NREMT EMT 1: Scene Size-Up and Safety - Responding to Violent Emergencies and Tactical Casualty Care, TECC/TCCC Principles

What This Is: Responding to Violent Emergencies and Tactical Casualty Care (TECC/TCCC)

When someone is hurt in a violent situation, like a shooting or a car accident, every second counts. Think of it like a fire: you need to put out the flames (stop the bleeding) before you can treat the burn (the injury). In TECC/TCCC, we focus on saving lives in high-risk situations.

Key Steps / Core Facts:

• Tactical Field Care (TFC): Assess the scene for danger, then prioritize the patient's airway, breathing, and circulation (ABCs). (OPQRSTI)
  • Why: If the patient can't breathe, they can't live.
  • Example: A patient is shot in the chest and can't breathe. You need to clear their airway and start CPR.
• Hemorrhage Control: Stop bleeding with a tourniquet or hemostatic agents. (CAT)
  • Why: Excessive bleeding can lead to shock and death.
  • Example: A patient is shot in the leg and bleeding heavily. You need to apply a tourniquet to stop the bleeding.
• CPR Compression Depth: At least 2 inches – like pushing down a soda can. (30:2 ratio)
  • Why: Proper compression depth ensures effective blood flow.
  • Example: A patient is in cardiac arrest and needs CPR. You need to compress their chest at least 2 inches deep.
• Hypothermia Prevention: Keep the patient warm with blankets or a space blanket. (Hypothermia is a "silent killer")
  • Why: Hypothermia can lead to cardiac arrest and death.
  • Example: A patient is injured in cold weather and needs to be kept warm.
• Scene Safety: Clear the area of hazards and secure the patient. (OPQRSTI)
  • Why: A safe scene ensures the patient's safety and the safety of responders.
  • Example: A patient is injured in a car accident and needs to be moved to a safe location.
• Patient Assessment: Use the AVPU scale to assess the patient's level of consciousness. (Alert, Verbal, Pain, Unresponsive)
  • Why: The AVPU scale helps you determine the patient's level of consciousness and guide treatment.
  • Example: A patient is injured and needs to be assessed for level of consciousness.
• Tactical Casualty Care (TCC): Use the TCCC guidelines to treat patients in high-risk situations. (TCCC is a set of guidelines for treating patients in combat or high-risk situations)
  • Why: TCCC guidelines ensure effective treatment in high-risk situations.
  • Example: A patient is injured in a combat situation and needs to be treated according to TCCC guidelines.
• Red Flags: Look for signs of shock, such as pale skin, cool skin, and decreased urine output. (Shock is a "silent killer")
  • Why: Recognizing shock early ensures timely treatment and improves outcomes.
  • Example: A patient is injured and shows signs of shock, such as pale skin and decreased urine output.

What Laypeople Can Do:

• If someone is injured in a violent situation, first check for danger (oncoming traffic, fire). Then shout and tap their shoulder to get their attention.
• If someone is bleeding heavily, apply pressure with a cloth or gauze to stop the bleeding.
• If someone is in cardiac arrest, call 911 and start CPR with 30 chest compressions followed by 2 breaths.
• If someone is injured and needs to be moved, use a backboard or stretcher to keep them stable and secure.
• If someone is injured and needs to be kept warm, use blankets or a space blanket to prevent hypothermia.

Common Mistakes:

• Mistake: Not clearing the scene of hazards before treating the patient.
  • Fix: Clear the area of hazards and secure the patient before treating them.
• Mistake: Not using the AVPU scale to assess the patient's level of consciousness.
  • Fix: Use the AVPU scale to assess the patient's level of consciousness and guide treatment.
• Mistake: Not recognizing shock early and treating it promptly.
  • Fix: Recognize shock early by looking for signs such as pale skin, cool skin, and decreased urine output, and treat it promptly with fluids and other interventions.

Quick Practice Scenarios:

1. A patient is shot in the chest and can't breathe. What should you do first?
   • Answer: Clear their airway and start CPR.
   • Reason: If the patient can't breathe, they can't live.
2. A patient is injured in a car accident and needs to be moved to a safe location. What should you do first?
   • Answer: Clear the area of hazards and secure the patient before moving them.
   • Reason: A safe scene ensures the patient's safety and the safety of responders.
3. A patient is injured and shows signs of shock, such as pale skin and decreased urine output. What should you do first?
   • Answer: Recognize shock early and treat it promptly with fluids and other interventions.
   • Reason: Shock is a "silent killer" that can lead to death if not treated promptly.

Last-Minute Exam Cram:

• Agonal breathing is NOT normal breathing – start CPR.
• Normal vital sign ranges: heart rate 60-100, blood pressure 90-140, respiratory rate 12-20.
• The 30:2 ratio for CPR is 30 chest compressions followed by 2 breaths.
• The AVPU scale is used to assess the patient's level of consciousness: Alert, Verbal, Pain, Unresponsive.
• The TCCC guidelines are used to treat patients in high-risk situations.
• Hypothermia is a "silent killer" that can lead to cardiac arrest and death.
• Shock is a "silent killer" that can lead to death if not treated promptly.
• The CAT mnemonic is used for hemorrhage control: Control, Apply, Tourniquet.
• The OPQRSTI mnemonic is used for patient assessment: Onset, Provocation, Quality, Region, Severity, Time, Involvement.