Tactical Field Care “Care in the potentially unsafe scene” – what was a safe GENTLY – the weapon is their friend. Enlist place may become unsafe: another trusted friend Avoid further injury MARCH algorithm vs ABCs- MARCH is the better approach, especially with Head up if possible blast or penetrating injuries No tight C-collar Massive hemorrhage, Airway, Respirations, Cardiac, Head Ensure open airway/respirations injury/Hypothermia C-spine immobilization PRN (large blast/ blunt injury, NOT penetrating and/or GLF) Primary survey, immediate intervention, reassess then delayed intervention Avoid hypothermia Massive hemorrhage HPMK Reassess tourniquets Blankets Blood sweep (cut clothes, remove armor) Warm vehicle DOWNSIDE INJURY Fine tune interventions Strap cutter vs. scissors Deliberate tourniquet (taped, timed) Disarm Analgesics Pack junctional regions PRN Antibiotics Specific techniques beyond scope Delayed airway intervention Airway REASSESS Patent, not patent, THREATENED No intervention, immediate intervention, TACEVAC Care (care while leaving the scene) potential delayed intervention Generally more equipment available Biggest bang for least time Monitors Nasal trumpet Oxygen Supraglottic Drugs ET tube Reassess all interventions (tourniquets, chest movement, pulse) Cric Apply monitors Respirations Fine tune interventions Open PTx Enroute critical care Chest seal, ideally vented Evidence of TPTx Review: Classic signs are late Right intervention at the right tactical time Long needles Death from bleeding, PTx, Airway Flail segments Fire superiority first Cardiac (pulses) MARCH Pulse correlation to BP has been debunked, but radial Selective immobilization pulse generally = brain perfusion Be prepared for phase changes Not everyone needs fluids. Head injury/Hypothermia Contact Steve Carroll DISARM any confused/altered/unresponsive patient Twitter-@embasic
Tactical Field Care “Care in the potentially unsafe scene” – what was a safe place may become unsafe: MARCH algorithm vs ABCs- MARCH is the better approach, especially with blast or penetrating injuries Massive hemorrhage, Airway, Respirations, Cardiac, Head injury/Hypothermia Primary survey, immediate intervention, reassess then delayed intervention Massive hemorrhage Reassess tourniquets Blood sweep (cut clothes, remove armor) DOWNSIDE INJURY Strap cutter vs. scissors Disarm Pack junctional regions PRN Specific techniques beyond scope Airway Patent, not patent, THREATENED No intervention, immediate intervention, potential delayed intervention Biggest bang for least time Nasal trumpet Supraglottic ET tube Cric Respirations Open PTx Chest seal, ideally vented Evidence of TPTx Classic signs are late Long needles Flail segments Cardiac (pulses) Pulse correlation to BP has been debunked, but radial pulse generally = brain perfusion Not everyone needs fluids. Head injury/Hypothermia DISARM any confused/altered/unresponsive patient GENTLY – the weapon is their friend. Enlist another trusted friend Avoid further injury Head up if possible No tight C-collar Ensure open airway/respirations C-spine immobilization PRN (large blast/ blunt injury, NOT penetrating and/or GLF) Avoid hypothermia HPMK Blankets Warm vehicle Fine tune interventions Deliberate tourniquet (taped, timed) Analgesics Antibiotics Delayed airway intervention REASSESS TACEVAC Care (care while leaving the scene) Generally more equipment available Monitors Oxygen Drugs Reassess all interventions (tourniquets, chest movement, pulse) Apply monitors Fine tune interventions Enroute critical care Review: Right intervention at the right tactical time Death from bleeding, PTx, Airway Fire superiority first MARCH Selective immobilization Be prepared for phase changes Contact Steve Carroll Twitter-@embasic