Page 134 - Journal of Special Operations Medicine - Fall 2014

b. Replace wet clothing with dry if possible. Get the casualty onto an insulated surface as soon as possible.
c. Apply the Ready-Heat Blanket from the Hypothermia Prevention and Management Kit (HPMK) to the casualty’s torso
(not directly on the skin) and cover the casualty with the Heat-Reflective Shell (HRS).
d. If an HRS is not available, the previously recommended combination of the Blizzard Survival Blanket and the Ready
Heat blanket may also be used.
e. If the items mentioned above are not available, use dry blankets, poncho liners, sleeping bags, or anything that will retain
heat and keep the casualty dry.
f. Warm fluids are preferred if IV fluids are required.
9. Penetrating eye trauma
If a penetrating eye injury is noted or suspected:
a. Perform a rapid field test of visual acuity.
b. Cover the eye with a rigid eye shield (NOT a pressure patch.)
c. Ensure that the 400mg moxifloxacin tablet in the combat pill pack is taken if possible and that IV/IM antibiotics are
given as outlined below if oral moxifloxacin cannot be taken.
10. Monitoring
Pulse oximetry should be available as an adjunct to clinical monitoring. All individuals with moderate/severe TBI should be
monitored with pulse oximetry. Readings may be misleading in the settings of shock or marked hypothermia.
11. Inspect and dress known wounds.
12. Check for additional wounds.
13. Analgesia on the battlefield should generally be achieved using one of three options:
Option 1
Mild to Moderate Pain
Casualty is still able to fight.
– TCCC Combat pill pack:
– Tylenol - 650mg bilayer caplet, 2 PO every 8 hours
– Meloxicam - 15mg PO once a day
Option 2
Moderate to Severe Pain
Casualty IS NOT in shock or respiratory distress AND
Casualty IS NOT at significant risk of developing either condition.
– Oral transmucosal fentanyl citrate (OTFC) 800μg
– Place lozenge between the cheek and the gum.
– Do not chew the lozenge.
Option 3
Moderate to Severe Pain
Casualty IS in hemorrhagic shock or respiratory distress OR
Casualty IS at significant risk of developing either condition.
– Ketamine 50mg IM or IN;
OR
– Ketamine 20mg slow IV or IO
*Repeat doses q30min prn for IM or IN
*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)
*Analgesia notes
a. Casualties may need to be disarmed after being given OTFC or ketamine.
b. Document a mental status exam using the AVPU method prior to administering opioids or ketamine.
c. For all casualties given opiods or ketamine – monitor airway, breathing, and circulation closely.
d. Directions for administering OTFC:
– Recommend taping lozenge-on-a-stick to casualty’s finger as an added safety measure OR utilizing a safety pin and
rubber band to attach the lozenge (under tension) to the patient’s uniform or plate carrier.
– Reassess in 15 minutes.
– Add second lozenge, in other cheek, as necessary to control severe pain.
– Monitor for respiratory depression.
e. IV Morphine is an alternative to OTFC if IV access has been obtained
– 5mg IV/IO
– Reassess in 10 minutes.
– Repeat dose every 10 minutes as necessary to control severe pain.
– Monitor for respiratory depression.
f. Naloxone (0.4mg IV or IM) should be available when using opioid analgesics.

126 Journal of Special Operations Medicine Volume 14, Edition 3/Fall 2014