Page 151 - 2020 JSOM Winter

– Odds of a stable, successful reduction are low – have bilateral needle decompression performed to en-
make a single attempt to reduce and then dress sure they do not have a tension pneumothorax prior to
in place. discontinuation of care. The procedure is the same as
– Hypothermia – monitor closely as exposed ab- described in section (5a) above.
dominal contents will result in more rapid heat 17. Communication
loss. a. Communicate with the casualty if possible. Encour-
– Reevisceration – In the event of reevisceration age, reassure, and explain care.
(hernia) remove the skin closure and cover the b. Communicate with tactical leadership as soon as pos-
eviscerated organs as recommended in 12 a. sible and throughout casualty treatment as needed.
– If no known endpoint exists for surgical care, Provide leadership with casualty status and evacuation
consider NOT attempting reduction. requirements to assist with coordination of evacuation
13. Check for additional wounds assets.
14. Burns c. Communicate with the evacuation system (the Pa-
a. Assess and treat as a trauma casualty with burns and tient Evacuation Coordination Cell) to arrange for
not burn casualty with injuries. TACEVAC. Communicate with medical providers on
b. Facial burns, especially those that occur in closed the evacuation asset if possible and relay mechanism
spaces, may be associated with inhalation injury. Ag- of injury, injuries sustained, signs/symptoms, and
gressively monitor airway status and oxygen satura- treatments rendered. Provide additional information
tion in such patients and consider early surgical airway as appropriate.
for respiratory distress or oxygen desaturation. 18. Documentation of care
c. Estimate total body surface area (TBSA) burned to the • Document clinical assessments, treatments rendered,
nearest 10% using the Rule of Nines. and changes in the casualty’s status on a TCCC Card
d. Cover the burn area with dry, sterile dressings. For ex- (DD Form 1380). Forward this information with the
tensive burns (>20%), consider placing the casualty in casualty to the next level of care.
the Heat-Reflective Shell or Blizzard Survival Blanket 19. Prepare for evacuation
from the Hypothermia Prevention Kit in order to both a. Complete and secure the TCCC Card (DD 1380) to
cover the burned areas and prevent hypothermia. the casualty.
e. Fluid resuscitation (USAISR Rule of Ten): b. Secure all loose ends of bandages and wraps.
• If burns are >20% of TBSA, fluid resuscitation c. Secure hypothermia prevention wraps/blankets/straps.
should be initiated as soon as IV/IO access is es- d. Secure litter straps as required. Consider additional
tablished. Resuscitation should be initiated with padding for long evacuations.
lactated Ringer’s, normal saline, or Hextend. If e. Provide instructions to ambulatory patients as needed.
Hextend is used, no more than 1000mL should be f. Stage casualties for evacuation in accordance with unit
given, followed by lactated Ringer’s or normal sa- standard operating procedures.
line as needed. g. Maintain security at the evacuation point in accor-
• Initial IV/IO fluid rate is calculated as %TBSA dance with unit standard operating procedures.
✕ 10mL/hr for adults weighing 40–80kg.
• For every 10kg ABOVE 80kg, increase initial rate Basic Management Plan for
by 100mL/hr.
• If hemorrhagic shock is also present, resuscitation Transition of Care to TACEVAC
for hemorrhagic shock takes precedence over re- Transition of Care From TFC
suscitation for burn shock. Administer IV/IO fluids 1. Tactical force personnel should establish evacuation point
per the TCCC Guidelines in Section (6). security and stage casualties for evacuation.
• Consider oral fluids for burns up to 30% TBSA if 2. Tactical force personnel or the medic should communicate
casualty is conscious and able to swallow. patient information and status to TACEVAC personnel as
f. Analgesia in accordance with the TCCC Guidelines in clearly as possible. The minimum information communi-
Section (10) may be administered to treat burn pain. cated should include stable or unstable, injuries identified,
g. Prehospital antibiotic therapy is not indicated solely and treatments rendered.
for burns, but antibiotics should be given per the 3. TACEVAC personnel should stage casualties on evacuation
TCCC guidelines in Section (11) if indicated to prevent platforms as required.
infection in penetrating wounds. 4. Secure casualties in the evacuation platform in accordance
h. All TCCC interventions can be performed on or with unit policies, platform configurations and safety
through burned skin in a burn casualty. requirements.
i. Burn patients are particularly susceptible to hypother- 5. TACEVAC medical personnel should reassess casualties
mia. Extra emphasis should be placed on barrier heat and reevaluate all injuries and previous interventions.
loss prevention methods.
15. Splint fractures and recheck pulses.
16. Cardiopulmonary resuscitation (CPR). Basic Management Plan for Tactical Evacuation Care
a. Resuscitation on the battlefield for victims of blast 1. Transition of Care
or penetrating trauma who have no pulse, no venti- 2. Massive Hemorrhage (same as Tactical Field Care)
lations, and no other signs of life will not be successful 3. Airway Management
and should not be attempted. Endotracheal intubation may be considered in lieu of crico-
b. However, casualties with torso trauma or polytrauma thyroidotomy if trained.
who have no pulse or respirations during TFC should 4. Respiration/Breathing

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