FMST Student Manual - 2008 Web Edition*

                                                                                                                                                                                                                                  NOTES

TIME:

Return fire, and take cover

Direct or expect casualty to remain engaged as a combatant, if appropriate

Direct casualty to move to cover and apply self-aid, if able

Try to keep the casualty from sustaining additional wounds

Stop LIFE-THREATENING hemorrhage if tactically feasible

-          Direct casualty to control hemorrhage by self-aid, if able

-          Use a tourniquet for life threatening external hemorrhage

-          For hemorrhage not controlled with a tourniquet, apply HemCon or QuikClot dressing with pressure

C-SPINE  CONSIDERATION– (PRN) *Dependent upon MOI

TIME (5 Minutes max time limit):

TACTICAL FIELD CARE

NOTES     

Casualties with an altered mental status should be disarmed immediately 

Airway Assessment (for UNCONSCIOUS PATIENT)

          Assess Airway  

         Casualty with airway obstruction or impending airway obstruction

                            - Chin lift or jaw thrust maneuver

                            - Consider Nasopharyngeal airway

                            - If previous measures unsuccessful perform a cricothyroidotomy   

           REASSESS AIRWAY ADJUNCT                     

Breathing                                                                                                                                                 NOTES     

NOTE RESPIRATORY EFFORT

INSPECT/ AUSCULTATE PALPATE Anterior Chest

TREAT LIFE THREATS

LOG ROLL (Log roll IF chest or abdominal wounds are noted)

TREAT/ REASSESS

Bleeding                                                                                                                                      NOTES

PULSE CHECK

BLOOD SWEEP

         * Assess for unrecognized hemorrhage, and control all sources of bleeding.

ASSESS PULSES

         * Assess radial pulse for quality.

Bleeding (con’t)

NOTES

TOURNIQUET CONVERSION

         * Assess for possibility of tourniquet conversion to a pressure dressing or a HemCon dressing as appropriate

IV/IO ACCESS (FLUID CONSIDERATION)

         * Determine fluid resuscitation needs

        * If NOT in shock: No IV fluids necessary, PO fluids if conscious

        * If in shock: Hextend 500 mL IV, Repeat in 30 minutes if still in shock, No more than 1000 mL of Hextend

PREVENTION OF HYPOTHERMIA

MONITOR VITAL SIGNS

HEAD  (DCAP-BTLS)                                                                                                                          Notes                                

SKULL

EYES

EARS

NOSE

MOUTH

TREAT/ REASSESS

NECK (DCAP-BTLS)                                                                                                                                        Notes

ASSESS NECK

TREAT/ REASSESS

CHEST (DCAP-BTLS)                                                                                                                                  Notes

INSPECT/ AUSCULTATE/ PALPATE

TREAT / REASSESS

 ABDOMEN (DCAP-BTLS)                                                                                                                  Notes            

INSPECT/ PALPATE

TREAT / REASSESS

 PELVIS (DCAP-BTLS)                                                                                                                        Notes    

INSPECT/ PALPATE

TREAT / REASSES

 LOWER  EXTREMITIES (DCAP-BTLS)                                                                                                                                  Notes

INSPECT/ PALPATE

TREAT/ REASSESS

UPPER  EXTREMITIES (DCAP-BTLS)                                                                                                   Notes

INSPECT/ PALPATE

TREAT/ REASSESS

POSTERIOR (DCAP-BTLS)                                                                                                                       Notes

LOG ROLL (If NOT previously done during assessment)

INSPECT/ PALPATE

TREAT/ REASSESS

PAIN MANAGEMENT                                                                                                                 

      NOTES

      * Able to fight: Mobic, 15 mg PO qd and Tylenol, 650 mg bilayer caplet, 2 PO q8h

     * Unable to fight: (Must have Naloxone available)

            * No IV/ IO access: Oral Transmucosal fentanyl citrate, 800 ug, transbuccally

            * IV/ IO access: Morphine Sulfate 5 mg, IV, reassess in 10 minutes, repeat every 10 minutes PRN to control pain, monitor for respiratory depression

            * Promethazine, 25 mg, IV/IO/IM PRN for Nausea

IMMOBILIZATION                                                                                                  

       NOTES

SPLINTING AND SECURING PATIENT FOR TRANSPORT

ANTIBIOTICS                                                                                                                    

       NOTES

  * If able to tolerate PO: Moxifloxacin, 400 mg, PO qd

  * If NOT able to tolerate PO: Cefotetan, 2g IV/IO (slow push) or IM q12h OR Ertapenem, 1g, IV/IO/IM q 24h

PATIENT TURNOVER

PATIENT TURNOVER                                                                                                                         NOTES       

VITAL SIGNS AND DOCUMENTATION

TIME (Student must complete the entire Casualty Assessment XP within 30 minutes):