Page 130 - JSOM Fall 2021

Treatment Phases TABLE 2 The LSP Code
Lesion/Injury
L1. Ventilatory compromise
L2. Nonpenetrating trauma
L
L3. Low-risk penetrating trauma
L4. High-risk penetrating trauma
L5. Neurological compromise
Subjective
S
Subjective evaluation by the NCVM system (Table 1)
Peligro “danger”
P1. No danger
P
P2. Low risk of danger
P3. High risk of danger
Red Zone
The first objective of the Red Team in the Red Zone is to keep with heavy armor. The team leader, usually a physician, an
itself safe from injury and keep the team members in a covered individual with rescue experience, or a medical specialist, was
position, able to observe the environment away from direct equipped with the radio and a flag to identify the team during
contact. The second objective is to analyze the environment the demonstration and thus be quickly identified to avoid be-
to avoid possible danger but be able to identify casualties and coming an accidental target. Four support members helped
determine the best route for extraction, treatment, and trans- with patient extraction, guarding from danger, or assisting
port. The Red Team maintains constant communication with with treatment.
the OC, which uses several ways to obtain information about
both the movement of possible danger in the scene and the Red Team equipment included, as basic equipment, hard flak
location of the other teams, principally by radio or cellphone. jackets (not always ballistic), helmets (not always ballistic),
boots, gloves with cut protection, gas masks, a shield (for the
The third objective of the Red Team is to identify casualties guard team member), a radio (for the team leader), and a flag
that require immediate attention. This can be difficult in a sit- (for the team leader). Special equipment included combat appli-
uation of social commotion, where many of the participants cation tourniquets (CATs), needles for chest decompression, alu-
with non-life-threatening injuries may be reacting in panic. minum-magnesium hydroxide solution for CS gas (ie, tear gas)
For this reason, we needed a system to identify the casualties injuries, bandages, rescue lines for extraction, nasopharyng eal
requiring immediate extraction and medical attention. Thus, and oropharyngeal airways, adhesive, and chest seal patches.
the NVCM system was developed (Table 1). NCVM is the ac-
ronym for the subjective evaluation that can be carried out The formations during the operations were similar to those
from the cover position to identify casualties. used in close-quarter combat operations and selected accord-
ing to the scenario or situation (Figures 3–7).
TABLE 1 The NCVM System
FIGURE 3 Formations.
Neurological
N1. Patient has normal speech and is oriented.
N
N2. Patient is disoriented.
N3. Patient does not respond to external stimulation.
Circulation
C C1. Patient is without apparent hemorrhage.
C2. Patient is hemorrhaging.
Ventilation
V1. Patient appears to be uncompromised.
V V2. Patient coughs without difficulty breathing.
V3. Patient coughs with breathing difficulty.
V4. Patient is not breathing.
Mobility
M1. Patient can walk without help.
M
M2. Patient walks with help.
M3. Patient cannot move.
After a quick visual evaluation, it is important to evaluate the
environment surrounding the casualty to be aware of possible
danger and to determine the best routes for extraction.
Casualty extraction methods in the Red Zone
These techniques were also compiled from the military PHTLS
In communicating with the OC before the extraction opera-
tion, we used the LSP code (Table 2). guidelines and other rescue manuals. Their use depended on
the method of extraction.
The Red Team was typically formed by a group of six opera- • Simple one- or two-person drag: Grasp casualty by
tors, as follows. equipment, under the arms or jacket, with one or two
hands, and begin the drag.
The shield guard was usually the physically strongest member • Central axis one- or two-person drag: Grasp casualty
of the team, whose primary objective was to protect the team by the pants from behind with one or two hands and
from imminent danger and projectiles and who was equipped begin drag.

128 | JSOM Volume 21, Edition 3 / Fall 2021