Page 276 - PJ MED OPS Handbook 8th Ed

Basic Management Plan for Tactical Evacuation Care (TACEVAC)
1. Transition of Care:
a. Establish evacuation point security and stage casualties for evacuation.
b. Communicate patient information and status to TACEVAC personnel if you are not evacuating
the patient. Include stable or unstable, injuries, and treatments rendered.
c. TACEVAC personnel should stage casualties on evacuation platforms as required.
d. Secure casualties in the evacuation platform.
e. Re-assess casualties, re-evaluate all injuries and previous interventions.
2. MARCH PAWS:

NOTE: Oxygen supplementation:
• Most combat casualties do not require supplemental oxygen, but administration of oxy-
gen may be of benefit for the following types of casualties:

i) Low oxygen saturation (<90%) by pulse oximetry
ii) Injuries associated with impaired oxygenation
iii) Unconscious casualty
iv) Casualty with TBI (maintain oxygen saturation >90%)
v) Casualty in shock
vi) Casualty at altitude
vii) Known or suspected smoke inhalation
3. Traumatic Brain Injury:
a. Casualties with moderate/severe TBI should be monitored and treated for:
i) Decreases in level of consciousness
ii) Pupillary dilation
iii) Keep SBP ≥100mmHg
iv) Keep O2 sat ≥90%
v) PCO2 (If capnography is available, maintain between 35–40mmHg)
vi) Penetrating head trauma (if present, administer antibiotics), use Versed for seizures
vii) Assume a spinal (neck) injury until cleared
b. Unilateral pupillary dilation accompanied by a decreased level of consciousness may signify
impending cerebral herniation; if these signs occur, take the following actions to decrease
intracranial pressure:
i) Administer Hypertonic saline (30mL – 23.4% Saline)
ii) Elevate the casualty’s head 30°
iii) Hyperventilate the casualty
a. Respiratory rate 20
b. Capnography should be used to maintain the end-tidal CO2 between 30–35mmHg.
c. The highest oxygen concentration (FIO2) possible should be used for hyperventilation.
d. Do not hyperventilate the casualty unless signs of impending herniation are present.
Casualties may be hyperventilated with oxygen using the bag-valve-mask technique.
4. Hypothermia Prevention:
a. Treat per Tactical Field Care Hypothermia Protocol
b. Protect the casualty from wind if doors must be kept open

274 n Pararescue Medical Operations Handbook / 8th Edition