Whiskey Phase

RICE

Rest, Ice, Compression, Elevation

Subjective Entry (SOAP Note)

What the patient tells you

Objective Entry (SOAP Note)

What you find in assessment or observation

Assessment Entry (SOAP Note)

Your diagnosis or hypothesis

Treatment Plan (SOAP Note)

What is the treatment plan for the patient?

What is MHS GENESIS 

Implemented by the Defense Health Agency (DHA), a new electronic Military Health System (MHS), with increased and secure technology

Who uses MHS GENESIS

In a health care setting, doctors, nurses, combat medics, other medical perfessionals

DD Form 689

Individual sick call form, used for medical or dental treatment or evaluation 

SF 600

Chronological record of medical care

What does a SF 600 form include

Date and time of visit

MTF involved

Signature of person making the entry

Patients name, unit, DOD ID

What is the purpose of a DD form 689

Communication from medical personnel to the patients commander, and to keep accountability of solders

Required procedures for medical entries on official medical documents

Legibly typed or handwritten

Black or blue-black ink

Signed by individual making the entry with the individuals information

Date (day, month, year)

Capitalized in the beginning

Written with past or present verbs

Recorded ASAP

Uses only approved abbreviations

Must be clear concise, and objective

Includes patient information 

Correction for an entry error

While writing cross out the error with ONE line and write error above and write the correct information following the error

If found when reviewing cross out error with ONE line and write correction at next available space at the end

What not to do on a Medical Entry

DO NOT erase, skip lines, write in between lines, document for someone else, leave blank lines above signature

Triage Purpose

Provide the most life saving care for the most amount of people in the least amount of time.

Techniques for Identifying Acutely Ill Patients

Headaches

Acute vision changes

Neck pain or stiffness

Chest pain

Shortness of breath (SOB)

Abdominal Pain

Altered Mental Status

What is the first thing a Combat Medic must obtain from a patient when they arrive to sick call?

The chief complaint

HIPAA

The Health Insurance Portability and Accountability Act

Access for Medical Information may be given to who?

The patient

Patient care representative

Medical researchers (with permission from patient or by court order)

Medical educators (with permission from patient or by court order)

Who Discloses Medical Information

Handled by patient administration personnel

NEVER by a 68W

History Taking Techniques

Observations

Listening

Open Ended Questions

Consider MOI

Maintain Suspicion (keep asking questions)

Collected Subjective Information from Patients

Demographics (age, sex, race, FDLMP (women))

Chief complaint

History of present illness (HPI) OPQRST

Patient History (AMPLE), past surgical history (PSH), social history, last oral intake, events leading up to illness

Form DA 3349

Profile form, rarely written by 68W unless the most senior medic or if it is a minor profile/injury and MO allows (ex no PT for 3 days)

QUARTERS Meaning

Patient can remain in their room/house or company day room and may leave to go to treatment facility or dining facility

BEDREST Meaning

Patient may only leave room/house for necessary dining facility and latrine, may not perform any military duties

DUTY Meaning

The patient can return to training

DD Form 1380

TCCC, tactical combat casualty card

DD Form 3019

Resuscitation record

Antibiotics

ABX

Ambulatory

amb

Blood

bl

Catheter

cath

Dressing

Drsg

Drops

gtts

Fractures

fx

Microgram

mcg or ug

Pupils Equal Round, Reactive to Light and Accommodation

PERRL-A

Tourniquet

TQ

With

c

Wounded in Action

WIA

Intraosseous

IO

Intravenous

IV

Gunshot Wound

GSW

What can disrupt your ability to provide medical care for a casualty

MCI, Weather, Terrain, Under Fire

Where are TCCC cards kept on a solder

Inside their improved first aid kit (IFAK)

What makes up a Patients Battle Roster number

Their first and last initial and the last 4 of their social security number ex (GP3138)

MEDAVAC

A vehicle that included medical equipment that is used to treat the injured

CASEVAC

A vehicle transporting medical patients but not the intended purpose of the vehicle, does not include any medical equipment

Who determines the need for a MEDEVAC or CASEVAC

The tactical leader or the senior military person present

Urgent Precedence

Assigned to emergency cases that are immediately life threatening but do not require emergency surgery, transport needed within the hour

Urgent-Surgical Precedence

Assigned to emergency cases that are immediately life threatening that do require emergency surgery, transport needed within the hour

Priority Precedence

Assigned to sick and wounded requiring prompt medical care, transport needed within 4 hours

Routine Precedence

Assigned to sick and wounded personnel requiring evacuation but who’s condition is not expected to deteriorate significantly, transport required within 24 hours

Convenience Precedence

Assigned to sick who’s evacuation is more of a convenience rather than needed, transport whenever possible

Line 1 (9 line)

Location of pickup site

Line 2 (9 line)

Radio frequency, call sign, and suffix

Line 3 (9 line)

Number of casualties by precedence

Where can you receive radio frequency, call sign, and suffix

Signal operation instruction (SOI)

Automated net control device (ANCD)

Radio and telephone operator (RTO)

Line 4 (9 line)

Special equipment

Line 5 (9 line)

Number of casualties by type

Line 6 (wartime) (9 line)

Security of pickup site

Line 6 (peacetime) (9 line)

Number and type of wound, injury, or illness

Line 7 (9 line)

Method of marking pickup site

Line 8 (9 line)

Casualty nationality and status

Line 9 (wartime) (9 line)

CBRN contamination

Line 9 (peacetime) (9 line)

Terrain description

MIST Report

M - MOI (landmine, GSW, RPG, RTA)

I - type of injury (found or suspected)

S - signs (pulse, blood pressure, respiratory rate)

T - treatment rendered 

Microorganisms

Microscopic living cells found everywhere in the enviornment, some are harmful and some are beneficial

Microorganisms Structure and Function

Similar structure to plant and animal cells

They have their own metabolism

They can increase in size, divide and mutate

Many react in different ways to environmental changes

Some form protective capsules

Environmental factors that influence microorganism growth

Oxygen

Nutrients

Temperature (warm temperatures)

Moisture

pH

Light

Algae

Resembles plant cells found in sunlit water and rarely causes human disease

Fungi

Yeasts and molds (athletes foot, jock itch)

Protozoa

Single celled microscopic microorganisms (vaginal infections or UTIs in men)

Bacteria

Single celled organisms without a nucleus

Spores

A dormant non-reproductive body formed by certain bacteria often in response to a lack of nutrients, and characteristically being highly resistant to heat, desiccation, and destruction by chemicals or enzymes, most difficult to destroy

Pathogenic Bacteria

Bacteria that causes disease

Viruses

Must use a host to make protein and energy, immunization is the most effective means for precenting viral infections

Chain of Infection

Pathogenic Microorganism

Reservoir

Portal of Exit

Modes of Transmission

Portal of Entry

Susceptible Host

Communicable Diseases

Diseases that spread from one person to another

Contagious Diseases

Diseases which are transmitted to many individuals quickly and easily

Epidemic

A large number of people in the same area infected in a relatively short time

Endemic

A disease or illness regularly found among a particular group of people or within a certain area

Direct Contact (Direct Transmission)

The most common method of transmission, transferred by sexual intercourse, kissing, skin to skin, contact with open wounds

Droplet Spread (Direct Transmission)

Distribution of pathogens from sneezing, coughing, or talking

Airborne (Indirect Transmission)

Occurs when pathogens are suspended in the air with dust particles 

Vehicles (Indirect Transmission)

Vehicles are indirectly transferred by food, water, biological products (saliva, blood), can also include objects like bedding

Vectors (Indirect Transmission)

Insects such as mosquitos, fleas, and ticks that carry and spread pathogens

Incubation Period (Response to Infection)

Occurs from when the pathogen enters the body to the appearance of the first symptoms

Prodromal Stage (Response to Infection)

Occurs from the onset of initial symptoms to a low grade fever to more severe symptoms

Full Stage of Illness (Response to Infection)

Occurs when symptoms are acute and specific to the type of infection such as lesions covering the body or high fever

Convalescent Stage

Occurs when acute symptoms of the infection subside and the patient recovers

Nosocomial Infection

Infections that patients acquire while in a health care facility, health care associated infections (HCAI)

Dirty (Asepsis Terminology)

A term for any object that hasn’t been cleaned or sterilized

Contaminated (Asepsis Terminology)

A term for an object that was cleaned or sterile but touched by a dirty object

Clean (Asepsis Terminology)

A term for an object that has had many microorganisms removed

Sterile (Asepsis Terminology)

Means the item is free from all microorganisms and spores

Disinfectants

Destroys most pathogens but not necessarily their spores

Sterilization

Destroys all microorganisms and spores by the process of exposing articles to heat or chemical disinfections

Infect Control Techniques

Must use standard precautions in all patients

Must use universal precautions to protect from bodily fluids

Basic Precautions

Wear gloves on every patient

Change gloves between patients

WASH YOUR HANDS

Handle needles appropriately

Use scoop method when recapping needles

Report exposure to blood and bodily fluids
Keep open wounds covered

Provide clean sterile bedding

Avoid talking, sneezing, or coughing directly over open wounds or sterile fields