Page 23 - PJ MED OPS Handbook 8th Ed

4. PJ Medical and Trauma Protocols (MTPs)

The PJ MTPs form the basic foundations for the most common medical and trauma emergencies that
Pararescuemen encounter. These injuries have been frequently identified in training mishaps and are
mandatory knowledge for training point of injury care. They are mission critical and MUST KNOW.
Dx= Diagnosis Rx= Treatment

Combat Shock Protocol (Hemorrhagic Shock)
Dx:
1. MOI and blood loss
2. Declining level of consciousness in the absence of head trauma, or weak/absent radial pulse
Rx:
1. Establish IV/IO access
2. Flush with TXA – 2g (1 minute slow IV push)
3. Administer blood (cold stored type ‘O’ whole blood>fresh low titer-‘O’ whole blood>PRBCs and
plasma>plasma alone>PRBCs alone>non-titered type ‘O’ fresh whole blood>non-titered type
specific fresh whole blood)
4. Administer Calcium (10mL of 10% calcium gluconate) via slow IV/IO push (establish second-
ary IV/IO access, if required). Repeat dosing (every 4 units of blood product) is considered safe
in the setting of on-going resuscitation with blood products; however, cardiac monitoring is
recommended.

NOTE:
• The priorities in hemorrhagic shock are to maintain perfusion and prevent coagulopathy.
• If using PRBCs and plasma, give in a 1:1 ratio. If both PRBCs and plasma are not available,
plasma is preferred over PRBCs due to its ability to provide volume replacement AND
coagulation factors.
• When using calcium, ensure to flush line before and after administration to avoid compat-
ibility issues with blood and other potential medications. Additionally, flushing confirms
line patency and reduces risk of calcium extravasation and resultant tissue necrosis.

Severe TBI
Dx:
1. Increased intracranial pressure with mechanism or injury present
2. Declining mental status in the absence of shock
3. Significant pupillary asymmetry
4. Unilateral or bilateral fixed and dilated pupils
5. Sustained decorticate or decerebrate posturing
6. Respiratory depression
7. Cushing triad: hypertension, bradycardia, irregular respiration

Chapter 4. PJ Medical and Trauma Protocols (MTPs) n 21