Medical Technician Training

TCCC Course MEDICAL SYSTEM PROTOCOL CMS System



Protocol made by (Insert Name)

With the help of : (Insert Name)

7CMBG community Edited and approved by: 11-10-2014



Preface
This Document is to be a guideline for any medical personnel and TCCC train personnel within this unit. This guideline is specifically made for the CMS mod use with the unit. A similar guideline will be made for Xmed. Both guidelines will be made in French and English. For the past month, we train and used a mod build to react the physical injuries sustained during battle.

Medical And Biologie Basis
When somebody is being wounded,A little water drop the is green on the left corner gonna turn to red. The patient will say that he is wounded and he needs medical attention. The dedicated medical personnel on station will, with the OK of is leader, will move to attend the wounded.

Airway
way the air flow through (nose/mouth to lungs)

Breathing
the actual action of breathing

Circulation
circulation of blood in your system, the body is like a hydraulic system, loss blood you’ll lose pressure and you will pass out/die.

Pulse Concept
The pulse is a mean of analysis of the cardiac performance of the patient. The standard for a healthy human being is between 70 and 100. If the heart rate go under 50 and over 150 it’s dangerous for the patient.

Blood pressure
The blood pressure is the pressure of the circulating blood through the vein and artery of the body. The body contain a certain amount of CC of blood throughout the system. The blood pressure will be expressed as BP. The normal is 110/80. It’s consider critical if the systolic (first number) it drop lower than 60 and higher than 200.

The Hemorrhagic Shock Or The Triad Of Hemorrhage
I won’t enter in the depth of this triad but you can see it as the following diagram.



Casualty Collection Points
Purpose of a CCP:

Casualty Collection Point or Field Treatment Site is a location within a jurisdiction that is used for the assembly, triage (sorting), medical stabilization and subsequent evacuation of casualties. It may be used for the receipt of incoming medical resources (doctors, nurses, supplies, etc.). Preferably the site should include or be adjacent to an open area suitable for use as a helicopter pad.

Types of CCPs
“Rolling” CCP

The term rolling CCP is to describe a CCP that gonna move with the troop, for instance, having a medical truck with medical personnel at the moving HQ flowing the section that are moving toward the objective. It’s is made to keep the troop closer to help and then stabilization and evac possible.

“Fixed” CCP In the contrary a fix CCP is more like a clinic or a non moving medical facility which is not an hospital or an advance medical emplacement. By that i mean a little medical tent in an avance FOB or the clinic of a friendly afghan village. It is to serve as a fix place to stash medical supply and make a triage and stabilisation easier.



Casualty Loading Points
It is the emplacement were the evacuation mean; either a boat, a plane/chopper, or a land vehicle, will collect the casualty to bring it to the medical facility. The CLP can be a complete entity or mix with the CCP as a simple place.

Concept Of Triage
Classification:

Expectant: Patient that will die no matter what.

Critical: Patient that need to be in a surgical yard in the next hours

Delayed: Patient that need to be evac to an Hopital but the treatment can be delayed.

Minor:Patient that need only minor medical treatment. (routine check)



TCCC
Tactical Combat Casualty Care (TCCC) is intended to treat potentially preventable causes of death on the battlefield, but acknowledges that application of these treatments may place the provider and even the mission in jeopardy if performed at the wrong time. Therefore, TCCC classifies the tactical situation with respect to health care provision into 3 phases (care under fire, tactical field care and tactical evacuation) and only permits certain interventions to be performed in specific phases based on the danger to the provider and casualty.

The Three Phase Of Care
There are 3 objectives to TCCC: treat the casualty, prevent further casualties and complete the mission. These are united together under the guiding principle of “providing the right medicine at the right time,” which is divided into phases of care.

Care Under Fire
Care under fire (CUF) is a situation during active combat where both the casualty and the care provider are in danger from enemy fire, may or may not be behind adequate cover and may need to contribute to the firefight. It is commonly said that “the best battlefield medicine is fire superiority;” therefore, winning the firefight and establishing a secure cordon within which to operate is the primary objective during CUF. It is emphasized that only 2 medical treatments are appropriate during this phase: tourniquet use for massive hemorrhage and the recovery position for airway obstruction.

Tactical Field Care
Tactical field care is the care rendered once the casualty, the care provider and their unit are no longer under effective hostile fire. It also applies to situations in which an injury has occurred on a mission, but in which hostile fire has not yet been encountered. Equipment is limited to that carried by the care provider, casualty and their team. It is during this phase of care that the bulk of the TCCC interventions are performed.

Tactical Evac Care
Tactical evacuation care is care rendered during evacuation to a medical treatment facility, usually on a vehicle, aircraft or boat. This may include dedicated personnel and propositioned equipment on these platforms. In a hostile environment it is important to note that these phases are fluid; the first responders may find themselves in a situation where the phases are dynamic, and they must always be ready to adapt.

Thing To Do Prior To Go In The Field
First of all you will be require to bind your user action key 2 to a key of your preference. As a standard i use key h but it's up to you to chose one that fit you. Afterwards, your load out will be up to your section command or your pilot (for air crew). With CMS, for now, each medical action cost you on first aid kit, so it will be critical to have a lot and by that i mean a lot of first aid kit with you. The standard TCCC load out comprise this list of item all put inside a backpack:

Bag: Medical bag with appropriate camo

10x elastic bandage

12x morphine auto-injector

9x nasopharyngeal tube

9x oropharyngeal tube

10x Quick cloth

8x chest seal

2x saline (1000ml)

3x Saline (500ml)

24x Bandage basic

10x Epinephrine auto-injector

10x Atropine auto-injector

8x Tourniquet

At the beginning of each mission/training it will be important that TCCC qual personnel are loaded with the proper equipment.

During The Mission
Keep in mind that as a TCCC you are part of two group; one being your first occupation (either infantry or part of a flight crew) and your second being a medical personal. That mean that your primary objective is to fulfil your primary role. After that role is bin completed you can attend the wounded or if your chain of command order you to do so. Reaching your patient is the most critical part of the intervention because during that, you can assess rapidly the situation and know the status of the casualty just by one quick look. You will be able to see the number of patient that you have, You will be able to classifies your patient with the start method (see annex 1).

The MARCHE Protocol
It's an assessment or an order on which you cheque the patient. It go as follow:

Marche Protocol


 * Massive hemorrhage control (tourniquets and packing dressings)


 * Airway management (including surgical cricothyroidotomy for TACMED medics)


 * Respiratory management (occlusive dressings for open pneumothoraces and needle decompression for tension pneumothoraces)
 * Circulation (BIFT)
 * Bleeding control
 * Intravenous/intraosseous access
 * Fluid resuscitation (HSD as a volume expander)
 * Tourniquet assessment and removal
 * Hypothermia


 * Head injury


 * Eye injury
 * Everything else (M-PHAAT-D)
 * Monitoring
 * Pain
 * Head to toe
 * Address all wounds
 * Antibiotics
 * Tactical evacuation preparation
 * Documentation of care

HSD = hypertonic saline/dextran; TACMED = tactical medicine.

(an algorithm chart will be provided)

Photo:https://www.flickr.com/photos/eucom/5841731809/in/photostream/

9 LINER
Line 1. Location of the pick-up site.

Line 2. Radio frequency, call sign, and suffix.

Line 3. Number of patients by precedence:


 * A - Urgent


 * B - Urgent Surgical


 * C - Priority


 * D - Routine


 * E - Convenience

Line 4. Special equipment required:


 * A - None


 * B - Hoist


 * C - Extraction equipment


 * D - Ventilator

Line 5. Number of patients:


 * A - Litter


 * B - Ambulatory

Line 6. Security at pick-up site:


 * N - No enemy troops in area


 * P - Possible enemy troops in area (approach with caution)


 * E - Enemy troops in area (approach with caution)


 * X - Enemy troops in area (armed escort required)


 * In peacetime - number and types of wounds, injuries, and illnesses

Line 7. Method of marking pick-up site:


 * A - Panels


 * B - Pyrotechnic signal


 * C - Smoke signal


 * D - None


 * E - Other

Line 8. Patient nationality and status:


 * A - 7cmbg


 * B - CANADIAN CIV


 * C - NATO Military


 * D - Civilian


 * E - EPW

Line 9. NBC Contamination:


 * N - Nuclear


 * B - Biological


 * C - Chemical


 * In peacetime - terrain description of pick-up site

CMS UI
With CMS, for now, there just a part of this that we can do. First thing first, when you are close to your patient, press h, it will bring the medical menu:

Assessing The Patient
First thing you would want to cheque a quick assessment of the bleeding and where it's from. You will do so by clicking one by one the tab in Check Unit. Keep in mind that a wound bleeding will have to be patch in each place.

As a TCCC you are gonna be able to stabilize this patient and evacuate him to the medical facility the nearest.



When the patient is on the ground and the fight has been successfully won, if the section can spare a member or if there is multiple TCCC, you will be required to work as a team to maximize the chance of the patient to make it. The most experience TCCC will take over as the lead on a case. If at any moment a TACMED come on the field, the TACMED will take the lead keeping the TCCC as an help.

Patient Is Unconscious
First off, the lead will direct his partner on what he want him to do. You will have to press Check Unit to know the status of your patient. If the patient is bleeding it's gonna to first apply bandage or if the patient is in cardiac arrest (unconscious), to start CPR immediately. Small wound can be fixed with basic bandage, medium and large wound on chest ans head gonna be patch with elastic bandage and basic bandage. For medium to large wound on arm and leg, you will apply an combat application tourniquet (CAT) on the limb to stop the bleeding. The TCCC in lead is to take note on the status of the patient to build is intervention plan, keep in mind that this plan must be tough true in a couple sec to a minute in sever case. When all bleeding has been stopped, the lead TCCC will start an 1000ml iv fluid drip before eny medication can be given. The course of action for medication in case of cardiac arrest is: 1x epi auto injector, Cpr, then monitor if the cpr is successful then push epi till heartrate is back to good value. Then CasEvac to med facility for full treatment.

Patient Is Conscious But Bleeding
The first action is gonna be provided by the wounded itself. If he can't manage the bleeding he is gonna call for a TCCC to come fix him. The TCCC is gonna start patching the wound by prioritizing the wound (large to small). If the wound is severe (large and medium) a medical tech or a casevac should be call in tough the bleeding have to be stopped (medical tech with an ambulance is better than a casevac). Then if the patient bleeding is stopped, check the blood pressure and start an 500ml iv saline drip and manage pain with morphine. After morphine administration check bp and hr regularly.

Patient Is Conscious But Is Hurt
The TCCC will first check the patient for bleeding. if there is none and the personal in only in pain, the TCCC will administer only one dose of morphine to the patient and monitor the hr and bp periodically. If the pain doesn't subside, the TCCC will contact his IC to make contact with a medical tech for support.

Medication
The medication you will be asked to use gonna be the morphine, epinephrine and atropine.

Epinephrine
(Also known as adrenaline or adrenalin) is a hormone and a neurotransmitter. Epinephrine has many functions in the body, regulating heart rate, blood vessel and air passage diameters, and metabolic shifts; epinephrine release is a crucial component of the fight-or-flight response of the sympathetic nervous system.

Atropine
Is a naturally occurring tropane alkaloid extracted from deadly nightshade (Atropa belladonna), Jimson weed (Datura stramonium), mandrake (Mandragora officinarum) and other plants of the family Solanaceae. It is a secondary metabolite of these plants and serves as a drug with a wide variety of effects. In general, atropine counters the "rest and digest" activity of glands regulated by the parasympathetic nervous system. This occurs because atropine is a competitive antagonist of the muscarinic acetylcholine receptors (acetylcholine being the main neurotransmitter used by the parasympathetic nervous system). Atropine dilates the pupils, increased heart rate, and reduces salivation and other secretions.

Morphine
Is a potent opiate analgesic drug that is used to relieve severe pain. Morphine is primarily used to treat both acute and chronic severe pain.

Epinephrine: Will increase the BP and The HR

Atropine: Will lower the HR and the BP

Morphine: Will lower the pain but also loser the heart rate.

Source and Index
Index:

Book: PHTLS Manual

Internet:

http://en.wikipedia.org/wiki/Morphine

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3322653/

http://en.wikipedia.org/wiki/Atropine

http://en.wikipedia.org/wiki/Epinephrine