Page 42 - 2022 Spring JSOM

APPENDIX A: TCCC GUIDELINES

TCCC Guidelines https://deployedmedicine.com/market/31/content/40
Open the attachment on the side menu or open the below link to print
or fill out electronically.
APPENDIX B: AIRWAY RESOURCES

Nursing Care Checklist https://prolongedfieldcare.org/wp-content/uploads/2018/05/PFC-
Open the attachment on the side menu or open the below link to print Nursing-Care-Plan_.pdf
or fill out electronically.
APPENDIX C: MASCAL RESOURCES

Triage Guiding Principles (see Figure 4 and Table 21) Triage Class 1 (MASCAL)
■ Priorities change based on time from injury Adequate medics to treat critical patients and handle the rest (see
■ Activities in first hour are CRITICAL Table 22)
■ Don’t waste time with formal triage tools ■ Many casualties
■ Threat controlled
Just extricate/stop threat, stop external bleeding, clear airway ■ Resources not severely limited
■ Transfusion and ventilator support within the first hour identify a ■ Medical personnel can arrive
resource-intensive patient ■ Evacuation possible
■ Damage control surgery has little impact after the first hour
TABLE 22 Triage Class 1 Actions and Goals
FIGURE 4 TRIAGE cheat cards STAR <1 Hour 1–4 Hours >4 Hours
START TRIAGE: Assess, Treat (use bystanders) After Injury After Injury After Injury
When you have a color: STOP – TAG – MOVE ON Goals Goals Goals
Move walking wounded
• Eliminate Threat • DCR/DCS as Evacuate
No RESPIRATIONS after head tilt • Establish CCP soon as possible
Breathing but UNCONSCIOUS • Blood transfusion • Use advanced
within 30 min resuscitation
Respirations over 30
D I • Evacuate to DCR/ to “extend the
M E M Perfusion capillary refill > 2 or NO RADIAL PULSE DCS within 1 hour Golden Hour”
I C M Control bleeding Actions Actions Actions
N E E Mental Status: unable to follow simple commands • Stop external bleeding • MARCH PAWS Use prolonged
O A D Otherwise • Clear airway • Transfuse care to optimize
R S I D • Ensure ventilation outcomes
E
E A L Remember: • Formal triage
D T A Respirations – 30 • Transfuse
E Y Perfusion – 2
E Mental Status – Can Do Triage Class 2 (MASCAL)
D
Unable to manage the number of critical patients (see Table 23)
■ Numerous casualties or MASCAL (i.e., < 100 Casualties)
TABLE 21 Triage Assessment ■ Threat has been controlled or partially controlled
Each Patient Triage Assessment Should Be Complete in Less Than ■ Resources are very limited
60 Seconds ■ Medical personnel can arrive (may be delayed > 1 hour)
Category Examples ■ Evacuation is possible (may be delayed > 1 hour)
Category I: • (Any MARCH issue)
Immediate (red chemlite) • Airway obstruction TABLE 23 Triage Class 2 Actions and Goals
• Flail/open chest wound <1 Hour 1 – 4 Hours >4 Hours
• Tension – Pneumothorax/hemothorax After Injury After Injury After Injury
• Massive hemorrhage
• 20–70% Burns Goals Goals Goals
• Unstable Vital Signs
• Severe TBI (unconscious alive Pt) • Eliminate threat • Evacuate urgent Evacuate
• Get medical personnel and priority remainder of
Category II: • Open fractures w/PMS intact on scene patients patients
Delayed (green chemlite) • Soft tissue injuries • Begin evacuation of • DCR/DCS as
• Moderate TBI (stable vital signs)
• Open abdominal wounds urgent but survivable soon as possible
Category III: • Minor abrasions, burns, sprains lacerations patients
Minimal (no chemlite) • Moderate/Mild anxiety Actions Actions Actions
remain armed continue to • Fractures/dislocations w/PMS • Stop external bleed • Formal triage • Re-triage
engage* • Mild TBI • Clear airway • MARCH PAWS • Complete
Category IV: • Massive head or spinal injury • Reserve intubation/ if able MARCH PAWS
Expectant or Hero • Third degree burns > 70% BSA transfusion • Transfuse • Use prolonged
(blue chemlite)** • Injuries incompatible with life • CCP if able, otherwise • Establish CCP care to optimize
*In combat, it is assumed that minimals will continue to stay armed/engaged if no get a count • Utilize minimals/ outcomes
mental status altering pharmaceuticals are given for pain. returns to duty • Wound/fracture
**Expectant category is ONLY used in combat operations and/or when the re- management
quirements to adequately treat these patients exceed the available resources. In
peacetime, it is generally assumed that all patients have a chance of survival.
Source: Special Operations Force Medic Handbooks (PJ, Ranger)

40 | JSOM Volume 22, Edition 1 / Sping 2022