Page 91 - Journal of Special Operations Medicine - Spring 2015
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Methods zone. The Department of the Army, Office of the Sur
geon General, mandated their attendance of this course.
This was an institutional review boardapproved, di During this 5day course, students are shown individual
rect observational study to assess accurate completion and team lifesaving interventions that support the goals
of the TCCC Card collected as part of an established of TCCC. The TCMC course is located at Fort Sam
precombat deployment medical training curriculum, the Houston, Texas, and it is a pillar program of the Center
TCMC course. This course is primarily attended by US for Predeployment Medicine within the Army Medical
Army physicians, physician assistants, and nurse prac Department Center and School.
titioners prior to combat deployment. The accuracy of
completing a TCCC Card was determined by using a These students are required to participate in Care Un
point system. The point system was based on 12 entry der Fire and Tactical Field Care trauma lanes designed
fields on the card being correctly completed, incorrectly to simulate a combat environment. Each of the trauma
completed, or not completed at all, using a score key for lanes had four manikins weighing 185–200lb each and
each manikin’s injuries. A final score was determined by dressed in full combat equipment, including Army com
summing the total points achieved and then dividing by bat uniform with boots, body armor, and IFAK with a
the total possible points.
TCCC card. Each manikin had permanent simulated
wounds applied by the program cadre well in advance
The median flight time for US military tactical helicop of the study. In a combat environment, the TCCC Card
ter evacuation in Afghanistan over the past 5 years is should already have the name and allergies section filled
43 minutes (R.S. Kotwal, personal communication, out by the soldier prior to placement in the IFAK. The
June 2014). The amount of time afforded each student remainder of the card was to be completed by treating
while on a trauma lane was 45 minutes. This included medical or nonmedical personnel and attached to the
a 5minute briefing and afteraction review at the be soldier upon becoming a casualty. Students attending
ginning and end of trauma lane training, respectively, TCMC receive didactic education and practical exercise
bringing the actual time on the trauma lane to 35 min training on the completion of the TCCC Card prior to
utes. A prevalent argument as to why TCCC Cards are the trauma lanes as part of the training curriculum.
not completed is lack of time. The goal of our study and
that of the TCMC staff was to conduct trauma lanes as On Monday, Day 1, students experienced a demonstra
close to current battlefield trends as possible. The two tion by the cadre on the three phases of care, including
primary outcome measures were to complete a TCCC the use of a TCCC Card as a means of patient documen
Card and to assess accuracy of the completed card.
tation. On the morning of Wednesday, Day 3, students
received a 30minute didactic lecture and practical exer
The inclusion criterion was a manikin with a TCCC cise on how to complete a TCCC Card. That afternoon,
Card physically attached at the time of handoff to simu students participated in a Care Under Fire and Tactical
lated tactical helicopter evacuation personnel, as deter Field Care trauma lane in a simulated combat environ
mined by TCMC staff. The exclusion criterion was a ment, including the use of a TCCC Card for patient
manikin without a TCCC Card physically attached at documentation. The training on Wednesday included
the end of trauma lane scenario at the time of handoff to mentoring by the cadre to instill muscle memory in all
tactical helicopter evacuation personnel, as determined aspects of lifesaving interventions and patient docu
by TCMC staff.
mentation. Upon completion of the Tactical Field Care
phase, students were required to transport the patient to
Informed consent was waived, since this was a direct a simulated helicopter landing zone, where they handed
observational study and the data were not attributable off the casualty to mock tactical helicopter evacuation
to specific individuals. No identifiable information or personnel. At that point, an end of exercise was declared
protected health information was collected on subjects by the cadre and an afteraction review was conducted.
during this study and there were no direct benefits for
the subjects whose data were analyzed. Our hypothesis On Friday, Day 5, the last day of training for each
was there was not a training deficit on using a TCCC TCMC course, students participated in Care Under
Card at the TCMC course. The null hypothesis was Fire and Tactical Field Care trauma lanes in a simulated
there was a training deficit on using a TCCC card at the combat environment. Each iteration of the trauma lane
TCMC course.
exercise was increasingly more difficult in order to fur
ther stress the student, incorporate nonmedical and ad
Setting ditional tactical aspects into the scenarios, and to strive
The TCMC course is a US Army medical predeployment for a mass casualty situation. Students encountered two
training course for physicians, physician assistants, and of four possible scenarios, with each scenario selected at
nurse practitioners prior to their deployment to a combat random and conducted by an unbiased cadre. Although
Prehospital Medical Documentation During Precombat Training 81
