Page 153 - Journal of Special Operations Medicine - Summer 2016

has been approved through the National Association of (AAJT) to the TCCC Guidelines. There are research re-
Emergency Medical Technicians (NAEMT) educational ports of adverse ischemic and reperfusion effects from 2
infrastructure as a qualifying course for TCCC certifica- hours of abdominal aortic occlusion. The AAJT instruc-
tion using the Joint Trauma System TCCC curriculum. tions for use state that it can be applied at the abdomi-
Identified limitations at present include the required nal placement site for up to 4 hours. There are also no
4:1 student to instructor ratio, and the $10 charge per data at present that documents the safety of AAJT place-
TCCC card. ment to control pelvic or junctional bleeding should the
casualty also have a vascular injury proximal to the aor-
4. TCCC Update: CAPT (Ret) Frank Butler, Chairman tic occlusion site.
of the CoTCCC, reviewed items of recent interest in
TCCC. The CoTCCC has approved the addition of XStat com-
pressed hemostatic sponges to the TCCC Guidelines.
TCCC concepts continue to be adopted by an increas- XStat has been shown to successfully control bleeding in
ing number of civilian emergency medical systems and a highly lethal bleeding model of combined subclavian
law enforcement agencies. There are frequent reports artery and vein injury.
of lives saved with officer-applied tourniquets or hemo-
static dressings. TCCC-based civilian courses include the Inconsistency in TCCC training across the DoD con-
NAEMTs Bleeding Control and Law Enforcement First tinues to be a significant problem. Many “TCCC”
Responder courses, the Tactical Emergency Casualty Care courses—are not. There has been no standardization
course, the Specialized Tactics for Operational Rescue of TCCC training across the DoD. TCCC courses are
and Medicine (STORM) course at the Medical College taught both by DoD organizations and civilian training
of Georgia, the Advanced Law Enforcement Rapid Re- vendors. Incorrect messaging has been directly associ-
sponse Training at Texas State University, among others. ated with adverse outcomes in casualties, while inap-
propriate training in some civilian courses puts both
The White House “Stop the Bleed” campaign is aimed students and future patients at risk. Further, supervising
at turning lay citizens who are present at trauma scenes physicians are often taught advanced trauma life sup-
into “immediate responders.” Immediate responders port and not TCCC and do not have a knowledge of
should be trained to use TCCC concepts, including DoD-approved TCCC recommendations.
tourniquets and hemostatic dressings, to save lives by
controlling external hemorrhage as quickly as possible. 5. Bulletized TCCC Guidelines: Mr Harold Montgom-
ery presented work he and other medics have done to
As presented during Hartford Consensus IV, civilian create a simplified version of the TCCC guidelines for
trauma leaders may be influenced by red/green charts medics’ quick reference. They removed language on
similar to those used by the CoTCCC to track service how and why to do things, and retained only language
individual first aid kit components. Readiness to accom- conveying what to do. This was done in response to in-
plish first responder external hemorrhage control (as put from the medics, corpsmen, and PJs noting that the
measured by tourniquets and hemostatic dressing issue TCCC Guidelines are now 14 pages long and that Com-
and personnel trained in TCCC-based courses) could be bat medical providers need a reference document that
quantified by these red/green charts. Additionally, out- conveys the needed information in a simpler, shorter
comes in wounded officers and mass casualty incidents format. Mr Montgomery also presented a concept for
should be captured through registries, case series, and an algorithmic version of the medic-level TCCC guide-
case reports. Officer and mass casualty fatalities should lines. This concept was well received by the audience
be subjected to preventable death analyses. and will be developed further.

Dr Butler noted that the Hartford Consensus papers rec- 6. IV/IO Medications in TCCC: SOCM James Holmes
ommend that organizations in the civilian sector that (Tactical Medic Program Manager for the Naval Special
are purchasing tourniquets or hemostatic dressings re- Warfare Command) presented the work done by him
view the recommendations and evidence base for these and a CoTCCC working group to develop a simplified
devices as compiled by the CoTCCC and Department approach to the administration of IV/IO medications
of Defense (DoD) research laboratories. With respect to in TCCC. The impetus for this effort is that there has
tourniquets and hemostatic dressings, Dr Butler pointed been little “how to” guidance in the TCCC curriculum
out that in 2016, one can be either evidence-based or on how to administer medications via IV or IO in the
brand neutral, but not both. tactical setting. Additionally, training medics in IV med-
ication administration is problematic in the hospital set-
The CoTCCC has suspended further discussion of add- ting. IV medications are essential to optimal battlefield
ing the Abdominal and Aortic Junctional Tourniquet trauma care, but dosing errors may occur during the

CoTCCC Meeting Minutes 139