Fieldcraft 3 - 68W
Important Points about PTSD
1. can be caused by exposure to a traumatic event 2. significantly impacts functioning (victims can no longer consistently perform duties of daily tasks) 3. is a diagnosis that requires a group of symptoms to be present for an extended period of time 4. must be diagnosed by a medical professional
Fleas
1. efficient vectors of plague, typhus and tularemia 2. become infected feeding on rodents and other mammals infected with the disease 3. transmit bacteria to humans when they feed (bite) *plague and typhus have been identified as potential bio warfare agents*
Which soldiers are at a higher risk of having serious stress-related problems?
1. genetic predisposition 2. early-life trauma 3. no strong social support system 4. regularly engaged in frequent or intense combat 5. witnessed injury or death 6. involved in a serious event where they felt they had no control, esp if they felt there was a mistake, poor leadership or negligence
When it comes to prevention, combat medics must be able to
1. identify high-risk individuals 2. be proactive and care for individuals 3. encourage help-seeking behavior 4. promote positive life coping skills to deal with life crises 5. be aware of suicidal thoughts and behavior in individuals 6. know the community-wide operational resources for referral of individual demonstrating self-destructive behavior 7. ensure that individual's problems are properly addressed (be an advocate for the individual)
What are the 3 things Medics are expected to do?
1. identify those warriors in your platoon/unit who are at-risk 2. talk to your soldiers and normalize their behavior 3. empower warriors to seek help because the sooner they get help the better the outcome *always recommend that warriors talk to the experts, whichever is more comfortable for them; your role is to help them get the help they need
What are the 4 triage categories?
1. immediate 2. delayed 3. minimal 4. expectant IDME
WHAT NOT TO DO when confronted with suicidal individual
1. keep the individual safe 2. don't assume the person is not the suicidal "type" 3. don't make moral judgments, act shocked, or make light of the situation 4. don't keep deadly secrets
Identifying Risk Factors Associated with Suicide
1. made a previous suicide attempt 2. a family or friend lost through suicide 3. a victim of childhood abuse or witnessed family violence 4. previously abused drugs and/or alcohol 5. alcohol abuse or dependency by significant family member
Do you have to lose consciousness to have a concussion?
NO
Army Suicide Prevention Program model
based on prevention, intervention, and integration of installation/community resources
What is ACTIVE TRANSMISSION?
(aka biological transmission) the disease causing agent undergoes some change in the body of the arthropod, the pathogen may multiply or simply develop into an infectious form there are 4 ways a pathogen can be passed to humans via active transmission: 1. Inoculation 2. Regurgitation 3. Fecal Contamination 4. Crushing the vector MNEUMONIC: I Really Fcking Care (if mosquitoes bite me)
What is PASSIVE TRANSMISSION?
(aka mechanical transmission) the arthropod carries the pathogen from one host to another; the pathogen does nothing during the transfer except 'go along for the ride'
What HELPS brain recovery following concussion?
1. Cognitive Thinking: (a) maximize downtime or rest during day (b) maintain adequate sleep routines 2. Physical: (a) stay out of heat (b) limit physical activity (c) get adequate sleep
What HURTS brain recovery following concussion?
1. Cognitive Thinking: (a) mental exertion (b) inadequate sleep 2. Physical: (a) physical exertion (b) physical activities that increase risk for second concussion like combative or sports
Lack of Sleep Effects
1. Performance - need sleep to think clearly, react quickly, and create memories 2. Mood - more irritable, short-tempered, and vulnerable to stress 3. Health - bodily systems are negatively affected by inadequate sleep (heart, lungs, kidneys, appetite, metabolism, weight control, immune function and disease resistance, sensitivity to pain, reaction time, mood, brain function) 4. Muscle Growth, immune system, body's use of energy
What was PTSD called in the past?
1. Soldier's Heart: physiological signs, increased HR, chest pains, panic, sense of doom 2. Shell Shock: concussive or vacuum effects of exploding artillery shells and trench warfare
Top 3 Priorities of Sleep for soldiers
1. Top priority: applies to leaders who make decisions critical to mission success and unit survival 2. Second priority: applies to service members who have guard duty, who are required to perform tedious tasks such as monitoring equipment for extended periods, and who judge and evaluate info 3. Third priority: applies to soldiers who perform duties involving only physical work *SLEEP MUST BE TREATED LIKE ANY OTHER LOGISTICAL RESUPPLY SUCH AS FOOD, FUEL, AND AMM)*
Examples of immediate category
1. airway obstruction 2. open pneumothorax WITH resp distress 3. tension pneumothorax 4. unstable abdominal wounds WITH shock 5. massive external bleeding (ex: amputation) 6. open fx of long bones 7. hypovolemic (hemorrhagic) shock 8. any burns to face, neck, hands, feet or perineum/genitalia *cardiorespiratory arrest may not be considered immediate on battlefield, would most likely be classified as expectant, contingent upon mission, battlefield situation, number of casualties, support, etc*
Signs and Symptoms/Triggers of behavioral health problems
1. behaviors/reactions that impair performance or jeopardize training 2. persistent problems with sleep 3. reckless or dangerous behaviors 4. drinking too much alcohol, misusing substances 5. severe guilt or hopelessness 6. withdrawals from buddies, friends or family 7. rage, threatening statements 8. talking/joking about not wanting to be alive
Signs and Symptoms of Malaria
1. fever alternating with chills 2. headache 3. muscle aches 4. sweats 5. abdominal pain with diarrhea
Establishing a Casualty Collection Point (CCP)
1. initial triage area should be established for all casualties to flow through and then directed to separate areas for tx (triage categories) *unidirectional flow is highly recommended in order to prevent clogging system* 2. proximity to receiving area/LZ/ground evac: reduces distance to be traveled by litter bearers (establish separate triage areas for contaminated casualties) 3. one way flow both into and out of triage areas into tx areas 4. casualty recorders to identify, tag and record initial triage/disposition and sufficient litter bearers 5. IMMEDIATE tx area should be close to initial tx area (should have room for three person team) 6. DELAYED and MINIMAL tx area should be large area containing all required supplies for minor tx 7. EXPECTANT tx area should be established away from all other tx areas to reduce stress and anxiety among casualties and attending soldier medics; a soldier medic should be available for pain control and chaplain's staff should have quick easy access; AFTER all casualties have been treated, a re-triage of these casualties should be performed and tx initiated if appropriate * each area can be designated specific color or number and route to that area clearly marked *
Prevention and Personal Protective Measures for Flies/Cockroaches
1. locate and remove the food sources of the filth fly an cockroach 2. field latrines and soaking pits should be constructed, used, maintained, and closed so not to foster fly breeding 3. sprays, fogs, sticky traps are useful tools but only successful when used with pest elimination measures
Prevention and PPM for Fleas
1. locating and removing the rodents is the key to eliminating the diseases they carry 2. sprays, fogs, powders and traps are useful tools but are only successful when used with pest elimination measures 3. isolate suspected cases of plague *modern antibiotics are effective against plague; the plague vaccine is currently not in use*
Examples of minimal category
1. minor lacerations, abrasions 2. contusions 3. sprains and strains 4. minor combat stress problems 5. burns, first or second degree under 20% TBSA and not involving critical areas such as hands, feet, face, genitalia, perineum 6. upper extremity fx WITHOUT neurovascular compromise 7. behavioral disorders or other psychiatric disturbances 8. suspicion of blast injuries (ruptured TMs) 9. symptomatic but unquantified radiation exposure
Examples of delayed category
1. open chest wound WITHOUT resp distress 2. abdominal wounds WITHOUT shock 3. eye and central nervous (CNS) injuries 4. soft tissue wounds requiring debridement (all combat wounds will require some form of debridement) 5. other fx open or closed 6. second or third degree burns 20% or more TBSA (not involving face, hands, feet, genitalia, perineum) 7. maxillofacial wounds WITHOUT airway compromise 8. genitourinary tract disruption
WHAT TO DO when confronted with suicidal individual
1. remove potential means of self-harm 2. ask directly 3. convey concerns 4. get help
How does deployment physically effect the body?
1. sleep deprivation during sustained operations 2. being on guard almost all of the time 3. physical threats 4. maintaining emotional control 5. extreme physical stress and exhaustion 6. carrying heavy loads, wear and tear on muscles and joints 7. injuries, including concussions/mTBIs and combat trauma
Immediate Danger Signals Related to Suicide
1. talking about their death or hinting at suicide 2. giving away important possession; making a will in connection with the disposal of personal property 3. obsession with death; sad music, or sad poetry (themes of death in letters or artwork) 4. uncharacteristic behavior, withdrawal from social activities 5. significant change in performance 6. has specific plans to commit suicide and access to lethal means 7. buying a gun in connection with any of the above *if the person demonstrates imminent behavior AND has experienced some life stress events associated with suicide, appears to be depressed, and/or has history known to cause an increased risk of suicide, the chances of suicide increase even more*
What are the Triage Principles (3)?
1. the medical sorting of casualties according to type and severity of injury, likelihood of survival and establishment of priorities of tx and evacuation 2. ensures that medical resources are used to provide care for the greatest benefit to the largest number of casualties 3. affords the greatest number of casualties the greatest chance of survival
Examples of expectant category
1. unresponsive casualties with penetrating head wounds and signs of impending death 2. burns, mostly third degree, covering more than 85% TBSA 3. cervical (high) spinal cord injuries 4. mutilating explosive wounds involving multiple anatomical sites and organs 5. profound shock with multiple injuries 6. agonal respirations 7. convulsions and vomiting within 24 hours post-radiation exposure 8. without vital signs or signs of life 9. trans-cranial GSW 10. open pelvic injury with uncontrolled bleeding (shock with decreased mental status)
When to get a medical evaluation for concussions
1. within 50m of a blast 2. direct blow to the head or LOC 3. vehicle involved in blast event 4. collision or rollover *NOT EVERY CONCUSSION IS THE SAME, concussed warriors may exhibit different symptoms*
Historical Suicide Rates from 2011-2013
2011 = 284 soldiers 2012 = 324 soldiers 2013 = 302 soldiers
Relationship Problem (red flags)
25% of warriors report stress reactions that may interfere with their ability to trust and be emotionally close to others
What is the Army Guidance on sleep?
7-8 hours of continuous uninterrupted sleep (previous standard 4-5 hours)
A review of suicidal cases in the Army revealed that
75% of complete suicides were triggered by relationship problems 50% occurred while soldiers were pending UCMJ action 42% were experiencing financial problems 34% were having drug and alcohol problems
ATC Model
A: activating event - who, what, when and where of a situation; acts as a "trigger" and can be a challenge, adversity or positive event T: thoughts - what we say to ourselves in the heat of the moment following an activating event; thoughts drive immediate reactions and can be productive or counterproductive C: consequences - what we feel and do following an activating event, including both emotions and reactions (emotions are how you feel based on your interpretation of the activating event and reactions are what you do in response to your thoughts about the activating event); can also include what you don't do *emotions are feelings and reactions are behaviors*
What is the standard antimalarial medication?
CHLOROQUINE
What is immediate category?
HIGHEST PRIORITY - casualties whose condition demands immediate resuscitative tx to save life (severe life-threatening wounds) and have a high likelihood of survival - after being stabilized, no further tx (non-life/limb-threatening) will be given until other "immediate" casualties have been treated *salvage of life takes priority over salvage of limb*
What is the Army's primary effort to reduce suicide
PREVENTION
TAIL
T: tell them you're concerned A: all are impacted by deployment I: insist that they talk with someone L: look for ways to help
Does the brain or body control sleep?
THE BRAIN *quality sleep is necessary for brain to recover from constant activity*
Who provides the sleep guidance?
Walter Reed Army Institute of Research (FM 6-22.5, Ch 4) this guidance applies to all levels of military operations including both training and tactical environments
Do all service members experience PTS?
Yes
Will dialing-down combat physiology take time?
Yes time, work, effort
During deployment all Warriors experience change?
Yes, everyone is impacted including families at home
What is a VECTOR?
a carrier (an arthropod that transports a disease causing organism or pathogen from one host to another)
What is MASCAL?
a situation that occurs when the number of casualties exceeds the available medical capability to rapidly treat and evacuate them; can occur at multiple locations with varying resources *technically a MASCAL can occur if soldier medic has more than one seriously injured soldier to manage at one time*
What is INOCULATION?
a vector injects the pathogen into host with its saliva while it feeds on the host ex: mosquitoes transmit malaria by inoculation
What is Post-traumatic stress (PTS)?
aka combat stress typical expected reactions to deployment stressors; everyone who deploys will experience at least a mild form of one or more of the signs at some point or points during their transition home the sooner warriors seek help, the better the outcome
What is Sandfly Fever?
an acute, self-limiting viral disease transmitted through the bite of the sandfly - occurs in TROPICAL and subtropical areas - epidemics are seen in non-native persons such as US troops entering endemic areas
What are ARTHROPODS?
animals, including ticks, spiders, mites and other insects as well as crustaceans such as shrimp, lobster and crabs
What is "dialing-down"?
anxiety begins to decrease as you adjust to being at home but will not necessarily return to how it was before deployment (post-traumatic growth)
What is the time between the infective bite and appearance of symptoms for malaria?
approx 7-30 days, depending on the type of mosquito
Mosquitoes
are the most important arthropod to the military, found everywhere, in high numbers, capable of transmitting a large number of diseases, some of which have been war stoppers
What is "dialing-up"?
as you progress through mobilization toward deployment, anxiety gradually increases: you are mentally and physically preparing yourself for this new deployed environment
What is delayed category?
casualties who have less risk of losing life or limb by tx being delayed and can tolerate delay prior to intervention without unduly compromising the likelihood of a successful outcome
What physical disorder must be ruled out with a warrior demonstrating behavioral change?
everyone experiences PTS but not everyone experiences PTSD
Alcohol (or other substance abuse) Problems (red flags)
half of all PTSD diagnosed warriors have associated alcohol problems, many of whom have not previously been "problem" drinkers
What treatment can be performed in the triage areas?
hemorrhage control with deliberate TQ/hemostatic agents, open airway, NCD
What is a temporary morgue?
it is a temporary holding area until the quartermaster can assume custody of the body and should be established out of sign of triage & tx areas *only remains that medical unit handles are those of its own unit members or casualties who are dead on arrival (DOA) or who died of wounds (DOW) while in their care*
Flea Habitat
large populations of fleas can usually be found around animal beds, burrows, and nests outdoors; fleas are abundant during rainy summers and high humidity areas
Why are concussions hard to diagnose?
mild TBIs can sometimes go undetected from the start and can be difficult to distinguish from moderate or severe brain injuries *make sure warrior takes a break (take a knee) even if they insist they are feeling fine*
Mosquito Habitat
mosquito larvae inhabit areas with standing water such as ponds, puddles and ditches
What is malaria?
one of the most important preventable diseases in man - humans get malaria from the bite of a malaria-infected female mosquito, it ingests microscopic malaria parasites found in the person's blood, then bites another person; the parasites go from the mosquito's mouth into the person's blood
What percent of soldiers are actually diagnosed with PTSD?
only around 3-5% are diagnosed with PTSD *most soldiers DO NOT develop PTSD as a result of their deployment experiences*
What is PTSD?
psychiatric disorder that can occur following the experience or witnessing of a life-threatening event such as military combat, natural disasters, terrorist incidents, serious accidents, or physical or sexual assault in adult or childhood
The transportation and disposition of the dead is the function of what group?
quartermaster function (assumes custody of the body) *on the battlefield when KIA's are identified, a spot report is generated identifying the location of remains and can be recovered when battle is over and turned over to mortuary affairs*
What is the key to preventing psychological trauma from further developing into a physical disorder?
recommend talking to experts (BH/chaplain)
Anger Problems (red flags)
returning warriors can be easily angered or have uncontrolled anger; anger has been found to be a prominent symptom of traumatic exposure
Sleep Problems (red flags)
returning warriors may have difficulty falling asleep or staying asleep, some may wake early and not be able to get back to sleep and have frequent nightmares (getting 7-8 hours of continuous uninterrupted sleep is extremely important)
What are Sandflies?
small, bloodsucking gnats that looks like small mosquitoes - attack the wrists, ankles or any exposed part of the body
What is expectant category?
so critically injured that only complicated and prolonged tx offers any hope of improving life expectancy; wounds so extensive that even if they were the sole casualty and had the benefit of optimal medical resources application, their survival would be very unlikely *should be separated from view of other casualties but not abandoned*
Treatment for Malaria
soldiers with an acute febrile illness must be evaluated by a MO 1. Chemoprophylaxis and effective early tx of cases minimizes the effect of malaria; however malaria prophylaxis provides no protection against other mosquito-borne diseases (malaria chemoprophylaxis not 100% effective) 2. most effective means of malaria control is avoiding mosquito bites *a complication of malaria, called Blackwater fever is an acute and potentially fatal hemorrhagic state, which causes kidney failure; mortality is from 20-30%*
What is ACE?
suicide prevention training programs
How to triage
survey and classify casualties for the most efficient use of available resources (medical personnel, supply capabilities, and evac assets) 1. number and location of the injured 2. severity of injuries (time constrains may not allow time intensive procedures like CPR) 3. assistance available (self-aid/buddy-aid, CLS, medical personnel) 4. determine the number of injuries by type (litter vs ambulatory) 5. identify availability of evacuation resources with regard to time, distance and terrain (ground vs air assets) 6. resupply capabilities and requirements (time and available class VIII) 7. assure tx is directed first towards casualties that have the best likelihood of survival by assigning appropriate triage category 8. locate troops with minor wounds and return them to duty (goal is to return greatest number of soldiers to combat asap) *NOTE: likely outcome of individual casualty must be factored into decision process prior to committing limited medical resources*
What is Encephalitis?
the Aedes and Culex mosquitoes carry several forms of this viral disease the mosquito-borne viral encephalitis are acute inflammatory diseases that involve the central nervous system (CNS) *West Nile virus (WNV) is a strain of encephalitis; most people who are infected with WNV have no symptoms; about 20% of people infected with WNV will develop mild symptoms of fever, headache, and body aches* *about 1 in 150 people infected will develop a more severe disease; the symptoms of severe infection (WNV or meningitis) include: high fever, neck stiffness, coma, seizures, paralysis; death is usually in the elderly*
What is Yellow Fever?
the Aedes mosquito transmits this viral disease uncommon in the US, but occurs in JUNGLE environments in Africa and Central/South America
What is Dengue Fever?
the Aedes mosquito transmits this viral disease; endemic in most areas in the TROPICS the military significance of dengue is its explosive nature, resulting in a high % of casualties in a short time, and the prolonged convalescent period
What are Filth Flies and Cockroaches?
the habits of flies and cockroaches make them easy vectors for disease; they pick up organisms from sewage, garbage, manure, and decaying animal bodies; the organisms are then passed to humans and animals through the feces and vomit of the fly and the 'taxi ride' of the cockroach
What is ENVENOMATION?
the injection of poisonous materials by bites or stings of arthropods or snakes
Mosquito Bite Prevention
the most effective means of malaria control is AVOIDING mosquito bites 1. insect bar (bed nets) - mosquitoes are night-biters and soldier can use aerosol on inside of net to kill any mosquitoes that may be under the net 2. long-sleeved, loose fitting clothing - mosquitoes can only bite through clothing when it is worn tightly against skin 3. chemical repellants - apply DEET on all exposed skin surfaces every 4-6 hours and apply PERMETHRIN on fabrics (permethrin should not be applied to inner clothing) 4. prevention - includes education on eliminating or destroying mosquito larval habitats
Ticks
the most efficient arthropod when it comes to disease transmission b/c the female tick can pass the pathogen to the egg so that when the larva hatches it is already able to pass on the disease upon eating its first meal
Prevention and PPM for Sandfly Fever
the proper wearing of the uniform and application of repellents will prevent most infections - PERMETHRIN to uniforms - DEET to skin - avoid domesticated animals
Risk-taking Behavior (red flags)
the start or increase in frequency of behaviors that may endanger health and the health and safety of those around them signs and symptoms are seen as "triggers"
What is FECAL CONTAMINATION?
the vector defecates into a wound on the host as the wound itches, scratching and rubbing by the host causes the pathogen to enter the host's body ex: Chagas' disease, aka North American Sleeping Sickness, is transmitted in this way by the kissing bug
What is CRUSHING THE VECTOR?
the vector is smashed onto the skin of the host; when the host wipes off the dead bug, the pathogen is rubbed into the skin ex: the bacteria that cause epidemic typhus live and multiply in the body of the body louse, the body louse transmits epidemic typhus in this manner
What is REGURGITATION?
the vector vomits the pathogen into the host while it feeds on the host ex: fleas transmit bubonic plague by regurgitation
Treatment for Dengue Fever
there is no specific therapy, tx is supportive, vaccine are currently under development *prevention and PPM used in malaria should be utilized for all mosquito-borne diseases*
Prevention and PPM for Leishmaniasis
there is no vaccine for Leishmaniasis - PERMETHRIN to uniforms - DEET to skin - avoid domesticated animals
What is Leishmaniasis?
this disease is found in most 3rd world countries and transmitted by the bite of an infected sandfly
Goal of Successful Transition
to minimize "collateral damage" such as damage to relationships or careers, and general self-destructive behavior; they must learn how to transition from deployed mindset back to the "home front" and it will take time, work and effort
What is the goal of resilience training?
to provide soldiers with adaptive skills to deal with any challenge to not just survive but thrive in the face of adversity
What is VENOM?
toxin produced by some animals, such as scorpions, spiders, and snakes
Medic Responsibilities for Triaging
triage establishes the order of tx based on life signs of casualty, NOT WHETHER TX IS GIVEN responsibilities are based on the tactical and environmental situation: - at a BAS or MTF, you may be a member of a tx or evac team - on a COP, mission or convoy as the only medic, you may be the primary decision maker and have to do all the roles
Treatment for Yellow Fever
tx is supportive prevention - soldier are immunized with yellow fever vaccine prior to deployment in endemic areas; booster doses are recommended every 10 years *mosquito control measured used in malaria should be utilized for all mosquito-borne diseases*
Treatment for Encephalitis
tx is supportive; vaccine is currently being developed *prevention and PPM used in malaria should be utilized for all mosquito-borne diseases*
Resilient soldiers
units with strong leadership, high cohesion, good morale have been shown to be more resilient and have less behavioral health problems
Leveraging the Healthcare System
when a conversation starts feeling like therapy, it is time to send the soldier to the experts, it is best to encourage self-referral so that the individual takes responsibility and is more likely to get the needed help sometimes command referrals are necessary, although it may be difficult for you to want to get the command involved
Broken Tail Light
when a warrior does not realize that he or she has a problem; TAIL can be used to help friends with transition problems
What is minimal (ambulatory/walking wounded) category?
wounds that are so superficial, they require no more than cleansing, minimal debridement under local anesthesia , administration of tetanus toxoid, and first-aid dressings *can be managed by self-aid or buddy-aid and usually not evacuated to MTF*
