CMP 015 - Evidence Based Medicine w Andrew Fisher

Disclaimer: The opinions or assertions contained herein are the private views of the author and are not to be construed as official or as reflecting the views of the Texas A&M College of Medicine, Texas Army National Guard, Department of the Army, or the Department of Defense.

Intro

Fisher Introduction 

Enlisted military background

EMT school → Paramedic

On to IPAP and active army

Now in medical school

Lets talk about the TCCC Committee

42 members, all deployed

Some active mil, some retired, some reserves.

Docs, medics/PJs/, PAs, PhDs

Recommendations not approval

Process of testing

Evidence Based Medicine

Why is this important …. 

Recommendations for civilians

Equipment?

Classes … Stop The Bleed and/or First Care Provider

Not TCCC

Future of Trauma Care

Guidance for younger people thinking about getting into military medicine 

Thanks guys.

EBM ETSY Link :https://www.etsy.com/shop/ChurchOfEBM?fbclid=IwAR0DdawLC6it3yzItKl0XPlyfk4Z2U3ChzEyPgpFiVxbBfepQTE2XaJASWc

Disclaimer: The opinions or assertions contained herein are the private views of the author and are not to be construed as official or as reflecting the views of the Texas A&M College of Medicine, Texas Army National Guard, Department of the Army, or the Department of Defense.

Disclosures: Voting member, Committee on Tactical Combat Casualty Care; Assistant Course Director, Resuscitation Adjuncts: Prehospital Transfusion & REBOA (RAPToR) course.


CMP 014 - Altered Mental Status

Last week we talked about tourniquets.

This week lets talk about altered mental status patients.

Make the scene safe.

Lets talk about them in detail and treatment.

Causes:

  • Infection

    • Sepsis

  • Strokes

    • Clot

    • Bleed

  • Trauma

  • Medications

    • Over the counter

    • Illegal

      • Opioates (Narcan)

        • Recent video of guy shooting people after Narcan

  • Seizures

    • Grand Mal - Body Shakes all over

    • Petit Mal “Absence Seizures” - Patient seems disconnected

    • Febrile - Infants with a fever

  • Low/High Blood Sugar

    • Low sudden onset

    • High gradual onset

  • Dementia

Video of the week:

Guy shoots fire figher after Narcan https://www.firefightingnews.com/body-cam-shows-man-being-revived-with-narcan-before-opening-fire-on-first-responders-killing-firefighter/


  • Give enough to help their breathing … don’t wake them up

  • Check for weapons


Product of the Week

TX2 and TX3 Tourniquets

Fast Facts:

  • Ratcheting mechanism makes for faster and easier application than a windlass

  • Wide width options to allow for faster control and better patient comfort

  • Ideal for rural EMS services, Civilians and the Military

  • Includes a self-locking system

TX2

Webbing width: 2 inches (50.8 mm)

Webbing length: 39 inches (990.6 mm)

TX 3

Webbing width: 3 inches (76.2 mm)

Webbing length: 39 inches (990.6 mm)

Note from Patrick S!



CMP 013 - All About Tourniquets

Lets talk tourniquets!!

Tourniquets are used to stop major bleeding in the arms or legs.

Blood that can’t be controlled with direct pressure

2” - 3” about the wound / high and tight

2 hours with no problem … could be longer

Improvised:

You really need a windlass

More than likely you are making a pressure bandage

Commercial:

Until recently, the CoTCCC recommended three tourniquets for combat use: the North American Rescue C-A-T, the Tactical Medical Solutions SOFTT-W, and the Delfi Medical Innovations EMT.

Current TCCC Recommended List:

  • Combat Application Tourniquet (C-A-T) Gen 7 and Gen 6

  • Ratcheting Medical Tourniquet -Tactical (RMT-T)

  • SAM Extremity Tourniquet (SAM-XT)

  • SOF Tactical Tourniquet – Wide (SOFTT-W)

  • Tactical Mechanical Tourniquet (TMT)

  • TX2” Tourniquet (TX2) and TX3” Tourniquet (TX3)

Others on the market

  • RATS

  • TK4

  • SWAT-T

  • Recon

  • Kids Tq

Product of the week

X Gauze
Medical Gear Outfitters code: civilianmedical for 10% off.

CMP 012 - Scene Safety

Scene Size Up and Scene Safety

Scene Size Up - ‘Windshield Survey”

  • Gloves - maybe eye protection

    • If no gloves then wash hands with warm soapy water afterwards

  • Danger Jones

    • Power lines, Fire ...

  • Clues for scene violence

    • If you get hurt then you are no good

    • Make the scene safe

    • Little clues tell a big story

      • Diabetic Call when guy tackled me

      • Assault call with knife towards me

  • Mechanism of injury

    • MVA, Fall, Car Wreck

  • Number of patients

    • Triage

      • Gross and Individual

    • Red, Yellow, Green, and Black Tags

      • Red have a problem with ABC

      • Yellow can’t walk but injured

      • Green are walking wounded

      • Black are dead

    • 30 - 2 - Can Do Triage Method

Equipment needed:

  • Gloves

  • Light (maybe head lamp, flashlight, chem light)

  • Eye protection

  • Reflective triangle

  • Maybe a level IIIa or IV vest :-)

After Action Video

  • VSO takes a NPA haha

  • Tony Simon in Missouri

Product of the Week:

Blizzard Compact Survival Blanket

  • Windproof, waterproof blanket that uses 2-layer Reflexcell Technology to insulate and protect. Metallized inner layer reflects body heat back toward user.

  • High visibility orange outside to make user easily findable by search and rescue personnel and pilots. Slim profile fits plate carriers, hydration sleeves, or kit bags.

  • Ideal for use by forest rangers, hunters, pilots, overlanders, foresters, surveyors, and other wilderness professionals to prevent the onset of hypothermia or shock in emergency situations.

  • Vacuum-sealed with flat profile, making this the ideal emergency blanket for compact spaces like vehicle and aircraft survival kits, go-bags, and backpacks.

  • Packed measurements: 6.75 in. x 7.5 in. x 0.5 in. Open measurements: 78 in. x 46 in. Weighs just 5 oz.


CIVILIANMEDICAL - code: civilianmedical for 10% off.

CMP 011 - PrepMedic

Sam “PrepMedic”

What is your background?

What made you get into EMS?

What made you start the YouTube channel?

Do you think that civilian interest in medical is growing?

Talk more about youtube channel, favorite video, hardest video, etc.

What advice would you give to civilians?

Advise on building a vehicle kit and home kit.

What is your favorite medical gear?

What do you think of the new COTCCC list?

Biggest Myths

Seeing as medical is gaining ground at least in the 2A community, any Improvements necessary in the Civ Med space?

PrepMedic Youtube

After Action Report:

Motorcycle VS pole

MedicalGearOutfitters.com Coupon Code: CIVILIANMEDICAL

CMP 010 - Fractures

Fracture vs dislocation

Open / Closed

Types of Fractures

  • Greenstick - Incomplete fracture. … (common in children)

  • Transverse - The break is in a straight line across the bone.

  • Spiral - The break spirals around the bone; common in a twisting injury.

  • Oblique - Diagonal break across the bone.

  • Compression - The bone is crushed, causing the broken bone to be wider or flatter in appearance.

Untreated fractures of the lower limbs can lead to significant blood loss, which may be external and obvious, or covert. The estimated blood loss for a closed fracture of the femur is 1000–1500 ml and for a closed fracture of the tibia is 500–1000 ml. These figures can be doubled if the fracture is open.

Treatment:

  • Fingers

  • Clavicle

  • Arms

  • Ribs

  • Hip / Pelvis

  • Femur

  • Lower Legs

PMS

  • Pulse - Motor - Sensory

Types of splints:

  • Air Splints

  • “SAM Splints”

  • Magazines

If no pulse then you may need to reset it, “make it look normal”. If no pulse then treat like you have a TQ.

TCCC Updated Guidelines on TQs

  • RMT

  • TX2/3

  • SAM

Product of the week: Acti Splint

https://medicalgearoutfitters.com/ - code: civilianmedical for 10% off.

Dynarex version of the SAM Splint

Finger, Flat, and Rolled Version

Rolled comes with Sensi-wrap (everything you need to use is included”

Moldable



CMP 009 - Range Kits and more!

You are more likely to use your first aid skills over your firearms skills.

May is National Stop the Bleed month

What supplies should you carry at the range?

  • Tourniquet

    • If you budget allows carry two.

    • Discuss different TQs

  • Gauze

    • Hemostatics

    • Compressed Gauze

    • Rolled Gauze

    • No tampon … unless you’re a girl hahah

  • Pressure Bandage

    • Discuss different ones

    • Uses

  • Possible carry an NPA

  • Chest Seals

    • Seal the box

    • Discuss different ones

  • Mylar Blanket

  • Trauma Shears??

Go back and listen to our MARCH episodes.

Future episodes … car kits, home kits, others

Next week Fractures!

Product of the week:

Screen_Shot_2018-12-22_at_3.47.49_PM_1024x1024@2x.png

Skinny Medic Essentials Kit

  • Complete Trauma Kit

  • Has everything we just talked about

  • No real expiration date

  • Under $100

Shout out to Vanquest for listening!

MedicalGearOutfitters.com code: civilianmedical



CMP 008 - Medical Emergencies

We have been talking a lot about trauma so let’s shift gears to …

Medical Emergencies Overview:

Breathing Problems

  • Asthma

  • Inhalers

Choking

  • Heimlich Maneuver

  • CPR

Allergic Reactions

  • Epi Pen

  • Difference between allergic reaction and anaphylactic shock

Heart Attack

  • Asprin

  • Difference between heart attack and cardiac arrest

Diabetes

  • Cake Icing for bring their sugar up

Stroke

  • Stroke Exam

Seizures

  • Protect the patient

  • Don’t put anything in their mouth

  • Recovery Position

Product of the week:

QuikClot Combat Gauze

  • Hemostatic Agent

  • Impregnated with kaolin (natural clay)

  • Helps with clotting

  • Doesn’t cause burns

Skinnymedic.com

http://medicalgearoutfitters.com - use code: civilianmedical

CMP 007 - Head Injuries and Hypothermia

FRN Meetup

m-a-r-c-H

Head Injuries and Heat Loss

Head Injuries


How to diagnose in the field:

Altered Mental Status
Trauma to Head

Dizziness

Memory Loss

Nausea

Feeling Tired

Sensitivity to light or noise

Unequal pupils in a late sign

Concussions

Slow Bleeds - subdural bleeds

Quick Bleeds - epidural bleeds

AMS patients should be disarmed - make it a fair fight

Hypothermia is part of the lethal triad

  • Lethal triad: A combination of acidosis, coagulopathy and hypothermia that usually leads to death in a patient experiencing trauma.

    • Acidosis: Lower than normal pH due to increased hydrogen ion concentration.

    • Coagulation system: A temperature- and pH-dependent series of complex enzymatic reactions that result in the formation of blood clots to stop both internal and external hemorrhage.

    • Coagulopathy: Any disorder of the blood that makes it difficult for blood to coagulate.

    • Hypothermia: Lowered body core temperature.

Temp below 95 F / 32 C can effect how the body clotts

Product of the week

SWAT-T

Great for kids and children

Multiple use tourniquet / pressure bandage

Works great IF you have both hands free

CIVILIANMEDICAL FOR A 10% AT MEDICAL GEAR OUTFITTERS - CODE IS CIVILIANMEDICAL

CMP 006 - Circulation and Shock

Recap: Phases of Care

m-a-r-C-h

Circulation

Pulses

Carotid

Femoral

Radial

Estimated blood pressures

Carotid 60-70

Femoral 70-80
Radial 80-90

Secondary Blood Sweep

Shock

What is Shock?

Some symptoms of shock

Compensated

Decompensated

Irreversible

Physiological responses to blood loss.

Basic shock first aid - is raising the legs above the heart myth or what

Medics Only

TXA - Prevents clots from breaking down

Whole Blood - carries o2

IV Fluid - regain mental status or radial pulse only

Product of the week:

TMT - Tactical Mechanical Tourniquet

1.85 inches wide

Audible click when windlass is secure

5-¾ min 38” max

They have a junctional plate that will attach to it which is why I think this TQ is worth a look at

After Action Video:

Video posted in Skinny Medic Facebook group

Guy has multiple stab wounds to the torso

Civilianmedical for a 10% at medical gear outfitters - code is civilianmedical



CMP 005 - Evacuation / Respiration

REFRESH: What does march stand for, the other phases of care

Third Phase of Care: tactical evacuation care

The final phase of care under TECC is called “Evacuation Care.” During this phase of care, an effort is being made to move the casualty toward a definitive treatment facility. Most additional interventions during this phase of care are similar to those performed during normal EMS operations.  However, major emphasis is placed on reassessment of interventions and hypothermia management.

Types of drags and carries

Triage patients

Vital Signs including pulse Ox

Training accident or not it is going to get treated like a crime scene. Maybe transport patient to ER or closer to the road.

There is where some times it is called MARCH-E

m-a-R-c-h

Respiratory:

Vented vs non-vented chest seals

No wound packing

holes in chest must be greater than 2/3 trachea for “sucking chest wound”

Decompression Needle - medics only

Civilianmedical for a 10% at medical gear outfitters

CMP 004 - Indirect Threat / Airway

civilian-medical-podcast.jpg

SECOND PHASE OF CARE - Indirect Threat or Tactical Field Care

a. Indirect Threat - care rendered once the responder and casualties are no longer under effective hostile fire or environment . Available medical equipment is still limited. Time to evacuation may vary from minutes to hours.

b. The Management Care Plan for Tactical Field Care begins with disarming any casualty with an altered mental status. Armed casualties pose a significant risk to others in their unit if they employ their weapons inappropriately. In the combat setting, altered mental status may be caused by traumatic brain injury, shock, or medications. Then, the MARCH algorithm is used. (1) M- Massive Hemorrhage Assessment.
(2) A-Airway Assessment.
(3) R-Respiratory Trauma Assessment.
(4) C-Circulatory Assessment.
(5) H-Head Trauma Assessment and Hypothermia Assessment.

Airway:

  • Positions

Head tilt chin lift

Jaw Thrust

  • Adjuncts

OPA

NPA

  • Suction

Suction device

Log Roll

  • Recovery Position

  • Advanced choices would be a surgical airway

Products

Lets talk about what went down with RATs.


Civilianmedical for a 10% at medical gear outfitters

CMP 003 - Direct Threat / Massive Bleeding

Direct Threat - “Care Under Fire”

Controlling major bleeding
Doing medicine in bad places

Put on a TQ and then re-evaluation after the fight

Self Aid

Massive Bleeding


TQ are for arms/legs and wound packing for junctional areas. You can also wound pack if you don’t have a TQ.

Tourniquets

  • Talk about different ones on the market

  • High and Tight or few inches about

  • Myths

Wound Packings

  • Regular Gauze

  • Combat Gauze

  • Celox

Use other bystanders to help you. During a bad event people will do what you tell them to do.

Product of the week:

SWAT-T Tourniquet

-not the best one handed

-great pressure bandage

-great for small kids or K-9


Civilianmedical for a 10% at medical gear outfitters

CMP 002 - MARCH

Today we’re going to talk about MARCH and Phases of Care.

Direct Threat / Care Under Fire

Presence of an immediate direct threat


Indirect Threat / Tactical Field Care

Treatment

Evacuation / Tactical Evacuation

CCP

Help EMS get patients close to the exit

Massive Bleeding

What is a massive hemorrhage?

  • Clothes covered in blood

  • Large pool getting larger

  • Unable to control with GOOD direct pressure

  • May not be spraying because of low B/P

Tourniquets

Commercial

Improvised

Wound Packing if no TQ available

Wound Packing

Clothes

Gauze

Hemostatic Agents

Pressure Bandages

Airway -

Position
Airway Adjunct

You CAN use an NPA

Suction

Recovery Position


Respiratory

Chest Seals

BVM

Hole must be .75 size of the trachea for a “sucking chest wound”

Circulation

Do a detail exam so you don’t miss another injury

Head Injury / Heat Loss

Cheap mylar blanket

Evaporation Cooling

Product

Gen 7 CAT

After Action

Leopard at the Zoo

Civilianmedical for a 10% at medical gear outfitters


CMP 001 - Not So Skinny Medic

civilian-medical-podcast.jpg

Civilian Involvement

We are not attorneys, ao….

Good samaritan laws -

  • Consent

    • Implied consent

  • Reasonable man concept

  • Negligence

    • Duty of care

    • Standard of care not met

    • Causation

Bystander Effect -

Introduction to MARCH-E

  • Evacuation

Introduction to Phases of Care

TCCC - TECC

Product

Gen 4 SOF-T

After Action

Motorcycle Accident

Civilianmedical for a 10% at medical gear outfitters

CMP 000 - What is the Civilian Medical Podcast about?

civilian-medical-podcast.jpg

The world is a dangerous place. The Civilian Medical Podcast aims to prepare and educate you for the day you hope never comes. Regardless of your skill level, we’ll be providing information on skills, products, techniques, mindset, as well as interviewing guests and experts in the field. Spend some time with us discussing medical training and skills you need, it just may save your life.