Page 21 - Journal of Special Operations Medicine - Winter 2015

care are identified. Any voting member of the CoTCCC projects that each member believed to be most impor-
may propose a change to the current TCCC guide- tant. Members were asked to consider the following in
lines. The order in which changes are presented to the selecting their Top 10 projects:
CoTCCC is determined by the chairman, in consultation
with the director of the JTS. The proposed change and • Will the project help to identify the causes of prevent-
the evidence that supports it are compiled into a draft able death on the battlefield?
position paper. The paper is then discussed by the voting • Will the project help reduce preventable deaths on the
members of the CoTCCC and by additional SMEs and battlefield?
liaisons from the Service medical departments, Combat • Will the project help reduce long-term disability?
Command Surgeons’ staffs, other government agencies, • Is the intervention in the project feasible for prehospi-
and allied nations that collectively compose the TCCC tal care providers?
Working Group. This review of proposed changes is ac- • What other methods to accomplish the desired effect
complished either at meetings or via teleconference. Once for the casualty are currently available?
the proposed change has been reviewed and items of con- • How long would the project take to complete?
tention have been discussed and addressed, the change is • How much will the project cost?
reworded to reflect the consensus views and opinions pre- • How much will the new equipment or medication
sented during the review process, and the position paper cost to field?
is revised and distributed. An electronic vote is then con- • What is the likelihood of successful completion of the
ducted among the 42 voting members of the CoTCCC. project?

Once the proposed change is approved by the CoTCCC The following list contains the Top 10 priorities for bat-
and, subsequently, by the director of the JTS, the change tlefield trauma care RDT&E as established by the votes
paper is finalized and submitted to the US Army Institute of the CoTCCC.
of Surgical Research (USAISR) for publication approval.
After approval, the TCCC change papers are published 1. Explore all options to make a US Food and Drug
in the Journal of Special Operations Medicine. Interim Administration (FDA)-approved dried plasma product
change notices are sent out to a TCCC distribution group available for all US Military Combat medical providers.
and posted on several websites that post TCCC mate- This product should be able to be transfused to casual-
rial as soon as the paper is approved by USAISR and the ties of any blood type, should be able to withstand the
training slides needed to train the change have been de- temperatures encountered in military prehospital set-
veloped. The Prehospital Trauma Life Support textbook tings, should have a long shelf life, and should not be
is updated every 3–4 years and new changes are also re- packaged in breakable containers.
flected in each updated version of the PHTLS textbook.
The TCCC change papers for 2013 through 2015 are in- Freeze-dried plasma (FDP) was identified at the Janu-
cluded in the references for this article. 12,18–25 ary 8–9, 2011, USAISR Medical Research and Materiel
Command Fluid Resuscitation Conference as the most
Each of the TCCC change papers has a section in which promising near-term fluid for damage-control resuscita-
additional research, development, test, and evaluation tion in circumstances when Special Operations Forces
(RDT&E) items of interest that emerged during the dis- (SOF) medics or other Combat medical personnel must
cussions of the proposed change are noted. These re- provide casualty care in remote locations where evacua-
search items are believed by the authors of that paper to tion may be delayed for several hours or days. FDP was
be of potential benefit to future CoTCCC decisions in recommended as a top research priority by the SMEs at
that aspect of prehospital trauma care. These potential this conference. 30
research items were compiled and placed into a consoli-
dated list of potential RDT&E topics. Also included in As a resuscitation fluid, plasma restores fibrinogen and
this list are research priorities identified by the CoTCCC other hemostatic factors, as well as volume, in contrast
and endorsed by the DHB in previous years, 26,27 and to crystalloids and colloids, which restore volume with-
RDT&E issues noted in the two Joint Training System out any hemostatic factors and, thus, contribute an iat-
(JTS)/US Central Command assessments of prehospital rogenic component to trauma-associated coagulopathy.
trauma care in Afghanistan. 28,29 Early administration of plasma to casualties in hem-
orrhagic shock is an essential part of the JTS damage
control resuscitation (DCR) strategy. DCR is also now
31
Current CoTCCC RDT&E Recommendations
widely used in the US civilian sector. 32–35
In April 2015, voting members of the CoTCCC were
provided with the compiled list of 116 proposed Plasma was preferred over crystalloids and colloids in
RDT&E projects and asked to identify the 10 research the recent TCCC review of resuscitation fluids. FDP
12

The Combat Medic Aid Bag: 2025 9