Page 108 - JSOM Spring 2024

• Initial IV/IO fluid rate is calculated as %TBSA× 10mL/hr for adults weighing 40–80kg.
• For every 10kg ABOVE 80kg, increase initial rate by 100mL/hr.
• If hemorrhagic shock is also present, resuscitation for hemorrhagic shock takes precedence over resuscitation for burn
shock. Administer IV/IO fluids per the TCCC Guidelines in Section (6).
• Consider oral fluids for burns up to 30% TBSA if casualty is conscious and able to swallow.
f. Analgesia in accordance with the TCCC Guidelines in Section (11) may be administered to treat burn pain.
g. Prehospital antibiotic therapy is not indicated solely for burns, but antibiotics should be given per the TCCC guidelines
in Section (12) if indicated to prevent infection in penetrating wounds.
h. All TCCC interventions can be performed on or through burned skin in a burn casualty.
i. Burn casualties are particularly susceptible to hypothermia. Extra emphasis should be placed on barrier heat loss preven-
tion methods.
16. Splint fractures and re-check pulses
17. Cardiopulmonary resuscitation (CPR)
a. Resuscitation on the battlefield for victims of blast or penetrating trauma who have no pulse, no ventilations, and no
other signs of life will not be successful and should not be attempted.
b. However, casualties with torso trauma or polytrauma who have no pulse or respirations during tactical field care should
have bilateral needle decompression performed to ensure they do not have a tension pneumothorax prior to discontinu-
ation of care. The procedure is the same as described in section (5a) above.
18. Communication
a. Communicate with the casualty if possible. Encourage, reassure, and explain care.
b. Communicate with tactical leadership as soon as possible and throughout casualty treatment as needed. Provide leader-
ship with casualty status and evacuation requirements to assist with coordination of evacuation assets.
c. Communicate with the evacuation system (the Patient Evacuation Coordination Cell) to arrange for Tactical Evacuation
Care (TACEVAC). Communicate with medical providers on the evacuation asset if possible and relay mechanism of in-
jury, injuries sustained, signs/symptoms, and treatments rendered. Provide additional information as appropriate.
19. Documentation of Care
a. Document clinical assessments, treatments rendered, and changes in the casualty’s status on a TCCC Card (DD Form 1380).
b. Forward documentation with the casualty to the next level of care.
20. Prepare for Evacuation
a. Complete and secure the TCCC Card (DD 1380) to the casualty.
b. Secure all loose ends of bandages and wraps.
c. Secure hypothermia prevention wraps/blankets/straps.
d. Secure litter straps as required. Consider additional padding for long evacuations.
e. Provide instructions to ambulatory casualties as needed.
f. Stage casualties for evacuation in accordance with unit standard operating procedures.
g. Maintain security at the evacuation point in accordance with unit standard operating procedures.

Principles of Tactical Evacuation Care (TACEVAC)
*The term “Tactical Evacuation” includes both Casualty Evacuation (CASEVAC) and Medical Evacuation (MEDEVAC) as de-
fined in Joint Publication 4-02.

Basic Management Plan for Tactical Evacuation Care
1. Transition of Care
a. Tactical force personnel should establish evacuation point security and stage casualties for evacuation.
b. Tactical force personnel or the medic should communicate casualty information and status to TACEVAC personnel as
clearly as possible. The minimum information communicated should include stable or unstable, injuries identified, and
treatments rendered.
c. TACEVAC personnel should stage casualties on evacuation platforms as required.
d. Secure casualties in the evacuation platform in accordance with unit policies, platform configurations and safety
requirements.
e. TACEVAC medical personnel should reassess casualties and re-evaluate all injuries and previous interventions.
2. Massive Hemorrhage (same as Tactical Field Care)
3. Airway Management
Endotracheal intubation may be considered in lieu of cricothyroidotomy if trained.
4. Respiration/Breathing
Most combat casualties do not require supplemental oxygen, but administration of oxygen may be of benefit for the following
types of casualties:
• Low oxygen saturation by pulse oximetry
• Injuries associated with impaired oxygenation
• Unconscious casualty
• Casualty with TBI (maintain oxygen saturation >90%)
• Casualty in shock

106 | JSOM Volume 23, Edition 1 / Spring 2024