Page 139 - Journal of Special Operations Medicine - Summer 2014

unconscious, utilize positioning to open the airway via Medical Provider TLO 6.1.3: Seal penetrating thoracic
head tilt-chin lift or jaw thrust in the event of suspected wounds in the tactical setting
spinal injury; properly place NPA as indicated; place pa- ELOs:
tient into the recovery position; verify correct placement • Demonstrate the ability to select a properly sized occlu-
of the NPA and reassess as appropriate)
sive dressing
Medical Provider TLO 5.1.2: Establish a patent airway • Demonstrate the ability to prepare the site prior to ap-
plication of dressing.
ELOs: • Demonstrate the ability to place an occlusive dressing
• Demonstrate appropriate airway management given over the wound
patient and tactical conditions (e.g., Allow a conscious • Demonstrate the ability to replace protective equipment
patient to assume a position of comfort; if the patient is based on the operational situation
unconscious, utilize positioning to open the airway via • Describe the importance of reassessing the patient and
head tilt-chin lift or jaw thrust in the event of suspected monitoring for potential development of a subsequent
spinal injury; repeatedly reassess the need for suctioning tension pneumothorax.
of the upper airway; properly place NPA if indicated;
place patient into recovery position; properly place SGA Medical Provider TLO 6.1.4: Treatment of suspected ten-
if indicated; provide bag valve mask respirations; prop- sion pneumothorax in the tactical setting
erly place and secure ET tube if indicated; perform cri- ELOs:
cothyroidotomy if indicated; verify correct placement of • Demonstrate decompression at the site of the wound
adjunct and secure and reassess as appropriate) (i.e., “burping the occlusive dressing”)
• Demonstrate the ability to select proper equipment to
DOMAIN 6: Breathing perform a needle thoracostomy.
Competency 6.1: Identify and treat thoracic injuries and re- • Demonstrate the ability to perform needle decompression
spiratory distress • Describe the indications for bilateral decompression
Operator TLO 6.1.1: Identify the presence of respiratory • Demonstrate the ability to reassess patient status and re-
distress peat the procedure or consider other treatments if required
ELOs:
• Identify abnormal breathing (e.g., increased effort, ab- DOMAIN 7: Circulation
normal sounds) Competency 7.1: Recognition and treatment of shock.
• Identify inadequate breathing Operator TLO 7.1.1: Recognize the signs/symptoms of in-
adequate perfusion/shock.
Operator TLO 6.1.2 Seal penetrating thoracic wounds.
ELOs:
ELOs: • Identify at-risk mechanism of injury for shock
• Identify potential penetrating thoracic injuries • Recognize altered/absent peripheral pulse
• Demonstrate the selection of a properly sized occlusive • Recognize altered mental status
dressing • Describe the potential for internal bleeding and its as-
• Demonstrate preparation of the site prior to application sociated risks
of dressing
• Demonstrate placing an occlusive dressing over the Operator TLO 7.1.2: Discuss the differences in assessment
wound to prevent air entrance in the various phases of TCCC/TECC
Operator TLO 6.1.3: Identify suspected tension pneumothorax. ELOs:
• Perform a tactically correct assessment of circulation status
ELOs:
• Describe the signs and symptoms of a tension pneumothorax Operator TLO: 7.1.3 Demonstrate ability to provide initial
• Describe the treatment options for a tension pneumothorax treatment of hypoperfusion.
• Demonstrate decompression at the site of the wound ELOs:
(i.e., “burping the occlusive dressing”) • Identify and correct, if possible, the etiology of hypoperfusion
Medical Provider TLO 6.1.1: Demonstrate the ability to Medical Provider TLO 7.1.1: Demonstrate the ability to do
identify the presence of respiratory distress in the tactical setting both a basic and an advanced assessment of the adequacy of
ELOs: circulation (e.g., monitoring, physical exam)
• Demonstrate the ability to determine respiratory rate, ELOs:
depth, quality and symmetry in the tactical setting • Describe potential causes of shock
• Identify when it is tactically appropriate to use available • Perform tactically appropriate assessment of circulation
equipment for monitoring respiratory status status
Medical Provider TLO 6.1.2: Identify presence of thoracic • Identify signs and symptoms of hemodynamic compro-
injuries in the tactical setting. mise including changes in vital signs (where tactically
appropriate)
ELOs: • Apply tactically appropriate advanced monitoring tech-
• Describe when it is appropriate to evaluate a patient for niques (e.g., blood pressure, pulse oximetry)
thoracic injury based on the operational situation
• Demonstrate the methods for identifying thoracic injury
based on the operational situation (continues)

National Consensus for TEMS Training Programs 129