Page 176 - JSOM Spring 2018

D. NAEMT TCCC Courses—chaired by Dr Frank Butler. His b.2. continued
briefback points from the breakout session included: – Whole blood
– AAJT?
– It is likely that the anticipated DoD Instruction on Medi- – ResQFoam—when FDA approved
cal Readiness Training (to include a requirement for TCCC – Intubation
training) will not specify that training be obtained through – Oxygen
an NAEMT-certified training site. This means that quality – Chest tubes with suction
assurance will remain a challenge. – What else?
– The JTS has identified significant quality issues in TCCC c. Potential Future Changes to the TCCC Guidelines
training in the past and addressed those in a white report c.1. Management of TBI
that was forwarded to the service Surgeons General in – Higher target systolic BP?
2015. This white report recommended the use of TCCC – TXA?
training courses that use the NAEMT educational infra- – Plasma?
structure to help assure standardized, high-quality training – New evidence on combination hypoxia and
and improved tracking of TCCC students. hypotension
– There are approximately 130,000 medical personnel in the – Whole blood?
active and reserve components of the DoD, according to – Or at least plasma and RBCs
DoD websites. This means that the $10/student cost for – Good O sat less helpful if not enough red cells
these individuals to be trained through the NAEMT edu- – Valproic acid?
2
cational infrastructure would result in an estimated $1.3 – What else?
million to train all DoD medical personnel in the TCCC for c.2. Relook at iTClamp/Combat Gauze combination for
Medical Personnel curriculum. scalp and cervical bleeding
– It is presently anticipated that the TCCC for All Combatant – CASE REPORT: 44-year-old woman with 25 stab
training will be conducted at basic military schoolhouses wounds to the chest and neck
and at combat units without working through NAEMT. – Arrived at the trauma center with a systolic BP of
This approach will save approximately $25 million for ini- 70 and unresponsive.
tial TCCC-AC training, but increases the quality assurance – She was given 4 U PRBC and 6 U FFP to resus-
challenge. citate her.
– Mr Montgomery is working with senior enlisted leaders to – There was severe bleeding from the base of the
transform the TCCC-AC content into a DoD-schoolhouse neck about 1cm above the clavicle through two
friendly curriculum format to facilitate its use at Army incisions that were close together.
training facilities.
– Initially packed with Combat Gauze. Soaked
through—ineffective.
22. CoTCCC Action Items: Dr Butler reviewed the pending – Repacked with Combat Gauze and then iTClamp
CoTCCC action items. used to close wounds.
a. Opportunities to Improve in TCCC
– Worked. No other major bleeding sites identified.
Survived.
c.3. Additional tourniquets included in TCCC?
– Tactical Mechanical Tourniquet (TMT)?
– SAM Extremity Tourniquet (SXT)?
– Others?
– Include negative evidence where appropriate
c.4. TXA use
– Slow IV push vs 10 minute infusion?
– Higher dose?
– No second prehospital dose?
c.5. CBRN section in the TCCC Guidelines?
– Or information report?
– Sarin first?
c.6. Replace moxifloxacin with levofloxacin?
– COL Clint Murray
c.7. Increase initial ketamine dose?
– MAJ Andy Fisher
c.8. Specify the two vented chest seals with laminar vents
as the preferred equipment items for TCCC?
– Dr Bijan Kheirabadi
b. Pending Changes to the TCCC Guidelines d. After FDA Approval and/or More Studies
b.1. Management of Suspected Tension Pneumothorax d.1. ResQFoam
– Indications d.2. Compensatory Reserve Index Monitor, OR
– Device d.3. POI lactate monitoring OR tissue O sat
– Site e. After USAISR Testing 2
– Steps to address failed NDC e.1. AAJT
b.2. Add an Advanced Field Care phase to TCCC – 1-hr limit
– REBOA – Bleeding sites above the aortic occlusion

170 | JSOM Volume 18, Edition 1/Spring 2018