[Field Care and Transportation of the Injured]
[From the U.S. Government Publishing Office, www.gpo.gov]

OCD Publication
Field Care and Transportation of the Injured
A MANUAL FOR THE TRAINING OF RESCUE WORKERS MEDICAL AUXILIARIES AMBULANCE DRIVERS AND ATTENDANTS AND STRETCHER BEARERS
MEDICAL DIVISION
U. S. OFFICE OF CIVILIAN DEFENSE Washington 25, D. C.
Field Care and Transportation of the Injured
A MANUAL FOR THE TRAINING OF RESCUE WORKERS MEDICAL AUXILIARIES AMBULANCE DRIVERS AND ATTENDANTS AND STRETCHER BEARERS
OCD Publication 2215, 1943
UNITED STATES GOVERNMENT PRINTING OFFICE, WASHINGTON :1943
CONTENTS
Part I.	CIVILIAN DEFENSE
Page
Chapter I. Organization and Operation....................... 1
1.	United States Citizens Defense Corps ...	1
2.	Field casualty service............ 2
a.	Mobile medical teams............ 2
b.	Express parties. ............... 3
c.	Casualty stations.............  .	3
d.	Stretcher teams ................ 4
e.	Ambulances...................... 5
3.	Hospital evacuation ................ 7
4.	Rescue service................ 7
5.	Central control.......................  9-
Part II.	EMERGENCY FIELD CARE
Chapter I. General Instructions............................ 10
1.	Procedure at incident..............'	10
2.	Principles of field care............... 11
3.	The handling of gas casualties......... 12
4.	Improvised protective measures for passing through contaminated areas ......	14
Chapter - II. Principles of Bandaging...................... 15
1.	Dressings and bandages...........  .	15
a.	Bandage compress (Carlisle dressing) .	15
b.	Triangular bandage . .............. 16
c.	Roller bandage ..................... 18
2.	Slings ..........................  .	18
a.	Large arm sling...................  18
b.	Small arm sling...................  18
c.	"Raised-hand” sling ........	19
d.	Improvised slings ................. 19
3.	Bandaging special parts of the body ...	19
*	a. Chin and side of face ............. 19
b.	Head............................... 19
c.	Both eyes	..............	20
d.	One eye...........................  20
e.	Elbow or	knee...................... 20
in
TV
CONTENTS
Chapter II. Principles of Bandaging—Continued.
3.	Bandaging special parts of the body—Con. Page f. Neck  ................................... 22
g.	Abdomen................................ 22
h.	Hip . . ..............*................ 22
i.	Shoulder................................ 22
j.	Chest ....................< . . .	22
k.	Foot..................................  22
1.	Lower	part of the abdomen .....	23
m.	Hand	 .............................. 24
Chapter III. Injuries and Conditions Encountered in Air
Raids and Other Wartime Disasters ...	25
1.	Types of injury.................... .	25
a.	General types................... 25
b.	Special types................... 26
2.	Hemorrhage (bleeding)............... 32
a.	Kinds of bleeding...................... 33
b.	Control of bleeding . .......... 33
3.	Shock.....................................  35
a.	Signs and symptoms of shock	....	35
b.	Treatment...................... 36
4.	Fractures and splints ....................  36
a.	Definitions.................... 36
b.	Recognition of fractures	......'.	37
c.	General rules for the first aid treatment
of fractures................. 38
d.	Improvised splints.............. 40
e.	Field treatment of special fractures.	.	40
5.	Burns..........;........................... 42
a.	Emergency care......................... 43
b.	First aid.............................. 43
c.	Eye burns.............................. 44
d.	Phosphorus burns . . . . -. . .. .—.	44
6.	Suffocation (asphyxia) .................... 45
7.	Carbon monoxide poisoning.................. 47
8.	Unconsciousness............................ 48
Chapter IV. Marking of Casualties and Disposal of the
Dead ................r........................... 50
1.	Identification tags................  .	50
2.	Forehead markings.......................... 51
3.	Diagnosis of death........................  51
4.	Collection of the dead..................... 51
OONTE^S	V
,	Page
Chapter V. Methods of Blanketing a Casualty...............	53
1.	Red Cross method.......................... 53
2.	British (Wanstead) method................. 54
a.	Preparing the stretcher............... 54
b.	Wrapping the patient.................. 54
c.	Blanket assembly for transit.......... 54
Chapter VI. Methods of Lashing a Casualty to a Stretcher .	56
1.	Lashing with triangular bandages.......... 56
a.	Patient on EMS metal stretcher ...	56
b.	Unblanketed patient on canvas stretcher..............................  57
2.	Lashing,patient to metal stretcher with rope.	59
Part III. TRANSPORTATION OF THE INJURED
Chapter I. Stretcher Transportation............................ 60
1.	General principles........................ 60
2.	Stretchers........................  .	.	60
a.	Army-type stretchers.................. 60
b.	EMS all-metal stretcher............... 61
c.	Stokes Navy stretcher................. 61
d.	Removable-pole type stretcher ....	61
e.	Improvised blanket stretcher.......... 62
f.	Blanket stretcher without poles ...	62
g.	Door, shutter, or ladder with boards 63
h.	Chair ................................ 63
i.	Improvised coat stretcher	......	64
3.	Stretcher bearing and drill......... 64
a.	Stretcher drill with four men and a leader ..............	64
b.	Loading a stretcher with three bearers.	69
c.	Loading a stretcher with two bearers .	69
d.	Loading a stretcher with untrained assistants ........................ ...	69
e.	Transferring patients from one stretcher to another......................... 71
f.	Carrying stretchers............. 71
g.	Sliding a stretcher............. 72
h.	Lowering a stretcher from a height . .	72
i.	Shoulder carry drill............ 73
4.	Injuries requiring special care in moving. .	73
a.	Fracture of spine .................... 73
b.	Injuries to head and face .......	75
c.	Injuries to legs.................. .	75
d.	Injuries to arms	76
e.	Chest injuries.......................  76
VI
CONTENTS
Chapter I. Stretcher Transportation—Continued.
4.	Injuries requiring special care in moving—
Continued.	Page
f.	Internal injuries......................... 76
g.	Fractured pelvis.......................... 76
h.	Asphyxia ................................  76
i.	Casualties with tourniquets............... 78
5.	Action by stretcher bearers if exposed to war gas . ’.	   78
Chapter II. Carrying Casualties Without Stretchers ...	79
1.	One-man carries............................... 79
a.	Pick-a-back............................... 79
b.	The fireman’s carry....................... 79
c.	Pack-strap carry.......................... 81
d.	Fireman’s drag...........................  82
e.	Carry in arms............................. 82
2.	Two-man carries............................... 83
a.	The two-handed seat....................... 83
b.	The four-handed seat . ................... 83
c.	The fore-and-aft carry.................... 85
3.	Three-man carry..............................  86
Chapter III. Ambulance Transportation.............................. 87
1.	Organization of the ambulance service . .	87
2.	Equipment of ambulances......................  89
3.	Operation of ambulances. . -................   90
a.	Action on receipt of an alert............. 90
b.	Action on receipt of a dispatching order .	90
c.	Action on arrival at incident .....	91
d.	Loading points . .........* . . .	91
4.	Loading the ambulance ........................ 91
a.	General instructions . ..................  91
b.	Loading an ambulance with four bearers.	92
Ci Unloading an ambulance with four bearers..........................; .	93
d.	Loading an ambulance with two bearers.	93
e.	Unloading an ambulance with two bearers................................. 93
5.	Action if war gases are used ................. 94
6.	Disposition of casualties  ................... 95
Appendix A. Schedule of Training Based on This Manual .	97
Appendix B. Stretcher Teams of the Emergency Medical Service...............................................  99
Appendix C. Organization of Rescue Service ......	102
Appendix D. How to Protect Yourself Against War Gas . .	106
Appendix E. Electrical Hazards in Air Raids....................... 108
Index...........................................................   Ill
INTRODUCTION
This manual is intended for the advanced training of rescue workers, medical auxiliaries, ambulance drivers and attendants, stretcher bearers and others who are entrusted with the wartime responsibility of caring for the injured before they reach a physician or hospital. It is based upon the procedures and organization developed by the U. S. Office of Civilian Defense, which take into account three years of British and other air raid experience. Grateful acknowledgment is made for material derived from ARP Handbook No. 10 (second edition), recently issued by the British Ministries o^ Home Security and Health.
The preface to ARP Handbook No. 10 states: “The measures for safeguarding the civil population against the effects of air attack are a necessary part of the defense organization of every country. Preparations to minimize the consequence of attack from the air cannot be improvised on the spur of the moment, but must be made, if they are to be effective, well in advance.” Such preparations must be made in this country even though the oceans still separate us from the theatres of active operation. The technique of modern warfare has made it possible to bring the hazards of war to civilians, however far they may be removed from the fighting forces. In order to develop a reliable and well disciplined organization, civilian protection forces require many months of training and practice.
A large percentage of persons injured by air raids and other major wartime disasters are seriously wounded and require immediate hospital care. They frequently suffer grave erushing or penetrating injuries or extensive burns for which simple first aid measures are inadequate.
Before medical and hospital care can be provided, casualties must be extricated from demolished buildings. Technical skill and experience are required to bring them out alive. Experience has demonstrated that properly trained rescue workers can save 25 percent more lives than workers with inadequate training. A special Rescue Service has therefore been established in the U. S. Citizens Defense Corps.
Often, before a casualty is extricated, emergency care must be administered by the rescue worker. After a seriously injured person is freed from the debris, careful handling is necessary if he is to survive.
VII
VIH	INTRODUCTION
The saving of lives also depends upon prompt transportation of casualties to a well equipped hospital where expert medical care is available. Rescue workers, medical auxiliaries, stretcher bearers, and ambulance drivers and attendants are required to complete an approved basic first aid course before induction into the U. S. Citizens Defense Corps. This manual provides additional material for advanced training in emergency field care and transportation of the injured, and includes certain of the basic first aid procedures considered of particular importance in'the field care of civilian war casualties.
PART I
>
Civilian Defense
CHAPTER I
Organization and Operation
1.	U. S. CITIZENS DEFENSE CORPS.
For the protection of communities and their inhabitants against the hazards of enemy air raids, sabotage, and other major wartime disasters, the U. S. Citizens Defense Corps has been established in more thaii 10,000 communities. The Corps includes the following services:
a.	Emergency Fire.
b.	Emergency Police.
c.	Air Raid Wardens (including Fire Guards).
d.	Emergency Medical (including ambulance transport).
e.	Rescue.
f.	Emergency Welfare.
g.	Emergency Public Works (including Demolition and Clearance, Decontamination, Road Repair).
h.	Emergency Utilities.
The services from a. through e. may be considered primarily as raid services, since they function chiefly during actual attack. It is often necessary, however, that they continue to carry on in the post-raid period until their work is completed. The services f. through h. are equally important. They may be considered as post-raid services, since their function is to restore essential services and eliminate hazards to life and property after the actual raid is over. They must also be available to assist during a raid if called upon by the Control Center because of special circumstances.
As the war has progressed, air raids have increased in intensity as a result of the employment by the armed forces of more and larger planes, heavier high-explosive bombs and larger numbers of incendiaries. Furthermore, the entire weight of bombs is often dropped within ten to thirty minutes. The purposes of the enemy are to increase the destruction of property and loss of life by “saturation”
1
2 FIELD CARE AND TRANSPORTATION OF THE1 INJURED bombing, and to disturb the morale and effectiveness of the civilian defense forces.
This new form of attack has been taken into account in thé preparation of this manual. Except under special conditions, the only groups other than Air Raid Wardens, Police, and Messengers to move through the streets during an air raid should be : Fire-fighting units moving to conflagrations, Rescue Squads en route to demolished structures in which persons are trapped, and Mobile Medical Teams and ambulances en route to incidents where casualties have been reported. Emergency services should be used economically and dispatched only to incidents where they are required.
It is recommended that Commanders avoid unnecessary risk to civilian protection workers, (1) by moving the minimum essential number of lifesaving units to incidents, (2) by holding reserves in their depots or stations until they are required at incidents, and (3) by curtailing post-raid activities during attack.
2.	FIELD CASUALTY SERVICE.
A field casualty service has been established as part of the Emergency Medical Service in most localities, following recommendations of the Medical Division of the U. S. Office of Civilian Defense. Its personnel consists of Mobile Medical Teams, ambulance and sittingcase car drivers and attendants, and Stretcher Teams.
a.	Mobile Medical Teams.
A Mobile Medical Team includes one physician, one nurse, and two or more auxiliaries and is composed preferably of the personnel of a Casualty Receiving Hospital. Where this is not possible, it is necessary for teams to assemble at hospitals or Casualty Stations on the “blue” signal. Teams residing in hospitals have the advantage of being always available for a sudden catastrophe. Their availability makes it unnecessary to disturb physicians, nurses, and auxiliaries in the community on every alert.
A Mobile Medical Team is dispatched by the local Control Center to incidents when the Air Raid Warden reports the presence of casualties. Additional teams are sent to an incident only when the physician, Rescue Squad Leader, or the Incident Officer at the scene calls the Control Center for further assistance.
Before enrollment in the U. S. Citizens Defense Corps, all medical auxiliaries must have had an approved basic course in first aid. After enrollment, instruction in the field care and transportation of the wounded should be continued as outlined in the Appendix of this manual.1
1 Appendix A.
ORGANIZATION AND OPERATION	3
b.	Express Parties.
An Express Party2 consists of one Mobile Medical Team, one ambulance, one sitting-case car (passenger car or station wagon) and one Rescue Squad. Upon receiving an Air Raid Warden’s report that a bombing incident has occurred and that persons are trapped, the Control Center will dispatch one Express Party. An Express Party will usually be sufficient to handle one major incident or a group of minor incidents. Additional medical and rescue personnel, ambulances, and passenger cars for transporting sitting cases are held in reserve and are dispatched by the Control Center only upon subsequent request from the physician, Rescue Squad Leader, or the Incident Officer at the scene. In this manner conservation of important personnel and equipment is achieved.
At minor incidents with few casualties only an ambulance may be required. If necessary, a Stretcher Team may be dispatched from a nearby hospital or Casualty Station.
c.	Casualty Stations.
„ Casualty Stations are established at hospitals in suitable locations to care for slightly injured persons who do not require hospitalization. Others are established in sections of a community isolated or distant from a hospital. They need not be closer than a mile apart. In larger cities, one Casualty Station to about 25,000 inhabitants has proved to be adequate, but all communities in target areas should have at least one. They are equipped only for the temporary care of minor casualties and are not intended to serve the severely injured who require hospital care. The movement of severely injured persons to a Casualty Station for preliminary clearance may jeopardize unnecessarily their chances of recovery; it cannot be justified if hospitals are so located as to provide reasonable coverage.
Casualty Stations are activated on the first audible alert by assembling Stretcher Teams assigned to them. Professional personnel do not report to a Casualty Station within 3 miles of a hospital at which Mobile. Medical Teams are based, unless such teams are dispatched to it because casualties have been reported in its vicinity.
If a Casualty Station is distant from a hospital or in an area difficult to reach, Mobile Medical Teams may be based upon it—the physicians, nurses, nurses’ aides, and auxiliaries being recruited from those residing in the neighborhood. Such teams must mobilize at the Casualty Station on the “blue” signal.
In rural areas, in towns without adequate hospitals, and in localities which may become isolated from a hospital it may be necessary to “up grade” a Casualty Station so that it may serve as a temporary
2 Express parties, as such, are not shown on the control panel.
4 FIELD CARE AND TRANSPORTATION OF THE' INJURED emergency hospital. In such areas the Casualty Station is activated by the assembling of teams composed of neighborhood physicians, nurses, and auxiliaries upon the “blue” air raid alarm.
The personnelof a Casualty Station should include four Stretcher Teams, as well as its complement of Mobile Medical Teams. In addition to its primary purpose as a place for the care of the slightly injured and those suffering from nervous shock or hysteria, the Casualty Station may serve as a depot for the storage of emergency medical supplies. One person should be made responsible for Casualty Station equipment.
Experience has shown that it is rarely necessary to establish a temporary First Aid Post. Because of darkness, confusion, and dirt, it is impossible to do much more for air raid casualties before they are removed to the hospital than cover their wounds, control hemorrhage, apply simple splints, and administer morphine. In most cases, such first aid will be given by the rescue workers or the physician at the incident by the time the casualty is extricated. Only at a very large incident with many trapped persons may it be desirable to establish a temporary First Aid Post at an appropriate protected site. Even under such circumstances, it should be used as a base for medical personnel and equipment rather than as a place where severely injured casualties are brought for treatment.
d.	Stretcher Teams.
Stretcher Teams 3 consist of four trained stretcher bearers and a team leader. Stretcher Teams are recruited from residents of the neighborhood of hospitals and Casualty’Stations. Those on call mobilize at their stations on the “blue” signal. Three years of British experience have demonstrated that Stretcher Teams are required primarily at hospitals and Casualty Stations to load or unload ambulances and for other duties concerned with the handling of the injured.
When there are a large number of casualties (as many as 50), Stretcher Teams may be required at the incident to assist the Rescue Squads, the Mobile Medical Team, and the ambulance attendants in the care and transportation of the injured.. They are dispatched by the Chief of Emergency Medical Service to such incidents from the hospitals or the Casualty Stations at which they are based. At large incidents, they serve under the incident physician or, in his absence, under the Leader of the Rescue Squad.
Stretcher Teams may also be dispatched from Casualty Stations and hospitals to minor incidents at which Rescue Squads are not required. Each member of a Stretcher Team should be supplied with a first aid pouch (fig. 3) containing two Carlisle shell dressings, two
8 Appendix B.
ORGANIZATION AND OPERATION
5
large pieces of sterile gauze, two triangular bandages, four safety pins, one book of 20 identification tags, one skin pencil, and one indelible pencil.
Because of their duties at hospitals, Casualty Stations, and at incidents, members of Stretcher Teams are required to complete an approved basic first aid course. After enrollment in the Citizens Defense Corps, they should be instructed and drilled in the field care and transportation of the wounded as outlined in this manual.4
e.	Ambulances.
The use of one-stretcher and two-stretcher ambulances in an air raid or other wartime disaster delays movement of casualties to hos-
Figure 1.—Emergency Medical Service ambulance.
pitals and may result in needless loss of life. To provide adequate transportation of casualties in air raids, cities in the target areas require, in addition to the one-stretcher and two-stretcher vehicles available in the community, at least one four-stretcher ambulance for every 25,000 persons, the actual number depending to a large extent upon the location and distribution of the hospitals. All ambulances should be under the control of the Chief of Emergency Medical Service so that they may be immediately available at all times.
4 Appendix A.
6 FIELD CARE AND TRANSPORTATION OF THE' INJURED
In addition to ambulances for stretcher cases, passenger cars or station wagons are required for transporting less severely injured persons (sitting cases).
To reduce the movement of emergency vehicles during an air raid, economize in driver personnel, and expedite the transportation of large numbers of serious casualties from incidents to hospitals, ambulances now in use should be remodeled, when possible, to carry four stretchers. Specifications for the conversion of used trucks and passenger cars into four-stretcher ambulances (see fig. 1) may be obtained through the State Chief of Emergency Medical Service from the Medical Division, U. S. Office of Civilian Defense, Washington 25, D. C.
Figure 2.—Conventional one-stretcher ambulance converted to accommodate four
stretchers.
The capacity of conventional one-stretcher and two-stretcher ambulances should be increased, if possible. Instructions for such conversion (see fig. 2) may also be obtained through the State Chief of Emergency Medical Service from the Medical Division, U. S. Office of Civilian Defense.
Ambulances and sitting-case cars should be parked at hospitals or assembled in ambulance depots located at garages in strategic parts of the community. Each ambulance should have a trained attendant
ORGANIZATION AN» OPERATION	7
as well as a driver. Only persons residing at or near hospitals or ambulance depots should be assigned as drivers or attendants for the vehicles. Those who reside outside the hospital or depot, if on first call, should report to their stations on the “blue” signal.
Both drivers and attendants are required to complete an approved basic first aid course before enrollment in the U.' S. Citizens Defense Corps. This manual should be used for their advanced instruction and drill after enrollment.
3.	HOSPITAL EVACUATION. *
Hospitals may require evacuation because of direct hits, blast damage, or the proximity of unexploded bombs or spreading fires. For this purpose a number of large vehicles, such as converted busses, should be promptly available day or night. In London it has been necessary at times during heavy raids to move as many patients from Casualty Receiving Hospitals to outlying Emergency Base Hospitals as from incidents to hospitals within the city. In cities in target areas, it should be possible by use of busses and similar vehicles to transfer all patients from a hospital in two, or at most, three hours without utilizing the ambulance service and facilities assigned to serve at incidents.
4.	RESCUE SERVICE.
A Rescue Service has been established in the U. S. Citizens Defense Corps as a lifesaving service which functions in cooperation with the other protective services, particularly the Emergency Medical Service.6 Without removing the essential rescue work connected with fire fighting from the responsibilities of the Fire Service, it has been found necessary to organize, train, and operate a special Rescue Service to remove persons trapped in buildings demolished by direct hits or the blast effect of high explosives.
Close coordination of the Rescue Service and the Mobile Medical Teams of the Emergency Medical Service is necessary, so that serious casualties may be extricated from debris and transported immediately to hospitals. Except for the services of the Mobile Medical Teams, first aid at most incidents is the responsibility of the Rescue Squads. Stretcher Teams may be dispatched by the Control Center to large incidents with many casualties, to assist the Rescue Squads in the transportation of casualties. They may also be sent from their posts at hospitals and Casualty Stations to assist with the handling of the injured at minor incidents nearby. Those on first call will mobilize at their depots on the “blue” signal.
8 Appendix C.
8
FIELD CARE AND TRANSPORTATION OF THE INJURED
The rescue worker is usually the first to reach a trapped person. Survival of the injured person may depend largely on the manner in which he is handled during rescue. Completion of an approved basic first aid course is obligatory for membership in the Rescue Service. After enrollment in the U. S. Citizens Defense Corps, ad-
Figure 3.—First aid pouch.
vanced training in the field care and transportation of the injured, based on this manual, is necessary, as well as the training provided in the Technical Manual for the Rescue Service, OCD Publication No. 2216.
In addition to its primary lifesaving function, it is the duty of the Rescue Service to recover the dead from damaged buildings and to take any immediate steps necessary for the temporary support or demolition of damaged structures whose collapse would endanger life or hinder the work of the Service itself or that of other civilian protection services.
Rescue Squads are composed of a Leader, an Assistant Leader, a Driver, and seven other members. The Driver is responsible for the equipment. There is no reason for a distinction between light and
ORGANIZATION AN© OPERATION
9
heavy Rescue Squads. The Rescue Service will call upon the Emergency Public Works Service when special technical personnel and special equipment such as cranes, tractors, compressors, etc., are required for rescue operations.
Each Rescue Squad requires a truck and the equipment listed in the Technical Manual for the Rescue Service. Four stretchers, one 40-foot length of ^-inch rope for lashing a casualty to a stretcher, and eight blankets ar.e included in this equipment. Each member of a Rescue Squad should be equipped with a first aid pouch (fig. 3). Additional first aid equipment is obtainable at the incident from the physician or nurse of the Mobile Medical Team.
5.	CENTRAL CONTROL.
The Chief of Emergency Medical Service, or his deputy, as a member of the staff of the Commander, is stationed at the Control Center during and after a raid to direct thé activities of the field casualty service. He has as reference a map showing all hospitals in his area and their casualty receiving capacities, all Casualty Stations, and medical supply depots. The map, with the control panel, provides a record of the location of all Mobile Medical Teams and ambulances in the control area.
Similarly, the Chief of Rescue Service or his deputy is on duty at the Control Center during and after a raid to direct the movement of Rescue Squads from their depots to incidents where persons are trapped. Usually, only one Rescue Squad is dispatched to an incident unless additional assistance is requested by the Rescue Squad Leader or by the Incident Officer.
537377°—43----------2
PAKT II
Emergency Field Cnre
CHAPTER I
General Instructions
1.	PROCEDURE AT INCIDENT.
Upon arriving at an incident,, the leaders of Mobile Medical Teams and Rescue Squads report immediately to the officer-in-charge at the incident. At minor incidents, where the damage is not great and casualties are few, general control of the situation will usually be exercised by an Air Raid Warden or by a regular or Auxiliary Policeman. At larger incidents, where damage is Extensive and there are many casualties, general control will be exercised by a specially trained Incident Officer.
The Incident Officer acts as the representative of the Commander of the Citizens Defense Corps at the scene. His function is to coordinate the various services so that relief can be provided as quickly and efficiently as possible. To attain this end, he establishes an Incident Post, preferably near a telephone by means of which he can keep the Control Center informed of the situation. During the day, the Incident Post is marked by a flag, and at night by two red lanterns placed one above the other. The Incident Officer is identified by a characteristic symbol on his helmet, the Warden by his arm band.
The Incident Officer, or the Warden or policeman serving in that capacity, indicates to the physician of the Mobile Medical Team and the Leader of the Rescue Squad, as they arrive at the scene, the points at which their vehicles should be parked. He also informs them of the locations of surface casualties and persons believed to be trapped.
The casualties encountered can usually be classified into three main groups:
a.	Those urgently needing medical attention in order to prevent imminent death, e. g., cases of severe external hemorrhage or of true asphyxia.
10
GENERAL INSTRUCTIONS
11
b.	Those severely injured and in shock, who require medical attention in order to prevent further shock.
c.	Those slightly injured who, after simple first aid, can make their way on foot or be transported by car to a Casualty Station.
Casualties in the first two categories should be transported immediately by ambulance to a hospital where skillful care can be given: they should not be taken to a Casualty Station if it can be avoided. Neither the staff nor the equipment of Casualty Stations is designed to deal with such casualties.
If persons requiring hospitalization are sent first to Casualty Stations, handling and transportation then will be doubled, space in ambulances and Casualty Stations will be occupied unnecessarily, and the lives of the injured may be jeopardized.
In exceptional cases, it may prove to be impossible to send casualties directly from an incident to a hospital because of blocked roads or other causes, or it may prove to be impractical in rural areas where the distance to a hospital is great. It will then be necessary to provide temporary accommodations for stretcher cases at Casualty Stations.
In the absence of a physician at an incident, the Rescue Squad Leader will assume the responsibility for casualties.
2.	PRINCIPLES OF FIELD CARE.
A casualty must be moved from a source of immediate danger before first aid is attempted. Severe bleeding must be controlled without delay, regardless of what other injuries may be present. A pressure dressing is usually sufficient. A tourniquet is rarely needed. Obstructions to breathing must be removed. Breathing, if stopped, must be reestablished promptly by artificial respiration and maintained without interruption.
At air raid incidents or other major wartime disasters, time should not be spent in elaborate splinting or dressing, but the simplest of the appropriate procedures should be chosen. An open wound should be covered with a sterile dressing to prevent further contamination. A fractured leg should be immobilized by splinting it to the opposite leg, a fractured arm by securing it to the trunk. A simple splint may be used. Traction splinting is usually better deferred until the casualty reaches a hospital. An exception is warranted only if the casualty is to be subjected to a long journey over rough roads.
Nothing beyond essential measures should be attempted. Little more than this is possible in the darkness and dirt which usually accompany mass air raids.
It is important to handle casualties gently arid to keep them comfortably warm. In cold weather careful blanketing and hot water bottles should be applied as early as possible to prevent chilling. The
12
FIELD CARE AND TRANSPORTATION OF THE' INJURED'
interests of the casualty are best served by prompt, comfortable removal to a hospital where he can be given shelter and expert care. Gentle handling of the patient, reassurance, and comfortable warmth have proved of great value in the prevention of shock. Excessive heat is as detrimental to the patient in shock as excessive chilling.
Common sense is necessary in applying first aid. The sequence of action in each case must depend on the circumstances. Certain general principles which apply in all cases are: ,
a.	A casualty must be removed at once from any source of further danger.
b.	Severe bleeding must receive attention at the earliest possible moment, no matter what othcr injuries are present.
c.	Obstruction to breathing must be removed without delay. If respirations have ceased, breathing must be reestablished promptly by artificial respiration and maintained without intermission.
d.	All injured persons should be treated for shock, even though it may not be evident. Shock is commonly present in air raid casualties, often affecting even those who are apparently uninjured or only slightly injured.
e.	Death is not to be assumed because signs of life are absent. For example, if in a case of asphyxia breathing has stopped, it is better to continue artificial respiration on a corpse than to let a man die for lack of efforts to save him. Patients may recover after several hours of artificial respiration.
f.	Injured persons must be handled gently and carefully to minimize pain and prevent further injury.
g.	When severe'lacerations have been sustained or bones fractured, the affected parts should be immobilized by simple methods or by th« application of splints before the patient is moved. The greatest care should be taken if a broken bone protrudes through the skin. The wound and protruding bone should be covered with sterile gauze, and a physician called.
h.	In all cases, the first consideration is to save life by correct prompt action; the second is to deal with shock; the third is to prevent aggravation of the condition by unwise movement or careless handling ; the fourth is to remove the casualty to shelter and skilled care.
3.	THE HANDLING OF GAS CASUALTIES.
In the. event war gases are used, those concerned with the field care and transportation of the injured should be able to recognize the type of gas used so that they pan determine what precautions are necessary to prevent injury to themselves and others. Gas masks must be worn in areas where there are war gases. In addition, protective clothing and gloves must be worn by those caring for persons
GENERAL INSTRUCTIONS
13
contaminated with persistent liquid gas. It must be remembered that gas masks furnished to Civilian Defense workers will not protect against carbon monoxide, ammonia or oxygen-deficient atmospheres.
In the care of casualties grossly contaminated with persistent war gas, any spots or. splashes of liquid gas on the skin should be dabbed off gently with a rag or other absorbent material, not wiped off. The affected area of the skin should then be thoroughly cleansed by the best means available (see page 31). Contaminated clothing should be removed to prevent further danger to the patient and his attendants.
When the face has been splashed with liquid .vesicant, the eyes should be washed out at once with water from a water bottle, canteen or other ready source. It is important that this be done within the first few minutes after exposure. Irrigation of the eyes is not indicated unless done within 5 minutes, nor is it indicated if exposure has been to vapor only.
If the concentration of war gas in the air is sufficient to be injurious, gas masks should be placed on all casualties. When a casualty has been contaminated with liquid vesicant gas, a mask must not be put on until the face has been cleansed and the eyes thoroughly irrigated.
In the presence of serious injury to the face or head, a surgical or tracheotomy helmet (identical with infant respirator) should be used if available. Such a device is convenient and affords protection otherwise impossible when bulky dressings to the head and face are necessary. The only disadvantage to its use is that an attendant' must operate the hand bellows continuously.
In some cases it may be necessary, in order to save life, to rush a gassed casualty to a hospital without attempting even minimal cleansing at the scene of the incident. In such instances, however, it should be possible to remove most of the contaminated outer clothing before placing the casualty in an ambulance.
Uninjured persons and walking casualties who are contaminated by persistent gas should be instructed by Wardens, Auxiliary Police, and other civilian protection workers to cleanse themselves at a near-by house, or other local facility (see Appendix D).
Persons exposed to phosgene -and other nonpersistent gases do not require cleansing of the body nor do their clothes need to be decontaminated. Persons suffering from phosgene poisoning should not be allowed to walk, but should be sent to a hospital on stretchers as soon as> possible.	'
Those concerned with the field care of casualties should note upon the casualty identification tag any evidence that indicates gas has been used in an area. If a Gas Reconnaissance Agent has identified the gas, this fact should be noted.
14 FIELD CARE AND TRANSPORTATION OF THE INJURED
4.	IMPROVISED PROTECTIVE MEASURES FOR PASSING THROUGH CONTAMINATED AREAS.
There may be occasions after an air raid when it will be necessary for members of the protective services to pass through contaminated areas when full protective clothing'is unavailable. Routes along which they must move should be decontaminated with chloride of lime. If this is not available, a section of the contaminated area may be covered with planks, layers of plywood, heavy cardboard or other suitable material. Sand, sawdust, and other granular materials, or snow, may be used instead of planks or boards.
Every person who must pass through an area contaminated by persistent blister gas must:
a.	Wear a gas mask.
b.	Wear overshoes or rubber shoes, if available; if these are not available, shoes should be protected with pieces of plywood, cardboard, sackcloth or other heavy material bound to the soles.
c.	Wear a rubberized overcoat, leather coat, or other type of over-clothing.
d.	Wear gloves.
On leaving a contaminated area it is necessary:
a.	To remove overshoes or other material worn to protect the shoes, not touching them with unprotected hands.
b.	To rub the shoes with chloride of lime; if this is unavailable, dirt may be used.
c.	To remove outer clothing and keep it separated from overshoes or material worn to protect the shoes.
d.	To remove gas mask and gloves and cleanse the hands.
e.	To cleanse the body at a near-by house or other suitable facility as directed by the officer-in-charge at the incident.
CHAPTER II
Principles of Bandaging
1.	DRESSINGS AND BANDAGES.
a.	Bandage Compress (Carlisle Dressing) (fig. 4).
One of the most satisfactory dressings for wounds is the bandage compress. It is a gauze compress attached to the center of a strip of bandage. The compress is opened Without touching the inside, placed over the wound, and bound in place by the bandage tails.
Figure 4.—Simple wound dressing.
When a bandage compress is not available, a sterile gauze pad of suitable size and thickness may be bound in place with roller bandages, triangular bandages, or short strips of adhesive plaster. Bandages which will hold a piece of gauze in place and keep out dirt and contamination can be improvised from many materials. They are used as emergency dressings which will be replaced later by a physician.
15
16
FIELD CARE AND TRANSPORTATION OF THE INJURED
b.	Triangular Bandage (fig. 5).
Triangular bandages are very useful in the field care of the injured. They may be used to keep splints or dressings in position; to afford support to injured parts, as arm slings; to secure a fractured limb to its fellow or to the trunk; to make pressure, as when used over a pad of sterile gauze in the treatment of bleeding; to make a tourniquet; or to prevent swelling (as in a sprained ankle).
Figure 5.—Triangular bandage.
'To make a triangular bandage, a piece of heavy muslin or cloth of similar texture, usually 40 inches square, is cut diagonally from corner to corner. Each half forms a triangular bandage. The longest edge is called the base; the other two are called the side borders. The corner opposite the basé is called the point ; the other comers are called the ends.
To fold a triangular bandage for packing :
Fold it vertically down the middle, placing the ends together, bringing the point and the two ends to the middle of the base. This forms a square. Fold the square in half from right to left. Fold in half from top to bottom and repeat.
Triangular bandages can be used in the following ways :
(1)	As a “whole-cloth”, i. e., unfolded, the triangle being spread out to its full extent (fig. 5A).
(2)	As a “broad-fold” bandage (wide or broad cravat). Carry the point to the middle of the base (fig. 5B) and then fold the bandage again in the same direction (fig. 5C).
(3)	As a “narrow-fold” bandage (cravat). Fold a “broad-fold” once, long edge to long edge.
Triangular bandages should be secured by square (reef) knots or .safety pins. Granny knots should be avoided.
To tie a square (reef) knot, take one end of the bandage in each hand, pass the end in the right hand over that in the left and tie a single knot ; pass the end now in the left hand over that in the right
PRINCIPLES OF BANDAGING
17
and complete the knot. The ends when pulled tight will be parallel with the turns of the bandage. The rule for tying a square or reef knot is, “Right over left, left over right” (fig. 0).
For securing splints triangular bandages may be used in broad or narrow folds as convenient. Either of the following methods may be used:
(1)	After adjusting the splints to the limb, place the center of the bandage over the outer splint, then pass the ends around the limb, cross them on the inside, and tie on the outside, over the splint.
(2)	Double the bandage lengthways on itself. Place the loop upon the outer splint, carry the ends around the limb, and pass the ends through the loop from opposite directions. Tighten the bandage by drawing on the two ends, and tie over the splint.
As improvisations in place of triangular bandages, scarves (e. g., Boy Scouts’ scarves) or folded squares of cloth can be used;, ties, suspenders, straps, belts, or lengths of rubber tubing can be used to secure splints or dressings or as improvised tourniquets.
18 FIELD CARE AND TRANSPORTATION OF THE INJURED
c.	Roller Bandage.
Roller bandages are useful, but are difficult to apply properly. They would probably not be used except in fixed units such as Casualty Stations or hospitals. Persons rendering field care should, however, have a general knowledge of roller bandaging. Roller bandages are long strips of gauze varying in length and width to facilitate bandaging of different parts of the body. A roller bandage to be applied to the head or upper limbs should be 2 to 3 inches wide and 4 to 6 yards long; to the fingers, 1 inch wide and 2 yards long; to the trunk or lower limbs, 3 or more inches wide and 6 yards long.
General rules for applying roller bandages to a limb:
(1)	First fix the bandage with two or three turns.
(2)	Bandage fro'm below upward, and from within outward over the front of the limb.
- (2) Apply uniform pressure through the entire process of bandaging.
(4)	Let each turn overlap about two-thirds of the preceding one.
(5)	Keep margins parallel. Let any crossings or reversings be in one line, preferably toward the outer aspect of the limb.
(6)	Secure either by a safety pin or by dividing the free end into two strips, by a scissor-cut parallel to its edge, knotting at end of cut and tying the ends of the two strips.
(7)	Stand or sit opposite-the patient, support the limb in the position in which it is to be placed when bandaged. Bandage snugly, but be careful not to put on the bandage so tightly that it causes pain or interferes with circulation. If, when the toes or fingers of a bandaged limb are squeezed, it is noticed that the color returns more slowly than in the unbandaged limb, the bandage is too tight.
2.	SLINGS.
a.	Large Arm Sling (supporting forearm and hand).
Spread out a triangular bandage on the front of the casualty with the point toward the injured arm, put one end over the shoulder on the sound side, pass it around the neck so that it appears over the shoulder of the injured side, and let the other end hang down in front of the chest. Carry the point behind the elbow of the injured arm, and place the forearm over the middle of the bandage; then bring the ends, together and tie them. Bring the point forward and secure to the front of the sling with safety pins.
b.	Small Arm Sling (supporting wrist and hand, leaving elbow free).
Place one end of a “broad-fold” triangular bandage over the shoulder of the sound side; pass it around the back of the neck so that it appears
PRINCIPLES OF BANDAGING	19
over the shoulder of the injured side; place the wrist over the middle of the bandage so that the front edge covers the base of the little finger. Bring up the second end to the first and tie them.
c.	“Raised-Hand” Sling.
(These directions apply for an injury on the left side; for a rightsided injury, substitute “right” for “left” and “left” for “right.”)
(1)	Place the patient’s left forearm diagonally across his chest so that his fingers point toward the right shoulder and his palm rests on his breastbone.
(2)	Holding an unfolded triangular bandage with its point in the right hand and one end in the left hand, lay the bandage over the left forearm with the point well beyond the elbow and the end in the left hand on the right shoulder.
(3)	Supporting the left elbow, tuck the base of the bandage well under the left hand and forearm and carry the lower end across the back of the right shoulder, allowing the point to hang loosely outward. Tie the ends in the hollow above the right collar bone.
(4)	With the left hand hold open the side of the bandage lying on the left forearm, and with the right hand tuck the point well in between the left forearm and the side of the bandage which is being held open.
(5)	Carry the resulting fold round over the back of the arm, and firmly pin it to a part of the bandage running up the back.
d.	Improvised Slings.
Slings may be improvised by pinning the coat sleeve to the front of the coat, by turning up the lower edge of the coat and pinning it, by passing the hand inside the coat or vest and buttoning it, or by using scarves, ties, or belts.
3.	BANDAGING SPECIAL PARTS OF THE BODY.
a.	Chin and Side of Face (fig. 7).
Put the center of a cravat bandage under the chin. Pass one end over the top of the head to the temple on the opposite side. Bring the other end to the temple, cross the bandage ends so that they go around the head in opposite directions. Tie at the side.
b.	The Head (fig. 8 A, B, C, D).
Take an unfolded triangular bandage and lay its center on top of the head so that the point is toward the back of the head and the base lies along the forehead just above the eyebrows. Take a short fold in the base and then pass the ends of the bandage around the back of the head above the ears (A). Cross the ends over the point of the
20 FIELD CARE AND TRANSPORTATION OF THE INJURED'
bandage (B), bring the ends to the front again, and tie in the middle of the forehead (C). Put a hand on the top of the head to steady the dressing and draw down the point of the bandage until the dressing is taut over the top of the head. Then turn up the point and tuck it under the bandage going around the head (D).
c.	Both Eyes.
Put the center of a wide cravat bandage over the eyes as a blind; fold, carry the ends backward, cross behind the head and tie at the side. Never cover any eye affected by war gas.
Figure 7.—Face and chin bandage.
d.	One Eye (fig. 8 E).
Lay a strip of narrow bandage about 3% feet long across the top of the head so that one end hangs down over the uninjured eye and the other end hangs down the back. Place the middle of a cravat over the injured eye; carry the ends obliquely around the head so as not to cover the uninjured eye and tie. Carry the loose ends of the narrow bandage strip over the top of the head, and tie tightly enough to keep the cravat above the uninjured eye. If the eyeball has been injured, bandage both eyes.
e.	Elbow or Knee (fig. 8 F, G). z
Bend the elbow to a right angle and use a cravat at least 8 inches wide. Place the middle over the elbow and carry the ends around, crossing in the hollow. Carry the upper end entirely around the arm above the elbow, bringing it back to the hollow. Carry the lower end entirely around the arm below the elbow, bringing it back to the hollow. Tie snugly at the outside edge of the hollow.
The knee bandage is applied in the same manner, except that the bandage is wider. In folding the bandage for the knee, bring the
PRINCIPLES OF BANDAGING
21
Figure 8.—Special bandages.
22 FIELD CARE AND TRANSPORTATION OF THE INJURED point of an open triangle bandage to the center of the base and do not fold again.	,
f.	Neck.
Put the center of a cravat bandage over the dressing, cross the ends in the back, and tie over the dressing.
g.	Abdomen.
Put the center of a wide cravat bandage over the dressing. Carry the ends around the abdomen in opposite directions and tie at the side.
h.	The Hip (fig. 8 H).
Pass a cravat bandage around the waist and tie in front. Then take an unfolded triangular bandage. Put the center over the hip, point upward, with its long border lying across the thigh. Pass the ends around the thigh, and tie on the outer side. Draw the point upward under the bandage around the waist, turn it down over the bandage going around the waist, and tie or pin in place.
i.	Shoulder (fig. 8 1).-
Lay the center of an unfolded triangular bandage on the top of the shoulder, point toward the head, with the base across the middle of the upper arm. Fold the base, carry the ends around the arm, cross them inside, and tie on the outer side. Take a cravat bandage; carry it from the shoulder of the injured side underneath the armpit on the opposite side, and tie over the shoulder on the injured side. Draw the point of the first bandage under the second bandage, fold it back on itself, and tie or pin in this position. Support the arm in a sling.,
j.	Chest (fig. 8 J, K, L).
Using an open triangular bandage, place the point over the shoulder on the injured side with the middle of the base below the shouldet. Carry the ends around the chest, and tie directly below the shoulder on the injured side. This leaves a long and a short end. Carry the long end to the bandage point and tie.
k.	The Foot.
Place the sole of the foot in the center of an unfolded bandage with the toes toward the point. Turn the point over the toes and instep. Take one of the ends in each hand close to the foot, bring them forward and cross them over the instep, covering the point. Draw the point upward to tighten the bandage, and fold it toward the toes. Carry the bandage ends back around the ankle; cross them
PRINCIPLES OF BANDAGING	23
behind, catching the border of the bandage at the heel. Bring the ends forward, cross them again over the instep so as to cover the point, carry one end under the foot, and tie on inner side.
1.	Lower Part of the Abdomen.
Pass a cravat bandage around the waist and tie. Pass the end of a wide cravat bandage under the first at the middle of the back, fold it over, and secure it with a safety pin. Bring the other end forward between the thighs and up to the waist bandage in. the front. Pass it under the waist bandage and pin or tie.
Figure 9.—Hand bandage.
24 FIELD CARE AND TRANSPORTATION OF THE.. INJURED
m.	The Hand (fig. 9).
Place the hand, palm down, in the center of an unfolded triangular bandage with the fingers toward the point of the bandage (A). Bring the point over the back of the hand to the wrist (B), and pass the bandage ends around it, crossing the ends over the point (C and D). Circle the wrist and tie (E and F). Then turn the point toward the fingers and pin to the bandage (G).
CHAPTER III
Injuries and Conditions Encountered in Air Raids and Other Wartime Disasters
1.	TYPES OF INJURY.
a.	General. Types.
Wounds resulting from air raids may vary within wide limits and may often be of mixed types. Multiple injuries are to be expected:
(1)	Lacerated wounds commonly occur in air raids. They may be extremely severe and extensive, with complete tearing off of limbs or with gross damage to the'trunk and internal organs. They may be less destructive, but associated with gross crushing of muscular and other tissue or with multiple injuries and irregular and extensive tearing and penetration. Injuries due to flying fragments of glass, often with fragments retained, are very common. Such wounds are likely to be filled with dirt and debris and are therefore particularly liable to infection.
(2)	Crushing wounds may result from falling masonry, girders, beams, or whole floors and are frequently associated with fractures, including those of the spine. Crushing injuries may be immediately fatal, especially if they involve vital areas such as the chest, or are so severe that the casualty does not survive extrication. Severe mangling of the limbs and compound and depressed fractures of the skull are common. There are also simple fractures and less dangerous injuries, such as contusions.
Casualties trapped by heavy beams or masses of rubble across a limb or limbs, although they may not seem to be severely injured, sometimes do poorly and die of kidney failure within a few days. When such casualties are found, call a doctor immediately, without waiting until they can be extricated (see page 29).
(3)	Wounds may be either perforating, i. e., passing through the body, or penetrating, i. e., with retention of the missile. Perforating and penetrating wounds are common air raid injuries and are caused chiefly by rifle or machine gun bullets, bomb fragments, or pieces of glass, wood, stone, brick or other debris hurled by the force of an exploding bomb. About 75 percent of fragments from high explosive bombs are extremely small, but travel with very high veloc-
537377°—43----------3
25
26 FIELD CARE AND TRANSPORTATION OF THE INJURED
ity._ The skin around perforating or penetrating injuries may be peppered with minute wounds from secondary missiles, such as fragments of glass, brick, stone, metal, or wood. Such wounds are difficult to distinguish from those caused by small bomb fragments. Injuries of this type are common about the back and buttocks, particularly in persons lying in the prone position.
(a)	Characteristic “perforating” wounds have an entrance wound, a track, and an exit wound. The entrance wound may be small and hence easily overlooked. If this is the case, the exit wound, which is frequently much larger, may be thought to be the only wound and even to have resulted from some other cause. The extent of the internal damage caused by the passage of the projectile will thus be unsuspected.
(b)	In the case of “penetrating” wounds, the underlying damage may likewise be much more extensive than the size of the wounds suggests. The wounds produced on the skin are generally small; yet the damage to the tissues beneath is frequently extensive. The brain or other internal organs may be seriously injured, although the skin wound may appear negligible.
(4)	Burns are frequently encountered among air raid casualties. Regardless of their cause, they must be considered serious injuries. When extensive areas of the skin are involved, shock is almost always present, and its importance cannot be overemphasized.
(5)	Shock of some degree will be present in almost every casualty, and frequently it will be extreme. Shock may occur at any time after injury, even without apparent external injury. Persons giving first aid to the injured should appreciate the importance of preventing shock, which might otherwise develop after the patient has been passed on to a hospital or Casualty Station.
b.	Special Types.
(1)	Head Injuries.—Head injuries are common war wounds. Severe injury may be caused by a blow on the head from falling timbers or flying debris; or a person may be thrown against a wall or to the ground by the force of an explosion in such a way as to cause severe injury to his head. The injured person may be unconscious or dazed. Shock is usually present. The patient often resists efforts to help him. He may tear off bandages or clutch at anyone who tries to help him.
In any case of head injury, the brain may be damaged. The skull may be fractured. If this has occurred, bloodstained fluid may leak from the ears or nose.
If a casualty is dazed or unconscious and there is no obvious injury, examine the head first.. Look for bruises or bumps. Even
INJURIES AND CONDITIONS IN AIR RAIDS	27
persons with slight or questionable head injuries must be seen by a physician as soon as possible.
Wounds of the scalp are common in warfare. Because they bleed profusely, they are often unnecessarily terrifying to the beginner in first aid.
First Aid.—If there is a wound of the scalp, apply a sterile compress to the wound and hold it in place with a firmly applied bandage as described on page 19. If there is bloody or watery discharge from the ears, do not plug them with cotton and do not try to clean them. Simply apply sterile dressings over the ears. Keep the victim warm and quiet. Keep him lying down with his head slightly elevated. Fill out the casualty identification tag promptly, for the victim may lose consciousness. Transport on a stretcher to a hospital as soon as possible.
(2)	Internal Injury.—Serious injury may occur to organs in the abdomen or chest as a result of penetration by missiles or of. crushing. Penetrating wounds about the hip joint dr buttocks are often associated with injury to abdominal organs. Internal injury is always accompanied by shock and internal bleeding. The casualty may tear at his clothing in an effort to get more air. Re may complain of thirst. If the wound is in the chest, he may cough up blood.
First Aid.—Treat for shock. Keep the victim from becoming chilled. Never give anything to drink. If the injury involves the abdomen, keep the victim lying down; but if the chest is involved, prop up the head and shoulders. All casualties suffering from internal injury must be transported on stretchers to hospitals as soon as possible. A casualty suffering from chest injuries should be propped' up on the stretcher in a semi-sitting position, leaning toward the injured side. A casualty suffering from an abdominal injury should be transported on his back with legs slightly flexed and supported at the knees.
(3)	Wounds of the Abdominal Wall.—Wounds of the abdomen may or may not be accompanied by protrusion of bowels or other organs through the wound. Immediate treatment is as follows:
(a)	If there is no protrusion of the organs and:
(i)	If the wound is vertical, keep the patient flat on his back with legs straight; or
(ii)	If the wound is horizontal, keep him on his back, with knees drawfl up and his head and shoulders well raised.
Apply a dressing and broad bandage firmly and evenly.
(b)	If bowels or other organs protrude, whether the wound is vertical or transverse, keep the patient lying on his back with knees
28 FIELD CARE AND TRANSPORTATION OF THE' INJURED drawn up, and support his head and shoulders in a well raised position.
Apply a sterile dressing or a clean soft towel over the wound, and over this place a pad of clean cotton wool or soft clean flannel. Secure this firmly but not too tightly with a broad bandage (triangular bandage—“broad-fold”). Do not attempt to replace protruding organs.
In all cases, give nothing by mouth. Keep the victim comfortably warm. Unless absolutely necessary, do not move him until he is to be placed in the ambulance. Shock will be extreme, but further shock may be avoided by careful management and smooth transport to the hospital.
If treating for shock, prevent chilling of the body but do not overheat the patient. If the injured person is cold or feels chilly, place hot water bottles wrapped in a coat or blanket in the armpits and across .both thighs, taking care that they do not scald or burn him. Never put a hot water bottle in direct contact with the skin. Make sure that blankets or heavy objects do not press on the abdomen. See that all manipulations are as gentle as possible.
(4)	Injury to the Face.—Probably no injury is so terrifying as an injury to the face. When facial expression is lost, the casualty appears to lose his identity as a human being. Bleeding is often profuse. Blood may run into the mouth or nose and strangle the victim. The jaw may be broken, in which case the tongue tends to fall backward and obstruct the air passages.
In treating victims with facial injuries, first aid workers would do well to remember the miracles accomplished through plastic surgery. Although facial injuries are gruesome, they are not the most dangerous to life.
First Aid.—Determine whether the tongue has fallen into the back of the throat. If it has, grasp it with the fingers and pull it forward. A piece of gauze will help to keep the fingers from slipping off the tongue. Turn the victim onto his abdomen so that the blood will not run into his nose or mouth and obstruct breathing. Apply a liberal number of sterile gauze dressings to the wound and bind in place with a triangular bandage as described on page 19.
(5)	Crush Injuries.—A large number of air raid casualties are caused by the collapse of buildings. Of these casualties, many are found to be pinned down by beams, brickwork, or other heavy debris and may remain trapped for long periods before they are released. During this period the muscles of the limbs and other portions of the body may be subjected to considerable pressure.
It has been found that some of these casualties, when released, show little sign of injury and may complain of nothing more than stiffness
INJURIES AND CONDITIONS IN AIR RAIDS	29
of the muscles in the crushed part. Their general condition may appear quite good both during the time they are trapped and for a few hours after release. In spite of this, death from kidney failure may -occur several days later.
Therefore a person who has been trapped by debris which has pressed upon any part of the body must be regarded as a serious casualty, whatever his apparent condition may be at the time of release. If there is a doctor at the incident, notify him immediately that a trapped casualty has been located. He may be able to institute valuable treatment before the victim is released and .make special arrangements for transportation of the casualty to a hospital after release.
If no doctor is immediately available, report the presence of trapped casualties to the local Control Center through the Incident Officer, so that a Mobile Medical Team may be promptly dispatched to the incident.
Treatment at the Incident.—In the absence of a doctor and if the casualty with a crush injury cannot be moved to a hospital, give the following treatment:
(a)	Administer by mouth as much fluid as possible. If baking . soda (bicarbonate of soda) is available, dissolve two teaspoonfuls in a pint of cold water and encourage the patient to drink as much of this as he can. Follow this with drinks of hot, sweet tea or coffee. Tea or coffee alone, or even plain water, should be given if baking soda solution is not available.
(b)	Treat the victim for shock as described on page 36.
(c)	If a limb has been crushed, and it is possible to do so, place a tourniquet loosely in position around the limb between the part that is crushed and the body. Tighten the tourniquet just before the crushing object which is pressing on the limb is lifted to release the ' casualty. If a tourniquet cannot be applied before release, one should be applied as soon as possible thereafter. If available, apply ice packs to the tourniqueted extremity.
(d)	Indicate .on the casualty identification tag that a tourniquet has been applied, also that the victim has suffered a crush injury. Mark on the patient’s forehead the letters TK and the time applied, and inform the ambulance attendant that a tourniquet is in place. -
(e)	All casualties suffering crush injuries, no matter how trivial, must be dispatched to a Casualty Receiving Hospital by ambulance. The ambulance attendant must be given full information concerning the nature of the injury.
(6)	Blast Injuries.—Exposure to blast may produce serious internal injury without external evidence of trauma. A lack of external evidence of injury therefore does not preclude serious internal injury. This is particularly true in blast injuries to the chest and ab
30 FIELD CARE AND TRANSPORTATION OF THE INJURED'
domen. Protection personnel should suspect blast injuries in every person found near the site of a bomb explosion, especially those who have obviously suffered injury and yet show no external evidence of it.
The chief signs of blast injury are severe shock, prostration, restlessness, and difficulty in breathing. Cyanosis (blueness of the face) is marked in the severe cases and usually present to some extent in all. Hemoptysis (spitting up of blood) may occur. The victim often complains of pain in the chest. Pain in the abdomen usually indicates damage to the abdominal organs.
All persons exposed to blast who present such symptoms should be treated for shock and sent to a Casualty Receiving Hospital at once as priority stretcher cases.
Care must be exercised to place a casualty with chest or lung injuries, even one suffering from shock, in a position which will make breathing as free and comfortable as possible to the patient.
The ambulance attendant must be given full information concerning the nature of the injury for transmission to the Casualty Receiving Hospital.
Since persons exposed to blast who are not obviously hurt may develop delayed evidences of lung or abdominal injury, they should be under medical observation for a period of at least 24 hours.
(7)	Injuries from War Gases.—War gases are irritant and poison- -ous chemicals which can be released as gases, solids (smokes), or liquids (sprays). They may be liberated by cylinder or airplane spray, bombs, shells, or grenades. They may be present as clouds of vapor, droplets, liquids, or solids. They are referred to as “gas” and may affect the body by being inhaled or swallowed or by coming in contact with the skin, eyes, or nose. Persons may be dangerously affected also by coming in contact with contaminated objects unless adequate protective measures have been taken. The chemicals used may damage the lungs; burn or blister the skin, eyes, nose, throat, or stomach; irritate the eyes, nose, and throat; or act as systemic (internal) poisons.
(a) Lung Irritants (phosgene, chlorpicrin, chlorine, nitric fumes).—Most chemical warfare agents may act as lung irritants under certain circumstances, but with phosgene, chlorpicrin, chlorine, and nitric fumes, lung irritation is the most conspicuous feature. Although nitric fumes have not been used directly in an attack, they may result from combustion of certain explosives and may therefore be encountered by rescue workers. Rescue workers and others required to enter poorly ventilated buildings or tunnels following explosions may be exposed to dangerous concentrations of nitric fumes.
Effects from low concentrations are coughing, throat spasm, retching, tight feeling in chest, blueness of face, increased pulse and breathing rate. The victim may collapse during exercise without previous warning.
INJURIES AND CONDITIONS' IN AIR RAIDS
31
First Aid.—Absolute rest for 48 hours and careful observation are essential even when no immediate symptoms appear. Keep the victim lying down and transport him on a stretcher to a hospital. Do not permit him to walk, even though he may insist that he is able to do so. Keep him warm. Do not. give artificial respiration in the hope of relieving difficult breathing, as it may do serious damage. It is indicated only if the patient hks actually stopped breathing. Hot coffee or tea may be given in small amounts. The victim should not be permitted to smoke.
(ft) Blister (Vesicant) Gases (mustard, nitrogen mustards, lewisite, ethyldichlorarsine).—The blister agents are not true gases, but oily, volatile liquids. They may be used in bombs or discharged from airplanes as a fine spray which behaves as a gas. The liquid slowly vaporizes into a true gas. .Contact of the skin or eyes with a liquid agent causes more severe injury than contact with vapor. Both vapor and spray, being heavier than air, tend to drift into and linger in cellars, ditches, and other low places. These agents are powerful, persistent, and dangerous.
Effects.—Burning of the eyes followed by acute inflammation. Itching, burning, and blistering of the skin. Discomfort in the nose, throat, and chest; brassy cough, if gas is breathed. Vomiting and pain in the stomach and abdomen if swallowed. Evidence of onset of action may be delayed as long as 24 hours, but first aid must be prompt to'be effective.
First Aid.—Act quickly. The degree of burning will depend on promptness of first aid given. All contaminated clothing must be removed before any treatment is given, so as to prevent continued exposure. For liquid contamination, alternately irrigate the eyes profusely with water from water bottle or other source for at least 2 minutes each. Dilute baking soda solution (one tablespoonful to a pint of warm water) is desirable but not necessary. Prompt, profuse irrigation is the important point. If irrigation of the eyes cannot be instituted within a few minutes following exposure, it should not be done at all. If done after 5 minutes, it may do harm. The eyes must not be rubbed or bandaged. Daub or pat the skin with dry cloths, pads or other absorbent material to remove any- gas remaining on the skin. If immediately available, apply household bleach (3 to 5 percent sodium hypochlorite) liberally to the affected area. Wash shin thoroughly with soap and water. Pat the area dry. Before cleansing, great care must be used in handling the victim and his clothing to prevent contamination of others.
(c) Sneeze Gases or Irritant Smokes (Adamsite, diphenylchlor-arsime).—These agents are used to produce irritation of the nose, throat, and eyes and are dispersed in clouds or smokes of very fine
32 FIELD CARE AND TRANSPORTATION OF'THE INJURED
particles rather than as true gases. Their action is so delayed that symptoms may not appear until after a gas mask has been put on. When this occurs, an untrained person may think his mask is unsatisfactory and remove it, becoming a casualty from further exposure. These agents are insidious, have, no odor, and are usually detected only when symptoms appear.
Effects.—Aching pain in the head, face, nose, throat, chest; sneezing, coughing and sometimes vomiting. Mental depression is severe; the victim may attempt suicide. Effects are severe but temporary.
First Aid.—Flush the nose and throat with a weak solution of baking soda (sodium bicarbonate)—one tablespoonful to a pint of warm' water—or breathe fumes of bleaching powder from a wide-mouthed jar. Reassure the casualty to prevent suicide.
[d} Tear Gases [chlovacetophenone, chloracetophenone solution, GNB solution, brombenzylcyanide}.—These substances produce severe but temporary eye irritation. Permanent damage rarely results. Tear gases may cause panic in an uninformed population that does-not understand their relative harmlessness and the rarity of serious aftereffects. Tear gases are not persistent, except for brombenzylcyanide, which is similar to mustard gas in its persistency.
Effects.—Burning pain in the eyes, copious tears. The victim may be unable to open his eyes because of spasm of the eyelids.
First Aid.—Get out of contaminated area; face the wind. Generally no treatment is necessary. Do not rub or bandage the eyes. In severe cases irrigate the eyes copiously with water or preferably with a solution containing one tablespoonful of baking soda to a pint of warm water.
(e) Systemic Poisons [hydrocyanic acid, hydrogen sulfide, arsine}.—It is unlikely that these agents will be used. They are not immediately irritating to the skin, eyes, nose, or lungs, but cause systemic (internal) poisoning and, if inhaled in sufficient quantity, they may cause death. Hydrocyanic acid and hydrogen sulfide may be immediately fatal. Arsine (an arsenic compound) poisoning produces destruction of the red blood cells and may result in death in a few days, usually from kidney failure.
First Aid.—Remove to fresh air. Give artificial respiration if needed. Treat for shock.
(/) Incendiaries [phosphorus shells or bombs}.—Phosphorus is the incendiary most likely to cause injury (see page 44).
2. HEMORRHAGE (BLEEDING).
Severe hemorrhage endangers life unless something is done about it immediately. Loss of blood is one of the main causes of shock. Persons with hemorrhage must, therefore, have priority treatment and transportation to a hospital.
INJURIES AND CONDITIONS IN AIR RAIDS	33
Although bleeding wounds require immediate attention, bleeding is in itself a poor indicator of the severity of wounds. Vigorous bleeding may make a minor injury appear more frightening than it really is. On the other hand, continued oozing of blood from a large area may lead to collapse and death if neglected. Some severe wounds—a torn-off limb, for example—may bleed very little because of shock.
All textbooks properly devote much consideration to the application of tourniquets, since under certain conditions their use may be essential. In practice under air raid conditions, however, such situations are seldom found, and tourniquets are very rarely needed. As a result of first aid training and instruction, many people still think the-only way to stop bleeding is to apply a tourniquet. They fail to consider the potential dangers. They should remember that limbs may be lost or paralyzed if tourniquets are allowed to remain in place too long without being loosened periodically.
A sterile pad held in place over a wound by a firm bandage, combined with elevation in the case of a limb, will stop bleeding in nearly all cases. If the pad becomes soaked with blood, it is not necessary to remove it. A fresh pad should be applied over the first one and the area bandaged again.
Arterial pressure points and methods of applying indirect pressure, already stressed in preliminary first aid training, should be reviewed and practiced.
a.	Kinds of Bleeding. .
(1)	Bleeding from Arteries.—Blood spurts with each beat of the heart unless the cut artery is deep in the tissue, in which case blood will well up.
(2)	Bleeding from Veins.—A steady flow of blood.
(3)	Bleeding from Small Vessels.—Oozing.
b.	Control of Bleeding.
(1)	Bleeding from Arteries.—(æ) Pressure Points.—Properly applied pressure over points beneath which arteries lie close enough to bony structures to allow compression will control bleeding. Hemorrhage may be controlled by pressure on these points until dressings can be applied to the bleeding wound as previously described.
(&)	Tourniquet for Arterial Bleeding.—If bleeding continues after proper application of sterile gauze pads and tight bandaging, the application of a tourniquet should be considered.
Materials.—A triangular bandage, a strip of cloth, or a belt at least 2 inches wide (never use wire or similar materials) and a stick about 6 inches long.
34 FIELD CARE AND TRANSPORTATION OF THE INJURED
Application.—Wrap the folded cloth twice around the arm a hand’s breadth below the armpit, or around the leg a hand’s breadth below the groin, and tie with a single knot. Place the stick on the knot, secure it with a square knot, and then twist until bleeding stops (fig. 10). Prevent the stick from untwisting by tying the ends of the stick to the limb with a bandage or handkerchief. Record the time the tourniquet was applied by writing the hour and minute on the tourniquet or on the casualty identification tag.
Precautions.— (i) Loosen tourniquet at the end of 15 to 20 minutes. If the dressing over the wound becomes more bloody, tighten the tourniquet again for another 10 or 15 minutes. If the dressing does not show new bleeding, leave the tourniquet loose, but in place, ready for use if bleeding starts again. Indicate the time of loosening and tightening on the tourniquet, or the identification tag. ’
(ii)	Always mark on the victim’s forehead with a skin pencil “TK” in large letters, to indicate presence of a tourniquet, and the time applied, so that it may be loosened by those who must care for him subsequently.
(iii)	Never apply a dressing over a tourniquet.
(iv)	Never transfer responsibility for a casualty to someone else (nurse, stretcher bearer, ambulance driver) until you make sure the other person knows a tourniquet has been applied.
(v)	If part of a limb has been blown off, tightly apply a tourniquet close to the end of the stump and do not remove it.
Figure 10.—Application of . a tourniquet.
INJURIES AND CONDITIONS IN AIR RAIDS	35
Dangers.—(i) Unless the tourniquet is released at short intervals (15 to 20 minutes), serious damage to the limb may occur.
(ii)	Crushing of tissues can increase shock gravely.
(iii)	Damage to nerves may be caused by pressure of thé tourniquet.
(iv)	The tourniquet, if not properly applied, will cause venous congestion and increase the bleeding.
(2)	Bleeding from Veins.—(a) Elevate a bleeding arm or leg, unless it is fractured.
(b) Apply a sterile dressing over the wound and bandage firmly in place. Remember not to touch the surface of the gauze which .is to face the wound. If no sterile dressing is at hand, use the cleanest cloth available, preferably the inside surface of a freshly laundered handkerchief or towel. If a fracture is present, first stop the bleeding and then give first aid for the fracture.
(3)	Bleeding from Small Vessels.—Treat as a simple wound. Apply a bandage cômpress so that it presses firmly on the wound. A thick pad of gauze may also be applied firmly by means of a triangular bandage.
(4)	Internal Bleeding.—Rescue Squad workers and medical auxiliaries who may be called upon to give first aid must be able to recognize internal hemorrhage by its signs—rapidly increasing pallor, cold clammy skin, rapid pulse becoming so weak it cannot be felt at the wrist, hurried and labored breathing, thirst, restlessness, and finally air hunger. If any of these signs are present, the attention of a physician is urgently needed.
3. SHOCK.
Shock6 is present to some extent in all injuries. Air raid injuries, unless trivial, are usually followed by shock. This varies in degree from faintness to extreme and dangerous prostration and is responsible for the majority of deaths among air raid casualties who are not killed outright. Persons apparently uninjured may be affected. The first aid worker must not become so intent on the care of the injury that the victim is allowed to develop severe shock because simple preventive measures were omitted. First aid measures for the prevention of shock are so simple anid commonplace that the inexperienced might see little harm, in omitting them. Shock treatment is vitally important.
a.	Signs and Symptoms of Shock.
Any or all of the following signs and symptoms may be present in a casualty suffering from shock. They may be evident immediately
•This term must not be confused with apoplexy or “stroke,” which is spoken of as “shock” in some sections of the United States.
36
FIELD CARE AND TRANSPORTATION OF THE INJURED
after the injury or their appearance may be delayed for some hours.
(1)	Faintness.
(2)	Cold clammy skin.
(3)	Restlessness.
(4)	Shallow, irregular breathing.
(5)	Rapid feeble pulse.
(6)	Vomiting.
(7)	Mental confusion.
Pallor of the face is always present but may not be obvious owing to the extremely dirty condition of ai^ raid casualties. In injured women, do not let make-up conf use you. Remove it.
Shock alone is rarely the cause of unconsciousness.
b.	Treatment.
If shock is present, it must be treated vigorously. If shock has not developed, treatment must be directed toward its prevention. In either case, the procedure is the same:
(1)	Stop bleeding.
(2)	Relieve pain by the gentle adjustment of the patient’s position or by suitable support of the injured part.
(3)	Lay the casualty flat with head low unless this causes difficulty in breathing or increases discomfort. Casualties with head wounds or injuries are exceptions and should be placed with the head above the horizontal.
(4)	Apply indicated first aid to any injuries which are present.
(5)	Maintain and conserve body heat. Protect the patient from chilling. Unnecessary removal of clothing should be avoided; the casualty should be wrapped in blankets or coats with more layers beneath him than over him. Apply heat by hot water bottles or other means cautiously, if at all. Do not overheat; do not produce sweating; do not allow hot objects, such as hot water bottles, to come in direct contact with the skin.
(6)	Give warm sweetened drinks, unless the person is unconscious or injured internally. Do not give alcoholic drinks.
(7)	Secure medical attention without delay.
(8)	Lift and handle the patient gently and smoothly.
The first aid treatment of shock is simple. Apply it to the best of your ability to every injured person. By these simple measures many lives will be saved.
4.	FRACTURES AND SPLINTS.
a.	Definitions.
Fracture—a broken bone (fig. 11).
Simple fracture—bone broken but skin intact.
INJURIES AND CONDITIONS IN AIR RAIDS
37
Figure 11.—Fractured bone.
Compound fracture—bone broken and skin broken. All fractures caused by bullets, bomb fragments, or other missiles are compound.
Splint—an appliance usually of wood or metal to keep in place and protect an injured part.
Fixed traction splint—a splint which prevents motion of broken bones by exerting pull from the ends of the bone.
Immobilize—to make bone fragments immovable by use of splints.
Displacement—bone fragments out of normal position.
Overriding—overlapping of the ends of a broken bone. This is caused by contraction-of muscles and results in shortening of the limb. It may take place shortly after the fracture and may be prevented by early application of a suitable splint.
b.	Recognition of Fractures.
The signs and symptoms which may be present in cases of fracture are :
(1)	Pain at or near the place where the bone is broken.
(2)	Loss of power of movement of the affected limb.
(3)	Swelling of the part affected. '
(4)	Deformity. The limb lies in an unnatural position and has an abnormal shape. It may be shortened by overriding of the fragments of the broken bone.
38 FIELD CARE AND TRANSPORTATION OF THE INJURED
(5)	Irregularity. If the bone is close to the surface, the break may be felt; if the fracture is compound, the bone may be exposed and visible.
(6)	Grating sound arid .feel upon motion of the limb.
c.	General Rules for the First Aid Treatment of Fractures.
(1)	The' object of first aid treatment for a fracture is to prevent a serious injury from being made worse by movement or careless handling of the patient. Either might convert a simple into a compound fracture.
(2)	The fracture should receive attention on the spot unless the surroundings or conditions are such that life is threatened or there is danger of further injury. In any case, stand by the patient until the fracture has been attended to and the injured «limb secured. Except for the reasons already mentioned, do not move the injured person until this has been done. Care in handling and movement is important for all fractures and is especially important for fractures of the spine, pelvis, and ribs.
(3)	If severe bleeding is endangering life, it must be controlled before anything else is done.
(4)	Wrap blankets or coats around the patient, using great care not to move him unduly. Merely covering the patient is not enough to prevent him from becoming chilled.
(5)	With great care, and without using force, place the limb in as natural a position as possible. In a case of compound fracture, do not attempt to pull the protruding fragment back into place.
(6)	In simple fractures apply splints, bandages, or slings over the clothing. In compound fractures repiove enough clothing to apply a sterile dressing to the wound. To avoid delay, elaborate splinting may be omitted, and the fracture may be immobilized by carefully securing the injured limb to its fellow (in the case of a fracture of the lower limb) or to the trunk (in the case of a fracture of the upper limb). This is usually all that is required under air raid conditions if the casualty is to be transported by ambulance over paved city streets.	"	.
Knowledge of the various forms of splints and their correct application is, however, essential. Their use is required:
(a)	When the injury occurs at a considerable distance from the hospital, as in rural areas. Application of traction splints to the lower extremities may be necessary in order to reduce pain and minimize shock during prolonged transportation over rough roads (fig. 12).
INJURIES AND CONDITIONS IN AIR RAIDS
39
Figure 12.—Traction splint.
(b)	When it is known that removal of the casualty to hospital may be delayed for some length of time.
(7)	Splints (regular or improvised) must be firm and long enough to keep at rest the joints immediately above and below the site of the fracture. The bandages must be applied firmly, but not so tightly as to interfere with the circulation of the blood.
(8)	In applying bandages near a fracture, the upper (proximal) one should be tied first. To apply a bandage when the patient is lying down, double the bandage over a splint or flat length of wood and push it under the body or limb, taking advantage of the natural hollows of the body.
(9)	In doubtful cases, treat as for fracture. Casualties with fractured spine, pelvis, or thigh should not be moved except lying down and with the greatest care.
Severely lacerated or crushed limbs should also be immobilized prior to initial removal and the casualty treated as if a fracture were known
to be present.
40 FIELD CARE AND TRANSPORTATION OF THE INJURED
d.	Improvised Splints.
Serviceable splints may be improvised from such materials as slats of a Venetian blind^ rifles, canes, folded coats, pieces of wood or cardboard, from rolled up linoleum or newspaper, and in fact anything that is firm enough to support the limb and long enough to prevent movement of the joints above and below the fracture. Hard objects used as splints must be well padded before they are applied.
Common sense application of the general rules for the first aid treatment of fractures will enable one to deal adequately with most fractures. However, fractures of the neck, spine, pelvis, thigh, ribs, and skull require special consideration.
e.	Field Treatment of Special Fractures.
(1)	Fractures of the Spine.—Broken necks and broken backs are potentially dangerous because improper care may result in permanent paralysis or death. Fractures of the. spine may be caused by direct violence (e. g., a fall across a bar or railing, a severe blow on the back as from falling debris or the impact of a missile while a person is standing or sitting in a slightly stooped position). Spinal fractures may also be caused by indirect violence (e. g., in falling or jumping from a height, a landing being made on the feet with the legs held rigidly extended).
Broken neck.—The victim, if conscious, will complain of pain in the neck. Some persons will hold the head and neck stiff and motionless, but some will be completely relaxed and have no control of the head. Injury to the spinal cord may cause paralysis. Record on the identification tag any paralysis or weakness.
Keep the victim lying in the position in which he was found and prevent motion of the head by the use of sandbags. Do not give him water, as he may move his head to drink. Cover him with blankets or wraps. Get a doctor. If he must be moved to save his life before the doctor arrives, follow the method described on page 73.
Broken back.—When the backbone is broken below the neck, the only symptom may be pain in the back. If the spinal cord is damaged or under pressure, the victim may be unable to move his feet, but can move his hands.
Any move which doubles the injured person forward may cause death or-paralysis for life. He must, therefore, be kept motionless in the position in which he is found. Get a doctor. Keep the casualty comfortably warm. Reassure him. Do not let him move. For details of transportation of patients with broken backs and broken necks, see pages 73-74.
INJURIES AND CONDITIONS IN _AIR RAIDS
41
(2)	Fracture of the Pelvis.—If after severe injury in the region of the hip or loin, a casualty with no signs of damage to the legs is unable to stand or move his legs without great pain, his’ pelvis is probably fractured, and he must be treated accordingly.
Place him in the position he finds most comfortable, raising or lowering his legs as he desires. He will probably prefer to be flat on his back with his legs straight. Apply a broad bandage round his hips firmly enough to give support but not so tightly as to press broken bones inward. Bandage both ankles and both knees together. Transport him carefully on a .stretcher. He should be discouraged from passing water until he reaches the hospital.
(3)	Fracture of the Thigh Bone (Femur).—This bone may be broken at any point—at its neck, in its shaft, or close to the knee.
In old people, relatively slight injury may lead to a fracture of the neck of the femur (hip), and it is often difficult to say whether or not a fracture is present. If an injured old person, lying on his back, is unable to raise his heel from the ground while keeping the knee straight, assume that a fracture of the neck of the femur (hip) has occurred.
In cases of fractured shaft or lower end of the femur, the general signs and symptoms of fracture are usually present. A specific sign is an abnormal turning outward of the foot. Shortening of the affected limb, which may be as much as three inches or as little as half an inch, will usually be present.
First Aid.—Steady the limb by holding the foot and ankle; gently draw the foot down into line with the opposite one and fasten it to its fellow with figure-of-8 bandage around both ankles and feet. Pass seven bandages under the body and limbs in this order:
(a)	Around the chest, just below the armpits.
(b)	Around the pelvis, at the level of the hip joints.
(c)	Around both ankles and feet (over the initial figure-of-8 bandage).
“(d) .Around both thighs above the fracture.
(e)	Around both thighs below the fracture.
(f)	Around both legs.
(g)	Around both knees (use a broad-fold bandage).
Now place a splint along the patient’s injured side, extending from the armpit to beyond the foot, and secure it by tying the bandages in the order of their application.	2
If a splint is not used, secure the injured limb to the opposite one, using the bandages just described, omitting the one at the chest level. Place padding material, such as folded towels, in the hollows between the limbs. While the patient is being loaded on a stretcher, carefully support the entire length of the body and legs.
537377°—43---4
42 FIELD CARE AND TRANSPORTATION OF THE INJURED'
(4)	Fractured Ribs.—Ribs may be broken by direct violence, in which case the broken ends of the bones may be forced inward, damaging the lungs or other internal organs.
Signs and symptoms are: a sharp cutting pain in the chest, especially on deep breathing; short and shallow breathing. If the lungs are injured, frothy blood may be coughed up. If the liver or spleen is injured, internal bleeding will occur with symptoms described on page 27.
If there are no signs of injury to an internal organ, tie two broad bandages firmly around the chest, with the center of the first im-mediately above, and the center of the second, immediately below, the site of fracture. The lower bandage should overlap the other by half its width. Tie on the opposite side and slightly toward the front of the chest. Support the arm of the injured side in a sling.
If an internal organ is injured, do not apply tight bandages to the chest. Lay the casualty down, roll him onto the injured side, and support him in this position with the injured side low. Loosen all clothing, keep him wrapped in blankets, give him ice to suck if it is available, and avoid moving him more than is necessary.
If there is an open wound of the chest wall, with sucking of air and resulting difficult breathing, coyer the opening quickly and completely with a thick sterile dressing bound tightly in place. Then get the casualty to a hospital as soon as possible, telling the ambulance attendant that the case is most urgent.
(5)	Fractures of the Skull.—Fractures of the base of the skull may be caused by indirect violence, as by a blow on the jaw or a fall on the feet from a height. The patient is usually unconscious, and bloodstained fluid (cerebrospinal) may escape from the nose or ears.
Fractures of the vault of the skull may be caused by direct im-pact, and portions of the broken bone may press on the brain. When a fracture of the vault is suspected in a person with a wound of the scalp, the dressings should not press directly over the wound; a ring pad should be used to prevent pressure.
A person with a head injury should not be moved unnecessarily. It is important that the patient should not be placed with head below the horizontal level, because more bleeding from the scalp wounds and into the brain will occur in that position; it is better to keep the head elevated. Tight clothing, especially about the neck and chest, should be loosened, and the casualty wrapped carefully in blankets. If unconscious, he should not be given anything to be swallowed.
5. BURNS.
Thermal burns in warfare may be extensive and serious. They may be caused by contact with dry or moist heat, by contact with live
INJURIES AND CONDITIONS IN AIR RAIDS	43
electric wires,- by incendiary bombs or shells, or they may occur in burning buildings.
a.	Emergency Care.
The purpose of immediate treatment is to reduce pain, prevent shock and protect a wound from contamination with dirt and bacteria. When a burned casualty can be transported to a hospital at once, no local treatment should be applied to the burned area except sterile gauze to prevent infection. This should be applied without delay and with the least possible handling of the burned area and the surrounding skin. If sterile gauze is not available, the affected area should be covered with soft clean cloths or cotton wool, held in place by loosely applied bandages. This is important to keep out the dust and dirt which fills the air after air raids and contaminates burns and wounds. Avoid breathing or coughing while applying treatment to burned areas; in casualty stations wear a gauze mask if available, or tie a clean handkerchief over your mouth and nose.
Patients with severe burns must be sent to the nearest hospital as soon as possible; those with minor burns should be sent to the nearest Casualty Station.
When burns are severe or extensive, shock will be marked. Chilling of the patient must be avoided. He should be wrapped in blankets and given fluids,-such as warm sweet drinks. He should not be kept too warm or be allowed to sweat profusely.
b.	First Aid.
If circumstances prevent removal of a burned patient to a hospital within 2 hours, the following first aid treatment is recommended: Cover the burned surfaces with sterile boric acid ointment or petrolatum (vaseline), over which one or two layers of fine mesh gauze are applied. Over this dressing, thick sterile gauze or sterile cotton waste is to be placed, and the entire dressing is to be bandaged firmly but not tightly. The addition of a simple splint to a burned extremity is desirable. Substitution of 5 percent sulfathiazole water-soluble jelly for sterile boric acid ointment or petrolatum is permissible. Preparations (ointments, 'jellies or solutions} containing tannic acid, gentian violet, triple dye, picric acid, or other crusting agents, should not be used.
No effort should be made to remove more clothing than is necessary to expose the burned area. This must be done with care, cutting away portions of clothing when necessary. Blebs and blisters when present should not be broken.
44
FIELD CARE AND TRANSPORTATION OF THE INJURED
c.	Eye Burns.
Burns of the eye require special consideration. They may be caused by heat or chemicals.
(1)	Thermal Burns.—Eyes burned in air raids often contain particles of dirt, plaster, and debris. Visible particles should be removed and the eyes irrigated freely with warm water. After thorough irrigation, the eyes should be closed and a soft pad of cotton wool or a folded handkerchief applied and secured firmly with a bandage. If available, a drop of mineral oil or olive oil should be instilled into the affected eye before bandaging.
(2)	Chemical Burns (Excluding Those Due to War Gases).—If the bum is due to a corrosive acid, irrigate the eyes with a weakly alkaline solution, such as* one made of two teaspoonfujs of bicarbonate of soda to a pint of water. If an alkaline solution is not available, use water.
If the burn is due to a corrosive alkali (such as quicklime), any particles that still adhere to the eyeball should be gently removed. Flush out the eyes with a weak acid solution, such as one made up of lemon juice or vinegar inan equal volume of water. If such a solution is not available, thoroughly irrigate the eyes with water.
After irrigation, chemical eye burns are treated as heat burns of the eye.
Every casualty with eye burns must be seen by a physician.
d.	Phosphorus Burns.
When fragments of phosphorus shells or bombs strike the skin, they cause severe burns which heal slowly..
Dry phosphorus continues to burn when exposed to air and should therefore be removed as soon as possible or kept wet with water until removed. When possible, particles of phosphorus (which are luminous in the dark) should be removed with a piece of wet lint or wool. Care should be taken that particles of phosphorus do not touch the bare fingers.
Ideal immediate treatment is immersion of the burned part in a water bath, warm if possible, to melt the phosphorus and make its removal easier. If this is impossible, the wound should be freely washed with water or bicarbonate of soda solution, and a heavy dressing, which has been thoroughly soaked with water before application, should be applied and kept wet. A 2 fo 5 percent copper sulfate solution, if available, is preferable to water. Copper sulfate\solution must not be used in the eyes. '
Persons with phosphorus burns should be sent as soon as possible to a hospital or Casualty Station where special treatment can be
INJURIES AND CONDITIONS IN AIR RAIDS	45
carried out. The ambulance attendant must be informed of the nature of the injury.
Oils and greasy dressings must not be applied to phosphorus burns.
Tannic acid, triple dye, and brilliant green ignite in the presence of phosphorus and must not be used on a phosphorus burn.
For field use, the application of dressings soaked and kept wet with water, baking soda, or copper sulfate solution is the only safe treatment.
6.	SUFFOCATION (ASPHYXIA).
Breathing may be arrested by pressure on the chest; blocking of the mouth or windpipe by false teeth, food, mud, dust, or other foreign materials; drowning or electric shock. Suffocation will also occur if the air breathed is poisoned by utility gas, coal gas, smoke, motor exhaust fumes or other toxic gases or smokes.
If a casualty has stopped breathing, search for the cause and remove it if possible. For example, the mouth must be cleared of obstructions, or, if the victim is in a gas-filled room, he must be removed to fresh air. If breathing does not start again immediately, artificial respiration must be instituted at once as follows:
a.	Lay the victim on his belly, one arm extended, directly overhead, the other arm bent at the elbow. Turn the face toward the extended arm, resting the head on the hand and fingers of the bent arm so that the nose and mouth are dree for breathing and may be seen by the operator (fig. 13).
b.	Kneel, straddling the victim’s thighs with your knees just above his knees, adjusting your position so that you can. comfortably lean forward, and place the palms of your hands on the lower part of his chest with the little fingers resting over the ribs. Your wrists should be about 4 inches apart.
c.	With your arms held straight, swing forward slowly, so that the weight of your body is gradually brought to bear upon the victim. Your shoulders should be directly over the heels of your hands at the end of the forward swing. This operation should take about two seconds. Do not bend your elbows.
d.	Quickly swing backward so as to remove pressure completely.
e.	After two seconds, swing forward again. Repeat steps “c” and “d” regularly 12 to 15 times a minute.
Continue artificial respiration without interruption until natural breathing is restored—for hours, if necessary—or until a physician declares the victim dead.
Have an assistant loosen tight clothing about the victim’s neck, chest, or waist. Keep the casualty warm. Do not give any liquids by mouth until he is fully conscious.
46
FIELD CARE AND TRANSPORTATION OF THE INJURED1
"Figure 13.—Artificial respiration.
INJURIES AND CONDITIONS IN AIR RAIDS	47
Keep patient lying down after he revives. He should be given hot tea or coffee to drink after he is fully conscious.
Resuscitation should be carried on as near to the scene of the incident as possible. Should it be necessary to move the victim from the site of the incident, artificial respiration should be carried on while he is being' moved. He should not be moved again until he is breathing normally, and then only in a recumbent position.
After temporary recovery of respiration, the victim may stop breathing again. He must be carefully watched, and if natural breathing stops, artificial respiration must be resumed at once.
In carrying out resuscitation, it may be necessary to change-operators. This change should be made without losing the rhythm of respiration.
The pressure exerted by the forward swing must be regulated to meet the comparative sizes of operator and victim. Too much pressure is harmful; the tendency is to press too hard in an effort to make the victim breathe. Sufficient pressure to empty the used air from the chest is all that is required. An inrush of fresh air takes place in the rest interval when no pressure is being exerted.
Pressure must be applied in the correct place to force air from the chest. Make sure that the hands are in the proper position and that they do not get too low.
Be sure that the nose and mouth are free from obstruction, so that air can pass in and out. If frothy bubbles collect in the mouth, they should be wiped out by an assistant.
»Keep the patient warm. Blankets, coats, or-even newspapers should be wrapped under and around him. You can continue to work through this covering without exposing the victim to the wind and the cold ground.
Only by continued practice can artificial respiration be given effectively under the excitement of an emergency. Therefore regular practice on willing subjects is essential. Many persons have been revived after hours of work. Alternate with other workers if fatigued. Stop only when the victim has been revived or the case has been taken over by a physician.
Note.—Artificial respiration must not be used when failing respiration is due to poisoning by phosgene, nitrous fumes or. other war gases, or is the result of exposure to blast. If, however, respiration has ceased, regardless of the cause, artificial respiration is indicated.
7.	CARBON MONOXIDE POISONING.
There is serious danger of carbon monoxide poisoning in modern warfare. Bombs exploding near a building or home may cause collapse or the blocking of a chimney or flue so that carbon monoxide
48 FIELD CARE AND TRANSPORTATION OF THE INJURED'
gas escapes into the house from the furnace. Utility gas other than pure natural’or hydrocarbon gas has a high content of carbon monoxide, and its escape through disrupted gas mains is a serious hazard. When a bomb explodes, a large amount of carbon monoxide gas may result from incomplete combustion of the explosive.
Carbon monoxide is odorless, colorless and tasteless. It may produce death even in low concentrations if breathed for some time. In high concentrations it may produce death in a few minutes. Since people doing manual labor breathe faster than those at rest, the former tend to be overcome more rapidly.
The Rescue Service manual describes methods for the detection of carbon monoxide and of other non-war gases and the special masks which protect the rescue workers from the poison. The ordinary civilian gas mask, supplied to civilian defense w’orkers, does not protect against carbon monoxide.
Carbon monoxide poisoning steals upon the victim in such a way that he may be overcome by the gas without warning.
Symptoms.—The common early symptoms are headache, yawning, giddiness, ringing in the ears, and weariness. Fluttering or throbbing of the heart is usually a late symptom. If the. victim breathes fresh air, these symptoms usually pass off, but a headache often persists. If the victim remains in the presence of carbon monoxide gas, his legs will collapse under him, and he may stagger and sink to the ground in a semiconscious or unconscious state. In severe carbon monoxide poisoning, the lips may show a cherry red tint.
First Aid.—a. Remove the victim to fresh air as quickly as possible.
b.	If breathing has stopped, is weak and intermittent, or is present only in occasional gasps, start artificial respiration at once, using the prone pressure method. If oxygen is available, it should be given while artificial respiration is administered.
c.	Aid the circulation by rubbing the limbs, keeping the victim warm with blankets and hot water bottles.
d.	Keep the victim at rest, lying down, to avoid any strain on the heart.
Inhalations of oxygen, when started promptly, decrease the possibility of serious aftereffects. Oxygen should therefore be given to all victims if possible.
8.	UNCONSCIOUSNESS.
Any casualty who is unconscious is in a serious condition and should have immediate medical attention. Before the doctor arrives, certain measures should be carried out by those trained in first aid. Bleeding, if present, must be controlled.
INJURIES AND CONDITIONS IN AIR RAIDS	. 49
a.	“Blue Unconsciousness.”
A person not breathing, with a bluish or blotched face, requires artificial respiration at once. Be sure there is no obstruction in the throat. Be careful of electric shock if the victim is found in contact with wires, plumbing or heating pipes, or other conductors of electricity which may have become temporarily charged.7 Do not expose yourself to electric shock by careless handling of the victim. Be careful of carbon monoxide gas and do not become a victim yourself. Remember that persons not breathing become chilled very rapidly and must be kept reasonably warm during artificial respiration?
b.	“Red Unconsciousness.”
Red face and strong pulse. Keep victim lying down, head slightly raised; place cold applications on head; give no stimulants. Prevent chilling, and transport in lying position.
c.	“White Unconsciousness.”
Treatment is the same as for shock. (See page 36.) .
7 Appendix E.
CHAPTER IV
Marking of Casualties and Disposal of the Dead
1.	IDENTIFICATION TAGS.
An OCD identification tag (fig. 14) should be attached to each casualty as soon as possible by the first rescue worker or medical auxiliary who reaches him. All members of Rescue Squads, Stretcher Teams, and Mobile Medical Teams are provided with books of tags. For future idehtification, it is most important that tags be filled out, if possible, before a casualty loses consciousness. All casualties, sur-
Figure 14.—Identification tag.
50.
MARKING OF CASUALTIES AND DISPOSAL OF DEAD*	51
viving and dead, must be tagged before they are taken from the scene of an incident to a hospital or morgue. Before a casualty is placed in an ambulance, a nurse or medical auxiliary on the Mobile Medical Team will fill in the data on emergency treatment and other items which the original Rescue Squad worker or stretcher bearer did not record. Identification tags should remain affixed to the wrists or ankles of casualties until they reach the hospital ward or morgue.
Slightly injured ambulatory casualties are also to be tagged at the incident if this is possible. Otherwise, the tag is to be filled out and affixed on arrival at the Casualty Station. Since a permanent record of all minor casualties is entered in the Casualty Record Book at the Casualty Station, the identification tag is to be retained by the casualty when he returns to his home or goes to a Rest Center. It may be used by him subsequently as evidence in support of a claim for War Civilian Security benefits.
2.	FOREHEAD MARKINGS.
A skin pencil is included in the. first aid pouch of rescue workers, stretcher bearers, and medical auxiliaries so that the foreheads of serious casualties can be marked distinctly so as to direct attention to the serious nature of injuries or complicating factors which may require urgent care. The identification tag should be similarly marked. The symbols to be employed are as follows :
U=Urgent—priority attention in transportation and examination on reaching the hospital.
H=Internal hemorrhage.
T—Tetanus antitoxin given.
TK= Tourniquet has been applied. The time of. application and of each subsequent release should also be entered on the identification tag.
M=Morphine has been given. The time of administration and the dose should be written on the identification tag.
C=Contaminated by persistent gas.
X=Poisoned by phosgene or other nonpersistent gas.
3.	DIAGNOSIS OF DEATH.
In the absence of a physician, the rescue worker or medical auxiliary should not assume the responsibility for diagnosing death, except in clear-cut cases. In doubtful cases, a physician should be summoned ; if no doctor is immediately available, the casualty should be sent directly to a hospital without delay and not to a Casualty Station.
4.	COLLECTION OF THE DEAD.
When bodies are recovered, they should be removed to thé nearest convenient building and covered with sheets or blankets. They should
52
FIELD CARE AND TRANSPORTATION OF THE INJURED
not be left in the street or in an open space. The public should be kept away until the bodies have been covered or removed.- The dead should be removed to a morgue as soon as possible after the bodies have been tagged, in vehicles provided by the Citizens Defense Corps for this purpose. When a name is unknown, it is most important for subsequent identification that the address at which the body was found be entered on the identification tag. In case a casualty is unidentified, the tag should, if possible, carry the following information and be signed by the leader of the Rescue Squad or the Mobile Medical Team:
a.	Address of the premises where the body was found.
b.	Location in the building.
c.	Time and date recovered.
d.	Apparent cause of death (e. g., bomb splinters, falling masonry, fire, etc.).
e.	Special information which might assist in identifying the body.
f.	If contaminated with persistent gas, indicate with large red “C” on the tag.
g.	If suspected to have died of phosgene or other nonpersistent gas, indicate with a red “X” on the tag.
A Rescue Squad has not completed its labors until every victim, alive or dead, has been recovered from the ruins.
CHAPTER V
Methods of Blanketing a Casualty
Before an injured person is placed on a stretcher, it should be covered with a blanket folded lengthwise, or with an overcoat, so that the patient does not lie in direct contact with the canvas or metal. This adds to his comfort and keeps him warm. It is more important to place blankets under the casualty than over him.
1.	RED CROSS METHOD (fig. 15).
Fold a blanket into thirds lengthwise, place it on the stretcher and turn the upper fold back so that it hangs off one side. Fold the second blanket in thirds, place it on the stretcher in such a way that when the upper fold is turned back it hangs from the opposite side. Place the victim on the stretcher. Turn the hanging fold of the second blanket over him. Then turn the hanging fold, of the first blanket over him. By this method the victim has four thicknesses of blanket under him and two over him.
Figure 15.—Red Cross method of blanketing.
53
54 FIELD CARE AND TRANSPORTATION OF THE INJURED
2.	BRITISH (WANSTEAD) METHOD (fig. 16).
This method also uses two blankets and provides four thicknesses beneath the patient and two above. The feet are tucked in snugly and are kept warm and the head is protected against the cold. When the blanket fold is completed, it securely fixes the extremities and trunk so that it can be used as a blanket carry.
a.	Preparing the Stretcher.
(1)	Place blanket A lengthwise across the stretcher so that one long edge is at the head end of the stretcher and the blanket extends farther over one side of the stretcher than the other (fig. 16a).
(2)	Fold blanket B in thirds lengthwise and place over A so that the upper edge of this folded blanket is about 15 inches below the upper edge of blanket A (fig. 16b). For very tall persons it is necessary to lay blanket B farther down on the stretcher to permit its lower end to extend a sufficient length below the patient’s feet so that it may be folded up and around them in the manner to be described.
(3)	Open the folds of blanket B for about 2 feet at the foot end (fig. 16b).
b.	Wrapping the Patient.
(1)	Lay the patient on blanket B and bring the foot of the blanket « up over the feet and make a small tuck between the feet.
(2)	Bring each of the two open folds (lower corners) of blanket B closely over and around the feet and ankles and tuck each fold securely behind the opposite ankle (fig. 16c).
(3)	Turn in the Upper corners of blanket A around the patient; wrap the shorter length of blanket A over the patient; then carry the longer end over him and tuck it well in at the side (fig. 16d).
c.	Blanket Assembly for Transit.
(1)	Proceed as in (1) and (2) under “Preparing the Stretcher.”
(2)	Fold in the two ends of blanket A in accordion pleats (fig. 16e).
(3)	Fold in the foot end of blanket B.
(4)	Roll up the blankets and secure the roll with a strap or rope (fig. 16f). A hot water bottle may be placed in the center’of the pack to keep it warm.
METHODS OF BLANKETING A CASUALTY	55
Figure 16.—British (Wanstead) method of blanketing casualties.
CHAPTER VI
Methods of Lashing a Casualty to a Stretcher
Lashing a casualty to a stretcher is advisable if the casualty is to be lowered from a height, carried up or down stairs or inclines and over rough terrain and obstacles.
1.	LASHING WITH TRIANGULAR BANDAGES.
a.	Patient on EMS Metal Stretcher (fig. 17).
Seven triangular bandages folded as cravats are needed. The greater part of the weight is borne by the ankle bandages when either the head or foot of the stretcher is raised. The knee bandage prevents flexion at the knee and gives some additional support. The crossed chest bandages give considerable lateral support when necessary and support some weight when the head is low. They can be applied quite firmly without serious interference with breathing.
The head bandage with the ends twisted so as to form a cap immobilizes the head very comfortably without supporting much weight. It is most important that the many alternative methods be kept in mind for securing persons with particular injuries; e. g., with leg injuries, a bandage goes across the pelvis, two slings go under the arms from the top bar of the'stretcher, and the legs are fastened to the stretcher with the weight-supporting ankle bandages omitted or modified.
Figure 17.—Method of lashing patient to metal stretcher with bandages.
56
METHODS OF LASHING A CASUALTY TO A STRETCHER 57
Proper knots are simple to tie but extremely important. The reef or square knot alone is dangerous. A round turn on the stretcher bar should be secured by two half-hitches of the free end around the stirrup; two round turns with two half-hitches are better, even if this brings the knot fairly near the end of the bandage, since nearly all the strain is removed from the knot itself. It is immaterial whether the two half-hitches are tied in the same way, making a clove hitch, or in opposite directions. When properly applied, the bandages will keep the patient in contact with the stretcher, allowing only 1 inch to 2 inches of movement,* whatever the position of the stretcher is.
If the use of the crossed bandages over the chest is inadvisable because of wounds or for other reasons, triangular bandages passed below the armpits may be used (fig. 18). When this is done, it is important to pad the armpits well.
Figure 18.—Patient secured to stretcher by arm slings.
b.	Unblanketed Patient on Canvas Stretcher (fig. 19).
Tie a triangular bandage to the stirrup on the left side of the stretcher near the patient’s foot, pass it over his left leg, then under his right buttock, and fasten to the stirrup on the right side of the
537377°—43----------5
58 FIELD CARE AND TRANSPORTATION OF THE INJURED
stretcher near the shoulder; Apply a similar bandage to the opposite stirrup, passing over the right leg and under the left buttock. Bind the feet together, and pass a lashing between the two stirrups at the foot of the stretcher, in which is included a half: hitch around the patient’s instep. Then tie a bandage across the patient’s chest, under both arms and through the upper stretcher stirrups. Finally, tie bandages around both the patient and the stretcher at the abdomen and thighs.
Figure 19.—Method of lashing unblanketed patient on canvas stretcher with bandages.

METHODS OF LASHING A CASUALTY TO A STRETCHER 59
Figure 20.—Method of lashing patient to metal stretcher with rope.
2.	LASHING PATIENT TO METAL STRETCHER WITH ROPE (fig. 20).
A 40-foot length of ^4-inch rope is required. The technique is as follows:
a.	A double clove hitch is made on the upper right handle of the stretcher (directions cited are in reference to patient’s position).
b.	The rope is carried across the stretcher to the upper left handle, where it is secured with a half-hitch.
c.	It is then carried down the left side of the metal stretcher to the level of the upper part of the chest, where a half-hitch is made around the stretcher pole.
d.	It is then passed across the upper part of the patient’s chest and looped similarly around the right hand pole at the same level.
e.	It is now carried down the right side of the stretcher to the level of the upper thighs, where it is again looped around the pole with a half-hitch and carried directly across the thighs to the left side of the stretcher, where another half-hitch secures it to the stretcher pole.
f.	It is then passed down the left side of the stretcher to just below the knees, looped around the left pole with a half-hitch and carried across the legs and secured with a half-hitch to the pole on the right side.
g.	It is now passed‘under the insteps and up the left pole making one half-hitch on the way" up.
h.	The end is finally secured at the upper left handle of the ' stretcher with a double clove hitch.
If the upper part of the body requires additional support, this may be accomplished before the casualty is lashed to the stretcher by using triangular bandages as described on page 57 and illustrated in figure 18.
PART III
Transportation of the Injured
CHAPTER I
Stretcher Transportation
1.	GENERAL PRINCIPLES.
Before transporting a casualty from an incident, be sure that bleeding is stopped, he is breathing, he is comfortably warm, fractures have been splinted. Rough, careless handling will increase shock and may result in death. Be gentle and go slowly. To lift a casualty onto a stretcher, four stretcher bearers are recommended; more are desirable if available and if the injury is serious.
2.	STRETCHERS.
a.	Army Type Stretchers (fig. 21).
Many stretchers furnished by the U. S. Office of Civilian Defense are of the army type, consisting of metal or wooden poles, a canvas bed, folding metal braces to spread the sidepoles, and metal stirrups which serve as legs. Dimensions are as follows:
Length
Bed---------------------------------------------- 72	inches
Poles----------------------,____________________ 90 inches
Width_________________________________     22	inches
Height------------------------------------- 6	inches
Figure 21.—Army stretcher.
60
STRETCHER TRANSPORTATION!
61
If difficulty is encountered in getting full-length stretchers into hospital elevators or converted ambulances, the handles may be shortened at each end by 2 or 3 inches without interfering with their utility.
b.	EMS All-Metal Stretcher (fig. 22).
Similar in dimensions to the Army stretcher, this all-metal stretcher is also being furnished by the U. S. Office of Civilian Defense. It consists of hollow metal poles to which is attached a bed of twisted wire interlaced so as to provide slight resiliency. It has the advantage of being easily cleaned or decontaminated. Bends in the metal poles correspond to the stirrups of the Army type stretcher and permit the nesting of stretchers for convenient transportation and storage.8
Figure 22.—EMS metal stretcher.
c.	Stokes Navy Stretcher (fig. 23).
The Stokes Navy stretcher is a woven wire basket made to conform to the general outlines of the human body. These will jiot be available to the Emergency Medical Service except when it is collaborating with Naval medical units in the handling of marine casualties.
Figure 23.—Stokes Navy stretcher.
d.	Removable Pole-Type Stretcher.
This simple type of stretcher has been provided by some communities. The poles of the stretcher slide through wide hems at the sides
8 There is some tendency for the legs of these stretchers to spread. If this occurs to such a degree that they will not fit into stretcher racks, it may be corrected by placing the stretcher with one edge on a firm base and exerting pressure on the uppermost legs.
62 FIELD CARE AND TRANSPORTATION OF THE INJURED
of the canvas. This is especially handy because the canvas, or substitute cover, can be left under a severely wounded person when he is placed on a cot or hospital bed and the poles slipped out for reuse. A wooden spreader to hold the poles apart and keep the canvas off the ground may be improvised from a board with a hole near each end, through which the handles of the stretcher can be inserted.
The disadvantage of this type of stretcher is that it cannot be readily loaded into ambulance racks.
e.	Improvised Blanket Stretcher (fig. 24).
- This stretcher is made with a blanket folded in thirds over poles. Place a pole a little longer than the blanket about a foot from the center of the blanket. Fold the short side of the material over the pole toward the other side. Place the second pole on the two thicknesses about 2 feet from the first pole and parallel to it. Fold the remaining side of the blanket back across the second pole toward the first pole. When the injured person is placed on the blanket, the folds are secured by the weight of the body.
Figure 24.—Improvised blanket stretcher.
f.	Blanket Stretcher Without Poles (fig. 25).
Place a blanket on a flat surface and, starting from the edge, roll the blanket tightly from each side toward the center until all the blanket except a strip 2 feet wide down the middle is in two tight rolls. Place the patient on the unrolled part.. The folded edges form satisfactory grips. Four bearers are required as a minimum, and six are preferable. This improvised stretcher is useful in carrying casualties up and down stairs, in elevators, and in other cramped quarters?
STRETCHER TRANSPORTATION
63
Figure 25.—Blanket stretcher without poles.
Blanket stretchers must never be used if there are injuries to the neck or spine.
Blankets applied according to the British (Wanstead) Method (see page 55, fig. 16) may be used effectively as a blanket stretcher.
g.	Door, Shutter, or Ladder with Boards. .
Any flat surface large and strong enough to support the body may be used for a stretcher. Since considerable discomfort may result if a patient is carried on a hard surface for any distance, a blanket or other padding should be used.
h.	Chair.
If a chair is used for a stretcher, the straightbacked variety is best. Seat the patient in the chair; tip it onto the back legs. One bearer
64 FIELD CARE AND TRANSPORTATION OF THE INJURED lifts by the front legs, the other by the back of the chair, the patient being in a semi-reclining position.
i.	Improvised Coat Stretcher (fig. 26).
A satisfactory stretcher may be improvised by using three or four jackets or coats and two poles. The jackets are turned inside out without turning the sleeves, and two poles are passed through the sleeves. The flaps are then turned down around thé poles and buttoned underneath. The strength of the stretcher should be tested before it is loaded.
Figure 26.—Stretcher improvised with coats.
3.	STRETCHER BEARING AND DRILL.
Casualties should be placed on stretchers and loaded into or removed from ambulances by methods which have b.een found by experience to be most comfortable to the patient. It is therefore important that Stretcher Teams be thoroughly drilled in correct procedures for loading and handling stretchers and in stretcher carrying. For instructions in ambulance loading, see page 91.
a.	Stretcher Drill with Four Men and a Leader (fig. 27).9
The Stretcher Team consists of five strong men or. older boys of approximately equal height, one of whom will be the leader. The team leader directs and supervises all work of the stretcher team, assigns each man to his position and assists, when needed, in the work of the team. The purpose of the drill here outlined is to train proficient stretcher bearers.
9 Grateful acknowledgement is made for material taken from th*e U. S. Bureau of Mines Manual of First Aid Instruction.
STRETCHER TRANSPORTATION
65
Figure 27.—Position of team members in stretcher drill.
All commands are given by the team leader in a military manner; that is, a preparatory command is given to place each man in readiness, followed after an interval of 1 to 2 seconds by the command of execution. By this method, movements can be made in unison, and a precise, coordinated' procedure developed. The dash (—) in the command, as written, represents the interval between the preparatory command and the command of execution.
Leader: “Fall in.”
The four men fall in line, standing side by side, each with head erect, hands at sides, heels together, and eyes straight ahead.
Leader: “Count off.”
The man at the right of the team calls, “one,” and the remainder of the team follow in order, counting “two,” “three,” “four.”
Leader: “Procure stretcher—march.”
At the command, “March,” Nos. 2 and 3 step forward, proceed to stretcher by shortest route (open it if it is of the folding Army type), No. 2 grasps the front handles, No. 3 the rear handles, and they march back to place No. 2 in line.
Leader: “Carry stretcher—march.”
66
FIELD CARE AND TRANSPORTATION OF THE INJURED
At the command, “March,” No. 1 steps to the middle of the right side of the stretcher, and No. 4 steps to the middle of the left side (fig. 28).
Leader: “To patient, forward—march.”
After reaching the patient, the bearers halt.
Leader: “Post to patient’s right (or left)—march.”
After placing the stretcher on the ground in line (parallel) with the patient, No. 3 takes his position on the appropriate side at the patient’s head, No. 1 at the patient’s hips, No. 2 at the patient’s ankles, and No. 4 on the opposite side of the patient at the hips (fig. 27). In placing the patient on the stretcher, the lift is to be made by the three men on the uninjured or less injured side.
Leader: “Prepare to lift—patient.”
Figure 28.—Preparing to lift patient.
Each of the four men kneels, No. 2 at the patient’s knees, No. 3 at the patient’s shoulders, and Nos. 1 and 4 at the patient’s hips on the opposite sides. Nos. 2,1 and 3 kneel on the knee nearest the patient’s feet. No. 3 places his hands under the patient’s neck and shoulders, No. 2 places his hand under the patient’s knees and ankles, while Nos. 1 and 4 place their hands under the patient’s pelvis and the small of his back (fig- 28).
Leader: “Lift—patient.”
The patient is slowly raised and supported on the knees of the three men (Nos. 2,1 and 3), and the other man (No. 4) places the stretcher under the patient (fig. 29). In injuries to the back or pelvis, lift the patient just high enough for the leader to slide a flat board or door (see page 73) under the patient.
STRETCHER TRANSPORTATION
67
Figure 29.—Patient resting on bearers’ knees; stretcher placed in position.
Leader: “Prepare to lower patient.”
The man who has placed the stretcher kneels and places his hands in position to support the patient.
Figure 30.—Lifting stretcher.
68 FIELD CARE AND TRANSPORTATION OF THE .INJURED
Leader.: “Lower—patient.”
The patient is gently and carefully lowered to the stretcher.
Leader: “Post to carry stretcher—march.”
The patient is usually carried on the stretcher feet first, the end at his feet being the front and the end at his head the rear. No. 3 takes his place at the rear end of the stretcher, No. 2 takes his position at the front end, and Nos. 1 and 4 stand on either side. Nos. 2 and 3 face each other, and Nos. 1 and 4 face each other.
Leader“Prepare to lift—stretcher.”
All stoop and grasp the stre.tcher, Nos. 2 and 3 by the handles and Nos. 1 and 4 by the sides (see fig. 30).
» Figure 31.—Carrying patient.
. Leader: “Lift—stretcher.”
The stretcher is gently and slowly raised. Nos. 1 and 4 shift one hand toward the front-of the stretcher and support this end, while No. 2 turns to the marching position (fig. 31). If the patient is suffering from severe bleeding of the head and must be carried up a steep grade on the stretcher, he should be carried head first, with No. 3 bearer leading.
Leader: “Forward—march.”
Nos. 1, 2 and 4 step off with the left foot, whereas No. 3 steps off with his right foot. This procedure prevents the stretcher from swaying.
In marching, when it is necessary to turn, the command is:
Leader: “Team right or left—march.”
STRETCHER TRANSPORTATION	69
When it is necessary to turn completely around or when an ambulance is approached from the rear:
Leader: “Team right about (or left about)—march.”
The squad makes a complete half turn about (180°) to the right or left.
Leader: “Team—halt.”
At the command “Halt,” each man takes an additional step forward and then brings the foot in the rear up to a heel-to-heel position with the foot that is forward.
Leader: “Prepare to lower—stretcher.”
Nos. 1 and 4 shift one hand toward the front of the stretcher and support this end, while No. 2 turns around, facing No. 3 and Nos. 1 and 4 take position facing each other.
Leader: “Lower—stretcher.”
The stretcher is then gently and slowly lowered to the ground.
b.	Loading a Stretcher with Three Bearers.
When only three bearers are available, all lift from the same side, one supporting the head and shoulders, one the waist and hips, the third the knees and ankles (fig. 32). They kneel, slip their hands under the patient, get a good hold and lift on command, resting the patient on their raised knees to get a better hold. Then, on the order “Lift—patient,” they rise to a standing position and walk to the stretcher.
c.	Loading a Stretcher with Two Bearers.
The stretcher is placed in line with the patient, preferably at his head; the two bearers stand astride the patient, facing the stretcher. The patient’s arms are folded across his chest if he is unconscious^ if he is conscious, he may be able to help, either by pressing up from the ground or by helping to lift himself by taking the leading bearer around the neck with one or both hands as he bends down. The bearers should bend together, lift the patient by the shoulders and thighs and shuffle forward, straddling the stretcher as they advance.
d.	Loading a Stretcher with Untrained Assistants.
If untrained persons must be used to load seriously injured persons onto stretchers, orders must be given clearly and explained carefully. If possible, use six or eight assistants who line up three or four to each side and move together upon orders from the leader:
(1)	“Kneel on the knee nearest the patient’s feet.”
(2)	“Slip your hands under the patient’s body until your fingers meet those of the man opposite you.”
70
FIELD CARE AND TRANSPORTATION OF THE INJURED
Figure 32.—Preparing to load a stretcher with three bearers.
(3)	“All together—lift.” The patient is lifted to the level of the knees, and another assistant slides the stretcher between the two rows of bearers. If no one is available to place the stretcher, the bearers will continue to lift until all are standing, and then step sideways to the stretcher, which has been placed at the feet of the patient.
STRETCHER TRANSPORTATION;	71
(4)	“All together—lower.” Gently and carefully, the patient is lowered to the stretcher.
e.	Transferring Patients from One Stretcher to Another.
When the transfer of a patient from one form of stretcher to another is necessary, the following movements will be carried out, upon orders from the leader
(1)	“Lower—stretcher.” The stretcher carrying the patient is lowered to the ground; Nos. 2 and 3 bearers will proceed to its right side and take up their positions alongside the No. 1 bearer.
(2)	“Face—stretcher.” All bearers turn toward the stretcher.
(3)	“Prepare to lift—patient.” They kneel on the knee nearest the patient’s feet and pass their hands beneath the blankets in which the patient is wrapped, No. 2 supporting the knees, Nos. 4 and 1 (by linking hands) the thighs and hips, and No. 3 the upper part of the trunk. Care must be taken not to disarrange the blankets.
(4)	“Lift—patient.” The patient is lifted onto the knees of Nos. 2, 1 and 3 bearers. No. 4 disengages, removes the stretcher and brings the second stretcher, places it on the ground in front of Nos. 2, 1 and 3 bearers, and resumes his position at the hips opposite No. 1.
(5)	“Lower—patient.” They. slowly lower the patient onto the second stretcher. The bearers then resume their original position, ready to lift the stretcher.
f.	Carrying Stretchers.
The bearers step off together with the inner foot, knees slightly bent, using short, shuffling steps. The party keeps out of step, which is more comfortable for the patient. If only two men can be spared to carry the. stretcher, the front man should step off with the left foot and the rear man with the right, thus being out of step. A stretcher should always be carried as nearly level as possible. This is not easy to do; inexperienced bearers find it difficult to prevent patients from sliding or rolling off stretchers.
As a rule, it does not matter whether a casualty is carried head first or feet first, but on a slope or stairs, it is more comfortable for him to be carried with his head higher unless there is some reason to the contrary. A casualty with head injuries should always be carried up or down stairs with the head elevated. However, a casualty with a fracture or wound of the lower limbs should be carried up or down stairs with the feet elevated.
Two men are needed at the lower end of the stretcher on stairs and hills. They should carry their end high enough that the patient is comfortable and does not tend to slide off.
72 FIELD CARE AND TRANSPORTATION OF THE INJURED
If a stretcher has to be carried over a wall or fence, the front handles of the stretcher should be rested on the obstruction and the stretcher held level by two bearers at the rear while two bearers cross the wall. All bearers then lift together, moving the stretcher forward until the rear handles can be rested on the wall, after which the stretcher is kept level by the bearers at the front end until the rear bearers cross the wall. A similar procedure is followed in passing a stretcher through a first floor window.
In crossing a wide ditch, lower the stretcher as near the edge as possible. Two bearers descend into the ditch. All four bearers, lifting together, move the stretcher forward until the rear handles can be rested on the near edge of the ditch. The bearers at the rear now enter the ditch. Again all working together, the stretcher is lifted until the front handles are resting on the far side. By similar movements the stretcher is lifted out of the ditch on the far side.
g.	Sliding a Stretcher.
It may be desirable to employ the technique of “sliding a stretcher” when moving a casualty through low narrow passageways or under circumstances when removal of the loaded stretcher can be expedited by sliding it along a ladder (see page 73). “Sliding a Stretcher” drills should be practiced for different situations.
It is emphasized that this method of moving a loaded stretcher should not be permitted unless the stretcher is supported by a bearer at the front end and guided by a bearer at the rear end; or supported on a skid which is under control at all times. The sag in the stretcher bed must be taken into account during this procedure so that it will not be permitted to strike obstructions such as might be present on surfaces over which the stretcher is being moved. Failure to take this precaution may result in further injury to the patient.
It is necessary that the patient be securely lashed to the stretcher when this method of moving a loaded stretcher is employed. The victim should be moved feet first.
h.	Lowering a Stretcher from a Height.
After lashing the casualty securely to the stretcher, it may be lowered:
(1)	Feet first by means of a supporting rope attached to the head of the stretcher which supports the weight of the stretcher and a guide rope to pull the foot of the stretcher away from the wall.
-(2) Horizontally by means of an improvised “derrick” or crane. The possibility that the stretcher may strike protrusions on the building
STRETCHER TRANSPORTATION	73
and be temporarily tipped on an end or side must be taken into account when this method is used.
(3)	By sliding along a ladder. This may be done safely with a ladder at any angle between 30° and 75°, provided the stretcher is carefully supported at the head (upper) end by hand or rope and guided at the foot (lower) end by a stretcher bearer.
i.	Shoulder Carry Drill.
(1)	“Halt.” The bearers halt upon the order.
(2)	“Face—stretcher.” They take their positions at the respective handles and face the stretcher.
(3)	“Kneel.” Each kneels and grasps a stretcher handle with both hands.
(4)	“To shoulder—lift.” They lift the stretcher gently and evenly onto their shoulders. When a stretcher is being carried on the shoulders, both hands are required to steady it. Padding over the shoulders is desirable.,
4.	INJURIES REQUIRING SPECIAL CARE IN MOVING.
a.	Fracture of Spine.
Casualties with broken backs and broken necks are so dangerously injured that they require special handling. Improper handling may result in permanent paralysis or sudden death by crushing of the spinal cord. Get a doctor, if at all possible, before moving such a casualty.
(1)	Broken Neck.—Keep the patient lying in the position in which he was found and prevent motion of the head. Do not give him water because he may move his head to drink. Do not move him until the doctor arrives.
If a patient with a broken neck must be moved to save his life before a doctor arrives, get a stretcher (or a door, shutter, or wide board), and place it alongside him with the end at least 4 inches above the top of his head. The board should be at least 15 inches wide and 5 feet or more long.	' -	".' ■ /
One person kneels at the patient’s head, holding the head between his hands, and steadies it so that the head, neck, and shoulders move as a unit with the body. One or more assistants grasp the patient’s clothing at the hips and shoulders and carefully slide him sideways onto the board or door so that he remains face upward, with arms at his sides, and his head, trunk, and extremities on the board. The head must not be raised or the neck bent forward or sideways. The arms may then be folded over the chest and held together by a bandage or with safety pins through the clothing.
537377°—43---------6
74 FIELD CARE AND TRANSPORTATION OF THE INJURED
Figure 33.—Carrying man with broken neck.
Several straps or cravat bandages should be placed around the patient and the board so as to hold him in place during transportation. A folded sweater or coat, or sandbags, should be placed on each side of his head to hold it in position. The board is then picked up and transported as a stretcher (fig. 33).
If a patient with a broken neck is found lying on his face, a door or wide board should be placed beside him as described above, and the arm at that side brought above the head. The person kneeling at the head grasps it firmly at the sides, covering the ear and the back end of the jaw with his hands. Assistants grasp the patient’s clothing at the shoulders and hips and gently roll him onto the board so that he lies on his back, the person at the head steadying the head so that it is kept in line with the rest of the body. The head must not be allowed to tilt either forward or backward or roll to either side. Sandbags properly placed about the head, neck and shoulders are of value in immobilizing the head.
(2)	Broken Back.—If, before a doctor arrives, it is necessary to move a patient with a broken back, who is found lying on his back, place a door or wide board beside him as described for casualties with broken necks. Raise the arm on the side toward the board so that it is straight above the victim’s head. Assistants kneel alongside the board opposite the victim and, grasping his clothing on the far side, roll him slowly and gently toward them so that he lies face downward on the board. If a door is used, the assistants kneel on the door, leaving enough space for the victim. In making this roll, the body must move as a unit. There should be no twisting or jerking. Then flex one forearm so that the head will rest on it (fig. 34).
If a casualty with a broken back is found lying on his belly, the door or board should be placed beside him. Assistants grasp his clothing and slide him onto the board, one person protecting his face.
STRETCHER TRÀNSPORTATKKNÌ	75
Figure 34.—Carrying man with broken back.
He remains in a face-down position. Several straps or bandages should then be placed around the patient and the board to bind him firmly in place during transportation.
Patients with broken backs should, if possible, be moved only on rigid supports. A blanket may be used if no rigid support is available and if the patient is carried on his belly.
If both the neck and back are broken, handle the casualty as if only the neck were broken.
In the case of doubt, handle a patient with a suspected fracture of the neck or back as if a fracture were actually present.
Never move a person, with a suspected fracture of the neck or back if it is possible to get a doctor, for movement may cause death The only justification is a precarious position of the patient; for example, proximity to a wall which is in danger of falling.
b.	Injuries to Head and Face.
Care must be taken that the injured part does not press against the stretcher. Casualties with severe injuries to the mouth and lower part of the face may need to be carried face downward, with the head hanging over the end of the stretcher in order to prevent choking by the tongue falling back in the throat or by bleeding. In this case the head must be supported in a sling formed by triangular bandages tied between the handles of the stretcher, and the casualty loaded feet first into the ambulance to avoid striking the face against the stretcher rack during loading.
c.	Injuries to Legs.
The casualty should be laid on his back, inclined toward the injured side. This position is less liable than others to cause motion of the injured limb during transport. A casualty who is in splints should, however, be placed flat on his back. Tying the legs together
76 FIELD GARE AND TRANSIPORTATTON OF THE INJURED
is a simple method of splinting an injured leg and is usually all that can be done under air raid conditions. Sandbags may be used for immobilizing injured arms and legs and should be carried in all ambulances. Only simple splints should be applied, except by physicians. Traction splints should be applied only by a physician and then only if the casualty is to be transported for several miles over rough roads.
In transporting a patient with a traction splint on a leg, the heel must not be allowed to touch the stretcher. Some traction splints have special rests which can be attached to them (fig. 35). If one of these rests has been attached, it will hold the heel above the stretcher. If no rest is available, the lower end of the splint should be suspended from the roof of the ambulance by a stout cord.
d.	Injuries to Arms.
If the patient is unable to walk or ride sitting, he should be placed on his back or on the uninjured side, as there is less liability of displacement of a broken bone. The arm may be bound to the side of the body or a simple side splint applied.
e.	Chest Injuries.
Casualties should be placed with chest well raised, the body being inclined toward the injured side. This tends to relieve difficult breathing.
f.	Internal Injuries.
Persons with internal injuries are generally more comfortable if they are placed on their backs with their knees flexed. A folded blanket or coat should be placed under the knees to support them. No attempt should be made to replace protruding organs. They should be covered with sterile gauze and a physician’s services obtained, if possible, before the patient is transported.
g.	Fractured Pelvis.
A person with a fractured pelvis should be transported on his back, with the legs straight. A wide cravat bandage should be placed around the body at the hips and tied firmly. Both knees and both ankles should be tied together before the victim is moved.
h.	Asphyxia.
A person who has stopped breathing must be made to breathe at once or he -will die. Time must not be wasted in unnecessary procedures. Artificial respiration must be started at once. When possi-
STRETCHER TRANSPORTATION	77
Figure 35.—Stretcher and casualty with traction splint.
ble, artificial respiration should be begun where the casualty is found. This may not be practical if, for instance, the victim is in an atmosphere containing carbon monoxide, or if he is near a collapsing wall. He should not be moved again until he is breathing normally, and then only in a recumbent position. After apparent recovery, the casualty must be carefully watched because he may stop breathing again, in which case artificial respiration must be resumed immediately. ■
78
FIELD CARE AND TRANSPORTATION OF THE INJURED'
IMPORTANT.—An unconscious person who is breathing shallowly does not need artificial respiration. Also, a person who has inhaled war gas and who acts as if he were suffocating must not be given artificial respiration so long as he is able to breathe. He must be kept absolutely quiet, and a physician or an ambulance should be summoned. A person breathing with difficulty may have an obstruction in the throat and nose, such as plaster or dirt, which only needs removal.
i.	Casualties with Tourniquets.
Tourniquets must be loosened briefly every 15 to 20 minutes and reapplied if profuse bleeding recurs.
5.	ACTION BY STRETCHER BEARERS IF EXPOSED TO WAR GAS.
On encountering gas, the bearers halt and lower the stretcher to the ground as rapidly as possible. All the bearers, and the casualty if he is able, put on their masks. If the casualty is unable to put on a mask, one should be put on by whichever bearer has first adjusted his own. If the casualty has been contaminated by liquid vesicant gas, his eyes must be thoroughly irrigated and his face cleansed before the mask is applied. Care should be taken to insure that the lower part of the facepiece is well under the patient’s chin before the head harness is drawn over the head.
Head bandages should be removed to insure gas-tightness of the mask, if this can be done with safety. Gas-tightness of the mask is obtained by insuring contact between the fitting surface of the facepiece and the skin which lies over the bony structure of the forehead, cheeks, and chin. Should it be absolutely necessary to place or leave a dressing on a wound over these parts, the minimum thickness should be used. It may be necessary to remove some of the thickness from ready-made pad dressings. It will be found that by adjusting the tension of the head harness, applying' the dressing and gradually tightening the head harness, the mask itself will retain the dressing. When an unconscious person is wearing a mask, it should be inspected frequently to see that he is getting enough air.
If available, a surgical or tracheotomy helmet (identical with infant respirator) is a convenient and safe way to protect casualties, injured about the head and neck, from war gases. When such a device is used, it is necessary for an attendant to supply adequate amounts of air by continuously operating the bellows attachment.
CHAPTER If
Carrying Casualties Without Stretchers
Injured persons can be carried in several ways if no stretcher is available or if it is impossible to use a stretcher. One-man and two-man carries are limited to short distances. Two bearers are rapidly fatigued when carrying a patient of average weight.
The one-man lifts and carries are dangerous for both patient and bearer and should not be used if it is possible to wait for help. They should be discouraged, even in practice, but they may be necessary in confined or very dangerous locations where only one person can reach the casualty. They must not be used for persons having or suspected of having back or neck injuries or fractures.
1.	ONE-MAN CARRIES.
a.	Pick-a-Back.
Carry casualty in the ordinary pick-a-baick position. This is the best way if he is conscious and able to hold on.
b.	The Fireman’s Carry (fig. 36).
A way of carrying a helpless or unconscious patient which allows the bearer a free hand is the fireman’s carry. It is easier for the bearer than pick-a-back, but not so comfortable for the patient. First roll him onto his face, keeping his arms to his sides. Stand at his head, put your hands under his shoulders and raise him to a kneeling position or get someone to help. Now put your hands under his armpits, and raise him up a little. Stoop, place your head under his right arm, put your own right arm between or round his legs, bring his weight well on to your shoulders, grasp his right wrist with your right hand, and rise. Shift the weight well up on to the back of the neck.
79
80
FIELD CARE AND TRANSPORTATION OF THE INJURED
Figure 36.—The fireman’s carry.
CARRYING CASUALTIES WITHOUT STRETCHERS	81
c.	Pack-Strap Carry (fig. 37).
This is a valuable carry when, the patient’s injuries do not prohibit its use. A bearer can carry a greater weight with safety this way than by any other carry.
Figure 37.—Pack-strap carry.
The patient’s arms are brought across the shoulders of the bearer. Great care must be taken that the patient’s armpits are well up on the bearer’s shoulders. The arms are crossed in front, where they may be held in place by one of the bearer’s; the other hand is thus left free. When the bearer bends forward, the patient will be suspended by his arms over, the bearer’s shoulders, and the bulk of his weight falls on the bearer’s back.
82 FIELD CARE AND TRANSPORTATION OF THE INJURE»
d.	Fireman’s Drag (fig. 38).
This technique is useful in rescue work where smoke or wreckage prevents use of other methods. Tie the patient’s forearms together. The rescuer straddles the patient, passes his head between the arms, raises the patient’s head and shoulders just off the floor, and crawls out, dragging the patient.
Figure 38.—Fireman’s drag.
An alternate method is for the bearer to get hold of an arm or the clothing and drag the patient along the floor without attempting to crawl over him.
e.	Carry in Arms (fig. 39).
Lift the patient by passing one arm beneath his knees and the other round his back. The arms must be placed well under before commencing to lift.
CARRYING CASUALTIES WITHOUT STRETCHERS
83
Figure 39.—Carry in arms.
2.	TWO-MAN CARRIES.
a.	The Two-Handed Seat (fig. 40) (for a patient who cannot assist the bearers).
Two bearers face one another on either side of the patient and stoop. Each bearer passes his’ arm nearest the patient’s head under the patient’s back just below the shoulders and each grips the other bearer’s shoulders. They raise the patient’s back and slip their arms under the middle of his thighs, clasping their hands with a hook grip. The bearers rise together and step off with short steps.
b.	The Four-Handed Seat (fig. 41) (for a patient who can assist bearers).
Two bearers face each other and grasp their own left wrists with their right hands. Their hands are then put together, the free left hand of each grasping the right wrist of the man opposite. The patient puts one arm or both arms around the necks of the two bearers.

84 FIELD CARE AND TRANSPORTATION OF THE INJURED
Figure 40.—The two-handed seat.
Figure 41.—The four-handed seat.
CARRYING CASUALTIES WITHOUT STRETCHERS
85
c.* The Fore-and-Aft Carry (fig. 42).
The patient is placed on his back. One bearer raises the shoulders and passes his hands under the arms from behind, clasping them in front of the chest while the other bearer takes one leg under each
I
Figure 42.—The fore-and-aft carry.
arm. The patient is carried feet first. If a leg is broken and a better method of moving cannot be used, both legs should be tied together or put in splints and carried together under one arm.
86 FIELD CARE AND TRANSPORTATION OF THE INJURED
3.	THREE-MAN CARRY.
When three bearers are available, all lift from the same side, one supporting the head and shoulders, one the waist and hips, the third the knees and ankles. They kneel, slip their hands under the patient, get a good hold and lift on command, resting the patient on their raised knees to get a better hold, and then rise to a standing position. To carry, the patient is then turned on his side and clasped to the bodies of the bearers.
CHAPTER III
Ambulance Transportation
1.	ORGANIZATION OF THE AMBULANCE SERVICE.
The Chief of Emergency Medical Service is responsible for directing necessary motor transportation of casualties. All available ambulances with their drivers and attendants must be under his control at the time of a disaster.
The local Transport Officer on the Staff of the Commander of the U. S. Citizens Defense Corps maintains' current inventories of all equipment (other than busses and trucks of the larger fleet owners) usable by the local U. S. Citizens Defense Corps in Fire, Police, Warden, Emergency Medical, or other protection services. This equipment includes passenger cars, station wagons, taxicabs, motorcycles, ambulances, trucks of small operators and miscellaneous units. He also organizes volunteer driver units. The local Chief of Emergency Medical Service, or an Ambulance Officer appointed by him, should call on the Transport Officer for permanent assignment to the Emergency Medical Service of adequate numbers of vehicles of types appropriate for the transport of stretcher and sitting patients and medical personnel and supplies. Assignment of the personnel necessary to man these vehicles should also be requested, unless available in hospitals at which ambulances are parked.
A driver and an attendant for each ambulance should be trained and enrolled as members of the Emergency Mediqal Service.
The training requirements for membership in the Citizens Defense Corps are listed in Regulations No. 3, U. S. Citizens Defense Corps (as amended August 1943). Ambulance and sitting-case car drivers and attendants must complete an approved basic first aid course before enrollment. Further instruction should be given by the Emergency Medical Service on the advanced material in this manual10 after enrollment. Attendants require the same training as drivers so that they may serve interchangeably.
The recommended ambulance carrying capacity provided for air raid protection in communities in target areas is one stretcher per 2,500 population. On the same basis, passenger cars or station wagons
10 Appendix A.
*	87
88 FIELD CARE AND TRANSPORTATION OF THE INJURED'
should be supplied for the transportation of sitting.cases. Experience indicates the need of providing for as many sitting cases as stretcher patients.
British experience shows that only four-stretcher ambulances can be used efficiently for transporting numerous casualties. Small commercial trucks have proved to be undependable in emergencies. Most air raids occur at night when such trucks are stored in company garages and the drivers are scattered throughout the city. Trailer ambulances have also proved to be inefficient and cumbersome at incidents and their use has been abandoned.
The Medical Division of the United States Office of Civilian Defense has designed for the Emergency Medical Service a four-stretcher ambulance body which can be mounted on the chassis of popular-priced passenger cars (see p. 6). Each exposed city in the target area requires at least one four-stretcher ambulance for each 25,000 to 50,000 residents in addition to the one-stretcher and two-stretcher vehicles available in the community.
If commercial vehicles are used as emergency ambulances, they should be long enough to accommodate standard Army stretchers. Two or three inches may be cut from the handles of stretchers if necessary fbr their accommodation in emergency vehicles. Improvised ambulances should be well sprung and should have enclosed bodies with a means of communication between the driver’s seat and the stretcher compartment. The motor exhaust system should be tight, and the vehicle should be well ventilated to avoid carbon monoxide poisoning.
Various types of stretcher supports may be improvised for converted ambulances. Racks which stand on the floor are preferable to those which are suspended on straps from above. A simple stretcher rack design is described in the Emergency Medical Service ambulance specifications.
Excessive speed, which is often considered an important factor in the selection of a peace-time ambulance, is inexcusable in casualty ambulance driving, both because of road hazards under air raid and blackout conditions, and because of the discomfort and danger to the injured induced by high speeds. Generally speaking, ambulances carrying casualties should not exceed fifteen miles an hour. While greater speeds on good roads may not appreciably increase the discomfort of patients, sudden application of the brakes may produce undesirable effects.
For the transfer of patients from Casualty Receiving Hospitals to Emergency Base Hospitals, larger trucks and busses capable of carry
AMBULANCE TRANSPORTATION	89
ing more persons are desirable. Ambulance trains may be used for the mass transfer of patients to distant base hospitals. Provision of adequate transportation for the movement of patients from one community to another within the State is the responsibility of the State Chief of Emergency Medical Service through the State Transport Officer. Movement between States will be arranged through the Regional Medical Officer and the Regional Office of Defense Transportation.
Insofar as possible, ambulance depots should be located at Casualty Receiving Hospitals ; at least one four-stretcher ambulance should be assigned to each hospital. Additional ambulance depots may be needed in each Control Area, preferably located at or near Casualty Receiving Hospitals. Ambulances and passenger cars attached to hospitals or medical headquarters are available for transporting Mobile Medical Teams to incidents as well as for transporting casualties from incidents to hospitals.
Drivers and attendants should live near the place where the vehicles are garaged and should be ready for prompt service. A team of alternates should also be assigned for times when the driver and attendant are not available. It is desirable to park ambulances and sitting-case cars at hospitals because drivers and attendants from the hospital’s staff are always available, day or night.
Ambulances used for the transportation of gas casualties should have interiors which can be washed with a strong solution of chlorinated lime or sodium hypochlorite. They should preferably, therefore, have all-metal bodies or interiors painted with silicate paint. The driver’s compartment should be separated from the patients’ compartment. If possible, stretchers and stretcher racks installed in these ambulances should be made of metal so that they can be readily decontaminated.
In emergencies, ambulance interiors can be protected with gas-proof or heavy building paper which can be destroyed by burning if contaminated.
2.	EQUIPMENT OF AMBULANCES.
The following equipment should be carried in each four-stretcher
ambulance when in action:
Double stretcher racks_______________________________________ 2
Stretchers____________________2______________________________ 4
Blankets (rolled up in pairs and placed on stretchers
for use)_________________________________________ 8
Sandbags_____________________________________________________ 4
537377°—43------------7
90 FIELD CARE AND TRANSPORTATION OF THE INJURE» Protective clothing, including masks, footwear,
gloves, etc., sets_______________________________ 2
Hot water bottles or chemical heat pads with covers 4
Drinking Water bottles_____________________________ 2
Flashlights---------------------------------------- 2
List of Casualty Receiving Hospitals_______________ 1
List of addresses of Casualty Stations------------- 1
Street map of city_________________________________ 1
Kidney basin_______________________________________ 1
Slop pail__________________________________________ 1
Fire extinguisher (carbon tetrachloride type)-----	1
Rope, 40-foot length of 14-inch sash cord---------- 1
The ambulance attendant is responsible for the following:
a.	General care of interior equipment.
b.	Filling hot water bottles or chemical heating pads on a “blue” warning and placing one or more in each roll of two blankets.
c.	Insuring that bottles or chemical heating pads remain in the ambulance at the incident, are placed in position as required when the ambulance is loaded, and are refilled as circumstances permit.
Sandbags are to be used to provide support for fractured limbs. It is not intended that they should be used in place of splints except in cases where splinting cannot conveniently be carried out, e. g., in the case of a broken neck.
Equipment need not be kept in the vehicles when at the depot; it should, however, be placed in the ambulance when a “blue” warning is received. The driver and attendant should carry gas masks and first aid pouches and should wear steel helmets, if available.
3.	OPERATION OF AMBULANCES.
a.	Action on Receipt of an Alert.
On the “blue” signal, attendants should see that all equipment is placed in ambulances if not already in position. Drivers should start engines and run them long enough to insure proper functioning. They should also make sure that their vehicles carry suitable identification to facilitate passage in an emergency and that headlight masks are in working order.
At the “red” signal, drivers and attendants stand by for further instructions.
b.	Action on Receipt of a Dispatching Order.
Drivers of ambulances and of sitting-case cars should be given written instructions of destination, route to incident and information concerning road blockages.
AMBULANCE TRANSPORTATION
91
On the way to the incident, the attendant should ride in the front part of the ambulance beside the driver and assist him to find the way. Whenever it is necessary to reverse the vehicle, he should get out and direct the driver when turning or backing. In an emergency the attendant substitutes for the driver.
Ambulances should not travel in convoy unless sent to another area for mutual assistance. If one ambulance is following another, drivers should maintain a safe distance between vehicles. They should obey signals from regular and Auxiliary Police and Wardens, and stop if directed.
Drivers and attendants must not allow themselves to be diverted from the incident to which they have been ordered. They should not stop for other casualties when transporting injured from an incident to a hospital.
c.	Action on Arrival at Incident.
Drivers must approach an incident slowly and obey any direction given by regular or Auxiliary Police, Wardens, or the Incident Officer as to parking. They work under the general supervision of the physician at the incident.
On arrival at an incident, ambulance and sitting-case car drivers should report at once to the Warden, or the Incident Officer if one is present. Instructions should be obtained from him as to the parking and loading point. They then return to their vehicles and await a signal to proceed to the loading point.
d.	Loading Points.
Loading points for casualties should be selected, if possible, to avoid the necessity for reversing the vehicle. When ordered to the loading point, drivers should turn their vehicles so that they face in the direction in which they will proceed after loading.
4.	LOADING THE AMBULANCE
a.	General Instructions.
At the incident, the driver and attendant must be ready to remove stretchers from the ambulance so that empty racks are available for the reception of casualties. Stretchers and blankets removed should be placed at the side of the ambulance where they will not impede loading.
Casualties should usually be loaded into an ambulance head first. They should be loaded in the following order when three or four stretcher cases are to be carried in one vehicle:
(1)	Upper rack away from curb.
(2)	Upper rack near curb.
92
FIELD CARE AND TRANSPORTATION OF THE IN JURE©
(3)	Lower rack away from curb.
(4)	Lower rack near curb.
If a casualty is brought to the ambulance by only two persons, the driver and attendant should assist in loading by taking the foot of the stretcher. The two bearers then take the head of the stretcher at either side.
The attendant should always secure the stretcher in the ambulance as soon as it has been placed in position. He should ascertain from the physician or Rescue Squad Leader at the scene the nature of the injuries of the casualties placed in the ambulance, particularly whether a tourniquet has been applied and whether there is danger of hemorrhage.
The attendant should see that a stretcher and two blankets are exchanged for each stretcher and two blankets loaded into an ambulance with a casualty. At the hospital he should, in turn, receive a stretcher and two blankets in exchange for each loaded stretcher which he leaves.
b.	Loading an Ambulance with Four Bearers.
The method of loading will depend on the type of rack in the vehicle. Upon the order (1) “lower stretcher,” the stretcher is lowered to the ground in line with the vehicle, the patient’s head to the front. After the team leader has made certain that the stretcher racks in the ambulance are clear and in proper position, he gives the order (2) “face— stretcher,” and the four bearers turn inward, each opposite a stretcher handle, so that Nos. 1 and 2 face each other and Nos. 3 and 4 face each other. At the order (3) “lift—stretcher,” they lift the stretcher together, and upon the order'(4) “load—ambulance,” they slide it into the racks, assisted when necessary by the ambulance driver and attendant.,
The most awkward rack to load, generally the upper rack, should be loaded first unless there are reasons to the contrary. In loading the upper rack, the stretcher is lifted to shoulder height, and the front handles are rested on the end of the tracks. The front bearers then face the stretcher and shift their holds back a few inches on the stretcher frame. They then lift the stretcher and place the front stirrups on the tracks. The rear bearers then push the stretcher into the rack. Under certain circumstances, it may be desirable to place a loaded stretcher directly into the ambulance without first lowering it to the ground.
The ambulance attendant should see that the stretcher is secured and that the patient is as comfortable as possible and well wrapped before the ambulance moves. Whenever possible, the attendant should travel inside the ambulance with his patients. If the attendant has to ride in the driver’s compartment, it is essential that
AMBULANCE TRANSPORTATION
93
means of communication between him and the patients exist. This may entail the provision of an opening in the partition between the front seat and the interior of the vehicle.
c.	Unloading an Ambulance with Four Bearers.
The reverse of the procedure for loading described in & is followed.
d.	Loading an Ambulance with Two Bearers.
Two persons should not attempt to load or unload an ambulance unless no help is available. Usually a four-man loading team can be formed by using the ambulance driver and attendant. There is, however, an emergency method of loading stretchers into the lower rack of an ambulance when the two persons available are unable to place the forward stretcher stirrups directly in the ambulance tracks. This is described as follows:
(1)	The stretcher should be placed at the rear of the ambulance in line with the lower rack selected for loading and with the head of the patient toward the ambulance.
(2)	The patient should be securely fastened to the stretcher to prevent him from sliding when the stretcher is tilted during loading.
(3)	Two bearers then take positions at opposite sides of the stretcher. They then lift the head end of the stretcher, draw the handles forward and rest them on the floor of the ambulance.
The handles are again lifted and the foot of the stretcher drawn forward until the ends of the handles rest on the ends of the tracks of the lower rack.
(4)	One of the bearers now moves to the foot of the stretcher, keeping his hands on the side nearer to him to prevent it from slipping; the other remains at the head of the stretcher holding it in position.
(5)	The bearer at the foot of the stretcher now lifts that end and pushes it forward so that the handles slide along the tracks of the berth, guided by the bearer at the head of the stretcher.
(6)	Both bearers then raise the foot of the stretcher above the level of the rack so that the weight of the stretcher is supported on the tips of the handles at the head end; now the stirrups of the stretcher will slide easily onto the tracks. When the stirrups of the stretcher are engaged in the tracks, the stretcher should be made level and pushed slowly into position.
e.	Unloading an Ambulance with Two Bearers.
(1)	The stretcher should be drawn out until the forward stirrups are almost at the end of the tracks.
94
FIELD CARE AND TRANSPORTATION OF THE INJURED
(2)	The foot should now be tilted upward until the weight is supported by the handle ends at the head of the stretcher, then drawn slowly outward until the stirrups have just cleared the ends of the tracks. The stretcher will then be lowered at the foot end until the rear handles rest on the ground while those at the head end remain on the ends of the tracks of the rack. One bearer should go to the head of the stretcher and hold it securely; the other bearer will take a position opposite him*.
(3)	Both bearers lift the head of the stretcher from the end of the tracks and swing it around until it is clear of the ambulance, the foot of the stretcher remaining on the ground. The head of the stretcher is then lowered gently to the ground.
5.	ACTION IF WAR GASES ARE USED.
a.	The Control Center should inform the ambulance driver of the presence of war gas when dispatching ambulances to incidents. Instruction for avoiding areas of contamination should be given, as far as possible.
b.	When available, metal stretchers should be used in transporting gas casualties, Extra gas masks for such injured casualties as may require them should be supplied to ambulances dispatched to incidents where gas is known to be present. . Tracheotomy or surgical helmets (identical with infant respirator) should be placed in ambulances dispatched to gassed areas.
c.	Drivers and attendants should put on protective clothing before leaving the ambulance depot for an incident if the presence of persistent gas at an incident has been reported. It should not be buttoned up until the contaminated area is reached.
d.	Civilian gas masks should be carried but not worn until the > presence of war gas is suspected or detected.
e.	Drivers and attendants should immediately put on gas masks and protective clothing if informed of the presence of persistent gas when they arrive at an incident. If persistent, gas is encountered or reported to an ambulance party while en route to an incident, arrangements should be made to change into protective clothing at a convenient house or building. Clothing left behind should be put in charge of the police or Wardens, who will arrange for its return. Protective clothing should not be buttoned up until the contaminated area is reached.
f.	Whenever possible, an ambulance should approach the gassed area from upwind. The driver must consult available Wardens, police or Incident Officers to be sure that any necessary detour is made so that arrival at the incident may be “with the wind” and to be sure that the vehicle is not exposed to heavy contamination.
AMBULANCE TRANSPORTATION
95
g.	If a contaminated casualty is placed in an ambulance, a yellow disk denoting contamination should be displayed on each end of the ambulance.
h.	Noncontaminated casualties should not be placed in the same ambulance with contaminated cases or in one previously used for contaminated cases.	•
i.	Drivers should take contaminated cases only to hospitals known to have cleansing facilities.
j.	Sitting-case cars should not be used for transporting contaminated casualties unless absolutely necessary.
k.	Upon arrival at Casualty Receiving Hospitals, attendants should exchange contaminated stretchers and equipment for clean equipment.
1.	Drivers and attendants should follow local instructions for cleansing themselves and their vehicles when gas casualties have been handled.
6.	DISPOSITION OF CASUALTIES.
The ambulance driver should report to the incident physician, Incident Officer, or to the Warden if no Incident Officer is present, when he leaves the scene of an incident.
Unless instructed differently by the incident physician at the scene or by the Incident Officer, ambulances and sitting-case cars will take casualties to the hospitals from which they were dispatched. Situations which might cause such orders to be given are :
a.	Another hospital is nearer.
b.	Another hospital is more accessible as a result of road blockage, etc.
c.	Receiving capacity of parent hospital is known to have been reached or almost reached.
Large numbers of casualties from large incidents should be divided among hospitals of about equal accessibility.
If a driver arrives at a hospital which cannot accept any more casualties, officials there should give him instructions in writing, based on information received from the Control Center, as to where to proceed with his load. When the driver returns to the incident, he should advise the Incident Officer.
If a hospital is unable to indicate other hospitals to which casualties can be conveyed, the driver and attendant must decide where to take casualties. Reference should be made to a map and list of Casualty Receiving Hospitals, provided by the Chief of Emergency Medical Service.
The attendant should direct the attention of a responsible officer at the hospital to any casualties in his ambulance load who require priority treatment.
96 FIELD CARE AND TRANSPORTATION OF THE INJURED
After delivering casualties to hospitals, drivers should immediately return to the incident unless they have been told by the Incident Officer that their services are no longer required. In the latter case they return to their hospital or depot, report their availability to the Control Center, and awajt further orders.
•Ambulance attendants and drivers of sitting-case cars should keep a record of the number of casualties transported by them and the places to which they are taken. Men, women, and children (under 12 years of age) should be recorded separately.
APPENDIX A
Schedule of Training Based on This Manual
The training schedule outlined below is intended for advanced training of ambulance drivers and attendants, Rescue Squad workers, stretcher bearers and other medical auxiliaries after their enrollment in the Citizens Defense Corps. Satisfactory completion of an approved basic first aid course is a prerequisite for enrollment.
Although much of the material in this manual is in the nature of a review of first aid, special attention has been given to its practical application to air raid conditions. The number of hours indicated in the following schedule represents the minimum; the training may be extended advantageously over a longer period. Practical training by exercises and drills in emergency field care and transportation of the injured should be continued after completion of the course.
Part I. Organization of Civilian Defense (Review)_______2 hours Part II. Emergency Field Care:
Chapter I, General Instructions; Chapter II, Principles of Bandaging; and Chapter III, Injuries and Conditions Encountered in Air Raids and Other
Wartime Disasters____________________ 5 hours
Chapter IV, Marking of Casualties and
Disposal of the Dead_________________ 1 hour
• Chapter V, Methods of Blanketing a Casualty; and Chapter VI, Methods of Lashing Casualty to a Stretcher__________4 hours
Total------------;_________________i_____ 10 hours
Part III. Transportation of the Injured:
Chapter I, Stretcher Transportation.
Section 1,	General Principles; and
Section 2,	Stretchers_____________ 1 hour
Section 3,	Stretcher Bearing and Drill;
Section 4,	Injuries Requiring Special
Care in Moving; and Section 5, Action by Stretcher Bearers if Exposed to Gas--------------------------------5 hours
97
98 FIELD CARE AND TRANSPORTATION OF THE INJURED
Part III. Transportation of the Injured.—Continued.
Chapter II,	Carrying Casualties Without Stretchers_______________1________2 hours
Chapter III,	Ambulance Transportation.
Section 1, Organization and Operation of the Ambulance Service; Section 2, Equipment of Ambulances; and Section 3, Operation of Ambulances_____2 hours Section 4, Loading the Ambulance;
Section 5, Action if War Gases Are Used; and Section 6, Disposition of Casualties_____2_‘________________ 2 hours
Total
12 hours
Grand total
24 hours
Stretcher and ambulance loading drills should be repeated frequently. After a satisfactory degree of efficiency is attained, combined or inter-service training involving the cooperation of various parties with other organized protection services is essential.
APPENDIX B
Stretcher Teams of the Emergency Medical Service
(OPERATIONS LETTER NO. 134)
The Rescue Service of the Citizens Defense Corps is responsible for extrication of trapped casualties at incidents where there are no fires. At incidents in which the majority of casualties are trapped or buried, the Rescue Squads of this Service will assume the duties previously assigned to Stretcher Teams, in addition to performing the technical rescue work. (Operations Letter No. 133, “Organization of Rescue Service.”)
Stretcher Teams, however, remain an essential part of the Emergency Medical Service. They have the following important functions :
(a) Assisting medical personnel at Casualty Stations in handling and non-professional care of minor casualties;
(Z>) Unloading ambulances and assisting in reception of casualties at hospitals, conducting the exchange of stretchers and blankets in order that ambulances may leave hospitals properly equipped;
(c)	Assisting Mobile Medical Teams in handling casualties;
(d)	Performing rescue work at incidents not requiring specialized Rescue Squads;
(e)	Assisting Rescue Squads at major incidents at which many casualties are trapped.
The Chief of Emergency Medical Service should appoint a deputy charged with responsibility for the organization and training of Stretcher Teams.
Team Organization.
A Stretcher Team is composed of a leader and four other persons, preferably men or older boys, one of whom is designated as assistant leader. Team members are derived from the immediate neighborhood of the facility to which the team is attached. No member of a hospital staff who has any maintenance function should be selected for duty on a Stretcher Team.
99
100 FIELD CARE AND TRANSPORTATION OF THE INJURE©!
Number of Stretcher Teams Attached to EMS Facilities.
Stretcher Teams should be attached to each Casualty Receiving Hospital and each Casualty Station. The number of teams attached to a Casualty Receiving Hospital should be determined in consultation with the administrator of the hospital, and should be based on the number of casualties the hospital is prepared to receive and the nature and extent of the duties the administrator expects team members to perform. The group attached to a Casualty Station should consist of two teams on call during the day and two on call during the night. On the basis of a previous Office of Civilian Defense recommendation, there should be one Casualty Station for each 25,000 persons and they need not be nearer than a mile apart (Circular, Medical Seris, No. 23).
Group and Team Leaders.
Stretcher Teams attached to any single facility of the Emergency Medical Service should be organized under a group leader. Group leaders are responsible, under general direction of the Chief of Emergency Medical Service, for the organization and training of teams in their groups. They will conduct and supervise such drills as may be necessary; arrange hours on call; maintain rosters of teams and team members.
Group leaders will be appointed by the Chief of Emergency Medical Service. Team leaders will be responsible to group leaders for the organization and efficiency of individual teams. Leaders should be selected so far as possible,-from employees or residents of the building in which the facility to which they are attached is located. Both group and team leaders should be trained in first aid and stretcher techniques. Group leaders should, if possible, have had experience in teaching first aid.
Mobilization.
Mobilization of Stretcher Teams on call occurs on the first audible public alarm. Mobilization of additional teams should be effected as these teams are needed or upon order of the control center. This mobilization should be accomplished rapidly according to a predetermined mobilization plan without recourse to public communication facilities and without requiring use of motor vehicles.
Control and Authority.
Stretcher Teams attached to Casualty Receiving Hospitals are responsible to the administrator of the hospital and are directed by him or such person as he designates. Team's attached to Casualty Stations are responsible to the administrator of the hospital to which the Casualty Station is related or to the physician in charge of the Mobile Medical Team at the Casualty Station when it is activated. At Cas
STRETCHER TEAM OF THE EMERGENCY MEDICAL SERVICE 101
ualty Stations not related to hospitals, Stretcher Teams are responsible to the physician in charge of the Station.
At incidents, Stretcher Teams are responsible to the physician in charge at the scene. If no physician is present, Stretcher Teams are responsible to the leader of the Rescue Squad, if such a squad is on hand; otherwise, directly to the Incident Officer or Senior Warden.
When needed in the field, Stretcher Teams will be dispatched from Casualty Stations and Casualty Receiving Hospitals on orders from the Control Center. For incidents in the immediate vicinity of a hospital or Casualty Station, the physician in charge of a Mobile Medical Team may send forward a Stretcher Team to the incident on his own initiative.
Training.	•
(«) Pre-induction.—To qualify for appointment to the Medical Unit of the Citizens Defense Corps stretcher team members must . meet the requirements of OCD Regulations No. 3, U. S. Citizens Defense Corps, by completing the basic 20-hour Red Cross first aid course for civilian defense workers (Instructors Manual, ARC 1055) or the standard Bureau of Mines first aid course. If a Red Cross or Bureau of Mines instructor is not available, the course may be given by a qualified person certified by the Chief of Emergency Medical Service as an instructor.
(5)	Post-induction.—After enrollment in the U. S. Citizens Defense Corps as members of Stretcher Teams of the Emergency Medical Service, training is to be continued under general direction of the Chief of Emergency Medical Service in accordance with the training schedule outlined in this textbook.
APPENDIX C
Organization of Rescue Service
(OPERATIONS LETTER NO. 133)
In accordance with the program announced in Operations Letter No. 102, the following organization is outlined for the Rescue Service:
1.	Responsibility.—Rescue in burning buildings must continue to be the responsibility of the organized Fire Services. The recovery of survivors and dead trapped under the structural debris of demolished buildings is the responsibility of the Rescue Service of the U. S. Citizens Defense Corps.
2.	Rescue Section of the Medical Division.—An engineer officer of the U. S. Public Health Service, formerly of the Bureau of Mines, has been designated Chief of the Rescue Section of the Medical Division, U. S. Office of Civilian Defense.
3.	Regional Rescue Officers.—Other mining engineers with rescue experience and commissioned in the U. S. Public Health Service will be assigned as Rescue Officers to the Civilian Defense Regions in the target areas to assist States and local communities in organizing and training the Rescue Service.
4.	Cooperation with Emergency Medical Service.—At the State and local levels, the Rescue Service is to be independent of the Emergency Medical Service but will cooperate with it closely . The Rescue Service is responsible for extricating trapped persons and cooperates with mobile teams of the Emergency Medical Service in handling casualties in the field.
5.	State Chiefs of Rescue Service.—State Directors of Civilian Defense are urged to appoint mining or civil engineers familiar with mining or construction work as Chiefs of Rescue Service of their States. It is the responsibility of the State Chief of Rescue Service to assist local Directors of Civilian Defense in selecting qualified safety engineers or structural experts trained in rescue work to serve as local Chiefs of Rescue Service.
6.	Local Chiefs of Rescue Service.—The local Chief of Rescue Service, or his deputy, is a member of the staff at the control center; during an air raid or other wartime disaster, he is responsible under the Commander for dispatching Rescue Squads to incidents. He is responsible for the training and discipline of Rescue Squads.
The Chiefs of the Emergency Medical and Rescue Services, through coordinated action in the control center, should dispatch an Express
102
ORGANIZATION OF RESCUE SERVICE	103
Party (one Rescue Squad, one ambulance, one Mobile Medical Team, and one passenger car or station wagon) to an incident when trapped persons are reported in a demolished building. Dispatch of additional units is to be deferred until requested through the incident officer or warden by the leaders of the Mobile Medical Team or Rescue Squad at the incident.
7.	Rescue Squads.—The personnel of the Rescue Service is best recruited from workers in the building and demolition trades, mechanics, mine workers, petroleum industry workers, and tunnel workers in the heavy construction industry. The Volunteer Office should assist in recruitment. The members of the Rescue Service are to be organized into squads of 10, of whom one is to be the leader, one assistant leader, and one driver of the truck. The driver should be responsible also for the rescue equipment of the squad.
It is desirable that the Fire Service maintain its own professional rescue squads for duty in connection with fires. Where an extensive volunteer rescue organization has been developed under the Fire Service, this should be transferred to the Rescue Service.
Where Stretcher Teams are constituted of persons especially fitted for rescue work, it may be desirable to effect a transfer of such persons to the Rescue Service. At the same time, an effective Stretcher Team organization, as described in Operations Letter No. 134, must be maintained and strengthened as an essential part of the Emergency Medical Service. Local Commanders will direct local Chiefs of Service in effecting such reorganization and transfers as may be necessary.
8.	Heavy Rescue Equipment and Personnel.—There is no reason for distinction between light and heavy Rescue Squads. The Rescue Service will call upon the Emergency Public Works Service when special technical personnel and extra heavy equipment, such as cranes, tractors, compressors, etc., are required for rescue of trapped persons. For this purpose, the Chief of Emergency Public Works Service will maintain an inventory of all such equipment in the community in the possession of private contractors and utility companies, as well as governmental departments..
9.	Rescue Depots.—The Rescue Squads are to be based in depots, such as garages, sheds, or other suitable places where training may be carried on and equipment stored and from which squads can be dispatched to incidents. Rescue Depots are best located away from obvious target areas, some being located on the periphery of the community. An average of one for each 50,000 population is recommended in the target areas. Each depot should have a complement of 30 rescue workers organized into 3 squads which rotate on periods of first call. The Chief of Rescue Service should designate the Leader of one of these squads as Depot Overseer, who will have supervisory responsibilities for the depot. He will maintain rosters and inventories,
104 FIELD CARE AND TRANSPORTATION OF THE INJURED arrange training schedules and squad rotation, and will report to the Chief of Rescue Service on depot activities. The equipment for a depot or squad is listed in the new Technical Manual for the Rescue Service, OCD Publication 2216.
10.	Unit Strength.—The number of Rescue Squads and Rescue Depots required for each vulnerable 'community in the target area is dependent not alone upon the population but upon the square miles over which the community is spread and the relative number of multistoried buildings of all kinds, particularly those constructed of stone, brick, or concrete. For those sections of a community in which the houses are largely of frame construction or of the one-story type, fewer Rescue Squads are needed because trapped persons will be fewer and their extrication less difficult.
For sections of a community in which the buildings are predominantly of stone, brick, or concrete and steel construction, the number of Rescue Depots will depend on local conditions and need not exceed 1 to 50,000 residents. A variation above or below these recommendations may be warranted by geographic considerations and population density and must, therefore, be left to the discretion of the Commander of the Citizens Defense Corps and the local Chief of Rescue Service. The national program contemplates an establishment of about 1,000 depots and a full rescue personnel of 30,000 organized into 3,000 squads. It is preferable to have a few well-trained squads which can serve as a nucleus for subsequent expansion of the Rescue Service if required, than to organize a large number for which training and equipment cannot be provided locally.
11.	Training.—(a) Pre-induction.—Before appointment to the Rescue Unit, trainees must have satisfactorily completed the training prescribed in OCD Regulations No. 3, U. S. Citizens Defense Corps. This includes a basic course in first aid which may be either the Red Cross First Aid for Civilian Defense (20 hours—Instructor’s Manual ARC 1055), or the Bureau of Mines standard course (15 hours).
(&) Post-induction.—After taking the required oath of the U. S. Citizens Defense Corps and being enrolled, members of the Rescue Unit are to continue to receive special technical training essential for rescue workers. At first this should consist of a 2-hour period twice weekly. The drills and practices in any one week should not be limited to one type of rescue work. They should range over all classes of rescue problems and include practice in advancedjirst aid and handling of the injured as well as rescue techniques.
Rescue Techniques.—This will include training and practice in reconnaissance, tunnelling, shoring, etc., in accordance with the outline of exercises and drills given in OCD Publication 2216, Technicals Manual for the Rescue Service.
ORGANIZATION OF RESCUE SERVICE	105
Emergency Field Care and Transportation of the Injured.—This is advanced training and practice in emergency field care and transportation of civilian war casualties. The instruction should be given by a physician or other qualified.person recommended by the Chief of Emergency Medical Service. Instruction may also be given by the Chief of the Rescue Service or by a Rescue Squad leader who has attended a Rescue Training School.
The lives of victims of an air raid or other wartime disaster depend in large part upon the training and skill of leaders and other members of the Rescue Squads. The technique which they employ in extricating trapped persons from under structural debris and the manner in which they handle the severely injured determine the chances of survival.
It is the intention of the U. S. Office of Civilian Defense to establish two pilot Rescue Service Training Schools in collaboration with the Bureau of Mines, one at Pittsburgh, Pa., and the other near San Francisco, Calif., at which appropriate technical instruction will be given to Chiefs of Rescue Services of the States and larger cities in target areas. They will in turn be able to establish Regional or State schools for training of local Chiefs of Rescue Service. Local Chiefs of Rescue Service, with the aid -of instructors whom they select, will carry on instruction in rescue work at local schools.	*
537377°—43---------8
APPENDIX D
How to Protect Yourself Against War Gas
(OPERATIONS LETTER NO. 128)
1.	Stay indoors. A tightly closed room affords protection against war gas. All windows and doors should be tightly shut, and blankets (to be soaked with water) or cardboard should be kept in readiness to cover and seal shattered windows. Choose a room on an upper floor if possible; most war gases are heavier than air, although they may be carried up with air currents.
2.	If caught outdoors in a gas attack, get out of the area at once. Look down and shield your eyes with your arm. Do not worry about any brief vapor exposure to which you may be subjected. The danger from this source is not great.
3.	Prompt action will avoid serious effects. If you know or suspect that you have gotten any of the gas on your person or clothing, do not go hunting for a casualty station or gas cleansing station and expect someone else to help you. Knock on the 'first door you come to, and take whatever steps are necessary. Self-aid is the quickest and safest way.
4.	This is what you should do. This routine should be memorized SO IT WILL BE DONE AUTOMATICALLY IN AN EMERGENCY:
(«) Remove shoes and outer clothing and drop them outside the house, in a covered can if available. Do not touch this clothing again except with sticks or gas-proof gloves. Do not cling to false modesty. To enter a house with contaminated clothing endangers everyone in it.
(fb) Get to a bathroom, kitchen, or laundry room as fast as possible.
(c)	If your eyes have been exposed to liquid gas or spray, flush them immediately. Plain water out of a faucet, shower-head, canteen, or douche bag will do, but a lukewarm dilute solution of bicarbonate of soda (heaping tablespoonful in a quart of water) is even better, if it is handy. Let anyone nearby help you.
(d} If drops of liquid blister gas have splashed the skin, you can prevent serious burns by adequate cleansing. Promptly blot up the liquid with pieces of cleansing tissue, cloth, or a handkerchief, which should be disposed of carefully in order that it cannot contaminate any one else. Then sponge the skin briskly with laundry bleach containing sodium hypochlorite, if it is at hand, and rinse off under the
106
HOW TO PROTECT YOURSELF AGAINST WAR GAS 107 shower or in a tub. A thorough bath with a vigorous lathering is the final step, which should never be omitted. Dry the skin by patting. Do not rub. Dress in whatever clean clothing you can get. If blisters develop, you should seek medical advice.
(e)	If your nose and throat feel irritated, snuff and gargle with a dilute solution of bicarbonate of soda. If your chest feels heavy and oppressed, if you have any trouble breathing, or if smoking becomes distasteful, lie down immediately and stay perfectly still until you can be taken to a doctor. Do this even if you feel fine otherwise.
5.	Remember: Cleanse yourself quickly and calmly. Follow THE INSTRUCTIONS OF YOUR AIR RAID WARDEN.
APPENDIX E
Electrical Hazards in Air Raids
In the performance of their duties members of the Citizens Defense Corps may be brought into situations where electric cables or wires have fallen to, or near the ground as the result of an air raid or other disaster. It is therefore imperative that they understand exactly what to do in such cases.
The voltage, and consequent danger, of a wire cannot be judged by its size or general appearance. Even if it could, it should be remembered that a comparatively low voltage, under certain conditions, is sufficient to cause death. Always assume that amy wire or cable is a “live” and dangerous one until it has been proved safe.
Initial Precautions.
Immediately upon the discovery of such a situation, a guard should be arranged to keep people and traffic away from the area containing the fallen wires. The area should be roped off and barricaded if necessary. If possible, have the current shut off.
As soon as possible, the Control Center should be notified of the incident.
Until an experienced utility repair crew arrives on the scene and makes necessary repairs, no one should be allowed to touch or handle a fallen wire. No amateur electricians should be allowed to “try a hand” at such a time.
Moving a “Live” Wire.
If it should be necessary to move a wire to effect rescue work or to perform other emergency tasks, use a long dry stick, a dry board, a dry rope, or other material which will not conduct electricity. Use no meted whatever. Be especially careful in your selection of the object to be used. Many materials commonly thought to be nonconductors will, under certain conditions, carry an electric current. For example, even apparently dry clothing may have a sufficient residue of salt from perspiration to conduct an electric current.
If necessary to move the wire, be very sure that the ground you stand on is perfectly dry. If at all possible, secure a large dry board and stand on this while moving the wire with a nonconducting object.
Never attempt to climb poles, towers, or other structures to investigate an electrical hazard. And never permit yourself or others- to work around fallen wires while wearing a metal helmet. Metal
108
ELECTRICAL HAZARDS IN AI R RAIDS	109
helmets must be removed before any attempt is made to move, inspect, or repair electric wires.
Should Fire Guards or others be fighting a fire where such wires are located, they must remember—water is a conductor of electricity. Live wires in water or upon wet surfaces may energize the surrounding ground or pavement ; thus it is extremely dangerous to use water under such conditions. If essential to continue the use of water to extinguish a fire in such an area, it is necessary to keep people still farther away from the fallen wires than under ordinary conditions.
In this connection, remember that a stream of water is a conductor. . Standing on the ground and holding a wet hose from which a stream of water is playing on a live wire, thè worker becomes a part of the circuity and the entire current may flow through his body.
Rescue ^Vorh
Attempting to rescue a person from contact with a live wire is very dangerous. Do not touch any portion of the person’s body until he has been freed from contact with the wire—and do not touch the wire with your hands or body. Do not attempt to cut the wire unless you have been trained and authorized to do such work,'and have the proper equipment.
Experience has shown that even the insulated coverings of wires afford little, if any, protection. Heavy rubber gloves may give some protection, but even these should not be depended upon.
In some cases it may be possible to free a victim by pulling upon his clothing, but this is dangerous because of the possibility previously mentioned—that the clothing may conduct electricity because of a residue of salt from perspiration. The safest step is to have the current shut off, if at all possible, before attempting a rescue.
In cases of electrical shock, when breathing has stopped, artificial respiration should be administered immediately by the prone pressure method after the victim has been removed from the live wire.
The victim should be given medical attention as soon as possible.
Finally, it must be remembered that it is not possible to suggest any one method of rescue which is safe and foolproof under all circumstances. It is only through special training, the use of adequate equipment, and the exercise of great care that a rescuer may be assured of safety from electrical hazards.
Summary.
Briefly, the steps to follow in dealing with electrical hazards are :
1.	Arrange to keep people away from the wire and surrounding area until the repair crew arrives, or the current can be shut off.
2.	Notify the Control Center as soon as possible.
3.	If a person is in contact with a live wire, try to have the current shut off before attempting a rescue.
110 FIELD CAKE AND’ TRANSPORTATION OF THE INJURED'
4.	Do not attempt to cut a wire unless you have received training, have been authorized to do such work, and have the proper equipment.
5.	If it is necessary to move a wire or a victim before the current is shut off, use an object of nonconducting material—do not touch the wire or person with your hands or body.
6.	Be sure the ground you stand on is perfectly dry.
7.	Give artificial respiration, if indicated, immediately after the person has been freed from the wire; secure medical assistance as soon as possible.
These suggestions are for the guidance of civilian defense workers who are not technically trained and who have not had previous experience in handling electric service facilities. Members of Utility Repair Units, pf course, should be governed by safety codes developed by the industry.
It is important that all civilian defense workers whose duties may in any way involve the handling of electrical hazards be given special training on this subject by a representative of the local electric industry.
INDEX
Page
Abdomen :
Bandaging________________2— 22, 23
Wounds of_______________________ 27
Air raid injuries, types of____	25
Air raid wardens_________2,10,13,101
Direction of ambulances-------91, 95
Report of______________________   3
Air raids :
Electrical hazards in__________ 108
New forms_____________________. „	1
Ambulances : See also Transportation.
Ambulance officer_____________ 87
Ambulance service, operation of_______________________87,90
Organization of___________;____ 87
Ambulance trains______________ 89
Ambulance attendants:
Availability of—_______________ 89
Duties of______________ 90, 91, 92^96
Training for_________’_________	87
Carrying capacity___________5, 6, 88
Commercial vehicles as________	88
Conversion of commercial vehicles-------------------6, 88
Decontamination of____________ 89
Depots--------------------6, 89
Drivers of____________________6, 7, 87
Availability of________________ 89
Duties of____________________2_	90
Instructions to________________' 90
Equipment for_________________ 89
For gas casualties____________	89
Four-stretcher, EMS____________‘ 5, 88
Identification of_____________ 90
Loading________________________ 91
With 2 bearers________________	93
With 4 bearers_________________	92*
One-stretcher, conversion of__	6
Speed of_________________________ 88
Stretcher racks for_______1___88, 89
Two-stretcher, conversion of__	6
Page
Arms:
Slings for_____________________ 18
Injuries to, moving casualties with________________________i 76
Army stretchers________________60, 88
Arsine________________________ 32
Arteries, bleeding from________ 33
Asphyxia: See Suffocation.
Back, broken:
First aid for__________________ 40
Moving casualty with_________;_	74
Bandaging; See also Dressings.
Abdomen ______________________22, 23
Bandage compress____________15, 27, 35
Carlisle	dressings_____________ 15
Chest____________________________ 22
Chin---------------------------19,20
Cravat bandage: See triangu-
lar bandage,
Elbow____________________________ 20
Eyes—--------------------------20,21
Face---------------------------19,20
Foot----------------------------- 22
Fractures________________________ 39
Hand____________________-______23, 24
Head___________________________19,21
Hip-----------------------------  22
Knee---------------------------20, 21
Neck_____________________________ 22
Principles of____________________ 15
Shoulder_________________________ 22
Triangular bandages:
Description_____________________ 16
Folding__________________________ 16
Lashing casualty to stretcher. 56, 57
On special parts of body______19, 20,
21, 22, 23, 24, 27, 28, 41,. 76
Securing splints with_________	17
Used as slings________________18,19
Used as tourniquets___________	33
"Til
112
INDEX
Page
Blanketing, methods of:
British (Wanstead)__________;_ 54
Red Cross--------------------- 53
Blankets, in ambulances---------91, 92
Blankets, in transporting casual-
ty with internal injuries-------	76
Stretchers improvised from____62, 63
Blast injuries:
Handling of___________________ 30
Symptoms of___________________ 29
Ble’ach, household--------—_____31,106
Bleaching powder—_________: 32
Bleeding: See Hemorrhage.
Blister gases: See Gases, War, vesicants.
Blood, loss of: See Hemorrhage.
Bombs:
Injuries caused by_____________ 25
Phosphorus bombs_______________32, 44
Saturation bombing_______'_____ 1
Boric acid ointment—_______._____	43
Brain, injury to___.______________  26
Brombenzylcyanide, tear gas______	32
Burns______________-____________	26
Causes___________________________ 42
Eyes_____________________________ 44
-First aid_______________________ 43
Phosphorus_______________________ 44
Treatment, emergency___________	43
Busses, for transfer of hospital patients___________________ 7, 88
Cables, electric, live____________ 108
Carbon monoxide poisoning_____L 47, 88
First aid_________________________ 48
Carries, carry in arms______________ 82
Fireman’s carry_______i________	79
Fireman’s drag________,__________	82
Fore-and-aft carry_______________ 85
Four-handed seat_______________83, 84
One-man__________________________ 79
Pack-strap_______________________ 81
Pick-a-b^ck______________________ 79
Three-man________,_______:_____ 86
Two-handed seat_______:________83, 84
Two-man________________________,_	83
Casualties :
Air raid, condition of_________	36
Blanketing_______________________ 53
Carrying without stretchers____	79
Classification of________________ 10
Dead, collection of______________ 51
Identification of_________________ 52
Disposition of___________________ 95
Page
Casualties—Continued. Field care of____________________ 11
From electric shock____________49,109
Gas:
Blister gases____________________ 31
Handling of_____________________*	13
Hospitalization of_______________ 13
Incendiaries_____________________ 32
Lung irritants___________________ 30
Sneeze gases_____________________ 31
Systemic poisons_________________ 32
Tear gases________-______________ 32
Transportation of____________— 89, 94
Identification of___:__________50, 52
Lashing to stretcher_______________ 56
Loading an ambulance with_______	91
Marking of_________________________ 50
Symbols___________________—2 	51
Moving, special care in________	73
Records of_____________________51, 96
- Transportation of___________ 4,
5, 60, 73, 78, 79,87
Trapped:
Injuries to__________________Xi- 25
Rescue of_______________________7,102
Treatment of______________;_____ 4,29
Casualty identification tag______	13,
.27, 29, 34, 50, 52
Casualty receiving hospitals: Ambulance depots_________________ 89
Disposition of casualties______	95
List of---------------------------- 95
Map of_____________________________ 95
Stretcher teams attached to____4,100
Transfer of patients from______	89
Casualty record book_____________ 51
Casualty stations:
Care of severely injured in____ 3,11
Function__________________________ 3,11
Location___________________________  3
Records in,____________________	51
Stretcher teams in_____________ 4, 99
Chair used as stretcher__________	63
Chin, bandaging__________________ * 19
Chest:
Bandaging.__________i_-________ 22
Injuries to, moving casualties with___________________________ 76
Chief of Emergency Medical Service:
Local___________________4, 5, 9, 87, 99
State__________________________ 6, 89
INDEX
113
Page
Chief of Rescue Service : Local--------—---------------9,102
State____________________________ 102
Chloracetophenone_____2_____________ 32
Chloracetophenone solution_______	32
Chlorine____________________________ 30
Chlorpicrin___________________~ 30'
Cleansing facilities, gas_.___14, 106
Clothing :
Gas-contaminated____________13, 31, 106
Protective__________________12,14, 94
CNB solution_____________________ 32
Commander, Citizens Defense
Corps________________________9, 10, 87
Compress, bandage__________Ï5, 27, 35
Contamination, gas: See under
Gases, war.
Contaminated areas________________ 14
Disk denoting_____________________ 95
Control :
Ambulances_______________5, 87, 91, 95
Central________________________9,	100
Express parties________________3,102
Incident Officer_________:_____	10
Rescue squads__________________3,102
Stretcher teams________________4,100
Control Center-__________________-	2,
3, 7, 9,10,	29, 94,100,102,108
Convoy, ambulances in____-•_________ 91
Copper sulfate______________________ 44
Crush injuries___________________25, 28
Cyanosis__________________________   30
Dead :
Collection of_______________i__	51
Recovery of____________________8,102
Death, diagnosis of_______________  51«
Decontamination of—Ambulances ______________________ 89
Areas__________________________ 14
Shoes__________________________ 14
Depots :
Ambulance______________________ 6, 89
Rescue-------------------------9, 103
Dressings________________________11,15
Bleeding from arteries____________ 34
Bleeding from small	vessels___	35
Bleeding from veins_______________ 35
Burns----------------------------- 43
Carlisle_______________________4,15
Compress--------------------15, 27, 35
Page
Drills :
Rescue squads___________________ 104
Stretcher_______________________  64
Training schedule__________________ 97
Drivers :
Ambulance :
Control________________________ "87
Duties of------------------;___ 90
Training of____________________7, 87, 97
Rescue vehicles___________________ 8
Elbow,-bandaging___________________ 20
Electric shock_________________49,108
Electric wires, burns	from_____________	42
Emergency Base Hospitals, trans-
fer of patients	to___________ 7,88
Emergency Medical Service: See also Ambulances, Casualty Stations, Express Party,
Field Casualty Service, Mobile Medical Teams, Stretcher Teams.
Ambulance service:
Operation of__________________ 90
Organization of_______________ 87
Ambulances, four-stretcher  	5,88
Chief of, local----------4, 5, 9, 87, 99
* Chief of, State_____________ 6, 89
Cooperation with Rescue Serv-
ice—2--------------------- 3,7,102
Operation of:
Casualty Stations_________________ 3
Express Party__________________3,102
Mobile Medical Teams__________2,10, 89
Stretcher Teams________________ 4,99
Stretcher, metal________________ 61
Training_______________2, 5,7,97,101
Emergency Public Works Service ----------------------- 1, 9
Equipment :
Ambulances____________________   89
First aid------------------------ 9
Rescue Squads___________________9,103
Evacuation of hospitals_______ 7, 89
Express Parties_______________3,102
Eyes:
Bandaging______________’________ _ 20
Burning, caused by war gas______	31
Burns of:
Chemical__________________s___	44
Phosphorus____________________ 44
Thermal_______________________ 44
Irrigation of_____ 13, 31,32, 44, 78,106
Irritation by war gases_____13, 32,102
114
INDEX
Page
Face:
Bandaging______________________ 19
Injuries to:
Characteristics of___________.___ 28
First aid for____________________ 28
Moving casualties with-----------	75
Femur, fracture of, first aid for_	41
Field care: See also First Aid, Rescue Service, Treatment.
Air raid injuries-----r________	25
Burns_____________________________  43
Crush injuries_____________________ 29
Fractures________s_____________	38
Hemorrhage______________________ 33
Principles of____________________   11
Shock___________________________ 35
Training in_______________97,101,105
War gases______________________13, 31
Field Casualty Service—------ --- 2
Fire Service, rescue	squads_ 7,100,103
Fireman’s—
Carry____________________________   79
Drag_______________________________ 82
First aid:
Asphyxia___________________________ 45
Blister	gases--------------------- 31
Broken back__________,_________ 40
Broken neck-------------------- . 40
Bureau of Mines Course_________101,104
Burns_____._2._________________—	43
Facial injuries------1___________	28
Fractures________x_____________ 38, 40, 41
Gas casualties_________________31, 32
Head injuries---------------- 26
Hemorrhage_______.—'___________	33
Internal injury _____________ 27
Lung irritants_______________ 30
Principles of________________ 12
Red Cross course_______________101,104
Sneeze gases (irritant smokes)_	31
Systemic poisons_____________ 32
Tear gases___________________ 32
Training_______ 2, 5, 7, 87, 97, 101, 105
First aid pouch_____________4, 9, 51, 90
Foot, bandaging_____________■—	22
Fractures___________________12, 36, 73
Definitions----------,---------	36
Femur------------------------------ 41
First aid for__________________38, 40
Legs, injuries	to________________  75
Pelvis_____________________________ 41
Moving patient with______________	76
Ribs_____________________________   42
Page Fractures—Continued.
Signs and symptoms  ----------- 37
Skull___________1______________26, 42
Spine__________________________ 40
Moving casualties with_______ 63, 73, 79 Splints: See Splints.
Gas Reconnaissance Agent_________	14
Gases, war-------- 12, 30, 78, 89, 94,106
Ambulance operation in presence of________________________ 94
Blister gases: See under Gases, war vesicants.
Casualties:
Cleansing of____________________13, 31
First aid for___________ 13, 31, 32, 78,106
Marking of______________________ 51
Masks for____________________13, 78, 94
Transportation of_______________89, 94
Cleansing facilities______13, 95, 107
Contaminated areas  ___________14, 94
Eyes affected by---------------13, 20, 31
’ Irritant smokes___________ 31
Liquid____________________13, 31, 78
Lung irritants_________________14, 30
Masks for Civilian Defense
workers___________________________ 13
For patient on stretcher________	78
In ambulances____________________ 94
Nonpersistent_____:_______13, 31, 32, 106
Persistent_____________________13, 31, 94
Protection against-------------14,106
Protective clothing____.__12, 14, 94
Self-cleansing____________________ 106
Sneeze gases_______________________ 31
Stretcher bearers, action of___	78
Systemic poisons___________________ 32
Tear gases_________________________ 32
Types of, injuries from________	30
Vesicants_________________13, 31, 78, 106
Hand, bandaging__________________ 24
Hazards, electrical_________ 42, 49,108
Head:
Bandaging-2________________________ 19
Injuries_______________________26, 42
Moving casualties	with ___	75
Hemoptysis_______________________ 30
Hemorrhage_______________________32, 51
Bleeding from arteries—.___________ 33
Small vessels____________________ 35
Veins____________________________ 35
Cause of shock____________J----	32
Control of________________4,11, 33, 36
INDEX
115
Page
Hemorrhage^—Continued.
Internal .i.____________________27, 35
Kinds of bleeding-------------- 33
Hip, bandaging-------.----------- 22
Hospitals :
Casualty receiving------ 2, 7, 29, 30, 88
Disposition of casualties------	95
Emergency base-------------------- 7
Evacuation of------------------ 7,88
Hydrocyanic acid_____1----------- 32
Hydrogen sulfide------------------- 32
Identification tag--- 27, 29, 34, 50, 52
Incendiaries (See also Phospho-
rous shells and	bombs)------	32
Incident officer------------------- 2,
3,	9, 10, 91, 95, 96, 103
Incident post---------------------- 10
Incident, procedure	at---------- 10
Injuries: See also Burns; Casualties ; First Aid; Fractures : Shock; Wounds.
Abdominal__________:___________ 27
Air raid, types of------_------ 25
Blast__________________________ 29
Brain___________________.______ 26
Burns__________________________ 42
Crushing_______________________ 25, 28
Facial_________________________28, 75
Fractures________________________	36
From war gases----------.------30,106
Head___________________________26,42
Internal:
First aid for_____________________ 27
Blast injuries____________________ 29
Moving casualties with_________	73
Insignia:
Incident Officer—________________ 10
Kidney failure:
In crush injuries________________ 29
Systemic poisons_________________ 32
Knee, bandaging____________________ 20
Knots, methods of tying__________16, 57
Lashing casualty to stretcher____	56
Legs, injuries to (see Fractures).
Lime, chlorinated-________1______14, 89
Lung irritants------------*______ 14
Effects________________________ a 30
First aid______________________31
Maps—-___________________________ 9, 95
Marking of casualties, symbols for____________________________ 51
Page
Masks: See Gases, war, masks.
Metal helmets, hazards----------- 108
Stretcher, EMS__________________56,61
Mobile Medical Team_______‘______	2,
3,	10, 50, 52, 89, 99, 103
Relation to Casualty Station— 2 Relation to Express Party_____	3
Relation to Rescue Service___7,102 Stretcher team and____________ 4,99
Transportation of_______________ 89
Mobilization:
Ambulance personnel_____________ 7, 90
Casualty Station personnel 	3
Mobile Medical Teams____________	2
Rescue Squads—:____________: 	7
Stretcher Teams____________'____4, 99
Mortuary Service_____________- 	51
Navy Stretcher, Stokes__________ 61
Neck:
Bandaging_______________________ 22
Broken_____________________ 40, 73, 79
Nitric fumes---------------------- 30
Office of Defense Transportation- 89
Oxygen________________«_________ 48
Pack-strap carry_________________  81
Paralysis-----------------------40, 73
Pelvis, fracture of: First aid  _______________-_______ 41
Moving casualties with__________	76
Petrolatum______________________ 43
Phosgene------------------ 13, 30, 47, 51
Phosphorus—
Bombs___________________________32,44
Burns_________________________   44
Shells________________________32,44
Pick-a-back_____..______________	79
Poisoning:
Carbon monoxide-----------------47, 88
Systemic poisons________________ 32
Police----------------------- 2,10, 91
Pressure points a_______________. 33
Protective clothing_______12, 14, 94
Records______________________—__ 51, 96
Red Cross first aid course---101,104 Red Cross method of blanket-
ing_______________I____________ 53
Rescue Depots___________________9,103
Rescue from electrical hazards  109 Rescue Section, Medical Divis-
ion, OCD_________________________.	102
116
INDEX
Page-
Rescue Service:
Local Chief of_______________9,102,104
Cooperation with EMS___________7,102
Function_____________________7, 99,102
Manual for______:--------------8, 48, 104
Organization of________j-------—	102
State Chiefs of-------------------- 102
Rescue Squads:
Dispatch of—___________________9,102
Equipment.--------------------------- 9
Function_______________ 7, 8, 50, 52,102
Leader responsible for casualties ____________________ 2,| 11
Organization___________________-	103
Part of Express Party__________3,102
Personnel______________________9,103
Stretcher teams and------------ 7,99
Training of________________ 7,97,104,105
Unit strength of--------------- 104
Workers exposed to gases-------	30
Respiration, artificial:
Artificial, danger in__________31, 78’
First aid for systemic poisons- 32
In asphyxia__________________12,	45, 76
In carbon monoxide poisoning-	48
In electric shock_________  109
* In unconsciousness-________	49
Procedure__________,----------- 45
Rest Center______________________ 51
Resuscitation: See Respiration, artificial.
Ribs, fracture of, signs and symptoms, first aid-------—-------- 42
Rope:
Lashing casualty to stretcher-	59
Lowering stretcher from height__________________-____ 72
Sandbags_________________ 40, 74, 76,90
Scalp, wounds of-----------------27,42
Shells, phosphorus_______________ 32
Shock_____________ 11,12, 26, 27, 28, 32
Burns and______________________26,43
Electric___________-___________49,108
Hemorrhage, and--------------------- 32
In blast injuries___________________ 30
Prevention_________________________  35
Signs and symptoms__________________ 35
Treatment for__________________28,36
Shoulder, bandaging___________________ 22
Sitting-case cars______________6, 87, 95
Skin, effect of blister gas on---13,^31
Skull, fracture of________________ 26, 42
Slings------->______________ 18,19, 56
Page
Smokes, irritant: See Sneeze
gases.
Smoking, harmful to gas casualty------------------------- 31
Sneeze gases :
Effects_________________________ 32
First aid______________________  32
Sodium bicarbonate (baking soda)___________________ 31,32,106,107
Sodium hypochlorite-------31,89,106
Spine, fractures of_______40, 63, 73, 79
Splints_____ 12, 37, 40, 41, 43, 75, 76, 90
In leg injuries_______________41, 75
Securing by bandages----------	17
Traction____________________ 11, 38, 76
State Chief of Emergency Medical Service---------:------- 6,89
State Chief of Rescue Service—	102
Stokes Navy Stretcher------------- 61
Stretcher Teams_________________ 3, 7
Functions_________-_____:_____ 4,99
Mobilization of________________ 100
Organization of_______________ 4, 99
Training of------------- 4, 60,97,101
Stretchers :
Accommodation in emergency Vehicles__________2_________ 88
Action of bearers exposed to gas_________________________ 78
Army__________________________60, 88
Blanket-_______________________  62
Canvas__________________________ 57
Carrying__________:____________ 71
Carrying casualties without—	79
Chairs__________________________ 63
Coats with poles____________64
Contaminated___________________  95
Door, shutter or board--------63, 73
Drill in carrying-—_________:— 64, 73
EMS metal_____________________ 61
Lashing casualty to-------------56, 59
Exchange of_________________92, 95, 99
Improvised_____2____________64
Ladder with boards______—I----	63
Loading the ambulance---------	91
Loading :
With 3 bearers--------------—	69
•With 2 bearers__________________ 69
With untrained	assistants—	69
Lowering from a height--------	. 72
Metal, for gas casualties---94
Navy____________________________ 61
INDEX
117
Page Stretchers—Continued.
Preparing for blanketing casualty—^.—-------------—f-------	54
Racks__________________________88, 92
Removable-pole type.---------	61
Shutter________________________ 63
Sliding---------------,-------- 72
Stokes Navy---------------- 61
Transferring -patients_______	71
Transportation of casualties—	60.
Types of____________________-—	60
Suffocation:
Asphyxia, treatment for--------12, 45
Moving asphyxiated patient_____	76
Sulfathiazole jelly________________ 43
Systemic poisons_________________   32
Tannic acid____.____________.____43, 45
Tear gases_______________________32
Effects___________1____________ 32
First aid---------------------- 32
Tourniquets:
Application, information concerning --------------s_____51, 92
Method of_________________________ 34
Dangers of_______________________ 33
In crush injuries_________I____;_	29
Moving casualties with_________	78
Need for________________________  11
Precautions______________________ 34
Training:
Ambulance attendant-------:______87, 97
Drivers________________________ 97
First aid_________ 2, 5, 7, 87, 97,101,105
Rescue Squads__________________8, 104
Schedule of___________1_—________ 97
Schools for Rescue Workers 	105
Stretcher teams_________________ 101
Trains, ambulance_______±________ 89
Transport Officer:
Local _________________________ 87
State__________________________ 89
Transportation: See also Ambulances, Sitting-case cars, Stretchers.
Blanketing casualties__________ 53
Busses for evacuation of
hospitals______________________ 7, 88
Carrying casualties without stretchers_____________________ 79
Disposition of casualties______	95
Injuries requiring special care_	73
Page
Transportation—Continued.
Training in_________i____„____ 105
Training schedule________ij»___	97
Trains______________________-,__	89
Trucks__________«_____________ 6, 88
Treatment :
Asphyxia______________________ 45
Burns_______________Û---------	43
Crush injuries______|---------	29
Fractures_____________________38, 40
Gas casualties______ 13,31, 32, 78,106
Shock_________________________28,36
Unconsciousness---------------—	49
Wounds, abdominal_____________ 27
Trucks, conversion into ambulances —___________________ 6, 88
Unconsciousness_________________36, 42
Asphyxia---------------------- 78
Blue________________1-------—__	48
Gas mask and____________________ 78
Red______________________—_____ 48
White__________________________  48
U. S. Bureau of Mines_________101,102
U. S. Citizens Defense Corps__•_	1,
97, 99,101,102
Commander of________________9,10, 87
Services, postraid'______________ 1
Services, raid___________________ 1
Training for enrollment_____2, 5, 7,101,104
U. S. Public Health Service-----	102
Utility gas----------------------- 45
Utility repair crew-------------- 108
Vehicles, identification of-----	90
Veins, bleeding from-------------- 35
Vesicants : See Gases, war, vesicants. Wanstead method of blanketing. 54 War Civilian Security_____________ 51
Wires, electric:
Live, burns from________________ 42
Dangers of______________________108
Wounds : See also Injuries.
? Abdominal______________________  27
■In blast injuries____________ 30
Crushing :
Characteristics of_______________ 25
Treatment for____________________ 28
Lacerated_______________________ 25
Penetrating_____:___.___________ 25
Perforating_________._______:_	25
Scalp_______________,_________27, 42
o