031 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 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. The patient had a burn on their arm which was treated, a possible head injury, possible eye injuries, but did not appear to have any fractures. 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 031).

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.

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've 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'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 eight minutes ago. You moved the patient to a more secure location, put on gloves, performed a blood sweep, managed bleeding from a groin wound, sat the patient upright, assessed respirations, assessed circulation, replaced clothing, identified a possible head injury, and treated a burn on his arm.
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 bleeding from a left groin wound, an airway obstruction from a facial burn, a possible head injury, and a burn on his left arm. His bleeding seems to be controlled with wound packing and a pressure bandage. His airway is doing better after sitting up, but the burn is pretty bad.”  
Radio Response: Received! Good job. We are on our way. Continue to watch the patient’s airway. We will bring equipment for cricothyroidotomy or intubation and a ventilator. 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, aim the marker at the TCCC card and click on a section. 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: 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. 
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.
Suddenly, a Medic enters the room! “Well done, keeping this patient alive! They wouldn’t have survived without you. Incredible work.” Your patient goes on to survive and, four months later, makes it home to a welcome party thrown by his mom, dad, and sister. A year later, he writes a book about his experience, describing how he survived, and the first chapter is about the heroic care he received on the battlefield.
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 032 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
  • external hemorrhage, left kidney
  • airway obstruction
Scoring details
  • Documentation
  • Disposition
  • Communicate with Leadership
  • Communicate with Evacuation Team
  • Communicate with Patient