Tactical Field Care is the care rendered by the first responder or combatant once no longer under effective hostile fire. It also applies to situations in which an injury has occurred, but there has been no hostile fire. Available medical equipment is still limited to that carried into the field by unit personnel. Time to evacuation to a medical treatment facility may vary considerably. Tactical field care allows more time and a little more safety, to provide further medical care.
But Remember – effective hostile fire could resume at any time.
After completing the Hemorrhage Control portion of Tactical Field Care, you will shift your focus to the casualty's airway and respirations. This module will show you how to evaluate the casualty’s respirations and perform a surgical airway, and/or treat an open pneumothorax or tension pneumothorax.
Note:
* If not treated promptly, tension pneumothorax may progress from respiratory distress to shock and traumatic cardiac arrest.
Notes:
* The NDC should be considered successful if:
* If the initial NDC fails to improve the casualty’s signs/symptoms from the suspected tension pneumothorax:
* If the initial NDC was successful, but symptoms later recur:
* If the second NDC is also not successful:
Tension pneumothorax is a very common cause of preventable death on the battlefield, yet it is easy to treat. It may occur with entry wounds in abdomen, shoulder, or neck. Blunt (motor vehicle accident) or penetrating trauma (such as a GSW) may also cause it.
If the casualty does not have a tension pneumothorax when you do your needle decompression, the needle won’t make it worse if there is no tension pneumothorax. If he DOES have a tension pneumothorax, you will save his life.
Tension pneumothorax is a common but easily treatable cause of preventable death on the battlefield. Diagnose and treat it aggressively! DO NOT MISS THIS INJURY!
Vented chest seals work reliably to prevent a tension pneumothorax in the presence of an open pneumothorax and an ongoing air leak from the lung, but non-vented chest seals do not.
Once the wound has been occluded with a dressing, air can no longer enter (or exit) the pleural space through the wound in the chest wall. The injured lung will remain partially collapsed, but the mechanics of respiration will be better. You have to be alert for the possible development of tension pneumothorax because air can still leak into the pleural space from the injured lung.
Place a vented chest seal on any open chest wounds.
Assess and aggressively treat any suspected pneumothorax.
Robert L. Mary, MD; Alan Frankfurt, MD, The Journal of Special Operations Medicine, J Spec Oper Med. 2012 Spring;12(1):17-23.
Historical review of modern military conflicts suggests that airway compromise accounts for 1-2 % of total combat fatalities. This study examines the specific intervention of pre-hospital cricothyrotomy (PC) in the military setting using the largest studies of civilian medics performing PC as historical controls The majority of patients who underwent PC died (66%). The largest group of survivors had gunshot wounds to the face and/or neck (38%) followed by explosion related injury to the face, neck and head (33%). Military medics have a 33% failure rate when performing this procedure compared to 15% for physicians and physician assistants. Minor complications occurred in 21 % of cases. The survival rate and complication rates are similar to previous civilian studies of medics performing PC. However, the failure rate for military medics is three to five times higher than comparable civilian studies.
Description with Key Points
An Analysis of Battlefield Cricothyrotomy in Iraq and Afghanistan
Military medics have a 33% failure rate when performing this procedure.
Historically, combat medics have often failed to get it right on the battlefield.
This is the most technically difficult procedure we ask medics, Corpsmen, and PJs to do.
Robert L. Mabry, MD; Matthew C. Nichols, DO; Drew C. Shiner, MD; Scotty Bolleter, BS, EMT-P; Alan Frankfurt, MD
Annals of Emergency Medicine, Ann Emerg Med. 2014 Jan;63(1):1-5.
The CricKey is a novel surgical cricothyroidotomy device combining the functions of a tracheal hook, stylet, dilator, and bougie incorporated with a Melker airway cannula. This study compares surgical cricothyroidotomy with standard open surgical versus Cric Key technique Participants included US Army combat medics credentialed at the emergency medical technician–basic level. After a brief anatomy review and demonstration, 15 military medics with minimal training performed in random order standard open surgical cricothyroidotomy and CricKey surgical cricothyroidotomy on cadavers. Compared with the standard open surgical cricothyroidotomy technique, military medics demonstrated faster insertion with the CricKey. First-pass success was notsignificantly different between the techniques.
Description with Key Points
A Comparison of Two Open Surgical Cricothyroidotomy Techniques by Military Medics Using a Cadaver Model
Medics were able to insert the CricKey in significantly less time (34 sec vs 65 sec.)
Though not statistically significant, there were three failures with the open surgical technique, and none with the CricKey.
Under test conditions, medics were faster and more successful using the CricKey technique compared to the open surgical technique.
COL H. Theodore Harcke, MC USA, COL H. Theodore Harcke, MC USA; LCDR Lisa A. Pearse, MC USN; COL Angela D. Levy, MC USA; John M. Getz, BS; CAPT Stephen R. Robinson, MC USN
Military Medicine, Vol. 172, December 2007
Advanced Trauma Life Support guidelines and combat casualty care doctrine recommend the use of needle thoracentesis (needle thoracostomy) for the emergency treatment of tension pneumothorax. Emergency situations require a reproducible, simple, and effective response for treatment of life-threatening pneumothorax. This study evaluated chest wall thickness in a forward-deployed tri-service population using a retrospective analysis of multidetector CT (MDCT)-assisted autopsies performed on combat casualties at the Armed Forces Institute of Pathology. If needle thoracentesis is attempted with an angiocatheter or needle of insufficient length, the procedure will fail. Recommended procedures for needle thoracentesis to relieve tension pneumothorax should be adapted to reflect use of an angiocatheter or needle of sufficient length. A 3.25 inch angiocatheter would have reached the pleural space in 99% of the cases in this series.
Description with Key Points
Chest Wall Thickness in Military Personnel: Implications for Needle Thoracentesis in Tension Pneumothorax:
Both lung function and heart function are impaired with a tension pneumothorax, causing respiratory distress and shock.
Treatment is to let the trapped air under pressure escape.
The recommended anatomic location to insert a needle thoracentesis catheter for emergency treatment of a pneumothorax is the second intercostal space at the midclavicular line.
When access to the second intercostals space midclavicular line is prevented by field conditions such as wound location, equipment, or position of the casualty, needle thoracentesis may need to be done at an adjacent location.
Several casualties died from needles being too short to get through the chest wall.
Previously used 2-inch needles were too short.
3.25 inch needles will get through the chest wall in 99% of individuals.
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