Virtual Manikin™ — TCCC with Austere Resuscitative and Surgical Care (TCCC / ARSC)

Learning Objectives

1. Rapidly recognize the need for early damage control resuscitation.
2. Demonstrate the ability to stop or reduce external hemorrhage as rapidly as possible.
3. Determine risk for massive transfusion, defined as the need for 10 or more units of red blood cells / whole blood within the first 24 hours.
4. Initiate warmed whole blood transfusion as close to the time-of injury as possible.
5. Optimize patient’s ionized calcium, and prevent hypocalcemia related to massive transfusion.
6. Understand that calcium gluconate is preferred for peripheral IV administration.
7. For casualties at high risk of hemorrhagic shock, demonstrate administration of TXA 2g IV/IO within three hours of injury.
8. Determine the risk of coagulopathy during massive transfusion.
9. Demonstrate appropriate hypothermia prevention by warming the casualty with available resources.
10. Demonstrate the ability to stabilize and prepare patients for casualty evacuation.
11. In prolonged casualty care situations, document urine output as a valuable indicator for adequate resuscitation from hemorrhagic shock.
12. Understand appropriate endpoints for resuscitation.
13. Understand that if casualty is not responsive to resuscitative efforts despite adequate resuscitation, either additional resuscitation and/or hemorrhage control interventions are needed, or the injury is not survivable given resources and capabilities available.
14. Understand that it is best to avoid use of crystalloid in pre-hospital settings and instead use blood products for resuscitation.
15. Understand that it is best practice to avoid use of vasopressors in hemorrhagic shock.
16. Understand that it is best practice to avoid use of hypertonic saline in hemorrhagic shock, which should only be used for patients with TBI and evidence/suspicion of raised intracranial pressure.
17. Demonstrate appropriate airway management and obtain oral endotracheal intubation.