Your SlideShare is downloading. ×
0
TC3
TC3
TC3
TC3
TC3
TC3
TC3
TC3
TC3
TC3
TC3
TC3
TC3
TC3
TC3
TC3
TC3
TC3
TC3
TC3
TC3
TC3
TC3
TC3
TC3
TC3
TC3
TC3
TC3
TC3
TC3
TC3
TC3
TC3
TC3
TC3
TC3
TC3
TC3
TC3
TC3
TC3
TC3
TC3
TC3
TC3
TC3
TC3
TC3
TC3
TC3
TC3
TC3
TC3
TC3
TC3
TC3
TC3
TC3
TC3
TC3
TC3
TC3
TC3
TC3
TC3
TC3
TC3
TC3
TC3
TC3
TC3
TC3
TC3
TC3
TC3
TC3
TC3
TC3
TC3
TC3
TC3
TC3
TC3
TC3
TC3
TC3
TC3
TC3
TC3
TC3
TC3
TC3
TC3
TC3
TC3
TC3
TC3
TC3
TC3
TC3
TC3
TC3
TC3
TC3
TC3
TC3
TC3
TC3
TC3
TC3
TC3
TC3
Upcoming SlideShare
Loading in...5
×

Thanks for flagging this SlideShare!

Oops! An error has occurred.

×
Saving this for later? Get the SlideShare app to save on your phone or tablet. Read anywhere, anytime – even offline.
Text the download link to your phone
Standard text messaging rates apply

TC3

4,428

Published on

0 Comments
5 Likes
Statistics
Notes
  • Be the first to comment

No Downloads
Views
Total Views
4,428
On Slideshare
0
From Embeds
0
Number of Embeds
0
Actions
Shares
0
Downloads
237
Comments
0
Likes
5
Embeds 0
No embeds

Report content
Flagged as inappropriate Flag as inappropriate
Flag as inappropriate

Select your reason for flagging this presentation as inappropriate.

Cancel
No notes for slide
  • The predominant principal of casualty triage is to treat and return to duty the greatest number soldiers in the shortest possible time. This gives the combat commander additional assets to defeat the enemy. A familiarity with the principles of casualty triage will assist the 91W in rendering vitally important emergency medical care to soldiers in a timely manner and will help reduce the number of soldiers who die of wounds
  • This medic is sitting up to high and look where his rifle is
  • “ I feel respiratory effort against my face, I hear clear respirations and I see bilateral rise and fall of the chest, the airway is patent”
  • “ I feel respiratory effort against my face, I hear clear respirations and I see bilateral rise and fall of the chest, the airway is patent”
  • “ I feel respiratory effort against my face, I hear clear respirations and I see bilateral rise and fall of the chest, the airway is patent”
  • B – Breathing : IAP = I nspect, A uscultate, P alpate. The chest should be exposed and assessed for wounds, equal bilat expansion and breathing quality, Auscultate 4 fields and palpate the chest. Inspection: Chest appears atraumatic or Negative (DCAP BTLS) make sure the student knows what to look for i.e., Deformities Contusions Abrasions Punctures/penetrations, Burns, (tenderness is palpated) lacerations and areas of swelling. “ Chest appears atraumatic, Negative DCAP-BTLS, pt has bilateral rise and fall of the chest with regular rate and normal depth of respirations” Auscultation : Auscultate 4 fields “ Clear respirations all 4 fields”. Example scenario feedback: “Absent breath sounds right, normal left” etc…. Palpation: Palpate the thorax for TIC (T enderness, I nstability and C repitus). Start with the pt’s clavicles and shoulders, pressing down slowly but firmly, palpate down both sides of the pt’s chest wall simultaneously—pushing from front to back and right side to left side. The exam should proceed in a systematic order covering all areas of the chest. The posterior of the chest will be palpated during the blood sweep for any possible wounds.   Note: Oxygen should be applied at this time . A non-rebreather mask, nasal cannula or ventilatory assistance if needed but all pts get oxygen. If the pt is apnec, the assistant should be instructed to bag the pt with high flow 0 2 at this time (or pocket mask) once every 5 seconds while still controlling his C-spine. Breathing pattern, rate and effort.  Normal rate for adults is between 12 and 18 breaths per minute.  Tachypnea may be caused by exertion, fever, hypoxia or pain.  Bradypnea may be caused by hypothermia or medication effect. Evaluate the patient for dyspnea . Breathing should not be a strenuous activity.  If you note use of accessory muscles or retractions during breathing, that means the patient has an increased WOB .  Normally we spend 1/3 of the breathing cycle in inspiration, 2/3 in exhalation for an I:E ratio of 1:2.  Longer expiratory times are associated with chronic pulmonary disease. Inspection Inspection permits an evaluation of the following: Rate of respiration. Rhythm of respiration. Symmetry of chest expansion. Thoracic shape. Thoracic contour. A rate of respiration of 12 to 20 cycles per minute is within the normal range for the adult. The normal respiratory cycle consists of an inspiratory phase followed by a short pause, then an expiratory phase which involves more rapid action than inspiration. Another longer pause precedes the next inspiratory phase. Normally, the rhythm of respiration is smooth and regular. Carefully evaluate any abnormal breathing patterns, such as: Tachypnea - an increased respiratory rate generally accompanied by a shallower breathing pattern. Bradypnea - a reduced respiratory rate. Apnea - a pattern in which there is an absence of breathing. Cheyne-Stokes - a pattern of increased deep respirations followed by a pattern of normal, then slower respirations, alternating with periods of apnea. Kussmaul - a pattern of rhythmic, rapid, deep respirations, which usually sounds labored. The symmetry of chest expansion is evaluated at the same time as rate and rhythm. Normally, the chest moves upward and outward symmetrically upon inspiration. Note any impaired movement or "lag" on either side which could be caused by pain, atelectasis, or other disease. Also note the inspiratory/expiratory ratio. Expiration is normally slightly longer. However, patients with obstructive diseases such as asthma or emphysema will have an altered inspiratory/expiratory breathing ratio. Note the patient's posture and use of accessory muscles in the neck or abdomen. Remember that men are more likely to use diaphragmatic breathing while women are more likely to breathe costally or thoracically. Next, assess thoracic shape and contour. Examine the posterior chest for the normal vertical appearance of the vertebral column and the normal parallel relationship of the shoulders and hips. Note any abnormal lateral deviation in the vertebral pattern. Have the patient cross his or her arms, causing the lateral areas to become more accessible. Note that the distance between the lateral borders is greater than the distance between the sternum and vertebral column. The normal ratio of anteroposterior to lateral diameter varies from 1:2 to 5:7. An abnormal finding is a barrel chest often seen in patients with chronic obstructive pulmonary disease. However, this finding is considered normal in the elderly patient. Palpation of Posterior Chest
  • B – Breathing : IAP = I nspect, A uscultate, P alpate. The chest should be exposed and assessed for wounds, equal bilat expansion and breathing quality, Auscultate 4 fields and palpate the chest. Inspection: Chest appears atraumatic or Negative (DCAP BTLS) make sure the student knows what to look for i.e., Deformities Contusions Abrasions Punctures/penetrations, Burns, (tenderness is palpated) lacerations and areas of swelling. “ Chest appears atraumatic, Negative DCAP-BTLS, pt has bilateral rise and fall of the chest with regular rate and normal depth of respirations” Auscultation : Auscultate 4 fields “ Clear respirations all 4 fields”. Example scenario feedback: “Absent breath sounds right, normal left” etc…. Palpation: Palpate the thorax for TIC (T enderness, I nstability and C repitus). Start with the pt’s clavicles and shoulders, pressing down slowly but firmly, palpate down both sides of the pt’s chest wall simultaneously—pushing from front to back and right side to left side. The exam should proceed in a systematic order covering all areas of the chest. The posterior of the chest will be palpated during the blood sweep for any possible wounds.   Note: Oxygen should be applied at this time . A non-rebreather mask, nasal cannula or ventilatory assistance if needed but all pts get oxygen. If the pt is apnec, the assistant should be instructed to bag the pt with high flow 0 2 at this time (or pocket mask) once every 5 seconds while still controlling his C-spine. Breathing pattern, rate and effort.  Normal rate for adults is between 12 and 18 breaths per minute.  Tachypnea may be caused by exertion, fever, hypoxia or pain.  Bradypnea may be caused by hypothermia or medication effect. Evaluate the patient for dyspnea . Breathing should not be a strenuous activity.  If you note use of accessory muscles or retractions during breathing, that means the patient has an increased WOB .  Normally we spend 1/3 of the breathing cycle in inspiration, 2/3 in exhalation for an I:E ratio of 1:2.  Longer expiratory times are associated with chronic pulmonary disease. Inspection Inspection permits an evaluation of the following: Rate of respiration. Rhythm of respiration. Symmetry of chest expansion. Thoracic shape. Thoracic contour. A rate of respiration of 12 to 20 cycles per minute is within the normal range for the adult. The normal respiratory cycle consists of an inspiratory phase followed by a short pause, then an expiratory phase which involves more rapid action than inspiration. Another longer pause precedes the next inspiratory phase. Normally, the rhythm of respiration is smooth and regular. Carefully evaluate any abnormal breathing patterns, such as: Tachypnea - an increased respiratory rate generally accompanied by a shallower breathing pattern. Bradypnea - a reduced respiratory rate. Apnea - a pattern in which there is an absence of breathing. Cheyne-Stokes - a pattern of increased deep respirations followed by a pattern of normal, then slower respirations, alternating with periods of apnea. Kussmaul - a pattern of rhythmic, rapid, deep respirations, which usually sounds labored. The symmetry of chest expansion is evaluated at the same time as rate and rhythm. Normally, the chest moves upward and outward symmetrically upon inspiration. Note any impaired movement or "lag" on either side which could be caused by pain, atelectasis, or other disease. Also note the inspiratory/expiratory ratio. Expiration is normally slightly longer. However, patients with obstructive diseases such as asthma or emphysema will have an altered inspiratory/expiratory breathing ratio. Note the patient's posture and use of accessory muscles in the neck or abdomen. Remember that men are more likely to use diaphragmatic breathing while women are more likely to breathe costally or thoracically. Next, assess thoracic shape and contour. Examine the posterior chest for the normal vertical appearance of the vertebral column and the normal parallel relationship of the shoulders and hips. Note any abnormal lateral deviation in the vertebral pattern. Have the patient cross his or her arms, causing the lateral areas to become more accessible. Note that the distance between the lateral borders is greater than the distance between the sternum and vertebral column. The normal ratio of anteroposterior to lateral diameter varies from 1:2 to 5:7. An abnormal finding is a barrel chest often seen in patients with chronic obstructive pulmonary disease. However, this finding is considered normal in the elderly patient. Palpation of Posterior Chest
  • C – Circulation: 1) look for life threatening bleeding. 2) Check circulation, start with radial pulses first, if absent, check for a carotid pulse. Then check skin temp, color and condition .   Note that checking the pulses in the order of radials and then carotids is also a quick check of the pt’s blood pressure. Radials represent a systolic B/P of at least 80mm/Hg, while carotids would represent a systolic of only about 60mm/Hg. •          **Soldier medic action : Look and feel for hemorrhage with a blood sweep from head to toe, pulling your hands out after each stroke and looking at them for the presence of blood.   o         Start at the head and work your way down the body in a systematic way, being sure to get your hands all the way under each body part. o         At the posterior of the chest, be sure to feel the whole back for possible wounds that can’t be seen.   Technique: Feel the posterior chest (downside) with the “home-boy check” reach under the shoulder with one hand and under the lateral side of the chest with the other, until your hands meet, spread the fingers out and rake back feeling for any wounds. Then check opposite side in the same manner. Next, move down the back, checking under the small of the back and then under the abdomen.   o         At the pelvis use the “Homeboy” technique again but under the buttocks. o         Then check each leg including the bottom of the feet and then each arm and the hands.   •          Soldier medic Action: Check circulation Check radial pulses first –if radials are absent then check carotid pulse if absent check heart sounds by auscultation. “Radial pulses are strong/regular and equal bilat”. Check the skin Temp, color and condition : “Warm, red and dry” or “Warm, red and moist” or ”Warm, pink and perfuse” or “Cool, pale and clammy” etc.
  • C – Circulation: 1) look for life threatening bleeding. 2) Check circulation, start with radial pulses first, if absent, check for a carotid pulse. Then check skin temp, color and condition .   Note that checking the pulses in the order of radials and then carotids is also a quick check of the pt’s blood pressure. Radials represent a systolic B/P of at least 80mm/Hg, while carotids would represent a systolic of only about 60mm/Hg. •          **Soldier medic action : Look and feel for hemorrhage with a blood sweep from head to toe, pulling your hands out after each stroke and looking at them for the presence of blood.   o         Start at the head and work your way down the body in a systematic way, being sure to get your hands all the way under each body part. o         At the posterior of the chest, be sure to feel the whole back for possible wounds that can’t be seen.   Technique: Feel the posterior chest (downside) with the “home-boy check” reach under the shoulder with one hand and under the lateral side of the chest with the other, until your hands meet, spread the fingers out and rake back feeling for any wounds. Then check opposite side in the same manner. Next, move down the back, checking under the small of the back and then under the abdomen.   o         At the pelvis use the “Homeboy” technique again but under the buttocks. o         Then check each leg including the bottom of the feet and then each arm and the hands.   •          Soldier medic Action: Check circulation Check radial pulses first –if radials are absent then check carotid pulse if absent check heart sounds by auscultation. “Radial pulses are strong/regular and equal bilat”. Check the skin Temp, color and condition : “Warm, red and dry” or “Warm, red and moist” or ”Warm, pink and perfuse” or “Cool, pale and clammy” etc.
  • C – Circulation: 1) look for life threatening bleeding. 2) Check circulation, start with radial pulses first, if absent, check for a carotid pulse. Then check skin temp, color and condition .   Note that checking the pulses in the order of radials and then carotids is also a quick check of the pt’s blood pressure. Radials represent a systolic B/P of at least 80mm/Hg, while carotids would represent a systolic of only about 60mm/Hg. •          **Soldier medic action : Look and feel for hemorrhage with a blood sweep from head to toe, pulling your hands out after each stroke and looking at them for the presence of blood.   o         Start at the head and work your way down the body in a systematic way, being sure to get your hands all the way under each body part. o         At the posterior of the chest, be sure to feel the whole back for possible wounds that can’t be seen.   Technique: Feel the posterior chest (downside) with the “home-boy check” reach under the shoulder with one hand and under the lateral side of the chest with the other, until your hands meet, spread the fingers out and rake back feeling for any wounds. Then check opposite side in the same manner. Next, move down the back, checking under the small of the back and then under the abdomen.   o         At the pelvis use the “Homeboy” technique again but under the buttocks. o         Then check each leg including the bottom of the feet and then each arm and the hands.   •          Soldier medic Action: Check circulation Check radial pulses first –if radials are absent then check carotid pulse if absent check heart sounds by auscultation. “Radial pulses are strong/regular and equal bilat”. Check the skin Temp, color and condition : “Warm, red and dry” or “Warm, red and moist” or ”Warm, pink and perfuse” or “Cool, pale and clammy” etc.
  • C – Circulation: 1) look for life threatening bleeding. 2) Check circulation, start with radial pulses first, if absent, check for a carotid pulse. Then check skin temp, color and condition .   Note that checking the pulses in the order of radials and then carotids is also a quick check of the pt’s blood pressure. Radials represent a systolic B/P of at least 80mm/Hg, while carotids would represent a systolic of only about 60mm/Hg. •          **Soldier medic action : Look and feel for hemorrhage with a blood sweep from head to toe, pulling your hands out after each stroke and looking at them for the presence of blood.   o         Start at the head and work your way down the body in a systematic way, being sure to get your hands all the way under each body part. o         At the posterior of the chest, be sure to feel the whole back for possible wounds that can’t be seen.   Technique: Feel the posterior chest (downside) with the “home-boy check” reach under the shoulder with one hand and under the lateral side of the chest with the other, until your hands meet, spread the fingers out and rake back feeling for any wounds. Then check opposite side in the same manner. Next, move down the back, checking under the small of the back and then under the abdomen.   o         At the pelvis use the “Homeboy” technique again but under the buttocks. o         Then check each leg including the bottom of the feet and then each arm and the hands.   •          Soldier medic Action: Check circulation Check radial pulses first –if radials are absent then check carotid pulse if absent check heart sounds by auscultation. “Radial pulses are strong/regular and equal bilat”. Check the skin Temp, color and condition : “Warm, red and dry” or “Warm, red and moist” or ”Warm, pink and perfuse” or “Cool, pale and clammy” etc.
  • C – Circulation: 1) look for life threatening bleeding. 2) Check circulation, start with radial pulses first, if absent, check for a carotid pulse. Then check skin temp, color and condition .   Note that checking the pulses in the order of radials and then carotids is also a quick check of the pt’s blood pressure. Radials represent a systolic B/P of at least 80mm/Hg, while carotids would represent a systolic of only about 60mm/Hg. •          **Soldier medic action : Look and feel for hemorrhage with a blood sweep from head to toe, pulling your hands out after each stroke and looking at them for the presence of blood.   o         Start at the head and work your way down the body in a systematic way, being sure to get your hands all the way under each body part. o         At the posterior of the chest, be sure to feel the whole back for possible wounds that can’t be seen.   Technique: Feel the posterior chest (downside) with the “home-boy check” reach under the shoulder with one hand and under the lateral side of the chest with the other, until your hands meet, spread the fingers out and rake back feeling for any wounds. Then check opposite side in the same manner. Next, move down the back, checking under the small of the back and then under the abdomen.   o         At the pelvis use the “Homeboy” technique again but under the buttocks. o         Then check each leg including the bottom of the feet and then each arm and the hands.   •          Soldier medic Action: Check circulation Check radial pulses first –if radials are absent then check carotid pulse if absent check heart sounds by auscultation. “Radial pulses are strong/regular and equal bilat”. Check the skin Temp, color and condition : “Warm, red and dry” or “Warm, red and moist” or ”Warm, pink and perfuse” or “Cool, pale and clammy” etc.
  • The predominant principal of casualty triage is to treat and return to duty the greatest number soldiers in the shortest possible time. This gives the combat commander additional assets to defeat the enemy. A familiarity with the principles of casualty triage will assist the 91W in rendering vitally important emergency medical care to soldiers in a timely manner and will help reduce the number of soldiers who die of wounds
  • The predominant principal of casualty triage is to treat and return to duty the greatest number soldiers in the shortest possible time. This gives the combat commander additional assets to defeat the enemy. A familiarity with the principles of casualty triage will assist the 91W in rendering vitally important emergency medical care to soldiers in a timely manner and will help reduce the number of soldiers who die of wounds
  • The predominant principal of casualty triage is to treat and return to duty the greatest number soldiers in the shortest possible time. This gives the combat commander additional assets to defeat the enemy. A familiarity with the principles of casualty triage will assist the 91W in rendering vitally important emergency medical care to soldiers in a timely manner and will help reduce the number of soldiers who die of wounds
  • The predominant principal of casualty triage is to treat and return to duty the greatest number soldiers in the shortest possible time. This gives the combat commander additional assets to defeat the enemy. A familiarity with the principles of casualty triage will assist the 91W in rendering vitally important emergency medical care to soldiers in a timely manner and will help reduce the number of soldiers who die of wounds
  • The predominant principal of casualty triage is to treat and return to duty the greatest number soldiers in the shortest possible time. This gives the combat commander additional assets to defeat the enemy. A familiarity with the principles of casualty triage will assist the 91W in rendering vitally important emergency medical care to soldiers in a timely manner and will help reduce the number of soldiers who die of wounds
  • The predominant principal of casualty triage is to treat and return to duty the greatest number soldiers in the shortest possible time. This gives the combat commander additional assets to defeat the enemy. A familiarity with the principles of casualty triage will assist the 91W in rendering vitally important emergency medical care to soldiers in a timely manner and will help reduce the number of soldiers who die of wounds
  • The predominant principal of casualty triage is to treat and return to duty the greatest number soldiers in the shortest possible time. This gives the combat commander additional assets to defeat the enemy. A familiarity with the principles of casualty triage will assist the 91W in rendering vitally important emergency medical care to soldiers in a timely manner and will help reduce the number of soldiers who die of wounds
  • The predominant principal of casualty triage is to treat and return to duty the greatest number soldiers in the shortest possible time. This gives the combat commander additional assets to defeat the enemy. A familiarity with the principles of casualty triage will assist the 91W in rendering vitally important emergency medical care to soldiers in a timely manner and will help reduce the number of soldiers who die of wounds
  • The predominant principal of casualty triage is to treat and return to duty the greatest number soldiers in the shortest possible time. This gives the combat commander additional assets to defeat the enemy. A familiarity with the principles of casualty triage will assist the 91W in rendering vitally important emergency medical care to soldiers in a timely manner and will help reduce the number of soldiers who die of wounds
  • The predominant principal of casualty triage is to treat and return to duty the greatest number soldiers in the shortest possible time. This gives the combat commander additional assets to defeat the enemy. A familiarity with the principles of casualty triage will assist the 91W in rendering vitally important emergency medical care to soldiers in a timely manner and will help reduce the number of soldiers who die of wounds
  • Transcript

    • 1. TC3
    • 2. <ul><li>On the Battlefield, rapid systematic assessment is key </li></ul><ul><li>Interventions identified as lifesaving measures are initiated immediately </li></ul><ul><li>Application of TC3 and in Combat </li></ul>Introduction
    • 3. Introduction <ul><li>Today our country is at war – </li></ul>68Ws Will be called upon to deploy and provide medical care on foreign soil and possibly in a combat zone. You must be able to distinguish between the care provided in the civilian community and the care necessary during hostile actions.
    • 4. Introduction <ul><li>Civilian medic training is based on the following principles: </li></ul><ul><li>Emergency Medical Technicians (EMT-B – EMT-P) </li></ul><ul><li>Basic Trauma Life Support (BTLS) </li></ul><ul><li>Pre-Hospital Trauma Life Support (PHTLS) </li></ul><ul><li>Advanced Trauma Life Support (ATLS) </li></ul><ul><li>Advanced Cardiac Life Support (ACLS) </li></ul>
    • 5. Battle Field Medicine <ul><li>Currently Soldier Medics are being trained according to the principles of Tactical Combat Casualty Care (TC-3) </li></ul><ul><li>The 3 principles of TC3 are </li></ul><ul><ul><li>Treat the Casualty </li></ul></ul><ul><ul><li>Prevent Additional Casualties </li></ul></ul><ul><ul><li>Complete the Mission </li></ul></ul><ul><ul><li>. </li></ul></ul>
    • 6. Introduction <ul><li>Up to 90% of all combat deaths occur before a casualty reaches a Medical Treatment Facility (MTF) </li></ul>
    • 7. In Making the Transition from Civilian Emergency Care to Tactical Combat Casualty Care <ul><li>Consider the management of injuries that occur in a combat mission as being divided into 3 distinct phases of care </li></ul>
    • 8. 3 PHASES OF CARE <ul><li>Care Under Fire </li></ul><ul><li>Tactical Field Care </li></ul><ul><li>Combat Casualty Evacuation Care </li></ul>Care under fire” is the care rendered by the medic at the scene of the injury while he and the casualty are still under effective hostile fire. Available medical equipment is limited to that carried by the soldier or the medic in his aid bag .
    • 9. 3 PHASES OF CARE Tactical Field Care” is the care rendered by the medic once he and the casualty are no longer under effective hostile fire. It also applies to situations in which an injury has occurred, but there has been no hostile fire. Available medical equipment is still limited to that carried into the field by medical personnel. Time to evacuation to a MTF may vary considerably. <ul><li>Care Under Fire </li></ul><ul><li>Tactical Field Care </li></ul><ul><li>Combat Casualty Evacuation Care </li></ul>
    • 10. 3 PHASES OF CARE “ Combat Casualty Evacuation Care” (CASEVAC) is the care rendered once the casualty has been picked up by an aircraft, vehicle or boat. Additional medical personnel and equipment may have been pre-staged and available at this stage of casualty management. <ul><li>Care Under Fire </li></ul><ul><li>Tactical Field Care </li></ul><ul><li>Combat Casualty Evacuation Care </li></ul>
    • 11. Care Under Fire
    • 12. Care Under Fire <ul><li>Priorities </li></ul><ul><ul><li>The number one priority is returning fire </li></ul></ul><ul><ul><ul><li>Medics firepower maybe essential </li></ul></ul></ul><ul><ul><ul><li>If unable to suppress enemy all may be lost </li></ul></ul></ul><ul><ul><ul><li>Attention to suppression may minimize additional injury to previously wounded Soldiers </li></ul></ul></ul>
    • 13. <ul><ul><li>The second priority is treating casualties </li></ul></ul><ul><ul><ul><li>Tactical situation dictates when and how much care is given </li></ul></ul></ul><ul><ul><ul><li>Limited number of medics and if inured there are no immediate replacements </li></ul></ul></ul><ul><ul><ul><li>Medics should not take unnecessary risks </li></ul></ul></ul><ul><ul><ul><ul><li>if wounded then there are two casualties to deal with and no medic </li></ul></ul></ul></ul>Care Under Fire
    • 14. <ul><ul><ul><li>All soldiers need to return fire, even in wounded. </li></ul></ul></ul><ul><ul><ul><li>No immediate management of the airway </li></ul></ul></ul><ul><ul><ul><li>Control hemorrhage </li></ul></ul></ul><ul><ul><ul><li>Use hasty tourniquets </li></ul></ul></ul><ul><ul><ul><li>Penetrating neck injuries do not need a C-Collar </li></ul></ul></ul>Care Under Fire
    • 15. Care Under Fire <ul><ul><li>Wounded unable to fight should </li></ul></ul><ul><ul><ul><li>Attempt to crawl, walk or run to cover </li></ul></ul></ul><ul><ul><ul><li>If unable to move or fight - lay flat and motionless </li></ul></ul></ul>
    • 16. Care Under Fire <ul><li>No immediate management of the airway is necessary </li></ul><ul><li>- Limited time and the need to move casualty to cover </li></ul><ul><li>- Airway problems typically play a minimal role in combat casualties </li></ul><ul><li>- Only 1% in Viet Nam, mostly from maxillofacial injuries </li></ul>
    • 17. Care Under Fire <ul><li>Control of hemorrhage is important since injury to a major vessel can result in hypovolemic shock in a short time frame </li></ul><ul><li>Extremity hemorrhage is the leading cause of preventable combat death </li></ul>
    • 18.  
    • 19. Care Under Fire <ul><li>Use of temporary tourniquets to </li></ul><ul><li>stop the bleeding </li></ul><ul><li>is essential in these types of casualties </li></ul>
    • 20. Care Under Fire <ul><li>Penetrating neck injuries do not require C-spine immobilization. Other neck injuries, such as falls over 15 feet, fast-roping injuries, or MVAs may require C-spine control unless the danger of hostile fire constitutes a greater threat in the judgment of the medic </li></ul>
    • 21. Scene Size Up
    • 22. Scene Size Up
    • 23. Scene Size Up
    • 24. Scene Size Up
    • 25. Care Under Fire <ul><li>Determine Scene Safety/Security </li></ul><ul><ul><li>1) When tactical situation allows, assess and treat life threatening hemorrhage </li></ul></ul><ul><ul><li>Triage Casualties, get those that can, back into the fight </li></ul></ul><ul><ul><li>Triage the rest for evacuation out of the danger area </li></ul></ul>Scene Size-up:
    • 26. Care Under Fire <ul><li>Scene Safety/Security Cont: </li></ul><ul><li>2) Determine the number of Casualties </li></ul><ul><li>If Casualties are in various locations </li></ul><ul><li>- Others will need to report to you the number of wounded, their location and the severity of their injuries </li></ul>
    • 27. Care Under Fire Triage Key Points: Sort Casualties: “ If you can hear my Voice”: “ And Can walk – move to me now” (these are the minimal patients) “ And Can’t walk – Raise your hand and let me know and I will come to you” (these are the delayed patients)
    • 28. Care Under Fire Triage Key Points: <ul><li>What remains are the Immediate, the Expectant and the Dead </li></ul><ul><li>Determine which are which and go to work </li></ul><ul><li>Stop life threatening hemorrhage with tourniquets </li></ul><ul><li>Direct treatment and movement to CCP </li></ul><ul><li>Defer airway treatment until out of the kill zone </li></ul>
    • 29. Care Under Fire <ul><li>Try to have wounded brought to you at a secure/covered location </li></ul><ul><li>Avoid working on wounded out in the open area of the kill zone </li></ul><ul><li>Call for squad members to assist you, Soldiers in full battle gear are to heavy for one man to lift </li></ul><ul><li>Someone may need to retrieve weapons and essential gear </li></ul><ul><li>If needed, Get Assistance from Combat Life Savers </li></ul>Request Additional Help
    • 30. Care Under Fire <ul><li>Remove casualties from the kill zone quickly </li></ul><ul><li>Even if the shooting has stopped you are still in the kill zone </li></ul><ul><li>Your goal is to get wounded to a covered position </li></ul><ul><li>Armored vehicle or a secured building is the best </li></ul>Remove Casualties to CCP/Secure Area
    • 31.  
    • 32. Care Under Fire <ul><li>The squad may have to retrieve casualties out of a hostile environment </li></ul><ul><li>It’s a good idea to use armored vehicles as cover while retrieving casualties </li></ul>Remove Casualties to CCP/Secure Area
    • 33. Care Under Fire <ul><li>3 basic ways to retrieve casualties </li></ul><ul><ul><li>Casualties crawl, walk or run out </li></ul></ul><ul><ul><li>Other squad members grab and drag to safety </li></ul></ul><ul><ul><li>Retrieve casualties by force </li></ul></ul><ul><ul><ul><li>Team element uses fire and maneuver and takes position past casualties </li></ul></ul></ul><ul><ul><ul><li>Provide covering fire </li></ul></ul></ul><ul><ul><ul><li>Recovery team moves in behind to pickup any casualties </li></ul></ul></ul>
    • 34.  
    • 35. Care Under Fire <ul><li>Make the decision on how to evacuate casualties early </li></ul><ul><li>Whether by vehicle or a call for a MEDEVAC helicopter </li></ul><ul><ul><li>- The longer you wait, the longer it takes to get them out </li></ul></ul><ul><li>Reassure casualties during this process </li></ul><ul><ul><li>- Talk to them in a confident calm tone </li></ul></ul><ul><li>Never leave weapons or essential equipment behind </li></ul>Remove Casualties to CCP/Secure Area
    • 36. Tactical Field Care
    • 37. Tactical Field Care <ul><li>Once in a secure area and no longer receiving enemy fire </li></ul><ul><li>Start triaging and treating casualties </li></ul><ul><li>with multiple casualties </li></ul><ul><ul><li>Should do at least ABC-D on each </li></ul></ul><ul><ul><li>Allows the medic to assess and treat the most life threatening injuries </li></ul></ul><ul><ul><li>Allows Prioritization of casualties for evacuation </li></ul></ul>
    • 38. Tactical Field Care <ul><li>The Patient Assessment Sequence </li></ul><ul><li>Sequence is written in an alphabetic A,B,C, D method </li></ul><ul><ul><li>- Each letter represents a step </li></ul></ul><ul><ul><li>Easy to remember </li></ul></ul><ul><ul><li>The sequence is a guideline and a tool to help find and treat the most life threatening injuries in the order of precedence </li></ul></ul><ul><ul><li>Not expected to be followed line by line in all cases </li></ul></ul><ul><ul><li>Modify to treat specific injuries of casualty at hand </li></ul></ul>
    • 39. Tactical Field Care <ul><li>The Patient Assessment Sequence </li></ul><ul><li>On the battlefield standard “ABC” will not provide optimal care </li></ul><ul><ul><li>Maybe appropriate to deviate to “H-ABC” (“H” stands for Hemorrhage) </li></ul></ul><ul><ul><li>Address life threatening hemorrhage and then return to “ABC’s” </li></ul></ul><ul><ul><li>Medic can learn to jump in and out of sequence to address life threats </li></ul></ul><ul><li>Therefore the purpose of the sequence is to: </li></ul><ul><ul><li>Find and treat life threats </li></ul></ul><ul><ul><li>Direct medic so no step is missed or injury gets overlooked </li></ul></ul>
    • 40. Tactical Field Care <ul><li>The Patient Assessment Sequence </li></ul><ul><li>While performing the patient assessment using the principles of TC3: </li></ul><ul><ul><li>- You will use many of the skills and techniques learned in your EMT training </li></ul></ul><ul><ul><li>- Add some more advanced skills </li></ul></ul><ul><li>Basic principles will remain the same; it is the environment and the MOI that has changed </li></ul>
    • 41. Tactical Field Care Sequence
    • 42. Tactical Field Care <ul><li>BSI: Put on Gloves </li></ul><ul><li>Put on Gloves if available </li></ul><ul><li>Protect medic and patient from infection </li></ul><ul><li>Wear to pair, blood is slippery and when doing intricate techniques remove outside pair </li></ul><ul><li>If not, hands get bloody and then you have to wipe your hands on your uniform </li></ul>
    • 43. Tactical Field Care <ul><li>Initial Assessment: GLC/H-ABC&D </li></ul><ul><li>G - General Impression: </li></ul><ul><ul><li>Gross observation of patient </li></ul></ul><ul><ul><li>Clues to MOI, Age, WT, HT, body position, appearance/distress, odors (urine, vomit, feces etc) </li></ul></ul><ul><li>Gain C-spine control/apply C-collar (if appropriate from MOI) </li></ul>
    • 44. ESTABLISH C-SPINE CONTROL AT THIS TIME IF NESSESARRY
    • 45. Tactical Field Care L: Level of Consciousness - AVPU and A&OX 1,2,3 or 4 C: Chief Complaint/Life Threats - Chief Complaint is the casualties description of the injuries - Life Threats are how the patient’s injuries threaten their life
    • 46. Apparent Life Threats
    • 47. Tactical Field Care H: Hemorrhage (Treat all major hemorrhage ASAP) - Reassess any tourniquets or dressings place during Care Under Fire - Quick visual inspection and blood sweep, looking for major bleeding - Treat significant hemorrhage when found then continue with remainder of blood sweep
    • 48. Reassess - This is obviously not working!!!
    • 49. CHECK FOR MAJOR BLEEDING <ul><li>Perform a complete </li></ul><ul><li>blood sweep </li></ul><ul><li>Apply a tourniquet if indicated </li></ul><ul><li>Apply dressings and or pressure dressings </li></ul><ul><li>Only the absolute minimum of clothing should be removed. </li></ul>
    • 50. Tactical Field Care Bleeding cont’d <ul><li>Significant bleeding should be controlled using a tourniquet as described previously. </li></ul><ul><li>Once the tactical situation permits, consideration should be given to loosening the tourniquet and replacing with a dressing and bandage </li></ul><ul><li>Consider a hemostatic dressings or hemostatic powder (QuikClot) to control any additional hemorrhage </li></ul>
    • 51. A – Airway <ul><li>A: Airway : There are 2 parts to airway </li></ul><ul><ul><li>Patency – Open the airway and check for patency using appropriate methods i.e. head-tilt-chin-lift or jaw thrust etc. </li></ul></ul><ul><li>  2) Airway Adjunct - Consider an airway adjunct. Nasopharyngeal Airway (NPA), a Combitube or an emergency Cricothyrotomy and then reassess the airway immediately to determine if the airway is still patent (assess-treat-reassess) </li></ul>
    • 52. A – Airway <ul><li>Unconscious casualties – insert NPA or Combitube </li></ul><ul><li>NPA is better tolerated than an OPA should casualty become conscious </li></ul><ul><li>If a more advanced airway is needed use a Combitube </li></ul><ul><li>Allow a conscious pt to assume a position that best protects the airway i.e. sitting up </li></ul><ul><li>A casualty with maxillofacial injuries should never be transported in a supine position </li></ul><ul><li>If all other methods fail then perform an emergency cricothyrotomy </li></ul><ul><li>. </li></ul>
    • 53.  
    • 54. NPA In Place Then Reassess!
    • 55. Combitube
    • 56. A – Airway <ul><li>NOTE: If an emergency cricothyrotomy or a Combitube was done then someone has to constantly monitor that casualty and suction the airway from time to time. </li></ul><ul><li>It may be necessary to use a BVM to ventilate the pt if respiratory rate falls </li></ul><ul><li>If the pt is moved or log-rolled then these devices have to be reassessed to ensure they did not become dislodged </li></ul>
    • 57.  
    • 58. B – Breathing: 4 parts <ul><li>IAPO = I nspect, A uscultate, P alpate, Oxygen </li></ul><ul><li>1) I nspect : Expose the chest and Inspect for (DCAP BLS) and equal rise and fall of the chest </li></ul><ul><li>If a penetrating wound is discovered, immediately seal with an occlusive dressing and inspect for an exit wound </li></ul><ul><li>2) Auscultate: Carefully listen to 4 fields for equality and presence of respirations </li></ul>
    • 59. B – Breathing: 4 parts <ul><li>IAPO = I nspect, A uscultate, P alpate, Oxygen </li></ul><ul><li>3) Palpate: Palpate both anterior and posterior of the chest, feeling for TIC </li></ul><ul><li>4) Oxygenate/BVM: Always consider oxygen and apply O 2 therapy if it is available and use BVM if needed for ventilation </li></ul>
    • 60. Tactical Field Care Breathing NOTE: Oxygen may not be available in this phase of care but always consider it, otherwise when it is available you will may forget to use it Keep in mind both FLAs and M113s can carry oxygen
    • 61.  
    • 62. Tactical Field Care <ul><li>Progressive respiratory distress secondary to a unilateral penetrating chest trauma should be considered a tension pneumothorax and decompressed with a 14 gauge needle </li></ul><ul><li>Tension pneumothorax is the 2 nd leading cause of preventable death on the battlefield </li></ul>
    • 63. TENSION PNUEMOTHORAX <ul><li>Required as a consideration by any or all of the following </li></ul><ul><ul><li>Decreased or absent breath sounds </li></ul></ul><ul><ul><li>Decreased LOC </li></ul></ul><ul><ul><li>Absent radial pulses </li></ul></ul><ul><ul><li>Dropping blood pressure </li></ul></ul><ul><ul><li>Cyanosis </li></ul></ul><ul><ul><li>JVD </li></ul></ul><ul><ul><li>Tracheal Deviation </li></ul></ul><ul><ul><li>Bad bag compliance </li></ul></ul>
    • 64. <ul><li>Needle Chest Decompression </li></ul><ul><li>Insert 2 nd ICS/MCL on the same side as the chest wound! </li></ul><ul><li>Indications </li></ul><ul><ul><li>Simply: Any pt displaying respiratory distress following a chest injury </li></ul></ul>INDICATIONS TO DECOMPRESS TENSION PNEUMOTHORAX
    • 65. Assess Circulation
    • 66. C – Circulation: 5 parts <ul><li>1) Assess & treat life threatening bleeding. </li></ul><ul><ul><li>If this step was completed in “H” reassess all treatments and go on to check pulses, if not done perform: </li></ul></ul><ul><ul><li>Visual inspection </li></ul></ul><ul><ul><li>Perform a blood sweep </li></ul></ul><ul><ul><li>Control hemorrhage </li></ul></ul><ul><li>2) Check Pulses </li></ul><ul><ul><li>this is a gross pulse check (present or not), do not count the rate </li></ul></ul><ul><ul><li>start with radial pulses first, if absent, check for a carotid pulse </li></ul></ul><ul><ul><li>Purpose 1 st are they alive? 2 nd is B/P sufficient to perfuse the brain (>80 systolic) </li></ul></ul>
    • 67. C – Circulation: 5 parts <ul><li>Finding the strongest palpable pulse is important when considering casualty’s circulatory status and level of shock. For reference: </li></ul><ul><ul><ul><li>Radial pulse = 80 systolic </li></ul></ul></ul><ul><ul><ul><li>Femoral pulse = 70 systolic </li></ul></ul></ul><ul><ul><ul><li>Carotid pulse = 60 systolic </li></ul></ul></ul>
    • 68. Tactical Field Care Circulation <ul><li>Key Point: </li></ul><ul><li>If the radial pulses are absent then the BP is less than 80 and the casualty’s brain is not being perfused with O 2 </li></ul>
    • 69. C – Circulation: 5 parts <ul><li>3) Skin Temperature, Color and Condition </li></ul><ul><ul><li>Temperature: Cool, warm or hot </li></ul></ul><ul><ul><li>Color: Pink, pale or cyanotic </li></ul></ul><ul><ul><li>Condition: Moist “clammy” or dry </li></ul></ul><ul><li>Normal skin should be pink and either dry or moist </li></ul><ul><li>Abnormal skin is pale, cool and clammy (shock) and with hypoxia the skin can become cyanotic (blue) </li></ul><ul><li>Red, hot and dry skin is a sign that the body has lost the ability to regulate heat </li></ul>
    • 70. C – Circulation: 5 parts <ul><li>4) Identify the Signs and Symptoms of Shock </li></ul><ul><li>Think about pt’s overall condition </li></ul><ul><li>Example: Cool, clammy skin; altered mental status; rapid weak pulse or absent radial pulse </li></ul><ul><li>Treat for shock – keep pt warm, elevate feet, place in position of comfort. Other treatments for shock come later, such as: IV fluids (if needed), splinting fractures and medications </li></ul>
    • 71. C – Circulation: 5 parts <ul><li>5) Gain Intravenous Access </li></ul><ul><li>The use of a single 18ga cath. is preferred in the field setting because of ease of starting </li></ul><ul><li>Saline lock should be used unless pt needs immediate fluid resuscitation </li></ul><ul><li>Do not initiate IV distal to significant injury </li></ul><ul><li>Consider Intraosseous if IV fails </li></ul><ul><li>Make the fluid decision (Hextend vs. LR) based on injuries and Hypotensive Fluid Protocol/burn formula </li></ul>
    • 72. Tactical Field Care Fluids <ul><li>Remember: </li></ul><ul><li>1000ml of Ringers Lactate (2.4lbs) will expand the intravascular volume by 250ml within 1 hour </li></ul><ul><li>500ml of 6% Hetastarch (trade name Hextend, weighs 1.3lbs) will expand the intravascular volume by 800ml within 1 hour, and will sustain this expansion for 8 hours </li></ul>
    • 73. D – Decision:
    • 74. Tactical Field Care <ul><li>D – Decision: </li></ul><ul><li>Make evacuation category decision based on the casualty’s present condition and call in a 9 line MEDEVAC request </li></ul><ul><li>Do not delay calling in the 9 line, waiting will delay life saving treatment and may add to a bad outcome </li></ul><ul><li>Prepare the 9-line or have some on do it for you </li></ul><ul><li>Ensure that the 9-line was called in </li></ul>
    • 75. Tactical Field Care <ul><li>D – Decision: </li></ul><ul><li>Categories are listed below for reference: </li></ul><ul><ul><li>Priority I: URGENT </li></ul></ul><ul><ul><li>Priority IA: URGENT SURGICAL </li></ul></ul><ul><ul><li>Priority II: PRIORITY </li></ul></ul><ul><ul><li>Priority III: ROUTINE </li></ul></ul><ul><ul><li>Priority IV: CONVIENCE </li></ul></ul><ul><li>NOTE: Evacuation categories, not Triage categories </li></ul><ul><li>*** END OF THE INITIAL ASSESSMENT </li></ul>
    • 76.  
    • 77. <ul><li>Used to further evaluate the casualty for other life-threatening conditions, not as obvious as hemorrhage </li></ul><ul><li>Start at the head and work to the feet, assessing and treating as you go </li></ul><ul><li>Simultaneously prepare for transport </li></ul>Tactical Field Care E: Expose/Evaluate The Rapid Trauma Assessment (Head to Toe, Treat As You Go)
    • 78. <ul><li>Key Points: </li></ul><ul><li>Similar to a blood sweep but inspect and palpate for fractures and other underlying Life-Threats </li></ul><ul><li>Logroll and inspect the pt’s posterior </li></ul><ul><li>Bandage and splint remaining wounds as you find them to speed up packaging the pt for MEDEVAC </li></ul>Tactical Field Care Rapid Trauma Assessment
    • 79. <ul><li>Review of Acronyms used: </li></ul><ul><li>DCAP-BLS – Used for inspection and palpation. </li></ul><ul><ul><li>D eformities, C ontusions, A brasions, P unctures, B urns, L acerations, S welling </li></ul></ul><ul><li>TIC – Used for palpation (esp. fx) </li></ul><ul><ul><li>T enderness, I nstability, C repitus </li></ul></ul><ul><li>TRD – (TURD) Used for palpating the abd </li></ul><ul><ul><li>T enderness, R igidity, D istension </li></ul></ul><ul><li>JVD – J ugular V ein D istension </li></ul><ul><li>PMS – P ulse, M otor, S ensory </li></ul>Tactical Field Care Rapid Trauma Assessment
    • 80. <ul><li>HEAD: </li></ul><ul><li>First reassess GLC, airway and need for advanced airway </li></ul><ul><li>Inspect: </li></ul><ul><ul><li>DCAP-BLS </li></ul></ul><ul><ul><li>Use a penlight </li></ul></ul><ul><ul><li>Check the eyes for PERRL </li></ul></ul><ul><ul><li>Check for Battle sign and raccoon eyes </li></ul></ul><ul><ul><li>Look for blood & CSF from the eyes, ears, nose and mouth. </li></ul></ul><ul><ul><li>look in the mouth for any broken teeth or other airway obstructions </li></ul></ul><ul><li>Palpate: the bones of the face and skull for TIC </li></ul>Tactical Field Care The Rapid Trauma Assessment
    • 81. <ul><li>Neck: </li></ul><ul><ul><li>Inspect: For wounds (DCAP-BLS), Tracheal deviation and JVD </li></ul></ul><ul><ul><li>Palpate: Vertebrae C-2 to T-1 for TIC </li></ul></ul><ul><ul><li>Apply C-collar if appropriate </li></ul></ul><ul><li>Chest: Reassess IAPO </li></ul><ul><ul><li>Inspect: Equal rise and fall of chest, DCAP-BLS </li></ul></ul><ul><ul><li>Auscultate: 4 fields for presence and quality of respirations </li></ul></ul><ul><ul><li>Palpate: skip is done before, it will not change </li></ul></ul><ul><ul><li>Oxygenate: Reconsider O 2 if available and consider using a BVM to ventilate the pt if needed </li></ul></ul>Tactical Field Care The Rapid Trauma Assessment
    • 82. <ul><li>Abdomen: </li></ul><ul><ul><li>Inspect: For wounds (DCAP-BLS) </li></ul></ul><ul><ul><li>Palpate: TRD </li></ul></ul><ul><li>Pelvis: </li></ul><ul><ul><li>Inspect: DCAP-BLS </li></ul></ul><ul><ul><li>Palpate : Pelvic Rock for TIC </li></ul></ul><ul><ul><li>NOTE: Do not perform pelvic rock if any s/s of fx </li></ul></ul>Tactical Field Care The Rapid Trauma Assessment
    • 83. <ul><li>Lower Extremities: </li></ul><ul><ul><li>Inspect: DCAP-BLS </li></ul></ul><ul><ul><li>Palpate : Palpate for TIC and check PMS </li></ul></ul>Tactical Field Care The Rapid Trauma Assessment
    • 84. <ul><li>Upper Extremities: </li></ul><ul><ul><li>Inspect: DCAP-BLS </li></ul></ul><ul><ul><li>Palpate: Palpate for TIC and check PMS </li></ul></ul><ul><li>Posterior : Logroll </li></ul>Tactical Field Care The Rapid Trauma Assessment
    • 85. <ul><li>Posterior : Logroll </li></ul><ul><ul><li>Inspect: DCAP-BLS </li></ul></ul><ul><ul><li>Palpate : Palpate the long spine for TIC </li></ul></ul><ul><li>- Secure to stretcher </li></ul><ul><li>- After the logroll reassess the pt’s ABCs, bandages and IVs (airways dislodge and bandages and IVs can get pulled off) </li></ul>Tactical Field Care The Rapid Trauma Assessment
    • 86.  
    • 87. <ul><li>1) Full set of Vitals: Pulse, blood pressure, respirations, skin (TCC), Pulse oximetry and Pupils (PERRL) </li></ul><ul><li>2) AMPLE History: </li></ul><ul><li>A = A llergies </li></ul><ul><li>M = M edications </li></ul><ul><li>P = P rior med hx (significant) </li></ul><ul><li>L = L ast meal </li></ul><ul><li>E = E vents leading up to the injury </li></ul><ul><li>3) Complete The Field Medical Card </li></ul>Tactical Field Care F: Full Set Of Vital Signs 3 Steps – Vital Signs/AMPLE/FMC
    • 88. <ul><li>GIVE: Give appropriate medications </li></ul><ul><ul><li>Administer analgesics and antibiotics </li></ul></ul><ul><ul><li>Finish packaging the pt for MEDEVAC </li></ul></ul><ul><ul><li>Tie up loose ends, document medications in FMC and reinforce dressings </li></ul></ul>Tactical Field Care G: Give and GO:
    • 89. GO: Transport and Ongoing Assessment Tactical Field Care
    • 90. <ul><li>GO: Transport and Ongoing Assessment </li></ul><ul><ul><li>Repeat all below every 5 min for unstable pt and every 15 min for a stable pt until MEDEVAC arrives </li></ul></ul><ul><li>Repeat Initial assessment including GLC/ABCs </li></ul><ul><ul><li>Is the pt getting better or worse? </li></ul></ul><ul><li>Repeat a full set of vital signs and document each set in the FMC </li></ul><ul><li>Repeat or reassess any interventions </li></ul><ul><ul><li>Airway adjuncts, bandages, tourniquets, IVs and fluids, occlusive dressings, splints along with distal circulation </li></ul></ul><ul><li>Re-evaluate your evacuation category </li></ul><ul><ul><li>The pt’s condition can change over time and you may have to move up or back in the order of evacuation precedence </li></ul></ul><ul><li>*** END OF TACTICAL FIELD CARE </li></ul>Tactical Field Care
    • 91. <ul><ul><li>NOTE: </li></ul></ul><ul><li>The Soldier Medic should constantly be talking and reassuring the casualty </li></ul><ul><li>Recheck the ABCs every few min. to ensure the pt is still “with” you </li></ul><ul><li>If you spend a few min. performing a treatment go back and check ABCs before moving on </li></ul><ul><li>Example of a quick reassessment: </li></ul><ul><li>The pt is talking so he has an airway, he can speak in full sentences so his breathing is good, I note his bandage is still dry so I have hemostasis, I can see his IV is still running and I see no infiltration at the IV site. </li></ul>Tactical Field Care
    • 92. Casevac Care
    • 93.  
    • 94. Combat Casualty Evacuation Care <ul><li>Combat Casualty Evacuation Care: The care rendered once the casualty has been placed by an aircraft, vehicle or boat </li></ul><ul><li>Additional medical personnel and equipment may have been pre-staged and are available at this phase of casualty management </li></ul>
    • 95. Casevac Care <ul><li>At some point in the operation, the casualty will be scheduled for evacuation. Time to evacuation may be quite variable from minutes to hours. </li></ul>
    • 96. Casevac Care <ul><li>There are a multitude of factors that will affect the ability to evacuate a casualty </li></ul><ul><li>Availability of aircraft or vehicles, weather, tactical situation and mission may all effect the ability of or inability to evacuate casualties </li></ul>
    • 97.  
    • 98. Casevac Care <ul><li>There are only minor differences in care when progressing from the Tactical Field Care phase to the Casevac phase </li></ul><ul><li>Additional medical personnel may accompany the evacuation asset and assist the soldier medic on the ground. This may be important for the following reasons: </li></ul>
    • 99. Additional medical personnel may accompany the evacuation asset
    • 100. Casevac Care <ul><li>The soldier medic may be among the casualties. </li></ul><ul><li>The soldier medic may be dehydrated, hypothermic or otherwise debilitated. </li></ul>
    • 101. Casevac Care <ul><li>The evacuation asset’s medical equipment may need to be prepared prior to evacuation. </li></ul><ul><li>There may be multiple casualties that exceed the capability of the soldier medic to care for simultaneously. </li></ul>
    • 102. Casevac Care <ul><li>Additional medical equipment can be brought in with the evacuation asset to augment the equipment the soldier medic already has. </li></ul><ul><li>This equipment may include: </li></ul>
    • 103. Casevac Care <ul><li>Electronic monitoring equipment capable of measuring a casualty’s blood pressure, pulse and pulse oximetry. </li></ul><ul><li>Oxygen should be available during this phase. </li></ul>
    • 104. Casevac Care <ul><li>Ringers Lactate at a rate of 250 ml per hour for casualties not in shock should help to reverse dehydration. </li></ul><ul><li>Blood products may be available during this phase of care. </li></ul>
    • 105. Casevac Care <ul><li>Thermal Angel ® fluid warmers. </li></ul><ul><li>PASG, if available, may be beneficial in pelvic fractures and helping to control pelvic and abdominal bleeding (they are contraindicated in thoracic and brain injuries). </li></ul>
    • 106. Summary <ul><li>How people die in ground combat: </li></ul><ul><li>31% penetrating head trauma. </li></ul>
    • 107. 25% surgically uncorrectable torso trauma. 10% potentially correctable surgical trauma.
    • 108. Summary <ul><li>9% Exsanguination from extremity wounds: (1 st ) </li></ul><ul><li>7% mutilating blast trauma. </li></ul><ul><li>5% tension pneumothorax: (2 nd ) </li></ul><ul><li>1% airway problems: (3 rd ) </li></ul><ul><li>12% died of wounds (mostly infections and complications of shock). </li></ul>
    • 109. Summary <ul><li>If during the next war you could do only two things, </li></ul><ul><li>(1) put a tourniquet on </li></ul><ul><li>(2) relieve a tension pneumothorax </li></ul><ul><li>then you can probably save between 70 and 90 percent of all the preventable deaths on the battlefield. </li></ul>
    • 110. Summary <ul><li>FOLLOW THE ALPHEBET </li></ul><ul><ul><li>H- Hemorrhage </li></ul></ul><ul><ul><li>A- Airway </li></ul></ul><ul><ul><li>B - Breathing </li></ul></ul><ul><ul><li>C- Circulation </li></ul></ul><ul><ul><li>D - Decision </li></ul></ul><ul><ul><li>E – Expose/ evaluate </li></ul></ul><ul><ul><li>F – Full set of VS, SAMPLE, FMC </li></ul></ul><ul><ul><li>G – Give & GO </li></ul></ul><ul><ul><li>This will minimize missing important information and will assist you in Conserving the Fighting Force </li></ul></ul>
    • 111. Summary <ul><li>Medical care during combat differs significantly from the care provided in the civilian community . </li></ul><ul><li>New concepts in hemorrhage control, fluid resuscitation, analgesia, and antibiotics are important steps in providing the best possible care to our combat soldiers. </li></ul>
    • 112. <ul><li>These timely interventions will be the mainstay in decreasing the number of combat fatalities on the battlefield. </li></ul>
    • 113. Questions?

    ×