PDA

View Full Version : Top 5 Procedures to Save a Life (Battlefield)


NousDefionsDoc
05-01-2004, 19:19
What are your top 5 (or less) DX and TX to save a life on the battlefield and their protocols? Be specific please.

Maple Flag
05-05-2004, 14:20
OK, it's gone 3 days without a response from those more knowledgable than I, so I'll take a WAG based on civilian BLS level training and my expectations of common battlefield trauma (in no particular order):

1. Extremity bleeding - Stop blood loss (direct pressure, elevation, pressure point, HCAs, TQ), manage volume if needed (ALS). Evacuate.

2. Airway, Head and facial injuries - C-Spine control dependant on MOI and Pt. assessment, airway managment, control external bleeding/allow drainage, assess for concussion, assess for ICP, evacuate.

3. Thermal Burns - assess airway for injury, irrigate for 15 mins max if clean water available, wrap in sterile dressings, ALS for pain and volume loss, evacuate

4. Penetrating Chest injury - spinal immobilization dependant on MOI and Pt. assessment, occlusive dressing, Pt. positioning (injured side down), ALS call (particularly for TPT, PT, HT, HPT, volume loss, etc), evacuate.

5. Concussion/shockwave injuries (primary blast injuries) - ABCDE as needed for specific injuries. Assess for concussion, ICP, and signs/sympoms of occult injury. Evacuate.

Feel free to pick the above apart. I come here to learn.

hoepoe
05-06-2004, 02:08
I'm far far from a medic:

oK, these started out inorder, but are now out of order..


This should be number 1

<b>Get on the radio for a medic!</b>

Make sure you're in a safe zone, or at least safe anough not to get yourself killed, i'm not saying ignore or leave the soldier, but do not focus all your energies on the patient and forget about the hositiles. Two injured are worse than one. IOW, keep your friggin head down!

Keep a note if possible, even in the sand, on his/her forhead of time, vitals, treatmant adminestered. This will help the medic/doctor/medivac get a full history and assess diagnosis.

1. Know how to stop bleeding:
KNow the pressure points, artery locations
KNow how the basics, pressure and where/how
Know when to and when not to remove objects (protruding)(such as a knofe, shrapnel etc
Know CPR, ABC-even if you're no medic, CPR could keep oxygen to the brain until a medic comes along.

Know how to id and treat acute shock

Know how and when to tornoquet (do you guys use that? we do) ALWAYS MARK WHEN IT WAS APPLIED AND NEVER REMOVE IT YOURSELF!

2. Carry a tampon, yes that's right, a tampon, works great to help stop bleeding of an open would, such as a stab/or bullet wound.

3. Do not move an injured person, unless you have to! Especially from blast injuries where multiple fractures are common.

4, Learn ICE, Isolate, Compact and Elevate for fractures. (Not life saving really)

5. Confirm, this one for me; Do not give food or water to patient as they may need surgery amd this could complicate anethesis.

remove all potentially explosive gear from the soldier..grenades etc., safety first, the last thing you wanna do,m is snag the safety pin whilest CPRing!

All i have time for now, Please feel free to correct what is BS!

Out

Hoepoe

hoepoe
05-06-2004, 02:11
BTW, great and usefull idea for a thread!

NousDefionsDoc
05-07-2004, 18:49
WTH? I'm not messing around here. Where are all the would be medics? Where are the 11Bs?

Kyobanim
05-07-2004, 19:51
Okay, 20 years out of date I'm sure

1. Asses the injured party
2. Clear the airway, get them breathing again.
3. Stop the bleeding
4. CPR, resusitat
5. Imobilize fractures, etc
6. Treat for shock

3 and 4 always confuse me but it makes sense to stop a bleeder before you get the heart pumping again?

NousDefionsDoc
05-07-2004, 20:05
Well yeah, but what I was thinking was more along the lines of specifics. Say:
1. Cricothyrotomy
etc.

Surgicalcric
05-07-2004, 20:16
Originally posted by NousDefionsDoc
1. Cricothyrotomy
etc.

2.) Hemorrhage control

...

Note: I was waiting for others to chime in but since they are apparently not going to...

rakkasan187
05-07-2004, 23:34
1. Shoot back
2. Get Pt out of line of fire.
3. Airway
4. Breathing
5. Circulation

Doc T
05-08-2004, 11:24
Originally posted by rakkasan187
1. Shoot back
2. Get Pt out of line of fire.
3. Airway
4. Breathing
5. Circulation

so assuming 1 and 2 are done...

what problems can you see with airway and what are the treatments that NDD wants you to discuss?

likewise, what, independent of difficulties with airway, cause breathing problems that you can fix in the field and how would you fix them?

finally, circulation....what can you see and how would you treat it?

I'll fill in my own blanks if no one else does....

doc t.

NousDefionsDoc
05-08-2004, 17:39
I guess it wasn't as important as I thought Doc.

I'll be over here practicing hand-tying sutures on the cat if you need anything.

rakkasan187
05-08-2004, 18:11
Airway:
1.Manually open airway maintaining C-spine immobilization if tactical situation permits and clinical condition warrants.
2. Clear airway of blood, secretions, teeth or other potential FBAO if present.
3. Position Pt to allow drainage of blood or secretions (recovery position) if tactical/clinical conditions allow.
4. Airway intervention to include NPA/ETT if Pt unable to protect airway or if you suspect that Pts condition may deteriorate and unable to protect airway.
5. If unable to secure airway by less invasive means due to facial trauma, swelling or FBAO perform needle or preferably surgical cric.

Breathing:
1. Be prepared to provide rescue breathing/ventilations to apneic Pt or Pt with inadequate spontaneous respirations.
2. Perform chest needle decompression to affected side if Pt presents with decreased BS, dyspnea, tachycardia, decreased BP (hemodynamic instability), cyanosis, JVD, tracheal shift secondary to penetrating trauma to thorax, abd, proximal upper extremeities or pelvis. Also indicated for blunt trauma to thorax abd etc if suspected tension pneumothorax.
3. Apply occlusive dressing (vaseline gauze wrapper, plastic wrap, Asherman, pediatric defib pad) to entrance/exit wounds. Be prepared to burp or relieve pressure from dressing if S/Sx in #2 present.

Circulation:
1. Control arterial/venous bleeding with direct pressure, elevation, pressure pts and/or tourniquet. Tourniquets reserved for extremity wounds that cannot be controlled by earlier mentioned means or that need immediate attenuation due to severity/tactical situation.
2. Place and or trans Pt in Trendelenburg if possible.
3. Gain IV access early prior to vascular collapse if possible. Resuscitate with crystalloid fluids titrating to mentation.
4. Gain second IV access site with saline/hep lock.
5. Needle decompression could be considered a circulation intervention due to clinical features of obstructive shock.


Getting the evil eye from the old lady...gotto go to the grocery store....will expound later...

rak

Surgicalcric
05-08-2004, 18:23
Originally posted by NousDefionsDoc
I guess it wasn't as important as I thought Doc...

Important indeed.

I thought I would lay off and give some of the others a chance to respond, but it appears the usual posters are not posting.

stinney
05-08-2004, 19:15
Ok, I'll take a shot

1) Establishment of airway.
2) Control of massive hemorrhage.
3) Intravascular fluid replacement.
4) Detection and treatment of hemo- or pneumothorax.
5) Immobilization of fractures
Transport

Stinney

Doc T
05-08-2004, 19:42
Originally posted by rakkasan187
Airway:
1.Manually open airway maintaining C-spine immobilization if tactical situation permits and clinical condition warrants.
2. Clear airway of blood, secretions, teeth or other potential FBAO if present.
3. Position Pt to allow drainage of blood or secretions (recovery position) if tactical/clinical conditions allow.
4. Airway intervention to include NPA/ETT if Pt unable to protect airway or if you suspect that Pts condition may deteriorate and unable to protect airway.
5. If unable to secure airway by less invasive means due to facial trauma, swelling or FBAO perform needle or preferably surgical cric.

Breathing:
1. Be prepared to provide rescue breathing/ventilations to apneic Pt or Pt with inadequate spontaneous respirations.
2. Perform chest needle decompression to affected side if Pt presents with decreased BS, dyspnea, tachycardia, decreased BP (hemodynamic instability), cyanosis, JVD, tracheal shift secondary to penetrating trauma to thorax, abd, proximal upper extremeities or pelvis. Also indicated for blunt trauma to thorax abd etc if suspected tension pneumothorax.
3. Apply occlusive dressing (vaseline gauze wrapper, plastic wrap, Asherman, pediatric defib pad) to entrance/exit wounds. Be prepared to burp or relieve pressure from dressing if S/Sx in #2 present.

Circulation:
1. Control arterial/venous bleeding with direct pressure, elevation, pressure pts and/or tourniquet. Tourniquets reserved for extremity wounds that cannot be controlled by earlier mentioned means or that need immediate attenuation due to severity/tactical situation.
2. Place and or trans Pt in Trendelenburg if possible.
3. Gain IV access early prior to vascular collapse if possible. Resuscitate with crystalloid fluids titrating to mentation.
4. Gain second IV access site with saline/hep lock.
5. Needle decompression could be considered a circulation intervention due to clinical features of obstructive shock.


Getting the evil eye from the old lady...gotto go to the grocery store....will expound later...

rak

i am not sure if this is what NDD was seeking but it was what I was looking for....

A much better answer than your previous one.

doc t.

rakkasan187
05-08-2004, 19:59
Sorry for the earlier answer Doc. Should have inserted imoticon thingy to show sarcasm for the most part.

Not exactly sure what NDD is looking for. My background is ex-infantry soldier, current practicing paramedic in a largish city.

I know the way I do things on the streets is different than the way military medics do things given the circumstances.

Take Care,

rak

PS-James I know your're itching to jump in on this one.....get some fellow Southern Fried Medic!!!

NousDefionsDoc
05-08-2004, 21:20
What I'm looking for is the medical section of the new and real world soldier's manual of common tasks.

I figure a non-medic can learn and retain about 5-6 "advanced" DX/TX that will save a life on the battlefield.

Emergency Procedures for the non-medick prioritized for the battlefield.

Roguish Lawyer
05-08-2004, 21:23
Originally posted by NousDefionsDoc
I'll be over here practicing hand-tying sutures on the cat if you need anything.

You'd better watch it, or Catwoman will kick your ass.

NousDefionsDoc
05-08-2004, 21:27
Let me put it another way:

Your A Detachment, A-001, just got alerted for Afghanistan. To deploy NLT 6 days. You are the only medic. The Team Sergeant tells you you have 5 one hour blocks of instruction to train the Team on medical subjects.

Show the POI.

Doc T
05-08-2004, 21:29
Originally posted by NousDefionsDoc


I'll be over here practicing hand-tying sutures on the cat if you need anything.

one of my old partners used to make medical students in the middle of their interview for surgical residency tie knots...... he'd pull out a piece of suture material and tell them to start, one handed and two handed... if they couldn't do it he gave them very low marks...

it was amazing how many couldn't ...lol.

doc t.

Razor
05-12-2004, 09:45
5 hours to teach? Are we then concentrating on trauma Tx? If so, how about the following:

1. Use of an NPA
2. How to do a good primary survey (reminding the guys that GSWs often have entry AND exit holes, how to log roll a pt, etc)
3. Quick refresher on TQ use (pre-made and expedient, placement, etc)
4. How to Dx a tension pneumothorax and perform a needle thoracostomy (is that the right term?) or apply an expedient flutter valve.
5. Make everyone open up their med kits, pull out each item, briefly go over its use and repack it so the equipment, its purpose and its location is fresh in everyone's mind.
6. Narcotic/other pain med administration

Team Sergeant
05-12-2004, 09:53
1.ABC’c

2.Primary surveys

3.IV’s

4.Dustoff procedures under fire

5.Basic GSW care and bandages

Maple Flag
05-12-2004, 15:14
Originally posted by Razor
5 hours to teach? Are we then concentrating on trauma Tx? If so, how about the following:

4. How to Dx a tension pneumothorax and perform a needle thoracostomy (is that the right term?) or apply an expedient flutter valve.

Just curious here, but if the intent here is to instruct non-medics, are there any military policy issues with non-medics performing a needle thoracostomy (which in my world is an ALS skill requiring medical control), or are we operating under the "save your buddy's life first, sort out the legal details later" principle? I'm not arguing against, just wondering if the military medical system is flexible enough to allow for this. I've also noticed that IV skills are taught fairly liberally in military cirlces.

Razor
05-12-2004, 16:29
Well, NDD set the scenario as a USSF ODA, operating with only one 18D. Considering their potentially austere operational environment and definite lack of medical support, I'm more concerned with saving lives than worrying about who is doing what. Shoot, I was only two weeks on a team when the 18D decided it was time to update shots, so he grabbed me and said, "Ok, this is how you administer an IM injection." After a 15 second demo, he handed me a syringe, grabbed the senior 18E and said, "Now you try it."

NousDefionsDoc
05-22-2004, 09:23
Here's mine
DX
1. Not breathing
2. Pneumo/hemo thorax
3. Arterial bleeding
4. Shock
5. Blast injuries/Burns
TX
1. Open airway
2. Cryc
3. Occlusive dsngs/ACS, etc.
3. Stop the bleeding
- Direct Pressure
- Clotting agents
- Tourniquet
5. Treat for shock/Ivs, etc.

NousDefionsDoc
05-30-2004, 11:12
Was this a bad question?

The Reaper
05-30-2004, 11:37
Originally posted by NousDefionsDoc
Was this a bad question?

Great question, I am just lurking to learn here.

TR