This is the fourth scenario in the Tier 2/Combat Life Saver curriculum pack. The following scenarios will provide training on additional TCCC at the Tier 2 Level. There are new interventions in the Airway, Respirations, Circulation, Head Injury, Hypothermia, and Fracture portions of TCCC. Additionally, Tier 2 introduces you to new medications that can be used for pain as well as infection prevention and treatment. We will proceed sequentially through MARCH.
Tier 2 Respiration Assessments and Treatments: You are in a SAFE and SECURE location – The primary learning objective is to show you how to treat open chest wall injuries that affect respirations. The estimated time to complete this scenario is 5 minutes. This scenario occurs in the Tactical Field Care Phase. Equipment Available: Combat Life Saver Pack. Evacuation/Disposition is possible through the tablet. Selecting the patient’s disposition will end the exercise.
Patient Communication
Patient: Can you tell me your name?
Response: The patient is sleepy and looks confused
Location: Head
Patient: Do you remember what happened?
Response: The patient is sleepy and looks confused
Location: Head
Patient: Do you feel any pain?
Response: The patient is sleepy and looks confused
Location: Head
Patient: Do you have any medical problems?
Response: The patient is sleepy and looks confused
Location: Head
Patient: Do you have any allergies?
Response: The patient is sleepy and looks confused
Location: Head
Patient: Do you take any medications?
Response: The patient is sleepy and looks confused
Location: Head
Patient: Are you feeling dizzy or confused?
Response: The patient is sleepy and looks confused
Location: Head
Patient: Are you having trouble breathing?
Response: The patient is sleepy and looks confused
Location: Head
Patient: Can you see clearly?
Response: The patient is sleepy and looks confused
Location: Head
Patient: Do you feel any swelling in your throat?
Response: The patient is sleepy and looks confused
Location: Head
Patient: Are your lips or tongue swollen?
Response: The patient is sleepy and looks confused
Location: Head
Patient: Is your voice hoarse or different?
Response: The patient is sleepy and looks confused
Location: Head
Guided Steps
The patient was injured in a blast from a drone attack about 30 minutes ago and other soldiers dragged them to your location. You already washed your hands, put on your gloves, and did a search for massive hemorrhage, which was normal. The patient's airway is clear. Next, assess respirations (chest). What do you find on your exam? Press and hold [B] to proceed to the next step.
If you found the open chest wounds on the right anterior (front) chest, and on the right posterior (back) chest, good job! How would you like to treat those open chest wounds?
If you said to place a chest seal, good job! Next, open your Combat Life Saver Pack and find a flat green package labeled Chest Seal and pick it up.
Informational Step: While every equipment provider is slightly different, most of these packages will include a chest seal with a protective side covering the sticky part of the seal and a piece of gauze.
This kit does not contain gauze, but you can use your hand to clean around the wound. Take your controller without the chest seal and put it near one of the wounds and pull the [TRIGGER], then put your the chest seal near the wound and pull the [TRIGGER] to place the chest seal.
Informational Step: In real life before placing this chest seal you would have to remove the backing from the chest seal that covers the sticky part. Then you would center the chest seal over the wound and press firmly from the center outward to avoid trapping air and ensure all edges are sealed to the skin. If the patients condition worsens you may need to “burp” the seal by lifting one edge to release the pressure.
Next, perform the same actions for the other wound making sure chest seals are placed on the right front and back of the patient’s chest.
Informational Step: In real life, if you run out of chest seals, or if you do not have a chest seal, then you can use a plastic wrapper to cover an open chest wound. Then you would secure the edges of the plastic wrapper with tape.
Informational Step: In real life, a common mistake is trying to ‘pack’ these open chest wounds with gauze or covering them with porous gauze. In real life if you tried to pack an open chest wound it could take piles of gauze as you are literally filling the patients chest up. Additionally, if you just cover the wound with gauze then air can still enter the wound and allow a life threatening pneumothorax to develop.
This concludes your scenario. Next, open your tablet [X], select the disposition tab, and select Medical Evacuation.