You’ve been in a training exercise in a forest in the United States with other units for about a week:

As you take a security halt during a movement through the woods you notice an obviously ill soldier from another platoon/team. As he holds his rifle he has maculopapular rashes on both hands, palms and forearms included from what you can see with his sleeves rolled up on his uniform top.

” I felt feverish, had headaches with some nausea and some stomach pain. My medic said I just had gastroenteritis and gave me some motrin but it’s not getting better. I’m not worried about the rash cause its not really hurting me, it’s the headache and stomach that is bothering me.”

1.) What do you think is going on? What other info would you want/ask? There are a lot of distractors here, you’ll have to rule out what is a distraction and what is important, or if they are all related.

2.) What can we do about it? Treatment? Prevention? Can we handle this? Send to PA/Doctor?

3.) How can you approach / handle the other medic and his handling of this patient?
(What if the medic was one rank lower than you vs one rank higher?)

4.) How would you describe these lesions? Dermatology can be intimidating, but if you know how to describe the rashes, then you can more easily search for them in textbooks, or express how it looks over the phone to providers in a more professional manner than saying ” Uhhh.. red spots.”  Even easier is taking pictures and sending it up if you have the capability.


STOP, Do not continue. 

Before you do, Write down the answers on a notepad, using your phones “notes” app, or at least say the answers out loud to yourself. It’s easy to say “yeah that is what I would have done” when you didn’t actually write it out or put effort in, as if that is what you did to this patient before looking at the answers below. Have some integrity and it will help you learn more, or be more confident if you got the answers correct.






“So what is it?”

First, it’s a reason every medic should strictly enforce tick checks because these are preventable by limiting the length the tick is on you to under 24 hours, which will drastically reduce risks. In addition, medics should know tickborne diseases because some can be fatal and effect quality of life with long term issues if not caught early. This scenario is based on a true (and common) incident, except it was two soldiers who had the rash and the first medic missed the diagnosis. A fever with a rash should draw red flags automatically, and another reason to have a tiny thermometer. The following picture shows some tick borne rashes, but these don’t present 100% of the time, so lack of these rashes/lesions can’t be used to rule these conditions out.

Excerpt from CDC on Rocky Mountain Spotted Fever:

Rocky Mountain spotted fever (RMSF) is a tickborne disease caused by the bacterium Rickettsia rickettsii. This organism is a cause of potentially fatal human illness in North and South America, and is transmitted to humans by the bite of infected tick species. In the United States, these include the American dog tick (Dermacentor variabilis), Rocky Mountain wood tick (Dermacentor andersoni), and brown dog tick (Rhipicephalus sanguineus).  Typical symptoms include: fever, headache, abdominal pain, vomiting, and muscle pain. A rash may also develop, but is often absent in the first few days, and in some patients, never develops.  Rocky Mountain spotted fever can be a severe or even fatal illness if not treated in the first few days of symptoms. Doxycycline is the first line treatment for adults and children of all ages, and is most effective if started before the fifth day of symptoms. The initial diagnosis is made based on clinical signs and symptoms, and medical history, and can later be confirmed by using specialized laboratory tests.  RMSF and other tickborne diseases can be prevented.


After that, consider doing some reading on the other Tick Borne diseases: