A: Airway Why it matters: No airway = no oxygen = no life. What to Look For - Snoring, gurgling, choking - Blood, vomit, broken teeth - Inability to speak clearly What to Do 1. Position patient 2. Jaw thrust / head tilt–chin lift 3. Clear visible obstructions 4. NPA / OPA as appropriate (if trained) Tactical Considerations - Facial trauma = airway risk - Secure airway without losing scene awareness Note: Most airway failures are positioning failures.

MARCH: Massive Hemorrhage – Reassessment Matters 🔴 Scenario You arrive first on scene of a vehicle vs pedestrian crash. A bystander applied a tourniquet to the patient’s left thigh. EMS is 6–8 minutes out. The patient is conscious, pale, and anxious. M – Massive Hemorrhage ✅ What To Do - Reassess the tourniquet Is it high and tight? Is bleeding fully controlled? - If bleeding continues: Tighten the tourniquet until bleeding stops Apply a second tourniquet above the first if needed - Check for hidden bleeding Groin, buttocks, armpits, behind knees - If a tourniquet can’t be placed: Pack the wound and apply direct pressure 👀 What To Look For - Blood soaking through clothing or bandages - Pooling blood beneath the patient - Pale or clammy skin - Fast pulse or increasing anxiety (early shock signs) 🆚 Civilian vs Law Enforcement Response 🧍‍♂️Civilian Focus - Prioritize personal safety - Call 911 early - Use commercial or improvised tourniquets - Apply direct pressure if unsure - Reassess only if safe to do so Goal: Stop the bleeding until help arrives Law Enforcement / First Responder Focus - Ensure scene security - Apply rapid hemorrhage control - Carry and use department-issued TQs and hemostatic gauze - Perform systematic MARCH reassessments - Prepare for handoff to EMS Goal: Stabilize, reassess, and maintain control until transport 👨‍🏫 Instructor Note Tourniquets fail more often from poor placement or hesitation than from overuse. Pain is expected. Bleeding control always comes first. Reassess after movement, stress, or time passes. 🔑 Key Takeaway The first tourniquet isn’t the finish line — reassessment saves lives.

Tactical Burn Care — Key Priorities 🟩 Care Under Fire: - Prioritize getting to cover. - Only life-saving interventions (e.g., tourniquet if needed). - Evacuate from danger zone ASAP. 🟨 Tactical Field Care: 🧠 Assessment (Primary Survey) - Airway: Ensure no facial burns or soot indicating airway compromise. - Breathing: Watch for smoke inhalation—may worsen over time. - Circulation: Burn shock is real. Monitor for signs of hypovolemia. - Disability: Check for associated trauma (blast injuries, falls). - Exposure: Remove smoldering clothes unless fused to skin.➤ Prevent hypothermia even in hot environments. 🚑 Treatment Principles: - Dry, clean dressings (preferably burn dressings if available). - Avoid applying ointments or ice in the field. - Pain management is critical—consider oral or injectable meds if within protocol. - Fluids: For large burns (>20% BSA), initiate fluid resuscitation if prolonged evac time. 🔺 Rule of Nines (Adult Burn Estimation): - Head = 9% - Each arm = 9% - Each leg = 18% - Torso front = 18% - Torso back = 18% - Genitalia = 1% ⚠️ Watch For: - Hoarse voice, stridor = airway swelling — prepare for advanced airway - Circumferential burns = risk of compartment syndrome - Electrical burns = suspect internal injuries

Scenario: You respond to an active scene where a victim has a deep arterial bleed from the upper thigh caused by shrapnel. Blood is pulsing and soaking through clothing rapidly. You’re under stress, heart rate elevated, and there’s chaos around you. Training Focus: ✅ Step 1 – Recognize Life-Threatening Bleeding: - Spurting or pooling blood - Soaked clothing - Victim becoming pale, clammy, or confused ✅ Step 2 – Immediate Action: - Expose the wound quickly - Apply the tourniquet high and tight (if the wound isn’t clearly visible, don’t waste time) - Pull the band tight — if it doesn’t hurt, it’s not tight enough - Twist the windlass until bleeding stops, then secure ✅ Step 3 – Time & Monitor: - Mark the time of application - Reassess for continued bleeding - Do not remove the tourniquet unless directed by advanced medical personnel Quick Tip: Practice one-handed application with both your dominant and non-dominant hands. Under stress, fine motor skills degrade — build muscle memory now. Drill for Today: Grab your tourniquet and time yourself: - Apply with dominant hand only - Apply with non-dominant hand only - Goal: Each under 30 seconds