Page 155 - JSOM Summer 2020

TCCC-CPP covers several advanced procedures and skills, TXA review and change proposal is evaluating several aspects
it is also focused on knowledge and science behind the prin- including the dosing of TXA (amount and timing), routes of
ciples of the TCCC Guidelines. This focus is to ensure that administration (intramuscular and intraosseous), speed of ad-
medical officers and providers that supervise tactical medics ministration (slow IV push vs 10 minute infusion), and the ap-
have a clear understanding of their capability and employment plicability and dosing of TXA as related to potential traumatic
strategies, especially in skills specific to TCCC. Additionally, brain injury.
TCCC-CPP will provide training in the establishment of unit-
based casualty response systems and their integration into Analgesia in TCCC was last addressed upon the introduction
combat trauma systems in a theater of operations. of the triple option analgesia plan that integrated ketamine
into the TCCC guidelines in 2014. Several recently published
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Finally, the revised curricula will entail a robust train-the- articles have highlighted the poor adherence to the TCCC an-
trainer program for each level of TCCC training. The train-the- algesia guidelines. This review and potential change proposal
trainer program will be a three-phased hybrid of prerequisite will re-evaluate ketamine dosing for analgesia and consider
training, online trainer course, and a proctored evaluation of sedation in TCCC. Also, new medications and new routes of
conducting TCCC training. Phase one is prerequisite training administration for known medications are being evaluated for
which will be recognized service-based instructor courses or guideline inclusion.
the DoD-wide train-the-trainer course on Joint Knowledge
Online (JKO) or previously recognized instructor certifica- Abdominal trauma and eviscerations is a new topic being
tion such that offered by the National Association of EMTs drafted for consideration in TCCC. Changes that have been
(NAEMT). The second phase will be completion of the formal initiated include a relook at airway management, and a reeval-
online TCCC train-the-trainer course structured for each level uation of the use and timing of antibiotics in TCCC.
of TCCC training which will be available on the Deployed
Medicine website and mobile application. Upon completion Harold Montgomery, ATP
of the second phase, a trainer will be eligible for a proctored Vice Chair, CoTCCC
evaluation while providing TCCC training. Upon completion Joint Program Manager, TCCC
of this third phase, the trainer can then conduct future TCCC Brendon Drew, DO
training independently. Chairman, Committee on TCCC

TCCC Pending and Emerging Change Proposals
References
Hypothermia prevention has been a key component of the 1. Giebner SD. The transition to the Committee on Tactical Combat
TCCC Guidelines since the original publication in 1996. There Casualty Care. Wildern Environ Med J. 2017;28:S18–S24.
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has not been an update to the TCCC hypothermia prevention 2. Butler FK. Tactical Combat Casualty Care turns 20. Mil Med.
2017;182:e1563–e1568.
and management guidelines in 14+ years. The time since has 3. National Defense Authorization Act for Fiscal Year 2017.
seen the development of several commercial hypothermia pre- 4. Department of Defense Instruction 1322.24: Medical Readiness
vention enclosure systems as well as increased requirements Training. 16 Mar 2018.
for IV fluid warming especially with the TCCC endorsement 5. Butler FK, Hagmann J, Butler EG. Tactical Combat Casualty Care
of packaged blood products. This proposed change was pre- in Special Operations. Mil Med. 1996;161(suppl):1–16.
sented by Brad Bennett, PhD, at the CoTCCC meeting of 6. Dickey NW, Jenkins D. Defense Health Board recommendation
10-11 SEP 2019 and further discussed on a CoTCCC telecon- for the addition of tranexamic acid to the Tactical Combat Casu-
alty Care guidelines. Defense Health Board Memo dated Septem-
ference held on 11 FEB 2020. ber 23, 2011.
7. Butler FK, Kotwal RS, Buckenmaier CC II, et al. A triple-option
Tranexamic acid (TXA) was integrated into the TCCC Guide- analgesia plan for Tactical Combat Casualty Care: TCCC Guide-
lines in 2011 and has since been reasonably well employed lines change 13-04. J Spec Oper Med. 2014;14(1):13–25.
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units and administered to many combat casualties. The ongoing

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