Page 38 - ATP-P 11th Ed

Table 2 PCC Role-Based Guidelines for Massive Hemorrhage Management
PCC Role-based Guidelines for Massive Hemorrhage Management
SECTION 1 T T T T *All Personnel - Complete Basic TCCC Management Plan for Massive Hemorrhage
C
C
C
C then:
C
C
C
C • Identify life-threatening bleeding that may have started or was not adequately controlled
C
with initial interventions in TCCC Basic Management Plan for Massive Hemorrhage.
- C - C - C - • Check tourniquets to ensure that they have not shifted or loosened.
A C C C
S L M P
M S C P
• Re-assess and re-apply MARCH interventions.
• Perform all recommended interventions from guidelines for above tier level.
• Ensure all interventions noted above are completed by TCCC ASM and CLS personnel.
• Conduct inventory of all resources.
• Document all pertinent information on PCC Flowsheet (attached).
• Additional interventions include:
Role 1a
• Conduct Triage – Time Assessment.
• Assess extremities distal to pressure dressings to ensure that they are not acting as a ve-
nous tourniquet which could result in compartment syndrome by checking pulses and the
skin color distal to the dressing.
• Communicate evacuation and re-supply requirements (i.e. , Blood resupply/Speedball).
• Administer Calcium and Tranexamic Acid (TXA) per TCCC guideline.
Role 1b
• Re-assess and re-apply MARCH interventions.
• Consider tourniquet conversion (>2 hours but before 6 hours).
• Assess for refractory shock – see Circulation Section.
Role 1c
• Evaluate for compartment syndrome.
• Consider teleconsultation.
• Continue resuscitation until min palpable radial pulse or improved mental status better:
SBP >90mmHg best: SBP between 100–110mmHg. Discontinue fluid administration
when one of the above end points have been achieved.
• Ensure interventions noted above are completed by TCCC ASM, CLS and Combat Medic/
Corpsmen (CMC) personnel.
• Conduct inventory of all resources.
• Document all pertinent information on PCC Flowsheet (attached).
• Additional interventions include:
Role 1a
• Re-assess all prior MARCH interventions.
Role 1b
• Assess using ultrasound (if available) including Extended Focused Assessment with
Sonography in Trauma, Central Venous Pressure.
• Determine hypovolemia vs. refractory shock to drive decision on further resource utilization.
Role 1c
• Convert to type-specific blood replacement, if testing available.
• Establish Foley catheter with goal Urine Output (UOP) of >1/2mL/kg/hr.
Damage Control Resuscitation (DCR) in Prolonged Field Care CPG, 01 Oct 2018 5
https://jts.health.mil/assets/docs/cpgs/Damage_Control_Resuscitation_PFC_01_Oct_2018_ID73.pdf
28 SECTION 1 TACTICAL TRAUMA PROTOCOLS (TTPs) ATP-P Handbook 11th Edition 29