Page 154 - Journal of Special Operations Medicine - Summer 2016

chaotic environment that is present in most combat ca- odds with actual TCCC recommendations. Additionally,
sualty scenarios, making this is a focus area for TCCC. medics and corpsmen have requested a TCCC knowl-
Improved training in this area is especially important edge product that provides a succinct overview of TCCC
for basic medics and corpsmen, who are not trained to concepts in a format that can be supported by the per-
the paramedic level. Proposed innovations in this area sonal smartphones that essentially all Combat medical
include simplifying guidance for administration (i.e., providers now own and carry with them while deployed.
standardizing dose sizes, infusion times, medication TCCC Mobile will be tailored to medic preferences and
concentrations, and so forth), minimizing IV adminis- will offer standard content across multiple communica-
tration system variation, and identifying a universal di- tions platforms. The platform will provide a range of
luent. This topic will be addressed as a revision to the blended learning—informal and formal training materi-
TCCC curriculum in the next annual update. als, combined with instructional videos, pushed alerts to
highlight changes in practice, and other informational
7. Advanced Field Care: Dr Butler discussed a concept resources. In Dr Steffensen’s recent survey of medics, the
that he designated as “Advanced Field Care.” Prolonged response to a proposed free TCCC app for mobile de-
Field Care (PFC) is for the medic who is stranded with vices was 90% positive. Dr Steffensen and Ms Cynthia
a casualty in circumstances that prevent evacuation. Barrigan have done outstanding work in securing MHS
Advanced Field Care (AFC) is conceptualized as more funding and executive sponsorship for the TCCC Mobile
than TCCC but less than damage control surgery, of- effort. It is anticipated that the initiative will be launched
fering additional advanced interventions in prehospital in June 2016. Mr Harold Montgomery, Mr Winn Kerr,
settings and focusing largely on noncompressible hem- MSG Curt Conklin, and SFC Danny Morrissette will
orrhage. AFC is envisioned for use on ships, in subma- serve as the medic collaborators in the design and de-
rines, by shock/trauma units, in Battalion Aid Stations, velopment of this platform and its medical content. An-
medical emergency response teams (MERTs), and in other update will be provided at the 2016 Fall CoTCCC
Special Operations Forces (SOF) Forward Operating meeting.
Bases. Possible treatment options and diagnostic capa-
bilities in AFC include: Mr Montgomery and Mr Kerr then previewed a con-
• Fresh whole blood or 1:1 resuscitation cept of an interactive website featuring bulletized TCCC
• ResQFoam guidelines with embedded links to explanatory text,
• REBOA (resuscitative endovascular balloon occlusion videos, and so forth, which could possibly serve as a
of the aorta) launching platform for the TCCC Mobile app. If this
• Chest tubes with possible reinfusion of shed blood course of action is adopted and funding is approved, a
• Focused assessment with sonography for trauma website could be launched in the very short term. Audi-
(FAST) scans ence feedback about the design and function of the pro-
• Assisted ventilation (SAVe II) with oxygen posed website was very positive. Dr Butler noted that
• Lateral canthotomy the current TCCC websites that present the Commit-
• Infrared scanning for intracranial hematomas tees’ knowledge products in the “TCCC Classic” for-
mat will be maintained until there is user consensus to
AFC could be used by providers at the paramedic level migrate to an updated format.
or above who are trained sufficiently to maintain proce-
dural fluency in these procedures. Locations where AFC 9. Proposed TCCC Guideline Change – iTClamp: MAJ
(which is basically a Role 1+ capability) is to be pro- Kyle Faudree from the 160th Special Aviation Regiment
vided must be appropriately equipped. This approach briefed the group on the proposal before the Committee
would assist in the transition of a number of treatment to add the iTClamp to the guidelines. The iTClamp is
modalities that are being developed under the Combat often described as a “chip clip” type of device designed
Casualty Care Research Program at the US Army Medi- for wound closure. The device costs $78, weighs 1.3 oz,
cal Research and Materiel Command. takes up 6 cubic inches of space, and has a 6-year shelf
life. The clamp creates a fluid-tight seal and uses build-
8. TCCC Mobile: Dr Steve Steffensen, the Chief of In- ing hydrostatic pressure to tamponade the wound bed
novation for the Military Health System (MHS), up- and promote clotting. MAJ Faudree pointed to 13 stud-
dated the Committee on the progress of a new Defense ies (five of them clinical) showing safety and efficacy of
Health Agency Innovation initiative focused on devel- the device. He noted that the device is easy to learn, rap-
oping a platform to streamline the flow of TCCC in- idly applied, and that the available literature indicates
formation and provide maximum access to available it is efficacious. Its proponents recommend using it as
resources. In the current world of TCCC training and an adjunct to, not a replacement for, other hemorrhage
education, various communities get TCCC content from control devices and hemostatic agents. MAJ Faudree
public and military sources, some of which may be at also discussed the latest version of the recommended

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