Page 167 - JSOM Spring 2020

2. Marines: Wet dressing, prevent hypothermia. • Replace moxifloxacin with levofloxacin? (COL Clint
Murray)
Questions for CoTCCC: • Increase initial ketamine dose? (MAJ Andy Fisher)
1. Does wound management in prehospital setting favor- • Specify using the two vented chest seals with laminar
ably impact patient mortality? vents? Or just don’t treat open pneumothorax? (Dr Bi-
2. If so, what is the preferred method for managing ab- jan Kheirabadi 2017)
dominal evisceration? • Incorporate sedation agents (benzos?) into the TCCC
3. Wet vs dry dressing? Guidelines? (Col Stacy Shackelford/MSG Mike Remley)
4. Sterile vs plastic/mylar (garbage bags need to be clear) • Relook at Cric-Key (75th Ranger Regiment experi-
™
5. Irrigation? ence) and NPA use
a. Yes or no • Tourniquets and hemostatic dressings: Need a combina-
b. If yes, what fluid? tion of preferred features and routine (annual) review of
6. Reduction? recommended devices using comprehensive, standard-
7. AAJT? ized metrics for both new devices and previously recom-
8. Antibiotics? mended devices that have been modified since CoTCCC
a. Combat Wound Pill Pack recommendation.
b. Ertapenem • Modify treatment of eye injuries to specify that life-
9. XSTAT threatening bleeding from the orbit should be treated
a. Potential 72-hour indication for prolonged field care. while addressing massive hemorrhage?
TCCC Proposed Change? • Snakebite?
• Near-drowning?
1. Inspect and dress known wounds. • CBRN Section in the TCCC Guidelines?
a. Abdominal evisceration – cover exposed bowel with • Additional Measures in ARC?
a moist, sterile dressing or sterile water – imperme- o Calcium and bicarb prior to balloon deflation?
able covering. o Valproic acid for TBI?
b. Attempt may be made to replace abdominal contents o Vasopressin?
by gently lifting the abdominal skin peripheral to the o Ventilators?
exposed viscera; DO NOT force contents back into o Glideslope intubation?
abdomen or reduce obviously contaminated or ac- o Progesterone?
tively bleeding viscera. o Suction for chest tubes?
Dr Warren Dorlac agreed with covering and not reducing. o AED?
Definitely need to cover it to prevent heat loss as well. o Wound care – irrigation?
o Lateral canthotomy
Dr Peter Rhee stated “There is a bowel bag (wet moist o Pneumatic tourniquet?
dressing). Cover it, wet it.” o What else?
Mr Don Parsons stated “A shower cap = bowel bag.” Future Technology Items
Harold “Monty” Montgomery asked, “What about ab- • After FDA approval and/or more studies
dominal bleeds?” • ResQFoam ™
• Compensatory Reserve Index Monitor
7. ACTION ITEMS • AAJT? (when NCTH bleeding can be localized)
• AFMES Conference 4 Sept 2019
Dr Frank Butler wrapped up the day-and-a-half of discus- • 2 potentially preventable deaths
sion by reviewing what is on the docket for the CoTCCC. • Isolated iliac vessels injuries
CoTCCC Changes Currently Under Consideration TCCC Business Practice Decision
19-01 Tourniquet Review Mr Montgomery How do we handle situations in which a TCCC-recom-
(Approved) mended item is significantly changed?
19-02 TXA Relook CAPT Brendon Drew • Tourniquets
• XStat – chitosan removed
®
19-03 Hypothermia Relook Dr Brad Bennett
• Celox Gauze to Celox - Rapid
™
™
19-04 IT Clamp Relook CDR Dana Onifer • Cric-Key packaging with Cric-Knife ™
™
(Approved)
CoTCCC Way Ahead – Leadership Recommendations
19-05 Evisceration Injuries LTC Jamie Riesberg • Interim CoTCCC Chairman: CAPT Brendon Drew
• Vice Chairman: Mr Harold “Monty” Montgomery
19-06 Fluid Resuscitation CDR Travis Deaton
8. AFTERNOON: Breakout Sessions
Other Proposed Changes to TCCC
• Plasma for fluid resuscitation in burn patients Acknowledgments
• Plasma for fluid resuscitation in TBI patients The authors gratefully acknowledge the ongoing efforts of
• End-tidal CO monitoring in TFC members of the TCCC working group, our invited speakers,
2
• Calcium administration in TFC even for casualties not and other meeting attendees to improve the battlefield trauma
yet being transfused – give it for the same indications care provided to our nations’ combat wounded.
as TXA?
• Modify treatment of eye injuries to specify that life- Disclaimers
threatening bleeding from the orbit should be treated The opinions or assertions contained herein reflect the events
while addressing massive hemorrhage? of the 10–11 September 2019 meeting of the CoTCCC. They
• Input on “Three Things I Would Change About TCCC” are not to be construed as reflecting the views of the Depart-
from the Service trauma consultants presented at this ment of the Army or the Department of Defense.
meeting
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