Page 144 - Journal of Special Operations Medicine - Fall 2015

resuscitation for burn shock. Administer IV/IO flu- – Standard open surgical technique using a flanged
ids per the TCCC Guidelines in Section 7. and cuffed airway cannula of less than 10mm
e. Analgesia in accordance with the TCCC Guidelines in outer diameter, 6mm to 7mm internal diameter,
Section 13 may be administered to treat burn pain. and 5cm to 8cm of intratracheal length (Least
f. Prehospital antibiotic therapy is not indicated solely desirable option)
for burns, but antibiotics should be given per the – Use lidocaine if the casualty is conscious.
TCCC guidelines in Section 15 if indicated to prevent c. Spinal immobilization is not necessary for casualties
infection in penetrating wounds. with penetrating trauma.
g. All TCCC interventions can be performed on or 2. Breathing
through burned skin in a burn casualty. a. In a casualty with progressive respiratory distress and
17. Communicate with the casualty if possible. known or suspected torso trauma, consider a tension
– Encourage; reassure pneumothorax and decompress the chest on the side of
– Explain care the injury with a 14-gauge, 3.25-inch needle/catheter unit
18. Cardiopulmonary resuscitation (CPR) inserted in the second intercostal space at the midclavicu-
Resuscitation on the battlefield for victims of blast or lar line. Ensure that the needle entry into the chest is not
penetrating trauma who have no pulse, no ventilations, medial to the nipple line and is not directed toward the
and no other signs of life will not be successful and should heart. An acceptable alternate site is the fourth or fifth
not be attempted. However, casualties with torso trauma intercostal space at the anterior axillary line (AAL).
or polytrauma who have no pulse or respirations during b. Consider chest tube insertion if no improvement and/or
TFC should have bilateral needle decompression per- long transport is anticipated.
formed to ensure they do not have a tension pneumotho- c. Most combat casualties do not require supplemental
rax prior to discontinuation of care. The procedure is the oxygen, but administration of oxygen may be of benefit
same as described in Section 3a above. for the following types of casualties:
19. Documentation of Care – Low oxygen saturation by pulse oximetry
Document clinical assessments, treatments rendered, and – Injuries associated with impaired oxygenation
changes in the casualty’s status on a TCCC Casualty Card – Unconscious casualty
(DD Form 1380). Forward this information with the ca- – Casualty with TBI (maintain oxygen saturation >
sualty to the next level of care. 90%)
– Casualty in shock
– Casualty at altitude
Basic Management Plan for Tactical Evacuation Care d. All open and/or sucking chest wounds should be treated
by immediately applying a vented chest seal to cover the
*The term “Tactical Evacuation” includes both Casu- defect. If a vented chest seal is not available, use a non-
alty Evacuation (CASEVAC) and Medical Evacuation vented chest seal. Monitor the casualty for the potential
(MEDEVAC) as defined in Joint Publication 4-02. development of a subsequent tension pneumothorax. If
1. Airway management the casualty develops increasing hypoxia, respiratory
a. Unconscious casualty without airway obstruction: distress, or hypotension and a tension pneumothorax is
– Chin lift or jaw thrust maneuver suspected, treat by burping or removing the dressing or
– Nasopharyngeal airway by needle decompression.
– Place casualty in the recovery position 3. Bleeding
b. Casualty with airway obstruction or impending air- a. Assess for unrecognized hemorrhage and control all
way obstruction: sources of bleeding. If not already done, use a CoTCCC-
– Chin lift or jaw thrust maneuver recommended limb tourniquet to control life-threatening
– Nasopharyngeal airway external hemorrhage that is anatomically amenable to
– Allow casualty to assume any position that best tourniquet use or for any traumatic amputation. Apply
protects the airway, to include sitting up. directly to the skin 2 to 3 inches above the wound. If
– Place unconscious casualty in the recovery position. bleeding is not controlled with the first tourniquet, ap-
– If the previous measures are unsuccessful, assess ply a second tourniquet side-by-side with the first.
the tactical and clinical situations, the equipment b. For compressible hemorrhage not amenable to limb
at hand, and the skills and experience of the person tourniquet use or as an adjunct to tourniquet removal,
providing care, and then select one of the following use Combat Gauze as the CoTCCC hemostatic dress-
airway interventions: ing of choice. Celox Gauze and ChitoGauze may also
– Supraglottic airway, or be used if Combat Gauze is not available. Hemostatic
– Endotracheal intubation or dressings should be applied with at least 3 minutes of
– Perform a surgical cricothyroidotomy using one of direct pressure. If the bleeding site is amenable to use of
the following: a junctional tourniquet, immediately apply a CoTCCC-
– Cric-Key technique (Preferred option) recommended junctional tourniquet. Do not delay in
– Bougie-aided open surgical technique using a the application of the junctional tourniquet once it is
flanged and cuffed airway cannula of less than ready for use. Apply hemostatic dressings with direct
10mm outer diameter, 6mm to 7mm internal di- pressure if a junctional tourniquet is not available or
ameter, and 5cm to 8cm of intratracheal length while the junctional tourniquet is being readied for use.

132 Journal of Special Operations Medicine Volume 15, Edition 3/Fall 2015