Page 48 - Journal of Special Operations Medicine - Summer 2014

An Observational Study Assessing
Completion Time and Accuracy of Completing the

Tactical Combat Casualty Care Card by Combat Medic Trainees

Sean P. Therien, DSc, EMPA-C; James E. Andrews II, DSc, APA-C EMPA-C;
Michael E. Nesbitt, DSc, EMPA-C; Robert Mabry, MD

ABSTRACT
Introduction: Prehospital care documentation is crucial “TCCC is a casualty response system that relies on a
to improving battlefield care outcomes. Developed by mastery and immediate application of basic and vital
United States Army Ranger Special Operations Combat lifesaving skills by all Soldiers.” In 1999, the 75th
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Medics (SOCMs), the Tactical Combat Casualty Care Ranger Regiment provided TCCC training to all per-
(TCCC) is currently fielded to deployed units to record sonnel assigned to their unit, whether or not medical,
prehospital injury data. This study documents length of to improve battlefield injury survival. At that time, the
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time and accuracy of U.S. Army Combat Medic trainees regiment developed the TCCC card (Figure 1) to im-
in completing the minimum preestablished required fields prove prehospital documentation in combat and to cap-
on the TCCC card, establishing a baseline for point-of- ture data fields that were not adequately captured by the
injury cards. Design and Methods: This was a prospec- existing Field Medical Card, the DD Form 1380.
tive observational study in which U.S. Army combat
medic trainees were timed while recording data on the For the combat medic, providing tactical medical care
TCCC card in both the classroom and simulated combat in a combat environment can be complicated by several
environment. We hypothesized that trainees could com- confounders, such as direct or indirect enemy fire, terrain,
plete the TCCC card in less than 1 minute with 90% limited supplies, and multiple casualties. In addition to
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or greater accuracy. Results: We enrolled 728 U.S. Army rendering care in these challenging conditions, it is im-
Combat Medic trainees in the study during May–June portant that medics are able to communicate important
2011 at Fort Sam Houston, TX. We observed an average casualty data to those receiving the casualty at the next
TCCC card completion time of less than 1 minute with echelon of care. Standardized communication becomes es-
greater than 90% accuracy in the unstressed classroom pecially important when the casualty may be moved from
environment but an increase to nearly 2 minutes on av- provider to provider during his or her journey to definitive
erage and a decrease to 85% accuracy in the simulated care. Furthermore, prehospital documentation is crucial
combat environment. Conclusion: Results imply that the to the advancement in battlefield clinical study of improv-
TCCC card is well designed to quickly and accurately ing survivability by confirming and/or providing evidence
record prehospital combat injury information. Further needed to improve TCCC protocols and procedures.
investigation and future studies may compare other pre-
hospital data collection methods with the TCCC card in Figure 1 The TCCC card.
terms of timely and accurate data collection.

Keywords: Tactical Combat Casualty Care (TCCC), Opera-
tion Iraqi Freedom, Operation Enduring Freedom, prehos-
pital combat documentation, Global War on Terrorism

Introduction

Background
The tenets of Tactical Combat Casualty Care (TCCC)
were developed in 1996 for the first responder (Com-
bat Lifesaver), combat medic, or military healthcare
providers who were traditionally tasked with delivering
front-line battlefield care at the point of injury (POI).
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