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TABLE 8 PCC Role-based Guideline for Hyperthermia Management
PCC Role-based Guidance for Hyperthermia Management
TCCC - TCCC - TCCC - TCCC - Complete Basic TCCC Management Plan for Hyperthermia then:
ASM CLS CMC CPP Role 1a:
• Move the casualty to the shade if possible.
• Insulate the casualty from the ground (conduction).
• Remove the casualty from a vehicle (radiation).
• If situation allows, remove the casualty’s helmet and vest (evaporation).
• Fan the casualty (convection).
• If the casualty is conscious and not vomiting, give liquids.
• Protect the casualty from exposure to sources of heat if possible.
• DO NOT give acetaminophen, aspirin or ibuprofen for hyperthermia, only for fever.
• Prevent heat illness/injury in casualties by maintaining hydration, adding salt to food, resting in shade, staying off
hot surfaces (ground or vehicle), removing tactical gear when possible.
Role 1b:
• Continue and/or initiate above hyperthermia interventions.
Role 1c:
• Continue and/or initiate the Role 1a/Role 1b phases as detailed above.
• Perform all recommended interventions from guidelines for above tier level
• Additional interventions include:
Role 1a:
• If the casualty is unconscious or vomiting, use IV/IO fluids.
• Communicate re-supply requirements.
Role 1b:
• Continue and/or initiate above hyperthermia interventions.
Role 1c:
• Continue and/or initiate the Role 1a/Role 1b phases as detailed above.
• Interventions for both CMC and CPP providers 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:
• If the casualty is unconscious or vomiting, use IV/IO fluids.
• Monitor for signs and symptoms of heat exhaustion – if present: Immediately replace fluids and electrolytes.
• Monitor for signs and symptoms of heat stroke – if present:
• Immediate cooling must be initiated.
o Minimum: Wetting clothing.
o Better: Fanning the casualty after wetting clothing.
o Best: Immersion in water.
• Casualties should eat, if possible, to prevent sodium loss, which may lead to dilutional hyponatremia (low sodium).
• Dilutional hyponatremia may look like heat illness, but is due to drinking and not eating.
• Seizures should be treated with benzodiazepines.
• 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.
• Best: Continuous core temperature monitoring.
• Prevent heat illness/injury in casualties by maintaining hydration, adding salt to food, resting in shade, staying off
hot surfaces (ground or vehicle), removing tactical gear when possible.
Role 1c:
• Continue and/or initiate the Role 1a/Role 1b phases as detailed above.
Interventions for both CMC and CPP are the same.

These PCC pain management guidelines are intended to be used after needed to maintain patient safety and/or operational control of the
TCCC Guidelines at the Role 1 setting, when evacuation to higher environment (i.e., in the back of an evacuation platform).
level of care is not immediately possible. They attempt to decrease 5. Stop awareness. During painful procedures, and during some mis-
complexity by minimizing options for monitoring, medications, and sion requirements, amnesia may be desired. If appropriate, disarm
the like, while prioritizing experience with a limited number of op- or clear their weapons and prevent access to munitions/mission es-
tions versus recommending many different options for a more custom- sential communications.
ized fashion. Furthermore, it does not address induction of anesthesia General Principles
before airway management (i.e., rapid sequence intubation).
Consider pain in three categories:
Remember, YOU CAN ALWAYS GIVE MORE, but it is very diffi- 1. Background: the pain that is present because of an injury or
cult to take away. Therefore, it is easier to prevent cardiorespiratory wound. This should be managed to keep a patient comfortable at
depression by being patient and methodical. TITRATE TO EFFECT. rest but should not impair breathing, circulation, or mental status.
2. Breakthrough: the acute pain induced with movement or manip-
Priorities of Care Related to Analgesia and Sedation ulation. This should be managed as needed. If breakthrough pain
1. Keep the casualty alive. DO NOT give analgesia and/or sedation if occurs often or while at rest, pain medication should be increased
there are other priorities of care (e.g., hemorrhage control).
2. Sustain adequate physiology to maintain perfusion. DO NOT give in dose or frequency as clinically prudent but within the limits of
safety for each medication.
medications that lower blood pressure or suppress respiration if 3. Procedural: the acute pain associated with a procedure. This should
the patient is in shock or respiratory distress (or is at significant be anticipated and a plan for dealing with it should be considered.
risk of developing either condition).
3. Manage pain appropriately (based on the pain categories below). ■ Analgesia is the alleviation of pain and should be the primary
focus of using these medications (treat pain before consider-
4. Maintain safety. Agitation and anxiety may cause patients to do ing sedation). However, not every patient requires (or should
unwanted things (e.g., remove devices, fight, fall). Sedation may be

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