Page 171 - JSOM Spring 2018

260,000 DoD personnel each year. He welcomed the group on literature and had 12 presentations at the Military Health
behalf of VADM Racquel Bono, the director of the DHA, and Research Symposium. Another recent JTS effort has been a
discussed the importance of caring for our nation’s wounded study that used DoDTR data to document what type and
as well as the pivotal role that DoD trauma training plays in how many surgical procedures were performed by combat
that. He thanked the group at the meeting for their role in trauma surgeons in theater.
helping to improve trauma care in the US military.
7. TCCC Update: Dr Frank Butler presented an update on
4. Senior Leader Remarks: Brigadier General John J. DeGoes TCCC issues. Among the topics covered were:
is vice commander of the 59th Medical Wing, Joint Base San – A thank-you to Ms Danielle Davis and Mr Dallas Burelison
Antonio-Lackland, Texas. The 59th Medical Wing is the Air for their assistance in meeting preparation.
Force’s largest medical wing, consisting of more than 8,000 – A farewell to departing CoTCCC members COL Jim
personnel, seven groups, 11 medical facilities across the San Geracci and COL Peter Benson and a welcome to new
Antonio metropolitan area, and multiple worldwide deploy- CoTCCC members Col Chet Kharod, SFC John Lacroix,
ment sites. He thanked the group for the outstanding work CDR Lanny Littleohn, and LTC Ethan Miles.
that it has done in improving combat trauma care in the mili- – A brief review of the history of TCCC for new attendees at
tary. He also noted that the TCCC Working Group is very the meeting.
typical of high-reliability organizations, with an intolerance – This year’s TCCC award for outstanding contributions to
for failure. Brig Gen DeGoes remarked that the JTS move to the TCCC effort was presented jointly to LTC Ethan Miles,
DHA is a good one, since DHA is currently gaining increased MSG (P) Curt Conklin, and the 75th Ranger Regiment for
power and responsibility in the Military Health System, and the outstanding leadership that has made the 75th Ranger
he pledged to provide whatever support that he can to the Regiment synonymous with excellence in TCCC.
group’s efforts. – Several recent leadership initiatives with respect to TCCC
were reviewed, including Secretary of Defense James Mat-
5. Point of Injury Whole Blood: COL Andre Cap from the tis’s 2013 letter to the Service Chiefs stressing the impor-
USAISR was presented with a Special TCCC Award in rec- tance of TCCC training; the pending DoD Instruction on
ognition of his ongoing innovations in the areas of injectable Military Readiness Training, including TCCC; and the
hemostatic agents and transfusion medicine, especially with 28 June 2017 directive from the Commanding General of
respect to the use of whole blood to resuscitate casualties in the Marine Corps Education and Training Command that
hemorrhagic shock as early as possible in the continuum of states that: “To mitigate the loss of lives and severity of
care. injuries on the battlefield, all combatants and medical per-
The central theme of COL Cap’s presentation was that sonnel on the modern battlefield must be proficient in the
far-forward resuscitation with blood products saves lives. He concepts of TCCC.”
discussed the recent mass casualty incident on the USS Bataan. – In a letter dated 6 November 2017, General Joseph Votel,
The ship’s walking blood bank program enabled them to trans- the current Commander of the US Central Command,
fuse the four casualties involved with 54 units of whole blood established a requirement for all medical personnel (phy-
after all of the available red blood cells had been used. He sicians, PAs, nurses, Medics, Corpsmen, and PJs) to be
noted that whole blood is more effective than blood compo- trained in TCCC for Medical Personnel (TCCC-MP)
nents and that whole blood, transfused as soon as needed, can within 180 days of their deployment. All other personnel
turn combat fatalities into lives saved. He provided guidance deploying to CENTCOM should be trained in TCCC for
on two important aspects of type O low transfusions: 1) type All Combatants (TCCC-AC).
O low transfusions from a walking blood bank require careful – New CoTCCC social media initiatives and the TCCC
follow-up; and 2) Get a blood sample before transfusing, since Quick Reference Guide that have been developed and im-
large volumes of type O low blood may make it difficult to plemented through the efforts of Mr Montgomery.
determine the casualty’s underlying blood type. – The new TCCC for Medical Personnel curriculum has been
COL Cap stressed the need for all combat units to develop completed and includes the latest changes to the TCCC
a Type O Low program and that this will require support from Guidelines, a number of very well-done videos provided
the senior leadership in the DoD. Dr John Holcomb added through a DHA research effort, and the new TCCC Criti-
that all medical treatment facilities that care for seriously in- cal Decision Case Studies.
jured trauma patients should be able to provide both prehospi- – Through the leadership of TCCC Working Group Members
tal and in-hospital resuscitation with whole blood—now! Dr Brad Bennett and COL Ian Wedmore, the Wilderness
Medical Society conducted a 2-day TCCC preconference in
6. Joint Trauma System Director Remarks: CAPT Zsolt Stock- 2016 prior to its annual summer meeting. In June of 2017,
inger, the Director of the JTS discussed the ongoing transi- there was a special edition of “Wilderness and Environ-
tion of the JTS from the Army Medical Research and Materiel mental Medicine” dedicated to covering the TCCC topics
Command to the Defense Health Agency (DHA.) presented by the 22 faculty members at the preconference.
CAPT Stockinger also highlighted the JTS effort to bet- – The latest change to the TCCC Guidelines was spearheaded
ter define what constitutes a preventable death, since this is by Dr Mel Otten and adds extraglottic airways (EGAs) as
one of the most important metrics the JTS uses to guide its an option for airway management in Tactical Field Care.
recommendations for improving combat casualty care. The It also recommends the i-gel as the preferred EGA because
preventable death project was undertaken at the direction of its gel-filled cuff makes it simpler to use than EGAs with
Dr Dave Smith, the acting Assistant Secretary of Defense for air-filled cuffs and eliminates the need for cuff pressure
Health Affairs. monitoring. The change notes that should an EGA with
CAPT Stockinger also noted that the JTS is making a an air-filled cuff be used, the pressure in the cuff must be
significant number of contributions to the combat trauma monitored, especially during and after changes in altitude.

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