Upload
john-alexander-gallin
View
219
Download
0
Embed Size (px)
Citation preview
7/24/2019 Tactical Emergency Medical Services
http://slidepdf.com/reader/full/tactical-emergency-medical-services 1/58
Tactical EMS (TEMS) Trainin g Module
WORKFORCE RELEVANCY STEWARDSHIP EDUCATION
E M E R G
E N C Y M E D I C A L S E R V I C E S
E M E R G
E N C Y M E D I C A L S E R V I C E S
N
ATIONAL
P
ARK
S
ERVICE
T
ACTICAL
EMS (TEMS)
T
RAINING
M
ODULE
Version – May 2012
7/24/2019 Tactical Emergency Medical Services
http://slidepdf.com/reader/full/tactical-emergency-medical-services 2/58
Tactical EMS (TEMS) Trainin g Module
WORKFORCE RELEVANCY STEWARDSHIP EDUCATION
E M E R G
E N C Y M E D I C A L S E R V I C E S
E M E R G
E N C Y M E D I C A L S E R V I C E S
C
OURSE
R
EQUIREMENTS
Required for completion
1. Registration of TEMS course with WASO
2. This presentation by NPS TEMS Instructor
3. Stations (with completed skill sheets)
a. Bleeding Control (Wound Packing/PressureDressing/Tourniquet)
b. Chest Trauma (Needle Decompression/Chest Seal)
c. IFAK and NPS TEMS Protocols
4. Online Test (InsideNPS) – Pass 80%
7/24/2019 Tactical Emergency Medical Services
http://slidepdf.com/reader/full/tactical-emergency-medical-services 3/58
Tactical EMS (TEMS) Trainin g Module
WORKFORCE RELEVANCY STEWARDSHIP EDUCATION
E M E R G
E N C Y M E D I C
A L S E R V I C E S
E M E R G
E N C Y M E D I C
A L S E R V I C E S
Provider Levels – Basic Life Support (BLS)*
EMR (Emergency Medical Responder)EMT (Emergency Medical Technician)
Provider Levels – Advanced Life Support (ALS)*
Parkmedic
AEMT (Advanced EMT)
Paramedic
RN/NP/PA/MD
*All TEMS programs/providers require Local EMS Medical Advisor(LEMA) Approval
NPS TEMS P
ROVIDER
L
EVELS
7/24/2019 Tactical Emergency Medical Services
http://slidepdf.com/reader/full/tactical-emergency-medical-services 4/58
Tactical EMS (TEMS) Trainin g Module
WORKFORCE RELEVANCY STEWARDSHIP EDUCATION
E M E R G
E N C Y M E D I C
A L S E R V I C E S
E M E R G
E N C Y M E D I C
A L S E R V I C E S
A
FTER
C
OMPLETION OF
NPS TEMS T
RAINING
M
ODULE
, A
LL
PROVIDERS WILL:
1. Recognize stages of patient care and treatment priorities
a. Care Under Fire / Direct Threat Careb. Tactical Field Care / Indirect Threat Care
c. Tactical Evacuation / TEMS Transport
Tactical Combat Casualty Care (TCCC) vs. TEMS Terminology
7/24/2019 Tactical Emergency Medical Services
http://slidepdf.com/reader/full/tactical-emergency-medical-services 5/58
Tactical EMS (TEMS) Trainin g Module
WORKFORCE RELEVANCY STEWARDSHIP EDUCATION
E M E R G
E N C Y M E D I C
A L S E R V I C E S
E M E R G
E N C Y M E D I C
A L S E R V I C E S
A
FTER
C
OMPLETION OF
NPS TEMS T
RAINING
M
ODULE
, A
LL
PROVIDERS WILL: (CONT)
2. Recognize and treat preventable causes of death in a tactical
setting#1 - extremity hemorrhage (60%)
#2 - tension pneumothorax (33%)
#3 - airway obstruction (6%)
3. Be competent to implement TEMS in your park withappropriate approval (LEMA, EMS-Coordinator)
7/24/2019 Tactical Emergency Medical Services
http://slidepdf.com/reader/full/tactical-emergency-medical-services 6/58
Tactical EMS (TEMS) Trainin g Module
WORKFORCE RELEVANCY STEWARDSHIP EDUCATION
E M E R G
E N C Y M E D I C
A L S E R V I C E S
E M E R G
E N C Y M E D I C
A L S E R V I C E S
3 C
ATEGORIES OF
C
ASUALTIES IN THE
T
ACTICAL
E
NVIRONMENT
1. Patients who will live regardless
2. Patients who will die regardless
3. Patients who will die from preventable deaths unless
proper life-saving steps are taken immediately
GOAL OF NPS TEMS
To Minimize Preventable Casualties
7/24/2019 Tactical Emergency Medical Services
http://slidepdf.com/reader/full/tactical-emergency-medical-services 7/58
Tactical EMS (TEMS) Trainin g Module
WORKFORCE RELEVANCY STEWARDSHIP EDUCATION
E M E R G
E N C Y M E D I C
A L S E R V I C E S
E M E R G
E N C Y M E D I C
A L S E R V I C E S
T
ACTICAL
C
OMBAT
C
ASUALTY
C
ARE
TCCC developed by military, and adapted for TEMS
Two important principles
1. To perform the correct intervention at the correct time inthe continuum of Tactical Care
2. A medically correct intervention performed at the wrong
time in combat may lead to further casualties
7/24/2019 Tactical Emergency Medical Services
http://slidepdf.com/reader/full/tactical-emergency-medical-services 8/58
Tactical EMS (TEMS) Trainin g Module
WORKFORCE RELEVANCY STEWARDSHIP EDUCATION
E M E R G
E N C Y M E D I C
A L S E R V I C E S
E M E R G
E N C Y M E D I C
A L S E R V I C E S
T
ACTICAL
C
OMBAT
C
ASUALTY
C
ARE
Conventional civilian medicine was not appropriate for
optimizing casualty care within the tactical environment.
• Butler, et. al., Military Medicine 1996
• After 1993 Battle of Mogadishu‘Black Hawk Down’
CoTCCC – Committee on TCCC
Updates guidelines on a regular basis
7/24/2019 Tactical Emergency Medical Services
http://slidepdf.com/reader/full/tactical-emergency-medical-services 9/58
Tactical EMS (TEMS) Trainin g Module
WORKFORCE RELEVANCY STEWARDSHIP EDUCATION
E M E R G
E N C Y M E D I C
A L S E R V I C E S
E M E R G
E N C Y M E D I C
A L S E R V I C E S
D
RIVING
F
ACTORS OF
TEMS
1. Mission
2. Overall Team Health
a. Self-care
b. Buddy Care
c. Team Care
3. Protection of:
a. Victims/Hostages
b. Bystanders
c. Team Members
d. Perpetrator
7/24/2019 Tactical Emergency Medical Services
http://slidepdf.com/reader/full/tactical-emergency-medical-services 10/58
Tactical EMS (TEMS) Trainin g Module
WORKFORCE RELEVANCY STEWARDSHIP EDUCATION
E M E R G
E N C Y M E D I C
A L S E R V I C E S
E M E R G
E N C Y M E D I C
A L S E R V I C E S
COMPARISON OF SURVIVAL AFTER TCCC (AND OTHER FACTORS)
World War II Vietnam War Iraq &
Afghanistan
KIA 23.7 21.3 12.5
DOW 3.4 3.5 4.1
CFR 19.1 15.8 9.4
KIA = Killed in Action; DOW=Died of Wounds; CFR=Case Fatality Rate
Holcom b JH et al. J Trauma 2006
7/24/2019 Tactical Emergency Medical Services
http://slidepdf.com/reader/full/tactical-emergency-medical-services 11/58
Tactical EMS (TEMS) Trainin g Module
WORKFORCE RELEVANCY STEWARDSHIP EDUCATION
E M E R G
E N C Y M E D I C
A L S E R V I C E S
E M E R G
E N C Y M E D I C
A L S E R V I C E S OIF – Operation Iraqi Freedom; OEF – Operation Enduring Freedom (Afghanistan)
CNS – Central Nervous System
MSOF – Multi-System Organ Failure
FST – Forward Surgical Team
CSH – Combat Support HospitalMost Preventable
7/24/2019 Tactical Emergency Medical Services
http://slidepdf.com/reader/full/tactical-emergency-medical-services 12/58
Tactical EMS (TEMS) Trainin g Module
WORKFORCE RELEVANCY STEWARDSHIP EDUCATION
E M E R G
E N C Y M E D I C
A L S E R V I C E S
E M E R G
E N C Y M E D I C
A L S E R V I C E S
TCCC/TEMS R
ECOGNIZED
B
Y
:
• DOD – all branches of the U.S. Military
• DHS, other federal agencies• National Tactical Officers Association (NTOA)
• National Association of EMTs (found in Prehospital
Trauma Life Support [PHTLS] Manual – MilitaryEdition
• American College of Surgeons
7/24/2019 Tactical Emergency Medical Services
http://slidepdf.com/reader/full/tactical-emergency-medical-services 13/58
Tactical EMS (TEMS) Trainin g Module
WORKFORCE RELEVANCY STEWARDSHIP EDUCATION
E M E R G
E N C Y M E D I C
A L S E R V I C E S
E M E R G
E N C Y M E D I C
A L S E R V I C E S
PHTLS
AND
TCCC G
UIDELINES
7th Ed. - 2011 May 2010
7/24/2019 Tactical Emergency Medical Services
http://slidepdf.com/reader/full/tactical-emergency-medical-services 14/58
Tactical EMS (TEMS) Trainin g Module
WORKFORCE RELEVANCY STEWARDSHIP EDUCATION
E M E R G
E N C Y M E D I C
A L S E R V I C E S
E M E R G
E N C Y M E D I C
A L S E R V I C E S
L
EVELS OF
C
OMBAT
C
ARE
(TCCC) / TEMS
Self Aid
Buddy Aid
IFAK – Individual First Aid Kit(Similar available to NPS TEMS Providers)
7/24/2019 Tactical Emergency Medical Services
http://slidepdf.com/reader/full/tactical-emergency-medical-services 15/58
Tactical EMS (TEMS) Trainin g Module
WORKFORCE RELEVANCY STEWARDSHIP EDUCATION
E M E R G
E N C Y M E D I C
A L S E R V I C E S
E M E R G
E N C Y M E D I C
A L S E R V I C E S
L
EVELS OF
C
OMBAT
C
ARE
P
ROVIDERS
(TCCC)
Combat Life Saver (CLS) - Military
NPS BLS TEMS Provider - NPS
7/24/2019 Tactical Emergency Medical Services
http://slidepdf.com/reader/full/tactical-emergency-medical-services 16/58
Tactical EMS (TEMS) Trainin g Module
WORKFORCE RELEVANCY STEWARDSHIP EDUCATION
E M E R G
E N C Y M E D I C
A L S E R V I C E S
E M E R G
E N C Y M E D I C
A L S E R V I C E S
TCCC S
KILLS
• Rapid casualty assessment (Triage)
• Control hemorrhage
• Treat penetrating chest trauma
• Maintain BLS airway
• Initiate saline lock and IVF (NPS ALS TEMS Provider)
• Package casualty for transport
7/24/2019 Tactical Emergency Medical Services
http://slidepdf.com/reader/full/tactical-emergency-medical-services 17/58
Tactical EMS (TEMS) Trainin g Module
WORKFORCE RELEVANCY STEWARDSHIP EDUCATION
E M E R G
E N C Y M E D I C
A L S E R V I C E S
E M E R G
E N C Y M E D I C
A L S E R V I C E S
ALS L
EVELS OF
C
OMBAT
C
ARE
(TCCC)
Military
• Combat Medic
• Special Forces Medic
NPS
• NPS ALS TEMS Provider
7/24/2019 Tactical Emergency Medical Services
http://slidepdf.com/reader/full/tactical-emergency-medical-services 18/58
Tactical EMS (TEMS) Trainin g Module
WORKFORCE RELEVANCY STEWARDSHIP EDUCATION
E M E R G
E N C Y M E D I C
A L S E R V I C E S
E M E R G
E N C Y M E D I C
A L S E R V I C E S
3 P
HASES OF
TCC/TEMS C
ARE
• Care Under Fire / Direct Threat Care
• Tactical Field Care / Indirect ThreatCare
• Tactical Evacuation
Recognize treatment priorities of each
7/24/2019 Tactical Emergency Medical Services
http://slidepdf.com/reader/full/tactical-emergency-medical-services 19/58
Tactical EMS (TEMS) Trainin g Module
WORKFORCE RELEVANCY STEWARDSHIP EDUCATION
E M E R G
E N C Y M E D I C
A L S E R V I C E S
E M E R G
E N C Y M E D I C
A L S E R V I C E S
XABC
X – eXsanguinating hemorrhage
care/eXtractionA – Airway management
B – Breathing
C – Circulation
7/24/2019 Tactical Emergency Medical Services
http://slidepdf.com/reader/full/tactical-emergency-medical-services 20/58
Tactical EMS (TEMS) Trainin g Module
WORKFORCE RELEVANCY STEWARDSHIP EDUCATION
E M E R G
E N C Y M E D I C
A L S E R V I C E S
E M E R G
E N C Y M E D I C
A L S E R V I C E S
C
ARE
U
NDER
F
IRE
/ D
IRECT
T
HREAT
C
ARE
• Return fire and take cover
• Expect casualty to remain engaged as acombatant (if appropriate)
• Provide basic care (self aid)
– Stop eXsanguination; bleeding (Tourniquet)• Direct or move patient to a Casualty Collection
Point (CCP) if safe
• Try to keep the patient from sustainingadditional wounds
• Airway management is deferred until TacticalField Care/Indirect Threat Care Phase
7/24/2019 Tactical Emergency Medical Services
http://slidepdf.com/reader/full/tactical-emergency-medical-services 21/58
Tactical EMS (TEMS) Trainin g Module
WORKFORCE RELEVANCY STEWARDSHIP EDUCATION
E M E R G
E N C Y M E D I C
A L S E R V I C E S
E M E R G
E N C Y M E D I C
A L S E R V I C E S
C
ARE
U
NDER
F
IRE
/ D
IRECT
T
HREAT
C
ARE
Bleeding Control
• ‘Tourniquet First’ for life threatening extremitybleeding
• C-A-T Tourniquet (NPS recommended)
• Tighten to Stop Bleeding AND Loss of Distal Pulse• Expose Tourniquet and
mark application time
7/24/2019 Tactical Emergency Medical Services
http://slidepdf.com/reader/full/tactical-emergency-medical-services 22/58
Tactical EMS (TEMS) Trainin g Module
WORKFORCE RELEVANCY STEWARDSHIP EDUCATION
E M E R G
E N C Y M E D I C
A L S E R V I C E S
E M E R G
E N C Y M E D I C
A L S E R V I C E S
C
ARE
U
NDER
F
IRE
/ D
IRECT
T
HREAT
C
ARE
Tourniquet Key Principles
• Width >1 inch
• Mechanical arm (cam)
• Easy application (<60 sec)
• Self-applied
• Adjustable• Non-slip
7/24/2019 Tactical Emergency Medical Services
http://slidepdf.com/reader/full/tactical-emergency-medical-services 23/58
Tactical EMS (TEMS) Trainin g Module
WORKFORCE RELEVANCY STEWARDSHIP EDUCATION
E M E R G
E N C Y M E D I C
A L S E R V I C E S
E M E R G
E N C Y M E D I C
A L S E R V I C E S
C
ARE
U
NDER
F
IRE
/T
ACTICAL
F
IELD
C
ARE
(DIRECT/INDIRECT THREAT CARE)
Bleeding Control (NPS TEMS Skills Station 1)
Options:
• Direct Pressure
• Wound Packing• Pressure Bandage
• Tourniquet (C-A-T)
7/24/2019 Tactical Emergency Medical Services
http://slidepdf.com/reader/full/tactical-emergency-medical-services 24/58
Tactical EMS (TEMS) Trainin g Module
WORKFORCE RELEVANCY STEWARDSHIP EDUCATION
E M E R G
E N C Y M E D I C
A L S E R V I C E S
E M E R G
E N C Y M E D I C
A L S E R V I C E S
T
ACTICAL
F
IELD
C
ARE
/ I
NDIRECT
T
HREAT
C
ARE
• No longer under direct fire
• Mental Status – AVPU• Airway, Breathing
– Chin lift or jaw thrust
– NPA – Recovery position (on side)
– Rescue breaths if needed
• If a victim of a blast or penetrating injury is foundwithout a pulse, respirations, or other signs of life
DO NOT attempt CPR
7/24/2019 Tactical Emergency Medical Services
http://slidepdf.com/reader/full/tactical-emergency-medical-services 25/58
Tactical EMS (TEMS) Trainin g Module
WORKFORCE RELEVANCY STEWARDSHIP EDUCATION
E M E R G E N C Y M E D I C A L S E R V I C E S
E M E R G E N C Y M E D I C A L S E R V I C E S
W
OUND
P
ACKING
(
VIDEO
)
For a demonstration, Click
Here to view the WoundPacking Video
7/24/2019 Tactical Emergency Medical Services
http://slidepdf.com/reader/full/tactical-emergency-medical-services 26/58
Tactical EMS (TEMS) Trainin g Module
WORKFORCE RELEVANCY STEWARDSHIP EDUCATION
E M E R G E N C Y M E D I C A L S E R V I C E S
E M E R G E N C Y M E D I C A L S E R V I C E S
H
ARMFUL
E
FFECTS OF
G
RANULAR
C
LOTTING
A
GENTS
• Kheirabadi, J Trauma 2009
• Exothermic local effect to soft tissues (injury tonerves and surrounding vessels)
• Embolic events (Pulmonary Embolism / Stroke)
Remove all granular clotting agents from TEMS Kits
Other Granular Agent Concerns:
• Wind/Rotor wash – Blow granular agents into eyes
– Disable team member temporarily/permanently
• Cost without benefit
7/24/2019 Tactical Emergency Medical Services
http://slidepdf.com/reader/full/tactical-emergency-medical-services 27/58
Tactical EMS (TEMS) Trainin g Module
WORKFORCE RELEVANCY STEWARDSHIP EDUCATION
E M E R G E N C Y M E D I C A L S E R V I C E S
E M E R G E N C Y M E D I C A L S E R V I C E S
CT A
NGIOGRAPHY
Kheirabadi, J Trauma 2009
7/24/2019 Tactical Emergency Medical Services
http://slidepdf.com/reader/full/tactical-emergency-medical-services 28/58
Tactical EMS (TEMS) Trainin g Module
WORKFORCE RELEVANCY STEWARDSHIP EDUCATION
E M E R G E N C Y M E D I C A L S E R V I C E S
E M E R G E N C Y M E D I C A L S E R V I C E S
W
HY TO
R
EMOVE
G
RANULAR
A
GENTS
(
VIDEO
)
For a demonstration, Click
Here to view the Quick ClotBurning Demo Video
7/24/2019 Tactical Emergency Medical Services
http://slidepdf.com/reader/full/tactical-emergency-medical-services 29/58
Tactical EMS (TEMS) Trainin g Module
WORKFORCE RELEVANCY STEWARDSHIP EDUCATION
E M E R G E N C Y M E D I C A L S E R V I C E S
E M E R G E N C Y M E D I C A L S E R V I C E S
T
ACTICAL
F
IELD
C
ARE
/ I
NDIRECT
T
HREAT
C
ARE
Penetrating Chest Trauma (Skill Station 2)
• Needle decompression (NDC)
• Cover open chest wounds – 4 sides
7/24/2019 Tactical Emergency Medical Services
http://slidepdf.com/reader/full/tactical-emergency-medical-services 30/58
Tactical EMS (TEMS) Trainin g Module
WORKFORCE RELEVANCY STEWARDSHIP EDUCATION
E M E R G E N C Y M E D I C A L S E R V I C E S
E M E R G E N C Y M E D I C A L S E R V I C E S
C
HEST
A
NATOMY
• Needle Decompression (NDC)
– 2nd InterCostal Space (ICS) - over 3rd rib – Mid-clavicular line (MCL)
See protocol 1120-T
7/24/2019 Tactical Emergency Medical Services
http://slidepdf.com/reader/full/tactical-emergency-medical-services 31/58
Tactical EMS (TEMS) Trainin g Module
WORKFORCE RELEVANCY STEWARDSHIP EDUCATION
E M E R G E N C Y M E D I C A L S E R V I C E S
E M E R G E N C Y M E D I C A L S E R V I C E S
P
NEUMOTHORAX
Simple Pneumothorax
• Immediate field treatment notneeded (close monitoring)
Tension Pneumothorax
• Severe Respiratory Distress• Life Threatening Emergency
• Requires Needle Decompression(NDC)
7/24/2019 Tactical Emergency Medical Services
http://slidepdf.com/reader/full/tactical-emergency-medical-services 32/58
Tactical EMS (TEMS) Trainin g Module
WORKFORCE RELEVANCY STEWARDSHIP EDUCATION
E M E R G E N C Y M E D I C A L S E R V I C E S
E M E R G E N C Y M E D I C A L S E R V I C E S
W
OUND
P
ACKING
(
VIDEO
)
For a demonstration, Click
Here to view the Open ChestWound Video 1
7/24/2019 Tactical Emergency Medical Services
http://slidepdf.com/reader/full/tactical-emergency-medical-services 33/58
Tactical EMS (TEMS) Trainin g Module
WORKFORCE RELEVANCY STEWARDSHIP EDUCATION
E M E R G E N C Y M E D I C A L S E R V I C E S
E M E R G E N C Y M E D I C A L S E R V I C E S
O
PEN
C
HEST
W
OUND
Chest Seal (cover the open ‘sucking’ wound)
• Goal: optimize spontaneous respiration• Maintain negative intra-thoracic pressure =
lung expansion
7/24/2019 Tactical Emergency Medical Services
http://slidepdf.com/reader/full/tactical-emergency-medical-services 34/58
Tactical EMS (TEMS) Trainin g Module
WORKFORCE RELEVANCY STEWARDSHIP EDUCATION
E M E R G E N C Y M E D I C A L S E R V I C E S
E M E R G E N C Y M E D I C A L S E R V I C E S
O
PEN
C
HEST
W
OUND
(
VIDEO
)
For a demonstration, Click
Here to view the Open ChestWound Video 2
7/24/2019 Tactical Emergency Medical Services
http://slidepdf.com/reader/full/tactical-emergency-medical-services 35/58
Tactical EMS (TEMS) Trainin g Module
WORKFORCE RELEVANCY STEWARDSHIP EDUCATION
E M E R G E N C Y M E D I C A L S E R V I C E S
E M E R G E N C Y M E D I C A L S E R V I C E S
W
HEN TO
P
ERFORM
N
EEDLE
D
E
C
OMPRESSION
(NDC)
Penetrating Chest Trauma
• Bullet• Knife
• Other penetrating Object
‘If there is a Hole’
-AND-
Worsening or Severe Respiratory Distress
7/24/2019 Tactical Emergency Medical Services
http://slidepdf.com/reader/full/tactical-emergency-medical-services 36/58
Tactical EMS (TEMS) Trainin g Module
WORKFORCE RELEVANCY STEWARDSHIP EDUCATION
E M E R G E N C Y M E D I C A L S E R V I C E S
E M E R G E N C Y M E D I C A L S E R V I C E S
W
HEN
NOT
TO
P
ERFORM
NDC
Blunt Chest Trauma
• Per BLS TEMS Protocols
Penetrating/Blunt Abdominal Trauma
Other causes of respiratory distress
• Asthma
• Anaphylaxis• Anxiety
7/24/2019 Tactical Emergency Medical Services
http://slidepdf.com/reader/full/tactical-emergency-medical-services 37/58
Tactical EMS (TEMS) Trainin g Module
WORKFORCE RELEVANCY STEWARDSHIP EDUCATION
E M E R G E N C Y M E D I C A L S E R V I C E S
E M E R G E N C Y M E D I C A L S E R V I C E S
C
ASE
1
GSW to the left abdomen, no radial pulse, altered
mental status, and respiratory distress
Do you perform a needle decompression?
Answer: (next slide)
7/24/2019 Tactical Emergency Medical Services
http://slidepdf.com/reader/full/tactical-emergency-medical-services 38/58
7/24/2019 Tactical Emergency Medical Services
http://slidepdf.com/reader/full/tactical-emergency-medical-services 39/58
Tactical EMS (TEMS) Trainin g Module
WORKFORCE RELEVANCY STEWARDSHIP EDUCATION
E M E R G E N C Y M E D I C A L S E R V I C E S
E M E R G E N C Y M E D I C A L S E R V I C E S
C
ASE
2
GSW to the left upper back with difficulty breathing,
gasping for air
Do you perform a needle decompression?
Answer: (next slide)
7/24/2019 Tactical Emergency Medical Services
http://slidepdf.com/reader/full/tactical-emergency-medical-services 40/58
Tactical EMS (TEMS) Trainin g Module
WORKFORCE RELEVANCY STEWARDSHIP EDUCATION
E M E R
G E N C Y M E D I
C A L S E R V I C E S
E M E R
G E N C Y M E D I
C A L S E R V I C E S
C
ASE
2
GSW to the left upper back with difficulty breathing,
gasping for air
Do you perform a needle decompression?
Answer: YES
7/24/2019 Tactical Emergency Medical Services
http://slidepdf.com/reader/full/tactical-emergency-medical-services 41/58
Tactical EMS (TEMS) Trainin g Module
WORKFORCE RELEVANCY STEWARDSHIP EDUCATION
E M E R
G E N C Y M E D I
C A L S E R V I C E S
E M E R
G E N C Y M E D I
C A L S E R V I C E S
C
ASE
3
Patient with GSW to the leg and then gets stung by a
bee and begins having an allergic reaction withdifficulty breathing, hives, wheezing anddiaphoresis
Do you perform a needle decompression?
Answer: (next slide)
7/24/2019 Tactical Emergency Medical Services
http://slidepdf.com/reader/full/tactical-emergency-medical-services 42/58
Tactical EMS (TEMS) Trainin g Module
WORKFORCE RELEVANCY STEWARDSHIP EDUCATION
E M E R
G E N C Y M E D I
C A L S E R V I C E S
E M E R
G E N C Y M E D I
C A L S E R V I C E S
C
ASE
3
Patient with GSW to the leg and then gets stung by a
bee and begins having an allergic reaction withdifficulty breathing, hives, wheezing anddiaphoresis
Do you perform a needle decompression?
Answer: NO
7/24/2019 Tactical Emergency Medical Services
http://slidepdf.com/reader/full/tactical-emergency-medical-services 43/58
Tactical EMS (TEMS) Trainin g Module
WORKFORCE RELEVANCY STEWARDSHIP EDUCATION
E M E R
G E N C Y M E D I
C A L S E R V I C E S
E M E R
G E N C Y M E D I
C A L S E R V I C E S
T
ACTICAL
F
IELD
C
ARE
/ I
NDIRECT
T
HREAT
C
ARE
Splint Obvious Fractures
7/24/2019 Tactical Emergency Medical Services
http://slidepdf.com/reader/full/tactical-emergency-medical-services 44/58
Tactical EMS (TEMS) Trainin g Module
WORKFORCE RELEVANCY STEWARDSHIP EDUCATION
E M E R
G E N C Y M E D I C A L S E R V I C E S
E M E R
G E N C Y M E D I C A L S E R V I C E S
T
ACTICAL
E
VACUATION
(TACEVAC)
Have medical ‘pre-plan’
• Nearest hospital• Evacuation resources
• Etc.
Additional care rendered while the patient is beingevacuated, generally more advanced ALS (airway,medications, procedures, etc.)
7/24/2019 Tactical Emergency Medical Services
http://slidepdf.com/reader/full/tactical-emergency-medical-services 45/58
Tactical EMS (TEMS) Trainin g Module
WORKFORCE RELEVANCY STEWARDSHIP EDUCATION
E M E R
G E N C Y M E D I C A L S E R V I C E S
E M E R
G E N C Y M E D I C A L S E R V I C E S
H
YPOTHERMIA
P
REVENTION
Triad of Death - Hypothermia Kills
• Hypothermia• Coagulopathy
• Acidosis
Even in Iraq, 18% of pts arrived T<36C (96.8F)
Temps in critical trauma pts < 34C (93F) = near 100%mortality
Arthurs 2006 Am J Surg
7/24/2019 Tactical Emergency Medical Services
http://slidepdf.com/reader/full/tactical-emergency-medical-services 46/58
Tactical EMS (TEMS) Trainin g Module
WORKFORCE RELEVANCY STEWARDSHIP EDUCATION
E M E R
G E N C Y M E D I C A L S E R V I C E S
E M E R
G E N C Y M E D I C A L S E R V I C E S
H
YPOTHERMIA
P
REVENTION
& M
ANAGEMENT
K
IT
(HPMK)
Keep your patients warm with HPMK kit or other
tools!
7/24/2019 Tactical Emergency Medical Services
http://slidepdf.com/reader/full/tactical-emergency-medical-services 47/58
Tactical EMS (TEMS) Trainin g Module
WORKFORCE RELEVANCY STEWARDSHIP EDUCATION
E M E R
G E N C Y M E D I C A L S E R V I C E S
E M E R
G E N C Y M E D I C A L S E R V I C E S
NPS TEMS BLS P
ROVIDER
Rapid casualty assessment (Triage) – TCCC/TEMS
Control hemorrhage
• Direct Pressure, Wound Packing, Pressure Bandage, Tourniquet
Treat penetrating chest trauma• Needle Decompression, Chest Seal
Maintain BLS airway
• OPA/NPA
Package casualty for transport
S ( S)
7/24/2019 Tactical Emergency Medical Services
http://slidepdf.com/reader/full/tactical-emergency-medical-services 48/58
Tactical EMS (TEMS) Trainin g Module
WORKFORCE RELEVANCY STEWARDSHIP EDUCATION
E M E R
G E N C Y M E D I C A L S E R V I C E S
E M E R
G E N C Y M E D I C A L S E R V I C E S
NPS TEMS IFAK
Individual First Aid Kit (specific for each member)
See NPS TEMS Protocols
Self/Buddy Aid for XABC
T ti l EMS (TEMS) T i i M d l
7/24/2019 Tactical Emergency Medical Services
http://slidepdf.com/reader/full/tactical-emergency-medical-services 49/58
Tactical EMS (TEMS) Trainin g Module
WORKFORCE RELEVANCY STEWARDSHIP EDUCATION
E M E R
G E N C Y M E D I C A L S E R V I C E S
E M E R
G E N C Y M E D I C A L S E R V I C E S
NPS TEMS ALS P
ROVIDER
Rapid casualty assessment (Triage) - TCCC
Control hemorrhage
• Direct Pressure, Wound Packing, Pressure Bandage, Tourniquet
Treat penetrating chest trauma• Needle Decompression, Chest Seal
Maintain BLS airway/Consider ALS airway
• OPA/NPA• Consider King Tube/Intubation/TTJI
T ti l EMS (TEMS) T i i M d l
7/24/2019 Tactical Emergency Medical Services
http://slidepdf.com/reader/full/tactical-emergency-medical-services 50/58
Tactical EMS (TEMS) Trainin g Module
WORKFORCE RELEVANCY STEWARDSHIP EDUCATION
E M E R
G E N C Y M E D I C A L S E R V I C E S
E M E R
G E N C Y M E D I C A L S E R V I C E S
NPS TEMS ALS P
ROVIDER
Consider IV/IO vascular access
• Permissive hypotension
– Titrate fluids to mental status and radial pulse (BPapproximately 80-90 mmHg)
• Standard trauma protocols of 2 L NS/LR may increasedbleeding and cause dilution of coagulation factors leading to
increased mortality.*
Package casualty for transport
Plus ALS Skills (all standing orders in tactical setting)
*Haut et al – Ann Surg 2011
Tactical EMS (TEMS) Trainin g Module
7/24/2019 Tactical Emergency Medical Services
http://slidepdf.com/reader/full/tactical-emergency-medical-services 51/58
Tactical EMS (TEMS) Trainin g Module
WORKFORCE RELEVANCY STEWARDSHIP EDUCATION
E M E R
G E N C Y M E D I C A L S E R V I C E S
E M E R
G E N C Y M E D I C A L S E R V I C E S
NPS TEMS M
EDIC
K
IT
• Basic kit for team medic
• Adjust contents based on mission
• See NPS TEMS Protocols
Tactical EMS (TEMS) Trainin g Module
7/24/2019 Tactical Emergency Medical Services
http://slidepdf.com/reader/full/tactical-emergency-medical-services 52/58
Tactical EMS (TEMS) Trainin g Module
WORKFORCE RELEVANCY STEWARDSHIP EDUCATION
E M E R
G E N C Y M E D I C A L S E R V I C E S
E M E R
G E N C Y M E D I C A L S E R V I C E S
D
OCUMENTATION
Documentation of Care
• Clinical Assessments• Treatments rendered
• Changes in status
Forward information onto the next level of care
Initial notes and/or triage/TCCC card informationneeds to be later transcribed onto formal ePCR(emsCharts)
Tactical EMS (TEMS) Trainin g Module
7/24/2019 Tactical Emergency Medical Services
http://slidepdf.com/reader/full/tactical-emergency-medical-services 53/58
Tactical EMS (TEMS) Trainin g Module
WORKFORCE RELEVANCY STEWARDSHIP EDUCATION
E M E R
G E N C Y M E D I C A L S E R V I C E S
E M E R
G E N C Y M E D I C A L S E R V I C E S
S
KILLS
S
TATIONS
Station 1: Bleeding Control (skill sheet)
• Wound Packing
• Pressure Dressing
• Tourniquet (C-A-T)
Station 2: Penetrating Chest Trauma (skill sheet)• Needle Decompression (NDC)
• Chest Seal
Station 3: IFAK and NPS TEMS Protocols (skill sheet)
Tactical EMS (TEMS) Trainin g Module
7/24/2019 Tactical Emergency Medical Services
http://slidepdf.com/reader/full/tactical-emergency-medical-services 54/58
Tactical EMS (TEMS) Trainin g Module
WORKFORCE RELEVANCY STEWARDSHIP EDUCATION
E M E R
G E N C Y M E D I C A L S E R V I C E S
E M E R
G E N C Y M E D I C A L S E R V I C E S
O
NLINE
T
EST
InsideNPS
• BLS NPS TEMS Test –15 Questions• ALS NPS TEMS Test – 25 Questions
• NPS TEMS Instructor – 30 Questions
Passing is greater than 80%
Tactical EMS (TEMS) Trainin g Module
7/24/2019 Tactical Emergency Medical Services
http://slidepdf.com/reader/full/tactical-emergency-medical-services 55/58
Tactical EMS (TEMS) Trainin g Module
WORKFORCE RELEVANCY STEWARDSHIP EDUCATION
E M E R
G E N C Y M E D I C A L S E R V I C E S
E M E R
G E N C Y M E D I C A L S E R V I C E S
R
EFRESHER
6 month refresher on skills/test (1-2 hr.)
– Ensure IFAK complete and familiar with contents – Perform skills to maintain proficiency and
indications
Every 2 years complete NPS TEMS module
Tactical EMS (TEMS) Trainin g Module
7/24/2019 Tactical Emergency Medical Services
http://slidepdf.com/reader/full/tactical-emergency-medical-services 56/58
( ) g
WORKFORCE RELEVANCY STEWARDSHIP EDUCATION
E M E R
G E N C Y M E D I C A L S E R V I C E S
E M E R
G E N C Y M E D I C A L S E R V I C E S
Q
UESTIONS
?
Developed by – Jay Shields, Will Smith, Mark Jacoby, Geoff Stroh,
Clay Anderson, Dean Ross, and NPS EMS Advisory Council
Tactical EMS (TEMS) Trainin g Module
7/24/2019 Tactical Emergency Medical Services
http://slidepdf.com/reader/full/tactical-emergency-medical-services 57/58
( ) g
WORKFORCE RELEVANCY STEWARDSHIP EDUCATION
E M E R
G E N C Y M E D I C A L S E R V I C E S
E M E R
G E N C Y M E D I C A L S E R V I C E S
P
ILL
P
ACK
– REMOVED J
ANUARY
2012 –
NOW
OPTIONAL
• Acetaminophen (Tylenol) – Pain
– 500 mg x 2 tabs = 1 gram
• Ibuprofen (Motrin, Advil) – Pain
– 800 mg x 1
• Levofloxacin (Levaquin) – fluoroquinolone antibiotic todecrease infections
– Decreased morbidity/mortality from infection/sepsis
If allergic to any of these, modify pill pack in IFAK per LEMA
• For Levaquin (Fluoroquinolone) allergy suggest: – Flagyl 1 gram plus Zithromax 500 mg
Tactical EMS (TEMS) Trainin g Module
7/24/2019 Tactical Emergency Medical Services
http://slidepdf.com/reader/full/tactical-emergency-medical-services 58/58
( ) g
WORKFORCE RELEVANCY STEWARDSHIP EDUCATION
E M E R
G E N C Y M E D I C A L S E R V I C E S
E M E R
G E N C Y M E D I C A L S E R V I C E S
P
ILL
P
ACK
– REMOVED J
ANUARY
2012 – N
OW
OPTIONAL
See individual NPS TEMS protocols
In general take pill pack for any open combat wound
Ensure no allergies and monitor kit for drugoutdates/expiration (every 6 months)
Per Local EMS Medical Advisor (LEMA)