Page 125 - Journal of Special Operations Medicine - Summer 2014

Combat Casualty Care. J Spec Oper Med. Spring for open globe eye injuries will, it is hoped, soon have its
2014;14(1):13–25. availability eliminated for DoD purchases. The effort to
have the newly updated TCCC Casualty Card approved
as the new DD Form 1380 is nearing completion.
Joint Trauma System Director’s Report
Col Jeff Bailey Documentation of Care in TCCC
Col Jeff Bailey provided a JTS Director’s Brief. Since the COL Russ Kotwal
implementation of the Theater and DoD Trauma Sys-
tem in 2005, the U.S. military has recorded a steady de- COL Kotwal reviewed the progress that has been made in
crease in the case-fatality rate to the lowest level in the improving documentation and data capture for prehospi-
history of modern warfare, despite an increasing bur- tal care in the U.S. military. The CoTCCC recommended
den of injury. He emphasized the importance of injury a revised and updated TCCC Casualty Card in April
prevention when possible, such as through the use of 2013. It was forwarded to DHA MEDLOG and Health
blast-protective pelvic undergarments. Col Bailey also Affairs and staffed with the Services and COCOMs as the
noted the positive impact on survival from the Secretary proposed new DD Form 1380—the standard prehospital
of Defense’s 2009 mandate that evacuation missions be casualty care card for the U.S. military. This action was
accomplished within 60 minutes of mission approval. adjudicated and approved through all of the Uniformed
Services, the Combatant Commands, and NATO. A com-
panion TCCC After Action Report (AAR) has also been
Deployed JTTS Director’s Report developed. The TCCC AAR is designed to be a second
Col Stacy Shackelford opportunity to document TCCC and is to be completed
by prehospital care providers within 72 hours following
Col Shackelford reviewed a number of issues that were a mission. A JTTS Prehospital Care Cell (physician, phy-
identified during her time as the Joint Theater Trauma sician assistant, and senior medic) has been established
System (JTTS) deployed director. The first prehospital in Combined Joint Operations-Afghanistan (CJOA) to
JTTS team was established during her time in theater, assist units in theater with prehospital efforts and initia-
DUSTOFF platforms began a trial program of carry- tives, especially documentation, data capture and analy-
ing red blood cells (RBCs) on their aircraft, the JTS/ sis, and performance improvement of prehospital care. A
CENTCOM Prehospital Trauma Care System Assess- Prehospital Trauma Registry (PHTR) was developed and
ment was carried out, and the first CENTCOM/JTTS fielded to the JTTS in theater to assist with these efforts.
Theater Trauma Conference was held at Bagram in No-
vember 2012 with 107 participants. Col Shackelford COL Kotwal also presented comprehensive data and
also reviewed recent JTS performance improvement ef- analysis that support a positive outcome resulting from
forts on analgesics (ketamine was found to be as safe the 2009 secretary of defense–mandated maximum
as narcotic pain medications for prehospital use), and 60-minute evacuation time in Afghanistan. Overall
DUSTOFF transfusions to date were reviewed (no ad- casualty survival has improved from 86.5% to 90.5%
verse events were reported in 61 transfusions). since that directive was issued. The key to trauma care
delivery is optimizing “time to a required capability,” as
requirements are dictated by injuries and the medical ca-
TCCC Equipment
pabilities must be available and successfully performed
CDR Tyson Brunstetter in a timely fashion to reduce morbidity and mortality.
CDR Brunstetter from the Defense Health Agency Medi- COL Kotwal also presented data from the newly devel-
cal Logistics office (DHA MEDLOG) discussed TCCC oped Military Orthopedic Trauma Registry (MOTR).
equipment issues. He noted that most tourniquets pur- This ancillary module of the DoD Trauma Registry
chased by the DoD in 2013 were C-A-Ts ($18.5 million in (DoDTR) is successfully providing more details and
purchases in FY13) with SOF Tactical Tourniquets being granularity on wounded warriors with orthopedic inju-
®
the second most common ($3 million). Combat Gauze ries as well as facilitating performance improvement for
was the predominant hemostatic dressing purchased. the care they are receiving.
CDR Brunstetter also noted that work on the Joint First
Aid Kit (JFAK) is progressing and that it should be fielded
in the near future. The Air Force is anticipated to pur- JTTS Prehospital Care Director’s Report
chase the first large increment of JFAKs in the near future.
LTC Jim Geracci
The inappropriate military eye injury first aid kit that en- LTC Geracci from the Army Department of Combat
courages pressure patching and antibiotic ointment use Doctrine Development discussed his experiences as the

TCCC Updates 115