016 ASM

Respiratory Management Essentials in TCCC – Tier 1. You remain in a SAFE and SECURE location – The primary learning objective is to practice the Respiratory phase of care in the M A R C H algorithm: inspecting the chest for wounds and for any evidence of a tension pneumothorax (dropped lung) in a tactical field care resuscitation scenario. You first started taking care of Luke Hensley in Care Under Fire, you moved the patient to safety, and then you identified massive bleeding from a groin wound and applied direct pressure, placed wound packing and placed a pressure bandage. Next, you identified an airway obstruction, which you helped resolve by sitting the patient up. You already have personal protective equipment (gloves) on. No other interventions have been performed. Initially, the casualty was near a drone explosion that occurred 8 minutes ago (it has been one minute since you last saw the patient). This scenario occurs in the Tactical Field Care Phase and covers the MA[R]CH 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 016).

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 going to remove your clothes to look for wounds.
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

You started caring for Private Luke Hensley four minutes ago. You moved the patient to a more secure location, put on gloves, performed a blood sweep, managed bleeding from a groin wound, and propped the patient upright. You are now in the Tactical Field Care phase of TCCC, starting the ‘Respiratory’ portion of the MARCH algorithm.
First, assess the patient’s respiratory effort (how hard they are working to breathe). Is this patient breathing slow, normal, or fast?
This patient’s respiratory rate is fast. The normal respiratory rate is between 12 and 20. This patient’s respiratory rate is faster than 20.
Next, assess (look at) the chest, upper back, and armpits for any wounds that could cause a tension pneumothorax. You must open the patient's IFAK and remove the patient’s clothing using shears. Did you find any wounds on this patient?  
The patient does not have any wounds on their chest, upper back, or armpits.
Next, see if the patient has unilateral chest rise and fall (only one side of the chest is rising and falling).  
Both sides of this patient’s chest rise and fall (normal).
Next, look for any tracheal deviation (windpipe shifted to one side or the other). Do you see any tracheal deviation?
This patient does not have any tracheal deviation.
The patient’s neck veins are normal.
Next, consider what you've seen in this patient. Do they have a tension pneumothorax (a dropped lung under pressure)?  
The patient is not showing signs of a tension pneumothorax. It is essential to realize these injuries can take time to show up, but at this time, for this patient, you should proceed to the next portion of care in the M A R C H treatment algorithm.
Next, open your tablet [X], select the disposition tab, and select Medical Evacuation to end this scenario. This concludes this training scenario on Respiratory Management in Tactical Field Care. After reviewing the feedback panel, exit this simulation and select scenario 017 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
  • Facial burn
  • Groin junctional wound, left side
  • Left lower hand burn
Pathologies
  • airway obstruction
  • external hemorrhage, left kidney
Scoring details
  • C-Exposure
  • Disposition