Emergency Medicine Skill Tasks
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Objective. To measure the candidate's ability to prioritize casualties and apply emergency medical treatment skills in a battlefield scenario.

Requirements. The candidate is required to complete the 10 tasks listed below, within 1 hour, and pass 8 of the 10. The tasks are tested in a simulated battlefield scenario with the required equipment.

The candidates' aid bags will contain the items on a packing list provided by the EFMB test board. The candidate is placed in a scenario with four simulated casualties. The casualties have a maximum of two injuries each and must receive proper triage and treatment within the 1-hour time limit. At the end of 1 hour, the tasks not completed will be scored a NO GO. This includes completing a Department of Defense (DD) Form 1380 (U.S. Field Medical Card) and performing a casualty assessment for each casualty.

Tasks. The following tasks are tested in a lane using reaction-style testing.

Triage casualties on a conventional battlefield [Video Clip]

Perform a casualty assessment [Video Clip]

Control bleeding [Video Clip]

Treat a casualty with an open chest wound [Video Clip]

Treat a casualty with an open abdominal wound [Video Clip]

Immobilize a suspected closed fracture of the arm [Video Clip]

Initiate treatment for hypovolemic shock [Video Clip]

Treat a casualty with an open head injury

Initiate an intravenous (IV) infusion   [Video Clip]

Initiate a U.S. Field Medical Card   [Video Clip]

Equipment.

The host unit may not recycle used consumable medical supplies during testing.

The host unit will have hazardous waste disposable containers for each emergency medical treatment lane.

Candidates are required to pack their own aid bags prior to the start of the lane.  Improper packing of the aid bags by the candidates is not grounds for rebuttal. The EFMB test board will provide the final packing list.

Table 3-3 contains a recommended packing list.

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TRIAGE CASUALTIES ON A CONVENTIONAL BATTLEFIELD

CONDITIONS: Given four casualties with conventional injuries.

STANDARDS: Complete all the steps necessary to establish priorities for the treatment of four casualties.

PERFORMANCE STEPS:

1. Assess the situation.

a. Sort the casualties and allocate treatment.

(1) Assess and classify the casualties for the most efficient use of available medical supplies.

(2) Give available treatment first to the casualties who have the best chance of survival.

(3) A primary goal is to locate and return to duty troops with minor wounds.

(4) Triage establishes the order of treatment, not whether treatment is given.

b. Determine the tactical and environment situation.

(1) Whether casualties must be transported to a more secure area for treatment.

(2) The number and location of the injured and severity of injuries.

(3) Available assistance (self-aid, buddy-aid, and medical personnel).

2. Assess the casualties and establish priorities for treatment.

a. Immediate. Casualties whose conditions demand immediate treatment to save life, limb, or eyesight. This category has the highest priority.

(1) Airway obstruction.

(2) Respiratory distress from otherwise treatable injuries.

(3) Massive external bleeding.

(4) Shock.

(5) Burns on the face, neck, hands, feet, genitalia, or perineum.

NOTE: After all life- or limb-threatening conditions have been successfully treated, give no further treatment to the casualty until all other "Immediate" casualties have been treated. Salvage of life takes priority over salvage of limb.

b. Delayed. Casualties who have less risk of loss of life or limb if treatment is delayed.

(1) Open wounds of the chest without respiratory distress.

(2) Open or penetrating abdominal injuries without shock.

(3) Severe eye injuries without hope of saving eyesight.

(4) Other open wounds.

(5) Fractures.

(6) Second and third degree burns (not involving the face, neck, hands, feet, genitalia, or perineum) covering 20 percent or more of the total body surface area.

c. Minimal. "Walking wounded," may be treated by self-aid or buddy-aid.

(1) Minor lacerations and contusions.

(2) Sprains and strains.

(3) Minor combat stress problems.

(4) First or second degree burns (not involving the face, neck, hands, feet, genitalia, or perineum) covering under 20 percent of the total body surface area.

d. Expectant. Casualties who are so critically injured that only complicated and prolonged treatment may improve life expectancy. This category is to be used only if resources are limited. If in doubt as to the severity of the injury, place the casualty in one of the other categories.

(1) Massive head injuries with signs of impending death.

(2) Burns, mostly third degree, covering more than 85 percent of the total body surface area.

NOTE: Provide ongoing supportive care if time and condition permits; keep separate from other triage categorized casualties.

REFERENCES:

Required Related

FM 4-02

STP 8-91W15-SM-TG, Task No. 081-833-0080 Triage Casualties On a Conventional Battlefield.

Determine Triage and MEDEVAC Procedures video

CTT 081-831-1000: EVALUATE A CASUALTY (INTERACTIVE MULTIMEDIA INSTRUCTION) VERSION 1 01-Mar-2005

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PERFORM A CASUALTY ASSESSMENT

CONDITIONS: Given four casualties with conventional injuries.

STANDARDS: Assess each casualty, identify all life-threatening injuries, and treat the injuries appropriately per triage priority without causing further injury. Perform the assessments in the correct order.

PERFORMANCE STEPS:

1. Perform an initial assessment.

NOTE: Life-threatening injuries should be treated as they are identified according to casualty triage. If casualty is expectant, move on to next casualty.

a. Assess the casualty's mental status using the AVPU scale.

(1) A - Alert and oriented.

(2) V - Responsive to verbal stimuli.

(3) P - Responsive to painful stimuli.

(4) U - Unresponsive.

b. Assess the airway.

c. Assess breathing.

d. Assess circulation.

(1) Skin color, condition, and temperature.

(2) Assess the pulse for rhythm and force.

(3) Check for major bleeding.

NOTE: The candidate will perform either a rapid trauma assessment (step 2) or a focused assessment (step 3) depending on the casualty’s mental status and injuries.

2. Perform a rapid trauma assessment.

a. Head.

(1) Inspect for deformities, contusions, abrasions, punctures or penetration, burns, tenderness, lacerations, swelling (DCAP-BTLS).

(2) Inspect for crepitus.

b. Neck.

(1) Inspect for DCAP-BTLS.

(2) Palpate spine step-offs.

(3) Inspect for jugular vein distention.

(4) Inspect for tracheal deviation.

(5) Apply a cervical collar, if necessary.

c. Chest.

(1) Inspect for DCAP-BTLS.

(2) Inspect for crepitus.

(3) Inspect for paradoxical motion.

(4) Inspect breath sounds (absent/present, equal).

d. Abdomen.

(1) Inspect for DCAP-BTLS.

(2) Palpate for tenderness.

(3) Palpate for rigidity.

(4) Inspect for distention.

e. Pelvis.

(1) Inspect for DCAP-BTLS.

(2) Gently compress to detect instability and crepitus.

(3) Determine the level of pain.

(4) Inspect for priapism.

f. Extremities.

(1) Inspect for DCAP-BTLS.

(2) Check the distal pulse.

(3) Check distal motor function.

(4) Check distal sensation.

g. Posterior.

NOTE: The casualty must be log-rolled to do this portion of the assessment.

(1) Inspect for DCAP-BTLS.

(2) Inspect for rectal bleeding.

3. Perform a focused assessment.

a. Perform a focused physical examination of the affected body part.

b. Provide interventions and treatment per triage priority.

4. Perform ongoing assessment (if time permits).

a. Repeat initial assessment.

b. Reevaluate interventions/treatments.

all casualties.

REFERENCES:

Required Related

STP 8-91W15-SM-TG, Task No. 081-833-0155 Perform a Casualty Assessment

Basic Trauma Life Support for Paramedics and Other Advanced Providers

Perform Patient Assessment video

CTT 081-831-1000: EVALUATE A CASUALTY (INTERACTIVE MULTIMEDIA INSTRUCTION) VERSION 1 01-Mar-2005

EMERGENCY CARE

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CONTROL BLEEDING

CONDITIONS: Given a conscious casualty who has a bleeding wound of the arm or leg and the necessary materials to treat the casualty.

STANDARDS: Control bleeding by applying field dressing, pressure dressing, and tourniquet without causing further injury to the casualty.

PERFORMANCE STEPS:

1. Apply a field dressing to the wound.

a. Uncover the wound unless clothing is stuck to it.

b. Apply the field dressing.

c. Wrap the tails so that the dressing is covered and both sides are sealed.

d. Tie a nonslip knot over the outer edge of the dressing, not over the wound.

e. Check the tightness of the dressing.

f. Check the distal pulse to make sure that the dressing has not been applied too tightly.

g. Elevate the affected extremity above the level of the heart.

CAUTION: DO NOT ELEVATE IF THERE ARE SUSPECTED MUSCULOSKELETAL INJURIES, IMPALED OBJECTS IN THE EXTREMITY, OR SPINAL INJURY.

2. Apply a pressure dressing if the wound continues to bleed. (Evaluator will state that wound continues to bleed.)

a. Place a wad of padding directly over the wound.

b. Apply a field dressing or cravat on top of the padding.

c. Tie a nonslip knot directly over the wound.

d. Check the distal pulse to make sure that the dressing has not been applied too tightly.

e. Elevate the affected extremity above the level of the heart.

CAUTION: DO NOT ELEVATE IF THERE ARE SUSPECTED MUSCULOSKELETAL INJURIES, IMPALED OBJECTS IN THE EXTREMITY, OR SPINAL INJURY.

3. Apply a tourniquet if the wound continues to bleed. (Evaluator will state that wound continues to bleed.)

CAUTION: A TOURNIQUET IS A LAST RESORT FOR LIFE-THREATENING INJURIES. TOURNIQUETS CUT OFF BLOOD FLOW TO AND FROM THE EXTREMITY AND ARE LIKELY TO CAUSE PERMANENT DAMAGE TO VESSELS, NERVES, AND MUSCLES. NEVER LOOSEN OR REMOVE THE TOURNIQUET AFTER IT HAS BEEN APPLIED.

a. Make a band at least 2 inches wide.

b. Position the tourniquet 2-4 inches above the edge of the wound but not on a joint.

c. Tie a half knot.

d. Place a stick (or similar object) on top of the knot.

e. Tie a full knot over the stick.

f. Twist the stick until the tourniquet is tight around the limb and bright red bleeding has stopped.

g. Secure the stick.

h. Mark the casualty’s forehead with a "T."

i. Do not cover the tourniquet.

j. Do not loosen the tourniquet.

REFERENCES:

Required Related

STP 8-91W15-SM-TG, Task No. 081-833-0161

Extremity Hemorrhage Control

C-A-T Instruction Sheet

Basic Trauma Life Support for Paramedics and Other Advanced Providers

Bleeding Wounds and Shock  video

CTT 081-831-1032: PERFORM FIRST AID FOR BLEEDING OF AN EXTREMITY (INTERACTIVE MULTIMEDIA INSTRUCTION) VERSION 1 01-Mar-2005

EMERGENCY CARE

Figure 3-25. Control Bleeding.

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TREAT A CASUALTY WITH AN OPEN CHEST WOUND

CONDITIONS: Given a conscious casualty with an open chest wound and the necessary materials to treat the casualty.

STANDARDS: Treat an open chest wound, minimizing the effects of the injury. Seal the entry and exit wounds without causing further injury to the casualty.

PERFORMANCE STEPS:

1. Check the casualty for signs and symptoms of an open chest wound.

NOTE: Casualty will exhibit one or more of the following signs and symptoms.

a. A "sucking" or "hissing" sound when the casualty inhales.

b. Difficulty breathing.

c. A puncture wound of the chest.

d. An impaled object protruding from the chest.

e. Froth or bubbles around the injury.

f. Coughing up blood or blood-tinged sputum.

g. Pain in the chest or shoulder.

2. Expose the wound.

a. Cut or unfasten the clothing that covers the wound.

b. Disrupt the wound as little as possible.

NOTE: Do not remove clothing stuck to the wound.

3. Check for an exit wound.

a. Feel and/or look at the casualty's chest and back.

b. Remove the casualty's clothing, if necessary.

4. Seal the wound (s), covering the larger wound first with an occlusive dressing.

NOTE: All penetrating chest wounds should be treated as if they were sucking chest wounds.

a. Cut the dressing wrapper on one long and two short sides and remove the dressing.

NOTE: In an emergency, any airtight material may be used. It must be large enough so it is not sucked into the chest cavity.

b. Apply the inner surface of the wrapper to the wound when the casualty exhales.

c. Ensure that the covering extends at least 2 inches beyond the edges of the wound.

d. Seal by applying overlapping strips of tape to three sides of the plastic covering to provide a flutter-type valve. The fourth side is not taped and its location is dependent on the position of the casualty.

e. Cover the exit wound in the same way, if applicable.

NOTE: Assess the effectiveness of the flutter valve when the casualty breathes. When the casualty inhales, the plastic should be sucked against the wound, preventing the entry of air. When the casualty exhales, trapped air should be able to escape from the wound and out the untaped side of the dressing.

5. Place the casualty in the position of comfort (on the injured side or in a seated position).

REFERENCES:

Required Related

STP 8-91W15-SM-TG, Task No. 081-833-0050

Basic Trauma Life Support for Paramedics and Other Advanced Providers

Treat an Open (Sucking) Chest Wound video

Figure 3-26. Treat a Casualty With an Open Chest Wound.

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TREAT A CASUALTY WITH AN OPEN ABDOMINAL WOUND

CONDITIONS: Given a conscious casualty with an open abdominal wound without protruding internal organs and the necessary materials to treat the casualty.

STANDARDS: Treat an open abdominal wound, minimizing the effects of the injury, and stabilize the casualty without causing further injury.

PERFORMANCE STEPS:

1. Position the casualty.

a. Place the casualty on his or her back (face up).

b. Flex the casualty's knees after the casualty assessment is completed.

c. Turn the casualty's head to the side and keep the airway clear if vomiting occurs.

2. Expose the wound.

3. Apply a sterile abdominal dressing.

a. Place the dressing directly on top of the wound.

b. Tie the dressing tails loosely in a nonslip knot at the casualty's side.

CAUTION: DO NOT APPLY PRESSURE ON THE WOUND OR EXPOSE INTERNAL PARTS.

c. If two dressings are needed to cover a large wound, repeat steps 3a and 3b.

Ensure that the ties of additional dressings are not tied over each other.

d. If necessary, loosely cover the dressings with cravats. Tie them on the side of the casualty, opposite that of the dressing ties.

4. Do not cause further injury to the casualty.

a. Do not touch any exposed organs with bare hands.

b. Do not tie the dressing tails tightly or directly over the dressing.

c. Do not give the casualty anything by mouth.

d. Do not touch the sterile side of the dressing.

REFERENCES:

Required Related

STP 8-91W15-SM-TG, Task No. 081-833-0045

Basic Trauma Life Support for Paramedics and Other Advanced Providers

Treat Open Abdominal Wounds video

EMERGENCY CARE

Figure 3-27. Treat a Casualty With an Open Abdominal Wound.

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IMMOBILIZE A SUSPECTED CLOSED FRACTURE OF THE ARM

CONDITIONS: Given a conscious casualty with a suspected fracture of the arm and the necessary materials to treat the casualty.

STANDARDS: Complete all the necessary steps to immobilize a suspected fracture of the arm without causing further injury.

PERFORMANCE STEPS:

1. Check the casualty's radial pulse. If no pulse is felt, bandage and/or splint the extremity and arrange for immediate evacuation.

2. Position a fractured arm by having the casualty support it with the uninjured arm and hand in the least painful position, if possible.

CAUTION: DO NOT TRY TO REDUCE OR SET THE FRACTURE. SPLINT IT WHERE IT LIES.

3. Immobilize the injury. Apply the appropriate treatment depending on the location of the injury.

a. Use a basswood or an improvised splint for a fractured forearm.

(1) Pad the splint.

(2) Place the padded splint under the casualty's forearm so that it extends from the elbow to beyond the fingertips.

(3) Place a rolled cravat or similar material in the palm of the cupped hand.

(4) Tie the cravats in a nonslip knot in the following order and recheck the radial pulse after each cravat is applied.

(a) Above the fracture site near the elbow.

(b) Below the fracture site near the wrist.

(c) Over the hand and tied in an "X" around the splint.

(5) Tie each cravat on the outside edge of the splint.

(6) Apply an arm sling and swathe.

b. Use a wire ladder splint for a fractured humerus and for multiple fractures of an arm or a forearm when the elbow is bent.

(1) Prepare the splint using the uninjured arm for measurements.

(a) Bend the prong ends of the splint away from the smooth side, about 1 1/2 inches down on the outside of the splint.

(b) With the smooth side against the elbow, place one end of the splint even with the top of the uninjured shoulder.

(c) Select a point slightly below the elbow.

(d) Remove the splint from the arm and bend the splint at the measured point to form an "L."

(e) Pad the splint.

NOTE: If padding is unavailable, apply the splint anyway.

(2) Position the splint on the outside of the injured arm, extending from the shoulder to beyond the fingertips.

NOTES:

1. Extend the "L" angle of the splint beyond, but do not touch, the elbow of the injured arm. Extend the leg of the angle touching the forearm beyond the ends of the fingers. If the splint is too short, extend it with a basswood splint. 2. If possible, have the casualty support the splint.

(3) Place a rolled cravat or similar material in the palm of the cupped hand.

(4) Check the radial pulse.

(5) Tie the cravats in a nonslip knot in the following order and recheck the radial pulse after each cravat is applied.

(a) On the humerus above any fracture site.

(b) On the humerus below any fracture site.

(c) On the forearm above any fracture site.

(d) On the forearm below any fracture site.

(e) Around the hand and splint.

(6) Tie each cravat on the outside edge of the splint.

NOTE: If the pulse is weaker or absent after tying the cravat, loosen and retie the cravat.

(7) Apply an arm sling and swathe.

c. Use a wire ladder splint for a fractured or dislocated humerus, elbow, or forearm when the elbow is straight.

(1) Prepare the splint.

(2) Position the splint on the outside of the arm against the back of the hand.

(3) Tie the cravats in a nonslip knot in the following order and recheck the radial pulse after each cravat is applied.

(a) Above the injury.

(b) Below the injury.

(c) High on the humerus, above the first cravat.

(d) Around the hand and wrist.

(4) Tie each cravat on the outside of the splint.

NOTE: If the pulse is weaker or absent after tying the cravat, loosen and retie the cravat.

(5) Apply swathes.

(a) Place the arm toward the midline in front of the body. Bind the forearm to the pelvic area with a cravat. Tie the knot on the uninjured side.

(b) Apply an additional cravat above the elbow. Secure it on the uninjured side at breast pocket level.

(6) Did not cause further injury to the casualty.

REFERENCES:

Required Related

STP 8-91W15-SM-TG, Task No. 081-833-0062

Basic Trauma Life Support for Paramedics and Other Advanced Providers

Splint a Suspected Fracture video

Apply a Universal Splint video

Splinting Procedures video

Figure 3-28. Immobilize a Suspected Fracture of the Arm.

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INITIATE TREATMENT FOR HYPOVOLEMIC SHOCK

CONDITIONS: Given a conscious casualty who is suffering from a severe loss of body fluids and the necessary materials to initiate treatment for hypovolemic shock.

STANDARDS: Initiate treatment for hypovolemic shock, stabilize the casualty, and minimize the effect of shock without causing further injury to the casualty.

PERFORMANCE STEPS:

NOTE: Hypovolemic shock results when there is a decrease in the volume of circulating fluids (blood and plasma) in the body. If dehydration (loss of body water) is present at the time of injury, shock will develop more rapidly.

1. Reassure the casualty to reduce anxiety.

NOTE: Anxiety increases the heart rate, which worsens the casualty's condition.

2. Initiate two large bore (16 gauge) IVs. (Initiate one large bore IV for EFMB purposes.) (See task "Initiate an Intravenous (IV) Infusion," Figure 3-31.)

3. Elevate the casualty's legs above chest level, without lowering the head below chest level.

4. Maintain normal body temperature. (The casualty will exhibit symptoms of being hot or cold.)

a. Watch for signs of sweating or chilling.

b. Cover the casualty in cold weather.

c. Do not cover the casualty in hot weather unless signs of chilling are noted. Loosen restrictive clothing and provide shade, if available.

5. Monitor the casualty every 5-15 minutes.

NOTE: Give nothing by mouth.

6. Did not cause further injury to the casualty.

REFERENCES:

Required Related

STP 8-91W15-SM-TG, Task No. 081-833-0047

Basic Trauma Life Support for Paramedics and Other Advanced Providers

EMERGENCY CARE

Figure 3-29. Initiate Treatment For Hypovolemic Shock.

Bleeding Wounds and Shock  video

Treat for Shock  video

CTT 081-831-1005: PERFORM FIRST AID TO PREVENT OR CONTROL SHOCK (INTERACTIVE MULTIMEDIA INSTRUCTION) VERSION 1 01-Mar-2005

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TREAT A CASUALTY WITH AN OPEN HEAD INJURY

CONDITIONS: Given a conscious casualty with an open head injury and the necessary materials to treat the head injury.

STANDARDS: Treat the casualty by covering the wound with a field dressing without contaminating the wound or causing further injury to the casualty.

PERFORMANCE STEPS:

1. Assess the casualty's pupil size.

a. Observe the size of each pupil.

NOTE: A variation of pupil size may indicate a brain injury. In a very small percentage of people, unequal pupil size is normal.

b. Shine a light into each eye to observe the pupillary reaction to light.

NOTES: 1. The candidate will not turn the pin light on. The evaluator will state to the candidate the condition of the pupils. 2. The pupils should constrict promptly when exposed to bright light. Failure of the pupils to constrict may indicate brain injury.

2. Assess the casualty's motor function. Evaluate the casualty's strength, mobility, coordination, and sensation.

NOTE: Progressive loss of strength or sensation is an important indicator of brain injury.

3. Position the casualty.

4. Treat the head injury.

a. Expose the wound.

b. Apply the dressing to the wound.

c. Tie the tails with a nonslip knot.

5. Monitor the casualty at 15-minute intervals.

6. Did not cause further injury to the casualty.

REFERENCES:

Required Related

STP 8-91W15-SM-TG, Task No. 081-831-0018 OPEN THE AIRWAY

STP 8-91W15-SM-TG, Task No. 081-833-0052 TREAT A CASUALTY WITH AN OPEN OR CLOSED HEAD INJURY

Basic Trauma Life Support for Paramedics and Other Advanced Providers

EMERGENCY CARE

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INITIATE AN IV INFUSION

CONDITIONS: Given a conscious casualty with a need for fluid replacement treatment and the necessary materials to establish an IV infusion.

STANDARDS: Initiate an IV infusion without causing further injury to the casualty.

PERFORMANCE STEPS:

1. Explain to the casualty what is going to be done.

2. Assemble and inspect the IV injection set for defects, expiration date, and contamination.

a. Spike, drip chamber, tubing, and needle adapter. Discard them if there are cracks or holes or if any discoloration is present.

b. Tubing clamp. Ensure that the clamp releases and catches.

c. Needle or catheter-over-needle. Discard them if they are flawed with barbs or nicks.

3. Prepare the equipment.

a. Clamp the tubing 6 to 8 inches below the drip chamber.

b. Remove the protective covers from the spike and from the outlet of the IV container.

CAUTION: DO NOT TOUCH THE SPIKE OR THE OUTLET OF THE IV CONTAINER.

c. Insert the spike into the container.

d. Hang the container at least 2 feet above the level of the casualty's heart, if possible.

NOTE: An IV bag container may be placed under the casualty's body if there is no way to hang it.

e. Squeeze the drip chamber until it is half full of the IV fluid.

f. Prime the tubing.

NOTE: Ensure that all air is expelled from the tubing.

(1) Hold the tubing above the level of the bottom of the container.

(2) Loosen the protective cover from the needle adapter to allow the air to escape.

(3) Release the clamp on the tubing.

(4) Gradually lower the tubing until the solution reaches the end of the needle adapter.

(5) Clamp the tubing.

(6) Retighten the needle adapter's protective cover.

(7) Loop the tubing over the IV stand or holder.

g. Cut several pieces of tape and hang them in a readily accessible place.

4. Select the infusion site.

NOTE: The candidate will initiate the infusion using a practice device.

a. Choose the most distal and accessible vein of an uninjured arm or hand.

b. Avoid sites over joints.

c. Avoid veins in infected, injured, or irritated areas.

d. Use the nondominant hand or arm, whenever possible.

CAUTION: DO NOT USE AN ARM THAT MAY REQUIRE AN OPERATIVE PROCEDURE.

e. Select a vein large enough to accommodate the size of needle/catheter to be used.

5. Prepare the infusion site.

a. Apply the constricting band.

NOTE: When applying the constricting band, use soft-walled latex tubing about 18 inches in length.

(1) Place the tubing around the limb, about 2 inches above the site of venipuncture.  Hold one end so that it is longer than the other, and form a loop with the longer end.

(2) Pass the looped end under the shorter end of the constricting band.

NOTE: When placing the constricting band, ensure that the tails of the tubing are turned away from the proposed site of venipuncture.

(3) Apply the constricting band tight enough to stop venous flow but not so tightly that the radial pulse cannot be felt.

(4) Tell the casualty to open and close his or her fist several times to increase circulation.

CAUTION: DO NOT LEAVE THE CONSTRICTING BAND IN PLACE FOR MORE THAN 2 MINUTES.

b. Tell the casualty to close his or her fist and keep it closed until instructed to open the fist.

c. Clean the skin over the selected area with 70 percent alcohol, using a firm circular motion from the center outward.

d. Allow the skin to dry and discard the pad.

6. Prepare to puncture the vein.

a. Pick up the assembled needle and remove the protective cover with the other hand.

(1) Ensure that the needle is bevel up.

(2) Place the forefinger on the needle hub to guide it during insertion through the skin and into the vein.

b. Position yourself so as to have a direct line of vision along the axis of the vein to be entered.

7. Puncture the vein (into the practice device).

CAUTION: KEEP THE NEEDLE AT THE SAME ANGLE TO PREVENT THROUGHAND-THROUGH PENETRATION OF THE VEIN WALLS.

NOTE: You may position the needle directly above the vein or slightly to one side of the vein.

a. Draw the skin below the cleaned area downward to hold the skin taut over the site of venipuncture.

b. Position the needle point, bevel up, parallel to the vein and about 1/2 inch below the site of venipuncture.

c. Hold the needle at a 20- to 30-degree angle and insert it through the skin.

d. Decrease the angle of the needle until it is almost parallel to the skin surface and direct it toward the vein.

e. Move the needle forward about 1/2 inch into the vein.

8. Confirm the puncture.

NOTE: A faint "give" will be felt as the needle enters the lumen of the vein.

a. Check for blood in the flash chamber. If successful, proceed to step 9.

b. If the venipuncture is unsuccessful, pull the needle back slightly (not above the skin surface) and attempt to pierce the vein again.

9. Advance the needle or the catheter.

a. Grasp the hub and advance the needle into the vein up to the hub.

b. If using the catheter-over-needle, grasp the hub and with a slight twisting motion fully advance the catheter.

c. While continuing to hold the hub, press lightly on the skin over the needle or catheter tip with the fingers of the other hand.

NOTE: This prevents the backflow of blood from the hub.

d. If using a catheter-over-needle, remove the needle from inside the catheter.

10. Remove the protective cover from the needle adapter on the tubing. Quickly and tightly connect the adapter to the catheter or needle hub.

WARNING: DO NOT ALLOW AIR TO ENTER THE BLOOD STREAM.

11. Tell the casualty to unclench the fist, and then release the constricting band.

12. Unclamp the IV tubing and adjust the flow rate to keep the vein open.

13. Check the site for infiltration. If it is painful, swollen, red, cool to the touch, or if fluid is leaking from the site, stop the infusion immediately.

14. Secure the site.

a. Apply a sterile 2- x 2-inch dressing over the puncture site and secure it with tape, leaving the hub and tubing connection visible.

b. Loop the IV tubing onto the extremity and secure the loop with tape.

c. Splint the arm loosely on a padded splint, if necessary, to reduce movement.

NOTE: The candidate will only state that he or she would splint the arm, if using antecubital fossa.

15. Readjust the flow rate.

16. Recheck the site for infiltration.

17. Did not cause further injury to the casualty.

REFERENCES:

Required Related

STP 8-91W15-SM-TG, Task No. 081-833-0033 INITIATE AN INTRAVENOUS INFUSION

Venipuncture Techniques Tutorial

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INITIATE A U.S. FIELD MEDICAL CARD

CONDITIONS: Given four treated casualties and a blank DD Form 1380 (U.S. Field Medical Card).

STANDARDS: Complete, as a minimum, blocks 1, 3, 4, 7, 9, and 11 for each casualty.

Complete blocks 2, 5, 6, 8, 10, 12, 13, 14, 15, 16, and 17 as appropriate. Complete other blocks as time permits.

PERFORMANCE STEPS:

1. Remove the protective sheet from the carbon copy.

2. Complete the minimum required blocks.

a. Block 1. Enter the casualty's name, rank, and complete social security number (SSN). If the casualty is a foreign military person (including prisoners of war), enter his or her military service number. Enter the casualty's MOS or AOC for specialty code.  Enter the casualty's religion and sex.

b. Block 3. Use the figures in the block to show the location of the injury or injuries.  Check the appropriate box (es) to describe the casualty's injury or injuries.

NOTES: 1. When more space is needed, attach another DD Form 1380 to the original.  Label the second card in the upper right corner "DD Form 1380 #2." It will show the casualty's name, grade, and SSN. 2. Use only authorized abbreviations. Except for those listed below, abbreviations may not be used for diagnostic terminology.

Abr W - Abraded wound.

Cont W - Contused wound.

FC - Fracture (compound) open.

FCC - Fracture (compound) open comminuted.

FS - Fracture (simple) closed.

LW - Lacerated wound.

MW - Multiple wounds.

Pen W - Penetrating wound.

Perf W - Perforating wound.

SL - Slight.

SV - Severe.

c. Block 4. Check the appropriate box.

d. Block 7. Check the yes or no box. Write in the dose administered and the date and time that it was administered.

e. Block 9. Write in the information requested. If you need additional space, use Block 14.

f. Block 11. Initial the far right side of the block.

3. Complete the other blocks as time permits. Most blocks are self-explanatory. The following specifics are noted:

a. Block 2. Enter the casualty's unit of assignment and the country of whose armed forces he or she is a member. Check the armed service of the casualty, that is, A/T = Army, AF/A = Air Force, N/M = Navy, and MC/M Marine.

b. Block 5. Write in the casualty's pulse rate and the time that the pulse was measured.

c. Block 6. Check the yes or no box. If a tourniquet is applied, you should write in the time and date it was applied.

d. Block 8. Write in the time, date, and type of IV solution given. If you need additional space, use Block 9.

e. Block 10. Check the appropriate box. Write in the date and time of disposition.

f. Block 12. Write in the time and date of the casualty's arrival. Record the casualty's blood pressure, pulse, and respirations in the space provided.

g. Block 13. Document the appropriate comments by the date and time of observation.

h. Block 14. Document the provider's orders by date and time. Record the dose of tetanus administered and the time it was administered. Record the type and dose of antibiotic administered and the time it was administered.

i. Block 15. The signature of the provider or medical officer is written in this block.

j. Block 16. Check the appropriate box and enter the date and time.

k. Block 17. This block will be completed by the United Ministry Team. Check the appropriate box of the service provided. The signature of the chaplain providing the service is written in this block.

4. Attach the completed Field Medical Card to the casualty.

REFERENCES:

Required Related

AR 40-66

STP 8-91W15-SM-TG, Task No. 081-831-0033 INITIATE A FIELD MEDICAL CARD

The Field Medical Card  video

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The tasks are not especially hard on this lane, but because the candidate is performing the tasks under simulated combat conditions with a one hour time limit it can cause stress and with stress comes errors. Knowledge of the skills and knowing how to perform the tasks is the key here. Know the tasks backwards and forwards, and be confident. If you realize a mistake don't let it effect the other tasks you have to accomplish on the lane remember; you are allowed three NO-GO's on this lane.  Be prepared and do the best you can on the lane. 

There are ten tasks to complete. You must pass eight of the ten.

"Splint a Suspected Fracture of the Arm" will be a closed fracture.

Once you know you will go try for the EFMB, get the EFMB study guide as soon as possible and start reading and practice the skills. You should already have STP 21-1-SMCT.

Usually, time starts when the grader sees you reach the first casualty. As you reach each casualty, perform a sweep of the patient to determine injuries. During your sweep, if you discover an immediate injury, treat it immediately. Once treated finish your sweep and note all other injuries, if applicable. If the casualty has no immediate injuries, reassure the casualty and move on to the next casualty. Continue until all casualties are completely treated and then do you DD Form 1380's.

Use your time wisely. Don't forget you have a one hour time limit. Tune out all the "noise". (i.e. the simulated explosions, weapons fire, and smoke).

Standards are set for the lane during validation week.  Ensure you know what the standards is before you begin the lane.

Ignore the grader during your testing as much as possible. Keep that in mind - your grader will most likely be writing the whole time but don't let it bother you. Concentrate on the tasks at hand.  Consider the grader a soldier in your area of operation.

Treat your patients in order of their injuries. The most serious are the sucking chest wound, shock, and amputation. Completely treat these injuries before moving on to the less serious ones. Triage includes a primary survey during which you check for the airway, gross bleeding, and circulation. Also, you do a secondary sweep for all casualties and that it when you treat those less than immediate injuries.

For the sucking chest wound, create a flutter valve so that the opening will be at the bottom in relation to how you position the casualty. Remember, your casualties can have more than one injury. If your chest casualty also has a head wound, you will eventually sit him up. Make sure your flutter valve opens at the bottom for proper drainage. Tie the knot ON TOP of the wound as the casualty exhales.

Treat for shock remembering not to move unsplinted fractures. Treat for shock as much as possible, and return later to splint the fracture and then elevate if applicable.

Make sure your stick or whatever is strong enough to twist that tourniquet. If it breaks, you are a NO GO. On your secondary sweep, dress the stump.

Get all your splinting materials together before you start splinting the suspected fracture. Expose the site of the suspected fracture and don't move it until it is splinted. Tie two knots above the fracture and two below.; Check for a pulse after every knot and you can't go wrong.

Do not replace or "fix" exposed organs when working on the abdominal wound. If the guts are laying on the ground, pick them up with the dressing and place them over the wound. Dress the wound so as to cover all the wound. Tie your knots tight enough to keep the dressing in place, but not so tight that it causes injury to exposed organs.

Ask questions to determine the level of consciousness for each casualty, particularly the head wound. Also, talking and reassuring each casualty will more than likely get them to shut up. Once identified, keep the head wound casualty talking for the entire hour! Do not cover the eyes or ears with the dressing or the tails.

When applying the field dressing, cover the wound completely and cover the white area of the dressing completely. The casualty can apply manual pressure and elevate it until you return to do the pressure dressing.

When applying the pressure dressing, the wad and the knot are directly over the wound.

IV's. This task gives everyone trouble, especially medics!!! Do it the way the graders tell you to do it. Check every piece of equipment before you begin. Once the constricting band is applied, you have one minute to stick and start the flow before that constricting band had better come off. If you know you are running out of time, release the constricting band and start over. Save this task for last.

The graders will tell you which blocks to fill out on the DD Form 1380, and how, but get you hands on a FMC to familiarize yourself with it. This task requires no thought, except you had better remember when you applied that tourniquet, because your grader will.

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