Skills

TREAT A CASUALTY FOR A SNAKE BITE.

a. Exposed the injury site. b. Checked the patient for signs and symptoms of a poisonous snakebite. c. Initiated treatment. d. Recorded the treatment on DD Form 1380 (Tactical Combat Casualty Care (TCCC) card). e. Evacuated the patient. f. Did not cause further injury to the patient.

PERFORM AN HEENT EXAMINATION

a. Gathered equipment and supplies. b. Identified the patient. c. Performed a history and physical examination of the eyes. d. Performed a history and physical examination of the ears. e. Performed a history and physical examination of the nose and sinuses. f. Performed a history and physical examination of the throat. g. Documented findings on the appropriate form.

INITIATE AN INTRAOSSEOUS INFUSION (FAST1®) The lead Bradley infantry fighting vehicle traveling directiy in front of vour vehicle has been struck by an IED. After securing the immediate area, the patients are moved to safety. Following your initial assessment, you determine that you must establish peripheral intravenous access for one of the patients in order to initiate fluids. After two attempts at initiating a peripheral Intravenous (IV), you are unable to establish venous access. You must establish vascular access by a sternal intraosseous (first access for shock and trauma /FAST1®device; you have been provided the necessary medical equipment.

a. Assembled the necessary equipment. b. Spiked the IV bag and properly prepared the IV tubing. c. Took body substance isolation precautions. d. Located the suprasternal notch. e. Cleaned site with alcohol. f. Placed the target patch at landmark. g. Rechecked the location of the target patch. h. Placed the bone needle cluster into the target zone of the target patch; maintalned perpendicular aspect of the introducer to the manubrium. 1. Applied firm, increasing pressure along the axis of the introducer until a distinct release was felt and heard J. Gently removed the introducer by pulling straight back k. Connected the infusion tube to the right angle connector on the target patch. I. Connected the syringe and flushed the Infusion tube with 5 ml of sterile saline m. Connected the IV infusion tubing; opened IV line. n. Attached the protective dome to target patch and secured with tape, O. Documented treatment on DD Form 1380 [Tactical Combat Casualty Care (TCCCL Card

ADMINISTER OXYGEN While responding to an emergency call, you encounter a patient with difficulty breathing. You must administer oxygen to the patient with an appropriate delivery device; you have been provided the necessary medical equipment.

a. Assembled the regulator/flow meter to oxygen cylinder. b. Checked for leaks. c. Checked the oxygen cylinder pressure. d. Positioned the patient in a position of comfort, unless contraindicated. e. Determined the delivery device to use and applied. f. Checked the equipment for security of tubing connections, oxygen flow and humidified water level, as indicated. 9. Adjusted the oxygen flow rate to at least 12 to 15 liters per minute. h. Calculated the duration of flow of the oxygen cylinder.

MANAGE AN INTRAVENOUS INFUSION You are working in a patient hold area in a battalion aid station. You have a patient with an established intravenous (IV) in place. You must manage the IV infusion.

a. Assessed for signs and symptoms of IV therapy complications. b. Performed interventions for IV therapy complications. c. Documented the IV therapy. d. Replaced the solution container (only). e. Changed the dressing. f. Replaced the solution container and tubing. g. Discontinued the infusion. h. Documented the procedure on the appropriate medical form,

TRIAGE CASUALTIES Your squad is the first to arrive at the site of an improvised explosive device (IED) explosion where there are multiple patients. The area has been secured. You must triage the patients.

a. Assessed the situation. b. Assessed each patient. c. Established the order of treatment. d. Initiated treatment in the correct sequence e. Documented treatment on DD Form 1380 (Tactical Combat Casualty Care (TCCC) Card). f. Assigned medical evacuation categories. g. Prepared the medical evacuation request.

APPLY A LONG SPINE BOARD

a. Checked for signs and symptoms of a spinal injury. b. Placed the patient on a long spine board. c. Secured the patient to the long spine board. d. Documented treatment on DD Form 1380 [Tactical Combat Casualty Care (TCCC) Card). e. Evacuated the patient.

INITIATE A 9-LINE MEDEVAC REQUEST

a. Collected all applicable information needed for the MEDEVAC request. b. Recorded the gathered MEDEVAC information using authorized brevity codes. C. Transmitted the MEDEVAC request.

CONTROL BLEEDING You arrive on the scene of an improvised explosive device explosion. You notice two vehicles have been involved. One vehicle has rolled onto the passenger side. The driver has just helped his passenger out of the vehicle and you notice the passenger's left leg is covered with blood. The scene has been secured. You have been provided the necessary medical equipment.

a. Determined if bleeding was life threatening. If so, immediately applied a Combat Application Tourniquet®. b. If bleeding is not life threatening, applied direct pressure. C. Applied a pressure dressing or emergency bandage if wound continued to bleed. d. Applied a tourniquet if the wound continued to bleed. e. Applied a hemostatic dressing to pack wounds not amenable to tourniquet use (neck, inguinal, axillary). f. Initiated treatment for shock, as needed. g. Documented care on a DD Form 1380 [Tactical Combat Casualty Care (TCCC) Card). h. Evacuated the patient.

CLEAR AN UPPER AIRWAY OBSTRUCTION During dinner at the dinning facility, a fellow Soldier starts coughing and choking. You must clear his airway obstruction.

a. Determined if the patient needs assistance. b. If the patient is lying down, brought him to a sitting or standing position. c. Applied abdominal or chest thrusts. d. Took appropriate action if the patient becomes unconscious. Began cardiopulmonary resuscitation. e. When the object is dislodged, checked for breathing. Performed rescue breathing if necessary. f. Did not cause further injury to the patient.

PERFORM MANUAL EVACUATION You have multiple patients that have been stabilized and now require evacuation. Perform manual evacuation maneuvers.

a. Determined the appropriate extraction device or carry for the tactical situation. b. Communicated the plan to the patient. c. If necessary, tactically approached the patient. d. Properly attached the appropriate extraction device or secured the patient for manual carry. e. Extracted the patient to cover.

INITIATE TREATMENT FOR BURNS You have a patient with a lower extremity burn. Initiate treatment for the burn.

a. Determined the cause of the burn. b. Stopped the burning process. C. Performed either an Emergency Medical Technician trauma assessment or a Combat Casualty Assessment, depending on situation. d. Maintained an open airway, as necessary. e. Determined the percentage of body surface area (BSA) burned. f. Determined the degree of the burn. g. Treated for shock if patient has second or third degree burns greater than 20% BSA. h. Removed potentially constricting items. i. Dressed the burns. j. Recorded the treatment on DD Form 1380 [Tactical Combat Casualty Care (TCCC) Card). k. Evacuated the patient.

TREAT A CASUALTY FOR INSECT BITES AND STINGS

a. Exposed the injury site(s). b. Checked for signs and symptoms of insect bites and stings. c. Treated the insect bites or stings. d. possible, determined the type of insect bite or sting. Did not delay treatment for this step e. Recorded the treatment on DD Form 1380 [Tactical Combat Casualty Care (TCCC) cardl. f. Evacuated the patient, if necessary.

INITIATE A SALINE LOCK A patient in your care requires a saline lock to be initiated.

a. Gathered, inspected and prepared the equipment. b. Applied a constricting band. c. Donned gloves. d. Cleaned site. e. Held skin taut distal to the site of the venipuncture with non-dominant hand. f. Held needle at a 20 to 30 degree angle, bevel up, parallel to the vein over the venipuncture site. g. Pierced the skin and advanced the needle-catheter until blood is visualized in the flash chamber, h. Decreased the angle of the needle/catheter to 10 to 15 degrees and advanced % of an inch. i. Advanced the catheter until the hub touches the skin or significant resistance is felt. j. Released the constricting band with the nondominant hand. k. Occluded the vein with the nondominant hand. I. Removed the needle and placed it in a sharps container. m. Connected the saline lock into the catheter hub. n. Covered both the hub and saline lock with a transparent dressing or tape. o. Cleaned the saline lock and flushed the lock with 5cc of sterile saline. p. Documented treatment on DD Form 1380 [Tactical Combat Casualty Care (TCCC) Card).

INITIATE TREATMENT FOR CHEST PAIN While working in a battalion aid station, a civilian contractor arrives with a chief complaint of chest pain that started 30 minutes ago. You must initiate treatment for chest pain.

a. Identified signs and symptoms of possible cardiac emergency or compromise. b. Administered the appropriate treatment. c. Obtained baseline vital signs. d. Assisted the patient in taking their prescribed nitroglycerin, if available and in accordance with local protocol. e. Transported promptly to the next higher medical facility. f. Performed an ongoing assessment while en route. g. Documented all interventions on DD Form 1380 [Tactical Combat Casualty Care (TCCC) Card) or SF 600 (Medical Record - Chronological Record of Medical Care).

INITIATE AN INTRAVENOUSS INFUSION The lead Stryker infantry carrier vehicle traveling directly in front of your vehicle has been struck by an improvised explosive device. You determine that you must establish peripheral intravenous (IV) access to the patients in order to give fluids.

a. Identified the patient and explained the procedure (if conscious). b. Selected and inspected the equipment for defects, expiration date and contaminațion. c. Prepared the equipment. d. Selected the infusion site. e. Donned gloves. f. Prepared the infusion site. g. Punctured the vein. h. Confirmed the puncture. i. Advanced the catheter over needle. J. Removed the protective cover from the needle adapter on the tubing; connected the adapter to the catheter or the needle hub. k. Released the constricting band. I. Loosened the flow regulator and adjusted the flow rate. m. Checked the site for infiltration. n. Secured the IV site with a transparent dressing. 0. Readjusted flow rate, if needed. p. Labeled a piece of tape with date/time initiated catheter size, and their Initials; secured the tape to the IV tubing. q. Removed gloves and disposed of them appropriately. r. Documented the procedure on the appropriate medical form.

PERFORM VISUAL ACUITY TESTING

a. Identified the patient. b. Explained the procedure to the patient. c. Positioned the patient 20 feet away from the eye chart. d. Instructed the patient to leave his corrective lenses on, if worn, except for reading glasses. e. Covered one eye with an opaque card and instructed the patient to read the smallest line possible. f. Repeated the procedure with the other eye. g. Repeated the procedure with both eyes. h. If in a field environment, determined gross visual acuity. 1. Recorded the results of the visual acuity examination.

PERFORM AN EXAMINATION OF THE KNEE

a. Identified the patient. b. Obtained the patient history. C. Performed a physical examination of the knee. d. Documented the history and physical examination findings. e. Referred the patient to a medical officer for further examination, as needed.

TREAT A CASUALTY FOR A HEAT INJURY You have a patient displaying signs and symptoms of a heat injury. Treat the heat injury.

a. Identified the type of heat injury based on signs and symptoms. b. Provided treatment for the heat injury. c. Recorded the treatment for a heat injury.

INITIATE TREATMENT FOR AN AMPUTATION Your infantry squad has been assigned the task to patrol the outskirts of a village. To your front, a mortar round impacts near your squad's point man; you drag the Soldier behind cover and perform a casualty assessment. The patient is conscious and has a traumatic amputation of his left lower leg. You must treat the amputation.

a. If an obvious amputation exists, immediately applied a Combat Application Tourniquet®. b. Using a marker, made a "T" on the patient's forehead. C. Treated for shock. d. Cared for the amputated part. e. Dressed the stump. f. Recorded all treatment on the patient's DD Form 1380 [Tactical Combat Casualty Care (TCCC) Card). g. Evacuated the patlent.

SET UP AN OXYGEN TANK SCENARIO: While responding to an emergency call, you encounter a patient with difficulty breathing. You must assemble an oxygen system for the patient with an appropriate delivery device.

a. Obtained the necessary equipment. b. Secured the oxygen cylinder. c. Removed the cylinder valve cap. d. Used either the hand wheel or a non-sparking wrench to "crack" the cylinder to flush out debris. e. Attached the regulator/flow meter to the cylinder. f. Filled the humidifier bottle to the level indicated with sterile water. g. Attached the humidifier to the flow meter. h. Posted warning signs. Documented/reported completion of the procedure.

PREPARE A SKEDCO® FOR HOIST OPERATIONS

a. Opened the Cordura® backpack, removed the rolled SKED® stretcher, and placed it on the ground. b. Unrolled SKED® completely to the opposite end (head end) of the stretcher. c. Inserted horizontal lift slings. d. Slid the patient onto the SKEDO stretcher. e. Buckled the cross straps f. Buckled the foot straps. g. Prepared the head end for hoist operations. h. Inserted the large locking 'D' carabineer. i. Performed final safety checks.

INITIATE TREATMENT FOR ANAPHYLACTIC SHOCK You are a Soldier Medic performing sick call examinations. Your next patient is carried in by another NCO. He was stung by a bee and now is having difficulty breathing. Initiate treatment for anaphylactic shock on this patient

a. Opened the airway, if necessary. b. Administered high concentration oxygen, if available. C. Administered one 0.3mg epinephrine auto-Injector. Administered a second dose in 5 to 10 minutes as needed. d. Performed an emergency medical treatment history and physical examination of the patient. e. Checked the patient's vital signs every 3 to 5 minutes until patient was stable f. Recorded the treatment given on DD Form 1380 [Tactical Combat Casualty Care (TCCC) Card). g. Evacuated the patient. Continued to monitor the patient while en route to further care.

PERFORM A PATIENT ASSESSMENT(EMT-B): MEDICAL

a. Performed a Scene Size-up (1) Took body substance isolation precautions. (2) Determined if the scene is safe. (3) Determined the nature of the illness. (4) Determined the number of patients. (5) Requested additional assistance, if necessary. (6) Considered stabilization of the spine. b. Performed a Primary Assessment (1) Formed a general impression of the patient. (2) Determined responsiveness/assessed the patient's mental status. (3) Assessed the airway (look, listen, feel). (4) Assessed the breathing (rate, rhythm, quality). (5) Initiated appropriate oxygen therapy. (6) Assessed the skin (color, temperature, condition). (7) Assessed the pulse (rate, rhythm, strength). (8) Assessed for and controlled significant bleeding. (9) Treated the patient for shock (10) Determined the priority of the patient and transport decision. c. Performed a History and a Secondary Assessment (1) Obtained a SAMPLE History (2) Performed a focused physical exam. EVALUATOR: The Soldier Medic performs the focused physical exam by verbalizing the assessment of affected body part. (3) Obtained vital signs. d. Reassessment (1) Repeated the primary assessment. (2) Reassessed chief complaint. (3) Checked interventions. (4) Repeated vital signs. (5) Documented treatment on DD Form 1380 [Tactical Combat Casualty Care (TCCC) Card). Did not cause further injury to the patient.

On a patrol in Afghanistan you have a patient who has sustained a penetrating thoracic injury. Treat the open chest injury.

a. Performed a combat casualty assessment. b. Checked the patient for signs/symptoms of chest injuries. c. Checked for an exit wound if a penetrating thoracic wound is found. d. Determined the type of injury. e. Initiated treatment for the open chest injury. f. Recorded the treatment given on DD Form 1380 [Tactical Combat Casualty Care (TCCC) Card). g. Prepared the patient for evacuation.

INITIATE TREATMENT FORA HEAD INJURY On a patrol in Afghanistan, you have a patient who has sustained a penetrating head injury. Treat the open head injury.

a. Performed a combat casualty assessment. b. Checked the patient for signs/symptoms of head injuries. C. Directed manual stabilization of the patient's head. d. Assessed the patient's level of consciousness. e. Initiated treatment for the open head injury. f. Reassessed the patient every 5 minutes and documented all findings. g. Recorded the treatment given on DD Form 1380 [Tactical Combat Casualty Care (TCCC) Card). h. Prepared the patient for evacuation.

INITIATE TREATMENT FOR HYPOVOLEMIC SHOCK On a patrol in Afghanistan, you have a patient who has sustained multiple injuries and has lost a significant amount of blood. He has altered mental status and an absent radial pulse. Initiate treatment for hypovolemic shock.

a. Performed a combat casualty assessment. b. Controlled bleeding. c. Maintained an open airway. d. Initiated one 18 gauge intravenous catheter. e. Infused Hextend®. f. Treated for hypothermia. g. Monitored the patient. h. Recorded the treatment on DD Form 1380 Tactical Combat Casualty Care (TCCC) Card). I. Prepared the patient for evacuation.

INITIATE TREATMENT FOR FOREIGN BODIES OF THE EYE SCENARIO: A patient presents to the battalion aid station for pain in his right eye. He claims his eye hit a bush during a patrol. You must initiate treatment for ocular foreign body.

a. Performed visual acuity testing. b. Assessed the eyes: pupils equal and round, regular in size and react to light. c. Located the foreign body. d. Removed the foreign body, if superficial. e. Repeated visual acuity examination if foreign body is removed. f. Did not remove embedded or impaled foreign bodies. g. Obtained details about the injury. h. Recorded all treatment on the patient's DD Form 1380 (Tactical Combat Casualty Care (TCCC) Card). L Evacuated the patient.

While responding to an emergency call, you encounter a patient with a medical illness or trauma-related injury. During your assessment and management of this patient, you must obtain a baseline set of vital signs. You must demonstrate the techniques for measuring respirations.

a. Positioned the patient, seated or lying supine. b. Had the patient remove any overgarments that obstructed the ability to observe the patient's chest rise and fall with each breath. C. Observed the rise and fall of the patient's chest as they breathe. Each cycle of inhalation and exhalation eguates to one respiration. d. Counted the number of respirations (rate) in a 30-second period and multiplied times two. EVALUATOR: If the patient is demonstrating an irregular breathing pattern, the Soldier Medic must measure the number of respirations for a full 60 seconds. e. Evaluated the depth of the respirations (unlabored, shallow, labored). f. Evaluated the quality(character) of the respirations (normal, noisy, etc.). Documented the respiration rate, depth, and quality and the time obtained on the appropriate medical form. h. Reported any abnormal respirations.

MEASURE A PATIENT'S PULSE

a. Positioned the patient, seated or lying supine. b. Palpated the pulse point. C. Counted the radial pulse for 30 seconds and multiplied times two. If the patient is demonstrating a weak or irregular pulse, the Soldier Medic must measure the pulse for a full 60 seconds. d. Evaluated the pulse rhythm (regular, irregular). e. Evaluated the pulse strength (strong, bounding, weak). f. Documented the pulse rate, rhythm, and strength and the time obtained on the appropriate medical form.

SCENARIO: On a patrol in Afghanistan you have a patient who has sustained an open abdominal injury. Treat the open abdominal injury.

a. Positioned the patient. b. Initiated treatment for shock. c. Exposed the wound. d. Stabilized any protruding objects. e. Applied a sterile abdominal dressing moistened with normal saline. f. Did not cause further injury to the patient. g. Prepared the patient for evacuation. h. Recorded the treatment given on DD Form 1380 [Tactical Combat Casualty Care (TCCC) Card).

On a patrol in Afghanistan you have a Soldier complaining of weakness, dizziness and headache. You have completed a combat ca Initiate treatment for altitude illness,

a. Recognized the signs and symptoms of altitude illness. b. Initiated prophylactic measures to prevent high altitude illness. c. Manage high altitude illness. d. Recorded the altitude illness treatment on the patient's DD Form 1380 (Tactical Combat Casualty Care (TCCC) card].

MEASURE A PATIENT'S PULSE OXYGEN SATURATION While responding to an emergency call, you encounter a patient with a medical illness or trauma-related injury. During your assessment and management of this patient, you must obtain a pulse oxygen saturation. You must demonstrate the techniques and procedures for measuring pulse oxygen saturation.

a. Took body substance isolation precautions. b. Wiped the selected site and ensured it was clean and dry. C. Applied the sensing probe. d. Attached the sensing probe cable to the monitor and turned it on. e. Notified the medical officer of abnormal findings. f. Documented the pulse oximeter reading, location of the device, and time taken. g. Removed the device unless continuous monitoring is required.

DOCUMENT MEDICAL CARE: SOAP NOTE FORMAT While working at the forward operating base aid station, you breathing and chest pain. He says he fell down a flight of steps and his chest hurts. His airway is open and he is too short of breath to speak in full encounter a conscious 66 vear old male contractor relating a chief complaint of difficulty sentences. His respirations are 22, rapid and shallow. He has a radial pulse of 130 and his blood pressure is 90 over 60. There are bruises on his ri cage. Using the SOAP Note format, record the appropriate information.

a. Recorded the patient's name and rank, and the date and time. b. Wrote the subjective (S) data as related by the patient. (Included history applicable to the chief complainant.) c. Wrote the objective (0) data. (Included a physical examination relevant to the chief complainant) d. Wrote assessment (A) data. e. Wrote the plan (P). f. Corrected recording errors, if applicable. g. Finished the entry with signature, printed name, rank, and title.

INITIATE A TACTICAL COMBAT CASUALTY CARE CARD

a. Removed the Tactical Combat Casualty Care (TC3) card from the patient's individual first aid kit. b. Completed all areas on the card. c. Attached the TC3 card to the patient's belt loop or inserted it in a cargo pocket. d. Did not attach the TC3 card to the patient's body armor.

PREPARE AN INJECTION FOR ADMINISTRATION SCENARIO: You are working in a battalion aid station. A patient requires a medication to be injected. You must prepare the injection for administration.

a. Selected an appropriate needle. b. Selected an appropriate syringe. c. Inspected the needle and syringe packaging for defects. d. Unpacked the syringe. e. Inspected the syringe. f. Unpacked the needle. g. Attached the needle to the syringe. h. Inspected the needle. i. Placed the assembled needle and syringe on the work surface. j. Verified the drug label and checked for defects. k. Prepared and drew the medication. I. Checked the syringe for air bubbles. m. Reverified the correct dosage. n. Covered the needle with the protective cover utilizing the scoop method. o. Did not violate aseptic technique.

INSERT A KING LT® On a humanitarian medical mission, one of the civillian contractors has suffered a cardiac arrest. He is pulseless and apneic. You must establish and maintain an airway using a King LTO.

a. Took body substance isolation precautions. b. Assessed the upper airway for visible obstruction. c. Directed assistant to pre-oxygenate the patient. d. Inspected and tested equipment. e. Lubricated distal end of tube. 1. Performed a tongue-jaw lift with nondominate hand. 9. Inserted the King LTO until the base connector is aligned with the patient's teeth. h. Inflated the cuffs with the appropriate amount of air based on the size of the tube. 1. Confirmed proper placement by auscultation and chest movement. |. Assessed patient for spontaneous respirations, if any, for 10 seconds. k. Attached pulse oximeter to patient, if available. I Directed the assistant to ventilate the patient with a Bag-Valve Mask when respirations are less than 8 or more then 30 or a pulse oximeter reading less than 90%. m. Secured the King LTO to the patient using tape. n. Documented the procedure on the appropriate medical form.

SCENARIO: While responding to an emergency call, you encounter a patient up an automated external defibrillator (AED), attach the defibrillator pads, initiate rhythm analysis, and, as appropriate, administer shocks to the patient to patient collapsed about 5 minutes ago; Cardiopulmonary resuscitation (CPR) was initiated immedlately. As your assistant takes over CPR, you must set demonstrating the clinical signs of cardiac arrest. According to the combat lifesaver, the restore an effective cardiac rhythm.

a. Took body substance isolation precautions. b. Briefly questioned the combat lifesaver about the arrest events. c. Directed rescuer to stop CPR to verify pulselessness and apnea. d. Directed the assistant to resume CPR. e. Turned on the AED. f. Attached the defibrillator pads to the chest. g. Directed the assistant to stop CPR and stated "clear the patient". h. Initiated analysis of the rhythm. I. If shock is indicated by the AED, stated "clear the patient" again. j. Delivered shock. k. Directed resumption of CPR. L. Confirmed effectiveness of CPR. m. Inserted an oropharyngeal or nasopharyngeal airway. n. Directed the assistant to resume CPR. O. Re-evaluated patient/CPR in 2 minutes. p. Reanalyzed the rhythm. q. Repeated steps i through k. r. Documented treatment on DD Form 1380 (Tactical Combat Casualty Care (TCCC) Card).

APPLY A TRACTION SPLINT While providing medical coverage for a drop zone in an airborne operation you hear the call for a medic to attend an injured Soldier. As you perform your Initial and rapid trauma assessment, the patient is conscious and complaining of severe pain in their mid-thigh, left leg. You detect moderate swelling and elicit crepitus of the left thigh. You determine the patient's sole injury is a closed fracture to the left femur. You must apply a traction splint to the patient's left leg: you have been provided the necessary medical equipment.

a. Took body substance isolation precautions. b. Exposed the injury by cutting away the patient's clothing. C. Assessed the patient's pulse, motor, sensory (PMS). d. Directed an assistant to manually support and stabilize the injured leg. e. Placed the traction splint beside the patient's uninjured leg and adjusted the splint to the proper length. f. Fastened the ankle hitch about the patient's ankle and foot. g. While supporting the leg at the site of the suspected injury (one hand above the site and one hand below the site), directed the assistant to manually apply gentle in-line traction to the ankle hitch and foot. h. Slid the splint Into position under the injured leg. Padded the groin area and fastened the ischial strap. Applied mechanical traction. k. Secured the Velcro straps. L. Reevaluated the ischial strap and ankle hitch. m. Reassessed the PMS. n. Documented treatment on DD Form 1380 [Tactical Combat Casualty Care (TCCC) Card).

APPLY A HEMOSTATIC DRESSING Your squad is moving through a built-up area when a sniper opens up on the rear guard striking him in the leg. Once the sniper has been eliminated, you move back to the patient's position. He appears alert and is screaming in pain. The squad automatic weapon gunner is applying direct pressure to a large gunshot wound in the patient's upper thigh. You determine that this type of bleeding is best controlled by a hemostatic agent. You must apply a hemostatic dressing to control the hemorrhage.

a. Took body substance isolation precautions. b. Exposed the injury by cutting away the patient's clothing. c. Opened the sterile package and removed the dressing without contaminating the cream-colored portion. d. Placed the cream-colored sponge portion of the dressing directly onto the wound and packed the wound where the bleeding is the heaviest. e. Held pressure on the dressing for 3 minutes or until the dressing adhered to the wound and bleeding stopped. f. Applied a pressure dressing over the hemostatic dressing to secure it in place. g. Documented treatment on DD Form 1380 (Tactical Combat Casualty Care (TCCC) Card].

APPLY A PRESSURE DRESSING TO AN OPEN WWOUND An infantryman moving through a built-up area has the point on your patrol. An artillery round impacts approximately 25 meters from where he is standing. Once counter-battery fire is initiated, you move forward to his position, The patient is alert and oriented, and has significant bleeding coming from his left forearm. Following your initial and rapid trauma assessment you determine that this is his only significant injury. You must apply a pressure dressing to the open wound.

a. Took body substance isolation precautions. b. Exposed the injury by cutting away the patient's clothing. c. Packed the wound with Kerlix or Combat Gauze® (if Combat Gauze® is used, verbalized holding pressure for 3 minutes.) d. Applied the emergency bandage to the extremity; applied the white portion directly over the wound. e. Wrapped the elastic portion of the emergency bandage around the extremity, and inserted the elastic wrap completely into the pressure bar. f. Pulled the emergency bandage tight and reversed it back over the top of the pressure bar forcing the bar down onto the wound pad. g. Continued to wrap the elastic bandage tightly over the pressure bar and wound pad; ensuring the edges of the wound pad were completely covered. h. Secured the hooking ends of the closure bar onto the last wrap of the bandage. I. Evaluated pulse, motor, sensory distal to injury. Secured the bandage with tape. k. Documented the treatment on the appropriate medical form.

APPLY AN OCCLUSIVE DRESSING While responding to an emergency call, you encounter a patient with penetrating chest trauma. You must apply an occlusive dressing.

a. Took body substance isolation precautions. b. Exposed the injury. c. Covered the injury (on patient expiration) with large occlusive material dressing (either a commercial chest seal or improvised); covering the first wound encountered. d. Ensured material extends 2 inches beyond the edge of the injury. If using improvised dressing, taped all four sides of the material down. e. Log rolled the patient or had the patient sit up and examined the back for an exit wound. f. Covered the exit wound on expiration, if present with a large occlusive dressing. g. Placed the patient in a sitting position or with his injured sided down in the recovery position. h. Continued assessment of the patient for signs of progressive respiratory distress.

APPLY A COMBAT APPLICATION TOURNIQUET® Your infantry squad has been assigned the task to patrol the outskirts of a village. To your front, a mortar round impacts near your squad's point man; you drag the Soldier behind cover and perform your initial assessment. The patient is conscious and has a severe mutilating injury of his left lower leg. You must apply a combat application tourniquet (C-A-T) to control the bleeding.

a. Took body substance isolation precautions. b. Exposed the wound by cutting away the patient's clothing. c. Removed the C-A-T® from the patient's individual first aid kit. d. Placed the C-A-TO 2 to 3 inches above the wound around the injured extremity. e. Pulled the free end of the self-adhering band through the buckle and routed it through the friction adapter buckle. It is not necessary to route through the friction adapter on an arm wound. f. Pulled the self-adhering band tight around the extremity and fastened it back on itself as tightly as possible. g. Twisted the windlass until bleeding stopped. This should occur in three rotations of the windlass. h. Locked the windlass in place with the windlass clip. i. Secured the windlass in the windlass strap. J. Assessed for absence of a distal pulse. k. Placed a "T" and the time of application on the patient. I. Secured the C-A-TO in place with tape. m. Documented treatment on DD Form 1380 (Tactical Combat Casualty Care (TCCC) Card).

INITIATE TREATMENT FOR NECK WOUNDS SCENARIO: While out on patrol, an infantry Soldier sustains a gunshot wound to the neck, You must control the bleeding to the neck wound.

a. Took body substance isolation precautions. b. Exposed the wound, checked for exit wound. C. Packed the wound with Combat Gauze® and held pressure for 3 minutes. d. Placed elastic bandage over dressing leaving a tail. e. Wrapped elastic bandage under opposite arm. f. Continued to wrap around neck and under arm pulling elastic bandage tight for pressure, covering the entire dressing. g. Secured dressing by tying a nonslip knot with end of elastic bandage and tail. h. Secured elastic bandage tail and knot with 2-inch tape wrapping a minimum of 1 to 1% times around tail and knot. i. Swathed arm to torso. J. Continued to assess wound for further bleeding. k. Documented procedure on DD Form 1380 [Tactical Combat Casualty Care (TCCC Card).

INITIATE TREATMENT FOR AXILLARY WOUNDS SCENARIO: While out on patrol, an infantry Soldier sustains a gunshot wound to the axilla. You must control the bleeding to the axillary wound.

a. Took body substance isolation precautions. b. Exposed the wound. C. Packed the wound with Combat Gauze®. Held pressure for 3 minutes. d. Placed 6-inch elastic bandage over shoulder, leaving a tail posterior. With the remainder of the elastic bandage completely covered packing material, wrapping in an anterior direction. e. Wrapped around injured shoulder twice ensuring to pull elastic bandage taut over covered packing material, f. Wrapped across back anchoring on opposite shoulder in a 'figure 8' pattern, while maintaining tension. g. Tied tails together with a nonslip knot h. Secured elastic bandage tails and knot with 2-inch tape wrapping a minimum of 1 to 1 % times around tail and knot. i. Swathed arm to torso to apply additional pressure to the wound. į Continued to assess wound for further bleeding. k. Documented procedure on DD Form 1380 [Tactical Combat Casualty Care (TCCC) Card).

INITIATE TREATMENT FOR INGUINAL WOUNDS SCENARIO: On a patrol in Afghanistan, you have a patient who has sustained a penetrating inguinal wound, not amenable to tourniquet. Treat the inguinal wound.

a. Took body substance isolation precautions. b. Exposed the wound. Checked for an exit wound. C. Packed the wound with Combat Gauze. Held pressure for 3 minutes. d. Placed tail of cravat under posterior belt on injured side and fan open cravat. e. Wrapped cravat from posterior to anterior completely covering packing along the contour of the groin. f. Tied nonslip knot to other tail of the cravat. g. Secured tails and knot with 3-inch tape 1-1/2 times around the whole cravat. h. Swathed legs together to provide additional pressure to the wound. I. Continued to assess wound for further bleeding Recorded the treatment given on DD Form 1380 (Tactical Combat Casualty Care (TCCC) Card].

While out on patrol, an infantryman is hit by an improvised explosive device explosion, He has a penetrating wound in his leg with a large impaled object sticking out. Initiate treatment for the impaled object.

a. Took body substance isolation precautions. b. Exposed the wound. c. Controlled the bleeding. d. Immobilized the impaled object. e. Applied the support bandages. f. Immobilized the affected area with a splint or sling, if applicable. g. Checked for a distal pulse to the injury site. h. Recorded the treatment given on DD Form 1380 [Tactical Combat Casualty Care (TCCC) Card]. i. Evacuated the patient.

PERFORM A SURGICAL CRICOTHYROIDOTOMY

a. Took body substance isolation precautions. b. Identified the cricothyroid membrane between the cricoid and thyroid cartilages. c. Cleaned the site with alcohol. d. Stabilized the larynx with nondominant hand. e. Made a 1 % inch vertical incision through the skin over the cricothyroid membrane. 1. Maintained the opening of the skin incision by pulling the skin taut with fingers of the nondominant hand. 9. Inserted the end of the endotracheal tube into the trachea and directed it towards the lungs % inch beyond the cuff. h. Inflated the cuff with 10 ml of air. I. Assessed patient for spontaneous respirations (must count for 10 seconds). J. Applied pulse oximeter to patient, if available. k. Auscultated lung fields and watched for rise and fall of the chest, to confirm tube placement. I. Applied a dressing around the tube. m. Secured the device to the patient around the patient's neck. n. Documented treatment on DD Form 1380 (Tactical Combat Casualty Care (TCCC) Card).

PERFORM A NEEDLE CHEST DECOMPRESSION

a. Took body substance isolation precautions. b. Located the second intercostal space on the anterior chest wall at the midclavicular line on the same side as the injury; approximately in line with the nipple. c. Thoroughly cleansed a 3 to 4 inch area around the insertion site. d. Inserted a 3 -inch, 14-gauge needle over the top of the rib at a 90-degree angle to the chest wall, to the hub e. Removed the needle, leaving the catheter in place. Placed the needle in a sharps container. f. Stabilized the catheter hub to the chest with adhesive tape. g. Placed the patient in a sitting position or in the recovery position with the injured side down. h. Documented treatment on DD Form 1380 [Tactical Combat Casualty Care (TCCC) Card). I. Did not cause further injury to the patient.

MANAGE A SEIZING PATIENT

a. Took body substance isolation precautions. b. Maintained the airway. c. Placed the patient on his side, if possible. d. Prevented injury to the patient by removing objects with which the patient may hurt himself. e. Administered oxygen via non-rebreather, if available. f. Recorded the seizure activity. g. Evacuated the patient on his side, in the recovery position. h. Did not cause further injury to the patient.

VENTILATE A PATIENT WITH A BAG-VALVE-MASK (BVM) While responding to an emergency call, you encounter a patient that is not breathing. You must ventilate the patient using a BVM device.

a. Took body substance isolation precautions. b. Positioned self at the top of the patient's head. c. Opened the patient's airway using a head-tilt, chin-lift or jaw-thrust maneuver. d. Inserted an appropriate airway adjunct (oropharyngeal or nasopharyngeal). e. Assembled the BVM system, selected the correct mask size, and applied mask to the patient's face with one hand. f. Performed "E.C." technique for holding mask in place over the patient's mouth. g. Ventilated the patient using the one hand method. h. Documented the procedure on the appropriate medical form.

PERFORM ORAL SUCTIONING While responding to an emergency call, you encounter a patient with altered level of consciousness and gurgling sounds coming from their airway. You must suction the patient's oropharynx to establish a clear airway.

a. Took body substance isolation precautions. b. Positioned the conscious patient in a semi-Fowler's position, or in the case of trauma, rolled the patient onto his side. c. Turned on/prepared suction unit. d. Selected the appropriate size catheter. e. Pre-oxygenated the patient, if oxygen is available. t. Suctioned the patient. Did not apply suction for more than 15 seconds at one time (adult). 9. Re-oxygenated the patient, if oxygen is available. h. Documented the procedure on the appropriate medical form.

INSERT A NASOPHARYNGEAL AIRWAY While responding to an emergency call, you encounter a patient with an altered level of consciousness, but has an active gag reflex. An airway must be established immediately. You must insert a nasopharyngeal airway.

a. Took body substance isolation precautions. b. Positioned the patient. c. Measured and selected the appropriate size of nasopharyngeal airway. d. Lubricated the nasopharyngeal airway. e. Fully inserted the nasopharyngeal airway. f. Placed the patient in the recovery position. 1. Documented treatment on DD Form 1380 [Tactical Combat Casualty Care (TCCC) Card]. h. Did not cause further injury to the patient.

INITIATE TREATMENT FOR A DIABETIC EMERGENCY You are working in a battalion aid station in Iraq. One of the civilian contractors comes in and states that he is a diabetic and doesn't feel well. You must assess and manage this patient.

a. Took body substance isolation precautions. b. Recognized the signs and symptoms of a diabetic emergency. C. Administered the appropriate treatment. d. Documented the treatment given. e. Did not cause further injury to the patient.

INSERT AN OROPHARYNGEAL AIRWAY While responding to an emergency call, you encounter an apneic patient. An airway must be established immediately. You must insert an oropharyngeal airway

a. Took body substance isolation precautions. b. Selected the appropriate size oropharyngeal airway. c. Performed the head-tilt/chin-lift or jaw thrust maneuver. d. Opened the patient's mouth using the scissors technique,. e. Inserted the oropharyngeal airway. f. Documented treatment on DD Form 1380 (Tactical Combat Casualty Care (TCCC) Card). g. Evacuated the patient. h. Did not cause further injury to the patient.

ADMINISTERA SUBCUTANEOUS INJECTION

a. Verified the required injection with the medical officer's order. b. Identified the patient by asking his name and date of birth. C. Asked the patient if he has any allergies or has experienced a drug reaction. d. Verified that the appropriate needle, syringe and medication are being used. e. Selected and exposed the injection site. f. Positioned the patient. g. Cleaned the injection site. h. Pulled the needle cover off without bending or touching the needle. i. Prepared the skin for the injection. J. Inserted the needle. k. Released the hold on the skin. I. Aspirated syringe to ensure medication will not go into a blood vessel. m. Administered the medication. n. Monitored the patient for any adverse reactions. 0. Discarded all equipment in accordance with standard precautions or SOP guidelines. p. Documented the procedure on the appropriate form.

ADMINISTER AN INTRAMUSCULAR INJECTION

a. Verified the required injection with the medical officer's order. b. Identified the patient by asking his name and date of birth. C. Asked the patient if he has any allergies or has experienced a drug reaction. d. Verified that the appropriate needle, syringe and medication are being used. e. Selected and exposed the injection site. f. Positioned the patient. g. Cleaned the injection site. h. Pulled the needle cover off without bending or touching the needle. i. Prepared the skin for the injection. j. Inserted the needle. k. Released the hold on the skin. I. Aspirated syringe to ensure medication will not go into a blood vessel. m. Administered the medication. n. Monitored the patient for any adverse reactions. o. Discarded all equipment in accordance with standard precautions or SOP guidelines. p. Documented the procedure on the appropriate form.