Page 135 - Journal of Special Operations Medicine - Summer 2016

DoD Joint Trauma System Tactical Combat Casualty Care

Coalition forces at the end of the Afghanistan conflict had
the best definitive care and evacuation system in history.
The Prehospital Arm of the US Military’s
Joint Trauma System

• Medics, Corpsmen, PJs
• TCCC’s job is to make sure that the casualties get to TCCC • Combat Lifesavers
the hospital alive so that they can benefit from it - • All Combatant Self/Buddy Care

• 87% of combat fatalities die in the prehospital phase. 4 • Includes Tactical Evacuation Care
Photo – MSG Harold Montgomery
5

Tactical Trauma Care at A Look Back:
Berator
8000 ft in the Hindu Kush Battlefield Trauma Care: 1970

“The striking feature was to see healthy young
Americans with a single injury of the distal
extremity arrive at the magnificently equipped
field hospital, usually within hours, but dead
on arrival. In fact there were 193 deaths due
to wounds of the upper and lower extremities,
…… of the 2600.”
CAPT J.S. Maughon
Mil Med 1970
* Extremity hemorrhage math in Vietnam:
193 of 2600 = 7.4% x 46, 233 fatalities = 3,421
preventable US deaths from extremity hemorrhage 7 7

6 6

Battlefield Trauma Care: 1970 Battlefield Trauma Care
1995
• Based on trauma courses NOT developed for combat
“All seem uncertain regarding the best method • Medics taught NOT to use tourniquets
to implement factual knowledge to the man
most in need, the front line trooper….citing • No hemostatic dressings
our ineptness in the field of self-help and first • Large volume crystalloid fluid resuscitation for shock
aid …..”little if any improvement has been • 2 large bore IVs on all casualties with significant trauma
made in this phase of treatment of combat • Civil War-vintage technology for battlefield analgesia (IM
wounds in the past 100 years.” morphine)
• No focus on prevention of trauma-related coagulopathy
• No tactical context for care rendered
• Special Ops Medics – venous cutdowns if trouble starting an IV
CAPT J.S. Maughon • Heavy emphasis on endotracheal intubation for prehospital
Mil Med 1970 8 8 9
airway management

TCCC Updates 121