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Warning

This document is distributed for use by the mine action community, review and comment. Although in a similar format to the International Mine Action Standards (IMAS) it is not part of the IMAS Series. It is subject to change without notice and may not be referred to as an International Mine Action Standard.
Recipients of this document are invited to submit, with their comments, notification of any relevant patent rights of which they are aware and to provide supporting documentation. Comments should be sent to mineaction@un.org with a copy to imas@gichd.org.

The content of this document has been drawn from open source information and has been technically validated as far as reasonably possible. Users should be aware of this limitation when utilizing information contained within this document. They should always remember that this is only an advisory document; it is not an authoritative directive.

Foreword

Management practices and operational procedures for humanitarian mine action are constantly evolving. Improvements are made, and changes required, to enhance safety and productivity. Changes may come from the introduction of new technology, in response to a new mine or UXO threat, and from field experience and lessons learned in other mine action projects and programmes. This experience and lessons learned should be shared in a timely manner.

Technical Notes provide a forum to share experience and lessons learned by collecting, collating and publishing technical information on important, topical themes, particularly those relating to safety and productivity. Technical Notes complement the broader issues and principles addressed in International Mine Action Standards (IMAS).

Technical Notes are not formally staffed prior to publication. They draw on practical experience and publicly-available information. Over time, some Technical Notes may be 'promoted' to become full IMAS standards, while others may be withdrawn if no longer relevant or if superseded by more up-to-date information.

Technical Notes are neither legal documents nor IMAS. There is no legal requirement to accept the advice provided in a Technical Note. They are purely advisory and are designed solely to supplement technical knowledge or to provide further guidance on the application of IMAS.

Technical Notes are compiled by the Geneva International Centre for Humanitarian Demining (GICHD) at the request of the United Nations Mine Action Service (UNMAS) in support of the international mine action community. They are published on the IMAS website at (www.mineactionstandards.org).

Introduction

IMAS 10.40 specifies the minimum requirements for medical emergency preparedness during mine action operations. However, the clinical content of IMAS 10.40 has not been revised since originally drafted in 2004, and the wording permits significant variance in terms of the clinical competencies displayed by medical staff.

As the mine action sector matures, operators are increasingly looking for more comprehensive, and context appropriate, guidance against which to assess and train their staff. There have also been clinical advances and doctrinal shifts in the pre-hospital management of explosive trauma since 2004 that should be incorporated into mine action medical practice and guidelines where appropriate and feasibly practicable.

This Technical Note aims to provide additional context specific guidance, informed by current pre-hospital trauma practice, on the provision of appropriate medical cover within the mine action context which can be used for assessment and standardisation of medical support to mine action programmes.

This Technical Note is informed heavily by the Committee for Tactical Emergency Casualty Care (C-TECC 2016) guidelines which are a “set of best practice treatment guidelines for trauma care in the high‐threat prehospital environment. These guidelines are built upon critical medical lessons learned by US and allied military forces over the past 15 years of conflict. They are appropriately modified to address the specific needs of civilian populations and civilian EMS practice.”

1. Scope

This document provides guidance on the recommended clinical competencies, scope of practice and sequence of care recommended for all staff involved in the accident response process. This document it is designed to be read in conjunction with, and augment, the guidance contained in IMAS 10.40.

The use of this document should enable mine action operators to improve the efficacy of medical responses to traumatic injuries and provide a tool for assessing the personal development needs of staff.

2. References

A list of normative references, to which reference is made in this Technical Note and which therefore form part of the provisions of this Technical Note, can be found in Annex A: (Normative) References.

Recommendations for each classification of care provider, to which this Technical Note makes reference, are tabulated in Annex B: (Informative) Clinical Competency by Provider Level, Annex C: (Informative) Equipment Familiarity by Provider Level, and Annex D: (Informative) Recommended Drugs List

Additional articles detailing the evolution of contemporary military medicine, that informs the C-TECC guidelines, can be found in Annex E: (Informative) References.

3. Terms, Definitions and Abbreviations

The term ‘CASEVAC Destination’ refers to a medical facility with the capacity to appropriately stabilise the casualty’s condition. E.g. trauma casualties will often require transport to a facility capable of relevant emergency surgical interventions, whereas a local clinic may suffice for casualties with more minor injuries. The chosen evacuation destination should be appropriately matched to the casualty’s injuries and condition to meet the definition of an appropriate ‘CASEVAC Destination.’

The term ‘Care Provider’ refers to personnel employed by mine action organisations that are authorised to deliver context appropriate medical care within their defined scope of practice. Care providers can be classified as ‘Basic Care Providers,’ (BCPs) ‘Intermediate Care Providers,’ (ICPs) or ‘Extended Care Providers’ (ECPs).

The term ‘Clinical Competency’ refers to a care provider’s ability to perform a given medical intervention safely and effectively. Emphasis is placed on practical performance; therefore, demonstrable competency must be proven irrespective of prior existing certification.

The term ‘Medical Professional’ refers to personnel that have undergone formal medical training that is endorsed by a nationally or internationally recognised medical authority or 

professional body. Only medical professionals are appropriately knowledgeable or experienced to fulfil the role of ECPs; examples include paramedics, nurses, doctors, etc.

The term ‘Casualty Evacuation’ (or ‘CASEVAC’) refers to all actions taken to move and treat the injured party from the point of injury until handover to CASEVAC destination.

The term ‘Medical Treatment Area’ refers to a designated location, or locations, within or in close proximity to a clearance task that has clear, safe, access and is sufficiently spacious to facilitate the safe, unhindered, provision of emergency medical care. The Medical Treatment Area may be referred to by different terms in organisational SOPs, however the sentiment, whether called a ‘Medical Treatment Area,’ ‘Medic Point,’ or otherwise, is the same.

4. Compliance

In this Technical Note, the words ‘should’ and ‘may’ are used to convey the intended degree of compliance. This use is consistent with the language used in ISO standards and guides.

In IMAS, ‘shall’ is used to indicate requirements, methods or specifications that are to be applied in order to conform to the standard. The term ‘shall’ is not typically used within Technical Notes, however due to the subject of this Technical Note the term ‘shall’ is used in order not to understate the importance of certain recommendations.

‘Should’ is used to indicate the recommended requirements, methods or specifications. ‘May’ is used to indicate a possible method or course of action.

5. Clinical Oversight

Mine action organisations should establish a framework for the formal provision of structured clinical oversight within their operational management structure.

The provision of structured clinical oversight will better enable mine action organisations to supervise and support their deployed care providers by providing an enhanced capability to:

  1. Perform medical needs assessments at both the programmatic and global level
  2. Liaise and coordinate with national health authorities
  3. Write and maintain informed internal clinical practice guidelines
  4. Train and assess deployed care providers in accordance with both national laws and regulations and internal clinical practice guidelines
  5. Perform internal quality assurance of accident response planning and procedures
  6. Collate and evaluate internal accident records to inform evidence-based practice

To achieve an appropriate level of clinical oversight, mine action organisations should engage medical professionals with relevant and appropriate training and experience on an employment or consultative basis.

6. Clinical Competencies

The tables in Annexes B, C and D outline the clinical competency and equipment familiarity recommendations for the management of the foreseeable injuries sustained during mine action operations and provide mine action operators with a framework against which to assess the clinical capacity of their care providers and identify development and training requirements.

In order for certification as a basic, intermediate, or extended care provider, the training provided shall enable the recipient to perform all of the competencies marked “should” for the respective level of care provider as tabulated in Annexes B and C, be formally assessed, and (where appropriate) be verified by the local authorities.

Mine action organisations shall strive to certify their staff as care providers of the level relevant to their role and sufficient to meet organisational requirements.

6.1. Training and Assessment

Mine action organisations will not typically have the capacity to deliver extensive formal medical training. However, mine action organisations should be able to perform practical training and assessment of all of the individual competencies marked “should,” where relevant to the level of care provider deployed, as tabulated in Annexes B, C and D. This training and assessment capacity would typically be provided by the same medical professionals providing clinical oversight, but may alternatively be provided by an external resource.

6.2. Maintenance of Clinical Competency

Care providers supporting clearance operations may suffer from skill fade. In addition to refresher training and the conduct of regular CASEVAC drills containing casualty simulations with a bona fide clinical component, where practicable it is recommended that mine action organisations also seek to arrange appropriate clinical placements within healthcare facilities.

7. Care Provider Levels

Mine action care providers may be classified as:

  1. Basic Care Providers (BCPs)

  2. Intermediate Care Providers (ICPs)

  3. Extended Care Providers (ECPs)

7.1. Basic Care Providers

All field personnel involved in survey and clearance activities should be trained to the level of Basic Care Provider.

The clinical competencies recommended for BCPs are informed by the Committee for Tactical Emergency Casualty Care (C-TECC 2016) “Guidelines for First Care Providers” and the US Department of Homeland Security Stop the Bleed initiative (DHS 2018).

7.2. Intermediate Care Providers

The designated person/s responsible for the initial formal emergency medical response should be trained to the level of Intermediate Care Provider. ICPs may act as dedicated standby medical personnel or fulfil a dual role in daily clearance operations.

All survey and clearance teams should have access to at least one ICP. In situations where there are multiple teams working in close proximity, one ICP may provide medical cover to more than one team. ICPs providing medical cover to multiple teams should be deployed in a dedicated standby role and be positioned in such a manner that they are able to respond to any of the teams under their jurisdiction within the normal time frame prescribed by the organisation’s SOP.

It should be understood that not all local medical professionals will automatically meet the recommended clinical competency criteria for ICPs.

It is recommended that members of clearance personnel with a supervisory capacity are also trained as ICPs.

In the event that there are no dedicated standby medical personnel and the ICPs are fulfilling a dual role in daily clearance, it is recommended that 1 in 4 members of clearance personnel are trained to the level of ICP and that there are at least 2 ICPs present on all tasks.

The clinical competencies encompassed by the ICP are informed by the Committee for Tactical Emergency Casualty Care (C-TECC 2016) “Guidelines for First Responders with a Duty to Act” and the World Health Organisation “Guidelines for essential trauma care” (WHO 2004) for Generalists.

7.3. Extended Care Providers

The term Extended Care Provider refers to experienced medical professionals that have undergone formal and relevant medical training that is recognised by a national medical authority, and therefore have a much more comprehensive underpinning knowledge and associated scope of practice than ICPs.

The following guidance is provided regarding the deployment of ECPs:

  1. The provision of an ECP should be considered to support teams operating in circumstances where the provision of an ECP is likely to improve casualty outcomes
    1. If an organisation determines the provision of an ECP is warranted following an internal assessment of the perceived foreseeable injuries and/or delayed complications, the organisation should strive to deploy an ECP in a manner that enables the ECP to rendezvous with the casualty en-route within a sensible time period

The clinical competencies encompassed by the ECP are informed by the Committee for Tactical Emergency Casualty Care (C-TECC 2017) “Guidelines for BLS/ALS Medical Providers,” the World Health Organisation “Guidelines for essential trauma care” (WHO 2004) for Specialists (where appropriate for the pre-hospital context), and the Clinical Practice Guidelines (JRCALC 2016) for Paramedics.

8. CASEVAC and Sequencing of Care

The CASEVAC process is intended to maximise casualty survivability by ensuring effective and timely casualty extraction, treatment, and evacuation whilst managing associated contextual risks.

Due to the contextual changes throughout the various points on the CASEVAC timeline it is helpful to split the CASEVAC process into 3 distinct phases, each with its own specific casualty care requirements:

  1. Phase 1: Hazardous Area Extraction

  2. Phase 2: Care on Site

  3. Phase 3: Care in Transit

8.1. Phase 1: Hazardous Area Extraction

Hazardous Area Extraction is the first phase of the CASEVAC process and covers all activities undertaken from the point of injury until the casualty is delivered to the Medical Treatment Area.

The priority in the Hazardous Area Extraction is for the trained rescue party to gain, or create, safe access to the casualty and then rapidly extract the casualty to the Medical Treatment Area.

Due to the limited safe space within clearance lanes, and the understanding that many casualties will require treatment beyond the scope of the BCP trained clearance personnel, non-time critical activities, e.g. bandaging and spinal immobilisation, should not be performed until the Care on Site phase when the casualty is under supervision of the receiving ICP/ECP care provider in an appropriately sized Medical Treatment Area.

In certain circumstances dictated by organisational SOPs, and where safe to do so, the receiving ICP/ECP may rendezvous with the rescue party before transfer to the Medical Treatment Area to delegate and/or otherwise assist with casualty care during the Hazardous Area Extraction phase.

The rescue party should aim to complete the Hazardous Area Extraction, within 5 minutes of initiation of the accident response.

It may not be possible to meet the 5-minute target in situations where extensive clearance is required to gain safe access to the casualty, and/or in situations with other hazards that need to be managed first, such as CBRN or tactical considerations.

The principles of hazardous area extraction should also be applied to accidents that occur outside of clearance tasks, e.g. vehicle collisions, where associated hazards such as fires or traffic may prohibit the safe provision of care at, or close to, the point of injury.

The scope of care during the Hazardous Area Extraction phase is informed by the scope of care during the “Direct Threat Care” phase within The Emergency Care Guidelines (C-TECC 2016).

8.2. Phase 2: Care on Site

Care on Site is the second phase of the CASEVAC process and covers all activities undertaken from when the casualty is delivered to the Medical Treatment Area until they loaded and ready for transport.

The attending care providers should aim to complete the Care on Site phase, performing holistic casualty assessment, time critical clinical interventions, and loading into the evacuation platform, within 15 minutes of receipt of the casualty at the Medical Treatment Area.

Trauma casualties will require treatment beyond the scope of the receiving on-site care providers, therefore time should not be wasted performing non-time critical clinical interventions that can be reasonably delayed and practicably performed in transit. This is especially important in time critical casualties and situations with short evacuation times.

Exceptions to this guidance include situations where the number of care providers enables non-time critical clinical interventions to be performed concurrently; the casualty’s injuries and condition are such that it is not deemed a time critical medical emergency; and/or in circumstances where there are known bottlenecks in the CASEVAC chain (e.g. air evacuation platform response times mean that a prolonged Care on Site phase will not negatively affect arrival time to an appropriate CASEVAC destination.)

Failure to heed this advice will complicate, and delay, packaging and transport to a surgical facility which is needed to definitely manage traumatic injuries.

The scope of care during the Care on Site phase is informed by the scope of care during the “Indirect Threat Care” phase within The Emergency Care Guidelines (C-TECC 2016, 2017), the Clinical Practice Guidelines (JRCALC 2016) for Trauma Emergencies.

8.3. Phase 3: Care in Transit

Care in Transit is the third and final phase of the CASEVAC process and covers all activities undertaken from when the casualty loaded for transport until handover to an appropriate CASEVAC destination.

Clinical care should not stop during transport, the attendant care provider/s should deliver appropriate care in transit with an emphasis on continual monitoring and reassessment of the casualty’s condition and the continued efficacy of previously performed interventions. The Care in Transit phase also provides the opportunity for the management of any remaining non-time critical conditions deferred during the Care on Scene phase.

The scope of care during the Care in Transit phase is informed by the scope of care during the “Evacuation Care” phase within The Emergency Care Guidelines (C-TECC 2016, 2017), the Clinical Practice Guidelines (JRCALC 2016) for Trauma Emergencies, and the Guidelines for essential trauma care (WHO 2004) for Generalists.

Annex A: (Normative) References

World Health Organisation (WHO) (2004), “Guidelines for essential trauma care,” (accessed 30 November 2018) <http://www.who.int/violence_injury_prevention/publications/services/en/guidelines_ traumacare.pdf>

Committee for Tactical Emergency Casualty Care (C-TECC) (2016) “Guidelines for First Care Providers,” (accessed 30 November 2018) <http://www.c-tecc.org/guidelines/civilian-first-care-provider>

Committee for Tactical Emergency Casualty Care (C-TECC) (2016) “Guidelines for First Responders with a Duty to Act,” (accessed 30 November 2018) <http://www.c-tecc.org/guidelines/first-responders-with-a-duty-to-act>

Committee for Tactical Emergency Casualty Care (C-TECC) (2017) “Guidelines for BLS/ALS Medical Providers,” (accessed 30 November 2018) <http://www.c-tecc.org/guidelines/als-bls>

United States Department of Defense Joint Trauma System (US DoD JTS) Committee on Tactical Combat Casualty Care (CoTCCC) (2018), “Tactical Combat Casualty Care Guidelines,” (accessed 30 November 2018) <https://www.deployedmedicine.com/market/11/category/43>

Joint Royal Colleges Ambulance Liaison Committee (JRCALC) (2016), “Clinical Practice Guidelines,”

“Journal of Special Operations Medicine” (accessed 01 May 2018) <https://www.jsomonline.org>

United States Department of Homeland Security (DHS) (2018) “Stop the Bleed” Initiative (accessed 01/10/2018) <https://www.dhs.gov/stopthebleed>

Annex B: (Informative) Clinical Competency by Provider Level

 

Safety

Clinical Competency Care Provider Level BCP Care Provider Level ICP Care Provider Level ECP
Scene Size-Up (Tactical/HAZMAT/Rescue/Enviro/Access/Traffic) SHOULD SHOULD SHOULD
Personal Protective Equipment / Body Substance Isolation SHOULD SHOULD SHOULD
CASEVAC procedures SHOULD SHOULD SHOULD

 

Diagnosis

Clinical Competency Care Provider Level BC    P Care Provider Level ICP Care Provider Level ECP
Recognition of catastrophic bleeding MAY      SHOULD SHOULD
Mechanism of Injury (MoI) assessment (incl. HAZMAT/CBRN) MAY SHOULD SHOULD
Triage MAY SHOULD SHOULD
Primary survey (Rapid Trauma Survey) MAY SHOULD SHOULD
C-Spine evaluation   SHOULD SHOULD
Vital signs assessment MAY SHOULD SHOULD
Secondary Survey MAY SHOULD SHOULD
Handover SHOULD SHOULD SHOULD
History taking   SHOULD SHOULD

 

Catastrophic Bleeding Control

Clinical Competency Care Provider Level BCP Care Provider Level ICP Care Provider Level ECP
Pressure application (direct and indirect) SHOULD      SHOULD SHOULD
Extremity tourniquet application SHOULD SHOULD SHOULD
Wound packing MAY SHOULD SHOULD
Pressure dressing application SHOULD SHOULD SHOULD
Junctional tourniquet application MAY MAY MAY
Tourniquet assessment/repositioning/conversion   SHOULD SHOULD
Pelvic assessment and splinting   SHOULD SHOULD

 

Airway Management

Clinical Competency Care Provider Level BCP Care Provider Level ICP Care Provider Level ECP
Casualty positioning (lateral/lean forward/casualty preference) SHOULD      SHOULD SHOULD
Head-tilt/chin-lift (for use in conjunction with chest compressions) MAY SHOULD SHOULD
Jaw thrust MAY SHOULD SHOULD
Nasopharyngeal airways MAY MAY SHOULD
Oropharyngeal airways MAY MAY MAY
Supraglottic airway devices (e.g. i-Gel)   MAY MAY
Manual suction   MAY SHOULD
Bougie assisted surgical cricothyroidotomy   MAY MAY

 

Respiratory Management

Clinical Competency Care Provider Level BCP Care Provider Level ICP Care Provider Level ECP
Oxygen therapy      MAY SHOULD
Manual ventilation MAY MAY SHOULD
Rescue breaths (for use in conjunction with chest compressions) MAY MAY MAY
Thoracic sealing, venting and maintenance MAY SHOULD SHOULD
Needle thoracostomy   MAY MAY
Surgical thoracostomy and blunt dissection     MAY

 

Circulatory Management

Clinical Competency Care Provider Level BCP Care Provider Level ICP Care Provider Level ECP
Peripheral intravenous or intraosseous access   SHOULD SHOULD
Chest compressions (de-emphasised in a trauma setting) MAY SHOULD SHOULD
ACLS (including defibrillation equipment permitting)     SHOULD
Establishment of a chest drain     MAY

 

Fracture Management

Clinical Competency Care Provider Level BCP Care Provider Level ICP Care Provider Level ECP
Splinting MAY SHOULD SHOULD
Femoral traction   SHOULD SHOULD
11      
Lifting and rolling SHOULD SHOULD SHOULD
Stretcher transport SHOULD SHOULD SHOULD
Spinal motion restriction SHOULD SHOULD SHOULD

 

Eye Injury Management

Clinical Competency Care Provider Level BCP Care Provider Level ICP Care Provider Level ECP
Irrigation MAY SHOULD SHOULD
Eye dressing   SHOULD SHOULD

 

Burn Management

Clinical Competency Care Provider Level BCP Care Provider Level ICP Care Provider Level ECP
Burn dressing MAY SHOULD SHOULD
Fluid replacement   SHOULD SHOULD

 

Miscellanous Injuries

Clinical Competency Care Provider Level BCP Care Provider Level ICP Care Provider Level ECP
Bites and stings   SHOULD SHOULD

 

Wound Management

Clinical Competency Care Provider Level BCP Care Provider Level ICP Care Provider Level ECP
Wound cleaning MAY SHOULD SHOULD
Wound closure (minor wounds only)   MAY MAY
Dressing of non-haemorrhagic injuries MAY SHOULD SHOULD

 

Metabolic Homeostasis Management

Clinical Competency Care Provider Level BCP Care Provider Level ICP Care Provider Level ECP
Hypothermia/hyperthermia management techniques MAY SHOULD SHOULD

 

Equipment Familiarity

Clinical Competency Care Provider Level BCP Care Provider Level ICP Care Provider Level ECP
See Annex C SHOULD SHOULD SHOULD

 

Drug Therapy

Clinical Competency Care Provider Level BCP Care Provider Level ICP Care Provider Level ECP
See Annex D   SHOULD SHOULD

Annex C: (Informative) Equipment Familiarity by Provider Level

Safety

Equipment Familiarity Care Provider Level BCP Care Provider Level ICP Care Provider Level ECP
Examination Gloves SHOULD SHOULD SHOULD
Protective Eyewear SHOULD SHOULD SHOULD
CPR Barrier Devices MAY MAY MAY

 

Diagnosis

Equipment Familiarity Care Provider Level BCP Care Provider Level ICP Care Provider Level ECP
Manual Sphygmomanometers   MAY SHOULD
Stethoscopes   MAY SHOULD
Pupil Torches   MAY SHOULD
Thermometers   MAY SHOULD
Pulse Oximeters   MAY MAY
Patient Monitors     MAY

 

Massive Haemorrhage Control

Equipment Familiarity Care Provider Level BCP Care Provider Level ICP Care Provider Level ECP
Extremity Windlass Arterial Tourniquets SHOULD SHOULD SHOULD
Compressed Gauze SHOULD SHOULD SHOULD
Topical Haemostatic Agents MAY MAY MAY
Pressure Dressings SHOULD SHOULD SHOULD
Junctional Tourniquets MAY MAY MAY

 

Airway Management

Equipment Familiarity Care Provider Level BCP Care Provider Level ICP Care Provider Level ECP
Nasopharyngeal airways   MAY SHOULD
Supraglottic airway devices (OPA/LMA/i-Gel/etc.)     MAY
Manual Suction Units   MAY SHOULD
Cricothyroidotomy Kits     MAY

 

Respiratory Management

Equipment Familiarity Care Provider Level BCP Care Provider Level ICP Care Provider Level ECP
Oxygen Cylinders, Regulators and Masks   MAY SHOULD
Bag Valve Masks (“ambu-bags”)   MAY SHOULD
Chest Seals MAY SHOULD SHOULD
Thoracostomy Needles   MAY MAY

 

Circulatory Management

Equipment Familiarity Care Provider Level BCP Care Provider Level ICP Care Provider Level ECP
Administration Sets   SHOULD SHOULD
IV Cannulae   SHOULD SHOULD
IO Cannulae   MAY MAY
Defibrillators MAY MAY MAY
Chest Tubes and Drains     MAY
Foley Catheter   MAY MAY

 

Fracture Management

Equipment Familiarity Care Provider Level BCP Care Provider Level ICP Care Provider Level ECP
Conformable Splints MAY SHOULD SHOULD
Traction Splints   MAY MAY

 

Packaging and Transportation

Equipment Familiarity Care Provider Level BCP Care Provider Level ICP Care Provider Level ECP
Soft Stretchers SHOULD SHOULD SHOULD
Spinal motion restriction equipment MAY MAY MAY

 

Burn Management

Equipment Familiarity Care Provider Level BCP Care Provider Level ICP Care Provider Level ECP
Burn Dressings MAY SHOULD SHOULD

 

Wound Management

Equipment Familiarity Care Provider Level BCP Care Provider Level ICP Care Provider Level ECP
Wound Closure Strips   SHOULD SHOULD
Suture Kits   MAY MAY
Bandages and Dressing Pads SHOULD SHOULD SHOULD
13      

 

Metabolic Homeostasis Management

Equipment Familiarity Care Provider Level BCP Care Provider Level ICP Care Provider Level ECP
Blankets SHOULD SHOULD SHOULD

Annex D: (Informative) Recommended Drugs List by Provider Level

Fluid Resuscitation

Reason for Administration, Drug Type and Route Care Provider Level BCP Care Provider Level ICP Care Provider Level ECP
0.9% NaCl / Ringers Lactate / Hartmann’s Solution   SHOULD SHOULD
Fresh Whole Blood   MAY MAY
Freeze Dried Plasma   MAY MAY

 

Internal Haemorrhage

Reason for Administration, Drug Type and Route Care Provider Level BCP Care Provider Level ICP Care Provider Level ECP
Analgesic agent for management of mild-moderate pain   SHOULD SHOULD
Analgesic agent for management of severe pain   SHOULD SHOULD
IM/IV Naloxone (where relevant)   MAY MAY
IV Antiemetic (where relevant)   MAY MAY

 

Infection Control

Reason for Administration, Drug Type and Route Care Provider Level BCP Care Provider Level ICP Care Provider Level ECP
PO Antibiotic   SHOULD SHOULD
IV/IO Antibiotic   SHOULD SHOULD
Topical antiseptic   SHOULD SHOULD

 

Anaphylaxis

Reason for Administration, Drug Type and Route Care Provider Level BCP Care Provider Level ICP Care Provider Level ECP
IM Adrenaline   MAY MAY
IV/IO Adrenaline     MAY

 

Resuscitation

Reason for Administration, Drug Type and Route Care Provider Level BCP Care Provider Level ICP Care Provider Level ECP
Oxygen   MAY MAY
IV/IO Adrenaline     MAY

 

Nerve Agent Exposure

Reason for Administration, Drug Type and Route Care Provider Level BCP Care Provider Level ICP Care Provider Level ECP
IM Atropine (where relevant)   SHOULD SHOULD
IV/IO Atropine (where relevant)     SHOULD

 

Cardiac

Reason for Administration, Drug Type and Route Care Provider Level BCP Care Provider Level ICP Care Provider Level ECP
PO/SL Platelet Aggregation Inhibitors     MAY
SL Vasodilators     MAY
IV/IO ACLS Drugs     MAY

 

Procedural Sedation / Seizure Arrest

Reason for Administration, Drug Type and Route Care Provider Level BCP Care Provider Level ICP Care Provider Level ECP
Benzodiazepines     MAY

 

Metabolic Homeostasis

Reason for Administration, Drug Type and Route Care Provider Level BCP Care Provider Level ICP Care Provider Level ECP
PO Glucose/Dextrose     MAY
IV/IO Glucose/Dextrose     MAY

 

Primary Health Care

Reason for Administration, Drug Type and Route Care Provider Level BCP Care Provider Level ICP Care Provider Level ECP
PO Rehydration Salts   SHOULD SHOULD
PO Antidiarrheal   SHOULD SHOULD
PO Antihistamine   SHOULD SHOULD
PO Antiemetic     MAY
Malaria test kit and appropriate PO treatment course   MAY MAY
Topical insect repellent SHOULD SHOULD SHOULD

Annex E: (Informative) References

Bulter, F. et al. (2017), “Management of Suspected Tension Pneumothorax in Tactical Combat Casualty Care: TCCC Guidelines Change 17-02” Journal of Special Operations Medicine Vol.18(2)

Doyle, G. S. (2010), “Tourniquet First!: Safe & rational protocols for prehospital tourniquet use,” Journal of Emergency Medicine (accessed 04 February 2018) <www.jems.com/articles/2010/05/tourniquet-first.html>

Eastridge, B. L. et al. (2012), “Death on the battlefield (2001-2011): implications for the future of combat casualty care,” Journal of Trauma Acute Care Surgery Vol.73(6)

Holcomb, J. B. et al. (2006), “Understanding combat casualty care statistics,” Journal of Trauma Vol.60(2)

Holcomb, J. B. et al. (2007), “Causes of death in U.S. Special Operations Forces in the global war on terrorism: 2001-2004,” Annals of Surgery Vol.245(6)

Kelly, J. F. et al. (2008) “Injury severity and causes of death from Operation Iraqi Freedom and Operation Enduring Freedom: 2003-2004 vs 2006,” Journal of Trauma Vol.64(2)

Kragh, J. F. et al. (2009), “Survival with emergency tourniquet use to stop bleeding in major limb trauma,” Annals of Surgery Vol.249(1)

Kotwal, R. S. et al. (2011), “Eliminating Preventable Death on the Battlefield,” Archives of Surgery Vol.146(12)

Lee, C. et al. (2007) “Tourniquet use in the civilian prehospital setting,” Emergency Medicine Journal Vol.24(8)

Richey, S.L. (2007), "Tourniquets for the control of traumatic hemorrhage: a review of the literature," World Journal of Emergency Surgery Vol.2(28)

United States Department of Defense Joint Trauma System (US DoD JTS) Committee on Tactical Combat Casualty Care (CoTCCC) (2008-2017) “Meeting Minutes” (accessed 30 November 2018) <https://www.jsomonline.org/TCCC.php>

Amendment Record

Technical Notes are subject to review on an ‘as required’ basis. As amendments are made to this Technical Note they will be given a number, and the date and general details of the amendment shown in the table below. The amendment will also be shown on the cover page of the TN by the inclusion under the version date of the phrase ‘incorporating amendment number(s) 1 etc.’

As reviews of TN are made new versions may be issued. Amendments up to the date of the new version will be incorporated into the new version and the amendment record table cleared. Recording of amendments will then start again until a further version is produced.

The most recently amended TN will be the versions that are posted on the IMAS website at www.mineactionstandards.org

Number Date Amendment Details
     
     
     

 

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