Page 149 - Journal of Special Operations Medicine - Spring 2015

Ways to expedite the transition of lessons learned in electrical activity. When the patient’s clothing was
prehospital trauma care from Afghanistan and Iraq finally removed, it was noted that he had died from
into the civilian sector were discussed. a single gunshot to the brachial artery. A simple
The National Association of Emergency Medical tourniquet could have saved his life.
Technicians (NAEMT) uses the JTS­developed TCCC
curriculum and teaches TCCC provider and instruc­ 14. SSG Jonathan Talbot from the 4th Infantry Brigade
tor courses, which are certification card­producing Combat Team, 4th Infantry Division in Fort Carson,
courses like BLS, ACLS, and ATLS. These courses CO, presented a casualty scenario in which an ANA
have been taught all over the US and in 20 other na­ Soldier arrived at Role 1 Aid Station after stepping
tions around the world. There was strong agreement on an IED outside of his vehicle. The casualty had
from the group that the DoD should require providers suffered a partial amputation of his right leg and
and combat medics to obtain certification just as we complete amputation of his left leg just below the
do a CPR card and have this training renewed every knee. The patient also had multiple amputated dig­
2 years. NAEMT also teaches the TCCC­ inspired but its on both of his hands.
civilian­oriented Tactical Emergency Casualty Care, Point of injury care (POI) consisted of CAT
Law Enforcement First Responder, and Trauma First Tourniquets to both lower extremities as well as a
Responder courses. CAT to his left arm.
On arrival at the Aid Station, the casualty was
showing signs of hemorrhagic shock. He was alert
4 February 2015 but incoherent and with absent radial pulses.
His initial vital signs were: BP 60/P, respirations
13. MG Brian Lein spoke about his views on TCCC and 10, and pulse 154. Aid station treatment consisted
the need to bring advanced care far­forward. He stated of:
that care should not be role dependent but rather ca­
sualty dependent. He recalled that the Joint IED De­ – Assessment and reinforcement of initial POI
feat Organization (JIEDDO) initiative took real­world tourniquets
IED events and incorporated these into training at – Administration of high­flow oxygen
the National Training Center (NTC) within 2 weeks, – IV access (right arm)
greatly improving the response and ability of deploy­ – Wound packing
ing military units. Why can’t medical units conduct – Pressure bandages (all four extremities)
similar training using real­world events? – Splints (both lower extremities)
MG Lein noted that future battlefields may be – Central line (right subclavian)
urban ones where, as in Mogadishu, we will not be – 5 units of O+ PRBCs
able to land a helicopter and achieve rapid casualty – 8mg IV Zofran
evacuation. He said that he was happy to see a num­ – 100µg fentanyl followed by 3 additional doses of
ber of representatives from our coalition partner 50µg of fentanyl
nations at the meeting and emphasized the need to – 1g TXA
continue and expand this international partnership – 2g ANCEF
dedicated to improving prehospital trauma care. He
also discussed the need for consideration of future The unit’s liaison at the NATO Role 3 medical
weapon systems and different wounding patterns in treatment facility at Kandahar Air Field called a
planning for combat casualty care. week later and reported that the patient was doing
Finally, MG Lein told the story of sitting on a well and his family was by his side.
Board at Fort Knox, KY, when someone came in and
reported that there was a gunshot wound casualty 15. COL Jim Geracci, III Corps Surgeon, discussed the
in the parking lot. He ran out to respond and found time crunch many units face in terms of medical
the victim pulseless and bleeding profusely from an training, and stated that TCCC must be integrated
unknown location. He started CPR and asked the into other training events as opposed to receiving
first responders for trauma shears; they had none. dedicated time. He discussed that Combat Lifesaver
In addition, the first responder medics told him to (CLS) and first responder type courses (Ranger
stop CPR since there was an ECG tracing on the First Responder, Pegasus First Responder, etc.) do
monitor; he declined, knowing this was pulseless not require Medics to teach them; rather, NCOs in

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