ASM 007

Massive Bleeding Control Essentials: Managing Hemorrhage in a Secure Zone – Tier 1 – You are now in a SAFE and SECURE location – The primary learning objective is to practice providing massive bleeding/hemorrhage control in a safe location. You first started taking care of this patient in Care Under Fire where you identified a LEFT LOWER EXTREMITY massive hemorrhage and placed a tourniquet, and then moved the patient to safety. The casualty was near a drone explosion that occurred 6 minutes ago (it has been two minutes since you last saw the patient). You already have personal protective equipment (gloves) on. 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 007).

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: I don't have any numbness or weakness.
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
Patient: I've called for help. A medic will be here soon.
Response: The patient isn't able to speak, and has noisy breathing
Location: Head

Guided Steps

You started caring for Private Danny Rivers two minutes ago. You placed a tourniquet on his left leg, moved the patient to a more secure location, and put on gloves. You are now in the Tactical Field Care phase of TCCC, continuing the ‘Massive Hemorrhage’ portion of the MARCH algorithm.
You were able to move the patient into a well-protected concrete building, but enemy fire blocks your route to the casualty collection point (CCP). It’s critical to get this patient to higher levels of care as quickly as possible. Use your radio to call for help so you can get the patient to the CCP (activating your radio will give you credit for this task).
Radio Response: Roger, we will try to get you out of there, but it's pretty bad out here; you will probably be there for a while (60 to 120 minutes). We do have one Medic that might be able to get to you. If there are any updates that could help them prioritize which patient to come to first, please radio us back.
You are the only person who can help this soldier. Let’s keep pushing through MARCH. First, reassess the tourniquet placed on the left leg. Check to ensure it is still there and working. Confirm that there is no active bleeding below the application site. If the tourniquet is not effective, tighten it or consider applying a second one.  
Informational Step: Anytime you move a casualty, you can dislodge treatments like tourniquets. This is why it is essential to reassess all interventions every time you move a patient. You can use the MARCH algorithm to prompt your memory on what has been done.  
Next, perform a blood sweep searching for any additional massive bleeding. If any bleeding is found, apply the appropriate intervention—apply direct pressure, wound packing, pressure dressing, or an additional tourniquet as necessary.
This patient has no other areas of active bleeding. Next, open your tablet [X], select the disposition tab, and select Medical Evacuation to end this scenario. You will see this patient again in future scenarios to complete the rest of the MARCH algorithm. After reviewing the feedback page, exit this simulation and select scenario 008 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
  • Abdominal internal bleeding
  • Airway obstruction
  • Amputated left leg at knee
  • Bruise behind right ear
  • Eye cornea trauma, left side
Pathologies
  • airway obstruction
  • external hemorrhage, left leg
  • internal hemorrhage, vena cava
Scoring summary
  • M-Blood Sweep
  • Radio Medic
  • Disposition