P2-20 Using the 7-step process

We have designed the following process which you can follow with any patient using the UNITAF medical settings for Arma 3.

The 7-step process:

If a fully operational team member is nearby, delegate them to Step 1 and Step 3. Under dire circumstances delegate them to assist you in Step 2 and Step 5 as well.
 

1. Apply tourniquets on limbs with multiple wounds. Delegate this task whenever you can.
    
2. Bandage torso, head, and tourniquet-free limbs, and check pulse if patient is non-responsive. You should avoid delegating this task.
   
   
   ----  the patient can be stitched at this stage (although this is not always required) to prevent wounds opening again during further treatment ----
   
    
3. Start CPR - CPR – CHECK PULSE routine if patient is non-responsive and no pulse is found. Delegate this task whenever you can
    
4. If the patient lost a large or fatal amount of blood – use IVs to restore its volume. You cannot delegate this task.
   
   
   ---- at this point the patient is stable they should be able to be re-categorised as CAT-2 DELAYED ----
   
    
5. Once pulse is back, apply splints to legs, and then treat wounds limb by limb and remove tourniquets after fully treating each limb. Monitor pulse in the meantime. If the patient goes into cardiac arrest again, go back to Step 3. You should avoid delegating this task.
    
6. If the patient does not wake up after blood level has been restored – use Epinephrine. You cannot delegate this task. Wait for the patient to wake up.
    
7. If the patient is in serious pain, ask him if he has used Morphine in the past 15 minutes. If not, administer or ask him to take Morphine. Remind him not to use Morphine if he used it in the past 15 minutes. You can also refer to info on triage log in medical menu
    

Tips for this process

• Remember that you must not apply any IV or auto-injectors to a limb with a tourniquet. On taking the tourniquet off, auto-injectors will start working simultaneously, possibly harming or killing your patient. IVs will not work on a tourniqueted limb as well.
   
• Try to prioritise wounds; velocity and avulsion have highest bleeding rates – 0.2 and 0.1 respectively.
   
• Morphine stays in the system for up to 30 minutes, two should not be used in the same 15 minutes.
   
• Move the wounded to a safer place. Delegate this task whenever you can.
   
• Patients cannot feel pain while incapacitated. Take advantage of that.