Operational Medicine 2001
Field Medical Service School
Student Handbook

MOLLE MEDICAL BAG/

SURGICAL INSTRUMENT SET

FMST 0420

17 Dec 99

TERMINAL LEARNING OBJECTIVE

1.  Given a casualty in a combat environment (day and night) and the standard Field Medical Service Technician medical equipment and supplies, utilize the MOLLE Medic bag and surgical instrument supply set, per the references. (FMST 0420)

ENABLING LEARNING OBJECTIVES

1.      Without the aid of reference materials and given a listing of medical items and components, inventory, pack and maintain a Molle Medical Bag, per the student handbook. (FMST.04.20a)

2.  Without the aid of reference materials and given the Molle Medical Bag, configure the       components for use in various environments/scenarios, per the student handbook.  (FMST.04.20b)

3.  Without the aid of reference materials and while functioning as a corpsman in a field environment with simulated casualties, complete the DD-1380 (Field Medical Card) for all injuries being treated, per the student handbook. (FMST.04.20c)

4.  Without the aid of reference materials and given a list of types of injuries and a list of indicators/contraindicators for the use of morphine, select the appropriate indicators    /contraindicators for each type of injury, per the student handbook. (FMST.04.20d)

5.  Without the aid of references and given a list of symptoms, identify the symptoms of morphine overdose, per the student handbook. (FMST.04.20e)

6. Without the aid of references and given a list of treatments, select the proper treatment for morphine overdose, per the student handbook.  (FMST.04.20f)

7.  Without the aid of references and given a list, select the proper dosage, route and frequency of morphine administration, per the student handbook. (FMST.04.20g)

OUTLINE:

A.  The Field Medical Service Technician are the first medical responders to treat casualties during training and in combat.  They require medical supplies to enhance treatment capabilities.  The MOLLE Medical Bag is the new medical module for the field.  It will greatly enhance carrying capacity and ease of retrieval over the old Unit One bag.

The medical components were selected with the objective of having medical supplies available to the Corpsmen which will greatly improve treatment capability.  Throughout this course you will use all components of the bag from physical assessment to initiating live IV’s  to help familiarize you with the new bag. 

B.  DESCRIPTION:

1.  8 external pouches.

2.  Two detachable flaps located inside the bag

3.  1 detachable IV bandoleer capable of carrying 3,1000ml IV bags

4.  Issued by the Marine Corps as part of the new Modular Lightweight Load-Bearing Equipment    

     (MOLLE) system as part of Individual Combat Equipment

5.  Weight:  approx. 22lbs fully loaded

6.  Physical characteristics:  Length - 22 inches/Width - 16 inches/Height - 12 inches.

C.  CONTENTS:

NO.      ITEM NOMENCLATURE 

1.         Ammonia Inhalant Pads (012)

2.         Diphenhydramine Hydrochloride Capsules USP 50 MG 100 Caps/BT (001)

3.         Atropine injection 0.7ML (010)

4.         ANA-Guard (Epinephrine Injectable) (001)

5.         Ringers Injection Lactated 500ML. (002)

6.         NaCI Inj. USP 0.9% 500ML Bag  (002)

7.         Ringers Inj. Lactated USP 1000ML Bag (001)

8.         Dressing First Aid Field Camoflage 4”WX6.250-7 250” LG Absorbent Pleated (006)

9.         Bandage Elastic Coban Brown 3”X5YD (002)

10.       Bandage Muslin Compress Camouflage 37”X37”X52” (010)

11.       Dressing First Aid Field Camouflaged 11.5-12”W11.5-12”LG  (002)

12.       Dressing First Aid Field Brown Camouflaged 7.75-8.25”LG 7.25-7.75”W  (004)

13.       Pad Abdominal 5”X9” Sterile Individual Wrapped (004)

14.       Bandage Gauze 6 Ply 4.1YDX4.5” White Individual Wrapped Sterile  (006)

15.       Sponge Surgical Cellulose Cotton Gauze 4X4” Sterile Individual Sealed (006)

16.       Pad Isopropyl Alcohol Impregnated Nonwoven Cotton/Rayon 1.5-2.6X1.8-2” (016)

17.       Bandage Adhesive Flesh 3”X.75”  (025)

18.      Tape Adhesive Surgical Porous Woven Rayon 3”X10YDS (001)

19.      Bandage Elastic Rolled 4X4.5YDS (004)

20.      Splint Structural Aluminum Malleable (Gray) 4.5”X36” “SAM”  (004)

21.      Dressing Burn 4X16IN Saturated W/Water Gel Individually Wrapped  (005)

22.      Dressing Chest Wound Seal (004)

23.             Tube Endotracheal Murphy E12 W/Cuff 8.0MM ID 10.7MM Diameter 32CM LG Disposable   (002)    

24.      Thermometer Clinical Human Rectal Fahrenheit Scale Red Tip  (002)

25.      Splint Finger Phalange 18X.75” Aluminum Alloy  (003)

26.      Syringe Hypodermic GP 10-12 ML Cap Luer Slip W/O NDL Concentric Tip (001)

27.      Scissors Bandage 7.25” Angle to HDL 1.5” Cut LG Blunt PTS CRS  (002)

28.      Airway Pharyngeal Berman Child Size (80mm) (001)

29.      Airway Pharyngeal Berman (100mm)  (001)

30.      Tube Tracheal Radiopaque Murphy Disposable 7.5MM ID 9.3MM OD 32CM LG (002)

31.      Sphygmomanometer Aneroid 300MM MAX Calibration W/Clip For Cuff (001)

32.      Case Sphygmomanometer (001)

33.      Intravenous Injection Set 12 Components Nonvented Sterile Disposable (003)

34.      Gloves Surgeons Gen. Surgical SZ 8 Rubber Prepow. Sterile Disposable (005)

35.      Airway Nasopharyngeal Robertazzi 30FR Oblique Tip (001)

36.      Stethoscope Combination Littman Classic II 28” LG Bell Diaphragm  (001)

37.            Catheter and Needle Unit (I.V) 18ga.X1.25” W/NDL Guard Beveled Tip Disposable  (005)

38.            Catheter and Needle Unit (I.V) 14ga.X1.25" Beveled Tip Radiopaque W/NDL Guard (005)

39.            Thermometer Clinical Human Rectal Subnormal Low Reading 86-100 Degree Fahrenheit 

           (001)

40.      Tube Drainage Surgical Penrose 12X7/8X 0.011” Amber Rubber  (003)

41.      Stylet Tracheal Tube 7.5-10MM Plastic  Sterile Disposable  (002)

42.             Laryngoscope Set (Includes: Handle, Pouch, (4) AAA Batteries, Miller#3 Macintosh#4            Blades   (001)                                                                                                                         

43.      Surgical Instrument Set Minor Surgery  (001)

44.      Pen Ball Point Retractable Medium Pt. Black  (001)

45.      Bag Plastic 4IN X4 IN (100)

46.      DD-1380  (020)

47.      Skin Cleanser 60PCT Ethyl Alcohol No Rinsing 4 OZ/BT PLAS  (001)

48.      Chemical Cold Pack Reusable “Dual Ice” 2 Packs per Unit  ( 001)

49.      Basic Field Corpsman ENT Kit W/(4) AAA Batteries (001)

50.      Vortec Headlamp, W/(4) AA batteries  (001)

51.      Red Lens for Vortec Headlamp (001)

52.      Cervical Collar, Adjustable (002)

53.      Medic Bag  (001)

54.      AA Alkaline Batteries (AR)(As required)

55.      AAA Alkaline Batteries (AR) (As required)

NOTE:  Each pack of morphine contains five syrettes of 16 mg.  Because morphine is a controlled item, it is not issued regularly with the “Mike Bag, but is issued prior to going on patrol.  Each issue is accounted for and returned when not used.

D.  NEW ITEMS:

#21 Dressing Burn, 4X16IN, Saturated W/Water Gel, Individually Wrapped  

Great for all burns and has been shown to reduce debriedment by as much as 90%.    Specifically intended to safely treat White Phosphorus burns (WP), as tested by MARCORSYSCOM during Desert Storm.  Even when the dressing is removed, as long as the gel remains on the WP, it will not reignite.

#22 Dressing, Chest Wound Seal

Otherwise known as the Asherman Chest Seal, is used for sucking chest wounds and allows air out, but not in.  It has oversized tabs for ease of use when wearing gloves and is clear to allow visibility of the wound.

#42 Laryngoscope Set

Comes with two different blades, a MILLER 3” and a MACK 3.5”, a light source that is interchangeable with #49 Basic Field Corpsman ENT KIT.  The reverse is also true.  The purpose of the two blades is to accommodate user preference.

Even though this item is very durable and can be used many times, it is classified as disposable to allow for field losses.

#48 Chemical, Cold Pack, Reusable, Dual Ice

Once the inner bag is broken, the pack will not return to the original state as issued.  However, it can be refrozen and reused repeatedly at Echelon II facilities or in Garrison.  Intended for use on sprains and blunt-trauma injuries, the packs can be used in the field where ice is not available.  For heat casualties, packs can be placed on the groin, in both axillary regions, and on the forehead.  Warning; these packs get cold (28 degrees in four seconds) Place a T-shirt or some article of clothing between the patient and the ice pack!  The bags are six ml. thick  greatly reducing any problem with leakage.  The contents are non-toxic, pH neutral, non-caustic and made of food grade material so it can be dumped on the ground in the field for disposal.

#49 Basic Field Corpsman ENT KIT

Contains:

1) Otoscope.  2) speculums 3) Fiberoptic nose light.

4) Red light lens for night operations.  5) Cobalt blue light. 6) Flour-I strips to observe lacerations/abrasions of the eye with fluorescent eye stain. 7) Three fiberoptic wands to place on the end of the flashlight to provide illumination at the source of the injury in an eye, ear, or nose.  (1) With a nylon loop that fluoresces under the blue cobalt lens.

(1) With a metal loop, to remove foreign bodies from an eye, nose or ear.

(1) With a magnet to remove metal chips from the eye.

Note:  Some of the early models of the flashlight had a problem with the plastic lens popping off when screwed down too tightly.  Should this happen, replacements can be obtained from the manufacturer.

#50, 51 Vortec Headlamp, W/(4) AA batteries and red lens

This light replaces the old disposable penlight and green angle flashlight.  It will fit onto your head or helmet with adjustable elastic straps, is waterproof and very durable.  It comes with a red lens for night use and is pre-wired to accept lithium batteries for longer life and use in cold environments.  You can use either the straight light reflector or defuse light reflector and supports a halogen bulb or krypton bulb.

E.  CONFIGURATION FACTORS:

1.  When individually configuring the “Mike” bag, (ie. medic pockets, complete bag, ect.),  many factors will guide you on the type and amount of equipment and supplies you will need.  Some of the common factor’s include:

            a. Type of mission

            b.  Duration of mission

            c.  Environment (Urban, Jungle, Desert, Mountain)

            d.  Casualty estimate

            e.  Casevac time

            f.  Resupply time

            g.  Level of training

h.  Weather (Cold, Hot Dry, Wet)

2.  Once common factors have been considered, more specific mission requirements can be determined such as:

a.  Patrols -

    - Weight (medic pockets vs entire bag)

b.  Vehicle -

      - Type (air, ground, or amphib)

      - Weight (no limits)

      - Space avalability

3.  Military Operations in Urban Terrain (MOUT) / Non-combatant Evacuation  

     Operations (NEO) / Miltary Operations Other Than War (MOOTW)

a.  Weight

b.  Impact injuries (more fractures)

c.  Civilian casualties (peds, geriatrics)

F.  SURGICAL INSTRUMENT SET, MINOR SURGERY WITH NON-RIGID CASE:

1.  USE:

a.  The set is checked out on a separate card.  It is used for the emergency treatment of battle and non-battle casualties.

2.  CONTENTS:

a.  Forceps, dressing and hemostats                              01 Ea.

b.  Holder, suture needle                                              01 Ea.

c.  Handle, surgical knife                                               01 Ea.

d.  Blade, surgical (#10 and #11)                                  01 Ea.

e.  Scissors, general surgical                                          01 Ea.

f.  Probe, general operating                                           01 Ea.

g.  Suture, nonabsorbable                                             01 Ea. (sizes 0 and 00)

h.  Needle, suture (sizes 12 and 16)                              01 Pg.

G.  DD FORM 1380, FIELD MEDICAL CARD:

1.  DESCRIPTION:

a. Issued in a pad, having a blue cover.

b. Dimensions approx. 4" x 8".

c. Twenty cards (with carbons) in each book.  Each original card has a copper wire for fastening to the patient.

2.  PURPOSE

a. The Field Medical Card, DD Form 1380 is the sole or initial medical record for the troops injured in combat.  The main purpose is to furnish the attending physician during the evacuation of a casualty with essential information about the injury or disease and the treatment provided.

b. It serves as a record of injury, illness and treatment during combat.

c. It records the disposition of the patient, including death.

d. It serves as a record during outpatient visits when the patient's health record is not available.

3.  USERS OF THE DD FORM 1380

a.  All U.S. Forces.

b.  Allied NATO Forces.

4.  DISPOSITIONS OF THE U.S. FIELD MEDICAL CARD (DD FORM 1380)

COMBAT SITUATION -  Admission and Disposition

a. Original:  Maintained as part of the patients to medical records.

b. Duplicate:  Health Record - BAS.

CARDED FOR RECORD PURPOSES ONLY (CRO) - Outpatient Treatment

a. Original:  BAS.

b. Duplicate:  Enter in the Health Record, copy to the Adjutant.

TRANSFER

a. Original:  Accompanies casualty.

b. Duplicate:  BAS.

NON-COMBAT SITUATION

a. Original and Duplicate:  BAS.

TRANSFER

a. Original:  To receiving facility.

b. Duplicate:  BAS.

TRANSFERRED CASES

a. When a patient is transferred from one Medical Treatment Facility (MTF) to another further to the rear, the card goes with the patient.  It remains attached to him or his clinical record (when established), until he reaches a hospital, dies and is buried, or is returned to duty.

COMPLETED CASES

a. If the patient is returned to duty or carded for record purposes only, the original copy of the Field Medical Card is forwarded to the BAS for entry into the journal.  Later, the MTF sends this copy to BUMED (according to the Standard Operating Procedures (SOP) of the command).  When a patient is killed in action or dies enroute to the MTF, the original is left attached to the body until it reaches the unit providing mortuary services.  Then it is removed for transmittal to BUMED.

CARBON COPIES

a. n overseas commands, carbon copies (duplicates) of the Field Medical Card are used as the Senior Command Surgeon prescribes.  In the United States, the Senior Medical Officer (SMO) prescribes the use of carbon copies of the cards through the SOP or in the Administrative/Logistics order.

 ACCURACY

a. Since the DD Form 1380 is the first (and sometimes only) record of treatment of combat casualties, accuracy and thoroughness of information provided on the card is of the utmost importance. 

REQUIRED INFORMATION ON THE DD FORM 1380

a. The following are detailed instructions for completing the DD Form 1380:

BLOCK #

1.  Name (last, first), Rank/Grade, male or female, SSN, specialty code, religious preference (if none, state none).

2. Unit:  Casualties Unit (Company 2/4 is written 2/4), Force, Nationality.

3.  Injury:  Mark the diagram in the appropriate area where the injury is located.

4.  Level of consciousness.

5.  Pulse and time it was taken.

6.  Tourniquet:  write either yes or no, if yes write down the time applied.

7.      Morphine:  If given, enter the dose, hour and date.  If not given, enter "NO" in the appropriate space and "NONE" in the dose section.  If Morphine is used, remember to mark "M" on the forehead if used.

8.  IV and time that it was started.

9.  Treatment, observations, current medications, allergies, NBC (antidote).  Special attention must be given to recording time, medications and treatment administered.

10.  Disposition:  If the casualty is deceased enter "CRO" in the box, it means "Carded for Record Purposes Only".  If the patient is evacuated, the platoon corpsman will enter the destination and the time, if known.

11.  Providers signature, unit and the date.

NOTE:  The back of the card is to be used if treatment is administered by different echelons of medical care.  If all the space on the original card has been used, an additional card is prepared and attached to the casualty.  The original DD Form 1380 is NOT removed when additional card (s) is attached.

12.  Reassessment.

13.  Clinical comments/diagnosis.

14.  Orders/antibiotics (specify)

15.  Providers signature and the date.

16.  Disposition.

17.  Religious services and the chaplains entries.

MISCELLANEOUS INFORMATION

a. The completed card is attached to the patient on his/her clothing.  Ensure the card will not fall off.

b. The card should be completed in pencil or ball point pen with permanent ink.

c. Upon establishment of a clinical record for the casualty, the DD Form 1380 becomes part of the clinical record.

d. If the patient requires decontamination, the contaminated DD Form 1380 is transcribed onto a clean form.

MORPHINE

a. As a member of the Hospital Corps in the field during wartime, you will normally be issued Morphine syrettes for relief of severe pain.  You will be issued this controlled drug under very strict procedures of  accountability.  Possession of this drug is a medical responsibility that must not be taken lightly.  It is a Federal offense to distribute without a perscription or following standard protocol

Description of Syrette

a. Morphine is supplied for use in the field in a syrette.  The syrette is composed of a collapsable tube (similar to a toothpaste tube), fitted with a hypodermic needle, a stylet in the needle and a plastic tube to protect the needle.  The syrette contains 16 mg of  Morphine Tartrate.

Use of Syrette

a. Remove the plastic tube, grasp the stylet and push it into the tube until the circle at the top of the stylet is stopped by the guard;  then remove the stylet and use the syrette with sterile technique as per the field conditions.

Dosage

a. The adult dose of morphine is 8mg to 16mg, every 4 hours, or as ordered by a medical officer.

Usage

a. Morphine is used to control moderate to severe pain.

Precautions

1)  Morphine has several side effects, and these must be thoroughly understood by Hospital Corps personnel.

2)  Morphine causes considerable mental confusion and interference with proper exercise of     judgment and therefore should not be given to ambulatory patients (THEY ARE NO LONGER AMBULATORY, AND IMMEDIATELY  POSE AN EVACUATION PROBLEM).

3)  It's a severe respiratory depressant and therefore must not be given to patients in moderate or severe shock or to patients with respiratory failure or respiratory obstruction.

4)  Morphine increases intracranial pressure and may induce vomiting.  These effects may be disastrous in casualties with head injuries.

5)  Causes constriction of the pupils (pinpoint pupils) and  this action prevents the use of the pupillary reaction changes for diagnosis in head injuries.

6)  Morphine has a very safe range, problems can occur when a patient is not dosed properly I.E.given too frequently.

7)  Morphine, if used improperly can be a dangerously habituating drug. It should not be given trivialy and must be rigidly accounted for.  Under no circumstances should Hospital Corps personnel administer morphine except in an emergency.

Morphine administration to patients in shock, or with extensive burns, should be rigidly controlled.  Morphine administered by subcutaneous or intramuscular routes may not be absorbed into the bloodstream due to reduced peripheral circulation, and pain may persist.  When this  happens, the uninformed often give additional doses, hoping to relieve pain.  When resuscitation occurs and the peripheral circulation improves, the stored quantities of Morphine are released into the system and an extremely serious condition (Morphine overdose) occurs.  When a patient is in shock or has burns and severe pain, 16 mg of Morphine may be given intramuscularly (followed by massage of the injection site), but the temptation to give more must be resisted.

When to give Morphine

If the pain from the wound is agonizingly severe, a Morphine syrette may be given if examination of the patient does not reveal the following:

Loss of consciousness.

Head injury.

Chest injury, including non sucking and sucking wounds.

Respiratory impairment, including chemical burns of the respiratory tract.  Any casualty having fewer than 16 respirations per minute should not be given Morphine.

Evidence of severe or deepening shock.

Overdose is an ever present danger.  For this reason, all casualties receiving morphine will be plainly identified by using the skin pencil, colored antiseptic or ink to mark the letter "M" and the hour of injection on the patient's forehead (Do not use water-soluble  ink).  The empty syrette should be attached to the patients collar or other conspicuous place with a safety pin.

RECORDING MORPHINE ON DD FORM 1380

Morphine will be recorded on U.S. Field Medical Card, DD Form 1380, in block 7

Record the dose in milligrams in block "7a" and the hour and date in block "7b".

MORPHINE OVERDOSING

SIGNS AND SYMPTOMS

Constricted pupils.

Slowed respirations.

Progressive fall in blood pressure.

TREATMENT

1.  Maintain airway, ventalatory support for respiratory arrest

2.  Oxygen.

3.  Administer Narcan.

Narcan is the drug of choice for morphine overdose. The usual adult dosage is 0.4-2.0 mg given IV.  Unit of issue is a unit dose vial.

If improvement is not immediately obtained, dose may be repeated every two to three minutes.

If, after two or three doses, there is no improvement, then the condition may be due to some other disease process or some other drug.

NOTE:

       Narcan is available at the Battalion Aid Station, but not to the corpsman.

REFERENCES:

Pre-Trauma Life Support, Second Edition, 1990

Emergency War Surgery, NATO Handbook, 1988

Prehospital Emergency Crisis Intervention, 1992

Advanced Emergency Care, 1992

PDR, 1999

Advanced Trauma Life Support, 1989

Health Services Support Operations, MCWP 4-11.1,10 Mar 1998

Field Medical Service School
Camp Pendleton, California

Approved for public release; Distribution is unlimited.

The listing of any non-Federal product in this CD is not an endorsement of the product itself, but simply an acknowledgement of the source. 

Operational Medicine 2001
Health Care in Military Settings

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