Page 90 - Journal of Special Operations Medicine - Spring 2015

documentation of prehospital care as it is provided by and treatments. The following year, All Army Activi­
8
all unit personnel. 6 ties message 010/2010 mandated issuance of the TCCC
Card in the following unit equipment and supply assem­
Prior to terrorist attacks on the United States on Sep­ blages: (1) Improved First Aid Kit (IFAK), (2) Combat
tember 11, 2001, and the ensuing conflicts in Afghani­ Lifesaver bag, and (3) Combat Medic aid bag. Shortly
9
stan and Iraq, only one medical form was approved afterward, training began on the TCCC Card at the Tac­
and globally distributed for use by US military medical tical Combat Medical Care Course (TCMC) at Fort Sam
personnel to document prehospital casualty care in the Houston, Texas.
field: Department of Defense (DD) Form 1380, US Field
Medical Card, dated December 1991. This form was de­ Tactical Combat Casualty Care
signed to be completed by medically trained personnel To better understand TCCC, it is helpful to know the
only. In 2007, the Committee on Tactical Combat Casu­ three phases of prehospital patient care from the point
alty Care (CoTCCC) convened to evaluate the DD Form of injury through evacuation to a hospital. These phases
1380 and other nonstandard field medical cards that are Care Under Fire, Tactical Field Care, and Tacti­
were currently being used, to address the lack of prehos­ cal Evacuation Care. Throughout these three phases,
pital medical documentation in Afghanistan and Iraq. empha sis is placed on three preventable causes of battle­
7
At that time, there were more than 30,000 casualties field death: life­threatening external hemorrhage, ten­
from these wars, but less than 10% of these casualties’ sion pneumothorax, and airway compromise. 10
records had documentation of prehospital care ren­
dered. One of the observations made by the CoTCCC Care Under Fire. Medical documentation is not recom­
7
was that the first responder arriving at point of injury mended during this phase of care and would be imprac­
was quite often not a medic, had not been trained in the tical for personnel to do so without endangering their
use of a DD Form 1380, and did not carry or possess life, the life of the casualty, and the military mission. 5,6
the form. The need for a user­friendly field medical card
was identified, with the requirement being a card usable Tactical Field Care. Treatment rendered to the casualty
by both medical and nonmedical first responders. After during this phase is often under suboptimal conditions.
obtaining input from more than 100 prehospital person­ Treating personnel should document during this phase
nel, including medical and nonmedical first responders but may defer documentation toward the end of this
from all military services, the CoTCCC recommended phase, partially document, or not document at all, based
that the military adopt a slightly modified Ranger Casu­ on enemy actions, weather and environmental condi­
alty Card as the official TCCC Card. tions, saturation through multiple or complex tactical
and treatment tasks, the injury severity of a casualty,
It was not until the fall 2009 that the TCCC Card was multiple casualties, and/or limited time due to rapid
adopted by the Department of the Army as DA Form transition to evacuation phase of care.
7656 Tactical Combat Casualty Care Card (Figure 1).
Subsequently, All Army Activities Message 355/2009 Tactical Evacuation Care. Treatment rendered to the ca­
directed the use of a TCCC Card for the prehospital sualty during transport from the point of injury is often
field documentation of combat casualty status, injuries, rendered in a ground vehicle or air platform under sub­
optimal conditions while performing evasive maneuvers
to avoid enemy fire. Treating personnel should docu­
Figure 1 Department of the Army Form 7656: ment during this phase but may defer documentation
Tactical Combat Casualty Care (TCCC) Card.
toward the end of this phase, partially document, or not
document at all, based on enemy actions, environmental
conditions, saturation through multiple or complex tac­
tical and treatment tasks, the injury severity of a casu­
alty, multiple casualties, and/or limited time due to rapid
transport to a medical facility.

In addition to successfully completing the tactical mis­
sion, providing treatment to the casualty is the priority.
Documentation of casualty status, injuries, and treat­
ment on a TCCC Card is part of this treatment and
should be accomplished whenever feasible. As demon­
strated by personnel during initial combat medic train­
ing, a TCCC Card can be accurately completed in 2
minutes or less. 11

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