- Reaction score
- 0
- Points
- 410
I was privileged to be able to DS the med portion of an operation conducted by A Sqn RCD as part of Ex Thundering Bear I last week:
Rules for this:
I am trying to paint the picture as best I can, but some decision factors I can not recreate here,
it is for learning and discussion,
do not trash my medics, as none of them are here and you were not there,
I leave out what was not done and what was not pertinent to casualty i.e. chest wound...not going to tell you everything else was good.
As for the stand. 3 RCR is doing the Sense Led Raid into a Afghan village and terrorist training camp. The basics of this particular activity is that A Sqn RCD is to enter and secure the compound and cover the approach and withdrawl of SF forces who are going to enter, secure a hostage and exit. Then they are to hand over the area to local police.
There are designated casualties marked with a US Army style card which shows a picture indicating the injuries, and giving minimal pertinent instructions to run the cas sim. Info on card as pertinent here is in bold.
The Coy/Sqn must evac their cas to a CCP and ultimately to my UAS. The medical assets for this op are:
The RCD had a Bison Amb with a Cpl QL 5 medic as part of their Sqn,
2 helos on call, and
one of my 3 RCR ambs crewed by a Res F Cpl medic dvr and a QL 3 Pte att at their CCP. The Sqn LO Coyote is the LSVW crews guide, local security and comms.
As part of their Battle procedure the Amb crews liaise and prep the LSVW to be the CCP by breaking down all the stretchers, and secruing them with straps. Extra fd dressings and med supplies are pushed from LS to Bison Amb. (essential kit for no-duff stays in place). For Ex purpose only Fd dressing and triangular badages will be applied. O2, IVs etc will be set beside cas and notionally used.
On the attack run in, the Bison Amb gets blowed up, and the medic survives, gets out of the veh alive and uninjured with FFO and wpn, without medical bag.
They call up the LSVW Amb. The medic is load up on board and we arrive into the camp. It is already passing last light on site and battle well underway as he and the 2 amb crew arrive on scene. On arrival there is already a casualty on the ground: (I need to use my flashlight so medics can read cas card)
Cas 1: a thru and thru GSW to upper right chest (pri 1) unconscious, rapid shallow breathing, rapid pulse. bubbly wound on chest and open fist size wound with minimal bleeding on back.
He gets onto the first cas with med bag from LS: LOC-not responding, A-open, b-poor and asks for O2, c-rapid and weak, chest- notes wound, puts Fd Dressing on, listens to chest- 0 breath sounds. fixes 3 sided dressing over top.
Dvr is now unstrapping and putting togther a stretcher.
During the middle of his Survey cas 2 is dragged over by 2 RCD skirmishers and laid down. Neck wound is dressed. Skirmishers leave.
Cas 2: with shrapnel to the throat (pri 1 or 2). awake, unable to talk, moderate bleeding, airway compromised by blood, choking cas if laid onto back.
Pte Medic takes him, LOC responding, combative, A- not open, blood being spit out. Pte needs help, Cpl assists. A-as before calls for suction, b- yes, but blood filling causing him to choke. Pt is sat up. A-suctioned and open, b-OK, c-rapid and strong, neck wound covered.
Sqn OC comes over asks Cpl whats he has. 2 Pri 1, req air evac. The Sqn medic has done as much as he can and as the critical mission objectives have been achieved, he can evac now. OC says they will call for helo.
The OC Cpl and Dvr load chest wound onto stretcher to prep for transport. I DS cas 2 to sit in truck due to our no duff kit. Medics load stretcher as OC goes to LO, calls helo and directs LO to escort us to LZ.
Time on scene was roughly 6-8 mins.
10 min drive to LZ. In Amb under light:
Cas 1: doing BTLS Rapid Trauma Survey: LOC-still unresponsive A- open clean now secured with OPA, B-still laboured, C-rapid and weak, no rad pulse, Chest-definitely no breath sounds R side, needle decompress- procedure GTG, but no change in pt. BP- 60 palp (Given 80/30 as to query IV question as Bison Amb is fitted with Propaq) P-130 R-25
Cas 2: sitting up ABC no change, bleeding controlled
At the LZ, the Coyote with 3 man crew do overwatch, and gunner is mark the LZ. There is to be a 2 man MRT crew in loc as well but they are not there. The medics unload their 2 cas (leaving a door open and red lights on). The helo is 10-15 mins out at this point.
Cas 1: reassess: as above except breathing not improving, Back now is being checked...noted fist sized hole. filled with 2 fd dressings and covered with fd dressing cover to make air tight. BP-70/0 P-150 B-30. 2 Large bore IV's are attempted, 1 successful, Cpl and Pte is now ds'd out of play for 1 min while Cpl is putting IV.
Dvr reassessing Cas 2, sitting up on ground, no change, covers with blanket.
Treatment and ongoing exams are going on as we heard several loud pops and see 2-3 baddies attacking us from across the LZ, as the helo guide withdraws to his 'yote. The medics scramble to grab their weapons from the back of the amb and begin to return fire. After the trooper remounts his veh the MG opens up. My medics are just sort of sitting watching the en withdraw. I ask what they are doing now. "Going to recheck the cas"...Uhm wrong, you now have won the firefight and the en is withdrawing, load the cas back up and move as your current position is compromised and keep them in the amb until the helo arrives. So they do that.
I assist the RCD Cpl in marking DZ. We use the Y marking because they have only 5 white glowsticks (nobody has NVGs). Due to position on 'yote and amb the marker is at the base of the Y. From where I am outside the amb, the wind is as my back as I face the LZ.
Once the helo arrives, I DS that all medical scenarios are on hold for safety reasons. The Cpl is in charge of the loading. We load the one pri 1 on board. There is some confusion as the FE has the understanding we are loading 3 but I have DS'ed it to 1 stretcher and one walking because we only have the 4 medics (Yes, the Sgt is humping the stretcher too). He tells us to load the as on top...so we try, unhooking him from the bottom, and attempting to lift him to the top. After 2 attempts and some switching of positions we get the heavy bastard up there. As we are strapping him up, I tell the FE there is only 1 stretcher...so he tells us to put it on the middle rack. God darn it. So we do. As we do a sudden surge of snow flurries kick up and on our return trip back to biv we are called back to unload the helo. So we do, but as we are walking the stretcher, the weather clears and the call is made to helo the cas again. So this time instead of lifting the heavy RCD Cpl on the stretcher one more time we just walk our cas to the helo and get them in. One the receiving end of the flight the cas is met by my other UMS Amb and are unloaded.
Overall mission was successful, achieving all aims.
end of scenario
I had a full fmp page of DS notes for the medics and the LO which were handed over at the AAR. To stimulate discussion I will post up my points either eve on the 20th or upon my return from the fd next weekend. I hope I have some more good learning points from doing similar activites with this stand 3x next week.
Rules for this:
I am trying to paint the picture as best I can, but some decision factors I can not recreate here,
it is for learning and discussion,
do not trash my medics, as none of them are here and you were not there,
I leave out what was not done and what was not pertinent to casualty i.e. chest wound...not going to tell you everything else was good.
As for the stand. 3 RCR is doing the Sense Led Raid into a Afghan village and terrorist training camp. The basics of this particular activity is that A Sqn RCD is to enter and secure the compound and cover the approach and withdrawl of SF forces who are going to enter, secure a hostage and exit. Then they are to hand over the area to local police.
There are designated casualties marked with a US Army style card which shows a picture indicating the injuries, and giving minimal pertinent instructions to run the cas sim. Info on card as pertinent here is in bold.
The Coy/Sqn must evac their cas to a CCP and ultimately to my UAS. The medical assets for this op are:
The RCD had a Bison Amb with a Cpl QL 5 medic as part of their Sqn,
2 helos on call, and
one of my 3 RCR ambs crewed by a Res F Cpl medic dvr and a QL 3 Pte att at their CCP. The Sqn LO Coyote is the LSVW crews guide, local security and comms.
As part of their Battle procedure the Amb crews liaise and prep the LSVW to be the CCP by breaking down all the stretchers, and secruing them with straps. Extra fd dressings and med supplies are pushed from LS to Bison Amb. (essential kit for no-duff stays in place). For Ex purpose only Fd dressing and triangular badages will be applied. O2, IVs etc will be set beside cas and notionally used.
On the attack run in, the Bison Amb gets blowed up, and the medic survives, gets out of the veh alive and uninjured with FFO and wpn, without medical bag.
They call up the LSVW Amb. The medic is load up on board and we arrive into the camp. It is already passing last light on site and battle well underway as he and the 2 amb crew arrive on scene. On arrival there is already a casualty on the ground: (I need to use my flashlight so medics can read cas card)
Cas 1: a thru and thru GSW to upper right chest (pri 1) unconscious, rapid shallow breathing, rapid pulse. bubbly wound on chest and open fist size wound with minimal bleeding on back.
He gets onto the first cas with med bag from LS: LOC-not responding, A-open, b-poor and asks for O2, c-rapid and weak, chest- notes wound, puts Fd Dressing on, listens to chest- 0 breath sounds. fixes 3 sided dressing over top.
Dvr is now unstrapping and putting togther a stretcher.
During the middle of his Survey cas 2 is dragged over by 2 RCD skirmishers and laid down. Neck wound is dressed. Skirmishers leave.
Cas 2: with shrapnel to the throat (pri 1 or 2). awake, unable to talk, moderate bleeding, airway compromised by blood, choking cas if laid onto back.
Pte Medic takes him, LOC responding, combative, A- not open, blood being spit out. Pte needs help, Cpl assists. A-as before calls for suction, b- yes, but blood filling causing him to choke. Pt is sat up. A-suctioned and open, b-OK, c-rapid and strong, neck wound covered.
Sqn OC comes over asks Cpl whats he has. 2 Pri 1, req air evac. The Sqn medic has done as much as he can and as the critical mission objectives have been achieved, he can evac now. OC says they will call for helo.
The OC Cpl and Dvr load chest wound onto stretcher to prep for transport. I DS cas 2 to sit in truck due to our no duff kit. Medics load stretcher as OC goes to LO, calls helo and directs LO to escort us to LZ.
Time on scene was roughly 6-8 mins.
10 min drive to LZ. In Amb under light:
Cas 1: doing BTLS Rapid Trauma Survey: LOC-still unresponsive A- open clean now secured with OPA, B-still laboured, C-rapid and weak, no rad pulse, Chest-definitely no breath sounds R side, needle decompress- procedure GTG, but no change in pt. BP- 60 palp (Given 80/30 as to query IV question as Bison Amb is fitted with Propaq) P-130 R-25
Cas 2: sitting up ABC no change, bleeding controlled
At the LZ, the Coyote with 3 man crew do overwatch, and gunner is mark the LZ. There is to be a 2 man MRT crew in loc as well but they are not there. The medics unload their 2 cas (leaving a door open and red lights on). The helo is 10-15 mins out at this point.
Cas 1: reassess: as above except breathing not improving, Back now is being checked...noted fist sized hole. filled with 2 fd dressings and covered with fd dressing cover to make air tight. BP-70/0 P-150 B-30. 2 Large bore IV's are attempted, 1 successful, Cpl and Pte is now ds'd out of play for 1 min while Cpl is putting IV.
Dvr reassessing Cas 2, sitting up on ground, no change, covers with blanket.
Treatment and ongoing exams are going on as we heard several loud pops and see 2-3 baddies attacking us from across the LZ, as the helo guide withdraws to his 'yote. The medics scramble to grab their weapons from the back of the amb and begin to return fire. After the trooper remounts his veh the MG opens up. My medics are just sort of sitting watching the en withdraw. I ask what they are doing now. "Going to recheck the cas"...Uhm wrong, you now have won the firefight and the en is withdrawing, load the cas back up and move as your current position is compromised and keep them in the amb until the helo arrives. So they do that.
I assist the RCD Cpl in marking DZ. We use the Y marking because they have only 5 white glowsticks (nobody has NVGs). Due to position on 'yote and amb the marker is at the base of the Y. From where I am outside the amb, the wind is as my back as I face the LZ.
Once the helo arrives, I DS that all medical scenarios are on hold for safety reasons. The Cpl is in charge of the loading. We load the one pri 1 on board. There is some confusion as the FE has the understanding we are loading 3 but I have DS'ed it to 1 stretcher and one walking because we only have the 4 medics (Yes, the Sgt is humping the stretcher too). He tells us to load the as on top...so we try, unhooking him from the bottom, and attempting to lift him to the top. After 2 attempts and some switching of positions we get the heavy bastard up there. As we are strapping him up, I tell the FE there is only 1 stretcher...so he tells us to put it on the middle rack. God darn it. So we do. As we do a sudden surge of snow flurries kick up and on our return trip back to biv we are called back to unload the helo. So we do, but as we are walking the stretcher, the weather clears and the call is made to helo the cas again. So this time instead of lifting the heavy RCD Cpl on the stretcher one more time we just walk our cas to the helo and get them in. One the receiving end of the flight the cas is met by my other UMS Amb and are unloaded.
Overall mission was successful, achieving all aims.
end of scenario
I had a full fmp page of DS notes for the medics and the LO which were handed over at the AAR. To stimulate discussion I will post up my points either eve on the 20th or upon my return from the fd next weekend. I hope I have some more good learning points from doing similar activites with this stand 3x next week.
