T.A.R.D.I.S

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T.A.R.D.I.S
Tactical Access Rapid Diagnosis and InterventionS
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• Focus on application of medical skills in the
  hostile environment
• Is the difference between high level training
  and low level application
• Uses a quick system of assessment
• There are three aims
• To rapidly assess firearms situation casualties
• To apply high quality lifesaving interventions
  against low thresholds
• To work to a strict time framework

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System of assessment AIRWAY BREATHING CIRCULATION
DRUGS FOR PAIN EXTREMITIES EVACUATION
1 GOOD 2 POOR 3 THREAT TO LIFE
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• Background
• Studies of how thinking works during stress
• Sectioning
• Compartmentalising
• Phased response
• Immediate (care under fire) TARDIS
• Primary (at a safer location)
• Secondary (at a safe location)

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The whole system is based on pre-planning The
whole system is based on aggressive
implementation of that plan The whole system is
based on low thresholds for care There is NO
accurate use of HR, RR, BP etc
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• Airway (Collar as required)
• Good (1)
• Do nothing
• Poor (2)
• OPA / NPA
• Life threatening (3)
• Combitube

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• Breathing
• Good (1)
• Do nothing (seal any chest wound)
• Poor (2)
• Oxygen at 15-20lpm
• Life threatening (3)
• IPPV if combitube
• Needle decompression

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• Circulation
• Good (1)
• Do nothing
• Poor (2)
• Control MEH Tourniquet
• Life threatening (3)
• Add Quickclot if needed

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• Drugs for pain
• No pain (1)
• Do nothing
• Pain or anticipated pain (2)
• 50mg Tramadol IV / IM
• Severe pain (3)
• Ketamine 200mg IM

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• Extremities
• No fractures (1)
• Do nothing
• Fractures (2)
• Align frac strap
• Fracture dislocations (3)
• Align frac strap

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• Evacuation
• Good (1)
• Walk them out
• Poor (2)
• Walk assisted
• Life threatening (3)
• Scoop stretcher

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• Example
• Wounded victim inside cleared section during
  entry
• Shot in thigh severe blood loss
• Fractured femur
• Pale, cool clammy skin
• In severe pain

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• Plan to diagnose, intervene and evacuate in
  under 5 minutes
• Airway leave
• Breathing leave or give 02
• Circulation Tourniquet
• Drugs Give Tramadol 50mg or Ketamine 25mg
• Extremities pull leg straight figure of
  eight at ankles
• Evacuation - scoop

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EVERYTHING IN THE IMMEDIATE PHASE IS DONE IN
UNDER 5 MINUTES
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• Caveats
• The system is superb with 2 people
• Where the 2 people have pre-planned roles
• Where those 2 people communicate well
• need to choose specific pieces of equipment for
  this technique
• Person 1 A, B and evacuate
• Person 2 C, D and extremities

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