View Full Version : New Combat Life Saver curriculum
haztacmedic
10-07-2005, 17:19
I have been reviewing the new CLS curriculum and I Imust say that the changes are for the better. One skill that totally suprised me is the recognition and treatment of tension pnuemothorax! Combat Life savers will now carry 14ga needles and be trained on how to "needle" a casualtie's chest!
This presents new challenges to CLS instructors. I have my own oppinions of training non medical soldiers to do this when I know that a great number of ordinary line medics would panic over having to stick a needle in someone's chest.
As for me, BTDT several times. The pucker factor is always high!
HTM
The CLS Course was only a guide for us when I was training my Team Mates years ago; meaning they were well up to speed when they got through. I knew as the lone Medic that I had to instill the skills necessary for them to take care of me if I needed help. ;)
You'd be very surprised at the level of cross-training we go through. No man is an Island on a Team. One of the best trauma clinic's I saw ran was from an 18C.
haztacmedic
10-08-2005, 10:31
Doc: That cross-training you mentioned sounds just like the type of stuff I like!
MY concern is the regular soldiers-many of whom are "forced" by their Cof C to be combat life savers being able to effectively use the CLS skills that they slept in class through. I see this often. Some students have gone so far as to tell the cadre that they want nothing to do with CLS!!! Slugs abound!
Understood.
I guess I was spoiled being around SF Guys. You taught a class and minutes later they are competing against each other to see who can do it the best and in the least amount of time.
haztacmedic
10-08-2005, 13:51
Spoiled Doc? Wow Thats the main reason I want to be a QP! Every now and then we do get soldiers in the CLS program that are motivated like that but there are plenty of the unmotivated," I dont want to be here" types running around....but you know that already. I love the mind set you guys have!
HTM
swatsurgeon
10-09-2005, 08:27
the course has broad appeal and is long overdue IMHO....
I sincerely hope that the needles used for chest decompression are 5cm (2.5 inches), 14 or 16 G....anything shorted has a 65% chance of not entering the pleural space.. This has been well documented in 2 studies...the regular 1 1/4 inch that most people carry for IVs are inadequate for the chest.
ss
where can i get my hands on the CLS curriculum?
52B, I Googled Army Combat Lifesaver with good results.
I went through CLS about a year ago, and loved it. Only ever had to put it to use once, to make a stick after a Soldier fell out in the 4 in 36. Even for soft skills, its a must, and anything they care to add on is just icing on the cake.
S
52B, I Googled Army Combat Lifesaver with good results.
I went through CLS about a year ago, and loved it. Only ever had to put it to use once, to make a stick after a Soldier fell out in the 4 in 36. Even for soft skills, its a must, and anything they care to add on is just icing on the cake.
S
cant find a new one just the old.
i like the new one
I'm doing the CLS course at the end of the month.. is the new curriculum already being taught?
Alphaonekilo
10-10-2005, 12:18
haztacmedic,
Can you elaborate on any other changes to the curriculum?
I am very excited that tension pnuemothorax will be taught.
I last went through CLS March 2005.
Thanks,
Rob K
haztacmedic
10-16-2005, 12:45
Moobob, A1k, Sorry guys Ive been at the great school of buffoonery called BNCOC. Moobob: My understanding is that if you go to CLS and get the old version-they are teaching you obsolete crap. You should be learning the new stuff.
A1K: The new course will have things like : The three stages of Tactical Combat Casualty Care, Saline locks in place of running Iv fluid, plueral decompression, skedcos, 9-line medevac requests, FMCs and so on.
If I dont get back to you guys this week I'll catch up with you next week.
HTM
Eagle5US
10-16-2005, 15:31
cant find a new one just the old.
i like the new one
http://www.cs.amedd.army.mil/clsp/
Use the above link...
Eagle
I went through the bulk of the new CLS course today, including the tension pnuemothorax training. Good stuff, very interesting. One of the instructors is a former SF medic with a long break in service, that recently joined the Guard.
DoctorDoom
11-28-2005, 00:23
x
swatsurgeon
11-28-2005, 12:39
MOOBOB,
which gauge and length needle were you shown to use?
ss
If I remember correctly they were 18gauge. Don't remember the length. Some of us did use a different size to stick the rubber training chest things, but I believe we were told to use the 18's.
Eagle5US
11-28-2005, 20:09
MOOBOB,
which gauge and length needle were you shown to use?
ss
SS-
Standard is a 16ga angiocath...
problem with the CLS "bag" is that it doesn't come stocked from DOD with any 16ga's inherant.
Eagle
SS-
Standard is a 16ga angiocath...
problem with the CLS "bag" is that it doesn't come stocked from DOD with any 16ga's inherant.
Eagle
Now that you mention it, that's what we were told to use. I'm definitely going to make time to study the CLS material some more. The class was great training, but I feel like the guy out of the Holiday Inn Express commercial. I'm not a medic but I did stay at a...
swatsurgeon
11-29-2005, 09:34
the reason I asked length is because 2 studies demonstrated that up to 50-60% of the 1 1/4 inch needles never make it into the chest (pleural space) to actually decompress the pneumothorax. You need a 5 cm (2 1/2 inch) needle to reliably enter the pleural space.....especially with the more muscular male bodies.
My 2 cents is that if they are not stating this in the class (using the 5cm needles), have the instructors do a literature search on it and find the articles (i don't have the references handy)....They should be teaching and equipping you with the best information and supplies that will get the job done reliably, efficiently and safely.......
ss
Eagle5US
11-29-2005, 11:45
the reason I asked length is because 2 studies demonstrated that up to 50-60% of the 1 1/4 inch needles never make it into the chest (pleural space) to actually decompress the pneumothorax. You need a 5 cm (2 1/2 inch) needle to reliably enter the pleural space.....especially with the more muscular male bodies.
My 2 cents is that if they are not stating this in the class (using the 5cm needles), have the instructors do a literature search on it and find the articles (i don't have the references handy)....They should be teaching and equipping you with the best information and supplies that will get the job done reliably, efficiently and safely.......
ss
An excellent point SS...thanks for pointing that out. Sometimes we take this type of information for granted.
Eagle
ON the length.
there are to study on it. one where use ultrasound on non-wounde and one where thay use CT one thorax trauma, if i rember right the CT study found that in 75% you can use a normal IV 14g 1.77in, but in 25% the cutan emfysem the musculature made it impossible, and also in female it impossible. it a ok large study.
the ultrasound had the same result, i think i was impossible in 15%.
there is also a lot of case repports on it so it is not new, but in ATLS thay dont point it out, i think the reson for taht is that when you use needl, you also put in a tube.
the study also say, that you have to use a 3in to get all, and most i know who has use it says 14g is on the small side, and that will go for 12gor10g
i if i rember it right, in have them on my computer one place.
and
swatsurgeon
11-30-2005, 09:09
your data was alittle flawed. The article you cited was from Acad Emerg Med, 2004, Feb:11;211-13. It stated a 5 cm needle would decompress 75% of all chests. Interestingly it also stated that females had a thicker chest wall....was this a civilian female or military??? With obesity so rampant here I can believe that fact if it was NON-military women. Otherwise the 5 cm should do it. We have seen "harpoons" used at other hospitals that have infact stuck into the heart and the lung and made matters worse not better...hence why 5 cm was the 'best alternative'.
I'm still looking for my original reference which was a study in England, at time of autopsy of Trauma patients demonstrating the 50-60% non-penetration of the 1 1/2 inch decomression needle....I'll find it sooner or later.
ss
Team Sergeant
11-30-2005, 09:16
Funny you should mention that SS, the correlation between fat people and needles. I read this just yesterday.....
CHICAGO (Reuters) - Fatter rear ends are causing many drug injections to miss their mark, requiring longer needles to reach buttock muscle, researchers said on Monday.
Standard-sized needles failed to reach the buttock muscle in 23 out of 25 women whose rears were examined after what was supposed to be an intramuscular injection of a drug.
Two-thirds of the 50 patients in the study did not receive the full dosage of the drug, which instead lodged in the fat tissue of their buttocks, researchers from The Adelaide and Meath Hospital in Dublin said in a presentation to the annual meeting of the Radiological Society of North America.
Besides patients receiving less than the correct drug dosage, medications that remain lodged in fat can cause infection or irritation, researchers Victoria Chan said.
"There is no question that obesity is the underlying cause. We have identified a new problem related, in part, to the increasing amount of fat in patients' buttocks," Chan said.
"The amount of fat tissue overlying the muscles exceeds the length of the needles commonly used for these injections," she said.
The 25 men and 25 women studied at the Irish hospital ranged in age from 21 to 87.
The buttocks are a good place for intramuscular injections because there are relatively few major blood vessels, nerves and bones that can be damaged by a needle. Plentiful smaller blood vessels found in muscle carry the drug to the rest of the body, while fat tissue contains relatively few blood vessels.
Obesity affects more than 300 million people worldwide and is based on a measure of height versus weight that produces a body mass index above 30. An estimated 65 percent of U.S. adults are overweight or obese.
© Reuters 2005. All Rights Reserved.
http://today.reuters.com/news/newsarticle.aspx?type=healthNews&storyid=2005-11-28T185012Z_01_MOL867559_RTRUKOC_0_US-BUTTOCKS.xml&rpc=22
your data was alittle flawed. The article you cited was from Acad Emerg Med, 2004, Feb:11;211-13. It stated a 5 cm needle would decompress 75% of all chests. Interestingly it also stated that females had a thicker chest wall....was this a civilian female or military??? With obesity so rampant here I can believe that fact if it was NON-military women. Otherwise the 5 cm should do it. We have seen "harpoons" used at other hospitals that have infact stuck into the heart and the lung and made matters worse not better...hence why 5 cm was the 'best alternative'.
I'm still looking for my original reference which was a study in England, at time of autopsy of Trauma patients demonstrating the 50-60% non-penetration of the 1 1/2 inch decomression needle....I'll find it sooner or later.
ss
your right sorry, 5 cm will only do in 75%, i will sill go for 3in=7,5 cm, but agree no harpoons.
here is some some from my powerpoint on TCCC, it a small summary of the articel is use in the ppt. thay are civ i think, but traind chest will give problem too we had one bodybilder in the ICU, a will back we try to needl.
Needle thoracostomy: implications of computed tomography chest wall thickness.
111 computed tomography (CT) scans
The mean chest wall thickness in the patients studied averaged 4.24 cm (95% confidence interval [CI] = 3.97 to 4.52)
Nearly one fourth (25) of the study patients had a chest wall thicker than 5 cm.
Women, on average, have thicker chest walls than men (4.90 for women; 4.16 for men; p = 0.022).
CONCLUSIONS: In this study, a catheter length of 5 cm would reliably penetrate the pleural space of only 75% of patients. A longer catheter should be considered, especially in women
Givens ML, Ayotte K, Manifold C.
Acad Emerg Med. 2004 Feb;11(2):211-3.
Needle thoracocentesis in tension pneumothorax: insufficient cannula length and potential failure.
ultrasound in 54 patients aged 18 to 55 years, and ranged from 1.3 to 5.2 cm (mean 3.2 cm).
In thirty-one patients (57 per cent) the chest-wall thickness (CWT) was greater than 3 cm.
two (4 per cent) was it greater than 4.5 cm.
recommended shortest length be increased to 4.5 cm.
Unsuccessful needle thoracocentesis using a 4.5 cm cannula should be followed immediately by insertion of a longer cannula or a definitive chest drain.
Britten S, Palmer SH, Snow TM.
Injury. 1996 Jun;27(5):321-2.
just have to say the reson for 3in is also that only can get my hand on needls in fix length.
a nother way is to do a am. "simpel Thoracotomy" it is use by HEMS in london. but you havt to be a MD.
swatsurgeon
11-30-2005, 12:54
TS,
this just goes to show that the average american patient is very different than the average military personnel. Those who defend this county and fight for everything good are in no way todays "average" american.(in a lot of ways)...therefore we can assume and I'll see about proving this, that the military personel that would need a chest decompression would be well served by carrying a 5 (to 6cm) cm decompression needle. They are NOT obese or carrying so much chest wall muscle mass that this size needle won't penetrate >90% of the time. There remains a HUGE difference between civilian/EMS and military medicine...that is one of my main points...some similarity but a lot of difference.
I will be contacting associates at military hospitals and have them do a sample of chest CT scans for wall thickness.....this should be interesting!!
ss
Please excuse this pogue for sticking his nose in, but I have to raise a point which is important to the discussion. This is in no way meant to disparage anyone's imput in this discussion, it is merely to make a correction which could be important when the situation comes down to "brass tacks."
I keep seeing "5cm = 2 1/2 inches" which isn't correct.
There are exactly 2.54cm to an inch, hence 5cm is just shy of 2 inches, not 2 1/2 inches. 2 1/2 inches would actually be 6.35cm. The only way to stretch this measurement would be to include the bedding material of the needle and then some, and even being a non-medico pogue, this does not sound like it could possibly be correct. Of course, I would also presume that measurements in inches would be damn near non-existant with medical supplies, but then again, not my area.
I only bring this up because in this case the measurement is fairly important, and it could have bad consequences if someone has the wrong numbers engrained in their brains and is trying to make a misinformed "educated guess" as to what will be appropriate for a given patients makeup under stress.
Please forgive my intrusion.
swatsurgeon
12-24-2005, 08:09
Thank you for pointing out the measurement correction ...it is a 'generic' length that we use in the hospital. The actual catheter length is 57mm which is 2 1/4 inches long........I should have been specific...the 2 1/2 inch length is the needle that is removed when the 2 1/4 inch catheter is in place....
thanks...
ss