CHAPTER  13 CASUALTY CARE AND CBR WARFARE As a dental assistant, your training in basic life support and emergency medical treatment makes you a vital resource in mass casualty situations. In such situations, you will be expected to assume the role of a medical aid person, to provide basic life support and emergency medical treatment, to sustain life, and to prevent further injuries. You can be called to these duties during either peace or wartime situations. This chapter  explains  your  roles  in  (1)  mass  casualty situations  and  (2)  chemical,  biological,  and radiological  (CBR)  casualty  situations. To meet these needs, we will explain procedures for providing emergency medical (first aid) treatment in a mass casualty and CBR situation. GENERAL MASS CASUALTY GUIDELINES The  general  guidelines  for  dealing  with  mass casualty situations are as follows: Assess the site. Assess the condition of casualties. Perform basic life support. Treat the obvious conditions. 1.  Control  external  hemorrhage. 2. Treat for shock. 3. Immobilize fractures. 4. Dress wounds. Perform a secondary examination. Prepare casualties for transport. Transport casualties to a safe area. In  the  following  sections,  the  guidelines  are explained. ASSESSMENT You must make a quick and accurate assessment of the  site  and  of  the  immediate  condition  of  the casualties. Site Assessment Before you attempt to rescue or to administer emergency treatment, it is essential that you assess the conditions at the casualty site to ensure that it is safe for both you and the casualty. Consider all aspects of the casualty site and the environment to determine the probability of success if a rescue is attempted. This assessment should include: Accessibility of the casualty site. Can the site be reached with available equipment? Once reached, can emergency treatment be rendered on site? Can the casualty be removed from the site if immobile? Safety of the casualty site. Is the site stable? Can you move safely at the site? Is the site exposed to hostile fire? In case of an unforeseen emergency, can you and the casualty be rescued from the site? Environmental  conditions  at  the  site.  Is  there adequate, breathable air at the site to sustain both the rescuer  and  the  casualty?  Are  there  poisonous  or dangerous  substances  in  the  area?  Will  weather conditions hamper an attempted rescue? Casualty Assessment During   the   initial   or   preliminary   casualty assessment, you will perform a primary examination of  the  casualty  to  determine  if  injuries  are  life- threatening. Basic   rules   for   casualty   assessment   are   as follows: 1.  Keep  the  casualty  lying  down,  with  the  head level with the body, until you have found out what kind of injury the person has and how serious it is. The following problems require that you place a casualty in different positions: a. Vomiting, bleeding about the mouth, or semiconscious. If the casualty is in danger of sucking in blood, vomited matter, or water, place the patient on the side, or back, with the head turned to one side, lower than the feet. 13-1