Differences Between Civilian and Combat First Aid Courses
There are fundamental differences in the ways first aid is taught to civilians and the military. Why are there different rules for different conditions and why is it important to teach them? This articles is about the right approaches at the right times.
On April 23, Patriot Defence's trainers were in Bila Tserkva for the national seminar “Kuznya zakhysnykiv Ukrayiny” (literally: forge for Ukraine's defenders)where they conducted training sessions on teaching first aid to military-patriotic clubs.
There were more than 100 participants from 22 oblasts across Ukraine present at the seminar, including leaders and representatives of military-patriotic clubs, youth organizations and Anti-Terrorist Operation (ATO) veterans' associations.
Patriot Defence trainers Oleksandr Voronetskyy and Mykola Korobenkov explained the difference between training Combat Lifesavers (CLS) and Basic Life Support (BLS) and the ways first aid is taught in schools.
The trainers suggested that schoolchildren should first be taught the BLS course as part of the “fundamentals of safety” subject of the regular curriculum for lower grades and that CLS be taught in higher grades as part of the “national defense” lessons during military training at school.
The following is a short comparison of BLS and CLS courses. The comparison is not exhaustive, but shows why civilians, especially schoolchildren, should first be taught the BLS course.
Conditions, scope and limitations of providing first aid
In a combat setting, doctors are rare and transporting an injured victim to a medical facility can take a long time in Ukraine.
In civilian conditions, medical professionals are able to begin administering qualified aid much sooner and the injured individual is delivered faster to a medical facility.
In first aid, it is important not only to save lives but to also maintain health. In a combat setting, the opportunities to provide aid is limited by tactical considerations and the principle of “life before health” comes into play sooner than in a non-combat environment. In addition, the risk of injury to the lifesaver is greater due to the dangerous environment.
In the civilian BLS course (meaning the BLS course for non-medical personnel ), trainees are taught how to stop bleeding, open up airways using manual methods, conduct cardiopulmonary resuscitation with or without an automatic external defibrillator, splint a fracture and treat spinal trauma.
The BLS course does not include invasive procedures, tourniquet manipulation or administration of pharmaceuticals as these are the jobs of medical professionals in civilian conditions. Prior to administering aid to a victim, one needs to get his or her direct or indirect consent.
Basic Life Support Course for the Ukrainian Academy of Leadership
The CLS course only provides the skills that may be useful for a soldier when he or his comrade has sustained injury in battle. Soldiers are taught how to open airways using various methods, treat penetrating wounds to the chest and rib cages as well as complications with such wounds, restore circulation to extremities that have been compressed with a tourniquet and administer pharmaceuticals contained in a pill pack (antibiotic, anti-inflammatory and non-narcotic analgesic). All these are lawful procedures. Attempting cardiopulmonary resuscitation is dangerous and ineffective in combat conditions, so this is not taught during the CLS course.
While providing aid in a civilian environment, it is necessary to secure outside help as soon as possible and call emergency services. It is also important to consider the risks associated with the cause of the trauma (that has already inflicted injury), threats from the external environment as well as the threats from the injured party.
On the battlefield, the top priority is the completion of the combat mission and ensuring no more personnel are wounded. The next priority is one's own safety and provision of aid to the wounded. Aid in the battlefield is divided into two stages: care under fire and tactical field care. During training, a strong accent is placed on self-aid.
Both courses share the CABC algorithm (Critical bleeding, Airways, Breathing, Circulation). The skills associated with each letter of the acronym vary according to the environment in which aid is provided and the education of the trainees.
Critical bleeding. In civilian conditions, massive bleeding is stopped by applying pressure on the major blood vessel proximal from the wound. Using a tourniquet to stop the bleeding is permitted only if less traumatic methods are unable to stop the bleeding. Where schoolchildren are concerned, teaching them to use a tourniquet should only be done on a mannequin. In a civilian setting, a tourniquet is often the last resort while in a combat setting, the tourniquet is first thing to be used.
Care under fire station during the Combat Life Saver course for the 80th marine-assault brigade of the Armed Forces of Ukraine
On the battlefield, critical bleeding is the #1 killer, thus it is afforded the most attention. A tourniquet is applied as high up the limb as possible if critical bleeding is suspected or traumatic amputation has occurred.
Extraction. On the battlefield, the principle of “grab and run” is applied when it's necessary to remove a wounded soldier from a dangerous area. In civilian life, an injured party is not moved anywhere until emergency services arrive, unless they're facing a deadly threat. The BLS course teaches how to immobilize the bones that have likely been fractured (splinting, neck brace, spinal board) prior to moving the injured person anywhere.
Аirways. BLS teaches how to manually open up airways. If a neck injury is suspected, then the head should not be manipulated but the jaw moved forward. If a spinal injury is suspected then the person should not be left lying in the stable side position. In CLS, treating spinal injuries is not taught due to their rarity and other approaches to treating trauma. Placing someone in the stable side position is the norm if the wounded person is immobile. Injured soldiers' airways are opened using manual techniques, stable side positioning and employing a nasopharyngeal tube.
Patriot Defence instructor Oleksandr Voronetskyi at the national seminar “Kuznya zakhysnykiv Ukrayiny”
Вreathing. The civilian course includes the checking of breathing and conducting pulmonary resuscitation if required. Using an automatic defibrillator is allowed. In contrast to the civilian course, the military are taught to check the chest and rib cage for any penetrating injuries and deal with tension pneumothoraces should they occur.
Сirculation. The CLS course focuses on pressure bandages and wound dressing. Then a lifesaver can try to restore circulation to the extremities that are compressed by a tourniquet. In the BLS course, only medical professionals are allowed to dress wounds. Non-professionals are allowed to perform splinting without retraction in certain situations. Typically, only professionals are allowed to work with spinal boards and splints.
In the civilian course, most wounds, with a few exceptions, are disinfected. On the battlefield, most wounds are deeps and are thus not disinfected.
In a civilian setting, only doctors are allowed to prescribe medicine to a patient. A non-doctor can help patients take medications as directed by a doctor. Soldiers take the contents of the pill pack as a preventative measure when combat wounds are present. Narcotic analgesics are administered by doctors.
Myths about “gradually loosening a tourniquet” or “pain shock” can end up killing people and using combat medical techniques in civilian situations can result in tragedy. You hear people talking about how to secure a persons tongue with a pin or the need to cover them with a black cloth; that a person who is alive has to be carried head forward because only dead people are carried feet forward.
Training must be based on evidence-based medicine, not on taboos and old wives' tales. Training courses that are built on international standards will help dispel these myths and, more importantly, save lives.