Page 53 - Journal of Special Operations Medicine - Summer 2014

Table 8 Accuracy of Stressed TCCC Card Data
95% Confidence Interval for Mean
No. Mean SD SE Lower Bound Upper Bound Minimum Maximum
A 52 83.269 13.2430 1.8365 79.582 86.956 40.0 100.0
B 19 87.121 9.2746 2.1277 82.651 91.591 66.7 100.0
C 25 83.600 15.7797 3.1559 77.086 90.114 50.0 100.0
D 21 74.286 20.1424 4.3954 65.117 83.454 40.0 100.0
E 37 82.703 16.6080 2.7303 77.165 88.240 30.0 100.0
F 9 86.421 10.7970 3.5990 78.122 94.720 66.7 100.0
G 9 87.879 20.8309 6.9436 71.867 103.891 36.4 100.0
H 46 90.000 10.5409 1.5542 86.870 93.130 60.0 100.0
I 1 100.000 — — — — 100.0 100.0
J 11 92.930 5.6053 1.6901 89.164 96.696 88.9 100.0
K 21 87.619 15.7812 3.4437 80.436 94.803 40.0 100.0
L 14 86.668 13.8079 3.6903 78.695 94.640 55.6 100.0
M 18 81.111 17.4521 4.1135 72.432 89.790 50.0 100.0
N 1 100.000 — — — — 100.0 100.0
Total 284 84.999 14.8733 .8826 83.261 86.736 30.0 100.0

Journal of Trauma by Therien and colleagues, 13,080 of TCCC through feedback from a prehospital trauma
entries into the Joint Theater Trauma Registry (JTTR) registry, has translated to an increase in survivability on
were recorded in the category of “battle injury” (BI) and the battlefield. In July 2009, an unclassified ALARACT
2
met inclusion criteria. Of those, 3187 (24%) BI entries (All Army Activities) bulletin was published directing
contained prehospital data. The percentage of casualty the use of the DA Form 7656, Tactical Combat Casualty
records containing prehospital data was 18.6% for Op- Care (TCCC) Card as the documentation tool for use by
eration Enduring Freedom and 25.4% for Operation first responders at the POI. 7
Iraqi Freedom. 6
Prehospital treatment of combat trauma patients is
The unit with the most successful prehospital docu- a critical phase of emergency medical practice on the
mentation program is the 75th Ranger Regiment. The battlefield, and accurate understanding of battle injury
Ranger First Responder Card was designed by Ranger is essential to improving tactical combat casualty care,
medics and is simple to use, focusing on the most im- thus highlighting the importance of POI documentation
portant aspects of care and using a format that mini- that can be reviewed, studied, and used to predict and
mizes the amount of writing required to document care. improve casualty outcomes. The importance of collect-
The 2007 conference recommended that the Ranger ing casualty statistics for research programs to improve
First Responder Card be adopted as the TCCC Casu- health care delivery and training for combat medics has
alty Card. This recommendation was approved by the also been historically confirmed by Bellamy and Butler. 5
8
CoTCCC in 2008. Other solutions such as the existing However, in a more recent study, it was demonstrated
DD 1380 (Field Medical Card) and AHLTA-mobile (an that prehospital medical documentation of U.S. military
electronic PDA device) were discussed and found to be combat battle injuries is still deficient. 6
less desirable alternatives. 5
Combat casualty data are currently collected in the
The 75th Ranger Regiment has been using what is now JTTR, a retrospective, standardized system of data col-
known as the TCCC card for more than 10 years and its lection for all echelons of combat casualty care. There
ease of use has paved the way for integration into the reg- are several areas of care from which information is
ular Army. The tenets of TCCC were published in 1996 gathered, from POI in combat to the treatment received
and integrated throughout the 75th Ranger Regiment in at the medical treatment facilities located in theater, in
1999. In order to validate and refine TCCC protocols Germany, and in the United States. The JTTR’s main
and procedures, the Regiment also developed and main- goal was to improve coordination of care by provid-
tained a prehospital trauma registry. The application of ing data to answer operational questions, better predict
2
TCCC, in conjunction with validation and refinement needed manpower, and answer medical questions such

TCCC Card Completion by Combat Medic Trainees 43