Page 50 - Journal of Special Operations Medicine - Summer 2015

the ordering and procurement process for units. The TCCC 20. Battalion Surgeon (Professional Filler System physi-
Card should be a requirement on the IFAK component list, the cian) would not give ketamine to his medics. He requested
Combat Lifesaver (CLS) bag component list, and the Warrior to see the data despite TCCC Guidelines, the medics “work
Aid and Litter Kit (WALK) component list. (Army ROLE-1) under his license,” and he had custody issues. (Army
7. Regional Command Medical Logistic units required ROLE-1)
a Letter of Justification (LOJ) staffed through command for 21. Battalion Surgeon would not allow medics to carry,
critical life-saving devices like the junctional tourniquet. (RC hang, or mix IV medications including TXA and TCCC-rec-
MEDLOG BN) (Through a Junctional Tourniquet IJC FRAGO, ommended antibiotics because he once saw a nurse mix up a
this issue was only temporarily resolved for 3 months.) (JTTS Pitocin (oxytocin) infusion incorrectly. (USMC ROLE-1)
Prehospital Coordinator) 22. Battalion Surgeon stopped trying to order replace-
8. LOJs for medical supplies should not be required by ment medical supplies, including chronic oral medications and
Medical Logistics (MEDLOG) for supplies that you are re- trauma supplies, because the Regiment’s medical supply told
quired maintain. For example, everyone is required to carry a them they were retrograding and no more Class VIII supply
CAT tourniquet, but you need a LOJ if you are ordering more orders would be honored. [Note: Unit was 4 months out from
than one CAT tourniquet. (Army ROLE-1) end of mission] (USMC ROLE-1).
9. Medics should carry black permanent markers and fill 23. The TXA vial label states temperature storage should
out the patient cards. We have forgotten on a few occasions to be between 59°F–89°F, which makes the medication unusable
fill them out and it leaves the evacuation team starting from during the hot months in Afghanistan. (Army ROLE-1)
scratch and having difficulties when considering medications 24. There are no 100mL NaCl bags in the Medical Chest
potentially given but not confirmed through documentation. Sets to administer TXA per TCCC Guidelines. (Army ROLE-1)
(Army ROLE-1) 25. Need to add medical supplies into the Medical Chest
10. In reference to MEDEVAC mission evacuation prior- Sets to support a Walking Blood Bank (fresh whole blood)
ity: Never downgrade patients (i.e. from urgent to routine). It plan for units that deploy to austere environments, such as
is my one rule of thumb. We are not on the ground to lay eyes in the beginning of the war. Add Walking Blood Bank to the
on the situation. If it turns out to be an unnecessary urgent TCCC Guidelines (Army ROLE-1)
triage, then troubleshoot it after the event during your AAR. 26. No physiologic monitoring devices like the Propaq
(Army MEDEVAC Detachment) (ZOLL Medical Corp.; www.zoll.com/propaqmd) or Tempus
11. We need small, compact phantom litters or equivalent (Remote Diagnostic Technologies Ltd.; www.rdtltd.com) are
for patrols. Phantoms litters are available and they are able to in the Medical Equipment Trauma for the Battalion Aid Sta-
fit on a battle belt or chest rig with ease, they weigh 1 lb. and tion (Army ROLE-1).
fold down to 1 ft. (Army ROLE-1) 27. There are several Chest Seals that can be ordered;
2
12. We need to standardize the training for enlisted medi- however, the Army needs to identify the two best vented chest
cal personnel and physicians across the DoD. This must in- seals for ordering, and they need to be listed in the TCCC
clude standardization of medical equipment in the IFAK, Guidelines. (Army ROLE-1)
Aid-Bags, and vehicular kits. The injury doesn’t change when 28. Medics who come straight from advanced individual
you are wearing marine pattern (MARPAT). (USMC ROLE-1) training have been trained not to give fluids to a casualty with
13. I noted an absence of IV fluid warmers. Two pocket traumatic brain injury. Fluids must be administered to gain a
hand warmers can keep a 500mL bag of fluid at approxi- peripheral pulse in a pulseless casualty, per TCCC Guidelines.
mately 80°F–85°F for almost 8 hours, and the warming pro- (Army ROLE-1)
cess should start 1 hour prior to patrol. (Army ROLE-1) 29. Units must have Department of Defense Activity Ad-
14. TCCC AARs: AARs should be done as soon as pos- dress Code (DODDAC) issues corrected prior to deployment.
sible after treating a POI patient. (Army ROLE-1). Unit went 90 days without the ability to order supplies due to
15. Add to the IFAK the 14F catheter, Fox Eyeshield Unit DODDAC issues. (JTTS Prehospital Coordinator)
(JEDMED; www.jedmed.com), TCCC Card, Bolin Chest Seal 30. How do we get the TCCC AAR to the JTTS when
(H&H Medical Corp.; gohandh.com), and nasopharyngeal the Internet (specifically, MS Outlook; Microsoft Corp.; www.
airway. To the Medical Chest Sets add the 100mL sodium microsoft.com) is not available? Handwritten documentation
chloride (NaCl) bag for TXA administration in accordance has proven to be ineffective, as it gets lost, damaged, or un-
with the TCCC Guidelines. (USMC ROLE-1) readable. (Army ROLE-1)
16. Navy: We need TXA, 3% NaCl, mannitol, and a 31. Our ROLE I PROFIS physician is a hematologist who
blood-product delivery system to be added to our Medical has never been assigned to a line unit? Is this really the best
Chest Sets. (USMC ROLE-1) provider for the Infantry? (Army ROLE-1)
17. We need two hand pumps for the SAM junctional 32. 68Ws (Combat Medics) should be issued an Aid Bag
tourniquet, and hand pumps should be fixed to the pneumatic with their initial issue from the Central Issue Facility, and they
disk, not removable. (CJSOTF ROLE-1) should be able to DX [direct exchange] it for the next updated
18. A Battalion’s CLS standard needs to be 100% of Sol- Aid Bag the Army adopts. (Army ROLE-1)
diers trained. (Army ROLE-1) 33. Medics need to carry and be trained to sue Valium (di-
19. A Commander would not authorize unit medics as- azepam) when carrying ketamine. The ketamine should come
signed to support a platoon on a nearby Combat Outpost to in a smaller vial (a one TCCC dose-volume) and should have
carry intramuscular morphine. His reasoning was they are the pop-seal device like the ketorolac vial has. (Army ROLE-1)
close enough to the Unit FOB for evacuation and it is not 34. Medics are authorized to carry IV/IM ketorolac in
needed. (Army ROLE-1) trauma but not TCCC Guideline analgesia.

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