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Guide to running Prolonged Casualty Care Training by Ragged Edge
Ragged Edge guide to designing and running a prolonged casualty care exercise at the unit level.
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Enhancing TCCC through Optimized Simulation
A guide on how to teach better TCCC and run trauma lanes through designing patients, scenarios and providing feedback.
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Enabling Medics to manage Sick Call
Guide for PA’s and Senior Medics on improving Sick Call operations within their unit.
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Cricothyroidotomy Training Guide for Military Medics: Ragged Edge of the Scalpel
Cric Training Guide for Military Medics and their Instructors
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Treating TBI from the Aid Bag
A medics guide to treating TBI with their Aid Bag.
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A Lost Opportunity
A must read article for TCCC Instructors on how common mistakes ruin training.
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Discord and Google Drive!
Our Google Drive, Discord, Social media and merch
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Ketamine Toolkit: Questions & Answers for your Medical Director
The goal of this page is to give the medic a resource for engaging with their battalion PA or Surgeon regarding the use of ketamine.
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Failure to Comply: Why Aren’t We Keeping Up?
TCCC standards are not secret. TCCC standards are not optional. Why then is compliance with TCCC standards so poor?
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High and Sick: Altitude Illness
Note: types and dosages of medication used to treat altitude illness will be determined by your organization’s guidelines as authorized by your physician oversight. While this article does list medication doses, refer to your local treatment protocols for all care. You and your team are conducting patrol operations on Mount Rainier (14,411 ft summit), a…
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Chemical Agent Casualty Recognition Simplified
Recognition of exposure is the first step in the management of casualties exposed to chemical agents. As rapid recognition is essential for rapid implementation of appropriate therapy, cognitive processes to streamline presumptive diagnosis need to be considered.
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Train With Your Food: The Chicken Thigh Abscess I&D Trainer
As we’ve previously described, medical simulation equipment, while having a place in training, can be expensive and therefore unobtainable for units with a tight budget. Not wanting to deprive medics of good training ideas simply because of money jockeys and fiscal restraints, we here at NGCM continue to scour the literature and the internet, as…
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Expired Meds: CAN You Use Them?
Scenario: You’re out in the field when an NCO approaches you about spraining his ankle during one of the last movements through some rough terrain. “It’s not that bad,” he tells you, “I just want some ibuprofen for the pain. Can you help me out?” You reach into your bag and pull out your favorite…
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Sepsis in Austere Environments
There is a 30-50% possibility that severe infection will develop into sepsis. For the Deployed Med, c this means that a minor laceration can turn into a severe infection and eventually sepsis. According to the National Centre for Health Statistics, the annual incidence of sepsis in the USA rose by 7–8% per year over a period of 8…
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The Pain Pack is as good as morphine
The Pain Pack Multiple studies have shown that using 1g of Paracetamol with 400mg of Ibuprofen provides mild and moderate pain relief. The most recent addition to this long line of evidence came out last month in the Journal of American Medical Association. They showed that the Pain Pack is just as good for moderate pain…
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Tuning fork ultrasound
How it works. Use a 128hz tuning fork and your stethoscope. Hold your stethoscope on one end of the bone and then hit the fork on the meaty part of your leg to get it vibrating. Starting at the other end of the bone and slowly walk your tuning fork towards your stethoscope. For major fractures,…
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Vent Practicalities
This is Part 5 of a 5 part series on fundamental concepts in ventilator management. See Part 1 here. Everything up to this point has been to provide a foundation to understanding ventilator management. This section will demonstrate how theory is translated into practice. This section is also structured to be used as a quick reference…
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Ventilator Theory
This is Part 2 of a 5 part series on fundamental concepts in ventilator management. See Part 1 is here. This section has a lot of equations in it, but don’t get wrapped up trying to commit them to memory. I’ve written them out purely to demonstrate how different variables relate to one another. Focus…
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Ventilatory Respiratory Control
This is Part 4 of a 5 part series on fundamental concepts in ventilator management. See Part 3 is here. We have discussed how to take over a patient’s work of breathing, now it’s time to discuss taking over control of respiration. This is a very important distinction in ventilator management: there are times when…
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Applied Ventilatory Theory
This is Part 3 of a 5 part series on fundamental concepts in ventilator management. See Part 2 is here. The goal of good ventilator management is to deliver appropriately sized breaths at appropriate rates and at appropriate times. This section will cover how to select the right breath settings, as well as how to…
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Train With Your Food: Suturing a Turkey
Editor’s Note: The mention of commercial devices in this article is not meant to either endorse or discourage the use of any particular company’s products. Recently I was prepping our turkey for the oven. I found myself appreciating how elastic and strong turkey skin was and how it would make a good platform for suture…
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Introduction to Vents
This is Part 1 of a 5 part series on fundamental concepts in ventilator management. What is a ventilator? The answer to this question seems obvious…a ventilator ventilates. On a very simplistic level, a ventilator is just a mechanical BVM, however, there’s a lot more to ventilation than just moving air. A fundamental understanding of…
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The Combat Medic’s Guide to Answering Flu and Vaccine Questions from Patients
It’s that time of the year again. No, not for pumpkin spice frappamochachialattamericana. It’s time for mandated flu vaccines. This is all in accordance with the Assistant Secretary of Defense for Health Affairs direction outline in the aptly-named “Interim Procedures Memorandum 17-005, 2017-2018 Seasonal Influenza Vaccination Program (IVP)”. For the vast majority of Soldiers, this…
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Buyer Beware: Selecting Your Everyday Carry Tourniquet
Source: Buyer Beware: Selecting Your Everyday Carry Tourniquet From Primary & Secondary By Andrew D. Fisher and Will G. With the increase in Active Violent Incidents (AVIs) over the last few years and the shared lessons learned (LL) from the U.S. and Canadian militaries’ experience in Afghanistan and Iraq, there has been an explosion of…
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The Case for Medical Training: An Appeal to Commanders
Commander, your Medics need more training. Medics require consistent, progressive medical training in order to maintain their readiness and medical capability. While training for war is an everyday goal of our armed forces, the reality is that support of peacetime priorities can compete with this mission [1]. Between 2001 and 2011 nearly one in four…
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Scenario: Back Pain with Thigh Numbness
A 38-year-old active duty male presents with sudden worsening of his chronic low back pain after trying to change a vehicle tire single-handedly while you are out in the field. He states that his back pain is accompanied by severe shooting pains going down his left leg to his calf, and that he feels like…
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Hyponatremia
Hyponatremia is usually associated with hypoosmolality and most often the result of impaired diluting capacity and inappropriately elevated ADH. There are four factors that are associated with hyponatremia 1) presence of antidiuretic hormone (ADH), 2) insufficient solute intake, 3) excessive free water intake, and 4) impaired urine diluting capacity. ADH is produced in the Supraoptic nucleus…
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Nephritic Syndrome
Nephritic syndrome is typically characterized by inflammation of the glomeruli and presents with hematuria, red cell casts, azotemia, oliguria, proteinuria, and hypertension. Acute proliferative glomerulonephritis is the result of a post infectious state (Postreptococcal). There is a diffuse proliferation of glomerular cells and influx of WBCs. The lesions are the result of immune complex deposition…
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Acute Respiratory Distress Syndrome and Extracorporeal Membrane Oxygenation
Extracorporeal membrane oxygenation (ECMO) use in combat is usually reserved for a Critical Care Air Transport Teams (CCATT) like team. These ECMO teams are specially trained to perform this skill. As as military medic, you may find yourself assisting or eventually part of the care team for a patient on ECMO. Like many other medical advancements ECMO…
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Embrace the full power of your SPO2
When the pulse oximeters were issued to us in the 90s, our first thought was that we are required to carry more ‘light weight’ kit. Those first units were not small and anything needing batteries was looked down on. They didn’t have the waveform and only showed the oxygen concentration and the pulse rate. We…
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A better way to use Saran Wrap
We have all been there. We finish our intravenous cannulation and reach for the Clingfilm or Saran Wrap to protect the IV site but find it impossible to find the end of the roll and once you find it you have a hard time peeling off the film without having it rip into strips. We…
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Anemia
This is an ongoing feature that will be updated daily until complete, check back often. Anemia is found worldwide, in fact, according to the World Health Organization (WHO), about 25% of the world’s population suffers from some sort of anemia. While you may only encounter a few types as a Combat Medic in the US…
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Lymph Node Infections
Thanks to Dr. Jeffrey D. Cirillo for his outline and presentation, which was the basis of this post. The most common lymph node swelling is due to infection (lymphadenitis). Groin, armpit, neck, under jaw/ears Oncological vs. microbiological Acute onset (infection) or gradual onset (cancer) Painful (infection) or painless (cancer -usually) Resolve in a few weeks…
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Prolonged Field Care for the Combat Medic
We anticipate the future threat environment may require casualty care holding that exceeds current evacuation planning factors (i.e. the Golden Hour). — LTG Nadja West, Army Surgeon General addressing the Senate Committee on Appropriations, March 2017 The Army Medical Department is pushing for medics to be capable of caring for a wounded patient in the…
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Scenario: Eye trauma with worsening vision
A 35-year-old active duty male presents with sudden onset of pain and decreased vision of the right eye, after he was in an altercation (but you can also see this in blast injuries or other objects hitting in this area.)
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Oral or I.V. fluid for Heat Casualties and Dehydration on extended patrols?
On multiple occasions, missions have taken longer than previously thought. (Shocking, I know.) When briefed that it’s only a few hours some may take less (or even no) water on mission to ‘stay lighter’, and then the mission can end up taking days instead of hours. This is a situation the Medic going…
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4 Things You Should Do Before You Pack an Aid Bag
One of the most common questions we get on the Facebook page goes something like this: I’m getting ready to deploy soon. What should I pack in my aid bag? The answer is, as usual in medicine, “it depends”. There are many factors which play into what you carry in your aid bag. Here are…
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Tourniquets Hurt: Training, Pain, and Compartment Syndrome
Tourniquets HURT, even if applied correctly. 1.) How do you handle a patient that loosens/removes their tourniquet due to pain? This is common, especially with our host nation partners that don’t understand what we are doing, and even our guys do it, too. (You keep a tourniquet on for 30-45+ minutes and…
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Guide to running Prolonged Casualty Care Training by Ragged Edge
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Enhancing TCCC through Optimized Simulation
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Enabling Medics to manage Sick Call
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Anti-venom research: A response to the venomous article by The Guardian and TBIJ
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Technician Badge for 68W – How to get yours:
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Cricothyroidotomy Training Guide for Military Medics: Ragged Edge of the Scalpel
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Evidence Under Fire: Military Medics guide to evaluating research
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CTC Medical Survival Guide
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Tranexamic Acid
Next Generation Combat Medic 