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Post by pigeons on June 5th 2013, 9:25 pm

Helix Advanced Field Manual
This manual is intended for use by units in HELIX ranked 02 and higher, for the learning and better understanding of conducting as well as overseeing advanced surgical operations. It is intended that this guide only be read by HELIX non-commissioned officers and officers.


One of the most common procedures you will be conducting in surgical operations are

extractions. An extraction involves the removal of bullet fragments, shrapnel, or other

foreign objects lodged inside of the patient's body following injury.

To begin, you will need:
● Tweezers
● Medical towels
● Latex surgical gloves
● x1 Bandage roll
● x2 Metal clip
● Scalpel
● Thread & needle
● Biogel formula
● Clamp
● Scissors
● CRS-PR, CRS-S, CRS-A (Any combination as addressed by the overseeing officer)

Check to make sure that all tools used are 100% sterile.

Begin the procedure by identifying where the objects/fragments are. If it is not possible

to locate, you may do a brief X-Ray scan under supervision of the overseeing officer, to

show where the objects are. Once located, clean the wounds with the biogel formula and

make sure the gel has been fully absorbed by the skin. Once absorbed, make an incision in

the skin just above the object.
To measure, if the object is half an inch large, the incision should be one inch larger.

If there is already an opening in the skin, make the opening larger as needed, but do not

inflict unnecessary damage.

Clean the incision as needed using the medical towels, as cutting the skin will always

force more blood onto the surface. Use the clamp to hold the incision open and keep a

light shined on it. You will then use the tweezers to extract the object from the wound,

and place it on a surgical tray. This must be done very gently as to not damage tissue.

Once completed, remove the clamps and use the thread & needle to close the wound. Cut off

the string once the wound is shut.

Clean the entire area off with biogel formula to sterilize the wound. Once the biogel has

been absorbed, wipe the skin off with a clean towel, and wrap a bandage roll around the

wound. If the wound is on the arm, wrap the roll around the arm. If on the chest/stomache,

wrap the roll around the torso, and so on. Use two metal clips to hold the bandages in

place on both top and bottom. CRS-PR, CRS-S, and CRS-A will be used when the overseeing

officer orders. This should complete the procedure.

Identifying Burns & Treating Them

HELIX Advanced Field Manual [02+] Skin10

To distinguish a minor burn from a serious burn, the first step is to determine the extent

of damage to body tissues. The three burn classifications of first-degree burn, second-

degree burn and third-degree burn will help you determine emergency care.

1st-degree burn
The least serious burns are those in which only the outer layer of skin is burned, but not

all the way through.

●The skin is usually red
●Often there is swelling
●Pain sometimes is present

Treat a first-degree burn as a minor burn unless it involves substantial portions of the

hands, feet, face, groin or buttocks, or a major joint, which requires emergency medical


2nd-degree burn
When the first layer of skin has been burned through and the second layer of skin (dermis)

also is burned, the injury is called a second-degree burn.

●Blisters develop
●Skin takes on an intensely reddened, splotchy appearance
●There is severe pain and swelling.

If the second-degree burn is no larger than 3 inches (7.6 centimeters) in diameter, treat

it as a minor burn. If the burned area is larger or if the burn is on the hands, feet,

face, groin or buttocks, or over a major joint, treat it as a major burn and get medical

help immediately.

3rd-degree burn
The most serious burns involve all layers of the skin and cause permanent tissue damage.

Fat, muscle and even bone may be affected. Areas may be charred black or appear dry and

white. Difficulty inhaling and exhaling, carbon monoxide poisoning, or other toxic effects

may occur if smoke inhalation accompanies the burn.

What causes a third-degree burn?
In most cases, third-degree burns are caused by the following:

•a scalding liquid
•skin that comes in contact with a hot object for an extended period of time
•flames from a fire
•an electrical source
•a chemical source

What are the symptoms of a third-degree burn?
The following are the most common symptoms of a third-degree burn. However, each person

may experience symptoms differently. Symptoms may include:

•dry and leathery skin
•black, white, brown, or yellow skin
•lack of pain because nerve endings have been destroyed

For minor burns, including first-degree burns and second-degree burns limited to an area

no larger than 3 inches (7.6 centimeters) in diameter, take the following action:

●Cool the burn. Hold the burned area under cool (not cold) running water for 10 or 15

minutes or until the pain subsides. If this is impractical, immerse the burn in cool water

or cool it with cold compresses. Cooling the burn reduces swelling by conducting heat away

from the skin. Don't put ice on the burn. Putting ice directly on a burn can cause a

person's body to become too cold and cause further damage to the wound

●Cover the burn with a sterile gauze bandage. Don't use fluffy cotton, or other material

that may get lint in the wound. Wrap the gauze loosely to avoid putting pressure on burned

skin. Bandaging keeps air off the burn, reduces pain and protects blistered skin.
●Administer low doses of CRS-PR if pain is persistent.

Minor burns usually heal without further treatment. They may heal with pigment changes,

meaning the healed area may be a different color from the surrounding skin. Watch for

signs of infection, such as increased pain, redness, fever, swelling or oozing. Avoid re-

injuring if the burns are still relatively new — doing so may cause more extensive

pigmentation changes.

Treatment for third-degree burns will depend on the severity of the burn. Burn severity

is determined by the amount of body surface area that has been affected. The burn severity

will be determined by overseeing officer. Treatment for third-degree burns may include the


● Early cleaning and debriding (removing dead skin and tissue from the burned area). This

procedure can be done in a special bathtub or as a surgical procedure.

● Intravenous (IV) fluids containing electrolytes

● Antibiotics by intravenous (IV) or by mouth

● Antibiotic ointments or creams

● A warm, humid environment for the burn

● Nutritional supplements and a high-protein diet

● Administration of CRS-PR

● Skin grafting (may be required to achieve closure of the wounded area). A skin graft is

a piece of the patient's unburned skin which is surgically removed to cover a burned area.

Skin grafts can be thin or thick. Skin grafts are performed in the operating room. The

burn that is covered with a skin graft is called a graft site.

● Functional and cosmetic reconstruction

Information on Skin Grafting:

The area where the piece of unburned skin was taken to be donated to a burned area is

called a donor site. After a skin graft procedure the donor sites look like a scraped or a

skinned knee. A skin graft is often performed after debridement or removal of the dead

skin and tissue. Once a skin graft is in place, a dressing must also cover the graft.
The dressing is left on the graft site for two to five days before it is changed, so that

the new skin will stay in place. For the first several days, graft sites need to be kept

very still and protected from rubbing or pressure.

The donor site is covered for the first one to two weeks. The site needs to be kept

covered. Donor sites usually heal in 10 to14 days. If a dressing is applied, it usually

remains on until it comes off by itself. Lotion is applied to the donor site after the

dressing comes off. This skin often flakes off and looks dry.

In the initial steps of finding an officer with a third degree burn, you must take the following action. Call for emergency medical help. Until an emergency unit arrives, follow these steps:

● Don't remove burned clothing. However, do make sure the victim is no longer in contact with smoldering materials or exposed to smoke or heat.

● Don't immerse large severe burns in cold water. Doing so could cause a drop in body temperature (hypothermia) and deterioration of blood pressure and circulation (shock).

● Check for signs of circulation (breathing, coughing or movement). If there is no breathing or other sign of circulation, begin CPR.

● Elevate the burned body part or parts. Raise above heart level, when possible.

● Cover the area of the burn. Use a cool, moist, sterile bandage; clean, moist cloth; or moist cloth towels.

Identifying & Treating Fractures

Treatment of a broken leg will vary, depending on the type and location of the break. If a unit breaks a leg, treatment may depend on the age of the unit. Stress fractures may require only rest and immobilization. Fractures are classified into one or more of the following categories:

● Open (compound) fracture. In this type of fracture, the skin is pierced by the broken bone. This is a serious condition that requires immediate, aggressive treatment to decrease your chance of an infection.

● Closed fracture. In closed fractures, the surrounding skin remains intact.

● Incomplete fracture. This term means that the bone is cracked, but it isn't separated into two parts.

● Complete fracture. In complete fractures, the bone has snapped into two or more parts.

● Displaced fracture. In this type of fracture, the bone fragments on each side of the break are not aligned. A displaced fracture may require surgery to realign the bones properly.

● Comminuted fracture. This term means that the bone is broken into several pieces. This type of fracture also may require surgery for complete healing.

● Greenstick fracture. In this type of fracture, the bone cracks but doesn't break all the way through — like when you try to break a green stick of wood.

Setting the leg
Initial treatment for a broken leg usually begins in a medical bay. Here, Field Medics or higher typically evaluate your injury and immobilize your leg with a splint. If you have a displaced fracture, the unit carrying out the procedure may need to manipulate the pieces back into their proper positions before applying a splint — a process called reduction. Depending on the amount of pain and swelling you have, you may need a muscle relaxant, a dose of CRS-S, or even CRS-A before this procedure. Some fractures are splinted for a day to allow swelling to subside before they are casted.

Restricting the movement of a broken bone in your leg is critical to proper healing. To do this, you may need a splint or a cast. And you may need to use crutches or a cane to keep weight off the affected leg for six to eight weeks or longer.

To reduce pain and inflammation, CRS-PR should be applied. If pain is extremely severe, it may require the use of an opioid-based pain reliever, which are very rarely used.

After your cast or splint is removed, you'll likely need rehabilitation exercises or physical therapy to reduce stiffness and restore movement in the injured leg. Because you haven't moved your leg for a while, you may even have stiffness and weakened muscles in uninjured areas. Rehabilitation can help, but it may take up to several months — or even longer — for complete healing of severe injuries. This is why these procedures are often skipped and augmentations are put in place.

Surgical and other procedures
Immobilization heals most broken bones. However, you may need surgery to implant internal fixation devices, such as plates, rods or screws, to maintain proper position of your bones during healing. These internal fixation devices may be necessary if you have the following injuries:

●Multiple fractures

●An unstable or displaced fracture

●Loose bone fragments that could enter a joint

●Damage to the surrounding ligaments

●Fractures that extend into a joint

●A fracture that is the result of a crushing accident

●A fracture in particular areas of your leg, such as your thighbone

Most internal fixation materials are left in place. Others may be removed after your bone heals, while some are made of materials that are absorbed into your body. Complications are rare, but can include wound-healing difficulties, infection and lack of bone healing.


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