When the casualty has received an injury that may result in shock (such as severe external or internal bleeding or severe burns), take measures to prevent shock from developing.

Do not wait until the signs and symptoms of shock appear before beginning to take action. The measures used to help prevent shock from occurring are also used to treat shock once it has developed. Perform the following measures when you suspect shock will develop or has already occurred.

a. Reassure Casualty.

Reassure the casualty that you will take care of him. This should help to calm the casualty and reduce his anxiety. Anxiety increases the heart rate, which makes the casualty’s condition worse.

b. Maintain Airway.

Make sure that the casualty’s airway remains open. Usethe head-tilt/chin-lift or jaw thrust, if needed. Administer oxygen if it is available.

c. Control Bleeding. Take measures to control external and internal bleeding.

d. Initiate IV. Initiate an intravenous infusion with Ringer’s lactate or normal saline to replace lost fluid. Select a large gauge (16 gauge or 18 gauge) needle.

(1) When fluid loss is due to bleeding, use small fluid bolus to return the casualty’s peripheral pulses and mental status.

(2) When fluid loss is due to burns, compute the flow rate as shown in Lesson 6.

e. Position the Casualty to Help Control Shock.

If the casualty has not already been placed in normal shock position (figure 7-1), place him in that position unless his condition dictates otherwise. If the casualty is on a litter, elevate the foot of the litter.

CAUTION: If the casualty has a suspected spinal injury, immobilize his head, neck, and back using the procedures given in Subcourse MD0533, Treating Fractures in the Field. Do not elevate his legs.

CAUTION: If the casualty has an abdominal injury, leave the casualty on his back with his knees flexed (Lesson 4).

(1) Position the casualty on his back. If possible, place a poncho or blanket under the casualty to protect him from the ground.

(2) Check for fractures of the lower extremities and splint any fractures found. Do not elevate the legs until all lower limb fractures have been splinted.

(3) Elevate the casualty’s legs so his feet are slightly higher than the level of his heart. This helps the blood in the veins of his legs to return to his heart.

(4) Place a small log, field pack, box, rolled field jacket, or other stable object under the casualty’s feet or ankles to maintain the elevation.

(5) If the casualty is unconscious, turn his head to one side so fluids can drain from his mouth.

f. Loosen the Casualty’s Clothing. Loosen any binding clothing, including boots. Tight clothing can interfere with blood circulation. Avoid rough handling during the process.

CAUTION: Do not loosen or remove the casualty’s protective clothing in a chemical environment.

g. Maintain Casualty’s Body Temperature.

(1) In warm weather, keep the casualty in the shade. If natural shade is not available, erect an improvised shade using a poncho and sticks or other available materials. It is better to keep the patient slightly warm rather than cool. A patient that is cool is losing body heat and is therefore at risk for hypothermia.

(2) In cool weather, cover the casualty with a blanket, poncho, or other available materials to keep him warm and dry (figure 7-2). Place covering under the casualty to prevent chilling due to contact with cold or wet ground.