Tier 3 Practice Pack 013

This is the second patient who was dropped off from the van. The soldier helping him gives you a report. “This casualty was 2 to 3 meters away from the unmanned ground vehicle when it detonated. The blast threw him into the side of a vehicle. We think his side impacted the vehicle first, somewhere around his hips. When we first got to him, he was knocked out, but he started to wake up after a couple of minutes. His left arm was bleeding, so we put a tourniquet on it. He yelled in pain when we tried to get him up on his feet. He couldn’t stand or walk, so we had to take him on a litter. He has been holding his abdomen and hips. The explosion happened about 50 minutes ago.”

You have equipment commonly found in a medic aid bag, a radio to call for evacuation, and the blood bank just gave you a cooler of blood products. Your task is to assess the casualty and perform all indicated TCCC Tier 3-level interventions.

You are near the frontline while the rest of your team is engaged in a firefight. Your team is providing security, leaving you as the only person available to treat the casualty. The casualties’ weapons and equipment have been removed.

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: The patient is unable to speak
Location: Head
Patient: Can you tell me your name?
Response: The patient is unable to speak
Location: Head
Patient: What happened?
Response: The patient is unable to speak
Location: Head
Patient: Are you hurting anywhere?
Response: The patient is unable to speak
Location: Head
Patient: Does your throat hurt or feel tight?
Response: The patient is unable to speak
Location: Head
Patient: Are you having a hard time breathing?
Response: The patient is unable to speak
Location: Head
Patient: Does your chest hurt?
Response: The patient is unable to speak
Location: Head
Patient: Did you pass out (lose consciousness)?
Response: The patient is unable to speak
Location: Head
Patient: Do you have any numbness or weakness?
Response: The patient is unable to speak
Location: Head
Patient: Does your head hurt?
Response: The patient is unable to speak
Location: Head
Patient: Does your head hurt?
Response: The patient is unable to speak
Location: Head
Patient: Does your back hurt?
Response: The patient is unable to speak
Location: Head
Patient: Does your abdomen hurt?
Response: The patient is unable to speak
Location: Head
Patient: Do you have any allergies?
Response: The patient is unable to speak
Location: Head
Patient: Do you take any medications?
Response: The patient is unable to speak
Location: Head
Patient: Do you have any medical problems?
Response: The patient is unable to speak
Location: Head
Patient: Have you ever had any surgeries?
Response: The patient is unable to speak
Location: Head
Patient: When did you last eat or drink something?
Response: The patient is unable to speak
Location: Head
Patient: Do you smoke, drink, or use recreational drugs?
Response: The patient is unable to speak
Location: Head
Patient: Tell the patient what you are going to do.
Response: The patient is unable to speak
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 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: Ask patient
Shoulder tap for response
Perform sternal rub
Exam: Assesment: Place SPO2 pleuth
Exam: Assessment: Remove the patient's shirt
Exam: Assessment: Roll the patient over
Exam: Assessment: Roll the patient back
Place Chest Seal Front Right
Place Chest Seal Back Right
Exam: Assessment: Palpate Pelvis/Check Pelvis Stability
Airway: Ambu Bag to assist breathing
Attach BVM to Laryngeal mask airway
Attach BVM to ET Tube
Attach BVM to Cric tube
Attach BVM to Face mask
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
Hypothermia Management: Place Blanket
Hypothermia Management: Put Back All Clothes
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 Acetaminophen 10 500mg
Events: Medication Administration: Give Ketamine 50mg
Events: Medication Administration: Give Moxifloxacin 400mg
Exam: Assessment: Complete TCCC card
Send 9-liner
Patient disposition: Medical Evacuation

Scenario Details

Scenario Package
TCCC Tier 3 Practice Pack
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
  • Oxygen Balloon
  • ETCO2
  • Penlight
  • Axial peripheral thermometer
  • BloodCollectionBag
  • Field Medical Card
  • Lubricant
  • Plastic Package
  • Sharps Container (small)
  • Hemostatic Injector
  • Fluid Warmer
  • Defibrillator
Available medications
  • IV Ketamine 2mg/ml
  • IV Hypertonic Saline 3%
  • Acetaminophen 500 mg
  • Meloxicam 15 mg
  • Fentanyl Lollipop 800 mcg
  • Fentanyl 50 mg/ml
  • Ketamine 50 mg
  • Morphine 10 mg
  • Lidocaine 10 mg/ml
  • Ertapenem
  • Epinephrine 1 mg
  • Prednisone 10 mg
  • Diphenhydramine 50 mg/ml
  • Diphenhydramine Benadryl 25 mg
  • Dexamethasone 4mg/ml
  • Epinephrine Syringe 0.1 mg/ml
  • Esketamine 140 mg/ml
  • Tranexamic Acid 100 mg/ml
  • Ondansetron 2 mg/ml
  • Ondansetron Tablet 4 mg
  • Naloxone 4 mg
  • Naloxone Syringe 40 mg/ml
  • Cephalexin 500 mg
  • Ceftriaxone 100 mg/ml
  • Moxifloxacin 400 mg
  • Suzetrigine 50 mg
  • Doxycycline Hyclate 100 mg
  • Calcium Gluconate 100 mg/ml
  • Cefadroxil 500 mg
Available blood and fluids
  • Whole Blood O+
  • Red Blood Cells O+
  • Red Blood Cells O-
  • Red Blood Cells A-
  • Red Blood Cells B-
  • Red Blood Cells AB-
  • Red Blood Cells A+
  • Red Blood Cells B+
  • Red Blood Cells AB+
  • Fresh Frozen Plasma O+
  • Fresh Frozen Plasma O-
  • Fresh Frozen Plasma A-
  • Fresh Frozen Plasma B-
  • Fresh Frozen Plasma AB-
  • Fresh Frozen Plasma A+
  • Fresh Frozen Plasma B+
  • Fresh Frozen Plasma AB+
  • Platelets
  • Normal Saline 0.9%
  • Lactated Ringers
  • Dextrose 5%
  • Dextrose 10%
Injury type
  • Abdominal internal bleeding
Pathologies
  • pneumothorax, closed, right
Scoring summary
  • PPE
  • M - Blood Sweep
  • A - Assess LOC
  • R - Assess O2
  • R - Exposure Remove Clothing
  • R - Exposure, Roll Patient
  • R - Place Chest Seal
  • R - Assess Pelvis
  • R - Ambu/BVM
  • C - Check Pulse
  • H - Hypothermia Management
  • H - Assess Neuro Response
  • PA - Pain Management
  • PA - Administer Antibiotics
  • Documentation
  • 9 Line MIST Report
  • Disposition