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Due to the hazardous setting and time constraints, you must focus on assessing these three functions. Airway If the casualty is conscious and breathing well on his or her own, there should be no attempt at airway intervention. Allow a conscious casualty to assume any position that best protects the airway, including sitting up. Open the airway with a chin-lift or jaw-thrust maneuver without worrying about cervical spine immobilization. With unconscious casualties, insert a nasopharyngeal airway (NPA) or Combitube and place him or her in the recovery position FIGURE 1-3 .
Survey the building’s structure for stability. Remove the casualty to a safe area, if necessary, prior to assessment or treatment. Getting the casualty to cover (or concealment) may entail moving the casualty. Tell the casualty to move as quickly as possible to cover while maintaining a low profile FIGURE 2-1 . If the casualty is unable to move, you may need to assist him or her using manual evacuation. The risk in moving the casualty is the possibility of aggravating existing injuries, but the benefit of protection outweighs the risk.
The additional trauma caused by a needle thoracostomy is not FIGURE 1-9 In a tension pneumothorax, air accumulates in the pleural space, eventually causing compression of the heart and great vessels. expected to worsen the casualty’s condition if a tension pneumothorax is not present. Chest tubes are not recommended in this phase of care because they are not needed to provide initial treatment for a tension pneumothorax. Also, chest tubes are more difficult and time consuming for inexperienced personnel to use, especially in the absence of adequate light.