Page 44 - Journal of Special Operations Medicine - Summer 2015

2. Discussion combat operations, due to location and unit of
The capability of combatant organizations to deliver assignment.
prehospital care capability within the TCCC Guide- 2. Discussion
lines is unpredictable and fragmented, as demon- Units with a maneuver mission placing them at risk
strated by finding only one ROLE-1 in full compliance of direct contact with enemy forces need sufficient
with TCCC guidelines. Frequently, the commitment organic medical assets to provide rapid TCCC pre-
to deliver prehospital care within TCCC guidelines hospital care at the point of injury. Adequate medical
was influenced by medical leaders’ concerns of pro- oversight with sufficient expertise and training must
fessional comfort based upon limited personal ex- also be provided, either organic to the unit or by
perience often derived from training and practice other arrangement, to ensure training is compliant
experiences outside of a combat environment. with TCCC Guidelines and to identify and correct
While the current doctrine strongly supports any skill deficiencies.
organization of any size adopting TCCC Guidelines The MERT concept is dependent upon a support-
and implementing them as the standard of care, there ing airframe with sufficient vertical lift capacity (i.e.,
is no requirement. Some leaders have seized this op- CH-47, CH-53, V-22) to move both the medical team
portunity to improve prehospital care within their and its equipment to the POI. Currently, there are no
organizations and have implemented the TCCC US MEDEVAC units with organic, heavy, vertical-lift
Guidelines. Others, however, have failed to fully capability. All heavy vertical-lift aircraft are assigned
implement proven, life-saving protocols based upon and operated by nonmedical aviation units. Thus,
limited experience or professional concern/comfort. there are only designated but not dedicated airframes
3. Findings to support this capability. Currently, there is no extant
The requirements to perform and support prehospi- joint capability requirement to deliver such advanced
tal TCCC could be standardized across Services (uni- resuscitative care forward to the POI. There is increas-
versally or at the Combatant Command level) with ing evidence that the provision of such early, advanced
the specific means to achieve these train-and-equip resuscitative care has positive effects upon both mor-
standards left up to the respective Services. bidity and mortality from battlefield trauma.
3. Findings
As with elements of prehospital care, organization
Organization
structures are highly variant, with a number of at-
CBA Question #8: Are our tactical and operational or- risk forces not having adequately manned/trained/
ganizations structured to support the delivery of prehos- equipped medical support. Units with a tactical evac-
pital care? uation mission requirement should be task organized
to be able to provide advanced, enroute resuscitative
1. Observations care from the POI.
a. “Orphan” units exist throughout the CJOA-A
without organic licensed providers or medics. Training
Within these organizations, general healthcare de-
livery is often provided through local area support CBA Question #9: Does the current training structure
by colocated medical units. For major bases and support the effective delivery of prehospital care using a
forward operating bases (FOBs), this is a reason- standard of care that is tactically and operational avail-
able and functional method. However, many of able across the spectrum of the battlefield?
the orphan units also conduct operations outside
of the bases. This means medics must be borrowed 1. Observations
from other organizations, with some units not a. Although medically contraindicated, two separate
having medics on combat operations and subse- Army medic testing standards require patching
quent degraded prehospital care for these units. (versus shielding) of a traumatized eye. A third
b. During 2013, a US Medical Emergency Response testing standard, the US Army’s Expert Field Med-
Team (MERT) proof of principle was conducted ical Badge, requires the ability to determine that
with a USAF Tactical Critical Care Evacuation the eye trauma is limited to the supporting struc-
Team (TCCET) modeled after the demonstra- tures versus the globe, and then patch the eye.
bly successful United Kingdom (UK) MERT in b. Several doctrinal publications within the Services
RC-South/Bastion. In-Theater training for the state that a tourniquet is a choice of last resort
TCCET included predeployment and ride-along and require a stepped approach to controlling life-
training with the UK MERT. Though staffed with threatening hemorrhage. TCCC Guidelines clearly
adequate medical personnel and capability, the state: “Use a CoTCCC-recommended tourniquet
US MERT was not successfully integrated into for hemorrhage that is anatomically amenable to

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