to Use a Diaphragm with Spermicide
Reference Source: A Book for Midwives
How to Use a Diaphragm with Spermicide

1. Squeeze some spermicide into the center of the diaphragm. Then spread a little around the edge of the diaphragm.
2. If you do not have spermicide, you can still use the diaphragm, but it may not work as...
diaphragm, how to use diaphragm, contraception, sexual health, spermicide, STI prevention
How to Use a Female Condom
Reference Source: A Book for Midwives
How to Use a Female Condom

1. Carefully open the packet without tearing the condom.
2. Find the smaller ring (inner ring), which is at the closed end of the condom.
3. Squeeze the inner ring together.
4. Put the inner ring in the vagina.
5. Use...
female condom, how to use female condom, contraception, sexual health, STI prevention, HIV prevention
Use the Withdrawal Method (Pulling Out)
Reference Source: Where There is no Doctor a Village Health Care Handbook + A Book for Midwives
Procedure for Using the Withdrawal Method

1. A man pulls his penis out of the woman’s vagina and away from her genitals before he ejaculates.
2. This prevents sperm from entering the vagina.
3. The method is cost-free, always available, and may...
withdrawal method, pulling out, coitus interruptus, contraception, STI prevention

Hpv Treatment (3)

HPV Wart Treatment with Trichloroacetic Acid (TCA) or Bichloroacetic Acid (BCA)
Standard Source: A Book for Midwives
Procedure:

Step 1: Put petroleum gel (Vaseline) or another greasy ointment on the skin around each wart to protect healthy skin.

Step 2: With a small stick, apply a little TCA 80% to 90% solution or BCA directly onto the wart....
HPV, warts, TCA, BCA, treatment, genital warts
Testing for HPV Warts
Standard Source: A Book for Midwives
Procedure:

• To test for HPV: touch the warts with a mixture of plain vinegar and water. The warts will turn a whitish color if they are caused by HPV.

Notes:
• This is a simple at-home method to help confirm whether growths on the...
HPV, warts, vinegar test, identification
HPV Vaccine Information and Administration
Reference Source: A Book for Midwives
Procedure:

• The Gardasil vaccine is available to protect against the most dangerous types of HPV, as well as those that cause most genital warts.

• It should be given in a series of 3 injections, starting at an early age (between **9...
HPV, Gardasil, vaccine, prevention, treatment

Labor Induction (3)

Encouraging Labor with Medicines
Standard Source: A Book for Midwives
Procedure:

1. Administer medications to encourage labor.

Details:
• This method is used when labor needs to be encouraged, particularly in cases where the second baby of twins is expected.
• However, it should be avoided if medical help is...
medications, labor induction, encouraging labor, midwifery procedures
Using Plant Medicines to Induce Labor
Standard Source: A Book for Midwives
Important considerations for using plant medicines:

Use with caution: Many traditional midwives and healers use plant medicines to start or strengthen labor.
• There may be plants in your area that work well, but some can be dangerous....
plant medicine,labor induction,midwifery,dose control,allergic reactions
Administering an Enema to Induce Labor
Standard Source: A Book for Midwives
Steps to Administer an Enema:

1. Gather the tools you will need:
- A pair of clean plastic gloves
- A clean enema bag, or a container to hold water
- A clean plastic tube to put into the rectum
- A clean hose to attach the enema...
enema,labor induction,midwifery,rectal fluids,warm water

Pelvic Exam (3)

Performing a Bimanual Exam to Check the Womb and Cervix
High Priority Source: A Book for Midwives
Materials Needed:
• Very clean or sterilized water-based lubricating jelly (e.g., _K-Y Jelly_) or clean water
• Plastic gloves

Procedure Steps:
1. Preparation:
- Ask the woman to urinate before starting.
- Have her lie on her back...
bimanual exam,womb examination,cervix check,pregnancy assessment,fibroids,clitoris avoidance
Conducting a Pelvic Exam: Pap Test for Infections and Cancer
Standard Source: A Book for Midwives
The Pap test is used to detect infections or cancer of the cervix.

Steps to perform the Pap test:
1. After performing the speculum exam, use a small brush or spatula to gently collect cells from the surface of the cervix and surrounding...
pap test, cervical cancer screening, infection detection
Conducting a Pelvic Exam: The Vinegar Test for HPV
Standard Source: A Book for Midwives
The vinegar test is used to detect the presence of human papillomavirus (HPV) on the cervix.

Steps to perform the vinegar test:
1. After performing the speculum exam, apply a small amount of vinegar solution (diluted white vinegar)...
vinegar test, hpv detection, cervical screening

Gynecological Exams (3)

Conducting a Pelvic Exam: The Speculum Exam
Standard Source: A Book for Midwives
The speculum exam is used to examine the inside of the vagina and cervix. It allows for visual inspection, testing for infections or cancer, inserting an IUD, or emptying the womb.

### Preparation:
• Practice opening and closing the...
speculum exam, pelvic exam, vagina examination, cervix inspection, Pap test, lubricant use, IUD insertion, infection detection
How to Check for Organ Prolapse During a Pelvic Exam
Standard Source: A Book for Midwives
Procedure:

1. Post-Examination Check: After the bimanual exam, take your fingers out of her vagina.
2. Positioning: Hold the lips of her genitals open and ask her to cough or push down as if she were passing stool.
3. Observation:...
organ prolapse,pelvic exam,genital bulging,womb prolapse
How to Palpate Ovaries During a Pelvic Exam
Standard Source: A Book for Midwives
Procedure:

1. Positioning and Preparation: Ensure the patient is in a comfortable position, typically lying on her back with knees bent and feet supported.
2. Initial Contact: Place both your inside fingers on one side of the cervix and...
ovary palpation,pelvic exam,gynecological examination,ovary size assessment

Reproductive Health Procedures (3)

Prepare Tools and Supplies for MVA
High Priority Source: A Book for Midwives
Procedure:

1. Obtain an MVA kit from a reputable source such as Ipas.
2. Understand the components of the kit:
- A 50 cc syringe with a wide opening that creates a vacuum to pull the contents of the womb out.
- A set of plastic...
MVA, manual vacuum aspiration, medical tools, midwife procedures, reproductive health
Sterilize Tools for MVA Procedure
High Priority Source: A Book for Midwives
Procedure:

1. Sterilize all tools that will be inserted into the vagina or womb (e.g., forceps, speculum, tenaculum, cannulas).
2. Lay out sterilized tools on a clean, sterilized cloth, paper, or dish.
3. Wear sterile gloves at all...
tool sterilization, MVA preparation, midwife procedures, medical hygiene
Clean and Maintain the MVA Syringe
High Priority Source: A Book for Midwives
Procedure:

1. Disassemble the syringe after each use.
2. Carefully clean all parts of the syringe with appropriate sterilization methods.
3. Lubricate the rubber ring at the bottom of the plunger with a small amount of silicone...
syringe maintenance, MVA cleaning, medical tool care, midwife procedures

Antimalarials (3)

Use Artemisinin for Malaria Treatment
High Priority Source: A Book for Midwives
Procedure:

1. Administer artemisinin as part of a combination therapy regimen for malaria.
2. Follow dosage guidelines based on the patient's weight and age, typically in conjunction with other antimalarial drugs (as recommended by...
artemisinin, malaria treatment, antimalarial drugs, combination therapy
Use Chloroquine for Malaria (with Caution)
High Priority Source: A Book for Midwives
Procedure:

1. Administer chloroquine only in regions where it is still effective and not contraindicated.
2. Follow dosage guidelines based on the patient's weight and age, typically in conjunction with other antimalarial drugs.
3....
chloroquine, malaria treatment, drug resistance, epilepsy contraindication
Use Quinine for Malaria Treatment (with Caution)
High Priority Source: A Book for Midwives
Procedure:

1. Administer quinine only when other antimalarial drugs are not available or contraindicated.
2. Follow dosage guidelines based on the patient's weight and age, typically in conjunction with other antimalarial drugs.
3....
quinine, malaria treatment, cardiac risks, antimalarial drug

Resuscitation (3)

Initiate Resuscitation for Combat Casualty
Critical Source: NATO Emergency War Surgery
Resuscitation should be initiated immediately upon identifying life-threatening conditions during the primary survey.

### a. Airway and Circulation
• Maintain airway patency using an oral or nasal airway, and use a bag valve device...
resuscitation, airway, oxygen therapy, iv access, fluid resuscitation, urinary catheter, nasogastric tube, combat casualty
Performing Mouth-to-Mouth Breathing on a Person Who Has Stopped Breathing
Critical Source: Where There is no Doctor a Village Health Care Handbook
Procedure:

Step 1: Quickly use a finger to remove anything stuck in the mouth or throat.
Step 2: Lay the person face up. Gently tilt their head back and pull their jaw forward.
Step 3: Pinch their nostrils closed with your...
mouth-to-mouth breathing, resuscitation, CPR basics, first aid for stopped breathing
Resuscitation in Cold Conditions
High Priority Source: Aids to Survival
Procedure:

1. Recognize signs of cold-related technical death (no pulse or breathing).
2. Understand that victims of cold can be resuscitated after a longer period than those at normal temperature.
3. Do not attempt resuscitation if the victim...
cold, resuscitation, technical death, first aid, hypothermia

Resuscitation Procedures (3)

Setting Up an Emergent Treatment Area
High Priority Source: Emergency War Surgery
Purpose: To create a functional resuscitation area for immediate care of critically injured casualties.

### Setup Requirements
Close proximity to the initial triage area with direct access.
• Administrative personnel stationed at...
emergent treatment area setup, resuscitation bay equipment, triage team roles
Staffing the Emergent Treatment Area
High Priority Source: Emergency War Surgery
Team Leader: A surgeon serves as the surgical triage officer and is responsible for determining priority for operative interventions. If a surgeon is unavailable, a physician who communicates closely with operating surgeons can fill this...
emergent treatment staffing, surgical triage officer, resuscitation team
Resuscitation Team Composition and Operations
Reference Source: Emergency War Surgery
Purpose: To manage the resuscitation process and determine patient disposition.

### Team Composition
• A team consisting of a physician, nurse, and medical technician is ideal for resuscitation.

### Operation Steps
1. The manpower team...
resuscitation, team composition, patient disposition, triage, emergency surgery

Respiratory Support (3)

Administer Supplemental Oxygen in Early Resuscitation
High Priority Source: Emergency War Surgery
- Supplemental oxygen is imperative in the early phase of resuscitation.
• The maximum fraction of inspired oxygen (FIO2) delivered by:
- Nasal cannula: approaches 0.35
- Venturi mask: 0.50
- Non-rebreathing reservoir mask:...
supplemental oxygen, FIO2 delivery, early resuscitation
Manage Mechanical Ventilation in ARDS Patients
High Priority Source: Emergency War Surgery
Objective: Properly manage mechanical ventilation to prevent complications in patients with Acute Respiratory Distress Syndrome (ARDS).

Steps:
1. Maintain patient analgesia and sedation to prevent agitation and ventilator/patient...
mechanical ventilation, ARDS, PEEP, tidal volume, SaO2, respiratory acidosis, permissive hypercapnia
Monitor Patients on Mechanical Ventilation
High Priority Source: Emergency War Surgery
- Monitoring may include:
- Portable chest radiographs
- Periodic ABGs (arterial blood gases)
- Regular assessments of level of sedation
- Airway pressures
- Functioning of ventilator alarms
ventilator monitoring, ABG monitoring, chest radiography, airway pressure assessment

Electrolyte Disorders (3)

Management of Hyponatremia in Emergency Settings
Critical Source: Emergency War Surgery
Hyponatremia: Indicative of excess free water or vasopressin (SIADH).

Serum sodium < 125 mEq/L is associated with mental status changes or seizures.
Treatment: Implement free water restriction or use IV normal saline.
-...
hyponatremia, free water restriction, normal saline, central pontine myelinolysis
Management of Hypophosphatemia in Casualty
High Priority Source: Emergency War Surgery
Treatment for hypophosphatemia:

• Phosphate is important as an energy source and should be repleted to a level of 2.5 mg/dL.
• Administer IV KPO4 or NaPO4, 30 mMol over 1 hour.
hypophosphatemia,phosphate replacement,KPO4,NaPO4
Management of Hyperkalemia in Emergency Settings
Standard Source: Emergency War Surgery
Steps for managing hyperkalemia (serum K > 6 mEq/L):

1. Verify again hyperkalemia and serum pH.
2. Give IV calcium chloride, 10 mL of 10% solution over 5 minutes.
3. Give IV NaHCO3, 50 mEq over 5 minutes.
4. Give IV Dextrose (D50),...
hyperkalemia, emergency treatment, IV calcium chloride, sodium bicarbonate, insulin, albuterol, sodium polystyrene sulfonate

Joint Injuries (3)

Immediate Treatment of Open-Joint Injuries
Critical Source: Emergency War Surgery
Objective: Provide immediate care to prevent infection and preserve joint function.

Steps for initial treatment:
1. Administer IV antibiotics immediately after injury, and continue them postoperatively for 48 hours.
2. Use a...
open-joint injury treatment, irrigation, synovium closure, internal fixation contraindicated, arthrotomy incisions
Post-Exploration Management of Open-Joint Injuries
High Priority Source: Emergency War Surgery
Objective: Ensure proper wound management and prevent complications after initial surgical exploration.

Steps for post-exploration care:
1. If synovium closure is not possible, dress the joint open with a **moist fine mesh gauze...
post-exploration care, delayed primary closure, skin grafts, range-of-motion therapy, synovium dressing
Recognize and Treat Open-Joint Injuries
Standard Source: Emergency War Surgery
Objective: Identify potential open-joint injuries and initiate appropriate treatment within 6 hours to prevent infection and joint destruction.

### Signs of Possible Open-Joint Injury:
• A wound located near a joint.
• Presence of...
open-joint injury, aspiration, injection, hemarthrosis, effusion, surgery, emergency treatment

Radiological Injuries (3)

Understand the Effects of Nuclear Detonations on Casualty Distribution
Critical Source: Emergency War Surgery
Nuclear detonation casualty distribution:
Blast injury: 50%.
Thermal injury: 35%.
Ionizing radiation injury:
- Initial (immediate transient ineffectiveness): 5%.
- Residual (long-term effects): 10%.

### **Factors...
nuclear detonation casualty distribution, blast injury, thermal injury, radiation injury
Understand the Effects of Radiological Dispersal Devices (RDDs)
Critical Source: Emergency War Surgery
Radiological dispersal devices (RDDs) are any device, other than a nuclear explosive device, specifically designed to spread radiation.

### Effects and Implications
Contaminate conventional casualties with radionuclides, complicating...
RDDs, radiological dispersal devices, terrorism, radiation contamination, decontamination
Managing and Protecting Against Radiation Injuries from Nuclear Detonation
Reference Source: Emergency War Surgery
Radiation injuries are caused by ionizing radiation released during and after a nuclear detonation. Two main types of radiation are emitted:

Electromagnetic (gamma) radiation
Particulate (alpha, beta, neutron) radiation

Shielding...
radiation injuries, nuclear detonation, alpha particles, beta particles, gamma radiation, neutron radiation, fallout hazards, surgical considerations

Chemical Injuries (3)

Initial Treatment Priorities for Chemical Casualties
Critical Source: Emergency War Surgery
Objective: Provide immediate and effective treatment to chemical casualties in a prioritized sequence.

### Steps:
1. Treat respiratory insufficiency (airway management) and control massive hemorrhage:
- Ensure the casualty's airway is...
chemical casualties, initial treatment, antidotes, decontamination, shock management
Personal Protection Against Chemical Injuries
High Priority Source: Emergency War Surgery
Objective: Prevent chemical injury and protect oneself and others from exposure.

### Steps:
1. Prevention:
- Avoid becoming a casualty by taking all necessary precautions.
- Protect yourself and ensure that personnel under your care...
personal protection, chemical injuries, decontamination, antidotes, MOPP ensemble
Chemical Injuries Overview
Standard Source: Emergency War Surgery
Procedure:

• This section introduces the topic of chemical injuries, but no specific procedures are detailed in the provided text.
• Further information is likely covered in Chapter 32.
chemical injuries, emergency war surgery, chapter 32

Vascular Access (3)

Subclavian Vein Access or Internal Jugular Venipuncture
Critical Source: Emergency War Surgery
Procedure for Subclavian Vein Access or Internal Jugular Venipuncture

Step 1: Patient Positioning
• Place the patient supine in Trendelenburg position (15° head down).

Step 2: Prep and Drape
• Prep and drape the subclavian/jugular...
subclavian vein access, internal jugular venipuncture, vascular catheterization, emergency surgery, trauma care
Perform Intraosseous Access Using the FAST1 System
High Priority Source: TCCC 17 13 Army Tactical Combat Casualty Care
Procedure:

Necessary Equipment: FAST1 System device, 10 cc syringe with normal saline for flush, saline lock, and tape.

1. Positioning and preparing the site:
- Providers should position themselves above the head of the casualty to...
intraosseous access, FAST1 system, vascular access, trauma care, emergency infusion, battlefield medical procedures
Performing a Femoral Artery/Vein Catheterization
High Priority Source: Emergency War Surgery
Procedure for Performing a Femoral Artery/Vein Catheterization:

1. Prepare the patient and equipment:
- Ensure informed consent is obtained.
- Gather supplies: sterile drapes, antiseptic solution (e.g., chlorhexidine), local...
femoral,catheterization,procedure

Field Hospital Operations (3)

Deploy Field Hospital (MF2K)
Standard Source: Emergency War Surgery
Procedure:

• Set up a Field Hospital (MF2K) as a semipermanent facility.
• Provide primarily convalescent care with at least 2 OR tables for 24 hours of surgery per day.
• Offer general, orthopedics, OB/GYN, urologic, oral surgery, and dental...
Field Hospital, MF2K, military hospital
Deploy Hospital Ship (TAH)
Standard Source: Emergency War Surgery
Procedure:

• Deploy a Hospital Ship (TAH), such as the USNS Mercy or USNS Comfort.
• Provide 1,000 beds with 100 ICU beds and 12 ORs.
• Requires 1,000 staff including over 50 physicians.
• Equipped with extensive laboratory and X-ray...
hospital ship, TAH, USNS Mercy, USNS Comfort
Level V Medical Care in CONUS
Standard Source: Emergency War Surgery
Procedure:

• Provide Level V medical care at CONUS (Continental United States) hospitals.
• These facilities include Department of Defense (DoD) and Department of Veterans Affairs (DVA) hospitals.
• Offer the ultimate treatment capability for...
Level V, CONUS hospitals, DoD medical care

Anesthesia Equipment (3)

Prepare Anesthesia Equipment in Forward Installation
Critical Source: NATO Emergency War Surgery
Procedure:

1. Ensure anesthesia equipment includes:
- Standard apparatus for administration of inhalation, IV, and regional anesthetics.
- Oxygen supplementation and ventilatory support systems.
2. In austere environments, consider...
anesthesia equipment, forward installation, airway management, ventilator, pediatric use
Ensure Proper Anesthetic Delivery Systems and Adapters
Critical Source: NATO Emergency War Surgery
Procedure:

1. Ensure appropriate adapters and delivery systems are available for proper anesthetic management.
2. Include the following:
- Nonrebreathing circuits.
- Pediatric circle systems.
3. Verify that all equipment is functional and...
nonrebreathing circuits, pediatric circle systems, anesthetic delivery
Field Anesthesia Equipment - Draw-over Vaporizer
Standard Source: Emergency War Surgery
Draw-over vaporizer (Ohmeda Portable Anesthesia Complete [PAC]):

Demand type system: No gas flow occurs unless the patient initiates a breath or the self-inflating bag is squeezed. No demand equals no flow.

-...
draw-over vaporizer, ohmeda pac, oxygen economizer tube, ether flammability

Antibiotic Therapy (3)

Antibiotic Regimen for Battlefield Wounds
Critical Source: Emergency War Surgery
Procedure:

1. Start empiric antibiotic therapy immediately after wounding and continue for 24 hours, depending on the wound's size, extent of destruction, and degree of contamination.
2. If time from injury to initiation of antibiotics...
empiric antibiotics,battlefield wound treatment,antibiotic regimen,wound infection
Administer Early Antibiotic Therapy for Wounds
High Priority Source: NATO Emergency War Surgery
Procedure:

1. Administer antibiotics as early as possible, ideally before infection becomes established.
2. During the Yom Kippur War, it was standard practice to administer antibiotics routinely to all wounded personnel.
3. In cases...
early antibiotic administration,war wounds,infection prevention,bacterial proliferation,penicillin therapy
Administer Empiric Antibiotic Therapy for Post-Influenza Bacterial Pneumonia
High Priority Source: HHSPandemicInfluenzaPlan
Guidelines for Empirical Treatment:

• Use broad-spectrum antibacterials in the absence of confirmed pathogen identification.
• Preferred agents include:
- Extended-spectrum macrolides (e.g., azithromycin, clarithromycin)
-...
empiric antibiotic therapy, post-influenza pneumonia, broad-spectrum antibiotics

Otologic Injuries (3)

Administer Steroids for Sensorineural Hearing Loss After Blast Injury or Noise Trauma
High Priority Source: Emergency War Surgery
Procedure:

• If sensorineural hearing loss is suspected and documented after a blast injury or noise trauma, administer 1 mg/kg of prednisone.
• Continue steroids for five days. If no improvement is noted by day five, discontinue the...
sensorineural hearing loss, prednisone, blast injury, noise trauma
Examine External Auditory Canal for Temporal Bone Fracture
High Priority Source: Emergency War Surgery
Procedure:

• Inspect the external auditory canal for a tear of the lining of the canal, which suggests a temporal bone fracture.
• If a temporal bone fracture is suspected, it is critical that the facial nerve be assessed.
external auditory canal, temporal bone fracture, otologic injury
Manage Tympanic Membrane Perforation in Otologic Injury
Standard Source: Emergency War Surgery
Procedure:

• Tympanic membrane perforations can be managed expectantly as the vast majority will heal spontaneously.
• The patient should be followed for evidence of cholesteatoma formation from traumatic implantation of the squamous...
tympanic membrane, otologic injury, cholesteatoma, antibiotic drops

Urology Injuries (3)

Intraoperative Localization and Repair of Ureteral Injuries
Critical Source: Emergency War Surgery
Intraoperative Localization and Repair of Ureteral Injuries

Intraoperative localization of the ureteral injury can be facilitated by:
- IV injection of indigo carmine, or
- **Direct injection into the collecting system under...
ureteral repair, indigo carmine, anastomosis, stent placement, psoas hitch
Repair Techniques for Ureteral Injuries Based on Anatomical Location
Critical Source: Emergency War Surgery
Repair Techniques for Ureteral Injuries Based on Anatomical Location

Upper or Middle Ureteral Injuries:
- For short segment loss/transection, perform a primary ureteroureterostomy (Fig. 18-5).
- For long segment loss,...
ureteroureterostomy, ureteroneocystostomy, psoas hitch, rectal injury, temporary diversion
Management of Ureteral Injuries in Combat Settings
High Priority Source: Emergency War Surgery
Management of Ureteral Injuries in Combat Settings

In combat settings, ureteral injuries may be best managed with:
- Temporary tube drainage using a small feeding tube or ureteral stent.
- Follow this with **delayed...
combat surgery, temporary drainage, delayed reconstruction, ureteral stent

Pelvic Injuries (3)

Management of Pelvic Injuries and Hemorrhage
Critical Source: NATO Emergency War Surgery
Procedure:

When managing pelvic injuries with hemorrhage, follow these steps:

1. Recognize the difficulty in treating pelvic injuries, which can be particularly frustrating due to unresponsive hemorrhage from fractures or fragment...
pelvic injury, hemorrhage, pelvic fixation device, bladder injury, rectosigmoid injury
Diagnose Pelvic Injuries in Battlefield Settings
Critical Source: Emergency War Surgery
Clinical Signs:
Instability of the pelvis when manual pressure is applied to the iliac crests.
Leg length difference, scrotal or labial swelling/ ecchymosis, or abrasions over the pelvis raise suspicion for pelvic ring...
pelvic injury diagnosis, battlefield trauma, radiography, CT scan, urethral injury
Stabilize Pelvic Injuries in Austere Environments
Critical Source: Emergency War Surgery
Importance: Early pelvic stabilization can control hemorrhage and reduce mortality.

Procedures for Stabilization:
1. Use mechanical stabilization methods, such as:
- Tying a sheet or placing a binder around the pelvis at the level of...
pelvic stabilization, hemorrhage control, battlefield trauma, mechanical fixation

Flu Treatment (3)

Assemble a Flu Treatment Kit (FTK) for One Person
High Priority Source: Flu Home Treatment
Flu Treatment Kit (FTK) For One Person

Grocery Store Items: Include items like water, electrolyte solutions, canned food, and non-perishable snacks.
Drug Store Items: Stock up on over-the-counter medications such as acetaminophen,...
flu treatment kit, home care, dehydration, fever, cough, children, medication, electrolyte solution
Administer Medications for Nausea and Diarrhea During Flu
Standard Source: Flu Home Treatment
Procedure:

1. For nausea, administer Meclizine at a dose of 25 to 50 mg every 4 to 6 hours as needed.
2. For diarrhea and abdominal cramping, administer diphenhydramine at a dose of 25 to 50 mg every 4 to 6 hours.
3....
Meclizine, diphenhydramine, loperamide, nausea, diarrhea, flu treatment
Administer ORS to Manage Nausea, Vomiting, Diarrhea, and Abdominal Pain
Standard Source: Flu Home Treatment
Procedure:

1. Place the patient on a clear liquid diet using Oral Rehydration Solution (ORS).
2. ORS is preferred because it minimizes the risk of provoking vomiting or diarrhea compared to other fluids or foods.
3. Monitor for any...
ORS, clear liquid diet, nausea, vomiting, diarrhea, abdominal pain, flu treatment

Dehydration Treatment (3)

Administer Oral Re-hydration Solution (ORS) for Dehydration in Adults
High Priority Source: Flu Home Treatment
Objective: Administer ORS to treat dehydration in adults.

### ORS Formula for Adults
• 1 quart clean water
• 1 level tsp table salt
• 3 tbsp table sugar

### Adjustments Based on Patient Preference
• Sugar can be increased up to 4 tbsp...
ORS, dehydration treatment, oral rehydration solution, hydration, flu symptoms
Administer Oral Rehydration Salts
High Priority Source: Where There is no Doctor a Village Health Care Handbook
Procedure:

1. Prepare the solution: Mix 1 level teaspoon (about 5 grams) of salt with 1 level teaspoon (about 5 grams) of sugar in a clean container.
2. Add water: Add 1 liter (about 4 cups) of clean, boiled, and cooled water to the...
oral rehydration salts, dehydration treatment, diarrhea, electrolyte replacement, emergency hydration
Switch to Alternative Fluids After Hydration is Restored
Standard Source: Flu Home Treatment
Objective: Transition the patient from ORS to other fluids once hydration is restored.

### When to Switch
• Once the patient is well hydrated and eating, there is no further need for ORS.
• If the patient is not eating but can drink and...
fluid transition, hydration restoration, ORS to juice, bouillon, tea

Hydration (3)

Providing Adequate Hydration for Survival
High Priority Source: Survival and Austere Medicine
Procedure for Ensuring Proper Hydration

1. Monitor the patient’s intake and output of fluids regularly to ensure adequate hydration.
2. Encourage oral consumption of clean water at regular intervals, especially in hot or dry environments.
3. If...
hydration, dehydration prevention, water intake, survival hydration, medical care
Administering Water via Proctoclysis
Standard Source: Survival and Austere Medicine
Procedure for Administering Water via Proctoclysis

1. Ensure the patient is in a comfortable position, preferably on their left side with knees bent to facilitate access.
2. Clean the anal area thoroughly with soap and water to reduce the risk...
proctoclysis, hydration, water administration, rectal hydration, emergency hydration
Managing Dehydration with ORS and Hydration Strategies
Standard Source: Flu Home Treatment
Procedure:

1. Administer ORS (Oral Rehydration Solution) to the patient if symptoms of dehydration are present (e.g., low urine output, high pulse rate >90, or signs of fever).
2. Provide the patient with a hot or cold caffeine-containing...
ORS,dehydration,fluid replacement,cough promotion

Diarrhea And Vomiting Treatment (3)

Administer Oral Rehydration Solution for Nausea and Diarrhea
High Priority Source: Flu Home Treatment
Procedure:

1. Stop feeding the child and place them on a clear liquid diet.
2. Start with an Oral Re-hydration Solution (ORS), plain or mixed with a small amount of powered fruit-flavored drink mix for taste.
3. **Give the child small...
oral rehydration solution, dehydration prevention, nausea treatment, vomiting management, diarrhea in children
Administer Diphenhydramine for Diarrhea in Children
Standard Source: Flu Home Treatment
Procedure:

1. Use a small dose of diphenhydramine to help calm the intestine and reduce diarrhea.
2. Administer every 4 to 6 hours, as needed, using an age/weight appropriate low dose.
3. **Avoid overuse or exceeding recommended...
diphenhydramine for diarrhea, anticholinergic treatment, pediatric diarrhea management
Administer Meclizine for Nausea in Children
Standard Source: Flu Home Treatment
Procedure:

1. Use Meclizine 25mg to reduce nausea in children aged 12 years and older.
2. Administer every 4 to 6 hours, as needed, but do not exceed the recommended dosage.
3. Do not use in children under 12 years of age, as it is...
meclizine for children, nausea medication, antiemetic treatment, pediatric vomiting management

Cardiovascular System (3)

Understand the Circulatory System and Blood Flow
High Priority Source: FM 4 25 11 First Aid
Procedure:

1. Understand that blood circulation is managed by the heart and blood vessels (arteries, veins, and capillaries), which circulate blood through the body tissues.
2. Recognize that the heart is divided into two halves, each...
circulatory system, blood flow, heart function, arteries and veins, oxygen transport
Understand the Heartbeat and Pulse
High Priority Source: FM 4 25 11 First Aid
Procedure:

1. Understand that the heart functions as a pump to circulate blood continuously through the blood vessels to all parts of the body.
2. Recognize that the heart contracts, forcing blood from its chambers, then relaxes,...
heartbeat, pulse rate, cardiovascular system, emergency medical procedures
Understand Circulation and Its Role in the Body
Reference Source: Where There is no Doctor a Village Health Care Handbook
Circulation is the flow of blood through the arteries and veins by the pumping of the heart.
circulation,blood flow,heart function

Pediatric Care (3)

Consider Antiviral Treatment for Infants Under One Year Admitted to Hospital
Critical Source: HHSPandemicInfluenzaPlan
Procedure:

1. For infants <1 year old admitted to hospital during a pandemic influenza outbreak:
- Consider the ability of the infant to take oral medication or its absorption as an important issue.

2. Note that **neuraminidase inhibitors...
infant treatment, antiviral drugs, neuraminidase inhibitors, pediatric care
Prepare for Pediatric Patients During Emergencies
High Priority Source: Home Health Emergency Preparedness
Pediatric patients receiving home health care are particularly at risk during an emergency. Often these patients are enrolled in the Children’s Special Health Care Services (CSHCS) program due to serious or chronic health conditions. Due to...
pediatric patients, cshcs, emergency preparedness, home health care
Manage Teething in Babies and Small Children
Standard Source: Where There is No Dentist
When babies or small children are teething:

Signs: Sore gums, discomfort, but not fever, head colds, or cough (these may be separate issues).

Treatment:
- If the child has another illness, do not assume it is caused by teething. Look...
teething, baby care, acetaminophen, chewing relief, gum soreness

Treatment (3)

Develop New Antiviral Drugs for Influenza Treatment and Prophylaxis
Critical Source: HHSPandemicInfluenzaPlan
Objective: Partner with industry, academia, and other interested parties to develop new influenza antiviral agents that can provide an option for therapy and chemoprophylaxis if strains resistant to currently available agents emerge and...
antiviral drugs,new therapies,RNA interference,combination therapy,long-acting neuraminidase inhibitors
Initiate Antiviral Treatment for Suspected Novel Influenza Cases
Critical Source: HHSPandemicInfluenzaPlan
Steps to Initiate Antiviral Treatment:

1. Start antiviral treatment as soon as possible, even if laboratory results are not yet available.
2. Clinical trials have shown that these drugs can reduce the duration of illness due to seasonal...
antiviral treatment, novel influenza, 48-hour window, drug resistance testing
Develop Rapid Methods to Detect Antiviral Resistance in Influenza Isolates
High Priority Source: HHSPandemicInfluenzaPlan
Objective: Develop new rapid methods to detect antiviral resistance in clinical influenza isolates.

Actions:
• Create rapid diagnostic tools capable of identifying antiviral resistance in clinical isolates from patients infected with...
antiviral resistance,detection methods,molecular techniques,clinical isolates

Epidemiology (3)

Detail the Natural History of the Pandemic Influenza Outbreak
High Priority Source: HHSPandemicInfluenzaPlan
Procedure:

To detail the natural history of the pandemic influenza outbreak:

1. Document the timeline and geographic spread of the outbreak.
2. Track the progression of disease from initial cases to widespread transmission.
3. Analyze patterns...
natural history, pandemic timeline, disease progression, outbreak analysis
Evaluate Population Impact of Outbreaks Early in Pandemic Development
High Priority Source: HHSPandemicInfluenzaPlan
Procedure:

To evaluate the population impact of outbreaks early in the development of a pandemic:

1. Monitor and document the initial spread of the virus across different regions.
2. Assess the burden on healthcare systems, including...
pandemic impact, outbreak evaluation, healthcare burden, economic consequences, modeling tools
Historical Incidence and Mortality of Clostridial Myonecrosis (Gas Gangrene)
Standard Source: NATO Emergency War Surgery
Procedure for Understanding Historical Trends in Gas Gangrene

1. World War I:
- 5% of wounded patients developed gas gangrene.
- Fatality rate: 28%.

2. World War II:
- 0.7% of wounded patients developed gas gangrene.
-...
historical data, gas gangrene, incidence, mortality, war surgery

Epidemiology Surveillance (3)

Define Suspected and Confirmed Cases of Pandemic Influenza
High Priority Source: HHSPandemicInfluenzaPlan
Procedure:

1. Establish case definitions for suspected and confirmed cases of pandemic influenza based on the characteristics of the virus and geographical spread.
2. Update definitions as needed over time depending on changes in the...
case definitions, pandemic influenza, epidemiologic data, surveillance
Conduct Disease and Non-Battle Injury (DNBI) Surveillance
High Priority Source: Medical NBC Battlebook
Objective: Monitor and report DNBI to detect outbreaks of infectious diseases or potential biological warfare agents.

Steps:
1. Submit daily DNBI reports through the chain of command from each medical treatment unit.
2. Use **automated...
DNBI surveillance, disease outbreak detection, biological warfare monitoring
Define Influenza and Influenza-Like Illness (ILI) for Surveillance Purposes
High Priority Source: HHSPandemicInfluenzaPlan
Procedure:

1. Define influenza as an acute viral disease of the respiratory tract with symptoms including:
- Fever
- Headache
- Myalgia
- Prostration
- Coryza
- Sore throat
- Cough
2. Note that otitis media, nausea, and...
influenza definition, ILI surveillance, respiratory illness

Influenza Surveillance (3)

Maintain Year-Round Influenza Testing Capability
Standard Source: HHSPandemicInfluenzaPlan
Procedure for Maintaining Year-Round Influenza Testing Capability:

1. Ensure Laboratory Capacity: Laboratories must maintain the ability to test for influenza viruses year-round.
2. Testing Methods: Use one or more of the following...
year-round testing,flu lab capacity,laboratory methods
Report Influenza Test Results to CDC
Standard Source: HHSPandemicInfluenzaPlan
Procedure for Reporting Influenza Test Results to CDC:

1. Collect Data: Laboratories must collect and compile weekly data on:
- Total number of respiratory specimens tested.
- Number of positive influenza tests by type (A/H1, A/H3,...
influenza surveillance,cdc reporting,laboratory testing,weekly data submission
Subtype Influenza A Isolates in State and County Laboratories
Standard Source: HHSPandemicInfluenzaPlan
Procedure for Subtyping Influenza A Isolates:

1. Scope of Subtyping:
- All 50 state health department laboratories.
- 4 large county public health laboratories.
- A DOD reference laboratory.
- ~25 tertiary-care hospital and...
influenza subtyping,laboratory reporting,state labs,cdc data

Occupational Health (3)

Implement Occupational Health Measures for Healthcare Workers During Pandemic Influenza
High Priority Source: HHSPandemicInfluenzaPlan
Objective: Ensure the health and safety of healthcare workers during a pandemic.

Steps:
1. Protect healthy workers from exposure through recommended infection control measures.
2. Evaluate and manage symptomatic or ill healthcare...
healthcare worker safety, pandemic occupational health, infection control protocols, mental health support for staff
Manage Ill Healthcare Workers During Pandemic Influenza Outbreaks
High Priority Source: HHSPandemicInfluenzaPlan
Objective: Implement procedures to manage ill healthcare workers and protect the healthcare system.

Steps:
1. Establish a plan for detecting signs and symptoms of influenza in healthcare personnel before they report for duty.
2. Develop...
ill healthcare worker management, pandemic alert period protocols, case-by-case exposure handling
Maintaining Occupational Health and Safety Practices for Laboratory Workers During a Pandemic
High Priority Source: HHSPandemicInfluenzaPlan
Procedure:

1. Ensure that all laboratory personnel are trained in biosafety practices appropriate for the level of risk involved.
2. Encourage routine vaccination of eligible laboratory workers who handle specimens from patients with...
laboratory safety,occupational health,vaccination,biosafety,medical surveillance

Virus Diagnosis (3)

Immunofluorescence Assays for Influenza Diagnosis
High Priority Source: HHSPandemicInfluenzaPlan
Procedure:

1. Use Direct (DFA) or Indirect (IFA) immunofluorescence antibody staining of virus-infected cells as a rapid and sensitive method to diagnose influenza and other viral infections.
2. Type and subtype influenza viruses using...
DFA, IFA, immunofluorescence assay, influenza diagnosis, HA typing
Reverse-Transcription Polymerase Chain Reaction (RT-PCR) for Influenza Diagnosis
High Priority Source: HHSPandemicInfluenzaPlan
Procedure:

1. Use RT-PCR as a molecular diagnostic method to detect and identify influenza viruses in clinical specimens.
2. RT-PCR is highly sensitive and specific, allowing for rapid detection of viral RNA without the need for virus...
RT-PCR, influenza diagnosis, molecular testing, RNA extraction
Virus Isolation for Influenza Diagnosis
High Priority Source: HHSPandemicInfluenzaPlan
Procedure:

1. Collect clinical specimens within 3 days of the start of illness, ideally within 72 hours of symptom onset.
2. Use appropriate specimen types: nasal washes, nasopharyngeal aspirates, nasopharyngeal and throat swabs, tracheal...
virus isolation, influenza diagnosis, cell culture, BSL-3, HPAI, RT-PCR, spin-amplification shell-vial method

Hospital Preparedness (3)

Collaborating with Local and Regional Entities for Pandemic Influenza Planning
High Priority Source: HHSPandemicInfluenzaPlan
Objective: Ensure coordination between hospitals, public health departments, and other community entities during a pandemic influenza outbreak.

### Steps:
1. Obtain copies of draft pandemic influenza plans from other local or regional...
collaboration, safety-net providers, FQHCs, regional planning, hospital coordination
Developing a Hospital Pandemic Influenza Response Plan
High Priority Source: HHSPandemicInfluenzaPlan
Objective: Ensure hospitals are prepared to manage both limited and large-scale patient influxes during a pandemic influenza outbreak.

### Steps:
1. Outline administrative measures for detecting the introduction of pandemic influenza,...
pandemic influenza, hospital preparedness, infection control, emergency response plan, public health collaboration
Establishing a Hospital Pandemic Influenza Planning Committee
High Priority Source: HHSPandemicInfluenzaPlan
Objective: Create a multidisciplinary team to oversee pandemic influenza preparedness and response.

### Steps:
1. Form an internal, multidisciplinary planning committee with responsibility for pandemic influenza preparedness and response....
planning committee, response coordinator, hospital preparedness, multidisciplinary team

Pandemic Influenza Management (3)

Optimize Antiviral Use During Widespread Transmission of Pandemic Influenza
Critical Source: HHSPandemicInfluenzaPlan
Action: When there is widespread transmission of pandemic influenza in the U.S., state and local health departments should:

1. Prioritize antiviral use to treat those at highest risk for severe illness or death, as well as to preserve...
widespread transmission, high-risk groups, vaccine response, drug resistance, healthcare delivery
Activate Antiviral Distribution Plans During Limited Transmission of Pandemic Influenza
High Priority Source: HHSPandemicInfluenzaPlan
Action: When there is limited transmission of pandemic influenza in the U.S., state and local health departments should:

1. Activate state-based plans for targeting antiviral drugs to priority groups for prophylaxis and treatment (see...
antiviral distribution, limited transmission, healthcare workers, SNS, monitoring drug safety
Implement Antiviral Drug Management for Novel Influenza Cases and Contacts
High Priority Source: HHSPandemicInfluenzaPlan
Action: When pandemic influenza is reported abroad or sporadic cases are identified in the U.S., state and local health departments should:

1. Use antiviral drugs to manage persons infected with novel strains of influenza and their contacts,...
antiviral drugs, pandemic influenza, prophylaxis, public health workers, drug resistance, distribution plan

Wound Healing (3)

Delayed Primary Closure for Wounds
High Priority Source: Medical Survival Wound Closure Manual
Delayed Primary Closure

• A safe method of managing contaminated, dirty, or infected traumatic wounds with extensive tissue loss and high infection risk.
• Commonly used in military settings and after incidents such as:
- Motor vehicle...
delayed primary closure, wound debridement, gauze packing, granulation tissue, secondary intention healing
Healing by Second Intention
Standard Source: Medical Survival Wound Closure Manual
Healing by Second Intention

• Occurs when a wound fails to heal by primary union due to:
- Infection
- Excessive trauma
- Tissue loss
- Imprecise approximation of tissue
• The wound is left open and allowed to heal from the inner layer...
healing by second intention, granulation tissue, myofibroblasts, wound healing complications
Understanding Phase 3 of Wound Healing
Standard Source: Medical Survival Wound Closure Manual
Phase 3 – Collagen Laying and Wound Contraction

• This phase begins on day 3 and continues as collagen is laid down across the wound, providing strength to withstand normal stress.
• The duration depends on the type of tissue involved and the...
wound healing, phase 3, collagen, wound contraction, remodelling, scar formation

Sutures And Wound Closure (3)

Precautions for Using MONOCRYL Sutures in Specific Patient Populations
High Priority Source: Medical Survival Wound Closure Manual
MONOCRYL suture should not be used where:

Extended tissue approximation under stress is required: Due to its absorbable nature.

Considerations for use:
User familiarity with surgical techniques: Required before using MONOCRYL...
monocryl sutures,elderly patients,malnourished,debilitated,wound healing
Identify and Manage Adverse Reactions to Synthetic Absorbable Sutures
Standard Source: Medical Survival Wound Closure Manual
Adverse effects associated with synthetic absorbable sutures include:

Wound dehiscence: Risk of wound opening due to inadequate support.
Failure in closure sites: In areas subject to expansion, stretching, or distension.
-...
adverse reactions,synthetic absorbable sutures,wound dehiscence,localized irritation,infection,broken needles,needle sticks
Understanding the In Vivo Behavior of NUROLON* Sutures
Standard Source: Medical Survival Wound Closure Manual
NUROLON suture elicits:

Minimal acute inflammatory reaction: Followed by gradual encapsulation by fibrous connective tissue.
Gradual loss of tensile strength: Due to hydrolysis over time, even though nylon is not...
nurolon suture,tensile strength,hydrolysis

Bone And Joint Injury (3)

Treat Dislocations
High Priority Source: Medical Emergencies
Objective: Stabilize dislocated joints until professional help arrives.

Steps:
1. Do not attempt to realign the joint: This can cause further injury or damage to surrounding tissues.
2. Immobilize the affected area: Use a splint or...
dislocations, treat dislocations, immobilize, emergency
Treat Fractures
High Priority Source: Medical Emergencies
Objective: Stabilize fractures to prevent further injury and pain.

Steps:
1. Do not move the injured limb: If possible, leave the broken bone in its current position to avoid causing more damage.
2. Immobilize the area: Use a splint...
fractures, treat fractures, splinting, emergency
Treat Sprains
Standard Source: Medical Emergencies
Objective: Reduce pain and swelling from sprained joints.

Steps:
1. Rest the injured joint: Avoid putting weight on it to prevent further damage.
2. Apply ice: Place an ice pack on the affected area for 15-20 minutes every few hours...
sprains, treat sprains, RICE method, emergency

Bites And Stings (3)

Treat Snakebites
Critical Source: Medical Emergencies
Objective: Minimize the effects of venom from a snakebite.

Steps:
1. Keep the person calm and still: Avoid movement to slow the spread of venom through the body.
2. Immobilize the affected limb: Use a splint or bandage to keep the...
snakebite, treat snakebite, pressure immobilization, emergency
Treat Bee and Wasp Stings
High Priority Source: Medical Emergencies
Objective: Reduce pain and prevent allergic reactions from bee or wasp stings.

Steps:
1. Remove the stinger: If it is still embedded in the skin, scrape it out with a blunt object (e.g., a credit card) to avoid squeezing more venom into...
bee sting, wasp sting, treat stings, emergency
Treat Spider Bites and Scorpion Stings
High Priority Source: Medical Emergencies
Objective: Reduce pain and prevent complications from spider bites or scorpion stings.

Steps:
1. Clean the wound: Wash the bite area with soap and water to reduce the risk of infection.
2. Apply ice: Place an ice pack on the...
spider bite, scorpion sting, treat bites, emergency

Skin Ailments (3)

Treat a Boil in a Survival Situation
Standard Source: Medical Emergencies
Procedure:

1. Apply warm compresses to the boil until it comes to a head.
2. Use a sterile knife, wire, needle, or similar item to open the boil.
3. Thoroughly clean out the pus using soap and water.
4. Cover the boil site with...
boil treatment,warm compresses,sterile tools,survival skin care
Treat Fungal Infections in a Survival Situation
Reference Source: Medical Emergencies
Procedure:

1. Keep the affected area clean and dry to prevent further spread of the infection.
2. Expose the infected skin to as much sunlight as possible, which can help kill fungi.
3. Avoid scratching the affected area to reduce...
fungal infection treatment,survival fungal care,natural antifungals,avoid scratching
Treating Skin Irritations with Oatmeal Paste
Reference Source: Where There is no Doctor a Village Health Care Handbook
Procedure:

1. Mix oatmeal with cool water to create a paste.
2. Apply the paste to the irritated areas of the skin to help calm itching.
3. If necessary, take aspirin or use antihistamines (see page 385) for additional...
oatmeal paste, skin irritation, antihistamines, cortisone cream, infection prevention

Gastrointestinal Issues (3)

Treating Diarrhea in Emergencies
Standard Source: Medical Emergencies
Procedure:

1. Limit fluid intake for the first 24 hours to prevent dehydration.
2. Drink one cup of a strong tea solution every 2 hours until diarrhea slows or stops:
- Use tannic acid from tea, inner bark of hardwood trees, or...
diarrhea,treatment,natural remedies,emergency care
Recognize and Respond to Emesis (Vomiting)
Standard Source: Medical NBC Battlebook
Emesis is the act of vomiting.

### Procedure:
1. Identify emesis: Look for forceful expulsion of stomach contents through the mouth, often preceded by nausea or retching.
2. Assess severity: Determine if vomiting is occasional or...
vomiting, emesis, nausea, dehydration
Prevent and Manage Constipation in Cold Weather Conditions
Reference Source: FM 31 70 Basic Cold Weather Manual
Causes of Constipation:
• Avoiding the inconvenience of relieving oneself under adverse conditions.
• Changes in eating habits.
• Failure to drink sufficient liquids.

Prevention Measures:
1. Adjust normal eating and drinking habits to fit...
constipation, cold weather, prevention, treatment, gastrointestinal health

Parasites (3)

Treat Intestinal Parasites with Hot Peppers
Standard Source: Medical Emergencies
Procedure:

1. Eat hot peppers raw or add them to soups, rice, and meat dishes.
2. Make sure they are a steady part of your diet for this remedy to be effective.

Notes:
• Hot peppers create an environment that is prohibitive to...
intestinal parasites,hot peppers
Treat Intestinal Parasites with Kerosene
Standard Source: Medical Emergencies
Procedure:

1. Drink 2 tablespoons of kerosene, but no more.
2. If necessary, repeat this treatment in 24 to 48 hours.

Notes:
• Be careful not to inhale the fumes, as they may cause lung irritation.
• This remedy works by...
intestinal parasites,kerosene
Treat Intestinal Parasites with Tobacco
Standard Source: Medical Emergencies
Procedure:

1. Eat 1 to 1.5 cigarettes.
2. The nicotine in the cigarette will kill or stun the worms long enough for your system to pass them.
3. If the infestation is severe, repeat the treatment in 24 to 48 hours, but **no...
intestinal parasites,tobacco,nicotine

Environmental Threats (3)

Conducting Environmental Threat Assessments for Deployed Forces
High Priority Source: Medical NBC Battlebook
Procedure:

1. Identify potential environmental and industrial threats based on the type of site (e.g., manufacturing sites, nuclear power plants, hospitals).
2. Gather required site information to complete an environmental threat...
environmental threat assessment,classified data,site information
Identifying Environmental and Industrial Threats Through Intelligence Channels
High Priority Source: Medical NBC Battlebook
Procedure:

1. Request intelligence about environmental and industrial hazards through standard intelligence channels.
2. Be as specific as possible when requesting information to ensure accurate data retrieval by the analyst.
3. Consult...
environmental threats,intelligence channels,S5/G5,industrial hazards
Identifying Industrial and Environmental Threats by Site Type
High Priority Source: Medical NBC Battlebook
Procedure:

1. Use Table 1-A: Industrial and Environmental Threats to the Deployed Force as a reference for identifying potential threats based on site type.
2. Identify the following types of sites and associated environmental threats:
-...
site type,threat identification,industrial hazards

Radiation Health (3)

Bone-Marrow Kinetics After Radiation Exposure
High Priority Source: Medical NBC Battlebook
Procedure:

1. Understand that bone marrow contains three cell renewal systems: erythropoietic (red cell), myelopoietic (white cell), and thrombopoietic (platelet).
2. Note differences in time cycles, cellular distribution patterns, and...
bone marrow kinetics, radiation exposure, erythropoiesis, myelopoiesis, thrombocytopoiesis
Gastrointestinal Kinetics After Radiation Exposure
High Priority Source: Medical NBC Battlebook
Procedure:

1. Understand that the gastrointestinal tract is highly radiosensitive due to high cell turnover in the crypt and proliferating cell compartments.
2. Recognize that whole-body radiation doses above the mid-lethal range cause marked...
gastrointestinal kinetics, radiation exposure, crypt damage, mitotic inhibition
Understanding Organ Radiosensitivity
High Priority Source: Medical NBC Battlebook
Procedure:

1. Review the relative radiosensitivity of various organs as outlined in Table 2-N.
2. Identify highly radiosensitive organs: hematopoietic and gastrointestinal systems.
3. Note fairly high radiosensitivity for skin, cornea, lens of...
organ radiosensitivity, radiation effects, nuclear exposure, FM 8-9, medical response

Mass Casualty Management (3)

Manage Mass Casualty Situations from BW Attacks
Critical Source: Medical NBC Battlebook
Mass casualty management for biological warfare (BW) attacks requires a tailored approach based on the specific agent involved.

Key Considerations:
- Medical equipment needed depends on the specific BW agent. Few BW patients will...
mass casualty,bw attacks,treatment protocols,supportive care
Prepare for Mass Casualty Situations as Anesthesia Personnel
Critical Source: NATO Emergency War Surgery
Procedure:

1. Become involved in the planning process for mass casualty situations.
2. Ensure staffing, organization, and logistical support are prepared for the triage/preoperative area.
3. Pay attention to critical details such as:
-...
anesthesia,mass casualty,triage,fluid resuscitation,airway management
Serve as a Continuous Resource for Anesthesiologists in Mass Casualty Situations
Critical Source: NATO Emergency War Surgery
Procedure:

1. The anesthesiologist must serve as a continuous resource and consultant.
2. Ensure safe pre-, intra-, and postoperative care is maintained throughout the process.
3. Assign a theater consultant in anesthesiology who has on-site...
anesthesiologist,theater consultant,patient care,quality of care

Blood Disorders (3)

Recognize and Treat Mustard Agent Bone Marrow Effects
High Priority Source: Medical NBC Battlebook
Treatment of Mustard Agent Effects on the Bone Marrow

1. Symptoms: Mustard agents may cause a general depletion of all elements of the bone marrow, leading to conditions such as leukopenia and anemia.

2. Medical Outcome: Systemic...
mustard agent, bone marrow suppression, anemia, leukopenia, hematopoietic damage
Recognize and Manage Anemia
High Priority Source: Where There is No Dentist
Title: Recognize and Manage Anemia

Content:
Anemia is a condition in which the blood gets thin due to a lack of red blood cells or hemoglobin. Signs include tiredness, pale skin, and lack of energy.

Management Steps:
1....
anemia,iron deficiency,blood thinning,tiredness,pale skin
Identify Leukopenia
Standard Source: Medical NBC Battlebook
Leukopenia is defined as a reduction in the number of leukocytes (white blood cells) in the blood, with a count of 5000 or less.

Symptoms and Signs:
• Increased susceptibility to infections
• Fatigue
• Fever
• Sore throat
• Mouth ulcers
-...
leukopenia, white blood cell count, infection risk, diagnosis, management

Injury Treatment (3)

Prevent Air Embolism in IV Tubing
Critical Source: STP 21 1 Warrior Skills Level 1
Procedure to Prevent Air Embolism in IV Tubing

Warning: If you do not remove the air from the tubing, it can enter the bloodstream and rapidly move to the heart. This can cause the casualty's heart to stop beating (cardiac arrest). It is...
air embolism prevention,IV safety,tubing inspection,medical emergency
Insert Catheter/Needle into Saline Lock
High Priority Source: STP 21 1 Warrior Skills Level 1
Procedure for Inserting a Catheter/Needle into a Saline Lock

Steps:

1. Remove the 18-gauge catheter/needle unit from its packaging and discard the packaging.

2. Hold the catheter/needle unit in your dominant hand.

3. **Stabilize...
catheter insertion,saline lock,needle removal,IV tubing,medical procedure
Contact US Army Medical Research Detachment for Laser/Radiofrequency Injury Assistance
Standard Source: Medical NBC Battlebook
Procedure:

1. Identify the need for assistance related to laser or radiofrequency injuries, including their medical effects, symptoms, and treatment.
2. Contact the US Army Medical Research Detachment located at Brooks AFB.
3....
US Army Medical Research Detachment,Brooks AFB,Walter Reed Army Institute of Research,laser injury,treatment,radiofrequency injury

Injuries And Trauma (3)

Recognize and Respond to Fluctuant Conditions (e.g., Swelling or Fluid Accumulation)
Standard Source: Medical NBC Battlebook
Fluctuant refers to showing varying levels, often used in medical contexts to describe swelling or fluid accumulation.

### Procedure:
1. Identify fluctuant conditions: Look for areas of the body that appear swollen and may feel soft or...
fluctuant, swelling, fluid accumulation, abscess
Recognize and Respond to Ecchymoses
Reference Source: Medical NBC Battlebook
Ecchymoses are small hemorrhagic spots in the skin or mucous membrane forming non-elevated, rounded or irregular, blue or purplish patches.

### Procedure:
1. Identify ecchymoses: Look for flat, discolored areas on the skin that appear blue...
ecchymoses, bruising, hemorrhage, skin injury
Recognize and Respond to Edema
Reference Source: Medical NBC Battlebook
Edema is the presence of abnormally large amounts of fluid in the intercellular tissue spaces of the body.

### Procedure:
1. Identify edema: Look for swelling, especially in the legs, feet, hands, or face. The skin may appear stretched and...
edema, swelling, fluid retention, interstitial edema

Musculoskeletal Illnesses (3)

Define and Recognize Sacroiliitis
Standard Source: Medical NBC Battlebook
Sacroiliitis is inflammation in the sacroiliac joint, which connects the spine to the pelvis. It can cause pain and stiffness in the lower back and hips.

### Action Steps:
Monitor for symptoms such as lower back or hip pain that worsens...
sacroiliitis,sacral joint,inflammation,pain management
Treating Stiff or Sore Muscles and Joints with Hot Compresses
Standard Source: Where There is no Doctor a Village Health Care Handbook
Procedure:

1. Prepare a hot water solution in a clean container.
2. Soak a clean cloth or towel in the hot water and apply it to the affected area for 10–15 minutes.
3. Repeat this process several times per day until discomfort improves.
4....
stiff muscles,joints,hot compresses,soreness
Treating Strains and Sprains with Cold and Hot Soaks
Standard Source: Where There is no Doctor a Village Health Care Handbook
Procedure:

1. First day of injury: Apply a cold compress to the affected area for 10–15 minutes every hour to reduce swelling and pain.
2. After the first day: Use hot soaks or compresses on the injured joint for 10–15 minutes several times...
strains,sprains,cold compresses,hot soaks

Trauma Injuries (3)

Evaluate for Arterial Air Emboli in Blast Injuries
Critical Source: NATO Emergency War Surgery
Objective: Identify and manage arterial air emboli caused by blast injuries.

Procedure:
1. Assess the casualty for signs of cerebral dysfunction, such as altered affect, confusion, disorientation, or focal neurologic signs after an...
air embolism, blast injury, cerebral dysfunction, retinal air bubbles, decompression illness
Assessing Fragment Wound Characteristics from Explosive Devices
High Priority Source: NATO Emergency War Surgery
Procedure for Assessing Fragment Wound Characteristics from Explosive Devices:

1. Identify fragment type and velocity:
- Most fragments are blunt or irregular in shape, not aerodynamic.
- Materials include steel or less dense...
fragment wounds, explosive devices, tissue disruption, crush mechanism, body armor, velocity, mass, trauma assessment
Differentiate Between Primary Blast Injury and Other Trauma in Complex Cases
High Priority Source: NATO Emergency War Surgery
Objective: Distinguish primary blast injury from other types of trauma to ensure appropriate management.

Procedure:
1. Assess the casualty's history, including proximity to an explosion, type of explosive (e.g., fuel air explosive or...
differentiation of blast injury, complex trauma, ARDS, secondary blast injuries, tertiary blast injuries

Hypothermia Frostbite (3)

Differentiate Between Degrees of Frostbite Injuries
High Priority Source: NATO Emergency War Surgery
Frostbite injuries are categorized into two major types: superficial and deep.

Superficial frostbite (first-degree):
• Early manifestations include erythema, edema, transient tingling or burning.
• The skin becomes mottled blue/gray and...
frostbite grading, frostbite stages, first degree frostbite, second degree frostbite, third degree frostbite, fourth degree frostbite
Identify Physical Manifestations of Frostbite and Hypothermia
High Priority Source: NATO Emergency War Surgery
Physical manifestations include:

1. Frostbite symptoms:
- Initial reddening of the skin, which later becomes pale, waxy white, and hard.
- Lack of mobility of skin over joints is a common finding.
2. Hypothermia signs:
-...
frostbite physical signs, hypothermia symptoms, CNS involvement in cold injury
Recognize Early Symptoms of Cold Injury
High Priority Source: NATO Emergency War Surgery
Early symptoms of cold injury include:

1. Initial feelings: A sensation of cold discomfort in extremities.
2. Progression: Varying periods of pain and mild discomfort, followed by a cyclic, dull ache.
3. Anesthesia phase: Symptoms...
cold injury, frostbite symptoms, hypothermia signs, early cold injury detection

Rehabilitation (3)

Initiation of Active Physiotherapy During Whirlpool Treatment
Standard Source: NATO Emergency War Surgery
Procedure:

1. Begin active physiotherapy during daily whirlpool sessions as soon as possible.

Details:
• This helps maintain or restore mobility and prevent joint stiffness.
physiotherapy, whirlpool treatment, active motion
Implement Occupational Therapy in Austere Environments
Standard Source: Survival and Austere Medicine
Occupational therapy focuses on helping individuals perform the activities required to look after themselves – eating, dressing, and personal hygiene.

Purpose: To enable injured or ill individuals to regain independence in daily living...
occupational therapy, daily living skills, austere environment, independence
Implement Physical Therapy in Austere Environments
Standard Source: Survival and Austere Medicine
Physical therapy supports medical and nursing care and is very important for maintaining and rehabilitating musculoskeletal function.

Key components of physical therapy:
1. Stretching exercises to improve flexibility and range of...
physical therapy, rehabilitation, austere environment, musculoskeletal function

Trauma Care (3)

Treatment of Multiple Injuries in Casualties
Critical Source: NATO Emergency War Surgery
Objective: Provide immediate and effective care to casualties with multiple injuries to reduce mortality and morbidity.

Procedure:
1. Assess the casualty:
- Identify all injuries, including those involving more than one organ...
multiple injuries, trauma care, shock management, organ involvement, casualty treatment, emergency surgery, wound debridement, multi-system injury
Establish Peripheral Vascular Access for Trauma Patients
Standard Source: Emergency War Surgery
Procedure:

1. Attempt peripheral vascular access first, using standard IV catheter techniques.
2. If peripheral access is unsuccessful, proceed with percutaneous central access at the following sites:
- Subclavian vein
- Internal...
vascular access, trauma patients, peripheral IV, central line, saphenous cutdown
Tourniquet Application and Management in Battlefield Situations
Reference Source: US Marine Corps Wilderness Medicine + NATO Emergency War Surgery
Objective: Control major hemorrhage using a tourniquet when necessary.

Procedure:
1. Apply tourniquet immediately to control massive external hemorrhage.
2. Place the tourniquet above the wound, but **below the joint closest to the...
tourniquet, hemorrhage control, battlefield medicine, emergency surgery, wilderness medicine

Trauma Assessment (3)

Perform Primary Survey for Combat Casualty
Critical Source: NATO Emergency War Surgery
Primary Survey is a critical initial assessment performed on combat casualties to identify life-threatening injuries.

### a. Airway and C-spine
• Assess the airway by checking for obstructions, such as foreign debris.
• Use chin-lift or...
primary survey, airway, c-spine, breathing, circulation, disability, expose, combat casualty, trauma assessment
Conduct a Secondary Survey of Trauma Patients
Critical Source: NATO Emergency War Surgery
Procedure for Conducting a Secondary Survey in Trauma Patients

1. Begin with an evaluation of the head:
- Check the scalp and bony structures for evidence of blunt or penetrating trauma.
- Examine the eyes for signs of...
secondary survey, trauma assessment, head exam, maxillofacial trauma, c-spine injury, chest examination, abdominal trauma, rectal exam, fractures, neurological exam
Assess Hearing Loss in Patients with Hemotympanum or Temporal Bone Injury
Standard Source: Emergency War Surgery
Procedure:

• Hemotympanum may be seen with acoustic and temporal bone trauma, often accompanied by hearing loss.
• If available, perform a gross audiological evaluation with tuning forks.
• Use a 512 Hz tuning fork for field examination:
-...
Hemotympanum, Temporal Bone Injury, Rinne Test, Weber Test, Conductive Hearing Loss, Sensorineural Hearing Loss

Spinal Injury Management (3)

Assess and Manage Spinal Injury in Combat Casualties
High Priority Source: NATO Emergency War Surgery
Procedure for Assessing and Managing Spinal Injury:

1. Evaluate for neurologic impairment: Field immobilization is not necessarily required for all combat casualties, but should be considered if there is frank evidence of neurologic...
spinal injury, combat casualty, field immobilization
Management of Complex Injuries with Spinal Column Involvement
Standard Source: Emergency War Surgery
Procedure for managing complex injuries involving the head, thorax, abdomen, or extremities with vertebral column injuries:

• When complex wounds involving the head, thorax, abdomen, or extremities coexist with vertebral column injuries,...
complex injuries, spinal column, vertebral injuries, emergency management, protective measures
Transport and Extrication of Patients with Thoracic or Lumbar Spine Injuries
Standard Source: Emergency War Surgery
Procedure for Transport and Extrication:

1. Use the log roll technique or a two-man carry, as demonstrated in Fig. 20-1.
2. The two-man carry alone does not protect the cervical spine; ensure additional stabilization is provided if...
spine injury, transport, extrication, log roll, two-man carry, cradle-drop drag, makeshift litter, thoracic spine, lumbar spine

Monitoring (3)

Implement Monitoring for Battle Casualties
Critical Source: NATO Emergency War Surgery
Procedure:

1. For typical battle casualties who are young and healthy prior to wounding:
- Routine monitoring includes:
- Electrocardiogram (ECG).
- Blood pressure.
- Heart sounds.
- Urine output.
- Pulse rate...
battle casualty monitoring, ECG, blood pressure, central venous pressure
Utilize Alternative Monitoring Techniques in Resource-Limited Settings
Critical Source: NATO Emergency War Surgery
Procedure:

1. In the absence of arterial blood gas analysis equipment:
- Use urine pH measurement with indicator paper as a guide for treatment of metabolic acidosis.
2. Consider using pulse oximeters, capnographs, and automated arterial...
urine pH, metabolic acidosis, pulse oximeter, capnograph
Use Pulse Oximetry for Clinical Monitoring
Standard Source: TCCC 17 13 Army Tactical Combat Casualty Care
Procedure:

1. Utilize pulse oximetry as an adjunct to clinical monitoring.
pulse oximetry, monitoring, clinical care

Anesthesia And Intubation (3)

Administer Succinylcholine for Rapid Sequence Intubation
Critical Source: NATO Emergency War Surgery
Indication: Used for rapid sequence intubation.

Procedure:
1. Administer intravenous (IV) succinylcholine at an appropriate dose.
2. Observe for fasciculations and muscle cramps, which are common side effects.
3. After approximately 1...
succinylcholine, rapid sequence intubation, flaccid paralysis, hyperkalemia, ventilatory support
Administer Vecuronium for Muscle Relaxation
High Priority Source: NATO Emergency War Surgery
Indication: Used as a short-acting nondepolarizing muscle relaxant.

Procedure:
1. Administer vecuronium intravenously at an initial dose of 0.1 mg/kg IV.
2. Monitor for minimal cardiovascular side effects, making it suitable for...
vecuronium, nondepolarizing relaxant, cardiovascular stability, renal failure
Use Nerve Stimulator to Monitor Neuromuscular Blockade
High Priority Source: NATO Emergency War Surgery
Indication: Used for monitoring the degree of neuromuscular blockade during administration of muscle relaxants.

Procedure:
1. Use a nerve stimulator as part of standard procedure during administration of muscle relaxants.
2. Apply...
nerve stimulator, neuromuscular blockade monitoring, muscle relaxant management

Neurological Assessment (3)

Conduct History and Neurological Evaluation for Head Injury Patients
Critical Source: NATO Emergency War Surgery
Procedure:

1. Record the history:
- Note the time of injury.
- Identify the type of missile or cause of injury.
- Document the patient's state of consciousness immediately after injury.
- Make permanent records for physicians in...
Glasgow Coma Scale, neurological evaluation, head injury, consciousness assessment, pupillary response, motor response, vital signs
Assessing Numbness, Weakness, or Loss of Control in the Body
High Priority Source: Where There is no Doctor a Village Health Care Handbook
Procedure:

1. Observe movement and gait: Watch how the person walks and moves. Look for any unevenness or difficulty.
2. Have them stand, sit, or lie straight: Compare both sides of their body carefully to check for asymmetry or...
numbness, weakness, loss of control, muscle testing, neurological assessment, stroke, polio, malnutrition, tuberculosis
Assess Glasgow Coma Scale (GCS) for Trauma Triage
Reference Source: US Marine Corps Wilderness Medicine + Emergency War Surgery
Procedure:

1. Evaluate the patient using the Glasgow Coma Scale (GCS), which assesses three components:
- Motor Response (Score 1–6):
- Obeys verbal command: 6
- Localizes pain: 5
- Flexion-withdrawal: 4
-...
Glasgow Coma Scale, GCS, trauma assessment, level of consciousness, head injury, triage

Sanitation (3)

Managing Linen for Nursing Care in Austere Conditions
Standard Source: Survival and Austere Medicine
Procedure for Managing Clean Linen in Emergency Situations

1. Ensure a sufficient supply of clean linen including sheets, blankets, washing cloths, and towels.
2. Store linen in a dry, clean area to prevent contamination or damage.
3. In the...
linen management, hygiene, sanitation, nursing care, emergency supplies
Conduct Sanitation and Habitability Inspections
Standard Source: NAVMED P 5010 US Navy Manual of Preventive Medicine
Procedure:

1. Inspect living quarters for cleanliness, presence of pests, and proper waste disposal.
2. Check food storage areas to ensure they are dry, secure, and free from contamination.
3. Evaluate water sources for safety and...
sanitation, habitability inspections, preventive medicine, unit health
Provide Veterinary Services for Food Safety and Disease Surveillance
Standard Source: TCCC 17 13 Army Tactical Combat Casualty Care
Objective: Ensure food safety and provide surveillance of zoonotic disease or foodborne illness.

Procedure:
1. Food Inspection and Safety: Conduct regular inspections to ensure the safety and security of food supplies.
2. **Disease...
veterinary services,food safety,disease surveillance,animal care

Wilderness Medical Kit Preparation (3)

Update Personal Wilderness Medical Kit with Version 1.2 Changes
High Priority Source: Personal Wilderness Medical Kit
Procedure for Updating the Personal Wilderness Medical Kit Based on Version 1.2 Revisions:

1. Review and Add Saline Lock and Flush:
- Include a saline lock and saline flush in the Advanced Kit to allow WEMTs at the scene to start an IV,...
personal wilderness medical kit,version 1.2,wemsi,kit updates,saline lock,midazolam,droperidol
Obtain Medications Through Prescriptions or Pharmacy Issuance
High Priority Source: survival personal wilderness medical kit
Procedure:

1. Prescription method:
- Have a physician prescribe medications for each WEMT individually.
- The WEMT may use these medications for personal use and, under state Good Samaritan Laws, for others in need during wilderness...
prescription, pharmacy issuance, DEA compliance, OTC, responsibility
Create a Personal Wilderness Medical Kit with Cost-Efficient Medications
Standard Source: survival personal wilderness medical kit
Procedure:

1. Source medications through samples:
- Contact physician offices or manufacturers for sample medications to reduce costs.
- Use these samples as part of the personal medical kit.
2. **Use generic over-the-counter (OTC)...
cost-effective, medications, samples, OTC, generic, standing orders, wilderness medical kit

Tactical Field Care (3)

Assess and Control Hemorrhage During Tactical Field Care
Critical Source: TCCC 17 13 Army Tactical Combat Casualty Care
Procedure:

Assess for an unrecognized hemorrhage and control all sources of bleeding.
Use one or more CoTCCC-recommended limb tourniquets, if necessary.
Use a CoTCCC-approved hemostatic dressing for compressible hemorrhage not...
hemorrhage control, tourniquet use, hemostatic dressing, junctional tourniquet
Reassess and Adjust Tourniquet Application During Tactical Field Care
Critical Source: TCCC 17 13 Army Tactical Combat Casualty Care
Procedure:

Expose the wound and determine if a tourniquet is needed.
Replace any limb tourniquet placed over the uniform with one applied directly to the skin, 2 to 3 inches above the wound.
Expose and use an indelible marker...
tourniquet reassessment, tourniquet marking, wound exposure
Return Fire and Take Cover During Combat
Critical Source: TCCC 17 13 Army Tactical Combat Casualty Care
Procedure:

Return fire to neutralize immediate threats.
Take cover behind any available protection to minimize exposure.
Direct or expect the casualty to remain engaged as a combatant, if appropriate.
• **Direct the casualty...
combat, return fire, take cover, casualty engagement, self-aid

Head Injury Management (3)

Administer Antibiotics for Penetrating Head Trauma and Assume C-Spine Injury
Critical Source: TCCC 17 13 Army Tactical Combat Casualty Care
Procedure:

1. For a penetrating head trauma, administer antibiotics (ertapenam, 1 gm).
2. Assume a C-spine injury until cleared.
ertapenam administration, c-spine injury
Manage Impending Herniation with Hypertonic Saline and Other Interventions
Critical Source: TCCC 17 13 Army Tactical Combat Casualty Care
Procedure:

1. If impending herniation is suspected, take the following actions:
- •*[Administer 250 ml of 3 percent or 5 percent hypertonic ] saline bolus by IV or IO.
- •*[Elevate the casualty’s head 30 degrees.]
- •*[Control...
hypertonic saline, herniation management
Monitor for Signs of Impending Herniation in Head Injury Patients
Critical Source: TCCC 17 13 Army Tactical Combat Casualty Care
Procedure:

1. For casualties with moderate to severe (penetrating) TBI, monitor for:
- •*[Decreases in level of consciousness.]
- •*[Pupillary dilation.]
- •*[SBP over 90 mmHg or mean arterial pressure over 60.]
- •*[Oxygen...
tbi monitoring, herniation signs, capnography

Combat Medical Support (3)

Deploy Casualty Receiving and Treatment Ship (CRTS) for Role 2 Navy Medical Support
Critical Source: TCCC 17 13 Tactical Combat Casualty Care
A casualty receiving and treatment ship (CRTS) is part of an amphibious ready group (ARG). An ARG typically comprises three ships with surgical capability only on the CRTS. Ships have **176 medical personnel supporting 45 ward beds, four operating...
CRTS, casualty receiving and treatment ship, role 2 navy, combat medical support
Deploy Forward Resuscitative Surgical System (FRSS) for Role 2 Marine Expeditionary Force Medical Support
Critical Source: TCCC 17 13 Tactical Combat Casualty Care
The forward resuscitative surgical system (FRSS) is an 8-person team (two surgeons, anesthesia, critical care nurse, two operating room technicians, and two corpsmen). The FRSS provides a high mobility resuscitative surgery asset for **18...
FRSS, forward resuscitative surgical system, role 2 marine expeditionary force, combat medical support
Deploy Role 3 Facility (Combat Support Hospital or EMEDS+25) for Comprehensive Medical Care
Critical Source: TCCC 17 13 Tactical Combat Casualty Care
A Role 3 facility (combat support hospital or EMEDS+25) is a medical treatment facility or veterinary facility (for working animals) staffed and equipped to provide care to all categories of patients. Capabilities of a Role 3 facility...
role 3 facility, combat support hospital, EMEDS+25, comprehensive medical care

First Aid Kits (3)

Organize Personal Wilderness Medical Kit Modules
High Priority Source: Personal Wilderness Medical Kit
To ensure readiness and efficiency in emergency situations, organize your Personal Wilderness Medical Kit into the following modules:

1. Minimum Module (Required for All WEMSI Medics):
• Must be carried at all times.
• Contains essential items...
personal wilderness medical kit,module organization,wems medics,minimum module,advanced module,search module,team medical kit
Assembling an Effective Medical Kit for Survival Situations
High Priority Source: Survival and Austere Medicine
Objective: Create a functional medical kit tailored to your knowledge, environment, and potential emergencies.

Steps:
1. Assess Your Needs: Identify the types of injuries or illnesses most likely in your environment (e.g., trauma from...
medical kit, survival medicine, first aid supplies, emergency care, austere medical treatment
M9 Medical Aid Bag Overview and Contents
High Priority Source: TCCC 17 13 Tactical Combat Casualty Care
Overview of the M9 Medical Aid Bag

The M9 Medical Aid Bag (NSN 6545-01-539-6448) is a standardized medical aid bag used by the Department of Defense. It has been modified to reduce its visibility and silhouette, making it easier for personnel...
M9 Medical Aid Bag, TCCC, first aid kit, military medical supplies, combat casualty care

Heat Illnesses (3)

Select Field Treatment for Heat Stroke
Critical Source: US Marine Corps Wilderness Medicine
Objective: Without the aid of references, select from a given list the correct field treatment for heat stroke.

Treatment Steps:
1. Immediately move the affected individual to a cooler environment, such as shade or an...
heat stroke, treatment, emergency response
Identify Heat Illnesses Based on Definitions
High Priority Source: US Marine Corps Wilderness Medicine
Objective: Without the aid of references, match definitions to the correct heat illness condition.

• Review and understand the following heat illnesses:
- Heat Cramps: Painful muscle spasms caused by electrolyte loss due to excessive...
heat illness, heat cramps, heat exhaustion, heat stroke, thermoregulation
Management of Minor Heat Illnesses
Reference Source: Emergency War Surgery
Minor heat illnesses include miliaria rubra, miliaria profunda, anhidrotic heat exhaustion (tropical anhidrotic asthenia), heat-induced syncope, heat edema, sunburn, and heat tetany.

### Miliaria Rubra:
Clinical presentation: Subacute...
miliaria rubra, miliaria profunda, anhidrotic heat exhaustion, heat-induced syncope, heat edema, sunburn, heat tetany

Cold Weather Injuries (3)

Classify Frostbite Injuries
Critical Source: Canadian Military Basic Cold Weather Training
Procedure:

1. Determine the type of frostbite based on tissue damage:
- (1) Superficial Frostbite:
- Involves only the skin or tissue immediately beneath it.
- After rewarming, the area becomes numb, mottled blue or purple,...
frostbite,classification,superficial,deep,cold injury,treatment
Managing Frostbite Injuries in the Field
High Priority Source: US Marine Corps Wilderness Medicine
### Managing Frostbite Injuries in the Field

Recognize frostbite as a cold weather injury that occurs when skin and underlying tissues freeze.

Understand the two mechanisms of injury for frostbite: direct exposure to extreme cold, and...
frostbite,cold weather injury,immersion foot,field treatment,rewarm
Recognize Signs of Frostbite
High Priority Source: Canadian Military Basic Cold Weather Training
Procedure:

1. Identify early signs of frostbite:
- (1) An uncomfortable sensation of coldness followed by numbness.
- (2) Tingling, stinging, or aching sensations, even cramping pain.
- (3) Skin initially turns red, later...
frostbite,signs,cold injury,early detection

Frostbite (3)

Identify Signs and Symptoms of Frostbite
High Priority Source: USMC Summer Survival Course Handbook
Signs and symptoms of frostbite include:

Ears, nose, fingers, and toes are affected first.
• Affected areas will feel cold and may tingle, leading to...
Numbness which progresses to...
• A waxy appearance with skin that...
frostbite, symptoms, signs, cold injury, numbness, waxy skin
Identify and Understand Frostbite
High Priority Source: US Marine Corps Wilderness Medicine
Definition: Frostbite is the actual freezing of tissue.

Causes:
- Exposure to subfreezing temperatures for a long period of time.
- Brief exposure to high wind-chill or very cold temperatures can also cause frostbite.
- Frostbite...
frostbite, cold injury, hypothermia, tissue damage, frostnip, signs of frostbite, symptoms of frostbite, classification of frostbite
Recognize and Treat Frostbite
High Priority Source: Student manual 2005
Procedure for Recognizing and Treating Frostbite

### Symptoms of Frostbite
• Skin that appears white to grayish-yellow.
• An intense cold, numb feeling in the affected area (commonly on cheeks, ears, nose, toes, or fingers).
-...
frostbite,treatment,symptoms,prevention,cold weather,outdoor safety,trapping

Pediatric Health (3)

Checking for Hip Dislocation in Newborns
High Priority Source: Where There is no Doctor a Village Health Care Handbook
When to Check:
• At about 10 days after birth.

What to Look For:
1. Compare the Legs:
- The upper leg may partly cover this part of the body on the dislocated side.
- There are fewer folds in the skin on that side.
- The leg...
hip_dislocation,newborn_check,baby_health,dislocated_hip,infant_care
Avoid Giving Sweet Drinks to Babies via Bottle
Standard Source: Where There is No Dentist
Procedure:

1. Do not give a baby anything sweet to drink from a bottle, such as:
- Sweet tea
- Sugar water
- Fruit juice
2. Use breast milk or formula for feeding infants, as these are safer and promote healthy teeth...
baby dental care, avoid sugary drinks for infants, breastfeeding benefits
Identifying Hydrocele or Hernia in a Baby’s Scrotum
Standard Source: Where There is no Doctor a Village Health Care Handbook
What to Look For:
• If the baby’s scrotum is swollen on one side, it may be due to a hydrocele (filled with liquid) or a hernia (a loop of gut has slipped into it).

How to Tell the Difference:
1. Shine a Light Through the Swelling:
-...
hydrocele,hernia,baby_scrotum_diagnosis,light_test,swelling_check

Oral Health Education (3)

Teach About the Causes of Sore Gums and Tartar Formation
Reference Source: Where There is No Dentist
Objective: To explain why gums become sore and how tartar forms on teeth.

### Procedure:
1. Explain Healthy Gums:
- Healthy gums are pink (or blue/dark yellow in some people) and never red.
- They fit tightly around the teeth, helping...
gums, sore gums, tartar, oral health, plaque
Conduct the 'Forming Colonies' Game to Teach About Oral Hygiene
Reference Source: Where There is No Dentist
Objective: To teach children about germs forming colonies on teeth through a physical activity.

### Materials Needed:
• 20 students (colonizers)
• 1 decolonizer (with a broom)
• Bases or markers for the game
• Monitors (for colony...
game, oral hygiene, germs, colonies, education, dental health
Discuss Oral Hygiene and Germs After the Game
Reference Source: Where There is No Dentist
Objective: To reinforce understanding of oral hygiene and germs after playing the 'Forming Colonies' game.

### Procedure:
1. Ask Questions: Engage students in a discussion about their mouths, such as:
- Can anyone see germs?
- What do...
germs, oral hygiene, education, discussion, dental health

Instrument Disinfection (3)

Proper Use and Disposal of Needles and Syringes
High Priority Source: Where There is No Dentist
Materials Needed:
• Reusable syringes
• Disposable needles
• Bleach solution (5%)
• Heavy gloves
• Boiling pot or steam sterilizer
• Clean containers for disposal

Procedure:
1. Disposable Needles: Use each disposable needle only one...
needle disposal, syringe sterilization, reusable instruments, infection prevention
Prepare Bleach Solution for Instrument Disinfection
Standard Source: Where There is No Dentist
Materials Needed:
• ½ cup (125 ml) of bleach
• 3½ cups (875 ml) of clean water
• Baking soda (optional)
• Clean containers or pans
• Alcohol wipes
• Clean cloth or storage container

Procedure:
1. Select Bleach Brand: Choose the cheapest...
bleach solution, instrument disinfection, rust prevention, sterilization, dental tools
Store and Maintain Sterile Instruments
Standard Source: Where There is No Dentist
Materials Needed:
• Clean cloth or storage container
• Tape (for labeling)
• Clean water
• Clean tweezers
• Covered containers for cotton gauze

Procedure:
1. Wrap Instruments: Keep your sterile instruments together in a clean place....
sterile instrument storage, labeling, work area hygiene, gauze handling

Dental Record Keeping (3)

Write a Detailed Medical Report for Referral to Healthcare Providers
Standard Source: Where There is No Dentist
Objective: Provide accurate and detailed reports when referring patients for further medical care.

Steps:
1. Write a report whenever sending someone for additional medical help.
2. Include the following information in your report:
-...
medical report, referral documentation, trauma reporting, dental referrals
Maintain Individual Patient Records for Dental Care
Reference Source: Where There is No Dentist
Objective: Keep detailed records of each patient to ensure continuity of care.

Steps:
1. For every person you see, keep a record that includes:
- Name of the individual
- Description of their dental problem or concern
- Any...
patient records, dental documentation, continuity of care, medical post
Identify Teeth Using Standard Dental Notation
Reference Source: Where There is No Dentist
Objective: Learn how to identify and label teeth using standard dental notation for record keeping.

Steps:
1. Divide the mouth into four parts:
- Upper Right (uR)
- Upper Left (uL)
- Lower Left (LL)
- Lower Right (LR)
2. Each...
dental notation, tooth labeling, record keeping, dental records

Nutritional Health (3)

Understanding Nutrition and Its Importance
Reference Source: Where There is No Dentist
- Nutrition is the mixture of foods the body needs to grow, be healthy, and fight off disease.
nutrition, dietary health, food intake
Understanding Protective Foods and Their Role in Health
Reference Source: Where There is No Dentist
- Protective foods are foods that are rich in vitamins and minerals. They help build healthy bodies and make people more able to resist or fight diseases. In this book they are called GLOW foods.
protective foods, vitamins, minerals
Understanding the Role of Proteins in Nutrition
Reference Source: Where There is No Dentist
- Proteins are body-building foods necessary for proper growth and strength. In this book they are called GROW foods.
proteins, body-building, nutrition

Nutrition And Diet (3)

Optimal Diet for Small Children (First 6 Months)
High Priority Source: Where There is no Doctor a Village Health Care Handbook
Overview: Proper nutrition is essential for the health and development of infants.

Recommendations for First 6 Months:
Breast milk only: For the first 6 months, give the baby breast milk and nothing else. It is better than any baby...
infant nutrition,breastfeeding,first six months,milk formula,child health,diet for children
Prepare Vegetable Soup as a Special Drink
Standard Source: Where There is No Dentist
Vegetable soup (special drink) is recommended for those who cannot eat properly. This soup should be prepared with easily digestible vegetables and served in a liquid form to ensure it can be consumed by individuals with compromised eating...
vegetable soup, special drink, nutrition, medical emergency
Avoid Harmful Foods During Illness
Reference Source: Where There is no Doctor a Village Health Care Handbook
Overview: Certain foods and substances can worsen illness or hinder recovery. Avoid them to support healing.

Foods and Substances to Avoid:
Alcoholic drinks: Cause or worsen diseases of the liver, stomach, heart, and nerves. Also...
alcohol,tobacco,greasy food,sugar,coffee,nutrition,diet,avoid foods,illness recovery

Community Health Assessment (3)

Assess Community Health Needs Through a Comprehensive Evaluation
Standard Source: Where There is no Doctor a Village Health Care Handbook
To effectively address the health needs of your community, follow these steps:

1. Understand the Felt Needs: Identify what people in your community perceive as their biggest health problems through direct interaction and observation.

2....
community health assessment, felt needs, real needs, willingness, resources, health evaluation
Conduct a Community Health Needs Assessment
Standard Source: Where There is no Doctor a Village Health Care Handbook
To identify the most important health problems and concerns in your community, follow these steps:

1. Create a list of questions that are relevant to the specific needs and conditions in your area.
2. Ensure questions are not too long or...
health assessment, community needs, health problems, health concerns, question list, village health care
Gather Information on Felt Needs and Daily Life Factors Affecting Health
Standard Source: Where There is no Doctor a Village Health Care Handbook
Objective: Identify factors in daily life that people believe contribute to their health or cause problems.

Steps:
1. Ask community members what aspects of their daily lives, such as living conditions, beliefs, and practices, they feel...
felt needs, daily life factors, health beliefs, community concerns, health care assessment

Infertility Treatment (3)

Managing Chronic Infections to Prevent Female Infertility
Standard Source: Where There is no Doctor a Village Health Care Handbook
Procedure:

1. Diagnose chronic infections such as pelvic inflammatory disease (PID) caused by gonorrhea or chlamydia.

2. Provide early treatment with appropriate antibiotics, following medical guidelines.

3. **Monitor the infection's...
pelvic inflammatory disease, gonorrhea, chlamydia, infertility prevention
Optimizing Sperm Count for Male Infertility
Standard Source: Where There is no Doctor a Village Health Care Handbook
Procedure:

1. Identify low sperm count as a potential cause of male infertility.

2. Advise the man to abstain from sexual activity for several days before the woman's fertile period (midway between menstrual cycles).

3. **Educate on...
sperm count, male infertility, fertility tracking, Counting Days Method, Mucus Method
Addressing Nutritional Deficiencies to Improve Fertility in Women
Standard Source: Where There is no Doctor a Village Health Care Handbook
Procedure:

1. Identify nutritional deficiencies that may be affecting fertility, such as severe anemia or iodine deficiency.

2. Provide adequate nutrition through a balanced diet rich in essential vitamins and minerals.

3. **Use...
nutritional deficiencies, anemia, iodine deficiency, iron pills, fertility treatment

Gynecological Health (3)

Managing Menopause and Its Symptoms
Standard Source: Where There is no Doctor a Village Health Care Handbook
Menopause is the time when a woman’s menstrual periods stop, typically between ages 40 and 50.

Irregular periods may occur for several months before stopping completely.
• It is still possible to become pregnant during menopause, so...
menopause, hot flashes, calcium intake, post-menopausal care, gynecological health
Recognizing Signs of Menstrual Problems
Standard Source: Where There is no Doctor a Village Health Care Handbook
Signs of menstrual problems:

Irregular periods may be normal for some women but could indicate chronic illness, anemia, malnutrition, tuberculosis, worsening HIV infection, or a tumor in the womb.
• If your period does not come when...
menstrual irregularity, miscarriage, heavy bleeding, medical advice, gynecological health
Managing Painful Menstrual Periods
Reference Source: Where There is no Doctor a Village Health Care Handbook
If your menstrual period is painful:

Avoid lying in bed as it can make the pain worse.
Walk around, take hot drinks, or put your feet in hot water to relieve discomfort.
• If the pain is very severe:
- Take **aspirin (p....
menstrual pain, hot water, aspirin, ibuprofen, menstrual care, gynecological health

Child Health Monitoring (3)

Interpreting a Child's Health Chart to Assess Growth
Standard Source: Where There is no Doctor a Village Health Care Handbook
Purpose: To understand how to read and interpret a child’s health chart for proper growth assessment.

Procedure:
1. Locate the two long curved lines on the chart, which represent the ‘Road to Health’ that a child’s weight should...
child health chart, growth monitoring, malnutrition, weight tracking, Road to Health
Interpreting Growth Chart Trends for a Child
Standard Source: Where There is no Doctor a Village Health Care Handbook
To interpret growth trends on a child’s growth chart:

1. Connect the dots with lines to visualize the child's growth pattern over time.
2. If the child is healthy, each new dot should be higher than the previous one, indicating normal weight...
growth chart interpretation, child health trends, weight monitoring
Determine a Child's Weight Using a Weighing Card
Reference Source: Where There is no Doctor a Village Health Care Handbook
To determine a child's weight using a weighing card:

1. Locate the child's weight in kilograms on the side of the card.
2. Identify the number corresponding to the child's current weight (e.g., 6 kg).
3. Use this information for further steps,...
child weight, weighing card, health monitoring

Vaginal Infections (3)

Avoid Use of Hydroxyquinolines for Vaginal Infections
Critical Source: Where There is no Doctor a Village Health Care Handbook
Warning: Do not use hydroxyquinolines (e.g., clioquinol, iodoquinol) for vaginal infections or other conditions.

Reasons:
• These medicines can cause permanent paralysis, blindness, and even death.
• They were previously...
hydroxyquinolines, dangerous medicines, vaginal infection, avoid use
Administer Povidone Iodine Douches for Vaginal Infections
Standard Source: Where There is no Doctor a Village Health Care Handbook
Indication: Treating bacterial infections of the vagina.

Preparation:
• Mix 2 tablespoons of povidone iodine (Betadine) in 1 liter of warm boiled water.

Usage:
• Give 1 douche a day for 10 to 14 days.

Additional Use:
-...
povidone iodine, vaginal infection, bacterial infection, goiter prevention
Administer White Vinegar Douches for Vaginal Infections
Standard Source: Where There is no Doctor a Village Health Care Handbook
Indication: Treating bacterial infections of the vagina.

Preparation:
• Mix 2 to 3 tablespoons of white vinegar in 1 liter of boiled water.

Usage:
• Give 1 to 3 douches a day for one week, then **1 douche every other...
vinegar douche, vaginal infection, bacterial infection, white vinegar

Epilepsy Medication (3)

Administer Diazepam for Seizures (Rectal Administration)
Critical Source: Where There is no Doctor a Village Health Care Handbook
Purpose: Administer diazepam to stop an epileptic seizure lasting more than 15 minutes.

Dosage:
Adults and children over 12 years: 5 to 10 mg.
Children 7 to 12 years: 3 to 5 mg.
Children under 7 years: 0.2 mg./kg. for...
diazepam,epileptic seizure,rectal administration,dosage,warnings
Administer Phenobarbital for Seizure Prevention in Children Under 12 Years
High Priority Source: Where There is no Doctor a Village Health Care Handbook
Purpose: Administer phenobarbital to prevent seizures in children under 12 years.

Dosage:
Children 5 to 12 years: 4 to 6 mg./kg./day, given as one dose at night or divided into two equal doses.
Children 1 to 5 years: 6 to 8...
phenobarbital,epilepsy,seizure prevention,dosage,children under 12 years
Administer Phenytoin for Seizure Prevention in Children Aged 6 Months to 4 Years
High Priority Source: Where There is no Doctor a Village Health Care Handbook
Purpose: Administer phenytoin to prevent seizures in children aged 6 months to 4 years.

Dosage:
Children 6 months to 4 years: 8 to 10 mg./kg./day, divided into 2 or 3 equal doses.

Instructions:
1. Take the medication by mouth...
phenytoin,epilepsy,seizure prevention,dosage,children aged 6 months to 4 years

Field Medicine (3)

Set Up Medical Clearing Station Shelters
High Priority Source: FM 5 103 Survivability
Medical Clearing Station Shelter Construction

1. Provide protection for a minimum of 40 patients as soon as possible.
2. Construct shelters with adequate overhead cover to ensure uninterrupted medical care and treatment.
3. Plan for:
...
medical clearing station, shelter construction, field medicine
Medic Responsibilities During Movement
High Priority Source: SH 21 76 Ranger Handbook
During movement, the Medic should:

1. Assess and treat march casualties
2. Advise chain of command on evacuation and transportation requirements for casualties

Key considerations: This includes providing immediate care to injured...
medic,during movement,casualty treatment,transportation requirements,evacuation
Identify Medical Threats to Field Forces
Standard Source: STP 21 24 Warrior Leader Skills Level 2 3 4
### Identify Medical Threats to Field Forces

Procedure:

1. Recognize the following medical threats:
- (a) Central nervous system depression.
- (b) Death.
- (c) Noise hazards (e.g., weapons, aircraft, military vehicles,...
medical threats, field forces, noise hazards, altitude sickness, skin disease, poisonous plants, tobacco use

Iv Administration (3)

Check for Signs of Infiltration at IV Site
High Priority Source: STP 21 1 Warrior Skills Level 1
Procedure for Checking for Signs of Infiltration:

1. Monitor the casualty for any unusual pain felt at the infusion site.
2. Look for swelling at the infusion site.
3. Observe for redness at the infusion site.
4. **Check if the site...
IV infiltration signs, IV site monitoring, medical warning, IV administration
Adjust IV Tubing Flow Rate
Standard Source: STP 21 1 Warrior Skills Level 1
Procedure for Adjusting IV Tubing Flow Rate:

1. Loosen the clamp on the IV tubing to allow the IV solution to flow.
2. Monitor the drip rate: Fluid will begin to flow into the drip chamber. The clamp should be adjusted so that the IV...
IV flow rate, IV tubing adjustment, IV administration, medical procedure
Secure IV Tubing to Casualty's Limb
Standard Source: STP 21 1 Warrior Skills Level 1
Procedure for Securing IV Tubing:

1. Unroll about 2 inches of the tape and place it on the casualty's limb and under the IV tubing a few inches beyond the catheter hub and beyond the Tegaderm® dressing.
2. **Ensure the sticky side of the...
IV tubing securing, tape application, IV administration, medical procedure

Radiation Emergencies (3)

Access Long-Term Health Monitoring Guide Following Nuclear or Radiological Incident
High Priority Source: Planning Guidance for Response to Nuclear Detonation May 2022 FEMA
Title: Access Long-Term Health Monitoring Guide Following Nuclear or Radiological Incident

Procedure:
1. Visit the official website of The National Academies Press at [https://www.nap.edu](https://www.nap.edu).
2. Locate and access...
health monitoring, nuclear incident, radiological emergency, National Academies Press
Access NCRP Report on Management of Persons Contaminated with Radionuclides
High Priority Source: Planning Guidance for Response to Nuclear Detonation May 2022 FEMA
Title: Access NCRP Report on Management of Persons Contaminated with Radionuclides

Procedure:
1. Visit the official website of the National Council on Radiation Protection and Measurements (NCRP) at...
radionuclide contamination, NCRP, radiation safety, emergency response
Access Population Monitoring in Radiation Emergencies Guide
High Priority Source: Planning Guidance for Response to Nuclear Detonation May 2022 FEMA
Title: Access Population Monitoring in Radiation Emergencies Guide

Procedure:
1. Visit the official website of the Centers for Disease Control and Prevention (CDC) at [https://www.cdc.gov](https://www.cdc.gov).
2. Navigate to the National...
radiation emergency, population monitoring, CDC, public health

Patient Refusal Evacuation (3)

Assess and Document Patient Understanding of Evacuation Risks
Critical Source: Home Health Emergency Preparedness
Assessment and documentation of the patient's understanding of the impact of their choice and the patient's assuming responsibilities for that choice;
patient refusal,evacuation,assessment,documentation
Notify Local Authorities of Patient Refusal to Evacuate
Critical Source: Home Health Emergency Preparedness
Notification to local authorities (fire department, emergency management, police, etc.) and
notification,patient refusal,evacuation,local authorities
Tailor Response Based on Patient Priority Status
Critical Source: Home Health Emergency Preparedness
Variations of response based on the patient's priority status (a Level 1 patient may require a different response than Level 3);
patient priority,status,response variation,Level 1 vs. Level 3

Toxins Poisons (3)

Treatment for Botulinum Toxin Exposure
Critical Source: LDS Preparedness Manual
Procedure:

1. Administer oxygen therapy immediately if botulinum toxin exposure is suspected or confirmed.
2. Provide antitoxin treatment to neutralize the effects of the toxin.
3. **Monitor for symptoms such as weakness, dizziness, dry...
botulinum treatment, antitoxin, botulism symptoms
Treatment for Ricin Toxin Exposure
Critical Source: LDS Preparedness Manual
Procedure:

1. Administer activated charcoal immediately if ricin toxin exposure is suspected or confirmed.
2. Provide fluids and gastric lavage to remove the toxin from the gastrointestinal tract.
3. **Monitor for symptoms such as...
ricin treatment, activated charcoal, ricin symptoms
Treatment for Staphylococcal Enterotoxin B (SEB) Exposure
Critical Source: LDS Preparedness Manual
Procedure:

1. Administer artificial ventilation immediately if SEB exposure is suspected or confirmed.
2. Monitor for symptoms such as fever, chills, shortness of breath, nausea, vomiting during and after treatment.
3. **Provide...
seb treatment, artificial ventilation, seb symptoms

Epidemic Disease (3)

Recognize and Respond to Lassa Fever Symptoms
Critical Source: Life After Doomsday
Procedure:

Step 1: Identify symptoms of Lassa fever.
• Look for initial signs such as fever, headache, vomiting, and malaise.
• In severe cases, the disease can progress rapidly with complications such as nerve damage and extreme...
lassa_fever,symptoms,isolation,treatment,epidemic
Recognize and Respond to Plague Symptoms
Critical Source: Life After Doomsday
Procedure:

Step 1: Identify symptoms of plague.
• Look for initial signs such as chills, fever, headache, vomiting, and delirium.
• Note that the victim may feel fine for two to four days after being bitten by a flea before symptoms...
plague,symptoms,airborne,transmission,antibiotics,isolation
Recognize and Respond to a Potential Epidemic of Childhood Diseases
Critical Source: Life After Doomsday
Procedure:

Step 1: Identify symptoms of common childhood diseases.
• Look for signs such as high fever, rash, coughing, difficulty breathing, or neurological symptoms.
• Polio can cause paralysis, diphtheria can lead to respiratory failure,...
childhood_diseases,epidemic,vaccination,isolation,treatment

Mass Fatality Management (3)

Manage Mass Fatality Incidents Involving Weapons of Mass Destruction
Critical Source: Planning Guidance Nuclear Detonation FEMA
Procedure for Managing Mass Fatality Incidents Involving Weapons of Mass Destruction

Overview: This procedure outlines steps for medical examiners and coroners (ME/Cs) to establish fatality management strategies that support key agencies in...
mass fatality management, weapons of mass destruction (WMDs), contaminated remains, FSLTT resources, communication with agencies
Mortuary Affairs in Joint Operations
Critical Source: Planning Guidance Nuclear Detonation FEMA
Procedure for Mortuary Affairs in Joint Operations

Overview: This procedure provides joint doctrine for mortuary affairs support in joint operations, outlining procedures for search, recovery, evacuation, and temporary internment of...
mortuary affairs, joint operations, search and recovery, human remain tracking, temporary internment, processing remains
Standard Operating Procedures for Mass Fatality Management
Critical Source: Planning Guidance Nuclear Detonation FEMA
Procedure for Standard Operating Procedures (SOPs) for Mass Fatality Management

Overview: This procedure provides an SOP for mass fatality management, including detailed information about scene responsibilities, incident morgues, family...
standard operating procedures, mass fatality management, incident morgue, family assistance centers, death certification, training exercises

Diseases (3)

Avoid Douves Infection Through Safe Water Practices
Critical Source: Survival Water Purification
Procedure:
1. Douves are found in stagnant and polluted water, especially in the tropics.
2. These parasites can penetrate the body through the skin, so avoid walking or bathing in contaminated waters.
3. If exposed to such...
douves prevention, tropical parasites, water safety
Manage Dysentery with Proper Hydration and Diet
Critical Source: Survival Water Purification
Procedure:
1. If you suspect dysentery, drink plenty of water (preferably boiled) to stay hydrated.
2. Consume coconut milk in small amounts, as it can act as a laxative.
3. Eat frequently and consume boiled rice, which is...
dysentery treatment, hydration, survival medicine
Prevent Cholera and Typhoid Through Water Hygiene
Critical Source: Survival Water Purification
Procedure:
1. Even with vaccines, you are still vulnerable to cholera and typhoid if proper water hygiene is not maintained.
2. Ensure that all drinking water is properly treated, boiled, or filtered before consumption.
3. Avoid...
cholera prevention, typhoid prevention, water hygiene

Syringe Usage And Sterilization (3)

Proper Sterilization of Syringes Using an Autoclave or Pressure Cooker
High Priority Source: Survival and Austere Medicine
Purpose: Ensure syringes are properly sterilized to prevent infection and maintain functionality.

Procedure:
1. Use a rack for optimal sterilization:
- The best method is to use a metal rack that suspends the syringe barrel and...
sterilize syringes, autoclave, pressure cooker, boiling water, medical sterilization, survival medicine
Identify and Differentiate Between Disposable and Reusable Syringes
Standard Source: Survival and Austere Medicine
Purpose: Understand the differences between disposable and reusable syringes to ensure proper usage in medical or survival situations.

Procedure:
1. Examine the materials:
- Reusable syringes are typically made of glass or a...
syringes, reusable syringes, disposable syringes, sterilization, medical equipment, survival medicine
Reuse of Syringes in Austere Situations
Standard Source: Survival and Austere Medicine
Purpose: Understand the guidelines for reusing syringes when medical supplies are limited.

Procedure:
1. Limit reuse to the same person only:
- Reusable syringes should be used solely on the same individual, not across multiple...
reuse syringes, survival medicine, medical reuse guidelines, syringe safety

Diagnostic Tests (3)

How to Use Blood Glucose Test Strips
Standard Source: Survival and Austere Medicine
Procedure:

1. Clean the finger or toe with alcohol and allow it to dry.
2. Use a lancet to prick the finger or toe lightly to obtain a drop of capillary blood.
3. Apply the blood drop to the test strip as directed by the manufacturer.
4. Allow...
blood glucose test, BM stix, diabetes diagnosis, capillary blood
How to Use a Pregnancy Test Kit
Standard Source: Survival and Austere Medicine
Procedure:

1. Collect a small amount of urine in a clean container.
2. Use the test kit as directed by the manufacturer, typically involving applying the urine sample to a test strip or using a device that detects HCG levels.
3. Wait for the...
pregnancy test, HCG, urine test, diagnostic tool
Considerations for Using Infectious Disease Test Kits
Reference Source: Survival and Austere Medicine
Procedure:

1. Research the availability of infectious disease test kits in your region.
2. Verify whether the tests are approved by regulatory bodies such as the US Food and Drug Administration (FDA) or equivalent organizations in other...
infectious disease test, FDA approved, Chlamydia, Syphilis, Malaria

Austere Medicine (3)

Producing Ether from Ethyl Alcohol and Sulphuric Acid
High Priority Source: Survival and Austere Medicine
Overview: Ether (diethyl ether) can be produced through dehydration of ethyl alcohol using sulphuric acid. This process is relatively simple but requires caution due to the volatile nature of the chemicals involved.

Materials Required:
-...
ether production, diethyl ether, sulphuric acid, ethyl alcohol, anaesthesia, austere medicine
Provide Austere Nursing Care with Limited Resources
High Priority Source: Survival and Austere Medicine
Austere nursing care is defined as the provision of ongoing treatment over a period of days, weeks or longer, using limited resources, little or no outside support and in the absence of a working modern medical care system. The role of the...
austere nursing, limited resources, improvisation, self-reliance, medical care, no outside support
Provide Ongoing Nursing Care in an Austere Environment
Standard Source: Survival and Austere Medicine
Overview: Proper nursing care is essential for the recovery of patients in austere environments, whether provided by trained professionals or family members. It involves addressing both physical and emotional needs over time.

**Key...
nursing care,austere environment,bedsores,blood clots,pneumonia,temperature assessment,injections,patient recovery

Anaesthesia (3)

Administer Ether Anaesthesia for Surgical Procedures
Critical Source: Survival and Austere Medicine
Procedure:

1. Ensure the patient is in a safe and stable position, ideally lying down with their head slightly elevated.
2. Prepare the ether solution:
- Use pure ether (if available) or a diluted form if necessary.
3. Administer anaesthesia...
ether anaesthesia,surgery,pain management
Administer Ketamine for Austere Anaesthesia
High Priority Source: Survival and Austere Medicine
Procedure:

Ketamine is a general anaesthetic agent suitable for use in austere environments due to its ease of administration and minimal airway or respiratory suppression. It can be administered via intramuscular, intravenous injection, or...
ketamine,austere medicine,anaesthesia,dissociative anaesthesia,emergence agitation,valium,debride wound
Avoid Using Ether with Naked Flames
Standard Source: Survival and Austere Medicine
Avoid using ether with naked flames – the risks probably outweigh the benefits.

References for Ether Anaesthesia in Austere Environments:
• The 1981 version of the US Special Forces Medical Handbook, specifically the Anaesthesia Chapter.
-...
ether, anaesthesia, fire risk, austere medicine

Vital Signs Measurement (3)

Selecting and Using Blood Pressure Cuff Tools
Standard Source: Survival and Austere Medicine
Objective: Choose the appropriate blood pressure cuff for austere environments.

Tools to Consider:
Mercury column devices: These maintain calibration longer than other types and can be used to calibrate aneroid gauges. They are highly...
blood pressure cuff, mercury column, aneroid gauge, electronic blood pressure device, vital signs measurement
Selecting and Using a Scale for Weight Measurement in Austere Environments
Standard Source: Survival and Austere Medicine
Objective: Choose the appropriate scale for measuring weight accurately.

Tools to Consider:
Electronic scales: Require power but are convenient and accurate.
Mechanical scales: Durable and do not require electricity, making them...
weight measurement, mechanical scale, electronic scale, improvised scale, austere environment
Selecting and Using a Watch or Clock for Pulse and Breathing Rate Measurement
Standard Source: Survival and Austere Medicine
Objective: Choose the appropriate timekeeping device to measure pulse and breathing rates accurately.

Requirements:
• A digital watch with seconds’ count or a sweep-hand clock marked in seconds is essential for accurate measurement...
pulse measurement, breathing rate, digital watch, vital signs, timekeeping device

Temperature Monitoring (3)

Monitoring Temperature for Infection and Dehydration
Standard Source: Survival and Austere Medicine
Purpose:
Track changes in body temperature to detect infections, adverse drug reactions, or dehydration.

Procedure:
1. Record Baseline Temperature:
- Document the patient's normal resting temperature.
2. Monitor Regularly:
-...
temperature monitoring, infection detection, dehydration, baseline temperature, antibiotic effectiveness
Selecting and Using Thermometers for Basal Temperature Monitoring in Austere Environments
Standard Source: Survival and Austere Medicine
Objective: Choose the appropriate thermometer to monitor basal temperatures for chronic condition management.

Tools to Consider:
Mercury thermometers: Highly durable and accurate, but require careful handling to avoid breakage. Ideal...
basal temperature monitoring, mercury thermometer, electronic thermometer, tympanic thermometer, chronic condition management
Selecting and Purchasing Clinical Thermometers
Standard Source: Survival and Austere Medicine
Purpose: To ensure accurate temperature monitoring in survival and austere medical settings.

Procedure:
1. Standard thermometers should be available for every 10 people, with at least two per group. These are suitable for general use...
thermometer selection, standard thermometer, basal thermometer, hypothermia thermometer, hyperthermia thermometer

Amputation Care (3)

Apply Low Hip Spica Cast
High Priority Source: Emergency War Surgery
Indications: Transfemoral amputation.

Technique:
1. Administer adequate anesthesia and place the patient on the fracture table.
2. Excise nonviable tissue as indicated above.
3. Apply stockinette or Webril over the lower abdomen and thigh...
low hip spica cast,application technique,transfemoral amputation,stockinette,webril,cramer wire splint
Apply Shoulder Spica Cast
High Priority Source: Emergency War Surgery
Indications: Transhumeral amputation.

Technique:
1. Administer adequate anesthesia.
2. Irrigate the wound and excise nonviable tissue.
3. Apply stockinette to the axilla for skin traction, using tincture of Benzoin.
4. Wrap Webril over the...
shoulder spica cast,application technique,transhumeral amputation,cramer wire splint
Applying Skin Traction for Amputations
Standard Source: Emergency War Surgery
Procedure for Applying Skin Traction to Prevent Retraction and Preserve Limb Length

Apply dry fine mesh gauze loosely over the open wound, ensuring preserved flaps are held in their intended position by the dressing.
• **Place an...
skin traction, amputations, emergency surgery, wound care, transportation cast

Zoonotic Diseases (2)

Responding to a Rabid Animal Encounter
High Priority Source: The Complete Outdoorsmans Handbook
Procedure:

1. Identify signs of rabies in animals: Look for unusual behavior, such as an animal approaching you instead of fleeing or appearing sick and disoriented.
2. Stay away from the animal: Keep yourself, your children, and pets...
rabies,animal,bite,veterinarian,diagnosis,vaccination
Avoiding Bat Hazards
Standard Source: Dangerous Animals
Procedure:

1. Avoid caves occupied by bats: Inhaling powdered bat guano can cause serious respiratory infections.
2. Do not handle sick or injured bats: They may carry rabies or other diseases and will bite readily when handled.
3....
bat hazards,rabies prevention,bat guano,cave safety

Snake Bite Treatment (2)

Respond to a Green Mamba Bite
Critical Source: Dangerous Animals
Procedure:

1. Immediate Actions After a Bite:
- Keep the victim calm and still to slow the spread of venom.
- Do not attempt to suck out the venom or apply a tourniquet.
- Immobilize the affected limb with a splint if possible.

2....
green mamba bite, treatment, medical emergency, neurotoxic effects
Respond to a King Cobra Bite
Critical Source: Dangerous Animals
Procedure:

1. Immediate Actions After a Bite:
- Remain calm and avoid moving the affected limb to prevent spreading venom.
- Keep the bitten area below heart level if possible.
- Do not attempt to suck out venom or apply a...
king cobra, snakebite treatment, medical response

Venomous Bites (2)

Respond to a Banded Sea Snake Bite
Critical Source: Dangerous Animals
Procedure:

1. Stay calm and immobilize the affected area: Avoid moving the bitten limb to prevent venom spread.
2. Remove any constricting items: Take off rings, watches, or tight clothing near the bite site.
3. Clean the wound:...
banded sea snake bite, first aid, antivenom, neurotoxic effects
Respond to a Mexican Beaded Lizard Bite
High Priority Source: Dangerous Animals
Procedure:

1. Stay calm and immobilize the affected area: Avoid moving the bitten limb to prevent venom spread.
2. Remove any constricting items: Take off rings, watches, or tight clothing near the bite site.
3. Clean the wound:...
mexican beaded lizard bite, first aid, antivenom, hemotoxic effects

Wound Treatment (2)

Management of Infected Battlefield Wounds
High Priority Source: Emergency War Surgery
Procedure:

1. Open the wound and remove all infected and necrotic tissue.
2. Inspect the wound for any retained foreign material.
3. Use drainage in abscess cavities to prevent premature closure and reformation of infection.
4....
infected wound management, surgical drainage, antibiotic therapy, battlefield infection, debridement protocol
Treating Wounds in Horses
High Priority Source: The Household Cyclopedia
Procedure for Treating Wounds in Horses

1. Apply the same rules used for treating wounds in humans, substituting 'horse' for 'patient'.
2. Do not use sticking plaster on wounds, as it is unsuitable for horses.
3. **Neatly stitch...
horse,wounds,treatment,stitching,bandages,avoid,cutting,stimulating_applications

Dentistry (2)

Prepare Tooth Cement (Method 1)
High Priority Source: The Household Cyclopedia
Ingredients:
• Anhydrous phosphoric acid: 12 grains
• Pure caustic lime: 13 grains

Steps:
1. Finely powder both anhydrous phosphoric acid and pure caustic lime.
2. Mix them rapidly in a mortar at the time of use.
3. Smooth off the...
tooth cement, phosphoric acid, caustic lime
Administering Local Anesthetic to a Person with Heart Problems
Standard Source: Where There is No Dentist
Important: If the person has a heart problem, do not inject more than 2 times in one visit. It is best not to use an anesthetic with epinephrine on persons with heart problems. Use lidocaine only, or mepivacaine 3% only.

Local...
heart problems, local anesthetic, lidocaine, mepivacaine, dental injection

Nutritional Supplements (2)

Preparing Liebig's Soup for Invalids
Standard Source: The Household Cyclopedia
Ingredients:
• 1/2 lb. of newly-killed beef or fowl
• 1 1/8 lbs. of distilled water
• 4 drops of pure muriatic acid
• 34 to 67 grains of common salt

Procedure:
1. Chop the meat fine and add all ingredients together, stirring well.
2. Let...
Liebig's Soup, invalids, nutrition, albumen, blood formation, digestion aid
Use Zinc for Dental and General Health
Standard Source: Where There is No Dentist
Zinc is important for maintaining overall health and can be used in various ways:

• As a supplement to support immune function and wound healing.
• In the treatment of Vincent’s infection, where it may help reduce inflammation and...
zinc, vitamin supplement, health, medical emergency

Disinfection (2)

Disinfect Dry Medical Supplies Using a Solar Cooker
High Priority Source: Solar Cookers
Disinfect dry medical supplies using a solar cooker:

1. Place the dry medical supplies (e.g., instruments, bandages, cloth materials) in a container or directly on the cooking surface of the solar cooker.
2. Ensure that the temperature inside...
disinfect medical supplies, solar cooker, sterilization, heat disinfection, field conditions
Disinfecting Instruments with Bleach
High Priority Source: Survival and Austere Medicine
Procedure:

1. Prepare a 0.1% or 1,000 ppm bleach solution (e.g., Clorox).
2. Soak the instruments in the solution for 15 minutes, but not longer than 30 minutes.
3. After soaking, rinse thoroughly with clean water and **dry...
bleach, disinfectant, instrument, wound care

Microbiology (2)

Classify Organisms into Animal, Plant, and Protista Kingdoms
Reference Source: US Army Preservation of Foods
Organisms can be classified into three main kingdoms based on their biological characteristics:

### Animal Kingdom
• Most animal cells have flexible outer walls.
• They are usually able to move independently.

### Plant Kingdom
• Plant...
classification,organisms,animal,plant,protista,fungi,bacteria,rickettsiae,viruses,protozoa
Understand the Early Developments in Microbiology - Leeuwenhoek's Contributions
Reference Source: US Army Preservation of Foods
Leeuwenhoek, a Dutch scientist, was the first to observe microorganisms using self-ground lenses. He discovered animalcules (tiny moving organisms) while examining a drop of water under his microscope. His observations included:

1. Bacteria...
Leeuwenhoek,microbiology,animalcules,bacteria,early developments

Parasite Control (2)

Treating Body Lice in Poultry
Standard Source: Practical Pointers On The Care of Lifestock
Procedure:
1. Use Pratts Powdered Lice Killer to eliminate body lice from poultry.
2. Apply the powder on perches, nest boxes, drop boards, floors, and inside walls of all poultry houses.
3. This helps kill lice and provides disinfecting...
lice treatment, poultry parasites, lice control
Treating Head Lice in Chicks
Standard Source: Practical Pointers On The Care of Lifestock
Procedure:
1. Keep a box of Pratts Head Lice Ointment on hand for treating head lice in chicks.
2. Apply the ointment to affected areas, especially around the head and neck.
3. Sprinkle the sitting hen with Pratts Powdered Lice Killer two or...
head lice treatment, chick care, parasite control

Professional Development (2)

Asking 'Why?' to Improve Practice
Standard Source: A Book for Midwives
Asking 'Why?' to Improve Practice

Asking 'why' is essential for:
Understanding the reasoning behind practices, allowing midwives to make informed decisions independently.
Adapting treatments or tools in ways that may not be commonly...
critical thinking, medical reasoning, problem-solving, midwife training
Continuing Education for Midwives
Standard Source: A Book for Midwives
Continuing Education for Midwives

Midwives should:
1. Watch how other midwives, health workers, and doctors do things to observe best practices.
2. Ask women and families about their preferences regarding the care provided to improve...
midwife education, continuing learning, professional development, medical practice improvement

Health Promotion (2)

Promote Community Collaboration to Improve Women’s Health
Reference Source: A Book for Midwives
Procedure:

1. Understand that health problems are influenced by a variety of factors including physical, social, economic, and political conditions.
2. Work with the community to address these underlying causes of poor health outcomes for...
community collaboration, health advocacy, systemic change
Model Healthy Behaviors to Influence Others
Reference Source: A Book for Midwives
Procedure:

1. Recognize that your actions can have a greater impact on others than your words.
2. Practice healthy behaviors such as breastfeeding, not smoking, and maintaining good health habits.
3. Demonstrate these behaviors consistently in...
healthy behaviors, role modeling, community influence

Community Health (2)

Promote Community Involvement in Women’s Health
Standard Source: A Book for Midwives
Procedure:

1. Identify community leaders who can help promote women's health (e.g., spiritual leaders, government officials, village heads).
2. Engage these leaders in discussions about the importance of improving women's health and...
community involvement,women's health,health education,cultural sensitivity
Promote Village Health Through Community Involvement
Reference Source: Where There is no Doctor a Village Health Care Handbook
Objective: Encourage all members of the village to contribute to improving health and well-being.

Steps:
1. Mothers and fathers should teach children about personal hygiene, such as handwashing and keeping clean.
2. Farmers can...
village health worker, hygiene education, agricultural improvement, school health education, shopkeeper advice, midwife counseling

Alternative Medicine (2)

Evaluate Alternative Therapies for Efficacy
Standard Source: Survival and Austere Medicine
Procedure:

1. Review Scientific Evidence: Investigate whether there is scientific evidence supporting the alternative therapy beyond anecdotal reports or testimonials.
2. Assess Trial Quality: Determine if the therapy has been tested...
alternative therapy, scientific evidence, randomized controlled trials, efficacy evaluation, conventional medicine, anecdotal reports
Evaluating the Use of Traditional Medicine
Standard Source: A Book for Midwives
Procedure:

1. Understand what traditional medicine includes:
- Techniques such as massage, plant-based remedies, and spiritual practices.
2. Assess effectiveness:
- Some traditional medicines have been scientifically tested and...
traditional medicine,effectiveness,safety,plant remedies,spiritual healing

Pregnancy Signs (2)

Identify Sure Signs of Pregnancy
Standard Source: A Book for Midwives
Sure signs of pregnancy are definitive indicators that a woman is pregnant.

### Steps to Identify Sure Signs:
1. Feel strong baby movements: By the 5th month, most women can feel the baby kicking strongly, which is a sure sign of...
sure signs of pregnancy, fetal movements, fetal heartbeat, medical pregnancy test
Identify Probable Signs of Pregnancy
Reference Source: A Book for Midwives
Probable signs of pregnancy are indicators that suggest a woman is likely pregnant, though they may also be caused by other conditions.

### Steps to Identify Probable Signs:
1. Check for stopped monthly bleeding: The absence of menstrual...
pregnancy signs, probable signs of pregnancy, nausea, fatigue, urination frequency, abdominal growth, breast enlargement, fetal movements

Anemia Treatment (2)

Administer Vitamin B12 for Pernicious Anemia
Standard Source: Where There is no Doctor a Village Health Care Handbook
Title: Administer Vitamin B12 for Pernicious Anemia

Procedure:
1. Indications: Vitamin B12 is useful only for a rare type of anemia called _pernicious anemia_, which is almost never found except in some persons over 35 years whose...
vitamin B12, pernicious anemia, northern European ancestry, blood analysis
Treating Anemia Through Diet and Supplements
Reference Source: A Book for Midwives
Procedure:

To treat anemia:

1. Encourage the consumption of iron-rich foods, such as beans, yams, and meat.
2. Include vitamin C-rich foods in the diet, like citrus fruits and tomatoes, to enhance iron absorption.
3. Administer **iron...
anemia, iron supplements, diet, vitamin C, ferrous sulfate, medical advice

Hypertension Management (2)

Respond to Blood Pressure Readings of 140/90 or Higher
High Priority Source: A Book for Midwives
Procedure:

1. Recheck blood pressure: If the mother’s blood pressure is high on the first reading, have her lie on her left side and help her relax (stress can elevate readings).

2. Wait 10–30 minutes, then recheck the blood...
high blood pressure in pregnancy, pre-eclampsia management, hypertension response, emergency care
Home Care for Moderately High Blood Pressure During Pregnancy
High Priority Source: A Book for Midwives
Procedure:

1. Monitor blood pressure regularly at home using a sphygmomanometer.

2. Rest on the left side: This can help reduce pressure on major blood vessels and may lower blood pressure slightly.

3. Avoid stress and fatigue:...
home care for hypertension, blood pressure management during pregnancy, self-care techniques

Placental Delivery (2)

Assist the Mother in Delivering the Placenta
Critical Source: A Book for Midwives
Procedure:

Step 1: If the placenta does not come out by itself within an hour or if the mother is bleeding heavily:

• Ensure the mother is already breastfeeding, as this helps cause contractions. If she is not bleeding too heavily, ask...
delivering the placenta, postpartum care, placental separation assistance, childbirth complications
Recognize Signs of Placental Separation
High Priority Source: A Book for Midwives
Procedure:

Step 1: Watch for the following signs that the placenta has separated from the womb:

• A small gush of blood comes from the vagina. This is a handful of blood that comes out all at once, not a trickle or flow.

• The **cord...
placenta separation, signs of placental delivery, postpartum care, childbirth complications

Hepatitis B (2)

Managing Hepatitis B in Pregnant Women
High Priority Source: A Book for Midwives
Procedure:

1. Avoid Medication: There is no medicine that will help with hepatitis B, and taking medication can harm the liver further.
2. Support Recovery: Encourage rest, easy-to-digest foods, and avoid alcohol to help the body...
Hepatitis B,management,pregnancy,liver health
Recognizing Signs of Hepatitis B in Pregnant Women
High Priority Source: A Book for Midwives
Procedure:

1. Monitor for Symptoms: Watch for the following signs of hepatitis B in pregnant women:
- Pain in the belly or nausea
- No appetite
- Brown, cola-colored urine and whitish stools
- Tiredness and weakness
- Yellow...
Hepatitis B,signs,symptoms,pregnancy,vaccination

Intravenous Administration (2)

Administering Intravenous Fluids in an Emergency
High Priority Source: A Book for Midwives
Steps to Administer Intravenous Fluids:

1. Prepare the environment and supplies:
- Wash your hands well with soap and clean water.
- Put on clean gloves.
- Gather all necessary supplies:
- A bag or bottle of sterile IV fluids...
IV administration, intravenous fluids, emergency IV setup, vein insertion, medical help, blood replacement
Prepare and Start an IV Infusion Using a Training Device
Standard Source: STP 21 1 Warrior Skills Level 1 + STP 21 1 Army Warrior Skills Level 1 Soldiers Manual of Common Tasks
Purpose: Prepare and start an intravenous (IV) infusion using a training device.

Overview: This procedure outlines the steps to prepare and start an intravenous (IV) infusion using a training device, as per STP 21-1-SMCT.

### **Steps to...
IV infusion, training device, intravenous administration, medical procedure

Female Genital Cutting (2)

Emergency Care for FGC Complications
Critical Source: A Book for Midwives
Procedure:

1. If a girl has recently undergone FGC and is experiencing bleeding or shock, get medical help immediately.

2. Press firmly on the bleeding spot right away using a clean, small cloth that will not soak up much...
FGC, female genital cutting, emergency care, shock, tetanus, sepsis, bleeding
Treating Infection After FGC
Critical Source: A Book for Midwives
Procedure:

1. Keep watching for warning signs of tetanus, shock, and other infections.

2. If the girl has not yet had a tetanus vaccination, she should get one immediately (see page 411).

3. Give modern or plant medicines...
FGC, female genital cutting, infection treatment, tetanus, sepsis, antibiotic use

Shock (2)

Recognize and Respond to Shock After Pregnancy Loss
Critical Source: A Book for Midwives
Procedure:

1. Identify signs of shock:
- Pale or clammy skin.
- Rapid, weak pulse.
- Shallow breathing or difficulty breathing.
- Dizziness or fainting.
- Confusion or loss of consciousness.

2. Stabilize the patient:
...
shock after pregnancy loss, pale skin, rapid pulse, medical help
Recognize and Respond to Shock in Cold Weather Conditions
High Priority Source: FM 31 70 Basic Cold Weather Manual
Signs of Shock:
• Apprehension
• Sweating
• Pallor (pale skin)
• Rapid, faint pulse
• Cold, clammy skin
• Thirst

First Aid for Shock:
1. Make the injured person as comfortable as possible.
2. Relieve pain by:
- Proper positioning
-...
shock, cold weather, first aid, signs of shock, treatment for shock

Post Abortion Care (2)

Provide Physical Care After a Pregnancy Ends Early
Standard Source: A Book for Midwives
Steps to Provide Physical Care:

1. Check the woman’s physical signs — like her temperature, pulse, and the amount she is bleeding. This will tell you what kinds of medical help she needs.
2. Monitor for healthy signs, which include:
...
physical care, post-abortion, midwife care, pregnancy complications
Post-MVA Recovery Care for Women
Standard Source: A Book for Midwives
Procedure:

1. Inform the woman about expected recovery time:
- It is normal for her body to take a couple of weeks to feel like it did before pregnancy.
2. Warn her about signs that require medical attention:
- Include symptoms...
post-abortion care, recovery after MVA, physical and emotional support, medical advice

Procedural Skills (2)

Inserting the Cannula During Manual Vacuum Aspiration (MVA)
High Priority Source: A Book for Midwives
Materials needed:
• Sterilized cannula
• Tenaculum

Procedure steps:
1. Preparation and communication:
- Inform the woman that you are ready to begin the procedure.
2. Insertion technique:
- Gently push the sterilized cannula...
cannula insertion, MVA procedure, manual vacuum aspiration, midwifery technique
Selecting the Appropriate Cannula for MVA
High Priority Source: A Book for Midwives
Materials needed:
• Various sizes of cannulas (size may be printed on them)

Procedure steps:
1. Assess pregnancy duration and womb size:
- For a woman who is:
- 5 to 7 weeks pregnant: Use a 5 mm cannula (9 cm long womb)
...
cannula selection, MVA procedure, manual vacuum aspiration, midwifery technique

Post Procedure Care (2)

Post-MVA Monitoring and Care
High Priority Source: A Book for Midwives
Procedure:

1. Monitor the woman closely for at least 24 hours after the MVA.
2. Check her temperature and pulse regularly to detect signs of infection.
3. Observe the amount and nature of bleeding:
- Healthy signs include bleeding similar to...
post-MVA care, monitoring signs, infection detection, bleeding management
Post-Invasive Abdominal Procedure Dietary Guidelines
Standard Source: Survival and Austere Medicine
Dietary Recommendations Following Invasive Abdominal Procedures in Austere Environments:

Step 1: Follow a clear liquid diet until the patient regains normal bowel function.

Step 2: Clear liquids include:
- Water
- Broth
-...
abdominal surgery diet,austere medicine,nutrition,clear liquid diet,post-operative care

Emergency Response (2)

Alert Emergency Services During an Emergency
Critical Source: UK National Risk Register 2025
Procedure:
1. In the event of an emergency, dial 999 immediately to alert emergency services.
2. Provide clear and concise information about the nature of the incident (e.g., fire, medical emergency, or natural disaster).
3. Stay on the line...
dial 999, emergency services, alert
Decide Quickly to Get Help When a Risk Sign is Present
Critical Source: A Book for Midwives
If you see a risk sign at any time, do not wait. If you can treat the problem at home, do so quickly. If you cannot treat it yourself, or if you have been trying to treat a problem that is not getting better — it is time to get medical...
risk sign recognition, emergency response, timely medical intervention

Healthcare Collaboration (2)

Collaborating with Medical Centers and Doctors
Standard Source: A Book for Midwives
Procedure:

1. Establish communication: Midwives should regularly communicate with doctors, nurses, and other health workers at medical centers.
2. Share community health insights: Discuss common health problems in the community and how...
collaboration,midwife,doctor,training,medical center
Learning from Medical Centers to Improve Practice
Standard Source: A Book for Midwives
Procedure:

1. Observe procedures: Watch how medical centers handle births, emergencies, and other health-related situations.
2. Ask questions: Seek clarification on any procedures or practices that are unfamiliar to you.
3....
learning,midwife,training,medical center,procedure improvement

Tools Equipment (2)

Calibrating a Spring Scale with Standard Weights
Reference Source: A Book for Midwives
Materials needed:
• Standard weights (e.g., 1-kilogram packages or cans of food)
• A merchant’s scale (if available)

Steps:
1. Obtain standard weights by borrowing from a merchant or using 1-kilogram packages of food.
2. If no standard...
calibrating scale,weight calibration,standard weights,spring scale accuracy
Constructing a Spring Scale
Reference Source: A Book for Midwives
Materials needed:
• A coil spring about 30 centimeters long
• A bamboo tube
• Plywood or sheet metal
• Wire or cord
• A metal hook
• A washer
• Nails
• A bent nail to mark the scale
• A slot in the bamboo tube
• A weight (15 kilograms to...
spring scale,bamboo tube,coil spring,weight measurement,tool construction

Anatomy Models (2)

Create a Pregnancy Model Using a Gourd and Doll
Reference Source: A Book for Midwives
Materials Needed:
• A gourd shaped like the womb
• A small doll made from cloth
• Small piece of rope or string (for the cord)
• Small pillow (for the placenta)
• Material for making a vagina (leather, cardboard, rubber, etc.)

Steps:
1....
pregnancy model, gourd womb, anatomy teaching tool, midwifery education, reproductive system model
Create a Vaginal Model for Teaching Purposes
Reference Source: A Book for Midwives
Materials Needed:
• A piece of material (size and shape as shown in the image)
• Soft wire or plastic
• Sewing tools
• Additional pieces of cloth

Steps:
1. Cut the Material: Cut a piece of material according to the size and shape shown...
vaginal model, teaching tool, anatomy model, midwifery education, reproductive system model

Education Training (2)

Create Birth Pants for Educational Demonstration
Reference Source: A Book for Midwives
Materials Needed:
• Large old pair of pants
• Doll

Steps:
1. Cut a hole in the pants to simulate a vaginal opening.
2. Have a woman wear the birth pants over her clothing and act as if she is in labor.
3. The woman should **push a doll...
birth pants, educational demonstration, childbirth simulation, midwifery training
Create a Birth Box for Educational Demonstration
Reference Source: A Book for Midwives
Materials Needed:
• Cardboard box
• Paint
• Doll
• Cot
• Cloth or blanket
• Optional: Additional materials to create a belly and breasts

Steps:
1. Cut and paint the cardboard box to resemble a woman’s body.
2. Make a hole in the box...
birth box, educational demonstration, childbirth simulation, midwifery training

Pregnancy Childbirth (2)

Managing Pregnancy and Childbirth in a Post-Antibiotic World
Critical Source: Survival and Austere Medicine
Procedure:

1. Provide prenatal care: Ensure access to proper nutrition, hydration, and rest for pregnant women.
2. Monitor for complications: Watch for signs of preterm labor, gestational diabetes, or infections that may arise without...
pregnancy management,childbirth,postpartum care,maternal mortality
Safe Use of Medicines During Pregnancy and Breastfeeding
Standard Source: A Book for Midwives
Overview:
Medicines are drugs used to help the body fight problems like bleeding, allergy, or infection. Some reduce pain.

Guidelines for Safe Medicine Use:
1. Most pregnancies and births are normal and safe, and medicine is not needed...
medicine use during pregnancy, breastfeeding safety, drug precautions, midwifery guidelines

Poisoning Overdose (2)

Recognize and Respond to Medicine Overdose
High Priority Source: A Book for Midwives
Procedure:

• Identify signs of medicine overdose: nausea, vomiting, stomach pain, dizziness, ringing in the ears, fast breathing, headache.
• Check if these symptoms are common side effects of the medicine being taken. If not:
- **Stop taking...
medicine overdose,overdose symptoms,nausea,vomiting,stomach pain,dizziness
Administer Activated Charcoal
High Priority Source: Where There is no Doctor a Village Health Care Handbook
Procedure for Administering Activated Charcoal

Overview:
Activated charcoal is used to absorb toxins in the stomach and intestines. It should be taken as soon as possible after poisoning or overdose.

Dosage Guidelines:
• Adults: 1 g...
activated charcoal, toxin absorption, poisoning treatment, overdose management

Malaria Prevention (2)

Administer Proguanil for Malaria Prevention
Standard Source: Where There is no Doctor a Village Health Care Handbook
Overview:
Proguanil is used in combination with chloroquine to prevent malaria in areas with low chloroquine resistance. It comes in 100 mg tablets.

Dosage Instructions:
• **Daily dosage (starting the day entering a malaria area until 28...
proguanil, malaria prevention, dosage instructions, medical emergency
Prevent Malaria Using Treated Bednets
Standard Source: A Book for Midwives
Procedure:

1. Use: Sleep under treated bednets.
2. Purpose: Prevent malaria transmission by reducing mosquito bites.
3. Additional Notes: Consult local health authorities for guidance on effective antimalarial drugs in your area.
malaria prevention, treated bednets, mosquito control

Pregnancy Termination (2)

Administer Misoprostol for Delivering the Placenta
High Priority Source: A Book for Midwives
Procedure:

Dosage: Give 600 micrograms by mouth.
Indication: For delivering the placenta (see p. 228).

Important Notes:
• Misoprostol is usually used with another medicine called mifepristone to end a pregnancy. Used by itself,...
misoprostol,delivering placenta
Administer Misoprostol for Heavy Bleeding After Birth or Incomplete Abortion
High Priority Source: A Book for Midwives
Procedure:

Dosage: Give 600 micrograms by mouth by putting tablets against each cheek or under the tongue until they dissolve, then swallow.
Alternative Route: If the woman cannot swallow, insert pills in her rectum where they will...
misoprostol,heavy bleeding,abortion

Hemorrhage (2)

Handling Blood Loss During Labor and Delivery
Critical Source: A Book for Midwives
Procedure:

1. If blood loss occurs during labor, monitor for signs of shock such as:
- Dizziness, fainting, or rapid heart rate.
- Pale skin or cold extremities.
2. In cases of severe blood loss:
- Administer IV fluids if trained...
blood loss,labor,delivery,hemorrhage,IV fluids
Manage Late Intra-Abdominal Hemorrhage
Critical Source: NATO Emergency War Surgery
Procedure for Managing Late Intra-Abdominal Hemorrhage

### Causes:
Late hemorrhage in abdominal wounds is often due to an infectious process eroding a significant blood vessel.
• Common locations include the retroperitoneum,...
intra-abdominal hemorrhage, retroperitoneum, hematoma, infection, lumbar venous plexus, surgical intervention

Dehydration Management (2)

Identifying And Managing Dehydration In Flu Patients
High Priority Source: Flu Home Treatment
Identifying And Managing Dehydration In Flu Patients

Recognize the symptoms and signs of dehydration, especially in patients with fever, vomiting, or diarrhea:
Symptoms: weakness, dizziness, headache, confusion, fainting.
Signs:...
dehydration symptoms, dehydration signs, flu treatment, hydration management, influenza care
Rehydration Drink Preparation
High Priority Source: A Book for Midwives
Procedure:

1. Mix the following ingredients in clean water:
- 1 liter of clean water
- 1 teaspoon of salt
- 8 teaspoons of sugar
2. Stir until the salt and sugar are fully dissolved.
3. **Allow the mixture to cool before...
rehydration drink, dehydration, midwifery, electrolytes

Heat Stroke (2)

Treatment of Heat Stroke (Hyperthermia)
Critical Source: Aids to Survival
Procedure:

1. Transfer the patient to a cool, shaded location immediately.
2. Immerse the body in cold water, or use ice packs, water, and alcohol on the skin for rapid cooling.
3. Focus on cooling the head, neck, and chest to lower...
hyperthermia, heat stroke, treatment, first aid, cooling
Recognition of Heat Stroke (Hyperthermia)
Critical Source: Aids to Survival
Procedure:

1. Check if the skin feels hot to the touch.
2. Observe for a flushed face and rapid pulse at rest.
3. Look for signs of dizziness, excessive fatigue, lethargy, or an absence of will to continue activity.
4. Note...
hyperthermia, heat stroke, recognition, symptoms

Death And Dying (2)

Properly Handle a Dead Body in the Wilderness
Critical Source: Aids to Survival
Title: Properly Handle a Dead Body in the Wilderness

Procedure to Follow:
1. Document the circumstances: Get everyone in the group to take careful notes of the events surrounding the death, as statements will be required for the...
dealing with death,body preservation,wilderness protocols
Recognize Signs of Death
Critical Source: Aids to Survival
Title: Recognize Signs of Death

Signs to Look For:
Fixed dilated pupils: Pupils that do not respond to light or resuscitation efforts.
Absence of spontaneous heartbeat: No detectable heart activity despite prolonged...
signs of death,rigor mortis,medical certification

Intubation (2)

Ketamine Dosage and Characteristics for Induction
Critical Source: Emergency War Surgery
Ketamine Dosage and Characteristics for Induction

Routine Dose: 1.0–2.0 mg/kg IV.
Characteristics: Dissociative anesthetic, amnestic.
Sympathomimetic effects: Useful in hypovolemia.
Potent bronchodilator.
Concerns:...
ketamine,dosage,intubation,emergency surgery
Succinylcholine Dosage and Contraindications
Critical Source: Emergency War Surgery
Succinylcholine Dosage and Contraindications

Dosage: 1.0–1.5 mg/kg.
Onset: 30–60 sec.
Duration: 5–10 min.
Warnings/Contraindications:
- Can cause bradycardia, fasciculations, elevated intragastric pressure, elevated...
succinylcholine,dosage,contraindications,intubation,emergency surgery

Nerve Injuries (2)

Assessing and Managing Facial Nerve Injuries
High Priority Source: Emergency War Surgery
Procedure for Assessing and Managing Facial Nerve Injuries

• Carefully examine for facial nerve function in all five branches: temporal, zygomatic, buccal, marginal mandibular, and cervical.
• If the injury is located **anterior to a...
facial nerve injury,nerve stimulator,epineurium,suture
Assessment and Management of Peripheral Nerve Injuries in Combat
High Priority Source: NATO Emergency War Surgery
Objective: Proper assessment and management of peripheral nerve injuries to optimize recovery and prevent complications.

### Initial Assessment
• Determine which nerve(s) are involved based on clinical signs and symptoms.
• Evaluate the...
peripheral nerve injuries, war wounds, nerve repair, neuroma prevention, range of motion, splinting, debridement

Neurology Head Injuries (2)

Assess Pupillary Reactivity in Head Injury Patients
Critical Source: Emergency War Surgery
Procedure:

1. Examine the pupillary reactivity of the patient:
- A single dilated or nonreactive pupil: Indicates urgency and implies a unilateral space-occupying lesion with secondary brain shift; immediate surgery is indicated.
...
pupillary reactivity, head injury, neurological assessment, emergency surgery
Assess Prognosis of Craniocerebral Injuries
High Priority Source: NATO Emergency War Surgery
Prognosis Assessment for Craniocerebral Injuries:

1. Determine Consciousness Level: The prognosis is good in patients who are not deeply unconscious and respond to simple commands.
2. Monitor for Deterioration: If a head-injured patient...
craniocerebral injuries, prognosis, consciousness level, neurological improvement, coma duration

Esophageal Injuries (2)

Managing Complex Esophageal Injuries
Critical Source: Emergency War Surgery
For injuries that cannot be primarily repaired:

• Staple above and below the injury.
• Place a nasogastric (NG) tube into the upper pouch.
• Place a gastrostomy tube into the stomach.
• Drain the chest as indicated above.

**Alternative for old...
controlled fistula,T-tube,mediastinum drainage,gastrostomy tube
Managing Esophageal Injuries in Thoracic Region
Critical Source: Emergency War Surgery
Isolated thoracic esophageal injuries are rare, usually diagnosed incidentally with other intrathoracic injuries.

Diagnostic clues include:

• Pain
• Fever
• Leucocytosis
• Cervical emphysema
• Hamman’s sign
• Chest X-ray (CXR) evidence of...
esophageal injury,thoracic surgery,chest tube,nasogastric tube,posterolateral thoracotomy

Diagnostic Tools (2)

Selecting and Using a Stethoscope for Auscultation in Austere Environments
Standard Source: Survival and Austere Medicine
Objective: Choose the appropriate stethoscope for assessing lung and bowel sounds.

Tools to Consider:
Single-head stethoscopes: A good quality single-head model with spare diaphragms is essential. These are preferred over dual-head...
stethoscope selection, lung sounds, bowel sounds, diagnostic tool, austere medicine
Ultrasound Views and Imaging Locations Procedure
Standard Source: Emergency War Surgery
### Ultrasound Views and Imaging Locations
Sonographic Windows:
• A typical portable sonography device is used (see Fig. 17-1)
• Standard locations for sonographic windows include:
- Cardiac view
- Left upper quadrant (LUQ)
- Right...
FAST imaging,sonographic windows,RUQ,LHQ,pelvic view,image examples

Sonography (2)

Interpret Normal and Abnormal Sonographic Examinations for the Left Upper Quadrant
High Priority Source: Emergency War Surgery
Procedure:

1. Purpose: To identify normal versus abnormal findings in sonographic examinations of the left upper quadrant.
2. Normal Findings (Fig. 17-5a):
- Clear visualization of spleen and surrounding structures with no signs of...
left upper quadrant,sonographic examination,spleen injury,hemoperitoneum,emergency surgery
Interpret Normal and Abnormal Sonographic Examinations for the Pelvic Window
High Priority Source: Emergency War Surgery
Procedure:

1. Purpose: To identify normal versus abnormal findings in sonographic examinations of the pelvic window.
2. Normal Findings (Fig. 17-6a):
- Clear visualization of bladder, uterus (in females), and prostate (in males) with...
pelvic window,sonographic examination,hemoperitoneum,pelvic fractures,emergency surgery

Crush Syndrome (2)

Hospital Care for Crush Syndrome
Critical Source: Emergency War Surgery
Objective: Continue treatment of crush syndrome in the hospital setting to protect renal function and manage complications.

### Steps:
1. Treat other injuries and electrolyte anomalies while continuing fluid resuscitation as outlined...
hospital care, crush syndrome, electrolyte management, dialysis, hyperbaric oxygen
Initiate Therapy for Crush Syndrome in the Field
Critical Source: Emergency War Surgery
Objective: Prevent acute renal failure in crush syndrome by early recognition and treatment of rhabdomyolysis.

### Steps:
1. Establish IV access as soon as possible, preferably in a free arm or leg vein.
2. **Avoid potassium and...
crush syndrome, rhabdomyolysis, IV fluids, emergency war surgery, renal failure prevention

Compartment Syndrome (2)

Diagnosis and Management of Compartment Syndrome
Critical Source: Emergency War Surgery
Objective: Identify and manage compartment syndrome promptly to prevent complications.

### Signs and Symptoms:
Early clinical signs:
- Pain out of proportion to the injury.
- Pain with passive stretch.
- Tense, swollen...
compartment syndrome, fasciotomy, diagnosis, emergency war surgery
Surgical Management of Crush Syndrome and Compartment Syndrome
Critical Source: Emergency War Surgery
Objective: Diagnose and treat compartment syndrome to prevent irreversible damage.

### Steps:
1. Diagnose compartment syndrome clinically, as measurement of compartment pressures is not recommended in the combat zone.
2. Look for signs of...
fasciotomy, compartment syndrome, hyperbaric oxygen therapy, surgical management, crush injuries

Extremity Fractures (2)

Apply Transportation Cast for Long Bone Fractures
High Priority Source: Emergency War Surgery
Procedure:

1. Assess the patient's condition and determine if a transportation cast is appropriate.
- Considerations include: soft tissue evaluation needs, presence of other injuries (e.g., abdominal injury), and burn severity.
2....
transportation cast,long bone fracture,emergency surgery,fracture management
Transportation Casts for Long Bone Fractures
High Priority Source: Emergency War Surgery
Procedure:

1. Indications for Use:
- When soft tissues need to be evaluated en route (e.g., vascular injury).
- When other injuries make casting impractical (e.g., femur fracture with abdominal injury or extensive burns).
- For...
transportation cast,long bone fracture,external fixation,soft tissue access,polytrauma patient

Surgical Care (2)

Handle Surgical Admissions for Internees in Combat Zones
Critical Source: Emergency War Surgery
Procedure:

1. Assess surgical needs: Be prepared to handle a high volume of internees requiring medical care, as seen during conflicts such as World War II, the Korean conflict, and Operation Desert Storm.

2. **Identify common surgical...
fragment wounds, debridement, fracture fixation, laparotomy, abscess drainage
Post-op Pulse Monitoring and DVT Prophylaxis
Standard Source: Emergency War Surgery
Post-op Pulse Monitoring and DVT Prophylaxis

Monitor for palpable pulses post-operatively, ensuring that any pulse obtained in the operating room (OR) remains palpable.
Watch for changes in pulse, even if Doppler signals remain, as...
post-op,pulse monitoring,dvt prophylaxis,graft thrombosis,edema management

Electrical Injuries (2)

Management of High-Voltage Electrical Injury
Critical Source: Emergency War Surgery
Procedure:

1. Assess for deep muscle injury, which is common in high-voltage electrical injuries (>1,000 volts), often more extensive than the overlying cutaneous injury.
2. Examine extremities for compartment syndrome and perform...
high-voltage injury,rhabdomyolysis,fasciotomy,spinal fracture,fluid resuscitation
Management of Pigmenturia Following Electrical Injury
Critical Source: Emergency War Surgery
Procedure:

1. Diagnose pigmenturia by observing reddish-brownish urine, with a dipstick test positive for blood but insignificant numbers of red blood cells on microscopy.
2. **Increase the hourly LR (Lactated Ringer's) rate until a...
pigmenturia,myoglobinuria,LR infusion,mannitol,sodium bicarbonate,rhabdomyolysis

Ethics And Compliance (2)

Comply with Medical Ethics for Internee Care
High Priority Source: Emergency War Surgery
Procedure:

1. Understand the ethical obligations: Healthcare personnel must adhere to the *Principles of Medical Ethics Relevant to the Role of Health Personnel, Particularly Physicians, in the Protection of Prisoners and Detainees Against...
medical ethics, Geneva Conventions, internee care, EPW, discrimination, compliance
Provide Medical Care to Internees in Armed Conflicts
High Priority Source: Emergency War Surgery
Procedure:

1. Identify the scope of medical care: Provide treatment for all internees, including but not limited to enemy prisoners of war (EPWs), retained personnel, civilian internees, and other detainees.

2. **Ensure access to...
internee care, Geneva Conventions, medical urgency, ethics, documentation

Burn Management (2)

Burn Injury Management in Wilderness Environment
High Priority Source: US Marine Corps Wilderness Medicine
Procedure:
1. Assess the burn injury and classify it based on depth (superficial, partial-thickness, full-thickness) and total body surface area (TBSA).
2. Cool the burn wound immediately with clean, running water for at least 10–20...
burn management, wilderness medicine, burn classification, TBSA assessment, shock prevention
Assess and Treat Thermal Burns in War Injuries
High Priority Source: Emergency War Surgery
Procedure:

1. Identify thermal burns caused by ignited fuel, ammunition, or hydraulic fluid.
2. Assess the severity of burns:
- Mild (1st degree): Superficial redness without blistering.
- Moderate (2nd degree): Blisters and...
thermal burns, burn management, war injuries, trauma care

Staff Management (2)

Manage Surgeon and Staff Fatigue During Mass Casualty Events
Critical Source: Emergency War Surgery
Procedure:

• After the first 24 hours of a mass casualty event, reduce the activities of care providers by 50% to allow for recovery and rest.
• Implement new rotations to sustain a modified but continuous effort in patient care.
• Enforce...
fatigue management, staff rotation, mass casualty, rest protocols
Ensure Personnel Are Drilled and Stationed Appropriately During Mass Casualty Events
High Priority Source: NATO Emergency War Surgery
After the initial notification of the anticipated large influx of casualties, a timely alert is passed along the chain of responsibility, and the triage officer ensures that all stations and services are prepared. Personnel should be well drilled in...
personnel training, mass casualty response, station readiness

Coagulopathy (2)

Managing Coagulopathy in Trauma Patients
Critical Source: Emergency War Surgery
- Blood loss, massive fluid resuscitation, and drop in body temperature may lead to inability to form clot.

Keep the patient warm (above 34 °C).

• Use warm fluids for resuscitation.

• Use crystalloid fluids sparingly.

• Transfuse...
coagulopathy,trauma,warmth,fluid resuscitation,whole blood transfusion
Prevent and Manage Coagulopathy from Massive Blood Transfusion in Trauma Patients
Critical Source: NATO Emergency War Surgery
Procedure:

1. Assess transfusion needs: Monitor for casualties with heart or liver wounds, pelvic crush injuries, or those requiring large volumes of whole blood.
2. Avoid complications:
- Do not infuse old bank blood directly into...
massive blood transfusion, coagulopathy, DIC, trauma patient, heparin therapy, platelet packs

Anesthesia Procedures (2)

Induction Agents and Sedatives for Emergency War Surgery
Critical Source: Emergency War Surgery
Table of Induction Agents and Sedatives:

|Agent|Routine Dose* |Characteristics|Concerns|
|---|---|---|---|
|Ketamine|1.0–2.0 mg/kg IV|Dissociative anesthetic and amnestic|Varying degrees of purposeful skeletal movement...
induction agents, sedatives, ketamine, thiopental, propofol, etomidate, hypovolemic shock, anesthesia
Establish Definitive Airway in Battlefield Anesthesia
Critical Source: Emergency War Surgery
Indications for a Definitive Airway:
Apnea/airway obstruction/hypercarbia.
Impending airway obstruction: facial fractures, retropharyngeal hematoma, and inhalation injury.
Excessive work of breathing.
• **Shock (BP < 80 mm Hg...
definitive airway, battlefield anesthesia, endotracheal intubation, emergency airway management

Intensive Care (2)

Nonoperative Intensive Care Management of Closed Injuries and Postoperative Patients
High Priority Source: NATO Emergency War Surgery
Objective: Provide non-surgical intensive care to prevent secondary brain injury.

Procedure:
1. Ensure good pulmonary care for intubated patients:
- Maintain intubation as long as possible without causing tracheal damage, typically up to...
nonoperative management, secondary brain injury prevention, intubation care, enteral feeding, hypertension control
Organ System Approach in Intensive Care
High Priority Source: Emergency War Surgery
- Use the organ system approach, where each organ system is addressed in a mini-SOAP format to ensure comprehensive care.

Important caveats for the intensivist:

• **“Patients don’t often suddenly deteriorate; healthcare providers suddenly...
organ system approach,SIRS,intensivist,caveats

Traumatic Brain Injury (2)

Manage Intracranial Hypertension in Traumatic Brain Injury
Critical Source: Emergency War Surgery
Objective: Reduce intracranial pressure (ICP) and prevent complications.

### Steps:
1. Elevate the head of the bed to 30° to help reduce ICP.
2. Monitor and control serum osmolarity:
- Use normal saline as the preferred IV...
intracranial hypertension, ICP management, traumatic brain injury, mannitol, hyperventilation, craniotomy, hyperglycemia, seizure prophylaxis
Traumatic Brain Injury (TBI) Management - Oxygenation and Blood Pressure Goals
Critical Source: Emergency War Surgery
Goal of treatment: Maintain cerebral perfusion pressure (CPP) and oxygenation.

### Actions:
• Identify potential intracranial surgical lesions for possible emergent craniotomy.
• Prevent hypoxemia:
- Maintain O2 sat >92%, **PaO2...
TBI,CPP,oxygenation,SBP,MAT,ICP,intubation,GCS

Cardiovascular Support (2)

Diagnose and Treat Myocardial Ischemia/Infarction (MI)
Critical Source: Emergency War Surgery
Objective: Diagnose and manage myocardial ischemia or infarction in a critical care setting.

Steps for Diagnosis:
1. Suspicion of MI arises when the patient exhibits:
- Angina-like chest pain.
- Unexplained cardiac instability...
myocardial infarction, MI, beta-blocker, aspirin, NTG, thrombolytic therapy
Evaluate Cardiovascular Deterioration in Stable Patients
Critical Source: Emergency War Surgery
Objective: Identify potential causes of cardiovascular deterioration after a period of apparent stability.

Steps to Evaluate:
• Rule out the following:
- Hypoxia or loss of airway.
- Tension pneumothorax.
- **Recurrent...
cardiovascular deterioration, tension pneumothorax, hypovolemia, sepsis, third spacing

Critical Care Procedures (2)

Recognize and Manage Life-Threatening Thoracic Injuries
Critical Source: Emergency War Surgery
Life-Threatening Injuries:

Injuries not immediately obvious but requiring urgent attention include:
- Tension pneumothorax
- Massive hemothorax
- Cardiac tamponade

Tension Pneumothorax:
- A patient with a known...
tension pneumothorax, massive hemothorax, cardiac tamponade, thoracotomy, pericardial window
Monitor and Support Cardiovascular System in Critical Care
Reference Source: Emergency War Surgery
Objective: Monitor hemodynamic parameters to support cardiovascular function in critically ill patients.

Steps:
Monitor end-organ perfusion (urine output, capillary refill).
• Use the following four parameters of hemodynamic...
cardiovascular support, hemodynamic monitoring, preload, afterload, sinus tachycardia, critical care

Heatstroke (2)

Manage Seizures in Heatstroke Patients
Critical Source: Emergency War Surgery
Seizures occur frequently (>50% of cases) with heatstroke and can hinder cooling efforts.

### Treatment:
• Administer diazepam (5–10 mg IV) to control seizures.
• Diazepam is effective for managing agitation, combative behavior, or...
seizures, diazepam, intubation, airway management
Recognize and Respond to Heatstroke
Critical Source: Emergency War Surgery
Heatstroke is a medical emergency that can be life-threatening if not treated immediately. It involves damage to multiple organ systems, including the brain, liver, kidneys, muscles, and hemostatic system.

### Clinical Presentation:
• **Altered...
heatstroke, emergency treatment, cooling, rectal temperature, diazepam, chlorpromazine

Altitude Illness (2)

Prophylaxis, Recognition, and Management of Acute Mountain Sickness (AMS)
High Priority Source: US Marine Corps Wilderness Medicine + USMC Winter Survival Course Handbook + FM 3 97 61 Military Mountaineering + Emergency War Surgery
Prophylaxis for AMS:

Diet: A high carbohydrate diet (<70% of total energy intake as carbohydrates) stimulates ventilation through increased carbon dioxide produced from metabolism.
Acetazolamide: 250 mg qid or 500 mg bid po,...
Acute Mountain Sickness, AMS, Prophylaxis, Treatment, Management, Dexamethasone, Acetazolamide, Oxygen Therapy, Descent, Symptoms
Recognize and Respond to Altitude Illness
High Priority Source: Emergency War Surgery
Procedure for Recognizing and Responding to Altitude Illness

Altitude illness occurs due to exposure to high altitudes, where the air pressure is lower and oxygen levels are reduced. This can lead to a range of symptoms from mild discomfort to...
altitude illness, acute mountain sickness, high-altitude pulmonary edema, high-altitude cerebral edema, hypoxia, acclimatization, oxygen administration, dexamethasone, nifedipine

Heat Injuries (2)

Treating Heat Stroke
Critical Source: Emergency War Surgery
Procedure for Treating Heat Stroke:

1. Recognize the signs of heat stroke:
- High body temperature (≥104°F or 40°C), altered mental state, hot and dry skin, rapid pulse, and possible loss of consciousness.

2. **Move the victim to a...
heat stroke,treatment,emergency first aid,cold injury
Recognize and Manage Heat Injuries in Mountain Environments
Critical Source: FM 3 97 61 Military Mountaineering
Procedure:

1. Monitor for signs of heat injuries:
- Watch for symptoms such as dizziness, nausea, headache, rapid pulse, and excessive sweating (heat exhaustion) or confusion, loss of consciousness, and hot, dry skin (heat stroke).
2....
heat exhaustion,heat stroke,cold treatment,mountain heat

First Aid In Armed Conflicts (2)

Establishing First Aid Posts in Armed Conflicts
High Priority Source: First Aid in Armed Conflicts
### Staffing and Organization

• First Aid posts are usually managed by staff and volunteers from the International Red Cross and Red Crescent Movement.
• Local community members may assist in setting up facilities, improvising materials (e.g.,...
first aid posts, staffing, organization, triage, equipment, evacuation, armed conflicts
Follow Basic Rules for Safety in Armed Conflicts
High Priority Source: First Aid in Armed Conflicts
Procedure:

• Be aware of and act in accordance with the basic rules protecting individuals in situations of violence, and the Fundamental Principles of the International Red Cross and Red Crescent Movement.
• Comply strictly with military...
armed conflict, safety rules, military security, first aid, international humanitarian law

First Aid In Armed Conflict (2)

Establish a First Aid Post in Armed Conflict Zones
High Priority Source: First Aid in Armed Conflicts
Purpose:

To gather all casualties arriving from combat or other situations of violence so as to better organize their management and, if necessary, evacuation.

Key Objectives:

• Assess the condition of casualties and provide emergency and...
first aid post,armed conflict,casualty care,emergency stabilization,security considerations,location requirements,medical facilities
Forward Projection of Resources for Casualty Care
High Priority Source: First Aid in Armed Conflicts
Definition:

Forward projection of resources means bringing advanced emergency and/or surgical care to casualties nearer the collection point.

Benefits:

• Reduces mortality and morbidity (health problems) rates.
• Reduces the need for...
forward projection,resource allocation,casualty care,emergency medical services,infrastructure requirements

Respiratory System (2)

Understand the Process of Respiration
Critical Source: FM 4 25 11 First Aid
Procedure:

1. Understand that respiration involves inhaling oxygen and exhaling carbon dioxide (CO2).
2. Recognize the components involved in respiration:
- Airway: Includes the nose, mouth, throat, voice box, and windpipe.
-...
respiration process, airway anatomy, lung function, breathing mechanics
Understand the Structure of the Bronchi
Reference Source: Where There is no Doctor a Village Health Care Handbook
Bronchi are the tubes leading to the lungs through which air passes when a person breathes.
bronchi,lungs,respiratory system

Cardiac Arrest (2)

Identifying and Responding to Heart Stoppage
Critical Source: FM 4 25 11 First Aid
Procedure:

1. If a casualty’s heart stops beating, immediately seek medical help. *Seconds count!*
2. Stoppage of the heart is soon followed by cessation of respiration unless it has occurred first.
3. Stay calm and think clearly.
4. When a...
heart stoppage,pulse check,cardiac arrest
Recognizing and Responding to Cardiac Arrest
Critical Source: FM 4 25 11 First Aid
Procedure:

1. Immediate Action Required: If a casualty’s heart stops beating, you must immediately seek medical help. SECONDS COUNT! Stoppage of the heart is soon followed by cessation of respiration unless it has occurred first.
2....
cardiac arrest,pulse detection,emergency response

Chemical Biological Agents (2)

Mask Without Order or Alarm During Chemical/Biological Attack
Critical Source: FM 4 25 11 First Aid
Procedure:

1. Stop breathing immediately upon detecting any of the following:
- Artillery missiles, rockets that produce vapors, smoke, and mists.
- A suspicious odor, liquid, or solid is present.
- Smoke or vapor cloud from an...
masking,chemical attack,biological agent,first aid
Use Field Protective Mask for Chemical/Biological Agents
Critical Source: FM 4 25 11 First Aid
Procedure:

1. Your field protective mask provides protection against biological and chemical warfare agents as well as radiological fallout.
2. Practice masking to ensure you can don your mask in 9 seconds or less, or put on your mask with...
field protective mask,chemical attack,biological agent

Spinal Injury Handling (2)

Positioning a Casualty with Suspected Neck/Spine Injury for Safe Movement
Critical Source: FM 4 25 11 First Aid
WARNING: If it is necessary to turn a casualty with a suspected neck/spine injury:
1. Roll the casualty gently onto his side, keeping the head, neck, and body aligned while providing support for the head and neck.
2. **DO NOT roll the casualty...
neck injury,spinal injury,casualty movement,safe handling
Rolling a Casualty from Prone Position to Supine Position
High Priority Source: FM 4 25 11 First Aid
Procedure for Rolling a Casualty Safely:

1. Assess the casualty’s position. If the casualty is lying on his chest (prone position), do not move him unless absolutely necessary.
2. Cautiously roll the casualty as a unit. Ensure that his...
rolling casualty, spinal injury, first aid, positioning casualty

Heat Related Injuries (2)

Provide First Aid for Heatstroke (Sunstroke)
Critical Source: FM 4 25 11 First Aid
Heatstroke (sunstroke) is characterized by:
Stoppage of sweating with red (flushed), hot, and dry skin
• Initial symptoms may include headache, dizziness, nausea, fast pulse and respiration, seizures, mental confusion
• Sudden...
heatstroke, sunstroke, first aid, emergency, cooling
Treating Heatstroke in Emergencies
Critical Source: Medical Emergencies
Procedure:

1. Recognize heatstroke by the following signs:
- Body temperature above 40.5°C (105°F).
- Swollen, beet-red face.
- Reddened whites of eyes.
- Victim not sweating.
- Unconsciousness or delirium with possible...
heatstroke,treatment,cold therapy,emergency care

Psychological Support (2)

Integrate Psychosocial Support into Pandemic Planning
High Priority Source: HHSPandemicInfluenzaPlan
Include psychosocial issues in planning

• Incorporate psychosocial support services into emergency preparedness planning for an influenza pandemic.
• Coordinate with business, corporations and other private sector interests in planning for...
pandemic planning, psychosocial support, emergency responders, behavioral health, public health messages
Provide Psychological Support During Incapacitating Agent Exposure
Standard Source: FM 4 25 11 First Aid
Procedure:

1. If the casualty is conscious and able to comprehend, provide reassurance and maintain a firm but friendly attitude.
2. If the casualty is incoherent or unable to understand, do not engage in conversation.
3. Focus...
psychological support, communication, restraint, evacuation

Anaphylaxis (2)

Provide First Aid for Severe Allergic Reactions to Insect Bites or Stings
Critical Source: Full First Aid Manual FM 2111
Purpose: To manage severe allergic reactions (anaphylaxis) caused by insect bites or stings.

Procedure:
1. Recognize signs of anaphylactic shock, such as generalized itching, hives, swelling of the face or throat, difficulty breathing,...
anaphylaxis, epinephrine, severe reaction, emergency treatment
Respond to Anaphylactic Shock from Insect Bites/Stings
Critical Source: FM 4 25 11 First Aid
Overview:

Anaphylactic shock is a life-threatening allergic reaction that can occur after an insect bite or sting. Immediate action is required.

Warning:
Insect bites/stings may cause anaphylactic shock, which is a **TRUE MEDICAL...
anaphylactic shock, insect bite, sting, emergency treatment, CPR, rescue breathing

Antivirals (2)

Distribute Antiviral Drugs During Pandemic Onset
Critical Source: HHSPandemicInfluenzaPlan
Objective: Distribute antiviral drugs from public stockpiles to healthcare facilities and others with direct patient care responsibility.

Procedure:
1. Begin distributing antiviral medications from the Strategic National Stockpile (SNS) at...
antiviral_distribution,priority_groups,stockpile_deployment
Procure and Stockpile Antiviral Medications
Critical Source: HHSPandemicInfluenzaPlan
Objective: Procure sufficient quantities of antiviral drugs to treat 25% of the U.S. population and stimulate domestic production capacity.

Procedure:
1. Collaborate with federal partners and states to procure antiviral medications for...
antiviral_stockpile,pandemic_preparedness,strategic_national_stockpile

Vaccination Assessment (2)

Assess Vaccine Coverage, Effectiveness of Targeting to Priority Groups, and Efficiency of Distribution and Administration
High Priority Source: HHSPandemicInfluenzaPlan
Procedure:

1. Evaluate the extent of vaccine coverage among different population groups.
2. Assess how effectively vaccines were targeted to priority groups (e.g., healthcare workers, elderly).
3. Analyze the efficiency of vaccine distribution...
vaccine coverage, targeting priority groups, distribution efficiency
Assess Vaccine Efficacy, Safety, and Impact During the Pandemic
High Priority Source: HHSPandemicInfluenzaPlan
Procedure:

1. Evaluate the effectiveness of vaccines used during the pandemic in preventing illness and death.
2. Assess the safety profile of vaccines, including any adverse effects reported.
3. Analyze the overall impact of vaccination...
vaccine efficacy, safety, impact assessment

Vaccination Priority Groups (2)

Prioritize High-Risk Groups for Vaccination
Critical Source: HHSPandemicInfluenzaPlan
Procedure:

1. Identify and prioritize the following groups for vaccination:
- Persons aged 2-64 years with a medical condition for which influenza vaccine is recommended.
- All persons aged 6-23 months (infants and toddlers).
-...
high-risk groups,vaccination priority,pandemic influenza,elderly,children with medical conditions
Prioritize Healthcare Workers and Essential Support Staff for Vaccination
High Priority Source: HHSPandemicInfluenzaPlan
Procedure:

1. Identify healthcare workers (HCW) with direct patient contact, including those in:
- Acute-care hospitals
- Nursing homes
- Skilled nursing facilities
- Urgent care centers
- Physician’s offices
- Clinics
-...
healthcare workers,vaccination priority,pandemic influenza,essential support staff

Pandemic Treatment (2)

Integrating Therapies for Avian Flu Management
High Priority Source: Bird Flu Summit Brochure
Procedure:

1. Develop a therapeutic intervention plan that integrates multiple treatment options for avian flu, including antivirals and supportive care.
2. Ensure that antiviral medications are available in sufficient quantities and...
therapeutic intervention, avian flu treatment, antivirals
Provide Antiviral Treatment to Outpatients Not in Priority Groups
Standard Source: HHSPandemicInfluenzaPlan
Objective: Treat outpatients not included in priority groups within 48 hours of illness onset.

Procedure:
1. Identify individuals who are not part of previously defined priority groups for antiviral treatment.
2. Administer antiviral...
antiviral treatment,outpatients,priority groups,treatment timing,equity

Vaccine Development (2)

Develop Inhaled Antibodies for Immunoprophylaxis Against Influenza
High Priority Source: HHSPandemicInfluenzaPlan
Objective: Develop inhaled antibodies for immunoprophylaxis against influenza.

Procedure:
1. Identify broadly neutralizing monoclonal antibodies with high affinity for multiple influenza strains.
2. Engineer these antibodies to be suitable...
inhaled antibodies, immunoprophylaxis, monoclonal antibodies
Develop Vaccines Against Pandemic Strains of Influenza
High Priority Source: HHSPandemicInfluenzaPlan
Objective: Ensure the development and availability of vaccines against pandemic strains of influenza.

Steps:
1. Collaborate with industry partners to enable emergency production of influenza vaccines at any time of year.
2. Facilitate the...
pandemic vaccine development, HHS, FDA licensure

Research (2)

Support Research Resources and Training for Influenza Studies
High Priority Source: HHSPandemicInfluenzaPlan
Procedure:

1. Ensure availability of research reagents such as antibodies, reference antigens, and viral isolates.
2. Expand access to genomic and immunologic databases for the global research community.
3. Develop and maintain animal models...
research,resources,training,virus,genomic
Update and Expand Influenza Virus Sequence Data for Global Access
High Priority Source: HHSPandemicInfluenzaPlan
Procedure:

1. Regularly update influenza virus sequence databases with new genetic information.
2. Collaborate with global research institutions to ensure data is accessible to the scientific community.
3. Use advanced sequencing technologies,...
sequence data,genomic,update,global access

Training (2)

Train Public Health Laboratories in Pandemic Virus Detection and Characterization
High Priority Source: HHSPandemicInfluenzaPlan
Procedure:

1. Develop training programs for public health laboratories on the detection and characterization of potential pandemic viruses.
2. Provide hands-on bench training to laboratory personnel, including techniques such as PCR,...
laboratory training,diagnosis,pandemic,virus
Conduct Animal Influenza Surveillance Training Courses in Asia
High Priority Source: HHSPandemicInfluenzaPlan
Procedure:

1. Identify key institutions and personnel in Asia who require training on animal influenza surveillance.
2. Develop a curriculum that includes techniques for sample collection, virus isolation, and molecular detection methods.
3....
animal surveillance,training,course,Asia

Public Health Policy (2)

Evaluate Effectiveness of Policies and Procedures Used During Pandemics
High Priority Source: HHSPandemicInfluenzaPlan
Procedure:

To evaluate the effectiveness of policies and procedures used during pandemics:

1. Review all implemented public health measures, including vaccination programs, antiviral distribution, and quarantine protocols.
2. Analyze outcomes...
pandemic policies, public health measures, effectiveness evaluation, preparedness planning
Public Acceptance of Quarantine During Pandemics
High Priority Source: HHSPandemicInfluenzaPlan
The public can accept quarantine when it is implemented with clear communication and appropriate justification.

### Factors Influencing Public Acceptance:
Negative connotations: Historically associated with misuse or abuse, but this does...
quarantine,policy,public compliance,SARS,communication,health education

Public Health Reporting (2)

Notify Local and State Health Departments for Suspected Novel Influenza Cases
Critical Source: HHSPandemicInfluenzaPlan
Steps to Notify Public Health Authorities:

1. Report each patient who meets the clinical and epidemiologic criteria for a suspected case of novel influenza to the local and state health departments as quickly as possible.
2. Designate...
health department notification, public health reporting, novel influenza case
Report Laboratory-Confirmed Influenza Cases to CDC
Standard Source: HHSPandemicInfluenzaPlan
Procedure:

1. Confirm influenza A or B cases using one of the following methods:
- Virus isolation followed by antigenic testing with IFA staining or HAI
- Molecular testing with RT-PCR
2. Submit weekly reports to the CDC...
CDC reporting, influenza surveillance, WHO collaborating laboratories, NREVSS, public health data

Diagnosis Influenza (2)

Collecting Paired Serum Samples for Influenza Diagnosis
Standard Source: HHSPandemicInfluenzaPlan
Procedure:

1. Collect acute-phase sera within one week of illness onset.
2. Collect convalescent sera 2–3 weeks after the initial sample.
3. Ensure both samples are from the same individual to compare antibody titers.
4. Use these paired...
serum collection, influenza diagnosis, paired samples, HAI test
Using Microneutralization Assay for Avian Influenza Diagnosis
Standard Source: HHSPandemicInfluenzaPlan
Procedure:

1. Use the microneutralization assay when HAI titers are very low or undetectable, which is common in avian influenza infections.
2. Prepare serum samples from patients suspected of being infected with avian influenza viruses.
3....
microneutralization assay, avian influenza, antibody detection

Vaccination Procedures (2)

Promote Influenza Vaccination Among Hospital Employees
High Priority Source: HHSPandemicInfluenzaPlan
Influenza vaccination and use of antiviral drugs

• Promote annual influenza vaccination among hospital employees. Increased vaccination coverage during the Interpandemic Period might help increase vaccine acceptance during a pandemic and will...
influenza vaccination, hospital employees, NHSN tracking
Second-Dose Pandemic Influenza Vaccination Strategy
High Priority Source: HHSPandemicInfluenzaPlan
Procedure:

1. Administer two doses of pandemic influenza vaccine at least one month apart to achieve immunity comparable to seasonal vaccines.
2. Issue recommendations on the number of required doses and timing for the second dose after...
second dose vaccine, two-dose regimen, immunogenicity trials

Influenza Pandemic (2)

Identify Common Complications of Pandemic Influenza
High Priority Source: HHSPandemicInfluenzaPlan
Objective: Recognize complications that may arise from pandemic influenza to guide appropriate treatment and management.

Common Complications:
1. Primary Viral Pneumonia:
- Severe respiratory symptoms including dyspnea, hypoxia, and...
pandemic influenza complications, secondary bacterial pneumonia, primary viral pneumonia, pulmonary edema, tracheobronchitis, neurological symptoms
Recognize and Monitor Symptoms of Severe Pandemic Influenza
High Priority Source: HHSPandemicInfluenzaPlan
Objective: Identify early signs and symptoms of severe pandemic influenza to facilitate timely medical intervention.

Symptoms to Monitor:
1. Fever – High-grade fever (≥ 38°C/100.4°F) that is persistent or worsening.
2. **Respiratory...
pandemic influenza, symptoms, severe illness, cyanosis, secondary bacterial pneumonia, monitoring, respiratory failure

Pneumonia Management (2)

Diagnosing and Managing Community-Acquired Pneumonia in Adults During an Influenza Pandemic
High Priority Source: HHSPandemicInfluenzaPlan
Procedure for Diagnosing and Managing Community-Acquired Pneumonia (CAP) in Adults During an Influenza Pandemic

### Screening Patients
• A history of preceding influenza-like illness, especially when pandemic influenza is circulating in the...
community-acquired pneumonia, antibiotic therapy, pandemic influenza, diagnostic testing, empiric treatment
Implement Guidelines for Management of Community-Acquired Pneumonia (CAP), Including Post-Influenza CAP
High Priority Source: HHSPandemicInfluenzaPlan
Objective: Provide a framework for the management of community-acquired pneumonia, including cases that develop after influenza infection.

Key Recommendations:
1. Diagnosis and Assessment:
- Use clinical evaluation, chest X-ray, and...
community-acquired pneumonia, post-influenza CAP, antibiotic therapy, management guidelines, hospitalization criteria

Isolation Procedures (2)

Criteria for Isolation Facilities During Pandemic Influenza
High Priority Source: HHSPandemicInfluenzaPlan
Procedure for Evaluating Isolation Facilities

1. Ensure that isolation facilities meet the same infrastructure and accommodation standards as home isolation environments.
2. Verify that the facility has:
- Functioning telephone, electricity,...
isolation facilities, pandemic influenza, infrastructure requirements
Evaluating Homes for Home Isolation of Pandemic Influenza Patients
High Priority Source: HHSPandemicInfluenzaPlan
Procedure for Evaluating a Home for Home Isolation

1. Evaluate the home environment by an appropriate authority (e.g., physician, health department official) to verify its suitability for isolation.
2. Ensure that the following minimum...
home isolation, pandemic influenza, evaluation criteria, infection control

Snakebite Treatment (2)

Administer Snakebite Remedies Based on Belief (Non-Effective for Poison)
High Priority Source: Where There is no Doctor a Village Health Care Handbook
Purpose: Administer traditional snakebite remedies to reduce fear and anxiety in victims, which may slow the spread of poison.

Procedure:
1. Identify a remedy based on belief: Choose a home remedy that the victim believes in (e.g.,...
snakebite remedies, belief-based treatment, guaco leaves, tobacco application, poison lizard skin
Treating a Poisonous Snakebite
High Priority Source: Medical Emergencies
Procedure:

1. Reassure the victim and keep them still to prevent panic and speed up toxin absorption.
2. Set up for shock by forcing fluids or administering intravenous (IV) treatment if available.
3. **Remove watches, rings,...
snakebite treatment, venom removal, constricting band, wound care, shock prevention

Threat Assessment (2)

Conduct Vulnerability Analysis for NBC Threats
High Priority Source: Medical NBC Battlebook
Procedure:

1. Vulnerability Assessment: The commander directs the S2/G2 section to conduct a vulnerability analysis of their position to determine its relative safety from NBC threats.

2. Information Gathering: This includes:
-...
NBC vulnerability analysis, threat assessment, troop briefing, S2/G2 coordination
Conduct NBC Threat Assessment for Deployment
High Priority Source: Medical NBC Battlebook
Objective: Assess NBC threats in the area of operations to inform medical and operational planning.

Steps:
1. Determine the overall situation, including the type of military operation (peacekeeping, conflict, or war).
2. Identify...
NBC threat assessment, climate impact on agents, heat stress, endemic diseases, military operation

Chemical Burns (2)

Decontaminate Skin Exposed to Blister Agents
High Priority Source: STP 21 1 Army Warrior Skills Level 1 Soldiers Manual of Common Tasks
WARNING: Blisters caused by a blister agent are actually burns. Do not try to decontaminate skin where blisters have already formed. If blisters have not formed, decontaminate the skin.

### Steps:
1. **Remove liquid chemicals from the burned...
blister agent, decontamination, chemical burn, white phosphorus
Decontamination and Treatment for Phosphorus Burns
High Priority Source: Medical NBC Battlebook
Procedure:

1. Immediate Removal of Contaminated Clothing: If burning phosphorus particles strike clothing, remove the contaminated clothing immediately to prevent the phosphorus from burning through to the skin.

2. **Smothering the...
phosphorus,burn,treatment,decontamination,fire,particles

Vision Assessment (2)

Administer Amsler Grid Test for Visual Field Assessment
Standard Source: Medical NBC Battlebook
Procedure for Administering the Amsler Grid Test:

1. Provide the Amsler Record Chart pad: This is used by the soldier to draw any irregularities they observe.
2. Test each eye separately in good light:
- Instruct the soldier to cover...
Amsler Grid, visual field test, eye assessment, macular degeneration
Administer Visual Acuity Test Using Aidman Vision Screener
Standard Source: Medical NBC Battlebook
Procedure for Administering a Visual Acuity Test Using the Aidman Vision Screener:

1. Prepare the Aidman Vision Screener card: Ensure it is in good light and held approximately 40 centimeters (about two card lengths) from the soldier's...
visual acuity, Aidman Vision Screener, eye test, vision assessment

Preventive Care (2)

Provide Preventive Medicine Services to Reduce Disease and Injury Incidence
Standard Source: TCCC 17 13 Army Tactical Combat Casualty Care
Objective: Reduce the incidence of disease and nonbattle injury through preventive medicine services.

Procedure:
1. Collect Medical Intelligence: Gather significant medical intelligence to support intelligence preparation of the...
preventive medicine,medical intelligence,disease prevention,sanitation protocols
Understand PVNTMED (Preventive Medicine)
Reference Source: Medical NBC Battlebook
PVNTMED stands for Preventive Medicine. It refers to measures taken to prevent disease and promote health, including immunizations, hygiene practices, and public health initiatives.
preventive medicine,pvntmed,health promotion,disease prevention

Wounding Mechanisms (2)

Assessing Wounding Potential Using Gelatin Tissue-Simulant Blocks
High Priority Source: NATO Emergency War Surgery
Procedure:

1. Prepare gelatin tissue-simulant blocks that mimic the properties of human soft tissue.
2. Fire missiles or projectiles through the gelatin blocks to capture their entire path.
3. Measure and record the dimensions of...
gelatin, wound profile, permanent cavity, temporary cavity, missile wounding potential
Understanding the Mechanism of Tissue Damage by Penetrating Missiles
High Priority Source: NATO Emergency War Surgery
Procedure:

1. Recognize that penetrating missiles cause tissue damage in two primary ways: *crushing* and *stretching.*
2. Identify the permanent cavity, which is the hole created as the missile passes through the tissue. This cavity's...
tissue damage, permanent cavity, temporary cavity, stretching, crushing

Chest Tube Insertion (2)

Chest Tube Insertion
Critical Source: NATO Emergency War Surgery
Procedure for Chest Tube Insertion

1. Fluid Resuscitation: Administer fluid resuscitation via a large-caliber IV while monitoring vital signs.

2. Determine Insertion Site: Choose the insertion site, typically at the nipple level (5th...
chest tube insertion, thoracostomy, pleural space, emergency surgery, trauma care
Insert a Chest Tube for Tension Pneumothorax
Critical Source: TCCC 17 13 Army Tactical Combat Casualty Care
Procedure:

1. Make a 2 to 3 cm transverse incision over the selected site and extend it down to the intercostal muscles.

NOTE: The skin incision should be 1 to 2 cm below the intercostal space through which the tube will be placed.

2....
chest tube insertion, tension pneumothorax, trauma care, battlefield medical procedures, pleural puncture, emergency chest decompression

Fluid Management (2)

Regulate Intravascular Volume via Endocrine Responses
High Priority Source: NATO Emergency War Surgery
Procedure:

1. Understand the endocrine response to acute blood loss:
- Vasopressin (ADH) is released from the posterior pituitary, increasing water reabsorption in renal collecting tubules.
- ADH release is influenced by volume...
vasopressin, ADH, aldosterone, renin-angiotensin system, fluid balance
Selecting and Using Fluid Measuring Devices for Urine Output and Intake Monitoring
Standard Source: Survival and Austere Medicine
Objective: Choose the appropriate fluid measuring device to monitor urine output and intake.

Tools to Consider:
Graduated containers: Used for accurate measurement of fluid volume. A see-through container with measurement markings is...
urine output measurement, fluid intake monitoring, graduated container, measuring device, hydration tracking

Gastrointestinal Hemorrhage (2)

Prevent and Manage Stress Ulcer Hemorrhage
High Priority Source: NATO Emergency War Surgery
Procedure for Preventing and Managing Stress Ulcer Hemorrhage

### Prevention:
• Administer H2 antagonists and antacids to postoperative casualties.
• Use antacids every 2 hours to titrate gastric pH to greater than 5.
• These...
stress ulcer hemorrhage, antacids, H2 antagonists, gastric pH, endoscopy, blood transfusion, vagotomy, pyloroplasty, sepsis
Manage Gastrointestinal Hemorrhage from Stress Ulceration in Trauma Patients
High Priority Source: NATO Emergency War Surgery
Procedure:

1. Identify risk factors: Monitor trauma patients for signs of splanchnic ischemia, especially those with sepsis or prolonged shock states.
2. Prophylactic therapy:
- Administer antacid buffering agents to neutralize...
gastrointestinal hemorrhage, stress ulceration, trauma patient, acalculous cholecystitis, nasogastric decompression, shock state

Wound Infection Prevention (2)

Prevent Wound Infection Through Early Surgical Intervention
Critical Source: NATO Emergency War Surgery
Objective: Prevent wound infections through early surgical treatment.

Procedure:
1. Assess the wound immediately after injury to determine severity and contamination level.
2. Perform debridement of all nonviable, devitalized tissue...
wound infection prevention, early surgery, debridement, hemostasis, drainage, vascular injury, wound closure
Administer Antibiotics for Open Combat Wounds
High Priority Source: TCCC 17 13 Tactical Combat Casualty Care
Procedure for Administering Antibiotics to Casualties with Open Combat Wounds:

1. If the casualty can swallow, administer 400 mg of moxifloxacin from the CWPP.
2. If the casualty cannot swallow (due to shock or unconsciousness), refer to a...
moxifloxacin,open wound infection,CWPP

Evacuation And Transport (2)

Evacuation and Medical Support in Vietnam Conflict
High Priority Source: NATO Emergency War Surgery
Procedure for Evacuation and Medical Support in Vietnam Conflict:

1. Use Air Ambulances for Casualty Retrieval:
- Deploy air ambulances to retrieve casualties from dispersed combat zones, as forward hospitals could not move forward.
2....
air ambulance,quonset hospital,must hospital,fuel supply,evacuation coordination
Understanding and Requesting Medical Evacuation (MEDEVAC)
Reference Source: FM 4 25 11 First Aid + STP 21 24 Warrior Leader Skills Level 2 3 4
Medical Evacuation (MEDEVAC)

_Medical evacuation_ is the timely and efficient movement of wounded, injured, or ill service members from the battlefield to medical treatment facilities (MTFs). During this process, en route medical care is...
MEDEVAC, medical evacuation, first aid, pickup site, request format, grid coordinates, en route care

Command Structure (2)

Commanding Officer's Role in Emergency War Surgery
Critical Source: NATO Emergency War Surgery
Objective: Ensure the medical treatment facility is prepared for and can respond to mass casualty events.

Procedure:
1. The medical treatment facility commanding officer must be kept informed of the tactical situation, likelihood of...
commanding officer, resource management, triage process, wounded prisoners, hospital security
Implement Medical Command, Control, and Intelligence Functions at All Levels of Command
Standard Source: TCCC 17 13 Army Tactical Combat Casualty Care
Objective: Ensure effective medical command, control, and intelligence functions across all levels of command.

Procedure:
1. Designate Command Surgeon: Assign a command surgeon as the AMEDD officer responsible for planning and executing...
medical command,command surgeon,AHS mission,mission command environment

Documentation (2)

Document Operative Findings and Injury Details
High Priority Source: NATO Emergency War Surgery
Documentation:
1. Document all operative findings in the medical record, including vascular, neural, tendon, or muscle damage, as well as skeletal injury.
2. This information is vital for subsequent care providers during patient evacuation.
3....
documentation,operative notes,injury recording
Document Care Using TCCC Casualty Card
Standard Source: TCCC 17 13 Army Tactical Combat Casualty Care
Procedure:

1. Communicate with the casualty and the next higher Role of care.
2. Use the TCCC Casualty Card to record care.
3. The card is formatted in the MIST Report, which includes:
- Mechanism of injury
- Injuries
-...
tccc card, documentation, mist report

Environmental Monitoring (2)

Interpret WBGTI Flag Colors and Temperatures
Reference Source: NAVMED P 5010 US Navy Manual of Preventive Medicine
Procedure for Interpreting WBGTI Flag Colors and Corresponding Temperatures

1. Identify the flag color based on the calculated WBGTI value.
2. Correspond the flag color to its temperature range:
- White Flag: <80°F
- **Green...
WBGTI flag colors, WBGTI temperature ranges, heat stress monitoring, environmental flags, military health
Maintain WBGTI Log Sheet
Reference Source: NAVMED P 5010 US Navy Manual of Preventive Medicine
Procedure for Maintaining the WBGTI Log Sheet

1. Locally reproduce or utilize a log book with the same information as provided in the WBGTI Log Sheet.
2. Record all readings from each instrument site on the log sheet or log book.
3....
WBGTI log sheet, WBGTI, Wet Bulb Globe Temperature Index, environmental monitoring, temperature logging, military health

Allergy Management (2)

Managing Allergic Reactions to Penicillin
Critical Source: Where There is no Doctor a Village Health Care Handbook
Procedure for Managing Allergic Reactions to Penicillin:

1. Recognize signs of an allergic reaction: Look for symptoms such as rash, itching, swelling, difficulty breathing, or sudden drop in blood pressure.
2. **Administer antihistamines...
penicillin allergy, anaphylaxis, epinephrine, antihistamine, allergic shock
Administer Diphenhydramine for Allergy Management
High Priority Source: survival personal wilderness medical kit
Procedure:

1. Assess the patient's condition and confirm that they are experiencing an allergic reaction.
2. Check the expiration date of the diphenhydramine vial (50 mg/1 mL) to ensure it is still valid.
3. Prepare the syringe: Use...
diphenhydramine,allergy treatment,IV administration,IM administration,dose

Tactical Combat Casualty Care (2)

Deploy and Operate Forward Resuscitative and Surgical Team (FRST)
Critical Source: TCCC 17 13 Army Tactical Combat Casualty Care
Procedure:

Step 1: Deploy FRST to Brigade Combat Team Area
• The Forward Resuscitative and Surgical Team (FRST) is assigned to the medical command or medical brigade.
• When not operationally employed forward with a medical company, the...
FRST deployment, damage control surgery, surgical team, brigade combat team area
Provide Role 2 Care for Combat Casualties
Critical Source: TCCC 17 13 Army Tactical Combat Casualty Care
Procedure:

Step 1: Continue Resuscitation from Role 1
• Ensure airway, breathing, and circulation (ABC) are maintained.
• Continue damage control resuscitation initiated at the Role 1 facility.

**Step 2: Provide Advanced Trauma...
Role 2 care, damage control surgery, DD Form 3019, ABCDE method, packed red blood cells

Cpr (2)

Bilateral NCD for Torso Trauma or Polytrauma
Critical Source: TCCC 17 13 Army Tactical Combat Casualty Care
Procedure:

1. For casualties with torso trauma or polytrauma and no pulse or respirations, perform bilateral needle chest decompression (NCD) to confirm or deny pneumothorax prior to discontinuing resuscitation.
ncd, chest decompression, torso trauma
Do Not Resuscitate Battlefield Blast or Penetrating Trauma Casualties
Critical Source: TCCC 17 13 Army Tactical Combat Casualty Care
Procedure:

1. Do not resuscitate battlefield blast or penetrating trauma casualties with no pulse, no respirations, and no other signs of life.
no resuscitation, battlefield trauma, cpr

Mass Casualty (2)

Identify Primary Cause of Death in Mass Casualty Situations
Critical Source: US Marine Corps Wilderness Medicine
Procedure:

1. Understand the primary cause of death:
- In mass casualty situations, the primary cause of death is often preventable trauma, such as uncontrolled hemorrhage, airway obstruction, or chest injuries.

2. **Assess for...
primary cause of death,mass casualty,wilderness medicine,preventable trauma,hemorrhage,airway obstruction,chest injury
Respond to a Mass Casualty Event (MASCAL)
Critical Source: TCCC 17 13 Army Tactical Combat Casualty Care
A mass casualty (MASCAL) event overwhelms any immediately available medical capabilities to include personnel, supplies, and/or equipment. Effective MASCAL response is founded on the principle of triage, the system of sorting and prioritizing...
mass casualty, MASCAL, triage, medical response

Antiemetics (2)

Administer Ondansetron for Anti-Emetic Use
Standard Source: TCCC 17 13 Tactical Combat Casualty Care
Indications: Anti-emetic (nausea and vomiting prevention) from opioid administration.

Dosage: 4 mg oral disintegrating tablets, rapid release.

Availability: Available in the Combat Medic MES.

Instructions: Administer as needed to...
ondansetron,Zofran,nausea prevention
Administer Ondansetron to Prevent Nausea and Vomiting from Opioid Administration
Standard Source: TCCC 17 13 Army Tactical Combat Casualty Care
Indication: Anti-emetic (nausea and vomiting prevention) from opioid administration.

Dosage: 4 mg rapid release oral disintegrating tablets.

Availability: Combat Medic MES.
ondansetron, zofran, antiemetic administration

Hypothermia Prevention And Treatment (2)

Signs and Symptoms of Hypothermia
Critical Source: US Marine Corps Wilderness Medicine
Recognizing the signs and symptoms of hypothermia is essential for timely intervention.

### Clinical Manifestations by Core Temperature Range
98°F–95°F (37°C–35.6°C): Mild shivering, cold sensation, and impaired fine motor coordination.
-...
hypothermia, signs and symptoms, paradoxical undressing, core temperature, diagnosis
Heat Conservation and Loss Mechanisms in Hypothermia
High Priority Source: US Marine Corps Wilderness Medicine
Understanding heat conservation and loss mechanisms is critical for preventing and managing hypothermia.

### Heat Production and Thermogenesis
• The body generates approximately 75% of its energy consumption as heat, with the remaining 25%...
heat conservation, thermogenesis, hypothermia, core temperature, radiation, convection, conduction, evaporation, respiratory loss

Pediatric Dental Care (2)

Examine a Child's Teeth for Cavities During Routine Checkups
Standard Source: Where There is No Dentist
Procedure:

1. When examining a child at the health clinic, lift his lip and look at his teeth as part of your routine examination.
2. Look for signs of cavities or gum bubbles (sore on the gums), which may indicate an abscess.
3. If a...
child teeth examination, cavities, gum bubble, abscess, dental care, routine checkup
Maintain Baby Teeth for Proper Permanent Tooth Alignment
Reference Source: Where There is No Dentist
Why Baby Teeth Are Important

Baby teeth are just as important to children as permanent teeth are to adults. They help a child to eat, talk, and look good.

However, many people feel that it is not worth the effort to look after baby teeth. Nor...
baby teeth, permanent teeth alignment, dental care for children, cavities in baby teeth, importance of baby teeth

Dental Tools (2)

Create a Filling Tool from Screws and a Stick Handle
Reference Source: Where There is No Dentist
Materials needed: Two long screws, file, hammer, small stick handle

Steps:
1. Remove the heads from both screws to create usable ends.
2. Use a file and hammer to shape one screw’s end into a flat surface and the other into a...
filling tool, screw, dental instrument, makeshift tool
Create a Spoon from Available Materials
Reference Source: Where There is No Dentist
Materials needed: Paper clip, needle, small stone, stick handle

Steps:
1. Bend the paper clip or needle into a suitable shape.
2. Flatten the end of the bent wire to create a flat surface.
3. **Pound a small stone against the...
spoon, paper clip, needle, dental tool, makeshift instrument

General Guidance (2)

Avoid Self-Medication Without Professional Guidance
Critical Source: Life After Doomsday
Warning: Self-medication under circumstances where a physician's care is available is not only illegal, it is extremely dangerous. The author and the publishers of this book do not recommend or endorse self-medication or the practice of medicine...
self-medication, professional guidance, medical help, illegal, dangerous
Understand the Purpose of This Book
Reference Source: Where There is no Doctor a Village Health Care Handbook
Purpose of Where There Is No Doctor:

• To provide basic health care guidance for people in areas where professional medical help is not always available.
• To encourage self-care and informed decision-making about one’s own and others’...
book purpose, self-care education, health worker training, traditional and modern medicine

Traditional Medicine (2)

Incorporate Local Home Remedies and Traditional Healing Practices
Standard Source: Where There is no Doctor a Village Health Care Handbook
To improve the relevance of health care advice in your community:

1. Identify commonly used local plants and traditional remedies that are accessible to most people.
2. Include only a few home remedies that use widely available items, such...
home remedies,traditional healing,local plants,garlic,community knowledge
Assess Local Healing Practices and Traditional Medicine
Standard Source: Where There is no Doctor a Village Health Care Handbook
Procedure:

1. Identify Healers: Determine the role of local midwives and healers in healthcare.
2. Document Traditional Methods: Record traditional healing practices and medicines used by the community.
3. **Evaluate Effectiveness and...
traditional medicine, local healers, safety assessment

Poisonous Bites Treatment (2)

Obtain Antivenom Before a Poisonous Bite Occurs
Critical Source: Where There is no Doctor a Village Health Care Handbook
Purpose: Ensure access to antivenom or serum for snakebite and other poisonous animal bites before an emergency occurs.

Procedure:
1. Research local antivenoms: Identify the types of venomous snakes in your area and obtain the...
antivenom, snakebite treatment, serum, venomous bites, emergency preparedness
Recognize the Limitations of Home Remedies for Poisonous Bites
Critical Source: Where There is no Doctor a Village Health Care Handbook
Purpose: Understand that home remedies have no direct effect on venom and should not be relied upon as sole treatment.

Procedure:
1. Educate others about limitations: Inform patients, families, and communities that traditional remedies...
home remedy limitations, snakebite treatment, antivenom necessity, venomous bites

Respiratory Assessment (2)

Assessing Breathing Rate and Quality for Respiratory Distress
High Priority Source: Survival and Austere Medicine
Purpose:
Monitor breathing rate and effort to detect respiratory distress or improvement in treatment.

Procedure:
1. Record Baseline Breathing Rate:
- Document the patient's normal resting breathing rate (14–20 breaths per minute for...
breathing rate monitoring, respiratory distress, treatment effectiveness, baseline respiration
Assessing Breathing Patterns and Respiratory Health
Standard Source: Where There is no Doctor a Village Health Care Handbook
Steps to assess breathing patterns:

1. Observe the depth of breathing (deep or shallow).
2. Count the rate of breaths per minute:
- For adults and older children: 12–20 breaths per minute is normal.
- For younger children: up to...
breathing assessment, respiratory rate, labored breathing, asthma detection, pulse monitoring

Physical Examination (2)

How to Check the Eyes for Medical Signs
High Priority Source: Where There is no Doctor a Village Health Care Handbook
Procedure:

1. Examine the white part of the eyes for color changes:
- Normal: No redness or yellowing.
- Red: May indicate infection (see p. 219).
- Yellow: Could be a sign of jaundice or liver issues.
2. Note any **changes in...
eye examination, pupil check, brain damage, medical emergency, vision changes
How to Check the Ears, Throat, and Nose for Medical Signs
High Priority Source: Where There is no Doctor a Village Health Care Handbook
Procedure:

Ears:
1. Check for signs of pain or infection, especially in children with fever or colds.
2. If a baby cries a lot or pulls at his ear, it may indicate an ear infection (see p. 309).
3. Gently pull the ear to see if this...
ear infection, throat examination, nose check, medical signs, physical exam

Symptom Assessment (2)

Check for Muscle Stiffness and Suspect Serious Conditions
Critical Source: Where There is no Doctor a Village Health Care Handbook
Procedure:

1. Examine the jaw: If it is stiff or will not open, suspect:
- Tetanus (p. 182)
- Severe infection of the throat (p. 309)
- Severe infection of a tooth (p. 231)
- If the problem began after yawning or being hit in...
muscle stiffness, tetanus, meningitis, spasticity, seizures, jaw stiffness, neck stiffness
Check for Loss of Feeling in the Body and Suspect Serious Conditions
High Priority Source: Where There is no Doctor a Village Health Care Handbook
Procedure:

1. Have the person cover his eyes.
2. Lightly touch or prick the skin in different places on the body and ask him to say 'yes' when he feels it.

Interpretation of findings:
• **Loss of feeling in or near spots or...
loss of feeling, leprosy, diabetes, back problem, nerve damage

Nutrition And Hydration (2)

Administer Liquids to a Very Sick Person
Standard Source: Where There is no Doctor a Village Health Care Handbook
Procedure:

It is extremely important that a very sick person drink enough liquid.

• If he only can drink a little at a time, give him small amounts often.
• If he can barely swallow, give him sips every 5 or 10 minutes.

**Monitoring...
liquid intake for sick person, dehydration signs, rehydration drink, intravenous solution, salt in liquids
Provide Nutritious Liquids to a Person Too Sick to Eat Solid Foods
Standard Source: Where There is no Doctor a Village Health Care Handbook
Procedure:

If the person is too sick to eat solid foods, give her soups, milk, juices, broths, and other nutritious liquids (see Chapter 11).

• A porridge of cornmeal, oatmeal, or rice is also good, but should be given together with...
nutritious liquids for sick person, body-building foods, small meals, porridge with protein

Dangerous Illness Signs (2)

Recognize Signs of Dangerous Illness Requiring Immediate Medical Help
Critical Source: Where There is no Doctor a Village Health Care Handbook
When to seek immediate medical help:

A person who has one or more of the following signs is probably too sick to be treated at home without skilled medical help. His life may be in danger. Seek medical help as soon as possible.

### Signs...
dangerous illness, medical help, signs of emergency, life-threatening symptoms, urgent care
Recognize and Respond to Signs of Dangerous Illness
Critical Source: Where There is no Doctor a Village Health Care Handbook
It is crucial to watch for signs that indicate a person's illness may be serious or dangerous. If any of the following Signs of Dangerous Illness are observed, seek medical help immediately:

• High fever (e.g., above 104°F/40°C)
-...
signs of dangerous illness, high fever, difficulty breathing, convulsions, loss of consciousness, severe pain, dehydration, blood in urine, swelling, weakness, vomiting, diarrhea

Medication Safety (2)

Avoid Excessive Lidocaine Dosage (Fictional Scenario)
Critical Source: Survival and Austere Medicine
Procedure:

1. In a fictional scenario involving the use of lidocaine for pain relief or local anesthesia:
2. Do not administer more than 3-4mg/kg without adrenaline or 5-6mg/kg with adrenaline.
3. Monitor the patient closely for signs...
lidocaine overdose, medication safety
When to Avoid Taking Medicines
High Priority Source: Where There is no Doctor a Village Health Care Handbook
Overview:

There are specific situations when it is best not to take certain medicines. These include:

1. Pregnant women and breastfeeding mothers should avoid all medicines that are not absolutely necessary. However, they can safely take...
medicine safety, pregnant women, breastfeeding mothers, newborns, allergies, ulcers, hepatitis, dehydration, kidney disease, sulfa drugs

Rickets (2)

Prevent and Treat Rickets with Sunlight and Vitamin D
Standard Source: Where There is no Doctor a Village Health Care Handbook
To prevent or treat rickets:

Expose the child’s skin to direct sunlight for at least 10 minutes a day (or longer periods more often), but avoid sunburn.
Give fortified milk and vitamin D, found in fish liver oil.
• **Never give...
prevent rickets with sunlight, vitamin D for children, treat rickets
Identify Signs of Rickets in Children
Standard Source: Where There is no Doctor a Village Health Care Handbook
Signs of rickets include:

Bowlegs (knees bend outward)
Bony necklace (swelling around the neck)
Curved bones
Big joints
Bone deformities
signs of rickets, bone deformities in children, bowlegs

Parasitic Illnesses (2)

Test and Treat Blood Fluke Infection
High Priority Source: Where There is no Doctor a Village Health Care Handbook
Testing and treatment for blood fluke infection include:

In areas where these diseases are known to occur, any person who has blood in his urine or stools should have a sample of it tested for fluke eggs.
• See a health worker.
-...
blood fluke treatment, praziquantel, metrifonate, oxamniquine, stool test for flukes
Identify Blood Fluke (Schistosomiasis) Infection Symptoms
High Priority Source: Where There is no Doctor a Village Health Care Handbook
Symptoms of blood fluke infection include:

The most common sign is blood in the urine (especially when passing the last drops)—or, for other kinds of flukes, bloody diarrhea.
• Pain may occur in the lower belly and between the legs;...
blood fluke, schistosomiasis, blood in urine, bloody diarrhea, liver damage, kidney damage

Chronic Conditions (2)

Care for a Child with Cerebral Palsy (Spasticity)
Standard Source: Where There is no Doctor a Village Health Care Handbook
Procedure:

1. Recognize the signs of cerebral palsy, such as stiff or tight muscles, jerky movements, and crossed legs resembling scissors.
2. Provide daily muscle-stretching exercises by slowly straightening and bending the child’s...
cerebral palsy, spastic child, muscle stretching, physical development, brain damage
Manage Varicose Veins Through Lifestyle Adjustments
Reference Source: Where There is no Doctor a Village Health Care Handbook
Procedure:

1. Avoid prolonged standing or sitting with feet down. If unavoidable:
- Lie down with your feet elevated above the level of your heart for a few minutes every half hour.
- When standing, walk in place or repeatedly lift your...
varicose veins, leg swelling, elastic stockings, prevention, chronic sores

Leprosy (2)

Treatment of Leprosy
High Priority Source: Where There is no Doctor a Village Health Care Handbook
Treatment of leprosy:

• Leprosy is usually curable but requires long-term treatment (usually years)
• The best medicine is dapsone, combined with 1 or 2 other medicines (see pages 362 to 363 for details)
• If a ‘lepra reaction’...
leprosy treatment, dapsone, lepra reaction, medical emergency
Recognize Advanced Signs of Leprosy
Standard Source: Where There is no Doctor a Village Health Care Handbook
Advanced signs of leprosy include:

• Loss of feeling in parts of the body
• Burns and scars where feeling has been lost
• Deformity of the hands, feet, nose, or ear lobe
• Blindness of the hands and feet
• Painless sores on the hands or feet...
leprosy, signs, symptoms, advanced signs, medical emergency

Eye Infections (2)

Identify Signs of Trachoma in the Eye
Standard Source: Where There is no Doctor a Village Health Care Handbook
Signs of trachoma include:

1. Red, watery eyes similar to conjunctivitis.
2. Formation of small, pinkish-gray lumps called follicles inside the upper eyelids (check by turning back the lid as shown on p. 218).
3. Slight redness in the white...
trachoma, eye infection, follicles, pannus, signs of trachoma
Treating Pink Eye (Conjunctivitis)
Standard Source: Where There is no Doctor a Village Health Care Handbook
Procedure:

1. Clean the eyelids with a clean, wet cloth several times a day.
2. Apply an antibiotic eye ointment inside the eyelids 3 or 4 times daily.
3. Isolate the child to prevent spreading the infection—do not let them play or...
pink eye, conjunctivitis, antibiotic ointment, isolation, eye infection treatment

Urinary System (2)

Recognize and Respond to Urinary Tract Problems
High Priority Source: Where There is no Doctor a Village Health Care Handbook
Procedure:

1. Be aware of symptoms that may indicate a urinary tract problem, such as:
- Pain or burning during urination.
- Frequent or urgent need to urinate.
- Blood in the urine.
- Lower abdominal pain or discomfort.
2....
urinary tract infection, UTI symptoms, kidney issues, bladder problems
Understand the Urinary System and Its Components
Reference Source: Where There is no Doctor a Village Health Care Handbook
Procedure:

1. Learn about the urinary system, which includes:
- Kidneys: Filter blood to form urine.
- Ureters: Tubes that carry urine from the kidneys to the bladder.
- Bladder: Stores urine until it is ready to be...
urinary system anatomy, bladder function, kidneys, urethra, genitals

Pregnancy Delivery (2)

Prepare Essential Supplies for Midwife or Birth Attendant
High Priority Source: Where There is no Doctor a Village Health Care Handbook
Purpose: Ensure a midwife or birth attendant has necessary tools for safe delivery.

Supplies Required:
1. Flashlight (torch): For lighting during the birthing process.
2. Fetoscope (fetal stethoscope): To listen to the baby’s...
midwife supplies, birth attendant equipment, delivery tools, emergency childbirth, medical kit for pregnancy
Prepare for Birth - General Guidelines
High Priority Source: Where There is no Doctor a Village Health Care Handbook
Purpose: Provide guidance on how to prepare for a safe and natural birth.

Key Principles:
Birth is a natural event. When the mother is healthy, the baby can be born without assistance from anyone.
• **The less intervention by the...
birth preparation, natural childbirth, midwife guidelines, safe delivery, pregnancy care

Lactation And Breast Health (2)

Manually Milk the Breasts
Standard Source: Where There is no Doctor a Village Health Care Handbook
Purpose: To express milk when the baby cannot suck or to relieve fullness.

Procedure:
1. Take hold of the breasts way back, near the base.
2. Move your hands forward and squeeze gently to press behind the nipple.
3. Continue squeezing until...
milk, breast, express, lactation, baby, breastfeeding, abscess
Prevent and Treat Sore or Cracked Nipples
Standard Source: Where There is no Doctor a Village Health Care Handbook
Purpose: To prevent and treat sore or cracked nipples during breastfeeding.

Procedure:
1. Prevention:
- Breastfeed frequently, for as long as the baby wants to suck.
- Ensure the baby takes a large portion of the breast into her...
sore nipples, cracked nipples, breastfeeding, lactation, healing, infection

Infections And Abscesses (2)

Recognize and Prevent Breast Infection (Mastitis) and Abscess
High Priority Source: Where There is no Doctor a Village Health Care Handbook
Purpose: To recognize the signs of breast infection or abscess and prevent them.

Signs of Infection or Abscess:
• Part of the breast becomes hot, red, swollen, and very painful.
• Fever or chills may occur.
• Lymph nodes in the armpit are...
mastitis, abscess, infection, breast lump, prevention, drainage
Treat Painful Breasts and Mastitis
High Priority Source: Where There is no Doctor a Village Health Care Handbook
Purpose: To relieve pain from painful breasts or mastitis (breast infection).

Procedure:
1. General Care:
- Breastfeed frequently, giving the infected breast first if possible.
- Rest in bed and drink plenty of liquids.
2. **Pain...
mastitis, breast infection, abscess, pain relief, antibiotics, breastfeeding

Healthcare Tools (2)

Marking the Child's Weight on a Growth Chart
Reference Source: Where There is no Doctor a Village Health Care Handbook
Materials Needed:
• Child growth chart
• Pencil or pen

Steps to Mark the Child’s Weight on the Chart:
1. Prepare the Chart: Write the months of the year in the little squares at the bottom of the chart.
- For example, if a baby was...
growth chart, child weight tracking, health care tools, medical equipment, WHO standards
Using the Direct Recording Scale with Growth Chart
Reference Source: Where There is no Doctor a Village Health Care Handbook
Materials Needed:
• Direct recording scale
• Child growth chart (available from TALC)

Steps to Use the Direct Recording Scale and Growth Chart:
1. Prepare the Chart: Write the months of the year in the little squares at the bottom of...
direct recording scale, growth chart, child weight tracking, health care tools, medical equipment

Ear Infections (2)

Treating Ear Infections in Children
High Priority Source: Where There is no Doctor a Village Health Care Handbook
Procedure:

1. Administer an antibiotic such as penicillin (p. 350), cotrimoxazole (p. 357), or ampicillin (p. 352) for children under 3 years old.
2. Give acetaminophen (p. 379) to relieve pain.
3. Clean pus from the ear using...
ear infection treatment, antibiotic for ear infection, pus removal, ampicillin, penicillin
Treating Infection in the Ear Canal
High Priority Source: Where There is no Doctor a Village Health Care Handbook
Procedure:

1. Gently pull the ear to check for pain—this may indicate an infection in the canal.
2. Apply vinegar and boiled water drops (mix 1 spoon of vinegar with 1 spoon of boiled water) into the affected ear 3–4 times daily.
3. If...
ear canal infection, vinegar drops, antibiotic for ear canal

Sickle Cell Disease (2)

Prevent and Treat Sickle Cell Disease in Children
High Priority Source: Where There is no Doctor a Village Health Care Handbook
Treatment and prevention steps for sickle cell disease in children:

Protect the child from malaria and other infections that can trigger a 'sickle cell crisis'.
Take the child for regular monthly visits to a health worker for an...
treatment sickle cell disease, malaria prevention, folic acid, infection treatment, antibiotics, cold avoidance
Recognize Signs of Sickle Cell Disease in Children
High Priority Source: Where There is no Doctor a Village Health Care Handbook
Signs to look for in children with sickle cell disease:

Fever and crying
Occasional swelling of the feet and fingers, which lasts for 1 or 2 weeks
Big belly that feels hard at the top
Anemia, and sometimes **yellow color...
sickle cell disease, signs in children, fever, swelling, jaundice, anemia, pain crisis

Stroke Cva (2)

Immediate Care for Stroke (Cerebro-Vascular Accident, CVA)
Critical Source: Where There is no Doctor a Village Health Care Handbook
Procedure:

1. Place the person in bed with her head slightly elevated above her feet.
2. If unconscious, roll her head back and to one side so that saliva or vomit drains out of her mouth rather than into her lungs.
3. **Do not give any...
stroke,CVA,cerebrovascular accident,unconscious,bed position,medical help,paralysis,recovery
Identify and Differentiate Bell’s Palsy from Stroke
High Priority Source: Where There is no Doctor a Village Health Care Handbook
Procedure:

1. Observe the symptoms in a younger or middle-aged person who suddenly develops paralysis on one side of the face.
2. Check for other signs of stroke, such as loss of consciousness, speech difficulties, or body paralysis.
3....
Bell's Palsy,differential diagnosis,stroke,face paralysis,self-resolving condition,eye bandage

End Of Life Care (2)

Providing Emotional Support to a Dying Person
High Priority Source: Where There is no Doctor a Village Health Care Handbook
Procedure:

1. Be present with the person who is dying. Sit with them, hold their hand if they allow it, and listen without judgment.
2. Acknowledge their feelings—whether they are afraid, angry, or ready to accept death. Let them know...
emotional support,dying person,end of life care,comfort,accepting death
Consider Euthanasia in Protracted Survival Situations
High Priority Source: Survival and Austere Medicine
Euthanasia is an extremely sensitive and controversial topic that must be considered in protracted survival situations.

Scenarios where euthanasia may be considered:
• When a person is suffering from a slow, painful death (e.g., cancer)...
euthanasia, end of life care, pain management, survival ethics

Neurological Illnesses (2)

Recognize and Manage Convulsions
Critical Source: Where There is no Doctor a Village Health Care Handbook
Convulsions are uncontrolled seizures or fits, often seen in conditions like meningitis or epilepsy. To manage convulsions:

1. Ensure the person is in a safe place to prevent injury during the seizure.
2. Do not restrain the person; allow them...
convulsions, seizures, first aid
Managing Seizures (Fits) with Medicines
High Priority Source: Where There is no Doctor a Village Health Care Handbook
Procedure:

1. Identify the need: Use anticonvulsant medications for managing seizures, especially in cases of epilepsy or other seizure disorders.
2. Select medication: Common options include phenobarbital, valproic acid, and...
seizure management, anticonvulsants, epilepsy treatment

Poisoning And Toxins (2)

Treating Scorpion Stings with Antivenoms
Critical Source: Where There is no Doctor a Village Health Care Handbook
Procedure:

1. Identify the sting: Determine if the patient has been stung by a scorpion, which can cause severe pain, swelling, and in some cases, systemic toxicity.
2. Immediate care:
- Keep the affected area still and below heart...
scorpion sting treatment, antivenom administration
Treating Snakebite with Antivenoms
Critical Source: Where There is no Doctor a Village Health Care Handbook
Procedure:

1. Identify the bite: Determine if the patient has been bitten by a venomous snake, which can cause severe pain, swelling, and systemic toxicity.
2. Immediate care:
- Keep the affected area still and below heart level to...
snakebite treatment, antivenom administration

Alternative Treatment (2)

Using Erythromycin for TB Treatment
High Priority Source: Where There is no Doctor a Village Health Care Handbook
Overview: Erythromycin is an alternative antibiotic that can be used in the treatment of TB under specific conditions.

Procedure:
1. Administer erythromycin as follows:
- Take 500 mg by mouth, 4 times a day for 7 days.
2. **Take with...
erythromycin, TB treatment, antibiotic alternative
Using Tetracycline for TB Treatment
High Priority Source: Where There is no Doctor a Village Health Care Handbook
Overview: Tetracycline is another antibiotic that may be used in the treatment of TB under specific conditions.

Procedure:
1. Administer tetracycline as follows:
- Take 500 mg by mouth, 4 times a day for 7 days.
2. **Avoid use during...
tetracycline, TB treatment, antibiotic alternative

Antivenom Administration (2)

Administer Scorpion Antitoxin or Antivenom
High Priority Source: Where There is no Doctor a Village Health Care Handbook
When to Use:
• Only in areas with dangerous or deadly scorpions.
• Primarily for small children stung on the upper body or head.

Preparation:
1. Ensure you have the correct antivenom (e.g., Alacramyn in Mexico) based on local scorpion...
scorpion sting, antitoxin, antivenom, administration, children, emergency care
Obtain and Store Snakebite Antivenom or Antitoxin
High Priority Source: Where There is no Doctor a Village Health Care Handbook
When to Use:
• In areas where poisonous snakebites are common.

Preparation:
1. Identify the type of antivenom available in your region (e.g., Crofab[TM] for North America, Antivipmyn[®] for Latin America).
2. Purchase and store antivenoms...
snakebite, antivenom, storage, administration, emergency care

Vitamin Deficiency (2)

Administering Vitamin A for Night Blindness and Xerophthalmia Prevention in Children
Standard Source: Where There is no Doctor a Village Health Care Handbook
Procedure:

• Identify children at risk of night blindness or xerophthalmia, especially those living in areas where these conditions are common.
• Ensure the child consumes a diet rich in yellow fruits, dark green leafy vegetables, and...
vitamin A,xerophthalmia,night blindness,children,measles,deficiency,treatment
Administering Mixed Vitamins for General Nutrition
Standard Source: Where There is no Doctor a Village Health Care Handbook
Procedure:

• Identify individuals who may benefit from mixed (multi) vitamins, especially those with poor nutrition or HIV.
• Select tablet form of mixed vitamins as it is the most cost-effective and efficient method.

**Usage...
mixed vitamins,nutrition,HIV,tablet form,daily dosage,vitamin A,B-complex,C,D,E,minerals

Hiv Aids Care (2)

Caring for Someone with HIV or AIDS Safely
Standard Source: Where There is no Doctor a Village Health Care Handbook
Overview: This procedure outlines safe practices when caring for someone with HIV or AIDS.

Safe Practices:
Avoid contact with blood and bodily fluids. If you must handle them, use gloves or other protective barriers.
• **Wash hands...
HIV care, AIDS care, safe handling, personal hygiene, biohazard waste
Provide Care for Someone with HIV or AIDS
Standard Source: Where There is no Doctor a Village Health Care Handbook
Steps to Provide Care:

1. Offer Emotional Support:
- Be kind and show compassion.
- Help the person feel comfortable and supported emotionally.

2. Assist with Nutrition and Medication:
- Ensure they have enough food and take...
HIV,AIDS,care,emotional support,nutrition,medicine,symptom management,prevention,spread,blood,sores,laundry

Digestive System (2)

Understand the Function of the Intestines
Reference Source: Where There is no Doctor a Village Health Care Handbook
Intestines are the tube-like part of the food canal that carries food and waste from the stomach to the anus.

They play a crucial role in digestion and nutrient absorption.

Common problems include:
• Diarrhea.
• Constipation.
-...
intestines, digestion, function
Understand the Function of the Stomach in Digestion
Reference Source: Where There is no Doctor a Village Health Care Handbook
Stomach is a sac-like organ where food is digested. It produces acids and enzymes to break down food into nutrients.

What to do:
1. Encourage proper digestion by ensuring adequate hydration and balanced meals.
2. Avoid overeating or...
stomach, digestion, enzymes, acids

Symptoms Management (2)

Manage Fever in Children and Newborns
High Priority Source: Where There is no Doctor a Village Health Care Handbook
Manage Fever in Children and Newborns

Fever is a common symptom of infection or illness, especially in children and newborns. It is important to manage it carefully to prevent complications.

### Steps to Manage Fever:
1. **Monitor the...
fever management, children, newborns, medical emergency, first aid
Recognize and Manage Fainting
Standard Source: Where There is no Doctor a Village Health Care Handbook
Recognize and Manage Fainting

Fainting is a sudden loss of consciousness due to reduced blood flow to the brain. It can be caused by various factors, including dehydration, low blood sugar, or emotional stress.

### Steps to Manage Fainting:
1....
fainting, unconsciousness, medical emergency, first aid, CPR

Blood Pressure Measurement (2)

Accurate Blood Pressure Measurement Techniques
High Priority Source: Survival and Austere Medicine
Purpose:
Ensure accurate blood pressure readings to detect hypertension or hypotension.

Procedure:
1. Select the Correct Cuff Size:
- Use a standard cuff for adolescents and adults with an upper arm circumference of approximately...
blood pressure cuff size, accurate measurement, hypertension detection, hypotension
Measure Blood Pressure (for Health Workers with Equipment)
Standard Source: Where There is no Doctor a Village Health Care Handbook
How to Measure Blood Pressure:

1. Prepare the equipment: Ensure the sphygmomanometer and stethoscope are clean and in working condition.
2. Position the person: Have them sit comfortably with their arm at heart level.
3. **Place the...
blood pressure measurement, normal blood pressure ranges, systolic and diastolic readings, high blood pressure detection

Herbal Medicines (2)

Prepare Willow Bark Tea for Aspirin Alternative
Standard Source: Survival and Austere Medicine
Warning: If you are allergic to aspirin, do not use willow in any form as it contains salicin which is converted to salicylic acid.

1. Harvest willow bark and twigs during the fall season.
2. Take 1 teaspoon of dried willow bark.
3. Add the...
willow bark, salicin, aspirin alternative, herbal medicine, pain relief
Use of Herbal Medicines in Survival Situations
Standard Source: USMC Winter Survival Course Handbook
Consider using herbal medicines only after proper training and when you lack or have limited medical supplies.

WARNING: Some herbal medicines are dangerous and may cause further damage or even death.
herbal,medicine,survival,training,limited supplies

Wildlife Diseases (2)

Prevention and Handling of Hantavirus Pulmonary Syndrome (HPS)
High Priority Source: USMC Winter Survival Course Handbook
Hantavirus Pulmonary Syndrome (HPS) is a serious respiratory illness caused by the hantavirus, which is carried by deer mice.

### Method of Transmission:
• The virus is shed in the droppings, urine, and saliva of the deer mouse. It becomes...
hantavirus,pulmonary syndrome,deer mouse,transmission,symptoms,treatment,prevention
Prevention and Handling of Plague (Yersinia pestis)
High Priority Source: USMC Winter Survival Course Handbook
Plague, caused by *Yersinia pestis*, is transmitted through flea bites, direct contact with infected rodents, or affected non-rodent hosts such as rabbits, hares, cats, and other animals.

### Signs & Symptoms:
• Severe disease in humans with a...
plague,Yersinia pestis,fleas,rodents,treatment,prevention

Triage And Resource Allocation (2)

Prioritizing Cytokine Administration for H-ARS Patients
Critical Source: Planning Guidance for Response to Nuclear Detonation May 2022 FEMA
Objective: Implement a fair and effective system to prioritize cytokine administration during shortages following a nuclear detonation.

Procedure:
1. Assess Patient Needs: Evaluate the radiation dose received by each patient, with...
cytokine prioritization,H-ARS,RITN,SNS,UMI
Triage and Resource Allocation for Burn Injuries in a Nuclear Detonation Scenario
Critical Source: Planning Guidance Nuclear Detonation FEMA
Objective: Prioritize burn casualties based on medical needs and available resources during a nuclear detonation.

Procedure:
1. Implement triage protocols:
- Casualties with burns >40% TBSA may require intense treatment, but medical...
nuclear detonation triage, burn casualty prioritization, resource allocation in emergencies

Vaccination Programs (2)

Developing Vaccination Strategies for Avian Flu Prevention
Critical Source: Bird Flu Summit Brochure
Procedure:

1. Create a vaccination strategy that outlines the distribution and administration of vaccines during an avian flu outbreak.
2. Ensure that vaccines are available in sufficient quantities and accessible to high-risk populations,...
vaccination strategy, avian flu prevention, vaccine distribution
Conducting Mass Vaccination Efforts
High Priority Source: Bird Flu Summit Brochure
Procedure:

1. Identify high-priority groups for mass vaccination (e.g., healthcare workers, first responders, and vulnerable populations).
2. Set up temporary vaccination sites in accessible locations such as community centers or schools.
3....
mass vaccination,vaccine administration,temporary sites,PPE,public communication

Antiviral Treatment (2)

Optimize Antiviral Treatment Approaches for Avian Influenza
Critical Source: Bird Flu Summit Brochure
Objective: Improve the effectiveness of antiviral therapies in treating avian influenza cases.

Steps:
1. Review current treatment guidelines and identify gaps or areas for improvement.
2. Conduct clinical trials to assess the efficacy of...
avian flu antivirals,treatment protocols,drug efficacy
Support Development of Antiviral Agents Against Influenza
High Priority Source: HHSPandemicInfluenzaPlan
Procedure:

1. Identify new antiviral drug targets through in vivo and in vitro screening programs.
2. Support the development of new antiviral agents by private sector companies and academic laboratories.
3. Conduct clinical trials to test the...
antiviral drugs,target identification,drug development,clinical trials,virus resistance

Poisoning Treatment (2)

Respond to Emetic Russula Poisoning
Critical Source: Boy Scout Handbook 1911
Procedure:

1. Immediate action if poisoning is suspected:
- Administer an emetic (induce vomiting) immediately.

2. Seek professional medical help:
- Send for a physician with instructions to bring a hypodermic syringe and...
emetic russula poisoning, atropine sulphate, medical response, vomiting, convulsions
Administer Activated Charcoal for Swallowed Poisons (After Effects Begin)
High Priority Source: Where There is no Doctor a Village Health Care Handbook
Indication: Use after the effects of a swallowed poison have begun and it is not strong acid, lye, gasoline, or kerosene.

Procedure:
1. Mix the indicated dosage of activated charcoal powder with 1 glass of water or juice.
2. Drink the...
activated charcoal, poison treatment, swallowed poisons, emergency antidote

Ear Health (2)

Prevent and Manage Ear Infections from Nasal Issues
High Priority Source: Boy Scout Handbook 1911
Procedure:

1. Be aware of nasal and throat conditions that affect the ears:
- Catarrh (inflammation) in the nose or throat can extend into the ear through a tube connecting the throat to the ear.
- Frequent syringing of the nose or...
nasal catarrh, ear infection, throat issues, medical attention
Recognize and Address Ear Affections Promptly
High Priority Source: Boy Scout Handbook 1911
Procedure:

1. Identify symptoms that require immediate attention:
- Pain in the ear
- Ringing or hissing sounds
- Discharge from the ear
- Any sign of deafness, even partial (e.g., inability to hear a watch tick at 30...
ear pain, deafness, hearing test, ear discharge, medical attention

Cold Related Illnesses (2)

Treating Freezing (Hypothermia)
Critical Source: Boy Scout Handbook 1911
Procedure for Treating Freezing

1. Move the patient to a cold room.
2. Rub the body with rough cloths wet in cold water.
3. Gradually increase the temperature of the room if possible.
4. **Wet the cloths in progressively warmer...
hypothermia, first aid, emergency treatment, gradual warming, stimulants
Treating Frostbite
Critical Source: Boy Scout Handbook 1911
Procedure for Treating Frostbite

1. Recognize symptoms: The affected part of the body has no feeling after being cold.
2. Rub the frozen area with snow or cold water to gradually restore warmth.
3. **Gradually warm the water used for...
frostbite, first aid, emergency treatment, gradual warming, cold injury prevention

Transportation Medical Care (2)

Identify Individual Responsible for Arranging Medical Transportation
High Priority Source: FEMA REP Program Manual Dec 2019
Procedure:

1. Identify by title/position the individual responsible for arranging transportation to an appropriate medical facility for contaminated or injured individuals.
2. Develop plans/procedures that outline how to select a medical...
medical transportation, emergency medical facility, contaminated individual, critical condition, priority transport
Determine Appropriate Vehicle for Transporting Contaminated Individuals
High Priority Source: FEMA REP Program Manual Dec 2019
Procedure:

1. Consider the following factors when selecting a vehicle:
- The type and severity of medical problems encountered
- Whether trained emergency medical services personnel are required
2. For individuals with early symptoms of...
vehicle selection, radiation exposure, medical transport, emergency vehicle, critical care unit

Definition And Scope (2)

Define Preparedness/Survival Medicine
Standard Source: Survival and Austere Medicine
Definition: Preparedness/survival medicine is the practice of providing medical care in environments where standard medical facilities and trained professionals are unavailable, often by individuals with no formal medical training.

Scope:...
preparedness,survival medicine,definition,scope,hygiene
Understand Austere Medicine
Standard Source: Survival and Austere Medicine
Definition: Austere medicine refers to the provision of medical care without access to modern investigations or technology.

Key Considerations: Medical care must be provided using limited resources and basic skills. This may include:
-...
austere medicine,limited resources,basic skills

First Aid Training (2)

Arrange Medical Training with Healthcare Professionals
Standard Source: Survival and Austere Medicine
Arrange some teaching:

• Another option is befriending (or recruiting) a health care professional and arranging classes through them.
• It is common for doctors to be asked to talk to various groups on different topics so an invitation to talk...
healthcare professional, medical training, first aid classes, pain relief, fracture treatment
Gain Experience Observing in an Emergency Department
Standard Source: Survival and Austere Medicine
Emergency Department Observing:

• It is possible to gain some experience observing or working in an ER.
• Many Emergency Departments regularly have a variety of people coming through for practical experience from army medics, to off-shore,...
emergency department, observing, practical experience, suturing, IV insertion, burn management

Surgical Preparedness (2)

Assemble a Basic Surgical Kit for Austere Conditions
High Priority Source: Survival and Austere Medicine
Objective: Create a functional surgical kit suitable for austere environments.

### Required Instruments:
Mayo scissors
Dissecting forceps
Small + medium needle holders
Small curved clamps
Small straight clamps
-...
surgical kit,austere medicine,emergency surgery,instruments,first aid
Categorize Surgical Instruments by Complexity Level
High Priority Source: Survival and Austere Medicine
Objective: Understand the different levels of surgical instrument complexity for austere conditions.

### Levels of Instrument Complexity:
Level 1 (Basic): Includes essential tools like Mayo scissors, dissecting forceps, scalpel handle +...
instrument levels,austere surgery,tool complexity,surgical preparedness

Biological Threats Treatment (2)

Recognize and Treat Inhalation Anthrax
Critical Source: Survival and Austere Medicine
Objective: Recognize the symptoms of inhalation anthrax and provide immediate treatment.

Symptoms:
• Initial non-specific flu-like symptoms, such as fever, fatigue, and muscle aches.
• A period of apparent recovery (asymptomatic)...
inhalation anthrax symptoms, doxycycline treatment, ciprofloxacin treatment
Recognize and Treat Tularaemia
Critical Source: Survival and Austere Medicine
Objective: Recognize the symptoms of tularaemia and provide appropriate treatment.

Symptoms:
Fever, shortness of breath, fatigue, malaise, coughing, and abdominal pain.

Treatment:
• Administer **doxycycline or...
tularaemia symptoms, doxycycline treatment, ciprofloxacin treatment, barrier precautions

Fluid Balance (2)

Monitor Urine Output for Fluid Balance
Standard Source: Survival and Austere Medicine
Purpose: Monitor urine output to assess fluid balance, especially in burn patients or those with heart failure.

Procedure:
1. Measure and record daily urine output using a calibrated container or measuring device.
2. Compare the measured...
urine output, fluid balance, burns, heart failure, kidney malfunction
Track Weight Changes for Fluid Imbalance Detection
Standard Source: Survival and Austere Medicine
Purpose: Use weight changes to detect fluid retention or loss, especially in burn patients or those with heart failure.

Procedure:
1. Weigh the patient daily at the same time using a calibrated scale.
2. Record the weight and compare it to...
weight tracking, fluid retention, heart failure, kidney dysfunction, burn patients

Health Assessment (2)

Assess Weight Fluctuations for Health Indicators
Reference Source: Survival and Austere Medicine
What Short-Term Weight Loss or Gain May Indicate:

• A gradual change in fluid retention or loss, or poor nutritional status.

Additional Clues to Look For:
• Fluid intake exceeding output by more than 20%
• Loss via urination...
weight loss, weight gain, fluid retention, nutritional status
Measure Weight of an Individual Unable to Stand Unassisted
Reference Source: Survival and Austere Medicine
How to Measure the Weight of Someone Who Cannot Stand:

1. Use a chair and place a platform on the scale to hold the chair.
2. Weigh the empty chair and write down its weight.
3. Place the patient in the chair and weigh them...
measure weight, bedpan, chair scale, patient weighing

Surgical Techniques (2)

Understanding Nonabsorbable Sutures
Standard Source: Medical Survival Wound Closure Manual + Encyclopedia of Knots
Definition of Nonabsorbable Sutures:

• Nonabsorbable sutures are strands of material that are suitably resistant to the action of living mammalian tissue.
• A suture may be composed of a single or multiple filaments of metal or organic fibers...
nonabsorbable sutures, sutures, medical materials, wound closure, U.S.P., F.D.A.
Selecting Appropriate Suture Materials Based on Tissue Type and Healing Time
Reference Source: Medical Survival Wound Closure Manual + Encyclopedia of Knots
Procedure for Selecting Appropriate Suture Materials Based on Tissue Type and Healing Time

1. Assess the tissue type and healing time requirements:
- Muscle, subcutaneous tissue, and skin typically require wound support for a few days.
...
suture materials, tissue type, healing time, absorbable sutures, wound closure

Midwifery And Obstetrics (2)

Create a Vacuum in the Syringe for MVA
Reference Source: A Book for Midwives
1. Create a vacuum in the syringe:

• Close the valve by pushing the button inward and forward — the button will make a “click” sound and will stay stuck in place until you open it again.

• Hold the barrel of the syringe with one hand and pull...
MVA, syringe vacuum, midwife procedure, cannula handling, emergency medical procedure
Understand and Manage the Stages of Labor
Reference Source: Where There is no Doctor a Village Health Care Handbook + A Book for Midwives
Purpose: Recognize and understand the different stages of labor to provide appropriate care during birth. Every labor is unique, and it's important to be prepared for variations in duration and intensity.

Stages of Labor:
1. **Stage 1...
labor stages, midwife care, birth process, cervix opening, placenta delivery

Medical Support Operations (2)

Deploy and Operate MRI CSH (Corps) and Echelon Above Corps (EAC)
Standard Source: Emergency War Surgery
Procedure for Deploying and Operating MRI Combat Support Hospitals (CSH):

MRI CSH (Corps):
• Provides hospitalization and outpatient services for all classes of patients in the theater, either returned to duty or stabilized for further...
MRI CSH, CSH (Corps), EAC, hospital company, ICU beds, OR tables, ICWs, NP patients, mobile hospital
Casualty Receiving & Treatment Ships (CRTS) Operations in Emergency War Surgery
Reference Source: Emergency War Surgery + TCCC 17 13 Army Tactical Combat Casualty Care
Casualty Receiving & Treatment Ships (CRTS):

• Part of an Amphibious Ready Group (ARG), usually comprising one landing helicopter assault or amphibious (LHA) Tarawa-class or landing helicopter deck (LHD) Wasp-class ship.
• Function as casualty...
CRTS, Casualty Receiving & Treatment Ship, Amphibious Ready Group, Fleet Surgical Team, Mass Casualty Operations, Triage Area, Medical Capacity

Facial Trauma Management (2)

Diagnose and Manage Mid-Face Fractures (Le Fort I, II, III)
Standard Source: Emergency War Surgery
Procedure for Diagnosing and Managing Mid-Face Fractures (Le Fort):

1. Ensure ABCs (Airway, Breathing, Circulation):
- Secure the airway if compromised by edema or bleeding.
- Use a nasal airway, tracheostomy, or...
Le Fort fracture, mid-face fracture, airway management, hemorrhage control, maxilla immobilization, facial trauma
Managing and Repairing Parotid Duct Injuries
Standard Source: Emergency War Surgery
Procedure for Managing and Repairing Parotid Duct Injuries

• Evaluate penetrating wounds in the parotid/buccal regions of the face for salivary leakage, which may indicate a lacerated parotid duct.
• Manually compress and inspect the...
parotid duct injury, salivary leakage, stent placement, sutures, emergency surgery

Ophthalmic Emergencies (2)

Assess and Manage Subconjunctival Hemorrhage (SCH)
Standard Source: Emergency War Surgery
Procedure:

1. Evaluate the size of SCH:
- Small subconjunctival hemorrhages may occur spontaneously or with blunt trauma and require no treatment.
2. Look for signs that may indicate an open globe:
- Large SCH with chemosis...
subconjunctival hemorrhage, SCH, open globe injury, chemosis, blunt trauma, penetrating injury
Management and Prevention of High-Altitude Retinal Hemorrhage (HARH)
Standard Source: US Marine Corps Wilderness Medicine + Emergency War Surgery
High-altitude retinal hemorrhage (HARH) is a self-limiting condition caused by bleeding from retinal vessels due to increased pressure changes at high altitudes, often triggered by blood pressure surges within distended vessels. It typically...
high-altitude retinal hemorrhage, HARH, descent, vision impairment, acclimatization

Vascular Injury Management (2)

Initial Management of Vascular Injuries
Reference Source: Emergency War Surgery
Procedure:

• Initially, holes in vessels should be digitally occluded.
• Stopgap measures include placing Fogarty or Foley catheters, side-biting clamps, or in the case of venous injuries, sponge sticks.
• Total occlusion or clamping may...
vascular injuries, digital occlusion, Fogarty catheter, Foley catheter, side-biting clamps, sponge sticks, resuscitation, on-the-table triage
Venous Repair in Vascular Injury
Reference Source: Emergency War Surgery
Step-by-step procedure:

1. Options for venous repair are similar to arterial repairs outlined above.
2. Ligation of major veins is acceptable in life-threatening situations, but if time permits and the patient is stable, perform venous...
venous repair, vascular injury, ligation, arterial patency, emergency surgery

Urological Emergencies (2)

Perform Suprapubic Tube Cystostomy for Urethral Injury or Obstruction
Standard Source: Emergency War Surgery
Procedure:

Suprapubic tube cystostomy is indicated for both urethral injury and urethral obstruction, particularly when urethral instrumentation is contraindicated.

• Insert a suprapubic urinary diversion (e.g., suprapubic...
suprapubic tube cystostomy, urethral injury, urethral obstruction, urinary diversion, emergency surgery
Suspect Urethral Injury and Confirm Integrity via Retrograde Urethrography
Standard Source: Emergency War Surgery + NATO Emergency War Surgery
Procedure:

Suspect urethral injury in patients presenting with:
- Scrotal hematoma
- Blood at the meatus
- A floating/highriding prostate

Do not perform catheterization until urethral integrity is confirmed by retrograde...
urethral injury, retrograde urethrography, catheterization, pelvic fracture, urogenital diaphragm

Gynecological Emergencies (2)

Managing Vaginal Hemorrhage from Cervical Cancer
Standard Source: Emergency War Surgery
Procedure for Managing Vaginal Hemorrhage from Cervical Cancer

1. Identify a hemorrhaging mass in the vagina, which is most likely due to cervical cancer.
2. Perform vaginal packing with gauze or other absorbent material to...
vaginal hemorrhage, cervical cancer, tamponade, urethral catheter, emergency surgery
Management of Spontaneously Aborted Ectopic Pregnancy in the Abdominal Cavity
Reference Source: Emergency War Surgery
Procedure for Management of Spontaneously Aborted Ectopic Pregnancy in the Abdominal Cavity

Indication: Ectopic pregnancy spontaneously aborted into the abdominal cavity through the end of the tube.

Treatment:
- Identify an...
ectopic pregnancy, abdominal cavity, spontaneous abortion, surgical management, hemostasis, salpingectomy

Obstetrics And Delivery Procedures (2)

Assess Cervix and Fetal Position Before Delivery
Reference Source: Emergency War Surgery
Procedure:

• Examine the cervix to determine dilation and fetal position.
• For the woman to begin pushing, the cervix must be completely dilated (10 cm), and no cervix should be felt on either side of the fetal head.
• If the baby’s head is...
cervix assessment, fetal position, cesarean section, delivery, heart rate monitoring
Preparation for Precipitous Vaginal Delivery
Reference Source: Emergency War Surgery
Procedure for Preparation for Precipitous Vaginal Delivery

1. Gather the following supplies: povidone-iodine sponges, a 10 cc syringe, lidocaine, 2 Kelly clamps, ring forceps, dry towels, a bulb syringe, and scissors.
2. Position the mother...
precipitous vaginal delivery, fetal heart rate monitoring, supplies for delivery, left side positioning, vascular Doppler

Obstetric Procedures (2)

Episiotomy Procedure, Repair, and Post-Delivery Management
Reference Source: Emergency War Surgery
Procedure:

• If an episiotomy is needed, it should be cut in the posterior midline from the vaginal opening approximately 1/2 the length of the perineum, and extend about 2–3 cm into the vagina.
• After delivery of the head, the **mouth...
episiotomy, repair, post-delivery procedures, nuchal cord, fetal delivery
Fetal Head Delivery and Control
Reference Source: Emergency War Surgery
Procedure:

• The fetal head delivers by extension.
Pushing upward on the fetal chin through the perineum can assist this process.
• It is extremely important to **control the rate of delivery of the head with the opposite...
fetal head delivery, control of delivery rate, extension, perineum, emergency surgery

External Fixation Techniques (2)

Apply External Fixation for Femur Diaphyseal Fractures
Standard Source: Emergency War Surgery
External Fixation for Femur Diaphyseal Fractures

• Prepare the entire limb from the ASIS to the toes.
• Use a standard OR table or portable fracture table.
• An assistant should apply counter pressure while pins are inserted.
• Precise...
external fixation, femur diaphyseal fracture, pin placement, emergency surgery, war surgery
General External Fixation Technique for Battle Casualties
Reference Source: Emergency War Surgery
General External Fixation Technique for Battle Casualties

• The surgeon should be familiar with four types of standard constructs of external fixation for use in the initial care of battle casualties: femur, tibia, knee, and ankle. External...
external fixation, battle casualties, emergency surgery, Hoffmann II, pin insertion, military medicine

Altitude Illness Management (2)

Nifedipine for High Altitude Pulmonary Edema (HAPE) - Treatment and Prophylaxis
Standard Source: Emergency War Surgery
Title: Nifedipine for High Altitude Pulmonary Edema (HAPE) - Treatment and Prophylaxis

Procedure (Treatment):
1. Administer nifedipine sublingually at 10 mg tid (three times daily).
2. If no improvement in symptoms is apparent after...
Nifedipine, HAPE, High Altitude Pulmonary Edema, Prophylaxis, Treatment
Recognizing and Managing High-Altitude Cerebral Edema (HACE)
Reference Source: US Marine Corps Wilderness Medicine + FM 3 97 61 Military Mountaineering + Emergency War Surgery
High-altitude cerebral edema is a severe form of altitude illness that requires immediate descent and medical intervention.

Definition: HACE is a high-altitude illness characterized by swelling of the brain. It can occur as low as 8,000...
HACE, High Altitude Cerebral Edema, altitude illness, dexamethasone, Gamow bag, oxygen therapy, descent, AMS

Pediatric Resuscitation (2)

Administer Fluid Resuscitation for Children in Shock
Standard Source: Emergency War Surgery
For fluid resuscitation in children:

1. Use isotonic fluids (e.g., normal saline or lactated Ringer’s).
2. Administer 20 cc/kg boluses as needed.
3. Monitor urine output and adjust total fluid volume to achieve a goal of **1–2...
fluid resuscitation, children, shock, dehydration, isotonic fluids, normal saline, lactated Ringer’s
Estimate Blood Volume in Pediatric Patients
Reference Source: Emergency War Surgery
Procedure:

1. Determine the age group of the child:
- Premature infants: 85–100 cc/kg
- Term infants: ~80 cc/kg
- 1–3 months old: 75–80 cc/kg
- >3 months old: ~70 cc/kg

2. Calculate blood volume:
- Multiply the child’s...
blood volume, pediatric patients, infants, children, resuscitation, hemorrhage, shock

Insect Stings (1)

Avoiding Bee Stings
Standard Source: Dangerous Animals
Procedure:

1. Identify bee behavior: Recognize bees by their hairy bodies and wasps/hornets by their slender, nearly hairless bodies.
2. Watch for feeding areas: Be cautious around flowers or fruit where bees may be feeding.
3. **Avoid...
bee,sting,avoidance,wasps,hornets,yellow jackets

Infections Abscesses (1)

Treating Abscesses in Animals
High Priority Source: The Household Cyclopedia
For abscesses:

1. Wash the swollen part with a quart of vinegar mixed with two ounces of sal ammoniac and half an ounce of sugar of lead.
2. If the swelling does not abate within 2-3 days, apply a suppurating poultice.
3. When the tumor becomes...
abscess treatment, sal ammoniac, poultice application, basilicon ointment

Medicinal Preparations (1)

Preparing Balls for Horses
Reference Source: The Household Cyclopedia
To prepare balls for horses:

1. Make the balls fresh each time they are to be used.
2. The balls should be approximately three-eighths of an inch in diameter and between two and a half to four inches long.
horse medication, ball preparation

Equine Health (1)

Treating Bog Spavin in Horses
High Priority Source: The Household Cyclopedia
For bog spavin:

1. Clip off the hair from the swelling.
2. Rub all around the outside of the swelling with a piece of hard brown soap.
3. Apply a blister made of the following ointment to the swelling:
- Hogs' lard: half an ounce
- Beeswax: 3...
bog spavin treatment, blistering ointment, cantharides oil

Bleeding Procedures (1)

Bleeding in Horses for Medical Conditions
High Priority Source: The Household Cyclopedia
Procedure for Bleeding in Horses

1. Use bleeding as a treatment for inflammatory conditions and fevers in horses.
2. Determine the appropriate location to bleed based on the condition:
- For general systemic issues, open the...
horse,bleeding,fever,inflammation,blood_removal,quantity,jugular_vein,temporal_arteries

Blood Conditions (1)

Bleeding for Fullness of Blood (Plethora) in Horses
High Priority Source: The Household Cyclopedia
Procedure for Bleeding to Treat Fullness of Blood in Horses

1. Use moderate bleeding as a treatment for fullness of blood or plethora, especially when accompanied by slight inflammatory symptoms.
2. **Recognize the signs of fullness of...
horse,blood_fullness,plethora,bleeding,laxatives,exercise,diet_regulation

Laxative Preparation (1)

Preparing and Administering Laxative and Diaphoretic Powder for Horses
Standard Source: The Household Cyclopedia
Procedure to Prepare and Administer Laxative and Diaphoretic Powder

1. Ingredients required:
- Nitre (potassium nitrate)
- Cream of tartar
- Flower of sulphur
2. Measure each ingredient: 4 ounces of each.
3. **Mix the...
horse,laxative_powder,diaphoretic,nitre,cream_of_tartar,flower_of_sulphur,administration

Animal Surgery (1)

Surgical Remedy for Lameness in Horses' Fore-Feet
High Priority Source: The Household Cyclopedia
This procedure is a surgical intervention for lameness originating from nerve issues in the fore-feet of horses.

1. Diagnose the cause of lameness: Determine that the lameness is due to nerve damage near the hoof.

2. **Perform nerve...
horse surgery, nerve amputation, lameness treatment, veterinary procedure

Poisoning Antidotes (1)

Bibron's Antidote for Snake-Bites
High Priority Source: The Household Cyclopedia
Procedure:
1. Prepare the antidote by combining the following ingredients:
- Bromine: 2 1/2 drams
- Iodide of potassium: 2 grains
- Corrosive sublimate: 1 grain
- Diluted alcohol: 30 fluid drams
2. Administer the dose as follows:
...
snake bite, bromine, iodide of potassium, corrosive sublimate, diluted alcohol, antidote

Nutrition Rehabilitation (1)

Restoring Persons Who Have Been Famished
High Priority Source: The Household Cyclopedia
Procedure for Restoring Individuals After Prolonged Fasting:

1. Apply Heat Carefully:
- Place a healthy person on each side of the patient to provide warmth through physical contact.
- Use pediluvia (fomentation of the feet) with...
famine recovery,warmth,cordials,food,nutrition_rehabilitation,fasting_recovery

Laboratory Techniques (1)

Understanding and Performing Dialysis (Graham's Method)
Standard Source: The Household Cyclopedia
Procedure for Performing Dialysis Using Graham’s Method:

1. Understand the Principle of Dialysis:
- Dialysis, as defined by Professor Graham, is a process that separates substances based on their ability to form crystals or remain in an...
dialysis,graham_method,crystalloid,colloid,laboratory_technique

Parasite Elimination (1)

Killing Parasites in Pork Through Cooking
High Priority Source: The Household Cyclopedia
To kill parasites in pork, it is necessary to thoroughly cook the meat so that every portion reaches a temperature of at least 160° Fahr. This is crucial for eliminating trichinae and preventing illness.

Important Notes:
• Eating uncooked pork...
pork, trichinae, parasite elimination, cooking temperature, food safety

Remote Monitoring (1)

Transmit Electrocardiograph (ECG) Signals Over Audio Channels
High Priority Source: Shortwave Radio Handbook
Electrocardiographs (ECGs) and other low-frequency medical sensors can be transmitted over audio channels using the same method as facsimile transmissions.

### Implementation Steps
1. Connect the ECG device to a transceiver that supports...
ECG transmission, medical sensors, audio channel, remote monitoring

Natural Remedies (1)

Use Cranberries for Nutritional and Medical Purposes
Standard Source: Edible Medicinal Plants
Procedure to Use Cranberries in Survival Situations:

1. Collect fresh cranberries from the ground or plant, ensuring they are fully developed.
2. To Make a Beverage: Cook the berries in a small amount of water until softened, then add sugar...
cranberry, diuretic, urinary tract infection, survival food

Toxic Exposure (1)

Avoid Inhaling Poison Ivy Smoke
Critical Source: Plant Identification
Procedure:

1. If you encounter a burning plant:
- Do not burn Poison Ivy under any circumstances.
2. Avoid inhaling smoke from burned Poison Ivy, as the oils can become airborne and cause internal poisoning.
3. If you are near a fire or...
poison ivy smoke, inhalation danger, fire safety, toxic exposure

Anatomy Reference (1)

How to Interpret Body Diagrams in the Book
Reference Source: A Book for Midwives
Body diagrams are used to illustrate different parts of the body:

• When we draw a person, we try to show the whole body, but may only show part if space is limited.
• If it is important to see specific areas (e.g., baby’s head and vagina),...
body diagrams,illustrations,anatomy

Referral Guidelines (1)

When to Seek Medical Advice or Help
High Priority Source: A Book for Midwives
Getting help is important when the information in this book is not enough:

Get medical advice: A skilled health worker or doctor should be able to help you decide what to do (not usually an emergency).
Get medical help: The woman or...
emergency,referral,medical help

Healthcare Teamwork (1)

Conduct Midwife Group Meetings for Knowledge Sharing
Reference Source: A Book for Midwives
Procedure:

1. Organize regular meetings between midwives and other health workers every few months.
2. Share experiences by taking turns telling stories about births attended, including difficult cases and mistakes made.
3. **Discuss...
midwife meetings, knowledge sharing, role play, healthcare collaboration, education materials

Confidentiality (1)

Maintain Confidentiality in Patient Care
Reference Source: A Book for Midwives
Procedure:

1. Ensure that all information shared by a woman during care is kept strictly confidential.
2. Never disclose personal health or care details to others without the woman’s explicit permission.
3. Conduct private conversations about...
patient confidentiality, privacy protection, sensitive information

Transportation In Emergencies (1)

Implementing a Yellow Flag System for Emergency Transport During Labor
High Priority Source: A Book for Midwives
Procedure:

1. Identify the need for emergency transport: When a woman is in labor and unable to reach a hospital due to lack of transportation, the midwife should initiate this procedure.

2. Signal for assistance using a yellow flag:...
yellow flag system, emergency transport during labor, midwife procedures, truck driver assistance, hospital access in rural areas

Community Collaboration (1)

Engaging with Truck Drivers and Unions for Emergency Support
High Priority Source: A Book for Midwives
Procedure:

1. Identify local truck drivers and unions: Midwives should establish contact with local truck drivers and their union to discuss the possibility of emergency assistance during labor.

2. Discuss the need for cooperation:...
truck driver collaboration, union involvement in emergencies, community support for midwives, emergency response systems

Health Problem Management (1)

Approach to Treating Health Problems as a Midwife
Standard Source: A Book for Midwives
Procedure:

1. Assess the immediate cause of the health problem: When a woman presents with symptoms such as exhaustion, abdominal pain, or heavy bleeding, the midwife must first identify the immediate cause of these symptoms.

2....
treating health problems, midwife procedures, root cause analysis, immediate care in emergencies

Treatment Planning (1)

Develop a treatment plan based on the diagnosed condition
Standard Source: A Book for Midwives
Procedure:

1. Explain the diagnosis: Clearly communicate the likely cause of the health problem to the patient.
2. Outline treatment options: Provide possible solutions such as dietary changes, medication, or lifestyle adjustments.
3....
treatment plan, anemia, medical advice

Treatment Monitoring (1)

Monitor the patient’s progress and adjust treatment as needed
Standard Source: A Book for Midwives
Procedure:

1. Schedule follow-up visits: Arrange for regular checkups to assess the effectiveness of the treatment plan.
2. Check for improvement or worsening symptoms: Observe changes in physical signs, such as improved energy levels...
monitor progress, treatment adjustment, patient follow-up

Treatment Selection (1)

Assess and choose the best treatment based on benefits and risks
Standard Source: A Book for Midwives
Procedure:

1. Evaluate all available treatments: Consider both conventional and alternative options.
2. Weigh benefits against potential harm: Choose a treatment that offers the greatest benefit with the least risk of complications.
3....
best treatment, risk assessment, medical decision-making

Decision Making (1)

Assessing Benefits and Risks of Medical Treatments
High Priority Source: A Book for Midwives
Procedure:

1. Understand the definition of benefits and risks:
- A *benefit* is the good that an action or treatment might bring.
- A *risk* is the harm that it might cause.
2. Compare the benefits and risks for each possible...
benefits,risk,balance,medical decision making,emergency treatment

Treatment Options (1)

Understanding Western Medicine and Its Role in Emergencies
High Priority Source: A Book for Midwives
Procedure:

1. Recognize the strengths of Western medicine:
- It is based on scientific testing and uses manufactured medicines (drugs) and surgery to treat health problems.
2. Understand when it is most effective:
- Western...
western medicine,emergency treatment,scientific testing,severe bleeding,life-saving care

Diagnosis And Treatment (1)

Identify Immediate and Root Causes of Health Problems
Standard Source: A Book for Midwives
Objective: Determine both the immediate and underlying causes of a health problem to provide effective treatment and prevent recurrence.

Procedure:
1. Assess the immediate cause of the health issue (e.g., anemia, infection, injury).
...
immediate cause, root cause, anemia, health problem, diagnosis, treatment, community involvement, social factors

Community Health Interventions (1)

Identify Community Health Problems to Prevent Maternal Mortality and Morbidity
Standard Source: A Book for Midwives
Objective: Identify root causes of health problems affecting pregnant women in the community.

Steps:
1. Gather community members, including midwives, families, and other health workers.
2. Discuss common dangers that affect all women during...
maternal mortality, root causes, community health problems, midwife interventions, pregnancy complications

Menstrual Health (1)

Understanding Menopause and Its Effects on Women’s Health
Reference Source: A Book for Midwives
Procedure:

1. Menopause is the stage in a woman’s life when she stops menstruating and loses the ability to become pregnant.
2. It typically occurs between the ages of 45 and 55, though it may happen suddenly or gradually over 1–2...
menopause,symptoms,vaginal dryness,hormonal changes,aging,women's health

Cultural Health Practices (1)

Use Cultural Beliefs to Promote Healthy Eating Habits
Standard Source: A Book for Midwives
Why it matters:
Cultural beliefs about food can influence dietary choices, especially during pregnancy. Finding ways to align health recommendations with these beliefs can improve outcomes.

Action Steps:
1. **Understand local cultural food...
cultural food beliefs, pregnancy nutrition, health education

Pregnancy Toxicity (1)

Avoiding Contact with Poisonous Chemicals for Pregnant Women and Families
High Priority Source: A Book for Midwives
Avoiding contact with poisonous chemicals is crucial to protect health, especially for pregnant women.

### Steps to Avoid Poisonous Chemicals:
1. Identify dangerous chemicals:
- Pesticides used in farming.
- Pesticides used at home to...
poisonous chemicals,pregnant women,toxins,pesticides,chemical exposure

Pregnancy And Birth (1)

Create a Transport Plan for Emergency Medical Care During Pregnancy and Birth
High Priority Source: A Book for Midwives
Objective: Ensure that a pregnant woman can access emergency medical care if needed during labor or birth.

Steps to Create a Transport Plan:
1. Identify Potential Emergencies: Discuss with the woman, her family, midwife, and community...
transport plan, emergency care, pregnancy, birth, medical help, community planning, prenatal care

Nutrition Assessment (1)

Identifying Signs of Poor Nutrition or Iodine Deficiency
Standard Source: A Book for Midwives
Procedure:

To check for signs of poor nutrition or iodine deficiency:

### Healthy Signs:
• General good health and high energy levels.

### Warning Signs of Poor Nutrition:
• Loss of appetite or reduced food intake.
• Lack of weight...
poor nutrition, iodine deficiency, goiter, weight gain, dietary assessment

Prenatal Monitoring (1)

Monitoring Weight Gain During Pregnancy
Standard Source: A Book for Midwives
Procedure:

To monitor weight gain during pregnancy:

### Healthy Signs of Weight Gain:
• The mother gains between 9 and 18 kilograms (20 to 40 pounds) over the course of her pregnancy.
• This is equivalent to a steady increase of **1 to...
weight gain, pregnancy monitoring, pre-eclampsia, gestational diabetes, twins

Vital Signs Checking (1)

Check the Mother's Pulse
Standard Source: A Book for Midwives
Procedure:

1. Ensure the mother is resting and relaxed before checking her pulse.
2. Use the pads of two fingers, not your thumbs, to feel for the pulse.
3. Locate the pulse on one of the following areas:
- The side of the throat,...
pulse checking, vital signs, medical emergency

Pregnancy Checkups (1)

Measure the Mother’s Womb During Prenatal Checkups
Standard Source: A Book for Midwives
How to measure the mother’s womb:

• Use fingers to determine how far the top of the womb extends.
Healthy signs include:
- The size of the womb matches the due date.
- The womb grows about 2 finger widths every month.

**Warning...
womb measurement,pregnancy checkup,healthy signs,warning signs

Health Record Management (1)

Create and Maintain a Health Record for Women
Reference Source: A Book for Midwives
Purpose: Keep track of a woman's health history, prenatal checkups, and important medical information.

Steps:
1. Use a chart or create your own to record:
- Name of mother
- Age
- Number of children
- Date of last childbirth
...
health record, prenatal checkups, medical history, midwife records, pregnancy tracking

Labor Preparation (1)

Prepare for Labor and Birth
High Priority Source: A Book for Midwives
Purpose: Ensure that the midwife, woman, family, and community are prepared for labor and birth.

Steps:
1. Recognize signs that labor will start soon (see page 149).
2. Know when to go to the birth (see page 151). This includes...
labor preparation, emergency planning, sterilization, medical supplies, prenatal readiness

Fetal Monitoring (1)

Respond to a Slow Baby Heart Rate (Below 100 bpm)
Critical Source: A Book for Midwives
Procedure:

1. Identify the cause of the slow heart rate:
- Umbilical cord is very short or being pinched.
- The baby is not healthy.
- Low amniotic fluid levels.
- Placental dysfunction (e.g., due to maternal high blood...
slow fetal heart rate, umbilical cord compression, placental dysfunction, maternal position change, oxygen administration

Monitoring Vital Signs (1)

Monitor Mother's Pulse During Labor
High Priority Source: A Book for Midwives
Procedure:

1. Check the mother’s pulse every 4 hours, or more often if there is a problem.
2. See page 120 to learn how to check the pulse.
3. During labor, a woman’s pulse should be between 60 and 100 beats per minute between contractions....
pulse monitoring, maternal vital signs, labor pulse, abnormal pulse, blood loss, infection

Infection Detection (1)

Check for Signs of Infection in a Mother with Fever
High Priority Source: A Book for Midwives
Procedure:

If the mother has a fever (38°C or higher), check for these signs of infection:

• The baby’s heartbeat is more than 180 beats per minute.
• The mother’s pulse is more than 100 beats per minute.
• The mother’s vagina smells...
infection signs, maternal fever, infection detection, labor infection, abdominal tenderness

Danger Signs (1)

Recognize Danger Signs of Low Blood Pressure in Labor
Critical Source: A Book for Midwives
Procedure:

• If the mother’s blood pressure suddenly drops 15 points or more in the bottom number (diastolic), this is a dangerous warning sign.
• This usually indicates heavy bleeding. If no visible bleeding is present, it may indicate...
low blood pressure, placental detachment, maternal bleeding, emergency signs

Convulsions Seizures (1)

Administering Diazepam Rectally During Convulsions
Critical Source: A Book for Midwives
Procedure:

Preparation:
1. Wash and dry your hands thoroughly.
2. Put on plastic gloves to maintain hygiene.
3. Fill a syringe with the injectable diazepam drug.
4. Remove the needle from the syringe barrel.

Administration:
5. Insert...
diazepam, convulsions, rectal administration, emergency medication, midwifery, seizure treatment

Labor Induction Risks (1)

Warning: Never Use Medicines to Start Labor at Home
Critical Source: A Book for Midwives
Important Warning: Never use medicines such as oxytocin or misoprostol to start labor at home. These medicines can cause contractions strong enough to kill the baby or the mother.

Action Required: If you see any signs of labor induction...
oxytocin misuse, misoprostol dangers, unsafe labor induction methods

Obstetrics Post Delivery (1)

Deliver Baby’s Body and Provide Immediate Care to the Newborn
Critical Source: A Book for Midwives
Procedure:

1. After the shoulders are born, the rest of the body usually slides out easily.
2. Remember that new babies are wet and slippery. Be careful not to drop the baby!
3. Dry the baby immediately with a clean cloth.
4. If everything...
newborn care, skin-to-skin contact, post-delivery

Postnatal Care (1)

Check the Mother's Physical Signs
Standard Source: A Book for Midwives
Procedure:

Steps:
1. Check the mother’s temperature, pulse, and blood pressure regularly.
2. Perform this check at least once an hour if the mother is experiencing any health problems.
3. Record all findings for monitoring...
temperature,pulse,blood pressure,monitoring,postpartum care,mother's health

Postpartum Infection (1)

Watch the Mother for Signs of Infection After Birth
High Priority Source: A Book for Midwives
Procedure:

1. Monitor the mother’s temperature and general well-being.

2. Be aware that a slightly elevated temperature is normal, especially on hot days.

3. If she shows any of these symptoms:
- Feeling ill
- Fever
- Fast pulse
-...
postpartum infection, fever after birth, uterine soreness, infection signs

Blood Clot Response (1)

Recognize and Respond to Blood Clot Signs
Critical Source: A Book for Midwives
Procedure: Watch for signs of a blood clot in the leg:

Warning signs:
• Swelling or heat in one leg or foot.
• Pain in one leg when it is squeezed or during walking.
• A painful red area on one leg.
• A hard lump in the leg.

If any of...
blood clot, leg swelling, postpartum care, DVT signs

Infant Dehydration (1)

Help a Dehydrated Baby with Rehydration
Critical Source: A Book for Midwives
Procedure:

Provide rehydration to an infant showing signs of dehydration.

Steps:
1. Encourage the mother to breastfeed frequently — every 1 to 2 hours.
2. Administer a rehydration drink (see page 160 for details) — give a few drops each...
rehydration,infant care,breastfeeding,dehydration treatment

Neonatal Tetanus (1)

Recognize and Respond to Signs of Neonatal Tetanus
Critical Source: A Book for Midwives
### Recognizing Tetanus in Newborns
• A baby with tetanus will usually be stiff, with her head bent back.
• The baby will have very brisk (strong) reflexes.

### Checking for Tetanus Reflexes
1. Let the baby’s leg hang freely.
2. Tap it just...
tetanus, newborn, infection, medical help, benzylpenicillin

Neonatal Meningitis (1)

Recognize and Respond to Neonatal Meningitis
Critical Source: A Book for Midwives
### Recognizing Meningitis in Newborns
• A baby with an infection in the brain (meningitis) will have:
- Stiff neck.
- Lie with her head bent back.
- May vomit.
- The soft spot on her head will bulge.
- May become...
meningitis, newborn, infection, medical help, antibiotics

Neonatal Jaundice (1)

Recognize and Respond to Neonatal Jaundice
High Priority Source: A Book for Midwives
### Recognizing Severe Jaundice in Newborns
• Signs of severe jaundice include:
- The yellow color starts on the first day of the baby’s life.
- The yellow color lasts for more than 2 weeks.
- The yellow color extends to the...
jaundice, newborn, bilirubin, sunlight, breastfeeding

Bacterial Vaginosis Treatment (1)

Treating Bacterial Vaginosis (BV) with Metronidazole
Standard Source: A Book for Midwives
Procedure:

If the woman is pregnant, she should wait until after the end of the third month before starting treatment. This drug is not safe in the first 3 months of pregnancy.

Treatment Options After Third Month:

• Give **400 to 500...
bacterial vaginosis,metronidazole,pregnancy,treatment

Genital Ulcer Care (1)

Cleaning and Care of Genital Sores (Genital Ulcers)
High Priority Source: A Book for Midwives
Procedure:

• Keep sores on the genitals clean.
• Wash them with soap and water.
• Dry them carefully.
• Wash any cloth used for drying before using it again.

Important Warning:

• When a person has a sore on the genitals, it is...
genital sores,clean with soap and water,dry carefully,HIV prevention,avoid sex until healed

Syphilis Treatment (1)

Understanding Syphilis as a Serious STI
High Priority Source: A Book for Midwives
Procedure:

Syphilis is a serious sexually transmitted infection (STI) that affects the whole body.
• It can last for many years and get worse over time.
• However, syphilis can be cured if it is treated early.
• Prompt medical attention...
syphilis,serious STI,long-term effects,cure with early treatment

Gynecological Exam (1)

Performing a Visual Exam of the Genitals
Reference Source: A Book for Midwives
Procedure:

1. Inspect the skin on the genitals: Ensure that the skin is smooth and healthy.
2. Check for cleanliness: The genitals should be clean, but some clear or white discharge from the opening of the vagina is normal.
3. **Look...
visual exam, genital inspection, lumps, sores, infection signs

Cancer Screening (1)

Performing the Vinegar Test for HPV on the Cervix
High Priority Source: A Book for Midwives
Procedure:

1. Insert a speculum and look at the cervix.

2. Hold a sterilized piece of gauze or cloth with a sterilized pair of forceps or long tweezers. You can also use a long swab if you have one.

3. Dip the gauze into plain...
vinegar test,cervix exam,HPV detection,cervical cancer screening,speculum exam

Infection (1)

Recognize and Respond to Infection After Pregnancy Loss
High Priority Source: A Book for Midwives
Procedure:

1. Identify signs of infection:
- Fever (temperature above 38°C or 100.4°F).
- Chills or shivering.
- Foul-smelling vaginal discharge.
- Increased pain in the lower abdomen or back.

2. Provide immediate care:
...
infection after pregnancy loss, fever, chills, foul-smelling discharge, medical help

Unsafe Abortion (1)

Prevent and Respond to Unsafe Abortion Practices
Critical Source: A Book for Midwives
Procedure:

1. Recognize unsafe abortion methods:
- Insertion of harmful objects such as soap, chemicals, dung, sharp sticks, or other dangerous items into the womb.
- Use of unsterilized tools or incorrect medicines for abortions.

2....
unsafe abortion, harmful objects, legal abortion, community education, medical help

Emotional Support (1)

Provide Emotional Support After Pregnancy Ends
Standard Source: A Book for Midwives
Steps to Provide Emotional Support:

1. Ask the woman if she wants to talk about how she feels. She may not tell you unless you ask.
2. Listen to her if she wants to talk or cry. Be present and offer comfort.
3. **Reassure her the way...
emotional support, miscarriage, abortion, midwife care, mental health

Ethical Care (1)

Avoid Blaming Women for Their Health Issues
High Priority Source: A Book for Midwives
Steps to Avoid Blaming:

1. Do not blame the woman for being sick. Some people think that women get sick because they deserve it.
2. Understand that no one deserves to be sick. Everyone deserves care when they are unwell.
3. **Avoid...
non-judgmental care, ethical midwifery, patient dignity

Abortion Complications (1)

Removing Tissue from the Cervix in an Incomplete Abortion
Critical Source: A Book for Midwives
Procedure:

• If MVA is not possible and medicines cannot be used, perform a speculum exam (see page 377) to look for tissue or clots of blood coming out of the cervix.
• Use sterilized forceps or long tweezers to remove the tissue or clots.
-...
tissue removal, cervix, incomplete abortion, medical emergency, speculum exam

Infection Recognition (1)

Recognize Signs of Infection After Early Pregnancy Loss
High Priority Source: A Book for Midwives
Warning signs of infection include:

High temperature, above 38°C (100.4°F)
Fast pulse, over 100 beats a minute
Feeling chills and shivering
Swollen, hard, or painful belly
• **Bad-smelling fluid coming from the...
infection signs, early pregnancy loss, infection warning signs, medical emergency

Internal Injury (1)

Identify and Respond to Internal Injury After Abortion or Miscarriage
Critical Source: A Book for Midwives
Procedure:

Signs of internal injury:
Belly feels stiff and hard with no sounds or gurgles inside.
Severe pain or cramps in the belly.
Fever with chills or shivering.
Nausea and vomiting.
• **Pain in one or both...
internal_injury,surgery,hospital,shock,treatment

Manual Vacuum Aspiration (1)

Handling an Incomplete MVA
Critical Source: A Book for Midwives
Procedure:

1. If you start to perform an MVA but cannot fully empty the womb, first try using a larger cannula.
2. If the womb still cannot be emptied completely, seek immediate assistance from another medical professional or transport the...
incomplete MVA, emergency transfer, misoprostol administration, infection monitoring

Contraception And Family Planning (1)

Family Planning After an MVA
Reference Source: A Book for Midwives
Procedure:

1. Discuss family planning options with the woman:
- Ask if she wants to know more about contraceptive methods after an MVA.
2. Inform her about fertility post-MVA:
- Emphasize that it is just as easy for a woman to...
family planning after MVA, contraception options, post-abortion fertility

Radiology Safety (1)

X-ray Safety During Pregnancy
High Priority Source: A Book for Midwives
Pregnant women should never be x-rayed unless absolutely necessary.

If an x-ray is required:

1. The abdomen must be covered with a lead apron to protect the baby.
2. X-rays can cause cell damage and increase cancer risk with repeated...
x-ray safety, lead apron, pregnancy, radiation risk, bone fracture

Transport Planning (1)

Plan for Transport to Medical Center Before an Emergency
High Priority Source: A Book for Midwives
Before there is an emergency, plan how you can bring a woman to medical help. This is especially important for village women whose closest medical center might be days away. Some women take buses or walk for miles to get medical help. Even women...
transport planning, medical center access, emergency preparedness, midwife collaboration

Collaboration With Healthcare (1)

Build Relationships with Medical Centers and Doctors Before an Emergency
High Priority Source: A Book for Midwives
Because of the challenges midwives may face when working with medical centers and doctors, it is important to build a relationship before an emergency happens. This way, when you need help, you are more likely to be treated with respect.

Try...
midwife collaboration, healthcare partnership, medical center relationship building

Patient Advocacy (1)

Advocating for a Patient in a Medical Emergency
Critical Source: A Book for Midwives
Procedure:

1. Assess the situation: Determine if the patient is in immediate danger and requires urgent medical attention.
2. Contact hospital staff: If the hospital is unwilling to accept the patient, explain the urgency of the case...
advocacy,emergency,patient care,midwife,hospital refusal

Teaching Tools (1)

Create a Paper Pelvis Model
Reference Source: A Book for Midwives
Materials Needed:
• Stiff paper or thin cardboard
• Thin paper for tracing
• Scissors
• Marker or pen
• Optional: Thin strip of cardboard

Steps:
1. Make a Pattern: Trace the shape provided in the book onto thin paper.
2. **Fold the...
paper pelvis,model,pelvis teaching tool,anatomy model,midwifery tools

Midwifery Tools (1)

Create a Placenta Model from Cloth
Reference Source: A Book for Midwives
Materials Required:
• Two pieces of cloth (at least 22 centimeters [8½ inches] in diameter)
• Thin, see-through material
• Sewing needle and thread
• Soft stuffing material (e.g., foam rubber, old rags, dried grass)
• Drawstring or...
placenta model, membranes material, midwifery tool, childbirth teaching aid, soft stuffing

Allergic Reaction Treatment (1)

Administer Adrenaline (Epinephrine) for Allergic Reactions or Severe Asthma Attacks
Critical Source: A Book for Midwives
Indication: For allergic reactions (e.g., anaphylaxis from penicillin), shock, or severe asthma attacks.

Procedure:
1. Inject 1:1000 adrenaline solution, 0.5 ml, just under the skin (subcutaneous injection) on the back of the upper...
adrenaline, epinephrine, anaphylaxis treatment, asthma attack

Allergies And Drug Interactions (1)

Avoid Amoxicillin in Patients with Penicillin Allergies
High Priority Source: A Book for Midwives
Important: Do not administer amoxicillin to individuals who are allergic to drugs in the penicillin family.

Alternatives:
• Ampicillin can be used instead of amoxicillin in many cases.
• For patients allergic to penicillins, consider using...
amoxicillin allergy, penicillin alternative, erythromycin use

Vaccines (1)

Administer BCG Vaccine for Tuberculosis Prevention
Standard Source: A Book for Midwives
Procedure:

1. Verify vaccine storage: Ensure the BCG vaccine is kept cold at all times to maintain its effectiveness.
2. Prepare injection site: Choose the upper arm as the standard location for intradermal injection.
3. **Administer...
BCG vaccine,tuberculosis,upper arm injection,vaccine storage

Anticonvulsants (1)

Administer Diazepam for Convulsions
High Priority Source: A Book for Midwives
Procedure:

1. For convulsions (see p. 182):
- Give 20 mg of injectable diazepam in the rectum using a syringe without a needle.
- Repeat if needed with 10 mg, 20 minutes after the first dose.
- Do not give more than...
diazepam, convulsions, seizures, rectal administration, HIV prevention, addiction warning

Tetanus Prevention (1)

Administer Tetanus Toxoid Vaccine
High Priority Source: A Book for Midwives
Procedure:

1. Determine if the patient is eligible for tetanus toxoid vaccination (e.g., during or after pregnancy, after abortion or female genital cutting).
2. Administer the vaccine intramuscularly at a dose of 0.5 ml.
3. **Follow...
tetanus toxoid vaccine, pregnancy, neonatal tetanus prevention, midwife procedure

Antiretroviral Drug Administration (1)

Administering Zidovudine for Prevention of Mother-to-Child HIV Transmission During Pregnancy
High Priority Source: A Book for Midwives
Procedure:

1. Start Antenatal Treatment:
- Begin administering AZT to the mother at 14 weeks of pregnancy, giving 300 mg twice a day every day.

2. Administer Intrapartum Dose:
- At the onset of labor, give the mother a single...
zidovudine,AZT,HIV prevention,pregnancy treatment,newborn prophylaxis

Anemia Management (1)

Recognizing and Managing Anemia in Patients on Zidovudine Therapy
High Priority Source: A Book for Midwives
Procedure:

1. Monitor for Signs of Anemia:
- Watch for symptoms such as pale skin, fatigue, dizziness, and shortness of breath.

2. Check Hemoglobin Levels Regularly:
- Perform hemoglobin testing before initiating AZT therapy and...
anemia management,zidovudine,AZT,hemoglobin monitoring,emergency care

Drug Interactions (1)

Avoiding Contraindicated Drug Combinations with Zidovudine
Standard Source: A Book for Midwives
Procedure:

1. Identify Contraindicated Drugs:
- Avoid administering zidovudine (AZT) in combination with stavudine (d4T), as this combination is associated with increased toxicity and adverse effects.

2. **Review Medication Regimens...
zidovudine,AZT,stavudine,d4T,contraindicated drug combinations

Healthcare Access (1)

Accessing Family Planning and Women’s Health Services through Pathfinder International
Standard Source: A Book for Midwives
Procedure:

1. Contact Pathfinder International at their office located at 9 Galen Street, Suite 217, Watertown, MA 02472, USA.
2. Call them at (1-617) 924-7200 or send an email to information@pathfind.org for more information about their...
Pathfinder International, family planning, women's health, healthcare systems, training, midwifery resources

Terminology (1)

Understand and Use Medical Terminology in Midwifery
Standard Source: A Book for Midwives
This book uses simple language to explain medical terms. However, it is also important to understand technical terms that may be used by healthcare professionals.

### Key Terms:
Amniotic fluid: The liquid surrounding the baby inside the...
medical terminology, midwifery terms, amniotic fluid, anesthesia, bacteria, bilirubin, biopsy, bowel, circulation, complication, contagious, embryo, engagement, engorgement, fallopian tubes, fertilization, forceps, genitals, hemorrhage, hemostat, ectopic pregnancy, high level disinfection, intestine, invasive procedure, kidneys, ligaments, membranes, menstrual cycle, menstruation, midwife, rh factor, scrub, sterilize, tissue, uterus, virus, obstetrics, premature, prolapse

Pregnancy Assessment (1)

Measuring the Womb for Pregnancy Assessment
Standard Source: A Book for Midwives
Procedure for Measuring the Womb During Pregnancy

Purpose:
To assess fetal growth and estimate gestational age.

Materials Needed:
• Cloth tape measure or ruler
• Knowledge of anatomical landmarks (e.g., pubic bone,...
fundal height, womb measurement, pregnancy assessment, fetal growth, gestational age

Pregnancy Medication (1)

Administering Medicines Safely During Pregnancy and Breastfeeding
High Priority Source: A Book for Midwives
Procedure for Administering Medicines Safely During Pregnancy and Breastfeeding

Overview:
Medications must be carefully selected to ensure the safety of both mother and baby. Some medications are contraindicated during pregnancy or...
safe medication use, pregnancy, breastfeeding, drug safety, teratogenic effects

Disability Care (1)

Provide Disability-Friendly Health Care for Women with Disabilities
Standard Source: A Book for Midwives
Procedure:

1. Assess individual needs: Evaluate the specific health care requirements of women with disabilities, taking into account their physical and cognitive abilities.
2. Ensure accessibility: Modify health care environments to be...
disability,family planning,pregnancy,health care,sexual relationships,caregivers,social stigma

Preparation (1)

Disclose Medical Limitations and Personal Factors
High Priority Source: Aids to Survival
Title: Disclose Medical Limitations and Personal Factors

Procedure:
1. Ensure that any medical condition or personal limitation of a group member is known to the leader prior to commencing the expedition.
2. Review all disclosed information...
medical disclosure, personal limitations, expedition preparation

Treatment Area Setup (1)

Nonemergent Treatment Area Setup and Management
Standard Source: Emergency War Surgery
Purpose: To provide care for non-critical casualties while maintaining readiness for emergency cases.

### Setup Requirements
• Use an empty ward, cleared-out supply area, or similar space that can be easily converted into a treatment...
nonemergent treatment setup, noncritical care, medical team roles

Expectant Casualty Management (1)

Expectant Casualty Management and Retriage
Standard Source: Emergency War Surgery
Purpose: To manage casualties with low survival probability while ensuring comfort and potential retriage if needed.

### Setup Requirements
• Expectant casualties should be kept in an area away from all other treatment areas to avoid...
expectant casualty care, retriage protocol, pain management

Ventilation (1)

Ventilation with Bag Valve Mask (BVM)
Critical Source: Emergency War Surgery
Objective: Provide effective ventilation to the patient using a bag valve mask.

Procedure:
1. Positioning: Bring the face into the mask rather than pushing the mask onto the face.
2. Head positioning: Use chin-lift and head tilt...
bag valve mask, ventilation, airway management, two-person mask ventilation, tension pneumothorax, chest decompression

Transfusion Reaction (1)

Field Management of a Transfusion Reaction
Critical Source: Emergency War Surgery
Immediate Actions

Stop the infusion of blood immediately.
• Continue to infuse normal saline through the intravenous line.

Diagnostic Evaluation

• Examine urine for hemoglobinuria and **plasma for...
transfusion reaction, hemoglobinuria, hemoglobinemia, saline infusion, oliguria, mannitol, furosemide, documentation

Wound Infections (1)

Identifying Wound Infections in Battlefield Conditions
High Priority Source: Emergency War Surgery
Procedure for Identifying Wound Infections in Battlefield Conditions:

1. Assess clinical signs: Look for the four “-ors”: dolor (pain and tenderness), rubor (redness), calor (warmth), and tumor (swelling).

2. **Check for...
battlefield wounds, infection signs, wound assessment, clostridial infection, necrotizing fasciitis

Critical Care (1)

Provide ICU Support for Sepsis-Related Organ Failure
Critical Source: Emergency War Surgery
ICU support is required for failing organ systems such as:
Cardiovascular collapse
Acute renal failure
Respiratory failure

Intensive care resuscitation involves vigorous efforts to restore perfusion and prevent multiple...
icu support, sepsis resuscitation, hemodynamic optimization, perfusion restoration, organ failure, urine output, base deficit, blood lactate

Transport Medical (1)

Prepare Patient for Transport Out of Theater
Standard Source: Emergency War Surgery
Prepare the patient for transport out of theater:

• Ensure all critical interventions have been completed.
• Stabilize the patient for safe movement and transfer to a higher level of care.
patient transport,stabilization,emergency evacuation

Cardiovascular Management (1)

Recognize and Treat Myocardial Ischemia/Infarction (MI) in Critical Care
Critical Source: Emergency War Surgery
Objective: Identify and treat myocardial ischemia or infarction in critical care settings.

Signs/Symptoms of MI:
Angina-like chest pain.
• Unexplained cardiac instability, such as arrhythmias or hypotension.

Diagnosis:
• Presence...
myocardial infarction,aspirin,nitroglycerin,beta-blocker,thrombolytic therapy

Endocrine Health (1)

Control Hyperglycemia in ICU Patients
High Priority Source: Emergency War Surgery
Hyperglycemia is a common complication in critically ill patients and must be managed to prevent complications such as ketoacidosis, hyperosmolar coma, and intravascular volume loss due to osmotic diuresis.

### Causes of Hyperglycemia:
-...
hyperglycemia,insulin infusion,tpn,osmotic diuresis,icu glucose management

Musculoskeletal Injuries (1)

Monitor for Musculoskeletal Complications
High Priority Source: Emergency War Surgery
Procedure:

• Continuously monitor for signs of compartment syndrome, which includes pain, pallor, paresthesia, paralysis, and pulselessness.
• Watch for symptoms of vascular ischemia such as coldness, numbness, or loss of function in...
compartment syndrome,vascular ischemia,rhabdomyolysis,musculoskeletal monitoring

Abdominal Compartment Syndrome (1)

Assess and Interpret Abdominal Pressure Degree of Elevation Clinical Effects
Critical Source: Emergency War Surgery
Objective: Understand the clinical implications of different levels of intra-abdominal pressure (IAP) to guide management decisions.

| Abdominal Pressure (mm Hg) | Degree of Elevation | Clinical Effect |
|---|---|---|
| **10–20 mm...
intra-abdominal pressure, IAP levels, abdominal compartment syndrome, clinical effects of IAP

Head And Face Injuries (1)

Manage Mandibular Fracture with Wires/Arch Bars
High Priority Source: Emergency War Surgery
Procedure for Managing Mandibular Fractures Using Wires or Arch Bars:

1. Assess the patient's airway and breathing, ensuring it is not compromised by swelling, bleeding, or displacement of the jaw.
2. **Immobilize the mandible using...
mandibular fracture, wire fixation, arch bar, facial immobilization

Head Injury Evacuation (1)

Evacuation of Severely Head-Injured Patient
Critical Source: Emergency War Surgery
Procedure:

• Transport only patients who can be expected to survive a 12–24 hour movement, considering potential delays, route changes, or tactical situations.
• Post-operative craniotomy patients should be observed for 12–24 hours...
evacuation, head injury, ICP monitoring, ventriculostomy, transport, GCS, critical care, hypothermia prevention

Anatomy And Injuries (1)

Identify Anatomic Boundaries of the Thoracic Inlet
High Priority Source: Emergency War Surgery
Anatomic Considerations:

• The superior border is at the level of the clavicles anteriorly and the junction of the C7-T1 vertebral bodies posteriorly.
• The thoracic inlet contains major structures including:
- Arteries: **common...
thoracic inlet, anatomy, chest injury, anatomic boundaries, thoracic trauma

Chest Injuries Treatment (1)

Treat Open Pneumothorax and Flail Chest Injuries
Critical Source: Emergency War Surgery
- Open pneumothorax (hole in the chest wall) is treated by:
- Placing a chest tube
- Sealing the hole with an oneway valve chest dressing or a square piece of plastic taped to the chest on three sides.

Flail chest (entire...
open pneumothorax treatment, flail chest management, intercostal nerve block, Marcaine use

Surgery Assessment (1)

Assess Physiologic Status and Plan Operatively
High Priority Source: Emergency War Surgery
Assess physiologic status. Considering casualty physiology, create operative plan to control contamination and complete operation. Consider damage control (see Chapter 12, Damage Control Surgery) early and often. If stabilized/improving, proceed...
physiologic assessment,surgery planning,damage control

Spinal Injury Classification (1)

Classification of Spinal Injuries in Combat Settings
High Priority Source: Emergency War Surgery
Objective: Classify spinal injuries based on four discriminators to guide treatment.

Steps:
1. Determine if the injury is open or closed.
- Open: Penetrating wounds with exposure of bone or tissue.
- Closed: No external wound, but...
spinal injury classification, open vs closed, neurologic status, spinal columns

Spinal Cord Pathophysiology (1)

Pathophysiology of Spinal Cord Injury in Combat Settings
Critical Source: Emergency War Surgery
Objective: Understand the mechanisms of spinal cord injury to guide treatment.

Steps:
1. Recognize primary injury mechanisms:
- Direct mechanical trauma from high-velocity missile wounds, even without direct contact with the spinal...
spinal cord injury, primary vs secondary mechanisms, decompressive laminectomy, hypoxia, neuroprotection

Spinal Injury Transport (1)

Transport of Spinal Injured Patients in Combat Settings
Critical Source: Emergency War Surgery
Objective: Ensure safe transport of spinal injured patients while prioritizing life-saving interventions.

Steps:
1. Prioritize life preservation and medic safety over spine immobilization on the battlefield.
2. **Evacuate to a secure...
battlefield transport, spinal immobilization, cervical collar, spine board, penetrating injuries

Surgical Preparation (1)

Operative Preparation for Vascular Repair
High Priority Source: Emergency War Surgery
Step-by-step procedure:

1. Prepare and drape the injured extremity as well as the contralateral uninjured limb in case autogenous vein graft is required.
2. Ensure that all necessary surgical instruments are available.
3. This...
vein graft, surgical preparation, drape, vascular repair

Circulation Management (1)

Circulation Management in Burn Patients
High Priority Source: Emergency War Surgery
- Secure all cannulae (peripheral and central) with suture, because tape will not adhere well.

Cuff blood pressure (BP) measurements may be inaccurate in patients with burned or edematous extremities. Arterial BP is preferred.
cannulae securing,suture,tape failure,burned extremities,arterial blood pressure

Surgery Postoperative Care (1)

Postoperative Care of Donor Sites and Grafted Extremities
Standard Source: Emergency War Surgery
Procedure for Postoperative Care:

1. Dressing Donor Sites:
- Dress donor sites with fine-mesh gauze.
- Treat the site open, applying a heat lamp until the gauze is dry.

2. Immobilization of Grafted Extremities:
- Immobilize...
postoperative care,donor site,grafted extremities,immobilization,compression garments

Chemical Burns And Agents (1)

Administer Treatment for Cyanogen Exposure (Hydrogen Cyanide or Cyanogen Chloride)
Critical Source: Emergency War Surgery
Procedure:

1. Immediate removal from contaminated atmosphere:
- Prevent further inhalation of cyanogens.

2. Provide 100% oxygen:
- Administer high-flow oxygen to the casualty.

3. **If ingested, perform gastric lavage and...
cyanide, sodium nitrite, sodium thiosulfate, hydrogen cyanide, cyanogen chloride

Endocrine Metabolism (1)

Manage Hypoglycemia in Infants and Children
Critical Source: Emergency War Surgery
Procedure:

1. Identify risk factors for hypoglycemia:
- Premature infants are at higher risk due to low glycogen storage capacity.
- Full-term infants can tolerate NPO status for about 5 days with an appropriate D10 solution.
-...
hypoglycemia, infant, child, D10 solution, TPN, NPO status

Renal (1)

Manage Electrolyte Imbalances and Renal Function in Infants
High Priority Source: Emergency War Surgery
Procedure:

1. Assess renal function:
- Infants have limited ability to concentrate urine (max 400–600 mOsm/L) and a fixed capacity to excrete sodium.
- Premature infants are salt wasters, while full-term infants are salt...
hypernatremia, electrolyte imbalance, renal function, sodium excretion, GFR, hydration

Initial Medical Screening (1)

Physical Examination and Vital Statistics for Internees
High Priority Source: Emergency War Surgery
- Each prisoner who comes into the facility must receive a complete physical examination including a dental examination. Vital statistics are recorded for each internee treated. Essential care should be given at this point. Other follow-up...
physical exam,vital stats,internee intake

Daily Sick Call (1)

Routine Sick Call and Care During Internment
Standard Source: Emergency War Surgery
- During internment, routine sick call is provided on a daily basis; this includes medication dispensing, wound care, and indicated minor procedures.
sick call,wound care,minor procedures

Standard Of Care (1)

Maintain the Same Standard of Care for Enemy Prisoners of War/Internees as US Forces
High Priority Source: Emergency War Surgery
- The same standard of care as that provided to US forces must be maintained.

• Retained medical personnel should be utilized for care of their compatriots in conformity with the Geneva Conventions.
standard of care,Geneva Conventions,enemy prisoners

War Injuries (1)

Understanding the Epidemiology of Injuries in Conventional Warfare
Standard Source: Emergency War Surgery
Objective: Understand the distribution and causes of injuries in conventional warfare.

Background:
• Weapons of conventional war can be divided into explosive munitions and small arms:
- Explosive Munitions: Artillery, grenades,...
epidemiology,warsurgery,bullets,mortars,grenades,vietnam,bougainville

Military Medical Care (1)

Level II Medical Care Overview
High Priority Source: Emergency War Surgery
Description:

Increased medical capability: Compared to Level I.
Inpatient bed space: Limited inpatient bed capacity available.

Services Provided:

• Basic primary care.
• Optometry services.
• Combat operational stress control...
level ii medical care, mobile units, inpatient services

Treatment Areas (1)

Expectant Area Setup and Management
Standard Source: Emergency War Surgery
Location: Expectant casualties should be kept in an area separate from all other treatment areas.

Staffing: The team leader can be anyone capable of administering parenteral pain medications.

Patient Care: Ensure the patient is...
expectant area, non-survivable casualties, retriage protocol

Shock Recognition (1)

Recognize and Classify Shock in a Combat Casualty
High Priority Source: Emergency War Surgery
Objective: Identify signs and symptoms of shock to initiate appropriate treatment.

Signs and Symptoms of Shock:
• Poor skin turgor
• Pallor
• Cool extremities
• Capillary refill > 2 seconds
• Anxiety, confusion, or obtundation
-...
shock recognition, hypovolemic shock, cardiogenic shock, distributive shock, septic shock, clinical correlates, blood volume loss

Hemorrhagic Shock (1)

Implement Controlled Resuscitation for Hemorrhagic Shock
Critical Source: Emergency War Surgery
Objective: Achieve and maintain adequate perfusion without excessive fluid resuscitation that may dislodge clots.

Indications: Prior to establishing definitive hemorrhage control in patients with severe bleeding or shock.

Goals:
1....
controlled resuscitation, hemorrhage control, hypotensive resuscitation, perfusion goals, SBP, MAP, hypothermia prevention

Intubation Procedures (1)

Rapid Sequence Intubation Drug Checklist
Critical Source: Emergency War Surgery
Drugs Required for Rapid Sequence Intubation:

Narcotics:
- Fentanyl: 2.0–2.5 µg/kg IV bolus, then titrate to effect
- Morphine: 5–10 mg IV bolus to load, then 2 mg q5min to effect
- Dilaudid (Hydromorphone): 1–2 mg IV to...
rapid sequence intubation, drug checklist, fentanyl, morphine, dilaudid, succinylcholine, vecuronium, rocuronium, pancuronium, versed, scopolamine

Anesthesia And Ventilation (1)

Conventional Plenum Anesthesia Machine Setup and Use in Battlefield Conditions
Standard Source: Emergency War Surgery
Objective: Understand the setup and use of conventional plenum anesthesia machines on the battlefield.

Currently Fielded Models:
Drager Narkomed
Magellan 2000

Description:
These are compact versions of standard OR...
plenum anesthesia machine, battlefield surgery, Drager Narkomed, Magellan 2000

Cardiac Management (1)

Dobutamine Use in Cardiac Dysfunction
High Priority Source: Emergency War Surgery
- Dobutamine should only be considered for patients with demonstrated cardiac dysfunction, which may occur in:
- Sepsis
- The elderly
- Myocardial infarction (MI).
dobutamine,cardiac dysfunction,sepsis,elderly,myocardial infarction

Hematologic Disorders (1)

Prevention of DVT and Pulmonary Embolism in Trauma Patients
High Priority Source: Emergency War Surgery
To prevent trauma-related deep venous thrombosis (DVT) and pulmonary embolism:

Prophylactic measures are required:
- Subcutaneous heparin
- Sequential compression devices
DVT prevention, pulmonary embolism, heparin, sequential compression devices

Facial Fractures (1)

Assess for Naso-Orbito-Ethmoid (NOE) Fractures
High Priority Source: Emergency War Surgery
Title: Assess for Naso-Orbito-Ethmoid (NOE) Fractures

Procedure:
1. Measure the intercanthal distance.
2. If the intercanthal distance measures > 40 mm (approximately the width of the patient’s eye), evaluate and treat for a possible...
NOE fracture,intercanthal distance,cerebrospinal fluid contamination

Diagnosis And Assessment (1)

Perform Systemic Palpation and Inspection for Facial Fractures
High Priority Source: Emergency War Surgery
Procedure:

1. Inspect the face for signs of trauma: crepitus, tenderness, ecchymosis (bruising), and subconjunctival hemorrhage.
2. Palpate the facial bones to detect mobility or instability in the hard palate, mid-face, or nasal...
facial fracture diagnosis,palpation,inspection,cns injury,orbital trauma

Brain Injury Mechanisms (1)

Understand Primary and Secondary Brain Injury Mechanisms
Critical Source: Emergency War Surgery
Procedure:

1. Recognize primary brain injury as a result of energy transmitted to the brain by an external agent (e.g., trauma, blast).

2. Note that little can be done medically to influence primary injury, making prevention...
primary injury, secondary injury, hypotension, hypoxia, ICP monitoring, CPP, brain edema, cerebral perfusion pressure

Thrombosis Prevention (1)

Prevent Deep Vein Thrombosis in Spinal Cord Injury Patients
High Priority Source: Emergency War Surgery
Prevention Protocol:
1. Start mechanical prophylaxis immediately (e.g., compression devices).
2. Initiate chemical prophylaxis after acute bleeding has stopped.
- Refer to Chapter 11, ICU Care, for detailed guidelines on chemical...
DVT prevention, spinal injury, mechanical prophylaxis, chemical prophylaxis

Urinary Tract Management (1)

Manage Bladder Dysfunction After Spinal Cord Injury
High Priority Source: Emergency War Surgery
Complication: Failure to decompress the bladder may lead to autonomic dysreflexia and a hypertensive crisis.

Management Steps:
1. Empty the bladder using intermittent or indwelling catheterization.
2. Do **not use antibiotic...
bladder dysfunction, spinal injury, catheterization, autonomic dysreflexia

Wound Prevention (1)

Prevent Decubitus Ulcers in Immobilized Patients with Spinal Injuries
High Priority Source: Emergency War Surgery
Risk: Skin breakdown begins within 30 minutes in immobilized hypotensive patients.

Management Steps:
1. For prolonged transport, remove the casualty from the hard spine board and place on a litter.
2. Perform frequent turning...
decubitus ulcers, pressure sores, spinal injury, immobilization, physical therapy

Imaging Procedures (1)

Biplanar Radiographs for Extremity Fractures
Standard Source: Emergency War Surgery
Procedure:

1. Purpose:
- Obtain biplanar radiographs to accurately assess the location, severity, and alignment of long bone fractures.

2. Steps:
- Ensure proper positioning of the patient for imaging.
- Use standard...
biplanar radiographs,extremity fracture,x-ray imaging,fracture assessment

Post Op Care (1)

Post-Operative Care and Delayed Primary Closure for Open-Joint Injuries
High Priority Source: Emergency War Surgery
Objective: Provide post-operative care and manage delayed primary closure (DPC) if needed.

### Action Steps:
1. If there are delays in evacuation or inability to move the patient, consider the following options:
- **Delayed primary...
delayed primary closure, range-of-motion therapy, bivalved cast, soft-tissue loss, skin grafts

Hand Foot Injuries (1)

Assess and Manage Hand and Foot Injuries in Combat
High Priority Source: Emergency War Surgery
Introduction:
Combat injuries to the hands and feet differ from those of the arms and legs in terms of mortality and morbidity. Death is rare, but a minor wound that would cause no lasting impairment on the thigh can result in life-long...
combat hand injuries,foot injuries,deep space infection,tendon sheath injury,compartment syndrome,munitions blast injuries

Wound Monitoring (1)

Daily Burn Wound Inspection by a Surgeon
High Priority Source: Emergency War Surgery
Objective: Identify early signs of infection or complications in burn wounds.

### Steps:
Daily inspection of the burn wound by a surgeon is essential to detect early infection complications.
• Look for:
- Changes in wound color...
burn wound inspection, infection monitoring, surgical evaluation

Renal Protection (1)

Management of Pigmenturia and Renal Protection in Burn Patients
High Priority Source: Emergency War Surgery
Procedure:

1. Pigmenturia (myoglobinuria) is diagnosed by:
- Reddish-brownish urine
- Positive dipstick test for blood
- Insignificant numbers of red blood cells on microscopy
2. Increase the hourly LR rate until a **urine output...
pigmenturia,myoglobinuria,LR rate,mannitol,sodium bicarbonate

Rhabdomyolysis (1)

Treatment of Hyperkalemia and Rhabdomyolysis in Burn Patients
Critical Source: Emergency War Surgery
Procedure:

1. Hyperkalemia may occur as a result of rhabdomyolysis, which must be carefully assessed and treated.
2. Treat hyperkalemia with:
- Calcium gluconate infusion
- Insulin and glucose administration
3. Monitor...
hyperkalemia,rhabdomyolysis,calcium gluconate,insulin glucose,surgical debridement

Heat Injury Response (1)

Recognize and Respond to Heat Illness in Service Members
Critical Source: Emergency War Surgery
Recognize and Respond to Heat Illness in Service Members

• One case of heat illness is a warning sign that many others are imminent.
• The most life-threatening condition is heatstroke.
• Severity of heat illness depends on the maximum core...
heat illness,heatstroke,symptoms,response,core temperature

Altitude Sickness Treatment (1)

Descent for Altitude Illness Management
Critical Source: Emergency War Surgery
Prompt descent is the most effective intervention for altitude illness.

Descent requirement: At least 1,000 m (3,300 ft) if not more.

Portable hyperbaric chamber alternatives: Gamow bag (USA) or Certec SA (Europe) can be used...
descent for altitude sickness, Gamow bag, HACE treatment, HAPE management

Biological Warfare Agents (1)

Diagnosis of Biological Warfare Agent Exposure
Critical Source: Emergency War Surgery
The first indication of an attack may be when large numbers of patients present with the same constellation of signs and symptoms, especially for a disease that is not endemic to the area of operations.

In forward areas, **rapid diagnostic...
diagnosis,BW agents,ELISA,PCR

Pediatric Gastrointestinal (1)

Manage Gastrointestinal Issues in Pediatric Patients
High Priority Source: Emergency War Surgery
To manage gastrointestinal issues in pediatric patients:

Common findings and considerations:
Reflux is common, especially in newborns, which can lead to feeding difficulties and frequent vomiting.
Hypoglycemia risk: Due to low...
gastrointestinal issues,pediatric care,reflux in infants,hypoglycemia in children,necrotizing enterocolitis,dehydration management

Renal Function (1)

Manage Renal Function in Pediatric Patients
High Priority Source: Emergency War Surgery
To manage renal function in pediatric patients:

Key considerations:
Urine concentration ability: Infants and young children have limited capacity to concentrate urine (max 400–600 mOsm/L) and a fixed ability to excrete sodium. This can...
pediatric renal function,hypernatremia management,sodium handling in infants,total body water estimation

Pediatric Immunology (1)

Immunological Considerations in Pediatric Patients
High Priority Source: Emergency War Surgery
To manage immunological risks in pediatric patients:

Key considerations:
Immune system development: Premature infants have an incomplete immune system, leading to a 60-fold increased risk of sepsis.
Prophylactic antibiotics: All...
infant sepsis prevention,prophylactic antibiotics in infants,pediatric immunology,elective surgery in neonates

Pediatric Diagnosis (1)

Evaluate and Diagnose Abdominal Pain in Pediatric Patients
High Priority Source: Emergency War Surgery
### Evaluate and Diagnose Abdominal Pain in Pediatric Patients

Procedure Steps:
1. Take a detailed history:
- Determine the duration and location of pain, as over one third of pediatric patients with abdominal pain lasting more than...
abdominal pain, pediatric diagnosis, bilious emesis, intestinal obstruction, GI bleeding, ultrasound, contrast enema, appendicitis, intussusception, constipation

Triage And Surge Capacity (1)

Assess and Manage Medical Workload for Internees
Critical Source: Emergency War Surgery
Objective: Prepare for the high medical workload associated with internee care.

Procedure:
1. Estimate the number of internees requiring medical in-processing or care, based on historical data (e.g., 425,000 in WWII, 105,000 in Korea,...
internee workload, surgical admissions, surge capacity, fragment wounds, fracture treatment

Informed Consent (1)

Obtain Signed Permission for Surgical or Invasive Procedures
High Priority Source: Emergency War Surgery
- If possible, signed permission should be obtained for all surgical or invasive procedures.

• In contrast to civilian medical photography, the patient’s identity should be absolutely clear in each photograph. This is invaluable should there be a...
signed permission,medicolegal photography,informed consent,amputation documentation

Diagnosis Of Death (1)

Diagnosing Death in Remote Wilderness Settings
Critical Source: First Aid and Management of Minor Injuries
Purpose: To accurately diagnose death, especially in remote or wilderness environments where burial or cremation may be necessary.

Procedure:
1. Confirm unresponsiveness of the casualty.
2. Check for absent heart sounds by listening...
death diagnosis, hypothermia, cold water immersion, rigor mortis, cornea clouding, remote wilderness

Legal Protection In Medical Care (1)

Understand International Humanitarian Law Protection
Standard Source: First Aid in Armed Conflicts
International humanitarian law (IHL) protects:

1. Civilians who are not involved in hostilities.
2. Combatants no longer taking part in hostilities, such as the wounded, sick soldiers, or prisoners of war.
3. **Medical personnel and...
international humanitarian law, protection of civilians, medical personnel rights, legal framework for first aid

Risk Assessment In Hostile Environments (1)

Identify Major Hazards and Risks in Armed Conflicts
High Priority Source: First Aid in Armed Conflicts
Major hazards and risks include:

1. Weapons: Designed to kill or injure; can cause harm indiscriminately (e.g., missing targets, exploding prematurely, ricocheting, or being used without distinction).
2. Explosive remnants of war:...
weapons hazards, explosive remnants of war, terrorist threats, psychological trauma, risk assessment

Social Impact Of Conflict (1)

Address Consequences for the Social Fabric in Armed Conflicts
High Priority Source: First Aid in Armed Conflicts
Consequences for the social fabric include:

1. Internal disorder: May lead to criminal violence such as rape, looting, or banditry.
2. Social fragmentation: Communities may be torn apart by internal dissension, sabotage, and unclear...
social fragmentation, internal disorder, humanitarian access, neutrality principles

Vulnerable Populations In Conflict (1)

Support Vulnerable Populations in Armed Conflicts
Critical Source: First Aid in Armed Conflicts
Vulnerable people are at increased risk during armed conflicts and other situations of violence:

1. Harassment: May lead to displacement, hunger, separation of family members, or disappearance of loved ones.
2. Aggravated vulnerability:...
vulnerable populations, displacement, trauma support, mental health in conflict

Public Health In Conflict (1)

Address Public Health Challenges in Armed Conflicts
High Priority Source: First Aid in Armed Conflicts
Public health challenges include:

1. Lack of basic needs: Food, water, and shelter may be unavailable or difficult to access.
2. Disruption of healthcare systems: Destruction of hospitals, health-care centres, and disorganization of the...
public health in conflict, healthcare access, sanitation challenges, malnutrition

Casualty Assessment (1)

ABCDE Sequence for Initial Casualty Assessment in Armed Conflicts
Critical Source: First Aid in Armed Conflicts
Procedure:

Follow the ABCDE sequence to assess and manage life-threatening conditions:

1. Airway: Rapidly identify if the airway is actually or potentially obstructed.
- Look for signs such as lack of consciousness, decreased level of...
ABCDE sequence,casualty assessment,airway,breathing,circulation,disability,extremities,exposure,shock,spine injury,life-saving techniques

Casualty Stabilization (1)

Complete Examination and Stabilization Measures for Casualties in Armed Conflicts
Critical Source: First Aid in Armed Conflicts
Procedure:

After the initial ABCDE assessment, perform a complete examination following a systematic sequence:

1. Head: Examine the scalp, ears, face (including nose, mouth, jaw, and eyes) for injuries or signs of trauma.
2. Neck:...
complete examination,casualty stabilization,head-to-toe examination,front-and-back-and-sides approach,trauma management

Explosive Remnants Injuries (1)

Responding to Casualties in Explosive Remnant Contaminated Areas
Critical Source: First Aid in Armed Conflicts
Procedure:

1. Do not enter areas contaminated by explosives.
2. Do not attempt to rescue the casualty yourself; accessing and rescuing the casualty is a demining task.
3. Immediately seek professional help from trained demining...
anti-personnel mines, explosive remnants, casualty management, demining task, safety precautions

Victims Of Conflict (1)

Identify Other Victims in Armed Conflicts
High Priority Source: First Aid in Armed Conflicts
In addition to the wounded and sick, there are other kinds of victims of armed conflicts and other situations of violence, including:

• People deprived of their freedom
• Refugees and other displaced persons
• Dispersed families
• Families without...
armed conflicts,victims,displaced persons,refugees,families,disabled,orphans,widows

Patient Monitoring (1)

Keeping Good Records Of Patient Vital Signs And Fluid Intake/Output
Standard Source: Flu Home Treatment
Keeping Good Records Of Patient Vital Signs And Fluid Intake/Output

To monitor a patient's condition at home:
1. Record vital signs daily, including temperature, pulse rate, breathing rate, blood pressure, and weight (if the patient can...
vital signs, patient monitoring, fluid intake, urine output, dehydration tracking

Recovery Procedures (1)

Exercise After Influenza Recovery
Reference Source: Flu Home Treatment
During the recovery period after influenza, passive stretching and massage can help a weakened patient recover. These activities help bring the dormant joints, tendons, and muscles back to life and work out the soreness that builds up in these...
flu recovery, passive stretching, range of motion exercise, post-flu exercise, muscle soreness, bed rest, assisted walking

Child Flu Care (1)

Keep Children With Flu Comfortable
Standard Source: Flu Home Treatment
Steps to Keep Children With Flu Comfortable

1. Ensure Rest: A child with flu should get lots of rest, which will help the body fight the virus and keep them more comfortable.

2. Provide Fluids with ORS: Use an Oral Rehydration Solution...
flu care, child flu treatment, ORS, hydration, humidifier, nasal aspirator, acetaminophen, dextromethorphan

Child Dehydration (1)

Recognize Signs and Symptoms of Dehydration in Children
High Priority Source: Flu Home Treatment
Signs and Symptoms of Dehydration in Children

Early signs: Cranky and irritable behavior.
Later signs: Lethargy or lifelessness, difficulty awakening, very little energy, and being “rag doll weak”.
Physical signs: Sunken eyes,...
dehydration in children, signs of dehydration, flu symptoms, child health

Child Dehydration Prevention (1)

Prevent Dehydration in Children with Flu
High Priority Source: Flu Home Treatment
Steps to Prevent Dehydration

Start Fluid Therapy Early: As soon as the child becomes ill, begin fluid therapy and keep pushing the fluids as long as she has a fever, diarrhea, or is not eating.

Use ORS Formula for Children: The...
preventing dehydration, ORS for children, flu prevention, hydration in children

Child Cough Management (1)

Manage Cough in Children with Bird Flu
Standard Source: Flu Home Treatment
Managing Cough in Children with Bird Flu

Understand the Purpose of Cough: Almost every child with bird flu will cough. A cough helps rid the lung of mucus and phlegm.

Dry Cough Management:
- A dry cough is usually due to an...
bird flu cough treatment, dextromethorphan use, humidifier for children, wet vs dry cough

Neurological Care (1)

Understand the Importance of Oxygen to the Brain
Critical Source: FM 4 25 11 First Aid
Procedure:

1. Recognize that brain cells begin to die within 4 to 6 minutes without oxygen.
2. Understand that once brain cells die, they are permanently lost and cannot regenerate.
3. Know that this can result in permanent brain damage,...
oxygen to brain, brain damage, emergency medical procedure, neurological care

Heat Injuries Prevention (1)

Prevent Heat Injuries Through Proper Clothing and Environmental Awareness
High Priority Source: FM 4 25 11 First Aid
Procedure:

1. Avoid exposure to extreme heat, such as from direct sunlight or high-temperature environments.
2. Wear proper clothing for the environment, including specialized gear like cold weather equipment when necessary.
3. **Avoid...
heat injury prevention, proper clothing, extreme heat, MOPP gear, closed spaces

Heat Injuries Monitoring (1)

Monitor Heat Casualty for Development of Life-Threatening Conditions
Critical Source: FM 4 25 11 First Aid
Procedure:

1. Continuously monitor the casualty for signs that may require basic lifesaving measures.
2. Watch for worsening symptoms, such as loss of consciousness, seizures, or no sweating (indicative of heatstroke).
3. **If any...
monitoring heat casualty, life-threatening conditions, first aid response

Head Injury Airway Management (1)

Positioning a Casualty with Head/Neck Injury for Airway Clearance
High Priority Source: FM 4 25 11 First Aid
DO NOT move the casualty if you suspect he has sustained a neck, spine, or head injury (which produces any signs or symptoms other than minor bleeding).

If the casualty has a minor (superficial) scalp wound and is conscious:
1. Have the...
head injury,airway management,casualty positioning,spinal injury

Wound Exposure Nbc (1)

Exposing a Wound in an NBC Environment
High Priority Source: FM 4 25 11 First Aid
(2) _Expose the wound._ Remove the casualty’s helmet (if necessary). In a nuclear, biological, and chemical (NBC) environment, the first aid provider must leave the casualty as much protection (such as protective mask, mission-oriented protective...
NBC environment,wound exposure,protective gear

Snakebite Response (1)

Responding to a Snakebite
Critical Source: FM 4 25 11 First Aid
Overview: All snakebites should be treated as potentially poisonous. Immediate medical attention is required for any snakebite, whether from a venomous or non-venomous snake.

Procedure:
1. Do not attempt to identify the snake unless it...
snakebite, medical attention, venomous snake, first aid, emergency response

Heat Related Illness (1)

Cooling Measures for Elevated Body Temperature from Incapacitating Agents
Critical Source: FM 4 25 11 First Aid
Procedure:

1. If the casualty has elevated body temperature and dry mucous membranes, take immediate action to cool them.
2. Use the following methods:
- Spray with cool water and provide air circulation (fanning).
- Apply...
cooling techniques, heatstroke, anticholinergic poisoning, evacuation

Facility Operations (1)

Understand the Role of Medical Treatment Facilities (MTFs)
Standard Source: Full First Aid Manual FM 2111
A Medical Treatment Facility (MTF) is any facility established for providing medical treatment and includes:

• Battalion aid stations
• Level II facilities
• Dispensaries
• Clinics
• Hospitals

*Note: These facilities are part of the health...
medical treatment facility, MTF, military medical facilities

Transition Procedures (1)

Understand the Transition from Casualty to Patient in the HSS Chain
Standard Source: Full First Aid Manual FM 2111
Once a casualty enters the health service support (HSS) chain:

1. The role of first aid ceases.
2. The casualty becomes referred to as a patient.
3. This transition occurs when the casualty is acquired by a dedicated medical vehicle with a...
casualty to patient, HSS chain, transition in medical care

Spinal Injury Prevention (1)

Do Not Move Casualty with Suspected Back or Neck Injury
Critical Source: Full First Aid Manual FM 2111
Objective: Prevent further injury to a casualty suspected of having a back or neck injury.

Procedure:
• **Unless there is an immediate life-threatening situation (such as fire, explosion), DO NOT move a casualty with a suspected back or...
spinal injury, do not move, first aid, emergency

Outbreak Reporting (1)

Report Suspected Giardiasis Outbreaks to Health Authorities
Critical Source: giardia factsheet
Procedure:

1. Identify Potential Outbreaks:
- If you or members of your family are diagnosed with giardiasis and suspect that others (e.g., neighbors, travelers, or children’s friends) may also be infected, take action immediately.

2....
reporting giardiasis,health department,CDC,EPA,outbreak investigation

Pandemic Vaccine Distribution (1)

Allocate and Administer Pandemic Vaccine to Priority Groups
High Priority Source: HHSPandemicInfluenzaPlan
Procedure:

1. Allocate and administer pandemic vaccine to pre-defined priority groups.
2. Ensure security for protection of scarce vaccines.
3. Implement state and local vaccine distribution plans, guided by recommendations for use...
vaccine allocation,priority groups,distribution plans,tabletop exercises

Pandemic Antiviral Distribution (1)

Allocate Stockpiled Antiviral Drugs for High-Risk Populations
High Priority Source: HHSPandemicInfluenzaPlan
Procedure:

1. Allocate stockpiled antiviral drugs for use in pre-defined high-risk and critical infrastructure populations.
2. Ensure availability of at least 81 million treatment courses of approved antiviral drugs—enough for treatment...
antiviral drugs,high-risk populations,distribution plans,manufacturing capacity

Resource Distribution (1)

Distribute Stockpiled Medical Supplies for Pandemic Response
High Priority Source: HHSPandemicInfluenzaPlan
Procedure:

1. Identify health departments and federal agencies that provide direct patient care.
2. Distribute stockpiled ventilators and other medical material needed to treat and care for infected individuals to these entities.
3. Ensure that...
ventilators, medical supplies, stockpile distribution, pandemic response

Healthcare Capacity (1)

Deploy Federal Medical Stations for Healthcare Surge Capacity
High Priority Source: HHSPandemicInfluenzaPlan
Procedure:

1. Identify the hardest-hit areas during a pandemic.
2. Deploy Federal Medical Stations to these areas as available.
3. Ensure that these stations are equipped with adequate personnel, facilities, equipment, and supplies.
4....
federal medical stations, healthcare surge, pandemic response

Public Health Services (1)

Provide Surge Mortuary Services During Pandemic Outbreaks
High Priority Source: HHSPandemicInfluenzaPlan
Procedure:

1. Assess the expected number of fatalities based on pandemic severity.
2. Prepare and deploy assets (people, facilities, equipment, supplies) to manage a large volume of deceased individuals.
3. Ensure that mortuary services are...
surge mortuary services, pandemic fatalities, respectful disposition

Vaccine Production (1)

Prepare Reference Strains for Vaccine Manufacturing
Critical Source: HHSPandemicInfluenzaPlan
Procedure:

1. Identify and isolate reference strains of the influenza virus that are appropriate for vaccine manufacturing.

2. Ensure these strains meet all necessary quality standards and regulatory requirements set by health authorities.

3....
reference strains, vaccine manufacturing, influenza virus, quality standards

Drug Regulation (1)

Regulate Manufacturing Process for Pandemic Vaccines and Antiviral Drugs
Critical Source: HHSPandemicInfluenzaPlan
Procedure:

1. Ensure that the manufacturing process of pandemic vaccines and antiviral drugs complies with all applicable regulations and standards.

2. Conduct regular inspections and audits of manufacturing facilities to verify...
manufacturing process, vaccine regulation, antiviral drugs, compliance standards

Vaccine Approval (1)

Evaluate and License Pandemic Vaccines
Critical Source: HHSPandemicInfluenzaPlan
Procedure:

1. Evaluate the safety, efficacy, and quality of pandemic vaccines before licensing them for public use.

2. Conduct thorough reviews of clinical trial data and other relevant information to support the licensing decision.

3. Issue...
pandemic vaccine evaluation, licensing process, safety standards, efficacy review

Drug Approval (1)

Evaluate and Approve Antiviral Drugs for Influenza
Critical Source: HHSPandemicInfluenzaPlan
Procedure:

1. Evaluate the safety, efficacy, and quality of antiviral drugs used to treat influenza.

2. Conduct thorough reviews of clinical trial data and other relevant information to support approval decisions.

3. Approve antiviral drugs...
antiviral drug evaluation, approval process, safety standards, efficacy review

Vaccine Quality Control (1)

Prepare Reagents to Standardize Potency of Inactivated Influenza Vaccines
Critical Source: HHSPandemicInfluenzaPlan
Procedure:

1. Develop and prepare reagents that can be used to standardize the potency of inactivated influenza vaccines.

2. Ensure these reagents meet all necessary quality standards and regulatory requirements.

3. Store and manage these...
reagent preparation, vaccine potency standardization, quality control, influenza vaccines

Antiviral Preparedness (1)

Support Antiviral Drug Availability for Priority Populations
High Priority Source: HHSPandemicInfluenzaPlan
Procedure:

1. Ensure availability of antiviral drugs to treat priority populations during a pandemic.
2. Support containment efforts by providing antivirals to those involved in pandemic response activities.
3. Maintain stockpiles of antiviral...
antiviral drugs, priority populations, pandemic response

Pandemic Assessment (1)

Estimate Overall Pandemic Health Impacts Including Mortality and Severe Morbidity
High Priority Source: HHSPandemicInfluenzaPlan
Procedure:

1. Collect data on the number of deaths and cases of severe illness caused by the pandemic.
2. Analyze trends in mortality and morbidity across different populations and regions.
3. Use this information to estimate the overall health...
health impact, mortality, morbidity, pandemic assessment

Vaccination Development (1)

Determine Potential Vaccine Formulation Changes to Improve Efficacy or Supply
High Priority Source: HHSPandemicInfluenzaPlan
Procedure:

1. Analyze the current vaccine formulations used during the pandemic.
2. Identify any limitations in terms of efficacy, supply, or distribution.
3. Evaluate potential changes to vaccine formulations that could improve these...
vaccine formulation, efficacy improvement, supply optimization

Vaccination Administration (1)

Monitor Continued Administration of Vaccine to Persons Not Previously Protected
High Priority Source: HHSPandemicInfluenzaPlan
Procedure:

1. Identify individuals who were not previously protected by the vaccine during the initial pandemic wave.
2. Monitor the administration of vaccines to these individuals in subsequent waves or phases.
3. Ensure that all eligible...
vaccine administration, unprotected individuals, monitoring

Antiviral Assessment (1)

Assess Antiviral Effectiveness and Safety
High Priority Source: HHSPandemicInfluenzaPlan
Procedure:

1. Evaluate the effectiveness of antiviral drugs used during the pandemic in treating illness.
2. Assess the safety profile of these drugs, including any adverse effects reported.
3. Analyze the overall impact of antiviral use on...
antiviral effectiveness, safety profile, impact analysis

Vaccination Production (1)

Evaluate Need to Expand Vaccine and Antiviral Production Capacity
High Priority Source: HHSPandemicInfluenzaPlan
Procedure:

1. Analyze the current production capacity for vaccines and antivirals.
2. Identify any limitations in meeting future demand during subsequent pandemic waves.
3. Evaluate potential strategies for expanding production capacity,...
production capacity, vaccine expansion, antiviral availability

Intervention Assessment (1)

Evaluate Effectiveness of Vaccine, Antiviral Drugs, and Other Interventions
High Priority Source: HHSPandemicInfluenzaPlan
Procedure:

1. Analyze the effectiveness of vaccines, antiviral drugs, and other interventions used during the pandemic.
2. Compare outcomes across different groups to identify what worked best.
3. Document findings for future reference and...
vaccine effectiveness, antiviral drugs, intervention assessment

Healthcare System Preparedness (1)

Anticipating Healthcare System Strain During a Pandemic
Critical Source: HHSPandemicInfluenzaPlan
Procedure:

1. Estimate increased demand: Prepare for a surge in hospitalizations and ICU admissions, with models suggesting increases of over 25% even during moderate pandemics.
2. Plan resource allocation: Ensure that healthcare...
healthcare system,strain,pandemic,resource allocation,CDC

Elderly Care (1)

Identify Persons in Skilled Nursing Facilities for Pandemic Response Planning
Critical Source: HHSPandemicInfluenzaPlan
Procedure:

1. Identify persons residing in skilled nursing facilities as a priority group during a pandemic.
2. Exclude individuals from other residential settings such as:
- Assisted living facilities (due to higher mobility and less...
skilled nursing facilities,priority group,elderly care,pandemic response

Pandemic Research (1)

Conduct Research on Antiviral Drug Use for Pandemic Influenza
High Priority Source: HHSPandemicInfluenzaPlan
Objective: Support research to improve the use of antiviral drugs during a pandemic.

Procedure:
1. Conduct research on the impact of treatment at hospital admission on patient outcomes.
2. Determine optimal treatment doses for H5N1 and...
antiviral research,H5N1,dosage studies,diagnostic tests,infant safety

Research Development (1)

Accelerated Research and Development for Pandemic Influenza Countermeasures
High Priority Source: HHSPandemicInfluenzaPlan
Objective: Accelerate the development of new vaccines, drugs, and diagnostics to combat pandemic influenza.

Procedure:
1. Basic Discovery Research: HHS will support research in priority areas including:
- Natural history of influenza...
accelerated research,HHS support,vaccine development,antiviral drugs,diagnostics

Virus Research (1)

Conduct Basic Research on Influenza Virus Biology
High Priority Source: HHSPandemicInfluenzaPlan
Objective: Facilitate new ways of detecting and rapidly characterizing influenza viruses as they emerge.

Steps:
1. Support scientific research through NIH grants focused on:
- Fundamental issues in virology, immunology,...
basic research, influenza virus biology, virology, immunology, pathogenesis, genetics, reverse genetics, vaccine development

Genomics (1)

Support the Influenza Genome Sequencing Project
High Priority Source: HHSPandemicInfluenzaPlan
Procedure:

1. Identify and collect influenza virus isolates from diverse geographic regions.
2. Use next-generation sequencing (NGS) technologies to determine complete genetic sequences of these isolates.
3. Store sequence data in a centralized...
genome sequencing,project,virus,data sharing

Public Health Intervention (1)

Evaluate Effect of Interventions During Pandemic Outbreaks Early in Development
High Priority Source: HHSPandemicInfluenzaPlan
Procedure:

To evaluate the effect of interventions such as travel restrictions or school closings during early pandemic outbreaks:

1. Implement targeted public health measures, including travel bans, quarantine protocols, and closure of...
travel restrictions, school closures, pandemic interventions, transmission rates, public health policies

Vaccination Guidelines (1)

Accessing the Smallpox Response Plan and Guidelines from CDC
High Priority Source: HHSPandemicInfluenzaPlan
Title: Accessing the Smallpox Response Plan and Guidelines from CDC

Content:

The CDC provides detailed guidelines for responding to a smallpox outbreak, including:

1. Implementation Criteria: Conditions under which the response plan...
cdc smallpox plan, vaccine deployment, outbreak response, personnel mobilization

Pharmaceutical Guidelines (1)

Accessing Influenza Antiviral Drug Information from FDA's Center for Drug Evaluation and Research (CDER)
Standard Source: HHSPandemicInfluenzaPlan
Title: Accessing Influenza Antiviral Drug Information from FDA's Center for Drug Evaluation and Research (CDER)

Content:

The Food and Drug Administration (FDA) provides information on influenza antiviral drugs through its Center for Drug...
fda cd er, flu antiviral drugs, drug safety, regulatory guidelines

Pharmacology Antivirals (1)

Determine Drug Susceptibilities of Pandemic Virus
High Priority Source: HHSPandemicInfluenzaPlan
Procedure:

1. Identify the drug susceptibilities of the pandemic virus through laboratory testing and analysis.
2. Collaborate with state and local health departments to collect data on antiviral resistance patterns.
3. Monitor changes in viral...
drug susceptibility, pandemic virus, antiviral resistance

Diagnostics Lab Tests (1)

Select Laboratory Tests for Pandemic Influenza Confirmation
High Priority Source: HHSPandemicInfluenzaPlan
Procedure:

1. Identify which laboratory tests are available locally to confirm pandemic influenza cases, including:
- Rapid antigen detection tests
- PCR (polymerase chain reaction) testing
- Viral culture
2. Determine which...
laboratory testing, pandemic influenza, CDC subtyping

Public Health Surveillance (1)

Utilize NREVSS Collaborating Laboratories for Influenza Surveillance
Standard Source: HHSPandemicInfluenzaPlan
Procedure:

1. Identify NREVSS collaborating laboratories in your area (over 90 laboratories nationwide, including hospital and public health labs).
2. Collect respiratory specimens from patients suspected of having influenza.
3. **Use...
NREVSS laboratories, influenza surveillance, rapid diagnostic tests, CDC reporting, public health data

Epidemiology Outbreaks (1)

Using Single Serum Samples in Outbreak Investigations
Standard Source: HHSPandemicInfluenzaPlan
Procedure:

1. In investigations of outbreaks due to novel viruses:
- Collect single serum samples from individuals suspected of being infected.
- Test these samples for antibody against the novel virus.
2. In other outbreak...
single serum sample, outbreak investigation, geometric mean titer

Infectious Disease Handling (1)

Laboratory Biosafety Guidelines for Handling Novel Influenza Strains
Critical Source: HHSPandemicInfluenzaPlan
Procedure:

Biosafety Requirements:
• All laboratories handling specimens or isolates of novel influenza strains must follow strict biosafety guidelines.
• Use appropriate personal protective equipment (PPE) and ensure that all...
laboratory biosafety H5N1, PPE for influenza strains, BSL-3 facility, specimen handling protocols

Surge Capacity (1)

Implement Surge Capacity Plans During Pandemic Influenza Outbreak
Critical Source: HHSPandemicInfluenzaPlan
Objective: Ensure healthcare delivery can continue during a surge in patient volume.

Procedure:
1. Activate surge capacity plans that include additional staffing, temporary beds, and alternative care sites (e.g., field hospitals).
2....
surge capacity planning, healthcare resource management, pandemic response

Triage And Isolation (1)

Implement Triage Strategies for Pandemic Influenza Patients
High Priority Source: HHSPandemicInfluenzaPlan
Objective: Develop and implement triage strategies to identify, isolate, and manage patients with pandemic influenza.

Steps:
1. Develop a triage strategy that includes:
- Using phone triage to determine if patients require...
pandemic influenza triage, hospital triage procedures, isolation protocols, emergency department management

Facility Access Control (1)

Establish Facility Access Controls During Pandemic Influenza Outbreaks
Critical Source: HHSPandemicInfluenzaPlan
Objective: Define and implement access control measures to limit unnecessary facility entry during a pandemic.

Steps:
1. Define essential vs. non-essential visitors based on the hospital’s needs and the population it serves.
2. Develop...
hospital access control, pandemic facility management, visitor restrictions, emergency hospital protocols

Antiviral Procedures (1)

Establish Strategy for Rapid Vaccination or Antiviral Prophylaxis/Treatment
High Priority Source: HHSPandemicInfluenzaPlan
- Establish a strategy for rapidly vaccinating or providing antiviral prophylaxis or treatment to healthcare personnel as recommended by HHS and state health departments. Preliminary recommendations on the use of antiviral drugs and vaccination have...
rapid vaccination, antiviral prophylaxis, HHS recommendations

Healthcare Standards (1)

Reviewing Altered Standards of Care in Mass Casualty Events
High Priority Source: HHSPandemicInfluenzaPlan
Overview: This resource discusses how mass casualty events can impact the ability of health systems to meet established standards of care.

Steps:
1. Access the Altered Standards of Care in Mass Casualty Events report at [AHRQ Altered...
mass casualty event, altered standards of care, healthcare protocols

Mass Casualty Handling (1)

Handling Human Remains During Mass-Casualty Events
High Priority Source: HHSPandemicInfluenzaPlan
Procedure for Handling Human Remains During Mass-Casualty Events

1. Follow Interim Health Recommendations: Workers who handle human remains should adhere to the guidelines provided by the CDC at...
human remains, mass casualty, disaster management, CDC guidelines, PPE, infection control

Contact Tracing (1)

Assist Public Health Officials in Identifying Exposed Contacts for Suspected Novel Influenza Cases
Critical Source: HHSPandemicInfluenzaPlan
Steps to Identify Exposed Contacts:

1. After consulting with state and local public health officials, clinicians may be asked to help identify persons exposed to the suspected novel influenza case-patient.
2. Persons in close contact...
contact tracing, public health officials, exposed contacts, novel influenza

Respiratory Disease (1)

Evaluate and Treat Suspected Post-Influenza Community-Associated Pneumonia
High Priority Source: HHSPandemicInfluenzaPlan
Procedure:

1. Follow the guidance provided in Appendix 3 for evaluating and treating suspected post-influenza community-associated pneumonia.

2. Ensure timely diagnosis and treatment based on clinical presentation and diagnostic testing.
post-influenza pneumonia, community-associated pneumonia, treatment guidelines

Laboratory Testing (1)

Specimen Collection and Laboratory Testing for Pandemic Influenza
High Priority Source: HHSPandemicInfluenzaPlan
Specimen Collection Guidelines:

• Collect respiratory samples such as:
- Nasopharyngeal wash/aspirate
- Nasopharyngeal, nasal, or oropharyngeal swabs
- Tracheal aspirates
• Store specimens at **4°C in viral transport...
specimen collection, viral transport media, laboratory testing, pandemic influenza, CDC guidelines

Home Care (1)

Home Management of Mild Pandemic Influenza Patients
Standard Source: HHSPandemicInfluenzaPlan
Instructions for Home Care:

• Provide standardized instructions on managing fever and dehydration.
• Offer pain relief as needed.
• Educate patients on recognizing signs of deterioration in status (e.g., worsening symptoms,...
home care, pandemic influenza, infection control, fever management, dehydration prevention

Influenza Diagnosis Limitations (1)

Understand the Limitations of Clinical Diagnosis for Influenza
Standard Source: HHSPandemicInfluenzaPlan
Procedure:

1. Recognize that clinical diagnosis of influenza is often indeterminate, as symptoms can be similar to those caused by other respiratory infections.
2. Understand that non-specific terms such as **'flu' and 'influenza-like...
clinical diagnosis, limitations, flu, influenza-like illness, predictive value, differential diagnosis

Influenza Lab Findings (1)

Recognize the Importance of Laboratory Testing in Influenza Diagnosis
Standard Source: HHSPandemicInfluenzaPlan
Procedure:

1. Understand that no routine laboratory test results are specific for influenza, and thus, clinical judgment remains crucial.
2. Be aware that leukocyte counts can vary significantly in patients with influenza:
-...
laboratory testing, influenza, leukocyte counts, thrombocytopenia, leukopenia, secondary bacterial infection

Infectious Disease Diagnosis (1)

Identify Differential Diagnoses for Influenza Symptoms
Standard Source: HHSPandemicInfluenzaPlan
Differential diagnosis is critical when evaluating patients with fever and respiratory symptoms that may be caused by influenza. These symptoms can also occur due to other pathogens, including:

Respiratory syncytial virus (RSV)
-...
differential diagnosis, influenza, RSV, parainfluenza, adenovirus, human metapneumovirus, rhinovirus, coronavirus, mycoplasma pneumoniae, diagnostic testing

Pediatric Complications (1)

Recognize and Respond to Influenza-Related Bronchiolitis in Children
Critical Source: HHSPandemicInfluenzaPlan
Objective: Identify and manage bronchiolitis caused by influenza in children.

Procedure:
1. Monitor for symptoms such as wheezing, rapid breathing, and difficulty feeding in infants and young children.
2. Look for clinical signs similar to...
bronchiolitis, influenza in children, respiratory distress

Cardiovascular Complications (1)

Recognize and Respond to Influenza-Related Cardiovascular Complications
Critical Source: HHSPandemicInfluenzaPlan
Objective: Identify and manage cardiovascular complications caused by influenza.

Procedure:
1. Monitor for symptoms such as worsening shortness of breath, chest pain, or palpitations in individuals with pre-existing heart conditions (e.g.,...
myocarditis, pericarditis, influenza complications, heart failure

Neurologic Complications (1)

Recognize and Respond to Influenza-Related Neurologic Complications in Children
Critical Source: HHSPandemicInfluenzaPlan
Objective: Identify and manage neurologic complications caused by influenza.

Procedure:
1. Monitor for symptoms such as high fever, seizures, altered mental status, or obtundation in children.
2. Look for signs of encephalopathy (e.g.,...
encephalopathy, seizures, influenza in children

Treatment Procedures (1)

Antibiotic Treatment for Post-Influenza Bacterial Community-Acquired Pneumonia
High Priority Source: HHSPandemicInfluenzaPlan
Procedure:

• Perform antibiotic susceptibility testing of any bacterial isolates when feasible to direct treatment.
• Use diagnostic results (e.g., from blood cultures, Gram stain, and culture) to guide appropriate antimicrobial therapy.
-...
antibiotic treatment, susceptibility testing, S. pneumoniae, CA-MRSA, antimicrobial therapy

Antibiotic Management (1)

Antibiotic Use During a Pandemic Influenza Period
High Priority Source: HHSPandemicInfluenzaPlan
Procedure for Managing Antibiotic Use During a Pandemic Influenza Period

### Antibiotic Shortage Considerations
• Antibiotics, particularly those needed to treat CAP (community-acquired pneumonia), will likely be in short supply during the...
pandemic influenza, antibiotic shortage, antimicrobial therapy, post-influenza pneumonia

Adverse Events (1)

Estimate Adverse Events Following Immunization (AEFIs) During Pandemic
High Priority Source: HHSPandemicInfluenzaPlan
Procedure:

1. Monitor and estimate the rates of mild and severe adverse events following immunization during mass vaccination campaigns.

2. Develop protocols for rapid response to AEFIs, including medical evaluation and reporting systems.

3....
AEFI monitoring, adverse events, vaccine safety

Vaccination Planning (1)

Planning for Large-Scale Influenza Vaccination Clinics
High Priority Source: HHSPandemicInfluenzaPlan
Guidelines for large-scale influenza vaccination clinic planning:

1. Overview: This document provides a general overview and guidelines for establishing and running a mass dispensing clinic.
2. Purpose: Developed by CDC's National...
influenza,vaccine,clinic planning,mass vaccination

Regulatory Guidance (1)

Understanding Investigational New Drug (IND) Use and Emergency Use Authorization (EUA)
High Priority Source: HHSPandemicInfluenzaPlan
Information on Investigational New Drug (IND) use and Emergency Use Authorization (EUA):

1. Regulations: Regulations governing IND applications are described in 21 CFR 312.
2. Reference for IND: [Link to full...
IND,EUA,regulations,emergency use authorization

Surveillance And Reporting (1)

Data Collection for Pandemic Influenza Management
High Priority Source: HHSPandemicInfluenzaPlan
Procedure:

1. Implement a robust data collection system to track:
- Number of confirmed and suspected cases
- Locations of outbreaks
- Demographic information (age, occupation, geographic distribution)
2. Use electronic health records...
data collection, pandemic surveillance, case tracking, public health reporting

Public Health Response (1)

Develop Protocols for Managing Ill Travelers at Ports of Entry
High Priority Source: HHSPandemicInfluenzaPlan
Objective: Establish procedures for managing ill arriving passengers identified by airplane or cruise ship personnel.

Steps:
1. Collaborate with law enforcement authorities and other partners to develop protocols that include:
- Meeting...
ill travelers, ports of entry, medical assessment, quarantine protocols, CDC reporting

Healthcare Workforce Preparedness (1)

Ensure Healthcare Providers Have Access to Critical Information During Pandemic
High Priority Source: HHSPandemicInfluenzaPlan
Procedure:

Healthcare providers should have ongoing access to the following information during a pandemic:

1. Pandemic Progression Information
- International, national, and local progress of the pandemic.
2. Work-Related Issues
...
healthcare providers, pandemic influenza, communication, PPE, cross training, stress management, information access

Regulatory (1)

FDA Overview and Role in Sutures
Standard Source: Medical Survival Wound Closure Manual
FDA stands for the federal Food and Drug Administration, which regulates medical devices and suture products.
FDA, Food and Drug Administration, regulatory agency, suture regulation

Surgical Risks (1)

Adverse Reactions Associated with PROLENE Hernia System
Standard Source: Medical Survival Wound Closure Manual
Procedure:

1. Be aware of potential adverse reactions typically associated with surgically implantable materials, which include:
- Infection potentiation
- Inflammation
- Adhesion formation
- Fistula formation
- Extrusion
2....
adverse reactions, PROLENE hernia system, surgical complications

Breathing Problems (1)

Open Airway and Maintain
Critical Source: Medical Emergencies
Objective: Ensure the airway is clear to allow breathing.

Steps:
1. Check for responsiveness: Tap the person's shoulder and shout, "Are you okay?" If there is no response, call 911 or ask someone else to do so.
2. Position the head:...
airway, breathing, CPR, emergency, open airway

Severe Bleeding (1)

Control Bleeding
Critical Source: Medical Emergencies
Objective: Stop or slow severe bleeding until professional help arrives.

Steps:
1. Apply direct pressure: Use a clean cloth or bandage and press firmly on the wound for at least 5 minutes. Do not lift the cloth to check the wound during...
bleeding, control bleeding, pressure bandage, emergency

Wounds (1)

Treat Open Wounds
Standard Source: Medical Emergencies
Objective: Clean and protect open wounds to prevent infection.

Steps:
1. Wash hands: Use soap and water or hand sanitizer before touching the wound.
2. Rinse the wound: Flush it with clean running water for several minutes to remove...
open wounds, treat wounds, antiseptic, emergency

Airway Obstruction (1)

Recognize and Respond to Airway Obstruction
Critical Source: Medical Emergencies
Procedure:

Step 1. Identify signs of airway obstruction:
• Foreign matter in the mouth or throat.
• Face or neck injuries.
• Inflammation or swelling from smoke, flames, vapors, or allergic reactions.
• A "kink" in the throat (chin resting...
airway obstruction, choking, abdominal thrusts, jaw thrust method, mouth-to-mouth resuscitation, Heimlich maneuver

Snakebite Identification (1)

Identifying Poisonous vs Nonpoisonous Snakebites
High Priority Source: Medical Emergencies
Procedure:

1. Determine whether the snake was poisonous or nonpoisonous before beginning treatment.
2. Bites from a nonpoisonous snake will show rows of teeth.
3. Bites from a poisonous snake may have rows of teeth showing, but will...
poisonous snake identification, nonpoisonous snake bite signs, venom symptoms

Unit Coordination (1)

Coordinate Medical NBC Units Prior to Deployment
High Priority Source: Medical NBC Battlebook
Procedure:

1. Prior Coordination: Before deployment, commanders should coordinate with relevant units involved in medical NBC operations to ensure a comprehensive approach.

2. Units Involved: The following units may be involved:
-...
NBC operations, unit coordination, medical readiness, intelligence gathering, deployment planning

Risk Communication (1)

Coordinate with Civil-Military Affairs (S5/G5) for Risk Communications
Standard Source: Medical NBC Battlebook
Procedure:

1. Information Gathering: The S5/G5 section may provide or locate information about industrial operations in the area of concern.

2. Risk Communication Support: If local populations believe that the US military has...
S5/G5, risk communication, USACHPPM, industrial operations, public relations

Decontamination Surveillance (1)

Utilize Chemical Units for NBC Support
High Priority Source: Medical NBC Battlebook
Procedure:

1. Decontamination Assistance: Chemical units can provide assistance with the decontamination of personnel and equipment.

2. NBC Surveillance: Special NBC surveillance units, such as BIDS (Biological Integrated Detection...
chemical units, decontamination, BIDS, FOX vehicles, sample transport

Ordnance Coordination (1)

Coordinate with Ordnance and Supply Units for NBC Operations
High Priority Source: Medical NBC Battlebook
Procedure:

1. Unexploded Ordnance Removal: Explosive Ordnance Detachments normally handle or coordinate the removal of all unexploded ordnance.

2. Equipment Processing: The Industrial Operations Command (IOC) assists in the removal,...
ordnance units, IOC, health physics, AMC, NRC licensing

Engineering Support (1)

Utilize Engineer Units for NBC Support and Environmental Hazards Assessment
Standard Source: Medical NBC Battlebook
Procedure:

1. Decontamination Infrastructure: Engineer units can assist in the construction of decontamination pits.

2. Environmental Hazard Information: They may provide information about local industrial and environmental hazards...
engineer units, decontamination pits, environmental hazards, NBC support

Special Forces Medical Support (1)

Provide Medical NBC Support for Special Operations Units
High Priority Source: Medical NBC Battlebook
Procedure:

1. Unique Challenges: Special Forces operating deep in the enemy's rear area may encounter NBC agents from various sources, such as strikes on enemy storage and production sites.

2. Self-Reliance: Due to their remote...
Special Forces, NBC exposure, self-support, rear area operations

Medical Unit Coordination (1)

Coordinate with Medical Units for NBC Operations
High Priority Source: Medical NBC Battlebook
Procedure:

1. Medical Unit Reference: The FM 8-10 series fully describes medical operations during deployment.

2. Unit Capabilities: Commanders should refer to these manuals for the mission and capabilities of:
- Theater Army...
FM 8-10, medical unit capabilities, deployment planning

Laboratory Assessment (1)

Utilize Theater Army Medical Laboratory (TAML) for NBC Hazard Assessment
High Priority Source: Medical NBC Battlebook
Procedure:

1. Mission of TAML: The Theater Army Medical Laboratory (TAML) identifies and evaluates health hazards in an area of operations using:
- Laboratory analyses
- Rapid health hazard assessments

2. Threats Assessed:...
TAML, hazard assessment, laboratory analysis, NBC threat identification

Preventive Medicine Support (1)

Provide Preventive Medicine Support for NBC Operations
High Priority Source: Medical NBC Battlebook
Procedure:

1. Technical Consultation: The Preventive Medicine Detachment provides technical consultation support on preventive medicine issues in its area of responsibility.

2. Specialized Support Areas: Includes:
- Disease and...
Preventive Medicine Detachment, sample collection, chain of custody, NBC surveillance

Treatment Facility Preparation (1)

Prepare Medical Treatment Facilities for NBC Casualties
High Priority Source: Medical NBC Battlebook
Objective: Ensure medical treatment facilities are ready to handle a wide range of injuries and large numbers of casualties from NBC weapons.

Steps:
1. Stockpile appropriate medical supplies and equipment for treating chemical,...
NBC casualty treatment, medical facility preparation, decontamination areas, mass casualties

Agent Detection (1)

Detect Suspected NBC Agents in the Field
High Priority Source: Medical NBC Battlebook
Objective: Identify and collect suspected NBC agents to prevent further exposure and facilitate analysis.

Steps:
1. Sample environment and troops for signs of NBC agent use, especially when symptoms are not immediately apparent (e.g.,...
NBC agent detection, FOX vehicle, BIDS system, radiation survey

Environmental Surveillance (1)

Conduct Medical and Environmental Surveillance During Deployment
Standard Source: Medical NBC Battlebook
Objective: Monitor environmental conditions and troop health to identify potential health threats.

Steps:
1. Collect environmental samples (air, water, soil) for analysis by units such as the 520[th] TAML or USACHPPM.
2. Forward all...
environmental surveillance, sample collection, TAML, USACHPPM

Hazard Assessment (1)

Conduct Health Hazard Assessments for Industrial and Environmental Threats
High Priority Source: Medical NBC Battlebook
Objective: Evaluate potential health risks from industrial and environmental hazards to protect service members.

Steps:
1. Request medical units to provide assessments of potential industrial and environmental hazards in the area of...
health hazard assessment, industrial threats, environmental hazards, risk management

Psychological Health (1)

Assessing Psychological Impact of Nuclear Weapons
Standard Source: Medical NBC Battlebook
Procedure:

1. Recognize that psychological issues following nuclear exposure are similar to those in other combat scenarios.
2. Use established treatment methods from past wars for managing acute psychological problems.
3. Refer to Chapter 6,...
nuclear weapons, psychological impact, combat psychology, mental health, FM 8-9

Radiation Medical Response (1)

Medical Response to Nuclear Power Plant Exposure
Critical Source: Medical NBC Battlebook
Objective: Prepare medical units for treating and managing patients exposed to nuclear power plant hazards.

Procedure:
1. Develop local procedures for:
- Treating contaminated patients.
- Decontaminating individuals.
- Transporting...
potassium iodide, decontamination, radiation medical response, hazard prediction

Biological Samples (1)

Biological Sample Collection for Radiological Contamination Monitoring
High Priority Source: Medical NBC Battlebook
Biological Sample Collection for Radiological Contamination Monitoring

1. Urine collection: If the patient urinates, save the urine for analysis of radiological contamination.
2. Urinalysis precautions: Normal urinalyses can be...
urine collection, fecal samples, radiobioassay

Biological Warfare Prevention (1)

Implement Immunoprophylaxis for BW Threats
High Priority Source: Medical NBC Battlebook
Immunoprophylaxis is the only means of providing continuous protection against biological warfare (BW) threats prior to and during a BW attack. Vaccines are available for several potential BW agents, but they often require a series of doses over...
immunoprophylaxis,bw threats,vaccination,biological warfare

Biological Warfare Treatment (1)

Implement Chemoprophylaxis for BW Agents
Critical Source: Medical NBC Battlebook
Chemoprophylaxis, using broad-spectrum antibiotics, may provide protection against some biological warfare (BW) agents.

Indications:
- Administration of antibiotics following exposure but before symptoms appear can be lifesaving.
-...
chemoprophylaxis,bw agents,antibiotics,prophylactic drugs

Bacterial Infections (1)

Prevent Human Infection from Glanders (Burkholderia mallei)
Critical Source: Medical NBC Battlebook
Procedure:

1. Avoid contact with infected animals such as horses, donkeys, and mules, especially in regions where glanders is endemic.
2. Practice strict hygiene for individuals working with animals or in laboratories:
- Wash hands...
Glanders,Burkholderia mallei,aerosol transmission,biological warfare agent,hygiene practices

Toxin Exposure (1)

Recognize and Respond to Saxitoxin Exposure
Critical Source: Medical NBC Battlebook
Procedure:

1. Identify symptoms:
- Initial signs include numbness or tingling of the lips, tongue, and fingertips.
- Progression includes numbness in the neck and extremities, followed by general muscular incoordination.
- Terminal...
saxitoxin, paralytic shellfish poisoning, PSP, neurotoxins, respiratory paralysis, medical intervention

Chemical Exposure Prevention (1)

Prevent Mustard Agent Skin Exposure
High Priority Source: Medical NBC Battlebook
Prevention of Mustard Agent Effects on the Skin

1. Physical Protection: The only practical prophylactic method is to use physical protection such as a protective mask and special clothing.

2. Chemical Protection: For very low doses,...
mustard agent, skin protection, chemical warfare, prophylaxis, chloramine paste

Gastrointestinal Injuries (1)

Recognize and Treat Mustard Agent Gastrointestinal Effects
High Priority Source: Medical NBC Battlebook
Treatment of Mustard Agent Effects on the Gastrointestinal Tract

1. Symptoms: Ingestion of contaminated food or water may cause destruction of mucous membranes, leading to nausea, vomiting, pain, diarrhea, and prostration.

2. **Medical...
mustard agent, gastrointestinal damage, food contamination, dehydration, vomiting treatment

Systemic Poisoning (1)

Recognize and Treat Lewisite Agent Systemic Effects
Critical Source: Medical NBC Battlebook
Treatment of Lewisite Agent Systemic Effects

1. Symptoms: Liquid arsenical vesicants on the skin or inhaled vapor may be absorbed, causing systemic poisoning.

2. Medical Outcome: A manifestation is a change in capillary permeability,...
lewisite agent, systemic poisoning, dimercaprol, antidote use, shock management

Detection And Diagnosis (1)

Detect Vomiting Agents Based on Clinical Symptoms and Signs
High Priority Source: Medical NBC Battlebook
Procedure:

1. Recognize the clinical symptoms of vomiting agents, which include:
- Strong pepper-like irritation in the upper respiratory tract.
- Eye irritation and excessive lacrimation (tearing).
- Violent, uncontrollable...
vomiting agents, detection, clinical symptoms, medical signs, chemical exposure

Laser Hazards (1)

Recognize and Identify Laser Hazards
Standard Source: Medical NBC Battlebook
Procedure: Recognize and identify laser hazards

1. Understand laser classifications:
- Refer to Table 6-A: Laser Classification Scheme for information on different laser classes (Class I, II, IIIa, IIIb, IV) and their associated...
laser hazards,laser classification,wavelengths,military lasers,hazard identification

Radiofrequency Hazards (1)

Recognize and Identify Radiofrequency Hazards
Standard Source: Medical NBC Battlebook
Procedure: Recognize and identify radiofrequency hazards

1. Understand radiofrequency bands: Refer to Table 6-G: Radiofrequency Bands and Spectral Designations for information on different frequency ranges (e.g., HF, VHF, UHF, SHF) and...
radiofrequency hazards,frequency bands,hazard identification,exposure sources,risk assessment

Laser Injuries Evacuation (1)

Assess and Determine Evacuation for Laser Injuries
High Priority Source: Medical NBC Battlebook
Procedure:

1. Evaluate the Soldier's Condition:
- Conduct a visual function assessment to determine if there is any impairment.
- Check for other injuries such as hemorrhage or signs of ocular damage.

2. Determine Duty Status:
...
evacuation, laser injuries, medical evaluation, ophthalmoscopic exam, duty status, type a injury, type b injury

Laser Technical Info (1)

Understand Laser Technical Information and Radiation Effects
Standard Source: Medical NBC Battlebook
Procedure:

1. Define Lasers:
- A laser is an acronym for Light Amplification by Stimulated Emission of Radiation.
- It produces an intense, narrow, and monochromatic beam of light.

2. Key Laser Parameters:
...
laser parameters, electromagnetic spectrum, radiation exposure, laser modes, wavelength, power density

Microbial Detection (1)

Conduct a Bioassay for Microbial Detection
High Priority Source: Medical NBC Battlebook
Procedure:

1. Sample Collection: Collect samples from the environment (e.g., soil, water) or clinical sources.
2. Culture Preparation: Cultivate the sample in appropriate media to obtain sufficient numbers of various cell types for...
bioassay,microbial detection,culture preparation,differential metabolic assays,colormetric monitoring,electron microscopy

Public Health Resources (1)

Contact CDC for Health and Disease Information
Standard Source: Medical NBC Battlebook
Procedure:

1. Visit the CDC website at [www.cdc.gov](http://www.cdc.gov) for information on disease prevention, diagnostic testing, sample management, and treatment.
2. Contact CDC directly by phone at (404) 639-3311 for expert assistance...
cdc, contact information, health resources, disease control, diagnostic testing

Terminology Reference (1)

Access Glossary of Terms and Acronyms for NBC Emergencies
Reference Source: Medical NBC Battlebook
Procedure:

1. Review the Glossary of Terms and Acronyms provided in the document to understand key terminology related to NBC (Nuclear, Biological, Chemical) emergencies.
2. Use this glossary as a reference guide for terms such as:
-...
glossary, nbc terminology, medical terms, radiation acronyms

Injuries And Conditions (1)

Understanding and Identifying Defervescence
Reference Source: Medical NBC Battlebook
Definition: Defervescence is the period of abatement of fever.

Procedure:
1. Recognize the symptoms associated with defervescence, which include a reduction in body temperature after a period of elevated temperature (fever).
2. Monitor for...
defervescence, fever abatement, temperature reduction, medical evaluation

Eye Injuries And Protection (1)

Understand and Respond to Flashblindness
Standard Source: Medical NBC Battlebook
Flashblindness is a temporary visual interference effect that persists after the source of illumination has been removed.

### Procedure:
1. Recognize flashblindness: Be aware of exposure to bright light sources such as flashbulbs, lasers,...
flashblindness, eye injury, visual interference, light exposure

Anatomy Terms (1)

Understand the Term Retrosternal
Reference Source: Medical NBC Battlebook
Retrosternal refers to a condition or location situated or occurring behind the sternum (breastbone). This term is often used in medical contexts, such as describing pain or disease affecting the heart or lungs.
retrosternal,sternum,heart condition,lung disease

Fever And Infections (1)

Recognize and Respond to Rigors (Chills)
Standard Source: Medical NBC Battlebook
Rigors are chills, often associated with fever or infection. They can be a sign of systemic illness.

### Action Steps:
Monitor body temperature and other symptoms such as sweating or shivering.
Provide warmth if the individual is...
rigors,chills,fever,infection

Orthopedic Care (1)

Apply External Fixation for Fractures in Emergency Situations
Critical Source: NATO Emergency War Surgery
Procedure:

1. Stabilize the patient and ensure proper positioning to access the fracture site.
2. Insert pins or wires through the bone on either side of the fracture, ensuring they are placed perpendicular to the long axis of the bone.
3....
external fixation, fracture management, orthopedic surgery, emergency care

Military Medical Organization (1)

Medical Roles and Echelonment in Military Medicine
Standard Source: NATO Emergency War Surgery
Procedure:

1. Distribution of Medical Resources: Modern military medical services distribute resources and capabilities across various locations and levels, referred to as 'roles' in formal military terminology.
2. **Echelonment...
medical roles,echelonment,military medical organization,flexibility in care

Wound Ballistics (1)

Understanding High Velocity Wound Ballistics
High Priority Source: NATO Emergency War Surgery
Objective: Understand the principles behind high velocity wound ballistics and their implications for medical treatment.

Background:
• Previous editions of this handbook focused on differentiating between injuries caused by "ordinary"...
high velocity wounds, wound ballistics, temporary cavitation, kinetic energy, exit wounds, projectile yaw, tissue disruption, triage, medical treatment

Burn Resuscitation (1)

Initial Treatment of Extensive Burns at a Definitive Medical Facility
Critical Source: NATO Emergency War Surgery
Procedure:

1. At the definitive treatment facility:
- Ensure control of hemorrhage and airway adequacy.
2. Perform a complete physical examination after removing the patient's clothing.
3. Establish a secure intravenous pathway...
fluid resuscitation,burn formulas,body weight,burn extent,combat medicine

Respiratory Injury (1)

Endoscopic Examination for Inhalation Injury from Vesicant Gases
Critical Source: NATO Emergency War Surgery
Procedure:

1. Perform endoscopic examination of the airway in patients with inhalation injury caused by vesicant gases.
2. Assess the extent of damage to the upper and lower respiratory tract using endoscopy.
3. Based on findings, determine...
inhalation injury, endoscopy, tracheal intubation, mechanical ventilation, vesicant gases

Triage Protocol (1)

Triage Protocol for Burn Patients in Combat Settings
High Priority Source: NATO Emergency War Surgery
Triage is essential to allocate medical resources effectively among burn casualties in combat environments. The following guidelines apply:

### Optimum Resource Availability (Civilian Practice)
Adults with second-degree burns: >25% of...
burn triage,military medical care,burn casualty management

Cold Injuries Physiology (1)

Understand the Physiologic Response to Cold Exposure
Standard Source: NATO Emergency War Surgery
Procedure:

1. **Recognize initial vasoconstriction:
- Upon exposure to cold, peripheral vasoconstriction occurs as a protective mechanism to conserve core body heat.
2. **Identify cold-induced vasodilation (CIVD):
- After the initial...
vasoconstriction,CIVD,cold,response,physiology,military,survival

Cold Injuries Pathology (1)

Assess the Pathologic Process of Cold Injury
Standard Source: NATO Emergency War Surgery
Procedure:

1. **Understand tissue damage mechanisms:
- Tissue loss in cold injuries is primarily due to impaired blood flow after thawing, not necessarily direct cellular damage.
2. **Recognize vascular stasis:
- After freezing and...
tissue,damage,cold,injury,vascular,stasis,capillary,permeability,pathology

Cold Injury Treatment (1)

Emergency Treatment for Cold Injury
High Priority Source: NATO Emergency War Surgery
Objective: Provide immediate first aid for cold injury.

Procedure Steps:
1. Classify the casualty: All casualties with involvement of the lower extremities should be treated as litter cases, if feasible.
2. **Assess concomitant...
cold injury, rewarming, first aid, tetanus, frostbite, military medicine, emergency treatment

Nutrition Hydration (1)

Nutritional and Hydration Management for Post-Injury Patients
Standard Source: NATO Emergency War Surgery
Procedure:

1. Encourage the patient to consume a nutritious diet.
2. Ensure the patient maintains adequate fluid intake to support hydration.

Details:
• Proper nutrition and hydration are essential for tissue repair and recovery.
nutritional management, hydration, post-injury diet

Systemic Effects (1)

Treat Systemic Effects of Blister Agents
Critical Source: NATO Emergency War Surgery
Systemic Treatment:

Bone marrow depression with severe leukopenia and thrombocytopenia occurs after extensive mustard absorption.
• Resistance to infection is diminished, increasing mortality from pneumonitis or bacterial infections.
-...
mustard gas, lewisite, systemic effects, BAL treatment, hemolytic anemia

Triage And Treatment (1)

Triage and Treatment Prioritization for Burn Patients in Nuclear Warfare
Critical Source: NATO Emergency War Surgery
Triage and Treatment Prioritization for Burn Patients in Nuclear Warfare

Burn casualties will constitute a large fraction of the patient load in nuclear warfare, requiring efficient sorting to conserve medical resources. Follow these...
burn triage, burn treatment, nuclear warfare, medical resources, critical areas, hospitalization criteria

Surgical Priority (1)

Order of Priority for Wound Care in Trauma Patients
Critical Source: NATO Emergency War Surgery
Procedure:

1. Prioritize Life-Threatening Injuries First: Treat injuries that are most life-threatening first, such as lacerated bronchus or major chest and abdominal wounds.
2. Postpone Non-Life-Threatening Injuries: Delay treatment of...
wound priority,surgical staging,trauma surgery

Surgical Team Management (1)

Surgical Staffing and Team Coordination in Trauma Patients with Multiple Injuries
Critical Source: NATO Emergency War Surgery
Procedure:

1. Ensure Sufficient Surgical Personnel: Provide enough medical staff to ensure appropriate care and minimize operating room and anesthesia time.
2. Use Separate Teams for Different Regional Injuries When Possible: Operate on...
team coordination,surgical staffing,trauma surgery

Surgical Principles (1)

Principles of Minimal Intervention in Trauma Surgery
Critical Source: NATO Emergency War Surgery
Procedure:

1. Perform Only Essential Lifesaving Procedures: Conduct only the simplest lifesaving surgical procedures consistent with established principles of combat surgery.
2. Avoid Unnecessary or Meddlesome Procedures: Refrain from...
minimal intervention,surgical principles,trauma surgery

Triage Resuscitation (1)

Organize a Triage and Resuscitation Facility
Critical Source: NATO Emergency War Surgery
Objective: Ensure the efficient triage, resuscitation, and coordination of casualties in shock.

Key Components:
Leadership: An experienced medical officer should oversee the facility, supported by well-trained staff.
-...
triage organization, resuscitation facility setup, casualty flow management, battlefield triage, emergency surgery coordination

Triage Setup (1)

Setting Up a Triage Facility
High Priority Source: NATO Emergency War Surgery
Objective: Establish an efficient triage facility for mass casualties.

Steps:
1. Choose a large, well-lighted space with uninterrupted movement and clear visibility throughout the area.
2. Ensure there are **no partitions or...
triage facility setup, emergency war surgery, mass casualty triage, medical facility layout, shock resuscitation

Triage Supplies (1)

Triage Area Equipment and Supplies Configuration
Critical Source: NATO Emergency War Surgery
Objective: Ensure the triage area is fully equipped with necessary tools and supplies for immediate care.

Steps:
1. Stretcher frames should be in place with enough space between patients for easy movement.
2. Avoid unnecessary...
triage supplies setup, emergency medical equipment, field triage kit, war surgery tools, IV administration setup

Hemorrhagic Shock Assessment (1)

Assessing Acute Blood Loss Volume in Hemorrhagic Shock
Critical Source: NATO Emergency War Surgery
Procedure for Assessing Acute Blood Loss Volume in Hemorrhagic Shock:

1. Class I hemorrhage (up to 15% blood volume loss):
- Represents a blood loss of 500 cc or less in the 70-kg person.
- Clinical signs:
- Mild tachycardia is...
blood loss, hemorrhage classification, shock assessment, crystalloid resuscitation, blood volume loss

Hemorrhagic Shock Complications (1)

Identifying Predisposing and Aggravating Factors in Hemorrhagic Shock
High Priority Source: NATO Emergency War Surgery
Procedure for Identifying Predisposing and Aggravating Factors in Hemorrhagic Shock:

Preexisting fluid or electrolyte imbalances (e.g., from excessive sweating, diarrhea, or vomiting) can hasten or aggravate circulatory collapse.
-...
predisposing factors, aggravating factors, shock complications, fluid imbalance, trauma handling

Venous Access (1)

Establish Multiple Venous Access Sites for Rapid Infusion and Monitoring
High Priority Source: NATO Emergency War Surgery
Procedure:
1. Select appropriate venous access sites, such as the internal jugular, subclavian, or median basilic veins.
2. Use large-bore, relatively central catheters to allow for both rapid infusion and venous pressure monitoring.
3....
venous access,large bore catheters,emergency infusion

Monitoring And Assessment (1)

Monitor Clinical Response to Fluid Resuscitation
High Priority Source: NATO Emergency War Surgery
Procedure:

1. Assess Parameters: Monitor the casualty's response using clinical parameters such as blood pressure, pulse rate, capillary refill, urine output, and mental status.
2. Use Central Venous Pressure Monitoring: For casualties...
clinical response, central venous pressure, monitoring, fluid resuscitation

Blood Transfusion Safety (1)

Administer Blood Safely During Transfusion
Critical Source: NATO Emergency War Surgery
Procedure:

1. Filter Whole Blood: Filter whole blood during administration using a 160 micron macropore filter to remove small clots and other aggregations.
2. Warm Blood Infusions: Warm blood infusions to prevent cardiac arrhythmias...
whole blood filtration, warming blood, catheter placement, transfusion safety

Emergency Procedures (1)

Infraclavicular Subclavian Catheterization
Critical Source: NATO Emergency War Surgery
Procedure:

1. Place the patient in a supine position, at least 15° head down to distend the neck veins and prevent an air embolism. Turn the patient's head away from the venipuncture site.

2. Cleanse and prep the skin around the...
infraclavicular subclavian catheterization, venipuncture, IV line placement, emergency surgery, air embolism prevention

Pericardiocentesis (1)

Pericardiocentesis
Critical Source: NATO Emergency War Surgery
Procedure for Pericardiocentesis

1. Monitor Vital Signs: Continuously monitor the patient's vital signs, central venous pressure (CVP), and ECG before, during, and after the procedure.

2. Prep Site: Prep the xiphoid and subxiphoid...
pericardiocentesis, cardiac tamponade, emergency surgery, trauma care

Trauma Pathophysiology (1)

Understanding Compensatory and Pathophysiological Responses to Trauma
Standard Source: NATO Emergency War Surgery
Understanding the Body's Response to Major Combat Wounds

Physiological and Metabolic Responses: Major combat wounds trigger sudden and intense physiological and metabolic responses. These responses are directly proportional to the extent...
trauma response, pathophysiology, compensatory mechanisms, combat surgery, post-traumatic complications

Trauma Response (1)

Assess Systemic Response to Trauma
High Priority Source: NATO Emergency War Surgery
Procedure:

1. Evaluate the magnitude of systemic response based on injury severity.
2. Recognize the biphasic nature of the response:
- Early phase: Hypofunction characterized by progressive circulatory insufficiency, decreased...
systemic response, trauma, biphasic response, hypofunction, hyperfunction, resuscitation

Wound Infection Treatment (1)

Manage Wound Infection Through Antibiotic Therapy
High Priority Source: NATO Emergency War Surgery
Objective: Use antibiotic therapy to prevent and treat wound infections.

Procedure:
1. Identify the likely causative organism based on wound type, location, and contamination source.
2. Select antibiotics that are effective against...
antibiotic therapy, wound infection treatment, antibiotic selection, broad-spectrum antibiotics, wound monitoring

Wound Infection Risk Factors (1)

Recognize and Address Risk Factors for Wound Infection
Critical Source: NATO Emergency War Surgery
Objective: Identify risk factors that may predispose a wound to infection and take appropriate action.

Procedure:
1. Assess the time lag between injury and treatment, as prolonged delays increase bacterial proliferation and infection...
infection risk factors, vascular injury, foreign bodies, drainage, secondary contamination, diabetes, malnutrition

Wound Care Tetanus Prevention (1)

Immediate Surgical Care for Wounds
Critical Source: NATO Emergency War Surgery
Objective: Provide immediate surgical care to wounds to prevent infection and tetanus.

Procedure Steps:
1. Thorough Cleansing and Debridement: Clean the wound thoroughly and remove all foreign bodies and necrotic tissue.
2. **Leave Open...
surgical wound care, tetanus prevention, debridement, penicillin, airway management, respiratory failure

Tetanus Immunization (1)

Tetanus Immunization Protocol for Adults
High Priority Source: NATO Emergency War Surgery
Objective: Provide tetanus immunization based on prior vaccination history and wound type.

Procedure Steps:
1. Routine Immunization: For adults, administer at least three injections of toxoid to achieve full immunization.
2. **Booster...
tetanus immunization, toxoid injections, immune globulin, wound classification, booster schedule

Abdominal Wound Management (1)

Prophylactic Antibiotic Therapy for Penetrating Abdominal Wounds
Critical Source: NATO Emergency War Surgery
Objective: Prevent sepsis in patients with penetrating abdominal trauma through appropriate antibiotic therapy.

Procedure Steps:
1. Target Pathogens: Use antibiotics effective against pathogens from the lower gastrointestinal tract...
penetrating abdominal wounds, sepsis prevention, antibiotic regimen, cefoxitin, Vietnam War data

Triage And Casualty Sorting (1)

Sorting of Casualties
High Priority Source: NATO Emergency War Surgery
Procedure for Sorting Casualties in a Medical Emergency

1. Initial Triage Assessment:
- Quickly assess all casualties to determine the severity of their injuries and medical needs.
- Use standardized triage categories (e.g.,...
casualty sorting, triage categories, medical prioritization, resource allocation, emergency response, injury assessment

Triage And Sorting (1)

Prioritize Casualties for Surgical Intervention (Sorting Procedure)
Critical Source: NATO Emergency War Surgery
Objective: Prioritize casualties based on urgency of surgical intervention.

Procedure:
1. Assess each casualty individually and determine their need for immediate, urgent, or delayed surgical care.
2. **Categorize casualties into one of...
casualty sorting, triage priority, surgical urgency, mass casualty management, medical resource allocation

Surgical Care And Transport (1)

Role of Forward Hospitals in Extensive Lifesaving Procedures
Critical Source: NATO Emergency War Surgery
Procedure for Role of Forward Hospitals in Extensive Lifesaving Procedures:

1. Provide Immediate Surgical Care:
- Conduct surgeries on the wounded as soon as possible after their arrival at the forward hospital.
2. **Stabilize...
forward hospital,surgery,stabilization,transfer,rear role hospitals

Transport And Evacuation (1)

Establish Heliport Near Receiving Area
High Priority Source: NATO Emergency War Surgery
Ideally, the helipad should be close enough to the hospital's receiving area to preclude the need for intermediate motorized surface transport.
helipad location, casualty transport, evacuation logistics

Resuscitation And Care (1)

Prepare Immediate Care Area for Urgent Casualties
Critical Source: NATO Emergency War Surgery
Those deemed urgent and requiring resuscitation should be taken to that specific area equipped for their evaluation and management. Type O-negative or O-positive low-titer blood should be available, as well as airway management equipment, suction,...
immediate care area, resuscitation setup, blood availability

Surgical Operations (1)

Managing Patient Flow in Emergency War Surgery
Critical Source: NATO Emergency War Surgery
Objective: Ensure efficient and prioritized movement of patients into the operating room during mass casualty events.

Procedure:
1. The surgeon-in-charge must assess the number of operating teams required based on the current patient...
patient flow, triage, operating room, mass casualty, surgical operations, resource management

Initial Assessment (1)

Initial Assessment and Stabilization of Combat Casualties
Critical Source: NATO Emergency War Surgery
Procedure for Initial Assessment and Stabilization:

1. Determine if the casualty poses a threat to medical personnel or other casualties:
- This includes checking for chemical, biological agents, or explosive ordnance.

2. **Remove...
combat casualty assessment,vital signs,dressings,splints,evacuation preparation

Tactical Medical Operations (1)

Positioning and Actions of the Surgeon During Engagements
High Priority Source: NATO Emergency War Surgery
Objective: Ensure optimal medical support during military engagements by positioning the surgeon appropriately based on tactical conditions.

### Procedure Steps:
1. Understand the Battle Plan: The battalion surgeon must be fully...
surgeon positioning, battlefield triage, medical company deployment, forward surgical team, casualty evacuation, tactical operations center, split-based operations

Preoperative Care (1)

Preoperative Assessment of Trauma Patients in Wartime
Critical Source: NATO Emergency War Surgery
Objective: Gather essential preoperative information to guide anesthesia and surgical management.

Procedure:
1. Before administering anesthesia, the anesthetist must obtain a **record of events from wounding until arrival at the...
trauma patient assessment, preoperative care, field medical card, resuscitation, anesthetic management

Equipment Maintenance (1)

Maintain and Calibrate Anesthesia Equipment in Definitive Care Facilities
High Priority Source: NATO Emergency War Surgery
Procedure:

1. In medical facilities dedicated to definitive care:
- Ensure anesthesia equipment is as close to state-of-the-art as possible, given time and local conditions.
2. Regularly check and calibrate all anesthesia equipment to ensure...
anesthesia equipment, calibration, maintenance, definitive care

Surgery Preparation (1)

Preoperative Preparation for Massive Hemorrhage
Critical Source: NATO Emergency War Surgery
Procedure:

1. In cases of massive ongoing hemorrhage:
- Perform laparotomy or thoracotomy if necessary.
- Administer the following to the patient:
- Intubation with a cuffed endotracheal tube (secure airway via awake...
massive hemorrhage, preoperative preparation, anesthesia, resuscitation, surgical control of bleeding, triage, airway management

Anesthesia Types (1)

Anesthetic Techniques Overview
Standard Source: NATO Emergency War Surgery
Procedure:

1. Identify the three categories of anesthetic techniques:
- Local anesthesia: Used for localized procedures with minimal systemic effects.
- Regional anesthesia: Involves numbing a larger area (e.g., spinal,...
local anesthesia, regional anesthesia, general anesthesia, anesthetic techniques

Anesthesia Induction (1)

Induction of Anesthesia in Trauma Patients
High Priority Source: NATO Emergency War Surgery
Procedure for Induction of Anesthesia in Trauma Patients

Overview:
Time constraints and the risk of aspiration usually dictate that induction be rapid and controlled. Several IV agents are available which are in common use in the trauma...
induction of anesthesia, thiopental, etomidate, ketamine, narcotics, hypovolemia, aspiration prevention, airway control

Battlefield Medicine (1)

Treatment Priorities in Battlefield Medicine
Critical Source: NATO Emergency War Surgery
Procedure:

1. Resuscitation Principles:
- Administer resuscitative care to the extent possible.
- If surgical control of high-grade hemorrhage is not feasible, use tourniquets for prolonged periods as necessary.

2. **Antibiotic...
treatment priorities,battlefield medicine,resuscitation,antibiotics,wound incision

Crush Injuries (1)

Management of Crush Injuries in Emergency War Surgery
Critical Source: NATO Emergency War Surgery
Procedure:

1. Assess the patient for signs of crush injury, including compartment syndrome, tissue necrosis, and potential vascular compromise.
2. Ensure immediate resuscitation and stabilize the patient's airway, breathing, and circulation...
crush injury,wound management,battlefield surgery,compartment syndrome,debridement

Wound Debridement (1)

Debridement of Wound and Injured Artery
Critical Source: NATO Emergency War Surgery
Procedure:

1. Perform rapid wound debridement: After gaining control of the injured artery, excise all devitalized tissue.
2. Remove damaged artery if necessary:
- Excise only grossly injured segments of the artery.
3. **Avoid...
debridement,wound care,devitalized tissue removal

Vascular Assessment (1)

Evaluation of Distal Arterial Patency
Critical Source: NATO Emergency War Surgery
Procedure:

1. Use a balloon-tipped catheter: Carefully pass a balloon-tipped catheter through the artery to evaluate distal arterial patency.
2. Assess back bleeding: The presence or rate of back bleeding does not confirm distal...
distal arterial patency,balloon-tipped catheter,arteriography,pulse assessment

Vascular Injury Assessment (1)

Search for Additional Arterial Injuries
Critical Source: NATO Emergency War Surgery
Procedure:

1. Consider the possibility of additional arterial injuries: Even after identifying an initial injury, consider that there may be other injuries close to or distant from the recognized site.
2. **Use intraoperative arteriography...
additional arterial injury,arteriography,direct exploration,multiple vascular injuries

Rehabilitation Mobility (1)

Exercising Non-Immobilized Joints During Cast Application
Standard Source: NATO Emergency War Surgery
Procedure:

1. For joints that are not immobilized, perform active exercises on a frequent basis.
2. Exercises should be performed to maintain joint mobility and prevent stiffness or contractures.
3. Ensure that the patient is...
joint exercise, non-immobilized joints, rehabilitation

Orthopedic Complications (1)

Recognize and Manage Compartment Syndrome in the Leg and Forearm
Critical Source: NATO Emergency War Surgery
Procedure:

1. Maintain a high index of suspicion for compartment syndrome following significant trauma or open fractures.
2. Monitor patients who have been splinted but continue to experience unremitting pain, especially with passive motion of...
compartment syndrome,fasciotomy,pain management,emergency surgery

Orthopedics (1)

Management of Sprains and Dislocations
High Priority Source: NATO Emergency War Surgery
Procedure for Managing Sprains and Dislocations:

1. Sprains (ligamentous injuries):
- Support the affected joint with bandaging, splinting, or casting to facilitate healing.
- Immobilization may allow a soldier to return to...
sprain treatment,dislocation management,joint reduction,neurovascular check,radiographic confirmation

Diagnosis Maxillofacial Injuries (1)

Diagnosis of Maxillofacial Injuries
High Priority Source: NATO Emergency War Surgery
Diagnostic Procedures for Maxillofacial Injuries:

1. Careful Examination: Patients with maxillofacial injuries require careful roentgenologic and local examination, including inspection and palpation.
2. **Rule Out Cervical Spine...
maxillofacial diagnosis, orbital floor fracture, CSF leak, temporomandibular joint, open-mouth facies

Neck Injuries (1)

Initial Management of Wounds and Injuries to the Neck
High Priority Source: NATO Emergency War Surgery
Procedure:

1. Assess for severity of neck wounds immediately due to proximity to vital structures.
2. Identify potential complications, such as:
- Asphyxia
- Severe hemorrhage
- Mediastinitis (due to contamination from...
neck wound management, debridement, antibiotic administration, mediastinitis prevention

Airway Injury Management (1)

Diagnose and Manage Laryngotracheal Injuries
Critical Source: NATO Emergency War Surgery
Objective: Identify and manage injuries to the larynx and trachea.

Procedure:
1. Assess for signs of airway injury, including:
- Asphyxia: Restlessness, cyanosis, or altered mental status due to cerebral hypoxia.
-...
laryngotracheal injury, airway obstruction, laryngoscopy, tracheostomy, trauma management

Surgical Intervention (1)

Stabilize and Reapproximate Laryngotracheal Injuries
Critical Source: NATO Emergency War Surgery
Objective: Stabilize laryngeal or tracheal injuries to prevent long-term complications.

Procedure:
1. Perform careful debridement of the injured area, removing only devitalized tissue and avoiding excessive removal of cartilage or...
laryngotracheal repair, stent placement, airway reconstruction, trauma surgery

Pathophysiology (1)

Understanding the Pathophysiology of Chest Trauma
High Priority Source: NATO Emergency War Surgery
Objective: Understand the physiological consequences of chest trauma to guide treatment decisions.

Key Concepts:
Shock and hypoxia are the primary pathophysiological derangements caused by chest trauma.
Shock results from...
chest trauma pathophysiology, shock, hypoxia, thoracic injury mechanisms

Pneumothorax (1)

Recognizing and Managing Pneumothorax in Combat Casualties
Critical Source: NATO Emergency War Surgery
Objective: Identify and manage pneumothorax in battlefield scenarios.

Definition: Pneumothorax occurs when air enters the pleural space, causing loss of negative intrapleural pressure and lung collapse.

Types:
• **Simple...
tension pneumothorax, simple pneumothorax, battlefield management, chest tube insertion

Hemothorax (1)

Understanding and Managing Hemothorax in Combat Situations
Critical Source: NATO Emergency War Surgery
Objective: Identify and manage hemothorax in battlefield scenarios.

Definition: Hemothorax is the accumulation of blood within the pleural space, which can lead to hypovolemic shock and respiratory compromise.

Causes:
• Lacerated...
hemothorax management, chest tube insertion, battlefield trauma, hypovolemic shock

Gastric Intubation (1)

Insertion of a Nasogastric Tube in Emergency War Surgery
High Priority Source: NATO Emergency War Surgery
Procedure:

1. Pass a nasogastric tube and connect to drainage: This should be done as part of the initial assessment.
2. Assess for blood in aspirate:
- Note the presence or absence of hematemesis or gastric bleeding.
nasogastric tube, emergency surgery, gastric aspiration

Rectal Examination (1)

Digital Rectal Exam in Emergency War Surgery
High Priority Source: NATO Emergency War Surgery
Procedure:

1. Perform a digital rectal exam for patients with lower abdominal or perineal wounds: This is critical to assess for internal injuries.
2. Assess for blood in the rectum:
- Note the presence or absence of rectal...
digital rectal exam, rectal bleeding, prostate assessment

Surgery Intestinal Injuries (1)

Repair of Small Intestine Perforations, Lacerations, or Tears
High Priority Source: NATO Emergency War Surgery
Procedure for Repairing Simple Perforations, Lacerations, or Tears of the Small Intestine:

1. Debridement and Closure:
- Minimally debride the injured area.
- Close the injury primarily with a single layer of interrupted sutures...
small intestine, repair, perforation, laceration, tear, debridement, mesentery, rule of twos, resection, vascular injury

Surgery Vascular Injuries (1)

Intraoperative Management of Aortic and Inferior Vena Cava Injuries
Critical Source: NATO Emergency War Surgery
Procedure for Managing Aortic or Inferior Vena Cava Injuries During Surgery:

1. Incision and Control:
- Make generous incisions to access the injured vessels.
- Obtain adequate proximal and distal control of the aorta and inferior...
aorta, inferior vena cava, vascular injury, hemostasis, thoracotomy, balloon catheter, sponge stick, vein graft

Surgery Ureteral Injuries (1)

Diagnosis and Repair of Ureteral Injuries
High Priority Source: NATO Emergency War Surgery
Procedure for Diagnosing and Repairing Ureteral Injuries:

1. Preoperative Diagnosis:
- Hematuria is a common sign of ureteral injury.
- If hematuria is noted preoperatively, perform an intravenous pyelogram to confirm the...
ureteral injury, hematuria, intravenous pyelogram, absorbable sutures, reimplantation, stricture prevention, drainage, closed suction

Gynecology And Male Reproductive Health (1)

Managing Injuries to Reproductive Organs
High Priority Source: NATO Emergency War Surgery
Procedure:

1. Practice conservation in managing injuries to the reproductive organs.
2. For penetrating or crush injuries of the labia, penis, scrotum, and testicles:
- Perform conservative debridement.
- Use **primary...
reproductive organ injury,conservative debridement,scrotal drainage,primary repair

Intestinal Obstruction (1)

Diagnose and Differentiate Postoperative Intestinal Obstruction
High Priority Source: NATO Emergency War Surgery
Procedure for Diagnosing and Differentiating Postoperative Intestinal Obstruction

### Diagnosis:
Postoperative mechanical intestinal obstruction typically develops within the first 2 weeks after injury.
• It is often caused by...
intestinal obstruction, Gastrografin, adhesions, intraloop abscesses, abdominal X-rays, mechanical obstruction, ileus

Abscess Management (1)

Drain and Prevent Recurrence of Intra-Abdominal Abscesses
High Priority Source: NATO Emergency War Surgery
Procedure for Draining and Preventing Recurrence of Intra-Abdominal Abscesses

### Management:
Abscess drainage is the most common reason for reoperation in abdominal wounds.
• If abscess presents early, it may be associated with other...
intra-abdominal abscess, drainage, closed suction drains, irrigation, cavity collapse, recurrence prevention

Renal Injury Diagnosis (1)

Diagnosing Renal Injury in Trauma Patients
High Priority Source: NATO Emergency War Surgery
Procedure for Diagnosing Renal Injury in Trauma Patients:

1. Assess the type of trauma sustained, including blunt or penetrating injuries to the flank, upper abdomen, or thorax.
2. Perform a physical examination and check for signs such...
renal injury, diagnosis, trauma, hematuria, intravenous pyelogram, IVP, physical examination

Renal Injury Classification (1)

Classifying Renal Trauma Injuries
High Priority Source: NATO Emergency War Surgery
Procedure for Classifying Renal Trauma Injuries:

1. Determine the type of injury (blunt or penetrating) based on trauma history and physical examination.
2. Classify renal injuries into minor or major categories:
- **Minor...
renal trauma, classification, minor injuries, major injuries, visceral injuries

Renal Injury Treatment (1)

Nonoperative Management of Minor Renal Injuries
Standard Source: NATO Emergency War Surgery
Procedure for Nonoperative Management of Minor Renal Injuries:

1. Confirm the injury is minor (e.g., renal contusion or shallow cortical laceration) through imaging and clinical evaluation.
2. Administer intravenous fluids to maintain...
minor renal injury, nonoperative treatment, hydration, bedrest, monitoring

Renal Injury Surgery (1)

Operative Management of Major Renal Injuries
Critical Source: NATO Emergency War Surgery
Procedure for Operative Management of Major Renal Injuries:

1. Confirm the injury is major (e.g., deep cortical lacerations, shattered kidneys, vascular pedicle injuries) through imaging and clinical evaluation.
2. **Prepare for...
major renal injury, surgery, laparotomy, vascular control, nephrectomy, urinary diversion

Wound Management Hand Injuries (1)

Initial Management of Hand Injuries in the Division Area
Standard Source: NATO Emergency War Surgery
Procedure:

1. Control hemorrhage and immobilize the hand using a compressive dressing (Figure 39).
2. Elevate the immobilized extremity to reduce swelling.
3. Initiate antibiotic therapy to prevent infection.
4. **Evacuate the...
hand injuries, wound management, compressive dressing, antibiotic therapy, evacuation, dead tissue removal

Anesthesia Hand Surgery (1)

Anesthesia for Hand Wound Surgery
High Priority Source: NATO Emergency War Surgery
Procedure:

1. Use general anesthesia or conduction (nerve) blocks for surgical management of hand wounds.
2. Avoid local anesthesia, as it does not provide adequate pain relief for hand surgery.
3. **Do not inject adrenalin into hands...
hand surgery, general anesthesia, nerve blocks, adrenalin avoidance

Command Responsibility (1)

Unit Commander's Responsibility for Personnel Health and Safety
Standard Source: NAVMED P 5010 US Navy Manual of Preventive Medicine
Objective: Ensure unit commanders fulfill their responsibility for the health and safety of personnel.

Procedure:
1. Unit commanders are ultimately responsible for the health and safety of all personnel under their command.
2. They must...
unit commander, health and safety, preventive medicine, responsibility

Gastrointestinal Illness Prevention (1)

Prevent and Treat Diarrheal Diseases in Deployed Environments
High Priority Source: NAVMED P 5010 US Navy Manual of Preventive Medicine
Procedure:

1. Maintain Strict Food and Water Sanitation Standards:
- Ensure all food is prepared using clean utensils and stored in hygienic conditions.
- Treat all water sources with appropriate purification methods (e.g., boiling,...
diarrheal disease prevention, food sanitation, water purification, ORS, military health

Environmental Hazards Prevention (1)

Mitigate Effects of Extreme Heat and Cold on Deployed Personnel
High Priority Source: NAVMED P 5010 US Navy Manual of Preventive Medicine
Procedure:

1. Prevent Heat-Related Illnesses:
- Provide adequate hydration by ensuring personnel have access to clean water at all times.
- Encourage frequent rest breaks in shaded or cooled areas during hot weather.
- Use cooling...
heat injury prevention, cold injury prevention, hydration, environmental training, military health

Disease Reporting (1)

Communicable Disease Reporting Procedure
High Priority Source: NAVMED P 5010 US Navy Manual of Preventive Medicine
Procedure for Communicable Disease Reporting:

1. Regulations and Requirements: Regulations pertaining to communicable disease reporting are contained in NAVMEDCOMINST 6220.2 series, Disease Alert Reports. These reports are required for:
...
communicable disease reporting, NAVMEDCOMINST 6220.2, Disease Alert Reports, operational readiness, medical assistance

Cardiovascular Illnesses (1)

Administer Antihypertensive for Chest Pain or Hypertension
Standard Source: Personal Wilderness Medical Kit
Procedure:

1. Assess the patient's symptoms, such as chest pain, hypertension, or high blood pressure.
2. Check the dosage instructions: 1 spray sublingually every 3 minutes as needed, up to a maximum of three doses.
3. **Administer the...
antihypertensive, nitroglycerine, chest pain treatment

Sedation Nausea (1)

Administer Droperidol for Sedation or Nausea
High Priority Source: Personal Wilderness Medical Kit
Procedure:

1. Assess the patient's condition and confirm that droperidol is appropriate (e.g., for sedation or nausea).
2. Check expiration date of droperidol.
3. Prepare syringe: Use a 1 mL syringe and draw up the required dose...
droperidol,sedation,nausea,dose,IV,IM

Inflammation Treatment (1)

Administer Dexamethasone for Inflammation or Allergic Reactions
Standard Source: Personal Wilderness Medical Kit
Procedure:

1. Assess the patient's condition and confirm that dexamethasone is appropriate (e.g., for inflammation or allergic reactions).
2. Check expiration date of dexamethasone.
3. Prepare syringe: Use a 1 mL syringe and draw up...
dexamethasone,inflammation,allergic reaction,dose,IV,IM

Wilderness Medical Kit Organization (1)

Organize Wilderness Medical Kit into Modular Components
Standard Source: survival personal wilderness medical kit
Procedure:

1. Identify Modules:
- The Minimum Module should always be carried by Wilderness EMTs, even during rapid response or small search teams.
- The Advanced Module is for those with ALS (Advanced Life Support) skills,...
modular medical kits,wilderness emt,minimum module,advanced module,search module

Allergies Anaphylaxis (1)

Administer Diphenhydramine for Allergies or Sedation
Standard Source: survival personal wilderness medical kit
Procedure for Administering Diphenhydramine Tablets for Allergy/Sedation

Steps:
1. Recognize allergy symptoms: Look for signs such as itching, hives, and swelling.
2. Check medication availability: Ensure you have diphenhydramine 25...
diphenhydramine,antihistamine,allergy relief,drowsiness

Sedation And Seizure Control (1)

Administer Midazolam for Sedation or Seizure Control
High Priority Source: survival personal wilderness medical kit
Procedure:

1. Assess the patient's condition and confirm that they require sedation or are experiencing a seizure.
2. Check the expiration date of the midazolam vial (5 mg/mL, 10 mL) to ensure it is still valid.
3. **Prepare the...
midazolam,sedation,seizure control,IV administration,IM administration,dose

Infection And Fracture Management (1)

Administer Ceftriaxone for Infection or Open Fracture Management
High Priority Source: survival personal wilderness medical kit
Procedure:

1. Assess the patient's condition and confirm that they have an infection or open fracture.
2. Check the expiration date of the ceftriaxone powder (2 g) and sterile water (10 mL) to ensure they are still valid.
3....
ceftriaxone,infection management,open fracture treatment,IV administration,IM administration,dose

Inflammatory Condition Management (1)

Administer Dexamethasone for Inflammatory Conditions
High Priority Source: survival personal wilderness medical kit
Procedure:

1. Assess the patient's condition and confirm that they require treatment for an inflammatory condition.
2. Check the expiration date of the dexamethasone vial (10 mg/mL, 10 mL) to ensure it is still valid.
3. **Prepare the...
dexamethasone,inflammatory condition treatment,IV administration,IM administration,dose

Wilderness Medical Kit (1)

Add Physician-Specific Items to Wilderness Medical Kit
High Priority Source: survival personal wilderness medical kit
To ensure that physicians have access to specialized medical items while in the wilderness, follow these steps:

1. Separate Packaging: Package physician-specific items separately from standard wilderness medical kits for clarity and ease of...
physician,medical kit,wilderness,medications,surgical tools,diagnostic tools

Intravenous Access (1)

Establish Peripheral Intravascular Access
High Priority Source: TCCC 17 13 Army Tactical Combat Casualty Care
Equipment Required: IV tubing, IV fluids, 18-gauge or larger IV needle with catheter, saline lock, constricting band, antiseptic wipes, gloves, tape, and 2- by 2-inch gauze sponges.

Procedure Steps:

1. Put on gloves to maintain...
IV access, peripheral intravascular access, IV needle insertion, catheter placement, medical emergency, tactical field care

Tourniquet Management (1)

Conversion of Tourniquets in Tactical Combat Casualty Care
Critical Source: TCCC 17 13 Army Tactical Combat Casualty Care
Convert limb tourniquets and junctional tourniquets if the following three criteria are met:

• The casualty is not in shock.
• It is possible to monitor the wound closely for bleeding.
• The tourniquet is not being used to control bleeding...
tourniquet conversion, tourniquet removal, evacuation time

Thermal Management (1)

Package Casualty in HPMK or Equivalent for Thermal Protection
High Priority Source: TCCC 17 13 Army Tactical Combat Casualty Care
Procedure:

1. Package the casualty in an HPMK or equivalent Blizzard Survival Blanket, poncho, sleeping bag, etc.
hp mk packaging, thermal protection

Blood Transfusion Risks (1)

Risks of Using Fresh Whole Blood (FWB) in a Walking Blood Bank Program
High Priority Source: TCCC 17 13 Army Tactical Combat Casualty Care
Overview: While FWB can be beneficial in austere conditions, it carries several risks that must be considered.

Procedure:
1. Be aware of the increased risk of transfusion-transmitted infections, such as HIV, hepatitis B and C, and...
FWB risks, transfusion-transmitted infections, ABO typing errors, bacterial contamination, donor screening, hemolytic reaction

Prolonged Field Care (1)

Implement Prolonged Field Care (PFC)
Critical Source: TCCC 17 13 Army Tactical Combat Casualty Care
Procedure for Implementing Prolonged Field Care (PFC)

1. Define the Scope of PFC: Apply field medical care beyond doctrinal planning timelines to reduce patient mortality and morbidity.
2. Use Limited Resources: Utilize only available...
prolonged field care, pfc, medical care, evacuation preparation, tactical combat casualty care

Head Injury Hypothermia (1)

Manage Head Injury and Hypothermia in Combat Settings
Critical Source: TCCC 17 13 Tactical Combat Casualty Care
Procedure:

1. Assess the casualty for signs of head injury or hypothermia.
2. For suspected mild traumatic brain injury (mTBI), use the Military Acute Concussion Evaluation (MACE) to assess symptoms.
3. For non-medical personnel, use...
head injury, hypothermia management, MACE evaluation, HPMK kit, lethal triad

Tactical Medical Care (1)

Provide Role 1 Medical Care
High Priority Source: TCCC 17 13 Tactical Combat Casualty Care
Procedure for Providing Role 1 Medical Care

Role 1 care includes prehospital medical care such as self-aid, buddy aid, and care provided by a combat medic. This level of care is delivered at the battalion aid station or unit-level medical...
Role 1 medical care, damage control resuscitation, TCCC Card, MIST Report, ADTMC algorithm

First Aid Equipment (1)

Assemble and Use the Warrior Aid and Litter Kit (WALK)
High Priority Source: TCCC 17 13 Tactical Combat Casualty Care
Overview: The WALK is a vehicle life-saving kit designed for first-aid treatment, immediate evacuation of one patient in a CASEVAC vehicle, and treatment of multiple trauma patients at the point of injury (POI). It weighs 29 pounds, 15 ounces...
WALK, Warrior Aid and Litter Kit, TALON II litter, CASEVAC, first-aid kit, trauma supplies, hypothermia prevention, medical evacuation

Evacuation Equipment (1)

Assemble and Use the Sked Basic Rescue System
High Priority Source: TCCC 17 13 Tactical Combat Casualty Care
Overview: The Sked is a semirigid litter that utilizes a sled design to allow the evacuator to continue returning fire as the casualty is evacuated. It is used for confined space, high angle, or technical rescue and provides patient protection...
Sked litter, rescue system, confined space evacuation, high-angle rescue, technical rescue, casualty evacuation, medical transport

Sedatives Anticonvulsants (1)

Administer Diazepam for Rapid Sequence Induction or Seizure Activity
High Priority Source: TCCC 17 13 Tactical Combat Casualty Care
Indications: Rapid sequence induction, current or anticipated seizure activity, or sedative for combative casualty.

Dosage: 5 mg/2 milliliter (ml) injection.

Availability: Available in both the Combat Medic and Tactical Combat Medical...
diazepam,Valium,sedative,seizure

Hemostatic Agents (1)

Administer Tranexamic Acid for Excessive Hemorrhage
High Priority Source: TCCC 17 13 Tactical Combat Casualty Care
Indications: Excessive hemorrhage, given within three hours of injury.

Dosage: 1 gram (gm) IV piggyback with 100 ml normal saline, lactated Ringers or Hextend solution.

Availability: Available in both the Combat Medic and Tactical...
tranexamic acid,TXA,hemorrhage,antifibrinolytic

Veterinary Services (1)

Veterinary Services in Military Operations
Standard Source: TCCC 17 13 Tactical Combat Casualty Care
Veterinary services provide the following:

1. Food inspection and safety to prevent contamination.
2. Surveillance and investigation of zoonotic diseases or food/waterborne illness.
3. Animal medical and surgical care for military...
food inspection, zoonotic disease, veterinary care

Cpr Wilderness (1)

When to Discontinue CPR in Wilderness Environments
High Priority Source: US Marine Corps Wilderness Medicine
Overview: In remote wilderness areas, CPR may not be effective or safe under certain conditions.

Indications for discontinuing CPR legally include:
1. The patient revives.
2. ACLS is started by higher authority.
3. Relieved by another...
CPR,wilderness,discontinue,CPR guidelines,remote areas,legal obligations

Circulatory Assessment (1)

Assess Circulation in a Trauma Patient
High Priority Source: US Marine Corps Wilderness Medicine
Procedure:

• Assess and control major bleeding:
- Identify and control major bleeding.
- Check pulse: Quality, rate, and regularity.
- Check pulse pressure: Radial first, then carotid.
- Check skin color for cyanosis, pallor, and...
major bleeding, pulse assessment, shock position, IV insertion, hypothermia prevention

Physical Exam (1)

Perform a Detailed Physical Exam in the Wilderness
High Priority Source: US Marine Corps Wilderness Medicine
Procedure:

• Conduct a head-to-toe assessment to identify and treat all secondary injuries.
• Expose one body part at a time, then cover it back up as you go.
• Look for deformities, contusions, abrasions, penetrations/punctures, bruising,...
wilderness physical exam, secondary injuries, DCAP-BTLS assessment

Head Management (1)

Manage Head Injuries in a Trauma Patient
High Priority Source: US Marine Corps Wilderness Medicine
Procedure:

• Maintain airway and continue ventilation as indicated.
• Control hemorrhage.
• Prevent secondary brain injury.
• Remove contact lenses.
airway management, head injury control, secondary brain injury prevention

Neck Management (1)

Manage Neck Injuries in a Trauma Patient
High Priority Source: US Marine Corps Wilderness Medicine
Procedure:

• Maintain an open airway.
• Ensure immobilization and protection of the cervical spine.
• Mark the trachea for reference.
cervical spine immobilization, airway management, trachea marking

Chest Assessment (1)

Assess the Chest in a Trauma Patient
High Priority Source: US Marine Corps Wilderness Medicine
Procedure:

• Inspect chest wall for signs of blunt trauma, penetrating injuries, and use of accessory muscles during respiration.
• Auscultate the chest wall and posterior bases for breath sounds.
• Auscultate for heart sounds.
• Palpate the...
chest trauma assessment, breath sounds auscultation, flail chest identification

Chest Management (1)

Manage Chest Injuries in a Trauma Patient
High Priority Source: US Marine Corps Wilderness Medicine
Procedure:

• Perform needle thoracenthesis if tension pneumothorax is suspected and proper training and equipment are present.
• Apply a three-sided dressing for open chest wounds.
• Perform pericardiocentesis if cardiac tamponade is suspected...
tension pneumothorax management, open chest wound dressing, pericardiocentesis

Abdominal Management (1)

Manage Abdominal Injuries in a Trauma Patient
High Priority Source: US Marine Corps Wilderness Medicine
Procedure:

• Correctly dress wounds.
• Keep the patient NPO until definitive care is delivered.
wound dressing, NPO management, abdominal injury treatment

Genitourinary Assessment (1)

Assess the Perineum, Rectum, Penis, and Vagina in a Trauma Patient
High Priority Source: US Marine Corps Wilderness Medicine
Procedure:

Perineum: Inspect for contusions/hematomas or lacerations.
Rectum: Check for blood, sphincter tone, and high-riding prostate.
Penis: Look for urethral bleeding.
Vagina: Assess for bleeding or lacerations.
perineal trauma assessment, rectal examination, penile injury evaluation, vaginal injury assessment

Musculoskeletal Assessment (1)

Assess Musculoskeletal Injuries in a Trauma Patient
High Priority Source: US Marine Corps Wilderness Medicine
Procedure:

• Inspect extremities for evidence of blunt or penetrating injury (deformities, altered range of motion).
• Palpate extremities for tenderness, crepitus, and abnormal movements.
• Palpate all pulses.
• Assess pelvis for stability...
extremity injury assessment, pulse palpation, pelvis stability check, spinal trauma evaluation

Thermoregulation (1)

Understand Thermoregulation and Heat Transfer Mechanisms
Standard Source: US Marine Corps Wilderness Medicine
Objective: Understand the body's thermoregulation process and the mechanisms of heat transfer.

Thermoregulation:
- The body constantly adjusts itself to maintain an optimal temperature. This is achieved through a balance between heat...
thermoregulation, heat transfer, conduction, convection, radiation, evaporation

Clinical Assessment (1)

Recognize Clinical Findings in a Medical Emergency
High Priority Source: US Marine Corps Wilderness Medicine
Clinical findings to look for in a medical emergency include:

### Central Nervous System (CNS):
• Altered mental status
• Agitation
• Ataxia
• Delirium
• Hallucinations
• Convulsions
• Seizures
• Coma
• Pupillary constriction

###...
clinical findings, central nervous system, cardiovascular, pulmonary, renal, gastrointestinal, hematologic, hepatic

Hyperthermia Treatment (1)

Emergency Treatment for Hyperthermia
Critical Source: US Marine Corps Wilderness Medicine
Steps to perform emergency treatment for hyperthermia:

### 1. Rapid Reduction of Body Core Temperature:
• Use any means available until core temperature is reduced to 102°F (38.9°C).

#### Methods to reduce body temperature:
1. **Ice...
hyperthermia, emergency treatment, core temperature reduction, ice water bath, cool water bath, IV fluids, valium, transport

Inhalation Injury (1)

Inhalation Injury Management in Burn Patients
Critical Source: US Marine Corps Wilderness Medicine
Procedure:

1. Recognize inhalation injury as a critical factor in fire-related deaths.
2. Assess for signs of inhalation injury, including carbon monoxide poisoning, thermal airway injury, and smoke poisoning.
3. **Provide immediate...
inhalation injury, smoke inhalation, carbon monoxide poisoning

Infections And Inflammation (1)

Treating Lymphadenopathy and Associated Symptoms
Standard Source: US Marine Corps Wilderness Medicine
### Treating Lymphadenopathy and Associated Symptoms

Apply contact tape to the affected area, then remove it. This will effectively remove spines from the affected area.

Use Group I corticosteroid cream or ointment for treatment of...
lymphadenopathy,corticosteroid,codeine,demerol,antiemetics

Combat Casualty Care (1)

Prioritize Treatment Based on Combat Casualty Care Concepts
Critical Source: US Marine Corps Wilderness Medicine
Procedure:

1. Understand the Primary Causes of Death in Mass Casualty Situations:
- Asphyxia and hemorrhage are initially the primary causes of death.
- Once at a definitive care facility, uncontrolled hemorrhage is the...
combat casualty care, treatment concepts, asphyxia, hemorrhage, priority of life over limb, triage priorities

Hygiene Prevention (1)

Maintain Personal Hygiene in Wilderness Environments
Reference Source: US Marine Corps Wilderness Medicine
Overview: Proper personal hygiene is essential for preventing infections and maintaining health during wilderness operations.

### Hair Care
Clean frequently to reduce the risk of infection.
Inspect at least once a week for parasites...
hair care, hand hygiene, foot care, oral hygiene, parasite prevention, infection control, wilderness medicine

Spinal Injury (1)

C-Spine Roll and Stability in Water Emergencies
Critical Source: US Marine Corps Wilderness Medicine
Procedure:

1. Suspect C-Spine involvement in any head injury.
2. Stabilize and immobilize the victim using a *C-Collar*, *Sam Splints*, or a field expedient method.
3. Keep the victim in the water until a *spine board* or equivalent is...
C-Spine roll, spinal injury, immobilization, Sam Splints, C-Collar, ABCs

Pregnancy And Child Health (1)

Avoid Tetracycline for Pregnant Women and Young Children
High Priority Source: Where There is No Dentist
Procedure:

1. Do not give tetracycline to a pregnant woman or a young child.
2. Tetracycline can cause the teeth of both the mother and child to turn dark permanently.
3. If an antibiotic is needed for a pregnant woman or young child, use...
tetracycline, pregnancy, child health, antibiotic use, dental discoloration

Nutrition Dental Health (1)

Maintain a Balanced Diet for Oral and General Health
Standard Source: Where There is No Dentist
To maintain good oral and general health, follow these steps:

1. Eat a variety of foods at every meal:
- Include one or two foods from each of the following groups in your meals:
- Grow food (body-building food) for protein.
-...
balanced diet, oral health, nutrition, grow food, glow food, go food, main food, cooking oil, dental care, teeth protection

Dental Diagnosis (1)

Conduct a Dental Examination for Diagnosis
Standard Source: Where There is No Dentist
Purpose: To gather information and make an accurate diagnosis of a dental problem.

### Steps:
1. Ask the person about the problem
- Give the sick person a chance to describe how they are feeling.
- Listen carefully and think about...
diagnosis, dental examination, patient interview, mouth inspection, pain assessment, scientific method

Sinus Infection (1)

Identify and Treat an Infected Sinus
Standard Source: Where There is No Dentist
Signs of an infected sinus:

• Toothache in several top teeth. The teeth look healthy, but hurt when you tap them.
• A head cold, and plugged nose. She can only breathe through her mouth.
• Hurts when you press against the bone under her eyes.
-...
infected sinus, toothache, penicillin, steam inhalation, warm compress

Cancer Treatment (1)

Recognize and Respond to Oral Cancer
Critical Source: Where There is No Dentist
Cancer is deadly.

Any sore or bump that does not heal within 2 weeks may be cancer. The lips and tongue are the two most common places in the mouth where cancer starts. Also check:
• The floor of the mouth under the tongue
• The soft part...
oral cancer, early detection, lips, tongue, gums

Hiv Oral Infections (1)

Recognize and Respond to Oral Infections That May Indicate HIV
High Priority Source: Where There is No Dentist
Procedure:

1. Observe symptoms in the mouth and throat:
- Look for white spots on the roof of the mouth.
- Check for soreness, bad odor, or difficulty chewing/swallowing.
- Note any signs of infection in the gums or throat.

2....
oral infection,hiv,dental care,testing,prevention,immune system,transmission

Hiv Aids Oral Health (1)

Recognizing Oral Symptoms of HIV/AIDS in the Mouth
Standard Source: Where There is No Dentist
Oral symptoms associated with HIV/AIDS include:

1. Sores and infections: These may appear on the lips, cheeks, tongue, roof of the mouth, under the tongue, and gums.
2. Dry mouth (xerostomia): Common in people taking anti-retroviral...
HIV,AIDS,oral symptoms,dental care,mouth infection,xerostomia,gum disease

Dental Examination (1)

Examine the Mouth and Face for Dental Issues
Standard Source: Where There is No Dentist
Steps to examine a person’s mouth and face:

1. Inspect visually: Always examine the lips, face, and inside the mouth of someone seeking dental advice. Look for signs such as swelling, broken skin, sores, redness, infection, or unusual color...
mouth examination, dental inspection, tongue inspection, jaw and neck check

Patient Communication (1)

Communicate Clearly and Respectfully During a Dental Examination
Standard Source: Where There is No Dentist
Steps to communicate clearly during a dental examination:

1. Explain procedures: Before examining someone, always explain carefully what you are going to do.
2. Inform about findings: After the examination, explain what you found and...
patient communication, informed consent, dental examination process

Patient Rights (1)

Respect the Privacy of a Person with HIV
Standard Source: Where There is No Dentist
Steps to respect the privacy of someone with HIV:

1. Confidentiality: No one else should know if someone has HIV, except for those the person wants to know.
2. Permission required: If you think it is important to tell others, always ask...
HIV privacy, patient confidentiality, informed consent, ethical treatment

Dental Care Hiv (1)

Provide Dental Care for a Person with HIV
Standard Source: Where There is No Dentist
Overview: In general, there is no need to change dental treatment because a person is infected with HIV. This is especially true if the person has no signs of HIV.

Steps:
1. If there is already an infection in the mouth, use a **mouth...
HIV,dental care,mouth infection,sterilized instruments,health worker

Dental Procedures Hiv (1)

Prevent Infection During Tooth Extraction for a Person with HIV
High Priority Source: Where There is No Dentist
Overview: When extracting a tooth from someone with HIV, special precautions must be taken to prevent infection and ensure proper healing.

Steps:
1. Follow all the guidelines in Chapter 11, page 157, for general tooth extraction...
tooth extraction,HIV,infection prevention,tartar removal,blood clotting

Infection Prevention Hiv (1)

Prevent and Treat Common Mouth Infections in People with HIV
High Priority Source: Where There is No Dentist
Overview: Many infections can occur in the mouth of a person infected with HIV. These include cold sores, gum infections, and other conditions that may be more severe due to the weakened immune system.

Steps:
1. Prevention: Take 480 mg...
HIV,mouth infection,cotrimoxazole,prevention,tobacco use

Illness Management (1)

Recognize and Manage an Acute Illness
High Priority Source: Where There is No Dentist
Title: Recognize and Manage an Acute Illness

Content:
An acute illness is one that starts suddenly and lasts a short time. It is the opposite of a chronic illness.

Symptoms to Watch For:
• Sudden onset of symptoms (e.g., fever, pain,...
acute illness,symptoms,management,rest,hydration

Basic Medical Knowledge (1)

Understanding Kilogram (kg) Measurement
Reference Source: Where There is No Dentist
Kilogram (kg) is a unit of mass equal to one thousand grams. A ‘kilo’ weighs approximately 2 pounds.
kilogram, kg, weight measurement, metric system

First Aid Supplies (1)

Understanding Petroleum Jelly (Vaseline) Usage
Reference Source: Where There is No Dentist
- Petroleum jelly (also known as Vaseline) is a grease-like jelly used in preparing skin ointments.
petroleum jelly, vaseline, first aid

Healthcare Administration (1)

Understanding the Importance of Records and Reports in Healthcare
Reference Source: Where There is No Dentist
- Records, reports are written information about sick persons and the treatment they receive. Records are for the personal use of the health worker, reports are written by one health worker to another to describe an illness and ask for further...
medical records, healthcare reports, documentation

Self Assessment (1)

Know When to Seek Professional Medical Help
Standard Source: Where There is no Doctor a Village Health Care Handbook
When to seek help from a health worker or doctor:

• If symptoms are severe, such as high fever, difficulty breathing, or loss of consciousness.
• If there is no improvement after following self-care steps for several days.
• If the condition...
seek help, professional medical care, self-care limits, when to call for help

Injuries Poisoning (1)

Revised Treatment of Snakebite
Critical Source: Where There is no Doctor a Village Health Care Handbook
Procedure:

1. Do not cut the bite site or apply a tourniquet, as these methods can cause more harm.
2. Keep the affected limb still and lower than the heart to slow the spread of venom.
3. **Remove any tight clothing or jewelry near the...
snakebite,treatment,antivenom,first aid

Health Worker Training (1)

Define and Support the Role of the Village Health Worker
High Priority Source: Where There is no Doctor a Village Health Care Handbook
To ensure effective health care delivery in rural areas:

1. Identify a village health worker who is respected by the community and has demonstrated ability and kindness.
2. Provide training and support, if possible, through programs such as...
village health worker,training,community leader,self-study,health promotion

Cultural Healthcare (1)

Respect Cultural Traditions in Healthcare Practices
Reference Source: Where There is no Doctor a Village Health Care Handbook
Objective: Integrate traditional healing practices with modern medical knowledge.

Steps:
1. Recognize the value of local customs and traditions in healthcare, even when learning about modern medicine.
2. **Avoid dismissing traditional...
traditional healing, cultural respect, integration of practices, community trust

Cultural Integration (1)

Integrate Modern and Traditional Medicine for Better Health Outcomes
Standard Source: Where There is no Doctor a Village Health Care Handbook
Combine modern medical practices with traditional healing methods when appropriate, as the combination may yield better results than either alone.

• Respect local traditions and customs, even if they are not scientifically validated. For...
traditional medicine, modern medicine, cultural respect, integration, health care

Individual Health Assessment (1)

Conduct a Health Needs Assessment for Individuals and Families
Standard Source: Where There is no Doctor a Village Health Care Handbook
To conduct a thorough health needs assessment for individuals and families within your community:

1. Visit Homes and Gatherings: Go to the homes, fields, schools, and gathering places of community members to observe their living conditions,...
health assessment, individual evaluation, family health, social dynamics, access to services

Community Health Programs (1)

Promote Community Participation in Health Improvement Projects
Standard Source: Where There is no Doctor a Village Health Care Handbook
To ensure the success of any health improvement project within your community:

1. Involve Community Members: Encourage active participation from all members of the community, including those who may not be directly affected by a specific...
community participation, health projects, collaboration, education, shared responsibility

Demographic Assessment (1)

Assess Population and Demographic Factors Affecting Health
Standard Source: Where There is no Doctor a Village Health Care Handbook
Objective: Understand the demographic profile of the community to identify health concerns.

Steps:
1. Population size: Determine how many people live in the community and the number of children under 15 years old.
2. Literacy rates:...
population assessment, demographic data, birth rates, death rates, literacy, family planning, child mortality

Maternal Child Health (1)

Host Mother and Child Health Meetings
High Priority Source: Where There is no Doctor a Village Health Care Handbook
Objective: Educate pregnant women and mothers of young children about health care and child development.

Steps:
1. Organize regular meetings for pregnant women and mothers with children under five years old.
2. Use these meetings to provide...
mother and child meetings, health education, growth chart, maternal care, child development

Community Health Education (1)

Facilitate Group Discussions Using Visual Aids
Reference Source: Where There is no Doctor a Village Health Care Handbook
Objective: Use pictures to encourage group discussions and critical thinking about health, community issues, and problem-solving.

### Steps:
1. Select a relevant picture that depicts people, their environment, or a health-related scenario...
group discussion,picture-based learning,health education,community problem-solving,visual aids,participation,communication skills

Psychosomatic Illnesses (1)

Use Belief-Based Remedies for Psychosomatic or Stress-Related Illnesses
Standard Source: Where There is no Doctor a Village Health Care Handbook
Purpose: Use belief-based remedies to help treat illnesses that are partly in people’s minds, such as anxiety, hysteria, or stress-related aches and pains.

Procedure:
1. Identify the illness: Determine if the condition is psychosomatic...
belief-based remedies, psychosomatic illnesses, stress-related conditions, anxiety, hysteria, migraine headaches, warts

Diarrhea Vomiting (1)

Administer Rehydration Drink to a Child with Diarrhea and Vomiting
High Priority Source: Where There is no Doctor a Village Health Care Handbook
Procedure:

1. Give the child plenty of liquid: Use Rehydration Drink (see p. 152), breast milk, or boiled water.

Details:
• Ensure the child drinks frequently in small amounts to avoid vomiting.
• Continue giving liquids even if the...
rehydration drink, diarrhea treatment, vomiting, child care, dehydration prevention

Gynecological Illnesses (1)

Recognize and Respond to Dolor de Ijar (Side Pains in Women)
High Priority Source: Where There is no Doctor a Village Health Care Handbook
Dolor de ijar refers to pain on one side of the belly that may radiate to the mid or lower back. This can be caused by several serious conditions, including:

### Possible Causes and Actions:
Urinary tract infection: Look for symptoms like...
dolor de ijar, side pain in women, gynecological issues, appendicitis

General Illnesses (1)

Understand and Address La Congestión (Sudden Illness or Distress)
High Priority Source: Where There is no Doctor a Village Health Care Handbook
La congestión is a term used in some cultures to describe any sudden illness that causes great distress. It may be applied broadly to various conditions, including:

### Possible Causes and Actions:
Food poisoning: Sudden vomiting followed...
la congestion, sudden illness, food poisoning, allergic reaction, heart attack

Diagnosis And Communication (1)

Avoid Misunderstandings Due to Confusion of Names in Health Communication
Standard Source: Where There is no Doctor a Village Health Care Handbook
Overview:
Misunderstandings can occur when villagers use local names for illnesses that differ from medical terminology.

Example: Spanish Name _CÁNCER_ (Cancer) vs. Local Understanding:
• In some areas, the word _cáncer_ is used to describe...
health communication,name confusion,cancer,skin infection,gangrene,medical terminology

Fever Analysis (1)

Understanding Patterns of Fever and Their Causes
Standard Source: Where There is no Doctor a Village Health Care Handbook
It is important to find out when and how the fever comes, how long it lasts, and how it goes away. This may help you identify the disease. Not every fever is malaria, though in some countries it is often treated as such. Remember other possible...
fever patterns, typhoid fever, tuberculosis symptoms, malaria vs other fevers

Skin Examination (1)

Conduct a Full Body Skin Examination for Illnesses
High Priority Source: Where There is no Doctor a Village Health Care Handbook
Procedure:

1. Examine the entire body of the sick person, even if the illness seems mild.
2. Undress babies and children completely to ensure thorough examination.
3. Look carefully for any abnormalities, including:
- Sores,...
skin examination, body inspection, rashes, inflammation, lymph nodes, leprosy, children skin check

Abdominal Assessment (1)

Assess Abdominal Pain and Identify Potential Causes
High Priority Source: Where There is no Doctor a Village Health Care Handbook
Procedure:

1. Determine the exact location of abdominal pain by asking the person to point with one finger where it hurts.
2. Ask about the nature of the pain: whether it is steady or comes and goes like cramps or colic.
3....
abdominal pain, appendicitis, peritonitis, rebound pain test, intestinal gurgles

Gastrointestinal Emergency (1)

Recognize and Respond to a Silent Belly (No Intestinal Sounds)
Critical Source: Where There is no Doctor a Village Health Care Handbook
Procedure:

1. Listen for intestinal gurgles using an ear or stethoscope placed on the belly.
2. If no sounds are heard after about 2 minutes, this is a danger sign indicating possible obstruction or severe gastrointestinal issue.
3....
silent belly, intestinal sounds, gastrointestinal emergency

Abdominal Pain Diagnosis (1)

Identify Common Abdominal Pain Locations for Medical Conditions
High Priority Source: Where There is no Doctor a Village Health Care Handbook
Procedure:

1. Use visual aids or diagrams to identify the typical locations of abdominal pain associated with specific conditions:
- Ulcer: Pain in the ‘pit of the stomach’ (see page 128)
- Appendicitis: Initially hurts near...
ulcer pain location, appendicitis symptoms, gallbladder pain, abdominal pain diagram

Sanitation And Hygiene (1)

Maintain Personal Cleanliness for a Seriously Ill Person
Standard Source: Where There is no Doctor a Village Health Care Handbook
Procedure:

Personal cleanliness is very important for a seriously ill person.

• She should be bathed every day with warm water.
• Change the bed clothes daily and each time they become dirty.
• Soiled or bloodstained clothes, bedding,...
cleanliness for sick person, bathing, bed clothes change, chlorine bleach, sanitation

Wound Care And Prevention (1)

Change Position in Bed to Prevent Complications for a Very Weak Person
Standard Source: Where There is no Doctor a Village Health Care Handbook
Procedure:

A person who is very weak and cannot turn over alone should be helped to change position in bed many times each day.

• This helps prevent bed sores (see p. 214).
• A child who is sick for a long time should be held often on her...
bed position change, bed sores prevention, pneumonia signs, weak person care

Monitoring Patient Condition (1)

Monitor and Record Vital Signs of a Sick Person
High Priority Source: Where There is no Doctor a Village Health Care Handbook
To monitor the condition of a sick person, you should record their vital signs four times a day. The following information should be written down:

1. Temperature: Measure and note how many degrees the person's temperature is.
2. Pulse:...
vital signs, temperature, pulse, breathing, liquids consumed, urination frequency, bowel movements, monitoring patient condition

Transport And Urgent Care (1)

When and How to Seek Medical Help
Critical Source: Where There is no Doctor a Village Health Care Handbook
General guidelines for seeking medical help:

Seek medical help at the first sign of a dangerous illness. Do not wait until the person is so sick that it becomes difficult or impossible to take him to a health center or hospital.

• If a...
transport injured, medical transport, emergency care, splinting, stretcher use

Self Care (1)

Basic Self-Care for Common Sicknesses
Reference Source: Where There is no Doctor a Village Health Care Handbook
Objective: Help the body fight off sickness through natural defenses.

Steps:
1. Keep clean:
- Wash hands regularly with soap and water, especially before eating or handling food, and after using the bathroom.
2. **Get plenty of...
rest, hydration, cleanliness, nutrition, self-care, common cold, flu

Water Safety (1)

Use of Water for Disease Prevention
Standard Source: Where There is no Doctor a Village Health Care Handbook
Objective: Prevent disease through proper use of water.

Steps:
1. Protect water sources:
- Put fences or walls around wells and springs to prevent contamination from dirt and animals.
2. Improve drainage: Use cement or rock...
water safety, disease prevention, hygiene, contamination, wells, springs

Fever Treatment (1)

Treating High Fever with Cool Water
Critical Source: Where There is no Doctor a Village Health Care Handbook
Procedure:

1. Remove all clothing from the person suffering from a high fever.
2. Soak the body in cool water, focusing on areas such as the forehead, neck, and underarms.
3. Use clean, cool (not cold) water to avoid causing shock or...
high fever,cool water,body soak,heatstroke

Eye Illnesses (1)

Treating Eye Irritations with Cool Water
High Priority Source: Where There is no Doctor a Village Health Care Handbook
Procedure:

1. Immediately rinse the affected eye with cool water for at least 30 minutes to remove any irritants.
2. Ensure that the water is clean and safe for use on the eyes.
3. Do not rub the eye, as this can cause further damage or...
eye irritations,cool water,treatment

Injections And Infusions (1)

Avoid Injecting Calcium Without Medical Advice
High Priority Source: Where There is no Doctor a Village Health Care Handbook
Never inject calcium without first seeking medical advice!

Injecting calcium into a vein can be extremely dangerous and may quickly kill someone if not injected very slowly. Injecting calcium into the buttocks sometimes causes very serious...
calcium injection dangers, medical advice, unsafe injections

Hydration And Nutrition (1)

Avoid Intravenous Solutions for Non-Critical Cases
Standard Source: Where There is no Doctor a Village Health Care Handbook
Intravenous (I.V.) solutions should be used only when a person can take nothing by mouth or is badly dehydrated (see p. 151). They are not effective for treating anemia, weakness, or malnutrition.

I.V. solutions are simply pure water with some...
IV solutions, rehydration drink, hydration methods, nutrition for the sick

Injections And Syringes (1)

Proper Needle and Syringe Sterilization Before Injection
High Priority Source: Where There is no Doctor a Village Health Care Handbook
Objective: To prevent infection from injections by properly sterilizing the needle and syringe.

Steps:
1. Boil the needle and syringe completely before injecting. Ensure that they are submerged in boiling water for at least 20 minutes...
needle sterilization, syringe boiling, injection safety, infection prevention, medical hygiene

Allergies And Reactions (1)

Recognizing and Managing Allergic or Poisonous Reactions to Medicines
Critical Source: Where There is no Doctor a Village Health Care Handbook
Objective: To identify signs of allergic or poisonous reactions after an injection and take appropriate action.

Signs of Reaction:
• Hives (patchy swellings on the skin) or a rash with itching
• Swelling anywhere in the body
• Difficulty...
allergic reaction, injection side effects, medical emergency, poison symptoms, adverse drug reactions

Shock Response (1)

Recognizing and Responding to Shock
Critical Source: Where There is no Doctor a Village Health Care Handbook
Signs of shock:

• Weak, rapid pulse (more than 100 per minute for adults; more than 140 per minute for children over 2 years old; more than 190 per minute for babies)
• Cold sweat; pale, cold, damp skin
• Blood pressure drops dangerously low
-...
shock, symptoms, response, emergency treatment, CPR

Loss Of Consciousness (1)

Check for Causes of Loss of Consciousness
Critical Source: Where There is no Doctor a Village Health Care Handbook
If a person is unconscious and you do not know why, immediately check the following:

1. Is he breathing well? If not:
- Tilt his head way back.
- Pull the jaw and tongue forward.
- If something is stuck in his throat, pull it out.
...
check unconscious person, causes of unconsciousness, first aid for loss of consciousness, signs of shock, heat stroke treatment

Choking Rescue (1)

Performing the Heimlich Maneuver on an Unconscious or Larger Person
Critical Source: Where There is no Doctor a Village Health Care Handbook
Procedure:

Step 1: Lay the person on their back.
Step 2: Tilt their head to one side.
Step 3: Sit over them with the heel of your lower hand on their belly between the navel and ribs. For fat persons, pregnant women, persons...
heimlich maneuver on unconscious person, choking rescue for large individuals, first aid for choking

Nosebleed Treatment (1)

How to Stop a Nosebleed
Standard Source: Where There is no Doctor a Village Health Care Handbook
Steps to stop a nosebleed:

1. Sit quietly and upright to reduce blood pressure in the nasal passages.
2. Blow the nose gently to remove mucus and blood.
3. Pinch the nose firmly for 10 minutes or until bleeding stops, holding the...
nosebleed, stop nosebleed, first aid, emergency treatment, bleeding control

Snake Bite (1)

What to Avoid After a Snakebite
High Priority Source: Where There is no Doctor a Village Health Care Handbook
After a snakebite, do not:

1. Cut the skin or the flesh around the bite.
2. Tie anything tight around the bite or the person’s body.
3. Put ice on or around the bite.
4. Shock the person with electricity.
5. Try to suck the blood or the venom...
snakebite,avoid,first aid,do not

Reptile Bite (1)

Treating a Beaded Lizard Bite (Gila Monster)
Critical Source: Where There is no Doctor a Village Health Care Handbook
Procedure:

1. Wash the bite area well with clean water.
2. Avoid movement of the affected limb or body to prevent spreading venom.
3. Keep the bite below the level of the heart to slow the spread of venom.

Note: The beaded lizard’s bite is...
beaded lizard,gila monster,bite,treatment

Insect Sting (1)

Treating a Scorpion Sting in Children Under 5 Years Old
Critical Source: Where There is no Doctor a Village Health Care Handbook
Procedure:

1. Give acetaminophen for the pain.
2. If the child stops breathing, use mouth-to-mouth breathing (see p. 80).
3. Administer tetanus antitoxin (see p. 388).
4. Seek medical help immediately if:
- The child is very young.
- The...
scorpion sting,treatment,children

Nutrition Deficiency (1)

Recognize Signs of Poor Nutrition in Individuals
Standard Source: Where There is no Doctor a Village Health Care Handbook
Signs of poor nutrition may include:

• Weakness and tiredness
• Loss of appetite
• Anemia
• Sores in the corners of the mouth
• Painful or sore tongue
• 'Burning' or numbness of the feet
• Diarrhea (may be worsened by poor nutrition)
• Frequent...
poor nutrition, signs of malnutrition, health symptoms, anemia, weakness, diarrhea, infections, mouth sores

Recovery Nutrition (1)

Maintain Good Nutrition During and After Illness
High Priority Source: Where There is no Doctor a Village Health Care Handbook
During and after any sickness, it is very important to eat well:

• A nutritious diet helps the body recover from illness.
• Poor nutrition during recovery can delay healing and increase complications.
• Encourage frequent meals with a variety...
nutrition during recovery, post-illness diet, healing support, healthy eating after sickness

Malnutrition Detection (1)

Identify Malnutrition in Children Using Upper Arm Circumference Measurement
High Priority Source: Where There is no Doctor a Village Health Care Handbook
Why it is important:
Malnutrition can lead to poor growth, frequent illness, and developmental delays in children. Early detection using simple measurements can help prevent serious health complications.

Procedure:
1. **Measure the middle...
malnutrition detection, upper arm circumference, child health, nutrition assessment

Malnutrition Prevention (1)

Prevent Malnutrition in Children from 6 Months to 2 Years of Age
High Priority Source: Where There is no Doctor a Village Health Care Handbook
### Instructions
1. Keep feeding the child breast milk as much as before. Breast milk is essential for nutrition and immunity.
2. Feed her other nutritious foods also, always starting with just a little.
3. **Feed her at least 5 times a...
malnutrition prevention, infant nutrition, breastfeeding and solids

Health Prevention (1)

Prevent Smoking to Protect Health
Standard Source: Where There is no Doctor a Village Health Care Handbook
Title: Prevent Smoking to Protect Health

Procedure:
1. Avoid smoking to reduce the risk of cancer in the lungs, mouth, throat, and lips.
2. Refrain from smoking to prevent serious lung diseases such as chronic bronchitis and emphysema,...
smoking, health risks, cancer prevention, lung disease, heart disease, children's health, pregnancy, financial impact

Malnutrition Diarrhea Cycle (1)

Break the Vicious Cycle of Malnutrition and Diarrhea
High Priority Source: Where There is no Doctor a Village Health Care Handbook
Objective: Prevent the cycle of malnutrition and diarrhea that can lead to severe health complications or death in children.

Steps:
1. Provide adequate nutrition to children, especially those who are at risk due to poor feeding...
malnutrition, diarrhea cycle, child health, nutrition intervention, medical check-ups

Diarrhea Prevention (1)

Prevent Diarrhea Through Breastfeeding and Cleanliness
High Priority Source: Where There is no Doctor a Village Health Care Handbook
Prevention of Diarrhea in Babies

Breastfeed rather than bottle feed babies. Give only breast milk for the first 6 months. Breast milk helps babies resist infections that cause diarrhea.
• If breastfeeding is not possible, feed the baby...
breastfeeding,disease prevention,diarrhea,baby care,nutrition,cleanliness

Vomiting Management (1)

Manage Vomiting and Provide Rehydration Drink
High Priority Source: Where There is no Doctor a Village Health Care Handbook
Vomiting is one of the signs of many different problems, some minor and some quite serious, so it is important to examine the person carefully. Vomiting often comes from a problem in the stomach or guts, such as: an infection (see diarrhea, p....
vomiting management,dehydration,acute abdomen,diarrhea

Sinusitis Treatment (1)

Treating Acute Sinusitis at Home
Standard Source: Where There is no Doctor a Village Health Care Handbook
Procedure:

1. Drink a lot of water to help thin mucus and reduce congestion.
2. Sniff salt water into the nose: Prepare a saline solution by mixing 1/4 teaspoon of non-iodized salt with 8 ounces of warm water. Tilt your head sideways...
sinusitis, treatment, home remedies, nasal congestion, antibiotics, hot compresses

Allergies Treatment (1)

Treating Hay Fever (Allergic Rhinitis)
Reference Source: Where There is no Doctor a Village Health Care Handbook
Procedure:

1. Use an antihistamine such as chlorpheniramine (page 386) or dimenhydrinate (Dramamine, page 386), which are also used for motion sickness.
2. Avoid allergens: Identify and avoid the substances that trigger symptoms, such...
hay fever treatment, antihistamines, allergy prevention, nasal sprays

Arthritis Management (1)

Relieving Arthritis Pain Through Rest and Hot Compresses
Reference Source: Where There is no Doctor a Village Health Care Handbook
Rest: Avoid hard work and heavy exercise that aggravate the painful joints. If arthritis causes fever, take naps during the day.

Hot Water Compresses: Place cloths soaked in hot water on the affected joints (see p. 195 for more details).
arthritis, rest, hot compresses, joint pain relief

Pediatric Back Pain (1)

Identifying and Managing Back Pain in Children and Young People
High Priority Source: Where There is no Doctor a Village Health Care Handbook
Possible Causes:
Rheumatic fever (see p. 310)
Tuberculosis of the spine (see p. 179)

Symptoms to Watch For:
• Mid-back pain in children with a hump or lump on the backbone.
• Chronic upper back pain with cough and weight loss...
back pain in children, rheumatic fever, TB spine

Back Injury Relief (1)

Treating Sudden Severe Low Back Pain from Injury or Strain
High Priority Source: Where There is no Doctor a Village Health Care Handbook
Symptoms:
• Sudden, severe low back pain after lifting or twisting.
• Knife-like pain when bending over.
• Numbness or weakness in the leg(s) or foot.

Management:
Rest flat on your back for a few days.
• Place something firm under the...
sudden back pain, slipped disc, nerve pinching

Swelling (1)

Recognize and Respond to Swelling of the Feet and Body
High Priority Source: Where There is no Doctor a Village Health Care Handbook
Procedure:

Signs and Symptoms:
• Swelling in feet only: May be due to poor circulation, especially in older adults or during pregnancy.
• Swelling in face or other body parts: Indicates a serious illness, such as heart failure,...
edema, swelling feet, pre-eclampsia, diuretics, salt restriction

Hernia Management (1)

How to Live with a Hernia
Standard Source: Where There is no Doctor a Village Health Care Handbook
How to live with a hernia:

• Avoid lifting heavy objects.
• Make a truss to hold the hernia in.

### Plan for a Simple Truss:
Put a little cushion here so it presses against the groin.

CAUTION: If a hernia suddenly becomes large or...
hernia,living with hernia,truss,manage hernia,painful hernia

Seizures Convulsions (1)

Recognizing and Managing Seizures (Fits/Convulsions)
High Priority Source: Where There is no Doctor a Village Health Care Handbook
What is a seizure?
A person has a seizure when he suddenly loses consciousness and makes strange, jerking movements (convulsions). Seizures come from a problem in the brain.

### Common Causes of Seizures:
• In small children: high fever,...
seizure,convulsion,epilepsy,fever,meningitis,cerebral malaria,eclampsia

Tetanus Symptoms Newborns (1)

Recognize Signs of Tetanus in Newborns
Critical Source: Where There is no Doctor a Village Health Care Handbook
Purpose: Identify early signs of tetanus in newborn children to initiate prompt treatment.

Procedure:
1. Watch for continuous crying that does not stop, especially if the baby is unable to suck or nurse.
2. **Look for stiffness in the...
tetanus symptoms, newborn signs, lockjaw, umbilical infection

Tetanus Diagnosis Newborns (1)

Perform the Knee Reflex Test for Tetanus Suspicions
Critical Source: Where There is no Doctor a Village Health Care Handbook
Purpose: Use a simple test to help confirm or rule out tetanus in newborns.

Procedure:
1. With the leg hanging freely, tap just below the kneecap with your knuckle (or another firm object).
2. Observe the response:
- If the leg...
knee reflex test, tetanus diagnosis, newborn examination

Tetanus Treatment Newborns (1)

Treat Tetanus in Newborns and Other Patients
Critical Source: Where There is no Doctor a Village Health Care Handbook
Purpose: Provide immediate treatment for tetanus when signs are present.

Procedure:
1. Examine the entire body for infected wounds or sores, especially at the umbilical site.
2. Clean the wound thoroughly with soap and cool boiled...
tetanus treatment, newborn care, wound cleaning, antibiotic use

General Illness (1)

Managing Mild Illness with Rest and Hydration
Reference Source: Where There is no Doctor a Village Health Care Handbook
Procedure:

• Ensure the person gets rest.
• Provide lots of liquids such as rehydration drink, fruit juice, or milk to prevent dehydration.
• Administer acetaminophen for fever and pain. Do not use aspirin or ibuprofen, as they...
rest, hydration, acetaminophen, fever, pain management, mild illness

Infectious Disease Recognition (1)

Recognize the Signs of Typhus Infection
Standard Source: Where There is no Doctor a Village Health Care Handbook
Procedure:

1. Look for symptoms similar to a bad cold followed by fever after one week or more.
2. Monitor for chills, headache, and muscle and chest pain.
3. Observe for a rash that appears in the armpits first, then on the body, arms, and...
typhus symptoms, rash identification, fever duration, tick-bite signs

Leprosy Prevention (1)

Prevent Deformities in Leprosy Patients
Standard Source: Where There is no Doctor a Village Health Care Handbook
Prevention of deformities:

• If you follow the above steps and begin treatment early, most deformities with leprosy can be prevented
• For more information about Hansen’s disease, see *Disabled Village Children*, Chapter 26
deformity prevention, leprosy care, medical emergency

Skin Problems (1)

Identify Common Skin Problems in Rural Areas
Reference Source: Where There is no Doctor a Village Health Care Handbook
Common skin problems in rural areas include:

• Diseases or irritations that affect the skin only (e.g., ringworm, diaper rash, warts)
• Signs of diseases that affect the whole body (e.g., rash of measles, sore and dry patches of pellagra)
-...
skin problems, rural health, skin diseases, medical emergency

Foot Care (1)

Treating Corns on the Feet
Reference Source: Where There is no Doctor a Village Health Care Handbook
### Treating Corns on the Feet

To reduce discomfort from corns:

1. Wear appropriate footwear: Get sandals or shoes that do not press on the corns.

2. Soak the foot: Soak the affected foot in warm water for 15 minutes to soften the...
corns, foot care, pain relief, footwear

Skin Cancer (1)

Recognizing and Preventing Skin Cancer
Standard Source: Where There is no Doctor a Village Health Care Handbook
### Recognizing and Preventing Skin Cancer

Signs of skin cancer:
• A small ring-shaped lesion with a hole in the center, often appearing on areas frequently exposed to sunlight (e.g., ears, cheeks, nose, lips).
• Lesions that grow slowly over...
skin cancer, prevention, sun protection, zinc oxide

Kidney Stones (1)

Identify Signs of Kidney or Bladder Stones
High Priority Source: Where There is no Doctor a Village Health Care Handbook
Signs of kidney or bladder stones include:

Sharp or severe pain in the lower back, side, lower belly, or base of the penis in men.
Difficulty passing urine, or inability to pass any urine at all.
• **Drops of blood may come out when...
signs of kidney stones, symptoms of bladder stones, pain in lower back, difficulty urinating, blood in urine, urinary infection with stones

Urological Conditions (1)

Manage Enlarged Prostate Gland Symptoms
Standard Source: Where There is no Doctor a Village Health Care Handbook
Procedure:

1. Assess symptoms: Look for difficulty in passing urine, dribbling or blocked urine flow, and inability to urinate for days.
2. Check for fever: If present, this indicates an infection is also involved.
3. **Use hot water...
enlarged prostate, urinary difficulty, hot water therapy, antibiotics, medical help, urological conditions

Miscarriage Care (1)

Control Bleeding from a Miscarriage with Medication
Critical Source: Where There is no Doctor a Village Health Care Handbook
Procedure:

1. If a woman is rapidly losing blood due to miscarriage and medical help is not immediately available:
- Administer oxytocin, misoprostol, or ergonovine as described for postpartum bleeding.
2. Follow the same dosage...
miscarriage bleeding, oxytocin, misoprostol, ergonovine, emergency care

Newborn Septicemia Treatment (1)

Administer Antibiotics for Septicemia in Newborns
Critical Source: Where There is no Doctor a Village Health Care Handbook
Procedure:

Step 1: Calculate Ampicillin Dosage:
- Inject 50 mg of ampicillin per kilogram of the baby’s weight, 2 times a day if the baby is less than 1 week old or 3 times a day if older than 1 week.
- If you cannot...
septicemia, newborn, ampicillin, gentamicin, antibiotics, medical emergency

Postpartum Infection Treatment (1)

Treatment for Childbirth Fever (Womb Infection)
Critical Source: Where There is no Doctor a Village Health Care Handbook
Procedure:

Step 1: Administer Ampicillin:
- Inject 2 grams of ampicillin as the first dose, then 1 gram 4 times a day.

Step 2: Administer Gentamicin:
- Inject 80 mg of gentamicin as the first dose, then **60 mg 3...
childbirth fever, womb infection, ampicillin, gentamicin, metronidazole

Breastfeeding Care (1)

Breastfeeding and Care of the Breasts for New Mothers
Standard Source: Where There is no Doctor a Village Health Care Handbook
Procedure:

Step 1: Early Breastfeeding:
- Begin breastfeeding as soon as possible after birth. The baby may want to breastfeed immediately or just lick the breast and be held.
- Encourage the baby to suck, as this helps milk flow and...
breastfeeding, colostrum, milk production, postpartum care

Abdominal Masses (1)

Identify Abnormal Lumps in the Lower Belly Area
High Priority Source: Where There is no Doctor a Village Health Care Handbook
Abnormal lumps or masses in the lower part of the belly may be caused by:

• A cyst or watery swelling often found in the ovaries.
• An ectopic pregnancy, where a baby begins to develop outside the womb (in one of the tubes that come...
lower belly lump, ovarian cyst, ectopic pregnancy, abdominal mass, cancer detection

Cancer Detection (1)

Recognize Signs of Uterine or Cervical Cancer
Standard Source: Where There is no Doctor a Village Health Care Handbook
Cancer of the uterus (womb), cervix (neck of the womb), or ovaries is most common in women over 40.

Early signs may include:
Anemia or unexplained bleeding.
• Later, an uncomfortable or painful lump in the belly may be...
uterine cancer, cervical cancer, anemia, unexplained bleeding, pap smear, vinegar test

Child Illness (1)

Managing a Child with an Illness (Fever, Earache, Diarrhea)
High Priority Source: Where There is no Doctor a Village Health Care Handbook
Procedure:

• Keep the child in bed and ensure she drinks lots of liquids.
• If the child cannot swallow solid food, give her liquids like soup. For babies who cannot breastfeed, use a spoon to feed breast milk (see p. 120).
• Provide nutritious...
child illness, fever treatment, earache, diarrhea, rehydration drink, vitamin A, antibiotic

Genetic Conditions (1)

Recognize and Manage Sickle Cell Disease in Children of African Origin
High Priority Source: Where There is no Doctor a Village Health Care Handbook
Procedure:

1. Identify children at risk for sickle cell disease, particularly those of African origin or from India.
2. Monitor for symptoms, which may appear after 6 months of age and include fatigue, pain episodes, and frequent...
sickle cell anemia, sickle cell disease, African origin, genetic condition, pain management

Circulation Health (1)

Managing Swelling of the Feet in Older Adults
High Priority Source: Where There is no Doctor a Village Health Care Handbook
Procedure:

1. Elevate the feet whenever possible to reduce swelling.
2. Encourage regular walking to improve circulation but avoid prolonged standing or sitting with feet down.
3. Monitor for signs of heart trouble (see page 325) such as...
swelling,feet,circulation,heart health

Urinary Health (1)

Addressing Difficulty Urinating in Older Men
High Priority Source: Where There is no Doctor a Village Health Care Handbook
Procedure:

1. Recognize that difficulty urinating or dribbling urine is often due to an enlarged prostate gland.
2. Encourage the individual to seek medical help as soon as possible (see page 235).
3. Avoid delaying treatment, as this can lead...
difficulty urinating,enlarged prostate,older men

Respiratory Health (1)

Managing Chronic Cough in Older Adults
High Priority Source: Where There is no Doctor a Village Health Care Handbook
Procedure:

1. Advise older adults with a chronic cough to avoid smoking and seek medical help.
2. Monitor for signs of tuberculosis such as coughing up blood or a history of TB symptoms.
3. Watch for additional symptoms like wheezing, trouble...
chronic cough,tuberculosis,heart trouble

Hearing Disorders (1)

Management of Ménière’s Disease (Deafness with Ringing and Dizziness)
High Priority Source: Where There is no Doctor a Village Health Care Handbook
Procedure:

1. Recognize the symptoms in an older person: sudden hearing loss in one or both ears, ringing or buzzing in the ears, severe dizziness, nausea, vomiting, and excessive sweating.
2. Administer an antihistamine, such as...
Ménière's disease,deafness,dizziness,ringing ears,antihistamine,salt restriction

Sleep Disorders (1)

Management of Insomnia in Older Adults
Standard Source: Where There is no Doctor a Village Health Care Handbook
Procedure:

1. Encourage regular physical activity during the day to promote tiredness at night.
2. Avoid caffeine-containing drinks, such as coffee or black tea, especially in the afternoon and evening.
3. **Consume a warm glass of milk...
insomnia,sleep disorders,older adults,warm milk,bath,relaxation techniques,antihistamine

Liver Disease (1)

Recognize and Respond to Cirrhosis of the Liver
Critical Source: Where There is no Doctor a Village Health Care Handbook
Procedure:

1. Identify risk factors such as long-term heavy alcohol consumption and poor diet in men over 40.
2. Observe early signs: weakness, loss of appetite, upset stomach, and pain on the right side below the ribs (similar to...
cirrhosis,liver disease,alcoholism,jaundice,ascites,vomiting blood,medical help

Liver Disease Management (1)

Manage Cirrhosis at Early Signs
High Priority Source: Where There is no Doctor a Village Health Care Handbook
At the first sign of cirrhosis, take these steps to improve your chances of survival:

Never drink alcohol again. Alcohol poisons the liver and worsens cirrhosis.
Eat as well as possible: Include vegetables, fruit, and some protein...
cirrhosis,liver disease,alcohol avoidance,diet management,swelling,salt restriction

Gallbladder Disease (1)

Recognize Signs of Gallbladder Problems
Standard Source: Where There is no Doctor a Village Health Care Handbook
Signs of gallbladder disease include:

Sharp pain in the upper right abdomen, sometimes radiating to the right side of the upper back.
Pain may occur an hour or more after eating rich or fatty foods. Severe pain may cause vomiting.
-...
gallbladder disease,symptoms,pain management,jaundice,abdominal pain

Parasite Treatment (1)

Assemble a First Aid Kit for Worms
Standard Source: Where There is no Doctor a Village Health Care Handbook
To assemble a first aid kit that includes medicines for treating worms, include the following:

1. Mebendazole: Include 40 tablets of Mebendazole (each containing 100 mg) or two bottles of the medication to treat parasitic infections like...
mebendazole,worm treatment,parasitic infection

Symptom Relief (1)

Assemble a First Aid Kit for Itching and Vomiting Relief
Standard Source: Where There is no Doctor a Village Health Care Handbook
To assemble a first aid kit that includes medicines for treating itching and vomiting, include the following:

1. Promethazine: Include 25 mg tablets of Promethazine to manage symptoms like itching and vomiting.

These medicines are essential...
promethazine,itching relief,vomiting treatment

Pharmacy Guidance (1)

Provide Accurate Medication Advice to Customers
Standard Source: Where There is no Doctor a Village Health Care Handbook
Title: Provide Accurate Medication Advice to Customers

Content:
If customers ask for medicines that are not appropriate for their condition, explain why they are not needed and may do more harm than good. For example:

• If people come...
medicine advice, pharmacy guidance, correct use of medicines, generic vs brand name drugs, expired medicine, customer education

Dosage Calculation (1)

How to Calculate Medication Dosage Based on Weight
Standard Source: Where There is no Doctor a Village Health Care Handbook
Procedure:

1. Determine the person's weight in kilograms (kg).
- If only pounds are known, convert by dividing by 2.2.

2. Identify the recommended dosage per kilogram of body weight per day (mg/kg/day).
- This information is...
dosage calculation, weight-based dosing, medication administration, medical emergency, child dosage

Dosage Administration (1)

How to Interpret and Use Fractional Doses of Medication
High Priority Source: Where There is no Doctor a Village Health Care Handbook
Procedure:

1. Understand the basic fractions used in medication dosing:
- ½ tablet = half a tablet
- ¼ tablet = one quarter or one fourth of a tablet
- 1⁄8 tablet = one eighth of a tablet (divided into 8 equal pieces and taking 1...
fractional doses, medication administration, dosage accuracy, pill splitting, measuring liquid medicine

Venomous Bites And Stings (1)

Administer Antitoxins for Venomous Bites and Stings
Critical Source: Where There is no Doctor a Village Health Care Handbook
Title: Administer Antitoxins for Venomous Bites and Stings

Procedure:
1. Use scorpion antitoxin or antivenom:
- Inject 0.5-1 mL intramuscularly as soon as possible after the sting.
2. Use snakebite antitoxin or antivenom:
-...
antitoxins,scorpion antivenom,snakebite antivenom,tetanus vaccine

Acidosis Treatment (1)

Administer Alkali (Sodium Bicarbonate)
Standard Source: Where There is no Doctor a Village Health Care Handbook
Procedure for Administering Sodium Bicarbonate

Overview:
Sodium bicarbonate is used to treat metabolic acidosis and as an antacid. It should be taken with food or after eating to avoid stomach upset.

Dosage Guidelines:
• Adults: 1–2 g...
sodium bicarbonate, antacid, acidosis treatment, metabolic acidosis, dosage guidelines

Antibiotic Resistance Prevention (1)

Preventing Penicillin Resistance
Standard Source: Where There is no Doctor a Village Health Care Handbook
Procedure for Preventing Penicillin Resistance:

1. Use penicillin only when necessary: Avoid using it for infections that are not caused by bacteria (e.g., colds, flu, viral infections).
2. Complete the full course of treatment: Stop...
penicillin resistance, antibiotic use, bacterial infection, treatment compliance

Tuberculosis Prevention (1)

Preventing Tuberculosis (TB) with Isoniazid (INH)
Standard Source: Where There is no Doctor a Village Health Care Handbook
Overview: Isoniazid (INH) can be used to prevent TB in people who are at high risk, such as family members of those infected with TB or individuals living with HIV.

Procedure:
1. Determine eligibility: Use INH for prevention in...
TB prevention, isoniazid, HIV co-infection, drug resistance

Tuberculosis Side Effects (1)

Managing Side Effects of TB Medications
High Priority Source: Where There is no Doctor a Village Health Care Handbook
Overview: TB medications can cause serious side effects that require immediate attention.

Procedure:
1. Monitor for symptoms: Watch for the following signs and symptoms while taking TB medications:
- Itching or rash
- Yellowing of...
TB medication side effects, jaundice, rash, blisters, liver damage

Pregnancy Treatment (1)

Administering TB Medications to Pregnant Women
Critical Source: Where There is no Doctor a Village Health Care Handbook
Overview: Special care must be taken when administering TB medications to pregnant women due to potential risks to the fetus.

Procedure:
1. Seek experienced medical advice: Consult with a trained health worker or specialist before...
pregnancy, TB treatment, vitamin B6, streptomycin avoidance

Leprosy Treatment (1)

Administer Clofazimine for Leprosy Treatment
Standard Source: Where There is no Doctor a Village Health Care Handbook
Overview:
Clofazimine is used in the treatment of leprosy, particularly for persons with MB (lepromatous) leprosy. It helps control lepra reactions and is often combined with other medications.

Dosage Instructions:
• **Regular Dose...
clofazimine, leprosy treatment, dosage instructions, side effects, lepra reaction

Skin Infections Parasites (1)

Prepare Sulfur Ointment for Parasite Prevention and Treatment
Standard Source: Where There is no Doctor a Village Health Care Handbook
Materials needed:
• Sulfur powder
• Petrolatum (Vaseline) or lard

Steps:
1. Mix the ingredients: Combine 1 part sulfur with 10 parts petrolatum or lard.
2. Apply to skin: Smear the ointment on affected areas, especially legs,...
sulfur, ointment, ticks, mites, scabies, ringworm, tinea, fungal infections

Gastrointestinal Illness (1)

Administer Belladonna for Gut Cramps
Standard Source: Where There is no Doctor a Village Health Care Handbook
Purpose: To relieve stomach or gut cramps (colic) and associated pain.

Materials Needed:
• Belladonna tablets (8 mg)
• Clean water

Procedure:
1. Adults: Take 1 tablet, 3 to 6 times a day.
2. Children aged 8–12 years: Take 1...
belladonna, gut cramps, antispasmodic, colic treatment

Diarrhea And Dehydration (1)

Prepare and Administer Rehydration Drinks for Severe Diarrhea and Dehydration
Critical Source: Where There is no Doctor a Village Health Care Handbook
Purpose: To treat severe diarrhea and dehydration in children.

Materials Needed:
• Cereal or ordinary sugar
• Salt (a little)
• Clean water

Procedure:
1. Make a homemade rehydration drink using the following ingredients:
- Mix 1...
rehydration drink, diarrhea treatment, ORS, zinc, dehydration, children

Tetanus Treatment (1)

Administer Ergonovine for Tetanus in Adults and Children Over 5 Years
High Priority Source: Where There is no Doctor a Village Health Care Handbook
For tetanus, give enough ergonovine or ergometrine maleate to control most of the spasms.

Dosage:
Adults and children over 5 years: Start with 5 mg. by mouth or into the anus (less in children). If necessary, repeat after **30...
ergonovine,tetanus,dosage,spasms,children,adults

Stis Genital Soress (1)

Identify and Manage Genital Sores for Syphilis or Other STIs
Standard Source: Where There is no Doctor a Village Health Care Handbook
Steps to Identify and Manage Genital Sores:

1. Recognize Signs of Syphilis:
- A single, painless sore on the genitals may be a sign of syphilis (see p. 237).
- Several sores are likely to indicate other sexually transmitted infections...
genital sores,syphilis,stis,condom use,transmission prevention

Blood Pressure Interpretation (1)

Recognize and Respond to Abnormal Blood Pressure Readings
High Priority Source: Where There is no Doctor a Village Health Care Handbook
Overview:

Abnormal blood pressure readings can indicate serious health conditions such as hypertension or hypotension. Proper recognition and response are essential for effective care.

Procedure Steps:
1. Interpret the readings:
- A...
high blood pressure, low blood pressure, hypertension, hypotension, shock, health worker, midwife

Poisoning Prevention (1)

Prevent Pesticide Poisoning Through Proper Use and Storage
High Priority Source: Where There is no Doctor a Village Health Care Handbook
Prevent pesticide poisoning by following these steps:

1. Read the labels carefully: Ensure you understand what the pesticide is, its dangers, and how to use it safely. Be sure to read the small print, as the pesticide may not be part of the...
pesticides, poisoning prevention, safety precautions, protective clothing, storage

Addiction And Substance Abuse (1)

Recognize and Address Drug Abuse in Communities
Standard Source: Where There is no Doctor a Village Health Care Handbook
Overview:
Drug abuse is a growing problem that affects individuals, families, and communities. It includes the use of harmful, habit-forming drugs such as alcohol, tobacco, marijuana, opium, methamphetamine, cocaine, and chemical sniffing...
drug abuse, addiction, community support, recovery groups, education, family involvement, substance use

Urinary Tract Disorders (1)

Recognize and Understand Bladder Stones
Standard Source: Where There is no Doctor a Village Health Care Handbook
Bladder stones are similar to kidney stones, which are hard deposits formed from minerals in the urine that can cause pain and blockages in the urinary tract.
bladder stones,kidney stones,urinary tract disorders

Oncology (1)

Understand Cancer and Its Characteristics
High Priority Source: Where There is no Doctor a Village Health Care Handbook
Cancer is a tumor or lump that grows and may keep growing until it finally causes death.
cancer,tumor,lump,oncology

Sexually Transmitted Diseases (1)

Understand the Chancre and Its Connection to Syphilis
Standard Source: Where There is no Doctor a Village Health Care Handbook
Chancre is a painless sore or ulcer on the genitals, finger, or lip that is one of the first signs of syphilis.
chancre,syphilis,genital sore

Chronic Diseases (1)

Understand Chronic Diseases and Their Characteristics
Reference Source: Where There is no Doctor a Village Health Care Handbook
Chronic is a term used to describe long-term or frequently recurring conditions (compare with acute). A chronic disease is one that lasts a long time.
chronic disease,long-term condition

Lymphatic Disorders (1)

Understand Bubo and Its Connection to Lymphogranuloma Venereum
Reference Source: Where There is no Doctor a Village Health Care Handbook
Bubo is a very swollen lymph node. Bubos is a common name for lymphogranuloma venereum.
bubo,swollen lymph node,lymphogranuloma venereum

Hydration Replacement (1)

Administering Rehydration Drinks Using Glucose
High Priority Source: Where There is no Doctor a Village Health Care Handbook
To prepare a rehydration drink using glucose:

1. Mix the following ingredients in clean water:
- 1 teaspoon of salt (about 5 grams)
- 8 teaspoons of sugar or glucose powder (about 40 grams)
- 1 liter of clean, boiled, and cooled...
rehydration drinks, glucose, dehydration, diarrhea, electrolytes, first aid

Genetics (1)

Understand Hereditary Conditions and Their Impact on Health
Reference Source: Where There is no Doctor a Village Health Care Handbook
Hereditary refers to traits or conditions that are passed from parents to children through genes.

Examples include certain diseases, physical characteristics, and medical conditions. Understanding heredity is important for identifying potential...
hereditary, genetics, inherited diseases

Abdominal Health (1)

Recognize and Manage Hernias (Rupture)
Standard Source: Where There is no Doctor a Village Health Care Handbook
A hernia is an opening or tear in the muscles covering the belly that allows a loop of the gut to push through, forming a ball or lump under the skin.

Signs include:
• A visible bulge near the navel or groin area.
• Pain or discomfort when...
hernia, abdominal rupture, bulge

Endocrinology (1)

Understand the Role of Hormones in the Body
Reference Source: Where There is no Doctor a Village Health Care Handbook
Hormones are chemicals produced by parts of the body to perform specific functions.

For example:
• Estrogen and progesterone regulate a woman’s menstrual cycle and fertility.
• Insulin controls blood sugar levels.

Disruptions in hormone...
hormones, estrogen, progesterone, insulin

Gastrointestinal Disorders (1)

Recognize and Treat Intussusception
Critical Source: Where There is no Doctor a Village Health Care Handbook
Intussusception is the slipping of one part of the gut into another, causing a dangerous blockage.

Common symptoms include:
• Severe abdominal pain.
• Vomiting.
• Bloody stools.

Treatment includes:
• Immediate medical attention to prevent...
intussusception, intestinal blockage, treatment

Neurological Issues (1)

Administer First Aid for Paralysis
High Priority Source: Where There is no Doctor a Village Health Care Handbook
Procedure:

1. Assess the situation: Determine if the paralysis is sudden or gradual and identify any possible causes such as injury, stroke, or neurological conditions.
2. Ensure safety: Make sure the individual is in a safe environment...
paralysis, emergency care, neurological conditions

Internal Medicine (1)

Understand the Role and Location of the Spleen
Reference Source: Where There is no Doctor a Village Health Care Handbook
Spleen is an organ located under the lower edge of the left rib cage. It plays a key role in:

Blood filtration: Removes old or damaged red blood cells.
Immune function: Produces white blood cells to fight infections.
Storage:...
spleen, blood filtration, spleen enlargement, splenic rupture

Respiratory (1)

Understand the Importance of Sputum in Diagnosis
Reference Source: Where There is no Doctor a Village Health Care Handbook
Sputum is mucus and pus coughed up from the lungs and bronchi. It can be used to diagnose respiratory infections (e.g., tuberculosis, pneumonia) or chronic lung conditions.

What to do:
1. Collect sputum samples using a clean container if...
sputum, mucus, respiratory infection, tuberculosis, pneumonia

Pulse Measurement (1)

Measure Pulse Rate for Adults, Children, and Babies
Standard Source: Where There is no Doctor a Village Health Care Handbook
How to Measure Pulse Rate:

1. Locate the pulse: The most common places are the radial artery (wrist), carotid artery (neck), or femoral artery (groin).
2. Place your fingers on the artery:
- For adults and children, use the thumb and...
pulse measurement, normal pulse rates, adult, child, baby, newborn

Hypothermia And Frostbite (1)

Understanding the Two Categories of Cold Injuries
Critical Source: Canadian Military Basic Cold Weather Training
Purpose: To understand how cold can cause injury to the human body.

Procedure:
1. Recognize that cold injuries fall into two categories: general hypothermia and local hypothermia.
2. General hypothermia is an injury by cold...
hypothermia, frostbite, cold injury, local hypothermia, general hypothermia, immersion foot

Eye Irritation (1)

Prevent and Treat Fume Irritation (Tent Eye)
Standard Source: Canadian Military Basic Cold Weather Training
Procedure:

1. Prevention:
- Ensure proper ventilation in tents when using gasoline stoves or lamps.
- Keep stoves and lamps clean to reduce fume production.

2. Treatment:
- If eye irritation occurs due to fumes, the...
fume irritation, tent eye, treatment, prevention, ventilation

Evacuation Planning (1)

Plan for Aeromedical Evacuation in Subzero Temperatures
High Priority Source: Canadian Military Basic Cold Weather Training
Procedure:

1. Develop Evacuation Plans Early: Plan for aeromedical evacuation of casualties as part of the initial operational planning.

2. Account for Cold Injury Casualties: During subzero temperatures, anticipate an increase in cold...
aeromedical evacuation,cold injury,subzero temperatures,dedicated aircraft

Cold Weather Medical Preparedness (1)

Protect Auto Injectors from Freezing in Cold Weather
Standard Source: Canadian Military Basic Cold Weather Training
Procedure:

1. Carry auto injectors under clothing to keep them warm.
2. Avoid exposing auto injectors to freezing temperatures.
3. Ensure that atropine remains protected from freezing, although its therapeutic value is not affected by freezing...
auto injectors,atropine,cold weather,warmth,freezing

Cold Weather Medical Installations (1)

Deploy Medical Installations in Cold Weather Environments
Critical Source: Canadian Military Basic Cold Weather Training
Procedure:

1. Deploy unit aid stations (UASs) and elements of the field ambulance well forward in the combat area to allow for rapid treatment of casualties.
2. Use large tents for medical installations, ensuring they are erected quickly and...
medical installations,cold weather,tents,heating,storage

Cold Weather Treatment (1)

Provide Supportive Treatment in Forward Areas During Cold Weather Operations
High Priority Source: Canadian Military Basic Cold Weather Training
Procedure:

1. Provide treatment in the forward area that is supportive to the immediate emergency and facilitates successful evacuation.
2. Implement a short-term holding policy for casualties ahead of the supporting base due to uncertainty in...
supportive treatment,cold weather,evacuation,holding policy

Predeployment Medical Screening (1)

Screen Personnel for Medical Conditions Before Northern Operations
High Priority Source: Canadian Military Basic Cold Weather Training
Procedure:

1. Screen field service troops who are liable to be employed in northern operations for the following conditions:
- a. Circulatory problems affecting body extremities.
- b. Skin grafts on the face.
- c. Inner ear problems.
...
medical screening,cold weather,circulatory issues,dental fitness

Sun Protection (1)

Prevent Sunburn in Arctic and Alpine Regions
Standard Source: Canadian Military Basic Cold Weather Training
Sunburn is a common casualty producer, especially during the spring in arctic and alpine regions.

Key considerations:
• Commanders should utilize periods of darkness, cloud cover, or other natural barriers to minimize exposure to...
sunburn,cold,weather,protection,arctic

Frost Burn Prevention (1)

Prevent Frost Burn from Metal Equipment
High Priority Source: Canadian Military Basic Cold Weather Training
Frost burn can occur due to contact with cold metal, such as wrist watches or spectacle frames.

Key considerations:
• Apply skilful application of adhesive tape to isolate the skin from cold metal surfaces.
• Use **combat glasses with...
frost,burn,cold,weather,equipment

Chemical Exposure Symptoms (1)

Symptoms of Chemical Agent Exposure (Blister and Nerve Agents)
High Priority Source: FM 3 4 NBC Protection
Symptoms associated with the ID for a blister agent would include redness, pain and swelling, but no blisters. Symptoms associated with an ID for a nerve agent would include pinpointing of the eye pupils (miosis), **dimness of...
blister agent,nerve agent,symptoms,ID,incapacitation risk

Health Maintenance (1)

Maintain Personal Health for NBC Conditions
Standard Source: FM 3 4 NBC Protection
Procedure:

1. Ensure all soldiers and leaders adhere to the basic principles of good health, including:
- Up-to-date immunizations.
- Good hygiene practices.
- Area sanitation.
- Physical conditioning.
2. These measures help...
personal health,nbc conditions,immunization,hygiene,sanitation

Immunization (1)

Ensure Up-to-Date Immunizations for NBC Conditions
High Priority Source: FM 3 4 NBC Protection
Procedure:

1. All soldiers must receive basic immunizations to protect against biological agents.
2. Medical personnel should periodically screen and update immunization records.
3. If deploying to areas where specific diseases are prevalent,...
immunizations,nbc conditions,biological agents,ipb process,deployment

Heat Stress (1)

Mitigate Heat Stress During Desert Decontamination Operations
Standard Source: FM 3 5 NBC Decontamination
Procedure:

1. Schedule decon operations during cooler hours: Avoid performing decontamination tasks during peak daytime temperatures.
2. Implement work-rest cycles: For soldiers working in full MOPP, alternate between short periods of...
heat stress, desert decon, MOPP, work-rest cycles, light discipline

Sun Exposure (1)

Manage Solar Injuries in Mountain Environments
High Priority Source: FM 3 97 61 Military Mountaineering
Procedure:

1. Prevent sun exposure:
- Use sunscreen with a high SPF (at least 30) and reapply frequently, especially after sweating or swimming.
2. Wear protective clothing:
- Cover exposed skin with long sleeves, pants, and...
solar injuries,sun protection,mountain sunburn,UV exposure

Skin Injuries (1)

Treating Sunburn
Reference Source: FM 3 97 61 Military Mountaineering
Procedure for Treating Sunburn:

1. Apply cool saline dressings to the affected area to alleviate pain and swelling.
2. Do not pop blisters if they form.
3. If blisters do break:
- Wash the area thoroughly with clean water.
-...
sunburn,treatment,saline,dressings,vinegar,tea bags,pain medication

Altitude Illnesses (1)

Recognize and Understand High-Altitude Illnesses
High Priority Source: FM 3 97 61 Military Mountaineering
Understanding the effects of altitude on the body is critical for preventing and managing high-altitude illnesses.

### Physiological Effects of Altitude Increase
1. As altitude increases, atmospheric pressure decreases.
2. The percentage of...
high altitude illness,HACE,HAPE,cerebral edema,pulmonary edema,altitude sickness,vasodilatation,systemic vasodilation,pulmonary vasoconstriction

Hypothermia Risks (1)

Understanding the Dangers of Hypothermia
Critical Source: FM 31 70 Basic Cold Weather Manual
Objective: Understand the risks and effects of hypothermia on the human body.

Procedure:
1. Recognize Temperature Effects: As central body temperature falls from the normal level of 98.6° F, various body processes are slowed....
hypothermia dangers, body temperature effects, heart risks

Cold Weather Health Risks (1)

Manage Physical Disorders in Cold Weather Conditions
Standard Source: FM 31 70 Basic Cold Weather Manual
Procedure:

1. Recognize increased risk factors for physical disorders in cold weather conditions:
- Individuals with heart disease are at higher risk due to the need for increased physical exertion.
- Those susceptible to upper...
physical disorders,cold weather,hydration,fluid loss,heart disease,respiratory infections,arthritis

Evacuation Plans (1)

Ensure Casualty Evacuation Plan is Complete and Executed Properly
High Priority Source: SH 21 76 Ranger Handbook
Duties of the Platoon Sergeant (PSG):

• Ensures that the casualty evacuation plan is complete and executed properly.

Key Actions:
1. Review and finalize the casualty evacuation plan with all relevant personnel.
2. Ensure that all necessary...
casualty evacuation,platoon sergeant,evacuation plan

Iv Care (1)

Flush a Saline Lock with Sterile Fluid
Standard Source: STP 21 1 Army Warrior Skills Level 1 Soldiers Manual of Common Tasks
Purpose: To flush a saline lock to maintain patency and prevent blockage.

Materials Required:
• IV bag containing sterile fluid (e.g., normal saline, Ringer's lactate, or Hextend®)
• Syringe and needle assembly
• Tegaderm® dressing (if...
flush saline lock,sterile fluid,Hextend,saline lock care,IV maintenance,wound infiltration

Chemical Biological Protection (1)

Don Protective Mask for C/B Contamination
Critical Source: STP 21 1 Warrior Skills Level 1
Procedure:

Steps to Don the Protective Mask within 9 Seconds:

1. Stop breathing and close your eyes. This prevents inhalation of contaminants during mask donning.

2. Remove your helmet. Ensure that you do not place it on a...
protective mask,C/B contamination,donning mask,chemical protection,biological protection

Vision Care (1)

Coordinate Emergency Eye Wear/Care with the Optometry Section at MEDPLT
Standard Source: STP 21 24 Army Warrior Leader Skills Level 2 3 and 4
Objective: Coordinate emergency eye wear and care with the optometry section at the MEDPLT.

Steps:
1. Identify Soldiers who require immediate vision correction or eye care (e.g., broken glasses, eye injuries).
2. Contact the battalion...
emergency eye care, optometry section, vision correction

Medical Evacuation (1)

Access Field Manual for Medical Evacuation in a Theater of Operations
High Priority Source: STP 21 24 Army Warrior Leader Skills Level 2 3 and 4
Title: Access Field Manual for Medical Evacuation in a Theater of Operations

Procedure:
1. Locate FM 8-10-6 titled *Medical Evacuation in a Theater of Operations Tactics, Techniques, and Procedures*.
2. Verify the publication date is...
field manuals,medical evacuation,FM 8-10-6

Health Service Planning (1)

Access Field Manual for Planning for Health Service Support
High Priority Source: STP 21 24 Army Warrior Leader Skills Level 2 3 and 4
Title: Access Field Manual for Planning for Health Service Support

Procedure:
1. Locate FM 8-55 titled *Planning for Health Service Support*.
2. Verify the publication date is 9 September 1994.
3. Note that this item is included on...
field manuals,health service,FM 8-55

Combat Health Support (1)

Coordinate Medical Activity Support
High Priority Source: STP 21 24 Warrior Leader Skills Level 2 3 4
Objective: Coordinate medical activity support as a noncommissioned officer (NCO) in a forward unit.

### Steps:
1. Integrate combat health support functional areas into the military decisionmaking process (MDMP):
- Confirm patient...
coordinate medical activity support, combat health support, MDMP integration, force health protection plan, preventive medicine program, field sanitation team, casualty evacuation routes, mental health control, combat lifesaver program

Welfare Safety Health (1)

Preserve Soldiers' Welfare, Safety, and Health
High Priority Source: STP 21 24 Warrior Leader Skills Level 2 3 4
Procedure: Preserve Soldiers' Welfare, Safety, and Health

Steps:
1. Monitor the physical and mental well-being of all personnel.
2. Ensure that living conditions are safe, clean, and conducive to health.
3. Provide access to medical care...
soldier welfare,safety,health,preserve health,leadership

Combat Stress (1)

Manage Combat Stress Reaction (COSR) - Heavy COSR
Critical Source: STP 21 24 Warrior Leader Skills Level 2 3 4
Procedure: Manage Combat Stress Reaction (COSR) - Heavy COSR

Steps:
1. Identify symptoms that indicate the Soldier is disruptive or potentially dangerous to self, others, or the mission.
2. Determine if urgent medical treatment is needed...
cosr,heavy cosr,stress management,combat stress,leadership

Cbnr Medical (1)

Ensure Antidotes and Decontaminating Kits are Serviceable
Critical Source: STP 21 24 Warrior Leader Skills Level 2 3 4
Procedure:

1. Inspect all antidote kits and decontamination supplies to ensure they are serviceable and not expired.
2. Verify that decontaminating kits are readily available for immediate use by personnel in case of exposure.
3. Ensure that...
antidotes,cbrn decontamination,kit inspection,medical supplies

Crisis Management (1)

Develop Plan for Crisis Standards of Care Implementation
Critical Source: Planning Guidance for Response to Nuclear Detonation May 2022 FEMA
Objective: Ensure that the locality has a plan to implement crisis standards of care during resource scarcity.

Procedure:
1. Review existing medical standards of care, including conventional, contingency, and crisis levels, as defined by...
crisis standards of care, resource scarcity, medical planning, responder stress

Radiation Sickness Info (1)

Review Radiation Sickness Information from Mayo Clinic
High Priority Source: Planning Guidance for Response to Nuclear Detonation May 2022 FEMA
Procedure:

1. Access the [Mayo Clinic Radiation Sickness page](www.mayoclinic.org/diseases-conditions/radiation-sickness/diagnosis-treatment/drc-20377061)
2. Review information on:
- Symptoms of radiation sickness
- Diagnosis methods
-...
Mayo Clinic, radiation sickness symptoms, treatment options

Hazardous Materials (1)

Protect Yourself from Gas or Vapour Contamination
Critical Source: All Hazard Preparedness Workbook
Objective: Minimize exposure to gas or vapour contamination during a hazardous material spill.

Procedure:
1. If you suspect gas or vapour contamination, take shallow breaths through a cloth or towel to reduce inhalation of harmful...
gas contamination, vapour exposure, decontamination, hazardous material safety

Medical Record Preparation (1)

Prepare and Maintain Medical Records for Emergencies
Critical Source: Basic Emergency Plan
Procedure:
1. Gather all current medical records for every family member, including vaccination history, allergies, medications, and emergency contact information.
2. Store copies of these records in a secure but accessible location,...
medical records,emergency preparedness,blood type,health information

Emergency Supplies (1)

Emergency Supply Checklist for Medicines
High Priority Source: Be Prepared Estonia Crisis Guide Paasteamet ERB
Procedure:

• Ensure that you have enough medicines to last at least seven days.

Recommended Items:
• Prescription medicines
• Painkillers
• Fever reducers
• Allergy treatment
• Digestive medication
• Anti-inflammatories
• Cold & flu...
medicines, emergency supplies, preparedness, survival, medical care

Vaccine Distribution (1)

Implement Strategies for Vaccine and Antiviral Medication Delivery During Outbreaks
Critical Source: Bird Flu Summit Brochure
Procedure for Implementing Strategies for Vaccine and Antiviral Medication Delivery During Outbreaks:

1. Develop a logistics plan for vaccine distribution:
- Identify storage, transportation, and administration protocols.
2. **Coordinate...
vaccine distribution, antiviral medication, outbreak response, healthcare logistics, priority groups

Resource Allocation Operations (1)

Prioritizing Antivirals and Essential Resources for Hospital Operations
High Priority Source: Bird Flu Summit Brochure
Procedure:

1. Develop a plan to prioritize the allocation of antiviral medications, personal protective equipment (PPE), and other essential resources for hospital operations.
2. Identify high-priority groups such as patients with severe...
antiviral prioritization,essential resources,hospital operations,inventory tracking,supply chain coordination

Antiviral Resistance (1)

Monitor and Manage Antiviral Resistance in Avian Influenza Treatment
High Priority Source: Bird Flu Summit Brochure
Objective: Track the emergence of antiviral resistance and implement strategies to manage it effectively.

Steps:
1. Conduct regular testing of avian influenza strains for resistance to commonly used antiviral drugs.
2. Analyze trends in...
drug resistance monitoring,avian flu treatment,antiviral management

Prevention (1)

Undergo Medical Examination Before Scout Activities
Standard Source: Boy Scout Handbook 1911
Procedure:

1. Have a thorough medical examination conducted by a physician who is experienced in working with boys.
2. Ensure that the examination includes an assessment of heart and lung function before participating in any physical contests...
medical examination, scout health, heart and lung check, injury prevention

Symptoms And Diagnosis (1)

Addressing Pain in the Body
Standard Source: Boy Scout Handbook 1911
Pain is a serious indicator that something may be wrong in the body. If you experience any form of pain, whether it's a dull headache, discomfort in the knee, or pain in the arch of the foot, take it seriously. Pain should not be...
pain, body, symptoms, medical consultation, health

Throat Health (1)

Addressing Frequent Sore Throat and Tonsil Issues
Standard Source: Boy Scout Handbook 1911
Procedure:

1. Recognize frequent sore throat as a potential sign of enlarged tonsils:
- Enlarged tonsils may require treatment or removal by a physician.

2. Maintain good health practices to reduce throat issues:
- For...
sore throat, enlarged tonsils, frequent colds, health practices

Electric Shock Rescue (1)

Electric Accident Rescue Procedure
Critical Source: Boy Scout Handbook 1911
Electric Accident Rescue Procedure

1. Do not touch the victim directly: A person in contact with a live wire or rail will transfer the current to anyone who touches them.
2. Insulate yourself before rescuing:
- Cover your hands with...
electric shock rescue, electrical safety, first aid for electric shock, emergency response to electricity

Gas Accidents (1)

Prevent Gas Accidents by Repairing Leaks
High Priority Source: Boy Scout Handbook 1911
Procedure:

1. Inspect gas pipes regularly for leaks.
2. Promptly repair any detected leaks to prevent dangerous gas accumulation.
3. Ensure that the gas is actually shut off when turning off the supply, not just partially closed.
4. Avoid...
gas leak, repair, safety, gas pipe, pressure, artificial respiration

Unconsciousness (1)

Assess and Treat Unconsciousness Due to Various Causes
High Priority Source: Boy Scout Handbook 1911
Procedure:

1. Determine the cause of unconsciousness if possible:
- Poisoning
- Bleeding
- Sunstroke
- Freezing
2. If the cause is unknown, assess the patient's condition:
- If pale and weak: Place the patient with their head...
unconsciousness,treatment,poisoning,bleeding,sunstroke,freezing

Brain Injury (1)

Respond to Apoplexy or Brain Injury
Critical Source: Boy Scout Handbook 1911
Procedure:

1. Assess the patient for signs of apoplexy or brain injury:
- Complete unconsciousness
- Large and unequal pupils
- Snoring breathing
- Full and slow pulse
- Paralysis on one side of the body (test by raising an...
apoplexy,brain injury,treatment,cold cloths

Hygiene (1)

Personal Hygiene for Boys
Reference Source: Boy Scout Handbook 1911
Title: Personal Hygiene for Boys

Content:

1. Wash your hands thoroughly with soap and water before eating, after using the restroom, and after handling dirty objects.
2. Brush your teeth twice a day using fluoride toothpaste to maintain...
personal hygiene, boy health, oral care, body cleanliness

Cold Weather Health (1)

Maintain Health During a Winter Storm Emergency
High Priority Source: FEMA Are You Ready
Action: Maintain your health during cold weather:

Health guidelines:
Eat regularly and drink ample fluids, but avoid caffeine and alcohol.
Avoid overexertion when shoveling snow, as it can lead to heart attacks. If you must...
frostbite, hypothermia, cold weather health, first aid for frostbite

Radiation Exposure Procedures (1)

Radiological Monitoring and Decontamination of Evacuated Personnel
Critical Source: FEMA REP Program Manual Dec 2019
Procedure:

1. Implement procedures for radiological monitoring of personnel evacuated from the NPP site.
2. If necessary, provide decontamination services to these individuals before they are allowed to return to non-restricted areas.
3. Ensure...
radiological monitoring,decontamination,evacuated personnel,radiation exposure,safety protocols

Radiological Protection (1)

Incorporate Radioprotective Drug Use in Protective Action Recommendations
Critical Source: FEMA REP Program Manual Dec 2019
Objective: Develop plans/procedures that consider the use of radioprotective drugs as part of protective action recommendations (PARs).

Procedure:
1. Identify Groups for Recommendation: Determine which groups may be advised to take...
radioprotective drugs, protective action recommendations, release pathways, isotopic mix

Radiological Contamination (1)

Conduct Annual Medical Services Drills for Radiological Emergencies
High Priority Source: FEMA REP Program Manual Dec 2019
Objective: Ensure that procedures for transporting contaminated, injured individuals to the appropriate medical facility can be implemented and that medical facility staff demonstrate proper care of contaminated, injured individuals at...
annual medical services drills, radiological contamination, emergency preparedness, contamination control, medical facility transport

Disability Support (1)

Define and Understand the Role of a Service Animal in Emergency Situations
Standard Source: FEMA REP Program Manual Dec 2019
A service animal is any dog individually trained to perform tasks for an individual with a disability. These tasks must be directly related to the handler's disability.

Key points:
• Service animals are not limited to specific breeds or...
service animal,disability assistance,emergency support

Emergency Medical Services (1)

Provide Medical Services During Emergencies
Critical Source: FEMA REP Program Manual Dec 2019
Procedure:

1. Ensure that medical services are available and accessible to affected populations during emergencies.
2. Coordinate with local healthcare providers, hospitals, and emergency medical services (EMS) to deploy additional resources if...
medical services, FEMA, emergency care

Radiological Medical Response (1)

Review NRC Notice on Potassium Iodide Use in Emergency Response
High Priority Source: FEMA REP Program Manual Dec 2019
Purpose: Review the notice from Paul Lohaus (NRC) regarding revisions to regulations on potassium iodide use during radiological emergencies.

Steps:
1. Access *Notice from Paul Lohaus (NRC) to All Agreement and Non-agreement States’ State...
NRC potassium iodide regulations, radiological emergency medical response, STP-01-006, potassium iodide use guidelines

Triage And Patient Classification (1)

Classify Patients Based on Risk Levels for Emergency Planning
High Priority Source: Home Health Emergency Preparedness
Patient classification risk levels are used to prioritize care during emergencies and allocate resources effectively. This system helps identify high-risk patients who need immediate attention and ensures that vulnerable individuals receive the...
patient classification, triage levels, emergency planning, high priority patients, moderate priority patients, low priority patients

Hospital Capacity (1)

Handling Hospital Admission During Major Emergencies
High Priority Source: Home Health Emergency Preparedness
Procedure:

1. Prioritize life-saving treatment: In a major emergency, hospitals may only admit patients requiring immediate life-saving care.
2. Follow hospital decisions: The hospital has the final authority to determine which patients...
hospital admission, emergency capacity, life-saving treatment, sheltering patients

Immunizations Healthcare (1)

Maintaining Immunization Records for Healthcare Providers
High Priority Source: Home Health Emergency Preparedness
Procedure:

1. Ensure that all direct care staff have up-to-date immunization records.
2. Maintain a system to document and track these records, especially if required by local regulations (e.g., Michigan Administrative Code R 325.70015).
3....
healthcare provider immunization, record keeping, pandemic influenza, emergency vaccination

Assessment Procedures (1)

Use Abbreviated OASIS Assessment During 1135 Waiver Periods
High Priority Source: Home Health Emergency Preparedness
Procedure:

1. Recognize that the abbreviated OASIS assessment can only be used when an 1135 waiver is in effect.

2. Train staff on how to perform and document the abbreviated OASIS assessment during emergencies or disasters.

3....
OASIS assessment,1135 waiver,emergency medical procedures

Patient Transport (1)

Patient Relocation Procedure for Unsafe Home Conditions
High Priority Source: Home Health Emergency Preparedness
Procedure:

1. If the patient is unharmed but the home is damaged or unsafe and the telephone system is working:
- Contact family or friends that the patient may request and make arrangements for the patient’s transportation.
- Keep track...
patient relocation, unsafe home, emergency supervisor, transportation

Patient Medical Info (1)

Create a Patient Medical Information Table
High Priority Source: Home Health Emergency Preparedness
Objective: Document critical medical information for quick reference during emergencies.

Steps:
1. Record personal details:
- Full name (e.g., Jack Doe)
- Date of birth (e.g., 05/05/1947)
2. List doctors and appointments:
-...
medical info, patient records, emergency preparedness, allergies, medications, medical history, surgeries

Chemical Biological Preparedness (1)

Biological and Chemical Agent Dispersion
Critical Source: LDS Preparedness Manual
Procedure:

• In the event of a biological or chemical agent dispersion:
- Evacuate immediately if instructed by authorities.
- Stay indoors and seal windows, doors, and vents to prevent contamination.
- Use air filters or masks if...
biological, chemical, decontamination, emergency response, preparedness

Infant Safety (1)

Avoiding Botulism Risk in Infants with Honey
Critical Source: LDS Preparedness Manual
Avoiding Botulism Risk in Infants with Honey

Do not give raw honey or foods containing raw honey to infants under one year of age, as it may contain spores of *Clostridium botulinum*, the bacterium that causes botulism.
• The risk arises...
botulism,honey,infants,safety,pediatrics

Botulism Prevention (1)

Understanding Botulism and Honey Spores
Critical Source: LDS Preparedness Manual
Understanding Botulism and Honey Spores

Raw honey can contain temperature-resistant spores of *Clostridium botulinum*, the bacterium that causes botulism.
• These spores are not harmful to adults or older children because their immune...
botulism,honey,spores,infants,prevention

Biological Agent Preparation (1)

Dietary and Hydration Adjustments During Biological Agent Exposure Incubation Period
Critical Source: LDS Preparedness Manual
Procedure:

1. Stop consuming your normal cooked food diet during the one to six day incubation period before symptoms of biological agent exposure arise.
2. Begin a very light diet consisting primarily of raw fruits, vegetables, and juices...
biological agent, incubation period, water purification, raw diet, oxygen liquid

Emergency Preparedness (1)

Identify Essential Medical Professionals for a Retreat Group
High Priority Source: Life After Doomsday
Procedure:

1. Assess group medical expertise: Evaluate whether your retreat group includes any physicians or other medical professionals.
2. Recruit a physician if possible: A physician is the ideal medical professional to have in a...
retreat group, medical professionals, emergency preparedness, self-reliance, nuclear war injuries

Self Reliance Medical Care (1)

Prepare for Self-Reliant Medical Care in Emergencies
High Priority Source: Life After Doomsday
Procedure:

1. Stock essential medical supplies and equipment: Ensure that you have access to books, equipment, and supplies needed to act as your own doctor under emergency conditions.
2. Include specialized knowledge: Include technical...
self-reliant medical care, emergency preparedness, alternative treatments, retreat medicine

Common Injuries And Illnesses (1)

Recognize and Respond to Common Medical Emergencies in a Post-Disaster Scenario
Critical Source: Life After Doomsday
Procedure:

1. Identify signs of infection: Monitor for symptoms such as red streaks spreading from wounds, fever, or swelling.
2. Respond to infections promptly: If someone develops an infection, take immediate action to prevent it from...
infection, serious injuries, first aid, nuclear war injuries, alternative treatments

Blood Analysis (1)

Performing Basic Blood Tests for A-B-O Typing and RH Compatibility
High Priority Source: Life After Doomsday
Objective: Perform basic blood typing (A-B-O and RH) to determine donor compatibility.

Materials Required:
• Microscope
• Glass microscope slide designed for blood tests
• Specific chemicals for blood analysis (as outlined in the Laboratory...
blood typing,A-B-O,RH compatibility,blood analysis,urinalysis,laboratory procedures,survival medical tests

Radiation Exposure Assessment (1)

Using Biological Assays for Dose Assessment (Biodosimetry)
Critical Source: Planning Guidance Nuclear Detonation FEMA
Objective: Assess an individual's radiation dose using biological assays.

Procedure:
1. Collect biological samples, such as blood or tissue, from the individual exposed to radiation.
2. Use laboratory techniques to analyze these samples...
biodosimetry, radiation dose assessment, biological assays, nuclear detonation, medical care

Triage Radiation Injury (1)

Triage Patients for Cytokine Treatment
Critical Source: Planning Guidance Nuclear Detonation FEMA
Procedure:

1. Assess Radiation Exposure: Determine the whole-body radiation dose received by the patient using medical evaluation and dosimetry tools.

2. Determine Eligibility: Administer cytokines only to patients who have received a...
Expectant category,2 Gy triage,H-ARS patient triage

Triage And Priority (1)

Prioritize Life-Threatening Injuries Over Contamination Screening
Critical Source: Planning Guidance Nuclear Detonation FEMA
Objective: Ensure that life-threatening or severe injuries are prioritized over contamination screening and decontamination.

Procedure:
1. Immediately assess individuals for life-threatening or severe injuries, such as bleeding, fractures,...
nuclear detonation, triage, life-threatening injuries, contamination screening, decontamination, medical priority

Radiation Syndromes (1)

Identifying and Managing Gastrointestinal Acute Radiation Syndrome (GI-ARS)
Critical Source: Planning Guidance Nuclear Detonation FEMA
GI-ARS is a subsyndrome of ARS that occurs at whole body radiation doses exceeding 6 Gy (600 rad).

### Symptoms:
• Initial symptoms include:
- Nausea
- Vomiting
- Diarrhea
• These can lead to complications such as:
- Dehydration
...
GI-ARS,radiation syndrome,gastrointestinal symptoms,nuclear exposure

Resource Access (1)

Access Additional Burn Injury Resources from REMM
High Priority Source: Planning Guidance Nuclear Detonation FEMA
Objective: Provide access to authoritative resources for burn injury management in radiation emergencies.

Procedure:
1. Visit the REMM website for detailed information:
- Access the following links:
- [REMM’s Burn Triage and...
REMM burn resources, radiation emergency treatment, thermal injury guidelines

Radiation Medical Guidance (1)

Utilize Emergency Radiation Medicine Response Pocket Guide
Critical Source: Planning Guidance Nuclear Detonation FEMA
Procedure:

1. Access the [AFRRI Pocket Guide](afrri.usuhs.edu/sites/default/files/2020-07/afrri-pocket-guide.pdf)
2. Review content including:
- Flow chart for radiation patient treatment
- Table of ARS survivability (including phases)
...
AFRRI pocket guide, ARS survivability, radiation patient treatment flowchart

Radiation Casualty Management (1)

Access Medical Management of Radiological Casualties Resource
Critical Source: Planning Guidance Nuclear Detonation FEMA
Procedure:

1. Visit the [AFRRI resource page](afrri.usuhs.edu/sites/default/files/2020-07/4edmmrchandbook.pdf)
2. Review information on:
- Emergency biodosimetry
- Acute Radiation Syndrome (ARS)
- Medical management of skin injury and...
AFRRI medical management, ARS treatment, radiation skin injury

Cdc Radiation Resources (1)

Utilize CDC Radiation Emergencies Resources
High Priority Source: Planning Guidance Nuclear Detonation FEMA
Procedure:

1. Access the [CDC Radiation Emergencies page](www.cdc.gov/nceh/radiation/emergencies/index.htm?CDC_AA_refVal=https%3A%2F%2Femergency.cdc.g)
2. Review resources tailored for:
- Clinicians (patient management, PPE, triage,...
CDC radiation resources, clinician guidelines, PPE for radiation emergencies

Radiation Medical Management (1)

Use REMM (Radiation Emergency Medical Management) Tool
Critical Source: Planning Guidance Nuclear Detonation FEMA
Procedure:

1. Access the [REMM website](remm.hhs.gov/index.html)
2. Utilize resources including:
- Patient management guidance
- Initial incident activities
- Management modifiers based on injuries and medical needs
- Practical...
REMM tool, radiation patient management, decontamination procedures

Animal Handling (1)

Understanding the Term Dispatch
Standard Source: Student manual 2005
Definition: Dispatch refers to killing an animal without delay in a humane manner.
dispatch,definition,humane killing

General Information (1)

Background Information on Survival and Austere Medicine
Reference Source: Survival and Austere Medicine
Overview: This book is a major revision of the *Survival Medicine FAQ’s* originally written for the misc. survivalism Usenet newsgroup in 1997. It was created to address recurring questions about survival medicine, many of which had incorrect or...
survival medicine, austere medicine, preparedness, remote healthcare, medical knowledge, disaster medicine

Chronic Illnesses (1)

Managing Chronic Illnesses in a Post-Antibiotic World
Critical Source: Survival and Austere Medicine
Procedure:

1. Identify the chronic illness: Determine if the individual has conditions such as diabetes, asthma, or epilepsy.
2. Maintain essential medication supplies: Store and preserve any available insulin or other critical...
diabetes,asthma,epilepsy,chronic illness management,insulin

Risk Assessment And Planning (1)

Identify Common Medical Risks in Major Disasters
High Priority Source: Survival and Austere Medicine
Survey Results: A recent Internet survey identified the following as the most likely sources of medical problems during a major disaster:

Infectious disease (naturally occurring): 64%
Lack of surgical care: 36%
• **Infectious...
infectious disease,surgical care,nuclear conflict,biological warfare

Remote Healthcare (1)

Understand Medical Care in Remote and Austere Locations
Standard Source: Survival and Austere Medicine
Experience Summary: An author’s experience in providing health care in remote and austere locations (third world and first world) to nearly two thousand people over a cumulative 15-month period (spread over 10 years) provides the following...
remote healthcare,austere environments,adaptability,prevention

Education And Training (1)

Learn Basic First Aid and Anatomy/Physiology for Medical Preparedness
High Priority Source: Survival and Austere Medicine
To prepare yourself for medical emergencies, follow these steps:

1. Start with basic first aid: Learn essential first aid skills such as CPR, wound care, splinting, and managing common injuries.
2. Study anatomy and physiology (A&P):...
first aid, anatomy, physiology, medical education, survival medicine, emergency care

General Medical Knowledge (1)

Use Medical Resources for Answering Questions
Standard Source: Survival and Austere Medicine
Procedure:

1. Access a good medical dictionary and basic medical textbook to find answers to questions you don’t know.
2. Identify the relevant section or topic in the dictionary or textbook that corresponds to your question.
3....
medical dictionary, textbook, answer questions, find information

Emergency Medical Training (1)

Enroll in EMT-Basic Course for Emergency Care Training
High Priority Source: Survival and Austere Medicine
Overview: The EMT-Basic course is the national standard for providing emergency care in the USA, set by the US Department of Transportation. It is offered by many community colleges and provides an overview of anatomy and physiology, as well as...
EMT-Basic, emergency care training, EMT-Intermediate, EMT-Paramedic, First Responder, First Aid course

Surgical Training (1)

Attend Basic Surgical Skills Course for Remote Medics in the UK
Standard Source: Survival and Austere Medicine
Title: Attend Basic Surgical Skills Course for Remote Medics in the UK

Description: This is an intensive three-day course aimed at teaching the basics of surgical practice and challenging students with different problems using their...
Surgical Skills, Remote Medics, UK

Specialized Training (1)

Enroll in Diploma in Remote and Offshore Medicine (UK)
High Priority Source: Survival and Austere Medicine
Title: Enroll in Diploma in Remote and Offshore Medicine (UK)

Description: This diploma is currently in development and was expected to be available in 2005. It is aimed at medics working in the oil/gas industry at remote...
Diploma, Remote Medicine, UK

Infrastructure Setup (1)

Establish a Dedicated Clinic Area for Medical Care
Standard Source: Survival and Austere Medicine
Objective: Create a functional and infection-controlled medical space.

Key Features to Include (if possible):
1. Clean Environment: Ensure the area is easy to keep clean and maintain hygiene standards.
2. Adequate Lighting: Provide...
clinic setup, medical area, infection control, privacy, lighting, storage

Ethics And Confidentiality (1)

Maintain Confidentiality and Trust in the Doctor-Patient Relationship During Emergencies
Standard Source: Survival and Austere Medicine
Objective: Preserve trust and confidentiality between medical providers and patients during survival situations.

Key Principles:
Confidentiality is Essential: Trust is a cornerstone of any medical relationship. Patients must feel...
confidentiality, trust, doctor-patient relationship, ethics, survival medicine

Medication Storage (1)

Proper Storage and Rotation of Medications
Standard Source: Survival and Austere Medicine
Proper Storage and Rotation of Medications

Storage Conditions: Store medications in a cool, dark, dry environment to optimize shelf life.
Special Cases: A small number of drugs require refrigeration to avoid loss of potency. These...
storage,rotation,medications,shelf life,expiration dates,cool,dark,dry,refrigeration,insulin,ergometrine,oxytocin,muscle relaxants,diazepam,aspirin,epinephrine,toxic metabolites,tetracycline,citric acid

Medication Stocking (1)

Estimate Medical Supply Quantities for Emergencies
High Priority Source: Survival and Austere Medicine
To estimate how much medical supplies to stock:

1. Assess the worst-case scenario: Consider what you are preparing for and the number of people you will be responsible for.
2. Double or triple calculated amounts: This is a general rule to...
medical supplies, medication stocking, emergency preparedness, dosing frequency, chronic medications

Chronic Medication Management (1)

Store Regular Medications Separately from Emergency Kits
Critical Source: Survival and Austere Medicine
To ensure access to essential medications during emergencies:

1. Keep regular medications separate: These include blood pressure pills, thyroid hormones, allergy pills, contraceptive pills, asthma inhalers, and any other regularly taken...
regular medications, chronic conditions, emergency medication storage, Epi-pen, prescription management

Advanced Medical Kit Preparation (1)

Assemble an Advanced Medical Kit
Critical Source: Survival and Austere Medicine
Assemble an Advanced Medical Kit

An advanced medical kit is designed for someone with extensive medical training and allows for the management of 90% of common medical problems, including some surgery, spinal and regional anaesthesia, and...
advanced medical kit, emergency surgery, anaesthesia equipment, trauma care, survival medicine

Medication Preparedness (1)

Assemble a Medication Kit for Austere Conditions
High Priority Source: Survival and Austere Medicine
Objective: Create a comprehensive medication kit suitable for austere environments.

### Required Medications:
Povidone - iodine: Prep antiseptic skin prep and/or Alcohol prep antiseptic skin prep
• **Chlorhexidine and cetrimide antiseptic...
medication kit,austere medicine,emergency drugs,first aid

Surgical Kit Assembly (1)

Assemble a Major Procedure Kit for Austere Medicine
High Priority Source: Survival and Austere Medicine
To assemble a major procedure kit, include the following items:

Surgical Instruments:
1. Needle driver, 4-5"
2. Needle driver, 6-7"
3. Sharp/blunt scissors, 5" straight (2 pieces)
4. Baby Metzenbaum or Mayo scissors, 5" curved (1 piece)
5....
survival medicine, surgical kit, austere medicine, medical emergency, procedure kit

Pregnancy And Breastfeeding (1)

Determine Safe Medication Use During Pregnancy and Breastfeeding
Standard Source: Survival and Austere Medicine
Procedure:

1. Check drug safety before use during pregnancy or breastfeeding.
- Penicillins and cephalosporins are generally safe to use.
- Many other medications may not be safe, or only safe during certain stages of pregnancy.
2....
pregnancy, breastfeeding, medication safety, penicillins, cephalosporins, PDR, drugs in pregnancy

Herbal Preparation (1)

Preparing Medicinal Botanicals for Use
Reference Source: Survival and Austere Medicine
Procedure:

1. Understanding variability in potency:
- Recognize that herbs and botanicals vary greatly in potency due to factors such as weather, soil conditions, and growing environment.
- Traditional measurements/dosages are based...
herb preparation, medicinal use, dosage guidelines, survival medicine, herbal safety

Antibiotics And Antimicrobials (1)

Understanding Colloidal Silver (CS) and Its Antibiotic Claims
Reference Source: Survival and Austere Medicine
Colloidal silver (CS) is a suspension of metallic silver atoms in solution, often used in preparedness circles for its purported antibiotic properties. However, there is no scientific evidence to support the claim that colloidal silver is an...
colloidal silver, antibiotic claims, argyria, silver compounds, antimicrobial effectiveness

Scientific Research And Evidence (1)

Reviewing Scientific Literature on Colloidal Silver
Standard Source: Survival and Austere Medicine
To make an informed decision about the use of colloidal silver (CS), it is essential to review relevant scientific literature. The following articles are recommended for anyone with a serious interest in CS:

1. D. L. Bowen & M. C. Fung,...
colloidal silver, scientific research, risk-benefit assessment, silver compounds, wound care

Psychological Interventions (1)

Leverage the Placebo Effect for Patient Improvement in Austere Situations
Standard Source: Survival and Austere Medicine
Procedure:

1. Understand the placebo effect: Recognize that a percentage of patients (0-30% depending on the therapy) may show improvement from sham therapies, such as an alcohol-based tonic, due to psychological factors.

2. **Present with...
placebo effect,austere medicine,patient improvement,sham therapy,confidence,alcohol based tonic

Long Term Care (1)

Understanding Long-Term Medical Care in Austere Environments
High Priority Source: Survival and Austere Medicine
Overview: This section discusses the challenges of maintaining medical care during long-term disasters or societal collapses.

Scenario Considerations:
- Possible scenarios include comet strikes, global pandemics, nuclear war, and...
austere medicine,long term care,disaster preparedness,medical planning,societal collapse

Knowledge Preservation (1)

Preserve Medical Knowledge During Long-Term Disasters
High Priority Source: Survival and Austere Medicine
Procedure:

1. Create a Comprehensive Medical Library: Ensure that you have access to a wide range of medical texts, including modern medicine and historical practices.
2. Prioritize Knowledge Preservation: Make it a priority to protect...
medical knowledge, long-term disaster, cross training, medical history, apprenticeship model, historical medicine, disease classification

Improvised Medical Tools (1)

Improvising Medical Equipment with Available Materials
Standard Source: Survival and Austere Medicine
Objective: Use available materials to create or repurpose medical equipment when proper supplies are unavailable.

Procedure:
1. Assess available materials and think creatively about their potential uses.
2. Consider the following examples:
...
improvised medical equipment, urethral catheter uses, safety pin uses, survival medicine, emergency tools

Respiratory Aid (1)

Creating an Asthma Spacer from a Plastic Bottle
High Priority Source: Survival and Austere Medicine
Objective: Create a makeshift asthma spacer to improve medication delivery during an asthma attack.

Procedure:
1. Use a 2L plastic soft drink bottle as the base for the spacer.
2. Cut vent holes in the base of the bottle (these will allow...
improvised asthma spacer, emergency respiratory aid, survival medicine tools

Fluids And Iv (1)

Manufacture Normal Saline Solution
Standard Source: Survival and Austere Medicine
Materials Required:
• 1000 ml of distilled water
• 9 grams of sodium chloride (table salt)

Procedure:
1. Sterilize Equipment: Ensure all containers and utensils are thoroughly cleaned and sterilized. This can be done by boiling or using...
normal saline, intravenous fluid, survival medicine, sodium chloride, distilled water

Hormonal Disorders (1)

Administering Thyroxine Using Sheep Thyroid Glands in Austere Conditions
Standard Source: Survival and Austere Medicine
Procedure:

1. Identify Patients on Thyroxine: Only administer this procedure to individuals who have been previously diagnosed with hypothyroidism and are already on synthetic thyroxine.

2. Source Sheep Thyroid Glands: Obtain sheep...
thyroxine,sheep thyroid glands,basal body temperature,hypothyroidism,austere medicine

Anaesthesia Administration (1)

Administering Ether Anaesthesia Using Open-Drop Technique
Critical Source: Survival and Austere Medicine
Important Warning: Administering ether anaesthesia without proper training can result in death. This procedure is provided for informational purposes only.

### Materials Needed:
• Ether
• Gauze (multiple layers)
• Wire frame or improvised mask...
ether anaesthesia, open-drop technique, Schimmelbusch mask, improvised mask, ether chimney, Atropine, flammable vapour, respiratory secretions, anaesthesia depth, safety precautions

Alternative Therapies (1)

Use Alternative Therapies in Long-Term Austere Situations
Reference Source: Survival and Austere Medicine
Alternative therapies that may be useful in long-term austere situations include:

Rectal fluid administration: A method of administering fluids directly into the rectum for hydration.
Honey and sugar as antimicrobials: Both have...
rectal fluid, honey, sugar, antimicrobial, maggot therapy

Biological Threats Prevention (1)

Implement Hygiene Protocols to Prevent Biological Threats
High Priority Source: Survival and Austere Medicine
Objective: Implement strict hygiene protocols to prevent illness and death from biological agents.

Steps:
1. Ensure access to clean drinking water for all members of the group.
2. Practice proper waste disposal, including both human...
hygiene protocols, biological threats prevention, clean water, waste disposal, food preparation, vaccinations, risk analysis

Biological Threats Medication (1)

Stock Essential Medications for Biological Threats
Critical Source: Survival and Austere Medicine
Objective: Stock essential medications to treat common biological agents.

Recommended Supplies:
Antibiotics: Ciprofloxacin and doxycycline are recommended as they cover a wide range of potential biological threats.
IV fluids:...
stock medications, biological threats, ciprofloxacin, doxycycline, IV fluids, antipyretics

Toxicology (1)

Provide Supportive Care for Ricin Poisoning
Critical Source: Survival and Austere Medicine
Procedure:

1. Identify symptoms of ricin poisoning: block protein synthesis within the body leading to abdominal pain, diarrhoea, nausea, vomiting, severe diarrhoea, and pneumonia if inhaled.
2. Provide supportive care, including...
ricin poisoning, supportive care, chemical agent, decontamination

Temperature Management (1)

Maintaining Body Warmth in Medical Emergencies
High Priority Source: Survival and Austere Medicine
Procedure for Maintaining Patient Warmth

1. Cover the patient with warm blankets to help retain body heat.
2. Use a hot water bottle or heated brick placed near the patient’s feet, hands, or under the blanket for additional warmth.
3. Consider...
body warmth, hypothermia prevention, shock management, cold exposure, medical care

Recovery Care (1)

Providing Recovery Care for Trauma or Medical Conditions
High Priority Source: Survival and Austere Medicine
Procedure for Providing Subacute Recovery Care

1. After the immediate medical crisis has been addressed, focus on long-term recovery and stabilization of the patient.
2. Monitor vital signs regularly including temperature, pulse, respiration...
recovery care, subacute care, patient monitoring, wound healing, medical treatment

Patient Care Planning (1)

Create a Simplified Care Plan for Patient Management
Standard Source: Survival and Austere Medicine
A simplified care plan ensures that major aspects of required care are not overlooked. The following steps outline how to create a basic care plan:

1. Assess the situation: Evaluate the patient's condition and needs.
2. **Document vital...
care plan, patient management, vital signs, nutrition, positioning, elimination, pain assessment, medication administration

Vital Signs Monitoring (1)

Establishing a Vital Signs Database
High Priority Source: Survival and Austere Medicine
Purpose:
Maintain a record of normal vital signs for accurate future comparisons and early detection of abnormalities.

Procedure:
1. Record Baseline Measurements:
- Document the patient's normal blood pressure in three positions:...
vital signs database, blood pressure, pulse rate, temperature, respiration, baseline measurements

Digestive Health Monitoring (1)

Tracking Bowel Movements for Digestive Health Monitoring
Standard Source: Survival and Austere Medicine
Purpose:
Monitor bowel movements to detect changes in digestive health and potential issues like constipation or dehydration.

Procedure:
1. Record Baseline Bowel Movement Frequency:
- Document the patient's normal frequency of bowel...
bowel movement tracking, digestive health, constipation detection, fiber intake

Chronic Care (1)

Managing Chronic Care in Austere Conditions
Standard Source: Survival and Austere Medicine
Overview: In situations where long-term access to medical care is not available, chronic care becomes focused on maintaining health and preventing deterioration rather than recovery.

### Key Considerations:
Stabilized Condition: The...
chronic care,austere medicine,immobility,prevention,health maintenance

Prevention Of Thrombosis (1)

Prevent Deep Vein Thrombosis Through Mobility and Care
High Priority Source: Survival and Austere Medicine
Prevention of Deep Vein Thrombosis (DVT):

• Encourage mobilization even in significantly unwell patients. Patients should be moved several times a day to reduce the risk of clot formation.
• Avoid crossing legs while in bed, as this can...
deep vein thrombosis,dvt,mobility,heparin,bed rest,leg stretching

Prevention Of Contractures (1)

Prevent Contractures Through Early Movement and Physical Therapy
Standard Source: Survival and Austere Medicine
Prevention of Contractures:

• Implement a program of early movement and physical therapy in cases of acute or orthopedic injury.
Exercise each joint separately, focusing on individual joints (e.g., for the leg: toes, ankle, knee,...
contractures,muscle tightening,joint exercise,physical therapy,immobility

Hygiene And Sanitation (1)

Administering an Enema Using a Hot Water Bottle
Reference Source: Survival and Austere Medicine
Materials Needed:
• Hot water bottle (latex rubber or plastic)
• Stopper (to seal the bottle or attach a hose)
• Appropriate tip for rectal insertion
• Warm water and soap suds

Procedure:
1. Fill the hot water bottle with warm water and...
enema, hot water bottle, rectal administration, sanitation, hygiene

Care Routine (1)

Establishing a Care Routine for a Patient
Standard Source: Survival and Austere Medicine
Establishing a Care Routine for a Patient

• Learn to sleep when your patient sleeps to avoid exhaustion.
• If you cannot sleep when your patient does, have someone else watch over the patient while you sleep. This helper can notify you of...
care routine,pacing,patient care,austere medicine,survival medicine

Death And Decomposition (1)

Determine if Someone is Dead
High Priority Source: Survival and Austere Medicine
Steps to Determine Death:

1. Check for a pulse – Place two fingers on the carotid artery (side of the neck) or radial artery (wrist). No pulse indicates no heart activity.
2. Check for breathing – Observe chest movement and listen for...
determine death, signs of death, hypothermia, pulse check, breathing check, pupil response

Pharmaceutical Interventions (1)

Understanding the Efficacy of Tamiflu in Pandemic Influenza Prevention and Treatment
Standard Source: Survival and Austere Medicine
Procedure:

When considering the use of Tamiflu (Zanamivir®) during an influenza pandemic, follow these guidelines:

1. Tamiflu reduces illness duration by 1-2 days if taken within 24 hours of symptom onset.
2. **Prophylactic use may reduce...
Tamiflu,Zanamivir,efficacy,pandemic influenza,antiviral medication,medical treatment

Cardiac Emergencies (1)

Recognize and Treat a Heart Attack in an Austere Situation
Critical Source: Survival and Austere Medicine
Steps for Recognizing and Treating a Heart Attack in an Austere Environment:

### Recognition of a Heart Attack
• Look for symptoms such as:
- Chest pain or discomfort that may radiate to the arms, back, neck, jaw, or stomach.
-...
heart attack,austere medicine,aspirin,willow bark,precordial thump,chest pain,emergency treatment

Resource Management (1)

Utilizing Second Tier References in Survival Medicine
Reference Source: Survival and Austere Medicine
Second tier references should not be your first priority but rather supplement your higher tier acquisitions. They expand capabilities, explore subjects in greater depth, and add muscle to the first tier meat. The information as presented is...
second tier references, resource management, survival medicine

Obstetric Gynecological Care (1)

Manage Obstetric and Gynecological Emergencies in Remote Settings
High Priority Source: Survival and Austere Medicine
Procedure:

1. Assess the patient: Evaluate for signs of hemorrhage, infection, or complications such as ectopic pregnancy or preterm labor.
2. Stabilize the patient: Ensure airway, breathing, and circulation are maintained. Administer...
pregnancy, hemorrhage, infection, evacuation, remote care

Emergency Nursing (1)

Acquire The Survival Nurse: Running An Emergency Nursing Station Under Adverse Conditions
Standard Source: Survival and Austere Medicine
Title: *The Survival Nurse: Running An Emergency Nursing Station Under Adverse Conditions* by Ragnar Benson
Format: Softbound
Publisher: Paladin Press
ISBN: 1-58160-075-5
Price: $19.00
Description: The only general reference...
nursing station,remote nursing,emergency care

Wilderness Medicine (1)

Acquire Wilderness Medicine: Beyond First Aid, 5th Edition
High Priority Source: Survival and Austere Medicine
Title: *Wilderness Medicine: Beyond First Aid, 5th Edition* by William Forgey, M.D.
Format: Paperback
Publisher: Globe Pequot Printing
ISBN: 076270490X
Price: $14.95
Description: Tells how to recognize, assess, and treat many...
wilderness medicine,cryptosporidiosis,immunizations

Military Medicine (1)

Acquire US Army Special Forces Medical Handbook
Standard Source: Survival and Austere Medicine
Title: *US Army Special Forces Medical Handbook* by Department of Army
Publisher: Apple Pie Publishers, LLC
ISBN: 0967512352
Price: $19.95 Paperback, 400 pages.
Description: Worthwhile as an adjunct but greatly superceded by...
special forces medicine,military medical handbook

Gender Specific Health (1)

Acquire Where Women Have No Doctor by Burns, Lovich, et al.
Standard Source: Survival and Austere Medicine
Title: *Where Women Have No Doctor* by Burns, Lovich, et al.
Publisher: Hesperian Foundation (1997)
ISBN: 0-942364-25-2
Price: $20.00
Description: Helps individuals understand, treat, and prevent most health problems affecting...
women's health,third world medicine,healthcare access

Terrorism Medical Response (1)

Assess and Respond to Potential Casualties in Terrorism Incidents
Critical Source: UK National Risk Register 2025
Objective: Ensure appropriate medical and emergency response for potential casualties following an assassination of a high-profile public figure.

Procedure:
1. Immediate Medical Response: Deploy emergency services (ambulances,...
casualty response, terrorism medical care, triage procedures, emergency services

Mass Casualty Response (1)

Specialist Treatment and Surge Capacity for Casualties Following a COMAH Site Fire or Explosion
Critical Source: UK National Risk Register 2025
Procedure:

1. Immediate Medical Response:
- Deploy emergency medical teams to the site of the incident.
- Provide immediate first aid and stabilize casualties at the scene if possible.
- Transport critically injured individuals to...
specialist treatment, surge capacity, casualties, fire explosion, COMAH site

Infectious Disease Outbreak (1)

Containment Measures for Laboratory-Released Pathogen
High Priority Source: UK National Risk Register 2025
Procedure:

1. Immediate Isolation: The infected individual must be isolated immediately in a designated containment area.
2. Medical Evaluation: The individual should undergo immediate medical evaluation by trained personnel to assess...
pathogen containment, contact tracing, antiviral drugs, quarantine, decontamination

Food Borne Illness (1)

Respond to Food Supply Contamination with Pathogens
High Priority Source: UK National Risk Register 2025
Procedure for Responding to Food Supply Contamination with Pathogens:

1. Identify the Source of Contamination: Investigate and identify the source of contamination, which may include cross-contamination, poor hygiene practices,...
food contamination, pathogen response, hygiene audit, recall procedures, food safety

Disease Transmission (1)

Educate Children About Disease Transmission via Faecal-Oral Route
High Priority Source: Safe Water Manual
Steps:
1. Inform children about dangerous organisms in faeces and their transmission through the faecal-oral route.
2. Provide details on the types of pathogens found in human excreta:
- 10,000,000 viruses per gram
- 1,000,000 bacteria per...
faecal-oral route, disease transmission, pathogen exposure

Hazardous Materials Incidents (1)

Evacuate Immediately if Asked to Do So During a Hazardous Materials Incident
Standard Source: FEMA Are You Ready
Action: If asked to evacuate during a hazardous materials incident, do so immediately.

Details:
• Evacuation is critical for minimizing the risk of contamination and exposure to toxic chemicals.
• Follow instructions from local authorities...
evacuation, hazardous materials, emergency response, safety procedures

Ecl And Emergency Measures Documentation (1)

Provide Summary of Emergency Response Measures Based on ECL and Offsite Conditions
Standard Source: FEMA REP Program Manual Dec 2019
Procedure:

Step 1: Identify each ECL (Emergency Condition Level) and its associated emergency response measures, including the purpose of each ECL.
Step 2: Assess offsite conditions, such as weather, road conditions, and potential...
ECL, emergency response measures, offsite conditions, ORO plans, coordination, stakeholders

Coordination And Planning (1)

Decide and Plan Emergency Response with EOC
Standard Source: US Antarctic Field Manual + US Antarctic Continental Field Manual
Procedure for decision-making and planning during an emergency:

1. Collaborate with the EOC (Emergency Operations Center) to make decisions.
- You are on the ground and best positioned to determine how outside help can be of assistance.
...
EOC, emergency response, decision-making, coordination, monitoring

Vaccination Protocols (1)

Administer Tetanus Toxoid Vaccinations According to Standard Schedule and for Unvaccinated Pregnant Women
Standard Source: A Book for Midwives
Procedure:

1. Administer the first tetanus toxoid injection (TT1) at any age.
2. Give the second injection (TT2) 4 weeks after TT1.
3. Provide the third injection (TT3) at least 6 months after TT2.
4. Administer the fourth injection...
tetanus toxoid, vaccinations, pregnant women, immunization schedule, midwifery care

First Aid For Trench Foot (1)

Provide First Aid for Trench Foot
Reference Source: Emergency War Surgery
Treatment:
• Prevent further cold exposure.
• Do not massage the affected area.
• Dry extremity, warm torso, and allow slow passive rewarming of feet. Never immerse feet in warm or hot water.
• Elevate feet.
• Rehydrate.

**Pain...
trench foot, first aid, cold exposure, rewarming, amitriptyline, infection management, debridement

First Aid For Cold Injuries (1)

Provide First Aid for Frostbite (Superficial and Deep)
Reference Source: Emergency War Surgery
Field treatment (first aid):

For superficial frostbite (blanched cheeks, nose, ears, fingertips):
- Warm with palm of hand or warm, wet cloth; warm fingers in armpits.
- Emollients may help prevent skin from drying or cracking.
- Do...
frostbite, first aid, superficial frostbite, deep frostbite, emergency care

Maxillofacial Surgery (1)

Management of Maxillofacial Injuries
Standard Source: NATO Emergency War Surgery
Immediate Phase Management for Maxillofacial Injuries:

1. Establish and Maintain Airway: This is the highest priority in the immediate phase.
2. Control Hemorrhage: Ensure effective control of bleeding.
3. **Apply Protective...
maxillofacial injuries, airway management, hemorrhage control, antimicrobial therapy, reconstructive surgery, deformity correction

Emergency First Aid (1)

Perform Needle Chest Decompression (NCD)
Reference Source: STP 21 1 Warrior Skills Level 1 + TCCC 17 13 Army Tactical Combat Casualty Care
Procedure for Performing Needle Chest Decompression (NCD):

1. Ensure the casualty is in a safe location.
2. Locate the correct insertion site, which is typically between the second and third ribs, in the midclavicular line on the affected...
Needle Chest Decompression, NCD, Tension Pneumothorax, Chest Injury, First Aid

Emergency Care (1)

Perform a Primary Survey Using ABCDE
Reference Source: Ranger Handbook 2006 + SH 21 76 Ranger Handbook
Objective: Perform a primary survey using the ABCDE method.

Procedure:
Use the ABCDE method to assess and manage life-threatening injuries:

A (Airway): Open the airway by positioning the patient or using airway adjuncts.
• **B...
ABCDE, primary survey, airway, breathing, circulation, disability, exposure

Casualty Care (1)

Place Casualty in Recovery Position
Standard Source: STP 21 1 Warrior Skills Level 1 + STP 21 1 Army Warrior Skills Level 1 Soldiers Manual of Common Tasks
Procedure for Placing a Casualty in the Recovery Position

1. Once the casualty is breathing and has a pulse, place them in the recovery position.
2. Watch the casualty closely for life-threatening conditions.
3. **Maintain an open...
recovery position, casualty care, breathing, pulse, airway management

Casualty Handling (1)

Place and Transport a Casualty on an Improvised Litter
Standard Source: STP 21 1 Warrior Skills Level 1
Procedure for Placing and Transporting a Casualty on an Improvised Litter:

1. Carefully place the casualty onto the improvised litter, ensuring that they are positioned securely and comfortably.
2. Ensure that the casualty is not in any...
casualty, improvised litter, placement, transport, injury prevention

Veterinary Care (1)

Prepare Purging Ball for Jaundice and Worms
Reference Source: The Household Cyclopedia
Ingredients (for Jaundice):
• Barbadoes aloes: 4 to 5 drachms
• White antimonial powder: 2 drachms
• Castile soap: 2 drachms
• Calomel: 1 drachm
• Syrup of buckthorn: sufficient quantity

Ingredients (for Worms):
• Barbadoes aloes: 8...
purging ball, jaundice, worms, horse treatment, barbadoes aloes, castile soap, syrup of buckthorn

Wound Closure And Suturing (1)

Principles of Suture Selection for Wound Closure
Reference Source: Medical Survival Wound Closure Manual + Encyclopedia of Knots
Procedure for Selecting Appropriate Sutures Based on Wound Healing and Contamination Risk

1. Understand the timing of suture removal based on tissue healing:
- When a wound has reached maximal strength, sutures are no longer needed.

2....
suture selection, wound closure, tissue healing, contamination risk, nonabsorbable sutures, absorbable sutures, cosmetic results

Midwifery (1)

Conducting a Pelvic Exam: Comprehensive Guide
Reference Source: A Book for Midwives
When to Perform a Pelvic Exam:

A pelvic exam should be performed in the following situations:
1. During routine prenatal care to assess the health of the reproductive organs.
2. To check for signs of infection, such as unusual discharge or...
pelvic exam, midwife, reproductive health, informed consent, bimanual exam, speculum exam, safety protocols

Gynecological Procedures (1)

Manual Vacuum Aspiration (MVA): Comprehensive Procedure Guide
Reference Source: A Book for Midwives
Deciding when to do MVA:
• Manual vacuum aspiration is used for early pregnancy termination or management of incomplete miscarriage.
• It should be performed by a trained midwife or healthcare provider in a safe, clean environment.
• It is...
Manual Vacuum Aspiration, MVA, Incomplete Abortion, Pregnancy Termination, Miscarriage Management, Midwifery Procedure, Infection Prevention

Nutrition During Pregnancy (1)

Consequences and Recognition of Poor Nutrition During Pregnancy
Standard Source: Where There is no Doctor a Village Health Care Handbook + A Book for Midwives
Poor nutrition during pregnancy can lead to:

• Weakness and anemia in the mother
• Increased risk of maternal death during or after childbirth
• Higher chance of miscarriage
• Risk of stillbirth or a baby being born dead, too small, or with a...
pregnancy, nutrition, maternal health, anemia, miscarriage, stillbirth, birth defects

Prenatal Care & Anemia Treatment (1)

Administer Folic Acid During Pregnancy and for Anemia
Standard Source: Where There is no Doctor a Village Health Care Handbook + A Book for Midwives
Overview: Folic acid is essential during pregnancy to prevent neural tube defects in the fetus and can also be used to treat anemia caused by conditions such as malaria, large spleen, or jaundice. It may also help prevent anemia in malnourished...
folic acid, pregnancy, anemia, neural tube defects, vitamin C, iron deficiency

Hiv And Pregnancy (1)

Administering Antiretroviral Therapy (ART) for Pregnant Women with HIV
Standard Source: Where There is no Doctor a Village Health Care Handbook + A Book for Midwives
Procedure:

1. Identify a pregnant woman who is living with HIV.
2. Prescribe antiretroviral therapy (ART) as part of her care plan, both for her own health and to reduce the risk of transmitting HIV to her baby during pregnancy and labor.
3....
ART, Pregnant Women, HIV, Mother-to-Child Transmission, Antiretroviral Therapy, Breastfeeding, EFV Avoidance

Allergy Management And Medication Safety (1)

Identify and Avoid Medicines That Cause Allergic Reactions
Standard Source: A Book for Midwives
Procedure:

1. Ask About Past Reactions: Inquire if the woman has ever had a health problem after taking a medicine (e.g., rash, swelling, difficulty breathing).
2. Avoid Allergens: If she has had an allergic reaction to a medicine, do...
allergic reactions, medicine safety, allergies, medication families, prevention, injections

Hydration And Dehydration Management (1)

Prepare and Administer a Rehydration Drink
Standard Source: Where There is no Doctor a Village Health Care Handbook + A Book for Midwives
Why it's important:
A rehydration drink helps keep the chemicals in the mother’s blood balanced so she does not get sick. It is essential for treating dehydration caused by diarrhea, vomiting, or labor-related fluid loss.

**How to prepare the...
rehydration drink, dehydration, salt, sugar, preparation, administration, emergency hydration

Emergency Obstetric Care (1)

Recognize and Respond to Detached Placenta (Abruption)
Standard Source: A Book for Midwives
### Recognize and Respond to Detached Placenta (Abruption)

If you suspect a detached placenta, seek medical help immediately. Do not wait!

#### Signs of Detached Placenta:
• The mother may have vaginal bleeding, but **sometimes no blood...
detached placenta, abruption, vaginal bleeding, baby heartbeat, shock, emergency care, labor complications

Obstetrics & Gynecology (1)

Management of Vaginal Hematoma
Reference Source: Emergency War Surgery + A Book for Midwives
Procedure:

1. Assess the Hematoma:
- Look for signs of a hematoma: swelling, dark coloration, pain, and softness in the vaginal area.
- Identify by palpation of a firm, tender mass bulging into the lateral vagina and associated with...
vaginal hematoma, hematoma management, emergency care, surgical intervention, pressure application, ligation, wound packing

Contraception And Menstrual Regulation (1)

Choosing and Using Low-Dose Birth Control Pills
Standard Source: A Book for Midwives
Procedure:

1. Select low-dose birth control pills:
- Ensure the pill contains 35 micrograms (mcg) or less of estrogen, and 1 milligram (mg) or less of progestin.
- Consider Groups 1, 2, and 3 for low-dose pills, which...
low-dose birth control pills, contraception, menstrual regulation, hormone content, backup contraception, brand names

Tetanus Management (1)

Administer Tetanus Antitoxin or Immunoglobulin Based on Exposure, Prevention, or Active Infection
Standard Source: Where There is no Doctor a Village Health Care Handbook + A Book for Midwives
Indication: Administer tetanus antitoxin or immunoglobulin based on the following scenarios:

1. For prevention after unsafe abortion or wound exposure (no vaccination in last 10 years):
- Inject **1500 Units of tetanus antitoxin...
tetanus antitoxin, immunoglobulin, wound exposure, unsafe abortion, active tetanus, horse serum, vaccination history, allergic reactions

Midwifery - Manual Vacuum Aspiration (Mva) (1)

Emptying the Syringe and Replacing the Cannula During MVA
Standard Source: A Book for Midwives
Procedure:

1. Remove the syringe and cannula from the womb.
2. Detach the syringe from the cannula.
3. Empty the syringe completely.
4. Insert a new, sterilized cannula into the womb.
5. Consider using a larger-sized cannula if necessary.
6....
MVA, cannula replacement, syringe emptying, clogged cannula, midwifery procedure

Weighing Devices (1)

Constructing a Homemade Beam Scale
Standard Source: Where There is no Doctor a Village Health Care Handbook + A Book for Midwives
Materials Needed:
• Dry wood or bamboo (for the beam)
• Hooks
• Bag, bottle, or tin can filled with sand (movable weight)
• Baby weight (about 1 kg)
• Plastic one-liter bottles
• Ruler
• Marker

Steps to Construct the Beam Scale:
1....
beam scale, homemade scale, healthcare tool, village health care, midwifery tools

Contraception And Reproductive Health (1)

Administer and Identify Different Types of Birth Control Pills
Standard Source: Where There is no Doctor a Village Health Care Handbook + A Book for Midwives
Procedure:

1. Tripahsic Birth Control Pills (Group 1):
- Use triphasic pills that contain low amounts of both estrogen and progestin in a varying mix throughout the month.
- Take the pills in order, as the hormone content changes each...
birth control pills, triphasic pills, high-dose pills, progestin-only pills, contraception, hormonal contraception

Hiv/Aids Management (1)

Administering and Taking Antiretroviral Therapy (ART) Medicines
Reference Source: Where There is no Doctor a Village Health Care Handbook + A Book for Midwives
Procedure for Administering and Taking ART Medicines

Take your medicines every day, at the same time each day. This ensures consistent levels of medication in the body to prevent drug resistance.

• **If medicines need to be taken 2 times...
ART, antiretroviral therapy, HIV, medication adherence, drug resistance, CD4 cell count

Midwifery Training Materials (1)

Accessing Life-Saving Skills Manuals for Midwives in Multiple Languages
Standard Source: A Book for Midwives
Procedure:

1. Contact the publisher of life-saving skills manuals for midwives at the American College of Nurse Midwives located at 8403 Colesville Rd, Suite 1550, Silver Springs, MD 20910, USA.
2. Call them at (1-240) 485-1800 or visit their...
midwives, life-saving skills manual, American College of Nurse Midwives, training resources, multilingual manuals

Missile Wound Mechanics (1)

Correct Understanding of Missile Wound Mechanics
Reference Source: Emergency War Surgery
Understanding missile wound mechanics is critical for proper surgical care.

Velocity and Tissue Damage: Increased velocity does not necessarily increase tissue damage. For example, the first 12 cm of an M-16A1 bullet wound profile causes...
missile wound mechanics, tissue damage, bullet fragmentation, temporary cavity effects, emergency surgery

Injury Types And Management (1)

Types of Antipersonnel Landmines and Their Injuries
Reference Source: Emergency War Surgery
Antipersonnel landmines can be categorized into three main types, each with distinct injury patterns:

Static Landmines: These are small, planted landmines (100–200 g of explosive) that detonate when stepped on. They cause two major areas...
antipersonnel landmines, injuries, static mines, bounding mines, horizontal spray mines, traumatic amputation

Combat Casualty Assessment (1)

Understanding Armored Vehicle Crew Casualty Patterns and Injury Characteristics
Reference Source: Emergency War Surgery
Objective: Understand the unique injury patterns, challenges, and characteristics associated with casualties from armored vehicle crews in combat situations.

### Procedure:
1. Recognize the context:
- Injuries to those inside or around...
armored vehicle, casualty patterns, combat injuries, burns, amputations, HEAT, RPG, mortality rate

Medical Care In Military Operations (1)

Level I Medical Care in Military Operations (Battalion Aid Station [BAS])
Reference Source: Emergency War Surgery
Description:

Immediate first aid delivered at the scene.

- Provided by self-aid, buddy aid, or a combat lifesaver (nonmedical team/squad member trained in enhanced first aid).

- Delivered by trauma specialists such as:
-...
Level I medical care, Battalion Aid Station (BAS), immediate first aid, combat lifesaver, combat medic, EMT-Basic, trauma specialist, nuclear, biological, chemical casualties, toxic industrial material casualties, disease prevention, combat stress control, nonbattle injury prevention

Forward Surgical Team Operations (1)

Forward Surgical Team (FST) Operations in Emergency War Surgery
Reference Source: Emergency War Surgery
Forward Surgical Team (FST): A 20-person team designed for rapid deployment to provide life-saving resuscitative surgery, including general, orthopedic, and limited neurosurgical procedures.

Key Features and Capabilities:
1. **Surgical...
Forward Surgical Team, FST, Emergency War Surgery, Resuscitative Surgery, Deployment, Medical Company Support

Spearr Team Operations (1)

Deploy and Operate Small Portable Expeditionary Aeromedical Rapid Response (SPEARR) Teams
Reference Source: Emergency War Surgery + TCCC 17 13 Army Tactical Combat Casualty Care
Small Portable Expeditionary Aeromedical Rapid Response (SPEARR) team:

• Composed of a 10-person team: 5-person Mobile Field Surgical Team (MFST), 3-person Critical Care Air Transport Team (CCATT) (see Chapter 4, Aeromedical Evacuation),...
SPEARR, Mobile Field Surgical Team (MFST), Critical Care Air Transport Team (CCATT), preventive medicine, emergency war surgery, deployment

Expeditionary Medical Support (Emeds) (1)

Expeditionary Medical Support (EMEDS) Basic Operations in Emergency War Surgery
Standard Source: Emergency War Surgery
Expeditionary Medical Support (EMEDS) Basic: A medical and surgical support unit designed to provide 24-hour sick call capability, resuscitative surgery, dental care, limited laboratory, and X-ray services.

Key Features and Capabilities:
1....
EMEDS, Expeditionary Medical Support, War Surgery, Emergency Care, Forward Surgical Unit

Combat Support Hospitals (Csh) (1)

Deploy and Operate a Level III Combat Support Hospital (CSH)
Standard Source: Emergency War Surgery
Procedure:

• Represents the highest level of medical care within the combat zone.
• Most deployable hospitals are modular, allowing commanders to tailor the response based on expected or actual demand.
Army Corps-level CSHs...
Level III CSH, Medical Force 2000, MRI CSH, modular hospital, combat zone medical care, surgical capacity, patient capacity

Field Hospital Deployment (1)

Set Up EMEDS +25 Field Hospital
Reference Source: Emergency War Surgery
Procedure for Setting Up EMEDS +25 Field Hospital:

• Use a 25-bed version of EMEDS Basic, which includes:
- 84 personnel
- 2 OR tables
- 9 x 600 sq ft tents
- 20 pallets
• Can perform up to **20 operations in 48...
EMEDS +25, field hospital, deployment, emergency surgery, austere environment

Medical Deployment (1)

Set Up Navy Fleet Hospital
Reference Source: Emergency War Surgery
Procedure for Setting Up Navy Fleet Hospital:

• A 500-bed hospital with:
- 80 ICU beds
- 6 ORs
- 1,000 personnel
• It is a standalone facility with full ancillary services.
• Takes 8–10 days to be operational.
-...
Navy Fleet Hospital, Hospital Ship, USNS Mercy, USNS Comfort, Medical Deployment, War Surgery

Hospital Setup And Deployment (1)

Set Up General Hospital (Level V)
Reference Source: Emergency War Surgery
Procedure for Setting Up a General Hospital (Level V):

• A permanent or semipermanent facility, providing comprehensive care.
• At least 8 OR tables, operating for 144 hours per day.
• Services include:
- General, orthopedic,...
General Hospital, Level V, OR tables, ICU capacity, CONUS, DoD hospitals, DVA hospitals

Aeromedical Evacuation Coordination (1)

Local Flight Surgeon Responsibilities in Aeromedical Evacuation (AE) Coordination
Standard Source: Emergency War Surgery
Procedure:

1. The local Flight Surgeon (FS) has the authority to determine whether patients are physiologically ready for air transport.
2. The FS serves as a resource for information, communication, and coordination with the AE system.
3....
Flight Surgeon, Aeromedical Evacuation (AE), Physiological Readiness, Coordination, PMRC, AELT

Hemorrhage Management (1)

Manage Internal Bleeding with Immediate Evacuation and Temporary Measures
Reference Source: Emergency War Surgery
Indication: Blood loss into the abdomen or chest that cannot be controlled in the field.

Procedure:
1. Immediate evacuation is required for internal bleeding, as it cannot be managed in the field without definitive surgery.
2. For...
internal bleeding, evacuation, pelvic fracture stabilization, tamponade, Foley catheter

Hemostatic Dressing Application (1)

HemCon Dressing Application and Considerations
Reference Source: Emergency War Surgery
- HemCon is a firm 4 x 4 inch dressing that is sterile and individually packaged.

• It works by adherence to the bleeding wound and has some vasoconstrictive properties.

• The blood and clot in the wound should be removed before...
HemCon, hemostatic dressing, wound care, external hemorrhage, emergency surgery

Airway Management And Oxygen Therapy (1)

Secure Airway and Administer Oxygen in Traumatic Shock
Reference Source: Emergency War Surgery
Objective: Ensure airway patency and adequate oxygenation.

Procedure:
1. Secure the airway using standard airway management techniques (e.g., head-tilt/chin-lift, jaw-thrust, or intubation if necessary).
2. **Administer supplemental...
airway management, oxygen administration, traumatic shock, emergency surgery

Hemorrhagic Shock Management (1)

Avoid Vasopressors in Initial Treatment of Hemorrhagic Shock
Reference Source: Emergency War Surgery
Objective: Prevent inappropriate use of vasopressors that may worsen outcomes.

Procedure:
1. Do not administer vasopressors during the initial management of hemorrhagic shock.
2. Focus on fluid resuscitation and bleeding control as...
vasopressors, hemorrhagic shock, fluid resuscitation, bleeding control, norepinephrine

Resuscitation And Fluid Management (1)

Fluid Selection and Management in Hemorrhagic Shock
Standard Source: Emergency War Surgery
Objective: Select appropriate fluids for resuscitation based on clinical context and availability.

Indications: Hypovolemia, dehydration, hemorrhage, shock, burns.

Available Fluids and Their Uses:
1. Crystalloids:
- Saline:...
fluid selection, hemorrhagic shock, resuscitation, crystalloids, hypertonic saline, colloids, albumin, hetastarch

Blood Transfusion And Obstetric Considerations (1)

Rh Blood Group Clinical Relevance in Female Casualties
Standard Source: Emergency War Surgery
Rh Blood Group Overview

• Approximately 85% of the American population is Rh positive.
• Serious consequences from Rh incompatible blood transfusions are rare in men.

Female Casualty Considerations

• In female casualties,...
Rh blood group, female casualties, anti-D antibodies, hemolytic disease of the newborn, blood transfusion

Blood Transfusion Protocols (1)

Administer Blood Transfusions in Rh Incompatible Situations
Reference Source: Emergency War Surgery
Under no circumstances should a life-saving transfusion be withheld because of Rh incompatibility; saving a life takes precedence over Rh immunization.

Prevention: When the supply of group O blood permits, group O Rh negative blood should...
blood transfusion, Rh incompatibility, massive transfusions, FFP, platelets, cryoprecipitate

Blood Transfusion And Collection (1)

Establishing and Using a Walking Blood Bank (WBB) in Emergency Situations
Reference Source: Emergency War Surgery + TCCC 17 13 Army Tactical Combat Casualty Care
Overview: A Walking Blood Bank (WBB) program provides fresh whole blood (FWB) in austere conditions for casualties requiring massive transfusions. FWB can be used when RBC, plasma, and platelets are transfused at a 1:1:1 ratio.

**When to...
Walking Blood Bank, Fresh Whole Blood, Emergency Blood Collection, Field Blood Transfusion, TCCC, War Surgery

Venous Access Procedures (1)

Perform Greater Saphenous Vein Cutdown
Standard Source: Emergency War Surgery + NATO Emergency War Surgery
Procedure for Greater Saphenous Vein Cutdown

Contraindications:
- Deep vein thrombosis (DVT) or severe ipsilateral lower extremity trauma.

Steps to Perform the Procedure:
1. Choose a venipuncture site: **greater saphenous vein...
saphenous vein cutdown, emergency venous access, greater saphenous vein, ankle procedure, venipuncture

Anesthesia Evaluation (1)

Evaluate Patient for Induction of General Anesthesia in Battlefield Conditions
Reference Source: Emergency War Surgery
**Evaluation Criteria for Induction of General Anesthesia:"

Concurrent illness and current state of resuscitation:
• Assess the patient's overall condition and ongoing resuscitative efforts.

Airway assessment:
• Evaluate for **facial...
general anesthesia, airway assessment, cervical spine mobility, battlefield conditions, resuscitation

Anesthesia And Sedation (1)

Induction Agents: Dosage, Characteristics, and Considerations
Reference Source: Emergency War Surgery
Induction Agents: Dosage, Characteristics, and Considerations

Barbiturate (Thiopental):
- Routine Dose: 3–5 mg/kg.
- Onset: Within 30–60 seconds.
- Concerns: May cause profound hypotension in hypovolemic shock...
Thiopental, Propofol, Etomidate, Induction agents, Dosage, Hypotension, Clonus, Sedation

Anesthesia Management (1)

Maintenance of General Anesthesia After Intubation
Reference Source: Emergency War Surgery
Oxygen: Titrate to maintain SaO₂ >92%.

Ventilation Parameters:
- Tidal volume (TV): 10–15 cc/kg.
- Respiratory rate (RR): 6–10/min.
- PEEP (positive end-expiratory pressure) if desired at 5 cm H₂O, titrate as...
general anesthesia, intubation, ventilation parameters, MAC, TIVA, oxygen saturation

Anesthesia Techniques (1)

Use of Local Anesthesia in Field Settings
Standard Source: Emergency War Surgery
When local anesthesia would suffice, such as in certain wound debridements and wound closures, it should be the technique of choice. Provides adequate analgesia without the need for general or regional anesthesia. Avoids complications associated...
local anesthesia, field settings, wound debridement, wound closure, analgesia

Ventilator Setup And Operation (1)

Setting Up and Operating the Impact Uni-Vent Eagle 754 Ventilator in Field Conditions
Reference Source: Emergency War Surgery
Objective: Properly configure a field ventilator for trauma patients, including setup with the UPAC draw-over apparatus and construction of separate circuits.

### Steps:
1. Positioning the ventilator distal to the vaporizer: Place the...
Impact Uni-Vent Eagle 754, UPAC draw-over apparatus, field ventilator setup, SIMV mode, FIO2 settings, PEEP control, circuit construction

Infection Control & Prophylaxis (1)

Tetanus Prophylaxis for Tetanus-Prone Wounds
Standard Source: Emergency War Surgery + NATO Emergency War Surgery
Procedure for Tetanus Prophylaxis in Tetanus-Prone Wounds:

1. Assess the wound type:
- Identify if the wound is a small, deep puncture wound or any other type that may be prone to tetanus infection.
- Consider all wounds contaminated...
tetanus prophylaxis, war wounds, tetanus toxoid, TIG, immunization, wound assessment

Battlefield Icu Management (1)

Establish and Manage a Battlefield ICU
Standard Source: Emergency War Surgery
Establish and manage an intensive care unit (ICU) for battlefield casualties with the following steps:

1. Ensure dedicated ICU staffing: Each battlefield ICU should have a dedicated intensive care physician, due to the severity of...
battlefield icu, intensive care unit, damage control resuscitation, hemorrhage control, rewarming, mechanical ventilation, organ-specific support

Pain Management In Trauma Patients (1)

Ensure Adequate Pain Control in Trauma Patients
Reference Source: Emergency War Surgery
Ensure adequate pain control:

• Use IV (not IM) narcotic agents in sufficient doses to alleviate pain.
• For patients on mechanical ventilation, administer both narcotics (morphine, fentanyl) and sedatives (**propofol,...
pain control, trauma patients, IV narcotics, mechanical ventilation, sedatives

Critical Care / Renal Failure Management (1)

Respond to Oliguria in ICU Patients
Standard Source: Emergency War Surgery
Objective: Address oliguria (<20 cc/h) in ICU patients promptly and effectively.

Procedure:
1. Irrigate or replace the Foley catheter, ensuring it is functioning properly.
2. Administer a bolus of 1–2 L IV saline over 30 minutes,...
oliguria, ICU, FENA, prerenal azotemia, acute renal failure, Foley catheter, pulmonary artery catheter

Renal Support Procedures (1)

Initiate Dialysis for Refractory Acute Renal Failure
Reference Source: Emergency War Surgery
Objective: Provide temporary renal support in patients with acute renal failure (ARF) who do not respond to initial management.

Purpose: To provide temporary renal support in patients with severe or refractory ARF that does not respond to...
dialysis, acute renal failure, refractory ARF, renal support, transport optimization

Metabolic Acidosis Management (1)

Management of Metabolic Acidosis in Emergency Settings
Reference Source: Emergency War Surgery
Metabolic acidosis: Primarily lactic (most commonly due to hypovolemia) and ketoacidosis.

Treatment note: Sodium bicarbonate is contraindicated in lactic acidosis.
Sodium bicarbonate has very limited role in ICU disorders:
...
metabolic acidosis, sodium bicarbonate, lactic acidosis, hypovolemia, ketoacidosis, hyperkalemia, myoglobinuria, renal tubular acidosis, gastrointestinal losses

Hematologic System Disorders (1)

Management of Coagulation Disorders in Casualty
Standard Source: Emergency War Surgery
Most common coagulation disorder: Dilutional coagulopathy.

• Others include: **heparin-induced thrombocytopenia, disseminated intravascular coagulation (DIC), coagulopathy due to hypothermia or diffuse hepatic damage, and...
coagulation disorders, dilutional coagulopathy, trauma, blood products, DVT prevention, pulmonary embolism

Infection Control In Trauma (1)

Use of Prophylactic Antibiotics in Trauma Patients
Standard Source: Emergency War Surgery
Prophylactic antibiotics are indicated for trauma patients to prevent infection, with specific considerations depending on the type of injury.

### Battlefield Trauma:
Administer a short course of prophylactic antibiotics (24–48 h)...
prophylactic antibiotics, battlefield trauma, gynecologic trauma, infection prevention, sepsis

Damage Control Surgery (1)

Damage Control Surgery Overview and Indications
Reference Source: Emergency War Surgery
Procedure:

Definition of Damage Control Surgery (DCS): A rapid initial control of hemorrhage and contamination followed by temporary closure, resuscitation to normal physiology in the ICU, and subsequent re-exploration and definitive...
damage control surgery, DCS, trauma care, emergency surgery, TASC, resuscitation, multisystem casualties

Damage Control Procedures (1)

Injuries Requiring Damage Control Techniques
Reference Source: Emergency War Surgery
Objective: Identify injuries that typically require damage control techniques.

Types of injuries that typically require damage control:
Upper abdominal injuries, excluding isolated spleen injuries (e.g., duodenal, large liver,...
damage control, upper abdominal injuries, penetrating pelvic trauma, retroperitoneal vascular injury

Abdominal Compartment Syndrome Management (1)

Manage Abdominal Compartment Syndrome (ACS)
Standard Source: Emergency War Surgery
Objective: Identify and manage abdominal compartment syndrome to prevent circulatory compromise and organ failure.

Definition: ACS is a condition where **increased intra-abdominal pressure adversely affects circulation and threatens the...
abdominal compartment syndrome, ACS, intra-abdominal pressure, decompressive laparotomy, urinary bladder measurement, organ dysfunction

Bleeding Control (1)

Control Bleeding from Facial Vascular Injuries
Standard Source: Emergency War Surgery
Title: Control Bleeding from Facial Vascular Injuries

Content:

Apply direct pressure to control bleeding initially.
• If bleeding cannot be controlled with direct pressure, immediate operative intervention is necessary.
• For...
facial vascular injury, direct pressure, vessel ligation, blind clamping, Foley catheter

Airway Management And Bleeding Control (1)

Manage Intraoral Bleeding and Ensure Airway Patency
Reference Source: Emergency War Surgery
Title: Manage Intraoral Bleeding and Ensure Airway Patency

Content:
Control intraoral bleeding to ensure a patent airway.
• Do not pack the oropharynx in an awake patient, as this may compromise the airway. Instead, first secure...
intraoral bleeding, endotracheal intubation, airway safety, antibiotic use, penetrating injuries, copious irrigation

Facial Injury Assessment (1)

Evaluate and Cleanse Facial Injuries for Assessment
Reference Source: Emergency War Surgery
Title: Evaluate and Cleanse Facial Injuries for Assessment

Content:
• Once the casualty is stabilized, gently cleanse dried blood and foreign bodies from wound sites to evaluate the depth and extent of injury.
• Palpate the bony orbits,...
facial injury evaluation,wound cleansing,fracture assessment,malocclusion,dental integrity,cranial nerve examination,ophthalmologist consultation

Maxillofacial Trauma (1)

Management of Mandible Fractures in Emergency Settings
Standard Source: Emergency War Surgery
### Goals
• Realignment and fixation of fragments in correct anatomic position using dental wire or plates and screws.

### Delayed Repair Considerations
**With the exception of fractures that significantly alter normal dental occlusion or...
mandible fractures, emergency management, dental wire, plates and screws, delayed repair, imaging, panorex, CT scan

Laryngotracheal Injury Repair (1)

Repair of Laryngotracheal Injuries with Suturing Technique and Concomitant Injury Search
Reference Source: Emergency War Surgery
Procedure:

Injury Type: Laryngotracheal injuries.

Steps:
1. Repair the injury using a single-layer monofilament absorbable suture.
2. Search for concomitant esophageal injuries during the procedure.

Details:
• Single-layer...
laryngotracheal injury, suture technique, esophageal injury, emergency surgery

Esophageal Fistula Management (1)

Esophageal Fistula Management
Reference Source: Emergency War Surgery
Procedure for Managing Esophageal Fistula:

1. Incidence and Causes:
- 10%–30% incidence.
- Due to:
- Inadequate debridement
- Devascularization of remaining esophageal wall
- Closure under tension
- Infection

2....
esophageal fistula, management, barium swallow, drains, nutrition

Otologic Injury Management (1)

Assess and Manage Vertigo Following Otologic Injury
Standard Source: Emergency War Surgery
Procedure:

• Dizziness and vertigo may result from acoustic trauma.
• If true vertigo exists after an otologic injury (observed nystagmus), the patient may have a perilymphatic fistula from depression of the stapes into the oval window or...
vertigo, otologic injury, perilymphatic fistula, acoustic trauma, nystagmus, tinnitus, hearing loss, Otolaryngologist

Ophthalmology (1)

Comprehensive Management of Corneal Abrasions
Standard Source: Emergency War Surgery + NATO Emergency War Surgery
Diagnosis:
• Be alert for the possibility of an associated open globe injury.
• Look for symptoms such as: severe pain, tearing, and photophobia; diminished vision due to abrasion or excessive tearing.
• Use **topical fluorescein with cobalt...
corneal abrasion, fluorescein, cycloplegia, antibiotic ointment, pressure patch, ophthalmologist

Ophthalmology / Eye Injuries (1)

Diagnosing and Treating Conjunctival and Corneal Foreign Bodies
Standard Source: Emergency War Surgery
Diagnosis of Conjunctival and Corneal Foreign Bodies:

• Look for sudden onset of discomfort or a history suggesting the presence of a foreign body.
• If an open globe is suspected, treat as discussed in the relevant section above.
• A...
conjunctival foreign body, corneal foreign body, fluorescein staining, eyelid eversion, topical anesthesia, spud removal, hypodermic needle, corneal abrasion

Ophthalmic Procedures (1)

Enucleation of a Traumatized Eye in Emergency Settings
Standard Source: Emergency War Surgery
Procedure for Enucleation of a Traumatized Eye in Emergency Settings

### Step-by-Step Procedure:
1. Assess Globe Integrity: A general surgeon in a forward unit should not remove a traumatized eye unless the globe is completely...
enucleation, traumatized eye, forward unit, sympathetic ophthalmia, emergency surgery

Imaging And Diagnostic Procedures (1)

Deploy and Maintain Field CT Scanners for Head Injury Evaluation
Standard Source: Emergency War Surgery
Procedure:

1. Deployable CT scanners should be used in the field environment when available:
- A qualified maintenance chief (referred to as a “crew-chief”) must be assigned to ensure the scanner remains operational.
2. Use CT scans...
CT scanner, head injury, field deployment, radiographic evaluation, surgical intervention, penetrating trauma

Thoracic Injuries (1)

Assess and Diagnose Thoracic Injuries in Combat Trauma
Reference Source: Emergency War Surgery
Evaluation and Diagnosis:

• Knowledge of the mechanism of injury (e.g., blast, fragment) can increase suspicion for specific injuries.
• A complete and accurate diagnosis is often not possible due to limited diagnostic tools in combat...
thoracic injuries, combat trauma, diagnosis, mechanism of injury, airway assessment

Thoracic Procedures (1)

Perform Tube Thoracostomy (Chest Tube) for Penetrating Chest Injuries
Standard Source: Emergency War Surgery
Indications:
• Known or suspected tension pneumothorax
• Pneumothorax (including open)
• Hemothorax
• Any penetrating chest injury requiring transport (mandatory in case of aeromedical evacuation)

Procedure:
1. **Immediate decompression...
tube thoracostomy, chest tube, tension pneumothorax, penetrating chest injury, hemothorax, cefazolin

Thoracic Trauma Procedures (1)

Resuscitative Thoracotomy for Penetrating Chest Injury in Extremis
Standard Source: Emergency War Surgery
Indications:
• Only indicated in penetrating chest injury in extremis or with recent loss of vital signs.

Procedure:
1. Perform a rapid assessment of injuries during the thoracotomy.
2. If unsalvageable injuries are identified,...
resuscitative thoracotomy, penetrating chest injury, extremis, emergency surgery, trauma care

Cardiac Procedures (1)

Subxiphoid Pericardial Window Procedure and Indications
Reference Source: Emergency War Surgery
Procedure:

• With the patient supine, make a 4–5 cm longitudinal incision just on and below the xiphoid process through the skin and fascia.

• Bluntly dissect superiorly toward the heart exposing the phrenopericardial membrane below the...
Subxiphoid pericardial window, pericardial window procedure, emergency surgery, cardiac injury, penetrating trauma

Diagnostic Procedures For Abdominal Injuries (1)

Diagnostic Adjuncts for Abdominal Injuries Procedure
Reference Source: Emergency War Surgery
### Diagnostic Adjuncts
Minimally invasive diagnostic tools include:
• Computed tomography (CT) scan
• Diagnostic peritoneal lavage (DPL)
• Ultrasound (US)

Use in Stable Patients:
• These adjuncts are used to decrease the number of negative...
abdominal injuries, diagnostic adjuncts, computed tomography (CT), diagnostic peritoneal lavage (DPL), ultrasound (US), laparotomy, mass casualty triage

Duodenal Injury Management (1)

Divert Gastric Stream with Gastrostomy for Major Duodenal Injuries
Reference Source: Emergency War Surgery
For major injuries, divert the gastric stream with a gastrostomy and close the pylorus—two options:

• Through a gastrotomy, ligate the pylorus with No. 0 absorbable suture.

• Using a noncutting stapling device, **staple but do not divide...
gastrostomy, duodenal injury, pylorus closure, jejunostomy, emergency surgery, war surgery

Trauma And War Surgery (1)

Diagnosis and Management of Rectal Injuries
Reference Source: Emergency War Surgery + NATO Emergency War Surgery
Rectal injuries can be difficult to diagnose unless very dramatic. Any question of an injury raised by proximity of another injury, rectal examination, or plain abdominal film radiography MANDATES proctoscopy.

**Procedure for rectal injury...
rectal injury, proctoscopy, diversion, colostomy, debridement, distal washout, emergency surgery, war surgery

Bladder Injuries (1)

Manage Intraperitoneal Bladder Injuries
Reference Source: Emergency War Surgery + NATO Emergency War Surgery
Indications:
• Cystography reveals contrast medium interspersed between loops of bowel.

Procedure:
1. Immediate surgical exploration is required for intraperitoneal bladder injuries.
2. Repair the injury using a multilayer technique...
intraperitoneal bladder injury, cystography, suprapubic tube cystostomy, multilayer repair, blunt trauma, penetrating trauma

Gynecological Injuries (1)

Management and Repair of Cervical Lacerations
Reference Source: Emergency War Surgery
Procedure:

1. Repair noninfected simple cervical lacerations using absorbable 0 grade suture.
2. Ensure proper restoration of normal anatomy to reduce the risk of future complications such as cervical incompetence, stenosis, or dysmenorrhea.
3....
cervical lacerations, repair, absorbable suture, pregnancy, trauma, prophylactic antibiotics

Trauma And Hemorrhage Management (1)

Managing Retroperitoneal Hematoma
Standard Source: Emergency War Surgery
Procedure for Managing Retroperitoneal Hematoma

1. Identify the cause, which is typically due to laceration of an arterial branch of the hypogastric artery, a common cause of retroperitoneal hematoma.
2. A large amount of blood may collect...
retroperitoneal hematoma, hypogastric artery laceration, ligation, emergency surgery, internal bleeding

Obstetric Emergencies (1)

Managing Acute Vaginal Hemorrhage in Pregnant Patients
Standard Source: Emergency War Surgery
Procedure for Managing Acute Vaginal Hemorrhage (Pregnant)

1. Bright red vaginal bleeding filling more than one large perineal pad per hour is considered acute vaginal hemorrhage.
2. Perform a pelvic exam and pregnancy test to determine...
acute vaginal hemorrhage, pregnant patient, spontaneous abortion, ectopic pregnancy, placental abruption, placenta previa, cesarean section, hysterectomy, RhoGAM

Genitourinary Trauma Repair (1)

Repair of Anal Sphincter and Rectovaginal Tears
Reference Source: Emergency War Surgery
Procedure:

• If the anal sphincter is lacerated, it should be reapproximated with 2-0 absorbable interrupted single or figure-of-eight sutures.
• If the patient has torn into the rectum, the **rectal-vaginal septum should be repaired...
anal sphincter repair, rectovaginal tear, sutures, emergency surgery, aseptic technique

Postpartum Hemorrhage Management (1)

Management of Postpartum Hemorrhage
Reference Source: Emergency War Surgery
Procedure:

• If no tissue is encountered during manual uterine exploration, use both hands to apply vigorous uterine massage to improve the uterine tone.

• If conservative measures fail to arrest the postpartum hemorrhage (e.g., uterine...
postpartum hemorrhage, uterine massage, laparotomy, uterine artery ligation, hysterectomy

Spinal Assessment (1)

Assessment of Spinal Column Integrity and Stability
Standard Source: Emergency War Surgery
Objective: Determine spinal stability to guide immobilization and transport.

Structural Columns of the Vertebral Column:
Anterior column: Includes anterior two-thirds of vertebral body, anterior longitudinal ligament, and anterior...
spinal column, stability assessment, immobilization, combat settings, radiographic criteria, CT scan

Cervical Spine Injury Management (1)

Extrication of a Patient with Suspected Cervical Spine Injury
Reference Source: Emergency War Surgery
Procedure for Extrication:

1. Do not hyperextend the neck at any point during extrication.
2. If an airway is needed:
- Attempt endotracheal intubation while maintaining inline neck stabilization.
- If intubation fails,...
extrication, cervical spine injury, neck stabilization, log roll, intubation, cricothyroidotomy

Neurogenic Shock Management (1)

Manage Neurogenic Shock Following Spinal Cord Injury
Reference Source: Emergency War Surgery
Definition: Neurogenic shock is a result of traumatic sympathectomy with spinal cord injury.

Symptoms: Bradycardia and hypotension.

Treatment Protocol:
1. Perform volume resuscitation to maintain systolic BP > 90 mm Hg.
2. Use...
neurogenic shock, spinal cord injury, volume resuscitation, phenylephrine, dopamine

Spinal Cord Injury Management (1)

Prevent and Manage Gastrointestinal Complications After Spinal Cord Injury
Standard Source: Emergency War Surgery
Complications: Ileus is common following spinal cord injury.

Management Steps:
1. Insert a nasogastric tube to manage ileus.
2. Use medical prophylaxis for stress ulcer prevention.
3. Initiate bowel training within one week of...
spinal cord injury, gastrointestinal complications, ileus management, stress ulcer prevention, bowel training

Pelvic Trauma Management (1)

External Fixator Placement in Pelvic Injuries
Standard Source: Emergency War Surgery
Procedure for External Fixator Placement in Pelvic Injuries:

External fixator placement in the iliac crests allows for the most direct control of the pelvis.
Angiography is a useful adjunct, but is not usually available in the...
external fixator, pelvic injury, iliac crest, war surgery, emergency trauma

Cast Application And Management (1)

Transportation Cast Preparation, Bivalving, and Application for Amputations
Reference Source: Emergency War Surgery
Preparation
• All casts must be bivalved prior to evacuation (hip spica is an exception).
• Use ½" dowel or similar material for crossbars in transportation casts.

Bivalving Technique
1. Remove the towel from the abdomen after...
transportation cast, bivalving, amputation, traction, evacuation, NATO litter, outrigger

Evacuation Care (1)

Evacuation Care for Patients with Skeletal Traction
Reference Source: Emergency War Surgery
Care during evacuation of patients with skeletal traction:

Patients do not improve in the evacuation system. Ensure this is understood by all involved personnel.

Preparation Steps:
1. Medications should be arranged prior to...
skeletal traction, evacuation care, pain control, cast management, neurovascular monitoring

Orthopedic Trauma (1)

Management of Complete Femoral Neck/Head Fractures
Standard Source: Emergency War Surgery
Management of Complete Femoral Neck/Head Fractures:

Resect complete fractures of the femoral neck/head, as they nearly uniformly lead to complications such as sepsis and avascular necrosis.
• Except in specific cases, **do not close the...
femoral neck fracture, femoral head fracture, resection, external fixator, hip spica cast, avascular necrosis, sepsis

Hand Procedures (1)

Perform Hand Fasciotomy with Specific Incisions
Reference Source: Emergency War Surgery
Procedure:

• A complete hand fasciotomy requires four incisions:
1. Radial side of the thumb metacarpal: Releases the thenar compartment.
2. Dorsal incision over the index finger metacarpal: Releases the 1st and 2nd dorsal...
hand fasciotomy, compartment syndrome, incisions, emergency surgery

Hand Injury Management (1)

Tissue Management in Hand Injuries
Reference Source: Emergency War Surgery
Procedure: Tissue Management in Hand Injuries

Bone: Leave fragments in place unless extruding or severely contaminated.
Tendon: Minimize excision; do not repair in the field.
Nerve: Do not excise nerve tissue; do not repair in...
tissue management, hand injuries, bone fragments, tendon repair, nerve excision, wound closure

Arterial Injury Evaluation (1)

Doppler Examination and ABI for Arterial Injury Evaluation
Reference Source: Emergency War Surgery
Procedure:

• Perform a doppler examination in patients with penetrating or blunt trauma who have:
- A normal distal pulse exam
- An ankle-brachial index (ABI) > 1.0
• In these cases, arteriography is not required.
• If the patient...
doppler examination, ABI, arterial injury, penetrating trauma, blunt trauma

Vascular Injury Diagnosis (1)

Use of Contrast Angiography for Vascular Injury Localization
Standard Source: Emergency War Surgery
Procedure: Use contrast angiography to precisely localize vascular injury in the following situations:

• Patients with multiple pellet wounds (e.g., shotgun blast)
• Patients with fractures or **penetrating injuries to the neck and...
contrast angiography, vascular injury, multiple pellet wounds, fractures, penetrating injuries, high-velocity wounds, soft signs of arterial injury, knee dislocations, popliteal artery thrombosis

Vascular Repair Procedures (1)

Order of Repair for Combined Arterial and Venous Injuries
Reference Source: Emergency War Surgery
Step-by-step procedure:

1. In injuries to both artery and vein, repair the artery first to minimize ischemic time.
2. Follow with venous repair after arterial restoration is complete.
3. This order reduces the risk of limb loss due to...
arterial injury, venous injury, repair order, ischemic time, limb loss prevention

Burn Care And Inhalation Injury Management (1)

Respiratory Care and Airway Management in Burn Patients with Inhalation Injury
Standard Source: Emergency War Surgery + NATO Emergency War Surgery
Procedure:

1. Administer inhaled heparin sodium at a dose of 10,000 units every 4 hours by nebulization to prevent the formation of obstructing bloody casts in patients with subglottic inhalation injury.
2. Respiratory care is essential...
burn patients, inhalation injury, respiratory care, airway management, heparin sodium, extubation, tracheostomy, bronchoscopy

Burn Wound Management (1)

Fascial Excision for Burn Wounds with Infection or Fat Involvement
Reference Source: Emergency War Surgery
Procedure for Fascial Excision of Burn Wounds with Infection or Fat Involvement:

1. Indication:
- This procedure is indicated when the burn extends into fat and/or demonstrates evidence of invasive burn wound infection.
2. **Excision...
fascial excision, burn wounds, infection, fat involvement, hemostasis, electrocautery

Skin Grafting Procedures (1)

Donor Site Preparation and Harvesting for Skin Grafts
Standard Source: Emergency War Surgery
Procedure for Donor Site Preparation and Harvesting for Skin Grafts:

1. Preparation of Donor Site:
- Clyse the subcutaneous space with a saline solution containing a 1:1,000,000 dilution of epinephrine to reduce bleeding.
- This is...
donor site harvesting, skin grafts, dermatome, epinephrine, hemostasis, emergency surgery

Thermal Emergencies (1)

Management of Hypothermia
Standard Source: Emergency War Surgery
Definition:
• Hypothermia is defined as whole-body cooling below 35 °C (95 °F).

Causative Factors and Prevention:
• Water immersion, rain, wind, and prolonged exposure to severe weather without adequate clothing.
• Wetness decreases the...
hypothermia, management, emergency medicine, thermal injury, core body temperature

Cpr Procedures (1)

CPR Guidelines for Hypothermic Patients
Reference Source: Emergency War Surgery
If the cardiac monitor shows any electrical complexes, check carefully for apical and carotid pulses before initiating CPR. If any pulse—however thready—is present, do NOT initiate CPR.
CPR, hypothermic patients, electrical complexes, apical pulse, carotid pulse

Hypothermia Management In Trauma Patients (1)

Aggressive Rewarming of Trauma Patients with Hypothermia
Reference Source: Emergency War Surgery
Trauma patients should be considered to have hypothermia more profound than the core temperature indicates and should be warmed more aggressively. This is due to the additional physiological stress from trauma, which can exacerbate...
hypothermia, trauma patients, aggressive rewarming, core temperature, physiological stress

Heat-Related Illnesses (1)

Complications and Management of Heatstroke Patients
Reference Source: Emergency War Surgery
Common complications include:
Rhabdomyolysis and secondary renal failure: Due to myoglobinuria, hyperuricemia, hyperkalemia, hypocalcemia, and compartment syndromes.
- Elevated creatine phosphokinase (CPK) in the thousands.
-...
heatstroke, rhabdomyolysis, renal failure, hyperkalemia, hypocalcemia, compartment syndrome, sodium bicarbonate, Kayexalate, coagulopathy

Thermal Injuries And Heat Illness (1)

Heat-Induced Syncope and Heat Tetany: Clinical Presentation and Management
Standard Source: Emergency War Surgery
Clinical presentation:
Heat-Induced Syncope: Due to reduced effective blood volume (thermal stress increases risk of classic neurally mediated syncope by aggravating peripheral pooling of blood in dilated cutaneous vessels). Symptoms range...
heat-induced syncope, heat tetany, thermal stress, respiratory alkalosis, carpopedal spasm, acclimatization

High Altitude Illness (1)

Management, Prevention, Recognition, and Treatment of High-Altitude Pulmonary Edema (HAPE)
Reference Source: USMC Winter Survival Course Handbook + FM 3 97 61 Military Mountaineering + Personal Wilderness Medical Kit + Emergency War Surgery + US Marine Corps Wilderness Medicine
High-altitude pulmonary edema (HAPE) is a life-threatening condition that occurs due to rapid ascent to high altitude. It involves the accumulation of fluid in the lungs and requires immediate action.

Recognition of HAPE:
• **Symptoms...
HAPE, high altitude pulmonary edema, oxygen therapy, descent, nifedipine, dexamethasone, acclimatization, prevention, symptoms, treatment

Radiological Injuries And Casualties (1)

Identify and Manage Radiological Injuries on the Battlefield
Reference Source: Emergency War Surgery
Radiological casualties may occur from:
Conventional nuclear weapons
Improvised or conventional nuclear devices
Radiological dispersal devices (RDDs), also known as “dirty bombs”.

### Factors Influencing Casualty Distribution...
radiological injuries, battlefield casualties, RDDs, dirty bombs, nuclear weapons, ionizing radiation

Biological Threats And Defense (1)

Detection and Categorization of Biological Warfare Agents
Reference Source: Emergency War Surgery + Medical NBC Battlebook
Indicators for detecting biological warfare (BW) agents include:

Compressed epidemiology: Record numbers of sick and dying in a short time.
High attack rates: 60%–90%.
Pulmonary involvement: Especially when the usual form of...
biological warfare agents, detection, categorization, epidemiology, weaponized agents, NBC battlebook

Biological Toxins (1)

Biological Toxins (Botulinum and Ricin) Management
Reference Source: Emergency War Surgery
Procedure:

Botulinum:
- Signs/Symptoms: Cranial nerve palsies, paralysis, respiratory failure.
- Medical Management: Antitoxin and supportive care.

Ricin:
- Signs/Symptoms: Fever, cough, shortness of breath...
Botulinum, Ricin, Toxins, Antitoxin, Supportive care, Biological warfare

Bacterial Agents (1)

Management of Bacterial Agents (Anthrax, Plague, Brucellosis, Cholera, Glanders, Tularemia, Q Fever)
Standard Source: Emergency War Surgery
Procedure:

Anthrax:
- Signs/Symptoms: Fever, malaise, cough, SOB, cyanosis.
- Medical Management: Ciprofloxacin.

Plague:
- Signs/Symptoms: High fever, chills, headache, cough, SOB, cyanosis.
- **Medical...
Anthrax, Plague, Brucellosis, Cholera, Glanders, Tularemia, Q Fever, Antibiotic treatment, BW threats

Viral Agents (1)

Management of Viral Agents (Smallpox, VHF, VEE)
Standard Source: Emergency War Surgery
Procedure:

VEE:
- Signs/Symptoms: Fever and encephalitis.
- Medical Management: Nonspecific or supportive care.

Smallpox:
- Signs/Symptoms: Malaise, fever, rigors, vomiting, headache followed by pustular...
Smallpox, VHF, VEE, viral hemorrhagic fever, medical management, biological warfare

Chemical Exposure Management (1)

Manage/Treat Exposure to Lung Damaging (Choking) Agents
Reference Source: Emergency War Surgery
Procedure:

1. Terminate exposure immediately:
- Remove the casualty from contaminated atmosphere.

2. Force rest and manage airway secretions:
- Ensure the casualty is at rest to prevent further respiratory distress.
- Provide...
lung damaging agents, choking agents, phosgene, chlorine, pulmonary edema, steroids, oxygen therapy, triage

Iv Fluid Administration (1)

Administer Maintenance IV Fluids to Children
Standard Source: Emergency War Surgery
For maintenance IV fluid replacement:

Children over 3 months: Use D5½NS + 20 mEq/dL KCl.
Children under 3 months: Use D10½NS + 20 mEq/dL KCl.

• This is the standard solution for maintaining hydration in children during...
maintenance IV fluids, children, D5½NS, D10½NS, KCl, hydration

Newborn Airway Management (1)

Avoid Nasal Airways in Newborns During Resuscitation and Emergencies
Reference Source: Emergency War Surgery
- Newborns are obligate nasal breathers, so nasal airways should be avoided if possible during resuscitation and emergencies.

Note: This is to prevent potential complications from improper airway management, including airway obstruction or...
newborns, nasal Airways, resuscitation, emergencies, airway management

Pediatric Cardiac Emergencies (1)

Recognize and Manage Bradycardia in Infants
Standard Source: Emergency War Surgery
- Cardiac stroke volume in children is relatively fixed, making bradycardia a significant concern.
Bradycardia or relative bradycardia can significantly decrease cardiac output, especially in infants.
• For over 90% of cases, **stimulation...
bradycardia, infants, oxygen therapy, stimulation, cardiac output

Burn Assessment (1)

Estimate Burn Area in Infants and Children Using Palm Method
High Priority Source: Emergency War Surgery
Procedure:

1. Assess the burn area:
- Use the palm of the child’s hand to estimate 1% of total body surface area (BSA) for burn calculations.
- This method is particularly useful in infants and children, as their head encompasses...
burn area estimation, palm method, infants, children, BSA calculation

Pediatric Medication Administration (1)

Administer Sedatives and Anticonvulsants for Pediatric Patients
Standard Source: Emergency War Surgery
Procedure:

1. Diazepam:
- Calculate the dose based on the patient's weight: 0.25 mg/kg IV.
- Administer intravenously (IV) as needed.
- Monitor for adverse effects such as respiratory depression, especially in neonates and...
Diazepam, Midazolam HCl, Phenytoin, Pediatric Patients, IV administration, Seizure control, Sedation

Surgical Procedures For Malnutrition (1)

Place Retention Sutures for Severe Malnutrition in Pediatric Patients
Standard Source: Emergency War Surgery
Procedure:

1. Use permanent sutures such as Prolene or nylon to place retention sutures in cases of severe malnutrition.
2. Pass the sutures through the rectus muscle and skin, ensuring full thickness penetration.
3. Take care to...
retention sutures, severe malnutrition, pediatric patients, Prolene, nylon, epigastric vessels, red rubber catheter

Medical Conditions In Internees (1)

Identify and Treat Common Medical Conditions in Internees
Standard Source: Emergency War Surgery
Objective: Recognize and manage the most common medical conditions observed in internees.

Procedure:
1. Assess for dental disease, which was the most common condition (24%) during Operation Desert Storm, including:
- Periodontal...
dental disease, internees, Operation Desert Storm, fever, kidney stones, peptic ulcer disease, malaria, wound care, malnutrition

Medical Screening And Medication Planning (1)

Medical Screening and Medication Planning for Enemy Forces
Standard Source: Emergency War Surgery
- Enemy forces may do little or no medical screening prior to conscription. Chronic medical problems will be more likely in these forces. Enemy forces may have preexisting diseases that are not present in the AO or US forces. Planning for...
enemy forces, medical screening, chronic conditions, medication planning, preexisting diseases

Combat Medical Recordkeeping (1)

Theater Joint Trauma Record Implementation Procedure
High Priority Source: Emergency War Surgery
Procedure:

1. Collect and record accurate data on casualties in combat situations to support optimal medical resource allocation.
2. Use the Theater Joint Trauma Record (TJTR) as a standardized form for documenting trauma cases, both...
theater joint trauma record, combat casualty, data collection, medical resource allocation

Orthopedic Surgery (1)

Surgical Treatment of Open-Joint Injuries
Critical Source: Emergency War Surgery
Objective: Remove foreign material and damaged tissue from the joint to preserve function and prevent infection.

### Action Steps:
1. Use standard arthrotomy incisions (see Fig. 24-2a,b,c for examples).
2. Ensure wound margins are...
arthrotomy incision, synovium closure, joint irrigation, internal fixation, K-wire, Steinmann pins

Amputation Casting (1)

Apply Transtibial Amputation Cast
High Priority Source: Emergency War Surgery
Indications: Transtibial amputations.

Technique:
1. Administer adequate anesthesia.
2. Evaluate the wound, excise nonviable tissue, and irrigate the wound.
3. Apply stockinette to the distal end of the residual limb with tincture of Benzoin...
transtibial amputation cast,application technique,plaster casting,stockinette,webril,cramer wire splint,benzoin

Diet Supplements (1)

Avoid Fad Diets and Herbal Supplements Without Medical Supervision
Standard Source: FM 4 25 11 First Aid
Procedure:

1. Do not start fad diets or take over-the-counter herbal supplements without medical supervision.
2. Medical records show that deaths and severe injuries have occurred in individuals using dietary/herbal supplements without...
fad diets,herbal supplements,medical supervision,supplement safety

Cold Related Conditions (1)

Identify Conditions Caused by Cold Exposure
High Priority Source: FM 4 25 11 First Aid
Procedure:

1. Recognize the various conditions caused by cold exposure:
- Chilblain: Caused by repeated prolonged exposure of bare skin at temperatures from 60° Fahrenheit (F) to 5-9.
- Immersion syndrome (immersion foot and...
chilblain, immersion syndrome, frostbite, snow blindness, hypothermia, cold conditions

Healthcare Capacity Planning (1)

Assess Surge Capacity of Medical and Emergency Response Systems
High Priority Source: HHSPandemicInfluenzaPlan
Procedure:

1. Evaluate the capacity of inpatient, outpatient, and long-term care facilities to handle increased patient loads during a pandemic.
2. Assess the surge capacity of federal medical assets (e.g., IHS, VA, DOD) to support healthcare...
surge capacity, medical facilities, emergency response systems

Influenza Symptoms Diagnosis (1)

Recognize and Differentiate Uncomplicated Seasonal Influenza Symptoms
Standard Source: HHSPandemicInfluenzaPlan
Procedure:

1. Identify the sudden onset of systemic symptoms, which are characteristic of uncomplicated seasonal influenza:
- Fever (typically 38–40°C, can be higher in children)
- Chills and myalgias
- **Anorexia, headache,...
seasonal influenza, uncomplicated illness, symptoms, diagnosis, fever, cough, myalgias, children, elderly, infants

Material Properties (1)

Description and Properties of PROLENE Polypropylene Mesh
Standard Source: Medical Survival Wound Closure Manual
Procedure:

1. Understand that PROLENE* polypropylene mesh is constructed of knitted filaments of extruded polypropylene, identical in composition to that used in PROLENE* Polypropylene Suture.
2. The mesh is approximately 0.020 inches thick and...
PROLENE mesh, material properties, surgical mesh

Surgical Complications (1)

Recognize and Manage Adverse Reactions to Sutures
Standard Source: Medical Survival Wound Closure Manual
Adverse reactions associated with suture use include:

Wound dehiscence: Separation of the wound edges.
Loss of tensile strength over time: Weakening of the suture material.
Calculi formation: Stone development in urinary or...
adverse reactions,wound dehiscence,suture complications,infection,needle stick injuries

Shock Treatment (1)

Prevent or Treat Shock
High Priority Source: Where There is no Doctor a Village Health Care Handbook
Steps to prevent or treat shock:

1. Loosen any belts or tight clothing the person may be wearing.
2. Have the person lie down with his feet a little higher than his head, unless he has a severe head injury, in which case put him in a...
shock treatment, first aid for shock, positioning for shock, managing shock, prevent shock

Trench Foot Prevention (1)

Prevent Trench Foot and Immersion Foot
Standard Source: Medical Emergencies
Procedure:

1. Keep your feet dry at all times to prevent trench foot or immersion foot.
2. Carry extra socks in a waterproof packet for emergencies.
3. If your socks become wet, dry them against your torso (back or chest).
4. Wash...
trench foot prevention,wet feet,trench foot symptoms

Sunburn Prevention (1)

Prevent and Treat Sunburn in Cold Weather
Standard Source: Medical Emergencies
Procedure:

1. Apply sunburn cream or lip salve to your face when exposed to the sun.
2. Be aware that sunburn can occur even below freezing temperatures, especially on lips, nostrils, and eyelids.
3. The sun's rays reflect off...
cold weather sunburn,sun protection,lip salve

Medical Intelligence (1)

Contact AFMIC for Medical Intelligence Products
Standard Source: Medical NBC Battlebook
Procedure:

1. For medical intelligence products and services, contact the Armed Forces Medical Intelligence Center (AFMIC) at:
- Phone: DSN 343-7574 or Commercial (301) 619-7574
- Fax: Unclassified FAX 301-619-2409 or DSN...
AFMIC, medical intelligence, RFI submission, contact information

Chemical Exposure Decontamination (1)

Use the MES Chemical Agent Patient Decontamination Kit
Critical Source: Medical NBC Battlebook
The MES Chemical Agent Patient Decontamination contains supplies and equipment required to decontaminate sixty contaminated casualties with nerve, blood, and/or blister agents. The basis of issue is one per battalion aid station/treatment squad,...
MES, decontamination kit, calcium hypochlorite, apron tap

Cold Injuries Diagnosis (1)

Recognize and Differentiate Between Trench Foot and Immersion Foot
Standard Source: NATO Emergency War Surgery
Procedure:

1. **Understand the definitions:
- *Trench foot:* A non-freezing cold injury typically caused by prolonged exposure to cold, wet conditions (e.g., standing in water or mud). It usually occurs at temperatures above freezing.
-...
trench,foot,immersion,foot,cold,injury,differentiation,symptoms,exposure

Overdose Management (1)

Administer Naloxone for Excess Narcotic Overdose
Critical Source: survival personal wilderness medical kit
Procedure:

1. Identify the signs of an opioid overdose, such as unresponsiveness, slow or stopped breathing, and pinpoint pupils.
2. Check the expiration date of the naloxone ampul (1 mg/mL, 1 mL) to ensure it is still valid.
3....
naloxone,opioid overdose,IV administration,IM administration,dose

Allergies And Anaphylaxis (1)

Administer Injectable Epinephrine for Anaphylaxis
Critical Source: survival personal wilderness medical kit
Procedure for Administering Injectable Epinephrine (Epi-Pen®) for Anaphylaxis

Steps:
1. Recognize anaphylaxis symptoms: Look for signs such as hives, swelling of the face/lips/tongue, difficulty breathing, and loss of consciousness.
2....
epi-pen,epinephrine injection,anaphylaxis treatment,severe allergy reaction

Tourniquet Application (1)

Apply Combat Application Tourniquet (CAT) During Care Under Fire Phase
Critical Source: TCCC 17 13 Army Tactical Combat Casualty Care
Step 1. Place the tourniquet as high on the extremity as possible and over the uniform. This is a hasty tourniquet.

Step 2. Route the self-adhering band through the friction adapter buckle. Pull the band tight, removing all...
tourniquet,application,CAT,combat,application,tactical,extremity,bleeding,emergency

Eye Injuries Fractures (1)

Manage Penetrating Eye Injury and Splint Fractures
High Priority Source: TCCC 17 13 Tactical Combat Casualty Care
Procedure for Managing a Penetrating Eye Injury and Splinting Fractures:

1. If a penetrating eye injury is noted or suspected, conduct the following:
- Cover the eye with a rigid eye shield and not a pressure patch.
- Administer...
penetrating eye injury,rigid eye shield,moxifloxacin,CWPP,splinting fractures

Chest Injury Management (1)

Management of Open or Sucking Chest Wounds
Critical Source: TCCC 17 13 Army Tactical Combat Casualty Care
Objective: Treat open and/or sucking chest wounds in a casualty.

Steps:
1. Immediately apply a vented chest seal to cover the defect.
2. If a vented chest seal is not available, use a non-vented chest seal.
3. If...
sucking chest wound,vented chest seal,non-vented chest seal,respiratory distress,needle decompression

Antidotes (1)

Administer Flumazenil for Benzodiazepine Reversal
High Priority Source: TCCC 17 13 Tactical Combat Casualty Care
Indications: As reversal agent for benzodiazepines (Diazepam [Valium]).

Dosage: 0.4 mg injection every 15 minutes.

Availability: Available in the Tactical Combat Medical Care MES.

Instructions: Administer via IV or IM. Monitor the...
flumazenil,Romazicon,benzodiazepine reversal,antidote

Hospitalization (1)

Provide Hospitalization at Level III and IV Care Facilities
High Priority Source: TCCC 17 13 Army Tactical Combat Casualty Care
Objective: Provide hospitalization for casualties requiring advanced medical treatment.

Procedure:
1. Level III and IV Care: Ensure that military treatment facilities (MTFs) staffed with combat support hospitals provide care for all...
Level III care,Level IV care,hospitalization,MTF coordination

Logistics (1)

Manage Medical Logistics for Class VIII Supplies and Equipment
Standard Source: TCCC 17 13 Army Tactical Combat Casualty Care
Objective: Ensure the availability of medical supplies, equipment, maintenance, and support services.

Procedure:
1. Class VIII Medical Supplies: Maintain a stockpile of Class VIII medical supplies including medications, surgical kits,...
Class VIII supplies,MEDLOG system,medical logistics,equipment maintenance,blood management

Hiv Aids Education (1)

Understanding HIV and AIDS Transmission
High Priority Source: Where There is no Doctor a Village Health Care Handbook
Overview: This procedure explains how HIV is transmitted and clarifies common misconceptions about its spread.

How HIV Spreads:
• Through unprotected sex between someone with HIV and someone without HIV.
• During **pregnancy, birth, or...
HIV transmission, AIDS, prevention, safe sex, blood transfusion, breastfeeding, HIV test

Hypertension (1)

Recognize Signs of Dangerously High Blood Pressure
High Priority Source: Where There is no Doctor a Village Health Care Handbook
Signs of dangerously high blood pressure:

Frequent headaches
Pounding of the heart and shortness of breath with mild exercise
Weakness and dizziness
Occasional pain in the left shoulder and chest

All these problems may...
high blood pressure, hypertension, symptoms, signs, medical emergency

Endocrine Disorders (1)

Prevent and Treat Goiter with Iodized Salt
Standard Source: Where There is no Doctor a Village Health Care Handbook
Overview:
A goiter is a swelling or lump on the throat caused by abnormal growth of the thyroid gland. Most are due to iodine deficiency in the diet.

Steps to Prevent and Treat Goiter:
1. Use iodized salt. Everyone living in areas where...
goiter, iodized salt, iodine deficiency, cretinism, cassava, seaweed, iodine oil

Seizure Treatment (1)

Administer Anticonvulsant Medications for Seizures (Epilepsy and Eclampsia)
Critical Source: Where There is no Doctor a Village Health Care Handbook
Indication: Use to prevent or stop seizures in epilepsy or eclampsia.

Procedure:
1. Phenobarbital and Phenytoin: These are common medicines used to prevent seizures of epilepsy. They should be taken at bedtime due to their sedative...
anticonvulsants, epilepsy treatment, eclampsia management, seizure prevention

Tetanus Prevention Newborns (1)

Prevent Tetanus in Newborns by Proper Cord Care
Critical Source: Where There is no Doctor a Village Health Care Handbook
Purpose: Prevent tetanus in newborn children by ensuring proper umbilical cord care.

Procedure:
1. Cut the umbilical cord close to the body to reduce the risk of infection.
2. **Ensure the cutting instrument is boiled and kept...
tetanus prevention, newborn care, umbilical cord, infection control

Newborn Health (1)

Recognize and Treat Neonatal Conjunctivitis (Infected Eyes in Newborns)
Critical Source: Where There is no Doctor a Village Health Care Handbook
Signs of neonatal conjunctivitis include:

• Red, swollen eyes with a lot of pus within the first month after birth.
• This may be caused by chlamydia or gonorrhea passed from an infected mother during childbirth.
• Immediate treatment is...
neonatal conjunctivitis, newborn eye infection, chlamydia, gonorrhea

Cancer And Tumors (1)

Recognize and Respond to Breast Cancer Signs
Critical Source: Where There is no Doctor a Village Health Care Handbook
Purpose: To recognize signs of breast cancer and encourage early medical intervention.

Signs of Breast Cancer:
• A persistent, non-tender lump in the breast that does not go away over time.
• Changes in size or shape of a breast lump during...
breast cancer, lump, tumor, early detection, surgery

Rheumatic Fever (1)

Recognizing and Managing Rheumatic Fever
Critical Source: Where There is no Doctor a Village Health Care Handbook
Overview:

Rheumatic fever is a serious complication that can occur 1 to 3 weeks after strep throat. It primarily affects children and young adults.

Signs of rheumatic fever (some may be present):
Fever
Joint pain,...
rheumatic fever, heart damage, penicillin, aspirin, joint pain, fever

First Aid Survival (1)

Emergency Medical Procedures for Survival Situations
Critical Source: FM 21 76 1 Survival Evasion and Recovery Multiservice Procedures
WARNING: These emergency medical procedures are for survival situations only and should not be considered a substitute for professional medical care. Seek professional medical treatment as soon as possible.

Procedure:

• Apply basic...
emergency medical procedures, survival first aid, professional care, vital signs monitoring

Documentation Procedures (1)

Document IV Procedures on Field Medical Card (FMC)
Reference Source: STP 21 1 Army Warrior Skills Level 1 Soldiers Manual of Common Tasks
Procedure to Document IV Procedures

1. Document the initiation of IV fluids in block 8 of the FMC.
2. If you must leave the casualty or the casualty is being evacuated, **tear the original from the FMC pad and attach the card to the...
IV documentation, field medical card, FMC procedures

Field Medical Support (1)

Determine Medical Support Requirements
High Priority Source: STP 21 24 Army Warrior Leader Skills Level 2 3 and 4
To determine medical support:

• Ensure that an assistant convoy commander is available to coordinate medical needs.
• Confirm that serial/march unit commanders are prepared for medical emergencies.
• Assign a pacesetter and trail officer to assist...
medical support,assistant commander,first aid,emergency care

First Aid Kit (1)

Assemble a Basic Medical Kit
Standard Source: Survival and Austere Medicine
Objective: Create a basic medical kit for survival scenarios.

### Bandages and Dressings:
• Include Combat dressings, Large gauze dressings, Small gauze squares, Roller Bandages (elastic + cotton in 2in/4in/6in sizes),...
basic medical kit,bandages,dressings,antiseptics,medications,instruments

Pulse Assessment (1)

Assessing Pulse Rate and Quality for Health Indicators
High Priority Source: Survival and Austere Medicine
Purpose:
Use pulse rate and quality to assess general health status and detect conditions like shock or pain.

Procedure:
1. Record Baseline Pulse:
- Document the patient's normal resting pulse rate, rhythm (regular or irregular), and...
pulse rate monitoring, shock detection, pain assessment, baseline pulse

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Disclaimer: This information is for educational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Content has been compiled by AI from open-source and public domain references including military field manuals, government health guidelines, and community preparedness resources. Always verify critical information independently. In an emergency, call 911.