022 ASM

Hypothermia Management Essentials in TCCC – Tier 1 – You are in a SAFE and SECURE location – The primary learning objective is to describe, review, and practice the Hypothermia phase of care in the M A R C H algorithm using clothing, moving a patient to a dry location, hypothermia prevention kits, and blankets to treat and prevent this condition that increases the lethality of traumatic injuries. 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 10 minutes ago. The massive hemorrhage, airway, respiratory, and circulation phases of care have been completed, and the patient had massive bleeding from a right upper extremity amputation (treated with a tourniquet), and no airway obstruction, respiratory, or circulation injuries. You already have personal protective equipment (gloves) on. No other interventions have been performed. This scenario occurs in the Tactical Field Care Phase and covers the MARC[H] 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 022).

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: Thank you. I feel really cold and shaky.
Location: Head
Patient: Can you tell me your name?
Response: Samantha Cole
Location: Head
Patient: What happened?
Response: There was a blast… I think I lost my arm.
Location: Head
Patient: Are you hurting anywhere?
Response: My shoulder hurts a lot… and my whole body feels cold.
Location: Head
Patient: Does your throat hurt or feel tight?
Response: No, but I feel really weak.
Location: Head
Patient: Are you having a hard time breathing?
Response: I feel weak, but my breathing feels okay
Location: Head
Patient: Does your chest hurt?
Response: No, just my arm and shoulder.
Location: Head
Patient: Did you pass out (lose consciousness)?
Response: I don’t know… everything feels foggy.
Location: Head
Patient: Do you have any numbness or weakness?
Response: My right arm is gone… and my body feels heavy.
Location: Head
Patient: Does your head hurt?
Response: No, I don’t think so.
Location: Head
Patient: Does your neck hurt?
Response: No, I don’t think so.
Location: Head
Patient: Does your back hurt?
Response: No, I don’t think so.
Location: Head
Patient: Does your abdomen hurt?
Response: Yes, it feels tight and really painful.
Location: Head
Patient: Do you have any allergies?
Response: No. I don't.
Location: Head
Patient: Do you take any medications?
Response: No. I don't take any medications.
Location: Head
Patient: Do you have any medical problems?
Response: No I am healthy.
Location: Head
Patient: Have you ever had any surgeries?
Response: No. I have never had any surgeries.
Location: Head
Patient: When did you last eat or drink something?
Response: I drank some water about an hour ago.
Location: Head
Patient: Do you smoke, drink, or use recreational drugs?
Response: No. I don't use any of those.
Location: Head
Patient: I'm here to take care of you.
Response: Thank you this is terrifying.
Location: Head

Guided Steps

This is your first time taking care of Samantha Cole. You are in a secure location. This scenario summarizes Hypothermia management in the MARCH Algorithm during TCCC Tactical Field Care. Samantha has a right arm amputation with massive bleeding (now controlled with a tourniquet) and is at risk of Hypothermia, which can increase the patient’s risk of death.
Informational Step: At the All Service Member (ASM) / Tier 1 level in Tactical Combat Casualty Care, preventing hypothermia is critical, even in hot environments. A casualty who has lost a lot of blood is at high risk of their body temperature dropping, which can lead to worsened bleeding and death.
Informational Step: When you finish treating immediate threats, protect the casualty from the ground and the elements. In the field, insulate them from the ground (with a jacket or pack), and cover them with a blanket, poncho, or hypothermia wrap—whatever is available. Focus on keeping their core warm, especially the chest, back, and head. Wet clothing should be removed if possible.
Informational Step: Other methods include moving the patient to a dry/sheltered location, using a hypothermia prevention kit if you have one, or turning heaters on in vehicles. While beyond Tier 1 TCCC, in cases of severe hypothermia, warm fluids or advanced rewarming techniques may be necessary.
The most important step in hypothermia management is to use whatever resources you have to minimize this condition. What can you do to prevent or manage hypothermia for this patient?
If you said, ‘put clothes back on the patient.’ Great job! While removal of clothing is very important to identify injuries initially, once you have performed your primary survey (looking for massive hemorrhage, airway obstruction, respiratory injuries, and assessed circulation), it is then critical to cover the patient. If not already completed, select the clothing pile to put clothes back on the patient.
Next, open your tablet [X], select the disposition tab, and select Medical Evacuation to end this scenario. This concludes this training scenario on Hypothermia Management in Tactical Field Care. After reviewing the feedback panel, exit this simulation and select scenario 023 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
5-10 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 right arm
Pathologies
  • external hemorrhage, right arm
Scoring details
  • H-Hypothermia Management
  • Disposition