TCCC Handbook Fall 2013

For those interested, I’ve uploaded a copy of the latest TCCC guidelines. This handbook represents the most current doctrine in tactical combat casualty care. This document is essential reading for any tactical or combat provider and is recommended for all EMS providers, as there are many commonalities between combat medicine and prehospital care. There is much more to this document than a breakdown of the phases of TCCC.

Some discussion points:

There is continued emphasis on the control of compressible hemorrhage, as this is the number one preventable cause of combat death.
Hypothermia is presented as a fourth preventable cause of combat death, and there is discussion of the “lethal triad” of hypothermia, acidosis, and coagulopathy. Warming devices including IV fluid warmers are advocated.
Fluid resuscitation only appropriate for shock and TBI. Hextend is the fluid of choice for resuscitation.
Discussion of pelvic immobilization.
“Rule of Ten” for fluid resuscitation in burns greater than 20% BSA: For patients between 40 and 80 kg, BSA (to nearest 10%) x 10 cc/hr. For each 10 kg over 80, add 100 cc/hr. LR is the fluid of choice for burns. This formula represents a standard that is more practical for field application than the Parkland formula, consensus formula, etc.
Traumatic arrest: CPR is not indicated in arrest secondary to blast or penetrating trauma. Bilateral needle decompression should be attempted. This recommendation is consistent with the most recent findings indicating the futility of standard resuscitation algorithms in traumatic arrest.
Elevated ICP is indicated in TBI with unilateral pupilary dilation. Treatment includes 250 cc hypertonic saline, 30 degree HOB, and hyperventilation at 20 BPM to target ETCO2 30-35.