Page 71 - Journal of Special Operations Medicine - Fall 2016

TCCC Standardization
The Time Is Now

Carl W. Goforth, PhD, RN, CCRN; David Antico, MSN, RN, FNP-BC

rauma remains the leading cause of death in adults as needed by the Committee on TCCC (CoTCCC),
worldwide, and a significant portion of those the prehospital arm of the Joint Trauma System (JTS).
1
Tdeaths occur within the first 6 to 24 hours after The CoTCCC was established at the Navy Operational
initial injury secondary to hemorrhage. The evolution Medical Institute in 2001, with funding from the US
2,3
of modern-day trauma care has witnessed revolution- Special Operations Command. This 42-member group
ary changes over the past century, with lessons learned comprises trauma surgeons, emergency medicine physi-
from war providing the primary stimulus. Major ad- cians, combatant unit physicians, physician assistants,
vances in surgical vascular procedures and resuscitation and combat medical educators. By charter, no less than
techniques, such as whole blood infusion, prehospital 30% of its membership is made up of active or former
hemorrhage control, and a resurgence of immediate Combat medics, corpsmen, and pararescue personnel.
and aggressive tourniquet use, are more recent develop- The CoTCCC has representation from all of the US
ments. In addition to prehospital advances, the timing Armed Services and, as of January 2016 [personal com-
4,5
from injury to medical interventions also emerged as an munication, CAPT (retired) Frank Butler], has 100%
important factor for positive outcomes. During the wars deployed experience among its members. The CoTCCC
in Iraq and Afghanistan, under the Tactical Combat was relocated in 2007 to the Defense Health Board and,
Casualty Care (TCCC) construct, trauma care and the in 2013, came under the auspices of the JTS (Figure 1)
enhanced capability to collect trauma information from to standardize the care and treatment across all of the
the battlefield have resulted in a greater understanding US Armed Forces. This consolidation has saved count-
of managing penetrating injuries, explosive injuries, less lives on and off the battlefield.
and life-threatening hemorrhage. The fatality rate dur-
ing Vietnam was approximately 14%; that has dropped
to 9% during Operation Enduring Freedom (OEF) and
Operation Iraqi Freedom (OIF). This improved sur-
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vivability is widely attributed to two recent advances: Figure 1
rapid evacuation from the battlefield and early prehos- The Committee
pital treatment. The purpose of our commentary is to on Tactical
emphasize that while great strides in prehospital care Combat Casualty
TCCC have been made in the past 14 years, the lack Care emblem.
of institutional standardization is one of the remaining
challenges of trauma care.

R. Adams Cowley, an Army veteran, is credited as the
pioneer of the “Golden Hour” concept in the 1970s.
7,8
The Golden Hour refers to the 60 minutes from time
of traumatic injury to definitive care that can to greatly
reduce the mortality of severe trauma. This concept led Practice guidelines and lessons learned from recent mili-
to the TCCC initiative, which was developed in 1996 by tary conflicts around the globe that apply to TCCC are
the Naval Special Warfare Community in partnership directly credited for increasing injury survivability. 10–12
with the Uniformed Services University of the Health Sci- The TCCC guidelines cover a broad range of prehos-
ences. This paradigm-changing concept was introduced pital procedures, from simple tourniquet placement to
in an article titled “Tactical Combat Casualty Care in prehospital blood administration and performing sur-
Special Operations,” in the journal Military Medicine. gical airways. These TCCC lessons learned also have
9
Since 2001, the TCCC guidelines have been updated potential benefits for civilian agencies. For instance,

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