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

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• 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!

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CARE UNDER FIRE

The guidelines for Care Under Fire: 

Key Skills:

• Limb Tourniquet Application 🎥

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TACTICAL FIElD CARE (MARCHE-PAWSB)

MASSIVE HEMORRHAGE 

These are the guidelines for Massive Hemorrhage:

Massive Hemorrhage

Key Skills:

• Tourniquet (Limb) 🎥
• Junctional Tourniquet 🎥
• Wound Packing 🎥
• X-Stat 🎥
• iTClamp 🎥
• Axillary Pressure Dressing 🎥
• Inguinal Pressure Dressing 🎥
• Neck Pressure Dressing 🎥

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TACTICAL FIElD CARE (MARCHE-PAWSB)

AIrway

These are the TCCC guidelines for Airway:

TCCC Airway

 

Key Skills:

• NPA 🎥
• Igel Insertion 🎥
• Cricothyrotomy 🎥
• Endotracheal Intubation 🎥

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TACTICAL FIElD CARE (MARCHE-PAWSB)

Respiration

The TCCC guidelines for Respiration:

TCCC Respirations

 

Key Skills:

• • Needle Decompression 🎥

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TACTICAL FIElD CARE (MARCHE-PAWSB)

Circulation

The TCCC guidelines for Circulation:

TCCC Circulation

 

Key Skills: 

• IO access 🎥
• IV Access 🎥
• TXA Administration 🎥
• Tourniquet Replacement 🎥
• Blood Typing 🎥
• Field Blood Transfusion 🎥

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TACTICAL FIElD CARE (MARCHE-PAWSB)

Hypothermia

The TCCC Guidelines for Hypothermia:

 

Key Skills:

• Ready Heat Blanket 🎥
• Fluid Warmer 🎥

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TACTICAL FIElD CARE (MARCHE-PAWSB)

eye injuries

The TCCC Guidelines for Eye Injuries:

 

Key Skills:

• Rigid Eye Shield 🎥

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TACTICAL FIElD CARE (MARCHE–PAWSB)

Pain Management

The TCCC Guidelines for Pain Management:

TCCC Pain Management

 

Key Skills:

• Acetaminophen📖
• Meloxicam 📖
• Fentanyl 📖 
• Ketamine 📖
• IV Medication Administration 🎥
• IM Medication Administration 🎥
• IN Medication Administration 🎥 

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TACTICAL FIElD CARE (MARCHE–PAWSB)

Antibiotics

The TCCC Guidelines for Antibiotics:

 

Key Skills

• Moxifloxacin 📖 
• Ertapenem 📖
• Powdered Medication Reconstitution 🎥

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TACTICAL FIElD CARE (MARCHE–PAWSB)

Wounds

The TCCC Guidelines for Wounds:

Key Skills:

• N/A

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TACTICAL FIElD CARE (MARCHE–PAWSB)

splinting

The TCCC Guidelines for Splinting:

Key Skills:

• Arm Splints🎥 
• Leg Splints🎥 

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TACTICAL FIElD CARE (MARCHE–PAWSB)

burns

The TCCC Guidelines for Burns:

TCCC Burns

 

Key Skills:

• N/A

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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

 

 

 

 

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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 it’s not done at the expense of providing lifesaving care to other casualties

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That’s TCCC in a nutshell!  Keep up to date with the guidelines at Deployed Medicine

 

Good luck out there!