Drug Reference

Acetaminophen

Acetaminophen (paracetamol)

A non-opioid analgesic and antipyretic that works centrally to reduce pain and fever without significant anti-inflammatory effects. Component of the TCCC Combat Wound Medication Pack (CWMP) since 2007 and retained through the 2026 update for mission-capable casualties.

Albuterol

Albuterol sulfate (salbutamol)

A short-acting selective beta-2 adrenergic agonist and the universal first-line bronchodilator for acute bronchospasm. Albuterol is in essentially every aid bag, IFAK with bronchodilator stocking, and emergency response kit. MDI (metered-dose inhaler) and nebulizer formulations available; nebulizer preferred for severe exacerbations and tactical/EMS use.

Aspirin

Acetylsalicylic acid (ASA)

A salicylate that irreversibly inhibits platelet cyclooxygenase, used in EMS primarily for suspected acute coronary syndrome and in select TCCC contexts for thromboprophylaxis during prolonged casualty evacuation. Aspirin at antiplatelet dose (81 to 324 mg) does not produce meaningful analgesia.

Atropine

Atropine sulfate

A competitive antagonist at muscarinic acetylcholine receptors used to reverse the muscarinic effects of organophosphate and nerve agent poisoning, treat symptomatic bradycardia, and reduce secretions during airway procedures. Atropine is the primary antidote for nerve agent exposure and the first drug administered in confirmed organophosphate toxicity.

Azithromycin

Azithromycin dihydrate

A macrolide antibiotic with broad gram-positive and atypical pathogen coverage, used in tactical and prolonged field care for respiratory infections, soft tissue infections in penicillin-allergic patients, and select sexually transmitted infections. Azithromycin's long half-life enables once-daily or even single-dose regimens.

Bacitracin (Topical)

Bacitracin zinc

A polypeptide antibiotic for topical use, providing gram-positive coverage for minor cuts, abrasions, and burns. Bacitracin is commonly carried in tactical and individual first aid kits as an over-the-counter wound ointment. The drug is not used systemically due to nephrotoxicity.

Benzonatate

A peripherally acting antitussive that anesthetizes stretch receptors in the respiratory passages, lungs, and pleura. Benzonatate is non-narcotic and non-sedating, making it well suited to operational use when cough suppression is needed without CNS effects. Available by prescription as a swallowed soft gelatin capsule.

Bismuth Subsalicylate

Bismuth subsalicylate

A combination of bismuth and salicylate that provides antidiarrheal, antimicrobial, and antacid effects. Bismuth subsalicylate is widely used in deployment medicine for traveler's diarrhea prophylaxis and treatment, and for symptomatic relief of indigestion, nausea, and heartburn. The dark stool and black tongue effects are benign but should be expected.

Caffeine

An adenosine receptor antagonist and the foundational fatigue countermeasure for sustained operations. Caffeine is the most extensively studied operational stimulant with the widest safety margin. Military operational protocols formalize 200 mg every 4 hours during sustained operations, with caffeine gum providing the fastest onset (5 to 10 minutes via buccal absorption). One of few TEMS supplemental agents that is explicitly mission-supporting.

Calcium Chloride

Calcium chloride 10%

A concentrated calcium salt (10% solution, 27.2 mg/mL elemental calcium) used to treat acute hypocalcemia, hyperkalemia, calcium channel blocker overdose, and magnesium toxicity. TCCC 2026 specifies 10 mL of 10% calcium chloride IV/IO after the first transfused blood product to address citrate-induced hypocalcemia. Calcium chloride delivers approximately three times the elemental calcium of an equivalent volume of calcium gluconate.

Calcium Gluconate

Calcium gluconate

An IV calcium salt used for hyperkalemia, calcium channel blocker overdose, hydrofluoric acid exposure, hypocalcemia from massive transfusion, and as part of damage-control resuscitation in trauma. Calcium gluconate is preferred over calcium chloride for peripheral IV administration due to lower risk of extravasation injury. The 2026 TCCC guidelines emphasize calcium administration during blood product resuscitation.

Cefadroxil

A first-generation oral cephalosporin antibiotic. The TCCC 2026 Guidelines designate cefadroxil 1 gram PO once daily as the preferred oral antibiotic for combat wound prophylaxis, replacing moxifloxacin in prior TCCC versions. Also indicated as the oral alternative for penetrating eye trauma prophylaxis.

Cefazolin

Cefazolin sodium

A first-generation parenteral cephalosporin and the most administered antibiotic in American hospitals due to its dominant role in surgical antimicrobial prophylaxis. In tactical EMS, cefazolin is the IV gram-positive workhorse for prolonged field care, role 2 surgical settings, and as the parenteral alternative when oral cefadroxil is not feasible.

Ceftriaxone

Ceftriaxone sodium

A third-generation parenteral cephalosporin used in the 2026 TCCC guidelines for wound infection prophylaxis when the casualty cannot tolerate oral medications. Ceftriaxone offers broad-spectrum coverage with once-daily dosing, making it well-suited to tactical environments where casualties cannot take PO.

Cephalexin

Cephalexin monohydrate

A first-generation oral cephalosporin antibiotic listed in the 2026 TCCC guidelines as the alternative oral wound infection prophylaxis when cefadroxil is unavailable. Cephalexin shares the same antibacterial spectrum as cefadroxil but has a shorter half-life requiring more frequent dosing.

Cetirizine

Cetirizine hydrochloride

A second-generation H1 antihistamine with faster onset than loratadine but mild sedation in a minority of users. Cetirizine is the fastest-acting of the three operational non-sedating antihistamines (loratadine, cetirizine, fexofenadine), useful for acute urticaria or new-onset allergic symptoms requiring rapid relief without the operational cost of diphenhydramine.

Cimetidine

A first-generation histamine H2 receptor antagonist that reduces gastric acid secretion. Cimetidine was the original H2 blocker but has largely been displaced by famotidine in modern practice due to its extensive CYP450 drug interaction profile and shorter duration. It remains on some tactical EMS supplemental formularies for acid suppression and as an adjunctive agent in anaphylaxis management.

Ciprofloxacin

A broad-spectrum fluoroquinolone antibiotic. Ciprofloxacin's primary tactical role is bioterrorism countermeasure for anthrax exposure (60-day post-exposure prophylaxis). It also covers complicated UTI, traveler's diarrhea, and selected gram-negative skin and soft tissue infections. FDA boxed warnings (tendinitis, peripheral neuropathy, CNS effects) and rising resistance patterns have narrowed its routine use.

Clindamycin

Clindamycin hydrochloride / Clindamycin phosphate

A lincosamide antibiotic with strong gram-positive and anaerobic coverage, used in tactical medicine for skin and soft tissue infections in penicillin-allergic casualties and for community-acquired MRSA coverage in austere environments. Clindamycin's broad anaerobic spectrum makes it useful in dental, head/neck, and complicated soft tissue infections.

Clotrimazole (Topical)

Clotrimazole

A topical imidazole antifungal effective against superficial dermatophyte and Candida infections. In tactical and deployment medicine, clotrimazole is essential for managing tinea pedis (athlete's foot), tinea cruris (jock itch), tinea corporis (ringworm), and superficial candidiasis that develop in hot, humid, and prolonged-wear-of-protective-equipment environments.

Clove Oil (Eugenol)

Eugenol

A topical dental anesthetic and bridge-to-care agent for operational dental pain. Eugenol, the active phenolic compound in clove oil, produces 20 to 30 minutes of meaningful pain relief when applied with a cotton pellet to a painful tooth. Useful for lost filling, exposed dentin, cracked tooth, or early dental abscess pain until the operator reaches dental capability.

DTPA (Diethylenetriamine Pentaacetic Acid)

Pentetate calcium trisodium / Pentetate zinc trisodium

A chelating agent used to bind and accelerate the elimination of transuranic radioactive metals (plutonium, americium, curium) from the body following internal radiological contamination. DTPA does not protect against external radiation or against radioactive iodine (potassium iodide is the antidote for iodine isotopes). Two formulations exist: Ca-DTPA for initial treatment, Zn-DTPA for extended treatment.

Dermabond (Cyanoacrylate Tissue Adhesive)

2-Octyl cyanoacrylate (Dermabond); n-butyl-2-cyanoacrylate (Histoacryl, Periacryl)

A topical tissue adhesive that polymerizes on contact with skin moisture, creating a flexible water-resistant film that bridges approximated wound edges. Dermabond closes clean, low-tension lacerations under 4 cm without anesthesia or sutures, in 60 seconds. Operational utility is significant for the right wound type. Patient selection is everything: bites, contaminated, puncture, high-tension, and mucosal wounds are contraindicated.

Dexamethasone

Dexamethasone sodium phosphate

A long-acting synthetic glucocorticoid with potent anti-inflammatory and immunosuppressive effects. Dexamethasone has broad applications in emergency medicine: airway swelling, anaphylaxis adjunct, croup, asthma exacerbation, increased intracranial pressure (cerebral edema from tumor or trauma), and adrenal insufficiency. Long half-life allows once-daily dosing for most indications.

Dextromethorphan

Dextromethorphan hydrobromide

A non-opioid centrally acting antitussive widely available over the counter for cough suppression. Dextromethorphan is structurally related to opioids but lacks significant analgesic and respiratory depressant effects at standard antitussive doses. Operationally useful in deployment medicine for upper respiratory infections that produce disruptive cough.

Diazepam

A long-acting benzodiazepine with active metabolites that extend the clinical duration to 24 to 48 hours. Diazepam is used for seizure termination, alcohol withdrawal, severe muscle spasm, and selected toxicology indications (organophosphate poisoning, severe sympathomimetic toxicity). Largely displaced by midazolam for prehospital seizure termination but remains essential in toxicology and alcohol withdrawal protocols.

Dimenhydrinate

A first-generation H1 antihistamine combined with 8-chlorotheophylline, used primarily for motion sickness and vertigo. The diphenhydramine component provides central anticholinergic and antiemetic effects; the theophylline component was added historically to offset sedation but has minimal practical impact. Sedation is significant and limits operational use - meclizine is preferred when the operator must remain functional.

Diphenhydramine

Diphenhydramine hydrochloride

A first-generation H1 antihistamine used as anaphylaxis adjunct (after epinephrine), for moderate allergic reactions, and for treatment of dystonic reactions from antipsychotic or metoclopramide administration. Significant sedation and anticholinergic effects limit operational use. Standard TCCC anaphylaxis bundle includes epinephrine, H1 blocker (diphenhydramine), and H2 blocker (famotidine or cimetidine).

Epinephrine

Epinephrine (adrenaline)

An endogenous catecholamine and the universally life-saving treatment for anaphylaxis and cardiac arrest. Epinephrine activates alpha-1, beta-1, and beta-2 adrenergic receptors, producing vasoconstriction, increased cardiac output, and bronchodilation simultaneously. Standard IM doses (0.3 mg adult, 0.15 mg pediatric) treat anaphylaxis. IV/IO doses (1 mg) drive cardiac arrest resuscitation. Wrong dose or wrong route can be lethal.

Ertapenem

Ertapenem sodium

A broad-spectrum carbapenem antibiotic historically used in TCCC for complicated combat wound infections and for casualties unable to take oral medications. Ertapenem's broad spectrum and once-daily dosing made it well-suited to prolonged field care, though its primary role has been superseded by ceftriaxone in current TCCC parenteral wound prophylaxis.

Esketamine

Esketamine hydrochloride

The S-enantiomer of ketamine, available as an intranasal formulation in the 2026 TCCC analgesia algorithm. Esketamine binds the same NMDA receptor target as racemic ketamine with greater affinity, allowing for lower total drug exposure at equivalent analgesic effect.

Fentanyl

Fentanyl citrate

A synthetic opioid analgesic with rapid onset and short duration, used in TCCC for moderate to severe pain in casualties who require an opioid analgesic. The TCCC 2026 guidelines retain fentanyl as an analgesic option, with ketamine generally preferred for non-mission-capable casualties due to the absence of respiratory depression.

Fexofenadine

Fexofenadine hydrochloride

A second-generation H1 antihistamine with the cleanest cognitive and sedation profile of the operational non-sedating antihistamines. Fexofenadine is FAA-approved for aircrew use, which makes it the preferred antihistamine for aviation operational personnel. The active metabolite of terfenadine (which was withdrawn for QT prolongation), but fexofenadine itself has no cardiac liability at therapeutic doses.

Fluconazole

A triazole antifungal active against Candida species and certain other fungi. In tactical and deployment medicine, fluconazole is used for vulvovaginal candidiasis, mucosal candidiasis, and prophylaxis or treatment of fungal infections that complicate prolonged antibiotic use in austere environments.

Fluorescein (Ophthalmic Stain)

Fluorescein sodium

A water-soluble fluorochrome dye used to visualize corneal epithelial defects and identify globe perforation under cobalt blue or Wood lamp light. Fluorescein staining is the single most useful diagnostic adjunct for ocular surface injury in tactical and emergency settings. Combined with topical anesthetic, it converts a painful, photophobic, blepharospasming eye into one that can be reliably examined in minutes.

Gatifloxacin

A fluoroquinolone antibiotic withdrawn from the systemic US market in 2006 due to dysglycemia events (hypoglycemia and hyperglycemia). Gatifloxacin remains available as an ophthalmic preparation for bacterial conjunctivitis. The drug appears in some legacy TCCC references but should not be used systemically. This entry documents the agent for historical context and to clarify current status.

Guaifenesin

The only FDA-approved oral expectorant in the United States, used to thin and loosen respiratory mucus and facilitate productive cough. Guaifenesin is widely available over the counter and is operationally useful in deployment medicine for upper respiratory infections with thick mucus and difficulty clearing secretions.

Hemostatic Dressings (QuikClot, Combat Gauze)

Kaolin-impregnated gauze; chitosan-based dressings

Topical hemostatic agents (kaolin-impregnated gauze, chitosan-based dressings) that accelerate clot formation at the wound site. Standard TCCC doctrine for compressible hemorrhage not amenable to tourniquet. QuikClot Combat Gauze (kaolin) is the TCCC standard. Technique discipline is everything: pack into the wound at the source, then 3 minutes of firm direct pressure.

Hespan

Hetastarch 6 percent in 0.9 percent sodium chloride

A synthetic colloid (hetastarch 6 percent in 0.9 percent sodium chloride) historically used for plasma volume expansion in hypovolemic shock. Hespan is the saline-carrier version; Hextend is the balanced-electrolyte version that was historically TCCC-preferred. Both are largely obsolete in current TCCC 2026 doctrine due to FDA boxed warnings for mortality and renal injury in critically ill patients and the operational rollout of cold-stored whole blood.

Hextend

Hetastarch 6 percent in lactated electrolyte solution

A synthetic colloid solution of 6 percent hetastarch in a balanced electrolyte vehicle, used historically as a TCCC volume expander for hemorrhagic shock. Hextend was a TCCC standard from approximately 2003 to 2018; it has since been removed from primary TCCC doctrine due to evidence of harm in critically ill patients. Current TCCC favors blood products for resuscitation when available. Hextend remains in some legacy kits and certain austere scenarios.

Hydrocortisone (Topical)

Hydrocortisone

A low-potency topical corticosteroid widely available over the counter for inflammatory skin conditions including contact dermatitis, insect bites, eczema, and minor pruritic conditions. Operationally important in deployment medicine for managing the dermatologic conditions that develop in field environments.

Hydroxocobalamin

A vitamin B12 precursor used as the first-line antidote for cyanide poisoning. Hydroxocobalamin binds free cyanide ions to form cyanocobalamin (vitamin B12), which is then renally excreted. Cyanokit is the formulation used in emergency response for smoke inhalation, fire-related cyanide exposure, and industrial cyanide poisoning.

Hypertonic Saline

Sodium chloride 3% or 23.4%

Concentrated saline solutions (3% or 23.4%) used as osmotic agents to reduce cerebral edema in traumatic brain injury with signs of herniation, treat severe symptomatic hyponatremia, and support volume resuscitation in specific contexts. TCCC 2026 explicitly adds hypertonic saline for traumatic herniation: 250 mL of 3% or 30 mL of 23.4% IV/IO over at least 10 minutes, may repeat once.

Ibuprofen

A non-selective NSAID that reduces pain, inflammation, and fever through cyclooxygenase inhibition. Ibuprofen is the standard oral NSAID in PA civilian EMS protocols and the most commonly carried OTC anti-inflammatory in TCCC and TEMS aid bags.

Ketamine

Ketamine hydrochloride

A non-competitive NMDA receptor antagonist used in tactical and emergency medicine for analgesia, procedural sedation, and management of excited delirium. Ketamine is unique among potent analgesics because it preserves respiratory drive and tends to support blood pressure rather than depress it.

Ketorolac

Ketorolac tromethamine

A parenteral NSAID used in EMS for moderate to severe pain management when oral NSAIDs are not appropriate. In PA Statewide ALS Protocols, ketorolac is available as a Possible Medical Command Order for pain in musculoskeletal trauma, renal colic, and migraine headache. Not included in standard TCCC doctrine.

Lactated Ringers

Lactated Ringer's solution (Hartmann's solution)

A balanced isotonic crystalloid containing sodium chloride with lactate as a bicarbonate precursor and small amounts of potassium and calcium. LR more closely approximates plasma composition than normal saline and produces less hyperchloremic acidosis with large volume resuscitation. In PA EMS protocols, LR is an optional alternative to NSS when approved by the agency medical director.

Lidocaine

Lidocaine hydrochloride

An amide local anesthetic that blocks sodium channels in nerves and cardiac tissue. In EMS, lidocaine is used for local anesthesia (wound care, IO needle placement pain), as a Class IB antiarrhythmic for ventricular dysrhythmias, and to reduce pain from IM ceftriaxone reconstitution in TCCC protocols.

Loperamide

Loperamide hydrochloride

A peripherally acting opioid receptor agonist that reduces intestinal motility and increases anal sphincter tone, producing antidiarrheal effect without CNS effects at therapeutic doses. Loperamide is operationally critical in deployment and tactical medicine for managing traveler's diarrhea and operational diarrhea that affects mission capability and hydration status.

Loratadine

A second-generation H1 antihistamine with minimal sedation and once-daily dosing. Loratadine is one of three operational-grade non-sedating antihistamines (with cetirizine and fexofenadine) appropriate for allergic complaints in operators who must remain fully functional. Onset is slower than diphenhydramine; effect is sustained over 24 hours.

Magnesium Sulfate

Magnesium sulfate

An electrolyte and physiologic calcium antagonist used in eclampsia and severe pre-eclampsia (prevention and treatment of seizures), refractory bronchospasm, torsades de pointes, hypomagnesemia, and digitalis toxicity. Magnesium sulfate has multiple mechanisms producing smooth muscle relaxation, membrane stabilization, and CNS depression.

Malarone (Atovaquone/Proguanil)

Atovaquone and proguanil hydrochloride

A fixed-combination antimalarial of atovaquone and proguanil used for prevention and treatment of Plasmodium falciparum malaria in deployment to endemic regions. Malarone is the preferred prophylactic antimalarial for many US military deployments due to its tolerability profile and once-daily dosing.

Meclizine

Meclizine hydrochloride

A piperazine-class H1 antihistamine with central anticholinergic activity used for motion sickness and vertigo. Meclizine is the preferred oral antiemetic for vestibular indications when the operator must remain functional: it has less sedation than dimenhydrinate and provides 24-hour protection from a single dose. Less effective than scopolamine patch for sustained operations but more accessible.

Meloxicam

A long-acting non-steroidal anti-inflammatory drug (NSAID) with COX-2 preferential activity, providing analgesia and anti-inflammatory effects with reduced platelet inhibition compared to non-selective NSAIDs. Component of the TCCC Combat Wound Medication Pack (CWMP) since 2007 and retained through the 2026 update.

Methylprednisolone

Methylprednisolone sodium succinate

An intermediate-acting synthetic glucocorticoid widely used in EMS for severe asthma exacerbations, COPD exacerbations, anaphylaxis adjunct, and acute inflammatory conditions. Methylprednisolone (Solu-Medrol) is the standard IV corticosteroid in PA ALS protocols and is available as a Possible Medical Command Order in PA Protocol 4022 for asthma/COPD/bronchospasm.

Metoclopramide

Metoclopramide hydrochloride

A dopamine D2 antagonist with both antiemetic and prokinetic properties. Metoclopramide is used for refractory nausea and vomiting, gastroparesis, and migraine-associated nausea. Carries an FDA boxed warning for tardive dyskinesia with prolonged use and a high incidence of extrapyramidal effects including akathisia. Not first-line for routine tactical antiemetic needs - ondansetron is preferred.

Metronidazole

A nitroimidazole antibiotic and antiprotozoal agent with potent activity against anaerobic bacteria and certain protozoa. In TCCC and deployment medicine, metronidazole is paired with other antibiotics for anaerobic coverage in intra-abdominal injuries and used for treatment of giardiasis and amebic infections in austere environments.

Midazolam

Midazolam hydrochloride

A short-acting benzodiazepine and the TCCC-doctrine anticonvulsant and procedural sedation agent. Midazolam's rapid onset (especially IN and IM), short duration, and water solubility (no propylene glycol vehicle) make it the field benzodiazepine of choice. Standard TCCC use: seizure termination, severe agitation in TBI, ketamine sedation adjunct, and procedural sedation.

Modafinil

A wakefulness-promoting agent with lower peripheral cardiovascular and abuse potential than amphetamines. Modafinil is the operational stimulant of choice for sustained operations and aviation medicine when sleep deprivation is the rate-limiting factor. Extensively studied by US military operational research. Standard dosing maintains alertness during prolonged operations without significant cognitive impairment.

Morphine

Morphine sulfate

A naturally occurring opioid analgesic and the reference standard for opioid potency. Morphine has largely been displaced in TCCC doctrine by fentanyl (faster onset, shorter duration) and ketamine (no respiratory depression), but remains in civilian EMS use for moderate to severe pain and in select cardiac protocols.

Moxifloxacin

Moxifloxacin hydrochloride

A fourth-generation fluoroquinolone antibiotic historically used in TCCC for combat wound prophylaxis. Moxifloxacin offers broad spectrum coverage with once-daily dosing. Its role in TCCC has diminished in recent guideline updates in favor of cefadroxil for routine oral wound prophylaxis, but moxifloxacin remains relevant for prolonged field care and as an alternative in penicillin/cephalosporin allergy.

Mupirocin (Topical)

Mupirocin calcium

A topical antibiotic with strong activity against Staphylococcus aureus including MRSA, used for impetigo, minor skin infections, and nasal MRSA decolonization. Mupirocin is operationally important in tactical and deployment medicine where MRSA carriage in close-quarters environments is a real concern.

Naloxone

Naloxone hydrochloride

A competitive mu-opioid receptor antagonist that reverses opioid-induced respiratory depression. Naloxone is carried at every level of EMS and is a required medication on PA ALS, IALS, and BLS vehicles. The drug is also positioned as a TEMS and TCCC safety countermeasure for accidental or operationally-induced opioid exposure.

Naproxen

Naproxen sodium

A long-acting non-steroidal anti-inflammatory drug (NSAID) used for mild to moderate musculoskeletal and inflammatory pain. Naproxen's primary operational advantage over ibuprofen is its 12-hour dosing interval, which reduces pill burden during sustained operations and training cycles. Available OTC at 220 mg and by prescription at higher strengths.

Nitroglycerin

Nitroglycerin (glyceryl trinitrate)

A potent venous and arterial vasodilator and the first-line antianginal agent. Nitroglycerin reduces preload (primary effect at lower doses), reduces afterload at higher doses, and dilates coronary arteries. Standard EMS use is acute coronary syndrome (chest pain) and acute decompensated heart failure with pulmonary edema. Absolutely contraindicated with phosphodiesterase-5 inhibitors (sildenafil family) due to fatal hypotension risk.

Norepinephrine

Norepinephrine bitartrate

A potent alpha-1 and beta-1 adrenergic agonist used as the first-line vasopressor for septic shock, distributive shock, and refractory hypotension from various causes. Norepinephrine increases vascular tone and modestly increases cardiac output, raising mean arterial pressure to support organ perfusion. The Surviving Sepsis Campaign designates norepinephrine as the initial vasopressor of choice.

Normal Saline

Sodium chloride 0.9 percent (NSS)

An isotonic crystalloid solution of 0.9 percent sodium chloride in water, used as the primary IV fluid in PA EMS protocols for volume resuscitation, medication delivery, and hydration. NSS is on the Required Medication List for PA IALS vehicles and is the default IV fluid throughout PA Statewide ALS and IALS protocols. Compatible with all EMS medications and preferred for traumatic head injury.

Omeprazole

A proton pump inhibitor (PPI) that irreversibly blocks the H+/K+ ATPase enzyme in gastric parietal cells, suppressing acid secretion regardless of stimulus. Omeprazole is the workhorse PPI for tactical and operational medicine: once-daily dosing, OTC availability, and a clean operational profile make it the preferred choice for symptomatic GERD or NSAID-related acid suppression in deployed operators.

Ondansetron

Ondansetron hydrochloride

A selective 5-HT3 serotonin receptor antagonist and the standard antiemetic across TCCC, TECC, and civilian EMS protocols. Ondansetron is the first-line agent for post-trauma, post-opioid, and chemotherapy-induced nausea due to its excellent efficacy, minimal sedation, and clean operational profile. The ODT (orally disintegrating tablet) form is particularly useful in field settings where water access is limited.

Oxymetazoline

Oxymetazoline hydrochloride

A topical alpha-adrenergic agonist used as a long-acting nasal decongestant and as a topical hemostatic agent for epistaxis. Oxymetazoline produces 8 to 12 hours of vasoconstriction with a single dose, longer than phenylephrine. Operationally important in tactical and deployment medicine for epistaxis control and severe nasal congestion.

Phenylephrine

Phenylephrine hydrochloride

A selective alpha-1 adrenergic agonist used in two distinct contexts: as a topical nasal decongestant and as an IV vasopressor for hypotension management. The oral OTC decongestant form is widely used but has minimal absorption and limited efficacy. The IV form is used in critical care for vasopressor support in anesthesia, sepsis, and select shock states.

Potassium Iodide (KI)

Potassium iodide

A stable iodine compound used to saturate the thyroid gland and block uptake of radioactive iodine isotopes (primarily iodine-131) following nuclear reactor releases or radiological incidents. KI provides thyroid-specific protection only; it does not protect against other radioactive isotopes or external radiation exposure.

Pralidoxime (2-PAM)

Pralidoxime chloride

An oxime that reactivates acetylcholinesterase inhibited by organophosphate compounds or nerve agents. Pralidoxime addresses the nicotinic effects of cholinergic toxicity (skeletal muscle weakness, paralysis, fasciculations) that atropine does not, making the two medications complementary rather than alternative therapies in nerve agent or organophosphate exposure.

Prednisone

An oral synthetic glucocorticoid used for short-course treatment of asthma and COPD exacerbations, severe allergic reactions, contact dermatitis (including significant poison ivy involvement), and inflammatory conditions. Prednisone is the oral follow-on after acute treatment with injectable steroids and the oral primary agent for sustained outpatient management.

Primaquine

Primaquine phosphate

An 8-aminoquinoline antimalarial used for terminal prophylaxis and radical cure of Plasmodium vivax and P. ovale malaria. Primaquine targets the dormant hypnozoite liver stage that other antimalarials do not address, preventing relapsing malaria after deployment to regions where these species are endemic. Requires G6PD screening before administration due to hemolytic anemia risk.

Promethazine

Promethazine hydrochloride

A first-generation phenothiazine with antihistamine, antiemetic, and sedative properties. Promethazine carries FDA boxed warnings for severe tissue injury from IV extravasation and for respiratory depression in children under 2 years. Ondansetron has displaced promethazine as the first-line antiemetic in most tactical and EMS protocols. Remaining role is severe nausea unresponsive to 5-HT3 antagonists.

Proparacaine

Proparacaine hydrochloride

An ester-type topical local anesthetic used for ophthalmic procedures. Proparacaine enables emergency ocular examination, foreign body removal, fluorescein staining setup, and tonometry. Rapid onset (under 30 seconds) and minimal stinging make it the field-preferred topical ocular anesthetic. Must never be dispensed for patient self-administration - chronic use causes severe corneal injury.

Pseudoephedrine

Pseudoephedrine hydrochloride

An oral sympathomimetic decongestant with good oral bioavailability and predictable nasal decongestant effect. Pseudoephedrine is significantly more effective than oral phenylephrine for nasal congestion. Behind-the-counter status in the US due to methamphetamine precursor concerns; specific state regulations may apply. Operationally relevant in deployment medicine for sinus and Eustachian tube dysfunction at altitude or in flight operations.

Push-Dose Epinephrine

Epinephrine (diluted)

A technique for administering small intravenous boluses of dilute epinephrine (10 mcg/mL) to treat peri-arrest hypotension, post-intubation hypotension, and bridge to vasopressor infusion. Push-dose epinephrine delivers vasopressor support in 5 to 20 mcg increments, allowing titration to effect without committing to a continuous infusion setup.

Sodium Thiosulfate

Sodium thiosulfate

A sulfur donor used as a cyanide antidote, typically in combination with sodium nitrite (legacy regimen) or as an adjunct to hydroxocobalamin in severe cyanide poisoning. Sodium thiosulfate provides sulfur substrate for the enzyme rhodanese to convert cyanide to thiocyanate, which is then renally excreted.

Suzetrigine

A non-opioid analgesic added to the TCCC Combat Wound Medication Pack in 2026 for mission-capable casualties with moderate to severe pain. Suzetrigine is a peripheral sodium channel blocker that does not depress respiratory drive or cause sedation.

TMP-SMZ (Trimethoprim/Sulfamethoxazole)

Trimethoprim and sulfamethoxazole

A fixed-combination antibiotic of trimethoprim and sulfamethoxazole with broad activity against many gram-positive and gram-negative organisms, including community-acquired MRSA. In tactical and deployment medicine, TMP-SMZ is used for skin and soft tissue infections (particularly suspected MRSA), urinary tract infections, and prophylaxis against certain opportunistic infections.

Tetracaine (Ophthalmic)

Tetracaine hydrochloride

An ester-type topical ocular anesthetic, functionally equivalent to proparacaine for tactical EMS use. Tetracaine has slightly longer duration but more pronounced stinging on instillation. Choice between tetracaine and proparacaine is typically driven by availability. Same caution applies: never dispense for patient self-administration.

Tramadol

Tramadol hydrochloride

A Schedule IV opioid analgesic with dual mu-opioid receptor agonism and SNRI activity. Tramadol's tactical role is limited by unpredictable pharmacogenomic response (CYP2D6 variability), serotonin syndrome risk in operators on SSRIs, and seizure threshold lowering in TBI populations. The TCCC analgesic ladder (acetaminophen plus meloxicam for mild, fentanyl for moderate to severe, ketamine for refractory) provides better predictability.

Tranexamic Acid (TXA)

Tranexamic acid

A synthetic antifibrinolytic agent that stabilizes formed clots by blocking fibrin breakdown. The TCCC 2026 guidelines specify a single 2 gram IV/IO push for casualties with hemorrhagic shock or anticipated need for blood transfusion. The earlier CRASH-2 regimen (1 gram plus 1 gram) is now superseded for TCCC use but remains current in many civilian EMS protocols including PA Protocol 6094.

Vasopressin

A synthetic analog of antidiuretic hormone (ADH) used as a second-line vasopressor in septic shock, refractory shock, and diabetes insipidus. Vasopressin acts on V1 vascular receptors to produce vasoconstriction independent of the adrenergic pathway, making it particularly useful in catecholamine-refractory hypotension and as an adjunct to norepinephrine to reduce catecholamine requirements.

Zaleplon

A short-acting Z-class sedative-hypnotic (GABA-A alpha-1 selective) used as a 4-hour sleep aid during controlled rest cycles in sustained operations. Zaleplon's 1-hour half-life is the operational advantage: useful for brief protected rest with minimal residual sedation if operations resume. Schedule IV with FDA boxed warning for complex sleep behaviors. Must have at least 4 hours of protected rest available before dosing.