(R) Respiration

After ensuring our casualty is not suffering from massive hemorrhage and their airway is open, we can address respiration. This is what the Red Cross model would call “breathing.” This is largely the search for breathing compromise from chest injuries, and most specifically tension pneumothorax.Tension pneumothorax was thought to be the cause of 10% of Vietnam fatalities, although reappraisal of that literature suggests it may have only been 3%. This data lead to the TCCC guidelines.

A casualty who is talking without any difficulty does not have any clinically significant breathing problem “right now.” Even if they have a pneumothorax, or collapse of one lung, if they do not have tension pneumothorax, there isn’t much to be done about it pre-hospital in a tactical or high-risk environment.