BOX 5-1 Basic 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

    SOURCE: Butler et al., 1196, p. 11.



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