DEEP VEIN THROMBOSIS PREVENTION

The most common locations for deep vein thrombosis (DVT) include the lower leg, thigh, and pelvis. Recognition and treatment of a DVT require specific medical training and can only be accomplished by a medical responder. However, the prevention of DVTs is not a medical task and should be performed by any available Service Member. If available, compression stockings, or elastic bandages (wrapped starting from the toes upward) should be placed on immobile or unconscious casualties, ensuring toes remain exposed for capillary refill assessment. Casualties who are conscious and able may perform the following exercises, completing 10 repetitions of each exercise every hour while awake. This may be done in burned extremities or in the presence of open wounds but should be avoided when fractures or severe extremity injuries are present.7,11

Signs and Symptoms of DVT

- Swelling
- Pain or tenderness
- Cramping, aching, or increased warmth
- Red or discolored skin

Non-medical and Medical Responders

Conscious Casualties: 10x every 2 hours, while awake

- Foot pumps. Have the casualty stretch toes up and back, flexing feet, and hold for a few seconds. Then point toes and hold before repeating.
- Ankle circles. Have casualty raise both feet and trace a circle or each letter of the alphabet with their toes.
- Leg raises. With left leg straight, have the casualty raise foot off the bed/cot or floor, then lower. Repeat with right leg. Alternatively, slowly have casualty lift left knee up to chest, then bring foot back to the bed/cot or floor; repeat with right leg.
- Hamstring stretches. While casualty is lying on their back with straight legs, have them raise one leg to 90°. Instruct casualty to pull the leg gently toward the head and hold for up to 30 seconds. Slowly bring the leg back down to a flat position and repeat with the other leg.
- Shoulder rolls. Although developing a clot in the upper body is less likely, venous stasis should be avoided. Have the casualty raise shoulders and circle them back and down five times. Then reverse direction for five more repetitions.

Unconscious Casualties: 10x every two hours

- Ankle plantarflexion-dorsiflexion. Hold the ankle and heel of one foot and alternately bend the foot forward into plantarflexion and then push the foot upward into dorsiflexion. Hold each position for 5–10 seconds.
- Lower extremity massage. Using both hands and starting at the ankle, apply consistent pressure, massaging the leg in an upward motion through the thigh. (Items such as a plastic bottle may be used to roll the skin toward the head.) Ensure deep pressure is avoided when massaging behind the knee or over bony prominences. Alternate legs (to simulate walking) for five times on each leg.