Appendix A: Class VIII Medical Materiel

Here is a detailed list of essential medical equipment and supplies required for Amputation: Evaluation and Treatment.

#### Initial Hemorrhage Control

1. Tourniquets: For immediate control of life-threatening extremity bleeding.
2. Hemostatic Dressings: To promote rapid clotting at the wound site.
3. Pressure Bandages: To maintain hemostasis after initial bleeding control.

#### Resuscitation (Blood and Intravenous Access)

1. Blood tubing set
2. Rapid infuser
3. IV catheters: (16G, 18G, 20G)
4. Central venous catheter (CVC) kits: large bore (Cordis or MAC)
5. Intraosseous (IO) needles
6. Whole blood or packed red blood cells (PRBCs)
7. Fresh frozen plasma (FFP) or Freeze-Dried Plasma (when appropriate and/or available)
8. Cryoprecipitate
9. Platelets

#### Induction, Anesthetics, Vasopressors, Antibiotics

1. Induction Agents- Ketamine, midazolam, succinylcholine, rocuronium
2. Analgesia-Morphine sulfate, Fentanyl, ketamine, acetaminophen
3. Local anesthetics-Lidocaine 1% or 2%, Bupivacaine
4. Vasopressors-Epinephrine, Norepinephrine, Phenylephrine
5. Antibiotics-Cefazolin, Ertapenem, Vancomycin (for patients with allergy or specific indications)

#### Surgical Drapes and Sterile Field

1. Sterile drapes
2. Fenestrated drapes
3. Sterile gloves
4. Surgical gowns
5. Betadine or chlorhexidine prep solution
6. Sterile towels
7. Mayo stand cover

#### Surgical Instruments

1. Vascular Clamps: To control blood vessels during surgery.
2. Vessel Loops or Ligatures: For controlling or ligating blood vessels.
3. Scalpels and Blades: For incision/excision.
4. Bone Saws or Gigli Saws: For bone transection during amputation procedures.
5. Forceps, Clamps, and Needle Holders: For tissue handling and suturing.

#### Wound Management

1. Sterile Saline Solution: For irrigation and cleaning of the wound.
2. Debridement Tools: Such as curettes and scissors to remove non-viable tissue.
3. Negative Pressure Wound Therapy (NPWT) Devices: To promote wound healing and reduce edema.

#### Postoperative Care

1. Regional Anesthesia Kits: Including nerve block needles and catheters.
2. Analgesic Medications: Both opioid and non-opioid options for pain control.
3. Sterile Dressings and Bandages: For wound coverage and protection.
4. Compression Garments: To manage swelling and support residual limbs.
5. Splints/Casts: to prevent contractures
6. Venous Thromboembolism Prophylaxis: enoxaparin or heparin

#### Additional Considerations

1. Sterilization Supplies: Ensure availability of autoclaves or chemical sterilization agents to maintain instrument sterility.
2. Documentation Tools: Accurate record-keeping materials to document surgical procedures and postoperative care plans.

For additional information including National Stock Number (NSN), please contact dha.ncr.med-log.list.lpr-cps@health.mil

DISCLAIMER: This is not an exhaustive list. These are items identified to be important for the care of combat casualties.