Module 7: Airway Management in TFC

COMBAT PARAMEDIC/
PROVIDER

TACTICAL COMBAT
CASUALTY CARE COURSE
MODULE 7: AIRWAY MANAGEMENT IN TFC

TCCC TIER 1 TCCC TIER 2 TCCC TIER 3 TCCC TIER 4

All Service Members Combat Lifesaver Combat Medic/Corpsman Combat Paramedic/Provider
 Module 7: Airway Management in TFC

CHANGE LOG - Curriculum Update History

CHANGE DATE PRODUCT UPDATE DESCRIPTION OF CHANGE

Updated TCCC 1380 Card image to

15 MAY 2025 Module 7 - Didactic PPT Slides 36 and 43
reflect changing “gender” to “sex”

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 Module 7: Airway Management in TFC

TACTICAL COMBAT CASUALTY CARE (TCCC) ROLE-BASED TRAINING SPECTRUM

ROLE 1 CARE
NONMEDICAL MEDICAL
PERSONNEL PERSONNEL

YOU ARE HERE

STANDARDIZED JOINT CURRICULUM

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 Module 7: Airway Management in TFC

LEARNING OBJECTIVES
07 Given a combat or noncombat scenario, perform airway management during Tactical Field Care
in accordance with CoTCCC Guidelines.

7.1 Identify signs of an airway obstruction.

7.2 Identify spinal immobilization considerations for casualties with suspected cervical spine injuries.
7.3 Describe the indications, contraindications and progressive strategies for airway management in Tactical Field
Care.
7.4 Demonstrate the placement of a casualty in the recovery position in Tactical Field Care.
7.5 Demonstrate opening the airway with the head-tilt/chin-lift or jaw-thrust maneuver.
7.6 Describe indications, considerations, and contraindications for use of a Manual Suction device in Tactical Field
Care.
7.7 Describe indications, considerations, and contraindications for use of a Mechanical Suction device in Tactical Field
Care.
7.8 Identify the indications, contraindications, and techniques for performing cricothyroidotomy in Tactical Field Care.
7.9 Identify the indications, contraindications, and administration methods of lidocaine as a local anesthesia when
performing a cricothyroidotomy in Tactical Field Care.
= Cognitive ELOs

01 TERMINAL LEARNING
OBJECTIVES (TLOs) 19 ENABLING LEARNING
OBJECTIVES (ELOs) = Performance ELOs
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 Module 7: Airway Management in TFC

LEARNING OBJECTIVES
07 Given a combat or noncombat scenario, perform airway management during Tactical Field Care
in accordance with CoTCCC Guidelines.
7.10 Demonstrate surgical cricothyroidotomy on a trauma casualty in Tactical Field Care.
7.11 Identify the considerations, indications, limitations, and principles of endotracheal intubation in tactical or
evacuation environment.
7.12 Demonstrate endotracheal intubation on a trauma casualty in Tactical Field Care.
7.13 Demonstrate the insertion of a nasopharyngeal airway In casualty in Tactical Field Care.
7.14 Describe proper Bag Valve Mask (BVM) technique for casualty ventilation in Tactical Field Care.
7.15 Identify the indications, considerations, limitations, and principles of automated ventilation in Tactical Field Care.
7.16 Demonstrate the application of service-specific automated ventilation to a trauma casualty in Tactical Field Care.
7.17 Identify the considerations, indications, and limitations for oxygen administration in Tactical Field Care.
7.18 Identify the importance, considerations, limitations, and application of pulse oximetry monitoring in Tactical Field
Care.
7.19 Identify any evidence-based medicine, best practices, casualty data, and Subject Matter Expert consensus on
airway management techniques in Tactical Field Care.

01 19 ENABLING LEARNING = Cognitive ELOs

TERMINAL LEARNING
OBJECTIVES (TLOs) OBJECTIVES (ELOs) = Performance ELOs
5
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 Module 7: Airway Management in TFC

ASSESSING THE EVIDENCE FOR GUIDELINES

Level of
AHA Recommendation System Terminology Explanation Why the AHA Classification System?
Evidence

Evidence from multiple randomized clinical trials (RCT) with • The level of evidence
A recommendations allow readers
concordant results or from HIGH-QUALITY meta-analyses.
to quickly glean information on
Evidence from moderate-quality trials, or a meta-analysis of the strength, certainty, and
B-R moderate quality (RCT) followed by an R to denote quality of evidence supporting
RANDOMIZED studies each recommendation.

Evidence from moderate-quality trials, or a meta-analysis of • A recommendation with Level of

B-NR moderate quality followed by NR to denote NON-RANDOMIZED
Evidence (LOE) C does not imply
studies
that the recommendation is
There is no convincing evidence and is followed by LD to weak.
C-LD
indicate LIMITED DATA
• Although, RCTs are unavailable,
There is no convincing evidence and is followed by EO if the there may be a very clear clinical
C-EO consensus is based on EXPERT OPINION, case studies or consensus that a particular test
standards of care. or therapy is useful or effective.

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 Module 7: Airway Management in TFC

MARCH PAWS
DURING LIFE-THREATENING AFTER LIFE-THREATENING

M MASSIVE BLEEDING P PAIN

#1 Priority

A AIRWAY A ANTIBIOTICS

R RESPIRATION W WOUNDS

C CIRCULATION S SPLINTING

H HYPOTHERMIA /
HEAD INJURIES
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 Module 7: Airway Management in TFC

AIRWAY MANAGEMENT INTRODUCTION

Airway obstruction on the battlefield
is often due to maxillofacial trauma
Unconscious casualties can also lose their
airway when the muscles of their tongue
relax, causing the tongue to block the airway
by sliding to the back of the pharynx and
covering the tracheal opening
Airway obstruction on the battlefield is often
easily corrected with simple maneuvers

M A RCH
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 Module 7: Airway Management in TFC

IDENTIFYING AN OBSTRUCTED AIRWAY

SIGNS AND SYMPTOMS
AIRWAY MAY BE
BLOCKED:
Casualty is in distress
and indicates they can’t
breathe properly
Casualty is making snoring
or gurgling sounds
Visible blood or foreign
objects are present in
the airway
Maxillofacial trauma
(severe trauma to the face)
IMPORTANT! Remove any is observed
visible objects, but DO NOT
perform a blind finger sweep
M A RCH
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 Module 7: Airway Management in TFC

SPINAL IMMOBILIZATION
CONSIDERATIONS IN TFC

Consider the mechanism of

injury when determining risk of
spinal injury

The Jaw-thrust If immobilization is indicated a second responder may

method is the be needed to maintain an open airway
preferred airway C-Spine stabilization is NOT necessary for casualties
opening maneuver in case of who have sustained penetrating trauma to the FACE
suspected spinal injuries or NECK ONLY

Level of Evidence: C-EO M A RCH

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PROGRESSIVE STRATEGIES
FOR AIRWAY MANAGEMENT
Conscious,
no obstruction
Recovery Position
Unconscious, Airway Maneuvers or
NPA or Assess
no obstruction YES
Extraglottic Airway Respiration
and Breathing
Airway Position of comfort Successful?
Assess
obstruction or Airway Maneuvers
Airway impending Suction NO
airway NPA or Extraglottic
obstruction Airway
Recovery Position, if
unconscious Cricothyroidotomy/
Endotracheal Intubation

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 Module 7: Airway Management in TFC

CASUALTY POSITION:
MAINTAINING THE AIRWAY
If a casualty can breathe on
their own, let them assume the
position that best protects the
airway, including sitting up and/or
leaning forward

DO NOT force a casualty into

a position or perform airway
procedures that causes them
difficulties in breathing

M A RCH
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RECOVERY POSITION
For an unconscious casualty not in shock,
or conscious casualty that can tolerate
any position, place them into the
RECOVERY POSITION

Clinical indications occasionally

During transport patient may need to be
dictate which side is lower in the
returned to a supine position
RECOVERY POSITION

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 Module 7: Airway Management in TFC

RECOVERY POSITION TECHNIQUE VIDEO

Video can be found on [Link]

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AIRWAY MANEUVERS

POTENTIAL LIMITATIONS
Lack of scene safety
Inadequate space to operate
Need for continued support
HEAD-TILT/CHIN-LIFT to maintain the airway position
If you suspect that the casualty
UNCONSCIOUS casualty's has suffered a neck or spinal
tongue may have relaxed, injury, use the jaw-thrust method
causing the tongue to BLOCK if tactically feasible
the airway by sliding to the back
of the mouth, occluding the
airway JAW-THRUST

Level of Evidence: C-EO M A RCH

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HEAD-TILT/CHIN-LIFT MANEUVER VIDEO

Video can be found on [Link]

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JAW-THRUST MANEUVER VIDEO

Video can be found on [Link]

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MANUAL AND MECHANICAL

SUCTIONING IN TFC

GOOD: BETTER: BEST:

Improvised Manual suction Mechanical
suction device device suction device
Only insert as far as you can Limit the suction time to Suction should only be applied
see to avoid eliciting a gag reflex NO more than 10 seconds when withdrawing the catheter

M A RCH
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MANUAL SUCTION VIDEO

Video can be found on [Link]

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 Module 7: Airway Management in TFC

MECHANICAL SUCTION VIDEO

Video can be found on [Link]

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SKILL STATION
Airway Maneuvers and Suctioning

Recovery Position

Head-Tilt/Chin-Lift
Jaw-Thrust Maneuver

Manual Suctioning

Mechanical Suctioning

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 Module 7: Airway Management in TFC

CRICOTHYROIDOTOMY
INDICATIONS
PRIMARY INDICATION Thermal and toxic
UNSUCCESSFUL airway gas injuries are
management with: additional indications
for cricothyroidotomy
Contraindications:
Ability to secure less
Airway maneuvers invasive airway
CRICOTHYROIDOTOMY Tracheal transection
is indicated for maxillofacial Massive swelling
injuries, to include partial or
complete airway obstruction Age Younger than 10-12
Suction NPA Extraglottic years old
(if appropriate) airway Massive Swelling
Massive Airway Trauma
Level of Evidence: B-R
M A RCH
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CRICOTHYROIDOTOMY TECHNIQUES
Cricothyroidotomy considerations:
DO NOT make incision too short
Practice locating anatomical landmarks frequently
Avoid a “stabbing” technique
Palpate cricothyroid membrane with the index finger,
identifying the landmark to make a horizontal incision
CoTCCC research results:
Preferred method: Cric-Key

ALTERNATE METHODS:
Standard open surgical method
Bougie-aided open surgical
method
M A RCH
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CRICOTHYROIDOTOMY TECHNIQUES (cont.)

Identify Stabilize Make 1” Make Hook

cricothyroid larynx vertical horizontal cartilage
membrane incision incision and lift to
through stabilize and
membrane maintain the
opening

M A RCH
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LIDOCAINE USAGE IN FIELD

CRICOTHYROIDOTOMIES
Consider LIDOCAINE Use lidocaine after identifying
for conscious or semi- anatomical landmarks
conscious casualties, or Anesthetize subcutaneous
casualties with a response structures without penetrating
to painful stimuli the cricothyroid membrane
or trachea

The clinical or tactical situation may be a contraindication

to lidocaine usage prior to placing the airway

M A RCH
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CRIC-KEY CRICOTHYROIDOTOMY
VIDEO

Video can be found on [Link]

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BOUGIE-AIDED
CRICOTHYROIDOTOMY VIDEO

Video can be found on [Link]

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OPEN CRICOTHYROIDOTOMY
VIDEO

Video can be found on [Link]

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INDICATIONS AND LIMITATIONS OF

ENDOTRACHEAL INTUBATION (ETI)

ETI limitations: ETI indications:

Low ETI experience even in Unsuccessful airway
seasoned medics management with:

White light requirements  Airway maneuvers

Maxillofacial injuries  Nasopharyngeal airway
 Extraglottic airway(s)
Difficulty recognizing esophageal
intubations Thermal and toxic gas injuries

Level of Evidence: B-NR M A RCH

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PRINCIPLES OF ETI IN TACTICAL FIELD

CARE AND EVACUATION SETTINGS
ETI CONSIDERATIONS TACTICAL LIMITATIONS
Equipment/Casualty preparation Equipment Shortages
Pre-ventilation/Preoxygenation Scene safety, space limitations
Rapid Sequence induction Conscious sedation with RSI requires
significant experience and training
Laryngoscope insertion Poor lighting, lack of suction
Endotracheal tube (ETT) advancement Lack of O2 or airway adjuncts
ETT cuff inflation Aeromedical concerns over cuff pressures at
altitude
ETT position check High noise level making auscultation difficult

Secure ETT Lack of capnography

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 Module 7: Airway Management in TFC

ENDOTRACHEAL TUBE INTUBATION

TECHNIQUES

1 2 3 4 5 6
ROLL the OPEN the mouth If available and VENTILATE SELECT the FILL the 10mL
casualty onto and look for tolerated, casualty with a appropriate size syringe with air
their back and visible INSERT airway bag-valve-mask of ETT for the and attach the
place them onto obstructions adjunct. device casualty and syringe to the
a hard surface (e.g., lacerations Nasopharyngeal open the ETT cuff valve
obstructions, (NPA) or proximal end (pilot balloon),
broken teeth, oropharyngeal keeping the ETT inflate the cuff,
burns, or swelling airway (OPA) in the packaging and inspect for
or other debris, leaks
such as vomit)

Direct Laryngoscopy (Stylet)

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ENDOTRACHEAL TUBE INTUBATION

TECHNIQUES

7 8 9 10 11 12
DEFLATE cuff by INSERT stylet SELECT POSITION the OPEN the REMOVE OPA, if
pulling back on into ETT appropriate casualty’s head casualty’s mouth in place
the plunger until laryngoscope by and hold the jaw
(a) The stylet
all the air is blade, attach to hyperextending open by pushing
should be
removed the handle and the neck down on the jaw
inserted in the
ETT so the tip of verify the light is NOTE:
the stylet is functioning Hyperextension of
recessed ½ inch the neck will allow
from the tip of the for visualization of
ETT the vocal cords

Direct Laryngoscopy (Stylet)

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ENDOTRACHEAL TUBE INTUBATION

TECHNIQUES

13 13 13 13 13
POSITION yourself at (c) PLACE the blade (e) INSERT the (ii) Using a Miller (f) Advance the blade
the top of the into the right side of laryngoscope blade blade, hook the a short distance to
casualty’s head. the casualty’s mouth into the posterior blade tip under the observe the epiglottis
(a) HOLD the pharynx and visualize epiglottis and pull up (g) Retract the
(d) MOVE the the vocal cords to fold back the
laryngoscope with laryngoscope to the epiglottis and
(i) Using a epiglottis to expose
your left hand. center of the mouth observe the vocal
Macintosh blade, the vocal cords
(b) OPEN and LOCK by sliding the cords
laryngoscope to the apply anterior CAUTION: DO NOT
the selected blade at
left side of the mouth, pressure to the use the casualty’s teeth
a 90- degree angle vallecula with the tip
moving the tongue as a fulcrum
out the way of the laryngoscope
blade.

Direct Laryngoscopy (Stylet)

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ENDOTRACHEAL TUBE INTUBATION

TECHNIQUES

14 15 16 17 18 19
(a) Grasp the REMOVE the MAINTAIN INFLATE the cuff ATTACH CHECK
ETT with your laryngoscope positive control of of the ETT by colorimetric placement of the
right hand from the airway the ETT with your injecting the device (CO2 ETT by
right hand and required amount detector) connecting BVM
(b) Carefully, remove the stylet of air (5-10mL) to between the ETT
guide the tip of with your left create a seal by and BVM, if
the tube between hand pressing the available. If not
the vocal cords plunger of the available,
until the cuff is syringe connect the BVM
just below the to the ETT
level of the vocal
cords

Direct Laryngoscopy (Stylet)

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ENDOTRACHEAL TUBE INTUBATION

TECHNIQUES

19 Cont. 19 Cont. 20 21 22 23
(a) Auscultate the (c) If casualty has SECURE positive MANUALLY ATTACH EtCO2 CONTINUE
epigastric area strong bilateral control of the ETT VENTILATE device between the MONITORING the
first, then lungs breath sounds CAUTION: Maintain casualty every 5-6 ETT and BVM, if casualty to ensure
fields while proceed to Step 20 manual control of the seconds available. If not correct tube
manually ventilate (d) If sound is ETT until the ETT is CONSIDER: If available, connect placement is
(b) If a rushing heard over one properly secured available, attach the BVM to the maintained by
sound is heard lung field only, oxygen reservoir to ETT auscultating the
over the epigastric consider a right BVM device and/or lungs and
area and no breath main stem connect to high-flow epigastric area
regulator (12-15 lpm)
sounds, repeat the intubation, deflate,
procedure withdraw slightly
and listen again

Direct Laryngoscopy (Stylet)

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ENDOTRACHEAL TUBE INTUBATION

TECHNIQUES
STEP 21 NOTE: If colorimetric
was previously utilized during
bag-valve-mask ventilation,
replace with new colorimetric or
transition to capnography, if
available.

STEP 21 NOTE: Colorimetric can

24 be used in both the TFC and PCC
environments but if the equipment
DOCUMENT all findings and treatments is available Capnography is the
on a DD Form 1380 TCCC Casualty Card
and attach it to the casualty gold standard and will be utilized.

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 Module 5: Tactical Trauma Assessment

ENDOTRACHEAL TUBE INTUBATION

SKILL
INSTRUCTOR-LED Demonstration
(Trainer-led demonstration review of the ETT
Intubation (Stylet) Skill sequence & key steps)

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ENDOTRACHEAL TUBE INTUBATION

TECHNIQUES

1 2 3 4 5 6
ROLL the OPEN the mouth If available and VENTILATE SELECT the FILL the 10mL
casualty onto their and look for visible tolerated, INSERT casualty with a appropriate size of syringe with air
back and place obstructions (e.g., airway adjunct. bag-valve-mask ETT for the and attach the
them onto a hard lacerations Nasopharyngeal device casualty and open syringe to the ETT
surface obstructions, (NPA) or NOTE: Monitor O2 the proximal end cuff valve (pilot
broken teeth, oropharyngeal Sat with a pulse keeping the ETT balloon), inflate
burns, or swelling airway (OPA) oximetry device and in the packaging the cuff, and
or other debris, attempt to maintain NOTE: Average inspect for leaks
such as vomit) O2 Sat at 94% adult male (7.5- NOTE: If you detect
9.0cm) Average a leak, discard ETT
adult female (7.0- and get a new one
8.0cm)

Direct Laryngoscopy (Bougie-Aided)

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ENDOTRACHEAL TUBE INTUBATION

TECHNIQUES

7 8 9 10 11 12
DEFLATE cuff by OPEN SELECT POSITION the OPEN the REMOVE OPA, if
pulling back on bougie/tube appropriate casualty’s head by casualty’s mouth in place
the plunger until introducer laryngoscope hyperextending and hold the it
all the air is CONSIDERATION: blade, attach to the neck open by pushing
removed Placement of the the handle and NOTE: down on the jaw
ETT on the verify the light is Hyperextension of
proximal end of functioning the neck will allow
bougie for insertion for visualization of
is an option, if the vocal cords
training and/or
resources permit

Direct Laryngoscopy (Bougie-Aided)

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ENDOTRACHEAL TUBE INTUBATION

TECHNIQUES

13 13 13 13 13
POSITION yourself at (c) PLACE the blade (e) INSERT the (ii) Using a Miller (f) Advance the blade
the top of the into the right side of laryngoscope blade blade, hook the blade a short distance to
casualty’s head. the casualty’s mouth into the posterior tip under the epiglottis observe the epiglottis
(a) HOLD the pharynx and visualize and pull up to fold
(d) MOVE the (g) Retract the
laryngoscope with your the vocal cords back the epiglottis to
laryngoscope to the epiglottis and observe
left hand. (i) Using a Macintosh expose the vocal cords
center of the mouth by the vocal cords
(b) OPEN and LOCK sliding the blade, apply anterior CAUTION: DO NOT
laryngoscope to the pressure to the
the selected blade at a use the casualty’s
left side of the mouth, vallecula with the tip of
90- degree angle the laryngoscope teeth as a fulcrum
moving the tongue out
the way blade.

Direct Laryngoscopy (Bougie-Aided)

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ENDOTRACHEAL TUBE INTUBATION

TECHNIQUES

14a 14b 14c 14d 15 16

When the vocal (b) While stabilizing (c) Grasp the ETT (d) Carefully guide REMOVE the REMOVE the
cords are the laryngoscope with your right hand the tip of the tube laryngoscope from bougie from the ET
visualized, INSERT with your left hand, and place over the between the vocal the airway. tube.
the bougie into the grasp the bougie proximal end of the cords until the cuff
trachea with the from your right bougie. is just below the
coude tip facing hand with the NOTE: If not level of the vocal
anteriorly. fingers from your previously placed on cords.
(a) You should feel left hand and hold the proximal end of
the bougie “vibrate” against the the bougie, this can
as the tip moves laryngoscope be done
against the cricoid handle. independently or with
rings. assistance.

Direct Laryngoscopy (Bougie-Aided)

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ENDOTRACHEAL TUBE INTUBATION

TECHNIQUES

17 18 18 19
INFLATE the cuff of the CHECK placement of the (c) If casualty has strong bilateral SECURE the ETT with ½-
ETT by injecting the ETT breath sounds, proceed to Step inch adhesive tape, ETT
required amount of air (5- XX. tie or commercial ETT
(a) Auscultate the epigastric
10mL) to create a seal by area first, then lung fields while (d) If sound is heard over one securing device.
pressing the plunger of the manually ventilate. lung field only, consider a right CAUTION: Maintain manual
syringe. (b) If a rushing sound is heard
mainstem intubation, deflate, control of the ETT the ETT is
withdraw slightly, and listen properly secured
over the epigastric area and no again.
breath sounds, repeat the
procedure.

Direct Laryngoscopy (Bougie-Aided)

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ENDOTRACHEAL TUBE INTUBATION

TECHNIQUES
STEP 21 NOTE: If
colorimetric was previously
utilized during bag-valve-
mask ventilation, replace with
new colorimetric or transition
20 21 22 to capnography, if available.
23
MANUALLY ATTACH EtCO2 CONTINUE DOCUMENT all
VENTILATE device between the MONITORING the findings and
casualty every 5-6 ETT and BVM, if casualty to ensure treatments on a DD
seconds. available. If not correct tube Form 1380 TCCC
connect the BVM to placement is Casualty Card and STEP 21 NOTE: Colorimetric
CONSIDER: If
available attach the ETT. maintained by attach it to the can be used in both the TFC
oxygen reservoir to auscultating the casualty. and PCC environments but if
BVM device and/or lungs and
connect to high flow epigastric area. the equipment is available
regulator (12-15 lpm) Capnography is the gold
standard and will be utilized.

Direct Laryngoscopy (Bougie-Aided)

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 Module 5: Tactical Trauma Assessment

ENDOTRACHEAL TUBE INTUBATION

SKILL
INSTRUCTOR-LED Demonstration
(Trainer-led demonstration review of the ETT
Intubation (Bougie-Aided) Skill sequence & key
steps)

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SKILL STATION
ADVANCED AIRWAY SKILL STATION

Cric-Key Cricothyroidotomy
Bougie-Aided Cricothyroidotomy

Open Surgical Cricothyroidotomy

Endotracheal Intubation

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NASOPHARYNGEAL AIRWAY
Can be used on both unconscious or
semiconscious casualties with NO
airway obstruction
Better tolerated than an oropharyngeal
airway (less likely to stimulate gag reflex)
Lubricate before inserting
Insert at 90-degree angle to the face,
NOT along the axis of the external nose
Tape it in place after insertion DO NOT attempt to insert an NPA if there is clear
fluid coming from nose or ears, signs of inhalation
To be used in conjunction with the use of burns, or moderate to severe trauma to the nose
a BVM

Level of Evidence: C-EO M A RCH

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NPA INSERTION VIDEO

Video can be found on [Link]

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BAG VALVE MASK

(BVM) CONSIDERATIONS
Provide one Use SLOW,
breath every 5-6 STEADY squeeze
seconds over 1-2 seconds

Situations where ventilation support may be

needed:
A casualty NOT breathing on their own
Progressive hypoxic respiratory distress The EC technique is also taught to
Combat Lifesavers so they can support you
Progressive hypercapnic respiratory distress
Ventilations can be performed alone or
Semi-conscious or conscious patients with two people working together
with mental status changes
M A RCH
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INDICATIONS AND LIMITATIONS

OF AUTOMATED VENTILATION
INDICATIONS: LIMITATIONS:
Same as BVM: Ventilator availability
 NOT breathing on their own Oxygen availability
 Hypoxic or hypercapnic distress
Battery life
 Mental status changes unable to
maintain airway Mask seals
Plus: Trained medical personnel
 Limited resources to maintain Alarms
manual ventilations
 Prolonged field care
 Transport considerations

Level of Evidence: B-NR M A RCH

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PRINCIPLES OF AUTOMATED
VENTILATION IN TFC AND EVACUATION SETTINGS
ADJUSTABLE VENTILATORS: LIMITED-ADJUSTMENT VENTILATORS:
Adjustments for various Several ventilator parameters
parameters are fixed
 Delivery modes Limited adjustment options
 Tidal volumes
 Pressure settings Allows medics with less training
 Oxygen concentrations manage ventilator
 Positive end-expiratory Limits the flexibility
pressures for adapting to a particular
 Ventilation rates casualty
Requires greater understanding of
mechanical ventilation

M A RCH
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OXYGEN ADMINISTRATION IN TFC

CONSIDERATIONS
Availability of oxygen is very
limited in TFC
Oxygen may be present at aid
stations, casualty collection points
or on convoys
Tactical Evacuation Phase
Current TCCC Guidelines only indications:
recommend oxygen for traumatic Low oxygen saturation
brain injury (TBI) Injuries with impaired oxygenation
Maintain O2 saturation >90% Shock
Smoke inhalation
Flow rate often 3 liters/min
Trauma at altitude
usually limited by O2 generation
If available, consider initiating oxygen
during TFC, just prior to evacuation
M A RCH
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PULSE OXIMETRY MONITORING

Hypoxemia in TFC is difficult to assess Factors Affecting Pulse Ox Readings
Low-light conditions mask signs Low readings may be seen with: Impaired readings
Physical findings impaired by the Shock may be seen with:
tactical environment Nail polish
Cold temperatures
Use pulse oximetry in Very bright
casualties with: High readings may be seen with: environments
Injuries that impair Skin pigmentations
Carboxyhemoglobinemia
oxygenation Motion artifact
Blasts, chest injuries, etc.
Traumatic brain injury TCCC Guideline Recommendation:
Ensure O2 sats >90% Monitor the hemoglobin oxygen saturation in
casualties to help assess airway patency

NOTE: Shock is not always preceded

by a fall in O2 saturation levels
M A RCH
Level of Evidence: B-NR

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AIRWAY MANAGEMENT OVERVIEW (VIDEO)

Video can be found on [Link]

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EVIDENCE SUPPORTING
AIRWAY MANAGEMENT STRATEGIES
Level of
Subject Category Study Types
Evidence

Spinal Immobilization Clinical consensus, Expert Opinion and Discussion C-EO

Airway Maneuvers Clinical consensus, Expert Opinion and Discussion C-EO

Nasopharyngeal Airways Clinical consensus, Expert Opinion and Discussion C-EO

Extraglottic Airways Meta-analyses of 1 or more randomized controlled studies B-R

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EVIDENCE SUPPORTING
AIRWAY MANAGEMENT STRATEGIES (cont.)
Level of
Subject Category Study Types
Evidence

Retrospective/Prospective Comparisons & Subject Matter

Cricothyroidotomies
Expert Consensus
B-R

Prospective Nonrandomized Observational study with

Endotracheal Intubation
limitations
B-NR

Automated Ventilation in
the TFC Setting
Retrospective Observational Study B-NR

Pulse Oximetry Prospective Studies, Clinical Practice Guideline Reviews B-NR

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SUMMARY
Knowledge Topics Skills and Abilities
Signs of airway obstruction Airway maneuvers
Considerations for (head-tilt/chin-lift or jaw-thrust method)
spinal immobilization Recovery position
Progressive strategies for airway Manual and mechanical suctioning
management Cricothyroidotomy
Indications for an advanced airway, Endotracheal intubation
including endotracheal intubation
Ventilating with BVM and NPA
Considerations for automated ventilation
Indications for using oxygen
Importance of pulse oximetry
Automated Ventilation
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CHECK ON LEARNING

What are the signs of an airway obstruction?

What is the best position for a conscious casualty
that is breathing on their own?
What are common errors when performing a
cricothyroidotomy?
What condition warrants oxygenation in TFC
according to the TCCC Guidelines?

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ANY QUESTIONS?

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REFERENCES
TCCC: Guidelines
by JTS/CoTCCC
These guidelines, updated regularly, are the result of
decisions made by CoTCCC in exploring evidence-
based research on best practices.

PHTLS: Military Edition, Chapter 25

by NAEMT
Prehospital Trauma Life Support (PHTLS), Military
Edition, teaches and reinforces the principles of
rapidly assessing a trauma patient using an orderly
approach.

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