b. Shortness of breath. If the casualty has a chest injury or has breathing difficulties, place the patient in a sitting or semi-sitting position.

c. Shock. If the casualty is in shock, place the patient on the back, with the head slightly lower than the feet. If the injuries permit, the casualty's feet should be raised and supported 6 to 12 inches above the head.

2. Move the casualty only when absolutely necessary. You may have to remove some clothing to determine the extent of the injuries. Remove enough clothing to get a clear idea of the extent of the injury. If you remove clothing incorrectly, you may do great harm, especially in fracture injuries. You may have to rip or cut clothing along the seams. When clothing is removed, ensure that the casualty does hot become chilled. Shoes may have to be cut off to avoid causing pain or increasing an injury.

3. Reassure the casualty and keep the patient as comfortable as possible.

4. Do not touch open wounds or burns with the fingers or other objects except when sterile compresses or bandages are not available and it is absolutely necessary to stop severe bleeding.

5. Do not try to give an unconscious person any solid food or liquid substance by mouth.

6. If a bone is broken, or if you suspect that one is broken, do not move the casualty until you have immobilized the injured part. When transporting a casualty, always make sure that the litter is carried feet forward no matter what the injuries are. This enables the rear litter bearer to observe the casualty for any respiratory obstruction or stoppage of breathing.

7. Keep the casualty comfortable and warm enough to maintain normal body temperature.

If the casualty is conscious and coherent, the primary assessment can be expedited by asking about the nature of the injuries and the conditions involved. You must rely on an unconscious casualty's signs (e.g., profuse hemorrhage, cyanotic skin, choking, etc.) and on surroundings.

Triage

Triage is the sorting of and allocation of treatment to patients, especially battle and disaster victims, based on a system of priorities designed to maximize the number of survivors.

Triage is normally the responsibility of the medical officer, dental officer, or Hospital Corpsman. But if they are not available, you will have to triage the casualties. Sorting decisions may be made at every stage in the movement of the wounded. Your goal in making these decisions is to do the most good for the largest number of casualties, given limited time, supplies, and personnel.

Casualties are grouped according to the serious- ness of their injuries. The groups are as follows:

Group 1 Those whose injuries are so slight they can be managed by self-help or buddy care. These casualties can be returned promptly to their units for full duty.

Group 2 Those whose wounds require medical care but are so slight that they can be managed at the battalion aid station. These casualties can be returned to duty after a brief period.

Group 3 Those whose injuries demand surgical attention immediately, after resuscitation, or as soon as practical.

Group 4 Those hopelessly wounded or dead on arrival.

The treatment order of the groups depends on whether it is a combat or noncombat situation.

Combat. This occurs when you are up against hostile, life-threatening situations (e.g., war, bombings, terrorist dealings, etc.). In the combat situation, you will triage the casualties in the group order of 1, 2, 3, and 4. This is done because Group 1 casualties must return to full duty as soon as possible to help fight the enemy, followed by Groups 2 and 3 when they are available. Because Group 4 casualties are hopelessly wounded or dead, they will be last.

Noncombat. This occurs when a disaster strikes (e.g., plane crash, automobile accident, earthquake, flood, etc.). In these situations, the least injured casualties (Groups 1 and 2) can care for themselves while you take care of the wounded in Group 4. In a noncombat situation there is usually no further life-threatening action, so you will have time to treat a Group 4 casualty who has a chance of survival. After you are done with Group 4, go back and treat Group 3, Group 2, and then Group 1.