Tactical combat casualty care ( TCCC )
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In the past, we've debated the best way to achieve a high standard of medical care under tactical conditions.
We've debated the deltas to be covered from a civilian paramedic to a deployable medical technician, we've covered topics to be taught to bring a cbt arms member up to a Cbt FR level; we've debated fluid resuscitation methodology, techniques and procedures, pre-MTF analgesia, training plans and techniques.
We've discussed reserve HS medic employment, and we've discussed limitation on skills and their maintenance. We've seen several different skill sets presented as "the solution," and progress seems to be proceeding apace at developing a national-level course to give our "sharp end" more ability to look after their wounded prior to contact with HS staff.
In the "CSS Less Deserving" thread, Infanteer summarized four attributes of a combat-ready CSS member: Physical preparedness for the rigors of combat; Mental preparedness for the psychology of combat (will to combat?-Author); Skill at arms (and a willingness to use them-Author); and tactical awareness. I won't dispute Infanteers analysis of this.
These leads me to consider which medical personnel have these attributes, fairly consistently, across a spectrum of the CF units, and are best able to provide medical support. Then it hit me. The pers who best embody these qualities aren't CF medical pers at all. In fact, most that I've encountered are extremely opposed to joining the CFHS. They're the Res Cbt Arms members who are also EMS. As Armymedic pointed out, tactical medicine is best achieved when
"both the shooters and the medics (regardless of the tactical situation) ...know and understand certain protocols that will aid in the rapid treatment of life threatening injuries." http://forums.army.ca/forums/threads/26415.210.html
Currently, these people are being told specifically that, unless employed as a 737, they are not authorized to provide treatment as a 737. This is due to the fact that:
"All medical services and treatments provided to the members of the CF fall under the legal responsibilities of the Surg Gen. Those responsibilities are delegated down thru (sic) the med chain to the lowest level at the MO, PA, NP level. Med Techs are authorized to provide medical services with a specific scope of practice that is allowed thru that chain, but ultimately its the supervising MO, PA or NP who is responsible for maintenance of the standard." Armymedic http://forums.army.ca/forums/threads/26415.135.html
Several posters have pointed out that, not only must we improve the medical skills of our cbt arms mbrs, but we must improve the tactical capabilities of our medics, and equip them with a skill set that embodies Infanteer's Four Points, and gives them the approach to provide only the necessary care required, as dictated by the tenets of TCCC.
Dr King expressed his concerns as to the advanced nature of the skill sets required to intervene in life-threatening battlefield wounds.
"There are some significant interventions taught in TCCC. Too short a course risks producing grads who are simply dangerous. ... Again, it is essential that there be an FTX component. Otherwise, we are simply teaching a medical course. The tactical component is just as important, if not more important to producing competent grads."
Dr Roger King
http://forums.army.ca/forums/threads/26415.150.html
The shooters have shown a remarkable interest in this topic. They want to look after their own, and they want medics who can look after themselves, put rounds on target when required, and provide the care needed without compromising the mission. But, we're handcuffing the people best able to provide this. One of the principle reasons these people are opposed to remustering is the reorganization of the HS and the "calling home" of the medics to the Fd Ambs, which is understandable. In the Res world, loyalty tends to lie with the Regiment, not the trade.
Acknowledging that there is a delta to be crossed to bring any res force member up to a deployable standard, is this delta perhaps not best crossed by someone who's clinically current and tactically aware? By someone who's used to working with both an infantry/ armoured/ eng/ arty unit AND taking care of sick and broken people? We need to embrace these paramedic/infanteers, not tell them they can't take care of their own because the CF won't cover them.
I'm not advocating a return to reserve trained med-a's on their own in UMS, or even to Reg F medics spending years in UMS. WRT the Reservists, they have neither the skills nor the experience to be working as we did in the past (fun as it was), and the Reg F are too few in number to dole out as they were, but these people who hold a civi license can be bridged to a working knowledge of CFHS procedures much more quickly then we can bridge a medic to be a integral member of an LIB, and provide a level of experience you will not see in a typical Reg F med tech.
Obviously there are exceptions. The medics who spent years in 2 Cdo, or was a crewman in the LdSH, or a Diver or Bos'n are clearly going to have a better understanding as to what's what in their old unit's operations.
Sqn Medic, Old Ranger, I'm especially interested in your views on this,
DF
We've debated the deltas to be covered from a civilian paramedic to a deployable medical technician, we've covered topics to be taught to bring a cbt arms member up to a Cbt FR level; we've debated fluid resuscitation methodology, techniques and procedures, pre-MTF analgesia, training plans and techniques.
We've discussed reserve HS medic employment, and we've discussed limitation on skills and their maintenance. We've seen several different skill sets presented as "the solution," and progress seems to be proceeding apace at developing a national-level course to give our "sharp end" more ability to look after their wounded prior to contact with HS staff.
In the "CSS Less Deserving" thread, Infanteer summarized four attributes of a combat-ready CSS member: Physical preparedness for the rigors of combat; Mental preparedness for the psychology of combat (will to combat?-Author); Skill at arms (and a willingness to use them-Author); and tactical awareness. I won't dispute Infanteers analysis of this.
These leads me to consider which medical personnel have these attributes, fairly consistently, across a spectrum of the CF units, and are best able to provide medical support. Then it hit me. The pers who best embody these qualities aren't CF medical pers at all. In fact, most that I've encountered are extremely opposed to joining the CFHS. They're the Res Cbt Arms members who are also EMS. As Armymedic pointed out, tactical medicine is best achieved when
"both the shooters and the medics (regardless of the tactical situation) ...know and understand certain protocols that will aid in the rapid treatment of life threatening injuries." http://forums.army.ca/forums/threads/26415.210.html
Currently, these people are being told specifically that, unless employed as a 737, they are not authorized to provide treatment as a 737. This is due to the fact that:
"All medical services and treatments provided to the members of the CF fall under the legal responsibilities of the Surg Gen. Those responsibilities are delegated down thru (sic) the med chain to the lowest level at the MO, PA, NP level. Med Techs are authorized to provide medical services with a specific scope of practice that is allowed thru that chain, but ultimately its the supervising MO, PA or NP who is responsible for maintenance of the standard." Armymedic http://forums.army.ca/forums/threads/26415.135.html
Several posters have pointed out that, not only must we improve the medical skills of our cbt arms mbrs, but we must improve the tactical capabilities of our medics, and equip them with a skill set that embodies Infanteer's Four Points, and gives them the approach to provide only the necessary care required, as dictated by the tenets of TCCC.
Dr King expressed his concerns as to the advanced nature of the skill sets required to intervene in life-threatening battlefield wounds.
"There are some significant interventions taught in TCCC. Too short a course risks producing grads who are simply dangerous. ... Again, it is essential that there be an FTX component. Otherwise, we are simply teaching a medical course. The tactical component is just as important, if not more important to producing competent grads."
Dr Roger King
http://forums.army.ca/forums/threads/26415.150.html
The shooters have shown a remarkable interest in this topic. They want to look after their own, and they want medics who can look after themselves, put rounds on target when required, and provide the care needed without compromising the mission. But, we're handcuffing the people best able to provide this. One of the principle reasons these people are opposed to remustering is the reorganization of the HS and the "calling home" of the medics to the Fd Ambs, which is understandable. In the Res world, loyalty tends to lie with the Regiment, not the trade.
Acknowledging that there is a delta to be crossed to bring any res force member up to a deployable standard, is this delta perhaps not best crossed by someone who's clinically current and tactically aware? By someone who's used to working with both an infantry/ armoured/ eng/ arty unit AND taking care of sick and broken people? We need to embrace these paramedic/infanteers, not tell them they can't take care of their own because the CF won't cover them.
I'm not advocating a return to reserve trained med-a's on their own in UMS, or even to Reg F medics spending years in UMS. WRT the Reservists, they have neither the skills nor the experience to be working as we did in the past (fun as it was), and the Reg F are too few in number to dole out as they were, but these people who hold a civi license can be bridged to a working knowledge of CFHS procedures much more quickly then we can bridge a medic to be a integral member of an LIB, and provide a level of experience you will not see in a typical Reg F med tech.
Obviously there are exceptions. The medics who spent years in 2 Cdo, or was a crewman in the LdSH, or a Diver or Bos'n are clearly going to have a better understanding as to what's what in their old unit's operations.
Sqn Medic, Old Ranger, I'm especially interested in your views on this,
DF
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WOW! Your synopsis is bang on. You're absolutely right that detached medics to cbt arms units tend to consider themselves members of that unit as opposed to the Fd Amb that pays them. Why? I feel, at least in my case, that medics are a valued commodity to that unit. And the unit we support make us feel that we are one of them. We are invited to train along side them in their trade and likewise they learn from us a few tricks of our trade. We compliment each other like some sort of symbiotic relationship.
When we are at our Fd ambs though we as individuals disappear. We become just another medic in a medical unit and whose skill is not unique to the unit. It may be a vain way to think about it but it's true.
I like you stated feel that cbt arms soldiers are very interested in the medical/trauma field. Whenever I'm on ex's I always answering very good and well thought out questions from infanteers and gunners etc. who are genuinely keen about casulty care. So why not train them up to a higher standard of casualty care? TCCC is a fantasic start.
I think that as a medic in a cbt arms unit you automatically get a sense that there is a sort of "tactical" aire about the training. Something you dont get while in a medical unit. And as a member of that cbt unit you are expected to be as proficient as they are in weapons drills etc. Hell the other day I learned how to saftey precaution the C7 with M203 for the first time. But it was expected of me. So why would it not be expected of me to be able to look after myself in a fire fight? I know that I have a lot to learn about cbt tactics but I'm sure I'm going to get taught this as a member of this unit.
Being civy trained as an ACP my skills are relied upon by the medical unit and the cbt arms unit. I have been "told" that I can practice up to my scope of practice. Which is great as long as I have my CO and CFMG baking me up. Are they? I dont know. I think my CO will but not so sure about CFMG. And what of civy trained PCP's are they able to practice up to their scope of practice? Also are they not able to learn and practice the skills that TCCC teaches to non medical pers? ie; needle decompression etc.
It's very frustrating time being a medic in the army today. In my perfect world you'd be able to have medics attaced to cbt arms units instructing TCCC to the troops but also returning to the Fd ambs for contiuation and upgrade training all the while becoming more proficient in their personal battle skills making them indeed a very integral part of the combat unit and not just a liability.
Thats all for now. I'll have to read your post again to think of more points to add.
DT
CHIMO
When we are at our Fd ambs though we as individuals disappear. We become just another medic in a medical unit and whose skill is not unique to the unit. It may be a vain way to think about it but it's true.
I like you stated feel that cbt arms soldiers are very interested in the medical/trauma field. Whenever I'm on ex's I always answering very good and well thought out questions from infanteers and gunners etc. who are genuinely keen about casulty care. So why not train them up to a higher standard of casualty care? TCCC is a fantasic start.
I think that as a medic in a cbt arms unit you automatically get a sense that there is a sort of "tactical" aire about the training. Something you dont get while in a medical unit. And as a member of that cbt unit you are expected to be as proficient as they are in weapons drills etc. Hell the other day I learned how to saftey precaution the C7 with M203 for the first time. But it was expected of me. So why would it not be expected of me to be able to look after myself in a fire fight? I know that I have a lot to learn about cbt tactics but I'm sure I'm going to get taught this as a member of this unit.
Being civy trained as an ACP my skills are relied upon by the medical unit and the cbt arms unit. I have been "told" that I can practice up to my scope of practice. Which is great as long as I have my CO and CFMG baking me up. Are they? I dont know. I think my CO will but not so sure about CFMG. And what of civy trained PCP's are they able to practice up to their scope of practice? Also are they not able to learn and practice the skills that TCCC teaches to non medical pers? ie; needle decompression etc.
It's very frustrating time being a medic in the army today. In my perfect world you'd be able to have medics attaced to cbt arms units instructing TCCC to the troops but also returning to the Fd ambs for contiuation and upgrade training all the while becoming more proficient in their personal battle skills making them indeed a very integral part of the combat unit and not just a liability.
Thats all for now. I'll have to read your post again to think of more points to add.
DT
CHIMO
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Duh! :
I just got the jist of your post. Infanteers, gunners, sappers, and armoured troops that have civy paramedic quals should be able to provide cas care to their own in a tacitcal situation, by all means. Like you said they already have the tactical awareness and the combat experience. However I think you can also train medical pers to have the same tactical skills a cbt arms soldier has. They too had to learn these skills so why cant we? In the civy world some people believe that as a paramedic I work for the fire dept therefore must be a firefighter. Or they say whats the difference? between a firefighter and a paramedic. We have a saying ... "you can train a paramedic to be a firefigher but you cant teach a firefighter to be a paramedic". I would'nt sell medical pers short on learning battle skills.
There are some medics who dont want to be in a cbt situation. They would prefer to be in a stable clinical environment. Which is cool and very important. But I feel you also need medics at ground zero if you will. They need to be on the scene.
Now I understand the fact that the civy trained infanteer/paramedic would be there also but his job is to be an infanteer. His sect. comd would be without a member of his sect. because he/she is providing cas care. If a tactical medic was there you would have just had an extra weapon at the fire fight. So no big deal when it's not there during the consolidation phase.
That's one reason medics should not have been pulled out of cbt arms units. If medics could stay in an inf. reg for example they would learn all the battle skills. So if a infanteer did have medic quals thats great, he/she can give the medic a hand when theres time for him/her to do so.
DT
CHIMO
I just got the jist of your post. Infanteers, gunners, sappers, and armoured troops that have civy paramedic quals should be able to provide cas care to their own in a tacitcal situation, by all means. Like you said they already have the tactical awareness and the combat experience. However I think you can also train medical pers to have the same tactical skills a cbt arms soldier has. They too had to learn these skills so why cant we? In the civy world some people believe that as a paramedic I work for the fire dept therefore must be a firefighter. Or they say whats the difference? between a firefighter and a paramedic. We have a saying ... "you can train a paramedic to be a firefigher but you cant teach a firefighter to be a paramedic". I would'nt sell medical pers short on learning battle skills.There are some medics who dont want to be in a cbt situation. They would prefer to be in a stable clinical environment. Which is cool and very important. But I feel you also need medics at ground zero if you will. They need to be on the scene.
Now I understand the fact that the civy trained infanteer/paramedic would be there also but his job is to be an infanteer. His sect. comd would be without a member of his sect. because he/she is providing cas care. If a tactical medic was there you would have just had an extra weapon at the fire fight. So no big deal when it's not there during the consolidation phase.
That's one reason medics should not have been pulled out of cbt arms units. If medics could stay in an inf. reg for example they would learn all the battle skills. So if a infanteer did have medic quals thats great, he/she can give the medic a hand when theres time for him/her to do so.
DT
CHIMO
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I'm going to take counter point on this one gentlemen.
This summed it up. If your a paramedic, and your not at work, then your probably not a paramedic.
Paramedics can only perform delegated acts under the medical licence of their medical director or base hospital
physician while on duty. They can not walk around on their time off practicing medicine or doing invasive procedure.
A medic should only be performing what their trade quals and their MO allows them to perform (standing orders). Civy paramedic quals
(myself included) are no good without green quals and the medical chain allowing me to perform skill sets.
Check with one of the MO's at your Field Ambulance. It's the medical chain of command you will wind up answering too.
Cheers.
This summed it up. If your a paramedic, and your not at work, then your probably not a paramedic.
Paramedics can only perform delegated acts under the medical licence of their medical director or base hospital
physician while on duty. They can not walk around on their time off practicing medicine or doing invasive procedure.
A medic should only be performing what their trade quals and their MO allows them to perform (standing orders). Civy paramedic quals
(myself included) are no good without green quals and the medical chain allowing me to perform skill sets.
Check with one of the MO's at your Field Ambulance. It's the medical chain of command you will wind up answering too.
Cheers.
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Hey Old Medic. as it pertains to me it was actually my CO who is an MO who said I can practice as an ACP while wearing green, so did my DCO who is a NO and my RSM is a PA. I hope this is enough to allow me to practice. What do you think? Obviously I have to prove my quals yearly. I would like something in writing though.
DT
CHIMO
DT
CHIMO
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Amen ;D
In regards to ParaMedtech's suggestion of combat arms troops that happen to be paramedics provide cas care, what if they had some affliliation to the closest Fd Ambs that would recognize their individual quals. If they recognize med tech's quals as ACP or PCP why not Bombardier Bloggins civy paramedic quals? On the same idea the Good Samaratan Act allows an individual to apply aid up to the level of care that the individual has been trained. So they in essence can care for the casualties as a good samaratan could'nt they?
DT
CHIMO
In regards to ParaMedtech's suggestion of combat arms troops that happen to be paramedics provide cas care, what if they had some affliliation to the closest Fd Ambs that would recognize their individual quals. If they recognize med tech's quals as ACP or PCP why not Bombardier Bloggins civy paramedic quals? On the same idea the Good Samaratan Act allows an individual to apply aid up to the level of care that the individual has been trained. So they in essence can care for the casualties as a good samaratan could'nt they?
DT
CHIMO
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What is missing in the above is a lot of those civy qualifiaction or protocals are irrelevant in a combat trauma scenario.
Where we jump to deadly bleeding some paramedic is busying pissing around with an airway.
We are using Tourniquets and that makes a lot of people cringe.
The fact that the CF keeps trying to shove USELESS (For COmbat Trauma) St John's First Aid down our throats does not help either.
IF the CF medical world wants to hang onto trauma medicine - it had best come up with a plan to either split the medic stream into tectical medicine and clinical -- or be VERY upfront and explain to the medics they are shooters first, and the namby pamby crap of I dotn want to carry a gun today is not going to cut it.
Where we jump to deadly bleeding some paramedic is busying pissing around with an airway.
We are using Tourniquets and that makes a lot of people cringe.
The fact that the CF keeps trying to shove USELESS (For COmbat Trauma) St John's First Aid down our throats does not help either.
IF the CF medical world wants to hang onto trauma medicine - it had best come up with a plan to either split the medic stream into tectical medicine and clinical -- or be VERY upfront and explain to the medics they are shooters first, and the namby pamby crap of I dotn want to carry a gun today is not going to cut it.
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I know that uncontrolled bleeding was the leading cause of death of soldiers during the Vietnam War, thus TCCC states that the bleed should be controlled prior to anything else. I'm not intending to insult your common sense but we're not going to piss around with an airway if dosent need to be dealt with. But I have a hard time understanding the theory of putting a fd dressing on someone who isn't breathing or has an airway. If you dont deal with the obstructed airway or lack of breathing the bleed will quickly be controlled on it's own. Then again if the cas isn't breathing chances are they're not going to make it anyway.
I appreciate the fact that you have been on tours and you have taken TCCC. So you know the difference's between non medical pers TCCC and our medical training. And your right. Civy protocols dont always apply to the military or a tactical situation. What we need is to return medics to combat arms units and not only have coy medics but platoon medics or even section medics. The medics you speak of that dont want to carry a weapon are the personnel that want to be in a clinical setting and tactical medicine is not for them. Fair enough. They fill an important role in its own right. But there are medics out there that prefer to be in the bush or in the urban ops working the tactical side of things (ooh pick me! pick me! ;D).
I think the point is though that if you already have fully trained medics whether civy or military trained they need to be taught battle skills and not shuffled away from the lines so they can provide the care that TCCC is geared to supplement.
Also I'm pretty sure the CF isn't expecting you to perform St. John's FA duing a fire fight. I think its more for when we're in garrison etc.
DT
CHIMO
I appreciate the fact that you have been on tours and you have taken TCCC. So you know the difference's between non medical pers TCCC and our medical training. And your right. Civy protocols dont always apply to the military or a tactical situation. What we need is to return medics to combat arms units and not only have coy medics but platoon medics or even section medics. The medics you speak of that dont want to carry a weapon are the personnel that want to be in a clinical setting and tactical medicine is not for them. Fair enough. They fill an important role in its own right. But there are medics out there that prefer to be in the bush or in the urban ops working the tactical side of things (ooh pick me! pick me! ;D).
I think the point is though that if you already have fully trained medics whether civy or military trained they need to be taught battle skills and not shuffled away from the lines so they can provide the care that TCCC is geared to supplement.
Also I'm pretty sure the CF isn't expecting you to perform St. John's FA duing a fire fight. I think its more for when we're in garrison etc.
DT
CHIMO
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Well considering we had to do St John's as our Afghan medialcal refresher check in the box...
WE HAD ZERO other medical famils...
I'm not saying ignore civy courses - but I am cautioning -- we have had problems in the past with some 031 trade EMT's and St John's Amb instructors...
CPR being a case in point - Trying to explain there is no point in trying to revive a GSW who's heart has stopped...
WE HAD ZERO other medical famils...
I'm not saying ignore civy courses - but I am cautioning -- we have had problems in the past with some 031 trade EMT's and St John's Amb instructors...
CPR being a case in point - Trying to explain there is no point in trying to revive a GSW who's heart has stopped...
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I hear ya. I'm a St. John's FA instuctor as well but trust me I'm not a slave to it's policy, or the CF's regarding the absolute need to have it in theatre.
I'm not sure about your experiences with medics or medic trained infanteers but not all of us think you can save the world by pushing on someones chest. Some of us are realistic. Thats another reason to have military medics ride out on civy ambs to expose them to the death's of patients, and again keep those medics with combat units.
DT
CHIMO
I'm not sure about your experiences with medics or medic trained infanteers but not all of us think you can save the world by pushing on someones chest. Some of us are realistic. Thats another reason to have military medics ride out on civy ambs to expose them to the death's of patients, and again keep those medics with combat units.
DT
CHIMO
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Kevin, Ack on the utility of standard treatments in a cbt environment, I am saying that someone with time treating sick and injured is better then someone without it. I'm advocating that we take these pers and train them in tactical care, and then authorize them to use it. That, if you had someone like Kopp in your section, that they, with appropriate training, would be the best bet for a high level of field care under fire.
I've said before, and I'll say it again, that having people run around punching needles into peoples chests is something we may regret. I'd much rather have someone who has seen respiratory distress go from bad to worse to life threatening make that call then someone whose exposure to it is "cyanosis is bad, mmmkay? Your next class is ..."
TCCC isn't the end-all and be-all of care--surgery is, it's trauma!
With regards to trauma-induced cardiac arrest, the civi world is realizing that prehospital penetrating trauma arrests are almost uniformly irretrievable in the field, even with a short transport to a facility that can crack the chest. Even worse outcomes for blunt trauma.
Sqn Medic, that's exactly what I'm advocating, that Med Gp take these cbt arms members with medical training, and embrace them, familiarize them to our equipment, run them through a Cbt FR, and employ them as such.
OM, what I'm advocating is that we provide these people with the medical direction they need to operate at their standard of care, that we 'bring them into the fold' so to speak, in the same way you were cautioning Sqn Medic about his oversight.
DF
I've said before, and I'll say it again, that having people run around punching needles into peoples chests is something we may regret. I'd much rather have someone who has seen respiratory distress go from bad to worse to life threatening make that call then someone whose exposure to it is "cyanosis is bad, mmmkay? Your next class is ..."
TCCC isn't the end-all and be-all of care--surgery is, it's trauma!
With regards to trauma-induced cardiac arrest, the civi world is realizing that prehospital penetrating trauma arrests are almost uniformly irretrievable in the field, even with a short transport to a facility that can crack the chest. Even worse outcomes for blunt trauma.
Sqn Medic, that's exactly what I'm advocating, that Med Gp take these cbt arms members with medical training, and embrace them, familiarize them to our equipment, run them through a Cbt FR, and employ them as such.
OM, what I'm advocating is that we provide these people with the medical direction they need to operate at their standard of care, that we 'bring them into the fold' so to speak, in the same way you were cautioning Sqn Medic about his oversight.
DF
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KevinB said:
Especially when the second round of the three round burst hits a little north of center of mass.
Actually its not so much the cause of cardiac arrest that will determine the worth of doing CPR, but the time until you can hook up that little shocky making machine to the patient...10% decrease in survivability/minute...so after 10 mins, they are FUBAR'ed
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Yes, and we all carry an AED in our jump bags. NB when we are doing dismounted support.
Lets not forget that CPR is very time consuming. The time you take on a casualty thats heart has actually stopped in a mass casualty environment will cause more pers to deteriorate from lack of care.
The needs of the many out weigh the needs of the one.
GF
Lets not forget that CPR is very time consuming. The time you take on a casualty thats heart has actually stopped in a mass casualty environment will cause more pers to deteriorate from lack of care.
The needs of the many out weigh the needs of the one.
GF
"Actually its not so much the cause of cardiac arrest that will determine the worth of doing CPR, but the time until you can hook up that little shocky making machine to the patient"
This is interesting! So when the cause of cardiac arrest is a a big hole in the heart, or maybe the aorta and theres no blood left for preload so the heart stops beating - asystole - then how does an AED work? What will CPR do? And when you've got a guy shot throught the arm hole in his vest and he's got a nasty tension with delayed care, so he arrests with PEA, how does this AED work again? The cause of cardiac arrest IS actually very relivent to determine whether CPR will be effective. AED's may be usefull in certain environmental injuries and certain illnesses, but how many drownings, electrocutions, hypothermia's, MI's occur in theatre? Potentially, but is it worth humpin that piece of kit for the few that may or may not happen, or should emphasis be on prevention of those injuries and illness?
This is interesting! So when the cause of cardiac arrest is a a big hole in the heart, or maybe the aorta and theres no blood left for preload so the heart stops beating - asystole - then how does an AED work? What will CPR do? And when you've got a guy shot throught the arm hole in his vest and he's got a nasty tension with delayed care, so he arrests with PEA, how does this AED work again? The cause of cardiac arrest IS actually very relivent to determine whether CPR will be effective. AED's may be usefull in certain environmental injuries and certain illnesses, but how many drownings, electrocutions, hypothermia's, MI's occur in theatre? Potentially, but is it worth humpin that piece of kit for the few that may or may not happen, or should emphasis be on prevention of those injuries and illness?
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janes,
Once again your observations are astute to the point of the mundane. If you were to actually READ what was posted instead of jumping on the last post made you would see that the majority are saying that CPR has virtually no place in phase I or II of TCCC.
I also note that you are still resistant to filling out your profile.
Once again your observations are astute to the point of the mundane. If you were to actually READ what was posted instead of jumping on the last post made you would see that the majority are saying that CPR has virtually no place in phase I or II of TCCC.
I also note that you are still resistant to filling out your profile.
medicineman
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As an ER doc so aptly put it on grand rounds one day - PEA with no blood still equals DEAD - so I'd say the cause of arrest has alot to do with whether or not you should do CPR. In combat, bad idea - ties up resources and makes you a very intriguing target.
MM
MM
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yeah yeah...first step of PEA algorithm is to attempt to correct the causemedicineman said:
And, yes, Cardiac arrest caused by penetrating chest trauma has less then a 1% survival rate.
My point was for the nonmedical troops, in response to KevB:
the cause of pulselessness is not what should prevent you from doing CPR, but it should be determined by time and resources.
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I appreciate I am preaching to the choir in here.
But there are a bunch of CFMS pers that need to be dragged kicking and screaming into the 21st Century. Of course I dont think that ratio is any different from other trades that are out to lunch.
Medics have to get more combat oriented -- We had one Cpl show up with a weapon, and then I lost a pissing match with a incredibly obstanate and obtuse MWO (Medic) when I made her go back and get her weapon.
I'd like to see TCCC courses become more wide spread and Advanced TCCC as well.
FWIW with needle decompressions I had a SF medic explain to me with the holes in the chest that you will already have, then one itty bitty needle hole is not going to make any changes for the worse...
Armymedic - time and resources - something I am unlikely to have in the field... But I agree if they are available - the casualty with get the best standard of care that we can afford to provide.
But there are a bunch of CFMS pers that need to be dragged kicking and screaming into the 21st Century. Of course I dont think that ratio is any different from other trades that are out to lunch.
Medics have to get more combat oriented -- We had one Cpl show up with a weapon, and then I lost a pissing match with a incredibly obstanate and obtuse MWO (Medic) when I made her go back and get her weapon.
I'd like to see TCCC courses become more wide spread and Advanced TCCC as well.
FWIW with needle decompressions I had a SF medic explain to me with the holes in the chest that you will already have, then one itty bitty needle hole is not going to make any changes for the worse...
Armymedic - time and resources - something I am unlikely to have in the field... But I agree if they are available - the casualty with get the best standard of care that we can afford to provide.
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