Page 170 - Journal of Special Operations Medicine - Summer 2015

ENCLOSURE 2 Wednesday, 4 February 2014
COTCCC MEETING AGENDA AM
0800 Butler – Administrative Remarks
3–4 February 2015 0815 MG Lein – Senior Leader Remarks
Tuesday, 3 February 2015 0845 Talbot – Combat Medic Presentation
AM 0915 Geracci – III Corps TCCC Overview
0800 Butler – Administrative Remarks and Introductions 0945 Break
0830 Hoard – Combat Medic Presentation 1000 Gross – JTS Director Brief
0900 Butler – TCCC Update 1030 Sims – Prop Change – XStat
0930 Break 1100 Group XStat Discussion
0945 David – JTTS Prehospital Director Brief 1130 Lueder – PHTLS TCCC Courses
1015 Czarnik – Trauma Considerations in Operation 1145 Kotwal – TACEVAC Time and Survival
United Assistance 1200 Lunch
1045 Faudree/Holcomb – Prop Change – iTClamp
1115 Group iTClamp Discussion PM
1145 Lunch 1300 Keenan – Prolonged Field Care Update
1330 Giebner – PHTLS 8 Military Textbook;
PM New TCCC Curriculum
1300 Spinella – Far-Forward Blood Product Options 1400 Timby – USMC TCCC Overview
1330 Strandenes – Far-Forward FWB/TXA in TCCC 1430 Break
1400 Conklin – 75th Ranger Regiment Blood Program 1445 Montgomery – TCCC Issues – Medic Perspective
1430 Break 1515 Butler – TCCC Research Priorities
1445 Sauer – Prop Change – AAJT 1600 Butler – CoTCCC Action Items
1515 Group AAJT – Discussion 1630 Group New Business
1545 Mazuchowski – JTS/AFMES Combat Fatality Reviews 1700 Finish
1615 Zeber – JFAK
1630 Group New Business
1700 Finish
1800 Dinner

Change to Replace Promethazine With Ondansetron

The proposed change to replace Phenergan (promethazine) including undifferentiated nausea and vomiting in the ED. It
with Zofran (ondansetron) as the preferred antiemetic medica- has a well-established record of efficacy and safety and has
tion in Tactical Combat Casualty Care (TCCC) has now been a side-effect profile more favorable for use on the battlefield
approved by the Committee on Tactical Combat Casualty than that of promethazine.
Care (CoTCCC).
The wording for ondansetron use in TCCC (in both Tactical
The original selection of promethazine over ondansetron for Field Care and Tactical Evacuation Care) is:
the TCCC Guidelines was made at a time when ondansetron
was still being sold under patent. Generic forms of the drug 13k. Ondansetron, 4mg ODT/IV/IO/IM, every 8 hours as
were not available and Zofran was prohibitively expensive for needed for nausea or vomiting. Each 8-hour dose can be re-
use as a battlefield anti-emetic. peated once at 15 minutes if nausea and vomiting are not im-
proved. Do not give more than 8mg in any 8-hour interval.
Ondansetron is now off patent and available at a much lower Oral ondansetron is NOT an acceptable alternative to the
cost than in the past. It is increasingly being used as the medi- ODT formulation.
cation of choice for the treatment of nausea and vomiting in
emergency departments (EDs) and the prehospital environ- The updated TCCC Guidelines (dated 9 February 2015) are
ment, as well as in inpatient, obstetrical, and postsurgical included this issue of the Journal of Special Operations Medi-
settings. cine. The position paper that supports this change has been
approved for release and will be published in the near future
Ondansetron is approved by the US Food and Drug Admin- in JSOM.
istration (FDA) for the treatment of nausea and vomiting in
cancer patients who are being treated with chemotherapy or Thanks to LCDR Dana Onifer from the Marine Corps Special
ionizing radiation. It is also FDA approved for postoperative Operations Command and his coauthors for their work in pre-
nausea and vomiting. There is, however, an extensive body of paring this change to the TCCC Guidelines.
literature describing its successful use in many other settings,

160 Journal of Special Operations Medicine Volume 15, Edition 2/Summer 2015