Tier 2 Pain Management Part 1: You are in a SAFE and SECURE location – The primary learning objective of this scenario is to review the basics of pain management and to cover the medication Acetaminophen, also known as Paracetamol. The estimated time to complete this scenario is 5 minutes. This scenario occurs in the Tactical Field Care Phase. Equipment Available: Combat Life Saver Pack. Evacuation/Disposition is possible through the tablet. Selecting the patient’s disposition will end the exercise.
Patient Communication
Patient: Can you tell me your name?
Response: I think it's Robert?
Location: Head
Patient: Do you remember what happened?
Response: There was an explosion. Everyone ran.
Location: Head
Patient: Do you feel any pain?
Response: Yes. I hit the ground.
Location: Head
Patient: Do you have any medical problems?
Response: No. I don't think I have any medical problems.
Location: Head
Patient: Do you have any allergies to medications?
Response: No. I don't have any allergies to medications.
Location: Head
Patient: Do you take any medications?
Response: No. I don't take any medications.
Location: Head
Patient: Are you feeling dizzy or confused?
Response: I'm feeling a little dizzy.
Location: Head
Patient: Are you having trouble breathing?
Response: No. I can breathe normally.
Location: Head
Patient: Can you see clearly?
Response: Yes. I can see clearly.
Location: Head
Patient: Do you feel any swelling in your throat?
Response: No. My throat feels normal.
Location: Head
Patient: Are your lips or tongue swollen?
Response: No. I don't think so.
Location: Head
Patient: Is your voice hoarse or different?
Response: I think it's sounds normal.
Location: Head
Guided Steps
This patient was injured in a blast from a drone attack about 45 minutes ago. Other soldiers eventually placed a tourniquet to a left leg amputation and dragged them to your location.
You already washed your hands, put on your gloves, and did a search for massive hemorrhage, which was normal while noting the functioning tourniquet. The patient's airway is clear. You assessed the patient’s chest and found an open chest wound but no obvious pneumothorax. You placed a chest seal. You tried to take the tourniquet down, but the bleeding resumed. A deliberate lower tourniquet is not possible in this simulator, but is considered to have been done. The patient responds to voice but likely has a mild closed head injury. You covered him with a blanket to prevent hypothermia.
Next, look through the medication pouch. What medication is the first line treatment for mild to moderate pain at the Tier 2 TCCC level?
If you said Acetaminophen also known as Paracetamol, good job! Next we will review several important aspects about this medication. For brevity we will use the name Acetaminophen for the rest of this tutorial.
Informational Step: What is Acetaminophen? Acetaminophen is a non-opioid pain reliever found in most Combat Wound Medication Packs (CWMP). This medication treats mild to moderate pain without causing sedation (sleepiness), allowing the patient to stay alert and engaged while managing discomfort from mild combat injuries.
Informational Step: When To Use Acetaminophen? Give acetaminophen to any casualty with mild to moderate pain. The casualty must be conscious and able to swallow safely. Use it for gunshot wounds, shrapnel injuries, fractures, or any combat wound causing manageable pain. It works best when combined with the meloxicam, also found in most medication packs.
Informational Step: When NOT To Use Acetaminophen? Do not give acetaminophen if the casualty has a known allergy to it or has severe liver disease. Avoid use in casualties who drink heavily or have existing liver problems. Never give more than 4,000 mg in 24 hours from all sources. If the casualty cannot swallow or is unconscious, do not attempt oral administration.
Informational Step: How To Give Acetaminophen? Have the casualty swallow the appropriate dosage (often between 500mg and 1,300mg depending on the tablet dosage available). Do not crush, break, or chew the extended-release tablets. The casualty can take them with or without food. Verify the casualty has no allergies before giving the medication. Use the casualty's own medication pack when possible to preserve unit medical supplies.
Informational Step: Dosing And Timing. Give 500 to 1,300 mg by mouth every six to eight hours as needed for pain. The medication starts working in twenty to forty-five minutes and lasts six to eight hours. Never exceed 4,000 mg total in 24 hours. Remember to document the dose and time on the TCCC Card. Most medication packs contain only one dose, so additional doses require extra supply.
Informational Step: What To Expect. Acetaminophen is very safe with minimal side effects at normal doses. The casualty will not experience drowsiness, confusion, or impaired judgment. Pain should decrease within one hour. The casualty can continue fighting and does not need to be disarmed.
Informational Step: Key Advantages. Acetaminophen provides effective pain relief without affecting combat readiness. It causes no sedation, no breathing problems, and no addiction risk. Unlike aspirin and other NSAIDs, it does not affect blood clotting or cause bleeding problems. When combined with meloxicam, it provides better pain control through two different mechanisms of action.
Informational Step: Monitoring The Casualty. Check the casualty's pain level thirty to sixty minutes after giving acetaminophen. Ask if pain is tolerable and if they can perform mission tasks. Watch for rare side effects like nausea, rash, or unusual symptoms. If pain is not controlled after two hours, consider adding additional pain medications per TCCC guidelines.
Informational Step: Documentation Requirements. Write on the TCCC Card in the MEDS section: Acetaminophen [DOSE] mg PO and the time given in military format. Note if it was given as part of the complete medication pack. Document any additional doses with their times. Clear documentation prevents double dosing and informs the receiving medical facility about medications already administered.
Informational Step: Common Mistakes To Avoid. Never crush the extended-release tablets thinking it helps absorption. Do not give to unconscious casualties or those who cannot swallow safely. Avoid exceeding the maximum daily dose of 4,000 mg. Do not forget to document administration on the TCCC Card. Remember that acetaminophen works best when given early before pain becomes severe.
Next, ask the patient if they have any allergies to medications.
Next, give the patient the appropriate dose of acetaminophen by picking up the tablet, placing near the patients mouth and pulling the [TRIGGER].
Pick up the TCCC card and document the acetaminophen dose you administered to the patient.
This concludes your scenario. Next, open your tablet [X], select the disposition tab, and select Medical Evacuation.