TACTICAL FIELD

CASUALTY CARE
dr Herdy Adriano
1st LT, NRP 542427
Biography
◦ Name : dr. Herdy Adriano
◦ Rank/ Corps : 1st Lieutenant/ Medical Corps
◦ NRP : 542427
◦ SePaPK XX/ 2013
◦ Current Position : Chief of Health Division
at PMPP TNI HQ Detachement (2018-Now)
◦ History of Deployment:
◦ Chief of Health at D. Dumatubun Airforce Base (2014-2017)
◦ Satgas Kizi TNI XX-N MONUSCO (DR. Congo) (2017-2018)
MILITARY ACTIVITIES

PEACE KEEPER OPERATION

MILITARY OPERATION

CHAPTER 7 (HIGH RISK)

MILITARY TRAINING
 EMERGENCY ALGORYTHM

PATIENT TRANSPORT
CONDITION
TACTICAL UNDER
FIRE CARE

POI FIELD HOSPITAL ADVANCE HOSPITAL

TACTICAL FIELD FMT MET/ AMET

CASUALTY CARE

CASEVAC MEDEVAC
 TACTICAL CARE UNDER FIRE
DANGER
SAFE ZONE
ZONE

One/ two person drag

POI TFCC

Modified firemen’s carry

1. Request covering fire/ help

2. Disarmed the victims with
altered mental status
3. Move the victim to the
nearest safe zone

Shoulder belt carry

TACTICAL FIELD CASUALTY CARE
◦Buddy First Aid
◦Emergency Efforts to an injured troops in order
to buy time/ life saving in emergency/
casualties situation
◦FMT takes Time to evacuate may vary from
minutes to several hours or longer.
◦ Rapid treatment of the most serious wounds with the expectation of a
re-engagement with hostile forces
 M.A.R.C.H Protocols
◦ Massive hemorrhage – control life-threatening bleeding.
◦ Airway – establish and maintain a patent airway.
◦ Respiration – decompress suspected tension pneumothorax, seal open
chest wounds, and support ventilation/oxygenation as required.
◦ Circulation – establish IV/IO access and administer fluids as required to
treat shock.
◦ Head injury/Hypothermia – prevent/treat hypothermia and to prevent
worsening of traumatic brain injury.
 Massive haemorrhage

CNS 9% MSOF 4%
Airway 14%

Hemorrhage 31% Compressible (prehospital target)

85% 69% Non-Compressible (FST/CSH target)

From evaluation of 982 casualties, and casualties could have more than 1
cause of death. (Kelly J., J Trauma 64:S21, 2008)
 C.A.T and C. Gauze aplication

Apply C.A.T
Apply Combat
Combat Aplication
Gauze
Tourniquet

Position tourniquet 2-3" above the

bleeding site

Simple, light and

easy to use
 Airway
Nasopharyngeal Airway (NPA)
◦ Well tolerated by the conscious Victim
◦ Lube before inserting
◦ Insert at 90 degree angle to the face
NOT along the axis of the external nose
craniofacial or basilar skull fractures
◦ Tape it in
◦ Don’t use an Oropharyngeal airway (‘J’
Tube)/OPA
◦ Will cause conscious casualties to gag
◦ Easily dislodged
Respiration/Breathing
Alternate site
◦ Casualty with progressive respiratory distress
/torso trauma/closed trauma Tension
pneumothorax  Decompress the chest on the
side of the injury with a 14-gauge, 3.25-inch
needle/catheter.
◦ Alternate site is the 4th or 5th intercostal space at Usual location for Needle
the anterior axillary line (AAL). Entry
• 2nd intercostal space in the
midclavicular line
• 2 to 3 finger widths below
the middle of the collar
bone
Circulation
NOT ALL CASUALTIES NEED IVs
◦IV fluids not required for minor wounds
◦IV fluids and supplies are limited
◦IVs take time
 500cc Blood Loss
• Mental State: Alert
• Radial Pulse: Full
• Heart Rate: Normal or slightly increased
• Systolic Blood pressure: Normal

Normal Adult Blood Volume 5 Liters • Respiratory Rate: Normal

• Is the casualty going to die from this?
No

1000cc Blood Loss

• Mental State: Alert
• Radial Pulse: Full
• Heart Rate: 100 +
• Systolic Blood pressure: Normal lying
down
• Respiratory Rate: May be normal
• Is the casualty going to die from this?
No
 2500cc Blood Loss
1500cc Blood Loss • Mental State: Alert but anxious
• Radial Pulse: May be weak
• Heart Rate: 100+
• Systolic Blood pressure: May be
decreased
• Respiratory Rate: 30
• Is the casualty going to die from
this?
Probably not
• Mental State: Unconscious
• Radial Pulse: Absent

2000cc Blood Loss • Mental State: Confused/lethargic • Heart Rate: 140+

• Radial Pulse: Weak • Systolic Blood pressure:
• Heart Rate: 120 + Markedly decreased
• Systolic Blood pressure: • Respiratory Rate: Over 35
Decreased
• Respiratory Rate: >35
• Is he going to die from this?

• Is the casualty going to die from Probably

this?
Maybe
Recognition of Shock on the
Battlefield
◦ The best TACTICAL indicators of shock are:
◦ Decreased state of consciousness (if casualty has not
suffered Head Injury)
and/or
◦ Abnormal character of the radial pulse (weak or
absent)
Head injury/Hypothermia
◦ Key Point: Even a small decrease in
body temperature can interfere
with blood clotting and increase
the risk of bleeding to death.
◦ Hypothermia is much easier to
prevent than to treat!
◦ Head InjuryApply Cervical Collar
and Head stabilizer
SUMMARY
◦ Limitation number of medic Pers that attached to the troops
◦ All of the troops need to be well trained of TFCC/ Buddy first aid
◦ Need to be equiped with medical kit (C.A.T, C. Gauze, NPA,
Needle Decompression, IV Fluids, Cervical Collar/ field blanket)
◦ Massive Hemorhage are the most potentialy preventable death
◦ Protocol of M.A.R.C.H increase survival rate in casualty
Reference
◦ Implication for the future Combat Casualty Care, Kelly J., J Trauma 64:S21, 2008
◦ Tactical Combat Casualty Care Guidelines, U.S. Departement of Defense Committee 1996
THANK’S FOR YOUR ATTENTION