Tactical Field Care (TFC)

Question 1

What is tactical field care?

Answer 1

1. Care provided during a reduced level of hazard. 2. Threat is lowered but not eliminated, fighting could resume at any time.
2. Medical supplies still limited to what is carried on individuals or in vehicles.

Question 2

What is M.A.R.C.H?

Answer 2

Massive hemorrhage control
Airway, establish and maintain
Respiratory, decompress tension pneumothorax, seal open chest wounds, support oxygen needs.
Circulation, establish IV/IO access and administer fluids to treat shock.
Head injury, hypothermia

Question 3

Transition from CUF to TFC

Answer 3

1. No longer under effective enemy fire.
2. Establish a secure perimeter.
3. Triage as required
4. Remove weapons and comms from altered patients.

Question 4

Managing an altered mental state.

Answer 4

1. Communicate with patient.
2. Causes of altered mental state include TBI, shock, hypoxia, pain and medication.
3. Secure all weapons, farms, explosives, edge weapons, reaching tools and communication gear.

Question 5

Treatment of massive hemorrhage

Answer 5

1. Place tourniquets immediately if indicated.
2. Assess to identify all sources of hemorrhage.
3. If tourniquet is not needed use combat gauze to pack wound.
4. 3 minutes of direct pressure at wound site and apply pressure bandage.

Question 6

Hemostatic agent use

Answer 6

1. Used where a tourniquet cannot be applied.
2. When a tourniquet must be removed due to time limitations.
3. Used with a pressure dressing.

Question 7

Wound packing with hemostatic dressings

Answer 7

1. ID wound area and expose.
2. Apply direct pressure on wound.
3. Open the combat gauze, make a ball that fits the wound.
4. While maintaining pressure, push ball and additional gauze until wound is full.
5. Applied direct pressure for 3 minutes.
6. Secure with pressure bandage.

Question 8

How to apply a pressure dressing/bandage

Answer 8

1. Maintain pressure with any digit.
2. Expose sterile portion of dressing.
3. Place over combat gauze.
4. As you wrap maintain pressure.
5. You short tugs to maintain tightness.
6. Velcro / secure ends on locking mechanism.

Question 9

What is Xstat?

Answer 9

1. Expanding mini sponges for deep wounds at junctional bleeding (groin and axillary).
2. Expand on contact with blood to compress wound from the interior.
3. Metal strip to ID on x-ray.
4. Loose or in a bag.
5. Only removed in hospital care.
6. For use up to 4 hours until surgical care.

Question 10

Xstat contraindicated locations

Answer 10

1. Pleural cavity.
2. Mediastinum/thorax.
3. Abdomen, retroperitoneal space.
4. Sacral space
5. Tissue above inguinal ligament.
6. Tissues above the clavicle.

Question 11

Xstat directions for use

Answer 11

1. Pull retractor until it locks.
2. Insert applicator directly into wound.
3. Push into wound until pressure is felt, then press downward on plunger.
4. Continue process until cavity is full.
5. Sponges expand 10 to 12 times in 20 seconds.
6. Apply pressure dressing over wound.
7. Attach Xstat packaging for MD, properly document use.

Question 12

What is a junctional hemorrhage?

Answer 12

Severe bleeding from the groin, buttocks, perineum, axillary, base of neck or extremity to proximal for a tourniquet.

Question 13

Dismounted complex blast injury. (DCBI)

Answer 13

1. IED, typically pressure detonated with small charges.
2. Characterized by high energy, bilateral amputation of lower extremities.
3. Junctional hemorrhages.
4. Wounds that appear sheared by hard edges such as body armor or armored vehicles.

Question 14

Junctional emergency treatment tool use (jett)

Answer 14

1. Route jett under patient.
2. Place under small of back.
3. Slide down to buttocks
4. Place pads on line between iliac crest and pubic bone.
5. Secure the buckle, take all slack out.
6. Twist handle to screw down pads.
7. Tighten until blood flow stops.
8. Confirm lack of distal pulse.
9. Reassess after movement.

Question 15

Use of combat ready clamp (CROC)

Answer 15

1. Assemble based on size of a casualty.
2. Remove bulky items from casualties pockets.
3. Slide security strap under casualty.
4. Slide into position, finalize adjustments.
5. Check placement before tightening.
6. Tighten until blood flow stops.
7. Check distal pulse.
8. Mark time of application.
9. Reassess after movement.

Question 16

Use of Sam junctional tourniquet

Answer 16

1. Route under casualty.
2. Place under buttock.
3. Snap buckle, place pads, pull strap until it clicks.
4. Inflate compression device until hemorrhage is controlled.
5. Check distal pulse.
6. Mark time of application.
7. Reassess after movement.