Watch your step

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Watch your step

Postby AGR416 » Sun Nov 18, 2012 9:02 am

http://www.michaelyon-online.com/watch-your-step.htm

Video at bottom of link.

The video shows an ANA soldier step on an IED, and how the medics treat him; from the instant it happens until post evacuation.

Didn't see it posted anywhere else.
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Re: Watch your step

Postby Ryan » Sun Nov 18, 2012 10:02 am

That was intense. But as one user said, "21 minutes from point of injury to medevac. That is outstanding". Definitely agreed. Whether it's sub-acute or prolonged care - it's got to be learnt.

He checks for a response, notes bleeding around face. Facial injury, half his jaw missing including teeth with patches of wounding around the face. Calls they have a man-down. Patient wheezing. Finding it hard to breathe. He physically checks his throat. Looks like his buddy is throwing a TQ up LL. Cuts away excess upper clothing once TQ is on LL. Calls for a ventilator. The patient tries to move, the medic keeps him down. It looks like they were prepping for a cricothyroidotomy at one point. I like the way they have his face on the side, but slightly elevated off the mud - draining away whatever could clog up his airway. Calls that he has severe shrapnel wounds to his face, he is a single left leg amputee. Litter is prepped. Severe left forearm wound noted. TQ goes on upper LA. Confirms IED is cause. Gives symptom list. Calls for suction device. Full body check is carried out - starting with front and moving to back. Cut away his lower clothing whilst checking his lower body. Get him sat up-right and check the rest of his body as another person bandages over his LA and LL. "Don't touch, Hey, let's bandage his face". I love the way they're communicating together and remaining calm. Adrenaline pumping and still remaining calm, that's the way to go. They get the terp in to calm him down, stop him fighting. Trying to get IV in. Gets him on the litter to LZ. Passes vital information on to the heli crew. Evacuated.

Don't know if I've missed anything but - those guys did absolutely great. Couldn't of asked for anymore. :D Not to mention the dude getting blown off his feed from the blast then going to render aid. The rest of the team must of been providing all around defense and clearing out the LZ for possible AP/IED mines.

Amazing video. If you come across anymore, post them up! :)
CQB-TEAM Education and Motivation.

"Pragmatism over theory."
"Anyone with a weapon is just as deadly as the next person."
"Unopposed CQB is always a success, if you wanted you could moonwalk into the room holding a Pepsi."
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Re: Watch your step

Postby AGR416 » Sun Nov 18, 2012 11:35 am

I agree that they did a very good job, particularly at staying calm.

The few learning points from the vid, as I see them, are:

-Remove casualty from site of explosion as soon as possible, in case of secondaries etc. Safety first!
-If a pt is having trouble breathing while in the supine position, try letting him sit upright or whatever position the casualty prefers. Training issue; most casualties are treated while supine during training, and that's the way we like them :wink:
-Prevent hypothermia; they should have covered the pt up with a space blanket, poncho or other item to prevent a drop in temperature.

Other than that, good job.
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Re: Watch your step

Postby Ryan » Sat Nov 24, 2012 12:21 am

Yeah prevent hypothermia is a big deal after all the emergency action deteriorates - you can always fill in the blanks.
For example - EMERGENCY stop the blood loss. Blah. After it's all done and dusted you don't want to forget the basics.
Temperature is one of them. Record the vitals too, keeping examining your patient for changing symptoms.
Some symptoms are short term and pop up relatively quick, some are longer and expose themselves over a time period.

Some mini-cheat cards:
http://www.kwikpoint.com/images/pdfs/vrg_medevac.pdf
CQB-TEAM Education and Motivation.

"Pragmatism over theory."
"Anyone with a weapon is just as deadly as the next person."
"Unopposed CQB is always a success, if you wanted you could moonwalk into the room holding a Pepsi."
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Ryan
 
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Re: Watch your step

Postby Ryan » Fri Apr 26, 2013 1:48 am

AGR416 wrote:-Prevent hypothermia; they should have covered the pt up with a space blanket, poncho or other item to prevent a drop in temperature.


Here's a good read AGR from a PowerPoint called 'Trauma Triad' by Max Dodge, an NREMT-P Flight Medic.

"So, what is this Lethal Triad?

The trauma triad of death is a medical concept describing the combination of blood loss leading to hypothermia and acidosis which then leads to coagulopathy which prevents clotting and exacerbates hemorrhage.

This combination is commonly seen in patients who have sustained severe traumatic injuries and results in a significant rise in the mortality rate.
It is a vicious bloody cycle...

Core temperature is controlled by the hypothalamus. The human body maintains core temperature at about 37 degrees Centigrade. Depending on what literature you read, hypothermia starts at 36C. Shivering thermogenesis starts around 35C. Shivering generates heat but consumes more energy reserves. Substrates for this heat generation rely mostly on the metabolism of glucose at about 2-5X the basal rate. Shivering also increases consumption of oxygen, which we determined previously was not something we have in abundance.

43% of combat trauma patients come to role 2 & 3 facilities with core temperatures less than 36C. Normothermic patients have a 97.5% survival rate. Hypothermic patients have a >75% survival rate. Patients with a temperature of 33C or less had a 100% mortality rate.

Hypothermia spurs a catecholamine release, steroid release and release of tissue thromboplastin from the ischemic tissue. Coupled with peripheral vasocontriction from both the hypothermia and the compensatory effects of shock, the ground work is set for disseminated intravascular shock (DIC). Furthermore, the cold strongly inhibits the enzymatic reactions of the coagulation cascade making it nearly impossible for the body to naturally create blood clots and staunch major bleeding...

So how do we interrupt this death spiral?
Tourniquets should be placed as high as possible every time. Cinch them down with the buckle and tighten them until bleeding stops.

Wound packing and pressure need to be applied to bleeds tourniquets can’t touch. All the newfangled gauze in the world won’t help the medic who can’t pack a wound and hold good pressure for three minutes. Crewchiefs can help here!

Keep the patient warm! Prevent heat loss through wind and exposure.

Titrate appropriate fluids to blood pressure (peripheral pulses). Overload will kill."
CQB-TEAM Education and Motivation.

"Pragmatism over theory."
"Anyone with a weapon is just as deadly as the next person."
"Unopposed CQB is always a success, if you wanted you could moonwalk into the room holding a Pepsi."
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Ryan
 
Posts: 2759
Joined: Sun Apr 10, 2011 3:10 am

Re: Watch your step

Postby Breacher01 » Tue Nov 01, 2016 5:03 pm

Disregarding the warning will cause me not to get any sleep tonight.

How do you guys deal with this kind of footage, when you lived through the real thing several times?
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Re: Watch your step

Postby Ryan » Fri Nov 04, 2016 8:47 am

Breacher01 wrote:Disregarding the warning will cause me not to get any sleep tonight.

How do you guys deal with this kind of footage, when you lived through the real thing several times?


The whole vicarious suffering thing you have to get past otherwise it will drag you down.
Life is not some picture-perfect step-by-step process where you save everyone and nothing goes wrong. Life is quirky and full of surprises - and errors.

If you are struggling in those regards you should really talk to somebody. Really mate. Otherwise it gets to you over time. Once you're on the job, it's okay. You put it behind you and do the job... but once it's over. You only have time to think.
CQB-TEAM Education and Motivation.

"Pragmatism over theory."
"Anyone with a weapon is just as deadly as the next person."
"Unopposed CQB is always a success, if you wanted you could moonwalk into the room holding a Pepsi."
User avatar
Ryan
 
Posts: 2759
Joined: Sun Apr 10, 2011 3:10 am


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