COMBAT LIFESAVER / TACTICAL COMBAT CASUALTY CARE
COMBAT LIFESAVER / TACTICALCOMBAT CASUALTY CARESTUDENT HANDOUT“THE BEST FORM OF TROOP WELFARE IS TOUGH,REALISTIC TRAINING”REVISED MARCH 2010RANK/NAME:
Table of ContentsTactical Combat Casualty Care/CLSOverview1Identify Medical Fundamentals11Manage Hemorrhage21Maintain Casualty Airway33Manage Penetrating Chest Injuries45Manage Hemorrhagic Shock56Manage Burn Casualties63Perform Splinting Techniques72Administer Battlefield Medications86Perform Casualty Movement94Perform Combat Lifesaver Triage109Perform Combat Lifesaver Care118Glossary128Appendix A132Appendix B134
TACTICAL COMBAT CASUALTY CARE/COMBAT LIFESAVER OVERVIEWLEARNING OBJECTIVES.a. TERMINAL LEARNING OBJECTIVE1. Without the aid of references, identifyTactical Combat Casualty Care, per thestated references. (CLS####)b. ENABLING LEARNING OBJECTIVES1. Without the aid of references, given adescription or list, identify the history ofTactical Combat Casualty Care, per PHTLS Manual,current edition. (CLS####)2. Without the aid of references, given adescription or list, identify the factorsinfluencing Tactical Combat Casualty Care/CombatLifesaver, per PHTLS Manual, current edition.(CLS####)3. Without the aid of references, given adescription or list, identify the objectives ofTactical Combat Casualty Care/Combat Lifesaver,per PHTLS Manual, current edition. (CLS####)4. Without the aid of references, given adescription or list, identify the phases of carethat apply to Tactical Combat CasualtyCare/Combat Lifesaver, per PHTLS Manual, currentedition. (CLS####)5. Without the aid of references, given adescription or list, identify the CombatLifesaver medical gear, per PHTLS Manual,current edition. (CLS####)1
1.HISTORY OF TCCCa. It is important to realize that civilian trauma carein a non-tactical setting is dissimilar to trauma care ina combat environment. TCCC and CLS are an attempt tobetter prepare medical and non-medical personnel for theunique factors associated with combat trauma casualties.b. Historical data shows that 90% of combat woundfatalities die on the battlefield before reaching amilitary treatment facility. This fact illustrates theimportance of first responder care at the point of injury.c. TCCC was originally a US Special Operations researchproject which was composed of trauma management guidelinesfocusing on casualty care at the point of injury.d. TCCC guidelines are currently used throughout the USMilitary and various allied countries.e. TCCC guidelines were first introduced in 1996 for useby Special Operations corpsmen, medics, and pararescumen(PJs).f. The TCCC guidelines are currently endorsed by theAmerican College of Surgeons, Committee on Trauma and theNational Association of Emergency Medical Technicians.The guidelines have been incorporated into the PrehospitalTrauma Life Support (PHTLS) text since the 4th edition.g. The Committee on Tactical Combat Casualty Care(CoTCCC) was established in 2002 by the US SpecialOperations Command with support from the US NavyBureau of Medicine and Surgery (BUMED). Thismultiservice committee is comprised of military andcivilian trauma specialists, operational physicians,and combat medical personnel. The CoTCCC isresponsible for updating the guidelines based oncurrent civilian and military trauma care, medicalresearch, and combat doctrine.2.Factors Influencing TCCC/CLSa. Factors affecting combat trauma that demonstrate thedissimilarity from civilian trauma care include takinghostile fire, night operations, resource limitations,varying evacuation times,2
varying transportation platforms, extreme environments,mission requirements, and tactical considerations.b. Three preventable causes of death on the battlefield, seeFigure 1:Figure 1(1) Hemorrhage from extremity wounds, see Figure 2Figure 2(2) Tension pneumothorax, see Figure 33
Figure 3(3) Airway compromise, see Figure 4Figure 43.Objectives of TCCC/CLSa. Treat the casualty – Following the TCCC/CLS systematicapproach to gain fire superiority, move, assess, treat,and evacuate the casualty.b. Prevent additional casualties – Continued firesuperiority, performing the correct intervention at thecorrect time.4
c. Complete the mission – Mission accomplishment is paramountbut the number and severity of casualties may require acontingency plan be considered.4.TCCC/CLS Phases of Carea. The 3 phases of CLS care during hostile engagementsfocus on eliminating threats first, then focusing oncasualty management.(1) Care Under Fire(a) The casualty and CLS at the point of injurytaking effective hostile fire with equipmentlimitations.(b) CoTCCC 2009 Updates – If tactically feasibleapply tourniquet proximal to the bleeding site,over the uniform, tighten, and move the casualtyto cover.(2) Tactical Field Care(a) The casualty and CLS are no longer takingeffective hostile fire or casualty sustainsinjury without hostile fire. Equipmentlimitations are still an issue. Consider TACEVAC.(c) CoTCCC 2009 Updates – If casualty presents withtorso trauma and progressive respiratorydistress,consider needle decompression to treat a tensionpneumothorax. Preferred needle/catheter is 14g3.25inches. Apply occlusive material to cover suckingchest wound and combat gauze is the hemostatic agentof choice.(d) CoTCCC 2009 Updates - Reassess tourniquet andmove to direct skin, 2-3 inches from wound, distalpulse check, tighten or apply another tourniquet ifnecessary. Expose and clearly mark tourniquet time.(e) CoTCCC 2009 Updates - Penetrating eye trauma,assess visual acuity, cover with rigid shield400mg Moxifloxacin from pill pack. Document oncasualty card.5
(3) Tactical Evacuation Care(a) Casualty picked up by an aircraft, vehicle orboat. Additional personnel and equipment may bepre-staged for continued casualty care.1 Encompasses both Casualty Evacuation (CASEVAC)and Medical Evacuation (MEDEVAC).(b) Updates 2009 same as tactical field care phase.(c) CASEVAC: (e.g. FEBA to BAS) Medical Care islimited by tactical and resource constraints tobasic interventions. Movement from forward edgeof battle area, aircraft may be exposed tohostile fire.(d) MEDEVAC: From one point of care to another intheater.(e) AEROMEDICAL EVACUATION: (e.g. CSH to RegionalMedical Center) from within theater to morerearward location.5.Combat Lifesaver Medical Geara. All Marines are issued an Individual First Aid Kit(IFAK), see Figure 5. The casualty’s IFAK should be usedby the CLS for initial treatment. Therefore it isimportant for CLS Marines to have a thorough understandingof the items in the IFAK to assist with casualty care.*Note – See Appendix B for a full list of IFAK contents.6
Figure 5b. In addition to a personal IFAK, CLS Marines will beissued a CLS Kit, see Figure 6. The CLS kit containssimilar items to the IFAK in addition to specific medicaltools to be used only by the CLS, which will be discussedthroughout this course. This kit should be utilized toaugment the casualty’s IFAK contents during casualty care.*Note – See Appendix A for a full list of CLS Kit contents.Figure 67
REFERENCESPHTLS Manual, current edition8
Notes9
IDENTIFY MEDICAL FUNDAMENTALS1.LEARNING OBJECTIVES.a.TERMINAL LEARNING OBJECTIVE. Without the aid ofreferences, given a description or list, identify basicmedical fundamentals, within 80% accuracy, per thestated references. (CLS####)b.ENABLING LEARNING OBJECTIVES(1) Without the aid of references, given a description orlist, identify the basic anatomy of the body, within 80%accuracy, per the NAVEDTRA 14295. (CLS####)(2) Without the aid of references, given a descriptionor list, identify vital body functions, within 80%accuracy, per the MCRP 3-02G and NAVEDTRA 14295.(CLS####)(3) Without the aid of references, given a description orlist, identify abnormal vital body functions, within 80%accuracy, per the MCRP 3-02G. (CLS####)10
1. ANATOMY OF THE BODY:Overview - Knowledge of how the human body is constructed andhow it works is an important part of the training of everyoneconcerned with healing the sick or managing conditions followinginjuries. The human body is a combination of organ systems, witha supporting framework of muscles and bones and an externalcovering of skin.a. THE MUSCLE/SKELETAL SYSTEM(1) The skeleton is the bony framework of the body and iscomposed of 206 bones. It supports and gives shape tothe body; protects vital organs; and provides sites ofattachment for tendons, muscles, and ligaments. Theskeletal bones are joined members that make musclemovement possible. (See Figure-1)(2) Axial Skeleton - The axial skeleton consists of theskull, spinal column and rib cage.(3) Appendicular Skeleton - The appendicular skeletonconsists of the bones of the upper extremitieswhich include the scapula, bones of the lowerextremities, and the pelvic girdle.(a)The upper extremities are made up of the humerus,ulna, radius and bones of the wrist & hand.(b)The lower extremities are made up of the femur,tibia, fibula, patella and bones that make up theankles & feet.11
Figure – 1 Skeletal System(4) Muscles are responsible for many different types ofbody movements. The action of the muscle is determinedmainly by the kind of joint it is associated with andthe way the muscle is attached to the joint. Muscleseldom act alone, they usually working in groups toprovide movement.2.VITAL BODY FUNCTIONSOverview - In order for the service member to learn to performfirst aid procedures, he must have a basic understanding of whatthe vital body functions are and what the result will be if theyare damaged or not functioning.a.Conscious or unconscious casualty. The AVPU scale(Alert, Voice, Pain, Unresponsive) is a system by whichthe CLS can measure and record a patient's level ofconsciousness.(1) Alert - a fully awake (although not necessarilyorientated) casualty. This casualty will havespontaneously open eyes, will respond to voice(although may be confused) and will have bodilymotor function.(2) Voice - the patient makes some kind of response whenyou talk to them, which could be in any of the threecomponent measures of Eyes, Voice or Motor. (e.g.patient's eyes open on being asked "are you12
okay?"). The response could be as little as a grunt,moan, or slight move of a limb when prompted by thevoice of the CLS.(3) Pain - the casualty makes a response on any of thethree component measures when pain stimulus is usedon them.(a) Sternal rub, where the CLS’s knucklesare firmly rubbed on the breastbone of thecasualty. A fully conscious casualty wouldnormally locate the pain and push it away;however, a casualty who is not alert and who hasnot responded to is likely to exhibit onlywithdrawal from pain, or even involuntaryflexion or extension of the limbs from the painstimulus.(b) Brachial pinch – here the CLS pinches theBrachial area of the causality to stimulatepain.(4) Unresponsive - this outcome is recorded if thecasualty does not give any Eye, Voice or Motorresponse to voice or pain.b.Breathing Process. All humans must have oxygen to live.Through the breathing process, the lungs draw oxygenfrom the air and put it into the blood. The heart pumpsthe blood through the body to be used by the cells thatrequire a constant supply of oxygen. Some cells are moredependent on a constant supply of oxygen than others.For example, cells of the brain may die within 4 to 6minutes without oxygen. Once these cells die, they arelost forever since they do not regenerate. This couldresult in permanent brain damage, paralysis, or death.c.Respiration. Respiration occurs when a person inhales(oxygen is taken into the body) and then exhales (carbondioxide [CO2] is expelled from the body). Respirationinvolves the airway, the lungs, and diaphragm. (SeeFigure-2)(1) Airway. The airway consists of the nose, mouth,throat, voice box, and windpipe. It is the canalthrough which air passes to and from the lungs.13
(2) Lungs. The lungs are two elastic organs made up ofthousands of tiny air spaces and covered by anairtight membrane. The bronchial tree is a part ofthe lungs.(3) Diaphragm. The diaphragm is a large dome-shapedmuscle that separates the lungs from the abdominalcavity. This muscle, which is controlled by thebrain, regulates the breathing cycle.(a) Respiration rate refers to the number of breathesper minute. The normal breathing rate is about 12to 20 breaths per minute.(b) Respiration rhythm refers to the manner inwhich a person breathes. Respiration rhythm isclassified as regular or irregular. A regularrhythm is when the interval between breaths isconstant, and an irregular rhythm is when theinterval between breaths varies.(c) Respiration depth refers to the amount of airmoved between each breath. Respiration depth isclassified as normal, deep, or shallow.Figure – 2 Respiratory Systemd.Blood Circulation. The heart and the blood vessels(arteries, veins, and capillaries) circulate bloodthrough the body tissues. The heart is divided into twoseparate halves, each acting as a pump.(See Figure – 3)(1) The left side pumps oxygenated blood (bright red)through the arteries into the capillaries.(2) The right side receives low oxygenated blood (dark14
red) from the capillaries where it returns it to thelungs to be re-oxygenated.(3) The heart contracts, forcing the blood from itschambers; then it relaxes, permitting itschambers to refill with blood. This is know asthe heartbeat, which is normally 60 to 80 beatsper minute.Figure – 3 Circulatory System(4) The heart expands and contracts forcing bloodthrough the arteries and veins in a pulsatingmanner. This cycle of expansion and contraction canbe felt (monitored) at various points in the bodyand is called the pulse. The common points forchecking the pulse are at the side of the neck(carotid), groin (femoral), and wrist(radial).(a) To check the carotid pulse, feel for a pulse onthe side of the casualty’s neck closest to you.This is done by placing the tips of your firsttwo fingers beside his/her throat.(See Figure- 4)15
Figure – 4 Carotid Pulse(b) To check the femoral pulse, press the tips ofyour first two fingers into the middle of thegroin. (See Figure - 5)Figure – 5 Femoral Pulse(c) To check the radial pulse, place your first twofingers on the thumb side of the casualty’swrist. (See Figure - 6)Figure – 6 Radial PulseNote: DO NOT use your thumb to check a casualty’s pulse becauseyou may confuse the beat of the CLS’s pulse with that of thecasualty.16
(5) Palpated Blood Pressure(a) To determine a casualty’s blood pressure in acombat environment the CLS should use thepalpated blood method. This systematic approachutilizes the casualty’s arterial pulse to get anestimated systolic blood pressure. The CLS mustwork from the furthest point away from the heartto get the highest blood pressure. (e.g. radialfirst, femoral second, carotid third)1 Find the radial pulse – if present, casualtyhas a systolic blood pressure of at least 80mmHg. This is verbalized as “80 over palp”and documented as 80/P.2 If the casualty has no radial pulse, attemptto find the femoral pulse – if present,casualty has a systolic blood pressure of atleast 70mmHG. This is verbalized as “70 overpalp” and documented as 70/P.3 If the casualty has no femoral pulse, attemptto find the carotid pulse – if present, thecasualty has a systolic blood pressure of atleast 60mmHg. This is verbalized as “60 overpalp” and documented as 60/P.(6) Skin(a) Color - Adequate perfusion produces a pinkishhue to the skin. Skin becomes pale when blood isshunted away from an area. Bluish colorationindicates incomplete oxygenation. Examination ofthe nail beds and mucous membranes serves toovercome the difference in skin pigments.Changes in color first appear in lips, gums orfingertips. (e.g. pink, pale, red)(b) Temperature – is influenced by environmentalconditions. Cool skin indicates decreasedperfusion, regardless of cause. (e.g. warm,cool)(c) Condition – dry skin indicates good perfusion.Moist skin is associated with shock anddecreased perfusion. (e.g. moist, dry)17
(7) Capillary Refill Time – check by pressing over thenail beds. This is a tool in estimating blood flowthrough the most distal part of the circulation.Should be less than 3 seconds. Greater than 3Seconds indicate a potential circulatory problem.3.ABNORMAL BODY FUNCTIONSa.Lack of Oxygen. Human life cannot exist without acontinuous intake of oxygen. Lack of oxygen rapidlyleads to death. First aid involves knowing how to openthe airway and restore breathing. CLS providers have 4to 6 minutes to provide an adequate airway.b.Life-Threatening Hemorrhage (Bleeding) . Human lifecannot continue without an adequate volume of bloodcirculating through the body to carry oxygen to thetissues. An important first aid measure is to stop thebleeding to prevent the loss of blood. CLS providershave 60-120 seconds to stop the massive lifethreatening hemorrhage.c.Shock. Shock means there is an inadequate blood flow tothe vital tissues and organs. Shock that remainsuncorrected may result in death even though the injuryor condition causing the shock would not otherwise befatal. Shock can result from many causes, such as lossof blood, loss of fluid from deep burns, pain, andreaction to the sight of a wound or blood. Firstaid includes preventing shock, since the casualty’schances of survival are much greater if he does notdevelop shock.d.Infection. The objective is to keep wounds clean andfree of organisms. A good working knowledge of basicfirst aid measures also includes knowing how to dress awound to avoid infection or additional contamination.18
REFERENCES:MCRP 3-02GNAVEDTRA 1429519
Notes20
MANAGE HEMORRHAGE1.LEARNING OBJECTIVES.a.TERMINAL LEARNING OBJECTIVE. Without the aid ofreferences, given a description or list, managehemorrhage, within 80% accuracy, per the statedreferences. (CLS####)b.ENABLING LEARNING OBJECTIVES(1) Without the aid of references, given a descriptionor list, identify the types of hemorrhage, within80% accuracy, per the PHTLS Manual, current edition.(CLS####)(2) Without the aid of references, given a list ofsymptoms, identify hemorrhage control materials,within 80% accuracy, per the PHTLS Manual, currentedition and MCRP 3-02G. (CLS####)(3) Without the aid of references, given a descriptionor list, identify the treatment for life-threateninghemorrhage, within 80% accuracy, per the PHTLSManual, current edition and MCRP 3-02G. (CLS####)(4) Without the aid of references, given a descriptionor list, identify the treatment for non-lifethreatening hemorrhage, within 80% accuracy, per thePHTLS Manual, current edition and MCRP 3-02G.(CLS####)(5) Without the aid of references, given a casualty,apply a tourniquet to prevent further injury ordeath, per the PHTLS Manual, current edition.(CLS####)(6) Without the aid of references, given a casualty,apply hemostatic agents to prevent further injury ordeath, per the PHTLS Manual, current edition.(CLS####)21
OVERVIEWHistorically, 20 percent of all injured combatants die on thebattlefield. Of the battlefield casualties who die,approximately 65 percent will die of massive, multi-systemtrauma and are probably not salvageable. On the basis of datafound from the Vietnam conflict, almost 50% of battlefieldcasualties died of hemorrhage (bleeding out) within 3 to 5minutes and could have been salvaged with timely intervention.Extremity hemorrhage is the most frequent cause of PREVENTABLEdeaths on the battlefield.These wounds may be fatal within minutes. In a combatenvironment, the treatment of a life-threatening hemorrhage isthe first priority. This is because the brain can go 4 to 6minutes without oxygen before permanent brain damage occurs.Once hemorrhage is controlled, the establishment of the airwayonce again becomes the primary concern AFTER the casualty hasbeen moved to a safer setting, as in the Tactical Field Carephase of TCCC.1.HEMORRHAGEHemorrhage is defined as blood escaping from arteries, veinsor capillaries. The heart pushes oxygen rich blood throughthe arteries and into the capillaries where oxygen isdropped off and carbon dioxide is picked up. Once thatexchange has taken place, the blood is then pushed into theveins back into the heart. The heart sends that blood tothe lungs where it picks up more oxygen and then continuesthat cycle.a. Types of Hemorrhage(1)Arterial. If an artery near the surface is cut,BRIGHT RED BLOOD will gush out in spurts that aresynchronized with the heartbeat.(2)Venous. Blood from the veins is DARK RED. Venousbleeding is characterized by a steady, even flow.22
2.(3)Capillary. Capillary blood is usually BRICK RED incolor. If capillaries bleed, the blood oozes outslowly.(4)Life Threatening. Any arterial bleed is lifethreatening. Some venous bleeds are consideredlife threatening based off of how much blood isbeing lost and how quickly.(5)Non-Life Threatening. Slow venous bleeds andcapillary bleeds.(6)Extremity. Bleeding from the arms, hands, legs orfeet.(7)Non-Extremity. Bleeding from head, neck, chest,back, abdomen, or pelvis.HEMORRHAGE CONTROL MATERIALSa.Dressings. Either a commercially manufactured absorbentmaterial or improvised materials used to cover andprotect wounds from further injury, infection, orphysical contamination.(1)(2)Purpose:(a)Promote hemorrhage control.(b)Protect the wound from further injury.(c)Immobilize soft tissue wounds (large wounds).(d)Protect the wound from further externalcontamination.(e)Provide physical and psychological support tothe patient.Types:(a)Cinch Tight:1Medium to Large battle dressing2Combined with a 4 inch ace wrap23
3(b)Metal “S” hook for pressure application“H” Bandage:1Medium to Large battle dressing2Combined with a 4 inch ace wrap3Plastic “H” hook for pressure applicationb. Bandages A piece of gauze either commerciallymanufactured or improvised. It can be applied to wrap orbind a body part or dressing.(1) Purpose:(a) Hold dressings and splints in place.(b) Provides additional pressure to the dressing orsplint.(c) Protects the dressing.(2) Types:(a)Kerlex:12AdvantagesaExtremely absorbentbWeave of material makes roll stretchablewithout elastic.cSteriledGood for packing cavities when used as adressing.DisadvantagesaLooses bulk when wetbCatches debris and snags very easily(b) Ace wrap:24
1Advantages:2aCan be applied quicklybGives pressure to the entire wound areacProvides excellent support for sprainsand strains.Disadvantages:a(c)Can decrease peripheral circulation.Cravats or Triangular Bandages (40”x40”x56”):12Advantages:aThe most versatile bandage made. Calledby some the workhorse of the aid bag.bComes in small packages with safety pins.cCan be used as a tourniquet.Disadvantages:aHas very little absorbency potential.(d) Expedient (Improvised) Dressings and Bandage:3.1Patients clothing.2Patients equipment.3The only limitations are on the CLS’simagination.TREATMENT OF LIFE-THREATENING HEMORRHAGEa.Apply direct pressure to the wound with your glovedhand.b.Extremity wounds:(1) Treatment of a life-threatening extremity wound isto apply a tourniquet.25
c.Non-extremity wounds:(1) Pressure Dressing(2) Hemostatic Agent(3) Monitor for shock(4) Evacuate to medical personneld. Tourniquets:Used to control life-threatening extremity hemorrhage.(1)Use the Combat Application Tourniquet (CAT) ifavailable (See Figure 1).(a)Tourniquet of choice(b)Lightweight(c)Easy to apply(d)Easy to use(e)Place 2-3 inches above the wound(f)Place tourniquet over casualty’s clothingFigure – 1 CAT(2)If the CAT is not available, make and utilize animprovised tourniquet (See Figure 2).(a) Choose a material about 2” wide. The new CLSbag and the IFAK contain triangular bandagesthat can be conformed into a cravat. Materialsuch as rope, wire and string should not beused because they can cut into flesh.26
(b) Tie a strong windless into a cravat or otherstrong material.(c) Slide one or two strong rings, such asgrenade pin rings, on each side of thecravat.(3)(4)(d)Tie the cravat around the affected limb two(2) to three (3) inches above the woundloosely. (This will allow the windless toturn creating circumferenial pressure tostop the bleed).(e)Twist the windless until the hemorrhage iscontrolled.(f)Slide the ring onto the windless and securewindless to the rings.Tourniquet Rules:(a)Never place a tourniquet on a joint (knee,elbow).(b)Document placement of a tourniquet byplacing a “T” and the time on thecasualty’s forehead.(c)Do not cover a tourniquet under anycondition. Leave it exposed (over theuniform) for open viewing.(d)Apply a second tourniquet proximal to thefirst to ensure hemorrhage control.Tourniquet Mistakes:(a)Not using one when you should(b)Using one when you shouldn’t(c)Putting it on too close to wound(d)Not tight enough(e)Removing the tourniquet. ONLY medical27
personnel are allowed to remove atourniquet once it is in place!Figure – 2 Improvised Tourniquete. Hemostatic agent:(1)Purpose - When applied to a wound, causes thewound to develop a clot that will stop the flow ofblood and will remain within the wound untilremoved by medical personnel.(2)Combat Gauze - Has been recommended as thehemostatic agent of choice due to its increasedability to stop bleeding. Other previoushemostatic agents (Quickclot, HemCon, etc.) havebeen removed from the guidelines as a result ofconcerns about its safety.(a)Combat Gauze (See Figure 3)1How it Works:aCombat Gauze is a 3x4 inch roll ofsterile gauze that is impregnated withkaolin, which helps promote bloodclotting.bUnlike Quickclot, Combat Gauze is notexothermic (heat producing) in nature.cThe combination of sterile gauze andproprietary inorganic material allowsCombat Gauze to be non-allergenic.28
2Application Procedures:aExpose wound and identify bleeding.bIf possible, remove any excess bloodthat is pooling in or around the wound.cPack wound tightly and directly on thesource of bleeding. If multiple CombatGauze rolls are needed, apply as many asnecessary to completely pack the wound.dApply direct pressure continually forapproximately 3 minutes, or untilbleeding stops. Reassess wound toensure bleeding is controlled. CombatGauze may be repacked or a second gauzeused if initial application fails.eLeave Combat Gauze in place and apply apressure dressing directly over top ofthe wound.fTransport and monitor casualty. Do notremove the pressure dressing or theCombat Gauze. Reassess the casualty toensure bleeding remains controlled.Figure – 3 Combat Gauze4.TREATMENT OF NON-LIFE THREATENING HEMORRHAGEa. Apply direct pressure to the wound with your gloved handb. Extremity wounds:29
(1)Pressure dressing(2)Hemostatic Agent, used if pressure dressing isineffectivec. Non-extremity wounds:(1)Pressure dressing(2)Hemostatic Agent (if pressure dressing isnot effective).(3)Monitor for shock(4)Evacuate to medical personneld. Pressure dressings: Used to control non-life threateningextremity hemorrhage and/or life threatening nonextremity hemorrhage.(1)When using cravats and battle dressings, must havetwo (2) dressings and two (2) bandages to beconsidered a pressure dressing.(2)The first dressing is placed directlybleeding and covered with a bandage.should cover the entire wound and theshould cover the entire dressing. Doknot of the first bandage directly on(tie to one of the 4 sides).(3)The second dressing is made as small and tight aspossible and placed over the first dressing/bandageand covered with the second bandage to apply theactual pressure. This knot is tied directly on topof the wound.over theThe dressingbandagenot tie thethe wound.(4)If the second dressing becomes saturated, theapplication of a tourniquet or hemostatic agentsmay be necessary to control the bleeding.(5)Cinch tight and “H”-bandage dressings now come inthe IFAK and/ or CLS bag. Only one of thesedressings is necessary and is more effective thanthe (2) bandage/dressing pressure dressing.30
REFERENCESPHTLS Manual, current editionMCRP 3-02G31
Notes32
MAINTAIN CASUALTY AIRWAY1.LEARNING OBJECTIVESa.TERMINAL LEARNING OBJECTIVE. Without the aid ofreferences, given a casualty, maintain a casualty’sairway, per the stated references. (CLS####)b.ENABLING LEARNING OBJECTIVES(1)Without the aid of references, given a casualty,identify the anatomy of an airway, within 80%accuracy, per the PHTLS Manual, current edition andMCRP 3-02G. (CLS####)(2)Without the aid of references, given a casualty,identify an airway emergency, within 80% accuracy,per the PHTLS Manual, current edition and MCRP 302G. (CLS####)(3)Without the aid of references, given a casualty,properly position the casualty to assist inventilations, per the PHTLS Manual, current editionand MCRP 3-02G. (CLS####)(4)Without the aid of references, given a casualty,open the airway to prevent obstructions, per thePHTLS Manual, current edition and MCRP 3-02G.(CLS####)(5)Without the aid of references, given a casualty,insert a nasopharyngeal airway to maintain a patentairway, per the PHTLS Manual, current edition andMCRP 3-02G. (CLS####)33
1.IDENTIFY THE ANATOMY OF AN AIRWAYa.Anatomical Structures(1)The airway consists of the nose, mouth, throat,voice box and wind pipe. It is the canal throughwhich air passes to and from the lungs (Figure 1).(2)The bronchial tree is the intersection at thebottom of the windpipe where the air is diverted tothe right and left lungs (Figure 1).The lungs are two elastic organs made up ofthousands of tiny air spaces and covered by anairtight membrane. The lungs are protected by therib cage, which is formed by the muscle-connectedribs, which join the spine in the back, and thebreastbone in the front (Figure 1).(3)(4)The top part of the rib cage is closed by thestructure of the neck, and the bottom part isseparated from the abdominal cavity by a largedome-shaped muscle called the diaphragm (Figure 1).(5)The diaphragm and rib muscles, which are under thecontrol of the respiratory center in the brain,automatically contract and relax. Contractionincreases and relaxation decreases the size of therib cage. When the rib cage increases and thendecreases, the air
casualty card. 6 (3) Tactical Evacuation Care (a) Casualty picked up by an aircraft, vehicle or boat. Additional personnel and equipment may be pre-staged for continued casualty care. 1 Encompasses both Casual
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TACTICAL COMBAT CASUALTY CARE (TCCC / TC3) ABBREVIATED TCCC GUIDELINES 31 JAN 2017 Return Fire and take cover Direct or expect casualty to remain engaged as a combatant if appropriate Direct casualty to move to cover and apply self-aid if able.
casualty develops progressive difficulty breathing, consider this a tension pneumothorax and perform a needle chest decompression. If no capability of NCD exists and the casualty continues to have progressive respiratory distress, . Tactical Combat Casualty Care Author:
EMC standards generally cover the range from 0 Hz to 400 GHz. Currently, however, not all frequency ranges are completely regu-lated. The first important frequency range is the range around the power network frequency, which in Europe is 50 Hz. Most loads connected to the power network are non-linear loads, i.e., they draw a current that does not follow the sinusoidal voltage. Non-linear loads .
