Page 150 - Journal of Special Operations Medicine - Spring 2015

leadership positions can be trained by medics to con­ There was strong agreement from the group that
duct CLS and first responder training independently. the DoD should require providers and combat med­
COL Geracci showed data from COL (Ret) Kotwal ics to obtain TCCC certification cards just as we
when he was the 75th Ranger Regiment Surgeon, do for BLS, ACLS, and ATLS. This training should
showing that the incidence of preventable deaths be repeated every 2 years. NAEMT also teaches the
was much lower in the 75th than in the US military TCCC­inspired but civilian­oriented Tactical Emer­
as a whole and attributed that drop to the fact that gency Casualty Care, Law Enforcement First Re­
every Ranger in the Regiment was trained on TCCC. sponder, and Bleeding Control courses.

16. COL Kirby Gross, the JTS Director and the Army 19. COL (Ret) Russ Kotwal discussed data that he and
Surgeon General’s Trauma Consultant, presented an his co­authors submitted to the NEJM for publica­
overview of the JTS, including its inception early in tion that clearly show that the concept of the Golden
the conflicts in Afghanistan and Iraq and subsequent Hour appears valid for combat casualties; mortality
evolution. Among the many functions performed by was decreased in Afghanistan after Secretary Gates’
the JTS at the end of the recent conflicts were own­ 2009 directive that the time from TACEVAC mis­
ership of the DoD Trauma Registry, combat casu­ sion approval to arrival at an MTF should be 60
alty care performance improvement, predeployment minutes or less.
training for Joint Theater Trauma System (JTTS)
teams, advocacy in CONUS for the deployed trauma 20. COL Sean Keenan, the 10th Special Forces Group
care mission, mentorship of JTTS leaders, ongoing Surgeon, discussed Prolonged Field Care (PFC) and
review and update as necessary of the JTS Clini­ his endeavors to define the optimal care for longer
cal Practice Guidelines, and the weekly worldwide periods in austere, remote environments. While still
combat casualty care performance improvement being developed, one of the concepts is to answer
teleconference. the question: “What happens at the end of TCCC?”
It is challenging to develop protocols for all possible
17. XStat : SGM Kyle Sims from the US Army Special contingencies a remote medic might face; therefore,
®
Operations Command discussed a new hemostatic perhaps the answer lies in training as opposed to
device, the XStat injectable chitosan­coated com­ more guidelines, and in the use of advanced tele­
pressed sponge system. The device is currently FDA medicine technology.
approved only for junctional hemorrhage and only
for use on the battlefield. Testing at the Naval Medi­ 21. Dr Steve Giebner, the CoTCCC Developmental Edi­
cal Research Unit–San Antonio using a porcine bleed­ tor, discussed both the PHTLS Eighth Edition text­
ing model of subclavian artery and vein injury found book and the TCCC curriculum. The textbook is
that XStat was applied in half the time of Combat published by Jones and Bartlett Learning, and the
Gauze (31 seconds vs 60 seconds). Blood loss was retail price is $82.95. Dr Giebner reviewed the titles
also significantly reduced, although there was no of the 13 TCCC­submitted chapters and offered his
difference in survival in this model. Another device, thanks to the contributing authors.
which is chitosan­free and intended for smaller en­ The TCCC curriculum will now be updated an­
trance wounds, is also being developed. A proposed nually each June with interim changes forwarded
change paper advocating for the incorporation of to TCCC users throughout the year as they are ap­
XStat into the TCCC Guidelines is being prepared. proved by the CoTCCC. The TCCC for All Combat­
ants curriculum is a new version of the curriculum
18. Mr Mark Lueder from the PreHospital Trauma Life designed for nonmedical combatants. The advanced
Support (PHTLS), organization discussed that orga­ skills sets and interventions that are intended for
nization’s TCCC training program. PHTLS courses medics have been removed or much abbreviated,
are taught under the sponsorship of the National and the terminology used in the curriculum is aimed
Association of Emergency Medical Technicians at the nonmedical individual.
(NAEMT) and use the JTS­developed TCCC curric­
ulum. Course graduates are maintained in a TCCC 22. MSG Harold Montgomery, the Senior Enlisted
training registry and receive a TCCC certification Medical Advisor for USSOCOM, presented an
card. These courses have been taught all over the US overview of TCCC issues from the combat medic
and in 20 other nations around the world. perspective. He pointed out that the easy part of

140 Journal of Special Operations Medicine Volume 15, Edition 1/Spring 2015