“That Others May Live”



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Pararescue Medication and Procedure Handbook
Second Edition
28 February, 2001

“That Others May Live”


Editor
Robert C. Allen, DO, FACEP

Lt Col, USAF MC
Contributors
James P. Bagian, MD

Col, USAFR MC
Lewis Neace, DO

Col, USAFR MC
John M. McAtee, PA-C

Lt Col, USAF BSC
Gus Varnivas, MD

Maj, USAF MC
Gary C. Perez, PA-C

Capt, USAF BSC
Michael L. Fleming, NREMT-P

TSgt, USAF
This book is dedicated to all Pararescuemen, past and present, who use their skill, training, courage and ingenuity so That Others May Live

Introduction
This handbook is designed to provide concise information regarding management of patients in austere environments. It is a ‘quick reference’ and is not meant to provide detailed discussions of physiological events. You are expected to provide the standard of care for your EMT certification, including the unique skills native to Pararescue.
Note: No handbook can anticipate every tactical and/or medical situation that might occur in a rescue. When faced with adverse situations, a PJ and his team will have to improvise, adapt, and overcome. Always keep in mind the mission, your safety, and your patient’s safety.
References used in the preparation of this handbook include, but were not limited to:
Brady Paramedic Emergency Care, Bledsoe, et al., Prentice Hall
Emergency Medicine: A Comprehensive Study Guide, 4th Ed., Tintanelli, et al. McGraw-Hill
Lippencott Nursing Manual, J. B. Lippencott Co.
Physicians' Desk Reference, Medical Economics Data Production Co.
Physicians GenRx, Mosby, 1998
Advanced Cardiac Life Support, American Heart Association, 2000 edition
Wilderness Medicine: Management of Wilderness and Environmental Emergencies, 3rd Ed., PA Auerbach, Mosby 1995.

Emergency Medicine Concepts and Clinical Practice, 4th Ed., Rosen, et al., Mosby 1998

Medical Management of Chemical Casualties Handbook, US Army Medical Research Institute

of Chemical Defense, Sept 1995.


Medical Management of Biological Casualties Handbook, US Army Medical Research

Institute of Infections Diseases, August 1996


TABLE OF CONTENTS
Medical Command and Control 8

Principles of Combat Casualty Care 9

 Resuscitation: Initiation and Guidelines 10

 Refusal of Medical Care 11
Trauma 12

 Primary Survey 12

 Secondary Survey 12

 Glasgow Coma Scale 13


Shock 14

 Hypovolemic 14

 Cardiogenic 14

 Anaphylactic 15

 Septic 15

 Neurogenic 16



Spinal Injuries 17

 Solu-Medrol Protocol (Blunt Spinal Chord Trauma) 17

 Clinical Clearing of the Cervical Spine 18

Dermatome Chart 19


Head Injuries 20

 Increased Intracranial Pressure (ICP) 21



Facial/eye trauma 22

 Snellen Visual Acuity Chart 24



Chest Trauma 25

Abdominal Trauma 27

Extremity Trauma 29

 Open Fractures 29

 Shoulder Dislocations 30

 Thumb/Finger Dislocations 31

 Knee Dislocations 33

 Ankle Fracture-Dislocations 33



Compartment Syndrome 33

Crush Injuries 34

Burns 35

 Burn Nomogram 39


Medical Procedures 40

Airway 40

 Jaw Thrust 40

 Chin Lift 40

 Naso-Pharyngeal Airway 40


 Oral-Pharyngeal Airway 40

 Endotracheal Intubation 41

 Nasotracheal Intubation 41

 Lighted Stylet Intubation 42

 Tactile Intubation 42

 Cricothyroidotomy 43




Breathing 44

 Oxygen Therapy 44

 Needle Thoracentesis 44

 Thoracostomy (Chest Tube) 45



Circulation 46

 Intravenous Insertion 46

 Saline Lock Insertion 47

 Intraosseous Infusion 48



Diagnostics and Patient Care 48

 Naso-Gastric Tube Insertion 48

 Urethral Catheterization 49

 Suprapubic Needle Cystotomy 50

 Wound Irrigation 50

 Debridement 51

 Delayed Primary Closure 51

 Escharotomy 51

 Fasciotomy 53

 Amputations 53

 MAST trousers 53

Extended Care and Transport 54

Triage 55
Operational and Environmental Emergencies 57

Dive Emergencies 57

Non-Trauma Dive Injuries 57


Trauma Dive Injuries 57

Open Circuit Diving Emergencies 58

 Pulmonary Over-Inflation Injuries 58

 Decompression Sickness 58

Barotrauma 59

 Ear Squeeze 59

 Middle Ear Squeeze 59

 Sinus Squeeze 59

 Reverse Squeeze 59

 Dental Barotrauma 59

 Reverse Squeeze 59

Closed Circuit Diving Emergencies 60

 Oxygen Toxicity 60

 Hypercarbia 60

 Hypoxia 61

 Chemical Injuries 61

Rapid Field Neurological Exam 62

Flying After Diving 63

Submersion Injury (Near-Drowning 64

High Altitude Illness 65

 Acute Mountain Sickness 65

 High Altitude Cerebral Edema 66

 High Altitude Pulmonary Edema 66

 Use of Nifedipine in High Altitude Pulmonary Edema 66

 UV Keratitis (Snow Blindness) 67



Cold Weather Injuries 68

 Freezing Injuries (Frostbite) 68

 Non-Freezing Cold Injuries 69

 Hypothermia 70

 Immersion Hypothermia 71

Heat injuries 72

 Heat Cramps 72

 Heat Exhaustion 72

 Heat Stroke 72

 Water Intoxication/Hyponatremia 73

Lightning Strikes 73

Venomous Injuries 74

 Reptiles 75

Universal Snakebite First Aid Protocol 75

 Bee, Wasps, Hornets, Ants 76

 Arachnids and Arthropods 76

 Venomous Marine Animals 77


PATROL MEDICINE 79

 Fever in Tropical Areas 79

 Malaria 79

 Cellulitis 79

 Skin Fungal infections 78

 Dysentery 79

 Ankle Sprains 79
WEAPONS OF MASS DESTRUCTION 82

 Choking Agents 82

 Nerve Agents 82

 Long-Term care of Nerve Agent Casualties 84

 Blood Agents 85

 Blister Agents 85

 Biological Agents 86

 Nuclear Contamination 87


MEDICAL EMERGENCIES 88

 Chest Pain 88

 Diabetes 89

 Coma 89

 Seizures 90

 Asthma 90

 Infectious Diarrhea 91

 Stool Guiac Testing 91


Cardiac Care Guidelines and Treatment Algorithms 92
Pharmacology 112

Anaphylaxis Protocol 115

Standard Medications 116


Analgesics & Anesthetics 116

 Lidocaine (xylocaine) 116

 Morphine 116

 Narcan (naloxone) 116



Antibiotics----------------------------------------------------------------------------------------------------------------------117

 Cefotan (cefotetan) 117

 Cipro (ciprofloxin) 117

 Gentamycin Opthalmic Ointment (garamycin) 117





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