This casualty was a passenger in a vehicle that was struck by a drone around 45 minutes ago. The casualties’ legs were trapped. The vehicle caught fire around the engine compartment. Luckily, another soldier was able to use a fire extinguisher to contain the flames. She was able to extricate this casualty. The windows were open around the passengers. A blood sweep revealed a right arm laceration with hemorrhage that was controlled with packing, three minutes of direct pressure, and a pressure bandage. The patient is maintaining his airway, and he does not have any soot or redness in his mouth or nose. He does not have any chest wounds or evidence of a pneumothorax. His radial pulse is palpable. His abdomen is soft and his pelvis is stable. You used your last intravenous line on another casualty and are waiting for more to arrive. The casualty is in pain but is alert and answering questions appropriately. His pupils are equal and responsive to light. You already have gloves on, and you already secured the patient’s gear and just completed exposure. It will take at least two hours to get the patient to a higher level of care. The patient appears to be around 70 kilograms.
The primary learning objective is to review the initial evaluation and management of casualties with burns, pain management, transmucosal medications (fentanyl), sublingual medications (ondansetron), and intramuscular medications (ketamine). The estimated time to complete this scenario is 20 minutes. This scenario occurs in the Tactical Field Care Phase.
Patient: Can you tell me your name?
Response: The patient is sleepy and looks confused
Location: Head
Patient: Do you remember what happened?
Response: The patient is sleepy and looks confused
Location: Head
Patient: Do you feel any pain?
Response: The patient is sleepy and looks confused
Location: Head
Patient: Do you have any medical problems?
Response: The patient is sleepy and looks confused
Location: Head
Patient: Do you have any allergies?
Response: The patient is sleepy and looks confused
Location: Head
Patient: Do you take any medications?
Response: The patient is sleepy and looks confused
Location: Head
Patient: Are you feeling dizzy or confused?
Response: The patient is sleepy and looks confused
Location: Head
Patient: Are you having trouble breathing?
Response: The patient is sleepy and looks confused
Location: Head
Patient: Can you see clearly?
Response: The patient is sleepy and looks confused
Location: Head
Patient: Do you feel any swelling in your throat?
Response: The patient is sleepy and looks confused
Location: Head
Patient: Are your lips or tongue swollen?
Response: The patient is sleepy and looks confused
Location: Head
Patient: Is your voice hoarse or different?
Response: The patient is sleepy and looks confused
Location: Head
Good job, you successfully placed a 16 Gauge intravenous catheter.
Good job, you successfully placed a 16 Gauge intravenous catheter.
Good job remembering to document care. In the field, it would be important to record specific injuries and treatments provided. For this simulator, completing the documentation step is considered sufficient
When performing this assessment, it is critical to avoid rocking the pelvis or putting any strain on the pelvis. The action you performed only checks for evidence of pelvic pain or gross instability. When in doubt, you can liberally place a pelvic binder.
Place non-adherent dressing on the left lower arm (deep wound)
Events: Medication Administration: Give Naloxone Syringe 40mg/mL
Events: Medication Administration: Give Fentanyl Lollipop 800mcg
Events: Medication Administration: Give Acetaminophen 10 500mg
Events: Medication Administration: Give Ondansetron Tablet 4mg
Events: Medication Administration: Give Ketamine 50mg
Hypothermia Management: Place Blanket
Exam: Assessment: Complete TCCC card
Patient disposition: Medical Evacuation
