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TABLE 7 PCC Role-based Guidance for Hypothermia Management
PCC Role-based Guidelines for Communication and Documentation
TCCC - TCCC - TCCC - TCCC - Complete Basic TCCC Management Plan for Hypothermia then:
ASM CLS CMC CPP Role 1a:
• Take early and aggressive steps to prevent further body heat loss and add external heat when possible for both
trauma and severely burned casualties.
• Minimize casualty’s exposure to cold ground, wind and air temperatures. Place insulation material between the
casualty and any cold surface as soon as possible.
• Keep protective gear on or with the casualty, if feasible.
• Replace wet clothing with dry clothing, if possible, and protect from further heat loss. If unable to replace the dry
clothing, wrap an impermeable layer around the casualty.
• Place an active heating blanket on the casualty’s anterior torso and under the arms in the axillae.
o Caution: DO NOT place any active external heating directly on the skin or in areas of skin which are under
pressure or have poor blood flow as this increases risk of injury and/or skin burns.
• Enclose the casualty with the exterior impermeable enclosure bag, if available.
• Protect the casualty from exposure to wind and precipitation on any evacuation platform.
Role 1b:
• Continue and/or initiate above hypothermia interventions.
• Pre-stage an insulated hypothermia enclosure system with external active heating for transition from the non-
insulated hypothermia enclosure systems; seek to improve upon existing enclosure system when possible.
• Upgrade hypothermia enclosure system to a well-insulated enclosure system using a hooded sleeping bag or other
readily available insulation inside the enclosure bag/external vapor barrier shell.
o Best: Improvised hypothermia wrap with high-quality insulation with cold-rated sleeping bag combined with heat
source, internal vapor barrier, outer impermeable enclosure.
• When using the Hypothermia Prevention and Management Kit (HPMK) ready-heat-blanket, perform frequent skin
checks to monitor for contact burns.
• Protect the casualty from exposure to wind and precipitation on any evacuation platform.
Role 1c:
• Continue and/or initiate the Role 1a/Role 1b phases as detailed above.
• Replace ready-heat-blanket when using >10 hr.
• Perform all recommended interventions from guidelines for above Tier level
• Additional interventions include:
Role 1a:
• Communicate re-supply requirements.
Role 1b:
• Protect the casualty from exposure to wind and precipitation on any evacuation platform.
Role 1c:
• Continue and/or initiate the Role 1a/Role 1b phases as detailed above
• Replace ready-heat-blanket when using >10 hr.
• Interventions for both CMC and CPP are the same.
• Ensure all interventions noted above are completed by TCCC ASM and CLS personnel
• Conduct inventory of all resources.
• Document all pertinent information on PCC Flowsheet (attached).
• Additional interventions include:
Role 1a:
• Use a battery-powered warming device to deliver IV resuscitation fluids, in accordance with current TCCC
guidelines, at flow rate up to 150mL/min with a 38°C output temperature.
• Communicate re-supply requirements.
Role 1b:
• Convert to continuous temperature monitoring.
o Minimum: Scheduled temperature measurement with vital sign evaluations.
o Better: Continuous forehead dot monitoring.
o Best: Continuous core temperature monitoring.
• Protect the casualty from exposure to wind and precipitation on any evacuation platform.
Role 1c:
• Continue and/or initiate the Role 1a/Role 1b phases as detailed above.
• Replace ready-heat-blanket when using >10 hr.
Interventions for both CMC and CPP are the same.
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*Link to Hypothermia Prevention, Monitoring and Management, 18 Sep 2012 CPG
affected and the injury severity. Alteration in consciousness and focal (as clinically indicated) and airway control (don’t just elevate the
neurologic deficits are common. Various forms of intracranial hem- head by bending the neck).
orrhage, such as epidural hematoma, subdural hematoma, subarach- 4. Define CSWB distribution quantities in area of responsibility.
noid hemorrhage, and hemorrhagic contusion can be components of 5. Determine feasibility and requirement for pre-deployment unit
TBI. The vast majority of TBIs are categorized as mild and are not level blood draw.
considered life threatening; however, it is important to recognize this 6. Conduct unit level pre-deployment blood draw as required.
injury because if a patient is exposed to a second head injury while 7. Ensure critical head-injury adjunct medications appropriately
still recovering from a mild TBI, they are at risk for increased long- stocked and storage requirements met.
term cognitive effects. Moderate and severe TBIs are life-threatening Treatment Guidelines (see Table 9).
injuries.
Pre-deployment, Mission Planning, and Pain Management (Analgesia and Sedation) –
Training Considerations Dr Andrew Fisher, SMSgt Brit Adams
1. Conduct unit level TTD/Titer testing and develop an operational Background
roster.
2. Conduct baseline neurocognitive assessment per Service guideline. A provider of PCC must first and foremost be an expert in TCCC and
then be able to identify all the potential issues associated with pro-
3. When possible and practical, keep patient in an elevated orientation viding analgesia with or without sedation for a prolonged (4–48 hr.)
to approximately 30 degrees while maintaining C-spine precautions
period (see Table 10).
Prolonged Casualty Care Guidelines | 25