After March and before Prolonged Field Care

Since we have finished the MARCH algorithm it made sense to continue on and hit the next step in TCCC. There are a few steps before we reach Prolonged Field Care, don’t worry we will hit that topic, and I wanted to cover them.

After MARCH there is another algorithm (big surprise) E-PAWS-B

• Eyes
• Pain
• Antibiotics
• Wounds
• Splinting
• Burns

And while each one of these could be a separate post, it wouldn’t make sense with how short they would be.

Eyes. This is mainly handling any penetrating eye trauma or damage to the eye in general. If you suspect any damage, you want to start with a quick eye exam. This includes the ability to read print, count fingers, identify hand motion, and sense light perception. Then you want to cover the eye with either a rigid eye shield or a donut. You do not want to use a pressure bandage or patch of any kind. It could further the damage done or cause the contents of the eye to exit through a cut or laceration. If you have made up combat pill packs then you would want to administer one of those at this time. If you make it with the medications recommended in the guidlines then it will include a medication to treat eye infections.

Pain and Antibiotics. Without the ability to push IV pain meds you will be limited to basically anything that is an oral over the counter medication. Again, this is where the combat pill pack comes into play. It has two medications in it to help with pain. It includes 2 650mg extended release Acetaminophin and 1 15mg meloxicam. This combines an anelgesic and an anti inflammatory together to help manage pain. For antibiotics it has 1 400mg moxiflaxacin. This medication is used because it can handle eye infections. Keep in mind, antiobiotic use at this stage is only broad spectrum antibiotics. Nothing that targets specific infections only. That is saved for prolonged field care. Even IV antiobitics pushed at this stage are broad spectrum. I won’t go into specifics on where to get these medications, use your imagination.

Wounds. The first step here is to once again recheck any intervention that is controlling bleeding. After that make sure all wounds have been attended to and have been dressed. This is our first chance at infection prevention. So cover any wounds up with gauze to keep anything else from getting into the wounds. If you don’t have gauze use any clean cloth available. Check all wounds for increased pain, color change, and lack of pulse. These can indicate an emergency. Check to make sure that you did not wrap any of the wounds too tight. The goal is not to wrap as tightly as possible, but to wrap as tightly as neccessary to control any bleeding.

Splinting. This is simply just splinting any broken bones. Keep in mind, an amputation is a break. If you don’t have the ability to properly splint the appendage, you can always buddy tape it. Be sure to check pulse, motor function, and sense of touch before and after splinting. If you need to apply traction to get a return of pulse, motor, or sense, you can try three times before you should just leave it and splint it as is. Be sure to immobolize the joint above and the joint below the break. If there is a wound near the break, be sure to dress it before you splint it. The most important aspect of splinting is to avoid damaging the nerves or blood vessels in the splinted extremity.

Burns. Burns can be caused by a multitude of different things. Everything from explosions, vehicle crashes, to even chemicals. For the most part, you need to stop the burning before you treat the burns. If it’s electrical then either shut off the source of the electricity or use a non conductive material to remove the causalty from the electrical source. If it’s thermal then extinguish the fire. Then cut away clothing from the burns. But do not pull off any burnt clothing that is stuck to the skin. If it’s chemical than try to brush off the chemical agent with something like a glove. If it’s white phosphorus than you need to soak the agent in water or submerge the affected area in water. This will prevent the agent from reigniting. Wrap it loosely with wet gauze and be sure to let the receiving facility know it is a white phosphorus burn. Otherwise they will be in for a very nasty surprise. Make sure to try to estimate the burn area percentage for burns greater than 2nd degree. An easy way to do this is with the rules of 9.

Notice how the ratio changes depending on the age of the casualty. Also, another way to figure out total burn surface area is to use the causalties hand as it equals 1% of the casualties body surface area. Anything over 30% requires serious medical care.

Want to learn more about this? Head on out to class. We cover all this and more.

I have Bleeder kits in stock.