. "5 Protocols of Care at the Site of Injury." Fluid Resuscitation: State of the Science for Treating Combat Casualties and Civilian Injuries. Washington, DC: The National Academies Press, 1999.
The following HTML text is provided to enhance online
readability. Many aspects of typography translate only awkwardly to HTML.
Please use the page image
as the authoritative form to ensure accuracy.
BOX 5-1Basic Tactical Casualty Management Plan for U.S. Special Forces Medics
1.
Airway management
Chin lift or jaw thrust
Unconscious casualty without airway obstruction: nasopharyngeal airway
Unconscious casualty with airway obstruction; cricothyroidotomy
Cervical spine immobilization is not necessary for casualties with penetrating head or neck trauma
2.
Breathing
Consider tension pneumothorax and decompress with needle thoracostomy if a casualty has unilateral penetrating chest trauma and progressive respiratory distress
3.
Bleeding
Control any remaining bleeding with a tourniquet or direct pressure
4.
IV
Start on 18-gauge IV (heparin or saline lock)
5.
Fluid resuscitation
Controlled hemorrhage without shock: no fluids necessary
Controlled hemorrhage with shock: Hespan 1,000 cc
Uncontrolled (intra-abdominal or thoracic) hemorrhage: no IV fluid resuscitation
6.
Inspect and dress wound
7.
Check for additional wounds
8.
Analgesia as necessary
Morphine: 5 mg IV, wait 10 minutes; repeat as necessary
9.
Splint fractures and recheck pulse
10.
Antibiotics
Cefoxitin: 2 g slow-IV push (over 3-5 minutes) for penetrating abdominal trauma, massive soft-tissue damage, open fractures grossly contaminated wounds, or long delays before casualty evacuation
11.
Cardiopulminary resuscitation
Resuscitation on the battlefield for victims of blast or penetrating trauma who have no pulse, no respirations, and no other signs of life will not be successful and should not be attempted
