Page 19 - PJ MED OPS Handbook 8th Ed

3. PJ Patient Assessment and Treatment

Establish Situational Awareness

• Scene safety – enemy threat/smoke/fire/avalanche/ocean conditions, etc.
• Establish security – near/far perimeter set, ground element coordination, ropes, etc.
• BSI PPE
• Determine the Mechanism of Injury (MOI)
• Determine the # of patients (in case triage is necessary)
• Request additional help if necessary, determine availability of resources
• In general, time and tactics take precedence over medicine in combat or dangerous non-
combat rescues
• These decisions are based on experience and judgment as well as direction from the Team
Commander or Leader

Primary Assessment and Treatments
MARCH PAWS: A mnemonic device used to cover the vast majority of care required during tactical
field care and tactical evacuation. It covers the care for any trauma patient. Other than the M, it also
covers the care for most medical patients since it is just a variation on the ABCs.
MARCH is the primary survey.
SAMPLE history, vital signs and head to toe exam with PAWS treatments comprise the secondary
assessment/treatment.
Establish patient is conscious and say out loud: “I am a PJ; I’m here to help you. What is your
name?” (Determines LOC, basic orientation, security of airway, absence of profound shock or TBI)
Massive Hemorrhage – Visualize and feel (sweep) for life-threatening hemorrhage:
• All 4 extremities
• Then junctional sites (neck, axillae, groins)
• Then torso including back
• Treatments: Apply tourniquet, hemostatic gauze, pressure dressing, suture/staple, clamp,
direct pressure, junctional hemorrhage device, elevate limb
Airway – Look: mouth and neck
• Treatments: clear airway, chin lift/jaw thrust, recovery position, sit up and lean forward posi-
tion, NPA, supraglottic device, ET tube, cricothyroidotomy
Respirations – Place pulse oximeter
• Look: chest rise and fall, paradoxical motion, chest wall injuries
• Listen: if possible with stethoscope, each side at anterior axillary line
• Feel: chest wall: ribs and sternum for fractures or tenderness, subcutaneous air, holes or defects
• Treatments: apply vented chest seal to actively SUCKING chest wounds, needle decompres-
sion, BVM, O2, finger or tube thoracostomy

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