ASM 004

Massive Bleeding Control Essentials: Managing Hemorrhage in a Hostile Zone – Tier 1 – You are in an UNSAFE and INSECURE location – The primary learning objective is to describe, review, and practice providing massive bleeding/hemorrhage control in an unsafe location. In addition, this scenario introduces you to a casualty that you will continue to provide care to using the TCCC M A R C H algorithm throughout a series of scenarios. The estimated time to complete this scenario is 5 minutes. This is your first time taking care of this casualty. The casualty was near a drone explosion that occurred 4 minutes ago. No interventions have been performed. This scenario occurs in the Care Under Fire Phase and covers the [M]ARCH portion(s) of care. Equipment Available: Individualized First Aid Kit (IFAK) U.S Version (x2). Evacuation/Disposition is possible through the tablet. Selecting the patient’s disposition will end the exercise. (This is Scenario 004).

Dynamic Physiology Disclaimer:
To obtain the most accurate and effective training experience, we recommend completing each scenario in one uninterrupted session. The virtual patients used in this training are powered by highly realistic physiological models that continuously adjust vital signs and overall condition. The scenarios have been modified to give you time to review instructional materials, and you will not lose points for delays in scenarios with instructional content. However, it is still possible that, depending on your completion pace, the scenario may not progress in perfect alignment with the guided prompts, and for critically injured patients, even moderate delays may result in deterioration or death before the scenario concludes. This is not meant to indicate you did not perform well; rather, it is because of how the high-fidelity engine performs.

Ongoing Development Disclaimer: In this package wording has not been updated to reflect new functionality to time and date tourniquets or for the non-adhesive burn bandage functionality. Additionally, it is possible other small updates or changes are not reflected in the wording. All grading is set to the current standard described in this package.

Patient Communication

Patient: Hey, I am here to take care of you.
Response: The patient isn't able to speak, and has noisy breathing
Location: Head
Patient: Can you tell me your name?
Response: The patient isn't able to speak, and has noisy breathing
Location: Head
Patient: What happened?
Response: The patient isn't able to speak, and has noisy breathing
Location: Head
Patient: Are you hurting anywhere?
Response: The patient isn't able to speak, and has noisy breathing
Location: Head
Patient: Does your throat hurt or feel tight?
Response: The patient isn't able to speak, and has noisy breathing
Location: Head
Patient: Are you having a hard time breathing?
Response: The patient isn't able to speak, and has noisy breathing
Location: Head
Patient: Does your chest hurt?
Response: The patient isn't able to speak, and has noisy breathing
Location: Head
Patient: Did you pass out (lose consciousness)?
Response: The patient isn't able to speak, and has noisy breathing
Location: Head
Patient: Do you have any numbness or weakness?
Response: The patient isn't able to speak, and has noisy breathing
Location: Head
Patient: Does your head hurt?
Response: The patient isn't able to speak, and has noisy breathing
Location: Head
Patient: Does your neck hurt?
Response: The patient isn't able to speak, and has noisy breathing
Location: Head
Patient: Does your back hurt?
Response: The patient isn't able to speak, and has noisy breathing
Location: Head
Patient: Does your abdomen hurt?
Response: The patient isn't able to speak, and has noisy breathing
Location: Head
Patient: Do you have any allergies?
Response: The patient isn't able to speak, and has noisy breathing
Location: Head
Patient: Do you take any medications?
Response: The patient isn't able to speak, and has noisy breathing
Location: Head
Patient: Do you have any medical problems?
Response: The patient isn't able to speak, and has noisy breathing
Location: Head
Patient: Have you ever had any surgeries?
Response: The patient isn't able to speak, and has noisy breathing
Location: Head
Patient: When did you last eat or drink something?
Response: The patient isn't able to speak, and has noisy breathing
Location: Head
Patient: Do you smoke, drink, or use recreational drugs?
Response: The patient isn't able to speak, and has noisy breathing
Location: Head
Patient: I am here to take care of you.
Response: The patient isn't able to speak, and has noisy breathing
Location: Head

Guided Steps

This is your first time taking care of Private Danny Rivers. He was near a drone explosion that occurred 4 minutes ago. No interventions have been performed. Incoming! Incoming! You are not safe. Scan for and treat life-threatening bleeding that can be resolved with a tourniquet only, then move the patient to safety.
This patient has massive bleeding from a left lower extremity amputation that requires a tourniquet (place it now, if not already done). This is the only intervention that should be performed for a casualty in an UNSAFE location. Once tourniquet is placed and tightened, mark time by using the marker on the tourniquet.
Informational Step: In real life you can ask the patient to apply the tourniquet themselves. You could also ask them to move themselves to a safer location.
Informational Step: If you perform additional interventions for this patient, even though this may seem like helping, it puts your and the patient’s lives at risk. If the location is unsafe, get to cover, then proceed with the rest of the patients’ care (beyond tourniquet placement).
Next, open your tablet [X], select the disposition tab, and select Medical Evacuation to move the patient to safety. You will see this patient again in future scenarios to complete the rest of the MARCH algorithm. This concludes the training scenario on providing Care Under Fire (Control Massive Hemorrhage). After reviewing the feedback page, exit this simulation and select the scenario 005 to continue.

Scenario Details

Scenario Package
TCCC Tier 1 Curriculum
Learner type
  • militaryMedic
Patient severity at start
Serious
Patient severity overall
Serious
Duration to complete
<5 minutes
Scenario difficulty
Standard
Environment
POI
Equipment
  • Bandage
  • Combat Application Tourniquet (1)
  • Combat Application Tourniquet (2)
  • Trauma Shears
  • Blanket
  • FoilBlanket
  • Nasopharyngeal airway
  • Chest Seal Package
  • Packing Gauze
  • Gloves
  • Eye Guard
  • Non-Adherent Dressing
  • Medication Pouch
  • Radio
  • Marker
  • Triage Tag (Minimal)
Available medications
  • Acetaminophen Pills
  • Moxifloxacin 1 g
  • Meloxicam 15mg
Injury type
  • Abdominal internal bleeding
  • Airway obstruction
  • Amputated left leg at knee
  • Bruise behind right ear
  • Eye cornea trauma, left side
Pathologies
  • airway obstruction
  • external hemorrhage, left leg
  • internal hemorrhage, vena cava
Scoring summary
  • M - Place Tourniquet
  • M - Tighten Tourniquet
  • Disposition