Page 150 - Journal of Special Operations Medicine - Fall 2015
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TCCC: A Brief History Battlefield Trauma Care:
Now
• Original paper published in 1996 • Phased care in TCCC
• First used by Navy SEALs, • Aggressive use of tourniquets in CUF
• Combat Gauze as hemostatic agent
Army Rangers, and Air Force • Aggressive needle thoracostomy
Pararescue in 1997 • Sit up and lean forward airway positioning
• Updates published in PHTLS • Surgical airways for maxillofacial trauma
manual since 1999 • Hypotensive resuscitation
• ACS COT and NAEMT • IVs only when needed/IO access if required
endorsement of PHTLS Manual • PO meds, OTFC, ketamine as “Triple Option”
• USSOCOM adopted TCCC in 2005 for battlefield analgesia
• Now used throughout the • Hypothermia prevention; avoid NSAIDs
U.S. military • Battlefield antibiotics
• Tranexamic acid
• Also allied nations and civilian sector 10 • Junctional tourniquets 11
Tourniquets in the U.S.
Military - 2003
Lest we forget – most of the U.S.
military went to war in Afghanistan
and Iraq without tourniquets
12
Tourniquets in Vietnam: Tourniquets in TCCC
A Historical Perspective Mil Med 1996
“The striking feature was to see healthy
young Americans with a single injury of “It is very important, however, to stop major bleeding as quickly as
the distal extremity arrive at the possible since injury to a major vessel may result in the very rapid
onset of hypovolemic shock…Although ATLS discourages the use
magnificently equipped field hospital, of tourniquets, they are appropriate in this instance because direct
usually within hours, but dead on arrival. pressure is hard to maintain during casualty transport under fire.
Ischemic damage to the limb is rare if the tourniquet is left in place
In fact there were 193 deaths due to less than an hour and tourniquets are often left in place for several
wounds of the upper and lower hours during surgical procedures. In the face of massive extremity
extremities, or two percent of the 2600.” hemorrhage, in any event, it is better to accept the small risk of
ischemic damage to the limb than to lose a casualty to
exsanguination….The need for immediate access to a tourniquet in
such situations makes it clear that all SOF operators on combat
CAPT J.S. Maughon missions should have a suitable tourniquet readily available at a
Mil Med 1970 standard location on their battle gear and be trained in its use.”
138 Journal of Special Operations Medicine Volume 15, Edition 3/Fall 2015
