Care Under Fire (CUF)

Question 1

CUF guidelines

Answer 1

1. Return fire intake cover.
2. Direct/expect casualty to engage.
3. Direct casualty to move to cover and self-aid.
4. Keep casualty from sustaining additional injury.
5. Remove casualty from burning buildings / vehicles.
6. Stop life-threatening external hemorrhage.

Question 2

Completing the mission and caring for the casualty maybe in _____________

Answer 2

Direct conflict

Question 3

When can you plan what to do in a tactical casualty situation?

Answer 3

Before it happens or after it happens.

Question 4

What is tactical priority?

Answer 4

1. Eliminate threats to prevent additional casualties.
2. Then treat casualties.

Question 5

The best battlefield medicine is ______________

Answer 5

Fire superiority.
-It will minimize risk of new casualties and additional injuries.
-fire power from current casualties and medical personnel may be essential to reduce the threat.

Question 6

Moving casualties in CUF

Answer 6

1. Self extraction
2. Drag rope
3. If casualty is unresponsive / not moving, they are likely beyond help.
4. If responsive but cannot move consider rescue if feasible.

Question 7

Rescue plan considerations

Answer 7

1. Nearest cover (not concealment)
2. Best method of moving the casualty.
3. Risk to rescuers.
4. Weight of casualty.
5. Distance to be covered
6. Suppressive fire/smoke/vehicle.
7. Recover/disable weapon if possible.

Question 8

Methods of carry for rescue during CUF

Answer 8

1. One person drag.
2. Two-person drag.
3. Seal team 3 carry.
4. Hawes carry.

Always communicate with casualty even if unconscious. Secure/disable weapons.

Question 9

Drag procedures

Answer 9

1. Attach line to harness to drag from head.
2. Use five to six feet of the line, attached to your build or harness to keep your hands-free.
3. Constantly evaluate your position and position of casualty.

Question 10

Seal team 3 carry technique (two man)

Answer 10

1. Roll casualty onto their back and sit them up.
2. With the rescuers and casualty facing the same direction, rescuers place casualtie’s hand over rescuer’s neck with outside hand holding wrists.
3. Rescuers use inside hand to grab casualty by belt / body armor.
4. Stand up and walk with casualty, feet dragon behind.

Question 11

Hawes carry technique (one man)

Answer 11

1. Place casualty on rescuers back.
2. If possible have casualty place arms around rescuer’s neck.
3. Rescuer reaches for casualty arm and grasp casualtie’s opposite arm above the elbow.

Question 12

Burn prevention measures

Answer 12

1. Move from burning vehicles and buildings, move to alternate cover.
2. Remove any equipment contributing to burn injury.
3. Stop the burning with any non-final liquid, smothering, rolling on the ground etc.

Question 13

What is the number one medical priority in CUF?

Answer 13

Early control of severe hemorrhage.

Question 14

When is hemorrhage life threatening?

Answer 14

1. Study or pulsing bleeding.
2. Pooling on the ground.
3. Clothing is soaked.
4. Standard dressing fails to control bleeding.
5. Traumatic amputation.
6. Prior bleeding and casualty is going into shock, confused, pale or unconscious.

Question 15

How long does it take for a casualty to die from femoral bleeding?

Answer 15

Is little as two to three minutes maybe irreversible.

Question 16

How is hemorrhage-controlled during CUF?

Answer 16

1. Tourniquet is the only recommended intervention.
2. If hemorrhage is not severe enough for a tourniquet do not treat during care under fire. Non-extremity wounds will be extremely difficult to treat during CUF.

Question 17

Field deployment of tourniquets.

Answer 17

1. Standard gear for all field personnel.
2. Standardized placement.
3. Be able to reach with either arm or have multiples.
4. First choice for severe extremity hemorrhage.

Question 18

Tourniquet application

Answer 18

1. Apply over the uniform.
2. If unsure of wound location apply high and tight on the extremity.If unsure of location apply high and tight on the extremity.
3. Take out all slack from the strap.
4. Use windlass to apply necessary pressure to stop the bleed.
5. Note the time of placement.

Question 19

Is the tourniquet tight enough?

Answer 19

1. Bleeding has stopped.
2. Distal pulse is lost.
3. Insufficient tightness can lead to compartment syndrome by stopping venous flow and not stopping arterial flow.

Question 20

Tourniquet mistakes

Answer 20

1. Not using when you should.
2. Waiting to long to apply.
3. Not taking out all the slack before using windlass.
4. Using a tourniquet for minor bleeding.
5. To proximal if bleed is clearly visible.
6. Not reducing if indicated.
7. Removal if in shock or short transport.
8. Loosening to “allow blood flow.”

Question 21

What if there is tourniquet pain?

Answer 21

1. Pain is expected.
2. Does not indicate incorrect application.
3. Just not mean it needs to be removed.

Question 22

Procedures after tourniquet application.

Answer 22

1. Monitor to ensure hemorrhage is controlled.
2. Reassess during tac care.
3. Reassess during/after transport.

Question 23

Are tourniquet reusable?

Answer 23

No, treat as a disposable item (except designated training TQ).

Question 24

Examples of field use, Baghdad, 2008

Answer 24

232 patients on 309 limbs.
Zero amputations caused by TQ use.
>3% had transient nerve palsies

Question 25

Summary of CUF

Answer 25

1. Return fire and take cover. 2. Through a casualty to engage. 3. Direct casualty to cover. 4. Keep casualty from taking additional wounds. 5. Get out of burning vehicles/buildings. 6. Use tourniquids to stop life-threatening bleeds if tactically feasible. 7. For airway Management until tactical field care.