msl402 l02b unit level medical operations (nxpowerlite)

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MSL 402, Lesson 02b: Unit Level Medical Operations

Revision Date: 30 November 2012

Unit Level Medical Operations

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Objectives

Evaluate a CasualtyFamiliarize Cadets on 9 Line MEDEVAC Format

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Evaluating a Casualty

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Care Under Fire

Scene Assessment Return fire as directed or required Casualty should return fire if able Keep yourself from getting shot Prevent additional wounds to casualty Maintain situational awareness!

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Approaching the Casualty Asses your situation

Small arms fire Fire or explosive

devices Chemical/

Biological agents Electrical hazards Structural stability

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Approaching the Casualty

Determine best route of access to the casualty and the best route of egress

Plan an evacuation route prior to exposing yourself to hostile fire

How many people will it take to move the casualty

Will you need a litter

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Approaching the Casualty Your plan should be

move to cover and/or use a tourniquet Request covering fire

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Approach the Casualty Do not expose yourself to enemy fire in order

to provide care. Talk to the casualty while moving to him Have a tourniquet ready AVPU and general impressions can be

obtained once behind cover

A - Alert

V - responds to Verbal stimulus

P - responds to Painful stimulus

U – Unresponsive

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Tactical Field Care

Primary Survey

- Airway

- Breathing

- Circulation

- Disability

- Expose/Environment

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Reassess Reassess any treatments that were done in

Care Under Fire Tourniquets

If you see any massive hemorrhage Tourniquets

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Check for Responsiveness

Gently shake or tap the casualty on the shoulder and ask in a loud, but calm, voice: “Are you okay?” A - Alert V - responds to Verbal stimulus P - responds to Painful stimulus U – Unresponsive

If conscious, ask where it hurts or where his body feels different than usual.

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Airway Check for patent airway Look for rise and fall of chest and abdomen Listen for sounds of

breathing Feel for breath on the side

of your face

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BreathingCheck for breathing, respiratory rate/depth

APPROXIMATE RATE: Use the method of abnormal vs. normal rate. (i.e. <10 or >28). “Slow or Rapid”

RHYTHM: Regular vs. Irregular. DEPTH: Shallow vs. Deep

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Breathing If the casualty has a penetrating chest wound,

is not breathing and is not making any effort to breath, do not attempt to treat the injury

In a combat situation, if you find a casualty with no signs of life (no respiration and no pulse), do not continue first aid on the casualty

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CirculationCheck for pulse presence, quality, rate, and

rhythm & skin capillary refill time, color, temperature, and moisture

Assess pulses If the patient is alert - assess the radial

pulse If the patient has a decreased LOC - assess

both the carotid and radial pulses simultaneously

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Circulation Check for and control remaining external

hemorrhage using necessary means

Look for blood soaked clothes

Look for entry and exit wounds

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Circulation Establish baseline vitals Assess pulses

Normal pulse (60-100) Slow or fast pulse

Assess respiration Is it to slow or to fast

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Circulation Assessment of perfusion can be easily

accomplished in three ways: Capillary refill - < 2 seconds Skin color : In light skinned patients color

will be obvious, in dark skinned patients it is easiest to assess the mucous membranes of mouth or fingernail beds.

Skin temperature - Warm

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Circulation Assess blood pressure

CAROTID PULSE: BP is > 60. FEMORAL PULSE: BP is > 70. RADIAL PULSE: BP is > 80.

Initiate Fluid resuscitation as needed IV Vs. IO

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Disability Check level of consciousness

Has the Patient status changed Did he respond to fluid therapy Is he getting worse

Splint any fractures

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Secondary Survey Head to Toe evaluation

“Where my hands go, my eyes follow” Improve on your treatments Reassess your ABC’s

“Look, listen, and feel”

See, don’t just look!

Hear, don’t just listen!

Feel, don’t just touch

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Casualty Evacuation

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Introduction

Being able to evacuate casualties quickly and effectively will result in saving lives

Your knowledge and ability to perform casualty evacuations in multiple situations and terrain will increase the likelihood of your casualty's survival

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Medical Evacuation Plan

Identify your medical evacuation requirements. Who is part of the aid and litter teams?

Primary and Alternate Where are your medics? Where are the casualty collecting points located? What are your evacuation request procedures

and channels?

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Medical Evacuation Plan

Where is the nearest aid station? How will I get my casualties there?

Ground or Air Identify routes, means and schedules (if any) of

evacuation and responsibilities

Where are the clinics and hospitals?

How far away are they?

What can they do for the casualty?

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Categories of Precedence

URGENT-PATIENT WHO SHOULD BE EVACUATED AS SOON AS POSSIBLE AND WITHIN TWO HOURS TO SAVE LIFE, LIMB, OR EYESIGHT.

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Categories of Precedence

PRIORITY-PATIENT WHO SHOULD BE MOVED WITHIN FOUR HOURS OR HIS/HER CONDITION WILL DETERIORATE TO SUCH A DEGREE THAT HE WILL BECOME URGENT.

ROUTINE-PERSONNEL WHOSE CONDITION IS NOT EXPECTED TO WORSEN SIGNIFICANTLY AND WHO WILL REQUIRE EVACUATION IN THE NEXT 24 HOURS.

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9-Line Request Line 1 - Location of Pick up site (6 or 8 digit

grid) Line 2 – Your call sign and frequency Line 3 - Number of patients (by precedence)

A URGENT (1 HR. LOSS LIFE/LIMB/EYESIGHT)

B URGENT SURGICAL(SURG. INTERVENTION)

C PRIORITY D ROUTINE

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9-Line Request Line 4 – Special Equipment Needed

A NONE B HOIST C EXTRACTION EQUIP D VENTILATOR

Line 5 – Number of patients by type (A) Ambulatory (L) Litter

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9-Line Request LINE 6: SECURITY AT PICKUP SITE:

E ENEMY TROOPS IN AREA N NO ENE. TROOPS P POSSIBLE ENE. TROOPS X ENE TROOPS IN AREA, ARMED

ESCORT REQUIRED LINE 7: METHOD OF MARKING PICKUP

SITE: A PANELS B PYROTECHNICS C SMOKE D NONE E OTHER IE, IR BUZZ SAW, NATO ‘Y’ OR

‘T’

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9-Line Request

LINE 8: PATIENT NATIONALITY/STATUS: A US MILITARY B US CIVILIAN C NON-US MILITARY D NON-US

CIVILIAN

Line 9 – Terrain Description Include details of terrain

features in and around proposed landing site

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Summary

Evacuation is a critical, life-saving skill, It can only be allied effectively is it is planned for and practiced.

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Collect and Record Information

You are conducting a routine dismounted presence patrol with five other members of your squad. You are moving along the designated route that runs through an open field. While moving along the route, SPC Coffman sees a shiny object lying in a ditch. Without SGT Hill’s authorization, he leaves the road to retrieve it. Suddenly, a loud explosion is heard. SPC Coffman has just stepped on an anti-personnel mine. His left leg is completely severed just inches above his ankle, SGT Hill receives a shrapnel wound across her face. A third soldier, PFC Fuel, receives shrapnel wounds across his upper body. All casualties are conscious and in pain. It’s up to you to get these casualties evacuated.

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You begin to collect information

Call sign: A6B88

Frequency is: 53.80 MHz

UTM Grid is: GF70296868

Frequencies of your medical support unit are 49.90 MHz and 23.75 MHz

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You begin to collect information

Line 1 – Location of pick up siteGF70296868Line 2 – Radio frequency, call sign, and suffix

53.80, A6B88Line 3 – Patient Precedence Codes

Urgent 1, Priority 2 A1,C3

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Line 4 – Special equipment needed

Hoist (B)Line 5 – Patients by type

Litter 1, Ambulance 2 (L1,A2) Line 6 – Number and type of wound or illness1 Lower left severed foot,1 Face shrapnel wound,1 Upper right torso shrapnel woundAll conscious, 1 B+ blood, 2 O+ blood

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Line 7 – Method of marking pick up site Smoke (C)

Line 8 – Patient nationality and statusUS Military 3 (A3)

Line 9 – Terrain description

Open field to the east of a cliff along route red

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Line 1 – GF70296868

Line 2 – 53.80, A6B88

Line 3 – A1, C2

Line 4 – B

Line 5 – L1, A2

Line 6 – (Peacetime) 1 B+blood: lower left foot severed; 2 O+blood: 1 face shrapnel wound, 1 upper right torso wound. All conscious.

Line 7 – C

Line 8 – A3

Line 9 – Open field to the east of a cliff along route red.

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Questions

msl402 l02b unit level medical operations (nxpowerlite)

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