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with Lactated Ringer’s, normal saline, or Hextend. 5. Provide instructions to ambulatory patients as needed.
If Hextend is used, no more than 1000 ml should 6. Stage casualties for evacuation in accordance with unit
be given, followed by Lactated Ringer’s or normal standard operating procedures.
saline as needed. 7. Maintain security at the evacuation point in accor-
• Initial IV/IO fluid rate is calculated as %TBSA x dance with unit standard operating procedures.
10mL/hr for adults weighing 40–80kg.
• For every 10kg ABOVE 80kg, increase initial rate Principles of Tactical Evacuation Care (TACEVAC)
by 100mL/hr. *The term “Tactical Evacuation” includes both Casualty Evac-
• If hemorrhagic shock is also present, resuscitation uation (CASEVAC) and Medical Evacuation (MEDEVAC) as
for hemorrhagic shock takes precedence over re- defined in Joint Publication 4-02.
suscitation for burn shock. Administer IV/IO fluids
per the TCCC Guidelines in Section (6). Basic Management Plan for Tactical Evacuation Care
• Consider oral fluids for burns up to 30% TBSA if 1. Transition of Care
casualty is conscious and able to swallow. a. Tactical force personnel should establish evacuation
f. Analgesia in accordance with the TCCC Guidelines in point security and stage casualties for evacuation.
Section (10) may be administered to treat burn pain. b. Tactical force personnel or the medic should communi-
g. Prehospital antibiotic therapy is not indicated solely cate patient information and status to TACEVAC per-
for burns, but antibiotics should be given per the sonnel as clearly as possible. The minimum information
TCCC guidelines in Section (11) if indicated to prevent communicated should include stable or unstable, inju-
infection in penetrating wounds. ries identified, and treatments rendered.
h. All TCCC interventions can be performed on or c. TACEVAC personnel should stage casualties on evacua-
through burned skin in a burn casualty. tion platforms as required.
i. Burn patients are particularly susceptible to hypother- d. Secure casualties in the evacuation platform in accor-
mia. Extra emphasis should be placed on barrier heat dance with unit policies, platform configurations and
loss prevention methods. safety requirements.
15. Splint fractures and re-check pulses. e. TACEVAC medical personnel should re-assess casualties
16. Cardiopulmonary resuscitation (CPR). and re-evaluate all injuries and previous interventions.
a. Resuscitation on the battlefield for victims of blast 2. Massive Hemorrhage (same as Tactical Field Care)
or penetrating trauma who have no pulse, no venti- 3. Airway Management
lations, and no other signs of life will not be successful Endotracheal intubation may be considered in lieu of crico-
and should not be attempted. thyroidotomy if trained.
b. However, casualties with torso trauma or polytrauma 4. Respiration/Breathing
who have no pulse or respirations during TFC should Most combat casualties do not require supplemental oxy-
have bilateral needle decompression performed to en- gen, but administration of oxygen may be of benefit for the
sure they do not have a tension pneumothorax prior to following types of casualties:
discontinuation of care. The procedure is the same as • Low oxygen saturation by pulse oximetry
described in section (5a) above. • Injuries associated with impaired oxygenation
17. Communication • Unconscious casualty
a. Communicate with the casualty if possible. Encour- • Casualty with TBI (maintain oxygen saturation > 90%
age, reassure and explain care. • Casualty in shock
b. Communicate with tactical leadership as soon as pos- • Casualty at altitude
sible and throughout casualty treatment as needed. • Known or suspected smoke inhalation
Provide leadership with casualty status and evacuation 5. Circulation (same as Tactical Field Care)
requirements to assist with coordination of evacuation 6. Traumatic Brain Injury
assets. a. Casualties with moderate/severe TBI should be moni-
c. Communicate with the evacuation system (the Pa- tored for:
tient Evacuation Coordination Cell) to arrange for o Decreases in level of consciousness
TACEVAC. Communicate with medical providers on o Pupillary dilation
the evacuation asset if possible and relay mechanism o SBP should be >90mmHg
of injury, injuries sustained, signs/symptoms, and o O sat > 90
2
treatments rendered. Provide additional information o Hypothermia
as appropriate. o End-tidal CO (If capnography is available, maintain
2
18. Documentation of Care between 35–40mmHg)
• Document clinical assessments, treatments rendered, o Penetrating head trauma (if present, administer
and changes in the casualty’s status on a TCCC Card antibiotics)
(DD Form 1380). Forward this information with the o Assume a spinal (neck) injury until cleared.
casualty to the next level of care. b. Unilateral pupillary dilation accompanied by a de-
19. Prepare for Evacuation creased level of consciousness may signify impending
1. Complete and secure the TCCC Card (DD 1380) to the cerebral herniation; if these signs occur, take the fol-
casualty. lowing actions to decrease intracranial pressure:
2. Secure all loose ends of bandages and wraps. • Administer 250mL of 3 or 5% hypertonic saline IV/
3. Secure hypothermia prevention wraps/blankets/straps. IO bolus.
4. Secure litter straps as required. Consider additional • Elevate the casualty’s head 30 degrees.
padding for long evacuations. • Hyperventilate the casualty.

16 | JSOM Volume 22, Edition 1 / Sping 2022