Tier 3 Curriculum 006

This casualty was near a drone explosion that occurred 9 minutes ago. You started taking care of this patient in Care Under Fire, moved the patient to safety, then identified massive bleeding from a groin wound, and placed wound packing and a pressure bandage. Next, you identified an airway obstruction, which you helped resolve by sitting the patient up. Then you performed a respiratory assessment, which was unremarkable. You already have personal protective equipment (gloves) on. No other interventions have been performed. You are in a SAFE and SECURE location.

The primary learning objective is to review how to control junctional hemorrhage with a junctional tourniquet and to review other advanced hemorrhage control techniques. The estimated time to complete this scenario is 10 minutes. This scenario occurs in the Tactical Field Care Phase. Equipment Available: Combat Medic Bag. Evacuation/Disposition can be done on the tablet. Selecting the patient’s disposition will end the exercise.

Patient Communication

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

Audio Triggers

The bleeding appears to stop.
The bleeding appears to stop.
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.

Scoring Details

Apply the junctional tourniquet to the left leg
Head-tilt-chin lift
Exam: Assessment: Complete TCCC card
Patient disposition: Medical Evacuation

Scenario Details

Scenario Package
TCCC Tier 3 Curriculum
Learner type
  • militaryMedic
Patient severity at start
Serious
Patient severity overall
Serious
Duration to complete
5-10 minutes
Scenario difficulty
Standard
Environment
POI
Equipment
  • Non-Adherent Dressing
  • Duct Tape
  • Eye Guard
  • Intravenous cannula
  • ChestSealPackage
  • SAM splint
  • Combat Application Tourniquet
  • Cardiac electrodes
  • Trauma Shears
  • Decompression needle
  • Blanket
  • Nasopharyngeal airway
  • bandage
  • pressure bandage
  • hemostatic gauze
  • wound packing gauze
  • AlcoholWipe
  • Gloves box
  • PackingGauze
  • TriageTag_Any
  • BVM
  • FaceMaskBVM
  • MedicationPouch
  • Marker
  • JETT
  • Laryngeal mask airway
  • Oxygen saturation device
  • Stethoscope
  • Surgical scalpel
  • Pelvic Binder
  • Blood pressure cuff
  • Yankauer suction tip
  • Cricothyrotomy Tube
  • Intraosseous drill
  • Simple oxygen mask
  • Eldon Card
  • Vital Monitor
  • IV Holder
  • Oxygen Balloon
  • ETCO2
  • Penlight
  • Axial peripheral thermometer
  • BloodCollectionBag
  • Field Medical Card
  • Lubricant
  • Plastic Package
  • Sharps Container (small)
  • Hemostatic Injector
  • Fluid Warmer
  • Defibrillator
Available medications
  • IV Ketamine 2mg/ml
  • IV Hypertonic Saline 3%
  • Acetaminophen 500 mg
  • Meloxicam 15 mg
  • Fentanyl Lollipop 800 mcg
  • Fentanyl 50 mg/ml
  • Ketamine 50 mg
  • Morphine 10 mg
  • Lidocaine 10 mg/ml
  • Ertapenem
  • Epinephrine 1 mg
  • Prednisone 10 mg
  • Diphenhydramine 50 mg/ml
  • Diphenhydramine Benadryl 25 mg
  • Dexamethasone 4mg/ml
  • Epinephrine Syringe 0.1 mg/ml
  • Esketamine 140 mg/ml
  • Tranexamic Acid 100 mg/ml
  • Ondansetron 2 mg/ml
  • Ondansetron Tablet 4 mg
  • Naloxone 4 mg
  • Naloxone Syringe 40 mg/ml
  • Cephalexin 500 mg
  • Ceftriaxone 100 mg/ml
  • Moxifloxacin 400 mg
  • Suzetrigine 50 mg
  • Cefadroxil 500 mg
  • Doxycycline Hyclate 100 mg
  • Calcium Gluconate 100 mg/ml
Available blood and fluids
  • Whole Blood O+
  • Red Blood Cells O+
  • Red Blood Cells O-
  • Red Blood Cells A-
  • Red Blood Cells B-
  • Red Blood Cells AB-
  • Red Blood Cells A+
  • Red Blood Cells B+
  • Red Blood Cells AB+
  • Fresh Frozen Plasma O+
  • Fresh Frozen Plasma O-
  • Fresh Frozen Plasma A-
  • Fresh Frozen Plasma B-
  • Fresh Frozen Plasma AB-
  • Fresh Frozen Plasma A+
  • Fresh Frozen Plasma B+
  • Fresh Frozen Plasma AB+
  • Platelets
  • Normal Saline 0.9%
  • Lactated Ringers
  • Dextrose 5%
  • Dextrose 10%
Injury type
  • Groin junctional wound, left side
  • Hemorrhage from the ear
Pathologies
  • external hemorrhage, left kidney
  • airway obstruction
Scoring summary
  • M-Place Junctional Tourniquet
  • A-Head Tilt Chin Lift
  • Documentation
  • Disposition