ADTMC- MUSCULOSKELETAL

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This is a broad topic, but a very common complaint from Soldiers – orthopedic complaints. The 68W Combat Medic should have a basic understanding of how to recognize and diagnose, as well as treat injuries. The medic can further expand skillsets to be able to handle smaller things at their own level, when necessary. The medic can be very useful to his/her Soldiers if able to reliably recognize and treat these common issues.

The topic of orthopedics is very expansive. Therefore, I will do my best to cover a lot of topics here. I have done several posts previously on orthopedic topics, and so they will also be referenced below. I will probably continue to add to this list as time progresses. Also, I’ve highlighted the “OTTAWA RULES” video for “when to get an x-ray” because I believe this topic is so important for a medic.

Anytime we see a patient, we have to take a good medical history. In orthopedics, especially, this guides everything. “Mechanism of Injury” is the essential piece in a musculoskeletal exam in order to have suspicions and to know where to look. If one is aware of the specific mechanisms of injury for certain injuries, then the diagnosis becomes easier. For instance, the ACL tear of the knee has a typical mechanism of injury.

The next videos aren’t perfect (I wouldn’t make a perfect video either), but it does present the way that a medic ought to think when approaching a patient with a musculoskeletal injury- he does a good job. I also like how he expands his thinking to include the possibility of other injuries as well.

In a clinical setting instead of a pre-hospital setting, this will be more complicated. We aren’t just determining if the patient needs to go to the ER or not. We are determining how to treat and how to disposition the patient. Therefore, if the medic wants to be able to play an effective role in diagnosising and potentially returning Soldiers to duty quicker, he/she must become more familiar with common injuries.

I would recommend that each medic reviews the multiple ADTMC protocols (NOV 2019 edition) for the various musculoskeletal areas of the body. Essentially, the ADTMC discusses ruling out red flag issues and then referring. Or, the ADTMC will point to a “home exercise plan.” This may not be all that helpful since a “home exercise plan” is vague. I do have some posts (links at top of page) above that detail some rehab programs promoted by previous US ARMY Physical Therapists.

Splinting

Most of the splinting videos on YouTube are inadequate, in my opinion. In the future, I may make videos to detail splinting techniques and ways to avoid pitfalls. However, most responders will be placing a splint that is temporary. Therefore, there is less necessity to get the perfect splint. Often a SAM splint is used on the way to the hospital. However, there are some principles that may be reviewed later. A splint is not effective if it does not immobilize. An example would be a forearm fracture splinted with a splint that does not control for rotation. Or, an ankle dislocation+fracture that does not stabilize the joint and does not prevent the ankle from returning to a compromising position. Of course, these “permanent splint” ideas become more important during Prolonged Field Care. I will make a post and video about this later. For now, I recommend reviewing this link to learn the different types of splints for various parts of the body.

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Contact me by Email: admin@nextlevelmedic.com

All content is intended to be educational only. Medics should operate under the supervision of a medical provider and abide by all local laws while stateside. Medics should only practice at the level credentialed, and only at the level allowed. This content is not intended to treat or give a substitution for any credentialed provider. Content is intended to aid in a deployed prolonged care setting. Take guidance from your leaders. Utilize these posts as preparation and as a supplement to your provider’s direction and teaching.

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Published by Medic Mentor

An Army PA seeking to share knowledge and skills to medics in order to better prepare them for the next fight, and to bridge the gap between future expectations and initial entry training. These posts are samples of similar training I share with my own medics, and are made available here to a wider audience. I am no expert. There are others more qualified, I'm sure. I am simply looking to contribute. Feel free to provide feedback and leave comments to help others.

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