Fieldcraft 3
treatment for heat injuries
-*first* remove the casualty from the environment. -Other Treatments include: Stretching of cramping muscles. Rapid, active cooling. -fluids
risk factors for heat and cold injuries
-Age & Predisposing medical conditions -medications (Peripheral vasodilators, Diuretics, Nicotine, Antihistamines) -fatigue -general health condition -lack of acclimatization
medics role in disposition of the dead
-Medical units handle remains of its own unit members or of casualties who are dead on arrival (DOA) or who died of wounds (DOW) while in their care -When necessary a medical unit may have to establish a temporary morgue
describe the expectant triage category
-SO critically injured that only complicated and prolonged treatment offers any hope of improving life expectancy. -should be separated from the view of other casualties -should not be abandoned ex. -Unresponsive casualties with penetrating head wounds and signs of impending death -Burns, mostly third degree, covering more than 85% of TBSA -Transcranial gunshot wound (GSW) -Open pelvic injury with uncontrolled bleeding (shock with decreased mental status)
what is a Wet Bulb Globe Thermometer (WBGT)
-Takes into account temperature, humidity and wind speed. -The use of MOPP or IBA gear increased the WBGT reading by 10 degrees
What is triage? why do we use it? when do we use it?
-The medical sorting of casualties according to the type/seriousness of injury, and likelihood of survival. -Affords the greatest number of casualties the greatest chance of survival -Mass-casualty (MASCAL) and during Sick call (establishes the order of treatment, NOT whether treatment is given)
What conditions must be present if you allow a heat injury casualty to drink fluids by mouth?
-alert -able to swallow -present radial pulse -not nauseated (Risk of emesis and aspiration is low)
What is a temporary morgue?
-area used to hold remains until quartermaster can assume custody of remains -Contains unit members or casualties who died on arrival or of wounds while in their care
How often are medical inspections performed in detainee centers? who conducts them? what do they check for?
-at least once a month -done by camp commander -general health, nutrition and cleanliness of the camp and the detainees
environmental factors influencing heat and cold injuries
-climate, season, weather -atmospheric pressure -terrain
what is the max recommended daily fluid intake?
12 quarts per day
where are DEET and permethrin applied
DEET = skin permethrin = clothing (outside only, not on inside)
types of passive (mechanical) transmission
Filth flies and cockroaches -act as a "Taxi Service" carrying fecal matter and other pathogens on their legs, feet, and mouthparts
3 types of heat injuries and distinguishing between them
HEAT CRAMPS -Muscle cramp or spasm of the voluntary muscles. -Caused by the depletion of the body's water and salt. (dehydration) HEAT EXHAUSTION -Systemic reaction to prolonged heat exposure. -Caused by excessive fluid and electrolyte loss. *-moist, clammy skin -dilated pupils -relatively normal temp* HEATSTROKE -Failure of brain's temperature regulation. -Usually involves excessive exposure to strenuous physical activity under hot conditions -*Hallmark of this condition is AMS* *-dry, hot skin -constricted pupils -high temp*
what significant treatments can be preformed in the triage area
Hemorrhage control -deliberate tourniquets -hemostatic agents open airway and NCD HABC's can be performed
describe the treatment area for each triage category
Immediate area: -close to the initial triage area -room for a 3 person team to work. Delayed and Minimal areas: -large enough to contain all required supplies for minor treatments(s) Expectant area: -away from all other treatment areas -medic should be available for pain control -chaplain's staff should have quick access -after treating all other categories, re-triage these casualties initiate treatment
What is the key to preventing psychological trauma from further developing into a physical disorder?
Mental Preparation and adaptive skills
what 2 methods could fluids be administered to heat casualties
PO -alert, able to swallow, has a present radial pulse and not nauseated IV -altered mental status -administer a 500 ml bolus of Lactated Ringers *If IV attempts fail, do not attempt IO access* Continue to cool the casualty and evacuate immediately to be evaluated by a MO
How are civilians protected in wartime?
Protected as noncombatants; may not be the subject of a military attack
What is the status of a 68W under the Geneva Conventions?
Protection from attacks and upon capture. If captured, medics will be "retained personnel"
International Humanitarian Law (IHL) is the body of rules, which in wartime, protects people who are not or are no longer participation in the hostilities? What is its central purpose?
To educate nations at war about the rules set forth in the Geneva
Which Warriors are most likely to develop behavioral health problems following a combat or high-risk deployment?
Warriors with risk-taking behaviors that endanger their health and safety
Is it possible to become dehydrated in a cold climate?
Yes -In colder climates, it is difficult to even realize the condition exist
Could a commander order the removal of the Red Cross and still use the vehicle for medical purpose?
Yes, but would lose the protection under the Geneva Convention
fleas -diseases -habitat -prevention
active transmission diseases -Plague, Typhus, Tularemia. habitat -found in the same places as rodents and become infected from biting them prevention -removing rodents while at the same time using sprays, powders and traps
ticks -diseases -habitat -prevention
active transmission diseases -lyme disease habitat -Found in the US, Europe, Asia and Australia -tall grass or underbrush, in close proximity to mammals prevention -search body and remove ticks daily -Permethrin and DEET
mites -diseases -habitat -prevention
active transmission diseases -scabies -chiggers habitat -tall grass or underbrush near mammals. prevention -good personal hygiene and hand washing
Who could you report a suspected war crime to?
chain of command
when should malaria be considered for soldiers
malaria must always be considered for soldiers deployed in malaria risk country and develops unexplained febrile illness (fever)
yellow fever -what is it -prevention -treatment
what is it -aedes mosquito -viral disease prevention -immunized with yellow fever vaccine before deployment to endemic areas -boosters every 10 years treatment -supportive treatment -chemoprophylaxis -avoid mosquito bites
What are the three things Medics are expected to do?
-Identify those Warriors in your platoon or unit who are at-risk -talk to your Soldiers -Empower them to seek help
casualties are surveyed and classified based on...
-Number and location of the injured -Severity of injuries -Assistance available -Number of injuries by type -Availability of evac resources -Re-supply
what is the immediate treatment for heatstroke
-Remove the casualty from the environment if possible -provide rapid, active cooling -administer 500 ml bolus of Lactated Ringers -immediate evacuation
what are general guidelines to establishing a triage site
-initial triage area should be established for all casualties to flow thru -area should be clearly marked -Unidirectional flow of casualties thru the triage site
what are the 4 diseases from mosquitos
-malaria -dengue fever -yellow fever -encephalitis
animals, including ticks, spiders, mites and other insects as well as crustaceans such as shrimp, lobster and crabs
arthropods
how long is acclimatization maintained
as long as the Soldier remains at that altitude, but is lost upon return to lower elevations
What does the E in the Army A.C.E. acronym stand for?
escort
what is Considered the most efficient arthropod. Why?
ticks -female tick can pass the pathogen to her eggs
describe an arthropod that transports a disease-causing organism, or pathogen, from one host to another.
vector
dengue fever -what is it -treatment
what is it -aedes mosquito -viral disease treatment -supportive treatment -chemoprophylaxis -avoid mosquito bites
sandfly fever -what is it -prevention
what is it -transmitted from sandfly -Tropical and subtropical areas of Europe, Africa, South America and Asia. -Seen in non-native persons entering endemic area prevention -Proper wearing of the uniform. -application of repellents. -Permethrin and DEET -Avoiding domesticated animals
Leishmaniasis -what is it -prevention
what is it -transmitted from sandfly -found in 3rd world counties prevention -Proper wearing of the uniform. -application of repellents. -Permethrin and DEET -Avoiding domesticated animals
what spider is commonly mistaken for a brown recluse spider
wolf spider
which diseased are a potential biowarfare agent and which insect carries them
-Plague, Typhus, Tularemia. -fleas
responsibilities of medical personnel during triage
-Responsibilities change based on location. -Survey and classify casualties -Direct treatment first towards those with the best chances of survival. -Locate and return troops to duty
the injection of poisonous materials by bites or stings of arthropods or snakes
envenomation
what category would cardiorespiratory arrest be triaged into
expectant -contingent upon mission, battlefield situation, number of casualties, support
what is a freezing injury
frostbite
snow blindness -what is it -sign/symptom -treatment
what is it -Damage to the cornea from UV radiation, similar to a welding flash burn. -More likely to occur in hazy, cloudy weather than in sunny weather sign/symptom -Scratchy, watery, red feeling in eyes. treatment -Visual acuity test -Cover and patch the eyes with a dark cloth (if tactical environment permits) -evacuate
what 4 categories are convention wounds and injuries traditionally sorted into
-Immediate -Delayed -Minimal -Expectant I.D.M.E (remember by: "hey, i am a casualty, ID me") (Triage is an ongoing process of reassessment which may change the casualties' category)
Suppose you are a Soldier in an advance guard which successfully overruns an enemy position. You come across a medical unit established just behind the lines. What are your duties towards the medical personnel in the units and the wounded being care for?
-Non-injured detainees will be evacuated into appropriate channels -wounded will evacuated separately to a MTF
characteristics of an ideal triage area
-Proximity to the receiving area -One-way flow -Well lit, covered and spacious areas for easy access -Casualty recorders to identify, tag and record initial triage/disposition -Sufficient litter bearers -No significant treatments performed in the triage area
What three things can help with Warriors deal with PTSD and have fewer behavioral health problems within a unit?
-Units with strong leadership -high cohesion -good morale
When are expectant casualties treated?
-after treating all other categories -re-triage these casualties initiate treatment
snakes -poisonous species -sign/symptom -treatment
-consider all snake bites to be from a poisonous snake species -pit vipers -coral snakes red touches black= touch a jack (scarlet king snake = harmless) red touches yellow = kill a fellow (coral snake = venomous) sign/symptom -Noticeable bite, pain and swelling of the area. -Increased pulse and labored breathing. -Nausea/vomiting. -Progressive weakness to unconsciousness. Anaphylaxis treatment -Assess & manage A-B-Cs. Apply oxygen, if available. -Watch for allergic reaction. -Remove jewelry from the affected extremity. -Keep the casualty as calm and as inactive as possible to slow down the absorption of the venom -Start an IV. in the unaffected extremity -Clean around bite & immobilization affected limb. -Evacuate casualty (Tetanus prophylaxis must be assessed) DO NOT: -Suction or cut into the bite site. -Place ice on the bite. -Touch the head of a dead snake, it may still contain venom
all info for disposition of dead
-death certificate prepared for each Soldier who dies on the battlefield -when KIA's are identified, a spot report is generated identifying the location of the remains -remains can be recovered and turned over to mortuary affairs when the battle is over -transportation and disposition of remains is a quartermaster function
describe the immediate triage category
-highest priority - severe, life-threatening wounds -procedures used to correct these conditions are short in duration and economical ex. -Massive external bleeding -Airway obstruction -Tension pneumothorax -Open pneumothorax *with* respiratory distress -Hypovolemic shock -Any burns of the face, neck, hands, feet, or perineum and genitalia -Unstable abdominal wounds *with* shock
what are the 5 non-freezing injuries
-hypothermia -chilblains -immersion syndrome -snow blindness -dehydration
how is WNV spread
-infected mosquito bites bird -bird become infected -other mosquitoes bit the infected bird and become infected -can spread to other species as well, such as horses
describe the delayed triage category
-less risk of losing life or limb by treatment being delayed -held until the immediate cases are cared for ex. -Open chest wound *without* respiratory distress -ABD wounds without shock -Maxillofacial wounds *without* airway compromise -Second and third degree burns covering 20% or more of TBSA -Soft tissue wounds requiring debridement
describe the immediate minimal category
-managed by self-aid or buddy-aid -wounds that are superficial and require no more than cleansing, minimal debridement, and first aid dressings ex. -Minor lacerations and abrasions Sprains, -Contusion and strains. -Minor combat stress problems -Burns, first or second degree under 20% of TBSA and not involving critical areas such as hands, feet, face, genitalia, or perineum.
what should you never do to repel insects and why
-never wear a flea collar -not labeled for human use -contact with skin can cause severe chemical burns and absorption of toxic levels of insecticide through skin
factors influencing heat and cold injuries
-risk factors -mechanisms of heat loss -environmental factors
what are the 2 diseases are sandflies known to spread
-sandfly fever -leishmaniasis
what is MASCAL
-situation that occurs when the number of casualties exceeds the available medical capability to rapidly treat and evacuate them (Technically, a MASCAL situation occurs if the Soldier medic has more than one seriously injured casualty)
what diseased does a cockroach carry
Cholera, dysentery, typhoid and food-borne gastroenteritis
what are the 2 was to acclimatize
STAGED ASCENT -Soldiers ascend to a moderate altitude and remain there for 3 days or more to acclimatize before ascending higher. -should make several stops for staging during the ascent to allow a greater degree of acclimatization GRADED ASCENT -Limits the daily gain to allow partial acclimatization. -altitude at which Soldiers sleep is the critical element. -Spend two nights at 9,000 ft and limit the sleeping altitude to no more than 1,000 ft per day above the previous night's sleep altitude
mosquitoes -diseases -habitat -prevention
active transmission diseases -malaria -dengue fever -yellow fever -encephalitis habitat -standing water prevention -DEET to skin -permethrin to clothes -lose long sleeves -destroying mosquito habitats
scorpion -species/identification -sign/symptom -treatment
active transmission species -Out of the almost 650 species of scorpions in the world and 40 species in the Southwest US, only 1 type can cause death. sign/symptom -initial sting is very painful with little or no swelling or redness treatment -MO evaluation (in case of a severe reaction) and ice application to relieve localized pain
what are the 3 altitude injuries
acute mountain sickness (AMS) -most common altitude disorder high altitude cerebral edema (HACE) -potentially fatal, condition with acute brain swelling due to too rapid ascent in altitude. high altitude pulmonary edema (HAPE) -pulmonary edema in an unacclimated individual after a rapid ascent to high altitude -increased sympathetic activity which produces vasoconstriction Leads to an increased in pulmonary capillary pressure; driving the fluid out of the pulmonary capillaries Producing pulmonary edema -The lowest altitude an injury may occur is 6,500 feet -Most injuries normally occur at 10,000 feet
what is significant about the kissing bug
bites host, takes few step forward, defecates into the wound
what causes a flea to regurgitate bacteria into a host? name a disease that this applies to.
bubonic plaque -bacteria multiplies rapidly within flea's gut and blocks it -when flea attempts to eat, it can't ingest hosts blood due to blockage -causing flea to regurgitate bacteria into host
5 mechanisms of heat loss
conduction -transfer of heat from direct contact (ground) convection -transfer of heat from air (wind) evaporation -(sweat) radiation -transfer of heat off body waves into air (body heat) respiration -loss of heat through expiration (breathing)
which heat injury will result in death if treatment is delayed
heatstroke has 80% fatality rate if left untreated
brown recluse spider -identification -habitat -sign/symptom -treatment
identification -dark, violin shaped area in back habitat -Woodpiles, garages and dark places. sign/symptom -initial bite is mild, normally goes unnoticed. -Pain begins 1-4 hours post bite. -A red area will appear along with a central pustule. -pustule may grow and form a crater over 3-4 days. -The venom causes local tissue destruction. -Healing is slow treatment -mostly supportive -Ice for the pain. -Antibiotics for secondary infections. -Surgical excision of ulcerated area, if necessary
black widow spider -identification -sign/symptom -treatment
identification -female: shiny black, red hourglass marking on abdomen sign/symptom -occur within 10-60min -1st Hour: Pain of the bitten extremity & muscle spasms of the trunk. -Over First 1.5 Days: headache, nausea and vomiting. treatment -Evac and MO evaluation for 12-24 hours. -Pain management. In rare cases the MO may order antivenom
4 types of active transmission
inoculation -vector injects pathogen into host with its saliva fecal contamination -vector defecated into wound on host regurgitation -vector vomits pathogen into host while feeding crushing -vector is smashed into skin on host (wiping off a dead bug rubs pathogen into skin)
body of rules which, in wartime, protects people who are not or are no longer participating in the hostilities
international humanitarian law (IHL)
what is the leading cause of vector-borne infectious diseases in the US
lyme disease
what are the temp ranges for mild, moderate, and severe hypothermia
mild: 93-97 moderate: 86-93 severe: <86
what is active transmission
or biological transmission -disease causing agent undergoes some changed in the body of arthropod
what is passive transmission
or mechanical transmission -arthropod carries pathogen from one host to another
flies and cockroaches -diseases -habitat -prevention
passive transmission diseases --sandfly fever -leishmaniasis habitat -in/near animal or human waste, garbage, manure, decaying animal bodies prevention -Remove their food sources. Construct and maintain field latrines and soakage pits properly. Use sprays, fogs and traps
how to prevent and treat altitude injuries
prevent -acclimatization treatment -stop ascent AMS -Stop until symptoms resolve HACE & HAPE -Descend Immediately -provide low flow O2 if available
what's the purpose of IHL
purpose is to limit and prevent human suffering in times of armed conflict
The transportation and disposition of the dead is a function of what group?
quartermaster
What is the most important thing to do when you encounter a person who is suicidal?
remove means of self-harm
lice -species -prevention
species -head lice: frequently found in schools and institutions -crab lice: spread through sexual contact -body lice: found in people living in crowded, unsanitary conditions and clothing is infrequently changed or laundered. prevention -Good personal hygiene, regular changing of clothes, effective laundry procedures, not sharing clothing or bedding
toxin produced by some animals, such as scorpions, spiders and snakes.
venom
prevention of heat and cold injuries
water consumption -Warm fluids in cold environment and cool fluids in hot environments dress (COLD) -C - KEEP IT CLEAN -O - AVOID OVERHEATING -L - LOOSE AND LAYERS -D - KEEP CLOTHING DRY acclimatization -Allow two weeks for Soldiers to become acclimated to the heat. -Progressively increase workload during second week. -During periods of sudden temperature change, treat all Soldiers as non-acclimated. cumulative effect -Heat effects build up during the day and over several days. -Recovery is slow even after temperatures have decreased work and rest -follow highest heat category reached for remainder of day -take breaks in shade -plan for weather
frostbite -what is it -sign/symptom -treatment
what is it -Caused from exposure to cold. -Usually below 32 degrees F depending on the wind chill factor, duration of exposure, and adequacy of protection sign/symptom (in order that they will typically appear) -usually takes 24-48 hours to appear -Loss of sensation or numbness -Sudden whitening of the skin followed by tingling -Redness/grayish skin -Clear fluid or blood blisters -Swelling/tender areas treatment -Warm the area. -Loose/remove tight clothing, watches and jewelry. -Evacuate. -Consider pain management -AVOID: Freeze - Thaw - Refreeze DO NOT: -Soak the frostbitten part. -Rub affected area with snow. -Expose to any extreme heat source. -Rub or move the part in any way to increase circulation. -Allow the casualty to smoke or drink alcohol. -Expose the frozen part to an open fire.
immersion syndrome -what is it -sign/symptom -treatment
what is it -Prolonged exposure of feet to cool/cold water or mud. sign/symptom -*Early Stages/First phase:* -(develops slowly over hours to days) -Area is cold, pale, numb, tingling. Pulses are diminished or absent. -*Later Stages/Advanced Phase:* -Limbs feel hot, burning with shooting pains. -Area is pale blisters, swelling, redness, and ulcerations. -Anesthesia(numbness), hyperhydrosis(excessive sweating) and cold sensitivity may persist for weeks. -Infection, and gangrene in very severe cases. treatment -Warm and dry the part. -Do not rub tissue. -Place in contact with a warm object. -Elevate, protect and evacuate Prevention is key. -Keep feet warm and dry -change wet socks several times daily. -Ensure boots fit well -never sleep in boots
chilblains -what is it -sign/symptom -treatment
what is it -Repeated prolonged exposure of bare skin. sign/symptom -Redness or cyanosis of affected areas, blue-red patches, hot, tender, itching skin. -Subcutaneous nodules. -Ulcerated or bleeding lesions with chronic repeated episodes treatment -Warm and dry the part. -Do not rub tissue. -Place in contact with a warm object. -Elevate, protect and evacuate
encephalitis -what is it -sign/symptom -treatment
what is it -aedes and culex mosquitos -several forms of viral disease -West Nile Virus (WNV) -St Louis encephalitis -Japanese B encephalitis -California encephalitis sign/symptom -acute inflammatory diseases involving CNS treatment -supportive treatment -chemoprophylaxis -avoid mosquito bites
malaria -what is it -sign/symptom -treatment
what is it -bite of malaria-infected female mosquito -chloroquine is standard antimalaria medication sign/symptom -time between inoculation and appearance of symptoms is 7-30 days -fever with alternating chills -headache -muscle aches -sweats -abd pain with diarrhea treatment -chemoprophylaxis -avoid mosquito bites
chiggers -what is it -sign/symptom -treatment
what is it -from immature stage of tiny red mite sign/symptom -Bites may continue to itch for 2-3 weeks. -itching -small welts treatment -Permethrin and DEET
scabies -what is it sign/symptoms -treatment
what is it -from itch mites sign/symptoms -Found in skin folds. (finger & toe webs, axilla, genital) treatment -apply ointments and clean clothes
lyme disease -what is it -sign/symptom -treatment
what is it -from ticks sign/symptom -red, slowly expanding "bulls-eye" rash or skin lesion (EM), tiredness, fever, headache, stiff neck, muscle and joint aches. -The illness typically presents in summer months. treatment -prevention -remove tick: Gloves on, gentle steady traction with forceps or tweezers applied close to the skin (Avoid leaving mouthparts in skn)
hypothermia -what is it -sign/symptom -treatment
what is it -prolonged exposure to low temps -systematic cold injury sign/symptom -Conscious to AMS to unconscious -Shivering, poor muscle coordination to rigid muscles -Weak to absent pulse -Pale, cold skin to ice cold skin treatment -Handle Gently (prone to V-Fib) -*Active rewarming should be confined to the trunk only* -Rewarming the extremities before the core can result in acidosis, hyperkalemia (excessive potassium) and actually LOWER the core temperature
