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Commander, again emphasized the lives that could be saved with experience. Mil Med. 2007;172(11 Suppl):1–19. doi:10.7205/mil
TCCC training and equipment and stated that: “I am instituting med.172.supplement_1.1
a theatre TCCC training requirement, to be completed with 180 Butler FK Jr, Holcomb JB. The tactical combat casualty care transition
days of deployment.” (Votel 2017). initiative. U.S. Army Medical Department Journal. 2005;April–
June:33–37.
The narrative above shows how many different directives have Casscells W. Tactical Combat Casualty Care. Assistant Secretary of
been issued on battlefield trauma care by the various services and Defense for Health Affairs memorandum, 4 March 2009.
combatant commands. On 16 March 2018, the Department of DOD Instruction 1322.24 – Medical Readiness Training (MRT).
Defense issued an instruction that clarified the issue for the U.S. March 16, 2018
Military. This directive reads in part: “It is DoD policy that. . . . DOD Instruction 1322.24 – Medical Readiness Training (MRT).
TCCC is the DoD standard of care for first responders (medi- Change 1; 15 February 2022
cal and non-medical) and the All Service Member TCCC course Eastridge BJ, Mabry RL, Seguin P, et al. Death on the battlefield
replaces Service trauma skills currently taught in first aid and (2001–2011): implications for the future of combat casualty
self-aid buddy care courses.” The directive also requires that: “All care. J Trauma Acute Care Surg. 2012;73(6 Suppl 5):S431–S437.
Service members receive role based TCCC training and certifica- doi:10.1097/TA.0b013e3182755dcc
tion in accordance with the skill level (i.e., All Service Members, Goforth C, Antico D. TCCC standardization: the time is now. J Spec
Combat Lifesaver, Combat Medic/Corpsmen, and Combat Para- Oper Med. 2016;16(3):53–56. doi:10.55460/LQ9Q-2YUF
medic/Provider) outlined by the Joint Trauma System, the DoD’s Greydanus DJ, Hassmann LL, Butler FK Jr. Quality assurance in tactical
Center of Excellence for trauma as designated in DoD Instruction combat casualty care for medical personnel training 16 April 2020.
(DoDI) 6040.47.” (DoD Instruction 1322.24, 2018). J Spec Oper Med. 2020;20(2):95–103. doi:10.55460/T63H-3OXX
Gross KR. Establishing a DoD Standard for TCCC Training: Joint
Work remains to be done to make this directive a reality, however. Trauma System. White paper to the US Military Services Surgeons
A letter sent to now-Secretary of Defense Mattis sent on 4 Decem- General. September 11, 2015. Accessed March 23, 2018. https://
ber 2018 by 17 members of the U.S. House of Representatives www.jsomonline.org/TCCC/06%20TCCC%20Reference%20
states in part: “We understand that Tactical Combat Casualty Documents/JTS%20White%20Paper%20TCCC%20Training
Care (TCCC) has achieved unprecedented success in decreasing %20150910%20v12.pdf.
preventable combat deaths in military units that have received Holcomb JB, Wilensky G. Tactical Combat Casualty Care and Min-
accurate TCCC training, but we are disturbed by reports high- imizing Preventable Fatalities in Combat. Defense Health Board
lighting inadequate training.” (U.S. House of Representatives 4 memorandum dated 6 August 2009. Accessed March 21, 2018.
December 2018). https://health.mil/About-MHS/Defense-Health-Agency/Special-
Staff/Defense-Health-Board/Reports.
Clearly, the Department of Defense Instruction does not immedi- Holcomb, JB. The 2004 Fitts Lecture: current perspective on combat
ately accomplish the desired intent of high-quality TCCC for all. casualty care. J Trauma. 2005;59(4):990–1002. doi:10.1097/01.ta.
What is needed to make that happen is for line combat leaders to 0000188010.65920.26
make this training a priority, as the 75th Ranger Regiment did, Hostage GM. USSOCOM visit to the Pararescue medical course at
and to ensure that DODI 1322.24 is well-executed within their Kirtland AFB September 2005. Air Force Education and Training
organizations. A model for senior leader attention to battlefield Command letter, 8 September 2005.
trauma care was the all-Navy “OPNAV” instruction in which the Kiley KC. Operational Needs Statement for Medical Simulation Train-
Chief of Naval Operations directed how TCCC training should ing Centers for Combat Lifesavers and Tactical Combat Casualty
be implemented for all Naval forces (OPNAV Instruction 1500.86 Care Training. Army Surgeon General letter DASG-ZA, 1 Septem-
ber 2005.
– 2021). Kotwal RS, Butler FK, Edgar EP, Shackelford SA, Bennett DR, Bai-
Most recently, on 15 February 2022, Change 1 to the DoD In- ley JA. Saving lives on the battlefield: a joint trauma system re-
struction 1322.24 mandated that the TCCC curriculum developed view of prehospital trauma care in combined joint operating area
and approved by the Joint Trauma System and posted on the De- Y Afghanistan (CJOA-A) executive summary. J Spec Oper Med.
fense Health Agency Deployed Medicine website, be used as the 2013;13(1):77–85.
single source for all TCCC training for U.S. military personnel Mattis J. Letter to the Chiefs of Staff of the U.S. Armed Services. U.S.
(DODI 1322.24 Change 1 – 2022). Central Command letter dated 18 January 2013
Nathan ML. BUMEDINST 1510.25A Navy Medicine Tactical Com-
bat Casualty Care Program. Accessed March 21. 2018. http://
References www.med.navy.mil/directives/ExternalDirectives/1510.25A.pdf.
Blackbourne LH, Baer DG, Eastridge BJ, et al. Military medical revolu-
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Training. 12 April 2021
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(Part II) – One Year Later. A Joint Theater Trauma System & Joint
mander, US Special Operations Command letter, 9 March 2005.
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Joint Operating Area Y Afghanistan (CJOA-A). USCENTCOM
111622Z: Tactical Combat Casualty Care training, December 2006.
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Butler FK, Blackbourne LH. Battlefield trauma care then and US Marine Corps Message 02004Z: Tactical Combat Casualty Care
now: a decade of tactical combat casualty care. J Trauma Acute
Care Surg. 2012;73(6 Suppl 5):S395–S402. doi:10.1097/TA. (TCCC) and Combat Lifesaver (CLS) Fundamentals, Philosophies,
and Guidance, August 2006.
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predeployment trauma training for Army medical department per-
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doi:10.7205/MILMED-D-16-00214 sonnel, 3 February 2009.
Butler FK. Leadership Lessons Learned in Tactical Combat Casualty US Coast Guard Message 221752Z: Tactical Medical Response Pro-
gram, November 2006.
Care. J Trauma Acute Care Surg. 2017;82(6S Suppl 1):S16-S25. U.S. House of Representatives letter dated 4 December 2018.
doi:10.1097/TA.0000000000001424
Butler FK, Smith DJ, Carmona RH. Implementing and preserving U.S. Special Operations Command message: Tactical Combat Casu-
alty Care Training and Equipment. Date/Time Group 222016Z
advances in combat casualty care from Iraq and Afghanistan
March 05; 2005
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321–326. doi:10.1097/TA.0000000000000745
Central Command letter dated 6 Nov 2017
Butler FK Jr, Holcomb JB, Giebner SD, McSwain NE, Bagian J. Tac- Woodson J. Tactical Combat Casualty Care. Assistant Secretary of De-
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fense for Health Affairs Memorandum. 23 August 2011.
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