Page 114 - JSOM Winter 2025

Spinella PC, Perkins JG, Grathwohl KW, Beekley AC, Holcomb JB. Warm process improvement video-teleconferences, and expert opinion
fresh whole blood is independently associated with improved sur- from both military and civilian trauma specialists.
vival for patients with combat-related traumatic injuries. J Trauma. • The single most successful TCCC intervention reported to date
2009;66(4 Suppl):S69–S76. doi:10.1097/TA.0b013e31819d85fb is the reintroduction of tourniquet use on the battlefield.
Strandenes G, De Pasquale M, Cap AP, et al. Emergency whole- • TCCC is now used throughout the U.S. military and the militar-
blood use in the field: a simplified protocol for collection and ies of numerous allied nations to train combat medical person-
transfusion. Shock. 2014;41 Suppl 1:76–83. doi:10.1097/SHK. nel to manage trauma in the tactical prehospital environment.
0000000000000114 • Department of Defense Instruction 1322.24 mandates TCCC
Te Grotenhuis R, van Grunsven PM, Heutz WM, Tan EC. Prehospital training for everyone in the U.S. military.
use of hemostatic dressings in emergency medical services in the • There is now Chief of Naval Operations–level guidance in
Netherlands: A prospective study of 66 cases. Injury. 2016;47(5): OPNAVINST 1500.86 that directs how TCCC training should
1007–1011. doi:10.1016/j.injury.2016.01.005
Teixeira PGR, Brown CVR, Emigh B, et al. Civilian prehospital tour- be implemented in the Navy.
niquet use is associated with improved survival in patients with • For TCCC to save as many lives as possible, commanders at
peripheral vascular injury. J Am Coll Surg. 2018;226(5):769–776. every level in the U.S. Military need to mandate that TCCC
e1. doi:10.1016/j.jamcollsurg.2018.01.047 will be the standard for battlefield trauma care and ensure that
Travers S, Lefort H, Ramdani E, et al. Hemostatic dressings in civil pre- that mandate is well-executed.
hospital practice: 30 uses of QuikClot Combat Gauze. Eur J Emerg • These senior leaders also need to ensure that all combatants and
Med. 2016;23(5):391–394. doi:10.1097/MEJ.0000000000000318 medical personnel are trained in the current version of TCCC
Yazer MH, Spinella PC, Bank EA, et al. THOR-AABB Working Party as developed by the DoD’s lead agency for trauma, the Joint
recommendations for a prehospital blood product transfusion pro- Trauma System, and taught through a standardized, high-quality
gram. Prehosp Emerg Care. 2022;26(6):863–875. doi:10.1080/10 curriculum. DoD Instruction 1322.24 (Change 1 – promulgated
903127.2021.1995089 on 15 February 2022), establishes the 4-tiered TCCC curriculua
Yazer MH, Cap AP, Spinella PC. Raising the standards on whole as the standard for training TCCC in the U.S. military.
blood. J Trauma Acute Care Surg. 2018;84(6S Suppl 1):S14–S17. • Adoption of TCCC Guidelines into civilian tactical EMS sys-
doi:10.1097/TA.0000000000001778 tems is underway, and TCCC principles are now saving lives in
Zietlow JM, Zietlow SP, Morris DS, Berns KS, Jenkins DH. Prehospi- those settings as well.
tal use of hemostatic bandages and Tourniquets: translation from
military experience to implementation in civilian trauma care. TCCC Case Study Solution
J Spec Oper Med. 2015;15(2):48–53. doi:10.55460/1P70-3H9D
Combat Swimmer Casualty Scenario –
Chapter Summary Gunshot Wound to the Chest
• Nighttime combat swimmer operation with 4 dive pairs
• Combat medical personnel often face multiple challenges in car- participating
ing for the wounded on the battlefield. These may include the • Operating in a harbor after swimming in from a small boat
threat of hostile fire, working in the dark, multiple casualties, • Divers are using MK 25/Draeger LAR V closed-circuit oxygen
limited medical equipment, and prolonged evacuation times. UBAs. (Figures 1–3)
º
• Failure to consider the tactical environment when developing • 78 F water—divers are wearing wet suits
battlefield trauma care strategies may increase the number of • Air temperature is 80°F
preventable deaths. • One combat swimmer is shot in the chest as he surfaces for a
• There are three goals in TCCC: (1) treat the casualty; (2) pre- quick bearing check.
vent additional casualties; and (3) complete the mission. • The wounded combat swimmer is conscious.
• TCCC is divided into three phases: Care Under Fire/Threat, • His dive buddy is trained in TCCC to the Tier 1 (All Combat-
Tactical Field Care, and Tactical Evacuation Care. ant) level.
• In Care Under Fire, combat medical personnel and casualties • The extraction plan is to swim back to the boat after the ac-
are under effective hostile fire, and tactical considerations pre- tions at the objective have been accomplished.
dominate. In this phase, medical care should be limited to con- The Casualty
trolling extremity hemorrhage with tourniquets.
• In Tactical Field Care, medical personnel and casualties are not • One diver is shot in the chest by a harbor patrol boat as he
surfaces to check his bearings
under effective hostile fire and there is more time to provide • Casualty is conscious on the surface
the medical care needed by the casualties.
• In Tactical Evacuation Care, casualties are transported to a Casualty Evaluation
medical treatment facility by aircraft, ground vehicle, or boat. • AVPU: Alert and able to respond to hand signals
An opportunity exists in this phase of care to provide addi- • Airway: Apparently patent
tional medical personnel and equipment, raising the level of • Breathing: Appears to be breathing well from his Mk 25
care that can be delivered. • Radial Pulse: N/A
• The TCCC Guidelines are published periodically in the mili- Question: You are the wounded SEAL’s dive buddy. What is the
tary version of the Prehospital Trauma Life Support (PHTLS) NEXT action you should take?
manual. They are posted on the Joint Trauma System website, 1. Perform a needle decompression of his chest
the Defense Health Agency Deployed Medicine website, and 2. Try to apply a chest seal to the wound over the wet suit
the National Association of Emergency Medical Technicians 3. Try to examine the diver’s back to see if there is an exit wound
website, all of which are available to the public.
• TCCC is the only set of battlefield trauma care guidelines ever to 4. Immediately help the diver to resubmerge
receive the triple endorsement of the U.S. Department of Defense, Answer:
the American College of Surgeons Committee on Trauma and the This is a Care Under Fire/Threat scenario. The swim pair has ob-
National Association of Emergency Medical Technicians. viously been spotted and, if they remain on the surface, they will
• The CoTCCC updates TCCC guidelines based on ongoing re- likely continue to take fire. The correct action in this case is to
view of the published civilian and military prehospital trauma immediately resubmerge to a transit depth of 20 feet. That will
literature, ongoing interaction with military combat casualty provide camouflage from the hostile forces on the surface and the
care research laboratories, direct input from experienced combat water column will attenuate the velocity of any additional rounds
medical personnel, input from the service medical lessons-learned that may be fired at their location.
centers, case reports discussed at the weekly Joint Trauma System
PMID: 41474878; DOI: 10.55460/RZMM-D9DA

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