Organization of Trauma Care COPY

Question 1

The process of prioritizing patient treatment during mass casualty events based on their need for or likely benefit from immediate medical attention

Answer 1

Triage

Question 2

Triage categories are based upon:

Answer 2

Number of injured

Available resources

Nature and extent of injuries

Change in patient’s condition

Hostile threats in the area

Question 3

The number of patients and the severities of their injuries DO NOT exceed the resources and capabilities

Answer 3

Multiple casualties

Question 4

The number of patients and the severities of their injuries DO exceed the resources and capabilities

Answer 4

Mass casualty

Question 5

Five principles of triage

Answer 5

Degree of life threat posed by the injuries sustained

Injury severity

Salvageability

Resources

Time, distance, and environment

Question 6

Categories of military triage

Answer 6

Immediate

Delayed

Minimal

Expectant

Question 7

Needs lifesaving interventions within minutes up to 2 hours on arrival to avoid death or major disability

Answer 7

Immediate

Question 8

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

Answer 8

Immediate

Question 9

Requires medical attention but CAN wait

Answer 9

Delayed

Question 10

Examples include 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

Answer 10

Delayed

Question 11

Can be treated with self aid, buddy aid, and corpsman aid

Answer 11

Minimal

Question 12

Often referred to as “walking wounded”

Answer 12

Minimal

Question 13

1) Minor burns, lacerations, contusions, sprains and strains.
2) Simple, closed fractures without neurovascular compromise.
3) Combat stress reaction.

Answer 13

Minimal

Question 14

Require complicated treatments that may not improve life expectancy

Answer 14

Expectant

Question 15

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

Answer 15

Expectant

Question 16

Fourth stripe on the triage tag, casualties are dead or non-salvageable and entails no care is needed

Answer 16

Black (deceased/expectant)

Question 17

Third stripe on the triage tag, casualties have minor injuries and will need minimal care

Answer 17

Green (minimal)

Question 18

Second stripe on the triage 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

Answer 18

Red (immediate)

Question 19

First stipe 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

Answer 19

Yellow (delayed)

Question 20

Simply and quickly categorizing patients; identifying and stop life threats. Breaks down patients down into more manageable groups.

Answer 20

Primary Triage

Question 21

Allows for adjustment on patient response, to direct more in-depth treatment and prepare for a nine-line medical evacuation request

Answer 21

Secondary triage

Question 22

Stage of triage that includes immediate life sustaining care

Answer 22

Primary triage

Question 23

Stage of triage that includes documenting, reassessing, and sorting patients by their treatment needs

Answer 23

Secondary triage

Question 24

Stage of triage where you begin the MEDEVAC/CASEVAC considerations and request the medical evacuation if not already done

Answer 24

Secondary triage

Question 25

Continued management of patients where more complicated procedures should be weighed against the situation

Answer 25

Tertiary triage

Question 26

(a) Reassess condition of patients relevant to resources, transportation capabilities and medical facilities available to receive casualties. (b) Determine the priority for disposition of patients from incident site. (c) CPR should only be considered for non-traumatic disorders such as hypothermia, near drowning, or electrocution

Answer 26

Tertiary triage

Question 27

Early trauma deaths are due to disruptions in one, or all, of three bodily systems:

Answer 27

Respiratory system Vascular system Nervous system

Question 28

Category of stress Immediate return to duty or return to unit or unit's noncombat support element with duty limitations or rest

Answer 28

Light stress

Question 29

Category of stress Send to combat stress control restoration center for up to 3 days reconstitution

Answer 29

Heavy stress

Question 30

Mnemonic used for combat stress

Answer 30

BICEP SO Brief: Keep interventions to 3 days or less of rest, food, and reconditioning Immediate: Treat as soon as symptoms are recognized Central: Keep in one area for mutual support and identity of SVM Expectant: Reaffirm that we expect them to return to duty 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

Question 31

TCCC Get the patients who are not clearly dead to cover if possible Continue with the mission/fight. Gain fire superiority.

Answer 31

Care under fire

Question 32

TCCC Perform an initial rapid assessment of the casualty for triage purposes. This should take no more than 1 minute per patient Perform immediate lifesaving interventions as indicated. Move rapidly

Answer 32

Tactical Field Care

Question 33

Talk to the casualty when checking radial pulse. If the patient obeys commands and has strong radial pulse, they have a >___% chance of living Should be categorized as minimal or delayed

Answer 33

>95%

Question 34

If patient obeys commands, but has weak and absent pulse, he/she is at increased risk of dying and may benefit from a lifesaving intervention This patient should be categorized as ________

Answer 34

Immediate

Question 35

If the casualty does not obey commands and has a weak or absent radial pulse, the casualty has markedly increased risk of dying of >__% Patient needs lifesaving intervention and should be categorized as immediate or possibly expectant

Answer 35

>92%

Question 36

Quickly choose a casualty collection point based on:

Answer 36

Proximity to patients Proximity to vehicular access Proximity to HLZ Geography, safety "geographic triage"

Question 37

First medical care military personnel receive Includes immediate life saving measures, disease and non-battle injury prevention and care, combat and operational stress control (COSC), patient location and acquisition Treatment provided by self aid, buddy aid, combat life saver

Answer 37

Level (role/echelon) 1

Question 38

Levels of care 1) Battalion Aid Station 2) Cruisers, Destroyers

Answer 38

Level (role/echelon) 1

Question 39

Initial resuscitative care is the primary objective of care at this level Saving life, limb, and when necessary stabilization for evacuation

Answer 39

Level 2

Question 40

Examples of Level 2

Answer 40

LHD LHA CVN MEDBN STP FRSS R2LM R2E

Question 41

Provides surgical care for the Marine Expeditionary Forces. Provides stabilizing surgical procedures capable of holding patients for 72 hours

Answer 41

Medical Battalion (MEDBN)

Question 42

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.

Answer 42

Shock trauma platoon (STP)

Question 43

Forward deployed surgical suite developed due to the medical battalion being too large

Answer 43

Forward resuscitative surgical suite (FRSS)

Question 44

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.

Answer 44

Role 2 light maneuver (R2LM)

Question 45

Provides basic secondary healthcare built around primary surgery, intensive care unit, and ward beds. Able to stabilize patients for evacuation to role 4 without having to route them through a role 3.

Answer 45

Role 2 enhanced

Question 46

The highest level of care available within a combat zone Advanced resuscitative care is the primary objective of care

Answer 46

Level 3

Question 47

Examples of Level 3

Answer 47

Fleet hospitals Hospital ships

Question 48

Definitive medical care is the primary objective at this level

Answer 48

Level 4

Question 49

Examples of Level 4

Answer 49

NH Yokosuka Landstuhl regional medical center

Question 50

Restorative and rehabilitative care is the primary objective of care at this level

Answer 50

Level 5 - NMCSD - Walter Reed National Medical Center

Question 51

Timely, efficient movement and en route care provided by medical personnel to the wounded being evacuated from the battlefield to the military treatment facility (MTF) using medically equipped vehicles or aircraft. This includes transportation from one MTF to another by medical personnel, such as ship to shore.

Answer 51

MEDEVAC

Question 52

The movement of casualties from the point of injury to medical treatment by non-medical personnel. Casualties transported under these circumstances may not receive en route medical care. Usually a lift of opportunity

Answer 52

CASEVAC

Question 53

Generally, utilizes USAF fixed-winged aircraft to move sick or 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 crewmembers. The crew may be augmented with Critical Care Air Transport Teams (CCATTs) to provide intensive care unit level of care.

Answer 53

Aeromedical Evacuation (AE)

Question 54

The maintenance of treatment imitated prior to evacuation and sustainment of the patient's medical condition during evacuation

Answer 54

En route care

Question 55

Prefabricated and may have accessories to be used with them. (a) Standard collapsible litter most widely used in theater. (b) Litter can be decontaminated.

Answer 55

Standard litter

Question 56

Most commonly used litter onboard ships. (a) Composed of steel or aluminum with a tubular frame with a wooden slat to support patients back. (b) It has ropes, cables or steel rings that can be attached to the litter for vertical recoveries.

Answer 56

Stokes

Question 57

Compact and lightweight transport system used to evacuate a patient over land. Can also be used to rescue a patient in water.

Answer 57

SKED litter

Question 58

Made from various materials normally available in a forward area. (a) Great for manual carries or may have an injury that may be aggravated by manual transport. (b) Must be well constructed to avoid dropping patient or furthering injury.

Answer 58

Improvised litter

Question 59

In moving a patient, the litter bearers must make every movement deliberately and gently as possible. The command "_______" should be used in order to prevent undue haste.

Answer 59

Steady

Question 60

Patients must be carried on the litter feet first, except when:

Answer 60

Going uphill/upstairs

Question 61

Consider cabin altitude (CAR) for the following:

Answer 61

Penetrating eye injuries with intraocular air Free air in any body cavity Severe pulmonary disease Decompression sickness and Arterial gas embolism

Question 62

MEDEVAC/CASEVAC Priorities Casualty must be evacuated within 2 hours in order to save life, limb or eye sight

Answer 62

Urgent

Question 63

MEDEVAC/CASEVAC Priorities Casualty must be evacuated within 4 hours or condition could worsen

Answer 63

Priority

Question 64

MEDEVAC/CASEVAC Priorities Casualty must be evacuated within 24 hours for further care

Answer 64

Routine

Question 65

First five lines of the MEDEVAC Request (9 line)

Answer 65

Location Frequency Number of patients by precedence Special equipment needed Number of patients by type

Question 66

Last 4 lines of MEDEVAC request (9-line)

Answer 66

Security of pickup site Method of marking pickup site Patient nationality and status NBC Contamination

Question 67

Instituted as a standard part of the MEDEVAC request during OEF in Afghanistan. Although not a requirement per NATO guidelines it has become a norm in combat theaters.

Answer 67

MIST reporting

Question 68

MIST stands for:

Answer 68

Mechanism of Injury Injuries Sustained Signs/symptoms Treatment

Question 69

The branch of mechanics that studies the motion of a body or a system of bodies without consideration given to its mass or the forces acting on it, its essence revolves around motion. All injury, except thermal and radiation, are related to the interaction of the host and a moving object.

Answer 69

Kinematics

Question 70

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.

Answer 70

Newton's first law

Question 71

Defines a force (F) as equal to the product of the mass (m) and acceleration (a). F=ma.

Answer 71

Newton's second law

Question 72

Mass x acceleration/deceleration

Answer 72

Force

Question 73

The forms energy can take are:

Answer 73

Mechanical Thermal Electrical Chemical

Question 74

Theodore Kocher first proposed that the kinetic energy possessed by the bullet was dissipated in what ways:

Answer 74

Heat Energy used to move tissue radically outward Energy used to form a primary path by direct crush of the tissue

Question 75

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 known as __________

Answer 75

Cavitation

Question 76

The characteristics of damage created along the track of a bullet are divided into two components

Answer 76

Temporary and permanent cavities

Question 77

Bullets can be constructed to alter their performance and increase the permanent cavity after they strike their target. This can be enhanced in four ways that all work by increasing the surface area of the projectile- tissue interface which facilitates the transfer of kinetic energy to the target. These include the following

Answer 77

Yaw Tumbling Deformation Fragmentation

Question 78

The deviation of the projectile in its longitudinal axis from the straight line of flight

Answer 78

Yaw

Question 79

The forward rotation around the center of mass

Answer 79

Tumbling

Question 80

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

Answer 80

Deformation

Question 81

In which multiple projectiles can weaken the tissue in multiple places and enhance the damage rendered by cavitation. This usually occurs in high-velocity missiles.

Answer 81

Fragmentation

Question 82

Penetrating trauma depends on:

Answer 82

Speed of entry Type of body tissue penetrated

Question 83

Energy Levels of Projectiles Knives, needles, ice picks (hand-driven weapons) 1) Tissue damage by crushing is minimal 2) Throat, thoracic, abdominal, and back stabbing

Answer 83

Low

Question 84

Energy Levels of Projectiles Firearms with muzzle velocity of less than 1,500 feet second. (.357 magnum, 9 mm, .45 auto)

Answer 84

Medium

Question 85

Energy Levels of Projectiles Firearms with muzzle velocity of more than 1500 feet per second. (.44 magnum, .50 AE) Injury track of high-powered weapons are at least 2-3 times the diameter of the projectile

Answer 85

High

Question 86

Tissue crush is limited by the:

Answer 86

Physical size or profile of the projectile

Question 87

Missiles that flatten upon impact

Answer 87

Deformation

Question 88

Tolerate damage better than non-elastic organs (heart, liver, kidney and brain.)

Answer 88

Elastic tissue (bowel and lung)

Question 89

____ velocity produces more energy and more cavitation

Answer 89

High

Question 90

_____ velocity produces localized injury and little force

Answer 90

Low

Question 91

Range The most devastation

Answer 91

Direct contact

Question 92

Close range =

Answer 92

7 yards or less

Question 93

High power =

Answer 93

More damage with muzzle velocities

Question 94

The two signs, which remain absolute indications for laparotomy following penetrating or blunt abdominal trauma are:

Answer 94

Peritonitis Hemodynamic instability

Question 95

Penetrating injuries to the head, particularly gunshot wounds to the head can carry as high as __% mortality

Answer 95

90%

Question 96

Neck The majority of penetrating trauma is a result of:

Answer 96

Stabbings and gunshots

Question 97

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

Answer 97

60

Question 98

Thoracic injuries are common following both penetrating and blunt trauma and it has been estimated that chest injuries are responsible for ___% of all trauma deaths.

Answer 98

20 to 25%

Question 99

The approach to thoracic injuries typically depends upon the:

Answer 99

Mechanism Severity Location of injury

Question 100

Stab wounds to the back result in significant injuries requiring surgical repair in only about ___% of patients.

Answer 100

15%

Question 101

The mere presence of a gunshot wound to the abdomen with potential violation of the peritoneum equals a:

Answer 101

Laparotomy

Question 102

The great majority of vascular injuries are due to _______ trauma

Answer 102

Penetrating

Question 103

As an IDC, your focus should be on:

Answer 103

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.

Question 104

Blast injuries are subdivided into four categories:

Answer 104

Primary Secondary Tertiary Quaternary

Question 105

Blast injury Effects of Overpressure and Underpressure from a blast wave-is distinctly uncommon in surviving casualties except in the form of perforated tympanic membranes.

Answer 105

Primary

Question 106

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

Answer 106

Secondary

Question 107

Blast injury Body displacement

Answer 107

Tertiary

Question 108

Blast injury Burns

Answer 108

Quaternary