68W Field Craft 1 Study Guide
When requesting a MEDEVAC, with what opening statement should you begin your transmission?
"I have a MEDEVAC request, over"
What analgesic can you give to a patient in mild to moderate pain?
(Combat Pill Pack) -Acetaminophen (Tylenol); 2 Bilayer caplets @ 650 mg each -Mobic; 1 tablet
What are anchor points and where are they?
(Points to wrap joints) Neck= Under Axilla opposite of the wound Axillary= Over opposite shoulder against the neck Inguinal = Thigh, Butt, or belt
What analgesic can you give to a casualty that is not in shock or respiratory distress and causality is not at significant risk of developing either condition?
- OTFC (Oral transmucosal fentanyl citrate) (Fentanyl) 800 ug (micrograms) on a lozenge
What are significant sources of non-compressible hemorrhage?
-Heart -Lungs -Subclavian vessels -Intercostal vessels
How much can a casualty bleed into each thigh?
1 liter= 1 thigh
What are the contraindications for an NPA?
1.) Basilar skull fracture 2.) Maxillofacial trauma 3.) Exposed brain matter 4.) CSF draining from nose, mouth, or ears
What are the four traits of a MEDEVAC?
1.) Collecting Wounded 2.) Triage 3.) Transportation 4.) Preforming Interventions
What are the goals of TC3
1.) Complete the mission 2.) prevent additional casualties 3.) treat the casualty
What are the three different manual carries you can preform to move a casualty and what is the distance range for each?
1.) Drag: <50 Meters 2.) Pack-Strap Carry: 50-300 Meters 3.) Two-Man Fore-and-Aft Carry: 300+ Meters
When would you provide CPR in a combat environment?
1.) Hypothermia 2.) Near Drowning 3.) Electrocution 4.) Was alive and lost vitals while en route to MTF
When should you not loosen a tourniquet?
1.) If casualty will arrive at surgical facility in <2 Hours 2.) It has been on for 6+ hours 3.) Amputation 4.) In profound shock
When would you consider spinal precautions for a combat causality?
1.) MVA 2.) 15+ foot falls 3.) IED blast involving a MRAP (Mine-Resistant Ambush Protected) vehicle
What are the complications of using a NPA?
1.) Nosebleed (which is okay for NPA) 2.) Can trigger Gag reflex (if left in too long)
What are complications of suction?
1.) Possible hypoxia 2.) Cardiac dysrhythmia (from hypoxia) 3.) Vagal nerve stimulation may lead to bradycardia and hypotension
What are the advantages to using a SKED litter?
1.) Reduces surface area on ground 2.) Helicopter Prefrence
What are the indications for an emergency cric?
1.) Severe maxillofacial trauma 2.) Airway obstruction 3.) Deformity 4.) Inhalation burns 5.) Unconscious casualty who cannot maintain airway
What are the two themes of rescue and what do each entail?
1.) Simple (no obstacles) 2.) Complex (obstacles)
What are the three most common devices used by the hoist on a UH-60 to extricate casualties?
1.) Stokes Basket 2.) Jungle Penetrator (JP) 3.) SKED
What are the indications for an NPA?
1.) Unconscious casualty with spontaneous respirations and no respiratory distress 2.) Unconscious casualty without airway obstruction 3.) Altered mental status with intact gag reflex
What are the four categories of patient precedence and their time requirements?
1.) Urgent/ Urgent-Surgical- 1 Hour 2.) Priority- 4 Hours 3.) Routine- 24 Hours 4.) Convenience- Convenience
What are the disadvantages/ complications to an emergency cric?
1.) Will always bleed (but will soon stop with gentle pressure) 2.) Tube could be misplaced
When may tourniquets be converted to other hemorrhage control?
1.) Wound has been assessed 2.) The tactical situation allows and 3.) There is enough time to do so
What % of head/neck injuries require immobilization?
1.4%
How much can a casualty bleed into the abdomen?
10 liters of blood and IV
How much can a casualty bleed into each side of the chest?
1500 ml (each side)
What % of combat fatalities are survivable by early intervention and transportation to a hospital?
24.3%
What is the load configuration for a MaxPro MRAP?
2L or 3A
What is the load configuration for a HAGA MRAP?
3L or 6A
What is the load configuration for an Armored Medical Evacuation Vehicle?
4L and 8A
What is the load configuration for a M113?
4L or 10A
What is the load configuration for a M1133 Stryker?
4L or 6A ("Bowling "Stryke")
What is the load configuration for a M997
4L or 8A
What two lines change depending on if it is wartime or peacetime?
6 + 9
At what temperature can blood no longer clot?
<93 degrees F
What temperature is Hypothermia?
<95 degrees F
What is a Substantial/ Anchor?
?
What are the brevity codes for Line 4?
A= None B= Hoist C= Extraction Equipment D= Ventilator
What are the brevity codes for Line 7?
A= Panels B= Pyrotechnic Signal C= Smoke Signal D= None E= Other
What are the brevity codes for Line 8?
A= US Military B= US Civilian C= Non-US, Military D= Non- US, Civilian E= EPW
What are the brevity codes for Line 3?
A= Urgent B= Urgent-Surg C= Priority D= Routine E= Convenience
Who supervises the loading of casualties onto an aeromedical vehicle?
Aeromedical Evacuation Personnel
Where does the exchange of CO2 and O2 occur in the lungs?
Alveoli
What is a deliberate tourniquet?
Applied directly to skin 2-3 inches proximal to wound
What is a non-compressible hemorrhage?
Bleeding that cannot be compressed w/ direct pressure, wound packing, or pressure dressing (Chest, Abs, and Pelvis)
What are hemostatic agents? What is the hemostatic dressing of choice in accordance with TC3?
Blood clotting Combat Gauze
Thoracic Injuries may be the result of _______ trauma or ________ trauma.
Blunt Penetrating
What is a tertiary blast injury?
Blunt trauma from being thrown in an explosion
Give examples of vehicles that can be used for CASEVAC
Bradley, Cargo Truck, LMTV, etc.
What are the three stage of TC3 and care rendered at each?
CUF, TFC, and TACEVAC
What is compressible hemorrhage?
Can be compressed w/ tourniquet, direct pressure, packing, or pressure dressing
What is Care Under Fire? What are your treatment options?
Caring under enemy fire. Use a High and Tight tourniquet. Use IFAK/ JFAK
What are primary blast injuries and what type of injuries would you expect to find?
Caused by blast pressure. (Most effective in a closed environment). Damage to Hallow Organs -Blast Lung: Pulmonary Hemorrhage w/ Hypoxia -Ruptured Colon: Hemorrhage w/ fecal contamination -Stomach: Gastric Hemorrhage w/ shock - Ear Drums: Tympanic membrane rupture
How does the clotting process work?
Chemical reactions in which clotting factors are activated and a fibrin net is formed over the injury of the vessel.
What is a secondary blast injury?
Collateral damage from projectiles/ shrapnel
How do tourniquets work?
Compress the tissue around a vessel
If you are treating a casualty with an airway problem, how would you position your casualty?
Either 1.) Sitting Upright 2.) Tripod 3.) Recovery
What is the preferred advanced airway in the combat environment?
Emergency Surgical Cricothyroidotomy
What is the single most significant obstacle to the combat medic's ability to provide care?
Enemy fire
How should a casualty be carried on a litter? When should you not?
Feet first. Unless when going uphill.
What do WBC do?
Fight infection, Consume dead tissue, and produce antibodies
What lines must be transmitted to initiate a MEDEVAC? How much time do you have to transmit them?
First 5 lines in 25 seconds.
What are s/s of non-compressible hemorrhage?
Guarding Rebounding tenderness Ecchymosis (Bruising) Hemoptysis (Coughing blood) Rectal Bleeding Hematemesis (Bloody vomit)
What is the only medical intervention preformed during CUF?
Hasty Tourniquet
How do you open the airway of an unconscious casualty?
Head Tilt/ Chin Lift
How should casualties be loaded onto ground ambulances? Why?
Head first 1.) Less likely to experience nausea 2.) Experience less noise 3.) Less danger of further injury in a rear collision
What is the leading cause of preventable death on the battlefield?
Hemorrhage
How does Blood Pressure disrupt coagulation?
High blood pressure causes faster bleeding
What analgesic can you give to a casualty who is in hemorrhagic shock or respiratory distress OR is at risk of those?
Ketamine -50 mg IM/IN (check every 30 minutes) -20 mg IV (check every 20 minutes)
What two analgesics have the potential to worsen severe TBI (Traumatic brain injury)?
Ketamine and OTFC (Do NOT use these for eye injuries)
What are the brevity codes for Line 5?
L#= Number by Litter A#= Number by Sitting
How does Acidosis disrupt coagulation?
Lactic build up causes shock
What must a rescuer do to gain leverage when moving a causility?
Lean forward
When moving a casualty, what muscles should you use primarily in order to avoid injury?
Leg Muscles
When does the MEDEVAC begin?
MEDEVAC begins when medical personnel receive injured
Alternative option to OTFC
Morphine 5 mg w/ 5cc of solution IV/IO Check every 10 minutes (can repeat same dose)
What are the brevity codes for Line 6?
N= No enemy troops in area P= Possible enemy troops in area X= Enemy troops in area
What are the brevity codes for Line 9?
N= Nuclear B= Biological C= Chemical
Why do we use NPAs rather than OPAs in the combat environment?
NPAs are better tolerated and less likely to dislodge
Once you begin providing medical care for a casualty, will you remain with that casualty until he reaches a MTF?
No
For how long do you suction a patients airway?
No longer than 15 seconds
What is Tactical Field Care? What are your treatment options?
No longer under fire. Use Aid bag and WALK bag
Difference between CASEVAC and MEDEVAC?
Non Medical Vehicle and a Medical Vehicle
When should you begin to treat the causality for hypothermia
Once exposed
What are the four "P"s of wound packing?
Peel, Push, Pile, Pressure
What are thrombocytes and what are their function?
Platelets; they stick to the fibrin net to form clots over damaged vessels
What does battlefield documentation do?
Provide a written record of assessment findings and treatments
Why would you convert a tourniquet?
Reduces unnecessary damage to an extremity
What can happen if you release a tourniquet that has been in place longer than 6 hours?
Releases acidic blood into the heart
How does Hypothermia disrupt coagulation?
Slows chemical reactions
How are casualties loaded into ground ambulances? UH-60 Blackhawk?
So that their head is forward
How do Medications disrupt coagulation?
Some medications prevent clotting (Asprin, Ibrofen, Naproxen)
Why should you not touch the hoist cable/ hook before it touches the ground?
Static Electricity
What is DD1380?
TC3 Card
What are the standard and non-standard methods of documentation?
TC3 Card/ Sharpie on Forehead/ Tape
Who is responsible for getting a casualty to the MEDEVAC site?
Tactical Commander
Who determines if a MEDEVAC is to be requested?
Tactical Leader
What is the first priority in CUF?
Take cover and return fire
Other than a casualty's name and battle roaster number, who's name and last four need to be on the DD1380?
The Person who fills it out
How are casualties loaded onto a UH-60 Blackhawk?
Three options (aka "577") 4L and 1A 6L and 1A 7A
What do you do if after applying a deliberate tourniquet the distal pulse is still present?
Tighten it harder. If that doesn't work, add another directly beside it.
What must you consider doing to a tourniquet after you administer fluids to a casualty?
Tightening it (because of increase in Blood Pressure)
What is TXA, when must you give it to a casualty and how do you administer?
Tranexamic Acid Prevents breakdown of clots Best for internal bleeding 1 gm in 100 cc of IV solution
What is the first step in circulation?
Treat any other significant non-pulsatile hemorrhage
When would you use a SAM Junctional Tourniquet?
Treat bleeding that a CAT tourniquet cannot
What is the loading sequence for four litter casualties?
UR, LR, UL, and LL (Like the letter "N")
What is a WALK and what can you find in it?
Warrior Aid and Litter Kit -Talon Litter -Extra Supplies/ Fluids
What is plasma and what is it's function?
Watery fluid w/ proteins, platelets, and minerals
What is Tactical Evacuation Care?
When Pt is picked up
What is coagulation?
blood clotting
What is the Triad of Death?
hypothermia, acidosis, coagulopathy
Where is the cricothyroid membrane?
it is located below the thyroid cartilage and above the cricoid cartilage
How does Hemodilution disrupt coagulation?
too much fluid, not enough blood