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FC 1 2015
| Question | Answer |
|---|---|
| The first medical care a Soldier receives: WTBD, Self aid, Combat Medic, PA. Includes Immediate lifesaving measures, collection. And the organizations. | Role 1- BAS and Medical Platoon |
| Organizations operated by the area support squad and medical treatment platoon: ATLS, TCCC, Packed Red blood cells. Patient RTD within 72 hours. And the organization: | Role 2 - BSB, Area Support Medical Company, FST |
| The treatment in a MTF. Patient unable to tolerate and survive long distance movement: Resuscitation, Initial wound surgery, Damage control surgery, Post Op Treatment. And the Organization: | Role 3 - Combat Support Hospital |
| Medical care found in CONUS-based hospitals and other safe havens. Most definitive medical care in AHS. | Role 4 |
| Leading Cause of preventable battlefield death and what categories are they | hemorrhage 90.9% : Truncal 67.3%, junctional 19.2%, extremity 13.5% |
| Where on the body are majority of combat wounds suffered | Extremities 60% |
| The majority of combat related wounds are due to | penetrating trauma |
| Tactical Indications for spinal immobilization | MVC, Falls greater than 15 feet, IED blast with MRAP |
| Combat environment CPR consideration | hypothermia, near-drowning, electrocution, or patient was alive and lost vital signs enroute to MTF |
| Why is spinal immobilization limited on the battlefield | Very few 1.4% of penetrating head or next injuries require immobilization |
| Caused by the blast overpressure (or wave) from an explosive, Damage to hollow organs | Primary Blast Injury |
| Caused by debris or shrapnel from an explosion | Secondary Blast Injury |
| Caused when the casualty is blown into a solid object | Tertiary Blast Injury |
| Single most significant obstacle to ability to provide care | Enemy Fire |
| Who will decide if causalities will be evacuated | Tactical leader |
| What is The X | Point of wounding |
| What personnel resources may be available on the battlefield | Warrior Tasks and battle drills (WTBD), Combat Life Saver (CLS) |
| Pain Medications in the Combat Pill Pack | Acetaminophen (Tylenol) and Meloxicam (Mobic) |
| OTFC is given to what Casualty, dosage and route | Moderate to severe Pain. Not in shock or respiratory Distress or risk of developing, 800 ug, between cheek and gum |
| Ketamine is given to what Casualty | Moderate to severe pain. In hemorrhagic shock or respiratory distress and at risk of developing |
| Dose of Ketamine IM/IN and repeat dosage time | 50mg IM/IN every 30 min PRN |
| Dose of Ketamine Slow IV/IO | 20 mg slow IV/IO every 20 min PRN |
| Nystagmus | rhythmic back-and-forth movement of the eyes secondary to Ketamine |
| Alternate to OTFC if IV access has been obtained and dose | Morphine, 5 mg IV/IO |
| Used to reverse effects of opioids (morphine and fentanyl) | Naloxone (NARCAN) (0.4 mg IV/IM |
| Used for nausea or vomiting | Ondansetran (Zofran) |
| Antibiotics are recommended for | all penetrating combat wounds |
| By mouth antibiotic | Moxifloxacin |
| IV/IM antibiotics | Cefotetan and Ertapenem |
| Goals of Tactical Combat Casualty Care (TCCC) | 1) Complete the Mission 2) Prevent additional casualties 3) Treat the casualty |
| Phases of Tactical Combat Casualty Care (TCCC) | 1) Care Under Fire 2) Tactical Field Care 3) Tactical Evacuation Care |
| What is the treatment goal during Care Under Fire | treatment of obvious extremity bleeding with a hasty tourniquet |
| Medical Evacuation (MEDEVAC) encompasses | 1) Collecting the wounded 2) Sorting (triage) and prioritizing for evac 3) Providing an evacuation mode (transportation) 4) Perform emergency medical interventions and care |
| Difference between MEDEVAC and CASEVAC | MEDEVAC dedicated medical vehicles CASEVAC Nonmedical vehicles or vehicles of opportunity |
| Why is battlefield documentation important | part of Soldier's official and permanent record, records treatment and follows casualty |
| What is the DD Form 1380 | Tactical Combat Casualty Care (TCCC) Card |
| What can disrupt your ability to thoroughly document medical care provided? | Tactical environment and supplies |
| How do you write the Battle Roster # | First letter of first name, first letter of last name and last four of SSN |
| How do you mark the blocks of the DD1380 | Mark an "x" |
| What format do you write date and time on the DD1380 | DD-MMM-YY and 24 hour time (L) local or (Z) Zulu |
| Who signs the TCCC card (DD1380) | The first Responder |
| Who makes the determination to request medical evacuation | Senior military person present: Tactical Leader |
| When should the Combat medic notify the tactical leader for a needed medical evac | As soon as he identifies the need |
| What is over-classification | Tendency to classify a wound as more severe than it actually is |
| Emergency cases evac as soon as possible: Evac within 1 hour, save life limb or eyesight, avoid permanent disability | Urgent |
| casualties must receive far-forward surgical interventions: goal is to save life and stabilize for further evac, Evac within 1 hour | Urgent Surgical |
| Sick and wounded requiring prompt medical care: evac within 4 hours, pt could deteriorate to Urgent, requires special treatment, will suffer unnecessary pain or disability | Priority |
| sick or wounded whose condition is not expected to deteriorate significantly: evac within 24 hours | Routine |
| evac by medical vehicle is a matter of medical convenience rather than necessity | Convenience |
| Line 1 of 9 line medevac request | Location of pickup site (PZ): grid zone letters and grid coordinates |
| Line 2 of 9 line medevac request | Radio frequency, call sign and suffix |
| Where do you obtain radio frequency, call sign and suffix of signal operation instructions | Signal Operating Instruction (SOI), Automated Net Control Device (ANCD) or Radio and Telephone Operator (RTO) |
| Line 3 of 9 line medevac request | Number of Casualties by precedence A: Urgent (1 hour) B: Urgent-Surgical (1 hour to nearest surgical unit) C: Priority (within 4 hours) D: Routine (within 24 hours) E: Convenience (convenience rather than necessity) |
| Line 4 of 9 line medevac request | Special Equipment A: None B: Hoist C: Extrication equipment D: Ventilator |
| Line 5 of 9 line medevac request | Number of causalities by type L: (litter) + number of causalities A: (ambulatory) + number of causalities |
| Lines of medevac that change during peace time and war time | Lines 6 and 9 |
| Line 6 of 9 line medevac request during Wartime | Wartime- Security of pick up site N: No enemy troops in the area P: Possibly enemy troops in area E: Enemy troops in the area X: Enemy troops in area (armed escort required) |
| Line 6 of 9 line medevac request during peacetime | Peacetime- Number and type of wound, injury or illness Report serious bleeding and blood type |
| Line 7 of 9 line medevac request | Method of marking pickup site A: VS 17 Panels B: Pyrotechnic signal C: Smoke Signal D: None E: Other |
| Who identifies the color of the VS 17 Panels and/or the color of the smoke | The aircrew should identify and the unit should respond by verifying the color |
| Line 8 of 9 line medevac request | Casualty nationality and status A: US Military B: US Civilian C: Non-US Military D: Non-US Civilian E: Enemy Prisoner of War (EPW) |
| Lines of medevac that change during peace time and war time | Lines 6 and 9 |
| Line 9 of 9 line medevac request during wartime | Wartime- NBC Contamination (include when applicable, omit from report when not applicable N: Nuclear B: Biological C: Chemical |
| Provide opening statement of MEDEVAC request | I have a MEDEVAC request |
| 9 Line transmission time | 25 Seconds Maximum |
| What lines of 9 line must be transmitted first to allow evacuation until to begin mission | lines 1-5 |
| Whose call sign and radio frequency is provided in Line 2 | call sign and frequency of the requesting unit, not the relaying unit |
| True or False: When on the "x" the rescuer is at their greatest vulnerability and must maintain situational awareness. | True |
| What are the proper body mechanics for lifting patients | Know physical limitations, Use leg muscles, keep back straight, Slide or roll rather than life |
| Type of rescue with no hindrances to removing casualties (open fields, vehicles, structures | Simple |
| Type of rescue involving vehicle extrication (door, hatches, window, hasty stabilization), structure ingress and egress (vertical movement) and Tactical Search and Rescue (collapsed buildings) | Complex |
| How does fight or flight affect ability to complete mission and job | as heart rate increases your fine motor skills will disappear and you must rely on gross muscle movement |
| Ways to reduce friction between the casualty and the ground | Reduce the body surface contact points with a medium |
| Why is it important to create a space of 2-3 feet between the rescuer and the casualty | to gain leverage and create counter balance, reduce chance of tripping over casualty |
| Difference between cover and concealment | Cover - stops bullets Concealment- hides you |
| Where is the litter squad leader located | casualty's right shoulder |
| Normally the casualty should be carried on the litter ________first, except when going up hill or upstairs. | feet |
| Manual drags are generally used for short distances of up to ____ meters | 50 |
| Manual carries are used to move a casualty a greater distance (from ____ to_____ meters) | 50 to 300 |
| The best carry for a moderate distance (50 to 300 meters) | Pack-Strap Carry |
| Best carry for a long distance (over 300 meters) | The two-man fore-and-aft carry |
| Combat medic responsibilities with ground Ambulance | 1) Responsible for Ambulance 2) Driver Maintenance 3) Navigation 4) Provide emergency care 5) Loading and unloading casualties 6) Messenger within medical channels |
| Capacity of M997 | 4 litters, 8 ambulatory or 2 litters and 4 ambulatory |
| Capacity of M113 Armored Personnel Carrier | 4 litters or 10 ambulatory or a combination of both |
| Capacity of Armored Medical Evacuation Vehicle | 4 litters and 8 ambulatory |
| Capacity of M1133 Stryker | 4 litters or 6 ambulatory or a combination of both |
| Capacity of MaxxPro MRAP | 2 litters or 3 ambulatory |
| Capacity of HAGA MRAP | 3 litters or 6 ambulatory |
| Reasons why litter casualties are normally loaded head first into ambulances | Less likely to get motion sickness, they experience less noise from doors opening and closing and there is less danger of injury from rear end collision |
| Loading sequence for four litter casualties | 1) Upper Right 2) Lower Right 3) Upper Left 4) Lower Left |
| True or False: The most seriously injured are loaded last so they will be the first to be off loaded | True |
| Who is responsible for delivery of the causalities to landing site | tactical commander who initiated the evacuation request |
| Who supervises the loading and positioning of the casualties aboard the helicopter | aeromedical evacuation personnel |
| Military Helicopters are designated by combination of letters and numbers e.g. UH-60 Name designator | (OH) Observation Helicopters (UH) Utility Helicopters (CH) Cargo/Transport Helicopters (AH) Attack Helicopters (MH) Spec Ops Helicopters |
| Capacity of UH-60 | Normal- 4 litter and 1 ambulatory Maximum- 6 litter and 1 ambulatory or 7 ambulatory |
| Three most common devices used by the hoist | 1) Stokes basket 2) Jungle Penetrator (JP) 3) S.K.E.D. litter |
| Which side of the Blackhawk can casualties be loaded | both sides simultaneously |
| Who makes the final decision regarding how many casualties may be safely loaded on helicopter | Pilot-in-command (PIC) |
| In care under fire what is tactical priority | gaining fire superiority |
| In care under fire what is medical priority | extremity hemorrhage control |
| A casualty is hypothermic when core body temperature falls below | 95 F |
| Clotting factors are usually not affected until the body temperature falls below | 93 F |
| In what phase of TCCC do you address airway concerns | Tactical Field Care |
| What is the advanced airway used in the combat environment | emergency cricothyroidotomy |
| What is the primary manual maneuver to open an airway in tactical field care | Head-tilt/chin-lift |
| In step 8 of CCA what lines must the medic provide to the tactical leader | lines 3,4, and 5 of the 9-line MEDEVAC |
| A systolic blood pressure above _______ is high enough to dislodge any blood clots | 93 mmHG |
| A present carotid pulse indicates a systolic blood pressure of at least | 60 mmHG |
| A present radial pulse indicates a systolic blood pressure of at least | 80 mmHG |
| A present femoral pulse indicates a systolic blood pressure of at least | 70 mmHG |
| Where 02 and CO2 exchange occurs | Capillaries |
| What is the first tool you would use to stop massive hemorrhage in TC3 | Tourniquets |
| How is deliberate tourniquet applied | 2-4 inches above the wound, on the skin not over a joint |
| How is a hasty tourniquet applied | High and tight over the clothing |
| Areas checked during blood sweep | Neck, axillary, inguinal and extremities |
| These carry oxygen to the tissues and provides the bloods red color | Red Blood cells |
| All tourniquets placed during care under fire are these types | Hasty Tourniquets |
| When should prevention of hypothermia begin | as soon as the casualty is identified |
| Bleeding cannot be compressed with direct pressure, wound packing, and pressure dressings: includes chest, abdomen and pelvis | Non-compressible hemorrhage |
| Typical adult can bleed up to ____ml into each side of the chest | 1500 ml for a total of 3000 ml |
| Typical adult can hemorrhage up to ____ liters of blood and IV fluid into the abdomen | 10 |
| Can be compressed with direct pressure, tourniquet's, wound packing and pressure dressing/bandages; includes arms, legs, axilla, groin and neck | Compressible hemorrhage |
| Typical adult can bleed up to ____ liter into 1 thigh | 1 |
| The hemostatic dressing of choice | Combat Gauze |
| TXA should be given within ____ hours of injury | 3 |
| Dose of TXA | 1 gm in 100 cc of IV solution (NS or LR) |
| 4 "P"s of wound packing | Peel, Push, Pile and pressure |
| Anchor points for Neck | under the axilla opposite of the wound |
| Anchor points for axillary wounds | over the opposite shoulder against the neck |
| Anchor points for inguinal wounds | the casualty's thigh, buttocks or belt |
| How do hemostatic agents work | they have chemical properties that stimulate clotting |
| Tourniquets should not be loosened if: | will arrive at surgical facility within 2 hours or tourniquet has been in place for longer than 6 hours |
| Tourniquet conversion reduces unnecessary damage to an extremity and should occur when | evac is delayed greater than 2 hours |
| Parts of the lower airway | Trachea, bronchi, bronchioles and lungs |
| Parts of the upper airway | Nasal and Oral cavity |
| Stimulation of this will lead to bradycardia and hypotension | The vagus nerve |
| When the body has increased levels of CO2 in the body the need to eliminate the CO2 stimulates and increases | Respirations |
| When you first reach an unconscious casualty, how should you open the airway | head tilt-chin lift |
| What are contraindications for an NPA | Maxillofacial trauma, exposed brain matter, CSF from the nose, mouth and ears |
| Indications for an NPA | Unconscious casualty with no respiratory distress or airway obstruction, an altered casualty with intact gag reflex |
| First step of circulation | Pack wounds not treatable with a tourniquet with combat gauze and hold pressure for three minutes and then apply a pressure bandage |
| Essential airway skills | Positioning, manual maneuvers, suction and NPA |
| What is the advanced airway used in the combat environment | emergency cricothyroidotomy |
| Where gas exchange takes place | Alveoli |
| Placement for NCD should not be medial to the nipple line to ensure the needle does not end up where | Cardiac Box |
| Membrane attached to the surface of the lung | visceral pleura |
| Membrane attached to the surface of the chest wall | Parietal pleura |
| The most commonly injured artery in combat | The superficial femoral artery (SFA) |
| What is main concern of pneumothorax | That it will turn into a tension pneumothorax |
| A watery fluid with proteins, other molecules and dissolved minerals. It constitutes half the blood volume and provides a fluid environment for other blood components | Plasma |
| Hemoptysis is | coughing up blood |
| How far should the tape extend on the improvised occlusive dressing | at least 2 inches beyond all edges of the wound |
| How many ribs does the human body have | 12 pairs, 10 attached to the sternum and two connected to the sternum by cartilage |
| Hematemesis is | bloody vomiting |
| How large a wound must be to be considered a sucking chest wound | 2/3 the size of the trachea |
| The cavity between the lungs that contains the heart and great vessels | mediastinum |
| abrupt drop in blood pressure, weak rapid pulse, cyanosis and chest pain are signs of | air embolism |
| acid base is directly related to | CO2 produced and CO2 eliminated |
| If you find entrance wound you always look for | exit wound |
| Subcutaneous emphysema is a sign of | exit wound |
| During inhalation does the diaphragm contract or relax | contract |
| A penetrating thoracic wound at the ______ intercostal space (level of the nipples) or lower should be assumed to be an abdominal injury as well as thoracic injury. | fourth |
| A penetrating abdominal wound above the level of __________ may be a thoracic injury | the umbilicus |
| Signs of progressive respiratory distress | increasing hypoxia, respiratory distress, hypotension |
| What is definitive treatment for a pneumothorax | Chest tube |
| _____ is a temporary (stop gap) intervention | NCD |
| Length and gauge of NCD | 14 gauge needle and catheter, 3.25 inches in length |
| Land mark for primary NCD | 2nd intercostal space (ICS) mid clavicular line (MCL) anterior chest, same side as injury, directly over the third rib |
| Alternate NCD site | 4th or 5th intercostal space at the Anterior Axillary Line (AAL) |
| Treatment for polytrauma casualty with no pulse or respirations during tactical field care | bilateral NCD |
| signs and symptoms of tension pneumothorax | JVD, cyanosis, progressive respiratory distress, anxiety, tracheal deviation |
| This occurs when the body suffers from shock and lactic acid build up in the tissue | Acidosis |
| Type of shock caused by increased stimulation of the vagus nerve causes vasodilation and hypotension and leads to dramatic fall in cardiac output | Psychogenic shock |
| Type of shock caused by the body's hypersensitive reaction to the antigen bronchospasm and vasodilation | Anaphylactic Shock |
| Type of shock when infection causes damage to the wall of the blood vessels, causing vasodilation and leakage of fluid from the capillaries into the interstitial space | Septic Shock |
| Type of shock caused by spinal cord injury interrupts the sympathetic nervous pathway` | Neurogenic shock |
| Type of shock that occurs when the vascular container enlarges without a proportional increase in the fluid volume | Distributive shock |
| When a patient is in shock, what is a sign of impending death | falling blood pressure |
| Fluid of choice for burn and dehydration casualties | Lactated Ringer's |
| Prehospital fluid of choice for combat trauma casualties suffering from hemorrhagic shock | Hextend |
| Preventive measures for phlebitis include | keep the infusion flowing at prescribed rate Select a large vein when using irritating drugs change tubing every 48 hours change solution and dressing every 24 hours Change IV site every 72 hours |
| What gauge needle catheter is recommended for IVs in combat casualties | 18 |
| True or False: A casualty with a radial pulse receives a direct line IV | False: Saline Lock. Only casualties without a radial pulse receive direct line IV |
| Occurs when too much intravenous fluid has been given and the clotting proteins, platelets and red blood cells have been "washed out" of the vascular space | hemodilution |
| This vein should be your first choice | Median cubital |
| Elevated blood pressure, distended neck veins, rapid breathing, shortness of breath, tachycardia and fluid intake is much greater than urinary output are indications of | circulatory overload |
| Factors that disrupt the process of clotting and promote coagulopathy (difficult clotting) | Hypothermia, acidosis, hemodilution, medications and blood pressure |
| Fluid used as a calorie replacement or when glucose is needed for a hypoglycemic patient | Dextrose and Water (D5W) |
| Intraosseus is indicated when | There is trauma to the extremities, for small children and after two unsuccessful IV attempts on a combat casualty with AMS and absent radial pulses |
| an accumulation of fluid in the tissue surrounding an IV needle site | infiltration |
| What is phlebitis | inflammation of vein wall |
| Second vein of choice | Cephalic vein |
| Third vein of choice | Basilic vein |
| A 10 gtts/ml drip set will require ____ drops to equal 1 ml | 10 |
| Corrective action for infiltration: | Stop infusion, remove needle, elevate extremity, apply warm compress, notify supervisor, document, restart another IV if directed |
| Characterized by redness and warmth at the IV site and along the vein | Phlebitis |
| Immediate treatment for an air embolism includes | Notify MO immediately, place Pt on left side with feet elevated (allows for pulmonary artery to absorb air bubbles), administer O2 |
| Pt complains of chills, fever, malaise. You see redness, swelling, tenderness, and a purulent drainage from an IV site. You also notice a sudden rise in the Pt's temperature and pule. You expect ______ | Infection (note* do not dispose of IV equipment in case a culture is required) |
| True/False - Changing IV tubing should coincide with the time the solution container will be changed | True |
| IV flow rate equation | (Volume to be infused in ml X Drops/ml of infusion set) / Total time of infusion in min |
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