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1、突发事件应对之战地救护,Combat First Aid,Combat First Aid,To Introduce the students with data regarding the importance of quick treatment of injuries during conflict 介绍关于战火下快速救护重要性的数据 To introduce the student to the sights and mechanisms of some trauma injuries 介绍一些创伤的样子以及原理 To train the students with fast tech
2、niques for treating battle injuries 训练快速战地急救技巧,Logic,First training learned Tactical Field Care学习战地救护 First aid in time of emergency is different from what is thuoght in most regular training不同于普通的急救 Pressure (Shooting, screaming, sight of blood, rain, must run away etc)压力环境（射击、尖叫、血腥场景、下雨、必需逃脱等等） Po
3、ssible that no first aid equipment可能没有装备,The fate of the wounded lays with those who apply the first dressing.伤员的命运取决于最先救助他的人 - Col. Nicholas Senn, 1844-1908,Importance of the First Responder 第一个救助者的重要性,75-90% of all combat deaths occur before the casualty reaches a Medical Treatment Facility (MTF)
4、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The fate of the injured often lies in the hands of the one who provides the first care to the casualty. 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,What factors must we think about in combat trauma care?战伤急救需要考虑的因素,Hostile fire敌人火力 Darkness黑暗 Environmental extremes极端环境 Different w
5、ounding epidemiology不同的伤情 Limited equipment缺少设备器材 Need for tactical maneuver需要作出战术动作 Long delays to hospital care长时间到不了医院 Different medic training and experience不同的训练和经验,Tactical Combat Casualty Care 战斗伤患照顾规范,6 Steps of Basic First Aid 基本急救的6个步骤,Ensure area is safe and get help 确定环境安全 Open the airwa
6、y and restore breathing 打开气道恢复呼吸 Stop bleeding and protect wounds 止血并保护伤口 Check for other injuries and treat 检查并治疗其他伤 Give a good report to Medical 向医生（医疗者）正确报告,Move to safety安全移动,Recall Threats lesson回顾威胁课 Building on fire? Vehicle on fire, Vehicle under fire? Smoke? Enemy approaching?建筑起火？车辆起火？车辆遭
7、遇射击？烟？敌人接近中？ Can I move the injured without harming him?我能在不伤害伤员的前提下搬运他吗？ Can I move him? 我能移动他吗？ Use cover or concealment运用掩蔽或掩护,First Dilemma第一个困境,Scoop and Run Vs Stay and Play “抢时间和跑” 与 “停下和施救” Scoop and Run take the patient without primary treatment and hurry him to the next hospital “抢时间和跑”：将未
8、受处理的伤员紧急送往医院 (movie in Kidnap lesson)Stay and Play first aid：停下和施救进行急救,AIRWAY气道,Airway气道,Check for airway obstruction/choking检查气道阻塞、抑制 Use Heimlich maneuver, back blows, or finger sweep to clear obstruction采取Heimlich操作法，或用手指清除障碍Open airway打开气道 Head-tilt/chin-lift头部倾斜、下巴上抬 Jaw-thrust推下颚,BREATHING,No
9、Breathing没有呼吸,If a victim of a blast or penetrating injury is found without a pulse, respirations, or other signs of life, DO NOT attempt CPR 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 Tilt head back and pinch nose向后提头，捏住鼻子 Give 2 full, slow breaths慢慢吹两口气 If not going in, check for obstruction如果吹不进去，检查气道是否
10、受阻 Reposition head if needed需要的话复位头 1 breath every 5 seconds每5秒吹一次,Airway Adjuncts and Control气道辅助和控制,Recovery Position 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 STOP THE BLEEDING止血,Stop visible bleeding 止住可见的流血伤口 Check for Chest wounds (also back side) 检查胸口伤（以及后背） Check for bleeding you have n
11、ot seen yet 检查有没有你忽略的流血伤口,Remove some clothes 脱掉部分衣服 Check for Clothes with blood 检查有血的衣服对应的身体部分 Entry and exit wounds 穿透伤,Battle Dressings战地绷带,Standard Battle Dressing Tear open plastic wrap.,Twist to open paper wrapper and remove dressing 扭开纸包装取出绷带,标准军用急救包 撕开塑料包装,Battle Dressings战地绷带,Unfold bandag
12、e and apply to wound. 打开绷带盖住伤口,Wrap tails around and tie together. 包扎好，系住尾部固定带,Emergency Bandage(Israeli Pressure Dressing) 紧急绷带（以色列式）,Emergency Bandage紧急绷带,Pressure Points按压止血点,Use finger pressure on these points to stop bleeding指压止血Also, place tourniquet band over these points (arteries)在这些点扎止血带（动
13、脉伤）,压力点止血,When to use Tourniquet什么时间用止血带,Amputation截肢 Shrapnel弹片 Problem in Air way气道的问题 More then one patient 不止一个伤员 Night time晚上 Pressure Dressings didnt help压力绷带无法止血 Under fire火力下MoviesFirst aid Bullet entry to legs.wmv,Penetrating trauma穿透伤,Splinter,Penetrating trauma穿透伤,伤员头部方向,肚脐,身体右侧,尖锐物,Penet
14、rating trauma 穿透伤,Tension pneumothorax气胸,Air leak through lung or chest wall 空气渗进胸腔或肺里 “One-way” valve lung collapse ”单向阀“-肺衰竭Mediastinum shifts to opposite side纵隔膜转到反向 Inferior vena cava “kinks” on diaphragm decreased venous return cardiovascular collapse 减少静脉回流 心血管崩溃,Tension pneumothorax气胸,MoviesP
15、neomothorax.wmv,Open pneumothorax打开气胸,Initial treatment: seal defect and secure on three sides (total occlusion may lead to tension pneumothorax 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） Definitive repair of defect in O.R. 只有在手术室才能最后封闭 Movie sucking Chest wound,Open pneumothorax打开气胸,MoviesFirst Aid Phnemutorax
16、 A.wmv,Needle Thoracentesis胸腔穿刺术,Emergently decompress affected hemithorax with 14-gauge needle inserted over 3rd rib in 2nd inter-costal space at mid-clavicular line 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,THE TARGET: PREVENTABLE COMBAT DEATH 目标：避免战斗死亡,Main points要点,Try to keep yourself from getting shot 首先要确保自己不要被击中 Try to keep the casualty from sustaining any additional wounds 要确保伤员不要再受伤 Airway management is generally best deferred until the Tactical Field Care phase 气道处理要等战术急救开始时再实施 Stop any life-threatening hemorrhage with a tourniquet 对任何威胁生命的出血用止血带进行止血 Reassure the casualty 为伤员打气,
