Page 130 - Journal of Special Operations Medicine - Summer 2014

Consider adding ondansetron as an option for manage- Consider the addition of spinal immobilization, bag-
ment of nausea and vomiting in the prehospital setting. valve-mask use, and CPR to the list of skill sets.

Review surgical airway indications. Surgical airways are Review the use of C-collars and spinal immobilization
being performed on casualties with GSWs to the head in TCCC.
when there is no evidence of airway obstruction. Basic Consider recommending the I-Gel as a preferred SGA
airway management techniques may be more appropri- because the cuff does not expand during flight.
ate in this situation.
Consider adding scalp skin clips (ITClamps) as an op-
Simplify and clarify the TCCC airway algorithm.
tion for hemorrhage control.
Review the use of pelvic binders in TCCC.
Consider recommending one-slit routing for the C-A-T
Reword the TCCC Guidelines to specify an “injured tourniquet as a preferred method for use.
side up” position for NDC.
Revisit the use of the impedance threshold device (ITD)
Consider adding mention of Foley balloon catheter in TCCC.
treatment of head and neck bleeding (Weppner, 2013)
®
Evaluate the potential use of the HemaClear Auto-
Reevaluate the Abdominal Aortic Junctional Tourniquet Transfusion Tourniquet in TCCC.
now that the directions for use have been changed.
Evaluate the potential use of the modified Veres needle
Consider adding supraglottic airways as an airway op- for needle decompression of suspected tension pneumo-
tion in tactical field care as well as TACEVAC care. thoraces in TCCC.

WHAT’S NEW

directive from U.S. Forces Afghanistan dated 21 March options and not enough clear guidance on which option to
A 2014 mandates that all U.S. military physicians, physician use for a given casualty; and (2) ketamine was being used by
assistants, nurse practitioners, nurses, medics, corpsmen, and some medics, corpsmen, and PJs in theater as a battlefield
PJs deployed in or deploying to Afghanistan be trained in the analgesic with excellent results.
current version of the TCCC Guidelines (dated 28 October
2013) as posted on the Military Health System website. Additionally, multiple casualties in the JTTS weekly trauma
teleconferences who were in shock and/or respiratory distress
The TCCC curriculum reflecting the 28 October 2013 TCCC were reported to have been given opioid analgesics (morphine
Guidelines is currently available on the MHS website at: or fentanyl)—neither is a good option for this type of casualty.
https://mhs.health.mil/References/REF_TCCC.cshtml%20.
Note that you will need a CAC card to access this section of The change presented in this paper does not change any of the
the MHS website. analgesic medications or doses recommended previously by
the CoTCCC. It does simplify the analgesic use recommen-
For individuals and groups not able to view the limited access dations and provide more definitive guidance about when to
MHS website, this material is available on the TCCC page use each of the three options recommended. This paper was
of the JSOM website at https://www.jsomonline.org/TCCC published in the Spring, Vol 14(1) edition of the Journal of
.html and on the TCCC/PHTLS section of the NAEMT web- Special Operations Medicine (JSOM).
site at http://www.naemt.org/education/TCCC/guidelines_
curriculum.aspx. Recently added to the JSOM’s TCCC page at htps://www
.jsomonline.org/TCCC.html are:
The TCCC Update for the most recent change to the TCCC
Guidelines: the Triple-Option Analgesia Plan has been added 1. A set of training slides that can be used to train unit person-
to https://www.jsomonline.org/TCCC.html. This change nel on this new change to the TCCC Guidelines
originated in the USCENTCOM/Joint Trauma System as- 2. The current version of the TCCC Guidelines dated 28 Oc-
sessment of prehospital care in Afghanistan in November tober 2013
2012. In discussions with combat medics, corpsmen, and PJs 3. Journal Watch
in theater, two important observations regarding pain medi- 4. TCCC article abstracts 1402
cations were noted: (1) the TCCC battlefield analgesia recom- 5. Memorandum on Tactical Combat Casualty Care Training
mendations needed to be simplified—there were too many for Deploying Personnel 2011-02

120 Journal of Special Operations Medicine Volume 14, Edition 2/Summer 2014