OPEN HEAD WOUND (CBRN)
Conditions: Teammate received fragmentation to head during indirect fire. CBRNE environment, MOPP level 3. Conscious and alert.
Understanding This Task
This task tests head wound treatment in a CBRNE environment. The key challenge is maintaining MOPP throughout while treating the wound. You must NOT apply pressure to visible brain matter, clean the wound, or remove protruding objects.
Three dressing techniques depending on wound location: forehead/back, top of head, or side/cheek. Each has a different wrapping pattern.
Common NO-GO Mistakes
- Removing MOPP garments (maintain throughout)
- Applying pressure to visible brain matter
- Attempting to push anything back into the skull
- Cleaning the wound or removing protruding objects
- Touching sterile (white) side of dressing
Task Basis: 081-831-1033
Video Resources
ATP 4-02.11 Doctrine
From Army Techniques Publication 4-02.11, 23 March 2026 — Chapter 11: Head Injury; Chapter 19: First Aid in a CBRN Environment
Open head wound — no pressure on brain matter (para 11-2, 11-3): An open head injury involves a break or penetration of the skull, exposing the brain to the external environment. Signs include visible wound or laceration of the scalp or skull; profuse bleeding from head vessels; possible skull deformity or depression; loss of consciousness; clear fluid (cerebrospinal fluid) or blood drainage from nose or ears. Treat as a medical emergency — seek immediate medical attention. Do NOT apply pressure to the wound if brain matter is visible, and do NOT push brain matter back into the skull.
Bandage patterns (para 11-19): Treating a head wound requires sterile gauze pads or clean cloth to cover and apply pressure (to scalp bleeding only — not over exposed brain). A cravat or gauze bandage can be used to secure the dressing. Do NOT touch the wound directly. For TBI assessment, use the HEADS mnemonic from the I.E.D. checklist: Headaches or vomiting; Ear ringing; Amnesia, altered consciousness, or loss of consciousness; Double vision or dizziness; Something feels wrong.
CBRN masking and MOPP maintenance (para 19-10, 19-14, 19-15): Once an attack is detected or suspected — stop breathing immediately and don the mask. The field protective mask must be donned in 9 seconds or less without the hood, 15 seconds with the hood. Steps: stop breathing → put on mask → seal → clear → check → resume breathing → give alarm → continue mission. Keep mask on until the "all clear" is given. Protective clothing provides good protection from most chemical agents.
CBRN CRESS assessment (para 19-20): For identifying type of chemical agent exposure, use the CRESS algorithm: Consciousness (unconscious, seizures, depressed consciousness, agitation); Respirations (present/absent, labored); Eyes (constricted, dilated, normal); Secretions (dry, normal, increased); Skin (diaphoretic, dry, hot, cyanosis). After ruling in/out CBRN injury, integrate TCCC and CBRN management using the (MARCHE)² algorithm.
Source: ATP 4-02.11, Chapter 11, para 11-2, 11-3, 11-19 through 11-25; Chapter 19, para 19-10 through 19-21
- Maintain MOPP throughout — do NOT remove MOPP garments.
- Do NOT apply pressure to visible brain matter — dress loosely.
- Do NOT clean the wound or remove protruding objects.
PERFORMANCE MEASURES
0/5 GO- 1
Check level of consciousness
- Ask name, location, and today's date.
- 2
Position the casualty
- Have casualty sit up.
- Turn head to opposite side of wound to prevent bleeding into mouth.
-
3
Expose the wound CRITICAL
- Remove helmet if necessary, but RETAIN all MOPP garments.
- Do NOT clean wound, remove protruding objects, or apply pressure dressing.
- Do NOT put pressure on wound or push brain matter back into skull.
- Do NOT touch white (sterile) side of dressing.
- 4
Apply field dressing
Forehead or back of head:
- Apply white side down over wound. Wrap tails around head in opposite directions (not covering eyes/ears). Tie at side with nonslip knot.
Top of head:
- Apply over wound. Wrap first tail under chin, up in front of ear, over dressing. Second tail under chin opposite direction. Cross tails. Wrap across forehead and around back. Tie with nonslip knot.
Side of head or cheek:
- Apply over wound with tails extending up and down. Wrap top tail over head, under chin. Other tail opposite direction. Cross and wrap forehead/back of head. Tie with nonslip knot.
- 5
Watch for life-threatening conditions, treat for shock, seek medical aid
Go Deeper — ATP 4-02.11 Reference
Detailed doctrine from the Army Techniques Publication: