This is your first time taking care of James Miller. He was injured in a drone strike 10 minutes ago. You are in a secure location. This scenario summarizes Head, Eye, Fracture, and Burn Injury Management during TCCC Tactical Field Care. James has a Head, Eye, Fracture, and Burn injuries. We will slowly review the management of these injuries for training purposes.
For this scenario, a teammate completed the Massive Hemorrhage, Airway, Respiratory, Circulation, and Hypothermia phases of care before your arrival. The patient has no external bleeding, airway, or respiratory injuries, and hypothermia has been addressed. You already have gloves on.
Informational Step: You are now transitioning to the more extended care phase (beyond the search for core life-threatening injuries covered in MARCH). Next, we will review the management of Head, Eye, Fracture, and Burn Injury.
Informational Step: Head injuries span from mild traumatic brain injuries ( such as concussions) to immediately lethal brain injuries. At the TCCC Tier 1 level, you have two goals. First, identify severe life-threatening head injuries to expedite immediate care. Second, identify events that could cause very subtle head injuries, so you can help ensure the person gets care when they can.
Informational Step: Any impact to the head or blast exposure can cause a head injury. While some head trauma is obvious (open skull fracture), most is more subtle. One of the best ways to identify a head injury is by assessing mental status (how a person is responding to you). Mental status is often described as alert (talking to you normally), verbal (opens eyes to voice), only responds to pain, or unresponsive.
First, let’s evaluate for severe head (brain) injuries. Start by looking at the patient. Are they responding to you, opening and tracking you with their eyes? Then ask them a question and ask them to move an arm or leg - are they responding normally? Next, check the patient’s head and scalp for any apparent traumatic injuries (cuts, bruises, soft spots, tender/painful areas).
Next, consider what you found. Does this patient have a head injury?
If you said yes, good job! This patient does not appear to be responding. Additionally, there is bruising forming behind the patient’s ears (called a battle’s sign) that can sometimes be found in patients with head injuries.
If you saw this patient in the field, getting them to somebody with more medical training as soon as possible would be critical. By identifying that the patient has a serious head injury, you can help them get the care they need faster! Use your radio to call and notify a Medic now.
Radio Response: "Tracking, thank you for telling us. This patient sounds like they will need more care urgently! We are working to pick up a few more patients and will send somebody in about 15 minutes. In the meantime, please keep the patient’s head elevated (they can sit up if needed). Also, do your best to minimize neck movements. Over.”
Informational Step: Other signs (clues) of a severe head injury include slurred speech, repeated questions, unequal pupils, or unusual behavior. Any patient exposed to a blast or other head impact should be further evaluated by a Medic for more mild head injuries (concussions) at some point. You can help by reminding them to ‘get checked out’ when possible.
Informational Step: Next, we will assess and manage Eye Injuries. At the TCCC Tier 1 level, your goal is to identify if an injury could be present and to do your best to protect that eye from further injury. By catching an eye injury and protecting that eye, you can help save your teammate’s eyesight!
Next, assess (look at) the patient’s eyes. Do you see any eye injuries? Minor injuries can be hard to spot.
If you said yes, good job! The patient does have an eye injury on the right eye, a small red injury towards the nose. Next, open an IFAK and use the Eye Shield to cover (protect) that eye. Click the [TRIGGER] near the eye to place it.
Informational Step: It is best to cover the eye with a protective shield if you have one; however, you can also use the bottom of a cup or eye protection goggles. When placing these, ensure that you do not put pressure on the eye itself (secure it on the bony areas around the eye). If an object is stuck in the patient’s eye, secure it the same way, and do not attempt to remove it from the patient's eye.
Informational Step: Next, we will assess and manage Fractures (Broken Bones). At the TCCC Tier 1 Level, realizing that these injuries can be very distracting is essential. Still, they are unlikely to kill a patient quickly unless there is associated massive bleeding. To minimize pain and further damage, you can stabilize the break using a stick or rifle stock and secure it above and below the break.
Next, evaluate the patient for any broken bones (fractures). Does this patient have any broken bones?
If you said ‘yes,’ good job! The patient’s right femur (thigh bone) appears to be broken. There is no active bleeding. You could stabilize the break in real life, but we do not currently have a method to do that in this simulator.
Informational Step: Next, we will assess and manage Burns. Burns can range from minor (small superficial burn) to severe, such as burns covering most of the body, or a facial burn with airway (mouth and throat) involvement. At the TCCC Tier 1 Level, it is essential to know that a facial burn can quickly cause a lethal airway obstruction, and it is good to understand the basic management of burns.
Next, evaluate the patient for any burns. Does this patient have any burn injuries?
If you said ‘yes,’ good job! The patient's left forearm appears to be burned. Next, use the shears to remove the burnt/burning clothing over that area to stop the burning process, and cover the burn with a clean dressing. Optimally, this would be a non-adherent burn dressing.
Next, open your tablet [X], select the disposition tab, and select Medical Evacuation to end this scenario. This concludes this training scenario on Head, Eye, Fracture, and Burn Injury Management in Tactical Field Care. After reviewing the feedback panel, exit this simulation and select scenario 027 to continue.
