ASM 006

Massive Bleeding Control Essentials: Managing Hemorrhage in a Hostile Zone – Tier 1 – You are in an UNSAFE and INSECURE location – The primary learning objective is to describe, review, and practice providing massive bleeding/hemorrhage control in an unsafe location. In addition, this scenario introduces you to a casualty that you will continue to provide care to using the TCCC M A R C H algorithm throughout a series of scenarios. The estimated time to complete this scenario is 5 minutes. This is your first time taking care of this casualty. The casualty was near a drone explosion that occurred 4 minutes ago. No interventions have been performed. This scenario occurs in the Care Under Fire 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 006).

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: The patient isn't able to speak, and has noisy breathing
Location: Head
Patient: Can you tell me your name?
Response: The patient isn't able to speak, and has noisy breathing
Location: Head
Patient: What happened?
Response: The patient isn't able to speak, and has noisy breathing
Location: Head
Patient: Are you hurting anywhere?
Response: The patient isn't able to speak, and has noisy breathing
Location: Head
Patient: Does your throat hurt or feel tight?
Response: The patient isn't able to speak, and has noisy breathing
Location: Head
Patient: Are you having a hard time breathing?
Response: The patient isn't able to speak, and has noisy breathing
Location: Head
Patient: Does your chest hurt?
Response: The patient isn't able to speak, and has noisy breathing
Location: Head
Patient: Did you pass out (lose consciousness)?
Response: The patient isn't able to speak, and has noisy breathing
Location: Head
Patient: Do you have any numbness or weakness?
Response: The patient isn't able to speak, and has noisy breathing
Location: Head
Patient: Does your head hurt?
Response: The patient isn't able to speak, and has noisy breathing
Location: Head
Patient: Does your neck hurt?
Response: The patient isn't able to speak, and has noisy breathing
Location: Head
Patient: Does your back hurt?
Response: The patient isn't able to speak, and has noisy breathing
Location: Head
Patient: Does your abdomen hurt?
Response: The patient isn't able to speak, and has noisy breathing
Location: Head
Patient: Do you have any allergies?
Response: The patient isn't able to speak, and has noisy breathing
Location: Head
Patient: Do you take any medications?
Response: The patient isn't able to speak, and has noisy breathing
Location: Head
Patient: Do you have any medical problems?
Response: The patient isn't able to speak, and has noisy breathing
Location: Head
Patient: Have you ever had any surgeries?
Response: The patient isn't able to speak, and has noisy breathing
Location: Head
Patient: When did you last eat or drink something?
Response: The patient isn't able to speak, and has noisy breathing
Location: Head
Patient: Do you smoke, drink, or use recreational drugs?
Response: The patient isn't able to speak, and has noisy breathing
Location: Head
Patient: I am here to take care of you.
Response: The patient isn't able to speak, and has noisy breathing
Location: Head

Guided Steps

This is your first time taking care of Private Kiara Mitchell. She was near a drone explosion that occurred 4 minutes ago. No interventions have been performed. Incoming! Incoming! You are not safe. Scan and treat life-threatening bleeding that can be resolved with a tourniquet only, then move the patient to safety.  
No interventions should be completed on this casualty in an UNSAFE location. While this patient has injuries that might appear concerning, such as a right leg fracture and a right upper extremity laceration, neither of them have any active hemorrhage. If you perform additional interventions for this patient, it puts your and the patient’s lives at risk. The location is unsafe. Get to cover, then proceed with the rest of the patient’s care. 
Next, open your tablet [X], select the disposition tab, and select Medical Evacuation to move the patient to safety. You will see this patient again in future scenarios to complete the rest of the MARCH algorithm. This concludes this training scenario on providing Care Under Fire (Control Massive Hemorrhage). After reviewing the feedback page, exit this simulation and select scenario 007 to continue. 

Scenario Details

Scenario Package
TCCC Tier 1 Curriculum
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
  • Deep wound on the right arm
  • Gunshot entry wound, chest right
  • Gunshot exit wound, back right
  • Open fracture of the right thigh with visible bone
  • Tracheal shift to the left side
Pathologies
  • airway obstruction
  • pneumothorax, open, right
Scoring summary
  • Disposition