Page 36 - Journal of Special Operations Medicine - Summer 2015

trauma conferences, and CJOA-A theater guidance and Findings
enforcement of prehospital documentation. Specific pre-
hospital trauma-care achievements include expansion 1. The lack of standardized TCCC capability may rep-
of transfusion capabilities forward to the point of in- resent a causal factor for the increased number of
jury, junctional tourniquets, and universal approval of Servicemembers killed in action and of preventable
tranexamic acid. deaths, and the increased case-fatality rate seen in
conventional forces when compared with Special
Operations Forces (SOF).
Observations and Discussion
2. Absent a validated joint requirement, which is
TCCC Guidelines are widely, though not universally, captured doctrinally, the prevailing resource-
accepted as authoritative “best practices” for prehos- constrained environment will challenge Services to
pital trauma care; however, they are not directive pol- fully organize, train, and equip to TCCC standards.
icy. The high degree of variance among deployed unit 3. There is no evidence that the DoD or CJOA-A
medical personnel, both in terms of clinical training and has policies or procedures in place to validate or
operational experience, results in inconsistent applica- enforce prehospital care within an organization.
tion and enforcement of TCCC compliance across the Service-specific doctrine requiring unit surgeons to
force. Since our line commanders are dependent upon each establish a standard of care allows for vari-
their unit medical personnel to inform their understand- ant, nonstandard delivery of battlefield trauma care
ing, appreciation, and prioritization of medical support across the Force. Furthermore, even within a single
requirements, their TCCC commitment and command command, rotation of unit surgeons introduces
emphasis understandably varies, as well. and magnifies discontinuity of unit trauma-care
standards.
In the face of near-term resource constraints, without 4. The requirements to perform and support prehos-
doctrinal and policy endorsement, the Services will pital TCCC could be standardized across Services
continue to struggle to adequately and fully organize, (universally or at the Combatant Command level)
train, and equip to meet TCCC Guidelines as the stan- with the specific means to achieve these train-and-
dard for prehospital care. A previous memorandum equip standards left up to the respective Services.
and recommendation by the Assistant Secretary of De- 5. As with elements of prehospital care, organization
fense for Health Affairs to train all combatants and structures are highly variant, with a number of at-
deployed medical personnel in TCCC remains incom- risk forces not having adequately manned/trained/
pletely implemented across the Department of Defense equipped medical support.
(DoD). In contrast, US Special Operations Command 6. Units with a tactical evacuation mission require-
( USSOCOM) and US Army Special Operations Com- ment should be task organized to be able to provide
mand (USASOC) have codified TCCC compliance as advanced enroute resuscitative care from the point
policy and reduced prehospital case-fatality rates. of injury.
7. Robust training platforms exist for prehospital
We must continue to embrace and explore emerging ca- trauma care, though not all course training syllabi
pabilities to deliver far-forward resuscitative care. Those keep pace with current best practices. Sufficient in-
capabilities that are both responsive and adaptive to the formation technologies exist to rapidly and widely
dynamic tactical landscape hold the greatest intrinsic disperse new TCCC Guidelines as they become im-
value for our line commanders and their personnel. We mediately available.
must also ensure that our supporting organize, train, 8. Unit equipment sets and supporting medical lo-
and equip functions have the agility to keep pace with gistics systems have not kept pace with evolving
these evolving standards of care. prehospital-care TCCC guidelines. Outdated items
remain within the supply chain and newly required
We must increase the investment in our medical person- items have not yet been incorporated into standard
nel to develop and retain true expertise in prehospital configurations.
trauma-care delivery and oversight. These must become 9. In the absence of a widely mandated policy that
core competencies in the unique domain of operational establishes TCCC Guidelines as the standard for
medical support, and we must embrace new medical prehospital battlefield care, and accountability for
training paradigms that advance these skills. Finally, of- deviations from this standard, the degree of pen-
ficer professional development for both line and medical etrance and acceptance of TCCC Guidelines will
leaders must emphasize the shared responsibilities for remain episodic and dependent upon individual
developing and enforcing robust unit commitment to (surgeon and Commander) commitment.
lifesaving, prehospital trauma-care principles. 10. Neither line nor operational medical leaders are op-
timally prepared to recognize the importance of a

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