020402 care under fire ig 110808

7/31/2019 020402 Care Under Fire IG 110808

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INSTRUCTORGUIDEFORCAREUNDERFIRE110808 1

CareUnderFire

ThefirstphaseofTCCCisCareUnderFire.

Objectives

DESCRIBEtheroleoffirepowersupremacyinthepreventionofcombattrauma.

DEMONSTRATEtechniquesthatcanbe

usedtoquicklymovecasualtiestocover

whiletheunitisengagedinafirefight.

EXPLAINtherationaleforearlyuseofa

tourniquettocontrollifethreatening

extremitybleedingduringCareUnderFire.

Readtext

Objectives

DEMONSTRATEtheappropriate

applicationoftheCATtothearmandleg.

EXPLAINwhyimmobilizationofthe

cervicalspineisnotacriticalneedin

combatcasualtieswithpenetratingtrauma

totheneck.

Readtext

NotethatCATreferstoaCombat

ApplicationTourniquet


2/34


CareUnderFireGuidelines

1.Returnfireandtakecover.

2.Directorexpectcasualtytoremain

engagedasacombatantifappropriate.

3.Directcasualtytomovetocoverand

applyselfaidifable.

4.Trytokeepthecasualtyfromsustaining

additionalwounds.

ReadtheCUFguidelines.


5.Casualtiesshouldbeextricatedfrom

burningvehiclesorbuildingsandmovedto

relativesafety.Dowhatisnecessarytostoptheburningprocess.

6.Airwaymanagementisgenerallybest

deferreduntiltheTacticalFieldCarephase.

ReadtheCUFGuidelines


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7.Stoplifethreateningexternalhemorrhage

iftacticallyfeasible:

Directcasualtytocontrolhemorrhageby

selfaidifable.

UseaCoTCCCrecommendedtourniquet

forhemorrhagethatisanatomically

amenabletotourniquetapplication.

Applythetourniquetproximaltothe

bleedingsite,overtheuniform,tighten,

andmovethecasualtytocover.

ReadCUFGuidelines

CareUnderFire

Prosecutingthemissionandcaringforthe

casualtiesmaybeindirectconflict.

WhatsbestforthecasualtymayNOTbewhatsbestforthemission.

Whenthereisconflictwhichtakes

precedence?

Scenariodependent

Considerthefollowingexample:

Inthehospital,thecasualtyISthemission.InTCCC,youhavethecasualtyANDthe

mission.

CaseStudiesinSpecialOperationsWarfare

TheoryandPractice

Letsexamineascenariofromthisbookby

ADMMcRaven.Thescenariosinthisbookare

allSpecialOps,butthePRINCIPLESdiscussed

applytoallcombatunits.


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RaidonEntebbe

byADMBillMcRaven

27June1976

AirFranceFlight139hijacked

FlowntoEntebbe(Uganda)

106hostagesheldinOldTerminalat

airport

7terroristsguardinghostages

100Ugandantroopsperimetersecurity

Israelicommandorescueplanned

Thisisoneofthemostfamoushostage

situationsinhistory.i

RaidonEntebbe

Rescue4July1976

ExitfromC130inaMercedesand2Land

RoverstomimicmodeoftravelofIdiAmin

theUgandandictatoratthetimeIsraelicommandosdressedasUgandan

soldiers

Droveuptotheterminalshotthe

Ugandansentry

Assaultedtheterminalthrough3doors

Thetacticsusedwereingenious:DECEPTION,SURPRISE,andVIOLENCE

Hereswhatthelayoutlookedlike.

BlackarrowsshowtheentrypathsoftheIsraeli

commandos.


5/34


RaidonEntebbe

LTCNetanyahuthegroundcommandershotinchestatthebeginningoftheassault

Whatshouldthecorpsmanormedicdo?

Disengagefromtheassault?

StartanIV?

Immediateneedledecompressionof

chest?

ImagineYOUarethecombatmediconthis

operation.

Whatwouldyoudonow?

(AskseveralpeopleintheaudiencewhatTHEY

woulddo.)

NotethatLTCNetanyahuwasthebrotherof

thefuturePrimeMinisterofIsrael.

Raidon

Entebbe

Aspreviouslyordered,thethreeassault

elementsdisregardedNetanyahuandstormedthebuilding.

Atthispointintheoperation,there

wasnttime

to

attend

to

the

wounded.

NOmedicalcareatthemoment.

Havetoestablishcontrolofthetactical

situationfirst.

Dosecondsreallymatterincombat?

LTCNetanyahudiedfromhiswounds.

Theassaultphaseoftheoperationtook90

seconds.

Didthe90secondtreatmentdelayaffecthis

chancesofsurvival?Probablynot.

Woulda90seconddelayincontinuingthe

assaultphaseoftheoperationhavemadeadifference?Absolutely.


6/34


MaalotRescueAttempt

byADMBillMcRaven

15May1974

3PLOterroriststake105hostages

Schoolchildrenandteachers

Whenassaultcommenced,terroristsbegan

killinghostages

22childrenkilled,56wounded

Thedifferencebetweenadramaticsuccess

andadisastermaybemeasuredinseconds.

Lookwhatevenamomentarydelaycanmean

toahostagerescueoperationOROTHER

TACTICALENGAGEMENTS.ii

CareUnderFire

Ifthefirefightisongoingdonttryto

treatyourcasualtyintheKillZone!

Suppressionofenemyfireandmoving

casualtiestocoverarethemajorconcerns.

Noteverycasualtyscenarioisahostagerescue,

butthesebasicprinciplesapply.

ImperativetogetyourcasualtyOfftheXand

behindcoverifyoucan.

CareUnderFire

Suppressionofhostilefirewillminimize

theriskofbothnewcasualtiesand

additionalinjuriestotheexistingcasualties.

Thefirepowercontributedbymedical

personnelandthecasualtiesthemselves

maybeessentialtotacticalfiresuperiority.

Thebestmedicineonthebattlefieldis

FireSuperiority.

Sustainingaminorwoundinafirefightdoes

notmeanthatyoushoulddisengagefromthe

fight.


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MovingCasualtiesinCUF

Ifacasualtyisabletomovetocover,heshoulddosotoavoidexposingothersto

enemyfire.

Ifcasualtyisunabletomoveand

unresponsive,thecasualtyislikelybeyond

helpandmovinghimwhileunderfiremay

notbeworththerisk.

Ifacasualtyisresponsivebutcantmove,a

rescueplanshouldbedevisediftactically

feasible.

Nextsequenceofslidesshowsthehazards

ofmovingcasualtiesbeforehostilefireis

suppressed.

UnitmembersshouldbeTRAINEDtomove

themselvestopointoffirstcoverifable.

Dontputtwopeopleatriskifitcanbeavoided.

1)Whileunderfireandwithoutaweapon,GunnerySgt.RyanP.ShanerunstoSgt.

LonnieWells,topullhimtosafetyduring

USMCcombatoperationsinFallujah.

Hereisadramaticexampleofcasualty

movementduringCareUnderFire.SGTWellshadsustainedafatalgunshotthroughhisleg,

whichseveredhisfemoralartery.Fromthe

momenthewashit,hewasunabletoconduct

selfaidanddidnotrespondtocallsfromhis

fellowMarines.

2)GunnerySgtShaneattemptstopulla

fatallywoundedSgtWellstocover.

Readtext


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3)AnotherMarinecomestohelp.ThethirdmanontheleftisHospitalCorpsman

JoelLambott,theplatoonsCorpsman.

4)Gunnery

Sgt.

Shane

(left)

is

hit

by

enemyfire.Readtext

5)GunnerySgtShane,ongroundatleft,

washitbyinsurgentsniperfire.

HMLambottwasstruckintheheeljustafter

GySgtShanewasinjured.Heprovidedlife

savingcaretoGySgtShane,directedhis

evacuation,anddressedhisowninjury.Hestayedwiththeplatoonandcontinuedhis

dutiesduringtheoperation.Inthisrescue

attempt,thefateofthefirstcasualtywas

unchangedandtwoadditionalcasualtieswere

sustainedbecauseeffectiveenemyfirewasnot

suppressed.


9/34


CasualtyMovement

RescuePlan

Ifyoumustmoveacasualtyunderfire,considerthefollowing:

Locationofnearestcover

Howbesttomovehimtothecover

Therisktotherescuers

Weightofcasualtyandrescuer

Distancetobecovered

Usesuppression

fire

and

smoke

to

best

advantage!

Recovercasualtysweaponsifpossible

DONTFORGETCOVERINGFIRE!

Ifpossible,letthecasualtyknowwhatyou

plan.

Considerdirectingavailablevehiclesto

moveintoapositiontoprovidecover.

TypesofCarries

forCareUnderFire

One

person

drag

with/without

lineTwopersondragwith/withoutline

SEALTeamThreeCarry

HawesCarry

Readtext

OnePersonDrag

Advantages:Noequipmentrequired

Onlyonerescuerexposedtofire

Disadvantages:RelativelyslowNotoptimalbodypositionfor

draggingthecasualty

(HaveotherInstructorsorstudents

demonstrate)


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TwoPersonDrag

Advantage:Getscasualtytocoverfasterthan

withonepersondrag

Disadvantage:Exposestworescuerstohostile

fireinsteadofone

(HaveotherInstructorsorstudents

demonstrate)

Video:TwoPersonDrag Clickonvideotoplay.

TwoPerson

DragUsingLines

Advantages:CanshootwhiledraggingFasterthandraggingwithoutlines

Fastermovementofthecasualtyto

cover

Disadvantage:Exposestworescuerstohostile

fireinsteadofone


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SEALTeamThreeCarry(1)

Advantages:Maybeusefulinsituations

wheredragsdonotworkwell

Lesspainfulforcasualtythandragging

Disadvantages:Exposestworescuerstohostile

fire.

Maybeslowerthandragging

Maybedifficultinkitandwithunconscious

casualty.

SEALTeamThreeCarry(2)

Casualtysarmsaroundshouldersofbothrescuers

Casualtyusesarmstoholdontorescuersif

able

Rescuersholdcasualtysarmsaroundnecksif

casualtynotableto

Bothrescuersgrabcasualtyswebbelt

Liftandgo


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HawesCarry

Technique:Rescuersquats;casualtysarms

aroundrescuersneck;rescuerliftswithlegs

Advantages:Onerescuer

Maybeusefulinsituationswhereadragis

notagoodoption

Worksmuchbetterthanoutdatedfiremans

carry

Disadvantages:Hardtoaccomplishwith

rescuerand/orcasualtyskitinplaceDifficultwhenrescuerissmallandcasualtyis

large

Oftenslowerthandragging

Highprofileforbothrescuerandcasualty

CarriesPractical

HowNOTtoDoIt.

ThisisagoodexampleofhowNOTtocarry

yourcasualty.

Forpracticalexercise:

Breakupintogroupsof6orlessstudentsper

instructor.

UseskillsheetsintheTCCCcurriculumthat

applytoeachpracticalexercise.

Practiceallofthecarriescovered.


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BurnPreventioninCUF

RemovecasualtyfromburningvehiclesorstructuresASAPandmovetocover.

Stopburningwithanynonflammable

fluidsreadilyaccessible,bysmothering,or

byrollingontheground.

Ifflammableliquidslikepetroleumproducts

causeafireonthecasualtysclothingthatyou

cantputout,thenyoullhavetocutthe

burninggarmentsoff.

BurnPreventioninCUF

WearfireretardantNomexglovesand

uniform!

Flameresistantclothingcanprotectyoufrom

burninjuries.Yourunitneedstheseclothingitemsifyou

donthavethemalready.

TheNumberOne

MedicalPriorityinCUF

Earlycontrol

of

severe

hemorrhage

is

critical.

Extremityhemorrhageisthefrequent

causeofpreventablebattlefielddeaths.

Over2500deathsoccurredinVietnam

secondarytohemorrhagefromextremity

wounds.

Injurytoamajorvesselcanquicklyleadtoshockanddeath.

Onlylifethreateningbleedingwarrants

interventionduringCareUnderFire.

IfyoucanonlydoONEthingforthecasualty

stophimfrombleedingtodeath.

DonottreatminorbleedingduringCareUnder

Fire.


14/34


Question

Howlongdoesittaketobleedtodeathfromacompletefemoralarteryandvein

disruption?

Answer:

Casualtieswithsuchaninjurycanbleedto

deathinaslittleas3minutes

10%ofanimalsinlabstudiesdiedwithin3

minuteswithouthemorrhagecontrolmeasures.

FemoralArtery

Bleeding

ThisisFEMORALARTERTYbleedinginapig.

Itdoesnottakelongtodiefromthis.

CareUnderFire

Theneed

for

immediate

access

to

atourniquetinsuchsituationsmakesit

clearthatallpersonneloncombat

missionsshouldhaveaCoTCCC

recommendedtourniquetreadily

availableatastandardlocationontheir

battlegearandbetrainedinitsuse.

Casualtiesshouldbeabletoeasilyand

quickly

reach

their

own

tourniquet.

DONOTburyyourtourniquetatthebottomof

yourpack.


15/34


CareUnderFire

Whereatourniquetcanbeapplied,itisthe

firstchoiceforcontroloflifethreatening

hemorrhageinCareUnderFire.

Forgetaboutdirectpressure,pressure

dressings,andanythingelseifyouhavesevereextremitybleedingintheCareUnderFire

phase.

Godirectlytoatourniquet.

APreventableDeath

Didnothaveaneffectivetourniquetapplied

bledtodeathfromalegwound

ThemedicinthisArmyunitwaskilledinthe

battleinwhichthissoldierwaswounded.

Othersintheunitattemptedtocontrolthe

bleedingfromthissoldierswoundjustbelow

hisleftknee.

Theseimprovisedtourniquetswereineffective,

andthesoldierbledtodeath.

DONTLETTHISHAPPENTOYOURBUDDIES!

TourniquetApplication

Applywithoutdelayifindicated.Boththecasualtyandthemedicarein

gravedangerwhileatourniquetisbeing

appliedinthisphasedontuse

tourniquetsforwoundswithonlyminor

bleeding.

Thedecisionregardingtherelativeriskof

furtherinjuryversusthatofbleedingto

deathmustbemadebythepersonrenderingcare.

Readtext


16/34


TourniquetApplication

NonlifethreateningbleedingshouldbeignoreduntiltheTacticalFieldCarephase.

Applythetourniquetwithoutremovingthe

uniformmakesureitisclearlyproximal

tothebleedingsite.

Tightenuntilbleedingiscontrolled.

Mayneedasecondtourniquetappliedjust

abovethefirsttocontrolbleeding.

Dontputatourniquetdirectlyoverthekneeorelbow.

Dontputatourniquetdirectlyovera

holsteroracargopocketthatcontains

bulkyitems.

Herearesomekeypointsaboutapplyinga

tourniquet.

AnatomyofaCATTM

TheCombatApplicationTourniquetTM(CA

TTM)(PatentPending)isasmalland

lightweightonehandedtourniquetthatcan

completelyoccludearterialbloodflowinan

extremity.

TheCATTMusesaSelfAdheringBandanda

FrictionAdaptorBuckletofitawiderangeof

extremitiescombinedwithaonehandedwindlasssystem.Thewindlassusesafree

movinginternalbandtoprovidetrue

circumferentialpressuretoanextremity.The

windlassisthenlockedinplace;thisrequires

onlyonehand,withtheWindlassClipTM.TheC

ATTMalsohasaHookandLoopWindlass

StrapTMforfurthersecuringofthewindlass

duringpatienttransport.


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18/34


CATOneHandedApplication

toan

Arm

Step4:Twisttheroduntilthebleedinghas

stopped.


to

an

Arm

Step5:LocktherodinplaceintheWindlass

ClipTM.


to

an

Arm

Hemorrhageisnowcontrolled.


toanArm

Foraddedsecurity,andalwaysbefore

movingapatient,proceedtosecurethe

WindlassRodTMwiththeWindlassStrapTM.

Forsmallextremities,youwillalsosecurethe

SelfAdheringBandTMundertheWindlassStrapTM.


19/34



toanArm

Step6:AdheretheSelfAdheringBand

OvertheRodandcontinuearoundthe

extremityasfarasitwillgo.


toanArm

Step7:Securetherodandthebandwiththe

WindlassStrapTM.Graspthestrap,pullit

tight,andadhereittotheoppositehookon

theWindlassClipTM.


to

an

Arm

Thecasualtyisnowreadyfortransport.


toan

Arm

Clicktostartvideo.


20/34


CATTwoHandedApplication

toaLeg

Step1:RoutetheSelfAdheringBand

Aroundtheleg.Passthefreerunningendof

thebandthroughtheinsideslitofthe

frictionadaptorbuckle.


toaLeg

Step2:Passthebandthroughtheoutside

slitofthebuckle.


toaLeg

Step3:PulltheSelfAdheringBandtight

andsecurelyfastenthebandbackonitself.


toaLeg

Step4:Twisttheroduntilbrightred

bleedinghasstopped.


21/34



toaLeg

Step5:LocktherodinplaceintheWindlass

ClipTM.


toaLeg

Hemorrhageisnowcontrolled.


toaLeg

Step6:Securetherodwiththestrap.Grasp

theWindlassStrapTM,pullittight,and

adhereittotheoppositehookonthe

WindlassClipTM.


toaLeg

Thecasualtyisnowreadyfortransport


22/34


CA

T

Two

Handed

Application

toaLegClicktostartvideo.

OtherTourniquets

TheSOFTacticalTourniquet(SOFTT)

byTacticalMedicalSolutions,Inc.

TheSOFTTisalsorecommendedbyISRand

theCoTCCC.Itwasfoundtobe100%effective

instoppingarterialflowinarmsandlegsin

laboratorytesting.Anecdotalreportssaythe

SOFTTmaybemoreeffectivethantheCAT

inindividualswithlargelegs.Itisnotfieldedas

widelyastheCATatpresent,butfeedback

frommedicsregardingitsusehasbeengood.

(NOTE:InstructionalslidesfortheSOFTTmay

befoundattheendofthispresentation.)

OtherTourniquets

EmergencyandMilitaryTourniquet

(EMT)byDelfiMedicalInnovations,Inc.

TheEMTfromDelfiwasfoundtobeaseffective

astheCATintestingattheISR.Itwasfound

tobebetterthantheCATinreportsfrom

MilitaryTreatmentFacilitiesintheater.The

EMTisapneumaticdevice,however,andnot

wellsuitedforcarriagebycombatmedics

becauseonefragmentofshrapnelthroughit

willrenderituseless.


23/34


ImpactofTourniquetUse

KraghAnnalsofSurgery2009

IbnSinaHospital,Baghdad,2006

Tourniquetsaresavinglivesonthe

battlefield

Bettersurvivalwhentourniquetswere

applied

BEFOREcasualtieswentintoshock

31livessavedinthisstudybyapplying

tourniquetsprehospitalratherthanintheED

Estimated10002000livessavedinwar

todatebytourniquets(dataprovided

toArmySurgeonGeneral)

MostimportantapplytourniquetsASAPwhen

theyareneeded.

Survivalimprovedifshockprevented.

SafetyofTourniquetUse

KraghJournalofTrauma2008

CombatSupportHospitalinBaghdad

232patientswithtourniquetson309

limbs

CATwasbestfieldtourniquet

Noamputationscausedbytourniquetuse

Approximately3%transientnervepalsies

RememberatthestartoftheGWOT,wewere

stilllosingcasualtiestoextremityhemorrhage.Weredoingmuchbetternow.

Thisstudydocumented232LIVESSAVEDin

thisONEhospitalinaONEYEARperiod.

MINIMALcomplicationsfromtourniquetuse.

Examplesof

Extremity

Wounds

That

DoNOTNeedaTourniquet

UseatourniquetONLY

forseverebleeding!

Neitherwoundislifethreateningbleedingisminimal.

Atourniquetshouldnotbeusedonthesetwo

woundsorotherwoundslikethemwherethe

bleedingisnotsevere.


24/34


TourniquetMistakes

toAvoid!

Notusingonewhenyoushould

Usingatourniquetforminimalbleeding

Puttingitontooproximally

NottakingitoffwhenindicatedduringTFC

Takingitoffwhenthecasualtyisinshock

orhasonlyashorttransporttimetothe

hospital

Notmakingittightenoughthetourniquetshouldeliminatethedistalpulse

Notusingasecondtourniquetifneeded

Waitingtoolongtoputthetourniqueton

Periodicallylooseningthetourniquetto

allowbloodflowtotheinjuredextremity

Thesearecommonmistakesmadebyfirst

respondersapplyingtourniquets.

TourniquetPain

TourniquetsHURTwhenapplied

effectively

Doesnotnecessarilyindicateamistakein

application

Doesnotmeanyoushouldtakeitoff!

ManagepainperTCCCGuidelines

Itisexpectedthattourniquetapplicationwill

causesomepain,butitwillalsosaveyour

casualtyslife.

Questions?


25/34


TourniquetPractical

Forpracticals:

BreakupintosmallgroupsAbout6or7studentsperinstructor

UseskillsheetsintheTCCCcurriculumthatgo

witheachpractical

HemorrhageControl

Somewoundsarelocatedinplaceswherea

tourniquetcannotbeapplied,suchas:Neck

Axilla(armpit)

Groin

Theuseofahemostaticagent(e.g.,

CombatGauze)isgenerallynot

tacticallyfeasibleinCUFbecauseofthe

requirement

to

hold

direct

pressure

for

3minutes.

BUTthecasualtymaygettocoverandhold

directpressureoverhiswoundsaspartofself

aid.

AirwayWillCoverinTFC

Noimmediatemanagementoftheairway

isanticipatedwhileintheCareUnder

Firephase.

Donttaketimetoestablishanairway

whileunderfire.Deferairwaymanagementuntilyouhave

movedcasualtytocover.

Combatdeathsfromcompromisedairways

arerelativelyinfrequent.

IfcasualtyhasnoairwayintheCareUnder

Firephase,chancesforsurvivalareminimal.

WewilladdressairwayintheTacticalFieldCarephase.


26/34


CSpineStabilization

Penetrating

head

and

neck

injuries

do

notrequireCspinestabilization

Gunshotwounds(GSW),shrapnel

Inpenetratingtrauma,thespinalcordis

eitheralreadycompromisedorisin

relativelylessdangerthanwouldbethe

casewithblunttrauma.

InstudiesfromtheVietnamconflict,ofthose

casualtieswithpenetratingnecktrauma,only

1.4%wouldhavebenefitedfromCspinestabilization.

Cspinestabilizationtakes56minutesevenfor

experiencedmedicalproviders.

ThisistoomuchtimetospendintheCare

UnderFirePhaseonaninterventionthatisnot

proventobenecessary

CSpineStabilization

Blunttraumaisdifferent!

Neckorspineinjuriesduetofalls,fast

ropinginjuries,ormotorvehicle

accidentsmayrequireCspine

stabilization.

Applyonlyifthedangerofhostilefiredoes

notconstituteagreaterthreat.

DonotprovideCspinestabilizationifthe

dangerofhostilefireconstitutesagreater

threatinthejudgmentofthemedic.

Summaryof

Key

Points

Returnfireandtakecover!

Directorexpectcasualtytoremain

engagedasacombatantifappropriate.

Directcasualtytomovetocoverifable.

Trytokeepthecasualtyfromsustaining

additionalwounds.Getcasualtiesoutofburningvehiclesor

buildings.

Askquestionstocoverkeypoints


27/34


SummaryofKeyPoints

AirwaymanagementisgenerallybestdeferreduntiltheTacticalFieldCarephase.

Stoplifethreateningexternalhemorrhage

iftacticallyfeasible.

Useatourniquetforhemorrhagethatis

anatomicallyamenabletotourniquet

application.

Directcasualtytocontrolhemorrhageby

selfaidifable.

Askquestionstoemphasize

Questions?

ScenarioBasedPlanning

IfthebasicTCCCcombattrauma

managementplanforCareUnderFire

doesntworkforyourspecifictactical

situationthenitdoesntwork.

Scenariobasedplanningiscriticalfor

success.Incorporatelikelycasualtyscenariosinto

unitmissionplanning!

Thefollowingisoneexample.

TheTCCCguidelinesarenotarigidprotocol.

Nothingincombatis.

Thinkonyourfeet!


28/34


Convoy

IED

Scenario

Letstakeascenariocommonlyencounteredin

IraqandAfghanistan.ImprovisedExplosiveDevices(IEDs)areavery

commoncauseofinjuryinthesetwotheaters.

ConvoyIEDScenario

Yourelementisinafivevehicleconvoy

movingthroughasmallIraqivillage.CommanddetonatedIEDexplodesunder

secondvehicle.

Moderatesniperfire.

Restoftheconvoyissuppressingsniper

fire.

Readtextinactionsequence

ConvoyIEDScenario

Youareamedicinthedisabledvehicle.

Personnexttoyouhasbilateralmidthigh

amputations.

Heavyarterialbleedingfromtheleftstump.

Rightstumphasonlymildoozingofblood.


ConvoyIEDScenario

Casualtyisconsciousandinmoderatepain.

Vehicleisnotonfireandisrightsideup.

Youareuninjuredandabletoassist.



29/34


ConvoyIEDScenario

First

decision:Returnfireortreatcasualty?

Treatimmediatethreattolife

Why?

Restofconvoyprovidingsuppressive

fire

TreatmentiseffectiveandQUICK

Firstaction?

Tourniquetonstumpwitharterialbleed


Askindividualsinaudiencetoanswer

questions

ConvoyIEDScenario

Nextaction?

Tourniquetonsecondstump?

NotuntilTacticalFieldCarePhase

Notbleedingrightnow

Nextactions?

Dragcasualtyoutofvehicleandmovetobestcover

Returnfireifneeded

Communicateinfototeamleader


Askindividualsinaudiencetoanswer

questions

Questions?ThisistheendofCareUnderFire.Thescenario

willbecontinuedinTacticalFieldCare.

INSTRUCTOR GUIDE FOR CARE UNDER FIRE 110808 30


30/34


SOFTacticalTourniquet SomeunitsusetheSOFTacticalTourniquet.

Theseslideswilldemonstrateitsuse.

SOFTTOneHandedApplication

toanArm

Step1:Openthetourniquet,exposingthe

loopofwebbing.Grasptherunningendof

thewebbingnearthebuckle,andslidethe

tourniquetovertheinjuredextremity.


toanArm

Step2:Pullthewebbinguntilthetourniquet

istightaroundthelimb.


toanArm

Step3:Twistthewindlassuntilthebleeding

stops.



31/34



toanArm

Step4:Tosecurethewindlass,latcheither

ofitsnotchedendsintooneofthetriangular

ringsonthetourniquetbase.


toanArm

Step5:Tightenthesafetyscrewtoprevent

accidentallooseningofthetourniquetwhile

movingthecasualty.Thecasualtyisnow

readyfortransport.

SOFTTTwoHandedApplication

toaLeg

Step1:Removethewebbingfromthe

buckle.


toaLeg

Step2:Positionthetourniquetbaseonthe

injuredlimbabovethewound.Routethe

webbingaroundthelimb.



32/34



toaLeg

Step3:Routethewebbingthroughthe

buckleandpulluntilthetourniquetistight.


toaLeg

Step4:Tightenthewindlassuntilthe

bleedingstops.


toaLeg

Step5:Tosecurethewindlass,lockeitherof

itsnotchedendsintooneofthetriangular

ringsonthetourniquetbase.


toaLeg

Step6:Tightenthesafetyscrewtoprevent

accidentallooseningofthetourniquetwhile

movingthecasualty.Thecasualtyisnow

readyfortransport.


33/34



34/34


Ontheseconddayofthestandoff,aunitoftheGolaniBrigadestormedthebuilding.Duringthetakeover,thehostagetakers

killedthechildrenwithgrenadesandautomaticweapons.Ultimately,25hostages,including22children,werekilledand68

morewereinjured.

020402 care under fire ig 110808

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