106 TACTICAL MEDICINE AND FIELD SANITATION FUNDAMENTALS Flashcards
Discuss the history of Tactical Combat Casualty Care (TCCC).
Historical data shows that 90% of combat wound fatalities die on the battlefield
before reaching a military treatment facility. TCCC guidelines are currently used
throughout the US Military and various allied countries. TCCC guidelines were first
introduced in 1996 for use by Special Operations Corpsmen, Medics, and
Pararescumen (PJs)
Discuss the three phases of Tactical Combat Casualty Care.
Care Under Fire (CUF)
Care rendered by the first responder or combatant at the scene of the injury
while under hostile fire.
Tactical Field Care (TFC)
Care rendered by the first responder or combatant when no longer under
effective hostile fire.
Tactical Evacuation Care (TACEVAC)
Care rendered once the casualty has been picked up by an aircraft, ground
vehicle or boat.
**Note: The term “Tactical Evacuation” encompasses both Casualty Evacuation
(CASEVAC) and Medical Evacuation (MEDEVAC)
Explain the treatment plans for Care Under Fire.
Casualty Management Plan
Maintain fire superiority and take cover. Fire supremacy is the key to
preventing combat trauma.
If able, casualty should stays engaged as a combatant.
Instruct casualty to move to cover and apply self-aid if possible.
Keep casualty from sustaining additional wounds.
Treatment Plan
Stop any life-threatening external hemorrhage from extremities with a
tourniquet over the uniform (if tactically feasible).
If not tactically feasible (e.g. fire superiority has not been obtained), do not try
to treat the casualty in the kill zone. Application of a tourniquet may be
deferred until patient has been moved to safety.
**NOTE: The decision regarding the relative risk of further injury versus that of
bleeding to death must be made by the person rendering care.
Non-life threatening bleeding should be deferred until Tactical Field Care.
Move casualty to cover as quickly as possible utilizing an evacuation plan.
Explain the treatment plan for Tactical Field Care.
The goal of this phase is to allow the Combat Life Saver (CLS) to systemically find,
identify, and treat all injuries. MARCHPAWS
Mental Status
Mental Status
Determine responsiveness using AVPU acronym. Check if casualty is Alert,
responsive only to Vocal commands, responsive only to Pain, or
Unresponsive.
Any casualty with an altered mental status should be disarmed immediately.
Airway Management
Anatomical Structures
Airway consists of nose, mouth, throat, voice box, and wind pipe.
Air is diverted to the left and right lungs at the bronchial tree, the bottom of
the wind pipe.
Lungs are elastic organs composed of thousands of small air spaces and
covered by an airtight membrane.
The rib cage protects the lungs.
The diaphragm is a large dome-shaped muscle that separates the bottom
of the lungs from the abdominal cavity.
General guidelines:
Assess the airway by using the look, listen and feel technique for 5 to 10
seconds.
Open airway using modified jaw thrust or chin lift techniques.
Look for foreign obstructions and clear if possible.
Insert a nasopharyngeal airway (NPA) if required (Do not use an NPA if a
facial fracture is suspected).
Reassess airway after any interventions.
Breathing Assessment
Inspect the anterior thorax for bilateral rise and fall and for possible
penetrating trauma.
Auscultate the chest, bad side then good side.
Palpate in order to feel any abnormalities.
Treat all life-threatening penetrating injuries of the chest, such as a sucking
chest wound, with an occlusive dressing.
Perform a needle thoracentesis (needle decompression) if a pneumothorax is
suspected.
Repe the assessment on the posterior thorax by carefully performing a log
roll.
Circulatory Assessment
Check for a carotid pulse
Perform a blood sweep by sweeping the downside of each limb in order to
identify wounds and bleeding.
If blood is found, gain control of any life-threatening hemorrhage with a
tourniquet or hemostatic agent.
Assess the radial pulses for rate (beats per minute) and quality (strong,
weak, thread).
Estimated blood pressure (BP). Blood pressure can be estimated based on
the presence of a casualty’s heart rate. Below are the parameters for
estimating blood pressure:
Radial pulse detected – 80/P
Femoral pulse detected – 70/P
Carotid pulse detected – 60/P
Normally, a BP reading consists of 2 numbers, but if assessing BP by
palpation (touch); “P” is substituted for the second number to denote that
it was determined by palpation.
Assess peripheral perfusion by checking:
Skin color (pale/flushed/normal)
Skin temperature (cold/cool/warm/hot)
Skin condition (dry/moist)
Check for capillary refill and ensure it is less than three seconds.
Assess for Shock
Shock is an abnormality of the circulator system that results in an inadequate
amount of blood flow and oxygen to organs and tissues.
Hemorrhagic shock is the most common form of shock encountered in the
battlefield.
Anatomy of the Cardiovascular System:
Pump
Heart (Contains 4 chambers)
Container
Arteries, veins, and capillaries
Fluid
Blood and blood plasma
Signs & Systems of Shock:
Heart rate: Greater than 100 beats per minute
Respirations: Greater than 20 beats per minute
Capillary Refill: Greater than 3 seconds
Skin: Cool, clammy, pale, or cyanotic
Mental Status: Restless, disoriented, lethargic, or unconscious
Treatments:
Control life-threatening extremity hemorrhage and non-life-threatening
hemorrhage with hemostatic agents and pressure dressings.
Provide supportive care for internal bleeding
Maintain the patient’s airway
Keep patient warm to prevent hypothermia
Reassess interventions and monitor vital signs.
TACEVAC.
Anatomy of the Cardiovascular System:
Pump
Heart (Contains 4 chambers)
Container
Arteries, veins, and capillaries
Fluid
Blood and blood plasma
Management of Burns
And an Antony of skin
The severity of all burns will vary depending on the source of the burn, duration of
exposure, and location of the burn.
Anatomy of the Skin:
The most important function is to form a protective barrier against the
external environment.
Skin also prevents fluid loss, regulates body temperature, and allows for
sensation. The skin is composed of three layers:
Epidermis
Outermost layer; made up of skin cells with no blood vessels.
Dermis
Underneath the epidermis; made up of connective tissues containing
blood vessels, nerve endings, sebaceous glands, and sweat glands.
Subcutaneous
Innermost layer; made up of a combination of elastic and fibrous
tissue as well as fat deposits.
The skin is composed of three layers:
Epidermis
Outermost layer; made up of skin cells with no blood vessels.
Dermis
Underneath the epidermis; made up of connective tissues containing
blood vessels, nerve endings, sebaceous glands, and sweat glands.
Subcutaneous
Innermost layer; made up of a combination of elastic and fibrous
tissue as well as fat deposits.
Burn Classifications
Burns are classified by the depth of the burn and the extent of the total body
surface area (TBSA) of the burn.
First-Degree Burns/Superficial Thickness Burns
Involves only the epidermis.
Signs & Symptoms:
Dry, red and inflamed skin.
Painful.
The burned area blanches (whites out) under firm pressure.
Typically will heal within one week.
Second-Degree Burns/Partial Thickness Burns
A burn in which the surface (epidermis) is destroyed and various portions
of the dermis are damaged.
Signs & Symptoms:
Skin will appear glistening or have a wet appearance.
Blisters or open weeping wounds
Deep, intense pain
Typically will heal in two to three weeks.
Fluid loss may be significant depending on the extent of the burn.
Third-Degree Burn/Full Thickness Burn
All three layers of the skin are damaged.
Signs & Symptoms:
Skin has a dry, leathery appearance.
The skin can range in color from white, yellow, cherry red, brown, or
charred black.
First and second-degree burns surround the third degree burn.
Severe pain around periphery of burn, but little to no pain near center of
burn.
Fourth-Degree Burns
A burn that not only encompasses all three layers
Types of Burns
Thermal
Most common type of burn, generally from fire or excessive heat.
Electrical
These are often more serious than they appear. Entrance and exit
wounds may be small but the electricity burns a large area as it travels
through the body.
Chemical
Occurs when skin comes in contact with various caustic agents.
Radiation
Associated with nuclear blasts and other forms of radiation.
Treatment of Burns
Treatment of Burns
Thermal/Radiation Burns
Stop the burning process
Remove all clothing and jewelry; however do not pull away clothes that
are stuck to skin.
Wrap the burn loosely with a dry sterile dressing.
Keep the casualty warm as the casualty will not be able to maintain their
body temperature.
Provide pain relief
Electrical Burns
Stop the electrical source
Use a nonconductive item, such as a wooden beam to disengage the
casualty from the source.
Wrap the burn loosely with a dry sterile dressing.
Chemical Burns
Flush the affected area with large amounts of water.
Brush dry chemicals off away from both yourself and the casualty.
For a confirmed acid burn. Irrigate the area for 15 minutes.
Wrap the burn loosely with a dry sterile dressing.
Prevent Hypothermia
Ensure all hemorrhage is controlled.
Keep patient warm by wrapping in available material.
