29.1 Organization Flashcards
The process of prioritizing patient treatment during mass casualty events based on their need for or likely benefit from immediate medical attention.
Triage
Multiple casualties or Mass casualties?
The number of patients and the severities of their injuries DO NOT exceed the resources and capabilities
Multiple casualties
Multiple casualties or Mass casualties?
The number of patients and the severities of their injuries DO exceed the resources and capabilities.
Mass casualties
5 Principles of triage
(1) Degree of life threat posed by the injuries sustained
(2) Injury severity
(3)Salvageability
(4)Resources
(5)Time, distance, and environment
What takes priority massive hemorrhage or air way?
Massive hemorrhage
Which triage principle entails looking at each patient in a total global fashion and assessing the patient as a
whole and not focusing on one severe injury
Injury severity
Which triage principle is the following:
(a) Determined by considering the order of priorities identified during the primary survey of an individual patient and applying these same principles to a group of patients.
(b) Massive hemorrhage takes priority over an airway problem.
Degree of life threat posed by the injuries sustained
Which triage principle is the following:
(a) Entails looking at each patient in a total global fashion and assessing the patient as a whole and not focusing on one severe injury.
(b) Regardless of the injuries sustained, do not become too focused on one patient. Attempt
to remain emotionally detached.
(c) Ideally patients should be triaged based solely on the severity of their injuries and not nationality
Injury severity
Which triage principle is the following:
(a)The patient with the most severe injury may not be the patient who will be the first to receive care.
(b)Consideration for survival of the patient, in a mass casualty situation CPR for victims of blast or penetrating traumas who have no pulse, respirations, or any other signs of life often times will be unsuccessful and should not be conducted.
(c)Attempts to resuscitate trauma patients in arrest have been futile even
Salvageability
Which triage principle is the following:
(a)Often only consumables and equipment are considered, but all aspects of the management, treatment, care and evacuation of casualties must be included.
(b)If the patients’ needs exceed the resources capabilities, they should receive a lower priority.
(c)During mass casualties the determining factor is not the magnitude of the incident or the total number of casualties. The determining factor shall be whether or not you haveenough resources to efficiently and effectively manage the incident.
Resources
Which triage principle is the following:
(a)Quick management of a patient may result in their triage category being lowered. The initial management of a massive hemorrhage which was appropriately transitioned to a pressure bandage may lower their immediate need for care or evacuation.
(b)Mission planning, knowledge of treatment facilities and an overall understanding of the capabilities of the unit in the given environment, and individual resources are required in the decision-making process
Time, distance, and environment
Characteristics of military triage
(1)Designed to maintain a fighting force.
(2)Limits the use of resources for that purpose.
(3)Priorities are based on returning the injured victim to a fighting capacity.
(4)Abandonment of casualties is NEVER to be considered.
(5)Always performed by the most qualified person available.
(6)Determine the tactical environmental situation and determine the need to move.
(7)Number and location of injured.
(8)Available assistance to the provider.
(9)Evacuation support in the area of operation.
Categories of military triage
“DIME”
- Delayed
- Immediate
- Minimal
- Expectant
Which military triage category?
- Needs lifesaving interventions within minutes up to 2 hours on arrival to avoid death or major disability.
- Salvage of life takes priority.
Immediate
Examples of immediate military triage category
1)Massive Hemorrhage
2)Airway obstructions or potential compromise, including potential complications from facial burns or anaphylaxis
3)Tension pneumothorax
4)Penetrating chest wound WITH respiratory distress
5)Torso, neck, or pelvis injuries WITH shock
6)Head injuries requiring emergent decompression
7)Threatened loss of limb
8)Retrobulbar hematoma (threat to loss of sight)
9)Multiple extremity amputations
Which military triage category?
- Requires medical attention but CAN wait
- Includes those who may require a surgical procedure, but whose delay in surgical treatment will not endanger the life, limb, or eyesight of a patient.
- Sustaining treatment will be required such as IV fluids, splinting, administration ofantibiotics, pain relief.
Delayed
Examples of delayed military triage category
those who show NO signs of shock with the following injuries:
1)Soft tissue injuries without significant bleeding.
2)Fractures
3)Compartment syndrome
4)Intra-abdominal and/or thoracic wounds
5)Moderate to severe burns with less than 20% of total body surface area
6)Blunt or penetrating torso injuries without the signs of shock
7)Facial fractures without airway compromise
8)Globe injuries
Which military triage category?
- Can be treated with self aid, buddy air, and corpsman aid
- Often referred to as “walking wounded.”
- These casualties should be continued to be used for scene security or help treat the moreseriously wounded.
Minimal
Examples of minimal military triage category
1)Minor burns, lacerations, contusions, sprains and strains.
2)Simple, closed fractures without neurovascular compromise.
3)Combat stress reaction.
Which military triage category?
- Require complicated treatments that may not improve life expectancy
- Even if they are the sole casualty with the optimal resources their survival would still be unlikely.
- Shall not be neglected. They should be continued to be reassessed and if resources allow, comfort measures and pain medication should be provided.
- Category should only be used when resources are limited. The goal is to not use limited resources with little chance of survival
Expectant
Examples of expectant military triage category
1)Massive head injuries with signs of impending death or in coma.
2)Cardiopulmonary failure.
3)Clearly dead casualty with no signs of life or vital signs regardless of mechanism of injury.
4)Second and third degree burns in excess of 85% total body surface area.
5)Open pelvic injuries with uncontrolled bleeding and class IV shock.
6)High spinal cord injuries.
What is primary triage
Simply and quickly categorizing patients; identifying and stop life threats. Breaks patients down into more manageable groups
What is secondary triage
Allows for adjustment on patient response, to direct more in-depth treatment and prepare for a nine-line medical evacuation request
What is tertiary triage
Continued management of patients where more complicated procedures should be weighed against the situation
When should CPR be considered?
traumatic disorders such as hypothermia, near drowning, or electrocution.
What is the cause of early trauma deaths
Early trauma deaths are due to disruptions in one, or all, of three bodily systems: the respiratory system, the vascular system, or the central nervous system.
Define light combat stress
Immediate return to duty or return to unit or unit’s non combatsupport element with duty limitations or rest.
Define heavy combat stress
Send to combat stress control restoration center for up to 3 days reconstitution.
What is the acronym BICEP used for
Utilized for treatment of combat stress
- Brief: Keep interventions to 3 days or less of rest, food, and reconditioning.
- Immediate: Treat as soon as symptoms are recognized. Do not delay!
- Central: Keep in one area for mutual support and identity as service members
- Expectant: Reaffirm that we expect them to return to duty after brief rest; normalize the reaction and their duty to return to their unit
- Proximal: Keep them as close as possible to the unit. This includes physical proximity and using the ties of loyalty to fellow unit members. Do this through any available means. Do not evacuate away from the area of operation or the unit, when possible
- Simple: Do not engage in psychotherapy. Address the present stress responseand situation only, using rest, limited catharsis and brief support
- refer: Must be referred to a facility that is better quipped or staffed forcare
Which TCC category:
(a)Get the patients who are not clearly dead to cover (not concealment) if possible.
(b)Continue with the mission/fight. Gain fire superiority!
Care under fire
Which TCC category:
(a)Perform an initial rapid assessment of the casualty for triage purposes. This should takeno more than 1 minute per patient.
(b)If a casualty can walk, he/she will probably do well. Slow internal/external hemorrhage may still be present.
(c)Perform immediate lifesaving interventions as indicated, stop the bleeding/decompression of pneumothorax/hemothorax. Move rapidly.
(d)Majority of preventable deaths are a result of an inability to control external hemorrhage. Assessing airway is a waste when the patient has bled out.
(e)Talk to the casualty when checking radial pulse. If patient obeys commands and hasstrong radial pulse, he/she has a greater 95% chance of living. Should be categorized asminimal or delayed.
(f)If patient obeys commands, but has weak or absent pulse, he/she is at increased riskofdying and may benefit from a lifesaving intervention. This casualty should be in theimmediate category.
(g)If the casualty does not obey commands and has a weak or absent radial pulse, thecasualty has a markedly increased risk of dying (>92%), and needs a life saving intervention. This patient should be in the immediate category or possibly expectantdepending on available resources.
(h)Prepare the casualties to move out of the area.
(i)Prevent hypothermia.
Tactical field care
Which TCC category:
(a)Triage casualties again.
(b)Use any advanced diagnostic equipment available at this time to aid in triage.
(c)Soft tissue injuries are common and may look bad but are not lethal if not accompanied with shock.
(d)Bleeding from most extremity wounds should be controlled with a tourniquet or hemostatic dressing. Tactical evacuation delays should not increase mortality ifbleeding is fully controlled.
(e)Casualties who are in shock should be evacuated as soon as possible.
(f)Casualties with penetrating wounds of the chest who have respiratory distressunrelieved with needle decompression of the chest should be evacuated as soon aspossible.
(g)Penetrating wounds of the chest or abdomen who are in shock have a high risk of dying.
(h)Blunt or penetrating trauma to the face associated with difficulty breathing shouldimmediately receive a definitive airway.
(i)Blunt or penetrating wounds of the head in which there is massive brain damage andunconsciousness are unlikely to survive with or without emergent evacuation.
(j)Casualties with blunt or penetrating wounds of the head in which the skull has beenpenetrated but are still conscious should be emergently evacuated.
(k)Casualties with penetrating wounds of the chest or abdomen who are not in shock at their 15-minute evaluation have a moderate risk of developing late shock from slowly bleeding internal injuries. They should be carefully monitored and evacuated as soon as feasible.
Tactical evacuation
CCP should be based on what factors
(a)Proximity to patients
(b)Proximity to vehicular access.
(c)Proximity to HLZ
(d)Geography, safety “geographic triage.”
What is level/role/echelon 1 of care
Self-aid and Buddy-aid
ex: BAS/Destroyer
Level/role/echelon 2 level of care
Saving life, limb, and when necessary stabilization for evacuation
What is the largest Casualty receiving and treatment ship
LHD
Who does MEDBN provide surgical care for and how long can they hold patients
Provides surgical care for the Marine Expeditionary Forces. Provides stabilizing surgical procedures capable of holding patients for 72hours
What is Shock Trauma Platoon (STP)?
A small forward unit with one physician supporting the MEF, specializing in patient stabilization and casualty evacuation, but does not have surgical capabilities. ATLS intensive consisting of a stabilization section and collecting/evacuation.
What is Role 2 light maneuver (R2LM)
Light, highly mobile medical units designed to support lane maneuver formations. Conducts advanced resuscitation procedures up to damage control surgery. Casualties will leave this level and be transported to either role 3 or R2E.
What is Role 2 enhanced (R2E)
Provides basic secondary healthcare built around primary surgery, intensive care unit, and ward beds. A R2E is able to stabilize patients for evacuation to role 4 without having to route them through a role 3.
What is level/role/echelon 3 of care
The highest level of care available within a combat zone. Advanced resuscitative care is the primary objective of care.
What is level/role/echelon 4 of care
Definitive medical care is the primary objective at this level
What is level/role/echelon 5 of care
Restorative and rehabilitative care is the primary objective of care at this level
Generally, utilizes USAF fixed-winged aircraft to move sickor injured personnel within the theater or operations (Intra-theater) or between two theaters(Inter-theater). This is a regulated system in which care is provided by AE crew members.The crew may be augmented with Critical Care Air Transport Teams (CCATTs) to provide intensive care unit level of care
Aeromedical evacuation (AE
HMMWV frame with armor protection for crew and patients
M997 Ambulance
HMMWV frame with removable soft top
M1035 Ambulance
Non-medical vehicle that may be utilized for casualty transport when available
MK 23 7 ton
What method of air evacuation has an on-board oxygen generation, and a medical suction system.
UH 60 A Blackhawk
Nomenclature for the seahawk
SH-60B
What is a Medium lift helicopter used to transport personnel and cargo (beingphased out by the MV-22 Osprey Tilt Rotor Aircraft).
CH-46 Sea Knight
What is a Medium/Heavy lift helicopter used to transport personnel and cargo.
CH-53 D/E Sea Stallion
What is Light transport helicopter used to transport personnel and cargo.
CH-1 Huey
What is Tilt-rotor aircraft that takes off and lands vertically but flies like a plane.This aircraft is designed to eventually replace the CH-46
MV-22 Osprey
What is Not equipped to evacuate litter patients, but in a pinch can transport 28 ambulatory patients.
C-2 (COD) Greyhound
MEDEVAC/CASEVAC Priorities
Casualty must be evacuated within 2 hours in order to save life, limb or eyesight
Urgent
Examples of Urgent MEDEVAC/CASEVAC priority
1)Cardiorespiratory distress
2)Uncontrolled hemorrhage
3)Shock not responding to IV therapy
4)Head injuries with signs of increased ICP
5)Extremities with neurovascular compromise
MEDEVAC/CASEVAC Priorities
Casualty must be evacuated within 4 hours or condition could worsen
Priority
Examples of Priority MEDEVAC/CASEVAC
1)Flail chest segments without respiratory compromise
2)Open fractures
3)Spinal injuries
4)Major burns
MEDEVAC/CASEVAC Priorities
Casualty must be evacuated within 24 hours for further care.
Routine
Examples of routine MEDEVAC/CASEVAC priority
1)Minor to moderate burns
2)Simple, closed fractures
3)Minor open wounds
4)Terminal Casualties
Line 1 of 9 line
Location of pick up site (Grid coordinates).
Line 2 of 9 line
Frequency/Call sign of pick up site.
Line 3 of 9 line
Number of patients by precedence:
(a)A- Urgent
(b)C- Priority
(c)D- Routine
Line 4 of 9 line
Special equipment needed:
(a)A- None
(b)B- Hoist
(c)C- Extraction equipment
(d)D- Ventilator
Line 5 of 9 line
Number of patients by type
(a)L - # of litter
(b)A- # of ambulatory
Line 6 of 9 line
Security of pickup site:
(a)N - No enemy
(b)P - Possible enemy
(c)E - Enemy in area
(d)X - Armed escort required
Line 7 of 9 line
Method of marking pickup site:
(a)A - Panels
(b)B - Pyrotechnics
(c)C - Smoke
(d)D - None
(e)E – Other
Line 8 of 9 line
Patient nationality and status:
(a)A - US Military
(b)B - US Civilian
(c)C - Non US Military
(d)D - Non U
(e)S Civilian
Line 9 of 9 line
NBC Contamination:
(a)N- Nuclear
(b)B- Biological
(c)C- Chemical
Mist Report consists of the four following categories
(a)Mechanism of Injury: A brief description of the mechanism of the injury. For example:IED blast, GSW, rollover, fall.
(b)Injuries Sustained: A brief description of the injuries sustained starting with the most serious first. Highlight life threatening injuries. For example: Bilateral lower extremity amputations.
(c)Signs/Symptoms: Vital signs or significant symptoms. For example: BP 90/palpand difficulty breathing.
(d)Treatment: Treatments rendered. For example: Tourniquets applied with bleeding controlled or Ketamine 50 mg IM.
The branch of mechanics that studies the motion of a body or a system ofbodies without consideration given to its mass or the forces acting on it, its essence revolvesaround motion. All injury, except thermal and radiation, are related to the interaction of the host and a moving object.
Kinematics
Newton’s first law states that
every object will remain at rest or in uniform motion unless compelled to change its state by the action of an external force. We know it more commonly as Inertia.
Newton’s second law builds on the first and further defines
a force (F) as equal to the product of the mass (m) and acceleration (a). F=ma
Force =
mass x acceleration/deceleration
The law of conservation of energy states
energy can neither be created nor destroyed. Itis only changed from one form to another.
The forms energy can take are
(a)Mechanical
(b)Thermal
(c)Electrical
(d)Chemical
Who first proposed that the kinetic energy possessed by the bullet was dissipated in four ways
Theodore Kocher
Theodore Kocher first proposed that the kinetic energy possessed by the bullet was dissipated in four ways:
(a)Heat
(b)Energy used to move tissue radically outward
(c)Energy used to form a primary path by direct crush of the tissue
The characteristics of damage created along the track of a bullet are divided into two components
the temporary and permanent cavities
The _________ _________ is the momentary stretch or movements of tissue away from the path of the bullet.
temporary cavity
The ________ _________also forms at the time of impact and is caused by compression or tearing of tissue, but it does not necessarily rebound to its original shape and can be seen later
permanent cavity
the deviation of the projectile in its longitudinal axis from the straight line offlight
Yaw
the forward rotation around the center of mass
Tumbling
mushrooming of the projectile that increases the diameter of the projectile, usually by a factor of 2, increases the surface area, and, hence, the tissue contact area by four times; hollow point, soft nose, and dum-dum bullets all promote deformation
Deformation
which multiple projectiles can weaken the tissue in multiple places and enhance the damage rendered by cavitation. This usually occurs in high-velocity missiles.
Fragmentation
Energy Levels of Projectiles:
(a)Knives, needles, ice picks (hand-driven weapons)
1)Tissue damage by crushing is minimal
2)Throat, thoracic, abdominal, and back stabbing
Low
Energy Levels of Projectiles:
Firearms with muzzle velocity of less than 1,500 feet second. (.357 magnum, 9 mm, .45auto)
Medium
Energy Levels of Projectiles:
(a)Firearms with muzzle velocity of more than 1500 feet per second. (.44 magnum, .50AE)
(b)Injury track of high-powered weapons are at least 2-3 times the diameter of the projectile
High
Important factors to assess in making this decision are
age of the patient, the circumstance of the injury, and the caliber of weapon
The majority of penetrating trauma is a result of
stabbings and gunshot injuries
The approach to thoracic injuries typically depends upon
the mechanism (penetrating vs. blunt), severity (life threatening vs. stable), and the location of injury (chest wall vs. pleura vs. lung)
the primary acute manifestation, also occurs in the chronic setting when the injured great vessel forms a fistula involving an adjacent structure or when a posttraumatic aneurysm or pseudoaneurysm ruptures
Exsanguinating hemorrhage
Blast injuries are subdivided into four categories
Primary
Secondary
Tertiary
Quaternary
Effects of Overpressure and Underpressure from a blast wave-is distinctlyuncommon in surviving casualties except in the form of perforated tympanicmembranes.
Primary blast injury
Flying Debris/fragments, missiles in conjunction with the “blast wind”(i.e., the mass of air displaced by the explosion) are responsible for the gross mutilation that is characteristic of such injuries.
Secondary blast injury
What are tertiary blast injuries
body displacement
What are quaternary blast injuries
Burns
