The last day of the 68W Boot Camp. Senior medics and/or providers may use this as a template to conduct internal training. Feel free to use these products and adapt, as necessary, to your unit’s specific needs.
Consider bringing out BAS Medications for visual learning
12:00 Lunch
13:30 Radio Operations Class
Set Up Training Course with S6 or knowledgeable senior NCOs
14:30 Study Time; More Q and A
15:00 Written Test
15:30 Culminating Trauma Lane
(Study those Deployed Medicine TCCC Videos)
17:00 Complete! AAR
This content is the author’s opinion alone and does not necessarily reflect the opinion, official position, or stance of the Department of Defense, or any other branch of the United States Military.
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.
From Military Apps, LLC. A Veteran Owned Business.
MRE APP is an app designed to help service members (or whoever is eating MREs) to choose the best MRE. See the contents of every MRE, search by desired item, search by category of snacks/desserts/beverages. See calorie content! Download now on Apple App Store or the Google Play Store.
Review Previous Information Taught for Written and Practical Tests
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.
This content is the author’s opinion alone and does not necessarily reflect the opinion, official position, or stance of the Department of Defense, or any other branch of the United States Military.
Read this and familiarize. The first half covers some basics.
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.
This content is the author’s opinion alone and does not necessarily reflect the opinion, official position, or stance of the Department of Defense, or any other branch of the United States Military.
If You Enjoy This Content, Please Consider Sharing with Others to Help Them Learn Also
From Military Apps, LLC. A Veteran Owned Business.
MRE APP is an app designed to help service members (or whoever is eating MREs) to choose the best MRE. See the contents of every MRE, search by desired item, search by category of snacks/desserts/beverages. See calorie content! Download now on Apple App Store or the Google Play Store.
This purpose of this post is to provide a template for senior medics and/or senior leaders to use for their 68W internal training. This is designed to be a three day “boot camp” for 68Ws to hit some of the high points from a PA’s perspective. The end state is that Medics receive a balanced and centered refresher course in order to better serve in a Role 1 BN Aid Station. It is not exhaustive nor comprehensive.
9:00 S.O.A.P. SAMPLE/OPQRST 9:30 SAMPLE/OPQRST – Taking a Good History (Practical) 10:00 TCCC 11:00 Initiate/Practice IVs on each other 12:00 Lunch 13:30 9 Line Class (Assigned and Self taught by Medics) 14:00 Aid Station Operations 15:00 Trauma Lane 1 16:00 AWT- How to Properly Pack an Aid Bag HOMEWORK: Assign Videos for Next Day
DAY 2(Click Here) 9:00 MSK Injuries – Knees/Ankles 10:00 MSK Injuries – Back Pain 10:30 MSK Injuries- Practical 11:00 Initiate IV in the Dark IV 12:00 Lunch 13:30 IM injection 14:00 CCP -Didactic Assigned and Self Taught by Medics 15:00 Physical Exam Skills 16:00 Intro to Pharm 16:30 Treat Casualty after Physical Exertion HOMEWORK: Watch Videos for Next Day
This content is the author’s opinion alone and does not necessarily reflect the opinion, official position, or stance of the Department of Defense, or any other branch of the United States Military.
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.
This post is all about a video. I created this video to be shown to the Soldiers in my unit when they are waiting in line – something we do a lot in the Army. This is true hip pocket training! Just about every Soldier has a Smart phone. So, why not send training content straight to their phone?
I envision this training to be supplemented with learning aids. I plan to pull out mannequins, a Bag Valve Mask, some tourniquets, and anything else our Medics want to show.
Feel free to use this training while YOUR Soldiers are standing in line…
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.
This content is the author’s opinion alone and does not necessarily reflect the opinion, official position, or stance of the Department of Defense, or any other branch of the United States Military.
From Military Apps, LLC. A Veteran Owned Business.
MRE APP is an app designed to help service members (or whoever is eating MREs) to choose the best MRE. See the contents of every MRE, search by desired item, search by category of snacks/desserts/beverages. See calorie content! Download now on Apple App Store or the Google Play Store.
Abdominal pain is a very common complaint that ranges in severity from benign and fleeting to issues which are severe and surgical. “Abdominal pain is the great masquerader,” as I was told in PA school. The complaint comes with a wide range of symptoms and is often vague.
As medics, corpsmen, or credentialed providers….we must be able to determine who needs prompt treatment or referral, and who may be managed more conservatively. This is a challenge, of course. This post will focus on an algorithm based approach and give a broad overview. There are also some videos on exam techniques and tips at the bottom of the page.
As with any complaint, a good history is important. Remember the basics:
OPQRST
ONSET
PROVOKING/PALLIATING
QUALITY OF PAIN
REGION AND RADIATION
SEVERITY (1-10)
TIMING (HOW LONG)
SAMPLE
SIGNS AND SYMPTOMS
ALLERGIES
MEDICATIONS
PERTINENT MEDICAL HISTORY
LAST INS/OUTS
EVENTS (HOW UNFOLDED)
Because abdominal pain is so vague and can represent a wide variety of problems, a good history is extremely important. Review the videos above to make sure you have a system. It’s important to be methodical, especially in the complaint of abdominal pain. It is too easy to miss something.
REFERENCE THE SMOG
A helpful resource for immediate red flag issues is the Standard Medical Operating Guidelines for Flight Paramedics. We can start here to think about the critical complaints.
For a more measured and less time sensitive complaint, most medics should use the ADTMC (Algorithm Directed Troop Medical Care) algorithm specific to the complaint. The primary objective of the ADTMC is to permit treatment for less severe conditions at the 68W Medic level, but also appropriately triage complaints.
Below are the Algorithms for Various Related Complaints
Abdominal Examination
Below is a fairly good abdominal examination video that goes way beyond a typical acute care visit. No provider does this extensive of an exam on most occasions. However, the video is good because in some ways because it highlights the breadth of issues that can occur, and it provides some helpful clues to how many conditions can present.
The extent of my typical abdominal exam for an acute complaint is:
Inspection
Listening to bowel sounds
Light palpation and deep palpation
Any special tests (see tests for appendicitis below)
Summary
There is some variation in the techniques of these tests. They are not perfect. The primary objective is to detect any peritoneal signs. I will often have young Soldiers stand on their toes and drop down on their heels to elicit a a jarring motion. Or, I will ask them to jump up and down, if they can handle it. Classically, the patients describe “every bump on the drive to the ER hurt,” and so I try to recreate that situation. This is not perfect, and it is meant to be evaluated by a credentialed provider. However, this website is about austere situations or scenarios in which care is not readily available. Stateside, the patient should be referred to a provider based on the algorithms. Overseas, a medic may use these tests to categorize evacuation priority based on tests performed.
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.
This content is the author’s opinion alone and does not necessarily reflect the opinion, official position, or stance of the Department of Defense, or any other branch of the United States Military.
Hand injuries are the most common type of injury treated in an emergency department, and make up more than 12% of all trauma cases in the US (Maroukis et al). Having a good understanding of the anatomy and key landmarks is paramount for a medic, or any other medical provider, responsible for providing emergency care.
Despite the need to accurately describe hand injuries, many practitioners struggle in this skill. However, with a good understanding of some key terms, any medic could easily describe an injury to a medical provider over the phone or radio. In fact, a good grasp of this topic is so rare that I believe this video would also be good for a medical resident. I can count many times that even an Emergency Room physician described the wrong terms or landmarks for a hand injury to me over the phone (when I worked for an orthopedic trauma service). To be fair, I struggled also prior to working in orthopedics- this topic is just not taught much in medical programs. But this stuff isn’t that hard once you familiarize yourself with the topic. I tried to keep it informal and short in my 5 minute video below. Future videos may involve some teaching on some procedures that medics can learn and perform themselves in the field- stay tuned.
EXTRA RESOURCES FOR HAND TRAUMA
Check out the Orthobullets.com Hand Trauma dashboard for links to all sorts of hand injury information, if you are interested in learning more. This site was created by ortho residents- its a great resource. Check it out here.
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.
Check on Learning Quiz
The quiz will be performed live. If you are an instructor and would like a copy of my very basic quiz, please send me an email. Instructors can design their own quizzes also.
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.
If You Enjoy This Content, Please Consider Sharing with Others to Help Them Learn Also
Allergic reactions can be complex and range on a scale of severity. The 68W Medic must know how to sort out life threatening emergencies from less severe reactions. The ADTMC protocol can help with this. A screenshot of the ADTMC protocol is at the bottom of the post.
The goals of this post will be to solidify the definition and warning signs of anaphylaxis, to educate some on the physiology behind allergic reactions, and to help the medic have a clearer understanding of how to help a his/her supervising medical provider when treating from a remote location.
Make sure to master the first section: “What is Anaphylaxis?” Then, to become an even better medic, tackle the second section next. Studying “Allergic Reactions Further Explained in Greater Detail” will take some more time and may require additional reading or investigation.
A few different definitions exist. However, I will cite from Uptodate.com the definition proposed by the Second National Institute of Allergy and Infectious Disease /Food Allergy and Anaphylaxis Network symposium from 20061. It should be noted that there is no universal agreement on the criteria for diagnosis.
Anaphylaxis is highly likely when any 1 of the following 3 criteria are fulfilled:
Acute onset of an illness (minutes to hours) with involvement of the skin, mucosal tissue, or both. Must also include either respiratory compromise (example wheezing, stridor, etc) or reduced blood pressure/syncope or collapse.
Two or more of the following that occur minutes to hours after a likely allergen for the specific patient:
Generalized skin involvement or swollen lips/tongue/uvula
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.
This content is the author’s opinion alone and does not necessarily reflect the opinion, official position, or stance of the Department of Defense, or any other branch of the United States Military.
REFERENCES
1 Sampson HA, Muñoz-Furlong A, Campbell RL, et al. Second symposium on the definition and management of anaphylaxis: summary report–Second National Institute of Allergy and Infectious Disease/Food Allergy and Anaphylaxis Network symposium. J Allergy Clin Immunol. 2006;117(2):391‐397. doi:10.1016/j.jaci.2005.12.1303
Dermatology concepts are difficult for everyone. It takes a lot of exposure and experience to be able to differentiate. However, this post will attempt to provide a place to return when review is necessary. This lesson will likely take at least 60 minutes to complete, but it may be split up and accomplished over time to make things easier. The post will start with general concepts and then move to easier topics that medics can often manage. The ADTMC protocol for an unknown rash is at the bottom, and there is a video about cellulitis as well. Don’t forget the quiz at the bottom to check learning.
GENERAL CONCEPTS AND DEFINITIONS
After watching these intro videos to the types of lesions, this website from Stanford Medicine is a good thorough review. The website includes pictures and descriptions in greater academic detail, as well as some videos to discuss a good physical exam.
CONTACT DERMATITIS
Contact dermatitis is a reaction to a substance. When Soldiers are in the field, this is often from a plant such as poison ivy. My treatment protocol depends on the severity of the reaction. There are reports that talk about washing the oils off of the body with soap and water within 30 minutes from exposure- this can help prevent a lot of the reaction. However, once the rash appears, I typically prescribe a few medications.
For minimal local reaction that is not widespread, I typically give a topical steroid cream. My treatment of choice tends to be Triamcinolone 0.1% cream twice daily for 14 days. There are other creams and gels in this range of potency. Lots of literature suggests even stronger potency, but I find that triamcinolone tends to work fine. It is widely available in DOD pharmacies.
For more widespread lesions (not just one limb) or for more intense spread, I will often add prednisone oral pills. I often do a 9 day taper with the triamcinolone. My cocktail has often been 60 mg for 3 days, 40 mg for 3 days, and 20 mg for 3 days. However, I change this up depending on severity or concern. I may also give a Decadron 4-8 mg IM injection on the first day and then follow it up with my 9 day taper, all while using the triamcinolone cream.
Treatment Regimen for Contact Dermatitis
Mild: Triamcinolone 0.1% cream used twice daily to affected area for 14 days
Moderate: Oral Prednisone 60 mg for 3 days, 40 mg for 3 days, and 20 mg for 3 days, and the Triamcinolone 0.1% cream twice daily
More than Moderate: Decadron 8 mg IM injection on day one, Triamcinolone 0.1% cream twice daily x 14 days, and oral Prednisone tapering cocktail above started the day after the injection.
These regimens have worked for me in the past. However, I give this only as an example and not as what medics should do without guidance. I am not recommending that this necessarily be done for patients in all circumstances, and I am aware that many other providers would disagree with this approach or recommend other approaches to contact dermatitis treatment. Some will use calamine lotion or other lotions, but these really only help with some of the itching and does not resolve the reaction.
HEAT RASH
My approach to treating heat rash has been to give a low dose hydrocortisone 0.1% cream (over the counter strength) to be used twice daily. I also encourage staying out of the heat as best as possible and changing clothes more often to keep the moisture from staying against the skin. Soldiers often wear gear that causes the moisture to be compressed up against the skin, so I typically recommend that they stay in PT uniforms (shorts and t-shirt) when I can in order to reverse the process. Sometimes I use other creams instead or other approaches, but the Soldier really needs to prevent the rash from continuing by removing the offending behavior for a few days.
PSEUDOFOLLICULITIS BARBAE
Psuedofolliculitis Barbae is essentially razor bumps after shaving. This is also treated with hydrocortisone 0.1% twice daily and allow the Soldier to have a shaving profile. Allowing the hair to grow (not shaving) for a little bit typically resolves this. Most people know what this looks like. However, the short video below does have a few pictures.
TINEA PEDIS
COMMON PRESCRIPTIONS:
Terbinafine cream applied twice daily for 2 weeks
Clotrimazole cream applied twice daily for 4 weeks
Tolnaftate powder applied to the feet twice daily
CELLULITIS
Cellulitis is a serious condition that should be seen by a provider. There are many causes for rashes, and many are difficult to tease out. The ones above are typically straightforward and can often be managed by medics. However, this protocol below is a helpful protocol from the new ADTMC that details when to refer to a provider.
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.
If You Enjoy This Content, Please Consider Sharing with Others to Help Them Learn Also
This content is the author’s opinion alone and does not necessarily reflect the opinion, official position, or stance of the Department of Defense, or any other branch of the United States Military.
