Page 143 - JSOM Fall 2018

patients and consider early surgical airway for respira­ a. Document clinical assessments, treatments rendered,
tory distress or oxygen desaturation. and changes in the casualty’s status on a TCCC Card
b. Estimate total body surface area (TBSA) burned to the (DD Form 1380). Forward this information with the
nearest 10% using the Rule of Nines. casualty to the next level of care.
c. Cover the burn area with dry, sterile dressings. For ex­ 19. Prepare for Evacuation.
tensive burns (>20%), consider placing the casualty in a. Complete and secure the TCCC Card (DD 1380) to
the Heat­Reflective Shell or Blizzard Survival Blanket the casualty.
from the Hypothermia Prevention Kit in order to both b. Secure all loose ends of bandages and wraps.
cover the burned areas and prevent hypothermia. c. Secure hypothermia prevention wraps/blankets/straps.
d. Fluid resuscitation (USAISR Rule of Ten) d. Secure litter straps as required. Consider additional
• If burns are greater than 20% of TBSA, fluid re­ padding for long evacuations.
suscitation should be initiated as soon as IV/IO ac­ e. Provide instructions to ambulatory patients as needed.
cess is established. Resuscitation should be initiated f. Stage casualties for evacuation in accordance with unit
with lactated Ringer’s, normal saline, or Hextend. standard operating procedures.
If Hextend is used, no more than 1000mL should g. Maintain security at the evacuation point in accor­
be given, followed by lactated Ringer’s or normal dance with unit standard operating procedures. 12
saline as needed.
• Initial IV/IO fluid rate is calculated as %TBSA × Basic Management Plan for
10mL/hr for adults weighing 40­80kg.
• For every 10kg ABOVE 80kg, increase initial rate Tactical Evacuation Care
by 100mL/hr. *The term “Tactical Evacuation” includes both Casualty Evac­
• If hemorrhagic shock is also present, resuscitation uation (CASEVAC) and Medical Evacuation (MEDEVAC) as
for hemorrhagic shock takes precedence over resus­ defined in Joint Publication 4­02.
citation for burn shock. Administer IV/IO fluids per 1. Transition of Care
the TCCC Guidelines in Section (6). a. Tactical force personnel should establish evacuation
e. Analgesia in accordance with the TCCC Guidelines in point security and stage casualties for evacuation.
Section (10) may be administered to treat burn pain. b. Tactical force personnel or the medic should commu­
f. Prehospital antibiotic therapy is not indicated solely nicate patient information and status to TACEVAC
for burns, but antibiotics should be given per the personnel as clearly as possible. The minimum infor­
TCCC guidelines in Section (11) if indicated to prevent mation communicated should include stable or unsta­
infection in penetrating wounds. ble, injuries identified, and treatments rendered.
g. All TCCC interventions can be performed on or c. TACEVAC personnel should stage casualties on evacu­
through burned skin in a burn casualty. ation platforms as required.
h. Burn patients are particularly susceptible to hypother­ d. Secure casualties in the evacuation platform in accor­
mia. Extra emphasis should be placed on barrier heat dance with unit policies, platform configurations and
loss prevention methods. safety requirements.
15. Splint fractures and recheck pulses. e. TACEVAC medical personnel should reassess casualties
16. Communication and reevaluate all injuries and previous interventions.
a. Communicate with the casualty if possible. Encour­ 2. Massive Hemorrhage
age, reassure, and explain care. a. Assess for unrecognized hemorrhage and control
b. Communicate with tactical leadership as soon as pos­ all sources of bleeding. If not already done, use a
sible and throughout casualty treatment as needed. CoTCCC­recommended limb tourniquet to control
Provide leadership with casualty status and evacuation life­threatening external hemorrhage that is anatomi­
requirements to assist with coordination of evacuation cally amenable to tourniquet use or for any traumatic
assets. amputation. Apply directly to the skin 2–3 inches
c. Communicate with the evacuation system (the Patient above the bleeding site. If bleeding is not controlled
Evacuation Coordination Cell) to arrange for TACE­ with the first tourniquet, apply a second tourniquet
VAC. Communicate with medical providers on the side­by­side with the first.
evacuation asset if possible and relay mechanism of b. For compressible (external) hemorrhage not amenable
injury, injuries sustained, signs/symptoms, and treat­ to limb tourniquet use or as an adjunct to tourniquet
ments rendered. Provide additional information as removal, use Combat Gauze as the CoTCCC hemo­
appropriate. static dressing of choice.
17. Cardiopulmonary resuscitation (CPR) • Alternative hemostatic adjuncts:
a. Resuscitation on the battlefield for victims of blast – Celox Gauze or
or penetrating trauma who have no pulse, no venti­ – ChitoGauze or
lations, and no other signs of life will not be successful – XStat (Best for deep, narrow­tract junctional wounds)
and should not be attempted. However, casualties with • Hemostatic dressings should be applied with at
torso trauma or polytrauma who have no pulse or least 3 minutes of direct pressure (optional for
respirations during TFC should have bilateral needle XStat). Each dressing works differently, so if one
decompression performed to ensure they do not have fails to control bleeding, it may be removed and a
a tension pneumothorax prior to discontinuation of fresh dressing of the same type or a different type
care. The procedure is the same as described in section applied. (Note: XStat is not to be removed in the
(5a) above. field, but additional XStat, other hemostatic ad­
18. Documentation of Care juncts, or trauma dressings may be applied over it.)

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