Page 163 - JSOM Spring 2020

v. Health Affairs chartered working groups for a. tc3committee
each tier level: b. 10,800+ followers
1. Tier 1 Chairman: COL Mike Charlton/MSG 4. LinkedIn
Michael Remley a. https://www.linkedin.com/groups/12036508
2. Tier 2 Chairman: LTC Ethan Miles 5. You Tube
3. Tier 3 Chairman: Master Chief Jeremy Torrisi a. Channel Name: CoTCCC Committee-on-TCCC
4. Tier 4 Chairman: CSM Dave Hasac
vi. Army and Navy – all combatants will do Com- Q1: Are you working with Dr Sawyer, J9
bat Life Saver (CLS). A1: Not currently
5. Train-the-Trainer:
a. Part 1: DoD common Trainer/Instructor course 14. Trauma Consultants: Three Things I Would Change in
i. Service specific: 6 weeks TCCC
b. JKO: 4hrs 1. Air Force and Navy: Brian Gavitt, Air Force Surgeon
c. Part 2: TCCC Trainer Qualification course (online) General Consultant, in collaboration with Dr Matt
d. Part 3: Proctored Instructor course Tadlock, Navy Trauma Specialty Lead. Dr Gavitt
6. Milestones: stated that he spoke on behalf of both services (Air
e. 1 June 2018 to 30 April 2020 Force and Navy), Dr Tadlock was unable to attend the
TCCC meeting. Dr Gavitt began with standard dis-
Q1: What about National Guard and Reserve units? claimers and disclosures.
A1: That will be up to the Service or State to direct a. Change #1: Increase target systolic blood pressure
training. (SBP) from 90 to 110mmHg in patients with mod-

Q2: Who will be the lead? erate to severe TBI.
A2: Joint Trauma Education and Training (JTET) branch of Where did the original recommendation for a target SBP
the Joint Trauma System. >90mmHg come from?
o Based on observations of normal blood pres-
Recommendation: Stand up the Education and Training sures in healthy subjects.
working group within CoTCCC to keep up with changes. o Not related to TBI.

13. Web Mobile Discussed multiple studies showing increasing harm with
Harold Montgomery, JTS contractor, began with stan- lower BP.
dard disclaimers. Mr Montgomery went over the number o Sparite papers shows 19% increase in odds of
of downloads from 61,500 downloads. There were over death for each 10-point drop in SBP
5,000 hits for just the TCCC guidelines. Worldwide web What do other organizations recommend?
traffic has risen as well to over 3,500 views per month. o BTF Guidelines: target SBP of 110mmHg
Website: www.deplyedmedicine.com o JTS Neurosurgery CPG: target SBP of 110mmHg
JTS Website: http://jts.amedd.army.mil/ o JTS Prolonged Field Care TBI CPG: target SBP
of 110mmHg

Q1: How does this correlate to/with noncompressionable
chest injuries?
A1: Mainly isolated head injuries.
Q2: How does blood pressure correlates to blood volume
in TBI patients?
A2: Pressure is the proxy for volume in the absence of ac-
curate measurement of volume.
Q3: What is the difference between “blunt and penetrat-
ing” injuries?
A3: Could not recall the difference but can send if needed.
b. Change #2: Increase target oxygen saturation
(SaO2) for TBI patients to 93–95%.
Dr Gavit’s second recommendation is to increase the ox-
TCCC can be accessed and followed on any of the follow- ygen saturation (SaO2) goal in moderate to severe head
ing social media sites: injuries.
1. Facebook Current TCCC guidelines set an SaO2 target of >90%.
a. @CoTCCC Similar to hypotension, hypoxia is association with
b. @JointTraumaSystem higher risk of death. Current literature tells us SaO2 of
c. 27,000+ followers 90% and PaO2 of 60% or above is ideal for the average
2. Twitter patient, but there is evidence that that may be too low for
a. @CommitteeonTCCC the patient with a brain injury and especially in an austere
b. @JointTraumaSyst environment where monitoring and equipment challenges
c. 2,700+ followers can predispose to desaturation events.
3. Instagram

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