Quick Tips on Tactical Casualty Care Topics
Initially designed as 15 & 30-second posts for social media, these quick tips are a good refresher to TECC/TCCC concepts.
Note: these hip pocket training videos were not professionally filmed like our online classes.
Teaching TECC/TCCC with Playmobil
Playing with your kid is the perfect time to teach TECC, right? How much space does a casualty collection point take?
How much bleeding is bad bleeding?
How much bleeding is bad bleeding? 🩸 What do you do for each type?
Proper Bandage Application
Proper bandage application requires covering the entire gauze pad with the elastic wrap, and then clipping as much of the elastic wrap into the clip. Improper application involves the elastic bandage roping up in the middle, the gauze pad “taco-ing” around the edges, and provides very little direct pressure on the wound.
#1 Rule Proper TQT Application
#1 rule in proper tourniquet application?
Take ALL the slack out FIRST.
Then tighten the windlass until all bleeding stops. Complete the application depending on the TQT you used. For a CAT, secure the windlass, ensure all the Velcro is secure & close the retaining band.
#1 LEO Question: Staging TQT on Gear
How do I stage my CAT tourniquet on my gear?
The most common mistake we see is officers who “tidy up” and clip the windlass in the retaining bar and close the velcro retaining strap. This is wrong. Leave the tourniquet the same way it came out of the package: winless free, and the velcro open for immediate use.
Resetting a Training Tourniquet
Resetting a tourniquet for use in training:
1. Feed 8” through the buckle
2. Lay the omnitape back on itself
3. Fold in half
4. Free windlass
5. Retaining band open
Training tourniquets should not be used operationally.
Step #1 in Wound Packing
Step #1 in wound packing: identify the source of bleeding & begin packing there.
Step #2 in Proper Wound Packing
The second step in wound packing is to get gauze directly to the point of bleeding. Starting with a large wad of gauze is problematic in narrow wound tracks. Start with a small piece of gauze at the tip of your packing finger, put that at the point of bleeding, then continue to pack the wound until you just can’t get any more gauze in it. Then force in even more gauze. Wound packing is just direct pressure at the point of bleeding.
Proper Dual TQT Application
Proper dual tourniquet application involves 2 TQT placed side by side & touching. That essentially doubles the width of the tourniquet – wider tourniquets occlude better.
Long held SF tradition of always being prepared to provide a block of instruction during down time. Cold blood does not clot: keeping casualties warm must be part of your casualty management strategy.
X-Stat for Wound Packing
All hemorrhage control is ultimately direct pressure. A tourniquet puts direct pressure on an artery. Wound packing puts direct pressure at the point of bleeding. As long as the pressure is higher than systolic blood pressure, the bleeding will stop. Sometimes that’s easier said than done. XSTAT makes wound packing a lot easier…
For the pulse oximeter’s O2 saturation reading to be valid, the device must also be consistently identifying the patient’s pulse. If the pulse waveform or notation isn’t steady, the oxygen reading isn’t valid.
#1 Tip for EZ-IO needles
The most important thing to set yourself up for success with the EZ-IO needle is to ensure you are using the correct size needle. Once the needle is in the casualty and touching bone, before you activate the drill, you must be able to see one of the black measurement lines.
Pediatric IO Needles
Size matters: Using an EZ-IO needle sized for kids is a better choice when treating pediatric patients.
NAR Tracheostomy with Bougie vs. Control Cric Key
Open surgical airways have a 66-91% success rate when done by paramedics and military prehospital providers. Using a bougie seems to make the technique easier.
How to Properly Size an NPA
Many question the utility of a nasal pharyngeal airway. A properly sized and placed NPA will put the tip close to the patient’s epiglottis. I have personally seen dual NPAs maintain an airway in a patient with progressive angio edema while prepping for intubation: it allowed for a controlled intubation, rather than a crash surgical airway.
#1 Common Mistake using NPA
Many question the utility of a nasal pharyngeal airway. A properly sized and placed NPA will put the tip close to the patient’s epiglottis. To properly place the NPA insert it IN the nose not UP the nose.
First Receivers – No Notice Events
Keeping the Ambulance Bay clear
Under normal circumstances, the ambulance bay works well. But during a no-notice or mass casualty event, it will get blocked You need to re-route traffic and block off the turn around with stretchers, wheelchairs, and anything else you can find to prepare for arriving casualties. You may have to get creative.
Unidirectional Flow: Through-put
In a No-notice event, the hospital must operate to maximize throughput, allocate resources, and manage the chaos.
One way to do this is to institute strict uni-directional flow.
Additional Problems: The Second Wave
In Las Vegas, 4-6 family & friends arrived for each patient, they stayed all night and wandered the halls looking for power outlets to charge phones and overwhelmed the bathrooms.
Hospital Response to MCI: Endoscopy to Morgue
In a no-notice MCI, non-trauma centers will receive casualties as resources are overwhelmed. Most hospital morgues can only hold 1-2 bodies and you may have more dead than the morgue can hold. What is your hospital’s plan?