Page 37 - Journal of Special Operations Medicine - Summer 2015

robust prehospital care system or equipped with the for operational medical corps officers, with empha-
requisite knowledge, skills, or experience to build sis upon prehospital care delivery.
or sustain such a system within their unit.
Conclusion
New Recommendations
History teaches that the lessons we have learned re-
1. DoD establishes TCCC Guidelines as the DoD stan- garding combat casualty care may be lost if we fail to
dard of care for prehospital care. attend to them in the coming years. Even in a resource-
2. DoD conducts a Doctrine, Organization, Training, constrained future, the Military Health System (MHS)
Materiel, Leadership and Education, Personnel, Fa- has the necessary raw materials of personnel, organi-
cilities, and Policy (DOTMLPF-P) assessment across zation, and experience to retain and refine our current
Services to assess and implement TCCC Guideline best practices. With continued efforts aimed at (1) for-
capability. malizing TCCC Guideline compliance across the force,
3. DoD systematically review and correct all prehospi- (2) embracing evidence-based methods to continually
tal care doctrine across the spectrum to accurately improve upon these Guidelines, and (3) selecting, de-
represent TCCC Guidelines, with the doctrine spe- veloping, and retaining operational medical personnel
cifically stating “in accordance with the current dedicated to prehospital trauma care, the MHS will en-
TCCC Guidelines published by the Committee on sure an organizational culture that fully embraces pre-
Tactical Combat Casualty Care” to ensure that the hospital combat casualty care as a core competency.
doctrine remains current.
4. Services immediately implement an aggressive
transition initiative to update all relevant medical CHANGING OLD PARADIGMS
equipment sets and medical logistic policies to en-
sure units have TCCC Guideline-specified medical “We succeed only as we identify in life, or in war,
materials. or in anything else, a single overriding objective,
5. DoD establishes a Battlefield Prehospital Trauma and make all other considerations bend to that
Care Program Proponent (or equivalent structure) one objective.”
in the Defense Health Agency (DHA). Dwight D. Eisenhower
6. DoD develops and mandates a TCCC Accredita-
tion, Certification, and Recertification program like
Basic Life Support, Advanced Trauma Life Support, SECTION 1. PURPOSE
and Advanced Cardiac Life Support for all military
personnel, with a requirement for biannual recer- Mission
tification and as based on level of ability and posi-
tion (e.g., nonmedical first responder, nonmedical To conduct a capabilities-based assessment of prehospi-
leader, medical provider, medical leader). tal trauma care within the Combined Joint Operations
7. Services require and track TCCC certification for all Area–Afghanistan (CJOA-A) and provide recommenda-
prehospital medical personnel and integrate track- tions to improve prehospital combat casualty care and
ing into combatant force readiness reporting (e.g., injury survivability. The largest potential gains for im-
Unit Status Reports). proving survival among US combat casualties remain in
8. Services incorporate TCCC Champion training into the prehospital environment.
all basic and advanced officer and noncommis-
sioned officer professional military development This report is not a standalone document. Both the
courses. methods used to develop this report and the content
9. Services incorporate and mandate casualty manage- must be viewed in the context of the US Central Com-
ment and hands-on practical exercises into all pro- mand (USCENTCOM) report by Kotwal et al. entitled
fessional military development courses. “Saving Lives on the Battlefield,” dated 30 January
10. DoD updates the Joint Capability Requirement for 2013. This report is an adjunct and follow-up assess-
Tactical Enroute Care to include the ability to pro- ment on the CJOA-A development and implementation
vide advanced resuscitative care from the point of of prehospital care 1 year from that document’s initial
injury. publication. Our assessment occurred from 15 Decem-
11. As military physicians are ultimately responsible for ber 2013 to 20 January 2014. It was also conducted
assuming the role of emergency medical services di- during the Afghanistan Campaign’s retrograde process
rector for prehospital services if assigned to a com- and concurrent “seasonal slowdown” of enemy activity.
batant unit, the military Services should study and Subsequently, the results of this survey will also need to
develop career, educational, and assignment tracks be viewed from that perspective.

Saving Lives on the Battlefield (Part II) 27