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Military Tactical Medicine

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Title: Military Tactical Medicine


1
Military Tactical Medicine
2
The Rest of the Story
What First Aid Forgot to Mention
3
Picture your section on a patrol in Kabul!
4
(No Transcript)
5
WHAT DO YOU DO NOW?
6
PANIC is Contagious
  • So is Calm

7
Military Tactical Medicine
TACTICAL MEDICINE FOR SOLDIERS
  • Cpl Christopher Kopp

Presented by Paul J Schonbrun, DO
8
This Briefing Will Cover
  • Civilian vs. Tactical Casualty Care
  • How Soldiers Die in Ground Combat
  • Combat Trauma Management Plan
  • Scenarios

9
Introduction
10
n
11
Differences in Treatment Environments
  • Tactical environments require noise and light
    discipline, and involve high noise environments
    that require sensory deprived assessments and
    treatments.
  • Situations where what is best for the casualty
    and what is best for the mission are in direct
    conflict.
  • Medical personnel are not in charge of emergency
    situations. They are in charge of casualty care
    and triage, however only inform and advise
    commanders who make situational decisions.

12
  • Conditions of effective enemy fire, prolonged
    fluid scene safety compromise, and constant
    potential threat.
  • Extremely unsanitary, austere conditions.
  • Limited resources and equipment available.
  • Extended CASEVAC times, where civilian times from
    accident to definitive care is usually 10 to 60
    minutes, tactical evacs can range from 4 to 72
    hours.
  • Evac resources are limited due to tactical
    situations, and may require escorts

13
  • Predominantly penetrating trauma as opposed to
    blunt trauma which predominates civilian
    casualties.
  • The distance to First World Level Care
    Facilities.
  • Stereotypical casualty being predominantly young
    healthy males with no medical conditions.
  • Presence of a pre-injury stressor such as
    dehydration and sleep derivation.
  • Casualties will occur in water, swamps, on
    mountains, in snow/dust storms etc.

14
Scenario
  • Platoon size assault team
  • Night assault operation on hostile position in
    dense jungle
  • Estimated hostile strength 12 men with automatic
    weapons
  • Insertion via assault boat on river
  • 4km patrol to objective

15
Scenario
  • As patrol reaches objective area, a booby trap is
    tripped resulting in a point man with no
    respirations, pulse, or other signs of life
  • And a patrol leader with massive trauma to one
    leg
  • Heavy incoming fire as hostiles respond
  • Planned extraction is by boat at a point on the
    river 1km from the target

16
BTLS Approach
  • CPR assign 2 individuals
  • C-Spine immobilization
  • Primary Survey
  • Definitive airway larygoscope with white light
  • Tourniquets discouraged
  • Immediate transport to MTF (impossible)

17
BTLS Approach
  • 2 Large bore IVs in both casualties
  • IV solution Normal Saline (NS) or Ringer Lactate
    (RL)
  • Continuous monitoring Blood pressure, ECG
  • Oxygen
  • Completely undress the casualty
  • Secondary Survey

18
Does anyone see a problem with doing all this in
the middle of a fire fight?
19
Good Medicine Can Be Bad Tactics
20
Bad Tactics Can Get Everyone KilledAND/ORCause
The Mission To Fail
n
21
Casualty Situations will entail both aMedical
Problemand aTactical Problem
22
What is best for the casualty and what is best
for the mission may be in direct conflict!
n
23
We want the best possible outcome for bothThe
Casualty andThe Mission
24
We often dont have all the information we need
to make a decision.That doesnt excuse us from
making the decision!
25
TCCC Objectives
  • Treat the casualty
  • Prevent additional casualties
  • Complete the mission

26
Why Train Soldiers inTactical Medicine?
n
27
Operation Apollo
  • Situation involving casualties where no medics
    were present
  • CASEVAC times were prolonged
  • CASEVACs were not available due to the tactical
    situation
  • Shear number of casualties overwhelming the
    medics
  • Considerable differences between First Aid and
    Tactical Care

28
FIRST AID
n
29
n
30
  • Comments/Questions?

31
The CasualtyMortality Curve
n
32
n
33
Mitigating Factors andPotential Solutions
34
In the First Few Minutes
  • The only things that Prevent Injuries are
  • Personal Protective Equipment
  • Good Tactics
  • Proper Training and Rehearsals
  • Superior Firepower

35
In the First Few Minutes
  • 20 of combat deaths occur here due to Major
    System Trauma to the Head/Trunk
  • 10 of combat deaths occur between the first few
    minutes and the first hour (if NMT)
  • If no medical care is provided, 50 of combat
    casualties are alive after 72 hours
  • Our First Aid interventions are critical to only
    30 of combat casualties

36
(No Transcript)
37
Guiding Principles of This Data
  • Half of combat casualties survive with NMT (no
    medical treatment)
  • There will be those that die no matter what we do
    (20) and those that survive no matter what we do
    (50)
  • If a casualty survives the first hour, it is
    highly likely they will live to the third hour
  • YOU HAVE TIME, REMAIN CALM

38
Treatment to be Initiated ASAP ASATF
  • Self Aid
  • Buddy Aid
  • TCCC Trained Soldiers
  • Early evac to definitive surgical center (for
    truncal wounds with penetrating trauma)
  • Stop Life Threatening Bleeding!
  • Decompress Chest
  • Open Occluded Airways

39
Every soldier needs to carry a tourniquet in a
standard location and be trained to use it.
U.S. Army One-Handed Tourniquet
SATS Tourniquet
40
Treatment to be Initiated ASAP ASATF
  • Advanced Life Support (ALS) Skills by Experienced
    and Competent 5A Medic
  • Oxygen Therapy
  • IV Access and Fluid Resuscitation with Volume
    Expanders (colloids)
  • Advanced Airway Management
  • Antibiotic Prophylaxis

41
Treatment to be Initiated ASAP ASATF
  • Full Body Survey
  • Inspect and Dress all Wounds
  • Pain control / Splint all Fractures
  • Blood Product Replacement
  • Chest Tubes

42
How Do Soldiers Die in Ground Combat?
n
43
31 Penetrating Head Trauma
44
25 Surgically Uncorrectable Torso Trauma
45
10 Potentially Surgically Correctable Trauma
46
9 Esanguination from Extremity Wound
47
7 Mutilating Blast Injury
48
5 Tension Pneumothorax
49
(No Transcript)
50
1 Airway Problems
51
(No Transcript)
52
12 Die Of Wounds (DOW)Mostly from infections
and complications of shock
53
(No Transcript)
54
Preventable Causes of Death on the Battlefield
55
1. Bleeding to Death from an Extremity 60
56
2. Tension Pneumothorax 33
57
3. Airway Obstruction, Maxillofacial Trauma 6
58
What this data says
  • Of battlefield casualties, only 15 can
    effectively be treated in the field
  • An additional 10 have the possibility to survive
    if surgical intervention is made shortly after
    the injury occurs
  • The most common battlefield injuries causing
    death are untreatable and account for 63 of
    combat casualties

59
What this data says
  • The most common causes of death are from head and
    chest trauma (56) which PPE is supposed to
    protect
  • This illustrates PPEs importance but not its
    100 effectiveness
  • Early antibiotic treatment may save as much as an
    additional 12 that will die from their wounds
  • Therefore, we can potentially make a difference
    in 37 of battlefield casualties

60
What this data says
  • It also shows the low percentage of airway
    problems on the battlefield which is the highest
    priority of treatment in civilian protocol
  • On the battlefield, hemorrhage control should
    take priority over airway management unless there
    in an obvious airway problem

61
The Most Likely Cause of Death, is the Easiest to
Treat
62
2500 soldiers died in Viet Nam from bleeding to
death from an extremity, that had no other
injuries
  • ALL PREVENTABLE

63
Tourniquets and Chest Decompression will save70
90 of preventable deaths on the next
battlefield IFWe train our soldiers in these
skills
64
Comparative Study This data is unofficial
  • Friendly Fire Incident, April 2002, Afghanistan
  • 500 lbs laser guided bomb dropped on Coy position
  • Coy assets included 3 medics and a Box Amb

65
Casualty Breakdown
  • 4 Killed
  • 8 Wounded
  • Approx. 1 in 10 (10) of personnel on the ground
    were killed or injured

66
33 of injuries had an Instantaneous Death Rate
  • 1 from penetrating head trauma
  • 3 from mutilating blast trauma

67
Serious Injuries
  • 1 Exsanguinating extremity injury
  • 1 Breathing problem, pulmonary edema/contusion
    from blast injury

68
Minor Injuries
  • 6 including shrapnel, concussions, and burns

n
69
What This Illustrates
  • Accuracy of data
  • Mortality Curve has the potential to remain
    unchanged after the IDR
  • Revealed potential problems if this had been in a
    tactical situation
  • The requirement for soldiers to be trained to a
    higher level of casualty care
  • Need to train like we fight

70
  • Forgetting about basic kit (field dressing on
    weapons), due to lack of use in training.
  • Some Box Amb kit was used, that wouldnt have
    been available in a tactical situation
  • PPE minimized and prevented injuries
  • Tourniquets save lives
  • Medics could have been casualties, as it was
    resources were stretched beyond their limits and
    required additional help from infantry soldiers

n
71
Comments/Questions?
72
Combat Trauma Management Plan
  • 1. Care Under Fire
  • 2. Tactical Field Care
  • 3. CASEVAC Care

n
73
CARE UNDER FIRE
  • Return Fire
  • Keep yourself from getting injured
  • Keep the casualty sustaining additional wounds
  • Stop Life-Threatening Bleeding
  • Take the casualty with you when you go

74
Return Fire
n
75
Fire Power is the Best Medicine
n
76
Try Keep Yourself From Getting Shot
AVOID BECOMING A CASULATY
n
77
Try Keep The Casualty From Sustaining Further
Injuries
KEEP THE CASUALTY FROM SUSTAINING FURTHER INJURIES
n
78
Stop Life Threatening Bleeding With A Tourniquet
n
79
Tourniquets
  • BTLS discourages the use of tourniquets
  • It is the most reliable choice during Care Under
    Fire
  • Direct pressure is hard to maintain in this phase
  • Damage to the limb is rare if in place less than
    an hour
  • Often left on in surgery for several hours
  • Better to accept the risk of some tissue damage
    than the loss of life

n
80
All Soldiers Must Carry A Proper Tourniquet
  • In A Standard Location
  • Know How To Use It
  • Practice Its Use In Training

81
Take The Casualty With You When You Go
n
82
C-Spine Control
83
Cervical Spine Immobilization
  • Only 1.4 of penetrating neck injuries in Viet
    Nam would have benefited from C-spine
    immobilization
  • A risk/benefit decision must be made
  • Blunt trauma from parachuting/rappelling etc.
    will require all precautions possible
  • If immediate casualty movement is required, they
    should be moved along their long axis with the
    neck supported by the flak vest if wearing one
  • Bottom line is, time, resources, and effort
    should not be wasted on C-spine immobilization
    with penetrating trauma above the clavicles
    unless the casualty shows obvious signs of
    neurological impairment

84
Cardiopulmonary Resuscitation
n
85
CPR
  • Near drowning
  • Hypothermia (new proposed guidelines delay CPR)
  • Electrocution

86
Care Under Fire
  • Return fire
  • Keep yourself from getting shot
  • Keep the casualty from sustaining additional
    injuries
  • Stop life threatening bleeding with a tourniquet
  • Take the casualty with you when you go

87
  • HOW COMPLEX
  • CAN IT GET?
  • SOUNDS SIMPLE ENOUGH, RIGHT!?!
  • WRONG..........

88
Scenario
  • Platoon size assault team
  • Night assault operation on hostile position in
    dense jungle
  • Estimated hostile strength 12 men with automatic
    weapons
  • Insertion via assault boat on river
  • 4km patrol to objective

89
Scenario
  • As patrol reaches objective area, a booby trap is
    tripped resulting in a point man with no
    respirations, pulse, or other signs of life
  • And a patrol leader with massive trauma to one
    leg
  • Heavy incoming fire as hostiles respond
  • Planned extraction is by boat at a point on the
    river 1km from the target

90
Scenario
  • Hostile force considerably more than suspected
    with armor reinforcements
  • Patrol Commander in zeroed zone
  • Massive blast trauma to left leg
  • Unable to crawl to safety
  • Hostile forces laying down heavy denial fire
  • Remainder of patrol under cover returning fire

91
(No Transcript)
92
Scenario specific issues to address in management
plan
  • The loss of the Patrol Commander becomes an
    operational issue
  • The raid becomes overwhelmed and a decision is
    made to abort the mission by the 2i/c
  • Should the dead soldier be left or an attempt
    made to recover the body?
  • Do you extract the Patrol Commander from the
    zeroed zone?

93
Scenario
  • Is there any medical care that should be provided
    between the time a patrol medic reaches the
    casualty and the time he reaches cover?
  • Is there a better plan for retrieving a casualty
    in this situation than having a medic run out and
    bring him back? Send a infantry soldier instead?
  • How many guys do you send for retrieval?
  • How many weapons do you take from the fire fight?

94
Scenario
  • Should the soldier attempt to fire his weapon
    while running to retrieve the casualty, or not in
    an attempt to maximize speed?
  • What does the soldier do with his weapon upon
    reaching the casualty and preparing him for
    transport to cover?
  • What is the best technique for moving the
    casualty to cover in this situation?
  • What if the rescuer is 140 pounds and the
    casualty is 220 pounds?

95
Scenario
  • Once the casualty has been moved to cover would
    you now start the Tactical Field Care phase or is
    it still Care Under Fire?
  • What treatment is immediately required for this
    casualty? Direct Pressure? Tourniquet?
    Morphine? IV fluid? What type, how much?
  • How is the casualty going to be carried to the
    extraction point?
  • What do you do with his kit?

96
Scenario
  • Assuming a delay of 6 hours to a surgical
    facility, what benefit would antibiotics have on
    the casualtys outcome?
  • Are there concealment or defensive techniques
    that could be employed?
  • Are there denial techniques that could be employed

97
Casualty Retrieval
  • Smoke
  • Diversions/Flankings
  • Carabiner and cord?
  • Vehicle cover
  • Air Support
  • Others?

98
Comments Questions?
Comments/Questions?
Comments/Questions?
99
TACTICAL FIELD CARE
Tactical Field Care
n
100
Tactical Field Care
  • Control Life-Threatening Bleeding
  • Control All other bleeding with direct pressure
    or hemostatic drsgs
  • Decision on req for early surgical care
  • Disarm casualties as required
  • Altered mental status/level of consciousness
  • Head injuries
  • Narcotic Administration
  • Shock, hypoxia
  • Battlefield Stress, Other

n
101
Tactical Field Care
  • A - Establish Airway (Adjuncts /or Recovery
    position)
  • B Breathing - Treat Pneumothorax (Decompress
    Tension Pnemo)
  • C - Treat Shock Fluid Resus (IV Therapy)
  • Head to Toe Exam and Vital Signs
  • Manage All Wounds
  • (Pain Control)
  • Splint Fractures
  • (Antibiotics)
  • Package Casualty for Transport

102
SCENARIO
-Coy Minus -Interdiction operation for weapons
convoy -Night parachute from CC-130 -8km patrol
over rocky terrain to the objective -Planned
helicopter extraction near target
-Company size parachute insertion
-Interdiction operation for weapons convoy
-Night parachute from CC-130s
-8km patrol over rocky terrain to the objective
-Planned helicopter extraction near target
n
103
SCENARIO 2 -One jumper sustains an open fracture
of his left tibia and fibula upon landing
SCENARIO -One jumper lands in a hole, sustains
an open fracture to his tibia fibula
n
104
  • HOW COMPLEX
  • CAN THIS GET?
  • SOUNDS SIMPLE ENOUGH, RIGHT!?!
  • WRONG..........

105
(No Transcript)
106
Scenario Medical Considerations
  • Do you immobilize the Spine?
  • How do you get him off the DZ?
  • How long do you delay the mission?
  • Do you take him with you?
  • Do you leave him there, with who, the medic?
  • How do you recover him?
  • Or consider this twist on the scenario........

107
SCENARIO -One jumper has his air stolen,
collapsed canopy 40 feet from the ground -Open
facial fractures with blood and teeth in the
airway -Both ankles fractured -Open angulated
fracture of the femur
n
108
This guy is in trouble... Or is it a girl!?!
109
  • HOW IMPORTANT IS THE MISSION?

110
Comments/Questions?
111
CASEVAC CARE
CASEVAC CARE
  • CASEVAC CARE

112
CASEVAC vs. MEDEVAC
  • CASEVAC-
  • Tactical evacuation of combat casualties
  • MEDEVAC-
  • Routine air medical transfer,
  • No tactical capability

n
113
(No Transcript)
114
The CASEVAC should include medical personnel and
equipment, and should NOT rely on the patrol
medic or his equipment
115
Reasons for CASEVAC Teams
  • The Medic should remain in the field with the
    Unit
  • The Medic may be a casualty
  • The Medic may be debilitated by dehydration or
    hypothermia
  • Overburdened by casualty numbers
  • Deficient in supplies

n
116
Considerations
  • Type of transport - the CASEVAC will
    involveHelicopter (Griffon capabilities?),
    Armour, Boat
  • Is a Combat Casualty Transport Team (CCTT)
    available?
  • What equipment should be on the CASEVAC?
  • Is the planned extraction the only available
    CASEVAC?
  • If not, is there room for the entire patrol on
    the CASEVAC?

117
Considerations
  • Medical equipment should be pre-placed on the
    extraction platform
  • The Medic should be prepared to do the CASEVAC
    care
  • The extraction may be the only CASEVAC

118
Pre-Mission Planning
119
Duties of the Patrol Medic
  • Perform duties as required to support the units
    mission
  • Treat Unit members with their scope of practice
  • Advise Commanders on all medical matters
  • Provide medical training to Unit members
  • Carry appropriate medical equipment and be
    trained to use it competently

120
Duties of the Patrol Medic
  • Know the team (allergies, blood types, pertinent
    history)
  • Be involved in intimate cross training
  • Medical equipment maintenance and inventory
  • Prepare for mass casualty incidents

121
Duties of the Other Unit Members
  • Be trained in Basic TCCC
  • Carry equipment required to treat themselves
    tourniquet, field dressings, and any other kit
    deemed necessary, in the standard location
  • Wear PPE as ordered
  • Have adequate training and participate in mission
    rehearsals

122
Duties of the Mission Commander
  • Ensure subordinates are adequately trained and
    periodically refreshed in basic combat casualty
    care
  • Identify keen individuals and have them trained
    to a higher level of combat casualty care
  • Establish SOPs including casualty extraction
    techniques and mass casualty incident plans
  • Ensure tactical combat casualty scenarios are
    practiced
  • Ensure subordinates are adequately trained and
    rehearsed on unit and mission specific SOPs

123
Duties of the Mission Commander
  • Ensure PPE is worn by all members
  • Ensure all members are carrying field dressings
    and tourniquet in a standard location
  • Ensure medical equipment is distributed among the
    group
  • Ensure CASEVAC teams are available and adequately
    prepared
  • Complete a CASEVAC coordination

124
CASEVAC Co-ordination Checklist
  • Theater assets / Unit assets
  • Frequency, C/Ss, and Report Formats every
    patrol member must have this info
  • Enemy Situation in regards to CASEVAC are they
    even possible? Do they require escorts? What
    assets are available?
  • Air/Ground CASEVAC plan
  • Air/Ground travel times, including a/c crank time
    and personnel Notice To Move times

125
CASEVAC Co-ord Checklist
  • Routes
  • HLZ standards, markings day and night
  • Specific loading drills equipment
    familiarization, triage, most serious loaded last
  • CASEVAC limitations altitude, weather, enemy,
    distance/fuel (FARPS)
  • Specific equipment required sky genie, jungle
    penetrator, stokes litter
  • How casualties are marked, by priority
  • Pre-position medical equipment on the extraction
    platform

126
Comments/Questions?
127
Afghanistan
128
SEAL Casualty - Afghanistan
  • August 2002
  • Somewhere in Afghanistan
  • SEAL element on direct action mission
  • Story of the casualty as described by the
  • first responder (Non-medic Operator)

129
SEAL Casualty - Afghanistan
  • There were four people in my team, two had
    been shot. Myself and the other uninjured
    teammate low crawled to the downed men. The man I
    came to was lying on his back, conscious, with
    his left leg pinned awkwardly beneath him. He was
    alert and oriented to person, place, time, and
    event. At that point I radioed C2 to notify them
    of the downed man.

130
SEAL Casualty - Afghanistan
  • Upon closer inspection, his knee was
    as big as a basketball and his femur had broken.
    The patient was in extreme pain and did not allow
    me to do a sweep of his injured leg. He would
    literally shove me or grab me whenever I touched
    his leg or wounds. I needed to find the entrance
    and exit wound and stop any possible arterial
    bleeding.

131
SEAL Casualty - Afghanistan
  • But there was zero illumination and he
    was lying in a wet irrigation ditch. So I
    couldnt see blood and I couldnt feel for
    blood.

132
SEAL Casualty - Afghanistan
  • We were also in danger because our
    position was in an open field (where the
    firefight had been) and I had to provide security
    for him and myself. So, I couldnt afford to turn
    on any kind of light to examine his wounds. I
    told him to point to where he felt the pain. He
    had to sort through his pains.

133
SEAL Casualty - Afghanistan
  • He had extreme pain in his knee and
    where his femur had been shattered as well as a
    hematoma at the site of the entrance wound
    (interior and upper left thigh). Finally, he
    pointed to his exit wound (anterior and upper
    left thigh). Again, I had no way of telling how
    much blood he had lost. But I did know that he
    was nonambulatory.

134
SEAL Casualty - Afghanistan
  • So I called C2 again. I gave him the
    disposition of the patient as well as a request
    for CASEVAC, a medic, and additional personnel
    to secure my position and assist in moving the
    patient to the helicopter. I thought about moving
    the two of us to some concealment 25 meters away,
    but we were both really low in a shallow
    irrigation ditch. I felt safer there than trying
    to drag or carry a screaming man to concealment.

135
SEAL Casualty - Afghanistan
  • Between providing security and spending
    a lot of time on the radio I didnt get to treat
    the patient as much as I wanted to. I had given
    him a Kerlix bandage to hold against his exit
    wound. When he frantically told me that he was
    feeling a lot of blood, I went back to trying to
    treat him. I couldnt elevate his leg. To move it
    would mean hed scream in pain, which wasnt
    tactical.

136
SEAL Casualty - Afghanistan
  • There was just no way he would allow me
    to apply a pressure dressing to the exit wound
    even if I could locate it and pack it with
    Kerlix. So, I decided to put a tourniquet on him.

137
SEAL Casualty - Afghanistan
  • His wounds were just low enough on his
    leg to get the tourniquet an inch or so above the
    site. I had a cravat and a wooden dowel with 550
    cord attached to it to use as a tourniquet. I
    told him to expect a lot of pain as I would be
    tightening the cravat down.

138
SEAL Casualty - Afghanistan
  • At this point he feared for his life so
    he agreed. Once I got it tightened I had trouble
    securing it. The 550 cord was hard to get
    underneath the tightened cravat.

139
SEAL Casualty - Afghanistan
  • After over 5 minutes, the medic
    arrived along with a CASEVAC bird and a security
    force. Moving the patient was very hard. Four of
    us struggled to move him and his gear 25 meters
    to the bird. The patient was over 200 pounds
    alone and we were moving over very uneven
    terrain.

140
SEAL Casualty - Afghanistan
  • We wanted to do a three-man carry with
    two men under his arms and one under his legs.
    But again, his leg was flopping around at the
    thigh and couldnt be used to lift him.

141
SEAL Casualty - Afghanistan
  • The bird, (a TF 160th MH-60) had a 50-cal
    sniper rifle strapped down, which made it hard
    for us to get him in. It took us minutes to get
    him 25 meters into the bird. The medic went
    with my patient as well as the other downed man
    in my team and I went back to the op.

142
Individual Operator Medical Training
  • Tactical Medicine Training
  • Tourniquet application
  • HemCon dressings
  • Chin-lift/jaw-thrust
  • Nasopharyngeal airway
  • Treat sucking chest wound

143
Individual Operator Medical Training (2)
  • Assess for shock
  • Administer IM morphine
  • Oral pain meds
  • Oral antibiotics
  • Splint fractures

144
Introduction to Scenario Based Planning
Introduction to Scenario Based Planning
n
145
Scenario Criteria
  • Are thought to have a relatively high probability
    of occurring
  • Have already occurred
  • Difficult medical management
  • Require a difficult Tactical and Medical decision
  • That require a major departure from standard
    civilian medical practice

n
146
There is only two times you can plan for
CASUALTIES
147
Before They Happen OR After They Happen
148
PLAN FOR THE WORST..HOPE FOR THE BEST
IT CAN GET PRETTY CRAZY OUT THERE..
D.S. SOLUTION!!??! HA!!! HA!!!!!
149
Appropriate Care May Vary Based On
  • The Criticality of the Mission
  • The Anticipated Time to Evacuation
  • The Environment in which Casualties Occur

n
150
Any management plan should be consider ADVISORY
rather than DIRECTIVE in nature
n
151
We must also have the intellectual agility to
conceptualize creative, useful solutions to
ambiguous problems.This means training and
educating soldiers how to think, not just what
to think.
  • Gen Peter Schomaker
  • Commander-In-Chief
  • US Special Operations Command

152
CONCLUSION
CONCLUSION
  • Common sense classroom vs. reality
  • Stress effect
  • Inexperience
  • Tunnel vision
  • Stay calm
  • Concentrate on the task at hand
  • Take your time
  • Re-check if unsure
  • Remember your training

n
153
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