Page 157 - JSOM Spring 2020

• Dosing 6. TCCC Awards:
o IV, IM, IO, etc. . . . Dr Butler recognized the following organizations and indi-
o Half-life is 180 minutes viduals for their outstanding support of the CoTCCC and
o Begins to wear off in 10–15 minutes TCCC:
• Rapid push = transit apnea
• RSI: 2mg/kg IV (max 200) Uniformed Services University (USU)
• 5mg/kg high intubation note Accepted by: Gen. Sharon Thomas
• Need “deep sedation privileges” in L.A. and other states USUHS continues to provide exceptional thought leaders in
• Transit apnea with IM dose (seeing more of it) battlefield trauma care. The USU faculty helped to inspire
the original TCCC concept and has been part of the TCCC
Head Injuries: effort since 1993. USU has produced more TCCC-fluent
• Based on “old studies” physicians than any other medical school in the world.
• New studies show no ICP elevation USU is also currently a national leader in transitioning the
• Safe to administer to head injured TCCC-inspired “Stop the Bleed” program to the citizens of
Eye Injuries: America and many other nations.
• Slight intraocular pressure but not clinically important The 75th Ranger Regiment
• Do not administer if you are going to do an eye exam Dr Butler noted that the 2017 TCCC Award was given to
Ketamine and Opioids: LTC Ethan Miles, SGM Curt Conklin, and to the entire
• Potentate analgesic effects of opioids. 75th Ranger Regiment. The regiment continues to be syn-
o Great for patients who cannot take any more opioids onymous with excellence in TCCC and leads the way for
• Ketamine + benzo + alcohol the rest of the DoD in caring for our combat wounded.
o Potent sedative effects National Association of EMTs
Kids: Accepted by Mr Dennis Rowe and Ms Pam Lane
• Safe and effective for kids and adults The NAEMT was TCCC’s first and most important ci-
• Safe if you use weight-based dose vilian strategic partner. With 72,000 members, NAEMT
is a worldwide leader in prehospital trauma care and
**Need deep sedation privileges in Los Angeles and other
states has been facilitating TCCC courses globally since 2009.
NAEMT also publishes the Prehospital Trauma Life Sup-
In the question and answer period the following her presen- port (PHTLS) textbook, which has included TCCC ma-
tation there was great discussion. terial since 1998. The current PHTLS Textbook (Military
9th Edition) is the single best reference for TCCC concepts
Q1: Pregnant and breastfeeding + >3 months old is this
contraindicated? available in print.
A1: No Naval Operation Medicine Institute (NOMI)
CAPT (Ret) Doug Freer and CAPT (Ret) Stephen Giebner
Q2: What is the way ahead for your paper? Both of these individuals have been recognized with TCCC
A2: Back through working committee and then through all Special Awards in the past, but Dr Butler wanted to again
our endorsing bodies before we can release it for publication. acknowledge their leadership in providing the first home
Q3: 0.5–0.9 dose, have noticed combativeness? for the Committee on TCCC. Without Doug Freer, Steve
A3: Yes, but there are little data to support not using this Giebner, and NOMI, there would be no CoTCCC.
dosage level. United States Army Institute of Surgical Research
Q4: (from Germany) Are there any studies comparing (USAISR)
benzo to ketamine in acute agitated prehospital patients Accepted by the Commander, COL Jerome Buller
with delirium? The USAISR has been responsible for a great many advances
A4: Yes, there are studies that compare ketamine to benzos in the science of battlefield trauma care. It has helped es-
in patients with acute agitation and what they show is there tablish the methodology for DoD preventable death anal-
is less hemodynamic stability issues as observed with large yses and to develop a number of TCCC’s most important
doses of benzos. lifesaving interventions including tourniquets, hemostatic
dressings, whole blood, and chest seals. USAISR has played
Q5: Can you reinforce if you should pre-dose with a small a key role in updating the TCCC guidelines for many years.
dose of benzo to avoid emergence as the nursing staff feel It is also the home of the world-famous ISR Burn Center
this is important? and the Burn Flight Team. USAISR truly lives up to ADM
A5: I would not recommend it. William McRaven’s quote that it is “The finest battlefield
trauma care research laboratory in the world.” Dr Butler
Q6: If you are in a deployed environment and do not have also recognized COL (Ret) John Holcomb, the former com-
US dosage of ketamine but have access to European S-ket- mander, who was instrumental in assisting the CoTCCC in
amine is there any difference in the dosing? (Warren) its transition from the Naval Operational Medicine Insti-
A6: Presenter did not feel comfortable commenting due tute to the Defense Health Board.
to the fact she did not have experience with the product.
Armed Forces Medical Examiner System
Dr Mann-Salinas, JTS PI, stated, “there are twelve (12) Accepted by Lt Col Ed Mazuchowski and Dr Ted Harcke
CPGs with different doses, there is the SMOG that pre- The AFMES has worked with the USAISR and CoTCCC
flight paramedics use . . . What is correct?”
since 2004, when the first preventable death analysis from

TCCC Updates | 151