027 ASM

Head injury, eye injury, fracture, and burn assessment and management essentials in TCCC – Tier 1 – You are in a SAFE and SECURE location – The primary learning objective is to describe, review, and practice head injury, eye injury, fracture, and burn assessment and management on a patient where the core M A R C H algorithm was already initially completed. The estimated time to complete this scenario is 5 minutes.

You first started taking care of Private Danny Rivers in Care Under Fire where you identified a left lower extremeity massive hemorrhage and placed a tourniquet on the left leg and then moved the patient to safety. Next you performed a blood sweep which was normal. You then identified an airway obstruction and implemented a head-tilt-chin lift. Then you performed a respiratory assessment which was unremarkable. Your circulation assessment revealed suspected shock from internal bleeding. You managed hypothermia by replacing the patient’s clothing and gear. You already have personal protective equipment (gloves) on. No other interventions have been performed.

Initially, the casualty was near a drone explosion that occurred 11 minutes ago (it has been one minute since you last saw the patient). This scenario occurs in the Tactical Field Care Phase and continues beyond the MARCH 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 027).

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'm 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 Danny Rivers seven minutes ago. You placed a tourniquet on his left leg, moved the patient to a more secure location, put on gloves, completed a blood sweep, performed a head-tilt-chin lift, assessed respirations, identified that the patient was in shock, replaced clothing, and called for help (ETA 9 minutes).
You are now in the Tactical Field Care phase of TCCC, starting the ‘Extended’ treatment portion for head, eye, fracture, and burn injuries.
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 then ask them to move an arm or leg - are they responding normally? Next, check the patient’s head and scalp for any traumatic injuries.
Next, consider what you found. Does this patient have a head injury?
If you said yes, good job! While it is hard to ask the patient questions because of the patient’s airway obstruction, the patient has some bruising behind their right ear (Battle’s Sign). Additionally, while the patient’s lack of responsiveness may be because of the airway obstruction, this should also raise the possibility of a concurrent head injury.
Next, assess (look at) the patient’s eyes. If the patient is unconscious you can place your hand by his eyes and pull the triggers to open them. 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 (left eye). Next, open an IFAK and use the Eye Shield or bandage to cover (protect) that eye. You can further protect the eye by placing a bandage over the sheild.
Next, evaluate the patient for any broken bones (fractures). Does this patient have any broken bones?
If you said no, good job! The patient doesn’t have any apparent fractures. It would be important to do a more detailed examination including palpation of the extremeties in the future after reaching a higher level of medical care.
Next, evaluate the patient for any burns. Does this patient have any burn injuries?
If you said no, good job! The patient doesn’t have any burn injuries.
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 028 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
  • Abdominal internal bleeding
  • Amputated left leg at knee
  • Bruise behind right ear
  • Eye cornea trauma, left side
Pathologies
  • external hemorrhage, left leg
  • internal hemorrhage, vena cava
  • airway obstruction
Scoring details
  • H-Assess Neuro & Response
  • Disposition
  • Place Eye Shield