Training Scenarios

[Max D]

Purpose: To provide an ongoing resource for NCOs and others responsible for training.
Format: To help standardize the amount of information in each post, please try to stick to the following format. This will help you put out as much medical goodness as possible while helping the trainer organize your information in a way they can practically apply. The following format should be familiar to most medics and can be copy/pasted and filled in as appropriate. Feel free to include pictures of the scene, the patient's injuries (screened for Privacy, OPSEC, PERSEC), and any sterilized documentation (TCCC cards, PCRs, SF 600).

Scenario Title
Short description of dispatch information, location, time of day, current environmental conditions, local disruptive activities, and any additional information that the medic may receive before they arrive "on-scene".
Scene Safety
A brief description of immediate hazards
No. of Patients
Include bystanders, potential patients, and non-emergent patients. Identify them by PT1, PT2,... etc.
Additional Resources Available
Include: other medical personnel (including first aid / CLS), closest hospital, QRF, MEDEVAC, distance and time for each.
Chief Complaint
...if the patient is complaining.
General Impression
A description of the patient's appearance
Level of Consciousness
AVPU + Alertness, anxiety, etc.
Life Threats
a.k.a. "H" in HABC or "M" in MARCH
Airway
patency, obvious trauma
Breathing
rate, depth, work, adequacy, sounds
Circulation
rate, rhythm, quality, skin color, temperature, condition
Decision to Transport, Disability
Transportation resources available?
Glasgow coma scale
Environment, Exposure
Hypothermia management resources?
Include a topographic description of the patient's injuries:
Head, Face, Neck
Chest
Abdomen
Pelvis, Inguinal
Lower Ext
Upper Ext
Back
Vitals
Good: HR, RR, BP by location of pulse or palpation
Better: Above + SpO2, BP (Sys/Dia), Glucose, Temp
Best: Above + cardiac monitor, EtCO2, UOP
OPQRST+AMPLE
"In the patient's own words"
Treatment Options, Goals and Outcomes
This is the tricky part. Put in a list of priorities of treatment along with the differential diagnosis. This section will change based on protocols, but the basics usually remain the same.
Reassessment
Good: Vitals after treatment
Better: Vitals for good and bad treatment
Best: Vitals for multiple treatment paths and additional indicators of progress
Continued Care (Optional)
Describe long-term care problems and goals.
Outcome (If Known)
Link to case study if available.

 

[Max D]

Fall of Significant Height
During a night-time mission in which your team is using ladders to enter a walled compound, one of your guys loses his balance and falls from the top of the 15ft wall. Your equipment includes body armor, assigned weapons, fighting load, and assault aid bag.
Scene Safety
As your team continues to enter the compound you hear gunfire from inside. The perimeter is secured by another team.
No. of Patients
You are called to the scene for one patient. You do not see anyone else who may be injured.
Additional Resources Available
There is one CLS certified guy who is holding C-spine when you arrive. Everyone else has continued mission. You walked in and only have what you've carried in your ruck. There is a truck with an additional aid bag about 15 minutes away. There is another medic in the team providing security. Your comms do not include a plan for online medical direction. MEDEVAC is about 10 minutes away once in-flight. CASEVAC is about 55 minutes by truck back to your outpost where there is an FST. CASEVAC is about 2 hours to the nearest Role III facility (Army CSH). The weather is currently dusty with a thunder storm in forecast for this evening making the MEDEVAC iffy.
Chief Complaint
Your patient complains of low back and shoulder pain.
General Impression
The patient is laying supine on the uneven ground next to the ladder, he is not trying to get up. The CLS guy is holding effective c-spine inline stabilization.
Level of Consciousness
Alert, responsive, talkative, anxious
Life Threats
You see no immediate life threats
Airway
open and clear
Breathing
elevated rate, slightly shallow, minimal work of breathing, seems adequate, no noticeable breath sounds sounds
Circulation
pulses present at carotid and bilateral radial. Elevated rate, regular rhythm, strong. Skin color pink, warm, sweaty.
Decision to Transport, Disability
There is a collapsible litter available at the truck.
GCS:15 (Eyes:4; Verbal: 5; Motor: 6)
Environment, Exposure
Current environmental temp: 58F (14C), with a predicted low of 52F(11C). Precipitation predicted in the next hour, (60% chance of rain, 40% hail)

Head, Face, Neck: ballistic helmet still on. grossly atraumatic, some minor scratches on face with no bleeding, slightly ugly.
Chest: protected by PC. grossly atraumatic, chest and clavicles stable, symmetrical chest movement, no accessory muscle use / retractions
Abdomen: grossly atraumatic, soft, non-tender, non-distended, no brusing
Pelvis, Inguinal: grossly atraumatic, stable pelvis
Lower Ext: grossly atraumatic, pedal pulses present in both feet, right and left motor strengths unequal (left side weak), parasthesia in left hip, leg and foot. Strong odor.
Upper Ext: grossly atraumatic, radial pulses present in both wrists, strong and regular. Motor strength and sensation equal bilaterally.
Back: grossly atraumatic, no deformities noted on examination of shoulders or spine, tremendous low back and lower extremity pain on movement.
Vitals
Good: HR 162, RR 20, BP>90 (94 by palpation)
Better: SpO2: 98%, BP (94/72), Glu: 64, 99.3F (37.3C)
Best: Mon: SVT@162 with infrequent PVCs, EtCO2: 38, UOP: N/A
OPQRST+AMPLE
O "I dunno, man. I lost my balance all of the sudden and fell over."
P "Moving makes it worse"
Q "It's sore everywhere, but my back and left butt feels like it's on fire. It feels like I'm getting electrocuted."
R "My left leg feels like pins and needles."
S "My shoulder is a 4, my back is a 6. It's a straight up 11 if I move."
T "I fell like two minutes ago"
A NKA
M Motrin 800mg occasionally for pain; N O Explode, Amino acid powder, whey protein, multivitamin, once a day; Stacker energy pills, before this mission.
P No recent pertinent medical history
L Not much of a "Buffalo chicken" T-ration 6 hours ago. 4 litres of water since dinner.
E Climbed the ladder to go over the wall

* if asked about being dizzy he will admit to feeling dizzy
* if asked about the fall: no loss of consciousness, head was protected by helmet, felt dizzy before fall, passes MACE.
* if asked about the energy pills: he took them about 20 minutes ago just before you dismounted the vehicles.
Treatment Options, Goals and Outcomes
Possible syncopal episode due to tachycardia from energy pills?
Possible low back spinal cord injury / cauda equina injury?
Possible hypoglycemic episode?

Evacuation may be possible by air if requested early. If not then patient must be evac'd by ground. Either way, patient must be transported to trucks or suitable LZ.
Spinal stabilization / immobilization precautions (IAW protocol)
Correct hypoglycemia
Correct tachycardia / relative hypotension
Provide analgesia
Provide hypothermia prevention

Reassessment
Physical assessment remains the same.
Pain increases with any movement of the back or lower body.
Pain increases with improper spinal immobilization
Pain decreases with proper spinal stabilization with padding
Pain decreases to 5/10 with Tylenol 650mg / Mobic 15mg
Pain decreases to 2/10 with 800mcg OTFC or 50mcg fentanyl, or 5mg morphine, or 20mg Ketamine.
Gluc increases to 102 with 25g Dextrose 50%
BP increases to 108, HR decreases to 140~ with 200cc NaCl 0.9% fluid challenge
BP increases to 112, HR decreases to 140~ with 500cc Hextend fluid challenge
BP decreases 10 points systolic if Morphine is administered, 5 points for fentanyl IV
HR increases 10 points, BP increases 5 points if Ketamine is administered.
Temp decreases to 96F (35.5C), patient begins to shiver if no hypothermia management is performed before evacuation
Improvised litter carry increases pain significantly.
Any ground transportation increases pain moderately unless adequate padding is applied.

* disarm patient if narcotic analgesia is given
* patient weights about 190lb (86kg)

Outcome
Unknown, no case study.

 

[A910]

Outcome if known?

 

[A910]

Also the possibility of case studies getting their own section in the medical area? That way discussions can take place on individual studies without confusion or derailment and allow for easier referencing and organization?

I know medical personel like to exchange a lot of ideas, knowledge and experiences which can end up flooding this thread with 182764 posts but only 8 studies.

Sorry for the double post, afterthought that came and I was unable to edit my original post.

 

[Max D]

Reorganization in progress. Good thinkings.

ETA: Added a whole Case Studies section with a sticky covering how a case study is written. This could either go belly up, or become a major win. Either way, I'm blaming you, A910!

 

[A910]

This could either go belly up, or become a major win. Either way, I'm blaming you, A910!

Haha no worries. I've been on the middle rung of the ladder long enough I'm used to catching flak from both directions!