68W FC1

Whole blood type O; Plasma, RBC and platelets 1:1:1 ratio; plasma and RBC in 1:1 ratio, any blood product alone; hextend

1st choice of fluid resuscitation in order

800ml

A 500 ml bag of hextend administered results in how much of intravascular fluid expansion?

Tracheal bronchial tree injury.

A rupture or tear in the windpipe or bronchial tubes, the major airways leading to the lungs. A tear can also occur in the tissue lining the windpipe.

1 Liter

A typical adult can bleed up to how much into 1 thigh?

1500 ml

A typical adult casualty can bleed up to how much in each side of the chest?

10 Liters of blood and IV fluid

A typical adult casualty can hemorrhage up to how much into the abdomen?

Rotary and fixed winged aircraft

Aeromedical evacuation is accomplished by both what?

Hypovolemic shock

Also called hemorrhagic shock is a life threatening condition when you lose 20% of your bodies blood or fluid supply.

IV Morphine 5 mg IV/IO

Alternative to OTFC if IV access has been obtained.

Vented Occlusive dressing

Apply what to a penetrating torso trauma injury?

M113

Armored personnel carrier, casualty capacity is 4 litters or 10 ambulatory casualties or a combination of the two.

He must notify the tactical leader

As soon as the combat medic identifies a need for medical evacuation what must he do?

Enclosed area

Blast overpressure is more effective in this type of area.

A

Brevity code for Ambulatory in Line 5

B

Brevity code for Biological in Line 9 (wartime)

C

Brevity code for Chemical in Line 9 (Wartime)

E

Brevity code for Convenience in Line 3

E

Brevity code for Enemy prisoner of War in Line 8

X

Brevity code for Enemy troops in area escort required in line 6 (wartime)

E

Brevity code for Enemy troops in the area in Line 6 (wartime)

C

Brevity code for Extraction Equipment in Line 4

B

Brevity code for Hoist in Line 4

L

Brevity code for Litter in Line 5

D

Brevity code for Non-U.S. Civilian in Line 8

C

Brevity code for Non-U.S. Military in Line 8

A

Brevity code for None in Line 4

N

Brevity code for Nuclear in Line 9 (wartime)

P

Brevity code for Possible enemy troops in the area in Line 6 (wartime)

C

Brevity code for Priority in Line 3

B

Brevity code for Pyrotechnic signal in Line 7

D

Brevity code for Routine in Line 3

C

Brevity code for Smoke signal in line 7

B

Brevity code for U.S. Civilian in Line 8

A

Brevity code for U.S. Military in Line 8

B

Brevity code for Urgent Surgical Line 3

A

Brevity code for Urgent in Line 3

A

Brevity code for VS17 panels in Line 7

D

Brevity code for Ventilator in Line 4

N

Brevity code for no enemy troops in the area in Line 6 (Wartime)

D

Brevity code for none in Line 7

E

Brevity code for other in line 7

Extrinsic causes

Cardiac tamponade, tension pneumothorax are examples of what type of damage to the heart?

M1133 Stryker Light Armored Vehicle or MEV

Carrying capacity 4 litters or 6 ambulatory casualties, or a combination of the two. Classified as a standard evacuation vehicle.

Loaded head first

Casualties are loaded in this position because they are less likely to experience motion sickness or nausea, less noise from doors opening and closing, less danger of further injury in the event of a rear collision.

500 ml bolus of LR by IV

Casualties suffering any cause of shock other than hypovolemia administer what?

Shock management and urgent surgical evacuation and surgery

Casualties with non-compressible hemorrhage need appropriate what?

MaxPro MRAP

Casualty capacity of 2 litters or 3 ambulatory casualties Cat 1.

HAGA MRAP

Casualty capacity of 3 litters or 6 ambulatory casualties Cat 2.

Urgent Surgical

Casualty requires evacuation with surgical intervention within a maximum of 1 hour

Urgent

Casualty requires evacuation within a maximum of 1 hour

Pack strap carry

Casualty's weight rests high on your back. This makes it easier to carry the casualty a moderate distance (50 to 300 meters)

2 mg IV (slow piush over 3-5 minutes or IM every 12 hours)

Cefotetan (If unable to take PO)

Body temp below 93 degrees

Clotting factors affected at what body temperature.

Medical Evacuation (MEDEVAC)

Collecting the wounded, sorting (Triage) and prioritizing for evacuation, providing an evacuation mode (transportation) and perform emergency medical interventions and care in route are all encompassed in what?

Casualty's IFAK

Combat medics should use what before using their own supplies in their aid bag?

Role 3

Combat support hospital

WW1 through today

Combat wounds have been consistent since when?

Tactical Combat Casualty Care Goals

Complete the mission, prevent additional casualties and treat the casualty are what?

6% Hetastarch in lactated eloectrolyte solution (Hextend)

Current prehospital fluid of choice for combat trauma casualties in the absence of blood and blood components. M9 aid bag comes stocked with two 500ml bags of hextend.

Sam junctional tourniquet (SJT)

Designed to control bleeding where traditional tourniquets would not be effective

Armored Medical Evacuation Vehicle (AMEV)

Designed to replace the shortcomings of M113, casualty capacity is 4 litters and 8 ambulatory

ResQGARD

Device makes it harder to inhale and increases the negative pressure in the chest. Can help increase BP

Tactical field care phase

During this phase the combat medic provides updates of evacuation category and changes in casualty status. Assesses for and treats preventable causes of death and disability. Non-life threatening injuries may be treated if time and resources permit.

Omit line 9

During wartime, how should you communicate there is no danger of CBRN?

1 gm IV/IM once a day

Ertapenem (If unable to take PO)

Pocho, Tarp, blanket, drag litter or SKED

Examples of mediums reducing friction between casualty and the ground.

Enemy fire, medical equipment limitations, widely variable evacuation time.

Factors influencing care on the battlefield.

Hypothermia; Acidosis; Hemodilution; Medications; Blood Pressure

Factors that contribute to coagulopathy (difficulty clotting)

Median cubital vein

First choice vein for vascular access.

Role 1

First medical care a soldier receives

Extracellular fluid

Fluid outside of the cells.

Intracellular fluids

Fluids found within the cells

Monitor airway, breathing and circulation

For casualties given opioids or ketamine ensure to do this.

Gain vascular access with a saline lock

For combat casualties with a significant injury assess mental status and radial pulse and also _______

Intrinsic causes

Heart muscle damage, dysrhythmia, valvular disruption are examples of what type of damage to the heart?

8 hours

How long will colloids maintain intravascular space?

90 degree angle from the front of the helicopter

How should litter bearers approach a UH-60 Blackhawk?

Anaphylactic shock

Hypersensitive reaction to the antigen causes severe bronchospasms and vasodilation.

Initiate Sternal intraosseous IO Line

If casualty needs fluid resuscitation after two failed attempts at initiating a saline lock what do you do?

Change method of hemorrhage control

If evacuation is delayed 2 or more hours you can reduce tissue damage by doing what?

Hypothermia, near drowning, electrocution

In a combat environment CPR should be considered for the following non-traumatic disorders.

Use call sign and frequency from SOI, keep transmission to a minimum of 25 seconds, provide the opening statement "I have a MEDEVAC request, over"

In sending a transmission a sender must

Psychogenic shock

Increase stimulation of the vagus nerve causes vasodilation and hypotension.

Confined spaces

Inhalation burns occur with greater frequency in fires in these areas.

Significant injury, AMS, Absent radial pulse

Initiate IV fluid resuscitation if the combat casualty meets the following criteria.

MEDEVAC

Is performed by dedicated medical vehicles and aircraft staffed with medical personnel who provide in route medical care.

Antibiotics

Kills or inhibits the growth of bacteria, recommended for all penetrating combat wounds.

Location of the pickup site

Line 1 of the medevac

Radio Frequency, call sign and suffix

Line 2 of the medevac

Number of casualty's by precedence

Line 3 of the medevac

Special Equipment

Line 4 of the medevac

Number of casualties by type

Line 5 of the medevac

Security of Pickup Site

Line 6 (Wartime) medevac

Number and type of wound, injury or illness

Line 6 peacetime

Blood type

Line 6 peacetime, if serious bleeding is reported what else should be given?

Method of marking pickup site

Line 7 of the medevac

Casualty nationality and status

Line 8 of the medevac

NBC Contamination

Line 9 Wartime

Terrain

Line 9 medevac (Peacetime)

Role 4

Medical care that is found in CONUS based hospitals and other safe havens.

Traumatic asphyxia

Medical emergency caused by intense compression of the thoracic cavity, causing venous backflow.

Brain, heart, lungs, kidney

Most important organs in shunting.

Penetrating trauma and hemorrhage

Most soldiers who die in combat do so within minutes due to what?

Tactical indications for spinal immobilization

Motor vehicle crashes, falls from greater than 15 feet, IED Blast involving MRAP Vehicle

400 mg PO once a day (in the pill pack)

Moxifloxacin (If able to take PO)

Deliberate tourniquet

Newly discovered life threatening hemorrhage on the upper or lower extremities should be treated with what?

Burns greater than 20% of body surface area

Non hemorrhagic causes of hypovolemic shock.

7.35 - 7.45

Normal pH required for clotting

Uphill or upstairs

Normally the casualty should be carried on the litter feet first, except when going where?

M997

Normally used within the operating base, casualty capacity is 4 Litters or 8 ambulatory casualties or 2 litters and 4 ambulatory casualties

Intravenous fluids

Not every injured casualty will require what?

Normal Saline solution

Not indicated for restoring the loss of body fluids

Signal operating instruction (SOI), automated net contral device (ANCD) or Radio and telephone operator (RTO)

Obtain radio frequency, call sign and suffix from one of the following sources.

Simple Rescue

Open fields, vehicles or structures, there are no hindrances to removing casualties.

Pill Pack self administered

Option 1 for mild to moderate pain, casualty is still able to fight - Medications on the battlefield.

Oral Transmuccal Fentanyl Citrate (OTFC) 800 ug

Option 2 for moderate to severe pain, casualty is not in shock or respiratory distress. Casualty is not at significant risk of developing either condition.

Ketamine 50 mg IM/IN or Ketamine 20mg slow IV or IO

Option 3 for moderate to severe pain, casualty is in hemorrhagic shock or respiratory distress or is at risk of developing either condition.

80 mmHg

Perfusion of vital organs can be maintained with a systolic BP of at least what?

Eergency surgical cricothyroidotomy

Preferred advanced airway in the combat environment

Role 2

Provides packed red blood cells (liquid), Forward surgical teams (FST) are found in this role of care.

Cardiogenic shock

Shock referred to as Pump failure

Routine

Sick and wounded in this category should be evacuated within 24 hours

Abdominal rigidity and tenderness, bloody vomiting.

Signs and symptoms of non-compressible hemorrhage include what?

Enemy Fire

Single most significant obstacle to the Combat medics ability to provide care.

Lactaded ringers

Solution of choice for burn casualties

Complex rescue

Structure ingress and egress, vehicle extrication, tactical search and rescue.

Neurogenic shock

Sympathetic control of the smooth muscle within the vascular walls is lost allowing vasodilation. Bradycardic, warm dry skin, alert and oriented, lucid when in the supine position.

Complete the mission, prevent additional casualties, treat casualties

TCC has three main goals what are they?

Tactical Evacuation Care phase

Tactical commander may direct use of vehicles of opportunity as needed for combat "load and go's"

Peel, Push, Pile, Pressure

The 4 P's of wound packing

The Tactical Leader

The decision to use CASEVAC rather than MEDEVAC for casualty transport is made by who?

1 gm in 100 cc of IV solution (NS or LR)

The dose and route given for TXA, must be given within first 3 hours from injury.

Hemorrhage 90.9%b

The majority of these potentially survivable deaths were due to?

NPAs

These are better tolerated and should be considered before OPAs in a combat environment, they are less likely to dislodge during transport.

Colloids

These expand and maintain the intravascular volume more than crystalloids.

Improvised tourniquets

These should be used as a last resort if manufactured tourniquets are not available.

King LT

This airway device can cause Esophageal rupture and dysphagia.

UH-60A Blackhawk

This assets normal evacuation configuration is 4 litter casualties and one ambulatory casualty, maximum evacuation is 6 litter casualties and one ambulatory or seven ambulatory casualties. This asset is also capable of loading from both side simultaneously.

Warrior Aid and Litter Kit (WALK)

This contains a folding talon litter and a robust amount of first aid supplies suitable for hemorrhage control and treatment for shock.

Ketamine

This drug is a useful adjunct to reduce the amount of opioids required to provide effective pain relief. It is safe to give to a casualty who had previously received morphine or OTFC. Should be given over 1 minute if IV.

Zofran, (Ondansetron) 4-8mg IV/IM/IO

This drug is given every 6 hours as needed for nausea and vomiting.

Naloxone (Narcan) 0.4 mg IV or IM

This drug should be available when using opioid analgesics (OTFC and Morphine)

Primary blast injury

This injury is caused by the blast overpressure (or wave) from an explosive.

Disarm the casualty

This intervention may be needed after administering OTFC, Ketamine or Morphine

Tranexamic Acid (TXA)

This is an intravenous medication that helps the body prevent breakdown of clots indicated in casualties with hemorrhagic shock, amputations, torso trauma or evidence of severe bleeding.

Cover and concealment

This is often overlooked and is a highly effective tool.

Septic shock

This type of shock shows signs that the body is fighting an infection, fever, rigors and petechiae.

Stokes basket, Jungel penetrator, SKED litter

Three most common devices used by the hoist to extract casualties are

6.0 mm

Tube diameter should be a minimum of what for a cricothyroidotomy?

Two man fore and aft carry

Two man carry for transporting the casualty over a long distance (Over 300 meters), useful for placing casualty on litter.

Hasty tourniquet

Used during care under fire, placed over the clothing, placed as high on extremity as possible.

SKED litter

Used to evacuate a casualty from confined spaces, rough and difficult terrain, water rescues with attached flotation devices, and is the primary litter used by the Army in helicopter hoist missions

Priority

Used when the individual should be evacuated within 4 hours.

Tourniquets

What are the first tactical choice for life threatening hemorrhage of an extremity in combat?

Care under fire, Tactical field care and Tactical evacuation phase

What are the three phases of tactical combat casualty care?

Platelets

What become activated and red blood cells stick to the fibrin net forming a clot.

Expiration date, color, particles and consistency

What do you look for when inspecting the IV bag before administering?

Microemboli released, acidotic blood, metabolic waste and toxins from non-perfused tissue back into circulation.

What happens if you loosen a tourniquet after 6 hours?

CPR

What is not appropriate to perform on a patient who has sustained blast or penetrating trauma and has no signs of life?

Infiltration

What is occurring when the infusion site is pale, swollen, cool and hard to the touch?

Phlebitis

What is occurring when you assess redness and warmth at the site and along the vein?

Air embolism

What is occurring when you find an abrupt drop in blood pressure, weak rapid pulse, cyanosis and chest pain?

Enemy Fire

What is suppressed before casualty care is rendered.

Chest tube

What is the definitive treatment for a pneumothorax?

18 gauge 1.25 inch

What is the gauge and length of recommended needle for intravascular access?

10 or 14 gauge needle and catheter 3.25 inches in length

What is the gauge and length of the Needle chest decompression?

Upper right, lower right, upper left, lower left.

What is the loading sequence for four litter casualties?

Extremity hemmorhage control

What is the medical priority for the combat medic?

Fourth intercostal space or lower

What penetrating thoracic wound location should be considered both abdominal and thoracic?

24%

What percent of combat fatalities are survivable by early intervention with Combat Medic Tasks and rapid evacuation to a surgical facility?

Hemostatic agents

What should be strongly considered with wounds of the neck, axillary area and inguinal area, especially in the presence of life threatening bleeding?

60 mmHg

What systolic BP does a carotid pulse indicate?

70 mmHg

What systolic BP does a femoral pulse indicate?

80 mmHg

What systolic BP does a radial pulse indicate?

93 mmHg

What systolic blood pressure is high enough to dislodge any blood clots?

Medical personnel recieve injured or ill soldiers and continue as far rearwards as the casualties medical condition warrants or military situation requires.

When does the MEDEVAC begin and end?

Alveoli

Where 02 and CO2 exchange occurs

Ketamine and OTFC

Which drugs have the potential to worsen severe TBI?

Lines 1-5

Which lines must be transmitted first to allow evacuation to begin without delay

6 + 9

Which two lines of the 9 line change in wartime as compared to peacetime operations.

Most Imjured

Who are loaded last so that they will be the first to be offloaded?

Tactical Leader

Who is always in command and will decide if casualties will be evacuated?

Aeromedical evacuation personnel

Who supervises the loading of loading casualties on a fixed or rotary wing?

Extremities 60%

Wound Data - Remember these areas are not protected by body armor.

Longer than 6 hours

You can not loosen tourniquet if it has been in place for how long or death may occur.

Impending death

falling blood pressure is a sign of what?

1500 ml or more

when does decompensated shock begin regarding fluid loss volume?