First Aid and Looking After Each Other

Lesson Overview

This lesson introduces one of the most human parts of soldiering, and one of the most likely to be asked of you: the care of the injured and the keeping well of a force in the field. You are joining a small, lightly armed, humanitarian home-defence force whose work is as often to help as to fight. Whether the casualty is a comrade on exercise, a stranger at a road accident, or a person in distress on a cold night, the soldier who arrives first is usually the only one who can act in the minutes that matter. So you are taught a recruit's foundation: that every soldier is a first responder; the ordered first actions that keep a casualty alive; the buddy system by which a team looks after its own; and the field health that keeps the casualty from happening at all.

The heart of it is small and precise. You are not being trained as a medic. You are given the handful of life-saving first actions any soldier can perform, taught only to the level a recruit can safely do. Everything beyond them is the work of the medic and qualified medical staff. Done well and done at once, those first actions are often enough to save a life.

By the end you will be able to explain why care is owed to everyone by their need alone; carry out in outline the ordered first actions at a casualty (check for danger and a response, get help coming, stop catastrophic bleeding, open the airway, check breathing, and use the recovery position); state where the recruit's role ends and the medic's begins; explain the buddy system of watching one another; and explain why prevention through field health spares the casualty that treatment would have to fight.

This is your first meeting with the subject. It is set out in full in the Basic Training Manual (Module 12), and taught in depth in the Phase Two courses on Combat First Aid and on Field Health, Hygiene, and Sanitation. Remember throughout that the knowledge is learned here, online, but the hands-on skills cannot be learned from a screen. They are taught and certified in person, under qualified supervision.

Key Terms

• First responder: the first person on the scene who can act, very often a soldier rather than a medic or a doctor.
• Duty of care: the obligation to preserve life and prevent avoidable harm when you are able to act.
• First actions: the short, ordered set of life-saving steps a recruit performs at a casualty in the first minutes, before the medic arrives.
• Catastrophic bleeding: blood loss heavy enough to kill in minutes, usually spurting, pooling, or fast-soaking; stopped before anything else.
• Airway: the passage carrying air to the lungs; in an unresponsive casualty it is most often blocked by the tongue falling back.
• Recovery position: a stable position on the side that keeps an unresponsive but breathing casualty's airway open and lets fluid drain.
• MARCH: the field order of priorities used in the Phase Two course, Massive bleeding, Airway, Respiration, Circulation, Hypothermia and the head; the fuller scheme your first actions sit inside.
• Buddy system: the discipline of looking after the comrade beside you, and being looked after in return.
• Field health and hygiene: the prevention side, clean water, clean food, sanitation, and hand-washing, that keeps a force well.

Every soldier is a first responder

The Army trusts you with force, and it trusts you, just as seriously, with care. To preserve life is a professional duty of the soldier, not an optional extra and not the business of medics alone. The reason is practical: soldiers work where injury is likely and help may be far away. The medic may be two hundred metres distant and the hospital hours off, and in the few minutes that decide whether a casualty lives there is rarely a clinician on hand, only a soldier and what they know. That is why the whole force is trained.

Learn from the first day to whom this duty is owed. It is owed to everyone who needs it: to your comrades, to members of the public, to a person held in custody, to yourself, and even to a former enemy once they have ceased to fight. Care is given by need and by nothing else, never by who the casualty is, where they are from, or which side they were on. This is both the law and the conscience of the Army. A force that abandons casualties, or rations care by category, loses the trust and legitimacy a humanitarian army depends upon. For a citizen in uniform raised to help its own people, that principle is the reason the Army exists.

The first actions: the drill that saves life

Under stress, the soldier needs one drill, not a debate. The part of the mind that reasons calmly is the first thing to go when the adrenaline rises, so you do not work out what to do at the casualty; you learn the order now, until it runs almost on its own. The Army teaches a single ordered set of first actions, the same at every casualty. The order is the point: it spends your scarcest resource, the first few minutes, on the threats that take a life soonest. Hold the whole of it as a short sequence you can say to yourself, Danger, Response, Shout, Bleeding, Airway, Breathing, Recovery. Each is a question and an action; do what you have been shown, then check before you move on.

   THE FIRST ACTIONS AT A CASUALTY   (work them in order, fix as you find)

   1. DANGER     Scene safe? Make it safe FIRST. No use as a 2nd casualty.
        |
   2. RESPONSE   Awake? Speak, then a firm tap: "Can you hear me?"
        |
   3. SHOUT      Get help COMING now. Send a named person; have them
        |        call it in and come back.
   4. BLEEDING   Heavy bleeding kills fastest. STOP IT NOW: hard, firm
        |        pressure straight on the wound, and DO NOT let up.
   5. AIRWAY     Open it: tilt the head, lift the chin. Clear only what
        |        you can plainly SEE.
   6. BREATHING  Look, listen, feel for up to ten seconds. Breathing?
        |
   7. RECOVERY   Unresponsive but breathing? Turn onto the side
        |        (recovery position). Stay. Watch.
        v
   Keep help coming. Keep checking. Stay calm. Hand over to the medic;
   beyond this is THEIR work.

Now take the steps in turn, each only to the level a recruit safely performs.

Danger: make the scene safe first. A common and costly error is to rush to a fallen comrade without asking what put them down. If the cause is still present, fire, a fall, electricity, a vehicle, water, a second casualty follows, and now there are two and one fewer rescuer. Stop a pace short, take one breath, and read the scene above you, underfoot, and around. Then deal with the danger before you treat: best of all, remove it from the casualty (switch off the power, beat out a small fire); failing that, move the casualty, but only when staying is the greater risk; failing that, keep everyone back and call for those who can make it safe. Treat blood and body fluids as a hazard, and put on gloves where you have them.

Response: are they awake? Approach from the direction the casualty is facing, so they need not turn an injured neck, and ask, "Can you hear me? Open your eyes." If there is no reply, give a gentle but firm tap on the collarbones or shoulders and ask again. A casualty who answers in clear words has told you, in that one fact, that their airway is open, that they are breathing, and that blood is reaching the brain. One who does not respond at all is in immediate danger and is treated as the most urgent.

Shout: get help coming now. The moment you grasp that the casualty is seriously hurt, get a message away while you keep working with your hands. Do not wait until you are free; you may never be free in time. Point at one person, name them if you can, and tell them exactly what to do, because a crowd told to "get help" often does nothing while each waits for another. A clear call gives where you are, what has happened, how many casualties, and what you have done, and asks the sender to come back and confirm help is coming.

Bleeding: stop the catastrophic bleed at once. Of all the quick killers, heavy bleeding from a limb or a major junction kills fastest and is the one your hands can most often defeat. An adult holds only about five litres, and a torn artery can empty enough to kill in two to three minutes. So the moment you find blood spurting, pooling, or soaking clothing fast, you stop it before anything else, before even the airway, because a casualty who bleeds out has no airway worth opening. Look deliberately, because blood hides under thick clothing and along the back. The recruit's action is direct, firm pressure: hard, straight down onto the bleeding point itself, gloved if nothing better is ready, firm enough to be uncomfortable, and you do not let up, because it is the pressure squeezing the torn vessel shut that stops the flow. Hold it and do not peek; lifting off strips away the forming clot and restarts the bleeding. If a dressing soaks through, press another on top and press harder rather than peeling it off. If an object is stuck in the wound, do not pull it out; press firmly around it. The fuller ladder of control, packing a deep wound and applying a tourniquet, exists for bleeding that firm pressure cannot hold, and is taught and certified in person in the Phase Two Combat First Aid course. Here you learn the first and most important rung.

Airway: open the air passage. Once any catastrophic bleeding is held, turn to the airway, the next quick killer, fatal in only a few more minutes than a bleed. In an unresponsive casualty on their back, the commonest cause is the tongue falling back against the throat as the muscles relax. Open it gently: one hand on the forehead tips the head back, and the fingertips of the other lift the bony point of the chin. This draws the tongue forward, and the snoring or rasping of a half-blocked airway usually stops the moment it opens. Look in the mouth and clear only what you can plainly see and reach. Never push a finger blindly into the mouth; a blind sweep can drive an unseen object deeper. (Where a neck injury is possible, after a fall, crash, or blow to the head, a gentler method is used, taught in person. Here, learn the basic head-tilt and chin-lift, and that an open airway is never optional.)

Breathing: is air actually moving? A clear airway is no use if the casualty is not breathing through it. With the airway held open, put your cheek close to their mouth and look along the chest: look for the chest rising and falling, listen for breath, and feel for air on your cheek, all at once, for up to ten seconds. If the casualty is breathing normally, move to the recovery position below. If they are unresponsive and not breathing normally, this is the gravest emergency of all: the casualty may be in cardiac arrest, needing the chest compressions and rescue breaths of resuscitation. Those are real first-responder skills, but they cannot be learned from a screen; they are taught and certified in person in the Phase Two course. Your part now is to recognise it and make sure help is racing in.

Recovery: the unresponsive casualty who is breathing. For the casualty who is unresponsive but breathing normally, with no injury that forbids being turned, one positioning skill does much of the work of keeping the airway open. Left flat on their back they are in danger: the tongue can fall against the throat, and vomit or blood can pool and be drawn into the lungs. Turned onto their side, the airway falls open, the tongue falls forward, and fluid drains away. This is the recovery position. Any stable position on the side that keeps the airway open and lets fluid drain is good; the recovery position is the safe, repeatable way to get there, learned in person until it is smooth. Once a casualty is in it you stay with them, keep checking the breathing, keep them warm, and be ready to roll them back at once if breathing stops.

Two habits close the drill. Keep help coming and keep checking: a casualty is not solved once and filed away. Bleeding can restart and breathing can fail, so go back over the steps every few minutes and after any move. And above all, stay calm. A calm first-aider saves more lives than a panicked one, because calm allows method, and method is what saves.

Where the recruit's role ends

This matters as much as anything you do, so it is set out plainly. The first actions above are the first-responder basics, the whole of what a recruit is trained and certified to do at this stage. You do what you have been shown and signed off to do, and no more, handing on to the medic and qualified help for anything beyond it. This is not timidity; it is discipline and safety. A first-aider who attempts what they have not been trained for can kill a casualty that a simpler, certified action would have saved, and the most important judgement in the whole subject is knowing the edge of your competence and handing over at it. So the line is firm. Stopping bleeding with firm pressure, opening an airway, the recovery position, and getting help coming are yours. Packing a wound, applying a tourniquet, resuscitation, sealing a chest wound, and anything done with a needle or a drug are not buddy aid; they are taught later in person if at all, several of them the work of qualified medical staff alone. The full treatment is the Phase Two Combat First Aid course, taught and certified in person under medical oversight. In the field these priorities are remembered by the word MARCH (Massive bleeding, Airway, Respiration, Circulation, Hypothermia and the head), the fuller scheme your simple first actions sit inside; you need only grasp that the things which kill fastest are dealt with first. Learn the first actions here, earn them in person, and the rest waits for you in Phase Two.

Looking after each other: the buddy system

Much of a soldier's care for the injured is given long before any injury, in the simple discipline of looking after the person beside you. This is the buddy system, and it rests on a plain truth: the field strips people of the ability to judge their own state. A soldier growing cold often does not feel the danger of it; one becoming dangerously hot may press on past the point of sense; one worn down by fatigue is frequently the last to notice. You will not always see these things in yourself, but you will see them in your comrade, and your comrade will see them in you.

So you watch one another, body and spirits both. You notice the comrade who has stopped shivering or gone slow in their speech in the cold, the one who has stopped sweating or gone quiet and unsteady in the heat, the one whose attention is drifting with tiredness. You check that they have eaten and drunk, that their kit is doing its job, that their feet are sound. And you watch their mood as closely as their body. The comrade who has gone silent, withdrawn, or short-tempered, who is sleeping badly or seems to have lost heart, may be carrying a load you cannot see, and a quiet word, a shared task, or telling someone in authority in time is as much first aid as a bandage. You speak up, because being watched in turn, trusting that your buddy has you, is part of what lets a person keep going. Welfare and morale are not soft extras but part of how a small force stays effective, and simple things carry most of it: rest when it can be taken, hot food and a dry place when they are to be had, a fair share of the unpleasant jobs, and the plain habit of looking out for one another. The buddy system is care, discipline, and teamwork joined together, and one of the truest expressions of the comradeship the Army asks of you.

Prevention: keeping a force well

There is a part of casualty care that prevents the casualty altogether, and through most of history it has mattered more than any treatment. Far more soldiers, in campaign after campaign, have been put out of action by sickness than by any weapon, and almost every such sickness was preventable. The discipline that prevents it is field health and hygiene.

Most field illness spreads by a few well-understood routes, and each can be closed by a simple, disciplined measure. Clean water, treated or from a safe source, never assumed safe because it looks clear. Clean food, handled, stored, and prepared so it does not make people ill. Sanitation, the proper disposal of human waste and refuse so it does not foul a camp. And hand-washing, the plainest and one of the most powerful measures of all. Field health is not fastidiousness; it is a discipline kept by each soldier for their own sake and by the unit for the sake of all. Keep the chain of disease broken, and the sickness never starts.

For this Army the matter has a second value. The very standards that keep a soldier well, safe water, clean food, proper sanitation, are exactly what a stricken population most needs when its own services have failed, and a welfare site run to a poor standard of hygiene can do more harm than the disaster that caused it. Field health is therefore a humanitarian skill as much as a soldierly one, and the surest medicine you carry, because prevention spares the casualty that treatment would have to fight to save. It is set out in full in the Phase Two Field Health, Hygiene, and Sanitation course; here you meet it for the first time.

In Practice: A Cold Night on a Welfare Round

Picture a winter welfare round on the harbour front of a quiet coastal town, the Army out among people sleeping rough through the cold months. No shots, no enemy, just the cold and the work. Your buddy has gone quiet over the last hour; the shivering has stopped and the speech has slowed, and you act before they would have, getting them warm and fed and reporting it. At a doorway you find a person who has fallen and cut their arm badly, the blood pooling on the step, and you run the first actions without having to invent them. You check the doorway is safe and get gloves on. You speak to the casualty and they answer, so airway and breathing are working for now. You point at a passer-by, name them, and send them to call it in and come back. Then, because the bleeding is what will kill, you put firm pressure straight onto the wound and do not let up, holding it through the wait, keeping the casualty warm and talking to them calmly, and hand over to the ambulance crew with a clear word of what happened and what was done. None of this is heroics or a doctor's work. It is a trained soldier doing the ordinary, decisive things, in order, for whoever needs them, and looking after their own at the same time.

Check Your Understanding

1. Why is every soldier trained as a first responder rather than leaving casualty care to medics, and to whom is the duty of care owed? Why is care given by need alone?
2. Set out, in order, the first actions at a casualty (Danger, Response, Shout, Bleeding, Airway, Breathing, Recovery): what you do before touching them, why heavy bleeding is dealt with before the airway, your action for a heavy bleed, and how you check breathing. When do you place a casualty in the recovery position?
3. Where does the recruit's role end and the medic's begin, and why does knowing that edge matter? Then explain the buddy system and why a soldier cannot always judge their own state, and say how field health and hygiene prevents casualties.

Reflection (write a short paragraph): You may one day be the first person beside a casualty, with no medic in sight, and you will be the buddy on whom a comrade's safety quietly depends. Think about the discipline this asks of you: to stay calm, to act in order, to put unrelenting pressure on a bleed and not let go, to watch the person beside you, and to keep the unglamorous standards of hygiene that keep a force well. Think too about the discipline of stopping, of doing only what you have been certified to do and handing on the rest. Which of these do you think will be hardest for you, and why does it matter that the knowledge is learned here but the skill is earned in person?

Summary

• Every soldier is a first responder; preserving life is a professional duty, and in the minutes that matter the first soldier on the scene is often the only one who can act.
• Care is owed to everyone by their need alone, comrade, civilian, detainee, self, and former enemy, and never by who the casualty is; this is the law and the conscience of the Army.
• The first actions are one ordered drill: Danger, Response, Shout, Bleeding, Airway, Breathing, Recovery. Make the scene safe first; stop catastrophic bleeding before even the airway, with firm pressure that does not let up, because it kills fastest; open the airway and check breathing; turn a breathing, unresponsive casualty onto their side. Keep help coming, keep checking, and stay calm. These sit inside the fuller MARCH scheme.
• The recruit does only what they have been shown and certified to do, and hands on to the medic and qualified help for anything more; packing, tourniquets, resuscitation, and chest and needle work are not buddy aid and are taught in person, later, if at all.
• The buddy system is the discipline of looking after one another, watching a comrade's body and spirits for the cold, heat, fatigue, and low morale they cannot always see in themselves, and speaking up in time; simple welfare and morale keep a small force effective.
• Field health and hygiene, clean water, clean food, sanitation, and hand-washing, keeps a force well and protects the vulnerable the Army helps; prevention spares the casualty that treatment would have to fight.
• This is the recruit's introduction; the subject is set out in full in Basic Training Manual Module 12 and taught in depth in the Phase Two Combat First Aid and Field Health, Hygiene, and Sanitation courses, where the hands-on skills are taught and certified in person.

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