!!!USA+SURVIVAL((2)-part1)

The Ultimate Guide to

U.S. Army
Survival
Skills, Tactics, and Techniques

Edited by
Jay McCullough



Skyhorse Publishing


Copyright © 2007 by Skyhorse Publishing

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Library of Congress Cataloging-in-Publication Data

The ultimate guide to U.S. Army survival skills, tactics, and techniques / edited by Jay
McCullough.

p. cm.
ISBN-13: 978-1-60239-050-8 (alk. paper)
ISBN-10: 1-60239-050-9 (alk. paper)
1. Unified operations (Military science) 2. Operational art (Military science) I. McCullough, Jay.
U260.U48 2007
355.5’4—dc22

2007016415

Printed in China


The Ultimate Guide to

U.S. Army
Survival
Skills, Tactics, and Techniques

Edited by
Jay McCullough



© 2007 by Skyhorse Publishing

This 2009 edition published by Fall River Press,
by arrangement with Skyhorse Publishing.

All rights reserved. No part of this publication may be reproduced,
stored in a retrieval system, or transmitted, in any form or by any means,
electronic, mechanical, photocopying, recording, or otherwise,
without prior written permission from the publisher.

Fall River Press
122 Fifth Avenue
New York, NY 10011

ISBN: 978-1-4351-1402-9

Printed and bound in China

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CONTENTS


Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . v

Part I
GENERAL SURVIVAL SKILLS


Chapter 1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
Chapter 2 Psychology of Survival. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
Chapter 3 Survival Planning and Survival Kits............................. 13

Part II
SURVIVAL MEDICINE


Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21
Chapter 1 Fundamental Criteria for First Aid .............................. 41
Chapter 2 Basic Measures for First Aid . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49
Chapter 3 First Aid for Special Wounds ................................. 75
Chapter 4 First Aid for Fractures ..................................... 103
Chapter 5 First Aid for Climatic Injuries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 121
Chapter 6 First Aid for Bites and Stings. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 135
Chapter 7 First Aid in Toxic Environments. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 147
Appendix A First Aid Case and Kits, Dressings, and Bandages . . . . . . . . . . . . . . . . . . . . . 165
Appendix B Rescue and Transportation Procedures. . . . . . . . . . . . . . . . . . . . . . . . . . . . 169
Appendix CCommon Problems/Conditions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 197
Appendix DDigital Pressure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 203
Appendix E Decontamination Procedures ................................. 205

Part III
SHELTERS


Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 213
Chapter 1 Planning Positions ....................................... 227
Chapter 2 Designing Positions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 257
Chapter 3 Special Operations and Situations. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 267
Chapter 4 Position Design Details. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 283

Part IV
WATER, FOOD, PLANTS, HERBAL REMEDIES, AND DANGEROUS PLANTS AND ANIMALS


Chapter 1 Water Procurement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 345
Chapter 2 Food Procurement. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 355
Chapter 3 Dangerous Insects and Arachnids. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 379
Chapter 4 Poisonous Snakes and Lizards. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 385
Chapter 5 Dangerous Fish, Mollusks, and Freshwater Animals . . . . . . . . . . . . . . . . . . . . 417
Chapter 6 Survival Use of Plants ..................................... 427
Chapter 7 Poisonous Plants ........................................ 497


Part V
FIRECRAFT, TOOLS, CAMOUFLAGE, TRACKING, MOVEMENT, AND COMBAT SKILLS


Chapter 1 Firecraft. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 511
Chapter 2 Field-Expedient Weapons, Tools, and Equipment. . . . . . . . . . . . . . . . . . . . . . 519
Chapter 3 Hand-to-Hand Combat. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 529
Chapter 4 Medium-Range Combatives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 555
Chapter 5 Long-Range Combatives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 579
Chapter 6 Sentry Removal . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 647
Chapter 7 Cover, Concealment, and Camouflage . . . . . . . . . . . . . . . . . . . . . . . . . . . . 657
Chapter 8 Tracking ............................................. 667
Chapter 9 Movement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 677
Chapter 10 Field-Expedient Direction Finding .............................. 693

Part VI
ENVIRONMENT-SPECIFIC SURVIVAL


Chapter 1 Tropical Survival ........................................ 701
Chapter 2 Desert Survival......................................... 731
Chapter 3 Cold Weather Survival . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 755
Chapter 4 Survival in Mountain Terrain ................................. 769
Chapter 5 Sea Survival . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 911
Chapter 6 Water Crossings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 935
Chapter 7 Survival in Nuclear, Biological, and Chemical Environments . . . . . . . . . . . . . . . 943


INTRODUCTION


The U.S. has the best-equipped and well-trained Army in the world. Barring unforeseen political considerations
or a catastrophic act of nature, it can deploy nearly anywhere and accomplish almost any reasonable
mission. This is due in large part to the Army’s experience as an institution in a variety of wartime
environments. Its hard-earned wisdom about how to cope with almost every imaginable scenario, on a
soldier-by-soldier basis, distinguishes it as a service of excellence whose individuals are highly adaptable.
They are well prepared, they accomplish the mission, and when the circumstances are truly unfavorable
to life itself, they are survivors.

The keys to this preparation are contained in the Army’s many sensible, well-written, voluminous, and
scattered publications. They address nearly every aspect of running, provisioning, or being in the Army,
but they are especially useful for their tips on how to stay alive under any circumstances. The task of culling
every bit of useful information about survival from every U.S. Army publication would take months
however, so I’ve done it here for you in The Ultimate Guide to U.S. Army Survival Skills, Tactics, and
Techniques.

Where subjects are duplicated throughout the literature, I’ve created a single clearinghouse for that information.
For instance, almost every Army manual remotely connected to survival seems to include the
same basic instructions about how to make a poncho lean-to, so you’ll find a single discussion about that,
and related information, in the Shelters section.

In other instances, a subject may be discussed in-depth in a more generalized or comprehensive manner,
say for example venomous snakes as a subcategory of dangerous animals. But the subject of snakes also
merits inclusion in other categories, especially within the contexts of those categories; jungle, desert, and
medical manuals add valuable information not otherwise contained in a herpetologist’s catalog of snake
habitats, habits, and geographical ranges.

I’ve tried to make the selections useful to a general reader who may find him- or herself in a survival
situation, whether they are alone or in a small group, probably unarmed. Some sections are invaluable;
nearly every aspect of first aid will be useful to someone at some time. When in doubt about whether particular
passages provide pertinent information, I’ve included them in the hope that they may serve as a
useful reference, comfort the afflicted, or perhaps even save a life. As an example, you will find a caution
in the first aid section that warns you not to apply a tourniquet to someone’s neck.

Will you ever dig a defensive position with a sloping floor and a grenade trench? Probably not. But
everyone who has done so probably never thought about it until they were up to their shoulders in dirt,
wondering how much further they had to dig. I should hope that you never find yourself in that circumstance,
or one like it. If you do, the best advice is contained in the first three chapters, particularly in regard
to your state of mind. Whatever your condition, keep a positive outlook, keep your sense of humor, keep
your humanity and sense of decency. Realize the conditions for what they are, be flexible, adapt, and never
say die.

Jay McCulloughJanuary 2007New Haven, Connecticut


PART I


General Survival Skills



CHAPTER 1


Psychology of Survival


INTRODUCTION

This manual is based entirely on the keyword SURVIVAL. The letters in this word can help guide
you in your actions in any survival situation. Whenever faced with a survival situation, remember
the word SURVIVAL.

SURVIVAL ACTIONS

The following paragraphs expand on the meaning of each letter of the word survival. Study and remember
what each letter signifies because you may some day have to make it work for you.

S - Size Up the Situation. If you are in a combat situation, find a place where you can conceal yourself
from the enemy. Remember, security takes priority. Use your senses of hearing, smell, and sight to get a
feel for the battlefield. What is the enemy doing? Advancing? Holding in place? Retreating? You will have
to consider what is developing on the battlefield when you make your survival plan.

Size Up Your Surroundings. Determine the pattern of the area. Get a feel for what is going on around you.
Every environment, whether forest, jungle, or desert, has a rhythm or pattern. This rhythm or pattern
includes animal and bird noises and movements and insect sounds. It may also include enemy traffic and
civilian movements.

Size Up Your Physical Condition. The pressure of the battle you were in or the trauma of being in a
survival situation may have caused you to overlook wounds you received. Check your wounds and give
yourself first aid. Take care to prevent further bodily harm. For instance, in any climate, drink plenty of
water to prevent dehydration. If you are in a cold or wet climate, put on additional clothing to prevent
hypothermia.

Size Up Your Equipment. Perhaps in the heat of battle, you lost or damaged some of your equipment.
Check to see what equipment you have and what condition it is in.

Now that you have sized up your situation, surroundings, physical condition, and equipment, you are
ready to make your survival plan. In doing so, keep in mind your basic physical needs—water, food, and
shelter.

U - Use All Your Senses, Undue Haste Makes Waste. You may make a wrong move when you react
quickly without thinking or planning. That move may result in your capture or death. Don’t move just for
the sake of taking action. Consider all aspects of your situation (size up your situation) before you make
a decision and a move. If you act in haste, you may forget or lose some of your equipment. In your haste
you may also become disoriented so that you don’t know which way to go. Plan your moves. Be ready to
move out quickly without endangering yourself if the enemy is near you. Use all your senses to evaluate
the situation. Note sounds and smells. Be sensitive to temperature changes. Be observant.

R - Remember Where You Are. Spot your location on your map and relate it to the surrounding terrain.
This is a basic principle that you must always follow. If there are other persons with you, make sure they
also know their location. Always know who in your group, vehicle, or aircraft has a map and compass. If
that person is killed, you will have to get the map and compass from him. Pay close attention to where you

3


The Ultimate Guide to U.S. Army Survival Skills, Tactics, and Techniques

are and to where you are going. Do not rely on others in the group to keep track of the route. Constantly
orient yourself. Always try to determine, as a minimum, how your location relates to—

The location of enemy units and controlled areas.
The location of friendly units and controlled areas.
The location of local water sources (especially important in the desert).
Areas that will provide good cover and concealment.


This information will allow you to make intelligent decisions when you are in a survival and evasion
situation.

V - Vanquish Fear and Panic. The greatest enemies in a combat survival and evasion situation are fear and
panic. If uncontrolled, they can destroy your ability to make an intelligent decision. They may cause you
to react to your feelings and imagination rather than to your situation. They can drain your energy and
thereby cause other negative emotions. Previous survival and evasion training and self-confidence will
enable you to vanquish fear and panic.

I - Improvise. In the United States, we have items available for all our needs. Many of these items are cheap
to replace when damaged. Our easy come, easy go, easy-to-replace culture makes it unnecessary for us to
improvise. This inexperience in improvisation can be an enemy in a survival situation. Learn to improvise.
Take a tool designed for a specific purpose and see how many other uses you can make of it.

Learn to use natural objects around you for different needs. An example is using a rock for a hammer.
No matter how complete a survival kit you have with you, it will run out or wear out after a while. Your
imagination must take over when your kit wears out.

V - Value Living. All of us were born kicking and fighting to live, but we have become used to the soft life.
We have become creatures of comfort. We dislike inconveniences and discomforts. What happens when
we are faced with a survival situation with its stresses, inconveniences, and discomforts? This is when
the will to live—placing a high value on living—is vital. The experience and knowledge you have gained
through life and your Army training will have a bearing on your will to live. Stubbornness, a refusal to give
in to problems and obstacles that face you, will give you the mental and physical strength to endure.

A - Act Like the Natives. The natives and animals of a region have adapted to their environment. To get
a feel of the area, watch how the people go about their daily routine. When and what do they eat? When,
where, and how do they get their food? When and where do they go for water? What time do they usually
go to bed and get up? These actions are important to you when you are trying to avoid capture.

Animal life in the area can also give you clues on how to survive. Animals also require food, water, and
shelter. By watching them, you can find sources of water and food.


WARNING
Animals cannot serve as an absolute guide to what you can eat and drink. Many
animals eat plants that are toxic to humans.

Keep in mind that the reaction of animals can reveal your presence to the enemy.

If in a friendly area, one way you can gain rapport with the natives is to show interest in their tools and
how they get food and water. By studying the people, you learn to respect them, you often make valuable
friends, and, most important, you learn how to adapt to their environment and increase your chances of
survival.

L - Live by Your Wits, But for Now, Learn Basic Skills. Without training in basic skills for surviving and
evading on the battlefield, your chances of living through a combat survival and evasion situation are
slight.


Psychology of Survival


Learn these basic skills now—not when you are headed for or are in the battle. How you decide to
equip yourself before deployment will impact on whether or not you survive. You need to know about the
environment to which you are going, and you must practice basic skills geared to that environment. For
instance, if you are going to a desert, you need to know how to get water in the desert.

Practice basic survival skills during all training programs and exercises. Survival training reduces fear
of the unknown and gives you self-confidence. It teaches you to live by your wits.

PATTERN FOR SURVIVAL

Develop a survival pattern that lets you beat the enemies of survival. This survival pattern must include
food, water, shelter, fire, first aid, and signals placed in order of importance. For example, in a cold environment,
you would need a fire to get warm; a shelter to protect you from the cold, wind, and rain or snow;
traps or snares to get food; a means to signal friendly aircraft; and first aid to maintain health. If injured,
first aid has top priority no matter what climate you are in.

Change your survival pattern to meet your immediate physical needs as the environment changes.

As you read the rest of this manual, keep in mind the keyword SURVIVAL and the need for a survival
pattern.


CHAPTER 2


Psychology of Survival


It takes much more than the knowledge and skills to build shelters, get food, make fires, and travel
without the aid of standard navigational devices to live successfully through a survival situation. Some
people with little or no survival training have managed to survive life-threatening circumstances.
Some people with survival training have not used their skills and died. A key ingredient in any
survival situation is the mental attitude of the individual(s) involved. Having survival skills is
important; having the will to survive is essential. Without a desire to survive, acquired skills serve
little purpose and invaluable knowledge goes to waste.

There is a psychology to survival. The soldier in a survival environment faces many stresses that
ultimately impact on his mind. These stresses can produce thoughts and emotions that, if poorly
understood, can transform a confident, well-trained soldier into an indecisive, ineffective individual
with questionable ability to survive. Thus, every soldier must be aware of and be able to recognize
those stresses commonly associated with survival. Additionally, it is imperative that soldiers be aware
of their reactions to the wide variety of stresses associated with survival. This chapter will identify
and explain the nature of stress, the stresses of survival, and those internal reactions soldiers will
naturally experience when faced with the stresses of a real-world survival situation. The knowledge
you, the soldier, gain from this chapter and other chapters in this manual, will prepare you to come
through the toughest times alive.

A LOOK AT STRESS

Before we can understand our psychological reactions in a survival setting, it is helpful to first know a little
bit about stress.

Stress is not a disease that you cure and eliminate. Instead, it is a condition we all experience. Stress can
be described as our reaction to pressure. It is the name given to the experience we have as we physically,
mentally, emotionally, and spiritually respond to life’s tensions.

Need for Stress. We need stress because it has many positive benefits. Stress provides us with challenges;
it gives us chances to learn about our values and strengths. Stress can show our ability to handle pressure
without breaking; it tests our adaptability and flexibility; it can stimulate us to do our best. Because we
usually do not consider unimportant events stressful, stress can also be an excellent indicator of the significance
we attach to an event—in other words, it highlights what is important to us.

We need to have some stress in our lives, but too much of anything can be bad. The goal is to have stress,
but not an excess of it. Too much stress can take its toll on people and organizations. Too much stress leads
to distress. Distress causes an uncomfortable tension that we try to escape and, preferably, avoid. Listed
below are a few of the common signs of distress you may find in your fellow soldiers or yourself when
faced with too much stress:

Difficulty making decisions
Angry outbursts
Forgetfulness
Low energy level
Constant worrying
Propensity for mistakes


7


The Ultimate Guide to U.S. Army Survival Skills, Tactics, and Techniques

Thoughts about death or suicide
Trouble getting along with others
Withdrawing from others
Hiding from responsibilities
Carelessness


As you can see, stress can be constructive or destructive. It can encourage or discourage, move us along or
stop us dead in our tracks, and make life meaningful or seemingly meaningless. Stress can inspire you to
operate successfully and perform at your maximum efficiency in a survival situation. It can also cause you
to panic and forget all your training. Key to your survival is your ability to manage the inevitable stresses
you will encounter. The survivor is the soldier who works with his stresses instead of letting his stresses
work on him.

Survival Stressors. Any event can lead to stress and, as everyone has experienced, events don’t always
come one at a time. Often, stressful events occur simultaneously. These events are not stress, but they
produce it and are called “stressors.” Stressors are the obvious cause while stress is the response. Once the
body recognizes the presence of a stressor, it then begins to act to protect itself.

In response to a stressor, the body prepares either to “fight or flee.” This preparation involves an internal
SOS sent throughout the body. As the body responds to this SOS, several actions take place. The body
releases stored fuels (sugar and fats) to provide quick energy; breathing rate increases to supply more oxygen
to the blood; muscle tension increases to prepare for action; blood clotting mechanisms are activated to
reduce bleeding from cuts; senses become more acute (hearing becomes more sensitive, eyes become big,
smell becomes sharper) so that you are more aware of your surrounding and heart rate and blood pressure
rise to provide more blood to the muscles. This protective posture lets a person cope with potential
dangers; however, a person cannot maintain such a level of alertness indefinitely.

Stressors are not courteous; one stressor does not leave because another one arrives. Stressors add up.
The cumulative effect of minor stressors can be a major distress if they all happen too close together. As the
body’s resistance to stress wears down and the sources of stress continue (or increase), eventually a state
of exhaustion arrives. At this point, the ability to resist stress or use it in a positive way gives out and signs
of distress appear. Anticipating stressors and developing strategies to cope with them are two ingredients
in the effective management of stress. It is therefore essential that the soldier in a survival setting be aware
of the types of stressors he will encounter. Let’s take a look at a few of these.

Injury, Illness, or Death. Injury, illness, and death are real possibilities a survivor has to face. Perhaps nothing
is more stressful than being alone in an unfamiliar environment where you could die from hostile action,
an accident, or from eating something lethal. Illness and injury can also add to stress by limiting your ability
to maneuver, get food and drink, find shelter, and defend yourself. Even if illness and injury don’t lead to
death, they add to stress through the pain and discomfort they generate. It is only by controlling the stress
associated with the vulnerability to injury, illness, and death that a soldier can have the courage to take the
risks associated with survival tasks.

Uncertainty and Lack of Control. Some people have trouble operating in settings where everything is
not clear-cut. The only guarantee in a survival situation is that nothing is guaranteed. It can be extremely
stressful operating on limited information in a setting where you have limited control of your surroundings.
This uncertainty and lack of control also add to the stress of being ill, injured, or killed.

Environment. Even under the most ideal circumstances, nature is quite formidable. In survival, a soldier
will have to contend with the stressors of weather, terrain, and the variety of creatures inhabiting an area.
Heat, cold, rain, winds, mountains, swamps, deserts, insects, dangerous reptiles, and other animals are just
a few of the challenges awaiting the soldier working to survive. Depending on how a soldier handles the
stress of his environment, his surroundings can be either a source of food and protection or can be a cause
of extreme discomfort leading to injury, illness, or death.


Psychology of Survival

Hunger and Thirst. Without food and water a person will weaken and eventually die. Thus, getting and preserving
food and water takes on increasing importance as the length of time in a survival setting increases.
For a soldier used to having his provisions issued, foraging can be a big source of stress.

Fatigue. Forcing yourself to continue surviving is not easy as you grow more tired. It is possible to become
so fatigued that the act of just staying awake is stressful in itself.

Isolation. There are some advantages to facing adversity with others. As soldiers we learn individual skills,
but we train to function as part of a team. Although we, as soldiers, complain about higher headquarters,
we become used to the information and guidance it provides, especially during times of confusion. Being
in contact with others also provides a greater sense of security and a feeling someone is available to help if
problems occur. A significant stressor in survival situations is that often a person or team has to rely solely
on its own resources.

The survival stressors mentioned in this section are by no means the only ones you may face. Remember,
what is stressful to one person may not be stressful to another. Your experiences, training, personal outlook
on life, physical and mental conditioning, and level of self-confidence contribute to what you will find
stressful in a survival environment. The object is not to avoid stress, but rather to manage the stressors of
survival and make them work for you.

We now have a general knowledge of stress and the stressors common to survival; the next step is to
examine our reactions to the stressors we may face.

NATURAL REACTIONS

Man has been able to survive many shifts in his environment throughout the centuries. His ability to adapt physically
and mentally to a changing world kept him alive while other species around him gradually died off. The
same survival mechanisms that kept our forefathers alive can help keep us alive as well! However, these survival
mechanisms that can help us can also work against us if we don’t understand and anticipate their presence.

It is not surprising that the average person will have some psychological reactions in a survival situation.
We will now examine some of the major internal reactions you and anyone with you might experience
with the survival stressors addressed in the earlier paragraphs. Let’s begin.

Fear. Fear is our emotional response to dangerous circumstances that we believe have the potential to cause
death, injury, or illness. This harm is not just limited to physical damage; the threat to one’s emotional and
mental well-being can generate fear as well. For the soldier trying to survive, fear can have a positive function
if it encourages him to be cautious in situations where recklessness could result in injury. Unfortunately, fear
can also immobilize a person. It can cause him to become so frightened that he fails to perform activities essential
for survival. Most soldiers will have some degree of fear when placed in unfamiliar surroundings under
adverse conditions. There is no shame in this! Each soldier must train himself not to be overcome by his
fears. Ideally, through realistic training, we can acquire the knowledge and skills needed to increase our
confidence and thereby manage our fears.

Anxiety. Associated with fear is anxiety. Because it is natural for us to be afraid, it is also natural for us
to experience anxiety. Anxiety can be an uneasy, apprehensive feeling we get when faced with dangerous
situations (physical, mental, and emotional). When used in a healthy way, anxiety urges us to act to
end, or at least master, the dangers that threaten our existence. If we were never anxious, there would
be little motivation to make changes in our lives. The soldier in a survival setting reduces his anxiety by
performing those tasks that will ensure his coming through the ordeal alive. As he reduces his anxiety, the
soldier is also bringing under control the source of that anxiety—his fears. In this form, anxiety is good;
however, anxiety can also have a devastating impact. Anxiety can overwhelm a soldier to the point where
he becomes easily confused and has difficulty thinking. Once this happens, it becomes more and more difficult
for him to make good judgments and sound decisions. To survive, the soldier must learn techniques
to calm his anxieties and keep them in the range where they help, not hurt.


10 The Ultimate Guide to U.S. Army Survival Skills, Tactics, and Techniques

Anger and Frustration. Frustration arises when a person is continually thwarted in his attempts to reach
a goal. The goal of survival is to stay alive until you can reach help or until help can reach you. To achieve
this goal, the soldier must complete some tasks with minimal resources. It is inevitable, in trying to do
these tasks, that something will go wrong; that something will happen beyond the soldier’s control; and
that with one’s life at stake, every mistake is magnified in terms of its importance. Thus, sooner or later,
soldiers will have to cope with frustration when a few of their plans run into trouble. One outgrowth of this
frustration is anger. There are many events in a survival situation that can frustrate or anger a soldier. Getting
lost, damaged or forgotten equipment, the weather, inhospitable terrain, enemy patrols, and physical
limitations are just a few sources of frustration and anger. Frustration and anger encourage impulsive
reactions, irrational behavior, poorly thought-out decisions, and, in some instances, an “I quit” attitude
(people sometimes avoid doing something they can’t master). If the soldier can harness and properly channel
the emotional intensity associated with anger and frustration, he can productively act as he answers the
challenges of survival. If the soldier does not properly focus his angry feelings, he can waste much energy
in activities that do little to further either his chances of survival or the chances of those around him.

Depression. It would be a rare person indeed who would not get sad, at least momentarily, when faced
with the privations of survival. As this sadness deepens, we label the feeling “depression.” Depression is
closely linked with frustration and anger. The frustrated person becomes more and more angry as he fails
to reach his goals. If the anger does not help the person to succeed, then the frustration level goes even
higher. A destructive cycle between anger and frustration continues until the person becomes worn downphysically,
emotionally, and mentally. When a person reaches this point, he starts to give up, and his focus
shifts from “What can I do” to “There is nothing I can do.” Depression is an expression of this hopeless,
helpless feeling. There is nothing wrong with being sad as you temporarily think about your loved ones
and remember what life is like back in “civilization” or “the world.” Such thoughts, in fact, can give you
the desire to try harder and live one more day. On the other hand, if you allow yourself to sink into a
depressed state, then it can sap all your energy and, more important, your will to survive. It is imperative
that each soldier resist succumbing to depression.

Loneliness and Boredom. Man is a social animal. This means we, as human beings, enjoy the company of
others. Very few people want to be alone all the time! As you are aware, there is a distinct chance of isolation
in a survival setting. This is not bad. Loneliness and boredom can bring to the surface qualities you
thought only others had. The extent of your imagination and creativity may surprise you. When required
to do so, you may discover some hidden talents and abilities. Most of all, you may tap into a reservoir of
inner strength and fortitude you never knew you had. Conversely, loneliness and boredom can be another
source of depression. As a soldier surviving alone, or with others, you must find ways to keep your mind
productively occupied. Additionally, you must develop a degree of self-sufficiency. You must have faith
in your capability to “go it alone.”

Guilt. The circumstances leading to your being in a survival setting are sometimes dramatic and tragic. It
may be the result of an accident or military mission where there was a loss of life. Perhaps you were the
only, or one of a few, survivors. While naturally relieved to be alive, you simultaneously may be mourning
the deaths of others who were less fortunate. It is not uncommon for survivors to feel guilty about
being spared from death while others were not. This feeling, when used in a positive way, has encouraged
people to try harder to survive with the belief they were allowed to live for some greater purpose in life.
Sometimes, survivors tried to stay alive so that they could carry on the work of those killed. Whatever
reason you give yourself, do not let guilt feelings prevent you from living. The living who abandon their
chance to survive accomplish nothing. Such an act would be the greatest tragedy.

PREPARING YOURSELF

Your mission as a soldier in a survival situation is to stay alive. As you can see, you are going to experience
an assortment of thoughts and emotions. These can work for you, or they can work to your downfall. Fear,


Psychology of Survival

anxiety, anger, frustration, guilt, depression, and loneliness are all possible reactions to the many stresses
common to survival. These reactions, when controlled in a healthy way, help to increase a soldier’s likelihood
of surviving. They prompt the soldier to pay more attention in training, to fight back when scared, to take
actions that ensure sustenance and security, to keep faith with his fellow soldiers, and to strive against large
odds. When the survivor cannot control these reactions in a healthy way, they can bring him to a standstill.
Instead of rallying his internal resources, the soldier listens to his internal fears. This soldier experiences
psychological defeat long before he physically succumbs. Remember, survival is natural to everyone; being
unexpectedly thrust into the life and death struggle of survival is not. Don’t be afraid of your “natural reactions
to this unnatural situation.” Prepare yourself to rule over these reactions so they serve your ultimate
interest—staying alive with the honor and dignity associated with being an American soldier.

It involves preparation to ensure that your reactions in a survival setting are productive, not destructive.
The challenge of survival has produced countless examples of heroism, courage, and self-sacrifice. These
are the qualities it can bring out in you if you have prepared yourself. Below are a few to help prepare
yourself psychologically for survival. Through studying this manual and attending survival training you
can develop the survival attitude.

Know Yourself. Through training, family, and friends take the time to discover who you are on the inside.
Strengthen your stronger qualities and develop the areas that you know are necessary to survive.

Anticipate Fears. Don’t pretend that you will have no fears. Begin thinking about what would frighten you
the most if forced to survive alone. Train in those areas of concern to you. The goal is not to eliminate the
fear, but to build confidence in your ability to function despite your fears.

Be Realistic. Don’t be afraid to make an honest appraisal of situations. See circumstances as they are, not
as you want them to be. Keep your hopes and expectations within the estimate of the situation. When
you go into a survival setting with unrealistic expectations, you may be laying the groundwork for bitter
disappointment. Follow the adage, “Hope for the best, prepare for the worst.” It is much easier to adjust
to pleasant surprises about one’s unexpected good fortunes than to be upset by one’s unexpected harsh
circumstances.

Adopt a Positive Attitude. Learn to see the potential good in everything. Looking for the good not only
boosts morale, it also is excellent for exercising your imagination and creativity.

Remind Yourself What Is at Stake. Remember, failure to prepare yourself psychologically to cope with
survival leads to reactions such as depression, carelessness, inattention, loss of confidence, poor decisionmaking,
and giving up before the body gives in. At stake is your life and the lives of others who are
depending on you to do your share.

Train. Through military training and life experiences, begin today to prepare yourself to cope with the
rigors of survival. Demonstrating your skills in training will give you the confidence to call upon them
should the need arise. Remember, the more realistic the training, the less overwhelming an actual survival
setting will be.

Learn Stress Management Techniques. People under stress have a potential to panic if they are not
well-trained and not prepared psychologically to face whatever the circumstances maybe. While we often
cannot control the survival circumstances in which we find ourselves, it is within our ability to control
our response to those circumstances. Learning stress management techniques can enhance significantly
your capability to remain calm and focused as you work to keep yourself and others alive. A few good
techniques to develop include relaxation skills, time management skills, assertiveness skills, and cognitive
restructuring skills (the ability to control how you view a situation).

Remember, “the will to survive” can also be considered to be “the refusal to give up.”


CHAPTER 3


Survival Planning
and Survival Kits


Survival planning is nothing more than realizing something could happen that would put you in a

survival situation and, with that in mind, taking steps to increase your chances of survival. Thus,

survival planning means preparation.

Preparation means having survival items and knowing how to use them. People who live in snow

regions prepare their vehicles for poor road conditions. They put snow tires on their vehicles, add

extra weight in the back for traction, and they carry a shovel, salt, and a blanket. Another example of

preparation is finding the emergency exits on an aircraft when you board it for a flight. Preparation

could also mean knowing your intended route of travel and familiarizing yourself with the area.

Finally, emergency planning is essential.

IMPORTANCE OF PLANNING

Detailed prior planning is essential in potential survival situations. Including survival considerations in
mission planning will enhance your chances of survival if an emergency occurs. For example, if your job requires
that you work in a small, enclosed area that limits what you can carry on your person, plan where you
can put your rucksack or your load-bearing equipment. Put it where it will not prevent you from getting out
of the area quickly, yet where it is readily accessible.

One important aspect of prior planning is preventive medicine. Ensuring that you have no dental problems
and that your immunizations are current will help you avoid potential dental or health problems. A dental
problem in a survival situation will reduce your ability to cope with other problems that you face. Failure to
keep your shots current may mean your body is not immune to diseases that are prevalent in the area.

Preparing and carrying a survival kit is as important as the considerations mentioned above. All Army
aircraft normally have survival kits on board for the type area(s) over which they will fly. There are kits
for over-water survival, for hot climate survival, and an aviator survival vest (see Tables 3-1 to 3-6 for a
description of these survival kits and their contents). If you are not an aviator, you will probably not have
access to the survival vests or survival kits. However, if you know what these kits contain, it will help you
to plan and to prepare your own survival kit.

Even the smallest survival kit, if properly prepared, is invaluable when faced with a survival problem.
Before making your survival kit, however, consider your unit’s mission, the operational environment, and
the equipment and vehicles assigned to your unit.

SURVIVAL KITS

The environment is the key to the types of items you will need in your survival kit. How much equipment
you put in your kit depends on how you will carry the kit. A kit carried on your body will have to
be smaller than one carried in a vehicle. Always layer your survival kit, keeping the most important items
on your body. For example, your map and compass should always be on your body. Carry less important
items on your load-bearing equipment. Place bulky items in the rucksack.

In preparing your survival kit, select items you can use for more than one purpose. If you have two items
that will serve the same function, pick the one you can use for another function. Do not duplicate items, as
this increases your kit’s size and weight.

13


14 The Ultimate Guide to U.S. Army Survival Skills, Tactics, and Techniques

Table 3-1: Cold Climate Kit.


Your survival kit need not be elaborate. You need only functional items that will meet your needs and a
case to hold the items. For the case, you might want to use a Band-Aid box, a first aid case, an ammunition
pouch, or another suitable case. This case should be—

Water repellent or waterproof
Easy to carry or attach to your body
Suitable to accept varisized components
Durable


Table 3-2: Hot Climate Kit.



Survival Planning and Survival Kits 15

Table 3-3: Overwater Kit.


In your survival kit, you should have—

First aid items
Water purification tablets or drops
Fire starting equipment
Signaling items
Food procurement items
Shelter items

Some examples of these items are–

Lighter, metal match, waterproof matches
Snare wire
Signaling mirror
Wrist compass
Fish and snare line
Fishhooks
Candle
Small hand lens
Oxytetracycline tablets (diarrhea or infection)
Water purification tablets
Solar blanket
Surgical blades
Butterfly sutures
Condoms for water storage
Chap Stick
Needle and thread
Knife

Include a weapon only if the situation so dictates. Read about and practice the survival techniques in this
manual. Consider your unit’s mission and the environment in which your unit will operate. Then prepare
your survival kit.


16 The Ultimate Guide to U.S. Army Survival Skills, Tactics, and Techniques

Table 3-4: Individual survival kit with general and medical packets.


(continued)


Survival Planning and Survival Kits 17

Table 3-4: (Continued)


The Army has several basic survival kits, primarily for issue to aviators. There are kits for cold climates,
hot climates, and overwater. There is also an individual survival kit with general packet and medical
packet. The cold climate, hot climate, and overwater kits are in canvas carrying bags. These kits are normally
stowed in the helicopter's cargo/passenger area.

An aviator’s survival vest, worn by helicopter crews, also contains survival items.

U.S. Army aviators flying fixed-wing aircraft equipped with ejection seats use a survival vest. The individual
survival kits are stowed in the seat pan. Like all other kits, the rigid seat survival kit (RSSK) used
depends on the environment.

18 The Ultimate Guide to U.S. Army Survival Skills, Tactics, and Techniques

Table 3-5: Aviator’s Survival Vest.


Table 3-6: Rigid Seat Survival Kits.



PART II


Survival Medicine



Introduction


Foremost among the many problems that can compromise a survivor’s ability to return to safety are
medical problems resulting from parachute descent and landing, extreme climates, ground combat,
evasion, and illnesses contracted in captivity.

Many evaders and survivors have reported difficulty in treating injuries and illness due to the lack
of training and medical supplies. For some, this led to capture or surrender.

Survivors have related feeling of apathy and helplessness because they could not treat themselves

in this environment. The ability to treat themselves increased their morale and cohesion and aided in

their survival and eventual return to friendly forces.

One man with a fair amount of basic medical knowledge can make a difference in the lives of many.
Without qualified medical personnel available, it is you who must know what to do to stay alive.

Part II meets the emergency medical training needs of individual soldiers. Because medical
personnel will not always be readily available, the non medical soldiers will have to rely heavily on
their own skills and knowledge of life-sustaining methods to survive on the integrated battlefield.
This manual also addresses first aid measures for other life-threatening situations. It outlines
both self-treatment (self-aid) and aid to other soldiers (buddy aid). More importantly, this manual
emphasizes prompt and effective action in sustaining life and preventing or minimizing further
suffering. First aid is the emergency care given to the sick, injured, or wounded before being treated
by medical personnel. The Army Dictionary defines first aid as “urgent and immediate life saving
and other measures which can be performed for casualties by non medical personnel when medical
personnel are not immediately available.” Non medical soldiers have received basic first aid training
and should remain skilled in the correct procedures for giving first aid. A combat lifesaver is a
non medical soldier who has been trained to provide emergency care. This includes administering
intravenous infusions to casualties as his combat mission permits. Normally, each squad, team, or
crew will have one member who is a combat lifesaver. This manual is directed to all soldiers. The
procedures discussed apply to all types of casualties and the measures described are for use by both
male and female soldiers.

Part II has been designed to provide a ready reference for the individual soldier on first aid. Only

the information necessary to support and sustain proficiency in first aid has been boxed and the task

number has been listed.

Commercial products (trade names or trademarks) mentioned in this publication are to provide

descriptive information and for illustrative purposes only. Their use does not imply endorsement by

the Department of Defense.

REQUIREMENTS FOR MAINTENANCE OF HEALTH: OVERVIEW

To survive, you need water and food. You must also have and apply high personal hygiene standards.

Water. Your body loses water through normal body processes (sweating, urinating, and defecating). During
average daily exertion when the atmospheric temperature is 20 degrees Celsius (C) (68 degrees Fahrenheit),
the average adult loses and therefore requires 2 to 3 liters of water daily. Other factors, such as heat
exposure, cold exposure, intense activity, high altitude, burns, or illness, can cause your body to lose more
water. You must replace this water.

21


22 The Ultimate Guide to U.S. Army Survival Skills, Tactics, and Techniques

Dehydration results from inadequate replacement of lost body fluids. It decreases your efficiency
and, if injured, increases your susceptibility to severe shock. Consider the following results of body
fluid loss:

•
A 5 percent loss of body fluids results in thirst, irritability, nausea, and weakness.
•
A 10 percent loss results in dizziness, headache, inability to walk, and a tingling sensation in the
limbs.
•
A 15 percent loss results in dim vision, painful urination, swollen tongue, deafness, and a numb
feeling in the skin.
•
A loss greater than 15 percent of body fluids may result in death.
The most common signs and symptoms of dehydration are—

•
Dark urine with a very strong odor.
•
Low urine output.
•
Dark, sunken eyes.
•
Fatigue.
•
Emotional instability.
•
Loss of skin elasticity.
•
Delayed capillary refill in fingernail beds.
•
Trench line down center of tongue.
•
Thirst. Last on the list because you are already 2 percent dehydrated by the time you crave fluids.
You replace the water as you lose it. Trying to make up a deficit is difficult in a survival situation, and
thirst is not a sign of how much water you need.

Most people cannot comfortably drink more than 1 liter of water at a time. So, even when not thirsty,
drink small amounts of water at regular intervals each hour to prevent dehydration.

If you are under physical and mental stress or subject to severe conditions, increase your water intake.
Drink enough liquids to maintain a urine output of at least 0.5 liter every 24 hours.

In any situation where food intake is low, drink 6 to 8 liters of water per day. In an extreme climate,
especially an arid one, the average person can lose 2.5 to 3.5 liters of water per hour. In this type of climate,
you should drink 14 to 30 liters of water per day.

With the loss of water there is also a loss of electrolytes (body salts). The average diet can usually keep
up with these losses but in an extreme situation or illness, additional sources need to be provided. A mixture
of 0.25 teaspoon of salt to 1 liter of water will provide a concentration that the body tissues can readily
absorb.

Of all the physical problems encountered in a survival situation, the loss of water is the most preventable.
The following are basic guidelines for the prevention of dehydration:

•
Always drink water when eating. Water is used and consumed as a part of the digestion process and
can lead to dehydration.
•
Acclimatize. The body performs more efficiently in extreme conditions when acclimatized.
•
Conserve sweat not water. Limit sweat-producing activities but drink water.
•
Ration water. Until you find a suitable source, ration your water sensibly. A daily intake of 500 cubic
centimeter (0.5 liter) of a sugar-water mixture (2 teaspoons per liter) will suffice to prevent severe
dehydration for at least a week, provided you keep water losses to a minimum by limiting activity
and heat gain or loss.
You can estimate fluid loss by several means. A standard field dressing holds about 0.25 liter (one-fourth
canteen) of blood. A soaked T-shirt holds 0.5 to 0.75 liter.


Introduction 23

You can also use the pulse and breathing rate to estimate fluid loss. Use the following as a guide:

•
With a 0.75 liter loss the wrist pulse rate will be under 100 beats per minute and the breathing rate
12 to 20 breaths per minute.
•
With a 0.75 to 1.5 liter loss the pulse rate will be 100 to 120 beats per minute and 20 to 30 breaths per
minute.
•
With a 1.5 to 2 liter loss the pulse rate will be 120 to 140 beats per minute and 30 to 40 breaths per
minute. Vital signs above these rates require more advanced care.
Food. Although you can live several weeks without food, you need an adequate amount to stay healthy.
Without food your mental and physical capabilities will deteriorate rapidly, and you will become weak.
Food replenishes the substances that your body burns and provides energy. It provides vitamins, minerals,
salts, and other elements essential to good health. Possibly more important, it helps morale.

The two basic sources of food are plants and animals (including fish). In varying degrees both provide
the calories, carbohydrates, fats, and proteins needed for normal daily body functions.

Calories are a measure of heat and potential energy. The average person needs 2,000 calories per day
to function at a minimum level. An adequate amount of carbohydrates, fats, and proteins without an
adequate caloric intake will lead to starvation and cannibalism of the body’s own tissue for energy.

Plant Foods. These foods provide carbohydrates—the main source of energy. Many plants provide enough
protein to keep the body at normal efficiency. Although plants may not provide a balanced diet, they will
sustain you even in the arctic, where meat’s heat-producing qualities are normally essential. Many plant
foods such as nuts and seeds will give you enough protein and oils for normal efficiency. Roots, green
vegetables, and plant food containing natural sugar will provide calories and carbohydrates that give the
body natural energy.

The food value of plants becomes more and more important if you are eluding the enemy or if you are
in an area where wildlife is scarce. For instance—

•
You can dry plants by wind, air, sun, or fire. This retards spoilage so that you can store or carry the
plant food with you to use when needed.
•
You can obtain plants more easily and more quietly than meat. This is extremely important when
the enemy is near.
Animal Foods. Meat is more nourishing than plant food. In fact, it may even be more readily available in some
places. However, to get meat, you need to know the habits of, and how to capture, the various wildlife.

To satisfy your immediate food needs, first seek the more abundant and more easily obtained wildlife,
such as insects, crustaceans, mollusks, fish, and reptiles. These can satisfy your immediate hunger while
you are preparing traps and snares for larger game.

Personal Hygiene. In any situation, cleanliness is an important factor in preventing infection and disease. It
becomes even more important in a survival situation. Poor hygiene can reduce your chances of survival.

A daily shower with hot water and soap is ideal, but you can stay clean without this luxury. Use a cloth
and soapy water to wash yourself. Pay special attention to the feet, armpits, crotch, hands, and hair as
these are prime areas for infestation and infection. If water is scarce, take an “air” bath. Remove as much
of your clothing as practical and expose your body to the sun and air for at least 1 hour. Be careful not to
sunburn.

If you don’t have soap, use ashes or sand, or make soap from animal fat and wood ashes, if your situation
allows. To make soap—

•
Extract grease from animal fat by cutting the fat into small pieces and cooking them in a pot.
•
Add enough water to the pot to keep the fat from sticking as it cooks.

24 The Ultimate Guide to U.S. Army Survival Skills, Tactics, and Techniques

•
Cook the fat slowly, stirring frequently.
•
After the fat is rendered, pour the grease into a container to harden.
•
Place ashes in a container with a spout near the bottom.
•
Pour water over the ashes and collect the liquid that drips out of the spout in a separate container.
This liquid is the potash or lye.
•
Another way to get the lye is to pour the slurry (the mixture of ashes and water) through a straining
cloth.
•
In a cooking pot, mix two parts grease to one part potash.
•
Place this mixture over a fire and boil it until it thickens.
After the mixture—the soap—cools, you can use it in the semiliquid state directly from the pot. You can
also pour it into a pan, allow it to harden, and cut it into bars for later use.

Keep Your Hands Clean. Germs on your hands can infect food and wounds. Wash your hands after handling
any material that is likely to carry germs, after visiting the latrine, after caring for the sick, and before
handling any food, food utensils, or drinking water. Keep your fingernails closely trimmed and clean, and
keep your fingers out of your mouth.

Keep Your Hair Clean. Your hair can become a haven for bacteria or fleas, lice, and other parasites. Keeping
your hair clean, combed, and trimmed helps you avoid this danger.

Keep Your Clothing Clean. Keep your clothing and bedding as clean as possible to reduce the chance of
skin infection as well as to decrease the danger of parasitic infestation. Clean your outer clothing whenever
it becomes soiled. Wear clean underclothing and socks each day. If water is scarce, “air” clean your clothing
by shaking, airing, and sunning it for 2 hours. If you are using a sleeping bag, turn it inside out after
each use, fluff it, and air it.

Keep Your Teeth Clean. Thoroughly clean your mouth and teeth with a toothbrush at least once each day. If
you don’t have a toothbrush, make a chewing stick. Find a twig about 20 centimeters long and 1 centimeter
wide. Chew one end of the stick to separate the fibers. Now brush your teeth thoroughly. Another way is to
wrap a clean strip of cloth around your fingers and rub your teeth with it to wipe away food particles. You
can also brush your teeth with small amounts of sand, baking soda, salt, or soap. Then rinse your mouth
with water, salt water, or willow bark tea. Also, flossing your teeth with string or fiber helps oral hygiene.

If you have cavities, you can make temporary fillings by placing candle wax, tobacco, aspirin, hot pepper,
toothpaste or powder, or portions of a ginger root into the cavity. Make sure you clean the cavity by
rinsing or picking the particles out of the cavity before placing a filling in the cavity.

Take Care of Your Feet. To prevent serious foot problems, break in your shoes before wearing them on
any mission. Wash and massage your feet daily. Trim your toenails straight across. Wear an insole and the
proper size of dry socks. Powder and check your feet daily for blisters.

If you get a small blister, do not open it. An intact blister is safe from infection. Apply a padding material
around the blister to relieve pressure and reduce friction. If the blister bursts, treat it as an open wound.
Clean and dress it daily and pad around it. Leave large blisters intact. To avoid having the blister burst or
tear under pressure and cause a painful and open sore, do the following:

•
Obtain a sewing-type needle and a clean or sterilized thread.
•
Run the needle and thread through the blister after cleaning the blister.
•
Detach the needle and leave both ends of the thread hanging out of the blister. The thread will absorb
the liquid inside. This reduces the size of the hole and ensures that the hole does not close up.
•
Pad around the blister.
Get Sufficient Rest. You need a certain amount of rest to keep going. Plan for regular rest periods of at
least 10 minutes per hour during your daily activities. Learn to make yourself comfortable under less than


Introduction 25

ideal conditions. A change from mental to physical activity or vice versa can be refreshing when time or
situation does not permit total relaxation.

Keep Camp Site Clean. Do not soil the ground in the camp site area with urine or feces. Use latrines, if
available. When latrines are not available, dig “cat holes” and cover the waste. Collect drinking water
upstream from the camp site. Purify all water.

MEDICAL EMERGENCIES

Medical problems and emergencies you may be faced with include breathing problems, severe bleeding,
and shock.

Breathing Problems. Any one of the following can cause airway obstruction, resulting in stopped breathing

•
Foreign matter in mouth of throat that obstructs the opening to the trachea.
•
Face or neck injuries.
•
Inflammation and swelling of mouth and throat caused by inhaling smoke, flames, and irritating
vapors or by an allergic reaction.
•
“Kink” in the throat (caused by the neck bent forward so that the chin rests upon the chest) may
block the passage of air.
•
Tongue blocks passage of air to the lungs upon unconsciousness.
•
When an individual is unconscious, the muscles of the lower jaw and tongue relax as the neck
drops forward, causing the lower jaw to sag and the tongue to drop back and block the passage
of air.
Severe Bleeding. Severe bleeding from any major blood vessel in the body is extremely dangerous. The
loss of 1 liter of blood will produce moderate symptoms of shock. The loss of 2 liters will produce a severe
state of shock that places the body in extreme danger. The loss of 3 liters is usually fatal.

Shock. Shock (acute stress reaction) is not a disease in itself. It is a clinical condition characterized by symptoms
that arise when cardiac output is insufficient to fill the arteries with blood under enough pressure to
provide an adequate blood supply to the organs and tissues.

LIFESAVING STEPS

Control panic, both your own and the victim’s. Reassure him and try to keep him quiet.

Perform a rapid physical exam. Look for the cause of the injury and follow the ABCs of first aid, starting
with the airway and breathing, but be discerning. A person may die from arterial bleeding more quickly
than from an airway obstruction in some cases.

Open Airway and Maintain. You can open an airway and maintain it by using the following steps.

Step 1. Check if the victim has a partial or complete airway obstruction. If he can cough or speak, allow him
to clear the obstruction naturally. Stand by, reassure the victim, and be ready to clear his airway and perform
mouth-to-mouth resuscitation should he become unconscious. If his airway is completely obstructed,
administer abdominal thrusts until the obstruction is cleared.

Step 2. Using a finger, quickly sweep the victim’s mouth clear of any foreign objects, broken teeth, dentures,
sand.

Step 3. Using the jaw thrust method, grasp the angles of the victim’s lower jaw and lift with both hands, one
on each side, moving the jaw forward. For stability, rest your elbows on the surface on which the victim is
lying. If his lips are closed, gently open the lower lip with your thumb (Figure I-1).


26 The Ultimate Guide to U.S. Army Survival Skills, Tactics, and Techniques


Figure I-1: Jaw thrust method.

Step 4. With the victim’s airway open, pinch his nose closed with your thumb and forefinger and blow
two complete breaths into his lungs. Allow the lungs to deflate after the second inflation and perform the
following:

•
Look for his chest to rise and fall.
•
Listen for escaping air during exhalation.
•
Feel for flow of air on your cheek.
Step 5. If the forced breaths do not stimulate spontaneous breathing, maintain the victim’s breathing by
performing mouth-to-mouth resuscitation.

Step 6. There is danger of the victim vomiting during mouth-to-mouth resuscitation. Check the victim’s
mouth periodically for vomit and clear as needed.

Note: Cardiopulmonary resuscitation (CPR) may be necessary after cleaning the airway, but only after major bleeding
is under control.

Control Bleeding. In a survival situation, you must control serious bleeding immediately because replacement
fluids normally are not available and the victim can die within a matter of minutes. External bleeding
falls into the following classifications (according to its source):

•
Arterial. Blood vessels called arteries carry blood away from the heart and through the body. A cut
artery issues bright red blood from the wound in distinct spurts or pulses that correspond to the rhythm
of the heartbeat. Because the blood in the arteries is under high pressure, an individual can lose a large
volume of blood in a short period when damage to an artery of significant size occurs. Therefore, arterial
bleeding is the most serious type of bleeding. If not controlled promptly, it can be fatal.
•
Venous. Venous blood is blood that is returning to the heart through blood vessels called veins. A
steady flow of dark red, maroon, or bluish blood characterizes bleeding from a vein. You can usually
control venous bleeding more easily than arterial bleeding.
•
Capillary. The capillaries are the extremely small vessels that connect the arteries with the veins.
Capillary bleeding most commonly occurs in minor cuts and scrapes. This type of bleeding is not
difficult to control.
You can control external bleeding by direct pressure, indirect (pressure points) pressure, elevation, digital
ligation, or tourniquet.


Introduction 27

Direct Pressure. The most effective way to control external bleeding is by applying pressure directly over
the wound. This pressure must not only be firm enough to stop the bleeding, but it must also be maintained
long enough to “seal off” the damaged surface.

If bleeding continues after having applied direct pressure for 30 minutes, apply a pressure dressing. This
dressing consists of a thick dressing of gauze or other suitable material applied directly over the wound
and held in place with a tightly wrapped bandage (Figure I-2). It should be tighter than an ordinary compression
bandage but not so tight that it impairs circulation to the rest of the limb. Once you apply the
dressing, do not remove it, even when the dressing becomes blood soaked.

Leave the pressure dressing in place for 1 or 2 days, after which you can remove and replace it with a
smaller dressing.

In the long-term survival environment, make fresh, daily dressing changes and inspect for signs of infection.

Elevation. Raising an injured extremity as high as possible above the heart’s level slows blood loss by aiding
the return of blood to the heart and lowering the blood pressure at the wound. However, elevation
alone will not control bleeding entirely; you must also apply direct pressure over the wound. When treating
a snakebite, however, keep the extremity lower than the heart.


Figure I-2: Application of a pressure dressing.


28 The Ultimate Guide to U.S. Army Survival Skills, Tactics, and Techniques

Pressure Points. A pressure point is a location where the main artery to the wound lies near the surface
of the skin or where the artery passes directly over a bony prominence (Figure I-3). You can use digital
pressure on a pressure point to slow arterial bleeding until the application of a pressure dressing. Pressure
point control is not as effective for controlling bleeding as direct pressure exerted on the wound. It is rare
when a single major compressible artery supplies a damaged vessel.

If you cannot remember the exact location of the pressure points, follow this rule: Apply pressure at the
end of the joint just above the injured area. On hands, feet, and head, this will be the wrist, ankle, and neck
respectively.


WARNING

Use caution when applying pressure to the neck. Too much pressure for too long
may cause unconsciousness or death. Never place a tourniquet around the neck.

Maintain pressure points by placing a round stick in the joint, bending the joint over the stick, and then
keeping it tightly bent by lashing. By using this method to maintain pressure, it frees your hands to work
in other areas.

Digital Ligation. You can stop major bleeding immediately or slow it down by applying pressure with a
finger or two on the bleeding end of the vein or artery. Maintain the pressure until the bleeding stops or
slows down enough to apply a pressure bandage, elevation, and so forth.

Tourniquet. Use a tourniquet only when direct pressure over the bleeding point and all other methods did
not control the bleeding. If you leave a tourniquet in place too long, the damage to the tissues can progress
to gangrene, with a loss of the limb later. An improperly applied tourniquet can also cause permanent
damage to nerves and other tissues at the site of the constriction.


Figure I-3: Pressure points.


Introduction 29

If you must use a tourniquet, place it around the extremity, between the wound and the heart, 5 to 10
centimeters above the wound site (Figure I-4). Never place it directly over the wound or a fracture. Use a
stick as a handle to tighten the tourniquet and tighten it only enough to stop blood flow. When you have
tightened the tourniquet, bind the free end of the stick to the limb to prevent unwinding.

After you secure the tourniquet, clean and bandage the wound. A lone survivor does not remove or
release an applied tourniquet. In a buddy system, however, the buddy can release the tourniquet pressure
every 10 to 15 minutes for 1 or 2 minutes to let blood flow to the rest of the extremity to prevent
limb loss.

Prevent and Treat Shock. Anticipate shock in all injured personnel. Treat all injured persons as follows,
regardless of what symptoms appear (Figure I-5):


Figure I-4: Application of a tourniquet.


30 The Ultimate Guide to U.S. Army Survival Skills, Tactics, and Techniques


Figure I-5: Treatment for shock.

•
If the victim is conscious, place him on a level surface with the lower extremities elevated 15 to 20
centimeters.
•
If the victim is unconscious, place him on his side or abdomen with his head turned to one side to
prevent choking on vomit, blood, or other fluids.
•
If you are unsure of the best position, place the victim perfectly flat.
•
Once the victim is in a shock position, do not move him.
•
Maintain body heat by insulating the victim from the surroundings and, in some instances, applying
external heat.
•
If wet, remove all the victim’s wet clothing as soon as possible and replace with dry clothing.
•
Improvise a shelter to insulate the victim from the weather.
•
Use warm liquids or foods, a pre-warmed sleeping bag, another person, warmed water in canteens,
hot rocks wrapped in clothing, or fires on either side of the victim to provide external warmth.

Introduction 31

•
If the victim is conscious, slowly administer small doses of a warm salt or sugar solution, if available.
•
If the victim is unconscious or has abdominal wounds, do not give fluids by mouth.
•
Have the victim rest for at least 24 hours.
•
If you are a lone survivor, lie in a depression in the ground, behind a tree, or any other place out of
the weather, with your head lower than your feet.
•
If you are with a buddy, reassess your patient constantly.
BONE AND JOINT INJURY

You could face bone and joint injuries that include fractures, dislocations, and sprains.

Fractures. There are basically two types of fractures: open and closed. With an open (or compound) fracture,
the bone protrudes through the skin and complicates the actual fracture with an open wound. After
setting the fracture, treat the wound as any other open wound.

The closed fracture has no open wounds. Follow the guidelines for immobilization, and set and splint
the fracture.

The signs and symptoms of a fracture are pain, tenderness, discoloration, swelling deformity, loss of
function, and grating (a sound or feeling that occurs when broken bone ends rub together).

The dangers with a fracture are the severing or the compression of a nerve or blood vessel at the site of
fracture. For this reason minimum manipulation should be done, and only very cautiously. If you notice
the area below the break becoming numb, swollen, cool to the touch, or turning pale, and the victim shows
signs of shock, a major vessel may have been severed. You must control this internal bleeding. Rest the
victim for shock, and replace lost fluids.

Often you must maintain traction during the splinting and healing process.

You can effectively pull smaller bones such as the arm or lower leg by hand. You can create traction by
wedging a hand or foot in the V-notch of a tree and pushing against the tree with the other extremity. You
can then splint the break.

Very strong muscles hold a broken thighbone (femur) in place making it difficult to maintain traction
during healing. You can make an improvised traction splint using natural material (Figure I-6) as follows:

•
Get two forked branches or saplings at least 5 centimeters in diameter. Measure one from the
patient’s armpit to 20 to 30 centimeters past his unbroken leg. Measure the other from the groin to
20 to 30 centimeters past the unbroken leg. Ensure that both extend an equal distance beyond the
end of the leg.
•
Pad the two splints. Notch the ends without forks and lash a 20- to 30-centimeter cross member
made from a 5-centimeter diameter branch between them.
•
Using available material (vines, cloth, rawhide), tie the splint around the upper portion of the body
and down the length of the broken leg. Follow the splinting guidelines.
•
With available material, fashion a wrap that will extend around the ankle, with the two free ends
tied to the cross member.
•
Place a 10- by 2.5-centimeter stick in the middle of the free ends of the ankle wrap between the cross
member and the foot. Using the stick, twist the material to make the traction easier.
•
Continue twisting until the broken leg is as long or slightly longer than the unbroken leg.
•
Lash the stick to maintain traction.
Note: Over time you may lose traction because the material weakened. Check the traction periodically. If you must
change or repair the splint, maintain the traction manually for a short time.

Dislocations. Dislocations are the separations of bone joints causing the bones to go out of proper alignment.
These misalignments can be extremely painful and can cause an impairment of nerve or circulatory
function below the area affected. You must place these joints back into alignment as quickly as
possible.


32 The Ultimate Guide to U.S. Army Survival Skills, Tactics, and Techniques


Figure I-6: Improvised traction splint.

Signs and symptoms of dislocations are joint pain, tenderness, swelling, discoloration, limited range of
motion, and deformity of the joint. You treat dislocations by reduction, immobilization, and rehabilitation.

Reduction or “setting” is placing the bones back into their proper alignment. You can use several methods,
but manual traction or the use of weights to pull the bones are the safest and easiest. Once performed,
reduction decreases the victim’s pain and allows for normal function and circulation. Without an X ray,
you can judge proper alignment by the look and feel of the joint and by comparing it to the joint on the
opposite side.

Immobilization is nothing more than splinting the dislocation after reduction. You can use any fieldexpedient
material for a splint or you can splint an extremity to the body. The basic guidelines for splinting
are—

• Splint above and below the fracture site.
• Pad splints to reduce discomfort.
• Check circulation below the fracture after making each tie on the splint.
To rehabilitate the dislocation, remove the splints after 7 to 14 days. Gradually use the injured joint until
fully healed.

Sprains. The accidental overstretching of a tendon or ligament causes sprains. The signs and symptoms are
pain, swelling, tenderness, and discoloration(black and blue).

When treating sprains, think RICE—

R—Rest injured area.
I—Ice for 24 hours, then heat after that.
C—Compression-wrapping and/or splinting to help stabilize. If possible, leave the boot on a sprained
ankle unless circulation is compromised.
E—Elevation of the affected area.



Introduction 33

BITES AND STINGS

Insects and related pests are hazards in a survival situation. They not only cause irritations, but they are
often carriers of diseases that cause severe allergic reactions in some individuals. In many parts of the
world you will be exposed to serious, even fatal, diseases not encountered in the United States.

Ticks can carry and transmit diseases, such as Rocky Mountain spotted fever common in many parts of
the United States. Ticks also transmit the Lyme disease.
Mosquitoes may carry malaria, dengue, and many other diseases.
Flies can spread disease from contact with infectious sources. They are causes of sleeping sickness,
typhoid, cholera, and dysentery.
Fleas can transmit plague.
Lice can transmit typhus and relapsing fever.


The best way to avoid the complications of insect bites and stings is to keep immunizations (including
booster shots) up-to-date, avoid insect-infested areas, use netting and insect repellent, and wear all clothing
properly.

If you get bitten or stung, do not scratch the bite or sting, it might become infected. Inspect your body at
least once a day to ensure there are no insects attached to you. If you find ticks attached to your body, cover
them with a substance, such as Vaseline, heavy oil, or tree sap, that will cut off their air supply. Without air,
the tick releases its hold, and you can remove it. Take care to remove the whole tick. Use tweezers if you
have them. Grasp the tick where the mouth parts are attached to the skin. Do not squeeze the tick’s body.
Wash your hands after touching the tick. Clean the tick wound daily until healed.

Treatment. It is impossible to list the treatment of all the different types of bites and stings. Treat bites and
stings as follows:

•
If antibiotics are available for your use, become familiar with them before deployment and use
them.
•
Predeployment immunizations can prevent most of the common diseases carried by mosquitoes
and some carried by flies.
•
The common fly-borne diseases are usually treatable with penicillins or erythromycin.
•
Most tick-, flea-, louse-, and mite-borne diseases are treatable with tetracycline.
•
Most antibiotics come in 250 milligram (mg) or 500 mg tablets. If you cannot remember the exact
dose rate to treat a disease, 2 tablets, 4 times a day for 10 to 14 days will usually kill any bacteria.
Bee and Wasp Stings. If stung by a bee, immediately remove the stinger and venom sac, if attached, by
scraping with a fingernail or a knife blade. Do not squeeze or grasp the stinger or venom sac, as squeezing
will force more venom into the wound. Wash the sting site thoroughly with soap and water to lessen the
chance of a secondary infection.

If you know or suspect that you are allergic to insect stings, always carry an insect sting kit with you.
Relieve the itching and discomfort caused by insect bites by applying—

•
Cold compresses.
•
A cooling paste of mud and ashes.
•
Sap from dandelions.
•
Coconut meat.
•
Crushed cloves of garlic.
•
Onion.

34 The Ultimate Guide to U.S. Army Survival Skills, Tactics, and Techniques

Spider Bites and Scorpion Stings. The black widow spider is identified by a red hourglass on its abdomen.
Only the female bites, and it has a neurotoxic venom. The initial pain is not severe, but severe local pain
rapidly develops. The pain gradually spreads over the entire body and settles in the abdomen and legs.
Abdominal cramps and progressive nausea, vomiting, and a rash may occur. Weakness, tremors, sweating,
and salivation may occur. Anaphylactic reactions can occur. Symptoms begin to regress after several
hours and are usually gone in a few days. Treat for shock. Be ready to perform CPR. Clean and dress the
bite area to reduce the risk of infection. An antivenom is available.

The funnel web spider is a large brown or gray spider found in Australia. The symptoms and the treatment
for its bite are as for the black widow spider.

The brown house spider or brown recluse spider is a small, light brown spider identified by a dark
brown violin on its back. There is no pain, or so little pain, that usually a victim is not aware of the bite.
Within a few hours a painful red area with a mottled cyanotic center appears. Necrosis does not occur in
all bites, but usually in 3 to 4 days, a star-shaped, firm area of deep purple discoloration appears at the bite
site. The area turns dark and mummified in a week or two. The margins separate and the scab falls off,
leaving an open ulcer. Secondary infection and regional swollen lymph glands usually become visible at
this stage. The outstanding characteristic of the brown recluse bite is an ulcer that does not heal but persists
for weeks or months. In addition to the ulcer, there is often a systemic reaction that is serious and may lead
to death.

Reactions (fever, chills, joint pain, vomiting, and a generalized rash) occur chiefly in children or debilitated
persons.

Tarantulas are large, hairy spiders found mainly in the tropics. Most do not inject venom, but some
South American species do. They have large fangs. If bitten, pain and bleeding are certain, and infection is
likely. Treat a tarantula bite as for any open wound, and try to prevent infection. If symptoms of poisoning
appear, treat as for the bite of the black widow spider.

Scorpions are all poisonous to a greater or lesser degree. There are two different reactions, depending
on the species:

•
Severe local reaction only, with pain and swelling around the area of the sting. Possible prickly
sensation around the mouth and a thick-feeling tongue.
•
Severe systemic reaction, with little or no visible local reaction. Local pain may be present. Systemic
reaction includes respiratory difficulties, thick-feeling tongue, body spasms, drooling, gastric distention,
double vision, blindness, involuntary rapid movement of the eyeballs, involuntary urination
and defecation, and heart failure. Death is rare, occurring mainly in children and adults with
high blood pressure or illnesses.
Treat scorpion stings as you would a black widow bite.

Snakebites. The chance of a snakebite in a survival situation is rather small, if you are familiar with the
various types of snakes and their habitats. However, it could happen and you should know how to treat
a snakebite. Deaths from snakebites are rare. More than one-half of the snakebite victims have little or
no poisoning, and only about one-quarter develop serious systemic poisoning. However, the chance of
a snakebite in a survival situation can affect morale, and failure to take preventive measures or failure to
treat a snakebite properly can result in needless tragedy.

The primary concern in the treatment of snakebite is to limit the amount of eventual tissue destruction
around the bite area.

A bite wound, regardless of the type of animal that inflicted it, can become infected from bacteria in the
animal’s mouth. With nonpoisonous as well as poisonous snakebites, this local infection is responsible for
a large part of the residual damage that results.

Snake venoms not only contain poisons that attack the victim’s central nervous system (neurotoxins)
and blood circulation (hemotoxins), but also digestive enzymes (cytotoxins) to aid in digesting their prey.


Introduction 35

These poisons can cause a very large area of tissue death, leaving a large open wound. This condition could
lead to the need for eventual amputation if not treated.

Shock and panic in a person bitten by a snake can also affect the person’s recovery. Excitement, hysteria,
and panic can speed up the circulation, causing the body to absorb the toxin quickly. Signs of shock occur
within the first 30 minutes after the bite.

Before you start treating a snakebite, determine whether the snake was poisonous or nonpoisonous.
Bites from a nonpoisonous snake will show rows of teeth. Bites from a poisonous snake may have
rows of teeth showing, but will have one or more distinctive puncture marks caused by fang penetration.
Symptoms of a poisonous bite may be spontaneous bleeding from the nose and anus, blood in
the urine, pain at the site of the bite, and swelling at the site of the bite within a few minutes or up to
2 hours later.

Breathing difficulty, paralysis, weakness, twitching, and numbness are also signs of neurotoxic venoms.
These signs usually appear 1.5 to 2 hours after the bite.

If you determine that a poisonous snake bit an individual, take the following steps:

•
Reassure the victim and keep him still.
•
Set up for shock and force fluids or give an intravenous (IV).
•
Remove watches, rings, bracelets, or other constricting items.
•
Clean the bite area.
•
Maintain an airway (especially if bitten near the face or neck) and be prepared to administer mouthto-
mouth resuscitation or CPR.
•
Use a constricting band between the wound and the heart.
•
Immobilize the site.
•
Remove the poison as soon as possible by using a mechanical suction device or by squeezing.
Do not–

•
Give the victim alcoholic beverages or tobacco products.
•
Give morphine or other central nervous system (CNS) depressors.
•
Make any deep cuts at the bite site. Cutting opens capillaries that in turn open a direct route into
the blood stream for venom and infection.
Note: If medical treatment is over one hour away, make an incision(no longer than 6 millimeters and no deeper
than 3 millimeters) over each puncture, cutting just deep enough to enlarge the fang opening, but only through
the first or second layer of skin. Place a suction cup over the bite so that you have a good vacuum seal. Suction the
bite site 3 to 4 times. Use mouth suction only as a last resort and only if you do not have open sores in your mouth.
Spit the envenomed blood out and rinse your mouth with water. This method will draw out 25 to 30 percent of the
venom.

•
Put your hands on your face or rub your eyes, as venom may be on your hands. Venom may cause
blindness.
•
Break open the large blisters that form around the bite site.
After caring for the victim as described above, take the following actions to minimize local effects:

•
If infection appears, keep the wound open and clean.
•
Use heat after 24 to 48 hours to help prevent the spread of local infection. Heat also helps to draw
out an infection.
•
Keep the wound covered with a dry, sterile dressing.
•
Have the victim drink large amounts of fluids until the infection is gone.

36 The Ultimate Guide to U.S. Army Survival Skills, Tactics, and Techniques

WOUNDS

An interruption of the skin’s integrity characterizes wounds. These wounds could be open wounds, skin
diseases, frostbite, trench foot, and burns.

Open Wounds. Open wounds are serious in a survival situation, not only because of tissue damage and blood
loss, but also because they may become infected. Bacteria on the object that made the wound, on the individual’s
skin and clothing, or on other foreign material or dirt that touches the wound may cause infection.

By taking proper care of the wound you can reduce further contamination and promote healing. Clean
the wound as soon as possible after it occurs by—

•
Removing or cutting clothing away from the wound.
•
Always looking for an exit wound if a sharp object, gun shot, or projectile caused a wound.
•
Thoroughly cleaning the skin around the wound.
•
Rinsing (not scrubbing) the wound with large amounts of water under pressure. You can use fresh
urine if water is not available.
The “open treatment” method is the safest way to manage wounds in survival situations. Do not try to
close any wound by suturing or similar procedures. Leave the wound open to allow the drainage of any
pus resulting from infection. As long as the wound can drain, it generally will not become life-threatening,
regardless of how unpleasant it looks or smells.

Cover the wound with a clean dressing. Place a bandage on the dressing to hold it in place. Change the
dressing daily to check for infection.

If a wound is gaping, you can bring the edges together with adhesive tape cut in the form of a “butterfly”
or “dumbbell” (Figure I-7).

In a survival situation, some degree of wound infection is almost inevitable. Pain, swelling, and redness
around the wound, increased temperature, and pus in the wound or on the dressing indicate infection is
present.

To treat an infected wound—

•
Place a warm, moist compress directly on the infected wound.
•
Change the compress when it cools, keeping a warm compress on the wound for a total of 30 minutes.
Apply the compresses three or four times daily.
Figure I-7: Butterfly closure.


Introduction 37

•
Drain the wound. Open and gently probe the infected wound with a sterile instrument.
•
Dress and bandage the wound.
•
Drink a lot of water.
Continue this treatment daily until all signs of infection have disappeared.

If you do not have antibiotics and the wound has become severely infected, does not heal, and ordinary
debridement is impossible, consider maggot therapy, despite its hazards:

•
Expose the wound to flies for one day and then cover it.
•
Check daily for maggots.
•
Once maggots develop, keep wound covered but check daily.
•
Remove all maggots when they have cleaned out all dead tissue and before they start on healthy
tissue. Increased pain and bright red blood in the wound indicate that the maggots have reached
healthy tissue.
•
Flush the wound repeatedly with sterile water or fresh urine to remove the maggots.
•
Check the wound every four hours for several days to ensure all maggots have been removed.
•
Bandage the wound and treat it as any other wound. It should heal normally.
Skin Diseases and Ailments. Although boils, fungal infections, and rashes rarely develop into a serious
health problem, they cause discomfort and you should treat them.

Boils. Apply warm compresses to bring the boil to a head. Then open the boil using a sterile knife, wire,
needle, or similar item. Thoroughly clean out the pus using soap and water. Cover the boil site, checking it
periodically to ensure no further infection develops.

Fungal Infections. Keep the skin clean and dry, and expose the infected area to as much sunlight as possible.
Do not scratch the affected area. During the Southeast Asian conflict, soldiers used antifungal powders, lye
soap, chlorine bleach, alcohol, vinegar, concentrated salt water, and iodine to treat fungal infections with
varying degrees of success. As with any “unorthodox” method of treatment, use it with caution.

Rashes. To treat a skin rash effectively, first determine what is causing it. This determination may be difficult
even in the best of situations. Observe the following rules to treat rashes:

•
If it is moist, keep it dry.
•
If it is dry, keep it moist.
•
Do not scratch it.
Use a compress of vinegar or tannic acid derived from tea or from boiling acorns or the bark of a hardwood
tree to dry weeping rashes. Keep dry rashes moist by rubbing a small amount of rendered animal fat
or grease on the affected area.

Remember, treat rashes as open wounds and clean and dress them daily. There are many substances
available to survivors in the wild or in captivity for use as antiseptics to treat wounds:

•
Iodine tablets. Use 5 to 15 tablets in a liter of water to produce a good rinse for wounds during healing.
•
Garlic. Rub it on a wound or boil it to extract the oils and use the water to rinse the affected area.
•
Salt water. Use 2 to 3 tablespoons per liter of water to kill bacteria.
•
Bee honey. Use it straight or dissolved in water.
•
Sphagnum moss. Found in boggy areas worldwide, it is a natural source of iodine. Use as a dressing.
Again, use noncommercially prepared materials with caution.


38 The Ultimate Guide to U.S. Army Survival Skills, Tactics, and Techniques

Frostbite. This injury results from frozen tissues. Light frostbite involves only the skin that takes on a dull,
whitish pallor. Deep frostbite extends to a depth below the skin. The tissues become solid and immovable.
Your feet, hands, and exposed facial areas are particularly vulnerable to frostbite.

When with others, prevent frostbite by using the buddy system. Check your buddy’s face often and
make sure that he checks yours. If you are alone, periodically cover your nose and lower part of your face
with your mittens.

Do not try to thaw the affected areas by placing them close to an open flame. Gently rub them in lukewarm
water. Dry the part and place it next to your skin to warm it at body temperature.

Trench Foot. This condition results from many hours or days of exposure to wet or damp conditions at
a temperature just above freezing. The nerves and muscles sustain the main damage, but gangrene can
occur. In extreme cases the flesh dies and it may become necessary to have the foot or leg amputated. The
best prevention is to keep your feet dry. Carry extra socks with you in a waterproof packet. Dry wet socks
against your body. Wash your feet daily and put on dry socks.

Burns. The following field treatment for burns relieves the pain somewhat, seems to help speed healing,
and offers some protection against infection:

•
First, stop the burning process. Put out the fire by removing clothing, dousing with water or sand,
or by rolling on the ground. Cool the burning skin with ice or water. For burns caused by white
phosphorous, pick out the white phosphorous with tweezers; do not douse with water.
•
Soak dressings or clean rags for 10 minutes in a boiling tannic acid solution (obtained from tea,
inner bark of hardwood trees, or acorns boiled in water).
•
Cool the dressings or clean rags and apply over burns.
•
Rest as an open wound.
•
Replace fluid loss.
•
Maintain airway.
•
Treat for shock.
•
Consider using morphine, unless the burns are near the face.
ENVIRONMENTAL INJURIES

Heatstroke, hypothermia, diarrhea, and intestinal parasites are environmental injuries you could face.

Heatstroke. The breakdown of the body’s heat regulatory system (body temperature more than 40.5
degrees C [105 degrees F]) causes a heatstroke. Other heat injuries, such as cramps or dehydration, do not
always precede a heatstroke. Signs and symptoms of heatstroke are—

•
Swollen, beet-red face.
•
Reddened whites of eyes.
•
Victim not sweating.
•
Unconsciousness or delirium, which can cause pallor, a bluish color to lips and nail beds (cyanosis),
and cool skin.
Note: By this time the victim is in severe shock. Cool the victim as rapidly as possible. Cool him by dipping him in a
cool stream. If one is not available, douse the victim with urine, water, or at the very least, apply cool wet compresses
to all the joints, especially the neck, armpits, and crotch. Be sure to wet the victim’s head. Heat loss through the scalp
is great. Administer IVs and provide drinking fluids. You may fan the individual.

Expect, during cooling—

•
Vomiting.
•
Diarrhea.

Introduction39

•
Struggling.
•
Shivering.
•
Shouting.
•
Prolonged unconsciousness.
•
Rebound heatstroke within 48 hours.
•
Cardiac arrest; be ready to perform CPR.
Note: Treat for dehydration with lightly salted water.

Hypothermia. Defined as the body’s failure to maintain a temperature of 36 degrees C (97 degrees F).
Exposure to cool or cold temperature over a short or long time can cause hypothermia. Dehydration and
lack of food and rest predispose the survivor to hypothermia.

Unlike heatstroke, you must gradually warm the hypothermia victim. Get the victim into dry clothing.
Replace lost fluids, and warm him.

Diarrhea. A common, debilitating ailment caused by a change of water and food, drinking contaminated
water, eating spoiled food, becoming fatigued, and using dirty dishes. You can avoid most of these causes
by practicing preventive medicine. If you get diarrhea, however, and do not have anti-diarrheal medicine,
one of the following treatments may be effective:

•
Limit your intake of fluids for 24 hours.
•
Drink one cup of a strong tea solution every 2 hours until the diarrhea slows or stops. The tannic
acid in the tea helps to control the diarrhea. Boil the inner bark of a hardwood tree for 2 hours or
more to release the tannic acid.
•
Make a solution of one handful of ground chalk, charcoal, or dried bones and treated water. If
you have some apple pomace or the rind of citrus fruit, add an equal portion to the mixture
to make it more effective. Take 2 tablespoons of the solution every 2 hours until the diarrhea
slows or stops.
Intestinal Parasites. You can usually avoid worm infestations and other intestinal parasites if you take
preventive measures. For example, never go barefoot. The most effective way to prevent intestinal parasites
is to avoid uncooked meat and raw vegetables contaminated by raw sewage or human waste used as
a fertilizer. However, should you become infested and lack proper medicine, you can use home remedies.
Keep in mind that these home remedies work on the principle of changing the environment of the gastrointestinal
tract. The following are home remedies you could use:

•
Salt water. Dissolve 4 tablespoons of salt in 1 liter of water and drink. Do not repeat this treatment.
•
Tobacco. Eat 1 to 1.5 cigarettes. The nicotine in the cigarette will kill or stun the worms long enough
for your system to pass them. If the infestation is severe, repeat the treatment in 24 to 48 hours, but
no sooner.
•
Kerosene. Drink 2 tablespoons of kerosene but no more. If necessary, you can repeat this treatment
in 24 to 48 hours. Be careful not to inhale the fumes. They may cause lung irritation.
•
Hot peppers. Peppers are effective only if they are a steady part of your diet. You can eat them raw
or put them in soups or rice and meat dishes. They create an environment that is prohibitive to
parasitic attachment.
HERBAL MEDICINES

Our modern wonder drugs, laboratories, and equipment have obscured more primitive types of medicine
involving determination, commonsense, and a few simple treatments. In many areas of the world,
however, the people still depend on local “witch doctors” or healers to cure their ailments. Many of the


40 The Ultimate Guide to U.S. Army Survival Skills, Tactics, and Techniques

herbs (plants) and treatments they use areas effective as the most modern medications available. In fact,
many modern medications come from refined herbs.


WARNING

Use herbal medicines with extreme care, however, and only when you lack or
have limited medical supplies. Some herbal medicines are dangerous and may
cause further damage or even death.


CHAPTER 1


Fundamental Criteria for First Aid


Soldiers may have to depend upon their first aid knowledge and skills to save themselves or other soldiers.
They may be able to save a life, prevent permanent disability, and reduce long periods of hospitalization
by knowing what to do, what not to do, and when to seek medical assistance. Anything soldiers can do
to keep others in good fighting condition is part of the primary mission to fight or to support the weapons
system. Most injured or ill soldiers are able to return to their units to fight and/or support primarily
because they are given appropriate and timely first aid followed by the best medical care possible. Therefore,
all soldiers must remember the basics:

•
Check for BREATHING: Lack of oxygen intake (through a compromised airway or inadequate
breathing) can lead to brain damage or death in very few minutes.
•
Check for BLEEDING: Life cannot continue without an adequate volume of blood to carry oxygen
to tissues.
•
Check for SHOCK: Unless shock is prevented or treated, death may result even though the injury
would not otherwise be fatal.
SECTION I. EVALUATE CASUALTY

1-1. Casualty Evaluation (081-831-1000). The time may come when you must instantly apply your knowledge
of lifesaving and first aid measures, possibly under combat or other adverse conditions. Any soldier
observing an unconscious and/or ill, injured, or wounded person must carefully and skillfully evaluate him
to determine the first aid measures required to prevent further injury or death. He should seek help from
medical personnel as soon as possible, but must NOT interrupt his evaluation or treatment of the casualty.
A second person may be sent to find medical help. One of the cardinal principles of treating a casualty is
that the initial rescuer must continue the evaluation and treatment, as the tactical situation permits, until he
is relieved by another individual. If, during any part of the evaluation, the casualty exhibits the conditions
for which the soldier is checking, the soldier must stop the evaluation and immediately administer first aid.
Ina chemical environment, the soldier should not evaluate the casualty until the casualty has been masked
and given the antidote. After providing first aid, the soldier must proceed with the evaluation and continue
to monitor the casualty for further medical complications until relieved by medical personnel. Learn the following
procedures well. You may become that soldier who will have to give first aid some day.

- NOTE
A casualty in shock after suffering a heart attack, chest wound, or breathing difficulty,
may breathe easier in a sitting position. If this is the case, allow him to sit upright, but
monitor carefully in case his condition worsens.


WARNING
Again, remember, if there are any signs of chemical or biological agent poisoning,
you should immediately mask the casualty. If it is nerve agent poisoning, administer
the antidote, using the casualty’s injector/ampules. See task 081-831-1031,
Administer First Aid to a Nerve Agent Casualty (Buddy Aid).
41


42 The Ultimate Guide to U.S. Army Survival Skills, Tactics, and Techniques

a. Step ONE. Check the casualty for responsiveness by gently shaking or tapping him while calmly
asking, “Are you okay?” Watch for response. If the casualty does not respond, go to step TWO.
See Chapter 2, paragraph 2-5 for more information. If the casualty responds, continue with the
evaluation.
(1) If the casualty is conscious, ask him where he feels different than usual or where it hurts. Ask him
to identify the locations of pain if he can, or to identify the area in which there is no feeling.
(2) If the casualty is conscious but is choking and cannot talk, stop the evaluation and begin treatment.
See task 081-831-1003, Clear an Object from the Throat of a Conscious Casualty. Also
see Chapter 2, paragraph 2-13 for specific details on opening the airway.
WARNING
If a broken neck or back is suspected, do not move the casualty unless to save his
life. Movement may cause permanent paralysis or death.
b. Step TWO. Check for breathing. See Chapter 2, paragraph 2-5c for procedure.
(1) If the casualty is breathing, proceed to step FOUR.
(2) If the casualty is not breathing, stop the evaluation and begin treatment (attempt to ventilate).
See task 081-831-1042, Perform Mouth-to-Mouth Resuscitation. If an airway obstruction is
apparent, clear the airway obstruction, then ventilate.
(3) After successfully clearing the casualty’s airway, proceed to step THREE.
c. Step THREE. Check for pulse. If pulse is present, and the casualty is breathing, proceed to step
FOUR.
(1) If pulse is present, but the casualty is still not breathing, start rescue breathing. See Chapter 2,
paragraphs 2-6, and 2-7 for specific methods.
*(2) If pulse is not found, seek medically trained personnel for help.

d. Step FOUR. Check for bleeding. Look for spurts of blood or blood-soaked clothes. Also check for
both entry and exit wounds. If the casualty is bleeding from an open wound, stop the evaluation
and begin first aid treatment in accordance with the following tasks, as appropriate:
(1) Arm or leg wound–Task 081-831-1016, Put on a Field or Pressure Dressing. See Chapter 2,
paragraphs 2-15, 2-17, 2-18, and 2-19.
(2) Partial or complete amputation–Task 081-831-1017, Put on a Tourniquet. See Chapter 2,
paragraph 2-20.
(3) Open head wound–Task 081-831-1033, Apply a Dressing to an Open Head Wound. See
Chapter 3, Section I.
(4) Open abdominal wound–Task 081-831-1025, Apply a Dressing to an Open Abdominal Wound.
See Chapter 3, paragraph 3-12.
(5) Open chest wound–Task 081-831-1026, Apply a Dressing to an Open Chest Wound. See
Chapter 3, paragraphs 3-9 and 3-10.
WARNING
In a chemically contaminated area, do not expose the wound(s).

Fundamental Criteria for First Aid 43

e. Step FIVE. Check for shock. If signs/symptoms of shock are present, stop the evaluation and
begin treatment immediately. The following are nine signs and/or symptoms of shock.
(1) Sweaty but cool skin (clammy skin).
(2) Paleness of skin.
(3) Restlessness or nervousness.
(4) Thirst.
(5) Loss of blood (bleeding).
(6) Confusion (does not seem aware of surroundings).
(7) Faster than normal breathing rate.
(8) Blotchy or bluish skin, especially around the mouth.
(9) Nausea and/or vomiting.
WARNING
Leg fractures must be splinted before elevating the legs as a treatment for shock.
See Chapter 2, Section III for specific information regarding the causes and effects, signs/symptoms, and
the treatment/prevention of shock.

f. Step SIX. Check for fractures (Chapter 4).
(1) Check for the following signs/symptoms of a back or neck injury and treat as necessary.
•
Pain or tenderness of the neck or back area.
•
Cuts or bruises in the neck or back area.
•
Inability of a casualty to move (paralysis or numbness).
•
Ask about ability to move (paralysis).
•
Touch the casualty’s arms and legs and ask whether he can feel your hand (numbness).
•
Unusual body or limb position.
WARNING
Unless there is immediate life threatening danger, do not move a casualty who
has a suspected back or neck injury. Movement may cause permanent paralysis
or death.
(2) Immobilize any casualty suspected of having a neck or back injury by doing the following
•
Tell the casualty not to move.
•
If a back injury is suspected, place padding (rolled or folded to conform to the shape of the
arch) under the natural arch of the casualty’s back. For example, a blanket may be used as
padding.
•
If a neck injury is suspected, place a roll of cloth under the casualty’s neck and put weighted
boots (filled with dirt, sand and so forth) or rocks on both sides of his head.
(3) Check the casualty’s arms and legs for open or closed fractures.
Check for open fractures.
Look for bleeding.
Look for bone sticking through the skin.



44 The Ultimate Guide to U.S. Army Survival Skills, Tactics, and Techniques

Check for closed fractures.

Look for swelling.

Look for discoloration.

Look for deformity.

Look for unusual body position.
*(4) Stop the evaluation and begin treatment if a fracture to an arm or leg is suspected. See Task
081-831-1034, Splint a Suspected Fracture, Chapter 4, paragraphs 4-4 through 4-7.

(5) Check for signs/symptoms of fractures of other body areas (for example, shoulder or hip) and
treat as necessary.
g. Step SEVEN. Check for burns. Look carefully for reddened, blistered, or charred skin, also check
for singed clothing. If burns are found, stop the evaluation and begin treatment (Chapter 3, paragraph
3-14). See task 081-831-1007, Give First Aid for Burns.
h. Step EIGHT. Check for possible head injury.
(1) Look for the following signs and symptoms
Unequal pupils.
Fluid from the ear(s), nose, mouth, or injury site.
Slurred speech.
Confusion.
Sleepiness.
Loss of memory or consciousness.
Staggering in walking.
Headache.
Dizziness.
Vomiting and/or nausea.
Paralysis.
Convulsions or twitches.
(2) If a head injury is suspected, continue to watch for signs which would require performance of
mouth-to-mouth resuscitation, treatment for shock, or control of bleeding and seek medical aid.
See Chapter 3, Section I for specific indications of head injury and treatment. See task 081-8311033,
Apply a Dressing to an Open Head Wound.
1-2. Medical Assistance (081-831-1000). When a non-medically trained soldier comes upon an unconscious
and/or injured soldier, he must accurately evaluate the casualty to determine the first aid measures needed
to prevent further injury or death. He should seek medical assistance as soon as possible, but he MUST
NOT interrupt treatment. To interrupt treatment may cause more harm than good to the casualty. A second
person may be sent to find medical help. If, during any part of the evaluation, the casualty exhibits the
conditions for which the soldier is checking, the soldier must stop the evaluation and immediately administer
first aid. Remember that in a chemical environment, the soldier should not evaluate the casualty until
the casualty has been masked and given the antidote. After performing first aid, the soldier must proceed
with the evaluation and continue to monitor the casualty for development of conditions which may require
the performance of necessary basic life saving measures, such as clearing the airway, mouth-to-mouth
resuscitation, preventing shock, and/or bleeding control. He should continue to monitor until relieved by
medical personnel.


Fundamental Criteria for First Aid 45

SECTION II. UNDERSTAND VITAL BODY FUNCTIONS

1-3. Respiration and Blood Circulation. Respiration (inhalation and exhalation) and blood circulation are
vital body functions. Interruption of either of these two functions need not be fatal IF appropriate first aid
measures are correctly applied.

a.
Respiration. When a person inhales, oxygen is taken into the body and when he exhales, carbon
dioxide is expelled from the body–this is respiration. Respiration involves the—
•
Airway (nose, mouth, throat, voice box, windpipe, and bronchial tree). The canal through which
air passes to and from the lungs.
•
Lungs (two elastic organs made up of thousands of tiny air spaces and covered by an airtight
membrane).
•
Chest cage (formed by the muscle-connected ribs which join the spine in back and the breastbone
in front). The top part of the chest cage is closed by the structure of the neck, and the bottom part
is separated from the abdominal cavity by a large dome-shaped muscle called the diaphragm
(Figure 1-1). The diaphragm and rib muscles, which are under the control of the respiratory center
in the brain, automatically contract and relax. Contraction increases and relaxation decreases
the size of the chest cage.
When the chest cage increases and then decreases, the air pressure in the lungs is first less and then more
than the atmospheric pressure, thus causing the air to rush in and out of the lungs to equalize the pressure.
This cycle of inhaling and exhaling is repeated about 12 to 18 times per minute.

b. Blood Circulation. The heart and the blood vessels (arteries, veins, and capillaries) circulate blood
through the body tissues. The heart is divided into two separate halves, each acting as a pump.
The left side pumps oxygenated blood (bright red) through the arteries into the capillaries; nutrients
and oxygen pass from the blood through the walls of the capillaries into the cells. At the same
time waste products and carbon dioxide enter the capillaries. From the capillaries the oxygen poor
blood is carried through the veins to the right side of the heart and then into the lungs where it
Figure 1-1: Airway, lungs, and chest cage.


46 The Ultimate Guide to U.S. Army Survival Skills, Tactics, and Techniques

expels carbon dioxide and picks up oxygen, Blood in the veins is dark red because of its low oxygen
content. Blood does not flow through the veins in spurts as it does through the arteries.

(1) Heartbeat. The heart functions as a pump to circulate the blood continuously through the blood
vessels to all parts of the body. It contracts, forcing the blood from its chambers; then it relaxes,
permitting its chambers to refill with blood. The rhythmical cycle of contraction and relaxation
is called the heartbeat. The normal heartbeat is from 60 to 80 beats per minute.
(2) Pulse. The heartbeat causes a rhythmical expansion and contraction of the arteries as it forces
blood through them. This cycle of expansion and contraction can be felt (monitored) at various
body points and is called the pulse. The common points for checking the pulse are at
the side of the neck (carotid), the groin (femoral), the wrist (radial), and the ankle (posterial
tibial).
(a) Neck (carotid) pulse. To check the neck (carotid) pulse, feel for a pulse on the side of the
casualty’s neck closest to you by placing the tips of your first two fingers beside his Adam’s
apple (Figure 1-2).
(b) Groin (femoral) pulse. To check the groin (femoral) pulse, press the tips of two fingers into
the middle of the groin (Figure 1-3).
Figure 1-2: Neck (carotid) pulse.


Figure 1-3: Groin (femoral) pulse.


Fundamental Criteria for First Aid 47


Figure 1-4: Wrist (radial) pulse.


Figure 1-5: Ankle (posterial tibial) pulse.

(c) Wrist (radial) pulse. To check the wrist (radial) pulse, place your first two fingers on the
thumb side of the casualty’s wrist (Figure 1-4).
(d) Ankle (posterial tibial) pulse. To check the ankle (posterial tibial) pulse, place your first two
fingers on the inside of the ankle (Figure 1-5).
- NOTE
DO NOT use your thumb to check a casualty’s pulse because you may confuse your
pulse beat with that of the casualty.

1-4. Adverse Conditions

a.
Lack of Oxygen. Human life cannot exist without a continuous intake of oxygen. Lack of oxygen
rapidly leads to death. First aid involves knowing how to OPEN THE AIRWAY AND RESTORE
BREATHING AND HEARTBEAT (Chapter 2, Section I).
b.
Bleeding. Human life cannot continue without an adequate volume of blood to carry oxygen to
the tissues. An important first aid measure is to STOP THE BLEEDING to prevent loss of blood
(Chapter 2, Section II).

48 The Ultimate Guide to U.S. Army Survival Skills, Tactics, and Techniques

c.
Shock. Shock means there is inadequate blood flow to the vital tissues and organs. Shock that remains
uncorrected may result in death even though the injury or condition causing the shock would not
otherwise be fatal. Shock can result from many causes, such as loss of blood, loss of fluid from
deep burns, pain, and reaction to the sight of a wound or blood. First aid includes PREVENTING
SHOCK, since the casualty’s chances of survival are much greater if he does not develop shock
(Chapter 2, Section III).
d.
Infection. Recovery from a severe injury or a wound depends largely upon how well the injury or
wound was initially protected. Infections result from the multiplication and growth (spread) of
germs (bacteria: harmful microscopic organisms). Since harmful bacteria are in the air and on the
skin and clothing, some of these organisms will immediately invade (contaminate) a break in the
skin or an open wound. The objective is to KEEP ADDITIONAL GERMS OUT OF THE WOUND.
A good working knowledge of basic first aid measures also includes knowing how to dress the
wound to avoid infection or additional contamination (Chapters 2 and 3).

CHAPTER 2


Basic Measures for First Aid


Several conditions which require immediate attention are an inadequate airway, lack of breathing or lack
of heartbeat, and excessive loss of blood. A casualty without a clear airway or who is not breathing may
die from lack of oxygen. Excessive loss of blood may lead to shock, and shock can lead to death; therefore,
you must act immediately to control the loss of blood. All wounds are considered to be contaminated, since
infection-producing organisms (germs) are always present on the skin, on clothing, and in the air. Any
missile or instrument causing the wound pushes or carries the germs into the wound. Infection results as
these organisms multiply. That a wound is contaminated does not lessen the importance of protecting it
from further contamination. You must dress and bandage a wound as soon as possible to prevent further
contamination. It is also important that you attend to any airway, breathing, or bleeding problem IMMEDIATELY
because these problems may become life-threatening.

SECTION I. OPEN THE AIRWAY AND RESTORE BREATHING

*2-1. Breathing Process. All living things must have oxygen to live. Through the breathing process, the
lungs draw oxygen from the air and put it into the blood. The heart pumps the blood through the body to
be used by the living cells which require a constant supply of oxygen. Some cells are more dependent on
a constant supply of oxygen than others. Cells of the brain may die within 4 to 6 minutes without oxygen.
Once these cells die, they are lost forever since they DO NOT regenerate. This could result in permanent
brain damage, paralysis, or death.

2-2. Assessment (Evaluation) Phase (081-831-1000 and 081-831-1042)

a.
Check for responsiveness (Figure 2-1A)—establish whether the casualty is conscious by gently
shaking him and asking, “Are you O.K.?”
b. Call for help (Figure 2-1B).
c.
Position the unconscious casualty so that he is lying on his back and on a firm surface (Figure 2-1C)
(081-831-1042).
WARNING (081-831-1042)
If the casualty is lying on his chest (prone position), cautiously roll the casualty
as a unit so that his body does not twist (which may further complicate a neck,
back or spinal injury).
(1) Straighten the casualty’s legs. Take the casualty’s arm that is nearest to you and move it so that
it is straight and above his head. Repeat procedure for the other arm.
(2) Kneel beside the casualty with your knees near his shoulders (leave space to roll his body)
(Figure 2-1B). Place one hand behind his head and neck for support. With your other hand,
grasp the casualty under his far arm (Figure 2-1C).
(3) Roll the casualty toward you using a steady and even pull. His head and neck should stay in line
with his back.
(4) Return the casualty’s arms to his sides. Straighten his legs. Reposition yourself so that you are
now kneeling at the level of the casualty’s shoulders. However, if a neck injury is suspected, and
the jaw-thrust will be used, kneel at the casualty’s head, looking toward his feet.
49


50 The Ultimate Guide to U.S. Army Survival Skills, Tactics, and Techniques


Figure 2-1: Responsiveness checked.

2-3. Opening the Airway—Unconscious and Not Breathing Casualty (081-831-1042). *The tongue is the
single most common cause of an airway obstruction (Figure 2-2). In most cases, the airway can be cleared
by simply using the head-tilt/chin-lift technique. This action pulls the tongue away from the air passage
in the throat (Figure 2-3).

a.
Step ONE (081-331-1042). Call for help and then position the casualty. Move (roll) the casualty onto
his back (Figure 2-1C above).
Figure 2-2: Airway blocked by tongue.


Basic Measures for First Aid51


Figure 2-3: Airway opened (cleared).


CAUTION
Take care in moving a casualty with a suspected neck or back injury. Moving an injured
neck or back may permanently injure the spine.

- NOTE (081-831-1042)
If foreign material or vomitus is visible in the mouth, it should be removed, but do not
spend an excessive amount of time doing so.


b. Step TWO (081-831-1042). Open the airway using the jaw-thrust or head-tilt/chin-lift technique.
- NOTE
The head-tilt/chin-lift is an important procedure in opening the airway; however, use
extreme care because excess force in performing this maneuver may cause further spinal
injury. In a casualty with a suspected neck injury or severe head trauma, the safest
approach to opening the airway is the jaw-thrust technique because in most cases it can
be accomplished without extending the neck.

(1) Perform the jaw-thrust technique. The jaw-thrust maybe accomplished by the rescuer grasping
the angles of the casualty’s lower jaw and lifting with both hands, one on each side, displacing
the jaw forward and up (Figure 2-4). The rescuer’s elbows should rest on the surface on which
the casualty is lying. If the lips close, the lower lip can be retracted with the thumb. If mouth-tomouth
breathing is necessary, close the nostrils by placing your cheek tightly against them. The
head should be carefully supported without tilting it backwards or turning it from side to side.
If this is unsuccessful, the head should be tilted back very slightly. The jaw-thrust is the safest
first approach to opening the airway of a casualty who has a suspected neck injury because in
most cases it can be accomplished without extending the neck.
(2) Perform the head-tilt/chin-lift technique (081-831-1042). Place one hand on the casualty’s forehead
and apply firm, backward pressure with the palm to tilt the head back. Place the fingertips

52 The Ultimate Guide to U.S. Army Survival Skills, Tactics, and Techniques


Figure 2-4: Jaw-thrust technique of opening airway.

of the other hand under the bony part of the lower jaw and lift, bringing the chin forward. The
thumb should not be used to lift the chin (Figure 2-5).

- NOTE
The fingers should not press deeply into the soft tissue under the chin because the airway
may be obstructed.

c.
Step THREE. Check for breathing (while maintaining an airway). After establishing an open airway,
it is important to maintain that airway in an open position. Often the act of just opening and
maintaining the airway will allow the casualty to breathe properly. Once the rescuer uses one of the
techniques to open the airway (jaw-thrust or head-tilt/chin-lift), he should maintain that head position
to keep the airway open. Failure to maintain the open airway will prevent the casualty from
receiving an adequate supply of oxygen. Therefore, while maintaining an open airway, the rescuer
should check for breathing by observing the casualty’s chest and performing the following actions
within 3 to 5 seconds:
(1) LOOK for the chest to rise and fall.
(2) LISTEN for air escaping during exhalation by placing your ear near the casualty’s mouth.
Figure 2-5: Head-tilt/chin-lift technique of opening airway.


Basic Measures for First Aid 53

(3) FEEL for the flow of air on your cheek (see Figure 2-6),
(4) If the casualty does not resume breathing, give mouth-to-mouth resuscitation.
- NOTE
If the casualty resumes breathing, monitor and maintain the open airway. If he continues
to breathe, he should be transported to a medical treatment facility.

2-4. Rescue Breathing (Artificial Respiration)

a.
If the casualty does not promptly resume adequate spontaneous breathing after the airway is open,
rescue breathing (artificial respiration) must be started. Be calm! Think and act quickly! The sooner
you begin rescue breathing, the more likely you are to restore the casualty’s breathing. If you are
in doubt whether the casualty is breathing, give artificial respiration, since it can do no harm to a
person who is breathing. If the casualty is breathing, you can feel and see his chest move. Also, if
the casualty is breathing, you can feel and hear air being expelled by putting your hand or ear close
to his mouth and nose.
b. There are several methods of administering rescue breathing. The mouth-to-mouth method is preferred;
however, it cannot be used in all situations. If the casualty has a severe jaw fracture or mouth
wound or his jaws are tightly closed by spasms, use the mouth-to-nose method.
2-5. Preliminary Steps—All Rescue Breathing Methods (081-831-1042)

a.
Step ONE. Establish unresponsiveness. Call for help. Turn or position the casualty.
b. Step TWO. Open the airway.
c.
Step THREE. Check for breathing by placing your ear over the casualty’s mouth and nose, and looking
toward his chest:
(1) Look for rise and fall of the casualty’s chest (Figure 2-6).
(2) Listen for sounds of breathing.
Figure 2-6:


54 The Ultimate Guide to U.S. Army Survival Skills, Tactics, and Techniques

(3)
Feel for breath on the side of your face. If the chest does not rise and fall and no air is exhaled,
then the casualty is breathless (not breathing). (This evaluation procedure should take only 3 to
5 seconds. Perform rescue breathing if the casualty is not breathing.
- NOTE
Although the rescuer may notice that the casualty is making respiratory efforts, the airway
may still be obstructed and opening the airway may be all that is needed. If the casualty
resumes breathing, the rescuer should continue to help maintain an open airway.

2-6. Mouth-to-Mouth Method (081-831-1042). In this method of rescue breathing, you inflate the casualty’s
lungs with air from your lungs. This can be accomplished by blowing air into the person’s mouth. The
mouth-to-mouth rescue breathing method is performed as follows:

a. Preliminary Steps.
(1) Step ONE (081-831-1042). If the casualty is not breathing, place your hand on his forehead, and
pinch his nostrils together with the thumb and index finger of this same hand. Let this same
hand exert pressure on his forehead to maintain the backward head-tilt and maintain an open
airway. With your other hand, keep your fingertips on the bony part of the lower jaw near the
chin and lift (Figure 2-7).
- NOTE
If you suspect the casualty has a neck injury and you are using the jaw-thrust technique,
close the nostrils by placing your cheek tightly against them.


(2) Step TWO (081-831-1042).Take a deep breath and place your mouth (in an airtight seal) around
the casualty’s mouth (Figure 2-8). (If the injured person is small, cover both his nose and mouth
with your mouth, sealing your lips against the skin of his face.)
(3) Step THREE (081-831-1042). Blow two full breaths into the casualty’s mouth (1 to 1 1/2 seconds
per breath), taking a breath of fresh air each time before you blow. Watch out of the corner of
Figure 2-7: Head-tilt/chin-lift.


Basic Measures for First Aid 55


Figure 2-8: Rescue breathing.

your eye for the casualty’s chest to rise. If the chest rises, sufficient air is getting into the casualty’s
lungs. Therefore, proceed as described in step FOUR below. If the chest does not rise, do the following
(a, b, and c below) and then attempt to ventilate again.

(a) Take corrective action immediately by reestablishing the airway. Make sure that air is not
leaking from around your mouth or out of the casualty’s pinched nose.
(b) Reattempt to ventilate.
(c) If chest still does not rise, take the necessary action to open an obstructed airway
(paragraph 2-14).
- NOTE
If the initial attempt to ventilate the casualty is unsuccessful, reposition the casualty’s
head and repeat rescue breathing. Improper chin and head positioning is the most common
cause of difficulty with ventilation. If the casualty cannot be ventilated after repositioning
the head, proceed with foreign-body airway obstruction maneuvers (see Open an
Obstructed Airway, paragraph 2-14).

(4) Step FOUR (081-831-1042). After giving two breaths which cause the chest to rise, attempt to
locate a pulse on the casualty. Feel for a pulse on the side of the casualty’s neck closest to you by
placing the first two fingers (index and middle fingers) of your hand on the groove beside the
casualty’s Adam’s apple (carotid pulse) (Figure 2-9). (Your thumb should not be used for pulse

56 The Ultimate Guide to U.S. Army Survival Skills, Tactics, and Techniques


Figure 2-9: Placement of fingers to detect pulse.

taking because you may confuse your pulse beat with that of the casualty.) Maintain the airway
by keeping your other hand on the casualty’s forehead. Allow 5 to 10 seconds to determine if
there is a pulse.

(a) If a pulse is found and the casualty is breathing—STOP and allow the casualty to breathe on
his own. If possible, keep him warm and comfortable.
(b) If a pulse is found and the casualty is not breathing, continue rescue breathing.
* (c) If a pulse is not found, seek medically trained personnel for help.
b. Rescue Breathing (mouth-to-mouth resuscitation) (081-831-1042). Rescue breathing (mouth-tomouth
or mouth-to-nose resuscitation) is performed at the rate of about one breath every 5 seconds
(12 breaths per minute) with rechecks for pulse and breathing after every 12 breaths. Rechecks can
be accomplished in 3 to 5 seconds. See steps ONE through SEVEN (below) for specifics.
- NOTE

Seek help (medical aid), if not done previously.

(1) Step ONE. If the casualty is not breathing, pinch his nostrils together with the thumb and index
finger of the hand on his forehead and let this same hand exert pressure on the forehead to
maintain the backward head-tilt (Figure 2-7).
(2) Step TWO. Take a deep breath and place your mouth (in an airtight seal) around the casualty’s
mouth (Figure 2-8).
(3) Step THREE. Blow a quick breath into the casualty’s mouth forcefully to cause his chest to rise.
If the casualty’s chest rises, sufficient air is getting into his lungs.
(4) Step FOUR. When the casualty’s chest rises, remove your mouth from his mouth and listen for
the return of air from his lungs (exhalation).
(5) Step FIVE. Repeat this procedure (mouth-to-mouth resuscitation) at a rate of one breath every 5
seconds to achieve 12 breaths per minute. Use the following count: “one, one-thousand; two, onethousand;
three, one-thousand; four, one-thousand; BREATH; one, one-thousand;” and so forth.
To achieve a rate of one breath every 5 seconds, the breath must be given on the fifth count.
* (6) Step SIX. Feel for a pulse after every 12th breath. This check should take about 3 to 5 seconds. If
a pulse beat is not found, seek medically trained personnel for help.

Basic Measures for First Aid 57

* (7) Step SEVEN. Continue rescue breathing until the casualty starts to breathe on his own, until you
are relieved by another person, or until you are too tired to continue. Monitor pulse and return
of spontaneous breathing after every few minutes of rescue breathing. If spontaneous breathing
returns, monitor the casualty closely. The casualty should then be transported to a medical treatment
facility. Maintain an open airway and be prepared to resume rescue breathing, if necessary.
2-7. Mouth-to-Nose Method. Use this method if you cannot perform mouth-to-mouth rescue breathing
because the casualty has a severe jaw fracture or mouth wound or his jaws are tightly closed by spasms.
The mouth-to-nose method is performed in the same way as the mouth-to-mouth method except that you
blow into the nose while you hold the lips closed with one hand at the chin. You then remove your mouth
to allow the casualty to exhale passively. It may be necessary to separate the casualty’s lips to allow the air
to escape during exhalation.

* 2-8. Heartbeat. If a casualty’s heart stops beating, you must immediately seek medically trained personnel
for help. SECONDS COUNT! Stoppage of the heart is soon followed by cessation of respiration unless
it has occurred first. Be calm! Think and act! When a casualty’s heart has stopped, there is no pulse at all;
the person is unconscious and limp, and the pupils of his eyes are open wide. When evaluating a casualty
or when performing the preliminary steps of rescue breathing, feel for a pulse. If you DO NOT detect a
pulse, immediately seek medically trained personnel.
Note: The U.S. Army deleted paragraphs 2-9, 2-10, and 2-11 of this manual as part of a revision.

2-12. Airway Obstructions. In order for oxygen from the air to flow to and from the lungs, the upper airway
must be unobstructed.

a. Upper airway obstructions often occur because—
(1) The casualty’s tongue falls back into his throat while he is unconscious as a result of injury, cardiopulmonary
arrest, and so forth. (The tongue falls back and obstructs, it is not swallowed.)
(2) Foreign bodies become lodged in the throat. These obstructions usually occur while eating (meat
most commonly causes obstructions). Choking on food is associated with—
•
Attempting to swallow large pieces of poorly chewed food.
•
Drinking alcohol.
•
Slipping dentures.
(3) The contents of the stomach are regurgitated and may block the airway.
(4) Blood clots may form as a result of head and facial injuries.
b. Upper airway obstructions may be prevented by taking the following precautions:
(1) Cut food into small pieces and take care to chew slowly and thoroughly.
(2) Avoid laughing and talking when chewing and swallowing.
(3) Restrict alcohol while eating meals.
(4) Keep food and foreign objects from children while they walk, run, or play.
(5) Consider the correct positioning/maintenance of the open airway for the injured or unconscious
casualty.
c. Upper airway obstruction may cause either partial or complete airway blockage.
* (1)
Partial airway obstruction. The casualty may still have an air exchange. A good air exchange
means that the casualty can cough forcefully, though he may be wheezing between coughs.
You, the rescuer, should not interfere, and should encourage the casualty to cough up the object
on his own. A poor air exchange may be indicated by weak coughing with a high pitched noise
between coughs. Additionally, the casualty may show signs of shock (for example, paleness of
the skin, bluish or grayish tint around the lips or fingernail beds) indicating a need for oxygen.
You should assist the casualty and treat him as though he had a complete obstruction.
(2)
Complete airway obstruction. A complete obstruction (no air exchange) is indicated if the casualty
cannot speak, breathe, or cough at all. He may be clutching his neck and moving erratically. In

58 The Ultimate Guide to U.S. Army Survival Skills, Tactics, and Techniques

an unconscious casualty a complete obstruction is also indicated if after opening his airway you
cannot ventilate him.

2-13. Opening the Obstructed Airway-Conscious Casualty (081-831-1003). Clearing a conscious casualty’s
airway obstruction can be performed with the casualty either standing or sitting, and by following a relatively
simple procedure.


WARNING

Once an obstructed airway occurs, the brain will develop an oxygen deficiency
resulting in unconsciousness. Death will follow rapidly if prompt action is not
taken.

a.
Step ONE. Ask the casualty if he can speak or if he is choking. Check for the universal choking sign
(Figure 2-18).
b. Step TWO. If the casualty can speak, encourage him to attempt to cough; the casualty still has a
good air exchange. If he is able to speak or cough effectively, DO NOT interfere with his attempts
to expel the obstruction.
c.
Step THREE. Listen for high pitched sounds when the casualty breathes or coughs (poor air
exchange). If there is poor air exchange or no breathing, CALL for HELP and immediately deliver
manual thrusts (either an abdominal or chest thrust).
- NOTE
The manual thrust with the hands centered between the waist, and the rib cage is called
an abdominal thrust (or Heimlich maneuver). The chest thrust (the hands are centered
in the middle of the breastbone) is used only for an individual in the advanced stages of
pregnancy, in the markedly obese casualty, or if there is a significant abdominal wound.


•
Apply ABDOMINAL THRUSTS using the procedures below:
•
Stand behind the casualty and wrap your arms around his waist. Make a fist with one hand
and grasp it with the other. The thumb side of your fist should be against the casualty’s
abdomen, in the midline and slightly above the casualty’s navel, but well below the tip of the
breastbone (Figure 2-19).
•
Press the fists into the abdomen with a quick backward and upward thrust (Figure 2-20).
•
Each thrust should be a separate and distinct movement.
Figure 2-18: Universal sign of choking.


Basic Measures for First Aid 59


Figure 2-19: Anatomical view of abdominal thrust procedure.


Figure 2-20: Profile view of abdominal thrust.

- *NOTE
Continue performing abdominal thrusts until the obstruction is expelled or the casualty
becomes unconscious.

•
If the casualty becomes unconscious, call for help as you proceed with steps to open the airway
and perform rescue breathing (See task 081-831-1042, Perform Mouth-to-Mouth Resuscitation.)
•
Applying CHEST THRUSTS. An alternate technique to the abdominal thrust is the chest thrust.
This technique is useful when the casualty has an abdominal wound, when the casualty is pregnant,
or when the casualty is so large that you cannot wrap your arms around the abdomen. TO
apply chest thrusts with casualty sitting or standing:
•
Stand behind the casualty and wrap your arms around his chest with your arms under his
armpits.
•
Make a fist with one hand and place the thumb side of the fist in the middle of the breastbone
(take care to avoid the tip of the breastbone and the margins of the ribs).
•
Grasp the fist with the other hand and exert thrusts (Figure 2-21).
•
Each thrust should be delivered slowly, distinctly, and with the intent of relieving the
obstruction.

60 The Ultimate Guide to U.S. Army Survival Skills, Tactics, and Techniques


Figure 2-21: Profile view of chest thrust.

•
Perform chest thrusts until the obstruction is expelled or the casualty becomes unconscious.
•
If the casualty becomes unconscious, call for help as you proceed with steps to open the
airway and perform rescue breathing. (See task 081-831-1042, Perform Mouth-to-Mouth
Resuscitation.)
2-14. Open an Obstructed Airway—Casualty Lying or Unconscious (081-831-1042). The following procedures
are used to expel an airway obstruction in a casualty who is lying down, who becomes unconscious,
or is found unconscious (the cause unknown):

•
If a casualty who is choking becomes unconscious, call for help, open the airway, perform a finger
sweep, and attempt rescue breathing (paragraphs 2-2 through 2-4). If you still cannot administer
rescue breathing due to an airway blockage, then remove the airway obstruction using the procedures
in steps a through e below.
•
If a casualty is unconscious when you find him (the cause unknown), assess or evaluate the situation,
call for help, position the casualty on his back, open the airway, establish breathlessness, and
attempt to perform rescue breathing (paragraphs 2-2 through 2-8).
a.
Open the airway and attempt rescue breathing. (See task 081-831-1042, Perform Mouth-to-Mouth
Resuscitation.)
b. If still unable to ventilate the casualty, perform 6 to 10 manual (abdominal or chest) thrusts. (Note
that the abdominal thrusts are used when casualty does not have abdominal wounds; is not pregnant
or extremely overweight.) To perform the abdominal thrusts:
(1) Kneel astride the casualty’s thighs (Figure 2-22).
(2) Place the heel of one hand against the casualty’s abdomen (in the midline slightly above the
navel but well below the tip of the breastbone). Place your other hand on top of the first one.
Point your fingers toward the casualty’s head.
(3) Press into the casualty’s abdomen with a quick, forward and upward thrust. You can use your
body weight to perform the maneuver. Deliver each thrust slowly and distinctly.
(4) Repeat the sequence of abdominal thrusts, finger sweep, and rescue breathing (attempt to ventilate)
as long as necessary to remove the object from the obstructed airway. See paragraph d
below.
(5) If the casualty’s chest rises, proceed to feeling for pulse.
c.
Apply chest thrusts. (Note that the chest thrust technique is an alternate method that is used when
the casualty has an abdominal wound, when the casualty is so large that you cannot wrap your
arms around the abdomen, or when the casualty is pregnant.) To perform the chest thrusts:

Basic Measures for First Aid 61


Figure 2-22: Abdominal thrust on unconscious casualty.

(1) Place the unconscious casualty on his back, face up, and open his mouth. Kneel close to the side
of the casualty’s body.
•
Locate the lower edge of the casualty’s ribs with your fingers. Run the fingers up along the
rib cage to the notch (Figure 2-23A).
•
Place the middle finger on the notch and the index finger next to the middle finger on the
lower edge of the breastbone. Place the heel of the other hand on the lower half of the breastbone
next to the two fingers (Figure 2-23B).
•
Remove the fingers from the notch and place that hand on top of the positioned hand on the
breastbone, extending or interlocking the fingers (Figure 2-23C).
•
Straighten and lock your elbows with your shoulders directly above your hands without
bending the elbows, rocking, or allowing the shoulders to sag. Apply enough pressure to
Figure 2-23: Hand placement for chest thrust (Illustrated A-D).


62 The Ultimate Guide to U.S. Army Survival Skills, Tactics, and Techniques

depress the breastbone 1 1/2 to 2 inches, then release the pressure completely (Figure 2-23D).
Do this 6 to 10 times. Each thrust should be delivered slowly and distinctly. See Figure 2-24
for another view of the breastbone being depressed.

(2) Repeat the sequence of chest thrust, finger sweep, and rescue breathing as long as necessary to
clear the object from the obstructed airway. See paragraph d below.
(3) If the casualty’s chest rises, proceed to feeling for his pulse.
d. Finger Sweep. If you still cannot administer rescue breathing due to an airway obstruction, then
remove the airway obstruction using the procedures in steps (1) and (2) below.
(1) Place the casualty on his back, face up, turn the unconscious casualty as a unit, and call out for help.
(2) Perform finger sweep, keep casualty face up, use tongue-jaw lift to open mouth.
•
Open the casualty’s mouth by grasping both his tongue and lower jaw between your thumb
and fingers and lifting (tongue-jaw lift) (Figure 2-25). If you are unable to open his mouth,
cross your fingers and thumb (crossed-finger method) and push his teeth apart (Figure 2-26) by
pressing your thumb against his upper teeth and pressing your finger against his lower teeth.
•
Insert the index finger of the other hand down along the inside of his cheek to the base of the
tongue. Use a hooking motion from the side of the mouth toward the center to dislodge the
foreign body (Figure 2-27).
WARNING
Take care not to force the object deeper into the airway by pushing it with the
finger.
Figure 2-24: Breastbone depressed 1 1/2 to 2 inches


Figure 2-25: Opening casualty’s mouth (tongue-jaw lift).


Basic Measures for First Aid 63


Figure 2-26: Opening casualty’s mouth (crossed-finger method).


Figure 2-27: Using finger to dislodge foreign body.

SECTION II. STOP THE BLEEDING AND PROTECT THE WOUND

2-15. Clothing (081-831-1016). In evaluating the casualty for location, type, and size of the wound or injury,
cut or tear his clothing and carefully expose the entire area of the wound. This procedure is necessary to
avoid further contamination. Clothing stuck to the wound should be left in place to avoid further injury.
DO NOT touch the wound; keep it as clean as possible.

WARNING (081-831-1016)
DO NOT REMOVE protective clothing in a chemical environment. Apply dressings
over the protective clothing.
2-16. Entrance and Exit Wounds. Before applying the dressing, carefully examine the casualty to determine
if there is more than one wound. A missile may have entered at one point and exited at another point.
The EXIT wound is usually LARGER than the entrance wound.


64 The Ultimate Guide to U.S. Army Survival Skills, Tactics, and Techniques

WARNING


Casualty should be continually monitored for development of conditions which
may require the performance of necessary basic lifesaving measures, such as
clearing the airway and mouth-to-mouth resuscitation. All open (or penetrating)
wounds should be checked for a point of entry and exit and treated accordingly.

WARNING


If the missile lodges in the body (fails to exit), DO NOT attempt to remove it or
probe the wound. Apply a dressing. If there is an object extending from (impaled
in) the wound, DO NOT remove the object. Apply a dressing around the object
and use additional improvised bulky materials dressings (use the cleanest material
available) to build up the area around the object. Apply a supporting bandage
over the bulky materials to hold them in place.

2-17. Field Dressing (081-831-1016)

a. Use the casualty’s field dressing; remove it from the wrapper and grasp the tails of the dressing
with both hands (Figure 2-28).
WARNING

DO NOT touch the white (sterile) side of the dressing, and DO NOT allow the
white (sterile) side of the dressing to come in contact with any surface other than
the wound.

b. Hold the dressing directly over the wound with the white side down. Pull the dressing open (Figure
2-29) and place it directly over the wound (Figure 2-30).
c.
Hold the dressing in place with one hand. Use the other hand to wrap one of the tails around the
injured part, covering about one-half of the dressing (Figure 2-31). Leave enough of the tail for a
knot. If the casualty is able, he may assist by holding the dressing in place.
d. Wrap the other tail in the opposite direction until the remainder of the dressing is covered. The tails
should seal the sides of the dressing to keep foreign material from getting under it.
e.
Tie the tails into a non-slip knot over the outer edge of the dressing (Figure 2-32). DO NOT TIE THE
KNOT OVER THE WOUND. In order to allow blood to flow to the rest of an injured limb, tie the
dressing firmly enough to prevent it from slipping but without causing a tourniquet-like effect; that
is, the skin beyond the injury becomes cool, blue, or numb.
Figure 2-28: Grasping tails of dressing with both hands.


Basic Measures for First Aid 65


Figure 2-29: Pulling dressing open.


Figure 2-30: Placing dressing directly on wound.


Figure 2-31: Wrapping tail of dressing around injured part.

2-18. Manual Pressure (081-831-1016)

a.
If bleeding continues after applying the sterile field dressing, direct manual pressure may be used
to help control bleeding. Apply such pressure by placing a hand on the dressing and exerting firm
pressure for 5 to 10 minutes (Figure 2-33). The casualty may be asked to do this himself if he is conscious
and can follow instructions.
b. Elevate an injured limb slightly above the level of the heart to reduce the bleeding (Figure 2-34).

66 The Ultimate Guide to U.S. Army Survival Skills, Tactics, and Techniques


Figure 2-32: Tails tied into nonslip knot.


Figure 2-33: Direct manual pressure applied.


Figure 2-34: Injured limb elevated.

WARNING
DO NOT elevate a suspected fractured limb unless it has been properly splinted.
(To splint a fracture before elevating, see task 081-831-1034, Splint a Suspected
Fracture.)

c. If the bleeding stops, check and treat for shock. If the bleeding continues, apply a pressure dressing.

Basic Measures for First Aid 67

2-19. Pressure Dressing (081-831-1016). Pressure dressings aid in blood clotting and compress the open
blood vessel. If bleeding continues after the application of a field dressing, manual pressure, and elevation,
then a pressure dressing must be applied as follows:

a.
Place a wad of padding on top of the field dressing, directly over the wound (Figure 2-35). Keep
injured extremity elevated.
- NOTE
Improvised bandages may be made from strips of cloth. These strips may be made from
T-shirts, socks, or other garments.

b. Place an improvised dressing (or cravat, if available) over the wad of padding (Figure 2-36). Wrap the
ends tightly around the injured limb, covering the previously placed field dressing (Figure 2-37).
c.
Tie the ends together in a non-slip knot, directly over the wound site (Figure 2-38). DO NOT tie so
tightly that it has a tourniquet-like effect. If bleeding continues and all other measures have failed,
or if the limb is severed, then apply a tourniquet. Use the tourniquet as a LAST RESORT. When the
bleeding stops, check and treat for shock.
Figure 2-35: Wad of padding on top of field dressing.


Figure 2-36: Improvised dressing over wad of padding.


68 The Ultimate Guide to U.S. Army Survival Skills, Tactics, and Techniques


Figure 2-37: Ends of improvised dressing wrapped tightly around limb.


Figure 2-38: Ends of improvised dressing tied together in nonslip knot.

- NOTE
Wounded extremities should be checked periodically for adequate circulation. The dressing
must be loosened if the extremity becomes cool, blue or gray, or numb.

- *NOTE
If bleeding continues and all other measures have failed (dressing and covering wound,
applying direct manual pressure, elevating limb above heart level, and applying pressure
dressing maintaining limb elevation), then apply digital pressure. See Appendix E
for appropriate pressure points.

2-20. Tourniquet (081-831-1017). A tourniquet is a constricting band placed around an arm or leg to control
bleeding. A soldier whose arm or leg has been completely amputated may not be bleeding when first
discovered, but a tourniquet should be applied anyway. This absence of bleeding is due to the body’s normal
defenses (contraction of blood vessels) as a result of the amputation, but after a period of time bleeding
will start as the blood vessels relax. Bleeding from a major artery of the thigh, lower leg, or arm and


Basic Measures for First Aid 69

bleeding from multiple arteries (which occurs in a traumatic amputation) may prove to be beyond control
by manual pressure. If the pressure dressing under firm hand pressure becomes soaked with blood and the
wound continues to bleed, apply a tourniquet.

WARNING
Casualty should be continually monitored for development of conditions which
may require the performance of necessary basic life-saving measures, such as:
clearing the airway, performing mouth-to-mouth resuscitation, preventing shock,
and/or bleeding control. All open (or penetrating) wounds should be checked
for a point of entry or exit and treated accordingly.
* The tourniquet should not be used unless a pressure dressing has failed to stop the bleeding or an arm
or leg has been cut off. On occasion, tourniquets have injured blood vessels and nerves. If left in place too
long, a tourniquet can cause loss of an arm or leg. Once applied, it must stay in place, and the casualty
must be taken to the nearest medical treatment facility as soon as possible. DO NOT loosen or release a
tourniquet after it has been applied and the bleeding has stopped.
a.
Improvising a Tourniquet (081-831-1017). In the absence of a specially designed tourniquet, a tourniquet
may be made from a strong, pliable material, such as gauze or muslin bandages, clothing, or
kerchiefs. An improvised tourniquet is used with a rigid stick-like object. To minimize skin damage,
ensure that the improvised tourniquet is at least 2 inches wide.
WARNING
The tourniquet must be easily identified or easily seen.
WARNING
DO NOT use wire or shoestring for a tourniquet band.
WARNING
A tourniquet is only used on arm(s) or leg(s) where there is danger of loss of
casualty’s life.
b. Placing the Improvised Tourniquet (081-831-1017).
(1) Place the tourniquet around the limb, between the wound and the body trunk (or between
the wound and the heart). Place the tourniquet 2 to 4 inches from the edge of the wound site
(Figure 2-39). Never place it directly over a wound or fracture or directly on a joint (wrist, elbow,
or knee). For wounds just below a joint, place the tourniquet just above and as close to the joint
as possible.
(2) The tourniquet should have padding underneath. If possible, place the tourniquet over the
smoothed sleeve or trouser leg to prevent the skin from being pinched or twisted. If the tourniquet
is long enough, wrap it around the limb several times, keeping the material as flat as
possible. Damaging the skin may deprive the surgeon of skin required to cover an amputation.
Protection of the skin also reduces pain.

70 The Ultimate Guide to U.S. Army Survival Skills, Tactics, and Techniques


Figure 2-39: Tourniquet 2 to 4 inches above wound.

c. Applying the Tourniquet (081-831-1017).
(1) Tie a half-knot. (A half-knot is the same as the first part of tying a shoe lace.)
(2) Place a stick (or similar rigid object) on top of the half-knot (Figure 2-40).
(3) Tie a full knot over the stick (Figure 2-41).
(4) Twist the stick (Figure 2-42) until the tourniquet is tight around the limb and/or the bright red
bleeding has stopped. In the case of amputation, dark oozing blood may continue for a short
time. This is the blood trapped in the area between the wound and tourniquet.
Figure 2-40: Rigid object on top of half-knot.


Figure 2-41: Full knot over rigid object.


Basic Measures for First Aid 71


Figure 2-42: Stick twisted.

(5) Fasten the tourniquet to the limb by looping the free ends of the tourniquet over the ends of
the stick. Then bring the ends around the limb to prevent the stick from loosening. Tie them
together under the limb (Figure 2-43A and B).
- NOTE (081-831-1017)
Other methods of securing the stick may be used as long as the stick does not unwind
and no further injury results.



Figure 2-43: Free ends looped (Illustrated A and B).


72 The Ultimate Guide to U.S. Army Survival Skills, Tactics, and Techniques

- NOTE
If possible, save and transport any severed (amputated) limbs or body parts with (but out
of sight of) the casualty.

(6) DO NOT cover the tourniquet—you should leave it in full view. If the limb is missing (total
amputation), apply a dressing to the stump.
(7) Mark the casualty’s forehead, if possible, with a “T” to indicate a tourniquet has been applied.
If necessary, use the casualty’s blood to make this mark.
(8) Check and treat for shock.
(9) Seek medical aid.
CAUTION (081-831-1017)
Do not loosen or release the tourniquet once it has been applied because it could enhance
the probability of shock.

SECTION III. CHECK AND TREAT FOR SHOCK
2-21. Causes and Effects

a. Shock may be caused by severe or minor trauma to the body. It usually is the result of—
• Significant loss of blood.
• Heart failure.
• Dehydration.
• Severe and painful blows to the body.
• Severe burns of the body.
• Severe wound infections.
• Severe allergic reactions to drugs, foods, insect stings, and snakebites.
b. Shock stuns and weakens the body. When the normal blood flow in the body is upset, death can
result. Early identification and proper treatment may save the casualty’s life.
c. See FM 8-230 for further information and details on specific types of shock and treatment.
2-22. Signs/Symptoms (081-831-1000). Examine the casualty to see if he has any of the following signs/
symptoms:

• Sweaty but cool skin (clammy skin).
• Paleness of skin.
• Restlessness, nervousness.
• Thirst.
• Loss of blood (bleeding).
• Confusion (or loss of awareness).
• Faster-than-normal breathing rate.
• Blotchy or bluish skin (especially around the mouth and lips).
• Nausea and/or vomiting.
2-23. Treatment/Prevention (081-831-1005). In the field, the procedures to treat shock are identical to procedures
that would be performed to prevent shock. When treating a casualty, assume that shock is present
or will occur shortly. By waiting until actual signs/symptoms of shock are noticeable, the rescuer may
jeopardize the casualty’s life.


Basic Measures for First Aid 73

a.
Position the Casualty. (DO NOT move the casualty or his limbs if suspected fractures have not been
splinted. See Chapter 4 for details.)
(1) Move the casualty to cover, if cover is available and the situation permits.
(2) Lay the casualty on his back.
- NOTE
A casualty in shock after suffering a heart attack, chest wound, or breathing difficulty,
may breathe easier in a sitting position. If this is the case, allow him to sit upright, but
monitor carefully in case his condition worsens.


(3) Elevate the casualty’s feet higher than the level of his heart. Use a stable object (a box, field pack,
or rolled up clothing) so that his feet will not slip off (Figure 2-44).
WARNING
DO NOT elevate legs if the casualty has an unsplinted broken leg, head injury, or
abdominal injury. (See task 081-831-1034, Splint a Suspected Fracture, and task
081-831-1025, Apply a Dressing to an Open Abdominal Wound.)
WARNING (081-831-1005)
Check casualty for leg fracture(s) and splint, if necessary, before elevating his
feet. For a casualty with an abdominal wound, place knees in an upright (flexed)
position.
(4) Loosen clothing at the neck, waist, or wherever it may be binding.
CAUTION (081-831-1005)
DO NOT LOOSEN OR REMOVE protective clothing in a chemical environment.

(5) Prevent chilling or overheating. The key is to maintain body temperature. In cold weather, place
a blanket or other like item over him to keep him warm and under him to prevent chilling
(Figure 2-45). However, if a tourniquet has been applied, leave it exposed (if possible). In hot
weather, place the casualty in the shade and avoid excessive covering.
(6) Calm the casualty. Throughout the entire procedure of treating and caring for a casualty, the
rescuer should reassure the casualty and keep him calm. This can be done by being authoritative
(taking charge) and by showing self-confidence. Assure the casualty that you are there to
help him.
(7) Seek medical aid.
Figure 2-44: Clothing loosened and feet elevated.


74 The Ultimate Guide to U.S. Army Survival Skills, Tactics, and Techniques


Figure 2-45: Body temperature maintained.


Figure 2-46: Casualty’s head turned to side.

b. Food and/or Drink. During the treatment/prevention of shock, DO NOT give the casualty any food
or drink. If you must leave the casualty or if he is unconscious, turn his head to the side to prevent
him from choking should he vomit (Figure 2-46).
c. Evaluate Casualty. If necessary, continue with the casualty’s evaluation.

CHAPTER 3


First Aid for Special Wounds


* Basic lifesaving steps are discussed in Chapters 1 and 2: clear the airway/restore breathing, stop the
bleeding, protect the wound, and treat/prevent shock. They apply to first aid measures for all injuries.
Certain types of wounds and burns will require special precautions and procedures when applying these
measures. This chapter discusses first aid procedures for special wounds of the head, face, and neck; chest
and stomach wounds; and burns. It also discusses the techniques for applying dressings and bandages to
specific parts of the body.
SECTION I. GIVE PROPER FIRST AID FOR HEAD INJURIES

3-1. Head Injuries. A head injury may consist of one or a combination of the following conditions: a concussion,
a cut or bruise of the scalp, or a fracture of the skull with injury to the brain and the blood vessels of
the scalp. The damage can range from a minor cut on the scalp to a severe brain injury which rapidly causes
death. Most head injuries lie somewhere between the two extremes. Usually, serious skull fractures and
brain injuries occur together; however, it is possible to receive a serious brain injury without a skull fracture.
The brain is a very delicate organ; when it is injured, the casualty may vomit, become sleepy, suffer paralysis,
or lose consciousness and slip into a coma. All severe head injuries are potentially life-threatening. For
recovery and return to normal function, casualties require proper first aid as a vital first step.

3-2. Signs/Symptoms (081-831-1000). A head injury may be open or closed. In open injuries, there is a
visible wound and, at times, the brain may actually be seen. In closed injuries, no visible injury is seen, but
the casualty may experience the same signs and symptoms. Either closed or open head injuries can be lifethreatening
if the injury has been severe enough; thus, if you suspect a head injury, evaluate the casualty
for the following:

• Current or recent unconsciousness (loss of consciousness).
• Nausea or vomiting.
• Convulsions or twitches (involuntary jerking and shaking).
• Slurred speech.
• Confusion.
• Sleepiness (drowsiness).
• Loss of memory (does casualty know his own name, where he is, and so forth).
• Clear or bloody fluid leaking from nose or ears.
• Staggering in walking.
• Dizziness.
• A change in pulse rate.
• Breathing problems.
• Eye (vision) problems, such as unequal pupils.
• Paralysis.
• Headache.
• Black eyes.
• Bleeding from scalp/head area.
• Deformity of the head.
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76 The Ultimate Guide to U.S. Army Survival Skills, Tactics, and Techniques

3-3. General First Aid Measures (081-831-1000)

a.
General Considerations. The casualty with a head injury (or suspected head injury) should be continually
monitored for the development of conditions which may require the performance of the
necessary basic lifesaving measures, therefore be prepared to—
•
Clear the airway (and be prepared to perform the basic lifesaving measures). Treat as a suspected
neck/spinal injury until proven otherwise. (See Chapter 4 for more information.)
•
Place a dressing over the wounded area. DO NOT attempt to clean the wound.
•
Seek medical aid.
•
Keep the casualty warm.
•
DO NOT attempt to remove a protruding object from the head.
•
DO NOT give the casualty anything to eat or drink.
b. Care of the Unconscious Casualty. If a casualty is unconscious as the result of a head injury, he is not
able to defend himself. He may lose his sensitivity to pain or ability to cough up blood or mucus that
may be plugging his airway. An unconscious casualty must be evaluated for breathing difficulties,
uncontrollable bleeding, and spinal injury.
(1) Breathing. The brain requires a constant supply of oxygen. A bluish (or in an individual with
dark skin—grayish) color of skin around the lips and nail beds indicates that the casualty is not
receiving enough air (oxygen). Immediate action must be taken to clear the airway, to position
the casualty on his side, or to give artificial respiration. Be prepared to give artificial respiration
if breathing should stop.
(2) Bleeding. Bleeding from a head injury usually comes from blood vessels within the scalp. Bleeding
can also develop inside the skull or within the brain. In most instances bleeding from the
head can be controlled by proper application of the field first aid dressing.
CAUTION (081-831-1033)
DO NOT attempt to put unnecessary pressure on the wound or attempt to push any
brain matter back into the head (skull). DO NOT apply a pressure dressing.

(3) Spinal injury. A person that has an injury above the collar bone or a head injury resulting in an
unconscious state should be suspected of having a neck or head injury with spinal cord damage.
Spinal cord injury may be indicated by a lack of responses to stimuli, stomach distention
(enlargement), or penile erection.
(a) Lack of responses to stimuli. Starting with the feet, use a sharp pointed object–a sharp stick
or something similar, and prick the casualty lightly while observing his face. If the casualty
blinks or frowns, this indicates that he has feeling and may not have an injury to the spinal
cord. If you observe no response in the casualty’s reflexes after pricking upwards toward the
chest region, you must use extreme caution and treat the casualty for an injured spinal cord.
(b) Stomach distention (enlargement). Observe the casualty’s chest and stomach. If the stomach
is distended (enlarged) when the casualty takes a breath and the chest moves slightly, the
casualty may have a spinal injury and must be treated accordingly.
(c) Penile erection. A male casualty may have a penile erection, an indication of a spinal injury.
CAUTION
Remember to suspect any casualty who has a severe head injury or who is unconscious as
possibly having a broken neck or a spinal cord injury! It is better to treat conservatively
and assume that the neck/spinal cord is injured rather than to chance further injuring the
casualty. Consider this when you position the casualty. See Chapter 4, paragraph 4-9 for
treatment procedures of spinal column injuries.


First Aid for Special Wounds 77

c.
Concussion. If an individual receives a heavy blow to the head or face, he may suffer a brain
concussion, which is an injury to the brain that involves a temporary loss of some or all of the brain’s
ability to function. For example, the casualty may not breathe properly for a short period of time, or
he may become confused and stagger when he attempts to walk. A concussion may only last for a
short period of time. However, if a casualty is suspected of having suffered a concussion, he must
be seen by a physician as soon as conditions permit.
d. Convulsions. Convulsions (seizures/involuntary jerking) may occur after a mild head injury. When
a casualty is convulsing, protect him from hurting himself. Take the following measures:
(1) Ease him to the ground.
(2) Support his head and neck.
(3) Maintain his airway.
(4) Call for assistance.
(5) Treat the casualty’s wounds and evacuate him immediately.
e.
Brain Damage. In severe head injuries where brain tissue is protruding, leave the wound alone;
carefully place a first aid dressing over the tissue. DO NOT remove or disturb any foreign matter
that may be in the wound. Position the casualty so that his head is higher than his body. Keep him
warm and seek medical aid immediately.
- NOTE

•
DO NOT forcefully hold the arms and legs if they are jerking because this can
lead to broken bones.
•
DO NOT force anything between the casualty’s teeth-especially if they are tightly
clenched because this may obstruct the casualty’s airway.
•
Maintain the casualty’s airway if necessary.
3-4. Dressings and Bandages (081-831-1000 and 081-831-1033)

* a.
Evaluate the Casualty (081-831-1000). Be prepared to perform lifesaving measures. The basic lifesaving
measures may include clearing the airway, rescue breathing, treatment for shock, and/or
bleeding control.
b. Check Level of Consciousness/Responsiveness (081-831-1033). With a head injury, an important
area to evaluate is the casualty’s level of consciousness and responsiveness. Ask the casualty questions
such as—
•
“What is your name?” (Person)
•
“Where are you?” (Place)
•
“What day/month/year is it?” (Time)
Any incorrect responses, inability to answer, or changes in responses should be reported to medical
personnel. Check the casualty’s level of consciousness every 15 minutes and note any changes from earlier
observations.

c. Position the Casualty (081-831-1033).
WARNING (081-831-1033)

DO NOT move the casualty if you suspect he has sustained a neck, spine, or severe
head injury (which produces any signs or symptoms other than minor bleeding).
See task 081-831-1000, Evaluate the Casualty.

•
If the casualty is conscious or has a minor (superficial) scalp wound:
•
Have the casualty sit up (unless other injuries prohibit or he is unable); OR

78 The Ultimate Guide to U.S. Army Survival Skills, Tactics, and Techniques

•
If the casualty is lying down and is not accumulating fluids or drainage in his throat, elevate
his head slightly; OR
•
If the casualty is bleeding from or into his mouth or throat, turn his head to the side or position
him on his side so that the airway will be clear. Avoid pressure on the wound or place
him on his side–opposite the site of the injury (Figure 3-1).
•
If the casualty is unconscious or has a severe head injury, then suspect and treat him as having
a potential neck or spinal injury, immobilize and DO NOT move the casualty.
- NOTE
If the casualty is choking and/or vomiting or is bleeding from or into his mouth (thus
compromising his airway), position him on his side so that his airway will be clear. Avoid
pressure on the wound; place him on his side opposite the side of the injury.

WARNING (081-831-1033)
If it is necessary to turn a casualty with a suspected neck/spine injury, roll the
casualty gently onto his side, keeping the head, neck, and body aligned while
providing support for the head and neck. DO NOT roll the casualty by yourself
but seek assistance. Move him only if absolutely necessary, otherwise keep the
casualty immobilized to prevent further damage to the neck/spine.
d. Expose the Wound (081-831-1033).
•
Remove the casualty’s helmet (if necessary).
•
In a chemical environment:
•
If mask and/or hood is not breached, apply no dressing to the head wound casualty. If
the “all clear” has not been given, DO NOT remove the casualty’s mask to attend the head
wound: OR
•
If mask and/or hood have been breached and the “all clear” has not been given, try to repair
the breach with tape and apply no dressing; OR
•
If mask and/or hood have been breached and the “all clear” has been given the mask can be
removed and a dressing applied.
WARNING
DO NOT attempt to clean the wound, or remove a protruding object.
Figure 3-1: Casualty lying on side opposite injury.


First Aid for Special Wounds 79

- NOTE
If there is an object extending from the wound, DO NOT remove the object. Improvise
bulky dressings from the cleanest material available and place these dressings around
the protruding object for support after applying the field dressing.

.
NOTE

Always use the casualty’s field dressing, not your own!

e.
Apply a Dressing to a Wound of the Forehead/Back of Head (081-831-1033). To apply a dressing to
a wound of the forehead or back of the head—
(1) Remove the dressing from the wrapper.
(2) Grasp the tails of the dressing in both hands.
(3) Hold the dressing (white side down) directly over the wound. DO NOT touch the white (sterile)
side of the dressing or allow anything except the wound to come in contact with the white
side.
(4) Place it directly over the wound.
(5) Hold it in place with one hand. If the casualty is able, he may assist.
(6) Wrap the first tail horizontally around the head; ensure the tail covers the dressing (Figure 3-2).
(7) Hold the first tail in place and wrap the second tail in the opposite direction, covering the dressing
(Figure 3-3).
(8) Tie a non slip knot and secure the tails at the side of the head, making sure they DO NOT cover
the eyes or ears (Figure 3-4).
Figure 3-2: First tail of dressing wrapped horizontally around head.


Figure 3-3: Second tail wrapped in opposite direction.


80 The Ultimate Guide to U.S. Army Survival Skills, Tactics, and Techniques


Figure 3-4: Tails tied in nonslip knot at side of head.

f.
Apply a Dressing to a Wound on Top of the Head (081-831-1033). To apply a dressing to a wound
on top of the head–
(1) Remove the dressing from the wrapper.
(2) Grasp the tails of the dressing in both hands.
(3) Hold it (white side down) directly over the wound.
(4) Place it over the wound (Figure 3-5).
(5) Hold it in place with one hand. If the casualty is able, he may assist.
(6) Wrap one tail down under the chin (Figure 3-6), up in front of the ear, over the dressing, and in
front of the other ear.
WARNING
(Make sure the tails remain wide and close to the front of the chin to avoid choking
the casualty.)

(7) Wrap the remaining tail under the chin in the opposite direction and up the side of the face to
meet the first tail (Figure 3-7).
(8) Cross the tails (Figure 3-8), bringing one around the forehead (above the eyebrows) and the
other around the back of the head (at the base of the skull) to a point just above and in front of
the opposite ear, and tie them using a non slip knot (Figure 3-9).
Figure 3-5: Dressing placed over wound.


First Aid for Special Wounds 81


Figure 3-6: One tail of dressing wrapped under chin.


Figure 3-7: Remaining tail wrapped under chin in opposite direction.


Figure 3-8: Tails of dressing crossed with one around forehead.

g. Apply a Triangular Bandage to the Head. To apply a triangular bandage to the head–
(1) Turn the base (longest side) of the bandage up and center its base on center of the forehead, letting
the point (apex) fall on the back of the neck (Figure 3-10 A).
(2) Take the ends behind the head and cross the ends over the apex.
(3) Take them over the forehead and tie them (Figure 3-10 B).
(4) Tuck the apex behind the crossed part of the bandage and/or secure it with a safety pin, if available
(Figure 3-10 C).

82 The Ultimate Guide to U.S. Army Survival Skills, Tactics, and Techniques


Figure 3-9: Tails tied in nonslip knot (in front of and above ear).


Figure 3-10: Triangular bandage applied to head (Illustrated A thru C).


Figure 3-11: Cravat bandage applied to head (Illustrated A thru C).

h. Apply a Cravat Bandage to the Head. To apply a cravat bandage to the head–
(1) Place the middle of the bandage over the dressing (Figure 3-11 A).
(2) Cross the two ends of the bandage in opposite directions completely around the head (Figure 3-11 B).
(3) Tie the ends over the dressing (Figure 3-11 C).

First Aid for Special Wounds 83

SECTION II. GIVE PROPER FIRST AID FOR FACE AND NECK INJURIES

3-5. Face Injuries. Soft tissue injuries of the face and scalp are common. Abrasions (scrapes) of the skin
cause no serious problems. Contusions (injury without a break in the skin) usually cause swelling. A contusion
of the scalp looks and feels like a lump. Laceration (cut) and avulsion (torn away tissue) injuries
are also common. Avulsions are frequently caused when a sharp blow separates the scalp from the skull
beneath it. Because the face and scalp are richly supplied with blood vessels (arteries and veins), wounds
of these areas usually bleed heavily.

3-6. Neck Injuries. Neck injuries may result in heavy bleeding. Apply manual pressure above and below
the injury and attempt to control the bleeding. Apply a dressing. Always evaluate the casualty for a possible
neck fracture/spinal cord injury; if suspected, seek medical treatment immediately.

- * NOTE
Establish and maintain the airway in cases of facial or neck injuries. If a neck fracture or
spinal cord injury is suspected, immobilize or stabilize casualty. See Chapter 4 for further
information on treatment of spinal injuries.

3-7. Procedure. When a casualty has a face or neck injury, perform the measures below.

a.
Step ONE. Clear the airway. Be prepared to perform any of the basic lifesaving steps. Clear the
casualty’s airway (mouth) with your fingers, remove any blood, mucus, pieces of broken teeth or
bone, or bits of flesh, as well as any dentures.
b. Step TWO. Control any bleeding, especially bleeding that obstructs the airway. Do this by applying
direct pressure over a first aid dressing or by applying pressure at specific pressure points on the
face, scalp, or temple. (See Appendix E for further information on pressure points.) If the casualty is
bleeding from the mouth, position him as indicated (c below) and apply manual pressure.
CAUTION
Take care not to apply too much pressure to the scalp if a skull fracture is suspected.

c. Step THREE. Position the casualty. If the casualty is bleeding from the mouth (or has other drainage,
such as mucus, vomitus, or so forth) and is conscious, place him in a comfortable sitting position
and have him lean forward with his head tilted slightly down to permit free drainage (Figure 3-12).
DO NOT use the sitting position if–
Figure 3-12: Casualty leaning forward to permit drainage.


84 The Ultimate Guide to U.S. Army Survival Skills, Tactics, and Techniques

•
It would be harmful to the casualty because of other injuries.
•
The casualty is unconscious, in which case, place him on his side (Figure 3-13). If there is a suspected
injury to the neck or spine, immobilize the head before turning the casualty on his side.
CAUTION
If you suspect the casualty has a neck/spinal injury, then immobilize his head/neck and
treat him as outlined in Chapter 4.

d. Step FOUR. Perform other measures.
(1) Apply dressings/bandages to specific areas of the face.
(2) Check for missing teeth and pieces of tissue. Check for detached teeth in the airway. Place
detached teeth, pieces of ear or nose on a field dressing and send them along with the casualty
to the medical facility. Detached teeth should be kept damp.
(3) Treat for shock and seek medical treatment IMMEDIATELY.
3-8. Dressings and Bandages (081-831-1033)

a. Eye Injuries. The eye is a vital sensory organ, and blindness is a severe physical handicap. Timely
first aid of the eye not only relieves pain but also helps prevent shock, permanent eye injury, and
possible loss of vision. Because the eye is very sensitive, any injury can be easily aggravated if it is
improperly handled. Injuries of the eye may be quite severe. Cuts of the eyelids can appear to be
very serious, but if the eyeball is not involved, a person’s vision usually will not be damaged. However,
lacerations (cuts) of the eyeball can cause permanent damage or loss of sight.
(1) Lacerated/torn eyelids. Lacerated eyelids may bleed heavily, but bleeding usually stops quickly.
Cover the injured eye with a sterile dressing. DO NOT put pressure on the wound because you
may injure the eyeball. Handle torn eyelids very carefully to prevent further injury. Place any
detached pieces of the eyelid on a clean bandage or dressing and immediately send them with
the casualty to the medical facility.
(2) Lacerated eyeball (injury to the globe). Lacerations or cuts to the eyeball may cause serious
and permanent eye damage. Cover the injury with a loose sterile dressing. DO NOT put pressure
on the eyeball because additional damage may occur. An important point to remember is
that when one eyeball is injured, you should immobilize both eyes. This is done by applying a
bandage to both eyes. Because the eyes move together, covering both will lessen the chances of
further damage to the injured eye.
CAUTION
DO NOT apply pressure when there is a possible laceration of the eyeball. The eyeball contains
fluid. Pressure applied over the eye will force the fluid out, resulting in/permanent
injury. APPLY PROTECTIVE DRESSING WITHOUT ADDED PRESSURE.

Figure 3-13: Casualty lying on side.


First Aid for Special Wounds 85

(3) Extruded eyeballs. Soldiers may encounter casualties with severe eye injuries that include an
extruded eyeball (eyeball out-of-socket). In such instances you should gently cover the extruded
eye with a loose moistened dressing and also cover the unaffected eye. DO NOT bind or exert
pressure on the injured eye while applying a loose dressing. Keep the casualty quiet, place him
on his back, treat for shock (make warm and comfortable), and evacuate him immediately.
(4) Burns of the eyes. Chemical burns, thermal (heat) burns, and light burns can affect the eyes.
(a) Chemical burns. Injuries from chemical burns require immediate first aid. Chemical burns
are caused mainly by acids or alkalies. The first aid is to flush the eye(s) immediately with
large amounts of water for at least 5 to 20 minutes, or as long as necessary to flush out the
chemical. If the burn is an acid burn, you should flush the eye for at least 5 to 10 minutes. If
the burn is an alkali burn, you should flush the eye for at least 20 minutes. After the eye has
been flushed, apply a bandage over the eyes and evacuate the casualty immediately.
(b) Thermal burns. When an individual suffers burns of the face from a fire, the eyes will close
quickly due to extreme heat. This reaction is a natural reflex to protect the eyeballs; however,
the eyelids remain exposed and are frequently burned. If a casualty receives burns
of the eyelids/face, DO NOT apply a dressing; DO NOT TOUCH; seek medical treatment
immediately.
(c) Light burns. Exposure to intense light can burn an individual. Infrared rays, eclipse light
(if the casualty has looked directly at the sun), or laser burns cause injuries of the exposed
eyeball. Ultraviolet rays from arc welding can cause a superficial burn to the surface of the
eye. These injuries are generally not painful but may cause permanent damage to the eyes.
Immediate first aid is usually not required. Loosely bandaging the eyes may make the casualty
more comfortable and protect his eyes from further injury caused by exposure to other
bright lights or sunlight.
CAUTION
In certain instances both eyes are usually bandaged; but, in hazardous surroundings leave
the uninjured eye uncovered so that the casualty may be able to see.

b. Side-of-Head or Cheek Wound (081-831-1033). Facial injuries to the side of the head or the cheek may
bleed profusely (Figure 3-14). Prompt action is necessary to ensure that the airway remains open and
also to control the bleeding. It may be necessary to apply a dressing. To apply a dressing—
(1) Remove the dressing from its wrapper.
(2) Grasp the tails in both hands.
(3) Hold the dressing directly over the wound with the white side down and place it directly on the
wound (Figure 3-15 A).
Figure 3-14: Side of head or cheek wound.


86 The Ultimate Guide to U.S. Army Survival Skills, Tactics, and Techniques


Figure 3-15: Dressing placed directly on wound. Top tail wrapped over top of head, down in front of ear,
and under chin (Illustrated A and B).

(4) Hold the dressing in place with one hand (the casualty may assist if able). Wrap the top tail over the
top of the head and bring it down in front of the ear (on the side opposite the wound), under the
chin (Figure 3-15 B ) and up over the dressing to a point just above the ear (on the wound side).
- NOTE
When possible, avoid covering the casualty’s ear with the dressing, as this will decrease
his ability to hear.

(5) Bring the second tail under the chin, up in front of the ear (on the side opposite the wound), and
over the head to meet the other tail (on the wound side) (Figure 3-16).
(6) Cross the two tails (on the wound side) (Figure 3-17) and bring one end across the forehead
(above the eyebrows) to a point just in front of the opposite ear (on the uninjured side).
(7) Wrap the other tail around the back of the head (at the base of the skull), and tie the two ends
just in front of the ear on the uninjured side with a non slip knot (Figure 3-18).
c.
Ear Injuries. Lacerated (cut) or avulsed (torn) ear tissue may not, in itself, be a serious injury. Bleeding,
or the drainage of fluids from the ear canal, however, may be a sign of a head injury, such as
a skull fracture. DO NOT attempt to stop the flow from the inner ear canal nor put anything into
the ear canal to block it. Instead, you should cover the ear lightly with a dressing. For minor cuts or
wounds to the external ear, apply a cravat bandage as follows:
Figure 3-16: Bringing second tail under the chin.


First Aid for Special Wounds 87


Figure 3-17: crossing the tails on the side of the wound.


Figure 3-18: Tying the tails of the dressing in a nonslip knot.


Figure 3-19: Applying cravat bandage to ear (Illustrated A thru C).

(1) Place the middle of the bandage over the ear (Figure 3-19 A).
(2) Cross the ends, wrap them in opposite directions around the head, and tie them (Figures 3-19 B
and 3-19 C).
(3) If possible, place some dressing material between the back of the ear and the side of the head to
avoid crushing the ear against the head with the bandage.
d. Nose Injuries. Nose injuries generally produce bleeding. The bleeding may be controlled by placing
an ice pack over the nose, or pinching the nostrils together. The bleeding may also be controlled by
placing torn gauze (rolled) between the upper teeth and the lip.

88 The Ultimate Guide to U.S. Army Survival Skills, Tactics, and Techniques


CAUTION
DO NOT attempt to remove objects inhaled in the nose. An untrained person who removes
such an object could worsen the casualty’s condition and cause permanent injury.

e.
Jaw Injuries. Before applying a bandage to a casualty’s jaw, remove all foreign material from the
casualty’s mouth. If the casualty is unconscious, check for obstructions in the airway. When applying
the bandage, allow the jaw enough freedom to permit passage of air and drainage from the
mouth.
(1) Apply bandages attached to field first aid dressing to the jaw. After dressing the wound, apply
the bandages using the same technique illustrated in Figures 3-5 through 3-8.
- NOTE
The dressing and bandaging procedure outlined for the jaw serves a twofold purpose.
In addition to stopping the bleeding and protecting the wound, it also immobilizes a
fractured jaw.


(2) Apply a cravat bandage to the jaw.
(a) Place the bandage under the chin and carry its ends upward. Adjust the bandage to make
one end longer than the other (Figure 3-20 A).
(b) Take the longer end over the top of the head to meet the short end at the temple and cross
the ends over (Figure 3-20 B).
(c) Take the ends in opposite directions to the other side of the head and tie them over the part
of the bandage that was applied first (Figure 3-20 C).
- NOTE
The cravat bandage technique is used to immobilize a fractured jaw or to maintain a sterile
dressing that does not have tail bandages attached.

SECTION III. GIVE PROPER FIRST AID FOR CHEST AND ABDOMINAL WOUNDS
AND BURN INJURIES

3-9. Chest Wounds (081-831-1026). Chest injuries may be caused by accidents, bullet or missile wounds,
stab wounds, or falls. These injuries can be serious and may cause death quickly if proper treatment is


Figure 3-20: Applying cravat bandage to jew (Illustrated A thru C).


First Aid for Special Wounds 89

not given. A casualty with a chest injury may complain of pain in the chest or shoulder area; he may have
difficulty with his breathing. His chest may not rise normally when he breathes. The injury may cause the
casualty to cough up blood and to have a rapid or a weak heartbeat. A casualty with an open chest wound
has a punctured chest wall. The sucking sound heard when he breathes is caused by air leaking into his
chest cavity. This particular type of wound is dangerous and will collapse the injured lung (Figure 3-21).
Breathing becomes difficult for the casualty because the wound is open. The soldier’s life may depend
upon how quickly you make the wound airtight.

3-10. Chest Wound(s) Procedure (081-831-1026)

* a.
Evaluate the Casualty (081-831-1000). Be prepared to perform lifesaving measures. The basic lifesaving
measures may include clearing the airway, rescue breathing, treatment for shock, and/or
bleeding control.
b. Expose the Wound. If appropriate, cut or remove the casualty’s clothing to expose the entire area
of the wound. Remember, DO NOT remove clothing that is stuck to the wound because additional
injury may result. DO NOT attempt to clean the wound.
- NOTE
Examine the casualty to see if there is an entry and/or exit wound. If there are two
wounds (entry, exit), perform the same procedure for both wounds. Treat the more serious
(heavier bleeding, larger) wound first. It may be necessary to improvise a dressing
for the second wound by using strips of cloth, such as a torn T-shirt, or whatever material
is available. Also, listen for sucking sounds to determine if the chest wall is punctured.


CAUTION
If there is an object extending from (impaled in) the wound, DO NOT remove the object.
Apply a dressing around the object and use additional improvised bulky materials/dressings
(use the cleanest materials available) to build up the area around the object. Apply a
supporting bandage over the bulky materials to hold them in place.


CAUTION (081-831-1026)
DO NOT REMOVE protective clothing in a chemical environment. Apply dressings over
the protective clothing.

c.
Open the Casualty’s Field Dressing Plastic Wrapper. The plastic wrapper is used with the field
dressing to create an airtight seal. If a plastic wrapper is not available, or if an additional wound
needs to be treated; cellophane, foil, the casualty’s poncho, or similar material maybe used. The
Figure 3-21: Collapsed lung.


90 The Ultimate Guide to U.S. Army Survival Skills, Tactics, and Techniques

covering should be wide enough to extend 2 inches or more beyond the edges of the wound in all
directions.

(1) Tear open one end of the casualty’s plastic wrapper covering the field dressing. Be careful not
to destroy the wrapper and DO NOT touch the inside of the wrapper.
(2) Remove the inner packet (field dressing).
(3) Complete tearing open the empty plastic wrapper using as much of the wrapper as possible to
create a flat surface.
d. Place the Wrapper Over the Wound (081-831-1026). Place the inside surface of the plastic wrapper
directly over the wound when the casualty exhales and hold it in place (Figure 3-22). The casualty
may hold the plastic wrapper in place if he is able.
e. Apply the Dressing to the Wound (081-831-1026).
(1) Use your free hand and shake open the field dressing (Figure 3-23).
(2) Place the white side of the dressing on the plastic wrapper covering the wound (Figure 3-24).
- NOTE (081-831-1026)
Use the casualty’s field dressing, not your own.

(3) Have the casualty breathe normally.
Figure 3-22: Open chest wound sealed with plastic wrapper.


Figure 3-23: Shaking open the field dressing.


First Aid for Special Wounds 91


Figure 3-24: Field dressing placed on plastic wrapper.

(4) While maintaining pressure on the dressing, grasp one tail of the field dressing with the other
hand and wrap it around the casualty’s back.
(5) Wrap the other tail in the opposite direction, bringing both tails over the dressing (Figure 3-25).
(6) Tie the tails into a non slip knot in the center of the dressing after the casualty exhales and before he
inhales. This will aid in maintaining pressure on the bandage after it has been tied (Figure 3-26). Tie
the dressing firmly enough to secure the dressing without interfering with the casualty’s breathing.
- NOTE (081-831-1026)
When practical, apply direct manual pressure over the dressing for 5 to 10 minutes to
help control the bleeding.



Figure 3-25: Tails of field dressing wrapped around casualty in opposite direction.


Figure 3-26: Tails of dressing tied into nonslip knot over center of dressing.


92 The Ultimate Guide to U.S. Army Survival Skills, Tactics, and Techniques

f. Position the Casualty (081-831-1026). Position the casualty on his injured side or in a sitting position,
whichever makes breathing easier (Figure 3-27).
g. Seek Medical Aid. Contact medical personnel.
* WARNING
Even if an airtight dressing has been placed properly, air may still enter the chest
cavity without having means to escape. This causes a life-threatening condition
called tension pneumothorax. If the casualty’s condition (for example, difficulty
breathing, shortness of breath, restlessness, or grayness of skin in a dark-skinned
individual [or blueness in an individual with light skin]) worsens after placing the
dressing, quickly lift or remove, then replace the airtight dressing.
3-11. Abdominal Wounds. The most serious abdominal wound is one in which an object penetrates the
abdominal wall and pierces internal organs or large blood vessels. In these instances, bleeding may be
severe and death can occur rapidly.

3-12. Abdominal Wound(s) Procedure (081-831-1025)

a.
Evaluate the Casualty. Be prepared to perform basic lifesaving measures. It is necessary to check for
both entry and exit wounds. If there are two wounds (entry and exit), treat the wound that appears
more serious first (for example, the heavier bleeding, protruding organs, larger wound, and so
forth). It may be necessary to improvise dressings for the second wound by using strips of cloth, a
T-shirt, or the cleanest material available.
b. Position the Casualty. Place and maintain the casualty on his back with his knees in an upright
(flexed) position (Figure 3-28). The knees-up position helps relieve pain, assists in the treatment of
shock, prevents further exposure of the bowel (intestines) or abdominal organs, and helps relieve
abdominal pressure by allowing the abdominal muscles to relax.
c. Expose the Wound.
(1) Remove the casualty’s loose clothing to expose the wound. However, DO NOT attempt to
remove clothing that is stuck to the wound; it may cause further injury. Thus, remove any loose
clothing from the wound but leave in place the clothing that is stuck.
CAUTION (081-831-1000 and 081-831-1025)
DO NOT REMOVE protective clothing in a chemical environment. Apply dressings over
the protective clothing.

(2) Gently pick up any organs which may be on the ground. Do this with a clean, dry dressing or with
the cleanest available material. Place the organs on top of the casualty’s abdomen (Figure 3-29).
Figure 3-27: Casualty positioned (lying) on injured side.


First Aid for Special Wounds 93


Figure 3-28: Casualty positioned (lying) on back with knees (flexed) up.


Figure 3-29: Protruding organs placed near wound.

- NOTE (081-831-1025)
DO NOT probe, clean, or try to remove any foreign object from the abdomen.
DO NOT touch with bare hands any exposed organs.
DO NOT push organs back inside the body.


d. Apply the Field Dressing. Use the casualty’s field dressing not your own. If the field dressing is not
large enough to cover the entire wound, the plastic wrapper from the dressing may be used to cover
the wound first (placing the field dressing on top). Open the plastic wrapper carefully without
touching the inner surface, if possible. If necessary other improvised dressings may be made from
clothing, blankets, or the cleanest materials available because the field dressing and/or wrapper
may not be large enough to cover the entire wound.
WARNING

If there is an object extending from the wound, DO NOT remove it. Place as much
of the wrapper over the wound as possible without dislodging or moving the
object. DO NOT place the wrapper over the object.

(1) Grasp the tails in both hands.
(2) Hold the dressing with the white, or cleanest, side down directly over the wound.
(3) Pull the dressing open and place it directly over the wound (Figure 3-30). If the casualty is able,
he may hold the dressing in place.

94 The Ultimate Guide to U.S. Army Survival Skills, Tactics, and Techniques


Figure 3-30: Dressing placed directly over the wound.

(4) Hold the dressing in place with one hand and use the other hand to wrap one of the tails around
the body.
(5) Wrap the other tail in the opposite direction until the dressing is completely covered. Leave
enough of the tail for a knot.
(6) Loosely tie the tails with a non slip knot at the casualty’s side (Figure 3-31).
WARNING


When dressing is applied, DO NOT put pressure on the wound or exposed internal
parts, because pressure could cause further injury (vomiting, ruptured intestines,
and so forth). Therefore, tie the dressing ties (tails) loosely at casualty’s side,

not directly over the dressing.

(7) Tie the dressing firmly enough to prevent slipping without applying pressure to the wound site
(Figure 3-32).
Field dressings can be covered with improvised reinforcement material (cravats, strips of torn T-shirt,
or other cloth), if available, for additional support and protection. Tie improvised bandage on the opposite
side of the dressing ties firmly enough to prevent slipping but without applying additional pressure to the
wound.


Figure 3-31: Dressing applied and tails tied with a nonslip knot.


First Aid for Special Wounds95


Figure 3-32: Field dressing covered with improvised material and loosely tied.


CAUTION (081-831-1025)
DO NOT give casualties with abdominal wounds food or water (moistening the lips is
allowed).

e. Seek Medical Aid. Notify medical personnel.
3-13. Burn Injuries. Burns often cause extreme pain, scarring, or even death. Proper treatment will minimize
further injury of the burned area. Before administering the proper first aid, you must be able to recognize
the type of burn to be treated. There are four types of burns: (1) thermal burns caused by fire, hot objects, hot
liquids, and gases or by nuclear blast or fire ball; (2) electrical burns caused by electrical wires, current, or
lightning; (3) chemical burns caused by contact with wet or dry chemicals or white phosphorus (WP)—from
marking rounds and grenades; and (4) laser burns.

3-14. First Aid for Burns (081-831-1007)

a.
Eliminate the Source of the Burn. The source of the burn must be eliminated before any evaluation
or treatment of the casualty can occur.
(1) Remove the casualty quickly and cover the thermal burn with any large non synthetic material, such
as a field jacket. Roll the casualty on the ground to smother (put out) the flames (Figure 3-33).
CAUTION

Synthetic materials, such as nylon, may melt and cause further injury.


Figure 3-33: Casualty covered and rolled on ground.


96 The Ultimate Guide to U.S. Army Survival Skills, Tactics, and Techniques

(2) Remove the electrical burn casualty from the electrical source by turning off the electrical current.
DO NOT attempt to turn off the electricity if the source is not close by. Speed is critical, so
DO NOT waste unnecessary time. If the electricity cannot be turned off, wrap any nonconductive
material (dry rope, dry clothing, dry wood, and so forth) around the casualty’s back and
shoulders and drag the casualty away from the electrical source (Figure 3-34). DO NOT make
body-to-body contact with the casualty or touch any wires because you could also become an
electrical burn casualty.
WARNING
High voltage electrical burns may cause temporary unconsciousness, difficulties
in breathing, or difficulties with the heart (heartbeat).
(3) Remove the chemical from the burned casualty. Remove liquid chemicals by flushing with as
much water as possible. If water is not available, use any nonflammable fluid to flush chemicals
off the casualty. Remove dry chemicals by brushing off loose particles (DO NOT use the bare
surface of your hand because you could become a chemical burn casualty) and then flush with
large amounts of water, if available. If large amounts of water are not available, then NO water
should be applied because small amounts of water applied to a dry chemical burn may cause a
chemical reaction. When white phosphorous strikes the skin, smother with water, a wet cloth,
or wet mud. Keep white phosphorous covered with a wet material to exclude air which will
prevent the particles from burning.
WARNING
Small amounts of water applied to a dry chemical burn may cause a chemical
reaction, transforming the dry chemical into an active burning substance.
(4) Remove the laser burn casualty from the source. (NOTE: Lasers produce a narrow amplified
beam of light. The word laser means Light Amplification by Stimulated Emission of Radiation
and sources include range finders, weapons/guidance, communication systems, and weapons
simulations such as MILES.) When removing the casualty from the laser beam source, be careful
Figure 3-34: Casualty removed from electrical source (using nonconductive material).


First Aid for Special Wounds 97

not to enter the beam or you may become a casualty. Never look directly at the beam source and
if possible, wear appropriate eye protection.

- NOTE
After the casualty is removed from the source of the burn, he should be evaluated for
conditions requiring basic lifesaving measures (Evaluate the Casualty).

b. Expose the Burn. Cut and gently lift away any clothing covering the burned area, without pulling
clothing over the burns. Leave in place any clothing that is stuck to the burns. If the casualty’s
hands or wrists have been burned, remove jewelry if possible without causing further injury (rings,
watches, and so forth) and place in his pockets. This prevents the necessity to cut off jewelry since
swelling usually occurs as a result of a burn.
CAUTION (081-831-1007)
•
DO NOT lift or cut away clothing if in a chemical environment. Apply the dressing
directly over the casualty’s protective clothing.
•
DO NOT attempt to decontaminate skin where blisters have formed.
c. Apply a Field Dressing to the Burn.
(1) Grasp the tails of the casualty’s dressing in both hands.
(2) Hold the dressing directly over the wound with the white (sterile) side down, pull the dressing
open, and place it directly over the wound. If the casualty is able, he may hold the dressing in
place.
(3) Hold the dressing in place with one hand and use the other hand to wrap one of the tails around
the limbs or the body.
(4) Wrap the other tail in the opposite direction until the dressing is completely covered.
(5) Tie the tails into a knot over the outer edge of the dressing. The dressing should be applied lightly
over the burn. Ensure that dressing is applied firmly enough to prevent it from slipping.
- NOTE
Use the cleanest improvised dressing material available if a field dressing is not available
or if it is not large enough for the entire wound.

d. Take the Following Precautions (081-831-1007):
•
DO NOT place the dressing over the face or genital area.
•
DO NOT break the blisters.
•
DO NOT apply grease or ointments to the burns.
For electrical burns, check for both an entry and exit burn from the passage of electricity through
the body. Exit burns may appear on any area of the body despite location of entry burn.
•
For burns caused by wet or dry chemicals, flush the burns with large amounts of water and
cover with a dry dressing.
•
For burns caused by white phosphorus (WP), flush the area with water, then cover with a wet
material, dressing, or mud to exclude the air and keep the WP particles from burning.
•
For laser burns, apply a field dressing.
•
If the casualty is conscious and not nauseated, give him small amounts of water.
e. Seek Medical Aid. Notify medical personnel.

98 The Ultimate Guide to U.S. Army Survival Skills, Tactics, and Techniques

SECTION IV. APPLY PROPER BANDAGES TO UPPER AND LOWER EXTREMITIES
3-15. Shoulder Bandage

a. To apply bandages attached to the field first aid dressing–
(1) Take one bandage across the chest and the other across the back and under the arm opposite the
injured shoulder.
(2) Tie the ends with a non slip knot (Figure 3-35).
b. To apply a cravat bandage to the shoulder or armpit–
(1) Make an extended cravat bandage by using two triangular bandages (Figure 3-36 A); place the
end of the first triangular bandage along the base of the second one (Figure 3-36 B).
(2) Fold the two bandages into a single extended bandage (Figure 3-36 C).
(3) Fold the extended bandage into a single cravat bandage (Figure 3-36 D). After folding, secure
the thicker part (overlap) with two or more safety pins (Figure 3-36 E).
Figure 3-35: Shoulder bandage.


Figure 3-36: Extended cravat bandage applied to shoulder (or armpit) (Illustrated A thru H).


First Aid for Special Wounds 99


Figure 3-36: (Continued)

(4) Place the middle of the cravat bandage under the armpit so that the front end is longer than the
back end and safety pins are on the outside (Figure 3-36 F).
(5) Cross the ends on top of the shoulder (Figure 3-36 G).
(6) Take one end across the back and under the arm on the opposite side and the other end across
the chest. Tie the ends (Figure 3-36 H).
Be sure to place sufficient wadding in the armpit. DO NOT tie the cravat bandage too tightly. Avoid
compressing the major blood vessels in the armpit.

3-16. Elbow Bandage. To apply a cravat bandage to the elbow–

a.
Bend the arm at the elbow and place the middle of the cravat at the point of the elbow bringing the
ends upward (Figure 3-37 A).
b. Bring the ends across, extending both downward (Figure 3-37 B).
c.
Take both ends around the arm and tie them with a non slip knot at the front of the elbow
(Figure 3-37 C).
Figure 3-37: Elbow bandage (Illustrated A thru C).


100 The Ultimate Guide to U.S. Army Survival Skills, Tactics, and Techniques


CAUTION
If an elbow fracture is suspected, DO NOT bend the elbow; bandage it in an extended
position.

3-17. Hand Bandage

a. To apply a triangular bandage to the hand–
(1) Place the hand in the middle of the triangular bandage with the wrist at the base of the bandage
(Figure 3-38 A). Ensure that the fingers are separated with absorbent material to prevent chafing
and irritation of the skin.
(2) Place the apex over the fingers and tuck any excess material into the pleats on each side of the
hand (Figure 3-38 B).
(3) Cross the ends on top of the hand, take them around the wrist, and tie them (Figures 3-38 C, D,
and E) with a non slip knot.
b. To apply a cravat bandage to the palm of the hand–
(1) Lay the middle of the cravat over the palm of the hand with the ends hanging down on each side
(Figure 3-39 A).
Figure 3-38: Triangular bandage applied to hand (Illustrated A thru E).


Figure 3-39: Cravat bandage applied to palm of hand (Illustrated A thru F).


First Aid for Special Wounds 101

(2) Take the end of the cravat at the little finger across the back of the hand, extending it upward
over the base of the thumb; then bring it downward across the palm (Figure 3-39 B).
(3) Take the thumb end across the back of the hand, over the palm, and through the hollow between
the thumb and palm (Figure 3-39 C).
(4) Take the ends to the back of the hand and cross them; then bring them up over the wrist and
cross them again (Figure 3-39 D).
(5) Bring both ends down and tie them with a non slip knot on top of the wrist (Figure 3-39 E and F).
3-18. Leg (Upper and Lower) Bandage. To apply a cravat bandage to the leg–

a.
Place the center of the cravat over the dressing (Figure 3-40 A).
b. Take one end around and up the leg in a spiral motion and the other end around and down the leg
in a spiral motion, overlapping part of each preceding turn (Figure 3-40 B).
c.
Bring both ends together and tie them (Figure 3-40 C) with a non slip knot.
3-19. Knee Bandage. To apply a cravat bandage to the knee as illustrated in Figure 3-41, use the same technique
applied in bandaging the elbow. The same caution for the elbow also applies to the knee.

3-20. Foot Bandage. To apply a triangular bandage to the foot–

a.
Place the foot in the middle of the triangular bandage with the heel well forward of the base (Figure
3-42 A). Ensure that the toes are separated with absorbent material to prevent chafing and irritation
of the skin.
Figure 3-40: Cravat bandage applied to leg (Illustrated A thru C).


Figure 3-41: Cravat bandage applied to knee (Illustrated A thru C).


102 The Ultimate Guide to U.S. Army Survival Skills, Tactics, and Techniques


Figure 3-42: Triangular bandage applied to foot (Illustrated A thru E).

b. Place the apex over the top of the foot and tuck any excess material into the pleats on each side of
the foot (Figure 3-42 B).
c.
Cross the ends on top of the foot, take them around the ankle, and tie them at the front of the ankle
(Figure 3-42 C, D, and E).

CHAPTER 4


First Aid for Fractures


A fracture is any break in the continuity of a bone. Fractures can cause total disability or in some cases
death. On the other hand, they can most often be treated so there is complete recovery. A great deal
depends upon the first aid the individual receives before he is moved. First aid includes immobilizing the
fractured part in addition to applying lifesaving measures. The basic splinting principle is to immobilize
the joints above and below any fracture.

4-1. Kinds of Fractures. See figure 4-1 for detailed illustration.

a.
Closed Fracture. A closed fracture is a broken bone that does not break the overlying skin. Tissue
beneath the skin may be damaged. A dislocation is when a joint, such as a knee, ankle, or shoulder,
is not in proper position. A sprain is when the connecting tissues of the joints have been torn.
Dislocations and sprains should be treated as closed fractures.
b. Open Fracture. An open fracture is a broken bone that breaks (pierces) the overlying skin. The
broken bone may come through the skin, or a missile such as a bullet or shell fragment may go
through the flesh and break the bone. An open fracture is contaminated and subject to infection.
4-2. Signs/Symptoms of Fractures (081-831-1000). Indications of a fracture are deformity, tenderness,
swelling, pain, inability to move the injured part, protruding bone, bleeding, or discolored skin at the
injury site. A sharp pain when the individual attempts to move the part is also a sign of a fracture. DO
NOT encourage the casualty to move the injured part in order to identify a fracture since such movement
could cause further damage to surrounding tissues and promote shock. If you are not sure whether a bone
is fractured, treat the injury as a fracture.

4-3. Purposes of Immobilizing Fractures. A fracture is immobilized to prevent the sharp edges of the bone
from moving and cutting tissue, muscle, blood vessels, and nerves. This reduces pain and helps prevent
or control shock. In a closed fracture, immobilization keeps bone fragments from causing an open wound
and prevents contamination and possible infection. Splint to immobilize.


Figure 4-1: Kinds of fractures (Illustrated A thru C).

103


104 The Ultimate Guide to U.S. Army Survival Skills, Tactics, and Techniques

4-4. Splints, Padding, Bandages, Slings, and Swathes (081-831-1034)

a.
Splints. Splints may be improvised from such items as boards, poles, sticks, tree limbs, rolled magazines,
rolled newspapers, or cardboard. If nothing is available for a splint, the chest wall can be used
to immobilize a fractured arm and the uninjured leg can be used to immobilize (to some extent) the
fractured leg.
b. Padding. Padding may be improvised from such items as a jacket, blanket, poncho, shelter half, or
leafy vegetation.
c.
Bandages. Bandages may be improvised from belts, rifle slings, bandoleers, kerchiefs, or strips torn
from clothing or blankets. Narrow materials such as wire or cord should not be used to secure a
splint in place.
d. Slings. A sling is a bandage (or improvised material such as a piece of cloth, a belt, and so forth)
suspended from the neck to support an upper extremity. Also, slings may be improvised by using
the tail of a coat or shirt, and pieces torn from such items as clothing and blankets. The triangular
bandage is ideal for this purpose. Remember that the casualty’s hand should be higher than his
elbow, and the sling should be applied so that the supporting pressure is on the uninjured side.
e.
Swathes. Swathes are any bands (pieces of cloth, pistol belts, and so forth) that are used to further
immobilize a splinted fracture. Triangular and cravat bandages are often used as or referred to as
swathe bandages. The purpose of the swathe is to immobilize. Therefore, the swathe bandage is
placed above and/or below the fracture—not over it.
4-5. Procedures for Splinting Suspected Fractures (081-831-1034). Before beginning first aid treatment
for a fracture, gather whatever splinting materials are available. Materials may consist of splints, such as
wooden boards, branches, or poles. Other splinting materials include padding, improvised cravats, and/
or bandages. Ensure that splints are long enough to immobilize the joint above and below the suspected
fracture. If possible, use at least four ties (two above and two below the fracture) to secure the splints. The
ties should be non slip knots and should be tied away from the body on the splint.

* a.
Evaluate the Casualty (081-831-1000). Be prepared to perform any necessary lifesaving measures.
Monitor the casualty for development of conditions which may require you to perform necessary
basic lifesaving measures. These measures include clearing the airway, rescue breathing, preventing
shock, and/or bleeding control.
WARNING (081-831-1000)
Unless there is immediate life-threatening danger, such as a fire or an explosion,
DO NOT move the casualty with a suspected back or neck injury. Improper movement
may cause permanent paralysis or death.
WARNING (081-831-1000)
In a chemical environment, DO NOT remove any protective clothing. Apply the
dressing/splint over the clothing.
b. Locate the Site of the Suspected Fracture. Ask the casualty for the location of the injury. Does he
have any pain? Where is it tender? Can he move the extremity? Look for an unnatural position of
the extremity. Look for a bone sticking out (protruding).
c.
Prepare the Casualty for Splinting the Suspected Fracture (081-831-1034).
(1) Reassure the casualty. Tell him that you will be taking care of him and that medical aid is on the way.
(2) Loosen any tight or binding clothing.

First Aid for Fractures 105

(3) Remove all the jewelry from the casualty and place it in the casualty’s pocket. Tell the casualty
you are doing this because if the jewelry is not removed at this time and swelling occurs later,
further bodily injury can occur.
- NOTE
Boots should not be removed from the casualty unless they are needed to stabilize a neck
injury, or there is actual bleeding from the foot.

d. Gather Splinting Materials (081-831-1034). If standard splinting materials (splints, padding, cravats,
and so forth) are not available, gather improvised materials. Splints can be improvised from wooden
boards, tree branches, poles, rolled newspapers or magazines. Splints should be long enough to
reach beyond the joints above and below the suspected fracture site. Improvised padding, such as
a jacket, blanket, poncho, shelter half, or leafy vegetation may be used. A cravat can be improvised
from a piece of cloth, a large bandage, a shirt, or a towel. Also, to immobilize a suspected fracture of
an arm or a leg, parts of the casualty’s body may be used. For example, the chest wall may be used
to immobilize an arm; and the uninjured leg may be used to immobilize the injured leg.
- NOTE
If splinting material is not available and suspected fracture CANNOT be splinted, then
swathes, or a combination of swathes and slings can be used to immobilize an extremity.


e.
Pad the Splints (081-831-1034). Pad the splints where they touch any bony part of the body, such as the
elbow, wrist, knee, ankle, crotch, or armpit area. Padding prevents excessive pressure to the area.
f. Check the Circulation Below the Site of the Injury (081-831-1034).
(1) Note any pale, white, or bluish-gray color of the skin which may indicate impaired circulation.
Circulation can also be checked by depressing the toe/fingernail beds and observing how
quickly the color returns. A slower return of pink color to the injured side when compared with
the uninjured side indicates a problem with circulation. Depressing the toe/fingernail beds is a
method to use to check the circulation in a dark-skinned casualty.
(2) Check the temperature of the injured extremity. Use your hand to compare the temperature of
the injured side with the uninjured side of the body. The body area below the injury may be
colder to the touch indicating poor circulation.
(3) Question the casualty about the presence of numbness, tightness, cold, or tingling sensations.
WARNING


Casualties with fractures to the extremities may show impaired circulation, such
as numbness, tingling, cold and/or pale to blue skin. These casualties should be
evacuated by medical personnel and treated as soon as possible. Prompt medical

treatment may prevent possible loss of the limb.


WARNING

If it is an open fracture (skin is broken; bone(s) may be sticking out), DO NOT
ATTEMPT TO PUSH BONE(S) BACK UNDER THE SKIN. Apply a field dressing
to protect the area. See Task 081-831-1016, Put on a Field or Pressure Dressing.

g. Apply the Splint in Place (081-831-1034).
(1) Splint the fracture(s) in the position found. DO NOT attempt to reposition or straighten the injury.
If it is an open fracture, stop the bleeding and protect the wound. (See Chapter 2, Section II, for

106 The Ultimate Guide to U.S. Army Survival Skills, Tactics, and Techniques

detailed information.) Cover all wounds with field dressings before applying a splint. Remember
to use the casualty’s field dressing, not your own. If bones are protruding (sticking out), DO
NOT attempt to push them back under the skin. Apply dressings to protect the area.

(2) Place one splint on each side of the arm or leg. Make sure that the splints reach, if possible,
beyond the joints above and below the fracture.
(3) Tie the splints. Secure each splint in place above and below the fracture site with improvised (or
actual) cravats. Improvised cravats, such as strips of cloth, belts, or whatever else you have, may
be used. With minimal motion to the injured areas, place and tie the splints with the bandages.
Push cravats through and under the natural body curvatures (spaces), and then gently position
improvised cravats and tie in place. Use non slip knots. Tie all knots on the splint away from the
casualty (Figure 4-2). DO NOT tie cravats directly over suspected fracture/dislocation site.
h. Check the Splint for Tightness (081-831-1034).
(1) Check to be sure that bandages are tight enough to securely hold splinting materials in place,
but not so tight that circulation is impaired.
(2) Recheck the circulation after application of the splint. Check the skin color and temperature. This
is to ensure that the bandages holding the splint in place have not been tied too tightly. A finger
tip check can be made by inserting the tip of the finger between the wrapped tails and the skin.
(3) Make any adjustment without allowing the splint to become ineffective.
i. Apply a Sling if Applicable (081-831-1034). An improvised sling may be made from any available
non stretching piece of cloth, such as a fatigue shirt or trouser, poncho, or shelter half. Slings may
also be improvised using the tail of a coat, belt, or a piece of cloth from a blanket or some clothing.
See Figure 4-3 for an illustration of a shirt tail used for support. A pistol belt or trouser belt
also may be used for support (Figure 4-4). A sling should place the supporting pressure on the
casualty’s uninjured side. The supported arm should have the hand positioned slightly higher than
the elbow.
Figure 4-3: Shirt tail used for support.


Figure 4-2: Nonslip knots tied away from casualty.


First Aid for Fractures 107


Figure 4-4: Belt Used for support.

(1) Insert the splinted arm in the center of the sling (Figure 4-5).
(2) Bring the ends of the sling up and tie them at the side (or hollow) of the neck on the uninjured
side (Figure 4-6).
(3) Twist and tuck the corner of the sling at the elbow (Figure 4-7).
j. Apply a Swathe if Applicable (081-831-1034). You may use any large piece of cloth, such as a soldier’s
belt or pistol belt, to improvise a swathe. A swathe is any band (a piece of cloth) or wrapping
used to further immobilize a fracture. When splints are unavailable, swathes, or a combination of
swathes and slings can be used to immobilize an extremity.
WARNING (081-831-1034)
The swathe should not be placed directly on top of the injury, but positioned above
and/or below the fracture site.


(1) Apply swathes to the injured arm by wrapping the swathe over the injured arm, around the
casualty’s back and under the arm on the uninjured side. Tie the ends on the uninjured side
(Figure 4-8).
Figure 4-5: Arm inserted in center of improvised sling.


108 The Ultimate Guide to U.S. Army Survival Skills, Tactics, and Techniques


Figure 4-6: Ends of improvised sling tied to side of neck.


Figure 4-7: Corner of sling twisted and tucked at elbow.


Figure 4-8: Arm immobilized with strip of clothing.

(2) A swathe is applied to an injured leg by wrapping the swathe(s) around both legs and securing
it on the uninjured side.
k. Seek Medical Aid. Notify medical personnel, watch closely for development of life-threatening conditions,
and if necessary, continue to evaluate the casualty.
4-6. Upper Extremity Fractures (081-831-1034). Figures 4-9 through 4-16 show how to apply slings, splints,
and cravats (swathes) to immobilize and support fractures of the upper extremities. Although the padding


First Aid for Fractures 109


Figure 4-9: Application of triangular bandage to form sling (two methods) (Illustrated A and B).


Figure 4-10: Completing sling sequence by twisting and tucking the corner of the sling at the elbow .

is not visible in some of the illustrations, it is always preferable to apply padding along the injured part for
the length of the splint and especially where it touches any bony parts of the body.

4-7. Lower Extremity Fractures (081-831-1034). Figures 4-17 through 4-22 show how to apply splints to
immobilize fractures of the lower extremities. Although padding is not visible in some of the figures, it


110 The Ultimate Guide to U.S. Army Survival Skills, Tactics, and Techniques


Figure 4-11: Board splints applied to fractured elbow when elbow is not
bent (two methods) (081-831-1034) (Illustrated A and B).


Figure 4-12: Chest wall used as splint for upper arm frature when no splint is availble (Illustrated A and B).


Figure 4-13: Chest wall, sling, and cravat used to immobilize fractured elbow when elbow is bent.


First Aid for Fractures 111


Figure 4-14: Board splint applied to fractured forearm (Illustrated A and B).


Figure 4-15: Fractured forearm or wrist splinted with sticks and supported
with tail of shirt and strips of material (Illustrated A thru C).


Figure 4-16: Board splint applied to fractured wrist and hand (Illustrated A thru C).


112 The Ultimate Guide to U.S. Army Survival Skills, Tactics, and Techniques

is preferable to apply padding along the injured part for the length of the splint and especially where it
touches any bony parts of the body.

4-8. Jaw, Collarbone, and Shoulder Fractures

a.
Apply a cravat to immobilize a fractured jaw as illustrated in Figure 4-23. Direct all bandaging support
to the top of the casualty’s head, not to the back of his neck. If incorrectly placed, the bandage
will pull the casualty’s jaw back and interfere with his breathing.
CAUTION
Casualties with lower jaw (mandible) fractures cannot be laid flat on their backs because
facial muscles will relax and may cause an airway obstruction.


Figure 4-17: Board splint applied to fractured hip or thigh (081-831-1034).


Figure 4-18: Board splint applied to fractured or dislocated knee (081-831-1034).


First Aid for Fractures 113


Figure 4-19: Board splint applied to fractured lower leg or ankle.


Figure 4-20: Improvised splint applied to fractured lower leg or ankle.

b. Apply two belts, a sling, and a cravat to immobilize a fractured collarbone, as illustrated in Figure 4-24.
c.
Apply a sling and a cravat to immobilize a fractured or dislocated shoulder, using the technique
illustrated in Figure 4-25.
4-9. Spinal Column Fractures (081-831-1000). It is often impossible to be sure a casualty has a fractured
spinal column. Be suspicious of any back injury, especially if the casualty has fallen or if his back has been
sharply struck or bent. If a casualty has received such an injury and does not have feeling in his legs or
cannot move them, you can be reasonably sure that he has a severe back injury which should be treated as
a fracture. Remember, if the spine is fractured, bending it can cause the sharp bone fragments to bruise or
cut the spinal cord and result in permanent paralysis (Figure 4-26A). The spinal column must maintain a
swayback position to remove pressure from the spinal cord.

a.
If the Casualty Is Not to Be Transported (081-831-1000) Until Medical Personnel Arrive—
•
Caution him not to move. Ask him if he is in pain or if he is unable to move any part of his body.
•
Leave him in the position in which he is found. DO NOT move any part of his body.
•
Slip a blanket, if he is lying face up, or material of similar size, under the arch of his back to support
the spinal column in a swayback position (Figure 4-26 B). If he is lying face down, DO NOT
put anything under any part of his body.
b. If the Casualty Must Be Transported to A Safe Location Before Medical Personnel Arrive—
•
And if the casualty is in a face-up position, transport him by litter or use a firm substitute, such
as a wide board or a flat door longer than his height. Loosely tie the casualty’s wrists together

114 The Ultimate Guide to U.S. Army Survival Skills, Tactics, and Techniques


Figure 4-21: Poles rolled in a blanket and used as splints applied to fractured lower extremity.


Figure 4-22: Uninjured leg used as splint for fractured leg (anatomical splint).

over his waistline, using a cravat or a strip of cloth. Tie his feet together to prevent the accidental
dropping or shifting of his legs. Lay a folded blanket across the litter where the arch of his back is
to be placed. Using a four-man team (Figure 4-27), place the casualty on the litter without bending
his spinal column or his neck.

•
The number two, three, and four men position themselves on one side of the casualty; all
kneel on one knee along the side of the casualty. The number one man positions himself to

First Aid for Fractures 115


Figure 4-23: Fractured jaw immobilized (Illustrated A thru C)


Figure 4-24: Application of belts, sling, and cravat to immobilize a collarbone.

the opposite side of the casualty. The number two, three, and four men gently place their
hands under the casualty. The number one man on the opposite side places his hands under
the injured part to assist.

•
When all four men are in position to lift, the number two man commands, “PREPARE TO
LIFT” and then, “LIFT.” All men, in unison, gently lift the casualty about 8 inches. Once

116 The Ultimate Guide to U.S. Army Survival Skills, Tactics, and Techniques


Figure 4-25: Application of sling and cravat to immobilize a
fractured or dislocated shoulder (Illustrated A thru D) .


Figure 4-26: Spinal column must maintain a swayback position (Illustrated A and B).


First Aid for Fractures 117


Figure 4-27: Placing face-up casualty with fractured back onto litter.

the casualty is lifted, the number one man recovers and slides the litter under the casualty,
ensuring that the blanket is in proper position. The number one man then returns to his
original lift position (Figure 4-27).

•
When the number two man commands, “LOWER CASUALTY,” all men, in unison, gently
lower the casualty onto the litter.
•
And if the casualty is in a face-down position, he must be transported in this same position.
The four-man team lifts him onto a regular or improvised litter, keeping the spinal column in a
swayback position. If a regular litter is used, first place a folded blanket on the litter at the point
where the chest will be placed.
4-10. Neck Fractures (081-831-1000). A fractured neck is extremely dangerous. Bone fragments may bruise
or cut the spinal cord just as they might in a fractured back.

a. If the Casualty Is Not to Be Transported (081-831-1000) Until Medical Personnel Arrive—
•
Caution him not to move. Moving may cause death.
•
Leave the casualty in the position in which he is found. If his neck/head is in an abnormal position,
immediately immobilize the neck/head. Use the procedure stated below.
•
Keep the casualty‘s head still, if he is lying face up, raise his shoulders slightly, and slip a
roll of cloth that has the bulk of a bath towel under his neck (Figure 4-28). The roll should
be thick enough to arch his neck only slightly, leaving the back of his head on the ground.
DO NOT bend his neck or head forward. DO NOT raise or twist his head. Immobilize the
casualty’s head (Figure 4-29). Do this by padding heavy objects such as rocks or his boots

118 The Ultimate Guide to U.S. Army Survival Skills, Tactics, and Techniques


Figure 4-28: Casualty with roll of cloth (bulk) under neck.


Figure 4-29: Immobilization of fractured neck.

and placing them on each side of his head. If it is necessary to use boots, first fill them with
stones, gravel, sand, or dirt and tie them tightly at the top. If necessary, stuff pieces of material
in the top of the boots to secure the contents.

•
DO NOT move the casualty if he is lying face down. Immobilize the head/neck by padding
heavy objects and placing them on each side of his head. DO NOT put a roll of cloth under
the neck. DO NOT bend the neck or head, nor roll the casualty onto his back.
b. If the Casualty Must be Prepared for Transportation Before Medical Personnel Arrive—
•
And he has a fractured neck, at least two persons are needed because the casualty’s head and
trunk must be moved in unison.
•
The two persons must work in close coordination (Figure 4-30) to avoid bending the neck.
•
Place a wide board lengthwise beside the casualty. It should extend at least 4 inches beyond the
casualty‘s head and feet (Figure 4-30 A).
•
If the casualty is lying face up, the number one man steadies the casualty’s head and neck
between his hands. At the same time the number two man positions one foot and one knee
against the board to prevent it from slipping, grasps the casualty underneath his shoulder and
hip, and gently slides him onto the board (Figure 4-30 B).
•
If the casualty is lying face down, the number one man steadies the casualty’s head and neck
between his hands, while the number two man gently rolls the casualty over onto the board
(Figure 4-30 C).

First Aid for Fractures 119


Figure 4-30: Preparing casualty with fractured neck for transportation (Illustrated A thru E).

•
The number one man continues to steady the casualty’s head and neck. The number two man
simultaneously raises the casualty’s shoulders slightly, places padding under his neck, and
immobilizes the casualty’s head (Figures 4-30 D, and E). The head may be immobilized with the
casualty’s boots, with stones rolled in pieces of blanket, or with other material.
•
Secure any improvised supports in position with a cravat or strip of cloth extended across the
casualty’s forehead and under the board (Figure 4-30 D).
•
Lift the board onto a litter or blanket in order to transport the casualty (Figure 4-30 E).

CHAPTER 5


First Aid for Climatic Injuries


It is desirable, but not always possible, for an individual’s body to become adjusted (acclimatized) to an
environment. Physical condition determines the time adjustment, and trying to rush it is ineffective. Even
those individuals in good physical condition need time before working or training in extremes of hot or
cold weather. Climate-related injuries are usually preventable; prevention is both an individual and leadership
responsibility. Several factors contribute to health and well-being in any environment: diet, sleep/
rest, exercise, and suitable clothing. These factors are particularly important in extremes of weather. Diet,
especially, should be suited to an individual’s needs in a particular climate. A special diet undertaken for
any purpose should be done so with appropriate supervision. This will ensure that the individual is getting
a properly balanced diet suited to both climate and personal needs, whether for weight reduction or
other purposes. The wearing of specialized protective gear or clothing will sometimes add to the problem
of adjusting to a particular climate. Therefore, soldiers should exercise caution and judgment in adding or
removing specialized protective gear or clothing.

5-1. Heat Injuries (081-831-1008). Heat injuries are environmental injuries that may result when a soldier
is exposed to extreme heat, such as from the sun or from high temperatures. Prevention depends on availability
and consumption of adequate amounts of water. Prevention also depends on proper clothing and
appropriate activity levels. Acclimatization and protection from undue heat exposure are also very important.
Identification of high risk personnel (basic trainees, troops with previous history of heat injury, and
overweight soldiers) helps both the leadership and the individual prevent and cope with climatic conditions.
Instruction on living and working ingot climates also contributes toward prevention.

- NOTE
Salt tablets should not be used in the prevention of heat injury. Usually, eating field
rations or liberal salting of the garrison diet will provide enough salt to replace what is
lost through sweating in hot weather.

a.
Diet. A balanced diet usually provides enough salt even in hot weather. But when people are on
reducing or other diets, salt may need to come from other sources. DO NOT use salt tablets to
supplement a diet. Anyone on a special diet (for whatever purpose) should obtain professional help
to work out a properly balanced diet.
b. Clothing.
(1) The type and amount of clothing and equipment a soldier wears and the way he wears it also
affect the body and its adjustment to the environment. Clothing protects the body from radiant
heat. However, excessive or tight-fitting clothing, web equipment, and packs reduce ventilation
needed to cool the body. During halts, rest stops, and other periods when such items are not
needed, they should be removed, mission permitting.
(2) The individual protective equipment (IPE) protects the soldier from chemical and biological
agents. The equipment provides a barrier between him and a toxic environment. However, a
serious problem associated with the chemical overgarment is heat stress. The body normally
maintains a heat balance, but when the overgarment is worn the body sometimes does not function
properly. Overheating may occur rapidly. Therefore, strict adherence to mission oriented
protective posture (MOPP) levels directed by your commander is important. This will keep
121


122 The Ultimate Guide to U.S. Army Survival Skills, Tactics, and Techniques

those heat related injuries caused by wearing the IPE to a minimum. See FM 3-4 for further
information on MOPP.

c.
Prevention. The ideal fluid replacement is water. The availability of sufficient water during work
or training in hot weather is very important. The body, which depends on water to help cool itself,
can lose more than a quart of water per hour through sweat. Lost fluids must be replaced quickly.
Therefore, during these work or training periods, you should drink at least one canteen full of water
every hour. In extremely hot climates or extreme temperatures, drink at least a full canteen of water
every half hour, if possible. In such hot climates, the body depends mainly upon sweating to keep
it cool, and water intake must be maintained to allow sweating to continue. Also, keep in mind that
a person who has suffered one heat injury is likely to suffer another. Before a heat injury casualty
returns to work, he should have recovered well enough not to risk a recurrence. Other conditions
which may increase heat stress and cause heat injury include infections, fever, recent illness or
injury, overweight, dehydration, exertion, fatigue, heavy meals, and alcohol. In all this, note that
salt tablets should not be used as a preventive measure.
d. Categories. Heat injury can be divided into three categories: heat cramps, heat exhaustion, and
heatstroke.
e.
First Aid. Recognize and give first aid for heat injuries.
WARNING
Casualty should be continually monitored for development of conditions which
may require the performance of necessary basic lifesaving measures, such as:
clearing the airway, performing mouth-to-mouth resuscitation, preventing shock,
and/or bleeding control.
*CAUTION
DO NOT use salt solution in first aid procedures for heat injuries.

(1) Check the casualty for signs and symptoms of heat cramps (081-831-1008).
•
Signs/Symptoms. Heat cramps are caused by an imbalance of chemicals (called electrolytes)
in the body as a result of excessive sweating. This condition causes the casualty to exhibit:
•
Muscle cramps in the extremities (arms and legs).
•
Muscle cramps of the abdomen.
•
Heavy (excessive) sweating (wet skin).
•
Thirst.
•
Treatment.
•
Move the casualty to a cool or shady area (or improvise shade).
•
Loosen his clothing (if not in a chemical environment).
•
Have him slowly drink at least one canteen full of cool water.
•
Seek medical aid should cramps continue.
WARNING
DO NOT loosen the casualty’s clothing if in a chemical environment. 160-065 0-94-3
(2) Check the casualty for signs and symptoms of heat exhaustion (081-831-1008).
•
Signs/Symptoms which occur often. Heat exhaustion is caused by loss of water through
sweating without adequate fluid replacement. It can occur in an otherwise fit individual

First Aid for Climatic Injuries 123

who is involved in tremendous physical exertion in any hot environment. The signs and
symptoms are similar to those which develop when a person goes into a state of shock.

•
Heavy (excessive) sweating with pale, moist, cool skin.
•
Headache.
•
Weakness.
•
Dizziness.
•
Loss of appetite.
•
Signs/Symptoms which occur sometimes.
•
Heat cramps.
•
Nausea—with or without vomiting.
•
Urge to defecate.
•
Chills (gooseflesh).
•
Rapid breathing.
•
Tingling of hands and/or feet.
•
Confusion.
•
Treatment.
•
Move the casualty to a cool or shady area (or improvise shade).
•
Loosen or remove his clothing and boots (unless in a chemical environment). Pour water
on him and fan him (unless in a chemical environment).
•
Have him slowly drink at least one canteen full of cool water. Elevate his legs.
•
If possible, the casualty should not participate in strenuous activity for the remainder of
the day.
•
Monitor the casualty until the symptoms are gone, or medical aid arrives.
(3) Check the casualty for signs and symptoms of heatstroke (sometimes called “sunstroke”)
(081-831-1008).
WARNING
Heatstroke must be considered a medical emergency which may result in death
if treatment is delayed.
•
Signs/Symptoms. A casualty suffering from heatstroke has usually worked in a very hot, humid
environment for a prolonged time. It is caused by failure of the body’s cooling mechanisms.
Inadequate sweating is a factor. The casualty’s skin is red (flushed), hot, and dry. He may experience
weakness, dizziness, confusion, headaches, seizures, nausea (stomach pains), and his respiration
and pulse may be rapid and weak. Unconsciousness and collapse may occur suddenly.
•
Treatment. Cool casualty immediately by—
•
Moving him to a cool or shaded area (or improvise shade).
• Loosening or removing his clothing (except in a chemical environment).
• *Spraying or pouring water on him; fanning him to permit a coolant effect of evaporation.
•
Massaging his extremities and skin which increases the blood flow to those body areas,
thus aiding the cooling process.
•
Elevating his legs.
•
Having him slowly drink at least one canteen full of water if he is conscious.
- NOTE
Start cooling casualty immediately. Continue cooling while awaiting transportation and
during the evacuation.


124 The Ultimate Guide to U.S. Army Survival Skills, Tactics, and Techniques

•
Medical aid. Seek medical aid because the casualty should be transported to a medical treatment
facility as soon as possible. Do not interrupt cooling process or lifesaving measures to seek help.
•
Casualty should be continually monitored for development of conditions which may require
the performance of necessary basic lifesaving measures, such as clearing the airway, mouthto-
mouth resuscitation, preventing shock, and/or bleeding control.
f. Table. See Table 5-1 for further information.
5-2. Cold Injuries (081-831-1009). Cold injuries are most likely to occur when an unprepared individual
is exposed to winter temperatures. They can occur even with proper planning and equipment. The cold
weather and the type of combat operation in which the individual is involved impact on whether he is
likely to be injured and to what extent. His clothing, his physical condition, and his mental makeup also are
determining factors. However, cold injuries can usually be prevented. Well-disciplined and well-trained
individuals can be protected even in the most adverse circumstances. They and their leaders must know
the hazards of exposure to the cold. They must know the importance of personal hygiene, exercise, care of
the feet and hands, and the use of protective clothing.

a. Contributing Factors.
(1) Weather. Temperature, humidity, precipitation, and wind modify the loss of body heat. Low temperatures
and low relative humidity-dry cold—promote frostbite. Higher temperatures, together
with moisture, promote immersion syndrome. Wind chill accelerates the loss of body heat and
may aggravate cold injuries. These principles and risks apply equally to both men and women.
(2) Type of combat operation. Defense, delaying, observation-post, and sentinel duties do create to a
greater extent—fear, fatigue, dehydration, and lack of nutrition. These factors further increase the
soldier’s vulnerability to cold injury. Also, a soldier is more likely to receive a cold injury if he is—
•
Often in contact with the ground.
Table 5-1: Sun or Heat Injuries (081-831-1008).


(continued)


First Aid for Climatic Injuries 125

Table 5-1: (Continued)


• Immobile for long periods, such as while riding in a crowded vehicle.
• Standing in water, such as in a foxhole.
• Out in the cold for days without being warmed.
• Deprived of an adequate diet and rest.
• Not able to take care of his personal hygiene.
(3) Clothing. The soldier should wear several layers of loose clothing. He should dress as lightly as
possible consistent with the weather to reduce the danger of excessive perspiration and subsequent
chilling. It is better for the body to be slightly cold and generating heat than excessively

126 The Ultimate Guide to U.S. Army Survival Skills, Tactics, and Techniques

warm and sweltering toward dehydration. He should remove a layer or two of clothing before
doing any hard work. He should replace the clothing when work is completed. Most cold injuries
result from soldiers having too few clothes available when the weather suddenly turns
colder. Wet gloves, shoes, socks, or any other wet clothing add to the cold injury process.


CAUTION
In a chemical environment DO NOT take off protective chemical gear.

(4) Physical makeup. Physical fatigue contributes to apathy, which leads to inactivity, personal
neglect, carelessness, and reduced heat production. In turn, these increase the risk of cold injury.
Soldiers with prior cold injuries have a higher-than-normal risk of subsequent cold injury, not
necessarily involving the part previously injured.
(5) Psychological factor. Mental fatigue and fear reduces the body’s ability to rewarm itself and
thus increases the incidence of cold injury. The feelings of isolation imposed by the environment
are also stressful. Depressed and/or unresponsive soldiers are also vulnerable because they are
less active. These soldiers tend to be careless about precautionary measures, especially warming
activities, when cold injury is a threat.
b. Signs/Symptoms. Once a soldier becomes familiar with the factors that contribute to cold injury, he
must learn to recognize cold injury signs/symptoms.
(1) Many soldiers suffer cold injury without realizing what is happening to them. They may be cold
and generally uncomfortable. These soldiers often do not notice the injured part because it is
already numb from the cold.
(2) Superficial cold injury usually can be detected by numbness, tingling, or “pins and needles”
sensations. These signs/symptoms often can be relieved simply by loosening boots or other
clothing and by exercising to improve circulation. In more serious cases involving deep cold
injury, the soldier often is not aware that there is a problem until the affected part feels like a
stump or block of wood.
(3) Outward signs of cold injury include discoloration of the skin at the site of injury. In lightskinned
persons, the skin first reddens and then becomes pale or waxy white. In dark-skinned
persons, grayness in the skin is usually evident. An injured foot or hand feels cold to the touch.
Swelling may be an indication of deep injury. Also note that blisters may occur after rewarming
the affected parts. Soldiers should work in pairs—buddy teams—to check each other for signs
of discoloration and other symptoms. Leaders should also be alert for signs of cold injuries.
c.
Treatment Considerations. First aid for cold injuries depends on whether they are superficial or
deep. Cases of superficial cold injury can be adequately treated by warming the affected part using
body heat. For example, this can be done by covering cheeks with hands, putting fingertips under
armpits, or placing feet under the clothing of a buddy next to his belly. The injured part should NOT
be massaged, exposed to a fire or stove, rubbed with snow, slapped, chafed, or soaked in cold water.
Walking on injured feet should be avoided. Deep cold injury (frostbite) is very serious and requires
more aggressive first aid to avoid or to minimize the loss of parts of the fingers, toes, hands, or feet.
The sequence for treating cold injuries depends on whether the condition is life-threatening. That
is, PRIORITY is given to removing the casualty from the cold. Other-than-cold injuries are treated
either simultaneously while waiting for evacuation to a medical treatment facility or while en route
to the facility.
- NOTE
The injured soldier should be evacuated at once to a place where the affected part can be
rewarmed under medical supervision.


First Aid for Climatic Injuries 127

d. Conditions Caused by Cold. Conditions caused by cold are chilblain, immersion syndrome (immersion
foot/trench foot), frostbite, snow blindness, dehydration, and hypothermia.
(1) Chilblain.
•
Signs/Symptoms. Chilblain is caused by repeated prolonged exposure of bare skin at temperatures
from 60°F, to 32°F, or 20°F for acclimated, dry, unwashed skin. The area may
be acutely swollen, red, tender, and hot with itchy skin. There may be no loss of skin tissue
in untreated cases but continued exposure may lead to infected, ulcerated, or bleeding
lesions.
•
Treatment. Within minutes, the area usually responds to locally applied body heat. Rewarm
the affected part by applying firm steady pressure with your hands, or placing the affected
part under your arms or against the stomach of a buddy. DO NOT rub or massage affected
areas. Medical personnel should evaluate the injury, because signs and symptoms of tissue
damage may be slow to appear.
•
Prevention. Prevention of chilblain depends on basic cold injury prevention methods. Caring
for and wearing the uniform properly and staying dry (as far as conditions permit) are of
immediate importance.
(2) Immersion syndrome (immersion foot/trench foot). Immersion foot and trench foot are injuries
that result from fairly long exposure of the feet to wet conditions at temperatures from approximately
50° to 32°F. Inactive feet in damp or wet socks and boots, or tightly laced boots which
impair circulation are even more susceptible to injury. This injury can be very serious; it can
lead to loss of toes or parts of the feet. If exposure of the feet has been prolonged and severe, the
feet may swell so much that pressure closes the blood vessels and cuts off circulation. Should an
immersion injury occur, dry the feet thoroughly; and evacuate the casualty to a medical treatment
facility by the fastest means possible.
•
Signs/Symptoms. At first, the parts of the affected foot are cold and painless, the pulse
is weak, and numbness may be present. Second, the parts may feel hot, and burning and
shooting pains may begin. In later stages, the skin is pale with a bluish cast and the pulse
decreases. Other signs/symptoms that may follow are blistering, swelling, redness, heat,
hemorrhages (bleeding), and gangrene.
•
Treatment. Treatment is required for all stages of immersion syndrome injury. Rewarm the
injured part gradually by exposing it to warm air. DO NOT massage it. DO NOT moisten the
skin and DO NOT apply heat or ice. Protect it from trauma and secondary infections. Dry,
loose clothing or several layers of warm coverings are preferable to extreme heat. Under no
circumstances should the injured part be exposed to an open fire. Elevate the injured part to
relieve the swelling. Evacuate the casualty to a medical treatment facility as soon as possible.
When the part is rewarmed, the casualty often feels a burning sensation and pain. Symptoms
may persist for days or weeks even after rewarming.
•
Prevention. Immersion syndrome can be prevented by good hygienic care of the feet and
avoiding moist conditions for prolonged periods. Changing socks at least daily (depending
on environmental conditions) is also a preventive measure. Wet socks can be air dried, then
can be placed inside the shirt to warm them prior to putting them on.
(3) Frostbite. Frostbite is the injury of tissue caused from exposure to cold, usually below 32°F
depending on the wind chill factor, duration of exposure, and adequacy of protection. Individuals
with a history of cold injury are likely to be more easily affected for an indefinite period. The
body parts most easily frostbitten are the cheeks, nose, ears, chin, forehead, wrists, hands, and
feet. Proper treatment and management depend upon accurate diagnosis. Frostbite may involve
only the skin (superficial), or it may extend to a depth below the skin (deep). Deep frostbite is
very serious and requires more aggressive first aid to avoid or to minimize the loss of parts of
the fingers, toes, hands, or feet.

128 The Ultimate Guide to U.S. Army Survival Skills, Tactics, and Techniques

WARNING


Casualty should be continually monitored for development of conditions which
may require the performance of necessary basic lifesaving measures, such as
clearing the airway, performing mouth-to-mouth resuscitation, preventing shock,
and/or bleeding control.

• Progressive signs/symptoms (081-831-1009).
•
Loss of sensation, or numb feeling in any part of the body.
•
Sudden blanching (whitening) of the skin of the affected part, followed by a momentary
“tingling” sensation.
•
Redness of skin in light-skinned soldiers; grayish coloring in dark-skinned individuals.
•
Blister.
•
Swelling or tender areas.
•
Loss of previous sensation of pain in affected area.
•
Pale, yellowish, waxy-looking skin.
•
Frozen tissue that feels solid (or wooden) to the touch.
CAUTION
Deep frostbite is a very serious injury and requires immediate first aid and subsequent
medical treatment to avoid or minimize loss of body parts.

• Treatment (081-831-1009).
•
Face, ears, and nose. Cover the casualty’s affected area with his and/or your bare hands
until sensation and color return.
•
Hands. Open the casualty’s field jacket and shirt. (In a chemical environment never remove
the clothing.) Place the affected hands under the casualty’s armpits. Close the field jacket
and shirt to prevent additional exposure.
•
Feet. Remove the casualty’s boots and socks if he does not need to walk any further
to receive additional treatment. (Thawing the casualty’s feet and forcing him to walk
on them will cause additional pain/injury.) Place the affected feet under clothing and
against the body of another soldier.
WARNING (081-831-1009)


DO NOT attempt to thaw the casualty’s feet or other seriously frozen areas if he
will be required to walk or travel to receive further treatment. The casualty should
avoid walking, if possible, because there is less danger in walking while the feet
are frozen than after they have been thawed. Thawing in the field increases the
possibilities of infection, gangrene, or other injury.

- NOTE
Thawing may occur spontaneously during transportation to the medical facility; this cannot
be avoided since the body in general must be kept warm.

In all of the above areas, ensure that the casualty is kept warm and that he is covered (to avoid further
injury). Seek medical treatment as soon as possible. Reassure the casualty, protect the affected area from
further injury by covering it lightly with a blanket or any dry clothing, and seek shelter out of the wind.
Remove/minimize constricting clothing and increase insulation. Ensure that the casualty exercises as much


First Aid for Climatic Injuries 129

as possible, avoiding trauma to the injured part, and is prepared for pain when thawing occurs. Protect the
frostbitten part from additional injury. DO NOT rub the injured part with snow or apply cold water soaks.
DO NOT warm the part by massage or exposure to open fire because the frozen part may be burned due
to the lack of feeling. DO NOT use ointments or other medications. DO NOT manipulate the part in any
way to increase circulation. DO NOT allow the casualty to use alcohol or tobacco because this reduces the
body’s resistance to cold. Remember, when freezing extends to a depth below the skin, it involves a much
more serious injury. Extra care is required to reduce or avoid the chances of losing all or part of the toes or
feet. This also applies to the fingers and hands.

•
Prevention. Prevention of frostbite or any cold injury depends on adequate nutrition, hot meals
and warm fluids. Other cold injury preventive factors are proper clothing and maintenance of
general body temperature. Fatigue, dehydration, tobacco, and alcoholic beverages should be
avoided.
•
Sufficient clothing must be worn for protection against cold and wind. Layers of clothing
that can be removed and replaced as needed are the most effective. Every effort must be
made to keep clothing and body as dry as possible. This includes avoiding any excessive
perspiration by removing and replacing layers of clothing. Socks should be changed
whenever the feet become moist or wet. Clothing and equipment should be properly fitted
to avoid any interference with blood circulation. Improper blood circulation reduces
the amount of heat that reaches the extremities. Tight fitting socks, shoes, and hand wear
are especially hazardous in very cold climates. The face needs extra protection against
high winds, and the ears need massaging from time to time to maintain circulation. Hands
may be used to massage and warm the face. By using the buddy system, individuals can
watch each other’s face for signs of frostbite to detect it early and keep tissue damage to
a minimum. A mask or headgear tunneled in front of the face guards against direct wind
injury. Fingers and toes should be exercised to keep them warm and to detect any numbness.
Wearing windproof leather gloves or mittens and avoiding kerosene, gasoline, or
alcohol on the skin are also preventive measures. Cold metal should not be touched with
bare skin; doing so could result in severe skin damage.
•
Adequate clothing and shelter are also necessary during periods of inactivity.
(4) Snow blindness. Snow blindness is the effect that glare from an ice field or snowfield has on the
eyes. It is more likely to occur in hazy, cloudy weather than when the sun is shining. Glare from
the sun will cause an individual to instinctively protect his eyes. However, in cloudy weather,
he may be overconfident and expose his eyes longer than when the threat is more obvious. He
may also neglect precautions such as the use of protective eyewear. Waiting until discomfort
(pain) is felt before using protective eyewear is dangerous because a deep burn of the eyes may
already have occurred.
•
Signs/Symptoms. Symptoms of snow blindness are a sensation of grit in the eyes with pain
in and over the eyes, made worse by eyeball movement. Other signs/symptoms are watering,
redness, headache, and increased pain on exposure to light. The same condition that
causes snow blindness can cause snow burn of skin, lips, and eyelids. If a snow burn is
neglected, the result is the same as a sunburn.
•
Treatment. First aid measures consist of blindfolding or covering the eyes with a dark cloth
which stops painful eye movement. Complete rest is desirable. If further exposure to light is
not preventable, the eyes should be protected with dark bandages or the darkest glasses available.
Once unprotected exposure to sunlight stops, the condition usually heals in a few days
without permanent damage. The casualty should be evacuated to the nearest medical facility.
•
Prevention. Putting on protective eye wear is essential not only to prevent injury, but to
prevent further injury if any has occurred. When protective eye wear is not available, an
emergency pair can be made from a piece of wood or cardboard cut and shaped to the width
of the face. Cut slits for the eyes and attach strings to hold the improvised glasses in place.

130 The Ultimate Guide to U.S. Army Survival Skills, Tactics, and Techniques

Slits are made at the point of vision to allow just enough space to see and reduce the risk of
injury. Blackening the eyelids and face around the eyes absorbs some of the harmful rays.

(5) Dehydration. Dehydration occurs when the body loses too much fluid, salt, and minerals. A certain
amount of body fluid is lost through normal body processes. A normal daily intake of food
and liquids replaces these losses. When individuals are engaged in any strenuous exercises or
activities, an excessive amount of fluid and salt is lost through sweat. This excessive loss creates
an imbalance of fluids, and dehydration occurs when fluid and salt are not replaced. It is very
important to know that it can be prevented if troops are instructed in its causes, symptoms, and
preventive measures. The danger of dehydration is as prevalent in cold regions as it is in hot
regions. In hot weather the individual is aware of his body losing fluids and salt. He can see,
taste, and feel the sweat as it runs down his face, gets into his eyes, and on his lips and tongue,
and drips from his body. In cold weather, however, it is extremely difficult to realize that this
condition exists. The danger of dehydration in cold weather operations is a serious problem.
In cold climates, sweat evaporates so rapidly or is absorbed so thoroughly by layers of heavy
clothing that it is rarely visible on the skin. Dehydration also occurs during cold weather operations
because drinking is inconvenient. Dehydration will weaken or incapacitate a casualty for
a few hours, or sometimes, several days. Because rest is an important part of the recovery process,
casualties must take care that limited movement during their recuperative period does not
enhance the risk of becoming a cold weather casualty.
•
Signs/Symptoms. The symptoms of cold weather dehydration are similar to those encountered
in heat exhaustion. The mouth, tongue, and throat become parched and dry, and swallowing
becomes difficult. The casualty may have nausea with or without vomiting along with
extreme dizziness and fainting. The casualty may also feel generally tired and weak and may
experience muscle cramps (especially in the legs). Focusing eyes may also become difficult.
•
Treatment. The casualty should be kept warm and his clothes should be loosened to allow
proper circulation. Shelter from wind and cold will aid in this treatment. Fluid replacement,
rest, and prompt medical treatment are critical. Medical personnel will determine the need
for salt replacement.
•
Prevention. These general preventive measures apply for both hot and cold weather. Sufficient
additional liquids should be consumed to offset excessive body losses of these elements.
The amount should vary according to the individual and the type of work he is doing
(light, heavy, or very strenuous). Rest is equally important as a preventive measure. Each
individual must realize that any work that must be done while bundled in several layers of
clothing is extremely exhausting. This is especially true of any movement by foot, regardless
of the distance.
(6) Hypothermia (general cooling). In intense cold a soldier may become both mentally and physically
numb, thus neglecting essential tasks or requiring more time and effort to achieve them.
Under some conditions (particularly cold water immersion), even a soldier in excellent physical
condition may die in a matter of minutes. The destructive influence of cold on the body is called
hypothermia. This means bodies lose heat faster than they can produce it. Frostbite may occur
without hypothermia when extremities do not receive sufficient heat from central body stores.
The reason for this is inadequate circulation and/or inadequate insulation. Nonetheless, hypothermia
and frostbite may occur at the same time with exposure to below-freezing temperatures.
An example of this is an avalanche accident. Hypothermia may occur from exposure to temperatures
above freezing, especially from immersion in cold water, wet-cold conditions, or from
the effect of wind. Physical exhaustion and insufficient food intake may also increase the risk
of hypothermia. Excessive use of alcohol leading to unconsciousness in a cold environment can
also result in hypothermia. General cooling of the entire body to a temperature below 95°F is
caused by continued exposure to low or rapidly dropping temperatures, cold moisture, snow,
or ice. Fatigue, poor physical condition, dehydration, faulty blood circulation, alcohol or other

First Aid for Climatic Injuries 131

drug intoxication, trauma, and immersion can cause hypothermia. Remember, cold affects
the body systems slowly and almost without notice. Soldiers exposed to low temperatures for
extended periods may suffer ill effects even if they are well protected by clothing.

•
Signs/Symptoms. As the body cools, there are several stages of progressive discomfort
and impairment. A sign/symptom that is noticed immediately is shivering. Shivering is an
attempt by the body to generate heat. The pulse is faint or very difficult to detect. People
with temperatures around 90°F may be drowsy and mentally slow. Their ability to move
may be hampered, stiff, and uncoordinated, but they may be able to function minimally.
Their speech may be slurred. As the body temperature drops further, shock becomes evident
as the person’s eyes assume a glassy state, breathing becomes slow and shallow, and the
pulse becomes weaker or absent. The person becomes very stiff and uncoordinated. Unconsciousness
may follow quickly. As the body temperature drops even lower, the extremities
freeze, and a deep (or core) body temperature (below 85°F) increases the risk of irregular
heart action. This irregular heart action or heart standstill can result in sudden death.
•
Treatment. Except in cases of the most severe hypothermia (marked by coma or unconsciousness,
a weak pulse, and a body temperature of approximately 90°F or below), the treatment
for hypothermia is directed towards rewarming the body evenly and without delay. Provide
heat by using a hot water bottle, electric blanket, campfire, or another soldier’s body heat.
Always call or send for help as soon as possible and protect the casualty immediately with
dry clothing or a sleeping bag. Then, move him to a warm place. Evaluate other injuries
and treat them. Treatment can be given while the casualty is waiting evacuation or while
he is en route. In the case of an accidental breakthrough into ice water, or other hypothermic
accident, strip the casualty of wet clothing immediately and bundle him into a sleeping
bag. Mouth-to-mouth resuscitation should be started at once if the casualty’s breathing
has stopped or is irregular or shallow. Warm liquids may be given gradually but must not
be forced on an unconscious or semiconscious person because he may choke. The casualty
should be transported on a litter because the exertion of walking may aggravate circulation
problems. A physician should immediately treat any hypothermia casualty. Hypothermia is
life-threatening until normal body temperature has been restored. The treatment of a casualty
with severe hypothermia is based upon the following principles: stabilize the temperature,
attempt to avoid further heat loss, handle the casualty gently, and evacuate as soon as
possible to the nearest medical treatment facility! Rewarming a severely hypothermic casualty
is extremely dangerous in the field due to the great possibility of such complications as
rewarming shock and disturbances in the rhythm of the heartbeat.
*CAUTION
Hypothermia is a MEDICAL EMERGENCY! Prompt medical treatment is necessary. Casualties
with hypothermic complications should be transported to a medical treatment facility
immediately.


CAUTION
The casualty is unable to generate his own body heat. Therefore, merely placing him in a
blanket or sleeping bag is not sufficient.

•
Prevention. Prevention of hypothermia consists of all actions that will avoid rapid and uncontrollable
loss of body heat. Individuals should be properly equipped and properly dressed
(as appropriate for conditions and exposure). Proper diet, sufficient rest, and general principles
apply. Ice thickness must be tested before river or lake crossings. Anyone departing a

132 The Ultimate Guide to U.S. Army Survival Skills, Tactics, and Techniques

fixed base by aircraft, ground vehicle, or foot must carry sufficient protective clothing and
food reserves to survive during unexpected weather changes or other unforeseen emergencies.
Traveling alone is never safe. Expected itinerary and arrival time should be left with
responsible parties before any departure in severe weather. Anyone living in cold regions
should learn how to build expedient shelters from available materials including snow.

e. Table. See Table 5-2 for further information.
Table 5-2: Cold and Wet Injuries (081-831-1009).


(continued)


First Aid for Climatic Injuries 133

Table 5-2: (Continued)


(continued)


Table 5-2: (Continued)



CHAPTER 6


First Aid for Bites and Stings


Snakebites, insect bites, or stings can cause intense pain and/or swelling. If not treated promptly and correctly,
they can cause serious illness or death. The severity of a snakebite depends upon: whether the snake
is poisonous or nonpoisonous, the type of snake, the location of the bite, and the amount of venom injected.
Bites from humans and other animals, such as dogs, cats, bats, raccoons, and rats can cause severe bruises
and infection, and tears or lacerations of tissue. Awareness of the potential sources of injuries can reduce
or prevent them from occurring. Knowledge and prompt application of first aid measures can lessen the
severity of injuries from bites and stings and keep the soldier from becoming a serious casualty.

6-1. Types of Snakes

a.
Nonpoisonous Snakes. There are approximately 130 different varieties of nonpoisonous snakes in
the United States. They have oval-shaped heads and round eyes. Unlike poisonous snakes, discussed
below, nonpoisonous snakes do not have fangs with which to inject venom. See Figure 6-1
for characteristics of a nonpoisonous snake.
b. Poisonous Snakes. Poisonous snakes are found throughout the world, primarily in tropical to moderate
climates. Within the United States, there are four kinds: rattlesnakes, copperheads, water moccasins
(cottonmouth), and coral snakes. Poisonous snakes in other parts of the world include sea
snakes, the fer-de-lance, the bushmaster, and the tropical rattlesnake in tropical Central America;
the Malayan pit viper in the tropical Far East; the cobra in Africa and Asia; the mamba (or black
mamba) in Central and Southern Africa; and the krait in India and Southeast Asia. See Figure 6-2
for characteristics of a poisonous pit viper.
Figure 6-1: Characteristics of nonpoisonous snake.


Figure 6-2: Characteristics of poisonous pit viper.

135


136 The Ultimate Guide to U.S. Army Survival Skills, Tactics, and Techniques

c. Pit Vipers (Poisonous). See Figure 6-3 for illustrations.
(1) Rattlesnakes, bushmasters, copperheads, fer-de-lance, Malayan pit vipers, and water moccasins
(cottonmouth) are called pit vipers because of the small, deep pits between the nostrils and eyes
on each side of the head (Figure 6-2). In addition to their long, hollow fangs, these snakes have
other identifying features: thick bodies, slit-like pupils of the eyes, and flat, almost triangularshaped
heads. Color markings and other identifying characteristics, such as rattles or a noticeable
white interior of the mouth (cottonmouth), also help distinguish these poisonous snakes.
Further identification is provided by examining the bite pattern of the wound for signs of fang
entry. Occasionally there will be only one fang mark, as in the case of a bite on a finger or toe
where there is no room for both fangs, or when the snake has broken off a fang.
(2) The casualty’s condition provides the best information about the seriousness of the situation, or
how much time has passed since the bite occurred. Pit viper bites are characterized by severe
burning pain. Discoloration and swelling around the fang marks usually begins within 5 to 10
minutes after the bite. If only minimal swelling occurs within 30 minutes, the bite will almost
certainly have been from a nonpoisonous snake or possibly from a poisonous snake which did
not inject venom. The venom destroys blood cells, causing a general discoloration of the skin.
This reaction is followed by blisters and numbness in the affected area. Other signs which can
occur are weakness, rapid pulse, nausea, shortness of breath, vomiting, and shock.
d. Corals, Cobras, Kraits, and Mambas. Corals, cobra, kraits, and mambas all belong to the same group
even though they are found in different parts of the world. All four inject their venom through short,
grooved fangs, leaving a characteristic bite pattern. See Figure 6-4 for illustration of a cobra snake.
(1) The small coral snake, found in the Southeastern United States, is brightly colored with bands
of red, yellow (or almost white), and black completely encircling the body (Figure 6-5). Other
nonpoisonous snakes have the same coloring, but on the coral snake found in the United States,
the red ring always touches the yellow ring. To know the difference between a harmless snake
and the coral snake found in the United States, remember the following:
“Red on yellow will kill a fellow. Red on black, venom will lack.”
Figure 6-3: Poisonous snakes.


First Aid for Bites and Stings 137


Figure 6-4: Cobra snake.


Figure 6-5: Coral snake.

(2) The venom of corals, cobras, kraits, and mambas produces symptoms different from those of
pit vipers. Because there is only minimal pain and swelling, many people believe that the bite is
not serious. Delayed reactions in the nervous system normally occur between 1 to 7 hours after
the bite. Symptoms include blurred vision, drooping eyelids, slurred speech, drowsiness, and
increased salivation and sweating. Nausea, vomiting, shock, respiratory difficulty, paralysis,
convulsions, and coma will usually develop if the bite is not treated promptly.
e.
Sea Snakes. Sea snakes (Figure 6-6) are found in the warm water areas of the Pacific and Indian oceans,
along the coasts, and at the mouths of some larger rivers. Their venom is VERY poisonous, but their
fangs are only 1/4 inch long. The first aid outlined for land snakes also applies to sea snakes.
6-2. Snakebites. If a soldier should accidentally step on or otherwise disturb a snake, it will attempt to
strike. Chances of this happening while traveling along trails or waterways are remote if a soldier is alert
and careful. Poisonous snakes DO NOT always inject venom when they bite or strike a person. However,
all snakes may carry tetanus (lockjaw); anyone bitten by a snake, whether poisonous or nonpoisonous,
should immediately seek medical attention. Poison is injected from the venom sacs through grooved or
hollow fangs. Depending on the species, these fangs are either long or short. Pit vipers have long hollow
fangs. These fangs are folded against the roof of the mouth and extend when the snake strikes. This allows
them to strike quickly and then withdraw. Cobras, coral snakes, kraits, mambas, and sea snakes have
short, grooved fangs. These snakes are less effective in their attempts to bite, since they must chew after


138 The Ultimate Guide to U.S. Army Survival Skills, Tactics, and Techniques


Figure 6-6: Sea snake.

striking to inject enough venom (poison) to be effective. See Figure 6-7 for characteristics of a poisonous
snakebite. In the event you are bitten, attempt to identify and/or kill the snake. Take it to medical personnel
for inspection/identification. This provides valuable information to medical personnel who deal with
snakebites. TREAT ALL SNAKEBITES AS POISONOUS.

a.
Venoms. The venoms of different snakes cause different effects. Pit viper venoms (hemotoxins)
destroy tissue and blood cells. Cobras, adders, and coral snakes inject powerful venoms (neurotoxins)
which affect the central nervous system, causing respiratory paralysis. Water moccasins and
sea snakes have venom that is both hemotoxic and neurotoxic.
b. Identification. The identification of poisonous snakes is very important since medical treatment will
be different for each type of venom. Unless it can be positively identified the snake should be killed
and saved. When this is not possible or when doing so is a serious threat to others, identification
may sometimes be difficult since many venomous snakes resemble harmless varieties. When dealing
with snakebite problems in foreign countries, seek advice, professional or otherwise, which may
help identify species in the particular area of operations.
*c. First Aid. Get the casualty to a medical treatment facility as soon as possible and with minimum
movement. Until evacuation or treatment is possible, have the casualty lie quietly and not move
anymore than necessary. The casualty should not smoke, eat, nor drink any fluids. If the casualty


Figure 6-7: Characteristics of poisonous snake bite.


First Aid for Bites and Stings 139

has been bitten on an extremity, DO NOT elevate the limb; keep the extremity level with the body.
Keep the casualty comfortable and reassure him. If the casualty is alone when bitten, he should go
to the medical facility himself rather than wait for someone to find him. Unless the snake has been
positively identified, attempt to kill it and send it with the casualty. Be sure that retrieving the snake
does not endanger anyone or delay transporting the casualty.

* (1) If the bite is on an arm or leg, place a constricting band (narrow cravat [swathe], or narrow gauze
bandage) one to two finger widths above and below the bite (Figure 6-8). However, if only one
constricting band is available, place that band on the extremity between the bite site and the
casualty’s heart. If the bite is on the hand or foot, place a single band above the wrist or ankle.
The band should be tight enough to stop the flow of blood near the skin, but not tight enough to
interfere with circulation. In other words, it should not have a tourniquet-like affect. If no swelling
is seen, place the bands about one inch from either side of the bite. If swelling is present, put
the bands on the unswollen part at the edge of the swelling. If the swelling extends beyond the
band, move the band to the new edge of the swelling. (If possible, leave the old band on, place a
new one at the new edge of the swelling, and then remove and save the old one in case the process
has to be repeated.) If possible, place an ice bag over the area of the bite. DO NOT wrap the
limb in ice or put ice directly on the skin. Cool the bite area—do not freeze it. DO NOT stop to
look for ice if it will delay evacuation and medical treatment.
CAUTION
DO NOT attempt to cut open the bite nor suck out the venom. If the venom should seep
through any damaged or lacerated tissues in your mouth, you could immediately lose
consciousness or even die.


(2) If the bite is located on an arm or leg, immobilize it at a level below the heart. DO NOT elevate
an arm or leg even with or above the level of the heart.
CAUTION
When a splint is used to immobilize the arm or leg, take EXTREME care to ensure the
splinting is done properly and does not bind. Watch it closely and adjust it if any changes
in swelling occur.


(3) When possible, clean the area of the bite with soap and water. DO NOT use ointments of any kind.
(4) NEVER give the casualty food, alcohol, stimulants (coffee or tea), drugs, or tobacco.
(5) Remove rings, watches, or other jewelry from the affected limb.
Figure 6-8: Constricting band.


140 The Ultimate Guide to U.S. Army Survival Skills, Tactics, and Techniques

- NOTE
It may be possible, in some cases, for an aidman who is specially trained and is authorized
to carry and use antivenin to administer it. The use of antivenin presents special
risks, and only those with specialized training should attempt to use it!

d. Prevention. Except for a few species, snakes tend to be shy or passive. Unless they are injured,
trapped, or disturbed, snakes usually avoid contact with humans. The harmless species are often
more prone to attack. All species of snakes are usually aggressive during their breeding season.
(1) Land snakes. Many snakes are active during the period from twilight to daylight. Avoid walking
as much as possible during this time.
• Keep your hands off rock ledges where snakes are likely to be sunning.
• Look around carefully before sitting down, particularly if in deep grass among rocks.
•
Attempt to camp on clean, level ground. Avoid camping near piles of brush, rocks, or other
debris.
•
Sleep on camping cots or anything that will keep you off the ground. Avoid sleeping on the
ground if at all possible.
•
Check the other side of a large rock before stepping over it. When looking under any rock,
pull it toward you as you turn it over so that it will shield you in case a snake is beneath it.
•
Try to walk only in open areas. Avoid walking close to rock walls or similar areas where
snakes may be hiding.
•
Determine when possible what species of snakes are likely to be found in an area which you
are about to enter.
•
Hike with another person. Avoid hiking alone in a snake-infested area. If bitten, it is important
to have at least one companion to perform lifesaving first aid measures and to kill the snake.
Providing the snake to medical personnel will facilitate both identification and treatment.
•
Handle freshly killed venomous snakes only with a long tool or stick. Snakes can inflict fatal
bites by reflex action even after death.
•
Wear heavy boots and clothing for some protection from snakebite. Keep this in mind when
exposed to hazardous conditions.
•
Eliminate conditions under which snakes thrive: brush, piles of trash, rocks, or logs and
dense undergrowth. Controlling their food (rodents, small animals) as much as possible is
also good prevention.
(2) Sea snakes. Sea snakes may be seen in large numbers but are not known to bite unless handled.
Be aware of the areas where they are most likely to appear and be especially alert when swimming
in these areas. Avoid swimming alone whenever possible.
WARNING

All species of snakes can swim. Many can remain under water for long periods. A
bite sustained in water is just as dangerous as one on land.

6-3. Human and Other Animal Bites. Human or other land animal bites may cause lacerations or bruises.
In addition to damaging tissue, human or bites from animals such as dogs, cats, bats, raccoons, or rats
always present the possibility of infection.

a.
Human Bites. Human bites that break the skin may become seriously infected since the mouth is
heavily contaminated with bacteria. All human bites MUST be treated by medical personnel.
b. Animal Bites. Land animal bites can result in both infection and disease. Tetanus, rabies, and various
types of fevers can follow an untreated animal bite. Because of these possible complications, the

First Aid for Bites and Stings 141

animal causing the bite should, if possible, be captured or killed (without damaging its head) so that
competent authorities can identify and test the animal to determine if it is carrying diseases.

c.
First Aid.
(1) Cleanse the wound thoroughly with soap or detergent solution.
(2) Flush it well with water.
(3) Cover it with a sterile dressing.
(4) Immobilize an injured arm or leg.
(5) Transport the casualty immediately to a medical treatment facility.
- NOTE
If unable to capture or kill the animal, provide medical personnel with any information possible
that will help identify it. Information of this type will aid in appropriate treatment.

6-4. Marine (Sea) Animals. With the exception of sharks and barracuda, most marine animals will not
deliberately attack. The most frequent injuries from marine animals are wounds by biting, stinging, or
puncturing. Wounds inflicted by marine animals can be very painful, but are rarely fatal.

a.
Sharks, Barracuda, and Alligators. Wounds from these marine animals can involve major trauma
as a result of bites and lacerations. Bites from large marine animals are potentially the most life
threatening of all injuries from marine animals. Major wounds from these animals can be treated
by controlling the bleeding, preventing shock, giving basic life support, splinting the injury, and by
securing prompt medical aid.
b. Turtles, Moray Eels, and Corals. These animals normally inflict minor wounds. Treat by cleansing
the wound(s) thoroughly and by splinting if necessary.
c.
Jellyfish, Portuguese men-of-war, Anemones, and Others. This group of marine animals inflict
injury by means of stinging cells in their tentacles. Contact with the tentacles produces burning pain
with a rash and small hemorrhages on the skin. Shock, muscular cramping, nausea, vomiting, and
respiratory distress may also occur. Gently remove the clinging tentacles with a towel and wash or
treat the area. Use diluted ammonia or alcohol, meat tenderizer, and talcum powder. If symptoms
become severe or persist, seek medical aid.
d. Spiny Fish, Urchins, Stingrays, and Cone Shells. These animals inject their venom by puncturing
with their spines. General signs and symptoms include swelling, nausea, vomiting, generalized
cramps, diarrhea, muscular paralysis, and shock. Deaths are rare. Treatment consists of soaking
the wounds in hot water (when available) for 30 to 60 minutes. This inactivates the heat sensitive
toxin. In addition, further first aid measures (controlling bleeding, applying a dressing, and so
forth) should be carried out as necessary.
CAUTION
Be careful not to scald the casualty with water that is too hot because the pain of the
wound will mask the normal reaction to heat.

6-5. Insect Bites/Stings. An insect bite or sting can cause great pain, allergic reaction, inflammation, and
infection. If not treated correctly, some bites/stings may cause serious illness or even death. When an allergic
reaction is not involved, first aid is a simple process. In any case, medical personnel should examine
the casualty at the earliest possible time. It is important to properly identify the spider, bee, or creature that
caused the bite/sting, especially in cases of allergic reaction when death is a possibility.

a.
Types of Insects. The insects found throughout the world that can produce a bite or sting are too
numerous to mention in detail. Commonly encountered stinging or biting insects include brown

142 The Ultimate Guide to U.S. Army Survival Skills, Tactics, and Techniques

recluse spiders (Figure 6-9), black widow spiders (Figure 6-10), tarantulas (Figure 6-11), scorpions
(Figure 6-12), urticating caterpillars, bees, wasps, centipedes, conenose beetles (kissing bugs),
ants, and wheel bugs. Upon being reassigned, especially to overseas areas, take the time to become
acquainted with the types of insects to avoid.

b. Signs/Symptoms. Discussed in paragraphs (1) and (2) below are the most common effects of insect
bites/stings. They can occur alone or in combination with the others.
(1) Less serious. Commonly seen signs/symptoms are pain, irritation, swelling, heat, redness,
and itching. Hives or wheals (raised areas of the skin that itch) may occur. These are the least
Figure 6-9: Brown recluse spider.


Figure 6-10: Black widow spider.


Figure 6-11: Tarantula.

Figure 6-12: Scorpion.

First Aid for Bites and Stings 143

severe of the allergic reactions that commonly occur from insect bites/stings. They are usually
dangerous only if they affect the air passages (mouth, throat, nose, and so forth), which could
interfere with breathing. The bites/stings of bees, wasps, ants, mosquitoes, fleas, and ticks are
usually not serious and normally produce mild and localized symptoms. A tarantula’s bite is
usually no worse than that of a bee sting. Scorpions are rare and their stings (except for a specific
species found only in the Southwest desert) are painful but usually not dangerous.

(2) Serious. Emergency allergic or hypersensitive reactions sometimes result from the stings of
bees, wasps, and ants. Many people are allergic to the venom of these particular insects. Bites
or stings from these insects may produce more serious reactions, to include generalized itching
and hives, weakness, anxiety, headache, breathing difficulties, nausea, vomiting, and diarrhea.
Very serious allergic reactions (called anaphylactic shock) can lead to complete collapse, shock,
and even death. Spider bites (particularly from the black widow and brown recluse spiders) can
be serious also. Venom from the black widow spider affects the nervous system. This venom can
cause muscle cramps, a rigid, nontender abdomen, breathing difficulties, sweating, nausea and
vomiting. The brown recluse spider generally produces local rather than system-wide problems;
however, local tissue damage around the bite can be severe and can lead to an ulcer and
even gangrene.
c.
First Aid. There are certain principles that apply regardless of what caused the bite/sting. Some of
these are:
•
If there is a stinger present, for example, from a bee, remove the stinger by scraping the skin’s
surface with a fingernail or knife. DO NOT squeeze the sac attached to the stinger because it may
inject more venom.
•
Wash the area of the bite/sting with soap and water (alcohol or an antiseptic may also be used)
to help reduce the chances of an infection and remove traces of venom.
•
Remove jewelry from bitten extremities because swelling is common and may occur.
•
In most cases of insect bites the reaction will be mild and localized. Use ice or cold compresses
(if available) on the site of the bite/sting. This will help reduce swelling, ease the pain, and slow
the absorption of venom. Meat tenderizer (to neutralize the venom) or calamine lotion (to reduce
itching) may be applied locally. If necessary, seek medical aid.
•
In more serious reactions (severe and rapid swelling, allergic symptoms, and so forth) treat the
bite/sting like you would treat a snakebite; that is, apply constricting bands above and below the
site. See paragraph 6-2c(1) above for details and illustration (Figure 6-8) of a constricting band.
•
* Be prepared to perform basic lifesaving measures, such as rescue breathing. Reassure the casualty
and keep him calm.

•
In serious reactions, attempt to capture the insect for positive identification; however, be careful
not to become a casualty yourself.
•
If the reaction or symptoms appear serious, seek medical aid immediately.
*CAUTION
Insect bites/stings may cause anaphylactic shock (a shock caused by a severe allergic
reaction). This is a life-threatening event and a MEDICAL EMERGENCY! Be prepared to
immediately transport the casualty to a medical facility.

- NOTE
Be aware that some allergic or hypersensitive individuals may carry identification (such
as a MEDIC ALERT tag) or emergency insect bite treatment kits. If the casualty is having
an allergic reaction and has such a kit, administer the medication in the kit according to
the instructions which accompany the kit.


144 The Ultimate Guide to U.S. Army Survival Skills, Tactics, and Techniques

d. Prevention. Some prevention principles are:
•
Apply insect repellent to all exposed skin, such as the ankles to prevent insects from creeping
between uniform and boots. Also apply the insect repellent to the shoulder blades where the shirt
fits tight enough that mosquitoes bite through. DO NOT apply insect repellent to the eyes.
•
Reapply repellent, every 2 hours during strenuous activity and soon after stream crossings.
•
Blouse the uniform inside the boots to further reduce risk.
•
Wash yourself daily if the tactical situation permits. Pay particular attention to the groin and
armpits.
•
Use the buddy system. Check each other for insect bites.
• Wash your uniform at least weekly.
6-6. Table. See Table 6-1 for information on bites and stings.
Table 6-1: Bites and Stings.

(continued)


First Aid for Bites and Stings 145

Table 6-1: (Continued)



CHAPTER 7


First Aid in Toxic Environments


American forces have not been exposed to high levels of toxic substances on the battlefield since World
War I. In future conflicts and wars we can expect the use of such agents. Chemical weapons will degrade
unit effectiveness rapidly by forcing troops to wear hot protective clothing and by creating confusion and
fear. Through training in protective procedures and first aid, units can maintain their effectiveness on the
integrated battlefield.

SECTION I. INDIVIDUAL PROTECTION AND FIRST AID EQUIPMENT
FOR TOXIC SUBSTANCES

7-1. Toxic Substances

a.
Gasoline, chlorine, and pesticides are examples of common toxic substances. They may exist as
solids, liquids, or gases depending upon temperature and pressure. Gasoline, for example, is a
vaporizable liquid; chlorine is a gas; and Warfarin, a pesticide, is a solid. Some substances are more
injurious to the body than others when they are inhaled or eaten or when they contact the skin or
eyes. Whether they are solids, liquids, or gases (vapors and aerosols included), they may irritate,
inflame, blister, burn, freeze, or destroy tissue such as that associated with the respiratory tract or
the eyes. They may also be absorbed into the bloodstream, disturbing one or several of the body’s
major functions.
b. You may come in contact with toxic substances in combat or in everyday activities. Ordinarily, brief
exposures to common household toxic substances, such as disinfectants and bleach solutions, do
not cause injuries. Exposure to toxic chemical agents in warfare, even for a few seconds, could result
in death, injury, or incapacitation. Remember that toxic substances employed by an enemy could
persist for hours or days. To survive and operate effectively in a toxic environment, you must be
prepared to protect yourself from the effects of chemical agents and to provide first aid to yourself
and to others.
7-2. Protective and First Aid Equipment. You are issued equipment for protection and first aid treatment
in a toxic environment. You must know how to use the items described in a through e. It is equally important
that you know when to use them. Use your protective clothing and equipment when you are ordered
to and when you are under a nuclear, biological, or chemical (NBC) attack. Also, use your protective clothing
and equipment when you enter an area where NBC agents have been employed.

a.
Field Protective Mask With Protective Hood. Your field protective mask is the most important piece
of protective equipment. You are given special training in its use and care.
b. Field Protective Clothing. Each soldier is authorized three sets of the following field protective
clothing:
• Overgarment ensemble (shirt and trousers), chemical protective.
• Footwear cover (overboots), chemical protective.
• Glove set, chemical protective.
c.
Nerve Agent Pyridostigmine Pretreatment (NAPP). You will be issued a blister pack of pretreatment
tablets when your commander directs. When ordered to take the pretreatment you must take
147


148 The Ultimate Guide to U.S. Army Survival Skills, Tactics, and Techniques

one tablet every eight hours. This must be taken prior to exposure to nerve agents, since it may take
several hours to develop adequate blood levels.

- NOTE
Normally, one set of protective clothing is used in acclimatization training that uses various
mission-oriented protective posture (MOPP) levels.

d. M258A1 Skin Decontamination Kit. The M258A1 Skin Decontamination (decon) Kit contains three
each of the following:
•
DECON-1 packets containing wipes (pads) moistened with decon solution.
•
DECON-2 packets containing dry wipes (pads) previously moistened with decon solution and
sealed glass ampules. Ampules are crushed to moisten pads.
WARNING


The decon solution contained in both DECON-1 and DECON-2 packets is a poison
and caustic hazard and can permanently damage the eyes. Keep wipes out of the
eyes, mouth, and open wounds. Use WATER to wash toxic agent out of eyes and
wounds and seek medical aid.

e.
Nerve Agent Antidote Kit, Mark I (NAAK MKI). Each soldier is authorized to carry three Nerve
Agent Antidote Kits, Mark I, to treat nerve agent poisoning. When NAPP has been taken several
hours (but no greater than 8 hours) prior to exposure, the NAAK MKI treatment of nerve agent
poisoning is much more effective.
SECTION II. CHEMICAL-BIOLOGICAL AGENTS
7-3. Classification

a.
Chemical agents may be classified according to the primary physiological effects they produce,
such as nerve, blister, blood, choking, vomiting, and incapacitating agents.
b. Biological agents may be classified according to the effect they have on man. These include blockers,
inhibitors, hybrids, and membrane active compounds. These agents are found in living organisms
such as fungi, bacteria and viruses.
WARNING


Ingesting water or food contaminated with nerve, blister, and other chemical
agents and with some biological agents can be fatal. NEVER consume water or
food which is suspected of being contaminated until it has been tested and found
safe for consumption.

7-4. Conditions for Masking Without Order or Alarm. Once an attack with a chemical or biological agent
is detected or suspected, or information is available that such an agent is about to be used, you must STOP
breathing and mask immediately. DO NOT WAIT to receive an order or alarm under the following circumstances:


•
Your position is hit by artillery or mortar fire, missiles, rockets, smokes, mists, aerial sprays, bombs,
or bomblets.
•
Smoke from an unknown source is present or approaching.

First Aid in Toxic Environments 149

•
A suspicious odor, liquid, or solid is present.
•
A toxic chemical or biological attack is present.
•
You are entering an area known or suspected of being contaminated.
•
During any motor march, once chemical warfare has begun.
•
When casualties are being received from an area where chemical or biological agents have reportedly
been used.
•
You have one or more of the following symptoms:
•
An unexplained runny nose.
•
A feeling of choking or tightness in the chest or throat.
•
Dimness of vision.
•
Irritation of the eyes.
•
Difficulty in or increased rate of breathing without obvious reason.
•
Sudden feeling of depression.
•
Dread, anxiety, restlessness.
•
Dizziness or light-headedness.
•
Slurred speech.
•
Unexplained laughter or unusual behavior is noted in others.
•
Numerous unexplained ill personnel.
•
Buddies suddenly collapsing without evident cause.
•
Animals or birds exhibiting unusual behavior and/or sudden unexplained death.
7-5. First Aid for a Chemical Attack (081-831-1030 and 081-831-1031). Your field protective mask gives
protection against chemical as well as biological agents. Previous practice enables you to mask in 9 seconds
or less or to put on your mask with hood within 15 seconds.

a.
Step ONE (081-831-1030 and 081-831-1031). Stop breathing. Don your mask, seat it properly, clear
and check your mask, and resume breathing. Give the alarm, and continue the mission. Keep your
mask on until the “all clear” signal has been given.
- NOTE

Keep your mask on until the area is no longer hazardous and you are told to unmask.

b. Step TWO (081-831-1030). If symptoms of nerve agent poisoning (paragraph 7-7) appear, immediately
give yourself a nerve agent antidote. You should have taken NAPP several hours prior to
exposure which will enhance the action of the nerve agent antidote.
CAUTION
Do not inject a nerve agent antidote until you are sure you need it.

c.
Step THREE (081-831-1031). If your eyes and face become contaminated, you must immediately try to
get under cover. You need this shelter to prevent further contamination while performing decon procedures
on areas of the head. If no overhead cover is available, throw your poncho or shelter half over
your head before beginning the decon process. Then you should put on the remaining protective clothing.
(See Appendix F for decon procedure.) If vomiting occurs, the mask should be lifted momentarily
and drained—while the eyes are closed and the breath is held—and replaced, cleared, and sealed.
d. Step FOUR. If nerve agents are used, mission permitting, watch for persons needing nerve agent
antidotes and immediately follow procedures outlined in paragraph 7-8 b.
e. Step FIVE. When your mission permits, decon your clothing and equipment.

150 The Ultimate Guide to U.S. Army Survival Skills, Tactics, and Techniques

SECTION III. NERVE AGENTS
7-6. Background Information

a.
Nerve agents are among the deadliest of chemical agents. They can be delivered by artillery shell,
mortar shell, rocket, missile, landmine, and aircraft bomb, spray, or bomblet. Nerve agents enter
the body by inhalation, by ingestion, and through the skin. Depending on the route of entry and the
amount, nerve agents can produce injury or death within minutes. Nerve agents also can achieve
their effects with small amounts. Nerve agents are absorbed rapidly, and the effects are felt immediately
upon entry into the body. You will be issued three Nerve Agent Antidote Kits, Mark I. Each
kit consists of one atropine autoinjector and one pralidoxime chloride (2 PAM Cl) autoinjector (also
called injectors) (Figure 7-1).
b. When you have the signs and symptoms of nerve agent poisoning, you should immediately put on
the protective mask and then inject yourself with one set of the Nerve Agent Antidote Kit, Mark I.
You should inject yourself in the outside (lateral) thigh muscle or if you are thin, in the upper outer
(lateral) part of the buttocks.
c.
Also, you may come upon an unconscious chemical agent casualty who will be unable to care for
himself and who will require your aid. You should be able to successfully—
(1) Mask him if he is unmasked.
(2) Inject him, if necessary, with all his autoinjectors.
(3) Decontaminate his skin.
(4) Seek medical aid.
7-7. Signs/Symptoms of Nerve Agent Poisoning (081-831-1030 and 081-831-1031). The symptoms of nerve
agent poisoning are grouped as MILD—those which you recognize and for which you can perform selfaid,
and SEVERE—those which require buddy aid.

a.
MILD Symptoms (081-831-1030).
• Unexplained runny nose.
• Unexplained sudden headache.
• Sudden drooling.
• Difficulty seeing (blurred vision).
• Tightness in the chest or difficulty in breathing.
• Localized sweating and twitching (as a result of small amount of nerve agent on skin).
• Stomach cramps.
• Nausea.
b. SEVERE Signs/Symptoms (081-831-1031).
• Strange or confused behavior.
• Wheezing, difficulty in breathing, and coughing.
Figure 7-1: Nerve Agent Antidote Kit, Mark I.


First Aid in Toxic Environments 151

• Severely pinpointed pupils.
• Red eyes with tearing (if agent gets into the eyes).
• Vomiting.
• Severe muscular twitching and general weakness.
• Loss of bladder/bowel control.
• Convulsions.
• Unconsciousness.
• Stoppage of breathing.
7-8. First Aid for Nerve Agent Poisoning (081-831-1030) and (081-831-1031). The injection site for administering
the Nerve Agent Antidote Kit, Mark I (see Figure 7-1), is normally in the outer thigh muscle (see
Figure 7-2). It is important that the injections be given into a large muscle area. If the individual is thinlybuilt,
then the injections must be administered into the upper outer quarter (quadrant) of the buttocks (see
Figure 7-3). This avoids injury to the thigh bone.


WARNING

There is a nerve that crosses the buttocks, so it is important to inject only into the
upper outer quadrant (see Figure 7-3). This will avoid injuring this nerve. Hitting
the nerve can cause paralysis.
a. Self-Aid (081-831-1030).

(1) Immediately put on your protective mask after identifying any of the signs/symptoms of nerve
agent poisoning (paragraph 7-7).
Figure 7-2: Thigh injection site.


Figure 7-3: Buttocks injections site.


152 The Ultimate Guide to U.S. Army Survival Skills, Tactics, and Techniques

(2) Remove one set of the Nerve Agent Antidote Kit, Mark I.
(3) With your non dominant hand, hold the autoinjectors by the plastic clip so that the larger autoinjector
is on top and both are positioned in front of you at eye level (see Figure 7-4).
(4) With the other hand, check the injection site (thigh or buttocks) for buttons or objects in pockets
which may interfere with the injections.
(5) Grasp the atropine (smaller) autoinjector with the thumb and first two fingers (see Figure 7-5).
CAUTION
DO NOT cover/hold the green (needle) end with your hand or fingers—you might accidentally
inject yourself.

(6) Pull the injector out of the clip with a smooth motion (see Figure 7-6).
WARNING
The injector is now armed. DO NOT touch the green (needle) end.
(7) Form a fist around the autoinjector. BE CAREFUL NOT TO INJECT YOURSELF IN THE HAND!
Figure 7-4: Holding the set of autoinjectors by the plastic clip.


Figure 7-5: Grasping the atropine autoinjector between the thumb and first two fingers of the hand.


First Aid in Toxic Environments 153


Figure 7-6: Removing the atropine autoinjector from the clip.

(8) Position the green end of the atropine autoinjector against the injection site (thigh or buttocks):
(a) On the outer thigh muscle (see Figure 7-7).
OR
(b) On the upper outer portion of the buttocks (see Figure 7-8).
Figure 7-7: Thigh injection site for self-aid.


Figure 7-8: Buttocks injection site for self-aid.


154 The Ultimate Guide to U.S. Army Survival Skills, Tactics, and Techniques

(9) Apply firm, even pressure (not a jabbing motion) to the injector until it pushes the needle into
your thigh (or buttocks).
WARNING
Using a jabbing motion may result in an improper injection or injury to the thigh
or buttocks.
- NOTE
Firm pressure automatically triggers the coiled spring mechanism. This plunges the needle
through the clothing into the muscle and injects the fluid into the muscle tissue.

(10) Hold the injector firmly in place for at least ten seconds. The ten seconds can be estimated by
counting “one thousand and one, one thousand and two,” and so forth.
(11) Carefully remove the autoinjector.
(12) Place the used atropine injector between the little finger and the ring finger of the hand holding
the remaining autoinjector and the clip (see Figure 7-9). WATCH OUT FOR THE NEEDLE!
(13) Pull the 2 PAM C1 autoinjector (the larger of the two injectors) out of the clip (see Figure 7-10)
and inject yourself in the same manner as steps (7) through (11) above, holding the black (needle)
end against your thigh (or buttocks).
(14) Drop the empty injector clip without dropping the used autoinjectors.
(15) Attach the used injectors to your clothing (see Figure 7-11). Be careful NOT to tear your protective
gloves/clothing with the needles.
(a) Push the needle of each injector (one at a time) through one of the pocket flaps of your
protective overgarment.
Figure 7-9: Used atropine autoinjector placed between the little finger and ring finger.


Figure 7-10: Removing the 2 PAM Cl autoinjector.


First Aid in Toxic Environments 155


Figure 7-11: One set of used autoinjectors attached to pocket flap.

(b) Bend each needle to form a hook.
WARNING

It is important to keep track of all used autoinjectors so that medical personnel can
determine how much antidote has been given and the proper follow-up treatment
can be provided, if needed.

(16) Massage the injection site if time permits.
WARNING

If within 5 to 10 minutes after administering the first set of injections, your heart
begins to beat rapidly and your mouth becomes very dry, DO NOT give yourself
another set of injections. You have already received enough antidote to overcome
the dangerous effects of the nerve agent. If you are able to walk without assistance
(ambulate), know who you are and where you are, you WILL NOT need the
second set of injections. (If not needed, giving yourself a second set of injections
may create a nerve agent antidote overdose, which could cause incapacitation.)
If, however, you continue to have symptoms of nerve agent poisoning for 10 to
15 minutes after receiving one set of injections, seek a buddy to check your symptoms.
If your buddy agrees that your symptoms are worsening, administer the
second set of injections.



156 The Ultimate Guide to U.S. Army Survival Skills, Tactics, and Techniques

- NOTE (081-831-1030)
While waiting between sets (injections), you should decon your skin, if necessary, and
put on the remaining protective clothing.


b. Buddy aid (081-831-1031).
A soldier exhibiting SEVERE signs/symptoms of nerve agent poisoning will not be able to care for
himself and must therefore be given buddy aid as quickly as possible. Buddy aid will be required
when a soldier is totally and immediately incapacitated prior to being able to apply self-aid, and all
three sets of his Nerve Agent Antidote Kit, Mark I, need to be given by a buddy. Buddy aid may also
be required after a soldier attempted to counter the nerve agent by self-aid but became incapacitated
after giving himself one set of the autoinjectors. Before initiating buddy aid, a buddy should
determine if one set of injectors has already been used so that no more than three sets of the antidote
are administered.
(1) Move (roll) the casualty onto his back (face up) if not already in that position.
WARNING
Avoid unnecessary movement of the casualty so as to keep from spreading the
contamination.
(2) Remove the casualty’s protective mask from the carrier.
(3) Position yourself above the casualty’s head, facing his feet.
WARNING
Squat, DO NOT kneel, when masking a chemical agent casualty. Kneeling may
force the chemical agent into or through your protective clothing, which will
greatly reduce the effectiveness of the clothing.
(4) Place the protective mask on the casualty.
(5) Have the casualty clear the mask.
(6) Check for a complete mask seal by covering the inlet valves. If properly sealed the mask will
collapse.
- NOTE
If the casualty is unable to follow instructions, is unconscious, or is not breathing, he will
not be able to perform steps (5) or (6). It may, therefore, be impossible to determine if the
mask is sealed. But you should still try to check for a good seal by placing your hands
over the valves.

(7) Pull the protective hood over the head, neck, and shoulders of the casualty.
(8) Position yourself near the casualty’s thigh.
(9) Remove one set of the casualty’s autoinjectors.
- NOTE (081-831-1031)
Use the CASUALTY’S autoinjectors. DO NOT use YOUR autoinjectors for buddy aid; if
you do, you may not have any antidote if/when needed for self-aid.



First Aid in Toxic Environments 157

(10) With your nondominant hand, hold the set of autoinjectors by the plastic clip so that the larger
autoinjector is on top and both are positioned in front of you at eye level (see Figure 7-4).
(11) With the other hand, check the injection site (thigh or buttocks) for buttons or objects in pockets
which may interfere with the injections.
(12) Grasp the atropine (smaller) autoinjector with the thumb and first two fingers (see Figure 7-5).
CAUTION
DO NOT cover/hold the green (needle) end with your hand or fingers–you may accidentally
inject yourself.


(13) Pull the injector out of the clip with a smooth motion (see Figure 7-6).
WARNING
The injector is now armed. DO NOT touch the green (needle) end.
(14) Form a fist around the autoinjector. BE CAREFUL NOT TO INJECT YOURSELF IN THE HAND.
WARNING
Holding or covering the needle (green) end of the autoinjector may result in accidentally
injecting yourself.
(15) Position the green end of the atropine autoinjector against the injection site (thigh or buttocks):
(a) On the casualty’s outer thigh muscle (see Figure 7-12).
- NOTE

The injections are normally given in the casualty’s thigh.


Figure 7-12: Injecting the casualty’s thigh.


158 The Ultimate Guide to U.S. Army Survival Skills, Tactics, and Techniques

WARNING
If this is the injection site used, be careful not to inject him close to the hip, knee,
or thigh bone.
OR

(b) On the upper outer portion of the casualty’s buttocks (see Figure 7-13).
- NOTE
If the casualty is thinly built, reposition him onto his side or stomach and inject the antidote
into his buttocks.

WARNING
Inject the antidote only into the upper outer portion of his buttocks (see Figure 713).
This avoids hitting the nerve that crosses the buttocks. Hitting this nerve can
cause paralysis.
(16) Apply firm, even pressure (not a jabbing motion) to the injector to activate the needle. This
causes the needle to penetrate both the casualty’s clothing and muscle.
WARNING
Using a jabbing motion may result in an improper injection or injury to the thigh
or buttocks.
(17) Hold the injector firmly in place for at least ten seconds. The ten seconds can be estimated by
counting “one thousand and one, one thousand and two, ” and so forth.
(18) Carefully remove the autoinjector.
Figure 7-13: Injecting the casualty’s buttocks.


First Aid in Toxic Environments 159

(19) Place the used autoinjector between the little finger and ring finger of the hand holding the
remaining autoinjector and the clip (see Figure 7-9). WATCH OUT FOR THE NEEDLE!
(20) Pull the 2 PAM Cl autoinjector (the larger of the two injectors) out of the clip (see Figure 7-10)
and inject the casualty in the same manner as steps (9) through (19) above, holding the black
(needle) end against the casualty’s thigh (or buttocks).
(21) Drop the clip without dropping the used autoinjectors.
(22) Carefully lay the used injectors on the casualty’s chest (if he is lying on his back), or on his back
(if he is lying on his stomach), pointing the needles toward his head.
(23) Repeat the above procedure immediately (steps 9 through 22), using the second and third set of
autoinjectors.
(24) Attach the three sets of used autoinjectors to the casualty’s clothing (see Figure 7-14). Be careful
NOT to tear either your or the casualty’s protective clothing/gloves with the needles.
(a) Push the needle of each injector (one at a time) through one of the pocket flaps of his protective
overgarment.
(b) Bend each needle to form a hook.
WARNING

It is important to keep track of all used autoinjectors so that medical personnel will
be able to determine how much antidote has been given and the proper followup/
treatment can be provided, if needed.

(25) Massage the area if time permits.
SECTION IV. OTHER AGENTS

7-9. Blister Agents. Blister agents (vesicants) include mustard (HD), nitrogen mustards(HN), lewisite (L),
and other arsenicals, mixtures of mustards and arsenical, and phosgene oxime (CX). Blister agents act on
the eyes, mucous membranes, lungs, and skin. They burn and blister the skin or any other body parts they
contact. Even relatively low doses may cause serious injury. Blister agents damage the respiratory tract
(nose, sinuses and windpipe) when inhaled and cause vomiting and diarrhea when absorbed. Lewisite
and phosgene oxime cause immediate pain on contact. However, mustard agents are deceptive and there
is little or no pain at the time of exposure. Thus, in some cases, signs of injury may not appear for several
hours after exposure.


Figure 7-14: Three sets of used autoinjectors attached to pocket flap.


160 The Ultimate Guide to U.S. Army Survival Skills, Tactics, and Techniques

a.
Protective Measures. Your protective mask with hood and protective overgarments provide you
protection against blister agents. If it is known or suspected that blister agents are being used, STOP
BREATHING, put on your mask and all your protective overgarments.
CAUTION
Large drops of liquid vesicants on the protective overgarment ensemble may penetrate it if
allowed to stand for an extended period. Remove large drops as soon as possible.

b. Signs/Symptoms of Blister Agent Poisoning.
(1) Immediate and intense pain upon contact (lewisite and phosgene oxime). No initial pain upon
contact with mustard.
(2) Inflammation and blisters (burns)–tissue destruction. The severity of a chemical burn is directly
related to the concentration of the agent and the duration of contact with the skin. The longer
the agent is in contact with the tissue, the more serious the injury will be.
(3) Vomiting and diarrhea. Exposure to high concentrations of vesicants may cause vomiting and
or diarrhea.
(4) Death. The blister agent vapors absorbed during ordinary field exposure will probably not
cause enough internal body (systemic) damage to result in death. However, death may occur
from prolonged exposure to high concentrations of vapor or from extensive liquid contamination
over wide areas of the skin, particularly when decon is neglected or delayed.
c. First Aid Measures.
(1) Use your M258A1 decon kit to decon your skin and use water to flush contaminated eyes.
Decontamination of vesicants must be done immediately (within 1 minute is best).
(2) If blisters form, cover them loosely with a field dressing and secure the dressing.
CAUTION
Blisters are actually burns. DO NOT attempt to decon the skin where blisters have formed.

(3) If you receive blisters over a wide area of the body, you are considered seriously burned. SEEK
MEDICAL AID IMMEDIATELY.
(4) If vomiting occurs, the mask should be lifted momentarily and drained—while the eyes are
closed and the breath is held—and replaced, cleared, and sealed.
(5) Remember, if vomiting or diarrhea occurs after having been exposed to blister agents, SEEK
MEDICAL AID IMMEDIATELY.
7-10. Choking Agents (Lung-Damaging Agents). Chemical agents that attack lung tissue, primarily causing
fluid buildup (pulmonary edema), are classified as choking agents (lung-damaging agents). This group
includes phosgene (CG), diaphosgene (DP), chlorine (CL), and chloropicrin (PS). Of these four agents,
phosgene is the most dangerous and is more likely to be employed by the enemy in future conflict.

a. Protective Measures. Your protective mask gives adequate protection against choking agents.
b. Signs/Symptoms. During and immediately after exposure to choking agents (depending on agent
concentration and length of exposure), you may experience some or all of the following signs/
symptoms:
• Tears (lacrimation).
• Dry throat.
• Coughing.
• Choking.

First Aid in Toxic Environments 161

• Tightness of chest.
• Nausea and vomiting.
• Headaches.
c.
First Aid Measures.
(1) If you come in contact with phosgene, your eyes become irritated, or a cigarette becomes tasteless
or offensive, STOP BREATHING and put on your mask immediately.
(2) If vomiting occurs, the mask should be lifted momentarily and drained—while the eyes are
closed and the breath is held—replaced, cleared, and sealed.
(3) Seek medical assistance if any of the above signs/symptoms occur.
- NOTE
If you have no difficulty breathing, do not feel nauseated, and have no more than the
usual shortness of breath on exertion, then you inhaled only a minimum amount of the
agent. You may continue normal duties.

d. Death. With ordinary field exposure to choking agents, death will probably not occur. However, prolonged
exposure to high concentrations of the vapor and neglect or delay in masking can be fatal.
7-11. Blood Agents. Blood agents interfere with proper oxygen utilization in the body. Hydrogen cyanide
(AC) and cyanogen chloride (CK) are the primary agents in this group.

a.
Protective Measures. Your protective mask with a fresh filter gives adequate protection against field
concentrations of blood agent vapor. The protective overgarment as well as the mask are needed
when exposed to liquid hydrogen cyanide.
b. Signs/Symptoms. During and immediately after exposure to blood agents (depending on agent
concentration and length of exposure), you may experience some or all of the following signs/
symptoms:
• Eye irritation.
• Nose and throat irritation.
• Sudden stimulation of breathing.
• Nausea.
• Coughing.
• Tightness of chest.
• Headache.
• Unconsciousness.
c.
First Aid Measures.
(1) Hydrogen cyanide. During any chemical attack, if you get a sudden stimulation of breathing or
notice an odor like bitter almonds, PUT ON YOUR MASK IMMEDIATELY. Speed is absolutely
essential since this agent acts so rapidly that within a few seconds its effects will make it impossible
for individuals to put on their mask by themselves. Stop breathing until the mask is on, if
at all possible. This may be very difficult since the agent strongly stimulates respiration.
(2) Cyanogen chloride. PUT ON YOUR MASK IMMEDIATELY if you experience any irritation of
the eyes, nose, or throat.
d. Medical Assistance. If you suspect that you have been exposed to blood agents, seek medical assistance
immediately.
7-12. Incapacitating Agents. Generally speaking, an incapacitating agent is any compound which can
interfere with your performance. The agent affects the central nervous system and produces muscular
weakness and abnormal behavior. It is likely that such agents will be disseminated by smoke-producing


162 The Ultimate Guide to U.S. Army Survival Skills, Tactics, and Techniques

munitions or aerosols, thus making breathing their means of entry into the body. The protective mask is,
therefore, essential.

a.
There is no special first aid to relieve the symptoms of incapacitating agents. Supportive first aid
and physical restraint may be indicated. If the casualty is stuporous or comatose, be sure that respiration
is unobstructed; then turn him on his stomach with his head to one side (in case vomiting
should occur). Complete cleansing of the skin with soap and water should be done as soon as
possible; or, the M258A1 Skin Decontamination Kit can be used if washing is impossible. Remove
weapons and other potentially harmful items from the possession of individuals who are suspected
of having these symptoms. Harmful items include cigarettes, matches, medications, and small items
which might be swallowed accidentally. Delirious persons have been known to attempt to eat items
bearing only a superficial resemblance to food.
b. Anticholinergic drugs (BZ - type) may produce alarming dryness and coating of the lips and tongue;
however, there is usually no danger of immediate dehydration. Fluids should be given sparingly, if
at all, because of the danger of vomiting and because of the likelihood of temporary urinary retention
due to paralysis of bladder muscles. An important medical consideration is the possibility of
heatstroke caused by the stoppage of sweating. If the environmental temperature is above 78° F,
and the situation permits, remove excessive clothing from the casualty and dampen him to allow
evaporative cooling and to prevent dehydration. If he does not readily improve, apply first aid measures
for heat stroke and seek medical attention.
7-13. Incendiaries. Incendiaries can be grouped as white phosphorus, thickened fuel, metal, and oil and
metal. You must learn to protect yourself against these incendiaries.

a.
White phosphorus (WP) is used primarily as a smoke producer but can be used for its incendiary
effect to ignite field expedients and combustible materials. The burns from WP are usually multiple,
deep, and variable in size. When particles of WP get on the skin or clothing, they continue to burn
until deprived of air. They also have a tendency to stick to a surface and must be brushed off or
picked out.
(1) If burning particles of phosphorus strike and stick to your clothing, quickly take off the contaminated
clothing before the phosphorus burns through to the skin.
(2) If burning phosphorus strikes your skin, smother the flame by submerging yourself in water
or by dousing the WP with water from your canteen or any other source. Urine, a wet cloth, or
mud can also be used.
- NOTE
Since WP is poisonous to the system, DO NOT use grease or oil to smother the flame. The
WP will be absorbed into the body with the grease or oil.

(3) Keep the WP particles covered with wet material to exclude air until you can remove them or
get them removed from your skin.
(4) Remove the WP particles from the skin by brushing them with a wet cloth and by picking them
out with a knife, bayonet, stick, or other available object.
(5) Report to a medical facility for treatment as soon as your mission permits.
b. Thickened fuel mixtures (napalm) have a tendency to cling to clothing and body surfaces, thereby
producing prolonged exposure and severe burns. The first aid for these burns is the same as for
other heat burns. The heat and irritating gases given off by these combustible mixtures may cause
lung damage, which must be treated by a medical officer.
c.
Metal incendiaries pose special problems. Thermite and thermate particles on the skin should be
immediately cooled with water and then removed. Even though thermate particles have their own

First Aid in Toxic Environments 163

oxygen supply and continue to burn under water, it helps to cool them with water. The first aid for
these burns is the same as for other heat burns. Particles of magnesium on the skin burn quickly
and deeply. Like other metal incendiaries, they must be removed. Ordinarily, the complete removal
of these particles should be done by trained personnel at a medical treatment facility, using local
anesthesia. Immediate medical treatment is required.

d. Oil and metal incendiaries have much the same effect on contact with the skin and clothing as those
discussed (b and c above). Appropriate first aid measures for burns are described in Chapter 3.
7-14. First Aid for Biological Agents. We are concerned with victims of biological attacks and with treating
symptoms after the soldier becomes ill. However, we are more concerned with preventive medicine and
hygienic measures taken before the attack. By accomplishing a few simple tasks we can minimize their effects.

a.
Immunizations. In the military we are accustomed to keeping inoculations up to date. To prepare for
biological defense, every effort must be taken to keep immunizations current. Based on enemy capabilities
and the geographic location of our operations, additional immunizations may be required.
b. Food and Drink. Only approved food and water should be consumed. In a suspected biological
warfare environment, efforts in monitoring food and water supplies must be increased. Properly
treated water and properly cooked food will destroy most biological agents.
c.
Sanitation Measures.
(1) Maintain high standards of personal hygiene. This will reduce the possibility of catching and
spreading infectious diseases.
(2) Avoid physical fatigue. Physical fatigue lowers the body’s resistance to disease. This, of course,
is complemented by good physical fitness.
(3) Stay out of quarantined areas.
(4) Report sickness promptly. This ensures timely medical treatment and, more importantly, early
diagnosis of the disease.
d. Medical Treatment of Casualties. Once a disease is identified, standard medical treatment commences.
This may be in the form of first aid or treatment at a medical facility, depending on the
seriousness of the disease. Epidemics of serious diseases may require augmentation of field medical
facilities.
7-15. Toxins. Toxins are alleged to have been used in recent conflicts. Witnesses and victims have described
the agent as toxic rain (or yellow rain) because it was reported to have been released from aircraft as a
yellow powder or liquid that covered the ground, structures, vegetation, and people.

a.
Protective Measures. Individual protective measures normally associated with persistent chemical
agents will provide protection against toxins. Measures include the use of the protective mask
with hood, and the overgarment ensemble with gloves and overboots (mission-oriented protective
posture level-4 [MOPP 4]).
b. Signs/Symptoms. The occurrence of the symptoms from toxins may appear in a period of a few
minutes to several hours depending on the particular toxin, the individual susceptibility, and the
amount of toxin inhaled, ingested, or deposited on the skin. Symptoms from toxins usually involve
the nervous system but are often preceded by less prominent symptoms, such as nausea, vomiting,
diarrhea, cramps, or burning distress of the stomach region. Typical neurological symptoms often
develop rapidly in severe cases, for example, visual disturbances, inability to swallow, speech difficulty,
muscle coordination, and sensory abnormalities (numbness of mouth, throat, or extremities).
Yellow rain (mycotoxins) also may have hemorrhagic symptoms which could include any/all of
the following:
• Dizziness.
• Severe itching or tingling of the skin.

164 The Ultimate Guide to U.S. Army Survival Skills, Tactics, and Techniques

•
Formation of multiple, small, hard blisters.
•
Coughing up blood.
•
Shock (which could result in death).
c. First Aid Measures. Upon recognition of an attack employing toxins or the onset (start) of symptoms
listed above, you must immediately take the following actions:
(1) Step ONE. STOP BREATHING, put on your protective mask with hood, then resume breathing.
Next, put on your protective clothing.
(2) Step TWO. Should severe itching of the face become unbearable, quickly—
• Loosen the cap on your canteen.
• Remove your helmet. Take and hold a deep breath and remove your mask.
•
While holding your breath, close your eyes and flush your face with generous amounts of
water.
CAUTION
DO NOT rub or scratch your eyes. Try not to let the water run onto your clothing or protective
overgarments.


•
Put your protective mask back on, seat it properly, clear it, and check it for seal; then resume
breathing.
• Put your helmet back on.
- NOTE
The effectiveness of the M258A1 Skin Decon Kit for biological agent decon is unknown at
this time; however, flushing the skin with large amounts of water will reduce the effectiveness
of the toxins.

(3) Step THREE. If vomiting occurs, the mask should be lifted momentarily and drained—while the
eyes are closed and the breath is held—and replaced, cleared, and sealed.
d. Medical Assistance. If you suspect that you have been exposed to toxins, you should seek medical
assistance immediately.
7-16. Radiological. There is no direct first aid for radiological casualties. These casualties are treated for
their apparent conventional symptoms and injuries.


APPENDIX A


First Aid Case and Kits,
Dressings, and Bandages


A-1. First Aid Case with Field Dressings and Bandages. Every soldier is issued a first aid case (Figure A-1A)
with a field first aid dressing encased in a plastic wrapper (Figure A-1B). He carries it at all times for his
use. The field first aid dressing is a standard sterile (germ free) compress or pad with bandages attached
(Figure A-1C). This dressing is used to cover the wound, to protect against further contamination, and to
stop bleeding (pressure dressing). When a soldier administers first aid to another person, he must remember
to use the wounded person’s dressing; he may need his own later. The soldier must check his first
aid case regularly and replace any used or missing dressing. The field first aid dressing may normally be
obtained through the medical unit’s assigned medical platoon or section.

A-2. General Purpose First Aid Kits. General purpose first aid kits listed in paragraph A-3 are also listed in
CTA 8-100. These kits are carried on Army vehicles, aircraft, and boats for use by the operators, crew, and
passengers. Individuals designated by unit standing operating procedures (SOP) to be responsible for the
kits are required to check them regularly and replace all items used, or replace the entire kit when necessary.
The general purpose kit and its contents can be obtained through the unit supply system.

- NOTE
Periodically check the dressings (for holes or tears in the package) and the medicines (for expiration
date) that are in the first aid kits. If necessary, replace defective or outdated items.

A-3. Contents of First Aid Case and Kits. The following items are listed in the Common Table of Allowances
(CTA) as indicated below. However, it is necessary to see referenced CTA for stock numbers.


Figure A-1: Field first aid case and dressing.

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166 The Ultimate Guide to U.S. Army Survival Skills, Tactics, and Techniques

CTA Nomenclature
Unit of Issue Quantity

a. 50-900 CASE FIELD FIRST AID DRESSING each 1
8-100 Dressing, first aid field, individual troop, white, 4 by 7 inches Each 1

b. 8-100
FIRST AID KIT, general purpose (Rigid Case) Each 1
Contents: Case, medical instrument and supply set, plastic, rigid, size A,
7. inches long by 4. inches wide by 2 3/4 inches high Each 1
Ammonia inhalation solution, aromatic, ampules, 1/3 ml, 10s Package 1
Povidone-iodine solution, USP: 10%,. fl oz, 50s Box 1/50
Dressing, first aid, field, individual troop, camouflaged, 4 by 7 inches Each 3
Compress and bandage, camouflaged, 2 by 2 inches, 4s Package 1
Bandage, gauze, compressed, camouflaged, 3 inches by 6 yards Each 2
Bandage, muslin, compressed, camouflaged, 37 by 37 by 52 inches Each 1
Gauze, petrolatum, 3 by 36 inches, 3s Package 1
Adhesive tape, surgical, 1 inch by 1 1/2 yards, 100s Package 3/100
Bandage, adhesive, 3/4 by 3 inches, Box 18/300
Blade, surgical preparation razor, straight, single edge, 5s Package 1
First aid kit, eye dressing Each 1
Instruction card, artificial respiration, mouth-to-mouth resuscitation
(Graphic Training Aid 21-45) (in English) Each 1
Instruction sheet, first aid (in English) Each 1
Instruction sheet and list of contents (in English) Each 1

c. 8-100
FIRST AID KIT, general purpose (panel-mounted) Each 1
Contents: Case, medical instrument and supply set, nylon, nonrigid,
No. 2, 7 1/2 inches long by 4 3/8 inches wide by 4 1/2 inches high Each 1

In Upper Ammonia Inhalation Solution aromatic, ampules, 1/3 ml, 10s Package 1
Pocket Compress and bandage, camouflaged, 2 by 2 inches, 4s Package 1
Bandage, muslin, compressed, camouflaged, 37 by 37 by 52 inches Each 1
Gauze, petrolatum, 3 by 36 inches, 12s Package 3/12
Blade, surgical preparation razor, straight, single edge, 5s Package 1

In Lower Pad, Povidone-Iodine, 100s Box 10/100
Pocket Dressing, first aid, field, individual troop, camouflaged, 4 by 6 inches Each 3
Bandage, gauze, compressed, camouflaged, 3 inches by 6 yards Each 2
Adhesive tape, surgical, 1 inch by 1. yards, 100s Package 3/100
Bandage, adhesive, 3/4 by 3 inches, 300s Box 18/300
First aid kit, eye dressing Each 1
Instruction card, artificial respiration, mouth-to-mouth resuscitation
(Graphic Training Aid 21-45) (in English) Each 1
Instruction sheet, first aid (in English) Each 1
Instruction sheet and list of contents (in English) Each 1

A-4. Dressings. Dressings are sterile pads or compresses used to cover wounds. They usually are made of
gauze or cotton wrapped in gauze (Figure A-1C). In addition to the standard field first aid dressing, other
dressings such as sterile gauze compresses and small sterile compresses on adhesive strips may be available
under CTA 8-100. See paragraph A-3 above.

A-5. Standard Bandages

a.
Standard bandages are made of gauze or muslin and are used over a sterile dressing to secure the
dressing in place, to close off its edge from dirt and germs, and to create pressure on the wound and
control bleeding. A bandage can also support an injured part or secure a splint.

b. Tailed bandages may be attached to the dressing as indicated on the field first aid dressing (Figure A-1C).


First Aid Case and Kits, Dressings, and Bandages 167

A-6. Triangular and Cravat (Swathe) Bandages

a.
Triangular and cravat (or swathe) bandages (Figure A-2) are fashioned from a triangular piece of
muslin (37 by 37 by 52 inches) provided in the general purpose first aid kit. If it is folded into a strip,
it is called a cravat. Two safety pins are packaged with each bandage. These bandages are valuable
in an emergency since they are easily applied.
b. To improvise a triangular bandage, cut a square of available material, slightly larger than 3 feet
by 3 feet, and FOLD it DIAGONALLY. If two bandages are needed, cut the material along the
DIAGONAL FOLD.
c.
A cravat can be improvised from such common items as T-shirts, other shirts, bed linens, trouser
legs, scarfs, or any other item made of pliable and durable material that can be folded, torn, or cut
to the desired size.
Figure A-2: Triangular and cravat bandages (Illustrated A thru E).


APPENDIX B


Rescue and Transportation Procedures


B-1. General. A basic principle of first aid is to treat the casualty before moving him. However, adverse
situations or conditions may jeopardize the lives of both the rescuer and the casualty if this is done. It may
be necessary first to rescue the casualty before first aid can be effectively or safely given. The life and/or the
well-being of the casualty will depend as much upon the manner in which he is rescued and transported as
it will upon the treatment he receives. Rescue actions must be done quickly and safely. Careless or rough
handling of the casualty during rescue operations can aggravate his injuries and possibly cause death.

B-2. Principles of Rescue Operations

a.
When faced with the necessity of rescuing a casualty who is threatened by hostile action, fire, water,
or any other immediate hazard, DO NOT take action without first determining the extent of the
hazard and your ability to handle the situation. DO NOT become a casualty.
b. The rescuer must evaluate the situation and analyze the factors involved. This evaluation involves
three major steps:
•
Identify the task.
•
Evaluate circumstances of the rescue.
•
Plan the action.
B-3. Task (Rescue) Identification. First determine if a rescue attempt is actually needed. It is a waste of
time, equipment, and personnel to rescue someone not in need of rescuing. It is also a waste to look for
someone who is not lost or needlessly risk the lives of the rescuer(s). In planning a rescue, attempt to obtain
the following information:

•
Who, what, where, when, why, and how the situation happened?
•
How many casualties are involved and the nature of their injuries?
•
What is the tactical situation?
•
What are the terrain features and the location of the casualties?
•
Will there be adequate assistance available to aid in the rescue/evacuation?
•
Can treatment be provided at the scene; will the casualties require movement to a safer location?
•
What equipment will be required for the rescue operation?
•
Will decon procedures and equipment be required for casualties, rescue personnel and rescue
equipment?
B-4. Circumstances of the Rescue

a.
After identifying the job (task) required, you must relate to the circumstances under which you
must work. Do you need additional people, security, medical, or special rescue equipment? Are
there circumstances such as mountain rescue or aircraft accidents that may require specialized
skills? What is the weather like? Is the terrain hazardous? How much time is available?
b. The time element will sometimes cause a rescuer to compromise planning stages and/or treatment
which can be given. A realistic estimate of time available must be made as quickly as possible to determine
action time remaining. The key elements are the casualty’s condition and the environment.
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170 The Ultimate Guide to U.S. Army Survival Skills, Tactics, and Techniques

c.
Mass casualties are to be expected on the modern battlefield. All problems or complexities of rescue
are now multiplied by the number of casualties encountered. In this case, time becomes the critical
element.
B-5. Plan of Action

a.
The casualty’s ability to endure is of primary importance in estimating the time available. Age and
physical condition will differ from casualty to casualty. Therefore, to determine the time available,
you will have to consider—
•
Endurance time of the casualty.
•
Type of situation.
•
Personnel and/or equipment availability.
•
Weather.
•
Terrain.
b. In respect to terrain, you must consider altitude and visibility. In some cases, the casualty may be of
assistance because he knows more about the particular terrain or situation than you do. Maximum
use of secure/reliable trails or roads is essential.
c.
When taking weather into account, ensure that blankets and/or rain gear are available. Even a mild
rain can complicate a normally simple rescue. In high altitudes and/or extreme cold and gusting
winds, the time available is critically shortened.
d. High altitudes and gusting winds minimize the ability of fixed-wing or rotary wing aircraft to assist
in operations. Rotary wing aircraft may be available to remove casualties from cliffs or inaccessible
sites. These same aircraft can also transport the casualties to a medical treatment facility in a
comparatively short time. Aircraft, though vital elements of search, rescue or evacuation, cannot be
used in all situations. For this reason, do not rely entirely on their presence. Reliance on aircraft or
specialized equipment is a poor substitute for careful planning.
B-6. Mass Casualties. In situations where there are multiple casualties, an orderly rescue may involve
some additional planning. To facilitate a mass casualty rescue or evacuation, recognize separate stages.

•
First Stage. Remove those personnel who are not trapped among debris or who can be evacuated
easily.
•
Second Stage. Remove those personnel who may be trapped by debris but require only the equipment
on hand and a minimum amount of time.
•
Third Stage. Remove the remaining personnel who are trapped in extremely difficult or timeconsuming
situations, such as under large amounts of debris or behind walls.
•
Fourth Stage. Remove the dead.
B-7. Proper Handling of Casualties

a.
You may have saved the casualty’s life through the application of appropriate first aid measures.
However, his life can be lost through rough handling or careless transportation procedures. Before
you attempt to move the casualty—
•
Evaluate the type and extent of his injury.
•
Ensure that dressings over wounds are adequately reinforced.
•
Ensure that fractured bones are properly immobilized and supported to prevent them from cutting
through muscle, blood vessels, and skin. Based upon your evaluation of the type and extent
of the casualty’s injury and your knowledge of the various manual carries, you must select the
best possible method of manual transportation. If the casualty is conscious, tell him how he is to be
transported. This will help allay his fear of movement and gain his cooperation and confidence.

Rescue and Transportation Procedures 171

b. Buddy aid for chemical agent casualties includes those actions required to prevent an incapacitated
casualty from receiving additional injury from the effects of chemical hazards. If a casualty is
physically unable to decontaminate himself or administer the proper chemical agent antidote, the
casualty’s buddy assists him and assumes responsibility for his care. Buddy aid includes—
• Administering the proper chemical agent antidote.
• Decontaminating the incapacitated casualty’s exposed skin.
• Ensuring that his protective ensemble remains correctly emplaced.
• Maintaining respiration.
• Controlling bleeding.
• Providing other standard first aid measures.
• Transporting the casualty out of the contaminated area.
B-8. Transportation of Casualties

a.
Transportation of the sick and wounded is the responsibility of medical personnel who have been
provided special training and equipment. Therefore, unless a good reason for you to transport a
casualty arises, wait for some means of medical evacuation to be provided. When the situation is
urgent and you are unable to obtain medical assistance or know that no medical evacuation facilities
are available, you will have to transport the casualty. For this reason, you must know how to
transport him without increasing the seriousness of his condition.
b. Transporting a casualty by litter is safer and more comfortable for him than by manual means; it is
also easier for you. Manual transportation, however, may be the only feasible method because of the
terrain or the combat situation; or it may be necessary to save a life. In these situations, the casualty
should be transferred to a litter as soon as one can be made available or improvised.
B-9. Manual Carries (081-831-1040 and 081-831-1041). Casualties carried by manual means must be carefully
and correctly handled, otherwise their injuries may become more serious or possibly fatal. Situation
permitting, evacuation or transport of a casualty should be organized and unhurried. Each movement
should be performed as deliberately and gently as possible. Casualties should not be moved before the type
and extent of injuries are evaluated and the required emergency medical treatment is given. The exception
to this occurs when the situation dictates immediate movement for safety purposes (for example, it may
be necessary to remove a casualty from a burning vehicle); that is, the situation dictates that the urgency
of casualty movement outweighs the need to administer emergency medical treatment. Manual carries
are tiring for the bearer(s) and involve the risk of increasing the severity of the casualty’s injury. In some
instances, however, they are essential to save the casualty’s life. Although manual carries are accomplished
by one or two bearers, the two-man carries are used whenever possible. They provide more comfort to the
casualty, are less likely to aggravate his injuries, and are also less tiring for the bearers, thus enabling them
to carry him farther. The distance a casualty can be carried depends on many factors, such as—

• Strength and endurance of the bearer(s).
• Weight of the casualty.
• Nature of the casualty’s injury.
• Obstacles encountered during transport.
a.
One-man Carries (081-831-1040).
(1) Fireman’s carry (081-831-1040). The fireman’s carry (Figure B-1) is one of the easiest ways for one
person to carry another. After an unconscious or disabled casualty has been properly positioned,
he is raised from the ground. An alternate method for raising him from the ground is illustrated
(Figure B-1 I). However, it should be used only when the bearer believes it to be safer for the
casualty because of the location of his wounds. When the alternate method is used, take care to

172 The Ultimate Guide to U.S. Army Survival Skills, Tactics, and Techniques


Figure B-1: Fireman’s carry (Illustrated A thru N).

prevent the casualty’s head from snapping back and causing a neck injury. The steps for raising
a casualty from the ground for the fireman’s carry are also used in other one-man carries.

- NOTE
The alternate method of raising the casualty from the ground should be used only when
the bearer believes it to be safer for the casualty because of the location of his wounds.
When the alternate method is used, take care to prevent the casualty’s head from snapping
back and causing a neck injury.

(2) Support carry (081-831-1040). In the support carry (Figure B-2), the casualty must be able to
walk or at least hop on one leg, using the bearer as a crutch. This carry can be used to assist him
as far as he is able to walk or hop.
(3) Arms carry (081-831-1040). The arms carry is used when the casualty is unable to walk. This carry
(Figure B-3) is useful when carrying a casualty for a short distance and when placing him on a litter.
(4) Saddleback carry (081-831-1040). Only a conscious casualty can be transported by the saddleback
carry (Figure B-4), because he must be able to hold onto the bearer’s neck.
(5) Pack-strap carry (081-831-1040). This carry is used when only a moderate distance will be traveled.
In this carry (Figure B-5), the casualty’s weight rests high on the bearer’s back. To eliminate

Rescue and Transportation Procedures 173


Figure B-1: (Continued)

the possibility of injury to the casualty’s arms, the bearer must hold the casualty’s arms in a
palms-down position.

(6) Pistol-belt carry (081-831-1040). The pistol-belt carry (Figure B-6) is the best one-man carry when
the distance to be traveled is long. The casualty is securely supported by a belt upon the shoulders
of the bearer. The hands of both the bearer and the casualty are left free for carrying a weapon or
equipment, climbing banks, or surmounting obstacles. With his hands free and the casualty secured
in place, the bearer is also able to creep through shrubs and under low hanging branches.

174 The Ultimate Guide to U.S. Army Survival Skills, Tactics, and Techniques


Figure B-1: (Continued)

(7) Pistol-belt drag (081-831-1040). The pistol-belt drag (Figure B-7) and other drags are generally used
for short distances. In this drag the casualty is on his back. The pistol-belt drag is useful in combat.
The bearer and the casualty can remain closer to the ground in this drag than in any other.
(8) Neck drag (081-831-1040). The neck drag (Figure B-8) is useful in combat because the bearer
can transport the casualty when he creeps behind a low wall or shrubbery, under a vehicle, or
through a culvert. This drag is used only if the casualty does not have a broken/fractured arm.
In this drag the casualty is on his back. If the casualty is unconscious, protect his head from the
ground.
(9) Cradle drop drag (081-831-1040). The cradle drop drag (Figure B-9) is effective in moving a
casualty up or down steps. In this drag the casualty is lying down.

Rescue and Transportation Procedures 175


Figure B-1: (Continued)

b. Two-man Carries (081-831-1041).
(1) Two-man support carry (081-831-1041). The two-man support carry (Figure B-10) can be used in
transporting both conscious or unconscious casualties. If the casualty is taller than the bearers, it
may be necessary for the bearers to lift the casualty’s legs and let them rest on their forearms.
(2) Two-man arms carry (081-831-1041). The two-man arms carry (Figure B-11) is useful in carrying
a casualty for a moderate distance. It is also useful for placing him on a litter. To lessen fatigue,
the bearers should carry him high and as close to their chests as possible. In extreme emergencies
when there is no time to obtain a board, this manual carry is the safest one for transporting
a casualty with a back/neck injury. Use two additional bearers to keep his head and legs in
alignment with his body.
(3) Two-man fore-and-aft carry (081-831-1041). The fore-and- aft carry (Figure B-12) is a most useful
two-man carry for transporting a casualty for a long distance. The taller of the two bearers

176 The Ultimate Guide to U.S. Army Survival Skills, Tactics, and Techniques


Figure B-1: (Continued)

should position himself at the casualty’s head. By altering this carry so that both bearers face the
casualty, it is also useful for placing him on a litter.

(4) Two-hand seat carry (081-831-1041). The two-hand seat carry (Figure B-13) is used in carrying a
casualty for a short distance and in placing him on a litter.
(5) Four-hand seat carry (081-831-1041). Only a conscious casualty can be transported with the
four-hand seat carry (Figure B-14) because he must help support himself by placing his arms
around the bearers’ shoulders. This carry is especially useful in transporting the casualty with a
head or foot injury and is used when the distance to be traveled is moderate. It is also useful for
placing a casualty on a litter.
B-10. Improvised Litters (Figures B-15 through B-17) (081-831-1041). Two men can support or carry a
casualty without equipment for only short distances. By using available materials to improvise equipment,
the casualty can be transported greater distances by two or more rescuers.

a.
There are times when a casualty may have to be moved and a standard litter is not available. The
distance may be too great for manual carries or the casualty may have an injury, such as a fractured
neck, back, hip, or thigh that would be aggravated by manual transportation. In these situations,
litters can be improvised from certain materials at hand. Improvised litters are emergency measures

Rescue and Transportation Procedures 177


Figure B-1: (Continued)

and must be replaced by standard litters at the first opportunity to ensure the comfort and safety of
the casualty.

b. Many different types of litters can be improvised, depending upon the materials available. Satisfactory
litters can be made by securing poles inside such items as blankets, ponchos, shelter
halves, tarpaulins, jackets, shirts, sacks, bags, and bed tickings (fabric covers of mattresses). Poles
can be improvised from strong branches, tent supports, skis, and other like items. Most flatsurface
objects of suitable size can also be used as litters. Such objects include boards, doors,
window shutters, benches, ladders, cots, and poles tied together. If possible, these objects should
be padded.

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Figure B-1: (Continued)

c.
If no poles can be obtained, a large item such as a blanket can be rolled from both sides toward the
center. The rolls then can be used to obtain a firm grip when carrying the casualty. If a poncho is
used, make sure the hood is up and under the casualty and is not dragging on the ground.
d. The important thing to remember is that an improvised litter must be well constructed to avoid the
risk of dropping or further injuring the casualty.
e.
Improvised litters may be used when the distance may be too long (far) for manual carries or the
casualty has an injury which may be aggravated by manual transportation.
f. Any of the appropriate carries may be used to place a casualty on a litter. These carries are:
• The one-man arms carry (Figure B-3).
• The two-man arms carry (Figure B-11).
• The two-man fore-and-aft carry (Figure B-12).

Rescue and Transportation Procedures 179


Figure B-1: (Continued)

• The two-hand seat carry (Figure B-13).
• The four-hand seat carry (Figure B-14).
WARNING

Unless there is an immediate life-threatening situation (such as fire, explosion),
DO NOT move the casualty with a suspected back or neck injury. Seek medical
personnel for guidance on how to transport.

g. Either two or four soldiers (head/foot) may be used to lift a litter. To lift the litter, follow the
procedure below.
(1) Raise the litter at the same time as the other carriers/bearers.
(2) Keep the casualty as level as possible.
- NOTE

Use caution when transporting on a sloping incline/hill.


180 The Ultimate Guide to U.S. Army Survival Skills, Tactics, and Techniques


Figure B-2: Support carry.


Figure B-3: Arms carry.


Rescue and Transportation Procedures 181


Figure B-4: Saddleback carry.


182 The Ultimate Guide to U.S. Army Survival Skills, Tactics, and Techniques


Figure B-5: Pack-strap carry (Illustrated A and B).


Rescue and Transportation Procedures 183


Figure B-6: Pistol-belt carry (Illustrated A thru F).


184 The Ultimate Guide to U.S. Army Survival Skills, Tactics, and Techniques


Figure B-6: (Continued)


Rescue and Transportation Procedures 185


Figure B-6: Pistol-belt carry (Illustrated A thru F).


Figure B-7: Pistol-belt drag.


Figure B-8: Neck drag.


186 The Ultimate Guide to U.S. Army Survival Skills, Tactics, and Techniques


Figure B-9: Cradle drop drag (Illustrated A thru D).


Rescue and Transportation Procedures 187


Figure B-9: (Continued)


188 The Ultimate Guide to U.S. Army Survival Skills, Tactics, and Techniques


Figure B-10: Two-man support carry (Illustrated A and B).


Rescue and Transportation Procedures 189


Figure B-11: Two-man arms carry (Illustrated A thru D).


190 The Ultimate Guide to U.S. Army Survival Skills, Tactics, and Techniques


Figure B-11: (Continued)


Rescue and Transportation Procedures 191


Figure B-12: Two-man fore-and-aft carry (Illustrated A thru C).


192 The Ultimate Guide to U.S. Army Survival Skills, Tactics, and Techniques


Figure B-12: (Continued)


Rescue and Transportation Procedures 193


Figure B-13: Two-hand seat carry (Illustrated A and B).


194 The Ultimate Guide to U.S. Army Survival Skills, Tactics, and Techniques


Figure B-14: Four-hand seat carry (Illstrated A and B).


Rescue and Transportation Procedures 195


Figure B-15: Improvised litter with poncho and poles (Illustrated A thru C).


196 The Ultimate Guide to U.S. Army Survival Skills, Tactics, and Techniques


Figure B-16: Improvised litter made with poles and jackets (Illustrated A and B).


Figure B-17: Improvised litters made by inserting poles through sacks or by rolling blanket.


APPENDIX C


Common Problems/Conditions


SECTION I. HEALTH MAINTENANCE

C-1. General. History has often demonstrated that the course of battle is influenced more by the health of
the troops than by strategy or tactics. Health is largely a personal responsibility. Correct cleanliness habits,
regular exercise, and good nutrition have much control over a person’s wellbeing. Good health does not
just happen; it comes with conscious effort and good habits. This appendix outlines some basic principles
that promote good health.

C-2. Personal Hygiene

a.
Because of the close living quarters frequently found in an Army environment, personal hygiene is
extremely important. Disease or illness can spread and rapidly affect an entire group.
b. Uncleanliness or disagreeable odors affect the morale of workmates. A daily bath or shower assists
in preventing body odor and is necessary to maintain cleanliness. A bath or shower also aids in preventing
common skin diseases. Medicated powders and deodorants help keep the skin dry. Special
care of the feet is also important. You should wash your feet daily and keep them dry.
C-3. Diarrhea and Dysentery

a.
Poor sanitation can contribute to conditions which may result in diarrhea and dysentery (a medical
term applied to a number of intestinal disorders characterized by stomach pain and diarrhea with
passage of mucus and blood). Medical personnel can advise regarding the cause and degree of illness.
Remember, however, that intestinal diseases are usually spread through contact with infectious
organisms which can be spread in human waste, by flies and other insects, or in improperly
prepared or disinfected food and water supplies.
b. Keep in mind the following principles that will assist you in preventing diarrhea and/or dysentery.
(1) Fill your canteen with treated water at every chance. When treated water is not available you
must disinfect the water in your canteen by boiling it or using either iodine tablets or chlorine
ampules. Iodine tablets or chlorine ampules can be obtained through your unit supply channels
or field sanitation team.
(a) To treat (disinfect) water by boiling, bring water to a rolling boil in your canteen cup for 5 to
10 minutes. In an emergency, boiling water for even 15 seconds will help. Allow the water
to cool before drinking.
(b) To treat water with iodine—
•
Remove the cap from your canteen and fill the canteen with the cleanest water available.
•
Put one tablet in clear water or two tablets in very cold or cloudy water. Double amounts
if using a two quart canteen.
•
Replace the cap, wait 5 minutes, then shake the canteen. Loosen the cap and tip the
canteen over to allow leakage around the canteen threads. Tighten the cap and wait an
additional 25 minutes before drinking.
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198 The Ultimate Guide to U.S. Army Survival Skills, Tactics, and Techniques

(c) To treat water with chlorine—
•
Remove the cap from your canteen and fill your canteen with the cleanest water available.
•
Mix one ampule of chlorine with one-half canteen cup of water, stir the mixture with a
mess kit spoon until the contents are dissolved. Take care not to cut your hands when
breaking open the glass ampule.
•
Pour one canteen capful of the chlorine solution into your one quart canteen of water.
•
Replace the cap and shake the canteen. Loosen the cap and tip the canteen over to allow
leakage around the threads. Tighten the cap and wait 30 minutes before drinking.
(2) DO NOT buy food, drinks, or ice from civilian vendors unless approved by medical personnel.
(3) Wash your hands for at least 30 seconds after using the latrine or before touching food.
(4) Wash your mess kit in a mess kit laundry or with treated water.
(5) Food waste should be disposed of properly (covered container, plastic bags or buried) to prevent
flies from using it as a breeding area.
C-4. Dental Hygiene

a.
Care of the mouth and teeth by daily use of a toothbrush and dental floss after meals is essential.
This care may prevent gum disease, infection, and tooth decay.
b. One of the major causes of tooth decay and gum disease is plaque. Plaque is an almost invisible film
of decomposed food particles and millions of living bacteria. To prevent dental diseases, you must
effectively remove this destructive plaque.
C-5. Drug (Substance) Abuse

a.
Drug abuse is a serious problem in the military. It affects combat readiness, job performance, and
the health of military personnel and their families. More specifically, drug abuse affects the individual.
It costs millions of dollars in lost time and productivity.
b. The reasons for drug abuse are as different as the people who abuse the use of them. Generally,
people seem to take drugs to change the way they feel. They may want to feel better or to feel happier.
They may want to escape from pain, stress, or frustration. Some may want to forget. Some may
want to be accepted or to be sociable. Some people take drugs to escape boredom; some take drugs
because they are curious. Peer pressure can also be a very strong reason to use drugs.
c.
People often feel better about themselves when they use drugs or alcohol, but the effects do not last.
Drugs never solve problems; they just postpone or compound them. People who abuse alcohol or
drugs to solve one problem run the risk of continued drug use that creates new problems and makes
old problems worse.
d. Drug abuse is very serious and may cause serious health problems. Drug abuse may cause mental
incapacitation and even cause death.
C-6. Sexually Transmitted Diseases. Sexually transmitted diseases (STD) formerly known as venereal diseases
are caused by organisms normally transmitted through sexual intercourse. Individuals should use a
prophylactic (condom) during sexual intercourse unless they have sex only within marriage or with one,
steady non infected person of the opposite sex. Another good habit is to wash the sexual parts and urinate
immediately after sexual intercourse. Some serious STDs include nonspecific urethritis (chlamydia), gonorrhea,
syphilis and Hepatitis B and the Acquired Immunodeficiency Syndrome (AIDS). Prevention of one
type of STD through responsible sex, protects both partners from all STDs. Seek the best medical attention
if any discharge or blisters are found on your sexual parts.

a.
Acquired Immunodeficiency Syndrome (AIDS). AIDS is the end disease stage of the HIV infection. The
HIV infection is contagious, but it cannot be spread in the same manner as a common cold, measles, or

Common Problems/Conditions 199

chicken pox. AIDS is contagious, however, in the same way that sexually transmitted diseases, such as
syphilis and gonorrhea, are contagious. AIDS can also be spread through the sharing of intravenous
drug needles and syringes used for injecting illicit drugs.

b. High Risk Group. Today those practicing high risk behavior who become infected with the AIDS
virus are found mainly among homosexual and bisexual persons and intravenous drug users. Heterosexual
transmission is expected to account for an increasing proportion of those who become
infected with the AIDS virus in the future.
(1) AIDS caused by virus. The letters A-I-D-S stand for Acquired Immunodeficiency Syndrome.
When a person is sick with AIDS, he is in the final stages of a series of health problems caused
by a virus (germ) that can be passed from one person to another chiefly during sexual contact
or through the sharing of intravenous drug needles and syringes used for “shooting” drugs.
Scientists have named the AIDS virus “HIV.” The HIV attacks a person’s immune system and
damages his ability to fight other disease. Without a functioning immune system to ward off
other germs, he now becomes vulnerable to becoming infected by bacteria, protozoa, fungi, and
other viruses and malignancies, which may cause life-threatening illness, such as pneumonia,
meningitis, and cancer.
(2) No known cure. There is presently no cure for AIDS. There is presently no vaccine to prevent
AIDS.
(3) Virus invades blood stream. When the AIDS virus enters the blood stream, it begins to attack certain
white blood cells (T-Lymphocytes). Substances called antibodies are produced by the body.
These antibodies can be detected in the blood by a simple test, usually two weeks to three months
after infection. Even before the antibody test is positive, the victim can pass the virus to others.
(4) Signs and Symptoms.
•
Some people remain apparently well after infection with the AIDS virus. They may have no
physically apparent symptom of illness. However, if proper precautions are not used with
sexual contacts and/or intravenous drug use, these infected individuals can spread the virus
to others.
•
The AIDS virus may also attack the nervous system and cause delayed damage to the brain.
This damage may take years to develop and the symptoms may show up as memory loss,
indifference, loss of coordination, partial paralysis, or mental disorder. These symptoms
may occur alone, or with other symptoms mentioned earlier.
(5) AIDS: the present situation. The number of people estimated to be infected with the AIDS virus
in the United States is over 1.5 million as of April 1988. In certain parts of central Africa 50%
of the sexually active population is infected with HIV. The number of persons known to have
AIDS in the United States to date is over 55,000; of these, about half have died of the disease.
There is no cure. The others will soon die from their disease. Most scientists predict that all HIV
infected persons will develop AIDS sooner or later, if they don’t die of other causes first.
(6) Sex between men. Men who have sexual relations with other men are especially at risk. About
70% of AIDS victims throughout the country are male homosexuals and bisexuals. This percentage
probably will decline as heterosexual transmission increases. Infection results from a sexual
relationship with an infected person.
(7) Multiple partners. The risk of infection increases according to the number of sexual partners one
has, male or female. The more partners you have, the greater the risk of becoming infected with
the AIDS virus.
(8) How exposed. Although the AIDS virus is found in several body fluids, a person acquires the
virus during sexual contact with an infected person’s blood or semen and possibly vaginal secretions.
The virus then enters a person’s blood stream through their rectum, vagina or penis. Small
(unseen by the naked eye) tears in the surface lining of the vagina or rectum may occur during
insertion of the penis, fingers, or other objects, thus opening an avenue for entrance of the virus
directly into the blood stream.

200 The Ultimate Guide to U.S. Army Survival Skills, Tactics, and Techniques

(9) Prevention of sexual transmission—know your partner. Couples who maintain mutually faithful
monogamous relationships (only one continuing sexual partner) are protected from AIDS
through sexual transmission. If you have been faithful for at least five years and your partner
has been faithful too, neither of you is at risk.
(10) Mother can infect newborn. If a woman is infected with the AIDS virus and becomes pregnant,
she has about a 50% chance of passing the AIDS virus to her unborn child.
(11) Summary. AIDS affects certain groups of the population. Homosexual and bisexual persons
who have had sexual contact with other homosexual or bisexual persons as well as those who
“shoot” street drugs are at greatest risk of exposure, infections and eventual death. Sexual partners
of these high risk individuals are at risk, as well as any children born to women who carry
the virus. Heterosexual persons are increasingly at risk.
(12) Donating blood. Donating blood is not risky at all. You cannot get AIDS by donating blood.
(13) Receiving blood. High risk persons and every blood donation is now tested for the presence of
antibodies to the AIDS virus. Blood that shows exposure to the AIDS virus by the presence of
antibodies is not used either for transfusion or for the manufacture of blood products. Blood
banks are as safe as current technology can make them. Because antibodies do not form immediately
after exposure to the virus, a newly infected person may unknowingly donate blood after
becoming infected but before his antibody test becomes positive.
(14) Testing of military personnel. You may wonder why the Department of Defense currently tests
its uniformed services personnel for presence of the AIDS virus antibody. The military feels this
procedure is necessary because the uniformed services act as their own blood bank in a combat
situation. They also need to protect new recruits (who unknowingly may be AIDS virus carriers)
from receiving live virus vaccines. HIV antibody positive soldiers may not be assigned
overseas (includes Alaska and Hawaii). They must be rechecked every six months to determine
if the disease has become worse. If the disease has progressed, they are discharged from the
Army (policy per AR 600-110). This regulation requires that all soldiers receive annual education
classes on AIDS.
SECTION II. FIRST AID FOR COMMON PROBLEMS
C-7. Heat Rash (or Prickly Heat)

a.
Description. Heat rash is a skin rash caused by the blockage of the sweat glands because of hot,
humid weather or because of fever. It appears as a rash of patches of tiny reddish pinpoints that
itch.
b. First Aid. Wear clothing that is light and loose and/or uncover the affected area. Use skin powders
or lotion.
C-8. Contact Poisoning (Skin Rashes)

a.
General.
(1) Poison Ivy grows as a small plant (vine or shrub) and has three glossy leaflets (Figure C-1).
(2) Poison Oak grows in shrub or vine form; and has clusters of three leaflets with wavy edges
(Figure C-2).
(3) Poison Sumac grows as a shrub or small tree. Leaflets grow opposite each other with one at tip
(Figure C-3).
b. Signs/Symptoms.
• Redness.
• Swelling.
• Itching.

Common Problems/Conditions 201


Figure C-1: Poison ivy.


Figure C-2: Western poison oak.


Figure C-3: Poison sumac.

• Rashes or blisters.
• Burning sensation.
• General headaches and fever.
- NOTE

Secondary infection may occur when blisters break.

c. First Aid.
(1) Expose the affected area: remove clothing and jewelry.
(2) Cleanse affected area with soap and water.
(3) Apply rubbing alcohol, if available, to the affected areas.
(4) Apply calamine lotion (helps relieve itching and burning).
(5) Avoid dressing the affected area.
(6) Seek medical help, evacuate if necessary. (If rash is severe, or on face or genitals, seek medical help.)
C-9. Care of the Feet. Proper foot care is essential for all soldiers in order to maintain their optimal health
and physical fitness. To reduce the possibilities of serious foot trouble, observe the following rules:


202 The Ultimate Guide to U.S. Army Survival Skills, Tactics, and Techniques

a.
Foot hygiene is important. Wash and dry feet thoroughly, especially between the toes. Soldiers who
perspire freely should apply powder lightly and evenly twice a day.
b. Properly fitted shoes/boots should be the only ones issued. There should be no binding or pressure
spots.
c.
Clean, properly fitting socks should be changed and washed daily. Avoid socks with holes or poorly
darned areas; they may cause blisters.
d. Attend promptly to common medical problems such as blisters, ingrown toenails, and fungus infections
(like athlete’s foot).
e.
Foot marches are a severe test for the feet. Use only properly fitted footgear and socks. Footgear
should be completely broken-in. DO NOT break-in new footgear on a long march. Any blisters,
sores, and so forth, should be treated promptly. Keep the feet as dry as possible on the march; carry
extra socks and change if feet get wet (socks can be dried by putting them under your shirt, around
your waist or hanging on a rack). Inspect feet during rest breaks. Bring persistent complaints to the
attention of medical personnel.
* C-10. Blisters. Blisters are a common problem caused by friction. They may appear on such areas as the
toes, heels, or the palm of the hand (anywhere friction may occur). Unless treated promptly and correctly,
they may become infected. PREVENTION is the best solution to AVOID blisters and subsequent infection.
For example, ensure boots are prepared properly for a good fit, whenever possible always keep feet clean
and dry; and, wear clean socks that also fit properly. Gloves should be worn whenever extensive manual
work is done.
- NOTE
Keep blisters clean. Care should be taken to keep the feet as clean as possible at all times.
Use soap and water for cleansing. Painful blisters and/or signs of infection, such as redness,
throbbing, drainage, and so forth, are reasons for seeking medical treatment. Seek
medical treatment only from qualified medical personnel.


APPENDIX D


Digital Pressure


APPLY DIGITAL PRESSURE

Digital pressure (also often called “pressure points”) is an alternate method to control bleeding. This
method uses pressure from the fingers, thumbs, or hands to press at the site or point where a main artery
supplying the wounded area lies near the skin surface or over bone (Figure D-1). This pressure may help
shut off or slow down the flow of blood from the heart to the wound and is used in combination with direct
pressure and elevation. It may help in instances where bleeding is not easily controlled, where a pressure
dressing has not yet been applied, or where pressure dressings are not readily available.


Figure D-1: Digital pressure (pressure with fingers, thumbs or hands).

203


APPENDIX E


Decontamination Procedures


APPLY DIGITAL PRESSURE
E-1. Protective Measures and Handling of Casualties

a.
Depending on the theater of operations, guidance issued may dictate the assumption of a minimum
mission-oriented protective posture (MOPP) level. However, a full protective posture (MOPP 4)
level will be assumed immediately when the alarm or command is given. (MOPP 4 level consists of
wearing the protective overgarment, mask, hood, gloves, and overboots.) If individuals find themselves
alone without adequate guidance, they should mask and assume the MOPP 4 level under any
of the following conditions.
(1) Their position is hit by a concentration of artillery, mortar, rocket fire, or by aircraft bombs if
chemical agents have been used or the threat of their use is significant.
(2) Their position is under attack by aircraft spray.
(3) Smoke or mist of an unknown source is present or approaching.
(4) A suspicious odor or a suspicious liquid is present.
(5) A toxic chemical or biological attack is suspected.
(6) They are entering an area known to be or suspected of being contaminated with a toxic chemical
or biological agent.
(7) During any motor march, once chemical warfare has been initiated.
(8) When casualties are being received from an area where chemical agents have reportedly been used.
(9) They have one or more of the following signs/symptoms:
(a) An unexplained sudden runny nose.
(b) A feeling of choking or tightness in the chest or throat.
(c) Blurring of vision and difficulty in focusing the eyes on close objects.
(d) Irritation of the eyes (could be caused by the presence of several toxic chemical agents).
(e) Unexplained difficulty in breathing or increased rate of breathing.
(f) Sudden feeling of depression.
(g) Dread, anxiety, restlessness.
(h) Dizziness or light-headedness.
(i) Slurred speech.
(10) Unexplained laughter or unusual behavior noted in others.
(11) Buddies suddenly collapsing without evident cause.
b. Stop breathing, don the protective mask, seat it properly, clear it, and check it for seal; then resume
breathing. The mask should be worn until unmasking procedures indicate no chemical agent is in
the air and the “all clear” signal is given. If vomiting occurs, the mask should be lifted momentarily
and drained—while the eyes are closed and the breath is held—and replaced, cleared, and sealed.
c.
Casualties contaminated with a chemical agent may endanger unprotected personnel. Handlers
of these casualties must wear a protective mask, protective gloves, and chemical protective clothing
until the casualty’s contaminated clothing has been removed. The battalion aid station should
be established upwind from the most heavily contaminated areas, if it is expected that troops will
remain in the area six hours or more. Collective protective shelters must be used to adequately manage
casualties on the integrated battlefield. Casualties must be undressed and decontaminated, as
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206 The Ultimate Guide to U.S. Army Survival Skills, Tactics, and Techniques

required, in an area equipped for the removal of contaminated clothing and equipment prior to
entering collective protection. Contaminated clothing and equipment should be placed in airtight
containers or plastic bags, if available, or removed to a designated dump site downwind from the aid
station.

F-2. Personal Decontamination. Following contamination of the skin or eyes with vesicants (mustards,
lewisite, and so forth) or nerve agents, personal decontamination must be carried out immediately. This
is because chemical agents are effective at very small concentrations and within a very few minutes after
exposure, decontamination is marginally effective. Decontamination consists of either removal and/or
neutralization of the agent. Decontamination after absorption occurs may serve little or no purpose. Soldiers
will decontaminate themselves unless they are incapacitated. For soldiers who cannot decontaminate
themselves, the nearest able person should assist them as the situation permits.

.
NOTE

In a cyanide only environment, there would be no need for decontamination.

a.
Eyes. Following contamination of the eyes with any chemical agent, the agent must be removed
instantly. In most cases, identity of the agent will not be known immediately. Individuals who suspect
contamination of their eyes or face must quickly obtain overhead shelter to protect themselves
while performing the following decontamination process:
(1) Remove and open your canteen.
(2) Take a deep breath and hold it.
(3) Remove the mask.
(4) Flush or irrigate the eye, or eyes, immediately with large amounts of water. To flush the eyes
with water from a canteen (or other container of uncontaminated water), tilt the head to one
side, open the eyelids as wide as possible, and pour water slowly into the eye so that it will
run off the side of the face to avoid spreading the contamination. This irrigation must be carried
out despite the presence of toxic vapors in the atmosphere. Hold your breath and keep
your mouth closed during this procedure to prevent contamination and absorption through the
mucous membranes. Chemical residue flushed from the eyes should be neutralized along the
flush path.
WARNING
DO NOT use the fingers or gloved hands for holding the eyelids apart. Instead,
open the eyes as wide as possible and pour the water as indicated above.


(5) Replace, clear, and check your mask. Then resume breathing.
(6) If contamination was picked up while flushing the eyes, then decontaminate the face. Follow
procedure outlined in paragraph b (2) (a) through (ae) below.
b. Skin (Hands, Face, Neck, Ears, and Other Exposed Areas). The M258A1 Skin Decontamination Kit
(Figure F-1) is provided individuals for performing emergency decontamination of their skin (and
selected small equipment, such as the protective gloves, mask, hood, and individual weapon).
(1) Description of the M258A1 kit. The M258A1 kit measures 1 3/4 by 2 3/4 by 4 inches and weighs
0.2 pounds. Each kit contains six packets: three DECON-1 packets and three DECON-2 packets.
DECON-1 packet contains a pad premoistened with hydroxyethane 72%, phenol 10%, sodium
hydroxide 5%, and ammonia 0.2%, and the remainder water. DECON-2 packet contains a pad
impregnated with chloramine B and sealed glass ampules filled with hydroxyethane 45%, zinc

Decontamination Procedures 207


Figure F-1: M258A1 Skin Decontamination Kit.

chloride 5%, and the remainder water. The case fits into the pocket on the outside rear of the
M17 series protective mask carrier or in an inside pocket of the carrier for the M24 and M25
series protective mask. The case can also be attached to the web belt or on the D ring of the
protective mask carrier.

(2) Use of the M258A1 kit. It should be noted that the procedures outlined in paragraphs (a) through
(ae) below were not intended to replace or supplant those contained in STP 21-1-SMCT but,
rather, to expand on the doctrine of skin decontamination.
WARNING
The ingredients of the DECON-1 and DECON-2 packets of the M258A1 kit are
poisonous and caustic and can permanently damage the eyes. KEEP PADS OUT
OF THE EYES, MOUTH, AND OPEN WOUNDS. Use water to wash the toxic
agent out of the eyes or wounds, except in the case of mustard. Mustard may be
removed by thorough immediate wiping.
WARNING
The complete decon (WIPES 1 and 2) of the face must be done as quickly as possible–
3 minutes or less.
WARNING
DO NOT attempt to decontaminate the face or neck before putting on a protective
mask.

208 The Ultimate Guide to U.S. Army Survival Skills, Tactics, and Techniques

- NOTE

Use the buddy system to decontaminate exposed skin areas you cannot reach.

- NOTE
Blisters caused by blister agents are actually burns and should be treated as such. Blisters
which have ruptured are treated as open wounds.

(a) Put on the protective mask (if not already on).
(b) Seek overhead cover or use a poncho for protection against further contamination.
(c) Remove the M258A1 kit. Open the kit and remove one DECON-1 WIPE packet by its tab.
(d) Fold the packet on the solid line marked BEND, then unfold it.
(e) Tear open the packet quickly at the notch, and remove the wipe and fully open it.
(f) Wipe your hands.
- NOTE
If you have a chemical agent on your face, do steps (g) through (t). If you do not have an
agent on your face, do step (m), continue to decon other areas of contaminated skin, then
go to step (n).

- NOTE
You must hold your breath while doing steps (g) through (l). If you need to breathe
before you finish, reseal your mask, clear it and check it, then continue.

(g) Hold your breath, close your eyes, and lift the hood and mask from your chin.
(h) Scrub up and down from ear to ear.
1. Start at an ear.
2. Scrub across the face to the corner of the nose.
3. Scrub an extra stroke at the corner of the nose.
4. Scrub across the nose and tip of the nose to the corner of the nose.
5. Scrub an extra stroke at the corner of the nose.
6. Scrub across the face to the other ear.
(i) Scrub up and down from the ear to the end of the jawbone.
1. Begin where step (h) ended.
2. Scrub across the cheek to the corner of the mouth.
3. Scrub an extra stroke at the corner of the mouth.
4. Scrub across the closed mouth to the center of the upper lip.
5. Scrub an extra stroke above the upper lip.
6. Scrub across the closed mouth to the corner of the mouth.
7. Scrub an extra stroke at the corner of the mouth.
8. Scrub across the cheek to the end of the jawbone.
(j) Scrub up and down from one end of the jawbone to the other end of the jawbone.
1. Begin where step (i) ended.
2. Scrub across and under the jaw to the chin, cupping the chin.
3. Scrub an extra stroke at the cleft of the chin.
4. Scrub across and under the jaw to the end of the jawbone.
(k) Quickly wipe the inside of the mask which touches the face.

Decontamination Procedures 209

(l) Reseal, clear, and check the mask. Resume breathing.
(m) Using the same DECON-1 WIPE, scrub the neck and the ears.
(n) Rewipe the hands.
(o) Drop the wipe to the ground.
(p) Remove one DECON-2 WIPE packet, and crush the encased glass ampules between the
thumb and fingers. DO NOT KNEAD.
(q) Fold the packet on the solid line marked CRUSH AND BEND, then unfold it.
(r) Tear open the packet quickly at the notch and remove the wipe.
(s) Fully open the wipe. Let the encased crushed glass ampules fall to the ground.
(t) Wipe your hands.
- NOTE
If you have an agent on your face, do steps (u) through (ae). If you do not have an agent
on your face, do step (aa), continue to decon other areas of contaminated skin, then go to
step (ab).

- NOTE
You must hold your breath while doing steps (u) through (z). If you need to breathe
before you finish, reseal your mask, clear it and check it, then continue.

(u) Hold your breath, close your eyes, and lift the hood and mask away from your chin.
(v) Scrub up and down from ear to ear.
1. Start at an ear.
2. Scrub across the face to the corner of the nose.
3. Scrub an extra stroke at the corner of the nose.
4. Scrub across the nose and tip of the nose to the corner of the nose.
5. Scrub an extra stroke at the corner of the nose.
6. Scrub across the face to the other ear.
(w) Scrub up and down from the ear to the end of the jawbone.
1. Begin where step (v) ended.
2. Scrub across the cheek to the corner of the mouth.
3. Scrub an extra stroke at the corner of the mouth.
4. Scrub across the closed mouth to the center of the upper lip.
5. Scrub an extra stroke above the upper lip.
6. Scrub across the closed mouth to the corner of the mouth.
7. Scrub an extra stroke at the corner of the mouth.
8. Scrub across the cheek to the end of the jawbone.
(x) Scrub up and down from one end of the jawbone to the other end of the jawbone.
1. Begin where step (w) ended.
2. Scrub across and under the jaw to the chin, cupping the chin.
3. Scrub an extra stroke at the cleft of the chin.
4. Scrub across and under the jaw to the end of the jawbone.
(y) Quickly wipe the inside of the mask which touches the face.
(z) Reseal, clear, and check the mask. Resume breathing.
(aa) Using the same DECON-2 WIPE, scrub the neck and ears.
(ab) Rewipe the hands.
(ac) Drop the wipe to the ground.

210 The Ultimate Guide to U.S. Army Survival Skills, Tactics, and Techniques

(ad) Put on the protective gloves and any other protective clothing, as appropriate. Fasten the
hood straps and neck cord.
(ae) Bury the decontaminating packet and other items dropped on the ground, if circumstances
permit.

c.
Clothing and Equipment. Although the M258A1 may be used for decontamination of selected items
of individual clothing and equipment (for example, the soldier’s individual weapon), there is insufficient
capability to do more than emergency spot decontamination. The M258A1 is not used to
decontaminate the protective overgarment. The protective overgarment does not require immediate
decontamination since the charcoal layer is a decontaminating device; however, it must be
exchanged. The Individual Equipment Decontamination Kit (DKIE), M280 (similar in configuration
to the M258A1), is used to decontaminate equipment such as the weapon, helmet, and other gear
that is carried by the individual.
E-3. Casualty Decontamination. Contaminated casualties entering the medical treatment system are decontaminated
through a decentralized process. This is initially started through self-aid and buddy aid procedures.
Later, units should further decontaminate the casualty before evacuation. Casualty decontamination
stations are established at the field medical treatment facility to further decontaminate these individuals
(clothing removal and spot decontamination, as required) prior to treatment and evacuation. These stations
are manned by nonmedical members of the supported unit under supervision of medical personnel. There
are insufficient medical personnel to both decontaminate and treat casualties. The medical personnel must
be available for treatment of the casualties during and after decontamination by nonmedical personnel.
Decontamination is accomplished as quickly as possible to facilitate medical treatment, prevent the casualty
from absorbing additional agent, and reduce the spread of chemical contamination.


PART III


Shelters



Introduction


A shelter can protect you from the sun, insects, wind, rain, snow, hot or cold temperatures, and enemy
observation. It can give you a feeling of well-being. It can help you maintain your will to survive. In some
areas, your need for shelter may take precedence over your need for food and possibly even your need for
water. For example, prolonged exposure to cold can cause excessive fatigue and weakness (exhaustion).
An exhausted person may develop a “passive” outlook, thereby losing the will to survive. The most common
error in making a shelter is to make it too large. A shelter must be large enough to protect you. It must
also be small enough to contain your body heat, especially in cold climates.

SHELTER SITE SELECTION

When you are in a survival situation and realize that shelter is a high priority, start looking for shelter as
soon as possible. As you do so, remember what you will need at the site. Two requisites are—

• It must contain material to make the type of shelter you need.
• It must be large enough and level enough for you to lie down comfortably.
When you consider these requisites, however, you cannot ignore your tactical situation or your safety.
You must also consider whether the site—

• Provides concealment from enemy observation.
• Has camouflaged escape routes.
• Is suitable for signaling, if necessary.
• Provides protection against wild animals and rocks and dead trees that might fall.
• Is free from insects, reptiles, and poisonous plants.
You must also remember the problems that could arise in your environment.

For instance—

• Avoid flash flood areas in foothills.
• Avoid avalanche or rockslide areas in mountainous terrain.
• Avoid sites near bodies of water that are below the high water mark.
In some areas, the season of the year has a strong bearing on the site you select. Ideal sites for a shelter
differ in winter and summer. During cold winter months you will want a site that will protect you from
the cold and wind, but will have a source of fuel and water. During summer months in the same area you
will want a source of water, but you will want the site to be almost insect free.

When considering shelter site selection, use the word BLISS as a guide.

B—Blend in with the surroundings.

L—Low silhouette.

I—Irregular shape.

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214 The Ultimate Guide to U.S. Army Survival Skills, Tactics, and Techniques

S—Small.

S—Secluded location.

TYPES OF SHELTERS

When looking for a shelter site, keep in mind the type of shelter (protection) you need. However, you must
also consider—

•
How much time and effort you need to build the shelter.
•
If the shelter will adequately protect you from the elements (sun, wind, rain, snow).
•
If you have the tools to build it. If not, can you make improvised tools?
•
If you have the type and amount of materials needed to build it.
To answer these questions, you need to know how to make various types of shelters and what materials
you need to make them.

Poncho Lean-To. It takes only a short time and minimal equipment to build this lean-to (Figure I-1). You
need a poncho, 2 to 3 meters of rope or parachute suspension line, three stakes about 30 centimeters long,
and two trees or two poles 2 to 3 meters apart. Before selecting the trees you will use or the location of your
poles, check the wind direction. Ensure that the back of your lean-to will be into the wind.

To make the lean-to—

•
Tie off the hood of the poncho. Pull the drawstring tight, roll the hood long ways, fold it into thirds,
and tie it off with the drawstring.
•
Cut the rope in half. On one long side of the poncho, tie half of the rope to the corner grommet. Tie
the other half to the other corner grommet.
•
Attach a drip stick (about a 10-centimeter stick) to each rope about 2.5 centimeters from the grommet.
These drip sticks will keep rainwater from running down the ropes into the lean-to. Tying
strings (about 10 centimeters long) to each grommet along the poncho’s top edge will allow the
water to run to and down the line without dripping into the shelter.
•
Tie the ropes about waist high on the trees (uprights). Use a round turn and two half hitches with
a quick-release knot.
•
Spread the poncho and anchor it to the ground, putting sharpened sticks through the grommets
and into the ground.
Figure I-1: Poncho lean-to.


Introduction 215

If you plan to use the lean-to for more than one night, or you expect rain, make a center support for the
lean-to. Make this support with a line. Attach one end of the line to the poncho hood and the other end to
an overhanging branch. Make sure there is no slack in the line.

Another method is to place a stick upright under the center of the lean-to. This method, however, will
restrict your space and movements in the shelter.

For additional protection from wind and rain, place some brush, your rucksack, or other equipment at
the sides of the lean-to.

To reduce heat loss to the ground, place some type of insulating material, such as leaves or pine needles,
inside your lean-to.

Note: When at rest, you lose as much as 80 percent of your body heat to the ground.

To increase your security from enemy observation, lower the lean-to’s silhouette by making two changes.
First, secure the support lines to the trees at knee height (not at waist height) using two knee-high sticks
in the two center grommets (sides of lean-to). Second, angle the poncho to the ground, securing it with
sharpened sticks, as above.

Poncho Tent. This tent (Figure I-2) provides a low silhouette. It also protects you from the elements on two
sides. It has, however, less usable space and observation area than a lean-to, decreasing your reaction time
to enemy detection. To make this tent, you need a poncho, two 1.5- to 2.5-meter ropes, six sharpened sticks
about 30 centimeters long, and two trees 2 to 3 meters apart.

To make the tent—

•
Tie off the poncho hood in the same way as the poncho lean-to.
•
Tie a 1.5- to 2.5-meter rope to the center grommet on each side of the poncho.
•
Tie the other ends of these ropes at about knee height to two trees 2 to 3 meters apart and stretch
the poncho tight.
•
Draw one side of the poncho tight and secure it to the ground pushing sharpened sticks through
the grommets.
•
Follow the same procedure on the other side.
If you need a center support, use the same methods as for the poncho lean-to. Another center support
is an A-frame set outside but over the center of the tent (Figure I-3). Use two 90- to 120-centimeter-long
sticks, one with a forked end, to form the A-frame. Tie the hood’s drawstring to the A-frame to support the
center of the tent.


Figure I-2: Poncho tent using overhanging branch.


216 The Ultimate Guide to U.S. Army Survival Skills, Tactics, and Techniques


Figure I-3: Poncho tent with A-frame.

Three-Pole Parachute Tepee. If you have a parachute and three poles and the tactical situation allows,
make a parachute tepee. It is easy and takes very little time to make this tepee. It provides protection from
the elements and can act as a signaling device by enhancing a small amount of light from a fire or candle.
It is large enough to hold several people and their equipment and to allow sleeping, cooking, and storing
firewood.

You can make this tepee using parts of or a whole personnel main or reserve parachute canopy. If using
a standard personnel parachute, you need three poles 3.5 to 4.5 meters long and about 5 centimeters in
diameter.

To make this tepee (Figure I-4)—

•
Lay the poles on the ground and lash them together at one end.
•
Stand the framework up and spread the poles to form a tripod.
•
For more support, place additional poles against the tripod. Five or six additional poles work best,
but do not lash them to the tripod.
•
Determine the wind direction and locate the entrance 90 degrees or more from the mean wind
direction.
•
Lay out the parachute on the “backside” of the tripod and locate the bridle loop (nylon web loop)
at the top (apex) of the canopy.
•
Place the bridle loop over the top of a free-standing pole. Then place the pole back up against the
tripod so that the canopy’s apex is at the same height as the lashing on the three poles.
•
Wrap the canopy around one side of the tripod. The canopy should be of double thickness, as you
are wrapping an entire parachute. You need only wrap half of the tripod, as the remainder of the
canopy will encircle the tripod in the opposite direction.
•
Construct the entrance by wrapping the folded edges of the canopy around two free-standing poles.
You can then place the poles side by side to close the tepee’s entrance.
•
Place all extra canopy underneath the tepee poles and inside to create a floor for the shelter.
•
Leave a 30- to 50-centimeter opening at the top for ventilation if you intend to have a fire inside the
tepee.
One-Pole Parachute Tepee. You need a 14-gore section (normally) of canopy, stakes, a stout center pole,
and inner core and needle to construct this tepee. You cut the suspension lines except for 40- to 45-centimeter
lengths at the canopy’s lower lateral band.


Introduction 217


Figure I-4: Three-pole parachute tepee.

To make this tepee (Figure I-5)—

•
Select a shelter site and scribe a circle about 4 meters in diameter on the ground.
•
Stake the parachute material to the ground using the lines remaining at the lower lateral band.
•
After deciding where to place the shelter door, emplace a stake and tie the first line (from the lower
lateral band) securely to it.
•
Stretch the parachute material taut to the next line, emplace a stake on the scribed line, and tie the line to it.
•
Continue the staking process until you have tied all the lines.
•
Loosely attach the top of the parachute material to the center pole with a suspension line you
previously cut and, through trial and error, determine the point at which the parachute material
will be pulled tight once the center pole is upright.

218 The Ultimate Guide to U.S. Army Survival Skills, Tactics, and Techniques


Figure I-5: One-pole parachute tepee.

•
Then securely attach the material to the pole.
•
Using a suspension line (or inner core), sew the end gores together leaving 1 or 1.2 meters for a
door.
No-Pole Parachute Tepee. You use the same materials, except for the center pole, as for the one-pole
parachute tepee.

To make this tepee (Figure I-6)—

•
Tie a line to the top of parachute material with a previously cut suspension line.
•
Throw the line over a tree limb, and tie it to the tree trunk.
•
Starting at the opposite side from the door, emplace a stake on the scribed 3.5- to 4.3-meter circle.
Figure I-6: No-pole parachute tepee.


Introduction 219

•
Tie the first line on the lower lateral band.
•
Continue emplacing the stakes and tying the lines to them.
•
After staking down the material, unfasten the line tied to the tree trunk, tighten the tepee material
by pulling on this line, and tie it securely to the tree trunk.
One-Man Shelter. A one-man shelter you can easily make using a parachute, a tree and three poles. One
pole should be about 4.5 meters long and the other two about 3 meters long.

To make this shelter (Figure I-7)—

•
Secure the 4.5-meter pole to the tree at about waist height.
•
Lay the two 3-meter poles on the ground on either side of and in the same direction as the 4.5-meter
pole.
•
Lay the folded canopy over the 4.5 meter pole so that about the same amount of material hangs on
both sides.
•
Tuck the excess material under the 3-meter poles, and spread it on the ground inside to serve as a
floor.
•
Stake down or put a spreader between the two 3-meter poles at the shelter’s entrance so they will
not slide inward.
•
Use any excess material to cover the entrance.
•
The parachute cloth makes this shelter wind resistant, and the shelter is small enough that it is easily
warmed. A candle, used carefully, can keep the inside temperature comfortable. This shelter is unsatisfactory,
however, when snow is falling as even a light snowfall will cave it in.
Parachute Hammock. You can make a hammock using 6 to 8 gores of parachute canopy and two trees
about 4.5 meters apart (Figure I-8).

Field-Expedient Lean-To. If you are in a wooded area and have enough natural materials, you can make a
field-expedient lean-to (Figure I-9) without the aid of tools or with only a knife. It takes longer to make this
type of shelter than it does to make other types, but it will protect you from the elements.

You will need two trees (or upright poles) about 2 meters apart; one pole about 2 meters long and 2.5
centimeters in diameter; five to eight poles about 3 meters long and 2.5 centimeters in diameter for beams;
cord or vines for securing the horizontal support to the trees; and other poles, saplings, or vines to crisscross
the beams.


Figure I-7: One-man shelter.


220 The Ultimate Guide to U.S. Army Survival Skills, Tactics, and Techniques


Figure I-8: Parachute hammock.

To make this lean-to—

•
Tie the 2-meter pole to the two trees at waist to chest height. This is the horizontal support. If a
standing tree is not available, construct a biped using Y-shaped sticks or two tripods.
•
Place one end of the beams (3-meter poles) on one side of the horizontal support. As with all lean-to
type shelters, be sure to place the lean-to’s backside into the wind.
•
Crisscross saplings or vines on the beams.
•
Cover the framework with brush, leaves, pine needles, or grass, starting at the bottom and working
your way up like shingling.
•
Place straw, leaves, pine needles, or grass inside the shelter for bedding.

Introduction 221


Figure I-9: Field-expedient lean-to and fire reflector.

In cold weather, add to your lean-to’s comfort by building a fire reflector wall (Figure I-9). Drive four
1.5-meter-long stakes into the ground to support the wall. Stack green logs on top of one another between
the support stakes. Form two rows of stacked logs to create an inner space within the wall that you can fill
with dirt. This action not only strengthens the wall but makes it more heat reflective. Bind the top of the
support stakes so that the green logs and dirt will stay in place.

With just a little more effort you can have a drying rack. Cut a few 2-centimeter-diameter poles
(length depends on the distance between the lean-to’s horizontal support and the top of the fire reflector
wall). Lay one end of the poles on the lean-to support and the other end on top of the reflector wall.
Place and tie into place smaller sticks across these poles. You now have a place to dry clothes, meat,
or fish.

Swamp Bed. In a marsh or swamp, or any area with standing water or continually wet ground, the swamp
bed (Figure I-10) keeps you out of the water. When selecting such a site, consider the weather, wind, tides,
and available materials.

To make a swamp bed—

•
Look for four trees clustered in a rectangle, or cut four poles (bamboo is ideal) and drive them firmly
into the ground so they form a rectangle. They should be far enough apart and strong enough to
support your height and weight, to include equipment.
•
Cut two poles that span the width of the rectangle. They, too, must be strong enough to support
your weight.
•
Secure these two poles to the trees (or poles). Be sure they are high enough above the ground or
water to allow for tides and high water.
•
Cut additional poles that span the rectangle’s length. Lay them across the two side poles, and
secure them.
•
Cover the top of the bed frame with broad leaves or grass to form a soft sleeping surface.
•
Build a fire pad by laying clay, silt, or mud on one comer of the swamp bed and allow it to dry.
Another shelter designed to get you above and out of the water or wet ground uses the same rectangular
configuration as the swamp bed. You very simply lay sticks and branches lengthwise on the


222 The Ultimate Guide to U.S. Army Survival Skills, Tactics, and Techniques


Figure I-10: Swamp bed.

inside of the trees (or poles) until there is enough material to raise the sleeping surface above the
water level.

Natural Shelters. Do not overlook natural formations that provide shelter. Examples are caves, rocky
crevices, clumps of bushes, small depressions, large rocks on leeward sides of hills, large trees with lowhanging
limbs, and fallen trees with thick branches. However, when selecting a natural formation—

•
Stay away from low ground such as ravines, narrow valleys, or creek beds. Low areas collect the
heavy cold air at night and are therefore colder than the surrounding high ground. Thick, brushy,
low ground also harbors more insects.
•
Check for poisonous snakes, ticks, mites, scorpions, and stinging ants.
•
Look for loose rocks, dead limbs, coconuts, or other natural growth that could fall on your shelter.
Debris Hut. For warmth and ease of construction, this shelter is one of the best.

When shelter is essential to survival, build this shelter.

To make a debris hut (Figure I-11)—

•
Build it by making a tripod with two short stakes and a long ridgepole or by placing one end of a
long ridgepole on top of a sturdy base.
•
Secure the ridgepole (pole running the length of the shelter) using the tripod method or by anchoring
it to a tree at about waist height.
•
Prop large sticks along both sides of the ridgepole to create a wedge-shaped ribbing effect. Ensure
the ribbing is wide enough to accommodate your body and steep enough to shed moisture.
•
Place finer sticks and brush crosswise on the ribbing. These form a latticework that will keep the
insulating material (grass, pine needles, leaves) from falling through the ribbing into the sleeping
area.
•
Add light, dry, if possible, soft debris over the ribbing until the insulating material is at least 1
meter thick—the thicker the better.
•
Place a 30-centimeter layer of insulating material inside the shelter.
•
At the entrance, pile insulating material that you can drag to you once inside the shelter to close the
entrance or build a door.
•
As a final step in constructing this shelter, add shingling material or branches on top of the debris
layer to prevent the insulating material from blowing away in a storm.

Introduction 223


Figure I-11: Debris hut.

Tree-Pit Snow Shelter. If you are in a cold, snow-covered area where evergreen trees grow and you have
a digging tool, you can make a tree-pit shelter (Figure I-12).

To make this shelter—

•
Find a tree with bushy branches that provides overhead cover.
•
Dig out the snow around the tree trunk until you reach the depth and diameter you desire, or until
you reach the ground.
•
Pack the snow around the top and the inside of the hole to provide support.
•
Find and cut other evergreen boughs. Place them over the top of the pit to give you additional overhead
cover. Place evergreen boughs in the bottom of the pit for insulation.
See Chapter 3 for other arctic or cold weather shelters.

Beach Shade Shelter. This shelter protects you from the sun, wind, rain, and heat. It is easy to make using
natural materials.

To make this shelter (Figure I-13)—

•
Find and collect driftwood or other natural material to use as support beams and as a digging tool.
•
Select a site that is above the high water mark.
•
Scrape or dig out a trench running north to south so that it receives the least amount of sunlight.
Make the trench long and wide enough for you to lie down comfortably.
•
Mound soil on three sides of the trench. The higher the mound, the more space inside the shelter.
•
Lay support beams (driftwood or other natural material) that span the trench on top of the mound
to form the framework for a roof.

224 The Ultimate Guide to U.S. Army Survival Skills, Tactics, and Techniques


Figure I-12: Tree-pit snow shelter.


Figure I-13: Beach shade shelter.

•
Enlarge the shelter’s entrance by digging out more sand in front of it.
•
Use natural materials such as grass or leaves to form a bed inside the shelter.
Desert Shelters. In an arid environment, consider the time, effort, and material needed to make a shelter. If
you have material such as a poncho, canvas, or a parachute, use it along with such terrain features as rock
outcropping, mounds of sand, or a depression between dunes or rocks to make your shelter.

Using rock outcroppings—

•
Anchor one end of your poncho (canvas, parachute, or other material) on the edge of the outcrop
using rocks or other weights.
•
Extend and anchor the other end of the poncho so it provides the best possible shade.

Introduction 225

In a sandy area—

•
Build a mound of sand or use the side of a sand dune for one side of the shelter.
•
Anchor one end of the material on top of the mound using sand or other weights.
•
Extend and anchor the other end of the material so it provides the best possible shade.
Note: If you have enough material, fold it in half and form a 30-centimeter to 45-centimeter airspace between the
two halves. This airspace will reduce the temperature under the shelter.

A below ground shelter (Figure I-14) can reduce the midday heat as much as 16 to 22 degrees C (30 to 40
degrees F). Building it, however, requires more time and effort than for other shelters. Since your physical
effort will make you sweat more and increase dehydration, construct it before the heat of the day.

To make this shelter—

•
Find a low spot or depression between dunes or rocks. If necessary, dig a trench 45 to 60 centimeters
deep and long and wide enough for you to lie in comfortably.
•
Pile the sand you take from the trench to form a mound around three sides.
•
On the open end of the trench, dig out more sand so you can get in and out of your shelter easily.
•
Cover the trench with your material.
•
Secure the material in place using sand, rocks, or other weights.
If you have extra material, you can further decrease the midday temperature in the trench by securing
the material 30 to 45 centimeters above the other cover. This layering of the material will reduce the inside
temperature 11 to 22 degrees C (20 to 40 degrees F).


Figure I-14: Belowground desert shelter.


226 The Ultimate Guide to U.S. Army Survival Skills, Tactics, and Techniques

Another type of below ground shade shelter is of similar construction, except all sides are open to air
currents and circulation. For maximum protection, you need a minimum of two layers of parachute material
(Figure I-15). White is the best color to reflect heat; the innermost layer should be of darker material.


Figure I-15: Open desert shelter.


CHAPTER 1


Planning Positions


This chapter highlights basic survivability knowledge required for planning fighting and protective
positions. Included are descriptions of the various directly and indirectly fired weapons and their multiple
penetration capabilities and effects on the positions. Both natural and man-made materials available
to construct the positions are identified and ranked according to their protection potential. Positions are
then categorized and briefly described. Construction methods, including the use of hand tools as well as
explosives, and special overall construction considerations such as camouflage and concealment, are also
presented.

WEAPONS EFFECTS

A fighting position is a place on the battlefield from which troops engage the enemy with direct and indirect
fire weapons. The positions provide necessary protection for personnel, yet allow for fields of fire and
maneuver. A protective position protects the personnel and/or material not directly involved with fighting
the enemy from attack or environmental extremes. In order to develop plans for fighting and protective
positions, five types of weapons, their effects, and their survivability considerations are presented.
Air-delivered weapons such as ATGMs, laser-guided missiles, mines, and large bombs require similar
survivability considerations.

Direct Fire. Direct fire projectiles are primarily designed to strike a target with a velocity high enough to
achieve penetration. The chemical energy projectile uses some form of chemical heat and blast to achieve
penetration. It detonates either at impact or when maximum penetration is achieved. Chemical energy projectiles
carrying impact-detonated or delayed detonation high-explosive charges are used mainly for direct
fire from systems with high accuracy and consistently good target acquisition ability. Tanks, antitank weapons,
and automatic cannons usually use these types of projectiles. The kinetic energy projectile uses high
velocity and mass (momentum) to penetrate its target. Currently, the hypervelocity projectile causes the
most concern in survivability position design. The materials used must dissipate the projectile’s energy and
thus prevent total penetration. Shielding against direct fire projectiles should initially stop or deform the
projectiles in order to prevent or limit penetration. Direct fire projectiles are further divided into the categories
of ball and tracer, armor piercing and armor piercing incendiary, and high explosive (HE) rounds.

Ball and Tracer. Ball and tracer rounds are normally of a relatively small caliber (5.56 to 14.5 millimeters
(mm)) and are fired from pistols, rifles, and machine guns. The round’s projectile penetrates soft targets on
impact at a high velocity. The penetration depends directly on the projectile’s velocity, weight, and angle
at which it hits.

Armor Piercing and Armor Piercing Incendiary. Armor piercing and armor piercing incendiary rounds
are designed to penetrate armor plate and other types of homogeneous steel. Armor piercing projectiles
have a special jacket encasing a hard core or penetrating rod which is designed to penetrate when fired
with high accuracy at an angle very close to the perpendicular of the target. Incendiary projectiles are used
principally to penetrate a target and ignite its contents. They are used effectively against fuel supplies and
storage areas.

High Explosive. High explosive rounds include high explosive antitank (HEAT) rounds, recoilless rifle
rounds, and antitank rockets. They are designed to detonate a shaped charge on impact. At detonation, an

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extremely high velocity molten jet is formed. This jet perforates large thicknesses of high-density material,
continues along its path, and sets fuel and ammunition on fire. The HEAT rounds generally range in size
from 60 to 120 mm.

Survivability Considerations. Direct fire survivability considerations include oblique impact, or impact of
projectiles at other than a perpendicular angle to the structure, which increases the apparent thickness of
the structure and decreases the possibility of penetration. The potential for ricochet off a structure increases
as the angle of impact from the perpendicular increases. Designers of protective structures should select
the proper material and design exposed surfaces with the maximum angle from the perpendicular to the
direction of fire. Also, a low structure silhouette design makes a structure harder to engage with direct
fire.

Indirect Fire. Indirect fire projectiles used against fighting and protective positions include mortar and
artillery shells and rockets which cause blast and fragmentation damage to affected structures.

Blast. Blast, caused by the detonation of the explosive charge, creates a shock wave which knocks apart
walls or roof structures. Contact bursts cause excavation cave-in from ground shock, or structure collapse.
Overhead bursts can buckle or destroy the roof,

Blasts from high explosive shells or rockets can occur in three ways:

• Overhead burst (fragmentation from an artillery airburst shell).
• Contact burst (blast from an artillery shell exploding on impact).
• Delay fuze burst (blast from an artillery shell designed to detonate after penetration into a target).
The severity of the blast effects increases as the distance from the structure to the point of impact
decreases. Delay fuze bursts are the greatest threat to covered structures. Repeated surface or delay fuze
bursts further degrade fighting and protective positions by the cratering effect and soil discharge. Indirect
fire blast effects also cause concussions. The shock from a high explosive round detonation causes headaches,
nosebleeds, and spinal and brain concussions.

Fragmentation. Fragmentation occurs when the projectile disintegrates, producing a mass of high-speed
steel fragments which can perforate and become imbedded in fighting and protective positions. The pattern
or distribution of fragments greatly affects the design of fighting and protective positions. Airburst of
artillery shells provides the greatest unrestricted distribution of fragments. Fragments created by surface
and delay bursts are restricted by obstructions on the ground.

Survivability Considerations. Indirect fire survivability from fragmentation requires shielding similar to
that needed for direct fire penetration.

Nuclear. Nuclear weapons effects are classified as residual and initial. Residual effects (such as fallout)
are primarily of long-term concern. However, they may seriously alter the operational plans in the immediate
battle area. Figure 1-1 shows how the energy released by detonation of a tactical nuclear explosion
is divided. Initial effects occur in the immediate area shortly after detonation and are the most tactically
significant since they cause personnel casualties and material damage within the immediate time span of
any operation. The principal initial casualty-producing effects are blast, thermal radiation (burning), and
nuclear radiation. Other initial effects, such as electromagnetic pulse (EMP) and transient radiation effects
on electronics (TREE), affect electrical and electronic equipment.

Blast. Blast from nuclear bursts overturns and crushes equipment, collapses lungs, ruptures eardrums,
hurls debris and personnel, and collapses positions and structures.

Thermal Radiation. Thermal radiation sets fire to combustible materials, and causes flash blindness or
burns in the eyes, as well as personnel casualties from skin burns.


Planning Positions 229


Figure 1-1: Energy distribution of tactical nuclear weapons.

Nuclear Radiation. Nuclear radiation damages cells throughout the body. This radiation damage may
cause the headaches, nausea, vomiting, and diarrhea generally called “radiation sickness. ” The severity
of radiation sickness depends on the extent of initial exposure. Table 1-1 shows the relationship
between dose of nuclear radiation and distance from ground zero for a l-kiloton weapon. Once the dose
is known, initial radiation effects on personnel are determined from Table 1-2. Radiation in the body is
cumulative.

Nuclear radiation is the dominant casualty-producing effect of low-yield tactical nuclear weapons. But
other initial effects may produce significant damage and/or casualties depending on the weapon type,
yield, burst conditions, and the degree of personnel and equipment protection. Figure 1-2 shows tactical
radii of effects for nominal l-kiloton and 10-kiloton weapons.

Electromagnetic Pulse. Electromagnetic pulse (EMP) damages electrical and electronic equipment. It
occurs at distances from the burst where other nuclear weapons effects produce little or no damage, and
it lasts for less than a second after the burst. The pulse also damages vulnerable electrical and electronic
equipment at ranges up to 5 kilometers for a 10-kiloton surface burst, and hundreds of kilometers for a
similar high-altitude burst.

Survivability Considerations. Nuclear weapons survivability includes dispersion of protective positions
within a suspected target area. Deep-covered positions will minimize the danger from blast and thermal
radiation. Personnel should habitually wear complete uniforms with hands, face, and neck covered.
Nuclear radiation is minimized by avoiding the radioactive fallout area or remaining in deep-covered
protective positions. Examples of expedient protective positions against initial nuclear effects are shown
on Figure 1-3. Additionally, buttoned-up armor vehicles offer limited protection from nuclear radiation.
Removal of antennae and placement of critical electrical equipment into protective positions will reduce
the adverse effects of EMP and TREE.


230 The Ultimate Guide to U.S. Army Survival Skills, Tactics, and Techniques

Table 1-1: Relationship of radiation dose to distance from ground zero for a 1-KT weapon.


Chemical. Toxic chemical agents are primarily designed for use against personnel and to contaminate terrain
and material. Agents do not destroy material and structures, but make them unusable for periods of time
because of chemical contaminant absorption. The duration of chemical agent effectiveness depends on—

• Weather conditions.
• Dispersion methods.
• Terrain conditions.
• Physical properties.
• Quantity used.
• Type used (nerve, blood, or blister).
Part II of this book provides chemical agent details and characteristics. Since the vapor of toxic chemical
agents is heavier than air, it naturally tends to drift to the lowest corners or sections of a structure. Thus,
low, unenclosed fighting and protective positions trap chemical vapors or agents. Because chemical agents
saturate an area, access to positions without airlock entrance ways is limited during and after an attack,
since every entering or exiting soldier brings contamination inside.

Survivability Considerations. Survivability of chemical effects includes overhead cover of any design
that delays penetration of chemical vapors and biological aerosols, thereby providing additional masking
time and protection against direct liquid contamination. Packing materials and covers are used to protect
sensitive equipment. Proper use of protective clothing and equipment, along with simply avoiding the
contaminated area, aids greatly in chemical survivability.

Special Purpose. Fuel-air munitions and flamethrowers are considered special-purpose weapons. Fuel-air
munitions disperse fuel into the atmosphere forming a fuel-air mixture that is detonated. The fuel is usually
contained in a metal canister and is dispersed by detonation of a central burster charge carried within
the canister. Upon proper dispersion, the fuel-air mixture is detonated. Peak pressures created within the
detonated cloud reach 300 pounds per square inch (psi). Fuel-air munitions create large area loading on a


Planning Positions 231

Table 1-2: Initial Radiation Effects on Personnel.


structure as compared to localized loadings caused by an equal weight high explosive charge. High temperatures
ignite flammable materials. Flamethrowers and napalm produce intense heat and noxious gases
which can neutralize accessible positions. The intense flame may also exhaust the oxygen content of inside
air causing respiratory injuries to occupants shielded from the flaming fuel. Flame is effective in penetrating
protective positions.

Survivability Considerations. Survivability of special purpose weapons effects includes covered positions
with relatively small apertures and closable entrance areas which provide protection from napalm and
flamethrowers. Deep-supported tunnels and positions provide protection from other fuel-air munitions
and explosives.


232 The Ultimate Guide to U.S. Army Survival Skills, Tactics, and Techniques


Figure 1-2: Tactical radii of effects of 1-KT and 10-KT fission weapons from low airburst.

CONSTRUCTION MATERIALS

Before designing fighting and protective positions, it is important to know how the previously-described
weapons affect and interact with various materials that are fired upon. The materials used in fighting and
protective position construction act as either shielding for the protected equipment and personnel, structural
components to hold the shielding in place, or both.

Shielding Materials. Shielding provides protection against penetration of both projectiles and fragments,
nuclear and thermal radiation, and the effects of fire and chemical agents. Various materials and amounts
of materials provide varying degrees of shielding. Some of the more commonly used materials and the
effects of both projectile and fragment penetration in these materials, as well as nuclear and thermal radiation
suppression, are discussed in the following paragraphs. (Incendiary and chemical effects are generalized
from the previous discussion of weapons effects.) The following three tables contain shielding
requirements of various materials to protect against direct hits by direct fire projectiles (Table 1-3), direct


Planning Positions 233


Figure 1-3: Examples of expedient protective positions against initial nuclear effects.


234 The Ultimate Guide to U.S. Army Survival Skills, Tactics, and Techniques

Table 1-3: Material thickness in inches, required to protect
against direct hits by direct fire projectiles



Planning Positions 235

fire high explosive (HE) shaped charges (Table 1-4), and indirect fire fragmentation and blast (Table 1-5).
Table 1-6 lists nuclear protection factors associated with earth cover and sandbags.

Soil. Direct fire and indirect fire fragmentation penetration in soil or other similar granular material is
based on three considerations: for materials of the same density, the finer the grain the greater the penetration;
penetration decreases with increase in density; and penetration increases with increasing water
content. Nuclear and thermal radiation protection of soil is governed by the following:

•
The more earth cover, the better the shielding. Each layer of sandbags filled with sand or clay
reduces transmitted radiation by 50 percent.
•
Sand or compacted clay provides better radiation shielding than other soils which are less dense.
•
Damp or wet earth or sand provides better protection than dry material.
•
Sandbags protected by a top layer of earth survive thermal radiation better than exposed bags.
Exposed bags may burn, spill their contents, and become susceptible to the blast wave.
Steel. Steel is the most commonly used material for protection against direct and indirect fire fragmentation.
Steel is also more likely to deform a projectile as it penetrates, and is much less likely to span than
concrete. Steel plates, only 1/6 the thickness of concrete, afford equal protection against nondeforming
projectiles of small and intermediate calibers. Because of its high density, steel is five times more effective
in initial radiation suppression than an equal thickness of concrete. It is also effective against thermal radiation,
although it transmits heat rapidly. Many field expedient types of steel are usable for shielding. Steel
landing mats, culvert sections, and steel drums, for example, are effectively used in a structure as one of
several composite materials. Expedient steel pieces are also used for individual protection against projectile
and fragment penetration and nuclear radiation.

Concrete. When reinforcing steel is used in concrete, direct and indirect fire fragmentation protection is
excellent. The reinforcing helps the concrete to remain intact even after excessive cracking caused by penetration.
When a near-miss shell explodes, its fragments travel faster than its blast wave. If these fragments
strike the exposed concrete surfaces of a protective position, they can weaken the concrete to such an extent
that the blast wave destroys it. When possible, at least one layer of sandbags, placed on their short ends,
or 15 inches of soil should cover all exposed concrete surfaces. An additional consequence of concrete penetration
is spalling. If a projectile partially penetrates concrete shielding, particles and chunks of concrete

Table 1-4: Material thickness, in inches, required to protect against direct fire
he shaped-charge.



236 The Ultimate Guide to U.S. Army Survival Skills, Tactics, and Techniques

Table 1-5: Material thickness, inches, required to protect against indirect fire fragmentation

and blast exploding 50 feet away.


Table 1-6: Shielding values of earth cover and sandbags for a hypothetical 2,400-rads (cgy)
free-in-air dose.



Planning Positions 237

often break or scab off the back of the shield at the time of impact. These particles can kill when broken
loose. Concrete provides excellent protection against nuclear and thermal radiation.

Rock. Direct and indirect fire fragmentation penetration into rock depends on the rock’s physical properties
and the number of joints, fractures, and other irregularities contained in the rock. These irregularities
weaken rock and can increase penetration. Several layers of irregularly-shaped rock can change the angle
of penetration. Hard rock can cause a projectile or fragment to flatten out or break up and stop penetration.
Nuclear and thermal radiation protection is limited because of undetectable voids and cracks in rocks.
Generally, rock is not as effective against radiation as concrete, since the ability to provide protection
depends on the rock’s density.

Brick and Masonry. Direct and indirect fire fragmentation penetration into brick and masonry have the
same protection limitations as rock. Nuclear and thermal radiation protection by brick and masonry is

1.5 times more effective than the protection afforded by soil. This characteristic is due to the higher compressive
strength and hardness properties of brick and masonry. However, since density determines the
degree of protection against initial radiation, unreinforced brick and masonry are not as good as concrete
for penetration protection.
Snow and Ice. Although snow and ice are sometimes the only available materials in certain locations, they
are used for shielding only. Weather could cause structures made of snow or ice to wear away or even
collapse. Shielding composed of frozen materials provides protection from initial radiation, but melts if
thermal radiation effects are strong enough.

Wood. Direct and indirect fire fragmentation protection using wood is limited because of its low density
and relatively low compressive strengths. Greater thicknesses of wood than of soil are needed for protection
from penetration. Wood is generally used as structural support for a survivability position. The low
density of wood provides poor protection from nuclear and thermal radiation. Also, with its low ignition
point, wood is easily destroyed by fire from thermal radiation.

Other Materials. Expedient materials include steel pickets, landing mats, steel culverts, steel drums, and
steel shipping consolidated express (CONEX) containers. Chapter 4 discusses fighting and protective positions
constructed with some of these materials.

Structural Components. The structure of a fighting and protective position depends on the weapon or
weapon effect it is designed to defeat. All fighting and protective positions have some configuration of
floor, walls, and roof designed to protect material and/or occupants, The floor, walls, and roof support
the shielding discussed earlier, or may in themselves make up that shielding. These components must also
resist blast and ground shock effects from detonation of high explosive rounds which place greater stress
on the structure than the weight of the components and the shielding. Designers must make structural
components of the positions stronger, larger, and/or more numerous in order to defeat blast and ground
shock. Following is a discussion of materials used to build floors, walls, and roofs of positions.

Floors. Fighting and protective position floors are made from almost any material, but require resistance
to weathering, wear, and trafficability. Soil is most often used, yet is least resistant to water damage and
rutting from foot and vehicle traffic. Wood pallets, or other field-available materials are often cut to fit floor
areas. Drainage sumps, shown in Figure 1-4, or drains are also installed when possible.

Walls. Walls of fighting and protective positions are of two basic types—below ground (earth or revetted
earth) and above-ground. Below-ground walls are made of the in-place soil remaining after excavation of
the position. This soil may need revetment or support, depending on the soil properties and depth of cut.
When used to support roof structures, earth walls must support the roof at points no less than one fourth
the depth of cutout from the edges of excavation, as Figure 1-5.

Above-ground walls are normally constructed for shielding from direct fire and fragments. They are
usually built of revetted earth, sandbags, concrete, or other materials. When constructed to a thickness


238 The Ultimate Guide to U.S. Army Survival Skills, Tactics, and Techniques


Figure 1-4: Drainage sump.


Figure 1-5: Earth wall roof support points.

adequate for shielding from direct fire and fragments, they are thick and stable enough for roof
support.

Roofs. Roofs of fighting and protective positions are easily designed to support earth cover for shielding
from fragments and small caliber direct fire. However, contact burst protection requires much stronger


Planning Positions 239

roof structures and, therefore, careful design. Roofs for support of earth cover shielding are constructed
of almost any material that is usually used as beams or stringers and sheathing. Tables 1-7 and 1-8 present
guidelines for wooden roof structures (for fragment shielding only). Table 1-9 converts dimensioned to
round timber. Tables 1-10 and 1-11 pertain to steel pickets and landing mats for roof supports (for fragment
shielding only).

When roof structures are designed to defeat contact bursts of high explosive projectiles, substantial additional
roof protection is required. Table 1-13 gives basic design criteria for a roof to defeat contact bursts.

Table 1-7: Maximum span of dimensioned wood roof support for earth cover.


Table 1-8: Maximum span of wood stringer roof support for earth cover.


POSITION CATEGORIES

Seven categories of fighting and protective positions or components of positions that are used together or
separately are—

• Holes and simple excavations.
• Trenches.
• Tunnels.
• Earth parapets.
• Overhead cover and roof structures.

240 The Ultimate Guide to U.S. Army Survival Skills, Tactics, and Techniques

Table 1-9: Converting dimensioned timber to round timber.


Table 1-10: Maximum span of steel picket roof supports for sandbag layers.


Table 1-11: Maximum span of inverted landing mats (M8A1)
for roof supports.



Planning Positions241

•
Triggering screens.
•
Shelters and bunkers.
Holes And Simple Excavations. Excavations, when feasible, provide good protection from direct fire and
some indirect fire weapons effects. Open excavations have the advantages of—

•
Providing good protection from direct fire when the occupant would otherwise be exposed.
•
Permitting 360-degree observation and fire.
•
Providing good protection from nuclear weapons effects.
Open excavations have the disadvantages of—

•
Providing limited protection from direct fire while the occupant is firing a weapon, since frontal
and side protection is negligible.
•
Providing relatively no protection from fragments from overhead bursts of artillery shells. The
larger the open excavation, the less the protection from artillery.
•
Providing limited protection from chemical effects. In some cases, chemicals concentrate in low
holes and excavations.
Trenches. Trenches provide essentially the same protection from conventional, nuclear, and chemical
effects as the other excavations described, and are used almost exclusively in defensive areas. They are
employed as protective positions and used to connect individual holes, weapons positions, and shelters.
They provide protection and concealment for personnel moving between fighting positions or in and out
of the area. They are usually open excavations, but sections are sometimes covered to provide additional
protection. Trenches are difficult to camouflage and are easily detected from the air.

Trenches, like other positions, are developed progressively. As a general rule, they are excavated deeper
than fighting positions to allow movement without exposure to enemy fire. It is usually necessary to provide
revetment and drainage for them.

Tunnels. Tunnels are not frequently constructed in the defense of an area due to the time, effort, and technicalities
involved, However, they are usually used to good advantage when the length of time an area
is defended justifies the effort, and the ground lends itself to this purpose. The decision to build tunnels
also depends greatly on the nature of the soil, which is usually determined by borings or similar means.
Tunneling in hard rock is slow and generally impractical. Tunnels in clay or other soft soils are also impractical
since builders must line them throughout to prevent collapse. Therefore, construction of tunneled
defenses is usually limited to hilly terrain, steep hillsides, and favorable soils including hard chalk, soft
sandstone, and other types of hard soil or soft rock.

In the tunnel system shown in Figure 1-5, the soil was generally very hard and only the entrances were
timbered. The speed of excavation using hand tools varied according to the soil, and seldom exceeded 25
feet per day. In patches of hard rock, as little as 3 feet were excavated per day. Use of power tools did not
significantly increase the speed of excavation. Engineer units, assisted by infantry personnel, performed
the work. Tunnels of the type shown are excavated up to 30 feet below ground level. They are usually
horizontal or nearly so. Entrances are strengthened against collapse under shell fire and ground shock
from nuclear weapons. The first 16 1/2 feet from each entrance should have frames using 4 by 4s or larger
timber supports.

Unlimbered tunnels are generally 31 1/2 feet wide and 5 to 6 1/2 feet high. Once beyond the portal or
entrance, tunnels of up to this size are unlimbered if they are deep enough and the soil will stand open.
Larger tunnels must have shoring. Chambers constructed in rock or extremely hard soil do not need timber
supports. If timber is not used, the chamber is not wider than 6 1/2 feet; if timbers are used, the width can
increase to 10 feet. The chamber is generally the same height as the tunnel, and up to 13 feet long.

Grenade traps are constructed at the bottom of straight lengths where they slope. This is done by cutting
a recess about 3 1/2 feet deep in the wall facing the inclining floor of the tunnel.


242 The Ultimate Guide to U.S. Army Survival Skills, Tactics, and Techniques

Figure 1-5: Typical tunnel system.

Much of the spoil from the excavated area requires disposal and concealment. The volume of spoil is
usually estimated as one third greater than the volume of the tunnel. Tunnel entrances need concealment
from enemy observation. Also, it is sometimes necessary during construction to transport spoil by hand
through a trench. In cold regions, air warmer than outside air may rise from a tunnel entrance, thus revealing
the position.

The danger that tunnel entrances may become blocked and trap the occupants always exists. Picks and
shovels are placed in each tunnel so that trapped personnel can dig their way out. Furthermore, at least
two entrances are necessary for ventilation. Whenever possible, one or more emergency exits are provided.
These are usually small tunnels with entrances normally closed or concealed. A tunnel is constructed from
inside the system to within a few feet of the surface so that an easy breakthrough is possible.

Earth Parapets. Excavations and trenches are usually modified to include front, rear, and side earth parapets.
Parapets are constructed using spoil from the excavation or other materials carried to the site. Frontal,
side, and rear parapets greatly increase the protection of occupants firing their weapons (see Figure 1-6).
Thicknesses required for parapets vary according to the material’s ability to deny round penetration.

Parapets are generally positioned as shown below to allow full frontal protection, thus relying on mutual
support of other firing positions. Parapets are also used as a single means of protection, even in the absence
of excavations.

Overhead Cover and Roof Structures. Fighting and protective positions are given overhead cover primarily
to defeat indirect fire projectiles landing on or exploding above them. Defeat of an indirect fire attack
on a position, then, requires that the three types of burst conditions are considered. (Note: Always place a
waterproof layer over any soil cover to prevent it from gaining moisture or weathering.)


Planning Positions 243


Figure 1-6: Parapets used for frontal protection relying on mutual support.

Overhead Burst (Fragments). Protection against fragments from airburst artillery is provided by a thickness
of shielding required to defeat a certain size shell fragment, supported by a roof structure adequate for
the dead load of the shielding. This type of roof structure is designed using the thicknesses to defeat fragment
penetration given in Table 1-5. As a general guide, fragment penetration protection always requires
at least 1 1/2 feet of soil cover. For example, to defeat fragments from a 120-mm mortar when available
cover material is sandbags filled with soil, the cover depth required is 1 1/2 feet. Then, Table 1-8 shows that
support of the l 1/2 feet of cover (using 2 by 4 roof stringers over a 4-foot span) requires 16-inch center-tocenter
spacing of the 2 by 4s. This example is shown in Figure 1-7.

Contact Burst. Protection from contact burst of indirect fire HE shells requires much more cover and roof
structure support than does protection from fragmentation. The type of roof structure necessary is given
in Table 1-13. For example, if a position must defeat the contact burst of an 82-mm mortar, Table 1-13 provides
multiple design options. If 4 by 4 stringers are positioned on 9-inch center-to-center spacings over a
span of 8 feet, then 2 feet of soil (loose, gravelly sand) is required to defeat the burst.


Figure 1-7: Position with overhead cover protection against fragments from a 120-mm mortar.


244 The Ultimate Guide to U.S. Army Survival Skills, Tactics, and Techniques

Delay Fuze Burst. Delay fuze shells are designed to detonate after penetration. Protection provided by
overhead cover is dependent on the amount of cover remaining between the structure and the shell at the
time of detonation. To defeat penetration of the shell, and thus cause it to detonate with a sufficient cover
between it and the structure, materials are added on top of the overhead cover.

If this type of cover is used along with contact burst protection, the additional materials (such as rock or
concrete) are added in with the soil unit weight when designing the contact burst cover structure.

Triggering Screens. Triggering screens are separately built or added on to existing structures used to
activate the fuze of an incoming shell at a “standoff” distance from the structure. The screen initiates detonation
at a distance where only fragments reach the structure. A variety of materials are usually used to
detonate both super-quick fuzed shells and delay fuze shells up to and including 130 mm. Super-quick
shell detonation requires only enough material to activate the fuze. Delay shells require more material to
both limit penetration and activate the fuze. Typical standoff framing is shown below.

Figure 1-8: Typical standoff framing with dimensioned wood triggering screen.


Planning Positions 245

Defeating Super-Quick Fuzes. Incoming shells with super-quick fuzes are defeated at a standoff distance
with several types of triggering screen materials. Table 1-10 lists thicknesses of facing material required
for detonating incoming shells when impacting with the triggering screen. These triggering screens detonate
the incoming shell but do not defeat fragments from these shells. Protection from fragments is still
necessary for a position. Table 1-11 lists required thicknesses for various materials to defeat fragments if
the triggering screen is 10 feet from the structure.

Defeating Delay Fuzes. Delay fuzes are defeated by various thicknesses of protective material. Table 1-12
lists type and thickness of materials required to defeat penetration of delay fuze shells and cause their premature
detonation. These materials are usually added to positions designed for contact burst protection.
One method to defeat penetration and ensure premature shell detonation is to use layers of large stones.
Figure 1-9 shows this added delay fuze protection on top of the contact burst protection. The rocks are
placed in at least three layers on top of the required depth of cover for the expected shell size. The rock
size is approximately twice the caliber of the expected shell. For example, the rock size required to defeat
82-mm mortar shell penetration is 2 x 82 mm = 164 mm (or 6 1/2 inches).

In some cases, chain link fences (shown below) also provide some standoff protection when visibility is
necessary in front of the standoff and when positioned as shown in Figure 1-10. However, the fuze of some
incoming shells may pass through the fence without initiating the firing mechanism.

Table 1-10: Triggering screen facing material requirements.
Table 1-11: Triggering screen material thickness, in inches, required to defeat
fragments at a 10-foot standoff.



246 The Ultimate Guide to U.S. Army Survival Skills, Tactics, and Techniques

Table 1-12: Required thickness, in inches, of protective material to resist penetration
of different shells (Delay Fuze).


Figure 1-9: Stone layer added to typical overhead cover to defeat the delay fuze burst
from an 82-mm mortar..

Shelters And Bunkers. Protective shelters and fighting bunkers are usually constructed using a combination
of the components of positions mentioned thus far. Protective shelters are primarily used as—

• Command posts.
• Observation posts.
• Medical aid stations.
• Supply and ammunition shelters.
• Sleeping or resting shelters.
Protective shelters are usually constructed above ground, using cavity wall revetments and earth-covered
roof structures, or they are below ground using sections that are air transportable. Fighting bunkers
are enlarged fighting positions designed for squad-size units or larger. They are built either above ground
or below ground and are usually made of concrete. However, some are prefabricated and transported forward
to the battle area by trucks or air.


Planning Positions 247


Figure 1-10: Chain link fence used for a standoff.

If shelters and bunkers are properly constructed with appropriate collective protection equipment, they
can serve as protection against chemical and biological agents.

CONSTRUCTION METHODS

For individual and crew-served weapons fighting and protective position construction, hand tools are
available. The individual soldier carries an entrenching tool and has access to picks, shovels, machetes, and
hand carpentry tools for use in individual excavation and vertical construction work.

Earthmoving equipment and explosives are used for excavating protective positions for vehicles and
supplies. Earthmoving equipment, including backhoes, bulldozers, and bucket loaders, are usually used
for larger or more rapid excavation when the situation permits. Usually, these machines cannot dig out
the exact shape desired or dig the amount of earth necessary. The excavation is usually then completed by
hand. Descriptions and capabilities of US survivability equipment are given in appendix A.

Methods of construction include sandbagging, explosive excavation, and excavation revetments.

Sandbagging. Walls of fighting and protective positions are built of sandbags in much the same way
bricks are used. Sandbags are also useful for retaining wall revetments as shown in Figure 1-11.

The sandbag is made of an acrylic fabric and is rot and weather resistant. Under all climatic conditions,
the bag has a life of at least 2 years with no visible deterioration. (Some older-style cotton bags deteriorate
much sooner.) The useful life of sandbags is prolonged by filling them with a mixture of dry earth and
portland cement, normally in the ratio of 1 part of cement to 10 parts of dry earth. The cement sets as the
bags take on moisture. A 1:6 ratio is used for sand-gravel mixtures. As an alternative, filled bags are dipped
in a cement-water slurry. Each sandbag is then pounded with a flat object, such as a 2 by 4, to make the
retaining wall more stable.

As a rule, sandbags are used for revetting walls or repairing trenches when the soil is very loose and
requires a retaining wall. A sandbag revetment will not stand with a vertical face. The face must have a
slope of 1:4, and lean against the earth it is to hold in place. The base for the revetment must stand on firm
ground and dug at a slope of 4:1.


248 The Ultimate Guide to U.S. Army Survival Skills, Tactics, and Techniques


Figure 1-11: Retaining wall revetment.

The following steps are used to construct a sandbag revetment wall such as the one shown in Figure 1-11.

•
The bags are filled about three-fourths full with earth or a dry soil-cement mixture and the choke
cords are tied.
•
The bottom corners of the bags are tucked in after filling.
•
The bottom row of the revetment is constructed by placing all bags as headers. The wall is built
using alternate rows of stretchers and headers with the joints broken between courses. The top row
of the revetment wall consists of headers.
•
Sandbags are positioned so that the planes between the layers have the same pitch as the base—at
right angles to the slope of the revetment.
•
All bags are placed so that side seams on stretchers and choked ends on headers are turned toward
the revetted face.
•
As the revetment is built, it is backfilled to shape the revetted face to this slope.

Planning Positions 249

Often, the requirement for filled sandbags far exceeds the capabilities of soldiers using only shovels. If
the bags are filled from a stockpile, the job is performed easier and faster by using a lumber or steel funnel
as shown in Figure 1-12.

Excavation Revetments. Excavations in soil may require revetment to prevent side walls from collapsing.
Several methods of excavation revetments are usually used to prevent wall collapse.

Wall Sloping. The need for revetment is sometimes avoided or postponed by sloping the walls of the excavation.
In most soils, a slope of 1:3 or 1:4 is sufficient. This method is used temporarily if the soil is loose
and no revetting materials are available. The ratio of 1:3, for example, will determine the slope by moving
1 foot horizontally for each 3 feet vertically. When wall sloping is used, the walls are first dug vertically
and then sloped.

Facing Revetments. Facing revetments serve mainly to protect revetted surfaces from the effects of weather
and occupation. It is used when soils are stable enough to sustain their own weight. This revetment consists


Figure 1-12: Expedient funnel for filling sandbags.


250 The Ultimate Guide to U.S. Army Survival Skills, Tactics, and Techniques

of the revetting or facing material and the supports which hold the revetting material in place. The facing
material is usually much thinner than that used in a retaining wall. Facing revetments are preferable to
wall sloping since less excavation is required. The top of the facing is set below ground level. The facing
is constructed of brushwood hurdles, continuous brush, poles, corrugated metal, plywood, or burlap and
chicken wire. The following paragraphs describe the method of constructing each type.

Brushwood Hurdle (Figure 1-13). A brushwood hurdle is a woven revetment unit usually 6 1/2 feet long
and as high as the revetted wall. Pieces of brushwood about 1 inch in diameter are weaved on a framework
of sharpened pickets driven into the ground at 20-inch intervals. When completed, the 6 1/2-foot lengths
are carried to the position where the pickets are driven in place. The tops of the pickets are tied back to
stakes or holdfasts and the ends of the hurdles are wired together.

Continuous Brush (Figure 1-14). A continuous brush revetment is constructed in place. Sharpened
pickets 3 inches in diameter are driven into the bottom of the trench at 30-inch intervals and about 4 inches
from the revetted earth face. The space behind the pickets is packed with small, straight brushwood laid
horizontally. The tops of the pickets are anchored to stakes or holdfasts.

Pole (Figure 1-15). A pole revetment is similar to the continuous brush revetment except that a layer of
small horizontal round poles, cut to the length of the revetted wall, is used instead of brushwood. If available,
boards or planks are used instead of poles because of quick installation. Pickets are held in place by
holdfasts or struts.

Corrugated Metal Sheets or Plywood (Figure 1-16). A revetment of corrugated metal sheets or plywood
is usually installed rapidly and is strong and durable. It is well adapted to position construction because
the edges and ends of sheets or planks are lapped, as required, to produce a revetment of a given height
and length. All metal surfaces are smeared with mud to reduce possible reflection of thermal radiation and
aid in camouflage. Burlap and chicken wire revetments are similar to revetments made from corrugated
metal sheets or plywood. However, burlap and chicken wire does not have the strength or durability of
plywood or sheet metal in supporting soil.


Figure 1-13: Brush wood hurdle.


Planning Positions 251

Approximately
4 in.
Brushwood
Earth face
Figure 1-14: Continuous brush revetment.


Figure 1-15: Pole revetment.

Continuous Brush (Figure 1-14). A continuous brush revetment is constructed in place. Sharpened
pickets 3 inches in diameter are driven into the bottom of the trench at 30-inch intervals and about 4 inches
from the revetted earth face. The space behind the pickets is packed with small, straight brushwood laid
horizontally. The tops of the pickets are anchored to stakes or holdfasts.

Pole (Figure 1-15). A pole revetment is similar to the continuous brush revetment except that a layer of
small horizontal round poles, cut to the length of the revetted wall, is used instead of brushwood. If available,
boards or planks are used instead of poles because of quick installation. Pickets are held in place by
holdfasts or struts.

Corrugated Metal Sheets or Plywood (Figure 1-16). A revetment of corrugated metal sheets or plywood
is usually installed rapidly and is strong and durable. It is well adapted to position construction because


252 The Ultimate Guide to U.S. Army Survival Skills, Tactics, and Techniques


Figure 1-16: Types of metal revetment.


Figure 1-17: Facing revetment supported by
timber frames.


Figure 1-18: Facing revetment supported by pickets.


Planning Positions 253

stake and the facing is at least equal to the height of the revetted face, with alternate anchors staggered and
at least 2 feet farther back. Several strands of wire holding the pickets against the emplacement walls are
placed straight and taut. A groove or channel is cut in the parapet to pass the wire through.

SPECIAL CONSTRUCTION CONSIDERATIONS

Camouflage And Concealment. The easiest and most efficient method of preventing the targeting and
destruction of a position or shelter is use of proper camouflage and concealment techniques. Following are
some general guidelines for position construction.

Natural concealment and good camouflage materials are used. When construction of a position begins,
natural materials such as vegetation, rotting leaves, scrub brush, and snow are preserved for use as camouflage
when construction is completed. If explosive excavation is used, the large area of earth spray created
by detonation is camouflaged or removed by first placing tarpaulins or scrap canvas on the ground prior
to charge detonation. Also, heavy equipment tracks and impressions are disguised upon completion of
construction.

Fields of fire are not overcleared. In fighting position construction, clearing of fields of fire is an important
activity for effective engagement of the enemy. Excessive clearing is prevented in order to reduce early
enemy acquisition of the position. Procedures for clearing allow for only as much terrain modification as
is needed for enemy acquisition and engagement.

Concealment from aircraft is provided. Consideration is usually given to observation from the air. Action
is taken to camouflage position interiors or roofs with fresh natural materials, thus preventing contrast
with the surroundings.

During construction, the position is evaluated from the enemy side. By far, the most effective means of
evaluating concealment and camouflage is to check it from a suspected enemy avenue of approach.

Drainage. Positions and shelters are designed to take advantage of the natural drainage pattern of the
ground. They are constructed to provide for—

• Exclusion of surface runoff.
• Disposal of direct rainfall or seepage.
• Bypassing or rerouting natural drainage channels if they are intersected by the position.
In addition to using materials that are durable and resistant to weathering and rot, positions are protected
from damage due to surface runoff and direct rainfall, and are repaired quickly when erosion begins.
Proper position siting can lessen the problem of surface water runoff. Surface water is excluded by excavating
intercepted ditches uphill from a position or shelter. Preventing water from flowing into the excavation
is easier than removing it. Positions are located to direct the runoff water into natural drainage lines. Water
within a position or shelter is carried to central points by constructing longitudinal slopes in the bottom of
the excavation. A very gradual slope of 1 percent is desirable.

Maintenance. If water is allowed to stand in the bottom of an excavation, the position is eventually undermined
and becomes useless. Sumps and drains are kept clean of silt and refuse. Parapets around positions
are kept clear and wide enough to prevent parapet soil from falling into the excavation. When wire and
pickets are used to support revetment material, the pickets may become loose, especially after rain. Improvised
braces are wedged across the excavation, at or near floor level, between two opposite pickets. Anchor
wires are tightened by further twisting. Anchor pickets are driven in farther to hold tightened wires. Periodic
inspections of sandbags are made.

Repairs. If the walls are crumbling in at the top of an excavation (ground level), soil is cut out where it is
crumbling (or until firm soil is reached). Sandbags or sod blocks are used to build up the damaged area.
If excavation walls are wearing away at the floor level, a plank is placed on its edge or the brushwood


254 The Ultimate Guide to U.S. Army Survival Skills, Tactics, and Techniques

is shifted down. The plank is held against the excavation wall with short pickets driven into the floor. If
planks are used on both sides of the excavation, a wedge is placed between the planks and earth is placed
in the back of the planks. If an entire wall appears ready to collapse, the excavation is completely revetted.
See Figure 1-19.

Security. In almost all instances, fighting and protective positions are prepared by teams of at least two
personnel. During construction, adequate frontal and perimeter protection and observation are necessary.
Additional units are sometimes required to secure an area during position construction. Unit personnel
can also take turns with excavating and providing security.


Figure 1-19: Excavation repair.


Planning Positions 255

Table 1-13: Center-to-center spacing for wood supporting soil cover to defeat contact bursts.

(continued)


256 The Ultimate Guide to U.S. Army Survival Skills, Tactics, and Techniques

Table 1-13: (Continued)



CHAPTER 2


Designing Positions


This chapter contains basic requirements which must be built into the designs of fighting and protective
positions. These requirements ensure soldiers are well-protected while performing their missions. The
positions are all continuously improved as time, assets, and the situation permit. The following position
categories are presented: hasty and deliberate fighting position for individual soldiers; trenches connecting
the positions; positions for entire units; and special designs including shelters and bunkers. The positions
in each category are briefly described and accompanied by a typical design illustration. Each category is
summarized providing time and equipment estimates and protection factors for each position. Complete
detailed construction drawings, and time and material estimates for a variety of positions are contained in
Chapter 4.

BASIC DESIGN REQUIREMENTS

Weapon Employment. While it is desirable for a fighting position to give maximum protection to personnel
and equipment, primary consideration is always given to effective weapon use. In offensive combat
operations, weapons are sited wherever natural or existing positions are available, or where weapon
emplacement is made with minimal digging.

Cover. Positions are designed to defeat an anticipated threat. Protection against direct and indirect fire is
of primary concern for position design. However, the effects of nuclear and chemical attack are taken into
consideration if their use is suspected. Protection design for one type of enemy fire is not necessarily effective
against another. The following three types of cover—frontal, overhead, and flank and rear—will have
a direct bearing on designing and constructing positions.

Frontal. Frontal cover provides protection from small caliber direct fire. Natural frontal protection such
as large trees, rocks, logs, and rubble is best because enemy detection of fighting positions becomes difficult.
However, if natural frontal protection is not adequate for proper protection, dirt excavated from
the position (hole) is used. Frontal cover requires the position to have the correct length so that soldiers
have adequate room; the correct dirt thickness (3 feet) to stop enemy small caliber fire; the correct height
for overhead protection; and, for soldiers firing to the oblique, the correct frontal distance for elbow rests
and sector stakes. Protection from larger direct fire weapons (for example, tank guns) is achieved by locating
the position where the enemy cannot engage it, and concealing it so pinpoint location is not possible.
Almost twice as many soldiers are killed or wounded by small caliber fire when their positions do not have
frontal cover.

Overhead. Overhead cover provides protection from indirect fire fragmentation. When possible, overhead
cover is always constructed to enhance protection against airburst artillery shells. Overhead cover is necessary
because soldiers are at least ten times more protected from indirect fire if they are in a hole with
overhead cover.

Flank and Rear. Flank and rear cover ensures complete protection for fighting positions. Flank and rear
cover protects soldiers against the effects of indirect fire bursts to the flanks or rear of the position, and the
effects of friendly weapons located in the rear (for example, packing from discarded sabot rounds fired
from tanks). Ideally, this protection is provided by natural cover. In its absence, a parapet is constructed as
time and circumstances permit.

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258 The Ultimate Guide to U.S. Army Survival Skills, Tactics, and Techniques

Simplicity and Economy. The position is usually uncomplicated and strong, requires as little digging as
possible, and is constructed of immediately available materials.

Ingenuity. A high degree of imagination is essential to assure the best use of available materials. Many different
materials existing on the battlefield and prefabricated materials found in industrial and urban areas
can be used for position construction.

Progressive Development. Positions should allow for progressive development to insure flexibility, security,
and protection in depth. Hasty positions are continuously improved into deliberate positions to provide
maximum protection from enemy fire. Trenches or tunnels connecting fighting positions give ultimate
flexibility in fighting from a battle position or strongpoint. Grenade sumps are usually dug at the bottom
of a position’s front wall where water collects. The sump is about 3 feet long, 1/2 foot wide, and dug at a
30-degree angle. The slant of the floor channels excess water and grenades into the sump. In larger positions,
separate drainage sumps or water drains are constructed to reduce the amount of water collecting at
the bottom of the position.

Camouflage and Concealment. Camouflage and concealment activities are continual during position
siting preparation. If the enemy cannot locate a fighting position, then the position offers friendly forces
the advantage of firing first before being detected.

INDIVIDUAL FIGHTING POSITIONS

Table 2-1 summarizes the hasty and deliberate individual fighting positions and provides time estimates,
equipment requirements, and protection factors.

Hasty Positions. When time and materials are limited, troops in contact with the enemy use a hasty fighting
position located behind whatever cover is available. It should provide frontal protection from direct
fire while allowing fire to the front and oblique. For protection from indirect fire, a hasty fighting position
is located in a depression or hole at least l 1/2 feet deep. The following positions provide limited protection
and are used when there is little or no natural cover. If the unit remains in the area, the hasty positions are
further developed into deliberate positions which provide as much protection as possible.

Deliberate Positions. Deliberate fighting positions are modified hasty positions prepared during periods
of relaxed enemy pressure. If the situation permits, the unit leader verifies the sectors of observation before
preparing each position. Continued improvements are made to strengthen the position during the period
of occupation. Small holes are dug for automatic rifle biped legs so the rifle is as close to ground level as
possible. Improvements include adding overhead cover, digging trenches to adjacent positions, and maintaining
camouflage.

TRENCHES

Trenches are excavated to connect individual fighting positions and weapons positions in the progressive
development of a defensive area. They provide protection and concealment for personnel moving between
fighting positions or in and out of the area. Trenches are usually included in the overall layout plan for the
defense of a position or strongpoint. Excavating trenches involves considerable time, effort, and materials,
and is only justified when an area is occupied for a long time. Trenches are usually open excavations, but
covered sections provide additional protection if the overhead cover does not interfere with the fire mission
of the occupying personnel. Trenches are difficult to camouflage and are easily detected, especially
from the air.

Trenches, as other fighting positions, are developed progressively. They are improved by digging
deeper, from a minimum of 2 feet to about 5 1/2 feet. As a general rule, deeper excavation is desired for
other than fighting trenches to provide more protection or allow more headroom. Some trenches may
also require widening to accommodate more traffic, including stretchers. It is usually necessary to revet


Designing Positions 259

Table 2-1: Characteristics of individual fighting positions.


Table 2-2: Shielding of m8a1 landing mats.


trenches that are more than 5 feet deep in any type of soil. In the deeper trenches, some engineer advice
or assistance is usually necessary in providing adequate drainage. Two basic trenches are the crawl trench
and the standard fighting trench.


260 The Ultimate Guide to U.S. Army Survival Skills, Tactics, and Techniques

UNIT POSITIONS

Survivability operations are required to support the deployment of units with branch-specific missions,
or missions of extreme tactical importance. These units are required to deploy and remain in one location
for a considerable amount of time to perform their mission. Thus, they may require substantial protective
construction.

SPECIAL DESIGNS

Table 2-3 summarizes construction estimates and levels of protection for the fighting positions, bunkers,
shelters, and protective walls presented in this section.

Fighting Positions. The following two positions are designed for use by two or more individuals armed
with rifles or machine guns. Although these are beyond the construction capabilities of non-engineer
troops, certain construction phases can be accomplished with little or no engineer assistance. For example,
while engineer assistance may be necessary to build steel frames and cut timbers for the roof of a structure,
the excavation, assembly, and installation are all within the capabilities of most units. Adequate support
for overhead cover is extremely important. The support system should be strong enough to safely support
the roof and soil material and survive the effects of weapon detonations.

Bunkers. Bunkers are larger fighting positions constructed for squad-size units who are required to remain
in defensive positions for a longer period of time. They are built either above ground or below ground and
are usually made of reinforced concrete. Because of the extensive engineer effort required to build bunkers,
they are usually made during strong- point construction. If time permits, bunkers are connected to other

Table 2-3: Characteristics of special design positions.


(continued)


Designing Positions 261

Table 2-3: (Continued)

(continued)


262 The Ultimate Guide to U.S. Army Survival Skills, Tactics, and Techniques

Table 2-3: (Continued)


(continued)


Designing Positions 263

Table 2-3: (Continued)

(continued)


264 The Ultimate Guide to U.S. Army Survival Skills, Tactics, and Techniques

Table 2-3: (Continued)


fighting or supply positions by tunnels. Prefabrication of bunker assemblies affords rapid construction and
placement flexibility. Bunkers offer excellent protection against direct fire and indirect fire effects and, if
properly constructed with appropriate collective protection equipment, they provide protection against
chemical and biological agents.

Shelters. Shelters are primarily constructed to protect soldiers, equipment, and supplies from enemy action
and the weather. Shelters differ from fighting positions because there are usually no provisions for firing
weapons from them. However, they are usually constructed near—or to supplement—fighting positions.
When available, natural shelters such as caves, mines, or tunnels are used instead of constructing shelters.
Engineers are consulted to determine suitability of caves and tunnels.

The best shelter is usually one that provides the most protection but requires the least amount of effort
to construct. Shelters are frequently prepared by support troops, troops making a temporary halt due to
inclement weather, and units in bivouacs, assembly areas, and rest areas. Shelters are constructed with as
much overhead cover as possible. They are dispersed and limited to a maximum capacity of about 25 soldiers.
Supply shelters are of any size, depending on location, time, and materials available. Large shelters
require additional camouflaged entrances and exits.

All three types of shelters—below ground, aboveground, and cut-and-cover—are usually sited on
reverse slopes, in woods, or in some form of natural defilade such as ravines, valleys, wadis, and other hollows
or depressions in the terrain. They are not constructed in paths of natural drainage lines. All shelters
require camouflage or concealment. As time permits, shelters are continuously improved.


Designing Positions 265

Below ground shelters require the most construction effort but generally provide the highest level of
protection from conventional, nuclear, and chemical weapons.

Cut-and-cover shelters are partially dug into the ground and backfilled on top with as thick a layer
of cover material as possible. These shelters provide excellent protection from the weather and enemy
action.

Above ground shelters provide the best observation and are easier to enter and exit than below ground
shelters. They also require the least amount of labor to construct, but are hard to conceal and require a large
amount of cover and revetting material. They provide the least amount of protection from nuclear and
conventional weapons; however, they do provide protection against liquid droplets of chemical agents.
Aboveground shelters are seldom used for personnel in forward combat positions unless the shelters are
concealed in woods, on reverse slopes, or among buildings. Above ground shelters are used when water
levels are close to the ground surface or when the ground is so hard that digging a below ground shelter
is impractical.

The following shelters are suitable for a variety of uses where troops and their equipment require protection,
whether performing their duties or resting.

Protective Walls. Several basic types of walls are constructed to satisfy various weather, topographical,
tactical, and other military requirements. The walls range from simple ones, constructed with hand tools,
to more difficult walls requiring specialized engineering and equipment capabilities.

Protection provided by the walls is restricted to stopping fragment and blast effects from near-miss
explosions of mortar, rocket, or artillery shells; some direct fire protection is also provided. Overhead
cover is not practical due to the size of the position surrounded by the walls. In some cases, modification
of the designs shown will increase nuclear protection. The wall’s effectiveness substantially increases by
locating it in adequately-defended areas. The walls need close integration with other forms of protection
such as dispersion, concealment, and adjacent fighting positions. The protective walls should have the
minimum inside area required to perform operational duties. Further, the walls should have their height
as near to the height of the equipment as practical.


CHAPTER 3


Special Operations and Situations


The two basic operations involving U.S. force deployment are combined and contingency. Combined operations
are enacted in areas where U.S. forces are already established, such as NATO nations. Where few
or no U.S. installations exist, usually in undeveloped regions, contingency operations are planned. In both
cases, survivability missions will require intensive engineer support in all types of terrain and climate. Each
environment’s advantages and disadvantages are adapted to survivability planning, designing, and constructing
positions. Fighting and protective positions in jungles, mountainous areas, deserts, cold regions,
and urban areas require specialized knowledge, skills, techniques, and equipment. This chapter presents
characteristics of five environments which impact on survivability and describes the conditions expected
during combined and contingency operations.

SPECIAL TERRAIN ENVIRONMENTS

Jungles. Jungles are humid, tropic areas with a dense growth of trees and vegetation. Visibility is typically
less than 100 feet, and areas are sparsely populated. Because mounted infantry and armor operations
are limited in jungle areas, individual and crew-served weapons fighting position construction and use
receive additional emphasis. While jungle vegetation provides excellent concealment from air and ground
observation, fields of fire are difficult to establish. Vegetation does not provide adequate cover from small
caliber direct fire and artillery indirect fire fragments. Adequate cover is available, though, if positions are
located using the natural ravines and gullies produced by erosion from the area’s high annual rainfall.

The few natural or locally-procurable materials which are available in jungle areas are usually limited
to camouflage use. Position construction materials are transported to these areas and are required to be
weather and rot resistant. When shelters are constructed in jungles, primary consideration is given to


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268 The Ultimate Guide to U.S. Army Survival Skills, Tactics, and Techniques


drainage provisions. Because of high amounts of rainfall and poor soil drainage, positions are built to
allow for good, natural drainage routes. This technique not only prevents flooded positions but, because of
nuclear fallout washing down from trees and vegetation, it also prevents positions from becoming radiation
hot spots.

Other considerations are high water tables, dense undergrowth, and tree roots, often requiring aboveground
level protective construction. A structure used in areas where groundwater is high, or where there
is a low-pressure resistance soil, is the fighting position platform, depicted below. This platform provides a
floating base or floor where wet or low-pressure resistance soil precludes standing or sitting. The platform
is constructed of small branches or timber layered over cross-posts, thus distributing the floor load over a
wider area. As shown in the following two illustrations, satisfactory rain shelters are quickly constructed
using easily-procurable materials such as ponchos or natural materials.

Mountainous Areas. Characteristics of mountain ranges include rugged, poorly trafficable terrain, steep
slopes, and altitudes greater than 1,600 feet. Irregular mountain terrain provides numerous places for
cover and concealment. Because of rocky ground, it is difficult and often impossible to dig below ground
positions; therefore, boulders and loose rocks are used in above ground construction. Irregular fields of fire
and dead spaces are considered when designing and locating fighting positions in mountainous areas.

Reverse slope positions are rarely used in mountainous terrain; crest and near-crest positions on high
ground are much more common. Direct fire weapon positions in mountainous areas are usually poorly
concealed by large fields of fire. Indirect fire weapon positions are better protected from both direct and
indirect fire when located behind steep slopes and ridges.

Another important design consideration in mountain terrain is the requirement for substantial overhead
cover. The adverse effects of artillery bursts above a protective position are greatly enhanced by rock and
gravel displacement or avalanche. Construction materials used for both structural and shielding components
are most often indigenous rocks, boulders, and rocky soil. Often, rock formations are used as structural
wall components without modification. Conventional tools are inadequate for preparing individual
and crew-served weapons fighting positions in rocky terrain. Engineers assist with light equipment and
tools (such as pneumatic jackhammers) delivered to mountain areas by helicopter.

In areas with rocky soil or gravel, wire cages or gabions are used as building blocks in protective walls,
structural walls, and fighting positions. Gabions are constructed of lumber, plywood, wire fence, or any
suitable material that forms a stackable container for soil or gravel.


Special Operations and Situations 269

The two-soldier mountain shelter is basically a hole 7 feet long, 3 1/2 feet wide, and 3 1/2 feet deep. The
hole is covered with 6- to 8-inch diameter logs with evergreen branches, a shelter half, or local material
such as topsoil, leaves, snow, and twigs placed on top. The floor is usually covered with evergreen twigs, a
shelter half, or other expedient material. Entrances can be provided at both ends or a fire pit is sometimes
dug at one end for a small fire or stove. A low earth parapet is built around the position to provide more
height for the occupants.

Deserts. Deserts are extensive, arid, arid treeless, having a severe lack of rainfall and extreme daily temperature
fluctuations. The terrain is sandy with boulder-strewn areas, mountains, dunes, deeply-eroded
valleys, areas of rock and shale, and salt marshes. Effective natural barriers are found in steep slope
rock formations. Wadis and other dried up drainage features are used extensively for protective position
placement.

Designers of fighting and protective positions in desert areas must consider the lack of available natural
cover and concealment. The only minimal cover available is through the use of terrain masking; therefore,
positions are often completed above ground. Mountain and plateau deserts have rocky soil or “surface
chalk” soil which makes digging difficult. In these areas, rocks and boulders are used for cover. Most often,
parapets used in desert fighting or protective positions are undesirable because of probable enemy detection
in the flat desert terrain. Deep-cut positions are also difficult to construct in soft sandy areas because
of wall instability during excavations. Revetments are almost always required, unless excavations are very
wide and have gently sloping sides of 45 degrees or less. Designing overhead cover is additionally important
because nuclear explosions have increased fallout due to easily displaced sandy soil.

Indigenous materials are usually used in desert position construction. However, prefabricated structures
and revetments for excavations, if available, are ideal. Metal culvert revetments are quickly emplaced in easily
excavated sand. Sandbags and sand-filled ammunition boxes are also used for containing backsliding soil.
Therefore, camouflage and concealment, as well as light and noise discipline, are important considerations
during position construction. Target acquisition and observation are relatively easy in desert terrain.

Cold Regions. Cold regions of the world are characterized by deep snow, permafrost, seasonally frozen
ground, frozen lakes and rivers, glaciers, and long periods of extremely cold temperatures. Digging in
frozen or semifrozen ground is difficult with equipment, and virtually impossible for the soldier with an
entrenching tool. When possible, positions are designed to take advantage of below ground cover. Positions
are dug as deep as possible, then built up. Fighting and protective position construction in snow
or frozen ground takes up to twice as long as positions in unfrozen ground. Also, positions used in cold
regions are affected by wind and the possibility of thaw during warming periods. An unexpected thaw
causes a severe drop in the soil strength which creates mud and drainage problems. Positions near bodies
of water, such as lakes or rivers, are carefully located to prevent flooding damage during the spring melt
season. Wind protection greatly decreases the effects of cold on both soldiers and equipment. The following
areas offer good wind protection:

•
Densely wooded areas.
•
Groups of vegetation; small blocks of trees or shrubs.
•
The lee side of terrain elevations. (The protected zone extends horizontally up to three times the
height of the terrain elevation).
•
Terrain depressions.
The three basic construction materials available in cold region terrain are snow, ice, and frozen soil. Positions
are more effective when constructed with these three materials in conjunction with timber, stone, or
other locally-available materials.

Snow. Dry snow is less suitable for expedient construction than wet snow because it does not pack as well.
Snow piled at road edges after clearing equipment has passed densifies and begins to harden within hours
after disturbance, even at very low temperatures. Snow compacted artificially, by the wind, and after a


270 The Ultimate Guide to U.S. Army Survival Skills, Tactics, and Techniques

brief thaw is even more suitable for expedient shelters and protective structures. A uniform snow cover
with a minimum thickness of 10 inches is sufficient for shelter from the weather and for revetment construction.
Blocks of uniform size, typically 8 by 12 by 16 inches, depending upon degree of hardness and
density, are cut from the snow pack with shovels, long knives (machetes), or carpenter’s saws. The best
practices for constructing cold weather shelters are those adopted from natives of polar regions.

The systematic overlapping block-over-seam method ensures stable construction. “Caulking” seams
with loose snow ensures snug, draft-free structures. Igloo shelters in cold regions have been known to
survive a whole winter. An Eskimo-style snow shelter, depicted below, easily withstands above-freezing
inside temperatures, thus providing comfortable protection against wind chill and low temperatures. Snow
positions are built during either freezing or thawing if the thaw is not so long or intense that significant
snow melt conditions occur. Mild thaw of temperatures or 2 degrees above freezing are more favorable
than below-freezing temperatures because snow conglomerates readily and assumes any shape without
disintegration. Below-freezing temperatures are necessary for snow construction in order to achieve solid
freezing and strength. If water is available at low temperatures, expedient protective structures are built
by wetting down and shaping snow, with shovels, into the desired forms.

Ice. The initial projectile-stopping capability of ice is better than snow or frozen soil; however, under sustained
fire, ice rapidly cracks and collapses. Ice structures are built in the following three ways:

Layer-by-layer freezing by water. This method produces the strongest ice but, compared to the other
two methods, is more time consuming. Protective surfaces are formed by spraying water in a fine mist on
a structure or fabric. The most favorable temperature for this method is –10 to –15 degrees Celsius with
a moderate wind. Approximately 2 to 3 inches of ice are formed per day between these temperatures
(1/5-inch of ice per degree below zero).

Freezing ice fragments into layers by adding water. This method is very effective and the most frequently
used for building ice structures. The ice fragments are about 1-inch thick and prepared on nearby plots or



Special Operations and Situations 271

on the nearest river or water reservoir. The fragments are packed as densely as possible into a layer 8 to 12
inches thick. Water is then sprayed over the layers of ice fragments. Crushing the ice fragments weakens
the ice construction. If the weather is favorable (–10 to –15 degrees Celsius with wind), a 16- to 24-inch thick
ice layer is usually frozen in a day.

Laying ice blocks. This method is the quickest, but requires assets to transport the blocks from the nearest
river or water reservoir to the site. Ice blocks, laid and overlapped like bricks, are of equal thickness
and uniform size. To achieve good layer adhesion, the preceding layer is lightly sprayed with water before
placing a new layer. Each new layer of blocks freezes onto the preceding layer before additional layers are
placed.

Frozen Soil. Frozen soil is three to five times stronger than ice, and increases in strength with temperatures.
Frozen soil has much better resistance to impact and explosion than to steadily-acting loads—an
especially valuable feature for position construction purposes. Construction using frozen soil is performed
as follows:

• Preparing blocks of frozen soil from a mixture of water and aggregate (icecrete).
• Laying prepared blocks of frozen soil.
• Freezing blocks of frozen soil together in layers.
Unfrozen soil from beneath the frozen layer is sometimes used to construct a position quickly before
the soil freezes. Material made of gravel-sand-silt aggregate wetted to saturation and poured like portland
cement concrete is also suitable for constructing positions. After freezing, the material has the properties
of concrete. The construction methods used are analogous to those using ice. Fighting and protective positions
in arctic areas are constructed both below ground and above ground.

Below ground positions. When the frost layer is one foot or less, fighting positions are usually constructed
below ground, as shown. Snow packed 8 to 9 feet provides protection from sustained direct fire
from small caliber weapons up to and including the Soviet 14, 5-mm KPV machine gun. When possible,
unfrozen excavated soil is used to form parapets about 2-feet thick, and snow is placed on the soil for



272 The Ultimate Guide to U.S. Army Survival Skills, Tactics, and Techniques

camouflage and extra protection. For added frontal protection, the interior snow is reinforced with a log
revetment at least 3 inches in diameter. The outer surface is reinforced with small branches to initiate bullet
tumble upon impact. Bullets slow down very rapidly in snow after they begin to tumble. The wall of logs
directly in front of the position safely absorbs the slowed tumbling bullet.

Overhead cover is constructed with 3 feet of packed snow placed atop a layer of 6-inch diameter logs.
This protection is adequate to stop indirect fire fragmentation. A layer of small, 2-inch diameter logs is
placed atop the packed snow to detonate quick fuzed shells before they become imbedded in the snow.

Above-ground positions. If the soil is frozen to a significant depth, the soldier equipped with only an
entrenching tool and ax will have difficulty digging a fighting position. Under these conditions (below the
tree line), snow and wood are often the only natural materials available to construct fighting positions. The
fighting position is dug at least 20 inches deep, up to chest height, depending on snow conditions. Ideally,
sandbags are used to revet the interior walls for added protection and to prevent cave-ins. If sandbags are
not available, a lattice framework is constructed using small branches or, if time permits, a wall of 3-inch
logs is built. Overhead cover, frontal protection, and side and rear parapets are built employing the same
techniques described in chapter 2.

It is approximately ten times faster to build above-ground snow positions than to dig in frozen ground
to obtain the same degree of protection. Fighting and protective positions constructed in cold regions are
excavated with combined methods using handtools, excavation equipment, or explosives. Heavy equipment
use is limited by traction and maneuverability.

Shelters. Shelters are constructed with a minimum expenditure of time and labor using available materials.
They are ordinarily built on frozen ground or dug in deep snow. Shelters that are completely above ground
offer protection against the weather and supplement or replace tents. Shelter sites near wooded areas are
most desirable because the wood conceals the glow of fires and provides fuel for cooking and heating. Tree
branches extending to the ground offer some shelter for small units or individual protective positions.



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274 The Ultimate Guide to U.S. Army Survival Skills, Tactics, and Techniques

Table 3-1: Snow construction for protection from grenades, small caliber fire, and HEAT projectiles.


Constructing winter shelters begins immediately after the halt to keep the soldiers warm. Beds of foliage,
moss, straw, boards, skis, shelter halves, and ponchos are sometimes used as protection against ground
dampness and cold. The entrance to the shelter, located on the side least exposed to the wind, is close to
the ground and slopes up into the shelter. Openings or cracks in the shelter walls are caulked with an earth
and snow mixture to reduce wind effects. The shelter itself is constructed as low to the ground as possible.
Any fire built within the shelter is placed low in fire holes and cooking pits. Although snow is windproof, a
layer of insulating material, such as a shelter half or blanket, is placed between the occupant and the snow
to prevent body heat from melting the snow.

Urban Areas. Survivability of combat forces operating in urban areas depends on the leader’s ability to
locate adequate fighting and protective positions from the many apparent covered and concealed areas
available. Fighting and protective positions range from hasty positions formed from piles of rubble, to
deliberate positions located inside urban structures. Urban structures are the most advantageous locations
for individual fighting positions. Urban structures are usually divided into groups of below ground and
above-ground structures.


Special Operations and Situations 275


Below Ground Structures. A detailed knowledge of the nature and location of below ground facilities and
structures is of potential value when planning survivability operations in urban terrain. Typical underground
street cross sections are shown in Figure 3-13.

Sewers are separated into sanitary, storm, or combined systems. Sanitary sewers carry wastes and are
normally too small for troop movement or protection. Storm sewers, however, provide rainfall removal
and are often large enough to permit troop and occasional vehicle movement and protection. Except for
groundwater, these sewers are dry during periods of no precipitation. During rainstorms, however, sewers
fill rapidly and, though normally drained by electrical pumps, may overflow. During winter combat, snow
melt may preclude daytime below ground operations. Another hazard is poor ventilation and the resultant
toxic fume build-up that occurs in sewer tunnels and subways. The conditions in sewers provide an excellent
breeding ground for disease, which demands proper troop hygiene and immunization.

Subways tend to run under main roadways and have the potential hazard of having electrified rails and
power leads. Passageways often extend outward from underground malls or storage areas, and catacombs
are sometimes encountered in older sections of cities.

Above-ground Structures. Above-ground structures in urban areas are generally of two types: frameless
and framed.


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Special Operations and Situations 277


Frameless structures. In frameless structures, the mass of the exterior wall performs the principal loadbearing
functions of supporting dead weight of roofs, floors, ceilings; weight of furnishings and occupants;
and horizontal loads. Frameless structures are shown in Figure 3-14.

Building materials for frameless structures include mud, stone, brick, cement building blocks, and reinforced
concrete. Wall thickness varies with material and building height. Frameless structures have thicker
walls than framed structures, and therefore are more resistant to projectile penetration. Fighting from frameless
buildings is usually restricted to the door and window areas.

Frameless buildings vary with function, age, and cost of building materials. Older institutional buildings,
such as churches, are frequently made of stone. Reinforced concrete is the principal material for
wall and slab structures (apartments and hotels) and for prefabricated structures used for commercial and


278 The Ultimate Guide to U.S. Army Survival Skills, Tactics, and Techniques


Figure 3-13: Cross sections of streets.

industrial purposes. Brick structures, the most common type of buildings, dominate the core of urban areas
(except in the relatively few parts of the world where wood-framed houses are common). Close-set brick
structures up to five stories high are located on relatively narrow streets and form a hard, shock-absorbing
protective zone for the inner city. The volume of rubble produced by their full or partial demolition provides
countless fighting positions.

Framed structures. Framed structures typically have a skeletal structure of columns and beams which
supports both vertical and horizontal loads. Exterior (curtain) walls are non load-bearing. Without the
impediment of load bearing walls, large open interior spaces offer little protection. The only available refuge
is the central core of reinforced concrete present in many of these buildings (for example, the elevator
shaft). Multistoried steel and concrete-framed structures occupy the valuable core area of most modern
cities. Examples of framed structures are shown in Figure 3-15.

Material and Structural Characteristics. Urban structures, frameless and framed, fit certain material generalities.
Table 3-2 converts building type and material into height/wall thicknesses. Most worldwide
urban areas have more than 60 percent of their construction formed from bricks. The relationship between
building height and thickness of the average brick wall is shown in Table 3-3.

Special Urban Area Positions.

Troop Protection. After urban structures are classified as either frameless or framed, and some of their
material characteristics are defined, leaders evaluate them for protective soundness. The evaluation is
based on troop protection available and weapon position employment requirements for cover, concealment,
and routes of escape. Table 3-4 summarizes survivability requirements for troop protection.

Cover. The extent of building cover depends on the proportion of walls to windows. It is necessary to
know the proportion of non-windowed wall space which might serve as protection. Frameless buildings,


Special Operations and Situations 279


Figure 3-14: Frameless building characteristics.

Figure 3-15: Framed building characteristics.

with their high proportion of walls to windows, afford more substantial cover than framed buildings
having both a lower proportion of wall to window space and thinner (non load-bearing) walls.

Composition and thickness of both exterior and interior walls also have a significant bearing on cover
assessment. Frameless buildings with their strong weight-bearing walls provide more cover than the curtain
walls of framed buildings. However, interior walls of the older, heavy-clad, framed buildings are
stronger than those of the new, light-clad, framed buildings. Cover within these light-clad framed buildings
is very slight except in and behind their stair and elevator modules which are usually constructed
of reinforced concrete. Familiarity with the location, dimension, and form of these modules is vital when
assessing cover possibilities.


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Table 3-2: Urban structure material thicknesses.


Table 3-3: Average brick wall thickness.


Concealment. Concealment considerations involve some of the same elements of building construction,
but knowledge of the venting (window) pattern and floor plan is added.

These patterns vary with type of building construction and function. Older, heavy-clad framed buildings
(such as office buildings) frequently have as full a venting pattern as possible, while hotels have only
one window per room. In the newer, light-clad framed buildings, windows are sometimes used as a nonload
bearing curtain wall. If the windows are all broken, no concealment possibilities exist. Another aspect
of concealment—undetected movement within the building—depends on a knowledge of the floor plan
and the traffic pattern within the building on each floor and from floor to floor.

Escape. In planning for escape routes, the floor plan, traffic patterns, and the relationships between
building exits are considered. Possibilities range from small buildings with front street exits (posing unacceptable
risks), to high-rise structures having exits on several floors, above and below ground level, and
connecting with other buildings as well.