It is my privilege and honor to welcome our global family of PHTLS instructors to

the 9th edition PHTLS Instructor Update. I am humbled by your presence here
this afternoon which reminds us why the PHTLS program continues to be the
global leader in prehospital trauma education. The great success of our
program is directly due to the tremendous dedication and passion of our global
PHTLS faculty. You are the ones who are responsible for providing our
prehospital practitioners with the knowledge and skills they need to make the
best decisions in the field for their patients. On behalf of NAEMT, thank you for
being here today and for what you do each and every day for your students and
communities.

1 2

You have come from all across the United States and across the globe, NAEMT is honored to support the EMS profession through education, advocacy
representing the 11,222 PHTLS instructors from 69 countries providing PHTLS and research. Education is core to our mission. In addition to our outstanding
to prehospital providers in their communities. PHTLS is truly a global movement global faculty, NAEMT’s leadership is fully committed to our global education
dedicated to excellence in prehospital trauma care. program.

NAEMT is led by an elected Board of 15 members, who are supported by 17

appointed committees and 16 staff members.

3 4
I would like to thank the NAEMT Board of Directors for their unwavering We are honored to welcome Dr. Eileen Bulger, Chair of the ACS Committee on
commitment and support for PHTLS and our education mission, and for Trauma to our meeting. NAEMT deeply appreciates our strong relationship with
providing the funds necessary to ensure that the 9th edition of PHTLS is the best the College on PHTLS and other trauma initiatives. Our organizations have an
ever produced. Our Board members are here with us today to welcome you and endurable bond based on our shared commitment to the care of trauma
thank you for your service. Board members, please stand. patients. Dr. Bulger, please stand so that our attendees can thank you.
<applause>

We appreciate your leadership and look forward to continuing our work with you
and your colleagues on the COT.

5 6

This 9th edition of PHTLS is dedicated to the founder of PHTLS and the father of I can honestly tell you that Dr. McSwain has been on the shoulder of every
all NAEMT education……Dr. Norman McSwain. Without Dr. McSwain’s vision, member of our PHT Committee and in the thoughts of every one of our chapter
passion, empathy and tenacity, PHTLS would not exist and we would not be editors and course authors as the 9th edition was created. Each contributor has
gathering here today. been motivated by Dr. McSwain’s standards of excellence and committed to
ensuring that the 9th edition is a product that Norman would be proud of.

7 8
Norman led PHTLS for over 30 years. He was supported over the decades by It is now my great pleasure to introduce to you the members of NAEMT’s
many dedicated volunteers who shared his vision and embraced the PHTLS Prehospital Trauma Committee. Will each member stand as your name is
mission. Some of these PHTLS missionaries were instrumental in the called…
development of earlier editions of the textbook. Others were on the road helping Dr. Alex Eastman
to spread PHTLS. NAEMT and the PHT Committee would like to express our
thanks to these PHTLS pioneers. PHTLS lives, breathes, and grows because of Dr. Andrew Pollak
the efforts of those who volunteered their time to the development of PHTLS. Mr. John Phelps
Dr. J.C. Pitteloud
I ask any and all members of past PHTLS Committees, PHTLS chapter editors, Dr. Faizan Arshad
contributors and reviewers, to please stand and be recognized. Dr. Warren Dorlac
Mr. Larry Hatfield
Dr. Frank Butler

9 10

It is now my great privilege to introduce my colleague and friend, Dr. Alex Thank you, Dennis. As we move into the future with the 9th edition of PHTLS, it
Eastman, to take us back to the history of PHTLS, Dr. McSwain’s monumental is very important for all of us to understand the history of PHTLS, how it
vision, and the partnership that continues between NAEMT and the American developed, and our special relationship with the American College of Surgeons.
College of Surgeons Committee on Trauma.

11 12
 Norman’s surgical expertise early in his career resulted in his induction, in 1973,
as a Fellow of the American College of Surgeons.
The history of PHTLS begins with its founder, Dr. Norman McSwain.
He began his involvement with the COT in 1975 through his work with the
Kansas Committee on Trauma. Also at that time, he helped found NAEMT.

Four years later he was appointed to the National COT where he led both the
Pre-hospital Care Committee and the ATLS Committee. ATLS launched in 1980.

13 14

Shortly thereafter, at the urging of Dr. Norman McSwain, the NAEMT Board Dr. McSwain’s philosophy on prehospital trauma education served as the
authorized development of a non-physician version of ATLS, called Prehospital foundation for the first PHTLS course and continues as the fundamental precept
Trauma Life Support. Dr. McSwain, representing the ACS-COT, worked with Bob of PHTLS in this 9th edition.
Nelson to develop a prototype of PHTLS under the title “Improved Trauma
Management” and introduced it to a packed room at the 1983 NAEMT annual
meeting in Dearborn, Michigan. His vision - to improve care and increase the survivability of trauma patients
through high-quality, evidence-based education that strengthens and enhances
the knowledge and skills of prehospital practitioners.
By 1984, the first PHTLS Committee was appointed, with Dr. McSwain serving
as the committee’s Medical Director. The first National PHTLS Faculty course
was held at Dr. McSwain’s own Tulane University. The first PHTLS provider His core belief - that given a sound foundation of knowledge and key principles,
course was offered in 1985 and the first PHTLS textbook followed in 1986. prehospital practitioners are capable of making reasoned decisions regarding
patient care.

And that, my friends, is how it all began.

15 16
Now let’s jump forward 33 years, and today, NAEMT and ACS have a solid and Dr. McSwain shepherded NAEMT’s relationship with ACS for over thirty years.
enduring relationship based on our shared vision for trauma care and our mutual Both organizations relied heavily on his leadership and with his passing, we had
respect, thanks to Dr. McSwain’s vision to bring these two organizations to feel our way through to a new relationship.
together.
I am pleased to inform you that NAEMT’s relationship with ACS has never been
NAEMT cooperates with the ACS-COT in the development of PHTLS. stronger. As the PHTLS Medical Director, I serve as NAEMT’s liaison to the
ACS-COT. Both Dennis and I participate on ACS’s EMS Committee and on their
Stop the Bleed initiative, and Dennis represents NAEMT on ACS’ Injury
Drs. Pollak and Dorlac, and myself are all Fellows of ACS, and serve on the Prevention Committee.
PHT Committee at the recommendation of ACS.

NAEMT thanks ACS’ Executive Director Dr. David Hoyt, along with Drs. Michael
Rotondo, Ronald Stewart, Mark Gestring and Eileen Bulger for working with
Dennis and the Board to strengthen our relationship.

17 18

PHTLS is also endorsed by several prestigious organizations – the Eastern Its now my great pleasure to introduce our PHTLS 9th edition Medical Editor who
Association for the Surgery of Trauma (EAST), the American Academy of led the revision of the PHTLS textbook. Please join me in welcoming my
Orthopedic Surgeons (AAOS), the Special Operations Medical Association colleague and friend, Dr. Andrew Pollak.
(SOMA), and the Trauma Center Association of America (TCAA).

19 20
Hello. It has been a true honor and pleasure to serve as PHTLS Medical Editor We were so fortunate to be able to bring together some of the greatest thought
for the ninth edition and I’m excited to be here today to share the textbook leaders in prehospital trauma to work on the 9th edition. Understanding the
updates with you. critical role of the prehospital provider to the survival of the trauma patient, each
of our chapter editors applied their expertise to ensure that the full spectrum of
In revising PHTLS, the Committee recruited subject matter experts from around trauma care was addressed.
the world, seeking out the best and brightest to review and revise the chapters.
As you will see on the next slide, an amazing group of physicians and
prehospital practitioners volunteered their time to this revision and poured their
passion and expertise into making the 9th edition an exciting, up-to-date,
evidence-based resource.

21 22

We are deeply grateful to these outstanding individuals for the time, effort, and On behalf of NAEMT and the PHT Committee, I would like to extend my deep
expertise they contributed to the 9th edition. Please join me in thanking each of appreciation to Dr. Richard Carmona, former Surgeon General of the United
our chapter editors. <applause> States, for the inspiring foreword he wrote for the 9th edition. Our special thanks
and gratitude also go to past PHTLS Medical Director Lance Stuke, for his
thoughtful and moving dedication to Dr. Norman McSwain.

23 24
In preparing to revise PHTLS, the Committee contacted our ATLS partners, who The Committee reviewed the 8th edition PHTLS table of contents and
provided updated references and a compendium of changes to the 10th edition streamlined the content to eliminate redundancies and create a more intuitive
of ATLS. The Committee met and reviewed these changes for applicability to flow to the chapters. Every chapter in the book has been updated with current
prehospital trauma care. The Committee also reviewed and considered new data and references.
evidence from the Department of Defense’s Committee on Tactical Combat
Casualty Care. The PHTLS chapters were then sent to the chapter editors with
guidance from the Committee.

25 26

There are now 22 chapters in the book. They are: 13. Burn Injuries
1. PHTLS: Past, Present, and Future 14. Pediatric Trauma
2. Golden Principles, Preferences, and Critical Thinking 15. Geriatric Trauma
3. Shock: Pathophysiology of Life and Death 16. Injury Prevention
4. The Physics of Trauma 17. Disaster Management
5. Scene Assessment 18. Explosions and Weapons of Mass Destruction
6. Patient Assessment and Management 19. Environmental Trauma I: Heat and Cold
7. Airway and Ventilation 20. Environmental Trauma II: Drowning, Lightning, Diving, and Altitude
8. Head Trauma 21. Wilderness Trauma Care
9. Spinal Trauma 22. Civilian Tactical Emergency Medical Support (TEMS)
10. Thoracic Trauma
11. Abdominal Trauma
12. Musculoskeletal Trauma

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While every chapter in the 9th edition PHTLS textbook has been revised and To start, the Committee decided to move from the ABCDE patient assessment
updated, there are some significant changes I’d like to highlight today, both mnemonic to XABCDE, which puts exsanguinating hemorrhage at the forefront
throughout the book and in specific chapters. of every patient encounter. As we know, it takes 2 minutes or less for a patient
to exsanguinate. No other intervention we perform is more time sensitive than
stopping that level of bleeding. While this change is not yet reflected in ATLS, it
is extremely relevant to prehospital care and it mirrors the MARCH assessment
(which stands for Massive hemorrhage, Airway Control, Respiratory support,
Circulation, Hypothermia management, Head injury mitigation) used in both
Tactical Combat Casualty Care and Tactical Emergency Casualty Care. You will
see the importance of XABCDE reflected in every PHTLS chapter.
Another change incorporated throughout the book is that boluses are now 250
cc each, with a recheck of patient blood pressure and other vital signs between
boluses. In the context of a growing body of evidence of the detrimental effects
of over-aggressive early fluid resuscitation, we are encouraging practitioners to
be thoughtful about fluid resuscitation. There are also new targets for blood
pressure with fluid resuscitation.

29 30

Chapters 1 and 2 provide the foundation of PHTLS. Chapter 1 takes the reader Dr. Craig Manifold, NAEMT Medical Director, was asked to revise the chapters
through the history of prehospital trauma care and the development and on Shock and the Physiology of Life and Death. Dr. Manifold streamlined the
philosophy of PHTLS. Chapter 2 is now a consolidation of two previous content into one incredible chapter. Major changes to this chapter include a
chapters: Golden Principles of Prehospital Trauma Care, and The Science, Art, focus on treating exsanguinating hemorrhage with tourniquets prior to the onset
and Ethics of Prehospital Care: Principles, Preferences, and Critical Thinking. of shock; a discussion of tranexamic acid (or TXA) dosing (if allowed per local
Thank you to Rick Ellis and Patrick Wick for their input on Chapter 1 and to Dr. protocols); and a suggestion for practitioners to attempt IV access with an 18-
Blaine Enderson for his excellent work on consolidating Chapter 2. gauge needle briefly before moving to IO access.

31 32
Drs. Andrew Schmidt and Lauren MacCormick edited Chapter 4: Physics of Chapter 5 – Scene Assessment – was edited by Drs. Blaine Enderson and
Trauma, ensuring that references are up to date, statistics are current, and that Catherine McKnight. We all know that scene safety is the number one priority in
it contains the latest evidence on air bags, car seats, and motorcycle crashes. prehospital trauma care – both our own safety and that of those around us.
Citing current evidence from NHTSA, OSHA, the CDC, and other national
institutions, this chapter covers scene safety considerations ranging from motor
vehicle collisions to active shooter events and events involving weapons of mass
destruction.

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Thank you to Drs. Vince Mosesso and Michael Holtz, for their work on Chapter One of the updates in the 10th edition of ATLS is a change from rapid sequence
6: Patient Assessment and Management. This chapter walks the reader through intubation to drug-assisted intubation. The Committee had an extensive
the new XABCDE patient assessment – addressing hemorrhage control first and discussion on this issue, as different jurisdictions use different terminology. You
foremost through tourniquet use, pressure dressing, and manual direct pressure. will see that the Airway Chapter refers to pharmacologically assisted intubation.
NAEMSP and ACS-COT revised guidelines for termination of resuscitation are The Committee agreed, however, that regardless of terminology, a rapid
referenced and the editors expanded the section on patient transfer from response is most important. This chapter also includes a great discussion on
prehospital care to the trauma team. apneic oxygenation and the addition of the new HEAVEN criteria to the LEMON
approach for predicting a difficult airway. Of note, the needle cricothyrotomy
technique has been eliminated from the text, given the minimal evidence of its
efficacy. Special thanks to Drs J.C. Pitteloud and Bruno Goulesque for their
work on this chapter.

35 36
The Head Trauma chapter, edited by Drs. Deborah Stein and Christine Ramirez, We all know there has been much debate in the field about spinal immobilization
includes an updated Glasgow Coma Scale to improve the accuracy and and the use of backboards and other immobilizing devices. Throughout the 9th
reliability of practitioners when they are describing the severity of traumatic brain edition, the terms spinal motion restriction, spinal stabilization, and spinal
injury. The chapter also continues to emphasize the importance of the motor immobilization are used interchangeably. Further, the Committee neither
exam component of the Glasgow Scale as a good predictor of TBI severity. In advocates for the removal of all long backboards nor the unnecessary use of
addition, the chapter authors included the following TBI guideline: to maintain immobilizing devices. In the spirit of Dr. McSwain and the history of PHTLS, the
systolic blood pressure at greater than or equal to 100 millimeters of mercury for Committee advocates for the use of applied critical thinking when practitioners
patients who are 50 to 69 years old; or at greater than or equal to 110 are faced with a patient who may need spinal immobilization.
millimeters of mercury for patients 15 to 49 years old or over 70 years. These
blood pressure guidelines may be considered to decrease mortality and improve
outcomes in our patients with traumatic brain injury.

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Chapter editors Drs. Steven Ludwig and Luke Brown, with Ian Bussey and The Thoracic Trauma chapter, edited by Dr. Mark Gestring, highlights new
Alyssa Nash, reviewed the signs and symptoms of spinal trauma, as well as the needle decompression guidelines, based on recent evidence that supports the
criteria necessary to determine when spinal motion restriction is unnecessary. 5th intercostal space at (or just anterior to) the mid-axillary line as the preferred
The chapter includes updated evidence on spinal cord injury and no longer needle thoracostomy site. However, while this new site is preferred, it is not the
supports the use of therapeutic hypothermia as a promising treatment, based on only option and the anterior approach is still taught, because PHTLS always
the latest evidence. upholds principles over preferences.

39 40
An exciting addition to the Abdominal Trauma chapter is the introduction of The Musculoskeletal Trauma chapter, edited by Drs. Robert O’Toole and David
REBOA – resuscitative endovascular balloon occlusion of the aorta – as a Potter, further addresses the use of pelvic binders and the need for prehospital
promising technique for managing and mitigating uncontrolled hemorrhage in the practitioners to employ their use to prevent exsanguination in the context of
torso. Currently, REBOA is only performed by highly trained teams and is not major pelvic ring disruption.
yet available in the United States for prehospital care. The chapter, edited by
Drs. Thomas Scalea, Ronald Tesoriero, and Jason Weinberger, also addresses
hemodynamically unstable blunt trauma patients with suspected pelvic injury, for
whom prehospital providers are advised to stabilize or close the pelvis by
securing it with a sheet or by applying a commercial binder.

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The Burn Injuries chapter, edited by Drs. Brian Williams and Spogmai Komak We were fortunate to have four pediatric physicians—Ann Dietrich, David
includes an important update on fluid resuscitation guidelines. The change in Tuggle, Jessica Naiditch, and Kate Remick—lending their subject matter
the 10th edition of ATLS is that fluid resuscitation for patients with deep partial expertise to the Pediatric Trauma chapter. The first important change is that
and full thickness burns involving greater than 20 percent of body surface area damage control resuscitation in children now represents a move toward limiting
should begin with 2cc per kilogram of lactated Ringer’s, times the percent of crystalloid resuscitation. In the child with moderate bleeding, no evidence of
total body surface area burned with subsequent adjustment as indicated by urine end-organ hypoperfusion, and normal vital signs, fluid resuscitation should be
output. This is a change from the previous Parkland formula, which started limited to no more than one or two normal saline boluses of 20 milliliters per
patients with fluid resuscitation at 4cc per kilogram. kilogram.

43 44
The Pediatric Trauma chapter also encourages providers to strongly consider Chapter 15 highlights the unique aspects and increased risks of trauma in
the risks of endotracheal intubation before attempting the procedure in the field. geriatric patients. It covers factors affecting control of severe external
Attempting advanced airway management is unnecessary and potentially hemorrhage in this population and provides an important reminder that even
harmful if the child is adequately ventilated and oxygenated using good basic life ground-level falls can cause fracture in elderly patients. Thank you to Drs.
support skills, such as bag-mask ventilation. Manish Shah, Michael Lohmeier, and Michael Mancera for their updates to this
Finally, there has been no change in the preferred site for needle decompression chapter.
in children – it is still the second intercostal space at the midclavicular line.

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Chapter 16 focuses on Injury Prevention. Thank you to Dr. Heidi Abraham and The Disaster Management Chapter, edited by Dr. Faizan Arshad, has been
Thomas Colvin for their work on providing the most up-to-date injury statistics, updated to introduce Psychological First Aid as an alternative resource to
including an important new section on intimate partner violence, and listing key address some of the limitations of mandatory Critical Incident Stress
elements from the National EMS Culture of Safety project. Management and provides teams with effective tools for immediate intervention
in situations in which providers have psychologically related complaints and are
amenable to assistance.

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The chapter on Weapons of Mass Destruction, edited by Drs. Arshad and Daniel The first of the PHTLS Environmental Trauma chapters focuses on heat and
Nogee, includes updated information about types of WMD incidents as well as cold. Chapter editors Dr. Seth Hawkins and Bryan Simon include an important
the inclusion of vehicles as a weapon and suicide bombers. The chapter editors discussion on hyperthermia, and stress that normal body temperature is a
offer new data on specialized decontamination agents, and updated data on reasonable goal for hyperthermia management. They also include an updated
newer cyanide antidote kits that contain IV hydroxocobalamin, which binds with recommendation for prehospital care providers. Regarding your personal
cyanide to form cyanocobalamin, a nontoxic agent. hydration, the Wilderness Medical Society recommends that you drink to thirst to
ensure proper hydration while preventing excessive fluid intake and onset of
exercise-associated hyponatremia. The chapter editors also provide updated
factors predisposing to hypothermia.

49 50

The second Environmental Trauma chapter, also edited by Dr. Seth Hawkins, The Wilderness Trauma Care chapter acknowledges the premise that just like
focuses on lightning, drowning, diving, and altitude and includes update with tactical medicine, proper care on the street may not be proper care in the
protocols in environmental trauma. Recommendations related to long spine wilderness. Wilderness EMS protocols may require an operationally specific
board immobilization in and out of water are changing, although spine boards scope of practice for optimum patient care. Chapter editors Drs. Will Smith and
are still very useful as a transportation tool when moving patients. The chapter John Trentini further the discussion on spinal immobilization to note that
includes updated protocols on the use of therapeutic hypothermia in drowning mechanism of injury alone is not an indication to immobilize a conscious patient
patients and Dr. Hawkins provides new material on drowning in submerged with a reliable exam. They also include updated content on improvised
vehicles, which accounts for 10% of drownings in the US. tourniquets, with key descriptions of a successful tourniquet.

51 52
The Civilian Tactical Emergency Medical Support chapter – coedited by Drs. It is now my great pleasure to introduce our PHTLS 9th edition Course Editor,
Eastman and Faroukh Mehkri – includes a new remote assessment John Phelps, who will walk us through all of the changes in the 9th edition
methodology flowchart and an emphasis on tourniquets placed “high and tight” course.
rather than focused on trying to locate them 2-3 inches above the wound.

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Good afternoon, everyone. I am truly honored to have been selected to lead the I am so very grateful for the tremendous effort of each of the members of the 9th
revision of the 9th edition course. I recognize what a great responsibility NAEMT edition course author team. Please join me in recognizing and thanking our
has given to me to ensure that this latest edition of the course is the very best course authors:
that it can be. Our team of course authors, contributors and reviewers have Amie Fuller, from Maryland
been hard at work for the past 18 months on this great project. Dr. J.C. Pitteloud from Switzerland
Anthony Harbour from Virginia
Dr. Faizan Arshad from Connecticut
And Jim McKendry from Canada

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I also want to thank James Bayreuther, Sean Britton, Riana Constantinou, All NAEMT courses are beta tested before being published. A very special thank
Shawn Couch, Jan Fillipo, Cody Jenkins, James Jensen, Lara Marcelo, Joanne you to the two training centers that ran beta tests of the PHTLS course and the
Piccininni, students and instructors who provided invaluable feedback. The initial beta was
Dr. Victor Pimentel, Dawn Poetter, Dr. Neil Pryde, Lee Richardson, Sarrissa held at University of Texas Health Science Center in San Antonio, a place near
Ryan, and Patrick Wick for their contributions to the 9th edition. and dear to my heart! Thank you to Cody Jenkins and Shawn Couch for helping
teach that course.

Jay Gould and his team at VCU Health were incredibly gracious and welcoming
and assembled an all-star team of instructors for our second beta. Thank you to
Jay and everyone who taught over those two days in July.

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The PHT Committee agreed on the following learning objectives for the 9th 10. Demonstrate the principle “First, do no harm.”
edition of the PHTLS course: 11. Evaluate emergency situations to determine the most appropriate course
1. Demonstrate safe and effective scene management of action
12. Implement principles of evidence-based research to prehospital trauma
2. Apply anatomically appropriate hemorrhage control techniques
care
3. Conduct a primary survey 13. Provide optimum patient care for all trauma patients
4. Perform airway management in a critically injured patient 14. Correlate patient criticality with transport timing and disposition decisions
5. Provide ventilatory support for a patient with inadequate breathing 15. Communicate pertinent patient information to the receiving facility
6. Defend pain management interventions in trauma patients 16. Determine appropriate intravenous fluid therapy for trauma patients in the
prehospital setting
7. Demonstrate best practices in spinal care for trauma patients
8. Manage shock within the provider’s scope of practice
9. Adapt trauma care principles to special populations

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The 9th edition course schedule incorporates time for skill stations on both day 1 As you can see, Day 2 incorporates time for either one of the optional PHTLS
and day 2. As practitioners, it is important that we continually hone our skills lessons or additional simulations. Faculty can choose from Kinematics of
and build our muscle memory. With the greater emphasis on bleeding control in Trauma, Point of Care Ultrasound, Altitude, Diving, Wilderness, Hypothermia, or
this edition, tourniquet application has been introduced as a required skill. Hyperthermia lessons. Additionally, faculty can choose optional skills to augment
Remember – every red blood cell counts!! the selected optional lesson or a skill focusing on organization needs.

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Revising the PHTLS course was a true labor of love and we took the team The 9th edition course offers new patient simulations, and an expanded library of
approach very seriously when starting this mission. We carefully considered optional lessons that gives the faculty the ability to tailor each course to the
feedback from you – our PHTLS faculty – and reached out to PHTLS instructors needs of their community. Baseline patient simulations from the 8th edition will
around the world for their input on best PHTLS teaching practices. Lessons now be available to instructors who wish to utilize them, but are not a required part of
follow a case-based approach that encourages critical thinking and student the course. We have also developed mass-casualty trauma scenarios for
engagement. Every lesson reflects the new XABCDE patient assessment training centers that wish to practice triage skills.
approach and aligns with updated content from the textbook. This iteration of the A very special thanks to Mike Bowen and his colleagues at Fisdap for partnering
course includes mandatory skills stations, and the removal of the final evaluation with NAEMT to create a validated test instrument for the 9th edition of PHTLS.
skill stations to allow more time for patient simulations and individual skill PHTLS is now the ONLY prehospital trauma course with a validated test. Thank
practice. you as well to all of the PHTLS faculty who participated in the process. We
appreciate your time and dedication.

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An added component to the 9th edition is the PHTLS Course Manual, created to There are 9 lessons in the 9th edition PHTLS course. Lesson 1 is an introduction
enhance the participant’s course experience. to the course and provides an overview of trauma care and PHTLS. In this
The 9th edition PHTLS Textbook will continue as the gold standard reference lesson, we focus on the societal and financial impacts of trauma; explain the
book containing the full spectrum of medical science of prehospital trauma care. goals, philosophy and educational approach of PHTLS; explain the history and
It is designed for use by students and instructors before, during and after the evolution of prehospital trauma care; list the three phases of trauma care, and
course. discuss the effects of communication and documentation in trauma care.
The new Course Manual presents content specific to the course lectures and
case studies, and highlights key knowledge from the course lessons to give
students a deeper understanding of the content. It includes content presented
by the instructor during the course so that students can access this information
after the course.
The PHTLS 9th edition textbook and course manual will be sold as a package.
They will NOT be sold separately. The PHT Committee designed the course to
utilize both the textbook and the course manual to ensure that students receive
the maximum educational benefits before, during and after the 16 hours of
classroom content.

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Lesson 2 covers scene management and the primary survey. The learning In Lesson 3, Airway, we expect that students will learn how to:
objectives for this lesson are to:

• Identify the
scene safety threats that pose a • Discuss the potential causes of airway obstruction.
• Demonstrate the steps of a primary and secondary survey of a trauma
hazard to personnel, patients, and bystanders. patient’s airway.
• Develop a patient approach plan using • Choose the most appropriate airway management intervention based on the
patient’s physical findings.
information gathered during the scene size-up.
and
• Describe the integration of assessment and • Describe the structural differences in the anatomy of adults and children.
management during the primary survey.
• Apply a MUCC-compliant triage method to
manage multiple casualty incidents.
and
• Identify indications of intimate partner violence.
This lesson also introduces the XABCDE patient-assessment approach.

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Lesson 4, Breathing, Ventilation and Oxygenation, looks at: Lesson 4 also considers:

• A review of the anatomy and physiology of • How to choose the most appropriate
breathing. airway management intervention.
• Evaluation of the ventilation and
• How to identify inadequate perfusion status of a trauma patient
breathing based on trauma using waveform capnography.
patient assessment. • Choosing the most appropriate
and supplemental oxygen delivery device
based on the patient’s signs and
• Management of life-threatening symptoms.
injuries impairing airway and and
breathing in a trauma patient. • Determining when to ventilate and

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when to oxygenate a trauma patient.

Lesson 5 is Circulation, Hemorrhage, and Shock.

The learning objectives here are for the students to:
•. Describe shock pathophysiology.
• Recognize the clinical signs of shock.
• Explain basic shock treatment.
• Identify the modalities of fluid replacement.
• Explain the role of blood component replacement in the management of
hemorrhagic shock.
and
• Describe special considerations in shock management (age, athletes,
hypothermia, medications, pacemakers, and pregnancy).

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Lesson 6 is Secondary Assessment, where we assume we have a bit more time The PHTLS Disability lesson has been broken into two parts. Part 1 focuses on
with the trauma patient and can take our assessment skills a step further. traumatic brain injury. Lesson objectives for part 1 are:
Following this lesson, students will be able to:
• Explain the purpose and sequencing of performing a secondary survey. • Identify the signs and symptoms of
• Choose the most appropriate secondary survey tool(s) to obtain pertinent
traumatic brain injury.
physical findings.
and
• Identify transport options for a trauma patient based on assessment findings. • Explain the pathophysiology of
traumatic brain injury.
• Discuss the physics of trauma that
cause TBI.
• Distinguish primary and secondary
brain injuries.
and
• Demonstrate proper medical

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management of traumatic brain

injuries.

The second part of the disability lesson focuses on spinal injury. Following this
lesson, students will be able to:

• Identify the signs and symptoms of spinal injury and neurogenic shock.
• Describe the pathophysiology of spinal injury and neurogenic shock.
• Demonstrate evidence-based care for spinal injury.
• Identify the indications for spinal motion restriction.
and
• Select appropriate pain management interventions.

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Lesson 8 looks at special considerations, such as burns, the unique features of Finally, we have lesson 9, the summation. The learning objectives for this
pediatric and geriatric trauma, and pain management. Learning objectives here lesson are to
include the ability to: • Discuss the key points in managing a trauma patient, known as the “Golden
• Discuss burn assessment and treatment. Principles.”
• Learn to assess and treat pediatric trauma patients. And to
• Apply adult trauma treatment concepts to pediatric trauma patients. • Discuss the EMS provider’s role in the nationwide reduction of trauma deaths
• Apply adult trauma treatment concepts to geriatric trauma patients. and disabilities.
• Apply adult trauma treatment concepts to obstetric trauma patients
and
• Choose the most appropriate pain management intervention based on clinical
findings.

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Throughout the course, students will participate in skills stations. Skills that are Course coordinators and instructors may choose to include additional optional
required in the 9th edition of the course are: skill stations, such as:
• Trauma assessment • Supraglottic airway devices
• Needle decompression • IO access
• Junctional hemorrhage and wound packing • ALS airway techniques
• Supraglottic airway • Immobilization
• Tourniquet application • For example, joint, long bone, and traction splinting
• Pelvic binder and
• Basic airway techniques • Other optional skills as needed per organization
and
• Extrication

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We are happy to announce that we have new and revised patient simulations for The 9th edition Course author team has begun work on the 9th edition refresher
the course. Thank you to everyone who worked on them! The following course, which will be available in English by Fall of 2019. All 9th edition PHTLS
categories of simulations are available: providers will be eligible to take the 8-hour refresher course.
• Airway
• Breathing
• Circulation
• Disability
• Multisystem
• Special Considerations
And
• Mass casualty

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It is now my pleasure to introduce Amie Fuller, author of the PHTLS 9th edition Thank you, John. I am Amie Fuller, and I am a Lieutenant at Frederick County
provider course for first responders… Fire and Rescue in Maryland, a former flight paramedic, and a PHTLS affiliate
faculty. I am honored to have the opportunity to lead a team to revise PHTLS for
First Responders. This is a course that is designed for first responders who are
NOT EMTs or paramedics. There is a huge need for this course within the first
responder community both domestically and around the globe. This community
includes fire fighters, law enforcement officers, EMRs and others. If your
training center is not currently offering this course to your community, we
strongly encourage you to reach out to your first responders to provide them
with this course.

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Thank you to my colleagues on the PHTLS for First Responders author team – As a team, we looked at the core PHTLS learning objectives and created
Aaron Miranda and Ken Delassandro. I appreciate their extensive subject objectives appropriate for the first responder community. Those learning
matter expertise and field experience in developing the curriculum. And of objectives include:
course, thank you to John Phelps for his leadership.
1. Demonstrate safe and effective scene management including infection
protection practices that apply to all patients
2. Evaluate emergency situations and apply the principles of triage to
determine the most appropriate course of action
3. Demonstrate safe patient movement practices to remove patients from
immediate harm and to assist EMS personnel
4. Apply anatomically appropriate hemorrhage control techniques
5. Conduct a simple primary survey with emphasis on identifying and
managing immediate life-threatening injuries within the first responder’s
scope of practice

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The remaining learning objectives are to: We have been diligently working on the course and expect to have it complete
6. Perform basic airway management in a critically injured patient and and ready to teach by June 2019. It should be available in Spanish by
provide ventilatory support as needed December 2019. All PHTLS 9th edition instructors are eligible to teach PHTLS
for First Responders. NAEMT and Jones & Bartlett will announce when the
7. Provide basic pain management interventions in trauma patients course is ready and instructors will be able to access the slides and instructional
8. Recognize signs and symptoms of shock and provide basic care materials through their JBL account. Additional course materials, such as a post-
procedures within the first responder’s scope of practice test and course evaluations will be available through the NAEMT Education
9. Reassess patient status while waiting for additional EMS providers or Portal. A course manual designed specifically for the first responder audience
transporting agency and communicate pertinent patient information when will also be available through the Jones & Bartlett website.
relinquishing care

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I am happy to now introduce Nancy Hoffmann of NAEMT who will update us on Thank you, Amie. In this next part of the Update, I will provide information
the publication aspects of our new course materials. regarding the pricing, formats, and translations of the 9th edition, and also
provide information about the 9th edition Instructor Update.

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NAEMT thanks Jones and Bartlett Learning Public Safety Group for their work Earlier this year, NAEMT met with our PSG partners to discuss pricing for the 9th
on the 9th edition. We greatly appreciate the tremendous support of Kim Brophy, edition. While recognizing that the price for the 8th edition had not been
Jennifer DeForge-Kling, Donna Gridley, Christine Emerton, Robert Furrier, Alison increased from the 7th edition, both PSG and NAEMT felt that we should try to
Lozeau, Tiffany Sliter, and the entire PSG team for truly being our partners in bring the price of the 9th edition down even further to address any competitive
this venture, right from the start. issues with other courses, and make the 9th edition as affordable as possible.
We also took into account that our students increasingly want options on how
they access the course materials, with many students now preferring digital
We also thank Kristin Parker, JBL’s designer on this project, for all of her great formats.
work and the many design samples she provided.
As John mentioned earlier, the textbook and course manual will ONLY be sold
as a package. We feel that the 9th edition pricing model will provide our training
centers with affordable options for their students. These are the prices for the
English student materials in US dollars.

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PHTLS in English will continue to be offered as a 16-hour classroom course, or For the ninth edition, translations will include the textbook, course manual, and
in a hybrid format, with 8 hours available online to be followed by 8 hours in the instructor toolkit.
classroom. We will also continue to offer 8 hours of PHTLS continuing
education online. Those students who choose this option will not receive the
PHTLS provider card but they will receive 8 hours of CAPCE credit. NAEMT and JBL will work with our partners in other countries to determine in
which formats – print or digital - course materials will be published.

In most cases, the translated versions of the 9th edition will be priced
comparably to the English version in the United States. There may be some
instances in countries with emerging economies, where the price will be lower.

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The English version of the online instructor update for the 9th edition will be The Spanish-language version of the online instructor update for the 9th edition
available in December of this year. All current PHTLS instructors will need to will be available in March 2019. All current Spanish-speaking PHTLS instructors
complete the update by July 1, 2019 to maintain their instructor status. The will need
online update will be available through JBL’s Public Safety Group at a price of to complete the update by October 1, 2019 to maintain their instructor status.
$25. Instructors taking the update will receive four hours of CAPCE continuing The online update will be available through JBL’s Public Safety Group at a price
education credit. of $25.

We are also pleased to announce that a live PHTLS 9th edition Instructor Update
will be offered in conjunction with EMS World Americas in Quito Ecuador in
March 2019.

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For countries that speak languages other than English and Spanish, NAEMT will I would like to now invite Dennis Rowe back to the podium to introduce our next
send our partners in those countries a copy of today’s PowerPoint presentation. presenter who is held in very high esteem among both civilian and military
Our partners will translate the PowerPoint and instructor notes into their own colleagues…
language and can then use the materials to register and conduct classroom
PHTLS 9th edition Instructor Updates.

Of course, our partners are welcome to utilize the online Instructor Update in
English or Spanish, as needed.

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Thanks, Nancy. It is now a great privilege to introduce Dr. Frank Butler, Military Thank you for that most appreciated introduction, Dennis. And, thanks to all of
Medical Advisor of NAEMT’s Prehospital Trauma Committee. Dr. Butler serves you for such a warm welcome.
as the Chair of the US Department of Defense Committee on Tactical Combat
Casualty Care. This committee develops the guidelines and curriculum for the
TCCC courses for military personnel and all combatants. Dr. Butler and his team
write the military chapters for the PHTLS Military textbook. This afternoon, Dr.
Butler will provide us with an overview of the changes in the military textbook
and in the TCCC course.

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First and foremost, I want to thank my colleagues and dear friends, retired
Master Sergeant Harold Montgomery and Dr. Steven Giebner for the
tremendous work they have done on the TCCC curriculum and the PHTLS
Military Edition chapters. Without their expertise and dedication, the program
would not be what it is today.

99 100

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 COL Shackelford will soon be the Director of the Joint Trauma System.
Dr. Holcomb is Chief of the Division of Acute Care Surgery at the Univ. of TX
Medical School at Houston.
Mr. Fisher is an Army Ranger PA and is currently a medical student at Texas
A&M.

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Dr. Champion is the Director of the MedStar shock-trauma unit at Washington Dr. Kotwal is an Emergency Medicine consultant at the ISR.
Hospital Center. COL Mabry is Chief of the Combat Casualty Care Service Line at the Army
COL Gurney is a burn surgeon and trauma surgeon. Medical Command.

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The 8th edition presented TCCC Guidelines dated 181028 that included change
13-04 Triple Option Analgesia. Change 13-05 is the first of several guideline
updates that will be reflected in the 9th edition….

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109 110
111 112

113 114
 115 116

There is the Deployed Medicine website with the TCCC Collection alongside the You can also download the Deployed Medicine mobile application to phone or
JTS deployed/combat casualty care collection. tablet from your respective app store. Just search for “Deployed Medicine”.

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All of the content available on the website is available on the mobile app and Currently available on Deployed Medicine, you will find the current TCCC
vice versa. When any of our education or reference content is published, it is Guidelines, Educational and How-To videos for TCCC concepts and procedures,
immediately available on both the website and the app. topic-based podcasts for TCCC and the Joint Trauma System, and a core TCCC
The future exception to this might be the instructor collection being developed reference material.
that would only be available on the website. This is primarily the instructor
support materials such as large powerpoint files, skill sheets and testing
materials that would not be used on mobile devices. AND, those are usually big
files that most people don’t want on their phone.

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are developing in-app quizzing and problem-solving that can help instructors
assess cognitive retention as well as critical decision-making. We are looking at
how we can use the app to record the evaluator’s assessment checklist when the
student is performing their hands-on skills assessment.

The next major phase of Deployed Medicine is the development of a adaptive

learning and course delivery system focused on the individual.
At the operational level, the learning queue can be offered as a pre-training
event for new TCCC students. For instance, a school or command can require
students to complete a self-paced TCCC online course in a read-ahead pre-
training week to better prepare them for focused didactic and practical training
conducted the next week. It then becomes “in-hand” reference material for
students as they conduct the formal TCCC training.

It would also allow local operational units to use the educational content for
refresher and sustainment training events, especially when limited time and
resources are available. For instance, a combat unit medic team can block 2
hours of sustainment training on Tuesdays and use the DM material as both
read-ahead material or quick hip-pocket training references.

At the individual level, they can maintain their knowledge and skill awareness at
the personal level.

Another aspect being developed is the ability for both instructors and students to
use the app as part of their assessments, whether cognitive or hands-on. We

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Find and follow TCCC on social media. Look for all major changes, updates, I will now turn the podium over to Dr. Eastman who will provide an overview of
new education materials announced on TCCC and JTS social media. the 2nd edition of NAEMT’s Tactical Emergency Casualty Care course.

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The first edition of our TECC course was developed in 2014. It was a great first It has been an honor to work with such a dedicated group of tactical and
effort that provided EMTs and paramedics with tactical emergency medical skills. instructional experts in developing the 2nd edition of TECC. NAEMT would like
After the course published, we heard from the field that the course needed to to acknowledge the hard work of the 2nd edition TECC author team: William
have a greater focus on civilian tactical situations that EMTs and paramedics Justice, David Flory, Mark Gibbons, Don Heath, Michael Hunter, Rich Nydam,
across the country and around the world might encounter. and Julie Chase.

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We greatly appreciate the work of Drs. Geoff Shapiro and Reed Smith for their NAEMT is committed to field testing all new and revised courses before release
expertise in thoroughly reviewing the course materials and providing their to the public. The second edition TECC Course was field tested on four
insights and recommendations. occasions and we would like to thank all involved.

Also thanks to Mike Meoli, Brendan Hartford, and Michael Costanza for their We would like to thank the additional instructors who helped teach in Las Vegas:
contributions to the course. Phil Carey, John Phelps, Lee Richardson, Bob Waddell, and Ron Wenzel. At
Thank you to Mike Ward to his dedication and hard work on the TECC Course Tinker Air Force Base in Oklahoma, we thank Chad Beals. For teaching the
Manual. TECC beta materials to hundreds of providers in Hawaii, we’d like to thank
Barbara Brennan, Dr. Elizabeth Char, Mike Jones, David Kingdon, and Jeff
Zuckernick. And, through the Indiana Department of Homeland Security,
And, thanks again to Mike Bowen, Christie Morley, and the rest of the Fisdap teaching in Greenwood, Indiana, thank you to Mike Brown and Mark Litwinko.
team, and all volunteers who participated in the validation process for the 2nd
Edition TECC exam.

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The content in the second edition NAEMT TECC Course addresses the current The EMS nomenclature of Hot, Warm, and Cold Zones has been integrated with
TEMS domains and is consistent with the most recently released Committee on the tactical nomenclature of Direct Threat, Indirect Threat, and Evacuation
TECC guidelines. phases of care.

The author team identified areas to promote practitioner understanding of civilian This edition of TECC offers all new patient simulations and tactical scenarios.
tactical prehospital casualty care. These areas include breaking down the
MARCH assessment into individual lessons to allow greater focus on each
Perhaps the biggest change is the addition of a TECC Course Manual. This
component and incorporating immediate action drills into every lesson to ensure
that practitioners not only know how to apply a tourniquet, but have the manual includes content from the 9th edition PHTLS TEMS chapter and is
opportunity to build muscle memory around that skill. designed to be a valuable resource to course participants with expanded
sections on TECC topics and references for each lesson.

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The course materials and course manual will be available in English in March As there are substantial changes in this 2nd edition of TECC, all current TCCC
2019. The Spanish-language version will follow in summer of 2019. NAEMT and TECC instructors will need to take the 2nd edition TECC Instructor Update to
partners who are interested in having TECC translated into another language, teach the 2nd edition of the course. This Update will be offered online in English
please contact Alison Lozeau at JBL. and Spanish, and as a classroom course in other languages, using the same
process that we are using for the PHTLS 9th edition Update.

If you’re currently not a TECC instructor, but want to become one, you will need
to follow NAEMT’s standard of process of completing the TECC provider course
and the NAEMT Instructor Preparation Course, and teaching your first course
monitored by an Affiliate Faculty.

All new TCCC instructors will need to complete the 2nd edition TECC Instructor
Update to be recognized as a 2nd edition TECC instructor.

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The 2nd edition TECC Instructor Update will be available online in English I have also had the pleasure of working with my dear friends and colleagues
February 2019. David Flory, Dr. Bruce Cohen, and Brian Lankford on the new TECC for Law
Enforcement Officers course.
The Spanish version of this Update will be online by summer 2019.

For all other languages, NAEMT will provide the English TECC Instructor Update
PowerPoint to our partners for translation.

All current TCCC and TECC instructors will have six months from the date of
availability of the Update to complete the Update. NAEMT will send out an
email notification with this information to all current TCCC and TECC instructors.

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TECC for Law Enforcement Officers is an 8-hour course designed specifically And now, the presenters are happy to take questions from the faculty.
for non-EMS law enforcement officers and other tactical first responders. The
content is based on the new 16 hour 2nd edition TECC course, with lessons on
hemorrhage control, rescue tactics, and airway procedures. The course will be
rich in scenario-based training with a focus on self-aid and buddy aid.

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It is my privilege and honor to welcome our global family of PHTLS instructors to Thank you to the faculty in countries around the world who are working on the
the 9th edition PHTLS Instructor Update. I am humbled by your presence here translations and localizations of PHTLS course materials.
this afternoon which reminds why the PHTLS program continues to be the global
leader in prehospital trauma education. The great success of our program is
directly due to the tremendous dedication and passion of our global PHTLS
faculty. You are the ones who are responsible for providing our prehospital
practitioners with the knowledge and skills they need to make the best decisions
in the field for their patients. On behalf of NAEMT, thank you for being here
today and for what you do each and every day for your students and
communities.

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We would like to extend our deep appreciation to our PHTLS instructors, Will the members of the PHT Committee, PHTLS chapter editors and course
coordinators and medical directors for your dedication and commitment to authors, and TCCC and TECC authors please come to the stage.
PHTLS, your students, and their patients.
On behalf of NAEMT, thank you for the months and months, in many cases,
years and years, of tremendous work that has gone into producing the very best
trauma courses in the world. Please join me in thanking this incredible group of
experts for their leadership on these projects. We are all very grateful for your
service.

<Applause and everyone stays on the stage>.

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Go Forth and Serve!

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