Page 45 - Journal of Special Operations Medicine - Fall 2015

patrols. K9 use on the battlefield by US Armed Ser- Medical Technicians’ Prehospital Trauma Life Sup-
vices was relatively little until 1942. The first wave of port (PHTLS) course, which subsequently became the
1
US MWDs served as messenger, sled, sentry, and scout basis for both civilian and military casualty care pro-
dogs. Today, use of MWDs has expanded to encompass tocols. Although PHTLS remains one of the lead-
20
a wide array of categories, such as apprehension and ing training programs for civilian prehospital trauma
protection, substance detection, and tracking. On the care throughout the world, it did not adequately ad-
battlefield and on the home front, OCs have provided dress managing out-of-hospital care during high-threat
an immeasurable service and act as a force multiplier situations such as battlefield trauma or urban tactical
throughout the world in the success of various law en- environments. 14,21,22
forcement, military, humanitarian, and SAR operations.
True to the words inscribed on the US Military Working On the battlefield, Tactical Combat Casualty Care
Dog Team Monument, these “Guardians of America’s (TCCC) has been one of the most influential develop-
Freedom” selflessly dedicate their lives to protect us ments for advancing out-of-hospital casualty care and
from danger and defend our way of life. reducing case fatality rates. In the mid-1990s, the Spe-
cial Operations medical community recognized the need
to initiate the TCCC program after realizing the limita-
The Development of tions of incorporating civilian sector-based PHTLS into
Tactical Combat Casualty Care
combat casualty care. In their seminal paper published
Unintentional injuries still remain one of the leading in 1996, Butler and Haggman discussed the limitations
causes of death worldwide in people from 1 to 44 years of PHTLS being related to mitigating factors such as
old. For civilian trauma and military combat casual- operating under darkness, hostile fire, or unsafe envi-
2–4
ties, about 40–70% of posttraumatic fatalities occur ronments; logistical and personnel resource limitations;
before the casualty ever reaches a medical treatment fa- variable provider experience levels; prolonged evacu-
cility (i.e., the prehospital period). 5–10 Many of these pre- ation times; casualty transportation assets; and com-
hospital fatalities occur within minutes of the injury as mand and tactical decisions affecting healthcare. 14,21,22
a result of either massive exsanguination and or severe In the same article, the authors officially proposed
brain injury. 6–10 Approximately 20% to 25% of these TCCC as a new set of prehospital trauma management
fatalities are due to what is termed preventable deaths, principles for combat casualty care. 14,21,22 Since then,
or deaths that can be prevented simply by implement- TCCC’s implementation on the battlefield during Op-
ing early and appropriate basic first aid techniques. 9,11–15 eration Enduring and Iraqi Freedom has been credited
On the battlefield, the three most commonly observed with significant reductions in combat-related case fatal-
trauma-related preventable deaths are hemorrhage from ity rates 14,21,22 The National Association of Emergency
extremity wounds, tension pneumothorax, and airway Medical Technicians has since partnered with the Com-
obstruction. 6,16 mittee on Tactical Combat Casualty Care and published
a TCCC-focused PHTLS manual. 23
In 1966, the Committee on Trauma and the Commit-
tee on Shock, both of the National Academy of Sci- The Development of
ences and the National Research Council, reported that Tactical Emergency Casualty Care
out-of-hospital fatalities due to vehicular trauma had
become the leading cause of death in people 1 to 37 The marked increase in active shooter and mass killing
years old and the leading cause of accidental deaths events (e.g., at Columbine High School [Colorado], Vir-
for people under the age of 75. 17,18 According to their ginia Polytechnical Institute and State University, Au-
study, the US economy suffered an estimated financial rora Movie Theater [Colorado], Ft. Hood [Texas]) over
loss of $18 billion as the result of 52 million accidental the past couple of decades has led to a paradigm shift in
injuries that left approximately 10 million people tem- the way LE agencies have come to operate in these situ-
porarily disabled, 400,000 permanently impaired, and ations. Instead of using the more traditional “contain,
107,000 dead. 17,18 The economic burden alone from the control, and wait for SWAT” approach toward active
rapidly expanding rate of vehicular trauma demanded shooter events, today’s LE community uses a rapid de-
a system for providing expedient prehospital care and ployment strategy, whereby the first LE officers to arrive
rapid transport to a medical facility. 17,18 The void in on-scene immediately form two- to four-person contact
prehospital care was initially filled with the creation of teams and move aggressively to take down or contain
a formalized Emergency Medical Service (EMS) in the the shooter. 24
late 1960s that was spearheaded by President Johnson’s
National Highway Safety Act of 1966. 18,19 In 1983, The rapid deployment model for LE agencies also in-
prehospital trauma care was further advanced with the creased the risk for injury to the LE contact teams;
development of the National Association of Emergency therefore, a shift in doctrine also became necessary for

Tactical Emergency Casualty Care Initiative 33