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the immediate need to develop a TCCC curriculum with 3. Perkins J, Beekley A. Damage control resuscitation. In: Sav-
a set of core training standards to aid in the national itsky E, Katz D (eds). Combat Casualty Care: lessons learned
standardization of education, examination, certifica- from OEF and OIF. Fort Detrick, MD: Office of the Surgeon
General, Department of the Army; 2012:121–164.
tion, and recertification with an option to add situation 4. Beekley AC, Sebesta JA, Blackbourne LH, et al. Prehospital
and/or service-specific components. Accomplishing this tourniquet use in Operation Iraqi Freedom: effect on hem-
task would be a revolutionary step forward in ensuring orrhage control and outcomes. J Trauma Acute Care Surg.
that TCCC, a time-tested methodology of tactical casu- 2008;64(2 suppl):S28–S37; discussion, S37.
alty care, would be a consistent and transportable skill 5. Eastridge BJ, Jenkins D, Flaherty S, et al. Trauma system de-
velopment in a theater of war: experiences from Operation
set across services and other governmental agencies. Iraqi Freedom and Operation Enduring Freedom. J Trauma.
2006;61(6):1366–1372; discussion 1372–1373.
Using the model of the Military Training Network’s 6. Goldberg MS. Death and injury rates of US military personnel
agreement with the AHA as a baseline program, we in Iraq. Mil Med. 2010;175:220–226.
propose that the solution to this lack of standardization 7. Osborn TM, Scalea TM. A call for critical care training of
emergency physicians. Ann Emerg Med. 2002;39:562–563.
is already in place. The civilian sector, namely the Na- 8. Cowley R. The resuscitation and stabilization of major mul-
tional Association of Emergency Medical Technicians tiple trauma patients in a trauma center environment. Clin
(NAEMT), has already incorporated the DoD’s TCCC Med. 1976;83:16–22.
course as part of the US prehospital trauma life sup- 9. Butler Jr F, Hagmann J, Butler E. Tactical combat casualty
care in special operations. Mil Med. 1996;161:3–16.
port (PHTLS) program. Therefore, the framework for 10. Butler FK Jr, Blackbourne L. Battlefield trauma care then and
29
standardization across Services and civilian agencies al- now: a decade of Tactical Combat Casualty Care. J Trauma
ready exists. The struggle to bring consistency, quality, Acute Care Surg. 2012;73(6 suppl 5):S395–402.
and competence to the delivery of prehospital Combat 11. Kotwal RS, Montgomery HR, Kotwal BM, et al. Eliminat-
casualty care over the past 14 years of conflict has been ing preventable death on the battlefield. Arch Surg. 2011;146:
1350–1358.
a major factor in the US Military achieving the highest 12. Eastridge B, Mabry R, Seguin P, et al. Death on the battlefield
historical wounded survival rate during OEF and OIF. (2001–2011): implications for the future of combat casualty
Despite paradigm-changing advances, adverse casualty care. J Trauma Acute Care Surg. 2012;73(6 suppl 5):S431.
care events directly attributed to inconsistent TCCC 13. Callaway D, Smith E, Cain J, et al. Tactical Emergency Casu-
training still persists, as most recently highlighted by alty Care (TECC): guidelines for the provision of prehospital
Col Kirby Gross, JTS Director. Therefore, we conclude trauma care in high threat environments. J Spec Oper Med.
24
2011;11:104–122.
that a clear opportunity exists for CoTCCC and other 14. Jacobs L, Eastman A, Mcswain N, et al. Improving survival
governmental and civilian agencies (e.g., NAEMT and from active shooter events: The Hartford Consensus. Bull Am
the PHTLS Executive Council) that have already ad- Coll Surg. 2015;100(1 suppl):32–34.
opted the TCCC construct to establish a strategic part- 15. Jacobs LM. The Hartford Consensus III: implementation of
bleeding control. Conn Med. 2015;79:431–435.
nership with the central vision and overarching goals of 16. Jacobs L, Wade D, McSwain N, et al. Hartford Consensus: a
developing national TCCC certifications applicable to call to action for THREAT, a medical disaster preparedness
all civilian services (fire, law enforcement, rescue), gov- concept. J Am Coll Surg. 2014;218(3):467–475.
ernmental agencies, and US Armed Services. 17. Aberle SJ, Lohse CM, Sztajnkrycer MD. A descriptive analy-
sis of US prehospital care response to law enforcement tacti-
cal incidents. J Spec Oper Med. 2015;15:117–122.
Disclosures 18. Office of Health Affairs, Department of Homeland Security.
The authors have nothing to disclose. First responder guide for improving survivability in impro-
vised explosive device and/or active shooter incidents. 2015.
http://www.dhs.gov/sites/default/files/publications/First
Disclaimer %20Responder%20Guidance%20June%202015%20
FINAL%202.pdf. Accessed 9 November 2015.
The views expressed are those of the authors and do 19. Pons PT, Jerome J, McMullen J, et al. The Hartford Consen-
not reflect the official policy or position of the United sus on Active Shooters: implementing the continuum of pre-
States Navy, the Uniformed Services University of the hospital trauma response. J Emerg Med. 2015;49:878–885.
Health Sciences, the Department of Defense, or the US 20. Jacobs L, McSwain N, Rotondo M, et al. Improving survival
from active shooter events: the Hartford Consensus. Bull Am
Government. Coll Surg. 2013;98:14–16.
21. Tien H, Jung V, Rizoli S, et al. An evaluation of tactical com-
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