11

TRAUMA CASUALTY TRAUMA CASUALTY ASSESSMENTASSESSMENT

RIFLES LIFESAVERSRIFLES LIFESAVERS

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Tactical Combat Casualty CareTactical Combat Casualty Care

Care Under FireCare Under Fire– ““The best medicine on any battlefield is fire The best medicine on any battlefield is fire

superiority”superiority”– Minimal casualty assessmentMinimal casualty assessment– Immediate treatment of extremity hemorrhageImmediate treatment of extremity hemorrhage

Tactical Field CareTactical Field Care– Rapid trauma assessment and immediate treatment Rapid trauma assessment and immediate treatment

of life-threatening injuriesof life-threatening injuries– More detailed trauma assessment and stabilization of More detailed trauma assessment and stabilization of

non life-threatening injuriesnon life-threatening injuries

Casualty Evacuation CareCasualty Evacuation Care– Continual casualty assessmentContinual casualty assessment

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Scene AssessmentScene Assessment

Determine safety of Determine safety of scene scene

Determine Determine mechanism of injurymechanism of injury

Determine number of Determine number of casualtiescasualties

Request additional Request additional help if necessaryhelp if necessary

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Primary Assessment: ABCDEPrimary Assessment: ABCDE

Communicate verbally with casualty Communicate verbally with casualty – Helps establish immediate status of airway, Helps establish immediate status of airway,

breathing, circulation, and mental statusbreathing, circulation, and mental status

AirwayAirway

BreathingBreathing

CirculationCirculation

Disability (Neurologic status)Disability (Neurologic status)

ExposureExposure

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IMPORTANT!IMPORTANT!When life-threatening injuries are When life-threatening injuries are encountered during the primary encountered during the primary assessment, stop and perform the assessment, stop and perform the necessary necessary life-savinglife-saving procedureprocedure before before proceedingproceeding

Failure to do so may result in an otherwise Failure to do so may result in an otherwise preventable deathpreventable death

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AirwayAirwayAttention to manual Attention to manual stabilization of cervical stabilization of cervical spine if appropriatespine if appropriateAirway obstructions are Airway obstructions are often noisy (but not often noisy (but not always)always)Suspect airway problemsSuspect airway problems– UnconsciousUnconscious– Head, face, neck, Head, face, neck,

chest injurieschest injuriesOpen, clear, and maintain Open, clear, and maintain the airwaythe airway

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BreathingBreathing

Look, listen, and feelLook, listen, and feel

If chest injury and If chest injury and severe difficulty severe difficulty breathing, perform breathing, perform needle chest needle chest decompression to decompression to relieve tension relieve tension pneumothoraxpneumothorax

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CirculationCirculationLook for severe Look for severe external bleedingexternal bleedingSTOP THE STOP THE BLEEDING!BLEEDING!– Direct pressureDirect pressure– Pressure pointsPressure points– TourniquetTourniquet

Assess for internal Assess for internal bleedingbleeding– Check pulsesCheck pulses– Observe for shockObserve for shock

Initiate IV fluidsInitiate IV fluids

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Disability Disability (Neurologic Status)(Neurologic Status)

Level of consciousness using AVPU scaleLevel of consciousness using AVPU scale– Alert: Converses spontaneously and appropriatelyAlert: Converses spontaneously and appropriately– Verbal: Responds to verbal stimuliVerbal: Responds to verbal stimuli– Painful: Responds to painful stimuliPainful: Responds to painful stimuli– Unresponsive: Unresponsive to any stimuliUnresponsive: Unresponsive to any stimuli

Pupil sizePupil size– Pupils should be equal and constrict vigorously to Pupils should be equal and constrict vigorously to

light stimuluslight stimulus

Motor functionMotor function– Strength should be normal and equal in all extremitiesStrength should be normal and equal in all extremities

1010

ExposureExposureRemove clothing to Remove clothing to expose area of injuryexpose area of injuryDo not delay Do not delay resuscitation to resuscitation to expose injuriesexpose injuriesKeep casualty Keep casualty covered after covered after exposure to avoid exposure to avoid hypothermia due to hypothermia due to blood lossblood loss

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Conditions that Require Conditions that Require Immediate TransportImmediate Transport

Poor general Poor general conditioncondition

UnresponsiveUnresponsive

Responsive but does Responsive but does not follow commandsnot follow commands

Difficulty breathingDifficulty breathing

Uncontrolled Uncontrolled breathingbreathing

Severe painSevere pain

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Secondary Trauma AssessmentSecondary Trauma Assessment

Perform more Perform more detailed exam of body detailed exam of body areas with attention to areas with attention to DCAP-BTLSDCAP-BTLS

DeformitiesDeformities

ContusionsContusions

AbrasionsAbrasions

Penetrating injuriesPenetrating injuries

BurnsBurns

TendernessTenderness

LacerationsLacerations

SwellingSwelling

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Secondary Trauma Assessment: Secondary Trauma Assessment: Head to ToeHead to Toe

HeadHeadNeckNeck– Apply cervical collar if Apply cervical collar if

unconscious or midline unconscious or midline spinal tendernessspinal tenderness

ChestChestAbdomenAbdomenPelvisPelvisExtremitiesExtremitiesBackBack– Log roll casualty to Log roll casualty to

stabilize spinestabilize spine

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Prepare to EvacuatePrepare to Evacuate

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Questions?