Page 144 - JSOM Fall 2019

Enclosure 2 contains a proposed set of TCCC for All Service- 23. TCCC MP Course Appraisals Breakout Session
members Guidelines customized for use in the Maritime En- Briefback: Mr Dom Greydanus
vironment developed by Subpanel 5 of the NATO Medical
Naval Panel*. Mr Greydanus is visiting various military and civilian TCCC
training sites and observing TCCC-MP courses. He gathers
data on:
21. New Technology Breakout Session Briefback:
Dr Mel Otten – Distinguished Professor of Emergency – How closely the teaching adheres to the JTS-approved
Medicine – University of Cincinnati Medical Center TCCC-MP curriculum;
– How long each segment of the training takes; and
Items Discussed: The New Technology Subcommittee breakout – What post-course metrics were used to assess effective
session focused on the new sublingual formulation of sufent- learning by the students.
anil that has recently been approved by the FDA. The Subcom-
mittee used competing pro/con presentations for this purpose. Mr Greydanus is compiling a database to pres ent his observa-
tions. His course appraisals will give us a better understanding
Sufentanil Pros and Cons: of the current state of TCCC training and may identify opportu-
Pros – CSM Tim Sprunger
nities to improve in ensuring that the JTS-approved TCCC-MP
– Provides an on-label option for management of acute pain curriculum is used by organizations providing that training.
severe enough to require an opioid analgesic in adults.
– Can be used in emergency department, inpatient, and 24. CoTCCC Action Items: Dr Frank Butler
postoperative settings. Proposed changes to the TCCC Guidelines currently being
– Lightweight, small packaging developed:
– Easy to administer
– Patient cannot drop it or lose it once administered. 19-01 Tourniquet Review Mr Harold Montgomery
– Primary endpoints in studies: time-weighted summed 19-02 TXA Relook CAPT Brendon Drew
pain intensity difference over 12 hours (SPID12) 19-03 Hypothermia Relook Dr Brad Bennett
– 2017 Minkowitz study 19-04 iTClamp Relook CDR Dana Onifer
o Prospective, randomized, controlled trial 19-05 Evisceration Injuries LTC Jamie Riesberg
o Sublingual sufentanil vs placebo after abdominal surgery 19-06 Fluid Resuscitation MAJ Marc Northern
o 161 patients Additional potential changes to the TCCC Guidelines that
o Pain reduction significantly better with sufentanil may be addressed going forward:
than placebo
– 2014 Singla Study – Recommend plasma as a burn resuscitation fluid?
o Prospective, randomized, controlled trial – Recommend plasma for fluid resuscitation in TBI patients?
o Sublingual sufentanil vs placebo after bunionectomy – Recommend end-tidal CO2 monitoring in TFC?
o 100 patients – Recommend calcium in TFC even for casualties not be-
o Pain reduction significantly better with 30μg sufent- ing transfused?
anil than placebo – Replace moxifloxacin with levofloxacin as the oral an-
tibiotic in TCCC?
Cons – CAPT Lanny Littlejohn – Increase the initial ketamine dose?
– There are no studies documenting that sufentanil is safe
in the prehospital environment. – Specify the two vented chest seals with laminar vents as
– There is no evidence that sufentanil is safer than the cur- the preferred option for treating open pneumothorax?
rently recommended opioid in TCCC (OTFC). – Add a CBRN Section in the TCCC Guidelines?
– There is no evidence that sufentanil is more efficacious – Add a maritime casualty scenario to the TCCC-MP cur-
than the currently recommended opioid in TCCC (OTFC). riculum?
– Sufentanil is more expensive than OTFC. Future technology items for consideration (After FDA ap-
– We should keep our recommendations simple. Poly- proval and/or more studies)
pharmacy is a real threat to patient safety.
– The cardiovascular effects of sufentanil in hemorrhagic – ResQFoam
shock have not been studied. There may be risk for hy- – Compensatory reserve index monitor
potension and bradycardia. TCCC Business Practice Decisions:
– In TBI, there may be a risk of reduced respiratory drive
and lowered seizure threshold. How do we handle situations in which a TCCC-recommended
– FDA Risk Evaluation and Mitigation Strategies are item is significantly changed after the recommendation to use
complex. that item in TCCC has been made? Examples include:
– There is a risk of androgen deficiency from sufentanil use. – Tourniquets in which the design of the device has been
significantly modified after their use in TCCC has been
recommended
22. Advanced Resuscitative Care Breakout Session
Briefback: COL Joe Dubose – XStat – now that the original chitosan coating has been
removed from the compressed mini-sponges
The working group identified important points from COL Du- – Celox Gauze after modification to Celox Rapid
bose’s presentation slides that should be covered in the ARC – CricKey – the recommended surgical airway device is of-
curriculum going forward. fered for sale only as packaged with CricKnife, a device
which has not been addressed by the CoTCCC
*2017 TCCC guideline documentation has been amended by the NATO Medical Naval Panel to highlight considerations in the Maritime envi-
ronment and application thereof.

142 | JSOM Volume 19, Edition 3 / Fall 2019