What would you do?

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Ryan
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What would you do?

Post by Ryan » Mon Nov 19, 2012 8:23 am

I've posted this before, but upon analyzing the training scenarios I thought I might ask. What would you do?
http://www.specialoperations.com/Navy/S ... dicine.htm

Tactical Combat Casualty Care Objectives

Treat the casualty
Prevent additional casualties
Complete the mission

How People Die in Ground Combat

KIA 31% Penetrating Head Trauma
KIA 25% Surgically Uncorrectable Torso Trauma
KIA 10% Potentially Correctable Surgical Trauma
KIA 9% Exsanguination from Extremity Wounds
KIA 7% Mutilating Blast Trauma
KIA 5% Tension Pneumothorax
KIA 1% Airway Problems
DOW 12% (Mostly infections and complications of shock)

KIA: Killed in action
WIA: Wounded in action
DOW: Died of wounds

PREVENTABLE Causes of Death on the Battlefield

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

Phases of Care

Care Under Fire (CUF)
Tactical Field Care (TFC)
Combat Casualty Evacuation (CASEVAC) Care

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

Tactical Field Care

CPR should not be attempted on the battlefield for victims of blast or penetrating trauma who have no pulse, respirations, or other signs of life.
The nasopharyngeal (tube in the nose) airway is the airway of first choice for unconscious patients until the CASEVAC phase. Patients who are shot in the face may require a surgical airway.
Progressive, severe respiratory distress in the setting of unilateral blunt or penetrating chest trauma on the battlefield should result in a presumed diagnosis of tension pneumothorax and that side of the chest should be decompressed with a needle.
Casualties who have controlled bleeding without shock do not need emergent IV fluid resuscitation.
Casualties who have had bleeding that is now controlled but who are in shock should receive 1000cc of Hespan.
Casualties who have uncontrolled hemorrhage from penetrating wounds of the chest or abdomen should receive no IV fluid in the field.
An exception to rule number 6 above is that casualties who have uncontrolled hemorrhage from penetrating wounds of the chest or abdomen and develop decreased mental status should either receive 1000cc of Hespan or be fluid resuscitated to an end point of improved mentation.
Saline locks (plastic IV catheters without fluids attached) may be used instead of IVs if fluid resuscitation is not required (for IV antibiotics and morphine, if required).
Morphine is to be used IV (5 mg) instead of IM.
IV antibiotics should be used as soon as possible for patients with penetrating abdominal trauma, grossly contaminated wounds, massive soft tissue trauma, open fractures, or any patient in whom a long delay until definitive treatment is expected.
Casualties should not be completely undressed for a secondary survey in the field. Removal of clothing should be limited to that necessary to expose known or suspected wounds.

Battlefield Triage

Control life-threatening bleeding
Disarm casualties as required
Establish airways (unconscious or respiratory distress)
Treat tension pneumothorax
Treat shock
Pain control
IV antibiotics





SCENARIOS AS FOLLOWS:
Urban Warfare Scenario 1 – Fast Rope Casualty
16 man Ranger team – security element for building assault
70 foot fast rope insertion for building assault
One man misses rope and falls
Unconscious
Bleeding from mouth and ears
Taking fire from all directions from hostile crowds
Anticipated extraction by ground convoy in 30 minutes.

Urban Warfare Scenario 7 - Helo Hit by RPG Round
Hostile and well-armed (AK-47s, RPG) urban environment
Building assault to capture members of a hostile clan
In Blackhawk helicopter trying to cover helo crash site
Flying at 300 foot altitude
Left door gunner with 6 barrel M-134 minigun (4000 rpm)
Hit in hand by ground fire
Another crew member takes over mini-gun
RPG round impacts under right door gunner
Windshields all blown out
Smoke filling aircraft
Right minigun not functioning
Left minigun without a gunner and firing uncontrolled
Pilot
Transiently unconscious - now becoming alert
Co-pilot
Unconscious - lying forward on helo’s controls
Crew Member
Leg blown off
Lying in puddle of his own blood
Femoral bleeding

Tib/Fib Fracture on Parachute Insertion
Twelve man SF team
Interdiction operation for weapons convoy
Night parachute jump from a C-130
4-mile patrol over rocky terrain to the objective
Planned helicopter extract near target
One jumper sustains an open fracture of his left tibia and fibula on landing

Multiple Trauma from Parachute Collapse
16 man SEAL patrol
Interdiction operation on a weapons convoy
Night static line jump from C-130
4 mile patrol over rocky terrain to objective
Planned helicopter extraction near target
One jumper has canopy collapse 40 feet above the drop zone
Open facial fractures with blood and teeth in the oropharynx
Bilateral ankle fractures
Open angulated fracture of the left femur

Fatality from Parachute Malfunction
16 man SEAL patrol
Interdiction operation on a weapons convoy
Night static line jump from C-130
4 mile patrol over rocky terrain to objective
Planned helicopter extraction near target
One jumper has streamer
Obviously dead on DZ

Underwater Explosion on Ship Attack
Ship attack
Launch from PC 12 miles out
One hour transit in two Zodiacs
Seven swim pairs
Zodiacs get in to a mile from the harbor
Turtleback half mile, then purge and go on bag
Charge dropped in water at target ship
Swim buddy unconscious

CNS Oxygen Toxicity during Ship Attack
Ship attack
Launch from PC 12 miles out
One hour transit in two Zodiacs
Seven swim pairs
Zodiacs get in to a mile from the harbor
78 degree water - wet suits
Turtleback half-mile, then go on bag
Very clear, still night - transit depth 25 feet
Diver notes that buddy is disoriented and confused with arm twitching

Gunshot Wound prior to SEAL Delivery Vehicle Extraction
2 SEAL Delivery Vehicle operation
Insertion from Dry Deck Shelter with a two hour transit to beach
Target is a heavily defended harbor in a bay
43 degree water - divers wearing dry suits
Air temperature 35 degrees
Boats bottomed for across-the-beach radio beacon placement
One man shot in chest at the objective
- Hostile forces in pursuit

Underwater Explosion on Ship Attack (2)
Ship attack
Launch from PC 12 miles out
One hour transit in two Zodiacs
Seven swim pairs
Zodiacs get in to a mile from the harbor
Turtleback half mile, then purge and go on bag
Swim pair approaching target ship
Underwater explosion
Both swimmers experience ear pain without other symptoms

Chance Contact on Parachute Insertion
Twelve man SF team
Interdiction operation for weapons convoy
Night parachute jump from a C-130
4-mile patrol over rocky terrain to the objective
Planned helicopter extract near target
Chance contact with three hostiles at the drop zone
Contact results in two KIA and one prisoner
Prisoner is a 15 year-old boy who was not armed

Entebbe Raid – Tactical Problem Scenario
27 June 1976
Air France Flight 139 hijacked by 4 terrorists
Flown to Entebbe (Uganda)
106 hostages held in Old Terminal at airport
7 terrorists guarding hostages
100 Ugandan troops perimeter security
Sayeret Matkal rescue 4 July 1986
Exit from C-130 in Mercedes and 2 Land Rovers
Assault team dressed as Ugandan soldiers
Shot Ugandan sentry when challenged
Planned assaulted terminal through 3 doors
First door reached booby trapped – multiple casualties
What should second and third element leaders do?

What would you do?!

Also note such scenarios here:
http://www.naemt.org/Education/IGe%20TC ... -17-09.pdf
It's always good to do some scenario training - mental, physical or both. Even though a lot of what is learnt is very "hands-on", you have to be mentally balanced enough to be able to instantly come up with a good solution - and such scenario training is great to keep you above the water, to look into such and do it passionately will benefit your patient.

If you come across any other such "what would you do's", for example a picture of a wound - then send it!
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: What would you do?

Post by Ryan » Mon Nov 19, 2012 8:25 am

Ryan wrote: Urban Warfare Scenario 1 – Fast Rope Casualty
16 man Ranger team – security element for building assault
70 foot fast rope insertion for building assault
One man misses rope and falls
Unconscious
Bleeding from mouth and ears
Taking fire from all directions from hostile crowds
Anticipated extraction by ground convoy in 30 minutes.
Let's start with UW Scenario #1. What would you do?
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: 2789
Joined: Sun Apr 10, 2011 3:10 am
Contact:

Re: What would you do?

Post by Ryan » Wed Apr 03, 2013 2:05 am

I'll give this a shot.

Bleeding from ears suggests spinal injury so spinal immobilization is key. Manual or via spinal board depending on situation. This is going against common TCCC guidelines which negate any spinal immobilization, especially under fire, and advocate two-man drags even with such possible injuries. This is due to research dictating that most penetrating injuries, even to the neck, do not involve spinal injuries. You're obviously taking fire so priority is to get you and the casualty to cover. This is a compromise.

He's unconscious so possibly needs airway management. Check for breathing and airway. OPA to maintain. Bleeding from the mouth may suggest other injuries and the need for better airway management such as a crico. Delayed extraction means you need to weigh up whether you can stabilize the person and keep them alive until not only extraction time but with time to get the casualty to a hospital/surgery. Depends on internal injuries and known injury specifics he might not even survive the journey. The toughest decision then is what to do.
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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