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DIRECT THREAT CARE (DTC) / HOT ZONE Guidelines: - Correct answer-Mitigate any immediate threat Direct the injured first responder to stay engaged Move patient to a safer position Stop life threatening external hemorrhage Place patient in a position to protect airway INDIRECT THREAT CARE (ITC) / WARM ZONE Guidelines - Correct answer-Secure weapons PMARCHP / X-ABCDE Control bleeding Reassess all tourniquets Tourniquets that are determined to be both necessary and effective? - Correct answer- Should remain in place if the patient can be evacuated within 2 hours to definitive medical care
TECC Exam QUESTIONS AND ANSWERS
RATED A+ 202 5 |202 6 UPDATE
If existing tourniquet is necessary but ineffective? - Correct answer-Either tighten the existing tourniquet further, or apply a second tourniquet, side-by-side and, if possible, proximal to the first to eliminate the distal pulse. If a tourniquet is determined based on wound assessment to not be necessary? - Correct answer-Use other techniques to control bleeding and remove the tourniquet Consider tourniquet downgrade/conversion if? - Correct answer-There will be a delay in evacuation more than 2 hours. Tourniquet downgrade: - Correct answer-Expose the wound fully, identify an appropriate location at least 2 - 3 inches above the most proximal injury (not over a joint), and apply a new tourniquet directly to the skin. Once properly applied, the prior tourniquet can be loosened but should be left in place. Tourniquet conversion: - Correct answer-Expose the wound fully, fully pack the wound with hemostatic or plain gauze, and properly apply a pressure dressing. Once properly applied, the prior tourniquet can be loosened but should be left in place.
If tension pneumothorax is suspected to be developing, - Correct answer-Decompress the chest on the side of the injury: ALS providers: Needle decompression should be performed (minimum a 14 - gauge, 3.25 inch needle/catheter) at the 2nd intercostal space mid-clavicular lateral to the nipple line and is not directed towards the heart or the 4th/5th intercostal space perpendicular to the chest wall anterior to the mid-axillary line BLS - Burp dressing If suspected severe traumatic brain injury (GCS < 9), - Correct answer-Apply oxygen if available to maintain saturation >90% and maintain etCO2 in ventilated patient between 35 - 45 mmHg. Avoid any hyperventilation as evidenced by an etCO2 below 35 mmHg. If available, consider PEEP 5 - 12 cm H2O. If immediate fluid resuscitation is required and is available, - Correct answer-Consider starting at least an 18 - gauge IV or obtaining intraosseous (IO) access. If patient has injuries that could potentially require significant blood transfusion - Correct answer-Consider administration of 1 gram of TXA as soon as possible.
Do not administer TXA later than 3 hours after injury. Assess for shock - Correct answer-<90mmHg with/without heart rate >100 bpm If not in shock - Correct answer-Patient can drink fluids and establish an saline lock If hemorrhagic shock is present: Fluid Resuscitation - Correct answer-Resuscitate using permissive hypotension in the non-head injured patient. Administer IV fluid bolus (per agency protocol) to a goal of improving mental status, radial pulses, or, if available, measured SBP>80mmHg. Repeat bolus once after 30 minutes if still in shock. If hemorrhagic shock is present: Calcium - Correct answer-If available, infuse 1 gram 10% Calcium chloride or 3 grams of 10% Calcium Gluconate
- 1g of CaCl 10% in 10mL is 13.65 meq / 10mL
- 1g of CaGlu 10% in 10mL is 4.65 meq/ 10 mL. In a patient who has altered mental status due to suspected or confirmed severe traumatic brain injury (GCS<9)? - Correct answer-Avoid any hypotension. Maintain BP
- Elevate head 30 degrees and avoid constricting collars or airway devices.
Administering analgesia using a multimodal approach to pain control - Correct answer-By using analgesics with different, but potentiating, mechanisms of action, lower doses and therefore less side effects may be used with the same or better pain control than using a single modality alone. Pain management considerations - Correct answer-In Traumatic Brain Injury anticipate possible hypotension if opioid analgesics are being used for pain control. Consider co-administering anti-emetic medications with pain medications. Warm Zone CPR - blast, penetrating or blunt trauma who have no pulse, no ventilations, no signs of life. - Correct answer-Will likely not be successful and should not be attempted. Consider bilateral needle decompression for? - Correct answer-Victims of torso or polytrauma with no respirations or pulse to ensure tension pneumothorax is not the cause of cardiac arrest prior to discontinuation of care. Warm Zone CPR - electrocution or drowning - Correct answer-Performing CPR may be of benefit and should be considered in the context of the operational situation.
EVAC Guidelines - Initial - Correct answer-Reassess / Triage EVAC Guidelines - Airway - Correct answer-Consider immobilization, high suspicion with>65 with blunt mechanism. Reasess, check seals, burp, repeat needles, add chest tube. Who can benefit from O2? - Correct answer-O2 may be of benefit for all traumatically injured patients, Unconscious or altered mental status Torso injuries with dyspnea Chest injury with known/suspected pneumothorax Hemorrhagic shock Patient at altitude EVAC Guidelines - Bleeding - Correct answer-Reassess interventions Burn care and resuscitation is consistent with? - Correct answer-The principles described in Indirect Threat Care / Warm Zone.
EVAC - Guidelines for Cardiopulmonary resuscitation: - Correct answer-CPR may have a larger role during the evacuation phase especially for patients with electrocution, hypothermia, non-traumatic arrest or near drowning. Hot Zone Care - Primary Goals: - Correct answer-Accomplish the mission with minimal casualties. Prevent any patient from sustaining additional injuries. Keep operational response maximally engaged in addressing the immediate threats Minimize public harm. Hot Zone Care - Operational Principles: - Correct answer-1. Establish operational control of the immediate incident
- Threat mitigation techniques will minimize risk to casualties and the providers.
- Triage should be deferred to a later phase of care.
- Minimal trauma interventions.
- Consider hemorrhage control before evacuation to a safer area. a. TQ application is the primary "medical" intervention to be considered in this phase of care. Hot Zone Care - Skill Set: - Correct answer-Tourniquet Extraction Recovery position
WARM ZONE CARE - Goals - Correct answer-Same as Hot Stabilize PT Warm Zone Care - Operational Principles: - Correct answer-Maintain operational control to stabilize the immediate scenario. Conduct dedicated patient assessment and initiate appropriate life-saving interventions DO NOT DELAY patient extraction for non-life-saving interventions. Consider establishing a CCP Establish communication Prepare casualties for evacuation Warm Zone Care - Triage - Correct answer-Unless in a fixed CCP, triage in this phase of care should be limited to the following categories: a. Uninjured b. Deceased / expectant c. All others Indirect Threat / Warm Zone - Hemorrhage - Correct answer-Application of direct pressure Application of tourniquet Application of wound packing with gauze or hemostatic agent Application of mechanical or improvised pressure dressing
loss. Indirect Threat / Warm Zone - Burn - Correct answer-Initiate Basic Burn Treatment Indirect Threat / Warm Zone - TBI - Correct answer-Position patient appropriately Apply appropriate resuscitative principles for TBI patient Indirect Threat / Warm Zone - Extraction - Correct answer-Move Patient (drags, carries, lifts) Identify patient at risk and apply commercial/improvised spinal immobilization devices Properly secure patient to litter Indirect Threat / Warm Zone - Other Skills - Correct answer-Perform Hasty Decontamination Initiate Patient Monitoring Recognize need for and establish Patient Collection Point Cold Zone - Primary Goals: - Correct answer-Maintain any lifesaving interventions conducted during Direct Threat /Hot Zone andIndirect Threat /Warm Zone phases of care.
- Provide rapid and secure evacuation to an appropriate (level of care) medical receiving facility.
- Provide good communication and patient care data between field medical providers and fixed medical receiving facility.
- Avoid additional preventable causes of death. Cold Zone - Operational Principles: - Correct answer-1. Reassess the patient
- Utilize a triage system/criteria
- Utilize available additional resources t
- Avoid developing hypothermia.
- Communication
- Maintain situational awareness Cold Zone - Skills - Correct answer-1. Same as Indirect Threat / Warm Zone Care.
- Apply triage prioritization
- Simple spinal immobilization as needed.
- Monitoring equipment
- Implement damage control resuscitation.
- Apply multimodal pain control principles.
- Effective communication between non-medical, pre-hospital and hospital medical assets TXA - Correct answer-Significant blood loss, not >3 later 1gm in 10ml (1ml p m)
