FMF Core - Section 136 Flashcards
TCCC
Tactical Combat Casualty Care
History of TCCC
90% of combat wound fatalities die before reaching MTF
Guidelines first introduced in 1996 by Special Ops Corpsman, Medics, and pararescuemen
Triage meaning
- French = To sort
- Quickly assess multiple casualties, assign priority according to severity of illness/injury
- Dynamic processes, priority subject to change
Phases of TCCC
1) Care Under Fire (CUF)
2) Tactical Field Care (TFC)
3) Tactical Evacuation Care (TACEVAC)
1) Care Under Fire (CUF)
Care rendered by first responder or combatant at scene of injury - Under Hostile Fire
2) Tactical Field Care (TFC)
Care rendered by first responder or combatant at scene of injury - No Longer Under Hostile Fire
3) Tactical Evacuation Care (TACEVAC)
Care rendered after casualty has been picked up by aircraft, ground vehicle, or boat
Treatment Plans for Care Under Fire (CUF)
1) Casualty Management Plan
- maintain fire superiority, take cover. key to preventing combat trauma
- casualty remains combatant (if possible)
- instruct to seek cover and apply self-aid (if possible)
- keep from sustaining additional wounds
2) Treatment Plan
- stop life-threatening hemorrhage with tourniquet
- if not tactically feasible, do not try to treat
- non-life threatening treatment defered until TFC
- move casualty to cover quickly
Treatment Plans for Tactical Field Care (TFC)
MAB CAM) (3B) F(MDM
1) Mental Status
2) Airway Management
3) Breathing Assessment
4) Circulatory Assessment
5) Assess for Shock
6) Management of Burns
7) Burn Classifications & types
8) Treatment of Burns
9) Management of Fractures
10) Administration of Medications
11) Document Baseline Vital Signs
12) Casualty Movement Technique Considerations
1) Mental Status
Determine responsiveness with AVUP
- Alert
- Vocal commands
- Pain
- Unresponsive
2) Airway Management
Anatomical Structures:
- Nose, mouth, throat, voicebox, windpipe
- Air diverted into lungs - bronchial tree, bottom of windpipe
- Lungs elastic organs
- Rib Cage protects lungs
- Diaphragm dome-shaped muscle separates bottom of lungs with abdominal cavity
General Guidelines:
- Assess with look, listen, feel technique for 5-10 seconds
- look for and remove foreign objects
- insert nasopharyngeal airway (NPA) - no if face fractures
- reassess after interventions
3) Breathing Assessment
- Inspect anterior thorax for bilateral rise and fall
- Auscultate chest (bad then good side)
- Palpate
- Treat penetrating injuries of chest with occlusive dressing
- Perform needle thoracentesis if pneumothorax is suspected
- Repeat assessment on posterior thorax
4) Circulatory Assessment
- Check for carotid pulse
- perform blood sweep
- apply tourniquet if necessary
- Assess radial pulse rate
- estimate blood pressure (radial 80/P, Femoral 70/P, Carotid 60/P)
- Assess peripheral perfusion: check skin color, skin temperature, skin condition.
- Check for capillary refill (<3sec)
5) Assess for Shock
Inadequate blood flow and oxygen to organs and tissues
- Anatomy of CVS: pump/container/fluid
- Signs & symptoms: Heart rate (>100 bpm); respirations (>20 bpm); Capillary refill (<3 sec); skin (cool, clammy, pale); Mental status: restless, disoriented, lethargic, unconscious
6) Management of Burns
Depends on source, exposure dose, location
- Anatomy: protective barrier, prevents fluid loss, regulates body temp, sensation
- Epidermis, Dermis, Subcutaneous
7) Burn Classifications
First: Epidermis
Second: Epidermis is destroyed
Third: all three layers destroyed
Fourth: all layers, plus fat, muscles, bone, organs
7) Types of burns
1) Thermal
2) Electrical
3) Chemical
4) Radiation
8) Treatment of Burns
Stop source - wrap with loose dry sterile dressing - prevent hypothermia - control hemorrhaging
1) Thermal/radiation - remove clothing and jewelry (unless stuck); keep warm
2) Electrical - disengage from ele. shock
3) Chemical - flush with water; brush off chemical; irrigate for 15 mins
9) Management of Fractures
open/closed fractures
- Signs & symptoms: deformity, pain with and w/o movement; protruding bone; swelling
- Splints to immobilize fracture: rigid/formable/improvised/anatomical/sling/swath
- Guidelines: control hemorrhaging; treat for shock; establish distal pulse; expose fracture site; cover both ends with dressing for open fracture; keep in position; keep immobile; reassess distal pulse
10) Administration of Medications
Combat pill pack:
- Moxifloxacin: One 400mg antibiotic tablet
- Mobic: One 15mg pain management tablet
- Tylenol: Two 650mg pain management tablets
11) Document Baseline Vital Signs
1) Respiratory Rate
2) Pulse Rate
3) Blood Pressure
12) Casualty Movement Technique Considerations
- conscious/unconscious
- location
- best method
- risk ro rescuer
- weight differences
- distance covered
Tactical Evacuation Priorities
Urgent Evac: to next higher echelon of care to save life or limb - within 2 hours
Priority Evac: to next higher echelon of care or patient will deteriorate to urgent category- within 4 hours
Routine Evac: to next higher echelon of care to complete treatement - within 24 hours
How to purify water under field conditions
1) Two iodine tablets for one-quart canteen
- wait 5 mins; soak threads; wait another 25 mins
2) boil water for 5 mins at sea level
