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Direct Threat Care (DTC) & Indirect Threat Care (ITC) Guidelines: Trauma Management, Exams of Traumatology

Guidelines and protocols for direct threat care (dtc) and indirect threat care (itc), focusing on immediate life-saving interventions in high-risk environments. It covers key aspects such as hemorrhage control, airway management, and treatment for specific conditions like tension pneumothorax and traumatic brain injury. The guidelines emphasize rapid assessment, minimal intervention in the hot zone, and preparation for evacuation to a safer area. It also includes considerations for pain management and cpr in various scenarios, providing a structured approach to trauma care in dynamic and challenging situations. Useful for medical students and practitioners.

Typology: Exams

2024/2025

Available from 06/03/2025

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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+ 2025|2026 UPDATE
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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
  1. 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

  1. Threat mitigation techniques will minimize risk to casualties and the providers.
  2. Triage should be deferred to a later phase of care.
  3. Minimal trauma interventions.
  4. 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.

  1. Provide rapid and secure evacuation to an appropriate (level of care) medical receiving facility.
  1. Provide good communication and patient care data between field medical providers and fixed medical receiving facility.
  2. Avoid additional preventable causes of death. Cold Zone - Operational Principles: - Correct answer-1. Reassess the patient
  3. Utilize a triage system/criteria
  4. Utilize available additional resources t
  5. Avoid developing hypothermia.
  6. Communication
  7. Maintain situational awareness Cold Zone - Skills - Correct answer-1. Same as Indirect Threat / Warm Zone Care.
  8. Apply triage prioritization
  9. Simple spinal immobilization as needed.
  10. Monitoring equipment
  11. Implement damage control resuscitation.
  12. Apply multimodal pain control principles.
  13. 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)