Was soldier riding or walking patrol? Proximity to blast device and position of body at time of blast in relation to blast (back, front, side), etc. I have never been very good with abstract patient assessment.

Riding in an unarmored HUMMV truck thing. Passenger side front.

30 meters.

Body position? - sitting LOL

Blast was right front quarter. They set it off too early, but not much.

NDD:

I can tell you what my primary concerns would be with this scenario, but I dont know how to put that into SOAP format without specific injuries being present with specific findings and specific complaints. Not trying to be evasive...

Go ahead Max, bail him out.

One of the few times I'll post, but I've had some first hand experience with this type of situation, and I've got the blessing from NDD. Background, spent 8 months in Iraq (Fallujah), 11B, line platoon. My platoon alone hit 5 IEDs, the whole Bn is probably around 50.

First IED, went off between two of our Humvees (mine and the one behind me), daisy chained 155s, only one detonated. Lots of shrapnel, but nothing hit anyone, no other injuries (concussions, etc.).

Second IED, went off right beside a Delta Co. truck, no injuries, but plenty shaken up.

Third IED, little further off (25-50m), two mild lacerations (forehead and below eye) and I believe one mild burn where a piece of shrapnel slid between a gunner's IBA and body (it happened, just can't remember which one it was).

Fifth IED, probably 5m or less away from a truck, lots of debris in the air (LOTS), but no contact injuries. Two guys were knocked around pretty good, one was close to unconcious for a few minutes and was still shaken when we got back.

The big one, IED number 4. 2 155s surrounded by 3 55gal fuel drums. Instant non-hearing status for me, and a lot of others, hearing took a few days to come back fully. Lots of shrapnel, 6 WIA, 1 KIA that day. Lots of lower extremity shrapnel wounds, 2 in my squad got peppered on the lower legs (mainly calves) (one still has a piece behind his patella, right next to a major artery), another had a piece go through the left thigh and embedded into his right (just missing cock and balls). 3 guys were extremely close to the IED, first in line was KIA, punctured IBA and chest, severe burns, second had mild burns and a compound fracture of the foot, third had a cut on his inner thigh. Two other guys had small shrapnel embedded in the rear and tricep, didn't even notice till we got back.

That should give you some idea that injuries vary from one IED to another and can run the full spectrum of what is possible. I know of one instance where the only injury was a guy that had his nose cut off (they fixed that). Another one where an IED went off right beside the passenger door (in fact much like your scenario), and because they had taken the armor doors off, a piece of shrapnel cut his throat. Believe he is doing fine now. Fractures occured on that one as well.

What it boils down to on IEDs is that what happens all depends on a few things: 1) how the IED is emplaced and what it consists of; 2) how close the vehicle is to it (which can vary depending on speed, seperation, when it was triggered, etc.); and 3) unfortunately, luck.

Hope that's fine with you NDD, if you want me to change anything, let me know.

Thanks Max.

Let's used IED number 4. That help SCrip?

I am going with second man.

S 26 y/o walking patrol when IED detonated. C/O pain to R foot and to face/neck/hands.

O Pt found lying on ground. ABC +, A&O, PEARL, Partial thickness burns to areas exposed(face, neck, hands). LS-clear/equal w/ good rise and fall. Airway clear of extension burns. Obvious deformity and Fx to R foot no gross hemorrhage noted. No other S/S of trauma noted.

A Open Fx R foot and partial thickness burns ~10% BSA.

P Bandage and splint R foot with wire ladder splint and elastic bandage. Moist, sterile dressings on burns. IV saline lock R AC 18ga. Phentenyl LP for pain. Transport to FSH for eval and further Tx.

Did you want one for every PT?

Let's finish this one first, especially since we are doing them in reverse triage order (apparently).

Are you sure about A&O? How are you going to know?

When you asked for SOAP I did not know you meant for everyone. Damn thats an MCI for me..lol In triage we dont do reports so I just started with the one with the most injuries.
___________

I guessed on the A&O. It would be questioning on Person, Place, Time, & Events leading up to accident.

You guys triage by number of wounds. not severity?

Thats not where I would start triage, but its the one I chose to start my 8-up SOAP report on. Triage would start with the first injured person I came upon. Treatment priorities assigned and then treatment and transport. Triage is based on mental status and repiratory rate.

LOL - we need to get Cap's missues to give you some SOAP trauma counseling.

Ok, again, how are you going to determine mental status - they're all deaf?

There might be a difference between battlefield triage and civilian - I don't know.

Does everybody agree that triage is based on mental state and respiratory rate or does somebody have a different idea?

What's the leading cause of death on the battlefield when its not immediate?

Anybody says gettin' shot or blown up is gonna sit in the corner for three days.

Questioning: person, place, time, and events. Written on note pad like in Saving Private Ryan at the crashed glider.

Internal hemorrhage?

If us non-medical types are permitted to guess, I would say exsanguination for those who do not make it to clinical treatment.

TR