Page 45 - Journal of Special Operations Medicine - Summer 2015

tourniquet application.” The jointly written US forces and ensure adequate medical materials to provide
Army Medical Department Center and School- prehospital care using TCCC Guidelines?
published Emergency War Surgery Fourth United
States Revision 2013 states, “Tourniquet may be 1. Observations
the first choice in combat” and then also states a. Use of the United States Army Medical Material
“Do not avoid use of a tourniquet in order to save Agency (USAMMA) approved national stock
a limb and then lose a life!” number (NSN) Eye Injury First Aid found in sets,
c. The 2013 version of the Emergency War Surgery kits, and outfits (SKOs) throughout the Services
Fourth United States Revision states, “Tourni- is directly contraindicated by TCCC Guidelines
quets should not be removed until the hemorrhage and the recommendations of the DoD Vision Cen-
can be reliably controlled by advanced hemostatic ter of Excellence. It is also contraindicated by the
agents or until arrival at surgery.” However, the most basic ubiquitously accepted trauma eye-care
TCCC Guidelines state, “Reassess prior tourni- guidelines. Using this NSN item may actually in-
quet application. Expose wound and determine crease the severity of the eye trauma and decrease
if tourniquet is needed. If so, move tourniquet the probability of optimal vision recovery. More
from over uniform and apply directly to skin 2–3 than $260,000 was spent last year buying and
inches above wound. If a tourniquet is not needed, fielding these kits to our combatant forces. This
use other techniques to control bleeding.” If edu- kit has been in the inventory since 1960.
cational and doctrinal publications cannot keep b. “Shield and Ship” has been a best practice guide-
pace with TCCC Guidelines, then we should sim- line for traumatic eye injuries for over a decade in
ply stick with the Guidelines as doctrine and not the US and the DoD. However, data from the JTS
use indirect methods of communication. indicated we are only 40% compliant with this
d. Some medical officers have deployed without any guideline. Besides issues with training and doc-
TCCC training or the attendance at the Combat trine, the first level where eye shields are available
Casualty Care Course. by logistics doctrine is at the ROLE-1 Battalion
2. Discussion Aid Station. There is no requirement (as evidenced
DoD-published guidance and teaching materials by the doctrinal Modified Table of Organization
should not be in conflict with one another. Profes- and Equipment) to have eye shields at the POI
sional peer-reviewed medical journal articles are where they are needed urgently to decrease further
published frequently to inform and guide medical harm and save eyesight.
providers on the most current research and best c. The Army SKO for a ROLE-1 is the Medical Equip-
evidence-based practices. It is generally expected that ment Set Tactical Combat Medical Care (TCMC).
medical providers remain current with the most cur- This set is missing several critical medical materials
rently available evidence-based practice standards necessary to provide TCCC Guideline capabilities.
and use them in guiding their decision-making and Missing items include medication delivery systems,
care of patients. The TCCC Guidelines are changed pain control medications, and antibiotics. The set
in near-real time as new technology and evidence be- does list antibiotics that, arguably, could be equiv-
come available, typically every several months (there alent to TCCC Guidelines.
were four changes to the TCCC Guidelines in 2013), 2. Discussion
in contrast to published texts, which are typically up- Since TCCC Guidelines are not recognized formally
dated every 3 to 4 years. as policy, organizations are not required and au-
3. Findings thorized to have, nor resourced with the necessary
Robust training platforms exist for prehospital medical materials to provide TCCC. Nor is there an
trauma care, though not all course training syllabi established mechanism to rapidly incorporate and
keep apace of current best practices. Sufficient in- sustain new materials across the logistics chain when
formation technologies exist to rapidly and widely mandated by evolving TCCC Guidelines (e.g., junc-
disperse new TCCC Guidelines as they become im- tional tourniquets), into unit equipment sets. As a
mediately available. result, though TCCC materials are available within
the system, medics must submit unnecessary justifi-
Materiel cations to order these materials.
3. Findings
CBA Question #10: Do our currently fielded tactical Unit equipment sets and supporting medical logistics
medical sets, kits, and outfits ensure the delivery of ef- systems have not kept pace with evolving prehospital
fective prehospital care using TCCC Guidelines?
care TCCC guidelines. Outdated items remain within
CBA Question #11: Do our current medical logistics the supply chain and newly required items have not
techniques comprehensively and effectively supply our yet been incorporated into standard configurations.

Saving Lives on the Battlefield (Part II) 35