028 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 Luke Hensley in Care Under Fire, you moved the patient to safety, and then you identified massive bleeding from a groin wound and applied pressure, placed wound packing and a pressure bandage. Next, you identified an airway obstruction, which you helped resolve by sitting the patient up. Then you performed a respiratory assessment which was unremarkable. Next, during the circulation phase you evaluated the patient and felt they were relatively stable (not in shock) currently. During the hypothermia phase you put the patient’s clothes and gear back on. 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 028).

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 Luke Hensley seven minutes ago. You moved the patient to a more secure location, put on gloves, performed a blood sweep, managed bleeding from a groin wound, propped the patient upright, assessed respirations, assessed circulation, and replaced clothing. You are now in the Tactical Field Care phase of TCCC, starting ‘Extended’ treatment 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. (Note: due to a limitation in the simulator, you cannot ask a patient sitting upright to move their limbs). 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 maybe, good job! While it is hard to ask the patient questions because of the patient’s airway obstruction, the apparent burn to the face (likely from a blast) could also have caused a head injury.
Next, assess (look at) the patient’s eyes. Do you see any eye injuries? Minor injuries can be hard to spot.
If you said no (or maybe), good job! The patient does not have direct evidence of a penetrating eye injury. However, having a flash facial burn like this can increase the chance of having an eye injury. In this patient, it would be acceptable to leave eye shields off (or) if the patient had eye pain, to place eye shields and tape.
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.
Next, evaluate the patient for any burns. Does this patient have any burn injuries?
If you said yes, good job! The patient has evidence of facial burns (causing an airway obstruction – help is on the way. At the Tier 1 level you are only expected to recognize a facial burn and relay that the casualty will need a higher level of care) and a burn to the forearm. 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 029 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
  • Facial burn
  • Groin junctional wound, left side
  • Left lower hand burn
Pathologies
  • airway obstruction
  • external hemorrhage, left kidney
Scoring details
  • C-Exposure
  • H-Assess Neuro & Response
  • Disposition
  • Bandage Burn