突发事件应对之战地救护

突发事件应对之战地救护CombatFirstAidCombatFirstAidToIntroducethestudentswithdataregardingtheimportanceofquicktreatmentofinjuriesduringconflict介绍关于战火下快速救护重要性的数据Tointroducethestudenttothesightsandmechanismsofsometraumainjuries介绍一些创伤的样子以及原理Totrainthestudentswithfasttechniquesfortreatingbattleinjuries训练快速战地急救技巧LogicFirsttraininglearnedTacticalFieldCare学习战地救护Firstaidintimeofemergencyisdifferentfromwhatisthuoghtinmostregulartraining不同于普通的急救Pressure(Shooting,screaming,sightofblood,rain,mustrunawayetc)压力环境（射击、尖叫、血腥场景、下雨、必需逃脱等等）Possiblethatnofirstaidequipment可能没有装备Thefateofthewoundedlayswiththosewhoapplythefirstdressing.伤员的命运取决于最先救助他的人-Col.NicholasSenn,1844-1908ImportanceoftheFirstResponder第一个救助者的重要性75-90%ofallcombatdeathsoccurbeforethecasualtyreachesaMedicalTreatmentFacility(MTF)75%-90%的战伤死亡都出现在伤员到达医疗急救设施前的路上Thefateoftheinjuredoftenliesinthehandsoftheonewhoprovidesthefirstcaretothecasualty.伤员的命运依赖于最先为他们施与援手的人四肢出血气胸呼吸阻塞Whatfactorsmustwethinkaboutincombattraumacare?战伤急救需要考虑的因素Hostilefire敌人火力Darkness黑暗Environmentalextremes极端环境Differentwoundingepidemiology不同的伤情Limitedequipment缺少设备器材Needfortacticalmaneuver需要作出战术动作Longdelaystohospitalcare长时间到不了医院Differentmedictrainingandexperience不同的训练和经验TacticalCombatCasualtyCare战斗伤患照顾规范6StepsofBasicFirstAid基本急救的6个步骤Ensureareaissafeandgethelp确定环境安全Opentheairwayandrestorebreathing打开气道恢复呼吸Stopbleedingandprotectwounds止血并保护伤口Checkforotherinjuriesandtreat检查并治疗其他伤GiveagoodreporttoMedical向医生（医疗者）正确报告Movetosafety安全移动RecallThreatslesson回顾威胁课Buildingonfire?Vehicleonfire,Vehicleunderfire?Smoke?Enemyapproaching?建筑起火？车辆起火？车辆遭遇射击？烟？敌人接近中？CanImovetheinjuredwithoutharminghim?我能在不伤害伤员的前提下搬运他吗？CanImovehim?我能移动他吗？Usecoverorconcealment运用掩蔽或掩护FirstDilemma第一个困境ScoopandRunVsStayandPlay“抢时间和跑”与“停下和施救”ScoopandRuntakethepatientwithoutprimarytreatmentandhurryhimtothenexthospital“抢时间和跑”：将未受处理的伤员紧急送往医院(movieinKidnaplesson)StayandPlayfirstaid：停下和施救进行急救AIRWAY气道Airway气道Checkforairwayobstruction/choking检查气道阻塞、抑制UseHeimlichmaneuver,backblows,orfingersweeptoclearobstruction采取Heimlich操作法，或用手指清除障碍Openairway打开气道Head-tilt/chin-lift头部倾斜、下巴上抬Jaw-thrust推下颚BREATHINGNoBreathing没有呼吸Ifavictimofablastorpenetratinginjuryisfoundwithoutapulse,respirations,orothersignsoflife,DONOTattemptCPR如果伤员因为爆炸或穿透伤而没有脉搏、呼吸或其他生命体征，不要作心肺复苏Tiltheadbackandpinchnose向后提头，捏住鼻子Give2full,slowbreaths慢慢吹两口气Ifnotgoingin,checkforobstruction如果吹不进去，检查气道是否受阻Repositionheadifneeded需要的话复位头1breathevery5seconds每5秒吹一次AirwayAdjunctsandControl气道辅助和控制RecoveryPosition恢复体位半卧式体位膝盖抬到腹部高度，支撑身体手支撑住头CIRCULATION循环系统STOPTHEBLEEDING止血Stopvisiblebleeding止住可见的流血伤口CheckforChestwounds(alsobackside)检查胸口伤（以及后背）Checkforbleedingyouhavenotseenyet检查有没有你忽略的流血伤口Removesomeclothes脱掉部分衣服CheckforClotheswithblood检查有血的衣服对应的身体部分Entryandexitwounds穿透伤BattleDressings战地绷带StandardBattleDressingTearopenplasticwrap.Twisttoopenpaperwrapperandremovedressing扭开纸包装取出绷带标准军用急救包撕开塑料包装BattleDressings战地绷带Unfoldbandageandapplytowound.打开绷带盖住伤口Wraptailsaroundandtietogether.包扎好，系住尾部固定带EmergencyBandage(IsraeliPressureDressing)紧急绷带（以色列式）EmergencyBandage紧急绷带PressurePoints按压止血点Usefingerpressureonthesepointstostopbleeding指压止血Also,placetourniquetbandoverthesepoints(arteries)在这些点扎止血带（动脉伤）压力点止血WhentouseTourniquet什么时间用止血带Amputation截肢Shrapnel弹片ProbleminAirway气道的问题Morethenonepatient不止一个伤员Nighttime晚上PressureDressingsdidn’thelp压力绷带无法止血Underfire火力下..\Movies\FirstaidBulletentrytolegs.wmvPenetratingtrauma穿透伤SplinterPenetratingtrauma穿透伤伤员头部方向肚脐身体右侧尖锐物Penetratingtrauma穿透伤Tensionpneumothorax气胸Airleakthroughlungorchestwall空气渗进胸腔或肺里“One-way”valvelungcollapse”单向阀“----肺衰竭Mediastinumshiftstooppositeside纵隔膜转到反向Inferiorvenacava“kinks”ondiaphragmdecreasedvenousreturncardiovascularcollapse减少静脉回流心血管崩溃Tensionpneumothorax气胸..\Movies\Pneomothorax.wmvOpenpneumothorax打开气胸Initialtreatment:sealdefectandsecureonthreesides(totalocclusionmayleadtotensionpneumothorax初治：封闭伤口，按住3个角留一个（完全封闭会导致张力性气胸）DefinitiverepairofdefectinO.R.只有在手术室才能最后封闭MoviesuckingChestwoundOpenpneumothorax打开气胸..\Movies\FirstAidPhnemutoraxA.wmvNeedleThoracentesis胸腔穿刺术Emergentlydecompressaffectedhemithoraxwith14-gaugeneedleinsertedover3rdribin2ndinter-costalspaceatmid-clavicularline紧急情况下为半胸减压，使用14-gauge针从2、3肋骨间，正对锁骨中间位刺入THETARGET:PREVENTABLECOMBATDEATH目标：避免战斗死亡Mainpoints要点Trytokeepyourselffromgettingshot首先要确保自己不要被击中Trytokeepthecasualtyfromsustaininganyadditionalwounds要确保伤员不要再受伤AirwaymanagementisgenerallybestdeferreduntiltheTacticalFieldCarephase气道处理要等战术急救开始时再实施Stopanylife-threateninghemorrhagewithatourniquet对任何威胁生命的出血用止血带进行止血Reassurethecasualty为伤员打气evacuation撤离Causeofinjury?Fallinvolved?受伤的原因？跌落？Typeofevacuation?Underfire?撤离的种类？火力下撤离？Reassurethecasualty给伤员打气..\Movies\VeryIntenseInjuryTransportFromKorengalValley,Afghanistan.wmvEvacuation撤离Causeofinjury?Fallinvolved?受伤的原因？跌落？Typeofevacuation?Underfire?撤离的种类？火力下撤离？Reassurethecasualty给伤员打气Movie“veryintense”Firststage第一步Onepersoncarry单人搬运Blanketdrag毯子拖拽Vehicle车辆Releasethelegsfromdebris将腿从车辆残骸中退出Casualtyheadleanonyourshoulder伤员的头靠在你的肩上Yourarmunderarmpit你