Evaluate a Casualty Tactical Combat Casualty Care Ref 081 -831 -1001
Standard: Evaluate the casualty following the correct sequence. Identify all life threatening conditions and other serious wounds.
Performance steps • Tactical combat casualty care can be broken down into separate phases. The first step is care under fire: the second is tactical field care: the third step is combat casualty evacuation care.
Care under fire Return fire as directed or required. The casualty should also return fire if able. Direct casualty to cover and apply self-aid if able. Try to keep the casualty from sustaining any additional wounds. • Airway management is generally best deferred until the Tactical Field Care phase. • Stop any life-threatening hemorrhage with a tourniquet or a hemostatic bandage if applicable. • •
Care Under Fire § Control of hemorrhage is important since injury to a major vessel can result in hypovolemic shock in a short time frame. § Over 2, 500 deaths occurred in Vietnam secondary to hemorrhage from extremity wounds. § Transport the casualty, weapon, and mission essential equipment.
Tactical Field Care • • • Initial assessment consists of: Recheck tourniquets Check LOC (AVPU) Airway Breathing Circulation
Airway • If your patient is conscious, reassure them and keep them talking as long as possible to try and identify any other areas which they might be suffering from. • If your patient is not conscious, open the airway using the head tilt chin lift or the jaw thrust. The jaw thrust technique should always be use when the patient has a suspected spinal injury.
Airway • Insert a nasopharyngeal airway on patients with no traumatic facial injuries. • Insert the NPA on patients right nostril, bevel facing septum until the base of the NPA rest on the nostril of the patient and secure.
Breathing Traumatic chest wall defects should be closed with an occlusive dressing (plastic, vaseline gauze) without regard to venting one side of the dressing or use an “Asherman Chest Seal®”, Bolin, Hy. Fin, etc. • Place the casualty in the sitting position if possible.
Breathing • Check for exit wounds by rolling patient on the affected side. If wound is found, cover using an occlusive dressing. • Progressive respiratory distress, secondary to a unilateral penetrating chest trauma, should be considered a tension pneumothorax and decompressed with a 14 gauge needle. • Tension pneumothorax is the 2 nd leading cause of preventable death on the battlefield.
Circulation • Perform a head to toe blood sweep, looking for deformities, contusions, abrasions, penetrating wounds, burns, lacerations or swelling. • If secondary bleeding is found, stop the assessment and control bleeding using a pressure dressing or bandage. • Fractures depending on the severity can be anatomically splinted on the unaffected limb.
Circulation • Splint fractures as circumstances allow, ensuring pulse, motor and sensory (PMS) checks before and after splinting. • Do not remove any clothing or debris that may be stuck on burns, wrap loosely. • Treat for shock
Pain Control • Able to fight • Meloxicam (Mobic®) 15 mg PO initially • Acetaminophen 650 mg Bi-layered caplet • 2 PO q 8 hr • Unable to fight • Morphine 5 mg IV/IO. Up to 20 mg may be • required for adequate paint management • Phenergan® 25 mg IV, IM
Documentation • Document clinical assessments, treatment rendered and changes in the casualty's status. • Forward with casualty to next level of care. • Make sure all interventions are documented to include any medication that were given.
Tactical Evacuation Care • Transport the casualty to the site where evacuation is anticipated. • Monitor an unconscious patient during casualty evacuation. A Soldier accompanying the patient should monitor the casualty’s airway breathing and bleeding.
Summary Three categories of casualties on the battlefield. Soldiers who will do well regardless of what we do for them. Soldiers who are going to die regardless of what we do for them. Soldiers who will die if we do not do something for them now (7 -15%).
Summary • Medical care during combat differs significantly from the care provided in the civilian community. • New concepts in hemorrhage control, fluid resuscitation, analgesia, and antibiotics are important steps in providing the best possible care to our combat soldiers. • These timely interventions will be the mainstay in decreasing the number of combat fatalities on the battlefield.