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Battlefield Casualty Triage
 

Battlefield Casualty Triage

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    Battlefield Casualty Triage Battlefield Casualty Triage Presentation Transcript

    • Battlefield Casualty Triage W-1/W-2 C191W027/1
      • Given multiple (simulated) casualties with varying injuries, requiring emergency medical care under simulated battlefield conditions, perform casualty triage and establish priorities of treatment and medical evacuation. Perform all measures IAW FM 8-10-6, Medical Evacuation in a Theater of Operations: Tactics, Techniques and Procedures and the principles of Tactical Combat Casualty Care.
      Terminal Learning Objective W-1/W-2 C191W027/1
      • Given the principles and techniques of casualty triage on a conventional or integrated battlefield, apply the principles and decision-making processes for casualty triage to establish priorities of medical treatment and evacuation IAW FM 8-10-6, Medical Evacuation in a Theater of Operations: Tactics, Techniques and Procedures and the principles of Tactical Combat Casualty Care.
      Enabling Learning Objectives W-1/W-2 C191W027/1
      • Given multiple (simulated) casualties with significant life-threatening injuries and a standardized medical aid bag stocked with a basic load, under simulated battlefield conditions, apply the principles and techniques of casualty triage to determine the priority of treatment and evacuation for the casualty IAW FM 8-10-6, Medical Evacuation in a Theater of Operations: Tactics, Techniques and Procedures and the principles of Tactical Combat Casualty Care.
      Enabling Learning Objectives W-1/W-2 C191W027/1
      • Which casualty do you treat first?
      • Who’s most serious?
      • Who’s most likely to survive?
      • What’s the tactical situation?
      • What’s the mission?
      • Triage is an attempt to impose order during chaos and make an initially overwhelming situation manageable.
      Introduction W-1/W-2 C191W027/1
      • A system used for categorizing and sorting patients according to severity of their injuries:
        • To rapidly sort the more serious casualties from those less serious to facilitate the rapid care of the more serious patients
        • When problems exceed resources, triage should facilitate “doing the greatest good for the greatest number”
        • To bring order to chaos thus facilitating the care of all casualties
      Perform Casualty Triage W-1/W-2 C191W027/1
        • Responsibility of medical personnel:
          • Survey and classify casualties:
            • Number and location of casualties
            • Severity of injuries
            • Time constraints
            • Assistance available
            • Evacuation assets
            • Supply and re-supply
      Perform Casualty Triage W-1/W-2 C191W027/1
        • Responsibility of medical personnel cont’d:
          • Treatment is first directed towards the casualties who have the best chance to survive
          • Locate troops with minor wounds, and return them to duty
      Perform Casualty Triage W-1/W-2 C191W027/1
        • Immediate - Immediate treatment to save life, limb or eyesight
        • Delayed - Casualties who have less risk of losing life or limb
        • Minimal - "Walking wounded", self-aid or buddy-aid ( Casualties in this category usually are not evacuated to a medical treatment facility)
        • Expectan t – Casualties so critically injured that only complicated and prolonged treatment offers any hope of improving life expectancy
      Triage Categories W-1/W-2 C191W027/1
      • Airway obstruction
      • Open pneumothorax (with respiratory distress)
      • Tension pneumothorax
      • Unstable abdominal wounds with shock
      • Massive external bleeding (e.g., amputation)
      • Open fractures of long bones
      • Hemorrhagic shock
      • Burns of the face, neck, hands, feet, or perineum and genitalia or second or third degree burns of 15-40% or more of the total body surface area (TBSA)
      Immediate W-1/W-2 C191W027/1
    • Immediate W-1/W-2 C191W027/1
    • Delayed
      • Abdominal wounds (without shock)
      • Open chest wound (w/o respiratory distress)
      • Eye and CNS injuries
      • Soft tissue wounds requiring debridement
      • Fractures requiring surgery
      • 2nd and 3rd degree burns >20% TBSA
      • Maxillofacial wounds (w/o airway compromise)
      • G/U tract disruption
      W-1/W-2 C191W027/1
    • Delayed W-1/W-2 C191W027/1
    • Minimal
      • Minor lacerations, abrasions
      • Contusions
      • Sprains and strains
      • Minor combat stress problems
      • Burns 1st or 2nd degree <15% TBSA
      • Upper extremity fractures (w/o neurovascular compromise)
      • Behavioral disorders; psychiatric disorders
      • Suspicion of blast injury (w/ stable VS)
      • Symptomatic but unquantified radiation exposure
      W-1/W-2 C191W027/1
    • Minimal W-1/W-2 C191W027/1
    • Expectant
        • Unresponsive casualties with penetrating head wounds and signs of impending death
        • Burns, mostly 3rd degree, covering more than 60% TBSA
        • Cervical (high) spinal cord injuries
        • Mutilating explosive wounds involving multiple anatomical sites and organs
        • Profound shock with multiple injuries
        • Agonal respirations
        • Convulsions and vomiting within 24 hours of radiation exposure
      W-1/W-2 C191W027/1
    • Expectant cont’d
        • Without vital signs or signs of life
        • Transcranial gunshot wound (GSW)
        • Open pelvic injury w/ uncontrolled bleeding
      W-1/W-2 C191W027/1
    • Alternate Triage Categories
      • Emergent (immediate) - require attention within minutes to hours
        • Uncontrolled bleeding
        • Airway obstruction
        • Shock (SBP<90 and AMS w/o head injury)
        • Unstable penetrating or blunt trauma
        • Threatened loss of limb or eyesight
        • Multiple long-bone fractures
      • Non-Emergent (delayed and minimal)
      W-1/W-2 C191W027/1
      • Triage is an ongoing process of reassessment which may change the casualty’s triage category.
      W-1/W-2 C191W027/1
    • Triage Decision Making W-1/W-2 C191W027/1 Walking Non-Emergent (Minimal) Responsive to shake and shout Yes No Palpable radial pulse, comfortable breathing Breathing / airway open or with simple maneuver Yes No Emergent (Immediate) Non-Emergent (Delayed and Minimal) Yes No Expectant/Dead
    • Triage Decision Making W-1/W-2 C191W027/1
      • Modified “START” has four key decision points :
      • Is the casualty able to walk (ambulate)?
      • Is the casualty responsive or unresponsive?
      • Is the casualty breathing?
      • Does the casualty have a radial pulse?
        • Care Under Fire:
          • Return fire as required or directed
          • Keep yourself from being shot
          • Scene size up
          • Once the shooting has stopped and it is safe to do so, triage casualties:
          • 1) “If you can hear my voice…..”
      Perform Casualty Triage W-1/W-2 C191W027/1
        • … and can walk, move to this area now ( Non-Emergent/Minimal )
      • … but can't walk, raise your hand and let me know ( Non-Emergent/Delayed )
      • Request Additional Help: squad members and/or CLS if available
      Perform Casualty Triage W-1/W-2 C191W027/1
      • 2) What remains are the Emergent/Immediate and Expectant/Dead
      • Assess as you encounter each casualty and continue to treat per TC-3 protocols (hemorrhage, A-B-Cs)
      • If you have assistance, you may direct immediate treatment and movement to secure area ASAP (CCP)
      • Note : Airway and breathing management is best deferred until you are off the &quot;X&quot;
      Perform Casualty Triage W-1/W-2 C191W027/1
    • W-1/W-2 C191W027/1 RPG Wound Right Knee - Somalia What is the Priority Injury? What is the Triage Category? What is the Evac Priority? Perform Casualty Triage
    • W-1/W-2 C191W027/1 Burn Casualty - Kosovo What is the Priority Injury? What is the Triage Category? What is the Evac Priority? Perform Casualty Triage
    • W-1/W-2 C191W027/1
    • Establish Triage Area
      • Easy access.
      • Smooth traffic flow.
      • Well marked ( I / D / M / E) .
      • Proximity to treatment areas.
      • CBRN considerations.
      W-1/W-2 C191W027/1
    • Triage Area W-1/W-2 C191W027/1 Expectant Emergent Nonemergent Nonemergent
      • Definition of triage.
      • Triage classification considerations.
      • Triage categories.
      • Alternative triage categories.
      • Triage decision-making
      • Establishing a triage area.
      • Be prepared to perform casualty triage in any given situation in order to afford the greatest number of casualties the greatest chance of survival.
      W-1/W-2 C191W027/1 Summary
    • W-1/W-2 C191W027/1 Questions?