Trauma First Aid for Civilians: Managing Wounds in a War Zone

Trauma First Aid for Civilians: Managing Wounds in a War Zone

Lesson Objective
By the end of this lesson, you will understand and be able to apply the MARCH trauma care protocol, control life-threatening bleeding, treat burns and fractures with improvised materials, and recognize when injuries require immediate professional medical intervention.

Introduction: Why Every Civilian Needs Trauma First Aid Skills
In a conflict zone, the time between when injury occurs and when professional medical care is available is often measured in hours or days, not minutes. During the 2022 Mariupol siege, civilians had to provide first aid to wounded neighbors for days before any evacuation was possible. In Gaza, Syria, and Yemen, ordinary people have repeatedly performed emergency medical procedures as hospital infrastructure collapsed.

The difference between survival and death from a traumatic wound is often determined in the first 5–10 minutes. This lesson teaches the fundamental skills that can keep an injured person alive until professional care is available.

The MARCH Protocol: Military Trauma Care Adapted for Civilians
The MARCH protocol is used by military medics worldwide. It provides a systematic approach to trauma care:

M – Massive Hemorrhage Control
Stopping life-threatening bleeding is the absolute first priority.

A – Airway Management
Ensure the casualty can breathe.

R – Respiration
Check for chest injuries that may prevent breathing.

C – Circulation
Address shock and circulatory issues.

H – Hypothermia Prevention
Prevent the patient from getting dangerously cold.

Step 1: Controlling Massive Bleeding
Heavy bleeding is the most preventable cause of death from traumatic injury. Every second of uncontrolled bleeding reduces survival chances.

Direct pressure technique:
1. Use the cleanest material available (medical gauze, clean cloth, torn clothing)
2. Apply firm, direct pressure on the wound
3. Maintain constant pressure for minimum 10 minutes without lifting to check
4. Do NOT remove blood-soaked material; add more on top
5. If pressure alone is insufficient for limb wounds, apply a tourniquet

Tourniquet application (limbs only):
1. Apply 5–10 cm above the wound (never on a joint)
2. Tighten until bleeding stops
3. Note the time of application on the casualty
4. Never loosen a tourniquet once applied
5. Improvised tourniquet: Tie a strip of cloth tightly above wound and twist using a stick inserted under the cloth until bleeding stops; secure the stick

Wound packing (for deep wounds):
1. Fill the wound cavity firmly with gauze or clean cloth
2. Apply direct pressure on top
3. Pack until the cavity is completely filled

Step 2: Airway Management
1. If unconscious, tilt the head back gently and lift the chin to open the airway
2. Check for breathing: look for chest rise, listen for breath sounds
3. Remove visible obstructions from mouth (blood clots, broken teeth)
4. Place unconscious breathing casualty in recovery position (on their side)
5. If not breathing and no signs of spinal injury: begin rescue breathing (2 breaths after every 30 chest compressions for CPR)

Step 3: Respiration – Treating Chest Injuries
Chest injuries are particularly dangerous in trauma.

Open chest wound (sucking chest wound):
A hole in the chest wall allows air in with each breath, collapsing the lung.
1. Seal with an improvised chest seal: plastic bag, foil wrapper, or tape
2. Cover three sides, leaving one side open to allow air to escape on exhale
3. Keep casualty upright or semi-upright if possible
4. Seek medical help immediately

Rib fractures:
– Support the chest by having casualty hold the injured side
– Position sitting or semi-upright
– Do not bind tightly (prevents breathing)
– Transport to medical care

Step 4: Treating Burns
Burns are common in conflict zones from incendiary weapons, fires, and explosions.

Burn first aid:
1. Remove casualty from burn source immediately
2. Cool the burn with clean, cool (not ice cold) water for minimum 20 minutes
3. Cover with clean, non-fluffy material (avoid cotton; use cling film if available)
4. Do NOT apply toothpaste, butter, or oils (these trap heat and cause infection)
5. Drink fluids to replace fluid lost through burns
6. Seek medical care for any burn larger than the palm of your hand, any burn on face/hands/genitals, or burns from chemicals

Step 5: Fracture Management
Fractures need immobilization to reduce pain and prevent further injury.

Improvised splinting:
1. Immobilize the joint above and below the fracture
2. Pad the splint material to prevent pressure sores
3. Use any rigid material: straight sticks, boards, rolled-up magazine/newspaper
4. Secure with strips of cloth; not so tight as to cut off circulation
5. Check circulation below the splint regularly (color, temperature, pulse)

Signs of serious fracture complications:
– Fracture through skin (compound fracture): Cover with clean material; treat as wound + fracture
– Spinal injury suspected: Do not move unless immediate life threat; immobilize head/neck
– Femur (thigh) fracture: Causes massive internal bleeding; treat as high priority

Recognizing and Treating Shock
Shock is a life-threatening condition where the body’s circulation fails.

Signs of shock:
– Pale, cold, clammy skin
– Rapid, weak pulse
– Rapid breathing
– Confusion or loss of consciousness
– Extreme thirst

First aid for shock:
1. Lay casualty flat; elevate legs 20–30 cm if no spinal/leg injury
2. Keep warm with blankets or coats
3. Offer small sips of water if conscious and no abdominal injury
4. Control any visible bleeding
5. Maintain airway
6. Seek medical care immediately — shock is a medical emergency

Do’s and Don’ts for Trauma First Aid

DO:
– Stop life-threatening bleeding first, always
– Apply and note the time of tourniquet application
– Keep the casualty warm to prevent hypothermia
– Continue checking and monitoring the casualty’s condition
– Keep the casualty calm and informed about what you are doing

DON’T:
– Remove objects impaled in wounds (stabilize in place)
– Apply tourniquets to the neck, torso, or abdomen
– Give fluids to unconscious patients
– Loosen a tourniquet once applied
– Ignore signs of shock — it kills even when the visible wound looks minor

Key Takeaways
– The MARCH protocol provides a systematic, life-saving approach to trauma care
– Controlling massive bleeding in the first 5 minutes is the single highest-impact intervention
– Improvised tourniquets and wound packing work effectively with available materials
– Burns require 20 minutes of cool water; never apply home remedies
– Shock is as dangerous as the original wound; treat it actively and urgently
– Every civilian in a conflict zone should learn these skills before they are needed

Image Reference: eduflo-war-survival-trauma-first-aid-civilians-conflict-zones.png