Page 48 - Journal of Special Operations Medicine - Summer 2015

SECTION 4: RECOMMENDATIONS in CJOA-A as they relate to tactics, techniques,
and procedures, tactical trends, personal protective
New Recommendations equipment), evolving injury patterns, and operations
tempo through a consolidated registry of findings
1. DoD establishes TCCC Guidelines as the DoD stan- from formal tactical investigations and theater-wide
dard of care for prehospital care.
2. DoD conducts a DOTMLPF-P assessment across tactical operations interfaced with the DoD Trauma
Registry.
Services to assess and implement TCCC Guideline 2. Services and the Services’ medical departments em-
capability.
3. DoD systematically reviews and corrects all pre- phasize to line commanders that the priority and un-
derstanding of their tactical casualty response system
hospital care doctrine across the spectrum to accu- is critical to preventing combat deaths. (e.g., 75th
rately represent TCCC Guidelines with the doctrine Ranger Regiment Casualty Response model).
specifically stating “in accordance with the current 3. Services and the Services’ medical departments train
TCCC Guidelines published by the Committee on all combatant unit personnel in basic TCCC initially,
Tactical Combat Casualty Care” to ensure that the annually, and within 6 months of combat deploy-
doctrine remains current.
4. Services immediately implement an aggressive ment (e.g., USSOCOM Directive 350-29 model).
This should be a requirement for deploying to a com-
transition initiative to update all relevant medical bat theater.
equipment sets and medical logistic policies to en- 4. Services and the Services’ medical departments train
sure units have TCCC Guideline-specified medical all medical personnel (physicians, physician as-
materials.
5. DoD establishes a Battlefield Prehospital Trauma sistants, nurses, medics) in instructor-level TCCC
courses initially and within 6 months of combat de-
Care Program Proponent (or equivalent structure) ployment. This should be a requirement for deploy-
in the DHA.
ing to a combat theater.
6. DoD develops and mandates a TCCC Accredita- 5. Services integrate TCCC-based casualty response
tion, Certification, and Recertification program like into battle drills, small unit tactics, and training ex-
Basic Life Support, Advanced Trauma Life Support, ercises at all levels (e.g., 75th Ranger Regiment Ca-
and Advanced Cardiac Life Support for all military sualty Response model).
personnel with a requirement for biannual recerti- 6. Services and the Services’ medical departments sup-
fication and as based on level of ability and posi- port enduring sustainment hands-on trauma training
tion (e.g., nonmedical first responder, non-medical for all prehospital medical personnel (live tissue and
leader, medical provider, medical leader).
7. Services require and track TCCC certification for trauma center rotations) (e.g., USASOC Regulation
350-1 model).
all prehospital medical personnel and integrate 7. Services and the Services’ medical departments em-
tracking into combatant Unit Status Reports.
8. Services incorporate TCCC Champion training into phasize contingency planning in both line and medi-
cal leader education to ensure evacuation capabilities
all basic and advanced officer and noncommissioned in non-permissive environments.
officer professional military development courses.
9. Services incorporate and mandate casualty manage- 8. Services, Services’ medical departments, and de-
ployed medical personnel minimize use of platelet-
ment and hands-on practical exercises into all pro- inhibiting drugs (e.g., aspirin, Motrin, other COX-1
fessional military development courses.
10. DoD updates the Joint Capability Requirement for nonsteroidal antiinflammatory drugs, selective sero-
tonin reuptake inhibitors) in individuals who leave
Tactical Enroute Care to include the ability to pro- secure areas for combat missions in CJOA-A.
vide advanced resuscitative care from the point of
injury.
11. As military physicians are ultimately responsible Funding, Disclaimer, Disclosure: This was an official as-
sessment and report provided to the US Central Com-
for assuming the role of EMS director for prehos- mand. The authors have no conflicts of interest to report
pital services if assigned to a combatant unit, the and they did not receive any external funding.
military Services should study and develop career,
educational, and assignment tracks for operational
medical corps officers, with emphasis on prehospi- COL Sauer, MC, USA, is Deployed Director, Prehospital
tal care delivery. Care Division, USCENTCOM Joint Theater Trauma System–
Afghanistan, Bagram Airfield, Afghanistan.
Renewed Recommendations
MAJ Robinson, SP, USA, is Deployed Coordinator, Pre-
1. DoD issues an instruction that command-directs an hospital Care Division, USCENTCOM Joint Theater Trauma
ongoing review and analysis of preventable deaths System–Afghanistan, Bagram Airfield, Afghanistan.

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