Page 149 - Journal of Special Operations Medicine - Summer 2016

What Can TCCC Offer to Intraosseous Vascular Access
My Civilian EMS System?

• Studied at US Army Institute of Surgical Research
• Tourniquets in 2000
• Hemostatic dressings • Pioneered in prehospital trauma by TCCC in 2002
• Trauma airway approach • First recommended for TCCC by a CoTCCC
• TCCC Needle Decompression Plan Ranger Medic (SFC Rob Miller)
• Tranexamic Acid (TXA) • Special Ops medics previously taught to do
battlefield venous cutdowns when peripheral IV
• Hypotensive resuscitation - with blood products where access was difficult to obtain
possible • PYNG FAST-1 and EZ-IO are the most commonly
• Intraosseous vascular access used devices
• Triple-Option Analgesia • IO techniques are used universally in the military

IO Vascular Access Save What Can TCCC Offer to
Houston – 27 March 2016 My Civilian EMS System?

• Memorial Hermann Hospital
• Multiple stab wound victim – including left popliteal • Tourniquets
artery and intercostal artery injuries • Hemostatic dressings
• BP reported as 90 systolic at scene; no pulse in ED • Trauma airway approach
• Multiple peripheral IV attempts failed • TCCC Needle Decompression Plan
• Central line attempt failed • Tranexamic Acid (TXA)
• IO started and 2 units RBCs/2 units plasma infused
• ED thoracotomy • Hypotensive resuscitation - with blood products where
possible
• pH 6.83; lactate 26; BD 24
• Survived and doing well • Intraosseous vascular access
• Trauma surgeon: “Would have died without IO” • Triple-Option Analgesia
Courtesy Dr. John Holcomb

150 Years of Evolution: Triple-Option Analgesia
Civil War vs US Mil 2001 in TCCC

The simplified “Triple-Option” approach to
battlefield analgesia has three primary goals:
Civil War Soldier Modern Soldier 1. Preserve the fighting force
2. Provide rapid and maximal
relief of pain from combat wounds
British 1853 Enfield Musket M4A1 Carbine 3. Minimize the likelihood of
adverse effects on the casualty
from the analgesic medication
Battlefield analgesia: Battlefield analgesia: used
Intramuscular morphine Intramuscular morphine

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