Page 47 - Journal of Special Operations Medicine - Fall 2015

OCs. However, distinct anatomic and physiologic dif- Operation Iraqi Freedom. Their analysis demonstrated
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ferences between the two species prohibits the direct that direct pressure alone was sufficient in abating ex-
extrapolation of human medicine to canines. Confor- tremity hemorrhages in the field. 31
mational dissimilarities account for variances in ana-
tomic sites for venous access, insertion sites for thoracic Canine TCCC consists of the same three dynamic phases
needle decompression, and the technique for endotra- of care as TCCC: care under fire, tactical field care, and
cheal tube intubation. Presence of a full, thick hair coat tactical evacuation. Since canine TCCC principles align
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may significantly compromise the provider’s ability to with current TCCC doctrine, the principles are easily
identify injuries or effectively seal an open chest wound. learned by first responders already familiar with TCCC.
In an OC suffering from heat stress or exhaustion, it The Department of Defense Military Working Dog Veter-
is important to realize that a canine’s primary mecha- inary Services (DODMWDVS) serves as the representing
nism for heat dissipation during states of environmental organization for providing oversight and coordination of
and exertional hyperthermia is via evaporative losses MWD healthcare for all Armed Services. The DODM-
through panting, not perspiration via sweat glands, as in WDVS fully endorses canine TCCC and now incorpo-
humans. During heat-related injuries, a muzzle that se- rates these principles into their training curriculum for all
cures the mouth in a closed position should be avoided; Veterinary Corps Officers, veterinary technicians (68T),
a basket muzzle that allows the OC to pant effectively non-veterinary healthcare providers, and MWD handlers.
should be used instead. These are some of the factors
that differ significantly between humans and canines. Traditionally, MWD handlers were limited in knowl-
Lack of awareness of these differences, regardless of edge of canine medical care and, therefore, would often
subtlety, may significantly hinder the provider’s ability need to defer care of an injured MWD or MPC to a
to provide appropriate and timely care to the OC. combat medic, corpsman, DUSTOFF medic, or para-
rescue specialist. But, as discussed, these non-veterinary
Regardless of the level of available first-responder care, care providers also typically possessed limited canine
access to appropriate care for injured OCs may be fur- medical expertise. In addition, when deployed medi-
ther hampered by limited logistic allocations of medi- cal evacuation assets and resources (to include medical
cal supplies or evacuation assets. Use of these resources providers) are prioritized for human casualties, delayed
may be prioritized to, or exhausted by, the concurrent transportation and care for MWD casualties often re-
presence of mass human casualties. The lack of read- sults. Therefore, being trained in advanced K9 field
ily available or adequate veterinary care, medical re- care principles is essential for K9 handlers deployed in
sources, and evacuation assets, combined with a high austere environments. Currently, initiatives are in mo-
risk for sustaining traumatic injuries, creates a recipe for tion to close these gaps across the military medical com-
high case fatality rates in these valuable team members. munity and bring forward a continuity of care. More
recently, it has been mandated that all new MWD han-
Based on the success of TCCC in reducing case fatal- dlers must now successfully pass both a written and a
ity rates in human combat casualties, a US Special Op- practical canine TCCC examination before graduat-
erations Command working group convened in 2009 to ing. The focus of handler-level care in the Department
develop canine-specific TCCC principles. Canine TCCC of Defense has evolved from the basics of hemorrhage
is modeled on the same guiding principles as TCCC but control and cardiopulmonary resuscitation to advanced
with adaptations to account for differences related to life-support skills such as surgical tracheostomy, anal-
canine-specific anatomy and physiology. For instance, gesic medication administration, and the use of plasma
in canine TCCC, tourniquets are not recommended as volume expanders in shock management. Canine TCCC
a first-line intervention for controlling extremity hemor- guidelines have recently been published. 34,35 Data from
rhage. Tourniquets tend to be more life-saving and, thus, the field have yet to be objectively analyzed in regard to
more often pursued in humans with massive vascular in- the effects of canine TCCC on OC battlefield mortality
juries to the extremities. People tend to be more prone rates; however, personal experience and experience of
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to massive extremity hemorrhage, since they possess a other MWD caregivers on the front line suggest an over-
large proportion of muscle mass in their limbs. On the all beneficial effect from canine TCCC on abating injury
other hand, dogs have a significantly lower proportion severity at the point of injury and allowing OCs to reach
of muscle mass in their limbs and are less prone to mas- a definitive care facility in a more optimized condition. 36
sive hemorrhage from extremity wounds. In addition,
human commercial tourniquets tend not to work well The Initiation of K9
for upper extremity wounds in dogs, due to the tapered Tactical Emergency Casualty Care
conformation of the dog limb as compared to the hu-
man limb. Baker et al conducted a retrospective study Present-day canine TCCC guidelines are military based
evaluating gunshot wounds suffered by MWDs during and fail to address factors that are unique to the civilian

Tactical Emergency Casualty Care Initiative 35