Page 26 - 2022 Spring JSOM

TABLE 5 Continued
PCC Level for Circulation and Resuscitation
TCCC - TCCC - • Re-assess and re-apply MARCH interventions.
CMC CPP • Review TTD/titer of present unit members.
• Ensure all interventions noted above are completed by TCCC ASM, CLS and CMC personnel
• Conduct inventory of all shock treatment supplies including whole blood, testing equipment, IVs, and other resources etc.
• Document all pertinent information on PCC Flowsheet (attached).
• Additional interventions include:
Role 1a:
• Interventions for both Tier 3 and Tier 4 level providers at this phase are the same.
Role 1b:
• Ultrasound may be used to further refine the cause of ongoing hemorrhage or other causes of shock if available and medical provider is
trained in its use.
• If ultrasound is available, teleconsultation can also be used to guide the provider in its implementation.
• Continually observe for changes in patient status, signs of clinical deterioration, alternate causes of shock, and need for change in
resuscitation strategies.
• Continue resuscitation until:
o Minimum: palpable radial pulse or improved mental status
o Better: SBP > 90mmHg
o Best: SBP between 100–110mmHg.
Role 1c:
• Convert to type-specific blood replacement.
• Ultrasound may be used to further refine the cause of ongoing hemorrhage or other causes of shock if available and medical provider is
trained in its use.
• If ultrasound is available, teleconsultation can also be used to guide the provider in its implementation.
• Continually observe for changes in patient status, signs of clinical deterioration, alternate causes of shock and need for change in
resuscitation strategies.
• Continue resuscitation until:
o Minimum: palpable radial pulse or improved mental status
o Better: SBP > 90mmHg
o Best: SBP between 100–110mmHg.
• If SBP remains less than 100–110mmHg despite appropriate resuscitation and hemorrhage control, a vasopressor agent should be
started if available.*
*All use of pressors should be administered by role-based approved protocols or teleconsultation approval:
• norepinephrine continuous infusion 0.1–0.4mcg/kg/min
• vasopressin continuous infusion 0.01–0.04 units
TABLE 6 PCC Role-based Guidelines for Communications and Documentation
PCC Role-based Guidelines for Communication and Documentation
TCCC - TCCC - TCCC - TCCC - Complete Basic TCCC Communication and Documentation Principles then:
ASM CLS CMC CPP • Identify requirements for communicating care to the casualty, leadership, and medical personnel in accordance
with TCCC Guidelines.
• Document casualty information on the DD Form 1380 TCCC Card and ensure proper placement of that card on
the casualty, in accordance with DHA-PI 6040.01.
• Initiate scripted teleconsultation.
• Monitor the documentation for each casualty and ensure that it is completed by those service members assisting
with care.
• Initiate scripted teleconsultation.
Ensure documentation and communication is completed for each casualty in accordance with PCC standards:
• Ensure that communication is established with evacuation assets and/or receiving facilities.
• Prepare evacuation request and set up priorities for evacuation for each casualty.
• Ensure DD1380 TCCC Cards are completed for every casualty.
• Initiate scripted teleconsultation.
• Complete AAR.
Ensure documentation and communication is completed for each casualty in accordance with PCC standards:
• Ensure communication is established with evacuation assets and/or receiving facilities.
• Initiate scripted teleconsultation, if needed.
• Prepare evacuation request and set up priorities for evacuation for each casualty.
• Ensure DD1380 TCCC Cards are completed for every casualty.
• Complete After Action Report with an emphasis on the scenario’s impact on future unit-level medical training and
logistics requirements.
*Link to Documentation in Prolonged Field Care, 13 Nov 2018 CPG
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*Link to Documentation Requirements for Combat Casualty Care, 18 Sep 2020 CPG
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Hyperthermia – Dr Edward Otten (see Table 8) Heat exhaustion
Symptoms: weak, dizzy, nauseated, headache, sweating, normal mental
Background status. Heat exhaustion requires replacement of fluids and electrolytes.
1. Hyperpyrexia is elevated body temperature.
2. Fever is elevated body temperature in response to a change in hy- Heat stroke
pothalamic set point (infections). Symptoms: Hyperthermia + mental status changes. Heat stroke requires
3. Hyperthermia is elevated body temperature without a change in immediate cooling.
hypothalamic set point (heat illness, hyperthyroid, drugs).
4. The Second Law of Thermodynamics states that heat flows from Head Injury/TBI – Dr Matt Martin
hot to cold. Background
5. Heat transfer can occur through several processes: TBI occurs when external mechanical forces impact the head and
a. Radiation cause an acceleration/deceleration of the brain within the cranial vault
b. Conduction which results in injury to brain tissue. TBI may be closed (blunt or
c. Convection blast trauma) or open (penetrating trauma). Signs and symptoms of
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d. Evaporation
TBI are highly variable and depend on the specific areas of the brain

24 | JSOM Volume 22, Edition 1 / Sping 2022