1stCpr

25/06/2026

‼️When did the Trauma Triad of Death become the Trauma Diamond of Death⁉️

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The lethal triad (or trauma triad of death) refers to the interaction of hypothermia, acidosis, and coagulopathy. These conditions are indicators of injury severity and as mutually reinforcing problems that influence trauma patient morbidity and mortality. Hypothermia impairs physiologic and coagulation processes, acidosis commonly reflects inadequate perfusion and tissue hypoxia, and coagulopathy limits the patient’s ability to control bleeding. Together, these conditions create a cycle in which shock, bleeding, impaired clotting, and worsening metabolic status accelerate clinical decline.

The triad became the “diamond of death” when hypocalcemia was added as a fourth interdependent component. Trauma care has traditionally centered on hemorrhage control while mitigating hypothermia, acidosis, and coagulopathy, but newer data support hypocalcemia as closely linked to each element of the triad. Calcium matters because it helps a bleeding patient form clots, maintain blood vessel tone, and keep the heart pumping effectively. When ionized calcium drops, clots may form poorly, blood pressure will become more difficult to control, all of which leads to exacerbation of shock.

C-TECC & C-TCCC both recommend calcium therapy during hemorrhagic shock and with blood-product resuscitation, especially after the first transfused blood product. For EMS, the practical takeaway is that calcium is part of supporting clotting and perfusion during major bleeding, especially when blood products are being given. But, the need for hemorrhage control, hypothermia prevention, rapid evacuation to definitive care are still key components to survival.

The trauma triad of death identifies a dangerous physiologic spiral; the diamond broadens that model by adding a modifiable variable that can affect clotting, perfusion, and response to transfusion. Regardless of the need for calcium, always ensure that trauma patients are covered with blankets to retain heat, bleeding is stopped, and oxygen is applied to help fight off acidosis.
***Always follow your local protocols, this is educational material only***

References
Casella, J., & Perry, M. (2024). EMS tactical paramedic lethal triad. In StatPearls. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK603758/
Committee for Tactical Emergency Casualty Care. (2018). Hypocalcemia and the lethal triad [PowerPoint slides].https://www.c-tecc.org/images/Hypocalcemic-Shock-C-TECC-min.pdf
Deaton, T. G., Montgomery, H. R., & Butler, F. K. (2026). Tactical Combat Casualty Care (TCCC) guidelines: 1 May 2026 updates. Journal of Special Operations Medicine. Advance online publication. https://doi.org/10.55460/J.Spec.Oper.Med.2026.8VSB-B7D7
Wray, J. P., Bridwell, R. E., Schauer, S. G., Shackelford, S. A., Bebarta, V. S., Wright, F. L., Bynum, J., & Long, B. (2021). The diamond of death: Hypocalcemia in trauma and resuscitation. The American Journal of Emergency Medicine, 41, 104–109. https://doi.org/10.1016/j.ajem.2020.12.065

25/06/2026

CPR Induced consciousness

24/06/2026

CLINICAL UPDATE: THE MAY 1, 2026 CoTCCC GUIDELINE AMENDMENTS

The CoTCCC has released comprehensive guidelines to optimize frontline outcomes through simplified interventions and corrected field vulnerabilities.

1. TOURNIQUET REPOSITIONING (Change 25-2)
Mandatory reassessment of all TQs. High-and-tight TQs from Care Under Fire (CUF) require repositioning: apply a second TQ 2–3 inches above the wound, confirm cessation, then loosen the initial TQ. ASM/CLS tiers are authorized, but non-medical personnel must not convert devices in place for >2 hours.

2. AIRWAY MANAGEMENT (Change 24-1)
Extraglottic airways (EGAs) are removed from the TFC toolset. The recovery position is the primary standard for unconscious casualties with patent airways. Surgical cricothyroidotomy requires mandatory end-tidal capnography for verification.

3. ANTIMICROBIAL & ANALGESIA (Change 25-1)
Ertapenem is replaced by Ceftriaxone (IV/IO/IM). Moxifloxacin is replaced by Cefadroxil PO.
Oral Transmucosal Fentanyl Citrate (OTFC) is phased out, with analgesic management shifting toward Ketamine in austere settings.

KEY CHANGES 2026
Massive Bleeding: Reposition 2nd TQ on skin, check, loosen 1stConversion Limits: ASM/CLS conversion cap at 2 hours

Airway: Recovery position preferred; EGAs removed
Airway (Surgical): Mandatory end-tidal capnography

Antibiotics: Ceftriaxone (IV/IO/IM) & Cefadroxil PO
Analgesia: Prioritized Ketamine & non-opioid protocols

22/06/2026

If you spot any of these stroke signs, consider it a red card. Stop everything and call 911. There’s no extra time when it comes to stroke -- every second counts. Recognizing the warning signs and getting help quickly can make all the difference in the world. Know B.E.F.A.S.T.

12/06/2026

Local course

CPR FOR EVERYONE

The CPR for EVERYONE course is designed to teach the techniques of CPR and choking in adults, children and infants, and the use of the AED to lay rescuers, particularly those who are expected to respond to emergencies in their occupation or workplace. The course is ideal for security personnel, law enforcement officers, firefighters, lifeguards, swimming coaches, health and fitness staff, corporate and retail employees and other lay responders.

The course provides hands-on practice in the skills of CPR and choking for adults, children and infants, including the use of barrier devices and pocket masks, and how to activate the emergency services. A colour manual is provided to each participant for review before, during and after the course.

The student will be required to pass a 15 question multiple choice test and successfully pass 3 skills tests before receiving a numbered Resuscitation Council of Southern Africa certificate of competence in CPR, choking and AED.

11/06/2026

08/06/2026

We are so relieved that this precious baby is unharmed after an accident on his side. This is why we do what we do! This is why we advocate for correct car seat use 🙏🏻

08/06/2026

Local Resuscitation Council of Southern Africa courses

ESSENTIAL FIRST AID FOR TREATING CHILDREN

This course is intended primarily for those who are expected to provide CPR and first aid directly to children.
The course targets all lay responders such as parents, caregivers, guardians, domestic workers, or family members of a child at high risk for sudden death, and other laypersons wanting to learn first aid essentials for children.

The course provides hands-on practice in the skills of first aid for children in the home, including accident prevention, medical emergencies, trauma injuries, environmental emergencies, CPR, choking and the use of Automated External Defibrillators (AEDs). A student workbook is provided to each participant for review before, during and after the course.

After completing the course, each participant will receive a Certificate of Attendance.

This course is an attendance only course and is not accredited as a level 1 first Aid course by the Department of Labour.