• Updated USSOCOM Tactical Trauma protocols to reflect most CoTCCC TCCC Guidelines for Medical Personnel dated 1 August 2019
• Changed recommendation to replace air with saline in endotracheal tube cuffs to DO NOT replace air with saline in endotracheal tube cuffs
• Added “Only use air in the endotracheal tube cuffs. Use a cuff manometer to monitor cuff pressures during air evacuation and adjust volumes as needed”
• Added Prolonged Field Care (PFC) Considerations
• Added warning that “Once you begin transfusion type O blood, if the patients’ blood type is not type O you may not switch to any other type” to the Administration of Blood and Blood Products Protocol
• Added field emergency donor panel questionnaire and triage tool to the Administration of Blood and Blood Products Protocol
• Added warnings for the administration of calcium gluconate
• Corrected calcium gluconate dosage for Administration of Blood and Blood Products Protocol
• Added Golden Minute Container to Administration of Blood and Blood Products protocol packing list
• Corrected calcium gluconate dosage for Crush Injury Protocol
• Added warnings for the administration of mannitol

• Changed number of vials of calcium gluconate in Crush Injury Kit
• Removed mannitol IV filters to the Crush Injury Kit for the safe administration of mannitol
• Updated Concussion Management in Deployed Settings charts to most current version and added new MACE2 exam chart
• Corrected contraindications for ketamine
• Removed Pneumatic Antishock Garment (PSAG)
• Standardized the wording for the administration of fosphenytoin (Cerebyx®) throughout.
• Revised prohibition against donating blood again for 56 days to no wait time if the blood is reinfused into the donor
• Removed recommendation to administer 500mL of Hextend® to blood donors and replaced with; If donor is expected to perform physical labor such as in a tactical situation. Have donor drink 500mL of oral rehydration salts (ORS) mixed in a ratio of 1 packet in 1000mL of potable water.
• Added provisions and guidance to infuse an incompletely filled blood collection bag
• Removed mannitol from the Crush Syndrome Protocol due to lack of practicality
• Modified analgesia guidelines to provide more options and to match the Pain Management Protocol (TMEPs)
• Updated Prolonged Casualty Care to include the most recent CPGs
• Expanded the Canine Casualty Care  

SECTION 1
TACTICAL TRAUMA PROTOCOLS

• USSOCOM Tactical Combat Casualty Care (TCCC) Tactical Trauma Protocols (TTPs)
• Preface and Changes
• Basic Management Plan for Care Under Fire
• Basic Management Plan for Tactical Field Care
• Principles of Tactical Evacuation Care (TAVEVAC)
• Basic Management Plan for Tactical Evacuation Care
• Prolonged Casualty Care Background
  • PCC Principles
  • Mascal/Triage
  • Massive Hemorrhage
  • Airway Management
  • Respiration and Ventilation
  • Circulation and Resuscitation
  • Communication and Documentation
  • Hypothermia
  • Hyperthermia
  • Head Injury/TBI
  • Pain Managment (Analgesia and Sedation) for PCC
  • Antibotics, Sepsis, and Other Drugs
  • Wound Care and Nursing
  • Splinting and Fracture Management
  • Burn Treatment
  • Special Considerations in Burn Injuries
  • Logistics
• Appendix A: TCCC Guidelines
• Appendix B: Airway Resources
• Appendix C: Mascal Resources
  • Triage Class 1 (MASCAL)
  • Triage Class 2 (MASCAL)
  • Triage Class 3 (Ultra-MASCAL)
• Appendix D: Documentation Resources
• Appendix E: TBI Resources
• Appendix F: Logistics Resources
• Administration of Blood and Blood Components Protocol
  • Indications
  • Overview
  • Transfusions
  • Administer FFP
  • Perform a Whole Blood (FWB) Transfusion
  • Canine Considerations
  • Administer Blood (WB, FWB, WFWB) or PRBCs
  • Blood Donation Questionnaire
  • Field Emergency Donor Planel Questionnaire and Triage Tool
  • Suggested Packing List
• Crush Syndrome
  • Crush Injury Kit
• Fasciotomy Protocol
• Mild Traumatic Brain Injury (mTBI) Protocol
  • Concussion Management in Deployed Settings Chart
  • MACE Charts
• Neurogenic / Spinal Shock Protocol
• Procedural Analgesia Protocol

SECTION 2
TACTICAL MEDICAL EMERGENCY PROTOCOLS

• Tactical Medical Emergency Protocols (TMEPs)
• Preface and Changes
• Clinical Pearls
• Abdominal Pain Protocol
• Allergic Rhinitis / Hay Fever / Cold-Like Symptoms Protocol
• Altitude Illness Protocol
• Anaphylactic Reaction Protocol
• Asthma (Reactive Airway Disease) Protocol
• Back Pain Protocol
• Barotrauma Protocol
• Behavioral Changes (Includes Psychosis, Depression, Suicidal Impulses) Protocol
  • USSOCOM Suicide Prevention Policy Enclosure 2
  • Counseling Areas and Leader Actions
• Blood and Blood Product Administration - See TTP Section 1
• Bronchitis / Pneumonia Protocol
• CBRN: Nerve Agent Poising Protocol
• Cellulitis/Cutaneous Abscess Protocol
• Chest Pain Protocol
• Cold Injury Protocol
• Constipation/Fecal Impaction Protocol
• Contact Dermatitis Protocol
• Corneal Abrasions / Corneal Ulcers / Conjunctivitis Protocol
• Cough Protocol
• Crush Syndrome - See Tactical Trauma Protocols
• Deep Venous Thrombosis (DVT) Protocol
• Dehydration Protocol
• Dental Pain Protocol
• Determination of Death / Discontinuing Resuscitation Protocol
• Ear Infection (Includes Otitis Media and Otitis Externa) Protocol
• Envenomation Protocols
• Snakes
• Marine
• Insects / Arthropods
• Scorpion
• Epistaxis Protocol
• Flank Pain (Includes Renal Colic, Pyelonephritis, Kidney Stones) Protocol
• Fungal Skin Infection Protocol
• Gastroenteritis Protocol
• Headache Protocol
• Head and Neck Infection (Includes Epiglottitis and Peritonsillar Abscess) Protocol
• Heat Illness Protocol
• HIV Post Exposure Prophylaxis Protocol
• Ingrown Toenail Protocol
• Joint Infection Protocol
• K9 Anaphylactic Reactions and Envenomation Protocol
• K-9 Evaluation and Treatment Protocol
• K9 Gastric Dilation Volvulus (GDV) / Bloat Protocol
• K-9 Heat Injuries Protocol
• K-9 High Altitude Sickness and Pulmonary Edema Protocol
• K-9 RDX (C-4) Ingestion Protocol
• K-9 Trauma Management Protocol
• Kidney Stone - See Flank Pain
• Loss of Consciousness (without Seizures) Protocol
• MACE - See Tactical Trauma Protocols
• Malaria Protocol
• Meningitis Protocol
• Nausea and Vomiting Protocol
• Open Globe Injury Protocol
• Otitis Externa - See Ear Infection
• Otitis Media - See Ear Infection
• Pain Management Protocol
• Pneumonia - See Bronchitis
• Pneumothorax - Acute (Atraumatic) Protocol
• Pulmonary Embolus - See Chest Pain
• Pyelonephritis - See Flank Pain
• Renal Colic - See Flank Pain
• Rhabdomyolysis Protocol
• Seizure Protocol
• Sepsis/Septic Shock Protocol
• Smoke Inhalation / Choking Agent / Toxic Industrial Chemicals (TICs) Protocol
• Subungual Hematoma Protocol
• Testicular Pain Protocol
• Traumatic Brain Injury - Mild (mTBI) - See Tactical Trauma Protocols
• Urinary Tract Infection Protocol

SECTION 3
RECOMMENDED DRUG LIST (RDL)

• Preface and Changes
• Recommended Drug List
  • Acetaminophen (PO, Tylenol)
  • Acetazolamide (Diamox)
  • Aciphex (Rabeprazole)
  • Actiq oral transmucosal fentanyl citrate (OTFC) lozenge – see Fentanyl, Oral
  • Adrenalin – see Epinephrine
  • Afrin Nasal Spray – see Oxymetazoline HCl
  • Albuterol Inhaler (Ventolin/Proventil)
  • Amoxicillin/Clavulanate Acid (Augmentin)
  • ASA – see Aspirin
  • Aspirin (ASA)
  • Atovaquone 250mg/Proguanil 100mg (Malarone)
  • Atripla (Efavirenz/Emtricitabine/Tenofovir)
  • Augmentin – see Amoxicillin/Clavulanate Acid
  • Avelox – see Moxifloxacin
  • Azithromycin (Zithromax, Z-Pak)
  • AZT (Zidovudine/Retrovir)
  • Bactrim – see Trimethoprim-Sulfamethoxazole
  • Bactroban – see Mupirocin Ointment 2%
  • Benadryl – see Diphenhydramine HCl
  • Bisacodyl (Dulcolax)
  • Calcium Chloride (10% solution)
  • Calcium Gluconate (Kalcinate)
  • Ceftriaxone Sodium (Rocephin)
  • Cephalosporins (General Antimicrobial Spectrum)
  • Cerebyx – see Fosphenytoin
  • Chloroquine Phosphate
  • Cialis – see Tadalafil
  • Cyklokapron – see Tranexamic Acid
  • Combivir (Lamivudine and Zidovudine, AZT/ZDV)
  • Decadron – see Dexamethasone
  • Dexamethasone (Decadron)
  • Dextrose – see Glutose
  • Diamox – see Acetazolamide
  • Diazepam (Valium)
  • Diflucan – see Fluconazole
  • Diphenhydramine HCl (Benadryl)
  • Dulcolax – see Bisacodyl
  • Efavirenz and Emtricitabine and Tenofovir – see Atripla
  • Emtricitabine and Efavirenz and Tenofovir – see Atripla
  • Emtricitabine and Tenofovir – see Truvada
  • Epinephrine (Adrenaline)
  • Ertapenem IV (Invanz)
  • Fentanyl
  • Fentanyl (Actiq) – see Oral Fentanyl
  • Flagyl – see Metronidazole
  • Fluoroquinolones – see Quinolones, Moxifloxacin, Gatifloxacin
  • Fluconazole (Diflucan)
  • Fosphenytoin (Cerebyx)
  • Gatifloxacin 0.3% Ophthalmic Liquid (Zymar)
  • Glutose – see Glucose
  • Glucose (Glutose)
  • Hespan (Hetastarch in NaCl) Plasma Volume Expander (Artificial Colloid)
  • Hextend (Hetastarch in Lactated Electrolyte Solution)
  • Ibuprofen (Motrin)
  • Imodium – see Loperamide
  • Invanz – see Ertapenem IV
  • Kalcinate – see Calcium Gluconate
  • Kaletra (Lopinavir and Ritonavir)
  • Ketalar – see Ketamine
  • Ketamine (Ketalar)
  • Ketorolac (Toradol)
  • Lamivudine and Zidovudine (AZT, ZDV) – see Combivir
  • Lariam – see Mefloquine
  • Lidocaine HCl – see Xylocaine
  • Loperamide HCl (Imodium)
  • Lopinavir and Ritonavir – see Kaletra
  • Macrolide Class of Antibiotics – see Azithromycin (Z-Pak)
  • Malarone – see Atovaquone 250mg/Proguanil 100mg
  • Mannitol (Osmotrol)
  • Mefloquine (Larium)
  • Meloxicam (Mobic)
  • Metronidazole (Flagyl)
  • Midazolam
  • Mobic – see Meloxicam
  • Motrin – see Ibuprofen
  • Morphine Sulfate (Opioid)
  • Moxifloxacin (Avelox)
  • Mupirocin Ointment 2% (Bactroban)
  • Narcan – see Naloxone HCl
  • Naloxone HCl (Narcan)
  • Nelfinavir (Viracept)
  • Nifedipine (Procardia)
  • Ofirmev – see Acetaminophen
  • Ondansetron (Zofran)
  • Oral Transmucosal Fentanyl Citrate (OTFC) (Actiq) Lozenge
  • Osmotrol – see Mannitol
  • Oxymetazline HCl (Afrin Nasal Spray)
  • Phenergan – see Promethazine HCl
  • Primaquine
  • Procardia – see Nifedipine
  • Promethazine HCl (Phenergan)
  • Proventil – see Albuterol Inhaler
  • Pseudoephedrine (Sudafed)
  • Quinolones (General Antimicrobial Spectrum)
  • Rabeprazole (Aciphex)
  • Ranitidine (Zantac)
  • Retrovir – see AZT, Zidovudine
  • Rifadin – see Rifampin
  • Rifampin (Rifadin)
  • Ritonavir and Lopinavir – see Kaletra
  • Rocephin – see Ceftriaxone Sodium
  • Salmeterol (Serevent)
  • Septra – see Trimethoprim-Sulfamethoxazole
  • Serevent – see Salmeterol
  • Sildenafil (Viagra)
  • Sodium Bicarbonate
  • Sudafed – see Pseudoephedrine
  • Tadalafil (Cialis)
  • Tenofovir (Viread)
  • Tenofovir and Emtricitabine – see Truvada
  • Tenofovir and Emtricitabine and Efavirenz – see Atripla
  • Tetracaine 0.5% Drops
  • Toradol – see Ketorolac
  • Tranexamic Acid (TXA) (Cyklokapron)
  • Trimethoprim-Sulfamethoxazole (TMP-SMZ, Bactrim, Septra)
  • Truvada (Emtricitabine and Tenofovir)
  • Tylenol – see Acetaminophen
  • Valium – see Diazepam
  • Ventolin – see Albuterol Inhaler
  • Versed – see Midazolam
  • Viagra – see Sildenafil
  • Viread – see Tenofovir
  • Viracept – see Nelfinavir
  • Xylocaine – see Lidocaine HCl
  • Z-Pak – see Azithromycin
  • Zantac – see Ranitidine
  • Zidovudine – see AZT
  • Zithromax – see Azithromycin
  • Zofran – see Ondansetron
  • Zidovudine (AZT, ZDV) and Lamivudine – see Combivir
  • Zymar – see Gatifloxacin 0.3% Ophthalmic Solution
• Master Drug List

SECTION 4
CANINE/K9 TACTICAL COMBAT CASUALTY CARE (C-TCCC)

• Canine/K9 Tactical Combat Casualty Care Guidelines
• Basic Management Plan for Care Under Fire
• Basic Management Plan for Tactical Field Care
• Surgical Airways
• Canine-Tactical Combat Casualty Care Card 

SECTION 5
BURN QUICK REFERENCE GUIDE

• Burn Quick Reference Guide

SECTION 6
NERVE CHART

• Nerve Charts