Safety

Rescue /

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Triage

Treatment

Prolonged

Care

Evacuation

CareC

Circulation& Shock

AAirway

Protocol

DDisability

Assessment

BBreathing Protocol

Rapid Primary Survey

CUF /A-STAR

Triage

Penetrating

Trauma

only?

CCatastrophic

Bleeding

Yes

EEnvironmentManagement

FSIFT SEARCH

(PFC)

GGet Ready to

Evacuate

Trauma

Safety

Rescue /

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Evacuation

CareC

Circulation& Shock

AAirway

Protocol

DDisability

Assessment

BBreathing Protocol

A-STAR

Triage

EEnvironmentManagement

FSIFT SEARCH

(PFC)

GGet Ready to

Evacuate

No

Primary Survey

Blunt/Medic

al/Enviro

Non - Trauma

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The “ASTAR” ApproachSafety

S = Senses

T = Think

A = Act

R = Report

A = Actions On

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Actions On (Taking a Casualty)

• Only applicable in while in hostile environment of situation:

– Prosecute the offensive/defensive action.

– Get into suitable cover.

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Senses• Look

– Hazards

– Location of hostile actions

– Direction of crowd flow

– Fire

• Listen

– Environment sounds

– Victim

• Smell

– Chemicals

– Victim noises such as snoring or gurgling

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Think

• Safety

– Possible impact of sense assessment

• Topography

– Does the ground affect the situation

• Meteorology

– Effect of weather on rescuers & victim/s

– Effect of weather on rescue & treatment

• What if?

– Back up Emergency Plan

• So what?

– Consequence assessment

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Act

• Command & Control

• Protect

• Rescue of Extract

• Triage

• Treatment

• Evacuate

Safety

Safety

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ReportSafety

UP

DOWN

SIDEWAYS

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Report – M. E.T.H.A.N.E.

E = Exact Location

T = Type of Incident

H = Hazards – Actual/Suspected

A = Assistance Required

M = My Call Sign

N = Number of Casualties

E = Emergency Services Required

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Rapid Primary Survey

The RPA allows you to gain as much clinical info as possible in the shortest possible time

and to allows you to rapidly treat the commonest cause of preventable death,

compressible arterial bleeding.

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Elements

Response:– Place one hand on the shoulder and COMMAND the

casualty to open their eyes. – Eyes open: command them to count to ten (C2-10)

in one breath out loud.– Eyes closed & No response: apply pain stimuli and

watch for response. If no response to pain, victim is deeply unconscious &

risks airway obstruction from a prolapsed tongue if on their back!

Note whether victim responds to voice, pain or not at all.

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Elements (2)

If victim responds to oral command easily then:– Their airway is open and clear, at this time.

– There is no immediate threat to the mechanics of ventilation or oxygenation. Breathing is ok at this time.

– The blood pressure is enough to support higher brain functions.

If victim responds by taking gasps or can only speak one word at a time then this indicates either airway or respiratory problem. Now check limbs!

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Elements (3)

• Check arms and legs for C severe arterial bleeding. If found, and the injury is amenable to TQ, then in hostile situation apply a TQ above the injury body side . Over clothing if necessary.

• Tighten the TQ to the point where bleeding stops, then lock off.

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Preventable Death

• There are three causes of preventable death in penetrating trauma.

– Compressible arterial bleeding – arms, legs, neck.

– Pressurised air trapped within the chest cavity between the lung & the chest wall. Called a Tension Pneu-mo-thorax.

– Airway obstruction secondary to facial injury, blood loss and head injury.

Treatment

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Preventable Death (2)• How quick could it take to bleed to the point of death

if you lacerated your:– Femoral artery?

– Brachial artery?

– Carotid artery?

• Not all arterial bleeding is compressible. Arteries hidden within body cavities for example.

• Arteries run through limbs close to the line of the bones & the fact that a limb is a cylinder means it can be compressed by dressings, by pressure, or by tourniquets if amenable.

• Arterial blood is bright red and often, but not always, will spurt in time with the heart beating.

Click once more for video

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Intervention

• Catastrophic Bleeding

• Airway Management with appropriate C – Spine controls & MIS

• Breathing Management

• Circulation & Shock Management

• Disability – AVPU and ?PEARL

• Environment – Hypo/Hyperthermia Management

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Rescue /

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Treatment

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Rescue /

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Triage

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Evacuation

Care

S.I.F.T. – S.E.A.R.C.H.Prolonged Field Care

• Secondary survey & treatment.• Infection control – wound & skin.• Fluid balance.• Tubes.

• Sterility – equipment, procedures, hands.• Elimination – urine & faeces.• Analgesia; antibiotics; antidotes etc.• Review & record.• Communication – up; down; sideways.• Monitor & intervene throughout evacuation.

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Rescue /

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Get Ready to Evacuate

• Complete repeat baseline vital signs & record.

• Check all tubes, dressings & drains.• Complete splinting & packaging.• If flying; replace air in balloons with

water.• Select best evacuation platform for the

situation.• Communicate with appropriate (burns,

neuro, etc) receiving medical facility.

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Abbreviations - Basic

Abbreviation Meaning

A.S.T.A.R. Actions On, Senses; Think; Act; Report.

MoI Mechanism of Injury.

C210 Count to Ten, out loud, in one breath.

R’s Responses, verbal & pain.

MILS Manual In Line Stabilisation.

Cx Cervical spine MoI.

F.L.A.P.S. Feel, Look, Armpits, Press the ribs; Sweep the back.

M.E.T.H.A.N.E. My call sign; Exact location; Type of incident; Hazards;

Assistance required; Number of casualties; Emergency

services required.

M.I.S.T. MoI; Injuries actual & suspected; Signs & symptoms;

Treatments.

Vitals Set Pulse Rate; Pulse present sites; Respiratory Rate; Capillary

Refill Time; Pupils check (P.E.A.R.L.);