Triage casualties as required.
Casualties with an altered mental status should immediately have weapons cleared and secured, communications secured, and sensitive mission items redistributed.
Possible causes of altered mental status are Traumatic Brain Injury (TBI), shock, hypoxia, and pain medications. The casualty may resist being disarmed. It may be useful to say “Let Smith hold your weapon for you while I check you out,” to help them better accept your taking their weapon.
1. Conscious casualty with no airway problem identified:
2. Unconscious casualty without airway obstruction:
3. Casualty with airway obstruction or impending airway obstruction:
4. If the previous measures are unsuccessful, perform a surgical cricothyroidotomy using one of the following:
5. Cervical spine stabilization is not necessary for casualties who have sustained only penetrating trauma.
6. Monitor the hemoglobin oxygen saturation in casualties to help assess airway patency.
7. Always remember that the casualty’s airway status may change over time and requires frequent reassessment.
Cricothyroidotomy is hard to do. Combat medics have often failed to get it right on the battlefield, with a 33% failure rate. This is the most technically difficult procedure we ask medics, corpsmen, and PJs to do.
The Cric-Key is the preferred surgical airway technique. Under test conditions, medics were faster and more successful using the Cric-Key technique compared to the open surgical technique.
To prepare, combat medics should perform a cricothyroidotomy at least five times during training on an anatomically realistic model.