BASIC LIFE SUPPORT In any casualty situation, you will concentrate on maintaining the ABCs (discussed in the “Basic Life Support” section of chapter 9 in Dental Technician, Volume 2, NAVEDTRA 12573) of the casualties. TREATING  OBVIOUS  CONDITIONS In your primary assessment, you will notice some obvious  conditions  that  require  treatment  (e.g., external hemorrhaging, shock, fractures, wounds, etc.). After you triage the casualties, you will start treatment of the obvious conditions. Hemorrhage Hemorrhage, or bleeding, occurs whenever there is a break in the wall of a blood vessel. Blood circulates throughout the body by means of three different kinds of blood vessels: arteries, veins, and capillaries. Arteries are large blood vessels that carry the blood away from the heart. Veins are large blood vessels that carry blood back to the heart. Capillaries are  smaller  blood  vessels  that  form  a  connecting network between the arteries and veins. Arterial bleeding is when bright red blood comes from the wound. If the artery is near the surface of the body, the blood will spurt out each time the casualty’s heart beats. If the artery is located deep within the body, the blood will flow from the wound in a steady stream. Venous  bleeding  is  when  dark  red  blood  comes from the wound in a steady stream. Capillary bleeding is when dark red blood comes from the wound in a steady stream. Slight  wounds  usually  cause  only  capillary bleeding.  This  bleeding  can  be  controlled  by  lightly fastening  a  sterile  dressing  over  the  wound.  Deeper wounds,  however,  may  cause  venous  or  arterial bleeding. Because the veins and arteries are large blood vessels, a casualty may lose a lot of blood. You should regard venous or arterial bleeding as a serious,  life-threatening  emergency. The four methods for controlling hemorrhage are direct pressure, elevation, applying pressure to the pressure points, and the use of a tourniquet. 13-3 WARNING Apply a tourniquet only as a last resort. DIRECT PRESSURE.—In most cases, serious external  bleeding  can  be  controlled  by  applying pressure directly on the wound with your hand on a sterile dressing as shown in figure 13-1. A  battle  dressing  is  a  combination  dressing  and bandage in one unit. It is made of many layers of gauze sewed to a muslin strip or strips. Emergency medical kits are supplied with battle dressings (fig. 13-2), each stored in a sterile package, ready for instant use. These dressings come in different sizes; select a size to completely cover the wound and extend at least 1 inch in  every  direction  beyond  the  border  of  the  wound. Make sure that the sterile side covering the wound does not come into contact with your fingers, your clothes, or other unsterile objects. Do not drag the dressing across the casualty’s skin, or allow it to slip out of place once it has been positioned over the wound. When the dressing is in place over’the wound, apply pressure to the dressing with the palm of your hand.  Maintain  pressure  until  the  bleeding  is controlled. If blood soaks through the dressing, do not replace it; add a second dressing on top of the first one and maintain hand pressure. When the bleeding is controlled, wrap the ends of the dressing around the wound and secure them by tying or pinning. If you have no battle dressings, you may use the cleanest  cloth  available  (e.g.,  freshly  laundered handkerchief, towel, or shirt) and a roller bandage (fig. 13-3). But never use material that will stick to the wound and be difficult to remove (e.g., absorbent cotton  and  adhesive  or  friction  tape).  The  roller bandage is used to hold a compress in place, create pressure,  and  immobilize  joints.  The  purpose  of  the bandage is to stop the bleeding, to prevent further Figure 13-1.—Direct pressure.