Organization of Trauma Care COPY Flashcards
The process of prioritizing patient treatment during mass casualty events based on their need for or likely benefit from immediate medical attention
Triage
Triage categories are based upon:
Number of injured
Available resources
Nature and extent of injuries
Change in patient’s condition
Hostile threats in the area
The number of patients and the severities of their injuries DO NOT exceed the resources and capabilities
Multiple casualties
The number of patients and the severities of their injuries DO exceed the resources and capabilities
Mass casualty
Five principles of triage
Degree of life threat posed by the injuries sustained
Injury severity
Salvageability
Resources
Time, distance, and environment
Categories of military triage
Immediate
Delayed
Minimal
Expectant
Needs lifesaving interventions within minutes up to 2 hours on arrival to avoid death or major disability
Immediate
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
Immediate
Requires medical attention but CAN wait
Delayed
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
Delayed
Can be treated with self aid, buddy aid, and corpsman aid
Minimal
Often referred to as “walking wounded”
Minimal
1) Minor burns, lacerations, contusions, sprains and strains.
2) Simple, closed fractures without neurovascular compromise.
3) Combat stress reaction.
Minimal
Require complicated treatments that may not improve life expectancy
Expectant
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
Expectant
Fourth stripe on the triage tag, casualties are dead or non-salvageable and entails no care is needed
Black (deceased/expectant)
Third stripe on the triage tag, casualties have minor injuries and will need minimal care
Green (minimal)
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
Red (immediate)
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
Yellow (delayed)
Simply and quickly categorizing patients; identifying and stop life threats. Breaks down patients down into more manageable groups.
Primary Triage
Allows for adjustment on patient response, to direct more in-depth treatment and prepare for a nine-line medical evacuation request
Secondary triage
Stage of triage that includes immediate life sustaining care
Primary triage
Stage of triage that includes documenting, reassessing, and sorting patients by their treatment needs
Secondary triage
Stage of triage where you begin the MEDEVAC/CASEVAC considerations and request the medical evacuation if not already done
Secondary triage
Continued management of patients where more complicated procedures should be weighed against the situation
Tertiary triage
(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
Tertiary triage
Early trauma deaths are due to disruptions in one, or all, of three bodily systems:
Respiratory system
Vascular system
Nervous system
Category of stress
Immediate return to duty or return to unit or unit’s noncombat support element with duty limitations or rest
Light stress
Category of stress
Send to combat stress control restoration center for up to 3 days reconstitution
Heavy stress
Mnemonic used for combat stress
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
TCCC
Get the patients who are not clearly dead to cover if possible
Continue with the mission/fight. Gain fire superiority.
Care under fire
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
Tactical Field Care
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
> 95%
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 ________
Immediate
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
> 92%
Quickly choose a casualty collection point based on:
Proximity to patients
Proximity to vehicular access
Proximity to HLZ
Geography, safety “geographic triage”
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
Level (role/echelon) 1
Levels of care
1) Battalion Aid Station
2) Cruisers, Destroyers
Level (role/echelon) 1
Initial resuscitative care is the primary objective of care at this level
Saving life, limb, and when necessary stabilization for evacuation
Level 2
Examples of Level 2
LHD
LHA
CVN
MEDBN
STP
FRSS
R2LM
R2E
Provides surgical care for the Marine Expeditionary Forces. Provides stabilizing surgical procedures capable of holding patients for 72 hours
Medical Battalion (MEDBN)
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)
Forward deployed surgical suite developed due to the medical battalion being too large
Forward resuscitative surgical suite (FRSS)
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.
Role 2 light maneuver (R2LM)
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.
Role 2 enhanced
The highest level of care available within a combat zone
Advanced resuscitative care is the primary objective of care
Level 3
Examples of Level 3
Fleet hospitals
Hospital ships
Definitive medical care is the primary objective at this level
Level 4
Examples of Level 4
NH Yokosuka
Landstuhl regional medical center
Restorative and rehabilitative care is the primary objective of care at this level
Level 5
- NMCSD
- Walter Reed National Medical Center
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.
MEDEVAC
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
CASEVAC
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.
Aeromedical Evacuation (AE)
The maintenance of treatment imitated prior to evacuation and sustainment of the patient’s medical condition during evacuation
En route care
Prefabricated and may have accessories to be used with them.
(a) Standard collapsible litter most widely used in theater.
(b) Litter can be decontaminated.
Standard litter
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.
Stokes
Compact and lightweight transport system used to evacuate a patient over land. Can also be used to rescue a patient in water.
SKED litter
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.
Improvised litter
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.
Steady
Patients must be carried on the litter feet first, except when:
Going uphill/upstairs
Consider cabin altitude (CAR) for the following:
Penetrating eye injuries with intraocular air
Free air in any body cavity
Severe pulmonary disease
Decompression sickness and Arterial gas embolism
MEDEVAC/CASEVAC Priorities
Casualty must be evacuated within 2 hours in order to save life, limb or eye sight
Urgent
MEDEVAC/CASEVAC Priorities
Casualty must be evacuated within 4 hours or condition could worsen
Priority
MEDEVAC/CASEVAC Priorities
Casualty must be evacuated within 24 hours for further care
Routine
First five lines of the MEDEVAC Request (9 line)
Location
Frequency
Number of patients by precedence
Special equipment needed
Number of patients by type
Last 4 lines of MEDEVAC request (9-line)
Security of pickup site
Method of marking pickup site
Patient nationality and status
NBC Contamination
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.
MIST reporting
MIST stands for:
Mechanism of Injury
Injuries Sustained
Signs/symptoms
Treatment
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.
Kinematics
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 first law
Defines a force (F) as equal to the product of the mass (m) and acceleration (a). F=ma.
Newton’s second law
Mass x acceleration/deceleration
Force
The forms energy can take are:
Mechanical
Thermal
Electrical
Chemical
Theodore Kocher first proposed that the kinetic energy possessed by the bullet was dissipated in what ways:
Heat
Energy used to move tissue radically outward
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 known as __________
Cavitation
The characteristics of damage created along the track of a bullet are divided into 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 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
Yaw
Tumbling
Deformation
Fragmentation
The deviation of the projectile in its longitudinal axis from the straight line of flight
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
Deformation
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.
Fragmentation
Penetrating trauma depends on:
Speed of entry
Type of body tissue penetrated
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
Low
Energy Levels of Projectiles
Firearms with muzzle velocity of less than 1,500 feet second. (.357 magnum, 9 mm, .45 auto)
Medium
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
High
Tissue crush is limited by the:
Physical size or profile of the projectile
Missiles that flatten upon impact
Deformation
Tolerate damage better than non-elastic organs (heart, liver, kidney and brain.)
Elastic tissue (bowel and lung)
____ velocity produces more energy and more cavitation
High
_____ velocity produces localized injury and little force
Low
Range
The most devastation
Direct contact
Close range =
7 yards or less
High power =
More damage with muzzle velocities
The two signs, which remain absolute indications for laparotomy following penetrating or blunt abdominal trauma are:
Peritonitis
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 a result of:
Stabbings and gunshots
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
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.
20 to 25%
The approach to thoracic injuries typically depends upon the:
Mechanism
Severity
Location of injury
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 a:
Laparotomy
The great majority of vascular injuries are due to _______ trauma
Penetrating
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.
Blast injuries are subdivided into four categories:
Primary
Secondary
Tertiary
Quaternary
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.
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
Body displacement
Tertiary
Blast injury
Burns
Quaternary
