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First Aid for Face and Neck Injuries

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US Army First Aid Manual
Fundamental Criteria for First Aid
Basic Measures for First Aid
First Aid for Special Wounds
First Aid for Fractures
First Aid for Climatic Injuries
First Aid for Bites and Stings
First Aid in Toxic Environments
First Aid for Psychological Reactions
Appendix A: First Aid Case and Kits, Dressings, and Bandages
Appendix B: Rescue and Transportation Procedures
Appendix C: Common Problems/Conditions
Appendix D: Digital Pressure
Appendix E: Decontamination Procedures
Appendix F: Glossary

First Aid for Face and Neck Injuries

3-5. Face Injuries

Soft tissue injuries of the face and scalp are common. Abrasions (scrapes) of the skin cause no serious problems. Contusions (injury without a break in the skin) usually cause swelling. A contusion of the scalp looks and feels like a lump. Laceration (cut) and avulsion (torn away tissue) injuries are also common. Avulsions are frequently caused when a sharp blow separates the scalp from the skull beneath it. Because the face and scalp are richly supplied with blood vessels (arteries and veins), wounds of these areas usually bleed heavily.

3-6. Neck Injuries

Neck injuries may result in heavy bleeding. Apply manual pressure above and below the injury and attempt to control the bleeding. Apply a dressing. Always evaluate the casualty for a possible neck fracture/spinal cord injury; if suspected, seek medical treatment immediately.


    Establish and maintain the airway in cases of facial or neck injuries. If a neck fracture or
    spinal cord injury is suspected, immobilize or stabilize casualty. See Chapter 4 for further information on treatment of spinal injuries.

3-7. Procedure

When a casualty has a face or neck injury, perform the measures below.

a. Step ONE. Clear the airway. Be prepared to perform any of the basic lifesaving steps. Clear the casualty's airway (mouth) with your fingers, remove any blood, mucus, pieces of broken teeth or bone, or bits of flesh, as well as any dentures.

b. Step TWO. Control any bleeding, especially bleeding that obstructs the airway. Do this by applying direct pressure over a first aid dressing or by applying pressure at specific pressure points on the face, scalp, or temple. (See Appendix E for further information on pressure points.) If the casualty is bleeding from the mouth, position him as indicated (c below) and apply manual pressure.


    Take care not to apply too much pressure to the scalp if a skull fracture is suspected.

c. Step THREE. Position the casualty. If the casualty is bleeding from the mouth (or has other drainage, such as mucus, vomitus, or so forth) and is conscious, place him in a comfortable sitting position and have him lean forward with his head tilted slightly down to permit free drainage (Figure 3-12). DO NOT use the sitting position if--

  • It would be harmful to the casualty because of other injuries.

  • The casualty is unconscious, in which case, place him on his side (Figure 3-13). If there is a suspected injury to the neck or spine immobilize the head before turning the casualty on his side.


    If you suspect the casualty has a neck/spinal injury, then immobilize his head/neck and
    treat him as outlined in Chapter 4.

d. Step FOUR. Perform other measures.

    (1) Apply dressings/bandages to specific areas of the face.

    (2) Check for missing teeth and pieces of tissue. Check for detached teeth in the airway. Place detached teeth, pieces of ear or nose on a field dressing and send them along with the casualty to the medical facility. Detached teeth should be kept damp.

    (3) Treat for shock and seek medical treatment IMMEDIATELY.

3-8. Dressings and Bandages (081-831-1033)

a. Eye Injuries. The eye is a vital sensory organ, and blindness is a severe physical handicap. Timely first aid of the eye not only relieves pain but also helps prevent shock, permanent eye injury, and possible loss of vision. Because the eye is very sensitive, any injury can be easily aggravated if it is improperly handled. Injuries of the eye may be quite severe. Cuts of the eyelids can appear to be very serious, but if the eyeball is not involved, a person's vision usually will not be damaged. However, lacerations (cuts) of the eyeball can cause permanent damage or loss of sight.

    (1) Lacerated/torn eyelids. Lacerated eyelids may bleed heavily, but bleeding usually stops quickly. Cover the injured eye with a sterile dressing. DO NOT put pressure on the wound because you may injure the eyeball. Handle torn eyelids very carefully to prevent further injury. Place any detached pieces of the eyelid on a clean bandage or dressing and immediately send them with the casualty to the medical facility.

    (2) Lacerated eyeball (injury to the globe). Lacerations or cuts to the eyeball may cause serious and permanent eye damage. Cover the injury with a loose sterile dressing. DO NOT put pressure on the eyeball because additional damage may occur. An important point to remember is that when one eyeball is injured, you should immobilize both eyes. This is done by applying a bandage to both eyes. Because the eyes move together, covering both will lessen the chances of further damage to the injured eye.


    DO NOT apply pressure when there is a possible laceration of the eyeball. The eyeball contains fluid. Pressure applied over the eye will force the fluid out, resulting in

    (3) Extruded eyeballs. Soldiers may encounter casualties with severe eye injuries that include an extruded eyeball (eyeball out-of-socket). In such instances you should gently cover the extruded eye with a loose moistened dressing and also cover the unaffected eye. DO NOT bind or exert pressure on the injured eye while applying a loose dressing Keep the casualty quiet, place him on his back, treat for shock (make warm and comfortable), and evacuate him immediately.

    (4) Burns of the eyes. Chemical burns, thermal (heat) burns, and light burns can affect the eyes.

      (a) Chemical burns. Injuries from chemical burns require immediate first aid. Chemical burns are caused mainly by acids or alkalies. The first aid is to flush the eye(s) immediately with large amounts of water for at least 5 to 20 minutes, or as long as necessary to flush out the chemical. If the burn is an acid burn you should flush the eye for at least 5 to 10 minutes. If the burn is an alkali burn, you should flush the eye for at least 20 minutes. After the eye has been flushed apply a bandage over the eyes and evacuate the casualty immediately.

      (b) Thermal burns. When an individual suffers burns of the face from a fire, the eyes will close quickly due to extreme heat. This reaction is a natural reflex to protect the eyeballs; however, the eyelids remain exposed and are frequently burned. If a casualty receives burns of the eyelids/face, DO NOT apply a dressing; DO NOT TOUCH; seek medical treatment immediately.

      (c) Light burns. Exposure to intense light can burn an individual. Infrared rays, eclipse light (if the casualty has looked directly at the sun), or laser burns cause injuries of the exposed eyeball. Ultraviolet rays from arc welding can cause a superficial burn to the surface of the eye. These injuries are generally not painful but may cause permanent damage to the eyes. Immediate first aid is usually not required. Loosely bandaging the eyes may make the casualty more comfortable and protect his eyes from further injury caused by exposure to other bright lights or sunlight.


    In certain instances both eyes are usually bandaged; but, in hazardous surroundings
    leave the uninjured eye uncovered so that the casualty may be able to see.

b. Side-of-Head or Cheek Wound (081-831-1033).

Facial injuries to the side of the head or the cheek may bleed profusely (Figure 3-14). Prompt action is necessary to ensure that the airway remains open and also to control the bleeding. It may be necessary to apply a dressing. To apply a dressing--

    (1) Remove the dressing from its wrapper.

    (2) Grasp the tails in both hands.

    (3) Hold the dressing directly over the wound with the white side down and place it directly on the wound (Figure 3-15 A).

    (4) Hold the dressing in place with one hand (the casualty may assist if able). Wrap the top tail over the top of the head and bring it down in front of the ear (on the side opposite the wound), under the chin (Figure 3-15 B) and up over the dressing to a point just above the ear (on the wound side).


    When possible, avoid covering the casualty's ear with the dressing, as this will decrease
    his ability to hear.

    (5) Bring the second tail under the chin, up in front of the ear (on the side opposite the wound) and over the head to meet the other tail (on the wound side) (Figure 3-16).

    (6) Cross the two tails (on the wound side) (Figure 3-17) and bring one end across the forehead (above the eyebrows) to a point just in front of the opposite ear (on the uninjured side).

    (7) Wrap the other tail around the back of the head (at the base of the skull), and tie the two ends just in front of the ear on the uninjured side with a nonslip knot (Figure 3-18).

c. Ear Injuries. Lacerated (cut) or avulsed (torn) ear tissue may not, in itself, be a serious injury. Bleeding, or the drainage of fluids from the ear canal, however, may be a sign of a head injury, such as a skull fracture. DO NOT attempt to stop the flow from the inner ear canal nor put anything into the ear canal to block it. Instead, you should cover the ear lightly with a dressing. For minor cuts or wounds to the external ear apply a cravat bandage as follows:

    (1) Place the middle of the bandage over the ear (Figure 3-19 A).

    (2) Cross the ends, wrap them in opposite directions around the head, and tie them (Figures 3-19 B and 3-19 C).

    (3) If possible, place some dressing material between the back of the ear and the side of the head to avoid crushing the ear against the head with the bandage.

d. Nose Injuries. Nose injuries generally produce bleeding. The bleeding may be controlled by placing an ice pack over the nose, or pinching the nostrils together. The bleeding may also be controlled by placing torn gauze (rolled) between the upper teeth and the lip.


    DO NOT attempt to remove objects inhaled in the nose. An untrained person who
    removes such an object could worsen the casualty's condition and cause permanent

e. Jaw Injuries. Before applying a bandage to a casualty's jaw, remove all foreign material from the casualty's mouth. If the casualty is unconscious, check for obstructions in the airway. When applying the bandage, allow the jaw enough freedom to permit passage of air and drainage from the mouth.

    (1) Apply bandages attached to field first aid dressing to the jaw. After dressing the wound, apply the bandages using the same technique illustrated in Figures 3-5, 3-6, 3-7, and 3-8.


    The dressing and bandaging procedure outlined for the jaw serves a twofold purpose.
    In addition to stopping the bleeding and protecting the wound, it also immobilizes a
    fractured jaw.

    (2) Apply a cravat bandage to the jaw.

      (a) Place the bandage under the chin and carry its ends upward. Adjust the bandage to make one end longer than the other (Figure 3-20 A).

      (b) Take the longer end over the top of the head to meet the short end at the temple and cross the ends over (Figure 3-20 B).

      (c) Take the ends in opposite directions to the other side of the head and tie them over the part of the bandage that was applied first (Figure 3-20 C).


    The cravat bandage technique is used to immobilize a fractured jaw or to maintain a
    sterile dressing that does not have tail bandages attached.

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