Page 93 - Journal of Special Operations Medicine - Spring 2015

Table 1 Department of the Army Form 7656/Tactical Table 3 Mann-Whitney U
Combat Casualty Care (TCCC) card grading results
Comparison Between
Proportion Correct Median Score Wednesday and Friday Proportions (cont'd)
Group (95% CI) (Interquartile Range) Wednesday Median Friday Median
Wednesday 83.5% (80.8–85.9) 10 (9–12) (Interquartile Range) (Interquartile Range) p value
Friday 77.8% (74.7–80.6) 10 (8–11) 10 (9–12) 10 (8–11) .06
Total 80.7% (78.7–82.6) 10 (8–11)
analyze patient data and identify those interventions
filled out correctly). Prehospital medical documentation that are effective and relevant and that possibly might
using the TCCC Card ranged from 83.5% on Wednes­ guide us toward other interventions that will result in
day to 77.8% on Friday (Table 1). The high­stress trauma increased battlefield survivability.
lane scenario training results are similar to that of the
75th Ranger Regiment actual patient data documenta­ The lack of prehospital documentation was a major
tion of 74%. topic of discussion at the August 2007 CoTCCC confer­
ence. At that time, there were more than 30,000 casual­
A secondary outcome was to compare the median dif­ ties from the wars in Afghanistan and Iraq, of whom
ferences between scores on the Wednesday training less than 10% had any prehospital documentation, and
sessions and Friday training sessions (Table 2). Initial only 1% of that information was deemed sufficient for
sample­size calculations were performed on the second­ analysis. From 2002 to 2009, prehospital data were
7
ary outcome because the primary outcome was purely received for only 18.6% of casualties in Afghanistan
descriptive. Based on an α of .05 and a β of .225, with and 25.4% in Iraq. However, from 2001 to 2010, the
3
population mean of 10 and standard deviation of 20, it 75th Ranger Regiment demonstrated a high prehospital
was determined that using an unpaired, two­sample t documentation rate of 74% for casualties during com­
test, approximately 60 TCCC Cards would be needed bat operations. Additionally, Combat Medics conduct­
2
per group for a total of 120. ing Advanced Individual Training at Fort Sam Houston,
Texas, have also demonstrated a high prehospital docu­
Table 2 Fisher’s Exact Test mentation rate of 100%, in less than 2 minutes, with an
11
Comparison Between Wednesday and Friday Proportions 85% accuracy rate. Our study results are consistent
Difference with these two latter studies. Thus, there are now three
Wednesday Friday Between 95% CI studies that mutually support the emphasis and prior­
Proportion Proportion Wednesday of the ity of prehospital medical documentation with resultant
Correct Correct and Friday Difference increased completion and receipt of prehospital medical
83.5 77.8 5.7 1.8–9.6 documentation.
After data collection, it was determined that the scores Our goal for conducting this study was to assess whether
were not normally distributed. Therefore, raw scores there was a training deficiency on using a TCCC Card
were described using medians with interquartile ranges, by military medical providers at the TCMC course. Our
and the Wednesday and Friday raw scores were com­ study results have shown the contrary. This research
pared using the Mann­Whitney U test (Table 3). Since further supports that if there are going to be increases
some groups failed to fill out the DA Form 7656 on in completion of a TCCC Card during future combat
both days, it was impossible to determine exactly which operations, leader and community ownership, respon­
card came from any individual group, so the scores were sibility, and priority emphasis need to be driving forces
treated as unpaired samples. for increasing prehospital medical documentation.

Discussion Addendum
Although it is mandated that a TCCC Card be placed Since the completion of this study, the 2009 Depart­
into every soldier’s IFAK, and soldiers are trained on ment of the Army DA Form 7656 Tactical Combat Ca­
how to properly use the TCCC Card, this form for sualty Care Card has been slightly modified from its
prehospital documentation on the battlefield remains initial configuration, used during this project, to gain
significantly underused. Without documentation of ca­ acceptance by all US military services to ultimately re­
sualty status, injuries, and lifesaving interventions per­ place the old 1991 DD Form 1380 US Field Medical
formed, there has been little evidence to validate current Card. As of June 2014, the new DD Form 1380 Tac­
or future prehospital emergency medical care rendered. tical Combat Casualty Care Card is readily available
This lack of information has degraded our ability to for all US military and NATO forces worldwide. These

Prehospital Medical Documentation During Precombat Training 83