ORGANIZATION OF TRAUMA CARE Flashcards
What is the process for prioritizing patient treatment during mass casualty events based on their need for or likely benefit from immediate medical attention?
Triage
What are some categories that can change the basis of triage?
- Numbers of injured
- Available resources
- Nature and extent of injuries
- Change in patient’s condition
- Hostile threat in the area
Multiple or Mass casualty situation?
The number of patients and the severities of their injuries DO NOT exceed the resources and capabilities.
Multiple Casualties
Multiple or Mass casualty situation?
The number of patients and the severities of their injuries DO exceed the resources and capabilities
Mass casualties
What are the 5 principles of triage?
- Degree of life threat posed by injuries sustained
- Injury severity
- Salvageability
- Resources
- Time, distance, and environment
What principle of trauma is determined by considering the order of priorities identified during the primary survey of an individual patient and applying the same principles to a group of patients?
Degree of life threat posed by the injuries sustained
What principle of trauma 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
What principle of trauma involves the consideration 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
Salvageability
During a mass casualty the determining factor is not the magnitude of the incident or the total number of casualties but rather whether or not you have what?
Appropriate resources
What category of military triage needs lifesaving interventions within minutes up to 2 hours on arrival to avoid death or major disability?
Immediate
These patients are examples of what category of military triage?
- Massive hemorrhage
- Airway obstruction or potential compromise, including potential complications from facial burns or anaphylaxis
- Tension pneumothorax
- Penetrating chest wound WITH respiratory distress
- Torso, neck, or pelvis injuries WITH shock
- Head injuries requiring emergent decompression
- Threatened loss of limb
- Retrobulbar hematoma (threat to loss of sight)
- Multiple extremity amputations
Immediate
What category of military triage are patients that require medical attention but CAN wait?
Delayed
What category of military triage 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?
Delayed
Examples of what kind of patients will show NO signs of shock on the following injuries?
- Soft tissue injuries without significant bleeding
- Fractures
- Compartment syndrome
- Intra-abdominal and/or thoracic bleeding
- Moderate to severe burns with less than 20% of total body surface area
- Blunt or penetrating torso injuries without the signs of shock
- Facial fractures without airway compromise
- Globe injuries
Delayed
What category of military triage can be treated with self aid, buddy aid, and/or Corpsman aid?
Minimal
What category of triage will patients with the following injuries fall into?
- Minor burns, lacerations, contusions, sprains and strains
- Simple, closed fractures without neurovascular compromise
- Combat stress reaction
Minimal
What category of military triage do patients who require complicated treatments that may not improve life expectancy fall into?
Expectant
The following are examples of what category of military triage?
- Massive head injuries with signs of impending death or in a coma
- Cardiopulmonary failure
- Clearly dead casualty with no signs of life or vital signs regardless of MOI
- Second and third degree burns in excess of 85% total body surface area
- Open pelvic injuries with uncontrolled bleeding and class IV shock
- High spinal cord injuries
Expectant
What strip on the triage tag is the fourth stripe on the tag, and casualties are either dead or non-salvageable and entails no care is needed?
Black (deceased/expectant)
What strip on the triage tag is the third stripe on the tag, casualties have minor injuries and will need minimal care; they should be transported after the immediate and delayed have been evacuated?
Green (minimal)
What strip on the triage tag is the second stripe on the tag, casualties are in the most need of care and or transport to a higher echelon of care; they should receive care before all other casualties?
Red (immediate)
What strip on the triage tag is the first stripe on the tag, casualties will need care, but in no hurry; they will be transported only after the more critically injured have been stabilized and transported?
Yellow (delayed)
What phase of triage is the simple and quick categorization of patients; identifying and stopping life threats, this breaks down patients into more manageable groups?
Primary triage
What are the two important parts of primary triage?
- Immediate life sustaining care
2. Situation awareness
What phase of triage allows for adjustment on patient response, to direct more in-depth treatment and prepare for a nine-line medical evacuation request?
Secondary triage
In what phase of triage will you document, reassess, and sort patients by their treatment need and provide medical treatment as appropriate and available?
Secondary Triage
- Give further direction of treatment and re-categorize patients as necessary
- Begin MEDEVAC/CASEVAC considerations and request the medical evacuation if not already done
What phase of triage is the continued management of patients where more complicated procedures should be weighed against the situation?
Tertiary triage
True or False
CPR should only be considered for non-traumatic disorders such as hypothermia, near drowning, or electrocution
True
In what phase of triage should you reassess the condition of patients relevant to resources, transportation capabilities and medical facilities available to receive casualties?
Tertiary triage
Early trauma deaths are due to disruption in one, or all, of what three bodily systems?
- Respiratory
- Vascular
- CNS
True or False
Field triage considerations: Rapid
In order to triage and provide lifesaving assistance to as many victims as possible. the provider must limit evaluations to the most significant medical characteristics of the victim
True
True or False
Wounded contaminated in a biological and/or chemical battlefield environment can just be decontaminated after they enter the MTF
False
These casualties must be decontaminated prior to entering the treatment facility.
Patients with what should be segregated immediately and treated last?
Retained, unexploded ordinance
Combat stress
With expeditious care, these casualties can be returned to duty what percentage of time?
80%
Patients with combat stress should be placed in one of what two categories?
- Light stress
2. Heavy stress
Combat stress
What category of stress is an immediate return to duty or return to unit or unit’s non combat support element with duty limitations or rest?
Light stress
Combat stress
What category of stress is when you send the patient to combat stress control restoration center for up to 3 days for reconstitution?
Heavy stress
What is the BICEP mnemonic used for?
Comat stress
What does the mnemonic BICEP stand for?
- Brief: keep intervention 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 identify 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
- Simple: Do not engage in psychotherapy. Address the present stress response and situation only, using rest limited catharsis and brief support
- Or refer: Must be referred to a facility that is better equipped or staffed for care
What are some important parts of Triage in TCCC?
- Care under fire
- Tactical field care
- Tactical evacuation
True or False
Care under fire
Get the patients who are clearly not dead to concealment if possible
False
Get the patients who are not clearly dead to COVER if possible
Tactical Field Care
The majority of preventable deaths are a result of an inability to control what?
External Hemorrhage
Tactical Field Care
Talk to the casualty when checking the radial pule; if the patient obeys commands and has a strong radial pulse, they have a ___% chance of living, should be categorized as minimal or delayed
95%
If patient obeys commands, but has weak or absent pulse, he/she is at increased risk of dying and may benefit from a lifesaving intervention. This casualty should be in what category?
Immediate category
True or False
Tactical Field Care
If the casualty does not obey commands and has a weak or absent radial pulse, the casualty has a markedly increased risk of dying (>92%), and needs a lifesaving intervention. This patient should be in the immediate category or possibly expectant depending on available resources.
True
During tactical evacuation is it recommended to triage casualties again?
Yes
Bleeding from extremity wounds should be controlled with what?
Tourniquet or hemostatic dressings
True or False
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.
True
You should quickly choose a casualty collection point based on what?
- Proximity to patients
- Proximity to vehicular access
- Proximity to HLZ
- Geography, safety “geographic triage”
What are some inherent problems with a CCP?
- Command and control
- Triage
- Equipment removal and dissemination
- Casualty accountability
- Changing triage categories
- Security
- Noise and light discipline
What level of care is the first medical care military personnel receive, includes live saving measures, disease and non-battle injury prevention and care, combat and operation stress control (COSC), patient location and acquisition?
Level (role/echelon) 1
What level of care does Self/Buddy Aid, Combat life savers, and medical personnel fall into?
Level (role/echelon) 1
What are some examples of Level (role/echelon) 1 care?
- Battalion Aid Station
2. Cruisers, Destroyers, and below
What level of care includes initial resuscitative care being the primary objective of care at this level; saving life, limb, and when necessary stabilization for evac to Level 3?
Level (role/echelon) 2
What are some examples of Level (role/echelon) 2 care?
- Casualty Receiving and Treatment Ships (CRTS)
a. LHD
b. LHA
c. CVN - Medical Battalion
- Shock Trauma Platoon
- Forwards Resuscitative Surgical Suite (FRSS)
- Role 2 Light Maneuver (R2LM)
- Role 2 Enhanced (R2E)
What provides surgical care for the Marine Expeditionary Forces and provides stabilizing surgical procedures capable of holding patients for 72 hours?
Medical Battalion
What is 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?
Shock Trauma Platoon (STP)
What is a forward deployed surgical suite developed due to the Medical Battalion being to large?
Forward resuscitative surgical suite (FRSS)
What is a light, highly mobile medical unit designed to support lane maneuver formations, conducts advanced resuscitation procedures up to damage control surgery?
Role 2 Light Maneuver (R2LM)
Casualties will leave this level and be transport to either a role 3 or R2E
What provides basic secondary healthcare built around primary surgery, ICU, and ward beds, this is able to stabilize patients for evacuation to a role 4 without having to route them through a role 3?
Role 2 Enhanced (R2E)
What is the
What is the
What level of care is the highest level of care available within a combat zone with advanced resuscitative care being the primary objective of care?
Level (role/echelon) 3
What are some examples of Level (role/echelon) 3 care?
- Fleet hospitals
2. Hospital Ships
What level of care has the primary objective of definitive medical care at that level?
Level (role/echelon) 4
What level of care has the primary objective of restorative and rehabilitative care at that level?
Level (role/echelon) 5
What form of evacuation is the timely and efficient movement and enroute care provided by medical personnel to the wounded being evacuated from the battle field to the MTF using medically equipped vehicles or aircraft; this includes transportation from one MTF to another by medical personnel such as ship to shore?
MEDEVAC
What form of evacuation is the movement of casualties from the point of injury to medical treatment by non-medical personnel, casualties transported under these circumstances may not receive enroute care, this is usually a lift of opportunity?
Casualty Evacuation (CASEVAC)
What evacuation generally utilizes USAF fixed-winged aircraft to move sick or injured personnel within the theater or operation (intra-theater) or between two theaters (inter-theater); this is a regulated system in which care is provided by the crew members?
Aeromedical Evacuation (AE)
The crew may be augmented with Critical Care Air Transport Teams (CCATTs) to provide intensive care unit level of care
What is the maintenance of treatment initiated prior to evacuation and sustainment of the patient’s medical condition during evacuation?
En route care
What kind of litter is prefabricated and may have accessories to be used with them, this is the standard collapsible litter most widely used in theater?
Standard litter
What is the most commonly used litter aboard ships?
Stokes litter
What litter is a compact and lightweight transport system used to evacuate a patient over land and can also be used in water?
SKED litter
In moving a patient, the litter bearers must make every movement deliberately and as gently as possible, the command ____ should be used in order to prevent undue haste
“steady”
Patients must be carried on the litter FEET first, except when?
When going uphill or up stairs
What are some examples of methods of ground evacuation?
- M997 Ambulance
- M1035 Ambulance
- MK 23 7 Ton
What are some examples of methods of air evacuation?
- UH 60 A Blackhawk
- SH-60B Seahawk
- CH-46 Sea Knight
- Ch-53 D/E Sea Stallion
- CH-1 Huey
- MV-22 Osprey
- C-2 Greyhound
- P-3 Orion
- C-130 Hercules
When transporting a patient by air you should consider cabin altitude restriction (CAR) for what?
- Penetrating eye injuries with intraocular air
- Free air in any body cavity
- Severe pulmonary disease
- Decompression sickness and arterial gas embolism
What MEDEVAC/CASEVAC priority is when a casualty must be evacuated within 2 hours in order to save life, limb, or eyesight?
Urgent
What MEDEVAC/CASEVAC priority is when the casualty must be evacuated within 4 hours or the condition could worsen?
Priority
In what MEDEVAC/CASEVAC priority is when the casualty must be evacuated within 24 hours for further care?
Routine
What are lines 1 through 5 of the 9 line?
- Location of pick up site (grid coordinates)
- Frequency/Call sign of pick up site
- Number of patients by precedence
a. A - Urgent
b. B - Priority
c. C - Routine - Special Equipment Needed
a. A - None
b. B - Hoist
c. C - Extraction Equipment
d. D - Ventilator - Number of patients by type
a. L - # of litter
b. A - # of ambulatory
What are lines 6 through 9 of the 9 Line?
- Security of pick up site
a. N - No enemy
b. P - Possible enemy
c. E - Enemy in the area
d. X - Armed escort required - Method of marking
a. A - panels
b. B - pyrotechnics
c. C - smoke
d. D - none
e. E - other - Patient Nationality and Status
a. A - US military
b. B - US civilian
c. C - Non US military
d. D - Non US Civilian
e. E - EPW - NBC Contamination
A Mist Report consists of what four categories?
- Mechanism of Injury
- Injuries sustained
- Signs/Symptoms
- Treatment
What is the branch of mechanics that studies the motion of a body or system of bodies without consideration given to its mass or the forces acting on it, its essence revolves around motion?
Kinematics
Mass x acceleration/deceleration = What?
Force
What are the forms that energy can take?
- Mechanical
- Thermal
- Electrical
- Chemical
Which of Newton’s laws 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, commonly referred to as Inertia?
Newton’s first law
Which of Newton’s laws builds on the first and further defines a force (F) as equal to the product of the mass (M) and acceleration (A)? (F=ma)
Newton’s Second Law
Theodore Kocher first proposed that the kinetic energy possessed by the bullet was dissipated in what ways?
- Heat
- Energy used to move tissue radically forward
- Energy used to form a primary path by direct crush of the tissue
When a solid object strikes the human body or when the body is in motion and strikes a stationary object, the tissue particles are knocked out of their normal position creating a hole or cavity; this process is called what?
Cavitation
The characteristics of damage created along the track of a bullet are divided into what two components?
Temporary and permanent cavities
Bullets can be constructed to alter their performance and increase the permanent cavity after they strike their target; this can be enhanced in what four ways that all work by increasing the surface area of the projectile - interface which facilitates the transfer of kinetic energy to the target, these include what?
- Yaw
- Tumbling
- Deformation
- Fragmentation
What is the deviation of the projectile in its longitudinal axis from the straight line of flight?
Yaw
What is the forward rotation around the center of mass?
Tumbling
What is the 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 points, soft nose, and dum-dum bullets all promotes this?
Deformation
What is it known in which multiple projectiles can weaken the tissue in multiple places and enhance the damage rendered by cavitation, usually occurs in high-velocity missiles?
Fragmentation
Penetrating trauma depends on what?
- Speed of entry
2. Type of body tissue penetrated
What energy level of projectiles is this?
- Knives, needles, ice picks (hand driven weapons)
a. tissue damage by crushing is minimal
b. throat, thoracic, abdominal, and back stabbing
Low
What energy level of projectiles is this?
Firearms with muzzle velocity of less than 1,500 feet per second (357 magnum, 9mm, 45 auto)
Medium
What energy level of projectiles is this?
- Firearms with muzzle velocity of more than 1500 fps (44 magnum, 50 AE)
- Injury track of high-powered weapons are at least 2-3 times the diameter of the projectile
High
True or False
Tissue crash is limited by the physical size or profile of the projectile
True
Missiles that flatten upon impact cause what?
Deformation
Elastic tissue (bowel and lung) can tolerate damage better than what kind of organs?
Non-elastic organs (heart, liver, kidney, and brain)
What determines the extent of cavitation and tissue deformation?
Striking velocity
Striking velocity
___ velocity produces more energy and more cavitation
High velocity
Striking velocity
___ velocity produces localized injury and little force
Low velocity
Range
Direct contact
Most devastation
Range
Close Range
7 yards or less
Range
High power
More damage with muzzle velocities
What are the two signs, which remain absolute indications for laparotomy following penetrating or blunt abdominal trauma are what?
- Peritonitis
2. Hemodynamic instability
Penetrating injuries to the head, particularly gunshot wounds to the head can carry as high as ___% mortality
90%
Neck
The majority of penetrating trauma is the result of what?
Stabbing and gun shot injuries
High velocity injuries, (>2,500 feet/second), such as high-powered rifles, often generate a missile velocity which has ___ times more energy generated than handguns that are associated with substantially lower missile velocities.
60 times
Thoracic injuries are common following both penetrating and blunt trauma and it has been estimated that chest injuries are responsible for ___% to ___% of all trauma deaths
20% to 25%
The approach to thoracic injuries typically depends on what?
- Mechanism (penetrating vs. blunt)
- Severity (life threatening vs. stable)
- Location of injury (chest wall vs. pleura vs. lung)
Stab wounds to the back result in significant injuries requiring surgical repair in only about __% of patients
15%
The mere presence of a gunshot wound to the abdomen with potential violation of the peritoneum equals what?
Laparotomy
The great majority of vascular injuries are due to what?
Penetrating trauma
What are the most common penetrating mechanisms of injuries in the military setting?
- Shrapnel from bombs
- Land mines
- Grenades
What are the most common penetrating agents causing civilian extremity vascular injury?
Gunshots, mostly low velocity
What is the most commonly injured artery from gunshot wounds?
Femoral
True or False
As an IDC, your focus should be on early identification and location of penetrating trauma, stabilization of the patient and MEDEVAC/CASEVAC to a higher echelon of care as soon as the patient(s) can tolerate the transfer.
True
The most commonly encountered exploding munitions are in the form of what?
- Grenades
- Rockets
- Bombs
- Mines
- Anti-material munitions with anti-personnel effects
Blast injuries are subdivided into what four categories?
- Primary
- Secondary
3, Tertiary - Quaternary
What category of blast injuries are the effects of over pressure and under pressure from a blast wave and is distinctly uncommon in surviving casualties except in the form of perforated tympanic membranes?
Primary
What category of blast injury involves flying debris/fragments, missiles in conjunction with the “blast wind” (the mass of air displaced by the explosion) are responsible for the gross mutilation that is characteristic of such injuries?
Secondary
What category of blast injuries involves body displacement ?
Tertiary
What category of blast injuries involves burns?
Quaternary
