Page 168 - Journal of Special Operations Medicine - Summer 2015

being developed. A change paper proposing the incorporation of The TCCC curriculum will now be updated annually each
XStat into the TCCC Guidelines is being prepared. June, with interim changes forwarded to TCCC users through-
out the year as they are approved by the CoTCCC. The “TCCC
Prehospital Trauma Life Support (PHTLS) for All Combatants” curriculum is a new version of the cur-
TCCC Courses: Mr Mark Lueder riculum designed for nonmedical combatants. The advanced
skills sets and interventions that are intended for medics have
Mr Lueder, from the PHTLS organization, discussed the PHTLS been removed and the terminology used in this version of the
TCCC training program. PHTLS courses are taught under the curriculum is aimed at the nonmedical individual.
sponsorship of the NAEMT and use the JTS-developed TCCC
curriculum. Course graduates are maintained in a central TCCC TCCC Issues: Medic Perspective:
training registry and receive a TCCC certification card upon MSG Harold Montgomery
completion of the course. These courses have been taught all
over the United States and in 20 other nations around the world. MSG Montgomery, the Senior Enlisted Medical Advisor for
USSOCOM, presented an overview of TCCC issues from the
There was strong agreement from the group that the DoD Combat medic’s perspective. He pointed out that the easy part
should require all medical personnel to obtain TCCC certi- of improving combat trauma care is behind us. Remaining
fication cards just as we do for Basic Life Support, Advanced challenges include planning for optimal trauma care for casu-
Cardiovascular Life Support, and Advanced Trauma Life Sup- alties sustained by small military groups widely dispersed over
port. This training should be repeated every 2 years. As noted, large geographic areas with few medical treatment facilities
NAEMT also teaches the TCCC-inspired but civilian-oriented and long evacuation times. TCCC in this setting may have to
previously Tactical Emergency Casualty Care, Law Enforce- transition to PFC. He emphasized the need to achieve con-
ment First Responder, and Bleeding Control courses in addi- stant medical readiness, as opposed to “just in time” training
tion to its PHTLS and TCCC courses. and to convince military physicians and line combat leaders
of the need to train their medics as well as all unit members
Tactical Evacuation Care (TACEVAC) in TCCC.
Time and Survival: Dr Russ Kotwal
Stellate Ganglion Block for PTSD:
COL (Ret) Kotwal presented the abstract for a manuscript that COL Sean Mulvaney
he and his coauthors submitted to the New England Journal of
Medicine for publication consideration. Their study evaluated COL Mulvaney, from Walter Reed National Military Medical
the concept of the “Golden Hour” by comparing outcomes be- Center, discussed his recent Military Medicine paper describ-
fore and after the 2009 mandate by Secretary of Defense Gates ing the use of stellate ganglion block (SGB) to treat Service-
to conduct prehospital Tactical Evacuation (TACEVAC) mis- members suffering from posttraumatic stress disorder (PTSD)
sions in 60 minutes or less (aircraft call to medical treatment when their symptoms fail to respond to first-line therapy. In a
facility arrival). Their study findings support the importance series of 166 patients from a military population with multiple
of expeditious TACEVAC and include significant reductions combat deployments who were treated with SGB, more than
of Killed in Action deaths as a result of more rapid prehospital 70% had a clinically significant improvement that persisted
helicopter transport as well as early blood transfusion. beyond 3–6 months after the procedure. Selective blockade of
the right cervical sympathetic chain at the C6 level was found
Prolonged Field Care: COL Sean Keenan to be a safe, effective, and minimally invasive procedure with
which to treat patients suffering from PTSD. Despite this pub-
COL Keenan, the 10th Special Forces Group Surgeon, discussed lished success, SGB is not being widely used in the DoD at this
Prolonged Field Care (PFC) and his group’s endeavors to define time to treat refractory PTSD symptoms.
optimal care for casualties who must be managed for long peri-
ods in austere, remote environments while awaiting evacuation. TCCC Research Priorities: Dr Frank Butler
One of the goals of the PFC effort is to answer the question:
What happens at the end of TCCC? It is challenging to develop Dr Butler reviewed the previous list of prioritized CoTCCC-
protocols for all possible contingencies that an isolated medic recommended battlefield trauma care research, development,
might face. The answer, therefore, likely lies in improved medic test, and evaluation projects from 2012, and solicited input
training and in the use of advanced telemedicine technology, for new items to add to this list. An updated ranking of these
rather than trying to develop protocols for every contingency. projects will proceed after the meeting via teleconference and/
or email communications.
PHTLS 8 Military Textbook/New TCCC Curriculum:
Dr Steve Giebner 17 April 2015
Frank K. Butler, MD, CAPT, MC, USN (Ret),
Dr Giebner, the CoTCCC Developmental Editor, discussed Chairman, Committee on TCCC
both the PHTLS Eighth Edition textbook and the TCCC
curriculum. The textbook is published by Jones and Bartlett Enclosures:
Learning and the retail price is $82.95. Dr Giebner reviewed (1) Attendance
the titles of the 13 TCCC-submitted chapters and offered his (2) Agenda 12
thanks to the contributing authors. Enclosure (1)

158 Journal of Special Operations Medicine Volume 15, Edition 2/Summer 2015