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MSL 402, Lesson 02b: Unit Level Medical Operations

Unit Level Medical Operations

MSL 402, Lesson 02b: Unit Level Medical Operations Unit Level Medical Operations Revision Date: 30 November

MSL 402, Lesson 02b: Unit Level Medical Operations

Objectives

Evaluate a Casualty

Familiarize Cadets on 9 Line MEDEVAC Format

MSL 402, Lesson 02b: Unit Level Medical Operations Objectives  Evaluate a Casualty  Familiarize Cadets

MSL 402, Lesson 02b: Unit Level Medical Operations

Evaluating a Casualty

MSL 402, Lesson 02b: Unit Level Medical Operations Evaluating a Casualty Revision Date: 30 November 2012

MSL 402, Lesson 02b: Unit Level Medical Operations

Care Under Fire

  • Scene Assessment

    • Return fire as directed or required

    • Casualty should return fire if able

    • Keep yourself from getting shot

    • Prevent additional wounds to casualty

    • Maintain situational awareness!

MSL 402, Lesson 02b: Unit Level Medical Operations

Approaching the Casualty

  • Asses your situation

    • Small arms fire

    • Fire or explosive

devices

  • Chemical/Biologic al agents

  • Electrical hazards

  • Structural stability

MSL 402, Lesson 02b: Unit Level Medical Operations Approaching the Casualty  Asses your situation 

MSL 402, Lesson 02b: Unit Level Medical Operations

Approaching the Casualty

  • Determine best route of access to the

casualty and the best route of egress

  • Plan an evacuation route prior to

exposing yourself to hostile fire

  • How many people will it take to move the casualty

  • Will you need a litter

MSL 402, Lesson 02b: Unit Level Medical Operations

Approaching the Casualty

  • Your plan should be

    • move to cover and/or use a tourniquet

  • Request covering fire

MSL 402, Lesson 02b: Unit Level Medical Operations Approaching the Casualty  Your plan should be

MSL 402, Lesson 02b: Unit Level Medical Operations

Approach the Casualty

  • Do not expose yourself to enemy fire in order

to provide care.

  • Talk to the casualty while moving to him

  • Have a tourniquet ready

  • AVPU and general impressions can be obtained once behind cover A - Alert

V - responds to Verbal stimulus

P - responds to Painful stimulus U Unresponsive

MSL 402, Lesson 02b: Unit Level Medical Operations

Tactical Field Care

  • Primary Survey

    • - Airway

    • - Breathing

    • - Circulation

    • - Disability

    • - Expose/Environment

MSL 402, Lesson 02b: Unit Level Medical Operations

Reassess

  • Reassess any treatments that were done in

Care Under Fire

  • Tourniquets

  • If you see any massive hemorrhage

    • Tourniquets

MSL 402, Lesson 02b: Unit Level Medical Operations

Check for Responsiveness

  • Gently shake or tap the casualty on the shoulder and ask in a loud, but calm, voice: “Are you okay?”

    • A - Alert

    • V - responds to Verbal stimulus

    • P - responds to Painful stimulus

    • U Unresponsive

  • If conscious, ask where it hurts or where his body feels different than usual.

  • MSL 402, Lesson 02b: Unit Level Medical Operations

    Airway

    • Check for patent airway

    • Look for rise and fall of chest and abdomen

    • Listen for sounds of

    breathing

    • Feel for breath on the side

    of your face

    MSL 402, Lesson 02b: Unit Level Medical Operations Airway  Check for patent airway  Look

    MSL 402, Lesson 02b: Unit Level Medical Operations

    Breathing

    Check for breathing, respiratory rate/depth

    • APPROXIMATE RATE: Use the method of abnormal vs. normal rate. (i.e. <10 or >28). “Slow or Rapid”

    • RHYTHM: Regular vs. Irregular.

    • DEPTH: Shallow vs. Deep

    MSL 402, Lesson 02b: Unit Level Medical Operations

    Breathing

    • If the casualty has a penetrating chest wound, is not breathing and is not making any effort to breath, do not attempt to treat the injury

    • In a combat situation, if you find a casualty with no signs of life (no respiration and no pulse), do not continue first aid on the casualty

    MSL 402, Lesson 02b: Unit Level Medical Operations

    Circulation

    Check for pulse presence, quality, rate, and

    rhythm & skin capillary refill time, color,

    temperature, and moisture

    • Assess pulses

      • If the patient is alert - assess the radial pulse

      • If the patient has a decreased LOC - assess

    both the carotid and radial pulses simultaneously

    MSL 402, Lesson 02b: Unit Level Medical Operations

    Circulation

    • Check for and control remaining external hemorrhage using necessary means

    • Look for blood soaked clothes

    • Look for entry and exit wounds

    MSL 402, Lesson 02b: Unit Level Medical Operations

    Circulation

    • Establish baseline vitals

    • Assess pulses

      • Normal pulse (60-100)

      • Slow or fast pulse

  • Assess respiration

    • Is it to slow or to fast

  • MSL 402, Lesson 02b: Unit Level Medical Operations

    Circulation

    • Assessment of perfusion can be easily accomplished in three ways:

      • Capillary refill - < 2 seconds

      • Skin color : In light skinned patients color will be obvious, in dark skinned patients it is easiest to assess the mucous membranes of mouth or fingernail beds.

      • Skin temperature - Warm

    MSL 402, Lesson 02b: Unit Level Medical Operations

    Circulation

    • Assess blood pressure

      • CAROTID PULSE: BP is > 60.

    • FEMORAL PULSE: BP is > 70.

    • RADIAL PULSE: BP is > 80.

    • Initiate Fluid resuscitation as needed

      • IV Vs. IO

    MSL 402, Lesson 02b: Unit Level Medical Operations

    Disability

    • Check level of consciousness

      • Has the Patient status changed

      • Did he respond to fluid therapy

      • Is he getting worse

  • Splint any fractures

  • MSL 402, Lesson 02b: Unit Level Medical Operations

    Secondary Survey

    • Head to Toe evaluation “Where my hands go, my eyes follow”

    • Improve on your treatments

    • Reassess your ABC‟s Look, listen, and feel” See, don’t just look!

    Hear, don’t just listen!

    Feel, don’t just touch

    MSL 402, Lesson 02b: Unit Level Medical Operations

    Casualty Evacuation

    MSL 402, Lesson 02b: Unit Level Medical Operations Casualty Evacuation Revision Date: 30 November 2012 24

    MSL 402, Lesson 02b: Unit Level Medical Operations

    Introduction

    • Being able to evacuate casualties quickly and effectively will result in saving lives

    • Your knowledge and ability to perform casualty evacuations in multiple situations and terrain will increase the likelihood of your casualty's survival

    MSL 402, Lesson 02b: Unit Level Medical Operations

    Medical Evacuation Plan

    • Identify your medical evacuation requirements.

    • Who is part of the aid and litter teams?

      • Primary and Alternate

    • Where are your medics?

    • Where are the casualty collecting points located?

    • What are your evacuation request procedures and channels?

    MSL 402, Lesson 02b: Unit Level Medical Operations

    Medical Evacuation Plan

    • Where is the nearest aid station?

    • How will I get my casualties there?

      • Ground or Air

    • Identify routes, means and schedules (if any) of evacuation and responsibilities

    • Where are the clinics and hospitals?

      • How far away are they?

      • What can they do for the casualty?

    MSL 402, Lesson 02b: Unit Level Medical Operations

    Categories of Precedence

    • URGENT-PATIENT WHO SHOULD BE EVACUATED AS SOON AS POSSIBLE AND WITHIN TWO HOURS TO SAVE LIFE, LIMB, OR EYESIGHT.

    MSL 402, Lesson 02b: Unit Level Medical Operations Categories of Precedence  URGENT- PATIENT WHO SHOULD

    MSL 402, Lesson 02b: Unit Level Medical Operations

    Categories of Precedence

    • PRIORITY-PATIENT WHO SHOULD BE

    MOVED WITHIN FOUR HOURS OR HIS/HER CONDITION WILL DETERIORATE TO SUCH A DEGREE THAT HE WILL BECOME

    URGENT.

    • ROUTINE-PERSONNEL WHOSE CONDITION IS NOT EXPECTED TO WORSEN SIGNIFICANTLY AND WHO WILL REQUIRE EVACUATION IN THE NEXT 24 HOURS.

    MSL 402, Lesson 02b: Unit Level Medical Operations

    9-Line Request

    • Line 1 - Location of Pick up site (6 or 8 digit

    grid)

    • Line 2 Your call sign and frequency

    • Line 3 - Number of patients (by precedence)

      • A URGENT (1 HR. LOSS LIFE/LIMB/EYESIGHT)

      • B URGENT SURGICAL(SURG. INTERVENTION)

      • C PRIORITY

      • D ROUTINE

    MSL 402, Lesson 02b: Unit Level Medical Operations 9-Line Request  Line 1 - Location of

    MSL 402, Lesson 02b: Unit Level Medical Operations

    9-Line Request

    • Line 4 Special Equipment Needed

      • A NONE

      • B HOIST

      • C EXTRACTION EQUIP

      • D VENTILATOR

  • Line 5 Number of patients by type

    • (A) Ambulatory

    • (L) Litter

  • MSL 402, Lesson 02b: Unit Level Medical Operations 9-Line Request  Line 4 – Special Equipment

    MSL 402, Lesson 02b: Unit Level Medical Operations

    9-Line Request

    • LINE 6: SECURITY AT PICKUP SITE:

      • E ENEMY TROOPS IN AREA

      • N NO ENE. TROOPS

      • P POSSIBLE ENE. TROOPS

      • X ENE TROOPS IN AREA, ARMED ESCORT

    REQUIRED

    • LINE 7: METHOD OF MARKING PICKUP SITE:

      • A PANELS

      • C SMOKE

      • E OTHER

    B PYROTECHNICS D NONE

    IE, IR BUZZ SAW, NATO YOR T

    MSL 402, Lesson 02b: Unit Level Medical Operations

    9-Line Request

    • LINE 8: PATIENT NATIONALITY/STATUS:

      • A US MILITARY

      • C NON-US MILITARY

    B US CIVILIAN D NON-US CIVILIAN

    • Line 9 Terrain Description

      • Include details of terrain

    features in and around

    proposed landing site

    MSL 402, Lesson 02b: Unit Level Medical Operations

    Summary

    Evacuation is a critical, life-saving skill, It can only be allied effectively is it is planned for and practiced.

    MSL 402, Lesson 02b: Unit Level Medical Operations Summary Evacuation is a critical, life-saving skill, It

    MSL 402, Lesson 02b: Unit Level Medical Operations

    Collect and Record Information

    You are conducting a routine dismounted presence patrol with five other members of your squad. You are moving along the designated route that runs through an open field. While moving along the route, SPC Coffman sees a shiny object lying in a

    ditch. Without SGT Hill‟s authorization, he leaves the road to

    retrieve it. Suddenly, a loud explosion is heard. SPC Coffman

    has just stepped on an anti-personnel mine. His left leg is completely severed just inches above his ankle, SGT Hill

    receives a shrapnel wound across her face.

    A third soldier,

    PFC Fuel, receives shrapnel wounds across his upper body. All

    casualties are conscious and in pain. It‟s up to you to get these

    casualties evacuated.

    MSL 402, Lesson 02b: Unit Level Medical Operations

    Collect and Record Information

    You begin to collect information Call sign: A6B88 Frequency is: 53.80 MHz

    UTM Grid is: GF70296868

    Frequencies of your medical support unit are 49.90 MHz and 23.75 MHz

    MSL 402, Lesson 02b: Unit Level Medical Operations

    Collect and Record Information

    You begin to collect information

    Line 1 Location of pick up site

    GF70296868

    Line 2 Radio frequency, call sign, and suffix

    53.80, A6B88 Line 3 Patient Precedence Codes

    Urgent 1, Priority 2

    A1,C3

    MSL 402, Lesson 02b: Unit Level Medical Operations

    Collect and Record Information

    Line 4 Special equipment needed Hoist (B) Line 5 Patients by type Litter 1, Ambulance 2 (L1,A2)

    Line 6 Number and type of wound or illness

    • 1 Lower left severed foot,

    • 1 Face shrapnel wound,

    • 1 Upper right torso shrapnel wound

    All conscious, 1 B+ blood, 2 O+ blood

    MSL 402, Lesson 02b: Unit Level Medical Operations

    Collect and Record Information

    Line 7 Method of marking pick up site Smoke (C)

    Line 8 Patient nationality and status US Military 3 (A3)

    Line 9 Terrain description Open field to the east of a cliff along route red

    MSL 402, Lesson 02b: Unit Level Medical Operations

    Collect and Record Information

    Line 1 GF70296868 Line 2 53.80, A6B88 Line 3 A1, C2 Line 4 B Line 5 L1, A2

    Revision Date: 30 November 2012

    Line 6 (Peacetime) 1 B+blood: lower left foot severed; 2 O+blood: 1 face shrapnel wound, 1 upper

    right torso wound. All conscious. Line 7 C Line 8 A3

    Line 9 Open field to the east of a cliff along route red.

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    MSL 402, Lesson 02b: Unit Level Medical Operations

    Questions

    MSL 402, Lesson 02b: Unit Level Medical Operations Questions Revision Date: 30 November 2012 41

    Revision Date: 30 November 2012

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