Analgesia and Sedation for Tactical Combat Casualty Care: TCCC Proposed Change 21-02

Andrew D. Fisher, Taylor T. DesRosiers, Wayne Papalski, Michael A. Remley, Steven G. Schauer, Michael D. April, Virginia Blackman, Jacob Brown, Frank K. Butler, Cord W. Cunningham, Jennifer M. Gurney, John B. Holcomb, Harold R. Montgomery, Margaret M. Morgan, Sergey M. Motov, Stacy A. Shackelford, Timothy Springer, Brendon Drew

Research output: Contribution to journalReview articlepeer-review


Analgesia in the military prehospital setting is one of the most essential elements of caring for casualties wounded in combat. The goals of casualty care is to expedite the delivery of life-saving interventions, preserve tactical conditions, and prevent morbidity and mortality. The Tactical Combat Casualty Care (TCCC) Triple Option Analgesia guideline provided a simplified approach to analgesia in the prehospital combat setting using the options of combat medication pack, oral transmucosal fentanyl, or ketamine. This review will address the following issues related to analgesia on the battlefield: 1. The development of additional pain management strategies. 2. Recommended changes to dosing strategies of medications such as ketamine. 3. Recognition of the tiers within TCCC and guidelines for higher-level providers to use a wider range of analgesia and sedation techniques. 4. An option for sedation in casualties that require procedures. This review also acknowledges the next step of care: Prolonged Casualty Care (PCC). Specific questions addressed in this update include: 1) What additional analgesic options are appropriate for combat casualties? 2) What is the optimal dose of ketamine? 3) What sedation regimen is appropriate for combat casualties?

Original languageEnglish (US)
Pages (from-to)154-165
Number of pages12
JournalJournal of special operations medicine : a peer reviewed journal for SOF medical professionals
Issue number2
StatePublished - May 31 2022


  • analgesia
  • casualties
  • fentanyl
  • ketamine
  • prehospital
  • Tactical Combat Casualty Care (TCCC) Triple Option Analgesia guideline

ASJC Scopus subject areas

  • Medicine(all)


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