5 - Military Medicine

Question 1

Levels of care in military medicine?

Answer 1

Role I: self/buddy aid - BTN aid station

Role II: brigade/division level

Role III: corps level - combat support hospital

Role IV: definitive care

Role V: hospital in US

Question 2

Capability of Role II?

Answer 2

Role II: brigade/division level

• medical support company
• forward surgical team (FST)
• blood, x-ray, lab, pt hold

Question 3

Capability of role III?

Answer 3

Role III: corps level - combat support hospital

• in theater mil tx facility
• full surgical care
• hold
• lab
• radiology (include CT)
• stabilizing care for evac

Question 4

Capability of role IV?

Answer 4

Role IV: definitive care

• out of theater
• full rehab care
• tertiary care capability

Question 5

Capability of Role V?

Answer 5

Hospital in US (if role IV is not in US)

Question 6

9 line medivac request

Answer 6

1: location
2: call sign/freq
3: # pts by PRECEDENCE
4: special equipment
5: # pts by TYPE

6:
- security (wartime)
- # and type of wounded (peacetime)
7: method of marking DZ
8: Pt nationality and status
9:
- NBC (wartime)
- landmarks (peacetime)

First 5: Low flying pilots eat tacos
- will get the bird off the ground

Question 7

What is TCCC designed for?

Answer 7

Address preventable causes of death

• extremity hemorrhage
• hemo/pneumothorax
• hypothermia/coagulopathy

Question 8

Phases of TCCC?

Answer 8

Phase 1: care under fire
Phase 2: tactical field care
Phase 3: casualty evacuation

Question 9

What is phase 1 (TCCC)

Answer 9

Care under fire

• during active enemy engagement
• 1st priority is to return fire/secure site
• very limited medical care

Question 10

What is the only medical care performed under phase 1?

Answer 10

Hemorrhage control

• tourniquets
• field and pressure dressings

Question 11

Phase 2 (TCCC)

Answer 11

Tactical field care

• no longer under effective hostile fire
• longest phase of care
• perform primary survey
• limited medical care

Question 12

What medical tx are performed in phase 2?

Answer 12

C-B-A/MARCH:

Hemorrhage control

• hemotstatic agents: combat gauze/hemcon
• tourniquets, pressure dressing, field dressing

Airway
- Needle D, Chest tuber, occlusive dressing, crichothyrodomy

Circulation
- IV/IO access - permissive HOTN

Hypothermia/head injury

• keep them warm
• inform air crew about head inj
• keep SBP 90-95 (brain perfusion)

Secondary survey

Pain control

Question 13

Phase 3?

Answer 13

Casualty evacuation

prepare for MEDEVAC
- secure and wrap pt

MEDEVAC

• proper handoff w flight medic
• prep meds etc

Question 14

What are considered special situations for TCCC?

Answer 14

Burns
Mass casualty
CPR
Joint/international ops

Question 15

Burns - special situation

Answer 15

• stop the burning
• treat life threats
• protect airway
• keep pt warm
• acute fluid resuscitaiton (LR Preferred)
• monitor urine output

Question 16

How is acute fluid resuscitaiton conducted with burns?

Answer 16

Rule of 10’s

Adults = 80kg: 10ml/hr x % TBSA
- adults >/= 80kg: add 100ml/hr for every 10kg over 80kg

Kids - 3x TBSA x body weight (kg) = amount of fluid given in 1st 24hrs
- 1/2 in first 8 hrs

Question 17

Urine output for burn therapy?

Answer 17

Maintain

• adults: 30-50ml/hr
• kids: 0.5-1ml/kg/hr

Question 18

Triage categories for Mass casualty event?

Answer 18

ID ME or DIME

I - immediate 
- “now” to avoid death
D - delayed
- surg intervention but can delay
M - minimal
- self/buddy aid
E - expectant
- will die no matter what (dont wast time/resources)

Question 19

Triage methods?

Answer 19

Simple and SALT

Slides 21, 22

Question 20

CPR in combat?

Answer 20

If req CPR = expectant
- don’t provide CPR at the expense of other casualties

NO CPR UNDER FIRE

Question 21

Goal of fluid rescuscitation in TCCC?

Answer 21

Enhance body’s ability to clot wile minimizing edema, dilution etc (iatrogenic resuscitaiton injury)

• keep vital organs perfused
• optimize oxygen carrying capacity

Question 22

Fluid resuscitation methods?

Answer 22

PO (preferred)
Crystalloids: MC - watch dilution
Colloids: not widely used
Whole blood: if youve got it
PRBC and platelets: difficult to store/transport

Question 23

Pain control in TCCC?

Answer 23

Crucial comfort for transport
Combat pill pack
Fentinyl lollipop
Ketamine 50mg IM, IV, IO, Intranasal

Nausea (from pain meds): ondasetron PO

Question 24

TCCC antibiotics?

Answer 24

Combat pill pack includes them

• moxifloxacin 400mg po
• cefotetan 2gm or ertapenem 1gm IV

Question 25

Whats wrong with velcro?

Answer 25

Its a total rip off