Page 147 - JSOM Fall 2019

the defect. If a vented chest seal is not available, use a b. Cover the burn area with dry, sterile dressings. For
nonvented chest seal. Monitor the casualty for respira- extensive burns, consider placing the casualty in the
tory distress. If it develops, you should suspect a tension Heat-Reflective Shell or Blizzard Survival Blanket
pneumothorax. Treat this by burping or temporarily from the Hypothermia Prevention Kit to both cover
removing the dressing. If that doesn’t relieve the respira- the burned areas and prevent hypothermia.
tory distress, refer to a medic. c. Refer any casualty with extensive or severe burns to a
6. Circulation medic as soon as possible.
a. Bleeding 11. Splint fractures and re-check pulses.
• Reassess every tourniquet that was applied earlier. 12. Hypothermia Prevention
Expose the wound and determine if the tourniquet a. Minimize casualty’s exposure to the elements. Keep
is controlling the bleeding. Any tourniquet that protective gear on or with the casualty if feasible.
was applied over the casualty’s uniform should be c. Apply the Ready-Heat Blanket from the Hypothermia
replaced by medical personnel with another tourni- Prevention and Management Kit (HPMK) to the ca-
quet applied directly to the skin 2–3 inches above the sualty’s torso (not directly on the skin) and cover the
wound, if possible. casualty with the Heat-Reflective Shell (HRS). ¶
• Ensure that bleeding is stopped. If there is no trau- d. If an HPMK is not available, use dry blankets, com-
matic amputation, check for pulses further out on forters, or anything that will retain heat and keep the
the limb than the tourniquet. If bleeding persists or a casualty dry.
distal pulse is still present, consider additional tight- 13. Communicate
ening of the tourniquet or the use of a second tour- a. Encourage and reassure the casualty.
niquet side-by-side with the first to eliminate both b. Explain to the casualty what you are doing to help
bleeding and the distal pulse. him/her.
• Expose and clearly mark all tourniquets with the c. Communicate with casualty clearing team/ship medi-
time of tourniquet application. Use a permanent cal authority as soon as possible and throughout casu-
marker to mark on the patient’s forehead. alty treatment as needed.
b. Hemorrhagic Shock 14. Cardiopulmonary resuscitation (CPR)
• Assess for hemorrhagic shock (altered mental status a. Resuscitation for victims of blast or penetrating
in the absence of brain injury and/or weak or absent trauma who have no pulse, no ventilations, and no
radial pulse). other signs of life will not be successful and should not
– If the casualty is not in shock: be attempted. In a maritime environment, with inte-
– No IV fluids are immediately necessary. gral Role 1 Sick-bay/medical personnel, this should be
– Fluids by mouth are permissible if the casualty is determined on a case by case/tactical basis.
conscious and can swallow. 15. Initiate transfer of casualty by the Casualty Clearing
– If the casualty is in shock or develops shock, re- Team(s) to ship sick-bay or Casualty Clearing Station.
fer to a medic.
7. Drowning/near drowning Basic Management Plan for Tactical Medical Care at Sea
a. Bring the patient out of water. (Phase 3)
b. Place the patient so that the head and feet are at the 16. Repeat primary survey and carry out necessary
same level. interventions
c. Check Airway, Breathing, Circulation 17. Hypothermia Prevention
– If unconscious and not breathing, start CPR, be- b. Replace wet clothing with dry if possible. Get the casu-
gin with 5 rescue breaths, then continue with 30:2 alty onto an insulated surface as soon as possible.
(compressions:rescue breaths). Five breaths are 18. Penetrating Eye Trauma
used initially because water in the airways can in- a. If a penetrating eye injury is noted or suspected:
terfere with effective alveolar expansion initially. A • Cover the eye with a rigid eye shield (NOT a pressure
drowning patient with only respiratory arrest usu- patch.)
ally responds after a few rescue breaths. • Ensure that the 400mg moxifloxacin** tablet in the
– Cardiac arrest from drowning is due primarily to Combat Wound Medication Pack (CWMP) is taken
lack of oxygen. if the casualty can swallow. If she cannot, refer to a
d. Ventilation support with available tools medic for IV or IM antibiotics.
e. Prepare for vomiting: 65% of victims require rescue 19. Pain relief:
breathing vomit; 88% of those receiving chest com- a. For mild to moderate pain :
††
pressions will vomit. – Combat Wound Medication Pack:
f. Hypothermia is common in drownings; make sure re- – Tylenol – 650mg bilayer caplet, 2 PO every 8 hours
duced respiratory frequency is not mistaken for respi- – Meloxicam – 15mg PO once a day ‡‡
ratory arrest. 20. Antibiotics: recommended for all open combat wounds
8. Inspect and dress known wounds. a. If the casualty can swallow:
9. Check for additional wounds. – Moxifloxacin** (from the CWMP), 400mg by
10. Burns mouth once a day
a. Facial burns, especially those that occur in closed b. If the casualty cannot swallow (shock, unconsciousness):
spaces, may be associated with toxic or thermal injury – Ertapenem 1g IV/IM
to the airways or lungs. Aggressively monitor the ca- 21. Documentation of Care
sualty’s airway status and refer to a medic as soon as a. Document clinical assessments, treatments rendered,
possible. and changes in the casualty’s status on a TCCC Card

CoTCCC Meeting Minutes | 145