TRAUMA ONE // AO OVERWATCH

◈ TRAUMA PROTOCOLS — GRID DOWN FIELD MEDICINE

These protocols are for use when professional medical care is unavailable. ALWAYS seek modern medical care if accessible. Train with hands-on courses — reading alone is not sufficient preparation.

▶ MARCH PROTOCOL — TACTICAL CASUALTY SEQUENCE▼

MARCH is the tactical order of treatment priorities. Work each phase before moving to the next.

MASSIVE HEMORRHAGE — Control life-threatening bleeding first. Every second counts.
AIRWAY — Establish and protect a patent airway. Unconscious patients need immediate airway management.
RESPIRATION — Assess for tension pneumothorax, open chest wounds, respiratory failure.
CIRCULATION — Address shock, establish IV/IO access if trained, fluid resuscitation.
HYPOTHERMIA / HEAD INJURY — Prevent heat loss (kills trauma patients), assess head injury.

CARE UNDER FIRE: The ONLY treatment during active fire is tourniquet HIGH AND TIGHT on bleeding extremity. Move the patient to cover, THEN treat.

▶ MASSIVE HEMORRHAGE CONTROL▼

Uncontrolled hemorrhage is the #1 preventable cause of death. Act immediately. The golden hour begins now.

STEP 1 — DIRECT PRESSURE

Don nitrile gloves. Grab a bandanna or cloth if no gloves available — never touch wound with bare hand.
Apply firm, direct pressure to the wound using gauze pads or any clean cloth.
If limb wound, elevate the extremity above the level of the heart while maintaining pressure.
Maintain pressure for a full 5–10 minutes without peeking. If blood soaks through, add more gauze on top — do NOT remove first layer.
If direct pressure slows but does not stop bleeding, locate the pressure point for that region and compress.

KEY PRESSURE POINTS: Brachial artery (mid-upper arm) for arm wounds; Femoral artery (groin crease) for thigh wounds; Popliteal artery (back of knee) for lower leg wounds.

STEP 2 — TOURNIQUET (Extremity Only)

Apply tourniquet when: Direct pressure fails, arterial (spurting) bleeding, amputation, or you are alone and cannot maintain pressure.

Place tourniquet 2–3 inches above the wound (not over a joint). For amputations or unclear wound location, apply high and tight — as high as possible on the limb.
Apply CAT tourniquet: thread limb through loop, tighten strap, twist windlass until bleeding stops and distal pulse is absent.
Lock the windlass in the clip. Secure the strap over the windlass.
WRITE THE TIME on the tourniquet AND on the patient's forehead. Time on tourniquet determines risk of limb loss.
Improvised tourniquet: use a 2–3" wide cloth (belt, bandanna, cravat). Tie around limb, insert a stick, pencil, or pen, twist until bleeding stops. Tie stick in place.
Check the wound at 10-minute intervals. If natural clotting has occurred, release pressure gradually — leave tourniquet in place within reach.

Tourniquet risks: Limb loss after 1–2 hours. Toxic buildup in extremity releases into core upon removal. Do not remove in the field if more than 2 hours applied. Note time — inform any medical personnel.

STEP 3 — WOUND PACKING (Junctional / Non-Compressible)

Use for wounds that cannot be tourniqueted: groin, armpit, neck, shoulder (junctional areas). Also for large lacerations requiring packing.

Open QuikClot or Celox hemostatic gauze. Note: Celox is chitosan-based — avoid if patient has severe shellfish allergy.
Pack the gauze DIRECTLY into the wound, as deep as possible, aiming for the bleeding source. Use your finger to push gauze firmly into the wound cavity.
Continue packing until the wound is filled with gauze. Do not just lay gauze on top — it must be packed in.
Apply firm manual pressure for a minimum of 3–5 minutes (QuikClot) or 3 minutes (Celox). Do not release early.
Apply an Israeli Battle Dressing or pressure bandage over the packed wound to maintain pressure.
If bleeding restarts, do NOT remove existing packing. Add more gauze on top and reapply pressure.

Direct pressure and gauze packing are your first line. Hemostatic agents (QuikClot/Celox) are second line when standard gauze alone fails. Hemostatic agents shelf life: ~3 years; store away from sunlight.

BLOOD LOSS ASSESSMENT

Adult body contains ~10 pints (5 liters) of blood:
• <1.5 pints: Little effect, patient may be asymptomatic
• 1.5–3.5 pints: Rapid heart rate, rapid breathing, pale skin, patient very agitated
• 3.5–4 pints: BP drops, patient confused, very rapid heartbeat
• >4 pints: Very pale, possibly unconscious, dropping heart rate — CRITICAL

▶ AIRWAY MANAGEMENT▼

CONSCIOUS PATIENT — CHOKING / OBSTRUCTION

Ask: "Are you choking?" If they can speak, airway is partially open. Encourage coughing. Do not intervene yet.
If complete obstruction (cannot speak, holding throat, nodding yes): Perform Heimlich maneuver — stand behind patient, make fist above belly button, wrap other arm around patient, thrust sharply upward and inward. Repeat until object dislodged.
If patient loses consciousness: lay flat, straddle hips, give upward abdominal thrusts with heel of palm. Check mouth after each attempt.
INFANT: Place face-down over forearm, give 5 back blows with heel of hand to upper back. Alternate with 5 chest thrusts. Never do abdominal thrusts on infant.

UNCONSCIOUS PATIENT — AIRWAY POSITIONING

Head-Tilt Chin-Lift: Tilt head back, grasp underside of chin and jaw, lift to straighten airway. Use only when NO suspected spinal injury.
Jaw Thrust (spinal precaution): Without tilting head, place fingers behind the angles of the jaw and thrust jaw forward. Use when spinal injury suspected.
Insert oral airway (OPA) if available: size from corner of mouth to earlobe. Insert upside-down in adults, rotate 180° once past teeth. Insert right-side up in children.
Insert nasal airway (NPA) if patient has gag reflex (cannot tolerate OPA): measure from nostril to earlobe, lubricate, insert straight back along floor of nasal passage.
Place unconscious breathing patient in RECOVERY POSITION: on their side, top leg bent forward for stability, head tilted slightly back, mouth down to drain vomit.

EMERGENCY CRICOTHYROIDOTOMY (Last Resort Only): For complete, unrelievable obstruction when Heimlich has failed and patient cannot breathe. Locate Adam's apple, move 1 inch below to cricoid cartilage. Make small horizontal incision in the crease between them. Insert hollow tube (straw, pen casing). Perform CPR rescue breaths through tube if needed. ONLY when patient will otherwise die in minutes.

▶ CPR — CARDIOPULMONARY RESUSCITATION▼

CPR is most effective for: airway obstruction, hypothermia, anaphylaxis, near-drowning, lightning strike. It is of limited value for cardiac arrest from heart disease in grid-down. TRAIN IN PERSON — reading is not enough.

ADULT / CHILD CPR

Verify scene safety. Check responsiveness: shake shoulders, call loudly "Are you OK?"
Check for pulse (carotid — neck) and breathing simultaneously for no more than 10 seconds.
No pulse, not breathing (or only gasping): Position patient flat on back on firm surface.
COMPRESSIONS: Place heel of hand on center of chest (lower half of sternum, nipple level). Second hand on top, fingers interlaced. Lock elbows, compress straight down 2 inches (adult) or 1.5 inches (child). Release fully.
Rate: 100–120 compressions per minute. Count aloud to maintain rhythm ("1-and-2-and-3..."). Use "Stayin' Alive" tempo as a mental guide.
After 30 compressions, open airway with head-tilt chin-lift. Give 2 rescue breaths (1 second each, watch chest rise). Pinch nose closed for mouth-to-mouth.
Continue 30:2 cycles. Reassess after 5 cycles (2 minutes). Continue until patient responds, trained help arrives, or 30 minutes without result (pupils dilated and fixed = cessation appropriate).

COMPRESSION-ONLY CPR: If untrained or unwilling to give rescue breaths, continuous compressions at 100/min still provide significant benefit. Better than nothing.

INFANT CPR: Use 2 fingers for compressions, compress 1.5 inches. Ratio 30:2 with 1 rescuer, 15:2 with 2 rescuers. Cover both nose and mouth for rescue breaths.

AED: If available, use immediately. Turn on, attach pads per diagram, follow prompts. Do not touch patient during shock. Resume CPR immediately after shock.

▶ BURN INJURIES▼

BURN CLASSIFICATION

1st Degree (Superficial): Redness, pain, no blistering. Epidermis only. Treat: cool water, aloe vera, OTC pain relief.
2nd Degree (Partial Thickness): Blisters, intense pain, weeping, red/mottled. Epidermis + dermis. Treat: cool water, sterile dressing, do NOT pop blisters.
3rd Degree (Full Thickness): White, brown or black, leathery, may be painless (nerve destruction). All skin layers. Treat: cover sterile dressing, NO cool water (hypothermia risk if large area), urgent care needed.
Inhalation Injury: Singed eyebrows/nasal hair, hoarse voice, soot in mouth. Airway swells — URGENT. Cool moist air, monitor airway closely.

TREATMENT PROTOCOL

Stop the burning: remove patient from source. Remove clothing and jewelry from burned area (unless fused to skin).
Cool the burn: run cool (NOT ice cold) water over burn for 20 minutes. For large burns (>20% body surface), limit cooling to prevent hypothermia.
Do NOT apply butter, oil, toothpaste, or other home remedies — increases infection risk.
Do NOT pop blisters — they are natural sterile barriers.
Cover with clean, non-stick dressing. Wet sterile gauze works well. Wrap loosely.
For 2nd/3rd degree burns: change dressing twice daily with dilute Betadine (1:10 with water) or sterile saline.
Aloe vera (fresh gel from leaf) is an effective natural treatment for 1st and mild 2nd degree burns.
Natural burn treatments: raw honey as antimicrobial dressing, lavender essential oil diluted in carrier oil for minor burns.
Monitor for infection: increasing redness, warmth, swelling, foul odor, fever = begin antibiotics (Amoxicillin or Doxycycline).

Burns >20% body surface = HIGH risk of shock and fluid loss. Push oral fluids aggressively. Burns to face/neck/hands/genitals require priority treatment.

▶ FRACTURES, DISLOCATIONS & SPRAINS▼

FRACTURE IDENTIFICATION

Signs of fracture: Severe pain and tenderness, swelling and bruising, abnormal deformity or angulation, loss of normal function, crepitus (grating sensation), abnormal motion.
Fracture types: Stable (aligned), Open/Compound (bone through skin — HIGH infection risk), Comminuted (shattered), Greenstick (partial break, children).

SPLINTING PROTOCOL

Check CMS BEFORE and AFTER splinting: Circulation (pulse beyond wound site, capillary refill <2 sec), Motor (can patient move fingers/toes?), Sensation (can patient feel touch beyond injury?).
Do NOT attempt to straighten a fractured bone unless circulation is absent (pulseless extremity). If pulse is absent, gentle traction may be necessary to restore flow.
Splint in position of comfort (or the position found). Splint should immobilize the joint ABOVE and BELOW the fracture.
SAM splint: mold to body contour, pad bony prominences, secure with elastic bandage or strips of cloth. If none available, use straight sticks, branches, a rolled magazine — pad them first.
Apply firmly enough to prevent movement but not so tight as to cut circulation. Ensure fingers/toes are visible to monitor.
Elevate the injured extremity above heart level to reduce swelling.
Open fracture: rinse wound thoroughly with sterile water or dilute Betadine (1:10). Cover exposed bone with wet sterile dressing. Do NOT push bone back in. Splint as found. Begin antibiotics immediately (Amoxicillin 500mg TID).

DISLOCATIONS

Check CMS. Shoulder, finger, kneecap, and ankle are most common dislocations in field settings.
Reduction (only if trained): gentle, steady traction along the axis of the limb while assistant stabilizes the proximal segment. Do NOT jerk or force.
If unable to reduce: splint in position found and transport. Successful reduction restores pulse — recheck CMS immediately after.
After reduction: apply ice (if available), sling or splint, rest.

SPRAINS

RICE protocol: Rest, Ice (20 min on/20 min off for first 48 hrs), Compression (elastic bandage), Elevation. Ibuprofen 400-600mg every 6-8 hours for swelling/pain.

▶ HYPOTHERMIA & COLD INJURIES▼

HYPOTHERMIA STAGES

Mild (96–90°F / 35–32°C): Shivering (body's warming mechanism — a GOOD sign), poor coordination, slurred speech, confusion begins.
Moderate (90–82°F / 32–28°C): Shivering STOPS (dangerous — body can no longer warm itself), muscle rigidity, severe confusion, drowsy.
Severe (<82°F / <28°C): Unresponsive, rigid muscles, barely perceptible pulse. May appear dead. "Not dead until warm and dead."

TREATMENT PROTOCOL

Move patient to shelter and out of wind, rain, and cold. Handle gently — rough handling can trigger ventricular fibrillation in severe hypothermia.
Remove wet clothing carefully. Replace with dry insulation. Wrap in sleeping bag, blankets, emergency space blanket (reflective side in).
Protect from ground conduction — always put insulation UNDER the patient (as much heat is lost to ground as to air).
Warm the CORE first: focus heat to armpits, groin, and neck (major blood vessel locations). Use warm water bottles, chemical heat packs, or body heat. Wrap in insulation, not direct high heat.
For mild hypothermia with active shivering: warm sweet liquids (hot cocoa, warm broth). No alcohol.
For moderate/severe: NO oral fluids (aspiration risk). Passive rewarming only unless warm IV saline available.
Monitor breathing. Severe hypothermia — if no pulse or breathing, begin CPR. Continue until patient is rewarmed to at least 86°F (30°C) before calling cessation.
Do NOT rub extremities (releases cold blood from periphery to core too rapidly).

FROSTBITE

Do NOT rewarm if there is any chance of refreezing — a thawed and refrozen extremity suffers far worse damage than frozen tissue.
Rewarm in warm water (100–105°F / 38–41°C) for 20–40 minutes. Protect from direct heat. Very painful — give pain relief.
Do NOT rub frostbitten tissue. Do not walk on frostbitten feet unless no alternative. Cover with clean, dry dressings.
Blisters are protective — do not pop. Elevate extremity. Watch for infection.

▶ SHOCK MANAGEMENT▼

Shock is life-threatening organ failure due to inadequate blood flow. Treat the CAUSE first, then manage the symptoms.

SHOCK TYPES

Hemorrhagic: Blood loss — most common trauma shock. Control bleeding first.
Hypovolemic: Fluid loss (dehydration, burns, vomiting/diarrhea).
Anaphylactic: Severe allergic reaction. Epinephrine immediately.
Septic: Severe infection. Antibiotics, fluids.
Neurogenic: Spinal cord injury. Warm patient, fluids.

SIGNS OF SHOCK

Pale, cool, clammy skin ("cold and clammy") • Rapid weak pulse (>100 bpm) • Rapid shallow breathing (>20/min) • Low BP (systolic <90 mmHg) • Altered mental status: anxious → confused → unresponsive • Capillary refill >2 seconds

TREATMENT PROTOCOL

Control all hemorrhage first. Nothing else matters while blood is pouring out.
Lay patient flat. Elevate legs 12 inches above heart level (the "shock position") unless head injury or chest injury suspected.
Maintain body temperature — cover with blankets. Hypothermia dramatically worsens shock outcomes.
If conscious and no abdominal/chest injury: push oral fluids (water, oral rehydration solution).
If IV capable: isotonic saline (0.9% NaCl) or lactated Ringer's — infuse to maintain systolic BP >90 mmHg. Do NOT over-hydrate.
Monitor mental status, pulse, and respirations every 5 minutes. Any deterioration = escalate treatment.
Do NOT give food or drink if abdominal injury suspected. Do NOT give aspirin or ibuprofen (increase bleeding).

▶ ANAPHYLAXIS — SEVERE ALLERGIC REACTION▼

Anaphylaxis is a medical emergency. Death can occur within minutes from airway obstruction or cardiovascular collapse.

SIGNS: Hives/rash, swelling (face, throat, tongue), difficulty breathing/wheezing, drop in blood pressure, rapid pulse, nausea/vomiting, sense of doom. Can follow insect stings, food (shellfish, nuts), medications.

EPINEPHRINE IMMEDIATELY: Inject EpiPen (0.3mg epinephrine 1:1000) into outer mid-thigh (through clothing if needed). Children <66 lbs: use EpiPen Jr (0.15mg). Hold for 10 seconds.
Call for help / prepare to transport. Epinephrine is temporary — patient needs definitive care.
Position: if breathing difficulty, allow patient to sit up. If low BP/shock, lay flat with legs elevated.
Give Diphenhydramine (Benadryl) 50mg orally — supports Epinephrine but NOT a substitute.
For wheezing: albuterol inhaler if available (2–4 puffs).
Repeat Epinephrine in 5–15 minutes if symptoms not improving. A second EpiPen may be required.
Begin CPR immediately if patient loses pulse or stops breathing. CPR can be successful in anaphylaxis with epinephrine on board.
Monitor for 4–8 hours — biphasic reactions can recur hours later.

▶ HEAD INJURIES▼

Head injuries can deteriorate rapidly and without warning. Frequent monitoring is mandatory.

ASSESSMENT — AVPU SCALE

Alert — fully awake and oriented
Voice — responds to verbal commands
Pain — only responds to painful stimulus
Unresponsive — no response to any stimulus

DANGER SIGNS — SEEK/ESCALATE CARE IMMEDIATELY

• Pupils unequal in size, or not reacting to light (suggests brain herniation)
• Loss of consciousness, or worsening level of consciousness
• Severe headache that is progressively worsening
• Repeated vomiting
• Seizures
• Clear fluid from ears or nose (indicates skull fracture)
• "Battle's sign" — bruising behind ear (suggests basilar skull fracture)

TREATMENT

ABC first — ensure airway is open, patient is breathing, no major bleeding.
Assume spinal injury with all significant head injuries. Use jaw thrust for airway. Log-roll for repositioning.
Elevate head of bed/patient 30 degrees to reduce intracranial pressure — only if no spinal injury concerns OR secured to backboard.
Pain: Acetaminophen ONLY (325–1000mg). NO aspirin or ibuprofen — these increase bleeding risk.
Place vomiting patient in lateral recumbent (recovery) position while maintaining spinal precautions.
Monitor AVPU every 15 minutes. Document any change — deterioration is the key warning sign.
Monitor pupils: check reactivity to light every 30 minutes. Unequal or non-reactive pupils = emergency.
Keep patient awake for first 4–6 hours if concussion suspected. After that, sleep is acceptable — check responsiveness every 2 hours.
Do NOT give fluids excessively — can worsen brain swelling.

▶ WOUND CARE & INFECTION MANAGEMENT▼

WOUND IRRIGATION

After bleeding is controlled: irrigate aggressively with sterile (boiled and cooled) water using a syringe or bulb syringe for pressure. "The solution to pollution is dilution."
First irrigation: dilute Betadine (1 part Betadine to 10 parts water) or Dakin's solution is acceptable.
Subsequent irrigations: plain sterile water — concentrated antiseptics damage new cells and slow healing.
Remove visible debris, dirt, and foreign material with gloved fingers or tweezers. Assume all wounds are dirty.

WOUND CLOSURE DECISION

Close (Primary Intention): Clean, fresh wounds (<6 hours old), low-tension, no signs of infection. Smaller scar but higher infection risk.
Leave Open (Secondary Intention): Bite wounds, dirty/contaminated wounds, puncture wounds, wounds >6 hours old, any signs of infection. Larger scar but safer. Granulation tissue fills in naturally.
RULE: When in doubt — leave it open. Infection in a closed wound is far more dangerous than an open wound healing slowly.

DRESSING CHANGES

Change dressings minimum twice daily, or whenever saturated.
Apply wet-to-dry dressing for open wounds: wet clean gauze with sterile water, wring out, apply to wound. Cover with dry outer dressing.
Triple antibiotic ointment (Neosporin/bacitracin) at wound edges — NOT inside deep wounds.

INFECTION SIGNS — ESCALATE ANTIBIOTICS

Increasing redness spreading from wound • Warmth • Swelling • Pus or foul-smelling discharge • Red streaking spreading up limb (cellulitis/sepsis) • Fever (>100.4°F) • Swollen lymph nodes

Red streaking up limb = potential blood poisoning (sepsis). This is life-threatening. Begin antibiotics immediately: Amoxicillin 500mg TID or Doxycycline 100mg BID for 7–10 days.

DAKIN'S SOLUTION (Field Antiseptic)

Dissolve ½ tsp baking soda in 4 cups boiled water. Add bleach per desired strength: 3 tsp = mild (clean wounds), 3 tbsp = moderate (infected wounds). Store in dark container at room temperature. Make fresh every 2–3 days — loses potency quickly.

☐ MEDICAL SUPPLY INVENTORY

TIER	ITEM	CATEGORY	ON HAND	NEEDED	STATUS	EXPIRY	LOCATION / CACHE	ACTIONS

No supplies logged.

📋 PATIENT LOG

ID / NAME	DATE	INJURY / CONDITION	TREATMENT	MEDICATIONS	STATUS	CAREGIVER	ACTIONS

No patient records. Add a patient to begin tracking.

◈ START TRIAGE BOARD

Simple Triage And Rapid Treatment — Assess RPM: 30 (respirations) — 2 (CRT seconds) — Can Do (follows commands). 30 sec per patient. Triage only — do NOT treat unless stopping massive bleeding, opening airway, or treating shock.

🔴 IMMEDIATE (RED) 0

NEEDS IMMEDIATE CARE / WILL NOT SURVIVE IF UNTREATED

🟡 DELAYED (YELLOW) 0

NEEDS CARE WITHIN 2–4 HRS / STABLE FOR NOW

🟢 MINIMAL (GREEN) 0

WALKING WOUNDED / MINOR INJURIES ONLY

⬛ EXPECTANT (BLACK) 0

DECEASED OR UNSURVIVABLE WITHOUT ADVANCED CARE

📖 QUICK REFERENCE

⊕ VITAL SIGNS — NORMAL RANGES

AGE GROUP	PULSE (BPM)	RESP RATE (/MIN)	BP SYSTOLIC	TEMP (°F)	O₂ SAT
Adult (18+)	60–100	12–20	90–140	97–99	>95%
Child (6–12)	70–120	18–25	80–120	97–99	>95%
Child (1–5)	80–130	22–30	75–115	97–99	>95%
Infant (<1 yr)	100–160	30–40	70–100	97–99	>95%

Tachycardia (>100 bpm) = pain, fever, shock, dehydration, anxiety. Bradycardia (<60) = severe hypothermia, head injury, medications, athletes (normal). RR >30 or <8 = emergency. Any temp >103°F or <95°F = urgent action.

⊕ RULE OF NINES — BURN SURFACE AREA ESTIMATION

ADULT

Head & Neck9%

Each Arm (entire)9%

Chest (front)9%

Abdomen (front)9%

Upper Back9%

Lower Back9%

Each Thigh9%

Each Lower Leg9%

Perineum1%

CHILD (MODIFIED)

Head & Neck18%

Each Arm9%

Chest (front)9%

Abdomen (front)9%

Back (entire)18%

Each Leg (entire)13.5%

Perineum1%

Burns >20% body surface = HIGH shock risk. Burns to face/hands/feet/genitals always require aggressive treatment. 2nd/3rd degree burns over 10%+ in field = urgent.

PALM METHOD: Patient's own palm (fingers together) = approximately 1% body surface area. Useful for irregular burn patterns.

⊕ HEMORRHAGIC SHOCK — CLASS STAGING

CLASS I — Compensated (<750 mL / <15%)
Pulse <100, BP normal, RR normal, mental status normal. Skin normal. Minimal symptoms.

CLASS II — Mild (750–1500 mL / 15–30%)
Pulse 100–120, BP normal or slightly low, RR 20–30, anxious/agitated. Skin pale, cool, clammy.

CLASS III — Moderate (1500–2000 mL / 30–40%)
Pulse >120, BP dropping (systolic 70–90), RR 30–40, confused. Skin pale/mottled, CRT >2 sec.

CLASS IV — Severe (>2000 mL / >40%)
Pulse >140 (or absent), BP systolic <70, RR >35 or agonal, lethargy/unresponsive. Death imminent without immediate intervention.

⊕ MEDICATION REFERENCE — FIELD USE

MEDICATION	USE	ADULT DOSE	NOTES / CAUTIONS
Ibuprofen (Advil/Motrin)	Pain, inflammation, fever	200–800mg q6–8h (max 3200mg/day)	Do NOT use for head injuries, GI bleeding, shock, or kidney disease. Take with food.
Acetaminophen (Tylenol)	Pain, fever	325–1000mg q4–6h (max 4000mg/day; 3g if elderly)	Preferred for head injuries. Do NOT exceed dose — liver damage. Avoid with alcohol.
Aspirin	Cardiac event, anti-platelet, pain	325mg chewable (cardiac); 81mg daily (prevention)	Do NOT give to children (<16) — Reye's syndrome risk. Avoid if bleeding, head injury.
Diphenhydramine (Benadryl)	Allergic reactions, anaphylaxis support, sleep aid	25–50mg q4–6h (max 300mg/day)	ADJUNCT to Epinephrine for anaphylaxis — never sole treatment. Causes drowsiness.
Epinephrine 1:1000 (EpiPen)	Anaphylaxis, cardiac arrest	0.3mg IM outer mid-thigh. Repeat in 5–15 min if needed.	Children <66 lbs: 0.15mg (EpiPen Jr). Refrigerate; expires ~1–2 years. Auto-injector preferred.
Amoxicillin (Fish-Mox Forte)	Wound infection, cellulitis, dental	500mg 3x/day (TID) for 7–10 days	Penicillin family. Avoid if PCN allergic. Good for skin/soft tissue infections.
Doxycycline (Bird-Biotic)	Infections (Lyme, respiratory, wound)	100mg 2x/day (BID) for 7–14 days	Do NOT give to children <8 or pregnant women. Take with full glass water. Sun sensitivity.
Ciprofloxacin	Gram-negative infections, UTI, some wound infections	500mg 2x/day (BID) for 7–14 days	Avoid in children and pregnancy. Reserve for resistant infections.
QuikClot / Celox	Hemostatic agent — hemorrhage control	Pack directly into wound, apply firm pressure 3–5 min	Celox: chitosan (shrimp-based) — caution if severe shellfish allergy. QuikClot: kaolin-based.
Oral Rehydration (ORS)	Dehydration, shock support, diarrhea	Drink to thirst; 200–400mL/hr if dehydrated	Make: 1L water + ½ tsp salt + 6 tsp sugar. Electrolytes critical for recovery.

⊕ PEDIATRIC CONSIDERATIONS

Airway: Smaller, softer, more anterior. Even slight obstruction is dangerous. Use smaller OPA/NPA. Sniffing position to open airway (not full head tilt).

CPR: 2-finger compressions (infant), one-hand for small child. Rate 100–120/min. Depth 1.5" (infant) to 2" (child). AED: use pediatric pads for <55 lbs.

Hypothermia: Children lose heat much faster — smaller mass relative to surface area. Dry immediately, wrap with adult bodies if needed.

Burns: Use modified Rule of Nines. Children are more susceptible to dehydration and burn shock. Aggressive oral hydration.

Dehydration signs: Sunken fontanelle (infant), dry mouth, no tears, no urine for >8 hours, sunken eyes.

Medications: Ibuprofen 5–10mg/kg q6–8h. Acetaminophen 10–15mg/kg q4–6h. No aspirin under 16. Diphenhydramine 1mg/kg up to 25mg.

⊕ START TRIAGE — RPM QUICK REFERENCE

STEP	ASSESS	RESULT	TAG
1. RESP	Is patient breathing?	Not breathing after airway repositioned	BLACK
		Starts breathing after airway opened	RED
		Respirations >30/min	RED
2. PERF	Radial pulse + CRT?	No radial pulse OR CRT >2 sec	RED
2. PERF	Radial pulse + CRT?	Pulse present AND CRT ≤2 sec	→ Check Mental Status
3. MENTAL	Follows simple commands?	Unresponsive or disoriented	RED
		Can follow commands but cannot get up	YELLOW
		Follows commands AND can walk	GREEN

When in doubt between categories — always tag the HIGHER priority. In START, only three interventions are permitted: stop massive bleeding, open airway, elevate legs for shock.

★ TRAINING LOG — GROUP MEDICAL CERTIFICATIONS

Key certifications for grid-down preparedness: Stop the Bleed, TCCC (Tactical Combat Casualty Care), Wilderness First Aid, CPR/AED, WEMT, Combat Lifesaver, CERT (Community Emergency Response Team), PHTLS.

MEMBER	CERTIFICATION / COURSE	LEVEL	DATE COMPLETED	EXPIRY DATE	CERT STATUS	ISSUING ORGANIZATION	ACTIONS

No training records. Log group medical certifications to track readiness.