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Emergency War Surgery NATO Handbook: Part III: General Considerations of Wound Management: Chapter XIX: Wounds and Injuries of Bones and Joints

Management by Field Medical Personnel

United States Department of Defense
Peer Review Status: Internally Peer Reviewed


The combat medic's main objective in the initial management of the casualty is to do no further harm and to evacuate the patient rapidly to a definitive treatment center. Wounds are covered with sterile dressings and hemorrhage is controlled by local compression. Rarely, a tourniquet may be necessary but normally should be avoided. If used, the tourniquet should not be released before arrival at a definitive surgical facility. Extremities with fractures should be gently aligned and splinted; no attempt should be made to reduce these injuries. Fluid replacement should be initiated.

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