Tactical evacuation care - Revision history

Danbot: Strip excess bold

2026-03-22T09:36:43Z

Strip excess bold

ClaireLewis: /* Analgesia on the battlefield */

2019-09-24T17:33:19Z

Analgesia on the battlefield

← Revisión anterior		Revisión del 17:33 24 sep 2019
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	==Check for additional wounds==		==Check for additional wounds==

	==Analgesia on the battlefield==		==[[Analgesia]] on the battlefield==
	Should generally be achieved using one of three options:		Should generally be achieved using one of three options:
	*'''Option 1''' (Mild to Moderate Pain; Casualty is still able to fight)		*'''Option 1''' (Mild to Moderate Pain; Casualty is still able to fight)
Línea 133:		Línea 133:
	*Casualties may need to be disarmed after being given OTFC or [[ketamine]].		*Casualties may need to be disarmed after being given OTFC or [[ketamine]].
	*Document a mental status exam using the [[AVPU]] method prior to administering [[opioids]] or [[ketamine]].		*Document a mental status exam using the [[AVPU]] method prior to administering [[opioids]] or [[ketamine]].
	*For all casualties given ~~opiods~~ or ketamine – monitor airway, breathing, and circulation closely		*For all casualties given opioids or ketamine – monitor airway, breathing, and circulation closely
	*Directions for administering OTFC:		*Directions for administering OTFC:
	**Recommend taping lozenge-on-a-stick to casualty’s finger as an added safety measure '''OR''' utilizing a safety pin and rubber band to attach the lozenge (under tension) to the patients uniform or plate carrier.		**Recommend taping lozenge-on-a-stick to casualty’s finger as an added safety measure '''OR''' utilizing a safety pin and rubber band to attach the lozenge (under tension) to the patients uniform or plate carrier.

Rossdonaldson1: Text replacement - "TBSA" to "TBSA"

2019-02-12T08:02:50Z

Text replacement - "TBSA" to "TBSA"

← Revisión anterior		Revisión del 08:02 12 feb 2019
Línea 163:		Línea 163:
	==[[Burns]]==		==[[Burns]]==
	*Facial burns, especially those that occur in closed spaces, may be associated with inhalation injury. Aggressively monitor airway status and oxygen saturation in such patients and consider early surgical airway for respiratory distress or oxygen desaturation.		*Facial burns, especially those that occur in closed spaces, may be associated with inhalation injury. Aggressively monitor airway status and oxygen saturation in such patients and consider early surgical airway for respiratory distress or oxygen desaturation.
	*Estimate total body surface area (TBSA) burned to the nearest 10% using the [[Rule of Nines]].		*Estimate total body surface area ([[TBSA]]) burned to the nearest 10% using the [[Rule of Nines]].
	*Cover the burn area with dry, sterile dressings. For extensive burns (>20%), consider placing the casualty in the Heat-Reflective Shell or Blizzard Survival Blanket from the [[Hypothermia]]Prevention Kit in order to both cover the burned areas and prevent hypothermia.		*Cover the burn area with dry, sterile dressings. For extensive burns (>20%), consider placing the casualty in the Heat-Reflective Shell or Blizzard Survival Blanket from the [[Hypothermia]]Prevention Kit in order to both cover the burned areas and prevent hypothermia.
	*Fluid resuscitation (USAISR Rule of Ten)		*Fluid resuscitation (USAISR Rule of Ten)
	**If burns are greater than 20% of Total Body Surface Area, fluid resuscitation should be initiated as soon as IV/IO access is established. Resuscitation should be initiated with Lactated Ringer’s, normal saline, or Hextend. If Hextend is used, no more than 1000ml should be given, followed by Lactated Ringer’s or normal saline as needed.		**If burns are greater than 20% of Total Body Surface Area, fluid resuscitation should be initiated as soon as IV/IO access is established. Resuscitation should be initiated with Lactated Ringer’s, normal saline, or Hextend. If Hextend is used, no more than 1000ml should be given, followed by Lactated Ringer’s or normal saline as needed.
	**Initial IV/IO fluid rate is calculated as %TBSA x 10cc/hr for adults weighing 40-80 kg.		**Initial IV/IO fluid rate is calculated as %[[TBSA]] x 10cc/hr for adults weighing 40-80 kg.
	**For every 10 kg ABOVE 80 kg, increase initial rate by 100ml/hr.		**For every 10 kg ABOVE 80 kg, 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 5.		**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 5.

Rossdonaldson1: Text replacement - "tourniquet" to "tourniquet"

2018-02-16T20:32:41Z

Text replacement - "tourniquet" to "tourniquet"

← Revisión anterior		Revisión del 20:32 16 feb 2018
Línea 30:		Línea 30:

	==Bleeding==		==Bleeding==
	*Assess for unrecognized hemorrhage and control all sources of bleeding. If not already done, use a CoTCCC-recommended tourniquet to control life-threatening external hemorrhage that is anatomically amenable to tourniquet application or for any traumatic amputation. Apply directly to the skin 2-3 inches above wound.		*Assess for unrecognized hemorrhage and control all sources of bleeding. If not already done, use a CoTCCC-recommended [[tourniquet]] to control life-threatening external hemorrhage that is anatomically amenable to [[tourniquet]] application or for any traumatic amputation. Apply directly to the skin 2-3 inches above wound.
	*For compressible hemorrhage not amenable to tourniquet use or as an adjunct to tourniquet removal (if anticipated evacuation time is longer than two hours), use [[Combat Gauze]] as the CoTCCC hemostatic dressing of choice. [[Celox Gauze]] and [[ChitoGauze]] may also be used if [[Combat Gauze]] is not available. [[Hemostatic dressings]] should be applied with at least 3 minutes of direct pressure. Before releasing any tourniquet on a casualty who has been resuscitated for hemorrhagic shock, ensure a positive response to resuscitation efforts (i.e., a peripheral pulse normal in character and normal mentation if there is no TBI.) If the bleeding site is appropriate for use of a junctional tourniquet, immediately apply a CoTCCC- recommended junctional tourniquet. Do not delay in the application of the junctional tourniquet once it is ready for use. Apply hemostatic dressings with direct pressure if a junctional tourniquet is not available or while the junctional tourniquet is being readied for use.		*For compressible hemorrhage not amenable to [[tourniquet]] use or as an adjunct to [[tourniquet]] removal (if anticipated evacuation time is longer than two hours), use [[Combat Gauze]] as the CoTCCC hemostatic dressing of choice. [[Celox Gauze]] and [[ChitoGauze]] may also be used if [[Combat Gauze]] is not available. [[Hemostatic dressings]] should be applied with at least 3 minutes of direct pressure. Before releasing any [[tourniquet]] on a casualty who has been resuscitated for hemorrhagic shock, ensure a positive response to resuscitation efforts (i.e., a peripheral pulse normal in character and normal mentation if there is no TBI.) If the bleeding site is appropriate for use of a junctional [[tourniquet]], immediately apply a CoTCCC- recommended junctional [[tourniquet]]. Do not delay in the application of the junctional [[tourniquet]] once it is ready for use. Apply hemostatic dressings with direct pressure if a junctional [[tourniquet]] is not available or while the junctional [[tourniquet]] is being readied for use.
	*Reassess prior tourniquet application. Expose wound and determine if tourniquet is needed. If so, replace tourniquet over uniform with another applied directly to skin 2-3 inches above wound. If a tourniquet is not needed, use other techniques to control bleeding.		*Reassess prior [[tourniquet]] application. Expose wound and determine if [[tourniquet]] is needed. If so, replace [[tourniquet]] over uniform with another applied directly to skin 2-3 inches above wound. If a [[tourniquet]] is not needed, use other techniques to control bleeding.
	*When time and the tactical situation permit, a distal pulse check should be accomplished. If a distal pulse is still present, consider additional tightening of the tourniquet or the use of a second tourniquet, side by side and proximal to the first, to eliminate the distal pulse.		*When time and the tactical situation permit, a distal pulse check should be accomplished. If a distal pulse is still present, consider additional tightening of the [[tourniquet]] or the use of a second [[tourniquet]], side by side and proximal to the first, to eliminate the distal pulse.
	*Expose and clearly mark all tourniquet sites with the time of tourniquet application. Use an indelible marker.		*Expose and clearly mark all [[tourniquet]] sites with the time of [[tourniquet]] application. Use an indelible marker.

	==Intravenous (IV) access==		==Intravenous (IV) access==

Mholtz: Text replacement - "prn" to "PRN"

2017-07-07T10:02:04Z

Text replacement - "prn" to "PRN"

← Revisión anterior		Revisión del 10:02 7 jul 2017
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	**[[Ketamine]] 50mg IM or IN, '''OR'''		**[[Ketamine]] 50mg IM or IN, '''OR'''
	**[[Ketamine]] 20mg slow IV or IO		**[[Ketamine]] 20mg slow IV or IO
	***Repeat doses q30min ~~prn~~ for IM or IN		***Repeat doses q30min PRN for IM or IN
	***Repeat doses q20min ~~prn~~ for IV or IO		***Repeat doses q20min PRN for IV or IO
	***End points: Control of pain or development of nystagmus (rhythmic back-and-forth movement of the eyes)		***End points: Control of pain or development of nystagmus (rhythmic back-and-forth movement of the eyes)

Mholtz: Text replacement - "OR" to "'''OR'''"

2017-05-31T02:13:41Z

Text replacement - "OR" to "'''OR'''"

← Revisión anterior		Revisión del 02:13 31 may 2017
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	**Place lozenge between the cheek and the gum		**Place lozenge between the cheek and the gum
	**Do not chew the lozenge		**Do not chew the lozenge
	*'''Option 3''' (Moderate to Severe Pain; Casualty IS in hemorrhagic shock or respiratory distress OR Casualty IS at significant risk of developing either condition)		*'''Option 3''' (Moderate to Severe Pain; Casualty IS in hemorrhagic shock or respiratory distress '''OR''' Casualty IS at significant risk of developing either condition)
	**[[Ketamine]] 50mg IM or IN, OR		**[[Ketamine]] 50mg IM or IN, '''OR'''
	**[[Ketamine]] 20mg slow IV or IO		**[[Ketamine]] 20mg slow IV or IO
	***Repeat doses q30min prn for IM or IN		***Repeat doses q30min prn for IM or IN
Línea 135:		Línea 135:
	*For all casualties given opiods or ketamine – monitor airway, breathing, and circulation closely		*For all casualties given opiods or ketamine – monitor airway, breathing, and circulation closely
	*Directions for administering OTFC:		*Directions for administering OTFC:
	**Recommend taping lozenge-on-a-stick to casualty’s finger as an added safety measure OR utilizing a safety pin and rubber band to attach the lozenge (under tension) to the patients uniform or plate carrier.		**Recommend taping lozenge-on-a-stick to casualty’s finger as an added safety measure '''OR''' utilizing a safety pin and rubber band to attach the lozenge (under tension) to the patients uniform or plate carrier.
	**Reassess in 15 minutes		**Reassess in 15 minutes
	**Add second lozenge, in other cheek, as necessary to control severe pain		**Add second lozenge, in other cheek, as necessary to control severe pain

Ostermayer: Text replacement - "Hypothermia " to "Hypothermia"

2017-03-10T11:23:49Z

Text replacement - "Hypothermia " to "Hypothermia"

← Revisión anterior		Revisión del 11:23 10 mar 2017
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	*Minimize casualty’s exposure to the elements. Keep protective gear on or with the casualty if feasible.		*Minimize casualty’s exposure to the elements. Keep protective gear on or with the casualty if feasible.
	*Replace wet clothing with dry if possible. Get the casualty onto an insulated surface as soon as possible.		*Replace wet clothing with dry if possible. Get the casualty onto an insulated surface as soon as possible.
	*Apply the Ready-Heat Blanket from the Hypothermia Prevention and Management Kit (HPMK) to the casualty’s torso (not directly on the skin) and cover the casualty with the Heat-Reflective Shell (HRS).		*Apply the Ready-Heat Blanket from the [[Hypothermia]]Prevention and Management Kit (HPMK) to the casualty’s torso (not directly on the skin) and cover the casualty with the Heat-Reflective Shell (HRS).
	*If an HRS is not available, the previously recommended combination of the Blizzard Survival Blanket and the Ready Heat blanket may also be used.		*If an HRS is not available, the previously recommended combination of the Blizzard Survival Blanket and the Ready Heat blanket may also be used.
	*If the items mentioned above are not available, use poncho liners, sleeping bags, or anything that will retain heat and keep the casualty dry.		*If the items mentioned above are not available, use poncho liners, sleeping bags, or anything that will retain heat and keep the casualty dry.
Línea 164:		Línea 164:
	*Facial burns, especially those that occur in closed spaces, may be associated with inhalation injury. Aggressively monitor airway status and oxygen saturation in such patients and consider early surgical airway for respiratory distress or oxygen desaturation.		*Facial burns, especially those that occur in closed spaces, may be associated with inhalation injury. Aggressively monitor airway status and oxygen saturation in such patients and consider early surgical airway for respiratory distress or oxygen desaturation.
	*Estimate total body surface area (TBSA) burned to the nearest 10% using the [[Rule of Nines]].		*Estimate total body surface area (TBSA) burned to the nearest 10% using the [[Rule of Nines]].
	*Cover the burn area with dry, sterile dressings. For extensive burns (>20%), consider placing the casualty in the Heat-Reflective Shell or Blizzard Survival Blanket from the Hypothermia Prevention Kit in order to both cover the burned areas and prevent hypothermia.		*Cover the burn area with dry, sterile dressings. For extensive burns (>20%), consider placing the casualty in the Heat-Reflective Shell or Blizzard Survival Blanket from the [[Hypothermia]]Prevention Kit in order to both cover the burned areas and prevent hypothermia.
	*Fluid resuscitation (USAISR Rule of Ten)		*Fluid resuscitation (USAISR Rule of Ten)
	**If burns are greater than 20% of Total Body Surface Area, fluid resuscitation should be initiated as soon as IV/IO access is established. Resuscitation should be initiated with Lactated Ringer’s, normal saline, or Hextend. If Hextend is used, no more than 1000ml should be given, followed by Lactated Ringer’s or normal saline as needed.		**If burns are greater than 20% of Total Body Surface Area, fluid resuscitation should be initiated as soon as IV/IO access is established. Resuscitation should be initiated with Lactated Ringer’s, normal saline, or Hextend. If Hextend is used, no more than 1000ml should be given, followed by Lactated Ringer’s or normal saline as needed.

Mholtz at 06:36, 27 December 2016

2016-12-27T06:36:23Z

← Revisión anterior		Revisión del 06:36 27 dic 2016
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	*[[Tactical combat casualty care]]		*[[Tactical combat casualty care]]
	*[[Nine line CASEVAC]]		*[[Nine line CASEVAC]]

			==External Links==
			*Tactical Combat Casualty Care Guidelines; 2 June 2014; http://www.usaisr.amedd.army.mil/pdfs/TCCC_Guidelines_140602.pdf

	==References==		==References==
	*Tactical Combat Casualty Care Guidelines; 2 June 2014; http://www.usaisr.amedd.army.mil/pdfs/TCCC_Guidelines_140602.pdf
	<references/>		<references/>

	[[Category:EMS]]		[[Category:EMS]]
	[[Category:Military]]		[[Category:Military]]

Neil.m.young: Text replacement - "0 ml" to "0ml"

2016-07-27T01:16:30Z

Text replacement - "0 ml" to "0ml"

← Revisión anterior		Revisión del 01:16 27 jul 2016
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	*Cover the burn area with dry, sterile dressings. For extensive burns (>20%), consider placing the casualty in the Heat-Reflective Shell or Blizzard Survival Blanket from the Hypothermia Prevention Kit in order to both cover the burned areas and prevent hypothermia.		*Cover the burn area with dry, sterile dressings. For extensive burns (>20%), consider placing the casualty in the Heat-Reflective Shell or Blizzard Survival Blanket from the Hypothermia Prevention Kit in order to both cover the burned areas and prevent hypothermia.
	*Fluid resuscitation (USAISR Rule of Ten)		*Fluid resuscitation (USAISR Rule of Ten)
	**If burns are greater than 20% of Total Body Surface Area, fluid resuscitation should be initiated as soon as IV/IO access is established. Resuscitation should be initiated with Lactated Ringer’s, normal saline, or Hextend. If Hextend is used, no more than ~~1000 ml~~ should be given, followed by Lactated Ringer’s or normal saline as needed.		**If burns are greater than 20% of Total Body Surface Area, fluid resuscitation should be initiated as soon as IV/IO access is established. Resuscitation should be initiated with Lactated Ringer’s, normal saline, or Hextend. If Hextend is used, no more than 1000ml should be given, followed by Lactated Ringer’s or normal saline as needed.
	**Initial IV/IO fluid rate is calculated as %TBSA x 10cc/hr for adults weighing 40-80 kg.		**Initial IV/IO fluid rate is calculated as %TBSA x 10cc/hr for adults weighing 40-80 kg.
	**For every 10 kg ABOVE 80 kg, increase initial rate by ~~100 ml~~/hr.		**For every 10 kg ABOVE 80 kg, 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 5.		**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 5.
	*Analgesia in accordance with [[TCCC guidelines]] in Section 11 may be administered to treat burn pain.		*Analgesia in accordance with [[TCCC guidelines]] in Section 11 may be administered to treat burn pain.

Neil.m.young: Text replacement - "0 mg" to "0mg"

2016-07-21T14:22:13Z

Text replacement - "0 mg" to "0mg"

← Revisión anterior		Revisión del 14:22 21 jul 2016
Línea 104:		Línea 104:
	*Perform a rapid field test of visual acuity.		*Perform a rapid field test of visual acuity.
	*Cover the eye with a rigid eye shield (NOT a pressure patch).		*Cover the eye with a rigid eye shield (NOT a pressure patch).
	*Ensure that the ~~400 mg~~ [[moxifloxacin]] tablet in the combat pill pack is taken if possible and that IV/IM antibiotics are given as outlined below if oral [[moxifloxacin]] cannot be taken		*Ensure that the 400mg [[moxifloxacin]] tablet in the combat pill pack is taken if possible and that IV/IM antibiotics are given as outlined below if oral [[moxifloxacin]] cannot be taken

	==Monitoring==		==Monitoring==
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	**Do not chew the lozenge		**Do not chew the lozenge
	*'''Option 3''' (Moderate to Severe Pain; Casualty IS in hemorrhagic shock or respiratory distress OR Casualty IS at significant risk of developing either condition)		*'''Option 3''' (Moderate to Severe Pain; Casualty IS in hemorrhagic shock or respiratory distress OR Casualty IS at significant risk of developing either condition)
	**[[Ketamine]] ~~50 mg~~ IM or IN, OR		**[[Ketamine]] 50mg IM or IN, OR
	**[[Ketamine]] ~~20 mg~~ slow IV or IO		**[[Ketamine]] 20mg slow IV or IO
	***Repeat doses q30min prn for IM or IN		***Repeat doses q30min prn for IM or IN
	***Repeat doses q20min prn for IV or IO		***Repeat doses q20min prn for IV or IO
Línea 156:		Línea 156:
	==[[Antibiotics]]: recommended for all open combat wounds==		==[[Antibiotics]]: recommended for all open combat wounds==
	*If able to take PO:		*If able to take PO:
	**[[Moxifloxacin]] ~~400 mg~~ PO once a day		**[[Moxifloxacin]] 400mg PO once a day
	*If unable to take PO (shock, unconsciousness):		*If unable to take PO (shock, unconsciousness):
	**[[Cefotetan]] 2 g IV (slow push over 3-5 minutes) or IM every 12 hours, or		**[[Cefotetan]] 2 g IV (slow push over 3-5 minutes) or IM every 12 hours, or

← Revisión anterior		Revisión del 09:36 22 mar 2026
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	***The highest oxygen concentration (FIO2) possible should be used for hyperventilation.		***The highest oxygen concentration (FIO2) possible should be used for hyperventilation.

	~~'''~~Notes:~~'''~~		Notes:
	*Do not hyperventilate unless signs of impending herniation are present.		*Do not hyperventilate unless signs of impending herniation are present.
	*Casualties may be hyperventilated with oxygen using the [[bag-valve-mask]] technique.		*Casualties may be hyperventilated with oxygen using the [[bag-valve-mask]] technique.
Línea 115:		Línea 115:
	==[[Analgesia]] on the battlefield==		==[[Analgesia]] on the battlefield==
	Should generally be achieved using one of three options:		Should generally be achieved using one of three options:
	*~~'''~~Option 1~~'''~~ (Mild to Moderate Pain; Casualty is still able to fight)		*Option 1 (Mild to Moderate Pain; Casualty is still able to fight)
	**TCCC Combat pill pack:		**TCCC Combat pill pack:
	**[[Tylenol]] - 650-mg bilayer caplet, 2 PO every 8 hours		**[[Tylenol]] - 650-mg bilayer caplet, 2 PO every 8 hours
	**[[Meloxicam]] - 15mg PO once a day		**[[Meloxicam]] - 15mg PO once a day
	*~~'''~~Option 2~~'''~~ (Moderate to Severe Pain; Casualty IS NOT in shock or respiratory distress AND Casualty IS NOT at significant risk of developing either condition)		*Option 2 (Moderate to Severe Pain; Casualty IS NOT in shock or respiratory distress AND Casualty IS NOT at significant risk of developing either condition)
	**Oral transmucosal [[fentanyl]] citrate (OTFC) 800 ug		**Oral transmucosal [[fentanyl]] citrate (OTFC) 800 ug
	**Place lozenge between the cheek and the gum		**Place lozenge between the cheek and the gum
	**Do not chew the lozenge		**Do not chew the lozenge
	*~~'''~~Option 3~~'''~~ (Moderate to Severe Pain; Casualty IS in hemorrhagic shock or respiratory distress ~~'''~~OR~~'''~~ Casualty IS at significant risk of developing either condition)		*Option 3 (Moderate to Severe Pain; Casualty IS in hemorrhagic shock or respiratory distress OR Casualty IS at significant risk of developing either condition)
	**[[Ketamine]] 50mg IM or IN, ~~'''~~OR~~'''~~		**[[Ketamine]] 50mg IM or IN, OR
	**[[Ketamine]] 20mg slow IV or IO		**[[Ketamine]] 20mg slow IV or IO
	***Repeat doses q30min PRN for IM or IN		***Repeat doses q30min PRN for IM or IN
Línea 135:		Línea 135:
	*For all casualties given opioids or ketamine – monitor airway, breathing, and circulation closely		*For all casualties given opioids or ketamine – monitor airway, breathing, and circulation closely
	*Directions for administering OTFC:		*Directions for administering OTFC:
	**Recommend taping lozenge-on-a-stick to casualty’s finger as an added safety measure ~~'''~~OR~~'''~~ utilizing a safety pin and rubber band to attach the lozenge (under tension) to the patients uniform or plate carrier.		**Recommend taping lozenge-on-a-stick to casualty’s finger as an added safety measure OR utilizing a safety pin and rubber band to attach the lozenge (under tension) to the patients uniform or plate carrier.
	**Reassess in 15 minutes		**Reassess in 15 minutes
	**Add second lozenge, in other cheek, as necessary to control severe pain		**Add second lozenge, in other cheek, as necessary to control severe pain