Page 49 - Journal of Special Operations Medicine - Summer 2015

SSG Smith, USA, is Deployed NCOIC, Prehospital Care Divi- Kotwal RS, Butler FK, Edgar EP, et al. Saving lives on the battle-
sion, USCENTCOM Joint Theater Trauma System–Afghanistan, field: a Joint Trauma System review of pre-hospital trauma
Bagram Airfield, Afghanistan. care in Combined Joint Operating Area–Afghanistan (CJOA-
A) Executive Summary. J Spec Oper Med. 2013;13:77–80.
Kotwal RS, Butler FK, Edgar EP, et al. Saving lives on the battlefield:
COL Gross, MC, USA, is Deployed Director, Joint Theater a Joint Trauma System review of pre-hospital trauma care in
Trauma System, USCENTCOM Joint Theater Trauma System– Combined Joint Operating Area–Afghanistan Full Report.
Afghanistan, Bagram Airfield, Afghanistan. Comprehensive 49-page report provided to USCENTCOM by
the Joint Trauma System on 30 January 2013.
COL Kotwal, MC, USA, is Outgoing Director of Trauma Orman JA, Eastridge BJ, Baer DG, et al. The impact of 10 years
Care Delivery, and Committee Member, Committee on Tacti- of war on combat casualty care research: a citation analysis.
cal Combat Casualty Care, DoD Joint Trauma System, Defense J Trauma Acute Care Surg. 2012;73:S403–S408.
Center of Excellence for Trauma, Joint Base San Antonio–
Fort Sam Houston, Texas. Appendix 2: Select Comments from the Theater

LTC Mabry, MC, USA, is Incoming Director of Trauma 1. Despite the existence of an USFOR-A FRAGO, imple-
Care Delivery; Director, Military EMS and Disaster Medicine mentation of TCCC-AARs submission languished at 9% for
Fellowship; and Committee Member, Committee on Tactical US Forces casualties for over 5 months. Of note, the 9% was
Combat Casualty Care, DoD Joint Trauma System, Defense primarily USASOC and Joint Special Operations Command
Center of Excellence for Trauma, Joint Base San Antonio–Fort submission of prehospital documentation. Conventional
Sam Houston, Texas. forces were generally noncompliant. Compliance did not im-
prove until the JTTS began tracking US casualties through the
CAPT Butler, MC, USN, is Director of Prehospital Trauma Defense Casualty Information Processing System USCENT-
Care; and Chairman, Committee on Tactical Combat Casu- COM J-1 Casualty Tracker and back-briefing noncompliance
alty Care, DoD Joint Trauma System, Defense Center of Excel- to USFOR-A/IJC. When the JTTS directly contacted ROLE-1
lence for Trauma, Joint Base San Antonio–Fort Sam Houston, leadership, it was commonly reported that they were unaware
Texas. of the requirement. This suggests a lack of effective leadership
and enforcement of policy to ensure medical systems comply
CAPT Stockinger, MC, USN, is Director of Performance with lawful orders. (JTTS Prehospital Director)
Improvement, DoD Joint Trauma System, Defense Center 2. From August 2013 to January 2014, JTTS personnel
of Excellence for Trauma, Joint Base San Antonio–Fort Sam directly engaged in the acquisition and distribution of junc-
Houston, Texas. tional tourniquets (and other medical supplies) to ensure their
availability to USFOR-A Warfighters conducting combat op-
Col Bailey, MC, USAF, is Director of the Joint Trauma erations. The JTTS is not organized to conduct this mission
System, DoD Joint Trauma System, Defense Center of Excel- but we recognized that the engaged forces did not have the
lence for Trauma, Joint Base San Antonio–Fort Sam Houston, requisite effort and support system to obtain these junctional
Texas. tourniquets in a timely fashion on their own. (JTTS Prehospi-
tal Director)
Col Mavity, MC, USAF, CFS, is Command Surgeon, Office 3. The JTTS also conducted battlefield circulation and
of the Command Surgeon, USCENTCOM, MacDill Air Force provided education and training on junctional tourniquets and
Base, Tampa, Florida. TCCC Guidelines after recognizing the gravity of the situa-
tion. This is another unofficial duty and self-imposed mission
LTC Gillies II, MC, USA, is with the Clinical Operations of the JTTS that is the responsibility of deployed combatant
Division, Office of the Command Surgeon, USCENTCOM, organizations and their medical leadership. (JTTS Prehospital
MacDill Air Force Base, Tampa, Florida. Director)
4. Recognizing the rarity of fully implemented TCCC
Guidelines capability and prehospital care advocacy, the JTTS
Appendix 1: References developed the “Ditch Medicine Award” for excellence in pre-
Butler FK, Hagmann J, Butler EG. Tactical combat casualty care hospital care delivery. (See http://www.dvidshub.net/news
in Special Operations. Mil Med. 1996;161:1–15. /120069/3-7-battalion-surgeon-awarded-lifesaving-medical-
Butler FK, Giebner SD, McSwain NE, et al. Prehospital trauma care#.UvZw1kJdWkQ) (JTTS Prehospital Director)
life support manual (7th ed, military version). St Louis, MO: 5. JTTS recommendations and prehospital medical in-
Mosby/Elsevier; 2010. formation is being filtered, diluted, changed, or inaccurately
Butler FK, Blackbourne LH. Battlefield trauma care then and conveyed to the end users by intermediate medical leadership.
now: a decade of tactical combat casualty care. J Trauma The information feels diluted or changed by higher echelon
Acute Care Surg. 2012;73(6 Suppl 5):S395–S402. (e.g., do not order TXA when a ROLE-1 is collocated with
Eastridge BJ, Mabry RL, Seguin P, et al. Death on the battlefield a forward surgical team). (Army Medical Platoon Leader at
(2001–2011): implications for the future of combat casu-
alty care. J Trauma Acute Care Surg. 2012;73(6 Suppl 5): ROLE-1)
S431–S437. 6. Units can’t order TCCC Cards through the medical
Kotwal RS, Montgomery HR, Kotwal BM, et al. Eliminating system and it is left up to them to figure out how to get them.
preventable death on the battlefield. Arch Surg. 2011;146: It needs to be a Class VIII item. It is the duty of the medi-
1350–1358. cal logistics system to obtain medical items and to standardize

Saving Lives on the Battlefield (Part II) 39