Although combat medics seldom carry oxygen with them due to its weight and potential injuries from the pressurized containers, advances in oxygen generation are moving smaller, safer oxygen resources closer to the battlefield, and oxygen may be found at casualty collection points (CCPs) or with some convoys. Current TCCC Guidelines recommended oxygen use, if available, in patients with signs of refractory shock or TBI patients, with the goal of maintaining an oxygen saturation greater than 90%.

The recommendations for oxygen use expand in the Tactical Evacuation Care phase, to include low oxygen saturation, injuries with impaired oxygenation (like chest wounds or pneumothorax), shock, smoke inhalation, and trauma at altitude. If any of these conditions are present, consideration for initiating supplemental oxygen administration during TFC, prior to evacuation, may be indicated.

Interestingly, studies have demonstrated that trauma casualties not in respiratory distress have worse outcomes when they receive supplemental oxygenation than their counterparts who do not receive oxygen. Therefore, supplementing all trauma casualties is not appropriate, and should be reserved for TBI, shock, or in preparation for Tactical Evacuation Care situations.

When administered, the dose is often 3 liters/min; but that is a function of the production capacity of the generators usually seen in a Tactical Field Care setting. If higher oxygen flows are available, they should be increased to maintain a pulse oximetry reading of more than 90%, particularly in cases of TBI.