Page 92 - Journal of Special Operations Medicine - Spring 2015

the scenario selections were random, the simulated Figure 3 Tactical Combat Casualty Care Card grading criteria.
manikin casualties remained the same during the entire Field Instructions Points
study. For the study, trauma­lane data were stratified by
date, Wednesday versus Friday. 1. TQ Time Record the time of 0­1
tourniquet placement
For the purpose of this study, 12 manikins were prese­ 2. Human figure Mark the location of injuries 0­1
lected for use on the trauma lanes, each with a variety of 3. Time Record the time of baseline 0­1
simulated injuries. The manikins were assigned a roster vital signs
number that was spray­painted on the head in red with 4. AVPU Record the baseline level of 0­1
“A1,” “A2.” “A3.” “B1,” through “D3” (Figure 2). The consciousness
manikin roster numbers corresponded to the simulated 5. Pulse Record the baseline pulse 0­1
combat injuries reflected on an answer­key TCCC Card (as stated by staff)
maintained by the associate investigator. Upon comple­ Record the baseline resp rate 0­1
tion of each trauma lane, cards were gathered by the 6. Respirations (as stated by staff)
associate investigator and labeled at the top, front, and Record the baseline BP 0­1
back, with the manikin’s roster number for data analysis 7. Blood Pressure (as stated by staff)
by the principal investigator. Circle any airway 0­1
8. A:
interventions performed
Figure 2 Manikin with simulated injuries. Circle any breathing 0­1
9. B:
Sucking chest wound requiring chest seal, interventions performed
Scenario A1
cric & TQ Circle circulation 0­1
10. C:
Sucking chest wound requiring chest seal, interventions performed
Scenario A2
King LT & TQ Circle the fluid route 0­1
11. Fluid Route
Scenario A3 Sucking chest wound requiring NPA & TQ initiated
Scenario B1 Wounds requiring TQ & cric 12. Fluid Type Circle the fluid type and 0­1
Sucking chest wound requiring chest seal, amount administered
Scenario B2
King LT & TQ
Sucking chest wound requiring chest seal, was removed from each simulated casualty card and re­
Scenario B3
King LT & hemostatic agent placed with a fictitious name by TCMC staff.
Scenario C1 Wounds requiring TQ & NPA
Sucking chest wound requiring chest seal, Thirty­five minutes were afforded for each simulated pa­
Scenario C2 NPA & TQ tient’s treatment and documentation during the trauma
lane, as determined by the established TCMC program
Wounds requiring hemostatic/packing &
Scenario C3 of instruction. If requested by the student provider, the
NPA/OPA
instructor gave vital signs verbally during physical ex­
Scenario D1 Wounds requiring hemostatic/packing & cric
amination of the simulated casualty, as determined by
Scenario D2 Wounds requiring TQ & NPA/OPA the standardized grading key.
Sucking chest wound requiring chest seal,
Scenario D3
NPA/OPA & TQ During the 4­month study period of January through
Abbreviations: Cric, cricothyroidotomy; TQ, tourniquet; NPA, naso­ April 2013, 131 manikins were pulled from the trauma
pharyngeal airway; OPA, oropharyngeal airway. lanes and a total of 130 TCCC Cards collected, with a
minimum of 120 TCCC cards needed to establish valid­
A running total number of manikins pulled for the ity. After receiving the TCCC Card from the associate
trauma lane was also recorded to compare to the num­ investigator, the principal investigator graded the cards
ber of cards collected. Accuracy of the completed TCCC in accordance with the predetermined grading criteria.
Card was assessed by examining the various fields on These results were forwarded to the study statistician
the card and recording them on an Excel spreadsheet for further analysis.
(Microsoft Corp; www.microsoft.com) that listed points
in each row against the fields listed in a column (Fig­ Results
ure 3), with zero points being scored for an incomplete
or wrong answer within the field, and one point be­ There were 130 TCCC Cards collected from 131 mani­
ing scored for an accurate answer. A total of 12 fields kins. Data analysis demonstrated prehospital medical
were examined and a maximum of 12 points could be documentation compliance of 99.20% (130 cards per
obtained if the card were correctly completed. To safe­ 131 manikins) in the use of a TCCC Card, with the accu­
guard personal information, the first responder’s name racy of information being 83.33% (1,300 of 1,560 fields

82 Journal of Special Operations Medicine Volume 15, Edition 1/Spring 2015