So we are no
longer under effective hostile fire and have reached
fire superiority. Now we can start caring
for the casualties. This is known as:
Tactical Field Care. At this point we will be
calling for a MEDEVAC, ASAP. We know things are going bad, so
we start bringing in the bird. Next we will start with
the redistribution of resources, if you haven't done that already
in the Care Under Fire phase. And if a guy is carrying mission sensitive
items we need those in safe hands. And also in the event that you're
giving our guy any painkillers and he's high as a kite, we really
don't want him holding on to his weapon and grenades. Also we need his ammo
for our security detail. Remember, this can change
at any given moment. So we're not out
of the woods yet. So be careful, before you start
taking care of your casualties. Make sure the place is secure and
maintain a 360-degree safety perimeter. And as needed do a
triage of the casualties. Oh yeah, if you find the
casualty with politrauma. In English: our guys is really fucked
up, without a pulse, no respirations and other vital signs,
we don't resuscitate. No CPR. “Tactical Field Phase”. Now let's jump right
into our assessment. We got our security set. I like to teach my guys the
simple acronym M.A.R.C.H., which stands for massive
bleeding, airway management, respiration, circulation, head
injury, hypovolemia and hypothermia. And now let's start
with massive bleeding. Basically, massive bleeding is everything
you see that's really bad, that's bleeding. You need to cover it.
No small boo-boos. But first of all, if our guy put the
tourniquet on in the care under fire phase, we double check it, if it's on
correctly, if it's on high and tight. Okay, everything
seems to be in order. If the tourniquet is not holding,
you put one next to it side by side. Cinch it in
and leave both in place. Okay, he did a good job.
I'm a good medic. Now check the neck, check the
X pockets, check the groin. If you see any blood, you cut the
uniform, you expose the bleed. If it's bad, you pack it in with a combat
gauze or any other hemostatic agent. Okay, you do a visual
sweep of his body. No bleeds.
Okay, good. You always talk with your guy. Hey buddy, are you okay?
Okay, say “I’m okay”. I’m okay. What does that okay mean to us? That means that his airway
is open, it’s patent. We don't need to waste
time checking it. If he's making any sense of
his words, like he's like: “God damn son of a bitch”
or something like that, PC correct, that means
that he's making sense. He's getting some blood into
his brain, he's getting oxygen and that means he's not
in shock at this moment. If he's doing like: I become an officer, okay
he's apparently losing it. He's not getting enough oxygen in his
brain, he’s probably going into shock. If you haven't
done that already, you take away his weapon, radio,
grenades, so he doesn't do any damage. We take away his magazines, give it to the security
detail, because they need it and that pretty much
sums up the massive bleeding portion of our M.A.R.C.H.
protocol. Now we're going into
“A”, airway management. If the patient is not talking with
us, we need to open this airway. We need to clean it, maybe
he has some snus in it. You need to listen
here for breathing. We can multi-task and see the rise and fall
of the chest. Okay he's breathing with us.
Okay that's wonderful. If he's unconscious, we
need to secure the airway. We can do that in
multiple different ways. We're gonna do it with an
NPA, nasopharyngeal airway, which is basically a nose tube.
Yes, it's funny a tube in his body. We're gonna take it
out of his IFAK. We take an NPA, we take
our trusty lubricant. I'm not gonna make fun of him why
he has lubricant in his IFAK. It can be used in
many different ways. I hope it's being
used only for the NPA. Level towards the septum. Okay, we check.
Okay he's breathing, awesome. Don't forget to tape it down. What we do if you don't have an NPA,
we can put him in a recovery position, this is the least
that we can do. The rule of thumb: If he's awake
and can't breathe and we're forcing him to stay on his back
and he doesn't want it, don't force him. Maybe he has facial trauma and the
blood is pooling into his airway. Lean him on his side. Okay.
Anything that helps him breathe. If he wants to stand up and the tactical
situation permits it, he can stand up. Whatever helps him breathe. Okay are you okay,
are you comfortable? Okay awesome. Okay, that pretty much sums up the
“A” portion from the M.A.R.C.H. algorithm. Now we go into respiration. Now we're going into the “R” portion of
our M.A.R.C.H. algorithm. Respiration. Basically that means we're gonna
check if we have any holes in the box. By the box I mean from the
nose to the bellybutton, if there's any holes, we put
an occlusive dressing on. But first of all,
we expose the chest. We'll check the neck. You check the armpits. We look for breathing bilateral
rise and fall of the chest. If we're too stressed out to hear
or see breathing, we take our hands. You say “no homo”
and we feel for breathing. Okay, good bilateral rise
and fall. Nice. Now we pray a bit. We go up. If we see any discoloration on the
collarbone, probably it’s broken. We're not gonna do any good, if we
find out, yes exactly it's broken. We just read it, it's broken. Now it's okay.
We just walk. Okay nice. We go on one side
of the rib cage. You do just a little
bit of a squeeze. We check if he's
doing like a grimace. If he's doing like
“Aaah” you stop. Nice. If we did find a hole
was here, use your hand. Put it on. Get an occlusive dressing. Open it up. Usually I pre-pack my
occlusive dressing with an NCE. Oh, I have troubles opening it. What do you do?
Don't be afraid to let it go. You're gonna be faster taking out
an occlusive dressing, wipe it off and put it on. Then like yeah this
number something good. Or get a partner. Put your hand here.
Anybody can do it. Okay, we put this on. What do you do? You check. No suck, no blow.
Okay, we patch the hole. Now we're just gonna go for
the rule of thumb again. If our patient is
experiencing trouble breathing and he has a hole in his chest that
you put an occlusive dressing on. We put two and two together: he has a
tension pneumothorax. We have to do an NCD. But that in a later video. All bad things come in two, so we have an
entry hole probably there's an exit hole. So we have to check the back. We do a “buddy hug”. Check it.
Okay. Okay, you don't see anything.
Good. If you see blood, we note that, but we're gonna check it later,
when we're checking his back. Now we're going to “C” circulation
from our M.A.R.C.H. protocol. First of all, we check our interventions
or if they are still holding. Okay, everything
seems to be in order. If we did any neck
wounds, X pocket wounds, angular wounds, we double-check it.
Yeah, it's good. And if our hands are bloody, we wipe them off and we do
the blood sweep. If we see any blood, we take our scissors,
we expose the wound and then decide what
we're gonna do with him. If it's a minor venous blood / small
cut, don't worry about it for now. Just go forward. Here I probaby
see blood, expose it. It's just a minor cut. So now what we're gonna do? It's a minor cut, he
has a tourniquet on. So the tourniquets is pretty much useless.
So now we decide what we're gonna do. We're gonna do a
compression bandage. We're gonna convert it. You don't know. That we're gonna cover
in the next video. We finished our blood sweeps. Now we check his pulse. Okay, if we feel the radial,
awesome, he's not in shock. If you don't feel the
radial, check the carotid. He's alive. If you don't feel the radial pulse,
that means he's in decompensated shock. He's not doing good.
He's pretty much fucked up. Okay, feel the skin. The color, okay. Pink, warm and dry?
Awesome. Now what we're gonna do?
We have to turn him over to check his back, but first
of all what we're gonna check, if he has a broken pelvis. We close
the book and then we open it. If you see a grimace on his face
at any time, we stop immediately. That tells us, that
he has a broken pelvis and we have to move him in another
way, but that in another video. Now we check this. We need to prep our equipment. We're gonna turn you over,
so pretty much what we need? Our litter, for
hypothermia ready heat. Before we saw an entry
wound in his chest. We prep our second halo,
we prepped our equipment, but what happened
beforehand I broke my glove and because I know my buddy's
sexual preference of women and small farm animals I'm
gonna put a fresh glove on. Okay, now we're gonna
turn him on his side. We check for his downside wound okay
nothing noted, we check his neck. No step-offs or deviations. We've already hit between his legs,
so we do the hypothermia portion. Okay, one, two, three. Back in. Now we ask him:
Hey buddy, how are you? You good? Okay. You're assessing his level of
consciousness, then check his airway. Yeah he's still breathing. I see rise
and fall of the chest. He still has a
radial pulse, nice. LOC ABC is done.
No interventions. We moved him, that's like an invasive
thing that we did with his body. And before that, we did a
couple of interventions on. Now we have to check, them
if they're still holding. Check the NPA.
Okay it's in. It was taped in. Okay.
The breathing, check his halo. No suck, no blow.
Nice. Check his tourniquet.
Yeah, still holding. Now let's do a bit of paperwork. Where's his TCCC card?
Time for the cat. Note it on
and note it on the TCCC card. And this you put somewhere on
him, that he's not gonna loose. On his hand, on his belt. Okay, the TCCC
card goes with him. We note all interventions that we
did on him, so the flight medic and the surgeon in the
hospital has an easier job. Now that we put our
guy on the litter, we checked his level of consciousness,
ABCs and interventions. Now we go into “H”, which stands for
hypovolemia, head injury and hypothermia. For hypothermia, we already
prepped our ready heat. We also have pre-staged blanket. And we cover him
up the best we can. If not, we improvise. We do something. You take your hat,
we put it on him. If he has any wet
clothes, you change them. Nothing works well, if
our casualty is cold. A bit of hypothermia is done. Check the head
for head injuries. If it's something minor,
we just bandage it up. But if you see blown out pupils,
raccoon eyes, which basically, means discoloration
under his eyes, if you see something
leaking out of his ears, something out of his
nose, that's an indication that he might have
traumatic brain injury. We pretty much can’t do
a lot of things for him. If he is not a shock, we
can raise his shoulders and head for about
thirty degrees. Keep him breathing and that's in our toolbox of
help that we can give him. Okay, now what? You're not a medic
and you need to cover hypovolemia. We suspect that he's going into
shock and we need to fight it. We need to give them an IV or an
IO, but do we have the capability, do we have the
knowledge, the skill? But that in another video. We packed the patient up,
but we can still help. We give him his combat pill
pack, if he can swallow it. Can you swallow? He can swallow
luckily, that's nice. Beforehand, in the M.A.R.C.H.
protocol we were saving a life, but now we
just make it a bit better. With the combat pill pack, we're
taking care of the antibiotic portion and a minor part of analgesia. Now we’re just dressing the burns and the small cuts, maybe
doing a tourniquet conversion, immobilizing anything that
needs to be mobilized, but if you don't know how to do this
or anything or other than M.A.R.C.H., remember probably we have comms up, so we call our tactical command
or next level of care, so they can help us,
guide us through all the procedures that we still can do to our patient. Okay, now we're waiting for the
MEDEVAC, we fill out his TCCC card, we prep our guy for transport,
so our blanket doesn't go flying off in the rotor. You put those glasses on
and that's pretty much it. Last thing enemy combatant,
sometimes we didn't do a good job and now we had to
treat a wounded enemy. Because the rules of engagement dictate it
and because it's the right thing to do. But safety first,
mobilize and secure the enemy, because he's still
trying to kill us. Remember to watch part 3. Where we cover a couple
of basic interventions.
Just gonna keep it real with you here, for those of you in AIT this video will be out of order, dont use it as a reference. Those of you out of whiskey land this should be a good reminder for you.