Page 79 - 2026 SMOG

(MARCHE) 2
C Consciousness (unconscious, seizures,
depressed consciousness, agitation)
R Respirations (present or absent,
labored, increased or decreased)
E Eyes (constricted, dilated, normal)
S Secretions (dry, normal, increased)
S Skin (diaphoretic, dry, hot, cyanosis)
Point of Injury (Hot Zone) Response—(MAR) 2
TCCC CBRN
Massive Hemorrhage Mask
Stop life-threatening external hemorrhage if • Don mask
tactically feasible: • Help the casualty don a mask or ensure a
• Direct casualty to control hemorrhage by proper seal if a mask is already in place.
self-aid • Ensure Powered Air Purifying Respirator
• Apply the limb tourniquet over the uniform (PAPR) or Self-Contained Breathing
proximal to the bleeding site(s). When in Apparatus (SCBA) is functional.
doubt, place a Hasty Tourniquet
Airway Antidotes
• Assess (excessive secretions may indicate • Antidotes are given in the Hot Zone if the
nerve agent exposure) casualty has symptoms of poisoning.
• Airway management is generally best • These agents are rapid killers:
deferred ˚ Nerve agent (give ATNAA, CANA)
Cyanide (give hydroxocobalamin)
˚ Pharmaceutical-based sedating agent
(give naloxone)
Respiration Rapid Spot Decon
• Assess: normal, shallow, labored, absent? • At the point of injury, physical removal
(increased respirations may indicate nerve of the agent/rapid Spot decontamination
agent exposure) is indicated if the agent can be seen on
• Complete the CRESS assessment and the skin, if there is suspicion of wound
determine if the agent or trauma causes it. contamination by the agent, or if there is a
• Respiratory intervention is generally best breach in the suit.
deferred • Apply RSDL, M100, M295, Sorbent, tech
wipe, etc.
Extraction
• Egress away from the threat
(continues)

2026 Standard Medical Operating Guidelines (SMOG) • 71