030 ASM

Documentation and communication protocols in TCCC – Tier 1 – You are in a SAFE and SECURE location – The primary learning objective is to practice TCCC documentation and communication protocols after completing the core M A R C H algorithm and the extended head injury, eye injury, fracture, and burn management phase. The estimated time to complete this scenario is 5 minutes.
You first started taking care of this patient private Danny Rivers in Care Under Fire where you identified a LEFT LOWER EXTREMITY 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. The patient had a possible head injury and a left side eye injury, but did not appear to have any fracture or burn injuries. You already have personal protective equipment (gloves) on. No other interventions have been performed.
Initially, the casualty was near a drone explosion that occurred 12 minutes ago (it has been one minute since you last saw the patient). This scenario occurs in the Tactical Evacuation Care Phase and covers elements after the initial MARCH, head injury, eye injury, fracture, and burn 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 030).

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 have called a medic for help. They will be here soon.
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 Danny Rivers eight 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, called for help (estimated arrival 8 minutes), replaced clothing, identified a possible head injury, and a left eye injury.
You are now in the Tactical Field Care phase of TCCC, starting documentation, communicating with the patient, and communicating with command.
Next, use the radio to update your command and the medical team (now that you have completed your evaluation and identified all the injuries). A common way to communicate this information is the MIST report (Mechanism, Injuries, Signs and Symptoms, and Treatments).  
Informational Step: Example MIST report for this patient “20-year-old male injured by a drone explosion 10 to 15 minutes ago with a left leg amputation, an airway obstruction, he appears to be in shock and has bruising on his abdomen, he might have a head injury, and he has a left eye injury. We placed a tourniquet, repositioned his airway, and placed an eye shield.”  
Radio Response: Received! Good job. We are on our way. Continue to watch the patient’s airway and be on the lookout for any other external bleeding you can help control. It sounds like this patient needs blood and surgery. We will bring two units of whole blood with us. Over.
Next, we need to document the injuries we found and the care we provided to be ready to hand the casualty over. Pick up the TCCC card (also known as Form DD 1380). Please review it and fill it out as best as possible. The card auto-fills in when you pick up the marker from the IFAK, point the marker towards the TCCC and click on a section, so you only need to update one section to get credit for this task. In real life, you would fill it out as completely as possible.
Informational Step: Next, while waiting for backup, it would be essential to update the casualty on what is going on, providing as much comfort as possible (for example, covering them with another jacket or blanket), and continuing to re-assess them for changes re-running MARCH, Head, Eye, Fracture, Burn, Communication, and Documentation. It is common to have new injuries manifest themselves over time.  
Press [A] to communicate with the patient. Let them know you are there to take care of them and more help is on the way.
Informational Step: If you cannot give that patient your complete attention, we suggest you consider placing the patient in the recovery position. Optimally, one person always stays with every casualty. However, if that is not possible, consider placing the patient in the recovery position (or sitting them up), as that is a more stable position.  
Suddenly, the Medic appears in the doorway! “Good job keeping this patient alive; they wouldn’t have made it this long without you! We have it from here. Excellent work.” Your patient goes on to survive and, four months later, makes it home to his wife and daughter, and one year later, he wins a local half-marathon with a prosthetic leg.
This concludes this training scenario on Communication and Documentation in Tactical Field Care. Soon, you will have a chance to care for this patient throughout the entire treatment course without any guidance. Next, open your tablet [X], select the disposition tab, and select Medical Evacuation to end this scenario. After reviewing the feedback panel, exit this simulation and select scenario 031 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 LOC
  • Documentation
  • Disposition
  • Communicate with Leadership
  • Communicate with Evacuation Team
  • Communicate with Patient