Wound Care/Basic 1st Aid

[RngrDoc75]

The current TCCC Classes are always available on the PHTLS Website.
http://www.naemt.org/education/PHTLS/TCCC.aspx" onclick="window.open(this.href);return false;

The current (and future updates) guidelines for TCCC will be posted on PHTLS and on the Defense Health Board website. Posting will normally occur within 3-4 weeks of TCCC Committee vote and Defense Health Board endorsement.

http://www.health.mil/Pages/Page.aspx?ID=34" onclick="window.open(this.href);return false;


...and around '91, I was getting an occasional smoking by one each Doc Donovan and Greg Bromund.

[panthersix]

Biggest error we had to watch out for was guys going right for the bloody wounds without checking the airway. NEVER forget to check to see if they can breath or are breathing before jumping on the squirting blood...helps if there's two of ya pulling medic duty. The more experienced person on the airway and jr. person on the bleeders...

[RngrDoc75]

That's where good triage fits in the picture. Some techniques work whether in combat or in a mass casualty disaster.

"If you are hurt and can walk, come to where I am (or continue fighting)."
"If you are hurt and cannot walk, begin treating yourself and tell someone what is wrong with you"
-Anyone who does not move or answer are either dead or the first people to get triaged.


Most of the Ranger platoons are operating with 2 medics nowadays, so that does work out well.

The reality is airway is still accounting for less than 5% of combat injuries. The vast majority of those are with massive airway damage with entire mandibles missing or extensive neck wounds. Other airway management needs tend to be on guys with unresponsive massive multi-system trauma. But, all too often, if they can take a tube down their throat, then they are too far gone. The other thing re-learned over the last 8 years is that simple airway positioning can do a lot without tubes and crics.

Bleeding to death from extremities is still the #1 killer in the tactical setting for the Army at large. Regiment has lost no Rangers to bleeding to death from an extremity wound. Bleeding to death from a non-compressible, non-tourniquetable wound remains the problem we are trying to fix.

So, I'm not disagreeing with you. Understand that your point is see if he is even breathing or can breath. However, a guy can have all the air in the world, but still needs blood in him for it to be useful.

[panthersix]

I've been away from combat medicine for 30 years! So no problem on the corrective action above and the more detailed info, which is BTW very comprehensive and very useful. I'm sure I could learn a lot from you and/or any current line company Ranger Medic.

Most my experience was on a goat....and in the back of a medevac helo and was a long, long time ago.

Thank you for your dedication to combat medicine and your brother Rangers.

God bless you and yours!

[dbmtrman]

Do you know the instances that lives have been saved by products such as Quick clot? I've seen a couple demos with that stuff and it looks pretty good.

[fritzscorner]

The other thing re-learned over the last 8 years is that simple airway positioning can do a lot without tubes and crics.

To chime in on what Ranger Doc said. When I went through 68w school they stressed a lot on positioning of pt. They used the following picture, there is a lot of stories on the internet about this picture. What they told us at ft. Sam was that the guy put a blasting cap in his mouth. Regardless of what truely happened the point remains the same.




The picture is obviously of major facial trauma. Most would probably think to cric the pt right away, but simply sitting the pt up and forward he was able to keep airway on his own.

[dbmtrman]

I have seen this type of facial trauma in person. In 19 years of law enforcement, I have never seen anything as horrific.
about a year ago, I was working an off duty detail at a trauma center in my city, when we had an armed robbery gone bad at a Dunkin Donuts in our city. The animals robbed the store at 10pm at night, when there were only about 8 retirees inside having coffee after going to the movies. Not one person resisted and they all got down on the ground as ordered. After emptying the register and taking jewelry from some of the victims. One of the savages armed with a sawed off shotgun, put the muzzle to the mouths of two of the elderly men and pulled the trigger. As they fled out the front of the store they then shot another old man in the face, through the windshield of his car as he pulled into the lot. I heard the call over the radio and advised the hospital staff of what we had coming in. I was standing at the door to the trauma room when the rescue truck was backing up and the doors came open.

What I saw was unbelievable. Both guys were sitting up in the truck, conscious with the bottom half of their faces missing. I couldn't believe how tough these old guys were. They looked just like the guy in the picture above. One of them was actually talking to me a short time later, as I tried to get a description of the suspects, to pass along to road patrol units still at the scene. It was amazing how much the guy could say even without a lower jaw or lips.

[panthersix]

I came upon a head on collision once and I went to the nearest vehicle and the female driver had a face on collision with the steering wheel. Her teeth were gone and she was bleeding profusely still sitting in the vehicle with her seat belt on. I just asked her if she could breath ok, she looked at me with those "I'm about to go into shock" eyes and nodded a bit so then I looked for "squirters". Then the volunteer EMTs showed up and I went and directed traffic.

[RngrDoc75]

Do you know the instances that lives have been saved by products such as Quick clot? I've seen a couple demos with that stuff and it looks pretty good.

When you say "Quik-Clot", you need to clarify what you mean. Does that mean the Quik-Clot powder/granules that were poured into a wound? OR does that mean Qwik-Clot branded "Combat Gauze" which is a Kaolin impregnated gauze? there is a big difference between the two.


Now, that being said, combat casualty statistics really suck for all the computer automation capabilities we have in this day and age. There is really good data out there that accounts for survival rates of casualties who made it to a hospital. What that means is we know what kinds of surgical techniques, drugs, and fluid resuscitations work well once patients are in the combat support hospitals. HOWEVER, there is incredibly poor data collection on anything done in the tactical and pre-hospital environment. This goes for good/bad techniques, equipment, training as well as patient outcomes (living or dead). The Regiment is one of the few units that have been tracking casualties and casualty trends from the beginning of the war(s). Because the Regiment has tracked our own guys, we can honestly say that NO RANGER has died from something that was preventable in the tactical environment.

[dbmtrman]

I was talking about the combat gauze, along with an asherman chest seal. I keep a package in the tactical ammo bag on keep on the console of my patrol car. Do you use the asherman seal in regiment, RngrDoc?

[RngrDoc75]

I was talking about the combat gauze, along with an asherman chest seal. I keep a package in the tactical ammo bag on keep on the console of my patrol car. Do you use the asherman seal in regiment, RngrDoc?

We began carrying Combat Gauze around May 09. There have been several uses of Combat Gauze in which it worked well. It's hard to say whether the wounds was managed "because" of the Combat Gauze or the other treatments such as tourniquets and trauma dressings.

As for the other items...

Trash the Asherman Chest Seals as they suck. They do not stick well and there is no science whatsoever that a one-way valve does anything for a chest wound. It is not going to re-inflate a lung and is not going to prevent tension pneumothorax. We are currently carrying Hyfen Chest Seals, HALO chest seals, or Bolin Chest Seals. They all use hydrogel as their adherent and stick much better. The Hyfen is just a plastic seal whereas the HALO and Bolin still try to make a one-way valve. They all are working pretty well on wounds. With any of them, you need to be prepared to decompress the chest to prevent a tension pneumothorax. Carry at least a 14G needle that is at least 3.25 inches long. Be prepared to decompress multiple times.

An Individual Ranger's Bleeding Control Kit contains the following: Tourniquet (CAT), Emergency Trauma Dressing (Israeli-style), Combat Gauze, Kerlex, Combat Wound Pill Pack, and a Casualty Card. That is the minimum. Many carry a needle for decompression as well as chest seals.