Tier 3 Curriculum 016

This casualty was near a drone explosion that occurred 28 minutes ago. You started by providing Care Under Fire, where you saw MASSIVE HEMORRHAGE from both of the patient’s legs. You placed two hasty high and tight tourniquets. Then you moved the patient to safety where you were able to treat the right lower extremity hemorrhage and take the tourniquet down. You replaced the left lower extremity tourniquet with a deliberate tourniquet. The patient is maintaining their AIRWAY. The patient’s chest is clear, and they do not have a RESPIRATORY injury. You identified that the patient’s pelvis was unstable and placed a pelvic binder. You identified that the patient was going into shock. You placed large bore intravenous access and gave one unit of Low-Titer O Whole Blood as well as a dose of Calcium. Then you identified the patient has an A+ blood type and you started a unit of A+ blood that is running now. You have an electronic vital signs monitor attached, and you already have gloves on. It will take at least two hours to get the patient to a higher level of care. \r\n\r\n The primary learning objective is to review administration of intravenous medications and to cover tranexamic acid (TXA) administration in the CIRCULATION section of MARCH. The estimated time to complete this scenario is 15 minutes. This scenario occurs in the Tactical Field Care Phase.

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

This site is okay to use, good job!
This site is okay to use, good job!
This site should not be used because of the pelvic injury. 
This site should not be used because of the pelvic injury. 
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

Wipe the access diaphragm using an alcohol wipe on the right arm
Wipe the access diaphragm using an alcohol wipe on the left arm
Events: Medication Administration: Give Tranexamic Acid 100mg/mL
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
  • Doxycycline Hyclate 100 mg
  • Calcium Gluconate 100 mg/ml
  • Cefadroxil 500 mg
Available blood and fluids
  • Whole Blood O+
  • Pack 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
  • Abdominal internal bleeding
  • Amputated left leg at knee
  • Deep wound on the right leg
  • Hemorrhage from the ear
Pathologies
  • external hemorrhage, left leg
  • add liquid bag, Blood
Scoring summary
  • Clean IV Line
  • Administer TXA
  • Flush IV Line
  • Documentation
  • Disposition