Austere Emergency Medical Support (AEMS) Field Guide aaa*TOC.indd C1 12/1/11 11:55 PM aaa*TOC.indd C2 12/1/11 11:55 PM Table of Contents I. Introduction ..........................................................................................................................................................1 A. Foreword ................................................................................................................................ 2 B. Disclaimer ............................................................................................................................... 3 C. Austere Medicine Defi ned ....................................................................................................... 4 D. Using This Guide ....................................................................................................................5 E. Format of the AEMS Field Guide .............................................................................................6 F. AEMS Acronyms ..................................................................................................................... 7 II. General Considerations ..................................................................................................................................10 A. Medical Threat Assessment (MTA) ........................................................................................ 11 B. Prevention of Infection ......................................................................................................... 16 C. Mass Casualty Incident Management .....................................................................................18 D. Medico-Legal Considerations ................................................................................................ 21 III. Environmental Protocols ................................................................................................................................26 A. Altitude-related Disorders ..................................................................................................... 27 B. Animal-related Injuries: Mammals and Marine Life ..............................................................31 C. Cold-related Disorders ........................................................................................................... 35 D. Dehydration ......................................................................................................................... 39 E. Dive Medicine ....................................................................................................................... 41 1. General ............................................................................................................................ 41 2. Drowning ........................................................................................................................ 42 3. Arterial Gas Emboli (AGE) ................................................................................................45 4. Decompression Sickness (DCS) ........................................................................................ 47 5. Barotrauma of the Ear ...................................................................................................... 50 6. Other Barotraumas ........................................................................................................... 53 F. Envenomation ....................................................................................................................... 55 1. Arthropods ...................................................................................................................... 55 2. Marine Life ...................................................................................................................... 57 3. Reptiles ............................................................................................................................ 60 G. Heat-related Disorders ...........................................................................................................64 1. Hyperthermia ..................................................................................................................64 2. Other Conditions ............................................................................................................. 72 H. Vector-borne Illnesses ........................................................................................................... 75 I. Lightning Injuries ................................................................................................................. 82 J. Motion Sickness (Sea Sickness) .............................................................................................. 85 IV. Trauma Protocols .............................................................................................................................................89 A. Advanced Hemostasis ............................................................................................................ 90 B. Burns .................................................................................................................................... 93 C. Epistaxis ................................................................................................................................ 97 D. Field Dentistry .................................................................................................................... 100 1. General Dental Care .......................................................................................................100 2. Alveolar Ridge Fracture ...................................................................................................101 3. Avulsed Tooth ................................................................................................................ 103 4. Dislocated Tooth ............................................................................................................ 105 i aaa*TOC.indd i 12/1/11 11:55 PM E. Fluid Resuscitation .............................................................................................................. 107 F. Management of Major Trauma ............................................................................................ 109 G. Orthopedic Injuries ..............................................................................................................113 H. Specifi c Orthopedic Injuries .................................................................................................117 1. Facial Fractures ...............................................................................................................117 2. Hand Disorders ...............................................................................................................121 3. Hand Injuries ..................................................................................................................124 V. Force Health Protection Protocols ............................................................................................................. 128 A. Field Sanitation ................................................................................................................... 129 B. Emergency Medical Evacuation from Operational Sites .......................................................134 C. Occupational Health Considerations ....................................................................................141 D. Sick Call Medicine ............................................................................................................... 143 E. Acute Abdomen ...................................................................................................................147 F. Altered Mental Status .......................................................................................................... 149 G. Cardiac Disorders ................................................................................................................ 152 H. Deep Vein Thrombosis (DVT) .............................................................................................154 I. Extended Patient Care ......................................................................................................... 156 J. Foot Care .............................................................................................................................162 K. Gastrointestinal Disorders ................................................................................................... 166 L. Genitourinary Disorders ..................................................................................................... 168 1. Kidney Stones ................................................................................................................. 168 2. Urinary Tract Infection (UTI) .........................................................................................170 M. Gynecologic Disorders ........................................................................................................ 172 N. Pregnancy-Related Disorders ................................................................................................174 O. Head, Eyes, Ears, Nose and Throat ...................................................................................... 177 1. Headache ....................................................................................................................... 177 2. Eye Disorders ..................................................................................................................178