Page 104 - JSOM Winter 2025

2006) General Doug Brown, Commander of USSOCOM, sent a he received care in accordance with the then-new TCCC Guide-
letter of appreciation to the Army Surgeon General for the out- lines. D’Angelo comments:
standing work done by the US Army Institute of Surgical Research
(USAISR) in establishing a pilot program called the TCCC Tran- “In any other war, at any other time in history, this Marine would
sition Initiative. This program was established to fast-track new have succumbed to his wounds and died.” (D’Angelo 2019)
TCCC training and equipment to deploying SOF units and to
collect data about the success of these measures. General Brown References
stated in his letter that the USAISR’s TCCC program had: “. . . Beekley AC, Sebesta JA, Blackbourne LH, et al. Prehospital tourni-
produced remarkable advances in our force’s ability to successfully quet use in Operation Iraqi Freedom: effect on hemorrhage control
manage battlefield trauma.” (Brown 2005, Butler 2005-TCCC TI). and outcomes. J Trauma. 2008;64(2 Suppl):S28–S37. doi:10.1097/
TA.0b013e318160937e
In a paper entitled “Understanding combat casualty care sta- Beekley AC, Starnes BW, Sebesta JA. Lessons learned from mod-
tistics,” Holcomb and his co-authors documented that combat ern military surgery. Surg Clin North Am. 2007;87(1):157–vii.
casualties of American forces in Iraq and Afghanistan were ex- doi:10.1016/j.suc.2006.09.008
periencing the highest casualty survival rate in U.S. history. They Bottoms M. Tactical Combat Casualty Care—Saving lives on the bat-
identified TCCC as one of the major factors responsible for this tlefield. Tip of the Spear (Command Publication of the US Special
landmark achievement (Holcomb 2006). Operations Command). 2006;June:34–35.
Brown BD. Letter of Commendation to Army Medical Command.
In their discussion of the newly developed Joint Theater Trauma Commander, US Special Operations Command, 17 August 2005.
System, Eastridge et al. stated: “Other courses such as Tactical Butler FK. Two decades of saving lives on the battlefield: tactical com-
Combat Casualty Care, Emergency War Surgery, and the Joint bat casualty care turns 20. Mil Med. 2017;182 (3):e1563–e1568.
Forces Combat Trauma Management Course, have revolutionized doi:10.7205/MILMED-D-16-00214
the way medical providers are trained for wartime deployment.” Butler FK. Leadership Lessons Learned in Tactical Combat Casualty
(Eastridge 2006). Care. J Trauma Acute Care Surg. 2017;82(6S Suppl 1):S16-S25.
A team from Madigan Army Medical Center used TCCC-based doi:10.1097/TA.0000000000001424
training to prepare 1317 combat medics for deployment to Iraq Butler FK. Military history of increasing survival: The US military
experience with tourniquets and hemostatic dressings in the Af-
or Afghanistan. Their 2007 study reported that of the 140 medics ghanistan and Iraq conflicts. Bull Am Coll Surg. 2015 Sep;100(1
who subsequently deployed to Iraq for one-year periods, “99% in- Suppl):60–64.
dicated that the principles taught in the TCCC course helped with Butler FK Jr, Holcomb JB, Giebner SD, McSwain NE, Bagian J. Tac-
the management of injured casualties during their deployment.” tical combat casualty care 2007: evolving concepts and battlefield
(Sohn 2007). experience. Mil Med. 2007;172(11 Suppl):1–19. doi:10.7205/mil
Beekley, Starnes and Sebesta reviewed major surgical lessons med.172.supplement_1.1
learned from the conflicts in Iraq and Afghanistan through 2006. Butler FK Jr, Holcomb JB. The tactical combat casualty care transition
Nine of the 19 advances that they highlighted were battlefield initiative. U.S. Army Medical Department Journal. 2005;April–
June:33–37.
trauma management strategies pioneered primarily by TCCC Butler FK Jr, Hagmann J, Butler EG. Tactical Combat Casualty
(Beekley 2007). Mabry and McManus noted that “the new con- Care in Special Operations. Mil Med. 1996;161 Suppl:3–16. doi:
cept of Tactical Combat Casualty Care has revolutionized the 10.1007/978-3-319-56780-8_1
management of combat casualties in the prehospital tactical set- Caravalho J. OTSG Dismounted Complex Blast Injury Task Force; Fi-
ting.” (Mabry 2008). In 2008, the Prehospital Trauma Chair for nal Report. 18 June 2011:44–47.
the American College of Surgeons Committee on Trauma wrote to D’Angelo M, Welder M, Chauhan R, Kearns MJ. Future trends in
the Assistant Secretary of Defense for Health Affairs, “I am writ- trauma care through the lens of the wounded: how lessons from the
ing to offer my congratulations for the recent dramatic advances battlefield may be used at home. Anesthesiol Clin. 2019;37(1):183–
in prehospital trauma care delivered by the U.S. military. Multiple 193. doi:10.1016/j.anclin.2018.09.008
recent publications have shown that Tactical Combat Casualty Davis JS, Satahoo SS, Butler FK, et al. An analysis of prehospital deaths:
Care is saving lives on the battlefield.” (Salamone 2008). Who can we save?. J Trauma Acute Care Surg. 2014;77(2):213–
218. doi:10.1097/TA.0000000000000292
Hetzler and Ball, two combat-experienced Special Forces med- Eastridge BJ, Mabry RL, Seguin P, et al. Death on the battlefield
ics, confirmed that “TCCC’s identification of causes of combat (2001–2011): implications for the future of combat casualty care.
mortality and essential procedures for their treatment (i.e., tour- J Trauma Acute Care Surg. 2012;73(6 Suppl 5):S431–S437. doi:10.
niquets, needle decompression, etc.) has greatly assisted the medic 1097/TA.0b013e3182755dcc
in focusing the cube space of his gear to the most relevant life Eastridge BJ, Jenkins D, Flaherty S, Schiller H, Holcomb JB. Trauma
threats.” system development in a theater of war: experiences from Opera-
(Hetzler 2008). COL Andy Pennardt reported no potentially pre- tion Iraqi Freedom and Operation Enduring Freedom. J Trauma.
2006;61(6):1366–1373. doi:10.1097/01.ta.0000245894.78941.90
ventable deaths among the 201 casualties (including 12 fatalities) Gresham J. Giving Back, Again: Master Sgt. Luis Rodriguez and the
sustained by the Army Special Missions Unit during the conflicts Tactical Combat Casualty Care Course. Faircount’s The Year in
in Afghanistan and Iraq through 2009 (Pennardt 2009). All com- Veterans Affairs and Military Medicine, 2005–2006 Edition. 2006;
batants in this command had been trained in TCCC beginning 2005-2006:136–139.
well before 2001. Hetzler MR, Ball JA. Thoughts on aid bags: part one. J Spec Oper
Based on this experience accumulated as the course of hostilities Med. 2008;8(3):47–53.
in Afghanistan and Iraq progressed, TCCC went from being used Holcomb JB, McMullin NR, Pearse L, et al. Causes of death in
by only a few USSOCOM and 18th Airborne Corps units to being U.S. Special Operations Forces in the global war on terrorism:
used throughout the U.S. military (Eastridge 2012). 2001–2004. Ann Surg. 2007;245(6):986–991. doi:10.1097/01.sla.
0000259433.03754.98
Although the lifesaving impact of TCCC on the care of the com- Holcomb JB, Stansbury LG, Champion HR, Wade C, Bellamy RF. Un-
bat wounded is well supported by the numerous studies discussed derstanding combat casualty care statistics. J Trauma. 2006;60(2):
above, perhaps the best and most powerful summary of the im- 397–401. doi:10.1097/01.ta.0000203581.75241.f1
pact TCCC on battlefield trauma care was made by D’Angelo in Kelly JF, Ritenour AE, McLaughlin DF, et al. Injury severity and causes
describing the wounding and care provided to a Marine in Fallu- of death from Operation Iraqi Freedom and Operation Enduring
jah in 2006. This Marine’s unit was described as being an early Freedom: 2003–2004 versus 2006. J Trauma. 2008;64(2 Suppl):
adopter of TCCC in the Marine Corps and when he was wounded, S21–S27. doi:10.1097/TA.0b013e318160b9fb

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