ATP 4-02.11 Reference

ABDOMINAL & THORACIC WOUNDS

Source: ATP 4-02.11, Chapter 14 — Abdominal and Thoracic Wounds, 23 March 2026

Key Points

  • Do NOT push exposed abdominal organs back into the body
  • Do NOT probe, clean, or remove foreign objects from the abdomen
  • Do NOT touch exposed organs with bare hands
  • Keep exposed organs moist — use moist sterile dressing
  • Tie dressing tails loosely at the side — never directly over wound
  • Do NOT give the casualty anything by mouth
  • Evacuation position: on back, knees flexed
  • Always check for both entry and exit wounds
  • Treat the more serious wound first (heavier bleeding, protruding organs)

Common Mistakes

  • Attempting to push organs back into the abdomen
  • Probing or cleaning the wound
  • Tying dressing tightly directly over the wound
  • Giving oral fluids/food to abdominal wound casualty
  • Missing an exit wound on the back
  • Using dry dressing on exposed organs (causes tissue to dry out)

Evacuation Position

Place casualty on their back (face up) with knees flexed. This relaxes abdominal muscle tension and reduces pain. Keep casualty warm. Check for shock every 5 minutes if evacuation is delayed.

Critical Rules — Abdominal Wounds
  • Do NOT probe, clean, or try to remove any foreign object from the abdomen
  • Do NOT touch exposed organs with bare hands
  • Do NOT push organs back inside the body
  • Do NOT give the casualty anything by mouth

Abdominal Evisceration — Wound Management

When abdominal organs are exposed through a wound, they must be kept moist and protected. Moist sterile dressings should be applied if available. (ATP 4-02.11, para 14-5)

  1. 1

    Using the sterile side of a dressing or cleanest material available, carefully gather any protruding organs near the wound opening — do NOT push them back in.

  2. 2

    Ensure the dressing is large enough to cover the entire mass of protruding organs or wound area.

  3. 3

    If large enough, place the sterile side of the plastic wrapper directly over the wound as an occlusive layer.

  4. 4

    Moisten the dressing with clean water prior to placing over the exposed organs — keeping organs moist prevents tissue death.

  5. 5

    Place the dressing directly on top of the wound or plastic wrapper.

  6. 6

    Tie the dressing tails loosely at the casualty's side — never tightly over the wound. If two dressings are needed for a large wound, tie the second set of tails at the opposite side from the first.

Entry and Exit Wounds

Always check for both entry and exit wounds. If there are two wounds (entry and exit), treat the wound that appears more serious first — heavier bleeding, protruding organs, larger wound, etc. (ATP 4-02.11, para 14-9)

  • For the second wound: improvise dressings from strips of cloth, a t-shirt, or the cleanest material available if needed
  • Use the casualty's dressing from their first aid kit, not your own
  • If the dressing is not large enough to cover the entire wound, place the plastic wrapper over the wound first, then the dressing on top

Post-Dressing Actions — Preparing for Evacuation

  1. 1

    Position the casualty on their back, face up, with knees flexed — reduces abdominal tension and pain.

  2. 2

    Keep the casualty warm — cover with a blanket as needed. Prevent hypothermia.

  3. 3

    Do NOT give the casualty anything by mouth — abdominal injuries typically require surgery; oral intake complicates anesthesia.

  4. 4

    If evacuation is delayed, check the casualty for shock every 5 minutes.

  5. 5

    Record all procedures on DD Form 1380. Seek medical aid and MEDEVAC — abdominal and thoracic wounds require definitive surgical care.

Thoracic (Chest) Wounds — Summary

Thoracic wounds that create an opening in the chest wall require a chest seal. See the Chest Injuries & Needle Decompression page for detailed procedures on open pneumothorax and tension pneumothorax treatment.

  • Apply vented chest seal to all penetrating chest wounds
  • Check for entry and exit wounds — seal both
  • Reassess breathing after dressing application
  • Monitor for development of tension pneumothorax

ATP 4-02.11 Source

Chapter 14: Abdominal and Thoracic Wounds — Army Techniques Publication 4-02.11, Casualty Response, Tactical Combat Casualty Care, and First Aid. Headquarters, Department of the Army, 23 March 2026.

See It in Practice — ESB Tasks

These ESB Medical Lane tasks apply this doctrine directly:

M9: Abdominal Wound & Eye Injuries
Fractures & Splinting Casualty Documentation