CCH_EMTprepLLC/playlists

https://www.youtube.com/user/EMTprepLLC/playlists
EMTprep

This is a good youtube site to learn some emergency management skills

Pitting Edema 

Le Fort Fractures

Becks Triad

SAMPLE History

Anaphylaxis

Capnography

CCH_ Spinal Immobilization Supine Patient

This is the spinal immobilization of a supine patient skill -Watch video

Welcome to the supine spinal immobilization practical assessment here

We will evaluate your ability to properly secure a patient to a long backboard during the assessment you will  have CCH assistant your patient's vitals are stable when you move the patient to the long backward I'd like you use both mine and the EMT assistance help you are in charge of ensuring proper directions that are given to your partners you may utilize any of the equipment shown before you and I'd like you to review that now BSI is my seat save the scene assay all right so the first thing I'm going to do is I'm going to direct my partner to come in and place the head in an inline neutral position and then I'm going to direct my partner to maintain c-spine stabilization.
 Once he's doing that I'm going to check CMS I have bilateral pulses can you squeeze my fingers for me awesome thank you tell me which is fingers I'm touching here okay and now I'm going to move down to the feet take the shoes off this espinal pulses and can you push down against my hands

perfect now pull back up against okay you tell me when shows are touching

I thank you all right

Pulses, sensation and motor function are intact and all accompanies all right so the next thing we're going to do is we're going to put a c-collar on so i'll size my patient for a c-collar select my c-color and set it to the appropriate size p for my c-collar a little bit apply the c-collar ensuring that I'm not moving the neck around too much all right can you open your mouth a little bit for me perfect

All right now we have the seek alarm the next thing we're going to do is we're going to log-roll the patient and place around the board so I'll have my other assistant come in and help me with that so on the heads count we're going to roll the patient towards us and then I will check her back and then I will position the board and then on the heads count again we will roll her flat okay

you can assess the back really quickly checking for any deformity any wounds position the board all right and on the heads count    okay so now

We’re going to position it properly on the board so we're going to move up and over in one swift motion all right one heads count     foot now we will secure the patient to the board using our straps so coming over the shaft alright I'm going to put this underneath your arms here we're going to tighten this up quick so if you can pick your hands up for just a minute and you can cross them again got once so the torsos secured again I would check to make sure
 let's see if I need it to pad anywhere you don't need the pad anywhere so next I will screw the

head all right patients head secure and then move down the body to secure the feet the legs and the feet alright so the patient's secured to the board

Now I will reassess CMS good pulses can you squeeze my fingers okay can you tell me which fingers in touch okay moving down to the feet good pedal pulses can you tell me which Axilla touching okay you push down against my hands all right and pull back up against them okay pulses sensation and motor function are present in all extremities all right is there anything else you'd like to do

nope that's it okay thank you
English (auto-generated)
Up next

HARE TRACTION SPLINT

 HARE TRACTION SPLINT

HARE Traction Splint has been setting the industry standard in treating fractured femurs for over 30 years.  It aids in effectively realigning a fractured femur to its proper position, reducing pain and restoring perfusion to an injured leg.  The HARE Traction Split inhibits further hemorrhage and additional nerve, vascular, bone and muscle damage. Its one-piece design makes application fast, easy and complete in minutes.

PRODUCT SPECS

• Larger traction knob for better grip and control
• One-handed traction adjustment
• Recessed traction release button
• Positive locking heel stand
• Faster length adjustment, collects locks with few quick turns
• Labeled to avoid applying the wrong size
• Includes: ratchet traction device and S ring hook, heel stand and locking release button, collet locking device, four leg-support straps, Ischial strap and pad, and Dyna Med adjustable ankle strap
• Nylon carrying case

CCH_FIRST AID SURGICAL SET

FIRST AID SURGICAL SET


PRODUCT SPECS
All Stainless Steel instruments
CORDURA® Nylon pouch
Pouch has MOLLE strap with snap
Set comes sealed in a plastic pouch with a list of contents
2 - Straight Hemostats
1 - Curved Hemostat
1 - Scalpel Handle, #3
2 - Scalpel Blades
1 - Needle Probe
1 - Pen Light
1 - Pair of Scissors
1 - Pair of Tweezers
1 - Suture Set
1 - Holder
2 - Alcohol Wipes
2 - Antiseptic BZK Wipes
NOTE: Contents of Surgical Set are not sterile

CCH_FIRST AID KIT

https://www.buyemp.com/product/ifak-officer-down-kit-orange-pouch-basic

Download the full "TCCC"
TACTICAL COMBAT CASUALTY CARE  HANDBOOK here

Medical Equipment

A combat medic will typically carry a backpack styled bag known as a "Unit One Pack". Aid bags are available from many different manufacturers, in many different styles. Depending on the unit and their standard operating procedures, the medic may have to follow a strict packing list, or may have the liberty of choosing their kit depending on the mission at hand. A typical aid bag will include:

Fluid Resuscitation

• IV fluids and tubing. The amount will depend on the length of mission. Normal Saline/Sodium Chloride, Hetastarch/Hextend, and Lactated Ringers(LR) are usually carried.
• 18, 16, and 14 gauge IV catheters.
• FAST 1 intraosseous infusion kit. The FAST 1 is a quick way to administer fluids when peripheral and external jugular venous access is unavailable due to massive blood loss, burns, or loss of limbs.

Hemorrhage (blood loss) Control

• CAT, SOFT-T or improvised tourniquets. Tourniquets are used for the care under fire phase of tactical combat casualty care, to stop massive life-threatening hemorrhage.
• Emergency Trauma Bandages, a newer version of the first aid pressure dressing.
• Kerlix gauze, for stopping hemorrhage, or creating a bulky dressing.
• Hemostatic agents, such as Celox, Hemcon bandages, and others. Some hemostatic agents are controversial due to their thermodynamic nature, which causes collateral damage if the user is not properly trained. These have been mostly phased out with newer versions which do not cause burns.

Airway Management

• 14 gauge catheter, at least 3.25 inches long, for needle chest decompression.
• Asherman chest seal, Bolin chest seal or Hyfin chest seal, as an occlusive dressing for sucking chest wounds.
• Nasopharyngeal Airway (NPA)w/surgilube or "nasal trumpet." This flexible tube secures a nasal airway when the casualty does not have, or may lose their ability to keep their own airway open. Contraindicated by signs of skull fracture.
• Oropharyngeal Airway, a hard "J" shaped plastic device that secures an oral airway, and can also be used to keep the teeth open for a more permanent airway device.
• King LTD, a simple tube airway with an inflatable cuff to create a sealed airway.
• Combitube, like a King LTD, but designed to be able to function almost no matter how the tube is placed due to the dual lumen tube design.
• Surgical Cricothyrotomy kit. Many different styles and kits exist, the choice is up to the individual medic's supply or preference. The most simple is a scalpel to open an airway, and to use an NPA to keep the airway patent.

Assorted Equipment

• Alcohol or Providine/Iodine swabs
• Cravats (muslin bandages)
• Assorted gauze bandages
• Band-Aids
• Assorted sizes of tape
• Assorted hypodermic needles and syringes
• Water Jel burn dressing
• Small sharps shuttle
• Safety pins

Personal Protection

• Gloves Black Nitrile
• Gloves, Patient Examination

Triage Systems

• Tactical Combat Casualty Card
• Sharpie Fine Point Permanent Marker Black
• Combat Casualty Card

Diagnostic Equipment

• Onyx II 9550 finger Pulse oximeter
• A Combat Medic may also carry other supplies as the mission dictates. A stethoscope, blood pressure cuff, pulse oximeter, otoscope, ophthalmoscope, and thermometer may help the medic treat his/her soldiers or civilians on the battlefield (COBs) while on an extended mission, as space dictates.

Casualty Management

• Paramedic Trauma Shears
• Benchmade Model 8 Rescue Hook

Splinting and Immobilitation

• SAM Splint—a flexible, reusable splint with a metal core covered in closed cell foam.
• Ace Bandages
• Extrication Collar - C-Spine Immobilization
• Coban, a stretchy, self clinging wrap/gauze

Hypothermia Prevention

• Blizzard Survival Blanket OD Green
• Ready-Heat Disposable Heated Blanket
• Us Army Blanket, Combat Casualty
• Us Army Blanket, Combat Casualty Type 2
• NAR Hypothermia Prevention and Management Kit (HPMK)
• Combat Casualty Lightweight Blanket

Battlefield Medicine

• Morphine
• Antibiotics
• Narcan, a narcotics antagonist, to counter morphine's respiratory-depressing effects.
• Phenergan, an anti-nausea treatment, which also increases the pain-reducing effects of morphine.
• Epi-pen, epinephrine in an auto injecting "pen" to counter anaphylactic (severe allergic) reactions.

A combat medic is generally expected to care for the needs of the soldiers in his group, including their everyday ailments. A medic will usually carry a small amount of what are referred to as "snivel" or "sick call meds." These are common over-the-counter medications that do not require a prescription.

• acetaminophen (Tylenol), anti-pyretic and pain reducer.
• Naproxen and ibuprofen, different NSAIDs which reduce pain and inflammation.
• Diphenhydramine (Benadryl), an antihistamine with a sedative side effect.
• Pseudoephedrine, a nasal decongestant.
• Guaifenesin, an expectorant.
• Loperamide (Imodium AD) an anti-diarrheal agent.
• Pepto Bismol tablets, to settle upset stomachs, treat diarrhea, and heartburn.
• Colace (docusate sodium), a medium strength stool softener.

What’s in your tactical medical kit?

When you’re on an operation and you can only take what you can carry, what do you choose?

Dec 9, 2013

---

Tactical medical equipment is an interesting and evolving topic area, with SWAT medics having as many opinions as there are vendors and products. 

FIRST AID KIT WEIGHT CONSIDERATIONS

There are the “minimalists” out there and then there are the, “you never know, I better have everything” types. The general consensus is that the medic needs to have enough equipment and supplies to stabilize a critically injured patient in a tactical environment. This equipment should be on their person, or carried in a medical pack, or both.

Not all of these tools are carried by each tactical medic. Some of the equipment is reserved for training and standby events such as team selection tryouts, swim tests, physical training days or range days. Some might be kept available in the medic vehicle. Tactical teams can have an ambulance that is overt (it looks like an ambulance) or covert (a long-bed, covered pick-up truck).Besides the medical equipment, the tactical medic is already carrying about 25-50 pounds of other gear. Most of the weight is in body armor/ ballistic plates and helmet. Other non-medical equipment might include weapons, ammo, incapacitating agents, knife, multi-tool, collapsible baton, radio / headset, lighting systems (including infrared), gas mask, eye protection, and a hydration system.

Less commonly carried or worn items might include binoculars, camera, computer tablet, body-cooling system and night vision goggles. The operational environment will also dictate additional equipment needs, such as cold weather or a hazardous materials event like a meth lab.

TACTICAL MEDICAL EQUIPMENT

In general, the medical equipment that is carried by the tactical medic can be broken down into the following areas:

Personal protective equipment (PPE): This refers to medical PPE, not ballistic protection. PPE should include gloves, mask and eye protection.

Patient assessment tools: These tools needed to assess, visualize and measure vital functions include a stethoscope, blood pressure cuff, micro pulse oximeter, thermometer and CO2 monitor.

One high-caliber tactical team I know of keeps a lightweight, portable I-Stat machine on hand to analyze blood chemistry and electrolytes, especially during endurance training/ team selection events.

Trauma supplies: These are tools designed to stop bleeding or seal off penetrating trauma:

• Hemostatic dressings of various sizes/purposes (Quik Clot, Celox)
• A large assortment of regular dressing ranging from 4x4s and 5x9s to ABD
• Combination of bandage wraps, 4” and 6”, such as Israeli Bandage, "H" wrap, Kling Roll gauze, NAR S-Rolled Gauze, Ace wraps, etc. (some of these have a dressing built in and others do not)
• Heavy-duty 1" and 2" tape, such as North American Rescue’s non-breathable Gecko Grip Multi-Purpose Tape
• Open chest injury seals (Bolin, Hyfin, Asherman, SAM); multiple sizes preferred
• Tourniquets such as C-A-T, SWAT-T, SOFT-T or others

Airway/breathing management:  These can range from a simple oropharyngeal airway to a full airway management pack. Equipment might include:

• Basic airway stabilization/ protection such as oral and nasal airways, a pocket mask, and a manual suction device such as V-Vac
• Collapsible bag valve mask (Cyclone Pocket)
• Chest decompression supplies (multiple sites)
• More invasive airway control devices, like endotracheal intubation or supraglottic airways such as King tubes

Routine medicines: Most EMS providers are not allowed to administer over the counter (OTC) medications, as it is not in their scope of practice. However, making OTC meds available to team members has largely been an acceptable alternative. In reality, this is by far the most common request by team members for medic services. The medic is the go-to guy or gal for just about anything related to the health and well-being of team members.

Having an assortment of commonly used OTC medications helps to keep minor ailments from progressing, and can help prevent an onset of problems such as allergies. Over the years, this part of my kit has expanded while the major trauma supplies have decreased. In my experience, it seems that ibuprofen, Pepto-Bismol, and allergy medications such as Claritin are most commonly requested.

Other common items include sunscreen, insect repellant, and Tecnu poison ivy/oak protection.

Routine materials for minor trauma, blisters and skin care: By far, the most commonly requested item is a Band-Aid. Minor wound care is a constant activity for the medic. Having a readily available supply of assorted sizes of adhesive bandages is a must. In addition, minor wound cleaning tools/wipes and topical antibiotic ointment are often needed. Have a good assortment of 1” and 2” breathable and non-breathable tape. Tools such as tweezers, forceps, small scissors, and wound/eye irrigation supplies are used often enough to have a place in the kit.

Ortho/sports medicine: Orthopedic injuries are common in training, and they happen on occasion during SWAT operations. Personnel can often have underlying orthopedic conditions that can be exacerbated during operations, and need evaluation by the medic. Having a background in sports medicine or orthopedic injuries is a plus.

Skills including taping, bracing and in-field stabilization of orthopedic injuries. SAM splints are pretty good for most splinting needs. Other items to consider might include cold packs and compression wraps.

ALS/prescription drugs: This area is a no-go zone for many teams for a variety of reasons. If the medic is authorized by a physician Medical Director, they may be authorized to be an ALS provider. Our team has an AED and first-line ACLS drugs. In addition we carry aspirin, nitroglycerin, albuterol (Proventil), ondansetron (Zofran) and ketorolac tromethamine (Toradol), a non-narcotic NSAID analgesic drug.

Patient transport system: As part of their standard operating procedures, many SWAT teams leave breaching gear and a med pack at the front door of the target location. This is called the “door pack.” This may include a collapsible / roll up stretcher such as a Sked. Oftentimes the medic will also carry a soft “roll up” stretcher on their person.

INDIVIDUAL FIRST AID KITS (IFAK)

In addition to what the tactical medic carries, each SWAT operator should carry, and be fully trained in the use of, their Individual First Aid Kit (IFAK). Operators should carry the IFAK on their vests. It should be accessible with either hand. Many operators will carry a second tourniquet that is also easily accessible on the tactical vest. Equipment might include:

• PPE (gloves, mask, eye protection)
• Small pocket mask, NPA, OPA
• Trauma scissors
• 1 or 2 tourniquets (SWAT-T, CAT)
• Chest decompression kit
• 2-3 trauma dressings (Israeli type)
• 4-6 hemostatic dressings
• 2-3 open chest seal (Bolin, Hyfin, Asherman)
• 4 roller gauze, compression bandages  
• 1 heavy duty 2" tape (e.g. NARP Gecko tape)
• 1 personal care kit (PCK) that includes personal medications, sunscreen, insect repellant, and/or contact lens supplies

As you can see, the medical equipment that is carried by the tactical medic is designed to cover the needs of the team. In the operational environment, that equipment will prove valuable in reducing the level of injury and stress — and promote a successful outcome.

CCH_Section III: Tactical Field Care_Detailed_Tension PTX.(Tension Pneumothorax)

Tension PTX.Download the full "TCCC"
TACTICAL COMBAT CASUALTY CARE  HANDBOOK here

 Assume any progressive, severe respiratory distress on the battlefield resulting from unilateral penetrating chest trauma represents a tension PTX.
 Do not rely on such typical signs as breath sounds, tracheal shift, and hyper-resonance on percussion for diagnosis in this setting,
because these signs may not always be present. Even if these signs are present, they may be difficult to detect on the battlefield.
 Treattension PTXs in the tactical field care phase via decompression (watch a video) with a 14-gauge, 3.25-inch-long needle catheter. 

Another Video More of a civilian bent 

A casualty with penetrating chest trauma will generally have some degree of hemothorax or PTX as a result of his primary wound.
 The additional trauma caused by a needle thoracostomy will not worsen his condition should he not have a tension PTX.
 Decompress the casualty with the needle and catheter, removing the needle and leaving the catheter buried to the hub.
The medic must monitor this casualty after the procedure to ensure the catheter has not clotted or dislodged and that respiratory symptoms have not returned.
If respiratory symptoms have returned or the catheter is clotted or dislodged, flush the catheter or perform a second needle thoracostomy adjacent to the first.

 Chest tubes are not recommended during this phase of care, as they are not needed for initial treatment of a tension PTX, are more technically difficult and time-consuming to perform, and are more likely to result in additional tissue damage and subsequent infection. 

CCH_ TRAUMA_SAM Splint

SAM Splint

Download the full "TCCC"

TACTICAL COMBAT CASUALTY CARE  HANDBOOK here

From Wikipedia, the free encyclopedia

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\

SAM Splint
Synonyms	Structural Aluminum Malleable Splint
Specialty	Emergency medicine
Intervention	bone immobilization
Inventor(s)	Dr. Sam Scheinberg
Invention date	1985
Manufacturer	Sam Medical Products
[edit on Wikidata]

The SAM (Structural Aluminum Malleable) Splint is a compact, lightweight, highly versatile device designed for immobilizing bone and soft tissue injuries in emergency settings. It consists of a layer of .016 inches (0.41 mm) strips of soft aluminum, with a polyethylene closed-cell foam coating.

The SAM Splint was invented by Dr. Sam Scheinberg who, as a trauma surgeon during the Vietnam War, found that field medics generally ignored the splint they were issued by the Army. He developed the idea while playing with a foil chewing gum wrapper.^[1]

The device is often found in First Aid Kits, Emergency Medical Technician "jump kits," ambulances, and other similar settings. Generally supplied in a roll or as a flat strip up to 36 inches (91 cm) long and 4.25 inches (10.8 cm) wide, it can be unrolled or unfolded and formed to the shape of the injured person's body. Once folded into a curve, it becomes quite rigid and capable of immobilizing a number of different wounds, including the leg, forearm or humerus. Folded properly, it can also be used to stabilize the cervical spine. It can be easily cut with any scissors or shears, to make smaller devices such as finger splints.^[2][3][4]

The SAM Splint is radiolucent meaning it does not interfere with X-Rays.

They are used on board the International Space Station as a light weight compact splint, for this reason the acronym SAM is often said to refer to “Space Aviation Medicine”.

After use, the SAM Splint can be cleaned, rerolled, and reused.

Additional sizes include 18 inches (46 cm) length, 9 inches (23 cm) length, 1.8 inches (4.6 cm) by 3.75 inches (9.5 cm) finger splint, and extra large 5.5 inches (14 cm) width by 36 inches (91 cm) length.

SAM SPLINT 4.25" X 18"
The SAM (Structural Aluminum Malleable) Splint contains all the properties of the many other splints that it replaces. It is constructed of .02 strips of soft aluminum with a polyvinyl coating. This metal presents no impediment to X-rays. When folded into a "structural bend" longitudinally the splint becomes quite rigid and easily supports the leg, forearm or humerus. It can also be contoured and crimped to stabilize the cervical spine. The coating on the SAM Splint does not stain and the splint is reusable with proper cleaning. Available in orange or gray.

PRODUCT SPECS
SAM Splint is 4-1/4" x 18" and is shipped flat
Can be applied to a variety of fracture locations
Easily trimmed (to form finger splints)
Easily stored (flat or rolled)
Inexpensive
Easily carried

CCH_Section III: Tactical Field Care_Detailed Airway Management

Airway Management 
Watch a video   # 2 video
Download the full "TCCC"

TACTICAL COMBAT CASUALTY CARE  HANDBOOK here

In the tactical field care phase, direct initial management to the evaluation and treatment of the casualty’s airway once all hemorrhage problems have been addressed.
 Intervention should proceed from the least invasive procedure to the most invasive.
Do not attempt any airway intervention if the casualty is conscious and breathing well on his own.

Allow the casualty to assume the most comfortable position that best protects his airway, to include sitting upright.
 Unconscious casualty without airway obstruction.
 If the casualty is unconscious, the most likely cause is either hemorrhagic shock or head trauma.
 In either case, an adequate airway must be maintained.
If the unconscious casualty does not exhibit signs of airway obstruction, the airway should first be opened with a chin lift or a jaw-thrust maneuver.
As in the care under fire phase, cervical spine immobilization is generally not required, except in the instance of significant blunt trauma.
 If spontaneous respirations are present without respiratory distress, an adequate airway in the unconscious casualty is best maintained with a nasopharyngeal airway (NPA).
An NPA is preferred over an oropharyngeal airway because it is better tolerated if the casualty regains consciousness and is less likely to be dislodged during casualty transport.
 After inserting the NPA, place the casualty in the recovery position (see Figure 1-1) to maintain the open airway and prevent aspiration of blood, mucous, or vomit.

 Figure 1-1. Recovery position

 Current or impending airway obstruction. 
For casualties with a current or impending airway obstruction, the initial intervention is again to open the airway with either a chin lift or a jaw-thrust maneuver. Either maneuver is followed by the insertion of an NPA.
However, if an airway obstruction develops or persists despite the use of an NPA, a more definitive airway is required.
 In some casualties a more definitive airway may consist of a supraglottic device, such as a combitube or King LT.
These airways are not well tolerated unless the casualty is totally obtunded.
 These devices are easily inserted and able to maintain an open airway better than a simple NPA.

 However, often a surgical cricothyroidotomy may be indicated. Cricothyroidotomy. Significant airway obstruction in the combat setting is likely the result of penetrating wounds of the face or neck, where blood or disrupted anatomy precludes good visualization of the vocal cords.
 This setting makes endotracheal intubation highly difficult, if not impossible.
 In these cases, surgical cricothyroidotomy is preferable over endotracheal intubation.

 This procedure has been reported safe and effective in trauma victims, and in the hands of a rescuer who does not intubate on a regular basis, it should be the next step when other airway devices are not effective.
 Furthermore, cricothyroidotomy can be performed under local anesthesia with lidocaine on a casualty who is awake.
The majority of preventable airway deaths occurred from penetrating trauma to the face and neck, where disrupted anatomy and significant bleeding made airway interventions very difficult.

Intubation.
 Endotracheal intubation is the preferred airway technique in civilian trauma settings, but this procedure may be prohibitively difficult in the tactical environment.
 Many medics have never intubated a live person; their experience is only with mannequins in a controlled environment and is infrequent at best.
 The standard endotracheal intubation technique requires the use of tactically compromising white light.
 Also, esophageal intubations are more likely with the inexperienced intubator and much more difficult to detect in the tactical environment.
 Finally, most airway obstructions on the battlefield are the result of penetrating wounds of the head and neck, where cricothyroidotomy is the procedure of choice.

 Breathing
 The next aspect of casualty care in the tactical field care phase is the treatment of any breathing problems, specifically the development of either an open PTX or a tension PTX.
Penetrating chest wounds. Traumatic defects in the casualty’s chest wall may result in an open PTX. All open chest wounds should be treated as such.
 Cover the wound during expiration with an occlusive dressing; numerous different materials are available for use.
In addition, multiple commercial chest seals are now available, many with excellent adhesive properties.
 The dressing should be sealed on all four sides. The casualty should then be placed in a sitting position, if applicable, and monitored for the development of a tension PTX, which should be treated as described next

CCH_Casualties and Wounds On the battlefield

Casualties and Wounds On the battlefield,
More and  more countries are being  pulled in to  various  types of  internal and external wars.
What can  a community Health worker do in theses situations?
Download the full "TCCC"
TACTICAL COMBAT CASUALTY CARE  HANDBOOK here

 The pre-hospital period is the most important time to care for any combat casualty.
 In previous wars, up to 90 percent of combat deaths occurred before a casualty reached a medical treatment facility.
 This highlights the primary importance of treating battlefield casualties at the point of injury, prior to casualty evacuation and arrival at a treatment facility.
Specifically, combat deaths result from the following:
• 31 percent: Penetrating head trauma.
• 25 percent: Surgically uncorrectable torso trauma.
• 10 percent: Potentially correctable surgical trauma.
• 9 percent: Exsanguination. 
• 7 percent: Mutilating blast trauma.
• 3-4 percent: Tension pneumothorax (PTX). 
• 2 percent: Airway obstruction/injury.
• 5 percent: Died of wounds (mainly infection and shock).

which means  a commonsense approach and training everyone in the rudimentary skills of  trauma care can at least save  about 20 % of injured.

 (Note: Numbers do not add up to 100 percent. Not all causes of death are listed. Some deaths are due to multiple causes.)
 A significant percentage of these deaths (highlighted above in bold type) are potentially avoidable with proper, timely intervention.

Of these avoidable deaths, the vast majority are due to exsanguination and airway or breathing difficulties, conditions that can and should be addressed at the point of injury.

It has been estimated that of all preventable deaths, up to 90 percent of them can be avoided with the simple application of a tourniquet for extremity hemorrhage, the rapid treatment of a PTX(Tension pneumothorax ), and the establishment of a stable airway.
 On the battlefield, casualties will fall into three general categories
: • Casualties who will die, regardless of receiving any medical aid.
• Casualties who will live, regardless of receiving any medical aid.
 • Casualties who will die if they do not receive timely and appropriate medical aid.

TCCC addresses the third category of casualties — those who require the most attention of the medical provider during combat.
TCCC versus Advanced Trauma Life Support Trauma care training for military medical personnel traditionally has been based on the principles of the civilian Emergency Medical Technicians Basic Course and basic and advanced trauma life support (ATLS). These principles, especially ATLS, provide a standardized and very successful approach to the management of civilian trauma patients in a hospital setting. However, some of these principles may not apply in the civilian pre-hospital setting, let alone in a tactical, combat environment. The pre-hospital phase of casualty care is the most critical phase of care for combat casualties, accounting for up to 90 percent of combat deaths. Furthermore, combat casualties can suffer from potentially devastating injuries not usually seen in the civilian setting. Most casualties during combat are the result of penetrating injuries, rather than the blunt trauma seen in the civilian setting. Combat casualties may also suffer massive, complex trauma, such as traumatic limb amputation. In addition to the medical differences between civilian and combat trauma, several other factors affect casualty care in combat, including the following: • Hostile fire may be present, preventing the treatment of the casualty. • Medical equipment is limited to that carried by mission personnel.

• Tactical considerations may dictate that mission completion take precedence over casualty care. • Time until evacuation is highly variable (from minutes to hours or days). • Rapid evacuation may not be possible based on the tactical situation.

TCCC Goals TCCC presents a system to manage combat casualties that considers the issues discussed above. An important guiding principle of TCCC is performing the correct intervention at the correct time in the continuum of field care. To this end, TCCC is structured to meet three important goals: • Treat the casualty. • Prevent additional casualties. • Complete the mission. Stages of Care In thinking about the management of combat casualties, it is helpful to divide care into three distinct phases, each with its own characteristics and limitations: • Care under fire is the care rendered at the point of injury while both the medic and the casualty are under effective hostile fire. The risk of additional injuries from hostile fire at any moment is extremely high for both the casualty and the medic. Available medical equipment is limited to that carried by the medic and the casualty. • Tactical field care is the care rendered by the medic once he and the casualty are no longer under effective hostile fire. It also applies to situations in which an injury has occurred on a mission but there has been no hostile fire. Available medical equipment is still limited to that carried into the field by mission personnel. Time to evacuation may vary from minutes to hours. • Tactical evacuation care is the care rendered once the casualty has been picked up by an aircraft, vehicle, or boat. Additional medical personnel and equipment that has been pre-staged in these assets should be available during this phase of casualty management. The chapters and sections of this handbook will present a discussion of each stage of TCCC as well as instructions for the procedures TCCC requires.  

CCH_Section III: Tactical Field Care_Hemorrhage Control Detailed

Hemorrhage Control
Download the full "TCCC"

TACTICAL COMBAT CASUALTY CARE  HANDBOOK here
In the tactical field care phase, hemorrhage control includes addressing any significant bleeding sites not previously controlled. When evaluating the casualty for bleeding sites, only remove the absolute minimum of clothing needed to expose and treat injuries.
 Stop significant extremity bleeding as quickly as possible, using a tourniquet without hesitation if necessary.
 It is important to note that after tourniquet application, a distal pulse must be assessed to ensure the arterial blood flow has been stopped.
 If a distal pulse remains after tourniquet application( see video), then a second tourniquet must be applied side by side and just above the original tourniquet.
 This second tourniquet applies pressure over a wider area and more easily stops the arterial flow. There have been a number of reports of compartment syndrome in distal extremities when the tourniquet is not applied tightly enough to stop arterial blood flow.
 In addition, there have been tourniquet failures when the care provider has attempted to tighten the tourniquet to the extreme.
 If a tourniquet is applied around the limb as snuggly as possible before the windlass is tightened, it should only take three revolutions (540 degrees) of the windlass to stop blood flow.
If a distal pulse is still present, it is more prudent to apply a second tourniquet as described above than to try and tighten the original one too tightly.
It must be pointed out that the additional step of checking a distal pulse should only be accomplished when the tactical situation permits
. Otherwise, direct pressure, pressure dressings, or homeostatic dressings (combat gauze) should be used to control bleeding.
 Tourniquets should remain in place until the casualty has been transported to the evacuation point. Once the patient has been transported to the site where evacuation is anticipated, and any time the casualty is moved, reassess any tourniquets previously applied.
 If evacuation is significantly delayed (greater than two hours), the medic should make a determination if the tourniquet should be loosened and bleeding control replaced with some other technique.
Hemostatic bandages, pressure bandages, etc. may be able to control the bleeding and lower the risk to the extremity that a tourniquet poses.
 However, it needs to be emphasized that there is no evidence that tourniquets have caused the loss of any limbs in hundreds of tourniquet applications.
If a decision to remove a tourniquet is made, the medic must be sure to complete any required fluid resuscitation prior to tourniquet discontinuation.
 It is not necessary to remove the tourniquet, only to loosen it. This allows the tourniquet to be reapplied if the hemorrhage cannot be controlled by other methods. Data from research done in theater have demonstrated tourniquet application before the casualty goes into shock significantly improves survival statistics.
The training emphasis must continue to be on the control of bleeding in all casualties.

CCH_Section III: Tactical Field Care CPR, Altered Mental Status

CPR
In casualties of blast or penetrating injury found to be without pulse, respiration, or other signs of life, CPR on the battlefield will generally not be successful and should not be attempted. Attempts to resuscitate trauma patients in arrest have been found to be futile even in urban settings where victims are in close proximity to trauma centers. On the battlefield, the cost of performing CPR on casualties with what are inevitably fatal injuries will result in additional lives lost as care is withheld from casualties with less severe injuries. Also, these attempts expose rescuers to additional hazards from hostile fire. Prior to the tactical evacuation care phase, rescuers should consider CPR only in the cases of nontraumatic disorders such as hypothermia, near drowning, or electrocution.

Altered Mental Status Immediately disarm any casualty with an altered mental status, including secondary weapons and explosive devices. An armed combatant with an altered mental status is a significant risk to himself and those in his unit.

 The four main reasons for an altered mental status are traumatic brain injury (TBI), pain, shock, and analgesic medication (for example, morphine).

CCH_Section III: Tactical Field Care

Section III: Tactical Field Care 
Tactical field care is the care rendered to the casualty once the casualty and rescuer are no longer under effective hostile fire. This term also applies to situations in which an injury has occurred on a mission but there has been no hostile fire. This phase of care is characterized by the following:
• The risk from hostile fire has been reduced but still exists.
• The medical equipment available is still limited by what has been brought into the field by mission personnel.
 • The time available for treatment is highly variable.
 Time prior to evacuation, or re-engagement with hostile forces, can range from a few minutes to many hours.
 Medical care during this phase of care is directed toward more in-depth evaluation and treatment of the casualty, focusing on those conditions not addressed during the care under fire phase of treatment.

 While the casualty and rescuer are now in a somewhat less hazardous situation, this is still not the setting for a true rapid trauma assessment and treatment.
Evaluation and treatment are still dictated by the tactical situation. In some cases, tactical field care will consist of rapid treatment of wounds with the expectation of a re-engagement with hostile forces at any moment.
 The need to avoid undertaking nonessential evaluation and treatment is critical in such cases.

Conversely, care may be rendered once the mission has reached an anticipated evacuation point without pursuit and is awaiting evacuation.
In these circumstances, there may be ample time to render whatever care is feasible in the field.

However, as time to evacuation may vary greatly, medical providers and medics must take care to partition supplies and equipment in the event of prolonged evacuation wait times. 

CCH_Care Under Fire _Hemorrhage Control

Hemorrhage Control 
Download the full "TCCC"

TACTICAL COMBAT CASUALTY CARE  HANDBOOK here

The number one cause of preventable battlefield deaths is hemorrhage from compressible wounds.
Therefore, the primary medical interventions during the care under fire phase are directed toward stopping any life-threatening bleeding as quickly as possible.
 Injuries to an artery or other major vessel can rapidly result in hemorrhagic shock and exsanguinations.
A casualty may exsanguinate before medical help arrives, so definitive control of life threatening hemorrhage on the battlefield cannot be overemphasized.
 In Vietnam, bleeding from an extremity wound was the cause of death in more than 2,500 casualties who had sustained no other injury.
 Extremity wounds.
 The rapid, temporary use of a tourniquet is the recommended management for all life-threatening extremity hemorrhage.
 Standard field dressings and direct pressure may not work reliably to control extremity hemorrhage.
While traditional ATLS training discourages the use of tourniquets, they are appropriate in the tactical combat setting.

 The benefits of tourniquet use over other methods of hemorrhage control include:
 • Direct pressure and compression are difficult to perform and maintain in combat settings and result in delays in getting the rescuer and casualty to cover.
 • Tourniquets can be applied to the casualty by himself, thus limiting the rescuer’s exposure to hostile fire.
 • There are few complications from tourniquet use. Ischemic damage is rare if the tourniquet is in place for less than two hours.
 During the care under fire phase, the casualty and rescuer remain in grave danger from hostile fire.

 If the casualty is observed to have bleeding from an extremity, the care provider should apply a tourniquet to the injured extremity over the uniform, high on the extremity, and move himself and the casualty to cover as quickly as possible.

 Non Extremity wounds.
 These injuries are difficult to treat in the care under fire phase. Attempt to provide direct pressure to these wounds as you rapidly move the casualty to cover.
 Once under cover, a hemostatic agent is appropriate for these injuries.

CCH_Section II: Care Under Fire

Section II: Care Under Fire  
Download the full "TCCC"
TACTICAL COMBAT CASUALTY CARE  HANDBOOK here

Care under fire is the care rendered by the rescuer at the point of injury while he and the casualty are still under effective hostile fire. The risk of additional injuries at any moment is extremely high for both the casualty and the rescuer. The major considerations during this phase of care are the following
: • Suppression of hostile fire.
 • Moving the casualty to a safe position.
 • Treatment of immediate life-threatening hemorrhage.
 Casualty care during the care under fire phase is complicated by several tactical factors.
 First, the medical equipment available for care is limited to that which is carried by the individual Soldiers and the rescuers.
 Second, the unit’s personnel will be engaged with hostile forces and, especially in small unit engagements, will not be available to assist with casualty treatment and evacuation.
 Third, the tactical situation prevents the medic or medical provider from performing a detailed examination or definitive treatment of casualties.
Furthermore, these situations often occur during night operations, resulting in severe visual limitations while treating the casualty.
Defensive Actions
 The best medicine on the battlefield is fire superiority.
The rapid success of the combat mission is the immediate priority and the best way to prevent the risk of injury to other personnel or additional injuries to casualties.
Medical personnel carry small arms to defend themselves and casualties in the field.
 The additional firepower from the medical personnel may be essential to obtaining fire superiority.

Initially, medical personnel may need to assist in returning fire before stopping to care for the casualty.
 Additionally, casualties who have sustained non-life-threatening injuries and are still able to participate in the fight must continue to return fire as they are able.
As soon as the rescuer is directed or able, his first major objective is to keep the casualty from sustaining additional injuries.
 Wounded Soldiers who are unable to participate further in the engagement should lay flat and still if no ground cover is available or move as quickly as possible if nearby cover is available

The medic may be able to direct the injured Soldier to provide self-aid.
 Airway Management
 Do not perform any immediate management of the airway during the care under fire phase.
 Airway injuries typically play a minimal role in combat casualties, comprising only 1 to 2 percent of casualties primarily from maxillofacial injuries.
 The primary concern is to move the casualty to cover as quickly as possible.
The time, equipment, and positioning required to manage an impaired airway expose the casualty and rescuer to increased risk.
 Rescuers should defer airway management until the tactical field care phase, when the casualty and rescuer are safe from hostile fire.