Page 19 - 2022 Spring JSOM

– Respiratory rate 20 b. Communicate with medical providers at the next level
– Capnography should be used to maintain the of care as feasible and relay mechanism of injury, in-
end-tidal CO between 30–35mmHg. juries sustained, signs/symptoms, and treatments ren-
2
– The highest oxygen concentration (FIO ) possi- dered. Provide additional information as appropriate
2
ble should be used for hyperventilation. 18. Documentation of Care (same as Tactical Field Care)
– Do not hyperventilate the casualty unless signs
of impending herniation are present. Casualties
may be hyperventilated with oxygen using the SUMMARY OF 2021 CHANGES:
bag-valve-mask technique. 3. Massive Hemorrhage
7. Hypothermia Prevention (same as Tactical Field Care) b. “CoTCCC-Recommended” is removed from junc-
8. Penetrating Eye Trauma (same as Tactical Field Care) tional tourniquets. No specific products are recom-
9. Monitoring (same as Tactical Field Care) mended by the CoTCCC. End users should select
10. Analgesia (same as Tactical Field Care) any FDA-approved device that is indicated for
11. Antibiotics (same as Tactical Field Care) junctional hemorrhage control.
12. Inspect and dress known wounds (same as Tactical Field 4. Airway Management
Care) d. Removes Cric-Key technique as preferred option
13. Check for additional wounds. (same as Tactical Field Care) for surgical cricothyroidotomy and remove “least
14. Burns (same as Tactical Field Care) desirable option” from the standard open surgi-
15. Splint fractures and re-check pulses (same as Tactical Field cal technique. Units and end users should use the
Care) technique they are best trained to execute.
16. Cardiopulmonary resuscitation (CPR) in TACEVAC Airway Notes: Removes iGel as the preferred extraglot-
a. Casualties with torso trauma or polytrauma who have tic airway. Units may still use iGel if mission are at high
no pulse or respirations during TACEVAC should have elevation or evacuation is at high altitudes.
bilateral needle decompression performed to ensure 6. Analgesia – adjust Ketamine IV/IO dosing to 20–
they do not have a tension pneumothorax. The pro- 30mg (or 0.2–0.3mg/kg)
cedure is the same as described in Section (4a) above. 12. Inspect and dress known wounds
b. CPR may be attempted during this phase of care if the b. Adds the preference of cleaning abdominal evis-
casualty does not have obviously fatal wounds and ceration with clean and warm water if possi-
will be arriving at a facility with a surgical capability ble; clarifies guidance on conditions to attempt
within a short period of time. CPR should not be done reduction of abdominal contents; that patient
at the expense of compromising the mission or deny- should remain NPO and NOT be administered
ing lifesaving care to other casualties. oral medicals (Combat Wound Medication
17. Communication pack) and removes prolonged care consider-
a. Communicate with the casualty if possible. Encour- ations (now covered in separate PCC guidelines).
age, reassure and explain care.

COMMITTEE ON TACTICAL COMBAT CASUALTY CARE (CoTCCC) in 2021
CMSgt Shawn Anderson Maj D. Marc Northern, MD Jeffrey Cain, MD
CAPT Sean Barbabella, DO Mr Keith O’Grady David Callaway, MD
HMC Kevin Baskin CDR Dana Onifer, MD Andre Cap, MD
SFC Hunter Black Dr Edward Otten, MD Howard Champion, MD
HMCM Mark Boyle SFC Justin Rapp Cord Cunningham, MD
SGM Curt Conklin MSG Michael Remley James Czarnik, MD
CAPT Travis Deaton, MD COL Jamie Riesberg, MD William Donovan, PA
CAPT John Devlin, MD HMCM Tyler Scarborough Warren Dorlac, MD
Col John Dorsch, MD COL Jason Seery, MD John Gandy, MD
COL Brian Eastridge, MD Col Stacy Shackelford, MD James Geracci, MD
Dr Erin Edgar, MD CMSgt Travis Shaw John Holcomb, MD
MAJ Andrew Fisher, MD CSM Timothy Sprunger Donald Jenkins, MD
LtCol Brian Gavitt, MD Mr Richard Strayer Russ Kotwal, MD
Mr William Gephart, PA, RN LtCol Matthew Streitz, MD Robert Mabry, MD
MAJ Christopher Gonzales, PA CAPT Matthew Tadlock, MD Ethan Miles, MD
COL Kirby Gross, MD SFC Dominic Thompson Kevin O’Connor, DO
COL Jennifer Gurney, MD HMCM Jeremy Torrisi Peter Rhee, MD
COL Bonnie Hartstein, MD Thomas Rich, NRP
CDR Shane Jensen, MD COTCCC STAFF Steve Rush, MD
COL Jay Johannigman, MD Dr Frank Butler, MD Marty Schreiber, MD
Mr Win Kerr Mr Matthew Adams Jeffrey Timby, MD
LTC Ryan Knight, MD Ms Danielle Davis
CDR Joseph Kotora, MD SUBJECT MATTER EXPERT ADVISORS
CAPT Lanny Littlejohn, MD Paul Allen, DSc, PA
CPT John Maitha, PA James Bagian, MD
MSgt Billie Nored Brad Bennett, PhD

TCCC Guidelines for Medical Personnel | 17