Page 85 - PJ MED OPS Handbook 8th Ed

CLINICAL PEARLS
When IV route is recommended, but not obtainable, consider IO, IM, IN, PO, or PR unless contrain-
dicated. If IV indicated and no veins seen, or 2 failed attempts, proceed to IO.
Current, available PO formulations: Benadryl, Zofran ODT, Decadron, moxifloxacin, meloxicam,
acetaminophen, Imodium.

DO NOT give epinephrine IV unless given under the ACLS protocols or the Neurogenic/Spinal
Shock Protocol. Specific training/equipment is required.

All IV medications may be given slow IV push with the exception of antibiotics, which should be in a
drip, unless otherwise specified.
*Tactical option for ertapenem IV is use in a 10mL syringe with NS and IV slow push (approx.
1mL/min over 10 minutes, simulating a 10-minute drip).

Document dose, route and time of all medications so the receiving facility may be informed.
Do not use local anesthetic with epinephrine on the ears, nose, digits, or penis. In general PJs do not
carry lidocaine with epi.
If oxygen is listed in a protocol, realize that it is recommended; O2 may not be available. Only use
O2 if limited resources when oxygen saturation is below 90% and is symptomatic. Otherwise only
use O2 for sats <90%.

Due to the high level of physical fitness of SOF personnel, there may be a prolonged period of men-
tal lucidity and apparent stable vital signs despite a severe injury. Also, tactical athletes will have
lower heart rates and blood pressures than the general population, another of several reasons we
rely on mental status and radial pulse to diagnose shock.

Medical Documentation (PJ patient care card, or DD 1380, AT MIST): In order to ensure proper
care and medical information transfer during patient treatment, a standardized format for medical
documentation is required. Reporting in AT MIST format and MARCH PAWS for the T portion is the
PJ standard.

If the PJ patient care card or the DoD TCCC card is not available, use the AT-MIST format below
AT MIST
• Age
• Time of injury, illness
• Mechanism of injury or illness
• Injuries or illness (diagnosis)
• Symptoms and Signs
• Treatments (MARCH PAWS algorithm)

Chapter 8. Tactical Medical Emergency Protocols (TMEPs) n 83