Page 49 - Journal of Special Operations Medicine - Summer 2014

When under duress, medics have hastily recorded essen- Figure 2 DD Form 1380, Field Medical Card.
tial medical information and interventions performed at
the POI on any piece of paper, scrap of cloth, or bandage
or with whatever means they have available. The TCCC
card is designed to be carried by each Soldier in a unit-
specified location, such as in their Improved First Aid
Kit (IFAK) or shoulder pocket. The cards are prefilled
with the Soldier’s name, unit, and allergies so the treat-
ing medic has this important information already on the
card and he or she knows where to find it on the Soldier.
Also, medics carry additional TCCC cards on them in
case of loss, destruction, or a mass casualty scenario.

The TCCC card (see Figure 1) contains information
blocks for Tourniquet Time (if a tourniquet is used),
mental status (in AVPU format, A: Fully Alert, V: Re-
sponds to Verbal commands, P: Responsiveness to Pain,
and U: Unresponsive), Heart Rate, Respirations (per
minute), and Blood Pressure, as well as the time these vi-
tal signs were taken. An anterior and posterior anatomic
picture is presented to mark the locations of injuries,
and fields are available to be circled such as mechanism
of injury (gunshot wound, blast, motor vehicle accident, Design and Methods
or other), airway (intact, adjunct, cricothyrotomy, intu-
bated), breathing (chest seal, needle decompression, or Study Design and Setting
chest tube), and circulation (hemostatic dressing, wound This study was conducted under a protocol reviewed
packed, pressure dressing). Finally, there are fields rep- and approved by the Brooke Army Medical Center In-
resenting interventions such as fluids given through in- stitutional Review Board and in accordance with the
travenous/intraosseous access and drugs by type/dose/ approved protocol. We conducted a prospective ob-
route. The TCCC card provides additional blocks where servational study of U.S. Army Soldiers during week
the time, vital signs, and mental status can be docu- 7 of the 16-week 68W Healthcare Specialist Advance
mented, allowing trending of important information at Individual Training (Combat Medic) course. Informed
a glance. In summary, the effectiveness of a card like this consent was waived because this was an observational
makes it simple to complete and enables accurate docu- study and the data were not attributable to specific indi-
mentation in the combat environment. viduals. No identifiable information or protected health
information (PHI) was collected during this study, and
Study Goals there were no direct risks or benefits for the subjects
The previously fielded card, the Field Medical Card whose data were analyzed.
(FMC) 1380, was confusing to read, time consuming,
and impractical in the current combat setting (Figure Participants
3
2). This study aims to answer two basic questions. How Participants were male and female U.S. Army enlisted
quickly can a combat medic trainee complete the TCCC Soldiers (Active Duty, National Guard, and Army Re-
card in a simulated combat environment? What level of serve) undergoing Advanced Individual Training (AIT)
accuracy is obtained when completing the TCCC card? to become Healthcare Specialists, commonly known as
In answering these questions, we aimed to establish a “combat medics,” or otherwise referred to by their Mili-
baseline for future prehospital combat documentation tary Occupation Specialty (MOS) of 68W. As part of their
techniques or cards for comparisons. We also sought to combat medic training, Soldiers undergo TCCC train-
determine time and accuracy standards by which future ing in a simulated combat environment, during which,
medics are taught. in addition to other procedures, they apply tourniquets
to extremity wounds with simulated arterial bleeding
To answer the two study questions, we hypothesized and apply chest seals and needle chest decompression
that the TCCC card could be completed with greater to simulated casualties with suspected pneumothorax.

than 90% accuracy in less than 1 minute. By doing so, Each participant was inexperienced at recording data on
this demonstrates that prehospital documentation in the TCCC card, encountering it only once earlier in a
combat can be recorded quickly and accurately by using classroom setting, where they were taught in a didactic
this “Soldier-centric” card. 2 lecture about the fields via a PowerPoint presentation.

TCCC Card Completion by Combat Medic Trainees 39