ASM 003

Massive Bleeding Control Essentials: Mastering Hemorrhage Management in TCCC – Tier 1 – You are in a SAFE and SECURE location – The primary learning objective is to describe, review, and practice the full range of massive bleeding/hemorrhage control methods: tourniquet application, applying direct pressure, hemostatic dressing application, wound packing with hemostatic dressing, pressure dressing application. We will review what injury characteristics would commonly indicate the need for which type of treatment. Subsequent scenarios will allow you to practice making the decision of which method to use. The estimated time to complete this scenario is 15 minutes. This is your first time taking care of Marcus Kane. The casualty was near a drone explosion that occurred 4 minutes ago. You already have personal protective equipment (gloves) on. No interventions have been performed. This specific scenario does not use realistic physiology. The casualty has catastrophic injuries but will remain alive for training purposes only. This scenario occurs in the Tactical Field Care Phase and covers the [M]ARCH portion(s) of care. Equipment Available: Individualized First Aid Kit (IFAK) U.S Version (x2). Evacuation/Disposition is possible through the tablet. Selecting the patient’s disposition will end the exercise. (This is Scenario 003).

Dynamic Physiology Disclaimer:
To obtain the most accurate and effective training experience, we recommend completing each scenario in one uninterrupted session. The virtual patients used in this training are powered by highly realistic physiological models that continuously adjust vital signs and overall condition. The scenarios have been modified to give you time to review instructional materials, and you will not lose points for delays in scenarios with instructional content. However, it is still possible that, depending on your completion pace, the scenario may not progress in perfect alignment with the guided prompts, and for critically injured patients, even moderate delays may result in deterioration or death before the scenario concludes. This is not meant to indicate you did not perform well; rather, it is because of how the high-fidelity engine performs.

Ongoing Development Disclaimer: In this package wording has not been updated to reflect new functionality to time and date tourniquets or for the non-adhesive burn bandage functionality. Additionally, it is possible other small updates or changes are not reflected in the wording. All grading is set to the current standard described in this package.

Patient Communication

Patient: Hey, I am here to take care of you.
Response: Please help me.
Location: Head
Patient: Can you tell me your name?
Response: My name is Marcus.
Location: Head
Patient: What happened?
Response: There was an explosion. It was right by me.
Location: Head
Patient: Are you hurting anywhere?
Response: Yes. So much pain on my arms and legs.
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: No. I didn't pass out.
Location: Head
Patient: Do you have any numbness or weakness?
Response: I'm just in a lot of pain.
Location: Head
Patient: Does your head hurt?
Response: No, My head feels normal.
Location: Head
Patient: Does your neck hurt?
Response: No. My neck feels normal.
Location: Head
Patient: Does your back hurt?
Response: No, My back feels normal.
Location: Head
Patient: Does your abdomen hurt?
Response: No. My abdomen feels normal.
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 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: I am here to take care of you.
Response: Thank you.
Location: Head

Scoring Details

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)
Place bandage on the left lower arm (deep wound)
Fill left hand wound with wound packaging
Apply pressure to groin
Hold Hands Over Bleeding Injury
Massive Hemorrhage: Place Tourniquet on Left Upper Leg
Massive Hemorrhage: Tighten Tourniquet on Left Upper Leg
Exam: Assessment: Remove the patient clothing around left arm
Exam: Assessment: Remove the patient clothing around left leg
Exam: Assessment: Remove the patient's underpants
Patient disposition: Medical Evacuation

Scenario Details

Scenario Package
TCCC Course
Learner type
  • militaryMedic
Patient severity at start
Serious
Patient severity overall
Serious
Duration to complete
<5 minutes
Scenario difficulty
Standard
Environment
POI
Equipment
  • Bandage
  • Combat Application Tourniquet (1)
  • Combat Application Tourniquet (2)
  • Trauma Shears
  • Blanket
  • FoilBlanket
  • Nasopharyngeal airway
  • Chest Seal Package
  • Packing Gauze
  • Gloves
  • Eye Guard
  • Non-Adherent Dressing
  • Medication Pouch
  • Radio
  • Marker
  • Triage Tag (Minimal)
Available medications
  • Acetaminophen Pills
  • Moxifloxacin 1 g
  • Meloxicam 15mg
Injury type
  • Amputated left leg at knee
  • Deep wound on the left arm
  • Deep wound on the right arm
  • Groin junctional wound, left side
  • Open fracture of the right thigh with visible bone
Pathologies
  • external hemorrhage, left leg
  • external hemorrhage, left arm
  • external hemorrhage, left kidney
Scoring summary
  • M-Blood Sweep
  • M-Place Bandage
  • M-Pack Wound
  • M-Hold Hands over Bleeding
  • M-Place Tourniquet
  • M-Tighten Tourniquet
  • C-Exposure
  • Disposition