Tactical field care - Revision history

Danbot: Strip excess bold

2026-03-22T09:36:42Z

Strip excess bold

Rossdonaldson1: Text replacement - "opiod" to "opioid"

2023-10-18T17:42:46Z

Text replacement - "opiod" to "opioid"

← Older revision		Revision as of 17:42, 18 October 2023
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	*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 patient’s 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 patient’s uniform or plate carrier.

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

2019-02-12T07:29:11Z

Text replacement - "TBSA" to "TBSA"

← Older revision		Revision as of 07:29, 12 February 2019
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	==[[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 [[Burns#Rule_of_Nines\|Rule of Nines]].		*Estimate total body surface area ([[TBSA]]) burned to the nearest 10% using the [[Burns#Rule_of_Nines\|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 6.		**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.

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

2018-02-16T13:28:47Z

Text replacement - "tourniquet" to "tourniquet"

← Older revision		Revision as of 13:28, 16 February 2018
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	==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 evacuation time is anticipated to be 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 [[traumatic brain injury]] (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 evacuation time is anticipated to be 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 [[traumatic brain injury]] (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"

2017-07-07T10:44:37Z

Text replacement - "prn" to "PRN"

← Older revision		Revision as of 10:44, 7 July 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'''"

2017-05-30T22:52:51Z

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

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

2017-03-10T12:55:21Z

Text replacement - "Hypothermia " to "Hypothermia"

← Older revision		Revision as of 12:55, 10 March 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 dry blankets, poncho liners, sleeping bags, or anything that will retain heat and keep the casualty dry.		#If the items mentioned above are not available, use dry blankets, poncho liners, sleeping bags, or anything that will retain heat and keep the casualty dry.
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	*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 [[Burns#Rule_of_Nines\|Rule of Nines]].		*Estimate total body surface area (TBSA) burned to the nearest 10% using the [[Burns#Rule_of_Nines\|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.

Rossdonaldson1: /* Fluid resuscitation */

2016-09-22T16:46:27Z

Fluid resuscitation

← Older revision		Revision as of 16:46, 22 September 2016
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	==Fluid resuscitation==		==Fluid resuscitation==
	The resuscitation fluids of choice for casualties in hemorrhagic shock, listed from most to least preferred, are: whole blood^; plasma, [[RBCs]] and platelets in 1:1:1 ratio; plasma and [[RBCs]] in 1:1 ratio; plasma or RBCs alone; Hextend; and crystalloid (Lactated Ringers or Plasma-Lyte A).		''The resuscitation fluids of choice for casualties in hemorrhagic shock, listed from most to least preferred, are: whole blood^; plasma, [[RBCs]] and platelets in 1:1:1 ratio*; plasma and [[RBCs]] in 1:1 ratio; plasma or RBCs alone; Hextend; and crystalloid (Lactated Ringers or Plasma-Lyte A).''
	*Assess for hemorrhagic shock (altered mental status in the absence of brain injury and/or weak or absent radial pulse).		*Assess for hemorrhagic shock (altered mental status in the absence of brain injury and/or weak or absent radial pulse).
	**If not in shock:		**If not in shock:

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

2016-07-27T01:18:34Z

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

← Older revision		Revision as of 01:18, 27 July 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 6.		**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.
	*Analgesia in accordance with the TCCC Guidelines in Section 12 may be administered to treat burn pain.		*Analgesia in accordance with the TCCC Guidelines in Section 12 may be administered to treat burn pain.

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

2016-07-21T15:19:21Z

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

← Older revision		Revision as of 15:19, 21 July 2016
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	#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
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	''Recommended for all open combat wounds''		''Recommended for all open combat wounds''
	*If able to take PO:		*If able to take PO:
	**[[Moxifloxacin]] ~~400 mg~~ PO one a day		**[[Moxifloxacin]] 400mg PO one 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

← Older revision		Revision as of 09:36, 22 March 2026
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	#Check for additional wounds.		#Check for additional wounds.
	#Analgesia on the battlefield should generally be achieved using one of three options:		#Analgesia on the battlefield 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
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	*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 patient’s 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 patient’s 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
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	**[[Moxifloxacin]] 400mg PO one a day		**[[Moxifloxacin]] 400mg PO one 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
	**[[Ertapenem]] 1 g IV/IM once a day		**[[Ertapenem]] 1 g IV/IM once a day

← Older revision		Revision as of 22:52, 30 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
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	*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 patient’s 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 patient’s 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
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	**[[Moxifloxacin]] 400mg PO one a day		**[[Moxifloxacin]] 400mg PO one 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'''
	**[[Ertapenem]] 1 g IV/IM once a day		**[[Ertapenem]] 1 g IV/IM once a day