Page 52 - ATP-P 11th Ed

Table 9 PCC Role-based Guideline for Head Injury/TBI Management
PCC Role-based Guidance for Head Injury/TBI Management
SECTION 1 T T T T Complete Basic TCCC Management Plan for Heat Injury/TBI then:
C
C
C C Role 1a
C
C
C C • Identification and local wound management of any open head wounds/skull fractures. Pri-
C
- C - C - C - orities should include hemorrhage control, removal of gross contamination, and protection/
coverage of any exposed dura or brain matter.
A C C C • Military Acute Concussive Evaluation 2 (MACE2) (*See Appendix E) examination per
S L M P DoD/TCCC guideline.
M S C P • Communicate evacuation requirements (need for TBI evaluation, neurosurgery)
• Communicate re-supply requirements.
Role 1b/1c
• Re-assess and re-apply MARCH interventions.
• Serial neurologic checks, including pupil exam and identify signs of elevated or rising
intracranial pressure (Appendix E) – at least hourly.
• Identify catastrophic/non-survivable brain injury.
• Upgrade evacuation priority and destination (facility with neurosurgical capabilities)
• for any patient with initial mild TBI who deteriorates to moderate/severe TBI category.
• Re-assess and re-apply MARCH interventions.
• Conduct inventory of all treatment supplies.
• Document all pertinent information on PCC Flowsheet (attached).
Role 1a
• Identification and local wound management of open head wounds/skull fractures. Priori-
ties should include hemorrhage control, removal of gross contamination, and protection/
coverage of any exposed dura or brain matter.
• MACE2 examination per TCCC guideline.
• Communicate evacuation requirements (need for TBI evaluation, neurosurgery).
• Communicate re-supply requirements.
Role 1b/1c
• Re-assess and re-apply MARCH interventions.
• Serial neurologic checks and identify signs of elevated or rising intracranial pressure
( Appendix E).
• Administer appropriate antibiotics for any open head wounds or skull fracture (see anti-
biotics section).
• Identify the critical observations that should be reported to medical personnel for trauma
casualties with a suspected head injury, in accordance with the MACE2.
• Teleconsultation with trauma surgeon and/or neurosurgeon as available.
• Upgrade evacuation priority and destination (facility with neurosurgical capabilities) for
any patient with initial mild TBI who deteriorates to moderate/severe TBI category.
• Re-assess and re-apply MARCH interventions.
• Ensure all interventions noted above are completed by non-medical TCCC ASM and CLS
personnel and CLS-trained service members.
• Conduct inventory of all treatment supplies.
• Document all pertinent information on PCC Flowsheet (attached).
Role 1a
• Identification and local wound management of any open head wounds/skull
• fractures. Priorities should include hemorrhage control, removal of gross contamination,
and protection/coverage of any exposed dura or brain matter.
(continues)

42 SECTION 1 TACTICAL TRAUMA PROTOCOLS (TTPs) ATP-P Handbook 11th Edition 43