“We were assigned to train the Colombian military in Reconnaissance operations. It was the rainy season, so travel was limited to trucks, ATVs, and good ol’ fashioned walking. We were about two days into our training mission/jungle slog, when we happened upon a vehicle at the base of the mountain that had been pushed off the road by a
When I got to the vehicle, I found an unconscious male with obvious decerebrate posturing. The vehicle, at least appeared stable enough, so I climbed inside to assess the driver. While the team fanned out to look for others and make a litter, I started on the driver. He didn’t appear to be bleeding, though he had a nasty gash on the side of his head. He reacted to a sternal rub with some noises. He was breathing spontaneously (12 deep and Irregular), but he had sonorous breath sounds. I decided to attempt an OPA… and sadly it went in without problem. His HR was 58 bpm and BP was 138/88. By then the team had brought a pole-less litter reinforced with some branches. Thankfully, the fall had ripped open the driver-side door, so after removing the driver seat, extraction was straight forward. When we got the driver out, I could assess for other injuries. Other than an obvious TBI, his pelvis felt unstable, which I splinted with his jeans and a branch as a windlass. On reassessment he had a GCS of 6 (E2/V2/M2), BP 132/86, HR 60 SR, RR 14 Deep/Irreg., SPO2 95%,and Temp 101.5°F.
The Captain was on the radio requesting MEDEVAC, but with the weather, the birds would not fly. The roads were impassable with the recent rains and mudslides. Our choices were to hunker down, make a clearing, and wait for the weather to clear enough for helos or walk back… Welcome to Prolonged Field Care.
We decided it was more dangerous for the patient to walk back. Between the Colombian medic (TCCC trained) and I, we had:
Things to think about:
We want you to be able to have more knowledge on this topic and more confidently be able to answer these questions and plan for it, as well as implement this into your training for hands on and trauma patient assessment skills.
Traumatic Brain Injury (TBI) is physical damage to the brain caused by a blow to the head, penetrating objects, motor vehicles crashes and explosions, or a combination of these, which are all familiar scenarios we encounter in our community. This is especially true for Motor Vehicle Crash, the number one cause of death of our Operators on peacetime deployments, and still 5% of deaths even in warzones. To make matters worse, the force that caused the TBI also created other injuries such as a hemothorax, making it even more of an animal to treat. It’s more difficult to understand what is going on because there isn’t an artery spurting blood we can address, so we have to put on our thinking caps and understand what is going on at the cellular level.
First, please answer these anonymous poll questions so we can see where our audience is at on the subject of Traumatic Brain Injury. This will give us more to discuss at our upcoming round table discussion on TBI which will be a follow-up podcast:
Let us know in the comments below or on our Facebook post.