Tier 3 Practice Pack 005

You are near the frontline while the rest of your team is engaged in a firefight. A casualty has just been dragged into your treatment area with no major interventions performed. The casualty has already been triaged for immediate care, and weapons and equipment have been removed.

Your team is providing security, leaving you as the only person available to treat the casualty.

You have equipment commonly found in a medic aid bag, including a unit of low titer O+ whole blood. Your task is to rapidly assess the casualty and perform all indicated TCCC Tier 3-level interventions.

Once you have completed all necessary care, select the appropriate disposition using your tablet to end the scenario.

Patient Communication

Patient: Hey, I am here to take care of you.
Response: Thank you.
Location: Head
Patient: Can you tell me your name?
Response: My name is Vitaliy.
Location: Head
Patient: What happened?
Response: I'm not sure, everyone was running so I ran too.
Location: Head
Patient: Are you hurting anywhere?
Response: My chest and abdomen hurt a lot
Location: Head
Patient: Does your throat hurt or feel tight?
Response: No. My throat feels normal.
Location: Head
Patient: Are you having a hard time breathing?
Response: No. I can breathe normally.
Location: Head
Patient: Does your chest hurt?
Response: Yes, my chest hurts, and its hard to breath
Location: Head
Patient: Did you pass out (lose consciousness)?
Response: No. I didn't pass out.
Location: Head
Patient: Do you have any numbness or weakness?
Response: I don't have any numbness or weakness.
Location: Head
Patient: Does your head hurt?
Response: No. My head feels normal.
Location: Head
Patient: Does your neck hurt?
Response: No. My neck feels normal.
Location: Head
Patient: Does your back hurt?
Response: It does not hurt along the bones in my back
Location: Head
Patient: Does your abdomen hurt?
Response: My abodmen hurts a lot
Location: Head
Patient: Do you have any allergies?
Response: I do not have any allergies.
Location: Head
Patient: Do you take any medications?
Response: I do not take any medications.
Location: Head
Patient: Do you have any medical problems?
Response: I do not have any medical problems.
Location: Head
Patient: Have you ever had any surgeries?
Response: I have never had a surgery.
Location: Head
Patient: When did you last eat or drink something?
Response: I had breakfast this morning.
Location: Head
Patient: Do you smoke, drink, or use recreational drugs?
Response: I don't do any of those.
Location: Head
Patient: Tell the patient what you are going to do.
Response: Thank you.
Location: Head

Audio Triggers

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.

Scoring Details

PPE: Blue Gloves (right side)
PPE: Blue Gloves (left side)
Blood Sweep (left lower thigh) (Left Leg Ampute)
Blood Sweep (right lower thigh) (Right Leg Ampute)
Blood Sweep (left upper arm) (Left Arm Ampute / Shrapnel Arm Left)
Blood Sweep (right upper arm) (Right Arm Ampute / Shrapnel Arm Right)
Blood Sweep (left arm) (Deep Wound Arm Left)
Blood Sweep (right arm) (Deep Wound Arm Right)
Blood Sweep (left lower leg) (Deep Wound Leg Left)
Blood Sweep (right lower leg) (Deep Wound Leg Right)
Blood Sweep (left upper thigh) (Left Leg Ampute / Shrapnel Leg Left)
Blood Sweep (right upper thigh) (Open Fracture / Open Fracture Blood / Shrapnel Leg Right)
Blood Sweep (right chest, front) (Gunshot Wound Chest Right)
Blood Sweep (left chest, front) (Gunshot Wound Chest Left)
Blood Sweep (right chest, back) (Gunshot Wound Back Right)
Blood Sweep (stomach) (Shrapnel)
Blood Sweep (groin)
Exam: Assessment: Remove the patient clothing around left arm
Exam: Assessment: Remove the patient's shirt
Exam: Assessment: Remove the patient clothing around left leg
Exam: Assessment: Remove the patient clothing around right leg
Massive Hemorrhage: Place Pelvic Binder
Exam: Ask patient
Perform sternal rub
Shoulder tap for response
Exam: Ask patient
Airway: Jaw thrust maneuver
Exam: Assesment: Place SPO2 pleuth
Exam: Assessment: Roll the patient over
Exam: Assessment: Roll the patient back
Exam: Assessment: Remove the patient clothing around left arm
Exam: Assessment: Remove the patient clothing around right arm
Exam: Assessment: Remove the patient clothing around left leg
Exam: Assessment: Remove the patient clothing around right leg
Exam: Assessment: Remove the patient's shirt
Exam: Assessment: Remove the patient's underpants
Exam: Assessment: Remove the patient clothing around left arm
Exam: Assessment: Remove the patient clothing around right arm
Exam: Assessment: Remove the patient clothing around left leg
Exam: Assessment: Remove the patient clothing around right leg
Exam: Assessment: Remove the patient's shirt
Exam: Assessment: Remove the patient's underpants
Breathing: Needle Decompression right side placement
Exam: Assessment: Check Carotid Pulse Right
Exam: Assessment: Check Carotid Pulse Left
Exam: Assesment: Check Radial Pulse Right
Exam: Assesment: Check Radial Pulse Left
Exam: Assesment: Check Femoral Pulse Right
Exam: Assesment: Check Femoral Pulse Left
Exam: Assesment: Check Pedial Pulse Right
Exam: Assesment: Check Pedial Pulse Left
Circulation: Place an IV line (right side)
Circulation: Place an IV line (left side)
Create intraosseous vascular access on left leg
Create intraosseous vascular access on right leg
Create intraosseous vascular access on left shoulder
Create intraosseous vascular access on right shoulder
Hypothermia Management: Place Blanket
Hypothermia Management: Put Back All Clothes
Perform sternal rub
Exam: Ask patient to move right leg
Exam: Ask patient to move left leg
Exam: Ask patient to move right arm
Exam: Ask patient to move left arm
Exam: Assesment: Check right pupil
Exam: Assesment: Check left pupil
Events: Medication Administration: Give Moxifloxacin 400mg
Events: Medication Administration: Give Ketamine 50mg
Events: Medication Administration: Give Acetaminophen 10 500mg
Events: Medication Administration: Give Tranexamic Acid 100mg/mL
Events: Medication Administration: Give Calcium Gluconate 100mg/mL
Send 9-liner
Exam: Assessment: Complete TCCC card
Patient disposition: Medical Evacuation

Scenario Details

Scenario Package
TCCC Tier 3 Practice Pack
Learner type
  • preshospital
Patient severity at start
Serious
Patient severity overall
Serious
Duration to complete
11-15 minutes
Scenario difficulty
Challenging
Environment
POI
Equipment
  • Non-Adherent Dressing
  • Duct Tape
  • Eye Guard
  • Intravenous cannula
  • ChestSealPackage
  • SAM splint
  • Combat Application Tourniquet
  • Cardiac electrodes
  • Trauma Shears
  • Decompression needle
  • Blanket
  • Nasopharyngeal airway
  • bandage
  • pressure bandage
  • hemostatic gauze
  • wound packing gauze
  • AlcoholWipe
  • Gloves box
  • PackingGauze
  • TriageTag_Any
  • BVM
  • FaceMaskBVM
  • MedicationPouch
  • Marker
  • JETT
  • Laryngeal mask airway
  • Oxygen saturation device
  • Stethoscope
  • Surgical scalpel
  • Pelvic Binder
  • Blood pressure cuff
  • Yankauer suction tip
  • Cricothyrotomy Tube
  • Intraosseous drill
  • Simple oxygen mask
  • Eldon Card
  • Vital Monitor
  • IV Holder
  • ETCO2
  • Penlight
  • Axial peripheral thermometer
  • BloodCollectionBag
  • Field Medical Card
  • Lubricant
  • Plastic Package
  • Sharps Container (small)
  • Hemostatic Injector
  • Fluid Warmer
  • Defibrillator
Available medications
Injury type
  • Abdominal internal bleeding
  • Jugular vein, left side
  • Jugular vein, right side
  • No translation found for 'TRAUMA_GunshotEntrancesWoundInBackRight' in VISUALIZATION
  • No translation found for 'TRAUMA_GunshotEntrancesWoundInChestRight' in VISUALIZATION
  • Tracheal shift to the right side
Pathologies
  • pneumothorax, open, right
  • internal hemorrhage, aorta
Scoring summary
  • PPE
  • M - Blood Sweep
  • M - Place Pelvic Binder
  • A - Assess LOC
  • A - Assess Airway
  • R - Assess O2
  • R - Exposure, Roll Patient
  • R - Exposure Remove Clothing
  • R - Treat Tension Pneumothorax
  • C - Check Pulse
  • C - Obtain Vascular Access
  • C - Blood Infusion
  • H - Hypothermia Management
  • H - Assess Neuro Response
  • PA - Administer Antibiotics
  • PA - Administer Painkiller
  • PA - Administer TXA
  • PA - Administer Calcium
  • 9 Line MIST Report
  • Documentation
  • Disposition