Tactical Trauma Casualty Care(TCCC) and Prolonged Field Care can be heavy on the medication administration, but during training we can’t really give our real role player patients or even our mannequins a bunch of narcotics and other controlled substances, so it’s often verbalized in training. Not training on the medication they carry downrange, far from providers, can lead to improper dosing, hesitation, using little or no medication when it’s indicated, not having aseptic technique or just being slow and inefficient at the medication drawing and administration. There is a HUGE difference between verbalizing “I’d give 5mg of Versed” and actually performing the aseptic administration correctly, with the correct dose, in a timely manner while under stress.
The solution is incorporating medication administration into your TCCC and PFC training by creating “fake” medication labels that can easily be stuck over a vial of normal saline (or sterile water if using mannequins) to help your training more effectively teach the psychomotor and cognitive skills associated with medication administration. This is done at Special Operations Combat Medic School (SOCM) and SOCM Sustainment Skills Course and can be implemented at unit level medical training, especially for pre-deployment. If this option is too time consuming and you are well funded there are commercial versions of these labels available.
Incorporate this into your scenario based on what your medics ( Or non-medics if training them to assist you) will have down range. If they are allowed to choose what they take and how much, then let them do that here so they can learn along the way. The operator may forget a medication such as Ondansetron and ends up with a vomiting head injury, or overdoses a medication and doesn’t have a reversal, and can also realize how much Ketamine and Versed it takes to keep someone on Total IntraVenous Anesthesia (TIVA). These are learning experiences they can make during training instead of on a real casualty.
You will need:
- Medication Vials ( Usually ordered in packs of 25; For Human Roleplayers: Non-Expired Sterile Normal Saline Vials, For Mannequins: sterile water vials and re-filled at the end of the scenario, or even ordering “fake vials.” )
- Label Paper (Dimensions: We used Skillcraft (Avery) 8161 1″x4″ 20 per sheet -or-
Avery 18160 1″ x 2 5/8″ 30 per sheet ( If not using sticky labels, or just regular paper, will need scissors and scotch tape to attach them to vial.)
- Microsoft Word
- Printer (Color preferred)
- Patience: Time consuming to get set up, but afterwards it is easier to just print sheets.
Choose which medications you would like to train them on. You can Google combinations such as “(Medication name) vial labels” and easily find what you are looking for in multiple strengths. Save the pictures you need in a folder, then proceed to step 2. Visit the Operational Medicine Facebook page for a compilation more than 70 of the most common labels HERE -or- websites such as http://medlibrary.org/
Besides grabbing the labels in the strengths of medication your unit uses, I would consider grabbing some other concentrations ( and expiration dates) to make sure that they don’t just memorize the label and get in the good habit of checking their 6 Rights of medication administration each time.
Common medications to consider: Ketamine, Tranexamic Acid, Morphine, Fentanyl, Narcan, Ondansetron, Promethazine, Midazolam, Valium, Flumazenil, Ceftriaxone, Invanz, Benadryl, Epinephrine 1:1000 & 1:10,000, Decadron…
Now that you have the medication you want we need to make sure it’s the correct size. This depends on size of paper and which labels you have and will take some experimenting.
Any labels should work, We used Skillcraft (Avery) 8161 1″x4″ 20 per sheet. You just go to the label makers site, such as Avery (www.avery.com/template) , and download the corresponding Word template. Insert picture of chosen medication and stretch to fit.
Do small test prints to ensure size is correct, can put settings on low quality and black and white ink to save money and time while getting the dimensions right. After you have desired specifications, switch back to color and select quality “Best” while printing.
If you used label paper, it should be a peel and stick onto the vials, ensuring not to cover the real labels expiration date, especially if using on human role players.
If non-sticky labels were used then clear scotch tape can secure it around the vial.
Consider marking the vials in a distinguishable way so training vials do not get mixed up with real medications.
If using these on mannequins, at the end of the training session have the medics re-fill the vials. They can be used for training well until the rubber seal becomes very leaky from dozens of punctures.
Hope this article can help some units with a relatively inexpensive way to get more out of their training and more importantly benefit our patients. If you do this and have some slight modifications, or a way we can improve this article, let us know.
Here are some additional links on Pharmacology with podcasts and handouts:
Ketamine & Pharmacology SOMSA Talk:
“How to use ketamine fearlessly” by Dr. Reuben Strayer & “Ketamine for PFC” by Scott Weingart:
Pharm Part 1: 12 Pharm Principles for SOF Medics:
Pharm Part 2: MSMAID for Prolonged Field Care
Pharm Part 3: Opiate Analgesic Pain Control
Pharm Part 4: Ketamine and PFC