Page 42 - Journal of Special Operations Medicine - Summer 2015

Table 1 Cont.
ROLE-1s
n = 26
TCCC ASSESSMENT QUESTION “YES” “NO” “SOMEWHAT”
Tranexamic Acid Capability
Do you have TXA at BAS? 35% 62% N/A
Do you have TXA in medics’ aid bags? 8% 92% N/A
TCCC Pain Management
Are you using TCCC guidelines pain medications? 4 42% 12% 46%
Fentanyl 69% 31% N/A
Ketamine 50% 50% N/A
Wound (Combat) Pill Pack 4% 96% N/A
What pain medication do your medics carry?
Morphine 5 92% 8% N/A
Fentanyl 35% 65% N/A
Ketamine 12% 88% N/A
TCCC Antibiotics
Are you using TCCC guidelines for systemic antibiotics? 35% 15% 50% 6
Moxifloxin 69% 31% N/A
Cefotetan 27% 73% N/A
Ertapenem 42% 58% N/A
Type of Cricothyrotomy Kit
H&H 58% 42% 0%
Tactical Crickit by North American Rescue 42% 58% 0%
Non-standard (homemade) 23% 77% 0%
Pelvic Binders
Do you use pelvic binders for LE blast injuries? 62% 23% 15%
Notes: *During the assessment period, only a single ROLE-1 demonstrated full implementation of TCCC Guidelines. This was among all of the
23 geographic locations and 26 ROLE-1s within the Regional Commands visited.
1. JTTS data demonstrated 9% to 21% TCCC AARs and 8% TCCC Card compliance from August 2013 to January 2014.
2. Selected Observation: A Battalion Surgeon would not allow medics to give IV medications (narcotics and antibiotics) because he considered
it too dangerous in his personal “bad experience with Pitocin in internship.” At another location, a unit company grade commander would not
allow medics to carry morphine outside the COP because “they are close enough to the aid station.”
3. At the time of the assessment, there were 456 SAM JTs and 500 JETT junctional tourniquets obtained by JTTS and distributed in Theater.
Because they had not been pushed forward from the some RC-Surgeon’s offices to the ROLE-1s, many ROLE-1’s did not have junctional tourni-
quets. Or, in one RC, they had been pushed forward and then recalled for redistribution when the USFOR-A JT FRAGO was published. CRoCs
were ordered and fielded by some units (4%). Waste was also an issue. We found verifiably JTTS procured, distributed, and new-in-wrapper
junctional tourniquets pending destruction at the Bagram AF REPAT burn pit less than 45 days after distribution.
4. This question assessed if medications were available at the ROLE-1 versus routinely issued and available to medics on patrol.
5. There are no published evidence-based studies regarding morphine intramuscular injection for trauma patients. Morphine is NOT a recom-
mended battlefield analgesic in the TCCC Guidelines.
6. Represents the use of non-TCCC Guideline systemic antibiotics for combat casualties.

Servicemembers killed in action and preventable within its 20 draft recommendations the develop-
deaths, and increased case-fatality rate seen in con- ment of a DoD policy and certification process for
ventional forces when compared with SOF. prehospital trauma care.
2. Discussion
CBA Question #3: Are the TCCC Guidelines doctrine? The capstone JP1 Doctrine for the Armed Forces of the
United States defines Joint Doctrine as follows: “Joint
1. Observations doctrine consists of the fundamental principles that
TCCC Guidelines have not yet been codified within guide the employment of US military forces in coordi-
Joint Publication (JP) 4-02, Health Service Support nated action toward a common objective. It provides
(26 July 2012). The current Joint Theater Patient the authoritative guidance from which joint operations
Movement CBA, led by the Joint Staff Surgeon, has are planned and executed.” Since TCCC Guidelines

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