The PJ Med Director and the PJ Medical Programs Manager discuss Ten key changes to the new handbook.

The handbook is being formatted and then out for print with the Journal of Special Operations Medicine.

DO NOT INSTITUTE THESE UNTIL THE HANDBOOK IS RELEASED OR YOUR FLIGHT DOC DIRECTS YOU TO.

1. Updated MARCH assessment to align w/ JTS TCCC guidelines
   1. Moved pelvic binder to circulation, specified how/how not to assess pelvis
2. Combat/Hemorrhagic Shock and blood protocol
   1. TXA – 2gm (1 minute slow IV push)-also used for suspected TBI
   2. cold stored type 'O' whole blood>fresh low titer-'O' whole blood >PRBCs and plasma>plasma alone>PRBCs alone>non-titered type ‘O’ fresh whole blood>non-titered type specific fresh whole blood
   3. added 10mL of 10% calcium gluconate
3. “bougie assisted cric” method
4. Added vent troubleshooting and adjustment guide
5. General fluid guidance
   1. Omitted Hextend
   2. LR is primary crystalloid for non-hemorrhagic shock casualties (may still carry 100CC for med recon)
   3. Removing 3% Saline (see TBI protocol update)
6. TBI
   1. Replaced 3% Saline with 30mL of 23.4% hypertonic saline (learn the technique first)
   2. Versed for active seizures, Keppra for prophylactic (depressed skull fx/penetrating head wounds)
7. Procedural Sedation
   1. Replaced procedural analgesia w/ procedural sedation and provided protocol
   2. No longer promoting ketamine/fentanyl/versed rotation
      1. Dilauded f/ long term pain control in hemodynamically stable
      2. Ketamine for unstable
   3. Medications added to formulary to support ATP small unit care capability/modified TMEPS
      1. Famotidine (Pepcid) – Zantac replacement
      2. Amoxicillin
      3. Azithromycin
      4. 1% Hydrocortisone cream
      5. Metronidazole (Flagyl)
      6. Malarone/primaquine
      7. Ciprofloxacin
      8. 4% saline
   4. Medications removed
      1. Albumin
      2. Ranitidine (Zantac)
   5. CBRNE updates
      1. Added CRESS acronym (Consciousness, Respirations, Eyes, Secretions, Skin)-NATO method
      2. Added MARCH Squared
      3. Updated Cyanide Antidote
         1. Hydroxycobalimin, Sodium thiosulfate and activated charcoal

Doc Dorsch then gives us an ATP update amongst other intel.

THAT OTHERS MAY LIVE