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New in this edition

  • 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)

Advanced Tactical Paramedic - Protocols
11th Edition
Table of Contents

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
    • Basic Management Plan for Tactical Evacuation Care
    • Prolonged Field Care Considerations
  • 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 TACTICAL COMBAT CASUALTY CARE (C-TCCC)

  • Canine Tactical Combat Casualty Care
    • C-TCCC Guidelines

SECTION 5
BURN QUICK REFERENCE GUIDE

  • Burn Quick Reference Guide

SECTION 6
NERVE CHART

  • Nerve Charts