Page 13 - 2022 Spring JSOM

Tactical Combat Casualty Care (TCCC) Guidelines
for Medical Personnel

15 December 2021*

RED text indicates new text in this year’s update to the TCCC • Alternative hemostatic adjuncts:
Guidelines; BLUE text indicates text that did not change but ■ Celox Gauze or
was relocated within the guidelines. ■ ChitoGauze or
Recent changes include junctional and airway device recom- ■ XStat (best for deep, narrow-tract junctional
mendations, analgesia, and abdominal evisceration guidelines. wounds)
■ iTClamp (may be used alone or in conjunction
with hemostatic dressing or XStat)
Basic Management Plan for Care Under Fire/Threat • Hemostatic dressings should be applied with at least
1. Return fire and take cover.
2. Direct or expect casualty to remain engaged as a combatant 3 minutes of direct pressure (optional for XStat).
if appropriate. Each dressing works differently, so if one fails to con-
3. Direct casualty to move to cover and apply self-aid if able trol bleeding, it may be removed and a fresh dressing
or when tactically feasible, move or drag casualty to cover. of the same type or a different type applied. (Note:
4. Try to keep the casualty from sustaining additional wounds. XStat is not to be removed in the field, but additional
5. Casualties should be extracted from burning vehicles or XStat, other hemostatic adjuncts, or trauma dress-
buildings and moved to places of relative safety. Do what is ings may be applied over it.)
necessary to stop the burning process. • If the bleeding site is amenable to use of a junc-
6. Stop life-threatening external hemorrhage if tactically tional tourniquet, immediately apply a junctional
feasible: tourniquet. Do not delay in the application of the
a. Direct casualty to control hemorrhage by self-aid if able. junctional tourniquet once it is ready for use. Apply
b. Use a CoTCCC-recommended limb tourniquet for hem- hemostatic dressings with direct pressure if a junc-
orrhage that is anatomically amenable to tourniquet use. tional tourniquet is not available or while the junc-
c. Apply the limb tourniquet over the uniform clearly prox- tional tourniquet is being readied for use.
imal to the bleeding site(s). If the site of the life-threaten- c. For external hemorrhage of the head and neck where the
ing bleeding is not readily apparent, place the tourniquet wound edges can be easily re-approximated, the iTClamp
“high and tight” (as proximal as possible) on the injured may be used as a primary option for hemorrhage control.
limb and move the casualty to cover. Wounds should be packed with a hemostatic dressing or
7. Airway management is generally best deferred until the XStat, if appropriate, prior to iTClamp application.
Tactical Field Care phase. • The iTClamp does not require additional direct pres-
sure, either when used alone or in combination with
other hemostatic adjuncts.
Basic Management Plan for Tactical Field Care • If the iTClamp is applied to the neck, perform fre-
1. Establish a security perimeter in accordance with unit tac-
tical standard operating procedures and/or battle drills. quent airway monitoring and evaluate for an ex-
Maintain tactical situational awareness. panding hematoma that may compromise the airway.
2. Triage casualties as required. Casualties with an altered • Consider placing a definitive airway if there is evi-
mental status should have weapons and communications dence of an expanding hematoma
equipment taken away immediately. • DO NOT APPLY on or near the eye or eyelid (within
3. Massive Hemorrhage 1cm of the orbit).
a. Assess for unrecognized hemorrhage and control all d. Perform initial assessment for hemorrhagic shock (al-
sources of bleeding. If not already done, use a CoTCCC- tered mental status in the absence of brain injury and/
recommended limb tourniquet to control life-threatening or weak or absent radial pulse) and consider immediate
external hemorrhage that is anatomically amenable to initiation of shock resuscitation efforts.
tourniquet use or for any traumatic amputation. Apply 4. Airway Management
directly to the skin 2–3 inches above the bleeding site. If a. Conscious casualty with no airway problem identified:
bleeding is not controlled with the first tourniquet, apply • No airway intervention required
a second tourniquet side-by-side with the first. b. Unconscious casualty without airway obstruction:
b. For compressible (external) hemorrhage not amenable • Place casualty in the recovery position
to limb tourniquet use or as an adjunct to tourniquet • Chin lift or jaw thrust maneuver or
removal, use Combat Gauze as the CoTCCC hemostatic • Nasopharyngeal airway or
dressing of choice. • Extraglottic airway
*Joint Trauma System Clinical Practice Guidelines are listed and available at https://jts.amedd.army.mil/index.cfm/PI_CPGs/cpgs

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