AUTHORIZED DENTAL SUPPLIES AND EQUIPMENT

The authorized dental allowance list (ADAL) for Naval Mobile Construction Battalions is the same as the FMF mentioned earlier in this chapter (dental field equipment).

SPECIAL QUALIFICATIONS

All Dental Technicians who serve with an NMCB attend the same Field Service Dental Technician School as do the FMF Dental Technicians.

Enlisted personnel permanently assigned to an NMCB have an opportunity to qualify as a Seabee Combat Warfare Specialist (SCW). The insignia is shown in figure 12-8. Contact the command master chief who serves as SCW coordinator for Personnel Qualification Standards (PQS) for your battalion.

Serving a tour on a ship, FMF, or with NMCBs are the building blocks for a successful naval career. Take advantage of earning a warfare device or the FMF ribbon when assigned to one of these units. A warfare device and FMF ribbon signifies that Sailors are competent in their rate and have acquired additional general knowledge that enhances their understanding of warfighting, mission effectiveness, and command survivability. Sailors who wear warfare devices or the FMF ribbon stand out as significant contributors to the

Figure 12-8.\Seabee Combat Warfare Specialist Insignia. ^Navy.

CHAPTER 13 CASUALTY CARE AND CBR WARFARE

As a dental assistant, your training in basic life support and emergency medical treatment makes you a vital resource in mass casualty situations. In such situations, you will be expected to assume the role of a medical aid person, to provide basic life support and emergency medical treatment, to sustain life, and to prevent further injuries. You can be called to these duties during either peace or wartime situations. This chapter explains your roles in (1) mass casualty situations and (2) chemical, biological, and radiological (CBR) casualty situations.

To meet these needs, we will explain procedures for providing emergency medical (first aid) treatment in a mass casualty and CBR situation.

GENERAL MASS CASUALTY GUIDELINES

The general guidelines for dealing with mass casualty situations are as follows:

Assess the site.

Assess the condition of casualties.

Perform basic life support.

Treat the obvious conditions.

1. Control external hemorrhage.

2. Treat for shock.

3. Immobilize fractures.

4. Dress wounds.

Perform a secondary examination.

Prepare casualties for transport.

Transport casualties to a safe area.

In the following sections, the guidelines are explained.

ASSESSMENT

You must make a quick and accurate assessment of the site and of the immediate condition of the casualties. Site Assessment

Before you attempt to rescue or to administer emergency treatment, it is essential that you assess the conditions at the casualty site to ensure that it is safe for both you and the casualty.

Consider all aspects of the casualty site and the environment to determine the probability of success if a rescue is attempted. This assessment should include:

Accessibility of the casualty site. Can the site be reached with available equipment? Once reached, can emergency treatment be rendered on site? Can the casualty be removed from the site if immobile?

Safety of the casualty site. Is the site stable? Can you move safely at the site? Is the site exposed to hostile fire? In case of an unforeseen emergency, can you and the casualty be rescued from the site?

Environmental conditions at the site. Is there adequate, breathable air at the site to sustain both the rescuer and the casualty? Are there poisonous or dangerous substances in the area? Will weather conditions hamper an attempted rescue?

Casualty Assessment

During the initial or preliminary casualty assessment, you will perform a primary examination of the casualty to determine if injuries are lifethreatening.

Basic rules for casualty assessment are as follows:

1. Keep the casualty lying down, with the head level with the body, until you have found out what kind of injury the person has and how serious it is. The following problems require that you place a casualty in different positions:

a. Vomiting, bleeding about the mouth, or semiconscious. If the casualty is in danger of sucking in blood, vomited matter, or water, place the patient on the side, or back, with the head turned to one side, lower than the feet.

b. Shortness of breath. If the casualty has a chest injury or has breathing difficulties, place the patient in a sitting or semi-sitting position.

c. Shock. If the casualty is in shock, place the patient on the back, with the head slightly lower than the feet. If the injuries permit, the casualty's feet should be raised and supported 6 to 12 inches above the head.

2. Move the casualty only when absolutely necessary. You may have to remove some clothing to determine the extent of the injuries. Remove enough clothing to get a clear idea of the extent of the injury. If you remove clothing incorrectly, you may do great harm, especially in fracture injuries. You may have to rip or cut clothing along the seams. When clothing is removed, ensure that the casualty does hot become chilled. Shoes may have to be cut off to avoid causing pain or increasing an injury.

3. Reassure the casualty and keep the patient as comfortable as possible.

4. Do not touch open wounds or burns with the fingers or other objects except when sterile compresses or bandages are not available and it is absolutely necessary to stop severe bleeding.

5. Do not try to give an unconscious person any solid food or liquid substance by mouth.

6. If a bone is broken, or if you suspect that one is broken, do not move the casualty until you have immobilized the injured part. When transporting a casualty, always make sure that the litter is carried feet forward no matter what the injuries are. This enables the rear litter bearer to observe the casualty for any respiratory obstruction or stoppage of breathing.

7. Keep the casualty comfortable and warm enough to maintain normal body temperature.

If the casualty is conscious and coherent, the primary assessment can be expedited by asking about the nature of the injuries and the conditions involved. You must rely on an unconscious casualty's signs (e.g., profuse hemorrhage, cyanotic skin, choking, etc.) and on surroundings.

Triage

Triage is the sorting of and allocation of treatment to patients, especially battle and disaster victims, based on a system of priorities designed to maximize the number of survivors.

Triage is normally the responsibility of the medical officer, dental officer, or Hospital Corpsman. But if they are not available, you will have to triage the casualties. Sorting decisions may be made at every stage in the movement of the wounded. Your goal in making these decisions is to do the most good for the largest number of casualties, given limited time, supplies, and personnel.

Casualties are grouped according to the seriousness of their injuries. The groups are as follows:

The treatment order of the groups depends on whether it is a combat or noncombat situation.

Combat. This occurs when you are up against hostile, life-threatening situations (e.g., war, bombings, terrorist dealings, etc.). In the combat situation, you will triage the casualties in the group order of 1, 2, 3, and 4. This is done because Group 1 casualties must return to full duty as soon as possible to help fight the enemy, followed by Groups 2 and 3 when they are available. Because Group 4 casualties are hopelessly wounded or dead, they will be last.

Noncombat. This occurs when a disaster strikes (e.g., plane crash, automobile accident, earthquake, flood, etc.). In these situations, the least injured casualties (Groups 1 and 2) can care for themselves while you take care of the wounded in Group 4. In a noncombat situation there is usually no further life-threatening action, so you will have time to treat a Group 4 casualty who has a chance of survival. After you are done with Group 4, go back and treat Group 3, Group 2, and then Group 1.

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BASIC LIFE SUPPORT

In any casualty situation, you will concentrate on maintaining the ABCs (discussed in the "Basic Life Support" section of chapter 9 in Dental Technician, Volume 2, NAVEDTRA 12573) of the casualties.