TEAM MEDIC DRILLS v4 | Cardiopulmonary Resuscitation | Clinical Medicine

TEAM MEDIC

CASUALTY DRILLS

AIDE MEMOIRE
ARMY CODE 64410
FIRST EDITION DECEMBER 2007

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ALL RIGHTS RESERVED

WARNING
Disposable gloves to be worn where possible to prevent cross infection of blood borne diseases

WARNING

MASTER DRILL DRILL 1 MULTIPLE CASUALTIES START HERE You must triage all casualties before treatment UNDER EFFECTIVE ENEMY FIRE YES WIN FIRE FIGHT 1. Assess the priority 2. casualty. Write it on casualty’s cheek or where visible 3. Move to next casualty START HERE Walking? NO IF ACCESS TO CASUALTY POSSIBLE • Self/buddy tourniquet for severe limb bleeding • Roll unconscious casualty face down (head to one side) to maintain airway/drainage YES STILL NONE Write T3 NO Breathing? NO Airway opening procedures DEAD THEN C A C T FIRE FIGHT WON CONTROL THE INCIDENT STARTS BREATHING ¾ prone position ASSESS Safety: self. weapons Casualties: how many. how bad? COMMUNICATE Send initial SITREP YES Catastrophic Limb Bleeding: use tourniquet Write T1 Write T1 NO Breathing Rate 10-30/min TRIAGE Pulse Rate missing or over 120/min under 120/min Write T1 Write T2 under 10 or over 30/min Write T1 Two or more Casualties: Drill 1 One Casualty: Drill 2 go to DRILL 2 MASTER DRILL DRILL 1 .

Check for breathing for YES up to 10 secs YES STARTS BREATHING Check the Airway Open mouth. any response? YES B Check breathing C OK Check for Bleeding. and pick out any debris. Check for breathing for up to 10 secs NO BREATHING NO BREATHING NO Then Head-Tilt Chin Lift Jaw Thrust Check for breathing for up YES YES Place in ¾ prone position Jaw Thrust Chin Lift Check for breathing for up to 10 secs to 10 secs A Shake and shout. look inside. and pick out any debris. • Press hard into the wound with fingers/ knuckles • Apply HemCon Check the Airway Open mouth. look inside.DRILL 2 INJURED SOLDIER DRILL 3 UNRESPONSIVE SOLDIER <C> CATASTROPHIC BLEEDING OTHER LIMB COMBAT INJURY NON-COMBAT INJURY Apply CAT tourniquet OR HemCon as needed • Pack wound with field dressing. Breaks and Burns STILL NO BREATHING Go to Drill 4 STILL NO BREATHING Dificulty Difficulty GO TO Drill 4 NO GO TO Drill 3 GO TO Drill 5 Go to Drill 3A GO TO BASIC LIFE SUPPORT DRILL 2 DRILL 3 . suction if required. suction if required.

Apply pressure through the dressing into the wound 4. If difficulty continues consider the following reasons: Chemical Contamination Follow CBRN Drills Airway Burn • Swelling • Burn in the mouth or tongue blisters • Coughing up sooty spit • Hoarse voice Maintain Airway and treat with sips of water EARLY EVAC ESSENTIAL DRILL 5 BLEEDING Conduct a TRaPS assessment remembering “Blood on the Floor and Four More”.DRILL 4 DIFFICULTY BREATHING If not already done check the AIRWAY. Apply an Emergency Bandage to the wound 2. Apply indirect pressure to the artery IF STILL BLEEDING Apply a second Emergency Bandage OVER the first. Secure the dressing in place 5. • If tourniquet applied during care under fire. For large wounds pack the wound with a dressing or use HemCon / tourniquet 3. bruising and tenderness Back: Slide hands under back check for injuries Log roll . DO NOT remove embedded foreign objects IF BLEEDING 1. open mouth and look inside. Pain relief if required Conduct RIBS Assessment Rate: Count the respiratory rate? Lower than 10 or more than 30 Injuries: Expose the chest and neck Look and feel for holes. Elevate bleeding limb (above heart level) 6. Pick out any debris and do suction as required. gently release tourniquet and assess if bleeding can be controlled by pressure through dressings and elevation • If tourniquet is still required write T where visible and record time ABDOMINAL WOUNDS • Do not push protruding organs back into place • Do not give any food or drink • If organs protruding apply wet dressing • If no protrusions apply firm dry dressing and support casualty in comfortable position INTERNAL BLEEDING SUSPECTED go If there is a rapid or absent radial pulse and no external bleeding. If not already used consider HemCon or Tourniquet.3 people Sides: Check under the arms for injury Treat Injuries Found If reduced level of response place in ¾ prone position to Drill 10 go to Drill 8 go to DRILL 5 go to DRILL 6 DRILL 4 DRILL 5 .

DRILL 6 FRACTURES DRILL 7 BURNS Treat fractures and dislocations the same Suspect a fracture or dislocation if there is: • History of trauma • Bruising • Pain • Swelling over a bone or joint • Reduced or loss of movement • Deformity of the bone or joint Apply water to cool the burn within 10 mins for at least 10 min DO NOT cover the whole body in cold water THEN Is there a Fracture? NO go to Drill 7 If NO airway burns consider pain relief Go to Drill 8 YES THEN Consider pain relief go to Drill 8 • Lightly cover skin burns with field dressing(s) • If phosphorous present – remove • Cover phosphorous burns with a wet dressing and keep wet • Protect from the environment: Cold and Direct sunlight THEN Re-align and immobilise the limb go to DRILL 7 go to DRILL 9 DRILL 6 DRILL 7 .

then remove autoinjector. 3. 2. remove safety pin. Remove from the cold. 4. or a running vehicle If conscious give warm drinks and hot food (if no further injury) Pain score of 5 or more NO Reassess in 10 min YES Physical: Psychological: • Dress wounds • Splint fractures • Cool and cover burns AND Is the casualty hypothermic? (cold to touch) • Distraction • Reassurance • Self control YES Is the casualty shivering? Hypothermia is severe AND Pharmacological: DO NOT give Morphine without medical advice if there is: • A reduced level of response • Difficulty breathing • A head injury 1.DRILL 8 PAIN RELIEF NO -.1 2 3 4 5 6 7 8 9 10 -. then break needle off 2. Place Morphine auto-injector against upper thigh. On the cheek write ‘M’ and the time using 24 hour clock Hypothermia is mild Is the casualty conscious? Re-warm and k Are there signs of life? NO Start BLS avoid rough handling & be cautious of suction: You may cause Heart Rhythm Problems YES YES Handle gently to avoid causing Heart Rhythm Problems THEN Breaks: Drill 6 Burns: Drill 7 Bleeding: Drill 5 Insulate from further heat loss and go to DRILL 10 Reassess pain score after 30 min and before giving 2 dose Adapted from JSP 539 (2003) nd DRILL 8 DRILL 9 Cold .Worst PAIN PAIN DRILL 9 COLD COLD SOLDIER Think about hypothermia when the individual : • Has been exposed to cold and wet • Is unresponsive and their treatment is delayed • Is pale and cold to touch 1. strip off any wet clothing and dry body Keep warm in sleeping bag/other insulator Move into a building. press and hold for 10 seconds.

nausea or vomiting. Give water to drink if the casualty is conscious Place the unconscious casualty in the recovery position Reassess: <C> Bleeding still controlled A – Still clear and protected B – Respiratory rate still between 10 & 30 C – Still has a radial pulse D – AVPU any changes A – Alert V – Voice P – Pain U – Unresponsive • Monitor pain score – consider 2nd Morphine • Alternate Recovery Position after 30 min • Protect from the environment Evacuate to medical care as quickly as possible Prepare MIST Handover: M . and hot to touch T1 T3 T2 Symptoms: Agitation. disturbed vision. dizziness. sponge or spray casualty with cool water and fan the skin. collapse or loss of consciousness All Others STOP activity Lie the casualty down in the shade. Strip to underwear. cramps.Signs initially and now T – Treatment: what have you done go to DRILL 10 Adapted from JSP 539 (2003) DRILL 9 HOT DRILL 10 .Mechanism of injury I .DRILL 9 HOT HOT SOLDIER DRILL 10 EVACUATION RULES Life threatening considerations: • Unresponsive • Upper airway burn • Breathing difficulties • Severe external bleeding • Tourniquet applied • Signs of internal bleeding All Walkers Think about heat illness when the individual: • Has done heavy exercise • Is tired and confused • Is red. Elevate feet if conscious. staggering or loss of coordination. confusion.Injuries found or suspected S .

DRILL 3A NO SIGNS OF LIFE TRAUMA BASIC LIFE SUPPORT CHECK RESPONSIVENESS Shake and shout OPEN AIRWAY If unresponsive and breathing place in recovery position Head tilt / Chin lift NO YES CHECK BREATHING Look. listen and feel Abnormal or Absent No longer than 10 sec MEDICAL CAUSE ELECTROCUTION DROWNING UNDER EFFECTIVE FIRE Send or go for help YES IF APPROPRIATE 30 CHEST COMPRESSIONS Do not start BASIC LIFE SUPPORT Rate 100 a minute YES NO OR Stop BASIC LIFE SUPPORT 2 RESCUE BREATHS 30 COMPRESSIONS Change rescuer every 2 minutes to prevent fatigue INJURIES OBVIOUSLY INCOMPATIBLE WITH LIFE YES SIGNS OF LIFE Recovery Position CONTINUE CPR 100 per minute go to Basic Life Support NO Check patient only if they begin to breath normally 30 2 DRILL 3A BASIC LIFE SUPPORT .

CUF (CARE UNDER FIRE) THIS SHOULD BE LEARNED AND REMEMBERED: IF YOU NEED TO READ A GUIDELINE WHILST UNDER FIRE YOUR TRAINING HAS FAILED NOTES ALL PERSONNEL (INCLUDING CASUALTIES WHERE ABLE) TO RETURN AND MAINTAIN FIRE TO SUPPRESS THE ENEMY BOTH MEDIC AND CASUALTY IN THE OPEN ONLY THE CASUALTY IN THE OPEN: MEDIC IN COVER DEPLOY SMOKE UPWIND IF AVAILABLE IF CASUALTY UNABLE TO RETURN EFFECTIVE FIRE. CONSIDERING: SUPPORT FROM FRIENDLY FORCES USE OF VEHICLES USE OF SMOKE BEST USE OF COVER USE OF ROPE LINE QUICKEST ROUTE EVACUATE TO COVER CUF (CARE UNDER FIRE) NOTES . TELL THEM TO LIE AS STILL AS POSSIBLE CONSIDER: TOURNIQUET FOR CATASTROPHIC HAEMORRHAGE ROLL CASUALTY FACE DOWN (POSTURAL AIRWAY OPENING) UNTIL READY TO MOVE PLAN RESCUE.

INITIAL SITREP YOU MUST ALWAYS START AT THE MASTER DRILL START AT THE TOP OF EACH PAGE AND WORK DOWN THE FOLLOWING RULES APPLY: RED BOXES ARE WARNINGS BLUE BOXES ARE ACTIONS DIRECTIONS TO ANOTHER DRILL CASUALTY NUMBERS: YOUR GRID REFERENCE: YELLOW BOXES ARE ADVICE GREY ARROWS ARE GENERAL DIRECTIONS BLS = BASIC LIFE SUPPORT INSTRUCTIONS FOR USE .

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