Page 46 - Journal of Special Operations Medicine - Summer 2015

Leadership within CJOA-A subordinate organizations. US-
CENTCOM’s Prehospital Directorate of the Joint
CBA Question #12: Are tactical, operational, and stra- Theater Trauma System is responsible for objec-
tegic Command Surgeons correctly empowered under tive data collection and analysis, and observa-
DOTMLPF-P integration to ensure the delivery of effec- tional reporting.
tive prehospital care using a standard of care?
d. RC Surgeons cannot effectively establish and pro-
mulgate medical polices for prehospital care in
1. Observations units where they have no technical or special staff
a. “We are not going to use ketamine in this RC. I leadership authority before entering the battle
had a patient who had a dissociative episode in space.
my residency and I’m not going to have that in the 3. Findings
field. The only person I have to please is my Divi- In the absence of a widely mandated policy that
sion Commander,” said one RC Surgeon.
b. Ketamine is a CoTCCC approved, recommended, establishes TCCC Guidelines as the standard for
prehospital battlefield care and accountability for de-
and preferred analgesic agent in accordance with viations from this standard, the degree of penetrance
the published TCCC guidelines.
c. Intramuscular morphine is relatively contraindi- and acceptance of TCCC Guidelines will remain epi-
sodic and dependent upon individual (Surgeon and
cated in patients with traumatic hypoperfusion Commander) commitment.
and specifically contraindicated in patients with
respiratory depression in the absence of resuscita- Personnel
tive equipment. Many battlefield wounds produce
respiratory depression through hypoperfusion, CBA Question #13: Are our maneuver commanders
direct lung injury, blast and other mechanisms. and medical leaders adequately trained and educated
Yet, the DoD systematically and regularly supplies to ensure the effective delivery of prehospital care using
morphine auto injectors to both medical and non- TCCC Guidelines across the battlefield?
medical combatants for the amelioration of pain CBA Question #14: Does the human capital manage-
on the battlefield.
d. RC Surgeons and RC Headquarters may deploy ment process assign the right leaders and technical ex-
perts to the right levels to ensure the effective delivery
with units they have never worked with, established of prehospital care using TCCC Guidelines across the
and promulgated policy, lead or commanded be- battlefield?
fore taking the battlefield. Subsequently, prepara-
tion and training of these deploying organizations 1. Observations
is dependent on home station command structures. 2
2. Discussion a. Commanders : Review of the US Army Infantry
and Armor Basic Officer Leader Course (BOLC)
a. Doctrinally, Command Surgeons as functional au- and the US Marine Corps Basic Officer Course
thorities are empowered through their Command- demonstrate that both include first aid training ;
3
ers to establish and enforce health-system support however, this is at the personal and buddy care
policies and standards of care. Inherent within level. It does not provide organizational delivery,
that authority is the need for Command Surgeons responsibility, and ownership of the prehospital
to identify and bring forward those policies and care delivery system. Additionally, the curriculum
standards that require command endorsement, does not incorporate the tactical and operational
and the willingness of those Commanders to act executive level training of medical evacuation
upon the best military medical advice of their Sur- doctrine or emphasize how “time to a required
geons and commit the resources necessary to sup- capability” prevents fatalities and improves the
port such policies and standards.
b. The medical literature shows that potentially sur- case-fatality rate. It is also worth recognizing that
US Army Command and General Staff College
vivable fatality rates can be reduced to 3% with Courses have no medical operational subjects in
the full commitment of unit leadership to train the published curriculum. This is true of nonmedi-
and adhere to TCCC Guidelines. In the absence cal enlisted leadership courses as well.
of mandatory DoD or theater policy to comply b. All Leaders: Understanding and integration of
with TCCC Guidelines, commitment of both Unit pre hospital care and TCCC tactics is incomplete,
Surgeons and Commanders remains highly vari-
ant across the CJOA, and there is no mechanism
2. Commander is used here generically. It is intended to
of accountability for suboptimal outcomes when represent all levels of nonmedical leaders among the combat-
TCCC Guidelines are not followed. ant units.
c. RC Surgeons have not consistently or effectively 3. First aid training that is not consistent with the TCCC
established prehospital quality assurance systems guidelines.

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