You are near the frontline while the rest of your team is engaged in a firefight. A casualty has been brought into your treatment area. The casualty’s weapons and equipment have been removed. Your team is providing security, leaving you as the only person available to treat the casualty.
You tried to place an intravenous line, but the patient’s veins were flat and you were unsuccessful. You do not have any more intravenous catheters. The patient is getting more groggy. You have equipment commonly found in a medic aid bag, including a unit of low titer O+ whole blood. Your task is to rapidly assess the casualty and perform all indicated TCCC Tier 3-level interventions.
Once you have completed all necessary care, select the appropriate disposition using your tablet to end the scenario.
Patient Communication
Patient: Hey, I am here to take care of you.
Response: Thank you.
Location: Head
Patient: Can you tell me your name?
Response: I think it's Vitaliy? I'm having a hard time remembering.
Location: Head
Patient: What happened?
Response: I don't know for sure. I think there was an explosion
Location: Head
Patient: Are you hurting anywhere?
Response: My right leg and arm are in a lot of pain.
Location: Head
Patient: Does your throat hurt or feel tight?
Response: No. My throat feels normal.
Location: Head
Patient: Are you having a hard time breathing?
Response: No. I can breathe normally.
Location: Head
Patient: Does your chest hurt?
Response: No. My chest does not hurt.
Location: Head
Patient: Did you pass out (lose consciousness)?
Response: I think so? I don't know.
Location: Head
Patient: Do you have any numbness or weakness?
Response: I don't have any numbness or weakness.
Location: Head
Patient: Does your head hurt?
Response: Yes. I think so.
Location: Head
Patient: Does your neck hurt?
Response: No. My neck feels normal.
Location: Head
Patient: Does your back hurt?
Response: No, the bones in my back do not hurt
Location: Head
Patient: Does your abdomen hurt?
Response: No. It feels fine.
Location: Head
Patient: Do you have any allergies?
Response: I do not have any allergies.
Location: Head
Patient: Do you take any medications?
Response: I do not take any medications.
Location: Head
Patient: Do you have any medical problems?
Response: I do not have any medical problems.
Location: Head
Patient: Have you ever had any surgeries?
Response: I have never had a surgery.
Location: Head
Patient: When did you last eat or drink something?
Response: I think I had breakfast this morning.
Location: Head
Patient: Do you smoke, drink, or use recreational drugs?
Response: I don't do any of those.
Location: Head
Patient: Tell the patient what you are going to do.
Response: Thank you.
Location: Head
Audio Triggers
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
PPE: Blue Gloves (right side)
PPE: Blue Gloves (left side)
Blood Sweep (left lower thigh) (Left Leg Ampute)
Blood Sweep (right lower thigh) (Right Leg Ampute)
Blood Sweep (left upper arm) (Left Arm Ampute / Shrapnel Arm Left)
Blood Sweep (right upper arm) (Right Arm Ampute / Shrapnel Arm Right)
Blood Sweep (left arm) (Deep Wound Arm Left)
Blood Sweep (right arm) (Deep Wound Arm Right)
Blood Sweep (left lower leg) (Deep Wound Leg Left)
Blood Sweep (right lower leg) (Deep Wound Leg Right)
Blood Sweep (left upper thigh) (Left Leg Ampute / Shrapnel Leg Left)
Blood Sweep (right upper thigh) (Open Fracture / Open Fracture Blood / Shrapnel Leg Right)
Blood Sweep (right chest, front) (Gunshot Wound Chest Right)
Blood Sweep (left chest, front) (Gunshot Wound Chest Left)
Blood Sweep (right chest, back) (Gunshot Wound Back Right)
Blood Sweep (stomach) (Shrapnel)
Blood Sweep (groin)
Exam: Assessment: Remove the patient clothing around left arm
Exam: Assessment: Remove the patient clothing around right arm
Exam: Assessment: Remove the patient clothing around left leg
Exam: Assessment: Remove the patient clothing around right leg
Exam: Assessment: Remove the patient's shirt
Exam: Assessment: Remove the patient's underpants
Massive Hemorrhage: Place Tourniquet on Left Lower Thigh
Massive Hemorrhage: Tighten Tourniquet on Left Lower Thigh
Massive Hemorrhage: Tighten Tourniquet on Left Lower Leg
Massive Hemorrhage: Take Down Tourniquet from Left Lower Leg
Mark tourniquet on Left Lower Thigh
Massive Hemorrhage: Take Down Tourniquet from Left Lower Leg
Massive Hemorrhage: Tighten Tourniquet on Left Lower Leg
Massive Hemorrhage: Tighten Tourniquet on Left Lower Thigh
Massive Hemorrhage: Place Tourniquet on Left Lower Thigh
Mark tourniquet on Left Lower Thigh
Exam: Ask patient
Perform sternal rub
Shoulder tap for response
Exam: Ask patient
Airway: Jaw thrust maneuver
Head-tilt-chin lift
Listen for breathing
Airway: Jaw thrust maneuver
Head-tilt-chin lift
Airway: Place Nasopharyngeal Airway
Airway: Suction Catheter Use
Exam: Assesment: Place SPO2 pleuth
Exam: Assessment: Roll the patient over
Exam: Assessment: Roll the patient back
Exam: Assessment: Check Carotid Pulse Right
Exam: Assessment: Check Carotid Pulse Left
Exam: Assesment: Check Radial Pulse Right
Exam: Assesment: Check Radial Pulse Left
Exam: Assesment: Check Femoral Pulse Right
Exam: Assesment: Check Femoral Pulse Left
Exam: Assesment: Check Pedial Pulse Right
Exam: Assesment: Check Pedial Pulse Left
Create intraosseous vascular access on right leg
Create intraosseous vascular access on left shoulder
Create intraosseous vascular access on right shoulder
Events: Medication Administration: Give Tranexamic Acid 100mg/mL
Events: Medication Administration: Give Calcium Gluconate 100mg/mL
Hypothermia Management: Place Blanket
Hypothermia Management: Put Back All Clothes
Exam: Ask patient to move right leg
Exam: Ask patient to move left leg
Exam: Ask patient to move right arm
Exam: Ask patient to move left arm
Exam: Assesment: Check right pupil
Exam: Assesment: Check left pupil
Events: Medication Administration: Give Moxifloxacin 400mg
Events: Medication Administration: Give Acetaminophen 10 500mg
Events: Medication Administration: Give Ketamine 50mg
Place bandage on the left leg amputation
Exam: Assessment: Complete TCCC card
Send 9-liner
Patient disposition: Medical Evacuation