PART 2 Care Under Fire and IADs

1
PART 2Care Under Fire and IADs
2
GOOD MEDICINE CANSOMETIMES BE BAD TACTICS

• BAD TACTICS CAN GET EVERYONE KILLED.
• BAD TACTICS CAN CAUSE THE MISSION TO FAIL.
• Timing is Everything

3
The Tactical Context

• Incoming fire
• Darkness
• Environmental factors
• Casualty transportation problems
• Delays to definitive care
• Command decisions

4
Basic Logic

• Treat the casualty
• Prevent additional casualties
• Complete the mission

5
How People Die in Combat

• KIA 31 Penetrating Head Trauma
• KIA 25 Surgically Uncorrectable Torso Trauma
• KIA 10 Potentially Correctable Surgical Trauma
• KIA 9 Bleeding out from Extremity Wounds
• KIA 7 Mutilating Blast Trauma
• KIA 5 Tension Pneumothorax (Air in the
  chest)
• KIA 1 Airway Problems
• DOW12 (Mostly infections and complications of
  shock)
• You may be able to save these people

6
PREVENTABLE Causes of Death on the Battlefield

• Bleeding to death from extremity wounds (60)
• Tension pneumothorax (33)
• Airway obstruction (maxillofacial trauma) (6)

7
Care under Fire

• Return fire as directed or appropriate
• The casualty(s) should also continue to return
  fire if able.
• Try to keep yourself from getting shot
• Try to keep the casualty from sustaining
  additional wounds
• Stop any life-threatening hemorrhage with a
  tourniquet
• Take the casualty with you when you leave

8
What does returning fire have to do with medical
care?

• THE BEST MEDICINE ON THE BATTLEFIELD IS FIRE
  SUPERIORITY.
• The Toohey Amendment
• I also expect the casualties to continue to
  return fire as long as they are able to do so.
• CDR Pat
  Toohey, CO ST4
• The Potter Amendment
• The Best Medicine on the Battle field is lead
  down range

9
Control of hemorrhage

• Control of hemorrhage is the top priority.
  Exsanguination from extremity wounds is the
  number one cause of preventable death on the
  battlefield. Cause of death in more than 2500
  American casualties in Vietnam

10
Tourniquets

• Damage to the extremity is rare if the tourniquet
  is left in place less than an hour
• Tourniquets are often left in place for several
  hours during surgical procedures
• In the face of massive extremity hemorrhage, in
  any event, it is better to accept the small risk
  of ischemic damage to the limb than to lose a
  casualty to exsanguination
• Both the casualty and the corpsman/medic are in
  grave danger while a tourniquet is being applied
  during the Care under Fire phase, so non-life
  threatening bleeding should be ignored until the
  Tactical Field Care phase

11
Tourniquets

• The decision regarding the relative risk of
  further injury versus that of exsanguination must
  be made by the corpsman/medic rendering care
• If applied, the tourniquet should be applied as
  close to bleeding site as possible
• The time of application should be noted
• They should be removed when feasible.

12
General Albert Sidney Johnston

• General Johnston was one of the senior
  commanders in General Robert E. Lees army. His
  command surgeon, Dr. David Yandell, had directed
  that tourniquets be issued to the troops prior to
  the battle. During the battle, General Johnston
  sustained a fatal hemorrhage from a popliteal
  artery injury that presumably could have been
  controlled by a tourniquet. The General forgot
  that he had one available and bled to death with
  his tourniquet in his pocket. (Shiloh, 7 April
  1862)

13
What about Cardiopulmonary Resuscitation (CPR)

• No battlefield CPRfor patients whose heart
  stops after a battlefield injury
• 138 trauma patients with pre-hospital cardiac
  arrest in whom resuscitation was attempted
• No survivors
• Authors recommended no CPR in cardiac arrest due
  to trauma
• Rosemurgy et al. J
  Trauma 1993
• CPR performers may get killed
• Mission gets delayed
• Casualty stays dead

14
Immediate Action Drills (IADs)

• Remember the 6 CUF Rules
• Return fire as directed or appropriate
• The casualty(s) should also continue to return
  fire if able.
• Try to keep yourself from getting shot
• Try to keep the casualty from sustaining
  additional wounds
• Stop any life-threatening hemorrhage with a
  tourniquet
• Scoop and Run or Stay and Play

15
IADs

• Force Dominant vs Non-force Dominant
• Know before you go
• Keep it Simple
• Keep Control
• Its not Rocket Science

16
IADs

• Four areas
• Basic Skills
• GSW
• Blast Wound
• Eye Injury
• Each Station will have
• Admin Brief
• Walk Through
• IAD execution
• After Action Report

17
Tenants of TactMed IADs

• Determine force dominance
• Listen to the instructor
• Identify the injury as soon as tactically
  possible
• Relay status to higher
• Dont stop until the instructor tells you to

18
(No Transcript)
19
QUESTIONS?
20
Immediate Action Drills

• Report to Designated Area in 15 minutes, bring
  tactical gear