c191 w1tc cmast point of wounding care

Point of Wounding CarePoint of Wounding Care

COMBAT MEDIC ADVANCED SKILLS TRAINING (CMAST)

CMASTCMAST 22


90% of all battlefield casualties die before 90% of all battlefield casualties die before they reach definitive medical care.they reach definitive medical care.

Point of wounding care is the responsibility Point of wounding care is the responsibility of the of the individual soldier, their battle buddyindividual soldier, their battle buddy, , the Combat Lifesaver, and the Soldier the Combat Lifesaver, and the Soldier Medic.Medic.

CMASTCMAST 33


Causes of death on the battlefield:Causes of death on the battlefield:– Penetrating head trauma 31%Penetrating head trauma 31%– Uncorrectable torso trauma 25%Uncorrectable torso trauma 25%– Potentially correctable torso trauma 10%Potentially correctable torso trauma 10%– **Exsanguination from extremity wounds 9%Exsanguination from extremity wounds 9%– Mutilating blast trauma 7%Mutilating blast trauma 7%– **Tension pneumothorax 5%Tension pneumothorax 5%– **Airway problems 1%Airway problems 1%

CMASTCMAST 44

Penetrating Head TraumaPenetrating Head Trauma

CMASTCMAST 55

Penetrating Torso TraumaPenetrating Torso Trauma

CMASTCMAST 66

Extremity HemorrhageExtremity Hemorrhage

CMASTCMAST 77

Mutilating Blast TraumaMutilating Blast Trauma

CMASTCMAST 88

Tension PneumothoraxTension Pneumothorax

Air pushes over heart and collapses lung

Air outside lung from wound

Heart compressed not able to pump well

CMASTCMAST 99

Airway TraumaAirway Trauma

CMASTCMAST 1010

Causes of Combat WoundsCauses of Combat Wounds

(WWI, WWII, Korea, Vietnam, Middle East)

CMASTCMAST 1111

CMASTCMAST 1212

CMASTCMAST 1313


Primary causes of preventable death: Primary causes of preventable death:

– Hemorrhage from extremity woundsHemorrhage from extremity wounds

– Tension pneumothoraxTension pneumothorax

– Airway problemsAirway problems

CMASTCMAST 1414

Point of Wounding CarePoint of Wounding Care There needs to be a shift in our thinking, the days of not There needs to be a shift in our thinking, the days of not

providing self-aid and laying there and yelling “providing self-aid and laying there and yelling “Medic”Medic” are over. We must have the ability to assess our own are over. We must have the ability to assess our own wounds, provide self or buddy-aid if needed, and wounds, provide self or buddy-aid if needed, and continue the mission if able. The bottom line is a soldier continue the mission if able. The bottom line is a soldier capability at the point of wounding, who is equipped and capability at the point of wounding, who is equipped and trained to decrease preventable battlefield death. This trained to decrease preventable battlefield death. This strategy will increase the unit’s combat effectiveness and strategy will increase the unit’s combat effectiveness and it’s survivability. If we could make some minor changes it’s survivability. If we could make some minor changes in our common soldier medical skills training, we can in our common soldier medical skills training, we can improve the survival rate of 15% of all battlefield deaths. improve the survival rate of 15% of all battlefield deaths.

CMASTCMAST 1515


Levels of prehospital care on the Levels of prehospital care on the battlefield:battlefield:– Self-Aid/Buddy-Aid (SABA)Self-Aid/Buddy-Aid (SABA)– Combat Lifesaver (CLS)Combat Lifesaver (CLS)– 91W Soldier Medic91W Soldier Medic

CMASTCMAST 1616

Self-aid / Buddy-aidSelf-aid / Buddy-aid

Rapid Casualty Assessment.Rapid Casualty Assessment. Control Hemorrhage.Control Hemorrhage. Treat penetrating chest trauma.Treat penetrating chest trauma. Maintain airway.Maintain airway. Package casualty for transport.Package casualty for transport.

CMASTCMAST 1717

SABA Assessment TasksSABA Assessment Tasks

Perform a rapid casualty initial assessment:Perform a rapid casualty initial assessment:– AirwayAirway– BreathingBreathing– CirculationCirculation

CMASTCMAST 1818

SABA Airway TasksSABA Airway Tasks

Provide Airway support in an unconscious Provide Airway support in an unconscious casualty using an NPA.casualty using an NPA.

Place the casualty in the recovery Place the casualty in the recovery position.position.

CMASTCMAST 1919

Nasopharyngeal AirwayNasopharyngeal Airway

CMASTCMAST 2020

SABA Breathing TasksSABA Breathing Tasks Place an occlusive Place an occlusive

dressing, on a dressing, on a penetrating chest penetrating chest wound.wound.

CMASTCMAST 2121

SABA Bleeding TasksSABA Bleeding Tasks

Control hemorrhage using a tourniquet or Control hemorrhage using a tourniquet or an Emergency Trauma Dressing (ETD; an Emergency Trauma Dressing (ETD; Israeli bandage).Israeli bandage).

Combat Application TourniquetCombat Application Tourniquet Emergency Trauma DressingEmergency Trauma Dressing

CMASTCMAST 2222

Hemorrhage ControlHemorrhage Control

CMASTCMAST 2323

Current First Aid KitCurrent First Aid Kit The Army has modified the medical tasks trained The Army has modified the medical tasks trained

during Basic Combat Training that should address during Basic Combat Training that should address these issues; however, the soldier medic must be these issues; however, the soldier medic must be provided with an upgraded provided with an upgraded “First-aid Kit” that will “First-aid Kit” that will provide the required provide the required medical supplies to render medical supplies to render that care. that care.

CMASTCMAST 2424

Improved First Aid Kit

Combat Application Tourniquet (CAT)

MOLLE Type Pouch

Weight: 1.08 lbs Cube: 128 ci

Emergency Trauma Dressing

(Israeli Bandage) 4” Kerlix

14g Needle

Nasopharyngeal Airway (NPA)

2” Tape

Exam Gloves (4)

CMASTCMAST 2525

Combat Lifesaver Training Combat Lifesaver Training

Combat Lifesavers (CLS) are primarily Combat Lifesavers (CLS) are primarily shooters, they are not junior medics. They shooters, they are not junior medics. They should be trained to provide Lifesaving should be trained to provide Lifesaving Care as the tactical situation permits. We Care as the tactical situation permits. We know what the most common causes of know what the most common causes of preventable death are. They should be preventable death are. They should be trained to treat these conditions.trained to treat these conditions.

CMASTCMAST 2626

Combat Lifesaver TasksCombat Lifesaver Tasks Rapid casualty assessment.Rapid casualty assessment. Control hemorrhage.Control hemorrhage. Treat penetrating chest trauma.Treat penetrating chest trauma. Maintain airway.Maintain airway. Initiate saline Lock.Initiate saline Lock. Package casualty for transport.Package casualty for transport. Initiate FMC.Initiate FMC. Initiate nine-line MEDEVAC request.Initiate nine-line MEDEVAC request.

CMASTCMAST 2727

Needle Chest DecompressionNeedle Chest Decompression

CMASTCMAST 2828

Needle Chest DecompressionNeedle Chest Decompression

CMASTCMAST 2929

Intravenous Fluids Intravenous Fluids Initiate an IV infusion with a saline lock.Initiate an IV infusion with a saline lock.

CMASTCMAST 3030

SKED LitterSKED Litter

CMASTCMAST 3131

Talon II LitterTalon II Litter

CMASTCMAST 3232

91W Health Care Specialist 91W Health Care Specialist

The soldier medic is the primary care The soldier medic is the primary care provider in the pre-hospital setting with provider in the pre-hospital setting with additional medical skills and equipment to additional medical skills and equipment to augment the lower levels of care and augment the lower levels of care and resupply the CLS. They are trained in resupply the CLS. They are trained in Tactical Combat Casualty Care principles.Tactical Combat Casualty Care principles.

CMASTCMAST 3333

TC-3, 91WTC-3, 91W

Care Under Fire.Care Under Fire.

Tactical Field Care.Tactical Field Care.

Combat Casualty Evacuation Care.Combat Casualty Evacuation Care.

CMASTCMAST 3434

TC-3TC-3

Casualty scenarios in combat usually Casualty scenarios in combat usually entail both a medical problem as well as a entail both a medical problem as well as a tactical problem. tactical problem.

We want the best possible outcome for We want the best possible outcome for both the man and the mission.both the man and the mission.

Good medicine can sometimes be bad Good medicine can sometimes be bad tactics, bad tactics can get everyone killed, tactics, bad tactics can get everyone killed, and/or cause the mission to fail.and/or cause the mission to fail.

CMASTCMAST 3535

TC-3TC-3

This approach recognizes a particularly This approach recognizes a particularly important principle: important principle:

Performing the correct intervention at the Performing the correct intervention at the correct time in the continuum of combat correct time in the continuum of combat care. A medically correct intervention care. A medically correct intervention performed at the wrong time in combat performed at the wrong time in combat may lead to further casualties.may lead to further casualties.

CMASTCMAST 3636

CMASTCMAST 3737

CMASTCMAST 3838

CMASTCMAST 3939

Warrior Aid and Litter KitWarrior Aid and Litter Kit

Attacks against lightly armored vehicles Attacks against lightly armored vehicles continue to be a source of injury and death continue to be a source of injury and death to our Soldiers. Direct and indirect fire to our Soldiers. Direct and indirect fire weapons, improvised explosive devices weapons, improvised explosive devices and mines produce devastating effects. and mines produce devastating effects.

CMASTCMAST 4040

Warrior Aid and Litter KitWarrior Aid and Litter Kit Several initiatives ranging from improved Several initiatives ranging from improved

armor kits, and sandbagging vehicle armor kits, and sandbagging vehicle floors, to improving Soldier body armor, to floors, to improving Soldier body armor, to changing Tactics Techniques and changing Tactics Techniques and Procedures have addressed improving Procedures have addressed improving Soldier survivability. However, nothing Soldier survivability. However, nothing substantial has been implemented to substantial has been implemented to address providing adequate casualty care address providing adequate casualty care at the point of wounding in these at the point of wounding in these scenarios. scenarios.

CMASTCMAST 4141


These convoys/patrols may or may not These convoys/patrols may or may not have a Soldier Medic or even a Combat have a Soldier Medic or even a Combat Lifesaver organic to the element. They Lifesaver organic to the element. They must rely on equipment carried on the must rely on equipment carried on the vehicles and on the individual to provide vehicles and on the individual to provide care and conduct evacuation. care and conduct evacuation.

CMASTCMAST 4242

Current Vehicle First aid KitCurrent Vehicle First aid Kit

CMASTCMAST 4343


A need exists for a vehicle life-saving kit A need exists for a vehicle life-saving kit that can be carried on every vehicle that can be carried on every vehicle traveling in a convoy or on a combat patrol traveling in a convoy or on a combat patrol within the current tactical theaters. within the current tactical theaters.

Positioning this kit on less than every Positioning this kit on less than every vehicle risks losing the ability if the vehicle vehicle risks losing the ability if the vehicle it is loaded on is destroyed. it is loaded on is destroyed.

CMASTCMAST 4444


This kit should provide a single unit of This kit should provide a single unit of issue that will contain a supply of life issue that will contain a supply of life saving medical equipment as well as a saving medical equipment as well as a compact litter to facilitate casualty compact litter to facilitate casualty evacuation without causing further injury, evacuation without causing further injury, utilizing any vehicle of opportunity. utilizing any vehicle of opportunity.

CMASTCMAST 4545

WARRIOR AID AND LITTER KIT Item NSN

1-Talon II Litter 90C 6530-01-504-9051 1-Litter Carrier 6530-01-504-9056 6- Cravats 6510-00-201-1755 4- Kerlix 6510-00-058-3047 4- Emergency Trauma Dressing 6510-01-492-2275 2- Combat Application Tourniquets6515-01-521-7976 2- Petrolatum gauze 6510-00-202-0800 1-Blanket Heating 4 panel 6532-01-525-4062 1-Blanket Blizzard Wrap 6532-01-524-6932 1- Nasopharyngeal Airway 6515-00-300-2900 2- 6in Ace Wraps 6510-00-935-5823 2-10-14 gauge 2.5-3 in catheters 6510-01-521-0910 2-Sam Splints II 6515-01-494-1951 2- Rolls 2 in Nylon Tape 6510-00-926-8883 1-Dressing, Elastic Abdominal 6510-01-532-6656 2-Strap, Tie Down Universal Litter 6530-01-530-3860 1- Panel Marker, Survival 8345-00-140-4232Weight 22lbs 8 oz with Talon II litter in Carrier; total cube space = 23”x12”x 12”

CMASTCMAST 4646


CMASTCMAST 4747


“WALK”stored on back skid of GMV using internal shoulder straps and quick release ratchet.

CMASTCMAST 4848

SummarySummary

The only place in the continuum of The only place in the continuum of battlefield care where we can directly battlefield care where we can directly influence survivability is at the point of influence survivability is at the point of wounding. By training every soldier to wounding. By training every soldier to provide point of wounding care we can provide point of wounding care we can save more lives on today's battlefield.save more lives on today's battlefield.

CMASTCMAST 4949

Questions?Questions?

c191 w1tc cmast point of wounding care

Health & Medicine