Page 51 - Journal of Special Operations Medicine - Summer 2015

35. Add IV saline lock and IV Hextend back to CLS and equip medics to operate when the evacuation times were
training, since now that the only lifesaving fluid needed to be greater than 2 hours. Medical needs to be in every Com-
carried is Hextend 500mL. This prevents hypotensive resus- mander’s top 4 priorities. Those Commanders that have had
citation problems by blowing clots with fluid overload. The casualties or had Soldiers die understand this, but as new
medic relies on CLS with multiple casualties to initiate IVs Commanders rotate in without that experience, the reality will
to also give medications like antibiotics and ketamine. (JTTS diminish. (Army Infantry Battalion Commander)
Prehospital Coordinator) 45. Nonmedical Platoon Sergeants need to know the
36. After our briefing on the TCCC Guidelines and the ROLE of the medic in his platoon, and should understand the
recent FRAGOs, unit medics were not aware of the standards. TCCC Guidelines. This should be accomplished at the Senior
They felt that the information they received was being diluted Leaders Course. In the contiguous United States (CONUS),
through the chain of information flow, or that the information medics should rotate through trauma centers for realistic
was being changed, or they were not getting the information training to understand combat casualties. (Army 1SG)
at all. (Army ROLE-1) 46. I was at C4 (Combat Casualty Care Course) and Bri-
37. The Interservice Physician Assistant Program (IPAP) gade Combat Team medical training earlier this week to see
used to be “from the line to the line.” Medics that grew up in what the tourniquet training is like, and the regular tourni-
the line units become the best PAs because they lived it and un- quets seem well integrated and mature. The junctional tour-
derstood how a combat unit operates and what medics need to niquets are taught lightly and are not fully integrated nor
know. The IPAP now receives nonmedic officers and enlisted as maturely used as regular tourniquets. Mostly there is an
personnel and puts them and the Unit at a disadvantage. A awareness gap, and the funding and lack of doctrinal enact-
dental technician became a PA and deployed straight out of ment are the main sources of the awareness gap. I suspect that
IPAP and is the sole provider in an isolated FOB. He admits other teaching venues may vary as the onus seems to be on the
his inadequacies for combat. (JTTS Prehospital Coordinator) key leaders. The services are being led by the small unit lead-
38. A FOB in the retrograde process had no heat for the ers. (John F. Kragh Jr, CIV MEDCOM, USAISR)
medic living area or the BAS for 3 to 4 weeks. The BAS got 47. Using Afghanistan as an example, we must train as
to 28°F, a bad scenario for potential trauma casualties. The we fight for the most common worst-case scenarios, which are
leadership acknowledged the deficiency, but did nothing about always in the beginning of the war. Units are more austerely
it. (USMC ROLE-1) located and isolated, and medical support is very limited. Evac-
39. TCCC instruction sites need to have the latest TCCC uation times are lengthy and medics will need to hold onto
Guidelines. (Army ROLE-1) casualties longer. All 68Ws, Corpsmen, and AF Medical Tech-
40. Unit ordered the FAST-1 interosseous device and was nicians entering the military need to be trained on all TCCC
told they will most likely not be receiving any. They also are Guidelines interventions if we are serious about providing the
not able to get Hextend. Each of the Corpsmen going out on best chance for combat casualties to survive at the point of in-
patrol has one bag, but there are none in the BAS and, there- jury. CONUS Medic training programs must mirror what med-
fore, no resupply if the Hextend has to be used. They were told ics do in combat, and must implement all the TCCC Guidelines
that as far as supplies go, they will only receive what they have as the standard of care in combat. Completion of the TCCC
on hand at Leatherneck because they are no longer allowed AAR and the Evacuation Patient Care Report (PCR) for com-
to order supplies due to Leatherneck closing down “soon.” bat casualties must be a part of the weekly Commander’s brief
(USMC ROLE-1). (JTTS Note: The authors observed hun- for his unit, just as disease non-battle injury (DNBI) trends and
dreds of new in-box TCCC medical supplies including FAST- deadlined vehicles are. (JTTS Prehospital Coordinator)
1s and Hextend being burned at the Bagram retrograde yard). 48. TCCC Guidelines should supersede a physician’s
41. Marines: Independent Corpsmen in an advisory mis- opinion when it comes to developing, implementing, and en-
sion ROLE to other militaries during deployment do not get suring an organization’s TCCC capability. A physician’s medi-
medical supplies to support their mission because they are not cal license is not threatened with the implementation of the
in an organic marine unit. Only organic units get supplies as TCCC Guidelines on the battlefield. All licensed providers at
designed for that unit. Command did not buy medical equip- all levels need to be educated on this issue during their career
ment with Overseas Contingency Operations funds because and reminded of this point just prior to deployment. (JTTS
they were too expensive. (USMC ROLE-1 minus) Prehospital Coordinator)
42. Many units in Afghanistan deployed and found them- 49. The TCCC curriculum does make a point of individual
selves subordinate to different Commands of other units. This providers treating individual patients as needed by the tactical
makes the chain-of-supply system difficult to use, and the Com- situation. However, this doesn’t mean that a provider should
mand Unit standard operating procedure in regard to utilization systematically and programmatically undermine a unit’s life-
of the medics interferes with the medical element to fulfill their saving capabilities that are provided by the full implementa-
mission (i.e., providing medics for guard duty). (Army ROLE-1) tion of the TCCC Guidelines. Especially when their decisions
43. MC4 computers automatically upload notes into The- compromise the command’s prehospital capabilities due to ig-
ater Medical Data Store. The system does not notify you if the norance and subsequent inappropriate professional concerns.
notes do not upload. I know where to look, so I was able to (JTTS Prehospital Director)
correct the problem, but if someone does not know where to 50. Unit medical training must be integrated into the unit
look, the notes would eventually be lost when the computer mission training, just as performed by units during National
gets wiped before going home. (Army ROLE-1) Training Center and Joint Readiness Training Center rota-
44. We need to focus medical training on the worst-case tions. This is realistic unit combat medical training. (Army
scenario, which was during the beginning of the war. Train ROLE-1)

Saving Lives on the Battlefield (Part II) 41