After an explosion, one of your guys legs are trapped under heavy debris that can not be lifted by your team…
1.) What are you planning as you run over to the patient, and what will you do first? Important parts of the trauma patient assessment to highlight?
2.) How do you prepare the patient for extraction? Then what do you do immediately after extraction?
3.) If you have no extraction equipment… what can you do?
Do you know what tools to ask for if you don’t have them?
4.) What is long term management and goals of this patient until you get him extracted? (Hours, Prolonged Field Care.)
5.) What are the differences in treating this out of an aid bag/ truck bag versus if you have a Role 1 or above capability nearby?
Crush Injury patients are grueling and resource intensive. This is a good trauma lane training to throw at your medics. Use a very lightweight object to simulate the entrapped limb (which causes no discomfort if using roleplayer instead of mannequin) and even though medic could easily lift the fake object off the patient, tell him it weighs thousands of pounds and can’t do it. If it accidentally comes off, place it back on for the sake of the scenario or find a way to safely stabilize in place.
There isn’t a lot of bullet holes with this patient to plug, but instead takes a lot of understanding what is going on underneath the skin and on a cellular level…
Let’s address the answers to these patients:
First, reference the U.S. Army Institute of Surgical Research(USAISR) Clinical Practice Guidelines(CPG) on Crush; U.S. Military Medics should read and know these:
Advanced: The Field Amputation
An advanced medic with special training and permission from telemedicine may have to consider the field amputation in the rare event that extraction equipment is not coming, or in situations where the stability of the structure isn’t safe enough to sit on this patient for extended periods. At minimum, all medics should recognize to request a surgeon or other higher level provider to do this for their patient.
“Taming the SRU” is a great podcast to subscribe to, which made a quick little article and video on field amputation: