Page 158 - Journal of Special Operations Medicine - Summer 2016

• Continue with research efforts in this area. • JKO tracking of TCCC-MP (medical personnel) and
• Improve the mental health capabilities of PJ flight TCCC-AC (all combatants) training for all Services
surgeons. • DMRTI coordination with DoD Simulation Centers
• Provide basic training for the Pararescue community to create a Joint Simulation and Medical Modeling
leaders on how to identify and handle operators in course to complement the approved Squad Over-
need of care and support. match Program being instituted by COL Irizarry at
the Joint Program Management Office for Medical
19. TCCC Training Initiatives at DMRTI: COL Kirby Modeling and Simulation
Gross and MAJ Walter Engle emphasized that the
number one priority of the Defense Medical Readiness COL Gross and MAJ Engle also proposed that DMRTI
Training Institute (DMRTI) is reinforcing TCCC as the provide a TCCC Handbook to TCCC course students.
standard for point-of-injury care throughout the US The Center for Army Lessons Learned has a TCCC
Military. They noted that there is currently no standard- Handbook that could be updated for this purpose.
ization of TCCC courses in the DoD, which has resulted (Chairman’s note: This is an excellent suggestion and
in wide variation in their content. This variation has has been taken for action by the CoTCCC. The TCCC
been associated with adverse outcomes in casualties and Handbook will be medic-driven and will present TCCC
has also resulted in students who participate in TCCC information in a more succinct format than present
courses being subjected to inappropriate and potentially TCCC knowledge products.)
hazardous medications and procedures as part of their
training. They also noted that, at present, not all mili- 20. Three Things That I Would Change About TCCC:
tary physicians and PAs obtain TCCC training. A Joint Surgeon Captain Steve Bree, Royal Navy, is the British
Trauma System White Paper sent to the service Sur- Liaison Officer to the Surgeon General of the Army. At
geons General in September 2015 highlighted the cur- the invitation of the CoTCCC Chairman, he offered his
rent problems with TCCC training and recommended thoughts about the top three opportunities to improve
corrective actions to address these deficiencies. in TCCC as he sees them. He prefaced his remarks by
noting that his opinion of TCCC is very positive. He re-
COL Gross and MAJ Engle also discussed current marked that the TCCC effort has a “Team Sky” mental-
DMRTI efforts to increase the quality and accuracy ity that maintains “a relentless and open-minded search
of TCCC training courses across the DoD. A strate- for every conceivable improvement.”
gic partnership between the NAEMT and the Military
Training Network (MTN) would facilitate military or- CAPT Bree then presented the organization and man-
ganizations functioning as NAEMT-approved training ning of prehospital emergency medicine (PHEM) in the
sites. NAEMT became involved in TCCC training in United Kingdom in the larger context of the UK National
2009, when, at the request of the CoTCCC Chairman, Health System. With respect to combat casualty care in
they helped provide TCCC training for the Spanish the US Military, he asked: “Where are your prehospital
Special Forces. The NAEMT has a robust educational emergency medicine physicians?” and noted that the ac-
infrastructure accredited by the Continuing Education complishments of the UK Medical Emergency Response
Coordinating Board of Emergency Medical Services. Team (MERT) “shone brightly” in the recent conflict
NAEMT TCCC courses use the curriculum developed in Afghanistan but commented it was only a single as-
by the CoTCCC and provide to course graduates a set against the large number of US medical evacuation
TCCC certification card that is endorsed by the JTS, the platforms. CAPT Bree stated that TCCC skills should be
CoTCCC, the NAEMT, and the American College of progressive and extend past the paramedic skillset, and
Surgeons Committee on Trauma. that the level of care should increase all along the evacu-
ation chain. Although he acknowledged the US medical
Issues that still need to be addressed include identify- mission of caring for dependents and beneficiaries, he
ing a funding source for the $10 per student cost for observed that this must be balanced against the need for
NAEMT TCCC courses and agreement on the qualifica- a highly developed level of expertise in trauma care that
tions that military medics must have to be designated as focuses on our deployed mission. CAPT Bree considers
TCCC instructors. the autonomy and authority of our senior enlisted med-
ics and the dynamism of TCCC to be lessons that should
DMRTI is exploring a number of initiatives that may be taken on board by the UK military.
help facilitate TCCC training throughout the DoD:
• Using Joint Knowledge Online (JKO) for registration CAPT Bree’s top three recommendations for improv-
of TCCC students ing TCCC are (1) to add pelvic binders to the TCCC
• DMRTI training teams to provide the TCCC for the Guidelines for casualties with suspected pelvic fractures,
Medical Personnel course to requesting units (2) to establish the placement of physicians and medics

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