TCCC

[0311_DoC]

is anybody familiar with the TCCC program? It is only used in a tactical or combat situation.

[Medic 1]

CAPT MC USN

Director of Biomedical Research

Naval Special Warfare Command

The opinions and assertions expressed by the author are his alone and do not necessarily reflect the views of the Departments of the Navy or Defense.

Abstract

The Tactical Combat Casualty Care (TCCC) project initiated by Naval Special Warfare and continued by the U.S. Special Operations Command has developed a new set of combat trauma care guidelines that seek to combine good medical care with good small-unit tactics. The principles of care recommended in TCCC have gained increasing acceptance throughout the Department of Defense in the four years since their publication and increasing numbers of combat medical personnel and military physicians have been trained in this concept. Since casualty scenarios in small-unit operations typically present tactical as well as medical problems, however, it has become apparent that a customized version of this course suitable for small-unit mission commanders is a necessary addition to the program. This paper describes the development of a course in Tactical Medicine for SEAL Mission Commanders and its transition into use in the Naval Special Warfare community.

Introduction

In the past, combat trauma training for Special Operations corpsmen, medics, and pararescuemen (PJs) was based on the principles taught in the Advanced Trauma Life Support (ATLS) Course. (1) ATLS is a standardized approach to trauma care that was developed by the Committee on Trauma of the American College of Surgeons. It is revised every 4 years and is widely accepted in the United States. ATLS is considered the standard of care for the Emergency Department management of trauma patients in both civilian and military hospitals. If one undertakes to use this course to train combat medical personnel, however, it quickly becomes apparent that ATLS was not designed to be used in the combat environment. ATLS was developed for physicians, not for combat medics. It assumes that hospital diagnostic and therapeutic equipment is available and, most importantly, does not recognize the existence of the tactical combat environment. There is no provision or allowance for such factors as incoming fire, darkness, environmental factors (the casualty may occur in a swamp, in the snow, or in the surf zone), casualty transportation problems, long delays to definitive care, and the need to balance the management of casualties with the conduct of an ongoing combat mission. Therapeutic measures that are taken for granted in the emergency department, such as CPR, c-spine immobilization, endotracheal intubation, starting two large-bore IVs, insertion of nasogastric tubes and foley catheters, supplemental oxygen therapy, and the complete undressing of the patient to complete a secondary survey would be inappropriate in the middle of an ongoing firefight. This is not a criticism of ATLS, rather, it is a reflection of the fact that those of us in military medicine were trying to use ATLS in a setting for which it was not intended.

This realization, however, leaves us with a question. If an approach to battlefield trauma care other than ATLS is to be used, what should it be? Combat medical personnel are expected to make appropriate adjustments to civilian trauma guidelines on the battlefield, but why wait until they are in the middle of a firefight to begin thinking about what these adjustments should be? Corpsmen and medics must be aware of the fact that good medicine can sometimes be bad tactics and that bad tactics can get everyone killed or cause the mission to fail. Casualty scenarios in Special Operations usually entail both a medical problem and a tactical problem, and we want the best possible outcome for both the man and the mission. This realization forces us to redefine our outcome measures for the management of trauma in combat as shown in the TCCC Objectives in Figure 1.

In 1993, the Naval Special Warfare Command established a formal requirement to review the management of combat trauma in the tactical Special Warfare environment and make recommendations for changes as appropriate. The research approach used was to do a preliminary literature review and establish an initial set of recommendations. The recommendations were then reviewed over a six-month period in meetings with Special Operations corpsmen, medics, and physicians and consensus opinions were developed. Draft copies of the paper were then sent out to approximately 30 subject matter experts in the fields of emergency medicine, general and trauma surgery, critical care medicine, anesthesiology and cardiothoracic surgery. The paper was again revised to incorporate changes recommended by these reviewers and subsequently published as a Supplement to Military Medicine. (2) The approach used was intended to ensure that the TCCC guidelines had as much input as possible from combat corpsmen and medics.

[0311_DoC]

Thanks Medic 1. I am A TCCC Instructor, I was just curious if anyone out there was familiar with it.

[Medic 1]

Hi Buddy
Yep, heard of it but as I am out of SOF now have not had much input. In UK SF we didn't have a set format and based most of the 'patrol medic' teaching around the ATLS course and added a tactical element based on operator skills etc etc.
I would like to see the training format if you could send it over to me off post?

Medic1

[0311_DoC]

TCCC is still a very basic skill. its more of what to do when in the tactical situation. bottom line is the mission still comes first. its more of what to do in each instance, like what you do while being engaged versus what to do when your under cover and concealment etc etc

[Jamie Davis, the Podmedic]

Great discussion, guys! I'll have to link to this post when I post the shownotes for the recent tactical medic discussion over at the MedicCast Live this past week. Keep the good posts and information coming!

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[0311_DoC]

your tactical medic podcast is why I started this thread.

[SnrMedic1/82]

I have the TC3 material from a recent Combat Medic recert. I think the basic of TC3 is remembering that you're a rifleman until you gain fire superiority. I learned a lot about TC3 from my old corpsman from when I was in the Marines, and there really is no difference between Navy/Army. When i deal with fieldcraft topics with other medics, it always comes down to gear setup. Every medic/corpsman organizes their gear according to their preference. I have my bag set up with MOLLE, so I can attach pouches to the sides. One side is Trauma, the other side is Airway. In my opinion, during TC3 with the high op tempo the faster i move, the better. Basically I've found that i move faster when i don't have to open the main portion of my bag and can work out of the attached pouches. I think the only thing that works better is the setup on the London Bridge bag, or the Blackhawk. During Care Under Fire, everything you need fits into the MOLLE medic pouches, which really is just tourniquets and gauze, NPAs, maybe some quick-klot. I also find medics carry equipment they don't need, like laryngoscopes, ENT kits or overstock on things like fluids. While the benefit of ET tubes is that they take less space, the simplicity of Combitubes allows faster soldier care. just a preference i guess. While there is no SOP on stocking the standard aid bag, medic/corpsman skill level and preference dictates bag setup. After Care Under Fire comes Tactical Field Care phase, which is where the soldier/Marine is transported to the CCP (Casualty Collection Point), and this is where the main bag should come into play. The Meat and Potatoes of Medics/Corpsman. Again, skill/personality dictates setup. Finally, CASEVAC phase, which for me is just double checking interventions while the RTO sends up a NATO 9 line and monitoring pain management. This of course is only my brief take on TC3.
Semper Fi.