A+
✔✔EVAC - Guidelines for TBI - ✔✔For hard physical signs of herniation syndromes,
consider:
Hypertonic saline 3% - 3 to 5 cc/kg IV bolus.
Mannitol 20% - 1g/kg IV bolus.
Hyperventilation: PaCO2 30-35 mmHg.
✔✔EVAC - Guidelines for Cardiopulmonary resuscitation: - ✔✔CPR may have a larger
role during the evacuation phase especially for patients with electrocution, hypothermia,
non-traumatic arrest or near drowning.
✔✔Hot Zone Care - Primary Goals: - ✔✔Accomplish the mission with minimal
casualties.
Prevent any patient from sustaining additional injuries.
Keep operational response maximally engaged in addressing the immediate threats
Minimize public harm.
✔✔Hot Zone Care - Operational Principles: - ✔✔1. Establish operational control of the
immediate incident
2. Threat mitigation techniques will minimize risk to casualties and the providers.
3. Triage should be deferred to a later phase of care.
4. Minimal trauma interventions.
5. Consider hemorrhage control before evacuation to a safer area.
a. TQ application is the primary "medical" intervention to be considered in this phase
of care.
✔✔Hot Zone Care - Skill Set: - ✔✔Tourniquet
Extraction
Recovery position
✔✔WARM ZONE CARE - Goals - ✔✔Same as Hot
Stabilize PT
✔✔Warm Zone Care - Operational Principles: - ✔✔Maintain operational control to
stabilize the immediate scenario.
Conduct dedicated patient assessment and initiate appropriate life-saving interventions
DO NOT DELAY patient extraction for non-life-saving interventions.
Consider establishing a CCP
Establish communication
Prepare casualties for evacuation
, ✔✔Warm Zone Care - Triage - ✔✔Unless in a fixed CCP, triage in this phase of care
should be limited to
the following categories:
a. Uninjured
b. Deceased / expectant
c. All others
✔✔Indirect Threat / Warm Zone - Hemorrhage - ✔✔Application of direct pressure
Application of tourniquet
Application of wound packing with gauze or hemostatic agent
Application of mechanical or improvised pressure dressing
✔✔Indirect Threat / Warm Zone - Airway - ✔✔Perform Manual Maneuvers (chin lift, jaw
thrust, recovery position)
Insert Nasal pharyngeal airway
Placement of supraglottic airway
Placement of endotracheal tube under direct visualization
Perform surgical cricothyrotomy
✔✔Indirect Threat / Warm Zone - Breathing - ✔✔Application of effective occlusive chest
seal
Apply oxygen
Recognize the symptoms of tension pneumothorax
Perform needle thoracentesis
Perform manual "burp" of non-vented occlusive dressing
✔✔Indirect Threat / Warm Zone - Shock - ✔✔Recognize the symptoms of hemorrhagic
shock
Obtain intravenous and/or intraosseous access
Resuscitate hemorrhagic shock using the principles of hypotensive resuscitation
✔✔Indirect Threat / Warm Zone -Hypothermia - ✔✔Identify patient at risk for
hypothermia
Apply techniques and available materials to control conductive and evaporative heat
loss.
✔✔Indirect Threat / Warm Zone - Burn - ✔✔Initiate Basic Burn Treatment
✔✔Indirect Threat / Warm Zone - TBI - ✔✔Position patient appropriately
Apply appropriate resuscitative principles for TBI patient
✔✔Indirect Threat / Warm Zone - Extraction - ✔✔Move Patient (drags, carries, lifts)
Identify patient at risk and apply commercial/improvised spinal immobilization devices
Properly secure patient to litter