Page 27 - ATP-P 11th Ed

e. Fluid resuscitation (USAISR Rule of Ten)
i. If burns are greater than 20% of TBSA, fluid resuscitation should be initiated
as soon as IV/IO access is established. Resuscitation should be initiated with
lactated Ringer’s, normal saline, or Hextend. If Hextend is used, no more the SECTION 1
1000mL should be given, followed by lactated Ringer’s or normal saline as
needed.
ii. Initial IV/IO fluid rate is calculated as %TBSA × 10mL/hr for adults weighing
40–80 kg.
iii. For every 10 kg ABOVE 80 kg, increase initial rate by 100mL/hr.
iv. If hemorrhagic shock is also present, resuscitation for hemorrhagic shock
takes precedence over resuscitation for burn shock. Administer IV/IO fluids
per the USSOCOM TTPs in number 6.
e. Analgesia in accordance with the TCCC guidelines in number 10 may be adminis-
tered to treat burn pain.
f. Prehospital antibiotic therapy is not indicated solely for burns, but antibiotics
should be given per the TCCC guidelines in number 11 if indicated to prevent
infection in penetrating wounds.
g. All TCCC interventions can be performed on or through burned skin in a burn
casualty.
h. Burn patients are particularly susceptible to hypothermia. Extra emphasis should
be placed on barrier heat loss prevention methods,
15. Splint fractures and re-check pulses
16. Cardiopulmonary resuscitation (CPR)
a. Resuscitation on the battlefield for victims of blast or penetrating trauma who have
no pulse, no ventilations, and no other signs of life will not be successful and
should not be attempted.
b. However, casualties with torso trauma or polytrauma who have no pulse or respira-
tions during TFC should have bilateral needle decompression performed to ensure
they do not have a tension pneumothorax prior to discontinuation of care. The
procedure is the same as described in section (5a) above.
17. Communication
a. Communicate with the casualty if possible. Encourage, reassure, and explain care.
b. Communicate with tactical leadership as soon as possible and throughout casualty
treatment as needed. Provide leadership with casualty status and evacuation re-
quirements to assist with coordination of evacuation assets.
c. Communicate with the evacuation system (the Patient Evacuation Coordination
Cell) to arrange for TACEVAC. Communicate with medical providers on the evac-
uation asset if possible and relay mechanism of injury, injuries sustained, signs/
symptoms, and treatments rendered. Provide additional information as appropriate.

16 SECTION 1 TACTICAL TRAUMA PROTOCOLS (TTPs) ATP-P Handbook 11th Edition 17