Page 106 - JSOM Winter 2025

• Prevention of hypothermia and secondary coagulopathy Sims K, Montgomery HR, Dituro P, Kheirabadi BS, Butler FK. Manage-
through the use of the best available methods to prevent heat ment of external hemorrhage in tactical combat casualty care: the
™
loss while in the prehospital phase of care. adjunctive use of XStat compressed hemostatic sponges: TCCC
• The use of fluoroquinolones and ertapenem on the battle- Guidelines Change 15-03. J Spec Oper Med. 2016;16(1):19–28.
field to reduce preventable deaths and morbidity from wound
infections. TCCC Use in the U.S. Military – 2022
• Combat scenario-based trauma training, emphasizing that Due to the resolute efforts of the Committee on TCCC and the
trauma care on the battlefield must be consistent with good members of the TCCC Working Group over the last 25 years, the
small-unit tactics. advances described in the preceding section made TCCC increas-
• Identification of casualties likely to derive the most benefit ingly prevalent as the standard for battlefield trauma care in the
from supplemental oxygen during TACEVAC. Department of Defense over that time span (Butler 2017 – TCCC
• Strategies for management of wounded hostile combatants. Turns 20, Butler 2017– TCCC LL, Butler 2015 Implementing and
• Combat evacuation “Rules of Thumb” and the use of specific Preserving, Butler 2012 – Then and Now).
injury patterns to help determine casualty evacuation priorities. USSOCOM mandated TCCC training for its forces (USSOCOM
• (Riesberg 2021, Deaton 2021, Montgomery 2021, Butler 2021, Msg 2005, Brown 2005) in 2005 and, in partnership with the
Drew 2020 – TCCC GL, Drew 2020 – TXA, Montgomery USAISR, established the TCCC Transition Initiative to fast-track
2020, Bennett 2020, Onifer 2019, Butler 2018, Butler 2017 – TCCC training and equipment to its units (Butler 2005). The
TCCC Turns 20, Sims 2016, Onifer 2015, Grissom 2006) Navy Bureau of Medicine and Surgery (BUMED)-directed review
of TCCC (BUMED Msg 2006) conducted in 2006/2007 found
References that TCCC was used not only by Special Operations forces, but
Bennett BL, Giesbrect G, Zafren K, et al. Management of hypother- also by all of the conventional forces in the U.S. military. The Ma-
mia in tactical combat casualty care: TCCC Guideline Proposed rine Corps likewise directed that TCCC be the standard for battle-
Change 20-01 (June 2020). J Spec Oper Med. 2020;20(3):21–35. field trauma care in 2006 (USMC Msg 2006). In February 2009,
doi:10.55460/QQ9R-RR8A
Butler FK Jr, Holcomb JB, Shackelford SA, et al. Management of sus- the Army directed that all medical department members get TCCC
pected tension pneumothorax in tactical combat casualty care: training as part of their pre-deployment trauma preparation (U.S.
TCCC Guidelines Change 17-02. J Spec Oper Med. 2018;18(2):19– Army ALARACT Msg 2009). This widespread adoption of TCCC
35. doi:10.55460/XB1Z-3BJU was noted in other reports (Eastridge 2012, Blackbourne 2012,
Butler FK Jr. Introduction to TCCC changes summary 6 May 2021. Butler 2007 – Evolving Concepts, USCG Msg 2006, Holcomb
J Spec Oper Med. 2021;21(2):120. 2005, Hostage 2005, Kiley 2005).
Butler FK. Two decades of saving lives on the battlefield: tactical com- In March of 2009, Dr. Ward Cascells, the Assistant Secretary of
bat casualty care turns 20. Mil Med. 2017;182 (3):e1563–e1568. Defense for Health Affairs, recommended to the military services
doi:10.7205/MILMED-D-16-00214 that TCCC be used as the standard for training combat medical
Butler FK Jr, Blackbourne LH, Gross KR. The combat medic aid bag: personnel to manage combat trauma in the tactical pre-hospital
2025. CoTCCC top ten recommended battlefield trauma care re- environment (Casscells 2009). In August of 2009, the Defense
search, development, and evaluation priorities for 2015. J Spec
Oper Med. 2015;15(4):7–19. doi:10.55460/5G8Q-R379 Health Board, the senior civilian medical advisory board to the
Butler FK. Tactical Combat Casualty Care: update 2009. J Trauma. Secretary of Defense, recommended that TCCC be taught to all
2010;69 Suppl 1:S10–S13. doi:10.1097/TA.0b013e3181e4220c deploying combatants and to all combatant unit medical provid-
Deaton TG, Auten JD, Betzold R, et al. Fluid resuscitation in tactical ers (Holcomb 2009 – DHB Memo). In 2011 and again in 2014,
combat casualty care; TCCC Guidelines Change 21-01. 4 Novem- this recommendation was repeated by Dr. Cascells’ successor, Dr.
ber 2021. J Spec Oper Med. 2021;21(4):126–137. doi:10.55460/ Jonathan Woodson (Woodson 2014, Woodson 2011).
JYLU-4OZ8 In 2015, Vice Admiral Matt Nathan, the Navy Surgeon General,
Drew B, Auten JD, Cap AP, et al. The use of tranexamic acid in tactical addressed a major disconnect in TCCC readiness training that
combat casualty care: TCCC Proposed Change 20-02. J Spec Oper
Med. 2020;20(3):36–43. doi:10.55460/ZWV3-5CBW had been identified in both Joint Trauma System / U.S. Central
Drew B, Montgomery HR, Butler FK Jr. Tactical Combat Casualty Command surveys of prehospital trauma care in Afghanistan
Care (TCCC) Guidelines for Medical Personnel: 05 November (Sauer 2014, Kotwal 2013)—the need to ensure that the medical
2020. J Spec Oper Med. 2020;20(4):144–151. doi:10.55460/ department officers who supervise combat medical personnel are
RBRA-WMWV also trained in TCCC concepts. VADM Nathan’s 2015 directive
Grissom CK, Weaver LK, Clemmer TP, Morris AH. Theoretical ad- mandated TCCC training for all active duty and reserve physi-
vantage of oxygen treatment for combat casualties during med- cians, physician assistants, advanced nurse practitioners, nurse
ical evacuation at high altitude. J Trauma. 2006;61(2):461–467. generalists, and Hospital Corpsmen assigned to the Navy Bureau
doi:10.1097/01.ta.0000221699.71596.9d of Medicine and Surgery BUMED (Nathan 2018). This directive
Montgomery HR, Drew B, Butler FK Jr. Summary of recent changes to also sought to address another major issue in TCCC training –
the TCCC guidelines 14 April 2021. J Spec Oper Med. 2021;21(2): the lack of a standardized TCCC curriculum. VADM Nathan’s
120–121. doi:10.55460/NX8I-0AUH guidance was that all BUMED TCCC training courses will use the
Montgomery HR, Drew B. Tactical Combat Casualty Care (TCCC) curriculum developed by the CoTCCC. The need to use the JTS/
Update. J Spec Oper Med. 2020;20(2):152–153. doi:10.55460/ CoTCCC curriculum as the standard in training TCCC has been
8BYB-KQQG identified in a number of recent reports (Greydanus 2020, Butler
Onifer DJ, McKee JL, Faudree LK, et al. Management of hemorrhage 2015 – TCCC LLL, Goforth 2016, Gross 2015).
from craniomaxillofacial injuries and penetrating neck Injury in
tactical combat casualty care: iTClamp mechanical wound closure From the warfighting Combatant Commander perspective, Gen-
device TCCC Guidelines Proposed Change 19-04 06 June 2019. eral James Mattis, when he was the Commander of the U.S. Cen-
J Spec Oper Med. 2019;19(3):31–44. doi:10.55460/H8BG-8OUP tral Command in 2013, wrote a letter to the Service Chiefs of
Onifer DJ, Butler FK Jr, Gross K, et al. Replacement of prometha- Staff in which he noted the unprecedented success in eliminating
zine with ondansetron for treatment of opioid- and trauma-related preventable death in combat casualties achieved by the Ranger
nausea and vomiting in tactical combat casualty care. J Spec Oper Casualty Response System through training all unit members in
Med. 2015;15(2):17–24. doi:10.55460/23QE-HGO7 TCCC. He urged each of them to be briefed on TCCC and the
Riesberg JC, Gurney JM, Morgan M, et al. The management of ab- importance of this lifesaving training (Mattis 2013). General Jo-
dominal evisceration in tactical combat casualty care: TCCC seph Votel went a step further in his letter to the Service Chiefs of
Guideline Change 20-02. J Spec Oper Med. 2021;21(4):138–142. 6 November 2017. General Votel, a former 75th Ranger Regiment
doi:10.55460/9U6S-1K7M

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