These are the TEMS COTCCC Guidlines, I thought some would be interested. As an EMT/ 2nd year paramedic Student there's all ways more and better ways to learn!
1. Take hard cover
2. Determine if patient is alive or dead.
3. Direct patient to move to cover and apply self-aid if able and try to keep the patient from sustaining additional wounds.
4. Airway management is generally best deferred until the Tactical Field Care phase.
5. Stop life-threatening external hemorrhage, using appropriate PPE, if tactically feasible.
a. b. c.
Use Emergency Trauma Dressing. Use a tourniquet for hemorrhage that is anatomically amenable to tourniquet application. For hemorrhage that cannot be controlled with a tourniquet, apply hemostatic agent.
6. Communicate with the patient if possible in order to encourage and reassure.
7. Extract patient from unsafe area (to include using a soft litter as needed). ► Call for tactical evacuation (ground or air ambulance).
PHASE II
Determine level of responsiveness. a. Use emergency trauma dressing. b. Patients with an altered mental status should be disarmed immediately.
2.
Airway management a. Unconscious patient without airway obstruction:
• Chin lift or jaw thrust maneuver. • Nasopharyngeal airway. • Place patient in recovery position.
b. Patient with airway obstruction or impending airway obstruction: • Chin lift or jaw thrust maneuver. • Nasopharyngeal airway. • Place unconscious patient in recovery position.
• If previous measures are unsuccessful:
– – –
King tube or combitube. Endotracheal nasotracheal intubation or blind nasotracheal intubation Cricothyroidotomy (needle or surgical)Breathing
a. Consider tension pneumothorax and decompress with needle thoracostomy if patient has torso trauma and respiratory distress.
b. Sucking chest wounds should be treated by applying a chest seal or three-sided occlusive dressing during expiration, then monitoring for development of a tension pneumothora.
4.
Bleeding
a. Assess for unrecognized hemorrhage and control all sources of bleeding.
b. Assess for discontinuation of tourniquets once hemorrhage is definitively controlled by other means. Before releasing any tourniquet on a patient who has been resuscitated for hemorrhagic shock, ensure a positive response to resuscitation efforts (i.e., a peripheral pulse normal in character and normal mentation if there is no traumatic brain injury (TBI).
5. Intravenous (IV) access
a. Start an 18-gauge IV (or saline lock) if indicated. b. If resuscitation is required and IV access is not obtainable, use the intraosseous (IO) route.
6.
Fluid resuscitation
a.
Assess for hemorrhagic shock; altered mental status in the absence of head injury and weak or absent peripheral pulses are the best field indicators of shock.
• •
• •
If NOT in shock: – No IV fluids necessary – PO fluids permissible if conscious and can swallow If in shock: – Normal saline (500-mL IV bolus) – Repeat once after 15 minutes if still in shock – Titrate to systolic BP of 90–100 If in shock: – Elevate lower extremities
If a patient with traumatic brain injury (TBI) is unconscious and has no peripheral pulse, resuscitate to restore the radial pulse.
7. Prevention of hypothermia a. Minimize patient’s exposure to the elements. Keep protective gear on if feasible. b. Replace wet clothing with dry if possible. c. Apply Ready-Heat Blanket to torso. d. Wrap in Blizzard Rescue Blanket. e. Put Thermo-Lite Hypothermia Prevention System Cap on the patient’s head, under the helmet.
f. If above gear is not available, use dry blankets, poncho liners, sleeping bags, body bags, or anything that will retain heat and keep the patient dry.
8. Monitoring ► Consider Pulse oximetry if available as an adjunct to clinical monitoring.SecOndaRY eXaM a. Check for additional wounds or conditions. b. Inspect and dress known wounds.
10. Treat Other Conditions as Necessary
a. b. c. d.
Spinal immobilization. Use of Mark I Kit for nerve agent exposure. Use of EpiPen for anaphylactic reaction. Treat for burns.
11. Penetrating eye trauma a. If a penetrating eye injury is noted or suspected:
• Perform a rapid field test of visual acuity. • Cover the eye with a rigid eye shield (NOT a pressure patch).
12. Splint fractures and recheck pulse.
13.
Provide analgesia as needed.
a. b.
Able to fight: • Tylenol (650-mg bilayer caplet, 2 caplets) Unable to fight: • Obtain IV or IO access.
– Morphine sulfate (5–10 mg IV/IO) - - Repeat dose every 10 minutes as needed to control severe pain. - - Monitor for respiratory depression; have Naloxone available.
14. Cardiopulmonary resuscitation (CPR) and AED
► Resuscitation in the tactical environment for victims of blast or penetrating trauma who have no pulse or respirations should only be treated when resources and conditions allow.
15. Communicate with the patient if possible. ► Encourage, reassure, and explain care.
16. Documentation a. Document clinical assessments, treatments rendered, and changes in the patient’s status. b. Forward this information with the patient to the next level of care.
PHaSe iii – extraction, evacuation, and Transportation
17. Prepare patient for TacTical eVacUaTiOn a. Move packaged patient to site where evacuation is anticipated. b. Monitor airway, breathing, bleeding, and reevaluate the patient for shock.