ANTIBIOTICS IN TACTICAL COMBAT CASUALTY CARE TCCC

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ANTIBIOTICS IN TACTICAL COMBAT CASUALTY CARE
(TCCC)

• Infections and sepsis are a late cause of
  morbidity and mortality in combat trauma
  patients. Recommendations for and commentary on
  early administration of antibiotics in the combat
  casualty have been recorded since WWII.

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ANTIBIOTICS IN TCCC

• All wounds sustained on the battlefield should
  receive antibiotics. But at a minimum, any
  patient presenting with penetrating abdominal
  trauma, massive soft tissue damage, a grossly
  contaminated wound, open fracture, or a long
  delay in CASEVAC/MEDVAC should receive
  prophylactic antibiotics.

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ANTIBIOTICS IN TCCC

• War wound antibiotics need to be simple,
  practical, effective, have a good safety profile,
  and a broad spectrum of activity.
• Treatment should start immediately and continue
  at least until surgical debridement has occurred.
• Coverage should be appropriate for the organisms
  implicated in combat wound infections.

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ANTIBIOTICS IN TCCC

• Consideration should be made as to how far
  forward the BN PA/MD want to push antibiotic
  supplies and release authority. This will depend
  on several factors
• Supply/Re-supply
• Education and training level of Medics, Combat
  Life Savers, and Laymen
• Mission and Unit priority

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PILL AND PARENTAL PACKS

• Pill Packs may be available thru the hospital
  Pharmacy/MedLog, or if stocks are plentiful can
  be assembled and packaged at the BAS.
• Parental Packs could also be assembled and used
  by the medics as directed particularly if their
  CASEVAC may by-pass the BAS en-route to the FST.
• PAs/MDs must educate and emphasize judicious use
  particularly of p.o. antibiotics to decrease
  development of resistant organisms.

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ORAL PROPHYLAXIS

• Decrease the logistical burden of carrying,
  reconstitution and injection of parental
  medications
• Simple, light, durable, and easily administered
• Single agent DOC is 1Gatifloxacin followed by
  2Moxifloxacin
• More realistic choices would be Levofloxacin or
  Ciprofloxacin alone or in combination with
  Metronidazole or Clindamycin

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PARENTAL ANTIBIOTICS

• Should be used in unconscious casualties,
  patients in shock, and penetrating abdominal
  trauma
• Does not lessen the importance of rapid transit
  to definitive care and surgical treatment
• Successful regimes include
• Single Agents 1Cefoxitin 1-2 Gms TID IV/IM. If
  IV push over 3-5 minutes. 2. Ertapenum 1Gm qd
  IV/IM. If IV, it must be given over 30 minutes.
  If IM, it should be mixed with 3.2cc of 1
  Lidocaine without Epinephrine.
• Combinations 1Gentamicin and Clindamycin,
  2Tobramycin and Clindamycin.
• What youll probably have and use most will be
  Cefazolin and Ciprofloxacin.

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MES SICKCALL

• Parental Antibiotics
• Ceftriaxone
• Cefazolin

• P.O. Antibiotics
• Pen VK
• Clindamycin
• Cephalexin
• Doxycycline
• Augmentin
• Metronidazole
• Ciprofloxacin
• Azithromycin
• Gatifloxacin
• Sulfamethoxazole

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MES TRAUMA

• P.O. Antibiotics
• Gatifloxacin

• Parental Antibiotics
• Cefazolin
• Ciprofloxacin

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AS SOON AS YOU ARRIVE

• Perform an inventory.
• Differentiate NEED and nice to have
• Speak with Div Surgeon/PA, Pharmacy Chief,
  MEDLOG, Returning or Sister Units, and
  Inter-theater MEDLOG via email to determine what
  is available, possible, impossible, and surplus
  to guide you on your request
• Be prepared to barter, do favors, and kiss-up to
  get what you want?

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PRIOR TO MISSION

• Request and or prepare Pill Packs and Parental
  Packs for the BAS, Platoon Medics, Combat Life
  Savers, and Laymen as supplies, training,
  mission, and confidence dictate.
• Pre-think drug protocols and combinations.
• Place orders to MEDLOG/Pharmacy ASAP!
• Dont break the bank on Pet Drugs.

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DURING MISSION

• BE AGGRESSIVE.
• Dont be afraid to go Old School.
• Safeguard your Z-Packs.
• Resist using Cipro for every soft stool.
• Use good wound care and frequent re-eval to
  optimize AB effect.
• Anticipate shortages, and order early!!!

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QUESTIONS???

• POC Shon Compton
• W [phone]
• C [phone]
• Email scompton1_at_satx.rr.com
• shon.compton_at_amedd.army.mil