突發(fā)事件應(yīng)對(duì)之戰(zhàn)地救護(hù)專家講座

CombatFirstAid突發(fā)事件應(yīng)對(duì)之戰(zhàn)地救護(hù)專家講座第1頁(yè)ToIntroducethestudentswithdataregardingtheimportanceofquicktreatmentofinjuriesduringconflict介紹關(guān)于戰(zhàn)火下快速救護(hù)主要性數(shù)據(jù)Tointroducethestudenttothesightsandmechanismsofsometraumainjuries介紹一些創(chuàng)傷樣子以及原理Totrainthestudentswithfasttechniquesfortreatingbattleinjuries訓(xùn)練快速戰(zhàn)地?fù)尵燃记赏话l(fā)事件應(yīng)對(duì)之戰(zhàn)地救護(hù)專家講座第2頁(yè)LogicFirsttraininglearnedTacticalFieldCare學(xué)習(xí)戰(zhàn)地救護(hù)Firstaidintimeofemergencyisdifferentfromwhatisthuoghtinmostregulartraining不一樣于普通搶救Pressure(Shooting,screaming,sightofblood,rain,mustrunawayetc)壓力環(huán)境（射擊、尖叫、血腥場(chǎng)景、下雨、必需逃脫等等）Possiblethatnofirstaidequipment可能沒有裝備The

fateofthewoundedlayswiththosewhoapplythefirstdressing.傷員命運(yùn)取決于最先救助他人-Col.NicholasSenn,1844-1908突發(fā)事件應(yīng)對(duì)之戰(zhàn)地救護(hù)專家講座第3頁(yè)ImportanceoftheFirstResponder

第一個(gè)救助者主要性75-90%ofallcombatdeathsoccurbeforethecasualtyreachesaMedicalTreatmentFacility(MTF)75%-90%戰(zhàn)傷死亡都出現(xiàn)在傷員抵達(dá)醫(yī)療搶救設(shè)施前路上Thefateoftheinjuredoftenliesinthehandsoftheonewhoprovidesthefirstcaretothecasualty.傷員命運(yùn)依賴于最先為他們施與援手人四肢出血?dú)庑睾粑枞话l(fā)事件應(yīng)對(duì)之戰(zhàn)地救護(hù)專家講座第4頁(yè)Whatfactorsmustwethinkaboutincombattraumacare?戰(zhàn)傷搶救需要考慮原因Hostilefire敵人火力Darkness黑暗Environmentalextremes極端環(huán)境Differentwoundingepidemiology不一樣傷情L(zhǎng)imitedequipment缺乏設(shè)備器材Needfortacticalmaneuver需要作出戰(zhàn)術(shù)動(dòng)作Longdelaystohospitalcare長(zhǎng)時(shí)間到不了醫(yī)院Differentmedictrainingandexperience不一樣訓(xùn)練和經(jīng)驗(yàn)突發(fā)事件應(yīng)對(duì)之戰(zhàn)地救護(hù)專家講座第5頁(yè)TacticalCombatCasualtyCare

戰(zhàn)斗傷患照料規(guī)范突發(fā)事件應(yīng)對(duì)之戰(zhàn)地救護(hù)專家講座第6頁(yè)6StepsofBasicFirstAid基本搶救6個(gè)步驟Ensureareaissafeandgethelp確定環(huán)境安全Opentheairwayandrestorebreathing打開氣道恢復(fù)呼吸Stopbleedingandprotectwounds止血并保護(hù)傷口Checkforotherinjuriesandtreat檢驗(yàn)并治療其它傷GiveagoodreporttoMedical向醫(yī)生（醫(yī)療者）正確匯報(bào)突發(fā)事件應(yīng)對(duì)之戰(zhàn)地救護(hù)專家講座第7頁(yè)Movetosafety安全移動(dòng)RecallThreatslesson回顧威脅課Buildingonfire?Vehicleonfire,Vehicleunderfire?Smoke?Enemyapproaching?建筑起火？車輛起火？車輛遭遇射擊？煙？敵人靠近中？CanImovetheinjuredwithoutharminghim?我能在不傷害傷員前提下搬運(yùn)他嗎？CanImovehim?我能移動(dòng)他嗎？Usecoverorconcealment利用掩蔽或掩護(hù)突發(fā)事件應(yīng)對(duì)之戰(zhàn)地救護(hù)專家講座第8頁(yè)FirstDilemma第一個(gè)困境ScoopandRunVsStayandPlay“搶時(shí)間和跑”與“停下和施救”ScoopandRuntakethepatientwithoutprimarytreatmentandhurryhimtothenexthospital“搶時(shí)間和跑”：將未受處理傷員緊急送往醫(yī)院(movieinKidnaplesson)StayandPlayfirstaid：停下和施救進(jìn)行搶救突發(fā)事件應(yīng)對(duì)之戰(zhàn)地救護(hù)專家講座第9頁(yè)AIRWAY氣道突發(fā)事件應(yīng)對(duì)之戰(zhàn)地救護(hù)專家講座第10頁(yè)Airway氣道Checkforairwayobstruction/choking檢驗(yàn)氣道阻塞、抑制UseHeimlichmaneuver,backblows,orfingersweeptoclearobstruction采取Heimlich操作法，或用手指去除障礙Openairway打開氣道Head-tilt/chin-lift頭部?jī)A斜、下巴上抬Jaw-thrust推下顎突發(fā)事件應(yīng)對(duì)之戰(zhàn)地救護(hù)專家講座第11頁(yè)BREATHING突發(fā)事件應(yīng)對(duì)之戰(zhàn)地救護(hù)專家講座第12頁(yè)NoBreathing沒有呼吸Ifavictimofablastorpenetratinginjuryisfoundwithoutapulse,respirations,orothersignsoflife,DONOTattemptCPR假如傷員因?yàn)楸ɑ虼┩競(jìng)鴽]有脈搏、呼吸或其它生命體征，不要作心肺復(fù)蘇Tiltheadbackandpinchnose向后提頭，捏住鼻子Give2full,slowbreaths慢慢吹兩口氣Ifnotgoingin,checkforobstruction假如吹不進(jìn)去，檢驗(yàn)氣道是否受阻Repositionheadifneeded需要話復(fù)位頭1breathevery5seconds每5秒吹一次突發(fā)事件應(yīng)對(duì)之戰(zhàn)地救護(hù)專家講座第13頁(yè)AirwayAdjunctsandControl氣道輔助和控制RecoveryPosition恢復(fù)體位半臥式體位突發(fā)事件應(yīng)對(duì)之戰(zhàn)地救護(hù)專家講座第14頁(yè)膝蓋抬到腹部高度，支撐身體手支撐住頭突發(fā)事件應(yīng)對(duì)之戰(zhàn)地救護(hù)專家講座第15頁(yè)CIRCULATION循環(huán)系統(tǒng)

STOPTHEBLEEDING止血

突發(fā)事件應(yīng)對(duì)之戰(zhàn)地救護(hù)專家講座第16頁(yè)Stopvisiblebleeding止住可見流血傷口CheckforChestwounds(alsobackside)檢驗(yàn)胸口傷（以及后背）Checkforbleedingyouhavenotseenyet檢驗(yàn)有沒有你忽略流血傷口突發(fā)事件應(yīng)對(duì)之戰(zhàn)地救護(hù)專家講座第17頁(yè)Removesomeclothes脫掉部分衣服CheckforClotheswithblood檢驗(yàn)有血衣服對(duì)應(yīng)身體部分Entryandexitwounds穿透?jìng)话l(fā)事件應(yīng)對(duì)之戰(zhàn)地救護(hù)專家講座第18頁(yè)BattleDressings戰(zhàn)地繃帶StandardBattleDressingTearopenplasticwrap.Twisttoopenpaperwrapperandremovedressing扭開紙包裝取出繃帶標(biāo)準(zhǔn)軍用搶救包撕開塑料包裝突發(fā)事件應(yīng)對(duì)之戰(zhàn)地救護(hù)專家講座第19頁(yè)BattleDressings戰(zhàn)地繃帶Unfoldbandageandapplytowound.打開繃帶蓋住傷口Wraptailsaroundandtietogether.包扎好，系住尾部固定帶突發(fā)事件應(yīng)對(duì)之戰(zhàn)地救護(hù)專家講座第20頁(yè)EmergencyBandage(IsraeliPressureDressing)

緊急繃帶（以色列式）突發(fā)事件應(yīng)對(duì)之戰(zhàn)地救護(hù)專家講座第21頁(yè)EmergencyBandage緊急繃帶突發(fā)事件應(yīng)對(duì)之戰(zhàn)地救護(hù)專家講座第22頁(yè)P(yáng)ressurePoints按壓止血點(diǎn)Usefingerpressureonthesepointstostopbleeding指壓止血Also,placetourniquetbandoverthesepoints(arteries)在這些點(diǎn)扎止血帶（動(dòng)脈傷）壓力點(diǎn)止血突發(fā)事件應(yīng)對(duì)之戰(zhàn)地救護(hù)專家講座第23頁(yè)WhentouseTourniquet什么時(shí)間用止血帶Amputation截肢Shrapnel彈片ProbleminAirway氣道問題Morethenonepatient不止一個(gè)傷員Nighttime晚上PressureDressingsdidn’thelp壓力繃帶無(wú)法止血Underfire火力下..\Movies\FirstaidBulletentrytolegs.wmv突發(fā)事件應(yīng)對(duì)之戰(zhàn)地救護(hù)專家講座第24頁(yè)P(yáng)enetratingtrauma穿透?jìng)话l(fā)事件應(yīng)對(duì)之戰(zhàn)地救護(hù)專家講座第25頁(yè)SplinterPenetratingtrauma穿透?jìng)麄麊T頭部方向肚臍身體右側(cè)尖銳物突發(fā)事件應(yīng)對(duì)之戰(zhàn)地救護(hù)專家講座第26頁(yè)P(yáng)enetratingtrauma穿透?jìng)话l(fā)事件應(yīng)對(duì)之戰(zhàn)地救護(hù)專家講座第27頁(yè)Tensionpneumothorax氣胸Airleakthroughlungorchestwall空氣滲進(jìn)胸腔或肺里“One-way”valvelungcollapse”單向閥“----肺衰竭

Mediastinumshiftstooppositeside縱隔膜轉(zhuǎn)到反向Inferiorvenacava“kinks”ondiaphragmdecreasedvenousreturncardiovascularcollapse降低靜脈回流心血管瓦解突發(fā)事件應(yīng)對(duì)之戰(zhàn)地救護(hù)專家講座第28頁(yè)Tensionpneumothorax氣胸..\Movies\Pneomothorax.wmv突發(fā)事件應(yīng)對(duì)之戰(zhàn)地救護(hù)專家講座第29頁(yè)Openpneumothorax打開氣胸Initialtreatment:sealdefectandsecureonthreesides(totalocclusionmayleadtotensionpneumothorax初治：封閉傷口，按住3個(gè)角留一個(gè)（完全封閉會(huì)造成張力性氣胸）DefinitiverepairofdefectinO.R.只有在手術(shù)室才能最終封閉MoviesuckingChestwound突發(fā)事件應(yīng)對(duì)之戰(zhàn)地救護(hù)專家講座第30頁(yè)Openpneumothorax打開氣胸..\Movies\FirstAidPhnemutoraxA.wmv突發(fā)事件應(yīng)對(duì)之戰(zhàn)地救護(hù)專家講座第31頁(yè)NeedleThoracentesis胸腔穿刺術(shù)Emergentlydecompressaffectedhemithoraxwith14-gaugeneedleinsertedover3rdribin2ndinter-costalspaceatmid-clavicularline緊急情況下為半胸減壓，使用14-gauge針從2、3肋骨間，正對(duì)鎖骨中間位刺入突發(fā)事件應(yīng)對(duì)之戰(zhàn)地救護(hù)專家講座第32頁(yè)THETARGET:PREVENTABLECOMBATDEATH

目標(biāo)：防止戰(zhàn)斗死亡

突發(fā)事件應(yīng)對(duì)之戰(zhàn)地救護(hù)專家講座第33頁(yè)Mainpoints關(guān)鍵點(diǎn)Trytokeepyourselffromgettingshot

首先要確保自己不要被擊中Trytokeepthecasualtyfromsustaininganyadditionalwounds

要確保傷員不要再受傷AirwaymanagementisgenerallybestdeferreduntiltheTacticalFieldCarephase

氣道處理要等戰(zhàn)術(shù)搶救開始時(shí)再實(shí)施Stopanylife-threateninghemorrhagewithatourniquet

對(duì)任何威脅生命出血用止血帶進(jìn)行止血Reassurethecasualty

為傷員打氣突發(fā)事件應(yīng)對(duì)之戰(zhàn)地救護(hù)專家講座第34頁(yè)evacuation撤離Causeofinjury?Fallinvolved?受傷原因？跌落？Typeofevacuation?Underfire?撤離種類？火力下撤離？Reassurethecasualty給傷員打氣..\Movies\VeryIntenseInjuryTransportFromKorengalValley,Afghanistan.wmv突發(fā)事件應(yīng)對(duì)之戰(zhàn)地救護(hù)專家講座第35頁(yè)Evacuation撤離Causeofinjury?Fallinvolved?受傷原因？跌落？Typeofevacuation?Underfire?撤離種類？火力下撤離？Reassurethecasualty給傷員打氣Movie“veryintense”突發(fā)事件應(yīng)對(duì)之戰(zhàn)地救護(hù)專家講座第36頁(yè)Firststage第一步Onepersoncarry單人搬運(yùn)突發(fā)事件應(yīng)對(duì)之戰(zhàn)地救護(hù)專家講座第37頁(yè)Blanketdrag毯子拖拽突發(fā)事件應(yīng)對(duì)之戰(zhàn)地救護(hù)專家講座第38頁(yè)突發(fā)事件應(yīng)對(duì)之戰(zhàn)地救護(hù)專家講座第39頁(yè)突發(fā)事件應(yīng)對(duì)之戰(zhàn)地救護(hù)專家講座第40頁(yè)Vehicle車輛Releasethelegsfromdebris將腿從車輛殘骸中退出Casualtyheadleanonyourshoulder傷員頭靠在你肩上Yourarmunderarmpit你手穿到他腋下Firmfooting,rigidneckanddrag踩實(shí)，挺直脖子，然后拖拽突發(fā)事件應(yīng)對(duì)之戰(zhàn)地救護(hù)專家講座第41頁(yè)Secondstage第二步AirAmbulanceavailable(Helicopter)假如有搶救直升機(jī)Sufficientspacemustbeprovidedforhoveringandmaneuvering必需為直升機(jī)提供足夠懸停和機(jī)動(dòng)空間selectapproachzonesthatpermitthehelicoptertolandandtakeoffintotheprevailingwind選擇著路場(chǎng)要考慮直升機(jī)降落和起飛時(shí)主風(fēng)Theminimumrequirementforlighthelicoptersisaclearedarea30metersindiameterwithapproachanddeparturezonesclearofobstructions對(duì)于輕型直升機(jī)來(lái)講，最少要清理出直徑30米沒有障礙起降場(chǎng)突發(fā)事件應(yīng)對(duì)之戰(zhàn)地救護(hù)專家講座第42頁(yè)Removeanyobjectlikelytobeblownaboutbythewindfromtherotor去除任何可能會(huì)被旋翼風(fēng)吹起物體Clearlymarkobstacles(AntennaEtc)清楚標(biāo)識(shí)出障礙物（比如天線等）突發(fā)事件應(yīng)對(duì)之戰(zhàn)地救護(hù)專家講座第43頁(yè)IdentifyingtheLandingSite標(biāo)志降落場(chǎng)Markalandingsitewiththeletter"H"or"Y,”在地面用“H”或“Y”來(lái)書寫indicatethewinddirection(rragtiedtotheendofastickattheedgetheLZ/Manstandingat