When it comes to penetrating thoracic trauma, it is vital that you meticulously check the entire torso, from umbilicus to clavicle, including the axillae and any folds of skin.Īn open chest wound (sometimes called a “sucking chest wound”) will trap air in the chest, creating a pneumothorax. Maintaining an open airway is crucial, especially in mass casualty scenarios where those providing aid may have their attention split amongst multiple patients.īear in mind that patients with airway obstructions, or those who do not respond to basic measures, require advanced intervention by a trained medic ASAP! The recovery position maintains an open airway while also preventing aspiration from blood, vomitus, etc. Two airway interventions that can be performed by non-medical personnel with minimal training are insertion of a nasopharyngeal airway (NPA) or simply placing the patient in the recovery position. Unconscious patients may require an airway intervention. This is especially true for patients with maxillofacial injuries. Conscious patients should be allowed to assume a position of comfort that facilitates the passage of air. Once finished, re-examine the casualty and look for missed major bleeding, especially in critical areas such as the neck, armpits, and groin.Įvaluate the patient’s degree of consciousness by talking to them (this will also help evaluate their airway.) Confusion or nonsensical speech can be indicative of either a head injury or severe hemorrhagic shock.Īfter controlling massive hemorrhage, it is important to evaluate airway patency in the trauma patient. Make sure you train the entire MARCH mnemonic until it becomes second nature. But remember-training only to place tourniquets is simply not enough. When you see such signs, apply a tourniquet, positioning it high and tight on the injured limb. Massive hemorrhage must be assessed and addressed rapidly and thoroughly before moving on to the next step. More readily treated in the field, through the use of tourniquets, hemostatic gauze, pressure bandages, and junctional devices.More common than any other life-threatening emergency on the battlefield. ![]() TCCC dict ates that massive hemorrhage is the first treatment priority in battlefield trauma for several reasons, as it is: The real work of tactical field care begins with an assessment: In this blog, we will focus on the second phase-the Tactical Field Care (TFC) phase. Most additional interventions during this phase of care are similar to those performed during normal EMS operations. However, major emphasis is placed on the reassessment of interventions and hypothermia management. Tactical Evacuation Care (TACEVAC) phase: During this phase of care, an effort is made to move the casualty toward a definitive treatment facility.In this phase, assessment and treatment priorities focus on the preventable causes of death as defined by military medical evidence: Major Hemorrhage, Airway, Breathing/Respirations, Circulation, and Head & Hypothermia. Tactical Field Care (TFC) phase: This phase can be initiated once the threat has been addressed and/or the casualty is in a safe location.Care Under Fire (CUF) phase: Wherein the primary concern is any threat to life/safety in the form of enemy fire or environment, as well as utilizing tourniquets to manage massive hemorrhage. ![]() The evidence-based approach that motivated the Committee on Tactical Combat Casualty Care (CoTCCC) to adopt the M A R C H mnemonic has drastically changed that approach for the better.Īccording to the TCCC guidelines, there are three phases of care: The old school approach to trauma was: Airway, Breathing, Circulation (ABC). Tactical Combat Casualty Care (TCCC) revolutionized our approach to trauma by utilizing evidence-based medicine in replacing the antiquated ABCs with the MARCH mnemonic. If you are not familiar with MARCH, here is what you need to know. Stop the Bleed > MARCH Mnemonic and TCCC MARCH Mnemonic and TCCC Tactical Combat Casualty Care (TCCC) revolutionized our approach to trauma by utilizing evidence-based medicine in replacing the antiquated “ABCs” with the MARCH mnemonic.
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