Treat a Casualty For Contusions or Abrasions
081-86A-0209
Purpose: This Training Support Package provides the instructor with a standardized lesson plan
for presenting instruction on the task treat a casualty for contusions or abrasions to an ANA
Medical Company.
Collective: Treat Unit Casualties
References Number Title Date Additional Information:
ANA STP 8-86C-E4-5-SM-TG, Soldier's Manual and Trainer's Guide MOS 86C, Mar 2008
ANA 4-02.2, Medical Evacuation, Feb 2009
ANA 4-25.11, First Aid, Jul 2009
STP 8-68W13-SM-TG
STP 8-91W15-SM-TG
Instructor Requirements:
1:20, MoD Defense Personnel, Contractor, ANA Personnel
Instructional Guidance
NOTE: Before presenting this lesson, instructors must thoroughly prepare by studying this lesson
and identified reference material.
Before class- This LESSON PLAN has practical exercises built throughout to check on learning or
generate discussion among the group members. You may add any questions you deem
necessary to bring a point across to the group or expand on any matter discussed.
 You must know the information in this LESSON PLAN well enough to teach from it, not
read from it.
SECTION II. INTRODUCTION
Method of Instruction: Conference / Discussion or Practical/Hands on
Technique of Delivery: Small Group Instruction
Instructor to Student Ratio is: 1:20
Motivator
One of the skills that the ANA Medic must be familiar with is how treat a casualty for contusions
or abrasions, without using proper technique and understanding the results of successfully
treating this injury, the casualty has an increasing chance of continued, prolonged or worsening
illness and or injury secondary to the infection brought on by not promptly and professionally
treating for contusions and abrasions.
Terminal Learning Objective
NOTE: Inform the students of the following Terminal Learning Objective requirements.
At the completion of this lesson, you [the student] will:
ACTION: Treat a casualty for contusions or abrasions
CONDITIONS: You have a casualty with a contusion or an abrasion. All other more serious
injuries have been assessed and treated. You will need the casualty's medical record, normal
saline, sterile water, gauze, exam gloves, marker, a needle, number 11 blade or tissue forceps,
dressing materials, wrap, antibiotic ointment, splinting material, ice, and tape.
STANDARDS: Treat the casualty for contusions or abrasions without causing further injury.
A. ENABLING LEARNING OBJECTIVES
ACTION: Medic can identify between contusion and abrasion, and treat each appropriately and
understands how to record the care provided on the appropriate form.
CONDITIONS: You have a casualty with a contusion or an abrasion. All other more serious
injuries have been assessed and treated. You will need the casualty's medical record, normal
saline, sterile water, gauze, exam gloves, marker, a needle, number 11 blade or tissue forceps,
dressing materials, wrap, antibiotic ointment, splinting material, ice, and tape.
STANDARDS: Correctly identify the proper location of the injury, evaluate and record results,
employing all the steps and performance measures necessary to treat the casualty for contusions
or abrasions without causing further injury.
Learning Step / Activity 1. Medical personnel within the medical element.
Method of Instruction: Conference / Discussion
Technique of Delivery: Small Group Instruction
Instructor to Student Ratio: 1:20
Time of Instruction: 2 hrs
Instructional Lead-In
A Soft tissue injury (STI) is the damage of muscles, ligaments and tendons throughout the body.
Common soft tissue injuries usually occur from a sprain, strain, a one off blow resulting in a
contusion or overuse of a particular part of the body. Soft tissue injuries can result in pain,
swelling, bruising and loss of function.
SHOW SLIDE 1
TREAT A CASUALTY FOR
CONTUSIONS OR ABRASIONS
081-86A-0209
CONTUSION
ABRASION
REFERENCES:
ANA-STP-8-86
ANA 4-02.2
ANA 4-25.11
STP 8-91W15-SM-TG
STP 8-68W13-SM-TG
SHOW SLIDE 2
Briefly detail the action, condition and standard to the students. Explain that this is performance
based and that the students will be tested on this following this block of instruction.
SHOW SLIDE 3, 4
When soliciting the casualty’s history; the medic can gain two kinds of information about the
patient’s present problem. The two kinds of information are signs and symptoms. A sign is
objective-something you see, hear, feel, and smell when examining the patient. A symptom is
subjective- an indication you can’t observe but that a patient feels and tells you about. An
important part of the information you should gain on all your patients is information about the
present problem plus the past medical history-together called the Sample History.
The term "soft tissue injury" is often used to describe an injury to the skin and/or mucous
membranes. The skin is the body's largest organ, it is watertight and bacteria cannot penetrate it
unless there is a break (open wound) in the skin. The skin helps to regulate body temperature.
The body is cooled in warm weather by the evaporation of perspiration and the dilation of blood
vessels in the skin. In winter, the constriction of blood vessels in the skin helps to retain body
heat. Specialized nerve endings transmit sensations such as heat, cold, pressure, pain, and
position of the body in space. If the skin or mucous membrane is penetrated, an open soft tissue
injury exists. The injury can be an abrasion, laceration, avulsion, or puncture.
An abrasion is an injury caused by scraping the skin against a rough surface. The damage is
usually confined to the epidermis and part of the dermis.
Observe the abrasion, and relate the severity verses depth of wound (relates to method of
anesthesia and cleaning). Assess the amount of body surface (fluid loss can be significant in
children) and the amount of contamination (precursor to infection).
SHOW SLIDE 5, 6
In closed soft tissue injuries, the surface of the skin is not broken. Although soft issue injuries can
and do occur on any part of the body, they are common on extremities. Two common closed soft
tissue injuries are contusions and hematomas.
Contusions (bruises) are usually caused by a blow from a blunt instrument (from a stick, for
example) or by the body impacting with an object (falling to the ground, for example). The site of
the injury normally turns "black and blue." The discoloration (ecchymosis) is caused by blood
from the injury which is trapped and, with time, changes color. The site of the injury often swells
due to the presence of blood and fluid leaking from the injured tissue cells (edema). Pain usually
accompanies the injury.
Evaluate and note contusions present which may have resulted in an underlying fracture. Forceful
impact of objects creating injury can result in fractures. Validate vascular involvement (extensive
bleeding into tissue). Check distal circulation. Measure or mark the outline of the contusion;
measure circumference of injured extremity, and compare measurement to uninjured extremity.
Observe carefully for neurological involvement. Test the sensation and movement of the injured
part. Be focused and engaged as any signs of neurologic deficit may indicate a serious
complication.
SHOW SLIDE 7, 8
Anytime the skin or mucous membranes are broken, the risk of infection is present. Also, open
wounds usually result in more blood loss than do closed wounds.
Treat the abrasion. Be aware of Principles of management which are as follows: prevention of
infection, promotion of rapid healing, prevention of "tattooing" from retained foreign bodies,
wound must be gently but thoroughly scrubbed with normal saline, remove all foreign matter that
cannot be scrubbed out by using a needle, number 11 blade, or tissue forceps, apply antibiotic
ointment.
SHOW SLIDE 9, 10
Administer antibiotic therapy, if needed. Antibiotic therapy may be indicated for prophylaxis
(consult medical officer). Give casualty instructions on wound care and signs and symptoms of
infection. Topical antibiotic ointment applied three times or four times a day. Dressing changed
every 2 to 3 days with gentle cleaning. Monitor abrasion for signs and symptoms of infection.
Treat the contusion,
Ensure that there is no underlying fracture or evidence of any neurological or vascular
involvement, pad and splint injury, if needed.
SHOW SLIDE 11, 12
Be conscious of injuries beyond your training and your ability to manage complications
appropriately (consult medical officer if question of underlying injury). Apply splint or cast to
fractures (following medical officer's recommendation). Refer vascular or neurologic injury to a
medical officer.
Minor bruises require no special care. If the injury is more severe, take measures to protect the
injured area. If the injury is on an extremity, apply the following measures.
The mnemonic device RICE (rest, ice, compression, elevation) may help you to remember the
treatment procedures.
Rest - allows time to recover from injury.
Ice - Apply cold (ice bag or chemical pack) to help reduce swelling and pain. CAUTION: Do not
apply ice directly to the skin. Applying ice directly to the skin could result in cold injury damage to
the skin and underlying tissues. Use an ice bag or wrap the ice in cloth material to protect the
casualty's skin.
Compression - Apply localized compression (elastic roller bandage or pneumatic counterpressure device) to help control bleeding and swelling. An elastic bandage can be applied to the
injured limb.
Elevation - Elevate the affected body part. If a fracture is involved, apply a splint before elevating
the limb.
Record all treatment in the casualty's medical record.
Document Patient’s treatment on ANA Form 600 (Medical Record- Chronological Record of
Medical Care).
SHOW SLIDE 13, 14
In summary, we have discussed the performance steps and treatment procedures for treating a
casualty with contusions and abrasions. In the field, you may likely encounter a casualty needing
this type of care. Understanding the wound healing process and proper wound care management
for this type of injury is essential. Questions?