COURSE SUMMARY
ANNEX: B
COURSE: GENERAL MEDICAL SUBJECTS
PHASE: 1 VER: A
PREPARATION DATE: 2011/02/13
COURSE TITLE: TRAUMA TREATMENT
REFERENCES: ANA-STP-8-86C-E4-5-SM-TG / (U.S. DOCTRINE STP 8-68W13-SM-TG)
ACADEMIC TITLE
PERFORM A TRAUMA CASUALTY ASSESSMENT
HOURS
081-86A-0155
10 HRS
Terminal Learning Objective:
Understand how to conduct a trauma casualty assessment, identifying all life threatening injuries
and manage them appropriately without causing further injury.
Enabling Learning Objectives:
1. Soldier understands how to perform a general survey of the scene.
2. Soldier understands how to determine what injuries may be found based on the type of
incident.
3. Soldier understands how to perform a primary and secondary survey.
4. Soldier understands how to record the treatment given and the observations noted.
5. Soldier understands how to evacuate the casualty, if necessary.
6. Soldier understands how to prevent further injury to the casualty.
PERFORM A TRAUMA CASUALTY ASSESSMENT
081-86A-0155
Conditions: You encounter a casualty with multiple injuries. You will need
sphygmomanometer, clean stethoscope, thermometer, airway adjuncts, oxygen, nonrebreathing
mask, cervical collar, long spine board, and an ANA Form 1380 (Field Medical Card).
Standards: Assess the casualty, identify all life-threatening injuries, and manage him
appropriately without causing further injury to the casualty. Perform the assessment in the
correct sequence.
Performance Steps
CAUTION: All body fluids should be considered potentially infectious. Always observe body
substance isolation (BSI) precautions by wearing gloves and eye protection as a minimal
standard of protection.
1. Take BSI precautions.
2. Perform a Scene Assessment.
NOTE: It may be necessary to move the casualty out of the line of effective enemy fire and
behind cover before properly assessing the trauma casualty.
a. Determine the safest route to access the casualty.
b. Determine the mechanism of injury (MOI).
c. Determine the number of casualties.
d. Request additional help, if necessary.
e. Consider the need for spinal stabilization.
NOTE: If the MOI is significant, direct another Soldier to provide manual, in-line stabilization of
the cervical spine.
3. Perform an Initial Assessment.
NOTE: Life-threatening injuries should be managed as they are identified.
a. Form a general impression (global overview) of the casualty's condition and environment.
b. Determine the chief complaint.
c. Assess the airway.
(1) Perform appropriate maneuver to open and maintain the airway.
(2) Insert an appropriate airway adjunct, if necessary.
d. Assess breathing.
(1) Determine the rate, rhythm, and quality of respirations (breathing).
(2) Administer supplemental oxygen by non-rebreathing mask, if available.
e. Assess circulation.
(1) Skin color, condition, and temperature (CCT).
(2) Assess the pulse for rate, rhythm, and strength.
(a) Check the radial pulse in adults.
(b) Check the radial pulse and capillary refill in children.
(c) Check the brachial pulse and capillary refill in infants.
(3) Check for significant hemorrhage (bleeding).
(4) Control bleeding.
(5) Treat for shock.
f. Assess the casualty's mental status using the Alert, Verbal, Pain, Unresponsive (AVPU)
scale.
(1) A - Alert and oriented (eyes open spontaneously as you approach; casualty appears
aware and responsive to the environment).
(2) V - Responsive to verbal stimuli (sound).
(3) P - Responsive to painful stimuli (touch, such as tapping the casualty on the shoulder
or pinching the casualty's ear).
(4) U - Unresponsive (does not respond to any stimuli).
g. Determine casualty priority and make a transport decision.
NOTE: High priority conditions that require immediate transport include a poor general
impression, unresponsive, responsive but not following commands, difficulty breathing, shock,
complicated childbirth, chest pain with systolic blood pressure less than 100 mm Hg,
uncontrolled bleeding, and severe pain.
4. If the MOI is significant, perform a Rapid Trauma Assessment.
NOTE: A significant MOI includes ejection from a vehicle, death in the same passenger
compartment, falls three times the casualty's height, rollover of vehicle, high-speed vehicle
collision, vehicle-pedestrian collision, motorcycle crash, unresponsive or altered mental status,
and penetrations of the head, chest, or abdomen (e.g., stab and gunshot wounds). Additional
significant MOI for a child include falls from more than 10 feet, bicycle collision, and vehicles in
medium speed collision.
a. Head.
(1) Inspect for deformities, contusions, abrasions, punctures or penetration, burns,
tenderness, lacerations, and swelling (DCAP-BTLS).
(2) Palpate for tenderness, instability, or crepitus (TIC).
b. Neck.
(1) Inspect for DCAP-BTLS.
(2) Palpate spinal step-offs.
(3) Inspect for jugular vein distention (JVD).
(4) Inspect to ensure the trachea is midline (without deviation).
(5) Apply a cervical collar, if necessary.
c. Chest.
(1) Inspect for DCAP-BTLS.
(2) Palpate for TIC.
(3) Inspect for the presence of paradoxical motion.
(4) Auscultate (listen) for breath sounds (present, diminished, absent, equal).
d. Abdomen.
(1) Inspect for DCAP-BTLS.
(2) Palpate for tenderness, rigidity, and distension (TRD).
e. Pelvis.
NOTE: If a conscious casualty complains of pain or if an unconscious casualty responds as if in
pain at any time during the assessment, do not continue the exam. Treat for pelvic fracture.
CAUTION: Do not "log roll" casualties suspected of having a pelvic fracture.
(1) Inspect for DCAP-BTLS.
(2) Gently compress (downward or inward) to detect TIC.
(3) Inspect for priapism.
f. Extremities.
(1) Inspect for DCAP-BTLS.
(2) Palpate for TIC.
(3) Check the distal pulses, motor function, and sensation (PMS).
g. Posterior.
NOTE: The casualty must be "log rolled" to do this portion of the assessment. If necessary, the
casualty should be placed on a long spine board after assessment. If the casualty has a suspected
pelvic fracture or bilateral femoral fractures, lift the casualty with multiple personnel, ensuring
the casualty is stabilized, and assess the posterior and place the casualty on the long spine board.
(1) Inspect for DCAP-BTLS.
NOTE: If penetrating wounds were noted during the anterior assessment, check for posterior
exit wounds while the casualty is log-rolled/lifted with assistance.
(2) Inspect for rectal bleeding.
5. If there is no significant MOI, perform a Focused History and Physical Exam.
a. Based on chief complaint.
b. Focus on the areas the casualty tells you are painful or that you suspect may be painful due
to the MOI.
6. Obtain a baseline set of vital signs.
7. Obtain a SAMPLE history.
NOTE: A SAMPLE history is obtained by questioning the casualty. If the casualty is unable to
answer, search the scene or ask bystanders or unit members that witnessed the event for
information.
a. Signs/symptoms.
(1) Ask the casualty what is wrong.
(2) Observe the casualty.
b. Allergies.
(1) Ask the casualty if there are any allergies to medications, foods, or environment.
c. Medications.
(1) Ask the casualty if he is taking any medications (prescription, over the counter, or
illegal).
d. Pertinent past history.
(1) Ask the casualty if there are any medical problems (past and present).
(2) Ask the casualty if he has been feeling ill.
(3) Ask the casualty about recent surgery or injuries.
(4) Ask the casualty if he is currently under the care of a medical officer and, if so,
what's their name and what type of care is being provided.
e. Last oral intake.
(1) Ask the casualty when his last meal or drink was.
(2) Ask the casualty what he ate or drank.
f. Events leading to the injury or illness.
(1) Ask about the sequence of events that led up to the current event.
(2) If the casualty is unable to answer, search the scene for anything that may indicate
what occurred.
8. Perform a Detailed Physical Examination.
NOTE: This is done only if time permits during casualty evacuation (CASEVAC) or while
waiting for CASEVAC, if not performing life-saving interventions. Do not delay evacuation to
perform this exam.
a. Assess the scalp and cranium.
(1) Inspect for DCAP-BTLS.
(2) Palpate for TIC.
b. Assess the ears.
(1) Inspect for DCAP-BTLS.
(2) Inspect for drainage.
(a) Blood or serous fluids.
(b) Clear fluids.
c. Assess the face for DCAP-BTLS.
d. Assess the eyes.
(1) Inspect for DCAP-BTLS.
(2) Inspect for discoloration.
(3) Inspect for unequal pupils.
(4) Inspect for foreign bodies.
(5) Inspect for blood in anterior chamber.
e. Assess the nose.
(1) Inspect for DCAP-BTLS.
(2) Inspect for drainage of blood and/or clear fluid.
f. Assess the mouth.
(1) Inspect for DCAP-BTLS.
(2) Inspect for loose or broken teeth.
(3) Inspect for objects that could cause obstruction.
(4) Inspect for swelling or laceration of the tongue.
(5) Inspect for unusual breath odor (alcohol, acetone, etc.)
g. Assess the neck.
(1) Inspect for DCAP-BTLS.
(2) Inspect for JVD.
(3) Inspect to ensure the trachea is still midline (without deviation).
(4) Palpate for TIC.
h. Reassess the chest.
(1) Inspect for DCAP-BTLS.
(2) Palpate for TIC.
(3) Auscultate breath sounds.
(4) Assess for flail chest.
i. Reassess the abdomen.
(1) Inspect for DCAP-BTLS.
(2) Palpate for TRD.
j. Reassess the pelvis.
NOTE: If pain, instability or crepitus was noticed in the rapid trauma assessment, ensure the
pelvis is properly stabilized and do not reassess.
(1) Inspect for DCAP-BTLS.
(2) Inspect for TIC.
k. Reassess the extremities.
(1) Inspect for DCAP-BTLS.
(2) Palpate for TIC.
(3) Check the PMS.
l. Reassess the posterior.
NOTE: If the casualty is secured to a long spine board, do not remove from the board.
Reassess the flanks and as much of the spine as you can without moving the casualty
unnecessarily.
(1) Inspect for DCAP-BTLS.
(2) Inspect for rectal bleeding.
m. Manage secondary injuries and wounds appropriately.
n. Reassess the casualty's vital signs every 5 minutes (if unstable), every 15 minutes (if
stable).
9. Document all assessment findings and care provided on the FMC.
Evaluation Preparation:
Setup: For training and evaluation, have another Soldier act as the casualty or use a trauma
mannequin. Describe a general scenario to the Soldier. The casualty must have more than one
injury or condition. Wounds may be simulated using moulage or other available materials. A
"conscious" casualty can be coached to show signs of such conditions as shock, and to respond
to the Soldier's questions about the location of pain and other symptoms of injury. The evaluator
will cue the Soldier during the assessment of an "unconscious" casualty as to whether the
casualty is breathing, and describe such conditions as shock to the Soldier as they are making the
checks. Tell the casualty not to assist the Soldier in any other way.
Brief Soldier: Tell the Soldier to tell you what action he would take for each wound or condition
identified.
Performance Measures
1. Took BSI precautions.
2. Performed a Scene Assessment.
3. Performed an Initial Assessment.
4. If the MOI was significant, performed a Rapid Trauma Assessment.
5. If there was no significant MOI, performed a Focused History and Physical
Exam.
6. Obtained baseline vital signs.
7. Obtained the SAMPLE history.
8. Performed a Detailed Physical Exam, if appropriate.
9. Documented medical findings and treatment provided on the FMC.
PASS
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FAIL
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Evaluation Guidance: Score each Soldier according to the performance measures in the
evaluation guide. Unless otherwise stated in the task summary, the Soldier must pass all
performance measures to be scored PASS. If the Soldier fails any step, show what was done
wrong and how to do it correctly.