Medical Lane
M6

SPINAL INJURY & SHOCK

1 min (signs/symptoms) 7 min (treatment)

Conditions: Casualty fell from guard tower. Suspected internal bleeding and spinal injury. On a FOB, non-CBRNE. Alert to pain only.

Understanding This Task

Two parts: first, a written identification of at least 6 signs/symptoms of shock (no incorrect answers). Then hands-on: apply a cervical collar, assess for shock with pulse checks at four locations, and treat for hemorrhagic shock.

All pulse checks: Skin-to-skin contact, never use your thumb. Check pedal, femoral, radial, then carotid.

Common NO-GO Mistakes

  • Fewer than 6 signs/symptoms or any incorrect answer
  • Moving casualty before immobilizing spine
  • Elevating legs when spinal injury is suspected
  • Using thumb for pulse check
  • Not wrapping casualty completely with blanket (heat loss prevention)

Task Basis: 081-COM-1001, 081-000-0083, 081-68C-3136, 081-COM-1005, 081-000-0013

Video Resources

First Aid & Casualty Evacuation
Shock treatment and handling

ATP 4-02.11 Doctrine

From Army Techniques Publication 4-02.11, 23 March 2026 — Chapter 7: Circulation Control

Table 7-1 — Shock indicators by blood volume loss: On the battlefield, assume shock is from severe blood loss (hemorrhagic shock). Key thresholds from ATP Table 7-1:

  • 500cc lost (4,500cc remaining): Possible increased heart rate. Usually no effects.
  • 1,000cc lost (4,000cc remaining): Radial pulse >100. Breathing probably normal. Unlikely to die from this amount alone.
  • 1,500cc lost (3,500cc remaining): Change in mental status. Weak radial pulse >100. Increased respirations. Still unlikely to die if no further blood loss.
  • 2,000cc lost (3,000cc remaining): Confusion and lethargy. Very weak radial pulse >120. High respiratory rate >35. Very possibly fatal if not managed.
  • 2,500cc lost (2,500cc remaining): Unconscious. No radial pulse; carotid pulse; HR >140; respirations >35. Fatal without immediate and rapid interventions.

Absence of radial pulse = shock (para 7-12): The TCCC guideline on shock states: assess for hemorrhagic shock by checking for altered mental status (in the absence of brain injury) or weak and absent radial pulse. Absence of a radial pulse is a definitive indicator the casualty is in shock — alert medical personnel immediately.

Anti-shock positioning (para 7-15): Place the conscious casualty in the shock recovery position — on their back with feet elevated slightly above the level of their heart. Do NOT place the casualty in the shock position if there is a fractured lower extremity (splint first). Do NOT elevate legs if spinal injury is suspected.

Source: ATP 4-02.11, Chapter 7, para 7-6 through 7-16, Table 7-1

Treatment Timer: 7 Minutes
7:00
Critical Notes
  • Must identify at least 6 signs/symptoms of shock with no incorrect answers.
  • Immobilize spine before moving. Do NOT elevate legs if spinal injury suspected.
  • All pulse checks: skin to skin, no thumb.

PERFORMANCE MEASURES

0/5 GO
  1. 1

    Identify signs and symptoms of shock (6+ required)

    • Sweaty but cool skin
    • Pale skin
    • Restlessness or nervousness
    • Thirst
    • Severe bleeding
    • Confusion
    • Rapid breathing
    • Blotchy blue skin
    • Nausea and/or vomiting
    • Low blood pressure
    • Absence of distal pulse
    • Capillary refill delayed more than 3 seconds
  2. 2

    Apply cervical collar

    • Have assistant maintain in-line stabilization of head and neck.
    • Reassure casualty and explain procedure.
    • Measure and size collar: front height fits between chin and chest at suprasternal notch.
    • Apply collar to supine casualty. Secure Velcro strap.
    • Maintain manual stabilization until casualty is immobilized on long spine board.
    • Immobilize with straps and head immobilization blocks.
  3. 3

    Assess for shock

    • Assess level of consciousness (AVPU).
    • Evaluate skin: pale, moist, distended abdomen.
    • Capillary refill test on finger.
    • Check pedal pulse (skin to skin, no thumb).
    • Check femoral pulse.
    • Check radial pulse.
    • Check carotid pulse.
    • Measure pulse for 30 seconds. Assess respirations for 30 seconds.
  4. 4

    Treat for hemorrhagic shock

    • Move casualty under shelter/shade (secure to litter first).
    • Maintain supine position with spinal immobilization.
    • Loosen clothing at neck, waist, binding areas.
    • Prevent chilling or overheating — wrap completely with blanket under litter straps.
    • Calm and reassure. Watch for life-threatening conditions.
  5. 5

    Complete TCCC card

    • Front: EVAC priority, date, time, mechanism (fall), injury site, vitals (pulse rate, resp rate, AVPU).
    • Back: EVAC priority, other treatments (cervical collar), notes (signs of shock).
    • First responder name and last 4 SSN. Secure card to casualty per SOP.

Go Deeper — ATP 4-02.11 Reference

Detailed doctrine from the Army Techniques Publication:

Shock Assessment & Treatment (Table 7-1, Blood Volume)
M5: Control Bleeding M7: Occlusive Dressing