Page 24 - ATP-P 11th Ed

c. TCCC Combat Paramedics or Providers:
i. Fentanyl 50μg IV/IO 0.5–1μg/kg
SECTION 1 ii. Fentanyl 100μg IN
(a) May repeat q30min
(a) May repeat q30min
Option 3
i. Moderate to Severe Pain
ii. Casualty IS in hemorrhagic shock or respiratory distress OR
iii. Casualty IS at significant risk of developing either condition:
(a) Ketamine 20–30mg (or 0.2–0.3mg/kg) slow IV or IO push
• Repeat doses q20min prn for IV or IO
• End points: Control of pain or development of nystagmus (rhythmic
back-and-forth movement of the eyes).
(b) Ketamine 50–100mg (or 0.5–1mg/kg) IM or IN
• Repeat doses q20–30min prn for IM or IN
Option 4
a. TCCC Combat Paramedics or Providers:
i. Sedation required: significant severe injuries requiring dissociation for patient
safety or mission success or when a casualty requires an invasive procedure;
must be prepared to secure the airway:
(a) Ketamine 1–2mg/kg slow IV/IO push initial dose
• Endpoints: procedural (dissociative) anesthesia
(b) Ketamine 300mg IM (or 2–3mg/kg IM) initial dose
• Endpoints: procedural (dissociative) anesthesia
• If an emergence phenomenon occurs, consider giving 0.5–2mg IV/IO
midazolam.
• If continued dissociation is required, move to the Prolonged Casualty
Care (PCC) analgesia and sedation guidelines.
ii. If longer duration analgesia is required:
(a) Ketamine slow IV/IO infusion 0.3mg/kg in 100mL 0.9% sodium chloride
over 5–15 minutes.
• Repeat doses q45min prn for IV or IO
• End points: Control of pain or development of nystagmus (rhythmic
back-and-forth movement of the eyes).
Analgesia and sedation notes:
a. Casualties need to be disarmed after being given OTFC, IV/IO fentanyl, ketamine,
or midazolam.
b. The goal of analgesia is to reduce pain to a tolerable level while still protecting their
airway and mentation.

14 SECTION 1 TACTICAL TRAUMA PROTOCOLS (TTPs) ATP-P Handbook 11th Edition 15