Page 136 - Journal of Special Operations Medicine - Summer 2016

Tourniquets Reconsidered: 1992 Tactical Combat Casualty Care
(TCCC) : A Different Approach
• ATLS 1992: NO tourniquets
• Fear of ischemic damage to limbs • Battlefield trauma care research effort – Special
But Operations and USUHS: 1993-1996
• Exsanguination from extremity hemorrhage was the #1 • Combat environment and mission considered
cause of preventable death among US casualties in • Combat medic training and equipment
Vietnam (estimated 3,421 deaths) considered
• Tourniquets can control extremity hemorrhage • Project included input from combat medics,
• Tourniquets are used routinely during orthopedic surgery corpsmen, and pararescuemen (PJs)
• Limbs are not lost there as a result • Evidence-Based – INCLUDING requiring
• Also - if you had to choose between death and losing a
leg…. evidence for prevailing practice at that time
• “No TQ” rule: NOT evidence-based; NOT logic based 10 • Goal – To Prevent Preventable Deaths 11

Combat Fatalities: Two Types The acceptable number of preventable
deaths is – ZERO.

• Non-Preventable:
• Helicopter hit by a rocket
and explodes in mid-air

• Potentially Preventable:
• Special Forces Soldier
• Shot in the knee
• No other major wounds
• Bled to death - 2003 12 13

Tactical Combat Casualty
Care in Special Operations
COL Brian Eastridge
J Trauma 2012
• 4, 596 Combat Fatalities
• 4, 016 Died Prehospital
• 24% Potentially Preventable
Military Medicine Supplement
August 1996

Evidence-based trauma care
guidelines customized for use
on the battlefield

122 Journal of Special Operations Medicine Volume 16, Edition 2/Summer 2016