This casualty was near a drone explosion that occurred 10 minutes ago. You started by providing Care Under Fire, where you saw MASSIVE HEMORRHAGE from both of the patient’s legs. You placed two hasty high and tight tourniquets. Then you moved the patient to safety, removed their clothing and gear, and completed a blood sweep that was otherwise normal. The patient is maintaining their AIRWAY for now. The patient’s chest is clear, and they do not have a RESPIRATORY injury. You are entering the CIRCULATION phase of care. You just checked the patient’s pulse, and their pulse has been fast, greater than 110, and it has been increasing. The patient also seems a little less alert; they were VERBAL on the AVPU scale and are now only responding to PAIN. You do not see any signs of a head injury. Also, their skin feels a bit clammy as it is cold and sweaty. You are worried the patient is entering shock. You already have gloves on. It will take at least two hours to get the patient to a higher level of care.
The primary learning objective is to review more advanced approaches to managing the CIRCULATION section of MARCH, including identifying hidden areas of hemorrhage and initiating shock management at the Tier 3 level. The estimated time to complete this scenario is 10 minutes. This scenario occurs in the Tactical Field Care Phase. Equipment Available: Combat Medic Bag. Evacuation/Disposition can be done on the tablet. Selecting the patient’s disposition will end the exercise.
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
The Patient’s abdomen feels tense and the patient seems to have pain when you push on it. There is probably bleeding into their abdomen.
The Patient’s abdomen feels tense and the patient seems to have pain when you push on it. There is probably bleeding into their abdomen.
The Patient’s abdomen feels tense and the patient seems to have pain when you push on it. There is probably bleeding into their abdomen.
The Patient’s abdomen feels tense and the patient seems to have pain when you push on it. There is probably bleeding into their abdomen.
The patient’s pelvis feels unstable and the patient seems to be in pain when you compressed the pelvis.
Good job remembering to document care. In the field, it would be important to record specific injuries and treatments provided. For this simulator, completing the documentation step is considered sufficient
When performing this assessment, it is critical to avoid rocking the pelvis or putting any strain on the pelvis. The action you performed only checks for evidence of pelvic pain or gross instability. When in doubt, you can liberally place a pelvic binder.
Massive Hemorrhage: Take Down Tourniquet from Right Upper Leg
Apply pressure to right leg
Place bandage on the right lower leg (deep wound)
Place bandage on the left leg amputation
Massive Hemorrhage: Place Tourniquet on Left Lower Thigh
Mark tourniquet on Left Lower Thigh
Exam: Assessment: Palpate Lower Left Abdomen
Exam: Assessment: Palpate Lower Right Abdomen
Exam: Assessment: Palpate Upper Left Abdomen
Exam: Assessment: Palpate Upper Right Abdomen
Exam: Assessment: Complete TCCC card
Patient disposition: Medical Evacuation
