Page 146 - JSOM Fall 2019

ENCLOSURE 2

Proposed Tactical Combat Casualty Care Guidelines
for All Servicemembers – Maritime Environment Application 2

Introduction 8. Airway management is generally best deferred until the
Although Tactical Combat Care Guidelines (TCCC) were Tactical Maritime Care (Phase 2).
originally developed in 1996 for utilization by United States
Special Operations Forces, since that time, these guiding prin- Basic Management Plan for Tactical Maritime Care (Phase 2)
ciples and tactical application have been further expanded for 1. Ensure a safe casualty collection point. Maintain tactical
use in more general land force operations. In fact significant situational awareness.
experience and success was gained during the International Se- 2. Casualties with an altered mental status should have
curity Assistance Force (ISAF) led mission in Afghanistan, for weapons and communications equipment taken away im-
which TCCC was utilized by medical technicians and some mediately (when applicable; not all sailors will have such
combat personnel respectively (Savage, December 2011). equipment).
However, TCCC should also be considered in the context of 3. Massive Hemorrhage
the Maritime environment, which is unique compared to land a. Assess for unrecognized hemorrhage and control all
operations and for which there are nuances on application sources of bleeding. If not already done, use a CoTCCC-
and other considerations. Although TCCC guidelines were de- recommended limb tourniquet to control life-threaten-
veloped for combat, there is potential whereby such skill-sets ing external hemorrhage that is anatomically amenable
could be applicable to noncombat scenarios; these would in- to tourniquet use or for any traumatic amputation. Ap-
clude such entities as major collision, fire or explosion and he- ply it directly to the skin 2–3 inches above the bleeding
lo-crash on deck.* Combat tactical threats while at sea can be site. If bleeding is not controlled with the first tourni-
varied, to include enemy fire from surface and sub-surface as- quet, apply a second tourniquet side-by-side with the
sets, asymmetric threats from small boats and aircraft, and at- first.
tack whilst alongside. In addition, Naval Boarding Parties may b. For compressible (external) hemorrhage not amena-
encounter direct enemy contact during boarding operations. ble to limb tourniquet use, use Combat Gauze as the
CoTCCC hemostatic dressing of choice.
Basic Management Plan for Care Under Threat at Sea • Alternative hemostatic adjuncts:
(Phase 1) – Celox Gauze or
1. Apply your personal safety gear like, flame hoods, life vest, – ChitoGauze or
escape mask, rescue suit or other relevant equivalents. If • Hemostatic dressings should be applied with at least
dark inside, turn on your headlight. 3 minutes of direct pressure. Each dressing works
2. Stay on stations if necessary for the ship to remain opera- differently, so if one fails to control bleeding, it may
tional. If not possible, escape from threats. (Staying on bat- be removed and a fresh dressing of the same type or
tle stations or damage control stations will be the maritime a different type applied.
equivalent to return Fire. The ships integrity first priority, 4. Airway Management †
since a ship is dependent on its own infrastructure to col- a. Unconscious casualty without airway obstruction:
lectively fight the threat) • Chin lift or jaw thrust maneuver
3. Direct or expect casualty to remain engaged as a combatant • nasopharyngeal airway ‡
if appropriate. • Place casualty in the recovery position
4. Direct casualty to move to closest safe zone and apply self- b. Casualty with airway obstruction or impending airway
aid if able. obstruction:
5. Try to keep the casualty from sustaining additional inju- • Chin lift or jaw thrust maneuver
ries, hypothermia and smoke inhalation. (This includes for • Nasopharyngeal airway
instance to put on breathing device on patient if escaping • Allow a conscious casualty to assume any position
smoke area) that best protects the airway, to include sitting up.
6. Casualties should be extricated from hazardous spaces like • Place an unconscious casualty in the recovery position.
burning/smoke-filled spaces, flooding compartments or c. If the previous measures are unsuccessful, refer to a
harsh outside environment and moved to places of relative medic immediately.
safety. 5. Breathing
7. Stop life-threatening external hemorrhage if tactically a. In a casualty with progressive respiratory distress and
feasible: known or suspected torso trauma, consider a tension
a. Direct the casualty to control his bleeding himself if pneumothorax and refer to a medic as soon as possible. §
able. b. In a Maritime environment, smoke and fire exposure is
b. Use a CoTCCC-recommended limb tourniquet for hem- a significant risk. Exposure risk is exacerbated by the
orrhage that is anatomically amenable to tourniquet use. confined spaces aboard a ship. Consider immediate ad-
c. Apply the limb tourniquet over the uniform clearly prox- ministration of O by nonrebreather mask or moving
2
imal to the bleeding site(s). If the site of the life-threaten- patient to open air, for sailors presenting with signs of
ing bleeding is not readily apparent, place the tourniquet respiratory distress.
“high and tight” (as proximal as possible) on the injured c. All open and/or sucking chest wounds should be treated
limb and move the casualty to cover. by immediately applying a vented chest seal to cover

144 | JSOM Volume 19, Edition 3 / Fall 2019