In this segment, I’m going to do a step-by-step breakdown review of the new 2019 TCCC Guidelines using the “MARCHE-PAWSB” pneumonic, which stands for:
- Massive Hemorrhage
- Airway
- Respirations
- Circulation
- Hypothermia
- Eye Injuries
- Pain Management
- Antibiotics
- Wounds
- Splinting
- Burns
The entire 24 page document is shown in the clickable image below:
TCCC Guidelines 2019
Let’s break it down!
CARE UNDER FIRE
The guidelines for Care Under Fire:
Key Skills:
TACTICAL FIElD CARE (MARCHE-PAWSB)
MASSIVE HEMORRHAGE
These are the guidelines for Massive Hemorrhage:
Massive HemorrhageKey Skills:
- Tourniquet (Limb) π₯
- Junctional Tourniquet π₯
- Wound Packing π₯
- X-Stat π₯
- iTClamp π₯
- Axillary Pressure Dressing π₯
- Inguinal Pressure Dressing π₯
- Neck Pressure Dressing π₯
TACTICAL FIElD CARE (MARCHE-PAWSB)
AIrway
These are the TCCC guidelines for Airway:
TCCC AirwayΒ
Key Skills:
Β
TACTICAL FIElD CARE (MARCHE-PAWSB)
Respiration
The TCCC guidelines for Respiration:
TCCC Respirations
Key Skills:
TACTICAL FIElD CARE (MARCHE-PAWSB)
Circulation
The TCCC guidelines for Circulation:
TCCC Circulation
Key Skills:
- IO access π₯
- IV Access π₯
- TXA Administration π₯
- Tourniquet Replacement π₯
- Blood Typing π₯
- Field Blood Transfusion π₯
TACTICAL FIElD CARE (MARCHE-PAWSB)
Hypothermia
The TCCC Guidelines for Hypothermia:
Key Skills:
TACTICAL FIElD CARE (MARCHE-PAWSB)
eye injuries
The TCCC Guidelines for Eye Injuries:
Key Skills:
TACTICAL FIElD CARE (MARCHE–PAWSB)
Pain Management
The TCCC Guidelines for Pain Management:
TCCC Pain Management
Key Skills:
- Acetaminophenπ
- Meloxicam π
- Fentanyl π
- Ketamine π
- IV Medication Administration π₯
- IM Medication Administration π₯
- IN Medication Administration π₯
TACTICAL FIElD CARE (MARCHE–PAWSB)
Antibiotics
The TCCC Guidelines for Antibiotics:
Key Skills
TACTICAL FIElD CARE (MARCHE–PAWSB)
Wounds
The TCCC Guidelines for Wounds:
Key Skills:
- N/A
TACTICAL FIElD CARE (MARCHE–PAWSB)
splinting
The TCCC Guidelines for Splinting:
Key Skills:
TACTICAL FIElD CARE (MARCHE–PAWSB)
burns
The TCCC Guidelines for Burns:
TCCC Burns
Key Skills:
- N/A
TACTICAL FIElD CARE (“cCDP”)
Not done yet! During your MARCHE-PAWSB, there are 4 points you need to consider:
-
Communication
-
Cardiopulmonary Resuscitation (CPR)
-
Documentation of care
-
Prepare for Evacuation
TACTICAL Evacuation CARE
What’s different? Tactical evacuation care is basically the same as tactical field care, but there are some subtle differences:
- A “Transition of care” section is added just prior to Massive Hemorrhage:
- Endotracheal Intubation is added as an option for airway management under Tactical Evacuation Care. Not specifically recommended in Tactical Field Care
- Guidelines for supplemental oxygen are further detailed in Tactical Evacuation Care following Respirations:
- Guidelines for Traumatic Brain Injury (TBI) are added after Circulation:
- A portable fluid warmer for IV fluids and blood products is mentioned under Hypothermia:
- Guidelines for CPR are slightly more flexible in Tactical Evacuation Care. They state that if you have a casualty with no obviously fatal wounds and you will be arriving at a facility with surgical capability within a short period of time, you MAY perform CPR so long as itβs not done at the expense of providing lifesaving care to other casualties
That’s TCCC in a nutshell! Keep up to date with the guidelines at Deployed Medicine
Good luck out there!
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