Page 50 - Journal of Special Operations Medicine - Summer 2014

Inclusion criteria for this study were U.S. Army Soldiers Table 1 Unstressed TCCC Card Scenarios
undergoing U.S. Army Combat Medic (68W) AIT at Right lower extremity blast injury requiring
Fort Sam Houston, TX. Soldiers not in training and Sol- Scenario A tourniquet placement
diers in 68W training on a physical profile that would Left lower extremity blast injury requiring
limit their ability to undergo combat simulation training Scenario B tourniquet placement
were excluded from this study.
Scenario C Left lower extremity gunshot wound
requiring tourniquet placement
Outcome Measures
The primary outcome measures were time to complete Scenario D Right lower extremity gunshot wound
requiring tourniquet placement
the TCCC card and accuracy of the completed card.
Fields were noted to be correctly filled out, incorrectly Scenario E Bilateral lower extremity blast injury
requiring two tourniquets
filled out, or not filled out. Collected data were sepa-
rated into two categories: simulated combat environ-
ment and classroom environment. Table 2 Simulated Combat TCCC Card Scenarios
Sucking chest wound requiring needle
Primary Data Analysis Scenario A decompression and chest seal
Data were collected to record the time it takes to com- Scenario B Maxillofacial trauma
plete the TCCC card in both simulated combat scenarios
and unstressed academic scenarios and to determine the Scenario C Right lower extremity gunshot wound
requiring tourniquet
accuracy of each card by evaluating if each field was ap-
propriately filled out. Accuracy was recorded by assign- Scenario D Right upper extremity amputation requiring
tourniquet
ing points to each category correctly filled out. This is
detailed later in Section A: “Scoring the TCCC Card for Scenario E Right lower extremity blast injury requiring
Accuracy.” Details of collecting data on the time it takes tourniquet
to completely fill out the card are listed in Section B: Scenario F Tension pneumothorax requiring needle
“Recording the TCCC Card Completion Time.” There decompression
was no time limit for completion of the card. There was Scenario G Bilateral hand amputations requiring
no control group in this study. In the unstressed card tourniquets
completion analysis, there were five different injury Scenario H Left lower extremity blast wound requiring
scenarios through which the medics rotated (Table 1). tourniquet
In the simulated combat (stressed) scenarios, the can- Scenario I Left axillary gunshot wound
didates encountered 14 different injury patterns, listed Scenario J Head injury
in Table 2. There were more scenarios in the simulated
combat groups because they had preestablished stations Scenario K Left lower extremity amputation requiring
tourniquet
set up for training the medics on specific scenarios and
interventions that are common in combat. Because this Scenario L Buttocks blast injury
was an observational study, the injury patterns could Scenario M Left lower extremity gunshot wound
not be changed. As the Soldiers rotated from one simu- requiring tourniquet
lated combat scenario to another, they performed several Scenario N Right axillary gunshot wound
minutes of physical activity, including sprints, pushups,
flutter-kicks, and other physically demanding exercises the candidates could score 0, 1, or 2 points depending
in order to increase their heart rates and physical stress. on whether they marked bilateral tourniquets in the pic-
While effective, this created a backlog of Soldiers wait- ture. There were a total of 11 fields that were examined
ing to rotate through the preestablished trauma lanes. and a maximum of 12 points that could be obtained if
These waiting Soldiers would complete the TCCC card the card was correctly filled out (Table 1). Not all fields
in unstressed scenarios, which were limited to the five or points were available for each scenario. For example,
basic injury patterns listed in Table 1. in a patient without pneumothorax, no points are avail-
able for circling anything in the “breathing” field. The
“fluids” and “drugs” fields were not used in this study
A. Scoring the TCCC Card for Accuracy
because the combat medic trainees were not yet trained
Accuracy of the completed TCCC cards were assessed in administering intravenous fluids or drugs. The fields
by examining the various fields on the card and record- being scored are listed in Table 3 with the maximum
ing them on an Excel spreadsheet that lists points in points available per field. Vital signs were given to the
each row against the fields listed in a column. Each cat- medic verbally by the instructor. For the purpose of this
egory was assigned a point value of either 0 or 1 with study, the TCCC card was completed at one time after
the notable exceptions of the picture category in the bi- all interventions and procedures had been performed to
lateral lower extremity amputation scenarios, in which facilitate ease of data collection.

40 Journal of Special Operations Medicine Volume 14, Edition 2/Summer 2014